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<p><strong>Background and Objectives: </strong>Previous research has examined the effect of family physician continuity of care within end-of-life care cancer patients and its association with reduced use of acute care services. However, such research has not been examined in the end of life homecare cancer population.<strong> Objectives: </strong>To investigate the association of family physician continuity with location of death, hospital and emergency room (ER) visits in the last 2 weeks of life in end of life homecare cancer patients.<strong> Research Design: </strong>Retrospective study involving secondary data analysis of 7 linked databases<strong>. Subjects: </strong>All those who died of cancer between January 1, 2006 to December 31, 2006 in Ontario who had at least 1 visit to a family physician and enrolled in homecare for at least 2 weeks.<strong> Methods: </strong>The relationship of family physician continuity of care and location of death, and hospital and ER visits in the last 2 weeks of life was examined using logistic regression.<strong> Results: </strong>The Usual Provider of Care (UPC) measure demonstrated a dose response relationship with increasing continuity resulting in decreased odds of dying in the hospital and visiting the hospital and ER in the last 2 weeks of life. The Family Physician visits per week measure demonstrated a threshold effect relationship with location of death and hospital visits and dose response relationship with ER visits in the last 2 weeks of life. <strong>Conclusions:</strong> These results demonstrate an association between family physician continuity of care and location of death and visits to the hospital and ER in the last 2 weeks of life. This indicates the need for more involvement of family physicians in end of life cancer care.</p> / Master of Science (MSc)

<p>This thesis reports on the development of a Two Way Interactive Video eConsult System (TWIVES), a telemedicine application for the continuity of care in rural communities, remote areas, and in developing countries. In developed countries like Canada, there has been much development of complex telemedicine solutions that may not be suitable for rural communities in developing countries. TWIVES can be a useful alternative when mobility is limited, the patient is disabled, or commuting is not an option for the patient. This system is both easy and inexpensive to use, and operates well in the low bandwidth Internet connections available in these areas.</p> <p>TWIVES aims to facilitate an environment where users can securely request medical consultations from healthcare providers at distant locations, thereby saving time, money, and providing patients access to medical expertise that would otherwise not be available. TWIVES also introduces the concept of web-based submission of requests, replacing the existing traditional method of telephoning to arrange personal face-to-face appointments.</p> <p>TWIVES is a proof of concept (POC) designed and built with the Drupal framework, with particular attention paid to access control and user management, content management, custom search, private messaging and file sharing, request management, and real time video consultation. This thesis explain the purpose and features of TWIVES, its interfaces, what it can do, the constraints under which it must operate, and how it will react to external stimuli.</p> / Master of Science (MSc)

Background Our objective was to identify and validate clinical and continuity of care variables associated with Oral anticoagulant (OAC)-related adverse events within 30 days of hospital discharge amongst seniors. Methods and Analysis This was a population-based retrospective cohort study of all adults aged 66 years or older who were discharged from hospital on an OAC from September 2010 to March 2015 in Ontario, Canada. The primary outcome was a composite of the time to first hospitalization or Emergency Department visit for a hemorrhage or thromboembolic event or mortality within 30 days of hospital discharge. A Cox proportional hazards model was used to determine the association between the composite outcome and a set of prespecified covariates. A split sample method was applied to validate the final model. Results We included 120 721 Ontario seniors of which 5423 suffered one of the primary adverse events. Patients discharged on a direct-acting oral anticoagulant (DOAC); dispensed the same OAC in the past 12 months; who had a history of a thromboembolic event; had a recent joint replacement or major surgery; had a cardiologist, hematologist or orthopedic surgeon as compared to a family medicine physician as the physician prescribing the OAC at discharge had a lower risk for the composite outcome. Though continuity of care was a variable in the final multivariate Cox model, it was not significant. The Cox model was stable with acceptable discrimination but poor goodness-of-fit. Conclusion In this study, we found that continuity of care as measured by outpatient follow-up in the 7 days post-discharge was not significantly associated with the composite outcome. Further exploration to improve the current model’s calibration and interpretation are required. / Thesis / Master of Science (MSc) / Background Oral anticoagulants (OACs) are associated with serious adverse events, with high rates immediately post-hospitalization. We aimed to identify and validate clinical and continuity of care variables in seniors discharged from hospital on an OAC, which are associated with OAC-related harm in the short-term high-risk period following hospitalization. Methods Data from administrative health databases in Ontario were used to identify and validate risk factors associated with time to first OAC-related serious events including hospitalization or emergency department visit for a bleeding or thromboembolic event, and mortality. Cox proportional hazards model and split-sample methods were utilized. Results We included 120,721 seniors of which 5423 suffered one of the primary events. Patient-, physician- and index hospitalization-characteristics were all associated with time to the composite outcome. Though continuity of care risk factor was part of the final model, it was not a significant predictor for the outcome. Conclusion Exploration of this model through sensitivity analysis is required.

Increasingly, we are faced with the finite nature of space in the urban context. We struggle with a desire to preserve ties to the past and our need to create spaces that are relevant to current circumstances and contemporary social and cultural ideas. This thesis explores the possibilities of an approach to design which embraces both change and continuity, adding a new chapter to the legacy of a given place. An understanding of history as a process of development running continuously from past to present, rather than as a series of specific moments in time, provides a broader view of the ways in which the past is connected to the present. The inclusion of change as part of the past opens the way for new changes which continue the process of development. An exploration of Richmond, Virginia's Monroe Park, leading to a proposed redesign of the park, provides a case study for this approach. A combination of historical research, analysis of current circumstances, and design investigations culminates in a proposed design for Monroe Park which provides continuity with the past, embraces the present, and presents possibilities for the future. / Master of Landscape Architecture

El espacio de funciones integrables con respecto a una medida vectorial, amén de interesante en si mismo, sirve de herramienta para aplicaciones en problemas importantes como la representación integral y el estudio del dominio óptimo de operadores lineales o la representación de retículos de Banach abstractos como espacios de funciones. Las medidas vectoriales clásicas se definen sobre -álgebras y con valores en un espacio de Banach, y los espacios correspondientes L1( ) y L1w( ) de funciones integrables y débilmente integrables respectivamente, han sido estudiados en profundidad por numerosos autores, siendo su comportamiento bien conocido. Sin embargo, este contexto no es suficiente, por ejemplo, para aplicaciones a operadores definidos en espacios que no contienen a las funciones características de conjuntos o retículos de Banach sin unidad débil. Estos casos requieren que la medida vectorial esté definida en una estructura más débil que la de -álgebra, a saber, en un -anillo. Más aún, la integración con respecto a medidas vectoriales definidas en -anillos es la generalización vectorial natural de la integración con respecto a medidas -finitas positivas µ, que no está incluida en el contexto de las medidas vectoriales en -álgebras si µ no es finita. En consecuencia, las medidas vectoriales definidas en un -anillo también juegan un rol importante y merecen ser estudiadas así como sus espacios de funciones integrables. La teoría de integración con respecto a estas medidas se debe a Lewis y Masani y Niemi. En este trabajo estamos interesados principalmente en encontrar las propiedades que garanticen la representación de un retículo de Banach a través de un espacio de funciones integrables. El Capítulo 4 se dedica a este objetivo y contiene nuestro resultado principal. Algunas cuestiones interesantes aparecen de forma natural al intentar resolver este problema de representación abstracto. / Juan Blanco, MA. (2011). Vector measures on delta-rings and representation theorems of banach lattices [Tesis doctoral]. Editorial Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/11300