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While distance education (DE) has burgeoned over the past twenty years and is permitting greater access to higher education (college and university), student persistence and quality of learning remain problematic. Promoting dialogue or work among peers is sometimes seen as a solution, but the techno-pedagogical devices for doing so are varied and their impacts poorly understood. This is what motivated this review and analysis of the techno-pedagogical devices introduced in Canadian colleges and universities to encourage distance interaction. Our systematic review examines sixty studies published between January 2005 and December 2014. It establishes a typology of research problems in the field that identifies four main research questions as well as a typology of techno-pedagogical devices based on their goals. These studies reveal that interaction and collaborative work are challenging for learners who are extremely concerned about the restraints relating to time flexibility, disregarding the opportunities offered. However, the studies also show that when students do interact and collaborate, which is the case in authentic learning situations targeting skills development, they derive satisfaction from social linkages with their peers and are likely to achieve deep learning.

Complex anatomy of the proximal femur makes total hip arthroplasty (THA) more challenging. Short, straight, fluted and conical titanium stem like the Wagner Cone can be helpful to address small femoral canal, increased femoral neck version, important leg length discrepancy or proximal femoral deformity. The outcome in these patients is less assured and associated with high rate of complications. Therefore, we did a retrospective study aiming to answer: 1) can the Wagner Cone stem provide acceptable mid- to long-term implant survivorship; 2) help minimizing perioperative adverse events; 3) produce favorable clinical outcome measured by WOMAC score; and 4) be associated with a favorable radiographic femoral bone remodeling at the last follow-up?Wagner Cone stem is an advantageous solution for the distorted proximal femur in complex THA.Our cohort was derived from the patient registries where medical records of 88 patients (103 hips) who underwent primary THA using the Wagner prosthesis were retrospectively reviewed. Then, data was analyzed for patients' demographics and surgical data, and comparing preoperative, immediate postoperative and last follow-up data. Eleven patients (12 hips) were excluded (7 hips followed up less than 2 years or lost to follow-up, 3 hips that had the Wagner stem for revision and 2 Wagner stems inserted for periprosthetic fracture). This left 77 patients (91 hips) with Wagner cone stems implanted for more than 2 years between March 2003 and February 2017 by 7 surgeons in 3 academic hospitals. Implant revision, reoperations, WOMAC score and radiographic analyses were recorded at last follow-up.After a mean follow-up of 7.8 (range, 2.0-16.2) years, Wagner stem survivorship was 98.9% (95% CI: 94 to 100%) with one (1.1%) stem revision for failure of osteointegration. Five (5.5%) acetabular revisions, one for aseptic loosening, 2 for adverse reaction to metal debris and 2 for infection. One (1.1%) sciatic neuropathy and 4 (4.4%) intraoperative fractures were encountered. The mean WOMAC score was 90.5±11.4 (59-100). Radiographic analysis showed clear signs of stem osseointegration and hypertrophic bone remodeling in 82 cases (92.1%).Used in complex cases with proximal distorted femurs, the Wagner Cone stem demonstrated a low complication rate, a high-rate consistent adaptive bone remodeling, excellent clinical results, and midterm survival. It is a safe, reliable and advantageous option in complex primary THA. However, the contribution of the underlying cause of the secondary osteoarthritis on the long-term survival of the stem remains to be demonstrated.IV; retrospective study.

Bipolar (BHA) and unipolar hemiarthroplasties (UHA) are interchangeably used in elderly patients with a displaced femoral neck fracture. We ask if there is a difference between BHA and UHA with regards to hip function, in elderly patients.Systematic review and meta-analysis was conducted of randomized controlled trials comparing BHA to UHA. The primary outcome was postoperative hip function scores. Secondary outcomes were overall health-related quality of life patient-reported outcomes, acetabular erosion, and postoperative complications. Data sources, last searched on June 1, 2020, were MEDLINE, EMBASE, Cochrane Library, and Web of Science.Fourteen randomized controlled trials were eligible for meta-analysis. There was no difference in hip function scores between BHA and UHA (standardized mean difference 0.32, 95% confidence interval [CI] -0.06 to 0.71, n = 1084, IThere seems to be no difference between BHA and UHA with regards to hip function at 2 years. BHA might decrease the risk of acetabular erosion. There is a need for a large randomized controlled trial with a follow-up2 years and better measurement tools to assess clinical benefits.II.

Copyright © 2018 by the American Society of Plastic Surgeons. Background: Soft-tissue complications often dictate the success of limb salvage and the overall outcome of open fractures. Based on prior work at the R Adams Cowley Shock Trauma Center, the authors hypothesize that wounds larger than 200 cm2 are associated with a greater likelihood of both flap-related reoperation and wound complications among patients requiring soft-tissue reconstruction with a rotational flap or free tissue transfer. Methods: This study was a secondary analysis of Fluid Lavage in Open Wounds trial data that included all patients who received a rotational or free tissue flap transfer for an open fracture. The primary outcome was flap-related reoperation within 12 months of injury. The secondary outcome was wound complication, which included events treated operatively or nonoperatively. Multivariable logistic regression was used to assess the association between wound size and outcomes, adjusting for confounders. Results: Seventeen percent of the 112 patients required a flap-related reoperation. A wound size greater than 200 cm2 was not associated with reoperation in an unadjusted model (p = 0.64) or adjusting for Gustilo type (p = 0.70). The sample had an overall wound complication rate of 47.3 percent. Patients with a wound size of greater than 200 cm2 were three times more likely to experience wound complications (OR, 3.05; 95 percent CI, 1.08 to 8.62; p = 0.04) when adjusting for moderate to severe wound contamination and wound closure in the operating room. Conclusion: The findings of this study demonstrate that wound surface area is an integral determinant for wound complication following soft-tissue flap treatment, but found no association between wound surface area and flap-related reoperation rates.

The authors report the case of a patient developing a gluteal compartment syndrome after DeBakey type I dissection repair. Prompt recognition and treatment led to successful results. The surgical approach to the gluteal compartment is described.

Cet article porte sur l’integration socioprofessionnelle d’ingenieurs francais immigrant au Quebec. Notre analyse vise a documenter le fonctionnement des reglements de l’Arrangement de reconnaissance mutuelle (ARM) France-Quebec et des mesures compensatoires exigees pour l’entree en pratique professionnelle d’ingenieurs francais au Quebec. Leurs parcours s’inscrivent dans le cadre du paradigme de la mobilite. Nous decrivons l’integration socioprofessionnelle selon deux grandes categories explicatives inspirees de Heckmann : les dimensions structurelles et les dimensions culturelles et relationnelles. Davantage qu’une question associee a la stricte regulation professionnelle, l’entree en pratique professionnelle apparait comme un processus multidimensionnel, ou interviennent les acteurs de l’immigration, du systeme professionnel et des employeurs, principalement. Notre etude de cas s’appuie sur quatorze entrevues menees aupres d’ingenieurs francais, d’acteurs du systeme professionnel et d’informateurs cles issus d’organisations locales, bien au fait des realites de cette categorie d’immigrants au Quebec.

Distance Education (DE) seems a way to meet the qualification requirements of contemporary societies, promoting lifelong learning anywhere. However, this mode of education often suffers from high dropout rates, notably caused by students’ isolation. The development of various communication tools offers spaces to interact and work together. To what extent do students take advantage of the proposed interaction devices to communicate and learn with others? Based on a systematic review of studies published over the last ten years addressing these types of devices established in Canada, our meta-analysis highlights that in general, students prefer to take advantage of the flexibility of DE and work alone. Thus, in most devices, there are not many students communicating. However, we will see that, when it is not only about socializing but also reflecting on a practice, interactions are much more frequent. RESUMEN La formacion a distancia (FAD) parece una manera de responder a las exigencias de cualificacion de las socie-dades modernas favoreciendo el aprendizaje en todo momento de la vida y en cualquier lugar. Sin embargo, este modo de formacion sufre a menudo de importantes tasas de abandono causadas en parte por el aislamiento de los estudiantes. El desarrollo de diferentes herramientas de comunicacion permite ofrecer a los estudiantes a distancia espacios para interactuar y trabajar juntos. ?En que medida los estudiantes aprovechan los dispositi-vos de interaccion propuestos para comunicarse y aprender con los demas? Basado en una revision sistematica de los estudios publicados durante los diez ultimos anos sobre estos tipos de dispositivos establecidos en Cana-da, nuestro meta-analisis pone en relieve que, de manera general, los estudiantes prefieren aprovechar la flexi-bilidad de la FAD y trabajar solos. Asi, en la mayoria de los dispositivos no son muchos los que comunican. Sin embargo, veremos que, cuando no se trata solamente de socializar sino tambien de reflexionar sobre una practi-ca, las interacciones se multiplican. Podremos asi cuestionar esos resultados a la luz de la teoria de investiga-cion.

Based on an in-depth case study of a healthcare organization, this chapter shows how paradoxical tensions were transferred between managers and professionals at different levels as they were dealing with them. It adds to the existing literature on nested tensions by showing more precisely how tensions transfer not only through discourse, but through control of specific structures and tools, according to actors’ power and views. The results shed light on how paradoxical tensions undergo transformation and surface, as actors at a higher level mobilize and impact others at a lower level. While previous studies have suggested that managers’ ability to embrace and deal with paradoxical tensions like quality and efficiency favours organizational change and maximizes organizational performance, the findings explained in this chapter question whether this permanent quest for performance could also compromise workers’ experience.

To compare the clinical and radiographic outcome after stabilization of an acute syndesmosis rupture with either a static implant (a 3.5-mm metallic screw through 4 cortices) or a dynamic device (TightRope; Arthrex).Multicenter randomized double-blind controlled trial.Study realized in 5 trauma centers (2 level 1 and 3 level 2) in 2 countries.Seventy subjects admitted for an acute ankle syndesmosis rupture entered the study and were randomized into 2 groups (dynamic fixation = 34 and static fixation = 36). The 2 groups were similar regarding demographic, social, and surgical data. Sixty-five patients (dynamic = 33 and static = 32) completed the study and were available for analysis.Syndesmosis fixation in the static group was realized with a 4 cortices 3.5-mm cortical screw (Synthes) and in the dynamic group with 1 TightRope (Arthrex). Standardized rehabilitation process for the 2 groups: no weight bearing in a cast for 6 weeks and then rehabilitation without protection.Olerud-Molander score.Subjects with dynamic fixation achieved better clinical performances as described with the Olerud-Molander scores at 3 (68.8 vs. 60.2, P = 0.067), 6 (84.2 vs. 76.8, P = 0.082), and 12 months (93.3 vs. 87.6, P = 0.046). We also observed higher American Orthopaedic Foot and Ankle Society scores at 3 months (78.6 vs. 70.6, P = 0.016), but these were not significant at 6 (87.1 vs. 83.8, P = 0.26) or 12 months (93.1 vs. 89.9, P = 0.26). Implant failure was higher in the screw group (36.1% vs. 0%, P0.05). Loss of reduction was observed in 4 cases in the static screw group (11.1% vs. 0%, P = 0.06).Dynamic fixation of acute ankle syndesmosis rupture with a dynamic device seems to result in better clinical and radiographic outcomes. The implant offers adequate syndesmotic stabilization without failure or loss of reduction, and the reoperation rate is significantly lower than with conventional screw fixation.Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

In recent years, successive work reorganization initiatives have been implemented in many healthcare settings. The failure of many of these change efforts has often been attributed in the prominent management discourse to change resistance. Few studies have paid attention to the temporal process of workers’ resource depletion/accumulation over time and its links with workers’ psychological states and reactions to change. Drawing upon the conservation of resources theory, this study examines associations between workers’ perceptions of loss of resources, burnout, and attitudes to change. The study was conducted in five health and social service centres in Quebec, in units where a work reorganization project was initiated. A prospective longitudinal design was used to assess workers’ perceptions at two time points 12 months apart. Our findings are consistent with the conservation of resources theory. The analysis of latent differences scores between times 1 and 2 showed that the perceived loss of resources was associated with emotional exhaustion, which, in turn, was negatively correlated with commitment to change and positively correlated with cynicism. In confirming the temporal relationship between perceived loss of resources, occupational burnout, and attitude to change, this research offers a new perspective to explain negative and positive reactions to change implementation.

Le discours sur les technologies de l’information et la haute technologie contribue à fonder une définition de la haute qualification qui néglige plusieurs dimensions et champs de qualifications, excluant plusieurs métiers où l’on retrouve des travailleurs hautement qualifiés. Ainsi, cette définition ignore les différentes structurations et dynamiques des univers de travail et fait abstraction des problèmes reliés à la notion de qualification, mais ignore également les processus sociaux et culturels qui contribuent à la définir. Des données ethnographiques tirées d’un travail de terrain permettent de tracer les repères d’une nouvelle définition de la haute qualification, davantage arrimée aux contextes de travail., The discourse on information technologies and high tech contributes to a definition of “highly qualified skilled labour” that excludes many aspects and sets of skills, including many professions that have highly qualified workers. For example, the definition does not incorporate the different structures and dynamics of the working world, deals with problems concerning high-skill jobs at too abs- tract a level, and disregards the social and cultural processes that contribute to the definition of this term. Ethnographic data drawn from a field research assignment allow to outline the parameters of a new definition of highly skilled labour that is more aligned with the realities of the working world.

Mon analyse porte sur des constructions de la mémoire et de l’identité, parmi trois générations de Juifs montréalais d’origine marocaine. En particulier, les rapports avec les mouvements ultra-orthodoxes sont révélateurs de positions quant à la judéité et à la séphardité, dans un processus de différenciation par rapport aux coreligionnaires ashkénazes. À travers une analyse du rapport au passé et des constructions de la mémoire, en plus de l’historiographie des rapports entre Ashkénazes et Sépharades depuis l’expulsion d’Espagne de 1492, il en découle une remise en question, partielle, de ces deux catégories ethnoreligieuses. Comme les cadres sociaux de la mémoire, la notion de frontière permet d’éclairer les processus contemporains de représentation de soi et des autres, parmi cet ensemble diasporique qui négocie ainsi, à la fois, ses rapports à la société locale, ses frontières internes et ses dynamiques transnationales., My analysis examines memory and identity constructions among three generations of Montreal Jews of Moroccan origin. Emphasis is placed on opinions towards ultra-orthodox movements which reveal positioning of their own Jewish and Sephardic identity, in a differentiating process from their Ashkenazim fellow Jews. Analysis of relations to the past and memory constructions, as well as the historiography of relations between Ashkenazim and Sephardim since the 1492 expulsion from Spain, results in a partial questioning of these two ethno-religious categories. Like memory’s social frames, the notion of frontier sheds light on contemporary processes of representations of self and others, inside this diasporic entity, therefore negotiating, at once, its relations with the local society, its internal frontiers and its transnational dynamics.

Mutual recognition arrangements (MRAs) are becoming increasingly frequent on the international scene, fostering enhanced professional mobility. This article focuses on the recent implementation of MRAs between France and Quebec, demonstrating how the political process played an important role in bringing organisations from both sides to reach arrangements that have allowed migrants faster access to professional practice in Quebec. The steps described highlight the complex yet ultimately feasible nature of such arrangements. Finally, this article raises several questions that will be addressed in an ongoing research project about French professionals entering the labour force in Quebec, with a focus on eight professions in particular.

Les auteurs cherchent à situer dans une perspective historique les diverses transformations subies par les programmes des écoles primaires publiques québécoises et à souligner l’influence que ceux-ci ont exercée sur les programmes de formation des maîtres entre 1861 et nos jours. Il a été possible de dégager, par la présentation d’une série de traits de compétence, les métamorphoses du rôle, des savoirs (savoir, savoir-faire, savoir-être) et de la formation des enseignants québécois. Trois grandes périodes semblent caractériser l’évolution du rôle et de la formation des enseignants, soit de 1861 à 1968, de 1969 à 1978 et de 1979 à nos jours., The authors try to relate from a historical point of view the transformations that were made to the curricula of Quebec's public primary scbools and to underline the influence those transformations had on the different education faculties between 1861 and nowadays. Through the presentation of a serie of competence traits, the authors identify changes in the educator's role, in his culture and abilities and in his training or education. The whole evolution can be separated in three great periods, being from 1861 to 1968, 1969 to 1978 and 1979 to nowadays.

Les parcours des professionnels formés à l’étranger et désirant intégrer une profession réglementée, sont parsemés d’obstacles. Notre analyse porte sur le cas de médecins français arrivés au Québec par le biais des arrangements de reconnaissance mutuelle (ARM) Québec-France. Dans cet article, nous décrivons le rôle des diverses institutions engagées dans le processus de reconnaissance des acquis des médecins français. Ces institutions cherchent à faciliter la mobilité professionnelle, tout en ayant pour mandat la protection du public. Dans ce contexte, l’entrée en pratique s'avère complexe à obtenir, malgré la signature d'un ARM, notamment dû à la multiplicité des institutions et des acteurs engagés dans ce processus., The career path of foreign-trained professionals wishing to enter a regulated profession is fraught with obstacles. Our analysis focuses on the case of French physicians who arrived in Quebec under the Quebec-France Mutual Recognition Arrangement (MRA). In this article, we describe the role of the various institutions involved in the prior learning assessment of French physicians. These institutions seek to facilitate professional mobility while fulfilling their public protection mandate. In this environment, obtaining a permit to practice is complicated, despite the existence of the MRA and particularly due to the multiplicity of institutions and actors.