Background: Long-term care nurses are in a pivotal position to be augmenting the quality of life for residents and improving the death and dying experience for residents, their family members and surrogate decision makers. Currently there is a paucity of literature that acknowledges the experiences of long-term care nurses and their involvement with end-of-life decision making and care. Purpose: To describe long-term care nurses’ perceptions of factors that influence their communication with end-of-life surrogate decision makers and the kind of support they need to support this discussion. Method: A descriptive study using mixed-methods convergent design was used to obtain responses from a sample of 30 long-term care nurses. An online survey included questions to obtain quantitative data and open-ended questions for short responses. Results from both sets of data were brought together and compared during the analysis phase. Results: The findings of this study highlight the personal factors of the nurse, the characteristics of the surrogate decision maker, contextual factors, situational related inputs, and the support desired by long-term care nurses. Participants rated factors according to importance in their experiences of communicating with surrogate decision makers. Seven themes were inductively derived from the analysis: 1) selected or appointed as surrogate makes a difference, 2) strong trusting bond between nurse-resident and nurse-family, 3) being too close to see resident’s wishes, 4) interdisciplinary team agreement, 5) living will as a communication roadmap, 6) peaceful environment, and 7) the need to create emotional distance. Long-term care nurses also identified the types of support they seek or need to be effective in communicating with end-of-life care surrogate decision makers. Conclusion: As the numbers of the older population continue to increase, the demand for nurses to develop expertise in caring for dying residents and communicating with them, their family members, and surrogate decision makers will increase. Understanding their experiences and providing support to long-term care nurses may strengthen their capacity to communicate about death and dying and their delivery of quality end-of-life care to residents.

This paper studies the effects of long-term climate change on the dynamics of violent conflict in the Kenyan crisis of 2007-2008. Climate change has been found to worsen livelihood conditions in East Africa, leading to a higher competition for resources and increased intergroup tensions. This, in turn, leads to a higher risk for violent conflict. The findings indicate that geographical areas that were more severely affected by the effects of long-term climate change were more likely to experience eruptions of violence during the 2007-2008 conflict. Even when controlling for other factors thought to influence the outbreak of violent conflict, this relationship continues to hold. The exact nature of the links between the two phenomena is still to be proven, but the findings seem to be relatively robust, providing a solid basis for future research on the often overlooked area of long-term climate change and its effects on violent conflict.

This project focused on developing a more complete picture of the event that most often occurs when an older adult’s health care needs can no longer be met in the community setting; the transition from home into a new long-term care (LTC) environment (i.e., assisted living [AL] or residential care [RC]). Informed by a life course perspective (Elder, 1998; Marshall, 2009) and by the health service utilization framework (Andersen, 1995; Andersen & Newman, 1973), this thesis explores the relationship between service users and their social and service contexts in the Fraser Health (FH) region of British Columbia. Employing a multi-method research design, two studies, one quantitative and one qualitative, were conducted. The goal of the quantitative study was to draw attention to individual, social, and structural factors (e.g., age, gender, marital status, presence of/relationship to primary caregiver, and health variables) that influence the transition from home and community care (HC) services to either AL or RC among older LTC clients (age 65+; N=3233) in three geographic areas (urban, suburban, and rural). Findings revealed that marital status, income, functional disability, and cognitive performance influenced type of transition for both rural and urban clients. However, gender, medical frailty (i.e., CHESS score), number of chronic conditions, and total hospitalizations emerged as significant among clients in suburban areas. The goal of the qualitative study was to draw attention to the role of family caregivers in the care transition context. Employing thematic analysis, this study drew on a sample of 15 semi-structured interviews with family caregivers who had helped a family member transition from home into a new care environment in FH. Out of this work, a conceptual framework was developed inductively to illustrate three key phases that seemed important in their care journey: ‘Precursors leading to transition’, ‘Preparing to transition into new care environment’, and ‘Post-transition: Finding a new balance Three overarching themes, labelled with direct quotes (in vivo), were also developed to capture how family caregivers made sense of their roles and responsibilities: “I’m just her daughter” / “I’m just his wife”, “Just go with the flow”, and “There wasn’t a door I didn’t try to open”. Overall, the findings from both studies draw attention to the importance of generating a better understanding of the local service and social contexts. Implications for social policy are addressed and highlight the need to continue to invest in efforts aimed at supporting older adults to remain in the community as long as possible, including ensuring appropriate forms of care are available and adequate resources for family caregivers are offered. / Graduate

This thesis provides an overview of accounting and tax implications of long-term intangible assets from the perspective of the Czech legislation and in terms of International Accounting Standards. The text is divided into theoretical and practical. The first part describes the intangible assets in five chapters. The first of these intangible assets is generally defined in terms of Czech and international law. Other chapters deal with valuation, depreciation and decommissioning of intangible assets. The last chapter deals with the deferred taxes that are due different concepts of accounting and tax regulations in the costs and revenues. Current legislation of intangible assets described in this work is compared with the previously applicable law. The practical part consists of a number of exercises that reflect the real situation of intangible assets in a Prague company.

This thesis has examined what long-term psychological and neurological effects that are apparent in children and adults who have experienced parental divorce. It was predicted that significantly more children and adult children from divorced families would have increased symptoms of mental disorders than children and adult children from married homes e.g., anxiety, depression, panic disorder, and generalized anxiety disorder. It was further predicted that parental divorce would negatively affect the neurological system in the offspring. The correlation between children of divorce and negative neurological effects was not found to be true. However, adult children of divorce have significantly lower baseline cortisol levels compared to adult children of marriage. Dysregulated cortisol levels are highly associated with the development of e.g., anxiety, depression, and brain damage. Parental divorce did not only influence how secretion of the hormone cortisol is regulated within adult children of divorce, but how both children and adult children of divorce psychologically adapt post-divorce. Children of divorce have for instance lower general well-being, more symptoms of anxiety and depression, lower self-esteem, and feel more stress than children of marriage. Adult children of divorce are more likely to experience marital discord, getting divorced themselves, anxiety and depression, lower academic performance, and substance abuse, etc. The result of the thesis suggests that children and adult children from divorced families are negatively affected, both psychologically and neurologically, regardless of age. Parental divorce and supplementary effects make it more likely for children and adult children to experience more symptoms of mental disorders.

This thesis has examined what long-term psychological and neurological effects that are apparent in children and adults who have experienced parental divorce. It was predicted that significantly more children and adult children from divorced families would have increased symptoms of mental disorders than children and adult children from married homes e.g., anxiety, depression, panic disorder, and generalized anxiety disorder. It was further predicted that parental divorce would negatively affect the neurological system in the offspring. The correlation between children of divorce and negative neurological effects was not found to be true. However, adult children of divorce have significantly lower baseline cortisol levels compared to adult children of marriage. Dysregulated cortisol levels are highly associated with the development of e.g., anxiety, depression, and brain damage. Parental divorce did not only influence how secretion of the hormone cortisol is regulated within adult children of divorce, but how both children and adult children of divorce psychologically adapt postdivorce. Children of divorce have for instance lower general well-being, more symptoms of anxiety and depression, lower self-esteem, and feel more stress than children of marriage. Adult children of divorce are more likely to experience marital discord, getting divorced themselves, anxiety and depression, lower academic performance, and substance abuse, etc. The result of the thesis suggests that children and adult children from divorced families are negatively affected, both psychologically and neurologically, regardless of age. Parental divorce and supplementary effects make it more likely for children and adult children to experience more symptoms of mental disorders.

Thesis advisor: Kevin J. Mahoney / Thesis advisor: Ce Shen / For young adults with disabilities, who face barriers in achieving markers of adulthood, a service gap has been identified during the transition to adulthood. Preliminary qualitative evidence suggests that participant-directed home and community-based services (PD-HCBS), which can be easily modified to meet an individual’s needs, might aid these young adults as they transition into adulthood and provide an option to fill the service gap. However, research was needed to determine if young adults are significantly affected by having the option to develop an individualized spending plan and manage their own budget. In this study, secondary data analysis was employed in evaluating the effectiveness of the Cash and Counseling budget authority model of PD-HCBS for young adults aged 18 to 35 with long-term care disabilities and eligible for Medicaid who were enrolled in the Cash and Counseling Demonstration and Evaluation randomized control trial (n = 831). Using a theoretical framework based on the developmental life stage of young adulthood, theories of self-determination and consumer direction, and past research on PD-HCBS, I examined young adults’ outcomes on community involvement, satisfaction ratings, unmet needs for assistance, and health status compared to peers through self-reports or through proxy respondents. Multivariate logistic regression results showed that Cash and Counseling significantly increased the likelihood of young adults attending school or college at a preferred level, being very satisfied with when care was received, care arrangement, transportation, help around the house and community, personal care, and getting along with paid attendants, and having fewer unmet needs with health care at home and with transportation than controls receiving agency-based care. Bivariate logistic regression models also showed Cash and Counseling members were significantly more likely to attend activities at a preferred level, be very satisfied with life, and have lower likelihoods of unmet personal care needs. These findings support the effectiveness of the Cash and Counseling model with young adults with disabilities and as an option to help fill the service gap for this population. Future research and intervention could address how other influential factors identified affect outcomes and test PD-HCBS during different aspects of the transition to adulthood. / Thesis (PhD) — Boston College, 2016. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

Real-world human visual perception is superb, despite pervasive attentional capacity limitations that can severely impact behavioral performance. Long-term memory (LTM) is suggested to play a key role in efficiently deploying attentional resources; however, the nature of LTM-attention interactions remains poorly understood. Here, I present a series of behavioral and functional magnetic resonance imaging (fMRI) investigations of the mechanisms of LTM-guided visual attention in 139 healthy participants (18-34 years). In Experiment 1, I hypothesized that humans can use memory to guide spatial attention to multiple discrete locations that have been previously studied. Participants were able to simultaneously attend to more than one spatial location using an LTM cue in a novel change-detection behavioral paradigm also used in fMRI Experiments 2 and 4. Cortical networks associated with LTM and attention often interact competitively. In Experiment 2, I hypothesized that the cognitive control network supports cooperation between LTM and attention. Three posterior regions involved with cognitive control were more strongly recruited for LTM-guided attention than stimulus-guided attention: the posterior precuneus, posterior callosal sulcus, and lateral intraparietal sulcus. In Experiment 3, I hypothesized that regions identified in Experiment 2 are specifically activated for LTM-guided attention, not for LTM retrieval or stimulus-guided attention alone. This hypothesis was supported. Taken together, the results of Experiments 2 and 3 identify a cognitive control subnetwork specifically recruited for LTM-guided attention. Experiment 4 tested how LTM-guided attention affected spatial responsivity of maps within intraparietal sulcus. I hypothesized that left parietal maps would change their spatial responsivity due to the left lateralized effects of memory retrieval. During stimulus-guided attention, contralateral visuotopic maps in the right but not left intraparietal sulcus responded to the full visual field. In contrast, during LTM-guided attention, maps in both the left and right intraparietal sulcus responded to the full visual field, providing evidence for complementary forms of dynamic recruitment under different attentional conditions. Together, these results demonstrate that LTM-guided attention is supported by a parietal subnetwork within the cognitive control network and that internal attentional states influence the spatial specificity of visuotopically mapped regions in parietal cortex.

O câncer de mama é a neoplasia mundialmente mais incidente em mulheres, representando a causa mais frequente de morte feminina por câncer, excetuando-se os tumores de pele não melanoma. O conhecimento da dinâmica de óbitos ao logo do tempo em pacientes com tal neoplasia é de grande importância para auxílio na definição de tratamentos e de políticas de prevenção. Modelos de risco que contemplem parâmetros com referência a situações de longa duração e diferentes funções de risco podem ser úteis nesse contexto. O objetivo desta dissertação é investigar as propriedades de um particular modelo, o modelo Weibull Modificado Exponenciado de Longa Duração (WMELD), para aplicação na avaliação de risco e sobrevida de mulheres diagnosticadas com câncer de mama atendidas no Hospital das Clínicas de Ribeirão Preto, São Paulo. As propriedades avaliadas neste estudo consideraram métodos de estimação pontual de Máxima Verossimilhança e estimação intervalar via teoria assintótica, reamostragem bootstrap e verossimilhança perlada. Critérios de seleção de modelos foram considerados: Teste de Razão de Verossimilhanças (TRV), critério de Akaike (AIC) e critério de Informação de Bayes (BIC), bem como métodos gráficos para avaliar a qualidade do ajuste do modelo: gráfico TTT na presença de censuras com intervalo de confiança bootstrap paramétrico. Foram realizados estudos de simulação de Monte Carlo em diferentes cenários do modelo WMELD, considerando Vício, Erro Quadrático Médio (EQM) e Custo dos estimadores pontuais, Probabilidade de Cobertura e Amplitude Média dos intervalos de confiança. Em relação ao estudo das propriedades do modelo, as estimativas pontuais de máxima verossimilhança apresentaram vício e EQM baixos e mais próximos de zero quanto maior o tamanho amostral e menor a proporção de pacientes imunes. Os intervalos construídos com base em reamostragem bootstrap mostraram-se mais adequados em relação à probabilidade de cobertura e amplitude média, com vantagem para o bootstrap paramétrico. AIC e TRV alcançaram poder discriminativo superior ao BIC, porém os três métodos apresentam-se defasados para pequenos tamanhos amostrais e valores dos parâmetros próximos do valor de nulidade. Os métodos de inferência com melhor desempenho nesse estudo foram considerados para avaliar os fatores associados ao risco e sobrevida de pacientes com câncer de mama atendidas no HCFMRP. Com o ajuste do modelo WMELD, mostraram-se associados à sobrevida os fatores: Estadiamento, Faixa Etária e Quantidade de tratamentos. A sobrevida em oito anos ou mais foi maior quanto menor o estadiamento e os óbitos ocorreram de forma mais acelerada ao longo do tempo em estadiamentos avançados. Pacientes com menos de 35 anos de idade nos estadiamentos II e III e com mais de 75 anos no estadiamento III têm menor sobrevida do que as pacientes com 35 a 75 anos. Pacientes que realizaram menos tratamentos nos estadiamentos III ou IV vão a óbito mais rapidamente do que pacientes que zeram mais tratamentos, porém a sobrevida após oito ou mais anos é igual nos dois grupos. Adicionalmente, e fundamental no contexto da clínica médica, o modelo WMELD apresenta interpretações relevantes em relação a seus parâmetros na dinâmica do processo de ocorrência de óbitos ao longo do tempo. Verificamos que os parâmetros , e p levam informações sobre o tempo de vida, já os parâmetros, e descrevem o comportamento do risco de óbito. / Breast cancer is the world\'s most common cancer in women, representing the most frequent cause of female death from cancer, except for non-melanoma skin tumors. Knowledge of the death dynamics over time in patients with such cancer is very important to support definition of treatments and prevention policies. Hazard models that include parameters with reference to long-term situations and dierent hazard functions can be useful in this context. This paper aims to investigate the properties of a particular model, Exponentiated Modified Weibull Model for long-term survivors (EMWLT), for use in risk of death and survival assessment of women diagnosed with breast cancer and treated at Hospital das Clínicas de Ribeirão Preto (HCFMRP), São Paulo. The properties evaluated in this study considered point estimation methods of Maximum Likelihood and interval estimation through asymptotic theory, bootstrap resampling and profile likelihood. Model selection criteria were considered: Likelihood Ratio Test (LRT), Akaike Criterion (AIC) and Bayesian Information Criterion (BIC), as well graphical methods to assess the quality of the model fit: TTT plot in the presence of censorship with an parametric bootstrap confidence interval. Monte Carlo simulation studies were performed in diferent model\'s scenarios considering Bias, Mean Square Error (MSE) and Cost of point estimators, Coverage Probability and Average Size of confidence intervals. Regarding the study of model properties, the point estimates of maximum likelihood showed lower and closer to zero bias and MSE the larger the sample size and the lower the proportion of immune patients. The intervals constructed based on bootstrap resampling seemed more appropriated in relation to the coverage probability and average size, advantageously the parametric bootstrap. AIC and LRT reached a higher discriminative power than BIC; however, all of these three methods seemed lagged for small sample sizes and close to null values of parameters. The inference methods with better performance in this study were considered to evaluate the factors associated with risk of death and survival in patients with breast cancer treated at HCFMRP. By adjusting the EMWLT model, the following were associated to survival: Staging, Age Group and Number of treatments. The survival of eight years or more was higher as the lower the staging was; and the deaths occurred more rapidly over time in advanced staging. Patients under 35 years old in stages II and III and older than 75 years in staging III had lower survival than patients aged 35 to 75 years. Patients who underwent fewer treatments in staging III or IV die earlier than patients who underwent more treatments, but survival after eight years or more is equal in both groups. In addition, the EMWLT model showed to be fundamental in clinical medicine presenting relevant interpretations regarding its parameters in the dynamics of the process of occurrence of deaths over time. We verified that the parameters , and p have information about the lifetime, on the other hand the parameters, and describe the risk of death behavior.

Projetos de monitoramento de longo prazo estão sendo desenvolvidos internacionalmente a fim de monitorar continuamente os impactos que as mudanças climáticas globais vêm gerando nas comunidades marinhas bentônicas, entretanto, no âmbito nacional, há uma carência desse tipo de estudo e dados para a costa brasileira. O objetivo do presente estudo foi a instalação de uma estação de monitoramento de longo prazo, bem como a caracterização da comunidade bentônica presente no médiolitoral do costão rochoso à direita da Enseada de Palmas, no Parque Estadual da Ilha Anchieta (Ubatuba, SP) seguindo as diretrizes do \"Protocolo de Médiolitoral para Monitoramento de Comunidades de Costão Rochoso\" da ReBentos (Rede de Monitoramento de Habitats Bentônicos Costeiros). As amostragens dependentes semestrais (n = 3) foram realizadas no período de um ano, compreendendo o inverno de 2014 e o verão de 2015, utilizando fotoquadrados de 10x10 cm na faixa superior e 25x25 cm nas faixas intermediária e inferior. A análise variância ANOVA two way para dados repetidos revelou variação sazonal na largura das faixas das unidades operacionais (UO) Tetraclita (39,1 cm) e Macroalgas (27 cm) e no recobrimento percentual médio (RPM) das UO Cianobactéria (12,6%) na faixa superior, T. stalactifera (16,6%), Espaço vazio (38,4%) e Algas Calcárias Articuladas (55,7%) na faixa intermediária. As análises multivariadas (Cluster, nMDS e PCA) revelaram alta similaridade para as faixas superior (80%) e inferior (85%) e baixa (65%) para a faixa intermediaria, indicando que as maiores diferenças entre verão e inverno foram encontradas nesta faixa. Como o médiolitoral apresenta UO bioindicadoras de monitoramento, como T. stalactifera, A. beauvoisii e Sargassum vulgare, e de variação sazonal, então eleva-se a importância da realização, integração e continuidade de projetos de monitoramento de longo prazo em costões rochosos a fim de gerar dados históricos ao longo do litoral brasileiro / The development of long-term monitoring projects around the world aims to monitor continuously the impacts that global environmental changes (GEC) have been causing in the benthic marine communities. However, nationally, there are few monitoring studies and data for the Brazilian coast. In this study, we aimed to install a long-term monitoring station and characterize the benthic community located in the intertidal zone of the rocky shore in the right of the Cove of Palmas at the Anchieta Island State Park (Ubatuba, São Paulo state). We intended to do that by following the guidelines of the \"Intertidal Protocol for the Monitoring of Rocky Shore Communities\" (Rocky Shores Working group, ReBentos). We studied the rocky shore for a year and collected the dependent samples every semester (n = 3), encompassing the winter of 2014 and the summer of 2015. We used photoquadrats in the intertidal zone (10x10 cm in the upper band and 25x25 cm in the intermediate and lower bands). Two-way analysis of variance (ANOVA) for repeated measures reveled seasonal variation in the bandwidth of Tetraclita (39,1 cm) and Macroalgae (27 cm) operational units (OU) and in the average percentage overlap for Cyanobacteria (12,6%) at upper band, T. stalactifera (16,6%), Empty space (38,4%) and Articulated Calcareous Algae (55,7%) at intermediate band. Multivariate analysis (Cluster, nMDS and PCA) revealed high similarity for upper (80%) and lower (85%) bands and low similarity for intermediate band (65%), suggesting major differences between summer and winter in the intermediate band. As the intertidal zone has monitoring bioindicators operational units, like T. stalactifera, A. beauvoisii and Sargassum vulgare, and seasonal variation, it is of great importance to implement, integrate and continue long-term monitoring projects in rocky shores in order to generate Brazilian coast historical data