Supercomputers have become increasingly important in recent years due to the growing amount of data available and the increasing demand for quicker results in the scientific community. Since supercomputers carry a high cost to build and maintain, efficiency becomes more important to the owners, administrators, and users of these supercomputers. One important factor in determining the efficiency of a supercomputer is the scheduling of jobs that are submitted by users of the system. Previous work has dealt with optimizing the schedule on the system’s end while the users are blinded from the process. The work presented in this thesis investigates a scheduling system that is implemented at the Oak Ridge National Laboratory (ORNL) supercomputer Kraken with a backfilling policy and attempts to outline the optimal methods from the user’s point of view in the scheduling system, along with using a simulation approach to optimize the priority formula. Normally the user has no idea which scheduling algorithms are used, but the users at ORNL not only know how the scheduling works but they can also view the current activity of the system. This gives an advantage to the users who are willing to benefit from this knowledge by utilizing some elementary game theory to optimize their strategies. The results will show a benefit to both the users, since they will be able to process their jobs sooner, and the system, since it will better utilized with little expense to the administrators, through competition. Queuing models and simulation have been well studied in almost all relevant aspects of the modern world. Higher efficiency is the goal of many researchers in several different fields; the supercomputer queues are no different. Efficient use of the resources makes the system administrator pleased while benefiting the users with more timely results. Studying these queuing models through simulation should help all parties involved by increasing utilization. The simulation will be validated and the utilization improvement will be measured and reported. User defined formulas will be developed for future users to help maximize utilization and minimize wait times.

In this dissertation, I examine individual decisions in occupational choice, labor supply, and health care utilization. Occupational choice decisions of female college graduates on whether to teach or not are analyzed to understand the role of fertility and relative wages using a panel estimation method. I also compare the behavioral changes in the labor force participation among teachers and non-teachers conditional on the presence of a new-born baby. Using the human capital model where a worker decides her hours of work responding to wages, and her human capital is accumulated proportional to her hours of work, I predict that the positive relationship between entry wages and post wages. Empirical evidence suggests that the shock in entry wages may be attributed to post wage differentials. I examine individuals?? choice of health insurance plan and utilization of health care services. Empirical evidence shows that there is favorable self-selection into health maintenance organizations (HMOs) plans and that HMO members use more of office-based and hospital outpatient services. It suggests ineffectiveness of HMO plans in reducing utilization.

This thesis focuses on the use of interpreters in Swedish healthcare. The overall aim was to explore how individuals, healthcare professionals and family members experience and perceive the use of interpreters in healthcare. The study design was explorative and descriptive. The thesis included Serbo-Croatian(Bosnian/Croatian/Serbian)speaking individuals(n=17), healthcare professionals(n=24), official documents(n=60)and family members(n=10)of individuals using interpreters in healthcare. Individual interviews, written descriptions, review of official documents in the form of incident reports from a single case study and focus group interviews were used to collect data. Data were analyzed using phenomenography, qualitative content analysis and qualitative data analysis of focus group interviews. The overall finding from all perspectives was the wish to have a qualified interpreter whose role was as a communication aid but also as a practical and informative guide in healthcare. The perception of a qualified interpreter was someone highly skilled in medical terminology, Swedish and individuals’ native language with ability to adapt to different dialects, wearing non-provocative and neutral clothes, of the same gender, with a professional attitude and preferably in personal contact through face-to-face interaction. Besides being a communication aid, the interpreter was perceived as having an important role in helping individuals to find the right way to and within the healthcare system because foreign-born individuals were unable to understand information in healthcare. Another aspect was to have a well-developed organization with good cooperation between the parties involved in the interpretation situation, such as patients, interpreter, interpreter agency, family members and healthcare professionals to offer a good interpretation situation. In conclusion, the use of an interpreter was determined by individual and healthcare situational factors. Individualized holistic healthcare can be achieved by offering and using high-quality interpreters and cooperation within a well-developed interpreter organization.   Keywords: communication, healthcare service, patient-safe quality care, qualitative data collection, qualitative data analysis, users’ perceptions/experiences, utilization of interpreters.

Objectives. The aim of this thesis was to study the prognosis, health care utilization and health situation in stroke patients, and informal caregiver burden during the first post-stroke year. Material and methods. 390 patients, 65 years or older, discharged from hospital after a stroke, were followed with repeated patient interviews, patient record and register data, and hospital staff and informal caregiver questionnaires. Results. Prognosis assessments performed by hospital staff at discharge regarding the course of events during the following year were highly accurate and were mainly influenced by the patient’s pre- and post-morbid state. The risk of dying or having a new stroke decreased rapidly during the early post-morbid phase. Health care utilization, in hospitals as well as in primary health care, and municipal social service support was considerably higher after the stroke than before, but the utilization of services was lower than previously reported. Health problem prevalence according to interview and record scrutiny was modest, peaked early after discharge and then declined. Support from informal caregivers increased significantly after discharge and remained high during the first post-stroke year. The support given was mainly determined by patient functional ability, distance to patient, relation to patient, municipal social service support provided, and patient sex. The informal caregivers reported considerable strain and burden, with significantly higher levels of anxiety and depression than the stroke patients. Moreover, there was a parallel between the patient’s and the caregiver’s situation regarding anxiety, emotional and social situation, and home, social and outdoor activities. Conclusion. Hospital staff prognosis assessments of patient outcomes during the next year were highly accurate. Risk of recurrence and mortality, and health problem prevalence was high in the early post-stroke period, and than declined. Health care utilization and municipality social support increased over time. Informal caregivers reported considerable strain and burden.

Globally, neonatal mortality has remained basically unchanged for the last three to four decades and every year almost four million newborns die before reaching one month of age. This persistent mortality is related to an invisibility of the newborn child in policies and statistics and a neglect of health care decision-makers, planners and practitioners to deliver a perinatal continuum of care. In recent years attention has however been brought to the unchanged neonatal mortality in an effort to improve survival. The present thesis seeks to increase understanding of obstacles for better neonatal survival. The studies performed are undertaken as sub-studies to the NeoKIP project in Quang Ninh province in northern Vietnam, a randomized controlled trial of knowledge implementation for improved neonatal survival (Neonatal Health – Knowledge Into Practice, ISRCTN 44599712). In the first paper we investigated and discussed the scope of invisibility of neonatal mortality through measuring the accuracy of official statistics on neonatal deaths. The second paper reports an inquiry of determinants of neonatal mortality by use of a population-based case-referent design. Paper III and IV analyse delivery care utilization and care seeking patterns prior to and at delivery using narratives and GIS technique. There was a substantial under-reporting of neonatal mortality in the official statistics, with study results showing a four times higher neonatal mortality rate in Quang Ninh province than reported to the Ministry of Health. This neonatal mortality rate of 16/1000 live births (as compared to 4.2/1000 in official reports) was unevenly distributed in the province, showing large geographical discrepancies. In the rural and remote areas of Vietnam education level is lower and the concentrations of ethnic minorities and poor households are higher. Ethnic minority belonging was associated with a more than doubled risk of neonatal death compared to the hegemonic group of Kinh (OR 2.08 CI 95 % 1.39 – 3.10). This increased risk was independent of household economic status or maternal education level. Neonatal mortality was also associated with home deliveries, non-attendance to antenatal care and distance to the health care facilities. However, ethnic minority mothers still had an increased risk of experiencing a neonatal death even if they attended antenatal care, delivered at or lived close to a health facility. The invisibility of the neonatal period in health information systems hides the true width of the neonatal mortality challenge. By not acknowledging the problem, the marginalization of already disadvantaged groups continues, leaving ethnic minority babies with an elevated risk of dying during the first month in life. This example of ethnic inequity highlights the importance to target those most in need. The studies of the present thesis should therefore be looked upon as a contribution to the struggle to illuminate the global burden of neonatal mortality.

Les Bartonelles sont des bactéries hémotropes responsables de zoonoses émergentes. Ces Alphaprotéobactéries sont auxotrophes pour l'hème et doivent donc l'importer du milieu extérieur pour croître. Les Bartonelles possèdent un système complet de transport de l'hème permettant de transporter ce composé dans le cytoplasme. Chez Bartonella, il a été montré que l'hème pouvait être utilisé comme source de fer. Comme pour d'autres bactéries utilisant l'hème comme une source de fer, Bartonella doit dégrader l'hème pour libérer le fer. Chez Bartonella, un ensemble de gènes codant pour le système de transport de l'hème, contient un gène codant pour un polypeptide (HemS) présentant des homologies avec des protéines liant ou dégradant l'hème. En utilisant des expériences de complémentation de mutants d'E. coli incapables de dégrader l'hème, nous avons mis en évidence que HemS de Bartonella henselae permet la libération du fer de l'hème. HemS purifié lie l'hème et le dégrade en présence de donneurs d'électrons. La diminution du niveau de HemS chez B. henselae décroit sa capacité de survivre à une exposition à H2O2. Les Bartonelles expriment quatre ou cinq protéines de la membrane externe ayant la capacité de fixer l'hème. Les gènes de structure de ces protéines sont exprimés différemment en fonction de paramètres comme la température ainsi que la concentration en oxygène ou en hème. Ces protéines ont été proposées comme étant impliquées dans divers processus cellulaires étant donné leur profil d'expression. Dans ce manuscrit, nous montrons que ces protéines sont impliquées dans la défense contre le stress oxydatif, la colonisation des cellules endothèliales et la survie dans la puce

Within the framework of the traditional sociological question, how the legal system is related to the society, the aim of this study is to treat the legal system as a conflict resolver. More specifically, the following questions will be treated:1.Which categories of people and which categories of organizations are as parties using the court for settling conflicts and in what types of conflicts do they act in this way?2.Howdoes the legal utilization vary over time? May socio-economical, demographical, and legal conditions explain these variations?This study only deals with conflict resolution in courts of first instance, so called district courts.One aim has been to get a general view over to what extent Swedish courts are utilized as conflict resolvers, and how this utilization varies over time. The discussion is mainly based upon official statistics. To complete this discussion, an empirical study has been realized. This study is comparative. The conflict solving activities between 1940 and 1969 has been examined in the town courts of Umeå and Luleå. The data basis consists of official statistics and collected informations from cases finally dealt with in the two courts. A stratified random sample out of these cases has been made. As a result of theoretical and methodological considerations the sample consists of only certain types of disputes and crimes.As a general conclusion, one can state that disputes before the courts nowadays as earlier are concerning socially and economically strong persons. However one must notify that this study is just a case study with its limitations.Concerning criminal cases, expected results from the study are that the proportion of workers among the prosecuted is bigger than the proportion of prosecuted business leaders. Interesting however, is that the unskilled are well represented in the data material. This means a different picture compared to the distribution of plaintiffs in civil cases. The changes in character of the conflict constellations occured in the two towns at the same time as summary legal processes were introduced in criminal cases at the end of the 1940's. A bigger proportion of workers as prosecuted party is observed after that processual simplification. Pro-cessual simplifications of that kind seem to strengthen rather than to weaken the occupational bias among the prosecuted persons, at least in crime cases with an injured person involved.Concerning criminal cases, we have finally assumpted that during phases of social and economical stagnation both the number of prosecuted workers and the number of theft and drunkeness cases increases in the type of industrialized community that Luleå belongs to. In more socially and economically differentiated communities, like Umeå, the same type of development is more linked to phases of economical expansion. While increases in the pressure of temptation are widening the economical conditions for people, this may be the reasonable explanation to the variations in the conflict resolving activities in the courts between different local communities. Explanations, close to those used to explain criminal activity caused by poverty, may refer to local communities dominated by industry. / digitalisering@umu

Background and Objectives: To describe patterns of healthcare utilization among patients with generalized anxiety disorder (GAD) in general practitioner (GP) settings in Germany. Methods: Using a large computerized database with information from GP practices across Germany, we identified all patients, aged > 18 years, with diagnoses of, or prescriptions for, GAD (ICD-10 diagnosis code F41.1) between October 1, 2003 and September 30, 2004 ("GAD patients"). We also constituted an age- and sex-matched comparison group, consisting of randomly selected patients without any GP encounters or prescriptions for anxiety or depression (a common comorbidity in GAD) during the same period. GAD patients were then compared to those in the matched comparison group over the one-year study period. Results: The study sample consisted of 3340 GAD patients and an equal number of matched comparators. Mean age was 53.2 years; 66.3% were women. Over the 12-month study period, GAD patients were more likely than matched comparators to have encounters for various comorbidities, including sleep disorders (odds ratio [OR] = 6.75 [95% CI = 5.31, 8.57]), substance abuse disorders (3.91 [2.89, 5.28]), and digestive system disorders (2.62 [2.36, 2.91]) (all p < 0.01). GAD patients averaged 5.6 more GP encounters (10.5 [SD = 8.8] vs 4.9 [5.7] for comparison group) and 1.4 more specialist referrals (2.3 [2.9] vs 0.9 [1.7]) (both p < 0.01). Only 58.3% of GAD patients received some type of psychotropic medication (i.e., benzodiazepines, antidepressants, and/or sedatives/hypnotics). Conclusions: Patients with GAD in GP practices in Germany have more clinically recognized comorbidities and higher levels of healthcare utilization than patients without anxiety or depression.

Graduation date: 1993

Objective: To determine who avoids the dentist and declines recommended dental treatment due to cost. Methods: A secondary data analysis was undertaken. Weights were utilized to ensure data were nationally representative. Univariate and bivariate descriptive statistics were calculated and logistic regressions were used to observe the characteristics that were predictive of reporting cost barriers to care. Results: Over 17 per cent of the Canadian population reported avoiding a dental professional due to cost, and 16.5 per cent reported declining recommended dental treatment due to cost. These individuals had a higher prevalence of needing treatment, had more untreated decay, missing teeth, and reported having poor oral health and oral pain often. Having no insurance, lower income, and reporting “poor to fair” oral health were the greatest predictors of reporting cost barriers to care. Conclusions: Individuals who report cost barriers experience more disease and treatment needs than those who do not.