The patient's autonomy is very important part of medical and nursing practice and every patient should have a right to express their opinion about their treatment. Advance directives give person an opportunity to express even in situations when it is not possible to communicate with others. Although it is possible to write advance directives in the Czech Republic only negligible percentage of people take advantage of this possibility. Why is it so? I have set two goals in my thesis. My first goal is to determine the awareness of the general public about the advance directives in the Czech Republic and also I want to find out awareness about the possibility to appoint a guardian as a mediator of fulfilment of advance directives of an individual. It is also my goal to discover whether respondents would welcome greater awareness of this topic. My second objective is to determine the attitudes of respondents to the problematics of advance directives. I want to discover if the respondents have ever dealt with the idea of being in a situation which they could not communicate with their environment and if they would like to have an opinion to decide about their treatment and also if they would like to name their mediator. I would like to provide the results of my thesis to the department of quality...

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第13327号 / 論医博第2195号 / 新制||医||1044(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 古川 壽亮, 教授 伊達 洋至, 教授 佐藤 俊哉 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM

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This graduation thesis deals with Bruker AXS D8 Advance adjustment. Target of this thesis is design and realization of equipment which is going to be applicable on existing D8 advance machine and works with Göbel mirror adjustment. Mentioned adjustment is basic part of service operations necessary for D8. Introduction deals with theory of diffraction and basics of X-ray. Following part is presenting design of model which can be applicable and useful for solving of our problem. This design is completed with function device. This device realization is created by driving mechanism, control unit and mechanical adapter which is flexible and compatible with existing D8 Advance machine. All parts of designed device are fully described and complemented for full technical documentation, which is part of attachments.

For the last four decades, psycholinguistic research has dealt with the question to what extent elements of simple sentences like “The monk read the book” are planned ahead both on the abstract-lexical and phonological processing level. While a number of studies have shown that all up to the final element can be activated on these two levels, empirical evidence on the flexibility of the respective planning scopes is inconsistent, and a systematic delineation of the influence of different forms of cognitive load has not yet been provided. This thesis presents a series of 9 picture-word interference experiments in which participants produced subject-verb-object sentences while ignoring auditory distractor words. Advance planning was assessed at an abstract-lexical (lemma) level and at a phonological (word form) level under varying working memory load conditions (no load, or visuospatial load, or verbal load). In the absence of a concurrent working memory load and with a concurrent visuospatial working memory load, subject and object nouns were found to be activated at the abstract-lexical and the phonological level prior to speech onset. By contrast, with a concurrent verbal working load, the scope of advance planning at the phonological level was reduced, while the scope of advance planning at the abstract-lexical level remained unaffected. Moreover, sentence planning had a more disruptive effect on verbal working memory performance than on visuospatial working memory performance. Overall, these results suggest that advance planning at the phonological level is more adaptive to external factors than advance planning at the abstract-lexical level. Also, they indicate an overlap of resources allocated to phonological processing in speech production and verbal working memory.

<p>In this dissertation, I investigated price dynamics in the hotel room-night market and attempted to explain pricing decisions from a market perspective. Since market dynamics of the hotel room-night market can be paralleled to those in the financial market, financial market models allowed for examination of various aspects of hotel room pricing decisions.</p><p>In the first study, advance-purchase discounts were estimated through application of an option pricing model considering property-specific attributes. Non-refundable advance-purchase discounts are a commonly used rate fence. One challenge to their implementation, however, is deciding upon the precise magnitude of the discount. Quan’s (2002) study on the price of room reservations is a good starting point, but it is a conceptual model that assumes away other property-specific factors. This study thus tested the idea that advance-purchase discounts are affected by various components, including the value of the right to cancel a reservation (e.g., cancelation option value) and the room- and property-specific factors in the hotel room-night market (e.g., uncertainty, reviews, and seasonality). The analysis supported this hypothesis and additionally revealed that advance-purchase discounts are smaller for rooms with high review ratings in a high-demand period. Interestingly, the divergence between advance-purchase discounts and cancelation option value components widened in a high-demand period, which implies a tendency by hotels to adjust their room rates rather than the amount of discount for customers who book their stay well in advance. Theoretically, this study thus contributes to finance literature by extending the application of the option pricing model to real options for non-financial assets. This study also contributes to the hospitality literature by demonstrating the effects of property-specific attributes on advance-purchase discount magnitude. The results also have implications to the hospitality industry by providing an analytical framework by which hoteliers can estimate property-specific advance-purchase discounts.</p><p>The second study concentrated on rate parity agreement’s effect on the hotel room-night market’s efficiency at reflecting product characteristics in room rates. This study examined the impact of rate parity agreement between hotels and online travel agencies by comparing hotel rates between Europe and the United States. This study found that room rates were less sensitive to property quality attributes under rate parity clauses. The reflection of property quality on room rates were less efficient when hotels have rate parity agreement with OTAs. Furthermore, the results supported the claim that rate parity exacerbates price increase in periods of high demand, which indicates possible collusion between suppliers (hotels) and distributors (OTAs). The findings provided theoretical implications by testing the market efficiency of the hotel room-night market and confirming the impact at the property level. This study also provided a perspective on pricing decision makers to understand how rate parity agreement influence their pricing decisions. Last, the findings provided support for recent policies in Europe that restrict rate parity agreements between hotels and OTAs.</p><p>The third study empirically examined hoteliers’ response to the demand by observing the price movement of two rates with different cancelation policies—free cancelation rates and non-refundable rates. By modifying Hasbrouck’s (1995) information share approach, this study examined the non-refundable rates’ contribution to the price discovery process. The perceived quality of accommodation by customers, one of the primary determinants of the price discovery process, was included in analysis. The results suggested that non-refundable rates were contribute more to the information variance than free cancelation rates did. The findings also suggested that consumers’ perceived quality and volatility influence non-refundable rates’ contribution to the price discovery process. The results also have practical implications for market participants, as they help to build an understanding of aggregated demand and its impact on pricing. Non-refundable rates are generally regarded as just one of many kinds of discounted rates, but the results of this study suggest that hoteliers should carefully consider the role that non-refundable rates play in their pricing strategy.<br></p>

Transfer pricing compliance related issues continue to pose challenges to leaders of multinational entities (MNEs) and tax regulators. MNE leaders strive to mitigate the risks of non-compliance violations and double taxation, while tax regulators seek to minimize profit shifting and revenue losses. This multiple case study explored strategies for managing transfer pricing risks against the backdrop of various risks MNE leaders face for non-compliance violations. The cost contribution agreement theory served as the conceptual framework for this study. Data were collected from organizational documents and semistructured interviews conducted with 6 finance executives representing 2 multinational entities in the midwest and southwest regions of the United States who have implemented successful strategies to manage transfer pricing risks. Data were analyzed using Yin's multiple-step thematic analysis process. Following the thematic data analysis 5 themes emerged, including commitment to tax compliance, tax minimization, advance pricing agreement (APA), comparable uncontrolled price method (CUP), and cost plus method (CPM). MNE leaders favor commitment to tax compliance as an effective strategy as penalties for non-compliance increases risks to business functionality. The findings of this study may help business leaders to follow compliance procedures and adopt risk mitigation strategies, while also informing regulators to update tax regulations to reflect current economic realities. The findings of this study could result in positive social change through an enhanced governmental revenue that stimulates economic growth, improves productivity, and promotes technological innovations.

Die vorliegende Arbeit befasst sich mit der Kenntnis über Patientenverfügungen sowie deren Akzeptanz und dem Vorhandensein dieser Vorsorgedokumente innerhalb eines Studienkollektives von Senioren in Leipziger Alten- und Pflegeheimen. Der Gegenstand der Patientenverfügung selbst wird, unter Berücksichtigung soziodemographischer, persönlicher sowie gesundheitlicher Aspekte, evaluiert. Außerdem werden Standpunkte der Heimbewohner wie beispielsweise die Bereitschaft zu lebensverlängernden Therapien sowie zu Reanimationsmaßnahmen hinterfragt. Vor dem Hintergrund der Ergebnisse werden Lösungsmöglichkeiten diskutiert, welche die Grenze zwischen medizinisch-technisch Möglichen und ethisch Vertretbarem bezüglich der Entscheidungen am Lebensende regulieren können.

Advance care planning is a conversation about personal values, future treatment choices, and designation of a surrogate decision-maker, that someone has in advance of a health crisis. Most existing studies on advance care planning have taken place outside of home health among populations with HIV/AIDS, cancer, dementia, and end stage renal disease. The U.S. home health population is living longer with chronic conditions such as pulmonary and cardiovascular illnesses, and hospitalization is a poor outcome. In 2016, Medicare implemented the Home Health Value-Based Purchasing Model, in which reimbursement rates for agencies in 9 regionally representative states were dependent on quantitative measures of quality performance. Part of the program was a process-level mandate requiring agencies to report on advance care planning. The aim of this study was to examine the relationship of home health advance care planning protocols with hospitalization rates. Descriptive and regression analyses were conducted on survey data of protocols and agency data of demographics and outcomes. Statistical significance was found in the positive correlation between advance care planning protocols and hospitalization. Recommendations are made for broadening the scope of evaluation of quality in home health to include goal-concordant care and transitions to appropriate services.

Background: Globally, cancers are the second leading cause of death. When the cancer can no longer be cured, the care can be re-focused to palliative care. It is then important for patients to be able to participate and influence their care, and the quality of life for patients improves. Advance care planning is a person-centered process, through for example conversations, that supports patients at different stages of health to understand and share their values, life goals and preferences about their future care. Aim: The purpose of this literature review is to describe views on advance care planning in patients with a cancer diagnosis.Method: Literature review based on 16 peer-reviewed qualitative articles that … via specific criteria, these have been quality reviewed, analyzed with thematic analysis, and compiled into a result. Searches were conducted in CINAHL, PubMed and PsycInfo. Results: Advance care planning (ACP) is associated with both positive and negative emotions linked to conducting the conversation, how the conversation is structured, and involving others in the conversation. Three main themes and 7 sub-themes emerged: (1) Views on participating in conversation - Positive to conversation; Negative to conversation. (2) Views on content and execution - The importance of information and how it is presented; The decision-making process. (3) Views on the role of others in the process - Family and other close relatives or friends; Healthcare staff; Spiritual support. Conclusion: Our conclusion is that patients believe that this is an important topic that needs to be addressed more, not only in palliative care but also before patients are in need of palliative care. It is important for the nurse to find out if the patient is ready for conversations, to contribute with the information the patient needs, to support the patient in the decisions they make, and to include relatives in the conversations if the patient so wishes.