ABSTRACT THE EXAMINATION OF FACTORS THAT INFLUENCE TREATMENT SEEKING DELAY AMONG OLDER ADULTS DIAGNOSED WITH ACUTE MYOCARDIAL INFARCTION By Deonna S. Tanner Early diagnosis and treatment of acute myocardial infarction (AMI) can greatly reduce the morbidity and mortality associated with this condition. However, individuals, particularly older adults, delay seeking treatment for AMI symptoms. The purpose of this study was to examine the relationship of factors that influence pre-hospital delay in seeking treatment among older adults diagnosed with AMI. A descriptive, cross-sectional, comparative study design with a correlational component was used. Data were collected from 82 hospitalized older adults (60-80 years of age). For statistical analyses, older adults were divided into two groups. The shorter delay group delayed ≤ 120 minutes from the onset of symptoms (OS) and the longer delay group delayed > 120 minutes. Using the Common Sense Model as a guide, groups were compared on the following variables: internal influences (age, gender, race, history of AMI) and external influences (personal and professional support), cognitive representations of symptoms (symptom interpretation, perceived level of control, seriousness), and emotional representations of symptoms (anxiety and uncertainty). The majority of participants were retired/unemployed (64.6%) White men (82.9%) who were married (73.2%) with a mean age of 69.04 (± 5.82) years. The median delay time was 2.6 hours (range 0.5 - 432 hours). Participants experienced on average eight (± 3.86) symptoms (typical and atypical) with high levels of pain (M= 7.1 ± 3.4) and high state anxiety (M = 56.47 ± 10.37) at the time of the AMI. Findings show the only significant independent predictor of delay time was personal support. Being more certain that symptoms were heart related or having a previous AMI resulted in significantly shorter delay time (p <.05). Contacting a healthcare provider was not helpful for these older adults. Findings show factors influencing delay are challenging and complex, yet laypersons play an important role in the decision to seek treatment. Future research should include community-based educational programs focusing on atypical AMI symptoms and ways to increase the activation of emergency medical services soon after the OS.

Ambient Intelligence (AmI) refers to a vision of the information society where everyday human environments will be permeated by intelligent technology: people will be surrounded and accompanied by intelligent interfaces supported by computing and wireless networking technology that is ubiquitous, embedded in virtually all kinds of everyday objects. These computationally augmented, smart environments - composed of a myriad of invisible, distributed, networked, connected, interactive, and always-on computing devices - are aware of human context; sensitive to people's needs; adaptive to, and anticipatory of, their behavior; personalized to their requirements; and responsive to their emotion and presence, thereby intelligently supporting their daily and social lives by providing limitless services in a seamless and unobtrusive way. The vision of AmI assumes a paradigmatic shift in both computing and society – far-reaching societal implications. The challenge lies in developing AmI forms that acclimatise to societal change and the diversity of European socio-cultural life. Indeed, one of the most fundamental views in the prevailing AmI vision is a radical and technology-driven change to social environments and people’s lives. Research emphasizes the fundamental role the ISTAG, a group of scholars and ICT industry experts, plays in the reproduction of AmI as a positive force for societal change. Therefore, the objective of this study is to carry out a critical reading of the scholarly and ICT industry’s construction of AmI in relation to societal transformation. To achieve this objective, a discourse analytical approach was employed to examine the selected empirical material: three reports published by the ISTAG in 2001, 2003 and 2006. The approach consists of seven stages: (1) surface elements and organizational structure, (2) discursive constructions, (3) social actors, (4) language and rhetoric, (5) framing as power and operation, (6) positioning and legitimation, and (7) ideological viewpoints.The AmI discourse (vision) construction tends to be deterministic, i.e. it assumes that the ‘amization’ of society will lead to radical social transformations, and has an unsophisticated account of how social change occurs. It is also inclined to be rhetorical - it promises revolutionary social changes without really having a holistic strategy for achieving the goal. Moreover, topicalization is accomplished in correspondence with the preferred mental models and social representations. Furthermore, the discourse is exclusionary: many issues (pertaining to trust, social sustainability, human-centred design, healthcare, and community life) are left out with the intention to advance the idea of the eventual societal acceptance of AmI. It additionally plays a role in wider processes of legitimation of social agents and structures on the basis of normative and political reasons, and it offers different subject positions: between ISTAG and Europe and European citizens, and between citizens and ICT designers and producers. Likewise, it plays a major role in constructing the image of social actors – ISTAG, ICT industry, research community and EU – as well as in defining their relations and identities in ways that reallocate roles and reflect new attributes. A great highlight and space is awarded to represent these actors, and their views dominate the reports. They are the prime definer of the represented reality. As to ideological reproduction, the discourse perpetuates power relations, serves the interest of certain stakeholders in European society, and reconstructs ideological claims. This discursive endeavor provides a valuable reference for social researchers or scientists in related research communities. Until now, there has been, to the best of one’s knowledge, no comprehensive discursive research of AmI in relation to societal transformation, more specifically the potential of AmI in modernizing the European social model and in shaping Europe’s future.

Au début de l'adolescence, les relations d'amitié jouent un rôle grandissant dans le développement social et affectif des jeunes. Différents aspects des relations entre pairs ont été examinés jusqu'à présent en lien avec le bien-être psychologique. La présente thèse propose de se pencher sur un aspect négligé des relations entre pairs au début de l'adolescence: le niveau de stabilité temporelle du réseau d'amis. La majorité des études présente une conception statique des amitiés. Or, les relations d'amitié à l'adolescence évoluent dans une perspective temporelle. Dans les rares cas où la stabilité est considérée, les amitiés sont typiquement mesurées à deux moments au cours d'une année scolaire. Les mesures annuelles sont restreintes dans leur capacité à bien cerner la nature changeante des réseaux d'amis au début de l'adolescence. Dans le cadre de cette thèse, des innovations sur le plan méthodologique ont donc été proposées afin d'évaluer les variations temporelles du réseau en se basant sur plus de deux temps de mesure et en utilisant des intervalles de temps plus rapprochés. L'objectif général de cette thèse de doctorat consiste à examiner la stabilité dans le réseau d'amis au début de l'adolescence. L'examen de la stabilité est basé sur l'utilisation d'une mesure auto-révélée des amitiés. En effet, les recherches démontrent que la perception des jeunes sur leurs relations interpersonnelles peut avoir un impact sur leur bien-être psychologique. Le premier objectif vise à décrire les changements qui peuvent être observés dans le réseau d'amis sur de très courts intervalles de temps. La stabilité a été examinée en tenant compte de différentes caractéristiques des amitiés qui composent le réseau, notamment le statut des amis (meilleur ami vs. ami secondaire), le sexe des amis (même sexe vs. sexe opposé) et le contexte de fréquentation des amitiés (école, hors école, multicontexte). Le second objectif consiste à approfondir le construit de stabilité du réseau en examinant les liens qu'il présente avec un indicateur de bien-être psychologique en hausse au début de l'adolescence, notamment les sentiments dépressifs. Une nouvelle procédure basée sur des entrevues téléphoniques mensuelles a été développée pour répondre à ces questions de recherche. Cent deux élèves (51 filles; âge moyen = 12 ans) provenant de la grande région de Montréal et de niveaux socio-économiques variés forment l'échantillon de cette étude. Un devis longitudinal a été employé. Les données portant sur le réseau d'amis et les symptômes dépressifs ont été obtenues à partir de questionnaires complétés en classe et d'entrevues téléphoniques menées sur une base mensuelle au cours d'une période de cinq mois. Les résultats indiquent qu'une proportion importante (i.e., environ un tiers) d'amitiés du réseau s'est avérée instable au cours de la période de cinq mois. Cette instabilité semble plus marquée chez les filles. De plus, les meilleures amitiés, celles de même sexe (seulement chez les filles) et celles provenant de multiples contextes ont été perçues comme étant plus stables que les amitiés secondaires, celles de sexe opposé et celles provenant d'un seul contexte. Par ailleurs, les adolescents qui ont rapporté un niveau élevé d'instabilité dans leur réseau ont également éprouvé une augmentation de leurs sentiments dépressifs au cours de la période de cinq mois. Des analyses mensuelles ont permis de déterminer plus spécifiquement la direction de ce lien. Les résultats ont indiqué que des symptômes dépressifs élevés à un mois donné prédit significativement une augmentation du niveau d'instabilité des amitiés le mois suivant. Par contre, la relation inverse ne s'est pas avérée significative. Enfin, la détresse psychologique est surtout observée lorsque les jeunes perçoivent de l'instabilité parmi leurs meilleures amitiés ou parmi leurs amitiés de l'école. En conclusion, la pertinence du construit de stabilité temporelle du réseau d'amis a été montrée dans cette thèse puisque des variations individuelles dans le niveau de stabilité ont été observées et associées à la détresse psychologique. L'analyse du changement basée sur l'utilisation d'un devis longitudinal comprenant de multiples prises de mesure séparées par de courts intervalles de temps a permis d'examiner les amitiés des adolescents sur une perspective temporelle, ce qui contribue ultimement à approfondir notre compréhension des processus dynamiques par lesquels les réseaux d'amis évoluent au début de l'adolescence et affectent leur bien-être psychologique. ______________________________________________________________________________ MOTS-CLÉS DE L’AUTEUR : Stabilité, Réseau, Amitié, Dépression, Adolescence.

Texte remanié de: Diss.--Tehologische Fakultät--Basel--Universität, 1996. / Bibliogr. p. 221-236. Index.

Advances in communication technology have led to the growth of what is called Ambient Intelligence (AmI). AmI refers to an environment which is intelligent and has advanced computing, networking technology and specific interfaces. It is aware of the specific characteristics of human presence and personalities, takes care of what people need and is capable of responding intelligently according to different activities, and even can engage in intelligent dialogue with the user. Variability of location and system behavior is a central issue in AmI, where behavior of software has to change and re-adapt to the different location settings. AmI refers to an environment that acts on behalf of humans. It is sensitive, contextualized, responsive, interconnected, transparent, and intelligent. This environment is coupled with ubiquity of computing devices that enables it to react differently according to different actions, and even to take the initiative towards fulfilling human needs. Security, privacy, and trust challenges are amplified with AmI computing model and need to be carefully engineered. From software engineering perspective, the shift towards AmI can be seen abstractly similar to the shift from object paradigm towards agent one. Objects provide functionality to be exploited, while agents possess functionality and know how and when to use and offer it autonomously. Agent paradigm is suitable for implementing AmI considering AmI as an open complex system. Moreover, developers argue that agent paradigm is useful for engineering all aspects of such intelligent systems. These days, the large diversity of needs in a home-based patient population requires complex technology. Meeting those needs technically requires the use of a distributed approach and the combination of many hardware and software techniques. Furthermore, this service should be accepted in all scales and should be sufficient enough to meet all the requirements. In this thesis, I study the factors which can affect the acceptance of AmI especially when it is used to support elderly people and people with dementia, and I give suggestions which can improve the acceptance of this technology. / <p>Validerat; 20101217 (root)</p>

Dans un contexte mondial d’émergence de bactéries résistantes aux antibiotiques, il est nécessaire d’explorer de nouvelles voies de recherche pour trouver de nouveaux traitements. Cet état de fait est particulièrement marqué dans le cadre d’infections chroniques associées à une colonisation des tissus par des biofilms bactériens. L’endocrinologie microbienne est un champ de recherche axé sur l’étude des mécanismes de communication inter-règnes qui peut s’établir entre des bactéries et leurs hôtes. Les molécules humaines qui permettent ce dialogue constituent de potentiels outils capables de moduler la physiologie des bactéries pour empêcher leur développement. Dans cette optique, l’objectif de ma thèse était d’approfondir nosconnaissances sur l’effet des peptides natriurétiques, une famille d’hormones humaines, sur la physiologie du pathogène opportuniste P. aeruginosa. Les travaux que j’ai menés ont permis de préciser les mécanismes de l’action anti-biofilm du peptide natriurétique de type C ou CNP. J’ai également montré qu’un autre peptide, le peptide natriurétique atrial (ANP), est capable de disperser un biofilm établis de P. aeruginosa. Dans un second temps, j’ai pu identifier que l’opéron ami, dans son intégralité, est indispensable aux effets des peptides natriurétiques et qu’en plus les protéines codées par les gènes de l’opéron ami ont un rôle important dans la régulation de la virulence bactérienne et dans la formation des biofilms. Ainsi, j’ai pu mettre en évidence que les protéines AmiE et AmiR, en plus de leur rôle dans le métabolisme secondaire, sont impliquées dans la régulation de la virulence et de la formation de biofilm de P. aeruginosa. / In a global context of emergence of antibiotic-resistant bacteria, it is necessary to explore new paths of research to find new treatments. This state of affairs is particularly marked in the context of chronic infections associated with tissue colonization by bacterial biofilms. Microbial endocrinology is a field of research focused on the study of inter-kingdom communication that can be established between bacteria and their hosts. The human molecules that allow this dialogue are potential tools capable of modulating bacterial physiology to prevent their development. In this perspective, the aim of my thesis was to deepen our knowledge about the effect of natriuretic peptides, a family of human hormones, on the physiology of the opportunistic pathogen P. aeruginosa. The work that I carried out allowed us to characterize the mechanisms of the anti-biofilm action of the natriuretic peptide type C or CNP. I have also shown that another peptide, the atrial natriuretic peptide (ANP), is able to disperse an established biofilm of P. aeruginosa. In a second step, I was able to identify that the entire ami operon is essential for the effects of the natriuretic peptides and that the proteins encoded by the genes of the ami operon have an important role in bacterial virulence regulation and in the formation of biofilms. Thus, I was able to demonstrate that the AmiE and AmiR proteins, in addition to their role in secondary metabolism, are involved in the regulation of virulence and biofilm formation of P. aeruginosa.

如何永續發展已成為人類面臨的重大議題，依據先進國外之經驗，透過智慧電網之相關技術，可以有效的提升能源效率與達成節能減碳之目的。在國外建置智慧電網的過程中，往往從先進讀表基礎建設(Advanced Metering Infrastructure, AMI)切入，AMI對往後智慧電網的延伸發展有很大的影響。 因此，本研究旨在探討我國未來發展AMI創新政策之關鍵因素和其優先排序。首先藉由蒐集次級資料瞭解主要先進國家的AMI相關發展經驗，以及目前我國AMI的發展現況，再透過文獻探討國家創新政策，並以Rothwell &Zegveld之國家創新政策理論作為基礎架構，建立層級結構，運用模糊層級分析法(Fuzzy Analytic Hierarchy Process, FAHP )，針對國內AMI之相關產官學人員進行專家問卷調查，並整理出各項政策因素的權重排序，求出影響台灣發展AMI之創新政策關鍵因素。 從本研究實證結果顯示主層級之三項政策構面中相對權重最重的是「環境面」，在次層級十二項政策工具中，「公共服務」、「資訊服務」、「法規管制」的相對總權重最重，其為目前台灣發展AMI創新政策中最急需政府優先考量的關鍵因素。 / The sustainable development has become major issue for human. According to the experience of foreign advanced countries, it can achieve the purpose effectively of improving energy efficiency and reducing carbon emissions through the related technologies of smart grid. In the process of building smart grid abroad, it often cuts into the Advanced Metering Infrastructure (AMI). AMI has a great influence on the future extending development of the smart grid. Therefore, the study explores the key factors and precedence of AMI innovation policy in future development of our country. First, understanding the relative development experience of AMI in major advanced countries through collecting the secondary data and the current development situation of AMI in our country. Second, exploring country innovation policy through literature review, and taking theory of Rothwell & Zegveld as infrastructure to build up hierarchical structure, and using FAHP (Fuzzy Analytic Hierarchy Process) method to conduct experts survey for relative persons of industry - government - academy of domestic AMI. Then, collating the sort weights for various policy factors. Finally, finding out key factors that affect development of Taiwan’s AMI innovation policy. From the empirical results of the research shows that the most important relative weights in three main policy dimensions of the hierarchy is the “environmental surface”. The relative total weights of “public service”, “information service” ,“regulation control” and “political strategic policies” are the highest among twelve policies. They are key factor of most urgent priority for government to consider among developing AMI innovation policies in current Taiwan.

International Telemetering Conference Proceedings / October 26-29, 1998 / Town & Country Resort Hotel and Convention Center, San Diego, California / An Improved AMI (Alternate Mark Inverse) Code used in telemetry system is proposed, its implementation and properties analysis are reported, including error performance analysis, power spectrum analysis, the relationship between acqusition probability of the first frame marker and error threshold and length of frame marker, etc. This type of code has the approximately identical power spectrum performance as the AMI Code. In addition, there have no long continuous zeroes in the data stream, which will cause phase-locked loop to fail. Using the Improved AMI Code, the equal probability of 0 and 1 is changed, which will increase acqusition probability of the first frame marker. Detailed description about how to create the Improved AMI Code is also discussed in this paper.

Le propos de « l'amitié dans l'œuvre de Guy de Maupassant » consiste à découvrir, étudier et analyser les occurrences de cette thématique dans le corpus maupassantien afin d'autoriser une nouvelle lecture de cette œuvre parfois ancrée dans certaines visions restrictives et tranchées comme le pessimisme qui la caractérise trop souvent alors qu'elle offre de multiples visages et notamment de plus favorables et humains. À cette fin, il est important d'une part de mettre en avant le comportement dans l'amitié de l'écrivain ainsi que celui de son entourage à son égard et d'autre part d'aborder également cette notion relationnelle et émotionnelle dans les domaines philosophique et littéraire afin d'en déterminer efficacement les différents aspects, tout en observant les liens et les rapprochements avec ces conceptions et ces visions de l'amitié qui peuvent constamment apparaître dans les textes (romans, contes, nouvelles, chroniques, essais, poèmes, pièces dramatiques mais également la correspondance) de l'auteur. L'étude à proprement parler du corpus non seulement confirme la présence de ce thème inabordé jusque là, mais dévoile en outre un traitement singulier de l'amitié par Maupassant parmi les thématiques qui sont les siennes dans son œuvre. Ce traitement souligne une place exceptionnelle, rare et privilégiée accordée à l'amitié qui semble préservée et mise à part dans la conception maupassantienne des échanges humains. La présence de l'amitié et la manière de l'exploiter à travers les divers genres du corpus permet ainsi de porter un nouveau regard sur l'œuvre de l'homme de lettres, un regard nettement plus humain et sympathique. / The aim of « friendship in the work of Guy de Maupassant » consists in discovering, studying and analyzing the occurrences of this thematic in the writer's corpus in order to allow a renewed reading of this work which is sometimes too set in some restrictive and clear-cut visions such as the pessimism which characterizes it too often while it offers multiple faces, in particular more favorable and human ones. To that purpose, it is important on one hand to point up the behavior in friendship of the writer as well as that of its circle of acquaintances towards him and on the other hand to address also this relational and emotional notion on the philosophic and literary domains to determine effectively the various aspects, while observing the links and the connections with these concepts and visions of the friendship which can constantly appear in the different texts (novels, tales, short stories, chronicles, essays, poems, dramatic plays but also the correspondence) of the writer. The study strictly speaking of the corpus not only confirms the presence of this unapproached theme so far, but reveals furthermore a singular handling of friendship from Maupassant among the themes which are his ones in his work. This handling underlines an exceptional, rare and privileged place granted to friendship which seems protected and set apart in the Maupassant's idea of the human exchanges. The presence of friendship and the way of exploiting it through the various genres of the corpus allows then to take a new gaze at the work of Maupassant, a gaze clearly more human and filled of sympathies.

Cardiovascular disease (CVD) is a complex combination of multiple conditions. The majority of deaths within CVD include heart attacks and strokes caused by atherosclerotic disease. The pathophysiological process for atherosclerotic disease occurs within the endothelial lining of the vessels of the body. This prolonged process occurs when cholesterol deposits form irregularity in luminal flow resulting in decreased blood flow and ischaemia. This unstable cholesterol plaque can rupture resulting in clot formation and artery occlusion. Within this thesis I aim to show background to the relevant pathophysiology of ischaemic heart disease (IHD) with the main emphasis on acute myocardial infarction (AMI), the history of its therapy to current therapy. I will discuss the theorised role of stem cell therapy within animal models and previous clinical trials within regenerative medicine and AMI. I will describe and discuss the method and the results of the REGENERATE-AMI trial (Clintrial.gov: NCT00765453), which will include the safety and efficiency of the therapy, and the possible cytokine mechanism by which this therapy may exert it effect. Additionally I will describe the potential for assessing myocardial oedema using 3-slice T2-STIR short axis stack imaging post AMI compared to the conventional 10-slice T2-STIR technique to assess its feasibility and clinical similarity to assess its use as a tool in translational research.