Class of 2012 Abstract / Specific Aims: Cellulitis accounts for the majority of skin and skin structure infections in patients who present to the emergency departments in the United States. The primary objective of this study was to evaluate the appropriateness of empiric cellulitis therapy prescribed in an emergency department of an academic medical center. The secondary objective of the study was to compare the cost-effectiveness of the empirical cellulitis therapy prescribed at the institution. Methods: This retrospective chart review study has been approved by the Institutional Review Board. Adult patients evaluated at an emergency department of a tertiary care, academic medical center, diagnosed with cellulitis and prescribed empiric antibiotic therapy between October and November 2010 were evaluated. Subjects were excluded if they required hospitalization or surgical intervention in an operating room or if they were diagnosed with necrotizing fasciitis, orbital cellulitis, or a diabetic foot infection. Data collected for each subject included type of cellulitis, therapy prescribed, and outcomes. Appropriateness of empiric cellulitis therapy was determined by expert opinion and guideline statements. A chi-square test was used to evaluate the statistical significance of treatment failure between the prescribed antibiotic groups. An independent t-test was used to analyze the cost between the prescribed antibiotic groups. An incremental cost-effectiveness ratio was used to determine the cost-effectiveness of the prescribed antibiotic groups. Main Results: The majority of patients were given a prescription for either clindamycin montherapy (37%) or trimethoprim-sulfamethoxazole plus cephalexin (40%) as empiric therapy when discharged from the emergency department. While follow-up (either repeat emergency department visit or clinic visit within the academic medical healthcare network) was only available in 78% of subjects, there was no statistical difference (p=0.51) in therapy outcomes between these two empiric therapy groups. Conclusions: Types of antimicrobials, doses, and duration of therapy prescribed for outpatient empiric cellulitis therapy at a single medical center were not consistent.

Class of 2016 Abstract / Objectives: 1. To compare appropriateness of therapy and the time it takes for appropriate empiric antibiotic therapy to be given from when patients are first admitted for treatment of diabetic foot infection. 2. To compare the time it takes for physicians to “streamline” therapies or switch from empiric antibiotic therapy to specific antibiotics after culture results are obtained 3. To Compare the incidence of readmission within 30 days to the hospital after initial discharge. Methods: In this IRB approved, retrospective study, antibiotic therapy prescribing patterns before and after the distribution of a health network specific empiric antibiotic reference material were compared in patients admitted for diabetic foot infection. Patients were excluded if no antibiotic therapy prescribed, if under the age of 18 years, or if admitted for less than 48 hours (including time spent in the emergency department). The following data were collected and analyzed between the two groups: number of appropriate antibiotic therapy administered, timing of appropriate therapies relative to when appropriate culture samples were obtained if applicable, time it takes to streamline antimicrobial therapy, and the incidence of 30-day readmission. Results: A total of 400 patients were evaluated with 17 pre-intervention and 10 post-intervention patients who meet the inclusion criteria. The pre- and post- intervention groups did not show significant difference in demographics except for comorbid conditions (p=0.055). Overall, there was no significant difference between the pre- and post-intervention group on appropriate empiric therapy given (p=0.382), timing to streamline therapy (p=0.4035), and readmission rates (p=0.401). Conclusions: The health network specific empiric antibiotic recommendations reference material did not influence the timing and appropriateness of empiric antibiotic therapy in treatment of diabetic foot infections and the patient 30-day readmission rates.

Class of 2012 Abstract / Specific Aims: Cellulitis accounts for the majority of skin and skin structure infections in patients who present to the emergency departments in the United States. The primary objective of this study was to evaluate the appropriateness of empiric cellulitis therapy prescribed in an emergency department of an academic medical center. The secondary objective of the study was to compare the cost-effectiveness of the empirical cellulitis therapy prescribed at the institution. Methods: This retrospective chart review study has been approved by the Institutional Review Board. Adult patients evaluated at an emergency department of a tertiary care, academic medical center, diagnosed with cellulitis and prescribed empiric antibiotic therapy between October and November 2010 were evaluated. Subjects were excluded if they required hospitalization or surgical intervention in an operating room or if they were diagnosed with necrotizing fasciitis, orbital cellulitis, or a diabetic foot infection. Data collected for each subject included type of cellulitis, therapy prescribed, and outcomes. Appropriateness of empiric cellulitis therapy was determined by expert opinion and guideline statements. A chi- square test was used to evaluate the statistical significance of treatment failure between the prescribed antibiotic groups. An independent t-test was used to analyze the cost between the prescribed antibiotic groups. An incremental cost-effectiveness ratio was used to determine the cost- effectiveness of the prescribed antibiotic groups. Main Results: The majority of patients were given a prescription for either clindamycin montherapy (37%) or trimethoprim-sulfamethoxazole plus cephalexin (40%) as empiric therapy when discharged from the emergency department. While follow-up (either repeat emergency department visit or clinic visit within the academic medical healthcare network) was only available in 78% of subjects, there was no statistical difference (p=0.51) in therapy outcomes between these two empiric therapy groups. Conclusions: Types of antimicrobials, doses, and duration of therapy prescribed for outpatient empiric cellulitis therapy at a single medical center were not consistent.

O fim da obrigatoriedade da correção monetária das demonstrações contábeis em 1995, fez com que as empresas brasileiras deixassem de reconhecer os efeitos da inflação na apuração dos seus resultados. Porém, mesmo com a aparente estabilização monetária promovida pelo Plano Real, a inflação acumulada de janeiro de 1996 a dezembro de 2004 ultrapassou 160% de acordo com dois dos principais indicadores nacionais. A inflação não deixou de existir com a extinção da correção monetária e, as empresas inseridas nesse contexto de alta generalizada dos preços, simplesmente deixaram de reconhecer seus efeitos na apuração de seus resultados. Nesse trabalho, coletamos as demonstrações contábeis de todas as empresas não financeiras de capital aberto listadas na Bolsa de Valores de São Paulo no período de 1996 a 2004 e procedemos com a Correção Monetária de Balanço, de acordo com a metodologia prevista na legislação brasileira. Os resultados do Teste de Diferença de Médias para Observações Emparelhadas e o Teste de Postos com Sinais de Wilcoxon para Pares Combinados mostraram que a desconsideração dos efeitos inflacionários distorceu o lucro das 255 empresas da amostra com um nível de confiança de 99%. Os resultados da correção monetária foram então comparados com o total de lucros distribuídos em dividendos por essas empresas, agrupadas em dezoito setores de diferentes atividades econômicas. As análises do índice de correlação de Pearson forneceram evidências de que os setores que mais ganharam com a inflação foram também aqueles que mais distribuíram dividendos aos acionistas e os setores que mais perderam com a corrosão do poder aquisitivo da moeda foram os que menos tiveram capacidade de distribuir lucro. O estudo empírico fornece uma visão mais clara de como a inflação tem impactado o lucro das empresas brasileiras e como o seu não reconhecimento pode afetar a distribuição desse lucro e a riqueza dos acionistas. / The end of obligatory price level adjustment of financial statements in 1995 accounts for Brazilian companies not recognition of the inflation effects in profit determination. However, even with the apparent monetary stabilization cause by the Real Plan, the accumulated inflation from January 1996 to December 2004 surpassed 160%, according to two of the main national indicators. Even with the end of price level adjustment, inflation still exists and the companies included in this ambit of generalized price increase, simply did not recognize their profit determination. For this work, we collected incomes statements of all non-financial Brazilian stock companies listed at São Paulo Stock Exchange from 1996 to 2004 and dealt with the Price Level Adjustment according to the methodology foreseen in Brazilian Legislation. The results of the T-Test and Wilcoxon Matched-Pairs Signed-Ranks Test showed that the lack of consideration for inflationary effects distorted the profit of the 255 companies of the sample with a 99% level of reliance. The results of price level adjustment were, then, compared to the total profit distributed in dividends by these companies, joint into eighteen sectors of different economical activities. The analyses of Pearson\'s index of correlation evidenced that the sectors that had most of the benefit from inflation were also the ones that participated more in the distribution of the dividends to the shareholders and the sector that have lost more with the purchasing power degradation were the ones that had less capacity to distribute profit. The empiric study provides a better understanding of how inflation has caused impact on Brazilian companies profit and how not recognizing inflation can affect the distribution of this profit and the richness of the shareholders.

O fim da obrigatoriedade da correção monetária das demonstrações contábeis em 1995, fez com que as empresas brasileiras deixassem de reconhecer os efeitos da inflação na apuração dos seus resultados. Porém, mesmo com a aparente estabilização monetária promovida pelo Plano Real, a inflação acumulada de janeiro de 1996 a dezembro de 2004 ultrapassou 160% de acordo com dois dos principais indicadores nacionais. A inflação não deixou de existir com a extinção da correção monetária e, as empresas inseridas nesse contexto de alta generalizada dos preços, simplesmente deixaram de reconhecer seus efeitos na apuração de seus resultados. Nesse trabalho, coletamos as demonstrações contábeis de todas as empresas não financeiras de capital aberto listadas na Bolsa de Valores de São Paulo no período de 1996 a 2004 e procedemos com a Correção Monetária de Balanço, de acordo com a metodologia prevista na legislação brasileira. Os resultados do Teste de Diferença de Médias para Observações Emparelhadas e o Teste de Postos com Sinais de Wilcoxon para Pares Combinados mostraram que a desconsideração dos efeitos inflacionários distorceu o lucro das 255 empresas da amostra com um nível de confiança de 99%. Os resultados da correção monetária foram então comparados com o total de lucros distribuídos em dividendos por essas empresas, agrupadas em dezoito setores de diferentes atividades econômicas. As análises do índice de correlação de Pearson forneceram evidências de que os setores que mais ganharam com a inflação foram também aqueles que mais distribuíram dividendos aos acionistas e os setores que mais perderam com a corrosão do poder aquisitivo da moeda foram os que menos tiveram capacidade de distribuir lucro. O estudo empírico fornece uma visão mais clara de como a inflação tem impactado o lucro das empresas brasileiras e como o seu não reconhecimento pode afetar a distribuição desse lucro e a riqueza dos acionistas. / The end of obligatory price level adjustment of financial statements in 1995 accounts for Brazilian companies not recognition of the inflation effects in profit determination. However, even with the apparent monetary stabilization cause by the Real Plan, the accumulated inflation from January 1996 to December 2004 surpassed 160%, according to two of the main national indicators. Even with the end of price level adjustment, inflation still exists and the companies included in this ambit of generalized price increase, simply did not recognize their profit determination. For this work, we collected incomes statements of all non-financial Brazilian stock companies listed at São Paulo Stock Exchange from 1996 to 2004 and dealt with the Price Level Adjustment according to the methodology foreseen in Brazilian Legislation. The results of the T-Test and Wilcoxon Matched-Pairs Signed-Ranks Test showed that the lack of consideration for inflationary effects distorted the profit of the 255 companies of the sample with a 99% level of reliance. The results of price level adjustment were, then, compared to the total profit distributed in dividends by these companies, joint into eighteen sectors of different economical activities. The analyses of Pearson\'s index of correlation evidenced that the sectors that had most of the benefit from inflation were also the ones that participated more in the distribution of the dividends to the shareholders and the sector that have lost more with the purchasing power degradation were the ones that had less capacity to distribute profit. The empiric study provides a better understanding of how inflation has caused impact on Brazilian companies profit and how not recognizing inflation can affect the distribution of this profit and the richness of the shareholders.

L'écoulement à travers un milieu poreux d'un fluide non newtonien, est un problème récurrent rencontré dans de nombreux domaines de l'industrie et dont la difficulté réside à la fois dans la géométrie complexe du milieu poreux et dans le caractère non-linéaire des matériaux utilisés. Dans cette thèse, nous adoptons une approche différente de celle menée dans les travaux antérieurs, en nous basant principalement sur l'expérimentation. En procédant à des essais systématiques d'injection dans un milieu poreux dont nous pouvons contrôler les données géométriques, nous montrons qu'un gradient de pression seuil, étant proportionnel au seuil du fluide et inversement proportionnel à la taille typique des pores, doit systématiquement être dépassé pour mettre le fluide en écoulement.En outre, nous étudions la possibilité de regrouper, via un redimensionnement, l'ensemble des résultats sur une courbe maîtresse et établir ainsi une base pour l'établissement d'une loi générale d'écoulement / The flow of a non-newtonian fluid through a porous medium is a matter of importance in several industrial applications whose difficulty arises from both the complex geometry of the porous medium and the non-linear behaviour of the complex fluids. In this thesis we investigate the flow of Herschel-Bulkley fluids via a mainly experimental approach and aim to set a generalized law for this particular type of complex fluid in porous medium.Our experimental set-up allows us to perform systematic trials of injection in model porous media whose we can control geometrical parameters. We show that a threshold pressure gradient, proportional to the yield stress and inversely proportional to the particles mean diameter has to be systematically surpassed to make the fluid flow through the porous medium. We also investigate the possibility, thanks to a resizing, to gather all the experimental data on a master curve representative of a generalized law

<div>Circulation studies, as the theory of ecological spread of information, impacts public perception of knowledge-making, and digital circulation (i.e. online information sharing) impacts what people expect online knowledge-making and online education is or should be. Online education is becoming a new norm for students and universities at a time when economic pressure is pushing both to be more austere and expedient; at the same time, circulation collapses together the complex ways we communicate, making them harder to differentiate. This dissertation responds to these conditions by focusing on the labor behind circulation and Online Writing Instruction (OWI) in order to study knowledge-making online. Through focus groups with instructors, case studies, and surveys of students in online classes, this dissertation identifies strategies that benefit both teachers and students and improve Online Writing Classes. This work intersects with recent considerations of how mis- and dis-information spread online, the impact of Data Science and Information Theory on communication and knowledge-making, and how to make universities accessible to more people.</div><div><br></div><div>Chapter 1 overviews the history of Distance Education (DE) and Online Education (OE) as well as the relevant disciplinary distinctions OWI makes for itself. Chapter 1 also identifies theoretical and practical challenges OE finds for itself and overviews recent shifts in OE student populations. Chapter 2 contextualizes the challenges OE and OWI face in a larger ecology of Information Theory, Rhetoric and Composition theory and practice, Technical Communication theory and practice, and Neoliberal economics, positing ecological links between modern data science, digital circulation, and economics. In doing so, Chapter 2 offers a rhetorical interpretation of the DIKW pyramid and definitions of data, information, knowledge, and wisdom (D, I, W, and W respectively) for rhetorical practitioners. Chapter 3 follows up on Chapter 2’s arguments to respond with research on teacher and student labor in online classes with methods for such inquiry, through focus groups, case studies, and surveys. Chapter 4 presents data from all stages of that inquiry, and Chapter 5 connects together observations from the data with theory from Chapters 1 and 2 to draw more concrete conclusions.</div><div><br></div>

O uso intensivo do solo e descarte incorreto e descontrolado de substâncias tóxicas no solo em decorrência do aumento das atividades agrícolas e industriais pode promover o acúmulo de elementos potencialmente tóxicos (EPTs). Isto ocorre, principalmente, nas camadas superficiais do solo, o que favorece a absorção dos EPTs pelas plantas e pode trazer riscos inaceitáveis à saúde humana, principalmente pela ingestão de alimentos contaminados. No Brasil existem poucos estudos relacionados à acumulação e à forma em que estes elementos estão presentes na solução do solo e podem ser absorvidos por plantas do tipo olerícolas, sendo que várias espécies são consumidas cruas pela população. Dessa forma, há exposição indireta desses elementos via ingestão dos vegetais. Uma das formas de estimar a acumulação do metal nas plantas é por meio do Fator de Bioconcentração (BCF), que é a razão entre a concentração total do EPT no vegetal e no solo. Os objetivos nesse estudo foram: (i) comparar resultados dos teores pseudototais de EPTs de solos e teores totais de plantas encontrados em referências bibliográficas provenientes de regiões tropicais úmidas e de regiões temperadas; (ii) calcular as concentrações críticas de Cu, Ni, Pb e Zn em cenários de exposição urbano e rural, por meio de dois modelos matemáticos para avaliação de risco à saúde humana: Planilha CETESB e CSOIL; (iii) avaliar as frações reativa, disponível e bioacessível de Ba, Cr, Cu, Ni, Pb e Zn em solos; e (iv) estimar os teores dos elementos presentes nas frações por funções empíricas a partir dos teores pseudototais e das propriedades física e químicas do solo. Foram levadas em consideração frações dos vegetais consumidos das áreas contaminadas: 10% para o cenário urbano e 25% para o cenário rural. O BCF foi o principal parâmetro avaliado no cálculo da concentração crítica dos EPTs, sendo que o ideal seria a obtenção de um BCF para cada situação/região, considerando principalmente os atributos físicos e químicos do solo, e tipo e espécie de vegetais cultivados para calcular as concentrações críticas baseada no risco à saúde humana. Os modelos empíricos foram capazes de predizer a relação entre as frações reativa e pseudototal desses elementos em função das propriedades dos solos e do seu teor pseudototal. Na fração disponível, 3% e 1% do teor de Ba e Zn, respectivamente, estavam disponíveis na solução do solo em relação aos teores pseudototais, o que sugere baixo potencial de mobilidade destes elementos no solo. O Ba apresentou grande solubilidade em ambientes ácidos, como o baixo pH encontrado no estômago de seres humanos. / The intensive land use and uncontrolled disposal of toxic substances in the soil due to the increase of agricultural and industrial activities can promote the accumulation of potentially toxic elements (PTEs) mainly in the upper soil layers, which favors the uptake by plants and can pose unacceptable risks to humans health, mainly by intake of contaminated food. In Brazil, there are few studies regarding the accumulation and the species in which these elements are present in the soil solution and can be absorbed by several vegetable crops eaten raw by the population, i.e., there is an indirect exposure by ingestion of vegetables. The Bioconcentration Factor (BCF) is the ratio of the total concentration of PTE in plant and soil. BCF is used to estimate the metal accumulation in plants. This study was carried out taking the following objectives into account: (i) the comparison of results obtained in bibliographic references from humid tropics and temperate regions; (ii) to calculate the critical concentrations of Cu, Ni, Pb and Zn for both urban and rural scenarios of exposure, using both mathematical models for assessment risk to human health: CETESB and CSOIL spreadsheets; (iii) to evaluate the reactive, available and bioaccessible fractions of Ba, Cr, Cu, Ni, Pb and Zn in soils cultivated with vegetable crops in Sao Paulo states, Brazil; and (iv) to estimate the PTEs contents in the fractions by empiric functions from pseudototals concentrations and soil physical and chemical properties. The following fractions of vegetables consumed in contaminated areas have taken into account: 10% for the urban scenario and 25% for the rural scenario. The BCF was the main parameter evaluated in the calculation of the critical concentration of EPTs. For calculating the critical concentrations based on risk to human health, it is suggested that the BCF should be determined for each state/region, mainly considering the physical and chemical soil properties, and the type and species of plants. The empirical models were able to predict the relationship between the reactive and the pseudototal fractions of the PTEs, and this fraction depended on the soil properties and on their pseudototal contents. In the available fraction, 3% and 1 % of Ba and Zn contents, respectively, were available in the soil solution in relation to pseudototal levels, suggesting the poor potential for the mobility of these elements in the soil. Moreover, Ba (bioaccessible fraction) had great solubility in acidic environments, such as the low pH found in the stomach.

O uso intensivo do solo e descarte incorreto e descontrolado de substâncias tóxicas no solo em decorrência do aumento das atividades agrícolas e industriais pode promover o acúmulo de elementos potencialmente tóxicos (EPTs). Isto ocorre, principalmente, nas camadas superficiais do solo, o que favorece a absorção dos EPTs pelas plantas e pode trazer riscos inaceitáveis à saúde humana, principalmente pela ingestão de alimentos contaminados. No Brasil existem poucos estudos relacionados à acumulação e à forma em que estes elementos estão presentes na solução do solo e podem ser absorvidos por plantas do tipo olerícolas, sendo que várias espécies são consumidas cruas pela população. Dessa forma, há exposição indireta desses elementos via ingestão dos vegetais. Uma das formas de estimar a acumulação do metal nas plantas é por meio do Fator de Bioconcentração (BCF), que é a razão entre a concentração total do EPT no vegetal e no solo. Os objetivos nesse estudo foram: (i) comparar resultados dos teores pseudototais de EPTs de solos e teores totais de plantas encontrados em referências bibliográficas provenientes de regiões tropicais úmidas e de regiões temperadas; (ii) calcular as concentrações críticas de Cu, Ni, Pb e Zn em cenários de exposição urbano e rural, por meio de dois modelos matemáticos para avaliação de risco à saúde humana: Planilha CETESB e CSOIL; (iii) avaliar as frações reativa, disponível e bioacessível de Ba, Cr, Cu, Ni, Pb e Zn em solos; e (iv) estimar os teores dos elementos presentes nas frações por funções empíricas a partir dos teores pseudototais e das propriedades física e químicas do solo. Foram levadas em consideração frações dos vegetais consumidos das áreas contaminadas: 10% para o cenário urbano e 25% para o cenário rural. O BCF foi o principal parâmetro avaliado no cálculo da concentração crítica dos EPTs, sendo que o ideal seria a obtenção de um BCF para cada situação/região, considerando principalmente os atributos físicos e químicos do solo, e tipo e espécie de vegetais cultivados para calcular as concentrações críticas baseada no risco à saúde humana. Os modelos empíricos foram capazes de predizer a relação entre as frações reativa e pseudototal desses elementos em função das propriedades dos solos e do seu teor pseudototal. Na fração disponível, 3% e 1% do teor de Ba e Zn, respectivamente, estavam disponíveis na solução do solo em relação aos teores pseudototais, o que sugere baixo potencial de mobilidade destes elementos no solo. O Ba apresentou grande solubilidade em ambientes ácidos, como o baixo pH encontrado no estômago de seres humanos. / The intensive land use and uncontrolled disposal of toxic substances in the soil due to the increase of agricultural and industrial activities can promote the accumulation of potentially toxic elements (PTEs) mainly in the upper soil layers, which favors the uptake by plants and can pose unacceptable risks to humans health, mainly by intake of contaminated food. In Brazil, there are few studies regarding the accumulation and the species in which these elements are present in the soil solution and can be absorbed by several vegetable crops eaten raw by the population, i.e., there is an indirect exposure by ingestion of vegetables. The Bioconcentration Factor (BCF) is the ratio of the total concentration of PTE in plant and soil. BCF is used to estimate the metal accumulation in plants. This study was carried out taking the following objectives into account: (i) the comparison of results obtained in bibliographic references from humid tropics and temperate regions; (ii) to calculate the critical concentrations of Cu, Ni, Pb and Zn for both urban and rural scenarios of exposure, using both mathematical models for assessment risk to human health: CETESB and CSOIL spreadsheets; (iii) to evaluate the reactive, available and bioaccessible fractions of Ba, Cr, Cu, Ni, Pb and Zn in soils cultivated with vegetable crops in Sao Paulo states, Brazil; and (iv) to estimate the PTEs contents in the fractions by empiric functions from pseudototals concentrations and soil physical and chemical properties. The following fractions of vegetables consumed in contaminated areas have taken into account: 10% for the urban scenario and 25% for the rural scenario. The BCF was the main parameter evaluated in the calculation of the critical concentration of EPTs. For calculating the critical concentrations based on risk to human health, it is suggested that the BCF should be determined for each state/region, mainly considering the physical and chemical soil properties, and the type and species of plants. The empirical models were able to predict the relationship between the reactive and the pseudototal fractions of the PTEs, and this fraction depended on the soil properties and on their pseudototal contents. In the available fraction, 3% and 1 % of Ba and Zn contents, respectively, were available in the soil solution in relation to pseudototal levels, suggesting the poor potential for the mobility of these elements in the soil. Moreover, Ba (bioaccessible fraction) had great solubility in acidic environments, such as the low pH found in the stomach.

<p>I den här artikeln undersöks implementationen av ett ärende och handläggningssystem kallat Platina vid Länsstyrelsen i Västerbotten. Problematik med implementationen identifieras genom intervjuer och observationer med anställda vid myndigheten. Undersökningarna leder till slutsatsen att myndigheten inte har fått ett färdigt system utan ett som kräver fortsatt utveckling innan det uppfyller de krav som ställs på det. Det finns även en risk att utvecklingen av systemet inom myndigheten läggs ner på grund av organisationsförändringar.</p> / <p>This article researches the implementation of a case and workflow system called Platina at the County Administrative Board in Västerbotten County. Problems with the implementation were identified through interviews and observations with employees. The empiric studies showed that the County Administrative Board did not get a fully functional system, but in fact a system that demands continued development to meet the expected demands. There is also a risk that the development of the system will be aborted due to organizational changes.</p>