Thesis (Dr. P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2001. / Supervisor: Beth E. Quill. Source: Dissertation Abstracts International, Volume: 62-09, Section: B, page: 3993. Includes bibliographical references (leaves 139-146).

Abstract Sanitation coverage in the Republic of Panama is 5 to 10 percent below the Millennium Development Goals targets set for the country. Population growth, urbanization, unplanned development and waste mismanagement have resulted in improvised trash sites and waste discharges into river systems that are important components of the biologically diverse natural environment of Panama. The study sought to investigate and estimate the burden of waste from domestic and agricultural sources in three regions of the Chilibre corrigimiento (district). It was hypothesized that the water quality and land cover data would reflect that the most populated region in the study sample (Region 2) would have more water quality violations than the adjacent background and attenuation regions (Region 1 and Region 3) in the study sample. The results supported that Region 2 had the most water quality violations -- particularly at the CHIL 3 monitoring station. Based on the results the most appropriate best management practices (BMPs) were recommended for the household, community, watershed, and regional level waste management in the study region. Future research will look determine the effectiveness of microfinance programs in bolstering sanitation-based entrepreneurship in Chilibre and across Panama.

The purpose of this study was to explore how teacher learning happened informally at the workplace. Another aim was to describe the ways in which informal learning contributes to teacher development. The study also endeavoured to establish if the school supported or hindered informal learning. The method of case study was used to understand how both novice and experienced teachers learn informally in a secondary school. The study examined five teachers’ informal learning experiences in the school by drawing on accounts of the individual teachers’ perceptions and reflections documented in journals, photographs and interviews. The journal entries were used to write narratives which outlined how teachers learnt informally in the workplace. Teachers were asked to take photographs of the places in which they learnt informally. The interviews awarded teachers the opportunity to talk about the photographs they chose to capture. The study found that teachers engage in various forms of informal learning opportunities at school. These opportunities were both planned and unplanned. The research indicated that informal learning is situated. Some of the learning opportunities included being part of a learning community, learning by interacting with colleagues in informal chats and attending meetings. In these instances it was found that teachers learnt with and from others, which is socially. This illustrates collaborative learning in the school. Teachers also engaged in individual learning. It was discovered that the school must provide opportunities for teachers to engage in informal learning. The study considered the various opportunities that existed in the school for teachers to develop and found that such opportunities contributed towards extending teacher knowledge and development. The study found that teachers in the study were willing to take the initiative to seek the learning they thought they required. The study recommends that informal learning be recognised as an authentic form of teacher learning and development in schools. Further, schools must become sites of learning for teachers by creating, encouraging and sustaining learning opportunities. / Thesis (M.Ed.)-University of KwaZulu-Natal, Pietermaritzburg, 2011.

Den digitala utvecklingen i dagens samhälle ger konsumenter reklam och erbjudande vart de än kollar. Via sociala medier når företag lätt ut till sin målgrupp och kan med små medel påverka konsumentens behov. Detta har skapat ett nytt sätt att konsumera där konsumenter inte endast handlar nödvändigheter utan skapar ett eget behov i takt med att den ständiga exponeringen för nya produkter. Denna exponeringen leder till impulsiva köp. I denna studie har en kvantitativ enkät och en kvalitativ intervju använts för att kartlägga konsumentens köpbeteende. Syftet är att undersöka de interna och externa faktorer sompåverkar konsumenternas impulsiva köpbeteende. Den kvantitativa enkäten användes för att ge en generell bild av konsumenternas köpbeteende för att sedan kompletteras med intervjuernas mer djupgående svar. Studiens resultat presenteras och analyseras utifrån tre utvalda kategorier som varit grund till enkät- och intervjufrågorna. Kategorierna utgår från studiens valda teoretiska perspektiv som innefattar modellerna Consumer Impulsive Formation Enactment (CIFE) och The Stimulus-Organism-Response (S-O-R). Modellerna används som hjälpmedel för att kartlägga konsumenternas beteende gällande såväl interna som externa faktorer. Utifrån modellerna har ett eget teoretiskt ramverk utvecklats för studien. Modellen heter DIA-modellen och är en sammanfattning av studiens teoretiska perspektiv och används för att kartlägga impulsiva konsumentbeteende i den digitala modehandeln. Modellen utgår ifrån följande kategorier: digitalt köpbeteende, impulsivt köpbeteende och affektiv påverkan. En slutsats som kan dras av denna undersökning är att de miljöpåverkande och externa faktorerna spelar en stor roll i skapandet av konsumenternas behov. Resultatet visade att respondenterna ansågs sig göra oplanerade köp som en följd avett behov som uppkom först när de presenterades för produkten i fråga. Detta visade sig även ha en större påverkan på de yngre respondenterna som påverkades i större utsträckning via sociala medier och dess omgivning. De interna faktorer som visade sig vara avgörande var utvärderingen och motiveringen av köpet. För vidare studier kan förslagsvis skillnader påmän och kvinnors impulsiva köpbeteende undersökas för att se om där finns skillnader. Studiens begränsningar är det utvalda kategorier som undersöker hur interna och externa faktorer påverkar impulsivt köpbeteende. Om konsumenten ansåg sig kunna motivera sitt köp i utvärderingsprocessen var möjligheten större att denne gjorde impulsiva inköp. Så som konsument gäller de att ställa sig själv och sin omgivning frågan: ” Hallå, behöver duverkligen den där?” / The digital development in today's society gives consumers advertising and offers wherever they look. Companies can easily reach their target group and easily influence the consumer's needs through social media. Today consumers not only buy their necessaries but also what they consider they want. This exposure leads to impulsive purchases. I denna studie har en kvantitativ enkät och en kvalitativ intervju använts för att kartlägga konsumentens köpbeteende. Syftet är att undersöka de interna och externa faktorer som påverkar konsumenternas impulsiva köpbeteende. Den kvantitativa enkäten användes för att ge en generell bild av konsumenternas köpbeteende för att sedan kompletteras med intervjuernas mer djupgående svar. Studiens resultat presenteras och analyseras utifrån tre utvalda kategorier som varit grund till enkät- och intervjufrågorna. Kategorierna utgår från studiens valda teoretiska perspektiv som innefattar modellerna Consumer Impulsive Formation Enactment (CIFE) och The Stimulus-Organism-Response (S-O-R). Modellerna används som hjälpmedel för att kartlägga konsumenternas beteende gällande såväl interna som externa faktorer. Utifrån modellerna har ett eget teoretiskt ramverk utvecklats för studien. Modellen heter DIA-modellen och är en sammanfattning av studiens teoretiska perspektiv och används för att kartlägga impulsiva konsumentbeteende i den digitala modehandeln. Modellen utgår ifrån följande kategorier: digitalt köpbeteende, impulsivt köpbeteende och affektiv påverkan. En slutsats som kan dras av denna undersökning är att de miljöpåverkande och externa faktorerna spelar en stor roll i skapandet av konsumenternas behov. Resultatet visade att respondenterna ansågs sig göra oplanerade köp som en följd av ett behov som uppkom först när de presenterades för produkten i fråga. Detta visade sig även ha en större påverkan på de yngre respondenterna som påverkades i större utsträckning via sociala medier och dess omgivning. De interna faktorer som visade sig vara avgörande var utvärderingen och motiveringen av köpet. För vidare studier kan förslagsvis skillnader på män och kvinnors impulsiva köpbeteende undersökas för att se om där finns skillnader. Studiens begränsningar är det utvalda kategorier som undersöker hur interna och externa faktorer påverkar impulsivt köpbeteende. Om konsumenten ansåg sig kunna motivera sitt köp i utvärderingsprocessen var möjligheten större att denne gjorde impulsiva inköp. Så som konsument gäller de att ställa sig själv och sin omgivning frågan: ” Hallå, behöver du verkligen den där?

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Background: Although the majority of German patients in a palliative state prefer to die at home, the actual place of death is most often a hospital. Unplanned hospital readmissions (UHA) not only contradict most patients’ preferences but also increase the probability of an aggressive end-of-life treatment. As limited knowledge is available which factors contribute to an UHA, the PRePP-project aims to explore predictors related to informal caregivers (IC) as well as medical and structural factors. - Methods: This prospective, observational, mono-centric study will assess structural and medical factors as well as ICs’ psychological burden throughout seven study visits. Starting in April 2021 it will consecutively include 240 patients and their respective IC if available. Standardized measures concerning ICs’ Quality of Life (WHOQOL-BREF), psychological distress (NCCN-Distress Thermometer), anxiety (GAD-7) and depressiveness (PHQ-9) will be assessed. If participants prefer, assessment via phone, browser-based or paper-based will be conducted. Medical records will provide routinely assessed information concerning patient-related characteristics such as gender, age, duration of hospital stay and medical condition. Nurse-reported data will give information on whether hospitalization and death occurred unexpectedly. Data will be progressed pseudonymized. Multivariable regression models will help to identify predictors of the primary endpoint “unplanned hospital admissions”. - Discussion: The PRePP-project is an important prerequisite for a clinical risk assessment of UHAs. Nevertheless, it faces several methodological challenges: as it is a single center study, representativity of results is limited while social desirability might be increased as the study is partly conducted by the treatment team. Furthermore, we anticipated an underrepresentation of highly burdened participants as they might refrain from participation.

The prevalence of and increase in unplanned pregnancies (UPs) and the termination of pregnancy (TOP) amongst tertiary students (TSs) have been found to have a detrimental impact on students, their significant others, and tertiary institutions. UPs amongst TSs have been mentioned as one of the factors contributing to the problem of high dropout rates, which calls for an investigation of this phenomenon and strategies to address it. Despite the need for support to TSs who find themselves in the predicament of an UP and/or TOP, a lacuna has been found with specific reference to practice guidelines from the ambit of social work to assist service providers (SPs) in the provision of psychosocial support services to the said students. To explore and describe the experiences, support, and support needs of TSs presenting with UPs and/or TOPs from the perspectives of these students and the SPs rendering services to them, as well as to gather suggestions from them to inform practice guidelines for psychosocial support, the qualitative research approach, designs, and methods of data collection were used to collect data from six TS- and 23 SP-participants that were purposively recruited. Presenting the findings against the backdrop of Schlossberg’s Transition Process Model (Schlossberg, 2011 & 1981), adopted as theoretical framework for the study, the following emerged: Experiencing an UP and/or TOP is a traumatic crisis event for TSs, which rings in a transition resulting in imminent and fundamental changes in their academic and social life, relationships, outlook on life, and self-image, as well as a smorgasbord of feelings and emotional reactions such as shock, denial, guilt, shame, loneliness, depression and anger following this event. The UP-crisis is arrested by deciding how to manage it (either through parenting, foster care, adoption, or TOP). This decision-making process is perceived as difficult with the formal and/or informal convoy of support, or lack thereof, having a decisive influence on the outcome of how the UP is managed. Apart from TS-participants’ appraisal of the support that they received in dealing with this life event, they articulated several support needs and suggestions for themselves and other TSs alike. The SPparticipants also offered several suggestions on how psychosocial support to a TS confronted with this phenomenon should be provided. The suggestions from both participant groups informed the practice guidelines to assist SPs in providing psychosocial support to TSs presenting with an UP and/or TOP. These guidelines focus specifically on how to establish a helping relationship with a TS presenting with the concern of an UP and/or a TOP, and how to assess and intervene in the situation, the self, the support, and the (coping) strategies surrounding the TS’s UP and/or TOP. In addition, recommendations for university policies on student pregnancies, social work practice, and further research were made. / Social Work / D. Phil. (Social Work)

Unplanned extubation is premature removal of endotracheal tube, is an adverse event; which can either, be accidental during a nursing procedure or self deliberate by the patient. The AACN Synergy Model for Patient Care was used as conceptual model for this study. A retrospective descriptive design revealed that over a period of two years, 327 patients admitted to the intensive care unit require intubation of which 40.4% were self-deliberate extubation and 59.4% accidental extubation. Of the accidental extubated patients, 29.8% had physical restrains, 57.6% received sedation, 43.9% had analgesic infusion and 38.9% were on neuromuscular blockade. A means Glasco Coma Scale was 9.4 and 56% of the patients were reported as being. Most patients (89.9%) required re-intubation. The findings also revealed that 49.1% of the nurses who cared for the patients when the extubation occured had one patient at the time. Also, 84.2% of nurses had 0-6 years of nursing experience and 74% of nurses had less than five years of ICU experience. / Health Studies / M.A. (Health Studies)

Introdução: A abordagem terapêutica da doença coronária multiarterial é possível por meio da aplicação de farmacologia dedicada em associação à revascularização miocárdica, seja por meio de intervenção coronária percutânea ou de cirurgia. Visando a reduzir os maiores limitantes destas duas estratégias, surge como alternativa o procedimento de revascularização híbrida, que objetiva combinar o que cada uma das técnicas tradicionais mais oferece em relação a benefícios para os pacientes. Objetivos: Avaliar a segurança e a eficácia da revascularização híbrida quando comparada à cirurgia convencional por meio da aferição da ocorrência da taxa de eventos cardiovasculares adversos compostos, como mortalidade global, infarto agudo do miocárdio, revascularização não programada e acidente vascular cerebral ao término de dois anos de acompanhamento clínico. Metodologia: Estudo piloto, prospectivo, unicêntrico e randomizado, que visa à inclusão de 60 pacientes, na proporção 2:1 para revascularização miocárdica híbrida ou convencional. Anatomicamente, os pacientes devem exibir acometimento coronariano triarterial e escore SYNTAX de valor intermediário a alto ( > 22), além de consenso do time cardíaco de que ambas as estratégias, cirúrgica ou percutânea, sejam viáveis para o tratamento. Resultados: Entre agosto de 2014 e outubro de 2018 foram incluídos 60 pacientes no estudo, sendo 40 no grupo híbrido e 20, no grupo controle, com período de acompanhamento clínico médio de 802 ± 500 dias. As características clínicas e demográficas da população foram semelhantes entre os grupos. O escore SYNTAX foi de 29,0 ± 4,3 no grupo cirurgia convencional e de 28,3 ± 4,7 no grupo híbrido (p = 0,60). A taxa total de eventos cardiovasculares adversos ao final de dois anos foi de 19,3% no grupo híbrido e de 5,9% no grupo controle, com incidência de mortalidade global (5,0% vs. 0%), infarto agudo do miocárdio (12,5% vs. 5,9%) e revascularização não programada (14,5% vs. 5,9%), sem diferença estatisticamente significativa. Conclusões: Nesse estudo piloto, a revascularização miocárdica híbrida mostrou-se factível porém associada a taxas crescentes de eventos cardiovasculares adversos ao longo de 2 anos de seguimento, ao passo que o grupo controle, tratado com cirurgia tradicional, mostrou-se com baixa incidência de complicações maiores no mesmo período. Esses resultados sugerem a necessidade de futuros estudos que visem otimizar e melhor avaliar o desempenho clínico da abordagem híbrida de revascularização miocárdica / Introduction: Coronary artery bypass grafting and percutaneous coronary intervention with drug eluting stents are the standard invasive strategies treatments for coronary artery disease. Hybrid myocardial revascularization merges the benefits of surgical approach with the advantages of state of the art percutaneous coronary intervention with second-generation drug eluting stents. Objective: This study aims to assess the long term safety and efficacy of hybrid procedures in comparison with traditional coronary artery bypass grafting regarding the combined end point rate of all cause death, acute myocardial infarction, unplanned revascularization and stroke at the end of 2 years of follow up. Methods: Pilot, prospective, randomized, single center trial enrolling 60 patients with multivessel coronary artery disease. Following diagnostic angiography demonstrating significant multivessel coronary disease (SYNTAX Score > 22) and consensus of the heart team, patients were consented and randomized 2:1 to hybrid treatment or conventional coronary artery bypass grafting. All patients were evaluated by the composite measure of major adverse cardiovascular events, defined as all cause death, myocardial infarction, stroke or unplanned revascularization. Results: From August 2014 to October 2018, 60 patients were enrolled with a mean follow-up of 802 ± 500 days. Clinical characteristics were similar between groups. The mean SYNTAX Score was 29.0 ± 4.3 at the control group and 28.3 ± 4.7 at the hybrid group (p=0.60). The total event rate was 19.3% at the hybrid group and 5.9% at the surgical group (p=0.35), with incidences of all-cause death (5.0% vs. 0%), acute myocardial infarction (12.5% vs. 5.9%) and unplanned revascularization (14.5% vs. 5.9%), not statistically different. Conclusions: In this trial, hybrid myocardial revascularization was feasible, but associated with increasing rates of major adverse cardiovascular events during 2 years of clinical follow up, while the control group treated with conventional surgery presented with low rates of complications during the same period. The small sample number does not provide precision for the analysis and the results warrant careful attention in future clinical trials

Made available in DSpace on 2016-04-04T18:31:33Z (GMT). No. of bitstreams: 1 Mauricio Becker.pdf: 1680814 bytes, checksum: e32eecc9e8f4e602513a2049aa488491 (MD5) Previous issue date: 2012-12-03 / In the current globalized and connected context where companies and organizations increasingly rely on their information technology infrastructure for business continuity, such critical systems and applications need to be available and operational for end users and customers almost twenty-four hours per day over the three hundred sixty-five days of the year. In view of this, this research sought to identify the state of the art in terms of technologies for high availability computing environments and how best practice guides for IT Governance & Management can help to maintain available and operational the business critical systems. As a complement, it sought through the application of a survey research to understand the existing IT practices in one of three states with greatest economic importance in the Brazilian Northeast area. The study was conducted among December 2011 and March 2012 and aimed to evaluate current investments in IT resources, identify the main causes of unplanned downtimes and measure their impacts. From the data analysis it was possible to identify improvement opportunities regarding infrastructure, people, processes and services in order to minimize the unavailability of business critical systems for companies and organizations. / No atual contexto globalizado e conectado, as empresas e organiza??es dependem cada vez mais de suas infraestruturas de tecnologia da informa??o para a continuidade de seus neg?cios. Por esse motivo, tais sistemas e aplica??es cr?ticos ?s organiza??es necessitam estar dispon?veis e operacionais aos usu?rios internos e clientes por praticamente vinte e quatro horas por dia ao longo dos trezentos e sessenta e cinco dias do ano. Diante disto, esta pesquisa buscou apreender o estado da arte em termos de tecnologias para ambientes computacionais de alta disponibilidade e como guias de melhores pr?ticas de Governan?a e Gerenciamento de TI podem contribuir para manterdispon?veis e operacionais os sistemas cr?ticos ao neg?cio. Como complemento, buscou por meio da aplica??o de um survey compreender a pr?tica de TI existente em um dos tr?s Estados do nordeste brasileiro de maior relev?ncia econ?mica. O estudo foi realizado entre dezembro de 2011 e mar?o de 2012 e teve por objetivos avaliar os atuais investimentos em recursos de TI, mensurar os impactos e identificar as principais causas das paradas n?o programadas. Da an?lise dos dados, foi poss?vel apontar as oportunidades de melhoria no que tange infraestrutura, pessoas, processos e servi?os visando minimizar a indisponibilidade dos sistemas cr?ticos ao neg?cio de empresas e organiza??es.