I denna uppsats undersöks om akutmottagningarnas långa väntetider kan bero på att olämpliga teorier appliceras på vårdmarknaden. Det undersöks med en fallstudie av hälso- och sjukvården i Västra Götaland där vi har genomfört semistrukturerade intervjuer med fem anställda i kanslierna som ansvarar för att ge politikerna information till sjukvårdsbeslut och för att stödja politikerna i styrandet av hälso- och sjukvården. Det är en kvalitativ studie med en abduktiv ansats.Vår empiri indikerar att en stor orsak till akutmottagningarnas långa väntetider är att de har ett inflöde av patienter med relativt milda symptom som kunde ha omhändertagits inom primärvården. Förklaringar till det är att klienterna ofta har bristfällig kunskap om lämpliga vårdenheter och ofta antar att de får bättre vård på akutmottagningar än inom primärvården. Många av de patienter på akutmottagningarna som kommit till olämplig vårdenhet är äldre och kroniskt sjuka.Den här studien indikerar att olämpliga teorier har applicerats på Västra Götalands vårdmarknad. Inspirationen till vårdmarknaden tycks till stor del härstamma från traditionella nationalekonomiska teorier. Vi anser dock att de är olämpliga på Västra Götalands vårdmarknad på grund av bristande utbud, bristande konkurrens, irrationella klienter och risker för missgynnanden. Vi föreslår istället ett större fokus på sociologiska marknadsteorier.Den här studien begränsas av det relativt låga antalet intervjusubjekt. Vi har dock hittat tecken i vår empiri på ett samband mellan missgynnade klienter inom primärvården och det ökade inflödet till akutmottagningarna. Vår förhoppning är att detta kan bidra med uppslag till framtida, mer omfattande undersökningar. / This paper addresses long waiting times in Swedish emergency units by examining if appropriate theories are applied to the healthcare sector. This is examined with a case study of the healthcare sector in Västra Götaland County where we have conducted semi-structured interviews with five members of the staff responsible for providing the county’s politicians with information for healthcare decisions as well as supporting the politicians in managing the healthcare sector. It is a qualitative study with an abductive approach.The findings from our empirical research indicate that one major reason for the emergency units’ long waiting times is that they have an influx of patients with relatively mild illnesses that could have been handled in the primary care. Explanations for that are that clients often are ill-informed and often expect to get better care at emergency units than in the primary care. Many of the emergency units’ misplaced patients are elderly and chronically ill.This study indicates that inappropriate theories have been applied to the healthcare sector in Västra Götaland County. The inspiration for the healthcare sector seems to be from traditional economics to a large extent. We conclude, however, that traditional economics is inappropriate on the healthcare sector in Västra Götaland County because of the lacking supply, lacking competition, irrational clients and risk for disadvantages. Instead, we suggest a higher focus on sociological market theories.This study is limited by the relatively low amount of interview subjects. We have, however, found indications in our empirical material for a connection between disadvantaged clients in the primary care and the increased influx to the emergency units. We hope that this could provide ideas for future and more elaborate studies.This paper is written in Swedish.

The first paper examines the value of a statistical life (VSL) for out-of-hospital cardiac arrest (OHCA) victims. We found VSL values to be higher for OHCA victims than for people who die in road traffic accidents and a lower-bound estimate of VSL for OHCA would be in the range of 20 to 30 million Swedish crowns (SEK). The second paper concerns hypothetical bias in contingent valuation (CV) studies. We investigate the link between the determinants and empirical treatment of uncertainty through certainty calibration and find that the higher the confidence of the respondents the more we can trust that stated WTP is correlated to actual WTP. The third paper investigates the performance of two communication aids (a flexible community analogy and an array of dots) in valuing mortality risk reductions for OHCA. The results do not support the prediction of expected utility theory, i.e. that WTP for a mortality risk reduction increases with the amount of risk reduction (weak scope sensitivity), for any of the communication aids. The fourth paper presents a cost-benefit analysis to evaluate the effects of dual dispatch defibrillation by ambulance and fire services in the County of Stockholm. The intervention had positive economic effects, yielding a benefit-cost ratio of 36, a cost per quality-adjusted life-year (QALY) of € 13 000 and the cost per saved life was € 60 000. The fifth paper explores how different response times from OHCA to defibrillation affect patients’ survival rates by using geographic information systems (GIS). The model predicted a baseline survival rate of 3.9% and reducing the ambulance response time by 1 minute increased survival to 4.6%. The sixth paper analyzes demographic determinants of incident experience and risk perception, and the relationship between the two, for eight different risk domains. Males and highly educated respondents perceive their risks lower than what is expected compared to actual incident experience.

呈現足球的公共形象在19世紀中晚期英格蘭地區的演進，以及此形象的演進如何促成現代足球(特別是協會足球)成形與流行，就是本論文的主要目的。 　　目前學界對於現代足球起源與成形有兩種主要看法：出身社會中上層的公學、大學師生，在19世紀中葉透過制定成文規則，「馴化」並保存此前社會上原有的民俗足球，最後促成統一足球規則的努力──此為其一；修正派學者則認為，早在公學、大學師生投入前，19世紀中葉以前的英格蘭社會中早已存在有組織、有規則的足球，而早期學者過分誇大了社會中上層對於現代足球帶來的影響。然而，現有史料尚不足以證明上述足球活動實際如何進行、組織，也無法顯示各種以「足球」為名的運動間是否有因果關係。 　　人們呈現過去的方式，足以暗示了他們希望別人，甚至是自己應該如何看待目前的現實。足球的規則，以及人們希望足球所能承載的價值、作用，都會隨著時間改變。除了用規則的出現與演變來追溯現代足球的起源，由制定規則的群體來判斷現代足球受到哪一階級影響較深以外，從時人對於足球的「印象」、「觀感」，也就是他們所相信的東西著手，或許更能推演出「現代足球」的「概念」源起於何時。 　　《英格蘭19世紀中晚期足球形象的演進》即以此為目標，利用19世紀《倫敦時報》的讀者投書，以及其他運動報紙和嚴肅期刊文章，試圖重建足球在19世紀中晚期英格蘭輿論中的公共形象，繼而回應、調和學界已有的兩種不同觀點。第一章〈斷裂或延續：現代足球起源問題〉呈現公學觀點與修正派學者的主張與其優劣擅場，並提出以足球的當代「形象」做為解決起源問題的可能方式。第二章〈公學地位競爭與足球議題上升的能見度(1858-63)〉直接回到上述學術論爭所指向的關鍵時代，透過當時媒體上有關「統一足球規則」的爭論來證明當時公學、大學師生與社會中上層人士對提高現代足球運動地位的影響。第三章〈從惡名昭彰到男子氣概：19世紀末輿論中足球形象的演進〉，則綜觀整個19世紀，在長時段中呈現足球形象在英格蘭輿論中的轉折，進一步突顯現代足球概念成形的時間。 　　透過足球形象的轉變與形塑，以及時人對於足球發展歷程的看法，我們得以了解19世紀中晚期的英格蘭人為何投身一種新興的運動，從而接近他們所追求的價值，並希望別人如何看待他們的所作所為。 關鍵詞：現代足球　協會足球　《倫敦時報》讀者投書

Timely access to child mental health services is a widespread concern. Many children with diagnosable disorders do not receive help. Untreated disorders can cause significant child and family impairment. Barriers to treatment can impede access. Few specialists, long wait lists and clinic-based services can be problematic. Families encounter treatment barriers related to travel (i.e., time off work or school; inconvenience; financial burden), stigma, and child resistance to therapy. Alternative models of care are needed. Distance telephone treatment (e.g., Strongest Families), can bridge the access gap. There is little understanding about the participants’ experience with distance treatment. The research objectives were: 1. to establish if therapeutic alliance exists between a) a parent-coach and b) a child-coach, when distance treatment is delivered by telephone with no face-to-face contact; 2. to explore the parents’ distance experiences and opinions; 3. to develop and validate the Treatment Barrier Index (TBI) scale derived from participants’ experiences; and 4. to use the TBI to examine treatment barrier differences (and therapeutic processes) between two delivery systems (Distance vs Face-to-face). Therapeutic alliance exists between adult-coach and child-coach with distance treatment. Participants found distance treatment to be more private and felt less stigmatized because of visual anonymity, compared to their opinions of face-to-face services. The TBI results indicated fewer perceived barriers with distance treatment. A significant difference was found between delivery systems in terms of perceived barriers, therapeutic alliance and self-disclosure as a group of variables. This suggests that there may be differences in therapeutic processes between systems. Therapeutic alliance scores were enhanced with distance treatment and found to positively correlate with self-disclosure and outcome scores; suggesting that these processes are important in the context of distance intervention. Cost-effective distance systems using non-professionals may be one way to increase access to child mental health services. Although some families may prefer the physical presence of face-to-face services, others prefer distance services. The results from these studies may help to inform system design improvements aimed at increasing service access. Improving models of care to meet participants’ needs could lead to increased service utilization, ultimately improving child health outcome.

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Ce mémoire portera sur le problème de la signification, dans la pensée de Heidegger, de la métaphysique moderne, à partir de la conception de l’histoire de l’être qu’il développe dans les années 1930. Plus précisément, nous nous baserons sur l’écrit Die Zeit des Weltbildes, que l’on retrouve dans le recueil nommé Holzwege, mais également, dans une moindre mesure, sur l’écrit Niezsches Wort « Gott ist tot » du même recueil. Nous commencerons par introduire le lecteur à l’idée qu’il se fait de la métaphysique en général dans son rapport à l’homme, et du nihilisme que constitue son histoire, lequel s’accentue à l’époque moderne. Nous rentournerons alors brièvement aux premiers commencements de la métaphysique, chez Parménide et Platon principalement, dans le but de dégager les aspects de la métaphysique moderne qui y ont trouvé leur source. C’est alors que nous entrerons dans le vif du sujet, en expliquant en quoi consiste l’inauguration de la métaphysique moderne chez Descartes qui, face à l’obligation religieuse, pose la confirmation autonome de la vérité qui trouve son lieu propre dans la conscience de soi. Il sera dès lors question de montrer précisément comment se fait cette confirmation par soi-même du vrai, au travers de certaines notions centrales de l’analyse heideggerienne : la pro-position, la présentation et la représentation, l’instauration, la production, l’obtention, la préhension et la compréhension, notamment. Nous analyserons ensuite le mouvement de la volonté du sujet qui sous-tend cette confirmation autonome du savoir jusqu’à son aboutissement chez des penseurs tels que Schopenhauer. Nous mettrons par le fait même en évidence le rapport fondamental, souligné par Heidegger, entre le sujet et son objet, l’homme moderne se soulèvant et se donnant lui-même le statut éminent de centre de référence de toute chose, rapportant à lui-même tout chose. Ce mémoire se terminera par l’analyse que fait Heidegger d’un phénomène propre à la modernité, et donc émanent de la métaphysique qui aura été examinée au préalable, soit la science moderne. Celle-ci constitue la voie privilégiée où l’homme moderne, après avoir sciemment pris position au centre du monde, peut « procéder » dans le monde comme dans son royaume, un monde qui se révèle alors comme étant essentiellement à sa disposition. La science, émanant selon Heidegger de la conception moderne de la vérité et de l’étant, se révèle alors non seulement comme une réalisation de la métaphysique qui aura été analysée dans les chapitres précédents, mais peut-être même comme le phénomène duquel Heidegger semble s’être inspiré pour développer son idée de la métaphysique moderne. / The present thesis explores the nature of the Heideggerian critique of Modern Times and of the metaphysics that constitutes their foundation, a critique that is based on the notion of the history of Being as conceived by Heidegger in the1930s. We will do so through a close reading of Die Zeit des Weltbildes, as well as of Nietzsches Wort « Gott ist tot », two essential writings found in the collection of texts called Holzwege. First, we will have a look at his idea of metaphysics in general, and of nihilism as the principle behind it’s history, of which we will then examine the first phases, leading to the emergence of Modern Times. At that point, we will explain of the nature of the inauguration of this era in Descartes’ philosophy, where he opposes the self-confirmation of truth by the human subject to religious obligation, a confirmation happening in self-consciousness. The modalities of this modern principle of knowledge will be examined, through key notions of Heidegger’s analysis: proposition, presentation, representation, production, objet, prehension, comprenhension, etc. After which a look at the human will as the main motor of this autonomous confirmation of truth, all through modern history up to philosophies such as that of Schopenhauer, is necessary to understand how Heidegger interprets this determination of truth in the light of the relation between man and his world. In his eyes, the Modern Times see man standing up to consciously assert himself as the center of reference of the whole world, bringing everything back to himself, therefore reducing ontology to anthropology. This paper will then, at the end of it’s path, take a close look at the way Heidegger interprets one of Modern Time’s main phenomena, originating according to him in modern metaphysics, that is to say modern science. It will reveal itself to be the privileged way by which man, after his positioning at the center of the world, proceeds through the world as his kingdom, all beings essentially being at his disposal. Modern science, this accomplishment of modern thought, almost seems to be the main inspiration from which he derives his theory concerning the essence of this thought.

Pour répondre aux exigences du gouvernement fédéral quant aux temps d’attente pour les chirurgies de remplacement du genou et de la hanche, les établissements canadiens ont adopté des stratégies de gestion des listes d’attentes avec des niveaux de succès variables. Notre question de recherche visait à comprendre Quels facteurs ont permis de maintenir dans le temps un temps d’attente répondant aux exigences du gouvernement fédéral pendant au moins 6-12 mois? Nous avons développé un modèle possédant quatre facteurs, inspiré du modèle de Parsons (1977), afin d’analyser les facteurs comprenant la gouvernance, la culture, les ressources, et les outils. Trois études de cas ont été menées. En somme, le 1er cas a été capable d’obtenir les exigences pendant six mois mais incapable de les maintenir, le 2e cas a été capable de maintenir les exigences > 18 mois et le 3e cas a été incapable d’atteindre les objectifs. Des documents furent recueillis et des entrevues furent réalisées auprès des personnes impliquées dans la stratégie. Les résultats indiquent que l’hôpital qui a été en mesure de maintenir le temps d’attente possède certaines caractéristiques: réalisation exclusive de chirurgie de remplacement de la hanche et du genou, présence d’un personnel motivé, non distrait par d’autres préoccupations et un esprit d’équipe fort. Les deux autres cas ont eu à faire face à une culture médicale moins homogène et moins axés sur l’atteinte des cibles; des ressources dispersées et une politique intra-établissement imprécise. Le modèle d’hôpital factory est intéressant dans le cadre d’une chirurgie surspécialisée. Toutefois, les patients sont sélectionnés pour des chirurgies simples et dont le risque de complication est faible. Il ne peut donc pas être retenu comme le modèle durable par excellence. / In response to federal government requirements regarding wait times for elective hip and knee surgery, hospitals have adopted wait list management strategies, with variable success. This research examined organizational and systemic factors that made it possible to keep wait times within federally established limits of 6-12 months. We used a model based on Parsons’ model. Four dimensions were used to analyze the following factors: governance, culture, resources, and tools. Three cases studies were done: Case 1 was able to meet the requirements for six months but unable to sustain this level; Case 2 was able to maintain compliance with requirements for > 18 months; and Case 3 was never able to meet the requirements. Documents were collected and interviews conducted with people involved in the strategies. In all, eight interviews were conducted at each site and all documents related to each strategy were collected. The results indicated that the one hospital that was able to maintain compliance with the wait time requirements had specific characteristics: an exclusive mandate to do only hip and knee replacement surgery; motivated staff who were not distracted by other concerns; and a strong team spirit. The two other cases had to contend with a medical culture that was less homogeneous and they were less focused on meeting targets and had resources that were dispersed as well as unclear inter-organizational policies. In the end, the hospital factory model is appealing in the context of superspecialized surgery. However, because patients are selected for simple surgeries, with little risk of complications, it cannot be promoted as a sustainable model of excellence.

Prostate cancer is the most common malignancy afflicting Canadian men in 2011. Physicians use digital rectal exams (DRE), blood tests for prostate specific antigen (PSA) and transrectal ultrasound (TRUS)-guided biopsies for the initial diagnosis of prostate cancer. None of these tests detail the spatial extent of prostate cancer - information critical for using new therapies that can target cancerous prostate. With an MRI technique called proton magnetic resonance spectroscopic imaging (1H-MRSI), biochemical analysis of the entire prostate can be done without the need for biopsy, providing detailed information beyond the non-specific changes in hardness felt by an experienced urologist in a DRE, the presence of PSA in blood, or the “blind-guidance” of TRUS-guided biopsy. A hindrance to acquiring high quality 1H-MRSI data comes from signal originating from fatty tissue surrounding prostate that tends to mask or distort signal from within the prostate, thus reducing the overall clinical usefulness of 1H-MRSI data. This thesis has three major areas of focus: 1) The development of an optimized 1H-MRSI technique, called conformal voxel magnetic resonance spectroscopy (CV-MRS), to deal the with removal of unwanted lipid contaminating artifacts at short and long echo times. 2) An in vivo human study to test the CV-MRS technique, including healthy volunteers and cancer patients scheduled for radical prostatectomy or radiation therapy. 3) A study to determine the efficacy of using the 1H-MRSI data for optimized radiation treatment planning using modern delivery techniques like intensity modulated radiation treatment. Data collected from the study using the optimized CV-MRS method show significantly reduced lipid contamination resulting in high quality spectra throughout the prostate. Combining the CV-MRS technique with spectral-spatial excitation further reduced lipid contamination and opened up the possibility of detecting metabolites with short T2 relaxation times. Results from the in vivo study were verified with post-histopathological data. Lastly, 1H-MRSI data was incorporated into the radiation treatment planning software and used to asses tumour control by escalating the radiation to prostate lesions that were identified by 1H-MRSI. In summary, this thesis demonstrates the clinical feasibility of using advanced spectroscopic imaging techniques for improved diagnosis and treatment of prostate cancer.

The strict divisions of city spaces created by physical urban planning disintegrated under transformations of capitalism and its accompanying crises of overaccumulation, social urban planning was elaborated to more effectively control the capitalist city and to reintegrate the increasingly blighted areas of the once popular amusements into the economy. / This disciplined reintegration, unsuccessfully attempted in New York City's Times Square since the late 1920s. is finally being realized by the redevelopment forces that began shaping the city's spatial practices in the wake of the fiscal crisis of 1975. The development projects undertaken in midtown Manhattan following the recovery from the fiscal crisis are transforming the renowned Times Square theater district into a strikingly different urban environment. The new politics of redevelopment under the regime of flexible accumulation are almost exclusively oriented towards economic development that is equated with speculative property investments, rebuilding Times Square to promote the global city's finance monopoly. Denying the existence of the public realm and celebrating free market laissez-faire policy, the 42nd Street Development Project, under the guise of removing blight, is eliminating the undesirable and underprivileged from the new image of the Bright Lights District. Times Square as a center of the local popular culture of Broadway theaters, cinemas, restaurants, billboard spectaculars, and public celebrations, has been lost as a public space. In the redevelopment projects now imaging the Crossroads of the World, the lost city of the past is recreated through the commodification of its collective memory, fashioning a Disneyfied spectacle for the global urban center. (Abstract shortened by UMI.)

This preliminary study examined the dominant frames used by the New York Times in the coverage of HIV/AIDS in Africa. The study also analyzed the tone of coverage used on HIV/AIDS stories on Africa and the volume of news coverage on the issue from January 2000 to December 2007. The results of the study indicated a dominant human disaster frame in the coverage of HIV/AIDS stories on Africa. Overall tone of coverage was neutral. However, findings indicated more negative tones of coverage than positive. The volume of coverage changed overtime. Ultimately, these media frames carry significant implications for public attitude and policy outcomes / Department of Journalism