L'insatisfaction des besoins en soins de support chez les patients atteints d'un cancer du poumon en fonction du genre, de l'âge et du tabagisme : étude descriptive corrélationnelle transversale

Les patients atteints d'un cancer du poumon souffrent de différents troubles physiques et psychosociaux sévères causés par la maladie et son traitement. Ces troubles engendrent plusieurs besoins en soins de support chez les patients. Afin de satisfaire leurs besoins et de leur offrir la meilleure qualité de soins possible, l'identification des besoins en soins de support des patients devient primordiale. But : Le but de l'étude est, dans un premier temps, d'identifier et de décrire les besoins insatisfaits en soins de support pour les patients souffrant d'un cancer du poumon pendant la phase de chimiothérapie dans un Centre Hospitalier Universitaire en Suisse (CHU). Dans un second temps, le but de l'étude est également d'explorer l'éventuelle existence de différences quant au degré d'insatisfaction, tel qu'exprimé par les patients, notamment en fonction de l'âge, du genre et du tabagisme des patients. Cadre théorique : La présente étude se base sur la théorie du déficit d'auto-soin de Dorothea Orem. Méthode : Le travail de recherche s'est basé sur un devis descriptif corrélationnel transversal. L'échantillon, composé de 26 patients atteints d'un cancer du poumon, a été recruté selon la méthode non probabiliste accidentelle dans le service d'oncologie ambulatoire du CHU. Le recueil des données a été effectué à travers deux questionnaires auto-administrés aux patients (Supportive Care Needs Survey Short Form 34 et un questionnaire socio-démographique). Les données médicales ont été recueillies par l'étudiant chercheur à travers la consultation des dossiers médicaux. Résultats : Les résultats montrent que les besoins les plus insatisfaits chez les patients se regroupent surtout autour des besoins liés aux aspects psychologiques et physiques/vie quotidienne. Les patients expriment aussi un degré d'insatisfaction par rapport aux besoins en information ainsi qu'aux soins et au soutien prodigués par les soignants. Les deux besoins le plus fréquemment (65,38 %) exprimés comme insatisfaits par les patients ont été : « être informé de ce que vous pouvez faire vous-même pour aller mieux » et « l'incertitude face à l'avenir ». Les différences des degrés d'insatisfaction, tel qu'exprimés par les patients, en fonction de l'âge, du genre du tabagisme ont permis de poser des hypothèses quant aux relations entre ces variables et le degré d'insatisfaction : les femmes seraient plus insatisfaites de toutes les dimensions liées aux besoins en soins de support ; les patients d'âge égal ou supérieur à 65 ans seraient plus insatisfaits quant aux besoins physiques/vie quotidienne, psychologiques et de soutien; les patients d'âge inférieur à 65 ans seraient plus insatisfaits quant aux besoins liés à la sexualité; les non-fumeurs avant le diagnostic seraient plus insatisfaits quant aux besoins physiques/vie quotidienne, d'information et sexuels ; les patients qui arrêtent de fumer après le diagnostic seraient plus insatisfaits quant aux besoins physique/vie quotidienne, psychologique et de soutien. Conclusion : Cette étude met en évidence le fait que, pendant la phase de chimiothérapie, les patients atteints d'un cancer du poumon expriment de l'insatisfaction par rapport à plusieurs besoins en soins de support. Afin d'améliorer la qualité des soins et de mieux répondre aux besoins des patients, les infirmières et les équipes interdisciplinaires présentes au sein des services d'oncologie du CHU sont appelés à prendre en considération l'insatisfaction exprimée par les patients.

A framework for the analysis of CLIL lecturers’ discourse from a genre perspective

Internationalization strategies and the European Space of Higher Education are causing a growing interest in English medium instruction (EMI). University linguistic and internationalization policies are attempting to provide lectures with the required training and education. Linguists can supply not only the knowledge of the language but the knowledge about language which may enable lecturers to increase their academic language competence autonomously. This paper presents a framework for the analysis of lecturers’ discourse to trigger reflection about the linguistic needs in CLIL/EMI contexts.

Elaborated Literary Violence: Genre and Ideology of the Two Stories I Sam 22,6-23 and II Sam 21,1-14

The present article focuses on two stories dealing with acts of big blood shed. I Sam 22,6-23 relates the massacre of the priests of Nob; II Sam 21,1-14 is about the execution of seven descendents of Saul, as atonement for Saul's attempt to exterminate the Gibeonites. Most researchers consider both stories or at least certain parts of them old.1 For both stories few verses are regarded as secondary. In this paper I try to reassess the analysis of these stories and will point to indices favoring a late date of origin for both of them. They concern the language in use, intertextual connections and particular motifs. A further indication consists in the fact that the reported events of the stories lack significant resonance in the corpus of the Hebrew Bible. There are only two texts, I Sam 2,33 and Ps 52,2, which allude or refer to I Sam 22,6-23.With regard to the importance of the related events and acts this silence in the Biblical context is astonishing. Interestingly, also in the Book of Chronicles one does not find any allusions to these stories. This raises the question whether the latter were composed after the formation of the book of Chronicles.

Feature selection for automatic analysis of emotional response based on nonlinear speech modeling suitable for diagnosis of Alzheimer׳s disease

Alzheimer׳s disease (AD) is the most common type of dementia among the elderly. This work is part of a larger study that aims to identify novel technologies and biomarkers or features for the early detection of AD and its degree of severity. The diagnosis is made by analyzing several biomarkers and conducting a variety of tests (although only a post-mortem examination of the patients’ brain tissue is considered to provide definitive confirmation). Non-invasive intelligent diagnosis techniques would be a very valuable diagnostic aid. This paper concerns the Automatic Analysis of Emotional Response (AAER) in spontaneous speech based on classical and new emotional speech features: Emotional Temperature (ET) and fractal dimension (FD). This is a pre-clinical study aiming to validate tests and biomarkers for future diagnostic use. The method has the great advantage of being non-invasive, low cost, and without any side effects. The AAER shows very promising results for the definition of features useful in the early diagnosis of AD.

Brain dynamics sustaining rapid rule extraction from speech

Language acquisition is a complex process that requires the synergic involvement of different cognitive functions, which include extracting and storing the words of the language and their embedded rules for progressive acquisition of grammatical information. As has been shown in other fields that study learning processes, synchronization mechanisms between neuronal assemblies might have a key role during language learning. In particular, studying these dynamics may help uncover whether different oscillatory patterns sustain more item-based learning of words and rule-based learning from speech input. Therefore, we tracked the modulation of oscillatory neural activity during the initial exposure to an artificial language, which contained embedded rules. We analyzed both spectral power variations, as a measure of local neuronal ensemble synchronization, as well as phase coherence patterns, as an index of the long-range coordination of these local groups of neurons. Synchronized activity in the gamma band (2040 Hz), previously reported to be related to the engagement of selective attention, showed a clear dissociation of local power and phase coherence between distant regions. In this frequency range, local synchrony characterized the subjects who were focused on word identification and was accompanied by increased coherence in the theta band (48 Hz). Only those subjects who were able to learn the embedded rules showed increased gamma band phase coherence between frontal, temporal, and parietal regions.

Melodic Analysis of Speech Method applied to Spanish and Catalan

In this paper, we present the Melodic Analysis of Speech method (MAS) that enables us to carry out complete and objective descriptions of a language's intonation, from a phonetic (melodic) point of view as well as from a phonological point of view. It is based on the acoustic-perceptive method by Cantero (2002), which has already been used in research on prosody in different languages. In this case, we present the results of its application in Spanish and Catalan.

Segmental Durations of Speech

This dissertation considers the segmental durations of speech from the viewpoint of speech technology, especially speech synthesis. The idea is that better models of segmental durations lead to higher naturalness and better intelligibility. These features are the key factors for better usability and generality of synthesized speech technology. Even though the studies are based on a Finnish corpus the approaches apply to all other languages as well. This is possibly due to the fact that most of the studies included in this dissertation are about universal effects taking place on utterance boundaries. Also the methods invented and used here are suitable for any other study of another language. This study is based on two corpora of news reading speech and sentences read aloud. The other corpus is read aloud by a 39-year-old male, whilst the other consists of several speakers in various situations. The use of two corpora is twofold: it involves a comparison of the corpora and a broader view on the matters of interest. The dissertation begins with an overview to the phonemes and the quantity system in the Finnish language. Especially, we are covering the intrinsic durations of phonemes and phoneme categories, as well as the difference of duration between short and long phonemes. The phoneme categories are presented to facilitate the problem of variability of speech segments. In this dissertation we cover the boundary-adjacent effects on segmental durations. In initial positions of utterances we find that there seems to be initial shortening in Finnish, but the result depends on the level of detail and on the individual phoneme. On the phoneme level we find that the shortening or lengthening only affects the very first ones at the beginning of an utterance. However, on average, the effect seems to shorten the whole first word on the word level. We establish the effect of final lengthening in Finnish. The effect in Finnish has been an open question for a long time, whilst Finnish has been the last missing piece for it to be a universal phenomenon. Final lengthening is studied from various angles and it is also shown that it is not a mere effect of prominence or an effect of speech corpus with high inter- and intra-speaker variation. The effect of final lengthening seems to extend from the final to the penultimate word. On a phoneme level it reaches a much wider area than the initial effect. We also present a normalization method suitable for corpus studies on segmental durations. The method uses an utterance-level normalization approach to capture the pattern of segmental durations within each utterance. This prevents the impact of various problematic variations within the corpora. The normalization is used in a study on final lengthening to show that the results on the effect are not caused by variation in the material. The dissertation shows an implementation and prowess of speech synthesis on a mobile platform. We find that the rule-based method of speech synthesis is a real-time software solution, but the signal generation process slows down the system beyond real time. Future aspects of speech synthesis on limited platforms are discussed. The dissertation considers ethical issues on the development of speech technology. The main focus is on the development of speech synthesis with high naturalness, but the problems and solutions are applicable to any other speech technology approaches.