Rozprawy doktorskie na temat „Strains emergence”

Human noroviruses (HuNoVs) are distributed globally, affect all age groups and place a significant burden upon health services. The diversity of this RNA virus is thought to play a significant role in the persistence of HuNoVs as the main cause of non-bacterial gastroenteritis globally. Molecular diagnostics have been critical for understanding the epidemiology of outbreaks and sporadic cases, and to design and implement effective intervention strategies and disease control measures. Immunocompromised individuals are widely considered to be a reservoir for epidemic variants of HuNoV and whilst there are studies investigating the emergence of novel strains in an immunocompetent general population, reports at the the individual level are scarce. Three separate methodologies were developed to characterise HuNoV persistence in acute convalescent and chronic infection. First, a standardised quantification method to accurately quantify the most prevalent HuNoV genogroup. Second, a PGM-MB capture method to select HuNoV prior to massively parallel sequencing (MPS). Third, an assay to measure host specific coproantibody responses to three epidemic variants from different epochs. Quantification of longitudinal samples from individuals with acute or chronic HuNoV infection showed the virus distribution was homogenous in stool and an RNA external standard, in contrast to DNA, did not underestimate virus titre. HuNoV PGM-MB capture meant near complete viral genomes could be recovered at variable mean coverage. A bioinformatics pipeline demonstrated over the course of chronic infection allele frequencies were much more variable. In acute infection, minor alleles were present at a much lower frequency, but potential immune escape mutants were present. Immune escape mutants existed as minority variants or conserved mutations in the consensus sequence, and were in the presence of HuNoV specific-coproantibody, which were mapped to the protein surface. In HuNoV chronic infection, immune pressure is variable or non-existent, and therefore epidemic variants could emerge over long periods of infection by random chance. However, under immune pressure exerted by coproantibodies, escape variants may be seen. In three individuals, acute HuNoV symptomatic infection occurred despite the presence of specific secretory Ab responses to the VLP classed as the closest phylogenetic relative. The closest relative (Sydney 2012), differed at two amino acids, one of which has been previously described (A340T) as belonging to an epitope, and another which can be classed as having a potential role in immune escape (A323T). A single individual with acute HuNoV infection established a more prominent response to an earlier strain of HuNoV, rather than two contemporary strains, which proposes a role for Original Antigenic Sin (OAS) or Antigenic Seniority in the secretory Ab immunity. Finally, the use of MPS in outbreak tracking was assessed and compared to the currently used amplicon and Sanger based method. Overall both methods showed significant correlation. However, MPS provided greater depth and the ability to identify variants among samples within an outbreak that represented consensus changes in one or more samples from the same outbreak. This meant that the MPS data would have been able to link all the samples into a single outbreak or transmission network, where the current Sanger sequencing may not have been able to link them all.

Aujourd'hui, les activités humaines comme l'exploitation de l'environnement (déforestation, chasse, agriculture...) et la mondialisation des échanges conduisent à l'émergence continuelle de nouvelles maladies dont la récente pandémie de COVID-19 n'est finalement qu'un exemple parmi une multitude d'autres. Au même moment l'humanité développe de nouvelles méthodes de lutte contre les agents infectieux, comme les antibiotiques et les vaccins, qui conduisent à l'émergence de nouveaux variants de pathogènes séculaires. La vaccination a par exemple conduit à la sélection de nouvelles souches de Corynebacterium diphtheriae et de Bordetella pertussis, les agents étiologiques de la diphtérie et de la coqueluche, respectivement. Dans mes travaux de thèse, je me suis dans un premier temps intéressé à la manière dont l'utilisation de vaccins à anatoxine contre C. diphtheriae pouvait conditionner l'évolution de cette bactérie pathogène. Pour ce faire, j'ai développé un modèle dynamique de type SIR. Ce modèle m'a permis de mettre en évidence que ce type de vaccin favorise la sélection de souches ne produisant pas la toxine diphtérique, principal facteur de virulence de C. diphtheriae. Je montre également que la compétition entre souches toxinogènes et souches non toxinogènes facilite l'éradication des souches toxinogènes, donc virulentes. Ainsi, la vaccination, combinée à la compétition entre souches, permet de réduire la circulation des souches virulentes de C. diphtheriae et de diminuer la prévalence de la diphtérie. Dans un deuxième temps, je me suis intéressé à identifier les facteurs environnementaux ayant un impact sur la vitesse d'émergence de nouvelles souches de pathogènes dans un contexte de vaccination de masse. Faute de données sur la diphtérie, j'ai étudié un jeu de données de souches de B. pertussis aux Etats-Unis. Plus précisément, je me suis intéressé à la vitesse de remplacement de souches sauvages de la bactérie par des souches mutantes déficientes en pertactine (PRN-), un antigène de surface présent dans une grande partie des vaccins en circulation. J'ai dû développer une nouvelle méthode pour analyser ces données, les approches traditionnelles se montrant inadaptées pour étudier un phénomène d'invasion par définition hautement autocorrélé dans le temps. Les résultats de cette analyse semblent indiquer que la température moyenne de l'environnement dans lequel ces souches circulent pourrait avoir une incidence sur la vitesse d'invasion des souches PRN-. Cependant, des analyses complémentaires ont montré que le jeu de données était finalement limité pour mettre en évidence un effet d'un facteur environnemental sur cette invasion. Dans un troisième temps, j'ai développé un modèle informatique et mathématique pour simuler la circulation de deux souches d'un pathogène type B. pertussis au sein d'une population mimant celle des Etats-Unis. Le but était in fine de produire des jeux de données artificiels similaires à celui étudié dans la partie précédente, pour vérifier comment pouvait fluctuer la qualité de l'échantillonnage et des estimations des cofacteurs telles que calculées dans le modèle précédent. Les résultats préliminaires de cette partie montrent que la dynamique de propagation d'un pathogène est un phénomène complexe, la rendant particulièrement difficile à étudier de manière rigoureuse. L'estimation des cofacteurs est biaisée par la qualité et la quantité des échantillons, et leur effet est alors difficile à mettre en évidence. Des travaux nécessaires sur ces aspects sont nécessaires. En conclusion, au cours de cette thèse j'ai employé diverses approches mathématiques et informatiques pour étudier la compétition entre souches de pathogènes dans un contexte vaccinal. J'ai pu mettre en évidence un rôle de la vaccination dans l'émergence de souches non virulentes, développé une méthode statistique pour étudier la vitesse d'émergence d'une telle souche, et étudié les forces et les limites d'une telle approche
Nowadays, human activities such as the exploitation of the environment (deforestation, hunting, agriculture...) and the globalization of trade lead to the continual emergence of new diseases, of which the recent COVID-19 pandemic is just one example. At the same time, humanity is developing new methods of combating infectious agents, such as antibiotics and vaccines, leading to the emergence of new variants of age-old pathogens. Vaccination, for example, has led to the selection of new strains of Corynebacterium diphtheriae and Bordetella pertussis, the etiological agents of diphtheria and pertussis, respectively. In my thesis work, I first investigated how the use of toxoid vaccines against C. diphtheriae could condition the evolution of this pathogenic bacterium. To do this, I developed a dynamic SIR-like model. This model enabled me to demonstrate that this type of vaccine favors the selection of strains that do not produce the diphtheria toxin, the main virulence factor of C. diphtheriae. I have also shown that competition between toxigenic and non-toxigenic strains facilitates the eradication of toxigenic, and therefore virulent, strains. Thus, vaccination, combined with competition between strains, reduces the circulation of virulent strains of C. diphtheriae and lowers the prevalence of diphtheria. Secondly, I set out to identify the environmental factors affecting the rate of emergence of new pathogen strains in the context of mass vaccination. In the absence of data on diphtheria, I studied a dataset of B. pertussis strains in the United States. More specifically, I was interested in the rate of replacement of wild strains of the bacterium by mutant strains deficient in pertactin (PRN-), a surface antigen present in a large proportion of vaccines in circulation. I had to develop a new method for analyzing these data, as traditional approaches proved unsuitable for studying an invasion phenomenon that is, by definition, highly autocorrelated over time. The results of this analysis suggest that the average temperature of the environment in which these strains circulate could have an impact on the invasion rate of PRN- strains. However, further analysis showed that the dataset was ultimately limited to highlight an effect of an environmental factor on this invasion. Thirdly, I developed a mathematical and computer model to simulate the circulation of two strains of a B. pertussis-like pathogen within a population mimicking that of the USA. The ultimate aim was to produce artificial datasets similar to the one studied in the previous section, in order to check how the quality of sampling and cofactor estimates calculated in the previous model might fluctuate. The preliminary results of this section show that pathogen propagation dynamics is a complex phenomenon, making it particularly difficult to study rigorously. The estimation of cofactors is biased by the quality and quantity of the samples, and their effect is therefore difficult to demonstrate. More work is needed on these aspects. In conclusion, in the course of this thesis I have employed various mathematical and computational approaches to study competition between pathogen strains in a context of mass vaccination. I was able to highlight the role of vaccination in the emergence of non-virulent strains, develop a statistical method to study the rate of emergence of such a strain, and study the strengths and limitations of such an approach

Le dioxyde d’azote (NO2), en tant que second polluant atmosphérique le plus meurtrier en Europe est un des plus préoccupants pour la santé humaine selon l’Agence Européenne de l’Environnement. Il est notamment connu pour être responsable de maladies cardiovasculaires, respiratoires ainsi que pour contribuer au vieillissement cutané et au développement de la dermatite atopique. Des facteurs endogènes à l’hôte tels que le microbiote cutané interviennent également dans cette pathologie. En effet, de nombreuses pathologies cutanées sont corrélées à un déséquilibre (dysbiose) du microbiote bactérien, un acteur essentiel du maintien de l’homéostasie de la peau. Or, il est fortement soupçonné que l’effet des polluants sur la peau implique des mécanismes d’action directe mais également un mécanisme d’action indirecte lié à l’altération du microbiote cutané par le polluant. En conséquence, il est pertinent d’aborder l’effet du NO2 gazeux (gNO2) sur le microbiote cutané bactérien. Cette thèse a donc pour objectif d’évaluer l’impact physiologique, morphologique et moléculaire du NO2 sur des souches bactériennes commensales d’espèces représentatives du microbiote cutané (Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus capitis, Pseudomonas fluorescens, Corynebacterium tuberculostearicum). Selon l’espèce, des réponses différentes au stress nitrosant généré par le gNO2 ont ainsi été mises en évidence ainsi qu’une tolérance plus importante au gNO2 pour certaines d’entre elles. Ces travaux suggèrent par conséquent que le NO2 pourrait contribuer à la formation d’un état dysbiotique du microbiote cutané et participer à l’action indirect du polluant sur la peau
Nitrogen dioxide (NO2), as the second most deadly air pollutant in Europe, is one of the most of concern for human health according to the European Environment Agency. It is notably known to be responsible for cardiovascular and respiratory diseases and also contributes to skin aging and atopic dermatitis. Host endogenous factors such as the cutaneous microbiota are also involved in this pathology, which is common in urban and suburban areas. Indeed, many skin pathologies are correlated to an imbalance (dysbiosis) of the bacterial microbiota, an essential player in the preservation of skin homeostasis. However, it is strongly presumed that the effect of pollutants on the skin involves direct mechanisms of action but also an indirect mechanism linked to the alteration of the cutaneous microbiota by the pollutant. Consequently, it is relevant to address the effect of gaseous NO2 (gNO2) on the cutaneous microbiota. This thesis aims to assess the physiological, morphological and molecular impact of gNO2 on commensal bacterial strains of representative species of the cutaneous microbiota (Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus capitis, Pseudomonas fluorescens, Corynebacterium tuberculostearicum). Depending on the species, different responses to gNO2-generated nitrosative stress were thus highlighted as well as a higher tolerance to gNO2 for some of them. This work therefore suggests that gNO2 could contribute to the formation of a dysbiotic state of the cutaneous microbiota and participate in the pollutant indirect action on the skin

Bakgrund: Vårdpersonal på akutmottagning besitter en högre autonomi, bredare kompetens samt högre nivå av teamarbete och kommunikation vilket har visat en lindrande effekt på arbetsrelaterad stress. Trots detta har tidigare studier rapporterat att sjuksköterskor som arbetar på akutmottagning i större utsträckning upplever arbetsrelaterad stress till skillnad från sjuksköterskor som arbetar inom andra vårdinstanser.  Motiv: Kvalitativ forskning inom det valda ämnet arbetsrelaterad stress hos sjuksköterskor på akutmottagning är limiterat och det föreligger brist på vetenskapliga studier som utförts på akutmottagning i Sverige. De besparings- och effektiviseringskrav vården står inför har resulterat i ökad arbetsbörda och arbetsrelaterad stress hos akutsjukvårdspersonalen. Motivet till studien var att bidra med en djupare kunskap om sjuksköterskors erfarenheter av stress på akutmottagning i norra delen av Sverige.   Syfte: Att belysa sjuksköterskors erfarenheter av arbetsrelaterad stress på akutmottagning.  Metod: Studien utfördes på ett mindre länsdelssjukhus i norra Sverige och kvalitativ metod innehållande enskilda intervjuer valdes då ambitionen var att studera sjuksköterskors erfarenheter av arbetsrelaterad stress. Kvalitativ innehållsanalys användes vid analys av textmaterialet. Resultat: Studiens fynd omfattade tre teman och dessa var; Att känna sig belastad och otillräcklig, Strävar efter kontroll samt Hinder inom verksamheten.  Konklusion: Sjuksköterskor på akutmottagning blir ofta utsatta för tidspress, hög arbetsbörda och prestationskrav vilket ökar risken för arbetsrelaterad stress. Stöd från arbetsgruppen i form av reflekterande samtal  är av stor vikt och det finns ett behov av reflekterande gruppsamtal för att förbättra det sociala stödet och teamkänslan på akutmottagningen.

This dissertation used a person-environment fit theoretical framework to examine the influence of person-job misfit as an organizational stressor on strain and well-being outcomes for emergency responders. Independent variables consisted of job attributes such as skill variety, task identity, task significance, autonomy and job-based feedback. These job characteristics are often used in work redesign efforts as they are amendable to organizational change initiatives. Dependent variables included strain outcomes relevant to those working in emergency services: physical symptoms, burnout, and secondary traumatic stress. Also, to include a positive aspect of emergency services work, the well-being outcome of compassion satisfaction was examined. Data were collected from 358 emergency responders across the United States via online survey, including law enforcement, firefighters, police/fire/medical dispatch, emergency medical technicians, and paramedics. Methodology utilized polynomial regression analysis in which joint linear and curvilinear effects from two predictors upon one outcome correspond to a three-dimensional response surface reflecting the fit-outcome relationship. This approach allowed a detailed examination of the nature of fit and the nature of misfit for each job attribute in relation to strain and well-being. Maximum likelihood with bootstrapping was used to estimate model parameters and test response surface features. Findings identified several influential fit-outcome relationships including skill variety fit-compassion satisfaction (a1 = 0.366), task identity fit-burnout (a2 = -0.083), task significance fit-burnout (a1 = -0.241) task significance fit-compassion satisfaction (a1 = 0.496,), job-based feedback fit-physical symptoms (a1 = -3.807), job-based feedback fit-burnout (a1 = -0.323), and job-based feedback fit-compassion satisfaction (a1 = 0.391). In terms of misfit, task identity misfit was related to secondary traumatic stress (a3 = -0.209) and job-based feedback misfit was related to burnout (a3 = -0.234). Conclusions regarding identified fit-outcome relationships suggested a potential to reduce frequency of physical symptoms, burnout, and secondary traumatic stress and increase employees’ experience of compassion satisfaction by considering employees’ preference for these job characteristics. On the basis of these findings, opportunities for Emergency Services Management agencies to facilitate wellness for personnel, as well as future research directions are discussed.

Tese de Doutoramento em Ciências Veterinárias na Especialidade Sanidade Animal
Salmonella serovar 1,4,[5],12:i:- is presently considered one of the major serovars responsible for human salmonellosis worldwide. A multidisciplinary approach, including the fields of epidemiology, spatial statistics, clinical and applied microbiology was used to perform an extensive characterization of Salmonella 1,4,[5],12:i:- isolates obtained by the National Health Institute Dr. Ricardo Jorge, which was lacking due to the recent emergence. It was observed that cases are reported in most districts, being more frequent in the Portuguese coastland. Spatial statistical analysis showed a significant geographic clustering, pointing out for the importance of evaluating these areas to identify risk factors, in order to establish adequate prevention programs. The most relevant antimicrobial profile in this serovar is the tetra-resistance pattern (R-type ASSuT), displaying resistance to ampicillin, streptomycin, sulphonamides and tetracyclines. A high occurrence of R-type ASSuT isolates was observed in the isolates under study, with the majority harboring the resistance genes frequently associated with the European clone, namely blaTEM, sul2, straA-straB, tetB. Additionally, resistance to quinolones and 3rd generation cephalosporin was also detected. In Portugal, the rapid spread of Salmonella 1,4,[5],12:i:- R-type ASSuT might be related with the diversity of pulsotypes and also the presence of a core of virulence factors, including biofilm production. Biofilm-forming ability varied between sample locations and collection year, and can be one of the virulence features related with the rise of this serovar. Furthermore, biofilm formation was evaluated in vitro using a simulated human intestinal environment. In such conditions was observed an impairment of biofilm production, revealing that conditions mimicking the human intestinal tract can influence the biofilm-forming ability of the isolates under study. This research highlight the critical importance of close surveillance of Salmonella 1,4,[5],12:i:- in Portugal, including R-type ASSuT isolates. Information gathered may unravel Salmonella 1,4,[5],12:i:- features, prevent the dissemination to other regions and also benefit the medical community in order to rationalize salmonellosis antimicrobial therapeutics.
RESUMO - Virulência de Salmonella Typhimurium 1,4,[5],12:i:-, a nova estirpe pandémica* - Salmonella é uma bactéria Gram-negativa pertencente à família Enterobacteriaceae, sendo uma das principais responsáveis pela morbilidade e mortalidade associadas a toxinfecções alimentares. Pode manifestar-se num espectro de sintomatologia variado, incluindo a gastroenterite, a bacteriémia e a infecção focal. Este género incluí mais de 2600 serovares descritos, distribuídos por apenas duas espécies: Salmonella enterica que inclui todos os serovares patogénicos para os humanos e Salmonella bongori. Actualmente, um dos principais serovares responsáveis pela salmonelose humana em todo o mundo é o 1,4,[5],12:i:-. Este serovar é uma variante monofásica de Salmonella Typhimurium, muito semelhante a nível molecular, sendo caracterizado pela ausência da expressão do gene fljB. Devido à sua recente emergência, estudos que avaliem este serovar são escassos, particularmente em Portugal, o que definiu o âmbito desta investigação, que teve como objectivo a caracterização epidemiológica e microbiológica, tanto do ponto de vista fenotípico e genotípico, de isolados de Salmonella 1,4,[5],12:i:- obtidos em Portugal a partir de diferentes origens, incluindo amostras humanas, animais e ambientais. Numa primeira fase foi realizada uma caracterização demográfica, epidemiológica e espacial de todos os casos de Salmonelose 1,4,[5],12:i:- humana notificados em Portugal pelo Instituto Nacional de Saúde Dr. Ricardo Jorge (INSA), durante um período de 10 anos, desde 2001 a 2011. Foram recolhidos dados sobre a origem, ano e mês de amostragem, género, idade, distrito e município de residência dos pacientes. Foi realizada a análise estatística descritiva, bem como, a análise estatística espacial através do software SaTScan™, combinada com análise através de software de georeferenciação, o QGIS™, de forma a caracterizar a epidemiologia e identificar agrupamentos espaciais de risco superior de infecção por Salmonella 1,4,[5],12:i:- em Portugal. Globalmente, observou-se que em Portugal, a maioria dos distritos tem casos notificados de infecção por Salmonella 1,4,[5],12:i:-. Verificou-se também um aumento da incidência durante o intervalo de 2004 a 2011, com um maior número de casos na região litoral do país, incluindo distritos como Porto, Lisboa e Aveiro, o que pode ser explicado pela maior densidade populacional nestas áreas. A maioria das infecções ocorreu durante Maio e Outubro, e o menor número em Fevereiro, afectando principalmente indivíduos jovens.[...]*O autor escreve segundo o antigo Acordo Ortográfico
This work was supported by National Health Institute Doutor Ricardo Jorge (INSA) and funded by Centre for Interdisciplinary Research in Animal Health (CIISA)
N/A

Emergency work is considered to be one of the most demanding occupations with significant social, physical and psychological consequences for the well-being of the emergency worker. Burnout, as well as its antithesis, work engagement, are two possible transactional outcomes impacting on the well-being of the emergency worker. Measurement of burnout and work engagement requires valid, reliable and culturally fair measuring instruments. However, research on burnout and work engagement in South Africa are characterised by poorly designed studies, a lack of sophisticated statistical analyses and poorly controlled studies. Furthermore, research paucity in terms of burnout and work engagement seems to prevail in the multicultural South African emergency worker context. A lack of norms for the Maslach Burnout Inventory – Human Services Survey (MBI-HSS), as well as the Utrecht Work Engagement Scale (UWES) makes the identification of burnout and engagement in the emergency services difficult. Consequently, investigating the reliability, validity, equivalence and bias would result in the standardisation of the MBI-HSS and the UWES, suitable for use in the multicultural emergency work setting. Amongst the factors that could play a role in the prevalence of burnout and work engagement are stress because of the demands of a job, a lack of job resources, as well as dispositional variables such as affect and situational variables, such as coping strategies. The operationalisation of occupational stress for emergency workers as well as information in terms of the standardisation of measurement of coping strategies for emergency workers in the South African context are lacking in the literature. The objectives of this research were to standardise the MBI-HSS, UWES and Coping Orientation to Problems Experienced (COPE) and to develop a valid and reliable occupational stress measure for emergency workers in South Africa. Another objective of the current study was to develop and test a causal model of burnout and work engagement of emergency workers, including occupational stress, coping strategies and affect. Finally, moderating effects of coping strategies and affect with regards to burnout and work engagement were tested for. The research method was by means of five separate articles, each consisting of a brief literature overview and an empirical study. A cross-sectional survey design was used. An accidental sample of emergency workers in Gauteng (N = 405) was used. The MBI-HSS, UWES, Emergency Worker Stress Inventory (EWSI), COPE, Affectometer 2 (AFM) and a biographical questionnaire were administered. Descriptive statistics, analysis of variance, correlations, principal component factor extraction, exploratory factor analysis with target rotations, canonical analysis, multiple regression analysis and structural equation modelling were used. Structural equation modelling confirmed 3-factor models of burnout (Emotional Exhaustion, Depersonalisation and Personal Accomplishment) as well as work engagement (Vigour, Dedication and Absorption). Internal consistency for the MBI-HSS and UWES was confirmed. Construct inequivalence was found for the Nguni group but not for the Afrikaans, English and Sotho groups. Item bias analysis revealed evidence of both uniform and no uniform bias for some items of the MBI-HSS, while no uniform bias was found for the UWES. In terms of the EWSI, a 3-factor structure was obtained by means of principal factor extraction with varimax rotation, namely lack of resources, job demands and inherent emergency work stressors. Principal factor extraction on the COPE revealed four factors, namely problem-focused coping, seeking social support, passive coping and turning to religion. Both the EWSI and COPE were found to be internally consistent. Construct equivalence was obtained for the Afrikaans, English and Sotho groups, but not for the Nguni group. Evidence of uniform bias was found for the EWSI, whereas no uniform bias was found for the COPE. Structural equation analysis showed that the lack of resources predicted the core of burnout, namely emotional exhaustion and depersonalisation. Problem-focused coping predicted personal accomplishment, while positive affect predicted emotional exhaustion. Work engagement was related to low burnout scores. Depersonalisation was associated with work engagement. Recommendations for the organisation and future research were made.
Thesis (Ph.D. (Industrial Psychology))--Potchefstroom University for Christian Higher Education, 2003.

Working with an organization outside the public school system that was creating schoolyard gardens, I began to think about culture and cultivation inside and outside of schooling practices. The liveliness of the schoolyard gardens presented possibilities for enlivening educational discourses. With two participants I planted a container box schoolyard garden outside Lamoureux Hall, which houses the Faculty of Education. Utilizing aspects of place-based pedagogy, ecoliteracy, ecopedagogy and a metissage of a/r/tography, eco-art and writing as a method of inquiry, we tended the garden and dwelled upon ideas of nature, culture, and their intersection in a particular place. Our garden experiences left cyber footprints in virtual space as blog spots on a thesis blog site. The garden and the inquiry it generated outside,is brought back inside the education building as a Master's thesis. The garden grew in different and unpredictable ways due to intense construction on site, entwining the planter boxes with unseen variables.

This thesis examines the construction of Aboriginality in recent public policy reasoning through identifying representations deployed by architects and supporters of the Commonwealth’s 2007 Northern Territory Emergency Response (the intervention). Debate about the Northern Territory intervention was explicitly situated in relation to a range of ideas about appropriate Government policy towards Indigenous people, and particularly about the nature, role, status, value and future of Aboriginality and of Aboriginal people and Torres Strait Islanders. This project involves analysis of constructions of Aboriginality deployed in texts created and circulated to explain and justify the policy program. The aim of the project is to identify the ideas about Aboriginality deployed by the intervention’s architects and supporters, and to examine the effects and implications of these discourses for political relationships between Indigenous people and settlers in Australia. This thesis will argue that advocates of the Northern Territory intervention construct Aboriginality in a range of important ways that reassert and reinforce the legitimacy of the settler colonial order and the project of Australian nationhood, and operate to limit Aboriginal claims. Specifically, it is argued that in linking Aboriginality to the abuse of Aboriginal children, the intervention’s advocates and supporters establish a political debate about the nature and future of Aboriginality within a discursive terrain in which the authority and perspectives of Indigenous people are problematised. Aboriginality is constructed in this process as both temporally and spatially separated from settler society, and in need of coercive integration into mainstream economic and political arrangements. Aboriginality is depicted by settler advocates of intervention as an anachronism, with Aboriginal people and cultures understood as primitive and/or savage precursors to settlers who are represented as modern and civilised. As such, the communities seen as the authentic home or location of Aboriginality represent a threat to Aboriginal children as well as to settlers. These constructions function to obscure the violence of the settler order, provide justification or moral rehabilitation for the colonising project, and reassert the sovereignty of the settler state. The resolution offered by the intervention’s advocates is a performance or enactment of settler sovereignty, representing a claim over and through both the territory of Aboriginal people and the discursive terrain of nationhood.

La Tension dans un Service d’Urgences (SU) est un déséquilibre entre le flux de charge des soins et la capacité de prise en charge sur une durée suffisante pouvant entrainer des conséquences néfastes au bon fonctionnement. Elle se reflète par la surcharge des locaux, l’allongement des délais de traitement et d’attente. Ce qui provoque à la fois l’insatisfaction des patients et l’anxiété du personnel. Cette thèse s’inscrit dans le cadre du projet HOST financé par le programme ANR-TECSAN-2011 afin d’élaborer un Système d'Aide à la Gestion de la Tension (SAGeT) assurant trois objectifs:1. L’évaluation multicritère grâce à une panoplie d’indicateurs agrégés par la logique floue afin de résoudre la subjectivité du ressentie humain de la tension. Chaque scénario d’évaluation déclenche des règles de décision spécifiques ciblant ainsi des points de défaillance à surveiller.2. L’anticipation de la demande sur différents horizons temporels : l’application des méthodes SARIMA et SARIMAX est justifiée par la saisonnalité des chroniques de visites et l’influence de certains paramètres externes (épidémies, vacances, météo). De plus, la qualité de l’information venant de l’historique a été améliorée par une recomposition d’historique basée sur la vraisemblance journalière.3. L’amélioration de la gestion des flux et le pilotage de l’activité puisque l’utilisation de SAGeT comme un tableau de bord offre une vue macro sur l’ensemble de l’activité (lits occupés, patients en attente, durées de passages prévisionnelles et allongements excessifs). Les simulations traitent des vrais scénarios de tension observés entre 2011 et 2013 dans le SU Pédiatriques Jeanne de Flandre du CHRU-Lille
He strain in an Emergency Department (ED) is an imbalance between the total demand load of healthcare treatment and resources ability to support it during a convenient horizon, which may results negative consequences on the smooth running of the activity. It is reflected by overcrowding, longer treatment and waiting times which causes both patients dissatisfaction and anxiety of personnel. This thesis is part of the HOST project funded by the ANR-TECSAN-2011 program to develop a Management Support System of Strain (MSSS) ensuring three objectives:1. Multi-criteria evaluation through a variety of indicators aggregated by fuzzy logic to solve the subjectivity of the human feeling of strain. Each evaluation scenario involves specific decision rules targeting to supervise failure points.2. Demand forecasting through several time horizons: applying SARIMA and SARIMAX methods is justified by the time series seasonality of visits and the influence of some external parameters (epidemics, holidays, weather). In addition, the quality of the historical information has been improved by a history rebuilding based on the daily likelihood.3. Improving flow management and activity monitoring since the use of MSSS as a dashboard provides a macro view of the whole activity (beds occupied, waiting, estimated length of stay, excessive elongation).The simulations address real strain scenarios observed between 2011 and 2013 in the Pediatric ED Jeanne de Flandre of the Regional University Hospital of Lille (France)

La prise en charge des flux des patients, en particulier les flux récurrents et consécutifs à des crises sanitaires (grippes, canicules, situations exceptionnelles) est l'un des problèmes les plus importants auquel les services des urgences (SU) doivent faire face. Pour gérer cet afflux de patients, les services des urgences nécessitent des ressources humaines et matérielles importantes, ainsi qu'un degré élevé de coordination entre ces ressources. Dans ces conditions, le personnel médical se voit confronté très fréquemment à des situations de tension qui compliquent très fortement sa tâche. L‘objet de cette thèse est de contribuer à l’amélioration de la gestion des situations de tension se produisant dans un service d’urgence en proposant un système d’aide à la décision, SAGEST (Système d’Aide à la décision pour la GEstion des Situations de Tensions), permettant i) le pilotage proactif du SU : prévision à court et/ou moyen terme de l'apparition de situations de tension et l'évolution du flux patients et la proposition d'actions de correction afin d'éviter l’occurrence de ces situations et ii) le pilotage réactif dans le cas où l'occurrence de la situation de tension n'a pas été détectée. Une architecture fonctionnelle du système SAGEST, s'appuyant sur le processus décisionnel du responsable du service d'urgence, est proposée. Les méthodologies et les modèles utilisés dans la construction des principales fonctions et de la base de connaissances sont décrits. Enfin, les résultats d’application des différents modèles du système SAGEST pour le service d’urgence pédiatrique (SUP) du centre hospitalier régional universitaire du Lille sont présentés et discutés
The management of patient flow, especially the flow resulting from health (flu, heat waves and exceptional circumstances) is one of the most important problems to manage in the emergency department (ED). To handle the influx of patients, emergency departments require significant human and material resources, and a high degree of coordination between these resources. Under these conditions, the medical and the paramedical staffs are often confronted with strain situations which greatly complicate their task. The main purpose of this thesis is to contribute to improving the management of situations of tension occurring in the emergency department by providing a decision support system, SAGEST. This DSS allows i) a proactive control of the ED: predicting at short and/or medium-term the occurrence of potential strain situations and proposing corrective actions to prevent the occurrence of these situations, ii) a reactive control in the case of no-detection of the strain situation occurrence. A functional architecture of the SAGEST system, based on the manager’s decision making process is proposed. Used methodologies and models embedded in the main functions and the knowledge base of the SAGEST system are described. Finally, experiments and results of different models of SAGEST system applied to the paediatric emergency department (PED) of the Regional University Hospital of Lille are presented and discussed

Thesis (M.S.)--University of Georgia, 2008.
Directed by Jeremiah Saliki. Includes an article publlished in Journal of veterinary diagnostic investigation. Includes bibliographical references (leaves 38-42).

碩士
國立中山大學
中國與亞太區域研究所
104
The present dissertation mainly discusses the role and function of the Government, Non-Governmental Organizations (NGOs), International GovernmentalOrganizations (IGOs) and International Non-Governmental Organization''s (INGO) under the circumstance of a natural disaster. This article attempts to compare cross-strait earthquakes through a case study of China Wenchuan earthquake and Taiwan 921 earthquake. We will explore and contrasts the emergency humanitarian assistance adopted by Taiwan during the 921 earthquake disaster and the one adopted by mainland China during the Wenchuan earthquake. When the disasters occurred what were the assistance actions of both countries Governments, NGOs, IGOs and INGO''s? Were there any difference between China Wenchuan earthquake and Taiwan 921 earthquake? Also, this article discusses the role and functions of Governments, NGOs, IGOs and INGO’s in these two different natural disasters. According to this study, we found that during the Taiwan 921 Earthquake, the emergency actions undertaken by the Government, NGOs and INGO show there was no single dominant mechanism of emergency assistance. Each of these institutions and organizations help each other to complete the rescue action. However, during Wenchuan earthquake, The Chinese mainland emergency action reflects the situation of a centralized government-led emergency relief. Furthermore, from the perspective of the Government, NGOs, IGOs and INGO, we can also see the humanitarian aid showed different pattern depending on each country.

碩士
銘傳大學
公共事務學系兩岸關係與安全管理碩士在職專班
101
There are many countries that experienced various natural disasters and non-conventional security threats in recent centuries. Human beings have been struggling against the Mother Natural. Some struggles are serious and have impacts on national security while others have minor impacts on personal health, life and asset safety which exemplifies “There is nothing without safety.” With the effects of globalization, the subject of “security” has become the core issue amongst the nations in the world. People began to be attentive to “security” and attached more importance to emergency management. In this context, both authorities of the Taiwan straits should initiate their cooperation in the areas of humanitarian rescue and low political ramifications in terms of crisis management and emergency preparedness. After the implementation of three-links policy in Taiwan, the development of economic activities has been booming and both air and surface transportations become necessary ways of movement. Therefore, unpredictable risks have become unavoidable coupled with maritime accidents. How to integrate maritime rescue resources, maintain sea navigation security and improve regional maritime rescue–related cooperation has become vital for both authorities of the Taiwan straits. Maritime rescue operations can be characterized as “humanitarian”, “mutual help” and “compulsory”. Countries that possess advanced maritime rescue technology and skill have already established sound maritime rescue operation system based on the principle of humanitarian rescue. This dissertation is focused on the study of maritime rescue mechanism of both sides of the Taiwan straits by analyzing related reports and documents as well as referring to the maritime rescue mechanisms of the United States and European countries.As a result, recommendations are made regarding maritime rescue cooperation mechanism and improvement options for the future development of cross-strait cooperation.

碩士
銘傳大學
公共事務學系兩岸關係與安全管理碩士在職專班
101
Cross-strait relations thaw and the risk of military confrontation reduced, however, confronting "non-traditional security threats,” there is the ever-increasing trend. For instance, Nantou Chi-Chi earthquake of Taiwan in 1999, Wenchuan earthquake occurred in Sichuan, Mainland China in 2008, the August 8th floods took place in southern Taiwan in 2009, H7N9 avian influenza in China in 2013 and so on. These non-traditional security crises have become a threat to part of the national security, and have tested the government''s ability to rule and govern profoundly. For a long period of time, China and Taiwan have been facing hidden dangers and risks by serious natural disasters. Due to the close geopolitical relations and the same language and race, establishing a cooperation mechanism to for Cross-strait for disaster prevention and relief is imperative. If China and Taiwan could work together, it will benefit the people of cross-strait. Since the disaster prevention and relief belongs to the field of humanitarian, its political sensitivity is relatively low; the feasibility of mutual cooperation is also higher. In this study not only the emergency rescue organizations, relief manpower, operating grouping, equipment and logistical information of United Nations, United States, Japan, Singapore and other countries are collected, the cases of China Earthquake Rescue Team and Taipei International Search and Rescue Team in Taiwan are also studied, by in-depth analyzing cross-strait emergency rescue organizations and cross-strait actual implementation of the rescue mission general situation, then to compare the differences. In spite of cross-strait cooperation on the implementation of international earthquake relief, there are still many constraints to be solved during the process. Therefore, this study aims to analyze and to compare the laws and regulations of the cross-strait relief organizations, mission mode, rescue energy and other aspects, so to enhance the capacity and level of cross-strait joint search and rescue and construct a safe rescue mechanism.

abstract: Infectious diseases are a leading cause of death worldwide. With the development of drugs, vaccines and antibiotics, it was believed that for the first time in human history diseases would no longer be a major cause of mortality. Newly emerging diseases, re-emerging diseases and the emergence of microorganisms resistant to existing treatment have forced us to re-evaluate our optimistic perspective. In this study, a simple mathematical framework for super-infection is considered in order to explore the transmission dynamics of drug-resistance. Through its theoretical analysis, we identify the conditions necessary for the coexistence between sensitive strains and drug-resistant strains. Farther, in order to investigate the effectiveness of control measures, the model is extended so as to include vaccination and treatment. The impact that these preventive and control measures may have on its disease dynamics is evaluated. Theoretical results being confirmed via numerical simulations. Our theoretical results on two-strain drug-resistance models are applied in the context of Malaria, antimalarial drugs, and the administration of a possible partially effective vaccine. The objective is to develop a monitoring epidemiological framework that help evaluate the impact of antimalarial drugs and partially-effective vaccine in reducing the disease burden at the population level. Optimal control theory is applied in the context of this framework in order to assess the impact of time dependent cost-effective treatment efforts. It is shown that cost-effective combinations of treatment efforts depend on the population size, cost of implementing treatment controls, and the parameters of the model. We use these results to identify optimal control strategies for several scenarios.
Dissertation/Thesis
Ph.D. Applied Mathematics for the Life and Social Sciences 2011

Dissertação de Mestrado Integrado em Psicologia apresentada à Faculdade de Psicologia e de Ciências da Educação
O atual contexto macroeconómico português tem-se revelado particularmente desfavorável para a população jovem. Tendo em conta que a adultez emergente é uma etapa do desenvolvimento marcada por um grande número de transições e pelos principais processos de exploração da identidade, torna-se relevante perceber como os jovens portugueses antecipam o seu futuro num cenário de incerteza e instabilidade macroeconómica. Deste modo, o presente estudo teve como principal objetivo investigar a orientação para o futuro (i.e., a representação subjetiva dos indivíduos sobre o seu futuro) de adultos emergentes portugueses. Pretendeu-se também analisar o efeito das variáveis sociodemográficas – sexo, idade, estatuto ocupacional, e nível socioeconómico da família (NSE) – na densidade da orientação para o futuro, bem como analisar a relação entre a orientação para o futuro e o stress económico reportado pelos jovens. Para tal, foi administrado um protocolo de investigação a 350 sujeitos, com idades compreendidas entre os 18 e os 30 anos (70.3% do sexo feminino; Midade = 22.4; DP = 2.6), que incluía a versão portuguesa do Hopes and Fears Questionnaire (Fonseca et al., 2018), um questionário de resposta aberta para a avaliação da orientação para o futuro, recentemente validado em Portugal. Os resultados demonstraram que a educação, o trabalho/carreira, e a família/casamento constituíram os principais domínios da orientação para o futuro reportados pelos participantes. Adicionalmente, verificou-se que indivíduos mais jovens (i.e., com idade inferior a 25 anos), não empregados e de NSE alto reportaram mais expectativas/receios relacionados com a educação, enquanto que indivíduos mais velhos, já empregados, e de NSE médio ou baixo mencionaram mais expectativas/receios relativos à propriedade, recursos financeiros, e família/casamento. Por último, verificou-se que o stress económico se associou a um maior número de expectativas/receios relacionados com as categorias relacionamento com a família, e recursos financeiros, além de um maior número de receios relativos ao lazer/viagens, e autonomia e estabilidade. Em suma, este estudo pretendeu dar um contributo adicional para a compreensão da orientação para o futuro na adultez emergente em Portugal, visando simultanenamente abrir caminho para a investigação sobre a influência do stress económico nas perspectivas dos jovens sobre as suas vidas futuras.
Currently, the Portuguese macroeconomic context has been particularly unfavorable for young people. Considering that emerging adulthood is a stage of development characterized by a large number of transitions and by the main processes of identity exploration, it is of utmost importance to understand how Portuguese youth anticipate their future in a scenario of macroeconomic uncertainty and instability. Therefore, the main goal of the present study was to evaluate the future orientation (i.e., the subjective representation of the individuals regarding their future) of Portuguese emergening adults. Additionally, this study intended to analyze the effect of sociodemographic variables – sex, age, occupational status, and socioeconomic status (SES) – in the density of the future orientation, as well as to examine the links between future orientation and economic strain as reported by emerging adults. To achieve these aims, 350 participants, aged from 18 to 30 (70.3% females; Mage = 22.4; SD = 2.6), answered to an assement protocol, which included the Portuguese version of the Hopes and Fears Questionnaire (Fonseca et al., 2018), an open-ended questionnaire for the assessment of future orientation, recently validated in Portugal. The results demonstrated that education, work/career, and family/marriage constituted the main domains of participants’ future orientation. Moreover, younger individuals (i.e., under 25 years of age), non-working, and with a higher SES reported more hopes/fears related to education, whilst older individuals, employed, and with a medium or low SES mentioned more hopes/fears regarding property, financial resources, and family/marriage. Lastly, it was found that economic strain was associated with a large number of hopes/fears concerning relationships with family, and financial resources, along with a larger number of fears related to leisure/travel, and autonomy and stability. In conclusion, this study intended to provide an additional contribute to the understanding of future orientation in emerging adulthood in Portugal, also aiming to lead the way to the investigation about the influence of economic strain in the views of young people about their future lives.

This research is concerned with the complex and contested relationship between the sovereign prerogatives of states and the international imperative of defusing world conflicts. Due to its historical setting following World War Two, the national vs. international staking of claims was framed within the escalating imperial-nationalist confrontation and the impending “end of empire”, both of which were significantly influenced by the role Israel played in this saga. The research looks at the issue of “decolonization” and the anti-colonial struggle waged under the leadership of Egypt’s President Nasser. The Suez War is analyzed as the historical event that signaled the beginning of the final chapter in the domination of the European empires in the Middle East (sub-Saharan decolonization followed beginning in the early 1960s), and the emergence of the United States as the new major Western power in the Middle East. The Suez experience highlighted a stubborn contest between the defenders of the concept of “sovereign consent” and the advocates of “International intervention”. Both the deployment of the United Nations Emergency Force (UNEF) and its termination were surrounded by controversy and legal-political wrangling. The role of UNEF and UN peacekeeping operations in general framed the development of a new concept for an emerging international human rights law and crisis management. The UNEF experience, moreover, brought into sharp relief the need for a conflict resolution component for any peace operation. International conflict management, and human rights protection are both subject to an increasing interventionist international legal regime. Consequently, the traditional concept of “sovereignty” is facing increasing challenge. By its very nature, the subject matter of this multi-dimensional research involves historical, political and international legal aspects shaping the research’s content and conclusions. The research utilizes the experience and contributions of several key participants in this pioneering peacekeeping experience. In the last chapter, recommendations are made –based on all the elements covered in the research- to suggest contributions to the evolving UN ground rules for international crisis intervention and management.
Graduate
hilmyh@uvic.ca