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Using ecological task analysis as a conceptual framework, this study sought to describe the experiences of choice in physical activity contexts for adults with mobility impairments. Experiences of 3 female and 2 male participants with mobility impairments, ages 18-23 years were explored using the phenomenological research methods of interviews, written stories, and field notes. Thematic analysis revealed three themes: (a) Interpreting the setting described participants interpretation of the environment, person, and task when making movement choices; (b) It just felt right described how participants actively engaged in a process of analyzing alternatives and choosing among them; and (c) Implications of choices made described participants evaluations of good and bad choices and what could be learned. The implications of this exploratory study include enhanced understanding of the assumptions surrounding choice, and appreciation for the multiple layers of affordances and constraints that influence choices in physical activity contexts.

ABSTRACT Speech-language pathology practice in the acute hospital setting has changed dramatically over the last 25 years. A significant increase in the number of referrals and a broadening of the speech-language pathologist’s caseload to include patients with dysphagia has meant there has been less time to see hospital inpatients with communication disabilities. This change in practice has caused speech-language pathologists working in the acute hospital setting to question their role in relation to patients with communication disabilities in the acute hospital setting. The thesis applies the World Health Organization’s International Classification of Functioning, Disability and Health (ICF) framework to explore the role of speech-language pathologists in the acute hospital setting, specifically the acute hospital stroke unit, in relation to patients with communication disabilities. The ICF proposes that a health condition can be understood in terms of four separate components. These components are Body Structures and Functions, Activities and Participation, Environmental Factors and Personal Factors. Whilst the distinction between body structures and body functions within the ICF Body Functions and Structures component is clear, there is less clarity about the relationship between the ICF concepts of activity and participation in the ICF Activities and Participation component. Therefore, the first part of the thesis explores the conceptual similarities and differences between the concepts of activity and participation generally and communication activity and communication participation in particular. This discussion concludes that the ICF concepts of activity and participation are distinct concepts that are considered separately in this thesis. Following this conceptual clarification, the thesis applies the ICF framework to patients with communication disabilities in the acute hospital stroke unit. Specifically, patients with communication disabilities are described from the perspective of communication-related body functions within the ICF Body Structures and Functions component, communication activities within the ICF Activities and Participation component and communication-related environmental factors in the ICF Environmental Factors component. It is important to understand how many patients experience a communication disability in the acute hospital stroke unit so that adequate supports can be developed. Therefore an efficient way of identifying patients in acute hospital stroke units with a communication-related body function impairment such as hearing, vision, speech, language and/or cognitive communicative impairment was required. Hence, the first study describes the development of ICF compatible scales, called the OHW scales, to rate a patient’s degree of speech, language and cognitive communicative impairment. These three rating scales were called the OHW scales because they reflect the WHO framework and also represent the authors’ initials. The concurrent validity and interrater reliability of the OHW scales were then investigated. Results indicated that the OHW had acceptable levels of concurrent validity against standardised measures of speech, language and cognitive communicative impairment. The speech and cognitive communicative OHW scales also demonstrated moderately high interrater reliability, but exact agreement on the OHW language impairment scale was low. At a minimum, the OHW scales were valid measures of speech, language and cognitive communicative impairment and therefore they were used by the researcher to determine the number of patients with communication-related impairments in the acute hospital stroke unit. Patients in acute hospital stroke units may have communication-related impairments, such as speech, language or cognitive communicative impairments as a consequence of stroke. Patients may also have communication-related impairments (e.g., in hearing, vision and cognitive communicative) due to ageing and age related illnesses. Therefore, the second study of the thesis describes the number of patients with communication-related impairments in acute stroke units, regardless of the cause. Of the 69 patients screened, 88% had a mild or more severe communication-related impairment. In addition, 69% of inpatients, screened on two or more measures, had multiple communication-related impairments. Although many patients in acute stroke units have communication-related impairments, what may be particularly important is how many patients experience difficulty communicating their healthcare needs with healthcare providers in acute hospital stroke units. The ICF describes a person’s ability to carry out an activity, such as communicate healthcare needs, as an activity limitation. The ICF describes activity limitations in four different ways. Two ways are capacity with assistance and performance. Capacity with assistance indicates the person’s highest probable level of function in an activity given assistance and performance indicates a person’s level of function in the context of everyday life. Therefore, the third study of the thesis details how many patients experienced capacity with assistance limitation, that is, difficulty communicating their healthcare needs given assistance, and performance limitation, that is, difficulty communicating their healthcare needs during everyday healthcare routines. Results indicated that 51% of 65 patients had a capacity with assistance limitation and 57% had a performance limitation. Strong and significant relationships were found between patients’ degree of communication-related impairments and their degree of communication activity limitation, in both capacity with assistance and performance. Furthermore, the presence of a communication-related impairment accounted for up to 77% of the variance in a patient’s capacity with assistance limitation. Such impairments only accounted for up to 32% of the variance in a patient’s performance limitation. This finding suggests that other factors, such as environmental factors also affect a patient’s ability to communicate, particularly during everyday health care routines. In light of this, a review of the literature on the range of environmental factors that influence communication between patients with communication-related impairments and healthcare providers in the acute hospital setting was conducted. The review of the literature indicated the need for research on the environmental factors that influence communication between patients and healthcare providers in the acute hospital stroke unit. Therefore, the final study of the thesis investigates this further. This study employed a focused ethnographic methodology to identify the range of environmental factors that appeared to influence communication between patients and their healthcare providers. Seven themes were identified including the healthcare providers’ knowledge of communication-related impairments, skills, attitudes, and individual characteristics. Other themes included the presence of family, the physical environment and hospital systems and services. In summary, this series of studies indicates that the majority of patients admitted into acute hospital stroke units have a communication-related impairment and approximately half to two thirds of patients experience difficulty communicating their healthcare needs with healthcare providers. Whilst having a communication-related impairment increases the likelihood that a patient will experience difficulty communicating with healthcare providers, other factors, such as the communicative environment also appear to play an important role. Speech-language pathologists working in the acute hospital stroke unit may have an important role in identifying patients who are experiencing difficulty communicating their healthcare needs and supporting these patients and their healthcare providers to communicate in optimal ways. Further research is required to demonstrate that improving a patient’s ability to communicate with his or her healthcare providers improves a patient’s health outcomes. With this evidence, speech-language pathologists may be more able to support patients with communication disabilities to get the healthcare they deserve.

Digitalisation in today’s society is constantly evolving. Research shows the positive effects of apps for people with cognitive impairments by enabling meaningful activities as well as increasing independence. The purpose of this study was to describe the occupational therapist's professional reasoning regarding the recommendation and use of apps to enable activity for people with a cognitive impairment. The study adopted a qualitative approach to capture the participants' reasoning whilst working with apps. The selection was carried out with purposeful selection based on the criteria set. A total of ten participants participated. Data was collected via semi-structured interviews with open-ended questions and then analysed with a qualitative content analysis. The analysis resulted in three categories; Identify the client's needs and prerequisites to promote activity, Match and customize the app for a sustainable use and The Occupational Therapist's prerequisites for using apps as an intervention. The results shows that the occupational therapist works closely with the client and its social network to match the appropriate app based on needs and conditions in activity. Furthermore, the occupational therapists see great benefits of using apps, primarily for the supportive features that can increase independence as well as the freedom of movement the app can contribute to. However, problem areas are in the form of uncertainty in app updates and difficulties in having sufficient knowledge of the available apps. The conclusion is that Occupational therapists in this study use a wide breadth in their reasoning. Where several aspects of the client's needs and prerequisites as well as the occupational therapist's own prerequisites are weighed together to use apps as intervention. This showed great complexity, as apps are a new and large area for the occupational therapists and therefore further studies are needed for more knowledge within the subject.

Introduction: In Sweden today a third of all those 60+ live alone and the absolute number will continue to increase because of the aging population. The aim of this thesis was to identify if the subgroup, older individuals living alone, might be more disadvantaged in regard to the four key sources to vulnerability suggested by Mechanic and Tanner (2007): Poverty and low socioeconomic status, personal functions, low social network and lack of support, and physical location. Gender differences were also investigated.   Method: Data was from the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) collected in 2014. The total sample in this thesis includes 987 individuals with an age between 70-105. To estimate the current living conditions in regard to vulnerability among the subgroup, five dimensions of vulnerability were analyzed with multiple logistic and linear regressions.   Results: More disadvantages are found for those men and women living alone in all domains, except in social activity for women where living arrangement made no difference. Significant gender differences can be seen in depressive symptoms and social activity, but not for financial insecurity, mobility problems or living in a disorganized local community.   Conclusion: Men and women living alone are more disadvantaged compared to those living with a partner, according to the four key sources to vulnerability. With this deeper insight it is possible to obtain a greater understanding in where policies to support and strengthen this subgroup should be placed.

Vascular cognitive impairment describes a heterogeneous condition in which cognitive decline is precipitated by underlying cerebrovascular dysfunction. Ageing, as well as vascular diseases such as hypertension, stroke, cerebral small vessel disease and cerebral amyloid angiopathy, are risk factors for vascular cognitive impairment. The precise mechanisms by which these conditions impact the cerebral vasculature to drive cognitive decline, however, are unknown. Previous research has indicated that vascular risk factors can lead to microvascular oxidative stress, inflammation and endothelial dysfunction that can lead to tissue hypoperfusion, the development of white and grey matter vascular lesions (microinfarcts and microbleeds) and cognitive impairment. It was hypothesised that ageing, a prominent risk factor for cognitive decline, would induce impairments on neurovascular coupling resulting from neurovascular unit disruption. It was further hypothesised that induction of chronic cerebral hypoperfusion would mediate neurovascular dysfunction and vascular lesion development through increased oxidative stress, resulting in cognitive decline. Finally, it was also hypothesised that neurovascular impairments resulting from ageing and chronic cerebral hypoperfusion would be exacerbated in the presence of amyloid deposition. Four studies were performed in order to test these hypotheses. Vascular risk factors can be reproduced using experimental mouse models and provide a valuable basis in which to test hypotheses and therapeutic interventions. As such, a primary aim of this thesis was to develop and validate sensitive MRI approaches that would allow the detection of vascular alterations in vivo. In the first series of studies, MRI techniques to assess resting cerebral blood flow, vessel number, vascular lesions and inflammation in experimental mice were validated using established in vivo and ex vivo techniques, so that these techniques could be used in subsequent studies for vascular assessments in vivo. Arterial spin labelling was developed to assess resting cerebral blood flow, and was able to detect reductions in blood flow following cerebral hypoperfusion that correlated well with those obtained from laser speckle imaging. Q-map imaging was able to detect reductions in vessel number in acute lesions, and in non-lesioned mice measures of vessel number correlated well with histopathological measures. Structural T2 imaging was performed in order to detect ischaemic and haemorrhagic lesions in chronically hypoperfused mice, and was validated using H&E and Perls’ staining. Finally, contrast-enhanced T2* imaging was used to detect iron oxide uptake by macrophages in the brains of hypoperfused mice, which was further validated by the identification of iron-containing macrophages in immunostained brain sections. The second study was conducted to test the hypothesis that ageing would impair neurovascular unit function and structure, and that these impairments would be exacerbated in the presence of amyloid pathology. The aim of the study was to incorporate previously developed in vivo imaging approaches in the assessment of vascular function and alterations in neurovascular unit structure in both wild type and TgSwDI mice. As predicted, ageing caused a pronounced deficit on measures of neurovascular coupling, however this was not exacerbated by accumulation of amyloid in TgSwDI mice and was not associated with alterations in baseline blood flow measured by arterial spin labelling. Structural assessment of the neurovascular unit revealed a loss of contact between astrocytic endfeet and vasculature, which was significantly associated with the impairment on neurovascular coupling, in addition to other markers of breakdown of the neurovascular unit such as loss of pericyte coverage and microglial activation. Age and thalamic vascular amyloid accumulation were also associated with an increase in the NADPH oxidase (NOX) subunit p47, indicative of increased oxidative stress. Data from this experiment indicate that ageing can profoundly impair neurovascular coupling, mediated by gliosis and loss of astrocytic contacts with vasculature. The third study aimed to test the hypothesis that chronic cerebral hypoperfusion (a prominent early feature of vascular cognitive impairment) would impair vascular function and induce the development of vascular lesions and cognitive decline. The impact of hypoperfusion on neurovascular coupling, ischaemic and haemorrhagic lesion burden and cognition was investigated in wild type and TgSwDI mice. Hypoperfusion induced deficits on neurovascular coupling, increased lesion burden and inflammation assessed with T2 and contrast-enhanced T2* imaging, and caused impairment on measures of learning and memory. Hypoperfusion was also associated with an increase in the levels of NOX2, NOX4 and 3-NT at 3 months following surgery, indicating persistent reactive oxygen species production and oxidative damage in hypoperfused mice. The findings from this study indicate that vascular dysfunction and cognitive impairment following hypoperfusion may be mediated by increased NADPH oxidase activity and resulting oxidative stress. The previous studies indicated that markers of oxidative stress were induced in response to ageing, vascular amyloid accumulation and cerebral hypoperfusion. The final study sought to determine whether increased NOX activity mediates downstream pathological effects on vascular function, vascular lesion development and cognitive decline following hypoperfusion. NOX activity was inhibited pharmacologically by administration of apocynin to hypoperfused TgSwDI mice for 3 months following surgery. Treatment with apocynin significantly restored neurovascular coupling to a level similar to sham-operated mice, and there was a trend toward reduction of ischaemic vascular lesions. However, it was unable to rescue the prominent inflammatory response or decline in cognitive ability, as apocynin-treated mice were no different on these measures to non-treated hypoperfused mice. The data indicate that whilst inhibiting NOX may have potential therapeutic value in improving vascular function, additional interventions, for example to reduce inflammation, may also be required in order to prevent cognitive decline. Overall, the work outlined within the thesis indicate that vascular risk factors of ageing, cerebral amyloid angiopathy and cerebral hypoperfusion may converge on common pathways involving oxidative stress and increased inflammation in order to drive vascular dysfunction and lead to cognitive decline. Inhibition of NOX activity was able to rescue vascular function, however the results indicate that this was not sufficient to protect against cognitive impairment, suggesting additional therapeutic targets may need to be sought in order to fully preserve vascular health and prevent cognitive decline.

Background: In the recent years, the focus of research has shifted to Quality of Experience(QoE) to maintain the user satisfaction levels and fulfill their expectations of the serviceoffered. Numerous work has been established in finding the relationship between the networklayer and QoE. But, it is fact that the transport layer is much closer to the end-user than thenetwork layer in the TCP/IP communication protocol suite. Thus, any changes in the degreeof satisfaction or degree of annoyance are directly reflected onto transport layer than on thenetwork layer. So, it becomes more significant to study the behavior of user satisfaction inrelation to transport layer than the network layer. Objectives: This research is to relate the behavior of TCP to QoE. The main considerations tobridge the gap between them are: (a) Analyzing the effects of using different versions of TCPon server and client side, (b) Monitoring and analyzing the intensity of TCP traffic in thereverse direction and (c) Investigating TCP control flags from client to server. Methods: QoE related parameters used in this research are: (a) Quality of video i.e., MOS, (b)Degree of disturbance caused by initial delay, (c) Degree of disturbance caused by jerkinessand (d) Degree of disturbance caused by freezes. Effects of network impairments like delay,jitter and packet loss are considered in this research. NetEm is used as the traffic emulationsoftware to shape the traffic. The packet capture analysis of traffic exchange is implementedusing tcpdump. Results and Conclusions: The aim of this research is to provide a passive-estimation methodto assess the user perceived performance. The results of this research provide valuablecontribution to service providers/operators to note the early warning signals from TCP reversetraffic to evaluate the decrease of user satisfaction level and try to cope or/and recover fromimpairments in the network. This research also provides a scope for future researchers toinvestigate other protocols both in transport and application layers.

The use of eye movements to interact with computers offers opportunities for people with impaired motor ability to overcome the difficulties they often face using hand-held input devices. Computer games have become a major form of entertainment, and also provide opportunities for social interaction in multi-player environments. Games are also being used increasingly in education to motivate and engage young people. It is important that young people with motor impairments are able to benefit from, and enjoy, them. This thesis describes a program of research conducted over a 20-year period starting in the early 1990's that has investigated interaction techniques based on gaze position intended for use by people with motor impairments. The work investigates how to make standard software applications accessible by gaze, so that no particular modification to the application is needed. The work divides into 3 phases. In the first phase, ways of using gaze to interact with the graphical user interfaces of office applications were investigated, designed around the limitations of gaze interaction. Of these, overcoming the inherent inaccuracies of pointing by gaze at on-screen targets was particularly important. In the second phase, the focus shifted from office applications towards immersive games and on-line virtual worlds. Different means of using gaze position and patterns of eye movements, or gaze gestures, to issue commands were studied. Most of the testing and evaluation studies in this, like the first, used participants without motor-impairments. The third phase of the work then studied the applicability of the research findings thus far to groups of people with motor impairments, and in particular,the means of adapting the interaction techniques to individual abilities. In summary, the research has shown that collections of specialised gaze-based interaction techniques can be built as an effective means of completing the tasks in specific types of games and how these can be adapted to the differing abilities of individuals with motor impairments.

Made available in DSpace on 2015-04-16T14:49:04Z (GMT). No. of bitstreams: 1 Arquivototal.pdf: 1656239 bytes, checksum: 9d00e13de4170ceada5fa34a5551bc40 (MD5) Previous issue date: 2013-11-26 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / phenomenon in three dimensions: access, cognition and behavior. Digital impairments address an individual s limitations to access the information and communication technologies (ICTs), as well as limitations in terms of the needed cognitive abilities and positive behaviors for him/her to make proper use of ICTs for leisure or for work. Accordingly, this study is focused on the two constructs related to an individual s cognitive impairments: self-efficacy and anxiety. So the objective of this study is to examine the relationship between self-efficacy and anxiety toward the use of a management system of academic activities. Considering the relevance of this discussion, this study is in the context of conceptual aspects (cognitive impairments present in human-computer interaction), methodological aspects (measurement scales) and managerial aspects (cognitive aspects that mediate the effectiveness of the use of ICTs). Aiming by means of a systematic literature review (SLR), this study searched the literature on information technology, psychology and education. Findings show that the literature is fully aware of the relationship between computer self-efficacy and anxiety, contributing as well with enough evidence to this study. Upon the presentation of the SLR, to enable the measurement of the constructs, knowledge of the theory of scale development and of statistical procedures was conducted to answer as well the research question, applied on a survey with 174 undergraduate students in a Brazilian state university. The results address the factorial structure of both constructs in the context of the research and the negative correlation that was found between them. Moreover, the significant gender effects were found (reporting empirically that males tending to report greater self-efficacy and lower anxiety than females), as well as the results that highlight the gender effects on the correlation between the constructs. Finally, this study may contribute by suggesting that self-efficacy and anxiety are components of the cognitive dimension of the digital impairments framework. The theoretical and practical implications of this research were presented at end of the study, as well as the limitations and the recommendations for further research involving the topics here analyzed. / Limitações digitais são uma nova forma de abordar a exclusão e a desigualdade digital em três dimensões: acesso, cognição e comportamento. Essas limitações operam em nível de cada indivíduo e referem-se ao acesso às tecnologias de informação e comunicação (TICs), às habilidades cognitivas para utilizá-las e ao comportamento esperado em relação a elas no trabalho ou no lazer. Com base nesse cenário, a presente pesquisa concentra-se em dois fatores que contribuem para estimar o nível de limitações digitais cognitivas de um indivíduo: autoeficácia e ansiedade. O objetivo desta pesquisa é analisar a relação entre autoeficácia e ansiedade face ao uso de um módulo de atividades acadêmicas (SIGAA) a ser implantado por uma universidade federal brasileira Universidade Federal da Paraíba (UFPB). Nesse sentido, a pesquisa se insere no contexto de estudos de natureza conceitual (limitações cognitivas presentes na interação pessoa-computador), metodológica (construção de escala) e gerencial (aspectos cognitivos que mediam a efetividade de uso das TICs). A princípio, visando revisar sistematicamente estudos empíricos em tecnologia da informação, psicologia e educação, a pesquisa diagnosticou que a corrente literatura está plenamente consciente sobre a relação entre autoeficácia e ansiedade, contribuindo com evidência suficiente para sua elaboração. Após a revisão sistemática da literatura, a fim de permitir a mensuração dos construtos, autoeficácia específica em SIGAA e ansiedade de uso do SIGAA, o conhecimento da teoria do desenvolvimento de escalas e de procedimentos estatísticos foi realizado para responder adequadamente a questão de pesquisa, investigada a partir do levantamento de 174 discentes de graduação da UFPB. Entre as contribuições, apresenta-se a estrutura fatorial dos dois construtos à luz do contexto e discute-se a correlação negativa encontrada entre eles. Além do mais, o efeito moderador do gênero foi evidenciado (estando os discentes do sexo masculino relatando maiores níveis de autoeficácia e menores níveis de ansiedade, comparados aos outros discentes do sexo feminino), incluindo ainda tal efeito moderador na correlação entre os construtos. Por fim, esta pesquisa pode contribuir ao sugerir que a autoeficácia e ansiedade são componentes da dimensão cognitiva do modelo de limitações digitais. As implicações teóricas e práticas pesquisa são apresentadas ao final do estudo, bem como as limitações e as recomendações para outras pesquisas envolvendo os tópicos aqui analisados.

Nos últimos anos, a discussão a respeito do patenteamento de invenções de segundo uso tem gerado muitas discussões técnicas e acadêmicas. Dentre as partes divergentes, destacam-se o Instituto Nacional da Propriedade Industrial, autarquia responsável pela concessão de patentes favorável ao instituto -, e a Agência Nacional de Vigilância Sanitária ANVISA, agência cuja função é anuir previamente na concessão de patentes relacionadas à área farmacêutica - contrária a este tipo de privilégio de invenção. Na doutrina não é diferente. Alguns autores defendem a completa possibilidade de concessão dessas patentes, ao passo que outros apontam, desde o não preenchimento dos requisitos legais, até a incidência direta em impedimentos legais. O objetivo do presente trabalho é examinar tais requisitos e restrições e verificar se essas patentes podem ou não ser concedidas. Para tanto, analisaremos a história do sistema de patentes, sua natureza e funções. Em seguida, discorreremos sobre os aspectos constitucionais, concorrenciais e internacionais do sistema. Logo após, examinaremos os requisitos gerais da concessão de patentes e os impedimentos legais, a regulação do tema no Brasil, a doutrina contrária ao instituto e a possibilidade do patenteamento de segundos usos à luz dos requisitos e impedimentos legais. Abordaremos, ainda, projetos de lei, jurisprudência, direito comparado e discutiremos se os novos usos constituem ou não contrafação de patentes anteriores ainda em vigor. Em conclusão, questionaremos se as patentes de segundo uso atendem às funções do sistema de patentes. Nossa proposta é discutir a questão de forma técnica e desprovida de ideologias, procurando contribuir para a discussão do tema sob à luz dos sistema de patentes, que, em nosso entendimento, possui todas as ferramentas necessárias para o correto balanceamento dos interesses envolvidos e, caso corretamente aplicado, pode não só impedir eventuais abusos oriundos das patentes de segundo uso, como também transformá-las em um instrumento de incentivo tecnológico / Over the last years, the patentability of second use inventions has stirred extensive technical and academic debates. Conflicting parties include the Brazilian Industrial Property Institute - INPI (the Brazilian body in charge of granting patents), which advocates the patentability of second use inventions, and the National Public Health Agency - ANVISA (the regulatory agency in charge of giving prior consent to granting of patents in the pharmaceutical area), which stands against such privilege. And this also goes for legal writings. Some scholars defend that second use inventions are generally patentable, while others allege that second use inventions do not meet legal requirements and are even subject to legal impairments. This work examines these requirements and impairments to check whether second use inventions are patentable or not. To that end, this work will address the history of the patent system, its nature and functions. It will then turn to the constitutional, competition and international aspects underlying this system. Subsequently, this work will examine the general requirements and legal impairments attaching to patents, how this issue is regulated in Brazil, the legal writings contrary to such patentability, and the possibility of obtaining \"second use invention\" patents vis-à-vis the existing requirements and legal impairments. We will also look into bills, past court rulings and comparative law to discuss whether new uses should be viewed as a counterfeit to past patents still in force. In conclusion, we will question whether second use patents meet the patent system objectives. Our proposal is to give a technical and unbiased contribution to this matter and to the patent system as a whole, which apparently has the tools necessary for proper balancing of the interests involved and, if adequately applied, may not only avoid the abuse of second use patents but also turn them into a valuable instrument to foster technological improvements.