Évaluation de l’impact des services en téléobstétrique du RUIS McGill offerts à une population de femmes inuites avec grossesse à risque élevé habitant sur la côte de la baie d’Hudson au Nunavik

L’accessibilité à des soins de santé pour une population habitant une région éloignée au Québec représente un défi de taille pour le Ministère de la santé et des services sociaux. Des solutions, telles que la télésanté, ont été présentées afin de pallier ce problème. Le RUIS McGill a ainsi développé un programme de téléobstétrique afin de desservir une population de femmes inuites à grossesse à risque élevé (GARE) habitant le Nunavik. L’objectif de ce mémoire fut de comprendre l’impact du service de téléobstétrique du RUIS McGill sur la santé des femmes et de leur nouveau-né ainsi que sur les coûts de santé et l’utilisation des services suite à son implantation au Centre de santé et de services sociaux Inuulitsivik sur la côte de la baie d’Hudson. Les femmes inuites à grossesse à risque élevé et leurs enfants de la région de la baie d’Hudson du Nunavik, éloignés des services obstétriques spécialisés, sont visés. Le service de téléobstétrique permet un accès aux obstétriciens du RUIS McGill localisés à Montréal. Un devis quasi-expérimental est utilisé pour examiner trois hypothèses portant sur l’état de santé des mères et des enfants, sur l’utilisation des services de santé et sur leurs coûts. Le service de téléobstétrique est devenu fonctionnel en 2006, offrant la possibilité de constituer une étude avant-après à deux groupes de femmes, soit celles ayant accouché avant 2006 (prétest) et celle ayant accouché après 2012 (post-test). La collecte de donnée se fit, dans son intégralité, par l’entremise des dossiers médicaux papier des participantes permettant l’analyse de 47 dossiers pour le prétest et de 81 dossiers pour le post-test. L’exécution d’analyse de covariance, de régression logistique et du test non paramétrique de Mann-Witney permit de conclure que le prétest et le post-test ne différent que sur deux variables, soient le poids à la naissance, plus faible dans le post-test et la pression artérielle de la mère à la naissance, plus élevée dans le post-test. Pour l’ensemble des autres variables portant sur les trois hypothèses à l’étude, les résultats de ce mémoire ne démontrent aucune différence significative entre les deux groupes démontrant ainsi qu’une même qualité de soins a été conservée suite à l’implantation du programme de téléobstétrique. Sur la base des résultats, ce mémoire recommande de revoir et modifier les objectifs du programme; de partager les bornes de communication de télésanté avec d’autres spécialités; d’entreprendre une évaluation du programme axée sur les coûts; de suivre rigoureusement l’utilisation du programme pour en maximiser l’efficacité et le potentiel; d’établir un tableau de bord; et d’entreprendre une étude évaluative comparative dans un service de téléobstétrique comparable.

Nurses knowledge of health effects of dietary fibre

Introduction: Nurses accompany patients throughout their health care to prevent and treat disease, so their knowledge about diet and dietary fibre is key to successful diet therapy, which is an essential part of a patient's non-pharmacological treatment. It is known from the literature that a high proportion of nurses have limited knowledge about diet therapy and about sources of soluble fibre and other foods that can prevent or treat certain diseases. Given the position of nurses as key providers of dietary guidance, and given the health benefits of dietary fibre, we wanted to assess the level of fibre-related knowledge among nurses in Croatia. Material and Methods: Cross-sectional study based on data collected between October 2014 and March 2015 using a survey developed by the CI&DETS Polytechnic Institute in Viseu, Portugal. The survey contains questions about demographic characteristics as well as about knowledge of sources of dietary fibre, recommended daily intake and effects of fibre intake on particular diseases. The study included a total of 369 nurses from two health institutions and one nursing school from Croatia older than 18 years. Differences in knowledge were assessed for significance using the non-parametric Mann-Whitney U test. Possible associations among variables were explored using Spearman's rank correlation. For all statistical analyses, the threshold of significance was defined as P<0.05. Results: The level of knowledge among nurses in Croatia about dietary fibre varied from «undecided» to «partial knowledge». The median for level of knowledge ranged from 3 to 4 with low variability ranging from 0.11 to 0.33. Average levels of knowledge in percentages varied from 57.6% to 82.1%. Nurses with higher education levels showed significantly higher knowledge levels about the influence of dietary fiber intake on the risk of certain diseases (p = 0.007), constipation (p = 0.016), bowel cancer (p = 0.005) and breast cancer (p = 0.039). Conclusion: The level of nurses’ knowledge about dietary fiber is suboptimal. This indicates the need to strengthen nurse education in the areas of diet and diet therapy. Increase the level of knowledge of nurses about nutrition can positively influence the quality of care.

Levnadsvanor och självskattad hälsa hos 40-åringar

Självskattad hälsa beskriver personens subjektiva uppfattning av sin hälsa. En lågt självskattad hälsa har samband med ökad framtida dödlighet. Ett starkt välbefinnande är enligt Katie Erikssons dimensioner av hälsa, förutsättningen för att hälsan ska skattas som bra. Syftet med denna studie var att beskriva eventuella skillnader i självskattad hälsa sett till olika levnadsvanor hos 40-åriga kvinnor och män. Metod: Enkätsvar från totalt 1144 40-åriga kvinnor och män har använts. Enkäterna genomfördes under 2014 på 55 vårdcentraler i två regioner i södra Sverige. Levnadsvanor som valdes till denna studie var fysisk aktivitet, grönsaks- och frukostvanor, alkoholintag, rökning, sysselsättning, sömn och stress. Självskattad hälsa kategoriserades som bra (”mycket bra” och ”bra”) och dålig (”någorlunda”, ”dålig” och ”mycket dålig”). För att studera skillnader användes Student T-test på parametrisk data och Chi-två på icke parametrisk data. Resultat: De levnadsvanor som var vanligare förekommande hos de med bra självskattad hälsa var ansträngande/hård motion, låg nivå av stress och att vara i arbete (p<.001). Att inte röka hos män och att äta frukost och grönsaker hos kvinnor var också vanligare förekommande hos de med bra självskattad hälsa. Lågt intag av alkohol visade inte på några skillnader.  Slutsats: För att minska risken för framtida sjuklighet är det viktigt för distriktssköterskor, samt flera andra samhällsinsatser, att försöka påverka och uppmuntra hög fysisk aktivitet och minskad stress.

Hilbert Space Valued Signal Plus Noise Models: Analysis of Structural Breaks under High Dimensionality and Temporal Dependence

This thesis is concerned with change point analysis for time series, i.e. with detection of structural breaks in time-ordered, random data. This long-standing research field regained popularity over the last few years and is still undergoing, as statistical analysis in general, a transformation to high-dimensional problems. We focus on the fundamental »change in the mean« problem and provide extensions of the classical non-parametric Darling-Erdős-type cumulative sum (CUSUM) testing and estimation theory within highdimensional Hilbert space settings. In the first part we contribute to (long run) principal component based testing methods for Hilbert space valued time series under a rather broad (abrupt, epidemic, gradual, multiple) change setting and under dependence. For the dependence structure we consider either traditional m-dependence assumptions or more recently developed m-approximability conditions which cover, e.g., MA, AR and ARCH models. We derive Gumbel and Brownian bridge type approximations of the distribution of the test statistic under the null hypothesis of no change and consistency conditions under the alternative. A new formulation of the test statistic using projections on subspaces allows us to simplify the standard proof techniques and to weaken common assumptions on the covariance structure. Furthermore, we propose to adjust the principal components by an implicit estimation of a (possible) change direction. This approach adds flexibility to projection based methods, weakens typical technical conditions and provides better consistency properties under the alternative. In the second part we contribute to estimation methods for common changes in the means of panels of Hilbert space valued time series. We analyze weighted CUSUM estimates within a recently proposed »high-dimensional low sample size (HDLSS)« framework, where the sample size is fixed but the number of panels increases. We derive sharp conditions on »pointwise asymptotic accuracy« or »uniform asymptotic accuracy« of those estimates in terms of the weighting function. Particularly, we prove that a covariance-based correction of Darling-Erdős-type CUSUM estimates is required to guarantee uniform asymptotic accuracy under moderate dependence conditions within panels and that these conditions are fulfilled, e.g., by any MA(1) time series. As a counterexample we show that for AR(1) time series, close to the non-stationary case, the dependence is too strong and uniform asymptotic accuracy cannot be ensured. Finally, we conduct simulations to demonstrate that our results are practically applicable and that our methodological suggestions are advantageous.

Impacto del Programa de Alimentación Escolar en el Trabajo Infantil: Una aproximación desde la toma de decisiones familiares

Esta investigación analiza el impacto del Programa de Alimentación Escolar en el trabajo infantil en Colombia a través de varias técnicas de evaluación de impacto que incluyen emparejamiento simple, emparejamiento genético y emparejamiento con reducción de sesgo. En particular, se encuentra que este programa disminuye la probabilidad de que los escolares trabajen alrededor de un 4%. Además, se explora que el trabajo infantil se reduce gracias a que el programa aumenta la seguridad alimentaria, lo que consecuentemente cambia las decisiones de los hogares y anula la carga laboral en los infantes. Son numerosos los avances en primera infancia llevados a cabo por el Estado, sin embargo, estos resultados sirven de base para construir un marco conceptual en el que se deben rescatar y promover las políticas públicas alimentarias en toda la edad escolar.

Guía de práctica clínica para la enfermedad hepática grasa no alcohólica

Objetivo: Brindar una guía de práctica clínica basada con la evidencia más reciente para el diagnóstico y tratamiento de la Enfermedad Hepática Grasa No alcohólica teniendo en cuenta la efectividad y seguridad de las intervenciones dirigidas a pacientes, personal asistencial, administrativo y entes gubernamentales de cualquier servicio de atención en Colombia. Materiales y métodos: Esta guía fue desarrollada por un equipo multidisciplinario con apoyo de la Asociación Colombiana de Gastroenterología, el Grupo Cochrane ITS y el Instituto de Investigaciones Clínicas de la Universidad Nacional de Colombia. Se desarrollaron preguntas clínicas relevantes y se realizó la búsqueda de guías nacionales e internacionales en bases de datos especializadas. Las guías existentes fueron evaluadas en términos de calidad y aplicabilidad. Una guía cumplió los criterios de adaptación, por lo que se decidió adaptar 3 preguntas clínicas. El Grupo Cochrane realizó la búsqueda sistemática de la literatura. Las tablas de evidencia y recomendaciones fueron realizadas con base a la metodología GRADE. Las recomendaciones de la guía fueron socializadas en una reunión de expertos con entes gubernamentales y pacientes. Resultados: Se desarrolló una guía de práctica clínica basada en la evidencia para el diagnóstico y tratamiento de la Enfermedad Hepática Grasa No alcohólica en Colombia Conclusiones: El diagnóstico y manejo oportuno de la Enfermedad Hepática Grasa No alcohólica contribuirá a disminuir la carga de la enfermedad en Colombia y las enfermedades asociadas

Propolis components accountable for bactericidal accomplishment and antibiofilm activity

This study aimed at evaluating antimicrobial and antibiofilm activity of phenolic compounds present in propolis ethanol extracts (PEE). Seventy per cent ethanol extracts from seven types of propolis, one Green, two Red and four Brown collected in four Brazilian States were prepared and total phenolics, flavonoids, tannins and anthocyanins were assessed by high-performance liquid chromatography (HPLC). Minimum bactericidal concentration (MBC) and inhibitor effect on Staphylococcus aureus biofilm formation and capacity to disrupt established biofilms were assessed towards eight S. aureus isolates from milk of small ruminants with mastitis, one methicillin-resistant S. aureus (MRSA) and S. aureus ATCC 25923. To evaluate different propolis components accountability for bactericidal accomplishment and antibiofilm activity, the results were analysed by the non-parametric Spearman coefficient. Results of phenolic compounds were 216,21 to 312,08 gallic acid milligram equivalent per extract gram (mg EGA/g) of total phenolics, 55,08 to 140,6 quercetin milligram equivalent per extract gram (mg EQ/g) of flavonoids, 118,51 to 3766,16 catechin milligram equivalent per extract gram (mg EC/g) of tannins and 1,03 to 8,39 milligram per extract gram (mg/g) of anthocyanins. Red1 and Red2 showed higher tannin contents, while Red2 exhibited superior amount of anthocyanins and total phenolics. Brown3 presented higher flavonoid quantity. Green, Red1 and Red2 PEE showed the lowest levels of flavonoids, but the higher antimicrobial activity. Most PEE exhibit bactericidal activity at a concentration of 1.6 mg/mL. Brown4 PEE showed the worst capacity to inhibit S. aureus. Green PEE showed to be the most efficient in both preventing and disrupting biofilm. All PEE studied exhibited a better inhibitory activity prior-to than post-biofilm formation. According to non-parametric Spearman correlation analysis, there seems to be a significant negative correlation between the ability to disrupt biofilm and both tannins and anthocyanins contents.

Restricting the flexibility in DEA models

DEA models have been applied as the benchmarking tool in operations management to empirically account operational and productive efficiency. The wide flexibility in assigning the weights in DEA approach can result on indicators of efficiency who do not take account the relative importance of some inputs. In order to overcome this limitation, in this research we apply the DEA model under restricted weight specification. This model is applied to Spanish hotel companies in order to measure operational efficiency. The restricted weight specification enables us to decrease the influence of assigning unrealistic weights in some units and improve the efficiency estimation and to increase the discriminating potential of the conventional DEA model.

Efeitos da dança criativa em mulheres idosas

Objectivo: Verificar os efeitos da prática da Dança Criativa (DC) em mulheres idosas, no peso (P), altura (A), índice de massa corporal (IMC), perímetro abdominal (PA), força, resistência e flexibilidade dos membros superiores e inferiores (F, R, FL-MS/MI), mobilidade física (MF) [agilidade (AG), velocidade (V), equilíbrio dinâmico (ED)], resistência aeróbia (RA) e satisfação com a vida (SV). Método: A amostra foi de 57 mulheres, entre os 65 e os 80 anos, tendo sido distribuídas aleatoriamente pelo grupo de controlo (GC) (n=25) e pelo grupo experimental (GE) (n=32). Este último frequentou aulas de DC durante 6 meses, 3 vezes por semana, com a duração de 50'. A análise estatística foi efectuada através do SPSS 17, b:mdo sido utilizadas técnicas não paramétricas. As variáveis funcionais foram avaliadas através da bateria funcional Fitness Test (Rikli & Jones, 1999) - Idosos e a SV através da Satisfaction with Live Scale (SWLS), (Diener, Larsen and Gri1fin, 1985). Resultados: Os resultados demonstraram diferenças significativas, para melhor, em todas as variáveis, excepto no P, no PA e na FLMS, entre o início e os 3 meses e entre o início E os 6 meses. No P e no PA foram observadas diferenças entre os 3 e os 15 meses. Na FRMS ambos os grupos apresentaram diferenças significativas, para melhor, e na FLMS só o GC apresentou diferenças significativas para pior. Não havia diferenças significativas entre o GE e o GC no início do estudo, excepto na RA. Conclusões: A DC promove melhorias no P; A; IMC; PA; F, R, FL-MI; MF; RA e SV em mulheres idosas. ABSTRACT: Objective: To test and verify the effects of the practice of Creative Dance in the weight, height, body mass, abdominal perimeter, strength, resistance and flexibility of the lower and upper limbs, as well as physical mobility (agility, velocity, dynamic balance), aerobic resistance and life satisfaction in elderly women. Method: 57 females constituted the sample analyzed within the ages of 65 and 80 years old randomly divided between the control group (25) and the experimental group (32). The experimental group attended 50 minutes’ classes prepared and orientated to the target core of this study during six months. The statistical analysis was processed with SPSS 17 software under non-parametric techniques. The functional battery Fitness Test (Rikli & Jones, 1999) was used to evaluate the functional variables and life satisfaction was accessed trough the Satisfaction with Live Scale (SWLS), (Diener, Larsen and Griffin, 1985). Results: The results defined positive significant differences in all variables evaluated, except weigh, abdominal perimeter and flexibility of the upper limbs between the beginning and the 3-month and the beginning and the 6- month. Differences were observed in weight and abdominal perimeter between the 3 and 6 months. 8oth groups showed considerable positive differences in the strength and resistance of the upper limbs and only the control group showed negative differences in flexibility of the upper limbs. At the beginning of the study there were no significant differences between the two groups, except in the aerobic resistance. Conclusions: Creative Dance promotes the improvement of weight, height, body mass index, abdominal perimeter, strength, resistance, flexibility of both upper and lower limbs in elderly women.

Financing innovative start-ups in Portuguese context: what is the role of business angels networks?

Business angels provide both financing and managerial experience, which increase the likelihood of the survival of innovative start-ups. Over the last years, European countries with developing informal venture capital markets have seen governments support the creation of business angels networks (BANs) to increase and consolidate these markets. Using the Portuguese context to carry out the empirical work, this paper provides an assessment of value added provided by angels’ networks. A total of 88 useable responses were received and analysed using non-parametric statistical techniques. This paper demonstrates that is evidence of positive contribution of BANs in terms of bringing together investors and linking them with entrepreneur’s seeking finance. BANs played an important role in financing innovative start-ups also in peripheral regions. Results lead us to conclude that government support BANs would appear to be an effective mechanism to stimulate the angel market in developing informal venture capital markets. The conclusions of this paper are likely to have relevance for countries where there is growing interest in the potential of business angels as a means of financing innovative start-ups.

Analysis of heat-related phenomena and their interactions at different spatio-temporal scales

This thesis analyzes the impact of heat extremes in urban and rural environments, considering processes related to severely high temperatures and unusual dryness. The first part deals with the influence of large-scale heatwave events on the local-scale urban heat island (UHI) effect. The temperatures recorded over a 20-year summer period by meteorological stations in 37 European cities are examined to evaluate the variations of UHI during heatwaves with respect to non-heatwave days. A statistical analysis reveals a negligible impact of large-scale extreme temperatures on the local daytime urban climate, while a notable exacerbation of UHI effect at night. A comparison with the UrbClim model outputs confirms the UHI strengthening during heatwave episodes, with an intensity independent of the climate zone. The investigation of the relationship between large-scale temperature anomalies and UHI highlights a smooth and continuous dependence, but with a strong variability. The lack of a threshold behavior in this relationship suggests that large-scale temperature variability can affect the local-scale UHI even in different conditions than during extreme events. The second part examines the transition from meteorological to agricultural drought, being the first stage of the drought propagation process. A multi-year reanalysis dataset involving numerous drought events over the Iberian Peninsula is considered. The behavior of different non-parametric standardized drought indices in drought detection is evaluated. A statistical approach based on run theory is employed, analyzing the main characteristics of drought propagation. The propagation from meteorological to agricultural drought events is found to develop in about 1-2 months. The duration of agricultural drought appears shorter than that of meteorological drought, but the onset is delayed. The propagation probability increases with the severity of the originating meteorological drought. A new combined agricultural drought index is developed to be a useful tool for balancing the characteristics of other adopted indices.

Nonlinear modelling of non-structural masonry walls under a low-intensity earthquake motion: calibration through a parametric study

This thesis aims to understand the behavior of a low-rise unreinforced masonry building (URM), the typical residential house in the Netherlands, when subjected to low-intensity earthquakes. In fact, in the last decades, the Groningen region was hit by several shallow earthquakes caused by the extraction of natural gas. In particular, the focus is addressed to the internal non-structural walls and to their interaction with the structural parts of the building. A simple and cost-efficient 2D FEM model is developed, focused on the interfaces representing mortar layers that are present between the non-structural walls and the rest of the structure. As a reference for geometries and materials, it has been taken into consideration a prototype that was built in full-scale at the EUCENTRE laboratory of Pavia (Italy). Firstly, a quasi-static analysis is performed by gradually applying a prescribed displacement on the roof floor of the structure. Sensitivity analyses are conducted on some key parameters characterizing mortar. This analysis allows for the calibration of their values and the evaluation of the reliability of the model. Successively, a transient analysis is performed to effectively subject the model to a seismic action and hence also evaluate the mechanical response of the building over time. Moreover, it was possible to compare the results of this analysis with the displacements recorded in the experimental tests by creating a model representing the entire considered structure. As a result, some conditions for the model calibration are defined. The reliability of the model is then confirmed by both the reasonable results obtained from the sensitivity analysis and the compatibility of the values obtained for the top displacement of the roof floor of the experimental test, and the same value acquired from the structural model.

Endurance in judogi grip strength tests: comparison between elite and non-elite judo players

Background and Study Aim: The ability to develop a strong grip and maintain it during a judo match has become an important element for judo athletes. Therefore, the purpose of this investigation was to examine differences between measurements of maximal isometric time on judogi pull-up, and number of repetitions during dynamic judogi pull-up. Material/Methods: The sample was composed by two groups: 16 high-level judo athletes from the male Brazilian National Team and 12 male state-level judo athletes, with at least one athlete per weight category. The tests were compared through analysis of co-variance (body mass as co-variable), followed by a post-hoc test (Scheffe). Significance level was set at 5%. Results: No difference was found in the isometric test: Brazilian Team: 35 +/- 18s; Regional: 39 +/- 14s. However, the Brazilian Team performed a high number of repetitions (12 +/- 5 rep) compared to regional group (9 +/- 4 rep) during the dynamic grip strength endurance test. Conclusions: Thus, dynamic grip strength endurance seems to be a discriminating variable between judo athletes, probably because judo combat involves many elbow extensions and flexions in order to avoid the opponent`s grip and to subdue them.

Characterization of micro-bubble size distribution and flow configuration in DAF contact zone by a non-intrusive image analysis system and tracer tests

This paper aims to investigate the influence of some dissolved air flotation (DAF) process variables (specifically: the hydraulic detention time in the contact zone and the supplied dissolved air concentration) and the pH values, as pretreatment chemical variables, on the micro-bubble size distribution (BSD) in a DAF contact zone. This work was carried out in a pilot plant where bubbles were measured by an appropriate non-intrusive image acquisition system. The results show that the obtained diameter ranges were in agreement with values reported in the literature (10-100mm), quite independently of the investigated conditions. The linear average diameter varied from 20 to 30mm, or equivalently, the Sauter (d(3,2)) diameter varied from 40 to 50mm. In all investigated conditions, D(50) was between 75% and 95%. The BSD might present different profile (with a bimodal curve trend), however, when analyzing the volumetric frequency distribution (in some cases with the appearance of peaks in diameters ranging from 90-100mm). Regarding volumetric frequency analysis, all the investigated parameters can modify the BSD in DAF contact zone after the release point, thus potentially causing changes in DAF kinetics. This finding prompts further research in order to verify the effect of these BSD changes on solid particle removal efficiency by DAF.

Parametric analysis of different compact tension specimens for fracture toughness characterisation in woven composite materials

Estudi elaborat a partir d’una estada a l’ Imperial College London, entre juliol i novembre de 2006. En aquest treball s’ha investigat la geometria més apropiada per a la caracterització de la tenacitat a fractura intralaminar de materials compòsits laminats amb teixit. L’objectiu és assegurar la propagació de l’esquerda sense que la proveta falli abans per cap altre mecanisme de dany per tal de permetre la caracterització experimental de la tenacitat a fractura intralaminar de materials compòsits laminats amb teixit. Amb aquesta fi, s’ha dut a terme l’anàlisi paramètrica de diferents tipus de provetes mitjançant el mètode dels elements finits (FE) combinat amb la virtual crack closure technique (VCCT). Les geometries de les provetes analitzades corresponen a la proveta de l’assaig compact tension (CT) i diferents variacions com la extended compact tension (ECT), la proveta widened compact tension (WCT), tapered compact tension (TCT) i doubly-tapered compact tension (2TCT). Com a resultat d’aquestes anàlisis s’han derivat diferents conclusions per obtenir la geometria de proveta més apropiada per a la caracterització de la tenacitat a fractura intralaminar de materials compòsits laminats amb teixit. A més, també s’han dut a terme una sèrie d’assaigs experimentals per tal de validar els resultats de les anàlisis paramètriques. La concordança trobada entre els resultats numèrics i experimentals és bona tot i la presència d’efectes no previstos durant els assaigs experimentals.