What supports do health system organizations have in place to facilitate evidence-informed decision-making? a qualitative study

Background: Decisions regarding health systems are sometimes made without the input of timely and reliable evidence, leading to less than optimal health outcomes. Healthcare organizations can implement tools and infrastructures to support the use of research evidence to inform decision-making. Objectives: The purpose of this study was to profile the supports and instruments (i.e., programs, interventions, instruments or tools) that healthcare organizations currently have in place and which ones were perceived to facilitate evidence-informed decision-making. Methods: In-depth semi-structured telephone interviews were conducted with individuals in three different types of positions (i.e., a senior management team member, a library manager, and a ‘knowledge broker’) in three types of healthcare organizations (i.e., regional health authorities, hospitals and primary care practices) in two Canadian provinces (i.e., Ontario and Quebec). The interviews were taped, transcribed, and then analyzed thematically using NVivo 9 qualitative data analysis software. Results: A total of 57 interviews were conducted in 25 organizations in Ontario and Quebec. The main findings suggest that, for the healthcare organizations that participated in this study, the following supports facilitate evidence-informed decision-making: facilitating roles that actively promote research use within the organization; establishing ties to researchers and opinion leaders outside the organization; a technical infrastructure that provides access to research evidence, such as databases; and provision and participation in training programs to enhance staff’s capacity building. Conclusions: This study identified the need for having a receptive climate, which laid the foundation for the implementation of other tangible initiatives and supported the use of research in decision-making. This study adds to the literature on organizational efforts that can increase the use of research evidence in decision-making. Some of the identified supports may increase the use of research evidence by decision-makers, which may then lead to more informed decisions, and hopefully to a strengthened health system and improved health

Barriers, facilitators and views about next steps to implementing supports for evidence-informed decision-making in health systems: a qualitative study

Background: Mobilizing research evidence for daily decision-making is challenging for health system decision-makers. In a previous qualitative paper, we showed the current mix of supports that Canadian health-care organizations have in place and the ones that are perceived to be helpful to facilitate the use of research evidence in health system decision-making. Factors influencing the implementation of such supports remain poorly described in the literature. Identifying the barriers to and facilitators of different interventions is essential for implementation of effective, context-specific, supports for evidence-informed decision-making (EIDM) in health systems. The purpose of this study was to identify (a) barriers and facilitators to implementing supports for EIDM in Canadian health-care organizations, (b) views about emerging development of supports for EIDM, and (c) views about the priorities to bridge the gaps in the current mix of supports that these organizations have in place. Methods: This qualitative study was conducted in three types of health-care organizations (regional health authorities, hospitals, and primary care practices) in two Canadian provinces (Ontario and Quebec). Fifty-seven in-depth semi-structured telephone interviews were conducted with senior managers, library managers, and knowledge brokers from health-care organizations that have already undertaken strategic initiatives in knowledge translation. The interviews were taped, transcribed, and then analyzed thematically using NVivo 9 qualitative data analysis software. Results: Limited resources (i.e., money or staff), time constraints, and negative attitudes (or resistance) toward change were the most frequently identified barriers to implementing supports for EIDM. Genuine interest from health system decision-makers, notably their willingness to invest money and resources and to create a knowledge translation culture over time in health-care organizations, was the most frequently identified facilitator to implementing supports for EIDM. The most frequently cited views about emerging development of supports for EIDM were implementing accessible and efficient systems to support the use of research in decision-making (e.g., documentation and reporting tools, communication tools, and decision support tools) and developing and implementing an infrastructure or position where the accountability for encouraging knowledge use lies. The most frequently stated priorities for bridging the gaps in the current mix of supports that these organizations have in place were implementing technical infrastructures to support research use and to ensure access to research evidence and establishing formal or informal ties to researchers and knowledge brokers outside the organization who can assist in EIDM. Conclusions: These results provide insights on the type of practical implementation imperatives involved in supporting EIDM

Acetylsalicylic acid, aging and coronary artery disease are associated with ABCA1 DNA methylation in men

BACKGROUND: Previous studies have suggested that DNA methylation contributes to coronary artery disease (CAD) risk variability. DNA hypermethylation at the ATP-binding cassette transporter A1 (ABCA1) gene, an important modulator of high-density lipoprotein cholesterol and reverse cholesterol transport, has been previously associated with plasma lipid levels, aging and CAD, but the association with CAD has yet to be replicated. RESULTS: ABCA1 DNA methylation levels were measured in leucocytes of 88 men using bis-pyrosequencing. We first showed that DNA methylation at the ABCA1 gene promoter locus is associated with aging and CAD occurrence in men (P < 0.05). The latter association is stronger among older men with CAD (≥61 years old; n = 19), who showed at least 4.7% higher ABCA1 DNA methylation levels as compared to younger men with CAD (<61 years old; n = 19) or men without CAD (n = 50; P < 0.001). Higher ABCA1 DNA methylation levels in older men were also associated with higher total cholesterol (r = 0.34, P = 0.03), low-density lipoprotein cholesterol (r = 0.32, P = 0.04) and triglyceride levels (r = 0.26, P = 0.09). Furthermore, we showed that acetylsalicylic acid therapy is associated with 3.6% lower ABCA1 DNA methylation levels (P = 0.006), independent of aging and CAD status of patients. CONCLUSIONS: This study provides new evidence that the ABCA1 epigenetic profile is associated with CAD and aging, and highlights that epigenetic modifications might be a significant molecular mechanism involved in the pathophysiological processes associated with CAD. Acetylsalicylic acid treatment for CAD prevention might involve epigenetic mechanisms

Overview of the challenges of alternative propulsion systems applied to business aircraft

Abstract: In order to reduce greenhouse gas emissions and reach the 2050 net-zero emissions target, the aviation sector is looking towards new propulsion architectures, such as electric, hybrid-electric, and hydrogen powertrains. The integration of these kinds of new powertrain technologies has a significant impact on aircraft performance. The loss of performance typically consists of a range reduction, a reduced payload capacity, a lower cruise speed than the baseline aircraft, etc. Cost in capabilities does not have the same impact depending on business or commercial aviation, as these are two radically different markets. The travel routes for a given airline are constant and well-known, and a loss of aircraft performance capability may therefore be acceptable, this is not the case for business aviation due to hard operational constraints. The operational constraints of business aircraft are reflected in a higher cruise speed than commercial aviation, a flight altitude above commercial traffic, a long-range capability, high volume and comfort of the cabin, the capability to takeoff and land at small regional airports, and so on. Since the operational flexibility of the aircraft is at the heart of the business aviation market and dependent on these performance indicators, these requirements are necessary to maintain the high level of competitiveness of the aircraft. The literature mainly focuses on the greenhouse gas emissions reduction of retrofitted aircraft without considerations for keeping the same level of performance as the baseline aircraft. As business aviation is expected to experience growth in deliveries over the next few years, the assessment of the impact of alternative propulsion systems on the performance of aircraft is crucial. Since all new propulsion technologies for the mitigation of aviation carbon footprint have drawbacks, the integration of these systems should result in an acceptable trade-off between the operational capabilities of the aircraft and CO2 emissions reduction. This paper presents the cost in performance and the key challenges of alternative propulsion system integration of business aircraft. The analysis focuses on three main architectures, the all-electric powertrain, hydrogen-powered aircraft, and parallel hybrid powertrain. The objective is to provide an overview of business aircraft requirements, the impact of alternative propulsion systems on such aircraft, and the key challenges to meet the operational constraints of the business aviation market.Résumé de la communication présentée lors du congrès international tenu conjointement par Canadian Society for Mechanical Engineering (CSME) et Computational Fluid Dynamics Society of Canada (CFD Canada), à l’Université de Sherbrooke (Québec), du 28 au 31 mai 2023

Automatisation de la fonction de façonnage de deux têtes d’abatteuses-façonneuses : effets sur la productivité et le taux de conformité des billes façonnées

Pour rester compétitives, les entreprises forestières cherchent à contrôler leurs coûts d’approvisionnement. Les abatteuses-façonneuses sont pourvues d’ordinateurs embarqués qui permettent le contrôle et l’automatisation de certaines fonctions. Or, ces technologies ne sont pas couramment utilisées et sont dans le meilleur des cas sous-utilisées. Tandis que l’industrie manifeste un intérêt grandissant pour l’utilisation de ces ordinateurs, peu de travaux de recherche ont porté sur l’apport en productivité et en conformité aux spécifications de façonnage découlant de l’usage de ces systèmes. L’objectif de l’étude était de mesurer les impacts des trois degrés d’automatisation (manuel, semi-automatique et automatique) sur la productivité (m3/hmp) et le taux de conformité des longueurs et des diamètre d’écimage des billes façonnées (%). La collecte de données s’est déroulée dans les secteurs de récolte de Produits forestiers résolu au nord du Lac St-Jean entre les mois de janvier et d'août 2015. Un dispositif en blocs complets a été mis en place pour chacun des cinq opérateurs ayant participé à l’étude. Un seuil de 5 % a été employé pour la réalisation de l’analyse des variances, après la réalisation de contrastes. Un seul cas a présenté un écart significatif de productivité attribuable au changement du degré d’automatisation employé, tandis qu’aucune différence significative n’a été détectée pour la conformité des diamètres d’écimage; des tendances ont toutefois été constatées. Les conformités de longueur obtenues par deux opérateurs ont présenté des écarts significatifs. Ceux-ci opérant sur deux équipements distincts, cela laisse entrevoir l’impact que peut aussi avoir l’opérateur sur le taux de conformité des longueurs.All forest companies try to control their supply costs. Single-grip harvesters are equipped with onboard computers that allow control and automation of some functions. However, these technologies are not used on a regular basis and are in the best cases underutilized. While industrials are showing a growing interest in the utilization of these systems, there have been only a few studies that have documented the impacts of the use of these systems on productivity and quality conformity. The objective of this study was to measure the impacts on productivity and on bucking quality of different degrees of automation of the bucking of a single-grip harvester head. Three different automation degrees, manual, semi-automatic and automatic, have been compared with two different teams composed of 5 operators. Each operator was a different case study. Comparisons were realized on the obtained productivities and on the conformities of the logs lengths and topping diameters. Data collection was made on the logging sites operated by Resolute forest products, in the northern part of Lac St-Jean between January and August 2015. A 5% significance level has been used to realise the variances analysis, where contrasts were employed. Only one case study showed a significant productivity difference linked to the in the automation degree changes. Even if the collected data did not show significant differences on the topping diameters conformities, some tendencies were detected. However, significant differences were detected on the conformity of the lengths of the logs of two operators. Because those two operators work on different harvesters, this might show that the operator can have an impact on the lengths conformity

Coloration de graphes et attribution d'activités dans des quarts de travail

Revue de littérature -- Organisation de la thèse -- Lower bounds and a tabu search algorithm for the minimum deficiency problem -- On a reduction of the interval coloring problem to a series of bandwidth coloring problems -- About equivalent interval colorings of weighted graphs -- Une approche de programmation en nombres entiers pour la résolution d'un problème d'horaire -- Discussion générale et conclusion