The transgender and gender diverse (TGD) patient population consists of a diverse group of people with unique needs who have, unfortunately, been underserved by the medical community. These individuals share a disproportionate burden of discrimination and disease when compared to cisgender persons. However, despite this, they continue to receive inequitable treatment, and transgender health topics still comprise just a small portion of medical education training. While efforts to improve awareness and training regarding transgender health care needs are underway, these take time to gain traction. It also relies heavily on changing medical providers’ own biases. Telemedicine has been proposed as a way to potentially bridge the gap and increase the access and availability of quality, informed medical care to this community. Although telemedicine has demonstrated its ability to do this in other areas of medicine, the existing research on whether it has the capacity to do so for transgender health care delivery is scant. The majority of the existing literature on the topic consists of retrospective qualitative feedback provided during a time where telemedicine was still emerging as a commonplace medium through which medical care is provided. Therefore, this thesis proposes to perform a randomized controlled trial investigating whether instituting a hybrid telemedicine approach has the capability to expand the accessibility of specialty transgender health care services as compared to fully in person medical care while maintaining a high standard of health care quality and patient satisfaction. This study would have the capacity to help inform future health care policy and provide support for continued telemedicine offerings and reimbursement moving forward.

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Cette thèse propose l’étude d’une méthode numérique permettant de simuler un plasma. On considère un ensemble de particules, dont le mouvement est régi par l’équation de Vlasov, et qui est sensible aux forces électromagnétiques, qui proviennent des équations de Maxwell. La résolution numérique des équations de Vlasov-Maxwell est réalisée par une méthode Particle In Cell (PIC). La résolution des équations de Maxwell nécessite un maillage suffisamment fin afin de modéliser correctement les problémes multi-échelles que nous souhaitons traiter. Cependant, mailler finement tout le domaine de calcul a un coût. La nouveauté de cette thèse est de proposer un solveur PIC sur des maillages cartésiens localement raffinés, des maillages non conformes, afin de garantir la bonne modélisation du phénomène physique et d’éviter une trop forte pénalisation des temps de calcul.Nous utilisons une méthode Galerkin Discontinue en domaine temporelle (GDDT), qui offre l’avantage d’être d'une grande flexibilité dans le choix du maillage et qui est une méthode d’ordre élevé. Un point fondamental dans l’étude des solveurs PIC concerne le respect de la conservation de la charge. Nous proposons deux approches afin de traiter cet aspect. La première concerne les méthodes utilisant un système de Maxwell augmenté, dont la nouveauté a été de les étendre aux maillages non conformes. La seconde approche repose sur une méthode originale de pré-traitement du calcul du terme source de courant. / This thesis deals with the study of a numerical method to simulate a plasma. We consider a set of particles whose displacement is governed by the Vlasov equation and which creates an electromagnetic field thanks to Maxwell equations. The numerical resolution of the Vlasov-Maxwell system is performed by a Particle In Cell (PIC) method. The resolution of Maxwell equations needs a sufficiently fine mesh to correctly simulate the multi scaled problems that we have to face. Yet, a uniform fine mesh of the whole domain has a prohibitive cost. The novelty of this thesis is a PIC solver on locally refined Cartesian meshes : non conforming meshes, to guarantee the good modeling of the physical phenomena and to avoid too large CPU time. We use the Discontinuous Galerkin in Time Domain (DGTD) method which has the advantage of a great flexibility in the choice of the mesh and which is a high order method. A fundamental point in the study of PIC solvers is the respect of the charge conserving law. We propose two approaches to tackle this point. The first one deals with augmented Maxwell systems, that we have adapted to non conforming meshes. The second one deals with an original method of preprocessing of the calculation of the current source term.

Even though America has seen an increase in the level of acceptance for people who identify as LGBTQ and/or gender non-conforming, certain aspects within society continue to hinder their rights, especially within public education. Specifically, there are insufficiencies regarding content of and attitudes toward including LGBTQ issues in teaching and leadership training programs. Add to that, the deficits in most Family Life Education (FLE) programs in elementary schools as they lack adequate coverage of developmentally appropriate teaching and learning about gender and sexuality. Taken together, it remains questionable whether the needs of LGBTQ and/or gender non-conforming children can truly be met. The purpose of this qualitative case study was to examine the policy discourse concerning teaching and learning gender and sexuality issues during early childhood at an elementary school in Virginia. Another purpose was to understand how educators perceive developmentally appropriate timing and content for these topics as well. A combination of critical policy analysis and critical advocacy research was utilized to compare and analyze the written policy discourse as presented within Virginia’s FLE policy to educators’ (teachers, counselors, principals) interpretation and enactment of these written discourses in their classrooms and schools. Findings revealed specific ways the written, spoken, and enacted discourses diverged and coalesced and how these similarities and differences inform future policy and practice. A critical analysis of the written discourses (and silences) suggest Virginia’s FLE curriculum and instruction maintains heteronormative undertones, while the spoken and enacted discourses indicates concern for expanding elementary students’ understanding and acceptance of LGBTQ and/or gender non-conforming children and non-normative family structures. Implications of findings include suggestions for future research and changes in policy and practice that aim to create more inclusive classrooms and schools.

Costs for repairing non-conforming parts may cause any company that is struggling with this problem, considerable damage. It is therefore essential that the problem was not relegated to the sidelines. The aim of this study was to find the cause of the large amount of non-conforming pieces and create a calculation of financial costs associated with the production of non-conforming parts and highlight the advantages of the individual methods of control depending on the size of the production of the four most problematic part. The first section summarizes the findings regarding the operational management-Industrial Engineering and Quality. A special chapter is devoted to the control systems in three foreign companies. The practical part deals with the resulting problem of non-conforming parts in Meopta-Optika, Ltd. and analyzes the situation through interviews, observation and application of mathematical and statistical methods to internal data. The outcome of the work will be recommendations that I could eliminate the problem.

The permeability of rocks has a critical influence on their fluid transport response in critical geo-environmental applications, such as pollutant transport or underground storage of hazardous nuclear waste. In such processes, the materials microstructure may be altered as a result of various stimuli, thereby impacting the fluid transfer properties. Stress or strain state modifications are one of the main causes for such evolutions. To numerically address this concern, an integrated and automated numerical tool was developed and illustrated on subsets of microCT scans of a Vosges sandstone (i) to explore the links between the pore space properties and the corresponding macroscopic transfer properties, with (ii) an incorporation of the microstructural alterations associated with stress state variations by using a realistic image-based representation of the microstructural morphology. The ductile mechanical deformation behavior under high confining pressures at the scale of the microstructure, inducing pore closures by local plastifications, was modelled using finite elements simulations with a non-linear elastoplastic law, allowing to take into account the redistribution of local stresses. These simulations require robust discretization tools to capture the complex geometry of the porous network and the corresponding solid boundaries of the heterogeneous microstructural geometries. To achieve this, an integrated approach for the conformal discretization of complex implicit geometries based on signed distance fields was developed, producing high quality meshes from both imaging techniques and computational RVE generation methodologies. This conforming discretization approach was compared with an incompatible mode-based framework using a non conforming approach. This comparison highlighted the complementarity of both methods, the former capturing the effect of more detailed geometrical features, while the latter is more flexible as it allows using the same (non conforming) mesh for potentially variable geometries.The evolution of permeability was evaluated at different confining pressure levels using the Lattice-Bolzmann method. This uncoupled solid-fluid interaction made it possible to study the combined influence on the permeability, porosity and the pores size distribution of the pore space morphology and the solid skeleton constitutive law parameters during loading and unloading conditions. The results highlight the need to consider elastoplastic laws and heterogeneities in the rock model to simulate the ductile behavior of rocks at high confining pressures leading to significant permeability alterations under loading, and irreversible alterations under loading/unloading cycles induced by progressive pore closures.The proposed methodology is designed to be flexible thanks to the interfacing with 'classical' discretization approaches and can be easily readapted to other contexts given the block approach. / Doctorat en Sciences de l'ingénieur et technologie / info:eu-repo/semantics/nonPublished

This study examined the hindering and helpful events that transgender and gender-nonconforming Ontarians experienced in therapy. To explore descriptive accounts of these experiences, we employed a systematic and rigorous investigation using the significant events framework and thematic analysis to interpret findings. Eleven participants underwent semi-structured interviews, providing rich accounts of their recent therapy experiences alongside their contexts and impacts. From these interview transcripts, we constructed eight major themes relevant to the research question: (1) Helpful and Hindering Relational Gestures; (2) Expectations about the Therapist’s Role; (3) Therapist’s Perception of Transness; (4) Topics in Therapy; (5) Significant Relational-Emotional Experiences; (6) Significant Event Impacts on the Client; (7) Client Processes in Understanding Significant Therapy Events; and (8) Contexts. Implications for therapeutic work are discussed.

In this thesis, evaluation of H(div)-conforming finite elements is implemented in a high-performance setting and used to solve the incompressible Navier-Stokes equation, obtaining an exactly point-wise divergence-free velocity field. In particular, the anisotropic Raviart-Thomas tensor-product polynomial space is considered, where the finite element operators are evaluated with quadrature in a matrix-free fashion using sum-factorization on tensor-product meshes. The implementation includes evaluation over elements and faces in two- and three-dimensional space, supporting non-conforming meshes with hanging nodes, and using the contravariant Piola transformation to preserve normal components on element boundaries. In terms of throughput, the implementation achieves up to an order of magnitude faster evaluation of finite element operators compared to a matrix-based evaluation. Correctness is demonstrated with optimal convergence rates for various polynomial degrees, as well as exactly divergence-free solutions for the velocity field.

Dans cette thèse on s'est intéressé à l'étude de problèmes concernant la théorie des écoulements compressibles. Dans une première partie on a traité le problème de transport instationnaire avec un champ de vitesse peu régulier, on a établi un résultat d'existence en passant à la limite sur des schémas numériques volumes finis avec un choix décentré amont qui garantie la positivité de la masse volumique. Pour le problème de Stokes, le résultat est démontré par deux approches : une approche par schéma numérique et une approche par régularité visqueuse.Dans la première méthode on propose une discrétisation qui combine la méthode des éléments finis et la méthode des volumes finis qui repose sur les espaces Crouzeix-Raviart. Une première difficulté de ce travail est de démontrer les estimations sur la solution discrète, en particulier à cause de la présence de la gravité dans le terme source de l'équation de quantité de mouvement. Le fait de considérer une loi d'état très générale conduit des difficultés supplémentaires en particulier dans le passage à la limite sur cette équation.Dans la deuxième méthode, le résultat d'existence est démontré en utilisant une approximation par viscosité. Ceci consiste essentiellement en deux parties : l'étude du problème de convection diffusion (qui apparait dans le problème régularisé) où on démontre l'existence et l'unicité de solution et en deuxième partie le passage à la limite sur le problème régularisé. / This thesis is concerned with the study of problems relating in the theory of compressible flows . We prove the existence of the considered problems in a first part by passing to the limit on the numerical schemes proposed for the discretisation of these problems. In the second part, the existence result is obtained by passing to the limit on the approximate solutions given by a corresponding regularized problem.The main result is to prove the existence of a solution of the stationnary compressible Stokes problem with a general equation of state.We first prove this result by passing to the limit on the numerical scheme as the mesh size tends to zero. The fact to consider a general E.O.S induces some additional difficulties in particular to get estimates on the discrete solution (which comes also from the presence of the gravity in the momentum equation) and in the passage to the limit on the E.O.S.We also prove the existence result by passing to the limit on a regularized problem. We first treat the convection-diffusion problem (which appears in the regularized problem), we give an existence and uniqueness result, and we then prove estimates on the approwimate solutions and pass to the limit on the regularized problem.

Recentemente a análise de capacidade do processo para dados com distribuição não normal começou a ser explorada, porém são raras as referências em língua portuguesa que abordem este assunto. Este trabalho apresenta os principais índices para análise da capacidade do processo com dados não normais encontrados na literatura, sendo o primeiro deles o método proposto por Clements em 1989, o segundo, proposto por Pearn e Chen (1997) e o terceiro método apresentado é o proposto por Chen e Ding em 2001. Os métodos de Clements (1989) e Pearn e Chen (1997) são parecidos em muitos aspectos, mas cada um deles apresenta uma novidade em relação ao cálculo dos índices de capacidade. Em comum, ambos os métodos apresentam índices semelhantes aos índices tradicionais, que supõem normalidade dos dados. O método de Chen e Ding (2001) traz como novidade o uso do índice proposto por eles para a estimação do número de itens não conformes apresentados pelo processo em estudo. Por fim, dois estudos de caso são apresentados neste trabalho. No primeiro deles tem-se a comparação entre os métodos de Clements (1989) e de Pearn e Chen (1997) para que se conclua sobre qual dos métodos é o melhor para o cálculo da capacidade do processo não normal. No segundo estudo de caso, todos os três métodos apresentados neste trabalho são aplicados em um conjunto de dados reais, obtidos de uma indústria metalúrgica. Para execução das análises nos estudos de caso, foi aplicado o software livre R versão 2.10. Os resultados apresentados mostram que o método proposto por Pearn e Chen (1997) é mais eficiente do que o proposto por Clements (1989) por considerar a assimetria do processo. Quanto ao processo da indústria metalúrgica observou-se que a etapa analisada é relativamente capaz. / The analysis of process capability for non-normal distribution data started to be explored recently, but is rare references that address this issue in Portuguese. This dissertation presents the main indices for process capability analysis for nonnormal data. The first method was proposed in 1989 by Clements, the second was proposed by Pearn e Chen (1997) and the third was proposed by Chen e Ding in 2001. The methods of Clements (1989) and Pearn e Chen (1997) are similar in many aspects, but each presents something new in the calculation of capability indices. In common, both methods have indices similar to the traditional indices, for normal data. The method proposed by Chen e Ding (2001) innovates using the index in the estimative of number of non-conforming in the process. Finally, two case studies are presented. The first compares the methods of Clement (1989) and Pearn e Chen (1997) to show the best method of calculation the capability of non-normal process. In the second, the three methods showing in this dissertation are applied in a metallurgical industry data. The R software version 2.10 was used in the analysis. The results show that the method proposed by Pearn and Chen (1997) is more efficient than that proposed by Clements (1989) for considering the asymmetry of the process. And the metallurgical process stage analyzed is relatively capable.