Bridging Knowledge Gaps in the Management of Acute Coronary Syndromes

Contexte L’occlusion d’une artère du cœur cause un syndrome coronarien aigu (SCA) soit avec une élévation du segment ST (IAMEST) ou sans élévation du segment ST (1). Le traitement des patients avec un IAMEST requiert soit une intervention coronarienne d’urgence (ICP primaire) ou une thérapie fibrinolytique (FL). La thérapie FL peut être administrée soit dans un contexte pré-hospitalier (PHL) ou à l’hôpital. Une prise en charge précoce des patients avec SCA peut être améliorée par un simple indice de risque. Objectifs Les objectifs de cette thèse étaient de : 1) comparer l’ICP primaire et la thérapie FL (2); décrire plusieurs systèmes internationaux de PHL; (3) développer et valider un indice de risque simplifié pour une stratification précoce des patients avec SCA. Méthodes Nous complétons des méta-analyses, de type hiérarchique Bayésiennes portant sur l’effet de la randomisation, d’études randomisées et observationnelles; complétons également un sondage sur des systèmes internationaux de PHL; développons et validons un nouvel indice de risque pour ACS (le C-ACS). Résultats Dans les études observationnelles, l’ICP primaire, comparée à la thérapie FL, est associée à une plus grande réduction de la mortalité à court-terme; mais ce sans bénéfices concluants à long terme. La FL pré-hospitalière peut être administrée par des professionnels de la santé possédant diverses expertises. Le C-ACS a des bonnes propriétés discriminatoires et pourrait être utilisé dans la stratification des patients avec SCA. Conclusion Nous avons comblé plusieurs lacunes importantes au niveau de la connaissance actuelle. Cette thèse de doctorat contribuera à améliorer l’accès à des soins de qualité élevée pour les patients ayant un SCA.

Détection moléculaire des métastases des ganglions lymphatique dans le cancer du col de l'utérus

Le Cancer du Col Utérin (CCU) chez la femme est provoqué par le virus oncogénique VPH. La métastase lymphatique ganglionnaire est un facteur pronostique majeur pour l’évolution de ce cancer et sa présence influence la décision thérapeutique. En général, l’envahissement ganglionnaire est diagnostiqué par histologie, mais cette méthode est laborieuse et parfois prise en défaut pour détecter les micrométastases et les cellules cancéreuses isolées et pour donner des résultats rapides en per opératoire. L’outil moléculaire que nous désirons développer pour combler cette lacune est basé sur une analyse d’ARN des gènes du VPH exprimés par les cellules du CCU. Ceci sera fait par transcription réverse de l’ARN cellulaire couplé à une réaction quantitative en chaine par polymérase en temps réel (RT-qPCR). Cette technique devrait nous permettre une détection et une évaluation rapide des micrométastases pour aider à déterminer immédiatement un pronostic fiable et la thérapie associée. C’est un test précis, sensible et rapide pour détecter un envahissement ganglionnaire dans le CCU visant à améliorer la gestion thérapeutique. Le projet est basé sur trois objectifs. En premier lieu, valider les marqueurs moléculaires E6 et E7 de VPH16 et 18 à partir des échantillons frais et des échantillons fixés dans des blocs de paraffine. En deuxième lieu, déterminer la fiabilité et la sensibilité des marqueurs pour la détection des macrométastases, des micrométastases et les cellules tumorales isolées en utilisant la technique de RT-qPCR. En troisième lieu et parallèlement au travail présenté dans ce mémoire, il est nécessaire de constituer une base de données des patientes qui ont le virus VPH16 et 18 intégré dans leur génome, qui ont été traitées et dont nous connaissons déjà le diagnostic final afin de valider la méthode (biobanque). Nous avons réussi à extraire de l’ARNm de haute qualité à partir d’échantillons complexes, à détecter les gènes E6 et E7 de VPH16 et 18 en RT-qPCR, et à déterminer précisément la limite de détection de E6 et E7 dans les échantillons frais qui est une proportion de 0,008% de cellules cancéreuses. Dans les échantillons fixés dans la paraffine, cette limite est de 0,02% et 0,05% pour E6-E7-VPH16 et E6-E7-VPH18 respectivement. Ceci comparativement à une limite de détection histologique de 1% qui est déterminée par immunohistochimie de CK19. Enfin, notre protocole est validé pour VPH18 dans les ganglions lymphatiques du CCU.

Knowledge transfer intervention theory : a model grounded in the strategies used by intermediate agents in the context of education

La présente thèse se base sur les principes de la théorisation ancrée (Strauss & Corbin, 1998) afin de répondre au manque de documentation concernant les stratégies adoptées par des « agents intermédiaires » pour promouvoir l’utilisation des connaissances issues de la recherche auprès des intervenants en éducation. Le terme « agent intermédiaire » réfère aux personnes qui sont positionnées à l’interface entre les producteurs et les utilisateurs des connaissances scientifiques et qui encouragent et soutiennent les intervenants scolaires dans l’application des connaissances scientifiques dans leur pratique. L’étude s’inscrit dans le cadre d’un projet du ministère de l’Éducation, du Loisir et du Sport du Québec visant à améliorer la réussite scolaire des élèves du secondaire provenant de milieux défavorisés. Des agents intermédiaires de différents niveaux du système éducatif ayant obtenu le mandat de transférer des connaissances issues de la recherche auprès des intervenants scolaires dans les écoles visées par le projet ont été sollicités pour participer à l’étude. Une stratégie d’échantillonnage de type « boule-de-neige » (Biernacki & Waldorf, 1981; Patton, 1990) a été employée afin d’identifier les personnes reconnues par leurs pairs pour la qualité du soutien offert aux intervenants scolaires quant à l’utilisation de la recherche dans leur pratique. Seize entrevues semi-structurées ont été réalisées. L’analyse des données permet de proposer un modèle d’intervention en transfert de connaissances composé de 32 stratégies d’influence, regroupées en 6 composantes d’intervention, soit : relationnelle, cognitive, politique, facilitatrice, évaluative, de même que de soutien et de suivi continu. Les résultats suggèrent que les stratégies d’ordre relationnelle, cognitive et politique sont interdépendantes et permettent d’établir un climat favorable dans lequel les agents peuvent exercer une plus grande influence sur l’appropriation du processus de l’utilisation des connaissances des intervenants scolaire. Ils montrent en outre que la composante de soutien et de suivi continu est importante pour maintenir les changements quant à l’utilisation de la recherche dans la pratique chez les intervenants scolaires. Les implications théoriques qui découlent du modèle, ainsi que les explications des mécanismes impliqués dans les différentes composantes, sont mises en perspective tant avec la documentation scientifique en transfert de connaissances dans les secteurs de la santé et de l’éducation, qu’avec les travaux provenant de disciplines connexes (notamment la psychologie). Enfin, des pistes d’action pour la pratique sont proposées.

Studying Your Own Country. Social Scientific Knowledge For Our Times and Places; Presidential Address to the Canadian Political Science Association, St Catharines, May 28, 2014

Political science is both a generalizing and an anchored, nationally defined, discipline. Too often, the first perspective tends to crowd out the latter, because it appears more prestigious, objective, or scientific. Behind the international/national dichotomy, there are indeed rival conceptions of social science, and important ontological, epistemological and methodological assumptions. This article discusses these assumptions and stresses the critical contribution of idiographic, single-outcome studies, the importance of producing relevant, usable knowledge, and the distinctive implications of studying one’s own country, where a scholar is also a citizen, involved in more encompassing national conversations. The aim is not to reject the generalizing, international perspective, or even the comparative approach, but rather to reaffirm the importance of maintaining as well, and in fact celebrating, the production of social scientific knowledge directly relevant for our own times and places.

Studies on the, Physical Aspects of the Mud Banks along the Kerala Coast

A detailed survey of the present knowledge on the physical aspects of the mud banks has been presented in chapter 1.The physical geographical and geological aspects of the kerala coast, the shore-line and the sea bed and the various views on the formation,movements and dissipation of the mud banks have been discussed.The scope of the present work and a description of the area of study have also been given in this chapter. The horizontal and vertical distribution and the seasonal variations of the concentration of suspended matter in the mud bank region are discussed in chapter 3.it is seen that the mud bank reses above the bottom in the form of a ridged ,irregular,solid come with a flat top. Chapter vi deals with waves and currents in the region of the mud bank. The orientation of the breakers on either side of the mud bank suggests the possibility of formation of opposing alongshore currents and convergence of energy caused by wave refraction.The distribution of currents during the formative nature and dissipating stages of the mud bank show that the converging alongshore currents give rise to offshore flows

Power Profile of Effective Managers: An Exploration among the Branch Managers of a Commercial Bank in Kerala

Managers are central to any fuction in a complex and developed society. Their talents are reckoned to be cardinal in developed economies and a basic yearning of all developing economies.In order to survive and produce results in a turbulent and transient environment, the task is to understand the nature of factors contributing to managerial effectiveness. This study is an attempt towards this core issue of the present from a different perspective. This study tries to focus attention on a group of managers functioning in the field of banking, a core sector in the country's economy. The gamut of economic activities in Kerala being predominantly service-oriented, importance of commercial banking is almost indisputable. Though economists would argue that the disproportionate development of service sector is anomalous when viewed against the hazy scenarios in the primary and secondary sectors of the state’s economy, the extent and pace of growth in the banking sector has had its dole meted out by ambitious and productive managers fiinctioning in the field. Researcher’s attempt here is to thresh the grain and chaff among bank managers in terms of their effectiveness and to account for the variations in the light of their ability to affect the thoughts and actions of their subordinates. To put it succinctly, the attempt herein is to explain the effectiveness of bank managers in the light of their ‘Power Profile’ taken to be comprising Power Differentials, Power Bases, their Visibility and Credibility in the organisation and, the Power Styles typically used by them for influencing subordinates.

Studies on the benthose of the mud bank regions of the Kerala coast

There is very little information on the subtidal bottom fauna of the shelf regions in the seas around India. What little is known is restricted to macro benthos. The paucity of the work on bottom fauna and the importance of mud banks in the fishery of the South West Coast of India has initiated the present study. Attempts have been made to obtain a picture of the bottom fauna of a mud bank region of the Kerala Coast. The difficulties involved in the sampling and analysis, especially the availability of a suitable vessel during the S.W. Monsoon, resulted in the work being restricted mainly to the Narakal mud bank region 6 Km. north of Cochin Detailed sampling is conducted using grab, dredge and to a small extent beam trawl, to assess the qualitative and quantitative nature of the macro benthos. Important species contributing to the fauna are identified and the standing crop estimated for different seasons. The meiobenthos was studied using core samples taken from the grab. Animals were identified to the major taxa. Standing crop of meiobenthos and the quantitative importance of different groups were also studied. The data collected have been interpreted and discussed. As an understanding of the physico-chemical aspects of the environment is essential in order to obtain a true picture of the benthos, attempts were made in this direction. Environmental parameters such as temperature of the sediment, salinity, temperature, and dissolved oxygen in the overlying water were studied .during the period of benthos investigation. Monthly observations on the dissolved inorganic and organic phosphorus in the area of investigation have been made. The physico-chemical nature of the sediment was also studied. Influence of these ecological variables on the bottom fauna is discussed.

A Study of Credit Guarantee Fund Trust for Micro and Small Enterprises with particular reference to Bank of Baroda in state of Kerala

While the quantum of advances from the public sector banks (PSBs) to the MSEs has increased over the years in absolute terms, from Rs.46, 045 crore in March 2000 to Rs.1, 85,208 crore in March 2009, the share of the 7credit to the MSE sector in the Net Bank Credit (NBC) has declined from 12.5 per cent to 10.9 per cent. Similarly, there has been a decline in the share of micro sector as a percentage of Net Bank Credit (NBC) from 7.8 per cent in March 2000 to 4.9% in March 2009. (TKA.Nair, 2010)9.The major reasons for low availability of bank finance to this sector are high risk perception of the banks in lending to MSEs and high transaction costs in processing of loan applications of MSEs. The problem is more serious for micro enterprises requiring small loans and the first generation entrepreneursThe thesis studies the divergence in guidelines by, CGTMSE, RBI & Bank of Baroda on collateral free lending and analyses the awareness of MSE about CGTMSE lending. The researcher tries to assess the problems faced by borrowers in availing advance under CGTMSE from Bank of Baroda, Kerala.

Refinance operations of the national bank for agriculture and rural development-the kerala experience

NABARD has completed 14 years of operation.ln the light of its experiences and achievements, the performance ev.ilu.ilion of the National Bank need to be looked into.This could provide certain criteria for its strength and weakness which may help in consolidating the institution for better utilisation of its potentialities. It is also noteworthy that no evaluative study on the National Bank has been conducted in Kerala. The Major objective of this study is to evaluate the role of NABARD in catering to the long-term agricultural requirements of Kerala for 1982 to 1992.This is done by analysing the quantum and quality of NABARD's schematic refinance. The qualitative indices like (1) the efficiency of loan recovery, (2) the impact or financial viability of NABARD refinanced schemes, (3) the credit gap, (4) the commitment-disbursement gap, and (5) the imbalances in the NABARD refinance form the core of the study.Hypotheses were formulated inorder to study and analyse these qualitative indices. The study is presented in eight chapters

Performance Effectiveness Of Bank Managers: A Study Of Psycho-Social Correlates

The present study by the researcher focuses attention on the problem of performance effectiveness among managers operating in one of the critical and socially important sectors of our economy namely commercial banking. The banking sector is selected for the study due to two reasons. Firstly, commercial banking plays an important role in the country's development. Secondly, for improving the efficiency of the banking system, we need to know more about the performance dynamics of the executives in our banking organizations

Meteorological aspects of mud bank formation along south west coast of India

The study mainly intends to investigate the meteorological aspects associated with the formation of mud banks along southwest coast of India. During the formation of mud bank, the prominent monsoon organized convection is located in the equatorial region and relatively low clouding over Indian mainland. The wind core of the low level jet stream passes through the monsoon organized convection. When the monsoon organized convection is in the equatorial region, the low level wind over the southwest coast of India is parallel to the coastline and toward south. This wind along the coast gives rise to Ekman mass transport away from the coastline and subsequently formation of mud bank, if the high wind stress persists continuously for three or more days. As a result of the increased alongshore wind stress, the coastal upwelling increases. An increase in chlorophyll-a concentration and total chlorophyll can also be seen associated with mudbank formation

A study on the Effect of Psychological Empowerment on Job Satisfaction and Job Related Stress Among the Bank Employees

The present research is carried out to understand how psychological empowerment, job satisfaction and job related stress are related.In banking sector, employees are less satisfied and less motivated than employees in other lines of work (Kelley, 1990; Bajpai, Naval and Deepak, 2004). The banking industry also suffers from high employee turnover rate (Branham, 2005; Nelson, 2007) and high level of stress (Chen and Lien, 2008). There are no adequate studies linking psychological empowerment and job satisfaction, stress, turnover etc. among employees of banking sector. Lack of psychological empowerment could be a reason for these problems faced by banking sector. Further majority of studies in psychological empowerment are carried out in manufacturing sector and studies in service sector are concentrated on hotel industry and hospitals. Empowerment takes different forms in different contexts (Zimmerman, 1995). In the light of above discussion, the present research is directed to explore the dimensions of psychological empowerment of employees in banking sector and to find out whether high psychological empowerment can increase job satisfaction and reduce job related stress among employees in banking sector

Information Dynamics and Knowledge Management in Science & Technology

This paper describes the current information dynamics and its effect in higher education and research in science and technology. Open access movement ,Institutional repositories ,Digital libraries,Knowledge gateways,Blogs,Wikis,and social bookmark tools have rapidly emerged on the web creating a new scenerio that radically changes the knowledge production process such as the creation of information,formats and sources of information,coding and processing ,accessing managing sharing and dissemination of information.The management of knowledge created by academia of Cochin University Of Science And Technology is examined in this challenging context of information dynamics.