De Quebec Research Articles

The case of a viable pregnancy post vaginal radical trachelectomy followed by combined chemo-radiation therapy

a Gynecologic Oncology Service, Centre Hospitalier Universitaire de Quebec (CHUQ), L'Hotel-Dieu de Quebec, Laval University, Quebec City, Canada b Gynecologic Oncology Division, Texas Oncology, Austin, TX, USA c Radiation Oncology Division, Austin Cancer Centers, Austin, TX, USA d Texas Fertility Center, Austin, Texas, University of Texas Southwestern Medical School, Dallas, TX, USA e Women Partners in Health, Austin, Texas, Seton Medical Center, University of Texas Southwestern Medical School, Dallas, TX, USA

Challenges in diagnosing brain death

Recognizing that the nature of the practice of clinical medicine involves areas of uncertainty, death is one diagnosis that doctors must not be allowed to miss. The concept of brain death, which originates from the Harvard Criteria, has allowed development of cadaveric organ transplantation programs. Over the years, the definition of brain death and the criteria for the neurological determination of death (NDD) have been updated. The Universal Determination of Death Act provides a definition of death but leaves the determination process to accepted medical standards (national, provincial, or even local), which can entail a high variability. In April 2003, in response to a perceived need in the general medical and critical care community, the Canadian Council for Donation and Transplantation (CCDT) held a national forum to revisit the process of declaring brain death and to propose updated recommendations. These are the current guidelines used by organ donation and transplantation organizations across Canada. The CCDT recommendations have the virtue of having brought uniformity to the process of NDD. Still, several of its recommendations are somewhat vague and open the door to clinical judgement and interpretation, a situation that is highly undesirable when facing potential organ donation. In this issue of the Journal, Roberts et al. report two cases where experienced physicians faced challenges in the clinical NDD. In both cases, it appears that several of the criteria for NDD were either misinterpreted or overlooked. Although they are usually not reported in the medical literature, similar incidents occur more than occasionally. This is somewhat disturbing. The existence of cadaveric organ donation and transplantation programs relies on the Dead Donor Rule that dictates that a patient’s death must be confirmed before any attempt at organ preservation or harvesting for the purpose of transplantation. Before a patient is dead, ethical principles mandate that medical care must be directed toward the sole and only benefit of this patient, even in a situation that could be perceived as ‘‘almost dead’’. Brain death is a complex concept that is very difficult for the general public to understand. Patients and their families place their trust in their treating physician. In organ donation, they trust that physicians will strictly abide by the Dead Donor Rule. Therefore, the process for NDD must be watertight. The CCDT recommendations define neurological death as the irreversible loss of all brain stem functions. The minimum criteria for clinical NDD are: 1) an established etiology capable of causing neurological death in the absence of reversible conditions capable of mimicking neurological death; 2) a deep unresponsive coma with bilateral absence of motor responses (excluding spinal reflexes); 3) absent brain stem reflexes, as defined by absent gag and cough reflexes, and the bilateral absence of corneal responses, pupillary responses to light (with pupils at mid-size or greater), and vestibulo-ocular responses; 4) absent respiratory effort based on the apnea test; and 5) absence of any confounding factors. Minimum means that at least all of these criteria must be met for clinical NDD. Confusion may arise regarding the first criterion. An etiology ‘‘capable of causing’’ neurological death is not the same as ‘‘sufficient to account for’’ the absence of clinical signs of brain function. For example, brain trauma is an M. R. Lessard, MD (&) J. G. Brochu, MD Department of Anesthesia and Critical Care, Centre hospitalier affilie universitaire de Quebec, Universite Laval, 1401, 18e rue, Quebec, QC G1J 1Z4, Canada e-mail: martin.lessard@anr.ulaval.ca

Canadian Association of Radiologists Technical Standards for Bone Mineral Densitometry Reporting

Department of Radiology and Diagnostic Imaging and Division of Endocrinology and Metabolism, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada Department of Radiology, Le Centre hospitalier universitaire de Quebec, Quebec, Quebec, Canada Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Alberta, Canada; representing the Canadian Panel of the International Society for Clinical Densitometry Division of Rheumatology, Department of Medicine, Laval University, Le Centre hospitalier universitaire de Quebec, Quebec, Quebec, Canada; representing the Scientific Advisory Council of Osteoporosis Canada

Évolution clinique des patients atteints d’un cancer prostatique de risque intermédiaire traités par implants permanents d’iode-125 : l’expérience de l’Hôtel-Dieu de Québec

Purpose To describe the biochemical failure-free survival (BFFS), GU toxicity and erectile dysfunction in intermediate risk prostate cancer treated with iodine 125 monotherapy (I125). Patients and methods Between October 1994 and October 2007, 1282 patients were treated with I125 at the Hotel Dieu de Quebec. Two hundred patients were intermediate risk prostate cancer. One hundred and fifty-seven had enough follow-up to be evaluated in this study. Biochemical failure-free survival is reported using Phoenix definition. Acute and late GU toxicity was described using the International Prostate Symptoms Score (IPSS) as well as with the rate of bladder catheter. Erectile dysfunction was also reported. Results The mean age of the patients was 65.6 years (S.D. = 6 years) and the mean pretreatment PSA was 8.7 ng/ml. About half of the patients (51%) were T2b/T2c. About 44.6% had a PSA greater than 10 and 4.5% had Gleason score of 7/10. More than half of the patients received a short course of hormones of less than 6 months for cytoreduction (57.4%). The median follow-up was 60 months. Biochemical failure-free survival at 60-month and 96-month were 87.1% and 81% according to Phoenix definition. The mean IPSS rose from 5 immediately after the implant to 15 1 month after and then slowly decreased to 8 at 24 months. Acute urinary retention with bladder catheter occurred in 10.9% of patients. Only 4.3% presented erectile dysfunction at 5 months post-implant. Conclusion I125 monotherapy for intermediate risk prostate implant gives biochemical failure-free survivals at 5 years and 8 years comparable to those obtained with high dose external beam radiotherapy. GU toxicity and erectile dysfunction were low and acceptable. Therefore, the use of I125 alone in this group of patients could be presented and discussed with the patient in the waiting of phase III validation.

Introduction to community psychology in Canada: Past, present, and future.

The introduction to the special section on community psychology in Canada provides background information about the field in Canada and provides summaries of the four articles and the commentary that comprise the issue. The articles address (a) theory, research, and practice in community psychology; (b) training in community psychology; (c) community psychology practice; and (d) a vision for the future of community psychology in Canada. These articles highlight the many contributions of Canadian community psychologists to a field that is growing throughout the world to address pressing social problems. Keywords: community psychology, community training, community research, community practice, vision Community psychology (CP) has a lengthy history in Canada. Pols (2000) traced the roots of community psychology to the Psychology Department at the University of Toronto, beginning in the mid 1920s. Moreover, the term community psychology was first used in 1951 by University of Toronto psychology professor William Line (Babarik, 1979). In spite of this history, community psychology remains a marginalized specialty in Canadian psychology with a relatively small network of researchers and practitioners. In this context, the special section in the current issue of Canadian Psychology was developed to inform Canadian psychologists about the many and varied contributions of this subdiscipline of psychology, as well as the current status of community psychology in Canada. The special section is a project developed by participants at the 2008 Quebec-Ontario Community Psychology Conference. The conference, held biennially since 2002, involves participation of faculty and students from Universite Laval, University of Ottawa, Universite de Quebec a Montreal, and Wilfrid Laurier University. All of these universities offer training in community psychology. While some articles on community psychology have been previously published in Canadian Psychology (Davidson, 1981; WalshBowers, 1 998), much of the literature on community psychology in Canada has been published elsewhere, including a previous special issue on community psychology (Tefft, 1 982) and a recent historical and substantive review (Nelson, Lavoie, & Mitchell, 2007). In developing the project, participants in the 2008 biennial conference believed that it was important that the work be presented in Canadian Psychology, the flagship journal of Canadian psychology. There are indications that community psychology as a subdiscipline of psychology is growing outside of Canada. The Society of Community Research and Action, which represents Division 27 of the American Psychological Association, has approximately 900 members. In addition, there has been increasing internationalization of community psychology globally with self-identified community psychologists in Australia, New Zealand, Europe, Central America, South America, and Japan (Reich, Riemer, Prilleltensky, & Montero, 2007; Vazquez Rivera, Figueroa Rodriguez, Pacheco Bou, & Perez-Jimenez, 2009). International community psychology conferences have been held in San Juan, Puerto Rico, in 1996; in Lisbon, Portugal, in 1998; and in Puebla, Mexico, in 2010. In Canada, there is a small committed group of community psychologists, as is reflected in attendees at the Quebec-Ontario conference and the membership of Section 3, the community psychology section of the Canadian Psychological Association (CPA), which was started in 1982. In light of the many contemporary complex social issues facing Canadian society - such as underdeveloped early childhood education and prevention, mental health problems in the population, economic and social marginalization of First Nations people, and integration challenges faced by new immigrants - the contributions that community psychology can make to social programs and policies to address these issues on behalf of Canadian psychology are as important today as they were when the subdiscipline first developed in Canada. …

Re: S Ratnapalan, MS Rayar, M Crawley. Educational services for hospitalized children. Paediatr Child Health 2009;14(7):433-6

To the Editor: I would like to bring to the attention of the editorial board and readers of Paediatrics & Child Health, the article intitled “Educational services for hospitalized children”, published in a past issue of Paediatrics & Child Health. Although the authors of this article were well intentioned, and their subject of query valuable, their methodology seemed to lack depth, their Web site review and telephone calls seemed incomplete, and their review of Quebec paediatric hospitals contained a few notable inaccuracies. Let me quote parts of the article: “The Montreal Children’s Hospital and the Centre hospitalier universitaire Sainte-Justine are under the McGill University Health Centre umbrella...” (page 433, last paragraph). “There are no other children’s hospitals in the province of Quebec” (other than the Montreal Children’s Hospital, the Centre hospitalier universitaire Sainte-Justine, and the Shriners Hospital for Children – page 436, first paragraph). The Centre hospitalier universitaire Sainte-Justine is one of the largest children’s hospitals in Canada, and its clinical, academic and research achievements are wellknown throughout North America, Europe and many other countries. To mistake its academic affiliation (it is affiliated with the University of Montreal) denotes a lack of rigueur in the authors’ fact-checking process. Furthermore, the authors write that there are no other children’s hospitals in the province, while there are two other major children’s hospitals. The Centre mere-enfant du Centre hospitalier universitaire de Quebec (CHUQ), in Quebec City, affiliated with the Universite Laval, boasts 51 neonatal intensive care unit beds, eight paediatric intensive care unit beds and 81 paediatric beds; the teaching staff comprises approximately 50 paediatricians, specialists and subspecialists. The Centre hospitalier universitaire de Sherbrooke (CHUS), affiliated with the Universite de Sherbrooke, has approximately 25 neonatal intensive care unit beds, six paediatric intensive care unit beds and 40 paediatric beds, and has a teaching staff of approximately 40. Both of these centres offer educational services to their patients via the help of one bilingual teacher at each centre, who works full time in the case of the CHUQ, and three days per week in that of the CHUS. The services are offered to children who are hospitalized for more than three days, and for grade levels from the first year of primary school to the last year of secondary school. The teachers are provided by the respective local school boards. Please note that there are also rehabilitation or psychiatric facilities that have been overlooked. As a board representative from Quebec, let me express to the authors my regrets that their research process was not more thorough. The Caring for Kids Web site provides functioning links to the CHUQ, CHUS and Centre hospitalier universitaire Sainte-Justine Web sites, with contact information for queries, and should members experience much difficulty with the French language, Canadian Paediatric Society board representatives can provide easy assistance. The information above was a 10 min phone call away, and was not at all “difficult” to obtain.

Pandemic (H1N1) 2009 lives in some people for at least eight days after symptoms develop

The pandemic (H1N1) 2009 virus remains alive on the eighth day in 8%–13% of people after they develop flu symptoms, a team of Quebec researchers has determined. Dr. Guy Boivin of the Centre Hospitalier Universitaire de Quebec and Dr. Gaston De Serres of Quebec’s Public Health Institute tested

A High-Mobility Low-Bandgap Poly(2,7-carbazole) Derivative for Photovoltaic Applications

ADVERTISEMENT RETURN TO ISSUEPREVCommunication to the...Communication to the EditorNEXTA High-Mobility Low-Bandgap Poly(2,7-carbazole) Derivative for Photovoltaic ApplicationsYingping Zou†, David Gendron†, Réda Badrou-Aïch†‡, Ahmed Najari†, Ye Tao‡, and Mario Leclerc*†View Author Information Département de Chimie, Université Laval, Quebec City, QC, Canada, G1K 7P4, and Institute of Microstructural Sciences, National Research Council of Canada, Ottawa, ON, Canada, K1A 0R6* To whom correspondence should be addressed. E-mail: [email protected]†Département de Chimie, Université Laval.‡Institute of Microstructural Sciences, National Research Council of Canada.Cite this: Macromolecules 2009, 42, 8, 2891–2894Publication Date (Web):April 1, 2009Publication History Received17 February 2009Revised17 March 2009Published online1 April 2009Published inissue 28 April 2009https://doi.org/10.1021/ma900364cCopyright © 2009 American Chemical SocietyRIGHTS & PERMISSIONSArticle Views6946Altmetric-Citations223LEARN ABOUT THESE METRICSArticle Views are the COUNTER-compliant sum of full text article downloads since November 2008 (both PDF and HTML) across all institutions and individuals. These metrics are regularly updated to reflect usage leading up to the last few days.Citations are the number of other articles citing this article, calculated by Crossref and updated daily. Find more information about Crossref citation counts.The Altmetric Attention Score is a quantitative measure of the attention that a research article has received online. Clicking on the donut icon will load a page at altmetric.com with additional details about the score and the social media presence for the given article. Find more information on the Altmetric Attention Score and how the score is calculated. Share Add toView InAdd Full Text with ReferenceAdd Description ExportRISCitationCitation and abstractCitation and referencesMore Options Share onFacebookTwitterWechatLinked InReddit Read OnlinePDF (268 KB) Get e-AlertsSupporting Info (1)»Supporting Information Supporting Information SUBJECTS:Energy levels,Photovoltaics,Polymers,Reaction products,Solar cells Get e-Alerts

Human Parechovirus and Neonatal Encephalitis

Clinical presentation, cranial ultrasound (cUS) and MRi findings, and neurodevelopmental outcome of 10 neonates (70% term) with human parechovirus (HPeV) encephalitis are described by researchers at University Medical Center, Utrecht, The Netherlands; University of Toronto, Ontario, Canada; and Universitaire de Quebec, Canada.

Use of urinary globotriaosylceramide for fabry disease screening in Canada

2008 S79 Clin Ther. 2008;30(Suppl C):S79–S80 © 2008 Excerpta Medica Inc. All rights reserved. 0149-2918/$32.00 Use of Urinary Globotriaosylceramide for Fabry Disease Screening in Canada Christiane Auray-Blais, LLM, PhD1; Denis Cyr, MSc1; Regen Drouin, MD, PhD1; Joe T.R. Clarke, MD, PhD1; and David S. Millington, PhD2 1Service of Genetics, Faculty of Medicine and Health Sciences, Department of Pediatrics, Universite de Sherbrooke, Sherbrooke, Quebec, Canada; and 2Biochemical Genetics Laboratory, Duke University Medical Center, Research Triangle Park, North Carolina

Diagnosis and Treatment of Sepiapterin Reductase Deficiency

The diagnosis and long-term effects of treatment of two cases of sepiapterin reductase deficiency (SRD) are reported from Service de Neuropediatrie, CHU Montpellier, France; University de Sherbrooke, Quebec, Canada; and centers in Germany and Switzerland.

Directly to the Heart

HomeCirculationVol. 114, No. 13Directly to the Heart Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplementary MaterialsFree AccessReview ArticlePDF/EPUBDirectly to the Heart Jonathan DeBlois, MD, Sebastien Bergeron, MD, Marie-Helene LeBlanc, MD, Mario Senechal, MD, Jocelyn Gregoire, MD and Marie Arsenault, MD Jonathan DeBloisJonathan DeBlois From Hopital Laval, Institut de Cardiologie de Quebec, Quebec, Canada. Search for more papers by this author , Sebastien BergeronSebastien Bergeron From Hopital Laval, Institut de Cardiologie de Quebec, Quebec, Canada. Search for more papers by this author , Marie-Helene LeBlancMarie-Helene LeBlanc From Hopital Laval, Institut de Cardiologie de Quebec, Quebec, Canada. Search for more papers by this author , Mario SenechalMario Senechal From Hopital Laval, Institut de Cardiologie de Quebec, Quebec, Canada. Search for more papers by this author , Jocelyn GregoireJocelyn Gregoire From Hopital Laval, Institut de Cardiologie de Quebec, Quebec, Canada. Search for more papers by this author and Marie ArsenaultMarie Arsenault From Hopital Laval, Institut de Cardiologie de Quebec, Quebec, Canada. Search for more papers by this author Originally published26 Sep 2006https://doi.org/10.1161/CIRCULATIONAHA.106.615062Circulation. 2006;114:e515–e516A 24-year-old male was intentionally shot with a 0.410-caliber rifle to the anterior chest from a distance of about 10 m. The patient did not lose consciousness and was able to seek medical assistance on his own. On presentation, the patient had normal vital signs. A chest x-ray (Figure 1) and thoracoabdominal computed tomographic scan (Figures 2 and 3) were immediately performed and showed multiple metallic foreign bodies, most of them in the anterior chest wall, many in the lung parenchyma, and some within the mediastinum. One pellet was located between the aorta and the superior vena cava. Another was adjacent to the esophagus, at the level of T3, where a small pneumomediastinum was also identified. Most importantly, 2 bullets were also visible within the heart. An echocardiogram was performed that demonstrated the exact localization of one of these bullets in the posterior wall of the heart near the base of the posterolateral papillary muscle (Figures 4 and 5). The patient also underwent an esophagoscopy and a bronchoscopy, both of which were normal. A right pleural effusion was drained with a chest tube. The patient remained stable without any cardiac symptoms or arrhythmias. Against medical advice, he left the hospital 3 days after his admission and was lost at follow-up. Download figureDownload PowerPointFigure 1. Chest x-ray showing the multiple foreign bodies resulting from the gunshot.Download figureDownload PowerPointFigure 2. Computed tomographic scan of the chest demonstrating a pellet (black arrow) just behind the ascending aorta and adjacent to the base of the left atria.Download figureDownload PowerPointFigure 3. Computed tomographic scan image of the chest showing the pellet (black arrow), which was later localized with the echocardiogram. Also identifiable are the small right hemothorax and 2 other pellets in the parietal chest.Download figureDownload PowerPointFigure 4. Apical 2-chamber view showing a metallic foreign body (white arrow) that moved with the posteroinferior left ventricular wall. The pellet appeared to be caught near the base of the posterior papillary muscle. LV indicates left ventricle; LA, left atrium.Download figureDownload PowerPointFigure 5. An off-axis posterior apical four-chamber view showing the projectile (white arrow). RV indicates right ventricle; RA indicates right atrium; LV indicates left ventricle.The online-only Data Supplement is available with this article at http://circ.ahajournals.org/cgi/content/full/114/13/e515/DC1.DisclosuresNone.FootnotesCorrespondence to Marie Arsenault, MD, Hopital Laval, 2725 chemin Ste-Foy, Quebec, Canada G1V 4G5. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Zurick A and Morse M (2016) A Shot to the Heart, Journal of Nuclear Cardiology, 10.1007/s12350-016-0485-4, 24:1, (325-328), Online publication date: 1-Feb-2017. Janssens S (2010) Stem Cells in the Treatment of Heart Disease, Annual Review of Medicine, 10.1146/annurev.med.051508.215152, 61:1, (287-300), Online publication date: 1-Feb-2010. Lundy J, Johnson E, Seery J, Pham T, Frizzi J and Chasen A (2009) Conservative Management of Retained Cardiac Missiles: Case Report and Literature Review, Journal of Surgical Education, 10.1016/j.jsurg.2009.04.002, 66:4, (228-235), Online publication date: 1-Jul-2009. September 26, 2006Vol 114, Issue 13 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.106.615062PMID: 17000915 Originally publishedSeptember 26, 2006 PDF download Advertisement SubjectsComputerized Tomography (CT)Echocardiography

OVEREXPRESSION OF ??B CRYSTALLIN IN THE GASTROINTESTINAL TRACT OF THE NEWBORN PIGLET AFTER HYPOXIA

Newborn animals are particularly sensitive to hypoxic stress. Oxygen is spared for sensitive tissues, including brain and heart. Scarce information is available concerning the molecular effects of hypoxia in the gastrointestinal tract (GIT). Moreover, stress protein expressions, including heat shock proteins (HSP), are still poorly documented in the GIT. Our objective was to determine the possible effect of hypoxia on HSP expression at birth. After western blotting, alphaB crystallin, HSP 27, and HSP 70 expressions were determined in newborn controls and piglets exposed to 1 or 4 h hypoxia (5% O2, 95% N2) allowed to recover from 1 to 68 h. Cytosol and nuclei were also separated and the extracts were tested for HSF1 and alphaB crystallin expressions. Surprisingly, alphaB crystallin was overexpressed in the stomach and colon in animals submitted to hypoxia, whereas HSP 27 and HSP 70 expression remained stable. Increases and return to basal levels in HSF1 and alphaB crystallin were simultaneously observed in the unique nuclear compartment. To our knowledge, the present study is the first to demonstrate the oxygen dependency of an HSP in the GIT, particularly in the colon in newborn piglets. The kinetics of alphaB crystallin overexpression after hypoxia parallels the activation of HSF1. This observation possibly indicates a correlation between this factor and alphaB crystallin after hypoxia. Taken together, the present results open the field of wide investigation about the specific response of this low-molecular-weight HSP and its possible involvement in pathological states in the GIT such as stomach and colon.

Surface Interiorities: Representing the Quebec Convent

The practice we have cultivated around here of focusing on interior things is a good safeguard against falling into such beastly ways. Saint Teresa d'Avila The Interior Castle WHAT ARE INTERIOR THINGS? For Saint Teresa d'Avila, the sixteenth-century Spanish nun, mystic, and reformer, the things of the interior are not the contents of an inside place but, instead, the matter of the interior's formation, that is, the form, materials, labour, technology, and affects pertaining to its construction. Each successive chapter of The Interior Castle--entitled First Dwelling; Second Dwelling; and so forth--is an interior that soon becomes the outer threshold for an interior to follow. Structured this way as a series of dwellings that guide readers ever further into the castle; Saint Teresa's access of the infinite interior through and especially as limitless movement is comparable to the much more recently conceived phenomenon of nomadism associated with Gilles Deleuze. By constantly moving from dwelling to dwelling, The Interior Castle separates or moves between matter and soul, the facade and the closed room, the outside and the Further, is a virtuality that never stops dividing itself (Deleuze, The Fold 35). For the question of the interior, precisely an architectural one, will always traverse the span between the building material, the exterior walls, the frame, and the space enclosed inside. In fact, Saint Teresa's Fifth Dwelling; movement is a state of the rapture God gives to the which Suddenly, the soul will become aware of a movement so swift that it seems as if her spirit were being whisked away. The sheer speed of this movement is terrifying-at least at the beginning.... I have heard of certain people whose bodies were even raised up with their spirits! (195-96) Saint Teresa's openness to an unforeseen, unpredictable movement, one that is decidedly material as much as it is spiritual, is similar to what I want to explore here, but the context of nineteenth- and twentieth-century representations of the Quebec convent. Whether the early travel guides to Quebec, the autobiographical expose Awful Disclosures of Maria Monk, Abbot Thomas Maguire's history of the Ursulines entitled Notes sur l'erection primitive du Monastere des Ursulines de Quebec, or Clara Gustche's photographs that make up The Convent Series, the convent has posed a significant problem to the authors and artists who have sought to represent this ultimate interior locale on paper. The result, as I will argue here, is that these attempts to come to know and reproduce the convent interior work such a way as to keep both those who make them, and those who subsequently encounter them, at the surface. To this end, if Saint Teresa's travels to the inside of the castle/soul are subject to the interrupting movement of an outside force, then those who make and engage with the Canadian texts question are similarly interrupted, this case from their journeys in to the convent. Yet, while these interruptions would seem to prevent the convent scholar from knowing the interior (although perhaps sanctifying it by doing so) they fact introduce a different representational aesthetic, one that proves satisfactory insofar as it offers a multiplicity of interiors. Saint Teresa seems an appropriate introduction to this essay on convents, but she also serves as an exemplary figure for Deleuze's project of re-orienting the interior as a surface locale. Specifically, Deleuze sees the interior and the exterior as the product of a surface that is the continual process of folding. For Deleuze, Bernini's statue of Saint Teresa is a primary example of the way which folds exhibit the surface's propensity to be moved by outside forces. He asks: Is it not fire that can alone account for the extraordinary folds of the tunic? When the surface of the sculpture can be shaped by fire, then, by extension, the nature of representation as we know it requires a kind of reshaping or re-orientation with respect to the space of signification. …

Contributions to the International Forum on Ecosystem Approaches to Human Health

In her opening statement to the participants of the May 2003 International Forum on Ecosystem Approaches to Human Health, Dr. Gro Harlem Brundtland captured an increasingly prominent sentiment: human health must be understood in context, and as a foundation for sustainable development. Ecosystem approaches to human health (Ecohealth) attempt to make this sentiment a reality. Consolidating the myriad experiences, successes, challenges, and knowledge that result from using them provided the impetus for the International Development Research Centre (IDRC) and the Universite de Quebec a Montreal (UQAM) to jointly organize an international Forum, which brought together 358 participants representing donors, government representatives, academic institutions, nongovernmental organizations (NGOs), and researchers from 42 countries. It provided an opportunity for different stakeholders to discuss the Ecohealth framework and its relevance to improving human health and well-being, as well as to explore the implications of evidence from the field. Discussions at the Forum were built around four themes. The first, definition and conceptualization, emphasized the need to develop concepts that can be broadly defined and applied from a transdisciplinary perspective, to achieve a holistic understanding of the links between ecosystems and human health. Building on this need, the case studies theme provided descriptions and analysis of ongoing research projects to examine the application of concepts in different contexts. The third theme, linking research to policy, explored the reality that the Ecohealth approach is a research paradigm with a strong commitment to changing human behavior and organization, and therefore requires the effective translation of research results into policy. The final theme, institutionalization, focused on building individual, institutional, funding, and community capacity, in order to implement, manage, and sustain the research or its resulting interventions. This supplementary issue demonstrates that Ecohealth approaches push us in the right direction for sustainable development, and make improved health an achievable outcome. It is hoped that in addition to presenting an overview of the most prominent issues arising from the Forum, these pieces will stimulate debate, foster dialogue, and contribute to the development of an emerging community of practice in Ecohealth.

The value of the number of nodes removed (or the ratio of involved nodes) as a prognostic factor in breast cancer

611 Background: To assess the prognostic value of the number of nodes removed and the ratio of positive nodes after breast conservative approach. Methods: A retrospective study including all breast cancer patients treated by conservative surgery between 1970 and 1997 at the Hotel-Dieu de Quebec. Kaplan-Meier and Cox multivariate analysis using known prognostic variables for distant metastases were performed in three groups: N0, N1–3 and N>3 positive nodes. Results: For the 1615 N0 patients, ten-year metastases free survival (10 year-MFS) was 75 % and 85% when <4 nodes and when ≥ 4 nodes were removed, p=0.0001. In a Cox model, the number of nodes removed (HR=0.64, p=0.002) ranks third after T stage (Hazard ratio:2.2, p<0.00) and age≥40 (HR=0.57, p=0.001). For the 919 N1–3 node positive patients, 10 year-MFS was 70 % and 61% when <8 nodes and when ≥ 8 nodes were removed, p=0.03. For the same group, 10 year-MFS were 70 % and 60% when the ratio of positive nodes was <0.25 and ≥0.25, p=0.0002. In a Cox model done on this group, ratio ranks third(after age and grade III) with a HR of 1.6, p=0.02. The number of positive nodes and the number of nodes removed were not independent prognostic factors. For the 444 N>3 node positive patients, 10 year-MFS was 47% and 46% when <10 nodes or ≥ 10 nodes were removed, p=0.5. For the same group, 10 year-MFS was 54%, 46 %, and 36% when ratio was <0.5, between 0.5–0.8 and ≥0.8, respectively, p=0.0009. In a Cox model done on this group, ratio is an independent prognostic factor(p=0.01) with T stage(p=0.01), number of positive nodes(p=0.01) and age(p=0.01). Compared to a ratio < 0.5, the HR of distant metastases was 1.26 and 1.5 when the ratio was 0.5–0.8 and ≥8, respectively. Conclusions: In N0 patients, the number of nodes removed (<4 vs. ≥4 ) is a prognostic factor. In N+ patients, ratio( <0.25 vs.≥0.25) for N1–3 and ratio (<0.5, 0.5–0.8 and ≥0.8) for N>3 positive nodes is an independent prognostic factor for distant metastases. No significant financial relationships to disclose.

The value of the number of nodes removed (or the ratio of involved nodes) as a prognostic factor in breast cancer

611 Background: To assess the prognostic value of the number of nodes removed and the ratio of positive nodes after breast conservative approach. Methods: A retrospective study including all breast cancer patients treated by conservative surgery between 1970 and 1997 at the Hotel-Dieu de Quebec. Kaplan-Meier and Cox multivariate analysis using known prognostic variables for distant metastases were performed in three groups: N0, N1–3 and N>3 positive nodes. Results: For the 1615 N0 patients, ten-year metastases free survival (10 year-MFS) was 75 % and 85% when <4 nodes and when ≥ 4 nodes were removed, p=0.0001. In a Cox model, the number of nodes removed (HR=0.64, p=0.002) ranks third after T stage (Hazard ratio:2.2, p<0.00) and age≥40 (HR=0.57, p=0.001). For the 919 N1–3 node positive patients, 10 year-MFS was 70 % and 61% when <8 nodes and when ≥ 8 nodes were removed, p=0.03. For the same group, 10 year-MFS were 70 % and 60% when the ratio of positive nodes was <0.25 and ≥0.25, p=0.0002. In a Cox model d...

Las políticas de reorganización municipal y supramunicipal en Quebec

El propósito de esta investigación es estudiar la fusión de los municipios en la ciudad de Quebec y la creación. de la Comunidad Metropolitana de Quebec (Communauté Métropolitaine de Quebec). Este estudio de caso se enmarca dentro de un contexto más amplio, ya que la política de fusión de los municipios y la consolidación de estructuras supramunicipales no solo afectó a la ciudad de Quebec, sino que también se planificó para toda la provincia. Las reacciones contra la política de reorganización municipal y supramunicipal se pueden relacionar con el Parti Québécois que pierde las elecciones de 2003 y la aprobación de una ley por parte del Partido Liberal, que permite que los municipios fusionados se reconstituyan. Una vez más, podemos ver que los criterios racionales para mejorar la eficiencia y la gestión no son suficientes para explicar las políticas de las organizaciones locales en el marco de los procesos de descentralización.

Bridgespotting: Lepage, Hitchcock, and Landmarks in Canadian Film

Se basant sur les théories de Colin McArthur au sujet de la reconnaissance complexe des lieux cinématographiques par le spectateur, cet article examine la représentation du Pont de Québec dans le film Le confessionnal de Robert Lepage. Les images du pont qui marquent le début et la fin du film font allusion au Forth Bridge écossais du film 39 Steps, d'Hitchcock. Ces images sont aussi porteuses d'une symbolique qui évoque des moments précis de l'histoire du Québec et du Canada. Cette utilisation polyvalente du pont illustre les façons par lesquelles le cinéma dépeint le lieu canadien à la fois comme matériau historique et potentialité cinématographique.

How to facilitate the orientation of new nurses into the workplace.

The orientation of new nursing graduates into the workplace is an impressive challenge. A research study was performed to identify the key elements of a program that would address the various issues regarding this orientation. A team of researchers from Laval University and the Centre Hospitalier Universitaire de Quebec (CHUQ) used a descriptive and participative research method and identified five key elements that must be considered in order for this orientation to succeed.