Background: As the diabetes (DM) epidemic in Canada continues to grow, the need to provide diabetes self-management education (DSME) becomes increasingly important. Research has shown that DSME can improve both physiological and behavioural outcomes in individuals with DM. Diabetes educators (DE) play an essential role in providing DSME to individuals with DM. Although considered an important role in the care of individuals with DM, the DE role is not well described in Ontario. Building a province-wide description of DEs’ role would outline the role of DE in Ontario is enacted, and suggest possible areas for improvement. The specific objectives of this study are: a) To describe the demographic characteristics of DEs in Ontario; b) To identify the structures, processes, and outcomes associated with the role of DEs; c) To identify the facilitators and barriers to providing DSME in Ontario; d) To identify the association between key characteristics of DEs (profession, education, certification, practice-setting, and DM-specific training) and the structures, processes and outcomes of this role. Methods: This cross-sectional study used an online questionnaire, the Diabetes Educator Questionnaire (DEQ). The DEQ was developed using the International Standards for Diabetes Education and Donabedian’s framework to examine the structures, processes and outcomes associated with the role of DEs. The study consisted of three sequential phases: (1) pre-testing the questionnaire in a tertiary care diabetes program, (2) pilot testing the questionnaire to a single Diabetes Educator Section (DES) chapter of the Canadian Diabetes Association (CDA), and (3) administering the DEQ to the remaining DES chapters across Ontario. The online questionnaire was created using LIME survey, an open source survey program housed at McMaster University. Data were downloaded, cleaned, and analyzed using statistical and geographical mapping software. Results: The DEQ demonstrated both face and content validity. A total of 178 out of an estimated 600 DEs across Ontario responded to the DEQ, for an overall response rate of 30%. The respondents consisted of 61 registered nurses, 94 registered dietitians, 18 pharmacists, and 4 nurse practitioners, and 1 undescribed. The majority (85%) of respondents were CDEs. Insufficient time, and organizational/management support were the two most common barriers to implementation of the role of the DE. Significant differences (p value greater than 0.05) in how DSME was provided and the use of outcomes were observed for profession, level of education, and practice setting. Limitations: With a low response rate, conclusions cannot be drawn from this study. Being an anonymous study, intra-rater reliability could not be performed. Conclusions: This study shows that the DEQ serves as a feasible tool to explore the role of DEs in Ontario, however, improved recruitment strategies are necessary before further research is performed. The study provides a foundational description of DEs across Ontario, generating possible hypotheses for future research. / Thesis / Master of Science in Nursing (MSN)

京都大学 / 新制・課程博士 / 博士(人間健康科学) / 甲第24810号 / 人健博第116号 / 新制||人健||8(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 黒木 裕士, 教授 青山 朋樹, 教授 松田 秀一 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DGAM

Yes / In recent years 3D printing has gained popularity amongst industry professionals and hobbyists alike, with many new types of Fused Filament Fabrication (FFF) apparatus types becoming available on the market. A massively overlooked component of FFF is the requirement for a simple method to calculate the geometries of polymer depositions extruded during the FFF process. Manufacturers have so far achieved adequate methods to calculate tool-paths through so called slicer software packages which calculate the required velocities of extrusion from prior knowledge and data. Presented here is a method for obtaining a series of equations for predicting height, width and cross-sectional area values for given processing parameters within the FFF process for initial laydown on to a glass surface.

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Climate change and rising temperatures is a well-known problem. To tackle global warming a transition from fossil fuels to renewable and reliable energy sources is necessary. Hydrogen, in fuel cells, is proposed to replace diesel and gasoline in the transport sector. Hydrogen is a pure fuel and the fuel cells only emit water and heat as a byproductbyproduct. Combined with electric motors, the hydrogen fuel cell can be 2-3 times more efficient compared to combustion engines fueled by gasoline. The performance of the fuel cell is affected by how the individual parts of the cell are designed. There are some difficulties in manufacturing complex geometries which requires require a forming in more than one step.  The goal isis to investigate, with the help of COMSOL Multiphysics software, how the performance of the fuel cell is affected by the shaped geometry at the cathode side of the flow plate. A numerical model is developeding will be made with varying parameters on the measurement of the cross-sections of the channels where pressure drop and flow distribution for ten different geometries isarewill be investigated. The model iswas built in the COMSOL Multiphysics 6.1 Software and includes a three-dimensional geometry consisting of a gas channel and a gas diffusion layer. The flow is laminar and the gas diffusion layer is set as a porous medium.  The results show that geometries with less sharp edges have lower pressure drops and more uniform flow distribution compared to geometries with sharper edges. The geometry with the sharpest edges has the highest pressure drop of 4.8 Pa/mm and the geometry with rounder edges has the lowest of 3.8 Pa/mm. A relationship between pressure drop and cross-sectional area can be found. With increasing radius and increasing cross-sectional area will the pressure drop decrease. The Reynolds number is higher for sharper geometries since the average velocity in the channels is higher, which also gives a lower friction factor. The length of the top flat becomes less for rounder geometries, which positively affects uniform flow distribution. The geometries with rounder edges have the most uniform distribution at the top of the gas diffusion layer and the sharpest geometry has the least uniform distribution. The deviation from the mean velocity is lower for sharper geometries, mainly because the velocities in the gas diffusion layer are lower. Sensitivity analysis was made over the mass flow rate and mesh, showing that the pressure drop is proportional to the mass flow rate and it becomes higher with less fine mesh.  Less fine mesh also gives lower velocities in the gas diffusion layer. Further studies can be made on how the gas diffusion layer behaves in the fuel cell when adding clamping force to the stack when putting it together and investigate if and how it affects pressure drop and flow distribution. The environmental benefit can be crucial if the performance of the fuel cells improves and motivates the investments which is are needed for, among other things, the infrastructure. / Klimatförändringar och stigande temperaturer är ett välkänt problem. För att ta itu med den globala uppvärmningen är en övergång från fossila bränslen till förnybara och pålitliga energikällor nödvändigt. Vätgas,  går bland annat att användas ii bland annat bränsleceller och , skulle kunna ersätta diesel och bensin inom transportsektorn. Vätgas är ett rent bränsle och bränslecellerna släpper bara ut vatten och värme som biprodukter. I kombination med elmotorer kan vätgasbränslecellen vara 2–3 gånger mer effektiva jämfört med förbränningsmotorer som drivs av bensin. Bränslecellens prestanda påverkas av hur de enskilda delarna av cellen är utformade. Det finns vissa svårigheter att tillverka komponenter med komplexa geometrier som kräver formning i fler än ett steg. Målet är att med hjälp av programvaran COMSOL Multiphysics undersöka hur bränslecellens prestanda påverkas av den formade geometrin på katodsidan av flödesplattan. En numerisk modellering kommer att utförasgöras utifrån med varierande parametrar därpå måtten hos kanalernas tvärsnitt varieras. Tdär tryckfall och flödesfördelning hos tio olika geometrier kommer att undersökas. Modellen byggdes i COMSOL Multiphysics 6.1 Software och inkluderar en tredimensionell geometri bestående av en gaskanal och ett gasdiffusionsskikt. Flödet är laminärt och gasdiffusionsskiktet antas vara ett poröst medium. Resultaten visar att geometrier med mindre skarpa kanter ger lägre tryckfall och jämnare flödesfördelning jämfört med geometrier med skarpare kanter. Geometrin med skarpast kanter har det högsta tryckfallet på 4.8 Pa/mm och geometrin med rundare kanter har ett tryckfall på 3.8 Pa/mm. Ett samband mellan tryckfall och tvärsnittsarea kan hittas då ökad radie och ökad tvärsnittsarea ger en minskning i tryckfall. Reynoldstalet är högre för skarpare geometrier eftersom medelhastigheten i kanalerna är högre, vilket också ger en lägre friktionsfaktor. Längden på toppen av kanalerna blir mindre för rundare geometrier, vilket påverkar flödesfördelningen positivt. Geometrierna med rundare kanter har den mest jämna fördelningen i toppen av gasdiffusionsskiktet och den skarpaste geometrin har den minst jämna fördelningen. Avvikelsen från medelhastigheten är lägre för skarpare geometrier, främst på grund av att hastigheterna i gasdiffusionslagret är lägre. Känslighetsanalys gjordes över storleken på massflödet och noggrannheten i meshen, vilket visar att tryckfallet är proportionellt mot massflödet och att det blir högre med mindre noggrann mesh. Mindre noggrann mesh ger också lägre hastigheter i gasdiffusionsskiktet. Ytterligare studier kan göras om hur gasdiffusionslagret beter sig i bränslecellen vid sammanpressning av alla delar i cellen och undersöka om och hur det påverkar tryckfall och flödesfördelning. Fördelen för miljönMiljönyttan kan vara stor om bränslecellernas prestanda förbättras och på så vis kan motivera de investeringar som behövs för utbyggnaden av bland annat infrastrukturen.

Background. Past research shows that anxiety disorders can impair work performance, but there are no national studies examining the relationship between anxiety disorder subtypes and low work performance. In a representative sample of employed US adults, we examined the association between low work performance and three types of anxiety disorders--generalized anxiety disorder (GAD), panic disorder (PD), and post-traumatic stress disorder (PTSD). Methods. We analyzed data collected in 2001-2003 on 4,418 employed US adults participating in the National Comorbidity Survey Replication (NCS-R). DSM-IV diagnostic criteria were used to determine the 12-month prevalence of GAD, PD, and PTSD. Low work performance was classified as a score of ≤7 on a 10-point scale in response to a single question (i.e. “What number describes your overall job performance on the days you worked during the past 30 days?”). Logistic regression predicting low work performance adjusted for age, gender, education, financial stress, having children, weekly work hours, race/ethnicity, and geographic region. Results. The prevalence of low work performances was 18.5%, while the prevalences of GAD, PD, and PTSD were 3.0%, 3.6%, and 4.2%, respectively. The prevalence of low work performance among those with GAD, PD, PTSD, or no anxiety disorder were 25.3%, 20.6%, 27.6%, and 18.0%, respectively. After adjustment for covariates, PTSD was the only anxiety disorder associated with a significantly higher risk of low performance (adjusted odds ratio = 1.44, 95 % confidence interval = 1.05, 1.98). Conclusion. Not all types of anxiety disorders may be associated with low work performance. Future research should examine these associations prospectively and by subtype of anxiety disorder. / Epidemiology