Background: Advance care planning (ACP) is a method used for patients to express in advance their preferences, beliefs and values for life-sustaining treatments at the end-of-life. With growing ethnocultural diversity in Canada, health care providers are managing an increasing number of diverse beliefs/values that are commonly associated with preferences for mechanical ventilation (MV) at the end-of-life. The aim of this project is to explore methods used by health care providers to set care plans for MV with ethnocultural populations. Methods: Qualitative analysis of semi-structured interviews with open-ended questions and two clinical vignette components was conducted with eight (8) health care providers who engage in ACP. Participants were recruited using a snowball-sampling approach from five acute-care hospitals within the Ottawa region. Results: Three major themes emerged from collected dataset: 1) Goals of care across illness trajectories, 2) Respecting beliefs, values, and wishes for care, and 3) Cross-cultural support in ACP. Using a value-based approach in ACP was described as an effective method for managing and interpreting diverse beliefs/values that impact decisions for MV. However, organizational, systemic, and personnel barriers that exist continue to hinder the provision of cross-cultural ACP across health settings. Contexte: La planification préalable des soins (PPS) est une méthode utilisée par les patients et les familles pour exprimer à l'avance leurs préférences liées aux traitements de prolongation de vie. En raison de la diversité ethnoculturelle croissante au Canada, les professionnels de la santé sont confrontés à des croyances et valeurs différentes, souvent associées à une préférence pour l’initiation et le maintien de la ventilation mécanique (VM) en fin de vie. L'objectif de ce projet consiste à explorer les stratégies utilisées par les professionnels de la santé lors des discussions associées à la VM auprès d'une clientèle multiculturelle. Méthodes: Huit (8) participants (médecins et infirmières) impliqués dans la PPS ont accepté de participer à une entrevue semi-structurée avec des questions ouvertes et deux scénarios cliniques. Les participants ont été recrutés à l'aide de la méthode d’échantillonnage par réseau (« boule de neige ») de cinq hôpitaux de la région d'Ottawa. Résultats: Trois grands thèmes ont émergé des entrevues: 1) les objectifs de soins à travers les trajectoires de la maladie, 2) le respect des croyances, valeurs et souhaits pour les soins, et 3) le soutien dans la PPS en contexte interculturel. Lors de la PPS, utiliser une approche basée sur les valeurs a été décrite comme une méthode efficace pour interpréter et prendre en compte les diverses croyances et valeurs qui ont une influence sur les décisions liées à la VM. Cependant, les barrières systémiques, organisationnelles et personnelles continuent d'entraver les services associés à la PPS en contexte interculturel dans les établissements de santé.

No description available.

No description available.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / The monitoring systems that are currently used as part of the management of construction projects consist of collecting the field information, documenting it manually and then digitizing it. Those responsible for carrying out the reports through this procedure dedicate between 28% and 41% of their time daily for their preparation. This traditional process is slow and inefficient because the information is dispersed in different documents, so data can be omitted, causing that no corrective actions are taken in a timely manner. Likewise, the construction sector has little use of technological resources, and therefore, there is no automated process, which makes it difficult to monitor construction projects in an efficient way. In this sense, this research establishes the optimization of the control procedure through the use of a data acquisition tool to reduce the man-hours used in advance control. With the application of this proposal, the hours spent by the personnel involved in project management were reduced by 30%. / Revisión por pares

Under the initiative of Department of Transportation (DOT) a safety-critical, dual redundant, open source traffic signal control application is currently being developed. The system named SCOPE, for Signal Control Program Environment, currently implements standard 8-phase NEMA logic and the National Cooperative Highway Research Program 3-66 preemption logic. SCOPE is designed to be part of the Advanced Traffic Controller (ATC), making use of API standard 2.06b to integrate with the hardware. Safety-critical status is achieved through redundancy of application logic that constantly compares expected signal phase information. From baseline requirements, engineers independently program application code, one using Ada95 and the other using C++. The Traffic EXperimental Analytical Simulation Model, a microscopic single-intersection vehicular simulation, was used for initial validation and testing of the functionality of the system. The second demonstration of the SCOPE, used actuated detector data collected from a recording of a live intersection. Actuator calls were placed on SCOPE at the same times the vehicles triggered the detectors in the video (assuming the vehicles were not in-queue). Using SCOPE the real-world traffic was not only right-of-way safely yielded, but the traffic flow state time average time in-queue reduced. The final phase of testing will occur when the DOT performs Formal Qualification Testing, which is scheduled for 2013. Upon validation and subsequent release to the open source community SCOPE will provide users the ability to replace the proprietary application software residing in ATC cabinets. Transparency will be provided into another aspect of the traffic control signal thus taking the initiative of ATC one step further.

The purpose of this study was to examine how institutional culture promoted or impeded the implementation of round one and two NSF ADVANCE initiatives designed to improve academic climates for women in science and engineering. This study was conducted in two phases. In phase one, 35 participants from 18 institutions were interviewed to answer three research questions. Participants identified a policy, process, or program designed to improve academic cultures for women in science and engineering fields. Participants also identified strategies that promoted the implementation of these efforts, and discussed factors that impeded these efforts. In phase two, site visits were conducted at two institutions to answer a fourth research question. How did institutional culture shape the design and implementation of faculty search processes? Policies, processes, and programs were implemented by participants at the institutional, departmental, and individual levels and included family friendly and dual career policies at the institutional level, improved departmental faculty search and climate improvement processes, and mentoring programs and training for department heads at the individual level. Communication and leadership strategies were key to the successful implementation of policies, processes, and programs designed to achieve institutional transformation. Communication strategies involved shaping change messages to reach varied audiences often with the argument that change efforts would improve the climate for everyone not just women faculty members. Administrative and faculty leaders from multiple levels proved important to change efforts. Institutional culture shaped initiatives to improve faculty search processes. Faculty leaders in both settings used data to persuade faculty members of the need for change. At one site, data that included national availability information was critical to advancing the change agenda. At the other site, social science data that illustrated gender bias was persuasive. Faculty members who were effective as change agents were those who were credible with their peers in that setting. / Ph. D.

No description available.

Advance notice, a warning of an upcoming demand or transition, is a common antecedent intervention used to reduce problem behavior and to increase compliance in educational settings. However, research conducted in the past decade has failed to uphold the efficacy of advance notice with either typically developing or developmentally disabled children. This study analyzed the frequency of noncompliance and problem behavior associated with transitions in two preschool children diagnosed with Autism Spectrum Disorder by applying advance notice, guided compliance and social praise, and advance notice combined with guided compliance and social praise during consecutive treatment phases. Compliance increased for all participants during phases including an advance notice component; however, problem behaviors increased as well, suggesting that while advance notice may increase compliance for some learners, it may also occasion problem behaviors. / Applied Behavioral Analysis

This study attempts to resolve to what extent individuals with Down syndrome benefit from advance information provided visually, versus the same information provided verbally when performing a manual aiming task. Adults with Down syndrome and undifferentiated developmental handicaps, as well as control subjects without a developmental handicap, performed manual aiming movements to targets 10.5 cm. away. On a particular trial, subjects were cued about the specific movement either visually or verbally. The cue provided either 50% or 80% certainty. Nonhandicapped control subjects initiated and completed their manual aiming movements more quickly than subjects with mental handicaps. As well, individuals with Down syndrome were found to be slower and more variable in reaction time than individuals in the other mentally handicapped group when valid information was provided verbally but not when the cue was provide visually. These results provide support for the Elliott and Weeks (1990) model of biological dissociation. Specifically, the atypical hemispheric lateralization for speech perception exhibited by individuals with Down syndrome results in a disruption in communication between functional systems responsible for the processing of verbal langauge, and the organization of complex movement. / Thesis / Master of Science (MS)

This work considers inventory systems with two demand classes, where advance demand information is available. Three related scenarios are presented: three-stage production-inventory systems are studied in first two, whereas pure inventory systems are studied in the last scenario. In the first scenario, continuous review production-inventory systems are considered, where only one class provides advance demand information and early demand fulfillment is permitted. A new approach for production replenishment and order fulfillment in such systems is proposed, which combines the benefits of early fulfillment with Kanban-based pull systems. Simulation is used to compare the performance of the resulting policy with two other policies for a variety of scenarios (depending on the arrival rates, system utilizations, cost structures, arrival ratio, priority levels and amount of the advance demand information). A simulation-based lower bound on the optimal cost is established for some specific scenarios. The proposed policy outperforms the existing policies in every setting considered. Also, the proposed policy has added advantage of both retaining the benefit at high system utilizations and increasing the benefit up to the maximum level of advance demand information provided. A small fraction of customers providing advance demand information with early fulfillment acceptable is shown to have higher benefit than all customers providing same advance demand information with no early fulfillment. In second scenario, both classes provide advance demand information in production-inventory systems, though only one class accepts early fulfillment. Different levels of system utilization, arrival ratio and backorder cost are considered in the simulation experiments to show the superiority of early fulfillment. Also, experiments suggest that lowering the expected supply lead time may be more beneficial than increasing the demand lead time by the same amount for production-inventory systems with utilization dependent supply lead times. In third scenario, pure inventory systems are considered, where the demand classes provide different amount of advance demand information, and only one class accepts early fulfillment. The structure of an optimal policy is analytically characterized for periodic review systems under some specific conditions. / Ph. D.