It is conventional to argue that the autonomy and reputation of regulatory agencies depend on their expertise. Yet the studies on how independent regulatory agencies (IRAs) create and deploy their knowledge capacity are few and far apart. Normatively, the justification for delegating decision-making powers to IRAs is that they operate by using technical analysis and expertise rather than political considerations. But yet again, although delegation has been discussed as a design principle, systematic evidence on the conditions under which IRAs make use of knowledge and how is still scarce. The literature on knowledge utilization portrays a rather complex link between expertise and policy, where relevant knowledge is not always reflected in policy outcomes and plays several functions besides facilitating the solution of policy problems. Unfortunately, scholars of IRAs have not exploited the insights of this literature yet. This dissertation addresses the under-explored question of the usage of economic knowledge by IRAs. We identify four possible uses of expertise: instrumental (i.e., to solve problems); strategic (e.g. to advocate a position); symbolic (e.g., to gain legitimacy), and non-use. Our aim is to explain under which conditions a certain usage is more likely to occur. To do so, we draw on the methodological device of explanatory typologies (Elman 2005). Specifically, we select two explanatory dimensions that reflect both the context and the content of policy: the level of conflict in the policy arena, and the degree problem tractability. We use different combinations of these two dimensions to derive four hypotheses on the possible uses of expertise mentioned above. The elusive nature of knowledge utilization makes the identification and measurement of these different usages highly dependent on an in-depth understanding of the institutional, organisational, and political context in which a regulatory decision is taken. We have thus opted for a qualitative approach based on case studies and process tracing (Bennett 2010; Brady 2010; Freedman 2010) to appraise the four hypotheses. Empirically, we performed three case studies on regulatory policy decisions taken by the UK Office of Communications (Ofcom) between 2005 and 2010. We find that, given certain scope conditions, the prevalent use of economic analysis is instrumental - a finding that contradicts previous research that labelled instrumental learning as extremely rare, if not a sort of technocratic utopia. Other uses still exist however, and given other scope conditions regulators can be strategic and symbolic in their approach to knowledge and expertise. This is not surprising if we accept the notion that regulators operate in a policy environment that is eminently but not exclusively technical: to survive in a (at least partially) political environment, regulators have to deploy usages of knowledge that deviate from the instrumental type.

Dynamic memory management required by allocation-intensive (i.e., Object Oriented and linked data structured) applications has led to a large number of research trends. Memory performance due to the cache misses in these applications continues to lag in terms of execution cycles as ever increasing CPU-Memory speed gap continues to grow. Sophisticated prefetcing techniques, data relocations, and multithreaded architectures have tried to address memory latency. These techniques are not completely successful since they require either extra hardware/software in the system or special properties in the applications. Software needed for prefetching and data relocation strategies, aimed to improve cache performance, pollutes the cache so that the technique itself becomes counter-productive. On the other hand, extra hardware complexity needed in multithreaded architectures decelerates CPU's clock, since "Simpler is Faster." This dissertation, directed to seek the cause of poor locality behavior of allocation--intensive applications, studies allocators and their impact on the cache performance of these applications. Our study concludes that service functions, in general, and memory management functions, in particular, entangle with application's code and become the major cause of cache pollution. In this dissertation, we present a novel technique that transfers the allocation and de-allocation functions entirely to a separate processor residing in chip with DRAM (Intelligent Memory Manager). Our empirical results show that, on average, 60% of the cache misses caused by allocation and de-allocation service functions are eliminated using our technique.

Evaluations are often an expectation that funders have for non-profit organizations such as Winnipeg’s child advocacy centre, Snowflake Place for Children and Youth (Snowflake Place). The purpose of this study was to evaluate the effectiveness of Snowflake Place through the use of a mixed methods case study evaluation employing the tenets of utilization-focused evaluation. A total of 30 interviews were conducted, with individuals from key service providing partners of Snowflake Place and non-offending caregivers of children who were forensic interviewed at Snowflake Place. This study also analyzed the data tracked by Snowflake Place on its service recipients. The results show that although the organization has only been operating for three years, Snowflake Place is able to provide consistent high quality services such as forensic interviews. Results indicate that Snowflake Place has the potential to improve upon the overall positive experiences of both service providing partners and service recipients. / February 2017

Bakgrund Utveckling av evidensbaserad omvårdnad i klinisk praxis innebär förbättring av kvalitén inom vården. Sjuksköterskestudenter påbörjar förberedelserna för evidensbaserad omvårdnad redan under sin utbildningsperiod, och nyexaminerade sjuksköterskor förväntas i hög grad tillämpa evidensbaserad omvårdnad i klinisk praxis. Syfte Syftet med denna litteraturöversikt är att beskriva nyexaminerade sjuksköterskors användning av evidensbaserad omvårdnad och vilka faktorer som har betydelse för sjuksköterskors tillämpning av evidensbaserad omvårdnad. Metod En litteraturöversikt baserad på 16 vetenskapliga artiklar som inkluderar både kvalitativa och kvantitativa studier. Resultat Utvecklingen i tillämpning av evidensbaserad omvårdnad bland nyexaminerade sjuksköterskor förefaller oförändrad eller avtagande under senaste decenniet. Mest tillämpad evidensbaserad omvårdnad är Instrumentell forskningsanvändning. Faktorer som har betydelse för sjuksköterskors tillämpning av evidensbaserad omvårdnad är: utbildning, oerfarenhet, stressiga arbetssituationer och stöd i arbetsmiljön. Slutsats Att granska i vilken utsträckning nyexaminerade sjuksköterskor tillämpar evidensbaserad omvårdnad är svårt då begreppet kan tolkas på olika sätt och det är enligt min kunskap fortfarande ett outforskat område. Nyexaminerade sjuksköterskor behöver mer stöd både före och efter examen för att utveckla sin tillämpning av evidensbaserad omvårdnad. De behöver mer stöd av lärare under utbildningsperioden och av erfarna seniora kollegor på arbetsplatsen. Därutöver krävs ett aktivt ledarskap. / Background Development of evidence-based nursing leads to improvement of the quality of care in clinical practice. Nursing students begin the preparations for evidencebased nursing already during their training period, and newly graduated nurses are highly expected to apply evidence-based nursing in clinical practice. Aim The aim of this review is to describe the newly graduated nurses' use of evidencebased nursing and the factors which are significant for the nurse´s application of evidence-based nursing. Method A literature review based on 16 articles that included both qualitative and quantitative studies. Result The development of application of evidence-based nursing among newly graduated nurses seems unchanged or decreasing in the last decade. The most applied implementation of evidence-based nursing among newly graduated nurses is Instrumental research use. The influential factors are: education, inexperience, stressful work situations and the support they perceive at their workplace. Conclusion In conclusion, this review emerged to that the whole situation of how and which extent newly graduated nurses apply evidence-based nursing is difficult to grasp within my comprehension. Since the apprehension of the concept of applying evidence-based nursing is complex, it is still an unexplored subject. Newly graduated nurses require further extensive support through their pregraduate to the post- graduate period to develop their application of evidencebased nursing. They need more guiding by the teachers, experienced senior colleagues and administrative support at their workplaces.

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Within the next 20 years, mental health problems are projected to be the leading cause of disability in Canada. Given that one in four Canadians is expected to be over the age of 65 by 2036, older adults’ mental health problems are a growing public health concern, especially because the rate of mental health service use is particularly low among this age group. Although there have been several decades of mental health research, it is still not well understood why older adults are not accessing treatment. A possible explanation for this is that identifying reasons for poor access alone does not capture the multifaceted, complex nature of individuals’ experiences with mental health problems and their paths into treatment. To address this gap in the literature, this study explored older adults’ experiences seeking psychological care and the factors that influence this dynamic process using the Network Episode Model-II (NEM-II; Pescosolido & Boyer, 2010; Pescosolido et al., 2013). To achieve this objective I conducted 15 individual semi-structured interviews with adults 60 years of age and older, who were receiving outpatient psychological services from a hospital in Winnipeg, Manitoba. Findings from this study suggest that participants’ background (social content), social support network, and the treatment system influence, and are influenced by, participants’ illness careers. Factors that delayed participants’ help-seeking included: a lack of support, “inappropriate” referrals or advice from treatment professionals, and a lack of knowledge among older adults about mental health and treatment options. This research has implications for researchers, clinicians, and public policy initiatives aimed at enhancing older adults’ access to psychological care. / October 2016

The overall purpose of the investigation was to determine the existence and extent of several relationships regarding the college student's seating position in the classroom.The design also included provisions for determining the relationships between the student's choice of seat and their academic achievement, academic ability, self-concept, self-acceptance, self-actual1zlng values, self regard, self-acceptance, initial expression of interest in the course, initial estimate of difficulty expected in the course, and initial estimate of his final grade in the course.

This cross-sectional, non-experimental study evaluates associations between cohort membership, type of dental coverage, and utilization of dental services in all patients age 47 and over who received dental care at Virginia Commonwealth University’s (VCU) School of Dentistry in 2011. Structural Lag Theory poses that society’s institutions lag behind the actuality of a healthy and capable older adult population. The two dynamisms of the Structural Lag Theory were used for this study. The Dynamism of Changing Lives is represented by Cohort differences. Cohort differences include cohort size, people living longer and retaining more of their natural teeth along with different attitudes toward dental care. This dynamism impacts the Dynamism of Structural Change, represented by the institutions of dental coverage and utilization of dental services. Cohort membership is an independent variable. The dependent variable, utilization, is defined as Financial-Total amount spent and Procedural-Routine adult dental prophylaxis. Dental coverage, a dichotomous variable, is used as an independent and dependent variable. Descriptive statistics revealed employer provided dental coverage is the most prevalent type of dental coverage. However, when considered a payment source, out of pocket funding is the primary source of payment for dental services. Using Chi-square and logistic regression, examination of Cohorts (1-Greatest Generation, 2-Silent Generation, 3-Baby Boomer Generation) revealed that Cohort 2 had more dental coverage than Cohort 1, and Cohort 3 had more dental coverage than Cohort 2. Using logistic regression, Cohort 2 showed the highest level of Procedural utilization. Evaluating Financial utilization, multiple regression models showed Cohort 1 utilized more than Cohort 2 and Cohort 2 utilized more than Cohort 3. Those with dental coverage spend more on dental services, fees for routine adult dental prophylaxis make up the majority of the total amount spent, and those with dental coverage utilize more dental services when defined as total amount spent. Because they have experienced different social, political, economic, and technological changes at different times in their life course, the receipt of dental services by new cohorts of older people differs from previous ones. Findings from this study confirm that there is a structural lag in Medicare policy and its coverage of dental services.

Individuals with overweight/obesity have been found to exhibit more negative attitudes toward health care and disproportionate rates of health care delay and avoidance, compared to their healthy weight peers. The present study sought to examine potential mechanisms through which weight status influences health care utilization and attitudes. Six hundred and thirty-three students completed a questionnaire measuring weight status, perceived weight bias, patient-provider relationship, and health care utilization and attitudes. Although the majority of the paths in the proposed theoretical mediation model were supported by the present findings, there was no support for the anticipated link between perceived weight bias and the patient-provider relationship or weight-related embarrassment. Overall, these results corroborated previous findings in a novel sample, but did not provide evidence that perceived weight bias mediates the relationship between weight status and health care outcomes. Possible explanations for these findings are deliberated.

Background: Regular access to dental services is a well-known factor in the oral health and development of children.1 As such, the United States federal government mandates each state to include dental services for children enrolled in Medicaid through the age of 21. Despite this mandate, the utilization rate of dental services among Medicaid enrolled children has remained remarkably low.2 In July 2005, Virginia implemented a sweeping Medicaid policy reform titled “Smiles for Children,” specifically aiming to increase Medicaid pediatric dental utilization rates. The purpose of this study aims to assess the effect of this 2005 policy reform on the utilization of dental services by children enrolled in Medicaid. Objective: The purpose of this study is to examine the impact of the 2005 Virginia Smiles for Children Medicaid policy reform on the utilization of dental services among Medicaid enrolled children. Methods: This was a retrospective cohort study of children (pre-reform n=559,820, post-reform n=690,538) enrolled in Virginia Medicaid from 2002 through 2008. Descriptive statistics and repeated measures multivariate logistic regressions were used to determine the relationship between enrollment (Pre- and Post-policy reform) and the utilization of dental services (1+ Dental Visits vs. No Dental Visits). Results: Descriptive analysis of the cohort found that 34% of pre-reform children had a dental visit while 44% of post-reform children. The logistic regression models revealed that children in the post reform period were 1.39 as likely to have had a dental visit. Stratifying for enrollment length reveals that as the length of exposure time to the post-reform policy increases, the odds of having a dental visit also increase as compared to the pre-reform period: for 31-36 months of enrollment the odds increase 1.54 times. Conclusions: Medicaid policy reform can significantly improve access to dental services for children and can therefore play an important role in promoting public health.