Thesis (Ph. D.)--University of Chicago, Dept. of History, 2001. / Includes bibliographical references. Also available on the Internet.

Thesis (Ph. D.)--University of Washington, 2002. / Vita. Includes bibliographical references (leaves 189-194).

This study aims to understand the use of a computer during GP consultations and to enable the development of EPR systems which are easier to review, enter data into, use to take action, and is more sensitive to the clinical context. This thesis reports the development of a multi-channel video and data capture toolkit, the ALFA (Activity Log File Aggregation) because existing observation techniques have limitations. None of the existing tools are designed to assess human-computer interaction in the context of the clinical consultation, where the social interaction is the prime focus. The ALFA tool-kit has been used to observe and study 163 live primary care consultations supported by computer systems with four different designs. A detailed analysis of consultation interactions was then performed focusing on doctor-patient communication and the integration of the computer into the consultation workflow. The data collection elements of the ALFA supported recording of consultation activities by providing rating techniques attuned with the characteristics of those interactions. The Log File Aggregation (LFA) component of the ALFA toolkit aggregated those multitudes of data files into a single navigable output that can be studied both quantitatively and qualitatively. A set of Unified Modelling Language (UML) sequence diagrams were then created as they could be used by software engineers to develop better systems. This research proposes a framework with three elements to analyse the computerised clinical consultation; (1) the overview of the context within which the consultation was carried out, (2) time taken to perform key consultation tasks and (3) the process used. Traditional analysis with its emphasis on the technology often misses crucial features of the complex work environments in which the technology is implemented. Direct observation could inform software designers in developing systems that are more readily integrated into clinical workflow. Direct observation of the consultation, using the ALFA toolkit is acceptable to patients; captures the context of the consultation the precise timing and duration of key tasks; and produces an output a software engineer can understand. ALFA offers a range of possibilities for research in the consulting room. The computer should be considered as an active element of the consultation; room layout and consultation models should let the computer in, while software engineers take in the capacity to sustain patient centred social interactions as a core facet of their design agenda.

Pulmonary embolism (PE) is an obstruction within the pulmonary arterial tree and in the majority of cases arises from a thrombosis that has travelled to the lungs via the venous system. Pulmonary embolism (PE) is a fatal condition which affects all age groups and is the third most common cause of death in the US. Computed tomographic angiography (CTA) imaging has recently emerged as an accurate method in the diagnosis of pulmonary embolism. Each CTA scan contains hundreds of CT images, so the accuracy and efficiency of interpreting such a large image data set is complicated due to various PE look-alikes and human factors such as attention span and eye fatigue. Moreover, manual reading and interpreting a large number of slices is time consuming and it is difficult to find all the pulmonary embolisms (PE) in a data set. Consequently, it is highly desirable to have a computer aided detection (CAD) system to assist radiologists in detecting and characterizing emboli in an accurate, efficient and reproducible manner. A computer aided detection (CAD) system for detection of pulmonary embolism is proposed in CTA images. Our approach is performed in three stages: firstly the pulmonary artery tree is extracted in the region of the lung and heart in order to reduce the search area (PE occurs inside the pulmonary artery) and aims to reduce the false detection rate. The pulmonary artery is separated from the surrounding organs by analyzing the second derivative of the Hessian matrix and then a hybrid method based on region growing and a new customized level set is used to extract the pulmonary artery (PA). In the level set implementation algorithm, a new stopping criterion is applied, a consideration often neglected in many level set implementations. In the second stage, pulmonary embolism candidates are detected inside the segmented pulmonary artery, by an analysis of three dimensional features inside the segmented artery. PE detection in the pulmonary artery is implemented using five detectors. Each detector responds to different properties of PE. In the third stage, filtering is used to exclude false positive detections associated with the partial volume effect on the artery boundary, flow void, lymphoid tissue, noise and motion artifacts. Soft tissue between the bronchial wall and the pulmonary artery is a common cause of false positive detection in CAD systems. A new feature, based on location is used to reduce false positives caused by soft tissue. The method was tested on 55 data scans (20 training data scans and 35 additional data scans for evaluation containing a total of 195 emboli). The system provided a segmentation of the PA up to the 6th division, which includes the sub-segmental level. Resulting performance gave 94% detection sensitivity with an average 4.1 false positive detections per scan. We demonstrated that the proposed CAD system can improve the performance of a radiologist, detecting 19 (11 %) extra PE which were not annotated by the radiologist.

Motyvacija yra tai, kas teikia mokiniui energijos ir kreipia kuria nors linkme jo elgesį. Mokymosi motyvai, susieti su mokymosi tikslais, yra neatskiriami nuo mokymosi turinio ir informacijos, su kuria mokiniai susipažįsta. / The final work of special professions studies deals with the problem of students’ learning motivation changes in a vocational school based on various factors of learning motivation. Education is not only spiritual and cultural values but also a solid and stable guarantee of statehood, also the people’ guideline development. Teacher and student are the main characters in the education process and success or failure depend on their interaction. Learning motivation is inseparable from human behavior, the reasons and motives, the interpretation and understanding. To promote students’ desire to learn, the most important is to find ways of reinforcing a desire to learn. Internal and external considerations influence students’ learning motivation. Internal motivation satisfies three innate psychological needs: competence, autonomy, and relationships.

This study is about the professionalization of nursing. Nursing leaders at the national level and in New Brunswick initiated a new education policy requiring the baccalaureate degree as entry to practice. The new education policy would eliminate the diploma programs which are two to three years in length in favour of the baccalaureate degree which is four years in length. This study demonstrates that the case of upgrading nurse education was a carefully planned event requiring the acceptance of groups within nursing and the government, and was not part of the occupation's natural evolution. / Publicly, nursing leaders argued that the increase in work complexity necessitates a more qualified and educated workforce. Less publicized reasons for the change were the desire to be perceived as a profession, the hope for more respect from other occupations, increased autonomy, and increased financial rewards. There was, as well, the desire to expand nursing tasks which would address the belief that traditional, valued nursing tasks were being taken on by other health care workers. / Four competing theoretical perspectives were used to interpret the education change in nursing: functionalist, human capital theory, the interactionist perspective, and conflict theory. The findings from this study support the explanatory power of both the interactionist perspective and conflict theory. The interactionist perspective, focusing on intra-occupational processes, suggests that the conflict between the professional nursing association in New Brunswick, who initiated the education policy change, and the provincial nursing union, who vehemently opposed the policy change, stems partially from differences in organizational memberships, beliefs about nursing roles and broader occupational goals. Conflict theory (in particular closure theory), describes how occupations pursuing a 'professional project' may define membership in such a way to exclude other subordinate groups (e.g. the use of credentials). Thus, the baccalaureate entry to practice may be interpreted as an exclusionary strategy which will close off opportunities to diploma nurses in an attempt to enhance nursing's status. In order to achieve this goal, nursing leaders needed the support of the provincial government.

En 1994, une nouvelle disposition voit le jour dans le Code des professions; l'inconduite sexuelle est désormais interdite au sein de toute relation professionnelle- que celle-ci relève du domaine des soins de santé ou non-, via l'article 59.1. Or, les relations sexuelles entre professionnels de la santé et patient sont interdites depuis la nuit des temps, que ce soit par le biais de condamnations morales ou légales, notamment à cause du rapport de force existant au sein de la relation thérapeutique. Selon le droit disciplinaire québécois, le patient est vulnérable et dépend de son traitant. Qu'il consente ou non à des relations sexuelles avec son traitant, ne change en rien la responsabilité qui incombe à ce dernier. Depuis l'entrée en vigueur de l'article 59.1 du Code des professions, les différents ordres professionnels du domaine de la santé ont décidé d'adopter une politique de "tolérance zéro", selon laquelle tout rapport à caractère sexuel est carrément interdit entre professionnel de la santé et patient. Or, force est de constater que les cas d'inconduite sexuelle ne s'estompent pas avec le temps et que le sujet est au coeur de l'actualité. Cette infraction, qui devrait normalement être punie sévèrement- si on se fie à cette politique de tolérance zéro-, se traduit, dans la majorité des cas, par de courtes périodes de radiation et de faibles amendes. Une étude approfondie du sujet nous apprend qu'il existe plusieurs lacunes au sein du système disciplinaire québécois empêchant justement l'atteinte de cette soi-disant tolérance zéro. Actuellement, l'on constate un certain soulèvement du public et des différents acteurs du système disciplinaire; le problème des inconduites sexuelles est loin d'être réglé. Le présent mémoire a pour objectif de se questionner sur cette tolérance zéro, à savoir si celle-ci constitue une utopie ou une réalité dans notre système disciplinaire québécois actuel.

Identifying how policy proposals are selected by policy-makers is an important question for scholars. This thesis evaluates the use of discourse and the role of actors in the exchange of ideas to support interprofessional collaboration (IPC) among Ontario’s regulatory colleges. A variation of discourse analysis was developed, based on the seven areas of reality that are constructed by language, to evaluate the interactions between state and policy actors. I argue that actors did not appear to engage in meaningful discourse because the state established the parameters of the consultative processes, which suggests the expert consultative processes were tools to legitimize the policy process for Bill 179. The state appears to have increasingly greater control of both the content and context of policy- making in this field. Further evaluation of the interactions between health professional organizations and the state is needed to better understand the importance of discourse in the health policy process.

No description available.

This study focuses on the relationship between women&rsquo / s work and women&rsquo / s liberation and emancipation from male domination by examining, within a feminist epistemological and methodological standpoint, the personal and occupational experiences of women doing professional work in Turkey. The aim of this study is to make a conceptual discussion by referring to the field of professional work and the particular form it takes in the Turkish case. Patriarchy at professional work, which operates differently than it does in waged work, has been approached with a socialist feminist standpoint. However, socialist feminist conceptualisation of patriarchy at work has been interpreted with a special focus on different forms of patriarchy. According to this, patriarchy is an incomplete formation which manifests itsef in different actual forms. Due to its changing and fluid nature it is maintained in different social practices. This interpretation of patriarchy with the notions of &quot / manifestation&rdquo / and &ldquo / practice&rdquo / provides for conceptualising the contextual features of patriarchy without being lost or dispersed in the contextuality of the patriarchal operations. It connects different contexts that arise from regional, religional, ethnic, racial, or class-based effects or social, economic, political and historical conditions without reducing them to a generalised sameness. In this context, women&rsquo / s becoming and being professionals in Turkey in the early republican period appears to be a significant example. In Turkey, Kemalism appears to be the practice which determines not only the professions but also the conditions of women&rsquo / s entery to the public realm as educated professionals. In this connection patriarchy is manifested within the interacting practices of professionalism and Kemalism. As the research design of oral history narratives of 18 women and some other biographic and historical sources indicates, women internalised professional values above and beyond Kemalist values together with their patriarchal contents. Although being professional has a certain liberating effect on women&rsquo / s lives they had to deal with patriarchal manifestations within the practices of professionalisma and Kemalism.