The study focused on the attitudes and beliefs regarding perceived and actual burden experienced by Latino caregivers and their use of formal support services. It also looked at the needs of Latino caregivers and explored their beliefs about why they had taken on the caregiver role, the responsibilities the role entailed, and coping skills used by these caregivers. Participants were obtained from two Alzheimer's caregiver support groups in the East Los Angeles area, and an adult day health care center in the high desert area of San Bernardino county. The author used both qualitative interviews and quantitative questionnaires. The findings suggest that high beliefs about responsibility to the family and low levels of service use may contribute to the stress and strain that these caregivers feel. Latino caregivers have been providing a significant amount of care without the help of sufficient formal services. Recommendations for social work practice, policy and further research are provided. Statistics for the study were generated by using SPSS Graduate Pack 13 for Windows.

Cognitive radio is a recent novel approach for the realization of intelligent and sophisticated wireless systems. Although the research and development on cognitive radio is still in the stage of infancy, there are significant interests and efforts towards realization of cognitive radio. Cognitive radio systems are envisioned to support context awareness and related systems. The context can be spectrum, environment, location, waveform, power and other radio resources. Significant amount of the studies related to cognitive radio in the literature focuses on the spectrum awareness since it is one of the most crucial features of cognitive radio systems. However, the rest of the features of cognitive radio such as location and environment awareness have not been investigated thoroughly. For instance, location aware systems are widespread and the demand for more advanced ones are growing. Therefore, the main objective of this dissertation is to develop an underlying location awareness architecture for cognitive radio systems, which is described as location awareness engine, in order to support goal driven and autonomous location aware systems. A cognitive radio conceptual model with location awareness engine and cycle is developed by inspiring from the location awareness features of human being and bat echolocation systems. Additionally, the functionalities of the engine are identified and presented. Upon providing the functionalities of location awareness engine, the focus is given to the development of cognitive positioning systems. Furthermore, range accuracy adaptation, which is a cognitive behavior of bats, is developed for cognitive positioning systems. In what follows, two main approaches are investigated in order to improve the performance of range accuracy adaptation method. The first approach is based on idea of improving the spectrum availability through hybrid underlay and overlay dynamic spectrum access method. On the other hand, the second approach emphasizes on spectrum utilization, where we study performance of range accuracy adaptation from both theoretical and practical perspectives considering whole spectrum utilization approach. Furthermore, we introduced a new spectrum utilization technique that is referred as dispersed spectrum utilization. The performance analysis of dispersed spectrum utilization approach is studied considering time delay estimation problem in cognitive positioning systems. Afterward, the performance of whole and dispersed spectrum utilization approaches are compared in the context of cognitive positioning systems. Finally, some representative advanced location aware systems for cognitive radio networks are presented in order to demonstrate some potential applications of the proposed location awareness engine in cognitive radio systems.

The general aim of this thesis is to describe and analyse the role of primary care in health care systems in terms of health, health care utilisation and costs, and to study the feasibility of retrieval of data from computerised medical records to monitor medical quality. The thesis includes five studies, a systematic literature review, a register study of utilisation of hospital and primary care, a study based on data from computerised medical records of individual patients cost for primary care, and two studies of management of respiratory infections in primary care based on data from computerised medical records of twelve health centres. The general findings of the literature review were that an expansion of the primary care component of the health care system would most likely result in better health, lower hospital care consumption and lower expenses for care. The personal physician and continuity of care were core elements to achieve this, and the significance of the way primary care is organised and funded was evident. In the register study fifty health centres were compared. Age and rates of outpatient hospital visits were the most important factors explaining the variation of rates of hospitalisations between the health centres’ areas. Hospital district also influenced hospitalisation rates in the different health centres’ areas, indicating that the health care structure in the district per se was an important factor. The rates of visits to general practitioners correlated negatively with rates of hospitalisations. The study of costs in primary care showed that the variation in the costs of the individual patients was substantial, also within age groups and within the diagnosis-related Adjusted Clinical Groups (ACG). Age and gender explained a smaller part of the variation in costs per patient in primary care. Adding the ACG weight had a major influence on improving the ability to explain the variation in costs at patient level. The ACG system might be of value in the calculation of weighted capitation in Swedish primary care, but appears to be sensitive to the thoroughness with which physicians register diagnoses. The retrieval of data from computerised medical records comprised a total number of 19 965 encounters for respiratory tract infections i.e. 199 per 1000 inhabitants during the year 2001. Most frequent diagnoses were common cold, acute tonsillitis, and acute bronchitis. The number of antibioticprescriptions was 7 961, accounting for 47% of the episodes. The most commonly prescribed antibiotics were phenoxymethylpenicillin (61%), tetracyclines (18%) and macrolides (8%). A rapid test was performed in 43% of the encounters: for C-reactive protein (CRP) in 31%; for Group A beta-haemolytic streptococci (StrepA) in 22%; and both tests were performed in 10% of the encounters. The findings in the study indicate that StrepA and CRP tests were used too frequently and often with minor contributions to patient management. The frequencies of tests and of antibiotic prescriptions varied greatly between health centres in a way that hardly could be explained by differences in morbidity. Computerised medical records provided a source of clinical information, which might be a feasible and pragmatic method for studying daily practice, and for follow-up of adherence to guidelines in general practice.

Scheduling in the context of manufacturing systems has become increasingly impor- tant in order for organizations to achieve success in dynamic and competitive scenarios. Scheduling can be described as allocation of available jobs over resources to meet the performance criteria defined in a domain. Our research work fo cuses on scheduling a given set of three-dimensional cylindrical items, each characterized by width wj , height hj, and depth dj , onto parallel non-identical rectangular heat treatment kilns, such that the capacities of the kilns is optimally used. The problem is strongly NP-hard as it generalizes the (one-dimensional) Bin Packing Problem (1BP), in which a set of n positive values wj has to be partitioned into the minimum number of subsets so that the total value in each subset does not exceed the bin capacity W. The problem has been formulated as a variant of the 3D-BPP by following the MILP approach, and we propose a weight optimization heuristic that produces solutions comparable to that of the LP problem, in addition to reducing the computational complexity. Finally, we also propose a Decomposition Algorithm (DA) and validate the perfor- mance effectiveness of our heuristic. The numerical analyses provides useful insights that influence the shop-floor decision making process.

The current study investigated maternal determinants of mental health service use, namely, individual child therapy, among preadolescent children diagnosed with ADHD. The Behavioral Model of Health Care Utilization (Andersen, 2008) was used as a theoretical framework for the study. Data from the last three rounds of ECLS-K dataset were employed to test a longitudinal model using Bayesian analysis. Socio-demographic variables and maternal mental health were tested as exogenous variables and mother-child relationship variables, discipline variables, and perceived maternal concern about child’s overall behavior and child’s emotional symptoms were tested as intervening variables. Results showed that only maternal mental health remained in the model as an exogenous variable. The effect of mental health on child therapy was mediated by maternal aggravation and maternal concern about overall behavior in one path and by maternal concern about emotional symptoms in another path, suggesting that maternal mental health needs to be considered when attempting to understand help-seeking determinants. Both concern variables were found to have large direct effects on child therapy. The results of the current study showed the importance of maternal mental health and the importance of determinants related to mother-child relationship in a mother’s decision to seek therapy for a child.

Background: The relationship between informational support and use of health care services among individuals newly diagnosed with cancer remains little documented despite its importance for optimal care delivery. Aim: To document the role of informational support in light of patterns of health services used by women and men newly diagnosed with cancer. Method: A sequential mixed methods approach (i.e., quantitative-qualitative) was conducted among women and men newly diagnosed with either breast or prostate cancer. First, an existing quantitative database was used to determine whether an intervention relying on multimedia tool as a complement to the provision of usual cancer informational support to patients (N = 250) would modify subsequent health care service use. A follow-up qualitative inquiry with distinct individuals also newly diagnosed (N = 20) was conducted to explore this relationship further. Next, the resulting quantitative and qualitative findings were merged and reanalyzed using a quantitative-hierarchical approach to enhance our understanding of the phenomenon. Findings: Several personal and contextual factors were found to qualify the relationship between cancer informational support and health service use. Although quantitative analyses showed no significant differences in terms of overall reliance on health care services among participants who received more intense cancer informational support as opposed to those who received care as usual, several sex differences were noted in terms of number of visits to health care professionals, time spent with nurses and satisfaction with cancer information received. Qualitative findings revealed that participants reported a variety of experiences pertaining to cancer information received (e.g., positive, unsupportive or mixed) as well as several processes at play (e.g., cancer information seen as enabling, confirming, or conflicting). These differences in informational support, in turn, influenced their subsequent service utilization (e.g., more phone calls made to health professionals, reduction in face-to-face visits, reluctance to use cancer-related services). The mixed data analysis clarified further the findings allowing a broader perspective to emerge. Conclusion: Findings underscore that the relationship between cancer information and use of services is not as straightforward as initially anticipated. These findings provide initial insights that may inform future research on the topic and assist health care providers in optimizing their cancer informational interventions to guide patients in their reliance on health care services.

Thesis (MSc (Forest and Wood Science))—University of Stellenbosch, 2007. / The utilization and commercialization of indigenous fruit trees has in the past been overlooked by extension agencies due to the misconception that they do not play a major role in contributing to the rural livelihoods. There is new and increasing emphasis on the contribution of non-timber forest products (NTFPs) on improving the livelihoods and sustainable management of forest ecosystems of the Miombo woodlands. This study was conducted around Mwekera area in the Copperbelt province, Zambia to determine the role of indigenous fruit trees in the rural livelihoods. A total of 70 households were interviewed in the survey using semi-structured questionnaires, in-depth open ended interviews and focus group meetings to collect information on the use of indigenous fruits. The study revealed that 99% of the households experience ‘hunger’ during the rainy season from November to April every year. Ninety seven percent (97%) of the households collect indigenous fruit, with the most collected fruits being Uapaca kirkiana (74%), Anisophyllea boehmii (71%) and Parinari curatellifolia (67%). Additionally, there is very little selling of indigenous fruit (31%) but that Uapaca kirkiana and Anisophyllea boehmii account for 95% of the fruits sold. Forty six percent (46%) of the households process fruits of U. kirkiana, A. boehmii and P. curatellifolia into juice and/or porridge. Furthermore IFTs are also used as traditional medicine. Sixty three percent (63%) of the households used IFTs for medicinal purposes with two-thirds of the respondents citing Anisophyllea boehmii as an important medicinal tree species. The study also showed that 85% of the respondents have seen a change in the forest cover resulting into loss of biodiversity with 70% of the respondents indicating that the change is with respect to reduction in forest size and scarcity of some species; and that charcoal production and clearance of land for cultivation are the major causes of the scarcity of indigenous fruit trees. It is concluded that the major contribution of IFTs in the study area is in filling the gap during times of hunger rather as being a source of income through selling. Charcoal production and clearance for agriculture are the main contributing agents for the loss of biodiversity and scarcity of IFTs. It is recommended that domestication of IFTs and sustainable forestry and agricultural management practices be employed to ensure that future generations continue to benefit from the forest resource.

As dimensões continentais de alguns países e a distribuição heterogênea da rede hospitalar dificultam o acesso ao atendimento inicial adequado ao trauma de face principalmente aos pacientes residentes em regiões mais remotas. Um modelo de atendimento por telemedicina pode ser uma opção ao atendimento especializado presencial. Os objetivos deste trabalho são apresentar um modelo de atendimento por especialistas à distância, por meio de videoconferência utilizando-se smartphone, e analisar a concordância deste atendimento por telemedicina com o atendimento presencial, considerado padrão ouro. Cinquenta pacientes com trauma de face e suspeita de fratura de face (n=50) foram atendidos, por duas equipes independentes, uma presencialmente e outra por telemedicina. A equipe presencial, que era formada pela equipe de plantão de cirurgia plástica na unidade de emergência, prestou o atendimento à beira do leito (história, exame físico e análise de imagens por tomografia computadorizada). A equipe telemedicina, composta por um médico generalista atendendo à beira do leito, prestou atendimento em conjunto com um cirurgião plástico à distância através de videoconferência com um smartphone. Após cada atendimento as duas equipes responderam a um questionário, com informações sobre dados epidemiológicos, dados do exame físico, sobre indicações de tomografia computadorizada, achados radiológicos da tomografia e conduta. Os dados foram analisados e comparados quanto à concordância das respostas através da análise estatística kappa, cálculo de acurácia, especificidade e sensibilidade. A amostra estudada foi representativa e concordante com a literatura, com predomínio de homens jovens. Acidentes de trânsito e violência interpessoal foram os principais mecanismos causadores do trauma. A concordância das respostas para os achados de exame físico foi considerada substancial (kappa=0,720), para a indicação da tomografia computadorizada foi quase perfeita (kappa=0,957), para os achados na tomografia foi quase perfeita (kappa=0,899) e para definir a conduta também foi quase perfeita (kappa=0,891). A alta concordância dos achados radiológicos nas tomografias computadorizadas de face também foi observada ao se calcular os valores preditivo positivo (VPP=89,9%), preditivo negativo (VPN=99,3%), sensibilidade (94,2%), especificidade (98,8%) e acurácia (98,3%). O estudo concluiu que o modelo de atendimento ao trauma de face à distância por videoconferência via smartphone é factível, encontrando altos índices de concordância quando comparados ao atendimento padrão ouro presencial, sendo uma opção ao atendimento para a triagem de pacientes vítimas de trauma de face em áreas remotas que não têm à disposição o atendimento especializado presencial / The continental size of some countries and heterogeneous distributed hospital network prevent many patients who live in remote areas from getting adequate initial assessment of facial trauma. The author presents a model for trauma assessment through telemedicine, which may be an alternative to face-to-face specialized attending. The goals of this study are presenting a model for non-attending specialized assessment through video conference via smartphones, and analyzing a comparison between telemedicine and face-to-face management, the latter currently being the gold standard. Fifty patients with either a confirmed or suspected diagnosis of facial trauma (n=50) were evaluated by two teams of physicians, one face-to-face and the other one telemedicine-based. The face-to-face team, which was made up by the attending plastic surgery team in the emergency unit, attended the patients at the bedside (physical examination and CT-scan analysis). The telemedicine team was made up by an in-house general practitioner working together with an on-call plastic surgeon through videoconference via smartphones. After each evaluation, both teams answered a similar questionnaire, which contained data concerning the patient\'s epidemiology, physical examination, CT-scan indications and findings, and the treatment option to be followed. The data were analyzed and compared regarding the similarity of answers, with the use of kappa statistics and analysis of data accuracy, sensitivity and specificity. The sample studied was representative and consistent with the literature, showing a predominance of young males. Traffic accidents and personal violence were the main causes of trauma. The agreement of answers for physical examination findings was considered substantial (kappa=0.720). For CT-scan indications, it was considered almost perfect (kappa=0.957); for CT-scan findings, it was almost perfect (kappa=0.899); and for defining the treatment option, it was also almost perfect (kappa=0.891). High concurrency of face CT-scan findings was also observed after we calculated the positive predictive value (PPV=89.9%), negative predictive value (NPV=99.3%), sensitivity (94.2%), specificity (98.8%) and accuracy (98.3%). The study concluded that the model for non-attending assessment of facial trauma through video conference via smartphones is feasible, showing high concurrence rates when compared to gold-standard in-house assessment, thus being an option for first assessment of facial trauma patients who live in remote areas, where specialized medical teams are not available

Cloud storage services allow users to store and access data in a secure and flexible manner. In recent years, cloud storage services have seen rapid growth in popularity as well as in technological progress and hundreds of millions of users use these services to store thousands of petabytes of data. Additionally, the synchronization of data that is essential for these types of services stands for a significant amount of the total internet traffic. In this thesis, seven cloud storage applications were tested under controlled experiments during the synchronization process to determine feature support and measure performance metrics. Special focus was put on comparing applications that perform client side encryption of user data to applicationsthat do not. The results show a great variation in feature support and performance between the different applications and that client side encryption introduces some limitations to other features but that it does not necessarily impact performance negatively. The results provide insights and enhances the understanding of the advantages and disadvantages that come with certain design choices of cloud storage applications. These insights will help future technological development of cloud storage services.

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