Introdução: Avaliar a relação do custo e da efetividade da radiofrequência (RF) em relação ao bloqueio seqüencial na Síndrome Dolorosa Complexa Regional-tipo I (SDCR-I). Métodos: 15 pacientes com dor somática e autonômica cervical foram submetidos a bloqueio torácico simpático, combinado com bloqueio facetário cervical bilateral por 4 semanas. Esta seqüência foi repetida quando a dor atingiu VAS 4 cm, e este período foi definido como tempo de analgesia. Posteriormente, os mesmos pacientes foram submetidos a um bloqueio teste seguido de modulação de RF do gânglio simpático torácico e ablação de ramos facetários medianos cervicais. Os pacientes atuaram como seu próprio controle relacionado à analgesia, atividades rotineiras e padrão de sono. Resultados: 13 pacientes completaram o estudo. O tempo de analgesia após a sequência de 4 bloqueios foi de 4 ± 1 mês e o custo anual R$ 15.000,00. O tempo de analgesia após RF foi de 13 ± 2 meses (p <0,001) e os custos foram reduzidos em 26% no primeiro ano e 34% -38% nos anos seguintes, com extrapolação. A qualidade de vida melhorou para ambos os tratamentos (p> 0,05). Não houve efeitos adversos. Discussão: A RF resultou em analgesia de 13 meses comparada a 4 meses após os bloqueios clássicos e melhora na capacidade física e no padrão de sono. Além disso, a RF foi rentável e reduziu as taxas em 23% durante a avaliação do primeiro ano, seguida de uma redução de custos de 32% a 36% nos anos seguintes, com extrapolação. / Objectives: To evaluate cost-effectiveness of radiofrequency (RF) compared to sequential block in Complex Regional Pain Syndrome-I (CRPS). Methods: 15 patients with cervical somathic and autonomic pain were submitted to a 4- weekly sympathetic thoracic block, combined to bilateral cervical facetary block. This sequence was repeated when pain reached VAS 4-cm, and this period was defined as time of analgesia. Thereafter, same patients were submitted to a test block followed by RF modulation of thoracic sympathetic ganglion and ablation of facetary cervical median branches. Patients acted as their own control related to analgesia, routine activities, sleep pattern and costs. Results: 13 patients completed the study. The analgesia time after the 4-block sequence was 4±1 months and the annual costs USA$5000. Analgesia time after RF was 13±2 months (p<0.001) and costs were reduced by 26% in the first year and 34%-38% in the following years extrapolation. Quality of life improved for both treatments (p> 0.05). There were no adverse effects. Discussion: RF resulted in 13-month compared to 4-month analgesia after the classical 4- weekly blocks, and improved physical capacity and sleep pattern. Besides that, RF was costeffective, and reduced rates by 23% during the first-year evaluation, followed by 32%-36% cost reduction in following years, by extrapolation.

Neurography is the most objective and reliable measure of the peripheral nerve function, and it is used to diagnose both local and generalized neuropathies. Neurography can measure both motor and sensory nerve functions. The principle for sensory neurgraphy is to stimulate over the nerve and record proximal or distal from the stimulated electrode. At the Department of Clinical Neurophysiology, University Hospital Uppsala, a problem has been identified, in that young adult patients tend to show unexpected abnormal neurography values in relation to the expected, indicated by the reference limits, without clinical correlates. This concerns foremost the sensory amplitudes in median and ulnar nerves. The hypothesis is that the requirement of young adults’ amplitudes is too high. A reference material better including more subjects in this age group may solve the problem. Sensory nerve conduction studies were performed in 33 subjects, aged 15-30. The nerve functions were tested on median, ulnar and radial nerves. Surface electrodes were used for both recording and stimulation. The result shows that the presently used reference material for some nerves indeed has too high requirement for young adults. After increasing the reference material for younger age groups, the new reference limits has been changed and this should cause fewer false positive findings.

This dissertation studies in depth the structure of the Discrete Ordered Median Problem (DOMP), to define new formulations and resolution algorithms. Furthermore we analyze an interesting extension for DOMP, namely MDOMP (Monotone Discrete Ordered Median Problem). This thesis is structured in three main parts.First, a widely theoretical and computational study is reported. It presents several new formulations for the Discrete Ordered Median Problem (DOMP) based on its similarity with some scheduling problems. Some of the new formulations present a considerably smaller number of constraints to define the problem with respect to some previously known formulations. Furthermore, the lower bounds provided by their linear relaxations improve the ones obtained with previous formulations in the literature even when strengthening is not applied. We also present a polyhedral study of the assignment polytope of our tightest formulation showing its proximity to the convex hull of the integer solutions of the problem. Several resolution approaches, among which we mention a branch and cut algorithm, are compared. Extensive computational results on two families of instances, namely randomly generated and from Beasley's OR-library, show the power of our methods for solving DOMP. One of the achievements of the new formulation consists in its tighter LP-bound. Secondly, DOMP is addressed with a new set partitioning formulation using an exponential number of variables. This chapter develops a new formulation in which each variable corresponds to a set of demand points allocated to the same facility with the information of the sorting position of their corresponding distances. We use a column generation approach to solve the continuous relaxation of this model. Then, we apply a branch-cut-and-price algorithm to solve to optimality small to moderate size of DOMP in competitive computational time.To finish, the third contribution of this dissertation is to analyze and compare formulations for the monotone discrete ordered median problem. These formulations combine different ways to represent ordered weighted averages of elements by using linear programs together with the p-median polytope. This approach gives rise to two efficient formulations for DOMP under a hypothesis of monotonicity in the lambda vectors. These formulations are theoretically compared and also compared with some other formulations valid for the case of general lambda vector. In addition, it is also developed another new formulation, for the general case, that exploits the efficiency of the rationale of monotonicity. This representation allows to solve very efficiently some DOMP instances where the monotonicity is only slightly lost. Detailed computational tests on all these formulations is reported in the dissertation. They show that specialized formulations allow to solve to optimality instances with sizes that are far beyond the limits of those that can solve in the general case. / Cette dissertation étudie en profondeur la structure du "Discrete Ordered Median Problem" (DOMP), afin de proposer de nouvelles formulations et de nouveaux algorithmes de résolution. De plus, une extension intéressante du DOMP nommée MDOMP ("Monotone Discrete Ordered Median Problem") a été étudiée.Cette thèse a été structurée en trois grandes parties.La première partie présente une étude riche aux niveaux théorique et expérimentale. Elle développe plusieurs formulations pour le DOMP qui sont basées sur des problèmes d'ordonnancement largement étudiés dans la littérature. Plusieurs d'entres elles nécessitent un nombre réduit de contraintes pour définir le problème en ce qui concerne certaines formulations connues antérieurement. Les bornes inférieures, qui sont obtenues par la résolution de la relaxation linéaire, donnent de meilleurs résultats que les formulations précédentes et ceci même avec tout processus de renforcement désactivé. S'ensuit une étude du polyhèdre de notre formulation la plus forte qui montre sa proximité entre l'enveloppe convexe des solutions entières de notre problème. Un algorithme de branch and cut et d'autres méthodes de résolution sont ensuite comparés. Les expérimentations qui montrent la puissance de nos méthodes s'appuient sur deux grandes familles d'instances. Les premières sont générées aléatoirement et les secondes proviennent de Beasley's OR-library. Ces expérimentations mettent en valeur la qualité de la borne obtenue par notre formulation.La seconde partie propose une formulation "set partitioning" avec un nombre exponentiel de variables. Dans ce chapitre, la formulation comporte des variables associées à un ensemble de demandes affectées à la même facilité selon l'ordre établi sur leurs distances correspondantes. Nous avons alors développé un algorithme de génération de colonnes pour la résolution de la relaxation continue de notre modèle mathématique. Cet algorithme est ensuite déployé au sein d'un Branch-and-Cut-and-Price afin de résoudre des instances de petites et moyennes tailles avec des temps compétitifs.La troisième partie présente l'analyse et la comparaison des différentes formulations du problème DOMP Monotone. Ces formulations combinent plusieurs manières de formuler l'ordre des éléments selon les moyennes pondérées en utilisant plusieurs programmes linéaires du polytope du p-median. Cette approche donne lieu à deux formulations performantes du DOMP sous l'hypothèse de monotonie des vecteurs lambda. Ces formulations sont comparées de manière théorique puis comparées à d'autres formulations valides pour le cas général du vecteur lambda. Une autre formulation est également proposée, elle exploite l'efficacité du caractère rationnel de la monotonie. Cette dernière permet de résoudre efficacement quelques instances où la monotonie a légèrement disparue. Ces formulations ont fait l'objet de plusieurs expérimentations dècrites dans ce manuscrit de thèse. Elles montrent que les formulations spécifiques permettent de résoudre des instances plus importantes que pour le cas général. / Este trabajo estudia en profundidad la estructura del problema disctreto de la mediana ordenada (DOMP, por su acrónimo en inglés) con el objetivo de definir nuevas formulaciones y algoritmos de resolución. Además, analizamos una interesante extensión del DOMP conocida como el problema monótono discreto de la mediana ordenada (MDOMP, de su acrónimo en inglés).Esta tesis se compone de tres grandes bloques.En primer lugar, se desarrolla un detallado estudio teórico y computacional. Se presentan varias formulaciones nuevas para el problema discreto de la mediana ordenada (DOMP) basadas en su similaridad con algunos problemas de secuenciación. Algunas de estas formulaciones requieren de un cosiderable menor número de restricciones para definir el problema respecto a algunas de las formulaciones previamente conocidas. Además, las cotas inferiores proporcionadas por las relajaciones lineales mejoran a las obtenidas con formulaciones previas de la literatura incluso sin reforzar la nueva formulación. También presentamos un estudio poliédrico del politopo de asignación de nuestra formulación más compacta mostrando su proximidad con la envolvente convexa de las soluciones enteras del problema. Se comparan algunos procedimientos de resolución, entre los que destacamos un algoritmo de ramificación y corte. Amplios resultados computacionales sobre dos familias de instancias -aleatoriamente generadas y utilizando la Beasley's OR-library- muestran la potencia de nuestros métodos para resolver el DOMP.En el segundo bloque, el problema discreto de la mediana ordenada es abordado con una formulación de particiones de conjuntos empleando un número exponencial de variables. Este capítulo desarrolla una nueva formulación en la que cada variable corresponde a un conjunto de puntos de demanda asignados al mismo servidor con la información de la posición obtenida de ordenar las distancias correspondientes. Utilizamos generación de columnas para resolver la relajación continua del modelo. Después, empleamos un algoritmo de ramificación, acotación y "pricing" para resolver a optimalidad tamaños moderados del DOMP en un tiempo computacional competitivo.Por último, el tercer bloque de este trabajo se dedica a analizar y comparar formulaciones para el problema monótono discreto de la mediana ordenada. Estas formulaciones combinan diferentes maneras de representar medidas de pesos ordenados de elementos utilizando programación lineal junto con el politopo de la $p$-mediana. Este enfoque da lugar a dos formulaciones eficientes para el DOMP bajo la hipótesis de monotonía en su vector $lambda$. Se comparan teóricamente las formulaciones entre sí y frente a algunas de las formulaciones válidas para el caso general. Adicionalmente, se desarrolla otra formulación válida para el caso general que explota la eficiencia de las ideas de la monotonicidad. Esta representación permite resolver eficientemente algunos ejemplos donde la monotonía se pierde ligeramente. Finalmente, llevamos a cabo un detallado estudio computacional, en el que se aprecia que las formulaciones ad hoc permiten resolver a optimalidad ejemplos cuyo tamaño supera los límites marcados en al caso general. / Doctorat en Sciences / info:eu-repo/semantics/nonPublished

Class of 2015 Abstract / Objectives: To evaluate the in vitro performance of various pressurized metered dose inhaler (pMDI) formulations by cascade impaction primarily focusing on throat deposition, fine particle fraction (FPF), and mass-median aerodynamic diameter (MMADR) measurements Methods: Ten solution pMDIs were prepared with varying cosolvent species in either low (8% w/w) or high (20% w/w) concentration. The chosen cosolvents were either alcohol (ethanol, n-propanol) or acetate (methyl-, ethyl-, and butyl acetate) in chemical nature. All formulations used HFA-134a propellant and 0.3% drug. The pMDIs were tested by cascade impaction with three different inlets to determine the aerodynamic particle size distribution (APSD), throat deposition, and FPF of each formulation. Theoretical droplet evaporation time (DET), a measure of volatility, for each formulation was calculated using the MMADR. Results: Highly volatile formulations with short DET showed consistently lower throat deposition and higher FPF than their lower volatility counterparts when using volume-constrained inlets. However, FPF values were not significantly different for pMDI testing with a non-constrained inlet. The MMADR values generated with volume-constrained inlets did not show any discernible trends, but MMADR values from the non-constrained inlet correlated with DET. Conclusions: Formulations with shorter DET exhibit lower throat deposition and higher FPF, indicating potentially better inhalational performance over formulations with longer DET. There appear to be predictable trends relating both throat deposition and FPF to DET. The shift in MMADR values for volume-constrained inlets suggests that large diameter drug particles are preferentially collected in these inlets.

Master of Arts / Department of Geography / John A. Harrington Jr / In late summer and fall, many migratory birds journey south from the North American Great Plains to spend the winter in locations with greater food availability. As spring returns, a combination of genetics and environmental cues trigger these birds to return north to their breeding grounds. Several bird migration phenology studies from Europe, Australia, and the eastern/northern United States have discovered that some bird species are returning earlier in the spring, a change that has often been correlated with a warming climate. This study aimed to be the first to analyze possible changes in both spring bird migration phenology and regional spring climate change in Kansas. First arrival dates (FADs) were collected for thirty bird species, resulting in a database with over 6,000 FAD entries. For northeast Kansas, 1997-2007 median arrival dates were calculated and compared to dates published by Dr. Richard Johnston in 1965. In southcentral Kansas, 1997-2007 and 1947-1967 median arrival dates were calculated and compared. Temperature data from spring (February through May) were also obtained from the National Climate Data Center's United States Historical Climatology Network for all stations within northeast and south central Kansas and temporal trends were analyzed with linear regression analysis. A comparison between median arrival dates in northeast Kansas found that eleven species had altered their arrival date by a potentially significant number of days. Nine of these had advanced their arrival and two showed a delay. In south central Kansas, nine species were shown to have statistically significant differences in median arrival dates between time periods. Six of these showed an advance and three showed a delay. Five species showed the same trend between both regions, with four arriving earlier by an average 9.4 days and one delaying by an average of 4.5 days. Temperature trends for both subregions in Kansas showed significant warming of 1.8-2.6°F (1.0-1.4°C) over the last century, with the largest warming observed in February and associated strongly with increasing minimum temperatures. The results from this study provide the first evidence that some bird species have recently altered the timing of their arrival in Kansas, with a greater shift toward earlier arrival dates. While the majority of these shifts were correlated with spring warming in Kansas, additional research is necessary to determine the precise cause(s) of these phenological shifts. Still, given existing literature and Intergovernmental Panel on Climate Change predictions for continued warming in the next century, continued alterations to bird migration phenology seem likely.

Diploma thesis deals with the concept of Corporate Social Responsibility - CSR. The chosen topic is currently up-to-date. Many companies begin to be interested in the ideas of this concept. Especially in recent years there can be seen activities and projects in this area. In the theoretical part of the work are captured substantive interpretations of the concept, there are also documented in the state of CSR -- both in the EU and more specifically in the Czech Republic. In the next part, thesis briefly introduces selected studies that are concerned with the topic. Practical part of the thesis is based on analysis of data of the agency Median and seeks to analyze of the perception of ideas, the concept of CSR is. Add to knowledge of the attitude of Czech society to the responsible conduct of companies.

Thesis focuses on describing the consumer behavior on the alcoholic beverages market in the Czech Republic. In addition to quantitative analysis, which uses the MML - TGI data from Median Ltd., thesis also includes qualitative research with further analysis of selected segments. Based on the findings from analysis, recommendation for creating a new alcoholic beverage is made according to lifestyle of the consumer.

Master thesis judge situation of wages of men and women in Czech republic and compare this situation with different results in chosen countries of European union. This situation is influenced by many factors which are described in thesis. My thesis is divided into two parts theoretical and practical. In theoretical part there are inequality of opportunities at labor market, reasons of inequality and differences between wages. In practical part there are statistical data which are connected with results of theoretical part. The conclusion contains recommendations how to decrease the differences of wages.

This study aims to compare three distinct methods used to compute access density and provide a comprehensive weighted methodology to enable standardization for research and application in the future. Access density is a widely used concept that calculates the number of access points within a given distance and has been extensively applied to studies related to crash modeling, operational impact and planning. Methods used in past research show that access density is computed differently by different studies and all studies do not include all access points. The weighted methodology proposed takes into account all access points including driveways, intersections and median openings and categorizes them into geometric combinations. Each geometric combination have potential number of conflict points which include diverging, weaving, merging and crossing movements depending on the type of access point. Weights were assigned to each geometry type based on these conflict point ratio. In conclusion the study identifies and compares methods previously used to compute access density and accordingly, recommends a weighted methodology that includes all access points which can be used as a standard, universal measure all access density related studies including but not limited to safety impacts, operational impacts and planning guidelines.

This dissertation presents spatial partitioning algorithms to solve location-allocation problems. Location-allocations problems pertain to both the selection of facilities to serve demand at demand points and the assignment of demand points to the selected or known facilities. In the first part of this dissertation, we focus on the well known and well-researched location-allocation problem, the "p-median problem", which is a distance-based location-allocation problem that involves selection and allocation of p facilities for n demand points. We evaluate the performance of existing p-median heuristic algorithms and investigate the impact of the scale of the problem, and the spatial distribution of demand points on the performance of these algorithms. Based on the results from this comparative study, we present guidelines for location analysts to aid them in selecting the best heuristic and corresponding parameters depending on the problem at hand. Additionally, we found that existing heuristic algorithms are not suitable for solving large-scale p-median problems in a reasonable amount of time. We present a density-based decomposition methodology to solve large-scale p-median problems efficiently. This algorithm identifies dense clusters in the region and uses a MapReduce procedure to select facilities in the clustered regions independently and combine the solutions from the subproblems. Lastly, we present a novel greedy heuristic algorithm to solve the contiguity constrained fixed facility demand distribution problem. The objective of this problem is to create contiguous service areas for the facilities such that the demand at all facilities is uniform or proportional to the available resources, while the distance between demand points and facilities is minimized. The results in this research are shown in the context of creating emergency response plans for bio-emergencies. The algorithms are used to select Point of Dispensing (POD) locations (if not known) and map them to population regions to ensure that all affected individuals are assigned to a POD facility.