Challenges, Strengths and Opportunities Related to Implementing Comprehensive Evidence-Based Guidelines on Breast Cancer Survivorship Care by Primary Care Physicians and Nurse Practitioners in Southeastern Ontario

Background Many breast cancer survivors continue to have a broad range of physical and psychosocial problems after breast cancer treatment. As cancer centres move forward with earlier discharge of stable breast cancer survivors to primary care follow-up it is important that comprehensive evidence-based breast cancer survivorship care is implemented to effectively address these needs. Research suggests primary care providers are willing to provide breast cancer survivorship care but many lack the knowledge and confidence to provide evidence-based care. Purpose The overall purpose of this thesis was to determine the challenges, strengths and opportunities related to implementing comprehensive evidence-based breast cancer survivorship guidelines by primary care physicians and nurse practitioners in southeastern Ontario. Methods This mixed-methods research was conducted in three phases: (1) synthesis and appraisal of clinical practice guidelines relevant to provision of breast cancer survivorship care within the primary care practice setting; (2) a brief quantitative survey of primary care providers to determine actual practices related to provision of evidence-based breast cancer survivorship care; and (3) individual interviews with primary care providers about the challenges, strengths and opportunities related to provision of comprehensive evidence-based breast cancer survivorship care. Results and Conclusions In the first phase, a comprehensive clinical practice framework was created to guide provision of breast cancer survivorship care and consisted of a one-page checklist outlining breast cancer survivorship issues relevant to primary care, a three-page summary of key recommendations, and a one-page list of guideline sources. The second phase identified several knowledge and practice gaps, and it was determined that guideline implementation rates were higher for recommendations related to prevention and surveillance aspects of survivorship care and lowest related to screening for and management of long-term effects. The third phase identified three major challenges to providing breast cancer survivorship care: inconsistent educational preparation, provider anxieties, and primary care burden; and three major strengths or opportunities to facilitate implementation of survivorship care guidelines: tools and technology, empowering survivors, and optimizing nursing roles. A better understanding of these challenges, strengths and opportunities will inform development of targeted knowledge translation interventions to provide support and education to primary care providers.

The evolution of lactase persistence in Europe. A synthesis of archaeological and genetic evidence

Lactase persistence, the ability to digest the milk sugar lactose in adulthood, is highly associated with a T allele situated 13,910 bp upstream from the actual lactase gene in Europeans. The frequency of this allele rose rapidly in Europe after transition from hunter–gatherer to agriculturalist lifestyles and the introduction of milkable domestic species from Anatolia some 8000 years ago. Here we first introduce the archaeological and historic background of early farming life in Europe, then summarize what is known of the physiological and genetic mechanisms of lactase persistence. Finally, we compile the evidence for a co-evolutionary process between dairying culture and lactase persistence. We describe the different hypotheses on how this allele spread over Europe and the main evolutionary forces shaping this process. We also summarize three different computer simulation approaches, which offer a means of developing a coherent and integrated understanding of the process of spread of lactase persistence and dairying.

Evolution of the diatoms: major steps in their evolution and a review of the supporting molecular and morphological evidence.

Over the years, many reviews of different aspects of diatom biology, ecology and evolution have appeared. Since 1993 many molecular trees have been produced to infer diatom phylogeny. In 2004, Medlin & Kaczmarska revised the systematics of the diatoms based on more than 20 years of consistent recovery of two major clades of diatoms that did not correspond to a traditional concept of centrics and pennates and established three classes of diatoms: Clade 1 = Coscinodiscophyceae (radial centrics) and Clade 2 = Mediophyceae (polar centrics + radial Thalassiosirales) and Bacillariophyceae (pennates). However, under certain analytical conditions, an alternative view of diatom evolution, a grades of clades, has been recovered that suggests a gradual evolution from centric to pennate symmetry. These two schemes of diatom evolution are evaluated in terms of whether or not the criteria advocated by Medlin & Kaczmarska that should be met to recover monophyletic classes have been used. The monophyly of the three diatom classes can only be achieved if (1) a secondary structure of the small subunit (SSU) rRNA gene was used to construct the alignment and not an alignment based on primary structure and (2) multiple outgroups were used. These requirements have not been met in each study of diatom evolution; hence, the grade of clades, which is useful in reconstructing the sequence of evolution, is not useful for accepting the new classification of the diatoms. Evidence for how these two factors affect the recovery of the three monophyletic classes is reviewed here. The three classes have been defined by clear morphological differences primarily based on gametangia and auxospore ontogeny and envelope structure, the presence or absence of a structure (tube process or sternum) associated with the annulus and the location of the cribrum in those genera with loculate areolae. New evidence supporting the three clades is reviewed. Other features of the cell are examined to determine whether they can also be used to support the monophyly of the three classes.

Evolution of the diatoms: major steps in their evolution and a review of the supporting molecular and morphological evidence.

Over the years, many reviews of different aspects of diatom biology, ecology and evolution have appeared. Since 1993 many molecular trees have been produced to infer diatom phylogeny. In 2004, Medlin & Kaczmarska revised the systematics of the diatoms based on more than 20 years of consistent recovery of two major clades of diatoms that did not correspond to a traditional concept of centrics and pennates and established three classes of diatoms: Clade 1 = Coscinodiscophyceae (radial centrics) and Clade 2 = Mediophyceae (polar centrics + radial Thalassiosirales) and Bacillariophyceae (pennates). However, under certain analytical conditions, an alternative view of diatom evolution, a grades of clades, has been recovered that suggests a gradual evolution from centric to pennate symmetry. These two schemes of diatom evolution are evaluated in terms of whether or not the criteria advocated by Medlin & Kaczmarska that should be met to recover monophyletic classes have been used. The monophyly of the three diatom classes can only be achieved if (1) a secondary structure of the small subunit (SSU) rRNA gene was used to construct the alignment and not an alignment based on primary structure and (2) multiple outgroups were used. These requirements have not been met in each study of diatom evolution; hence, the grade of clades, which is useful in reconstructing the sequence of evolution, is not useful for accepting the new classification of the diatoms. Evidence for how these two factors affect the recovery of the three monophyletic classes is reviewed here. The three classes have been defined by clear morphological differences primarily based on gametangia and auxospore ontogeny and envelope structure, the presence or absence of a structure (tube process or sternum) associated with the annulus and the location of the cribrum in those genera with loculate areolae. New evidence supporting the three clades is reviewed. Other features of the cell are examined to determine whether they can also be used to support the monophyly of the three classes.

Examination of stress and strain in glass structures during pressure treatment using FEM simulation and experimental tests

Otto-von-Guericke-Universität Magdeburg, Fakultät für Maschinenbau, Dissertation, 2016

Experimental Evidence that Retaliation Claims Are Unlike Other Employment Discrimination Claims

The type of discrimination claim that strikes fear in the hearts of all employers is the dreaded retaliation claim. While employers contend, and plaintiffs admit, that retaliation is different from other discrimination complaints, employee advocates have put forth legislation that would equalize retaliation with the other types of discrimination. This bill, Protecting Older Workers against Discrimination Act (POWADA), would expand the so-called mixed-motive jury instruction to age, and disability, as well as retaliation. Moreover, it would allow plaintiffs, not judges, to decide which types of instruction the jury would receive. In this article, the authors argue that retaliation claims should not receive the same treatment as other discrimination claims (including age and disability), because it’s easy for juries to believe that retaliation is a factor, regardless of other facts. Once a fact-finding jury checks the box to indicate that an employer’s motive might include retaliation, the employer will likely have to pay fees and costs, at minimum, regardless of the claim’s final resolution.

Professional service productization and its implications to knowledge transfer in internationalization processes –Case: Company X in Finnish, Swedish and Norwegian markets

As a result of globalization, two thirds of the world’s business takes place nowadays in the service sector. In line, professional service firms are growing their share of the global service production. However, saturation of the professional service sector has forced professional service firms to search for more heuristic ways to conduct business in the international markets. By leveraging effectively the firm’s professionals, a professional service firm can lower its costs to clients and simultaneously generate additional value for the company and thus gain competitive advantage. Even though the academic field has shown growing interest towards services for decades, the fields of service productization and service internationalization are heavily understudied even today. Hence, the objective of this study was to contribute to the research on professional service internationalization and productization. The study concentrated on examining the impact that productization has on knowledge sharing and leveraging in professional service firms operating internationally. The research question focused on examining what implications productization has on knowledge transfer and leveraging during professional service internationalization by leaning on the existing research and on an empirical research. The empirical research was conducted as a single case study within a professional service firm operating in debt-related administrative service business. The case company is one of the leading operators in its field of business and therefore offered a fruitful environment to observe and analyze the topics in question. Additionally, the case company has a strong international presence and a large scale of operations in the selected markets, Finland, Norway and Sweden. Based on the previous literature and on the empirical research, this study found that for professional service firms to efficiently utilize individual, tacit knowledge, in its internationalization processes, it must be shared with the whole organization. By exploiting productization as a knowledge leveraging mechanism, a PSF can apply and transfer knowledge profoundly during its internationalization processes that would otherwise be difficult to tap into. Productization might not be sufficient alone, but by complementing it with a favorable organizational structure and culture, and by encouraging open communication, a PSF may take advantage of the whole potential that productization has to offer.

Towards sustainable transport: A comparison of demographic and behavioural characteristics of Finnish and international car sharing users

Strong evidence suggests that the climate is changing and that these changes are largely caused by human activities. A consensus exists among researchers that human activity is causing global warming and that actions to mitigate global warming need to be taken swiftly. The transportation sector, which relies heavily on fossil fuel burning and primarily oil, is one of the big contributors to air pollution problems at local, regional and global levels. It is the fastest growing source of greenhouse gas emissions and is estimated to be responsible for nearly a quarter of global energyrelated carbon dioxide emissions. Car sharing is a mobility solution encouraging its users to decrease private car usage in favour of communal transit and environmental goals. The idea of car sharing originates from the aspiration to decrease personal car ownership and to reduce vehicle distance travelled. This thesis seeks to complement the understanding of Finnish car sharing users and their usage through better categorization. Through better categorization and segmentation of Finnish car sharing users the thesis seeks to provide information for improved marketing insight. Research is done on the demographic and behavioural characteristics of Finnish car sharing users and they are compared with international findings about the characteristics of International car sharing users. The main research problem is Are Finnish car sharing users similar to international ones? A theoretical research framework on the determinants of individual car sharing usage is built based on international research about demographic and behaviouristic characteristics. After this a quantitative survey is performed to the customers of a Finnish car sharing organization. The data analysed in the thesis consist out of 532 answers received from the car sharing organizations customers. The data is analysed with descriptive and other exploratory methods, which create an understanding of Finnish car sharing users. At the end of the analysis the demographic and behavioural characteristics of Finnish car sharing users are compared with international ones. The research findings of the thesis indicate that the demographic and behavioural characteristics of Finnish car sharing usage largely follow those of their international counterparts. Thanks to the thesis results the car sharing organization is able to better target their customers through improved marketing insight.

Test Anxiety, Coping, Gender and Academic Performance in English Exams: A Study of Finnish Upper Secondary School Students

In this MA thesis, test anxiety related to English exams among Finnish upper secondary school students was studied. In addition, the ways students try to cope with test anxiety were investigated. The purpose of the study was to investigate gender differences in test anxiety, the effects of test anxiety on academic performance and relationships between test anxiety, academic performance and coping strategies. Test anxiety and coping strategies were analysed as scores of questionnaire responses. Coping strategies comprised of three categories – task-orientation and preparation, seeking social support and avoidance. Academic performance was analysed as teacher ratings of general performance in English exams. In total 67 subjects were studied. The subjects were Finnish general upper secondary school students. The data were collected by using online questionnaires. This data were mainly quantitative, but also qualitative elements were included. The quantitative data were analysed by using statistical methods. The results showed that females experienced statistically significantly more test anxiety than males. In addition, a statistically significant correlation was found between test anxiety levels and academic performance ratings of the subjects: the higher the test anxiety score, the lower the academic performance rating. A meaningful correlation was found between test anxiety and seeking social support as a coping strategy: a higher test anxiety score was related to using social support as a coping strategy. However, no relationships were found between academic performance and the three coping strategies when quantitative and qualitative data were analysed. Therefore, different coping strategies per se did not seem to be related to academic performance, but instead it was assumed that the effectiveness of coping strategies is dependent on individual differences. In order to obtain more generalisable results and to gain more understanding of test anxiety and coping with it, a larger number of subjects form different areas of Finland and of different ages could be examined in future studies. Moreover, cross-national and cross-cultural studies could provide valuable information. As a practical recommendation for educational purposes, the results of this study indicated that a more individualised approach is needed.

Translation – The fifth language skill? A comparison of the role of translation in Finnish lukio and the International Baccalaureate Diploma Programme

This study attempts to answer the question “Should translation be considered a fifth language skill?” by examining and comparing the use of translation as a language learning and assessment method in the national Finnish lukio curriculum and the curriculum of the International Baccalaureate Diploma Programme (IBDP). Furthermore, the students’ ability to translate and their opinions on the usefulness of translation in language learning will be examined. The students’ opinions were gathered through a questionnaire that was given to 156 students studying in either lukio or the IBDP in Turku and Rovaniemi. I present and compare the role of translation in selected language teaching and learning methods and approaches, and discuss the effectiveness of translation as a language learning method and an assessment method. The theoretical discussion provides the basis for examining the role of translation as a language learning method and an assessment method in the curricula and final examinations of both education programs. The analysis of the two curricula indicated that there is a significant difference in the use of translation, as translation is used as a language learning method and as an assessment method in lukio, but is not used in either form in the IB. The data obtained through the questionnaire indicated that there is a difference in the level of language competence between the lukio and IB students and suggested that the curriculum in which the student studies has some effect on his/her cognitive use of translation, ability to translate and opinions concerning the usefulness of translation in language learning. The results indicated that both groups of students used translation, along with their mother tongue, as a cognitive language learning method, and, contrary to the expectations set by the analysis of the two curricula, the IB students performed better in the translation exercises than lukio students. Both groups of students agreed that translation is a useful language learning method, and indicated that the most common dictionaries they use are bilingual Internet dictionaries. The results suggest that translation is a specific skill that requires teaching and practice, and that perhaps the translation exercises used in lukio should be developed from translating individual words and phrases to translating cultural elements. In addition, the results suggest that perhaps the IB curriculum should include the use of translation exercises (e.g., communicative translation exercises) in order to help students learn to mediate between languages and cultures rather than learn languages in isolation from each other.