Mise en place d'un programme de prévention et de prise en charge du diabète en Suisse: le point de vue des patients et des professionnels de la santé [Implementation of a diabetes disease management program in Switzerland: patients' and healthcare professionals' point of view].

BACKGROUND: A reorganization of healthcare systems is required to meet the challenge of the increasing prevalence of chronic diseases, e.g. diabetes. In North-America and Europe, several countries have thus developed national or regional chronic disease management programs. In Switzerland, such initiatives have only emerged recently. In 2010, the canton of Vaud set up the "Diabetes Cantonal Program", within the framework of which we conducted a study designed to ascertain the opinions of both diabetic patients and healthcare professionals on the elements that could be integrated into this program, the barriers and facilitators to its development, and the incentives that could motivate these actors to participate. METHODS: We organized eight focus-groups: one with diabetic patients and one with healthcare professionals in the four sanitary areas of the canton of Vaud. The discussions were recorded, transcribed and submitted to a thematic content analysis. RESULTS: Patients and healthcare professionals were rather in favour of the implementation of a cantonal program, although patients were more cautious concerning its necessity. All participants envisioned a set of elements that could be integrated to this program. They also considered that the program could be developed more easily if it were adapted to patients' and professionals' needs and if it used existing structures and professionals. The difficulty to motivate both patients and professionals to participate was mentioned as a barrier to the development of this program however. Quality or financial incentives could therefore be created to overcome this potential problem. CONCLUSION: The identification of the elements to consider, barriers, facilitators and incentives to participate to a chronic disease management program, obtained by exploring the opinions of patients and healthcare professionals, should favour its further development and implementation.

Choline-PET in prostate cancer management: The point of view of the radiation oncologist.

Among PET radiotracers, FDG seems to be quite accepted as an accurate oncology diagnostic tool, frequently helpful also in the evaluation of treatment response and in radiation therapy treatment planning for several cancer sites. To the contrary, the reliability of Choline as a tracer for prostate cancer (PC) still remains an object of debate for clinicians, including radiation oncologists. This review focuses on the available data about the potential impact of Choline-PET in the daily clinical practice of radiation oncologists managing PC patients. In summary, routine Choline-PET is not indicated for initial local T staging, but it seems better than conventional imaging for nodal staging and for all patients with suspected metastases. In these settings, Choline-PET showed the potential to change patient management. A critical limit remains spatial resolution, limiting the accuracy and reliability for small lesions. After a PSA rise, the problem of the trigger PSA value remains crucial. Indeed, the overall detection rate of Choline-PET is significantly increased when the trigger PSA, or the doubling time, increases, but higher PSA levels are often a sign of metastatic spread, a contraindication for potentially curable local treatments such as radiation therapy. Even if several published data seem to be promising, the current role of PET in treatment planning in PC patients to be irradiated still remains under investigation. Based on available literature data, all these issues are addressed and discussed in this review.

Routine use of point-of-care tests: usefulness and application in clinical microbiology.

Point-of-care (POC) tests offer potentially substantial benefits for the management of infectious diseases, mainly by shortening the time to result and by making the test available at the bedside or at remote care centres. Commercial POC tests are already widely available for the diagnosis of bacterial and viral infections and for parasitic diseases, including malaria. Infectious diseases specialists and clinical microbiologists should be aware of the indications and limitations of each rapid test, so that they can use them appropriately and correctly interpret their results. The clinical applications and performance of the most relevant and commonly used POC tests are reviewed. Some of these tests exhibit insufficient sensitivity, and should therefore be coupled to confirmatory tests when the results are negative (e.g. Streptococcus pyogenes rapid antigen detection test), whereas the results of others need to be confirmed when positive (e.g. malaria). New molecular-based tests exhibit better sensitivity and specificity than former immunochromatographic assays (e.g. Streptococcus agalactiae detection). In the coming years, further evolution of POC tests may lead to new diagnostic approaches, such as panel testing, targeting not just a single pathogen, but all possible agents suspected in a specific clinical setting. To reach this goal, the development of serology-based and/or molecular-based microarrays/multiplexed tests will be needed. The availability of modern technology and new microfluidic devices will provide clinical microbiologists with the opportunity to be back at the bedside, proposing a large variety of POC tests that will allow quicker diagnosis and improved patient care.

Adult native septic arthritis: a review of 10 years of experience and lessons for empirical antibiotic therapy.

Objectives To review the epidemiology of native septic arthritis to establish local guidelines for empirical antibiotic therapy as part of an antibiotic stewardship programme. Methods We conducted a 10 year retrospective study based on positive synovial fluid cultures and discharge diagnosis of septic arthritis in adult patients. Microbiology results and medical records were reviewed. Results Between 1999 and 2008, we identified 233 episodes of septic arthritis. The predominant causative pathogens were methicillin-susceptible Staphylococcus aureus (MSSA) and streptococci (respectively, 44.6% and 14.2% of cases). Only 11 cases (4.7%) of methicillin-resistant S. aureus (MRSA) arthritis were diagnosed, among which 5 (45.5%) occurred in known carriers. For large-joint infections, amoxicillin/clavulanate or cefuroxime would have been appropriate in 84.5% of cases. MRSA and Mycobacterium tuberculosis would have been the most frequent pathogens that would not have been covered. In contrast, amoxicillin/clavulanate would have been appropriate for only 75.3% of small-joint infections (82.6% if diabetics are excluded). MRSA and Pseudomonas aeruginosa would have been the main pathogens not covered. Piperacillin/tazobactam would have been appropriate in 93.8% of cases (P < 0.01 versus amoxicillin/clavulanate). This statistically significant advantage is lost after exclusion of diabetics (P = 0.19). Conclusions Amoxicillin/clavulanate or cefuroxime would be adequate for empirical coverage of large-joint septic arthritis in our area. A broad-spectrum antibiotic would be significantly superior for small-joint infections in diabetics. Systematic coverage of MRSA is not justified, but should be considered for known carriers. These recommendations are applicable to our local setting. They might also apply to hospitals sharing the same epidemiology.

The role of motivational systems in community service involvement : initiating and sustaining factors and quality of experience /

Community service participation can have a positive impact on development, especially for youth. Although researchers have found positive outcomes, there has been a notable decline in youth participation over the past few years (Statistics Canada, 2000). Given the positive outcomes and current decline, it has been argued that youth should be encouraged to get involved in service activities. In the present study, quantitative and qualitative data were collected to determine factors that would help youth to initiate and sustain service, along with examining the quality of their experience. Eighty-two university undergraduate students (23 men), ranging in age from 17-20 years completed a 60-minute self-report questionnaire. Initiating and sustaining factors, motivational systems (similar to approach and avoidance dimensions), activity dimensions {Structure, Supportive Social Environment), quality of experience {Positive, Stress-Challenge), and future intention to participate in community service were measured. Eight participants also completed a 20-minute telephone interview to complement and expand on the quantitative data collected. Some initiating and sustaining factors were specific to individuals higher on the avoidance dimension, while others were relevant to those higher on the approach dimension. Several factors also were important to individuals regardless of their motivational system orientation. Positive quality of experience was related positively to experiencing a supportive social environment. In addition, women rated their community service as more positive than did men. A predicted interaction between the avoidance dimension and Structure in predicting positive quality of experience was not supported; however, positive quality of experience was predicted by the interaction of the approach dimension and Structure. A tested interaction between the avoidance dimension and Supportive Social Environment in predicting positive quality of experience was not supported. Similarly, a predicted interaction between the approach dimension and Supportive Social Environment in predicting positive experience quality was not supported. However, Supportive Social Environment was positively related to positive quality of experience. No support was found for a mediational role for positive quality of experience or stress-challenge quality of experience in exploring the relation between motivational orientation and fiiture intention to engage in service activities. The results of this study suggest that participating in a service environment that is supportive and provides the opportunity for social interactions with others would promote positive quality of experience and help youth sustain involvement. Thus, to help youth have positive experiences and to remain active in service, it is important for service agencies to promote these types of environments. In addition, some initiating and sustaining factors were specific to youth higher on the avoidance dimension and some were relevant to youth higher on the approach dimension. Therefore, service agencies may need to consider using different recruitment and retention strategies, depending on the type of youth they wish to recruit.

From absolutes to aesthetics : John Dewey and the art of experience /

In this thesis I sought to capture something of the integrity of John Dewey's larger vision. While recognizing this to be a difficult challenge, I needed to clear some of the debris of an overly narrow reading of Dewey's works by students of education. The tendency of reducing Dewey's larger philosophical vision down to neat theoretical snap shots in order to prop up their particular social scientific research, was in my estimation slowly damaging the larger integrity of Dewey's vast body of work. It was, in short, killing off the desire to read big works, because doing so was not necessary to satisfying the specialized interests of social scientific research. In this thesis then I made a plea for returning the Humanities to the center of higher education. It is there that students learn how to read and to think—skills required to take on someone of Dewey's stature. I set out in this thesis to do just that. I took Dewey's notion of experience as the main thread connecting all of his philosophy, and focused on two large areas of inquiry, science and its relation to philosophy, and aesthetic experience. By exploring in depth Dewey's understanding of human experience as it pertains to day-to-day living, my call was for a heightened mode of artful conduct within our living contexts. By calling on the necessity of appreciating the more qualitative dimensions of lived experience, I was hoping that students engaged in the Social Sciences might begin to bolster their research interests with more breadth and depth of reading and critical insight. I expressed this as being important to the survival and intelligent flourishing of democratic conduct.

Narratives of Experience in Education: Living and Working Through Poverty in a Rural Community

In this study, I use my own experiences in education as a former elementary student, research assistant, and as a current secondary school teacher, to examine how living in a marginalised rural community challenged by poverty affected my formal education. The purpose of this study was to use stories to: (a) explore my formative elementary education growing up in a community that was experiencing poverty, and; (b) to examine the impact and implications of these experiences for me as a teacher and researcher considering the topic of poverty and education. This study used narrative inquiry to explore stories of education, focusing on experiences living and working in a rural community. My role in the study was both as participant and researcher as I investigate, through story, how I was raised in a marginalised, rural community faced with challenges of poverty and how I relate to my current role as a teacher working in a similar, rural high school. My own experiences and reflections form the basis of the study, but I used the contributions of secondary participants to offer alternative perspective of my interpretation of events. Participants in this study were asked to write about and/or retell their lived stories of working in areas affected by challenging circumstances. From my stories and those of secondary participants, three themes were explored: student authorship, teaching practice, and community involvement. An examination of these themes through commonplaces of place, sociality and time (Connelly and Clandinin, 2006) provide a context for other educators and researchers to consider or reconsider teaching practices in school communities affected by poverty.

The Role of Experience in the Organization and Refinement of Face Space

Adults code faces in reference to category-specific norms that represent the different face categories encountered in the environment (e.g., race, age). Reliance on such norm-based coding appears to aid recognition, but few studies have examined the development of separable prototypes and the way in which experience influences the refinement of the coding dimensions associated with different face categories. The present dissertation was thus designed to investigate the organization and refinement of face space and the role of experience in shaping sensitivity to its underlying dimensions. In Study 1, I demonstrated that face space is organized with regard to norms that reflect face categories that are both visually and socially distinct. These results provide an indication of the types of category-specific prototypes that can conceivably exist in face space. Study 2 was designed to investigate whether children rely on category-specific prototypes and the extent to which experience facilitates the development of separable norms. I demonstrated that unlike adults and older children, 5-year-olds rely on a relatively undifferentiated face space, even for categories with which they receive ample experience. These results suggest that the dimensions of face space undergo significant refinement throughout childhood; 5 years of experience with a face category is not sufficient to facilitate the development of separable norms. In Studies 3 through 5, I examined how early and continuous exposure to young adult faces may optimize the face processing system for the dimensions of young relative to older adult faces. In Study 3, I found evidence for a young adult bias in attentional allocation among young and older adults. However, whereas young adults showed an own-age recognition advantage, older adults exhibited comparable recognition for young and older faces. These results suggest that despite the significant experience that older adults have with older faces, the early and continuous exposure they received with young faces continues to influence their recognition, perhaps because face space is optimized for young faces. In Studies 4 and 5, I examined whether sensitivity to deviations from the norm is superior for young relative to older adult faces. I used normality/attractiveness judgments as a measure of this sensitivity; to examine whether biases were specific to norm-based coding, I asked participants to discriminate between the same faces. Both young and older adults were more accurate when tested with young relative to older faces—but only when judging normality. Like adults, 3- and 7-year-olds were more accurate in judging the attractiveness of young faces; however, unlike adults, this bias extended to the discrimination task. Thus by 3 years of age children are more sensitive to differences among young relative to older faces, suggesting that young children's perceptual system is more finely tuned for young than older adult faces. Collectively, the results of this dissertation help elucidate the development of category-specific norms and clarify the role of experience in shaping sensitivity to the dimensions of face space.

What Is the Point of Development Ethics?

Research and teaching in societal development ethics face potentially four fundamental types of objection: first, that ethics is obvious already; second, that it is instead impossible, on epistemological grounds; third, that it is theoretically possible but in practice fruitless; and fourth, that it is in any case politically insignificant. The paper presents qualified rebuttals of the four objections. In the process of doing so, it builds up a picture of this field of thought and practice: its modes, methods and alternative forms of organization, and some of its pitfalls and potentials, exemplars and achievements.

Is there more to restorative justice than mere compliance to procedural justice? : a qualitative reflection from the victims' point of view

Une multitude de recherches évaluatives ont démontré que les victimes de crime, qu’elles soient victimes d’un crime contre les biens ou contre la personne, apprécient l’approche réparatrice. Cependant, nous sommes toujours à la recherche des facteurs théoriques qui expliqueraient la satisfaction des victimes en ce qui concerne leur expérience avec les interventions réparatrices. La recherche décrite dans cette thèse concerne l’exploration des facteurs contribuant à la satisfaction des victimes de crime avec l’approche réparatrice ainsi que ses liens avec la théorie de justice procédurale. Selon la théorie de justice procédurale, la perception de justice n’est pas uniquement associée à l’appréciation du résultat d’une intervention, mais également à l’appréciation de la procédure, et que la procédure et le résultat peuvent être évalués de façon indépendante. Les procédures qui privilégient la confiance, la neutralité et le respect, ainsi que la participation et la voix des parties sont plus appréciées. Notre objectif de recherche était d’explorer l’analogie entre l’appréciation de la justice réparatrice et le concept de justice procédurale. En outre, nous avons voulu déterminer si la justice réparatrice surpasse, en termes de satisfaction, ceux prévus par la théorie de justice procédurale. Nous avons également examiné la différence dans l’appréciation de l’approche réparatrice selon le moment de l’application, soit avant ou après adjudication pénale. Ainsi, nous avons exploré le rôle d’une décision judiciaire dans l’évaluation de l’approche réparatrice. Pour répondre à nos objectifs de recherche, nous avons consulté des victimes de crime violent au sujet de leur expérience avec l’approche réparatrice. Nous avons mené des entrevues semi-directives avec des victimes de crime violent qui ont participé à une médiation auteur-victime, à une concertation réparatrice en groupe ou aux rencontres détenus-victimes au Canada (N=13) et en Belgique (N=21). Dans cet échantillon, 14 répondants ont participé à une intervention réparatrice avant adjudication judiciaire et 14 après adjudication. Nous avons observé que l’approche réparatrice semble être en analogie avec la théorie de justice procédurale. D’ailleurs, l’approche réparatrice dépasse les prémisses de la justice procédurale en étant flexible, en offrant de l’aide, en se concentrant sur le dialogue et en permettant d’aborder des raisons altruistes. Finalement, le moment de l’application, soit avant ou après adjudication, ne semble pas affecter l’appréciation des interventions réparatrices. Néanmoins, le rôle attribué à l’intervention réparatrice ainsi que l’effet sur l’évaluation du système judiciaire diffèrent selon le moment d’application. Les victimes suggèrent de continuer à développer l’approche réparatrice en tant que complément aux procédures judiciaires, plutôt qu’en tant que mesure alternative. Les témoignages des victimes servent la cause de l’offre réparatrice aux victimes de crime violent. L’offre réparatrice pourrait aussi être élargie aux différentes phases du système judiciaire. Cependant, la préférence pour l’approche réparatrice comme complément aux procédures judiciaires implique la nécessité d’investir également dans la capacité du système judiciaire de répondre aux besoins des victimes, tant sur le plan de la procédure que sur le plan du traitement par les autorités judiciaires.

Adaptation of agriculture to climate change in Quebec : the co-construction of agricultural policies in the RCM of Haut-Richelieu

Les facteurs climatiques ainsi bien que les facteurs non-climatiques doivent être pris en considération dans le processus d'adaptation de l'agriculture aux changements et à la variabilité climatiques (CVC). Ce changement de paradigme met l'agent humain au centre du processus d'adaptation, ce qui peut conduire à une maladaptation. Suite aux débats sur les changements climatiques qui ont attiré l'attention scientifique et publique dans les années 1980 et 1990, l'agriculture canadienne est devenue un des points focaux de plusieurs études pionnières sur les CVC, un phénomène principalement dû à l’effet anthropique. Pour faire face aux CVC, ce n’est pas seulement la mitigation qui est importante mais aussi l’adaptation. Quand il s'agit de l'adaptation, c'est plutôt la variabilité climatique qui nous intéresse que simplement les augmentations moyennes des températures. L'objectif général de ce mémoire de maîtrise est d'améliorer la compréhension des processus d'adaptation et de construction de la capacité d'adaptation ai niveau de la ferme et de la communauté agricole à travers un processus ascendant, c’est-à-dire en utilisant l'approche de co-construction (qui peut également être considéré comme une stratégie d'adaptation en soi), pour développer une gestion et des outils de planification appropriés aux parties prenantes pour accroître ainsi la capacité d'adaptation de la communauté agricole. Pour y arriver, l'approche grounded theory est utilisée. Les résultats consistent de cinq catégories interdépendantes de codes élargis, conceptuellement distinctes et avec un plus grand niveau d'abstraction. La MRC du Haut-Richelieu a été choisie comme étude de cas en raison de plusieurs de ses dimensions agricoles, à part de ses conditions biophysiques favorables. 15 entrevues ont été menées avec les agriculteurs. Les résultats montrent que si certains agriculteurs ont reconnu les côtés positifs et négatifs des CVC, d’autres sont très optimistes à ce sujet comme se ils ne voient que le côté positif; d'où la nécessité de voir les deux côtés des CVC. Aussi, il y a encore une certaine incertitude liée aux CVC, qui vient de la désinformation et la désensibilisation des agriculteurs principalement en ce qui concerne les causes des CVC ainsi que la nature des événements climatiques. En outre, et compte tenu du fait que l'adaptation a plusieurs caractéristiques et types, il existe de nombreux types d'adaptation qui impliquent à la fois l'acteur privé et le gouvernement. De plus, les stratégies d'adaptation doivent être élaborées conjointement par les agriculteurs en concert avec d'autres acteurs, à commencer par les agronomes, car ils servent en tant que relais important entre les agriculteurs et d'autres parties prenantes telles que les institutions publiques et les entreprises privées.

Development of Best Practices for Ship Recycling Processes

Ship recycling has been considered as the best means to dispose off an obsolete ship. The current state of art of technology combined with the demands of sustainable developments from the global maritime industrial sector has modified the status of erstwhile ‘ship breaking’ involving ship scrap business to a modern industry undertaking dismantling of ships and recycling/reusing the dismantled products in a supply chain of pre owned product market by following the principles of recycling. Industries will have to formulate a set of best practices and blend them with the engineering activities for producing better quality products, improving the productivity and for achieving improved performances related to sustainable development. Improved performance by industries in a sustainable development perspective is accomplished only by implementing the 4E principles, ie.,. ecofriendliness, engineering efficiency, energy conservation and ergonomics in their core operations. The present study has done a comprehensive investigation into various ship recycling operations for formulating a set of best practices.Being the ultimate life cycle stage of a ship, ship recycling activities incorporate certain commercial procedures well in advance to facilitate the objectives of dismantling and recycling/reusing of various parts of the vessel. Thorough knowledge regarding these background procedures in ship recycling is essential for examining and understanding the industrial business operations associated with it. As a first step, the practices followed in merchant shipping operations regarding the decision on decommissioning have been and made available in the thesis. Brief description about the positioning methods and important preparations for the most feasible ship recycling method ie.,. beach method have been provided as a part of the outline of the background information. Available sources of guidelines, codes and rules & regulations for ship recycling have been compiled and included in the discussion.Very brief summary of practices in major ship recycling destinations has been prepared and listed for providing an overview of the global ship recycling activities. The present status of ship recycling by treating it as a full fledged engineering industry has been brought out to establish the need for looking into the development of the best practices. Major engineering attributes of ship as a unique engineering product and the significant influencing factors on her life cycle stage operations have been studied and added to the information base on ship recycling. Role of ship recycling industry as an important player in global sustainable development efforts has been reviewed by analysing the benefits of ship recycling. A brief synopsis on the state of art of ship recycling in major international ship recycling centres has also been incorporated in the backdrop knowledgebase generation on ship recycling processes.Publications available in this field have been reviewed and classified into five subject categories viz., Infrastructure for recycling yards and methods of dismantling, Rules regarding ship recycling activities, Environmental and safety aspects of ship recycling, Role of naval architects and ship classification societies, Application of information technology and Demand forecasting. The inference from the literature survey have been summarised and recorded. Noticeable observations in the inference include need of creation of a comprehensive knowledgebase on ship recycling and its effective implementation in the industry and the insignificant involvement of naval architects and shipbuilding engineers in ship recycling industry. These two important inferences and the message conveyed by them have been addressed with due importance in the subsequent part of the present study.As a part of the study the importance of demand forecasting in ship recycling has been introduced and presented. A sample input for ship recycling data for implementation of computer based methods of demand forecasting has been presented in this section of the thesis.The interdisciplinary nature of engineering processes involved in ship recycling has been identified as one of the important features of this industry. The present study has identified more than a dozen major stake holders in ship recycling having their own interests and roles. It has also been observed that most of the ship recycling activities is carried out in South East Asian countries where the beach based ship recycling is done in yards without proper infrastructure support. A model of beach based ship recycling has been developed and the roles, responsibilities and the mutual interactions of the elements of the system have been documented as a part of the study Subsequently the need of a generation of a wide knowledgebase on ship recycling activities as pointed out by the literature survey has been addressed. The information base and source of expertise required to build a broad knowledgebase on ship recycling operations have been identified and tabulated. Eleven important ship recycling processes have been identified and a brief sketch of steps involved in these processes have been examined and addressed in detail. Based on these findings, a detailed sequential disassembly process plan of ship recycling has been prepared and charted. After having established the need of best practices in ship recycling initially, the present study here identifies development of a user friendly expert system for ship recycling process as one of the constituents of the proposed best practises. A user friendly expert system has been developed for beach based ship recycling processes and is named as Ship Recycling Recommender (SRR). Two important functions of SRR, first one for the ‘Administrators’, the stake holders at the helm of the ship recycling affairs and second one for the ‘Users’, the stake holders who execute the actual dismantling have been presented by highlighting the steps involved in the execution of the software. The important output generated, ie.,. recommended practices for ship dismantling processes and safe handling information on materials present onboard have been presented with the help of ship recycling reports generated by the expert system. A brief account of necessity of having a ship recycling work content estimation as part of the best practices has been presented in the study. This is supported by a detailed work estimation schedule for the same as one of the appendices.As mentioned earlier, a definite lack of involvement of naval architect has been observed in development of methodologies for improving the status of ship recycling industry. Present study has put forward a holistic approach to review the status of ship recycling not simply as end of life activity of all ‘time expired’ vessels, but as a focal point of integrating all life cycle activities. A new engineering design philosophy targeting sustainable development of marine industrial domain, named design for ship recycling has been identified, formulated and presented. A new model of ship life cycle has been proposed by adding few stages to the traditional life cycle after analysing their critical role in accomplishing clean and safe end of life and partial dismantling of ships. Two applications of design for ship recycling viz, recyclability of ships and her products and allotment of Green Safety Index for ships have been presented as a part of implementation of the philosophy in actual practice.

Using Neural Network Classifier Support Vector Machine Regression for the prediction of Melting Point of Drug – like compounds

In our study we use a kernel based classification technique, Support Vector Machine Regression for predicting the Melting Point of Drug – like compounds in terms of Topological Descriptors, Topological Charge Indices, Connectivity Indices and 2D Auto Correlations. The Machine Learning model was designed, trained and tested using a dataset of 100 compounds and it was found that an SVMReg model with RBF Kernel could predict the Melting Point with a mean absolute error 15.5854 and Root Mean Squared Error 19.7576