Évaluation du projet Hôpital promoteur de santé en contexte de périnatalité : analyse logique et analyse d’implantation

Problématique : Le concept d’« Hôpital promoteur de santé » (HPS) a émergé dans le sillon de la Charte d’Ottawa (1986) qui plaide notamment pour une réorientation des services de santé vers des services plus promoteurs de santé. Il cible la santé des patients, du personnel, de la communauté et de l’organisation elle-même. Dans le cadre de la réforme du système de santé au Québec qui vise à rapprocher les services de la population et à faciliter le cheminement de toute personne au sein d’un réseau local de services de santé et de services sociaux (RLS), l’adoption du concept HPS semble constituer une fenêtre d’opportunité pour les CHU, désormais inclus dans des réseaux universitaires intégrés de soins de santé et rattachés aux RLS, pour opérer des changements organisationnels majeurs. Face au peu de données scientifiques sur l’implantation des dimensions des projets HPS, les établissements de santé ont besoin d’être accompagnés dans ce processus par le développement de stratégies claires et d’outils concrets pour soutenir l’implantation. Notre étude porte sur le premier CHU à Montréal qui a décidé d’adopter le concept et d’implanter notamment un projet pilote HPS au sein de son centre périnatal. Objectifs : Les objectifs de la thèse sont 1) d’analyser la théorie d’intervention du projet HPS au sein du centre périnatal; 2) d’analyser l’implantation du projet HPS et; 3) d’explorer l’intérêt de l’évaluation développementale pour appuyer le processus d’implantation. Méthodologie : Pour mieux comprendre l’implantation du projet HPS, nous avons opté pour une étude de cas qualitative. Nous avons d’abord analysé la théorie d’intervention, en procédant à une revue de la littérature dans le but d’identifier les caractéristiques du projet HPS ainsi que les conditions nécessaires à son implantation. En ce qui concerne l’analyse d’implantation, notre étude de cas unique a intégré deux démarches méthodologiques : l’une visant à apprécier le niveau d’implantation et l’autre, à analyser les facteurs facilitants et les contraintes. Enfin, nous avons exploré l’intérêt d’une évaluation développementale pour appuyer le processus d’implantation. À partir d’un échantillonnage par choix raisonnés, les données de l’étude de cas ont été collectées auprès d’informateurs clés, des promoteurs du projet HPS, des gestionnaires, des professionnels et de couples de patients directement concernés par l’implantation du projet HPS au centre périnatal. Une analyse des documents de projet a été effectuée et nous avons procédé à une observation participante dans le milieu. Résultats : Le premier article sur l’analyse logique présente les forces et les faiblesses de la mise en oeuvre du projet HPS au centre périnatal et offre une meilleure compréhension des facteurs susceptibles d’influencer l’implantation. Le second article apprécie le niveau d’implantation des quatre dimensions du projet HPS. Grâce à la complémentarité des différentes sources utilisées, nous avons réussi à cerner les réussites globales, les activités partiellement implantées ou en cours d’implantation et les activités reposant sur une théorie d’intervention inadéquate. Le troisième article met en évidence l’influence des caractéristiques de l’intervention, des contextes externe et interne, des caractéristiques individuelles sur le processus d’implantation à partir du cadre d’analyse de l’implantation développé par Damschroder et al. (2009). Enfin, le dernier article présente les défis rencontrés par la chercheure dans sa tentative d’utilisation de l’évaluation développementale et propose des solutions permettant d’anticiper les difficultés liées à l’intégration des exigences de recherche et d’utilisation. Conclusion : Cette thèse contribue à enrichir la compréhension de l’implantation du projet HPS dans les établissements de santé et, particulièrement, en contexte périnatal. Les résultats obtenus sont intéressants pour les chercheurs et les gestionnaires d’hôpitaux ou d’établissements de santé qui souhaitent implanter ou évaluer les projets HPS dans leurs milieux.

Habeas Corpus Reform in El Salvador

In this paper I compare the habeas corpus systems of El Salvador, the United States and Argentina. My purpose is to develop a general understanding of the procedure for bringing the writ in each country and analyze the substantive law governing the rights of habeas corpus petitioners in each country. I evaluate the systems against the backdrop of each country’s political and legal history with respect to the writ of habeas corpus. The ultimate aim of this paper is to reform the habeas corpus law of El Salvador by analyzing the Salvadoran system as compared to the Argentine and U.S. systems. I conclude that the Argentine habeas corpus system provides a better model for the Salvadoran system than does the U.S. system. I draw this conclusion because the two countries share common foundations for their legal systems, in addition to common histories of civil war, during which there were numerous disappearances and denial of habeas corpus rights. Moreover, Argentina’s habeas corpus law protects the liberty interest of the detained individual more so than U.S. habeas corpus law. This heightened protection of the right to liberty largely results from the country’s past history of forced disappearances and incommunicado detention. Because El Salvador witnessed similar problems in its past, the Argentine model provides a good model for Salvadoran reform.

Performance Improvement of Fuzzy and Neuro Fuzzy Systems: Prediction of Learning Disabilities in School-age Children

Learning Disability (LD) is a classification including several disorders in which a child has difficulty in learning in a typical manner, usually caused by an unknown factor or factors. LD affects about 15% of children enrolled in schools. The prediction of learning disability is a complicated task since the identification of LD from diverse features or signs is a complicated problem. There is no cure for learning disabilities and they are life-long. The problems of children with specific learning disabilities have been a cause of concern to parents and teachers for some time. The aim of this paper is to develop a new algorithm for imputing missing values and to determine the significance of the missing value imputation method and dimensionality reduction method in the performance of fuzzy and neuro fuzzy classifiers with specific emphasis on prediction of learning disabilities in school age children. In the basic assessment method for prediction of LD, checklists are generally used and the data cases thus collected fully depends on the mood of children and may have also contain redundant as well as missing values. Therefore, in this study, we are proposing a new algorithm, viz. the correlation based new algorithm for imputing the missing values and Principal Component Analysis (PCA) for reducing the irrelevant attributes. After the study, it is found that, the preprocessing methods applied by us improves the quality of data and thereby increases the accuracy of the classifiers. The system is implemented in Math works Software Mat Lab 7.10. The results obtained from this study have illustrated that the developed missing value imputation method is very good contribution in prediction system and is capable of improving the performance of a classifier.

Design for design: support for creative practice in computer-supported collaborative work (CSCW) in design

This paper describes a novel methodology for observing and analysing collaborative design by using the concepts of cognitive dimensions related to concept-based misfit analysis. The study aims at gaining an insight into support for creative practice of graphical communication in collaborative design processes of designers while sketching within a shared white board and audio conferencing environment. Empirical data on design processes have been obtained from observation of groups of student designers solving an interior space-planning problem of a lounge-diner in a shared virtual environment. The results of the study provide recommendations for the design and development of interactive systems to support such collaborative design activities.

Design of a minimum variance multiple input-multiple output neuro self-tuning proportional-integral-derivative controller for non-linear dynamic systems

In this study a minimum variance neuro self-tuning proportional-integral-derivative (PID) controller is designed for complex multiple input-multiple output (MIMO) dynamic systems. An approximation model is constructed, which consists of two functional blocks. The first block uses a linear submodel to approximate dominant system dynamics around a selected number of operating points. The second block is used as an error agent, implemented by a neural network, to accommodate the inaccuracy possibly introduced by the linear submodel approximation, various complexities/uncertainties, and complicated coupling effects frequently exhibited in non-linear MIMO dynamic systems. With the proposed model structure, controller design of an MIMO plant with n inputs and n outputs could be, for example, decomposed into n independent single input-single output (SISO) subsystem designs. The effectiveness of the controller design procedure is initially verified through simulations of industrial examples.

Cultured neural networks

This article looks at the use of cultured neural networks as the decision-making mechanism of a control system. In this case biological neurons are grown and trained to act as an artificial intelligence engine. Such research has immediate medical implications as well as enormous potential in computing and robotics. An experimental system involving closed-loop control of a mobile robot by a culture of neurons has been successfully created and is described here. This article gives a brief overview of the problem area and ongoing research. Questions are asked as to where this will lead in the future.

A neural network enhanced generalized minimum variance self-tuning proportional, integral and derivative control algorithm for complex dynamic systems

A neural network enhanced proportional, integral and derivative (PID) controller is presented that combines the attributes of neural network learning with a generalized minimum-variance self-tuning control (STC) strategy. The neuro PID controller is structured with plant model identification and PID parameter tuning. The plants to be controlled are approximated by an equivalent model composed of a simple linear submodel to approximate plant dynamics around operating points, plus an error agent to accommodate the errors induced by linear submodel inaccuracy due to non-linearities and other complexities. A generalized recursive least-squares algorithm is used to identify the linear submodel, and a layered neural network is used to detect the error agent in which the weights are updated on the basis of the error between the plant output and the output from the linear submodel. The procedure for controller design is based on the equivalent model, and therefore the error agent is naturally functioned within the control law. In this way the controller can deal not only with a wide range of linear dynamic plants but also with those complex plants characterized by severe non-linearity, uncertainties and non-minimum phase behaviours. Two simulation studies are provided to demonstrate the effectiveness of the controller design procedure.

Self-tuning proportional, integral and derivative controller based on genetic algorithm least squares

A self-tuning proportional, integral and derivative control scheme based on genetic algorithms (GAs) is proposed and applied to the control of a real industrial plant. This paper explores the improvement in the parameter estimator, which is an essential part of an adaptive controller, through the hybridization of recursive least-squares algorithms by making use of GAs and the possibility of the application of GAs to the control of industrial processes. Both the simulation results and the experiments on a real plant show that the proposed scheme can be applied effectively.

Neurofuzzy control using Kalman filtering state feedback with coloured noise for unknown non-linear processes

This paper presents a controller design scheme for a priori unknown non-linear dynamical processes that are identified via an operating point neurofuzzy system from process data. Based on a neurofuzzy design and model construction algorithm (NeuDec) for a non-linear dynamical process, a neurofuzzy state-space model of controllable form is initially constructed. The control scheme based on closed-loop pole assignment is then utilized to ensure the time invariance and linearization of the state equations so that the system stability can be guaranteed under some mild assumptions, even in the presence of modelling error. The proposed approach requires a known state vector for the application of pole assignment state feedback. For this purpose, a generalized Kalman filtering algorithm with coloured noise is developed on the basis of the neurofuzzy state-space model to obtain an optimal state vector estimation. The derived controller is applied in typical output tracking problems by minimizing the tracking error. Simulation examples are included to demonstrate the operation and effectiveness of the new approach.

The concept of e-service from a social interaction perspective

Today’s e-services are complex phenomenon consisting of several different e-services linked together. The e-services are provided by IT systems and presented to customers through user interfaces. Within web design research criteria are laid out for the design of good user interfaces, but one problem is that these analyses are performed without a service focus. This lack of service focus can result in the designed user interfaces providing indistinct service concepts, especially where several e-services are intertwined with each other.In order to design IT system interfaces, we have to be clear about which e-services are provided by the IT system and how these e-services are related to each other. This paper presents a framework for the analysis of user interfaces in terms of focused e-service, service environment and two types of intertwined e-services; related e-services and interrelating e-services. The analyses are exemplified by an Internet based e-marketplace. The paper discusses how the framework can be combined with ordinary web design criteria and how it can be used for e-service development.

PV-Wind Hybrid Systems for Swedish Locations

PV-Wind-Hybrid systems for stand-alone applications have the potential to be more cost efficient compared to PV-alone systems. The two energy sources can, to some extent, compensate each others minima. The combination of solar and wind should be especially favorable for locations at high latitudes such as Sweden with a very uneven distribution of solar radiation during the year. In this article PV-Wind-Hybrid systems have been studied for 11 locations in Sweden. These systems supply the household electricity for single family houses. The aim was to evaluate the system costs, the cost of energy generated by the PV-Wind-Hybrid systems, the effect of the load size and to what extent the combination of these two energy sources can reduce the costs compared to a PV-alone system. The study has been performed with the simulation tool HOMER developed by the National Renewable Energy Laboratory (NREL) for techno-economical feasibility studies of hybrid systems. The results from HOMER show that the net present costs (NPC) for a hybrid system designed for an annual load of 6000 kWh with a capacity shortage of 10% will vary between $48,000 and $87,000. Sizing the system for a load of 1800 kWh/year will give a NPC of $17,000 for the best and $33,000 for the worst location. PV-Wind-Hybrid systems are for all locations more cost effective compared to PV-alone systems. Using a Hybrid system is reducing the NPC for Borlänge by 36% and for Lund by 64%. The cost per kWh electricity varies between $1.4 for the worst location and $0.9 for the best location if a PV-Wind-Hybrid system is used.

Evaluation of a micro PV-Wind hybrid system in Nordic climate conditions

A one year data analysis for a micro PV-Wind hybrid system (0.52 kW + 1 kW), installed in Borlänge/Sweden is presented in this paper. The system performance was evaluated according the guidelines of the IEC 61724 standard. The parameters obtained allow a comparison with similar systems. The measurement data are also used to evaluate the sizing and operation of the hybrid system. In addition, the system was modelled in HOMER to study sizing options.

Mobile Assisted Language Learning : A Literature Review

Mobile assisted language learning (MALL) is a subarea of the growing field of mobile learning (mLearning) research which increasingly attracts the attention of scholars. This study provides a systematic review of MALL research within the specific area of second language acquisition during the period 2007 - 2012 in terms of research approaches, methods, theories and models, as well as results in the form of linguistic knowledge and skills. The findings show that studies of mobile technology use in different aspects of language learning support the hypothesis that mobile technology can enhance learners’ second language acquisition. However, most of the reviewed studies are experimental, small-scale, and conducted within a short period of time. There is also a lack of cumulative research; most theories and concepts are used only in one or a few papers. This raises the issue of the reliability of findings over time, across changing technologies, and in terms of scalability. In terms of gained linguistic knowledge and skills, attention is primarily on learners’ vocabulary acquisition, listening and speaking skills, and language acquisition in more general terms.

Uma perspectiva pós-fordista na operação de sistemas elétricos

O objetivo deste trabalho é mostrar através de um estudo de caso que a implantação de um modelo de organização da produção e do trabalho baseado na gestão por processos pode acenar com uma perspectiva pós-fordista para a atividade de operação de sistemas de energia elétrica. As grandes empresas brasileiras do setor de energia elétrica adotaram, desde a sua criação, um modelo organizacional com base nas funções gerenciais propostas por Henri Fayol, sendo estruturadas de forma vertical e hierárquica. Por outro lado, as tarefas realizadas nas salas de controle dos Centros de Operação dessas empresas se processam de acordo com a forma preconizada pelo sistema de Administração Científica de Frederick Taylor e pelos princípios propostos por Henry Ford. Porém, em decorrência da mudança do modelo institucional do setor de energia, ocorrida em meados da década de 90, além da maior conscientização da sociedade a respeito dos seus direitos de cidadania e também da busca dos trabalhadores pela democratização nas relações sociais em seu ambiente de trabalho, as empresas de energia elétrica foram compelidas a buscar novas formas de gestão mais adequadas ao novo cenário cultural, político, social e econômico. Em FURNAS, como nova forma de organização da produção e do trabalho, o Departamento de Operação do Sistema resolveu adotar um sistema baseado na gestão por processos que respeita a estrutura funcional da Empresa, formando, assim, uma estrutura organizacional matricial. Por outro lado, observou-se que, dependendo da forma de implantação e dos mecanismos de gestão adotados, esse novo sistema podia acenar com uma perspectiva pós-fordista para a atividade de operação de sistemas elétricos de grande porte que, tipicamente, no Brasil, é desenvolvida por empresas fayolistas, segundo uma perspectiva taylorista-fordista. Para verificar se essa possibilidade se concretizou foi realizada uma pesquisa que abrangeu os cinco Centros de Operação do Departamento de Operação do Sistema de FURNAS Centrais Elétricas S.A., tomando como elemento-chave a seguinte caracterização do paradigma do pós-fordismo: diferenciação integrada da organização da produção e do trabalho sob a trajetória de inovação tecnológica em direção à ~ democratização das relações sociais nos sistemas-empresa. O trabalho apresenta a percepção da evolução nos relacionamentos interpessoais e a percepção das ações gerenciais empreendidas visando a implantação do novo sistema, bem como também mostra as transformações ocorridas no tocante à democratização das relaçõe~ sociais no Departamento, entre outros fatores que substanciam a pesquisa, cujo resultado aponta para uma nova forma de gestão do trabalho e da produção em que essas relações sociais tendem a ser pautadas por ações gerenciais dialógicas que caracterizam a perspectiva pós-fordista.