Warfarin has well-proven benefit (stroke prevention) but an associated increase in harm (major bleeding) in patients with atrial fibrillation (AF). Current clinical prediction rules (CPRs) are limited in that stroke CPRs predict only the probabilities of “stroke” and “no stroke” and bleeding CPRs predict only “bleed” and “no bleed” despite the fact that outcomes actually include combinations of these four groups. The study objective was to evaluate methods to create a CPR that calculates individual patient probabilities of warfarin’s four combined benefit/harm outcome groups: i) no stroke/no bleed; ii) no stroke/bleed; iii) stroke/no bleed; iv) stroke/bleed. Methods: Patient-level data were analyzed from a randomized controlled trial database (n=9,155) and an observational anticoagulant clinic database (n=5,475) from start of trial or time of AF diagnosis respectively (baseline), until end of follow-up. Patients were stratified into the four groups based on their outcomes during follow-up. Due to high mortality in both datasets, death was included as an outcome. Decision tree modeling and polytomous logistic regression (PLR) were conducted to identify baseline patient factors predicting each outcome group. Results: Based on a literature review of recent high quality RCTs, benefit and harm are reported separately and not at a more individualized level than subgroup analysis. In this individualized combined benefit/harm analysis, both PLR and decision tree modeling identified predictors of no stroke/no bleed, no stroke/bleed, stroke/no bleed and death without a prior stroke or bleed. PLR results predicted probabilities of combined benefit/harm outcomes for every patient but required detailed computation. However, results could potentially be converted into automated form for ease of use. Decision trees provided a visual algorithm approach to risk assessment but did not i) predict the probability of warfarin’s combined benefit/harm outcomes based on all predictors simultaneously, ii) predict the probability of these outcomes for every patient or iii) provide statistical parameters of predictive value (odds ratios). Conclusions: The PLR technique could be used to predict patient probabilities of combined benefit/harm outcomes with warfarin. The study results require validation, preferably prospectively, in other cohorts. If validated, this approach should be tested to determine if it aids patient decision-making.

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Currently, in North America, a large percentage of infrastructure assets, including education and healthcare buildings, are deteriorating rapidly due to age and over capacity. The budget constraints under which municipalities and public agencies operate also make the sustainability of these buildings a serious challenge. This is particularly so when capital renewal programs are downsized to save money, thus hindering the proper inspection of buildings and the allocation of renewal funds. In addition, building inspections and condition assessments are generally resource intensive, subjective, time-consuming, and costly. To support capital renewal decisions that pertain to buildings, this research introduces a comprehensive condition assessment framework that overcomes the drawbacks of the existing processes. A prototype of the framework utilizing hand-held devices has been developed and tested on the capital renewal program of the Toronto District School Board (TDSB). The framework is innovative on three main fronts: (1) it utilizes available reactive-maintenance records to predict the condition of components and to prioritize inspection tasks among limited available resources; (2) it employs a unique visual guidance system that is based on extensive surveys and field data collection to support uniform condition assessment of building components; and (3) it introduces a location-based inspection process with a standardized building hierarchy. The research contributes to restructuring the inspection and condition assessment processes, providing a better understanding of the interactions among building components, integrating capital renewal and maintenance data, and developing a practical condition assessment framework that is economical, less-subjective, and suitable for use by individuals with less experience. The framework also incorporates permanent documentation of the condition of the asset along its life cycle, and aids in scheduling inspections so as to maintain low-cost condition tracking. Ultimately, the proposed system will provide timely and sufficient information to facilitate accurate repair decisions for maintaining the building infrastructure. The framework is of benefit to both researchers and practitioners. Its formulation is innovative and helps building owners automate most inspection tasks, quantify the impact of alternative funding scenarios, and reduce the cost of asset management. In addition, because asset management is a less-developed multi-billion dollar business, the research is expected to establish leading technology and know-how that will help Canadian companies gain a competitive global advantage. At the municipality level, the proposed prototype is expected to assist managers in arriving at decisions that will ensure the cost-effective operation of buildings and uninterrupted service to the public.

Currently, in North America, a large percentage of infrastructure assets, including education and healthcare buildings, are deteriorating rapidly due to age and over capacity. The budget constraints under which municipalities and public agencies operate also make the sustainability of these buildings a serious challenge. This is particularly so when capital renewal programs are downsized to save money, thus hindering the proper inspection of buildings and the allocation of renewal funds. In addition, building inspections and condition assessments are generally resource intensive, subjective, time-consuming, and costly. To support capital renewal decisions that pertain to buildings, this research introduces a comprehensive condition assessment framework that overcomes the drawbacks of the existing processes. A prototype of the framework utilizing hand-held devices has been developed and tested on the capital renewal program of the Toronto District School Board (TDSB). The framework is innovative on three main fronts: (1) it utilizes available reactive-maintenance records to predict the condition of components and to prioritize inspection tasks among limited available resources; (2) it employs a unique visual guidance system that is based on extensive surveys and field data collection to support uniform condition assessment of building components; and (3) it introduces a location-based inspection process with a standardized building hierarchy. The research contributes to restructuring the inspection and condition assessment processes, providing a better understanding of the interactions among building components, integrating capital renewal and maintenance data, and developing a practical condition assessment framework that is economical, less-subjective, and suitable for use by individuals with less experience. The framework also incorporates permanent documentation of the condition of the asset along its life cycle, and aids in scheduling inspections so as to maintain low-cost condition tracking. Ultimately, the proposed system will provide timely and sufficient information to facilitate accurate repair decisions for maintaining the building infrastructure. The framework is of benefit to both researchers and practitioners. Its formulation is innovative and helps building owners automate most inspection tasks, quantify the impact of alternative funding scenarios, and reduce the cost of asset management. In addition, because asset management is a less-developed multi-billion dollar business, the research is expected to establish leading technology and know-how that will help Canadian companies gain a competitive global advantage. At the municipality level, the proposed prototype is expected to assist managers in arriving at decisions that will ensure the cost-effective operation of buildings and uninterrupted service to the public.

This research involves conducting a resilience assessment on the Town of Caledon in southern Ontario, Canada, through the use of the Resilience Assessment Workbook authored by the Resilience Alliance. The purpose of the research is to develop a comprehensive understanding of Caledon, and identify ways to enhance its resilience as a linked social-ecological system in the context of urban growth. Urban growth pressures have brought multiple challenges to Caledon in land use, infrastructure maintenance, farmland preservation and watersheds conservation. Urban growth management in Caledon is situated in the provincial growth strategy for the Greater Golden Horseshoe areas in Ontario. Provincial legislation including the Places to Grow Act (2005), the Greenbelt Act (2005), the Oak Ridges Moraine Conservation Act (2001) and the Provincial Policy Statement (2005) aim to reconcile the needs for population increase, economic growth and environmental protection. The results of the resilience assessment of Caledon consist mainly of a cross-scalar study and interviews with twenty-six community members. The cross-scalar study examines Caledon in its social, ecological and economic domains on the provincial, regional and municipal levels. The study also identifies potential resilience threats and assets of Caledon in the context of urban growth. Interviews have been conducted to verify and complement findings of the cross-scalar study. Interviewees include Caledon municipal staff, residents, environmental group leaders, politicians, an aggregates industry representative, a social services representative and a local property developer. The results of this research reveal resilience threats and assets in Caledon, and identify ways for the town to enhance resilience against urban growth pressures. Threats to resilience are found to be associated with urbanization, agricultural land loss, aggregates mining and a lack of affordable housing. Assets of resilience in Caledon are found to be related to civic engagement, participatory planning and agricultural diversification. Based on the cross-scalar study and interview results, emerging themes of resilience and recommendations are developed. Recommendations for Caledon to enhance its resilience include: promoting continual learning and adaptive governance; diversifying agriculture; providing affordable housing; treating urbanization as an opportunity; and developing trade-off principles for the implementation of an integrated plan for resilience.

Nutrition monitoring is important for determining nutrient intakes of a population but trend evaluation requires greater than two points. This thesis provides national mean nutrient intake estimates of Canadians aged 18 to 74 based on published 1990s provincial nutrition surveys that fall between the Nutrition Canada Survey (1970/72) and Canadian Community Health Survey (2004). The focus of this thesis was on four key nutrients (calcium, iron, folate, and vitamin C) reported by childbearing age women. Objectives included examining data for temporal or geographic patterns; reviewing for similarities to 1970/72; and assessing intake adequacy using Dietary Reference Intakes (DRIs). <p>Estimates were derived from 24-hour recall data reported by 16,915 adults of nine provinces, excluding Manitoba. Provincial group mean nutrient intakes were population-weighted using the Canadian census appropriate to the data collection years and totaled in proportion to provincial population size. The eight adult age and gender groups were then called the Province-derived Nutrition Survey (PNS). A temporal folate trend was noted as 1998 folate fortification doubled intake for the female population. In terms of geography, calcium intake appeared higher in British Columbia compared to Newfoundland. Nutrient intake declined with age except for some micronutrients associated with fruit/vegetables. Nutrient density indicated that the quality of womens diets improved with age. Nutrients which appeared inadequate for childbearing age women included fibre, potassium, magnesium, folate, iron, and calcium. Micronutrients that were below AI or RDA values suggest plant-based food intake was inadequate. Nutrient density showed that diet quality had improved since Nutrition Canada however, increased efforts are required to improve dietary intake further. <p>This thesis provides Canadas most recent comprehensive national nutrient intakes and a point with which to observe change. Intake in the 1990s compared to the previous Nutrition Canada Survey (NCS) showed that many nutrients had increased but education efforts did not appear to have resulted in optimum intake. Fortification and food consumption habits influenced which foods were the primary micronutrient sources, e.g., fortification with folic acid. While calcium and folate intake was higher in the 1990s compared to the NCS, these increases did not bring young women to their desired intake. When the 2004 Canadian Community Health Survey cycle 2.2 (nutrition) is published, it could be compared to the PNS to confirm whether these patterns are trends.

Changes brought about primarily by accelerating information technology have elevated innovation to the forefront of organizations’ strategic concerns as the only sustainable competitive advantage. Innovation in turn requires organizational environments where creativity is supported and fostered. The vital initial step in an effective change effort to bring about more creative organizational environments is to conduct an assessment. However, no new creativity assessment instrument has been developed in over two decades. This study presents the findings from a new organizational creativity assessment instrument, supplemented with data from a qualitative data-collection process involving in-depth interviews with a few representative employees from each organization. The development of the instrument draws upon recent creativity literature, primarily theoretical and anecdotal, resulting in 28 questionnaire items. Each item represents a potential environmental influence of creativity in a particular organization. One subset is physical or tangible environmental factors, such as the building where people work, as well as less tangible factors, such as “management response.” The instrument was administered in four different organizations in four different industries in an effort to begin to determine the utility of the instrument (n = 81). The results from the different organizations, including straightforward statistical tests, facilitated comparisons of differences in the amount and type of creativity supports between organizations. The qualitative data provided a check of confirmatory detail to the quantitative results, as well as providing rich contextual detail. A factor analysis was conducted on the overall results in order to determine if there was a possible underlying structure to the multitude of variables included in the survey instrument. The analysis revealed five factors, Creativity Management Process, Cultural Support Mechanisms, Organizational Inputs, Discussion Stimuli, and Organizational Helpfulness. Overall, the major conclusion is that the instrument is a potentially useful tool warranting further development and refinement and, ultimately, a full test of its validity and reliability. Also, the qualitative data added valuable context to understanding an organization’s creativity culture, as well as providing confirmatory support for the survey findings. An additional finding is that physical aspects of the environment were not recognized as significant factors in influencing organizational creativity.

Ammonia refrigeration systems are widely used in industry. Demand of these systems is expected to increase due to the advantages of ammonia as refrigerant and because ammonia is considered a green refrigerant. Therefore, it is important to evaluate the risks in existing and future ammonia refrigeration systems to ensure their safety. LOPA (Layer of Protection Analysis) is one of the best ways to estimate the risk. It provides quantified risk results with less effort and time than other methods. LOPA analyses one cause-consequence scenario per time. It requires failure data and PFD (Probability of Failure on Demand) of the independent protection layers available to prevent the scenario. Complete application of LOPA requires the estimation of the severity of the consequences and the mitigated frequency of the initiating event for risk calculations. Especially in existing ammonia refrigeration systems, information to develop LOPA is sometimes scarce and uncertain. In these cases, the analysis relies on expert opinion to determine the values of the variables required for risk estimation. Fuzzy Logic has demonstrated to be useful in this situation allowing the construction of expert systems. Based on fuzzy logic, the LOPA method was adapted to represent the knowledge available in standards and good industry practices for ammonia refrigeration. Fuzzy inference systems were developed for severity and risk calculation. Severity fuzzy inference system uses the number of life threatening injuries or deaths, number of injuries and type of medical attention required to calculate the severity risk index. Frequency of the mitigated scenario is calculated using generic data for the initiating event frequency and PFD of the independent protection layers. Finally, the risk fuzzy inference system uses the frequency and severity values obtained to determine the risk of the scenario. The methodology was applied to four scenarios. Risk indexes were calculated and compared with the traditional approach and risk decisions were made. In conclusion, the fuzzy logic LOPA method provides good approximations of the risk for ammonia refrigeration systems. The technique can be useful for risk assessment of existing ammonia refrigeration systems.

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The purpose of this research is to investigate group problem-solving processes , interactions , and also, the factors that influence the operation on performance assessment. The main points for this study are: 1.What kind of situation does the model of group problem-solving form? 2.What situation does the group participate in each process of problem-solving? 3.What changes do the group participate in each stage of problem-solving after performance assessment? 4.What influences do manipulatives make on the operation of problem-solving processes? 5.What do the members think about the method of assessment? The method of this research is as follow. The investigators referred to the mathematics textbook (Volume 11) to develop five units of performance assessment. The participants were a group of four 6th grade elementary school children in Kaohsiung. The investigator collected the think-aloud protocols of the group and observed the behaviors from video and recordings. Finally, in order to understand children¡¦s feelings of assessment, the investigator arranged semi-structured interviews. The data was used to prepare chart according to Schoenfeld¡¦s model, also its distribution table, and the ratio of participation. The main conclusions of this research are: 1.The process of group problem-solving is affected by discussions among peers. 2.The model of process of problem-solving is affected by actually performing and acting out. 3.The group may or may not be engaged in all stages of problem-solving. 4.The changes of problem-solving stage for each member were different. 5.The use of manipulatives affects each problem-solving stage. 6.Children expressed that they enjoyed group performance assessments. Based on results of this study, the investigator highly recommended performance assessment to take place in elementary mathematics classroom.