La critique de l'institution asilaire dans « Le pas de Gamelin » de Jacques Ferron : la question du théâtre

Ce mémoire porte sur « Le pas de Gamelin », un récit de Jacques Ferron publié en 1987 à titre posthume dans un recueil intitulé La conférence inachevée. Bien qu'il s'agisse de l'ultime tentative de Ferron pour mener à terme un projet qui le préoccupait depuis longtemps, soit de réaliser une grande oeuvre sur la folie, peu de chercheurs s'y sont intéressés. Pourtant, celle-ci est particulièrement riche: Ferron, en dressant le portrait de plusieurs folles auprès desquelles il a travaillé comme médecin à l'asile Saint-Jean-de-Dieu entre 1970 et 1971, formule un véritable réquisitoire contre \ud l'institution asilaire. Or, si la dimension polémique du « Pas de Gamelin » semble être une évidence, les modalités de son inscription dans le texte ont rarement été étudiées. C'est donc ce que nous nous proposons de faire en explorant la piste du théâtre. En effet, après avoir effectué un survol socio-historique de l'évolution de la notion de folie et des mesures qui ont été prises contre elle au cours des siècles, nous serons en mesure de comprendre comment l'internement est souvent la conséquence d'une confrontation entre rôles sociaux et rôles individuels, quand un individu ne se conforme pas aux moules prescrits par la société qui l'entoure. Nous constaterons aussi que, dans un monde où chacun joue son existence dans le regard d'autrui, la frontière entre rôle social, individuel et dramatique est poreuse car, lorsqu'un rôle sert à en masquer un autre, les interactions deviennent théâtralisées. C'est donc en nous appuyant sur ces quelques considérations théoriques que nous pourrons étudier les relations qui unissent les personnages du « Pas de Gamelin ». Nous observerons comment l'usage que font les protagonistes des artifices du théâtre contribue à révéler une théâtralité latente dans l'asile, qui se trouve décuplée par la description que donne Ferron du jeu des folles. En effet, l'auteur, en accentuant leur aspect carnavalesque, démontre leur volonté d'aménager un espace d'unicité individuelle dans cette grande mise en scène ourdie par l'autorité asilaire dans le dessein de forcer l'uniformisation. Enfin, en transposant ce modèle d'interaction sur celui du théâtre dans le théâtre, il nous sera possible de cerner la position qu'y occupe Jacques Ferron, qui se met lui-même en scène parmi les folles et les représentants de l'autorité. Nous verrons ainsi que, tel un fou du roi moderne, Ferron tire profit de sa situation ambivalente entre la médecine et la folie pour critiquer l'institution asilaire et, plus encore, le processus de catégorisation qui y mène. ______________________________________________________________________________ MOTS-CLÉS DE L’AUTEUR : Jacques Ferron, « Le pas de Gamelin », Folie, Théâtre, Critique de l'institution asilaire

Comment encadrer les travailleurs indépendants et précaires de la gig Economy? : réflexion sur le modèle coopératif belge Smart

Travail dirigé présenté à l'École des Relations industrielles en vue de l'obtention du grade de Maître ès Sciences (M. Sc.) en Relations industrielles.« Comment encadrer les travailleurs indépendants et précaires de la gig economy? Réflexion sur le modèle coopératif belge Smart ». Cette recherche porte sur l’encadrement des travailleurs précaires issus de la gig economy (l’économie de plateforme ou à la demande) via le modèle coopératif. En réponse aux nouvelles formes de capitalisme qui ont modifié le marché de l’emploi contemporain, certains groupes de travailleurs ont décidé de s’organiser et ont formé des coopératives dans plusieurs pays d’Europe. Cette idée leur permet de mutualiser plusieurs services et d’accéder à certaines protections sociales. Le principe est que le travailleur autonome parvient à obtenir un statut de salarié, mais de la coopérative, et ce, pour la durée du contrat. En Belgique, le modèle Smart existe déjà depuis une vingtaine d’années. Il s’est ensuite développé dans sept pays d’Europe. Il est toutefois uniquement rentable en Belgique. Plusieurs coopératives coexistent maintenant. Bien que ce modèle soit imparfait et que plusieurs critiques lui soient adressées, ces coopératives répondent à un besoin de protection des travailleurs indépendants. Ces initiatives, nées et développées au sein de contextes institutionnels particuliers, sont-elles « exportables »? Dit autrement, est-ce que ces initiatives, permettant de contrer la précarité de plusieurs travailleurs n’ayant pas accès à la syndicalisation traditionnelle, pourraient être développées ailleurs dans le monde? Le travail dirigé tente donc de répondre aux questions suivantes; comment les coopératives de travailleurs autonomes pourraient-elles s’implanter au Québec? Est-ce que cette expérimentation institutionnelle pourrait être une nouvelle forme de revitalisation de l’action syndicale? C’est grâce aux théories de renouveau syndical de Murray (2017) que ce travail a été majoritairement théorisé. Le travail dirigé a démontré que les coopératives de travailleurs autonomes ne pourraient pas s’implanter à première vue au Québec sans une réflexion sérieuse de la part des centrales syndicales, sans des adaptations majeures du modèle coopératif belge et sans une modification du cadre juridique québécois. Ensuite, ce travail dirigé réfléchit à la possibilité de pousser le modèle malgré les limites afin d’en faire une expérimentation institutionnelle tout comme l’a fait Smart il y a une vingtaine d’années. Vu la montée fulgurante des emplois précaires découlant de la gig economy ainsi que la difficulté pour les syndicats de renouveler leur membership, il s’agit d’une opportunité pour les syndicats de s’intéresser à ces travailleurs traditionnellement exclus des zones syndicables (Haiven, 2006).« How to organize the independent and precarious workers of the gig economy? Reflections on the Belgian Smart cooperative model ». This research focuses on the supervision of precarious workers from the gig economy via the cooperative model. In response to the new forms of capitalism that have altered the contemporary job market, certain groups of workers have decided to organize themselves and have formed cooperatives in several European countries. This idea enables them to pool a number of services and gain access to certain social protections. The principle is that the self-employed worker obtains employee status, but from the cooperative, for the duration of the contract. In Belgium, the Smart model has been around for some twenty years. It has since spread to seven European countries. However, it is only profitable in Belgium. Several cooperatives now coexist. Although this model is imperfect, and has been criticized on several counts, these cooperatives respond to a need to protect self-employed workers. Are these initiatives, born and developed within specific institutional contexts, "exportable"? In other words, could these initiatives, which counter the precariousness of many workers who have no access to traditional unionization, be developed elsewhere in the world? How could worker cooperatives become established in Quebec? Could this institutional experiment be a new way of revitalizing union action? Murray's (2017) theories of union renewal were used to theorize this work. This research showed that worker cooperatives could not, at first glance, take root in Quebec without serious reflection on the part of central labour unions, major adaptations of the Belgian cooperative model and changes to the Quebec legal framework. Secondly, this directed work reflects on the possibility of pushing the model beyond its limits as an institutional experiment, just as Smart did some twenty years ago. Given the dramatic rise in precarious employment resulting from the gig economy, and the difficulty for unions to renew their membership, this is an opportunity for unions to take an interest in these workers traditionally excluded from unionizable areas (Haiven, 2006)

Surgically created double-orifice left atrioventricular valve: A valve-sparing repair in selected atrioventricular septal defects

AbstractObjectives: Some features of the left atrioventricular valve (large mural leaflet, dystrophic tissue) represent a challenge for repair of atrioventricular septal defects without postoperative regurgitation. A retrospective study was conducted to evaluate the results of surgically creating a double-orifice left atrioventricular valve in such circumstances. Clinical results were analyzed according to valvular and subvalvular left atrioventricular valve measurements in pathologic specimens with atrioventricular septal defects. Methods: Among 157 patients operated on for atrioventricular septal defect since October 1989, 10 patients underwent primary repair (n = 8) or reoperation (n = 2) by this procedure. Median age at repair was 3.3 years (0.1-33 years). Anatomic types were complete (n = 3), intermediate (n = 5), and partial (n = 2). Preoperative moderate to severe left atrioventricular valve regurgitation was present in 6 patients. After the repair (two-patch technique in complete atrioventricular septal defect, cleft closed in each case), these 10 patients were found to have moderate to severe residual regurgitation not amenable to repair by annuloplasty. The top edge of the mural leaflet was anchored to the facing free edge of the cleft. Results: No hospital death or morbidity was observed. Left atrioventricular valve regurgitation was absent or trivial (8 patients) and mild (2 patients). Color-coded echocardiography did not show significant left atrioventricular valve stenosis. The mean diastolic pressure gradient across the left atrioventricular valve was 3.2 ± 1.1 mm Hg (1.4-4.5 mm Hg). At a median follow-up of 72 months (6-91 months), there was 1 late death, unrelated to left atrioventricular valve malfunction, due to pulmonary vascular obstructive disease. Left atrioventricular valve regurgitation did not increase over time, except in 1 patient in whom regurgitation recently progressed from mild to moderate. At rest, the mean diastolic pressure gradient across the left atrioventricular valve was 3.8 ± 2.9 mm Hg (1.5-11.2 mm Hg). One child had an early moderate stenosis without pulmonary hypertension. Studies on pathologic specimens (n = 34) indicated that long chordal lengths and large mural leaflet size are essential independent anatomic features to assess its feasibility. Conclusions: Surgical creation of a double-orifice left atrioventricular valve is an effective additional procedure for repair of atypical cases of atrioventricular septal defect. The operation may decrease the need for reoperation or left atrioventricular valve replacement. (J Thorac Cardiovasc Surg 2001;121:352-65

Preoperative and postoperative evaluation of airways compression in pediatric patients with 3-dimensional multislice computed tomographic scanning: Effect on surgical management

ObjectivesSurgical management of airway compression of vascular origin requires an accurate analysis of anatomy and various mechanisms of compression. This study assessed the usefulness of 3-dimensional computed tomographic scanning in the preoperative and postoperative evaluation of airways compression in a pediatric population.MethodsThirty-seven consecutive patients (median age, 4 months) were examined with multislice 3-dimensional computed tomographic scanning: 18 patients before surgical treatment of anomalies of vascular rings, 2 patients because of respiratory symptoms after repair of esophageal atresia, and 17 patients because of persisting respiratory symptoms or prolonged mechanical ventilation after cardiac surgery for congenital heart disease.ResultsThe procedure was successful, with high-quality diagnostic imaging obtained in all cases without any complications. The anatomy and relationship between the vascular arches and airways was analyzed in all referred patients with vascular arch anomalies confirmed on the basis of the surgical findings, and this helped the surgeon to plan the procedure and choose the best approach. After cardiac surgery, the airway and vascular structures involved and the mechanism of compression were specified in all but one case, and the 3-dimensional computed tomographic scan serves as an important tool for deciding whether to perform reoperation on patients requiring prolonged mechanical ventilation.ConclusionThree-dimensional computed tomographic scanning is a safe, fast, and noninvasive method useful for accurately analyzing the mechanisms of airway compression of vascular origin and thus possible improving the surgical management of pediatric patients

Synergic PDE3 and PDE4 control intracellular cAMP and cardiac excitation-contraction coupling in a porcine model

International audienc

HIV-1-infected patients from the French National Observatory experiencing virological failure while receiving enfuvirtide

Objectives We studied gp41 mutations associated with failing enfuvirtide salvage therapy. Methods This multicentre study involved patients with HIV-1 plasma viral load (pVL) > 5000 copies/mL after at least 3 months of uninterrupted enfuvirtide therapy and with plasma samples available at inclusion (T0), at initial enfuvirtide failure (T1) and at last follow-up visit during continued failing enfuvirtide therapy (T2). The HR-1 and HR-2 domains of the gp41 gene were sequenced at T0, T1 and T2. Results Ninety-nine patients were enrolled. At baseline, the median pVL and CD4 cell count were 5.1 log copies/mL and 72 cells/mm3, respectively. Based on the ANRS Resistance Group algorithm, the proportion of patients harbouring viruses with enfuvirtide resistance mutations increased significantly between T0 and T1. In the HR-1 domain, the V38A/M, Q40H, N42T, N43D and L45M mutations wereselected (P < 0.02). In the HR-2 domain, no mutations were significantly selected during the follow-up. None of the mutations was associated with a CD4 cell count increment. Conclusions Mutations selected during failing enfuvirtide salvage therapy are mainly located in the HR-1 domain of the gp41 gene, between codons 38 and 45. No mutations were associated with an increase in the CD4 cell coun

International registry of congenital porto-systemic shunts: a multi-centre, retrospective and prospective registry of neonates, children and adults with congenital porto-systemic shunts.

BACKGROUND Congenital portosystemic shunts (CPSS) are rare vascular malformations associated with the risk of life-threatening systemic conditions, which remain underdiagnosed and often are identified after considerable diagnostic delay. CPSS are characterized by multiple signs and symptoms, often masquerading as other conditions, progressing over time if the shunt remains patent. Which patients will benefit from shunt closure remains to be clarified, as does the timing and method of closure. In addition, the etiology and pathophysiology of CPSS are both unknowns. This rare disorder needs the strength of numbers to answer these questions, which is the purpose of the international registry of CPSS (IRCPSS). METHOD A retrospective and prospective registry was designed using secuTrial® by the ISO certified Clinical Research Unit. Given that a significant number of cases entered in the registry are retrospective, participants have the opportunity to use a semi-structured minimal or complete data set to facilitate data entry. In addition, the design allows subjects to be entered into the IRCPSS according to clinically relevant events. Emphasis is on longitudinal follow-up of signs and symptoms, which is paramount to garner clinically relevant information to eventually orient patient management. The IRCPSS includes also three specific forms to capture essential radiological, surgical, and cardiopulmonary data as many times as relevant, which are completed by the specialists themselves. Finally, connecting the clinical data registry with a safe image repository, using state-of-the-art pseudonymization software, was another major focus of development. Data quality and stewardship is ensured by a steering committee. All centers participating in the IRCPSS have signed a memorandum of understanding and obtained their own ethical approval. CONCLUSION Through state-of-the-art management of data and imaging, we have developed a practical, user-friendly, international registry to study CPSS in neonates, children, and adults. Via this multicenter and international effort, we will be ready to answer meaningful and urgent questions regarding the management of patients with CPSS, a condition often ridden with significant diagnostic delay contributing to a severe clinical course

Influence of Mycotoxins and a Mycotoxin Adsorbing Agent on the Oral Bioavailability of Commonly Used Antibiotics in Pigs

It is recognized that mycotoxins can cause a variety of adverse health effects in animals, including altered gastrointestinal barrier function. It is the aim of the present study to determine whether mycotoxin-contaminated diets can alter the oral bioavailability of the antibiotics doxycycline and paromomycin in pigs, and whether a mycotoxin adsorbing agent included into diets interacts with those antibiotics. Experiments were conducted with pigs utilizing diets that contained blank feed, mycotoxin-contaminated feed (T-2 toxin or deoxynivalenol), mycotoxin-contaminated feed supplemented with a glucomannan mycotoxin binder, or blank feed supplemented with mycotoxin binder. Diets with T-2 toxin and binder or deoxynivalenol and binder induced increased plasma concentrations of doxycycline administered as single bolus in pigs compared to diets containing blank feed. These results suggest that complex interactions may occur between mycotoxins, mycotoxin binders, and antibiotics which could alter antibiotic bioavailability. This could have consequences for animal toxicity, withdrawal time for oral antibiotics, or public health