In the United States, rural hospital closures increased 34% since 2015 due to financial reasons, affecting access to healthcare services in rural communities. For rural hospital leaders, improving the hospital's financial performance is a valuable strategic goal. This multiple case study was designed to explore strategies that rural hospital leaders implement to improve their hospital's financial performance in Arizona, Georgia, Illinois, Oklahoma, Pennsylvania, and the United States Virgin Islands. The strategic decision-making framework supported the study because top leaders make decisions that affect the organization's health and survival. Fifteen rural hospital leaders who maintain their hospital's financial stability provided hospital documentation and pertinent strategic information from their respective semistructured interviews. Sections of text signifying concepts from collected documentation and transcribed interviews were organized and coded according to research question and interview questions to explore strategies rural hospital leaders implemented to improve their hospital's financial performance. The methods triangulation process encompassed comparing findings from the interview themes and hospital strategic documentation analysis. The key themes that emerged from coded data were rural hospital leaders' decision-making when addressing rural hospital financial performance, developing synergies with external providers and hospitals, creating effective short-term and long-term strategies, and translating success to the entire organization. Implications for social change include the potential to prevent rural hospital closure and ensure access to healthcare services for the communities rural hospitals serve.

Nutrition labeling research suggests consumers want nutrition information on the label; however, many do not comprehend it. The purpose of Phase I was to determine the effect of: 1. two levels of nutrition label formats; 2. three levels of nutrition information load on consumers' preference for product choice using adaptive conjoint analysis. A computer interactive interview was conducted on 252 consumers in Crossroads Mall, Salt Lake City, Utah. label alternatives were printed on soup cans to realistically portray the information. The conjoint analysis compared the attributes, nutrition information format, and nutrition information load in addition to brand and price and determined how the study participants ranked choices within each of these attributes and against the other attributes. There were significant differences (p < .000) among all three mean utility values± Standard Error of the Mean (SEM) of information load, most (.300 ± .03) , more (.154 ± .02), and some (-.231 ± .03). There was no difference between graphical (.093 ± .027) and traditional (.055 ± .020) formats (p = .298). For the other attributes, there were significant differences (p < .000) among all brands, Campbell's (.590 ± .03), Private label (-.007 ± .02) Generic (-.361 ± .03) and all prices, (p < .000), low (.431 ± .03), medium (.022 ± .02), and high (-.230 ± .03). Market simulations were performed and market share was shifted from the major brand when nutrition information was added to a Private label or Generic brand. The purpose of Phase II was to determine the effect of: 1. three levels of nutrition information content load; 2. two levels of nutrition information order; 3. three levels of nutrition information format; and 4. four levels of nutrition information expression on consumers' perceptions of label usefulness in purchase decisions. The methodology was the same as Phase I. There were significant differences (p < .000) among all three mean utility values ± SEM of information load, most (.327 ± .02), more (.091 ± .02) , and some (-.213 ± .03), and between the two mean utility values ± SEM of information order, rearranged (.157 ± .03) and traditional (-.02 ± .02). Consumers significantly preferred (p < .000) the graphical format (.148 ± .02) over the graphical nutrient density (.038 ± .02) and traditional (.018 ± .03) formats. Consumers significantly preferred (p < .000) nutrition information stated in absolute numbers and percentages (.296 ± .03), versus absolute numbers only (.028 ± .03), traditional (-.026 ± .03), and percentages only (-.025 ± .03) expressions. The most useful nutrition label in a purchase decision was one that contained the most information, in a rearranged order, with a graphical format, and an absolute number and percentages expression.

A dissertação Por que pacientes com câncer vão à Justiça? Um estudo sobre ações judiciais movidas contra o Sistema Único de Saúde (SUS) e contra os planos de saúde na Cidade de São Paulo descreve e analisa as decisões judiciais proferidas entre 2015 e 2017 pela segunda instância do Tribunal de Justiça do Estado de São Paulo em ações judiciais que demandaram tratamentos para neoplasias. Foram analisadas 1.951 decisões judiciais, sendo 157 delas (8,05% do total) relacionadas ao Sistema Único de Saúde (SUS) e 1.794 (91,95% do total) envolvendo empresas de planos e seguros de saúde privados. A maioria das decisões foi favorável (96,57%) tanto aos pacientes do SUS (88,54%) quanto da saúde suplementar (97,27%). A negativa de cobertura de quimioterapias foi o tema mais frequente nas decisões analisadas (47,00%), presente em 44,87% das decisões contra os planos de saúde e em 71,34% das decisões contra o SUS. O principal motivo alegado pelos gestores para essa recusa é o fato de o tratamento pleiteado não estar contemplado no Rol de Procedimentos e Eventos em Saúde da ANS ou nos protocolos do SUS. Conclui-se que os planos de saúde, se comparados ao SUS, são mais frequentemente reclamados na Justiça por pacientes de câncer, bem como que o Tribunal pesquisado tem posicionamento fortemente favorável aos pacientes. Há similaridades e diferenças na judicialização de tratamento para câncer demandados contra os setores público e privado da saúde. O estudo contribui para discussão e estudos futuros sobre a relação da judicialização da saúde com a qualidade da rede assistencial, a incorporação de tecnologias, as políticas públicas, a regulamentação e a fiscalização das atividades dos planos de saúde / The essay Why cancer patients go to justice? A study on lawsuits filed against health plans and against the SUS in the City of São Paulo describes and analyzes the judicial decisions handed down between 2015 and 2017 by the Court of Appeal of the State of São Paulo, in lawsuits that claimed for treatments for neoplasia. 1,951 judicial decisions were analyzed, being 157 of them (8,05%) related to the unified health system (SUS) and 1,794 (91,95%) involving companies of private health insurance plans. Most of the decisions was favorable (96,57%), both for SUS patients (88,54%) as for health plans patients (97,27%). The denial of coverage of chemotherapy was the most frequent issue in the decisions analyzed (47.00%), present in 44.87% of decisions against health plans and in 71.34% of decisions against the SUS. And the main reason alleged by the managers for such refusal, it was that the claimed treatment is not included in the list of procedures and events in the Health ANS or in protocols of the SUS. It is concluded that the health plans, if compared to the SUS, are most frequently claimed in court by cancer patients, and that the researched Court has a strong patient favorable position. There are similarities and differences in cancer treatment judicialization defendants against the public and private health sectors. The study contributes to the discussion and future studies on the relation of health judicialization to the quality of the health care network, the incorporation of technologies, public policies, regulation and supervision of health plan activities

A quantitative survey was conducted in two Canberra hospitals that aimed at ascertaining the impact of information provided by medical libraries on clinical decision making. Specifically, this research study investigated clinical, cognitive and quality value of information provided by the medical librarians to the management of patients and doctors' ability to handle clinical cases differently as a result of such information. Furthermore, the relative value of information received from the library was assessed by comparing it to the value of information received from other sources in dealing with clinical problems. The research involved medical specialists and registrars affiliated with these hospitals. Doctors were asked to select any clinical situation which they frequently or currently encounter and for which further information would be useful to them. Once their information requests were identified, they were then asked to present such requests to the hospital library. In order to avoid any special treatment, participants were urged not to identify themselves to the library staff as partaking in the study. It was important that participants did not search for the information themselves. The doctors were asked to evaluate the material provided by the library in relation to clinical care and, thereafter, complete a short questionnaire. This research took place between October 1994 and March 1995. The questionnaires were sent to 288 doctors. This represented the total population of specialists and registrars affiliated with both hospitals at the time of the study. Analysis of the results is based on a 34% useable response rate. Medical specialists were by far the higher number of respondents (70%) as compared with registrars (30%). Eighty-one per cent of the doctors said that the information provided by the library refreshed their memory and 82% said that it would contribute to better quality of medical care. Eighty-six per cent indicated that some of this information was new to them and 99% said that the information provided was up to date. Ninety-four per cent said that the information provided by the library was of clinical value to them. As the result of the information provided by the library 75% of respondents would either definitely or probably handle some aspects of the clinical situation differently than they would have done it otherwise. The level of importance of the change for the optimal care of patients was assessed with 54% regarding it as important, 42% as moderately important. Specifically, as the result of the information provided, the doctors were able to change the following: diagnosis 10%, choice of lab tests 20%, choice of other diagnostic investigations 24%, choice of drugs 27%, choice of other management 58%, reduce length of hospitalisation 10%, post-operative care of patients 25%, advice given to patients 47%. On the basis of the received information the doctors were able to avoid the following: hospitalisation of patients 11%, risk of hospital acquired infection 8%, surgical intervention 19%, tests or other investigation 23%, additional out-patient visits 12%. Discussions with colleagues were reported to be most valued sources of information for the purpose of clinical decisions (59%), followed by diagnostic imaging (49%), librarian (45%), lab tests (42%) and patients' medical records (30%). The librarian's role as contributing to the process of clinical decisions was rated highly with 88% ranking it as either important or moderately important. The results of significance p test statistic performed at 0.05 significance level suggested that, for this study, there was a significant relationship between the frequency of library use and doctors' ability to change the choice of laboratory tests, diagnostic investigations, and the choice of prescribed drugs. The results of this research study demonstrate that medical librarians can positively contribute to clinical management of patients by providing timely and accurate information. Further research is recommended in order to determine the impact of the whole range of library services on health care outcomes.

<p>This thesis investigates the adaptation to climate change that is taking place in the WaterSupply and Waste Water (WSW) sector of the Stockholm Region. The adaptation processis analyzed in terms of building adaptive capacity and implementing adaptive decisions.Theories on organizational learning and the concept of an organization’s adaptation spaceare used to understand the factors that influence the adaptation process and the capacityof the studied WSW organizations to adapt to climate change. A case study approach hasbeen used and by focusing the research on four regional WSW organizations – thatcomprise a majority of the region’s WSW activities – it is argued that conclusionsrelevant to the region’s WSW sector as a whole can be made. Semi-structured interviewswith the complete management board – in three out of four organizations – and officialdocuments and reports, are the main sources of primary data for the analysis.The results show that adaptation to climate change is occuring in the WSW sector of theStockholm Region. The adaptation is mainly taking the form of building adaptivecapacity and there is only limited evidence of implementation of adaptive decisions. Theresearch suggests that there are few technical and organizational limitations foradaptation to take place and that the main factors influencing the adaptation space of thesector is how the climate change issue and risks are interpreted and perceptions of howthe WSW organizations should function and use their limited economical resources. Twoconclusions are drawn from these results: first, factors influencing the feasibility andattractiveness of different adaptation options need to be included and analysed in order tounderstand the actual adaptation space of an organization. Second, due to the factorsidentified as influencing the adaptation space, it is unlikely, at present, that robustinfrastructure solutions – which have been suggested in the literature as a viable way todeal with the intrinsic uncertainties related to climate change – can be implemented in theWSW sector of the Stockholm Region solely due to concerns of climate change.</p>

Condictio indebiti innebär att felaktiga betalningar skall gå åter. Banker har emellertid svårt att förlita sig på denna huvudregel. Bankernas centrala ställning i samhället kombinerat med deras uppgift att korrekt förmedla transaktioner, försätter dem i en förtroendeställning. Mottagaren skall kunna lita på att en utbetalning från en bank är korrekt. Bankernas utbetalningar har blivit ett genomgående undantag till principen om condictio indebiti. Praxis har stadgat att banker i princip aldrig återfår en felaktig utbetalning. Av detta kan en ny huvudregel för banker konstateras, att en felaktig utbetalning från en bank skall kvarstå hos mottagaren. Liknande strikta regler finns för förvaltningsmyndigheter. Förvaltningsmyndigheter meddelar beslut och uppsatsen fokuserar på beslut av gynnande karaktär. Det vill säga beslut som innebär någon form av fördel för mottagaren, till exempel tillstånd, ekonomiskt bistånd eller bifallen ansökan. Huvudregeln för gynnande förvaltningsbeslut är att dessa inte kan återkallas utom i fyra undantagsfall. Detta på grund av att den enskilde skall kunna förlita sig på beslutet och inrätta sig efter det. Huvudregeln för återkallelse av förvaltningsbeslut och den nya huvudregeln för återbetalning till banker, är lika. Anledningen till svårigheten att återkalla/återfå något från den gynnade parten är att både banker och myndigheter anses ha en förtroendeställning. Förtroendeställningen beror dels på den enskildes trygghetsperspektiv men även på bankers och myndigheters större möjligheter att ha en god överblick över dessa situationer. Begränsningarna i återkallelse/återbetalning motiveras vidare med att det alternativ som är minst kännbart, skall väljas.  Detta resulterar i att mottagaren av beslutet eller transaktionen i princip alltid påverkas mer om återkallelse eller återbetalning skulle ske, än vad banker eller myndigheter påverkas av att beslutet eller transaktionen kvarstår. Likheterna i dessa motiveringar visar att banker behandlas, trots att de är att anses som privaträttsliga subjekt, såsom ett offentligrättsligt subjekt. / The principle of condictio indebiti means that a faulty transaction should be repaid. This general rule is however, not easily applicable on banks.  The central position the banks possess in our community combined with one of its main tasks, to correctly manage transactions and payments, put the banks in a position of trust. Customers should have unconditional trust in a transaction from a bank and its correctness. Hence, the bank has become an exception to the principle of condictio indebiti. Case studies have shown that banks will never be repaid for a faulty transaction. According to this, a new principle can be stated, that a faulty transaction from a bank shall remain with the recipient. Similar strict rules are to be found for the administrative authorities. Administrative authorities pass decisions and this essay focuses on decisions of favorable character. That is decisions that involve some kind of benefit for the recipient such as; permissions, financial assistance and approved applications. The general rule for favorable administrative decision is that these can not be withdrawn because the recipient should be able to trust, and act according to, a decision of an administrative authority. The general rules for these actions, withdrawal and reimbursement, are similar. The reason for the difficulty in withdrawal and reimbursement is that both banks and administrative authorities are considered to have a position of trust. The individual should always be able to trust an action from these two institutions. The position of trust is based on individuals need for security and that banks and administrative authorities have more knowledge and ability to overview the situation. Withdrawal and reimbursement should therefore never be preceded if it generates a disadvantage for the individual. The court should select the available option resulting in least negative impact. This justifies the difficulties in withdrawing or reimbursing an action that is favorable for the individual. Withdrawal and reimbursement will often have more negative impact on the recipients compared to how it affects banks and administrative authorities if the transaction or decision withstands. These similarities show that banks are treated as a public entity even though they are regarded as a private entity.

Sammanfattning Syftet med litteraturstudien var att beskriva sjuksköterskors inställning till eutanasi. Metoden var en beskrivande litteraturstudie. Av 220 artiklar valdes 14 artiklar med kvalitativ eller kvantitativ ansats. Resultatet visade att eutanasi är en komplex fråga där olika etiska och moraliska aspekter spelar in. Sjuksköterskorna ansåg att eutanasi kunde vara etiskt försvarbart för värnandet av patientens autonomi, vid svår obotlig sjukdom, om alla andra behandlingsmetoder blivit uttömda samt om patienten själv tog upp förfrågan om eutanasi. Argument emot eutanasi var att sjuksköterskan har en livsbevarande roll, att risk för missbruk av eutanasi kan förekomma samt religiösa skäl. Yngre deltagare och de med lägre utbildning var mer positiva till eutanasi medan äldre sjuksköterskor och de med högre utbildning hade en mer negativ inställning. Inställningen till eutanasi skilde sig beroende på vart sjuksköterskorna arbetade t.ex. vid intensivvårds-, palliativ- eller pediatrisk vårdavdelning. De som arbetade inom pediatrisk och palliativ vård var i högre omfattning emot mot eutanasi. Sjuksköterskor som uppgavs sig vara religiösa var mer negativt inställda till eutanasi och till legalisering av eutanasi. I länder där eutanasi är legaliserat pågår diskussioner om sjuksköterskans roll inom eutanasivården och dess beslutsprocess. Slutsatsen är att frågor kring eutanasi är viktigt att undersöka, inte bara allmänhetens inställning utan även olika professioners reflektioner. Debatten kring eutanasi kommer att fortgå.   Nyckelord: eutanasi, sjuksköterskors inställningar, palliativ vård, beslut i livets slutskede / Abstract The aim of this literature review was to describe nurse’s attitudes towards euthanasia. The method used was a descriptive design. Of the 220 hits, 14 was chosen by CINAHL and PubMed (MedLine) and then analyzed. Both qualitative and quantitative aspects were included. The results showed that euthanasia is a complex issue where many ethical and moral aspects come in to play. The nurses felt that euthanasia was ethically acceptable for safeguarding patient autonomy, but also when patients’ suffered from incurable disease and severe pain therefore requested euthanasia. Arguments against euthanasia where directed towards the nurse’s role as lifesaver and preserver of life, the risk of misuse and religious beliefs. The study showed that younger nurses and those with lower formal education where more prone to the use of euthanasia than elderly nurses and those with higher education. Attitudes toward euthanasia differed depending on what type of ward the nurses worked in, for example at intensive care units, palliative care or pediatrics. Those who work in pediatric wards or with palliative care are those who more often oppose the use of euthanasia. Nurses who described themselves as religious often argued against the use of euthanasia and its legislation. In countries where euthanasia is legal there is an ongoing debate about nurses’ role in euthanasia and in its decision processing. The conclusion is that questions regarding euthanasia are important to investigate, not only by exploring the public’s attitudes but also by exploring the reflections of professionals. The debates will continue regarding euthanasia.  Keywords: Euthanasia, nurses’ attitudes, palliative care, end of life decisions

Forskare skriver om att ledarskap grundar sig i de egenskaper en person besitter, situationer en person befinner sig i och roller en person tar sig an. Ledarskapsfenomenet i ett tillverkande företag har en intressant angreppsvinkel. Med en snabb teknisk utveckling, är det lättare att byta ut mänsklig arbetskraft och med expansionen av självstyrande team är ledarpositionen i tillverkande företag ifrågasatt. Trots dessa aspekter har den humanitära aspekten i företag idag fått en allt större roll. Idag läggs ett större fokus på att tillfredställa personalen och se till deras välmående. De anställda i tillverkande företag är av större betydelse idag då de är bland de viktigaste tillgångarna i en effektiv produktionsprocess. Detta leder till ett större ansvar för en produktionsledare som ansvarar för produktionsprocessen samt personalen. Större fokus måste läggas på den sociala aspekten hos en ledare för att få de anställdas respekt och förtroende. Rätt kompetens och rätt egenskaper är viktiga hos en ledare för att kunna leda sina anställda till en bättre organisation. En annan viktig aspekt för ett företags framgång är de roller en ledare tar sig an vilka kan leda till en effektivare process. Produktionsledarens allt mer viktiga roll i tillverkande företag har lett till den här studiens forskningsfråga: Hur påverkar produktionsledarens ledarskap produktionsprocessen i ett medelstort företag? En fallstudie har skett på Kalmar Lantmäns med en avgränsning mot deras produktionsprocess. I denna studie har vi använt oss av en kvalitativ forskningsdesign. Fokus har legat på semistrukturerade intervjuer som primär datainsamling. 15 intervjuer med ledare och personal i Kalmar Lantmäns produktionsprocess hölls. Teorin har sammanställts av vetenskapliga artiklar och litteratur med fokus på egenskaper, roller samt effektivitet inom ledarskap. Studiens slutsats visar att produktionsledaren påverkar produktionsprocessen genom de egenskaper denne besitter, vilka roller denne tar sig an samt vilka beslut han eller hon fattar. Hur en produktionsledare agerar i vissa situationer kan vara avgörande för hur denne påverkar processen. En produktionsledare skall vara bestämd och rättvis samt ha en hög social kompetens. Studien visar att en produktionsledare inte skall ha en för privat relation till sina anställda, personalen vill ha en ledare, inte en vän. / The problem with not being able to define what good leadership really is, makes the phenomenon so much more interesting. Scientist writes that leadership is formed in the abilities, situations and roles a person takes on. The phenomenon of leadership in a producing company is an even more interesting angle. With a fast moving technology market, the handcraft of human resources is easily replaced and with an expansion in self-managed teams the leader position is questionable. Although one might think that the people of organizations could be replaced in today’s producing organizations, the reality tells us something different. Human resources today have gained an increased attention towards the wellbeing of organizations employees. The people of a producing organization are of greater importance today, them being one of the keystones to an effective production process. This leads to a greater responsibility for the leader, being responsible for the production process and the people within it. A greater emphasize has to be put on the social skills of the leader to gain the trust and respect of the employees. The right competences and abilities of a leader are vital in order to be able to lead the employees to a greater organization. The roles which a leader chooses can lead to a better process. The importance of the production leader has lead to our research question: How does the leadership style of a production leader affect the production process in a middle-sized company? A case study was made at Kalmar Lantmän limited to the production process. In this study a qualitative research design has been used. Focus has been on semi-structured interviews as a primary soruce of data. 15 interviews with leaders and personnel in the production process were made. The theoretical framework has been collected from scientific articles and literature with a focus on attributes, roles and efficiency in the leadership area. The result of this study shows that a production leader can affect the production process through the attributes he or she has, through the roles he or she chooses to take and through the decisions the leader makes. How a production leaders acts in different situations can be vital in how he or she affect the process. A production leader should be firm and fair and have a high level of social competence. This study shows that a production leader should not have a too private relationship with his or hers employees, the personnel wants a leader, not a friend.

Although finance has been studied for thousands years, behavioral finance which considers the human behaviors in finance is a quite new area. Behavioral finance theories, which are based on the psychology, attempt to understand how emotions and cognitive errors influence individual investors’ behaviors (investors mentioned in this study are refered to individual investors). The main objective of this study is exploring the behavioral factors influencing individual investors’ decisions at the Ho Chi Minh Stock Exchange. Furthermore, the relations between these factors and investment performance are also examined. As there are limited studies about behavioral finance in Vietnam, this study is  expected to contribute significantly to the development of this field in Vietnam.  The study begins with the existing theories in behavioral  finance, based on which, hypotheses are proposed. Then, these hypotheses are tested  through the questionnaires distributed to individual investors at the Ho Chi Minh Stock Exchange. The collected data are analyzed by using SPSS and AMOS soft wares. Semi-structured interviews with some managers of the Ho Chi Minh Stock Exchange are conducted to have deeper understanding of these behaviors. The result shows that there are five behavioral factors affecting the investment decisions of individual investors at the Ho Chi Minh Stock Exchange: Herding, Market, Prospect, Overconfidence-gamble’s fallacy, and Anchoring-ability bias. Most of these factors have moderate impacts whereas Market factor has high influence.  This study also tries to find out the correlation between these behavioral factors and investment performance. Among the behavioral factors mentioned above, only three factors are found to influence the Investment Performance: Herding (including buying and selling; choice of trading stocks; volume of trading stocks; speed of herding), Prospect (including loss aversion, regret aversion, and mental accounting), and Heuristic (including overconfidence and gamble’s fallacy). The heuristic behaviors are found to have the highest positive impact on the investment performance while the herding behaviors are reported to influence positively the investment performance at the lower level. In contrast, the prospect behaviors give the negative impact on the investment performance.

This dissertation presents an evaluation of coprolite specimens from the Lower Pecos canyonlands as records of individual dietary decisions. Prior studies of coprolites from this region have greatly expanded our knowledge of Archaic subsistence patterns, but have not taken full advantage of the record of individual dietary decisions recorded in each coprolite specimen. The menu, or dietary combinations, reflected in individual coprolite specimens are assessed through the identification of several congruent botanical components derived from the same food resource, phytoliths, fiber ultimates, and epidermal sheets. The data is analyzed with hierarchical cluster analysis, an exploratory statistical technique. The resultant menus reflected in these clusters are evaluated with reference to the diet-breadth model developed for the known staple resources of the canyonlands as well as the seasonal subsistence patterns observed in the ethnohistoric record of modern-day Mexico and Texas. This same technique is also applied to the coprolite data available from previous studies in the Lower Pecos canyonlands. Overall, the combined dietary data available for the Lower Pecos canyonlands presents a similar dependence on desertic plant resources throughout the Archaic. Three main menus are apparent in the specimens. The first menu consists of prickly pear (Opuntia sp.) cladodes, or nopales, and was principally, although not exclusively, consumed in the late spring. This menu is primarily consumed when other resources were not readily available and may be considered a dependable but undesirable meal. The second menu consists of pit-baked lechuguilla (Agave lechuguilla) and sotol (Dasylirion sp.) caudices, or hearts, common throughout the cool season. This menu entails high processing costs, but would provide a reliable caloric return. The third menu exhibits a monolithic reliance on prickly pear fruits, or tunas, during the summer. The ease of harvest and consumption is reflected in the seasonal dominance of this resource, which was assuredly a highly desirable meal. The dietary patterns recorded in the coprolite specimens from the Lower Pecos canyonlands demonstrate a seasonally variable diet-breadth that incorporated low-ranked resources during times of seasonal scarcity as well as a monolithic dependence on high-ranked resources when they were available in the local landscape.