Background/Objectives: Gaps in care due to the movement of patients between health settings and/or practitioners, known as transitions of care (TOC), may contribute to second stroke or TIA events. The elements that impact TOC in the stroke/TIA population have not been fully elucidated. The purpose of this study is to identify key elements of a Doctor of Nursing Practice-led TOC model that could be used to develop and evaluate a TOC program for the stroke/TIA population. Design: A descriptive study was performed to 1) identify elements that may affect transitions of care using a stroke database and post-discharge phone surveys and 2) based on information from Aim 1, propose a DNP-led TOC model specific to the stroke/TIA. Setting: An urban primary stroke center in the southwest United States. Participants: All patients in the GWTG®-stroke database from May 1 - December 31st, 2012 and patients who consented at discharge from the stroke unit following a stroke or TIA. Measurements: Patient demographics including: length of stay (LOS), age, race, ethnicity, comorbidities, insurance, discharge status, thirty-day readmission rate, and follow up survey. Results: Patient data (n=276) from GWTG®-stroke database was obtained. Average LOS was 7.81 +/- 11.15 days. The majority of patients were greater than age 65 (59%); 53% relied on Medicare support; those age 50-59 (21%) were most likely to be uninsured (47%). Fifty-one percent were discharged directly home, 48% of those were referred to outpatient rehab services. Two-thirds received rehabilitation services during hospitalization. Eight patients experienced a subsequent hospital readmission; two of those had a repeat stroke event. Although patients reported understanding their discharge instructions, their perception of ongoing care was poor. Conclusion: Key elements of a TOC model specific to the stroke and TIA patient population could include: patient surveillance, comprehensive care planning, follow-up, stroke education and point of contact. Advanced practice nurses have been successful in leading such programs, and a DNP-led model providing continuity of care would support the transition of an effective model into clinical practice.

The purpose of the study was to investigate what factors affect the young athletes in the transition from junior to senior sport. The study’s secondary purpose was to find out what the athletes do to cope with the transitions and the final purpose was to revile what indicates the end of the transition to the athletes. The interview guide had three parts with questions about background information, personal experience related to the transition from junior to senior sport and finally the transition’s effect on the athlete’s career, life outside sport and lessons drawn from the experience. The study consisted of nine interviews, with four male and five female athletes. The data was analysed by using sentence categorisation. Quotations were used to underline the results. The results were divided into several categories, namely: demands, resources, barriers, coping, indicators and long-term effects. The results implicate that the participants felt that it was a big step to take that involved changes in demands both in the sport and in the life outside sport. The participants also felt that social demands, demands on the self, school and planning caused the biggest barriers during the transition. The results also imply that the resource most commonly mentioned by the participants were social factors (such as team cohesion) followed by individual factors. The coping strategies mainly involved mental strategies while the long-term effects show effects of evolving mental skills. Finally the indicators most commonly mentioned were objective and involved an increase in responsibility and better statistics. It is discussed in which way the results of this study can be further strengthened by the results of earlier studies and theories.

There are three interrelated concepts of what medical students learn, which include the formal, informal, and hidden curriculum. Several researchers who have investigated notions of the hidden curriculum have demonstrated how the experiences of medical training entrenched in the hidden curriculum can have a profound impact on medical student adaptation. The most influential transitional stage in undergraduate medical education is the third-year clinical clerkship, when medical students transition from classroom learners into clinicians. The Northern Ontario School of Medicine’s (NOSM) clinical clerkship year consists of a mandatory eightmonths of living and working in rural and northern communities throughout Northern Ontario, and learning in the context of rural family practice. Informed by a social constructivist research paradigm, I explored how 12 third-year students described the challenges they had to manage and, in response, the strategies they employed to adapt to their clerkship. I elicited their experiences and perspectives to contribute to a rich understanding of how students at the NOSM describe developing processes of adaptation during the Comprehensive Community Clerkship. Data were collected between August 2011 and April 2012, including: a) pre-clerkship interviews and a demographic questionnaire, b) mobile methods in the form of ‘guided walks’ in the communities, and c) post-clerkship interviews. The quality of the data collection and analysis were enhanced through processes of methodological and interpretive rigour, representativeness and authenticity, rich description and contextual relevance, audit trail, and reflexivity. Through an inductive thematic analysis of the data, the findings provide a rich description of events experienced such as medical training in one’s hometown or a familiar community, iv transitions including adaptation to the clinical setting and to the medical profession, and the influence of the clerkship on career path, personal well-being, and empathy for patients. The findings serve to advance our understanding of how medical students describe developing processes of adaptation throughout a longitudinal integrated clerkship. Implications are considered for medical students, the NOSM, the clerkship communities, and medical schools nationally and internationally. I propose recommendations regarding the suitability of authentic methods in medical education research, and discuss the implications for rural and northern health research.

Poorly executed transitions between health care settings can lead to poor outcomes and greater use of health care resources for older adults. Older adults with complex needs often receive care from many health care providers in multiple care settings, and face greater risk of experiencing fragmented care. System navigation roles have been suggested as an innovative strategy to address these challenges, yet there is a lack of consensus on the desired characteristics and effectiveness of the role. The goal of this research is to develop a framework for a system navigation role to enhance coordination of formal and community-based services to older persons with chronic disease through health care transitions. This research gathered information from multiple perspectives and a variety of data sources, including a systematic literature review, focus group interviews and in-depth interviews with a variety of health care consumers and providers. A critical analysis of collected data, using a frame derived from content analysis, sought to understand how older adults navigate the health care system, and subsequently to explore the potential of a “system navigator” role to facilitate successful transitions across care settings. Finally, following a grounded theory approach, a model was empirically derived to reflect what role system navigators may have on the experience of older adults navigating the health care system in Waterloo Wellington. This research study aimed to describe optimal care coordination practices across the continuum of care for complex, high-risk individuals, such as those with chronic disease or hip fracture. Ultimately, this study may lead to improved patient care coordination, safety and satisfaction during transitions and in accessing community services, which may assist patients to achieve a higher quality of life.

Thèses (Ph.D.)--Université de Sherbrooke (Canada), 1997. / Titre de l'écran-titre (visionné le 20 juin 2006). Publié aussi en version papier.

The lattice-gas model of sorption in disordered porous media is studied for a variety of settings, using existing, updated and newly developed numerical techniques. Firstly, we construct an efficient algorithm to calculate the exact partition function for small lattice-gas systems. The exact partition function is used for detailed analysis of the core features exhibited by such systems. We proceed to develop an interactive Monte Carlo (MC) simulation engine, that simulates sorption in a porous media sample and provides real-time visual data of the state space projection and the 3d view of the sample among other parameters of interest, as the external fields are manipulated. The use of such tool provides a more intuitive understanding of the system behaviour. The MC simulations are employed to study sorption in several porous solids: silica aerogel, Vycor glass and soil. We investigate how the phenomena depend on the microstructure of the original samples, how the behaviour varies with the external conditions, and how it is reflected in the paths that the system takes across its state space. Secondly, we develop two methods for estimation of the relative degeneracy (the number of microstates that have the same value of some macroscopic variables) in the systems that are too large to be handled exactly. The methods, based on a restricted infinite temperature sampling, obtain equidegenerate surfaces and the degeneracy gradient across the state space. Combined with the knowledge of an internal energy of a microstate, it enables us to construct the free energy map and thus the equilibrium probability distribution for the studied projection of the state space. Thirdly, the jump-walking Monte-Carlo algorithm is revisited and updated to study the equilibrium properties of systems exhibiting quasi-ergodicity. It is designed for a single processing thread as opposed to currently predominant algorithms for large parallel processing systems. The updated algorithm is tested on the Ising model and applied to the lattice-gas model for sorption in aerogel and Vycor glass at low temperatures, when dynamics of the system is significantly slowed down. It is demonstrated that the updated jump-walking simulations are able to produce equilibrium isotherms which are typically hidden by the hysteresis effect characteristic of the standard single-flip simulations. As a result, we answer the long standing question about the existence of the first-order phase transitions in Vycor. Finally, we investigate sorption in several distinct topology network representations of soil and aerogel samples and demonstrate that the recently developed analytical techniques for random networks can be used to achieve a qualitative understanding of the phenomena in real materials.

Ces travaux de thèse, réalisés dans le cadre du programme de recherche ASZTech, portent sur l’étude de deux réfractaires électrofondus : un matériau Alumine-Zircone-Silice (AZS) et un produit à Très Haute Teneur en Zircone (THTZ), destinés à l’industrie verrière. La zircone étant non stabilisée, ces réfractaires subissent donc, lors de l’étape de recuisson (refroidissement), la transformation quadratique (Q) à monoclinique (M) de la zircone qui, de par sa forte expansion volumique, est une source d’endommagement. L’objectif de cette étude a consisté à caractériser, au cours de traitements thermiques représentatifs, le comportement thermomécanique de ces matériaux et à établir des corrélations avec les évolutions microstructurales rencontrées. En étudiant leurs comportements sous sollicitations thermiques par des techniques acoustiques, l’impact de la transformation Q-M de la zircone sur le développement de l’endommagement a été mis en évidence. En s’intéressant particulièrement au comportement mécanique au passage de cette transformation, la présence d’un phénomène de plasticité de transformation (TRIP) a été confirmée. Outre le phénomène de TRIP qui participe à la relaxation des contraintes au passage de la transformation de phase, un phénomène d’endommagement diffus, offrant également une capacité d’accommodation, a été identifié pour le matériau THTZ. Au final, ces données ont permis d’améliorer le modèle de simulation numérique décrivant l’étape de recuisson de blocs industriels. En outre, la robustesse de ce modèle pourra maintenant être validée par confrontation à des mesures expérimentales de contraintes résiduelles réalisées au cours de cette étude. / This thesis, carried out under the research program ASZTech, focuses on the study of two fused cast refractories: an Alumina-Zirconia-Silica (AZS) product and a product with very High content of Zirconia (HZ), used in glass industry. These refractories containing non-stabilized zirconia are therefore subjected, during the annealing step (cooling), to the tetragonal (T) to the monoclinic (M) phase transition of zirconia associated with a very high volumetric expansion which is a source of stresses. This study aims at characterizing, during representative thermal treatments, the thermo-mechanical behavior of these materials, in correlation with the detected microstructural evolutions. Thanks to the analysis of their behavior under thermal stresses by acoustic techniques, the effect of the T-M transition of zirconia on the development of damage has been highlighted. In particular, the occurrence of a TRansformation Induced Plasticity (TRIP) phenomenon during the zirconia phase transition has been identified and characterized thanks to cooling tests under mechanical stress. In addition to this TRIP phenomenon which allows to relax the mechanical stresses induced during the phase transition, a diffuse damage phenomenon has been also identified for HZ product. Eventually, these data have led to an improvement of the numerical model which simulates the annealing step of industrial blocks. Moreover, the reliability of this model will be now checked by comparison to experimental measurements of residual stresses performed during this study.

The magnetocaloric and thermomagnetic properties of the MnNiGe1-xAlx, Ni50Mn35(In1−xCrx)15 and (Mn1−xCrx)NiGe1.05 systems have been studied by x-ray diffraction, differential scanning calorimetry (DSC), and magnetization measurements. Partial substitution of Al for Ge in MnNiGe1−xAlx results in a first-order magnetostructural transition (MST) from a hexagonal ferromagnetic to an orthorhombic antiferromagnetic phase at 186 K (for x = 0.09). A large magnetic entropy change of ∆SM = -17.6 J/kg K for ∆H = 5 T was observed in the vicinity of TM = 186 K for x = 0.09. This value is comparable to those of well-known giant magnetocaloric materials, such as Gd5Si2Ge2, MnFeP0.45As0.55, and Ni50Mn37Sn13 [1]. The values of the latent heat (L = 6.6 J/g) and corresponding total entropy changes (∆ST = 35 J/kg K) have been evaluated for the MST using DSC measurements. Large negative values of ∆SM of -5.8 and -4.8 J/kg K for ∆H = 5 T in the vicinity of TC were observed for x = 0.09 and 0.085, respectively. Partial substitution of Cr for Mn in(Mn1−xCrx)NiGe1.05 results in a MST from a hexagonal paramagnetic to an orthorhombic paramagnetic phase near TM ~ 380 K (for x = 0.07). Partial substitution of Cr for In in Ni50Mn35(In1−xCrx)15 shifts the magnetostructural transition to a higher temperature (TM ~ 450 K) for x = 0.1. Large magnetic entropy changes of ∆SM = -12 (J/kgK) and ∆S = -11 (J/kgK), both for a magnetic field change of 5 T, were observed in the vicinity of TM for (Mn1−xCrx)NiGe1.05 and Ni50Mn35(In1−xCrx)15, respectively. The concentration-dependent (T-x) phase diagram of transition temperatures (magnetic, structural, and magnetostructural) has been generated using magnetic, XRD, and DSC data. The role of magnetic and structural changes on transition temperatures are discussed.

The primary objective of this study was to explore the relationship between personality and employability using a sample of 100 employees at a meat producing company in South Africa. A secondary objective was to determine if personality could be used to predict employability, and whether individuals from different demographic groups differed regarding their employability. The instruments used were the sixteen personality factor inventory (16PF) and the Van Der Heidje employability measure. The research findings indicated that the personality factors of submissiveness and seriousness correlated to the employability dimensions of anticipation/ optimization and occupational expertise respectively. Openness and corporate sense were also correlated, with anxiety in particular correlating with the overall employability measure. Differences between the race groups and employability were also noted. Particular interventions aimed at improving individual career decision making and employability practices within the organisation concluded the study. / M.A. (Industrial and Organisational Psychology)

A technology that has the potential to liquefy hydrogen and natural gas efficiently is an Active Magnetic Regenerative Liquefier (AMRL). An AMRL exploits the magnetocaloric effect displayed by magnetic materials whereby a reversible temperature change is induced when the material is exposed to a magnetic field. This effect can be used to produce cooling. By using the magnetic materials in a regenerator as the heat storage medium and as the means of work input, one creates an Active Magnetic Regenerator (AMR). Because the adiabatic temperature change is a strong function of temperature for most materials, to span a large temperature range such as that needed to liquefy hydrogen, a number of different materials may be needed to make up one or more regenerators. Single material AMRs have been proven, but layering with more than one material has not. This thesis is a study of AMRs using magnetic refrigerants displaying second-order paramagnetic to ferromagnetic ordering. An analysis of AMR thermodynamics is performed and results are used to define properties of ideal magnetic refrigerants. The design and construction of a novel test apparatus consisting of a conduction-cooled superconducting solenoid and a reciprocating AMR test apparatus are described. A numerical model is developed describing the energy transport in an AMR. Experiments using Gd are performed and results are used to validate the model. A strong relationship between flow phasing is discovered and possible reasons for this phenomenon are discussed. Simulations of AMRs operating in unconventional modes such as at temperatures greater than the transition temperature reveal new insights into AMR behaviour. Simulations of two-material layered AMRs suggest the existence of a jump phenomenon occurring regarding the temperature span. These results are used to explain the experimental results reported by other researchers for a two-material AMR. / Graduate