La bioéthique et les conflits armés : la réflexion éthique des médecins militaires

Le but de la recherche est d’étudier les tensions éthiques que peuvent vivre les médecins militaires, qui doivent agir à la fois comme soignants, militaires (même s’ils sont non combattants) et parfois comme acteurs humanitaires. Parmi la littérature sur l’éthique de la médecine militaire, les dilemmes la concernant sont souvent présentés comme le fruit de pressions réelles ou perçues provenant de l’institution militaire, des règles, codes, lois ou de politiques, ceci afin de détourner le médecin de son but premier, soit l’intérêt du patient. Pour mieux comprendre les défis éthiques auxquels sont confrontés les médecins militaires canadiens et comment ceux-ci les traitent, la recherche utilise une approche de bioéthique empirique. À partir d’une analyse de la littérature, nous examinons les dilemmes éthiques des médecins militaires, le concept de profession, ainsi que les codes d’éthique (médicaux et militaires) canadiens. L’expérience éthique est ensuite explorée à partir d’entrevues semi-directives effectuées auprès de quatorze médecins militaires ayant participé à des missions opérationnelles, notamment à Kandahar en Afghanistan, entre 2006 et 2010. Les résultats, tant conceptuels qu’empiriques, nous indiquent que plusieurs nuances s’imposent. Tout d’abord, les médecins militaires canadiens ne vivent pas les dilemmes tels qu’ils sont présentés dans la littérature, ni en nombre ni en fréquence. Ils sont conscients qu’ils doivent à la fois tenir compte de l’intérêt du patient et du bien commun, mais n’en ressentent pas pour autant un sentiment de double loyauté professionnelle. De plus, ils ont l’impression de partager l’objectif de la mission qui est de maintenir la force de combat. Des distinctions s’imposent aussi entre les médecins eux-mêmes, dans la conception qu’ils se font de leur profession, ainsi que dans les contextes (opération ou garnison), selon le type de travail qu’ils exercent (généraliste ou spécialiste). Les principaux défis éthiques rapportés portent sur les inégalités de soins entre les soldats de la coalition et les victimes locales (soldats et civils), ainsi que sur le manque de ressources, engendrant des décisions cliniques éprouvantes. Un résultat étonnant des entrevues est la présence de deux groupes distincts au plan de l’identification professionnelle. Huit médecins militaires se considèrent avant tout comme médecin, alors que les six autres ne sont pas arrivés à accorder une priorité à l’une ou l’autre des professions. Ces deux groupes se différencient également sur d’autres plans, comme le nombre et le type de défis éthiques identifiés, ainsi que les mécanismes de résolution des dilemmes utilisés. Malgré les formations éthiques offertes par l’institution, des lacunes subsistent dans la capacité d’identification des expériences éthiques et des valeurs impliquées, de même que des mécanismes de résolution utilisés. Compte tenu du faible échantillonnage, ces résultats sont difficilement généralisables. Néanmoins, ils peuvent nous inspirer au niveau théorique en faisant ressortir le caractère multidimensionnel de la médecine militaire, ainsi qu’au niveau pratique en nous permettant de suggérer des éléments de formation facilitant la réflexion éthique des médecins militaires.

Interventions infirmières de stratégies de transfert de connaissances pour prévenir et dépister le délirium chez la clientèle âgée

Rapport de stage présenté à la Faculté des sciences infirmières en vue de l’obtention du grade Maître ès sciences (M.Sc.) en sciences infirmières option expertise-conseil

Beyond Doing Good: An Interview with Dr. Kirsten Johnson on the Canadian Disaster and Humanitarian Response Training Program

Compte-rendu / Review

Semiautomated 3D liver segmentation using computed tomography and magnetic resonance imaging

Le foie est un organe vital ayant une capacité de régénération exceptionnelle et un rôle crucial dans le fonctionnement de l’organisme. L’évaluation du volume du foie est un outil important pouvant être utilisé comme marqueur biologique de sévérité de maladies hépatiques. La volumétrie du foie est indiquée avant les hépatectomies majeures, l’embolisation de la veine porte et la transplantation. La méthode la plus répandue sur la base d'examens de tomodensitométrie (TDM) et d'imagerie par résonance magnétique (IRM) consiste à délimiter le contour du foie sur plusieurs coupes consécutives, un processus appelé la «segmentation». Nous présentons la conception et la stratégie de validation pour une méthode de segmentation semi-automatisée développée à notre institution. Notre méthode représente une approche basée sur un modèle utilisant l’interpolation variationnelle de forme ainsi que l’optimisation de maillages de Laplace. La méthode a été conçue afin d’être compatible avec la TDM ainsi que l' IRM. Nous avons évalué la répétabilité, la fiabilité ainsi que l’efficacité de notre méthode semi-automatisée de segmentation avec deux études transversales conçues rétrospectivement. Les résultats de nos études de validation suggèrent que la méthode de segmentation confère une fiabilité et répétabilité comparables à la segmentation manuelle. De plus, cette méthode diminue de façon significative le temps d’interaction, la rendant ainsi adaptée à la pratique clinique courante. D’autres études pourraient incorporer la volumétrie afin de déterminer des marqueurs biologiques de maladie hépatique basés sur le volume tels que la présence de stéatose, de fer, ou encore la mesure de fibrose par unité de volume.

Marine Engineering Training in India -A Pedagogic Introspection

Indian marine engineers are renowned for employment globally due to their knowledge, skill and reliability. This praiseworthy status has been achieved mainly due to the systematic training imparted to marine engineering cadets. However, in an era of advancing technology, marine engineering training has to remain dynamic to imbibe latest technology as well as to meet the demands of the shipping industry. New subjects of studies have to be included in the curriculum in a timely manner taking into consideration the industry requirements and best practices in shipping. Technical competence of marine engineers also has to be subjected to changes depending upon the needs of the ever growing and over regulated shipping industry. Besides. certain soft skills are to be developed and improved amongst the marine engineers in order to alter or amend the personality traits leading to their career success.If timely corrective action is taken. Indian marine engineers can be in still greater demand for employment in global maritime field. In order to enhance the employability of our mmine engineers by improving their quality, a study of marine engineers in general and class IV marine engineers in particular was conducted based on three distinct surveys, viz., survey among senior marine engineers, survey among employers of marine engineers and survey of class IV marine engineers themselves.The surveys have been planned and questionnaires have been designed to focus the study of marine engineer officer class IV from the point of view of the three distinct groups of maritime personnels. As a result of this, the strength and weakness of class IV marine engineers are identified with regard to their performance on board ships, acquisition of necessary technical skills. employability and career success. The criteria of essential qualities of a marine engineer are classified as academic, technical, social, psychological. physical, mental, emergency responsive, communicative and leadership, and have been assessed for a practicing marine engineer by statistical analysis of data collected from surveys. These are assessed for class IV marine engineers from the point of view of senior marine engineers and employers separately. The Endings are delineated and graphically depicted in this thesis.Besides. six pertinent personality traits of a marine engineer viz. self esteem. learning style. decision making. motivation. team work and listening self inventory have been subjected to study and their correlation with career success have been established wherever possible. This is carried out to develop a theoretical framework to understand what leads a marine engineer to his career attainment. This enables the author to estimate the personality strengths and weaknesses of a serving marine engineer and eventually to deduce possible corrective measures or modifications in marine engineering training in India.Maritime training is largely based on International Conventions on Standard of Training. Certification and Watch keeping for Seafarers 1995. its associated Code and Merchant Shipping (STCW for Seafarers) Rules 1998. Further, Maritime Education, Training and Assessment (META) Manual was subjected to a critical scrutiny and relevant Endings of thc surveys arc superimposed on the existing rule requirement and curriculum. Views of senior marine engineers and executives of various shipping companies are taken into account before arriving at the revision of syllabus of marine engineering courses. Modifications in the pattern of workshop and sea service for graduate mechanical engineering trainees are recommended. Desirable age brackets of junior engineers and chief engineers. use of Training and Assessment Record book (TAR Book) during training etc. have also been evaluated.As a result of the pedagogic introspection of the existing system of marine engineering training in India. in this thesis, a revised pattern of workshop training of six months duration for graduate mechanical engineers. revised pattern of sea service training of one year duration and modified now diagram incorporating the above have been arrived at. Effects of various personality traits on career success have been established along with certain findings for improvement of desirable personality traits of marine engineers.

Vocational Higher Secondary Education in Kerala: A Status Study of Students, Pass Outs and Training Components

This study analyses the socio-economic backgrounds and entrepreneurial profiles of the students and pass outs of the Vocational Higher Secondary Education in Kerala and the academic achievements of the Vocational Higher Secondary students and pass outs in Kerala in terms of their performance in the examinations. The study also analyses the quality and availability of the various training and support facilities of the Vocational Higher Secondary Schools in Kerala, nature and rate of employment and higher studies among the pass outs of the Vocational Higher Secondary Education in Kerala and the awareness of students, pass outs, teachers and principals regarding the goals and objectives, mode of implementation, apprenticeship training and higher study and employment opportunities of the programme of the Vocational Higher Secondary Education in Kerala.

Recruitment And Training Of Managers In The Public Sector Concerns In Kerala

Public undertakings have been assigned a significant role to play in the systematic socio-economic development of India. My interest in the subject was kindled while I was doing my Masters Diploma in Public Administration at the Indian Institute of Public Administration, New Delhi during 1960-61. It was further strengthened by my teaching of the subject in different courses offered by me at the School of Management Studies and in several programmes organised by various voluntary and training organisations like the Institute of Management in Government, Trivandrum, Centre for Management Development, Trivandrum, etc. The several years in which I served as a member of the faculty in the School of Management Studies, University of Cochin,gave me the opportunity to come into close contact with different public sector concerns and their managers at various levels. This rich opportunity gave me a better insight into the problems faced by these concerns. The present study is a result of the interest so developed.

Alignment Model and Training Technique in SMT from English to Malayalam

This paper investigates certain methods of training adopted in the Statistical Machine Translator (SMT) from English to Malayalam. In English Malayalam SMT, the word to word translation is determined by training the parallel corpus. Our primary goal is to improve the alignment model by reducing the number of possible alignments of all sentence pairs present in the bilingual corpus. Incorporating morphological information into the parallel corpus with the help of the parts of speech tagger has brought around better training results with improved accuracy

Evaluation of the agricultural vocational training programmes conducted by the Krishi Vigyan Kendras (Farm Science Centres) in Indian Punjab

Krishin Vigyan Kendras-KVKs (Farm Science Centres) have been established by the Indian Council of Agricultural Research in 569 districts. The trust areas of KVKs are refinement and demonstration of technologies, and training of farmers and extension functionaries. Imparting vocational trainings in agriculture and allied fields for the rural youth is one of its mandates. The study was undertaken to do a formative and summative (outcome and impact) evaluation of the beekeeping and mushroom growing vocational training programmes in the Indian state of Punjab. One-group pre and post evaluation design was employed for conducting a formative and outcome evaluation. The knowledge tests were administered to 35 beekeeping and 25 mushroom cultivation trainees, before and after the training programmes organized in 2004. The trainees significantly gained in knowledge. A separate sample of 640 trainees, trained prior to 2004, was selected for finding the adoption status. Out of 640, a sample of 200 was selected by proportionate sampling technique out of three categories, namely: non-adopters, discontinued-adopters and continued-adopters for evaluating the long-term impact of these training programmes. Ex-post-facto one-shot case study design was applied for this impact analysis. The vocational training programmes have resulted in continued-adoption of beekeeping and mushroom cultivation enterprises by 20% and 51% trained farmers, respectively. Age and trainee occupation had significant influence on the adoption decision of beekeeping vocation, whereas education and family income significantly affected the adoption decision of mushroom cultivation. The continued adopters of beekeeping and mushroom growing had increased their family income by 49% and 24%, respectively. These training programmes are augmenting the dwindling farm income of the farmers in Indian Punjab.

Enlarging a training set for genomic selction by imputation of un-genotyped animals in populations of varying genetic architecture

Background: The most common application of imputation is to infer genotypes of a high-density panel of markers on animals that are genotyped for a low-density panel. However, the increase in accuracy of genomic predictions resulting from an increase in the number of markers tends to reach a plateau beyond a certain density. Another application of imputation is to increase the size of the training set with un-genotyped animals. This strategy can be particularly successful when a set of closely related individuals are genotyped. ----- Methods: Imputation on completely un-genotyped dams was performed using known genotypes from the sire of each dam, one offspring and the offspring’s sire. Two methods were applied based on either allele or haplotype frequencies to infer genotypes at ambiguous loci. Results of these methods and of two available software packages were compared. Quality of imputation under different population structures was assessed. The impact of using imputed dams to enlarge training sets on the accuracy of genomic predictions was evaluated for different populations, heritabilities and sizes of training sets. ----- Results: Imputation accuracy ranged from 0.52 to 0.93 depending on the population structure and the method used. The method that used allele frequencies performed better than the method based on haplotype frequencies. Accuracy of imputation was higher for populations with higher levels of linkage disequilibrium and with larger proportions of markers with more extreme allele frequencies. Inclusion of imputed dams in the training set increased the accuracy of genomic predictions. Gains in accuracy ranged from close to zero to 37.14%, depending on the simulated scenario. Generally, the larger the accuracy already obtained with the genotyped training set, the lower the increase in accuracy achieved by adding imputed dams. ----- Conclusions: Whenever a reference population resembling the family configuration considered here is available, imputation can be used to achieve an extra increase in accuracy of genomic predictions by enlarging the training set with completely un-genotyped dams. This strategy was shown to be particularly useful for populations with lower levels of linkage disequilibrium, for genomic selection on traits with low heritability, and for species or breeds for which the size of the reference population is limited.

Förderung des kritischen Denkens thailändischer Deutschlernender durch Training des kritischen Lesens im Deutschunterricht

Die vorliegende Dissertation untersucht das Leseverhalten thailändischer Deutschlernender mit dem Ziel, ihre Fähigkeit zum kritischen Lesen unter Anwendung des MURDER-Schemas im fremdsprachlichen Deutschunterricht zu fördern. Neben der Lesefertigkeit soll aufgrund der bestehenden Zusammenhänge zusätzlich das kritische Denken der Lernenden gefördert werden.

Rotation Invariant Object Recognition from One Training Example

Local descriptors are increasingly used for the task of object recognition because of their perceived robustness with respect to occlusions and to global geometrical deformations. Such a descriptor--based on a set of oriented Gaussian derivative filters-- is used in our recognition system. We report here an evaluation of several techniques for orientation estimation to achieve rotation invariance of the descriptor. We also describe feature selection based on a single training image. Virtual images are generated by rotating and rescaling the image and robust features are selected. The results confirm robust performance in cluttered scenes, in the presence of partial occlusions, and when the object is embedded in different backgrounds.

Support Vector Machines: Training and Applications

The Support Vector Machine (SVM) is a new and very promising classification technique developed by Vapnik and his group at AT&T Bell Labs. This new learning algorithm can be seen as an alternative training technique for Polynomial, Radial Basis Function and Multi-Layer Perceptron classifiers. An interesting property of this approach is that it is an approximate implementation of the Structural Risk Minimization (SRM) induction principle. The derivation of Support Vector Machines, its relationship with SRM, and its geometrical insight, are discussed in this paper. Training a SVM is equivalent to solve a quadratic programming problem with linear and box constraints in a number of variables equal to the number of data points. When the number of data points exceeds few thousands the problem is very challenging, because the quadratic form is completely dense, so the memory needed to store the problem grows with the square of the number of data points. Therefore, training problems arising in some real applications with large data sets are impossible to load into memory, and cannot be solved using standard non-linear constrained optimization algorithms. We present a decomposition algorithm that can be used to train SVM's over large data sets. The main idea behind the decomposition is the iterative solution of sub-problems and the evaluation of, and also establish the stopping criteria for the algorithm. We present previous approaches, as well as results and important details of our implementation of the algorithm using a second-order variant of the Reduced Gradient Method as the solver of the sub-problems. As an application of SVM's, we present preliminary results we obtained applying SVM to the problem of detecting frontal human faces in real images.