Reducing ED wait times is a top health care priority for the Ontario government and hospitals in Ontario are incentivised to meet provincial ED wait time targets. In this study, we considered the costs and benefits associated with increasing the number of acute-care beds to reduce the time an admitted patient spends boarding in the ED. A shorter hospital LOS has often been cited as a potential benefit associated with shorter ED wait times. We derived a multivariable Cox regression model to examine this association. We found no significant association between ED boarding times and the time to discharge. Using a Markov model, we estimated an increased annual operating cost of $2.1m to meet the prescribed wait time targets. We concluded that increasing acute-care beds to reduce ED wait times would require significant funding from hospitals and would have no effect on total length of stay of hospitalized patients.

For a long time, the development of component-based systems has been a crucial part of real-time software development required for embedded and automotive domains. However, most of the existing tools used in these fields are not only proprietary, but also expensive and not research-friendly. Open-source tools in this domain are so far quite limited in terms of the features supported, especially, code generation. In this thesis, we demonstrate how we can improve the development of real-time and concurrent systems by the introduction of component-based modelling into Umple, an open-source modelling tool. Our work enables component-based modelling to be performed both textually and visually, as is the case with other Umple features. We introduce a number of major features into Umple. First, we introduce support for real-time C++ code generation. This includes supporting all Umple features, such as class diagrams, associations, state machines, and attributes. In order to achieve this, we also introduce Umple Template Language (Umple-TL), which helps Umple developers to use Umple itself to emit text using easy-to-use constructs, such that the text emitted can be in different target languages such Java and C++. Umple-TL provides additional capabilities relying on Umple being a model-oriented and object-oriented language. Umple-TL has become the technology for all code generation in Umple, not just our real-time C++ generators. Umple-TL also plays a vital role easing writing component descriptions Second, we support concurrency, which is crucial for the underlying architecture of composite structure. We have to avoid relying on any third-party libraries in order to make sure that the code generated will be deployable on embedded devices, which are limited and do not provide a lot of options. The concurrency pattern we follow extends the active object pattern aiming to enhance communication among active objects. Concurrency development in general, even if a programming language used is not real-time, is not easy. Hence, we simplify active object concepts, such as future, promise, and delay, using new Umple keywords. We also add composite structure support to Umple, we believe that our syntax and language constructs are comprehensive, and do not require a wide knowledge of modelling and UML concepts. Additionally, we introduce a novel protocol-free approach that dynamically extracts communication protocols from ports, bindings, and active objects as a way to simplify development, and to lead to concise and optimized code generation. We demonstrate the effectiveness of our work using cases studies, in which we implement Umple models using our new composite structure and concurrency constructs. We show that the amount of code required to specify complex concepts is reduced, and the generated systems are effective.

Orientador: Jose de Assis Fonseca Faria / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Engenharia de Alimentos / Made available in DSpace on 2018-08-04T01:05:22Z (GMT). No. of bitstreams: 1 Petrus_RodrigoRodrigues_D.pdf: 1772681 bytes, checksum: a2e739a7a3e2168d1c5de3ebe70fed22 (MD5) Previous issue date: 2004 / Resumo: O objetivo desta pesquisa consistiu na adaptação e avaliação do desempenho de um sistema asséptico piloto para leite fluido em garrafa plástica. O sistema foi avaliado através da identificação e monitoração sistemática de pontos de controle do processo, testes de esterilidade comercial, análises sensorial e físico-química do produto e avaliação da embalagem. Os pontos de controle foram monitorados antes e simultaneamente aos processamentos, a saber: tratamento térmico do leite; conformidade operacional da sala de envase, incluindo pressurização, taxa de movimentação de ar, contagem de partículas totais e microrganismos no ar e avaliação de limpeza e sanificação de superfícies; análise microbiológica da água de enxágüe da linha de processamento e envase, análise das embalagens e de sua água de enxágüe. Quatro lotes de 150L de leite com pH próximo a 6,7 foram processados entre 135 a 144ºC durante 10s em um trocador de calor a placas e acondicionados assepticamente em garrafas de polietileno de alta densidade (PEAD) de 500mL, em uma sala limpa ISO classe 7. A assepsia das embalagens foi feita através de aspersão de uma mistura contendo 0,5% de ácido peracético e 0,8% de peróxido de hidrogênio a 30ºC/10s. O leite processado através do sistema asséptico piloto avaliado foi comparado ao leite longa vida comercial em embalagens cartonadas e em garrafas plásticas de PEAD de alta barreira, aplicando-se testes de aceitação sensorial. Os resultados da avaliação dos pontos de controle do processo indicaram um bom desempenho apresentado pelo sistema desenvolvido, justificado pelas baixas contagens ou ausência de microrganismos nos pontos avaliados. Dos 4 lotes processados, 2 atingiram a esterilidade comercial, baseado nos critérios físico-químicos e microbiológicos adotados. A vida útil do produto, estimada através de testes sensoriais, atingiu 4 semanas para os dois primeiros lotes produzidos, 8 semanas para o lote 3 e 11 semanas para o lote 4. A opacidade das embalagens utilizadas na pesquisa foi de 90%, inferior a opacidade das embalagens comerciais, que foi de 100%. Portanto, a barreira à luz foi considerada insuficiente para a embalagem em avaliação, em virtude da elevada sensibilidade do leite à fotoxidação. Concluiu-se que o sistema asséptico piloto avaliado correspondeu às expectativas de desempenho, devendo, entretanto, ser submetido à implementação de melhorias em sua infra-estrutura para que possa ser eventualmente disponibilizado para processamentos em pequena escala, visando a produção de leite comercialmente estéril acondicionado em garrafas plásticas / Abstract: The objective of this research was the adaptation and performance evaluation of a pilot aseptic system for liquid milk filled into plastic bottles. The system was evaluated by identifying and systematically monitoring the process control points, by commercial sterility tests, sensory, physical and chemical analyses of the product and an evaluation of the packaging. The control points were monitored before and during process as follows: heat treatment of the milk; operational conformity during filling in the aseptic room including pressurization, air movement rate, total and viable particle count and evaluation of surface cleanliness and sanitation; microbiological analyses of the rinsing waters used in the process and filling lines and an analysis of the packages and their rinsing water. Four 150L batches of milk with pH values of about 6.7 were heat processed between 135 and 144°C for 10s in a plate heat exchanger and filled aseptically into 500mL high density polyethylene (HDPE) bottles in an ISO class 7 clean room. The aseptic condition of the bottles was obtained by spraying with a mixture containing 0.5% peracetic acid and 0.8% hydrogen peroxide for 10s at 30°C. The processed milk using the pilot aseptic system was compared by sensory analysis with commercial long life milk filled into carton-type packages and plastic bottles. The results of the microbial evaluation of the control points indicated good performance of the system developed based on the low counts and absence of microorganisms at some evaluated points. Of the 4 batches processed, 2 attained commercial sterility based on the physical-chemical and microbiological criteria adopted. The shelf life of the product, estimated according to the sensory tests, was 4 weeks for the first two batches processed, 8 for batch 3 and 11 for batch 4. The opacity of the packaging used was 90%, lower than that of commercial packaging, which was 100%. Thus the light barrier property was considered inadequate considering the high sensitivity of milk to the photooxidation. It was concluded that the pilot aseptic system evaluated corresponded to the performance expectations, however, it should be submitted to some implementations of improvements in its infrastructure in order to be recommended for small-scale commercially ile milk production / Doutorado / Doutor em Tecnologia de Alimentos

Bakgrund: Studier visar att mobiltelefoner används i operationsrummen både för tjänsterelaterat och privat bruk och det beskrivs för- och nackdelar relaterat till mobiltelefonanvändning inom sjukvården. Syftet: Var att beskriva och kartlägga användning av tjänstetelefoner och personalens privata mobiltelefoner i operationsrummen. Metod: Kvantitativ ansats, designen är en beskrivande tvärsnittsstudie med 40 strukturerade observationer i operationsrummen samt en enkätundersökning, som besvarades av 33 personer. Deltagarna var  anestesisjuksköterskor, läkare, operationssjuksköterskor och undersköterskor. Data analyserades deskriptivt i SPSS. Resultat: Observationerna i operationsrummen visade att av 477 telefonanvändningar var 287 (60,2 %) privata mobiltelefoner och 190 (39,8 %) tjänstetelefoner. Följsamheten till basalhandhygien riktlinjer före och efter telefonanvändning, n=477, var 93 (19,4 %) respektive 103 (21,5 %). Av enkäten framgick att 9 (27,2%) av deltagarna dagligen upplevde att användning av privata mobiltelefoner störde teammedlemmar i operationsrummen. Åtta (24, 2%) av deltagarna upplevde dagligen, 7 (21,7%) varje vecka, att medarbetare blev mindre koncentrerade på grund av användning av privata mobiltelefoner. Konklusion: Ökad följsamhet till basal handhygien, utformning av riktlinjer angående användning av privata mobiltelefoner i operationsrummen samt en diskussion angående vad som är etiskt riktigt i förhållande till patienterna kan anses som väsentligt. Ytterligare studier behövs för fortsatt kartläggning av användning och hantering av mobiltelefoner i operationsrummen. / Background: Studies show that mobile phones are used in the operating rooms for both service-related and private use, and the advantages and disadvantages associated with the use of mobile phones in the healthcare sector are described. Purpose: To describe and map the use of service phones and staff's private mobile phones in the operating rooms. Method: Quantitative approach, the design is a descriptive crosssectional study with 40 structured observations in the operating rooms and a questionnaire survey, which was answered by 33 people. The participants were anesthetic nurses, anesthesiologists, operating room nurses and assistant nurses. Data was analyzed descriptively in SPSS. Result: The observations in the operating rooms showed that of 477 phone uses, 287 (60.2%) were private mobile phones and 190 (39.8%) service phones. The adherence to basal hygiene guidelines before and after telephone use, n = 477, was 93 (19.4%) and 103 (21.5%), respectively. The survey showed that 9 (27.2%) of the participants experienced daily that the use of private mobile phones disturbed team members in the operating rooms. Eight (24, 2%) of participants experienced daily, 7 (21.7%) weekly, employees became less concentrated due to the use of private cell phones. Conclusion: Increased compliance with basic hand hygiene, designing guidelines regarding the use of private mobile phones in the operating rooms and a discussion regarding what is ethically correct in relation to the patients can be considered essential. Further studies are needed for continued examination of the use and management of mobile phones in the operating rooms.

Bakgrund: Hur patienter påverkas av att dela sal är ett ämne som är relevant för sjuksköterskor som arbetar på sjukhus med flerbäddsalar. För att kunna ge en personcentrerad vård utifrån individuella behov behövs kunskap om patienters upplevelser av att dela sal. Ämnet är aktuellt eftersom utvecklingen av nya sjukhus behöver ske med patienternas behov i centrum. Syfte: Att undersöka patienters upplevelser av att vårdas i flerbäddsal på sjukhus. Metod: En litteraturstudie av elva artiklar med kvalitativ ansats och en artikel med mixedmethod utfördes. För att systematiskt studera och strukturera patienternas upplevelser under analysprocessen hämtades inspiration från metoden innehållsanalys. Resultat: Fyra huvudkategorier utröntes – Samvaro, Integritet, Psykosocialt och Solidaritet. Ur dessa förvärvades tio kategorier genom analysen. Konklusion: Patienternas upplevelser av att vårdas i flerbäddsal var individuella, men vissa mönster uppenbarades. En stor del av patienterna upplevde fördelar såsom sällskap, gemenskap och stöd av att dela sal. Medan andra belyste nackdelar med att dela sal som till exempel bristen på privatliv och påverkan av medpatientens hälsotillstånd. Det är därför av vikt att sjuksköterskan är medveten om att patienter har olika uppfattningar om att dela sal och anpassar vården efter patienternas individuella behov. / Background: How sharing room impacts on patients’ experience is a relevant subject for nurses working at hospitals with multi-bed wards. To be able to provide person centred care there’s a need for knowledge about patients’ experiences of sharing room. The constant development of hospitals should be based on knowledge about patients’ needs and person centred care. Aim: To explore patients’ experiences of sharing hospital room. Method: A literature review of eleven articles with qualitative study design and one article with mixed method study design was performed. To systematically capture the patients’ experiences through the process analysis inspiration was taken from the method content analysis. Result: Four main categories appeared – Socializing, Integrity, Psychosocial and Solidarity. From these themes ten categories emerged through the analysis. Conclusion: The patients’ experiences of being cared for in a multibed room was personal but some patterns was recognized. A major part of the patients experienced advantages as company, socialization and support from sharing room. While others recognized disadvantages from sharing room as lack of privacy and the negative impact of roommates’ health condition. It is therefore of importance that nurses are aware that patients have different opinions about sharing room and should customize the care to the patients’ individual needs.

Dans cette thèse, nous montrons que nous avons réussi à observer des skyrmions isolés sub-100nm dans des échantillons Ir|Co|Pt. Ces observations ont été faites via deux techniques différentes : le STXM (technique synchrotron qui permet d’imager l’aimantation hors du plan de l’échantillon) et le MFM (technique de laboratoire qui permet d’imager le gradient de l’aimantation). Nous avons également montré que nous les avions observés à la fois dans les films étendus ainsi que dans des nanostructures (nanodisques de diamètre entre 200 nm et 1 μm, ainsi que les bandes dont la largeur varie de 400 nm à 1 μm). Nous avons également développé deux approches différentes pour estimer l’amplitude DMI dans les échantillons. La première est basée sur la périodicité des domaines dans les échantillons après désaimantation. La deuxième technique est basée sur l’évolution de la taille des skyrmions avec un champ magnétique appliqué hors-plan. Pour la nécessité des simulations micromagnétiques, nous avons également essayé de déterminer l’échange de nos échantillons. Avec cette valeur, le DMI trouvé dans nos échantillons est d’environ 2 mJ/m². Nous avons effectué une étude systématique sur des échantillons avec variation de différents paramètres: nombre de répétitions de la tricouche principale, épaisseur du Co, épaisseur du Pt, épaisseur de l’Ir, composition des couches d’Ir avec W ou AlOx. Nous avons montré que pour tous les systèmes, nous avons pu observer des skyrmions stabilisés à température ambiante grâce au MFM. Nous avons également observé que la densité des skyrmions diminue avec l’augmentation de l’anisotropie effective. / We have been able to successfully observe isolated sub-100nm skyrmions in Ir|Co|Pt samples. Moreover, we have been able to observe them with two different techniques: STXM - a synchrotron technique that maps the out-of-plane magnetization of a sample, and MFM - a laboratory technique that images the gradient of the magnetization. We have also shown that we have stabilized them in extended films as well as in nanostructures (nanodisks with diameter from 200 nm to 1 μm, as well as stripes with width from 400 nm to 1 μm). Secondly, we have developed two different approaches to estimate the DMI amplitude in samples. The first one is based on the mean domain periodicity in samples after demagnetization. The second technique is based on the size evolution of skyrmions with applied out-of-plane magnetic field. For the need of the micromagnetic simulations, we have also tried to determine the exchange stiffness of our samples. With this value, the DMI aplitude found in our samples is about 2 mJ/m². We have performed a systematic study on samples with variation of different parameters : number of repetitions of the main trilayers, Co thickness, Pt thickness, Ir thickness, composition of the buffer layers, and switching Ir with W or AlOx. We also observed that the density of skyrmions is decreasing with increasing effective anisotropy.

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