An Assessment of How Nurse Practitioners Create Access to Primary Care in Canadian Residential Long-Term Care Settings

The aim of this paper is to explore the role and activities of nurse practitioners (NPs) working in long-term care (LTC) to understand concepts of access to primary care for residents. Utilizing the "FIT" framework developed by Penchanksy and Thomas, we used a directed content analysis method to analyze data from a pan-Canadian study of NPs in LTC. Individual and focus group interviews were conducted at four sites in western, central and eastern regions of Canada with 143 participants, including NPs, RNs, regulated and unregulated nursing staff, allied health professionals, physicians, administrators and directors and residents and family members. Participants emphasized how the availability and accessibility of the NP had an impact on access to primary and urgent care for residents. Understanding more about how NPs affect access in Canadian LTC will be valuable for nursing practice and healthcare planning and policy and may assist other countries in planning for the introduction of NPs in LTC settings to increase access to primary care.

Primary Health Care Providers' Perspectives: Facilitating Older Patients' Access to Community Support Services

The purpose of the study examined in this article was to understand how non-physician health care professionals working in Canadian primary health care settings facilitate older persons’ access to community support services (CSSs). The use of CSSs has positive impacts for clients, yet they are underused from lack of awareness. Using a qualitative description approach, we interviewed 20 health care professionals from various disciplines and primary health care models about the processes they use to link older patients to CSSs. Participants collaborated extensively with interprofessional colleagues within and outside their organizations to fi nd relevant CSSs. They actively engaged patients and families in making these linkages and ensured follow-up. It was troubling to fi nd that they relied on out-of-date resources and ineffi cient search strategies to fi nd CSSs. Our fi ndings can be used to develop resources and approaches to better support primary health care providers in linking older adults to relevant CSSs. 

Clinical approach of atresia coli in a calf

Atresia coli is a congenital defect with disruption of the intestinal flow. Its etiopathogenesis is still unknown and the prognosis is reserved. This paper describes the case of a one week old Holstein Friesian calf that was referred to the HCVC, and was diagnosed with atresia coli. This confirmation was made by contrast radiography and the lesion was detected in dorsal portion of the spiral colon. A cecostomy was performed followed by a marsupialization of the intestinal cecum to the abdominal wall. After 36 hours of surgery, calf’s state worsens dramatically and for reasons of welfare, it was proceeded to sacrifice. The post-operative recovery is possible, even though the mortality rate is high. As in this case, this mortality rate increases when early diagnosis of atresia coli does not take place and there is peritonitis.

The Influence of Geology and Season on Macroinvertebrates in Belizean Streams: Implications for Tropical Bioassessment

Considerable attention has been paid to the potentially confounding effects of geological and seasonal variation on outputs from bioassessments in temperate streams, but our understanding about these influences is limited for many tropical systems. We explored variation in macroinvertebrate assemblage composition and the environmental characteristics of 3rd- to 5th-order streams in a geologically heterogeneous tropical landscape in the wet and dry seasons. Study streams drained catchments with land cover ranging from predominantly forested to agricultural land, but data indicated that distinct water-chemistry and substratum conditions associated with predominantly calcareous and silicate geologies were key determinants of macroinvertebrate assemblage composition. Most notably, calcareous streams were characterized by a relatively abundant noninsect fauna, particularly a pachychilid gastropod snail. The association between geological variation and assemblage composition was apparent during both seasons, but significant temporal variation in compositional characteristics was detected only in calcareous streams, possibly because of limited statistical power to detect change at silicate sites, or the limited extent of our temporal data. We discuss the implications of our findings for tropical bioassessment programs. Our key findings suggest that geology can be an important determinant of macroinvertebrate assemblages in tropical streams and that geological heterogeneity may influence the scale of temporal response in characteristic macroinvertebrate assemblages.

Women of the future : gender, technology, and cyborgs in Frank Herbert’s dune

Cette thèse défend les mérites d’une lecture cyborgienne de l’oeuvre de science-fiction de Frank Herbert, Dune, où la vision particulière des sciences et technologies nous permet d’interpréter plusieurs personnages en tant que réitération Nouvelle Vague du cyborg. Publié en 1965, Dune introduit des personnages féminins atypiques pour cette époque compte tenu de leurs attributs tels qu’une capacité intellectuelle accrue, une imposante puissance de combat et une immunité manifeste contre la faiblesse émotionnelle. Cependant, le roman reste ambivalent en ce qui concerne ces femmes : en dépit de leurs qualités admirables, elles sont d’autre part caractérisées par des stéréotypes régressifs, exposants une sexualité instinctive, qui les confinent tout au mieux aux rôles de mère, maitresse ou épouse. Finalement, dans le roman, elles finissent par jouer le rôle du méchant. Cette caractérisation se rapproche beaucoup de celle du cyborg femelle qui est d’usage courant dans les productions de science fiction pour le grand public des décennies plus récentes. Par conséquent, cette thèse défend qu’une lecture cyborgienne de Dune complète et accroisse une analyse sexospécifique, car cette approche comporte une théorisation essentielle des réactions à l’égard de la technologie qui, selon Evans, sont entretissées dans la réaction patriarcale de ce roman à l’égard des femmes. Bien que ces créatures fictives ne soient pas encore communes à l’époque de la rédaction de Dune, Jessica et certains autres personnages du roman peuvent néanmoins être considérés comme exemples primitifs des cyborgs, parce qu’ils incarnent la science et la technologie de leur culture et qu’ils possèdent d’autres éléments typiques du cyborg. L’hypothèse propose que la représentation des femmes dans Dune ne découle pas seulement de l’attrait pour le chauvinisme ou la misogynie, mais qu’elle est en fait grandement influencée par la peur de la technologie qui est transposée sur la femme comme c’est couramment le cas dans la littérature cyborg subséquente. Ainsi, ce roman annonce le futur sous-genre cyborg de la science-fiction.

User Behavioral Modeling of Web-based Systems for Continuous User Authentication

Authentication plays an important role in how we interact with computers, mobile devices, the web, etc. The idea of authentication is to uniquely identify a user before granting access to system privileges. For example, in recent years more corporate information and applications have been accessible via the Internet and Intranet. Many employees are working from remote locations and need access to secure corporate files. During this time, it is possible for malicious or unauthorized users to gain access to the system. For this reason, it is logical to have some mechanism in place to detect whether the logged-in user is the same user in control of the user's session. Therefore, highly secure authentication methods must be used. We posit that each of us is unique in our use of computer systems. It is this uniqueness that is leveraged to "continuously authenticate users" while they use web software. To monitor user behavior, n-gram models are used to capture user interactions with web-based software. This statistical language model essentially captures sequences and sub-sequences of user actions, their orderings, and temporal relationships that make them unique by providing a model of how each user typically behaves. Users are then continuously monitored during software operations. Large deviations from "normal behavior" can possibly indicate malicious or unintended behavior. This approach is implemented in a system called Intruder Detector (ID) that models user actions as embodied in web logs generated in response to a user's actions. User identification through web logs is cost-effective and non-intrusive. We perform experiments on a large fielded system with web logs of approximately 4000 users. For these experiments, we use two classification techniques; binary and multi-class classification. We evaluate model-specific differences of user behavior based on coarse-grain (i.e., role) and fine-grain (i.e., individual) analysis. A specific set of metrics are used to provide valuable insight into how each model performs. Intruder Detector achieves accurate results when identifying legitimate users and user types. This tool is also able to detect outliers in role-based user behavior with optimal performance. In addition to web applications, this continuous monitoring technique can be used with other user-based systems such as mobile devices and the analysis of network traffic.

The Definition of Curriculum Areas in Occupational Health Psychology

Across the international educational landscape, numerous higher education institutions (HEIs) offer postgraduate programmes in occupational health psychology (OHP). These seek to empower the next generation of OHP practitioners with the knowledge and skills necessary to advance the understanding and prevention of workplace illness and injury, improve working life and promote healthy work through the application of psychological principles and practices. Among the OHP curricula operated within these programmes there exists considerable variability in the topics addressed. This is due, inter alia, to the youthfulness of the discipline and the fact that the development of educational provision has been managed at the level of the HEI where it has remained undirected by external forces such as the discipline’s representative bodies. Such variability makes it difficult to discern the key characteristics of a curriculum which is important for programme accreditation purposes, the professional development and regulation of practitioners and, ultimately, the long-term sustainability of the discipline. This chapter has as its focus the imperative for and development of consensus surrounding OHP curriculum areas. It begins by examining the factors that are currently driving curriculum developments and explores some of the barriers to such. It then reviews the limited body of previous research that has attempted to discern key OHP curriculum areas. This provides a foundation upon which to describe a study conducted by the current authors that involved the elicitation of subject matter expert opinion from an international sample of academics involved in OHP-related teaching and research on the question of which topic areas might be considered important for inclusion within an OHP curriculum. The chapter closes by drawing conclusions on steps that could be taken by the discipline’s representative bodies towards the consolidation and accreditation of a core curriculum.

Aldeias de crianças SOS

Dissertação de Mestrado para obtenção do grau de Mestre em Design de Comunicação, apresentada na Universidade de Lisboa - Faculdade de Arquitectura.

Association between parent and child dietary sodium and potassium intakes as assessed by 24-h urinary excretion

The aim of this study was to assess the association between parent and child sodium (Na) and potassium (K) intake as assessed by 24-h urinary excretion (24hUE). Primary school children and their parent(s) provided one 24-h urine sample and information on cooking and children's discretionary salt use. Valid urine samples were provided by 108 mothers (mean age 41.8 (5.1) (SD) years, Na 120 (45) mmol/day) (7.0 g/day salt equivalent) and 40 fathers (44.4 (4.9) years, Na 152 (49) mmol/day (8.9 g/day salt), and 168 offspring (51.8% male, age 9.1 (2.0) years, Na 101 (47) mmol/day (5.9 g/day salt). When adjusted for parental age, child age and gender a 17 mmol/day Na (1 g/day salt) increase in mother's 24hUE was associated with a 3.4 mmol/day Na (0.2 g/day salt) increase in child's salt 24hUE (p = 0.04) with no association observed between father and child. Sixty-seven percent of parents added salt during cooking and 37% of children added salt at the table. Children who reported adding table salt had higher urinary excretion than those who did not (p = 0.01). The association between mother and child Na intake may relate to the consumption of similar foods and highlights the importance of the home environment in influencing total dietary sodium intake.

The prose poem as Igel: a reading of fragmentation and closure in prose poetry

This paper takes up Nikki Santilli’s lament about the scarcity of scholarship on the prose poem in English to analyse two key features of prose poetry: fragmentation and closure. This paper argues that the prose poem’s visual containment within the paragraph form promises a complete narrative while simultaneously subverting this visual cue by offering, instead, gaps and spaces. Such apertures render the prose poem a largely fragmentary form that relies on metonymic metamorphoses to connect to a larger, unnamed frame of reference. In this way, the prose poem is both complete and yet searching for completeness, closed and lacking closure.The prose poem’s reaching outwards to embrace a larger, absent whole connects this literary form to Friedrich Schlegel’s ‘Athenaeum Fragment 206’ and to the Romantic critical fragment more generally. ‘Athenaeum Fragment 206’ has provided this paper with its title, as a metaphorical reading of Schlegel’s igel, or hedgehog, as fragment ‘implies the existence of [a form that suggests] what is outside itself’ (Rosen 1995: 48). The final section of this paper, analyses two prose poems from the University of Canberra’s International Poetry Studies Institute’s Prose Poetry Project. These works by Jen Webb and Carrie Etter are read for their appeal to metonymy in their exploration of time passing and ultimately, death. They demonstrate that prose poetry is both fragmented and open ended in ways very different from lineated poems.

Travailleuses sociales diplômées à l’étranger : les enjeux du transfert de leurs connaissances au contexte de pratique montréalais

Les travailleurs sociaux font partie des professionnels de la santé et des services sociaux, de plus en plus nombreux, qui choisissent d’immigrer au Québec afin d’y vivre et d’y poursuivre leur carrière. La reconnaissance des diplômes obtenus à l’étranger et l’obtention d’un permis de pratique délivré par l’Ordre des travailleurs sociaux et des thérapeutes conjugaux et familiaux du Québec constituent un passage obligé afin d’exercer la profession en contexte québécois. Une fois ces étapes franchies, les travailleurs sociaux immigrants disposent de connaissances acquises dans leur pays d’origine pour intervenir dans un nouvel univers professionnel et culturel. Prenant la forme d’un mémoire par articles et prenant appui sur les données obtenues dans le cadre d’une recherche qualitative pancanadienne sur l’adaptation professionnelle des travailleurs sociaux issus de l’immigration (Pullen Sansfaçon, Brown et Graham, CRSH 2011-2012, CRSH 2012- 2015), ce mémoire explore les enjeux inhérents au transfert des connaissances, des expériences professionnelles et des valeurs acquises à l’étranger vers un contexte de pratique québécois. L’expérience vécue par 26travailleuses sociales immigrantes, diplômées à l’étranger et pratiquant actuellement dans la grande région montréalaise, a permis de rendre compte des aspects transférables ou moins transférables du travail social. Ainsi, la mission et les valeurs du travail social, les expériences professionnelles, les connaissances théoriques et les habiletés cliniques apparaissent comme des connaissances se transférant bien au-delà des frontières nationales. Par contre, le récit des participantes indique que les connaissances relatives aux lois, aux politiques sociales, aux procédures organisationnelles et à la langue se transfèrent plus difficilement, ce qui peut générer certaines lacunes dans un contexte de pratique différent de celui où la formation en travail social a été obtenue. Dans ce contexte, il ressort que la contribution des milieux de pratique et le soutien des collègues de travail sont des éléments centraux favorisant l’acquisition de connaissances locales.

Le mode de ventilation neurally adjusted ventilatory assist (NAVA) est faisable, bien toléré, et permet la synchronie entre le patient et le ventilateur pendant la ventilation non invasive aux soins intensifs pédiatriques : étude physiologique croisée

Introduction: La ventilation non invasive (VNI) est un outil utilisé en soins intensifs pédiatriques (SIP) pour soutenir la détresse respiratoire aigüe. Un échec survient dans près de 25% des cas et une mauvaise synchronisation patient-ventilateur est un des facteurs impliqués. Le mode de ventilation NAVA (neurally adjusted ventilatory assist) est asservi à la demande ventilatoire du patient. L’objectif de cette étude est d’évaluer la faisabilité et la tolérance des enfants à la VNI NAVA et l’impact de son usage sur la synchronie et la demande respiratoire. Méthode: Étude prospective, physiologique, croisée incluant 13 patients nécessitant une VNI dans les SIP de l’hôpital Ste-Justine entre octobre 2011 et mai 2013. Les patients ont été ventilés successivement en VNI conventionnelle (30 minutes), en VNI NAVA (60 minutes) et en VNI conventionnelle (30 minutes). L’activité électrique du diaphragme (AEdi) et la pression des voies aériennes supérieures ont été enregistrées pour évaluer la synchronie. Résultats: La VNI NAVA est faisable et bien tolérée chez tous les enfants. Un adolescent a demandé l’arrêt précoce de l’étude en raison d’anxiété reliée au masque sans fuite. Les délais inspiratoires et expiratoires étaient significativement plus courts en VNI NAVA comparativement aux périodes de VNI conventionnelle (p< 0.05). Les efforts inefficaces étaient moindres en VNI NAVA (résultats présentés en médiane et interquartiles) : 0% (0 - 0) en VNI NAVA vs 12% (4 - 20) en VNI conventionnelle initiale et 6% (2 - 22) en VNI conventionnelle finale (p< 0.01). Globalement, le temps passé en asynchronie a été réduit à 8% (6 - 10) en VNI NAVA, versus 27% (19 - 56) et 32% (21 - 38) en périodes de VNI conventionnelle initiale et finale, respectivement (p= 0.05). Aucune différence en termes de demande respiratoire n’a été observée. Conclusion: La VNI NAVA est faisable et bien tolérée chez les enfants avec détresse respiratoire aigüe et permet une meilleure synchronisation patient-ventilateur. De plus larges études sont nécessaires pour évaluer l’impact clinique de ces résultats.

Translation Studies on an Annular Field Reversed Configuration Device for Space Propulsion

This research investigated annular field reversed configuration (AFRC)devices for high power electric propulsion by demonstrating the acceleration of these plasmoids using an experimental prototype and measuring the plasmoid's velocity, impulse, and energy efficiency. The AFRC plasmoid translation experiment was design and constructed with the aid of a dynamic circuit model. Two versions of the experiment were built, using underdamped RLC circuits at 10 kHz and 20 kHz. Input energies were varied from 100 J/pulse to 1000 J/pulse for the 10 kHz bank and 100 J/pulse for the 20 kHz bank. The plasmoids were formed in static gas fill of argon, from 1 mTorr to 50 mTorr. The translation of the plasmoid was accomplished by incorporating a small taper into the outer coil, with a half angle of 2°. Magnetic field diagnostics, plasma probes, and single-frame imaging were used to measure the plasmoid's velocity and to diagnose plasmoid behavior. Full details of the device design, construction, and diagnostics are provided in this dissertation. The results from the experiment demonstrated that a repeatable AFRC plasmoid was produced between the coils, yet failed to translate for all tested conditions. The data revealed the plasmoid was limited in lifetime to only a few (4-10) μs, too short for translation at low energy. A global stability study showed that the plasma suffered a radial collapse onto the inner wall early in its lifecycle. The radial collapse was traced to a magnetic pressure imbalance. A correction made to the circuit was successful in restoring an equilibrium pressure balance and prolonging radial stability by an additional 2.5 μs. The equilibrium state was sufficient to confirm that the plasmoid current in an AFRC reaches a steady-state prior to the peak of the coil currents. This implies that the plasmoid will always be driven to the inner wall, unless it translates from the coils prior to peak coil currents. However, ejection of the plasmoid before the peak coil currents results in severe efficiency losses. These results demonstrate the difficulty in designing an AFRC experiment for translation as balancing the different requirements for stability, balance, and efficient translation can have competing consequences.

Travailleuses sociales diplômées à l’étranger : les enjeux du transfert de leurs connaissances au contexte de pratique montréalais

Les travailleurs sociaux font partie des professionnels de la santé et des services sociaux, de plus en plus nombreux, qui choisissent d’immigrer au Québec afin d’y vivre et d’y poursuivre leur carrière. La reconnaissance des diplômes obtenus à l’étranger et l’obtention d’un permis de pratique délivré par l’Ordre des travailleurs sociaux et des thérapeutes conjugaux et familiaux du Québec constituent un passage obligé afin d’exercer la profession en contexte québécois. Une fois ces étapes franchies, les travailleurs sociaux immigrants disposent de connaissances acquises dans leur pays d’origine pour intervenir dans un nouvel univers professionnel et culturel. Prenant la forme d’un mémoire par articles et prenant appui sur les données obtenues dans le cadre d’une recherche qualitative pancanadienne sur l’adaptation professionnelle des travailleurs sociaux issus de l’immigration (Pullen Sansfaçon, Brown et Graham, CRSH 2011-2012, CRSH 2012- 2015), ce mémoire explore les enjeux inhérents au transfert des connaissances, des expériences professionnelles et des valeurs acquises à l’étranger vers un contexte de pratique québécois. L’expérience vécue par 26travailleuses sociales immigrantes, diplômées à l’étranger et pratiquant actuellement dans la grande région montréalaise, a permis de rendre compte des aspects transférables ou moins transférables du travail social. Ainsi, la mission et les valeurs du travail social, les expériences professionnelles, les connaissances théoriques et les habiletés cliniques apparaissent comme des connaissances se transférant bien au-delà des frontières nationales. Par contre, le récit des participantes indique que les connaissances relatives aux lois, aux politiques sociales, aux procédures organisationnelles et à la langue se transfèrent plus difficilement, ce qui peut générer certaines lacunes dans un contexte de pratique différent de celui où la formation en travail social a été obtenue. Dans ce contexte, il ressort que la contribution des milieux de pratique et le soutien des collègues de travail sont des éléments centraux favorisant l’acquisition de connaissances locales.