Vertebral fragility fractures are common, affecting approximately 50% of all postmenopausal women and 33% of men over the age of 50, and are the most common type of fracture seen in osteoporosis. The management of vertebral fragility fractures in the acute care setting is lacking in standardization, in the use of evidence-based practice, and in addressing the underlying cause of osteoporosis. The purpose of this project was to develop an evidence-based protocol to standardize the care of the vertebral fragility fracture in the acute care setting. This protocol included patient education, fall risk assessment, screening for osteoporosis, and follow up with an osteoporosis clinic for comprehensive management once discharged. This project used the Donabedian model to provide a conceptual framework for evaluating the structure, process, and outcomes related to the practice problem. This quantitative study involved 10 participants that were selected using purposive sampling and used process control charting to show compliance with elements of the guideline, and descriptive data to depict process change. Guideline compliance was measured over an 8-week period and indicated successful implementation of fall risk assessment with a 100% compliance rate and osteoporosis screening with an 80% compliance rate. Compliance with fracture education and securement of follow up were difficult to ascertain in the 8-week period and non-compliance evident. In conclusion, two elements of the guideline showed to be an unstable process and further work is necessary to improve. Positive social change may result from empowering nurses by education and giving them autonomy to use evidence-based practice to decrease the risk for secondary vertebral fragility fractures.

The hypothesis that calcium influxes from the extracellular space play an important role in the pathogenesis of irreversible anoxic injury was tested using isolated adult rat myocytes. Myocytes treated with 6 mm amytal and 3 mm iodoacetate and subsequently incubated in either calcium-containing (1.12 mm) or calcium-free media (with or without 1 mm EGTA) developed rigor contracture (cell squaring) and cell death (trypan blue permeability) at the same rate. The rates of cell death in both calcium-containing and calcium-free media were increased by incubation in hypotonic media even though the rates of contracture development remained unaltered. Cells developed osmotic fragility prior to membrane permeability increases. The calcium ionophore, A23187 (10 μm), induced rapid rounding of rod-shaped cells subjected only to mitochondrial inhibition in calcium containing media, confirming its ability to cause an increase in cellular permeability to calcium. However, A23187 did not alter the rates of cell death of totally metabolically inhibited myocytes in either calcium-containing or calcium-free media with EGTA. The results indicate that influxes of calcium are not necessary for the development of irreversible injury in metabolically inhibited, isolated myocytes.

No description available.

No description available.

Seismic isolation systems are widely recognized as beneficial for protecting both acceleration- and displacement-sensitive nonstructural systems and components. Furthermore, adaptive isolation systems have been shown to enable engineers to achieve various performance goals under multiple hazard levels. These systems have been implemented for horizontal excitation, but there has been very limited research on isolation for vertical excitation. Thus, this paper seeks to evaluate the benefit of adaptive vertical isolation systems for component isolation, specifically for nuclear plants. To do this, three vertical isolation systems are designed to achieve multiple goals: a linear spring and a linear damper (LSLD), a linear spring and a nonlinear damper (LSND) and a nonlinear spring and a linear damper (NSLD). To investigate the effectiveness of the proposed systems, a stiff piece of equipment is considered at an elevated floor within a power plant. A set of 30 triaxial ground motions is used to investigate the seismic response of the equipment. The maximum isolation displacement and equipment acceleration are used to assess the effectiveness of the three isolation systems. While all systems significantly reduce the seismic accelerations on the equipment compared to the fixed-base case, a LSND system is shown to exhibit superior seismic performance across multiple hazard levels. / Thesis / Master of Applied Science (MASc)

Urban service networks have come under increased pressure due to expansion of urban population, decrease of capital investment, growing interdependence, and man-made and natural hazards. This thesis introduces a simulation-based methodology for the estimation of the fragility of urban networks subjected to earthquake perturbation. The proposed Interdependent Fragility Assessment (IFA) algorithm abstracts the steps required for perturbation-induced damage propagation within and between networks through internal and interdependent links, respectively. Damage propagation uncertainty is accounted by considering conditional probabilities of failure for components and interdependent strengths measuring the likelihood of intersystemic failure propagation. The IFA algorithm is used in four applications. The first application subjected two simplified models of real interdependent urban power and water networks to selected seismic scenarios. Test results showed that interdependence presence worsens systemic fragility, but that the features of interdependence effects were jointly influenced by local fragility properties and interdependence strengths. A second application examined the role of cascading failures caused by component overloading in systemic fragility. The results showed that cascading failures worsen interdependence fragility, and that mitigation actions improving local component capacity have limited effect on controlling interdependent-induced fragility. Two additional conceptual mitigation measures, component fragility reduction ( CFR ) and interdependence redundancy enhancement ( IRE ), were explored. CFR , decreases component seismic fragilities while IRE adds interdependence links to dependent nodes. Test results showed that CFR outperforms IRE ; however, their combination achieved comparable fragility reductions. This outcome highlights the potential of synergistic mitigation policies in controlling interdependent systemic fragility. Finally, the IFA methodology was adapted to use a probabilistic seismic description for the estimation of unconditional systemic fragilities. The hazard description was obtained following an existing approach that uses importance sampling for the generation of intensity maps. The value of the hybrid methodology rests on its capacity to generate unconditional fragility estimates for direct use in risk assessment. Topics for future work include the development of more sophisticated models of cascading failure, the analysis of optimal mitigation actions using mitigation cost-structures and life-cycle costs, the extension of the IFA methodology for perturbation such as hurricanes and flooding, and interdependent fragility studies of theoretical network models.

Made available in DSpace on 2017-07-10T17:51:42Z (GMT). No. of bitstreams: 1 Jaqueline_Fruet.pdf: 6458874 bytes, checksum: a17de0fa4dd9eb336b0168fe008522f6 (MD5) Previous issue date: 2016-05-18 / Fundação Araucária / The Watersheds are used as geographical studies units that are intended monitoring, analysis and containment of environmental problems. Guided by the "natural potential frailty model" presented by Ross (1994, 1996), it was made the diagnosis of environmental fragility in seven (07) periurban watersheds of the city of Marechal Cândido Rondon, which are part of the Paraná Basin III, belonging the State of Paraná Western region. The preparation of letters of potential and emerging fragility, generated from the interpolation of the use of maps and land use, slope and soil type, allowed diagnose different degrees of environmental fragility potential and emerging basins. The objective was to contribute to the knowledge of the organization and distribution of soils in the landscape, according to their weaknesses in order to assist in the use and occupation process. The analysis of social and environmental factors that interrelate these landscape units showed that sectors with lower potential environmental fragility (very weak / weak) are the medium to high side, convex and divergent, with slope classes between 0 and 6% under the rule of Red Latosol. Areas with environmental average potential fragility occupy sectors with slope classes between 6 and 12%, with the presence of Red Nitosol, and strands of convergent-concave shapes, especially in the basins of streams and Butterfly Apepú. To a lesser extent, potential fragility classes of strong and very strong commitment denote the environmental balance of the basins in the aspect of sectors with convergent-divergent-concave and convex forms, associated with slopes above 20% and shallow soils. As for the emerging environmental fragility, all the basins were classified as medium-strong, respecting the interaction between the analyzed attributes (slope, forms the slopes, slope and land use). It notes that the results can inform future research in periurban catchments Rondon, for example, the loss of soil, integrating research results with a view to planning and management of land use / As bacias hidrográficas são utilizadas como unidades de estudos geográficos que têm por finalidade o monitoramento, a análise e a contenção dos problemas socioambientais. Pautado no modelo de fragilidade natural potencial apresentado por Ross (1994; 1996), foi realizado o diagnóstico da fragilidade ambiental em sete (07) bacias hidrográficas periurbanas da cidade de Marechal Cândido Rondon, as quais integram a Bacia do Paraná III, pertencente à região Oeste do Estado do Paraná. A elaboração das cartas de fragilidade potencial e emergente, geradas a partir da interpolação dos mapas de uso e ocupação dos solos, de declividade e tipo de solos, permitiu diagnosticar os diferentes graus de fragilidade ambiental potencial e emergente nas bacias. O objetivo foi contribuir com o conhecimento da organização e distribuição dos solos na paisagem, de acordo com suas fragilidades, a fim de auxiliar no processo de uso e ocupação. A análise dos fatores socioambientais que se inter-relacionam nestas unidades de paisagem demonstraram que os setores com menor fragilidade ambiental potencial (muito fraca/fraca) são os de média a alta vertente, convexas e divergentes, com classes de declividade entre 0 e 6%, sob o domínio dos Latossolos Vermelhos. As áreas com fragilidade ambiental potencial média ocupam os setores com classes de declividade entre 6 e 12%, com presença do Nitossolo Vermelho, e vertentes de formas convergente-côncavas, sobretudo nas bacias dos córregos Borboleta e Apepú. Em menor proporção, as classes de fragilidade ambiental potencial forte e muito forte denotam o comprometimento do equilíbrio ambiental das bacias nos setores de vertente com formas convergente-côncavas e divergente-côncavas, associados às declividades acima de 20 % e aos solos rasos. Quanto à fragilidade ambiental emergente, todas as bacias foram classificadas como média-forte, respeitando-se a interação entre os atributos analisados (declividade, formas das vertentes, declividade e uso do solo). Cabe ressaltar que os resultados obtidos podem subsidiar futuras pesquisas nas bacias hidrográficas periurbanas de Marechal Cândido Rondon, como, por exemplo, a perda de solos, integrando os resultados das pesquisas com vistas ao planejamento e gestão do uso do solo

Osteogenesis imperfecta, innate brittle bone disease, is a very serious disease. It is inheritable disease of connective tissue, which shows by abnormal fragility of bones. The occurrence of this disease is one case in 10 000 30 000 births. The theoretical part of the thesis deals with the disease itself, also the psychical impact on children suffering from Osteogenesis imperfecta and the impact on their families as well. At the beginning of the research, three goals of this thesis were set: map out (on the basis of theoretical and practical backgrounds) the pitfalls of life of children with the disease Osteogenesis imperfecta, find out what are the most common difficulties by children with the disease Osteogenesis imperfecta and also find out the experiences of nurses with the care for children with disease Osteogenesis imperfecta. The empirical part of the thesis was processed by means of qualitative research conducted by the technique of semi-structured interview and narrative biographical interview. The research set were nurses working at the child departments in hospitals, parents of ill children and also an adult woman with the diagnosis of Osteogenesis imperfecta and two doctors. From the research emerged that among the most common difficulties of children is pain, which decreases the quality of their life. Small children can't engage in typical activities of children, such as going to a playground, older children can't attend for example music festivals. Children feel fear from fractures and are therefore limited in sports. Because of injuries and their treatments, the children have more absences at schools and therefore are isolated from peers. Nevertheless, the children with this disease can live a happy life. From the results of the research also emerges, that nurses working at the child departments of the hospitals attended by children with this illness have a good experiences with their treatment. They are able to give parents important information and know the specifics of application of the treatment. The results of the diploma thesis were presented at a national student conference and will be further published.

Problématique : Bien que l’implantation réussie des services de liaison à la suite d’une fracture (Fracture Liaison Services – FLS) soit essentielle afin de soutenir leur efficacité à prévenir la survenue d’autres fractures de fragilité (FF), l’implantation des FLS a été peu étudiée. Objectifs : Évaluer l’implantation d’un FLS par l’analyse des facteurs influençant : 1) le degré d’implantation du FLS ; et 2) l’adhésion des participants aux recommandations du FLS. Méthodologie: Une étude de cas multiples avec un devis mixte imbriqué à prédominance qualitative a été menée de 2013 à 2015 afin d’identifier les facteurs influençant l’implantation du FLS dans 3 régions du Québec (Canada) : Estrie, Montréal et Lanaudière. Le degré d’implantation a été déterminé selon la mise en œuvre de 7 composantes du FLS : 1) la nomination d’un coordonnateur, 2) la formation en première ligne sur les FF, 3) l’identification de patients avec une FF, 4) l’investigation de leur FF, 5) la communication avec leur médecin de famille, 6) la référence en prévention des chutes et 7) la prescription d’une médication. Les données ont été recueillies au moyen de la base de données des participants du FLS, des comptes rendus des réunions du comité d’implantation et d’entrevues avec des parties prenantes : comité d’implantation, coordonnateurs, orthopédistes et membres de l’équipe d’orthopédie. Les comptes rendus et les verbatim d’entrevues ont fait l’objet d’une analyse guidée par le Cadre consolidé pour la recherche sur l’implantation. Un devis mixte séquentiel explicatif a ensuite été utilisé afin d’identifier les facteurs influençant l’adhésion des participants aux recommandations concernant : 1) la médication; 2) les habitudes de vie (vitamine D, calcium et activité physique); et 3) la prévention des chutes. Des caractéristiques des participants ont été modélisées pour estimer la probabilité d’adhérer aux recommandations du FLS et des entrevues ont été réalisées avec des participants afin d’approfondir ces résultats. Résultats : Au cours de la période d’implantation analysée de 30 mois, un coordonnateur a été nominé dans chaque région et des formations sur les FF ont été données. Un total de 457 patients ont été identifiés et ont accepté de participer au FLS. Parmi les participants, 376 (82%) ont été investigués pour leur risque de FF, la communication avec leur médecin a été établie pour 456 (98%), 299 (65%) ont initié une médication et 158 (35%) ont été référés en prévention des chutes. L’initiation de la médication et la référence en prévention des chutes ont significativement varié entre les régions. L’analyse des 39 comptes rendus et des 10 entrevues a montré que des caractéristiques des coordonnateurs ont facilité l’implantation des composantes du FLS alors que l'accès difficile à des activités de prévention des chutes a nui à l’implantation. La connaissance de leur diagnostic d'ostéoporose (n=106/354) a augmenté la probabilité des participants d’adhérer à la médication (OR=2,47; IC 95% 1,47-3,93) et à la vitamine D (OR=2,34; IC 95% 1,23-4,46). Paradoxalement, cela a diminué leur probabilité d’adhérer à l’activité physique (OR=0,45; IC 95% 0,25-0,81). Les entrevues avec les participants (n=16) ont montré que l’éducation centrée sur le patient les aidait à mieux comprendre que leur FF était causée par l’ostéoporose et que le soutien à l’autogestion facilitait la mise en place de stratégies pour adhérer aux recommandations du FLS. Conclusion : Cette étude met en évidence l'importance du rôle du coordonnateur pour promouvoir l’implantation réussie des composantes d'un FLS, faciliter la compréhension que le patient se fait de sa maladie et le soutenir dans la gestion de ses soins à la suite d’une FF, tout en favorisant l’intégration du continuum de soins et services du patient visant à prévenir la survenue d’autres FF. / Abstract : Background: Although Fracture Liaison Services (FLSs) are clinically- and cost-effective to prevent subsequent fragility fractures (FF), their rigorous implementation is essential to support their effectiveness. Despite the emergence of FLS, few studies have analysed their implementation. Objectives: Evaluate the factors influencing: 1) the degree of implementation of a FLS components; and 2) the adoption to the FLS recommendations by participants. Methodology: A multiple case study using a quantitative approach embedded within a predominantly qualitative method was firstly conducted between 2013 and 2015 in 3 regions of the province of Quebec (Canada): the Eastern Townships, Montreal, and Lanaudiere. The degree of implementation was determined according to 7 FLS components: 1) the employment of a coordinator, 2) the training on FF to primary care providers, 3) the identification of FF patients, 4) the investigation of their FF, 5) the communication with their family physician, 6) the referral to a fall prevention activity, and 7) the prescription of a medication. Data were collected through the FSL participant database, implementation committee meeting minutes, and interviews with stakeholders (i.e. implementation committee, coordinators, orthopaedic surgeons and members of orthopaedic teams). The Consolidated Framework for Implementation Research guided analysis of meeting minutes and interview verbatim. An explanatory sequential mixed methods design was secondly used to identify factors influencing the adoption of FLS recommendations by participants regarding: 1) medication; 2) lifestyle habits (vitamin D, calcium and physical activity); and 3) fall prevention. Participants' characteristics were modeled to estimate the likelihood of adopting FSL recommendations, and interviews were conducted with FLS participants to deepen these results. Results: During the 30-month implementation period analyzed, a coordinator was nominated in each region and FF training was provided. A total of 457 patients were identified and agreed to participate in the FSL. Of the participants, 376 (82%) were investigated for their risk of FF, a communication with their physician was established for 456 (98%), 299 (65%) initiated medication and 158 (35%) were referred for fall prevention. The referral to fall prevention activities and the prescription of medications varied significantly between regions. The analysis of the minutes of 39 meetings and 10 verbatim showed that some coordinator characteristics facilitated the implementation of FLS components whereas the problematic access to fall prevention activities impeded the implementation. Participant knowledge of their diagnosis of osteoporosis (n=106/354) increased the likelihood of adopting medication (OR=2.47, 95% CI 1.47-3.93) and vitamin D (OR=2.34, 95% CI 1.23-4.46). Paradoxically, this decreased their likelihood of adopting physical activity (OR=0.45, 95% CI 0.25-0.81). Interviews with participants (n=16) showed that patientcentered education helped them to understand that their FF was caused by osteoporosis, and that self-management support facilitated the development of strategies to adopt FLS recommendations. Conclusion: This study highlights the importance of the role of the coordinator in promoting the successful implementation of FSL components, facilitating patient understanding of its disease, and supporting self-management of FF, while fostering the integration of the patient's continuum of care and services that aim to prevent the occurrence of subsequent FFs.

Este trabalho apresenta uma comparação de três modelos metodológicos aplicados aos estudos da Fragilidade Ambiental. A aplicação destes modelos resultou na confecção de três mapeamentos diferenciados de Fragilidade, os quais foram analisados e comparados entre si. Dos três modelos metodológicos aplicados, dois foram propostos por ROSS (1994), um com apoio nos Índices de Dissecação do Relevo, e o outro nas Classes de Declividade. O terceiro modelo foi proposto por CREPANI et ali (1996) baseado nas Unidades Territoriais Básicas - UTB's. Os três modelos de análise da Fragilidade ambiental propostos partem do mesmo princípio: as Unidades Ecodinâmicas preconizadas por TRICART (1977) para delimitar áreas no contexto dos diagnósticos ambientais. As áreas são caracterizadas por diversos atributos: rochas, relevo, solo, cobertura vegetal/ uso da terra e pluviosidade. No entanto, estes modelos apresentam diferenças na operacionalização dos métodos, e também, nas variáveis analisadas. Destas divergências resultam três mapeamentos diferenciados. Apesar dos diferentes resultados apresentados pelos três modelos de análise da Fragilidade, seus objetivos são os mesmos, servir como subsídio ao planejamento estratégico ambiental. Os mapeamentos das Fragilidades Ambientais identificam e analisam os ambientes em função de seus diferentes níveis de fragilidade. Através destes documentos torna-se possível apontar as áreas onde os graus de fragilidade são mais baixos favorecendo, então, determinados tipos de inserção; e áreas mais frágeis onde são necessárias ações tecnicamente mais adequadas a essas condições. / This work presents a comparison between three methodological models which were applied to Environmental Fragility studies. The application of these models resulted in three different Environmental Fragility maps, which were analyzed e compared with each other. Of the three methodological methods used, two were proposed by ROSS (1994), one of them based on the Relief’s Dissection Index and the other on the Slope Classes. The third model was proposed by the INPE (1996), based on the Basic Territorial Units – BTU's. The three models come from the same principle: The Ecodynamics Units, defended by TRICART (1977) to classify areas regard to its environmental diagnosis. The areas characterized by several information: rocks, topography, soil, vegetation/ use of the soil and pluviosity. However, these models present differences in the operationalization of the methods, and also in the variables analyzed. These divergences results three different mappings. Although the different results presented by the three models, its purposes are the same: to gather information to the Environmental Strategic Planning. The environmental Fragility mappings identify and analyze the areas according to its different fragility levels. Through these documents it´s possible to point out the lowest fragility rated areas, favoring then certain types of insertion; and the most fragile areas, where more adequate technical actions are required.