Introdução: A Doença Renal Crônica (DRC) está associada à alta morbidade e mortalidade, com aumento progressivo nas populações mundiais. A DRC e o tratamento hemodialítico podem desencadear mudanças no estilo de vida dos pacientes como alterações em seu cotidiano, na capacidade para desempenhar atividades do seu dia a dia e no autocuidado. Objetivos: Caracterizar os pacientes atendidos nos serviços de hemodiálise de uma cidade do interior paulista quanto aos aspectos sociodemográficos, econômicos e clínicos; descrever a independência funcional utilizando o instrumento de Medida de Independência Funcional (MIF); descrever a capacidade de autocuidado utilizando a escala para avaliar as capacidades de autocuidado (ASA-A); verificar a associação da independência funcional e da capacidade do autocuidado com as variáveis sociodemográficas e clínicas e verificar correlação entre a independência funcional e a capacidade de autocuidado. Material e Método: Foi realizado um estudo transversal, populacional e descritivo com abordagem quantitativa nos três serviços de diálise do município de São José do Rio Preto-SP, nos quais foram entrevistados 214 pacientes com 18 anos ou mais de idade, residentes nesse município, em tratamento por hemodiálise e que aceitaram participar do estudo. Os instrumentos utilizados para a coleta de dados foram: Miniexame do Estado Mental (MEEM) para a avaliação do estado cognitivo; instrumento para caracterização dos dados sociodemográficos, econômicos e clínicos; a MIF e a ASA-A. Os dados foram analisados por meio do programa estatístico SAS®9.0, no qual foram gerados as análises descritivas, os testes de associação e a correlação entre as variáveis do estudo. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da Faculdade de Medicina de São José do Rio Preto - FAMERP. Resultados: Dos 214 pacientes, 108 eram adultos e 106 idosos, dos quais 136 eram homens e 78 mulheres. O número médio de comorbidades para cada paciente foi de 2,3, e o número médio de complicações físicas foi de 4,7 por paciente. Foram evidenciados um nível de independência completa ou modificada nessa população (média MIF total 118,38; dp12,4) e um relativo conhecimento dos pacientes referente a sua capacidade de autocuidado (média 94,53; dp12,86). A MIF se correlacionou positivamente com a ASA-A e as duas negativamente com as variáveis idade, complicações relacionadas ao tratamento hemodialítico e comorbidades. Conclusão: Os pacientes em tratamento hemodialítico apresentaram resultados satisfatórios de independência funcional e a capacidade de autocuidado. À medida que aumentam os escores de independência funcional, aumentam também os de capacidade de autocuidado. As variáveis sexo, idade, comorbidades, complicações relacionadas ao tratamento hemodialítico constituíram fatores importantes que prejudicaram a independência funcional e a capacidade de autocuidado dessa população. Os resultados deste estudo permitiram compreender aspectos referentes a essas variáveis que poderão subsidiar intervenções para a melhoria da assistência de enfermagem prestada a essa população. / Introduction: Chronic Kidney Disease (CKD) is associated with high and progressively increasing morbidity and mortality levels around the world. CKD and hemodialysis treatment can trigger changes in patients\' lifestyles, such as changes in their daily lives, in their ability to perform daily activities and in self-care. Aims: To characterize the patients attended at hemodialysis services in an interior city in São Paulo State, Brazil regarding sociodemographic, economic and clinical aspects; to describe their functional independence using the Functional Independence Measure (FIM) scale; to describe their self-care ability using the Appraisal of Self-Care Agency Scale (ASA-A); to check the association between functional independence and self-care ability and sociodemographic and clinical variables and to check for the correlation between functional independence and self-care ability. Material and Method: A cross-sectional and descriptive population study with a quantitative approach was developed at the three dialysis services in the city of São José do Rio Preto- SP, where 214 patients were interviewed, aged 18 years or older, living in this city, under hemodialysis treatment and who accepted to participate in the study. The instruments used for data collection were: Mini-Mental State Examination (MMSE) for cognitive state assessment; instrument to characterize sociodemographic, economic and clinical data; FIM and ASA-A. Data were analyzed in SAS®9.0, used to generate descriptive analyses, association tests and correlations among the study variables. Approval for the project was obtained from the Research Ethics Committee at São José do Rio Preto Medical School - FAMERP. Results: Out of 214 patients, 108 were adults and 106 elderly, with 136 men and 78 women. The average number of comorbidities for each patient was 2.3, and the mean number of physical complications was 4.7 per patients. Complete or modified independence levels were evidenced in this population (mean total FIM 118.38; sd12.4) and patients\' relative knowledge about their self-care skills (mean 94.53; sd12.86). The FIM was positively correlated with the ASA-A and both instruments were negatively correlated with age, hemodialysis treatment-related complications and comorbidities. Conclusion: Patients under hemodialysis treatment presented satisfactory functional independence and self-care ability results. Gender, age, comorbidities, hemodialysis treatment-related complications represented important factors that impaired this population\'s functional independence and self-care ability. These study results permitted understanding aspects related to these variables that can support interventions to improve nursing care delivery to this population.

L’expertise du risque biologique joue un rôle central dans l’élaboration et la mise en œuvre de la politique sanitaire et environnementale au niveau de l’Union européenne. Depuis la crise dite de la « vache folle », le législateur de l’Union a reconnu la nécessité d’encadrer davantage cette expertise. Toutefois, si le droit de l’Union s’intéresse au cadre scientifique de l’expertise du risque biologique, il traite de façon lacunaire la question de son cadre juridique. En effet, si les exigences d’indépendance, d’impartialité et de transparence sont affirmées à l’égard de l’expert, leur application manque de clarté et menace à terme la protection de la santé et de l’environnement des citoyens de l’Union. Pour remédier à ce problème, cette étude propose des critères ayant pour but l’établissement d’une réglementation au niveau de l’Union de l’expertise du risque biologique. Ces critères ont été établis après l’analyse du cadre juridique existant, des modèles d’expertise issus des législations de certains Etats membres et tiers à l’Union ainsi que de contributions doctrinales. / Biological risk expertise plays a central role in the development and implementation of health and environmental policy at EU level. Since the "mad cow" crisis, the Union's legislator has recognized the need to provide more guidance for this expertise. However, while EU law is concerned with the scientific framework of biological risk expertise, it does not address the issue of its legal framework in a comprehensive way. Indeed, while the requirements of independence, impartiality and transparency are affirmed with regard to the expert, their application lacks clarity and ultimately threatens the protection of the health and environment of EU citizens. To address this problem, this study proposes criteria for establishing EU-level regulation of biological risk expertise. These criteria were established after analysis of the existing legal framework, models of expertise from the legislation of certain Member States and third countries as well as doctrinal contributions.

Support for the creation of an independent Catalan state has increased significantly during the past two decades. In 2017, an estimated 40.2 percent of the total Catalan population supported the creation of an independent Catalonia. The road towards independence has shown to be filled with legal obstacles. While the separatists tend to base their demand for independence on a supposed “right to self-determination” and a “right to decide”, the meaning and effects of invoking these “rights” can be questioned. The purpose of this thesis is to investigate the legal possibilities of forming an independent Catalan state based on these commonly invoked rights. With regard to self-determination, this thesis concludes that all peoples have a right to self-determination, but this right does not necessarily entail a right to secession. Only under grave circumstances can self-determination lead to secession. The Catalans are not in such a situation and cannot therefore successfully claim that their right to self-determination entails a right to secede from Spain. As to a “right to decide”, the right as such exists neither within international law nor Spanish national law. This right can be broken down into two parts: The possibility to hold a referendum on independence and the possibility to declare independence based on the referendum. The thesis concludes that despite a referendum being complicated, but not impossible, to organise based on the Spanish Constitution, the Catalans can organise such a referendum based on international human rights law. The Catalans can also unilaterally declare independence since there is no explicit prohibition against doing so. Finally, the thesis discusses the issue of international recognition. Catalonia is unlikely to receive international recognition under the current circumstances. The thesis then concludes that even though the Catalans do not have a right to self-determination in the form of secession, they could organise a referendum and unilaterally declare independence. Such a declaration will however have no effect in practice without recognition from the international community. / El apoyo a la creación de un estado catalán independiente ha incrementado considerablemente en las últimas dos décadas. En 2017, se estimaba que un 40,2 por ciento de la población catalana apoyaba la creación de una Cataluña independiente. El camino hacia la independencia ha demostrado varios obstáculos jurídicos. Las personas que abogan por esta independencia, tienden a fundar su anhelo de establecer una Cataluña independiente apoyándose en un “derecho a la autodeterminación” y un “derecho a decidir”. El significado y los efectos de invocar estos “derechos” pueden ser cuestionados. El objetivo de esta tesis es investigar las posibilidades e incertidumbres legales que podrían conllevar el crear una Cataluña independiente protegiéndose en estos derechos. Con respecto a la autodeterminación, esta tesis concluye que todos los pueblos tienen un derecho a la autodeterminación, pero este derecho no implica un derecho a la secesión. El derecho a la autodeterminación sólo puede implicar un derecho a la secesión bajo circunstancias graves. Hoy en día los catalanes no se encuentran en una situación de tal gravedad, es por ello que el derecho a la autodeterminación no les da un derecho a la secesión de España unilateralmente. El “derecho a decidir” no existe en el orden jurídico español ni en el nivel internacional. Sin embargo, este derecho puede ser dividido en dos partes: La posibilidad de organizar un referéndum, y la posibilidad de unilateralmente declarar independencia según el resultado del referéndum. Esta tesis concluye que, a pesar de que un referéndum es complicado, no sería imposible organizar uno según la constitución española. Es por ello que la población catalana que aboga por la independencia, podrían organizar un referéndum apoyándose en derechos humanos internacionales. Los catalanes también pueden unilateralmente declarar la independencia, porque no hay ninguna prohibición explicita contra una declaración de independencia. Para finalizar, la tesis examina el tema de reconocimiento internacional. Es improbable que Cataluña obtenga reconocimiento internacional como un estado independiente. La tesis concluye que, a pesar de no disfrutar de un derecho a la autodeterminación, los catalanes podrían organizar un referéndum y unilateralmente declarar la independencia. Pero, en todo caso, sería una declaración vacía de contenido y no tendría ningún efecto sin un reconocimiento de la comunidad internacional. / El suport a la creació d’un estat català independent ha incrementat considerablement les últimes dues dècades. El 2017, s’estimava que el 40,2% de la població catalana va donar suport a la creació d’una Catalunya independent. El camí cap a la independència s’ha topat diversos obstacles jurídics. Les persones que advoquen per aquesta independència, tendeixen a fundar el seu anhel d’establir una Catalunya independent en un “dret a l’autodeterminació” i un “dret a decidir”. El significat i els efectes d’invocar aquests “drets” es poden qüestionar. L’objectiu d’aquesta tesi és investigar les possibilitats i incerteses legals que podria comportar el fet de crear una Catalunya independent protegida per aquests drets. Pel que fa a l’autodeterminació, aquesta tesi conclou que tots els pobles tenen un dret a l’autodeterminació, però aquest dret no implica un dret a la secessió. El dret a l’autodeterminació només pot implicar un dret a la secessió sota circumstàncies greus. Avui dia, la població catalana que advoca per la independència no es troba en una situació d’aquesta gravetat, és per això que el dret a l’autodeterminació no els dona un dret a la secessió d’Espanya unilateralment. Pel que fa al “dret a decidir”, aquest dret no existeix en l’ordre jurídic espanyol ni en l’àmbit internacional. No obstant, aquest dret pot dividir en dues parts: la possibilitat d’organitzar un referèndum, i la possibilitat d’unilateralment declarar la independència segons el resultat del referèndum. Aquesta tesi conclou que, tot i que un referèndum és complicat, no seria impossible organitzar-ne un segons la constitució espanyola. És per això que els catalans podrien organitzar un referèndum basant-se en drets humans internacionals. Els catalans també podrien unilateralment declarar la independència, perquè no hi ha cap prohibició explícita contra una declaració d’independència. Per finalitzar, la tesi examina el tema del reconeixement internacional. És improbable que Catalunya obtingui reconeixement com a un estat independent de la comunitat internacional. La tesi conclou que els catalans, malgrat no tenir un dret a l’autodeterminació, podrien organitzar un referèndum i podrien unilateralment declarar la independència. Però, en tot cas, seria una declaració buida de contingut i no tindria cap efecte sense un reconeixement de la comunitat internacional.

No description available.

The Monte Carlo tree search-algorithm (MCTS) has been proven successful when applied to combinatorial games, a term applied to sequential games with perfect information. As the focus for MCTS has tended to lean towards combinatorial games, general MCTS-strategies for other types of board games are hard to find. On another front, board games under the name of “Eurogames” have become increasingly popular in the last decade. These games introduce yet another set of challenges for game-playing agents on top of what combinatorial games already offer. Since its initial conception, a large number of enhancements to the MCTS-algorithm has been proposed. Seeing that eurogames share much of the same game-mechanics with each other, MCTS-enhancements proving effective for one game could potentially be aimed towards eurogames in general. In this paper, alterations to the expansion phase, the playout phase and the backpropagation phase are made to the standard MCTS-algorithm for agents playing the game of Carcassonne. To detect how enhancements are affected by chance events, both a deterministic and a stochastic version of the game is examined. It can be concluded that a reward policy relying solely on in-game score outperforms the conventional wins-against-losses policy. Concerning playouts, the Early Playout Termination enhancement only yields better results when the number of MCTS-iterations are somewhat restricted. Lastly, delayed node expansion is shown to be preferable over that of conventional node expansion. None of the enhancements showed any increasing or declining performance with regard to chance events. Additional experiments on other eurogames are needed to reaffirm any findings. Moreover, subsequent studies which introduce modifications to the examined enhancements is proposed as a measure to further increase agent performance. / Monte Carlo tree search-algoritmen (MCTS) har visat sig framgångsrik när den tillämpats på "combinatorial games", en term som används för sekventiella spel med perfekt information. Eftersom fokusområdet för MCTS har tenderat att luta mot "combinatorial games", är det svårt att hitta allmänna MCTS-strategier för andra typer av brädspel. På en annan front har brädspel under namnet "Eurogames" blivit allt populärare under det senaste decenniet. Dessa spel introducerar ännu en uppsättning utmaningar för agenter utöver vad "combinatorial games" redan erbjuder. Sedan dess begynnande så har ett stort antal förbättringar av MCTS-algoritmen föreslagits. Med tanke på att eurogames delar mycket av samma spelmekanik med varandra kan MCTS-förbättringar som visar sig vara effektiva för ett spel potentiellt riktas mot eurogames i allmänhet. I denna studie görs förändringar av expansionsfasen, playout-fasen och backpropagation-fasen i standard MCTS-algoritmen för agenter som spelar spelet Carcassonne. För att upptäcka hur förbättringar påverkas av slumpmässiga händelser undersöks både en deterministisk och en stokastisk version av spelet. Man kan dra slutsatsen att en belöningspolicy som enbart förlitar sig på poäng i spelet överträffar konventionell vinst-mot-förlust-policy. När det gäller "playouts" så bidrar Early Playout Termination-tillägget endast med bättre resultat när antalet MCTS-iterationer är något begränsat. Slutligen kan det visas att fördröjd expansion av noder att föredra framför konventionell expansion. Ingen av förbättringarna visade någon ökande eller minskande prestanda med avseende på slumpmässiga händelser. Ytterligare experiment på andra eurogames behövs för att bekräfta eventuella fynd. Dessutom föreslås efterföljande studier som introducerar modifieringar av de undersökta förbättringarna som ett mått för att ytterligare öka agentens prestanda.

This diploma thesis deals with the topic of the independence of the judiciary, which is grasped in its full complexity. The thesis aims to answer two research questions: what techniques of influencing of the independence of the judiciary exist and how could be the resistance of the Czech judiciary against these techniques strengthened. In order to answer these two questions, thesis introduction elaborates the theory of the concept of an independent judiciary, independent court and independent judge and explains the difference between the concepts of judicial independence and judicial impartiality. After the introduction, the thesis describes in detail the steps which have been undertaken in Hungary and Poland since 2010 and which enabled to paralyze the independence of the judiciary in these states. The detailed description of the attacks against the independent judiciary helps to conceive different kinds of techniques by which can be the judiciary influenced. These techniques are categorized in the third part of the thesis. More attention is given to the court- packing technique and to the technique of disciplinary proceedings with judges. Another part of the thesis is dedicated to the second research question - how one can successfully fight against techniques of influencing an independent...

No description available.

Objective: The transition to long-term care (LTC) of older adults receiving home care services is preceded by declining functional independence with basic and instrumental activities of daily living (ADL and IADL, respectively). These individual, and group, level time-dependent changes occur within unique provincial and regional policy contexts across Canada, which determine the amount and types of services received by home care recipients during this transition period. It is currently unknown whether activities of daily living (ADL) or IADL (instrumental activities of daily living) exhibit accelerated decline preceding transition to LTC, and if so, whether the onset and rate of decline differs for ADL versus IADL. This dissertation sets out to determine whether such change points exist within longitudinal data gathered from home care recipients in Ontario during the years of 2008 to 2015. Methods: A profile likelihood method was employed to identify the best fitting change points at which the slopes of functional decline in ADL and IADL for those who transition to LTC from home care services depart from the normative age slope of those who remain in community. Data analyzed was collected at approximately 6-month intervals using the International Residential Assessment Instrument – Home Care (RAI-HC) in Ontario, Canada, and was obtained from the Canadian Institutes for Health Information (CIHI) for the period of 2006-2015. A policy review was conducted to determine whether changes had occurred to the amount or type of home care services provided during the data collection period, and subsequently data from 2008 to 2015 were retained. IADL was measured using the 21-point IADL Involvement Scale and ADL was measured using the 28-point ADL Long Form. Best fitting change point models were first identified for ADL and IADL scores in the full sample of participants who remained in community and those who transitioned to LTC and within subgroups stratified by sex. Two additional subgroups were also examined: 1) participants without a primary or secondary caregiver living in the home, and 2) participants with a primary caregiver living in the home. Each caregiver group was also stratified by sex, resulting in a total of 9 groups in which IADL and ADL change points were estimated and compared. Results: In all groups who remained in community with home care services, age-related decline in IADL and ADL were observed. Further, IADL impairment was higher at the time of first assessment and had a greater age-related slope than ADL for those who remained in community. Both measures had discernable change points preceding discharge to LTC and the change point for IADL preceded that of ADL in all groups. Across groups, the change point for ADL had a range of 0.5 years before LTC discharge for men without a primary or secondary caregiver living in the home to 2 years for women with a primary caregiver in the home. IADL change points ranged from 2.5 years before LTC discharge for men with a primary caregiver in the home to 3.6 years for women without a primary or secondary caregiver in the home. Within the full sample, including both men and women, the onset of accelerated IADL decline for those discharged to LTC preceded the onset of home care service by 1.49 years and the time of first assessment by 1.84 years. Women in the full sample, and in both caregiver groups, experienced an earlier IADL change point relative to the availability of home care services and assessment when compared to men. Conclusions: Both IADL and ADL have discernible change points for in the years preceding discharge from home care to LTC. The change point for IADL consistently precedes that of ADL for the entire sample, for those with or without a caregiver in the home and for both men and women. The onset of accelerated IADL decline in the presence of age normative ADL decline may be an early indicator of pending transition from home care to LTC for home care recipients identified in this study. The province of Ontario has committed to providing the right care, at the right time in the right place. This study demonstrates that home care policy in Ontario during this study period, which does not provide for IADL services until after patients first qualify for ADL services, may not be achieving the provinces commitment of ensuring IADL care is provided at the right time for recipients of home care services. Opportunities for early identification and intervention may be available through early monitoring of, and intervention with, IADL function. A stepped care model holds promise for early identification and intervention of IADL impairment in community living older adults. Future research will help to confirm if accelerating decline in IADL function in the absence of appropriate rehabilitation and support services may hasten the onset of accelerated ADL impairment and subsequent admission to LTC. / Graduate / 2022-12-16

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At the dawn of independence in Africa, colonial rulers hastily introduced new structures such as national parliaments, local councils, and opposition parties in a bid to channel popular demands into responsive policies. These structures while all laudable were no match for the ethnic identities that had been created during the colonial period. Colonial rulers had drawn ethnic and geographic boundaries arbitrarily perhaps as part of the divide and rule policy which are said to have contributed immensely to the development of ethnic identities. This seems to give credibility to Mngomezulu argument that the concept of ‘ethnicity’ itself was imposed by colonial administrators upon an otherwise undifferentiated group of people. Thus, while it may be true that Africans in the pre-colonial societies were not homogeneous as evidenced by the migration of various groups across the continent, the colonial era played on the divisions making them rigid. / Thesis (LLM (Human Rights and Democratisation in Africa)) -- University of Pretoria, 2011. / http://www.chr.up.ac.za/ / nf2012 / Centre for Human Rights / LLM