This dissertation examines banks' resolution of distressed commercial mortgage loans. Following the introduction in the first chapter, the second chapter reviews the literature on banks' resolutions of distressed loans. In chapter 3, I present a model of banks' resolution decisions under information asymmetry. The model shows that banks prefer to renegotiate instead of foreclosing problem loans when there is a cost associated with revealing the quality of their mortgage portfolios. The fourth chapter presents empirical findings that are consistent with the model, i.e., that banks' resolution decisions are affected by their concerns of revealing negative information through large foreclosures. I find that larger loans are more likely to be renegotiated than smaller loans and that banks take a shorter amounts of time to renegotiate rather than to foreclose on problem loans. Secondly, the impact of loan size on the propensity to renegotiate is magnified for banks with superior past performance and for banks with lower local mortgage distress. In addition, I find that banks that raised new equity capital exhibit a stronger tendency to renegotiate larger problem loans in the previous year. In chapter 5, as a falsification test, I compare the bank-held sample with a Commercial Mortgage Backed Securities (CMBS) sample that does not share banks' mimicking motives, because special servicers of problem loans are not the originators of those loans. I find that the results are weaker or not present for CMBS, in contrast to the bank loan sample. In chapter 6, I study banks' resolution of problem loans while considering their problem loan portfolios. I consider two aspects of banks' problem loan portfolios -- their relationships with borrowers and the degree of regional diversification. Empirical results suggest that the sample banks choose to act "tougher", i.e., foreclose more, as they have more loans with a borrower. Finally, the degree of geographical diversification in problem loan portfolios may affect banks' resolution decisions. I find that as banks have geographically concentrated problem loan portfolios, they are more likely to renegotiate larger loans, measured either absolutely or relatively. Chapter 7 concludes. / text

Given that pandemic swine flu outbreak led to substantial admission in intensive care unit, extracorporeal membrane oxygenation has been increasingly applied to those who suffered from H1N1 infection induced acute respiratory distress syndrome. This review is going to evaluate the effectiveness of using ECMO based on five related observational studies. The result, discussion and policy implication in Hong Kong are discussed. Since the ECMO system has been technological improved in recent years, there are less complications when applying ECMO. In view of evidence of reviewed studies, application of ECMO in Hong Kong can be considered as cost effective. And since only a few hospitals in Hong Kong can offer ECMO application, retrieval teams are needed to ensure safety transfer between hospitals. / published_or_final_version / Public Health / Master / Master of Public Health

In 1946 the World Health Organization (WHO) stated that in order to promote overall health in a given population, it is necessary to identify factors that contribute to health and well-being, and not to solely focus on methods to reduce vulnerability to distress. Over 50 years later the WHO (2006) identified the Lesbian, Gay, Bisexual, Transgender, and Questioning (LGBTQ) community as a specific sub-population that requires particular investment in finding ways to reduce their observed higher rates of distress and suicidality. During this same half-century, U.S. colleges and universities transitioned from being fundamentally mono-cultural student bodies to becoming more multicultural in nature. In essence, each college’s student body is now a population of populations. One prominent population among the larger student body is the LGBTQ college student community. Furthermore, the LGB portion of this college sub-population has been identified as an under-researched subset of the larger LGBTQ population (Russell et al., 2011). This is because past research has been limited by drawing primarily upon non-college adolescent LGBTQ samples and has over generalized its findings by the inclusion of the Transgender and Questioning populations, which have been observed to report even higher rates of distress and suicidality than the LGB community (Clements-Nolle et al. 2006; Goldblum et al. 2012). This study is designed to refine our understanding of the LGB college sub-population by first examining if trends of increased acquired vulnerability for distress and suicidality found in studies of the adolescent LGBTQ population (Garofalo, Wolf, Kessel, Palfrey, & DuRant, 1998; Russell & Toomey, 2010; Haas et al., 2011; King et al., 2008) also exist in the LGB college sub-population. Second, in line with the World Health Organization’s goal of identifying protective qualities capable of enhancing and preserving one’s state of well-being and resilience, this study will be the first to examine if Sense of Coherence (SOC) serves as a moderating factor on LGB college students’ vulnerability to distress and suicidality, and thereby, contributes to overall well-being and health. Through this study, we hope to achieve a better understanding of LGB students’ vulnerability to distress and suicidality during the college years, as well as to examine the applicability of the SOC construct for health promoting interventions in the college population. / text

<p>Breast cancer is the most common type of cancer among women in the United States. Despite more women undergoing treatment and increased survival rates, many women continue to suffer from emotional distress and physical symptoms associated with treatments for breast cancer (e.g., surgery). To date, there has been limited research investigating the efficacy of psychosocial interventions for breast cancer patients during the surgical time frame. This randomized controlled pilot study examined the effect of a lovingkindness meditation intervention on key psychological and physical outcomes surrounding breast surgery. Sixty women undergoing surgery were randomly assigned to one of three treatment conditions at breast biopsy: 1) lovingkindness meditation, 2) music, 3) standard care. Assessments of emotional distress, physical symptoms, and positive psychosocial resources occurred prior to patients' biopsy, following their biopsy, one week after receipt of their biopsy results, and one week following breast surgery. Multilevel model analyses demonstrated that lovingkindness meditation significantly improved anxiety, pain, self-compassion, emotional suppression, mindfulness, social isolation, and heart rate levels over time compared to control conditions. These results support the efficacy of a brief lovingkindness meditation intervention for breast cancer patients during the surgical time frame. The implications of these findings on future research, theory, and policy are discussed.</p> / Dissertation

Recent studies have shown that sexual functioning and sexually related personal distress are weakly related in women, with only a minority of sexual difficulties resulting in significant levels of distress. However, there has been little systematic research to date on which factors moderate the relationship between sexual functioning and sexual distress. Our aim was to assess the degree to which relational intimacy and attachment anxiety moderate the association between sexual functioning and sexual distress in college-age women. Two hundred women (mean age = 20.25) completed surveys assessing sexual functioning, relational intimacy, attachment anxiety, and sexual distress. Relational intimacy and attachment anxiety moderated the association between multiple aspects of sexual functioning and sexual distress. For lubrication and sexual pain, functioning was more strongly associated with distress in low-intimacy vs. high-intimacy relationships, but only for women with high levels of attachment anxiety. Results regarding desire were mixed and neither intimacy nor attachment anxiety interacted with subjective arousal or orgasm in predicting distress. We conclude that both relational intimacy and attachment anxiety are important moderators of the association between sexual functioning and subjective sexual distress in women. Theoretical and practical implications are discussed. / text

Acute Respiratory Distress Syndrome (ARDS) is the most extreme form of acute lung injury and continues to have a significant morbidity and mortality. Unfortunately, the mechanisms involved in the recovery and repair of the lung following ARDS remain poorly understood. An understanding of these is pivotal to improving outcome from acute lung injury. Several observational studies have suggested a potential relationship between Vascular Endothelial Growth Factor (VEGF) in the lung and the development/outcome of ARDS. In this thesis, three potential mechanisms underlying these observations have been explored: 1. What is the anatomical distribution of VEGF receptor and isoform expression in normal and ARDS lung? How does this change at early and later time points following acute lung injury? 2. Are human type 2 alveolar epithelial (ATII) cells a source of and target for VEGF? How does exposure to a pro-inflammatory milieu modify their expression of VEGF isoforms and receptors? 3. Is there a relationship between a functional VEGF polymorphism and susceptibility to developing and severity of ARDS? I have demonstrated VEGF receptor expression on both sides of the alveolarcapillary membrane with upregulation in later ARDS. All three principal isoforms (VEGF121, VEGF165 and VEGF189) are expressed in normal human lung with uniform downregulation of all three in early ARDS, which normalises with increasing time following injury. I have not found any evidence of VEGF isoform switching. I have also demonstrated human ATII cells are both a significant cellular source of and a target for VEGF (via VEGF receptor expression) confirming autocrine VEGF activity in the lung. VEGF is an ATII cell survival factor. ATII cells differentially respond to pro-inflammatory stimuli by increasing VEGF isoform but not receptor expression, which may serve as a regulatory control mechanism. Finally, I have demonstrated the VEGF 936 T allele increases susceptibility to and the severity of lung injury. The T allele is associated with an increase in plasma VEGF level in ARDS patients but intra-alveolar levels are unaffected.

This thesis explores distress and reactions after crime by a previously unknown perpetrator in a two-year perspective. Distress was investigated at eight months and two years, using quantitative and qualitative methods. The specific aims of the thesis were (I) to explore the level of distress and the role of risk factors for post-traumatic and general symptoms eight months post crime, (II) to examine the natural course of adjustment at a two-year follow-up in female and male victims of interpersonal violence, III) to investigate the relationship between shame, guilt, and distress among 35 victims of a single severe violent crime, and (IV) to use qualitative analysis to describe individual post-crime trajectories. The following questionnaires were used: Symptom Check List 90 (Derogatis &amp; Cleary, 1977), Harvard Trauma Questionnaire (Mollica et al., 1992), the Test for Self-Conscious Affect (Tagney et al., 1989). Data were also obtained via semi-structured interviews, including the use of visual analog scales for subjective mental health measures. The participants in paper I were male and female Swedish adult victims of reported interpersonal violence eight months earlier. Participants were between 18 and 66 years of age (n=41). At follow-up (Paper II) the sample size had decreased (n=35). In paper III, adult victims (aged 18-64) of reported interpersonal violence were assessed within two weeks of reported crime (n=35). In paper IV a subsample of 11 adult crime victims were drawn from among the participants from papers I and II. Paper I showed that women reported more distress than men. Prior trauma, adverse childhood, female sex, previous psychiatric history, and unemployment were all associated with more distress. Peritraumatic reactions (especially secondary emotions following cognitive appraisals after the event) predicted the three core PTSD symptoms and comorbid conditions, together with female sex and psychiatric history. Paper II confirmed most of the risk factors at eight months and that, in general, no further recovery took place between eight months and two years. Paper III showed that shame-proneness and event-related shame were highly intercorrelated and related to higher symptoms levels, while the guilt measures were unrelated to each other as well as to symptoms. Paper IV explored narratives of victimization; the results suggest that individual differences within the same trajectories of recovery should be expected.

Neonatal respiratory distress syndrome (RDS) is a disease that affects premature infants born prior to 32 weeks gestation. The main cause is a deficiency in pulmonary surfactant due to immature type II pneumocyte cells found in the alveoli. These cells are not capable of producing the required surfactant which normally functions to reduce the surface tension at the air-liquid interface of the lungs, as well as reduce the work of breathing and prevent alveolar collapse. A current treatment method for RDS is exogenous surfactant replacement therapy involving application of an exogenous surfactant preparation directly into the lungs of premature infants. Current surfactant preparations are animal-derived and very costly. Synthetic preparations, on the other hand, are an attractive alternative. The goal of this research is to synthesize a diether phosphonolipid analogue of dipalmitoyl phosphatidylcholine (DPPC), designated DEPN-8. When incorporated into a synthetic exogenous surfactant mixture, DEPN-8 exhibits greater adsorption and surface activity compared to its natural counterpart, DPPC. The synthesis of several components related to the re-tailored synthesis of DEPN-8 will be presented and discussed below. / National Institute of Health, NSERC

Sjuksköterskor upplever stora krav och stor belastning i sitt dagliga arbete, dels från patienter, dels från kollegor och dels från sig själva vilket gör att de ofta känner sig otillräckliga. Den stora fysiska och psykiska belastningen leder till att sjuksköterskor känner oro över kvaliteten på vården vilket ger upphov till moralisk stress. Sjuksköterskor upplever moralisk stress i högre grad än andra professioner och är en betydande orsak till att sjuksköterskor avslutar sin anställning. I tidigare forskning har få studier moralisk stress som huvudsyfte. Därför syftar denna allmänna litteraturstudie till att undersöka närmare vad sjuksköterskan upplever i sin moraliska stress. Syftet var att beskriva sjuksköterskans upplevelser av moralisk stress. För att besvara syftet valdes 13 kvalitativa vetenskapliga artiklar ut. I resultatet framkom sex kategorier: Maktlöshet, Frustration, Vånda, Ilska, Självtvivel och Skuld. Maktlöshet har en betydande roll och många av de andra känslorna bottnar i maktlösheten. Maktlöshet beror framförallt på att sjuksköterskan inte känner sig delaktig i beslutsfattandet kring patienten. För att minska sjuksköterskans moraliska stress kan samverkan mellan professioner främjas. Vidare svensk forskning kan behövas för att identifiera om moralisk stress är en bidragande orsak till rådande sjuksköterskebrist. / Nurses are experiencing huge demands and big loads in their daily work, both from patients and from colleagues and from themselves so that they often feel inadequate. This great physical and psychological workload means that nurses are concerned about the quality of care which gives rise to the moral distress. Nurses are experiencing this moral distress at greater extent than other professions and is a major reason why nurses quit their jobs. In previous research, few studies have moral distress as their main purpose. Therefore this general literature review intends to look more closely at what the nurse is experiencing in his or her moral distress. The purpose was to describe the nurse's experiences of moral distress. For this purpose, 13 qualitative research articles were selected and the results revealed six categories: Powerlessness, Frustration, Agony, Anger, Self-doubt and Guilt. Powerlessness has a significant role and contributed to many of the other emotions listed. Powerlessness is mainly due to the nurse not feeling involved in decision-making regarding the patient. To reduce the nurse's moral distress collaboration between professions could be encouraged. Further Swedish research could be needed to identify whether moral distress is a contributing factor to the current nursing shortage.

Children undergoing surgical procedures often experience pain in the recovery room where parents are typically responsible for managing children’s distress. Research suggests that parents’ behavior influences children’s distress; however, no study has used time-window sequential analysis to examine the likelihood of parents’ reassurance and children’s distress interactions. The purpose of this study was to utilize time-window sequential analysis to examine the likelihood of parents’ distress preceding and following the start of children’s distress. Participants included 148 families with children 2-11 years old undergoing outpatient surgery. Reassurance was positively associated with children’s distress, but sequential analyses revealed that children’s nonverbal distress was significantly less likely to start and stop following parents’ reassurance and children’s verbal distress was significantly less likely to occur after fathers’ reassurance. These data suggest that reassurance does not prompt distress to start; however, it may maintain children’s distress.