The public health crisis surrounding opioid use is pronounced among justice-involved populations, who face high rates of overdose mortality as well as HIV, and hepatitis C due to injection drug use. The majority of opioid-related overdoses are due to polysubstance use (PSU), and a better understanding of the prevalence and patterns of PSU are necessary in order to inform interventions. This dissertation project has three aims: (1) understand the patterns of opioid PSU among a justice-involved population, (2) identify PSU patterns most at-risk for post-release relapse, and (3) examine engagement in post-release health service utilization. Post-release aims are guided by the Gelberg Behavioral Model of Vulnerable Populations. This project utilizes secondary data from the Criminal Justice Kentucky Treatment Outcome Study, a Kentucky Department of Corrections funded two-wave longitudinal study of individuals who participated in substance abuse treatment programming while incarcerated. Latent profile analysis is used to determine the patterns of pre-incarceration opioid PSU in aim 1. Analyses for aims 2 and 3 examine PSU profiles, along with variables drawn from the Behavioral Model for Vulnerable Populations, in order to predict important reentry outcomes of relapse and health service utilization 12-months post-release in a series of logistic regressions. Six unique profiles of opioid PSU were found among the current justice-involved population, which faced disproportionate risk of adverse outcomes at follow-up. Findings indicate heterogeneity of opioid use among a justice-involved population. The role of mental and physical health in PSU severity is also highlighted. Further, results from post-release analyses indicate that a continuum of risk exists among PSU such that PSU patterns are unique and important predictors of post-release outcomes which can be used to inform interventions during incarceration. The importance of accounting for vulnerability as conceptualized in the Behavioral Model for Vulnerable Populations is also discussed.

The operating room (OR) is accountable for most hospital admissions and is one of the most cost and work intensive areas in the hospital. From recent trends, we discover an unexpected parallel increase in expenditure and waiting time. Therefore, improving OR planning has become obligatory, particularly regarding utilization, and service level. Significant challenges in OR planning are the high variations in demand, processing times of surgical specialties, the trade-off between the objectives, and control of OR performance in long-term. Our model provides OR configurations at a strategical level of OR planning to minimize the tradeoff between the utilization and service level accounting for variation in both demand and processing times of surgical specialties. An adaptive control scheme is proposed to aid OR managers to maintain the OR performance within the prescribed controllable limits. Our model is validated using a simulation of demand and processing time data of surgical services at University of Kentucky Health Care.

Hospitals stand to lose millions of dollars in revenue due to patients who leave without treatment (LWT). Grounded in queueing theory, the purpose of this correlational study was to examine the relationship between daily arrivals, daily staffing, triage time, emergency severity index (ESI), rooming time, door-to-provider time (DTPT), and LWT rates. The target population comprised patients who visited a Connecticut emergency room between October 1, 2017, and May 31, 2018. Archival records (N = 154) were analyzed using multiple linear regression analysis. The results of the multiple linear regression were statistically significant, with F(9,144) = 2902.49, p < .001, and R2 = 0.99, indicating 99% of the variation in LWT was accounted for by the predictor variables. ESI levels were the only variables making a significant contribution to the regression model. The implications for positive social change include the potential for patients to experience increased satisfaction due to the high quality of care and overall improvement in public health outcomes. Hospital leaders might use the information from this study to mitigate LWT rates and modify or manage staffing levels, time that patients must wait for triage, room placement, and DTPT to decrease the rate of LWT in the emergency room.

"September 2002" Includes bibliographical references (leaves 301-318)

"September 2002" / Includes bibliographical references (leaves 301-318) / viii, 318 leaves : ill. (col.) ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (Ph.D.)--University of Adelaide, Dept. of Clinical Nursing, 2003

There are many terms used to describe pressure ulcers: pressure sores, decubitus ulcers, bedsores, and pressure necrosis or ischaemic ulcers. Essentially they all describe damage to the patient's skin and underlying tissue. The nursing literature abounds with information about the risk, grading, prevention and treatment of pressure ulcers. These ulcers are a problem in hospital and long term care facilities, and are a major cause of morbidity. In the hospital setting they contribute to an extended length of stay and by doing so 'block' the bed for use by another patient. The ulcers are difficult to treat, are an ongoing cause for pain and discomfort for the patient and can be a strain on hospital finances. Pressure ulcers are not unique to modern times, as they have been discovered on the remains of an Egyptian mummified body (Armstrong & Bortz 2001). This would suggest that the problem dates back to the Pharoahs, and has continued to be a challenging problem throughout the centuries (Bridel 1992). The escalating costs of treating these ulcers today, has brought about an emphasis on the risk factors, prevention and the appropriate interventions, rather than an acceptance of these ulcers as a tolerable ondition (Bridel 1992). In the operating room, nurses are faced with unique challenges when caring for their patients. This is due to difficulty in caring for patients under the influence of the anaesthesia required for surgery, long periods of forced immobility and the inability of the patient to perceive pain and discomfort from the pressure of the hard surface of the operating room table. These problems are increased by nurses' inability to gain access to the patient because of the sterile drapes required to cover the patient for surgery. Armstrong and Bortz (2001) present information from one study in which it is stated that surgical patients have 90% greater chance of developing pressure ulcers than medical patients. One reason for this may be due to the limited information available in regard to the most effective support surface to place on top of the operating room table. This gap in information is problematic for operating room nurses as it limits their ability to select the most effective item of equipment, and determine if the chosen equipment reduces pressure on tissue intra- operatively. The most effective operating room table mattress used and the skills and knowledge of the operating room nurse about the aetiology and prevention of pressure ulcer prevention, are important aspects of nursing care and can influence patient outcomes. The potential for complications to occur may be dependent on single or combined factors such as the patient's age, disease processes, nutritional status and mobility. Preparatory and supportive nursing interventions for surgical procedures based on best available evidence, nursing experience and patient preference, can reduce the incidence of pressure ulcer development in the perioperative environment. This doctoral portfolio contains four separate sections related and linked together by a common theme - pressure ulcer prevention in the perioperative environment. This first section of the portfolio situates the topic and provides a brief overview of the portfolio. The second section is a critical review of the literature pertaining to the most commonly used operating room table mattresses, and the effectiveness of these mattresses in the prevention of pressure ulcer development. This review highlighted a lack of quality research in this area, and while many evaluations have been undertaken to determine the effectiveness of perating room table mattresses, the results are contradictory concerning the patients, exposures and interventions. Because of issues related to the methodological quality of published research in this area a systematic review using meta- analysis was not possible rather a critical review of the research literature is used. The third section of the portfolio reports on a hermeneutic ethnography of the perceived skills and knowledge of nurses in the prevention of pressure ulcer development in the perioperative environment. This study was designed to determine if pressure ulcer prevention forms an aspect of the everyday practice of perioperative nurses. This review has highlighted the need for operating room nurses to review practices when caring for patients in the perioperative environment particularly in respect of pressure ulcer prevention. The fourth and final section of the portfolio summarises the research and provides recommendations for nursing practice and further research in the area of pressure ulcer prevention in the perioperative environment. / Thesis (D.Nurs.)--Department of Clinical Nursing, 2004.

<p>This report is founded in lack of knowledge concerning the design and layout procedureduring a new engine room construction.The prime question is how the engine room takes its form from idea to construction and whathappens in between. We want to give the reader a better understanding in how the work isdone and why it is designed the way it is concerning layout, ergonomics and safety. Duringthis report we will enhance the knowledge concerning regulations and rules that are of greatsubstance such as SOLAS, Swedish Sjöfartsverket and IMO.By contacting the parties involved in the process in newly designing a vessel and its engineroom, we will assume their approaches and experiences. We will study the work progressfrom planning to construction of a vessels machinery spaces. We will with the help ofinterviews with interested parties get an idea of the approach and also compare the finishedproduct a bit depending on company size and resources.The investigation resulted in a good basis for how a ship engine room design takes shape andwhich aspects are taken into account, however, we found that the existing rules concerningengine room layout was very vague and was seen as the most recommendations. For thecontrol room, there were however some points to consider. We believe that it would facilitatea more comprehensive legal framework relating to engine room design.</p> / <p>Denna studie grundar sig i en okunskap gällande maskinrums design och layout. Frågan viställde oss var hur ett fartygs maskinrum kom till från idé till ritning och slutligen beställning.Syftet med arbetet är att ge läsaren grundläggande kunskaper gällande maskinrums design,layout samt ergonomiska aspekter då detta är relevant gällande säkerhet och avhjälpandekring det dagliga arbetet ombord på ett fartyg. Vi kommer även ta upp information som rörregelverk så som (SOLAS, Sjöfartsverket och arbetsmiljöverket),riktlinjer (IMO) standarder (ISO).Genom att kontakta de parter som är inblandade i ett nykonstruerande av ett fartyg och dessmaskinrum kommer vi utgå ifrån deras tillvägagångssätt och erfarenheter. Vi kommer studeravägen från beställning och planering till konstruering. Vi kommer med hjälp av intervjuermed berörda parter skaffa oss en uppfattning om tillvägagångssättet vid planering avmaskinrums designen och även jämföra resultatet beroende på rederiets storlek och resurser.Undersökningen resulterade i ett bra underlag för hur ett fartygs maskinrums konstruktion tarform och vilka aspekter som det tas hänsyn till, dock upptäckte vi att reglerna gällandemaskinrummets utformning var mycket vaga och sågs mest som rekommendationer. Förkontrollrummet fanns det däremot en del punkter att ta hänsyn till. Vi anser att det skulleunderlätta med ett mer utförligt regelverk som rör maskinrummets utformning.</p>

<p>This essay examines expressions of power and resistance, in relation to gender and sexuality, in Karin Boye´s novel Kallocain. I read the novel´s theme of resistance on a level of sexuality. Because differing sexualities and genderpractises are often hidden within the heteronormative mechanisms of oppression, I focus my reading on the meaning of the room and the eye. With theories of Michel Foucault and queer theories, I show how the novel´s rooms in both a material and an immaterial way demarcate based on heteronoramative structures. Further I use the theoretical tools of Foucault and show how looks become the gatekeepers of normativity. I investigate how Judith Butler’s theory on how gender is performatively constructed take shape in the novel and how there can be queer leakage, for example in the potentially homoerotic relation between the two main male characters. I will argue that the heteronormative novelworld of Kallocain contains an emancipating potential in the rooms for resistance created both through the spirit of community in the “fools community” and in other relations, foremost the one between the main male character and the female who is married to him.</p>

<p>Bullying is a serious problem for many children and youths in today’s society. Surveys have shown that more than 145 000 children and youths are concerned by the problem as a victim or as bullies. The purpose with this survey is to obtain a clear picture of the students’ views of bullying in physical education and health.</p><p>The main questions in this study are:</p><p>·         Does bullying occur in a bigger extent within the subject physical education and health than within other subjects?</p><p>·         In which elements during physical education lessons is the risk highest to be exposed to bullying?</p><p>·         Are there any differences concerning the students’ views of physical education in relation to what age they are. </p><p>To acquire an understandable picture of bullying I have chosen to do a literature study where different kinds of definitions are presented. There are also different varieties of bullying such as physical or social.  Further, to answer my research questions, I have done interviews with students in secondary school.</p><p>Physical education and health is a subject where bullying is more common than in other school subjects according to my results. Further the survey shows that lessons in swimming is an element where the risk to be exposed to bullying is highest.</p><p>Since bullying is a big problem in today`s school I think that it`s important that the staff has good knowledge when it comes to bullying. With open eyes and a big commitment I think that we can go far when it comes to the problems with bullying.</p> / <p>Mobbning är i dagens samhälle ett allvarligt problem för många barn och ungdomar, och då framförallt i skolan men även på fritiden. Undersökningar har visat att mer än 145 000 barn och ungdomar är berörda av problemet som offer eller som mobbare. Syftet med den här undersökningen är att få en inblick i elevers uppfattningar angående mobbning inom ämnet idrott och hälsa.</p><p>Frågeställningarna jag använt mig av är:</p><p>·         Förekommer mobbning i större utsträckning inom ämnet idrott och hälsa än inom övriga ämnen?</p><p>·         Under vilket moment inom ramarna för idrott och hälsa är det störst risk att bli utsatt för mobbning?</p><p>·         Hur skiljer sig uppfattningarna i årskurserna 5-9 åt då det gäller mobbning under lektioner i idrott och hälsa?</p><p>Jag har genomfört en litteraturundersökning för att få en klarare bild av begreppet mobbning. I denna undersökning presenteras olika definitioner, liksom att det finns olika typer av mobbning såsom fysisk och social. För att få svar på mina frågeställningar har jag gjort en intervjuundersökning med elever i årskurserna 5-9.  Enligt mina resultat är ämnet idrott och hälsa ett ämne där mobbning förekommer i större utsträckning än inom övriga ämnen. Vidare visar också min undersökning på att bad är det moment inom ämnet där risken att bli utsatt för mobbning är som störst</p><p>Eftersom mobbning är ett stort problem i dagens skola anser jag att det är viktigt att all berörd personal har goda kunskaper om mobbning. Med öppna ögon och ett stort engagemang tror jag att det går att komma långt med mobbningsproblematiken.</p>

The research question was stirred by observations that the set-up of the clinical situation seems to contain elements that have a deep impact on the patient. I found that the clinical situation shows important similarities to the space for play that children negotiate when they want to immerse themselves in mutual phantasy play. Consequently, one overall purpose of the present study is to explore the psychoanalytic situation as a play situation with the help of two clinical vignettes.In the first part, I give a picture of my understanding of Freud’s reasons for shaping his clinical situation as he did. A critical scrutiny of Freud’s case of the Rat Man gave us keys to an understanding of the clinical method’s contradictoriness.A tentative hypothesis was framed that the set-up of psychoanalysis’s clinical situation induces an ambiguity about different levels of reality, the purpose being to create a space in the course of the analysis in which this confusion can be analyzed and comprehended. This work on the ambiguity of the reality links psychoanalysis with the intimate and spontaneous interaction that characterizes children’s social phantasy play. The investigation came to the conclusion that there exists a conspicuous equivalence between the two situations. The issue of what connects the universal play situation of children on the one hand, with the specific psychoanalytic situation on the other, makes a point of departure from which to approach and investigate the field of inquiry.The theory is that a ‘play’ with factual and illusory asymmetry generates a field of tension that serves as a sounding board from the moment of psychoanalysis's introductory negotiations until its ending. A third area is created that supports a mutual explorative space that in its turn makes a bridge between outer and inner reality and between now and the past. In such a context the phenomenon of play becomes a transformational concept.The conclusion is that psychoanalysis organizes a clinical situation that speaks to a profound and universal human need and that it is understood as an analogy of the play situation of children.