In a teaching clinic, healthcare students and their supervisors talk with their patients in the examination room and they talk about their patients during teaching consultations outside the examination room. Effective doctor-patient communication helps to establish management plans that are appropriate for both doctors and their patients. Amid a pressure to provide more patient-centered care, communicating effectively with older adult patients is particularly crucial because the occurrence of health problems and the likelihood of age-based communication barriers and negative attitudes increase with age. This project is a qualitative, collective case study of eye examinations, case presentations and participant interviews. This study took place in the Primary Care Clinic at the University of Waterloo, School of Optometry. Participants included 8 fourth-year optometry students, 5 supervising optometrists, and 10 patients between 60 and 85 years of age. The study involved audio-recording and analyzing eye examinations of older adult patients, case discussions about these patients, and interviews of older adult patients, optometry students and their optometrist supervisors. Data were analyzed using a constant-comparative approach, consistent with grounded theory. This study identified some of the discursive features of and reflections about patient-centered communication during the talk with and about older adult patients. During the eye examinations, optometry students incorporated five types of verbal communication that were consistent with a patient-centered model: Patient Agenda, Social Talk, Analogies, Patient Agency, and Health Promotion & Prevention. Although these successful attempts to incorporate patient-centered communication strategies were evident in the talk with patients, optometry students routinely engaged in seven other verbal strategies that challenged this patient-centered ethos: Closed-Ended Questions, Biomedical and Technical Language, Patient as a Problem, Unacknowledged Patient Voice, Patient Understanding, Doc Talk, and Caregiver Agency. Two types of discursive strategies related to patient-centered care were identified in the talk about older adult patients during novice case presentations: Voice of Optometry and Voice of Patient. The Voice of Optometry incorporated field-sanctioned language strategies including three subcategories: Biomedical, Technical and Judgment. In contrast, the Voice of Patient represented various levels of patient agency: Passive Recipient, Negotiated Agency and Patient Agency. According to their interviews, optometry students received limited explicit training, in both classroom and clinic instruction, on how to talk with and about patients. During their interviews, optometry students and their supervisors made clear distinctions between patient–centered and doctor-centered care. Most of the students and supervisors believed that the optometry profession and the optometry school promoted patient-centered care. Elements of patient voice were represented in the eye examinations, the case presentations and the post-examination patient interviews. During novice case presentations patient voice was often fragmented into sound bytes of the original patient statements or translated into field-sanctioned language. Although many instances of patient education and counselling were evident throughout the eye exams, limited discussion occurred in the novice case presentations between students and their instructors about what to say to patients, In addition, the majority of topics addressed during educational and counselling moments were not discussed during the novice case presentations. Additionally, post-examination patient recall regarding education and counselling was generally limited. Throughout this study, talk about age appeared in four ways: 1) caregivers used age to make clinical decisions during case presentations, 2) caregivers referenced age during counseling and education to explain eye and vision changes, 3) patients commented on the impact of age on themselves, and 4) caregivers spoke about how they considered age when speaking to their patients. While the caregivers generally valued a patient-centered approach, the talk with and about patients was skewed towards strategies that may limit the ability to support this ethos. It is questionable what audience (i.e. patient or supervisor) optometry students value and how this affects their ability to adopt patient-centered communication strategies. Findings from this study suggest that caregivers and their patients might benefit from some changes in the way patient-centered practice is taught and practiced in this optometry teaching clinic. As a greater understanding develops of the strategies of and challenges to patient-centered practices in optometry, it is my hope that optometry training programs as well as optometry professional organizations will further embrace patient-centered practices.

Thesis (Ph. D.)--Rutgers University, 2009. / "Graduate Program in Education." Includes bibliographical references (291-301).

Thesis (M.A.)--York University, 1998. Graduate Programme in Psychology. / Typescript. Includes bibliographical references (leaves 253-263). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL:http://wwwlib.umi.com/cr/yorku/fullcit?pMQ27360.

In humanoid robotics, there is a long pursuit of making bipeds capable of walking in highly unstructured and roughly sensed environments. Within this goal, our objective is to develop a compliant bipedal humanoid robot, based on McKibben pneumatic actuators that can move in these terrains as well as quickly adapt to unpredicted variations on the contact state. We present here the first part of our work, focusing on the design, construction and control of a pneumatic robotic joint capable of achieving the control performance necessary for responding compliantly and accurately to contact transitions while delivering high forces needed to handle the physical challenges associated with rough terrains. In particular, we address our progress in the mechanical and embedded electronic design, actuator modeling, and compliant control strategies for a robotic joint based on fluidic pneumatic artificial muscles (PAMs). The proposed robotic joint has been validated experimentally, exploring various aspects of its performance as well as its shortcomings, but overall demonstrating the potential benefits of using pneumatic muscles. / text

The Baby-boom generation, a major contributor to an unprecedented increase in older-aged people, is known for its zest for life and autonomy. Boomers are predicted to enter nursing homes in record numbers with multiple chronic illnesses and person-centered health care expectations. The purpose of this work was to describe current chronic illness management practices in nursing homes focused on person-centered (resident-directed) care and involvement of residents in health-related decision-making and self-care activities. Four projects were undertaken to accomplish this objective: (1) a systematic review of the quantitative literature regarding the management of type 2 diabetes, an exemplar chronic illness; (2) a synthesis of the qualitative literature describing chronically ill, older-aged adults' perceptions of chronic illness care decision-making; (3) an ethnographic pilot study describing the meaning of having type 2 diabetes to nursing home residents; and (4) a qualitative descriptive study of secondary data describing nursing home stakeholder perceptions of opportunities for resident involvement in chronic illness decision-making and self-care activities. Wagner's Chronic Care Model, modified for the nursing home, was the sensitizing framework for this research. Twenty studies met criteria for the systematic review, which described a lack of adherence to clinical practice guidelines and rare inclusion of the resident and family in management practices. The synthesis of 7 qualitative studies revealed 4 themes: (1) Being recognized because I matter; (2) Awareness of importance; (3) Empower through connections and opportunities; and (4) Time is precious. Cognitively capable older-aged adults described benefits from involvement in health care decisions and harm from non-involvement. They perceived inadequate time spent with health care providers as a major determinant of involvement. The pilot ethnography included 3 residents. Findings revealed a perception of few diabetes management choices but many unspoken resident preferences. The qualitative descriptive secondary analysis study included 5 residents, 7 family members, 8 advanced practice registered nurses, 5 physicians, and 6 administrators. Stakeholders perceived many opportunities for resident involvement in decision-making and self-care, but described as many limitations. Findings indicated a shortage of health care providers and differing stakeholder ideas of purpose and goals restricted resident involvement. Clinical, research, and policy implications were discussed. / text

In an effort to accentuate the need for Black Psychological theory, research and methodology within the field of Africology, Africana professor Dr. DeReef Jamison argues that in order to gain a full understanding of the African American experience, Africana scholars must consider the importance of Black Psychology as it relates to their work. In his article entitled, Through the Prism of Black Psychology: A Critical review of Conceptual and Methodological Issues in Africology as seen through the Paradigmatic Lens of Black Psychology he notes that while Black Psychology is identified as a core component of Black Studies, few programs include such courses within their curricula. He further suggests that the goal within Black Psychology of examining the impact of African Americans historical experiences on their psyche speaks to the primary goal of Black Studies. Thus the empirical nature of Black Psychology utilized to understand the African American psychological experience can have tremendous implications for the field of Black studies. Through an overview of the field of Black Studies, its core curriculum, select graduate programs, and the field of Black Psychology, this paper will extend Dr. Jamison’s arguments by suggesting that African-Centered psychology specifically, needs to be central in the field of Black studies. While Black Psychology empirically addresses the African American psyche considering African-American historical experiences, it is the African Worldview analytical approach, which is central to African-Centered psychological theory and methodology and provides a culturally specific analysis, which is critical to the Black Studies intellectual pursuit. / text

Despite being exposed to the Learner-Centred Approach (LCA) through traditional teacher professional development since 2000, teachers in Tanzania have generally failed to implement LCA in secondary schools. However, previous studies on the learning study in different parts of the world have shown encouraging results in developing teachers’ competencies. This study investigates how the learning study guided by the variation theory can enhance teachers’ competencies using the LCA in Tanzania secondary schools. It addresses two questions: what are the changes of teachers’ understanding of LCA through learning study rounds in a Tanzanian secondary school? And, what are the changes of teachers’ capability of implementing LCA through learning study rounds in bringing about student learning in a Tanzanian secondary school? A group of three teachers (John, Benja & Peter) in a school implemented learning studies for a period of one year. All forms two (N= 255) and three (N=240) students took part in three research lessons. The study adopted case study and phenomenographic research approaches. It used teachers’ interview protocols, lesson video recordings, lesson preparatory meetings, teacher’s journals, and students’ tests as research instruments. The teachers’ experiences and implemention of the LCA were studied before and during the three rounds of learning studies. Data were analysed using variation framework and SPSS version 16.0 for students’ tests. The study has two main findings. First, teachers involved in the three learning study rounds changed their understanding of LCA. They changed from seeing LCA as methodological (before the learning study) to treating it as subject content and even as far as seeing it as object of learning (during the learning studies) orientations. These changes were gradual and differed slightly, depending on the particular aspect(s) (the method, the content or the object of learning) a teacher focused more on than other aspects at a given time. Second, guided by the variation theory through learning studies, teachers’ capability to implement LCA improved progressively in slightly different ways, which in turn improved student learning. The teachers changed from simply making classroom pedagogical arrangements before the learning study to engaging the learners in either the content or the object of learning and enabling them to discern critical aspects of the objects of learning in terms of variation and invariance of those aspects during the learning studies. The study concludes that implementing learning study - guided by the variation theory - may be effective in enhancing teachers’ ways of conceiving and practicing LCA with a primary focus on student learning. In addition, as teachers increase their understanding of learning study and the use of variation theory they may advance their understandings in designing and teaching LCA lessons, thereby increasing possibilities for student learning. Such a conclusion lends credence to the variation theory which purports that powerful ways of acting originates from powerful ways of seeing. It also extends this theory to teacher learning of the LCA pedagogy. / published_or_final_version / Education / Doctoral / Doctor of Philosophy

The proposed study will investigate the dimensions of the relationship between three conceptualizations of African-centered worldview (ACWV) and racial identity (RI) attitudes in a sample of African American college students. A canonical correlation analysis will be conducted to explain the relationship between the ACWV variable set and the RI attitudes variable set. It is hypothesized there will be several significant correlations and multiple linear correlations (i.e., dimensions) between the variable sets. Specifically, it is hypothesized that endorsement of each conceptualization of ACWV will be negatively related to Pre-encounter RI attitudes. It is also hypothesized that each conceptualization of ACWV will differentially predict identity salient RI attitudes. Implications and limitations of this study will be discussed. / text

Using learner centered instruction (LCI), a group of beef farmers were guided to design a farm in a layout that would most effectively offer continual learning opportunities for the beef practitioners themselves. Learner centered instruction was used as the primary teaching method for the project's completion. When using LCI, coupled with the correct facilitation of programs, student empowerment, and subject interest, positive experiences are more likely to result.

One purpose of this study was to present a theoretical model for research in counseling, involving matching counselor and client variables, expressed as: Counselor effectiveness is a function of the interaction of counselor characteristics and client characteristics. The second purpose, examination of the interaction effect of counselor and client variables in the counseling relationship, was an application of the model. The counselor and client characteristic selected was dogmatism; and the experimental problem was to determine if the overall effectiveness of a counseling interaction is significantly influenced by matching counselor and client on dogmatism level.Volunteers were solicited from seven classes of a graduate level counseling course taught concurrently in a counselor education program for Americans stationed with the United States Military in West Germany. This sample was administered the Rokeach Dogmatism Scale, Form E, to determine dogmatism level for matching counselor-client dyads. The mean of the total sample of scores obtained on this scale, 127.1, divided the sample into two groups, 72 low and 73 high dogmatic subjects.Based on the scores from this instrument, the 145 subjects were randomly matched with persons of either similar or dissimilar dogmatism levels according to the high and low dogmatic pools in each class. In the matching procedure, the subjects were also randomly assigned to one of two roles, counselor or client. This procedure produced four different dyad-type groups:counselor low dogmatic / client low dogmatic; (2) counselor low dogmatic / client high dogmatic; (3) counselor high dogmatic / client low dogmatic;(4) counselor high dogmatic / client high dogmatic.One week after the initial testing for dogmatism levels, the students were again asked to voluntarily participate in an experimental study. From these 109 male and female volunteers, 54 dyads formed by the earlier matching procedure were given audio-cassette tapes with their assigned roles and instructions regarding these roles. They then taped a 30 minute counseling session. After two dyads were deselected for statistical purposes, there were thirteen dyads in each of the four dyad-type groups. Subjects were debriefed following the experiment and anonymity was guarded throughout the study.To investigate counselor effectiveness, the Gross Facilitative Interpersonal Functioning Scale was used to rate counseling effectiveness. Four male and five female raters were trained in the use of the scale. Three 3-minute segments from each of the 30 minute taped sessions were rated from three master tapes, three raters per tape. Criteria were specified for the 3-minute segments and the recording of the master tapes.Analyses of the three hypotheses of the study, using a two-way analysis of variance, showed no main effect significance and a significant interaction effect. Analysis of the interaction effect and additional post hoc analysis indicated a significant interaction effect based on similarity of dogmatism levels in counselor-client dyads when compared to dissimilarly matched counselor-client dyads.When the conclusions of the study were viewed in the context of the theoretical model, it appeared that the matching model may be a useful construct for future research in counseling. In view of the problem of this study, the findings indicated that counselor effectiveness maybe a function of the interaction of similar counselor and client dogmatism levels and not a function of a particular dogmatism level in either counselor or client. If supported by further research, the implication of this finding is that counseling effectiveness might be enhanced by considering counselor and client level of dogmatism when client assignments are made and by matching counselor and client on dogmatism level.