Critically ill patients experience overwhelming communication problems; caused by intubation and cognitive, sensory or language deficits that distance the patients from communicating their needs and wants from nurses and loved ones. The purpose of this study was to explore communication patterns and strategies with the aim of implementing intervention strategies for nurse/patient communication in the intensive care units. The American Association of Critical Care Nurses’ Synergy Model for Patient Care was used to guide the study. A mixed method approach using quasi-experimental design combining quantitative and qualitative data collections and analysis was used. Concurrent data collection for quantitative and qualitative data was used. Auditing of patient’s files, protocols, family counselling conference and in-service books and a survey for nurses was used for quantitative data. Qualitative data collection was through interviewing nurses and nurse managers. Lack of documentation and use of other communication strategies were the key findings of the study. In accordance with the model used for the study clinical judgment and moral distress were found to be common among nurses. Lack of collaboration between nurses and other health care workers was also attributed to poor communication with mechanically ventilated patients. Conclusions derived from the study are that nurses need to be supported through informal and formal training on documentation and use of communication methods available / Health Studies / D. Litt. et Phil. (Health Studies)

Text in Afrikaans / Talle Christelike kerke in Suid- Afrika, onder meer die Nederduitsch Hervormde Kerk van Afrika, verkeer tans in 'n krisis. Die lidmaattalle toon 'n drasties dalende tendens, minder kinders word gedoop en minder Iidmate le belydenis van geloof af Hierdie krisis, asook die invloed van die postmodernisme op die hedendaagse mens, word aan die hand van die handelingswetenskaplike benadering ondersoek. Die gemeenteboumodel van Kenon L Callahan word gebruik, en daar word gevra tot watter mate hierdie model op die Nederduitsch Hervormde Kerk van Afrika toegepas kan word. Wat sal die prakties- teologiese implikasies daarvan op die gemeenskap van gelowiges in die Nederduitsch Hervormde Kerk van Afrika wees? Die resultaat van die studie is dat die Nederduitsch Hervormde Kerk van Afrika wel met vrug gebruik kan maak van Callahan se model, met inagneming van die kerk se bestaande struktuur, tradisie en geskiedenis. In die toepassing van die model sal daar nuwe, ongekende eise aan die kerk gestel word. / Numerous christian churches in South Africa, including the Dutch Reformed Church of Africa is currently experiencing a crisis. Membership is declining, less children are baptised While new and unknown demands will be made on the church, new and exciting opportunities will also be met each year, and less members are confirmed. This crisis, together with the influence of the post- modernism, is explored using an operational science approach, and a possible solution to this problem is sought. The church growth model ofK.L. Callahan is used to facilitate this research. The applicability of this model to the Dutch Reformed Church of Africa is explored, together with the practical theological implications thereof on the holy community. The result of the study is that the Dutch Reformed Church of Africa can apply Callahan' s model to great affect, while cognisance should be taken of the church's own structure, tradition and history. / Philosophy, Practical and Systematic Theology / Th. M. (Practical Theology)

[pt] Esta tese apresenta uma proposta de modelo conceitual para a produção do açaí (Euterpe precatoria) no Estado do Amazonas, a partir de uma reflexão sobre metodologias emergentes de design sustentável. Tais metodologias buscam integrar as dimensões ambiental, econômica e social aos processos de desenvolvimento de produtos. Na pesquisa, conceitos de ecodesign, design social, design participativo, design sustentável e tecnologia apropriada são abordados. Foi realizado um levantamento dos impactos ambientais e sociais observados no modelo produtivo do açaí (Euterpe precatoria) do Amazonas, tendo como objeto de estudo a Cooperativa de Açaí de Codajás, e em seguida foi elaborada uma proposta de modelo conceitual para a produção do açaí na região, buscando responder aos princípios ambientais e priorizar a responsabilidade socioeconômica, visando ao desenvolvimento da região e à melhoria da qualidade de vida dos agricultores envolvidos no processo. / [en] This thesis presents a proposal of a conceptual model for the production of açaí (Euterpe precatoria) in the State of Amazonas, based on a reflection on emerging sustainable design methodologies. These methodologies seek to integrate the environmental, economic and social dimensions into the product development processes. In the research, concepts of ecodesign, social design, participatory design, sustainable design and appropriate technology are addressed. A survey of the environmental and social impacts observed in the açaí (euterpe precatoria) production model of Amazonas was carried out, having the Cooperativa de Acaí de Codajás as the object of study. In the sequence, a conceptual model was proposed for the production of the açaí in the region, seeking to respond to environmental principles and to prioritize socio-economic responsibility, aiming at the development of the region and the improvement of the quality of life of farmers involved in the process.

Made available in DSpace on 2014-06-11T19:27:48Z (GMT). No. of bitstreams: 0 Previous issue date: 2006-07-04Bitstream added on 2014-06-13T19:15:19Z : No. of bitstreams: 1 borba_ea_me_mar.pdf: 587417 bytes, checksum: 44ca3b4ae618d2558f3387e45e5c36b1 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / The teaching of indexing procedures by means of the Documentary Reading Model for Indexing of Scientific Articles offers to the apprentice indexer strategies of reading and development of his previous professional knowledgement. The Documentary Reading Model for Indexing of Scientific Articles by Fujita (2003a) is a proposal of improvement and evolution of the methodology of indexing through the indexer's metacognition (non-automatized behaviour as the reader is conscious of how the reading is being carried out), using the knowledgement of textual structures of the reader, relying on strategies of systematic approach of concepts offered in his education. Considering the learning of the documentary reading process in classroom, it is searched into the applicability of this Model as pedagogical resource to apprentice indexers. By means of introspective technique of data collecting of the Interative Verbal Protocol, observing the process of apprehending the methodology, this research reveals difficulties by the apprentice and his development towards more satisfactory grades of carring out the indexing task. It was chosen three students from the second class of Librarianship that had not attended the discipline Indexing and Abstracting and were intested in taking part in the applying of the Verbal Protocol combined with the indexing task. The analysis of the Verbal Protocol's transcriptions shows that the apprentices had difficulties in identifying the concepts of this Model: to choose terms to represent the concepts, to understand the terminology of the medical science and to to set up the terms' form (singular or phrases). Such difficulty is relating to the using of the Reading Model adapted from the original where there was inversion of the concepts action and object. The Interactive Verbal Protocol consists of an innovative methodology functioning as pedagogical resource... (Complete abstract, click electronic address below)

Made available in DSpace on 2014-06-11T19:22:53Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-05-31Bitstream added on 2014-06-13T18:49:50Z : No. of bitstreams: 1 reis_igm_me_rcla.pdf: 1760261 bytes, checksum: dec7c3739e75a3afb0a688fcc68236aa (MD5) / No modelo de natação para ratos, a associação das intensidades de exercício determinadas por meio da lactacidemia com as suas respectivas sobrecargas são passíveis de crítica, uma vez que a quantificação dos pesos atados ao animal pode não representar efetivamente o esforço real do animal para sua manutenção na superfície da água, devido a esta metodologia sofrer influência da densidade corporal e dos padrões de nado apresentados pelos animais. O principal objetivo desse estudo foi desenvolver um modelo de natação atada para roedores o qual permitiu a determinação direta e em tempo real da força de nado realizada pelo animal e verificar a possível existência de diferentes padrões de nado. Além disso, foi feita a discriminação da densidade corporal em animais controles e induzidos à obesidade, com intuito de destacar consistentemente a influência da flutuabilidade na natação. Foram utilizados 24 rattus norvegicus albinus, machos, com 150 dias de idade, divididos em animais controles e induzidos à obesidade por meio da redução de ninhada somada a uma dieta hiperlipídica. Os animais tiveram a densidade corporal determinada por meio de um aparato de pesagem hidrostática utilizando um sistema de aquisição de dados. Posteriormente todos os ratos foram avaliados no teste de máxima fase estável de lactato adaptado para natação atada. Por meio do modelo experimental de indução a obesidade, foi possível induzir aumento significativo do peso e volume corporal, alem da redução da densidade corporal dos animais no grupo obeso. As avaliações de animais controles e obesos revelaram a influência significativa da densidade corporal na determinação das intensidades de exercício, principalmente quando as cargas foram expressas em valores absolutos. Estudos que fazem uso do modelo de natação para ratos, principalmente de caráter longitudinal... / In the swimming model for rats, the association between the blood lactate concentration with the exercise intensity could be criticized once the workload quantification could not represent effectively the effort performed by the rat to keep himself on the surface, due to it be affected by the body density and the swimming patterns present by the animals. Thus, the mainly objective of this study was develop a apparatus for tethered swimming for rats, that allows the monitoring of swimming force during all exercise time and to verify the existence of different sorts of swimming patterns. 24 male rattus novergicus albinus, with 150 days of age were used, divided in control and obese induced animals by a nest reduction and hyper-lipid diet. All animals had their body density determined by hydrostatic weighing with an acquiring data device. Later the animals were evaluated in maximal lactate steady state test adapted to the tethered swimming. Was possible to induce significant weight and body volume increase in the obese group beside the reduction of the body density. The assessment of control and obese animals reveled significant body density influence in the workload determination, mainly when the workload was expressed in absolute values. Tethered swimming model allowed the investigation of statistic parameters of the data signal, which showed that the signal amplitude varied in function of the intensity, however the dispersion did not. Also the visual analyses of the force kinetic allowed the identification of 4 swimming patterns and the speculation about the reason and consequences of it incidence. Therefore animals that present such swimming patterns which can influence the assessment should be removed from the sample. Studies that make use of the swimming model for rats, mainly those of longitudinal duration or that make use of interventions that may change the animal’s body composition...(Complete abstract click electronic access below)

Alguns setores da economia não se identificam ou não se beneficiam da imagem passada pelo seu país de origem. Para eles é necessária a criação de uma identidade própria por meio das marcas setoriais, para competição no mercado externo. O presente estudo propõe um modelo de identidade para marcas setoriais e verifica sua aplicabilidade para a marca setorial Brasil Fashion System. Foram definidos três objetivos específicos. O primeiro consiste em identificar quais são os atributos envolvidos na construção da identidade setorial da marca estudada diante das organizações responsáveis pela sua formação. O segundo, em identificar quais são os aspectos comuns percebidos na sua identidade entre as organizações responsáveis pela sua formação. O terceiro, em identificar quais são os desafios e os benefícios trazidos pela marca setorial Brasil Fashion System. Foi desenvolvida uma pesquisa qualitativa exploratória por meio de entrevistas em profundidade, realizadas com três grupos: i) Gestores das associações que fazem parte da marca Brasil Fashion System; ii) Gestora da Agência de Promoção a Exportação Brasileira (Apex-Brasil); iii) Diretor da empresa Gad, responsável pela consultoria realizada para a marca setorial estudada. Os resultados indicam que os atributos do modelo de identidade para marcas setoriais podem ser aplicados à marca Brasil Fashion System com exceção de dois elementos: embalagem e ação dos distribuidores e fornecedores. Foi descoberto que os atributos da identidade da marca setorial de moda não foram percebidos de modo convergente pelas associações que a compõem e, por fim, que a marca setorial Brasil Fashion System atualmente não está trazendo benefícios para o setor de moda brasileiro porque não está sendo utilizada corretamente. Os entrevistados acreditam que se a sua campanha de marketing fosse colocada em prática a marca poderia trazer benefícios ao setor. Os motivos indicados pela falta de utilização da marca estão relacionados à dificuldade de encontrar mercados-alvo comuns entre as associações para que elas possam realizar eventos no exterior em conjunto; ao grande número de marcas da Apex existentes e que devem ser utilizadas ao mesmo tempo pelas associações; à definição de atributos para a Brasil Fashion System que não são adequados a todas as associações; à frequente troca de gestores da Apex e das associações que dificulta a continuidade de projetos setoriais e à ausência de um comitê responsável pelo desenvolvimento da marca. Acredita-se que marcas setoriais que representem setores menores podem trazer maiores benefícios, uma vez que a sua gestão é facilitada pelo menor número de diversidade existente entre as organizações representadas pela marca. Espera-se que o modelo desenvolvido possa ser aplicado para a construção da identidade de marcas setoriais de outros setores em trabalhos posteriores, contribuindo para a gestão e estudos nesta área / Some economy\'s sectors do not identify or do not benefit themselves from disseminated image for their country of origin. For them is necessary to create their own identity through sector brands to compete in foreign markets. This study aims to propose a model of identity for sector brands and verify its applicability to the sector brand Brazil Fashion System. Additionally, this study has also defined three specific objectives. The first is to identify what are the attributes involved in the construction of the sector brand identity in view of the brand management organizations. The second one is to identify what are the common attributes perceived by fashion industry association in the sectorial brand. The third one is to identify what are the challenges and benefits brought by the sector brand Brazil Fashion System. An exploratory qualitative research through in-depth interviews was developed. Interviews were conducted with three groups: i) managers of trade associations that are part of Brazil Fashion System brand; ii) manager of Brazilian Exports Promotion Agency (Apex-Brasil); iii) the company\'s director Gad, responsible for consulting performed for the sector brand studied. As a result of this study, it was found that the model of identity for sector brands developed in this study can be applied to the analysis of Brazil Fashion System brand identity attributes with the exception of two elements: packing and action of distributors and suppliers. It was also discovered that the attributes of the sector fashion brand identity were not perceived equally by the associations that compose it and, finally, the sector brand Brazil Fashion System is not currently bringing benefits to the Brazilian fashion industry because it is not being used properly. The respondents believe that if their marketing campaign was put into practice, the brand could bring benefits to the sector. The reasons given for the lack of use of the brand were relate to: the difficulty of finding common target markets among associations so that they can hold events abroad together; the large number of Apex\'s brands to be used at the same time by the associations; the definition of attributes for the Brazil Fashion System that are not suitable for all associations; the frequent change of Apex and association\'s managers which makes the continuity of sector projects and the absence of a committee responsible for brand development. It is believed that sector brands representing smaller sectors can bring greater benefits, since their management is facilitated by the lower number of diversity among the organizations represented by the brand. It is expected that the developed model can be applied to identity development of sectorial brands from other sectors in later works, in order to verify its applicability to different sectors and to contribute to the management and for further studies about sector brands

[pt] Nos últimos 40 anos, tem-se observado um crescente interesse por compósitos formados pela adição de fibras a matrizes de concreto, os chamados concretos reforçados com fibras. Esse interesse é justificado, sobretudo, pelo significativo ganho em tenacidade que as fibras proporcionam, atenuando as características frágeis do concreto. De fato, em virtude do mecanismo de reforço promovido pelas fibras, o concreto com fibras é capaz de absorver muito mais energia de deformação até a ruptura, apresentando, no regime pós-fissuração, um comportamento muito mais suave que o concreto simples. Esse comportamento é acompanhado por um processo de fissuração mais uniforme, no qual observam-se fissuras mais finas e menos espaçadas. Além disso, registram-se aumentos nos valores de resistência do material e nos níveis de deformação que ele atinge até seu completo esgotamento. Tendo em vista os benefícios que as fibras aportam ao desempenho do concreto, seu emprego seria recomendável a estruturas em que a ductilidade é um dos parâmetros principais de projeto, ou naquelas feitas com concretos de alta resistência, uma vez que estes apresentam um comportamento ainda mais frágil que os concretos de resistência normal. Além disso, a utilização de fibras no combate aos esforços de cisalhamento mostra-se extremamente vantajosa e promissora. Neste trabalho, apresenta-se um modelo constitutivo para concreto reforçado com fibras baseado na formulação hipoelástica de ELWI E MURRAY (1979), originalmente proposta para concreto simples. As especificidades do comportamento do concreto com fibras frente às mais diversas solicitações, tais como, tração, compressão e cisalhamento, são incorporadas ao modelo através de relações tensão-deformação adequadas a esse material. Tais relações provêm de estudos analíticos e experimentais sobre o assunto, publicados na literatura técnica especializada. O modelo assim obtido é implementado no programa FEPARCS (ELWI E MURRAY, 1980), capaz de realizar análises númericas não-lineares através do método dos elementos finitos. Por fim, utiliza-se esse program para simular a resposta de uma estrutura de concreto com fibras, cujo ensaio experimental aparece minuciosamente descrito em (CRAIG, 1987). Os resultados numéricos obtidos são comparados com os experimentais correspondentes, em termos da curva carga versus deslocamento, desenvolvimento e distribuição de fissuras, progressão do escoamento da armadura longitudinal (convencional) e modo de ruptura. Avalia-se, então, a eficiência da implementação realizada na descrição do comportamento de estruturas de concreto com fibras. / [en] Along the past forty years, an increasing interest on composite materials formed by the addition of discrete fibers to a concrete matrix is being observed. These composites are known as fiber reinforced concretes. The interest on the use of fibers as reinforcement is justified by their significative contribution to concrete thoughness, as they reduce the brittle characteristics of that material. In fact, due to fiber reinforcement mechanism, fiber reinforced concrete can absorb much more strain energy until failure, in comparison to ordinary concrete. The cracking process seems to be more uniform, as the distance between cracks are reduced. Besides that, the material strength and the deformation levels at cracking and rupture are greater, on the case of fiber reinforced concrete. The benefits that fibers bring to concrete behavior indicate that they could be used as complementary reinforcent for concrete structures when ductility is a major design concern, or when high strength concrete is employed, as this class of material tends to be much more brittle then normal strength concrete. Fibers are also effective as shear reinforcement, and they could even replace stirrups in this function. In this work, a constituive model for fiber reinforced concrete is presented. This model is based on the formulation originally proposed by ELWI AND MURRAY (1979) for the case of ordinary concrete. The behavior characteristcs of fiber reinforced concrete are incorporated as adaquated uniaxial stress-strain relations in tension and compression. The behavior under shear stress is also considered. The model is then implemented in the finite element program FEPARCS (ELWI AND MURRAY, 1980). A numerical analysis on the response of a fiber reinforced concrete structure is conducted. Results reported in technical literature (CRAIG, 1987) are compared to those obtained by the finite element analysis. The efficiency of the model is then verified. / [es] En los últimos 40 anos, se ha observado un creciente interés por compuestos formados por la adición de fibras a matrizes de concreto, los llamados concretos reforzados con fibras. Ese interés se debe a la significativa ganancia en tenacidad que las fibras proporcionan, atenuando las características frágiles del concreto. De hecho, en virtud del mecanismo de refuerzo promovido por las fibras, el concreto con fibras es capaz de absorver mucha más energía de deformación hasta la ruptura, presentando, en el régimen posfisuración, un comportamiento mucho más suave que el concreto simple. Este comportamiento se ve acompañado por un proceso de fisuración más uniforme, en el cual se observan fisuras más finas y menos espaciadas. Además, se registran aumentos en los valores de resistencia del material y en los niveles de deformación que alcanza hasta su completa destrucción. Teniedo en cuenta los beneficios que las fibras aportan al desempeño del concreto, sería recomendable su empleo en extructuras donde la ductilidad es uno de los parámetros principales de proyecto, o en aquellas hechas con concreto de alta resistencia, ya que éstos presentan un comportamiento más frágil que los concretos de resistencia normal. En este trabajo, se presenta un modelo constitutivo para concreto reforzado con fibras que tiene como base la formulación hipoelástica de ELWI Y MURRAY (1979), originalmente propuesta para concreto simple. Las especificidades del comportamiento del concreto con fibras frente a las más diversas solicitudes, tales como, tracción, compresión y cisallamiento, se incorporan al modelo a través de relaciones tensión-deformación adecuadas a ese material. Tales relaciones provienen de estudios analíticos y experimentales sobre el asunto, publicados en la literatura técnica especializada. La implementación del modelo obtenido fue realizada a través del programa FEPARCS (ELWI Y MURRAY, 1980), capaz de realizar análisis númerico no lineal a través del método de los elementos finitos. Por fin, se utiliza ese programa para simular la respuesta de una extructura de concreto con fibras, cuyo ensayo experimental aparece minuciosamente descrito en (CRAIG, 1987). Los resultados numéricos obtenidos se comparan con los experimentales correspondientes, considerando la curva carga versus deslocamiento, desarrollo y distribuición de fisuras, progresión del deslizamiento de la armadura longitudinal (convencional) y modo de ruptura. Se evalúa entonces, la eficiencia de la implementación en la descrición del comportamiento de extructuras de concreto con fibras.

Flooding is an important concern for the UK, as evidenced by the many extreme flooding events in the last decade. Improved flood risk intervention strategies are therefore highly desirable. The application of hydroinformatics tools, and optimisation algorithms in particular, which could provide guidance towards improved intervention strategies, is hindered by the necessity of performing flood modelling in the process of evaluating solutions. Flood modelling is a computationally demanding task; reducing its impact upon the optimisation process would therefore be a significant achievement and of considerable benefit to this research area. In this thesis sophisticated multi-objective optimisation algorithms have been utilised in combination with cutting-edge flood-risk assessment models to identify least-cost and most-benefit flood risk interventions that can be made on a drainage network. Software analysis and optimisation has improved the flood risk model performance. Additionally, artificial neural networks used as feature detectors have been employed as part of a novel development of an optimisation algorithm. This has alleviated the computational time-demands caused by using extremely complex models. The results from testing indicate that the developed algorithm with feature detectors outperforms (given limited computational resources available) a base multi-objective genetic algorithm. It does so in terms of both dominated hypervolume and a modified convergence metric, at each iteration. This indicates both that a shorter run of the algorithm produces a more optimal result than a similar length run of a chosen base algorithm, and also that a full run to complete convergence takes fewer iterations (and therefore less time) with the new algorithm.

Un corpus de recherches en sciences sociales et en santé publique menées principalement en Amérique du Nord depuis les années 1980 montre que l'absence de logement personnel a un effet délétère sur l'état de santé, physique et psychique des familles sans logement. En France, les études quantitatives sur la santé des femmes sans-domicile restaient exceptionnelles avant la réalisation de l'enquête ENFAMS conduite en Ile-de-France en 2013. A partir des données de cette enquête, nous avons montré que, bien qu’elles soient plus jeunes que les femmes en population générale, la santé des femmes sans logement est plus mauvaise, en particulier en ce qui concerne leur santé mentale et leur santé nutritionnelle. Malgré un état de santé plus mauvais, les femmes sans logement ont moins recours aux soins que les femmes en population générale. Cette thèse a permis de souligner l’importance du suivi gynécologique dans l’accès au dépistage des cancers féminins puisque la proportion de femmes dépistées du cancer du col de l’utérus est deux fois plus élevée chez les femmes avec un suivi que chez celles sans suivi. Nous avons aussi montré que dans le contexte français d’une couverture maladie universelle et de l’existence de filets de protection sociale, nous ne retrouvons pas les associations classiquement observées entre renoncement aux soins et ressources financières ou assurance maladie. Les professionnels en soins primaires doivent s’appuyer sur les fenêtres d’opportunité de dépistage qu’offre chacun de leur contact avec les services de soins. Les stratégies d’amélioration à l’accès aux soins de ces femmes ne doivent pas seulement viser à lever les obstacles financiers. / Social sciences and public health research conducted mainly in North America, since the 1980s, have shown that homelessness has a significant impact on health, physical conditions and psychological health of families without housing. In France, quantitative studies on homeless women were scarce until the realization of the ENFAMS survey in Paris region in 2013.Based on data from this survey, we showed that, although younger than women in the general population, the health of homeless women is worse, especially with regards to their mental health and nutritional status. Despite their poor health, homeless women have less access to health care than women in the general population. Our research has highlighted the importance of gynecological follow-up in accessing women's cancer screening since the proportion of women who were screened for cervical cancer was twice as high among women with follow-up than among women without follow-up. We have also shown that in the French context of universal health coverage and numerous social safety nets, we do not find the classic associations between unmet health care needs and financial resources or health insurance status.Primary care professionals need to rely on windows of opportunity provided by each of their contact with health care services to make them benefit from cancer screening. Strategies to improve the access to health care of these women must not only aim to remove financial barriers.

The thesis deals with the creation for a numerical model of a solar collector with a phase change material as a heat storage medium. The model was implemented in Python. Using the created model, design optimization of several problems was carried out with the use of selected methods of heuristic optimization. The results of the behaviour of the created model and of design optimization were then analysed and evaluated.