Enjeux éthiques, défis dans les soins de santé et prise de décisions pour les patients souffrant de troubles neurologiques de la conscience

Le coma, l’état végétatif et l’état de conscience minimale sont classés comme « troubles de la conscience ». La caractéristique commune à ces diagnostics est un état de conscience altéré. La technologie permet désormais de maintenir en vie les individus affligés de ces diagnostics. La nature même de leur condition et les soins disponibles pour ces patients conduisent à des dilemmes médicaux et éthiques importants. Ce mémoire propose une brève introduction des troubles de la conscience suivie d’une recension des écrits sur les enjeux éthiques et sociaux en lien avec ces diagnostics. Force est de constater que certains enjeux perdurent depuis des années comme le retrait de traitement. D’autres sont apparus plus récemment, comme l’enjeu lié à l’usage de la neuroimagerie. Un deuxième volet présente les résultats d’une étude qualitative examinant les perspectives et l’expérience des professionnels de la santé face aux enjeux éthiques lors de la prise en charge des patients atteints de troubles de la conscience. Cette étude a été réalisée par le biais d’un court questionnaire et d’entrevues semi-dirigées qui furent enregistrées puis analysées à l’aide du logiciel Nvivo. Les résultats démontrent entre autres que les répondants éprouvent un niveau de certitude élevé face au diagnostic bien qu’il soit souvent signalé comme un défi important dans la littérature. Le pronostic représente un enjeu crucial, y compris sa divulgation aux proches. Enfin, la relation avec la famille est un élément clé dans la prise en charge des patients et celle-ci est teintée par de multiples facteurs.

Étude des collisions proton-proton dans l’expérience ATLAS avec les détecteurs ATLAS-MPX

Les seize détecteurs MPX constituant le réseau ATLAS-MPX ont été placés à différentes positions dans le détecteur ATLAS et sa averne au CERN dans le but de mesurer en emps réel les champs de radiation produits ar des particules primaires (protons des faisceaux) et des particules secondaires (kaons, pions, g, protons) issues des collisions proton-proton. Des films de polyéthylène (PE) et de fluorure de lithium (6LiF) recouvrent les détecteurs afin d’augmenter leur sensibilité aux neutrons produits par les particules primaires et secondaires interagissant avec les matériaux présents dans l’environnement d’ATLAS. La reconnaissance des traces laissées par les particules dans un détecteur ATLAS-MPX se fait à partir des algorithmes du logiciel MAFalda (“Medipix Analysis Framework”) basé sur les librairies et le logiciel d’analyse de données ROOT. Une étude sur le taux d’identifications erronées et le chevauchement d’amas a été faite en reconstruisant les activités des sources 106Ru et 137Cs. L’efficacité de détection des neutrons rapides a été mesurée à l’aide des sources 252Cf et 241AmBe (neutrons d’énergie moyenne de 2.13 et 4.08 MeV respectivement). La moyenne des efficacités de détection mesurées pour les neutrons produits par les sources 252C f et 241AmBe a été calculée pour les convertisseurs 6LiF et PE et donnent (0.8580 ± 0.1490)% et (0.0254 ± 0.0031)% pour LiF et (0.0510 ± 0.0061)% et (0.0591 ± 0.0063)% pour PE à bas et à haut seuil d’énergie respectivement. Une simulation du calcul de l’efficacité de détection des neutrons dans le détecteur MPX a été réalisée avec le logiciel GEANT4. Des données MPX correspondant aux collisions proton-proton à 2.4 TeV et à 7 TeV dans le centre de masse ont été analysées. Les flux détectés d’électrons et de photons sont particulièrement élevés dans les détecteurs MPX01 et MPX14 car ils sont plus près du point de collision. Des flux de neutrons ont été estimés en utilisant les efficacités de détection mesurées. Une corrélation avec la luminosité du LHC a été établie et on prédit que pour les collisions à 14 TeV dans le centre de masse et avec une luminosité de 10^34 cm-1*s-1 il y aura environ 5.1x10^8 ± 1.5x10^7 et 1.6x10^9 ± 6.3x10^7 particules détectées par les détecteurs MPX01 et MPX14 respectivement.

Implémentation de la répartition de charge et du mode TOT pour la simulation d’un détecteur Timepix à pixels

Les détecteurs à pixels Medipix ont été développés par la collaboration Medipix et permettent de faire de l'imagerie en temps réel. Leur surface active de près de $2\cm^2$ est divisée en 65536~pixels de $55\times 55\um^2$ chacun. Seize de ces détecteurs, les Medipix2, sont installés dans l'expérience ATLAS au CERN afin de mesurer en temps réel les champs de radiation produits par les collisions de hadrons au LHC. Ils seront prochainement remplacés par des Timepix, la plus récente version de ces détecteurs, qui permettent de mesurer directement l'énergie déposée dans chaque pixel en mode \textit{time-over-threshold} (TOT) lors du passage d'une particule dans le semi-conducteur. En vue d'améliorer l'analyse des données recueillies avec ces détecteurs Timepix dans ATLAS, un projet de simulation Geant4 a été amorcé par John Id\'{a}rraga à l'Université de Montréal. Dans le cadre de l'expérience ATLAS, cette simulation pourra être utilisée conjointement avec Athena, le programme d'analyse d'ATLAS, et la simulation complète du détecteur ATLAS. Sous l'effet de leur propre répulsion, les porteurs de charge créés dans le semi-conducteur sont diffusés vers les pixels adjacents causant un dépôt d'énergie dans plusieurs pixels sous l'effet du partage de charges. Un modèle effectif de cette diffusion latérale a été développé pour reproduire ce phénomène sans résoudre d'équation différentielle de transport de charge. Ce modèle, ainsi que le mode TOT du Timepix, qui permet de mesurer l'énergie déposée dans le détecteur, ont été inclus dans la simulation afin de reproduire adéquatement les traces laissées par les particules dans le semi-conducteur. On a d'abord étalonné le détecteur pixel par pixel à l'aide d'une source de $\Am$ et de $\Ba$. Ensuite, on a validé la simulation à l'aide de mesures d'interactions de protons et de particules $\alpha$ produits au générateur Tandem van de Graaff du Laboratoire René-J.-A.-Lévesque de l'Université de Montréal.

The Experience of Treatment of Persons Presenting with Concomitant Psychotic and Borderline Personality Disorders

Essai doctoral présenté à la Faculté des arts et des sciences en vue de l'obtention du grade de doctorat en psychologie (D.Psy.) option psychologie clinique

Swift heavy ion induced surface and microstructural evolution in metallic glass thin films

Swift heavy ion induced changes in microstructure and surface morphology of vapor deposited Fe–Ni based metallic glass thin films have been investigated by using atomic force microscopy, X-ray diffraction and transmission electron microscopy. Ion beam irradiation was carried out at room temperature with 103 MeV Au9+ beam with fluences ranging from 3 1011 to 3 1013 ions/cm2. The atomic force microscopy images were subjected to power spectral density analysis and roughness analysis using an image analysis software. Clusters were found in the image of as-deposited samples, which indicates that the film growth is dominated by the island growth mode. As-deposited films were amorphous as evidenced from X-ray diffraction; however, high resolution transmission electron microscopy measurements revealed a short range atomic order in the samples with crystallites of size around 3 nm embedded in an amorphous matrix. X-ray diffraction pattern of the as-deposited films after irradiation does not show any appreciable changes, indicating that the passage of swift heavy ions stabilizes the short range atomic ordering, or even creates further amorphization. The crystallinity of the as-deposited Fe–Ni based films was improved by thermal annealing, and diffraction results indicated that ion beam irradiation on annealed samples results in grain fragmentation. On bombarding annealed films, the surface roughness of the films decreased initially, then, at higher fluences it increased. The observed change in surface morphology of the irradiated films is attributed to the interplay between ion induced sputtering, volume diffusion and surface diffusion

Local food security and principle of organic farming (from farm to fork) in context of food culture in Indonesia: Minangkabau's case study

The basic idea behind improving local food security consists of two paths; first, accessibility (price, stock) and second, availability (quantity and biodiversity); both are perquisites to the provision of nutrients and a continuous food supply with locally available resources. The objectives of this thesis are to investigate if indigenous knowledge still plays an important role in traditional farming in the Minangkabau`s culture, thus supporting local food security. If the indigenous knowledge still plays a role in food culture in the Minangkabau`s culture which is linked to the matrilineal role and leads to a sound nutrition. Further, it should be tested if marantau influences traditional farming and food culture in Minangkabau`s, and if the local government plays a role in changing of traditional farming systems and food culture. Furthermore this thesis wants to prove if education and gender are playing a role in changing traditional farming system and food culture, and if the mass media affects traditional farming systems and food culture for the Minangkabau. The study was completed at four locations in West Sumatera; Nagari Ulakan (NU) (coastal area), Nagari Aia Batumbuak (NAB) (hilly area), Nagari Padang Laweh Malalo (NPLM) (lake area), Nagari Pandai Sikek (NPS) (hilly area). The rainfall ranged from 1400- 4800 mm annually with fertile soils. Data was collected by using PRA (Participatory Rural Appraisal) to investigate indigenous knowledge (IK) and its interactions, which is also combining with in depth-interview, life history, a survey using semi-structured-questionnaire, pictures, mapping, and expert interview. The data was collected from June - September 2009 and June 2010. The materials are; map of area, list of names, questionnaires, voices recorder, note book, and digital camera. The sampling method was snowball sampling which resulted in the qualitative and quantitative data taken. For qualitative data, ethnography and life history was used. For quantitative, a statistical survey with a semi-structured questionnaire was used. 50 respondents per each site participated voluntarily. Data was analyzed by performing MAXQDA 10, and F4 audio analysis software (created and developed by Philip-University Marburg). The data is clustered based on causality. The results show that; the role of IK on TFS (traditional farming system) shown on NPLM which has higher food crop biodiversity in comparison to the other three places even though it has relatively similar temperature and rainfall. This high food crop biodiversity is due to the awareness of local people who realized that they lived in unfavourable climate and topography; therefore they are more prepared for any changes that may occur. Carbohydrate intake is 100 % through rice even though they are growing different staple crops. Whereas most of the people said in the interviews that not eating rice is like not really eating for them. In addition to that, mothers still play an important role in kitchen activities. But when the agriculture income is low, mothers have to decide whether to change the meals or to feel insecure about their food supply. Marantau yields positive impact through the remittances it provides to invest on the farm. On the other hand, it results in fewer workers for agriculture, and therefore a negative impact on the transfer of IK. The investigation showed that the local government has a PTS (Padi Tanam Sabatang) programme which still does not guarantee that the farmers are getting sufficient revenue from their land. The low agricultural income leads to situation of potential food insecurity. It is evident that education is equal among men and women, but in some cases women tend to leave school earlier because of arranged marriages or the distances of school from their homes. Men predominantly work in agriculture and fishing, while women work in the kitchen. In NAB, even though women work on farmland they earn less then men. Weaving (NPS) and kitchen activity is recognized as women’s work, which also supports the household income. Mass media is not yielding any changes in TFS and food culture in these days. The traditional farming system has changed because of intensive agricultural extension which has introduced new methods of agriculture for the last three decades (since the 1980’s). There is no evidence that they want to change any of their food habits because of the mass media despite the lapau activity which allows them to get more food choices, instead preparing traditional meal at home. The recommendations of this thesis are: 1) The empowerment of farmers. It is regarding the self sufficient supply of manure, cooperative seed, and sustainable farm management. Farmers should know – where are they in their state of knowledge – so they can use their local wisdom and still collaborate with new sources of knowledge. Farmers should learn the prognosis of supply and demand next prior to harvest. There is a need for farm management guidelines; that can be adopted from both their local wisdom and modern knowledge. 2) Increase of non-agricultural income Increasing the non-agricultural income is strongly recommended. The remittances can be invested on non-agricultural jobs. 3) The empowerment of the mother. The mother plays an important role in farm to fork activities; the mother can be an initiator and promoter of cultivating spices in the backyard. Improvement of nutritional knowledge through information and informal public education can be done through arisan ibu-ibu and lapau activity. The challenges to apply these recommendations are: 1) The gap between institutions and organizations of local governments. There is more than one institution involved in food security policy. 2) Training and facilities for field extension agriculture (FEA) is needed because the rapid change of interaction between local government and farmer’s dependent on this agency.

Indigenous Knowledge (IK) of Water Resources Management in West Sumatra, Indonesia

This study was aim to describe the indigenous knowledge of farmers at Nagari Padang laweh Malalo (NPLM) and their adaptability to climate change. Not only the water scarcity is feared, but climate change is also affecting their food security. Local food security can be achieved if biodiversity in their surrounding area is suitable to the local needs. The study was conducted by using Participatory Rural Appraisal (PRA) such as observation and discussion. The combination of in depth interview, life history, semi structure questionnaire, pictures, mapping and expert interviews was implemented. Data was analyzed by using MAXQDA 10 and F4 audio analysis software. The result shows awareness of the people and scarcity of water conditions has allowed the people of NPLM to face this challenge with wisdom. Aia adat (water resources controlled and regulate by custom) is one of their strategies to distribute the water. The general rule is that irrigation will flow from 6 pm – 6 am regularly to all farm land under supervision of kapalo banda. When rains occur, water resources can be used during the day without special supervision. They were used traditional knowledge to manage water resources for their land and daily usage. This study may be helpful for researcher and other farmers in different region to learn encounter water scarcity.

CODAPACK3D. A new version of Compositional Data Package

The statistical analysis of compositional data should be treated using logratios of parts, which are difficult to use correctly in standard statistical packages. For this reason a freeware package, named CoDaPack was created. This software implements most of the basic statistical methods suitable for compositional data. In this paper we describe the new version of the package that now is called CoDaPack3D. It is developed in Visual Basic for applications (associated with Excel©), Visual Basic and Open GL, and it is oriented towards users with a minimum knowledge of computers with the aim at being simple and easy to use. This new version includes new graphical output in 2D and 3D. These outputs could be zoomed and, in 3D, rotated. Also a customization menu is included and outputs could be saved in jpeg format. Also this new version includes an interactive help and all dialog windows have been improved in order to facilitate its use. To use CoDaPack one has to access Excel© and introduce the data in a standard spreadsheet. These should be organized as a matrix where Excel© rows correspond to the observations and columns to the parts. The user executes macros that return numerical or graphical results. There are two kinds of numerical results: new variables and descriptive statistics, and both appear on the same sheet. Graphical output appears in independent windows. In the present version there are 8 menus, with a total of 38 submenus which, after some dialogue, directly call the corresponding macro. The dialogues ask the user to input variables and further parameters needed, as well as where to put these results. The web site http://ima.udg.es/CoDaPack contains this freeware package and only Microsoft Excel© under Microsoft Windows© is required to run the software. Kew words: Compositional data Analysis, Software

Prevalencia de dolor lumbar en los trabajadores de una planta de fabricación de productos de cerámica de Madrid, Cundinamarca, en el turno de 6 am a 2pm, año 2014.

Objetivo: Establecer la prevalencia, incapacidad y discapacidad de dolor lumbar en los trabajadores de la planta de fabricación de productos de cerámica, de Madrid Cundinamarca, del turno de 6 am a 2 pm año 2014. Metodología: Se realizó un estudio de corte transversal para determinar la prevalencia, incapacidad y discapacidad de dolor lumbar en un grupo de trabajadores que asisten en el turno de 6 am a 2 pm, en una empresa fabricante de productos de cerámica en el municipio de Madrid, departamento de Cundinamarca, Colombia. Se tuvieron en cuenta variables como edad, puesto de trabajo, antigüedad en cargo actual, consumo de cigarrillo, actividad física, presencia o ausencia de dolor lumbar e intensidad del dolor lumbar. Se aplicaron dos escalas para determinar el nivel de incapacidad y discapacidad para el dolor lumbar. Se empleó la escala de Owestry (ODI, OswestryDisabilityIndex) para evaluar la incapacidad de dolor lumbar y la escala de Roland-Morris para discapacidad física. Para le análisis de las variables continuas se determinó el supuesto de normalidad utilizando la prueba de ShapiroWilks.Para determinar la presencia de asociaciones se utilizó la prueba de Ji cuadrado de Pearson o el test exacto de Fischer si el valor esperado es menor a cinco. Para el análisis de la información se utilizó el software EpiInfo versión 7.1.3 (CDC, Atlanta, EE.UU.) Resultados: Se incluyeron 99 trabajadores, rango de edad entre 32 y 46 años y una mediana de 37 años. Más de la mitad de los trabajadores evaluados reportaron un dolor moderado (n=57), tan solo un 10% reportó máximo dolor, la escala de incapacidad de Oswestry78 trabajadores se ubicaron entre 0 y 40% reflejando esto ausencia de incapacidad, y solo 4 pacientes presentaron valores entre 40 y 60% incapacidad moderada. La escala de discapacidad de Roland-Morris mostró que la mayoría de los trabajadores presentan una discapacidad leve (n=97) y tan solo 2 trabajadores presentaron discapacidad moderada.La única asociación positiva encontrada se dio entre la presencia de dolor lumbar y la ejecución de actividad física una vez a la semana (p 0,005). Conclusiones: el dolor lumbar está presente en más del 50% de los trabajadores encuestados; sin embargo solo 4 de los trabajadores encuestados, presenta incapacidad por este dolor. En cuanto a la discapacidad pudimos determinar que solo 2 de los trabajadores la manifiesta.

Análisis del impacto del tamaño de los activos en la cuenta de resultados mediante la utilización de espacios de fase y análisis de recurrencia

Los resultados financieros de las organizaciones son objeto de estudio y análisis permanente, predecir sus comportamientos es una tarea permanente de empresarios, inversionistas, analistas y académicos. En el presente trabajo se explora el impacto del tamaño de los activos (valor total de los activos) en la cuenta de resultados operativos y netos, analizando inicialmente la relación entre dichas variables con indicadores tradicionales del análisis financiero como es el caso de la rentabilidad operativa y neta y con elementos de estadística descriptiva que permiten calificar los datos utilizados como lineales o no lineales. Descubriendo posteriormente que los resultados financieros de las empresas vigiladas por la Superintendencia de Sociedades para el año 2012, tienen un comportamiento no lineal, de esta manera se procede a analizar la relación de los activos y los resultados con la utilización de espacios de fase y análisis de recurrencia, herramientas útiles para sistemas caóticos y complejos. Para el desarrollo de la investigación y la revisión de la relación entre las variables de activos y resultados financieros se tomó como fuente de información los reportes financieros del cierre del año 2012 de la Superintendencia de Sociedades (Superintendencia de Sociedades, 2012).

La ??tica en el Aprendizaje-Servicio (ApS) : un Meta-An??lisis a partir de Education Resources Information Center (ERIC)

Resumen basado en el de la publicaci??n

Radar studies of the vertical distribution of insects migrating over southern Britain: the influence of temperature inversions on nocturnal layer concentrations

Insects migrating over two sites in southern UK (Malvern in Worcestershire, and Harpenden in Hertfordshire) have been monitored continuously with nutating vertical-looking radars (VLRs) equipped with powerful control and analysis software. These observations make possible, for the first time, a systematic investigation of the vertical distribution of insect aerial density in the atmosphere, over temporal scales ranging from the short (instantaneous vertical profiles updated every 15 min) to the very long (profiles aggregated over whole seasons or even years). In the present paper, an outline is given of some general features of insect stratification as revealed by the radars, followed by a description of occasions during warm nights in the summer months when intense insect layers developed. Some of these nocturnal layers were due to the insects flying preferentially at the top of strong surface temperature inversions, and in other cases, layering was associated with higher-altitude temperature maxima, such as those due to subsidence inversions. The layers were formed from insects of a great variety of sizes, but peaks in the mass distributions pointed to a preponderance of medium-sized noctuid moths on certain occasions.

Comparison of survival rates of captive-reared and wild-bred Mauritius kestrels (Falco punctatus) in a re-introduced population

Re-introduction is a technique widely used in the conservation of threatened bird species. With advances in aviculture the use of captive-produced individuals as the release stock is becoming more commonplace, and ideally, survival of captive-produced, released individuals should be no different from their wild-bred counterparts. During the late 1980s the Critically Endangered Mauritius kestrel (Falco punctatus) was successfully re-introduced into the Bambous mountain range, Mauritius, some 30 years after its local extinction. Between 1987 and 2001 the developing population was closely monitored enabling us to construct re-sighting histories for 88 released and 284 wild-bred kestrels. We used age-structured models in the survival analysis software program MARK to determine if an individual's origin influenced its subsequent survival. Our analysis indicated no compelling evidence for reduced survival among juvenile captive-reared and released individuals, relative to their wild-bred counterparts, across the majority of cohorts and only limited evidence of a cohort-specific effect. This study illustrates that despite the lack of a formal experimental approach it is still feasible to conduct an assessment of re-introduction outcomes and techniques.

Stress-induced changes in the Schizosaccharomyces pombe proteome using two-dimensional difference gel electrophoresis, mass spectrometry and a novel integrated robotics platform

Robotic and manual methods have been used to obtain identification of significantly changing proteins regulated when Schizosaccharomyces pombe is exposed to oxidative stress. Differently treated S. pombe cells were lysed, labelled with CyDye and analysed by two-dimensional difference gel electrophoresis. Gel images analysed off-line, using the DeCyder image analysis software [GE Healthcare, Amersham, UK] allowed selection of significantly regulated proteins. Proteins displaying differential expression were excised robotically for manual digestion and identified by matrix-assisted laser desorption/ionisation - mass spectrometry (MALDI-MS). Additionally the same set of proteins displaying differential expression were automatically cut and digested using a prototype robotic platform. Automated MALDI-MS, peak label assignment and database searching were utilised to identify as many proteins as possible. The results achieved by the robotic system were compared to manual methods. The identification of all significantly altered proteins provides an annotated peroxide stress-related proteome that can be used as a base resource against which other stress-induced proteomic changes can be compared.

Comparison of survival rates of captive-reared and wild-bred Mauritius kestrels (falco punctatus) in a re-introduced population

Re-introduction is a technique widely used in the conservation of threatened bird species. With advances in aviculture the use of captive-produced individuals as the release stock is becoming more commonplace, and ideally, survival of captive-produced, released individuals should be no different from their wild-bred counterparts. During the late 1980s the Critically Endangered Mauritius kestrel (Falco punctatus) was successfully re-introduced into the Bambous mountain range, Mauritius, some 30 years after its local extinction. Between 1987 and 2001 the developing population was closely monitored enabling us to construct re-sighting histories for 88 released and 284 wild-bred kestrels. We used age-structured models in the survival analysis software program MARK to determine if an individual's origin influenced its subsequent survival. Our analysis indicated no compelling evidence for reduced survival among juvenile captive-reared and released individuals, relative to their wild-bred counterparts, across the majority of cohorts and only limited evidence of a cohort-specific effect. This study illustrates that despite the lack of a formal experimental approach it is still feasible to conduct an assessment of re-introduction outcomes and techniques. (C) 2003 Elsevier Ltd. All rights reserved.