Reproduction de : Thèse de doctorat : Science et génie des matériaux : Toulouse, INPT : 2006. / Titre provenant de l'écran-titre. Bibliogr. 18 réf.

Thèse de doctorat : RONDON GONZALEZ : INPL : 2007. / Titre provenant de l'écran-titre. Bibliogr.

Reproduction de : Thèse de doctorat : Physique nucléaire : Lyon 1 : 2002. / Titre provenant de l'écran-titre. 50 réf. bibliogr.

This dissertation explores the question “how does a person who is a cancer patient finds their way to being a dying person?” Through the lens of modernism (Giddens), discourse analysis (Foucault), and philosophical hermeneutics (Gadamer) the author examines how the institution of cancer control is constituted, and how the cancer patient is co-constructed by this system and people entering into it as people needing cancer treatment. Language is explored to uncover meanings and discourses which help shape this experience and self-narrative of the cancer patients who face leaving the cancer control system and do or do not find their way to palliative care systems. From this perspective the more solitary and less shaped experience of ‘unbecoming a cancer patient’ is explored for those cancer patients whose treatment has failed. The liminal space between the expert systems of cancer control and palliative care is what is revealed and problematized. What is explored is what this liminal space between these two systems is, and how people who find or lose themselves in this space at this time might be met, without succumbing to the modernist temptation to create yet another expert system to manage what is explored. What is at stake for people at this time is their own self-narrative going on, and it was found for some people in a liminal space this self-narrative faltered. It is revealed that nurses are best positioned epistemologically to support people at this time, and the question of where this support ought to happen is explored in terms of the ideological fit within current health system alignments. This work adds an important theoretical rendering of the term liminality and has important implications for person centred nursing care and health system redesign. / Graduate

This paper examines three important and interrelated concepts pertinent to the provision of high quality health care namely care transitions, integration and leadership. The population focus is seniors over the age of sixty-five living within the geographical boundary who access care and services across the continuum. The examination illustrates some of the current challenges, opportunities, barriers and gaps identified in the literature and to draw out pertinent evidence to support future practices. Nurse leaders are well positioned to make a significant contribution to patient-centered care and integration by drawing together the strands of the management of care systems, cross-boundary working and thinking and the effective allocation of resources. / Graduate / 5069

Th. Univ.--Chimie moléculaire--Paris-Sud, 1990. / Résumé en anglais. Notes bibliogr.

L’atteinte prévisible des limites de la loi de Moore dans les dix prochaines années poussent les concepteurs de systèmes de communication à intégrer le maximum de fonctionnalités dans des modules 3D de plus en plus petits, incluant des capteurs, de l’intelligence embarquée, des modules radio avec leurs antennes,(Approche More than Moore). On passe donc du concept de SoC (System-on-Chip) au concept de SiP (System-in-Package) pouvant intégrer des SoC mais offrant d’autres fonctionnalités au niveau de la perception de l’environnement, de la communication, de la reconfigurabilité et de la possibilité d’auto-organisation en réseau ad-hoc, tout en minimisant le volume et la consommation énergétique.C’est dans ce contexte que s’inscrivent ces travaux de thèse, qui présentent cette technologie d’intégration hétérogène (System-In-Package) miniature, faible coût associant des MEMS RF à des circuits MMIC actifs et des antennes intelligentes pour établir des communications robustes en gamme millimétrique. Pour cela, nous proposons, par le projet SIPCOM, la réalisation et le test d’un module radio ultra compact et performant en gamme millimétrique grâce à une l’approche d’« intégration hétérogène ». Ce module intégrera toutes les fonctions nécessaires pour la réalisation d’un émetteur 60 GHz : le réseau d’antennes, les déphaseurs à base de MEMS pour assurer l’agilité du faisceau, le convertisseur DC/DC pour alimenter les MEMS, un FPGA (du commerce) pour commander la reconfigurabilité du module radio et les circuits mise en veille/réveil du module pour une consommation minimale. Dans ce contexte, ces travaux de thèse visent à développer la technologie de mise en boitier et les interconnexions et transitions verticales. Au cours de ce manuscrit, nous proposons une nouvelle approche de transitions verticales, les TSCV (Through Silicon Coaxial Vias). Transition verticale basée sur le modèle coaxial, utilisant du benzocyclobuitène (BCB) en guise de matériau diélectrique, son étude, son développement, et l’évolution de la structure sont présentés. Du fait de sa nature, cette transition coaxiale offre tous les avantages à la mise en boitier à haute densité d’intégration, avec une totale isolation électromagnétique par rapport au substrat, et donc une totale indépendance quant à la nature du substrat, un rayonnement électromagnétique parasites ultra faible et, par les propriétés du BCB, des pertes électromagnétiques ultra faibles en bande millimétrique. Nous détaillons également le procédé e réalisation technologique et son évolution, qui permet la fabrication et le test de ces structures. / Achieving predictable limits of Moore's Law over the next ten years, communication systems designers try to integrate a maximum of functionality into smaller and smaller 3D modules, including sensors, embedded intelligence, radio modules with their antenna (Approach More than Moore). So we go from the concept of SoC (System-on-Chip) to the concept of SiP (System-in-Package) that can integrate SoC but offering more features concerning the environmental perception, communication, reconfigurability and the possibility of self-organization in ad-hoc network, while minimizing the volume and energy consumption. This thesis was performed in this context and presents this heterogeneous integration technology (System-in-Package), miniature, low cost RF MEMS, combining MMIC circuits and smart antennas to establish communications in millimeter range. For this, by SIPCOM project, we propose the realization of an ultra compact radio module and efficient testing in millimeter range thank to “heterogeneous integration” approach. This module will integrate all the functions necessary for the implementation of a 60 GHz transmitter: network antennas, phase shifters based on MEMS to ensure the agility of the beam, the DC / DC converter to power the MEMS, an FPGA (trade) to control the reconfigurability of the radio module and circuit standby / alarm module for minimum consumption. In this context, the thesis aims to develop technology in packaging and interconnexions and vertical transitions.In this manuscript, we propose a new approach to vertical transitions, the TSCV (Through Silicon Coaxial Vias).Vertical transition based on the coaxial model, using benzocyclobutène (BCB) as a dielectric material, the study, development, and evolution of the structure are presented. Because of its nature, this coaxial transition offers all the advantages in packaging with high integration density, with a total electromagnetic isolation from the substrate, and thus completely independent of the nature of the substrate, an ultra low parasitic electromagnetic radiation, and by properties of the BCB, ultra low electromagnetic losses in the millimeter band. We also detail the process e technological achievement and its evolution, allowing the manufacture and testing of these structures.

Long wait times for elective services are seen as one of the major challenges for Canadian healthcare. Canadians report that they wait longer for specialists than citizens in other countries. An average of 25% of patients are waiting longer than evidence-based benchmarks in priority areas. One reason for this is that the referral process is poorly coordinated and leads to delays in care. Electronic referral is seen as a potential means of improving the referral process and enabling faster access to care. There is a major national initiative and multiple provincial initiatives that are looking to implement or expand electronic referral. However, existing projects have encountered challenges with user adoption. Therefore, it is critical that information about user perspectives on electronic referral inform future implementation. Before examination of the literature, frameworks for the evaluation of health information systems that could be relevant to electronic referral were examined. Then a literature review was conducted and aligned to the most suitable evaluation framework. This literature review found that the evidence from the Canadian perspective on electronic referral is sparse and that further study is needed. In addition, validated instruments have not been used to determine user perspectives and a formal qualitative methodology was only used in one study. Therefore, a mixed methods approach was undertaken to address these deficiencies. The System and Use Survey developed by Canada Health Infoway is a validated tool that was used to survey both users of faxed based referral as well as users of electronic referral. These two groups of users were then compared. As well, thematic analysis was used for the qualitative study to analyze interviews of users of electronic referral. This approach yielded a rich source of information that added significantly to the findings in the literature and addressed most components of the evaluation framework. The quantitative findings showed that most family physicians using fax were satisfied overall with the process. This highlighted how challenging any changes to this process would be to implement. Correspondingly, the overall user satisfaction was not significantly different between family physicians using fax and those using eReferral. There were, however, some significant results between family physicians using fax and those using eReferral, which were response time, the overall quality of referral information, completeness of the information, the timeliness of the information, and the format and layout of the referral information. It seemed that family physicians using eReferral were more satisfied by performance in these domains than family physicians using fax, although further research needs to be completed to verify this. The qualitative analysis highlighted user perspectives on the impact of electronic referral on the referral process, the usability of electronic referral, the experience with deployment, the effect on process outcomes, the improvement of patient outcomes as well as patient experience, the interaction with information technology, the importance of the content of the system, and the impact on society. The contribution from this mixed methods study to the currently available evidence can help to inform future deployment of electronic referral. / Graduate

Transitions are an inevitable part of the human experience. This inquiry aimed to investigate how psychologists experienced some personal transitions in relation to their clinical work. The two examples of transitions investigated were a personal bereavement and the decision to live without a Christian faith. There were two purposive samples of psychologists in this inquiry, one for each transition. This phenomenological study used an adapted version of Moustakas‟s heuristic inquiry which emphasised co-construction. This inquiry found that transitions affected the author‟s and participants‟ therapeutic practice in each study in idiosyncratic ways. Some effects were changes in personal philosophy, increased empathy and an increased ability to work therapeutically with clients experiencing transitions. Some of the implications of these affects were on the therapists‟ use of personal experiences in clinical work, fitness to practise and the development of empathy. Conducting this inquiry led to the researcher‟s personal and professional development, comparable to personal therapy. Examples of the researcher‟s personal development were increased self-reflection and ability to cope with vulnerability. Examples of the researcher‟s professional development were an increased understanding of transition theory and its application in clinical work, and a greater focus on facilitating clients to identify specific resources and coping mechanisms during transition. The implications of the findings of this inquiry for Counselling Psychology were on the importance of therapists‟ self-care and its promotion within applied psychology, the role of reflexive research methods in psychology training and the content of clinical supervision. Specific areas of further research were highlighted including targeted aspects of self-care, the personal effects of leaving religious sects and the relevance of research in the personal development requirement of training. Limitations of the studies were critiqued with reference to phenomenology and phenomenological methods and the use of an adapted version of heuristic inquiry.

Energy intensity in the U.S. from 1780 to 2010 shows a declining trend when traditional energy is included, in contrast to the "inverted U-curve" seen when only commercial energy is considered. The analysis quantifies use of human and animal muscle power, wind and water power, biomass, harvested ice, fossil fuels, and nuclear power. Historical prices are provided for many energy resources. The analysis reaffirms the importance of innovation in conversion technologies in energy transitions. An increase in energy intensity in the early 20th century is explained by diminishing returns to pre-electric manufacturing systems, which produced a transformation in manufacturing. In comparison to similar studies for other countries, the U.S. has generally higher energy intensity. A population-weighted series of heating degree days and cooling degree days partially explains differences in energy intensity. Series are developed for 231 countries and territories with multiple reference temperatures, with a "wet-bulb" series accounting for the effects of humidity. Other variables considered include energy prices, income per capita, and governance indices. A panel regression of thirty-two countries from 1995 to 2010 establishes GDP per capita and share of primary energy as determinants of energy intensity, but fails to establish statistical significance of the climate variables. A group mean regression finds average heating and cooling degree days to be significant predictors of average energy intensity over the study period, increasing energy intensity by roughly 1.5 kJ per 2005 international dollar for each annual degree day. Group mean regression results explain differences in countries' average energy intensity, but not changes within a country over time. Energy Return on Investment (EROI) influences the economic competitiveness and environmental impacts of an energy resource and is one driver of energy transitions. The EROI of U.S. petroleum production has declined since 1972, with a partial rebound in the 1980s and 1990s. External Energy Return (EER), which excludes the consumption of energy from within the resource, falls by two-thirds from 1972 to 2007. A literature review finds the projected EROI of oil shale to be much lower than the EROI of U.S. petroleum production.