Thesis (M.B.A.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

Background. A reliable and valid instrument printed in English that measures self-management for adults with vascular diseases receiving hemodialysis therapy was not found in the literature. The Vascular Disease Self-Management Instrument (VSMI) was developed to support the measurement and assessment of self-management. Objectives. The primary objective was to assess the feasibility of the study methods to develop and explore the psychometric properties of the Vascular Disease Self-Management Instrument (VSMI) for adults receiving hemodialysis therapy. Feasibility outcomes included recruitment, consent and completion rates. The secondary objective was to begin to explore the reliability (internal consistency and test-retest), and construct validity using exploratory factor analysis and criterion-related validity. Method. This feasibility study used seminal work (Thabane et al., 2010) and clinical expertise to determine feasibility outcomes. Examination of psychometric properties was based on Streiner & Norman (2008). Results. Of the 267 eligible patients, a total of 136 patients were recruited into the study. The consent rate was 51% and completion rate was 32% for the test-retest analysis. Study participants were primarily male (61%), diagnosed with chronic kidney disease for 12 years and receiving hemodialysis therapy for 6 years. Half (50%) the participants were at moderate risk for psychological distress and used avoidant-oriented coping. Preliminary psychometric analysis suggested good reliability (Cronbach’s alpha = 0.945) and stability (Intraclass correlation coefficient = 0.927, p <0.0001). The results of the exploratory factor analysis indicated four main factors comprised the self-management instrument including collaborative partnerships, self-advocacy, self-monitoring and normalcy. Preliminary evidence of criterion-related validity demonstrated a significant positive relationship between task-orientated coping and self-management. Conclusion. Feasibility outcomes were successfully met. Preliminary evidence suggests that the VSMI has the potential to become a reliable and valid instrument. A full-scale psychometric evaluation with a sample that includes adults receiving peritoneal dialysis is needed to support utilization of the VSMI in research and clinical practice. / Dissertation / Doctor of Philosophy (PhD) / Background: Adults receiving dialysis therapy must engage in self-management of their illnesses. A questionnaire on self-management activities based on the individuals’ experiences would help health care providers to identify areas where people struggle. This information could be used to develop programs that support self-management. What Did We Learn: A total of 136 people took part in the study. The development and testing of a self-management questionnaire for adults undergoing hemodialysis is a worthwhile and reasonable goal. The questionnaire provided people with the opportunity to describe their self-management activities. Half the people that participated in the study were at risk for experiencing anxiety and depression and tried to avoid stress. Conclusions: The questionnaire would assist health care providers to engage in future research projects and develop programs and resources that help people more independently manages their illnesses.

A methodology was developed for determining the economic feasibility of a wood products industrial park. The methodology consists of twelve steps that address the goals of park owners, the feasibility of secondary manufacturing alternatives, the feasibility of the development corporation, and the financial areas needing management attention. Prerequisites to the financial analysis include market and technical analyses. Community impact analysis was also acknowledged as an important component of an overall feasibility analysis. A case study was performed that consisted of an economic feasibility analysis for a wood products industrial park in Southwest Virginia. The case study assumed private ownership and found that the best mix of park tenants included: an edge-glued dimension panel manufacturer, a solid dimension lumber manufacturer, a custom millwork manufacturer, and a pallet manufacturer. Primary manufacturing and marketing services were included in the preferred park formation as subsidiaries of the park development corporation. The park was predicted to have a strong positive impact on the regional economy. / Master of Science

The Industrial Laser is firmly established in metalcutting as the tool of choice for many applications. The elevator division of Montgomery KONE Inc., in an effort to move towards quality, ontime, complete deliveries and 100% customer satisfaction, decided to invest in new equipment to improve manufacturing processes. A huge investment is proposed for a laser-cutting machine. It is the responsibility of Manufacturing Engineering to direct the management by justifying its benefits, which includes payback time and financial gains. Factors such as common line cutting, automated material handling system and cutting time were involved in justification of the initial cost of a laser-cutting machine. Comparative statistics on appropriate factors accurately determine and justify the initial cost of a laser-cutting machine.

Background: Stroke survivors often have persistent neural deficits related to motor function and sensation, which increase their risk of falling, most of which occurs at home or in community settings. The use of wearable technology to monitor fall risk and gait in stroke survivors may prove useful in enhancing recovery and/or preventing injuries. Objective: Determine the feasibility of using wearable technology (PAMSys (TM)) to objectively monitor fall risk and gait in home and community settings in stroke survivors. Methods: In this feasibility study, we used the PAMSys to identify fall risk indicators (postural transitions: duration in seconds, and number of unsuccessful attempts), and gait (steps, speed, duration) for 48 hours during usual daily activities in stroke survivors (n=10) compared to age-matched controls (n=10). A questionnaire assessed device acceptability. Results: Stroke survivors mean age was 70 +/- 8 years old, were mainly Caucasian (60%) women (70%), and not significantly different than the age-matched controls (all P-values >0.20). Stroke survivors (100%) reported that the device was comfortable to wear, didn't interfere with everyday activities, and were willing to wear it for another 48 hours. None reported any difficulty with the device while sleeping, removing/putting back on for showering or changing clothes. When compared to controls, stroke survivors had significantly worse fall risk indicators and walked less (P<0.05). Conclusion: Stroke survivors reported high acceptability of 48 hours of continuous PAMSys monitoring. The use of in-home wearable technology may prove useful in monitoring fall risk and gait in stroke survivors, potentially enhancing recovery.

Para se avaliar as possibilidades de expansão dos serviços municipais de saúde no Paraná procurou-se, primeiramente, fazer um diagnóstico do conjunto de serviços existentes no Estado. Em seguida foram pesquisadas as variáveis envolvidas com as possibilidades de expansão e realizado um estudo de caso sobre os serviços da Prefeitura Municipal de Londrina, que se constituem na rede municipal mais antiga do Paraná. Concluiu-se que existem varáveis favoráveis à municipalização como índices razoavelmente elevados de população aglomerada, distribuição territorial bastante homogênea dos maiores municípios, boa capilaridade da rede de unidades sanitárias do Estado e conjuntura politicamente favorável. Os principais entraves detectados encontram-se na área financeira, como a estrutura tributária nacional e o perfil de arrecadação do tesouro do Estado, bem como os percentuais de recursos do Estado destinados à área da saúde. Quanto ao município de Londrina a análise dos serviços reforça a idéia de viabilidade da municipalização e oferece dados que poderão orientar futuros serviços semelhantes. / The evaluation of the possible expansion of municipal health services began, initially, with a diagnosis existing health services throughout the state of Parana. At a second stage certain variables thought to be relevant to this possible expansion were analyzed. It was felt that there are variables favouring the locally-based expansion including the reasonably high indicators of population clusters, homogeneous territorial distribution of the larger cities, the wide distribution of the state sanitary units network, favorable political circumstances. The main obstacles encountered are in the financial sector, including the structure of the Brazilian rates and taxes, and the organization of collection by the state treasury as well as the resource percentages destinated for health by the state government. The study above is illustrated by a case-study that involves health services of the city of Londrina, wich are among the oldest in the state of Paraná, in the south of Brazil. This analysis of the health services of the city of Londrina has led to a reinforcement of the viability of expansion at a local level and offer data which may serve as a model for similar services in the future. xiii

Background: Having a diagnosis of schizophrenia is associated with employment difficulties, high mortality rates, substantial family burden and impoverished quality of life and it costs between 1.5 to 3 per cent of the total expenditure on national health care (Knapp et al 2004). However social functioning and participation can have a protective impact on mental health of people with a diagnosis of psychosis (Stain et al 2013). Method: A systematic and phased approach to complex intervention development was undertaken involving: (1) A systematic review of effectiveness and (2) a feasibility study, designed to explore and test the key uncertainties of an effectiveness study, was conducted in two phases. This involved the development of an occupational therapy intervention specification and a feasibility study for a pragmatic randomised controlled trial (RCT). It utilised the Developing and evaluating complex interventions guidelines (MRC 2008). A task analysis approach was applied to extrapolate occupational therapy theory, practice and outcomes for the intervention specification (Gitlin 2013). The feasibility study was carried out across two centres. It used the intervention specification and included both study and process outcomes. The primary outcome was participation in activities of everyday life and the secondary outcomes were health-related quality of life and self-reported experience of occupational performance and satisfaction with occupational performance. Service user and carer involvement was integrated into the method. Results: The systematic review highlighted that there was no evidence of effectiveness for individualised client-centred occupational therapy interventions on participation in activities of everyday life or quality of life/ health related quality of life. The methodological quality of the effectiveness studies was generally low and details provided regarding interventions made replication difficult. The feasibility study recruited less people (n=20) than planned (n=64). However the outcomes of self-reported experience of occupational performance (p=.002) and satisfaction with occupational performance (p=.001) and self-evaluated transition (SET) (p=.026) improved with occupational therapy and were found to be statistically significant (p < .05). The intervention specification captured 98% of occupational therapy provided and was shown to have good utility for research and practice purposes. Conclusion: An intervention specification that reflects practice and has utility has been developed. Methods of measuring fidelity and adherence of occupational therapy have been designed and tested. Knowledge about how occupational therapy enables participation has advanced. The essential preparatory work to address the previously key uncertainties in a pragmatic RCT has been completed and the foundations for the next stage — a larger pragmatic RCT — have been put in place.

Cílem diplomové práce je analyzovat současnou situaci na hotelových investičních trzích a pomocí metody dedukce určit faktory ovlivňující rozhodování o umístění hotelové investice. Druhým cílem této práce je charakterizovat teorii oceňování hotelových projektů tak, jak ji zachycuje česká i zahraniční literatura a následně tuto teorii aplikovat na konkrétní hotelový projekt.

Para se avaliar as possibilidades de expansão dos serviços municipais de saúde no Paraná procurou-se, primeiramente, fazer um diagnóstico do conjunto de serviços existentes no Estado. Em seguida foram pesquisadas as variáveis envolvidas com as possibilidades de expansão e realizado um estudo de caso sobre os serviços da Prefeitura Municipal de Londrina, que se constituem na rede municipal mais antiga do Paraná. Concluiu-se que existem varáveis favoráveis à municipalização como índices razoavelmente elevados de população aglomerada, distribuição territorial bastante homogênea dos maiores municípios, boa capilaridade da rede de unidades sanitárias do Estado e conjuntura politicamente favorável. Os principais entraves detectados encontram-se na área financeira, como a estrutura tributária nacional e o perfil de arrecadação do tesouro do Estado, bem como os percentuais de recursos do Estado destinados à área da saúde. Quanto ao município de Londrina a análise dos serviços reforça a idéia de viabilidade da municipalização e oferece dados que poderão orientar futuros serviços semelhantes. / The evaluation of the possible expansion of municipal health services began, initially, with a diagnosis existing health services throughout the state of Parana. At a second stage certain variables thought to be relevant to this possible expansion were analyzed. It was felt that there are variables favouring the locally-based expansion including the reasonably high indicators of population clusters, homogeneous territorial distribution of the larger cities, the wide distribution of the state sanitary units network, favorable political circumstances. The main obstacles encountered are in the financial sector, including the structure of the Brazilian rates and taxes, and the organization of collection by the state treasury as well as the resource percentages destinated for health by the state government. The study above is illustrated by a case-study that involves health services of the city of Londrina, wich are among the oldest in the state of Paraná, in the south of Brazil. This analysis of the health services of the city of Londrina has led to a reinforcement of the viability of expansion at a local level and offer data which may serve as a model for similar services in the future. xiii

Over the past twenty years, the number of grandparents raising grandchildren has increased substantially. In many cases, raising grandchildren can be stressful and may aggravate pre-existing health conditions. Grandchildren in these kinship relationships often experience poor health outcomes as well. Typically, both grandparents and grandchildren do not engage in positive health behaviors. Thus, there is a need to develop intergenerational health promotion interventions for grandparents raising grandchildren. This study used the community-based participatory research approach to develop and implement an eight-week intergenerational program for kinship families. The specific goals of this descriptive study were to understand the process and feasibility of developing and implementing the intervention from the perspective of key stakeholders. Content analysis of observational, focus group, and interview data from grandparents, nurses, exercise consultants, and recreation staff provided an in-depth account of the intervention's process (i.e., recruitment, dose delivered, dose received, fidelity, and context) and feasibility (i.e., acceptability, demand, practicality, and integration). Repeated measures ANOVAs were used to determine if the intervention had an effect on participants' health outcomes (i.e., depression, blood pressure, waist circumference, heart rate, weight, balance, and BMI) over time. Although analyses did not result in statistically significant effects on health outcomes, the data trends indicated the possibility of health improvements given a larger sample size. The distinct details gleaned from this study can provide researchers, community organizations, and practitioners with guidance on how to use community partnerships and existing strengths to develop and implement effective community-based intergenerational interventions.