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Shaffer, Claire. "EMERGENCY DEPARTMENT CROWDING: EXPLORING BIAS AND BARRIERS TO EQUITABLE ACCESS OF EMERGENCY CARE." Master's thesis, Temple University Libraries, 2018. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/487771.
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Urban Bioethics<br>M.A.<br>The emergency department (ED) has often been considered the safety net of the American healthcare system. It earned this distinction because every person in the United States has access to a medical screening exam and stabilization at an ED regardless of their ability to pay. Unfortunately, over the past several decades, decreasing numbers of EDs and inpatient beds, coupled with increasing rates of ED usage, has led to crowding of EDs across the country. Crowding leads to unsafe conditions that may increase morbidity and mortality for patients, or cause patients to leave the ED without being evaluated by a physician. Essentially, crowding causes a barrier for patients to access their right to emergency evaluation. The problem of crowding is most pronounced in large urban communities, and these already frequently underserved patients suffer the most from the crowding burden. The main cause of crowding seems to be the boarding of admitted patients in the ED, however many often cite high rates of non-urgent patients presenting to the ED as a cause of crowding. Some have even suggested diverting non-urgent patients to help solve the problem of crowding. I became interested in this topic due to crowding concerns and initiatives to decrease the number of patients who left without being seen at my own institution. As I reviewed relevant research, I became aware of my own misconceptions and noted a trend of literature suggesting non-urgent patients are not the cause of crowding. Drawing on research from many different sources, paired with evaluation based on principles in bioethics, I have come to several conclusions. I believe the systematic diversion of non-urgent patients is unsafe, and that the unequal burden of ED crowding on urban communities represents an unjust barrier in access to care. We must continue to carefully research the demographics of patients frequently presenting to EDs to avoid perpetuating stereotypes about which types of patients are responsible for crowding. We should also look for ways to ease the crowding burden in urban communities. Additionally, we should take a qualitative assessment of our individual communities to determine if there are any particular reasons in our community that people choose to use the ED rather than other healthcare options. I believe these suggestions can be an important addition to the efforts already in motion to help reduce ED crowding and provide equitable access to emergency medical evaluation.<br>Temple University--Theses
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Manu, Alexander Ansah. "Newhints home visits cluster randomised controlled trial : impact on access to care for sick newborns and determinants, facilitators and barriers to this." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2012. http://researchonline.lshtm.ac.uk/768506/.
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Approximately 3.3 million (41 %) of global child deaths occur among children in the first 28 days of life (the neonatal period). Neonatal death reduction is imperative to achieving the 4th millennium development goal (MDG-4) which seeks to reduce global child deaths by two-thirds its levels in 1990 come 2015. Three direct causes: infections, asphyxia, and prematurity or low birthweight and its complications account for approximately 80% of these deaths, majority of which are preventable. Infection is the single most important cause in about a third (and up to half in high mortality settings) of all neonatal deaths. However, care seeking for sick newborns is generally poor and besieged by myriads of barriers with many newborn deaths occurring at home with no contact with health providers. Trials in south Asia have shown that prompt detection and treatment of newborn infections coupled with effective preventive measures can significantly reduce newborn deaths. The Ghana Newhints home visits cluster randomised controlled trial (CRT) is the first trial in sub-Saharan Africa to evaluate the impact of a community-based strategy on newborn care practices and neonatal mortality.
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Andersson, Emelie. "Att ha tillgång till mödravård eller inte, det är frågan. : En fältstudie i Akim Oda, Ghana." Thesis, Uppsala universitet, Kulturgeografiska institutionen, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-192978.
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Islam, Mofakharul. "Age estimation and illicit image detection using a stochastic vision model." Thesis, University of Ballarat, 2013. http://researchonline.federation.edu.au/vital/access/HandleResolver/1959.17/44503.
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The main objective of this research is to investigate and implement a robust approach with a view to provide the Law Enforcement Agencies (LEAs) with a dedicated forensic tool in future for inspecting confiscated PCs from the suspected paedophile to detect pedophilic images automatically and prevent children viewing pornographic and age-inappropriate images at their home and school and adults at their workplace while they are on the Internet. To achieve this goal, we use a novel face descriptor to differentiate child face from adult face based on categorical age specific contextual cues that are based on new knowledge in terms of features or contexts representatives of child and adult face. Given that the craniofacial cues contain enough structural information on visual cues on human face encoded in the form of high level features we can categorize age into adult and children in tandem with low level features. Finally, we will present a novel stochastic vision model based on Markov Random Fields (MRF) prior, which learned the pornographic contextual constraints from the training pornographic images and eventually introduce knowledge on pornography into our proposed stochastic classifier allowing classification of images into pornographic or benign.<br>Doctor of Philosophy
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Marks, Lori J. "Project PAVE: Providing Access to the Visual Environment: Low Vision Inservice." Digital Commons @ East Tennessee State University, 1999. https://dc.etsu.edu/etsu-works/3718.
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Coates, Chad O. "Private Higher Education in Jamaica: Expanding Access in Pursuit of Vision 2030." Bowling Green State University / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=bgsu1329100651.
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Bangor, Aaron W. "Improving Access to Computer Displays: Readability for Visually Impaired Users." Thesis, Virginia Tech, 1998. http://hdl.handle.net/10919/36939.
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In the field of human factors engineering the issue of how to present electronic text to people has been studied intensely for over 35 years. However, one major consideration that has largely been overlooked in these studies is how visual impairments affect reading of computer text. Specifically, the issue of how text can be modified to improve readability of CRTs for individuals with low vision. A 2x5x2x3 (visual capability, font size, polarity, and contrast) mixed-factor, repeated-measures experimental design was used to determine if changes in font size, contrast polarity, and/or contrast can improve reading speeds and reduce error rate for people with low vision.
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The results of this experiment show that alterations in text can be made that do not affect unimpaired vision readers while dramatically improving the reading capabilities of the impaired vision population. For character size, 12 and 14 point font sizes were found to be too small for the visually impaired population examined. In general, 18 and 30 point font sizes were equal to each other and to the 24 point font size, but for some interactions these two were found to produce longer response times and higher error rates. Thus, a 24 point font size is recommended.
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Unlike previous research with visually impaired participants, this experiment found that negative (white-on-black) polarity worsened reading performance. It is thought that this discrepancy is a result of polarity's interaction with small font sizes. For this reason, it is recommended that for font sizes of 18 points and below, positive polarity should be used. For 24 and 30 point sizes either polarity is satisfactory, though previous research (Legge, Pelli, Rubin, and Schleske, 1985b; NRC, 1995; Rubin and Legge, 1989) suggests negative polarity might be better for some visually impaired readers..
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Contrasts of 3:1, 7:1, and 18:1 were used in this experiment and had no significant effect for either vision group. However, contrast did significantly interact with both font size and polarity. For font sizes of 18 points or below, it is recommended that contrasts of 18:1 be used for either polarity, but this is very important if negative polarity is used.
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The above recommendations are based on a small group of impaired vision readers. Visual impairments vary widely and the sample used in this experiment represented only a portion of them, with respect to both cause and severity. Wherever possible, computer text should be tailored to the unique needs of its users.<br>Master of Science
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Higgins, John William. "Tracing the vision : a study of community volunteer producers, public access cable television, and empowerment /." The Ohio State University, 1994. http://rave.ohiolink.edu/etdc/view?acc_num=osu1487859313348271.
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Ferdousi, Wahida. "Inequality in Access to Dental and Vision Care| Examining the Role of Income and Insurance." Thesis, State University of New York at Albany, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10275036.
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<p> This dissertation explores inequality in access to dental and vision care. It includes three chapters. The first chapter examines the impact of vision coverage on vision health and vision care utilizations using nationally representative Behavioral Risk Factor Surveillance System (BRFSS) data. It also examines the trend in cost/insurance barrier to access vision care. I found significant evidence suggesting positive relationship between vision insurance and vision care utilization. This finding confirms the findings of previous studies on the same topic. Examining the cost/insurance barrier to access vision care, I have found evidence suggesting increase in the barrier to access vision care in recent years. </p><p> The second chapter analyzes the effect of the early Medicaid expansion under the Affordable Care Act (ACA) on dental care utilization among U.S. adults using nationally representative BRFSS survey data for the years 2006 to 2012. Childless adults, who were not eligible to be covered in Medicaid before the implementation of the ACA except through 1115 waiver or state/locally funded programs, were made eligible for mainstream Medicaid through the ACA. In this chapter, I examine whether the early implementation of the Medicaid eligibility expansion to childless adults during 2010-2012, gave rise to increase in dental care utilization of this group. Using differences-in-differences model for the analysis, I find no significant evidence of changes in dental care utilization of childless adults in the post expansion period. Also, I find evidence of no (very small) significant change in dental care utilization of childless adults compared to parents in the post eligibility expansion period as Medicaid payment to dentist’s increase. </p><p> The third chapter analyzes income related inequality and inequity in dental care utilization among adults in New York state using data from the BRFSS survey. To my knowledge, this is the first paper which tries to estimate income related inequality in adult dental care utilization in New York state. I improve on existing inequality literature by using multiple imputation to deal with the problem of calculating income inequality using interval-censored and top-coded income data. This paper calculates inequality using the corrected concentration index proposed by Erreygers which has not been commonly used in previous literature to estimate inequality in dental care utilization. In decomposition of inequality, I allow for heterogeneity in the utilization with respect to need using the procedure proposed by Van de Poel, Van Doorslaer and O’Donnell (2012) and thereby allow for violation of the assumption of vertical equity which is an implicit assumption in decomposition of inequality in previous literature analyzing inequality in dental care. I find evidence of pro-rich inequality and inequity in dental care utilization. The findings suggest that conventional horizontal inequity index overestimates the need-justified index of inequity for the state of New York.</p><p>
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Woodrow, Alaric J. "Trauma of the 'quasi-prisoner' : the voice of visitors denied access at the prison gates." Thesis, University of Portsmouth, 2017. https://researchportal.port.ac.uk/portal/en/theses/trauma-of-the-quasiprisoner--the-voice-of-visitors-denied-access-at-the-prison-gates(d700080f-5c15-40f5-b443-b8876463dfe1).html.
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This thesis examines a previously ignored, highly sensitive and important area of Criminology as it addresses the unique question about how and why visitors to prison are denied entry to visit their incarcerated relatives. It examines how various Technologies of Exclusion (TE) are used in this visit denial process to create the Visitor Victim (V2) and Trauma of the "Quasi-Prisoner". The significant tension created between family visitation and security issues is explored. The impact of privacy laws upon the process of finding participants for this sensitive research is explained, acknowledging that most people prefer not to discuss incarcerated relatives. Third party non- governmental agencies, working with individuals who have ‘run up against’ the penal system, assisted in this search. Visitors' issues and attitudes towards prison staff and emerging visit issues are examined, with the impact of visit refusal as a main focus of this research. Safeguarding facilities, at the expense of family relationships, is a constant theme of concern. Better prospects for the reintegration of offenders and the retention of important family relationships can be brought about through the modification of prison regulations. Removal of some of the Technologies of Exclusion would allow prison visits to become less traumatic and a more comfortable experience for offenders, prison staff and visitors.
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Sukaryavichute, Elina. "Transit Planning, Access, and Social Justice: Competing Visions of Bus Rapid Transit and the Chicago Street." Miami University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=miami1468179645.
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Espinoza, Vásquez Gerardo Alfonso Joel. "Sistema de reconocimiento de patrones en placas vehiculares para el acceso automático de visitas a un edificio." Bachelor's thesis, Pontificia Universidad Católica del Perú, 2014. http://tesis.pucp.edu.pe/repositorio/handle/123456789/5753.
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Actualmente se poseen distintos sistemas de seguridad en edificios, donde el acceso
vehicular es realizado manualmente por medio de personal del edificio. Este método
da lugar a esperas cuando se tiene un visitante y se tiene que autorizar su entrada,
ya que se tiene que contactar con el personal para confirmar. Asimismo, para los
residentes en ciertos casos puede ser un inconveniente perder su llave de acceso.
La propuesta de este trabajo es la creación de un software de reconocimiento de
placas vehiculares el cual será de ayuda a los sistemas de control de acceso
utilizados en edificios. El software intentará automatizar el proceso de acceso de
residentes y visitantes autorizados por medio de acceso basado en reconocimiento
visual de la placa vehicular.
En el mundo son usados sistemas de reconocimiento de placas vehiculares que
apoyan en labores de vigilancia, parqueo inteligente y control de tráfico. El uso de
estos sistemas es impulsado por los gobiernos que los usan, difundiendo el desarrollo
a través de inversiones tecnológicas o por empresas que ofrecen el servicio, sin
embargo, por ejemplo en nuestro país, aún no se tiene un sistema de este tipo que
funcione adecuadamente, esto podría ser por diferentes motivos, donde el más
característico es el poco control sobre la norma del uso de las placas de autos. En
ese sentido nuestra propuesta se restringirá al uso del sistema dentro de un ambiente
controlado como el acceso a un edificio por parte de residentes y visitantes
autorizados. El principal problema que se abordará en el presente trabajo es el referido a la
detección automática de la placa vehicular del sistema peruano de placas
vehiculares, lo cual implica realizar un pre-procesamiento de la imagen el cual incluye
la binarización y detección de bordes de la imagen, y finalmente la segmentación
(detección) de la placa. Una vez detectada la placa, esta puede ser procesada por
un sistema de reconocimiento óptico de caracteres (OCR). Lo que se pretende es
desarrollar un método que extraiga la placa de los automóviles, teniendo como
espacio de aplicación controlado el acceso vehicular de un edificio, considerando las
características de las placas de autos nacionales además de los factores de error
presentes en el entorno peruano.<br>Tesis
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Schenck, Marcia C. "Land, water, truth, and love : visions of identity and land access from Bain's Bushmen to Khomani San /." Connect to online version, 2008. http://ada.mtholyoke.edu/setr/websrc/pdfs/www/2009/366.pdf.
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Zhou, Shuting. "Navigation of a quad-rotor to access the interior of a building." Thesis, Compiègne, 2015. http://www.theses.fr/2015COMP2237.
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Ce travail de recherche est dédié à l’élaboration d’une stratégie de navigation autonome qui comprend la génération d’une trajectoire optimale en évitant des obstacles, la détection de l’objet d’intérêt spécifique (i.e. une fenêtre) et puis l’exécution de la manoeuvre postérieure à approcher la fenêtre et enfin accéder à l’intérieur du bâtiment. Le véhicule est navigué par un système de vision et une combinaison de capteurs inertiels et d’altitude, ce qui réalise une localisation relative du quadri-rotor par rapport à son environment. Une méthode de planification de trajectoire basée sur Model Predictive Control (MPC), qui utilise les informations fournies par le GPS et le capteur visuel, a été conçue pour générer une trajectoire optimale en temps réel avec des capacités d’évitement de collision, qui commence à partir d’un point initial donné par l’utilisateur et guide le véhicule pour atteindre le point final à l’extérieur du bâtiment de la cible. Dans le but de détecter et de localiser l’objet d’intérêt, deux stratégies de détection d’objet basées sur la vision sont proposées et sont respectivement appliquées dans le système de stéréo vision et le système de vision en utilisant la Kinect. Après l’estimation du modèle de la fenêtre cible, un cadre d’estimation de mouvement est conçu pour estimer ego-mouvement du véhicule à partir des images fournies par le capteur visuel. Il y a eu deux versions des cadres d’estimation de mouvement pour les deux systèmes de vision. Une plate-forme expérimentale de quad-rotor est développée. Pour l’estimation de la dynamique de translation du véhicule, un filtre de Kalman est mis en œuvre pour combiner les capteurs d’imagerie, inertiels et d’altitude. Un système de détection et de contrôle hiérarchique est conçu pour effectuer la navigation et le contrôle de l’hélicoptère quadri-rotor, ce qui permet au véhicule d’estimer l’état sans marques artificielles ou d’autres systèmes de positionnement externes<br>This research work is dedicated to the development of an autonomous navigation strategy which includes generating an optimal trajectory with obstacles avoiding capabilities, detecting specific object of interest (i.e. a window) and then conducting the subsequent maneuver to approach the window and finally access into the building. The vehicle is navigated by a vision system and a combination of inertial and altitude sensors, which achieve a relative localization of the quad-rotor with respect to its surrounding environment. A MPC-based path planning method using the information provided by the GPS and the visual sensor has been developed to generate an optimal real-time trajectory with collision avoidance capabilities, which starts from an initial point given by the user and guides the vehicle to achieve the final point outside the target building. With the aim of detecting and locating the object of interest, two different vision-based object detection strategies are proposed and are applied respectively in the stereo vision system and the vision system using the Kinect. After estimating the target window model, a motion estimation framework is developed to estimate the vehicle’s ego-motion from the images provided by the visual sensor. There have been two versions of the motion estimation frameworks for both vision systems. A quad-rotor experimental platform is developed. For estimating the translational dynamic of the vehicle, a Kalman filter is implemented to combine the imaging, inertial and altitude sensors. A hierarchical sensing and control system is designed to perform the navigation and control of the quad-rotor helicopter, which allows the vehicle to estimate the state without artificial marks or other external positioning systems
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Blancaneaux, Minerva Patricia. "The rhetoric and reality of equitable access to higher education in the Anglophone Caribbean: Transforming vision into action." Thesis, Blancaneaux, Minerva Patricia (2022) The rhetoric and reality of equitable access to higher education in the Anglophone Caribbean: Transforming vision into action. PhD thesis, Murdoch University, 2022. https://researchrepository.murdoch.edu.au/id/eprint/66019/.
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This study is about access to higher education (HE) in the Anglophone Caribbean. It seeks to answer two questions: what rhetoric is evident in current policies that guide access to higher education in the Anglophone Caribbean? And what is the reality of how policies and practices impact access to higher education opportunities for students? These questions are answered through an equity-focused lens. The study used a sequential mixed-method design and the research was conducted in three phases. Phase one was an analysis of extant documentation on existing policies and practices for twelve Anglophone Caribbean countries. Phase two comprised a series of interviews with government officials and higher education officers about their conceptualizations and perceptions of equitable access to HE. In phase three, an online student survey was organized to compare the experiences of students across the region in accessing HE and to examine their perceptions about the policies and practices guiding access. The findings of this research reveal a region-wide deficit in data management, program and policy implementation, and monitoring and evaluation. Additionally, the existing policy documents include mostly implicit references to equity of access to HE. Further findings reveal that while there is ample provision for HE across the region, fair access to those opportunities is still a challenge. The major barriers to access perceived by students and education officials are HE funding, HE cost and related expenses, access for persons with disabilities, and rural/remote access. Equity groups most affected are those with low socio-economic status (SES) and first generation in higher education students (FGHEs). Variables NOT perceived as barriers to HE access in the region were gender, race/ethnicity, religion, age, sexual orientation and cultural/linguistic background. These findings are discussed in the context of the Caribbean’s ongoing development.
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Thibault, Louis. "The role of attention in conscious access mechanisms and their influence on visual representation : evidence from psychophysics and fMRI." Thesis, Sorbonne Paris Cité, 2016. http://www.theses.fr/2016USPCB225/document.
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Un des principaux résultats de l'étude scientifique de la conscience concerne l'existence de deux phases distinctes du traitement visuel. La première est caractérisée par une propagation antérograde de l'activité évoquée par le cortex visuel primaire et n'est pas typiquement associée à une perception consciente. La seconde, en revanche, est souvent citée comme un corrélat neuronal de la conscience, et implique une réactivation du cortex visuel précoce par le cortex parieto-frontal. Cette dichotomie soulève plusieurs questions : premièrement, quelle est l'origine de ce phénomène de feedback, et deuxièmement, qu'est-ce qui distingue un stimulus ayant subi ce traitement supplémentaire du stimulus n'ayant pas provoqué une telle réactivation ? Au jour d'aujourd'hui, deux grandes théories ont été proposées. La première, que nous appelons la théorie "précoce et locale" pose l'hypothèse que l'accès conscient émerge lorsque la boucle de réactivation sensorielle est établie. Ceci implique que seuls les stimuli présentant une qualité hautement saillante dès leur apparition peuvent accéder à un traitement conscient, et de ce fait, que le rapport subjectif d'un stimulus dépend uniquement de l'activité locale du cortex sensoriel. La théorie "tardive et globale", par contraste, propose que la perception consciente est le résultat d'un routage informationnel à travers un réseau cortico-cortical distribué appelé le Global Neuronal Workspace (GNW). Cette théorie suggère que l'information sensorielle provenant de diverses régions corticales accède à cette infrastructure de routage par le biais d'un processus sélectif : l'attention. En 2013, Sergent et collègues ont testé l'une des prédictions dérivées de cette seconde théorie : en principe, un stimulus dont l'observateur n'a pas pris conscience peut néanmoins accéder au GNW suite à un amorçage attentionnel. Afin de tester cette prédiction, des participants humains ont visionné un stimulus placé au seuil perceptif ainsi qu'une amorce attentionnelle qui pouvait soit attirer l'attention vers la position de la cible, soit du coté opposé. Ces participants discriminaient plus finement les caractéristiques de la cible au sein des essais pour lesquels l'amorce dirigeait l'attention vers la position préalable de la cible, ce qui suggère que l'intervention rétrospective de l'attention déclenche un accès conscient pour des faibles traces mnésiques qui ne seraient normalement pas traitées par le GNW. Nous présentons des données de modélisation psychophysique ainsi que des données d'imagerie fonctionnelle qui suggèrent que l'attention joue un rôle causal dans l'émergence d'un percept conscient, et qui offrent des indices quand à la structure des représentations perceptuelles au sein du cortex sensoriel primaire<br>A major finding in the scientific study of conscious perception has been the existence of two temporally-distinct phases of visual processing. The first, characterized by the feed-forward propagation of evoked activity in early visual cortex, is not typically associated with conscious perception. The second phase involves a reactivation of early sensory cortex by downstream regions and is often cited as a correlate -- if not a proximal cause -- of consciousness. This raises a few crucial questions: firstly, what causes this feedback process to emerge, and secondly, what distinguishes a stimulus representation that has undergone such feedback processing from one that has not ? At the time of writing, two competing theories have been proposed. The first theory, hitherto referred to as "early-and-local", posits that conscious access emerges from the very emergence of a feedback loop between high-level sensory cortex and its primary counterpart, and that this cortical resonance is driven entirely by upstream activations along the feed-forward chain. This implies that only those stimuli that exhibit high salience from the onset can become conscious, and by extension, that the stimulus' reportability is governed entirely by early evoked activity in primary sensory cortex. "Late-and-global" theory, by contrast, posits that conscious perception is the direct result of routing of information through a distributed cortico-cortical network called the Global Neuronal Workspace (hereafter GNW). By this account, visual information in various local cortical regions is given access to routing infrastructure by some selective process, namely attention. In 2013, Sergent and colleagues tested a prediction derived from this second model: that an arbitrary sensory representation that has initially failed to become conscious can be hooked into the GNW by means of an attentional manipulation. To do this, a low threshold target Gabor patch was presented, followed by an extrinsic cue either at the location in which the Gabor had been presented, or on the opposite side of the screen. Subjects were better at discriminating the orientation of the Gabor in trials where the cue had been presented on the same side as the target, and also reported seeing the target more clearly, suggesting that the retrospective intervention of attention was enabling a weak signal to gain access to the global neuronal workspace. We present data from psychophysical modeling and functional magnetic resonance imaging that point to a causal role for attention in the emergence of a conscious percept, with implications for the structure of perceptual representations in early sensory cortex
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Akano, Obinna Ferdinand. "Vision health disparity and reasons for no access to vision care among United States adults aged 40 and above| Behavioral Risk Factor Surveillance System (BRFSS), 2007- 5 states." Thesis, Icahn School of Medicine at Mount Sinai, 2013. http://pqdtopen.proquest.com/#viewpdf?dispub=1537270.
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<p><b>Purpose</b>: To examine if disparities exist among US adults aged 40 and above that reported reasons for no access to eye care. </p><p> <b>Methods</b>: A secondary analysis was conducted on 14,129 US adults aged 40 and above who responded to the Vision Module of the 2007 BRFSS using cross-tabulations, logistic regression and chi square statistics. </p><p> <b>Results</b>: Respondents reporting cost/insurance as the main reason for not accessing an eye doctor was greater among adults with education level < HS than with > HS (p<0.001). The percentage who reported cost/insurance as the main reason was greater among adults with income < $25,000 than with >$50,000 (p<0.001). Similarly, a greater percentage of Black adults reported cost/insurance as the reason for not accessing an eye doctor compared to White adults. </p><p> <b>Conclusion</b>: Given that Cost/Insurance was the most frequently cited reason, making eye health/health insurance available to most or all Americans will go a long way in narrowing the gap in vision health disparities. </p>
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Kufa, Erica. "The timing of first antenatal care visit and factors associated with access to care among antenatal care attendees at Chitungwiza municipal clinics, Zimbabwe." Thesis, University of the Western Cape, 2012. http://hdl.handle.net/11394/4553.
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Magister Public Health - MPH<br>Background and Rationale: Antenatal care (ANC) is vital for accessing prevention of mother to child transmission (PMTCT) services. The timing of the first ANC visit is critical for HIV infected pregnant women to access antiretroviral (ARV) prophylaxis as recommended. In addition pregnant women access other interventions like syphilis screening and treatment, provision of ferrous iron supplements, malaria prevention and treatment, health education, identification and management of risk factors. There is however paucity of information on factors associated with the timing and adequate use of ANC services in Chitungwiza Township, Zimbabwe. Aim: This study aimed to determine the factors associated with early access to and adequate use of ANC services among women attending ANC in the four polyclinics in Chitungwiza Township.Method:The study included a retrospective record review of women who registered for ANC in 2010 and a cross sectional study of pregnant women attending ANC clinic for the first time during the current pregnancy during the survey period. Data on gestation age at first ANC visit, number of ANC visits, age, gravidity, parity, tetanus, iron sulphate, rhesus results, HIV test result, WHO clinical stage, CD4 count, cotrimoxazole, PMTCT option accepted, date of initiation of AZT or ART; partner HIV test results; and infant feeding adherence done was abstracted into an MS Excel spreadsheet from the 2010 ANC registers in the four primary health care clinics. Every fourth record was captured. Exit interviews were also conducted on all women attending ANC for the first time during the current pregnancy using a structured questionnaire. Questions on socio-economic status, pregnancy history, reasons for seeking ANC, knowledge and belief about ANC services and their perception of the service received were asked. The outcome variables were gestation age at first ANC visit and the number of ANC visits. The spreadsheet was imported into Epi Info 7.0.9.7 and STATA 11 for analysis. The questionnaires were captured into an Epi Info 7 database exported to STATA 11 for analysis. A sample of 1,236 of first ANC visit records were abstracted from the 2010 ANC registers in the four primary care clinics and 80 women coming for ANC were interviewed in three clinics. The prevalence of pregnant women attending ANC for the first time at gestation age less or equal to 14 weeks and the prevalence of women with less than 4 ANC visits were computed. Pearson Chi-square tests were used to determine the strength of the relationships between the dependent variable (gestation age at the time of the first visit) and independent variables of age, marital status, level of education, parity, gravidity. All statistical tests were performed at 5% significance level and estimates were calculated at 95% confidence interval. Multiple logistic regression analysis was used to investigate the association between the outcome and the independent variables. Model interpretation was done using odds ratios (OR). Levels of knowledge and perception about ANC services as well as service content during the visit were also summarized. Results: Less than 1% of the women who attended ANC in 2010 came for 1st visit at week 14 or less, while of the women interviewed, 2.5% came at similar gestation age. Thirty-nine percent of women attending ANC in 2010 had at least four visits. Lower parity and tetanus immunization were significantly associated with early ANC initiation, while tetanus immunization and syphilis screening were associated with the number of visits.Among the interviewed women (n=80), 72.1% believed that a pregnant women should start ANC at 14 weeks or earlier. Most women (61.7%) cited having no money for booking as the reason for not coming earlier. Need for husband or partners permission, procrastination and not having any health problems with previous pregnancies were also a barrier to access. Uptake of HIV testing was very high at 94.7% of the women. However partner testing was very low at 2.1%. Knowledge of the appropriate time of the first ANC visit was somewhat high but not universal. Conclusions and Recommendations: Timely and adequate uptake of ANC services is very low in Chitungwiza Township. The user-fees appeared to be a major barrier to accessing ANC timely. While correct knowledge about when to go for ANC and the health problems women face during pregnancy and childbirth is prevalent,other factors like the need for permission from spouse or partner and procrastination were barriers to seeking service. Abolishing maternity fees should be seriously considered in order to increase access to timely ANC services. Sustainable means of financing services without reducing quality should be sought. There was variable uptake of various interventions in the ANC package due in part to supplies stock outs. There is need for strengthening the procurement and distribution systems so as to ensure continuous supplies at service delivery level.
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Beach, Sarah S. "And vegetables for all: urban and civic agriculture in Kansas City and visions for the U.S. agrifood system." Diss., Kansas State University, 2013. http://hdl.handle.net/2097/16699.
Full textAbstract:
Doctor of Philosophy<br>Department of Sociology, Anthropology, and Social Work<br>László J. Kulcsár<br>In the United States, many are critical of agricultural policies and economic incentives that support large-scale food production and the dominant actors in the mainstream agrifood system. Critics point out that at the same time agribusinesses and very large-scale farmers receive support, there are those in poverty who struggle to meet their food needs. Critics question what that relationship should be between civil society and the agrifood system. A variety of activities are addressing concerns of social injustices in the system. For example, participation is increasing in civic and urban agriculture. Civic agriculture is the interrelated activities of small-scale, socially and environmentally sound practices of food production and consumption that aim to increase community sustainability. Urban agriculture is food production in and near cities. By focusing on Kansas and the Kansas City metropolitan area, this dissertation addresses the following questions: How do the relations between civil society and the U.S. agrifood system impact the level of fairness in the system? To what extent are urban agricultural activities fostering fairness in the agrifood system, including access to fresh foods, civic engagement, and fulfilling careers, while also benefiting the environmental health of the city? Survey and interview data collected by a research team on agriculture in Kansas sets the context for my examination of urban agriculture in Kansas City’s urban core. In addition to participant observations and primary and secondary data analysis, I conducted 38 semi-structured interviews with growers (27), food advocates (4), community organizers (4), and governmental employees (3). In Kansas City, many of the activities and programs in place are building community, strengthening civil society, and promoting food justice for the poor and for people of color, for example, in food deserts, which are locales where people particularly face challenges in meeting their food needs. While some participants are more focused on their immediate communities and less so on overt widespread change, others feel a part of a social movement aiming to change the agrifood system. Diverse people from various social classes and races are increasingly becoming involved in growing food and food advocacy to expand fairness in the system.
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Parker, Julia. "Reinvention and continuity in the making of an historic visitor attraction : control access and display at Hampton Court Palace, 1838-1938." Thesis, Kingston University, 2009. http://eprints.kingston.ac.uk/20230/.
Full textAbstract:
In the twenty-first century Hampton Court Palace is widely recognised as one of the UK's top historic visitor attractions. Historic Royal Palaces, the charitable trust responsible for the upkeep and display of the palace, has a strong organisational identity, with a purpose that is carefully coordinated to engage the visiting public through displays that focus on key events in the site's history. However, when Hampton Court was opened up free of charge in 1838, visitors were presented with a rather different public spectacle. The majority of rooms were set up to display paintings from the Royal Collection and the site was promoted by the social reformers of the day as a place where the public, particularly the working classes, could be educated and improved. This thesis will demonstrate how Hampton Court has developed from a public art gallery of the 1830s to the site of historic significance that we know today. It is a transition which features a significant duality. On the one hand, the palace has been periodically reinvented in line with changing ideas of what role it should perform in society; on the other, clear circular trends can be identified in successivea pproachesto the administration and display at Hampton Court, which often link the twenty-first century idea of the palace surprisingly closely to its historical characterisationsT. his thesis arguest hat Hampton Court Palace's development has been a chequered process, which paradoxically combines both innovative reinvention and significant continuity. Using significant episodes in the palace's history - the re-decoration of the Great Hall (1840-6), the removal of the Raphael Cartoons (1865), the excavation of the moat (1909-10), the refurbishment of the State Apartments (1938) and the introduction of admission fees (1914) - this thesis seeks to investigate the varied, and often conflicting, guises that Hampton Court has adopted between 1838 and 1938. The discussion will be set in the context of three broad themes, that of `control', `access' and `display'. Within this frame of reference, the thesis uses source material that illuminates both the creation of the palace's outward face and the public's response to it. The first category is largely dominated by the records of the Office of Works, the government department responsible for the site during the period in question. The second aspect of the study is informed by a rather more disparate group of sources, ranging from newspaper reports to advertising images. Together they build a picture of how an historic visitor attraction at Hampton Court Palace was `made'.
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Cortes, Antoine. "Une vision socialiste de la politique contemporaine de santé : la couverture maladie universelle." Thesis, Aix-Marseille, 2014. http://www.theses.fr/2014AIXM1095.
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La loi du 27 juillet 1999 portant création de la couverture maladie universelle est intervenue dans le cadre d'une politique générale de lutte contre l'exclusion. Afin d'améliorer l'accès aux soins d'un nombre croissant de personnes pauvres, les socialistes ont élaboré un dispositif comportant deux volets. Le premier volet visait la généralisation de l'assurance maladie, en permettant l'affiliation au régime général sur un critère subsidiaire de résidence. Le second volet avait pour ambition d'offrir une couverture santé complémentaire, aux millions de personnes qui n'en bénéficiaient pas. Cette prestation étant soumise au respect d'une condition de résidence et d'une condition de ressources. L'ensemble du dispositif instauré par la loi CMU s'est substitué à l'aide médicale départementale et à l'assurance personnelle. L'ampleur des inégalités de santé, touchant en premier lieu les individus les plus pauvres et les plus isolés de la société, a conduit au bon accueil général de la loi CMU. Cependant, bien que considérée comme une grande loi de santé publique, certaines mesures ont été le théâtre de débats et d'oppositions, tant sur la scène politique que dans la société. Cela a été le cas concernant l'effet de seuil induit par l'instauration d'un plafond de ressources, le risque de déresponsabilisation des bénéficiaires ayant accès gratuitement au dispositif, les règles de financement essentiellement basées sur des taxes et contributions publiques, le choix d'une gestion partenariale entre sécurité sociale et partenaires privés, ou encore concernant la réticence d'une minorité de professionnels de santé à l'égard du dispositif<br>The law of the bearing July 27th, 1999 creation of the universal health coverage intervened within the framework of a general policy of fight against exclusion. In order to improve the access to the care of a growing number of poor people, the Socialists worked out a device comprising two facets. The first facet aimed at the generalization of the health insurance, by allowing the affiliation the general scheme on a subsidiary criterion of residence. The second facet had as an ambition to offer a complementary coverage health, to the million people who did not profit from it. This service being subjected to the respect of a condition of residence and a condition of resources. The whole of the device founded by law CMU replaced for the departmental medical assistance and the personal insurance. The extent of the inequalities of health, concerning initially the poorest individuals and most isolated from the society, led to general warm welcome of law CMU. However, although regarded as a great law of public health, certain measurements were the theatre of debates and oppositions, as well on the political scene as in the society. That in particular was the case concerning the effect of threshold induced by the introduction of a ceiling of resources, the risk of deresponsabilisation of the recipients having access free to the device, rules of financing primarily based on public taxes and contributions, the choice of a partnership management between social security and private partners with in particular the organizations of complementary health, or concerning the reserve of a minority of health professionals with regard to the device leading to refusal of care
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Booth, Benjamin Keith Willoughby. "An investigation of museum data storage and access technologies including case studies on archaeological records at the National Maritime Museum and visitor information at the Science Museum." Thesis, University College London (University of London), 1996. http://discovery.ucl.ac.uk/1317527/.
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This dissertation investigates the technology for storage and access to data in museums, focusing on requirements for collections management and the information needs of visitors. The various components of museum information systems, including data structures and terminology, recording media, computer software and hardware, manual systems, and management procedures are comprehensively examined through case studies at the National Maritime and Science Museums. The first case study describes and assesses manual and computer based techniques developed for the storage and retrieval of records in the Archaeological Research Centre at the UK National Maritime Museum. The types of data which the system encompasses were derived from a wide range of sources, including both land based and underwater fieldwork; archaeological, historical and ethnographic research; routine curatorial activities, including conservation; and research into the conservation of waterlogged materials. Further aspects considered included the collection of data in the field, and the development of a framework on which the analysis of boat finds could be based. Archaeological and museum record keeping, and contemporary developments in computer technology are reviewed. The design, development and use of the system are described, and the system is assessed against the initial specification and in the light of users' experience. The second case study builds on the experience of the first, and examines the requirements for a visitor information system at the Science Museum in London.Sources which are used include an analysis of overall visitor needs, specific requirements for object based information and public interest in information as exhibited through the use of the Museum's World Wide Web pages. Building on these studies and the experience of other museums providing such a facility, a model system is outlined, including visitor orientation and information points within the Museum and external access to information.The data requirements of this system are tested against the types of information which are already available in the museum. An overall approach to designing the system is described. In conclusion a comparison is made between the information requirements for collection management and visitor information. Technological issues including data structures and database design are reviewed, and the costs of various options are considered.
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Portaz, Maxime. "Accès à de l'information en mobilité par l'image pour la visite de Musées : Réseaux profonds pour l'identification de gestes et d'objets." Thesis, Université Grenoble Alpes (ComUE), 2018. http://www.theses.fr/2018GREAM053/document.
Full textAbstract:
Dans le cadre du projet GUIMUTEIC, qui vise à équiper les visiteurs de musées d'un outils d'aide à la visite équipé d'une caméra, cette thèse adresse le problème d'accès à l'information en mobilité.On s'intéresse à comment rendre l'information à propos des œuvres accessible et automatique aux visiteurs de lieux touristiques.Elle s'inscrit dans le cadre du projet GUIMUTEIC, qui vise à équiper les visiteurs de musées d'un outil d'aide à l'accès à l'information en mobilité.Être capable de déterminer si le visiteur désire avoir accès à l'information signifie identifier le contexte autour de lui, afin de fournir une réponse adaptée, et réagir à ses actions.Ceci soulève les problématiques d'identification de points d'intérêts, pour déterminer le contexte, et d'identification de gestes de utilisateurs, pour répondre à ses demandes.Dans le cadre du notre projet, le visiteur est donc équipé d'une caméra embarquée.L'objectif est de fournir un solution à l'aide à la visite, en developpant des méthodes de vision pour l'identification d'objet, et de detection de gestes dans les vidéos à la première personne.Nous proposons dans cette thèse une étude de la faisabilité et de l'intérêt de l'aide à la visite, ainsi que de la pertinence des gestes dans le cadre de l'interaction avec un système embarqué.Nous proposons une nouvelle approche pour l'identification d'objets grâce à des réseaux de neurones profonds siamois pour l'apprentissage de similarité entre les images, avec apprentissage des régions d'intérêt dans l'image.Nous explorons également l'utilisation de réseaux à taille réduite pour le détection de gestes en mobilité.Nous présentons pour cela une architecture utilisant un nouveau type de bloc de convolutions, pour réduire le nombre de paramètres du réseau et permettre son utilisation sur processeur mobile.Pour évaluer nos propositions, nous nous appuyons sur plusieurs corpus de recherche d'image et de gestes, crée spécialement pour correspondre aux contraintes du projet<br>This thesis is part of the GUIMUTEIC project, which aim is to equip museum tourist with an audio-guide enhanced by a camera.This thesis adress the problem of information access in mobile environment, by automaticaly providing information about museum artefacts.To be able to give this information, we need to know when the visitor desire guidance, and what he is looking at, to give the correct response.This raises issues of identification of points of interest, to determine the context, and identification of user gestures, to meet his demands.As part of our project, the visitor is equipped with an embedded camera.The goal is to provide a solution to help with the visit, developing vision methods for object identification, and gesture detection in first-person videos.We propose in this thesis a study of the feasibility and the interest of the assistance to the visit, as well as the relevance of the gestures in the context of the interaction with an embedded system.We propose a new approach for objects identification thanks to siamese neural networks to learn images similarity and define regions of interest.We are also exploring the use of small networks for gesture recognition in mobility.We present for this an architecture using new types of convolution blocks, to reduce the number of parameters of the network and allow its use on mobile processor.To evaluate our proposals, we rely on several corpus of image search and gestures, specificaly designed to match the constraints of the project
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Sergent, Claire. "Dynamique de l' accès à la conscience : caractérisation comportementale et bases cérébrales de l' accès à la conscience lors du clignement attentionnel (attentional blink)." Paris 6, 2005. http://www.theses.fr/2005PA066548.
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Garth-Davis, Bryan. "A needle positioning system for percutaneous procedures." Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/71626.
Full textAbstract:
Thesis (MScEng)--Stellenbosch University, 2012.<br>ENGLISH ABSTRACT: In percutaneous procedures, where the surgeon inserts a needle into a target in
the patient, it is challenging to access the target at the rst attempt. Repeated
needle insertion attempts are highly undesirable, as they lead to increased
theatre time, patient haemorrhage and radiation exposure. The proposal of
this thesis was to develop a low-cost system to aid surgeons with the process of
positioning and orientating the needle prior to insertion. The proposed system
uses a stereo pair of images produced by a standard C-arm uoroscope. By
applying computer vision techniques, such as triangulation, the desired needle
position and orientation are determined from the set of images. An articulated
manipulator is used to position and orientate the needle. The surgeon makes
selections on the images, via a graphical user interface (GUI), to indicate the
desired position and orientation of the needle. Following these selections, an
algorithm determines the necessary angles for the manipulator. The surgeon
then positions the manipulator accordingly.
Results from tests on a phantom showed the system to be repeatable and
accurate to 2 mm. This is less accurate than similar, existing systems which,
reported accuracies of 0:25 and 1:21 mm. However, 2 mm accuracy is considered
adequate as it allows a range of percutaneous procedures to be performed
such as needle biopsy, regional anaesthesia, brachytherapy and percutaneous
nephrolithotomy (PCNL). Tests on both a phantom kidney and a porcine kidney
indicated that the system can function in a real percutaneous procedure
and with an anatomical target. The total cost to develop the prototype system
was R15 000. The accuracy of the proposed system and the time to gain access to the target
indicate that the system can be a bene cial aid to surgeons when performing percutaneous procedures. As minimal X-ray imaging is required, patients
will also be spared excessive radiation exposure and theatre time.<br>AFRIKAANSE OPSOMMING: In perkutane prosedures, waar die chirurg 'n naald in 'n teiken op die pasiënt
invoeg, is dit moeilik om met die eerste probeerslag toegang tot die teiken
te bekom. Herhaalde pogings om die naald in te voeg is hoogs ongewens,
aangesien dit tot verlengde teatertyd, bloeding by pasinte sowel as stralingsblootstelling
lei. 'n Laekostestelsel is ontwikkel om chirurge by te staan met die
proses om die naald voor invoeging te plaas en te oriënteer. Die stelsel gebruik
'n paar stereobeelde wat deur 'n standaard-C-arm- uoroskoop voortgebring
word. Met behulp van rekenaarsigtegnieke, soos triangulasie, word die gewenste
naaldposisie en -oriëntasie uit die stel beelde bepaal. 'n Geartikuleerde
manipuleerder word gebruik om die naald te plaas en te oriënteer. Die chirurg
voer die vereiste invoerdata deur middel van 'n gra ese gebruikerskoppelvlak
(GGK) in, waarna 'n algoritme die vereiste hoeke vir die manipuleerder bepaal.
Die chirurg plaas dan die manipuleerder dienooreenkomstig.
Die resultate van toetse op 'n fantoom toon dat die stelsel herhaalbaar en
tot op 2 mm akkuraat is. Dit is minder akkuraat as soortgelyke, bestaande
stelsels, wat 'n akkuraatheid van 0:25 mm en 1:21 mm onderskeidelik aangemeld
het. Tog kan akkuraatheid van 2 mm as voldoende beskou word, aangesien
dit 'n verskeidenheid perkutane prosedures moontlik maak, soos naaldbiopsies,
regionale anestesie, bragiterapie en perkutane nefrolitotomie (PCNL). Toetse
op 'n fantoomnier dui daarop dat die stelsel wél in 'n werklike perkutane prosedure
kan funksioneer. Toetse op 'n varknier toon dat die stelsel wél ook met
'n anatomiese teiken kan werk. Die totale koste om die prototipe te ontwikkel
was R15 000.
Die akkuraatheid van die voorgestelde stelsel en die tydsduur om toegang
tot die teiken te bekom, dui daarop dat die stelsel 'n nuttige hulpmiddel kan wees vir chirurge wat perkutane prosedures uitvoer. Aangesien minimale Xstraalbeelding
vereis word, sal dit pasiënte ook oormatige stralingsblootstelling
en verlengde teatertyd spaar.
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Valencia, López Priscila Ivette. "Desarrollo de modelo de negocios para cadena de jardines infantiles con una visión de igualdad de oportunidades al acceso a una educación de calidad y movilidad social." Tesis, Universidad de Chile, 2016. http://repositorio.uchile.cl/handle/2250/140027.
Full textAbstract:
Magíster en Gestión para la Globalización<br>El objetivo de la presente tesis es presentar el modelo de negocios de Formado Futuro, un proyecto educacional que se enmarca en las nuevas oportunidades y desafíos que han estado surgiendo en educación preescolar: cambios legislativos, aumento de beneficios, mayor conciencia y presión social a nivel local y global.
La metodología utilizada en el desarrollo del modelo de negocios tiene como etapa inicial la identificación y definición de la necesidad, contrastada con el estudio de la oferta, entendiendo las brechas existentes. La generación de este marco teórico es el que orienta a definir cuál es la propuesta de valor que requiere el beneficiario y el modelo de negocios más adecuado para sustentarla. El modelo de negocios es realizado con la metodología Canvas, y posteriormente analizado utilizando herramientas como 5 Fuerzas de Porter, PESTEL y FODA; de manera de proponer estrategias para una organización exitosa. La metodología concluye con el análisis económico y las conclusiones que dan cuenta de su viabilidad.
Formando Futuro contempla la creación de una red de jardines infantiles orientado a generar igualdad de oportunidades al acceso a una educación de calidad que además no seleccione a su alumnado y promueva la movilidad social mediante la equiparación de competencias.
La propuesta de valor se basa en entregar un servicio de educación preescolar para niños entre 2 y 6 años, asegurando estándares de cuidado y enseñanza exigidas por la JUNJI, y sumado a ello, ampliando la propuesta a la incorporación de metodologías y mejores prácticas a internacional adaptadas a la realidad local. Inspirados en el benchmark internacional, se definen los pilares fundamentales del proyecto educativo: el valor del individuo, la cooperación y el aprendizaje por medio de la acción.
El proyecto fue evaluado para tres (3) establecimientos para un horizonte de evaluación de 15 años, con una tasa social de descuento de 6%. El valor presente neto es de 962 millones de pesos, con una tasa interna de retorno de un 18, con lo que el proyecto es atractivo para inversionistas que estén evaluando ser benefactores de iniciativas sociales. Sin embargo, la nueva normativa que prohíbe el lucro en la educación incrementa las exigencias para los sostenedores de los establecimientos lo que a su vez ha provocado un desincentivo para llevar a cabo este tipo de iniciativas. Sin perjuicio de lo anterior, un proyecto como éste genera muchas externalidades positivas motivan a organizaciones sin fines de lucro, corporaciones religiosas o municipalidades a invertir; como por ejemplo: el aumento de cobertura y calidad educacional, el apoyo a la inserción laboral femenina, la creación de nuevas fuentes laborales, la capacitación familiar y social en temas relacionados con educación infantil, posibles proyectos con la comunidad, etc.
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Vermandel, Sébastien. "Accès aux systèmes d'information pour les handicapés moteurs grâce à la commande par le regard." Compiègne, 2001. http://www.theses.fr/2001COMP1371.
Full textAbstract:
Cette thèse présente les travaux de recherches menés pour concevoir un dispositif commandé par le regard permettant d'accéder à un ordinateur à l'intention des handicapés moteurs lourds. Ces travaux font partie intégrante du projet Visioboard, financé par la commission européenne, qui a rassemblé six équipes européennes. Le mémoire est organisé en quatre parties. La première présente les mouvements oculaires et leurs mesures, puis dresse un état de l'art des dispositifs existant destinés aux personnes handicapées. Dans la deuxième partie, les objectifs de la recherche sont définis à partir des besoins des utilisateurs potentiels, collectés par les équipes partenaires. La troisième partie traite de l'étude de faisabilité, des différents essais menés et des développements mis en uvre pour satisfaire aux besoins des utilisateurs. Les solutions techniques qui ont émergé de cette phase ont été implantées dans un appareil prototype qui a ensuite été reproduit en une petite série. La quatrième et dernière partie donne les résultats et leurs interprétations de l'évaluation multicentrique des premiers appareils par des professionnels des technologies assistives et par des personnes handicapées Au final, l'appareil est commercialisé par la société Métrovision. Il apporte des solutions innovantes afin d'améliorer la précision, la fiabilité dans un environnement lumineux naturel et la facilité d'utilisation
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Forsberg, Daniel. "An efficient wavelet representation for large medical image stacks." Thesis, Linköping University, Department of Electrical Engineering, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-8394.
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<p>Like the rest of the society modern health care has to deal with the ever increasing information flow. Imaging modalities such as CT, MRI, US, SPECT and PET just keep producing more and more data. Especially CT and MRI and their 3D image stacks cause problems in terms of how to effectively handle these data sets. Usually a PACS is used to manage the information flow. Since a PACS often is implemented with a server-client setup, the management of these large data sets requires an efficient representation of medical image stacks that minimizes the amount of data transmitted between server and client and that efficiently supports the workflow of a practitioner.</p><p>In this thesis an efficient wavelet representation for large medical image stacks is proposed for the use in a PACS. The representation supports features such as lossless viewing, random access, ROI-viewing, scalable resolution, thick slab viewing and progressive transmission. All of these features are believed to be essential to form an efficient tool for navigation and reconstruction of an image stack.</p><p>The proposed wavelet representation has also been implemented and found to be better in terms of memory allocation and amount of data transmitted between server and client when compared to prior solutions. Performance tests of the implementation has also shown the proposed wavelet representation to have a good computational performance.</p>
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Lebat, Cindy. "Les personnes en situation de handicap sensoriel dans les musées : réalités d’accueil, expériences de visite et trajectoires identitaires." Thesis, Sorbonne Paris Cité, 2018. http://www.theses.fr/2018USPCA060.
Full textAbstract:
Cette thèse présente les modalités d’expérience muséale proposées aux visiteurs déficients visuels et auditifs. Elle expose pour cela à la fois les dispositifs d’accueil et de médiation culturelle des musées, leurs discours sur l’accessibilité et la différence, mais aussi la réception et l’expérience vécue par ces visiteurs. À partir d’un travail de terrain mené dans des établissements muséaux d’Île-de-France et auprès d’individus en situation de handicap, il s’agit d’abord de montrer comment ces institutions structurent et révèlent le traitement social du handicap. Les processus sociaux assignant une place et une identité sociale y étant fortement perceptibles, le musée est pris comme cadre d’analyse et de compréhension des trajectoires identitaires des personnes en situation de handicap. Plus encore, le dispositif muséal conditionne aussi le rapport sensible à l’environnement, notamment par le biais des outils de médiation culturelle. Il contribue en conséquence à imposer une image de soi, et à structurer la carrière de visiteur. En outre, cette recherche souligne la capacité des individus à s’emparer de ces éléments pour élaborer leurs propres trajectoires identitaires. Ainsi, la responsabilité portée par l’institution muséale est mise en évidence, puisqu’elle participe à la construction des identités sociales et des modalités d’être au monde des visiteurs en situation de handicap<br>This PhD dissertation focuses on the ways and means of the museum experience for visitors with visual or hearing deficiencies. For that matter, the aim is to grasp both the cultural mediation systems, the welcoming apparatus proposed by museums but also the experience lived by the visitors. This allows to touch upon the discourses then carried out regarding accessibility and difference. A field work was carried out in the museums of the region Île-de-France and through interviews with people with disabilities. The main objective was to bring out the way in which museums, through the devices they propose and by the discourses they carry and relay on accessibility, organize and reveal at the same time the social treatment of disability. Museums can be considered frameworks for analysis and for understanding identity trajectories, since the social processes giving a place and an identity to people are strongly perceptible in this institution. Moreover, the sensitive connection to environment and, in this case to the exhibits, is also conditioned by the museum. It therefore contributes to establish a self-image for the visitor, and thus to structure the visitor's journey. In addition, by also highlighting the ability of individuals to seize these elements to develop their identity trajectories, this work highlights the responsibility of the museum as an institution, which participates in the construction of social and personal identities
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Rebouillat, Violaine. "Ouverture des données de la recherche : de la vision politique aux pratiques des chercheurs." Thesis, Paris, CNAM, 2019. http://www.theses.fr/2019CNAM1254/document.
Full textAbstract:
Cette thèse s’intéresse aux données de la recherche, dans un contexte d’incitation croissante à leur ouverture. Les données de la recherche sont des informations collectées par les scientifiques dans la perspective d’être utilisées comme preuves d’une théorie scientifique. Il s’agit d’une notion complexe à définir, car contextuelle. Depuis les années 2000, le libre accès aux données occupe une place de plus en plus stratégique dans les politiques de recherche. Ces enjeux ont été relayés par des professions intermédiaires, qui ont développé des services dédiés, destinés à accompagner les chercheurs dans l’application des recommandations de gestion et d’ouverture. La thèse interroge le lien entre idéologie de l’ouverture et pratiques de recherche. Quelles formes de gestion et de partage des données existent dans les communautés de recherche et par quoi sont-elles motivées ? Quelle place les chercheurs accordent-ils à l’offre de services issue des politiques de gestion et d’ouverture des données ? Pour tenter d’y répondre, 57 entretiens ont été réalisés avec des chercheurs de l’Université de Strasbourg dans différentes disciplines. L’enquête révèle une très grande variété de pratiques de gestion et de partage de données. Un des points mis en évidence est que, dans la logique scientifique, le partage des données répond un besoin. Il fait partie intégrante de la stratégie du chercheur, dont l’objectif est avant tout de préserver ses intérêts professionnels. Les données s’inscrivent donc dans un cycle de crédibilité, qui leur confère à la fois une valeur d’usage (pour la production de nouvelles publications) et une valeur d’échange (en tant que monnaie d’échange dans le cadre de collaborations avec des partenaires). L’enquête montre également que les services développés dans un contexte d’ouverture des données correspondent pour une faible partie à ceux qu’utilisent les chercheurs. L’une des hypothèses émises est que l’offre de services arrive trop tôt pour rencontrer les besoins des chercheurs. L’évaluation et la reconnaissance des activités scientifiques étant principalement fondées sur la publication d’articles et d’ouvrages, la gestion et l’ouverture des données ne sont pas considérées comme prioritaires par les chercheurs. La seconde hypothèse avancée est que les services d’ouverture des données sont proposés par des acteurs relativement éloignés des communautés de recherche. Les chercheurs sont davantage influencés par des réseaux spécifiques à leurs champs de recherche (revues, infrastructures…). Ces résultats invitent finalement à reconsidérer la question de la médiation dans l’ouverture des données scientifiques<br>The thesis investigates research data, as there is a growing demand for opening them. Research data are information that is collected by scientists in order to be used as evidence for theories. It is a complex, contextual notion. Since the 2000s, open access to scientific data has become a strategic axis of research policies. These policies has been relayed by third actors, who developed services dedicated to support researchers with data management and sharing.The thesis questions the relationship between the ideology of openness and the research practices. Which kinds of data management and sharing practices already exist in research communities? What drives them? Do scientists rely on research data services? Fifty-seven interviews were conducted with researchers from the University of Strasbourg in many disciplines. The survey identifies a myriad of different data management and sharing practices. It appears that data sharing is embedded in the researcher’s strategy: his main goal is to protect his professional interests. Thus, research data are part of a credibility cycle, in which they get both use value (for new publications) and exchange value (as they are traded for other valuable resources). The survey also shows that researchers rarely use the services developed in a context of openness. Two explanations can be put forward. (1) The service offer comes too early to reach researchers’ needs. Currently, data management and sharing are not within researchers’ priorities. The priority is publishing, which is defined as source of reward and recognition of the scientific activities. (2) Data management services are offered by actors outside the research communities. But scientists seem to be more influenced by internal networks, close to their research topics (like journals, infrastructures…). These results prompt us to reconsider the mediation between scientific communities and open research data policies
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Fischer, Manfred M., and Martin Reismann. "A methodology for neural spatial interaction modeling." Wiley-Blackwell, 2002. http://epub.wu.ac.at/5491/1/NeuralSpaital.pdf.
Full textAbstract:
This paper attempts to develop a mathematically rigid and unified framework for
neural spatial interaction modeling. Families of classical neural network models, but
also less classical ones such as product unit neural network ones are considered for the
cases of unconstrained and singly constrained spatial interaction flows. Current
practice appears to suffer from least squares and normality assumptions that ignore the
true integer nature of the flows and approximate a discrete-valued process by an
almost certainly misrepresentative continuous distribution. To overcome this deficiency
we suggest a more suitable estimation approach, maximum likelihood estimation under
more realistic distributional assumptions of Poisson processes, and utilize a global
search procedure, called Alopex, to solve the maximum likelihood estimation problem.
To identify the transition from underfitting to overfitting we split the data into training,
internal validation and test sets. The bootstrapping pairs approach with replacement is
adopted to combine the purity of data splitting with the power of a resampling
procedure to overcome the generally neglected issue of fixed data splitting and the
problem of scarce data. In addition, the approach has power to provide a better
statistical picture of the prediction variability, Finally, a benchmark comparison
against the classical gravity models illustrates the superiority of both, the
unconstrained and the origin constrained neural network model versions in terms of
generalization performance measured by Kullback and Leibler's information criterion.
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Glais, Estelle. "Le contrôle français des opérateurs économiques : Pour un meilleur équilibre entre le renforcement de l’action publique et le respect des droits fondamentaux." Thesis, Rennes 1, 2018. http://www.theses.fr/2018REN1G011.
Full textAbstract:
Les méthodes et pouvoirs confiés aux administrations françaises de contrôle économique (DGCCRF et Autorité de la Concurrence) ont considérablement évolué depuis le début des années 2000. Sous de nombreux aspects, ces nouvelles prérogatives confiées aux autorités de contrôle suscitent des inquiétudes, alors que les sanctions financières infligées aux opérateurs économiques, en augmentation sensible et régulière, atteignent des niveaux sans précédent. Le fait est qu'en cherchant à rendre plus rapide et efficace l'action de contrôle et de régulation de ces administrations, le législateur a notamment accepté de leur accorder une plus grande autonomie, en particulier vis à vis des juges, dans l'interprétation des textes (eux-mêmes de plus en plus complexes) comme dans le prononcé des sanctions. Le transfert d'une part importante des dispositions des codes de commerce et de la consommation, d'un régime civil ou pénal, vers un régime purement administratif, constitue une illustration révélatrice de ce phénomène. Il en résulte une concentration de plus en plus marquée des pouvoirs d'instruction, de poursuite et de sanction entre les mains des autorités de contrôle. Cette réalité pose la question du respect, par les autorités et leurs agents, des droits fondamentaux reconnus depuis 1992 aux personnes morales, notamment du droit à un procès équitable (article 6.1 de la Convention EDH). L'objectif de cette thèse est ainsi de déterminer, après avoir dressé un état des lieux des garanties essentielles octroyées aux opérateurs économiques (personnes physiques ou morales), dans quelles mesures certains pouvoirs et procédures confiés aux autorités de régulation peuvent poser des difficultés au regard de ces droits fondamentaux. Des solutions sont alors proposées dans le but de favoriser un meilleur équilibre entre le renforcement de l'action publique et le respect des droits des opérateurs. Ces propositions sont notamment structurées en deux catégories principales: Tout d'abord les propositions de portée générale, prérequis visant à renforcer, " en amont ", la sécurité juridique des opérateurs ; Ensuite, les propositions spécifiques à chacune des procédures de l'Autorité de la Concurrence ou de la DGCCRF susceptibles de poser problèmes<br>The powers and enforcement methods used by the french economic control authorities constantly changed since the beginning of the 00s. In many aspects, these new prerogatives and approach have raised concern, as the amount of sanctions imposed to the operators exploded. One of the problems relies in the fact that, willing to foster a quicker and more effective public action, the legislator accepted to give more autonomy to the authorities, especially vis a vis the courts and judges. Thus facilitating the concentration of powers in the sole hands of the control authorities, which in many branches of economical regulation, are now able both to prosecute and impose penalties. However, since 1992, a growing array of fundamental rights have been attributed to the economic operators as legal persons, especially the right to have a fair trial, and to have access to legal recourse. The aim of our research, is to determine how the equilibrium between the law enforcement and the respect of this fundamental rights could be improved. After analysing the different hard spots in the procedures of the french authorities regarding fundamental rights, several solutions are proposed, classified in two categories: Upstream, the measures that could be taken to improve the legal security of economic operators in France ; The more targeted measures to be taken regarding the major hard spots in the authorities powers and procedures
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PIRIU, ANDREEA ALEXANDRA. "ESSAYS ON GLOBALISATION: EFFECTS AND IMPLICATIONS FOR INDIVIDUALS." Doctoral thesis, Università degli Studi di Milano, 2020. http://hdl.handle.net/2434/728739.
Full textAbstract:
This thesis studies the effects of import competition from China and Eastern Europe
on the health and fertility decisions of German individuals working in manufacturing.
Individuals are matched with separate measures of exposure to competition from China
and Eastern Europe, respectively. To isolate exogenous supply shocks from the origin,
instrumental variables for competition from each of China and Eastern Europe are constructed.
Results in Chapter 1 suggest that higher import competition worsens individual health via
job displacement, wage decline, shortened employment duration, increased reliance on
welfare and less future orientation, with Chinese import competition affecting individuals
twice as much. Health declines as individuals increase their visits to the doctor, exercise
less frequently and have a higher probability of developing chronic illness. Also, there is
some evidence that individuals do not tend to become disabled but may be slowly pushed
into chronic illness.
Findings in Chapter 2 show that import competition negatively affects the individual’s
probability of having children via reduced earnings, lower satisfaction with personal
income and shortened employment duration. The chapter then investigates effects of
import exposure by gender. Results show that male and female fertility choices differ
upon rising import competition. Higher import exposure lowers female earnings and
job autonomy, which in turn generates a lower opportunity cost of work, to the point
where having children would become a more rewarding alternative for female workers.
By contrast, increased import exposure negatively affects male workers’ fertility through
reduced earnings and employment duration.
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AlSagob, Eman I. "Non-traumatic dental visits to hospital-based emergency departments Rhode Island." Thesis, 2017. https://hdl.handle.net/2144/26203.
Full textAbstract:
OBJECTIVES: (1) to investigate trends in non-traumatic dental visits (NTDV) to hospital-based emergency departments (ED) in Rhode Island (RI) and to compare them with those for other ambulatory sensitive care conditions (ACSC); (2) to examine the effect of expansion of Medicaid coverage on the rate NTDV to ED; (3) and to examine community-level factors associated with NTDVs.
METHODS: Data for ED visits in 2005–2014 were obtained from RI hospital discharge data and annual population estimates from the U.S.Census Bureau, and were used to calculate annual visit rates. Medicaid enrollment report for the calendar years 2013 and 2014 were used to calculate monthly enrollment and an interrupted time series analysis was used to examine the effect of expansion of Medicaid coverage on visit rates. Zip code was used as a unit of analysis for community-level factor analysis, 2010 data. A negative binomial regression model with log link was performed.
RESULTS: From January 2005 to December 2014, the annual average number of ED NTDV was 7440, accounting for 1.4–2.1% of all ED visits each year, there was a slight but not statistically significant decrease in the NTDV rate between 2005 and 2014. Visits for asthma also declined slightly, but the decrease was statistically significant. There were statistically significant increases in ED visit rates for diabetes and back pain. The NTDV rate increased by 34.8/100,000 enrollees per month immediately and significantly after expansion, amounting to more than 1000 additional ED visits. ED visits for asthma and back pain declined immediately after the expansion of coverage, but not significantly so. Community-level factors associated with NTDVs were higher level of poverty and communities with younger population (more individuals aged 20–34 years) which had significantly higher ED NTDV rates.
CONCLUSION: RI NTDVs slightly declined, but still accounts for around 1.6% of ED visits. Medicaid expansion under the ACA, caused an immediate increase in NTDVs to ED, that might be attributed to the increased number of Medicaid enrollees, with no change in the workforce. Among community-level factors, high poverty level and high percent of young population had the highest impact on visit rates.<br>2019-09-26T00:00:00Z
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Ali, Shameen. "A study of visitor satisfaction in tourism enterprises." Thesis, 2012. http://researchonline.federation.edu.au/vital/access/HandleResolver/1959.17/57293.
Full textAbstract:
Satisfying customers is fundamental to the marketing concept and has long been recognised as important, firstly in the economic discipline and subsequently in marketing and in business generally. In a competitive marketplace customer satisfaction is closely linked to the ability of the organisation to deliver quality. Therefore, organisations rely on the feedback received from customers about how satisfied or dissatisfied they are with product and service provision and their perceptions of the value received. The study examines the various product and service attributes that contribute to visitor satisfaction and experience, and evaluates the role of price-value perceptions and behavioural intentions. This examination was undertaken by the study of three tourism enterprises operating in the heritage tourism area. These included Sovereign Hill, which is an historic goldfields township; Brambuk, which is an indigenous cultural centre located in the Grampians in Western Victoria; and Werribee Mansion, which depicts the life of a wealthy farming family in the early periods in Victoria. This study has provided insight into the understanding of visitor satisfaction in tourism enterprises by evaluating the relationship between overall satisfaction and dissatisfaction and how these influence revisit and recommending behaviour, as well as the influence of price-value perceptions on satisfaction, experience and enjoyment. The study shows that price-value dissatisfaction impacts negatively on the willingness of visitors to recommend a tourism venue to others and that price dissatisfaction tends to impact negatively on satisfaction. The results provide some insight into what contributes to tourist satisfaction, enjoyment and experience. The findings are expected to assist strategic and operational managers in their quest for continued quality enhancement and the provision and renewal of tourism products and services. It is expected that the findings will provide some guidance to managers, tourism operators, marketers and researchers alike in developing well informed data and analyses that are the key to strategic and competitive advantage.<br>Doctor of Business Adminstration
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Chien-Chang, Huang, and 黃建彰. "Museum visit access design：case study of the National Palace Museum display space." Thesis, 2007. http://ndltd.ncl.edu.tw/handle/36006626866172194740.
Full textAbstract:
碩士<br>國立臺灣師範大學<br>美術學系在職進修碩士班<br>95<br>This study investigated the influences on visit access design in terms of visitor behavior, museum display space and access-affecting exhibition design through literature review to understand factors affecting visit access design and case study with survey and site observation to assess the influences on the design of visit access in the display spaces of the case.
Results indicated that 56.5% of visitors were lost in the visit; the difference between visitor attribute and characteristics and visit access is insignificant; the values of influence in ascending order in the regressive analysis of display design elements are “showroom and floor layout correlations”, “production and placement of access signs”, “lighting design and layout”, and “location of text description”; where the “coordination between guiding vision and special display contents” and visit access satisfaction are negatively correlated. The possible reason for this construct is that most visitors visit a show randomly, though this visitor behavior is correlated with the museum’s spatial arrangement. Also, the influence of “DM” (tour map) and “monument/artwork placement and display manner” on visit access is insignificant.
This study primarily investigated the suitability of the design elements of display spaces in museums in terms of visit access design and planning, hoping to provide a reference for display space planners of museums and so to ensure both designers and visitors can enjoy a successful and effective exhibition.
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LO, KAI-WEN, and 羅凱玟. "A Study of Museum Access Programs for Visitors with Dementia." Thesis, 2015. http://ndltd.ncl.edu.tw/handle/43839212024614447656.
Full textAbstract:
碩士<br>國立臺南藝術大學<br>博物館學與古物維護研究所<br>103<br>Museums are social educational institutions that promote public welfare and also the places for storing memorial objects. To cope with problems stemming from population aging and increasing prevalence of dementia, many foreign museums have launched access programs for visitors with dementia. Utilizing collections and rich educational resources, these museums work with professional organizations in providing services such as reminiscence therapy, art tour, and social interactions to visitors with dementia and their care partners.
This study first reviewed related literature to investigate the implementation methods, strategies, and characteristics of museum access programs in United States and United Kingdom. Later, using “Meet Me at MoMA”, an access program created by Museum of Modern Art in New York, and “A Tour of Taiwan History” launched by National Museum of Taiwan History for patients with Alzheimer's disease as examples, this study analyzed the implementation methods, required supportive systems, current implementation statuses, problems encountered, and effectiveness of these two programs. Besides, the opinions of directors of these programs and related professional organizations were collected through interview. This study attempted to integrate domestic and foreign experiences and provide substantive suggestions to museums.
Results showed that museums can make use of their spatial characteristics, diverse collections, and interpretive media to develop access programs for visitors with dementia. The access programs will have positive effects on the living quality and emotions of visitors with dementia and their care partners. For museums, developing substantive support policies, implementing professional training, integrating internal resources, and seeking external cooperation are keys to developing this kind of activities. When designing activities for elderly patients and patients with dementia, they should take into account the fitness of participants and develop diverse and inclusive courses. In the present, local museums do not have as abundant internal and external resources as foreign museums. Therefore, developing a resource sharing mechanism and promoting cross-department cooperation may be the directions for the authority concerned when providing assistance to museums.
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Bosch, Steve, Scott Cossel, Yan Han, Jim Martin, and Atifa Rawan. "Direction and Vision for the Delivery of and Access to Information Resources." 2006. http://hdl.handle.net/10150/337105.
Full textAbstract:
Poster presentation from the Living the Future 6 Conference, April 5-8, 2006, University of Arizona Libraries, Tucson, AZ.<br>This session will focus on how strategic directions are established for the University of Arizona Libraries in order to satisfy customers information resource needs in a timely, efficient, and transparent fashion. We will discuss how the Library develops cost-effective solutions meetings customers' needs for access to information.
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Kaldenberg, Jennifer Marie. "Stakeholder-driven approach to optimizing access to low vision rehabilitation services in Massachusetts." Thesis, 2018. https://hdl.handle.net/2144/30704.
Full textAbstract:
BACKGROUND: Visual impairment impacts over 15% of Americans over the age of 65, roughly 7.3 million people. Currently there is no statewide model for low vision rehabilitation services that serves individuals across the visual impairment continuum. This dissertation sought to examine the existing eye care service delivery models, identify best practices, and explore perceived barriers and facilitators to access low vision rehabilitation services for older adults in order to inform the development of a revised service delivery model. The model will guide practice and policy change for existing and future services.
METHODS: A mixed methods convergent approach was used to achieve the study’s overarching objectives. First, quantitative data from a synthetic estimation, was used to categorize high and low resource communities, which informed the purposeful sampling of focus groups and provided essential data to guide model development. Next, focus groups and one-on-one key stakeholder interviews were held to understand stakeholder perspectives on access to low vision rehabilitation services in both high and low resource communities. Further, one-on-one interviews with focus group participants provided additional quantitative data on individual prioritized barriers. Taken together, qualitative and quantitative research was conducted concurrently and then merged and expanded to inform a low vision rehabilitation focused care delivery model grounded in the Institute for Health Improvement’s Chronic Care Model.
RESULTS: Key findings indicate the need for a model of service delivery that provides the full continuum of care, beginning with a low vision eye exam, which is coordinated throughout the community and health systems and addresses the chronic nature of visual impairment. Care should be client-centered and provided when the client is ready to accept services. Lastly, ongoing education to health care providers, consumers, and society will facilitate productive interactions and positive health outcomes.
CONCLUSION: The stakeholder-driven low vision rehabilitation focused care delivery model grounded in the Chronic Care Model will provide a structure for service delivery throughout the state. This collaboration with community and health systems, as well as case management, will assist with program sustainability and reach to all adults throughout the state living with VI.<br>2020-06-30T00:00:00Z
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Marques, Ana Patrícia Rego da Silva Santos. "Essays on the impact of vision impairment in Portugal." Doctoral thesis, 2019. http://hdl.handle.net/10362/75022.
Full textAbstract:
SUMMARY - Background: Visual impairment is a major public health problem as it affects 252. 2 million persons worldwide. In 2015 36 million people were blind and 216.6 million people had moderate to severe visual impairment. With the aging population, the number of people with VI will increase dramatically, leading to a much heavier disease and economic burden in the coming future.
Purpose: The purpose of thesis was to investigate and characterize the impact of vision impairment in selected aspects of the healthcare system and the society. To accomplish this purpose five research papers were developed. Three papers are considered the main studies and investigated: 1) The access to a new anti-VEGF treatment for retinal diseases; 2) The use of informal care and its determinants in persons with vision impairment; 3) Productivity losses in persons with vision impairment and its predictors. In addition, two complementary studies were conducted to: 4) Investigate patient-reported outcome measures using a condition-specific instrument (activity inventory) and a generic health-utilities instrument (EQ5D); 5) Investigate the profile of the participants in the face-to-face interviews that were conducted as part of the main studies.
Methods: Two different data sources were used to perform the investigations reported in the research papers. A national database of inpatient and day cases episodes was used to investigate access to anti – VEGF treatments. Data from the Prevalence and Costs of Visual Impairment in Portugal: a Hospital Based Study (PCVIP-study) were used to investigate informal care, productivity losses, to characterize patient-reported outcome measures and to investigate the profile of the participants. Different strategies were used to select our participants/cases and to collect information.
Descriptive statistics was used to summarize socio-demographic and clinical characteristics of the participants. Chi-square tests were used to compare the composition of groups. T-tests were used to compare normally distribute variables and the Mann-Whitney–test or Kruskal-Wallis were used for other non-parametric comparisons between groups. Spearman Correlation was used to determine the association between variables. Generalised linear modelling was used to investigate determinants of the geographical diffusion of anti-VEGF. Logistic regression was used to determine explanatory factors associated with the use of informal care and to determine explanatory factors of productivity losses. Linear regression was used to determine factors associated with the amount of informal care.
Results: The diffusion and consequently the access to new eye care treatment was found to be large but unequally distributed and associated with availability of healthcare delivery services. The reduced number of treatments found in some counties is worrisome since it can lead to an increased number of people becoming visually impaired due to treatable causes. We also found that vision impairment in Portugal has substantial socioeconomic implication since it affects individual’s autonomy levels that are associated with an intensive use of informal care. It also affects individual’s participation in society, namely employment status and health related quality of life that led to significant productivity losses.
Conclusion: Vision impairment in Portugal has a wide ranging impact. Many of the causes of vision loss could be reversible and preventable with currently available healthcare technology. Eye care has a range of proved, low risk, high success and cost effective health interventions so the key element is to guarantee that these interventions are available and reaches all the persons that can benefit from it.<br>RESUMO - Enquadramento: A deficiência visual é um importante problema de saúde pública que afeta 252,2 milhões de pessoas no mundo. Em 2015 existiam globalmente 36 milhões de pessoas cegas e 216,6 milhões de pessoas com deficiência visual severa a moderada. Dado o envelhecimento da população estima-se que o número de pessoas com deficiência visual irá aumentar dramaticamente provocando uma maior carga de doença e um maior impacto económico no futuro.
Objetivos: Com a realização desta tese pretendeu-se investigar e caracterizar o impacto da deficiência visual em aspetos selecionados do sistema de saúde e da sociedade. Para alcançar este objetivo foram desenvolvidos cinco artigos de investigação. Considerou-se que três artigos constituíam a componente principal do trabalho realizado investigando: 1) O acesso de doentes com doenças da retina a um novo tratamento com anti-VEGF; 2) A utilização de cuidados informais em pessoas com deficiência visual e os fatores associados a essa utilização; 3) Perdas de produtividade e os seus determinantes em pessoas com deficiência visual. Foram ainda desenvolvidos mais dois artigos complementares que pretendiam: 4) Investigar medidas de resultados auto-reportadas utilizando um questionário específico para a deficiência visual (activity inventory) e um questionário genérico (EQ5D);5) Investigar o perfil dos indivíduos que aceitaram participaram nas entrevistas realizadas no âmbito dos estudos apresentados nos artigos principais.
Metodologia: Foram utilizadas duas bases de dados. A base de dados nacional de morbilidade hospitalar foi utilizada para investigar o acesso a tratamentos com anti-VEGF. Dados do estudo sobre a Prevalência e custos da baixa visão em Portugal foram utilizados para os artigos referentes aos cuidados informais, perdas de produtividade, análise de medidas auto-reportadas e análise do perfil dos entrevistados. Utilizaram-se diferentes estratégias para selecionar os casos e para a recolha de informação.
Utilizou-se estatística descritiva para sintetizar a informação sociodemográfica e clínica. Utilizou-se testes de chi-quadrado para comparar a composição de grupos. Utilizou-se testes T para comparar variáveis com distribuição normal e testes não-paramétricos nomeadamente teste de Mann-Whitney e teste de Kruskal-Wallis para comparar grupos. Para analisar os determinantes associados à difusão dos tratamentos anti-VEGF recorreu-se a modelos lineares generalizados. Utilizou-se modelos de regressão logística para investigar fatores associados à utilização de cuidados informais e às perdas de produtividade. Recorreu-se a modelos de regressão linear para determinar fatores associados à intensidade de utilização de cuidados informais.
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Resultados: Verificou-se que a difusão e consequentemente o acesso a um novo tratamento ocular foi significativo, distribuído de forma desigual e associado à disponibilidade de prestadores de cuidados de saúde. O número reduzido de tratamentos encontrado em alguns concelhos é problemático na medida em que pode conduzir a um aumento do número de indivíduos com deficiência visual por causas tratáveis. Verificou-se também que a deficiência visual tem repercussões significativas a nível socioeconómico dado que afeta o nível de autonomia dos indivíduos que está por sua vez associado à necessidade de cuidados informais. Afeta também a participação dos indivíduos na sociedade, afetando, a situação no mercado de trabalho e a qualidade de vida produzindo perdas de produtividades avultadas.
Conclusão: A deficiência visual em Portugal produz um impacto diverso e significativo. Muitas das causas de perda de visão podem ser preveníeis ou tratadas através da tecnologia existente. Os cuidados de saúde oculares dispõem de um conjunto de intervenções de saúde baseadas na evidência, custo-efetivas e de baixo risco pelo que a medida mais importante a tomar é a de garantir que estas intervenções estão disponíveis e alcançam todas as pessoas que delas podem beneficiar.
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Jones, Burton S. "Crafting and implementing a school vision for all students : how access to resources and participation in the comprehensive school reform demonstration program helps schools that enroll limited English proficient students /." 2001. http://www.library.wisc.edu/databases/connect/dissertations.html.
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Wang, Jai-Peng, and 王嘉鵬. "A Study on Taipei Citizens’ Willingness to Accept 3G Mobile Phone─Using Life Styles as Consumer Segmentations and Visitors to the 2000 Taipei Communication Exhibits as Samples." Thesis, 2001. http://ndltd.ncl.edu.tw/handle/87374433650962591309.
Full textAbstract:
碩士<br>國立交通大學<br>經營管理研究所<br>89<br>The two fast developing industries, mobile communication and the internet, will converge in the 21st century. It is already a reality that user is able to surf the internet or view their emails and messages directly through their mobile devices, and the 3G mobile phone will soon fulfill the dream of "Internet in the pocket".
The purpose of this paper, while using Roger''s Innovation Adoption Theory as its frame, is to identify the acceptance of the 3G mobile phone based on consumers'' preference and their demand for broad band. In addition, we try to find out whether the mobile phone consumers can be segregated by their life style so as to identify target consumer groups and to provide our research results to the industry to formulate their marketing strategies.
The samples we used for this study are the attendants of the 2000 Taipei Communication Exhibits. From the samples we discovered that potential users can be effectively segregated by life style and Group 2 and 4 have the highest acceptance rate, though difference do exist in terms of marketing, servicing, brand, appearance and expendability. In order to target these potential customers, different marketing strategies are required. About 70% of the sample attendants who has heard of 3G mobile phone have expressed that the new generation mobile phone can provide multifunctional services when compared to WAP and GPRS phones. Primary sources of such 3G mobile phone information comes from TV, newspapers and magazines, the rest are from internet and telecommunication industry. Majority of the sample attendants showed strong interests in this new generation mobile phone and have expressed their intention to purchase the phone within a 6 to 12 month period. Between those who accept the 3G mobile phone and those who don''t, there is a clear variance on the convenience, the expandability and the appearance.