Resource management is at the heart of many diverse science and engineering research areas. Although the general notion of what constitutes a resource entity seems similar in different research areas, their types, characteristics, and constraints governing their behavior are vastly different depending on the particular domain of research and the nature of the research itself. Often research related to resource modeling and management focus on largely homogeneous resources in a relatively simplified model of the real world. The problem becomes much more challenging to deal with when working with a complex real life domain with many heterogeneous resource types and intricate constraints. In this dissertation, we have looked at the modeling and management of resource instances and tried to develop a better sense of what makes them different from other objects in a system. As part of this work, We formally define the general resource management problem, identify its major sub problem areas and their associated complexities, and look at the problem in the context of a particularly complex and dynamic environment, namely the emergency department (ED) of a hospital. We propose an approach to the problem and some of its complexities by presenting an overall unifying view, as well as tools and methods for dealing with, this pervasive, yet surprisingly under examined, type of entity, i.e. resources. We have discovered that one of the discerning characteristics of resource instances in complex and dynamic environments seem to be their dynamic capability profile that may changes depending on system context. This, in turn, often results in complex substitutability relationship amongst resource instances. We have identified four major sub-problem areas that can provide a holistic view of any resource management service. These separate, yet interconnected, areas of con- cerns include resource modeling, resource request specification, resource constraint management, and resource allocation. Resource modeling involves capturing of re- source characteristics and their potentially dynamic behavior. Request definitions describe how resource users specify requirements for resources in a particular do- main. In most domains, there are constraints that need to be satisfied while serving resources to fulfill specific requests. The fourth area of concerns, the allocation of resources, is a complex component with multiple subcomponents that closely inter- act with each other. In this thesis, we have described an architecture for a exible resource management service based on the above described separation of concerns. We have proposed some simple, yet effective, techniques for modeling resource in- stances, specifying resource requests, specifying and managing resource constraints, and allocating resource instances to meet a resource demand characterized by a con- tinuous stream of requests. Using our proposed design, we have developed ROMEO, a resource management service and customized it to serve a task coordination frame- work based on Litlle-JIL process definition language. Our work then concentrated on evaluating the effectiveness of ROMEO in supporting simulations and executions of complex processes. For this evaluation purpose, we developed a simulation infras- tructure named JSim on top of Juliette, Little-JIL's execution environment. We ran a variety of simulations of patient care processes in EDs using our ROMEO-JSim infrastructure. We also used ROMEO to support the actual execution (rather than just the simulation) of a large mediation process. A central premise, hypothesized and explored in this thesis, is a novel way of thinking about resource instances in dynamic domains, namely defining them with a set of guarded capabilities, some of which may be dependent on the execution state of the system. This has led us to think about how to represent execution states of a running system and what types of system state information might be important for representing the guard functions on the capabilities of a resource instance that define the resource instance's ability to satisfy a request at a given execution state of the system. We have also identified a small set of common types of attributes of resource instances that seem able to support specification of a large variety of resource instances in complex domains. We believe that our research supports our hypothesis that specifying resource instances as having sets of guarded capabilities provides a useful abstraction for modeling many of the complex dynamic behaviors of resource instances in such domains as hospital EDs.

Tyrimo tikslas – Ištirti skubios pagalbos skyriaus slaugytojų patiriamo smurto paplitimą ir valdymą. Tyrimo uždaviniai: 1) nustatyti skubios pagalbos skyriaus slaugytojų darbe patiriamo smurto rūšis ir dažnį, jo pasiskirstymą pagal darbą pamainomis; 2) ištirti, pagrindinius smurto šaltinius su kuriais susiduria slaugytojai dirbantys skubios pagalbos skyriuose; 3) įvertinti smurto poveikį skubios pagalbos skyrių slaugytojų emocinei sveikatai; 4) nustatyti smurto valdymo būdus skubios pagalbos skyriuose slaugytojų požiūriu. Tyrimo metodas – 2013 metų sausio 14 – vasario 28 dienomis buvo vykdoma anoniminė anketinė apklausa. Apklausoje dalyvavo Vilniaus, Kauno, Panevėžio bei Šiaulių miestų didžiūjų ligoninių, skubios pagalbos skyriuose dirbantys slaugytojai ( n=213, atsako dažnis – 88 proc.). Respondentų tarpe buvo trys vyrai, likusios moterys. Tyrimui buvo naudojamas klausimynas smurto darbo vietoje tyrimams, įvairių šalių sveikatos priežiūros sektoriuje, atlikti. Gautas sutikimas atlikti tyrimą iš Bioetikos komiteto ( 2013-01-09 Nr. BEC-KS(M)-181 ). Tyrimo rezultatai. Tyrimo rezultatai parodė, jog 20,2 proc. visų apklaustų respondentų, teigė patyrę fizinį smurtą. Apklaustieji slaugytojai (46,5 proc.) teigė, buvę fizinio smurto SPS liudininkais. Respondentai patyrė ir psichologinio smurto apraiškas, tokias kaip užgauliojimus (81,2 proc.), grasinimus (67,1 proc.), patyčias (45,1 proc.), seksualinį priekabiavimą (6,6 proc.), rasinį priekabiavimą (1,4 proc.). Tyrimo išvados... [toliau žr. visą tekstą] / Aim: to investigate prevalence and management of violence experienced by nurses in emergency department. Tasks: 1) to identify types and frequency of violence experienced by nurses in emergency department, and categorize it according to work shifts; 2) to define main sources of violence experienced by nurses in emergency department; 3) to evaluate impact of violence to emotional health emergency department nurses; 4) to identify methods management of violence according to emergency department nurses. Methods. Anonymous questionnairing was performed during Jan 14 – Feb 28, 2013. Nurses of emergency department from eight biggest hospitals of Vilnius, Kaunas, Panevėžys and Šiauliai, participated the survey (n=213, response rate was 88 %). Answers of three male and rest female respondents were included into study. The questionnaire “Workplace violence in the health sector. Country case studies research instruments” was used. The Committee on Bioethics at Lithuanian University of Health Sciences approved the study. Results: Results of the study indicate that 20.2 percent of respondents affirmed their experience of physical violence. 46.5 percent of nurses questioned witnessed physical violence in ED. Respondents experienced appearances of psychological violence like abuse (81.2 percent), threats (67.1 percent), bullying (45.1 percent), sexual harassment (6.6 percent) and racial harassment (1.4 percent). Conclusions: Nurses of ED do experience physical and psychological... [to full text]

Le décès d’une personne sur cinq à travers le monde est associé à l’hypertension artérielle (HTA). Or, près de la moitié des individus avec HTA ignorent leur condition : ils n’ont pas été dépistés. Cette thèse a pour objectif, principalement à travers la présentation de deux articles originaux, de contribuer à l’amélioration du dépistage de l’HTA. Avant la présentation des deux articles de cette thèse, les résultats d’un examen de la littérature sur les effets des démarches de dépistage de l’HTA en milieux hors hospitaliers sont exposés. On y constate notamment qu’une telle démarche permet d’identifier près d’un adulte sur trois comme ayant une pression artérielle (PA) élevée. La pratique infirmière dans la prise en charge de l’HTA est également explorée. Il en ressort que leurs interventions non pharmacologiques et leurs interventions directes sur le traitement pharmacologique permettent à la fois une amélioration des habitudes de vie ainsi qu’un abaissement de la PA au moins équivalente aux soins médicaux usuels. Le premier article de cette thèse consiste en une revue systématique effectuée en utilisant le protocole Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Diagnostic Test Accuracy (PRISMA-DTA). Les objectifs de cette revue systématique étaient de décrire la performance (valeur prédictive positive, taux de suivi) de la stratégie de dépistage de l’HTA qui consiste à tirer profit de la mesure de la PA effectuée d’emblée auprès des millions de personnes qui se présentent annuellement dans les départements d’urgence. Les méthodes de mesure de la PA utilisées lors de la consultation initiale à l'urgence, les moyens utilisés pour assurer un suivi, ainsi que les méthodes utilisées pour confirmer un diagnostic de l’HTA sont également décrits. À la suite d’une recension initiale de 1030 articles, 10 de ceux-ci répondaient aux critères d’inclusion. L’outil Quality Assessment of Diagnostic Accuracy Studies-2 (Quadas-2) a été utilisé pour l’évaluation de la qualité des études. L’âge moyen des participants est de 51,6 ± 6,4 ans. Pour effectuer la mesure de la PA au département d’urgence, un appareil au mercure a été utilisé dans la moitié des études, quatre ont utilisé un appareil électronique et pour deux études, cette information n’était pas disponible. Parmi ceux ayant eu un dépistage positif, le taux de suivi moyen est de 61,9 %. Parmi eux, 50,2 % ont reçu la confirmation d’un diagnostic d’HTA à la suite d’une démarche de suivi. L’on retrouve dans seulement deux études une méthode de confirmation diagnostique correspondant aux standards des sociétés savantes en HTA. Une autre solution pour l’amélioration du dépistage de l’HTA est d’augmenter la validité de la méthode de mesure de la PA. Le second article de cette thèse avait pour objectif d’évaluer la performance (valeurs prédictives, sensibilité, spécificité, coefficient de kappa et taux de suivi) d’une nouvelle stratégie de dépistage de l’HTA au moment d’une consultation pour urgence mineure. La stratégie consiste, à la suite d’une mesure initiale de la PA dont le résultat est élevé, en l’ajout d’une seconde méthode de mesure de la PA : la mesure oscillométrique en série. Un monitorage ambulatoire de la pression artérielle (MAPA) d’une durée de 24 heures a été fait pour chaque participant afin d’évaluer la performance de la combinaison des deux méthodes de mesures cliniques. Le MAPA constitue la mesure étalon en HTA. Effectuée dans une clinique GMF de Laval, 50 des 80 participants (62,5 %) inclus ont complété l’étude en se présentant au rendez-vous de suivi pour un MAPA. L’âge moyen des participants est de 51,9 ans. À la suite d’une mesure initiale de la PA dont le résultat est élevé, l’ajout de la mesure oscillométrique en série a été associé à une valeur prédictive positive de 62,5 % et une valeur prédictive négative de 83,3 % (sensibilité, 87 %; spécificité 56 %; coefficient de kappa 0,41). Cette thèse permet d’offrir des pistes de réponses qui pourront contribuer à l’amélioration du dépistage de l’HTA. Tout d’abord, le premier article met en lumière le fait que les consultations au département d’urgence représentent une excellente opportunité pour le dépistage de l’HTA. En effet, cela permet de rejoindre un nombre très important d’individus. Une mesure de la PA est effectuée à chacun d’eux, ils sont plutôt jeunes et lorsque le résultat de la mesure est élevé, cela correspond réellement à une HTA pour la moitié des cas. Le taux de suivi se situe à environ 60 %. La démarche de dépistage à l’urgence consiste essentiellement à reconnaitre une PA élevée, puis d’effectuer une référence afin d’obtenir une prise en charge. Cela implique qu’à chaque 100 adultes avec une PA élevée à l’urgence et pour qui une démarche de dépistage serait effectuée, 30 individus pourraient avoir un diagnostic d’HTA confirmé ainsi qu’une prise en charge subséquente. Malgré cela, le défi de la validité de la mesure et du suivi demeure. La contribution originale du deuxième article s’attarde à cette question. À la suite d’une mesure initiale de la PA dont le résultat est élevé, l’ajout de la mesure oscillométrique en série permet d’augmenter la validité de la démarche de dépistage. En effet, ceux pour qui le résultat de cette mesure est normal peuvent être considérés, d’une façon sécuritaire, comme étant non hypertendus. Ainsi, les individus dirigés afin d’effectuer un examen de confirmation diagnostique seront mieux ciblés, les ressources existantes mieux utilisées. Enfin, des recommandations sont présentées relativement au dépistage de l’HTA, à sa prise en charge, mais également sur la pratique infirmière. / One out of five people worldwide dies from causes linked to hypertension (HTN). Yet, nearly half of individuals with HTN are unaware of their condition as they have not been screened. The goal of this thesis, mainly through the presentation of two original articles, is to help improve HTN screening. Before presenting the two articles, the results of a literature review on the effects of the HTN screening process in an out-of-hospital setting are outlined. In particular, it is noted that such a process helps to identify nearly one out of three adults as having elevated blood pressure (BP). The nursing practice in HTN management is also explored. It is concluded that their non-pharmacological interventions and direct interventions on the pharmacological treatment help to improve lifestyles and lower BP by at least the same amount as customary medical care. The first article of this thesis consists in a systematic review conducted with the use of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - Diagnostic Test Accuracy (PRISMA-DTA) protocol. The purposes of this systematic review are to describe the performance (positive predictive value, follow-up rate) of the HTN screening strategy, which consists in drawing on the BP measurement taken on millions of people who show up in the emergency department (ED) annually. The BP measurement methods used during the initial ED consultation, the methods used to ensure follow-up, and the methods used to confirm an HTN diagnosis are also described. Following an initial review of 1030 articles, 10 of these met the inclusion criteria. The Quality Assessment of Diagnostic Accuracy Studies-2 (Quadas-2) tool was used to evaluate the quality of the studies. The average age of participants is 51.6 ± 6.4 years. To take a BP measurement in the ED, a mercury device was used in half of the studies, four used an electronic device and for two studies, this information was unavailable. Among those with a positive screen, the average monitoring rate is 61.9%. Among them, 50.2% received confirmation of an HTN diagnosis following the follow-up process. Only two studies mention a diagnosis confirmation method that meets the standards of learned HTN societies. Another solution to improve HTN screening is to increase the validity of the BP measurement method. The goal of the second article of this thesis was to evaluate the performance (predictive values, sensitivity, specificity, kappa coefficient and monitoring rate) of a new HTN screening strategy when consulting for a minor emergency. Following the initial high BP measurement, the strategy consists in adding a second BP measurement method: the automated office blood pressure measurement (AOBP). Each participant underwent 24-hour ambulatory blood pressure monitoring (ABPM) to evaluate the performance of the combination of both clinical measurement methods. ABPM is the gold standard for BP measurement. Conducted in a GMF clinic in Laval, Quebec, 50 of the 80 participants (62.5%) included completed the study by showing up to the follow-up ABPM appointment. The average age of participants is 51.9 years old. Following an initial high BP measurement, adding the AOBP is linked to a positive predictive value of 62.5% and a negative predictive value of 83.3% (sensitivity 87%, specificity 56%, kappa coefficient 0.41). This thesis offers possibilities that can help improve HTN screening. The first article highlights the fact that ED consultations are an excellent opportunity to screen for HTN. Indeed, this helps to reach many individuals: BP measurement is taken on each one, they are rather young, and when the measurement is high, this actually corresponds to an HTN for half of the cases. The follow-up rate is about 60%. The ED screening process mainly consists in recognizing high BP, and then making a referral to obtain treatment. This implies that for every 100 adults with high BP in the ED and on whom a screening process would be conducted, 30 people could have a confirmed HTN diagnosis and subsequent treatment. And yet, the validity of the measurement and follow-up remains a challenge. The original contribution of the second article examines this question. Following an initial high BP measurement, adding the AOBP helps to increase the validity of the screening process. Indeed, those for whom the result of this measurement is normal can safely be considered as non-hypertensive. As such, those referred to complete a diagnosis confirmation exam will be better targeted and the existing resources better used. Lastly, recommendations are made regarding HTN screening, its management, and the related nursing practice.