Direct acoustic computations of cold and heated jets

Round jets having a Mach number of 0.9 and a Reynolds number of 1700 are computed by direct numerical simulations using a characteristic-type formulation and high-order compact finite differences. Two simulations are carried out where the ratio of inflow to ambient temperature is equal to 1 (isothermal jet) and to 2 (anisothermal one) respectively. The influence of the jet temperature on the main features of the flow and its associated sound field is investigated

Pensée et langage chez Henri Michaux

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.[À l'origine dans / Was originally part of : Thèses et mémoires - FAS - Département de littérature comparée

Sous la cloche de verre : analyse des métaphores récurrentes de textes féminins de l’internement

[À l'origine dans / Was originally part of : Thèses et mémoires - FAS - Département de littérature comparée]Cette thèse est une réflexion concernant les particularités du langage, principalement de l’utilisation de la métaphore, dans les textes d’écrivaines ayant été internées. Mon analyse considère les œuvres de Janet Frame, Sylvia Plath, Unica Zürn, Emma Santos et Susanna Kaysen, ainsi que d’autres textes étant mentionnés dans une moindre mesure. Le fait d’avoir vécu une expérience de vie extrême, physique et psychique, a des répercussions sur l’esprit et la perception de soi, leurs représentations textuelles, ainsi que le rapport à l’écrit et à la littérature. Des figures subies ou choisies se répètent dans ces textes. Elles renseignent sur ce que ces femmes ont vécu, comment elles ont été affectées et la littérature. Cette thèse est divisée en cinq idées principales concernant les liens entre la folie, l’écriture et les femmes internées correspondant à la division des chapitres. Le premier porte sur la figure de la cloche de verre et ses variations chez diverses écrivaines. Il s’agit d’une métaphore puissante, efficace pour traduire l’état d’esprit de l’internée qui permet d’expliciter l’importance et le fonctionnement de la métaphore, son rôle dans l’écriture et la pensée. Le deuxième traite des métaphores spatiales et des lieux de pensée présents dans ces textes. Il est un examen de comment, alors que l’esprit devient de plus en plus fragile et l’image du corps incertaine en raison des traitements et des conditions de vie imposées, apparaît la nécessité d’un lieu, figuré ou réel, d’où écrire et de comment ce lieu est en relation avec le langage et la structuration de l’écrit et de la pensée. Le troisième porte sur la notion d’abjection. Ces femmes sont considérées, traitées, se perçoivent et vivent comme des animaux, des excréments ou des déchets. Il est une décortication de la représentation de l’effritement des limites de la subjectivité lors de l’internement. J’y explique à quel point l’hôpital pousse la personne vers la saleté et l’animalité plutôt que vers la guérison, ainsi que les conséquences pour la perception de soi que le fait d’être placé hors du social entraîne. Le quatrième concerne la notion d’objet et les processus qui font qu’à force d’être réifiées les narratrices des textes se perçoivent comme des objets plutôt que des personnes. Le rapport que l’esprit entretient avec les objets et l’importance qu’ils ont pour son fonctionnement y sont examinés. Le cinquième traite enfin des réflexions sur l’utilisation du langage, que ces écrivaines ont réalisées, sur les mots et procédés qu’elles emploient pour les communiquer ainsi que sur l’importance du corps féminin et de la conception de la féminité dans la production des textes et des idées qu’ils portent. J’en arrive à établir à quel point, pour ces écrivaines, la vie dépend du littéraire. Ma thèse démontre comment la littérature leur a fourni un espace d’analyse et de structure de leur personne et de leur pensée, ainsi qu’un lieu de parole émergeant de l’utilisation du langage et des interactions entre l’esprit, les mots et le monde.This thesis reflects on the particularities of the use of language, especially in terms of recurring metaphors, in the texts of women writers who spent a part of their life in a psychiatric hospital. I question the texts of Janet Frame, Sylvia Plath, Unica Zürn, Emma Santos and Susanna Kaysen. Some other women writers are also examined, to a lesser extent. It shows that the fact of having lived an experience, which I would qualify as physically and psychologically extreme living conditions, affects these writers’ mind, the self-perception and their textual representations. It also shows how one’s relation to writing and literature is changed by this situation. Undergone, imposed, selected or created metaphors are born, are shown or repeated in those texts. They detail both how these women lived and processed the effects associated to this life, as well as how their writing of these experiences reflects general aspects of literary discourse. This thesis is divided into five main ideas concerning the singular relationship that bonds madness, writing and the experience of living in a psychiatric ward. In the first chapter, I analyze the bell jar figure and its variations according to different writers. This strong metaphor, which is incredibly efficient to translate the internee’s state of mind, helps me explain the functioning of metaphor and the crucial role it plays in the writing and human thought. The second chapter looks at spatial metaphors and spatial representations of the mind. It shows how, while the self and its corporal images are becoming more fragile because of the imposed treatments and living conditions, there appears the necessity of a real or figurative space from which to write. This space is in relation with writing, but also with the mere possibility of human thought. The third chapter builds on the notion of abjection. These women were considered and treated as animals, excrements or waste, and they came to see themselves as such. I analyze those representations and also how they figure the dissolution of the limits to one’s subjectivity that occurs during the internment. The fourth chapter draws on the object notion and the reification of human existence, through processes of subjective reification, which lead the narrators to perceive themselves as objects rather than people. I also examine the relation we can posit between the mind, the objects it chooses to consider, and how they affect the mind’s reflexive operations. The fifth chapter reflects on the use of language, according to the theories developed by these women writers. It also looks at the importance of the female body and femininity in the production of the texts and the ideas fostered by these concepts. My thesis demonstrates how literature gave them a space to analyze and structure both their self and thought. For these women, literature was also a place to speak from. This possibility emerges from the use of language and from the interactions between the mind, language and the world

In-home Telerehabilitation for Proximal Humerus Fractures: A Pilot Study

The objective of this study was to investigate the feasibility of an in-home telerehabilitation program for proximal humerus fractures. Seventeen patients with proximal humerus fractures were recruited by an orthopedic specialist during emergency room visits. Telerehabilitation treatments were given at the patient's home over an 8-week period using a videoconferencing system. Pain (Short-Form McGill Pain Questionnaire [SF-MPQ]), disabilities including shoulder range of motion (flexion, extension, internal rotation, external rotation, abduction), and upper limb function (Disability of the Arm, Shoulder and Hand questionnaire [DASH]) were measured in face-to-face evaluations before (T1) and immediately after (T2) the program. Participant satisfaction with the health care received was also evaluated at T2 with the Health care satisfaction questionnaire. All the clinical outcomes improved post-intervention (p < 0.05). Also, patient satisfaction was high (overall score of 82 ± 7%). Therefore, in-home teletreatment seems to be a promising way to dispense rehabilitation services for this population

Ancient genomes in South Patagonia reveal population movements associated with technological shifts and geography

Archaeological research documents major technological shifts among people who have lived in the southern tip of South America (South Patagonia) during the last thirteen millennia, including the development of marine-based economies and changes in tools and raw materials. It has been proposed that movements of people spreading culture and technology propelled some of these shifts, but these hypotheses have not been tested with ancient DNA. Here we report genome-wide data from 20 ancient individuals, and co-analyze it with previously reported data. We reveal that immigration does not explain the appearance of marine adaptations in South Patagonia. We describe partial genetic continuity since ~6600 BP and two later gene flows correlated with technological changes: one between 4700–2000 BP that affected primarily marine-based groups, and a later one impacting all <2000 BP groups. From ~2200–1200 BP, mixture among neighbors resulted in a cline correlated to geographic ordering along the coast.Fil: Nakatsuka, Nathan. Harvard Medical School; Estados UnidosFil: Luisi, Pierre. Universidad Nacional de Córdoba. Facultad de Filosofía y Humanidades; ArgentinaFil: Motti, Josefina María Brenda. Universidad Nacional del Centro de la Provincia de Buenos Aires; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Salemme, Monica Cira. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Austral de Investigaciones Científicas; Argentina. Universidad Nacional de Tierra del Fuego; ArgentinaFil: Santiago, Fernando Carlos. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Austral de Investigaciones Científicas; ArgentinaFil: D'angelo del Campo, Manuel Domingo. Universidad Nacional del Centro de la Provincia de Buenos Aires. Facultad de Ciencias Sociales. Grupo de Estudios Interdisciplinarios sobre Poblaciones Humanas de Patagonia Austral; Argentina. Universidad Autónoma de Madrid; EspañaFil: Vecchi, Rodrigo Javier. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional del Sur; ArgentinaFil: Espinosa Parrilla, Yolanda. Consejo Superior de Investigaciones Científicas; EspañaFil: Prieto, Alfredo. Universidad de Magallanes; ChileFil: Adamski, Nicole. Harvard Medical School; Estados UnidosFil: Lawson, Ann Marie. Harvard Medical School; Estados UnidosFil: Harper, Thomas K.. University of Pennsylvania; Estados UnidosFil: Culleton, Brendan J.. University of Pennsylvania; Estados UnidosFil: Kennett, Douglas J.. University of California; Estados UnidosFil: Lalueza Fox, Carles. Consejo Superior de Investigaciones Científicas; EspañaFil: Mallick, Swapan. Harvard Medical School; Estados UnidosFil: Rohland, Nadin. Harvard Medical School; Estados UnidosFil: Guichón, Ricardo A.. Universidad Nacional del Centro de la Provincia de Buenos Aires; ArgentinaFil: Cabana, Graciela S.. University of Tennessee; Estados UnidosFil: Nores, Rodrigo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Antropología de Córdoba. Universidad Nacional de Córdoba. Facultad de Filosofía y Humanidades. Instituto de Antropología de Córdoba; ArgentinaFil: Reich, David. Harvard Medical School. Department Of Medicine; Estados Unido

Canadian guidelines for clinical practice: an analysis of their quality and relevance to the care of adults with comorbidity

<p>Abstract</p> <p>Background</p> <p>Clinical guidelines have been the subject of much criticism in primary care literature partly due to potential conflicts in their implementation among patients with multiple chronic conditions. We assessed the relevance of selected Canadian clinical guidelines on chronic diseases for patients with comorbidity and examined their quality.</p> <p>Methods</p> <p>We selected 16 chronic medical conditions according to their frequency of occurrence, complexity of treatment, and pertinence to primary care. Recent Canadian clinical guidelines (2004 - 2009) on these conditions, published in English or French, were retrieved. We assessed guideline relevance to the care of patients with comorbidity with a tool developed by Boyd and colleagues. Quality was assessed using the Appraisal of Guidelines Research and Evaluation (AGREE) instrument.</p> <p>Results</p> <p>Regarding relevance, 56.2% of guidelines addressed treatment for patients with multiple chronic conditions and 18.8% addressed the issue for older patients. Fifteen guidelines (93.8%) included specific recommendations for patients with one concurrent condition; only three guidelines (18.8%) addressed specific recommendations for patients with two comorbid conditions and one for more than two concurrent comorbid conditions. Quality of the evaluated guidelines was good to very good in four out of the six domains measured using the AGREE instrument. The domains with lower mean scores were Stakeholder Involvement and Applicability.</p> <p>Conclusions</p> <p>The quality of the Canadian guidelines examined is generally good, yet their relevance for patients with two or more chronic conditions is very limited and there is room for improvement in this respect.</p

Implementing shared decision-making in nutrition clinical practice: A theory-based approach and feasibility study

<p>Abstract</p> <p>Background</p> <p>There are a growing number of dietary treatment options to choose from for the management of many chronic diseases. Shared decision making represents a promising approach to improve the quality of the decision making process needed for dietary choices that are informed by the best evidence and value-based. However, there are no studies reporting on theory-based approaches that foster the implementation of shared decision making in health professions allied to medicine. The objectives of this study are to explore the integration of shared decision making within real nutritional consultations, and to design questionnaires to assess dieticians' intention to adopt two specific behaviors related to shared decision making using the Theory of Planned Behavior.</p> <p>Methods</p> <p>Forty dieticians will audiotape one clinical encounter to explore the presence of shared decision making within the consultation. They will also participate to one of five to six focus groups that aim to identify the salient beliefs underlying the determinants of their intention to present evidence-based dietary treatment options to their patients, and clarify the values related to dietary choices that are important to their patients. These salient beliefs will be used to elaborate the items of two questionnaires. The internal consistency of theoretical constructs and the temporal stability of their measurement will be checked using the test-retest method by asking 35 dieticians to complete the questionnaire twice within a two-week interval.</p> <p>Discussion</p> <p>The proposed research project will be the first study to: provide preliminary data about the adoption of shared decision making by dieticians and theirs patients; elicit dieticians' salient beliefs regarding the intention to adopt shared decision making behaviors, report on the development of a specific questionnaire; explore dieticians' views on the implementation of shared decision making; and compare their views regarding the implementation of shared decision making in different clinical settings.</p> <p>It is anticipated that the results generated by the proposed research project will significantly contribute to the emergence of shared decision making in nutrition through a theory-based approach.</p

Piloting online self-audit of methadone treatment in Irish general practice: results, reflections and educational outcomes

Background: Work based learning underpins the training and CPD of medical practitioners. Medical audit operates on two levels; individual self-assessment and professional/practice development. In Ireland, annual practice improvement audit is an essential requirement for the successful completion of continuous professional development (CPD) as determined by the regulatory body, the Irish Medical Council. All general practice (GP) doctors providing methadone maintenance treatment (MMT) in Ireland have a contractual obligation to partake in a yearly methadone practice audit. The Irish College of General Practitioners (ICGP) as national training provider is tasked to facilitate this annual audit process. The purpose of this audit is to assess the quality of care provided to patients against an agreed set of national standards, enhance learning, and promote practice improvement and reflective practice. The aim was to present an online MTP self-audit and evaluate results from a 12-month pilot among GPs providing MMT in Ireland. Method A mixed method study describing three phases (design and development, pilot/implementation and evaluation) of a new online self –audit tool was conducted. Descriptive and thematic analysis of audit and evaluation data was conducted. Results: Survey Monkey is a suitable software package for the development and hosting of an easy to use online audit for MMT providing doctors. Analysis of the audit results found that the majority of GPs scored 80% or over for the 25 identified essential criteria for MMT provision. The evaluation of the GP audit experience underscores the positive outcomes of the online self-audit in terms of improving practice systems, encouraging reflective practice, enhanced patient care and doctor commitment to continued provision of MMT in addiction clinics and in primary care. Conclusions: Results from this audit demonstrate a high level of compliance with best practise MMT guidelines by Irish GPs providing MMT. The online self-audit process was well received and encouraged reflective practice. The audit process hinged on the individual GP’s ability to review and critically analyse their professional practice, and manage change. This model of audit could be adapted and used to monitor the management of other chronic illnesses in general practice

Users' perspectives of barriers and facilitators to implementing EHR in Canada: A study protocol

<p>Abstract</p> <p>Background</p> <p>In Canada, federal, provincial, and territorial governments are developing an ambitious project to implement an interoperable electronic health record (EHR). Benefits for patients, healthcare professionals, organizations, and the public in general are expected. However, adoption of an interoperable EHR remains an important issue because many previous EHR projects have failed due to the lack of integration into practices and organizations. Furthermore, perceptions of the EHR vary between end-user groups, adding to the complexity of implementing this technology. Our aim is to produce a comprehensive synthesis of actual knowledge on the barriers and facilitators influencing the adoption of an interoperable EHR among its various users and beneficiaries.</p> <p>Methods</p> <p>First, we will conduct a comprehensive review of the scientific literature and other published documentation on the barriers and facilitators to the implementation of the EHR. Standardized literature search and data extraction methods will be used. Studies' quality and relevance to inform decisions on EHR implementation will be assessed. For each group of EHR users identified, barriers and facilitators will be categorized and compiled using narrative synthesis and meta-analytical techniques. The principal factors identified for each group of EHR users will then be validated for its applicability to various Canadian contexts through a two-round Delphi study, involving representatives from each end-user groups. Continuous exchanges with decision makers and periodic knowledge transfer activities are planned to facilitate the dissemination and utilization of research results in policies regarding the implementation of EHR in the Canadian healthcare system.</p> <p>Discussion</p> <p>Given the imminence of an interoperable EHR in Canada, knowledge and evidence are urgently needed to prepare this major shift in our healthcare system and to oversee the factors that could affect its adoption and integration by all its potential users. This synthesis will be the first to systematically summarize the barriers and facilitators to EHR adoption perceived by different groups and to consider the local contexts in order to ensure the applicability of this knowledge to the particular realities of various Canadian jurisdictions. This comprehensive and rigorous strategy could be replicated in other settings.</p