Primary health care (PHC) is a term used to refer to the parts of the health system that people interact with most of the time when health care is needed. It is considered the first point of contact for health services in Canada. Access to PHC services is an important issue regarding health care delivery in Canada today. There is a need to advance current understanding of access to PHC providers at local scales such as neighbourhoods. The primary objective of this study is to examine the variation in geographic (spatial) accessibility to permanently located primary care services in the Canadian urban environment. Furthermore, the analysis of spatial patterns of accessibility, both visually and statistically using GIS, is to provide a better understanding of among and between neighbourhood variations. This research took place in the 14 urban areas across Canada: Victoria and Vancouver, British Columbia; Calgary and Edmonton, Alberta; Saskatoon, Saskatchewan; Winnipeg, Manitoba; Hamilton, and Toronto, Ontario; Montréal and Québec, Quebec; Halifax, Nova Scotia; St. John’s, Newfoundland; Saint John, New Brunswick; and Ottawa–Gatineau, Ontario and Quebec. A GIS based method, the Three-Step Floating Catchment Area (3SFCA), was applied to determine the spatial accessibility to PHC services (accessibility score). First, for increasing geocoding match rates with reduced positional uncertainty, an integrated geocoding technique was developed after an empirical comparison of the geocoding results based on manually built and online geocoding services and subsequently applied to generate geographic coordinates of PHC practices which are an essential element for measuring potential access to health care. Next, the results of the Three-Step Floating Catchment Area (3SFCA) method was compared with simpler approachs to calculate the City level physician-to-population ratios and this research highlights the benefit of using the 3SFCA method over simpler approaches in urban areas by providing similar or comparable results of City level physician-to-population ratios with the advantage of intra-urban measurements. Further, the results point out that considerable spatial variation in geographical accessibility to PHC services exists within and across Canadian urban areas and indicate the existence of clusters of poorly served neighbourhoods in all urban areas. In order to investigate the low accessibility scores in relation to population health care needs, spatial statistical modeling techniques were applied that revealed variations in geographical accessibility to PHC services by comparing the accessibility scores to different socio-demographic characteristics across Canadian urban settings. In order to analyse how these relationships between accessibility and predictors vary at a local scale within an urban area, a local spatial regression technique (i.e., geographically weighted regression or GWR) was applied in two urban areas. The results of GWR modelling demonstrates intra-urban variations in the relationships between socio-demographic variables and the geographic accessibility to PHC services. In addition, the influences of “unit of analysis” on accessibility score were analyzed using spatial statistical modeling that emphasize the use of units of analysis that are pertinent to policy and planning purposes such as city defined neighbourhoods. Overall, this research shows the importance of measuring geographic accessibility of PHC services at local levels for decision makers, planners, researchers, and policy makers in the field of public health and health geography. This dissertation will advance current understanding of access to primary care in Canadian urban settings from the perspective of the neighbourhood.

Understanding transit usage has become a critical transportation research interest and policy goal. This thesis presents results of an analysis of the 2001 NHTS data specifically focusing on the newly released appended variables that measure access or distance to public transportation. Statistically significant public transportation distance intervals from households and individuals were chosen for analysis in relation to other key variables in the original dataset. Actual relationships between public transportation and traditional household and person characteristics nationwide are explored, specifically focusing on both rail and bus transit modes for the work commute trip. Geographically, both inclusions and exclusions in analysis are conducted due to the widely accepted ubiquitous transit network present in the NY region. The analysis reveals strong differences in household and workplace access to transit as a function of race, income, auto ownership, and urban area size. Additionally, a very high sensitivity to access exists suggesting that the share of transit accessible trips is smaller than previously acknowledged. Approximately 53 percent of households are within aviimile of bus service and 40 percent within a quarter-mile. Approximately 10 percent of the population lives within one mile of rail. Over 50 percent of workplaces are within a quarter mile walk radius of a bus line. Not surprisingly, work is more closely concentrated near transit than are residences. Furthermore, mode share for transit declines approximately two thirds beyond the first interval beyond 0.15 miles from a bus route. These observations imply a high value to services in close proximity to residential areas.Historical work in this topic area include geographically specific data analysis obtained from surveys which potentially allow a degree of subjectivity in perceived responses whereas accessibility and distance data analyzed in this thesis are actual and spatially measured. Additionally, a regression model exploring the significance of actual access to transit upon mode choice is performed to explore the significance of influence by measured access variables. The analysis suggests that access is even more critical than might have previously been acknowledged by the transit planning profession.

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This thesis is concerned with the challenges of devising a full-masked theatre performance that is largely accessible to audiences of every age, social background and culture. The contribution to original knowledge is in the study's examination of the relationship between the devising processes of a full-masked performance, neurobiology, human ethology and the accessibility of audience reception (Bennett, 1994). The thesis addresses the concept of accessibility by taking a phenomenological approach to devising and audience reception, with particular focus on the role of neurobiological systems and structures, in particular the mirror neuron system, the pleasure-reward system, and pattern recognition systems, in the communication and reception of performance meaning (McConachie, 2008). The research is framed by the concept of a universal theatrical language proposed by practitioners Peter Brook and Tadeshi Suzuki, which has the potential to connect people at the deepest levels of their humanity (Pavis, 1996: 6). Practical approaches adopted in the research are informed and supported by anthropological and human ethological claims of universality (Ekman, 1975; Brown, 1991; Eibl-Eibesfeldt; 2007 [1989]; Schmitt et al. 1997). This thesis theorizes that human beings possess innate neurobiological systems that interact with culturally specific concepts, conditions and knowledge in such a way that when deployed appropriately, these innate neurobiological systems can be a platform for human cognition and for the designing of performances accessible to an audience of different ages, social backgrounds and cultures. It also proposes that innate neurobiological systems create a universal framework that makes it possible for the said broad-based audience to read and receive a performance using similar codes of cognition and aesthetic reference irrespective of age, social and cultural backgrounds. The research process led to the creation of an original full-masked theatrical performance and eighteen performances of this piece were given to different audiences in a range of venues and locations in Northamptonshire. Qualitative and quantitative data analysis of how the various audiences received the performance suggest that the devising methods employed did contribute to making the performance accessible to an audience with a broader constituency than theaters normally envision (Pitts-Walker, 1994: 9-10). This research enables practitioners for whom a wide audience and accessibility are an explicit focus to adopt devising approaches that will help to achieve the desired wide-ranging reception and accessibility in mixed audiences irrespective of race, age, gender and culture.

This study examines how Design principles affect the view of Usability in Agile development. This case study has been conducted together with Uppsala Municipality’s Development department. The Design principles from Användningsforum and Government Digital Service are studied together with Agile development strategy to determine the influence on Usability. This is an empirical inductive study where data is collected and analyzed so that a theory may be presented. The thesis is based on qualitative data gathered from Uppsala Municipality’s development project and focus on the experience and attitude of the developers in the department. Data is collected through interviews and observations of the team members. Data is analyzed with Grounded theory approach. From the results it is concluded that the Design principles influence members of the department's awareness and focus on Usability when work with Agile development project.

Only one of the hillforts of southern Gwynedd has been submitted to a small excavation, and the forts in this study are quite forgotten in the larger British hillfort research. This thesis explores the forts’ possible uses through an analysis of their landscape setting, accessibility and view, architecture, internal features and archaeological setting. The result of the analysis show a variety of uses , for example related to occupation, trade, exchange or communication, agriculture and pastoralism, defence, religion and ritual. In addition, some larger patterns, connections and pairings of forts also come to light. Hopefully this study will lead to a heightened interest in, and future studies and excavations of the forts of southern Gwynedd.

This thesis undertakes two main tasks; to explore, within the authentic educational context, variables that influence the quality and outcomes of the knowledge-constructing activity during the simulation exercise; and to find appropriate instruments and methods to measure these variables, processes and outcomes. Closed-ended tasks that provided a high degree of structure, i.e., supported students’ regulation of learning during the simulation exercise, were more beneficial for perceived improvement of declarative knowledge and students’ motivation than open-ended tasks. Open-ended tasks did however lead to substantial shifts in students’ cognitive focus in subsequent laboratory exercises and improvement of students’ level of chemistry reasoning in interviews. Student attitudes toward learning proved important in the first paper where significantly higher ability to apply chemistry knowledge in interviews could be found for students with relativistic attitudes compared to those with more dualistic perspectives on learning. In the subsequent papers, the effects of attitudes were not as clear, possibly due to too small differences in the learning situations that were compared. Quality of the learning discourse during simulation was measured with three qualitatively different methods, focusing on partly different aspects. The different methods gave very similar results regarding the relative quality of the discourses. Thus, “quality” as such seems to be an underlying feature that permeates many aspects of the discourse and consequently could be targeted in different ways, e.g., focusing on quantitative as well as qualitative aspects. The analyses revealed several components of quality; co-operative activity, correctness and complexity of chemistry reasoning, discussion length and intensity, ability to realize cognitive conflict, and reference to theory while reasoning. Doing the simulation exercise in a distributed learning setting (written e-communication), supported discussions with higher accuracy and complexity of chemistry reasoning and frequent references to theory while the face-to-face situation allowed for longer and more intense discussions and a higher degree of co-operative activity. Not very surprisingly, high-quality discussions were characterized by high scores in all these components. There were indications that relatively good pre-knowledge might be required to benefit fully from face-to-face discussions. The validity of instruments and methods, used to measure flow experiences, attitudes (i.e., epistemological beliefs), knowledge accessibility (intuitive knowledge) and discourse quality are discussed thoroughly. Special interest has been devoted to whether qualitative data should be quantified or not, providing arguments in favor of quantitative methods for analyzing and reporting qualitative data.

The doctoral thesis explores accessibility of adult learning in the context of education policy of the European Union. On the political level, both in the European Union and Lithuania it has been increasingly recognized that in order to achieve the objectives set out in the Lisbon strategy lifelong learning is to become a reality only if the increasing demands of a multicultural society are taken into consideration. The thesis seeks to provide answers to the following research questions: How does accessibility of adult learning influence involvement in adult learning activities? What is the political context in the EU and Lithuania as regards accessibility of adult learning? To what extent factors of accessibility are influenced by cultural differences? Answers to these and other related questions highlight the basic guidelines of adult learning policies as reflected in the relevant legal documents of the EU and Lithuania. The thesis also analyzes interaction between adult learning and socio-economic environment. A thorough investigation of the literature in the field has served as a reliable means for singling out basic factors determining accessibility of adult learning. These factors are classified into subjective and objective, with further division of the latter group into socio-economic, individual, exclusion and cultural factors. / Disertacijoje analizuojamas suaugusiųjų mokymo(si) prieinamumas Europos Sąjungos politikos kontekste. Europos Sąjungos ir Lietuvos politiniame lygmenyje pradedama aiškiai suvokti, kad norėdami pasiekti Lisabonoje užsibrėžtų tikslų turime mokymąsi visą gyvenimą paversti tikrove įvertindami šį procesą įtakojančių veiksnių raišką daugiakultūrėje visuomenėje. Disertacijoje ieškoma atsakymų į tokius klausimus: kaip suaugusiųjų mokymo(si) prieinamumas įtakoja jų dalyvavimą švietime; koks yra politinis Europos Sąjungos ir Lietuvos kontekstas suaugusiųjų mokymo(si) prieinamumo atžvilgiu; kaip suaugusiųjų mokymo(si) prieinamumo veiksnius įtakoja kultūriniai skirtumai. Disertacijoje, remiantis išsamia tiek Europos Sąjungos, tiek Lietuvos teisinių dokumentų analize yra išryškinamos pagrindinės suaugusiųjų švietimo politikos gairės. Disertacijoje nagrinėjama suaugusiųjų mokymo(si) ir socioekonominės aplinkos sąveika. Remiantis moksline literatūra išskiriami veiksniai, lemiantys suaugusiųjų mokymosi prieinamumą. Jie skirstomi i subjektyviuosius ir objektyviuosius, o pastarieji į politinį, socioekonominį, individualųjį, atskirties ir kultūrinį veiksnius. Atlikti empiriniai tyrimai parodo kokią svarbą vienam ar kitam veiksniui suteikia Lietuvos gyventojai bei pagrindžia kultūrinio veiksnio būtinybę. Pateikiamos išvados apibendrinančios suaugusiųjų mokymo(si) prieinamumą lemiančius veiksnius.

Results: QMS have been implemented in 63.9 per cent of the Lithuanian general hospitals. This system is currently under implementation in 22.2 per cent of the hospitals mentioned, and no QMS have been implemented so far in 13.9 per cent of the Lithuanian general hospitals. More than one third of institutions have implemented the ISO standard. Institutions wich have alredy implemented the QMS enjoy higer patient satisfaction (accordingly 5,36 (1,05) and 4,18 (2,14)), improved quality of the services provided (accordingly 6,09 (0,32) ir (4,83 (1,64)). The functioning QMS improves motivation of the employees (4,60) and the patient safety (5,83). Hospitals with the well-functioning QMS more actively record (accordingly 4,78 (2,19) and 2,73 (1,62)) and analyse adverse events (accordingly 5,41 (2,01) and 3,09 (1,97)). Recording of adverse events helps to identify problems (6,41), improve the quality of the services provided (6,13). Conclusions: 1. QMS have been implemented in more than a half of the Lithuanian general hospitals. The hospital managers and the managers of the local medical audit group acknowledge important role of the QMS. 2. Hospital managers and managers of the local medical audit group implementing the QMS in hospitals have encountered with the following problems: the employees avoid recording adverse events, the staff lacks motivation to engage in implementation of the quality management system, hospitals lack employees competent in the field of quality... [to full text]

The presence of disability in the political sphere has increased with the enactment of the Accessibility for Ontarians with Disabilities Act (AODA) in 2005. In 2008, implementation of the first standard focused on Customer Service began in accordance with the AODA. While this legislation was in its early phase, it was crucial to conduct research to understand the ways the legislation was being expressed in practical terms. Research makes it possible to point to areas of unmet promises between theoretical and practice application of the AODA so that it may attain its full potential. The purpose of this study was to conduct a narrative policy analysis during the implementation phase of the AODA to identify the parallel and divergent stories that arise from policy actors. Using an interpretive stance, this study was conducted with key people who played a role in implementing the AODA in the municipal recreation context. Participants included both persons responsible for implementing the AODA (i.e., city employees) and people with disabilities who have been directly affected by this policy. This narrative policy analysis sought to uncover the stories (stories that are repeatedly told), counter-stories (those that run counter to dominant stories), and non-stories (stories that are not present) (Roe, 1994). Three groups of narratives arose from this study. Narratives about creating and implementing the AODA included stories about clear steps to implementation, enforcement guidelines, and proactive steps to achieve accessibility. Counter-stories described a need for more specific details, explicit enforcement guidelines, and a “deal with things as they come up” course of action. Narratives about disability examined meanings of disability present in the AODA for people with and without disabilities. Additional narratives explored discrimination against people with disabilities, links between accessibility standards and the removal of barriers for people with disabilities. Issues of accessibility were further explored in the context of leisure and recreation. Analysis revealed the diversity in leisure experiences of people with disabilities, and the need to expand the definition of accessibility for better inclusion in municipal recreation. These narratives were then contrasted and combined to form a metanarrative (alternative to consensus) to recast issues surrounding the AODA in a new light. The metanarrative highlighted a gap between the theory of the AODA and its practical applications. In theory, a policy was needed to improve the inclusion of people with disabilities in community; however, in practice, the AODA might not have the desired impact due in part to the interplay of policy and disability issues. This study suggests that the AODA is much more than what is written on paper in that it has the power to transform our society. The full intent of the AODA will be difficult to achieve until more people are aware of the legislation, its impacts, and its importance.