A rehabilitation intervention to promote physical recovery following intensive care: a detailed description of construct development, rationale and content together with proposed taxonomy to capture processes in a randomised controlled trial.

Background: increasing numbers of patients are surviving critical illness, but survival may be associated with a constellation of physical and psychological sequelae that can cause on going disability and reduced health-related quality of life. Limited evidence currently exists to guide the optimum structure, timing, and content of rehabilitation programmes. There is a need to both develop and evaluate interventions to support and expedite recovery during the post-ICU discharge period. This paper describes the construct development for a complex rehabilitation intervention intended to promote physical recovery following critical illness. The intervention is currently being evaluated in a randomised trial (ISRCTN09412438; funder Chief Scientists Office, Scotland). Methods: the intervention was developed using the Medical Research Council (MRC) framework for developing complex healthcare interventions. We ensured representation from a wide variety of stakeholders including content experts from multiple specialties, methodologists, and patient representation. The intervention construct was initially based on literature review, local observational and audit work, qualitative studies with ICU survivors, and brainstorming activities. Iterative refinement was aided by the publication of a National Institute for Health and Care Excellence guideline (No. 83), publicly available patient stories (Healthtalkonline), a stakeholder event in collaboration with the James Lind Alliance, and local piloting. Modelling and further work involved a feasibility trial and development of a novel generic rehabilitation assistant (GRA) role. Several rounds of external peer review during successive funding applications also contributed to development. Results: the final construct for the complex intervention involved a dedicated GRA trained to pre-defined competencies across multiple rehabilitation domains (physiotherapy, dietetics, occupational therapy, and speech/language therapy), with specific training in post-critical illness issues. The intervention was from ICU discharge to 3 months post-discharge, including inpatient and post-hospital discharge elements. Clear strategies to provide information to patients/families were included. A detailed taxonomy was developed to define and describe the processes undertaken, and capture them during the trial. The detailed process measure description, together with a range of patient, health service, and economic outcomes were successfully mapped on to the modified CONSORT recommendations for reporting non-pharmacologic trial interventions. Conclusions: the MRC complex intervention framework was an effective guide to developing a novel post-ICU rehabilitation intervention. Combining a clearly defined new healthcare role with a detailed taxonomy of process and activity enabled the intervention to be clearly described for the purpose of trial delivery and reporting. These data will be useful when interpreting the results of the randomised trial, will increase internal and external trial validity, and help others implement the intervention if the intervention proves clinically and cost effective.

A New Formulation of the Spectral Energy Budget of the Atmosphere, with Application to Two High-Resolution General Circulation Models

International audience

Problems of Tourism Development on a Regional Scale

In the first part of the study the types of barriers to tourism development that may occur during the planning phase of this development, and in the phase of implementation of these plans, including the endogenous and exogenous barriers, were presented. The second part presents the results of research on the factors hindering the development of tourism identified in the selected region of Wielkopolska Province (Poland). The article presents detailed description of tourism barriers categories, which include: political and legal, economic, infrastructure, social, geographical and organizational problems. In the final part article presents a difference in the understanding of problems depending on the stakeholder groups, which leads to the conclusion that in order to be able to specifically identify problematic issues opinion of different stakeholders categories should be recognized. Only such action can lead to the construction of the development strategy, which will not have any areas of uncertainty (i.e. «gaps» in the identifying problem areas).

Study of the development and evolution of seasonal thermocline and turbulent processes in the northern parts of Persian Gulf using numerical modeling

The Persian Gulf (PG) is a semi-enclosed shallow sea which is connected to open ocean through the Strait of Hormuz. Thermocline as a suddenly decrease of temperature in subsurface layer in water column leading to stratification happens in the PG seasonally. The forcing comprise tide, river inflow, solar radiation, evaporation, northwesterly wind and water exchange with the Oman Sea that influence on this process. In this research, analysis of the field data and a numerical (Princeton Ocean Model, POM) study on the summer thermocline development in the PG are presented. The Mt. Mitchell cruise 1992 salinity and temperature observations show that the thermocline is effectively removed due to strong wind mixing and lower solar radiation in winter but is gradually formed and developed during spring and summer; in fact as a result of an increase in vertical convection through the water in winter, vertical gradient of temperature is decreased and thermocline is effectively removed. Thermocline development that evolves from east to west is studied using numerical simulation and some existing observations. Results show that as the northwesterly wind in winter, at summer transition period, weakens the fresher inflow from Oman Sea, solar radiation increases in this time interval; such these factors have been caused the thermocline to be formed and developed from winter to summer even over the northwestern part of the PG. The model results show that for the more realistic monthly averaged wind experiments the thermocline develops as is indicated by summer observations. The formation of thermocline also seems to decrease the dissolved oxygen in water column due to lack of mixing as a result of induced stratification. Over most of PG the temperature difference between surface and subsurface increases exponentially from March until May. Similar variations for salinity differences are also predicted, although with smaller values than observed. Indeed thermocline development happens more rapidly in the Persian Gulf from spring to summer. Vertical difference of temperature increases to 9 centigrade degrees in some parts of the case study zone from surface to bottom in summer. Correlation coefficients of temperature and salinity between the model results and measurements have been obtained 0.85 and 0.8 respectively. The rate of thermcline development was found to be between 0.1 to 0.2 meter per day in the Persian Gulf during the 6 months from winter to early summer. Also it is resulted from the used model that turbulence kinetic energy increases in the northwestern part of the PG from winter to early summer that could be due to increase in internal waves activities and stability intensified through water column during this time.

Using Needs Assessment to Understand Continuing Disability in Patients with Enduring Mental Illness. Implications for Considerations of Service Development

Particular strengths of the MRC Needs for Care Assessment Schedule have been used to investigate the treatment status of patients with persistent psychiatric disability in ways that other needs assessment tools are unable to. One hundred and seventy-nine such patients from three settings; a private sector psychiatric hospital, two public sector day hospitals situated in the same town, and a high security hospital, were found to have a high level of need. Although there were differences between settings, overall these needs were well met in all three. The high level of persistent disability found amongst these patients could not be attributed to failure on the part of those treating them to use the best available methods, or to failures to comply or engage with treatment on the patient's part. In some two thirds of instances persistent disability was best explained by the fact that even the most suitable available treatments have to be considered only partially effective.

Justification the strategy of enterprise development: PJSC Elektrotermometriya: case study

The research is orientated to the actual issues of strategic management of industrial enterprises. The theoretical aspects of strategic management are generalized, its role is certain in organization development, methods and processes of strategic management are investigational. In this context the main objective of study is based on the strategic analysis of PJSC «Elektrotermometriya», formation ways to improve the strategic management of the company with regard to the readiness of the company to strategic changes and conducting of developments and recommendations for improvement activity of the enterprise. To answer to the main objective it was conducted the strategic analysis of activity of PJSC «Elektrotermometriya». The results proved the basic strategy to achieve the strategic goal of PJSC «Elektrotermometriya». According to the life cycle, and based on the current conditions of its functioning, is appropriate to use the strategy of gradual growth. Forecast implementing strategies defined by the optimistic, probable and pessimistic forecasts. According to the pessimistic forecast the company should use a strategy of stabilization, while to the optimistic and the most likely scenario - moderate growth strategy. Thus to achieve the main strategic goals according to each scenario PJSC «Elektrotermometriya» should use set of functional strategies and define the business strategy.

An Assessment of Professional Development for Astronomy and Physics Faculty: Expanding Our Vision of How to Support Faculty's Learning About Teaching

In this thesis, we will explore approaches to faculty instructional change in astronomy and physics. We primarily focus on professional development (PD) workshops, which are a central mechanism used within our community to help faculty improve their teaching. Although workshops serve a critical role for promoting more equitable instruction, we rarely assess them through careful consideration of how they engage faculty. To encourage a shift towards more reflective, research-informed PD, we developed the Real-Time Professional Development Observation Tool (R-PDOT), to document the form and focus of faculty's engagement during workshops. We then analyze video-recordings of faculty's interactions during the Physics and Astronomy New Faculty Workshop, focusing on instances where faculty might engage in pedagogical sense-making. Finally, we consider insights gained from our own local, team-based effort to improve a course sequence for astronomy majors. We conclude with recommendations for PD leaders and researchers.

Pharmacokinetic and pharmacodynamic responses in adult patients with Chagas disease treated with a new formulation of benznidazole

controversial in chronically infected adults. We report the pharmacokinetics and pharmacodynamics in six adult patients with Chagas disease treated with the new BNZ formulation (ABARAX®) in doses between 2.5-5.5 mg/Kg/ day. All but one patient had plasmatic BNZ concentrations within the expected range. All patients finalised treatment with nondetectable Trypanosoma cruzi quantitative polymerase chain reaction, which remained nondetectable at the six month follow-up. Our data suggests parasitological responses with the new BNZ and supports the hypothesis that treatment protocols with lower BNZ doses may be effective.

Women-led Community Development Organizations (CDOs) in Miami-Dade County: A Model of Community Development Efforts Impacting the Economic Security of Women

Recent studies on the economic status of women in Miami-Dade County (MDC) reveal an alarming rate of economic insecurity and significant obstacles for women to achieve economic security. Consistent barriers to women’s economic security affect not only the health and wellbeing of women and their families, but also economic prospects for the community. A key study reveals in Miami-Dade County, “Thirty-nine percent of single female-headed families with at least one child are living at or below the federal poverty level” and “over half of working women do not earn adequate income to cover their basic necessities” (Brion 2009, 1). Moreover, conventional measures of poverty do not adequately capture women’s struggles to support themselves and their families, nor do they document the numbers of women seeking basic self-sufficiency. Even though there is lack of accurate data on women in the county, which is a critical problem, there is also a dearth of social science research on existing efforts to enhance women’s economic security in Miami-Dade County. My research contributes to closing the information gap by examining the characteristics and strategies of women-led community development organizations (CDOs) in MDC, working to address women’s economic insecurity. The research is informed by a framework developed by Marilyn Gittell, who pioneered an approach to study women-led CDOs in the United States. On the basis of research in nine U.S. cities, she concluded that women-led groups increased community participation and “by creating community networks and civic action, they represent a model for community development efforts” (Gittell, et al. 2000, 123). My study documents the strategies and networks of women-led CDOs in MDC that prioritize women’s economic security. Their strategies are especially important during these times of economic recession and government reductions in funding towards social services. The focus of the research is women-led CDOs that work to improve social services access, economic opportunity, civic participation and capacity, and women’s rights. Although many women-led CDOs prioritize building social infrastructures that promote change, inequalities in economic and political status for women without economic security remain a challenge (Young 2004). My research supports previous studies by Gittell, et al., finding that women-led CDOs in Miami-Dade County have key characteristics of a model of community development efforts that use networking and collaboration to strengthen their broad, integrated approach. The resulting community partnerships, coupled with participation by constituents in the development process, build a foundation to influence policy decisions for social change. In addition, my findings show that women-led CDOs in Miami-Dade County have a major focus on alleviating poverty and economic insecurity, particularly that of women. Finally, it was found that a majority of the five organizations network transnationally, using lessons learned to inform their work of expanding the agency of their constituents and placing the economic empowerment of women as central in the process of family and community development.

The Wiley-Blackwell Handbook of the Psychology of Training, Development, and Performance Improvement

This handbook is a unique contribution to the field, as it joins together training and appraisal as tools for promoting individual development within organizations. The handbook is divided into four sections: training, e-learning, personal and professional development in organizations, and performance management.

Formulation of ionogel, hydrogel and films using a cellulose rich solid obtained from Pinus radiata

The purpose of my internship, carried out during my Erasmus period at the Complutense University of Madrid, was focused on the formulation of ionogels and hydrogels for the obtainment of films with high lignin content, and on their characterization measuring their antibacterial properties. For biomass formulation I used lignocellulosic biomass (Pinus Radiata) as raw material and ionic liquid as solvent. The two ionic liquids proposed were: 1-ethyl-3-methylimidazoliumdimethylphosphate [Emim][DMP] and 1-ethyl-3-methylimidazoliumdiethylphosphate [Emim][DEP]. The two-starting cellulose-rich solids were obtained from Pinus radiata wood that had been submitted to an organosolv process, to reduce its lignin content to fifteen (ORG15) and twenty per cent (ORG20). Having two ionic liquids and two solids available, the first phase of the project was devoted to the screening of both solids in both ionic liquids. Through this, it was possible to identify that only the [Emim][DMP] ionic liquid fulfils the purpose. It was also possible to discard the cellulose-rich solid ORG20 because its dissolution in the ionic liquid was not possible (after the time fixed) and, additionally, a Pinus radiata cellulose-rich solid bleached with hydrogen peroxide and containing ten per cent of lignin (ORG10B) was included in the screening. After screening, a total of five ionogels were subsequently formulated: two gels were formulated with the starting raw material ORG15 (with 1% and 1.75% cellulose, respectively) and three with ORG10B (with 1%, 1.75% and 3% cellulose, respectively). Five hydrogels were obtained from the ionogels. Rheological tests were performed on each ionogel and hydrogel. Finally, films were formulated from hydrogels and they were analysed by antibacterial testing to see if they could be applied as food packaging. In addition, antioxidant and properties such as opacity and transparency were also studied.

Kestävän kehityksen toimintasuunnitelman laatiminen Lappeenrannan teknilliselle yliopistolle

Työn tavoitteena oli tuottaa kestävän kehityksen toimintasuunnitelman rakentamiseen ja seuraamiseen viitekehys, josta Lappeenrannan teknillisen yliopiston yksiköt saavat tarvittavan tiedon kestävän kehityksen indikaattorien valitsemiseen ja yksikkökohtaisten hallintaohjelmien rakentamiseen. Työssä on selvitetty mitkä ovat yliopiston yksiköiden kestävän kehityksen näkökohdat ja niiden seuraamisessa tarvittavat yksikkökohtaiset indikaattorit sekä miten indikaattoreita ja opetusministeriöiden hyväksymää Baltic 21E –ohjelmaa voitaisiin käytännössä hyödyntää. Kestävän kehityksen toimintasuunnitelma perustuu Global Reporting Initiativen (GRI:n) vuonna 2002 julkaisemaan yhteiskuntavastuun raportointiohjeeseen. Toimintasuunnitelma perustuu osittain myös ympäristöjärjestelmästandardi ISO 14001:een ja työssä on huomioitu opetusministeriön ohjeen mukaisesti Baltic 21E –raportti ja erityisesti opetusministeriön asettaman työryhmän ehdotus Baltic 21E –ohjelman käynnistyssuunnitelmaksi. Työssä teoriaosuuden ja raportointiperusteiden jälkeen on kuvattu GRI:n ohjeiden mukaisesti yliopiston organisaatio, visio, strategia ja hallintajärjestelmät. Pääasiassa haastatteluin tehdyllä kestävän kehityksen katselmuksella on selvitetty Lappeenrannan teknillisen yliopiston yksiköiden kestävän kehityksen näkökohdat. Näkökohdat on jaoteltu ympäristöhallintajärjestelmän mukaisesti toimintoihin, tuotteisiin ja palveluihin. Näkökohdissa on huomioitu Baltic 21E –raportti ja sen tavoite- ja toimenpide-ehdotukset. Kestävän kehityksen näkökohtien ja vaikutusten seuraamiseksi on jokaiselle yksikölle tunnistettu indikaattorit, jotka on muotoiltu GRI:n Sustainability Reporting Guideliness –julkaisun indikaattorien pohjalta. Työssä on selvitetty indikaattorien käyttötarkoitusta ja esimerkein havainnollistettu indikaattorien ja Baltic 21E –ohjelman käyttöönottomahdollisuuksia ISO 14001 –järjestelmän mukaisesti. Haastattelujen ja Baltic 21E –toimintaohjelman perusteella yliopiston kestävän kehityksen näkökohdat liittyvät opetukseen, tutkimukseen, täydennyskoulutukseen ja julkaisutoimintaan sekä yliopistoyhteisön omaan kestävän kehityksen tietoisuuteen ja toimintaperiaatteiden noudattamiseen. Yliopistotoiminnassa kestävä kehitys on myös mukana alueellisessa vuorovaikutuksessa sidosryhmäsuhteiden ja uuden tiedon tuottamisen kautta. Yliopiston yksiköiden kestävää kehitystä mittaavia indikaattoreita tunnistettiin suuri joukko. Eniten tunnistettiin yhteiskunnalliseen vaikutusluokkaan kuuluvia indikaattoreita. Jaoteltaessa indikaattorit käyttötarkoituksittain tarkasteltavien indikaattorien määrä hieman vähenee. Tämän työn jälkeen tulisi GRI:n ohjeiden mukaisesti käydä sidosryhmien välistä vuoropuhelua yksikkökohtaisten merkittävimpien indikaattorien tunnistamiseksi ja kestävän kehityksen päämäärien ja tavoitteiden asettamiseksi. Tämän työn indikaattorien pää-asialliset käyttökohteet olisivat yksiköiden sisäisessä kehittämisessä ja viestinnässä, vähemmässä määrin tuloskeskusteluissa.

Tourisme et colonisation en Indochine 1898-1939

Comment le tourisme s’est-il développé dans un territoire en pleine expansion coloniale ? Comment tourisme et colonisation se sont-ils conjugués ? Quel lien peut-on établir entre ces deux dynamiques ? C’est ce à quoi cette thèse tente de répondre en démontrant l’instrumentalisation du tourisme par les politiques coloniales. Elle se divise en sept chapitres abordant successivement le transfert des pratiques touristiques de l’Europe à l’Indochine, leurs implantations, leurs intégrations aux politiques de mise en valeur des années 1920, les conséquences spatiales de leurs implantations (construction de voies de communication et d’hébergements hôteliers) et la communication instaurée par l’Etat pour promouvoir l’Indochine comme une destination touristique auprès des Indochinois comme des touristes étrangers.

Indicadores del desempeño clínico fisioterapéutico en el manejo hospitalario temprano del accidente

Las oportunidades conocidas de intervenciones tempranas en los accidentes cardiocerebrovasculares (ACV) desde el punto de vista médico y de rehabilitación hacen necesario avanzar en la formulación de indicadores del desempeño clínico en el manejo fisioterapéutico hospitalario de una persona con ACV. Objetivo: identificar los indicadores de desempeño clínico fisioterapéutico en el manejo hospitalario temprano de personas sobrevivientes de ACV. Materiales y métodos: se trata de un estudio exploratorio descriptivo que indaga sobre las pruebas y prácticas fisioterapéuticas existentes, la evidencia científica sobre indicadores clínicos en ACV, los indicadores estándar y los posibles indicadores clínicos en el escenario. Se llevó a cabo una revisión sistemática de estudios descriptivos, guías de práctica clínica, revisiones sistemáticas, estudio de casos clínicos basados en la evidencia en bases de datos como Pubmed, Proquest, Pedro y en revistas electrónicas, además del análisis de datos epidemiológicos de la prevalencia del ACV en Colombia y en Chile, en páginas web de la Organización Mundial de la Salud, Ministerio de Salud y Departamento AdministrativoNacional de cada país. Resultados: la evidencia señala que la rehabilitación temprana del ACV debe iniciarse durante la hospitalización, tan pronto como el diagnóstico se establezca y los problemas que ponen en riesgo la vida del paciente estén controlados. Las prioridades en la intervención fisioterapéutica en ACV son prevenir las complicaciones (trombosis venosa, infecciones y dolor) y facilitar la movilización temprana. Actualizaciones recientes de estas directrices incluyen la rehabilitación temprana, en particular la movilidad luego de las veinticuatro horas posteriores al ACV.Las pruebas que sustentan los indicadores de desempeño en rehabilitación para la atención en la etapa subaguda del ACV son escasas. Conclusiones: se hace notoria la importancia de la atención temprana fisioterapéutica en el proceso agudo del paciente con ACV, puesto que la evidencia disponible resalta un mejor pronóstico para pacientes que son intervenidos por el área dentro de las primeras veinticuatro horas posteriores al evento y la importancia de los indicadores de atención del paciente, como la calidad y el tiempo de atención, la periodicidad y el aprovechamiento de la intervención dentro de la ventana temporal aguda de recuperación del paciente.