The implementation of Electronic Health Records (EHR) has improved medical documentation in terms of accuracy, team communication, and ease of ordering tests and prescriptions; however, charting in an EHR strains the provider/patient relationship and contributes to physician burnout. Medical scribes are a promising potential solution to these problems. Our study aims to demonstrate that implementation of scribes into a medical residency program positively affects provider/patient satisfaction and improves quality and efficiency of EHR documentation. Our study evaluated the effectiveness and utility of scribes in a residency training program utilizing the established implementation framework “RE-AIM,” or Reach, Effectiveness, Adoption, Implementation (quality), and Maintenance. During the study’s initial “Training Phase,” 11 first and second-year Family Medicine residents conducted scribe-facilitated patient visits. Patient and provider satisfaction ratings were collected, note quality was evaluated, and time to note closure was measured. During the subsequent “Choice Phase,” residents were given the option of whether to utilize scribes, and the same data measures were collected. Resident satisfaction ratings during the Training Phase showed an average score of 6.03 (on a 1-7 scale where “7” = “strongly agree” with positive statements), and a pilot sample of 9 patients showed an average patient satisfaction rating of 4.77 (on a 1-5 scale where “5” = “strongly agree” with positive statements). Scribe-facilitated notes coded for quality had an average score of 3.375 (on a 1-5 scale where 5 is “extremely” high quality). Finally, residents’ average time to note closure was decreased by more than 8 hours in scribe-facilitated visits. During the Choice Phase, all 11 participating residents requested scribe-facilitated visits, again with very high patient satisfaction scores (4.67 on a 1-5 scale) as well as high clinician satisfaction scores (6.06 on a 1-7 scale). Choice Phase note quality and note-closure time are currently being assessed. These results demonstrate that scribes improve clinician and patient satisfaction, as well as quality and efficiency of EHR documentation. Limitations include a small sample size of clinicians and patients. Further research is needed with larger sample sizes to determine whether scribes in a medical residency program represent a sustainable and effective intervention.

Query containment under constraints is the problem of determining whether the result of one query is contained in the result of another query for every database satisfying a given set of constraints. This problem is of particular importance in information integration and warehousing where, in addition to the constraints derived from the source schemas and the global schema, inter-schema constraints can be used to specify relationships between objects in different schemas. A theoretical framework for tackling this problem using the DLR logic has been established, and in this paper we show how the framework can be extended to a practical decision procedure. The proposed technique is to extend DLR with an Abox (a set of assertions about named individuals and tuples), and to transform query subsumption problems into DLR Abox satisfiability problems. We then show how such problems can be decided, via a reification transformation, using a highly optimised reasoner for the SHIQ description logic.

To create more sustainable power systems, as well as achieve environmental goals, further integration of Renewable Energy Sources (RES) is essential. However, this may result in a power system more vulnerable to disturbances, since RES do not contribute to the system’s inertia. A power system’s ability to counteract disturbances is highly dependant on inertia. This is because the power system uses the kinetic energy of rotating machines, i.e. inertia, to restore the power balance after a disturbance. This causes a deviation of the system’s frequency, which must be contained within certain limits or, in the worst case scenario, a blackout could follow. Frequency Containment Reserves (FCR) stabilizes the frequency first dozens of seconds after a disturbance, therefore, it is the inertia that plays the major role in controlling the initial frequency deviation. One possibility to counter disturbances in a power system with less inertia is to use electrical batteries as fast power support, by injecting power into the system when needed. This project aims to investigate the dynamics of the FCR as well as the possibility to use batteries as fast power support. Different parameters of the batteries are also analyzed. The project is conducted through a case study of a power system model in Simulink and Matlab. Additional aspects, such as sustainability, cost-effectiveness, and future research, are discussed. / För att skapa mer hållbara kraftsystem, men även uppnå miljömål, är fortsatt integrering av förnyelsebara energikällor viktigt. Dock kan detta resultera i ett kraftsystem som är mer sårbart mot störningar, då förnyelsebara energikällor inte bidrar till systemets svängmassa. Ett kraftsystems förmåga att möta störningar är direkt relaterad till svängmassan i systemet. Detta är på grund av att systemet använder kinetisk energi från roterande maskiner, deras svängmassa, för att återställa balans mellan produktion och konsumtion efter en störning. Dock orsakar detta en avvikelse hos systemets frekvens, som måste hållas inom vissa gränser, annars kan det i värsta fall leda till strömavbrott. Primärreglering stabiliserar frekvensen först dussin sekunder efter en störning, därför är det svängmassan som spelar den avgörande rollen för att kontollera den initiella avvikelsen. En möjlig lösning för att möta störningar i ett kraftsystem med mindre svängmassa är att använda elektriska batterier som snabbt kraftstöd, genom att tillföra effekt till systemet vid behov. Detta projekt syftar till att undersöka dynamiken hos primärregleringen men även huruvida batterier kan användas som snabbt kraftstöd. Olika parametrar hos batterierna analyseras även. Projektet görs genom en fallstudie av en model av ett kraftsystem i Simulink och Matlab. Andra aspekter, så som hållbarhet, kostnadseffektivitet samt framtida forskning diskuteras.

Renewable energy resources are projected to claim a larger part of the Swedish power mix in coming years. This could potentially increase frequency fluctuations in the power grid due to the intermittency of renewable power generating resources. These fluctuations can in turn cause issues in the power grid if left unchecked. In order to resolve these issues, countermeasures are employed. One such countermeasure is for private actors to regulate power; in exchange they are financially compensated through reserve markets. The reserve market studied in this thesis is called Frequency Containment Reserve – Normal (FCR-N). Currently hydroelectric power provides almost all regulated power within this market. As the need for power regulation is expected to increase in the coming years, there exists a need to study other technologies capable of power regulation. This thesis focuses on one such technology called, virtual power plants. While virtual power plants are operating in other parts of the world, there were no virtual power plants operating in Sweden. As a result, the nature of an optimized virtual power plant and the economic benefits of optimization had not been previously investigated. To answer such questions, this thesis modelled and optimized the revenue of a virtual power plant. The examined virtual power plant consisted of cooling chillers, lighting, ventilation fans and a battery energy storage system. Where varying their total power demand allowed for them to provide power regulation. With the virtual power plant market in Sweden being in its infancy, this thesis serves as a first look into how an optimized virtual power plant using these components could function. To put the economic results of the optimization into context, a comparative model was constructed. The comparative model was based on a semi-static linear model. This is what the thesis’s industry partner Siemens currently uses. For the simulated scenarios, the optimized model generated at least 85% higher net revenues than the semi-static linear model. The increase in revenue holds potential to increase the uptake of virtual power plants on the Swedish market, thus increasing stability in the power grid and easing the transition to renewable energy. / Då förnyelsebara energiresurser antas omfatta en större roll av den svenska elproduktionen inom kommande år, så kan detta leda till att frekvensfluktueringar i elnätet ökar. Detta sker på grund av att den oregelbundna elproduktionen från förnyelsebara energiresurser inte matchas med konsumtion. Om dessa fluktueringar inte hanteras kan det i sin tur leda till skadliga störningar inom elnätet. För att motverka detta och således stabilisera elnätet används diverse lösningar. Ett sätt att åstadkomma ökad stabilisering i elnätet är att låta privata aktörer kraftreglera. De privata aktörerna som står för kraftregleringen gör detta i utbyte mot ekonomisk kompensation, genom att delta i reservmarknader. Den reservmarknad som studerades inom detta examensarbete kallas Frequency Containment Reserve – Normal (FCR-N). I nuläget står vattenkraft för nästan all reglerad kraft inom den här marknaden. Men då behovet av kraftreglering antas öka inom kommande år så behövs nya teknologier studeras som kan bistå med kraftregleringen. Den studerade teknologin inom detta examensarbete var ett virtuellt kraftverk. Då inga virtuella kraftverk var i bruk i Sverige då denna uppsats skrevs fanns det osäkerheter kring hur man optimalt styr ett virtuellt kraftverk och de ekonomiska fördelarna som detta skulle kunna leda till. Detta examensarbete modellerade och optimerade ett virtuellt kraftverk ur ett vinstperspektiv. Det virtuella kraftverket var uppbyggt utav kylmaskiner, ljus, ventilationsfläktar och ett batterisystem. Deras kraftkonsumtion styrdes på ett sådant sätt som lätt de bidra till kraftreglering på reservmarknaden. För att kunna analysera de ekonomiska resultaten från det optimerade virtuella kraftverket, så byggdes en jämförelsemodell. Denna jämförelsemodell är baserad på en semistatisk linjär modell, vilket är det som examensarbetets industripartner Siemens använder. Den ekonomiska jämförelsens resultat påvisade att inkomsten från den optimerade modellen var minst 85% högre än den semistatiskt linjära modellen, inom de studerade scenarierna. Denna inkomstökning skulle potentiellt kunna öka användningen av virtuella kraftverk på den svenska reservmarknaden vilket i sin tur skulle medföra högre stabilitet på elnätet. Genom att öka stabiliteten på elnätet kan således förnyelsebara energiresurser i sin tur lättare implementeras.

The depositional styles of sediment gravity currents depend, in part, on the relationship of flow magnitude to the scale of topographically controlled containment and range from unconfined lobes to fully contained deposits. Determining the degree of containment is important for understanding depositional processes, land to ocean sediment transfer and subsurface reservoir characterization/prediction. Depositional models of the fully contained (commonly referred to as 'ponded') end member have been developed (e.g. fill-and-spill model). However, fully contained deposits represent only a portion of deepwater deposits and little work has been done identifying and examining the degree of containment of the more complex, partially contained deposits in outcrop. Here, I document the sedimentological facies and stratigraphic architecture of the Zorrillo Unit, a partially contained system exposed at Cerro Solitario within the Upper Cretaceous Tres Pasos Formation of the Magallanes Basin. The evolution of partial containment at this outcrop is expressed as: 1) bypass in the proximal zone and flow stripping in the distal zone, 2) backstepping and blanketing of the outcrop, followed by 3) renewed bypass. The partially contained system at Cerro Solitario deviates from the widely used fill-and-spill model due to subtle relief. This record of infilling provides insight into the overall evolution of the depositional system. Within the Magallanes Basin, the partially contained and linked depocenters along the Chingue Clinoform represent the dying breaths of the Cerro Toro axial conglomerate channel system as the canyon-fed point source collapsed and choked off the sediment routing system out to the distal basin. / Master of Science

This study sought to hear the narratives of individuals that have recovered from self-harming, with the intention of bearing witness to both the narratives and remaining scars in order to better understand and inform clinical practice. A purposive sample of seven individuals was recruited. Participants were asked to photograph their scars and bring them to an interview. Narratives were generated and explored through a relatively unstructured individual interview. Both the images and narratives were analysed using a narrative approach exploring content, performance and structural aspects, emphasising researcher reflexivity throughout. Findings were understood through psychoanalytic theory and highlighted a theme of validation and ‘being seen’, evidenced in stories of past invalidation that had been internalised into the self-structure and defended against by presenting a ‘defended’ self. Self-harm enabled this ‘unseen self’ to be expressed, validated and contained. Recovery was storied in terms of internalising experiences of validation, which enabled integration of the invalidated parts of the self. Many of the participants highlighted how their scars told a story of discovery; of becoming, coping and surviving. In the healing of scars this recovery is evident, but they may also continue to convey the unseen and unspoken experiences of pain, incoherence and invalidation. Self-harm and remaining scars may be understood as connecting, containing and re-embodying the internalised invalidation and ‘unseen’ aspects of the self. These findings are discussed with reference to the clinical implications, strengths and limitations of the methodology and directions for future research.

Les travaux de thèse ont permis de quantifier l'efficacité de confinement de deux dispositifs distincts (un poste de sécurité microbiologique et une sorbonne classique) lors de la production simultanée de nanoaérosols et d'un gaz traceur (SF6). Deux techniques de mesure différentes ont été exploitées : la première basée sur la mesure de la distribution granulométrique de l'aérosol s'échappant (SMPS-C), l'autre reposant sur la détection de fluorescence d'échantillons prélevés (fluorescéine sodée utilisée comme marqueur des nanoparticules). Les résultats ont permis d'établir une forte corrélation entre le comportement d'un nanoaérosol et celui d'un gaz traceur lorsqu'ils sont émis simultanément dans une enceinte ventilée. Plus encore, on a observé une rétrodiffusion gazeuse quasiment deux fois plus importante pour le gaz traceur que pour les nanoparticules testées dans différentes configurations. Le dépôt ainsi que l'agglomération présents dans le cas du transport d'un nuage de nanoparticules peuvent expliquer ces écarts dans le niveau global de confinement obtenu. Cependant, ce constat n'est pas un gage de protection suffisante dans la mesure où il n'existe pas de valeur spécifique de référence lors de l'exposition à des nanoparticules. Il est alors utile de respecter les règles de bonne conduite qui ont été définies dans de nombreux guides INRS ou au travers de multiples études de l'IRSN. En plus de ces études expérimentales, le banc d'essai développé à l'INRS a fait l'objet d'une simulation numérique permettant de valider un modèle eulérien de transport et de dépôt implémenté dans un code de CFD destiné à modéliser le comportement d'un nanoaérosol. Les résultats numériques/expérimentaux sont concordants ; les ordres de grandeur des niveaux de confinement atteints sont comparables / The thesis works have enabled us to quantify the containment efficiency of two devices (a microbiological safety cabinet and classical fume hood) during the simultaneous production of nanoaerosols and a tracer gas (SF6). Two different measurement techniques were used: the first based on the measurement of particle size distribution of the escaping aerosol (SMPS-C), the other based on the detection of fluorescence of samples (sodium fluorescein used as marker of nanoparticles). The results have established a strong correlation between the behavior of a nanoaerosols and the tracer gas when they are emitted simultaneously in a ventilated enclosure. More, we observed that tracer gas back diffusion was almost twice greater than for nanoparticles back diffusion in all the tested configurations. The deposit and the agglomeration present in the case of transport of a cloud of nanoparticles can explain these differences in the overall level of containment. However, this observation does not guarantee sufficient protection since there is no specific reference value for nanoparticle exposure. It is useful to observe the guidelines that have been defined in many INRS publications or through IRSN studies. In addition to these experimental studies, the test-rig developed at INRS has been numerically simulated to validate an eulerian transport and deposition model implemented in a CFD code for modeling the behavior of a nanoaerosol. Numerical and experimental results are concordant; orders of magnitude for the achieved containment levels are comparable

Submitted by JOSIANE SANTOS DE OLIVEIRA (josianeso) on 2018-07-31T13:31:34Z No. of bitstreams: 1 Ricardo de Barros Falcão Ferraz_.pdf: 1768733 bytes, checksum: 0a86d258f17b689d6df79b3430459682 (MD5) / Made available in DSpace on 2018-07-31T13:31:34Z (GMT). No. of bitstreams: 1 Ricardo de Barros Falcão Ferraz_.pdf: 1768733 bytes, checksum: 0a86d258f17b689d6df79b3430459682 (MD5) Previous issue date: 2018-01-10 / Nenhuma / A presente tese tem por objetivo propor uma análise crítica em perspectiva fenomenológico-hermenêutica do potencial contributivo da Justiça Eleitoral ao desenvolvimento da democracia brasileira. Em questão se coloca o profundo vínculo dogmático do Direito Eleitoral aos contornos normativos conferidos ao sistema representativo. E, partindo da premissa de que os modelos democráticos historicamente experimentados encontram-se parcialmente superados, questiona-se o descompasso institucional diante do impacto transformador da cultura política desenvolvida por uma individualidade culturalmente em transformação. De um lado, lastreada na teoria funcionalista da cultura política, objetiva-se demonstrar a contribuição fenomênica do Direito Eleitoral no processo de formação da cultura; de outro, pela ótica da metodologia individualista, a contínua reconfiguração dos canais tradicionais de articulação e agregação deliberativa de interesses promovidos no âmbito da comunicação política. Como resultado dialógico, conforma-se a autodeterminação política, que é operacionalizada por meio dos princípios da liberdade plena e da autocontenção, características deliberativas individualistas destacadas na atual fase da democracia brasileira, principais estruturas informadoras de ressignificação cultural das funções e atribuições exercidas pelas instituições do Direito Eleitoral, dentre as quais eleva-se sobre as demais a Justiça Eleitoral. / The present thesis aims to propose a critical analysis in phenomenological-hermeneutic perspective of the potential contribution of the Electoral Justice to the development of Brazilian democracy. In question, the dogmatic deep link of the Electoral Law is placed to the normative contours conferred to the representative system. And, based on the premise that the historically experienced democratic models are partially overcome, we question the institutional mismatch with the transformative impact of the political culture developed by a culturally changing individuality. On the one hand, backed by the functionalist theory of political culture, it aims to demonstrate the phenomenal contribution of Electoral law in the process of culture formation; on the other, from the perspective of the individualist methodology, the continuous reconfiguration of the traditional channels of articulation and deliberative aggregation of interests promoted in the scope of political communication. As a dialogical result, political self-determination is experienced, operationalized through the principles of full freedom and self-restraint, individualist deliberative characteristics highlighted in the current phase of Brazilian democracy, as the main structures that inform the cultural re-signification of the functions and attributions exercised by the institutions of the Electoral Law, among which the Electoral Court rises above the others.

La dimension intersubjective familiale du devenir mère lors de la période sensible du post­ partum a été peu abordée en psychanalyse ou dans les autres courants en psychologie. Hypothèses : le défaut d'étayage de la famille dans l'immédiat post-partum impacte les processus de la maternalité chez la mère : son état psychique (dépression et anxiété), sa préoccupation primaire et sa rêverie, ainsi que le destin de ses motions hostiles dans ses relations. Approches épistémologiques : la psychologie clinique et la psychopathologie avec d'autres apports. Méthode mixte (clinique et quantitative) longitudinale et comparative sur une population de 35 familles. Outils : des entretiens, des temps d'observations et des auto-questionnaires évaluant l'état psychique de la mère (EPDS et STA I), ses relations conjugales (EAD), parentales (IAP) et ses ressources internes (RSQ et PBI). Résultats : les mères qui ont peu bénéficié de soutien familial sont plus nombreuses à présenter des signes de détresse psychique et ces signes perdurent dans le temps, 6 mois après la naissance de leur enfant. L'analyse de trois cas cliniques permet de suivre dans le temps la complexité des processus de la maternalité, leurs liens avec l'étayage familial et les facteurs intra-psychiques , intersubjectifs et sociétaux qui les soutiennent ou au contraire les fragilisent. Les motions hostiles de la mère, non contenues par la famille élargie, alimentent sa détresse et l'ensemble de ses relations, avec le conjoint, le père et/ou l'enfant. Conclusion : le travail psychique nécessaire dans le post-partum immédiat du devenir mère ne peut être envisagé sans son réseau d'étayage familial. Celui-ci est en interaction avec ses appuis internes et dépend des relations avec le père. Le contexte social l'influence. Conséquences : cette recherche montre l'importance de prendre en compte,chez la mère, le besoin dans la réalité du soutien de sa famille juste après la naissance et la mise en place d'étayage professionnel adapté. / The intersubjective family dimension of becoming a mother during the sensitive postpartum period has been little discussed in psychoanalysis or in other currents in psychology. Hypotheses: the lack of family's shoring in the immediate post-partum impact the motherhood processes: her psychic state (depression and anxiety). the establishment of maternai processes (primary maternai concern and maternai reverie), as well as the fate of her hostile motions in her relations. Epistemological approaches: clinical psychology and psychopathology with other contributions. Longitudinal and comparative mixed (clinical and quantitative) method in a sample of 35 families. Tools : interviews. observations and self-questionnaires assessing the psychic state of the mother (EPDS and STAI). her conjugal relationship (DAS), parental relationship (PAi) and her internai resources (RSQ and PBI). Results: Mothers with little family support are more likely to show signs of psychic distress and these signs persist over time, 6 months after the child birth. The analysis of three clinical cases makes it possible to follow over time the complexity of maternai processes, their links with family's shoring and the intra-psychic, intersubjective and societal factors that support or weaken them. The mother's hostile motions. not contained in the extended family, fuel her distress and her whole relationship with the spouse. father, and / or child. Conclusion: the necessary psychic work of becoming a mother in the immediate postpartum can not be considered without her family support network. This one is in interaction with her internai supports and depends on the relations with the father. The social context influences it. Consequences: this research shows the importance of taking into account, for the mother, the need in reality of the family support just after the birth and the setting up of adapted professional support.

L’objectif de cette recherche est d’analyser les caractéristiques de la relation entre les villes et leurs fleuves, ainsi que les transformations des zones riveraines sous l’effet de l’urbanisation, avec le cas d’études de Hanoï et le fleuve Rouge, qui est représentatif de cette relation des pays du sud-est asiatique. Ce fleuve est la base importante de l’installation des Vietnamiens, de l’évolution des zones riveraines et de la forme urbaine de Hanoï. Sa relation avec cette ville est structurée par des caractères contradictories. Le fleuve offre la ville des opportunités, mais la menace par un risque d’inondations : tout d’abord, il contribue à développer l’agriculture en alimentant la ville en eau et alluvions, effectue un axe de transport fluvial important et constitue la forme d’une ville au milieu des eaux. Mais ses crues sont toujours un péril persistant de la ville. Au long de l’histoire, les habitants ont cherché à s’adapter au courant du fleuve. La construction et l’évolution de la digue est l’exemple de cette adaptation. La digue protège la ville contre les inondations, mais la sépare en deux parties. Cette séparation entraîne beaucoup de problèmes. Sous l’urbanisation et en raison du manque d’un cadastre d’autorités, les zones densément peuplées hors digue au centre ville et les nouveaux quartiers riverains du sud se transforment rapidement. Donc, une recherche pluridisciplinaire a été effectuée pour analyser le processus et les conséquences de ces transformations. Dans le contexte de la « nouvelle capitale » depuis 2008 et de son schéma directeur pour le développement de 2030, avec plusieurs stratégies du développement, l’étalement urbain et la migration vers le centre ville, cette recherche s’appuie particulièrement sur l’évolution économique suite aux changements administratifs, les questions foncières, les transformations des infrastructures et leurs conséquences environnementales des nouveaux quartiers ; les problèmes sociaux et démographiques des zones centrales où concentrent un grand nombre de migrants ; l’hésitation entre la préservation des valeurs architecturales et la modernité des villages de métiers. Enfin, la thèse cherche à analyser aussi les impacts de ces transformations sur le développement urbain de Hanoï, surtout au niveau du paysage et de la technique urbaine. / This thesis is aimed to analyze the characteristics of the relation between cities and rivers, and also the transformations of riverine zones under urbanization, with the case study of Hanoi and Red river, which is typical of this relation in Southeast Asia. Red river is an important base of Vietnamese’s settlement, the evolution of the riverine zones and urban water form of Hanoi. Its relation with the city is built by some contrary characteristics. The river brings the city opportunities, but also threatens it with a risk of inundation: firstly, the river contributes to the development of agriculture by bringing water and depositing alluvium on the riverbank; it also creates an important fluvial traffic and make up the city’s form. However, flood from the river is always a persistent peril. Throughout the history, the inhabitants have been seeking to cohabit with the river. The construction and the evolution of the dyke is a typical example of this process. The dyke prevents the river from flooding the city, but it also divides the city into 2 parts. This separation brings on many problems. Under pressure of urbanization and lack of land register, the densely populated outside-dyke zones in city center and the new urban quarters in the South are transforming rapidly. Accordingly, an interdisciplinary research was carried out in order to analyze the process and the consequences of these transformations. In the context of a « new capital » from 2008 and its master plan for 2030 with many development strategies concerning urban expansion and the migration towards the city center, this research focus on economic evolution, land dispute, transformations of the system of urban infrastructure and their environmental consequences in the new riverine urban quarters, social problems in the central zones where concentrated by a lot of immigrants, the hesitation between modernity and tradition in the handicraft villages. Finally, this thesis is aimed to analyze the contrary impacts of these transformations to urban development of Hanoi, especially in landscape and in urban infrastructure.