<p>SAMMANFATTNING</p><p>Vårdpersonal möter patienter med självskadebeteende på olika avdelningar inom sjukvården. Vårdpersonalen har ofta svårt att bemöta denne patientgrupp eftersom de trots allt vårdar patienterna efter bästa förmåga ändå skadar sig igen. Detta väcker frustration och negativa känslor som vrede och mindre sympati för dessa patienter. Oftast är det unga kvinnor som lindrar sin ångest med att skada sig själva medan unga män oftare väljer att vara våldsamma eller aggressiva. Syftet med studien var att belysa vårdpersonalens uppfattning och bemötande av patienter med självskadebeteende. Metoden är en artikelgranskning. Resultatet visade att det är viktigt att vårdpersonal ser, förstår och bemöter patienterna med respekt för att de skall få ett bättre självförtroende. Varje person är unik och en egen individ. Det är därför viktigt att se bakom självskadande för att se till varje persons behov och förstå att det oftast är andra problem som ligger bakom självskadandet. Vårdpersonal med utbildning till att vårda patienter med självskadebeteende är bättre på att ta hand om dessa patienter än personal utan utbildning.</p><p>Mera kunskap och utbildning om självskadandet skulle hjälpa personal till att upptäcka problemet tidigare. Vården skulle då bli bättre och kanske kortare för patienter med självskadebeteende.</p>

善因行銷之行銷聯盟在台可行否？ 發展一種模式以辨識必要之行銷和環境因素 / Cause-related marketing (CRM) alliances offer businesses and not-for-profit organizations (NPOs) a unique partnership opportunity to reach corporate and philanthropic goals. Since its inception in 1981 in the United States, CRM alliances have grown in popularity as a way for companies to increase sales and market share, open new market segments, build employee morale, differentiate their products and create brand image. For NPOs, the alliances have provided new ways to raise funds, reach out to new potential donors, increase awareness of the cause, and mobilize the public. While CRM alliances have been for the most part successful in the West, there is little in the way of research into the underlying factors that allow this success. For example, are there certain consumer markets that are more likely to respond positively to CRM? Are there environmental factors that encourage businesses and NPOs to partner, and that may not be present in every industry or country or do the characteristics of organizations themselves set the stage for partnership? These are the types of questions this paper address. By examining the factors that are shared across successful CRM alliances in the West, a new model is created that outlines the factors that are necessary to foster CRM within a national market. After introducing this model, we apply it to the case of Taiwan to determine if CRM is likely to succeed in the long-term on the island. We discover that business plays a strong role in driving the CRM movement in Taiwan, while NPOs and external forces play only a moderate role. Consumers, the government and outside facilitators, the other components of the CRM model, play a relatively weak role in bringing CRM alliances to the island, and therefore are the greatest challenges to CRM’s sustainability in the area. We also discover that the model needs to be modified to fit Taiwan’s unique environment. In the conclusion, future areas of research are discussed as well as recommendations and implications for the future of CRM alliances in Taiwan.

Introduction: Medication errors are a major cause of illness and hospitalization of patients throughout the world. This study examines the situation regarding medication errors in the Armed Forces Hospital, Kuwait since no literature exists of any such studies for this country. Several types of potential errors were studied by physicians, nurses and pharmacists. Their attitudes to the commission of errors and possible consequences were surveyed using questionnaires. Additionally, patient medical records were reviewed for possible errors arising from such actions such as the co-administration of interacting drugs. Methods: This study included direct observations of physicians during the prescribing process, pharmacists while they dispensed medications and nurses as they distributed and administered drugs to patients. Data were collected and compiled on Microsoft Excel spreadsheet and analyses were performed using SPSS. Where applicable, results were reported as counts and/ or percentages of error rates. Nurses, pharmacists and physicians survey questionnaires: From the 200 staff sent questionnaires a total of 149 respondents comprising nurses (52.3%), physicians (32.2%) and pharmacists (16.1%) returned the questionnaires a total response rate of 74.5%. All responses were analyzed and compared item-by-item to see if there were any significant differences between the three groups for each questionnaire item. All three groups were most in agreement about their perception of hospital administration as making patient safety a top priority with regard to communicating with staff and taking action when medication errors were reported (all means 3.0 and p > 0.05). Pharmacists were most assured of administration support when an error was reported whereas nurses were least likely to see the administration as being supportive ( p < 0.001), and were more afraid of the negative consequences associated with reporting of medication errors (p = 0.026). Although nurses were generally less likely to perceive themselves as being able to communicate freely regarding reporting of errors compared to pharmacists there was no significant difference between the two groups. Both however were significantly different from physicians (p< 0.001). Physicians had the most favorable response to perceiving new technology as helping to create a safer environment for patients and to the full utilization of such technologies within the institution in order to help prevent medical errors. Scenario response - Responses to two scenarios outlining possible consequences, should a staff member commit a medication error, tended to be very similar among the three groups and followed the same general trend in which the later the error was discovered and the more grievous the patient harm, the more severe would be the consequences to the staff member. Interestingly, physicians saw themselves as less likely to suffer consequences and nurses saw themselves as more likely to suffer consequences should they have committed a medication error. All three groups were more likely to see themselves as facing dismissal from their job if the patient were to die. RESULTS OF ALL THREE OBSERVATIONS: Result of Nursing observations: For 1124 doses studied, 194 resulted in some form of error. The error rate was 17.2% and the accuracy was 82.8%. The commonest errors in a descending order were: wrong time, wrong drug, omission, wrong strength/ dose, wrong route, wrong instruction and wrong technique. No wrong drug form was actually administered in the observational period. These were the total number of errors observed for the entire month period of the study. IV Result of Pharmacist observations: A total of 2472 doses were observed during the one month period. Observations were done for 3 hours per day each day that the study was carried out. The study showed that there were 118 errors detected which were in the following categories respectively: 52 no instructions, 28 wrong drug/unordered, 21 wrong strength/dose, ignored/omission 13, shortage of medication 3 and expired date 1. Result of Prescribers in Chart review for drug-drug interactions: The analysis of the drug-drug interactions showed that out of a total of 1000 prescriptions, 124 had drug-drug interactions. None were found to fall into the highest severity rating i.e. 4 (contraindicated). Only twenty-one interactions were rated 3 (major), 87 interactions were rated moderate and 15 interactions were rated minor according the modified Micromedex scale. Patient education: All health care such as physician, pharmacist, and nurses have a responsibility to educate patient about their medication use and their health conditions to protecting them from any error can occur by wrong using drugs. Conclusion This study has contributed to the field of medication errors by providing data for a Middle Eastern country for the very first time. The views and opinions of the nurses, pharmacists and physicians should be considered to enhance the systems to minimize any errors in the future.

Corporate citizenship is a debatable topic, according to many authors corporate citizenship is equivalent to corporate governance, corporate social responsibility and business ethics. Therefore, we have explained all the four theories in order to equip our reader with the subject in concern. This topic is of growing concern taking the evolutions of the subject, the previous and ongoing scandals into consideration.   The paper will present an overview of the concept of Corporate Citizenship and its alliances and provides the readers with different definitions of the above mentioned concept. We explained the relation between Corporate Citizenship (CC) and Corporate Social Responsibility (CSR). We shall use both the terms CC and CRS interchangeably. After going through the literature we felt that there was not enough written about the leader’s role with regards to the ideology of Corporate Citizenship. Therefore, we took the opportunity and used these concepts to screen Steve Job the CEO of apple against the norms of corporate citizenship. Our choice of topic was also motivated by Fortune Magazine 2008-2009 edition.   We used Explorative study to fill our research gap by framing very general and broad research questions. A qualitative study was conducted with fifty (50) people from Umeå – Sweden.  Our interviewees were mostly students from university and one interview was conducted from the IT head of a public organization from Umeå Sweden.   Defying the theoretical concepts we used, we concluded that the consumers we interviewed embrace highly about the concepts of Corporate Citizenship but in practice, they did not bother to take these concepts into consideration before buying the product

It is of interest that researchers study competing risks in which subjects may fail from any one of K causes. Comparing any two competing risks with covariate effects is very important in medical studies. This thesis develops omnibus tests for comparing cause-specific hazard rates and cumulative incidence functions at specified covariate levels. In the thesis, the omnibus tests are derived under the additive risk model, that is an alternative to the proportional hazard model, with by a weighted difference of estimates of cumulative cause-specific hazard rates. Simultaneous confidence bands for the difference of two conditional cumulative incidence functions are also constructed. A simulation procedure is used to sample from the null distribution of the test process in which the graphical and numerical techniques are used to detect the significant difference in the risks. A melanoma data set is used for the purpose of illustration.

Les données statistiques compilées par l'ONU et la CEPAL nous montrent que la Colombie se classe parmi les cinq principaux pays d'immigration en l'Amérique Latine et les Caraïbes. Ce pays est aussi le premier pays d'émigration en Amérique du Sud. Le Canada est devenu depuis le début des années 1980 l'une des principales destinations des émigrants colombiens dans le monde. Le Québec est, au Canada, la deuxième province accueillant le plus grand nombre d'immigrants colombiens au pays. Ce mémoire aborde l'analyse du flux migratoire colombien vers le Québec, de 1950 à nos jours. Nous nous penchons sur cet aspect à partir de la perspective historique, dans le but d'identifier et d'analyser les causes qui ont donné origine à ce flux migratoire, et ce afin de préciser les périodes dans lesquelles il s'est déroulé et de caractériser la composition des différentes vagues migratoires. Le mémoire se divise en quatre chapitres. Le premier porte sur le bilan bibliographique sur le sujet et les trois suivants sont consacrés à chacune des trois périodes dans lesquelles nous avons divisé le laps de temps étudié. L'analyse du phénomène se déroule à la lumière de l'histoire de la Colombie durant les derniers 60 ans, afin d'identifier les facteurs qui ont contribué à stimuler l'émigration dans ce pays durant la période étudiée. Notre travail cherche à donner des réponses à une série de questions, incluant les suivantes : À quel moment s'est produite l'arrivée des premiers Colombiens au Québec? Quelle sorte de gens était ces immigrants? Le flux migratoire des Colombiens vers le Québec est-il un événement qui a sa propre dynamique ou est-il une prolongation du flux migratoire des Colombiens vers les États-Unis depuis les années 1960? Le flux migratoire colombien vers le Québec s'inscrit-il dans la dynamique du flux migratoire latino-américain vers le Canada? Quel impact a eu la législation canadienne sur l'immigration et la condition de réfugiés pour la venue des Colombiens? Cette recherche a un caractère exploratoire et elle est la première étude qui se penche sur le phénomène à partir de la perspective historique. ______________________________________________________________________________ MOTS-CLÉS DE L’AUTEUR : Flux migratoire, émigration colombienne, émigration, immigration, Colombiens au Québec, Québec, Colombie, Canada, réfugiés, réfugiés colombiens, histoire des migrations.

Quality defects are a common problem for producing companies, but causes and consequences are often unknown. The purpose of this thesis assignment is to develop a step-by-step analysis method for identifying the root causes of quality defects based on previously examined consequences. The first steps focus on customer recovery meanwhile the following steps concentrate on process recovery. The analysis method is process-orientated as the complete production and delivery process are scrutinized upstream by the combination of commonly used quality tools.   For testing the applicability of the presented method this thesis comprises a case study conducted at one company receiving complaints about quality defects. For the Case Study Company the consequences and causes of quality defects are described, analyzed and suggestions for improvement are developed.   In the investigated case, the developed method helps to identify causes and consequences of incomplete delivery, the company’s major quality problem. The upstream approach proved advantages for two reasons. First of all including the customer side guarantees that the cause analysis is limited to the relevant problems. With the help of the method the severity of consequences depending on the customers’ awareness of defects and available time can be detected. Secondly problems can be scrutinized in natural order as difficulties in production once identified can be followed step by step to the causes in a preceding step. The main causes identified in this case study are a lack of process definition and of standardization. Thus, the portrayed case suggests that regular appearances of quality defects are not a coincidence. The reasons are the underlying, possibly insufficiently defined and managed processes.   The general finding of the thesis assignment is the presented analysis method that comprises a systematic process-oriented approach designed to examine consequences and causes of quality defects. In contrast to the root cause analysis approaches found in literature each analysis step is described in detail. This makes the method easy to apply in practice. Therefore the method is a valid tool to deal with a high degree of complexity. The case study proved that it is effective and efficient to scrutinize problems with these characteristics. Under different circumstances the application of single quality tools might be sufficient and hence resource effective. Further investigation is necessary since this method has only been tested in one case study.

Klimato kaita ir jos švelninimo instrumentų įgyvendinimas yra prioritetinis visų pasaulio šalių tikslas. Šiuo metu yra taikoma daug įvairių klimato kaitos švelninimo instrumentų, skirtų atsinaujinančių energijos išteklių ir energijos efektyvumo didinimui, energijos tiekimo patikimumui ir kt., kuriuos plačiai nagrinėja daugelis pasaulio mokslininkų. Magistro baigiamojo darbo tikslas buvo apžvelgti Lietuvoje šiuo metu taikomus ekonominius klimato kaitos švelninimo instrumentus bei juos kokybiškai ir kiekybiškai įvertinti. Iškeltam tikslui pasiekti suformuluoti uždaviniai: apžvelgti moksline literatūroje nagrinėjamus pagrindinius klimato kaitos švelninimo instrumentų taikymo teorinius aspektus; išnagrinėti pagrindinius klimato kaitos švelninimo instrumentus, taikomus Lietuvoje; įvertinti klimato kaitos ekonominius instrumentus įtakojančiais šiltnamio efektą sukeliančių dujos sumažėjimą bei atsinaujinančiųjų energijos išteklių plėtrą Lietuvoje; sudarytu vertinimo modeliu atlikti klimato kaitos švelninimo instrumentų ekonominį vertinimą; remiantis atliktu vertinimu, pateikti išvadas. Darbo struktūrą nulėmė užsibrėžti darbo tikslai bei numatyti uždaviniai, kurių sprendimas pateikiamas trijose darbo dalyse. Pirmoje dalyje apžvelgti moklinėje literatūroje nagrinėjami pagrindiniai klimato kaitos švelninimo instrumentų taikymo teoriniai apsektai, tokie kaip klimato indikatoriai bei būklė pasaulyje ir Lietuvoje, Lietuvos darnios plėtros prioritetiniai rodikliai ir apžvelgtos ekonominius... [toliau žr. visą tekstą] / Climate change and implementation of its reducing instruments is underlying goal of all countries. At present there are plenty of climate change instruments being applied which are used for increasing shifting energy resources and effectiveness of energy, reliability of energy supplying etc. that are widely discussed by many scientists all over the world. The goal of Master's thesis was a review of economical instruments for reducing climate change used in Lithuania and their quantitative and qualitative evaluation. To reach the goal following tasks were set: to survey the nonfiction theoretical aspects of using main instruments for reducing climate change; analyse the main instruments for reducing climate change that are used in Lithuania; evaluate the economical instruments for reducing climate change that affect the reduction of gas causing the greenhouse effect and development of shifting energy resources in Lithuania; to make the economical evaluation of instruments for reducing climate change with the help of created evaluating model; to make conclusion refering to the evaluation. Thesis consist of three parts that were determined by stated goals and tasks. In first part are analysed the nonfiction theoretical aspects of using main instruments for reducing climate change, such as climate indicators and state in Lithuania and all over the world, underlying rates of Lithuanian regular development. Also the directives introducing economical instruments of regulating... [to full text]

The primary objective of this study was to assess the relationship between dietary patterns with diabetes and mortality risk from all-cause and cardiovascular disease while controlling for the confounding effects of fitness. The secondary objective was to examine the combined effects of dietary patterns and fitness on chronic disease and mortality risk. Participants consisted of 13,621 men and women from the Aerobics Center Longitudinal Study who completed a standardized medical examination and 3-day diet record between 1987 and 1999. Reduced rank regression was used to identify dietary patterns that were predictive of unfavorable profiles of cholesterol, white blood cell count, glucose, mean arterial pressure, HDL-cholesterol, uric acid, triglycerides, and body mass index. One primary dietary pattern emerged, which was labeled the “Unhealthy Eating Index”. This pattern was characterized by a large consumption of processed meat, red meat, white potato products, non-whole grains, added fat, and a small consumption of non-citrus fruits. After adjustment for covariates, the odds ratio for diabetes and the hazard ratio for all-cause mortality were 2.55 (95% confidence interval: 1.81-3.58) and 1.40 (1.02-1.91) in the highest quintile of the Unhealthy Eating Index when compared to the lowest quintile, respectively. After controlling for fitness, these risk estimates were reduced by 51.6% and 55.0%. The Unhealthy Eating Index was not a significant predictor of cardiovascular disease mortality before or after controlling for fitness. Examining the combined effects of dietary patterns and fitness revealed that both variables were independent predictors of diabetes (Ptrend <0.0001), while fitness (Ptrend <0.0001) but not unhealthy eating (Ptrend=0.071) significantly predicted all-cause mortality risk. These results suggest that both diet and fitness must be considered when studying disease. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2009-07-08 07:11:06.809

The collapse of Redcliffs’ cliff in the 22 February 2011 and 13 June 2011 earthquakes were the first times ever a major failure incident occurred at Redcliffs in approximately 6000 years. This master’s thesis is a multidisciplinary engineering geological investigation sought to study these particular failure incidents, focusing on collecting the data necessary to explain the cause and effect of the cliff collapsing in the event of two major earthquakes. This study provides quantitative and qualitative data about the geotechnical attributes and engineering geological nature of the sea-cut cliff located at Redcliffs. Results from surveying the geology of Redcliffs show that the exposed lithology of the cliff face is a variably jointed rock body of welded and (relatively intact) unwelded ignimbrite, a predominantly massive unit of brecciated tuff, and a covering of wind-blown loess and soil deposit (commonly found throughout Canterbury) on top of the cliff. Moreover, detailing the external component of the slope profile shows that Redcliffs’ cliff is a 40 – 80 m cliff with two intersecting (NE and SE facing) slope aspects. The (remotely) measured geometry of the cliff face comprises of multiple outstanding gradients, averaging a slope angle of ~67 degrees (post-13 June 2011), where the steepest components are ~80 degrees, whereas the gentle sloping sections are ~44 degrees. The physical structure of Redcliffs’ cliff drastically changed after each collapse, whereby seismically induced alterations to the slope geometry resulted in material deposited on the talus at the base of the cliff. Prior to the first collapse, the variance of the gradient down the slope was minimal, with the SE Face being the most variable with up to three major gradients on one cross section. However, after each major collapse, the variability increased with more parts of the cliff face having more than one major gradient that is steeper or gentler than the remainder of the slope. The estimated volume of material lost as a result of the gradient changes was 28,267 m³ in February and 11,360 m³ in June 2011. In addition, surveys of the cliff top after the failure incidents revealed the development of fissures along the cliff edge. Monitoring 10 fissures over three months indicated that fissured by the cliff edge respond to intense seismicity (generally ≥ Mw 4) by widening. Redcliffs’ cliff collapsed on two separate occasions as a result of an accumulated amount of damage of the rock masses in the cliff (caused by weathering and erosion over time), and two Mw 6.2 trigger earthquakes which shook the Redcliffs and the surrounding area at a Peak Ground Acceleration (PGA) estimated to be around 2 g. The results of the theoretical study suggests that PGA levels felt on-site during both instances of failure are the result of three major factors: source of the quake and the site affected; topographic amplification of the ground movement; the short distance between the source and the cliff for both fault ruptures; the focus of seismic energy in the direction of thrust faulting along a path that intercepts Redcliffs (and the Port Hills). Ultimately, failure on the NE and SE Faces of Redcliffs’ cliff was concluded to be global as every part of the exposed cliff face deposited a significant volume of material on the talus at the base of the cliff, with the exception of one section on the NE Face. The cliff collapses was a concurrent process that is a single (non-monotonic) event that operated as a complex series of (primarily) toppling rock falls, some sliding of blocks, and slumping of the soil mantle on top of the cliff. The first collapse had a mixture of equivalent continua slope movement of the heavily weathered / damaged surface of the cliff face, and discontinuous slope movement of the jointed inner slope (behind the heavily weathered surface); whereas the second collapse resulted in only discontinuous slope movement on account of the freshly exposed cliff face that had damage to the rock masses, in the form of old and (relatively) new discontinuous fractures, induced by earthquakes and aftershocks leading up to the point of failure.