Mesure de la performance dans les organisations de réadaptation en déficience physique

La présente thèse vise à évaluer le degré d’implantation et d’utilisation de systèmes de mesure de la performance (SMP) par les décideurs des organisations de réadaptation et à comprendre les facteurs contextuels ayant influencé leur implantation. Pour ce faire, une étude de cas multiples a été réalisée comprenant deux sources de données: des entrevues individuelles avec des cadres supérieurs des organisations de réadaptation du Québec et des documents organisationnels. Le cadre conceptuel Consolidated Framework for Implementation Research a été utilisé pour guider la collecte et l’analyse des données. Une analyse intra-cas ainsi qu’une analyse inter-cas ont été réalisées. Nos résultats montrent que le niveau de préparation organisationnelle à l’implantation d’un SMP était élevé et que les SMP ont été implantés avec succès et utilisés de plusieurs façons. Les organisations les ont utilisés de façon passive (comme outil d’information), de façon ciblée (pour tenter d’améliorer des domaines sous-performants) et de façon politique (comme outil de négociation auprès des autorités gouvernementales). Cette utilisation diversifiée des SMP est suscitée par l’interaction complexe de facteurs provenant du contexte interne propre à chaque organisation, des caractéristiques du SMP, du processus d’implantation appliqué et du contexte externe dans lequel évoluent ces organisations. Au niveau du contexte interne, l’engagement continu et le leadership de la haute direction ont été décisifs dans l’implantation du SMP de par leur influence sur l’identification du besoin d’un SMP, l’engagement des utilisateurs visés dans le projet, la priorité organisationnelle accordée au SMP ainsi que les ressources octroyées à son implantation, la qualité des communications et le climat d’apprentissage organisationnel. Toutefois, même si certains de ces facteurs, comme les ressources octroyées à l’implantation, la priorité organisationnelle du SMP et le climat d’apprentissage se sont révélés être des barrières à l’implantation, ultimement, ces barrières n’étaient pas suffisamment importantes pour entraver l’utilisation du SMP. Cette étude a également confirmé l’importance des caractéristiques du SMP, particulièrement la perception de qualité et d’utilité de l’information. Cependant, à elles seules, ces caractéristiques sont insuffisantes pour assurer le succès d’implantation. Cette analyse d’implantation a également révélé que, même si le processus d’implantation ne suit pas des étapes formelles, un plan de développement du SMP, la participation et l’engagement des décideurs ainsi que la désignation d’un responsable de projet ont tous facilité son implantation. Cependant, l’absence d’évaluation et de réflexion collective sur le processus d’implantation a limité le potentiel d’apprentissage organisationnel, un prérequis à l’amélioration de la performance. Quant au contexte externe, le soutien d’un organisme externe s’est avéré un facilitateur indispensable pour favoriser l’implantation de SMP par les organisations de réadaptation malgré l’absence de politiques et incitatifs gouvernementaux à cet effet. Cette étude contribue à accroître les connaissances sur les facteurs contextuels ainsi que sur leurs interactions dans l’utilisation d’innovations tels les SMP et confirme l’importance d’aborder l’analyse de l’implantation avec une perspective systémique.

Stable isotope ratios of interstitial fluids from ODP Leg 110 sites

Delta18O values of pore waters from the northern Barbados accretionary prism range from -0.3 to -3.6? and reflect pervasive reaction of volcanic ash to form smectite within the sedimentary sequence and continued low temperature alteration of basalt in the underlying ocean crust with the overprint of diffusive exchange between water in the sediment pores and the open ocean. Delta D values of pore waters in sediments sampled seaward of the deformation front drop from +5? at the sediment surface to -6? at the deepest levels sampled. These changes may also be related to alteration processes but remain largely enigmatic. Sediment deformation caused by impingement of the Caribbean plate on the Atlantic plate has instigated migration of chemically and isotopically distinct fluid along faults and coarse-grained sedimentary beds; delta18O values of pore waters are also locally affected by thrust stacking which increases diffusive pathlengths and possibly modifies diagenetic reaction rates in Pleistocene sediments. Migrating fluids are distinguished by anomalous delta18O values that are as much as 1? higher than those of surrounding fluids. Uncertainties in hydrogen isotope fractionation resulting from processes occurring under these conditions hinder identification of the hydrogen isotope composition of expelled fluid. Stable isotope analyses of pore waters help constrain the fluid migration history of the accretionary prism by limiting the source of fluids, the paths along which fluid flows, and the timing of faulting and subsequent fluid flow.

Analysis of media coverage on breastfeeding policy in Washington State

Thesis (Master's)--University of Washington, 2016-06

CYP2D6: a global analysis of phenotypic and genotypic variation in search of radical cure of Plasmodium vivax malaria

Thesis (Master's)--University of Washington, 2016-06

Coordinations in business interactions between Hong Kong Chinese, Mainland Chinese and western actors

Hong Kong firms continue to play an important role in the development of mainland China trade. This paper studies the nature of coordinations in triadic interactions between Hong Kong Chinese intermediaries and mainland Chinese sellers, and buyers from the West, and their impact on relationships development. Contrary to popular belief, the results presented here identify that interactions between Hong Kong intermediaries and mainland Chinese sellers tend to include relationships based on price and authority. These interactions tend to be classical in nature, and serve to hinder the development of relationships. On the other hand, interactions between buyers from the West and Hong Kong intermediaries tend to be relational in nature. They include different forms of personal relationships, which tends to be positive for the development of relationships. A new plural form of international business relationship triad is also identified.

WTO oriented telecommunications reform in the Socialist Republic of Vietnam

Socialist Republic of Vietnam's reform process in the telecommunications sector - obligations imposed on Vietnam by the Bilateral Trade Agreement (BTA) - the regulatory framework required by the General Agreement on Trade in Services (GATS) and the associated, telecommunications-specific WTO agreements - institutional and political problems that may hinder full implementation of these international obligations.

Novel strategies in feedforward adaptation to a position-dependent perturbation

To investigate the control mechanisms used in adapting to position-dependent forces, subjects performed 150 horizontal reaching movements over 25 cm in the presence of a position-dependent parabolic force field (PF). The PF acted only over the first 10 cm of the movement. On every fifth trial, a virtual mechanical guide (double wall) constrained subjects to move along a straight-line path between the start and target positions. Its purpose was to register lateral force to track formation of an internal model of the force field, and to look for evidence of possible alternative adaptive strategies. The force field produced a force to the right, which initially caused subjects to deviate in that direction. They reacted by producing deviations to the left, into the force field, as early as the second trial. Further adaptation resulted in rapid exponential reduction of kinematic error in the latter portion of the movement, where the greatest perturbation to the handpath was initially observed, whereas there was little modification of the handpath in the region where the PF was active. Significant force directed to counteract the PF was measured on the first guided trial, and was modified during the first half of the learning set. The total force impulse in the region of the PF increased throughout the learning trials, but it always remained less than that produced by the PF. The force profile did not resemble a mirror image of the PF in that it tended to be more trapezoidal than parabolic in shape. As in previous studies of force-field adaptation, we found that changes in muscle activation involved a general increase in the activity of all muscles, which increased arm stiffness, and selectively-greater increases in the activation of muscles which counteracted the PF. With training, activation was exponentially reduced, albeit more slowly than kinematic error. Progressive changes in kinematics and EMG occurred predominantly in the region of the workspace beyond the force field. We suggest that constraints on muscle mechanics limit the ability of the central nervous system to employ an inverse dynamics model to nullify impulse-like forces by generating mirror-image forces. Consequently, subjects adopted a strategy of slightly overcompensating for the first half of the force field, then allowing the force field to push them in the opposite direction. Muscle activity patterns in the region beyond the boundary of the force field were subsequently adjusted because of the relatively-slow response of the second-order mechanics of muscle impedance to the force impulse.

Segmented polyurethane nanocomposites: Impact of controlled particle size nanofillers on the morphological response to uniaxial deformation

A series of TPU nanocomposites were prepared by incorporating organically modified layered silicates with controlled particle size. To our knowledge, this is the first study into the effects of layered silicate diameter in polymer nanocomposites utilizing the same mineral for each size fraction. The tensile properties of these materials were found to be highly dependent upon the size of the layered silicates. A decrease in disk diameter was associated with a sharp upturn in the stress-strain curve and a pronounced increase in tensile strength. Results from SAXS/SANS experiments showed that the layered silicates did not affect the bulk TPU microphase structure and the morphological response of the host TPU to deformation or promote/hinder strain-induced soft segment crystallization. The improved tensile properties of the nanocomposites containing the smaller nanofillers resulted from the layered silicates aligning in the direction of strain and interacting with the TPU sequences via secondary bonding. This phenomenon contributes predominantly above 400% strain once the microdomain architecture has largely been disassembled. Large tactoids that are unable to align in the strain direction lead to concentrated tensile stresses between the polymer and filler, instead of desirable shear stresses, resulting in void formation and reduced tensile properties. In severe cases, such as that observed for the composite containing the largest silicate, these voids manifest visually as stress whitening.

Interagency collaboration between child protection and mental health services: Practices, attitudes and barriers

Objective: The aim of this paper is to examine some of the factors that facilitate and hinder interagency collaboration between child protection services and mental health services in cases where there is a parent with a mental illness and there are protection concerns for the child(ren). The paper reports on agency practices, worker attitudes and experiences, and barriers to effective collaboration. Method: A self-administered, cross-sectional survey was developed and distributed via direct mail or via line supervisors to workers in statutory child protection services, adult mental health services, child and youth mental health services, and Suspected Child Abuse and Neglect (SCAN) Teams. There were 232 completed questionnaires returned, with an overall response rate of 21%. Thirty-eight percent of respondents were statutory child protection workers. 39% were adult mental health workers, 16% were child and youth mental health workers, and 4% were SCAN Team medical officers (with 3% missing data). Results: Analysis revealed that workers were engaging in a moderate amount of interagency contact, but that they were unhappy with the support provided by their agency. Principle components analysis and multivariate analysis of variance (MANOVA) on items assessing attitudes toward other workers identified four factors, which differed in rates of endorsement: inadequate training, positive regard for child protection workers, positive regard for mental health workers, and mutual mistrust (from highest to lowest level of endorsement). The same procedure identified the relative endorsement of five factors extracted from items about potential barriers: inadequate resources, confidentiality, gaps in interagency processes, unrealistic expectations, and professional knowledge domains and boundaries. Conclusions: Mental health and child protection professionals believe that collaborative practice is necessary; however, their efforts are hindered by a lack of supportive structures and practices at the organizational level. (c) 2005 Published by Elsevier Ltd.

Early combination disease modifying antirheumatic drug treatment for rheumatoid arthritis

Most people presenting with rheumatoid arthritis today can expect to achieve disease suppression, can avoid or substantially delay joint damage and deformities, and can maintain a good quality of life. Optimal management requires early diagnosis and treatment, usually with combinations of conventional disease modifying antirheumatic drugs (DMARDs). If these do not effect remission, biological DMARDs may be beneficial. Lack of recognition of the early signs of rheumatoid arthritis, ignorance of the benefits of early application of modern treatment regimens, and avoidable delays in securing specialist appointments may hinder achievement of best outcomes for many patients. Triage for recognising possible early rheumatoid arthritis must begin in primary care settings with the following pattern of presentation as a guide: involvement of three or more joints; early-morning joint stiffness of greater than 30 minutes; or bilateral squeeze tenderness at metacarpophalangeal or metatarsophalangeal joints.

On the equilibrium and dynamic behavior of alcohol vapors in activated carbon

As alcohol molecules such as methanol and ethanol have both polar and non-polar groups, their adsorption behavior is governed by the contributions of dispersion interaction (alkyl group) and hydrogen bonding (OH group). In this paper, the adsorption behavior of alcohol molecules and its effect on transport processes are elucidated. From the total permeability (B-T) of alcohol molecules in activated carbon, an adsorption mechanism is proposed, describing well the experimental data, by taking combination effects of clustering, entering micropores, layering and pore filling processes. Unlike the case of non-polar compounds, it was found that at low pressures there are two rises in the BT of alcohol molecules in activated carbon. The first rise is due to the major contribution of surface diffusion to the transport (which is the case of non-polar molecules) and the second one may be associated with cluster formation at the edge of micropores and entering micropores when the clusters are sufficiently large enough to induce a dispersive energy. In addition the clusters formed may enhance surface diffusion at low pressures and hinder gas phase diffusion and flow in meso/macropores. (c) 2006 Elsevier Ltd. All fights reserved.

Position information but not force information is used in adapting to changes in environmental dynamics

This study investigated how movement error is evaluated and used to change feedforward commands following a change in the environmental dynamics. In particular, we addressed the question of whether only position-error information is used or whether information about the force-field direction can also be used for rapid adaptation to changes in the environmental dynamics. Subjects learned to move in a position-dependent force field (PF) with a parabolic profile and the dynamics of a negative spring, which produced lateral force to the left of the target hand path. They adapted very rapidly, dramatically reducing lateral error after a single trial. Several times during training, the strength of the PF was unexpectedly doubled (PF2) for two trials. This again created a large leftward deviation, which was greatly reduced on the second PF2 trial, and an aftereffect when the force field subsequently returned to its original strength. The aftereffect was abolished if the second PF2 trial was replaced by an oppositely directed velocity-dependent force field (VF). During subsequent training in the VF, immediately after having adapted to the PF, subjects applied a force that assisted the force field for similar to 15 trials, indicating that they did not use information about the force-field direction. We concluded that the CNS uses only the position error for updating the internal model of the environmental dynamics and modifying feedforward commands. Although this strategy is not necessarily optimal, it may be the most reliable strategy for iterative improvement in performance.

Promoting Learning for Sustainability: Principals' Perceptions of the Role of Outdoor and Environmental Education Centres

Outdoor and Environmental Education Centres provide programs that are designed to address a range of environmental education aims, and contribute broadly to student learning for sustainability. This paper examines the roles such Centres can play, and how they might contribute to the Australian Government’s initiative in relation to sustainable schools. Interviews with the principals of 23 such Centres in Queensland revealed three roles or models under which they operate: the destination model; the expert/advisor model; and the partnership model. Principals’ understandings of these roles are discussed and the factors that support or hinder their implementation are identified. It is concluded that while the provision of programs in the environment is still a vital role of outdoor and environmental education centres, these can also be seen as a point of entry to long-term partnerships with whole school communities.

Effect of microstructure on material removal mechanisms in nano/micro grinding of tungsten carbide mould inserts

Nano/micro grinding of tungsten carbide (WC) mould inserts was performed. A form accuracy of 〜200nm (in PV) and a surface roughness of 〜7nm were achieved. Nanoindentation revealed that small chipping or cracking occurred even at a penetration depth of 38nm, which could hinder the further improvement of surface quality during grinding. It was found that when grinding was conducted at nanometric scale, the microstructure of the work material and the morphology of the WC grains should be taken into account to enable a fully ductile removal. Copyright 2005 by the Japan Society of Mechanical Engineers