Proefschrift Maastricht. / Lit. opg. - Samenvatting in het Engels.

The prevalence of overweight and obesity in adolescents has increased dramatically over the past few decades. This increase is associated with a higher risk of developing Type 2 Diabetes Mellitus (T2DM). The "R.U.A. Healthy Kid?" program was created to target modifiable risk factors related to development of T2DM. This study specifically focuses on the influence of snacking habits. Researchers have documented an increase in snacking occasions and preference for low-nutrient snacks among adolescents. Many adolescent diabetes prevention programs target dietary behaviors, but none have used the Stages of Change as a theoretical framework to promote behavior change. The purpose of this study was to determine the impact of a three month community-based intervention on snack consumption and snacking habits of adolescents with risk factors for T2DM. Additionally, it explored the use of the Stages of Change model to understand how the intervention impacted adolescents' movement through the stages, and if reported stage was related to reported snack consumption and snacking habits. At completion of the study, the majority of participants reported forward progress in stages of change, indicating they were actively making changes in regards to high-nutrient (healthy) snacking. There was also a decrease in low-nutrient (unhealthy) snack consumption, and a significant improvement in overall snacking score. Participants reported several factors influenced their snack choice including hunger, taste, and availability. These findings are important to the development of appropriate programs to encourage healthy dietary behaviors at a young age.

The Defense Systems Management College (DSMC) is beginning a major transition from its traditional classroom training methods to technology-based education and training. Conventional classroom courses will be rewritten and restructured to a computer-based format and be delivered on-line. According to the Concerns-Based Adoption Model, the faculty will experience concerns during the process of adopting this innovation. Identification of these concerns can assist in selecting appropriate interventions to minimize problems and to ease the adoption process. This study had two purposes. The first was to identify the Stages of Concern of the DSMC faculty toward the use of technology-based education and training by measuring faculty responses to the Stages of Concern (SoC) Questionnaire. The second was to determine appropriate interventions to assist the faculty through the change process. The study accomplished both purposes. All teaching faculty (N=135) received the questionnaire about their concerns and issues with this innovation, and 126 responses were returned (93% response rate). A total of eighty-one respondents (64%) reported no experience with technology-based courses, and the composite faculty SoC profile correspondingly reflected the "nonuser" category. No significant differences in Stages of Concern were found between groups of faculty when divided by common demographic criteria such as years of teaching experience, civilian or military status, and experience with educational technology. Quantitative methods of analysis included SoC profile comparison, High Stage Score and Second High Stage Score analysis, analysis-of variance (ANOVA), and multivariate analysis of variance (MANOVA). Qualitative methods were also used to analyze responses to an open-ended question on the survey instrument. Results reflected a general lack of knowledge and awareness about the innovation from the faculty and strong personal concerns about what impact it will have on them. The faculty clearly displayed a negative attitude toward this innovation and seemed unconvinced that it was the optimal solution. Written responses to the open-ended question provided key insight into faculty attitudes. The majority of concerns identified were educational issues, particularly dealing with the effectiveness of a computer-based format when teaching highly-interactive management courses. Based on these results, recommended intervention strategies for DSMC were generated. These strategies focus on the need for better information dissemination about educational technology and for a realistic implementation plan. More importantly, interventions were recommended to provide incentives for faculty to increase proficiency with educational technology and the use of technology in their courses. / Ed. D.

Cette thèse a pour but d’explorer et de comprendre les points de vue des ex-étudiantes en sciences infirmières, des professeures cliniques et des préceptrices sur les meilleures pratiques d’enseignement à adopter durant les stages cliniques. Les meilleures pratiques sont celles fondées sur des données probantes ayant pour but d’améliorer les façons de faire dans un certain domaine (Mackey et Bassendowski, 2016). La formation clinique en sciences infirmières n’y échappe pas et vise l’éducation de l’infirmière dans l’environnement clinique pour qu’elle maitrise ces bonnes pratiques (Association des infirmières et des infirmiers de l’Ontario, 2016). Des recherches indiquent qu’en l’absence des meilleures pratiques d’enseignement, les formatrices en stage clinique utiliseraient parfois des jugements ou des stratégies non testées, entrainant une inconsistance dans la formation offerte (MacIntyre, Murray, Teel et Karshmer, 2009). De plus, selon LeGrande (2016), le manque de préparation et le manque de consistance dans les pratiques d’enseignement des professeures et des préceptrices nuiraient aux meilleures pratiques en stages cliniques. La question générale qui guide l’étude est : quelles sont les meilleures pratiques d’enseignement durant les stages cliniques en sciences infirmières ? L’étude qualitative est basée sur une collecte de données par entrevue semi-dirigée avec trois catégories de participants (n=10) : les ex-étudiantes infirmières, les préceptrices et les professeures cliniques. Les données ont été analysées thématiquement. Les résultats indiquent que quatre thèmes sont identifiés comme faisant partie des meilleures pratiques en stages cliniques : réfléchir à ses expériences et partager ses réflexions en stages cliniques comme étudiantes infirmières, fournir des expériences interprofessionnelles aux étudiantes infirmières, apprendre les techniques de soins infirmiers en médecine-chirurgie et établir une relation de confiance entre l’étudiante infirmière et les formatrices. Les meilleures pratiques d’enseignement et les pistes de solution proposées par les participantes pourront potentiellement servir à identifier des pistes de changements pour guider la révision des programmes de baccalauréat afin d’assurer une meilleure formation clinique en soins infirmiers. Durant les stages cliniques, les professeures cliniques, les préceptrices et les écoles de sciences infirmières doivent continuellement chercher à améliorer les situations d’enseignement et d’apprentissage pour contribuer au développement des compétences cliniques des étudiantes.

Tailored communications have been effective in increasing both recall and readership of health information. However, there is no clear evidence that tailoring is necessary or beneficial in creating behavior change. There are many possible sources for the inconsistencies in the empirical literature. This current research explores possible approaches to increase the effectiveness of message tailoring by incorporating components from the four main conceptual structures found in the literature. In the first study, the Stages of Change Model was used to segment the sample into four distinct groups (precontemplative, contemplative, action, and maintenance). The behavioral determinants for respondents in each group were then identified. The differences between the precontemplative and contemplative segment suggest that an affective message will be more effective in changing intention for precontemplative respondents and a cognitive message will be more effective for the respondents in the contemplative segment. In a second study, an experimental study was conducted to test these alternative approaches. Results show that the proposed approaches did influence males as expected. However, females did not behave in the manner expected. Possible explanations for the differences between gender, such as behavior salience and information processing styles, are discussed. Overall, support is found for the use of tailoring messages to create behavior change. / Master of Science

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<p> The study of the different sleep stages of a patient using his/her recorded EEG signals falls in the area of signal classification. In general, this involves extracting from the EEG signals, a signal feature on which the classification is performed. In this thesis, we apply the techniques of signal classification to the analysis of the sleep of a patient. The feature we use is the power spectral density (PSD) matrices of a multi-channel EEG signal. This not only allows us to examine the power spectrum contents of each signal which complies with what clinical experts use in their visual judgement of EEG signals, but also allows the correlation between the multi-channel signals to be studied. To establish a metric facilitating the classification, we analyze the structure as well as exploit the specific geometric properties of the space of PSD matrices. Specifically, we study this space from the viewpoint of Riemannian manifolds. We apply a Riemannian metric and, with the aid of fibre bundle theory, develop intrinsic (geodesic) distance measures for the PSD matrix manifold. To utilize such new distance measures effectively for EEG signal classification, we need to find a suitable weighting matrix for the PSD matrices so that the distances between similar features are minimized while those between dissimilar features are maximized. A closed form expression for this weighting matrix is obtained by solving an equivalent convex optimization problem. The effectiveness of using these novel weighted distance measures is verified by applying them to the sleep pattern classification of a collection of recorded EEG signals using the k-nearest neighbor decision algorithm with excellent results. </p> / Thesis / Doctor of Philosophy (PhD)

The Defense Finance and Accounting Service (DFAS) is changing from traditional training methods to satellite delivery systems. According to the Stages of Concern about the Innovation (SoC), one dimension of the Concerns-Based Adoption Model (CBAM), individuals experience concerns during the process of adopting an innovation. Research supports that identification of concerns and appropriate interventions facilitate innovation adoption. However, little research has been published with respect to use of SoC other than in education since the conceptualization of CBAM in 1973. The purposes of this study were : 1) identify the Stages of Concern of the civilian managers employed in the five DFAS Centers toward satellite education and training with the use of the SoC Questionnaire (SoCQ) and the Open-Ended Statement of Concern About an Innovation; 2) explore the utility of the SoC to this population; and 3) draw implications from the expressed concerns of the managers to determine appropriate interventions to assist the managers through the change process. The purposes were accomplished through a census survey with a response rate of 55% (N=370). A modified version of the original SoCQ and the Stages of Concern about the Innovation Open-Ended Statement identified both the managers' SoC and specific concerns. Eighty-four percent (84%) of the respondents reported no experience with satellite education. SoC profiles typified a positive "nonuser" with highest Stages in 0 (Awareness), 1 (Informational), and 2 (Personal). A peaked Stage 5 in each SoC profile suggested "Collaboration" concerns, as would be anticipated from a population of managers. Chi-square showed no association between highest SoC and Center. Pearson r correlations showed no relationship between highest SoC and years of employment in the federal government, the financial management career field, or the number of employees within the managers' scope of responsibilities. Correlational analysis showed a weak relationship, r = .24, between highest SoC and number of courses completed by satellite. SoC group profiles by number of courses completed showed similar "nonuser" patterns. Written comments identified competing concerns between training programs and satellite medium. SoC constructs appeared to be operating throughout the findings which supported previous SoC research. / Ph. D.

For people aged 44 and under, the primary cause of loss of life in the U.S. is not due to heart disease or cancer, but to something as common as injuries (U. S. Bureau of Labor Statistics, 1998). As such, injuries kill an average of 142,000 Americans and require an estimated 62.5 billion dollars in medical attention each year (U. S. Bureau of Labor Statistics, 1998). This is close to three people dying and over 170 people sustaining a disabling injury every 10 minutes (National Safety Council, 1999). Every year more than 80,000 Americans are permanently disabled as a result of injury to the brain or spinal cord. Thus, unintentional injury represents a serious public health concern, and a theory-driven community, school, and organizational injury prevention technology is needed to improve the health and safety of individuals. / Ph. D.