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Yes / Medicines are often suboptimally managed for heart failure patients across the transition from hospital to home, potentially leading to poor patient outcomes. The Improving the Safety and Continuity Of Medicines management at Transitions of care programme included: understanding the problems faced by patients and healthcare professionals; developing and co-designing the Medicines at Transitions of care Intervention (MaTI); a cluster randomized controlled trial testing the effectiveness of a complex behavioural MaTI aimed at improving medicines management at the interface between hospitals discharge and community care for patients with heart failure; and a process evaluation. The MaTI included a patient-held My Medicines Toolkit; enhanced communication between the hospital and the patient's community pharmacist and increased engagement of the community pharmacist postdischarge. This paper reports on the patients' experiences of the MaTI and its implementation from the process evaluation. Twenty one-to-one semi-structured patient interviews from six intervention sites were conducted between November 2018 and January 2020. Data were analysed using the Framework method, involving patients as co-analysts. Interview data were triangulated with routine trial data, the Consolidated Framework for Implementation Research and a logic model. Within the hospital setting patients engaged with the toolkit according to whether staff raised awareness of the My Medicines Toolkit's importance and the time and place of its introduction. Patients' engagement with community pharmacy depended on their awareness of the community pharmacist's role, support sources and perceptions of involvement in medicines management. The toolkit's impact on patients' medicines management at home included reassurance during gaps in care, increased knowledge of medicines, enhanced ability to monitor health and seek support and supporting sharing medicines management between formal and informal care networks. Many patients perceived that the MaTI offered them support in their medicines management when transitioning from hospital into the community. Importantly, it can be incorporated into and built upon patients' lived experiences of heart failure. Key to its successful implementation is the quality of engagement of healthcare professionals in introducing the intervention. Patients were involved in the study design, as qualitative data co-analysts and as co-authors. / Programme Grants for Applied Research. Grant Number: RP-PG-0514-20009.

Family caregivers of older persons with dementia (PWD) and multiple chronic conditions (MCC) provide high levels of in-home care. Caregiving is complicated by transitions such as changes to one's environment, roles, relationships, and overall health. Although PWD often have MCC, few studies have focused on the influence of MCC on dementia caregiving and transitions. The purpose of this study was to explore the transition experiences of caregivers of PWD and MCC. This study is a sub-study of a larger pragmatic mixed methods randomized controlled trial called MyTools4Care (MT4C). Using interpretive description methodology, semi-structured interviews were conducted across Ontario with a subset of caregivers (n=19) and clinicians working with dementia caregivers (n=7). Purposive theoretical sampling and concurrent data collection and analysis were used. Participants described their transition experiences, factors that influenced these experiences, potential outcomes of transitions, and the influence of MCC on dementia caregiving. Participants identified five key transitions which included: (a) There's no turning off (progressive increase in responsibilities); (b) I'm filling in many roles (changes in roles and relationships); (c) I'm sick, too (changes in overall health and well-being); (d) Dementia defines my social life (changes in social boundaries), and; (e) I know that day will come (changes in preparing for the future). Study findings emphasized how the co-existence of dementia and MCC resulted in added complexity and burden to care management and decision-making for caregivers. Findings suggest that health care professionals (HCP) are an important extension of caregivers' support networks. Thus, HCP need to be comfortable, trained, and knowledgeable in diagnosing and managing dementia and MCCs in order to support caregivers in their transitions. Future research should explore the experience of dementia within the broad context of MCC in order to understand the impact on the dementia caregiving experience. / Thesis / Master of Science (MSc)

Faced with increasing risks from climate change, food systems will need to transition away from dominant industrial paradigms and move towards a more sustainable way of producing, distributing, and consuming food. One solution or one side alone though might not have the desired systemic change or might not capture the full complexity of food systems. To go beyond two known criticisms of local food sustainable initiatives, i.e., to be rather small and to be developed outside policy frameworks and/or in stark opposition to current food systems, in this thesis I argue to look at governance spaces of transformation at local level where community members, professionals, and governments get together to share knowledge, deliberate, and collectively devise place-based strategies to address complex food systems issues. The thesis is divided into three chapters. To completely understand spaces of transformation, the first chapter provides a conceptual framework of analysis combining ideas from sustainability transitions, environmental governance and sustainable food communities’ approaches. With the first chapter laying out the theoretical framework, chapter 2 and 3 will rely on the empirical analysis of data gathered through interviews and surveys. The conceptualization of territorial spaces of transformation and the analysis of whether biodistricts can be considered such spaces of transformation for food systems, will be laid out in chapter 2. Chapter 3 will consider two additional research questions, namely how territorial characteristics influence the emergence of a biodistrict, and what role the biodistricts have in territorial transformations towards agroecology. The aim of the thesis is to generate solid and harmonized evidence on the impact of biodistricts on key sustainability characteristics, such as a biodiverse environment, inclusive societal and cultural values, sustainable economic development, sound governance systems and organic, regenerative agricultural practices. The results allow to develop a blueprint for biodistricts as meso-spaces, showing how the presence of actors, the objectives, activities, and governance structure should evolve according to the maturity phases. Moreover, the application of the CAET-TAPE assessment shows that the biodistricts are performing solidly on agroecological transitions.

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Fault Lines is a collection of nine stories that explore the themes of otherness, isolation, and transitions. In most of these stories I explore the concept of isolation in its many forms— emotional, physical, social, and spiritual. Many of my characters are people who have been "othered" for one reason or another, and many of them are people on the cusp, not only of society but also their own lives. I also explore characters who are on the verge of transition, either staring one down with fear and denial, moving hesitantly and trepidatiously toward one, or, in rare instances, jumping gleefully toward that next big moment in their lives. Many of my characters yearn for something to transcend their ordinary, material lives, whether through a spiritual encounter or simply an ordinary yet unusual one. Some of these characters are stuck in the mire of their current lives, and we see an uncomfortable mix of lethargy and longing. Primarily, I explore exactly what catalysts people require in order to move from a state which, though unsatisfying, might be comfortable, to one that is unknown and risky but potentially fulfilling. The title of the collection refers to those moments or events in one's life that indicate or cause shifts or transitions, whether mental, physical, or emotional. / Master of Fine Arts

No / The two known crystalline phases of resorcinol and their phase transitions are of considerable interest. The crystals exhibit pyro- and piezo-electricity and, remarkably, the higher temperature phase is the denser phase. Furthermore, crystals of the phase, by virtue of having a polar axis, have played a crucial role in investigating fundamental issues of crystal growth. We report an optimized force field for the molecular simulation of crystalline phases of resorcinol. The hydroxyl groups of the resorcinol molecule have a torsional degree of freedom and the molecule adopts a different conformation in each of the two phases of resorcinol. The torsional barrier, therefore, was considered to be critical and has been characterized using ab initio methods. Although the atomic partial charges showed some dependence on the molecular conformation, a single set of partial charges was found to be sufficient in describing the electrostatic potential for all conformations. The parameters for the van der Waals interactions were optimized using sensitivity analysis. The proposed force field reproduces not only the static structures but also the stability of the crystalline phases in extended molecular dynamics simulations.

Yes / Abstract: Background: Medicines are often suboptimally managed for heart failure patients across the transition from hospital to home, potentially leading to poor patient outcomes. The Improving the Safety and Continuity Of Medicines management at Transitions of care programme included: understanding the problems faced by patients and healthcare professionals; developing and co-designing the Medicines at Transitions of care Intervention (MaTI); a cluster randomized controlled trial testing the effectiveness of a complex behavioural MaTI aimed at improving medicines management at the interface between hospitals discharge and community care for patients with heart failure; and a process evaluation. The MaTI included a patient-held My Medicines Toolkit; enhanced communication between the hospital and the patient's community pharmacist and increased engagement of the community pharmacist postdischarge. This paper reports on the patients' experiences of the MaTI and its implementation from the process evaluation. Design: Twenty one-to-one semi-structured patient interviews from six intervention sites were conducted between November 2018 and January 2020. Data were analysed using the Framework method, involving patients as co-analysts. Interview data were triangulated with routine trial data, the Consolidated Framework for Implementation Research and a logic model. Results: Within the hospital setting patients engaged with the toolkit according to whether staff raised awareness of the My Medicines Toolkit's importance and the time and place of its introduction. Patients' engagement with community pharmacy depended on their awareness of the community pharmacist's role, support sources and perceptions of involvement in medicines management. The toolkit's impact on patients' medicines management at home included reassurance during gaps in care, increased knowledge of medicines, enhanced ability to monitor health and seek support and supporting sharing medicines management between formal and informal care networks. Conclusion: Many patients perceived that the MaTI offered them support in their medicines management when transitioning from hospital into the community. Importantly, it can be incorporated into and built upon patients' lived experiences of heart failure. Key to its successful implementation is the quality of engagement of healthcare professionals in introducing the intervention. Patient or Public Contribution: Patients were involved in the study design, as qualitative data co-analysts and as co-authors. / Programme Grants for Applied Research. Grant Number: RP-PG-0514-20009

Cette thèse porte sur la modélisation numérique des problèmes de changement de phase. Le but est de proposer un algorithme robuste, basé essentiellement sur la méthode CutFEM, pour résoudre le problème avec la plus grande précision possible. Dans notre démarche, la méthode level-set est employée pour une représentation implicite de l'interface entre différentes phases, tandis que l'imposition des conditions essentielles sur cette dernière se fait à l'aide de la variante symétrique de la méthode de Nitsche. Le premier résultat de la thèse porte sur le développement d'un post-traitement fiable, facile à implémenter, pour une meilleure estimation du flux à travers une frontière immergée. La solution proposée est inspirée de la méthode de l'intégrale de domaine, à la différence que nous introduisons une stabilisation de type Ghost Penalty pour éliminer la sensibilité de la qualité de l'approximation à l'interface par rapport aux nœuds du maillage. L'idée est validée à travers une série d'exemples 2D et 3D.Le deuxième résultat concerne le développement d'un solveur CutFEM pour la simulation des problèmes de Stefan à deux phases sans convection. Dans notre approche, nous nous servons du premier résultat pour une meilleure évaluation de la vitesse de l'interface. Quant à la stabilisation des formulations d'extension de la vitesse et du transport de la fonction level-set, nous avons opté pour la méthode CIP (Continuous Interior Penalty) qui a déjà fait preuve d'une grande efficacité pour des problèmes fortement dominés par la convection. Des exemples numériques 2D permettent de confirmer l'efficacité de notre algorithme puisque des taux de convergence optimaux sont obtenus. Une simulation 3D est également proposée pour démontrer la validité du solveur dans une configuration plus réaliste. Pour le dernier résultat, nous reconsidérons le problème de Stefan, mais cette fois en prenant en compte la convection naturelle dans la phase liquide. L'équation de conduction de la chaleur est alors modifiée par l'ajout d'un terme de convection. De plus, cette équation est couplée aux équations de Navier-Stokes, introduisant de fait des non-linéarités supplémentaires. Un schéma itératif basé sur la méthode de Newton est alors proposé pour une résolution efficace du système. Les autres étapes de résolution sont assez similaires à celles de l'algorithme développé pour les problèmes de Stefan sans convection. Une étude numérique approfondie du solveur est présentée. Premièrement, l'efficacité de la discrétisation en temps et en espace est étudiée pour des problèmes (relativement simples) avec des solutions manufacturées. Ensuite, pour un problème beaucoup plus complexe modélisant la solidification de l'eau, une comparaison des résultats obtenus numériquement avec les résultats expérimentaux connus dans la littérature est présentée. Enfin, d'autres problèmes de changement de phase encore plus complexes tels que la fusion du gallium dans une cavité rectangulaire, ou encore celle du n-octadécane dans une cavité cubique sont considérés, et une comparaison des résultats de simulation avec les données expérimentales est également présentée. / This thesis focuses on the numerical modeling of phase change problems. The aim is to proposea robust CutFEM-based algorithm to solve the problem with the highest possible accuracy.In our approach, the level-set technique is used for an implicit representation of the interface,whereas the imposition of the essential conditions on the interface is done using the symmetric variant of the Nitsche method.The first result of the thesis is the development of a reliable, easy-to-implement post-processingfor an accurate estimate of the flux across an interface. The proposed solution is inspired by the domain integral method, with the difference that we introduce Ghost Penalty stabilization to eliminate the sensitivity to the interface location relative to the mesh nodes. The accuracy of the method is validated through a series of two- and three-dimensional examples. The second result concerns the development of a CutFEM method for the numerical simulation of two-phase Stefan's problems without convection. In our approach, we use the idea of the first result for an accurate evaluation of the normal speed of the interface. Regarding the stabilization of the velocity extension and front transportation problems, we opted for the Continuous Interior Penalty method which has shown great effectiveness for convection-dominated problems. Two-dimensional numerical examples are used to confirm the effectiveness of our algorithm since optimal convergence rates are achieved. A three-dimensional simulation is also provided to demonstrate the validity of the solver in a more realistic configuration. For the last result, we reconsider the Stefan problem, but this time taking into account natural convection in the liquid phase. In this phase, the heat conduction equation is then modified by the addition of a convection term. Furthermore, this equation is coupled to the Navier-Stokes equations, there by introducing additional nonlinearities. An iterative scheme based on Newton's method is then proposed for an efficient solution of the system. The other steps of the proposed solver are quite similar to those of the solver developed for Stefan problems without convection. An in-depth numerical study of the solver is presented. First, the efficiency of discretization in time and space is studied for (relatively simple) problems with manufactured solutions. Then, for a much more complex problem modeling the solidification of water, acomparison of the results obtained numerically with the experimental results known in the literature is presented. Finally, other even more complex phase change problems such as the fusion of gallium in a rectangular cavity, or that of n-octadecane in a cubical test cellare considered, and a comparison of the simulation results with experimental data is alsoprovided.