Political will as a determinant of health in Ontario: Implications for progressive human services

The social determinants of health (SDOH) are the broad range of societal factors such as income and its distribution, education and literacy, (un)employment, health care, and so on, that contribute to the overall (aggregate) health, well-being and quality of life of our society as a whole (vis-a-vis, population health). Central questions in this thesis are: Is political will a determinant of health? and if so, How is political will a determinant of health? In responding to these questions this study analyzes a never-before-assembled Province of Ontario data set (1980 through 2000) rigourously operationalized as ten indicators of political will and seven SDOH policy development and SDOH outcome proxies. The case context of Ontario is used because during the 20 year period studied six regime changes occurred in the Province, each with very different ideologically-oriented governance mandates. Cross-correlation and exploratory factor analytic (EFA) techniques were used to analyze major relationships and identify statistical factors shedding light on how political will is a determinant of health. A three-factor outcome accounting for 88.9% of the total variance (r2) of political will as a determinant of health was produced. The resulting three-factor solution suggested that a social-economic governance capacity factor, a government ideology factor, and an SDOH outcomes factor connected political will to a party\u27s capacity to govern, government ideology, and SDOH outcomes. The high variance accounted for in this study occurred because of the high quality of data used and the rigourous, meticulous and innovative methodology used to operationalize the data. Very strong relationships between political will and SDOH variables indicated substantive associations between these proxies. The resulting model provides compelling evidence that political will can be conceived of as a determinant of health. This study provides a compelling case for future research and has specific implications for progressive human services providers

A Critical Assessment of Theories of Strain Gradient Plasticity

Theories to extend plasticity to the micron scale have been in existence for over a decade, complemented by a growing body of experimental data. Here, materials and mechanics aspects of two prominent strain gradient theories of plasticity, due to Nix and Gao and to Fleck and Hutchinson, are assessed within the context of simple bending. Differences between the theories are highlighted. The theories predict different trends relative to the size dependence of initial yielding and rate of hardening. The dislocation mechanics underpinning the two theories is addressed. Distinctions between lower-order theories and higher-order theories are also drawn, emphasizing the flexibility of higher-order theories to solve problems for a wide range of boundary conditions, especially those where, locally, the dislocations are blocked (pile up) and the plastic strain is zero.Engineering and Applied Science

Tackling unemployment, supporting business and developing careers

The issue of unemployment remains high on the political agenda. However, there is evidence that employers can be wary of employing people who are out of work. Employer practice is key, both in terms of providing employment opportunities to job seekers, and in providing space for low-skilled people to develop their skills and cement their attachment to the labour market. This report discusses the role of career guidance in mediating between job seekers and employers to allow both to achieve their objectives.The issue of unemployment remains high on the political agenda. However, there is evidence that employers can be wary of employing people who are out of work. Employer practice is key, both in terms of providing employment opportunities to job seekers, and in providing space for low-skilled people to develop their skills and cement their attachment to the labour market. This report discusses the role of career guidance in mediating between job seekers and employers to allow both to achieve their objectives

Cancer patients’ experiences of living with venous thromboembolism: A systematic review and qualitative thematic synthesis

Background: Cancer-Associated thrombosis is common. Recommended treatment is daily injected low-molecular-weight heparin for 6months. Most studies focus on prophylaxis and treatment; few have explored patients’ experience. Aims To identify and synthesise the available literature concerning patients’ experience of cancer associated thrombosis. Design Systematic literature review and qualitative thematic synthesis. MethodsMEDLINE, Embase, CINAHL, PsychINFO (until 10/2016; limited to English) were searched. Eligible papers were qualitative studies of adult patients’ experience of cancer-associated thrombosis. Two researchers screened titles/abstracts/papers against inclusion criteria with recourse to a third for disagreements. Critical Appraisal Skills Programme qualitative checklist tool was used for quality appraisal. Results1397 articles were identified. Five qualitative studies (total n=92; age range 32 to 84 years) met the inclusion criteria. Participants had various cancer types. Most had advanced disease and were receiving palliative care. Four major themes emerged from the data: knowledge deficit (patients and clinicians); effects of cancer associated thrombosis (physical and psychological); effects of anticoagulation; coping strategies. ConclusionThe cancer journey is difficult in itself, but thrombosis was an additional, frightening and unexpected burden. Although the association between cancer and thromboembolism is well known, cancer patients are not educated routinely about the risk or warning symptoms/signs of thromboembolism which may otherwise be misattributed to the cancer by patient and clinician alike. This systematic review highlights the impact of cancer-associated thrombosis on the lives of cancer patients, and calls for education for patients and clinicians to be part of routine care, and further work to address this patient priority

A Stretch/Bend Method for In Situ Measurement of the Delamination Toughness of Coatings and Films Attached to Substrates

A stretch/bend method for the in situ measurement of the delamination toughness of coatings attached to substrates is described. A beam theory analysis is presented that illustrates the main features of the test. The analysis is general and allows for the presence of residual stress. It reveals that the test produces stable extension of delaminations, rendering it suitable for multiple measurements in a single test. It also provides scaling relations and enables estimates of the loads needed to extend delaminations. Finite element calculations reveal that the beam theory solutions are accurate for slender beams, but overestimate the energy release rate for stubbier configurations and short delaminations. The substantial influence of residual stress on the energy release rate and phase angle is highly dependent on parameters such as the thickness and modulus ratio for the two layers. Its effect must be included to obtain viable measurements of toughness. In a companion paper, the method has been applied to a columnar thermal barrier coating deposited onto a Ni-based super-alloy.Engineering and Applied Science

Cancer patients’ experiences of the diagnosis and treatment of incidental pulmonary embolism (a qualitative study)

Background: The diagnosis of symptomatic cancer-associated thrombosis often causes distress and alarm for patients, especially for those unaware of the risk, or the signs and symptoms to look out for. There are few data about cancer patients’ experiences of incidentally diagnosed pulmonary embolism (IPE), where lack of warning (recognised signs, symptoms) may cause delayed diagnosis and aggravate distress. Objectives: To explore cancer patients’ experience of the diagnosis of and living with incidental pulmonary embolism treated with anticoagulation. Methods: A qualitative study using modified grounded theory approach. Semi-structured interviews were conducted as part of a mixed- methods prospective observational survey study of consenting patients with IPE. Data were subjected to thematic analysis. The qualitative findings are presented. Findings: Eleven participants were interviewed (mean age 68.3 years, range 38–82 years; various forms of cancer and stages). Three major themes and one cross-cutting theme were generated. Theme (1): IPE is experienced in the context of cancer and concomitant comorbidities. Issues are understood in the shadow of–and often overshadowed by—current serious illness. Theme (2): Being diagnosed with IPE. Misattribution to cancer or other comorbidities caused delay in help-seeking and diagnosis. Theme (3): Coping with anticoagulation. Participants’ incorporated anticoagulation treatment and its effects into their daily routine with acceptance and stoicism. Finally, the cross-cutting theme relates to a lack of information and uncertainty, contributing to distress throughout the experience. Conclusion: The diagnosis of IPE was upsetting and unexpected. Expert and timely information was valued by those with IPE. Education called for about the increased risk of cancer-associated thrombosis and the signs and symptoms to be aware of

A connected autonomous vehicle testbed: Capabilities, experimental processes and lessons learned

VENTURER was one of the first three UK government funded research and innovation projects on Connected Autonomous Vehicles (CAVs) and was conducted predominantly in the South West region of the country. A series of increasingly complex scenarios conducted in an urban setting were used to: (i) evaluate the technology created as a part of the project; (ii) systematically assess participant responses to CAVs and; (iii) inform the development of potential insurance models and legal frameworks. Developing this understanding contributed key steps towards facilitating the deployment of CAVs on UK roads. This paper aims to describe the VENTURER Project trials, their objectives and detail some of the key technologies used. Importantly we aim to introduce some informative challenges that were overcame and the subsequent project and technological lessons learned in a hope to help others plan and execute future CAV research. The project successfully integrated several technologies crucial to CAV development. These included, a Decision Making System using behaviour trees to make high level decisions; A pilot-control system to smoothly and comfortably turn plans into throttle and steering actuation; Sensing and perception systems to make sense of raw sensor data; Inter-CAV Wireless communication capable of demonstrating vehicle-to-vehicle communication of potential hazards. The closely coupled technology integration, testing and participant-focused trial schedule led to a greatly improved understanding of the engineering and societal barriers that CAV development faces. From a behavioural standpoint the importance of reliability and repeatability far outweighs a need for novel trajectories, while the sensor-to-perception capabilities are critical, the process of verification and validation is extremely time consuming. Additionally, the added capabilities that can be leveraged from inter-CAV communications shows the potential for improved road safety that could result. Importantly, to effectively conduct human factors experiments in the CAV sector under consistent and repeatable conditions, one needs to define a scripted and stable set of scenarios that uses reliable equipment and a controllable environmental setting. This requirement can often be at odds with making significant technology developments, and if both are part of a project’s goals then they may need to be separated from each other