Proposition théorique constructiviste du développement de la compétence culturelle infirmière

Dans un contexte de mondialisation, les frontières géographiques et politiques se font de plus en plus diffuses et donnent lieu à un mélange des cultures tant au niveau local qu'international. Ce pluralisme culturel observé dans la population se transpose dans les milieux de soins, amenant son lot d'enjeux et de défis pour la pratique et la formation infirmière. Le développement de la compétence culturelle chez les professionnels de la santé est considéré comme l'une des solutions favorisant la qualité et l'équité dans les soins en contexte de diversité culturelle. La compétence culturelle fait l'objet de nombreux articles scientifiques en sciences infirmières, mais bon nombre d'entre eux sont issus d'une perspective essentialiste. À notre connaissance, aucune étude ne permet de représenter la trajectoire de développement de cette compétence sur un continuum intégrant des apprentissages réalisés à la fois chez des étudiantes et des infirmières selon une perspective constructiviste. Cette étude vise donc à formuler une proposition théorique constructiviste du développement de la compétence culturelle infirmière. L'approche de théorisation ancrée de Corbin et Strauss (2008) a permis de documenter le processus de développement de la compétence culturelle chez des infirmières et des étudiantes dans un Centre de santé et de services sociaux desservant une population qui présente une grande diversité culturelle. Une stratégie d'échantillonnage intentionnel a permis de recruter des infirmières identifiées par leurs pairs comme étant expertes du domaine des soins en contexte de diversité culturelle, des infirmières se disant intéressées par une pratique culturellement compétente et des étudiantes en dernière année d'un programme de baccalauréat en sciences infirmières. Un total de 24 participantes, dont 13 infirmières et 11 étudiantes ont pris part à cette étude. Un questionnaire sociodémographique, des périodes d'observation participante et des entrevues semi-structurées ont servi d'outils de collecte des données. La catégorie centrale « apprendre à réunir les différentes réalités afin d'offrir des soins efficaces en contexte de diversité culturelle » a été construite à partir d'une analyse inductive des données. Cette catégorie centrale se divise en trois sous-catégories : « construire la relation avec l'autre », « sortir du cadre habituel de pratique » et « réinventer sa pratique dans l'action ». La proposition théorique formulée présente l'évolution concomitante de ces trois sous-catégories en trois niveaux de développement de la compétence culturelle infirmière : « s'ouvrir aux différentes réalités entourant la pratique en contexte de diversité culturelle », « mettre à l'épreuve sa pratique » et « réunir les différentes réalités de la pratique en contexte de diversité culturelle de façon intégrée ». La proposition théorique constructiviste est ancrée dans les données empiriques, circonscrit des étapes de développement interreliées et met en contexte les apprentissages du début du développement de la compétence culturelle à l'expertise. Les éléments contextuels précisés suggèrent l'ajout des dimensions sociales et politiques dans la définition du concept de compétence culturelle. Les deux principales contributions théoriques de cette étude soulignent que l'interaction entre l'infirmière et l'environnement de même que l'expérience clinique sont constitutifs du développement de cette compétence. Les retombées de cette recherche se situent non seulement en formation, mais aussi dans la pratique, la gestion et la recherche en sciences infirmières.

Ressources résidentielles pour adultes avec un trouble mental : développement d'un modèle et d'un instrument de mesure

Ce projet de recherche revisite la conceptualisation du logement et des ressources résidentielles pour les adultes avec un trouble mental. Les objectifs visent : (1) à identifier les attributs, dimensions et domaines ; (2) à développer un nouveau modèle ; (3) à concevoir un instrument de mesure pour décrire l’éventail des ressources résidentielles en santé mentale. Méthodologie : Phase 1: Le devis de recherche s’articule autour de la cartographie de concepts, caractérisée par une méthodologie mixte. L’échantillonnage, par choix raisonné, a permis de recueillir une pluralité de perceptions et d’expériences (p.ex. personnes utilisatrices de services, proches, responsables de ressources résidentielles, gestionnaires). Les participants proviennent de cinq régions du Québec (nombre total de participations = 722). Au cours des six étapes de la cartographie de concepts, les participants ont généré des attributs décrivant le logement (n = 221), leur ont accordé une cote numérique (n = 416) et les ont regroupés en catégories (n = 73). Douze participants ont interprété des cartes conceptuelles produites par des analyses multivariées, soit l’échelonnage multidimensionnel (MDS) et la typologie hiérarchique. Des analyses par composantes principales (PCAs) ont été utilisées pour raffiner la conceptualisation (n = 228). Phase II: L’instrument a été développé, utilisé et ajusté à la suite de deux groupes de discussions (n = 23) et d’une étude transversale auprès de ressources résidentielles (n = 258). La passation se fait via une entrevue téléphonique semi-structurée enregistrée, d’une durée moyenne de 130 minutes. Résultats : Les participants ont généré 1382 idées (99.5% de saturation). Les cartes conceptuelles issues de la cartographie de concepts comprennent 140 idées (attributs du logement), 12 dimensions et cinq domaines (indice de stress MDS = 0.2302, 10 itérations). Les analyses PCAs ont permis de retenir quatre domaines, 11 composantes (α = 0.600 à 0.933) et 81 attributs. Les domaines sont : (1) environnement géophysique; (2) atmosphère et fonctionnement du milieu; (3) soutien et interventions offerts; (4) pratiques organisationnelles et managériales. L’instrument développé comprend quatre domaines, 10 dimensions et 83 attributs. À cela s’ajoutent des variables descriptives. L’instrument résulte des Phases I et II de ce projet. Conclusion : L’instrument a été développé en collaboration avec diverses parties prenantes, à partir de considérations ontologiques, réalistes, causales et statistiques. Il dresse le profil détaillé d’une ressource résidentielle sous ses différentes facettes et s’appuie sur la prémisse qu’il n’existe pas de milieu résidentiel idéal pour tous.

Sequential Optimal Recovery: A Paradigm for Active Learning

In most classical frameworks for learning from examples, it is assumed that examples are randomly drawn and presented to the learner. In this paper, we consider the possibility of a more active learner who is allowed to choose his/her own examples. Our investigations are carried out in a function approximation setting. In particular, using arguments from optimal recovery (Micchelli and Rivlin, 1976), we develop an adaptive sampling strategy (equivalent to adaptive approximation) for arbitrary approximation schemes. We provide a general formulation of the problem and show how it can be regarded as sequential optimal recovery. We demonstrate the application of this general formulation to two special cases of functions on the real line 1) monotonically increasing functions and 2) functions with bounded derivative. An extensive investigation of the sample complexity of approximating these functions is conducted yielding both theoretical and empirical results on test functions. Our theoretical results (stated insPAC-style), along with the simulations demonstrate the superiority of our active scheme over both passive learning as well as classical optimal recovery. The analysis of active function approximation is conducted in a worst-case setting, in contrast with other Bayesian paradigms obtained from optimal design (Mackay, 1992).

A three-dimensional magnetometer for motion sensing of a balloon-carried atmospheric measurement package

An instrument is described which carries three orthogonal geomagnetic field sensors on a standard meteorological balloon package, to sense rapid motion and position changes during ascent through the atmosphere. Because of the finite data bandwidth available over the UHF radio link, a burst sampling strategy is adopted. Bursts of 9s of measurements at 3.6Hz are interleaved with periods of slow data telemetry lasting 25s. Calculation of the variability in each channel is used to determine position changes, a method robust to periods of poor radio signals. During three balloon ascents, variability was found repeatedly at similar altitudes, simultaneously in each of three orthogonal sensors carried. This variability is attributed to atmospheric motions. It is found that the vertical sensor is least prone to stray motions, and that the use of two horizontal sensors provides no additional information over a single horizontal sensor

The accuracy of digital elevation models derived from digitised contour data

Although accuracy of digital elevation models (DEMs) can be quantified and measured in different ways, each is influenced by three main factors: terrain character, sampling strategy and interpolation method. These parameters, and their interaction, are discussed. The generation of DEMs from digitised contours is emphasised because this is the major source of DEMs, particularly within member countries of OEEPE. Such DEMs often exhibit unwelcome artifacts, depending on the interpolation method employed. The origin and magnitude of these effects and how they can be reduced to improve the accuracy of the DEMs are also discussed.

A case study of sample design for longitudinal research: young lives

This paper presents a case study to illustrate the range of decisions involved in designing a sampling strategy for a complex, longitudinal research study. It is based on experience from the Young Lives project and identifies the approaches used to sample children for longitudinal follow-up in four less developed countries (LDCs). The rationale for decisions made and the resulting benefits, and limitations, of the approaches adopted are discussed. Of particular importance is the choice of sampling approach to yield useful analysis; specific examples are presented of how this informed the design of the Young Lives sampling strategy.

Investigating the impact of defects on key stakeholders in the UK new housing sector

The UK house building sector is facing dual pressures to expand supply, along with delivering against tougher Building Regulations’ requirements, predominantly in the areas of sustainability. A review of current literature has highlighted that the pressures the UK house building industry is currently under may be having a negative impact on build quality, causing an increase in defects. A review and synthesis of the current defect literature with respect to new-build housing and the wider construction sector has found that the prevailing emphasis is limited to the classification, causes, pathology and statistical analysis of defects. There is thus a need to better understand the overall impact of individual defects on key stakeholders within the new-build housing defect detection and remediation process. As part of ongoing research to develop and verify a defect impact assessment rating system, this paper seeks to contribute to our understanding of the impact of individual defects from a key stakeholder perspective by undertaking the literature review and synthesis phase. The literature review identifies the three distinct, but interrelated, dominant impact factors: cost, disruption, and health and safety. By pulling the strands of defect literature together the theoretical lens and key stakeholder sampling strategy is formed as the basis for the subsequent impact weighting development phase.

Periodontal diseases in a representative urban population in south Brazil

Background and Aims: There is little information about the epidemiology and risk factors of periodontal diseases in Latin America in general, and Brazil in particular. The principal aims of this study were to: 1) describe the prevalence and severity of periodontal attachment loss and gingival recession, and to assess the contribution of demographic, behavioral, and environmental exposures to the occurrence of periodontal disease outcomes in a sample representative of the urban population in the state of Rio Grande do Sul in south Brazil; and 2) report the epidemiology and risk indicators of aggressive periodontitis in this population. Methods: A representative sample consisting of 1,586 subjects 14-103 years of age (mean 38 y) and comprising 45.3% males and 54.7% females was selected using a multi-stage, probability, cluster sampling strategy. The subjects were interviewed using a structured questionnaire and underwent a full-mouth, six sites per tooth clinical examination in a mobile examination center. Results: Moderate and severe clinical attachment loss and gingival recession were widespread among adults in this population. The prevalence and extent of attachment loss ³5 and ³7 mm were 79% and 52% subjects, and 36% and 16% teeth; and for gingival recession ³3 mm and ³5 mm were 52% and 22% subjects, and 17% and 6% teeth, respectively. Aggressive periodontitis was diagnosed in 5.5% of subjects, which is significantly higher than the reported prevalence in most other populations. Among the main risk indicators for chronic as well as aggressive destructive periodontal diseases were: older age, low socioeconomic status, dental calculus, and smoking. Cigarette smoking accounted for an important part of periodontal disease burden, particularly in adults, and should be considered an important target in any prevention strategy aimed at reducing the burden of periodontal diseases. Partial recording methods consistently underestimated the prevalence of attachment loss in the population, and the extent of underestimation was dependent on the type of system used and the threshold of attachment loss. Conclusions: Destructive periodontal diseases are prevalent in this Brazilian population. Suitable disease prevention and health promotion programs should be established to improve the periodontal health in this population.

The Olympic impact on hosting candidate countries

In this paper, we analyze the impact of hosting the Summer Olympics on macroeconomic aggregates such as GDP, consumption, government consumption and investments per capita. The data is in panel structure and includes the period of ten years before and ten years after the event containing the Olympic Summer Games between 1960 and 1996. The sample countries comprise only candidates to host the games. This sampling strategy allows us to estimate the average treatment effect consistently, because it is assumed that these countries are comparable to each other, including those that ultimately hosted the games. The impact of hosting the Olympic games is measured by Fixed Effect and First Difference regressions. Moreover, we do a structural break test developed by Andrews (1993) to identify if hosting the Olympic Games creates anticipation effects for demand changes that stimulate current GDP, consumption, government consumption and investments. The results indicate a positive effect of the Summer Olympics in all variables of interest. However, the distribution in time and anticipation of these effects is unclear in the tests, changing significantly depending on the model and the significance level used.

Checklist das Cryptophyceae do estado de São Paulo, Brasil

Usando como base de informações a monografia sobre o grupo publicada pelo projeto Flora Ficológica do Estado de São Paulo (Programa BIOTA), o acervo depositado no Herbário Científico do Estado de São Paulo Maria Eneyda P. Kauffmann Fidalgo (SP), a Lista de Espécies da Flora do Brasil e artigos científicos, dissertações e teses (com descrições e ilustrações) temos: nove gêneros e 39 espécies de criptoficeas, sendo 16 espécies exclusivas para o Estado de São Paulo, todas registradas em ambientes de água doce. A carência de especialistas no Estado de São Paulo e no Brasil, além de problemas de estratégia amostral, necessidade de uso da microscopia eletrônica e ausência de estudos de biologia molecular, são fatores que devem ter subestimado o conhecimento taxonômico de Cryptophyceae no Estado.

Ocorrência de animais persistentemente infectados pelo vírus da diarréia viral bovina em rebanhos bovinos nos Estados de Minas Gerais e São Paulo

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Fatores associados à doença pulmonar em idosos

OBJETIVO: Investigar a prevalência de doença pulmonar referida entre idosos segundo características sociodemográficas, econômicas, estilo de vida, mobilidade física e condições de saúde. MÉTODOS: Trata-se de um estudo transversal, de base populacional, do qual participaram 1.957 idosos (60 anos ou mais). As informações foram coletadas por meio de entrevistas. Os participantes foram selecionados a partir de amostragem probabilística, estratificada, por conglomerados e obtida em dois estágios em seis municípios do Estado de São Paulo, no período de 2001 a 2002. Foram utilizadas estatísticas descritivas, testes de associação pelo chi2, razões de prevalência e intervalos de confiança de 95%. A análise ajustada foi conduzida por meio de regressão de Poisson. RESULTADOS: Dos entrevistados, cerca de 7% referiram doença pulmonar. Não houve associação entre doença pulmonar referida e vacinação contra influenza. A partir da análise ajustada foi possível identificar os seguintes fatores independentemente associados à referência da doença: tabagismo (RP=2,03; IC 95%: 1,39-2,97); uso de medicamentos (RP=2,05; IC 95%: 1,11-3,79); auto-avaliação do estado de saúde atual como ruim ou muito ruim (RP=1,89; IC 95%:1,20-2,96); e depressão, ansiedade ou problemas emocionais (RP=1,86; IC 95%: 1,11-3,10). CONCLUSÕES: Os achados do presente estudo reforçam a importância das doenças respiratórias em idosos, particularmente em grupos mais vulneráveis, justificando medidas preventivas e assistenciais específicas.

PM2.5 and PM10: The influence of sugarcane burning on potential cancer risk

In Brazil, sugarcane fields are often burned to facilitate manual harvesting, and this burning causes environmental pollution from the large amounts of soot released into the atmosphere. This material contains numerous organic compounds such as PAHs. In this study, the concentrations of PAHs in two particulate-matter fractions (PM2.5 and PM10) in the city of Araraquara (SE Brazil, with around 200,000 inhabitants and surrounded by sugarcane plantations) were determined during the sugarcane harvest (HV) and non-harvest (NHV) seasons in 2008 and 2009. The sampling strategy included four campaigns, with 60 samples in the NHV season and 220 samples in the HV season. The PM2.5 and PM10 fractions were collected using a dichotomous sampler (10 L min(-1), 24 h) with Teflon (TM) filters. The filter sets were extracted (ultrasonic bath with hexane/acetone (1:1 v/v)) and analyzed by HPLC/Fluorescence. The median concentration for total PAHs (PM2.5 in 2009) was 0.99 ng m(-3) (NHV) and 3.3 ng m(-3) (HV). In the HV season, the total concentration of carcinogenic PAHs (benz(a)anthracene, benzo(b)fluoranthene, benzo(k)fluoranthene, and benzo(a)pyrene) was 5 times higher than in the NHV season. B(a)P median concentrations were 0.017 ng m(-3) and 0.12 ng m(-3) for the NHV and HV seasons, respectively. The potential cancer risk associated with exposure through inhalation of these compounds was estimated based on the benzo[a]pyrene toxic equivalence (BaPeq), where the overall toxicity of a PAR mixture is defined by the concentration of each compound multiplied by its relative toxic equivalence factor (TEF). BaPeq median (2008 and 2009 years) ranged between 0.65 and 1.0 ng m(-3) and 1.2-1.4 ng m(-3) for the NHV and HV seasons, respectively. Considering that the maximum permissible BaPeq in ambient air is 1 ng m(-3), related to the increased carcinogenic risk, our data suggest that the level of human exposure to PAHs in cities surrounded by sugarcane crops where the burning process is used is cause for concern. (C) 2010 Published by Elsevier Ltd.

Contribution of sugar-cane harvesting season to atmospheric contamination by polycyclic aromatic hydrocarbons (PAHs) in Araraquara city, Southeast Brazil

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Gráficos de controle de EWMA e de X-barra para monitoramento de processos autocorrelacionados

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)