What are the components of humanized childbirth in a highly specialized hospital? : an organizational case study

Many studies have focused on the concept of humanization of birth in normal pregnancy cases or at low obstetric risk, but no studies, at our knowledge, have so far specifically focused on the humanization of birth in both high-risk, and low risk pregnancies, in a highly specialized hospital setting. The present study thus aims to: 1) define the specific components of the humanized birth care model which bring satisfaction to women who seek obstetrical care in highly specialized hospitals; and 2) explore the organizational and cultural dimensions which act as barriers or facilitators for the implementation of humanized birth care practices in a highly specialized, university affiliated hospital in Quebec. A single case study design was chosen for this thesis. The data were collected through semi-structured interviews, field notes, participant observations, selfadministered questionnaire, relevant documents, and archives. The samples comprised: 11 professionals from different disciplines, 6 administrators from different hierarchical levels within the hospital, and 157 women who had given birth at the hospital during the study. The performed analysis covered both quantitative descriptive and qualitative deductive and inductive content analyses. The thesis comprises three articles. In the first article, we proposed a conceptual framework, based on Allaire and Firsirotu’s (1984) organizational culture theory. It attempts to examine childbirth patterns as an organizational cultural phenomenon. In our second article, we answered the following specific question: according to the managers and multidisciplinary professionals practicing in a highly specialized hospital as well as the women seeking perinatal care in this hospital setting, what is the definition of humanized care? Analysis of the data collected uncovered the following themes which explained the perceptions of what humanized birth was: personalized care, recognition of women’s rights, humanly care for women, family-centered care,women’s advocacy and companionship, compromise of security, comfort and humanity, and non-stereotyped pregnancies. Both high and low risk women felt more satisfied with the care they received if they were provided with informed choices, were given the right to participate in the decision-making process and were surrounded by competent care providers. These care providers who humanly cared for them were also able to provide relevant medical intervention. The professionals and administrators’ perceptions of humanized birth, on the other hand, mostly focused on personalized and family-centered care. In the third article of the thesis, we covered the dimensions of the internal and external components of an institution which can act as factors that facilitate or barriers that prevent, a specialized and university affiliated hospital in Quebec from adopting a humanized child birthing care. The findings revealed that both the external dimensions of a highly specialized hospital -including its history, society, and contingency-; and its internal dimensions -including culture, structure, and the individuals present in the hospital-, can all affect the humanization of birth care in such an institution, whether separately, simultaneously or in interaction. We thus hereby conclude that the humanization of birth care in a highly specialized hospital setting, should aim to meet all the physiological, as well as psychological aspects of birth care, including respect of the fears, beliefs, values, and needs of women and their families. Integration of competent and caring professionals and the use of obstetric technology to enhance the level of certainty and assurance in both high-risk and low risk women are both positive factors for the implementation of humanized care in a highly specialized hospital. Finally, the humanization of birth care approach in a highly specialized and university affiliated hospital setting demands a new healthcare policy. Such policy must offer a guarantee for women to have the place of birth, and the health care professional of their choice as well as those, which will enable women to make informed choices from the beginning of their pregnancy.

Prediction of scoliosis curve type based on the analysis of trunk surface topography

Scoliosis treatment strategy is generally chosen according to the severity and type of the spinal curve. Currently, the curve type is determined from X-rays whose acquisition can be harmful for the patient. We propose in this paper a system that can predict the scoliosis curve type based on the analysis of the surface of the trunk. The latter is acquired and reconstructed in 3D using a non invasive multi-head digitizing system. The deformity is described by the back surface rotation, measured on several cross-sections of the trunk. A classifier composed of three support vector machines was trained and tested using the data of 97 patients with scoliosis. A prediction rate of 72.2% was obtained, showing that the use of the trunk surface for a high-level scoliosis classification is feasible and promising.

Optimization of the Mechanical and Optical Properties of Tunable Optical Sensor Arrays (TOSA) for a Nanospectrometer in the Visible and Near Infrared Spectral Range

Tunable Optical Sensor Arrays (TOSA) based on Fabry-Pérot (FP) filters, for high quality spectroscopic applications in the visible and near infrared spectral range are investigated within this work. The optical performance of the FP filters is improved by using ion beam sputtered niobium pentoxide (Nb2O5) and silicon dioxide (SiO2) Distributed Bragg Reflectors (DBRs) as mirrors. Due to their high refractive index contrast, only a few alternating pairs of Nb2O5 and SiO2 films can achieve DBRs with high reflectivity in a wide spectral range, while ion beam sputter deposition (IBSD) is utilized due to its ability to produce films with high optical purity. However, IBSD films are highly stressed; resulting in stress induced mirror curvature and suspension bending in the free standing filter suspensions of the MEMS (Micro-Electro-Mechanical Systems) FP filters. Stress induced mirror curvature results in filter transmission line degradation, while suspension bending results in high required filter tuning voltages. Moreover, stress induced suspension bending results in higher order mode filter operation which in turn degrades the optical resolution of the filter. Therefore, the deposition process is optimized to achieve both near zero absorption and low residual stress. High energy ion bombardment during film deposition is utilized to reduce the film density, and hence the film compressive stress. Utilizing this technique, the compressive stress of Nb2O5 is reduced by ~43%, while that for SiO2 is reduced by ~40%. Filters fabricated with stress reduced films show curvatures as low as 100 nm for 70 μm mirrors. To reduce the stress induced bending in the free standing filter suspensions, a stress optimized multi-layer suspension design is presented; with a tensile stressed metal sandwiched between two compressively stressed films. The stress in Physical Vapor Deposited (PVD) metals is therefore characterized for use as filter top-electrode and stress compensating layer. Surface micromachining is used to fabricate tunable FP filters in the visible spectral range using the above mentioned design. The upward bending of the suspensions is reduced from several micrometers to less than 100 nm and 250 nm for two different suspension layer combinations. Mechanical tuning of up to 188 nm is obtained by applying 40 V of actuation voltage. Alternatively, a filter line with transmission of 65.5%, Full Width at Half Maximum (FWHM) of 10.5 nm and a stopband of 170 nm (at an output wavelength of 594 nm) is achieved. Numerical model simulations are also performed to study the validity of the stress optimized suspension design for the near infrared spectral range, wherein membrane displacement and suspension deformation due to material residual stress is studied. Two bandpass filter designs based on quarter-wave and non-quarter-wave layers are presented as integral components of the TOSA. With a filter passband of 135 nm and a broad stopband of over 650 nm, high average filter transmission of 88% is achieved inside the passband, while maximum filter transmission of less than 1.6% outside the passband is achieved.

Model catalyst studies of the strong metal-support interaction: Surface structure identified by STM on Pd nanoparticles on TiO2(110)

Model catalysts of Pd nanoparticles and films on TiO2 (I 10) were fabricated by metal vapour deposition (MVD). Molecular beam measurements show that the particles are active for CO adsorption, with a global sticking probability of 0.25, but that they are deactivated by annealing above 600 K, an effect indicative of SMSI. The Pd nanoparticles are single crystals oriented with their (I 11) plane parallel to the surface plane of the titania. Analysis of the surface by atomic resolution STM shows that new structures have formed at the surface of the Pd nanoparticles and films after annealing above 800 K. There are only two structures, a zigzag arrangement and a much more complex "pinwheel" structure. The former has a unit cell containing 7 atoms, and the latter is a bigger unit cell containing 25 atoms. These new structures are due to an overlayer of titania that has appeared on the surface of the Pd nanoparticles after annealing, and it is proposed that the surface layer that causes the SMSI effect is a mixed alloy of Pd and Ti, with only two discrete ratios of atoms: Pd/Ti of 1: 1 (pinwheel) and 1:2 (zigzag). We propose that it is these structures that cause the SMSI effect. (c) 2005 Elsevier Inc. All rights reserved.

Structure of the snake-venom toxin convulxin

Snake venoms contain a number of proteins that interact with components of the haemostatic system that promote or inhibit events leading to blood- clot formation. The snake- venom protein convulxin ( Cvx) binds glycoprotein ( GP) VI, the platelet receptor for collagen, and triggers signal transduction. Here, the 2.7 Angstrom resolution crystal structure of Cvx is presented. In common with other members of this snake-venom protein family, Cvx is an alphabeta- heterodimer and conforms to the C- type lectin- fold topology. Comparison with other family members allows a set of Cvx residues that form a concave surface to be putatively implicated in GPVI binding. Unlike other family members, with the exception of flavocetin- A ( FL- A), Cvx forms an (alphabeta)(4) tetramer. This oligomeric structure is consistent with Cvx clustering GPVI molecules on the surface of platelets and as a result promoting signal transduction activity. The Cvx structure and the location of the putative binding sites suggest a model for this multimeric signalling assembly.

Interdecadal enhancement of the Walker circulation over the Tropical Pacific in the late 1990s

The Walker circulation is one of the major components of the large-scale tropical atmospheric circulation and variations in its strength are critical to equatorial Pacific Ocean circulation. It has been argued in the literature that during the 20th century the Walker circulation weakened, and that this weakening was attributable to anthropogenic climate change. By using updated observations, we show that there has been a rapid interdecadal enhancement of the Walker circulation since the late 1990s. Associated with this enhancement is enhanced precipitation in the tropical western Pacific, anomalous westerlies in the upper troposphere, descent in the central and eastern tropical Pacific, and anomalous surface easterlies in the western and central tropical Pacific. The characteristics of associated oceanic changes are a strengthened thermocline slope and an enhanced zonal SST gradient across the tropical Pacific. Many characteristics of these changes are similar to those associated with the mid-1970s climate shift with an opposite sign. We also show that the interdecadal variability of the Walker circulation in the tropical Pacific is inversely correlated to the interdecadal variability of the zonal circulation in the tropical Atlantic. An enhancement of the Walker circulation in the tropical Pacific is associated with a weakening zonal circulation in the tropical Atlantic and vise versa, implying an inter-Atlantic-Pacific connection of the zonal overturning circulation variation. Whether these recent changes will be sustained is not yet clear, but our research highlights the importance of understanding the interdecadal variability, as well as the long-term trends, that influence tropical circulation.

High resolution simulation of the variability of surface energy balance fluxes across central London with urban zones for energy partitioning

The parameterization of surface heat-flux variability in urban areas relies on adequate representation of surface characteristics. Given the horizontal resolutions (e.g. ≈0.1–1km) currently used in numerical weather prediction (NWP) models, properties of the urban surface (e.g. vegetated/built surfaces, street-canyon geometries) often have large spatial variability. Here, a new approach based on Urban Zones to characterize Energy partitioning (UZE) is tested within a NWP model (Weather Research and Forecasting model;WRF v3.2.1) for Greater London. The urban land-surface scheme is the Noah/Single-Layer Urban Canopy Model (SLUCM). Detailed surface information (horizontal resolution 1 km)in central London shows that the UZE offers better characterization of surface properties and their variability compared to default WRF-SLUCM input parameters. In situ observations of the surface energy fluxes and near-surface meteorological variables are used to select the radiation and turbulence parameterization schemes and to evaluate the land-surface scheme

Analysis of the seasonal cycle within the first international urban land-surface model comparison

A number of urban land-surface models have been developed in recent years to satisfy the growing requirements for urban weather and climate interactions and prediction. These models vary considerably in their complexity and the processes that they represent. Although the models have been evaluated, the observational datasets have typically been of short duration and so are not suitable to assess the performance over the seasonal cycle. The First International Urban Land-Surface Model comparison used an observational dataset that spanned a period greater than a year, which enables an analysis over the seasonal cycle, whilst the variety of models that took part in the comparison allows the analysis to include a full range of model complexity. The results show that, in general, urban models do capture the seasonal cycle for each of the surface fluxes, but have larger errors in the summer months than in the winter. The net all-wave radiation has the smallest errors at all times of the year but with a negative bias. The latent heat flux and the net storage heat flux are also underestimated, whereas the sensible heat flux generally has a positive bias throughout the seasonal cycle. A representation of vegetation is a necessary, but not sufficient, condition for modelling the latent heat flux and associated sensible heat flux at all times of the year. Models that include a temporal variation in anthropogenic heat flux show some increased skill in the sensible heat flux at night during the winter, although their daytime values are consistently overestimated at all times of the year. Models that use the net all-wave radiation to determine the net storage heat flux have the best agreement with observed values of this flux during the daytime in summer, but perform worse during the winter months. The latter could result from a bias of summer periods in the observational datasets used to derive the relations with net all-wave radiation. Apart from these models, all of the other model categories considered in the analysis result in a mean net storage heat flux that is close to zero throughout the seasonal cycle, which is not seen in the observations. Models with a simple treatment of the physical processes generally perform at least as well as models with greater complexity.

The influence of Antarctica on the momentum budget of the southern extratropics

The antarctic plateau acts as a strong heat sink for the global climate, cooling the atmosphere and radiating energy to space. A cold dense atmospheric boundary layer is formed. Strong surface winds are formed as the boundary layer drains off the plateau. These drainage winds and the eddy fluxes necessary to maintain them are analysed in a general circulation model (GCM). The drainage flow is well represented in the GCM. The associated mean meridional circulation is analysed in isentropic coordinates. The momentum budget over Antarctica reveals a balance between the Eliassen-Palm flux convergence and the Coriolis torque exerted by the mean meridional mass flux. Both vertical and horizontal components of the Eliassen-Palm flux contribute, the vertical component being the greater.

Key conclusions of the first international urban land surface model comparison project

he first international urban land surface model comparison was designed to identify three aspects of the urban surface-atmosphere interactions: (1) the dominant physical processes, (2) the level of complexity required to model these, and 3) the parameter requirements for such a model. Offline simulations from 32 land surface schemes, with varying complexity, contributed to the comparison. Model results were analysed within a framework of physical classifications and over four stages. The results show that the following are important urban processes; (i) multiple reflections of shortwave radiation within street canyons, (ii) reduction in the amount of visible sky from within the canyon, which impacts on the net long-wave radiation, iii) the contrast in surface temperatures between building roofs and street canyons, and (iv) evaporation from vegetation. Models that use an appropriate bulk albedo based on multiple solar reflections, represent building roof surfaces separately from street canyons and include a representation of vegetation demonstrate more skill, but require parameter information on the albedo, height of the buildings relative to the width of the streets (height to width ratio), the fraction of building roofs compared to street canyons from a plan view (plan area fraction) and the fraction of the surface that is vegetated. These results, whilst based on a single site and less than 18 months of data, have implications for the future design of urban land surface models, the data that need to be measured in urban observational campaigns, and what needs to be included in initiatives for regional and global parameter databases.

Reconstructing paleosalinity from δ18O: coupled model simulations of the Last Glacial Maximum, Last Interglacial and Late Holocene

Reconstructions of salinity are used to diagnose changes in the hydrological cycle and ocean circulation. A widely used method of determining past salinity uses oxygen isotope (δOw) residuals after the extraction of the global ice volume and temperature components. This method relies on a constant relationship between δOw and salinity throughout time. Here we use the isotope-enabled fully coupled General Circulation Model (GCM) HadCM3 to test the application of spatially and time-independent relationships in the reconstruction of past ocean salinity. Simulations of the Late Holocene (LH), Last Glacial Maximum (LGM), and Last Interglacial (LIG) climates are performed and benchmarked against existing compilations of stable oxygen isotopes in carbonates (δOc), which primarily reflect δOw and temperature. We find that HadCM3 produces an accurate representation of the surface ocean δOc distribution for the LH and LGM. Our simulations show considerable variability in spatial and temporal δOw-salinity relationships. Spatial gradients are generally shallower but within ∼50% of the actual simulated LH to LGM and LH to LIG temporal gradients and temporal gradients calculated from multi-decadal variability are generally shallower than both spatial and actual simulated gradients. The largest sources of uncertainty in salinity reconstructions are found to be caused by changes in regional freshwater budgets, ocean circulation, and sea ice regimes. These can cause errors in salinity estimates exceeding 4 psu. Our results suggest that paleosalinity reconstructions in the South Atlantic, Indian and Tropical Pacific Oceans should be most robust, since these regions exhibit relatively constant δOw-salinity relationships across spatial and temporal scales. Largest uncertainties will affect North Atlantic and high latitude paleosalinity reconstructions. Finally, the results show that it is difficult to generate reliable salinity estimates for regions of dynamic oceanography, such as the North Atlantic, without additional constraints.

Downward longwave radiation estimates for clear and all-sky conditions in the Sertozinho region of So Paulo, Brazil

The accurate estimate of the surface longwave fluxes contribution is important for the calculation of the surface radiation budget, which in turn controls all the components of the surface energy budget, such as evaporation and the sensible heat fluxes. This study evaluates the performance of the various downward longwave radiation parameterizations for clear and all-sky days applied to the Sertozinho region in So Paulo, Brazil. Equations have been adjusted to the observations of longwave radiation. The adjusted equations were evaluated for every hour throughout the day and the results showed good fits for most of the day, except near dawn and sunset, followed by nighttime. The seasonal variation was studied by comparing the dry period against the rainy period in the dataset. The least square linear regressions resulted in coefficients equal to the coefficients found for the complete period, both in the dry period and in the rainy period. It is expected that the best fit equation to the observed data for this site be used to produce estimates in other regions of the State of So Paulo, where such information is not available.

SURFACE ALFVEN WAVE DAMPING IN A THREE-DIMENSIONAL SIMULATION OF THE SOLAR WIND

Here we investigate the contribution of surface Alfven wave damping to the heating of the solar wind in minima conditions. These waves are present in the regions of strong inhomogeneities in density or magnetic field (e.g., the border between open and closed magnetic field lines). Using a three-dimensional (3D) magnetohydrodynamics (MHD) model, we calculate the surface Alfven wave damping contribution between 1 and 4 R(circle dot) (solar radii), the region of interest for both acceleration and coronal heating. We consider waves with frequencies lower than those that are damped in the chromosphere and on the order of those dominating the heliosphere: 3 x 10(-6) to 10(-1) Hz. In the region between open and closed field lines, within a few R(circle dot) of the surface, no other major source of damping has been suggested for the low frequency waves we consider here. This work is the first to study surface Alfven waves in a 3D environment without assuming a priori a geometry of field lines or magnetic and density profiles. We demonstrate that projection effects from the plane of the sky to 3D are significant in the calculation of field line expansion. We determine that waves with frequencies >2.8 x 10(-4) Hz are damped between 1 and 4 R(circle dot). In quiet-Sun regions, surface Alfven waves are damped at further distances compared to active regions, thus carrying additional wave energy into the corona. We compare the surface Alfven wave contribution to the heating by a variable polytropic index and find it as an order of magnitude larger than needed for quiet-Sun regions. For active regions, the contribution to the heating is 20%. As it has been argued that a variable gamma acts as turbulence, our results indicate that surface Alfven wave damping is comparable to turbulence in the lower corona. This damping mechanism should be included self-consistently as an energy driver for the wind in global MHD models.

Atmospheric effects on extensive air showers observed with the surface detector of the Pierre Auger observatory

Atmospheric parameters, Such as pressure (P), temperature (T) and density (rho proportional to P/T), affect the development of extensive air showers initiated by energetic cosmic rays. We have Studied the impact of atmospheric variations on extensive air showers by means of the surface detector of the Pierre Auger Observatory. The rate of events shows a similar to 10% seasonal modulation and similar to 2% diurnal one. We find that the observed behaviour is explained by a model including the effects associated with the variations of P and rho. The former affects the longitudinal development of air showers while the latter influences the Moliere radius and hence the lateral distribution of the shower particles. The model is validated with full simulations of extensive air showers using atmospheric profiles measured at the site of the Pierre Auger Observatory. (C) 2009 Elsevier B.V. All rights reserved.

The fluorescence detector of the Pierre Auger Observatory

The Pierre Auger Observatory is a hybrid detector for ultra-high energy cosmic rays. It combines a surface array to measure secondary particles at ground level together with a fluorescence detector to measure the development of air showers in the atmosphere above the array. The fluorescence detector comprises 24 large telescopes specialized for measuring the nitrogen fluorescence caused by charged particles of cosmic ray air showers. In this paper we describe the components of the fluorescence detector including its optical system, the design of the camera, the electronics, and the systems for relative and absolute calibration. We also discuss the operation and the monitoring of the detector. Finally, we evaluate the detector performance and precision of shower reconstructions. (C) 2010 Elsevier B.V All rights reserved.