Relationship between monitored elements and prescribed ventilator setting modifications in critically ill children

Les pédiatres intensivistes ont plusieurs éléments disponibles pour guider leurs décisions par rapport à la ventilation mécanique. Par contre, aucune étude prospective ne décrit les éléments auxquels les intensivistes se réfèrent pour modifier les paramètres du respirateur. Objectifs : Décrire la pratique actuelle de la modification des paramètres du respirateur aux soins intensifs du CHU Sainte-Justine, un hôpital pédiatrique tertiaire. Hypothèse : 80% des modifications des paramètres du respirateur influant sur l’épuration du CO2 sont liées à l’analyse de la PCO2 ou du pH et 80% des modifications des paramètres d’oxygénation sont liés à l’analyse de l’oxymétrie de pouls. Méthodes : En se servant d’un logiciel de recueil de données, les soignants ont enregistré un critère de décision primaire et tous les critères de décision secondaires menant à chaque modification de paramètre du respirateur au moment même de la modification. Résultats : Parmi les 194 modifications des paramètres du respirateur influant sur l’épuration du CO2, faites chez vingts patients, 42.3% ±7.0% avaient pour critère primaire la PCO2 ou le pH sanguin. Parmi les 41 modifications de la pression expiratoire positive et les 813 modifications de la fraction d’oxygène inspirée, 34.1% ±14.5% et 84.5% ±2.5% avaient pour critère primaire l’oxymétrie de pouls, respectivement. Conclusion : Les médecins surestiment le rôle de la PCO2 et du pH sanguins et sousestiment le rôle d’autres critères de décision dans la gestion de la ventilation mécanique. L’amélioration de notre compréhension de la pratique courante devrait aider à l’éboration des systèmes d’aide à la décision clinique en assistance respiratoire.

Innovations pédagogiques et culture disciplinaire en enseignement supérieur

Cette recherche qualitative porte sur les innovations pédagogiques utilisées à l’Université de Montréal en contexte de cultures disciplinaires. La recherche visait à étudier les innovations pédagogiques, entendues comme tout enseignement dispensé de manières différentes de la pratique traditionnelle du cours magistral, proposées par les professeurs dans une université fortement engagée en recherche. ll nous a paru utile de contribuer à compléter les savoirs existants dans ce domaine peu exploré, particulièrement lorsque nous savons que les innovations pédagogiques en contexte de cultures disciplinaires n’ont encore pas été étudiées à l’Université de Montréal. D’un point de vue social, la pertinence de cette recherche réside dans le cadre de la valorisation de l’enseignement universitaire souhaitée tant par les politiques, les institutions et la société que les professeurs et, au-delà, elle invite au rééquilibrage des deux piliers indispensables à l’université centrée sur la recherche qui laisse paraître une relation dichotomique marquée entre enseignement et recherche. Deux modes de cueillettes de données ont été privilégiés : les entrevues individuelles semi-structurées et un entretien de groupe auprès de trente-deux professeurs lauréats du Prix d’excellence en enseignement de l’Université de Montréal. Pour cette recherche, nous avons employé la théorisation ancrée comme méthode d’analyse de données recueillies selon d’autres approches. En d’autres mots, nous avons souhaité utiliser la théorisation ancrée comme un « processus » (Paillé, 1994, p. 149) d’analyse des données avec pour objectif d’approfondir l’objet de notre recherche par-delà la simple analyse descriptive sans pour autant prétendre à une théorisation avancée. En premier lieu, nos résultats nous ont permis de connaître les innovations pédagogiques utilisées dans l’enceinte de notre terrain de recherche, l’Université de Montréal et de dresser un portrait actualisé de leurs innovateurs. Nous avons aussi exploré les raisons qui amènent les professeurs à innover, décrit le processus nécessaire à l’innovation pédagogique et expliqué les freins s’opposant à cette dernière. En second lieu, nos résultats énumèrent les différences liées à la matière d’enseignement, au champ de recherche et soulignent le rapport de la discipline à l’innovation comme critère déterminant à son implication. En dernier lieu, nos résultats révèlent l’existence d’une expertise pédagogique partagée au sein de l’Université de Montréal qui permet de rompre la solitude des professeurs par un soutien entre pairs et favorise la transférabilité des innovations pédagogiques d’une culture disciplinaire à une autre. Finalement, nous présentons une théorisation actualisée des paramètres constituant une innovation pédagogique et détaillons les nouveaux paramètres qui influent sur la construction d’une innovation pédagogique. Nous concluons cette thèse par des recommandations et des pistes de recherches.

Interventions infirmières en regard du phénomène de l’automutilation en milieu pédopsychiatrique : étude qualitative exploratoire

En milieu pédopsychiatrique, les infirmières connaissent bien le phénomène de l’automutilation des adolescentes parce qu’elles sont souvent appelées à intervenir lorsque ce type de situation survient. Cependant, puisqu’elles ont parfois une mauvaise compréhension du phénomène, des perceptions erronées et des attitudes négatives quant à celui-ci, les infirmières deviennent moins aptes à intervenir auprès de cette clientèle. Cette étude a pour objectifs d’explorer le phénomène de l’automutilation auprès des infirmières œuvrant en milieu pédopsychiatrique et de décrire les interventions infirmières privilégiées en cas d’automutilation ainsi que les facteurs du contexte organisationnel susceptible d’avoir une influence sur la façon dont ces interventions sont prodiguées. L’étude privilégie un devis qualitatif de type exploratoire. Plusieurs méthodes de collecte des données ont été sélectionnées pour mener à bien cette étude entre autres des entrevues auprès des participantes et une période d’observation au sein de l’unité où la recherche a eu lieu. L’analyse des verbatim selon les étapes élaborées par Tesch (1990) a permis d’identifier sept catégories d’interventions infirmières : les interventions de relation d’aide, d’accompagnement, d’évaluation, de sécurité, d’enseignement, les interventions en lien avec les émotions et les perceptions de l’automutilation ainsi que les interventions pour éviter la contamination sociale. En ce qui a trait aux facteurs ayant une influence sur ces interventions infirmières, trois catégories sont ressorties des données : la constitution de l’équipe interpersonnelle, la lourdeur des tâches de l’infirmière en pédopsychiatrie ainsi que la culture organisationnelle dans laquelle évoluent les membres de l’équipe soignante. Les résultats qui sont issus de cette étude permettront aux infirmières de mieux comprendre le phénomène de l’automutilation chez les adolescentes. Cette étude suggère également des pistes d’interventions qui pourraient aider les infirmières œuvrant en milieu pédopsychiatrique à mieux intervenir. De plus, cette étude serait susceptible de permettre aux gestionnaires des établissements d’apporter certains ajustements notamment en ce qui a trait à l’organisation du travail et à la formation des infirmières.

A qualitative analysis of immigrant population health practices in the Girona Healthcare Region

The research we present here forms part of a two-phase project - one quantitative and the other qualitative - assessing the use of primary health care services. This paper presents the qualitative phase of said research, which is aimed at ascertaining the needs, beliefs, barriers to access and health practices of the immigrant population in comparison with the native population, as well as the perceptions of healthcare professionals. Moroccan and sub-Saharan were the immigrants to who the qualitative phase was specifically addressed. The aims of this paper are as follows: to analyse any possible implications of family organisation in the health practices of the immigrant population; to ascertain social practices relating to illness; to understand the significances of sexual and reproductive health practices; and to ascertain the ideas and perceptions of immigrants, local people and professionals regarding health and the health system. Methods: qualitative research based on discursive analysis. Data gathering techniques consisted of discussion groups with health system users and semi-structured individual interviews with healthcare professionals. The sample was taken from the Basic Healthcare Areas of Salt and Banyoles (belonging to the Girona Healthcare Region), the discussion groups being comprised of (a) 6 immigrant Moroccan women, (b) 7 immigrant sub-Saharan African women and (c) 6 immigrant and native population men (2 native men, 2 Moroccan men and 2 sub-Saharan men); and the semi-structured interviews being conducted with the following healthcare professionals: (a) 3 gynaecologists, (b) 3 nurses and 1 administrative staff. Results: use of the healthcare system is linked to the perception of not being well, knowledge of the healthcare system, length of time resident in Spain and interiorization of traditional Western medicine as a cure mechanism. The divergences found among the groups of immigrants, local people and healthcare professionals with regard to healthcare education, use of the healthcare service, sexual and reproductive healthcare and reticence with regard to being attended by healthcare personnel of the opposite sex demonstrate a need to work with the immigrant population as a heterogeneous group. Conclusions: the results we have obtained support the idea that feeling unwell is a psycho-social process, as it takes place within a specific socio-cultural situation and spans a range of beliefs, perceptions and ideas regarding symptomology and how to treat it

Perspetivas de professores de Educação Especial sobre o seu papel na inclusão de alunos com necessidades educativas especiais

O presente estudo visa identificar opiniões e conceções de cinco professoras de educação especial em relação ao seu contexto profissional e ao seu desempenho no mesmo. O estudo lida, assim, com as perspetivas dessas professoras, pretendendo-se caraterizar o seu pensamento sobre as condições reais para a inclusão de crianças com Necessidades Educativas Especiais (NEE) e o seu papel nesse sentido, apesar dos constrangimentos existentes. Assume-se que o professor é, enquanto profissional, não só produto de valores pessoais, sociais e institucionais/políticos como também seu veículo. Os dados foram recolhidos através da realização de entrevistas semiestruturadas às referidas professoras, seleccionadas pelos seus largos anos de experiência em escolas da região da Grande Lisboa. Os resultados do estudo sugerem que as professoras são afetadas no seu desempenho profissional por fatores pessoais e sociais e ainda pelas interações com professores titulares de turma, técnicos especializados e poder institucional. Pode ainda concluir-se que as professoras preocupam-se em fazer uma intervenção ecológica junto do aluno, preocupando-se não só com o seu desenvolvimento pessoal, como também com a sua inclusão na escola, família e sociedade. Ressaltam ainda, do estudo, preocupações no que concerne ao futuro destes alunos e à evolução da Educação Especial, resultado das políticas educativas vigentes.

A simple column model to explore anticipated problems in variational assimilation of satellite observations

We investigate a simplified form of variational data assimilation in a fully nonlinear framework with the aim of extracting dynamical development information from a sequence of observations over time. Information on the vertical wind profile, w(z ), and profiles of temperature, T (z , t), and total water content, qt (z , t), as functions of height, z , and time, t, are converted to brightness temperatures at a single horizontal location by defining a two-dimensional (vertical and time) variational assimilation testbed. The profiles of T and qt are updated using a vertical advection scheme. A basic cloud scheme is used to obtain the fractional cloud amount and, when combined with the temperature field, this information is converted into a brightness temperature, using a simple radiative transfer scheme. It is shown that our model exhibits realistic behaviour with regard to the prediction of cloud, but the effects of nonlinearity become non-negligible in the variational data assimilation algorithm. A careful analysis of the application of the data assimilation scheme to this nonlinear problem is presented, the salient difficulties are highlighted, and suggestions for further developments are discussed.

Gaussian quadrature 4D-VAR

A new incremental four-dimensional variational (4D-Var) data assimilation algorithm is introduced. The algorithm does not require the computationally expensive integrations with the nonlinear model in the outer loops. Nonlinearity is accounted for by modifying the linearization trajectory of the observation operator based on integrations with the tangent linear (TL) model. This allows us to update the linearization trajectory of the observation operator in the inner loops at negligible computational cost. As a result the distinction between inner and outer loops is no longer necessary. The key idea on which the proposed 4D-Var method is based is that by using Gaussian quadrature it is possible to get an exact correspondence between the nonlinear time evolution of perturbations and the time evolution in the TL model. It is shown that J-point Gaussian quadrature can be used to derive the exact adjoint-based observation impact equations and furthermore that it is straightforward to account for the effect of multiple outer loops in these equations if the proposed 4D-Var method is used. The method is illustrated using a three-level quasi-geostrophic model and the Lorenz (1996) model.

A real-time measurement system for long-life flood monitoring and warning applications

A flood warning system incorporates telemetered rainfall and flow/water level data measured at various locations in the catchment area. Real-time accurate data collection is required for this use, and sensor networks improve the system capabilities. However, existing sensor nodes struggle to satisfy the hydrological requirements in terms of autonomy, sensor hardware compatibility, reliability and long-range communication. We describe the design and development of a real-time measurement system for flood monitoring, and its deployment in a flash-flood prone 650 km2 semiarid watershed in Southern Spain. A developed low-power and long-range communication device, so-called DatalogV1, provides automatic data gathering and reliable transmission. DatalogV1 incorporates self-monitoring for adapting measurement schedules for consumption management and to capture events of interest. Two tests are used to assess the success of the development. The results show an autonomous and robust monitoring system for long-term collection of water level data in many sparse locations during flood events.

The error of representation: basic understanding

Representation error arises from the inability of the forecast model to accurately simulate the climatology of the truth. We present a rigorous framework for understanding this kind of error of representation. This framework shows that the lack of an inverse in the relationship between the true climatology (true attractor) and the forecast climatology (forecast attractor) leads to the error of representation. A new gain matrix for the data assimilation problem is derived that illustrates the proper approaches one may take to perform Bayesian data assimilation when the observations are of states on one attractor but the forecast model resides on another. This new data assimilation algorithm is the optimal scheme for the situation where the distributions on the true attractor and the forecast attractors are separately Gaussian and there exists a linear map between them. The results of this theory are illustrated in a simple Gaussian multivariate model.

Simultaneous mobile sink allocation in home environments with applications in mobile consumer robotics

This paper presents a novel mobile sink area allocation scheme for consumer based mobile robotic devices with a proven application to robotic vacuum cleaners. In the home or office environment, rooms are physically separated by walls and an automated robotic cleaner cannot make a decision about which room to move to and perform the cleaning task. Likewise, state of the art cleaning robots do not move to other rooms without direct human interference. In a smart home monitoring system, sensor nodes may be deployed to monitor each separate room. In this work, a quad tree based data gathering scheme is proposed whereby the mobile sink physically moves through every room and logically links all separated sub-networks together. The proposed scheme sequentially collects data from the monitoring environment and transmits the information back to a base station. According to the sensor nodes information, the base station can command a cleaning robot to move to a specific location in the home environment. The quad tree based data gathering scheme minimizes the data gathering tour length and time through the efficient allocation of data gathering areas. A calculated shortest path data gathering tour can efficiently be allocated to the robotic cleaner to complete the cleaning task within a minimum time period. Simulation results show that the proposed scheme can effectively allocate and control the cleaning area to the robot vacuum cleaner without any direct interference from the consumer. The performance of the proposed scheme is then validated with a set of practical sequential data gathering tours in a typical office/home environment.

Efficiency issues of evolutionary k-means

One of the top ten most influential data mining algorithms, k-means, is known for being simple and scalable. However, it is sensitive to initialization of prototypes and requires that the number of clusters be specified in advance. This paper shows that evolutionary techniques conceived to guide the application of k-means can be more computationally efficient than systematic (i.e., repetitive) approaches that try to get around the above-mentioned drawbacks by repeatedly running the algorithm from different configurations for the number of clusters and initial positions of prototypes. To do so, a modified version of a (k-means based) fast evolutionary algorithm for clustering is employed. Theoretical complexity analyses for the systematic and evolutionary algorithms under interest are provided. Computational experiments and statistical analyses of the results are presented for artificial and text mining data sets. (C) 2010 Elsevier B.V. All rights reserved.

Factors influencing the choice of a bank : An international student perspective

Purpose: The purposeof this thesis is to identify what factors influence international students in their choice of a bank.Literature review: A review of previous research about bank selection criteria related to students as well as a few examples of bank choice studies in the general population is presented. The review consists of studies from different years to illustrate criteria that reoccur in order to decrease the chances of overlooking important criteria that may be of importance for today‘s customers. Method: The thesis is based upon empirical data gathering through a non-probability sampling technique by distributing questionnaires through the Internet and in person. The data was analyzedwith the help of exploratory factor analysis (EFA). Conclusion: We found thatfive factors influence the choice of bank for international students. These factors are: cost of the bank services, use of technology, convenience, banks‘ reputation and marketing communication effectiveness. These factors could be helpful for banks who want to gain customers from international students, which are a relatively unexploited customer segment.

LiLEDDA – a six step forum-based netnographic research method for nursing and caring sciences

Internet research methods in nursing science are less developed than in other sciences. We choose to present an approach to conducting nursing research on an internet-based forum. This paper presents LiLEDDA, a six-step forum-based netnographic research method for nursing science. The steps consist of: 1. Literature review and identification of the research question(s); 2. Locating the field(s) online; 3. Ethical considerations; 4. Data gathering; 5. Data analysis and interpretation; and 6. Abstractions and trustworthiness. Traditional research approaches are limiting when studying non-normative and non-mainstream life-worlds and their cultures. We argue that it is timely to develop more up-to-date research methods and study designs applicable to nursing science that reflect social developments and human living conditions that tend to be increasingly online-based.

Orçamentos de edificações residenciais : método sistematizado para levantamento de dados em planta e calculo de quantitativos

O Orçamento Discriminado de obras de edificação tem seus resultados originários do interrelacionamento de varios fatores, entre eles: dados levantados em planta, cálculo de quantitativos e composições unitárias para serviços. Estudou-se nesse trabalho dois desses três itens fundamentais. Os aspectos abordados foram o levantamento de dados, para torná-lo ágil e não repetitivo, e o cálculo de quantitativos, transformando-o em tarefa objetiva. A sistematização da medição que é aqui proposta trabalha sobre esses dois elementos e demonstra que até em serviços como instalações, um estudo profundo possibilita a criação de planilhas e encaminhamento genérico que torna o serviço de orçamentação metódico e acessível a todos, e não só ao responsável por sua execução. Tenta-se mostrar que a criação de metadalogia sistematizada permite introduzir a orçamentação em tratamentos computacionais já na fase de cálculo de quantitativos e não só para cálculo de produtos finais (quantitativo x consumos unitários) e impressão de resultados.

Uma metodologia para adaptação e melhoria de produtos a partir da engenharia reversa

O tema desta dissertação de mestrado é o estudo da Engenharia Reversa como ferramenta de suporte à melhoria e adaptação de produtos. A partir de conceitos teóricos sobre desenvolvimento de produtos e melhoria de processos, propõe-se uma metodologia para adaptação de produtos destinados à exportação. A metodologia proposta consiste de oito passos, contemplando etapas de identificação e priorização das demandas de adaptação de produtos e elencando ferramentas auxiliares no atingimento dos objetivos desejados. A etapa inicial deste trabalho consiste de uma revisão bibliográfica dividida em duas partes: (i) adaptação de produtos através da utilização da Engenharia Reversa e seus habilitadores, e (ii) ferramentas para melhoria de processos. Os tópicos contemplados em (ii) incluem ferramentas para o mapeamento de processos de manufatura e para a sua melhoria. Destaque especial é dado ao Desdobramento da Função Qualidade – QFD (Quality Function Deployment), a Análise de Modos e Efeitos de Falhas (FMEA – Failure Mode and Effect Analysis) e às Cartas de Processos. Na seqüência, apresentam-se os passos da metodologia proposta para a adaptação de produtos às demandas de mercado utilizando a Engenharia Reversa e seus habilitadores. Finalmente, os passos metodológicos são aplicados a um caso prático, cujo objetivo é a adaptação de um pincel, produzido por uma empresa gaúcha, às demandas de um distribuidor alemão de ferramentas manuais.