This research is motivated by our collaborations with a large French university teaching hospital in order to reduce the Length of Stay (LoS) of stroke patients treated in the neurovascular department. Quick diagnosis is critical for stroke patients but relies on expensive and heavily used imaging facilities such as MRI (Magnetic Resonance Imaging) scanners. Therefore, it is very important for the neurovascular department to reduce the patient LoS by reducing their waiting time of imaging examinations. From the neurovascular department perspective, this thesis proposes a new MRI examinations reservation process in order to reduce patient waiting times without degrading the utilization of MRI. The service provider, i.e., the imaging department, reserves each week a certain number of appropriately distributed contracted time slots (CTS) for the neurovascular department to ensure quick MRI examination of stroke patients. In addition to CTS, it is still possible for stroke patients to get MRI time slots through regular reservation (RTS). This thesis first proposes a stochastic programming model to simultaneously determine the contract decision, i.e., the number of CTS and its distribution, and the patient assignment policy to assign patients to either CTS or RTS. To solve this problem, structure properties of the optimal patient assignment policy for a given contract are proved by an average cost Markov decision process (MDP) approach. The contract is determined by a Monte Carlo approximation approach and then improved by local search. Computational experiments show that the proposed algorithms can efficiently solve the model. The new reservation process greatly reduces the average waiting time of stroke patients. At the same time, some CTS cannot be used for the lack of patients.To reduce the unused CTS, we further explore the possibility of the advance cancellation of CTS. Structure properties of optimal control policies for one-day and two-day advance cancellation are established separately via an average-cost MDP approach with appropriate modeling and advanced convexity concepts used in control of queueing systems. Computational experiments show that appropriate advance cancellations of CTS greatly reduce the unused CTS with nearly the same waiting times.

Advance Care Planning has been advocated for over 20 years as a way in which individuals who are no longer able to speak for themselves, may still convey their preferences regarding a wide of array of decisions, including medical care. Advance care planning may not be initiated by individuals for many reasons, and even when initiated, may not be specific enough to help guide decision making. Recent advance care planning models have utilized disease specific information to help guide end of life health care decision-making. Persons diagnosed with mild cognitive impairment face an increased possibility of developing dementia at some point in the future, but may retain decision making capability for a window of time, and thus the opportunity to participate in advance care planning. The advance care planning experiences of individuals with mild cognitive impairment have not been extensively studied. This study explored the advance care planning experiences of persons with mild cognitive impairment and their care partners' understanding and views of advance care planning, and if the diagnosis of mild cognitive impairment affects the advance care planning practices of these two groups. A convenience sample of 10 individuals with mild cognitive impairment and their 10 care partners (n=20) were recruited and interviewed. Using a grounded theory qualitative analysis approach, four themes were identified (1) decreased awareness regarding advance care planning from individuals with mild cognitive impairment versus a heightened awareness for the care partners; 2) the preference for comfort care measures only; 3) preferences for future end of life healthcare decisions largely influenced by previous end of life experiences with family and friends; and 4) lack of discussion of end of life healthcare decisions related to dementia and/or artificial nutrition and hydration by physicians or other healthcare providers. In addition two latent themes emerged including from the care partners, the importance of the mild cognitive impairment support group and lawyers for advance care planning and from both care partners and the mild cognitive impairment participants, trying to maintain autonomy, to `hang on' to self were identified. Study implications include the need for structured advance care planning interventions with individuals diagnosed with mild cognitive impairment to focus on common end of life scenarios, such as whether to use artificial nutrition and hydration, which will require future surrogate decision making.

Thesis (master's)--Thammasat University, 1999. / Includes bibliographical references (leaves 125-128).

No Litoral Norte do Rio Grande do Sul, ao norte do balneário Xangri-lá, a barreira holocênica encontra-se parcialmente coberta pela fase moderna e relativamente ativa de um campo de dunas transgressivo, enquanto que, ao sul deste balneário, o campo de dunas cobre completamente a barreira. Este trabalho contribuiu para o conhecimento acerca desse comportamento diferenciado de desenvolvimento da fase moderna do campo de dunas transgressivo sobre a barreira holocênica. Foram utilizadas séries temporais de vento (direção e velocidade) e precipitação de estações meteorológicas localizadas ao sul e ao norte de Xangri-lá, bem como foram realizadas medições simultâneas de vento, por meio de anemômetros portáteis, imediatamente ao norte e ao sul desse balneário. Potenciais de transporte de areia foram calculados para ambas as estações meteorológicas. Os registros históricos da estação de Tramandaí (mais ao sul) indicaram maiores velocidades de vento e menores de precipitação em relação à estação de Torres (mais ao norte). Devido a maior velocidade dos ventos em Tramandaí, o potencial de transporte de areia nessa localidade foi superior a Torres, indicando o favorecimento da migração das dunas em suas proximidades. O comportamento desigual de desenvolvimento da fase moderna do campo de dunas transgressivo pode então estar relacionado a maior velocidade e frequência dos ventos NNE, NE, ENE e E em Tramandaí (ou seja, ao sul de Xangri-lá), além da menor precipitação que também favorece um transporte de areia mais eficiente ao sul de Xangri-lá. / In the north coast of Rio Grande do Sul, to the north of Xangri-lá beach, the Holocene barrier is partially covered by the modern and relatively active phase of a transgressive dune field, while to the south of this balneario the dune field completely covers the barrier. This work contributed to the knowledge about this differentiated development behavior of the modern phase of the transgressive dune field on the holocene barrier. Time series of wind (direction and speed) and precipitation of meteorological stations located to the south and north of Xangri-lá were used, as well as simultaneous wind measurements using portable anemometers, immediately to the north and south of this balneario. Sand transport potentials were calculated for both meteorological stations. Historical records of the Tramandaí station (further south) indicated higher wind speeds and lower precipitation relative to the Torres station (further north). Due to the greater speed of the winds in Tramandaí, the potential of sand transport in this locality was higher than Torres, indicating the favor of the migration of the dunes in its proximities. The uneven developmental behavior of the modern phase of the transgressive dune field can then be related to the higher speed and frequency of the NNE, NE, ENE and E winds in Tramandaí (ie, south of Xangri-lá), as well as the lower precipitation also favors more efficient sand transportation south of Xangri-lá.

abstract: This study aimed to understand the factors that influence Chinese American older adults’ advance care planning (ACP) on end-of-life care. The Theory of Planned Behavior (TPB) and Health Belief Model (HBM) were primarily applied to explain Chinese American older adults’ intentions toward two behaviors: 1) discussion of end-of-life care plans with family members and 2) completion of an advance directive (AD). Additionally, acculturation and family cohesion were considered to examine their impacts on the TPB and HBM. A cross-sectional survey was conducted through face-to-face interviews on a sample of 298 community-dwelling Chinese-American adults aged 55 and older living in the metropolitan Phoenix area of Arizona. Based upon random assignment, 161 participants answered questions regarding discussing end-of-life care plans with family members, while 137 participants answered questions related to the completion of an AD. Hierarchical multiple regression analysis was used to focus on the influence of TPB and HBM measures on behavioral intentions toward the two behaviors. Results indicated that both the TPB and HBM had predictive power to explain the target population’s intentions. However, the predictability of TPB and HBM measures varied across the two behaviors. Acculturation moderated the relationship between attitudes and intentions to complete an AD negatively. Family cohesion moderated the relationship between perceived benefits and intentions to discuss end-of-life care plans with family members negatively. These findings would help inform future interventions for improving the target population’s ACP awareness and engagement. / Dissertation/Thesis / Doctoral Dissertation Communication 2018

No Litoral Norte do Rio Grande do Sul, ao norte do balneário Xangri-lá, a barreira holocênica encontra-se parcialmente coberta pela fase moderna e relativamente ativa de um campo de dunas transgressivo, enquanto que, ao sul deste balneário, o campo de dunas cobre completamente a barreira. Este trabalho contribuiu para o conhecimento acerca desse comportamento diferenciado de desenvolvimento da fase moderna do campo de dunas transgressivo sobre a barreira holocênica. Foram utilizadas séries temporais de vento (direção e velocidade) e precipitação de estações meteorológicas localizadas ao sul e ao norte de Xangri-lá, bem como foram realizadas medições simultâneas de vento, por meio de anemômetros portáteis, imediatamente ao norte e ao sul desse balneário. Potenciais de transporte de areia foram calculados para ambas as estações meteorológicas. Os registros históricos da estação de Tramandaí (mais ao sul) indicaram maiores velocidades de vento e menores de precipitação em relação à estação de Torres (mais ao norte). Devido a maior velocidade dos ventos em Tramandaí, o potencial de transporte de areia nessa localidade foi superior a Torres, indicando o favorecimento da migração das dunas em suas proximidades. O comportamento desigual de desenvolvimento da fase moderna do campo de dunas transgressivo pode então estar relacionado a maior velocidade e frequência dos ventos NNE, NE, ENE e E em Tramandaí (ou seja, ao sul de Xangri-lá), além da menor precipitação que também favorece um transporte de areia mais eficiente ao sul de Xangri-lá. / In the north coast of Rio Grande do Sul, to the north of Xangri-lá beach, the Holocene barrier is partially covered by the modern and relatively active phase of a transgressive dune field, while to the south of this balneario the dune field completely covers the barrier. This work contributed to the knowledge about this differentiated development behavior of the modern phase of the transgressive dune field on the holocene barrier. Time series of wind (direction and speed) and precipitation of meteorological stations located to the south and north of Xangri-lá were used, as well as simultaneous wind measurements using portable anemometers, immediately to the north and south of this balneario. Sand transport potentials were calculated for both meteorological stations. Historical records of the Tramandaí station (further south) indicated higher wind speeds and lower precipitation relative to the Torres station (further north). Due to the greater speed of the winds in Tramandaí, the potential of sand transport in this locality was higher than Torres, indicating the favor of the migration of the dunes in its proximities. The uneven developmental behavior of the modern phase of the transgressive dune field can then be related to the higher speed and frequency of the NNE, NE, ENE and E winds in Tramandaí (ie, south of Xangri-lá), as well as the lower precipitation also favors more efficient sand transportation south of Xangri-lá.

O proposito deste estudo foi avaliar as alteracoes esqueleticas, dentoalveolares e tegumentares decorrentes da utilizacao do aparelho fixo associado ao Jasper Jumper e aos elasticos intermaxilares de Classe II em fases distintas do tratamento da ma oclusao de Classe II por meio da analise cefalometrica de 96 telerradiografias, em norma lateral, de 24 pacientes de ambos os generos, com idade inicial media de 12,58 anos, tratados por um periodo medio de 2,14 anos. As telerradiografias, em norma lateral, foram avaliadas em cada fase do tratamento: T1 (inicial), T2 (final do nivelamento e alinhamento), T3 (apos o Jasper Jumper) e T4 (final). As variaveis cefalometricas foram comparadas por meio da analise de variancia (ANOVA) a um criterio e o teste de comparacoes multiplas de Tukey. Houve restricao do deslocamento da maxila para anterior, porem, sem diferença estatisticamente significantes entre as fases estudadas. Observou-se ausencia de alteracoes significantes no posicionamento mandibular, sendo que ocorreu um aumento significante no comprimento mandibular na fase do nivelamento. A relação maxilomandibular foi corrigida, ja a fase de utilizacao de elasticos nao teve influencia estatisticamente significante nessa relacao. O tratamento ocasionou a rotação horaria da mandibula, sendo significante apenas para a medida S-GO na fase de nivelamento, ocorrendo aumento significante da altura facial antero-inferior nas fases de nivelamento e Jasper Jumper. Os incisivos superiores apresentaram extrusão estatisticamente significante na fase do Jasper Jumper. Na fase de nivelamento e dos elasticos de Classe II, nao houve influencia estatistica significante nessa variavel. Houve inclinacao para lingual dos incisivos superiores em todas as fases. Foi observada retrusao significante dos incisivos superiores, exceto na fase dos elasticos; Nao houve alteracao significante para o posicionamento mesiodistal dos molares superiores. Os incisivos inferiores apresentaram uma tendencia de protrusao estatisticamente significante apos a fase de nivelamento e restrição estatisticamente significante do seu desenvolvimento vertical nas fases ortopedica e de elasticos. Os molares inferiores foram extruidos significantemente nas fases de nivelamento e ortopedica e mesializados (alteracao estatisticamente significante obtida na fase ortopedica e mantida nas outras fases). O trespasse vertical diminuiu (estatisticamente significante) em todas as fases. Ja o trespasse horizontal não apresentou significancia estatistica apenas na primeira fase estudada. Na relação molar, a maior alteracao (estatisticamente significante) foi observada na fase ortopedica. O perfil tegumentar (H.NB, H-Nariz, Ls-E) apresentou alterações estatisticamente significantes com a utilizacao do Jasper Jumper. Na fase do nivelamento e de utilizacao dos elasticos, a unica variavel tegumentar que apresentou significancia estatistica foi Li-E, tendo demonstrado retrusao do lábio inferior. / The aim of this study was acess the skeletal, dentoalveolar and soft tissue changes occured with fixed appliance associated to Jasper Jumper and Class II intermaxillary elastics in distinct phases of Class II malocclusion treatment by means of the cephalometric analysis of 96 lateral radiographs of 24 patients of both genders, with initial mean age of 12.58 years, treated for a mean period of 2.14 years. The lateral radiographs were evaluated in each phase of the treatment: T1 (initial), T2 (final of alignment and leveling), T3 (after the Jasper Jumper), T4 (final). The cephalometric variables were compared by means of the Variance Analysis (ANOVA) to a criterion and the Tukey multiple comparison test. There was a restriction of the anterior displacement of the maxilla, however, without statistical significant differences among the studied phases. It was observed absence of significant changes in the mandibular position occurring a significant increase in the mandibular length during the leveling phase. The maxillomandibular relationship was corrected without any statistically significant influence of the elastics in this relation. The treatment caused a clockwise mandibular rotation being significant only for S-GO measure during the leveling phase occurring significant increase of the lower anterior facial height during the leveling and Jasper Jumper phases. The upper incisors showed a statistically significant extrusion in the Jasper Jumper phase. During the leveling and Class II elastic phases there were no statistically significant influence of this variable. There was a palatal inclination of the upper incisors during all phases. It was observed a significant retrusion of the upper incisors, except in the elastic phase; there were not significant change for the mesiodistal position of the upper molars. The lower incisors showed a tendency of a significant protrusion after the leveling phase and a statistically significant restriction of their vertical development during the orthopedic and elastic phases. The lower molars extruded significantly during the leveling and orthopedic phases and they mesialized (statistically significant change obtained in the orthopedic phase and maintained during the other phases. The vertical trespass decreased (statistically significant) in all phases. On the other hand, the horizontal trespass do not showed any statistical significance only in the first studied phase. In the molar relationship, the great change (statistically significant) was observed in the orthopedic phase. The soft tissue profile (H.NB, Hnose, Ls-E) showed statistically significant changes with the wear of Jusper Jumper. In the leveling and elastic phases the only soft tissue variable that showed statistical significance was Li-E having demonstrated lower lip retrusion.

O presente trabalho tem por escopo o estudo do princípio do respeito à autonomia do paciente à luz das recentes alterações trazidas pelo novo CEM Resolução do Conselho Federal de Medicina nº 1.931, de 17 de setembro de 2009 , que prestigia a autonomia do paciente e propõe um novo formato para a relação médico-paciente, impondo novas posturas tanto ao médico como ao paciente, e privilegia sua autodeterminação, ao mesmo tempo em que o obriga à tomada de decisões e à assunção de responsabilidade compartilhada quanto ao processo terapêutico. O objeto do estudo é a nova relação médico-paciente sob o enfoque da autonomia do último, ressaltando-se a responsabilidade compartilhada com o médico em relação à tomada de decisões atinentes ao processo terapêutico, às escolhas terapêuticas, bem como os limites e o conteúdo do poder de decidir e sua autonomia diante da enfermidade e da terminalidade da vida. Nesta hipótese, a reflexão concentra-se nos cuidados paliativos e na adoção de diretivas prévias estatuídas pelo paciente a serem observadas pelo médico e por eventual terceiro responsável por aquele, caso ele não possa manifestar sua vontade durante cuidados paliativos ou situações que revelem iminente terminalidade. / This proposal aims to study the principle of respect for patient autonomy in light of recent changes introduced by the new CEM Resolution of the Federal Medical Council nº 1931 of September 17, 2009 which honors the patients autonomy and proposes a new format for the doctor-patient relationship, imposing new attitudes to both the patient and physician, emphasizes self-determination and, at the same time that forces decision making and the assumption of shared responsibility as to the therapeutic process. The object of the study is the new doctor-patient relationship from the perspective of this autonomy, emphasizing shared responsibility with the physician regarding decisions pertaining to the therapeutic process, the therapeutic choices, and the limits of power and content and their autonomy to decide on the terminally ill and life. In this case, reflection focuses on palliative care and the adoption of policies laid by the previous patient to be seen by the doctor and by any third party responsible for that, if he can not express his desire for palliative care or situations that reveal impending finality.

In this project-collaboration between Växjö University and Sideum company- a matchmakingportal is designed. This portal’s purpose is to ease the communication betweenVäxjö university’s students who are interested in doing their final thesis/project in anenvironment outside the university and companies which have some appropriatethesis/projects for these students and would like their projects to be done by them.There are different kinds of users that have different roles on this portal. The majorusers are students and companies which take the most advantage of this website.Once a student registers her name and completes her profile, she will receive emailscontaining information about uploaded projects on the portal by companies, which aresuitable according to what she already has mentioned in her profile. She can also searchherself to find her desired project as soon as companies upload their projects on the portal.On the other hand companies can search to find students who meet their requirements.Administrators of the portal are able to do match-making between students andcompanies. They access to every part of the portal and have right to edit, delete, change,upload, making reports and supervise the system.Other groups are guests of system. Guests are users of the system who are not registeredyet, they will not receive any email about uploaded thesis/projects on the portal but theycan search for them, themselves.

Politicians and tax practitioners often claim that tax uncertainty negatively affects investment. In many countries, firms can request fee-based Advance Tax Rulings (ATRs) to mitigate tax uncertainty. We analyze theoretically the circumstances under which investors request ATRs, how tax authorities should price them and how they can affect investment. We assume that tax authorities integrate investors' reasoning into their decisions. We find that it is often optimal for tax authorities to charge prohibitively high fees to discourage firms from requesting an ATR. However, we find that revenue-maximizing tax authorities offer ATRs if the ruling enables them either to significantly reduce their tax audit costs or to increase the probability of detecting ambiguous tax issues. Under certain circumstances, ATRs may effectively foster investment and potentially benefit both the tax authorities and taxpayers. Our results provide new explanations for why taxpayers that face high levels of tax uncertainty often do not request ATRs, even when the fee is rather low. Our results also hold when the tax authority maximizes social wealth instead of its revenues. Regulatory changes in ATR requirements might serve as a natural quasi-experiment for an empirical study of our predictions regarding investment decisions. (authors' abstract) / Series: WU International Taxation Research Paper Series