Transformer les pratiques professionnelles vis-à-vis des personnes prestataires de l’aide sociale : développement participatif et évaluation d’une formation continue en cabinet dentaire

L’objectif de la présente thèse est de générer des connaissances sur les contributions possibles d’une formation continue à l’évolution des perspectives et pratiques des professionnels de la santé buccodentaire. Prônant une approche centrée sur le patient, la formation vise à sensibiliser les professionnels à la pauvreté et à encourager des pratiques qui se veulent inclusives et qui tiennent compte du contexte social des patients. L’évaluation de la formation s’inscrit dans le contexte d’une recherche-action participative de développement d’outils éducatifs et de transfert des connaissances sur la pauvreté. Cette recherche-action aspire à contribuer à la lutte contre les iniquités sociales de santé et d’accès aux soins au Québec; elle reflète une préoccupation pour une plus grande justice sociale ainsi qu’une prise de position pour une santé publique critique fondée sur une « science des solutions » (Potvin, 2013). Quatre articles scientifiques, ancrés dans une philosophie constructiviste et dans les concepts et principes de l’apprentissage transformationnel (Mezirow, 1991), constituent le cœur de cette thèse. Le premier article présente une revue critique de la littérature portant sur l’enseignement de l’approche de soins centrés sur le patient. Prenant appui sur le concept d’une « épistémologie partagée », des principes éducatifs porteurs d’une transformation de perspective à l’égard de la relation professionnel-patient ont été identifiés et analysés. Le deuxième article de thèse s’inscrit dans le cadre du développement participatif d’outils de formation sur la pauvreté et illustre le processus de co-construction d’un scénario de court-métrage social réaliste portant sur la pauvreté et l’accès aux soins. L’article décrit et apporte une réflexion, notamment sur la dimension de co-formation entre les différents acteurs des milieux académique, professionnel et citoyen qui ont constitué le collectif À l’écoute les uns des autres. Nous y découvrons la force du croisement des savoirs pour générer des prises de conscience sur soi et sur ses préjugés. Les outils développés par le collectif ont été intégrés à une formation continue axée sur la réflexion critique et l’apprentissage transformationnel, et conçue pour être livrée en cabinet dentaire privé. Les deux derniers articles de thèse présentent les résultats d’une étude de cas instrumentale évaluative centrée sur cette formation continue et visant donc à répondre à l’objectif premier de cette thèse. Le premier consiste en une analyse des transformations de perspectives et d’action au sein d’une équipe de 15 professionnels dentaires ayant participé à la formation continue sur une période de trois mois. L’article décrit, entre autres, une plus grande ouverture, chez certains participants, sur les causes structurelles de la pauvreté et une plus grande sensibilité au vécu au quotidien des personnes prestataires de l’aide sociale. L’article comprend également une exploration des effets paradoxaux dans l’apprentissage, notamment le renforcement, chez certains, de perceptions négatives à l’égard des personnes prestataires de l’aide sociale. Le quatrième article fait état de barrières idéologiques contraignant la transformation des pratiques professionnelles : 1) l’identification à l’idéologie du marché privé comme véhicule d’organisation des soins; 2) l’attachement au concept d’égalité dans les pratiques, au détriment de l’équité; 3) la prédominance du modèle biomédical, contraignant l’adoption de pratiques centrées sur la personne et 4) la catégorisation sociale des personnes prestataires de l’aide sociale. L’analyse des perceptions, mais aussi de l’expérience vécue de ces barrières démontre comment des facteurs systémiques et sociaux influent sur le rapport entre professionnel dentaire et personne prestataire de l’aide sociale. Les conséquences pour la recherche, l’éducation dentaire, le transfert des connaissances, ainsi que pour la régulation professionnelle et les politiques de santé buccodentaire, sont examinées à partir de cette perspective.This thesis aims to generate knowledge on how a continuing education course might contribute to the evolution of oral health professionals’ perspectives and practices. Promoting patient centered care, the course aims to sensitize professionals to poverty issues and to encourage socially inclusive practices that take into account the social context of patients. The course evaluation is nested within a participatory action research project aimed at developing educational and knowledge transfer tools to sensitize oral health professionals to poverty issues and Our research strives to contribute to the fight against social inequities in health and in access to care in Québec; it is grounded in our intent for greater social justice and reflects our belief in the importance of a critical public health founded on a « science of solutions » (Potvin, 2013). Four scientific articles, grounded in constructivism and in the concepts and principles of transformative learning theory (Mezirow, 1991), constitute the heart of this thesis. The first presents a critical review of the literature on health professional education for patient-centered care. We focus on the concept of shared epistemology as a foundation for patient-centered care and determine and analyse the educational principles allowing for its development in students and practitioners. Our second article, located within the participatory developmental process, delves into the co-construction of a social realist screenplay portraying poverty and issues of access to dental care. The article examines and reflects on the participatory processes, in particular the co-learning that took place among the partners involved in writing the screenplay and in producing the educational tools on poverty. We discover the potency of shared knowledge among professionals, citizens, educators and academics for enhancing reflection on bias and perspective taking. The educational tools developed have been integrated into an onsite credited continuing education course on poverty and oral health, privileging critical reflection, founded on transformative learning theory, and integrating dimensions of person-centered care. The results of an instrumental case study among the 15 members of a dental team having participated in the course constitute the last two articles of the thesis. The first describes and analyzes the new meanings and actions among course participants, emphasizing shifts in thinking about the causes of poverty, about life on welfare, about certain patient behaviors and about the participants themselves. New actions refer to changes made in verbal and non-verbal communication and appointment giving policy. The article also examines unanticipated and paradoxical effects of learning, such as the reinforcement of certain beliefs. The final thesis article presents the case study results in terms of the participants’ experience of their workplace ideologies and how these constitute obstacles or objections to learning or to making practice or policy changes. These ideologies include 1) identification with a for-profit and private market oral health care system; 2) “equal treatment”, a belief constraining concern for equity and the recognition of discriminatory practices; 3) a predominantly biomedical orientation to care; and 4) stereotypical categorization of publically insured patients into « deserving » vs. « non-deserving » poor. This knowledge contributes to our understanding of systemic influences on professionals’ practices and interactions with patients living on welfare. We discuss implications for research, dental education and knowledge translation, as well as in terms of oral health policy and oral health professional regulation

Improved resolution and signal-to-noise ratio in laser-ultrasonics by SAFT processing.

Laser-ultrasonics is an emerging nondestructive technique using lasers for the generation and detection of ultrasound which presents numerous advantages for industrial inspection. In this paper, the problem of detection by laser-ultrasonics of small defects within a material is addressed. Experimental results obtained with laser-ultrasonics are processed using the Synthetic Aperture Focusing Technique (SAFT), yielding improved flaw detectability and spatial resolution. Experiments have been performed on an aluminum sample with a contoured back surface and two flat-bottom holes. Practical interest of coupling SAFT to laser-ultrasonics is also discussed

Lowbush blueberry fruit yield and growth response to inorganic and organic N-fertilization when competing with two common weed species

Inorganic N fertilizers are commonly used in commercial blueberry fields; however, this form of N can favor increased weed species’ growth, which can ultimately reduce the benefits of fertilization. We hypothesized that chipped ramial wood (CRW) compost is an effective alternative organic fertilizer for blueberry plants when weeds are present, as ericaceous shrub species are generally more efficient in utilizing organic N than herbaceous weed species. In this study, we measured the growth, fruit yield, and foliar N response of lowbush blueberry (Vaccinium angustifolium Aiton) to an application of 45 kg N ha-1 in the form of organic (CRW) or inorganic N (ammonium sulfate) in two areas of a commercial field colonized by either poverty oat grass (Danthonia spicata (L.) Beauv.) or sweet fern (Comptonia peregrina (L.) Coult.). We also assessed the impact of the fertilization treatments on litter decomposition rates. Contrary to our hypothesis, we found no significant increase in blueberry fruit yield or growth using CRW. By contrast, inorganic N-fertilization increased fruit yield by 70%. The effect was higher in the area colonized by D. spicata (+83%) than by C. peregrina (+45%). Blueberry fruit yield was on average twice higher in the area of the field having D. spicata than C. peregrina, suggesting a stronger competition with the latter. However, the increase in D. spicata density from 0–1 to >25 plants m-2 reduced fruit production by three-fold and strongly impacted vegetative growth in both fertilized and unfertilized plots. The impact of increased C. peregrina density was comparatively much lower, especially on vegetative growth, which was much higher in the area having C. peregrina. These patterns are likely due to a lower competition for N uptake with C. peregrina as this species can derive N from the atmosphere. Interestingly, the higher fruit yield in the area colonized by D. spicata occurred even in plots where the weeds were nearly absent (density of 0–1 plant m-2), revealing the influence of unidentified variables on blueberry fruit yield. We hypothesized that this difference resulted from over-optimal foliar N concentrations in the area colonized by C. peregrina as suggested by the significantly higher foliar N concentrations and by the negative correlation between foliar N concentrations and fruit yields in this area. The possibility of an influence of C. peregrina on flowering and pollination success, as well as of unidentified local site conditions is discussed. The tested N-fertilization treatments did not affect foliar N concentrations or litter decomposition rates. Overall, our results show that ammonium sulfate is very effective at increasing fruit yields but that both fruit yields and the efficiency of the N-fertilization treatment are decreased by increased D. spicata density, especially above 25 plants m-2. Although CRW did not significantly enhance fruit yields in the short term, this fertilizer may have a long-term beneficial effect

Trade union strategies in the age of austerity: the Romanian public sector in comparative perspective

This article examines the impact of the economic crisis and its aftermath on collective bargaining, by comparing reactions to austerity policies of trade unions in healthcare and education in Romania. We develop an encompassing theoretical framework that links strategies used by trade unions with power resources, costs and union democracy. In a tight labour market generated by the massive emigration of doctors, unions in healthcare have successfully deployed their resources to advance their interests and obtain significant wage increases and better working conditions. We also show that in the aftermath of the crisis, healthcare trade unions have redefined their strategies and adopted a more militant stance based on a combination of local strikes, strike threats and temporary alliances with various stakeholders. By comparison, we find that unions in the education sector have adopted less effective strategies built around negotiations with governments combined with national-level militancy

Analysis of the Pythium ultimum transcriptome using Sanger and Pyrosequencing approaches

<p>Abstract</p> <p>Background</p> <p><it>Pythium </it>species are an agriculturally important genus of plant pathogens, yet are not understood well at the molecular, genetic, or genomic level. They are closely related to other oomycete plant pathogens such as <it>Phytophthora </it>species and are ubiquitous in their geographic distribution and host rage. To gain a better understanding of its gene complement, we generated Expressed Sequence Tags (ESTs) from the transcriptome of <it>Pythium ultimum </it>DAOM BR144 (= ATCC 200006 = CBS 805.95) using two high throughput sequencing methods, Sanger-based chain termination sequencing and pyrosequencing-based sequencing-by-synthesis.</p> <p>Results</p> <p>A single half-plate pyrosequencing (454 FLX) run on adapter-ligated cDNA from a normalized cDNA population generated 90,664 reads with an average read length of 190 nucleotides following cleaning and removal of sequences shorter than 100 base pairs. After clustering and assembly, a total of 35,507 unique sequences were generated. In parallel, 9,578 reads were generated from a library constructed from the same normalized cDNA population using dideoxy chain termination Sanger sequencing, which upon clustering and assembly generated 4,689 unique sequences. A hybrid assembly of both Sanger- and pyrosequencing-derived ESTs resulted in 34,495 unique sequences with 1,110 sequences (3.2%) that were solely derived from Sanger sequencing alone. A high degree of similarity was seen between <it>P. ultimum </it>sequences and other sequenced plant pathogenic oomycetes with 91% of the hybrid assembly derived sequences > 500 bp having similarity to sequences from plant pathogenic <it>Phytophthora </it>species. An analysis of Gene Ontology assignments revealed a similar representation of molecular function ontologies in the hybrid assembly in comparison to the predicted proteomes of three <it>Phytophthora </it>species, suggesting a broad representation of the <it>P. ultimum </it>transcriptome was present in the normalized cDNA population. <it>P. ultimum </it>sequences with similarity to oomycete RXLR and Crinkler effectors, Kazal-like and cystatin-like protease inhibitors, and elicitins were identified. Sequences with similarity to thiamine biosynthesis enzymes that are lacking in the genome sequences of three <it>Phytophthora </it>species and one downy mildew were identified and could serve as useful phylogenetic markers. Furthermore, we identified 179 candidate simple sequence repeats that can be used for genotyping strains of <it>P. ultimum</it>.</p> <p>Conclusion</p> <p>Through these two technologies, we were able to generate a robust set (~10 Mb) of transcribed sequences for <it>P. ultimum</it>. We were able to identify known sequences present in oomycetes as well as identify novel sequences. An ample number of candidate polymorphic markers were identified in the dataset providing resources for phylogenetic and diagnostic marker development for this species. On a technical level, in spite of the depth possible with 454 FLX platform, the Sanger and pyro-based sequencing methodologies were complementary as each method generated sequences unique to each platform.</p

Hearing the voices of older adult patients: processes and findings to inform health services research

Background Clinical academic research and service improvement is planned using Patient and Public Involvement and Engagement (PPIE) but older PPIE participants are consulted less often due to the perception that they are vulnerable or hard to engage. Objectives To consult frail older adults about a recently adopted service, discharge to assess (D2A), and to prioritise services improvements and research topics associated with the design and delivery of discharge from hospital. To use successive PPIE processes to enable a permanent PPIE panel to be established. Participants Following guidance from an established hospital PPI panel 27 older adult participants were recruited. Participants from Black, Asian and Minority Ethnic (BAME) communities, affluent and non-affluent areas and varied social circumstances were included. Methods Focus groups and individual interviews were conducted in participants own homes or nearby social venues. Results Priorities for discharge included remaining independent despite often feeling lonely at home; to remain in hospital if needed; and for services to ensure effective communication with families. The main research priority identified was facilitating independence, whilst establishing a permanent PPIE panel involving older adults was viewed favourably. Conclusions Taking a structured approach to PPIE enabled varied older peoples’ voices to express their priorities and concerns into early discharge from hospital, as well as enabling the development of health services research into hospital discharge planning and management. Older people as participants identified research priorities after reflecting on their experiences. Listening and reflection enabled researchers to develop a new “Community PPIE Elders Panel” to create an enduring PPIE infrastructure for frail older housebound people to engage in research design, development and dissemination