HAL Portal Cnam (French National Conservatory for Arts and Crafts)
Not a member yet
31010 research outputs found
Sort by
Reduced-order Model of Water Distribution System Based on Graph Decomposition for Digital Twin Design
No full textThis article presents the first step chosen for the conception of a digital twin of water distribution networks (WDN), which consists in developing an exact reduced order model (ROM) of the system describing WDN based on graph decomposition. This model will be connected to data collected from sensors providing a real-time overview in order to propose solutions to be applied to the physical network. First, We will review some existing graph decomposition algorithms, then present the new results observed using the graph decomposition method applied to different WDN configurations. Finally, we will outline the future perspectives for the developpement of the digital twin
Improving Access to General Medical Care for French Nursing Home Residents: Evaluation of a Natural Experiment on the Quality of Drug Prescriptions
No full textInternational audienceSince 2017, the Paris Regional Health Agency has implemented an innovative program to address medical care shortages in nursing homes. The initiative provides funding for dedicated prescription time by physicians to care for residents without regular GPs. The program allocates subsidies based on a full-time equivalent (FTE) system, ranging from 0.10 to 0.90 FTE depending on resident numbers. Either general practitioners, specialists, or coordinating physicians can provide this service. Following a series of application calls between 2017-2019, 163 nursing homes (25% of the region's total) joined the program. The funding model uses a capitation system where 0.1 FTE (equivalent to a half-day per week) covers 10-15 patients. The initiative aims to ensure consistent medical monitoring while reducing polypharmacy risks and unnecessary hospitalizations.The purpose of the research was to determine the extent to which the care consumption of nursing homes residents can be affected by the introduction of a dedicated prescribing time for residents who do not have GP. To assess the causal effect of this time allocation, the methodology used is the “double differences” method. This method can be used because of the quasi-experimental nature of the deployment of the prescription support system, since the financing of this dedicated time did not concern all the nursing homes in the Paris region, but only some of them. The principle of this method is to compare the care consumption of residents in nursing homes benefiting from this dedicated time with that of residents in nursing homes not benefiting from it. In the specific context of our study, this method considers the fact that the introduction of this dedicated time did not take place, for all experimental nursing homes, in the same year, but over three successive years (2018, 2019 or 2020).The implementation of dedicated medical time significantly impacted prescription patterns and healthcare services delivery. Notable improvements emerged in the detection and treatment of previously underdiagnosed conditions, particularly depressive syndromes. The study observed a reduction in polypharmacy alongside increased screening procedures for biological, radiological, and dental issues.The analysis revealed distinct approaches between coordinating and non-coordinating physicians:- Non-coordinating physicians showed preference for single-treatment approaches, including anxiolytics and fluoroquinolone-based antibiotics, with increased reliance on biological testing and hospital referrals.- Coordinating physicians demonstrated greater focus on long-term treatment management, particularly in adjusting hypnotics and antidepressants prescriptions, while favoring safer antibiotic profiles and preventive care measures.The findings highlight not only the importance of physician specialization in geriatric care but also the effects of a regular presence in nursing homes for optimal resident care management. Coordinating physicians, with their geriatric expertise and institutional involvement, showed greater tendency toward preventive care and quality-of-life considerations, while non-coordinating physicians adopted more cautious, standard clinical approaches.These results suggest the value of promoting specialized geriatric training and supporting coordinating physicians in expanding their prescriptive roles within nursing homes. This could inform ongoing legislative discussions regarding the expansion of the French nursing homes coordinating physicians' prescriptive authority
La vie, le travail et la santé à l’épreuve de l’expérience contemporaine de la crise
No full textInternational audienc
Optimal Sizing and Energy Management for Multi-Energy Microgrids Integrated with Combined Heat and Power Unit
No full textInternational audienc
Comparative Evaluation of Robust Control Strategies for Grid-Tied Solar Generator Under External Disturbances
No full textInternational audienc
Transformer les activités vers un paradigme de soutenabilité forte dans les Commissions Locales de l'Eau : est-ce possible ?
No full textNational audienceLa qualité et les quantités d’eau disponibles dans les écosystèmes sont des indicateurs mesurés et suivis en France dans le cadre des Commissions Locales de l’Eau (CLE) depuis la loi sur l’eau de 1992. Les autres limites planétaires sont également en relation avec ces indicateurs, ce qui demande de réduire les pressions anthropiques sur ces limites de façon concertée. Certaines des activités humaines responsables de ces dépassements sont invitées à coopérer dans les CLE afin de stopper ou réduire ces problématiques. Crozier et Friedberg définissent le concept de capacités, qui sont l’habilité des acteurs à agir grâce aux instruments qui forgent leurs activités (ici, les CLE). Par une revue de littérature et par une transcription des luttes écologiques ayant lieu dans les CLE dans la théorie des capacités, je définis les capacités écologiques d’organisations ayant pour objectif de régénérer les écosystèmes. Je réalise des entretiens dirigés avec les acteurs de différentes CLE pour les évaluer. Je propose ensuite des ateliers sur les interdépendances (territoriales par le concept de nexus et internationales par le concept de systèmes sociotechniques) afin d’identifier les capacités supplémentaires nécessaires pour réaliser des changements sociétaux durables. Cette recherche n'a pas de résultats préliminaires (les entretiens dirigés sont en cours
Development of back-face coatings for the characterization of non-reflective and opaque materials by laser shocks
No full textInternational audienceThe present study intends to make possible the dynamic characterization of a non-reflective and opaque material using a laser shock test which must lead to the establishment of an equation of state and a constitutive law. The instrumentation used is a back-face velocity measurement by a green laser interferometry (VISAR). In this study,a metallic coating (aluminum) is added to the back-face of the non-reflective material to be characterized (here an elastomer). The influence of the back-face coating thickness on material characterization is studied experimentally and numerically. The experimental results indicate that, whatever the thickness of the metal coating, it is possible to determine the equation of state of the material using a simulation model. Limitations of the pro posed protocol are then finally discussed to get a constitutive law at loading up to 20 GPa. The role of a probable early damaging at the back-face of the sample and improvements proposals are given through numerical analysisof the shock tests
Vécu et évaluation qualitative de deux prototypes d’apaisement en psychiatrie
No full textInternational audienceObjectives - The need for alternatives to restraint and seclusion in psychiatry is widely recognized. To this end, a collaborative research project between patients, caregivers and designers resulted in the production of two containing prototypes (a covering armchair and a sensory totem). The aim of the research project was to understand whether these prototypes offered a calming alternative and could limit the need for restraint.Method - Semi-structured interviews were carried out as well as participant observations, and feedback forms were given to participants. Qualitative data analysis was integral and inductive, initially thematic and then oriented according to the “type of ward” variable.Results - The prototypes had beneficial effects on calming and empowering patients; they supported the patient-staff relationship and contributed to team reflexivity. Rather than pathologies, the prototypes responded to appeasement needs and situations of agitation or anxiety. For closed wards, the prototypes were therapeutic and supported patient autonomy in crisis situations. For open wards, they were integrated into the activities offered but needed to be accompanied by caregivers to ensure patient safety.Discussion - The results prompted discussion on three points: 1) research methods in psychiatry and the need to integrate users in research design; 2) conceptions of autonomy in psychiatric care; 3) the place of sensory rooms and soothing techniques in reducing the use of restraint and seclusion
