Le rôle des institutions financières dans la lutte contre la maltraitance financière et matérielle envers les personnes aînées en situation de vulnérabilité : élaboration d'un protocole respectueux du droit à l'autonomie

La gestion des cas de maltraitance envers des personnes âgées en situation de vulnérabilité a beaucoup évolué au Québec, surtout avec l’adoption de la Loi visant à lutter contre la maltraitance envers les aînés et toute autre personne majeure en situation de vulnérabilité qui prévoit la dénonciation obligatoire au commissaire local aux plaintes et à la qualité des services, lorsque la victime est hébergée dans un centre d’hébergement et de soins de longue durée. De plus, la maltraitance financière a été identifiée comme l’une des orientations prioritaires du deuxième plan d’action gouvernemental pour contrer la maltraitance envers les personnes aînées. Depuis son entrée en vigueur, plusieurs initiatives ont été prises, notamment par l’Autorité des marchés financiers et l’Association des banquiers canadiens, afin d’encadrer davantage le secteur financier. Les institutions financières sont souvent identifiées comme étant des actrices de première ligne dans la lutte contre la maltraitance financière, mais contrairement à la lutte contre le blanchiment d’argent, les banques ne sont pas réglementées pour gérer des cas de maltraitance financière et matérielle sur des personnes aînées en situation de vulnérabilité. Les représentants des institutions financières au Québec ont montré leur volonté de participer à la lutte contre la maltraitance des personnes aînées en situation de vulnérabilité, notamment par leur participation au forum qui a eu lieu à Québec en 2018. Une intervention législative est-elle nécessaire pour atteindre ce but ? La dénonciation devrait-elle être obligatoire ? Les institutions financières peuvent-elles adopter certaines pratiques et protocoles, selon les lois actuelles en vigueur, afin de leur permettre de mieux prévenir et repérer les cas de maltraitance financière des personnes en situation de vulnérabilité et de connaître comment et quand intervenir ? Nous souhaitons apporter des réponses à ces questions dans ce mémoire. Pour y parvenir, nous exposerons d’abord le cadre législatif en vigueur au Québec, au fédéral et dans deux provinces : la Saskatchewan et la Colombie-Britannique. Nous ferons également une étude du cadre juridique en vigueur aux États-Unis et en Australie, à des fins comparatives. Nous explorerons ensuite les pratiques et les procédures mises en place par certaines institutions financières aux États-Unis et au Royaume-Uni. Nous croyons que notre étude permettra de démontrer qu’une intervention législative serait souhaitable pour encadrer les institutions financières canadiennes, mais qu’une dénonciation obligatoire serait contraire au principe de la bientraitance et au droit à l’autodétermination. Enfin, en nous inspirant des façons de faire dans les autres provinces et à l’international, nous proposerons certains protocoles et pratiques aux institutions financières québécoises.The management of elder mistreatment cases has greatly evolved in Quebec, especially since the adoption of the Act to combat maltreatment of seniors and other persons of full age in vulnerable situations. In virtue of this law, certain people are obligated to report elder mistreatment cases to the Services Quality and Complaints Commission. In the most recent government action plan, known as the “Plan d’action gouvernemental pour contrer la maltraitance envers les personnes aînées 2017- 2022”, financial elder mistreatment is identified as one of its seven key elements. There have been some considerable steps taken to combat elder financial mistreatment, particularly by the Autorité des marches financiers who recently published a guide to help those working in the financial sector better serve their elderly and vulnerable clients. The Canadian Bankers Association also recently adopted a new Code of Conduct for the Delivery of Banking Services to Seniors (2019), although adherence to said Code is on a purely voluntary basis. While these initiatives remain voluntary, they provide a model framework from which financial institutions can build upon, if they wish to help combat elder financial mistreatment. The employees of financial institutions are often identified as a potential first-line of defense to help combat elder financial mistreatment, but there exists no federal legal framework, to regulate the financial sector. This absence of legislation is particularly evident when compared to the regulations imposed on banks to prevent and report situations of money laundering. During a roundtable discussion having taken place in Quebec City, certain bank representatives expressed the need for a framework that would better guide their interactions with vulnerable elderly clients, but does this framework necessarily need to be legal? Is legislative intervention required or can financial institutions use the current laws in force to adopt appropriate protocols that would help them better prevent and detect cases of elder mistreatment and intervene when necessary? In the first part of this thesis, we will present the current legal framework existing in Quebec, on a Federal level and in Saskatchewan and British Columbia. We will then present the regulation of the financial sector in the United States and in Australia, for comparative purposes. We believe that our presentation of the regulation of financial institutions in these countries and provinces will support our conclusion that a legislative intervention is highly advisable, while an obligation to report would go against the concepts of well-treatment (“bientraitance”) and of self-determination (“autodétermination”). In the second part of our thesis, we will present certain practices and protocols already enforced by certain financial institutions in the United States and in Great Britain and then demonstrate how they an be transposed and used in Quebec, in accordance with the current legal framework in force

Technoeconomical Study & Analysis of Business Models of Optical Access Networks

134 σ.Το δημόσιο χάλκινο τηλεπικοινωνιακό δίκτυο αδυνατεί να καλύψει τις μελλοντικές ανάγκες εύρους ζώνης στα δίκτυα πρόσβασης. Μοναδική ικανοποιητική λύση για το μέλλον αποτελεί η ανάπτυξη οπτικών δικτύων πρόσβασης και ιδιαίτερα FTTH (Fiber To The Home) δικτύων. Παρά τις όποιες τεχνικές και κυρίως οικονομικές δυσκολίες, η κατασκευή δικτύων FTTH έχει χαρακτηριστεί από πολλούς ως το μεγαλύτερο τεχνολογικό άλμα για μια χώρα μετά τον εξηλεκτρισμό αυτής. Ένα οπτικό δίκτυο πρόσβασης χαρακτηρίζεται από την αντίστοιχη Αρχιτεκτονική (FTTH,FTTB,FTTN), τοπολογία (Point to Point, Point to Multipoint) και τεχνολογία (Ενεργό ή Παθητικό Οπτικό Δίκτυο). Οι συνηθέστερες επιλογές για FTTH είναι Point to Point Active και Point to Multipoint Passive, χωρίς να αποκλείονται οι υπόλοιποι συνδυασμοί. Ανάλογα με τις επιμέρους επιλογές,υπεισέρχονται και διαφορετικά κόστη. Τα επιχειρηματικά μοντέλα για παρόχους οπτικών δικτύων πρόσβασης είναι αυτά του Παρόχου Παθητικής Υποδομής, του Παρόχου Χωρητικότητας και του Παρόχου Λιανικής. Στην πράξη,ένας πάροχος Λιανικής ακολουθεί ταυτόχρονα και τα τρία μοντέλα μαζί, εφόσον η αγορά είναι κατάλληλα ρυθμισμένη. Το μοντέλο του Παρόχου Παθητικής Υποδομής απαιτεί τα μικρότερα κόστη ,αλλά και επιφέρει τα μικρότερα έσοδα. Το μοντέλο του Παρόχου Λιανικής απαιτεί τα μεγαλύτερα κόστη ,αλλά και επιφέρει τα μεγαλύτερα έσοδα. Αποτελεί αντικείμενο έρευνας και βελτιστοποίησης αφενός η επιμέρους κατανομή της παροχής υπηρεσιών σε Παροχή Παθητικών Υποδομών, Χωρητικότητας και Λιανικής, αφετέρου η ευαισθησία της αύξησης του ARPU, αφού καθοριστικός παράγοντας της ελκυστικότητας της επένδυσης αναδεικνύεται ο επιτυγχανόμενος βαθμός διείσδυσης.Last mile, made of copper, is unable to cover the future needs of bandwidth of the access networks. The only future proof solution is the development of optical access networks, especially FTTH (Fiber To The Home). Despite the technical and mainly financial difficulties, the construction of FTTH networks has been characterized by many as the largest technological jump of a country after its electrification. Every optical access network is identified by its Architecture (FTTH,FTTB,FTTN), its topology (Point to Point, Point to Multipoint) and its Technology ( Active or Passive Optical Network). The most usual choices for FTTH are Point to Point Active and Point to Multipoint Passive, without eliminating the rest of the combinations. Depending on these choices, different costs occur. The business models for the optical access networks providers are: Dark Fiber Provider, Capacity Wholesaler and Retailer . In practice, a Retailer follows all three models simultaneously, as long as the market is appropriately regulated.The business model of Dark Fiber Provider demands the smallest expenses, but produces the smallest revenues as well. The business model of Retailer demands the largest expenses, but produces the largest revenues. Both the side allocation of providing the services of Dark Fiber, Capacity Wholesaler and Retailer and the sensitivity of the ARPU increase are objects of research and optimization. Penetration emerges as the decisive factor of the attractiveness of the investment .Αναστάσιος Γ. Καματερό

Evaluation of a French adaptation of a community-based advance serious illness planning decision aid

Objective: The Plan Well Guide™ (PWG) is a decision aid that empowers lay persons to better understand different types of care and prepares them, and their substitute decision-makers, to express both their authentic values and informed treatment preferences in anticipation of serious illness. We aimed to determine the acceptability of the newly translated French PWG and to evaluate decisional readiness and decisional conflict following its use by lay people. Methods: This is an acceptability and exploratory outcomes evaluation.Participants were requested to read and complete the French PWG and to engage in an online interview. We used the Acceptability Scale to determine the acceptability and the Preparation for Decision-making Scale and decisional conflict Scale to evaluate decisional readiness. Results: Forty-two (42) people participated. The average score on the Acceptability Scale was 18.1 (scale range: 4–20 [high–better]) and 26.6 on the Preparation for Decision-Making Scale (scale range: 6–30 [high–better]). A significant number of respondents reported needing more support to help them make better decisions. Conclusion: The French PWG has been deemed acceptable and relevant for lay people not currently facing clinical decisions. Innovation: The Plan Well Guide is innovative as it is the first decision aid empowering lay people for advance serious illness planning

The Patient Remote Intervention and Symptom Management System (PRISMS) - a Telehealth-mediated intervention enabling real-time monitoring of chemotherapy side-effects in patients with haematological malignancies: study protocol for a randomised controlled trial

Background: Outpatient chemotherapy is a core treatment for haematological malignancies; however, its toxicities frequently lead to distressing/potentially life-threatening side-effects (neutropenia/infection, nausea/vomiting, mucositis, constipation/diarrhoea, fatigue). Early detection/management of side-effects is vital to improve patient outcomes, decrease morbidity and limit lengthy/costly hospital admissions. The ability to capture patient-reported health data in real-time, is regarded as the 'gold-standard' to allow rapid clinical decision-making/intervention. This paper presents the protocol for a Phase 3 multi-site randomised controlled trial evaluating a novel nurse-led Telehealth intervention for remote monitoring/management of chemotherapy side-effects in Australian haematological cancer patients. Methods/Design: Two hundred and twenty-two patients will be recruited from two hospitals. Eligibility criteria include: diagnosis of chronic lymphocytic leukaemia/Hodgkin's/non-Hodgkin's lymphoma; aged >= 18 years; receiving >= 2 cycles chemotherapy. Patients will be randomised 1: 1 to either the control or intervention arm with stratification by diagnosis, chemotherapy toxicity (high versus low), receipt of previous chemotherapy and hospital. Patients allocated to the control arm will receive 'Usual Care' whilst those allocated to the intervention will receive the intervention in addition to 'Usual Care'. Intervention patients will be provided with a computer tablet and software prompting twice-daily completion of physical/emotional scales for up to four chemotherapy cycles. Should patient data exceed pre-determined limits an Email alert is delivered to the treatment team, prompting nurses to view patient data, and contact the patient to provide clinical intervention. In addition, six scheduled nursing interventions will be completed to educate/support patients in use of the software. Patient outcomes will be measured cyclically (midpoint and end of cycles) via pen-and-paper self-report alongside review of the patient medical record. The primary outcome is burden due to nausea, mucositis, constipation and fatigue. Secondary outcomes include: burden due to vomiting and diarrhoea; psychological distress; ability to self-manage health; level of cancer information/support needs and; utilisation of health services. Analyses will be intention-to-treat. A cost-effectiveness analysis is planned. Discussion: This trial is the first in the world to test a remote monitoring/management intervention for adult haematological cancer patients receiving chemotherapy. Future use of such interventions have the potential to improve patient outcomes/safety and decrease health care costs by enabling early detection/clinical intervention

Die Astrologie der Antike

Die Astrologie der Antike. - In: Berichte zur Wissenschaftsgeschichte. 8. 1985. S. 7-2