Les troubles respiratoires du sommeil ont une prévalence élevée dans la population générale, l’apnée obstructive du sommeil étant le plus important de ces troubles. Malgré tout, une grande proportion des patients avec apnée ne sont pas diagnostiqués. La méthode la plus complète pour diagnostiquer l’apnée est l’enregistrement d’une nuit de sommeil par polysomnographie, aussi appelée enregistrement de type 1, qui est un processus long et coûteux. Pour surmonter ces difficultés, des appareils d’enregistrements portables (ou de type 3) ont été développés. Toutefois, ces enregistrements de type 3 ne capturent pas l’activité cérébrale, mesurée avec l’électroencéphalographie (EEG). Le présent mémoire décrit une étude comparative entre les enregistrements de type 1 et de type 3. Tous les événements respiratoires d’apnée, d’hypopnée et d’éveils liés à un effort respiratoire (RERA, en anglais) seront analysés ainsi que les éveils cérébraux (ou éveils EEG) et les éveils autonomiques. Ces éveils autonomiques se définissent par une hausse de la fréquence cardiaque suite à un événement respiratoire. Pour enrichir les analyses, les variables respiratoires suivantes ont été étudiées : une chute de la saturation en oxygène de 4 % (ODI), l’index d’apnée-hypopnée (IAH), l’indice de perturbations respiratoires avec apnées + hypopnées + RERAs et les éveils EEG (RDIe, en anglais) et le RDI incluant les éveils autonomiques définis par une augmentation de la fréquence cardiaque de 5 bpm (RDIa5). L’objectif de la présente étude est d’évaluer la proportion d’événements respiratoires avec éveils autonomiques ainsi que leur impact sur le RDI des enregistrements de type 1 et 3. L’hypothèse suggère que les événements avec éveils autonomiques auraient un plus grand impact sur le RDI des enregistrements de type 3 contrairement au type 1. Cette étude inclut 72 sujets ayant suivi un enregistrement de polysomnographie complète de type 1 ainsi que 79 sujets différents ayant suivi un enregistrement ambulatoire de type 3. Les analyses suivantes ont été effectuées : 1) les pourcentages d’événements associés avec seulement des éveils autonomiques dans les enregistrements de type 1 et de type 3 ; 2) les fréquences de migration entre les catégories basses et élevées de sévérité de l’AHI en prenant en compte les événements associés avec seulement des éveils autonomiques ; 3) les Bland-Altman (B-A) pour mesurer l’accord entre l’AHI, le RDIe et le RDIa5 (type 1), et entre l’AHI et le RDIa5 (type 3) et ; 4) les corrélations de Pearson et les coefficients de corrélation intraclasse (ICC) pour mesurer l’accord entre l’AHI, le RDIe et le RDIa5 (type 1), et entre l’AHI et le RDIa5 (type 3). L’utilisation du critère de RDIa5 permet d’ajouter 49 % d’événements comptés avec l’AHI pour les enregistrements de type 1, et 51 % d’événements pour ceux de type 3. La présente étude montre que les éveils autonomiques ont un impact similaire autant pour le RDI des enregistrements de type 3 que de type 1. En conclusion, on peut affirmer que le RDIa5 est acceptable et fiable pour les enregistrements de type 3. / The general adult population has a high prevalence of sleep breathing disorders, of which obstructive sleep apnea is the most common, yet many cases remain undiagnosed. Although overnight laboratory polysomnography, called type 1 recording, is the most effective diagnostic tool, it is expensive and time-consuming. To overcome these disadvantages, several portable home (type 3) recording devices have been developed. However, they do not measure brain activity (with EEG). This study presents a comparison between type 1 and type 3 recordings. All apnea, hypopnea, and RERA respiratory events were analyzed, as well as cerebral arousals (EEG arousals) and autonomic arousals. Autonomic arousals are defined by increased heart rate following a respiratory event. To enrich the analysis, the following respiratory outcome measures were included: 4% oxygen saturation index (ODI), apnea-hypopnea index (AHI), respiratory disturbance index with apneas + hypopneas + RERAs including EEG arousals (RDIe), and RDI including autonomic arousals scored as an increase of 5 bpm (RDIa5). The objective of this study was to determine the proportion of respiratory events associated with autonomic arousals and the impact on RDI detected with type 1 compared to type 3 recordings. The hypothesis is that respiratory events with autonomic arousals will have a greater impact on RDI using type 3 compared to type 1 recordings. This study included 72 subjects who underwent type 1 full polysomnography recording and 79 different subjects underwent type 3 ambulatory recording. The following analyses were performed: 1) percentage of events associated with only autonomic arousals in type 1 and type 3 studies; 2) frequency of migration from lower to higher AHI severity category when accounting events associated with only autonomic arousals; 3) Bland-Altman (B-A) for agreement between AHI, RDIe, and RDIa5 (type 1) and AHI and RDIa5 (type 3) and; 4) Pearson correlations and intraclass coefficient correlation (ICC) for agreement between AHI, RDIe and RDIa5 (type 1) and between AHI and RDIa5 (type 3). The use of the RDIa5 criterion increased the number of AHI scoring events by 49% for type 1 recordings and by 51% for type 3 recordings. These results show that autonomic arousals have a similar impact on RDI data using both type 3 and type 1 recordings. We conclude that RDIa5 is a suitable and reliable criterion for type 3 recordings.

Master of Landscape Architecture / Department of Landscape Architecture/Regional and Community Planning / Timothy D. Keane / This thesis documents an exploratory design process that examines the efficacy of a framework for designing dementia gardens based on: theory, Stephen and Rachel Kaplan’s Attention Restoration Theory (A.R.T.), (Kaplan and Kaplan, 1989) and Roger Ulrich’s Theory of Supportive Gardens (Ulrich, 1999); John Zeisel’s (2007) process for designing dementia gardens; and design details, Claire Cooper Marcus’ Garden Audit Tool (2007) and Moore’s analysis of exemplary dementia gardens (2007). It documents the integration of theory that is not specific to dementia gardens (Kaplans’ A.R.T. and Ulrich’s Theory of Supportive Gardens) with process (Zeisel) and programming elements that are specific to dementia gardens (Cooper Marcus’ Garden Audit Tool Kit and Moore’s exemplary dementia gardens). The framework was developed during an illustrative courtyard design project for a retirement center whose clientele included patients with varying need levels. Throughout the illustrative design project, knowledge of the four A.R.T. characteristics (Being Away, Fascination; Compatibility and Extent) guided design decision-making in an effort to create an engaging environment, where improved health outcomes and restorative person-environment interactions could occur.

Master of Science / Department of Hospitality Management and Dietetics / Kevin R. Roberts / The Centers for Disease Control and Prevention estimated that one in six Americans become ill,128,000 are hospitalized, and 3,000 die each year due to foodborne illness. Children are at a higher risk of acquiring foodborne illness than adults for several reasons, including: an immune system that has yet to fully develop, limiting their ability to fight infections; a lack of control over the food they consume because their meals are usually provided by others; and the lack of awareness of food safety risks. Thus, it is critical to ensure that childcare center employees practice safe food handling. The purpose of this study was to explore the food safety knowledge, practices, and barriers to safe food handling practices of childcare center employees. Observations were conducted in 10 childcare centers in Manhattan, Kansas. Each childcare center was observed for two days during lunch preparation and service. Observations of foodservice employees were conducted in the kitchen using a structured observation form. Teacher observations were conducted in the classroom using detailed notes. A questionnaire was used to collect demographic, food safety training, and food safety knowledge information. SPSS (v. 20.0) was used to analyze data. Childcare center employees had high average scores on the safety knowledge assessment. The majority of employees received some type of food safety training. Time pressures, availability of equipment, and small food preparation space were found as the main barriers to implementing safe food handling. Childcare center foodservice workers and teachers were knowledgeable about handwashing and time/temperature control, but failed to utilize on the job. Results of this study will help childcare educators to develop materials to improve food safety practices and encourage owners/managers of childcare centers to enhance their food safety behaviors.

Master of Science / Department of Grain Science and Industry / Sajid Alavi / The objective of the study was to investigate extrusion as an alternative processing method and grain sorghum as a viable substitute for corn in fortified blended foods (FBFs) used in nutrition and food assistance programs around the world. In the first part of this study, sorghum-soy blend (SSB), corn-soy blend (CSB) and whole corn-soy blend (WCSB) were developed using extrusion and compared with traditional CSB13 for physico-chemical and sensory properties. After milling of extrudates, average particle size (PS) ranged between 341-447 microns, with 78-85% below 600 microns. In general, Bostwick flow rates (VB=12-23 cm/min) of rehydrated blends (11.75% solids) were within standard specifications but higher than CSB13. Descriptive sensory analysis indicated that the sorghum-based rehydrated blends were significantly less lumpy and had a more uniform texture as compared to corn-based blends and CSB13. In the second part, the impact of decortication level and process conditions was investigated with respect to sorghum-based extruded blends. Degree of gelatinization of the whole sorghum-soy blend (WSSB) and decorticated sorghum-soy blend (DSSB) extrudates ranged from 93-97%. Expansion ratio (ER=3.6-6.1) was correlated with specific mechanical energy input (SME=145-415 kJ/kg; r=0.99) and average particle size after milling (PS=336-474 microns; r= -0.75). Rehydrated blends at 20% solids concentration provided recommended energy density (0.8 kcal/g) for FBFs. Bostwick flow rates had high correlation (r = -0.91) with pasting data (final viscosity) obtained using rapid visco analyzer (RVA). Addition of oil (5.5%) prior to extrusion was also studied, and resulted in process instabilities and also lower shelf-life as determined via descriptive sensory analysis (rancid and painty attributes) and gas chromatography-mass spectroscopy (hexanal, heptenal and octanal concentrations). In conclusion, extruded sorghum-soy blends met standard specifications for energy density and consistency (Bostwick flow rate), and were superior in some aspects as compared to extruded corn-soy blends and traditional corn-soy blends (CSB13). Relationships between extrusion mechanical energy input, expansion, particle size after milling and consistency of rehydrated blends were established. Consistency of the rehydrated blends is an extremely important criterion as it affects the ease of ingestion by target consumers (children below 5 years, in this case).

Master of Science / Department of Industrial and Manufacturing Systems Engineering / Chih-Hang John Wu / The University of Kansas Medical Center’s Emergency Department is adopting a new residency program. In the past, generalized Residents have supported attending physicians during a required three month rotation in the Emergency Department. As of July 2010, the University of Kansas Medical Center’s Emergency Department has switched to a dedicated Emergency Medicine Residency program that allows recently graduated physicians the opportunity enter the field of Emergency Medicine. This thesis shows that although not initially a dedicated residency program provides an advantage to the Emergency Department. Discrete Event Simulations have been used to predict changes in processes, policies, and practices in many different fields. The models run quickly, and can provide a basis for future actions without the cost of actually implementing changes in policies or procedures. This thesis applies a learning curve in a Simulation Model in order to provide data that the University of Kansas Medical Center’s Emergency Department can utilize to make decisions about their new Residency Program. A generalized learning curve was used for the base model and compared to all alternatives. When it was compared with an alternative curve following a Sigmoid Function (Logistic Function), there were no significant differences. Ultimately, a Gompertz Curve is suggested for hospitals attempting to develop or improve their residency programs using learning curves because it is easily fitted to their desired shape. This thesis shows the effect that Residents have on the performance of the Emergency Department as a whole. The two major components examined for the generalized learning curve were the initial position for first year residents determined by the variable [alpha], and the shape of the curve determined by the variable [beta]. Individual changes the value of [alpha] had little effect. Varying values of [beta] have shown that smaller values elongate the shape of the curve, prolonging the amount of time it takes for a resident to perform at the level of the attending physician. Each resident’s personal value of [beta] can be used to evaluate the performance in the emergency department. Resident’s who’s [beta] value are smaller the emergency department’s expected value might have trouble performing.

O gerenciamento de recursos materiais na área hospitalar tem assumido destaque principalmente com os avanços tecnológicos ocorridos nas últimas décadas. A incorporação de tecnologia sofisticada pode ser percebida pelo aumento da complexidade das práticas assistenciais e dos desafios que os gestores de instituições públicas e privadas enfrentam diante do aumento da oferta de produtos, que visam maior segurança aos pacientes e equipe de profissionais que lhes assistem, e do consumo dos materiais médico-hospitalares, com consequente elevação dos custos na prestação de serviços. A Agência Nacional de Vigilância Sanitária (ANVISA) tem como atribuição a regulamentação e regulação dos produtos para a área da saúde como forma de promover a vigilância em saúde e subsidiar as instituições quanto ao controle dos produtos na fase de pós-comercialização. Compete à Gerência de Risco Hospitalar o controle dos produtos das áreas de Tecnovigilância, Hemovigilância e Farmacovigilância. O objetivo desta pesquisa é analisar o processo de notificação da queixa técnica de material de consumo de uso hospitalar no contexto do gerenciamento de recursos materiais em um hospital universitário público, no período de 2007 a 2009. Trata-se de um estudo descritivo, retrospectivo, documental com abordagem quantitativa. Compreende a análise de 409 Impressos de Notificação, enviados para a Seção de Parecer Técnico, utilizados na instituição para formalizar o relato da ocorrência de queixa técnica. Destes, 260 preenchem os critérios de inclusão, constituindo-se na população investigada. As notificações analisadas estão agrupadas de acordo com sua finalidade, formando-se três grupos: material médico-hospitalar, material para higiene pessoal e material para uso no processo de esterilização. A construção do fluxograma do encaminhamento do Impresso de Notificação para material padronizado evidencia que a sequência de trabalho possibilita a caracterização da ação dos profissionais e das instâncias de decisão. No conjunto dos anos em análise, o mês de junho apresenta o maior número de notificações (36). Em relação à queixa técnica evidenciam-se os maiores índices no grupo de material médico-hospitalar. Os produtos identificados com maior frequência de notificação são representados pela luva cirúrgica, dispositivo de acesso venoso, equipo, seringa, papel toalha interfolha, fralda e embalagem para processo de esterilização. De acordo com a categoria de queixa técnica (embalagem, estrutura e aspecto alterado) destaca-se a presença das questões de estrutura nos três grupos de material. A participação da equipe de enfermagem é marcante, em especial a do profissional enfermeiro, totalizando 211 notificações; destas 69 enviadas pela Divisão de Centro Cirúrgico e 51 pela Divisão Materno Infantil. Em relação ao turno de trabalho, predomina o período diurno. Um dos objetivos do monitoramento das notificações de queixas técnicas é subsidiar informações para o sistema de Notificações em Vigilância Sanitária (NOTIVISA); sendo assim, foi possível a contribuição desta instituição com 20 notificações pertinentes à área de Tecnovigilância. Conclui-se que o Impresso de Notificação é uma ferramenta importante no gerenciamento de recursos materiais na área hospitalar. Através desse feedback é possível realizar o monitoramento da qualidade dos produtos na pós-comercialização, preservando a segurança para o paciente e equipe de saúde. / The management of material resources in the nosocomial field has gained prominence mainly due to the technological advances that have occurred in recent decades. The incorporation of sophisticated technology can be perceived by the increase in the complexity of care practices and the challenges that the managers of public and private institutions face due to both the increase in the supply of products that aim at greater safety for the patients and the team of professionals who assist them, and the consumption of medical-nosocomial material, with a consequent increase in costs in the provision of services. The National Health Surveillance Agency (ANVISA) is in charge of the rules and regulation of products for the health care area to promote health surveillance and assist the institutions as to the control of the products in the after sales phase. The Hospital Risk Management is in charge of the control of products in the areas of Tecnovigilância, Haemovigilance and Pharmacovigilance. This research aims to analyze the notification process of technical complaints about consumption material for hospital use in the context of material resources management in a public university hospital, in the period from 2007 to 2009. This is a documentary retrospective descriptive study with a quantitative approach. The analysis comprises 409 Notification Forms sent to the Section on Technical Advice, used by the institution to formalize the report of technical complaint occurrences. Of these, 260 met the inclusion criteria, thus composing the investigated population. The notifications under analyzes have been categorized according to their purpose, forming three groups: medical and nosocomial material, material for personal hygiene and material for use in the sterilization process. The construction of a flow chart of Notification Forms Reference for standardized material shows that the work sequence enables the characterization of the actions of professionals and decision-makers. In all the years under review, the month of June presents the greatest number of notifications (36). In relation to the technical complaints this research reveals that the group of medical nosocomial products received the highest indices. The products identified with increased notification rates are surgical gloves, devices for venous access, hoses, syringes, interfolha paper towels, diapers and packaging for the sterilization process. According to the category of technical complaints (packaging, structure and altered appearance), structure stands out in all three groups. The participation of the nursing team is notable, especially the professional nurses, totaling 211 notifications, 69 of which sent by the Surgical Center Division and 51 by the Infant Maternal Division. In relation to work shift, the day shift prevails. One of the objectives of monitoring technical complaints notifications is to feed the Sanitary Surveillance Notification System (NOTIVISA) with information. Thus this institution contributed with 20 pertinent notifications to the area of Tecnovigilância. It is concluded that the Notification Form is an important tool in material resources management in the nosocomial area. Through this feedback it is possible to carry out the monitoring of the quality of the products after sale while preserving the safety for the patient and the health care team.

No description available.

The goal of this thesis was to find out the current state of the operation of the risk management in selected health service providers. For this purpose, there was a questionnaire survey conducted together with a form of interview. There was created a questionnaire for selected health service providers (Annex 1). It was necessary to set certain criteria for the selection of the health services providers. The first criterion was to cover health service providers in the whole Czech Republic. The second criterion set that it should be a inpatient facility. The third criterion definded that only hospitals should be covered. The forth criterion excluded University Hospitals from the selected sample. The fifth criterion required that there will be hospitals with more than 400 medical beds in their facilities. Reviews of annual reports of hospitals were drawn up to implement all the criterions for selecting the sample of health services providers and there were excluded facilities with less than 400 medical beds. The theoretical part deals with health care in the Czech Republic defining the providers of health services and health care system. Furthermore, it deals with crisis management in health care including crisis preparedness of health care, crisis documentation and exercises. There was specified a health risk management and risk analysis methods. There was a questionnaire containing 13 closed and 12 opened questions created for selected providers of health services used in the practical part. The questionnaire was divided into five categories related to the definition of Act No. 240/2000 Coll., crisis management, namely analysis and evaluation of security risks, planning, organization, implementation, control of activities (Annex 1). The questionnaire was distributed via the Click4Survey internet portal, it was an online questionnaire and the interviewed persons were also contacted by telephone. The interviewees were persons engaged in risk management at a particular selected health service providers. There were 18 hospitals out of a total of 33 hospitals surveyed participated in the survey. The results were processed into graphs, tables and interpreted in the discussion section of the thesis. The goal of the thesis was "To find out the current state of the operation of the risk management in selected health service providers." The results show that, risk management in the hospitals surveyed does not reach sufficient knowledge and experience in some cases.

Despite more than 60 years of research about the nature of change, resistance to change remains a problem across industries. Health care leaders have limited knowledge of how health care managers' perceptions of empowerment, years of experience, and resistance to change (RTC) relate. The purpose for this nonexperimental correlational study was to examine the relationship between empowerment, years of experience, and RTC among managers via an online survey. The theoretical framework incorporated Kanter's structural empowerment theory and Kotter's change theory. The sample included 245 out of 1,181 health care managers from Veterans Administration (VA) hospitals in the New York metropolitan region, recruited through a nonrandom purposive sampling method. There was a significant association measured between empowerment and RTC (r = -.132, p = .05), but no association between years of experience and RTC (r = .060, p =.348). The regression model showed that years of experience and perceptions of empowerment together in one model was not a significant predictor of RTC (F(2,242) =2.82, p = .062, R2 = .023). In the model, perceptions of empowerment was a statistically significant predictor of RTC (â = -.136, p = .03), but years of managerial experience was not (â = .074, p = .249). These findings, while not generalizable, offer a unique examination of organizational change among an underexamined population. According to study results, as empowerment increased, RTC diminished. In contrast, experience did not relate to the propensity to resist change. These findings have social implications for VA and general business leaders who may use these results to improve change management plans, empower staff, reduce RTC, and enhance organizational and patient outcomes.

acase@tulane.edu