Réflexions sur la réforme de la responsabilité médicale au Québec

La responsabilité médicale est devenue un sujet de préoccupation au Québec. On s'interroge aujourd'hui à la fois sur l'ampleur de la crise et sur les réformes qu'on pourrait concevoir pour éviter que la situation ne s'aggrave. Pourtant cette réflexion sur la réforme de la responsabilité médicale n'est pas aussi neutre qu'on le croit. L'auteur suggère qu'en cette matière, la description du malaise peut prendre plusieurs formes selon la conception qu'on se fait du rôle de la responsabilité civile. Il en est de même de l'analyse des réformes possibles. Les juristes québécois hésitent devant un bouleversement du cadre juridique en matière d'accidents thérapeutiques parce que leur examen de la situation s'effectue à l'intérieur d'un cadre épistémologique dont il est difficile de se départir.Discussions about medical responsibility, the extent of the « crisis » surrounding it, and the types of reforms that can be envisaged have become quite frequent in Quebec. But such thinking about the future of medical responsibility cannot be absolutely neutral and objective. The author suggests that the description of the crisis varies depending on one's conception of the role of civil responsibility. The same can be said of the analysis of possible reforms. Quebec jurists are reluctant to change their institutions in the area of iatrogenic injuries because analysis of the situation takes place within an imposing epistemological framework that cannot be avoided

Culture et droit processuel : le cas du Québec

Cet article aborde l’influence de la culture au sein du droit processuel québécois, prenant appui sur la récente réforme du Code de procédure civile. L’auteur affirme que la spécificité du droit processuel québécois réside dans la mixité de sa culture. Celle-ci résulte de la superposition de perspectives différentes sur les valeurs et symboles attachés au traitement des litiges par les institutions de l’État.Ainsi, la culture juridique officielle se compose de trois strates : culture politique, professionnelle et normative. La culture politique du contentieux et de son économie est nord-américaine par certaines caractéristiques, telles que la marginalisation, la désacralisation, la logique marchande et les fins politiques de la justice civile. La culture des professionnels du droit s’inscrit clairement dans la culture de common law. L’approche procédurale est en effet libérale et individualiste, avec un processus contradictoire et en grande partie oral. La culture normative véhicule quant à elle une résurgence de la tradition civiliste. Le fondement identitaire à l’origine de l’inscription de la procédure civile québécoise dans une tradition d’interprétation civiliste accorde une place importante au Code de procédure civile dans l’arrimage du droit processuel au droit substantiel.L’auteur conclut à une pluralité des cultures au sein du droit processuel québécois, plutôt qu’à l’existence d’une culture intégrée. Il en appelle à une étude plus approfondie de l’interaction entre ces trois strates culturelles juridiques différentes.This article considers the influence of culture within Quebec’s procedural law, building upon the recent reform of the Code of Civil Procedure. The author affirms that the distinctiveness of Quebec’s procedural law resides in its mixed culture, which is the product of the superimposition of different perspectives on the institutional values and symbols of the state’s dispute-processing mechanisms.Thus, official legal culture is composed of three spheres: political culture, professional culture, and normative culture. The political culture of litigation and its economy is North American by virtue of certain characteristics, such as marginalization, secularization, the market-based provision of legal services, and the mobilization of civil justice for political goals. The culture of legal professionals is clearly a common law culture. The procedural approach is, in effect, liberal and individualist, with an adversarial and largely oral trial process. The normative culture promotes a resurgence of the civilian tradition. Quebec’s national and cultural roots explain the inscription of its civil procedure within a civilian interpretative tradition, which accords a role of primacy to the Code of Civil Procedure in the reconciliation of procedural and substantive law.The author concludes that there exists a plurality of cultures within Quebec’s procedural law, rather than an integrated culture. He calls for a deeper study of the interaction of these three distinct spheres of legal culture

Impacts of high precipitation on the energy and water budgets of a humid boreal forest

The boreal forest will be strongly affected by climate change and in turn, these vast ecosystems may significantly impact global climatology and hydrology due to their exchanges of carbon and water with the atmosphere. It is now crucial to understand the intricate relationships between precipitation and evapotranspiration in these environments, particularly in less-studied locations characterized by a cold and humid climate. This study presents state-of-the-art measurements of energy and water budgets components over three years (2016–2018) at the Montmorency Forest, Québec, Canada: a balsam fir boreal forest that receives ∼1600 mm of precipitation annually (continental subarctic climate; Köppen classification subtype Dfc). Precipitation, evapotranspiration and potential evapotranspiration at the site are compared with observations from thirteen experimental sites around the world. These intercomparison sites (89 study-years) encompass various types of climate and vegetation (black spruces, jack pines, etc.) encountered in boreal forests worldwide. The Montmorency Forest stands out by receiving the largest amount of precipitation. Across all sites, water availability seems to be the principal evapotranspiration constraint, as precipitation tends to be more influential than potential evapotranspiration and other factors. This leads to the Montmorency Forest generating the largest amount of evapotranspiration, on average ∼550 mm y−1. This value appears to be an ecosystem maximum for evapotranspiration, which may be explained either by a physiological limit or a limited energy availability due to the presence of cloud cover. The Montmorency Forest water budget evacuates the precipitation excess mostly by watershed discharges, at an average rate of ∼1050 mm y−1, with peaks during the spring freshet. This behaviour, typical of mountainous headwater basins, necessarily influence downstream hydrological regimes to a large extent. This study provides a much needed insight in the hydrological regimes of a humid boreal-forested mountainous watershed, a type of basin rarely studied with precise energy and water budgets before

Hepatitis C Virus seroconversion among persons who inject drugs in relation to primary care physician visiting: The potential role of primary healthcare in a combined approach to Hepatitis C prevention

Background: Meaningful reductions in Hepatitis C Virus (HCV) transmission rates among persons who inject drugs (PWID) require a comprehensive prevention approach, including access to harm reduction measures and to healthcare-related interventions, such as HCV screening, testing and antiviral treatment. Little is known, however, about the role of visiting a primary care physician (PCP) in relation to HCV infection risk among PWID, when integrated within a combined prevention approach. This study assessed the association between PCP visiting and HCV seroconversion among PWID attending needle exchange programs (NEP). Methods: A prospective cohort study, HEPCO, was conducted among active PWID in Montréal (2004-2013). Interviews scheduled at three- or six-month intervals included completion of an interviewer-administered questionnaire, and collection of blood samples for HCV antibody testing. HCV-seronegative participants who reported NEP attendance at baseline and had at least one follow-up visit were eligible for this study. HCV incidence was calculated using the person-time method. Time-varying Cox regression modeling was conducted to evaluate the relationship between self-reported recent PCP visiting and HCV incidence. Results: At baseline assessment, of 226 participants (80.5% male; median age: 30.6 years), 37.2% reported having recently visited a PCP. During 449.6 person-years of follow-up, 79 participants seroconverted to HCV [incidence rate: 17.6 per 100 person-years, 95% confidence interval (CI): 14.0-21.8]. Covariate-adjusted analyses indicated that visiting a PCP was associated with a lower risk of HCV infection [Adjusted Hazard Ratio: 0.54, 95% CI: 0.31-0.93]. Other independent predictors of HCV infection included unstable housing, cocaine injection and prescription opioid injection. Conclusion: Among PWID attending NEP, visiting a PCP was associated with a lower risk of HCV infection. Yet, only a minority of participants reported PCP visiting. Efforts to intensify engagement with PCP among PWID could potentially contribute to lower HCV transmission when integrated within a combined approach to prevention

Extracellular proteolytic cascade in tomato activates immune protease Rcr3

Proteolytic cascades regulate immunity and development in animals, but these cascades in plants have not yet been reported. Here we report that the extracellular immune protease Rcr3 of tomato is activated by P69B and other subtilases (SBTs), revealing a proteolytic cascade regulating extracellular immunity in solanaceous plants. Rcr3 is a secreted papain-like Cys protease (PLCP) of tomato that acts both in basal resistance against late blight disease (Phytophthora infestans) and in gene-for-gene resistance against the fungal pathogen Cladosporium fulvum (syn. Passalora fulva) Despite the prevalent model that Rcr3-like proteases can activate themselves at low pH, we found that catalytically inactive proRcr3 mutant precursors are still processed into mature mRcr3 isoforms. ProRcr3 is processed by secreted P69B and other Asp-selective SBTs in solanaceous plants, providing robust immunity through SBT redundancy. The apoplastic effector EPI1 of P. infestans can block Rcr3 activation by inhibiting SBTs, suggesting that this effector promotes virulence indirectly by preventing the activation of Rcr3(-like) immune proteases. Rcr3 activation in Nicotiana benthamiana requires a SBT from a different subfamily, indicating that extracellular proteolytic cascades have evolved convergently in solanaceous plants or are very ancient in the plant kingdom. The frequent incidence of Asp residues in the cleavage region of Rcr3-like proteases in solanaceous plants indicates that activation of immune proteases by SBTs is a general mechanism, illuminating a proteolytic cascade that provides robust apoplastic immunity

Parental Substance Abuse As an Early Traumatic Event. Preliminary Findings on Neuropsychological and Personality Functioning in Young Drug Addicts Exposed to Drugs Early.

open5noParental substance use is a major risk factor for child development, heightening the risk of drug problems in adolescence and young adulthood, and exposing offspring to several types of traumatic events. First, prenatal drug exposure can be considered a form of trauma itself, with subtle but long-lasting sequelae at the neuro-behavioral level. Second, parents’ addiction often entails a childrearing environment characterized by poor parenting skills, disadvantaged contexts and adverse childhood experiences (ACEs), leading to dysfunctional outcomes. Young adults born from/raised by parents with drug problems and diagnosed with a Substance Used Disorder (SUD) themselves might display a particularly severe condition in terms of cognitive deficits and impaired personality function. This preliminary study aims to investigate the role of early exposure to drugs as a traumatic event, capable of affecting the psychological status of young drug addicts. In particular, it intends to examine the neuropsychological functioning and personality profile of young adults with severe SUDs who were exposed to drugs early in their family context. The research involved three groups, each consisting of 15 young adults (aged 18–24): a group of inpatients diagnosed with SUDs and exposed to drugs early, a comparison group of non-exposed inpatients and a group of non-exposed youth without SUDs. A neuropsychological battery (Esame Neuropsicologico Breve-2), an assessment procedure for personality disorders (Shedler-Westen Assessment Procedure-200) and the Symptom CheckList-90-Revised were administered. According to present preliminary results, young drug addicts exposed to drugs during their developmental age were characterized by elevated rates of neuropsychological impairments, especially at the expense of attentive and executive functions (EF); personality disorders were also common but did not differentiate them from non-exposed youth with SUDs. Alternative multi-focused prevention and intervention programs are needed for children of drug-misusing parents, addressing EF and adopting a trauma-focused approach.openParolin, Micol; Simonelli, Alessandra; Mapelli, Daniela; Sacco, M.; Cristofalo, P.Parolin, Micol; Simonelli, Alessandra; Mapelli, Daniela; Sacco, M.; Cristofalo, P

Cross-cutting principles for planetary health education

Since the 2015 launch of the Rockefeller Foundation Lancet Commission on planetary health,1 an enormous groundswell of interest in planetary health education has emerged across many disciplines, institutions, and geographical regions. Advancing these global efforts in planetary health education will equip the next generation of scholars to address crucial questions in this emerging field and support the development of a community of practice. To provide a foundation for the growing interest and efforts in this field, the Planetary Health Alliance has facilitated the first attempt to create a set of principles for planetary health education that intersect education at all levels, across all scales, and in all regions of the world—ie, a set of cross-cutting principles