Dialyse à domicile : évaluation du modèle de dialyse à domicile intégrée

Les modalités de dialyse à domicile, soit la dialyse péritonéale (DP) et l’hémodialyse à domicile (HDD), offrent plusieurs avantages aux patients avec insuffisance rénale terminale (IRT), que ce soit par rapport à la qualité de vie ou à une diminution des complications liées à l’IRT. Peu de données sont toutefois disponibles quant aux répercussions cliniques de l’initiation de la thérapie de suppléance rénale via la DP ou l’HDD et de l’optimisation subséquente du traitement à domicile. Le présent mémoire visait donc à répondre aux trois questions suivantes soit (1) la comparaison entre la survie des patients débutant la thérapie de suppléance rénale par une ou l’autre des modalités à domicile, (2) l’évaluation du modèle de dialyse à domicile intégrée (c’est la dire l’initiation de la suppléance rénale en DP avec un transfert subséquent en HDD) et (3) l’évaluation des prédicteurs dudit modèle de dialyse à domicile intégrée. L’évaluation de 11 416 patients ayant débuté la suppléance rénale en Australie et Nouvelle-Zélande entre 2000 et 2012 a montré une association entre une mortalité globale inférieure chez les patients traités par HDD comparativement à ceux traités par DP (rapport des risques [hazard ratio - HR] 0.47, intervalle de confiance [IC] de 95%, 0.38-0.59). Par contre, les patients ayant débuté la suppléance rénale en DP et ayant ensuite été transférés en HDD (modèle de dialyse à domicile intégrée) avaintt une survie en dialyse à domicile similaire à ceux directement traités par l’HDD (HR 0.92, IC de 95%, 0.52-1.62). Finalement, les caractéristiques démographiques de base (jeune âge, sexe masculin, ethnie), les comorbidités, la cause de l’insuffisance rénale terminale, la durée du traitement et la raison de l’arrêt de la DP étaient des prédicteurs du modèle de dialyse à domicile intégrée.

Dialyse à domicile : évaluation du modèle de dialyse à domicile intégrée

Les modalités de dialyse à domicile, soit la dialyse péritonéale (DP) et l’hémodialyse à domicile (HDD), offrent plusieurs avantages aux patients avec insuffisance rénale terminale (IRT), que ce soit par rapport à la qualité de vie ou à une diminution des complications liées à l’IRT. Peu de données sont toutefois disponibles quant aux répercussions cliniques de l’initiation de la thérapie de suppléance rénale via la DP ou l’HDD et de l’optimisation subséquente du traitement à domicile. Le présent mémoire visait donc à répondre aux trois questions suivantes soit (1) la comparaison entre la survie des patients débutant la thérapie de suppléance rénale par une ou l’autre des modalités à domicile, (2) l’évaluation du modèle de dialyse à domicile intégrée (c’est la dire l’initiation de la suppléance rénale en DP avec un transfert subséquent en HDD) et (3) l’évaluation des prédicteurs dudit modèle de dialyse à domicile intégrée. L’évaluation de 11 416 patients ayant débuté la suppléance rénale en Australie et Nouvelle-Zélande entre 2000 et 2012 a montré une association entre une mortalité globale inférieure chez les patients traités par HDD comparativement à ceux traités par DP (rapport des risques [hazard ratio - HR] 0.47, intervalle de confiance [IC] de 95%, 0.38-0.59). Par contre, les patients ayant débuté la suppléance rénale en DP et ayant ensuite été transférés en HDD (modèle de dialyse à domicile intégrée) avaintt une survie en dialyse à domicile similaire à ceux directement traités par l’HDD (HR 0.92, IC de 95%, 0.52-1.62). Finalement, les caractéristiques démographiques de base (jeune âge, sexe masculin, ethnie), les comorbidités, la cause de l’insuffisance rénale terminale, la durée du traitement et la raison de l’arrêt de la DP étaient des prédicteurs du modèle de dialyse à domicile intégrée.

An integrated information management model for ecologically sustainable development

Ecologically sustainable development has become a major feature of legal systems at the international, national and local levels throughout the world. In Australia, governments have responded to environmental crises by enacting legislation imposing obligations and restrictions over privately-owned land. Whilst these obligations and restrictions may well be necessary to achieve sustainability, the approach to management of information concerning these instruments is problematic. For example, management of information concerning obligations and restrictions in Queensland is fragmented, with some instruments registered or recorded on the land title register, some on external registers, and some information only available in the legislation itself. This approach is used in most Australian jurisdictions. This fragmented approach has led to two separate but interconnected problems. First, the Torrens system is no longer meeting its goal of providing a complete and accurate picture of title. Second, this uncoordinated approach to the management of land titles, and obligations and restrictions on land use, has created a barrier to sustainable management of natural resources. This is because compliance with environmental laws is impaired in the absence of easily accessible and accurate information. These problems demonstrate a clear need for reform in this area. To determine how information concerning these obligations and restrictions may be most effectively managed, this thesis will apply a comparative methodology and consider three case studies, which each utilise different models for management of this information. These jurisdictions will be assessed according to a set of guidelines for comparison to identify which features of their systems provide for effective management of information concerning obligations and restrictions on title and use. Based on this comparison, this thesis will devise a series of recommendations for an effective system for the management of information concerning obligations and restrictions on land title and use, taking into account any potential legal issues and barriers to implementation. This series of recommendations for reform will be supplemented by suggested draft legislative provisions.

Integrated Acquisition Engineering Model for acquiring heavy engineering assets

In asset intensive industries such as mining, oil & gas, utilities etc. most of the capital expenditure happens on acquiring engineering assets. Process of acquiring assets is called as “Procurement” or “Acquisition”. An asset procurement decision should be taken in consideration with the installation, commissioning, operational, maintenance and disposal needs of an asset or spare. However, such cross-functional collaboration and communication does not appear to happen between engineering, maintenance, warehousing and procurement functions in many asset intensive industries. Acquisition planning and execution are two distinct parts of asset acquisition process. Acquisition planning or procurement planning is responsible for determining exactly what is required to be purchased. It is important that an asset acquisition decision is the result of cross-functional decision making process. An acquisition decision leads to a formal purchase order. Most costly asset decisions occur even before they are acquired. Therefore, acquisition decision should be an outcome of an integrated planning & decision making process. Asset intensive organizations both, Government and non Government in Australia spent AUD 102.5 Billion on asset acquisition in year 2008-09. There is widespread evidence of many assets and spare not being used or utilized and in the end are written off. This clearly shows that many organizations end up buying assets or spares which were not required or non-conforming to the needs of user functions. It is due the fact that strategic and software driven procurement process do not consider all the requirements from various functions within the organization which contribute to the operation and maintenance of the asset over its life cycle. There is a lot of research done on how to implement an effective procurement process. There are numerous software solutions available for executing a procurement process. However, not much research is done on how to arrive at a cross functional procurement planning process. It is also important to link procurement planning process to procurement execution process. This research will discuss ““Acquisition Engineering Model” (AEM) framework, which aims at assisting acquisition decision making based on various criteria to satisfy cross-functional organizational requirements. Acquisition Engineering Model (AEM) will consider inputs from corporate asset management strategy, production management, maintenance management, warehousing, finance and HSE. Therefore, it is essential that the multi-criteria driven acquisition planning process is carried out and its output is fed to the asset acquisition (procurement execution) process. An effective procurement decision making framework to perform acquisition planning which considers various functional criteria will be discussed in this paper.

Development and evaluation of an integrated clinical learning model to inform continuing education for acute care nurses

Background Significant ongoing learning needs for nurses have occurred as a direct result of the continuous introduction of technological innovations and research developments in the healthcare environment. Despite an increased worldwide emphasis on the importance of continuing education, there continues to be an absence of empirical evidence of program and session effectiveness. Few studies determine whether continuing education enhances or develops practice and the relative cost benefits of health professionals’ participation in professional development. The implications for future clinical practice and associated educational approaches to meet the needs of an increasingly diverse multigenerational and multicultural workforce are also not well documented. There is minimal research confirming that continuing education programs contribute to improved patient outcomes, nurses’ earlier detection of patient deterioration or that standards of continuing competence are maintained. Crucially, evidence-based practice is demonstrated and international quality and safety benchmarks are adhered to. An integrated clinical learning model was developed to inform ongoing education for acute care nurses. Educational strategies included the use of integrated learning approaches, interactive teaching concepts and learner-centred pedagogies. A Respiratory Skills Update education (ReSKU) program was used as the content for the educational intervention to inform surgical nurses’ clinical practice in the area of respiratory assessment. The aim of the research was to evaluate the effectiveness of implementing the ReSKU program using teaching and learning strategies, in the context of organisational utility, on improving surgical nurses’ practice in the area of respiratory assessment. The education program aimed to facilitate better awareness, knowledge and understanding of respiratory dysfunction in the postoperative clinical environment. This research was guided by the work of Forneris (2004), who developed a theoretical framework to operationalise a critical thinking process incorporating the complexities of the clinical context. The framework used educational strategies that are learner-centred and participatory. These strategies aimed to engage the clinician in dynamic thinking processes in clinical practice situations guided by coaches and educators. Methods A quasi experimental pre test, post test non–equivalent control group design was used to evaluate the impact of the ReSKU program on the clinical practice of surgical nurses. The research tested the hypothesis that participation in the ReSKU program improves the reported beliefs and attitudes of surgical nurses, increases their knowledge and reported use of respiratory assessment skills. The study was conducted in a 400 bed regional referral public hospital, the central hub of three smaller hospitals, in a health district servicing the coastal and hinterland areas north of Brisbane. The sample included 90 nurses working in the three surgical wards eligible for inclusion in the study. The experimental group consisted of 36 surgical nurses who had chosen to attend the ReSKU program and consented to be part of the study intervention group. The comparison group included the 39 surgical nurses who elected not to attend the ReSKU program, but agreed to participate in the study. Findings One of the most notable findings was that nurses choosing not to participate were older, more experienced and less well educated. The data demonstrated that there was a barrier for training which impacted on educational strategies as this mature aged cohort was less likely to take up educational opportunities. The study demonstrated statistically significant differences between groups regarding reported use of respiratory skills, three months after ReSKU program attendance. Between group data analysis indicated that the intervention group’s reported beliefs and attitudes pertaining to subscale descriptors showed statistically significant differences in three of the six subscales following attendance at the ReSKU program. These subscales included influence on nursing care, educational preparation and clinical development. Findings suggest that the use of an integrated educational model underpinned by a robust theoretical framework is a strong factor in some perceptions of the ReSKU program relating to attitudes and behaviour. There were minimal differences in knowledge between groups across time. Conclusions This study was consistent with contemporary educational approaches using multi-modal, interactive teaching strategies and a robust overarching theoretical framework to support study concepts. The construct of critical thinking in the clinical context, combined with clinical reasoning and purposeful and collective reflection, was a powerful educational strategy to enhance competency and capability in clinicians.

Improving factory performance using an integrated sugar factory model

A whole of factory model of a raw sugar factory was developed in SysCAD software to assess and improve factory operations. The integrated sugar factory model ‘Sugar-SysCAD’ includes individual models for milling, heating and clarification, evaporation, crystallisation, steam cycle, sugar dryer and process and injection water circuits. These individual unit operation models can be either used as standalone models to optimise the unit operation or in the integrated mode to provide more accurate prediction of the effects of changes in any part of the process on the outputs of the whole factory process. Using the integrated sugar factory model, the effect of specific process operations can be understood and practical solutions can be determined to address process problems. The paper presents two factory scenarios to show the capabilities of the whole of factory model.

Integrated conceptual ecosystem model development for the Florida Keys/Dry Tortugas coastal marine ecosystem: MARine Estuarine goal Setting (MARES) for South Florida

The overall goal of the MARine and Estuarine goal Setting (MARES) project for South Florida is “to reach a science-based consensus about the defining characteristics and fundamental regulating processes of a South Florida coastal marine ecosystem that is both sustainable and capable of providing the diverse ecosystem services upon which our society depends.” Through participation in a systematic process of reaching such a consensus, science can contribute more directly and effectively to the critical decisions being made by both policy makers and by natural resource and environmental management agencies. The document that follows briefly describes the MARES project and this systematic process. It then describes in considerable detail the resulting output from the first two steps in the process, the development of conceptual diagrams and an Integrated Conceptual Ecosystem Model (ICEM) for the first subregion to be addressed by MARES, the Florida Keys/Dry Tortugas (FK/DT). What follows with regard to the FK/DT is the input received from more than 60 scientists, agency resource managers, and representatives of environmental organizations beginning with a workshop held December 9-10, 2009 at Florida International University in Miami, Florida.

Integrated conceptual ecosystem model development for the southeast Florida coastal marine ecosystem: MARine Estuarine goal Setting (MARES) for South Florida

The overall goal of the MARES (MARine and Estuarine goal Setting) project for South Florida is “to reach a science-based consensus about the defining characteristics and fundamental regulating processes of a South Florida coastal marine ecosystem that is both sustainable and capable of providing the diverse ecosystem services upon which our society depends.” Through participation in a systematic process of reaching such a consensus, science can contribute more directly and effectively to the critical decisions being made both by policy makers and by natural resource and environmental management agencies. The document that follows briefly describes MARES overall and this systematic process. It then describes in considerable detail the resulting output from the first step in the process, the development of an Integrated Conceptual Ecosystem Model (ICEM) for the third subregion to be addressed by MARES, the Southeast Florida Coast (SEFC). What follows with regard to the SEFC relies upon the input received from more than 60 scientists, agency resource managers, and representatives of environmental organizations during workshops held throughout 2009–2012 in South Florida.

Integrated conceptual ecosystem model development for the southwest Florida shelf coastal marine ecosystem: MARine Estuarine goal Setting (MARES) for South Florida

The overall goal of the MARine and Estuarine goal Setting (MARES) project for South Florida is “to reach a science-based consensus about the defining characteristics and fundamental regulating processes of a South Florida coastal marine ecosystem that is both sustainable and capable of providing the diverse ecosystem services upon which our society depends.” Through participation in a systematic process of reaching such a consensus, science can contribute more directly and effectively to the critical decisions being made by both policy makers and by natural resource and environmental management agencies. The document that follows briefly describes the MARES project and this systematic process. It then describes in considerable detail the resulting output from the first two steps in the process, the development of conceptual diagrams and an Integrated Conceptual Ecosystem Model (ICEM) for the second subregion to be addressed by MARES, the Southwest Florida Shelf (SWFS). What follows with regard to the SWFS is the input received from more than 60 scientists, agency resource managers, and representatives of environmental organizations beginning with a workshop held August 19-20, 2010 at Florida Gulf Coast University in Fort Myers, Florida.

An integrated 2-D model of a lithium ion battery: The effect of material parameters and morphology on storage particle stress

An integrated 2-D model of a lithium ion battery is developed to study the mechanical stress in storage particles as a function of material properties. A previously developed coupled stress-diffusion model for storage particles is implemented in 2-D and integrated into a complete battery system. The effect of morphology on the stress and lithium concentration is studied for the case of extraction of lithium in terms of previously developed non-dimensional parameters. These non-dimensional parameters include the material properties of the storage particles in the system, among other variables. We examine particles functioning in isolation as well as in closely-packed systems. Our results show that the particle distance from the separator, in combination with the material properties of the particle, is critical in predicting the stress generated within the particle. © 2012 Springer-Verlag.

Building a person home behavior model based on data from smart house sensors 2015

Dissertação para a obtenção do grau de Mestre em Engenharia Electrotécnica Ramo de Energia

ITEM : An Integrated Transport Economy Model - Price Elasticities of Freight Transport Demand in Canada : Three Canadian Markets and Four Commodities.

Rapport de recherche

Integrated Nitrogen CAtchment model (INCA) applied to a tropical catchment in the Atlantic Forest, Sao Paulo, Brazil

Stream-water flows and in-stream nitrate and ammonium concentrations in a small (36.7 ha) Atlantic Forest catchment were simulated using the Integrated Nitrogen in CAtchments (INCA) model version 1.9.4. The catchment, at Cunha, is in the Serra do Mar State Park, SE Brazil and is nearly pristine because the nearest major conurbations, Sao Paulo and Rio, are some 450 km distant. However, intensive farming may increase nitrogen (N) deposition and there are growing pressures for urbanisation. The mean-monthly discharges and NO3-N concentration dynamics were simulated adequately for the calibration and validation periods with (simulated) loss rates of 6.55 kg.ha(-1) yr(-1) for NO3-N and 3.85 kg.ha(-1) yr(-1) for NH4-N. To investigate the effects of elevated levels of N deposition in the future, various scenarios for atmospheric deposition were simulated; the highest value corresponded to that in a highly polluted area of Atlantic Forest in Sao Paulo City. It was found that doubling the atmospheric deposition generated a 25% increase in the N leaching rate, while at levels approaching the highly polluted Sao Paulo deposition rate, five times higher than the current rate, leaching increased by 240%, which would create highly eutrophic conditions, detrimental to downstream water quality. The results indicate that the INCA model can be useful for estimating N concentration and fluxes for different atmospheric deposition rates and hydrological conditions.