Évaluation de la simulation à haute fidélité pour améliorer la communication interprofessionnelle aux soins intensifs : étude expérimentale à double insu

Objectifs: Les patients hospitalisés aux soins intensifs (SI) sont souvent victimes d’erreurs médicales. La nature interprofessionnelle des équipes de SI les rend vulnérables aux erreurs de communication. L’objectif primaire du projet est d’améliorer la communication dans une équipe interprofessionnelle de soins intensifs par une formation en simulation à haute fidélité. Méthodologie Une étude prospective randomisée contrôlée à double insu a été réalisée. Dix équipes de six professionnels de SI ont complété trois scénarios de simulations de réanimation. Le groupe intervention était débreffé sur des aspects de communication alors que le groupe contrôle était débreffé sur des aspects techniques de réanimation. Trois mois plus tard, les équipes réalisaient une quatrième simulation sans débreffage. Les simulations étaient toutes évaluées pour la qualité, l’efficacité de la communication et le partage des informations critiques par quatre évaluateurs. Résultats Pour l’issue primaire, il n’y a pas eu d’amélioration plus grande de la communication dans le groupe intervention en comparaison avec le groupe contrôle. Une amélioration de 16% de l’efficacité des communications a été notée dans les équipes de soins intensifs indépendamment du groupe étudié. Les infirmiers et les inhalothérapeutes ont amélioré significativement l’efficacité de la communication après trois sessions. L’effet observé ne s’est pas maintenu à trois mois. Conclusion Une formation sur simulateur à haute fidélité couplée à un débreffage peut améliorer à court terme l’efficacité des communications dans une équipe interprofessionnelle de SI.

Mechanical simulation of the endovascular repair of abdominal aortic aneurysms

Ce travail de thèse porte sur la simulation du déploiement des prothèses vasculaires de type stent-graft (SG) lors de la réparation endovasculaire (EVAR) des anévrismes de l’aorte abdominale (AAA). Cette étude se présente en trois parties: (i) tests mécaniques en flexion et compression de SG couramment utilisés (corps et jambage de marque Cook) ainsi que la simulation numérique desdits tests, (ii) développement d’un modèle numérique d’anévrisme, (iii) stratégie de simulation du déploiement des SG. La méthode numérique employée est celle des éléments finis. Dans un premier temps, une vérification du modèle éléments finis (MEF) des SG est realisée par comparaison des différents cas de charge avec leur pendant expérimental. Ensuite, le MEF vasculaire (AAA) est lui aussi vérifié lors d’une comparaison des niveaux de contraintes maximales principales dans la paroi avec des valeurs de la littérature. Enfin, le déploiement est abordé tout en intégrant les cathéters. Les tests mécaniques menés sur les SG ont été simulés avec une différence maximale de 5,93%, tout en tenant compte de la pré-charge des stents. Le MEF de la structure vasculaire a montré des contraintes maximales principales éloignées de 4,41% par rapport à un modèle similaire précédemment publié. Quant à la simulation du déploiement, un jeu complet de SG a pu être déployé avec un bon contrôle de la position relative et globale, dans un AAA spécifique pré-déformé, sans toutefois inclure de thrombus intra-luminal (TIL). La paroi du AAA a été modélisée avec une loi de comportement isotropique hyperélastique. Étant donné que la différence maximale tolérée en milieu clinique entre réalité et simulation est de 5%, notre approche semble acceptable et pourrait donner suite à de futurs développements. Cela dit, le petit nombre de SG testés justifie pleinement une vaste campagne de tests mécaniques et simulations supplémentaires à des fins de validation.

Méthodes rapides et efficaces pour la résolution numérique d'équations de type Hamilton-Jacobi avec application à la simulation de feux de forêt

Cette thèse est divisée en trois chapitres. Le premier explique comment utiliser la méthode «level-set» de manière rigoureuse pour faire la simulation de feux de forêt en utilisant comme modèle physique pour la propagation le modèle de l'ellipse de Richards. Le second présente un nouveau schéma semi-implicite avec une preuve de convergence pour la solution d'une équation de type Hamilton-Jacobi anisotrope. L'avantage principal de cette méthode est qu'elle permet de réutiliser des solutions à des problèmes «proches» pour accélérer le calcul. Une autre application de ce schéma est l'homogénéisation. Le troisième chapitre montre comment utiliser les méthodes numériques des deux premiers chapitres pour étudier l'influence de variations à petites échelles dans la vitesse du vent sur la propagation d'un feu de forêt à l'aide de la théorie de l'homogénéisation.

Spectrum simulation of rough and nanostructured targets from their 2D and 3D image by Monte Carlo methods

Corteo is a program that implements Monte Carlo (MC) method to simulate ion beam analysis (IBA) spectra of several techniques by following the ions trajectory until a sufficiently large fraction of them reach the detector to generate a spectrum. Hence, it fully accounts for effects such as multiple scattering (MS). Here, a version of Corteo is presented where the target can be a 2D or 3D image. This image can be derived from micrographs where the different compounds are identified, therefore bringing extra information into the solution of an IBA spectrum, and potentially significantly constraining the solution. The image intrinsically includes many details such as the actual surface or interfacial roughness, or actual nanostructures shape and distribution. This can for example lead to the unambiguous identification of structures stoichiometry in a layer, or at least to better constraints on their composition. Because MC computes in details the trajectory of the ions, it simulates accurately many of its aspects such as ions coming back into the target after leaving it (re-entry), as well as going through a variety of nanostructures shapes and orientations. We show how, for example, as the ions angle of incidence becomes shallower than the inclination distribution of a rough surface, this process tends to make the effective roughness smaller in a comparable 1D simulation (i.e. narrower thickness distribution in a comparable slab simulation). Also, in ordered nanostructures, target re-entry can lead to replications of a peak in a spectrum. In addition, bitmap description of the target can be used to simulate depth profiles such as those resulting from ion implantation, diffusion, and intermixing. Other improvements to Corteo include the possibility to interpolate the cross-section in angle-energy tables, and the generation of energy-depth maps.

Simulation of the postoperative trunk appearance in scoliosis surgery

Persistence of external trunk asymmetry after scoliosis surgical treatment is frequent and difficult to predict by clinicians. This is a significant problem considering that correction of the apparent deformity is a major factor of satisfaction for the patients. A simulation of the correction on the external appearance would allow the clinician to illustrate to the patient the potential result of the surgery and would help in deciding on a surgical strategy that could most improve his/her appearance. We describe a method to predict the scoliotic trunk shape after a spine surgical intervention. The capability of our method was evaluated using real data of scoliotic patients. Results of the qualitative evaluation were very promising and a quantitative evaluation based on the comparison of the simulated and the actual postoperative trunk surface showed an adequate accuracy for clinical assessment. The required short simulation time also makes our approach an eligible candidate for a clinical environment demanding interactive simulations.

Décès pendant une simulation médicale : perspectives des apprenants et impacts sur le stress et la performance des réanimateurs

L’acceptabilité d’un décès lors d’une simulation médicale reste débattue mais il existe peu de données sur la perspective des apprenants. Des médecins résidents ont effectué une pratique de code et ont rempli un questionnaire pré et post-simulation. Ils ont été exposés à deux scénarios où un bébé naissait sans signe de vie: 1. Nouveau-né ne répondant pas aux manœuvres de réanimation (DCD); 2. Nouveau-né s’améliorant avec une réanimation adéquate (REA). Les performances étaient évaluées à l’aide de la grille standardisée du Programme de Réanimation Néonatale. Le stress objectif (cortisol salivaire) et subjectif a été mesuré après le code. La rétroaction («feedback»), individuelle et en groupe, fut analysée à l’aide de méthodologies qualitatives. 59/62 apprenants ont répondu au questionnaire et 42 ont participé à la simulation. Tous les résidents trouvent les simulations bénéfiques et souhaitent y être exposés davantage. Le type et l’ordre des scénarios n’ont pas eu d’impact sur la performance. Un seul résident a interrompu les manœuvres de réanimation après 10 minutes d’asystolie, tel que recommandé, et 31% ont poursuivi après 20 minutes. Les participants trouvaient le scénario DCD plus stressant. Les niveaux de cortisol salivaire ont augmenté après les simulations (p<0.001) et ce, pour les deux scénarios. Cette augmentation était indépendante du scénario (p=0.06) et n’était pas associée à la performance. Les réponses à la question « Comment a été votre expérience? », ont permis d’identifier deux thèmes: 1. Le mannequin ne meurt pas en simulation médicale; 2. Le décès lors de la simulation signifie une réanimation inadéquate. Le décès lors d’une pratique de code est stressant, mais n’interfère pas avec la performance des soignants. Les apprenants trouvent cet exercice acceptable et bénéfique à leur pratique future.

Spray Pyrolysed Zinc Oxide Thin Films : Effects of Doping and Ion Beam Irradiation

In recent years scientists have made rapid and significant advances in the field of semiconductor physics. One of the most important fields of current interest in materials science is the fundamental aspects and applications of conducting transparent oxide thin films (TCO). The characteristic properties of such coatings are low electrical resistivity and high transparency in the visible region. The first semitransparent and electrically conducting CdO film was reported as early as in 1907 [1]. Though early work on these films was performed out of purely scientific interest, substantial technological advances in such films were made after 1940. The technological interest in the study of transparent semiconducting films was generated mainly due to the potential applications of these materials both in industry and research. Such films demonstrated their utility as transparent electrical heaters for windscreens in the aircraft industry. However, during the last decade, these conducting transparent films have been widely used in a variety of other applications such as gas sensors [2], solar cells [3], heat reflectors [4], light emitting devices [5] and laser damage resistant coatings in high power laser technology [6]. Just a few materials dominate the current TCO industry and the two dominant markets for TCO’s are in architectural applications and flat panel displays. The architectural use of TCO is for energy efficient windows. Fluorine doped tin oxide (FTO), deposited using a pyrolysis process is the TCO usually finds maximum application. SnO2 also finds application ad coatings for windows, which are efficient in preventing radiative heat loss, due to low emissivity (0.16). Pyrolitic tin oxide is used in PV modules, touch screens and plasma displays. However indium tin oxide (ITO) is mostly used in the majority of flat panel display (FPD) applications. In FPDs, the basic function of ITO is as transparent electrodes. The volume of FPD’s produced, and hence the volume of ITO coatings produced, continues to grow rapidly. But the current increase in the cost of indium and the scarcity of this material created the difficulty in obtaining low cost TCOs. Hence search for alternative TCO materials has been a topic of active research for the last few decades. This resulted in the development of binary materials like ZnO, SnO2, CdO and ternary materials like II Zn2SnO4, CdSb2O6:Y, ZnSO3, GaInO3 etc. The use of multicomponent oxide materials makes it possible to have TCO films suitable for specialized applications because by altering their chemical compositions, one can control the electrical, optical, chemical and physical properties. But the advantages of using binary materials are the easiness to control the chemical compositions and depositions conditions. Recently, there were reports claiming the deposition of CdO:In films with a resistivity of the order of 10-5 ohm cm for flat panel displays and solar cells. However they find limited use because of Cd-Toxicity. In this regard, ZnO films developed in 1980s, are very useful as these use Zn, an abundant, inexpensive and nontoxic material. Resistivity of this material is still not very low, but can be reduced through doping with group-III elements like In, Al or Ga or with F [6]. Hence there is a great interest in ZnO as an alternative of ITO. In the present study, we prepared and characterized transparent and conducting ZnO thin films, using a cost effective technique viz Chemical Spray Pyrolysis (CSP). This technique is also suitable for large area film deposition. It involves spraying a solution, (usually aqueous) containing soluble salts of the constituents of the desired compound, onto a heated substrate.

Fabrication and Characterization of Spray Pyrolysed Cadmium Sulphide Homojunction Solar Cells

The study on the fabrication and characterization of spray pyrolysed cadmium sulphide homojunction solar cells. As an alternative to the conventional energy source, the PV technology has to be improved. Study about the factors affecting the performance of the existing solar cells and this will result in the enhancement of efficiency of the cells. At the same time it is equally important to have R&D works on developing new photovoltaic devices and processes which are less expensive for large scale production. CdS is an important binary compound semiconductor, which is very useful in the field of photovoltaics. It is very easy to prepare large area CdS thin films. In order to fabricate thin film homojunction cadmium sulphide cells, prepared and characterized SnO2 thin film as the lower electrode, p-CdS as the active layer and n-CdS as window layer. Cadmium material used for the fabrication of homojunction solar cells is highly toxic. The major damage due to continued exposure to low levels of cadmium are on the kidneys, lungs and bones. The real advantage of spray pyrolysis process is that there is no emission of any toxic gases during the deposition. Very low concentration of the chemicals is needed in this process. The risk involved from this material is very low, though they are toxic. On large scale usage it may become necessary that the cells after their life, should be bought back by the companies to retrieve chemicals like cadmium. This will reduce environmental problem and also the material wastage

Automation of Chemical Spray Pyrolysis Unit and Fabrication of Sprayed CuInS2/In2S3 Solar Cell

Aim of the present work was to automate CSP process, to deposit and characterize CuInS2/In2S3 layers using this system and to fabricate devices using these films.An automated spray system for the deposition of compound semiconductor thin films was designed and developed so as to eliminate the manual labour involved in spraying and facilitate standardization of the method. The system was designed such that parameters like spray rate, movement of spray head, duration of spray, temperature of substrate, pressure of carrier gas and height of the spray head from the substrate could be varied. Using this system, binary, ternary as well as quaternary films could be successfully deposited.The second part of the work deal with deposition and characterization of CuInS2 and In2S3 layers respectively.In the case of CuInS2 absorbers, the effects of different preparation conditions and post deposition treatments on the optoelectronic, morphological and structural properties were investigated. It was observed that preparation conditions and post deposition treatments played crucial role in controlling the properties of the films. The studies in this direction were useful in understanding how the variation in spray parameters tailored the properties of the absorber layer. These results were subsequently made use of in device fabrication process.Effects of copper incorporation in In2S3 films were investigated to find how the diffusion of Cu from CuInS2 to In2S3 will affect the properties at the junction. It was noticed that there was a regular variation in the opto-electronic properties with increase in copper concentration.Devices were fabricated on ITO coated glass using CuInS2 as absorber and In2S3 as buffer layer with silver as the top electrode. Stable devices could be deposited over an area of 0.25 cm2, even though the efficiency obtained was not high. Using manual spray system, we could achieve devices of area 0.01 cm2 only. Thus automation helped in obtaining repeatable results over larger areas than those obtained while using the manual unit. Silver diffusion on the cells before coating the electrodes resulted in better collection of carriers.From this work it was seen CuInS2/In2S3 junction deposited through automated spray process has potential to achieve high efficiencies.

CFD Simulation of Multiphase Reactors

Regional Research Laboratory

Spray Pyrolysed CuInS2/In2S3 Solar Cell: Material Characterization and Device Fabrication

As emphasis towards sustainable and Renewable energy resources grows world-wide,interest in the capture and use of solar energy is increasing dramatically.Solar cells have been known and used for many years,but depletion of conventional energy resources resulted in the intensification of research on solar cells leading to new design and technique of fabrication.The current emphasis is directed towards high effiency inexpensive solar cells.This thesis includes deposition and characterization of CuInS2 and In2S3 thin films using chemical Spray Pyrolysis(CSP) technique.The optimum condition for these films to be used as absorber and buffer layer respectively in solar cells were thus found out.Solar cell with the stucture,ITO/CuInS2/In2S3/metal electrode was fabricated using these well-characterized films,which yielded an efficiency of 9.5%.

Drought Climatology of Indo-Gangetic Region of India Using Remote Sensing and Crop Growth Simulation Models

Department of Atmospheric Sciences, Cochin University of Science and Technology

Studies Using Computer Simulation Models to Solve Problems Related to Logistics Terminals

This thesis deals with the use of simulation as a problem-solving tool to solve a few logistic system related problems. More specifically it relates to studies on transport terminals. Transport terminals are key elements in the supply chains of industrial systems. One of the problems related to use of simulation is that of the multiplicity of models needed to study different problems. There is a need for development of methodologies related to conceptual modelling which will help reduce the number of models needed. Three different logistic terminal systems Viz. a railway yard, container terminal of apart and airport terminal were selected as cases for this study. The standard methodology for simulation development consisting of system study and data collection, conceptual model design, detailed model design and development, model verification and validation, experimentation, and analysis of results, reporting of finding were carried out. We found that models could be classified into tightly pre-scheduled, moderately pre-scheduled and unscheduled systems. Three types simulation models( called TYPE 1, TYPE 2 and TYPE 3) of various terminal operations were developed in the simulation package Extend. All models were of the type discrete-event simulation. Simulation models were successfully used to help solve strategic, tactical and operational problems related to three important logistic terminals as set in our objectives. From the point of contribution to conceptual modelling we have demonstrated that clubbing problems into operational, tactical and strategic and matching them with tightly pre-scheduled, moderately pre-scheduled and unscheduled systems is a good workable approach which reduces the number of models needed to study different terminal related problems.

Monte Carlo simulation of interface alloying

An Ising-like model, with interactions ranging up to next-nearest-neighbor pairs, is used to simulate the process of interface alloying. Interactions are chosen to stabilize an intermediate "antiferromagnetic" ordered structure. The dynamics proceeds exclusively by atom-vacancy exchanges. In order to characterize the process, the time evolution of the width of the intermediate ordered region and the diffusion length is studied. Both lengths are found to follow a power-law evolution with exponents depending on the characteristic features of the model.