Falls among the elderly population continue to be a growing concern in the healthcare industry and are marked by staggeringly high social and economic costs. The incidence of falls is known to increase with age, and currently the elderly population is growing at an astounding rate as baby-boomers are now entering this age group. Also, recovery following fall-related injuries decreases with increased age. These confounding factors currently make falls a very important area of research. Of the injuries typically seen in falls among the elderly, head injuries are one of the most debilitating. Death due to head trauma among the elderly is gaining national attention; head trauma is now considered the number one cause of death among elders who fall1. Among other technologies, medical helmets are often employed to protect against such injuries, but patient compliance with these helmets remains an issue. Current helmets use foams and cotton as padding, contributing to clumsy designs. Dilatent and honeycomb materials may be the future of this industry as their low weight and high efficacy per thickness make them ideal materials for thinner, lighter, less cumbersome head protection devices. This study outlines various modes of head injury and then highlights several head protection measures. The newer materials are tested using various methods to determine the most promising candidates for prototype designs. Next, three prototypes are assembled from the newer materials and compared directly based on the protection measures established. Finally, the top-performing prototype is compared against two existing medical helmets in a similar fashion. The results show that the best prototype significantly outperforms one of the existing medical helmets, and shows slight improvement over the other. These results establish the promise of these newer materials in the application of head protection devices.

E-health is an emerging field in the intersection of information systems, healthcare and business management, referring mainly to healthcare services delivered and enhanced through the use of information and communication technologies (ICT). In a broader sense, the term characterizes not only a technical development, but also a wider way of thinking, an attitude, and a commitment for a network to improve and connect provider, patients and governments. Such a network will be used to educate and inform healthcare professionals, managers and healthcare users; to stimulate innovation in care delivery and health system management; and to improve the healthcare system locally, regionally, and globally. The evaluation of e-health services in both theory and practice has proved to be important and complex. E-health evaluation will help achieve better user services utilization, justify the enormous investments of governments on delivering e-health services, and address the aspects that are hampering healthcare services from embracing the full potential of ICT towards successful e-health initiatives. The complexity of evaluation is mostly due to the challenges faced at the intersection of three areas, each well-known for its complexity; healthcare services, information systems, and evaluation methodologies. However, despite the importance of the evaluation of e-health services, literature shows that e-health evaluation is still in its infancy in terms of development and management. The aim of this research study is to develop, and assess a cross disciplinary evaluation framework for e-health services and to propose evaluation criteria for better user’s utilization and satisfaction of e-health services. The evaluation framework is criteria based, while the criteria are determined by an evaluation matrix of three elements, the evaluation rationales, the evaluation timeframes, and the evaluation stakeholders. The evaluation criteria have to be multi-dimensional as well as grounded in, or derived from, one or more specific perspectives or theories. The framework is designed to deal effectively with the challenges of e-health evaluation and overcome the limitation of existing evaluation frameworks. The cross disciplinary evaluation framework has been examined and validated by adopting an interpretive case study methodology. The chosen case study is NHS direct which is currently one of the largest e-health services in the world. The data collection process has been carried out by using three research methods; archival records, documentation analysis and semi-structured interviews. The use of multiple methods is essential to generate comparable data patterns and structures, and enhance the reliability of conclusions through data triangulation. The contribution of the research study is in bridging the gap between the theory and practice in the evaluation of e-health services by providing an efficient evaluation framework that can be applied to a wide range of e-health application and able to answer real-world concerns. The study also offers three sets of well-argued and balanced hierarchies of evaluation criteria that influence user’s utilization and satisfaction of e-health services. The evaluation criteria can be used to help achieve better user services utilization, to serve as part of e-health evaluation framework, and to address areas that require further attention in the development of future e-health initiatives.

The planning and implementation of effective water resources management strategies need an assessment of multiple (physical, environmental, and socio-economic) issues, and often requires new research in which knowledge of diverse disciplines are combined in a unified methodological and operational framework. Such integrative research to link different knowledge domains faces several practical challenges. The complexities are further compounded by multiple actors frequently with conflicting interests and multiple uncertainties about the consequences of potential management decisions. This thesis aims to overcome some of these challenges, and to demonstrate how new modeling approaches can provide successful integrative water resources research. It focuses on the development of new integrated modeling approaches which allow integration of not only physical processes but also socio-economic and environmental issues and uncertainties inherent in water resources systems. To achieve this goal, two new approaches are developed in this thesis. At first, a Bayesian network (BN)-based decision support tool is developed to conceptualize hydrological and socio-economic interaction for supporting management decisions of coupled groundwater-agricultural systems. The method demonstrates the value of combining different commonly used integrated modeling approaches. Coupled component models are applied to simulate the nonlinearity and feedbacks of strongly interacting groundwater-agricultural hydrosystems. Afterwards, a BN is used to integrate the coupled component model results with empirical knowledge and stakeholder inputs. In the second part of this thesis, a fuzzy-stochastic multiple criteria decision analysis tool is developed to systematically quantify both probabilistic and fuzzy uncertainties associated with complex hydrosystems management. It integrates physical process-based models, fuzzy logic, expert involvement and stochastic simulation within a general framework. Subsequently, the proposed new approaches are applied to a water-scarce coastal arid region water management problem in northern Oman, where saltwater intrusion into a coastal aquifer due to excessive groundwater extraction for irrigated agriculture has affected the aquifer sustainability, endangering associated socio-economic conditions as well as traditional social structures. The results show the effectiveness of the proposed methods. The first method can aid in the impact assessment of alternative management interventions on sustainability of aquifer systems while accounting for economic (agriculture) and societal interests (employment in agricultural sector) in the study area. Results from the second method have provided key decision alternatives which can serve as a platform for negotiation and further exploration. In addition, this approach suits to systematically quantify both probabilistic and fuzzy uncertainties associated with the decision problem. The new approaches can be applied to address the complexities and uncertainties inherent in water resource systems to support management decisions, while serving as a platform for stakeholder participation.

Supplier selection plays an important role in any organisation. This study investigates and examines supplier selection criteria and the impacts on buying firm performance; specifically focusing on the telecommunications industry in Malaysia. Previous studies in this area have focussed on the criteria such as quality, price, delivery, supplier relationship management and decision making tools and techniques. However, little research has been undertaken to include government policies and business ethics as elements in the supplier selection criteria. After a literature review and interviews, the development of conceptual frameworks and a number of hypotheses were put forward. To achieve an in-depth study, four major telecommunications service provider companies in Malaysia were chosen as a case study. A questionnaire was used as the main instrument in gathering data. The questionnaire is principally concerned with the understanding of supplier selection and its criteria; based upon the variables that are used for the model and hypothesis testing. The study also investigates the relationship between supplier selection and the impact of supplier selection to the company performance. This model was tested using Structural Equation Modelling (SEM) technique with the AMOS software application. Results indicated all of the criteria include quality, price, delivery, supplier relationship management, decision making tools and techniques, government policy and business ethics as valid constructs. A good model fit was also established. The findings of this research conclude that the influencing criteria to supplier selection in the telecommunications industry in Malaysia are supplier delivery performance standards and supplier relationship management even when considering the remainder of the above mentioned elements.The price factors were found to be less important due to this factor possibly leading to unhealthy competition in the market in terms of price wars among the suppliers in order to win the business. Most of the criteria are also interrelated to each other and affect the supplier selection decision. This model has added new perspectives to the study of supplier selection in the supply chain management field. As for future research it is suggested that intangible elements such as political, cultural and social influences are included in the conceptual framework; as this would offer important insight for management bodies in organisation, academia and public policy fields alike.

Geographic Information System (GIS) technologies and remote sensing (RS) technologies have developed rapidly in recent years, and they have been widely used indaily life of ordinary people. The combination of these two remarkable technologies isuseful for location decision making and has been applied in different kinds of study cases.Guangyuan is one of the fastest developing cities in the southwest of China. Especiallyafter the Wenchuan earthquake in 2008, the development in economic and urbanreconstruction increased rapidly. Many infrastructure constructions and the reformprojects are in progress. At the same time, China's urban sewage treatment facilities areseriously inadequate. Only a small percentage of sewage has been treated by sewagetreatment plants in China. So the purpose of this study is to select an optimal site for asewage treatment plant in Guangyuan in a scientific way.In this particular study, based on GIS software and GIS-based multi-criteria analysis(MCA), a decision making model has been built for optimal site selection for a sewagetreatment plant. Two types of data were used in this study. Digital elevation model andsatellite image, several factor maps and constraint maps were created for the final analysis.The analytic hierarchy process was used to apply the weights for each factor along withformula method, in order to get the best result and find the optimal site. Finally, a MCAmodel has been made to be an example for future similar studies.In the end, an optimal site has been selected. Although aims are achieved in this study,there are still some limitations in different perspectives of the study. In the future, moreprecise data can be used in MCA studies, data limitations could be reduced with thedevelopment of RS techniques. In the future, more similar studies will be finished, whichmeans more scientific papers can provide reliable references of determining the criteriaand weights.

The National Institute of Mental Health’s (NIMH) Research Domain Criteria (RDoC; Insel et al., 2010; Sanislow et al., 2010) were established in an effort to explore underlying dimensions that cut across many existing disorders as well as to provide an alternative to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5; APA, 2013). The present dissertation aimed to study one major component of the RDoC model, negative valence, as compared to other models hypothesized to be closely related, as well as its relationship to a key component of psychopathology, affective instability. Participants were adult community residents (N=90) currently in mental health treatment. Participants received self-report measures of RDoC negative valence, five-factor model (FFM) neuroticism, and DSM-5 Section 3 negative affectivity, along with measures of affective instability, borderline personality disorder, and social-occupational impairment. Through this investigation, a better understanding and potential expansion of this new model of diagnosis for clinicians and researchers is provided. In particular, it is suggested that RDoC negative valence is commensurate with FFM neuroticism and DSM-5 negative affectivity, and it would be beneficial if it was expanded to include affective instability.

Distributed rainfall runoff hydrologic models can be highly effective in improving flood forecasting capabilities at ungauged, interior locations of the watershed. However, their implementation in operational decision-making is hindered by the high dimensionality of the state-parameter space and by lack of methods/understanding on how to properly exploit and incorporate available spatio-temporal information about the system. This dissertation is composed of a sequence of five studies, whose overall goal is to improve understanding on problems relating to parameter identifiability in distributed models and to develop methodologies for their calibration.The first study proposes and investigates an approach for calibrating catchment scale distributed rainfall-runoff models using conventionally available data. The process, called regularization, uses spatial information about soils and land-use that is embedded in prior parameter estimates (Koren et al. 2000) and knowledge of watershed characteristics, to constrain and reduce the dimensionality of the feasible parameter space.The methodology is further extended in the second and third studies to improve extraction of `hydrologically relevant' information from the observed streamflow hydrograph. Hydrological relevance is provided by using signature measures (Yilmaz et al 2008) that correspond to major watershed functions. While the second study applies a manual selection procedure to constrain parameter sets from the subset of post calibrated solutions, the third develops an automatic procedure based on a penalty function optimization approach.The fourth paper investigates the relative impact of using the commonly used multiplier approach to distributed model calibration, in comparison with other spatial regularization strategies and also includes investigations on whether calibration to data at the catchment outlet can provide improved performance at interior locations. The model calibration study conducted for three mid sized catchments in the US led to the important finding that basin outlet hydrographs might not generally contain information regarding spatial variability of the parameters, and that calibration of the overall mean of the spatially distributed parameter fields may be sufficient for flow forecasting at the outlet. This then was the motivation for the fifth paper which investigates to what degree the spatial characteristics of parameter and rainfall fields can be observable in catchment outlet hydrographs.

Due to confirming characteristics, events can be considered to be specification of projects. Large events are particularly described by their complexity and the many stakeholders involved. Because of these characteristics, the achievement as well as the evaluation of project success are extremely difficult. This is aggravated by the diverse perspectives on success by the many different stakeholders involved. A key stakeholders in large events are destination management/ marketing organization (DMO) of the host community. Rationale is the tremendous impact events have on the destination. Particularly, the enhanced tourism development, the increase of tourist arrivals as well as the improvement of the destination’s image and brand awareness can be highlighted. By marketing a destination to potential tourists, establishing a destination’s image and managing an increasing international attention, DMOs play a primary role in handling these major impacts. Nevertheless, managing the major impacts as well as leveraging them into sustainable benefits for the host destination is extremely difficult. Like any other stakeholder, DMOs have certain expectations for large evens and may determine success based on whether these expectations were met. Identifying certain success criteria allows the stakeholders involved to evaluate whether a project was successful and whether it met ones expectations. This thesis shall increase the understanding on the evaluation of project success from the DMOs’ perspective as a key stakeholder in large events. In order to identify the role of DMOs in large event as well as their perception of project success and the success criteria used for evaluation, eight semi-structured interviews were conducted. By doing so, managers of particular DMOs were interviewed, while each DMO represents another large event. It was found that DMOs of a host destination are usually neither involved in the organization of large events nor in managerial tasks. In fact, the large event is used for marketing purposes and is further included in marketing activities to promote a destination to the specified target markets. In order to draw the potential benefits from a large event, it needs to be implemented in a DMOs long-term strategy. At the same time, cooperation between a DMO and a large event is crucial. This underlines the important role DMOs have in large events. DMOs perceive large events as successful if the related marketing activities fulfill the previous set expectations for amount and content of media coverage. In addition, success is perceived by the DMOs if a sustainable destination development can be recognized. Within the distinct task areas of a DMO, different perspectives on success become apparent. Multiple different success criteria used by the DMO to evaluate success are identified, which can be allocated to three different success concepts. First, event success is marked by the impact on the tourist and impact on the DMO. Moreover, destination success can be recognized, while organizational success is specified by preparing for the future and for future large events. In addition, the success concepts can be allocated to medium- and long-term dimensions. It becomes apparent that a short-term dimension and a success concept related to project management success can be neglected, as DMOs are less involved in project management tasks related to the event. From the empirical material collected and the existing theoretical matters, a framework is developed accordingly.

Hipofizės adenoma yra biologiškai gerybinis navikas, augantis iš priekinės hipofizės dalies – adenohipofizės ląstelių, galinčių produkuoti įvairius hipofizės hormonus. Jos paplitimas yra 20 atvejų 100000 gyventojų, kasmet nustatomi 1,5 – 2 atvejai 100000 gyventojų. Pagrindiniu priėjimu prie hipofizės šiuo metu tapo transsfenoidinis priėjimas, transkranijinį naudojant tik labai retais atvejais. Nors hipofizės adenomos diagnostikos ir gydymo galimybės tobulėja, vis dar išlieka nemaža neišspręstų problemų. Šio darbo tikslas buvo nustatyti veiksnius, turinčius reikšmės hipofizės adenomų chirurginio gydymo rezultatams. Darbo uždaviniai: 1. Įvertinti intraoperacinių ir pooperacinių komplikacijų dažnį naudojant skirtingus priėjimo prie turkiabalnio metodus. 2. Nustatyti intraoperacinį smegenų skysčio tekėjimą įtakojančius veiksnius. 3. Įvertinti naujo daugiasluoksnio turkiabalnio uždarymo metodo efektyvumą, palyginti su anksčiau naudotais metodais, esant intraoperaciniam smegenų skysčio tekėjimui. 4. Išnagrinėti prolaktinomų chirurginio gydymo baigtį lemiančius veiksnius. 5. Nustatyti veiksnius, leidžiančius prognozuoti gerą somatotropinį hormoną sekretuojančių adenomų chirurginio gydymo baigtį. 6. Įvertinti regos atsistatymo po transsfenoidinio hipofizės adenomos pašalinimo rezultatus ir nustatyti prognozinius veiksnius, leidžiančius tikėtis regos atsistatymo po operacijos. 7. Įvertinti Farnsword – Munsell spalvų skyrimo ir spalvų juslės slenksčio kompiuterinio testo jautrumą ir... [toliau žr. visą tekstą] / Pituitary adenoma is a biologically benign tumour growing from the anterior part of pituitary gland - adenopituitary cells that can produce different hormones. Its incidence rate is 20 cases per 100 000 population and each year 1.5 - 2 cases per 100 000 population are diagnosed. Transsphenoidal approach has become the major approach to the pituitary gland, with transcranial approach being applied in extremely rare cases. Although the possibilities of pituitary adenoma diagnosis and treatment have been improving, a number of problems remain unsolved. Aim of the study - to identify the factors that have an effect on the results of surgery for pituitary adenomas. Objectives: 1. To assess the incidence of intraoperative and postoperative complications by using different approach to sella turcica. 2. To identify the factors that have an effect on intraoperative cerebrospinal fluid leak. 3. To assess the efficiency of the new multi-layer sella turcica closure technique as compared to the previously used techniques in the presence of intraoperative cerebrospinal fluid flow. 4. To analyse the factors determining the outcome of surgery for prolactinomas. 5. To identify the factors enabling to prognosticate a favourable outcome of surgery for adenomas secreting the somatotropic hormone. 6. To assess the vision recovery results after transsphenoidal removal of pituitary adenoma and to establish prognostic criteria enabling to expect vision recovery after surgery. 7. To assess the... [to full text]

Magistro baigiamajame darbe išanalizuotas ir įvertintas Lietuvos ir Slovėnijos infliacijos, valdžios sektoriaus metinio biudžeto deficito ir bendrosios skolos, ilgalaikių Vyriausybės vertybinių popierių (VVP) palūkanų normos bei nacionalinės valiutos stabilumo lygio atitikimas konvergencijos kriterijams 2000-2008 m. laikotarpiu. Pirmoje darbo dalyje analizuojami infliacijos, valdžios sektoriaus metinio biudžeto deficito ir bendrosios skolos, ilgalaikių Vyriausybės vertybinių popierių palūkanų normos bei šalių dalyvavimo antrajame valiutų kurso mechanizme (VKM II) teoriniai aspektai – pateikiama kiekvieno iš šių kriterijų samprata, analizuojamos atsiradimo priežastys bei pasekmės, nagrinėjami vieną ar kitą reiškinį lemiantys veiksniai, pateikiami su šių makroekonominių rodiklių pokyčiais susijusių problemų sprendimo būdai. Antrojoje darbo dalyje aptariami tyrimui atlikti naudoti kiekybiniai ir kokybiniai metodai bei įvertinama jų taikymo galimybė konvergencijos kriterijų įvertinimui. Trečiojoje darbo dalyje tiriama Lietuvos ir Slovėnijos infliacijos, valdžios sektoriaus metinio biudžeto deficito ir bendrosios skolos, ilgalaikių Vyriausybės vertybinių popierių (VVP) palūkanų normos ir nacionalinės valiutos stabilumo lygio dinamika 2000-2008 m. ir identifikuojami tokį kitimą lėmę veiksniai bei priežastys. Taip pat įvertinamos Lietuvos perspektyvos ateityje įsivesti bendrąją ES valiutą – eurą ir aptariama Slovėnijos narystės euro zonoje nauda šaliai. / In the Final Master’s Degree Work there are evaluated Lithuania and Slovenia‘s inflations, government‘s annual budget deficit and gross debts, long-term government stock interest rate and national currency stability level conformity to the convergence criteria in 2000-2008. The first part of the paper explores theoretical aspects of inflation, government‘s annual budget deficit and gross debts, long-term government stock interest rate and participation of the countries in ERM II – conceptions of every of those criteria are presented, the reasons and outcomes of the appearance are being analysed, factors causing one or another occurrence are being examined, solving methods for the problems related to these macroeconomical indexes are being introduced. In the third part of the work Lithuania and Slovenia‘s inflation, long-term government‘s annual budget deficit and gross debts, long-term government stock interest rate and national currency stability level dynamics in 2000-2008 are researched and the factors and reasons that caused this kind of change are identified. Also, perspectives of Lithuania in the future to introduce the common EU currency – euro are being estimated and benefit of the Slovenia membership in the euro zone to the country is being discussed.