Étude de l'évolution de la détérioration du béton incorporant des granulats riches en sulfures de fer

Dans la région de Trois-Rivières, de nombreuses résidences ont été construites sur une fondation de béton incorporant des granulats riches en sulfures de fer, notamment de la pyrrhotite et de la pyrite. Plus de trois cents échantillons ont été prélevés au sein de seize fondations de maisons montrant différents degrés d’endommagement, de très faible à très élevé, afin de les analyser et de contribuer à une meilleure compréhension des mécanismes en cause. Plusieurs types d’essais pétrographiques, mécaniques et chimiques ont ainsi été effectués sur ces échantillons, tant sur le terrain qu’en laboratoire. Le suivi de l’expansion et du développement de la fissuration sur des blocs prélevés au sein de fondations résidentielles a permis de démontrer le potentiel résiduel d’endommagement du béton lorsque soumis aux conditions climatiques naturelles. De plus, les résultats des travaux effectués sur les blocs suggèrent que la méthode de l’indice de fissuration est un bon outil du suivi l’évolution de l’endommagement du béton. Finalement, les résultats des travaux effectués en laboratoire suggèrent que le Damage Rating Index et le Stiffness Damage Test ont la capacité de quantifier l’état d’endommagement des bétons détériorés fabriqués avec des granulats incorporant des sulfures de fer.In the Trois-Rivières area, many houses were built on a concrete foundation made with aggregates containing large amounts of iron sulfides, such as pyrrhotite and pyrite. To allow for a better understanding of the oxidation mechanism, more than three hundred samples were extracted from sixteen foundations, showing different degrees of damage. A variety of petrographic, mechanical and chemical tests were conducted on these samples, in the laboratory as well as in the field. The monitoring of the development of expansion and cracking in the concrete blocks taken from residential foundations demonstrated a potential for residual concrete deterioration when exposed to natural environmental conditions. Furthermore, results of experiments performed on the blocks suggest that the cracking index method is a good indicator of the evolution of damage. Finally, laboratory testing suggests that the Damage Rating Index and the Stiffness Damage Test can potentially quantify damage suffered by deteriorated concrete made with aggregates incorporating iron sulfide minerals

Study of the Deterioration of Concrete Incorporating Sulfide-Bearing Aggregates

In the Trois-Rivières area (Québec, Canada), several hundred foundations of private houses, apartment and public buildings were built using concrete incorporating an anorthositic gabbro coarse aggregate containing sulfide minerals. A large number of those concrete structures developed serious deterioration within 3 to 5 years after their construction, which triggered, in many cases, their demolition/replacement. To help understanding the deterioration mechanisms and the conditions most prone to the development of premature damage, as well as quantifying the rate of deterioration, concrete blocks, 1 m x 1 m x 0.225 mm in size, were extracted from housing foundations just prior to their demolition. The blocks were disposed on an outdoor exposure site where they were monitored for the development of cracking and expansion over a five-year period. More than three hundred cores were extracted at different depths in eight housing foundations. A variety of tests including in-situ relative humidity measurements, petrographic, physical, mechanical and chemical tests on those cores were conducted for a full condition assessment of the concrete. A good correlation was observed between the monitoring of crack and the development of expansion in concrete foundation walls of different initial damage degree. Deterioration was also found to be largely influenced by the exposure conditions and RH conditions within the concrete. The determination of the total sulfur content of the concrete is a way to estimate the amount of sulfide minerals in the aggregate but significant variability was observed on values measured on different core samples from the same foundation

Revisión de la literatura integradora acerca de intervenciones de la enfermería volcadas hacia el incremento del autocuidado entre pacientes con insuficiencia cardiaca

Objective: to analyze and summarize knowledge concerning critical components of interventions that have been proposed and implemented by nurses with the aim of optimizing self-care by heart failure patients.Methods: PubMed and CINAHL were the electronic databases used to search full peer-reviewed papers, presenting descriptions of nursing interventions directed to patients or to patients and their families and designed to optimize self-care. Forty-two studies were included in the final sample (n=4,799 patients).Results: this review pointed to a variety and complexity of nursing interventions. As self-care encompasses several behaviors, interventions targeted an average of 3.6 behaviors. Educational/counselling activities were combined or not with cognitive behavioral strategies, but only about half of the studies used a theoretical background to guide interventions. Clinical assessment and management were frequently associated with self-care interventions, which varied in number of sessions (1 to 30); length of follow-up (2 weeks to 12 months) and endpoints.Conclusions: these findings may be useful to inform nurses about further research in self-care interventions in order to propose the comparison of different modalities of intervention, the use of theoretical background and the establishment of endpoints to evaluate their effectiveness.Objetivo:analisar e sintetizar o conchecimento relacionado aos componentes críticos das intervençoes que têm, sido propostas e implementadas por enfermeiros(as) com objetivo de optimizar o auto-cuidado de pacientes portadores de insuficiência cardíaca.Método:PubMed e CINAHL foram as bases de dados electrônicas utilizadas para investigar artigos revisados por pares (peer review), apresentando as descrições das intervenções dirigidas ao paciente ou ao paciente e sua familia, visando melhorar o auto-cuidado. Foram incluídos 42 estudos na amostra final (n=4799 pacientes).Resultados:esta revisão apontou variedade e complexidade das intervenções de enfermagem. Como o auto-cuidado envolve diferentes comportamentos, as intervenções visaram em média 3,6 comportamentos. As Atividades de educação e aconselhamento foram combinadas ou não com estratégias cognitivo-comportamentais, mas somente a metade dos estudos utilizaram suporte teórico para guiar as intervenções. A avaliação e o manejo clínico foram frequentemente associados às intervenções de auto-cuidado, as quais variam em número de sessões (1 a 30), duração do seguimento (2 semanas a 12 meses) e desfechos.Conclusão:estes resultados podem ser úteis para guiar os enfermeiros no que se refere à futuros estudos sobre intervenções de auto-cuidado, de maneira a propor a comparação de diferentes modalidades de intervenção, uso de suporte teórico e estabelecimento de desfechos para melhor avaliar sua eficácia.Objetivo:analizar y sintetizar el conocimiento relacionado a componentes críticos de intervenciones que han sido propuestas e implementadas por enfermeros(as) con el objetivo de optimizar el autocuidado entre pacientes con insuficiencia cardiaca.Método:PUBMED y CINAHL han sido las bases de datos electrónicas usadas para investigar artículos revisados por pares (peer review), presentando descripciones de intervenciones destinadas a perfeccionar el autocuidado dirigido al paciente o al paciente y a su familia. Se incluyeron 42 estudios en la muestra final (n=4799 pacientes).Resultados:esta revisión apuntó a una variedad y complejidad de intervenciones de enfermería. Como el autocuidado abarca varios comportamientos, las intervenciones tuvieron como blanco, en media, 3,6 comportamientos. Actividades de educación/consejería fueron combinadas o no con estrategias cognitivo-comportamentales, pero tan solo cerca de la mitad de los estudios tenían aporte teórico para guiar intervenciones. La gestión y la evaluación clínica fueron frecuentemente asociadas a intervenciones de autocuidado, las cuales oscilaron en número de sesiones (1 a 30), duración del seguimiento (2 semanas a 12 meses) y objetivos.Conclusiones:estos resultados pueden ser útiles para informar a las enfermeras acerca de nuevas investigaciones en intervenciones de autocuidado, de modo a proponer la comparación de distintas modalidades de intervención, el uso de un aporte teórico y el establecimiento de objetivos para evaluar su eficacia

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

La construction sociale de la qualité alimentaire dans un lien producteur-consommateur : le cas du marché public de Rimouski au Québec

RÉSUMÉ: Plus d'un quart de siècle durant, la grande distribution en alimentation du Québec a su tirer profit de sa situation de marché oligopolistique en imposant aux producteurs et consommateurs ses propres standards de qualité. Depuis une dizaine d'années, cependant, un acteur historique hérité de l'époque de la Nouvelle-France renaît au Québec et attribue aux producteurs et consommateurs un pouvoir dans la définition de leurs propres standards de qualité: le marché public. Cette nouvelle dynamique impose un questionnement général: comment un marché défini par le pluralisme et l'incertitude sur la qualité qu'il soulève peut-il fonctionner? Ce mémoire développe une meilleure compréhension de ce phénomène en s'intéressant à la construction sociale de la qualité alimentaire dans un lieu et une institution comme le marché public à travers deux aspects de son fonctionnement: la force des relations existantes entre les producteurs et les consommateurs, d'une part, et les dynamiques d'échanges autour d'une offre de produits locaux et de saison, et des caractéristiques qui fondent leur qualité, d'autre part. À partir d'une enquête réalisée au marché public de la ville moyenne de Rimouski implanté au Bas-Saint-Laurent (Québec), nous montrons que le marché est surtout un lieu de discussion, d'expérimentation et de transmission, et moins de négociation ouverte. Les accords y sont construits dans la confiance des consommateurs à l'égard des producteurs et dans l'échange d'informations singulières, très peu dans le débat. Les proximités favorisées entre les agents sont à la source d'un jeu dialogique centré sur le goût des produits et sur d'autres caractéristiques dont le prix. Nous soulevons ainsi l'enjeu du prix au sein du processus et cherchons à résoudre la contradiction qu'il apporte en dissociant le processus de construction sociale de la qualité des conventions. -- ABSTRACT: As the most powerful actors in the modem food chain, the oligopoly of corporate chains of grocery distributors have imposed their own quality norms on producers and consumers for more th an a quarter of a century. However, since about ten years from now, food production tends to be reconnected with its consumption in an old traditional ex change context that almost died out in post-war Quebec: the farmers' market (FM). As FMs are deliberately free of market intermediary, both of producers and consumers are actually regaining sorne control over their own definition of what food quality is and should be. This change in Quebec foodscape caUs for one critic questioning: within such context involving quality uncertainty, how the market may operate? The purpose ofthis master is to better understand the phenomenon of social construction of food quality, examining the nature and the strength of the relationships involved between producers and consumers, and the infonnation exchange about the products and their qualities. Based on a 2009 fieldwork undertaken at the FMs of Rimouski (Bas-Saint-Laurent, Quebec), we show that the market is especially a place of discussion, experiment and transmission, and less opened negotiation. The conventions on the quality of products are built in the trust of consumers towards the producers and in the exchange of singular infonnation, little in the debate. The proximities between the agents are at the source of dialogues centred on the taste of products and on other characteristics of which the price. So we raise the problem of the price and try to resolve the contradiction which it brings by separating the process of social construction of quality of the conventions

Réhabiliter les « brebis égarées »

Tableau d'honneur de la Faculté des études supérieures et postdoctorales, 2018-2019Le Refuge Notre-Dame de la Merci a ouvert ses portes en décembre 1931. Tenu par les Sœurs du Bon-Pasteur de Québec jusqu’en 1972, l’établissement fait office de prison pour femmes à Québec. Ce mémoire vise à cerner les méthodes d'intervention de la Congrégation des Sœurs du Bon-Pasteur de Québec auprès des prisonnières, et ce, au regard des caractéristiques des femmes incarcérées qui influencent les modèles de réhabilitation proposés par les religieuses. Le Refuge, tout en s’inscrivant dans le réseau d’institutions développées par les Sœurs du Bon-Pasteur depuis 1850, est une institution judiciaire qui vise la répression de la déviance féminine et la réhabilitation des femmes selon les représentations de la féminité et des rôles féminins en vigueur au milieu du XXe siècle. L’institution fournit plusieurs formes d’assistance envers les femmes, donnant aux prisonnières des services peu accessibles autrement avant l’étatisation des services sociaux dans la décennie 1970. L’étude trace également un portrait de la déviance féminine représentée à la prison de Québec à partir des registres d’écrou de l’institution. Les Sœurs du Bon-Pasteur, employées du gouvernement provincial dans ce contexte, disposent d’un pouvoir d’action non-négligeable dans l’organisation de l’horaire quotidien des détenues et dans l’implantation d’activités réhabilitatrices. La teneur de ces activités, axées sur la pratique religieuse et l’apprentissage de travaux ménagers, reste fortement influencée par des stéréotypes genrés déterminant des comportements prescrits, tout en favorisant la diffusion des connaissances spécialisées et l’adoption d’une éthique de travail utiles pour les femmes à leur sortie de prison