The role of the health care organization in supporting nurses in the delivery of culturally competent care

This study was designed to explore ways in which health care organizations (HCOs) can support nurses in their delivery of culturally competent care. While cultural competence has become a priority for the federal government as well as the major health professional organizations, its integration into care delivery has not yet been realized. Health professionals cite a lack of educational preparation, time, and organizational resources as barriers. Most experts in the field agree that the cultural and linguistic needs of ethnic minorities pose challenges that individual care providers are unable to manage without the support of the health care organizations within which they practice. While several studies have identified implications for HCOs, there is a paucity of research on their role in this aspect of care delivery. Using a qualitative design with a case study approach, data collection included face-to-face interviews with 23 registered nurses, document analysis, and reports of critical incidents. The site chosen was a large health care system in South Florida that serves a culturally diverse population. Major findings from the study included language barriers, lack of training, difficulty with cultural differences, lack of organizational support, and reliance on culturally diverse staff members. Most nurses thought the ethnic mix was adequate, but rated other supports such as language services, training, and patient education materials as inadequate. Some of the recommendations for organizational performance were to provide the expectations and support for culturally competent care. Implications and recommendations for practice include nurses using trained interpreters instead of relying on coworkers or trying to "wing it", pursuing training, and advocating for organizational supports for culturally competent care. Implications and recommendations for theory included a blended model that combines both models in the conceptual framework. Recommendations for future research were for studies on the impact of language bathers on care delivery, develop and test a quantitative instrument, and to incorporate Gilbert's model into nursing research.

The relationship between faculty perceptions and implementation of elements of transactional distance theory and online web-based course completion rates

The purpose of this study was to explore the relationship between faculty perceptions, selected demographics, implementation of elements of transactional distance theory and online web-based course completion rates. This theory posits that the high transactional distance of online courses makes it difficult for students to complete these courses successfully; too often this is associated with low completion rates. Faculty members play an indispensable role in course design, whether online or face-to-face. They also influence course delivery format from design through implementation and ultimately to how students will experience the course. This study used transactional distance theory as the conceptual framework to examine the relationship between teaching and learning strategies used by faculty members to help students complete online courses. Faculty members' sex, number of years teaching online at the college, and their online course completion rates were considered. A researcher-developed survey was used to collect data from 348 faculty members who teach online at two prominent colleges in the southeastern part of United States. An exploratory factor analysis resulted in six factors related to transactional distance theory. The factors accounted for slightly over 65% of the variance of transactional distance scores as measured by the survey instrument. Results provided support for Moore's (1993) theory of transactional distance. Female faculty members scored higher in all the factors of transactional distance theory when compared to men. Faculty number of years teaching online at the college level correlated significantly with all the elements of transactional distance theory. Regression analysis was used to determine that two of the factors, instructor interface and instructor-learner interaction, accounted for 12% of the variance in student online course completion rates. In conclusion, of the six factors found, the two with the highest percentage scores were instructor interface and instructor-learner interaction. This finding, while in alignment with the literature concerning the dialogue element of transactional distance theory, brings a special interest to the importance of instructor interface as a factor. Surprisingly, based on the reviewed literature on transactional distance theory, faculty perceptions concerning learner-learner interaction was not an important factor and there was no learner-content interaction factor.

Users Acceptance of Online Enrollment Processes in a Higher Education Institution

Little is known about students’ perceptions of online enrollment processes. Student satisfaction is part of the assessment required for accreditation, but evidence suggests that college administrators are oriented to retention and graduation rates rather than to consumer perception. The purpose of this descriptive quantitative study was to develop and validate a model that enables the measurement of online enrollment processes by the analysis of the students’ perceptions. The theoretical framework used to support this study was the process virtualization theory while the conceptual framework was based on Technology Acceptance Model (TAM). TAM is the most valid framework for studying user acceptance of technology and virtual processes. The model was modified, adding a new variable to fit this study. Research questions were used to determine if an institution knows how its students perceive online enrollment processes and how they can become more efficient and effective, improving usage and satisfaction. Descriptive data were collected and analyzed in phases: the pilot study phase, data collection phase, and analysis phases. Inferential statistics were used to draw information from sampled observations of the population; a Cronbach Alpha was conducted to determine the reliability and validity of the model. The study demonstrated that the modified TAM is valid, reliable, and fit to assess the perceptions of the users of online enrollment processes. This study will effect positive social change by providing enrollment managers and administrators information on how to analyze the acceptance their online enrollment processes from the perspective of their students as customers of an institution of higher learning.

3D navigation with six degrees-of-freedom using a multi-touch display

With the introduction of new input devices, such as multi-touch surface displays, the Nintendo WiiMote, the Microsoft Kinect, and the Leap Motion sensor, among others, the field of Human-Computer Interaction (HCI) finds itself at an important crossroads that requires solving new challenges. Given the amount of three-dimensional (3D) data available today, 3D navigation plays an important role in 3D User Interfaces (3DUI). This dissertation deals with multi-touch, 3D navigation, and how users can explore 3D virtual worlds using a multi-touch, non-stereo, desktop display. ^ The contributions of this dissertation include a feature-extraction algorithm for multi-touch displays (FETOUCH), a multi-touch and gyroscope interaction technique (GyroTouch), a theoretical model for multi-touch interaction using high-level Petri Nets (PeNTa), an algorithm to resolve ambiguities in the multi-touch gesture classification process (Yield), a proposed technique for navigational experiments (FaNS), a proposed gesture (Hold-and-Roll), and an experiment prototype for 3D navigation (3DNav). The verification experiment for 3DNav was conducted with 30 human-subjects of both genders. The experiment used the 3DNav prototype to present a pseudo-universe, where each user was required to find five objects using the multi-touch display and five objects using a game controller (GamePad). For the multi-touch display, 3DNav used a commercial library called GestureWorks in conjunction with Yield to resolve the ambiguity posed by the multiplicity of gestures reported by the initial classification. The experiment compared both devices. The task completion time with multi-touch was slightly shorter, but the difference was not statistically significant. The design of experiment also included an equation that determined the level of video game console expertise of the subjects, which was used to break down users into two groups: casual users and experienced users. The study found that experienced gamers performed significantly faster with the GamePad than casual users. When looking at the groups separately, casual gamers performed significantly better using the multi-touch display, compared to the GamePad. Additional results are found in this dissertation.^

A experiência do usuário idoso no design de jogo digital para a reabilitação neural de pacientes com quadro de acidente vascular cerebral (AVC)

Stroke is nowadays one of the main causes of death in Brazil and worldwide. During the rehabilitation process, patients undergo physioterapic exercises based on repetition, which may cause them to feel little progress is being made. Focusing on themes from the areas of Human-Computer Interaction and Motor Imagery, the present work describes the development of a digital game concept aimed at motor rehabilitation to the neural rehabilitation of patients who have suffered a stroke in a playful and engaging way. The research hypothesizes that an interactive digital game based on Motor Imagery contributes to patients' raised commitment in the stroke sequel rehabilitation process. The research process entailed the investigation of 10 subjects who live with sequels caused by stroke - it was further established that subjects were over 60 years old. Using as foundation an initial survey regarding target-users' specificities, where an investigation on subjectrelated aspects was carried out through Focus Group (n=9) and Contextual Analysis (n=3), having as subjects elderly individuals, a list with the necessary requirements for the conceptualization of a digital game was fleshed out. The initial survey also enabled the establishment of preliminary interactions for the formulation of game prototypes. At first, low-resolution prototypes were used, with two distinct interaction models for the game - one with a direct approach to the Motor Imagery concept, and another using a narrative with characters and scene settings. The goal was to verify participants' receptivity regarding the addition of playful activities into game dynamics. Prototypes were analyzed while being used by five patients, through the Cooperative Evaluation technique. The tests indicated a preference for option with elements in a playful narrative. Based on these results high fidelity prototypes were created, where concepts close to the game's final version were elaborated. The High Fidelity prototype was also evaluated with four patients through the Cooperative Evaluation technique. It was concluded that elderly individuals and patients were receptive to the idea of a digital game for the rehabilitation from sequels caused by stroke; that, for the success of devices aimed at these cohorts, their contexts, needs and expectations must be respected above all; and that user-centered design is an essential approach in that regard.

Novas abordagens para configurações automáticas dos parâmetros de controle em comitês de classificadores

Significant advances have emerged in research related to the topic of Classifier Committees. The models that receive the most attention in the literature are those of the static nature, also known as ensembles. The algorithms that are part of this class, we highlight the methods that using techniques of resampling of the training data: Bagging, Boosting and Multiboosting. The choice of the architecture and base components to be recruited is not a trivial task and has motivated new proposals in an attempt to build such models automatically, and many of them are based on optimization methods. Many of these contributions have not shown satisfactory results when applied to more complex problems with different nature. In contrast, the thesis presented here, proposes three new hybrid approaches for automatic construction for ensembles: Increment of Diversity, Adaptive-fitness Function and Meta-learning for the development of systems for automatic configuration of parameters for models of ensemble. In the first one approach, we propose a solution that combines different diversity techniques in a single conceptual framework, in attempt to achieve higher levels of diversity in ensembles, and with it, the better the performance of such systems. In the second one approach, using a genetic algorithm for automatic design of ensembles. The contribution is to combine the techniques of filter and wrapper adaptively to evolve a better distribution of the feature space to be presented for the components of ensemble. Finally, the last one approach, which proposes new techniques for recommendation of architecture and based components on ensemble, by techniques of traditional meta-learning and multi-label meta-learning. In general, the results are encouraging and corroborate with the thesis that hybrid tools are a powerful solution in building effective ensembles for pattern classification problems.

Resonance Energy Transfer-Based Molecular Switch Designed Using a Systematic Design Process Based on Monte Carlo Methods and Markov Chains

A RET network consists of a network of photo-active molecules called chromophores that can participate in inter-molecular energy transfer called resonance energy transfer (RET). RET networks are used in a variety of applications including cryptographic devices, storage systems, light harvesting complexes, biological sensors, and molecular rulers. In this dissertation, we focus on creating a RET device called closed-diffusive exciton valve (C-DEV) in which the input to output transfer function is controlled by an external energy source, similar to a semiconductor transistor like the MOSFET. Due to their biocompatibility, molecular devices like the C-DEVs can be used to introduce computing power in biological, organic, and aqueous environments such as living cells. Furthermore, the underlying physics in RET devices are stochastic in nature, making them suitable for stochastic computing in which true random distribution generation is critical.

In order to determine a valid configuration of chromophores for the C-DEV, we developed a systematic process based on user-guided design space pruning techniques and built-in simulation tools. We show that our C-DEV is 15x better than C-DEVs designed using ad hoc methods that rely on limited data from prior experiments. We also show ways in which the C-DEV can be improved further and how different varieties of C-DEVs can be combined to form more complex logic circuits. Moreover, the systematic design process can be used to search for valid chromophore network configurations for a variety of RET applications.

We also describe a feasibility study for a technique used to control the orientation of chromophores attached to DNA. Being able to control the orientation can expand the design space for RET networks because it provides another parameter to tune their collective behavior. While results showed limited control over orientation, the analysis required the development of a mathematical model that can be used to determine the distribution of dipoles in a given sample of chromophore constructs. The model can be used to evaluate the feasibility of other potential orientation control techniques.

Building resilience for social-ecological sustainability in Atlantic Europe

This thesis argues that complex adaptive social–ecological systems (SES) theory has important implications for the design of integrated ocean and coastal governance in the EU. Traditional systems of governance have struggled to deal with the global changes, complexity and uncertainties that challenge a transition towards sustainability in Europe’s maritime macro-regions. There is an apparent disconnect between governance strategies for sustainability in Europe’s maritime macro-regions and a sound theoretical basis for them. My premise is that the design of governance architecture for maritime regional sustainability should be informed by SES theory. Therefore, the aim of this research was to gain insight into a multilevel adaptive governance architecture that combines notions of sustainability and development in the context of the Atlantic Europe maritime macro-region. The central research question asked whether it is possible to achieve this insight by using a SES as a framework and analytical tool. This research adopted social ecology and sustainability science as a foundation for understanding society–nature relations. Concepts from complex adaptive systems, SES and resilience theories were integrated into a conceptual framework that guided the investigation and analysis. A study was conducted to conceptualise the European Atlantic social–ecological system (EASES). This was used to represent and understand the Atlantic Europe macro-region as a SES. The study examined the proposition that governance can be focused on building SES resilience to help achieve maritime regional sustainability. A workbook method was developed and used to elicit expert opinion regarding EASES. The study identified sources of resilience and resilience dynamics that require management in the context of multilevel adaptive governance. This research found that the Atlantic Europe macro-region is a key focal level for multilevel adaptive governance architecture. The majority of the findings are specific to Atlantic Europe and not generalisable to other maritime macro-regions in Europe.

3D Navigation with Six Degrees-of-Freedom using a Multi-Touch Display

With the introduction of new input devices, such as multi-touch surface displays, the Nintendo WiiMote, the Microsoft Kinect, and the Leap Motion sensor, among others, the field of Human-Computer Interaction (HCI) finds itself at an important crossroads that requires solving new challenges. Given the amount of three-dimensional (3D) data available today, 3D navigation plays an important role in 3D User Interfaces (3DUI). This dissertation deals with multi-touch, 3D navigation, and how users can explore 3D virtual worlds using a multi-touch, non-stereo, desktop display. The contributions of this dissertation include a feature-extraction algorithm for multi-touch displays (FETOUCH), a multi-touch and gyroscope interaction technique (GyroTouch), a theoretical model for multi-touch interaction using high-level Petri Nets (PeNTa), an algorithm to resolve ambiguities in the multi-touch gesture classification process (Yield), a proposed technique for navigational experiments (FaNS), a proposed gesture (Hold-and-Roll), and an experiment prototype for 3D navigation (3DNav). The verification experiment for 3DNav was conducted with 30 human-subjects of both genders. The experiment used the 3DNav prototype to present a pseudo-universe, where each user was required to find five objects using the multi-touch display and five objects using a game controller (GamePad). For the multi-touch display, 3DNav used a commercial library called GestureWorks in conjunction with Yield to resolve the ambiguity posed by the multiplicity of gestures reported by the initial classification. The experiment compared both devices. The task completion time with multi-touch was slightly shorter, but the difference was not statistically significant. The design of experiment also included an equation that determined the level of video game console expertise of the subjects, which was used to break down users into two groups: casual users and experienced users. The study found that experienced gamers performed significantly faster with the GamePad than casual users. When looking at the groups separately, casual gamers performed significantly better using the multi-touch display, compared to the GamePad. Additional results are found in this dissertation.

Developmental Paths and Activities of Successful Sport Coaches

The purpose of this research report is to present an overview of an ongoing, international project designed to chart the developmental paths and activities of sport coaches. This brief report includes three sections: (a) conceptual framework used to guide the project, (b) project design and methodology, and (c) results from pilot studies with a sample of 15 successful coaches working in different sport contexts in the United States Unlike the findings for athletic profiles, where several trends across coaching contexts were evident, only one trend was found in how these diverse groups of coaches invested their time in coach developmental activities. In relation to other coaching activities very little time was devoted to formal coach education on an annual basis. The results reinforce the need to consider the coaching context when examining coach development and when designing coach development initiatives.

Extending Science Gateway Frameworks to Support Big Data Applications in the Cloud

Cloud computing offers massive scalability and elasticity required by many scien-tific and commercial applications. Combining the computational and data handling capabilities of clouds with parallel processing also has the potential to tackle Big Data problems efficiently. Science gateway frameworks and workflow systems enable application developers to implement complex applications and make these available for end-users via simple graphical user interfaces. The integration of such frameworks with Big Data processing tools on the cloud opens new oppor-tunities for application developers. This paper investigates how workflow sys-tems and science gateways can be extended with Big Data processing capabilities. A generic approach based on infrastructure aware workflows is suggested and a proof of concept is implemented based on the WS-PGRADE/gUSE science gateway framework and its integration with the Hadoop parallel data processing solution based on the MapReduce paradigm in the cloud. The provided analysis demonstrates that the methods described to integrate Big Data processing with workflows and science gateways work well in different cloud infrastructures and application scenarios, and can be used to create massively parallel applications for scientific analysis of Big Data.

A Framework for Citizen-Centred Social Statistics and Analysis (Working Paper 48)

Economic policy-making has long been more integrated than social policy-making in part because the statistics and much of the analysis that supports economic policy are based on a common conceptual framework – the system of national accounts. People interested in economic analysis and economic policy share a common language of communication, one that includes both concepts and numbers. This paper examines early attempts to develop a system of social statistics that would mirror the system of national accounts, particular the work on the development of social accounts that took place mainly in the 60s and 70s. It explores the reasons why these early initiatives failed but argues that the preconditions now exist to develop a new conceptual framework to support integrated social statistics – and hence a more coherent, effective social policy. Optimism is warranted for two reasons. First, we can make use of the radical transformation that has taken place in information technology both in processing data and in providing wide access to the knowledge that can flow from the data. Second, the conditions exist to begin to shift away from the straight jacket of government-centric social statistics, with its implicit assumption that governments must be the primary actors in finding solutions to social problems. By supporting the decision-making of all the players (particularly individual citizens) who affect social trends and outcomes, we can start to move beyond the sterile, ideological discussions that have dominated much social discourse in the past and begin to build social systems and structures that evolve, almost automatically, based on empirical evidence of ‘what works best for whom’. The paper describes a Canadian approach to developing a framework, or common language, to support the evolution of an integrated, citizen-centric system of social statistics and social analysis. This language supports the traditional social policy that we have today; nothing is lost. However, it also supports a quite different social policy world, one where individual citizens and families (not governments) are seen as the central players – a more empirically-driven world that we have referred to as the ‘enabling society’.

Design, analysis and evaluation of sigma-delta based beamformers for medical ultrasound imaging applications

The inherent analogue nature of medical ultrasound signals in conjunction with the abundant merits provided by digital image acquisition, together with the increasing use of relatively simple front-end circuitries, have created considerable demand for single-bit  beamformers in digital ultrasound imaging systems. Furthermore, the increasing need to design lightweight ultrasound systems with low power consumption and low noise, provide ample justification for development and innovation in the use of single-bit  beamformers in ultrasound imaging systems. The overall aim of this research program is to investigate, establish, develop and confirm through a combination of theoretical analysis and detailed simulations, that utilize raw phantom data sets, suitable techniques for the design of simple-to-implement hardware efficient  digital ultrasound beamformers to address the requirements for 3D scanners with large channel counts, as well as portable and lightweight ultrasound scanners for point-of-care applications and intravascular imaging systems. In addition, the stability boundaries of higher-order High-Pass (HP) and Band-Pass (BP) Σ−Δ modulators for single- and dual- sinusoidal inputs are determined using quasi-linear modeling together with the describing-function method, to more accurately model the  modulator quantizer. The theoretical results are shown to be in good agreement with the simulation results for a variety of input amplitudes, bandwidths, and modulator orders. The proposed mathematical models of the quantizer will immensely help speed up the design of higher order HP and BP Σ−Δ modulators to be applicable for digital ultrasound beamformers. Finally, a user friendly design and performance evaluation tool for LP, BP and HP  modulators is developed. This toolbox, which uses various design methodologies and covers an assortment of  modulators topologies, is intended to accelerate the design process and evaluation of  modulators. This design tool is further developed to enable the design, analysis and evaluation of  beamformer structures including the noise analyses of the final B-scan images. Thus, this tool will allow researchers and practitioners to design and verify different reconstruction filters and analyze the results directly on the B-scan ultrasound images thereby saving considerable time and effort.

Design and implementation of generalized topologies of time-interleaved variable bandpass Σ−Δ modulators

In this thesis, novel analog-to-digital and digital-to-analog generalized time-interleaved variable bandpass sigma-delta modulators are designed, analysed, evaluated and implemented that are suitable for high performance data conversion for a broad-spectrum of applications. These generalized time-interleaved variable bandpass sigma-delta modulators can perform noise-shaping for any centre frequency from DC to Nyquist. The proposed topologies are well-suited for Butterworth, Chebyshev, inverse-Chebyshev and elliptical filters, where designers have the flexibility of specifying the centre frequency, bandwidth as well as the passband and stopband attenuation parameters. The application of the time-interleaving approach, in combination with these bandpass loop-filters, not only overcomes the limitations that are associated with conventional and mid-band resonator-based bandpass sigma-delta modulators, but also offers an elegant means to increase the conversion bandwidth, thereby relaxing the need to use faster or higher-order sigma-delta modulators. A step-by-step design technique has been developed for the design of time-interleaved variable bandpass sigma-delta modulators. Using this technique, an assortment of lower- and higher-order single- and multi-path generalized A/D variable bandpass sigma-delta modulators were designed, evaluated and compared in terms of their signal-to-noise ratios, hardware complexity, stability, tonality and sensitivity for ideal and non-ideal topologies. Extensive behavioural-level simulations verified that one of the proposed topologies not only used fewer coefficients but also exhibited greater robustness to non-idealties. Furthermore, second-, fourth- and sixth-order single- and multi-path digital variable bandpass digital sigma-delta modulators are designed using this technique. The mathematical modelling and evaluation of tones caused by the finite wordlengths of these digital multi-path sigmadelta modulators, when excited by sinusoidal input signals, are also derived from first principles and verified using simulation and experimental results. The fourth-order digital variable-band sigma-delta modulator topologies are implemented in VHDL and synthesized on Xilinx® SpartanTM-3 Development Kit using fixed-point arithmetic. Circuit outputs were taken via RS232 connection provided on the FPGA board and evaluated using MATLAB routines developed by the author. These routines included the decimation process as well. The experiments undertaken by the author further validated the design methodology presented in the work. In addition, a novel tunable and reconfigurable second-order variable bandpass sigma-delta modulator has been designed and evaluated at the behavioural-level. This topology offers a flexible set of choices for designers and can operate either in single- or dual-mode enabling multi-band implementations on a single digital variable bandpass sigma-delta modulator. This work is also supported by a novel user-friendly design and evaluation tool that has been developed in MATLAB/Simulink that can speed-up the design, evaluation and comparison of analog and digital single-stage and time-interleaved variable bandpass sigma-delta modulators. This tool enables the user to specify the conversion type, topology, loop-filter type, path number and oversampling ratio.

Estrategias resilientes ante la situación adversa de los desahucios

Los desahucios en España se han convertido en los últimos años en un fenómeno social emergente, de interés tanto para la investigación como para la intervención de los profesionales de la acción social. Aun así, no existen estudios suficientes relacionados con esta situación adversa, y menos aún centrados en las respuestas resilientes que las personas son capaces de ofrecer ante ella. Con el objetivo de identificar los factores internos y externos que se presentan en la experiencia de las familias que viven procesos de desahucios y que les están permitiendo desarrollar estrategias resilientes ante dicha adversidad, se lleva a cabo la presente investigación en la que participan 20 sujetos, pertenecientes a familias que acuden a la Plataforma de Afectados por las Hipotecas (PAH) de Málaga. A los participantes se les realiza una entrevista semi-estructurada y a través de ellas se han podido definir las características socio-familiares de las personas afectadas, las diferentes estrategias de afrontamiento desarrolladas, las principales fuentes de apoyo con las que han contado, así como las preocupaciones que les han acompañado. Los resultados muestran los principales factores internos y externos que están presenten en las estrategias resilientes que han desarrollado las familias afectadas por los desahucios durante el proceso vivido y destacan como fuente de apoyo informacional a la PAH. Se concluye con la necesidad de continuar con esta línea de investigación para tratar de diseñar intervenciones que refuercen y fomenten las estrategias de afrontamiento ante la situación adversa del desahucio.