A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.

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Modern society since the 1970s has been characterised by an ongoing information revolution which has been led by innovations in Information and Communication Technologies (ICTs). Technological breakthroughs have pushed social organisations to constantly adjust themselves to fit new possibilities and demands. But, in spatial planning, comparing to other fields, the influences of the ICT innovations are still limited due to the ‘mismatch’ between real demands and technology supply and ‘bottlenecks’ in implementations. This research is aimed at improving the technological support practice in spatial planning decision-making by, linking the technology supply with planning demand. This is based on both theoretical debate and practical experiences, to develop a new model for a successful Planning Support System (PSS), and to test and implement it in the practice of ‘sustainable urban regeneration’. In this research, new opportunities have been created from matching the innovations of Web 2.0 internet applications and geo-semantic web services with the standing demand on gathering and exchanging knowledge in spatial planning, which facilitate the shift of decision-making towards a more communicative and collaborative mode. To do this, a new PSS framework was proposed for bridging the ICT innovations and the planning world, focusing on the common interest in the positive combination of technology, knowledge and people. A prototype system was designed, developed and implemented with local authorities in Greater Manchester in a case study of sustainable transport planning. The experiences learnt show that: 1) the contradiction between the limited expectations of the planners and the complex technological facilities that the developers offer affected the motivation to take up innovations in the first place; 2) the wider context of planning decision-making, i.e. the changing ideology of public policy-making, affects the acceptance of ICT innovations in practice, 3) the organisational structure and politics within planning institutions can also limit the diffusion of innovations. Besides, the actors (i.e. initiator, developers and targeted users) in technology implementation are often not clearly defined, which causes uncertainties and misunderstandings in the process. Furthermore, there is a dilemma in that using ICT innovations to facilitate policy innovations also means unexpected changes in daily routine or organisational culture, which most governmental departments are not fully ready and willing to accept. Therefore, it is recommended that future development in PSS should: 1) actively embrace the new technologies and interfaces, 2) find suitable ‘use-cases’ which support knowledge exchange in the multi-level and multi-agent plan-making, 3) follow a task-based approach to produce a useful tool with clearly defined purposes, 4) identify the appropriate actors and partnerships for PSS development and implementation and 5) try to institutionalise PSS development and implementation within the planning authority, to minimise resistance caused by non-technical issues and organizational obstacles.

Objectives: To describe learning outcomes of undergraduate nursing students following an online basic life support course (BLS). Methods: An online BLS course was developed and administered to 94 nursing students. Pre- and post-tests were used to assess theoretical learning. Checklist simulations and feedback devices were used to assess the cardiopulmonary resuscitation (CPR) skills of the 62 students who completed the course. Results: A paired t-test revealed a significant increase in learning [pre-test (6.4 +/- 1.61), post-test (9.3 +/- 0.82), p < 0.001]. The increase in the average grade after taking the online course was significant (p < 0.001). No learning differences (p = 0.475) had been observed between 1st and 2nd year (9.20 +/- 1.60), and between 3rd and 4th year (9.67 +/- 0.61) students. A CPR simulation was performed after completing the course: students checked for a response (90%), exposed the chest (98%), checked for breathing (97%), called emergency services (76%), requested for a defibrillator (92%), checked for a pulse (77%), positioned their hands properly (87%), performed 30 compressions/cycle (95%), performed compressions of at least 5 cm depth (89%), released the chest (90%), applied two breaths (97%), used the automated external defibrillator (97%), and positioned the pads (100%). Conclusions: The online course was an effective method for teaching and learning key BLS skills wherein students were able to accurately apply BLS procedures during the CPR simulation. This short-term online training, which likely improves learning and self-efficacy in BLS providers, can be used for the continuing education of health professionals.

Abstract The objective of this thesis was to evaluate the effects of return migration on the mental well-being of Finnish children and adolescents in the short and long term. The thesis presents results on the prevalence of mental symptoms and how mental well-being is associated with social contacts and language use among returning migrants. The children and adolescents in this study had lived part of their lives in Sweden. Many Finnish young adults migrated to Sweden in search for work in the 1960s and 1970s, when job opportunities were better in Sweden than in Finland. In the 1980s the direction of migration flow changed, and many of the migrants moved back with their families. The sample consisted all the 320 Finnish remigrant children who remigrated from Sweden to northern Finland in the years 1984 and 1985 and who attended comprehensive school after their remigration. A control group was formed by assigning each remigrant child a non-migrant counterpart of the same sex, age and class level in Finland. Information was gathered in three phases: In the first phase in 1986, questionnaires were sent to the children and their parents and teachers. In the second phase in 1992, questionnaires were sent to the adolescents and their parents, but not to the teachers, because many had already finished school. Thirdly, information on the hospital admissions of these children was obtained in the years 1986-96 from the Finnish Hospital Discharge Register (FHDR), which is held by the state. The main outcome variables were obtained from Children"s Depression Inventory (CDI) and Children"s Behavioural Questionnaire for Parents (RA2) and Teachers (RB2). Remigrant children had more depression and behavioural disturbances than their native peers shortly after remigration. Six years later they still had more depression. During the 10-year period after remigration, 13 remigrants had had inpatient care because of a psychiatric diagnosis compared to only two controls with such a diagnosis. Age at remigration and sex had an influence on the manifestation of psychiatric symptoms after remigration. Especially preadolescent boys had more psychiatric symptoms shortly after migration. After remigration to Finland, the remigrants had equally many friends as their controls, but they still felt more lonely as long as six years after remigration. Simultaneous maintenance of both the native language and the second language together with the two cultures experienced in childhood enhanced the remigrant"s mental well-being. However, the principle of one person - one language was essentially important.

I palliativ vård ingår det i sjuksköterskans ansvarsområde att ge stöd till den döendes närstående. Denna typ av vård är vanligt förekommande för många sjuksköterskor. Studien beskriver sjuksköterskors syn på hur stödet till närstående kan se ut.  Palliativ vård innebär att ge vård till patienter med sådan sjukdom som ej går att bota. Vården fokuserar här på att lindra symtom. Trots att det finns riktlinjer om hur palliativ vård ska utföras finns det gråzoner om vad som är rätt och fel. Sjuksköterskor har i tidigare forskning beskrivit att de har kunskapsbrist om hur de kan stödja närstående till palliativa patienter, vilket ledde till att de blev osäkra på vad de skulle göra. Det finns tidigare studier där det framkommer att sjuksköterskor ibland ser de närstående som ett hinder för god palliativ vård. Detta examensarbete är en litteraturstudie av elva vetenskapliga artiklar där analysen ger fyra olika teman om hur sjuksköterskan kan stödja närstående: möjliggöra närvaro, göra närstående delaktiga, ge omsorg till närstående och möta informationsbehov.    Det framkom bland annat att sjuksköterskorna strävade efter att få de närstående att närvara fysiskt, ge dem tid och anpassa miljön i rummet. Sjuksköterskorna ville göra närstående delaktiga i vården, både i hemmet samt på sjukhuset. Detta skulle ske på de närståendes villkor, och inget ska tas för givet. Det framkom även att de närstående hade behov av information. Informationen skulle vara byggd på ärlighet, vara korrekt, framlagd med respekt och med empati. Att ge omsorg till en närstående var ett återkommande tema. Detta innebar bland annat att sjuksköterskor gav känslomässigt stöd, avsatte tid för fysisk närvaro samt lyssnade på tankar och åsikter.   När analysen jämfördes mot annan forskning framkom det olika uppfattningar angående vissa åtgärder, men generellt bekräftas eller fördjupas det som framkommer i analysen. Detta examensarbete kan summeras som att sjuksköterskor arbetade för att identifiera och uppfylla de närståendes unika omvårdnadsbehov samt bemötte dem som unika individer. Resultatet ger en förståelse för hur sjuksköterskor kan stödja närstående till patienter i behov av palliativ vård. / Palliative care treatment is a common phenomenon to many registered nurses. When caring for a patient palliatively, the nurse should also care for the ones closest to the dying patient. Previous studies have shown that nurses are uncertain on how to support these relatives and that some nurses even see them as a burden. The aim of this study was to describe nurses’ views on how they can support the ones closest to the patients that need palliative care. The method used is a literature study, aiming at contributing to evidence based care grounded in analysis of qualitative research. Two electronic databases, Cinahl and Pubmed, were used for searches. Inclusion criteria were: studies should be written in the English language, no older than ten years, qualitative, presenting data in palliative care setting for adult patients only, and written from a registered nurse’s perspective. Eleven studies were included. Four themes emerged on how nurses give support: Facilitate presence, Involve the ones closest to the patient, Care for the ones closest to the patient and Meet informational needs. The conclusion is that the nurse should care for the ones closest to the patient as unique human beings and strive to fulfil individual nursing needs.

Class of 2014 Abstract / Specific Aims: To assess the prevalence of mothers asking pharmacists for pediatric dosing and mothers’ knowledge of pediatric OTC use. Subjects: Mothers with ≥ one child under 6 years old in a local mothers’ support group in Tucson. Methods: Questionnaires were sent out weekly for a month by the group’s listserv and social media website to determine the prevalence of mothers that ask pharmacists questions and assess their knowledge of OTC medications and what medical sources they use. Data on ages, ages of children, number of children, race/ethnicity, pharmacy visited, education, insurance coverage, and children’s chronic diseases were collected. Main Results: Twenty-six people responded. About 46% of the participants were 30 - 34 years old. Forty-six percent of mothers had 2 children; 42% had 1 child. About 54% of mothers have asked a pharmacist for pediatric OTC dosing. The reasons mothers gave for not asking pharmacists dosing information were that they hadn’t needed to ask (25%), they asked a doctor (16%), they used an online resource (8%), and they didn’t think about asking (8%). Three questions assessed OTC knowledge; 50% of participants got all questions correct, 38.5% got two questions correct, and 11.5% got one question correct. There wasn’t a difference in OTC knowledge and whether they asked a pharmacist questions (p=0.373). Conclusion: More than half of mothers asked pharmacists dosing information, but this percentage could still be higher. Fifty percent got all three questions right, 38.5% got two questions correct, and 11.5% of mothers got only 1 question correct.

Magister Artium - MA / This study explored the social support provided by family of women diagnosed with early stage breast cancer. The aim was to present an account of social support that is solicited by and given to women diagnosed with early stage breast cancer. There is a dearth amount of literature on support from families of women with breast cancer in South Africa. Thus, this study can potentially contribute to filling the gap of knowledge in this area in the country. Qualitative method was used and in-depth interviews were utilized to study the women's experience of family social support. The theoretical framework underpinning the study is the relational communicational perspective.

Philosophiae Doctor - PhD / The aim of this study was to develop guidelines for an HIV/AIDS support programme for teachers. In order to achieve this goal, Intervention Research: Design and Development model by Rothman and Thomas (1994) was adopted to guide the research process. Intervention research is a form of applied qualitative research utilized by researchers to design and develop interventions to ameliorate social problems. Intervention research: design and development model has six phases and unique operational steps to follow in each phase. The researcher adopted the first three phases to facilitate the design of the guidelines to assist with development of a programme to support teachers. Problem analysis and project planning is the first phase. In this phase, the aim was to understand the experiences of HIV/AIDS among teachers and in schools. Information was gathered from HIV/AIDS coordinators, principals, teachers living with HIV. / South Africa

Magister Scientiae (Physiotherapy) - MSc(Physio) / The education system in South Africa has been on a path of change since 1994, in an effort to correct the injustices and inequalities of our apartheid past. In 2001 Education White Paper Six and the inclusive education policy was introduced. This policy is based on creating an environment where special needs education is seen as a non-racial and integrated part of the education system and envisages the role of special schools changing in order to facilitate this process. Special schools will continue to provide services to the severely disabled and high needs learner. However staff at special schools will be encouraged to make their expertise and resources available to the ordinary schools in the community. This study is focused on the role of the physiotherapist in special schools. The introduction of the new policy required physiotherapists to serve the needs of learners at special schools as well as provide indirect support to ordinary schools in the community. However physiotherapists have not been trained to provide indirect support and feel that they have not had adequate assistance to improve their skills and knowledge in this area. This study therefore looked at how the knowledge, skills and attitudes of physiotherapists can be enhanced and developed in order to meet the need of successfully implementing inclusive education. The aim of the study was to design, implement and evaluate an intervention aimed at improving the knowledge, skills and attitudes of physiotherapists in providing indirect support in the education system. In order to do so, it was necessary to meet the following objectives. Firstly to determine how physiotherapists perceive indirect support and their role in the district based support team; and secondly to determine the barriers experienced by physiotherapists in providing indirect support as well as their needs to provide appropriate support within the inclusive education framework. A qualitative study was conducted using the action research method. This study involved five special schools in the Western Cape and a total of nine participating physiotherapists. Focus group discussions were used to collect data. The first focus group discussion involved participants identifying their perceptions of indirect support, their role in the district based support team, barriers to indirect support and their needs in order to provide appropriate support in the inclusive education framework. The data collected were analyzed using content analysis. The findings revealed that many of the physiotherapists are experiencing difficulties in making the shift from direct to indirect support, due to not having been provided with the necessary support, resources and training to facilitate the transition to inclusive education practices. A second round of focus group discussions were held for the physiotherapists to prioritise a need that the intervention would be based on. Thereafter a training workshop was held, based on the prioritised need, to improve the provision of indirect support by physiotherapists. This research has shown that physiotherapists have begun to engage with the change process by questioning the implications of the inclusive education policy and looking at how their role in special schools needs to change. The physiotherapists require assistance in the facilitation of a transition from providing mainly direct support in special schools, to also providing indirect support in an inclusive education setting. They require the assistance of the school management and the Department of Education to provide the necessary support, resources and training to facilitate the transition to inclusive education practices.