L'étude des facteurs psychosociaux qui déterminent les comportements liés à la création d'entreprise est essentielle à l'explication de l'intention entrepreneuriale et du processus cognitif de sa transformation en action. Dans cette perspective nous nous sommes intéressés à la dynamique personnelle impliquée dans les conduites de création d'entreprise. Trois catégories de personnes ont participé à cette étude : les étudiants, les entrepreneurs en création et les entrepreneurs actifs. Cela nous a permis de contourner la difficulté méthodologique liée à la réalisation d'une observation longitudinale. A partir de la littérature internationale sur le sujet, nous présentons l'entrepreneuriat comme un processus téléologique qui s'élabore dans le temps. Ainsi, nous avons construit un modèle d'analyse par équations structurales établissant les liens entre les variables déterminantes de l'intention entrepreneuriale, les variables intermédiaires en particulier en référence au modèle du comportement planifié, à celui de Gollwitzer sur les phases de l'action et à Kuhl sur le contrôle de l'action et les conduites de création d'entreprise. Nos résultats nous ont permis de proposer un modèle théorique dit de la hiérarchisation de la mobilisation des capacités volitionnelles. Son postulat est semblable à celui de la théorie des besoins de Maslow. Toutefois, contrairement à la pyramide des besoins, nous faisons l'hypothèse d'une remobilisation possible des capacités volitionnelles d'une phase inférieure du processus

Bronchoalveolar lavage (BAL) is a minimally invasive technique utilized in human and veterinary medicine to sample the lower generation bronchi and alveolar spaces. The basic technique for BAL involves infusion of sterile saline into the lower airways and re-aspiration of the fluid (bronchoalveolar lavage fluid; BALF). Certain aspects of BAL technique and BALF processing affect sample quality, and sample quality is important to ensure meaningful cytology. Aspiration techniques for retrieval of BALF have not been critically evaluated in companion animal medicine. This research project compared three aspiration techniques for retrieval of BALF in dogs [manual aspiration without tubing (MA), manual aspiration through polyethylene tubing (MAPT) and suction pump aspiration (SPA)] and their effect on sample quality in healthy dogs and dogs with respiratory tract disease. SPA consistently retrieved a higher proportion of BALF than MA and MAPT. In addition, SPA yielded improved sample quality compared to MA and MAPT. The improved BALF retrieval and cellularity scores in SPA samples did not significantly increase the diagnostic rate achieved from BALF cytology in dogs with pulmonary disease. The results indicated that both MA and SPA are suitable for BAL in dogs with respiratory tract disease. Yet, for the purpose of creating a standardized BAL technique in dogs, SPA is recommended for BALF retrieval due to the improved sample quality parameters. / Ontario Veterinary College Pet Trust

No description available.

One of the most elusive challenges in the diagnosis and treatment of dysphagia is the reliable identification of silent aspiration (aspiration in the absence of cough). The citric acid inhalation cough challenge offers potential for aiding in identification of silent aspiration; however clinical application of this technique is currently problematic due to an absence of normative data. Therefore, this study aimed to establish a normative data set for the Citric- Acid Inhalation Cough Challenge, as administered with facemask method. 80 healthy subjects will participate in this study, constituting 2 age groups: above and below 60 years, with equal gender representation. On 3 separate trials, they will be asked to passively inhale, via a facemask, nebulised citric acid of concentrations ranging from 08M to 2.6M with placebo interspersed. ‘Natural cough thresholds’ (NCT) and ‘Suppressed Cough Thresholds’ (SCT) will be reached when subjects cough on at least 2 out of 3 trials. The majority (92.5%) of participants reached Natural Cough Threshold by 0.8M, with 68% demonstrating Suppressed Cough Threshold also at this concentration. There were no significant differences found between males and females (p<0.05) for either NCT (p=0.9885) or SCT (p=0.44). Whilst no difference was found between youngers and elders for NCT (p=0.7254), there was a significant difference for SCT (p=0.018), with youngers better able to suppress cough. Over 90% of healthy people were found to elicit cough at 0.8M, inferring that this level would be an adequate guide for use by clinicians testing for presence/absence of cough.

Silent aspiration is associated with pneumonia and mortality, and is poorly identified by traditional clinical swallowing evaluation (CSE). Currently, there is no reliable test for detecting silent aspiration during CSE. There is, however, increasing evidence for the validity of cough reflex testing (CRT) for identifying silent aspiration. This test has the potential to significantly improve clinical assessment of dysphagia. The aim of this research programme was to further investigate the validity, reliability and clinical utility of CRT for identifying patients at risk of silently aspirating. Several aspects of CRT were explored during this research programme. Two correlational studies were conducted to validate CRT for identifying silent aspiration against videofluoroscopic swallowing study (VFSS) and flexible endoscopic evaluation of swallowing (FEES). Cough reflex threshold testing was completed on 181 patients using inhaled, nebulised citric acid. Within one hour, 80 patients underwent VFSS and 101 patients underwent FEES. All tests were recorded and analysed by two researchers blind to the result of the alternate test. Significant associations between CRT result and cough response to aspiration on VFSS (p = .003) and FEES (p < .001) were identified. Sensitivity and specificity were optimised at 0.6mol/L in patients undergoing VFSS (71%, 60% respectively) and at 0.4mol/L in patients undergoing FEES (69%, 71% respectively). A concentration of 0.8mol/L had the highest odds ratio (OR) for detecting silent aspiration (8 based on VFSS, 7 based on FEES). Coughing on lower concentrations of citric acid (0.4mol/L compared with 1.2mol/L) was a better predictive measure of silent aspiration. Diminished cough strength has also been associated with aspiration and increased risk of pneumonia. Reflexive cough is our primary defensive mechanism against aspiration and a measure of reflexive cough strength therefore holds greater relevance than one of voluntary cough strength. Despite common use and clinical applicability, the reliability of subjective cough judgements has received little attention. The inter- and intra-rater reliability of subjective judgements of cough in patients following inhalation of citric acid was assessed. Forty-five speech-language therapists (SLTs) were recruited to the first study. Of these, 11 SLTs were currently using CRT in their clinical practice (experienced raters) and 34 SLTs reported no experience with CRT (inexperienced raters). Participants provided a rating of strong, weak or absent to ten video segments of cough responses elicited by inhalation of nebulised citric acid. The same video segments presented in a different sequence were re- evaluated by the same clinicians following a 15-minute break. Inter-rater reliability for experienced raters was calculated with a Fleiss’ generalised kappa of .49; intra-rater reliability was higher with a kappa of .70. Inexperienced raters showed similar reliability with kappa values for inter-rater and intra-rater reliability of .36 and .62, respectively. SLTs demonstrated only fair to moderate reliability in subjectively judging a patient’s cough response to citric acid. Experience in making cough judgements did not improve reliability significantly. In a second study, specific training in cough physiology and cough judgement was provided to 58 trained SLTs. Inter-rater reliability of subjective judgements of cough in patients following inhalation of citric acid was assessed. Participants provided a rating of present or absent, and if present then a rating of strong or weak, to ten video segments of cough responses. Inter-rater reliability for cough presence was calculated with a Fleiss’ generalised kappa of .71 and cough strength was calculated at .61. Years of clinical experience did not improve inter-rater reliability significantly. Experience in using CRT did improve inter-rater reliability. Further validity and reliability research would be beneficial for guiding clinical guidelines and training programmes. By identifying patients at risk of silent aspiration, more informed management decisions can be made that consequently lead to a reduction in preventable secondary complications such as pneumonia. The clinical utility of CRT for reducing pneumonia in acute stroke patients was assessed through a randomised, controlled trial. Three hundred and eleven patients referred for swallowing evaluation were assigned to either 1) a control group receiving standard evaluation or 2) an experimental group receiving standard evaluation with CRT. Participants in the experimental group were administered nebulised citric acid with test results contributing to clinical decisions. Outcomes for both groups were measured by pneumonia rates at three months post stroke and other clinical indices of swallowing management. Analysis of the data identified no significant differences between groups in pneumonia rate (p = .38) or mortality (p = .15). Results of CRT were shown to influence diet recommendations (p < .0001) and referrals for instrumental assessment (p <.0001). Despite differences in clinical management between groups, the end goal of reducing pneumonia in post stroke dysphagia was not achieved. Through this research, the characteristics and outcomes associated with dysphagia secondary to stroke in New Zealand were identified. Baseline characteristics of 311 patients with dysphagia following acute stroke were collected during their hospital stay and outcomes were measured at three months post stroke. Mortality rates were 16% and pneumonia rates 27%. Mean length of stay was 24 days and only 45% of patients were in their own home at three months post stroke. Pneumonia was significantly associated with mortality and increased length of stay. Only 13% of patients received referral for instrumental assessment of swallowing. These data are discussed in reference to the National Acute Stroke Services Audit 2009 and internationally published data. The outcomes for stroke patients with dysphagia in New Zealand are poor with a high risk of pneumonia and long hospital stays when compared internationally. In summary, this research programme has contributed to our understanding of the use of CRT in patients with dysphagia. The addition of a measure of reflexive cough strength may add to clinical assessment but specific training is required to reach adequate reliability. CRT results are significantly associated with aspiration response on instrumental assessment and lower concentrations of citric acid provide a better predictive measure of silent aspiration. CRT can be standardised and therefore is not as susceptible to interpretative variance that plagues much of CSE. Sensitivity and specificity values using this CRT methodology are adequate for CRT to be incorporated into clinical protocols. Inclusion of CRT alone was not shown to be sufficient to change clinical outcomes however integration of CRT into clinical pathways may prove more successful. Further research evaluating the addition of CRT to a comprehensive CSE would add greatly to the field of dysphagia assessment.

Thesis studied correlations between swallowing accelerometry parameters and anthropometrics in 50 healthy participants. Anthropometrics include: age, gender, weight, height, body fat percent, neck circumference and mandibular length. Dual-axis swallowing signals, from a biaxial accelerometer were obtained for 5-saliva and 10-water (5-wet and 5-wet chin-tuck) swallows per participant. Two patient-independent automatic segmentation algorithms using discrete wavelet transforms of swallowing sequences segmented: 1) saliva/wet swallows and 2) wet chin-tuck swallows. Extraction of swallows hinged on dynamic thresholding based on signal statistics. Canonical correlation analysis was performed on sets of anthropometric and swallowing signal variables including: variance, skewness, kurtosis, autocorrelation decay time, energy, scale and peak-amplitude. For wet swallows, significant linear relationships were found between signal and anthropometric variables. In superior-inferior directions, correlations linked weight, age and gender to skewness and signal-memory. In anterior-posterior directions, age was correlated with kurtosis and signal-memory. No significant relationship was observed for dry and wet chin-tuck swallowing

Diss. Stockholm : Univ.

Thesis (M.S.)--University of Michigan, 1980.

Thesis (M.S.)--University of Michigan, 1980.

Thesis (M.A.)--Miami University, Dept. of Spanish and Portuguese, 2003. / Title from first page of PDF document. Includes bibliographical references (p. 65-66).