The population of older adults is growing worldwide, particularly in North America. Health information technology (HIT) is a group of technologies and systems that enhance care by electronically storing, managing, and exchanging data. HIT presents opportunities to support older adults' healthcare needs in communities and long-term care (LTC) environments. Despite their potential benefits, these technologies remain limited in LTC and older adults' healthcare contexts. Evidence is scattered on the factors that affect older adults' adoption of HIT. Little research has investigated the adoption of these technologies by formal healthcare providers and the technologies' impacts on LTC. A multi-method approach was employed in this thesis research, using a combination of a systematic qualitative review, an inductive semi-qualitative Delphi survey, and a quantitative deductive study to manage each research question in order to address these gaps. The systematic literature review used the PRISMA guidelines to identify and critically appraise studies that examined the effect of various HIT adoption factors among older adults in the community. The search involved five databases and a combination of keywords, resulting in the selection of critically appraised articles based on their evidence level and research rigor. A coding scheme was developed to extract information from the selected articles. The results showed that the main factors affecting HIT adoption by older adults relate to performance expectancy, effort expectancy, and high price/cost value. It also highlighted the importance of considering privacy/security and product design when evaluating HIT adoption by older adults. In light of the limited available studies on HIT adoption and impacts in the context of LTC, a Delphi study was developed to collect data from key formal healthcare providers (i.e., nurses) working in LTC at one of the largest and most progressive older adult healthcare facilities in Ontario, Canada. The Delphi study aimed to identify and prioritize the key factors that affect nurses' adoption of new technologies in support of older adults' care. A panel of nurses was solicited to participate in the Delphi study, which involved three rounds of data collection: brainstorming, narrowing down, and ranking. A total of 20 nurses completed the Delphi study, and the top factors that the LTC nurses identified were mainly related to the organizational and technological dimensions, including the complexity of HIT, the training and support provided, the interoperability of HIT systems, the cost of implementation, and the availability of HIT infrastructure. For the last part of this research, quantitative secondary data analysis was conducted on a Canadian national survey of nurses to examine their perceived impacts of HIT adoption by nurses in LTC. The survey included questions related to the current state of electronic medical records (EMR) and EMR adoption, the state of virtual care technologies, attitudes and perceptions related to access and the impact of the adoption of digital health technologies in practice, benefits and effects of EMR adoption, and barriers preventing nurses from getting total value from electronic health. A subset of 166 nursing homes/long-term care facilities/older adult residences and homecare nurses were selected for this analysis. Data management and analysis were conducted using IBM SPSS v28. The results showed that HIT adoption by nurses in LTC was positively associated with perceived benefits and organizational support. However, HIT adoption was negatively associated with perceived complexity and privacy/security concerns. This thesis research suggests that HIT adoption by older adults and nurses in LTC is complex and multifaceted, requiring attention to individual, organizational, and technological factors. There is a need for improved communication and collaboration among LTC team members and better working conditions to improve staff well-being and reduce turnover. The findings from the systematic review and Delphi study contribute to the theoretical understanding of the factors influencing the adoption of HIT in LTC facilities. The survey results provide valuable insights into the current state of HIT use in LTC facilities and can be used to inform the development of targeted interventions to improve HIT adoption and use. Overall, this study contributes to the growing body of knowledge on HIT adoption in LTC facilities and provides important recommendations for policymakers, administrators, and LTC staff to improve the use of HIT and ultimately enhance the quality of the care supplied to LTC residents.

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Poängräkning och resultatanalys vid skytteträning är en viktig aspekt i utvecklingen av skyttens skjutförmåga. En bildbaserad träffpunktdetektionsalgoritm skulle automatisera denna process och bidra med digital presentation av resultatet. Befintliga lösningar är högkvalitativa metoder som detekterar träffpunkter med hög precision. Dessa lösningar är dock anpassade efter orealistiska användningsfall där måltavlor i gott skick som beskjutits vid ett enda tillfälle fotograferas i gynnsamma miljöer. Realistiska skytteförhållanden förekommer utomhus där träffpunkterna täcks med klisterlappar mellan skottrundorna och måltavlorna återanvänds tills dem faller sönder. Detta kandidatarbete introducerar en metod för automatisk detektion av träffar anpassad efter realistiska användningssituationer och bygger på tillgängliga bildanalystekniker. Den föreslagna metoden detekterar punkter med 40 procent noggrannhet i lågkvalitativa måltavlor och uppnår 88 procents noggrannhet i måltavlor av hög kvalitet. Dock produceras ett betydande antal falska positiva utfall. Resultatet påvisar möjligheten att utveckla ett sådant system och belyser de problem som tillkommer en sådan implementation. / Score calculation and performance analysis on shooting targets is an important aspect in development of shooting ability. An image based automatic scoring algorithm would provide automation of this procedure and digital visualization of the result. Prevailing solutions are high quality algorithms detecting hit points with high precision. However, these methods are adapted to unrealistic use cases where single-used, high-quality target boards are photographed in favourable environments. Usually gun shooting is performed outdoors where bullet holes are covered with stickers between shooting rounds, and targets are reused until they fall apart. This bachelor thesis introduces a method of automatic hit point detection adapted to realistic shooting conditions and relies solely on available image processing techniques. The proposed algorithm detects holes with 40 percent detection rate in low-quality target boards, reaching 88 percent detection rate in targets of higher quality. However, producing a significant number of false positives. The result demonstrates the possibilities of developing such a system and highlights the difficulties associated with such an implementation.

Le système de santé d'aujourd'hui fait appel à de nombreuses technologies de l'information nommées TIS (Technologies de l’Information en Santé). Celles-ci ont donné naissance à de nouvelles formes d’interaction médecin-patient et ont complexifié l'approche thérapeutique dite
« centrée sur le patient ». Les TIS promettent une plus grande efficacité et l’augmentation de la satisfaction des patients par le biais d’une meilleure compréhension de la maladie pour le patient. Or, elles peuvent également devenir des sources de conflit pour le professionnel de la santé, étant donné leur utilisation en dehors des rencontres cliniques ainsi que leur tendance à agir comme des barrières communicationnelles lors des consultations. Cette recherche vise a étudier les critères de design nécessaires à la conception d’un TIS pouvant améliorer la relation médecin-patient et donc, faciliter la communication et améliorer l’alliance thérapeutique. L’étude utilise une approche centrée sur l’utilisateur et vise donc à comprendre les besoins et les attentes des médecins et des patients. En étudiant les nouvelles approches en santé et les TIS, il a été possible de comprendre le contexte et les besoins des utilisateurs en terme de communication. Ces derniers sont primordiaux au processus dit centré sur l’utilisateur. Le faible taux de rétention du discours du médecin devient une barrière communicationnelle importante, tout comme le temps pressurisé. La recherche nous montre que l’ajout d’un outil virtuel de vulgarisation peut, à l’aide de média visuels (tel que des modélisations, des animations 3D et des dessins), grandement aider la relation médecin-patient. / Today’s medical system is using an increasing number of information technologies to help healthcare professionals in their daily practice. Commonly known as HIT (Health Information Technologies), they create new forms of doctor-patient interaction and complexify the therapeutic approach called “patient centered approach”. Their use promises to improve the efficiency of the healthcare system and the overall satisfaction of the patient by improving his understanding of his illness, yet they can also become communication barriers during a consultation and even a source of conflict when used outside a clinical context. This research project aims at studying the design criteria for a Health Information tool that can help improve the doctor-patient relationship. The study uses a user-centered approach and therefore, focuses on understanding the needs and expectations of both doctors and patients. The study of the theoretical and "on the field" therapeutic approach shows that the pressurized time of the consultation, the many communication barriers and the low level of information remembered by patients are problems that can be solved by a HIT. A virtual vulgarization tool that uses multimedia such as 3D animations, 3D models and drawings can considerably help the doctor-patient relationship.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Recent large-scale genome-wide studies for many human disorders have identified associations with numerous genetic variants. The biological interpretation of these variants presents a major challenge. In particular, the identification of biological pathways underlying the association could provide crucial insights into the disease aetiologies. In this thesis, I used functional genomics approaches to increase our understanding of neuropsychiatric and neurodevelopmental disorders. Firstly, in an integrative analysis of autism spectrum disorder (ASD), I looked into the role of genes targeted by Fragile-X Mental Retardation Protein ("FMRP targets"). I found evidence that FMRP targets contribute to ASD via two distinct aetiologies: (1) ultra-rare and highly penetrant single disruptions of embryonically upregulated FMRP targets ("single-hit aetiology") or (2) the combination of multiple less penetrant disruptions of synaptic FMRP targets ("multiple-hit aetiology"). In particular, I developed a pathway-association test sensitive to multiple-hit aetiologies. Secondly, I carried out an integrative analysis of bipolar disorder, following up a previously identified association with long-term potentiation. The association was not consistent across independent SNP and CNV datasets. Thirdly, I addressed the difficulty in identifying functional relationships between genes by integrating different datasets into a gene functional-linkage network tuned to the nervous system ("NsNet"). NsNet identified functional links between the genes disrupted by de novo loss-of-function mutations in ASD and, separately, in schizophrenia probands more sensitively than a general functional-linkage network. Fourthly, I considered the challenge of interpreting the phenotypic impact of gene disruptions, focusing on the identification of haploinsufficient genes. I constructed a gene haploinsufficiency score based on genome-wide datasets. Compared to existing approaches, the new score performed better in identifying less-studied haploinsufficient genes. This work both extends the methodology to detect the contribution of genetic variation to neuropsychiatric disorders and also yields insights into the variant genes and the pathways that underlie them. Firstly, in an integrative analysis of autism spectrum disorder (ASD), I looked into the role of genes targeted by Fragile-X Mental Retardation Protein ("FMRP targets"). I found evidence that FMRP targets contribute to ASD via two distinct aetiologies: (1) ultra-rare and highly penetrant single disruptions of embryonically upregulated FMRP targets ("single-hit aetiology") or (2) the combination of multiple less penetrant disruptions of synaptic FMRP targets ("multiple-hit aetiology"). In particular, I developed a pathway-association test sensitive to multiple-hit aetiologies. Secondly, I carried out an integrative analysis of bipolar disorder, following up a previously identified association with long-term potentiation. The association was not consistent across independent SNP and CNV datasets. Thirdly, I addressed the difficulty in identifying functional relationships between genes by integrating different datasets into a gene functional-linkage network tuned to the nervous system ("NsNet"). NsNet identified functional links between the genes disrupted by de novo loss-of-function mutations in ASD and, separately, in schizophrenia probands more sensitively than a general functional-linkage network. Fourthly, I considered the challenge of interpreting the phenotypic impact of gene disruptions, focusing on the identification of haploinsufficient genes. I constructed a gene haploinsufficiency score based on genome-wide datasets. Compared to existing approaches, the new score performed better in identifying less-studied haploinsufficient genes. This work both extends the methodology to detect the contribution of genetic variation to neuropsychiatric disorders and also yields insights into the variant genes and the pathways that underlie them.

A isquemia e reperfusão intestinal (I/R-i) é relevante fator para o desenvolvimento da síndrome do desconforto respiratório agudo (SDRA). A lesão tecidual decorrente da I/R-i pode ser local e em órgãos distante do sitio isquêmico, notadamente o pulmão. Indivíduos submetidos à isquemia intestinal ao tornarem-se vulneráveis, desenvolvem resposta exacerbada a estímulos inflamatórios secundários constituindo assim a percepção de lesão decorrente de uma dupla agressão. Neste estudo desenvolvemos modelo murino de dupla agressão pulmonar ocasionada pela I/R-i seguida de estímulo da instilação nasal de LPS ou de suco gástrico (SG). A fase de caracterização do modelo de I/R-i revelou aumento de IL-6, G-CSF, KC, IP-10 e MCP-1, mas não de TNF-a no soro e em homogeneizados de pulmão e intestino. Anticorpos anti TNF-a e o etanercepte falharam em inibir o aumento de MPO pulmonar e intestinal após a I/R-i. A instilação nasal de LPS após a I/R-i aumentou a atividade pulmonar de MPO e exacerbou a permeabilidade vascular pulmonar. Neste caso, aminoguanidina ou a vimblastina reverterem o aumento da permeabilidade vascular, sugerindo a participação conjunta de neutrófilos e óxido nítrico no processo lesivo causado pela dupla agressão. A instilação nasal de SG induziu aumento inicial (2h) de MPO pulmonar seguido de influxo de neutrófilos (24h) para o espaço alveolar. Tal processo foi acompanhado por expressão inicial e transiente de TNF-a no LBA e contrabalanceada por IL-10. A resposta inflamatória aumentada de camundongos IL-10 KO à instilação de suco gástrico mostra o papel fundamental desta citocina do controle da inflamação. O rolipram ou o composto PKF 241-466 (inibidores de TNF-a) reduziram a inflamação pulmonar induzida pelo SG. A instilação de SG após a I/R-i (I/R-i +SG) exacerbou o aumento da permeabilidade vascular pulmonar. Os dados apresentados sugerem que a exposição do organismo ao trauma intestinal torna o pulmão suscetível a um estímulo secundário como o LPS e o suco gástrico. Visto a gama de estímulos inflamatórios a que indivíduos internados em unidades de terapia intensiva podem ser submetidos, os resultados deste estudo podem contribuir para a compreensão dos mecanismos reguladores do recrutamento de neutrófilos e geração de mediadores inflamatórios na síndrome do desconforto respiratório agudo. / Intestinal ischemia and reperfusion (I/R) is implicated as a prime initiating event in the development of systemic inflammatory syndrome and Acute Respiratory Distress Syndrome (ARDS). Several studies pointed the possibility of massive systemic inflammatory events rendering the lungs more susceptible to an exacerbated inflammatory response, the so called two-hit hypothesis. In this way, minor local inflammatory stimuli could be a trigger for ARDS. In this study we investigated the effects of low-dose LPS or gastric juice (GJ) administered by nasal instillation to mice previously submitted to intestinal I/R. Our data showed that i-I/R alone induced histological signs of edema in lung as well as an increase of lung MPO activity and IL-6, G-CSF, KC, IP-10 and MCP-1 levels. Nasal instillation of LPS following i-I/R increased lung MPO activity and exacerbated lung vascular permeability. In this case, aminoguanidine or vinblastine blocked the increase of vascular permeability, suggesting the role of neutrophils and nitric oxide in injury induced by the two-hit stimuli. Instillation of GJ induced an initial (2h) increase of lung MPO followed by the influx of neutrophils (24h) to the alveolar space. Such process was followed by the transient expression of TNF-a in BAL and balanced by IL-10. The exacerbated inflammatory response of IL-10 KO mice to GJ instillation shows the importance of this cytokine in the control of the inflammation in such model. Treatment with rolipram or PKF 241-466 compound (TNF-a inhibitors) reduced lung inflammation induced by GJ. Nasal instillation of GJ after i-I/R exacerbated the increase in lung vascular permeability. The data shown suggest that the exposition of the organism to mesenteric trauma primes the host organism to a secondary inflammatory stimulus such as LPS or gastric juice. Considering the possible multiple insults to lung to which patients in intensive care units are submitted, the results of this study might contribute to the understanding of the regulatory mechanisms of neutrophils and generation of inflammatory mediators in the context of ARDS.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

The budding yeast Saccharomyces cerevisiae has been an invaluable model organism in contributing to the current understanding of cellular biology, owing mainly to its highly tractable genetic system and the completion of its genome sequencing in 1996. Indeed, these bolstered the development of novel methods that have provided great insights into genetic and protein networks in human cells. With the large collection of datasets, S. cerevisiae also became an ideal platform for investigating the mechanism of action of novel compounds. The first part of my thesis uses a validated chemogenomic assay to investigate the mechanism of action of structurally related novel DNA-damaging agents, delineating valuable structure-activity relationship in the process. The second part describes the development of a method that uses drug-induced wild-type growth dynamic to characterize novel compounds, which, in combination with the chemogenomic assay, may complement existing high throughput screening experiments to improve the current drug development process.

The budding yeast Saccharomyces cerevisiae has been an invaluable model organism in contributing to the current understanding of cellular biology, owing mainly to its highly tractable genetic system and the completion of its genome sequencing in 1996. Indeed, these bolstered the development of novel methods that have provided great insights into genetic and protein networks in human cells. With the large collection of datasets, S. cerevisiae also became an ideal platform for investigating the mechanism of action of novel compounds. The first part of my thesis uses a validated chemogenomic assay to investigate the mechanism of action of structurally related novel DNA-damaging agents, delineating valuable structure-activity relationship in the process. The second part describes the development of a method that uses drug-induced wild-type growth dynamic to characterize novel compounds, which, in combination with the chemogenomic assay, may complement existing high throughput screening experiments to improve the current drug development process.