The impact of chronic diseases on people's daily lives and the exponential number of people affected is a major public health issue. The consequences on individuals and their families is significant, ...particularly in terms of quality of life. In the literature, this phenomenon is well described in terms of care policy and cost. Although there is a link between a supportive environment and empowerment, there is little literature describing a supportive environment and the daily lives of people living with cardiovascular disease. The objectives of this study are to identify the strategies people use to develop an enabling environment. It will be a qualitative ethnographic study that will address both human behavior and the notion of culture in a broad sense. In the context of this study, an orientation towards critical ethnography will be considered for its particular interest in vulnerable people and in the power relations that may exist in the socio-cultural system. Data will be collected directly in people's homes through observations and interviews with 10 people with cardiovascular disease. For each person, the data collection will take place over three days and will represent approximately 210 h of observation. This protocol was registered in the Research Register on 30 June 2021 and its number is 6933. This study will explore strategies for developing an enabling environment for people living with heart disease and eventually provide recommendations for nursing practices in terms of support.
A simple, fast and accurate Fourier transform mid-infrared spectroscopy method was developed for simultaneously determining sugar and organic acid contents in apricot fruit slurries using the ...attenuated total reflectance. The potential of this method coupled with chemometric techniques based on partial least squares was assessed by comparison with currently used enzymatic determination of sucrose, glucose, fructose, malic acid and citric acid. Fruits of eight contrasted cultivars harvested at different ripening stages were used in this study and randomly divided in a calibration set (505 apricots) and in a validation set (252 apricots). The most suitable region was found in the range between 1500 and 900
cm
−1. Good prediction performances were obtained (
R
2 ⩾
0.74 and RMSEP
⩽
18%). Results concerning the prediction of other quality traits such as firmness, skin colour, ethylene production, soluble solids content and titratable acidity were discussed.
► GLCM can be used successfully to investigate bolus formation during chewing. ► 60–73% of images were correctly classified in their respective chewing cycles. ► The contrast textural feature of ...images was the best marker of food breakdown. ► Kinetics of bolus formation varied between breads and subjects.
The methods currently used to characterise food breakdown during mastication are not easily applicable to cohesive and heterogeneous products such as white bread (baguettes). During this study, we investigated the applicability of image texture analysis to characterising the kinetics of bread bolus formation during chewing. Food boluses were collected from five subjects chewing four different breads after 10, 20 and 30 chewing cycles or at swallowing. Images were acquired and analysed using the Grey level co-occurrence matrix (GLCM) method. Food boluses were successfully discriminated: 60–73% of the images were correctly classified into their respective chewing cycles. Incorrect classifications arose from overlapping between subsequent cycles. Among the texture features the contrast was identified as being the best marker of food degradation. Different kinetics of bolus formation were observed between breads. This method revealed specific patterns of food degradation between subjects, which could be explained by their mastication behaviour and chewing efficiency.
Anticancer drugs are prescribed and administrated to an increasing number of patients on a daily basis. As a consequence, a number of concerns have been raised about the patient health and safety in ...the case that the drugs administered are not at the required concentration or even worse not the correct ones. Quality control of therapeutic solutions has therefore been extensively implemented in hospital environments, in order to avoid any failure in the intense workflow faced by administering pharmacists. In the present study, infrared (IR) and Raman spectroscopy have been employed for the analysis of 3 commercially available therapeutic solutions TEVA®, MYLAN®, CERUBIDINE®, respectively containing doxorubicin, epirubicin and daunorubicin. They perfectly illustrate the analytical difficulties encountered, as these 3 chemotherapeutic drugs are isomers, hardly distinguishable with conventional approaches such as UV/VIS spectrometry. Any analytical failure to identify these molecules can lead to delays in patient treatment. While Partial Least Squares Regression analysis demonstrates that both Raman and IR can deliver satisfactory quantitative analysis in the clinical range, with respective Root Mean Square Error of Cross Validation (RMSECV) between 0.0127 – 0.0220 g·L−1 and 0.0573 – 0.0759 g·L−1, the identification rate between the 2 techniques differs substantially. Indeed, Principal Component Analysis – Factorial Discriminant Analysis (PCA-FDA) highlights that, depending on the data preprocessing applied to Raman spectra, the discrimination between the 3 drugs is decreased, with in some cases specificity and sensitivity below 50%. However, IR analysis displays encouraging results with an overall specificity and sensitivity between 99 and 100%, suggesting that reliable validation of the therapeutic solution for administration to patients can be achieved. IR and Raman spectroscopy could assist and support quality control of chemotherapeutic solutions prepared in personalised concentrations for each patient. The effective and reliable characterisation of therapeutic solutions could have a lot to offer to improve current practices in a near future.
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•Raman spectroscopy delivers high quantitative performances for anticancer drugs.•Infrared spectroscopy is more specific for discrimination of therapeutic solutions.•Chemotherapeutic molecules and excipients contribute to spectral signatures.•Both approaches have potential for quality control in clinical environment.•Multivariate analysis remains essential for quantitative and qualitative analysis.
A non-destructive optical method based on near-infrared spectroscopy has been used for the evaluation of apricot fruit quality. Diffuse reflectance measurements (800–2500
nm), physical, physiological ...and biochemical measurements were performed individually on 877 apricot fruits from eight contrasted cultivars harvested at different ripening stages. Relationships between spectral wavelengths and quality attributes were evaluated by application of chemometric techniques based on partial least squares (PLS) on fruit set divided randomly into two groups: 598 fruits for calibration and 279 for validation. Good prediction performance was obtained for soluble solids and titratable acidity with correlation coefficients of 0.92 and 0.89 respectively and root mean square errors of prediction of 0.98% Brix and 3.62
meq
100
g
−1
FW respectively. For the other quality traits such as firmness, ethylene, individual sugars and organic acids, the prediction models were not satisfactorily accurate due to the high error of calibration and prediction.
Quality Improvement Programs (QIP) in cystic fibrosis (CF) care have emerged as strategies to reduce variability of care and of patient outcomes among centres facilitating the implementation of Best ...Practices in all centres. The US CF Foundation developed a Learning and Leadership Collaborative program which was transposed in France in 2011. Patient and parent involvement (P&PI) on the local quality teams (QTs) is one dimension of this complex intervention. The conditions and effects of this involvement needed to be evaluated.
In all settings, patients and parents were recruited by their centre care team. They were trained to QI method and tools and contributed their own expertise to improve the process of care. This involvement has been analyzed in the frame of the whole process evaluation. Observations and interviews conducted during the course of the first training year explored the motivations of the patients and parents to participate and the vision of the health care teams. A research study was carried out after three years with the patients/parents and the professionals to assess the French QIP's effectiveness using a questionnaire to report their opinions on various components of the program, including their experience of P&PI. Responses were analyzed in view of identifying consensus and dissensus between the two groups.
At the introduction of the program, P&PI was an opportunity for healthcare providers to reflect on their conceptions of these individuals both as patients and as healthcare system users. Curiosity about the teams' functioning, the various center organizations and outcomes led patients to overcome their initial barriers to participation. Seventy-six people including 12 patients/parents from the 14 pilot centres responded to the questionnaire after 3 years. Consensus between professionals and patients/parents was high on most items characterizing the performance of the QIP, QT effectiveness and QT functioning. Patients, parents and professionals agreed on the main characteristics of care such as an optimized organization, multidisciplinary care and patient-centredness. Regarding the use of patient electronic records, the use of care guidelines or the organization of support in the patient community, responses were not consensual amongst patients/parents and a source of dissensus between the two groups. All agreed that the French QIP created good conditions for their involvement. In the end, both groups agreed that it was difficult to attribute the paternity of some changes specifically to any member in the team.
Perspectives such as an educational framework to develop the skills and behaviors of professionals engaged in collaborative practice with patients and families and large patient experience surveys could be used to capture patients' experience of care in the improvement work.
Success factors for patient/parent long-term involvement in QIPs have been identified. Answers to questions raised by the stakeholders about the feasibility, efficiency and usefulness of P&PI in this CF QIP could be given but new questions arose about the sustainability of continuous quality improvement over time.
Ecotourism managers and researchers often assume that apparently habituated primate groups no longer experience adverse consequences of prolonged exposure to tourists or researchers. We examined the ...effects of tourists and researchers on fecal glucocorticoid metabolite output (FGCM) in three critically endangered, wild crested macaque (Macaca nigra) groups in Tangkoko Nature Reserve, Sulawesi, Indonesia. We assayed FGCM from 456 fecal samples collected from thirty-three adults. Tourists can walk through and among macaque groups freely. Hence, we examined the possible effects of tourists both (1) in the reserve when away and not interacting with the study groups and (2) when they were present within the macaque groups. Generalized Linear Mixed Model (GLMM) analysis indicated that when tourists were present in the forest, but not directly among the macaques, FGCM levels in the macaque tourism groups were higher in months with more tourists. When tourists were among the macaque groups, some female macaques experienced rises and subsequent postexposure decreases in FGCM levels, consistent with predictions for acute stress. Male FGCM levels increased with tourist numbers within the group. Nevertheless, they were not significantly different from levels during undisturbed or postexposure conditions. FGCM responses related to researchers in groups varied by group, sex, and tourist presence. However, the temporal patterning of FGCM responses showed little evidence of chronic stress from tourism at this site.
An agreement, signed in 2007 by the 49 French Cystic Fibrosis Centers, included a commitment to participate, within the next 5 years, in a care quality assessment and improvement program (QIP). The ...objective was to roll out in the French Cystic Fibrosis (CF) care network a QIP adapted from the US program for Accelerating Improvement in Cystic Fibrosis Care developed by The Dartmouth Institute Microsystem Academy (TDIMA) and customized by the US CF Foundation between 2002 and 2013.
The French national team at the Nantes-Roscoff CF Center of Expertise was trained at TDIMA and visited US CF centers involved in US Learning and Leadership Collaboratives (LLCs). It introduced the PHARE-M QIP in France by transposing the Action Guide and material. A PHARE-M LLC1 including seven centers, underwent two external assessments. Adjustments were made, then a PHARE-M LLC2 was rolled out at seven more centers in two regions. On-site coaching was strengthened. The teams' satisfaction was assessed and further adjustments were made. In 2014, the program sought recognition as a continuing education program for healthcare professionals.
Ninety-six trainees including 14 patients/parents from the 14 CFCs volunteered to participate, test and adapt the program during LLC1 and LLC2 sessions. Comparison of patient outcomes collected in the Registry report by CF center, reflection on potential best practices, selection by each team of an improvement theme, implementation of improvement actions, and exchanges between teams fostered the adhesion of the teams. The program strengthened quality of care, interdisciplinary functioning and collaboration with patients/parents at the centers. The satisfaction expressed by the teams increased over time. A post-PHARE-M cycle maintains the focus on continuous quality improvement (CQI). In 2015, PHARE-M was recognized as a continuing professional development program in healthcare.
The PHARE-M is a complex intervention in multidisciplinary teams working in a variety of hospital settings. A confluence of factors motivated teams to engage in the program. Involving Patient/Parent in quality improvement (QI) work and developing patient therapeutic education for self-management appeared to be complementary approaches to improve care. Incorporating the program into hospital continuing education insures its sustainability. Transparency of Patient Registry indicators per center published in a brief lapse of time is required to effectively support CQI. The impact of the PHARE-M on patient outcomes after 3 years is the subject of a research program funded by the French Ministry of Health whose results will be available in 2017.
The objective of this study was to investigate the possibility of predicting the quality parameters of tomato by mid-infrared spectroscopy. For 2 years, tomato samples, representing a large ...variability in the chemical composition, were scanned using the attenuated total reflectance accessory of a Fourier transform spectrometer in the wavenumber region between 4000 and 400
cm
−1
. Calibration models were developed using partial least squares (PLS) regression method and were tested with internal validation sample set in the first year. Different spectral preprocessing techniques were investigated and different spectral regions were selected to optimise the calibration models. In addition, the models obtained in 2007 were used to predict the soluble solids, dry matter and total acidity in tomato harvested in 2008.
The regression models of the spectra showed reasonable ability to estimate the dry matter, soluble solids, total acidity, citric acid and individual sugars contents in tomatoes grown in 2007, with high coefficients of determination (from 0.98 for soluble solids to 0.92 for fructose) and low percentage errors of prediction (from 3% to 7% for soluble solids and citric acid, respectively). By contrast, the predictive capability of model for malic acid was unsatisfactory with error of prediction of 26%. When the best calibration models from 2007 were used to predict the selected parameters in tomato picked in 2008, very high correlations were obtained, confirmed by low errors of prediction, from 4% to 7% for dry matter and total acidity, respectively. Mid-infrared spectroscopy is an attractive alternative for standard methods for determination of internal quality parameters in tomato.
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