Yes / We explored carers experiences during the COVID-19 pandemic in England to identify long-term impacts and implications, and to suggest future support for caregivers. Data were collected during COVID-19 rapid response studies (IDEAL-CDI; INCLUDE) from carers participating in a British longitudinal cohort study (IDEAL). Semi-structured interview data were compared to their accounts from previous interviews conducted during the first 18 months of the pandemic. There was indication of some return to pre-pandemic lifestyles but without appropriate support carers risked reaching crisis point. Evidence points to a need for assessment and management of support needs to ensure well-being and sustainable dementia caregiving. / Economic and Social Research Council (ESRC) through grant ES/V004964/1. Economic and Social Research Council (ESRC) and the National Institute for Health and Care Research (NIHR) through grant ES/L001853/2. Alzheimer’s Society, grant number 348, AS-PR2-16-001.

Yes / Heart failure is a major global health challenge incurring a high rate of mortality, morbidity and hospitalisation. Effective medicines management at the time of hospital discharge into the community could reduce poor outcomes for people with heart failure. Within the Improving the Safety and Continuity Of Medicines management at Transitions of care (ISCOMAT) programme, the Medicines at Transitions Intervention (MaTI) was co-designed to improve such transitions, with a cluster randomised controlled trial to test effectiveness. The MaTI includes a patient toolkit and transfer of discharge medicines information to community pharmacy. This paper aims to determine the degree to which the intervention was delivered and identify barriers and facilitators experienced by staff for the successful implementation of the intervention. Methods: The study was conducted in six purposively selected intervention sites. A mixed-methods design was employed using hospital staff interviews, structured and unstructured ward observations, and routine trial data about adherence to the MaTI. A parallel mixed analysis was applied. Qualitative data were analysed thematically using the Framework method. Data were synthesised, triangulated and mapped to the Consolidated Framework for Implementation Research (CFIR). Results: With limited routines of communication between ward staff and community pharmacy, hospital staff found implementing community pharmacy-related steps of the intervention challenging. Staff time was depleted by attempts to bridge system barriers, sometimes leading to steps not being delivered. Whilst the introduction of the patient toolkit was often completed and valued as important patient education and a helpful way to explain medicines, the medicines discharge log within it was not, as this was seen as a duplication of existing systems. Within the CFIR the most applicable constructs were identified as ‘intervention complexity’ and ‘cosmopolitanism’ based on how well hospitals were networked with community pharmacies, and the availability of hospital resources to facilitate this. Conclusion: The MaTI was generally successfully implemented, particularly the introduction of the toolkit. However, implementation involving community pharmacy was more challenging and more effective communication systems are needed to support wider implementation.

No description available.

La modélisation dans le domaine de l'agro-écologie est importante car elle permet de mieux comprendre les interactions entre l'environnement et les activités humaines. Des travaux basés sur la simulation ont été développés depuis des années. Cependant, non seulement ces outils restent difficiles à utiliser par les utilisateurs non experts, mais aussi le coût des modèles rend leur utilisation difficile à case de la complexité élevée en cas d'application réelle. Nous proposons une approche qui consiste à représenter le système étudié dans un formalisme de système à événements discrets qui est bien adapté quand la dynamique du système est liée à des interactions entre les entités concernés. Ceci permet de profiter l'efficacité du model-checking pour étudier le comportement du système modélisé et d'utiliser la synthèse de contrôleur pour générer automatiquement des stratégies optimales. Nous présentons deux contributions dans cette thèse. La première contribution concerne le projet EcoMata. Cette modélisation qualitative en automates temporisés pour un réseau trophique marin de type proie-prédateur permet d'analyser l'écosystème à l'aide de model-checking sans avoir à faire des simulations. Des scénarios de requête prédéfinis ont été développés dans un langage naturel pour que les utilisateurs non expert puissent faire des requêtes sur les réseaux trophiques sans avoir des connaissances sur la langage TCTL. Nous avons amélioré la génération automatique d'automates temporisés à partir d'une description des équation Lotka-Votera. Nous avons aussi proposé une approche de synthèse de contrôleur pour générer automatiquement des stratégies optimales de gestion de pêche. Le prototype logiciel EcoMata implémente l'ensemble des propositions incluant la recherche de stratégies optimales. Dans la seconde contribution, nous proposons une modélisation hybride en automates temporisés d'une exploitation de pâturage. Cette modélisation hybride combine un modèle numérique de la croissance d'herbe et un modèle qualitatif des activités de pâturage. Une structure hiérarchique organise les modèles dans quatre couches: la couche biologique, la couche activité, la couche décisionnelle et la couche d'horloge. Nous proposons quatre méthodes pour générer des stratégies optimales des activités de pâturage. La première méthode est appliquée à la recherche de stratégies optimales de la mise au pâturage. Trois méthodes sont dédiées à la recherche de stratégies optimales de la fertilisation. Une d'entre elles utilise la synthèse de contrôleur alors que les deux autres combinent la synthèse de contrôleur et l'apprentissage supervisé pour générer des stratégies génériques par type d'exploitation. Un prototype logiciel PaturMata a été développé implémentant cette modélisation, permettant aux utilisateurs de simuler des scénarios de pâturage et rechercher des stratégies optimales de mise au pâturage. / The modeling in the domain of agro-ecology is important since it helps us to better understand the interactiosn between the environment and the human activities. Some research works based on simulation has been carried out during the recent years. Mainwhile, not only these simulation tools are difficult to use by the non expert users, but also the high complexity of models makes interactive uses impossible. We propose an approch in which we represent the system to be studied in a discret event system formalism. This kind of representation benefits the efficiency of model-checking and makes it possible to use controller synthesis to generate strategies. We present two contributions in this thesis. The first one concerns the project EcoMata. This project proposes a qualitative modelling which represents a marine prey-predator type food chain in timed automata. Predifined query patterns in natural langurage are also proposed which allow users to investigate easiy the food chain. We have improved the efficiency of the algorithm of timed automata generation and also developped a strategy synthesis method to generate best fishing management strategy. The prototype software EcoMata implements all these propositions including the best strategy synthesis. In the second contribution, we propose a hybrid modelling which represents grazing activities in timed automata. This hybrid modelling combines a numerical grass model and a qualitative grazing model. These sub models are organized in a hierarchical struture of four layers: the biological layer, the activity layer, the decision layer and the clock. We propose four methods to generate best grazing management strategy. One of these methods is applied to the movement of herd. The other three methods are applied to fertilization among which one of them use controller synthesis on timed automata and the other two combine controller synthesis and machine learning to generate generic strategy for a exploitation type. A prototype software PaturMata has been developped which implements this modelling method and the generation of the best strategy of herd movement.

Ce travail se propose de définir la place du jeu dans les pratiques de loisirs des enfants de 8 à 14 ans en identifiant les déterminations qui l’organisent et en esquissant une sociographie du jeu des enfants de cet âge. Il envisage le jeu comme un choix contingent sous contrainte, qui ne prend sens qu’à la lumière du système d’action concret dans lequel l’enfant évolue. Le jeu est une activité « sous contrainte », dont les contours sont esquissés par les adultes et dont l’occurrence est socialement organisée. La décision de jouer n’est pas une décision libre pour l’enfant. Elle est modelée par un ensemble de facteurs, matériels, sociaux et symboliques, qui viennent orienter, organiser et limiter son choix. La contrainte de temps, d’espace et le projet éducatif parental sont au cœur de ces contraintes. A partir de la question du jeu, il éclaire la question de la dépendance des enfants en donnant à voir ce que les « adultes font aux enfants » et la manière dont ils « réagissent aux situations qui leur sont faites ». En se penchant sur les pratiques de jeux des enfants, ce travail montre que le jeu est à la fois un espace de construction identitaire, de socialisation et de « libération dans l’imaginaire » des contraintes du quotidien. En replaçant le jeu dans le champ plus large des activités récréatives des enfants de 8 à 14 ans, il souligne le changement qui s’opère pendant cette période dans la vie des enfants et qui conduit à une évolution de leurs pratiques récréatives et à un déplacement du jeu vers de nouvelles sphères d’activités, plus fortement orientée vers la sociabilité entre pairs. / This research analyzes the place of play in the recreational practices of children aged 8 to 14. It focuses on how these theses practices are determined and describes play practices of children of this age. Play is not a free choice but rather it is conditioned by a larger social system, drawn by adults and organized socially. The decision to play is not a free decision for children. It is shaped by a combination of material, social, and symbolic factors that direct, organize, and limit their choices. Time, space and parental educational priorities act as major constraints in this process. The research draws light on the issue of children’s dependency, by analyzing what "the adults do to children" and how children "react to the situations in where they are placed”. By focusing on children’s game practices, this research indicates that play is not only a part of identity construction and socialization; it nevertheless also allows a symbolic way to escape the constraints of daily life and adults’ control. Looking at play and the broader field of recreational activities provides insights on the change that occurs between 8 and 14, change that modifies children’s recreational practices and initiates a shift towards new areas of activities, more oriented towards peers.

Ancré dans le champ du marketing interne, ce travail s’intéresse au phénomène de participation des salariés à la prise de décision. Inscrit dans le paradigme interprétativiste, il adopte une approche qualitative compréhensive et s’appuie sur une méthode d’étude de cas. Il est illustré par le cas de la démarche « Vision 2020 », mise en place auprès des salariés de la RATP en vue de la création du plan d’entreprise 2013-2020. Abordés dans une perspective systémique et interactionnelle, propre à l’approche communicationnelle de l’école de Palo Alto, les résultats émanent d’un raisonnement abductif et sont construits à l’aide d’un processus itératif d’allers retours entre la théorie, le recueil et l’analyse des données empiriques. Ainsi, l’analyse et l’interprétation des données recueillies par triangulation ont permis d’aborder la notion de participation selon trois angles, en se plaçant du point du vue des salariés : la conceptualisation du phénomène de participation, les objectifs et les effets de ce type d’initiative et les éléments pouvant exercer une influence sur l’attitude des employés envers celle-ci. Ce travail a par ailleurs souligné des enjeux majeurs inhérents à la participation des salariés, tels que le suivi de l’action participative, l’importance des supports, l’évolution de l’attitude des salariés lors de la mise en place de ce type d’action, ou encore le rôle particulier du manager dans ce type de démarche. Il constitue une théorisation de pratiques managériales existantes. / Anchored in the field of internal marketing, this work investigates the phenomenon of employee participation in decision-making. Inside an interpretivist paradigm, it adopts a qualitative and comprehensive approach, based on a case study method. We choose the case of the initiative "Vision 2020", set up with RATP employees in order to create the 2013 to 2020 business plan. Addressed in a systemic and interactional perspective, specific to the communication approach of Palo Alto, the findings result from an abductive reasoning and are built using an iterative process that goes back and forth between theory, collection and analysis of empirical data. The analysis and interpretation of data collected by triangulation thus allow us to address the notion of participation from three angles, adopting the point of view of employees: the conceptualization of the phenomenon of participation, the objectives and effects of this type of initiative and the elements influencing the attitude of employees towards it. This work highlights major challenges inherent in employee participation, such as the monitoring of participatory action, the importance of media, changing the attitude of employees during the implementation of this type action, or the special role of the manager in this type of initiative. It proposes a theorization of existing management practices.

A partir da promulgação da Resolução CNE/CEB Nº 2, de fevereiro de 2001, indivíduos surdos obtiveram a oportunidade de ser integrados à escola básica ao receberem acesso aos conteúdos curriculares presentes no Plano Nacional de Educação (PNE). Desde então vem se buscando metodologias que ofereçam uma educação que atenda a esses alunos de forma adequada, alicerçada não somente na linguagem verbal e escrita, mas também na primeira língua do surdo, a Língua Brasileira de Sinais (LIBRAS). Diante do desafio de propiciar o ensino, principalmente em ciências, algumas alternativas foram selecionadas a luz da Pedagogia Visual, que tem como principal alicerce o argumento de que indivíduos surdos apresentam uma capacidade visual muito além daquela possuída pelo indivíduo ouvinte. A primeira alternativa, denominada \"Mapa Conceitual\", se adéqua a Pedagogia Visual por sua estrutura em moldes de diagrama, porém ainda possui uma base muito ligada a linguagem escrita, o que dificulta o aprendizado em alunos que ainda não possuem uma fluência na língua portuguesa, ou seja, ainda não são bilíngues. Outra dificuldade se encontra nos primeiros anos do ensino fundamental, em que alunos surdos ingressantes não apresentam fluência nem mesmo em LIBRAS, mas exibem um sistema particular de sinais apoiados na visão. Esse déficit pode ser contornado pela segunda alternativa, denominada de \"Modelo Qualitativo\" baseado em Raciocínio Qualitativo (RQ). O modelo qualitativo além de apresentar uma base gráfica que atende a pedagogia visual, trabalha com modelos de causalidade, emulando um sistema da forma mais real possível para que o aluno o compreenda. Para a construção do modelo foi usado um simulador denominado de DynaLearn, desenvolvido com o objetivo de integrar o aprendizado do aluno por meio de modelos qualitativos. Para que isso aconteça foram (I) desenvolvidos modelos qualitativos sobre Poluição Humana baseados em RQ, por meio do software DynaLearn, que atendessem aos Parâmetros Curriculares Nacionais (PCN) do 6º Ano do Ensino Fundamental, especificamente em relação ao ensino de ciências. Em seguida (II) o modelo foi aplicado no ensino de Ciências Naturais, em regime de contra turno, para uma turma de alunos surdos proficientes em LIBRAS, porém deficientes em Língua Portuguesa do Ensino Fundamental I, que posteriormente (III) teve seu aprendizado avaliado por meio de questionários e transcrições das aulas. Conclui-se que a aplicação do modelo qualitativo atingiu seus objetivos ao levar os alunos a desenvolverem o raciocínio qualitativo por meio da compreensão das relações causais, da mesma maneira que o software DynaLearn satisfaz os requisitos visualização requeridos pela Pedagogia Visual, destacando alguns pontos que podem melhorar devido ao público-alvo. Também foi observado que a aquisição de conceitos científicos pelos alunos apresenta relação íntima com seus sinais correspondentes. / Since the enactment of Resolution CNE/CEB No. 2, February 2001, deaf individuals had the opportunity to be integrated into the basic school to receive access to curriculum content present in the Plano Nacional de Educação (PNE). Since then has been seeking methodologies that provide an education that attends these students adequately grounded not only in verbal and written language, but also in the first language of the deaf, the Brazilian Sign Language (known as \"Libras\"). Faced with the challenge of providing education, especially in science, some alternatives were selected in view of Visual Education, whose main foundation the argument that deaf people have a visual capacity beyond that possessed by the individual listener. The first alternative, called \"Concept Map\" fits the Visual Pedagogy by your diagram templates structure, however still has a very connected based written language, which hinders learning in students who do not have fluency in Portuguese, that is, they are not bilingual. Another difficulty is in the early years of elementary school, where new deaf students do not have fluency even in \"Libras\", but show a particular system of signs supported in the vision. This deficit can be overcome for the second alternative, called \"Qualitative Model\" based on Qualitative Reasoning (QR). The qualitative model besides presenting a graphical basis that meets the visual pedagogy, works with causal models, emulating a system more real as possible so that the student understands. For the construction of the model was used a simulator called DynaLearn developed with the aim of integrating student learning through qualitative models. To make it happen were (I) developed qualitative models on Human Pollution based in RQ, through the DynaLearn software, which met the National Curriculum Parameters (NCP) of the 6th year of elementary school, specifically in relation to science teaching. Then (II) the model was applied in the teaching of Natural Sciences, in counter-shift system, to a group of proficient deaf students in \"Libras\" but deficient in Portuguese of the elementary school, which later (III) had their learning assessed by through questionnaires and transcripts lessons. It is concluded that the application of qualitative model reached these objectives by bringing students to develop the qualitative reasoning by understanding the causal relationships in the same way that the DynaLearn software meets the requirements of view required by Visual Education, highlighting some points that can improve due to the target audience. It was also noted that the acquisition of scientific concepts by students presents a close relationship with their corresponding signals.

Multipel skleros, MS, är en neurologisk autoimmun sjukdom som drabbar centrala nervsystemet. Trötthet/fatigue upplevs av många som ett av de svåraste symptomen som inverkar starkt på det vardagliga livet. MS-relaterad fatigue/trötthet ger en känsla av utmattning och brist på energi som kan vara överväldigande. Tröttheten är orimlig i förhållande till de aktiviteter som utförs. Syftet med uppsatsen var att beskriva hur det är att leva med MS-relaterad fatigue/trötthet. Metoden som användes var litteraturstudie med kvalitativ innehållsanalys som baserats på åtta vetenskapliga artiklar. Dataanalysen skedde med hjälp av Fribergs (2006) beskrivning. Ur resultatet framkom fyra teman varav det första var upplevelsen av kroppen som ett fysiskt hinder. Detta tema belyser hur ett antal intervjupersoner upplever sin kropp som ett hinder och hur fatigue/trötthet begränsar och påverkar det dagliga livet. Tema två och tre beskriver hur relationer till familj och vänner kan förändras samt hur den psykiska hälsan påverkas. Det fjärde och sista temat handlar om hur personer som lever med denna trötthet lägger upp strategier och på bästa sätt planerar sin vardag för att orka mer. I diskussionen diskuteras begrepp som hälsa och sjukdom. Vi belyser också hur fysisk träning och annan självhjälp kan minska fatigue/trötthet och öka en människas psykiska hälsa. I de praktiska implikationerna tar vi upp vikten av information och kommunikation som vi anser är grunden till en god vårdrelation. / <p>Program: Sjuksköterskeutbildning</p><p>Uppsatsnivå: C</p>

Palliativ vård och vård i livets slutskede har på senare år uppmärksammats allt mer. I Sverige dör ca 90 000 människor per år och av dem dör ca 85 procent på institutioner. Vård av svårt sjuka och döende förekommer inom all hälso- och sjukvård. Palliativ vård - lindrande vård- påbörjas då kurativ vård - botande vård - inte längre är möjlig. Det övergripande målet med palliativ vård är att uppnå bästa möjliga livskvalitet för patienten och dennes familj. Det innefattar en livssyn som bejakar livet och ser döendet som en normal process men att arbeta som sjuksköterska med palliativ vård inom den slutna vården är ett område som i låg grad beskrivits inom forskning. Däremot finns mer studier gjorda som beskriver distriktssjuksköterskors och hospicesjuksköterkors upplevelser i att arbeta med svårt sjuka och döende patienter.Syftet med studien var att beskriva innebörden i sjuksköterskors upplevelser av att vårda patienter i ett palliativt skede och som vårdas inom den slutna vården. Studien är kvalitativ och vilar på en livsvärldsteoretisk grund. Åtta sjuksköterskorna inom den slutna vården intervjuades i anslutning till respektive arbetsplats. Intervjuerna analyserades sedan utifrån en fenomenologisk hermeneutisk ansats. Resultatet av sjuksköterskornas upplevelser presenteras i åtta teman: tacksamhet över att få ta del av en annan människas liv och avslut, att bli berörd av det kroppsliga och existentiella, att leva platsen och rummet, att ge och ta emot kraft/energi, öppenhet inför patienter och kollegor, att införliva kunskapen i sig själv, förmåga att göra om sig själv och tiden som inte finns. Den tolkade helheten handlar om innebörder av kontraster och det motsägelsefulla i vårdandet. I mötet med patienter som är nära döden, är det viktigt att veta hur vårdarna upplever sin situation. Ökad förståelse och kunskap inom området kan bidra till bättre vårdkvalitet för patienterna samt ge sjuksköterskor bekräftelse i det som de gör i denna prioriterade kontext. / <p>Program: Fristående kurs</p><p>Uppsatsnivå: D</p>

Cette thèse porte sur les médiums (tâng-ki, « l’enfant de divination »), leurs différentes pratiques et évolution au cours de l’histoire dans la société taiwanaise. L’enjeu est d’étudier ce domaine médiumnique en employant des approches de sociologie historique et anthropologie religieuse mettant en œuvre une démarche comparative de l’image du médium et de celle perçue après une enquête de terrain. Afin de saisir « le vrai visage » du médium. D’un point de vue méthodologique, cette thèse s’appuie sur une démarche qualitative et l’usage des entretiens directs avec les médiums et médiums apprentis. Le corpus se compose de cinq chapitres. Au chapitre I il y a les travaux de recherche sur les médiums à Taïwan d’où l’exemple du professeur Lin Fu-shih. Les évènements après la libération de l’île de Taiwan ont été relatés ainsi qu’une étude sur l’histoire de la religion à Taiwan basée sur les faits historiques marquants. Pour le chapitre II, la thèse s’articule autour des éléments du terrain où il a été présenté le récit de l’enquête que l’auteur lui-même a mené ; il s’agit de la structuration des temples : exemples de temples publics et privés qui se terminent par l’entrée au temple Tshú-nai. Le chapitre III se consacre principalement à l’univers du médium aux quatre terrains enquêtés marqués par des commentaires et interprétation. Au chapitre IV l’intérêt est porté sur la présentation et description du temple Tshú-nai. Au dernier chapitre, il y a les étapes d’initiation des pratiquants de tsáo-lîng-san (se rendre sur la montagne des esprits) et les histoires annexes des médiums apprentis. / This thesis deals with mediums in taiwanese community (tâng-ki, « the child of divination »), their different practices and how they evolved with time. It aims at studying the medium field using some historical social facts and religious anthropology and a comparative approach to the general image of mediums and that obtained through a field survey to let people know the “real face” of a medium. Methodologically, this thesis relies on a qualitative approach and direct questioning of mediums and mediums to be. The corps of this paper is divided into five chapters. Chapter I is about researches on mediums in Taiwan with reference to Professor Lin Fu-shih. It also presents events which happen after the liberation of the Taiwan Island and a study on relevant historical religious facts in Taiwan. Chapter II deals with the results of a survey. The story of this survey lead by the author himself is reported in this chapter. It is mainly about how temples are structured. The study of some public and private temples will lead to the presentation of Tshú-nai temple. Chapter III specifically covers the medium’s universe discovered in the four areas of the survey followed by commentaries and interpretations. In chapter IV, the thesis focuses on the presentation and description of Tshú-nai temple. The last chapter reveals the different steps of the tsáo-lîng-san believers’ initiation (which includes going to the Spirits' Mountains) and a supplementary history of mediums to be.