Perceptions de personnes vivant avec une MPOC sévère au regard de leur fin de vie

Vivre avec une maladie pulmonaire obstructive chronique (MPOC), c’est vivre avec une maladie chronique, dégénérative et irréversible. La dyspnée qui l’accompagne demande une adaptation continuelle à de multiples incapacités. La qualité de vie des personnes vivant avec la MPOC s’en trouve compromise. Au Québec, le taux de mortalité de la MPOC a doublé depuis 20 ans. Si plusieurs études se sont intéressées à la symptomatologie vécue dans la dernière année de vie, aucune n’a abordé spécifiquement les perceptions de personnes vivant avec une MPOC sévère au regard de leur fin de vie. La présente étude avait justement pour but de décrire ces perceptions dans la perspective de la théorie de l’humain en devenir. Cette étude qualitative descriptive fut réalisée auprès de six personnes dans un centre hospitalier universitaire de la région de Montréal. L’analyse des entrevues a été réalisée selon la méthode de Miles et Huberman (2003) à partir de la transcription intégrale des entrevues. Cette analyse a permis de dégager quatre thèmes qui reflètent les perceptions des participants au regard de leur fin de vie, soit: 1) vivre et se voir décliner, 2) vivre et se préparer à mourir, 3) mourir d’une MPOC c’est étouffer et 4) mourir entouré à l’hôpital. Cette étude a mis en évidence que les personnes vivant avec une MPOC sévère souhaitent mourir à l’hôpital entouré de leurs proches. Cette étude contribue à une connaissance plus globale de l’expérience de fin de vie. De plus, elle propose des recommandations pour la recherche, la pratique, la formation et la gestion infirmière.

A randomized controlled trial evaluating the quality of life and the sense of coherence in seniors wearing complete conventional dentures or mandibular two-implant overdentures

La supériorité des prothèses mandibulaires retenues par deux implants (IODs) sur les prothèses conventionnelles (CDs) nécessitent d’être éclaircies notamment en rapport à leur influence sur la qualité de vie reliée à la santé bucco-dentaire (OHRQoL) ainsi que sur la stabilité de cet effet de traitement. De plus, l’influence des facteurs psychologiques, tel que le sens de cohérence (SOC), sur l’effet de traitement reste encore inconnue. Le but de cette étude est de déterminer l’amplitude de l’influence du port des IODs et des CDs sur l’OHRQoL et d’évaluer la stabilité de l’effet de traitement dans le temps, tout en prenant en considération le niveau du SOC. MÉTHODOLOGIE: Des participants édentés (n=172, âge moyen 71, SD = 4.5) ayant reçu des CDs ou des IODs ont été suivis sur une période de deux ans. L’OHRQoL a été évaluée à l’aide du questionnaire « Oral Health Impact Profile (OHIP -20) » et ce avant le traitement et à chacun des deux suivis. Le SOC a été évalué à l’aide du questionnaire « The Orientation to Life (SOC -13) » à chacun des deux suivis. Des analyses statistiques ont été effectuées pour évaluer les différences intra et entre groupes (analyses statistiques descriptives, bivariées et multivariées). RÉSULTATS: Une amélioration statistiquement significative de l’OHRQoL entre les statuts avant et après traitement a été notée dans les deux groupes (Wilks’s Lambda = 0.473, F (1,151) = 157.31, p < 0.0001). L’amplitude de l’effet du traitement IOD est 1.5 fois plus grande que celle du traitement CD. Ces résultats ont été stables pendant les deux années d’étude et ils n’ont pas été influencés par le SOC. CONCLUSION: Le traitement IOD amène une meilleure OHRQoL à long terme en comparaison avec le traitement CD et ce sans influence du niveau du SOC. Ces résultats sont cliniquement significatifs et confirment la supériorité des IODs sur les CDs.

Gender, genre and the (re)invention of life in Charlotte Salomon's Life? or Theatre?

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Prise en charge clinique en physiothérapie oncologique: promotion d’une décision partagée dans le contexte des soins palliatifs

Article

Parental projections of developmental outcome, quality of life and coping in children who require neonatal intensive care

Aux soins intensifs néonataux, les professionnels et les parents évaluent le pronostic du développement et de la qualité de vie (QdV). Le but de cette thèse est de comprendre comment les parents prédisent la QdV future de leurs enfants. Cette étude qualitative basée sur la théorisation ancrée comprend dix entrevues avec des parents. Les résultats indiquent que le pronostic développemental influence les prédictions parentales de QdV, mais il n’est pas suffisant, car la QdV est multidimensionnelle. Les parents utilisent des mécanismes d’adaptation pour gérer la maladie et l’hospitalisation de leur enfant. Ceux qui pensent qu’ils, et leur enfant, seront capables de s’adapter à un mauvais état développemental, prévoient une QdV réévaluée. Le pronostic neuro-développemental et la QdV future ne sont pas facilement estimés et les professionnels doivent en être conscients. Aider les parents à identifier des mécanismes d’adaptation peut les amener à estimer un meilleur pronostic de la QdV.

Development of Best Practices for Ship Recycling Processes

Ship recycling has been considered as the best means to dispose off an obsolete ship. The current state of art of technology combined with the demands of sustainable developments from the global maritime industrial sector has modified the status of erstwhile ‘ship breaking’ involving ship scrap business to a modern industry undertaking dismantling of ships and recycling/reusing the dismantled products in a supply chain of pre owned product market by following the principles of recycling. Industries will have to formulate a set of best practices and blend them with the engineering activities for producing better quality products, improving the productivity and for achieving improved performances related to sustainable development. Improved performance by industries in a sustainable development perspective is accomplished only by implementing the 4E principles, ie.,. ecofriendliness, engineering efficiency, energy conservation and ergonomics in their core operations. The present study has done a comprehensive investigation into various ship recycling operations for formulating a set of best practices.Being the ultimate life cycle stage of a ship, ship recycling activities incorporate certain commercial procedures well in advance to facilitate the objectives of dismantling and recycling/reusing of various parts of the vessel. Thorough knowledge regarding these background procedures in ship recycling is essential for examining and understanding the industrial business operations associated with it. As a first step, the practices followed in merchant shipping operations regarding the decision on decommissioning have been and made available in the thesis. Brief description about the positioning methods and important preparations for the most feasible ship recycling method ie.,. beach method have been provided as a part of the outline of the background information. Available sources of guidelines, codes and rules & regulations for ship recycling have been compiled and included in the discussion.Very brief summary of practices in major ship recycling destinations has been prepared and listed for providing an overview of the global ship recycling activities. The present status of ship recycling by treating it as a full fledged engineering industry has been brought out to establish the need for looking into the development of the best practices. Major engineering attributes of ship as a unique engineering product and the significant influencing factors on her life cycle stage operations have been studied and added to the information base on ship recycling. Role of ship recycling industry as an important player in global sustainable development efforts has been reviewed by analysing the benefits of ship recycling. A brief synopsis on the state of art of ship recycling in major international ship recycling centres has also been incorporated in the backdrop knowledgebase generation on ship recycling processes.Publications available in this field have been reviewed and classified into five subject categories viz., Infrastructure for recycling yards and methods of dismantling, Rules regarding ship recycling activities, Environmental and safety aspects of ship recycling, Role of naval architects and ship classification societies, Application of information technology and Demand forecasting. The inference from the literature survey have been summarised and recorded. Noticeable observations in the inference include need of creation of a comprehensive knowledgebase on ship recycling and its effective implementation in the industry and the insignificant involvement of naval architects and shipbuilding engineers in ship recycling industry. These two important inferences and the message conveyed by them have been addressed with due importance in the subsequent part of the present study.As a part of the study the importance of demand forecasting in ship recycling has been introduced and presented. A sample input for ship recycling data for implementation of computer based methods of demand forecasting has been presented in this section of the thesis.The interdisciplinary nature of engineering processes involved in ship recycling has been identified as one of the important features of this industry. The present study has identified more than a dozen major stake holders in ship recycling having their own interests and roles. It has also been observed that most of the ship recycling activities is carried out in South East Asian countries where the beach based ship recycling is done in yards without proper infrastructure support. A model of beach based ship recycling has been developed and the roles, responsibilities and the mutual interactions of the elements of the system have been documented as a part of the study Subsequently the need of a generation of a wide knowledgebase on ship recycling activities as pointed out by the literature survey has been addressed. The information base and source of expertise required to build a broad knowledgebase on ship recycling operations have been identified and tabulated. Eleven important ship recycling processes have been identified and a brief sketch of steps involved in these processes have been examined and addressed in detail. Based on these findings, a detailed sequential disassembly process plan of ship recycling has been prepared and charted. After having established the need of best practices in ship recycling initially, the present study here identifies development of a user friendly expert system for ship recycling process as one of the constituents of the proposed best practises. A user friendly expert system has been developed for beach based ship recycling processes and is named as Ship Recycling Recommender (SRR). Two important functions of SRR, first one for the ‘Administrators’, the stake holders at the helm of the ship recycling affairs and second one for the ‘Users’, the stake holders who execute the actual dismantling have been presented by highlighting the steps involved in the execution of the software. The important output generated, ie.,. recommended practices for ship dismantling processes and safe handling information on materials present onboard have been presented with the help of ship recycling reports generated by the expert system. A brief account of necessity of having a ship recycling work content estimation as part of the best practices has been presented in the study. This is supported by a detailed work estimation schedule for the same as one of the appendices.As mentioned earlier, a definite lack of involvement of naval architect has been observed in development of methodologies for improving the status of ship recycling industry. Present study has put forward a holistic approach to review the status of ship recycling not simply as end of life activity of all ‘time expired’ vessels, but as a focal point of integrating all life cycle activities. A new engineering design philosophy targeting sustainable development of marine industrial domain, named design for ship recycling has been identified, formulated and presented. A new model of ship life cycle has been proposed by adding few stages to the traditional life cycle after analysing their critical role in accomplishing clean and safe end of life and partial dismantling of ships. Two applications of design for ship recycling viz, recyclability of ships and her products and allotment of Green Safety Index for ships have been presented as a part of implementation of the philosophy in actual practice.

Characterizations of Life Distributions Using Conditional Expectations of Doubly (Interval) Truncated Random Variables

In this article, we study reliability measures such as geometric vitality function and conditional Shannon’s measures of uncertainty proposed by Ebrahimi (1996) and Sankaran and Gupta (1999), respectively, for the doubly (interval) truncated random variables. In survival analysis and reliability engineering, these measures play a significant role in studying the various characteristics of a system/component when it fails between two time points. The interrelationships among these uncertainty measures for various distributions are derived and proved characterization theorems arising out of them

Effects of fertility management strategies on phosphorus bioavailability in four West African soils

Low phosphorus (P) in acid sandy soils of the West African Sudano-Sahelian zone is a major limitation to crop growth. To compare treatment effects on total dry matter (TDM) of crops and plant available P (P-Bray and isotopically exchangeable P), field experiments were carried out for 2 years at four sites where annual rainfall ranged from 560 to 850 mm and topsoil pH varied between 4.2 and 5.6. Main treatments were: (i) crop residue (CR) mulch at 500 and 2000 kg ha^-1, (ii) eight different rates and sources of P and (iii) cereal/legume rotations including millet (Pennisetum glaucum L.), sorhum [Sorghum bicolor (L.) Moench], cowpea (Vigna unguiculata Walp.) and groundnut (Arachis hypogaea L.). For the two Sahelian sites with large CR-induced differences in TDM, mulching did not modify significantly the soils' buffering capacity for phosphate ions but led to large increases in the intensity factor (C_p) and quantity of directly available soil P (E_1min). In the wetter Sudanian zone lacking effects of CR mulching on TDM mirrored a decline of E_1min with CR. Broadcast application of soluble single superphosphate (SSP) at 13 kg P ha^-1 led to large increases in C_p and quantity of E_1min at all sites which translated in respective TDM increases. The high agronomic efficiency of SSP placement (4 kg P ha^-1) across sites could be explained by consistent increases in the quantity factor which confirms the power of the isotopic exchange method in explaining management effects on crop growth across the region.

Effect of initial status and growth in pseudoword reading on Spanish reading comprehension at the end of first grade

Resumen tomado de la publicaci??n

Conways Game of Life JavaScript Exercise

For students learning JavaScript programming, this exercise sets out a fairly complete template for a DHTML implementation of Life. Students have to program the missing sections of code and attempt the extra features described. Only I have the password to unlock the solution!

SOES3010/6005 - Scaling analysis (Week 1, end of lecture)

This is the end of the scaling analysis we saw in class on Friday. In class, we managed to scale the mass conservation equation and the x-momentum equation, but we didn't finish scaling the z-momentum equation in order to arrive at the hydrostatic approximation.

Clonidina para el Tratamiento del Dolor Oncológico: una Revisión Sistemática de la Literatura

El dolor oncológico representa una de las principales causas de dolor crónico, siendo los opioides la primera línea de manejo, sin embargo 10% de los pacientes requieren estrategias analgésicas multimodales. La eficacia analgésica de la clonidina como coadyuvante ha sido demostrada para diversos modelos de dolor. Sin embargo no hay revisiones sistemáticas que validen su eficacia y seguridad en dolor crónico oncológico. Se realizó una revisión sistemática de la literatura a noviembre 26 de 2012, encontrando 15 trabajos (12 reportes de caso y tres ensayos clínicos controlados), n=138 pacientes. La intervención tuvo una eficacia entre 44,7 y 100%, mostrando mayor beneficio en pacientes con componente de dolor neuropático. La adición de clonidina fue bien tolerada, siendo la sedación y la disminución en tensión arterial y frecuencia cardiaca los efectos secundarios más frecuentes, con relación dosis dependiente, de resolución espontánea y en ninguno de los casos se documentó lesión secundaria en los pacientes. La vía de administración más frecuente fue neuroaxial (intratecal y peridural). La revisión sistemática no fue susceptible de metaanálisis por la heterogeneidad clínica de los estudios. Los resultados obtenidos sugieren que la adición de clonidina puede ser una opción terapeútica eficaz y segura en los pacientes con dolor crónico oncológico severo refractario a opioides a altas dosis asociado o no a infusión neuroaxial de anestésico local, en especial en presencia de componente neuropático. Sin embargo se identificó la necesidad de un mayor número de ensayos clínicos controlados aleatorios que permitan establecer conclusiones definitivas.

Diferencias en costo efectividad del cuidado paliativo domiciliario frente a la atención convencional hospitalaria para el manejo de enfermedades crónicas en fase terminal

En Colombia la dinámica poblacional ha experimentado cambios a través de los años; lo cual modifica las características epidemiológicas y los perfiles de morbimortalidad de la población, aumentando la incidencia y prevalencia de enfermedades crónicas de difícil pronóstico dentro de la población; siendo estos grupos etarios hacía quienes deben destinarse nuevas modalidades de atención y soporte paliativo. Se realizó una revisión sistemática de diversos artículos, clasificados con niveles de evidencia I y II; cuyas variables de análisis fueron: El lugar de fallecimiento del paciente, alivio de la sintomatología, nivel de satisfacción del paciente y sus cuidadores con los servicios recibidos, número de ingresos hospitalarios independientemente de la causa y días promedio de estancia hospitalaria. El 88% de los pacientes que fueron vinculados a la atención domiciliaria falleció en su hogar; el 68% refirió haber experimentado disminución en la intensidad de al menos 2 síntomas como resultado de la atención en casa. El nivel de satisfacción para el cuidado en casa puntuó 19 puntos porcentuales por encima de la calificación que obtuvo el manejo hospitalario. El 23% de los pacientes tratados en su hogar, requirió al menos una hospitalización durante el manejo; mostrando una disminución en el tiempo de estancia hospitalaria de 3.4 días promedio. El manejo paliativo domiciliario de pacientes crónicos en fase terminal, no sólo es una alternativa en la reducción de costos para el sistema de salud, sino que es un factor protector de tipo emocional que refleja también una importante disminución de los riesgos de la hospitalización.