Following spinal cord injury (SCI), bladder management is of primary importance. As an activity of daily living (ADL), it affects community integration and quality of life (QOL). Women with SCI have neurogenic bladders that require self-catheterization, but they are unable to catheterize the native urethra, thus making bladder management physically and emotionally challenging. The purpose of this study was to understand the experiences of women with SCI who undergo urinary diversion surgery for bladder management. Qualitative data were collected using semistructured interviews from 10 women with SCI after urinary diversion surgery for bladder management. Qualitative Nvivo analysis of interview data was based on cognitive adaptation theory, which emphasizes adaptation to life-threatening events. Analysis showed improved quality of life among these 10 women, with improvements in independence, convenience, aesthetics, confidence, and sexuality. The women's lived experiences also showed enhanced privacy, dignity, normalcy, and safety. The lack of awareness in health care workers to offer this procedure was universally highlighted by participants. The social change implications include the need to advocate for women with SCI with bladder management needs who are unaware of this surgery option. Understanding the bladder management needs of women with SCI may help this population make choices for a better quality of life.

Ce travail présente le développement d’une nouvelle approche pharmacoépidémiologique, reposant sur les bases de données de l'assurance maladie, permettant de caractériser et d’estimer le détournement d’usage de médicaments psychoactifs. Cette approche utilisant la méthode de classification, regroupe, a posteriori, les sujets en différents sous-groupes, menant à l’identification, la caractérisation et la quantification de différents profils de comportement dont le comportement déviant. Nous avons appliqué cette méthode sur plusieurs médicaments. Pour chaque médicament, nous avons inclus l'ensemble des sujets affiliés au régime général des régions PACA et Corse ayant eu un remboursement. Leurs délivrances ont été suivies sur 9 mois. Après une analyse descriptive, une méthode de classification est appliquée, suivie d’une analyse des différents sous-groupes.Un premier travail a permis de confirmer l'importance du détournement d'usage d'une molécule émergente, le clonazépam (publication n°1). Ensuite nous avons adapté notre méthode afin de pouvoir suivre l'évolution sur plusieurs années de ce détournement (publication n°2). Nous avons appliqué cette méthode pour souligner l’existence, sur plusieurs années, du détournement d'usage du méthylphénidate (publication n°3). Notre équipe avait également développé une autre méthode pour estimer la polyprescription (publication n°4). Enfin, nous avons appliqué de façon conjointe ces deux méthodes (publication n°5). La méthode de classification est de plus en plus utilisée afin de surveiller l'évolution du détournement d'usage de médicaments et commencent à être intégrés au système français de surveillance de l’abus de médicament.aux cotés des autres outils pharmacoépidémiologiques plus traditionnels (OSIAP, OPPIDUM, OPEMA, ASOS, DRAMES). / This work presents the development of a new pharmacoepidemiologic method. This methodallows to estimate abuse of psychoactive prescription drugs in real life using prescriptiondatabase. The method is based on a cluster analysis which is a statistical method used todetermine, a posteriori, different subgroups of subjects. According the subgroups’characteristics, we can determine and estimate different behaviours whose subjects with adeviant behaviour. It assesses the rate of subjects with a deviant behaviour among all thesubjects that obtain the drug from a pharmacy.We used this method on several prescription drugs. For each prescription drug, we includedall individuals, affiliated to the French health reimbursement system of two southern Franceareas (Provence-Alpes-Côte-d’Azur and Corsica), who have had a prescription drugreimbursed during the first weeks of the year. Their deliveries have been monitored over a 9month-period. After a descriptive analysis, a clustering method has been used. The fourquantitative variables used to establish profiles of consumers were : number of differentprescribers, number of different pharmacies, number of dispensings and quantity dispensed(DDD). Finally, the characteristics of different subgroups have been presented, especiallythose with a deviant behavior.The first study using this method allows to confirm and assess the magnitude of the abuseliability of an emerging prescription drug as clonazepam (publication n°1). Then we adapt thismethod in order to follow the abuse evolution during several years. In the second publicationon clonazepam, we identified that the proportion of deviant subjects has increased between2001 and 2006 (from 0.86% to 1.38%). We also applied this method to estimatemethylphenidate abuse during several years (from 2005 to 2008) (publication n°3).Methylphenidate abuse is already describe in other countries whereas few data are available inFrance. This study estimates the proportion of subjects with a deviant behaviour (from 0.5%9in 2005 and in 2006 to 2.0% in 2007 and 1.2% in 2008) and assesses its evolution since theapplication of a specific regulation.Our research team has also developed an other method using prescription database : thedoctor shopping indicator which measures the quantity obtained by doctor shopping amongthe overall quantity reimbursed (publication n°4). The objective of the last publication is toanalyze and compare results from those two methods applied to High Dosage Buprenorphine,a product well-known to be diverted in France.Actually, clustering method is more and more used on prescription drugs in order to assesstheir abuse. The results obtained by this method begin to be included in the other postmarketing surveillance of CNS drugs (OSIAP, OPPIDUM, OPEAM, ASOS, DRAMES)which are used by French public health authorities.

Inter-Basin-Water Transfers significantly reduce flow and sediment regimes to the downstream ecosystem effecting differential channel adjustment at various locations. It is not known how macroinvertebrates adjust to flow regulation, either spatially or temporally, because research is lacking into how morphological adjustment affects benthic habitat. Feedback mechanisms that initiate the adjustment process must first be identified, then the effect on benthic habitat becomes apparent, thus, providing a link to macroinvertebrate response. Since regulation there has been a 95% reduction in flow volume, a complete downward shift in both the flow duration and flood frequency curves and a 194% increase in flow constancy compared to the pre- dam period. Furthermore, Jindabyne Dam traps 99.9% of the total incoming sediment load. Upstream of the tributary the dominant river response was accommodation adjustment with subsequent contraction of the river channel. Associated feedback mechanisms were ?armouring? and vegetation encroachment. Downstream of the tributary response was more complex, with channel contraction through aggradation and specifically the formation of a tributary mouth bar and fan, mid channel lobate bar, transverse bar and in-channel bench. Associated feedback mechanisms were interactions between vegetation and sediment; channel morphology, flow and sediment distribution; and sediment distribution, flow and channel morphology. These processes have had site specific and reach scale impacts on benthic habitat. Macroinvertebrate response to flow regulation was habitat specific (riffle or edge) and seemed to correspond to either site, or reach scale morphological adjustment, whereas, flow constancy seemed to affect edge macroinvertebrates throughout both reaches. Spatially, macroinvertebrates have not adjusted to the post- dam flow regime and temporally, macroinvertebrates have not recovered 30 years after the closure of Jindabyne Dam. How physical processes change habitats and how these impact on a river?s ecology and at what scale, are important considerations in river management.

Thesis (Ph. D.)--Ohio State University, 2007. / Title from first page of PDF file. Includes bibliographical references (p. 206-221).

<p>Background: A large part of the daily political and economic debate in Sweden concerns the EU. One question that has been debated since the beginning of European integration is whether trade is created as a consequence of integration and, ifso, how great are the gains related to the increased trade. An equally important but maybe less debated question is whether countries outside the union are affected by the increased European integration. Is increased European integration made at the cost of countries outside the EU? </p><p>Purpose: The purpose of this study is, by calculating trade creation and trade diversion, to evaluate if a number of developing countries’ trade with Sweden has decreased after Sweden’s membership in the European Union. </p><p>Limitations: The study is limited to the years 1990-1999, and not all developing countries are included in the study. All developed countries are also omitted from the study. </p><p>Method: The empirical material consists of calculations of consumption shares for Sweden, partner countries and third countries. The method is called residual imputation, meaning that the actual evolution of the trade is compared with a hypothetical, calculated one. These calculations where made for three groups of countries, divided after GDP/capita. </p><p>Conclusions: On the aggregated level, and for the two least poor groups of countries, there is no evidence that these countries have seen their shares decreased as a consequence of Sweden entering the EU. The poorest group of countries has, however, not been able to maintain the same level of exports to Sweden after the membership.</p>

<p>Diverting urine from faeces or mixed wastewater and reusing it to fertilize crops, is a traditional method used in Asia. It is also a contemporary approach to sustainable nutrient and water management in Scandinavia and other parts of Europe. Urine diversion and reuse is a proven socio-technical system that has significant potential benefits on both a local and global scale, such as recirculating scarce plant nutrients like phosphorus back to agriculture, reducing eutrophication of waterways and improving water and sanitation systems. This thesis explores the nature of these benefits in Australia and the global context and what barriers would need to be overcome if a urine diversion and reuse system were implemented in Australia to achieve significant environmental benefits. These questions are investigated through stakeholder interviews in Sweden, to identify the ‘lessons learnt’ from the Swedish experience with urine diversion and reuse, and, through interviews with relevant stakeholders in Australia to identify possible barriers and opportunities, costs and benefits, and roles and responsibilities in the Australian context. Findings from both the stakeholder interviews are triangulated with other sources of knowledge, such as the literature, personal communications and a qualitative assessment of costs and benefits.</p><p>This thesis found that while urine diversion is likely to benefit the Australia situation and warrants further research, these benefits are fragmented and spread across a range of discourses and separate institutions. Its acceptance and effective introduction into Australia might therefore be challenged by its lack of a single obvious organisational home. To overcome this and other identified challenges, several recommendations are made. For example, an Australian demonstration trial of urine diversion and reuse is recommended where clear drivers and opportunities exist, such as: in new developments adjacent to agricultural land; in regions where algal blooms are a critical problem and are predominantly caused by municipal sewage discharges; and where synergies with waterless urinals are being considered for water conservation value. This thesis does not promote urine diversion and reuse as the ‘silver bullet’ to Australia’s water and nutrient problems, however it does recommend that it be considered on an equal basis next to other possible options. For example, if reducing nutrient loads on receiving water bodies is a key objective, then a cost-effective analysis of urine diversion and reuse, compared to other options to reduce nutrient loads, could be undertaken, ensuring all relevant costs and benefits to the whole of society are included in the analysis.</p>

<p>In 2000 “the European Union and South Africa Free Trade Agreement” was established with</p><p>the aim to gradually increase the amount of duty-free agricultural and industrial products to</p><p>each market. The aim of this paper is to investigate if South Africa benefits from the EU-SA</p><p>Free Trade Agreement and also what impacts this agreement has on South Africa’s trade with</p><p>Southern Africa and the rest of the world. The result from the study indicates that South</p><p>Africa benefits from the agreement in terms of improve trade. The result also shows that</p><p>South Africa’s trade with some Southern African countries has been negative effected by the</p><p>agreement but it is difficult to state if this is caused by the agreement or not. The rest of the</p><p>world has not been negatively affected by the agreement.</p>

Seductive details (SDs) are interesting, but not necessarily relevant, information that may be included in text to capture students’ attention. Unfortunately, including such details often hinders learning. Schraw (1998) differentiated between context-independent (i.e., interesting without surrounding context) and context-dependent (i.e., interesting only in light of surrounding context) SDs. In the first study, 388 undergraduate students read six paragraphs describing Sigmund Freud’s psychosexual stages (i.e., target material). Participants in four groups also read one of two biographical paragraphs. The biographical paragraphs contained SDs about Freud that were either context-dependent or -independent to the target material and presented before (primacy) or after (recency) the target-material paragraphs or not at all (Control). After reading, students took a quiz. Quiz performance was not influenced by the type of SDs but rather its placement relative to the target text. Students in the primacy conditions performed worse than students in the recency and control conditions. Thus, both types of SDs reduced learning when they were presented at the beginning of the text. Study 2 examined a potential interaction between SDs and a graphic organizer (GO). GOs are designed to help learners make connections among ideas in the text by visually representing the concepts to be learned (Ausubel, 1960; Robinson & Kiewra, 1995). In Study 2, 207 undergraduate students read the same target material from Study 1. Depending on condition, the participants also read the context-dependent biographical paragraph (SD only), read a GO that linked the SDs to the target material (GO only), read both (GO + SD), or only read the target material (Control). After reading, students took a quiz. Participants in the GO only group and the Control group performed significantly better on the quiz items than participants in the SD only group. There was no significant difference between the Control group and the GO + SD group. Results from both studies suggest that the GO mitigated the seductive details effect but did not reverse it. There is evidence for both the diversion hypothesis (priming inappropriate schema) and the distraction hypothesis (focusing the reader’s attention on the SDs as opposed to the target material).

Background: A large part of the daily political and economic debate in Sweden concerns the EU. One question that has been debated since the beginning of European integration is whether trade is created as a consequence of integration and, ifso, how great are the gains related to the increased trade. An equally important but maybe less debated question is whether countries outside the union are affected by the increased European integration. Is increased European integration made at the cost of countries outside the EU? Purpose: The purpose of this study is, by calculating trade creation and trade diversion, to evaluate if a number of developing countries’ trade with Sweden has decreased after Sweden’s membership in the European Union. Limitations: The study is limited to the years 1990-1999, and not all developing countries are included in the study. All developed countries are also omitted from the study. Method: The empirical material consists of calculations of consumption shares for Sweden, partner countries and third countries. The method is called residual imputation, meaning that the actual evolution of the trade is compared with a hypothetical, calculated one. These calculations where made for three groups of countries, divided after GDP/capita. Conclusions: On the aggregated level, and for the two least poor groups of countries, there is no evidence that these countries have seen their shares decreased as a consequence of Sweden entering the EU. The poorest group of countries has, however, not been able to maintain the same level of exports to Sweden after the membership.

The number of operations for morbid obesity is rising fast. We have examined aspects of postoperative physiology and results after bariatric surgery. The pH in the proximal pouch after Roux-en-Y gastric bypass (RYGBP) was investigated with catheter-based and wire-less technique. Gastric emptying, PYY-levels in the fasting state and after a standardized meal was evaluated after biliopancreatic diversion with duodenal switch (DS). A clinical trial was undertaken, comparing DS to RYGBP in patients with BMI&gt;48. Main outcome variables were safety and long-term weight results as well as abdominal symptoms and laboratory results. Patients with stomal ulcer had significantly lower pH in their proximal gastric pouch as compared to asymptomatic control subjects. Long-time pH measurements with the wire-less BRAVO-system were feasible and demonstrated pH&lt;4 in median 10.5% of the time in asymptomatic post-RYGBP patients. After DS, the T50 of gastric emptying was 28±16 minutes. PYY-levels were higher after DS than in age-matched control subjects. BMI-reduction was greater after DS (24 BMI-units) than after RYGBP (17 BMI-units) in median 3.5 (2.0-5.3) years after surgery (p&lt;0.001). Fasting glucose and HbA1c levels were lower one and three years after DS as compared to RYGBP. On the other hand, DS-patients reported having more diarrhea and malodorous flatus. This thesis has resulted in deepened knowledge. Acid produced in the proximal pouch is an important pathogenetic factor in the development of stomal ulcer after RYGBP. However, symptom-free patients have an acidic environment in the proximal Roux-limb as well. After DS, gastric emptying is fast, but not instantaneous, and PYY-levels are high. DS results in superior weight reduction and better glucose control as compared to RYGBP in patients with BMI&gt;48. We believe that DS has a place in surgical treatment of the super-obese, even though symptoms of diarrhea and malodorous flatus are more common after DS.