Élaboration d’un programme de formation continue en ligne sur les soins palliatifs aux personnes atteintes d’insuffisance cardiaque

Travail dirigé présenté à la Faculté des études supérieures et postdoctorales en vue de l’obtention du grade de Maître ès sciences (M.sc.) en soins infirmiers option formation

Development and Analysis of a Novel Isosceles Trapezoidal Dielectric Resonator Antenna For Wireless Communication

This thesis describes the development and analysis of an Isosceles Trapezoidal Dielectric Resonator Antenna (ITDRA) by realizing different DR orientations with suitable feed configurations enabling it to be used as multiband, dual band dual polarized and wideband applications. The motivation for this work has been inspired by the need for compact, high efficient, low cost antenna suitable for multi band application, dual band dual polarized operation and broadband operation with the possibility of using with MICs, and to ensure less expensive, more efficient and quality wireless communication systems. To satisfy these challenging demands a novel shaped Dielectric Resonator (DR) is fabricated and investigated for the possibility of above required properties by trying out different orientations of the DR on a simple microstrip feed and with slotted ground plane as well. The thesis initially discusses and evaluates recent and past developments taken place within the microwave industry on this topic through a concise review of literature. Then the theoretical aspects of DRA and different feeding techniques are described. Following this, fabrication and characterization of DRA is explained. To achieve the desired requirements as above both simulations and experimental measurements were undertaken. A 3-D finite element method (FEM) electromagnetic simulation tool, HFSSTM by Agilent, is used to determine the optimum geometry of the dielectric resonator. It was found to be useful in producing approximate results although it had some limitations. A numerical analysis technique, finite difference time domain (FDTD) is used for validating the results of wide band design at the end. MATLAB is used for modeling the ITDR and implementing FDTD analysis. In conclusion this work offers a new, efficient and relatively simple alternative for antennas to be used for multiple requirements in the wireless communication system.

Curing studies of elastomer blends with special reference to NR/ NBR and NR/BR blends

There are a large number of commercial examples and property advantages of immiscible elastomer blends.73 Blends of natural rubber (NR) and polybutadiene (BR) have shown various advantages including heat stability, improved elasticity and abrasion resistance. Ethylene-propylene-diene-rubber (EPDM) blended with styrene-butadiene rubber (SBR) has shown improvements in ozone and chemical resistance with better compression set properties. Blends of EPDM and nitrile rubber (NBR) have been cited as a compromise for obtaining moderate oil and ozone resistance with improved low temperature properties. Neoprene (CR)/BR blends offer improved low temperature properties and abrasion resistance with better processing characteristics etc. However, in many of the commercial two-phase elastomer blends, segregation of the crosslinking agents, carbon black or antioxidants preferentially into one phase can result in failure to attain optimum properties. Soluble and insoluble compounding ingredients are found to be preferentially concentrated in one phase. The balance of optimum curing of both phases therefore presents a difficult problem. It has been the aim of this study to improve the performance of commercially important elastomer blends such as natural rubber (NR)/styrene-butadiene rubber (SBR) and natural rubber/polybutadiene rubber (BR) by industrially viable procedures

Liderazgo y emprendimiento. Factores culturales relacionados

El emprendimiento es una característica del liderazgo que puede contribuir al progreso económico de un país. Para que el emprendimiento como habilidad se presente en los individuos, debe existir una serie de variables relacionadas con factores internos y externos que impulsen su desarrollo. Con base en lo anterior, con este trabajo se pretende analizar el efecto que tienen los factores culturales en el emprendimiento, como característica de los líderes, a través de una revisión de la literatura, que permita, por medio de la exposición de sus hallazgos comprender estos fenómenos de manera más integral.

Pressure-relieving equipment: promoting its correct use amongst nurses via differing modes of educational delivery

Aims and objectives. To examine the impact of written and verbal education on bed-making practices, in an attempt to reduce the prevalence of pressure ulcers. Background. The Department of Health has set targets for a 5% reduction per annum in the incidence of pressure ulcers. Electric profiling beds with a visco-elastic polymer mattress are a new innovation in pressure ulcer prevention; however, mattress efficacy is reduced by tightly tucking sheets around the mattress. Design. A prospective randomized pre/post-test experimental design. Methods. Ward managers at a teaching hospital were approached to participate in the study. Two researchers independently examined the tightness of the sheets around the mattresses. Wards were randomized to one of two groups. Groups A and B received written education. In addition, group B received verbal education on alternate days for one week. Beds were re-examined one month later. One researcher was blinded to the educational delivery received by the wards. Results. Twelve wards agreed to participate in the study and 245 beds were examined. Before education, 113 beds (46%) had sheets tucked correctly around the mattresses. Following education, this increased to 215 beds (87.8%) (chi(2) = 68.03, P < 0.001). There was no significant difference in the number of correctly made beds between the two different education groups: 100 (87.72%) beds correctly made in group A vs. 115 (87.79%) beds in group B (chi(2) = 0, P 0.987). Conclusions. Clear, concise written instruction improved practice but verbal education was not additionally beneficial. Relevance to clinical practice. Nurses are receptive to clear, concise written evidence regarding pressure ulcer prevention and incorporate this into clinical practice.

Deterministic equalization and results of a DVB-T multipath equalizer for both 16-QAM and 64-QAM operation

Recent developments in the UK concerning the reception of Digital Terrestrial Television (DTT) have indicated that, as it currently stands, DVB-T receivers may not be sufficient to maintain adequate quality of digital picture information to the consumer. There are many possible reasons why such large errors are being introduced into the system preventing reception failure. It has been suggested that one possibility is that the assumptions concerning the immunity to multipath that Coded Orthogonal Frequency Division Multiplex (COFDM) is expected to have, may not be entirely accurate. Previous research has shown that multipath can indeed have an impact on a DVB-T receiver performance. In the UK, proposals have been made to change the modulation from 64-QAM to 16-QAM to improve the immunity to multipath, but this paper demonstrates that the 16-QAM performance may again not be sufficient. To this end, this paper presents a deterministic approach to equalization such that a 64-QAM receiver with the simple equalizer presented in this paper has the same order of MPEG-2 BER performance as that to a 16-QAM receiver without equalization. Thus, alleviating the requirement in the broadcasters to migrate from 64-QAM to 16-QAM Of course, by adding the equalizer to a 16-QAM receiver then the BER is also further improved and thus creating one more step to satisfying the consumers(1).

The death of John Stuart Mill

This article surveys the fiercely contested posthumous assessments of John Stuart Mill in the newspaper and periodical press, in the months following his death in May 1873, and elicits the broader intellectual context. Judgements made in the immediate wake of Mill's death influence biographers and historians to this day and provide an illuminating aperture into the politics and shifting ideological forces of the period. The article considers how Mill's failure to control his posthumous reputation demonstrates both the inextricable intertwining of politics and character in the 1870s, and the difficulties his allies faced. In particular, it shows the sharp division between Mill's middle and working class admirers; the use of James Mill's name as a rebuke to his son; the redefinition of Malthusianism in the 1870s; and how publication of Mill's Autobiography damaged his reputation. Finally, the article considers the relative absence of both theological and Darwinian critiques of Mill.

Mid-term evaluation of African Technology Policy Studies Network Phase VI Strategic Plan: for the period January 1, 2009 to December 31, 2010

The African Technology Policy Studies Network (ATPS) is a multidisciplinary network of researchers, private sector actors, policymakers and civil society. ATPS has the vision to become the leading international centre of excellence and reference in science, technology and innovation (STI) systems research, training and capacity building, communication and sensitization, knowledge brokerage, policy advocacy and outreach in Africa. It has a Regional Secretariat in Nairobi Kenya, and operates through national chapters in 29 countries (including 27 in Africa and two Chapters in the United Kingdom and USA for Africans in the Diaspora) with an expansion plan to cover the entire continent by 2015. The ATPS Phase VI Strategic Plan aims to improve the understanding and functioning of STI processes and systems to strengthen the learning capacity, social responses, and governance of STI for addressing Africa's development challenges, with a specific focus on the Millennium Development Goals (MDGs). A team of external evaluators carried out a midterm review to assess the effectiveness and efficiency of the implementation of the Strategic Plan for the period January 1, 2009 to December 31, 2010. The evaluation methodology involved multiple quantitative and qualitative methods to assess the qualitative and quantitative inputs (human resources, financial resources, time, etc.) into ATPS activities (both thematic and facilitative) and their tangible and intangible outputs, outcomes and impacts. Methods included a questionnaire survey of ATPS members and stakeholders, key informant interviews, and focus group discussions (FGDs) with members in six countries. Effectiveness of Programmes Under all six strategic goals, very good progress has been made towards planned outputs and outcomes. This is evidenced by key performance indicators (KPIs) generated from desk review, ratings from the survey respondents, and the themes that run through the FGDs. Institutional and Programme Cost Effectiveness Institutional Effectiveness: assessment of institutional effectiveness suggests that adequate management frameworks are in place and are being used effectively and transparently. Also technical and financial accounting mechanisms are being followed in accordance with grant agreements and with global good practice. This is evidenced by KPIs generated from desk review. Programme Cost Effectiveness: assessment of cost-effectiveness of execution of programmes shows that organisational structure is efficient, delivering high quality, relevant research at relatively low cost by international standards. The evidence includes KPIs from desk review: administrative costs to programme cost ratio has fallen steadily, to around 10%; average size of research grants is modest, without compromising quality. There is high level of pro bono input by ATPS members. ATPS Programmes Strategic Evaluation ATPS research and STI related activities are indeed unique and well aligned with STI issues and needs facing Africa and globally. The multi-disciplinary and trans-boundary nature of the research activities are creating a unique group of research scientists. The ATPS approach to research and STI issues is paving the way for the so called Third Generation University (3GU). Understanding this unique positioning, an increasing number of international multilateral agencies are seeking partnership with ATPS. ATPS is seeing an increasing level of funding commitments by Donor Partners. Recommendations for ATPS Continued Growth and Effectiveness On-going reform of ATPS administrative structure to continue The on-going reforms that have taken place within the Board, Regional Secretariat, and at the National Chapter coordination levels are welcomed. Such reform should continue until fully functional corporate governance policy and practices are fully established and implemented across the ATPS governance structures. This will further strengthen ATPS to achieve the vision of being the leading STI policy brokerage organization in Africa. Although training in corporate governance has been carried out for all sectors of ATPS leadership structure in recent time, there is some evidence that these systems have not yet been fully implemented effectively within all the governance structures of the organization, especially at the Board and National chapter levels. Future training should emphasize practical application with exercises relevant to ATPS leadership structure from the Board to the National Chapter levels. Training on Transformational Leadership - Leading a Change Though a subject of intense debate amongst economists and social scientists, it is generally agreed that cultural mindsets and attitudes could enhance and/or hinder organizational progress. ATPS’s vision demands transformational leadership skills amongst its leaders from the Board members to the National Chapter Coordinators. To lead such a change, ATPS leaders must understand and avoid personal and cultural mindsets and value systems that hinder change, while embracing those that enhance it. It requires deliberate assessment of cultural, behavioural patterns that could hinder progress and the willingness to be recast into cultural and personal habits that make for progress. Improvement of relationship amongst the Board, Secretariat, and National Chapters A large number of ATPS members and stakeholders feel they do not have effective communications and/or access to Board, National Chapter Coordinators and Regional Secretariat activities. Effort should be made to improve the implementation of ATPS communication strategy to improve on information flows amongst the ATPS management and the members. The results of the survey and the FGDs suggest that progress has been made during the past two years in this direction, but more could be done to ensure effective flow of pertinent information to members following ATPS communications channels. Strategies for Increased Funding for National Chapters There is a big gap between the fundraising skills of the Regional Secretariat and those of the National Coordinators. In some cases, funds successfully raised by the Secretariat and disbursed to national chapters were not followed up with timely progress and financial reports by some national chapters. Adequate training in relevant skills required for effective interactions with STI key policy players should be conducted regularly for National Chapter coordinators and ATPS members. The ongoing training in grant writing should continue and be made continent-wide if funding permits. Funding of National Chapters should be strategic such that capacity in a specific area of research is built which, with time, will not only lead to a strong research capacity in that area, but also strengthen academic programmes. For example, a strong climate change programme is emerging at University of Nigeria Nsukka (UNN), with strong collaborations with Universities from neighbouring States. Strategies to Increase National Government buy-in and support for STI Translating STI research outcomes into policies requires a great deal of emotional intelligence, skills which are often lacking in the first and second generation universities. In the epoch of the science-based or 2GUs, governments were content with universities carrying out scientific research and providing scientific education. Now they desire to see universities as incubators of new science- or technology-based commercial activities, whether by existing firms or start-ups. Hence, governments demand that universities take an active and leading role in the exploitation of their knowledge and they are willing to make funds available to support such activities. Thus, for universities to gain the attention of national leadership they must become centres of excellence and explicit instruments of economic development in the knowledge-based economy. The universities must do this while working collaboratively with government departments, parastatals, and institutions and dedicated research establishments. ATPS should anticipate these shifting changes and devise programmes to assist both government and universities to relate effectively. New administrative structures in member organizations to sustain and manage the emerging STI multidisciplinary teams Second Generation universities (2GUs) tend to focus on pure science and often do not regard the application of their know-how as their task. In contrast, Third Generation Universities (3GUs) objectively stimulate techno-starters – students or academics – to pursue the exploitation or commercialisation of the knowledge they generate. They view this as being equal in importance to the objectives of scientific research and education. Administratively, research in the 2GU era was mainly monodisciplinary and departments were structured along disciplines. The emerging interdisciplinary scientific teams with focus on specific research areas functionally work against the current mono-disciplinary faculty-based, administrative structure of 2GUs. For interdisciplinary teams, the current faculty system is an obstacle. There is a need for new organisational forms for university management that can create responsibilities for the task of know-how exploitation. ATPS must anticipate this and begin to strategize solutions for their member institutions to transition to 3Gus administrative structure, otherwise ATPS growth will plateau, and progress achieved so far may be stunted.

Variability in fecal water genotoxicity, determined using the Comet assay, is independent of endogenous N-nitroso compound formation attributed to red meat consumption

Red meat consumption causes a dose-dependent increase in fecal apparent total N-nitroso compounds (ATNC). The genotoxic effects of these ATNCs were investigated using two different Comet assay protocols to determine the genotoxicity of fecal water samples. Fecal water samples were obtained from two studies of a total of 21 individuals fed diets containing different amounts of red meat, protein, heme, and iron. The first protocol incubated the samples with HT-29 cells for 5 min at 4 degrees C, whereas the second protocol used a longer exposure time of 30 min and a higher incubation temperature of 37 degrees C. DNA strand breaks were quantified by the tail moment (DNA in the comet tail multiplied by the comet tail length). The results of the two Comet assay protocols were significantly correlated (r = 0.35, P = 0.003), however, only the second protocol resulted in detectable levels of DNA damage. Inter-individual effects were variable and there was no effect on fecal water genotoxicity by diet (P > 0.20), mean transit time (P = 0.588), or weight (P = 0.705). However, there was a highly significant effect of age (P = 0.019). There was no significant correlation between concentrations of ATNCs in fecal homogenates and fecal water genotoxicity (r = 0.04, P = 0.74). ATNC levels were lower in fecal water samples (272 microg/kg) compared to that of fecal homogenate samples (895 microg/kg) (P < 0.0001). Failure to find dietary effects on fecal water genotoxicity may therefore be attributed to individual variability and low levels of ATNCs in fecal water samples.

Fault tolerant decentralised K-Means clustering for asynchronous large-scale networks

The K-Means algorithm for cluster analysis is one of the most influential and popular data mining methods. Its straightforward parallel formulation is well suited for distributed memory systems with reliable interconnection networks, such as massively parallel processors and clusters of workstations. However, in large-scale geographically distributed systems the straightforward parallel algorithm can be rendered useless by a single communication failure or high latency in communication paths. The lack of scalable and fault tolerant global communication and synchronisation methods in large-scale systems has hindered the adoption of the K-Means algorithm for applications in large networked systems such as wireless sensor networks, peer-to-peer systems and mobile ad hoc networks. This work proposes a fully distributed K-Means algorithm (EpidemicK-Means) which does not require global communication and is intrinsically fault tolerant. The proposed distributed K-Means algorithm provides a clustering solution which can approximate the solution of an ideal centralised algorithm over the aggregated data as closely as desired. A comparative performance analysis is carried out against the state of the art sampling methods and shows that the proposed method overcomes the limitations of the sampling-based approaches for skewed clusters distributions. The experimental analysis confirms that the proposed algorithm is very accurate and fault tolerant under unreliable network conditions (message loss and node failures) and is suitable for asynchronous networks of very large and extreme scale.

Priority setting in healthcare: from arbitrariness to societal values

This paper develops an account of the normative basis of priority setting in health care as combining the values which a given society holds for the common good of its members, with the universal provided by a principle of common humanity. We discuss national differences in health basket in Europe and argue that health care decision-making in complex social and moral frameworks is best thought of as anchored in such a principle by drawing on the philosophy of need. We show that health care needs are ethically ‘thick’ needs whose psychological and social construction can best be understood in terms of David Wiggins's notion of vital need: a person's need is vital when failure to meet it leads to their harm and suffering. The moral dimension of priority setting which operates across different societies’ health care systems is located in the demands both of and on any society to avoid harm to its members.

Whole-brain functional connectivity during emotional word classification in medication-free Major Depressive Disorder: abnormal salience circuitry and relations to positive emotionality

Major Depressive Disorder (MDD) has been associated with biased processing and abnormal regulation of negative and positive information, which may result from compromised coordinated activity of prefrontal and subcortical brain regions involved in evaluating emotional information. We tested whether patients with MDD show distributed changes in functional connectivity with a set of independently derived brain networks that have shown high correspondence with different task demands, including stimulus salience and emotional processing. We further explored if connectivity during emotional word processing related to the tendency to engage in positive or negative emotional states. In this study, 25 medication-free MDD patients without current or past comorbidity and matched controls (n=25) performed an emotional word-evaluation task during functional MRI. Using a dual regression approach, individual spatial connectivity maps representing each subject’s connectivity with each standard network were used to evaluate between-group differences and effects of positive and negative emotionality (extraversion and neuroticism, respectively, as measured with the NEO-FFI). Results showed decreased functional connectivity of the medial prefrontal cortex, ventrolateral prefrontal cortex, and ventral striatum with the fronto-opercular salience network in MDD patients compared to controls. In patients, abnormal connectivity was related to extraversion, but not neuroticism. These results confirm the hypothesis of a relative (para)limbic-cortical decoupling that may explain dysregulated affect in MDD. As connectivity of these regions with the salience network was related to extraversion, but not to general depression severity or negative emotionality, dysfunction of this network may be responsible for the failure to sustain engagement in rewarding behavior.

Globalization and technology-mediated distance education: developing countries’ perspective

The contemporary global economy places great value on highly educated workers but devalues workers in repetitive or low skill jobs. In order to thrive in this new economy, countries must ensure sufficient higher education opportunities for their population. However, a lack of resources is a major barrier faced by many developing countries in expanding their higher education systems. Technology-mediated distance education has the potential to be an invaluable tool in offering educational opportunities to people, if the other necessary conditions for participation are met. Although technology-mediated education was first considered to be a medium to bridge the learning divide across space, today it is feared that it could well become an inequality intensifier. Drawing on examples from developing countries, this paper considers factors regarding implementing technology-mediated distance education, including failure to address contextual issues and possible consequences. Challenges and policy implications are also discussed.

Automatic ability attribution after failure: a dual process view of achievement attribution

Causal attribution has been one of the most influential frameworks in the literature of achievement motivation, but previous studies considered achievement attribution as relatively deliberate and effortful processes. In the current study, we tested the hypothesis that people automatically attribute their achievement failure to their ability, but reduce the ability attribution in a controlled manner. To address this hypothesis, we measured participants’ causal attribution belief for their task failure either under the cognitive load (load condition) or with full attention (no-load condition). Across two studies, participants attributed task performance to their ability more in the load than in the no-load condition. The increased ability attribution under cognitive load further affected intrinsic motivation. These results indicate that cognitive resources available after feedback play crucial roles in determining causal attribution belief, as well as achievement motivations. (PsycINFO Database Record (c) 2013 APA, all rights reserved)(journal abstract)

Should system dynamics be described as a 'hard' or 'deterministic' systems approach?

This paper explores the criticism that system dynamics is a ‘hard’ or ‘deterministic’ systems approach. This criticism is seen to have four interpretations and each is addressed from the perspectives of social theory and systems science. Firstly, system dynamics is shown to offer not prophecies but Popperian predictions. Secondly, it is shown to involve the view that system structure only partially, not fully, determines human behaviour. Thirdly, the field's assumptions are shown not to constitute a grand content theory—though its structural theory and its attachment to the notion of causality in social systems are acknowledged. Finally, system dynamics is shown to be significantly different from systems engineering. The paper concludes that such confusions have arisen partially because of limited communication at the theoretical level from within the system dynamics community but also because of imperfect command of the available literature on the part of external commentators. Improved communication on theoretical issues is encouraged, though it is observed that system dynamics will continue to justify its assumptions primarily from the point of view of practical problem solving. The answer to the question in the paper's title is therefore: on balance, no.