Pédagogie collégiale

Titre de l'écran-titre (visionné le 17 juin 2009

L’intégration des services passe‑t‑elle par des fusions d’établissements?

Les modes d'organisation hérités d'une époque où dominait l'institutionnalisation des patients sont aujourd'hui caducs. La coordination des services, jadis effectuée à l'intérieur des murs d'un même établissement, relève dorénavant d'intervenants rattachés à des organisations différentes et pratiquant en des lieux différents. Une des difficultés que pose l'intégration de ces services est que les organisations mises à contribution continuent souvent de fonctionner de façon individualiste, ce qui va à l'encontre de l'objectif poursuivi. La solution la plus souvent avancée pour contourner ce cloisonnement consiste à renforcer l'intégration des organisations, ce qui devrait, à terme, favoriser l'intégration des services. Une des façons de réaliser cette intégration organisationnelle est de réduire le nombre d'organisations existantes, par exemple en fusionnant un certain nombre d'entre elles. C'est cette voie, celle de la hiérarchisation, qu'a empruntée la réforme du système québécois de la santé et des services sociaux effectuée au cours des années 1990. D'autres voies, dont celle de l'organisation en réseau, ont aussi été expérimentées durant cette période. Pour juger de la pertinence de ces options, nous proposons de renverser la perspective dominante selon laquelle l'intégration des services passe nécessairement par la mise en place de mécanismes d'intégration organisationnelle. Sans nier l'importance de ces derniers, nous mettons de l'avant que l'intégration des services exige avant tout la collaboration des praticiens qui les dispensent. Sous cet angle, la pertinence d'un mode d'intégration organisationnelle dépend de l'effet qu'il aura sur la capacité et la volonté des praticiens d'agir de façon concertée. Nous soumettons à cet égard que le fait de confier à une même autorité la gouverne des organisations existantes n'est pas la panacée que certains voudraient y voir.Is merging organizations the solution to service integration? Organizational models inherited from the time when institutionalizing patients was common practice are now obsolete. Service coordination, undergone earlier within a same institution, is now governed by professionnals linked to various organizations and different settings. One of the difficulties of integration of these services is that contributing organizations often continue to operate individually, consequently going against the pursued goal. The solution most often proposed to counter this compartimentalization consists in reinforcing integration of organizations, which will in time favor integration of various services. One of the ways to realize this organizational integration is to reduce the number of existing organizations, by merging for example, a certain number of them. It is this path of hierarchical organization that the Québec health care system has taken during the 1990. Other paths that of networking have also been experienced during the same period. To judge of the relevance of these options, the authors propose a reversal of the dominating perspective according to which service integration necessarily pass through installing mecanisms of organizational integration. Withought minimizing the importance of such mecanisms, the authors put forth that integration of services commands first and foremost collaboration between professional health workers. Through this angle, the relevance of an organizational integration model depends on the impact it will have on the capacity and willingness of health workers to work in a concerted way. The authors submit that the fact of giving to a sole authority the govern of existing organizations is not the panacea some would like to believe.¿Pasa la integración de servicios por fusiones de establecimientos? Los modos de organisación heredados de una época dominada por la institutionalisación de los patientes estan hoy caducos. La coordinación de servicios, antiguamente efectuada a dentro de un establecimiento, depende hoy de intervenantes quienes dependen de organisaciones diferentes y practican en lugares diferentes. Uno de los problemas que plantea la integración de servicios se encuentra en el hecho de que organismos contribuyendo siguen muchas veces funcionando de manera individualista, lo que va en contra del objectivo perseguido. La integración de organismos, la cual deberia favorecer la integración de servicios, es la solución más avanzada para dar la vuelta a este tabique. Para realizar esta integración de servicios se propone reducir el nombre de organizaciones con fusiones. La vía de jerarquización fue adoptada por la reforma del sistema quebequense de servicios de salud y de servicios sociales efectuada durante los años 1990. Otras vías, tal la organización en red, han sido tambien experimentadas durante esta perioda. Para jusgar de la pertinencia de estas opciones se propone de invertir la perspectiva dominante según la cual la integración de servicios pasa necesariamente por la puesta en lugar de mecanismos de integración organizacional. Sin negar la importancia de los últimos, propongamos que la integración de servicios requiere ante todo la colaboración de los prácticos. Así la pertinencia de un modo de integración organisacional depende del efecto que tendrá sobre la capacidad y la voluntad de los prácticos de actuar de manera concertada. Sometemos que el hecho de confiar a una sola autoridad la gubernancia de las organizaciones existantes no es la panacea que ciertos quisieran ver.A integração dos serviços passa pela fusão dos estabelecimentos? Os métodos de organização herdados da época em que dominava a institucionalização dos pacientes estão, atualmente, ultrapassados. A coordenação dos serviços, antigamente efetuada dentro dos muros de um mesmo estabelecimento, depende, a partir de agora, de assistentes ligados a organizações diferentes e trabalhando em locais diferentes. Uma das dificuldades da integração destes serviços encontra-se no fato de que as organizações participantes continuam sempre a funcionar de maneira isolada, o que prejudica o objetivo esperado. A solução mais freqüentemente proposta para contornar este isolamento seria reforçar a integração das organizações, que deveria, no futuro, favorecer a integração dos serviços. Uma das maneiras de realizar esta integração organizacional é reduzir o número de organizações existentes, por exemplo, fazendo a fusão de algumas delas. Foi este caminho, o da hierarquização, que escolheu a reforma do sistema quebequense da saúde e dos serviços sociais efetuada durante os anos 1990. Outros caminhos, como o da organização em rede, também foram experimentados durante este período. Para avaliar a pertinência destas opções, os autores propõem derrubar a perspectiva dominante, segundo a qual a integração dos serviços passa obrigatoriamente pela criação de mecanismos de integração organizacional. Sem negar a importância destes mecanismos, eles ressaltam que a integração dos serviços exige, antes de mais nada, a colaboração dos profissionais que os fornecem. Neste ponto de vista, a pertinência de um modo de integração organizacional depende do efeito que ele terá na capacidade e na vontade dos profisionais de trabalhar em harmonia uns com os outros. A este respeito, os autores destacam que o fato de confiar a uma só autoridade a direção das organizações existentes não é o remédio para todos os males que alguns gostariam que fosse

Semiclassical quantum states for black holes

I discuss the semiclassical approximation for the Wheeler-DeWitt equation when applied to the CGHS model and spherically symmetric gravity. Special attention is devoted to the issues of Hawking radiation, decoherence of semiclassical states, and black hole entropy.Comment: 8 pages, LATEX, contribution for the Second Conference on Constrained Dynamics and Quantum Gravity, Santa Margherita, Italy, September 199

Quantum general relativity and Hawking radiation

In a previous paper we have set up the Wheeler-DeWitt equation which describes the quantum general relativistic collapse of a spherical dust cloud. In the present paper we specialize this equation to the case of matter perturbations around a black hole, and show that in the WKB approximation, the wave-functional describes an eternal black hole in equilibrium with a thermal bath at Hawking temperature.Comment: 13 pages, minor revisions in: (i) para 5 of Introduction, (ii) para following Eqn. (10). Revised version to appear in Phys. Rev.

Machine Performers: Agents in a Multiple Ontological State

In this thesis, the author explores and develops new attributes for machine performers and merges the trans-disciplinary fields of the performing arts and artificial intelligence. The main aim is to redefine the term “embodiment” for robots on the stage and to demonstrate that this term requires broadening in various fields of research. This redefining has required a multifaceted theoretical analysis of embodiment in the field of artificial intelligence (e.g. the uncanny valley), as well as the construction of new robots for the stage by the author. It is hoped that these practical experimental examples will generate more research by others in similar fields. Even though the historical lineage of robotics is engraved with theatrical strategies and dramaturgy, further application of constructive principles from the performing arts and evidence from psychology and neurology can shift the perception of robotic agents both on stage and in other cultural environments. In this light, the relation between representation, movement and behaviour of bodies has been further explored to establish links between constructed bodies (as in artificial intelligence) and perceived bodies (as performers on the theatrical stage). In the course of this research, several practical works have been designed and built, and subsequently presented to live audiences and research communities. Audience reactions have been analysed with surveys and discussions. Interviews have also been conducted with choreographers, curators and scientists about the value of machine performers. The main conclusions from this study are that fakery and mystification can be used as persuasive elements to enhance agency. Morphologies can also be applied that tightly couple brain and sensorimotor actions and lead to a stronger stage presence. In fact, if this lack of presence is left out of human replicants, it causes an “uncanny” lack of agency. Furthermore, the addition of stage presence leads to stronger identification from audiences, even for bodies dissimilar to their own. The author demonstrates that audience reactions are enhanced by building these effects into machine body structures: rather than identification through mimicry, this causes them to have more unambiguously biological associations. Alongside these traits, atmospheres such as those created by a cast of machine performers tend to cause even more intensely visceral responses. In this thesis, “embodiment” has emerged as a paradigm shift – as well as within this shift – and morphological computing has been explored as a method to deepen this visceral immersion. Therefore, this dissertation considers and builds machine performers as “true” performers for the stage, rather than mere objects with an aura. Their singular and customized embodiment can enable the development of non-anthropocentric performances that encompass the abstract and conceptual patterns in motion and generate – as from human performers – empathy, identification and experiential reactions in live audiences

Comparing the resident populations of private and public long-term care facilities over a fifteen-year period: a study from Quebec, Canada

In the province of Quebec, Canada, long-term residential care is provided by two types of facilities: privately-owned facilities in which care is privately financed and delivered, and publicly-subsidised accredited facilities. There are few comparative data on the residents served by the private and public sectors, and none on whether their respective population has changed over time. Such knowledge would help plan services for older adults who can no longer live at home due to increased disabilities. This study compared 1) the resident populations currently served by private and public facilities and 2) how they have evolved over time. The data come from two cross-sectional studies conducted in 1995-2000 and 2010-2012. In both studies, we randomly selected care settings in which we randomly selected older residents. In total, 451 residents from 145 settings assessed in 1995-2000 were compared to 329 residents from 102 settings assessed in 2010-2012. In both study periods, older adults housed in the private sector had fewer cognitive and functional disabilities than those in public facilities. Between the two study periods, the proportion of residents with severe disabilities decreased in private facilities while it remained over 80% in their public counterparts. Findings indicate that private facilities care today for less-disabled older adults, leaving to public facilities the heavy responsibility of caring for those with more demanding needs. These trends may impact both sectors’ ability to deliver proper residential care