Drug default is the failure of a patient to comply fully with medication regimens and is major unsolved problem confronting health care providers oday. Drug default is also known as medication noncompliance. Very few studies have been reported comparing the effects of counseling and the unit dose packaging upon compliance. Further, no studies have been reported on the effects of counseling and unit dose packaging upon compliance in ambulatory psychiatric patients. The present investigation was undertaken to (i) evaluate the effectiveness of the Medication Reminder Record, a type of patient calender sheet, with counseling as a means of improving compliance with medication regimens in an ambulatory psychiatric patient population; and (ii) contrast the effects of the Daily Medication Package with counseling and Medication Reminder Records for ambulatory psychiatric patients.

This diploma thesis is focused on the evaluation of the effectiveness of using municipal waste to produce energy. On the basis of legislation applicable in the EU methodology is summarized evaluation of the facility as an energy recovery of waste. In the thesis is also created a consecution to determine decisive coefficients of legislatively-based criteria. The consecution is applied to the case study. Thesis serves as the basis for a software application.

Presently, extensive research supporting the overcrowding of emergency departments (EDs) and behavior disorder patients presenting to EDs are prevalent. There exists a knowledge gap between specific behavior disorders diagnoses associated to repeated visits to the ED. The purpose of this quantitative study was to address whether a relationship exists between patients with psychotic and/or substance abuse disorders and the repeated ED visits within 72 hours. The Andersen Behavioral framework model and the secondary data were used in the study. The cross-sectional archival data from the 2016 National Ambulatory Medical Care Survey was analyzed by using cross-tabulation with the 2 test followed by multiple logistic regression analysis. The author found that the primary independent variables were not significant in (un)weighted multivariate results. However, the primary independent variables were statistically significant in the unweighted cross tabulation analyses, along with the covariates of homelessness, geographical region, and gender. The findings also showed a strong likelihood of return to the ED for the primary independent variables and covariates. The implications of this study with regard to social change and health care practices are providing proper outpatient resources through behavior disorder urgent care facilities, behavior disorder travel clinics, follow-up communications directly to the patients’ care managers, and creating a treatment team, which will decrease future financial effects on the healthcare system.

Black Hawk Creek was included in the Iowa Department of Natural Resources (DNR) 303(d) list of impaired waters in 1998 due to non-point sources of fecal coliform bacteria. Water quality degradation in the stream network is also impacted by excess nutrients in surface runoff from cropped fields and pastures, sedimentation erosion of streambanks from the high volume of water flow following storm events, and the pulse of enriched groundwater drained into the streams from the subsurface tile network. Rotational grazing will replace the current continuous grazing management system. Implementation includes controlling both sides of Black Hawk Creek in the permanent pastures with electric fencing, installing reinforced controlled stream crossing sites, establishing a permanent clean water distribution system and enhancing the Kentucky bluegrass dominated pastures with three cool season naturalized grass and three legume species adapted to the north central Iowa loess landscape. Multi-species ripariain buffers based on the Leopold Center for Sustainable Agriculture's model and other models based on simulating the functionality of presettlement ecosystem savannah grassland will be created between monocultures of corn and soybean fields and the stream network. Follow on studies will monitor the effectiveness of a managed forage sward, riparian buffers, and natural healing of streambanks to mitigate excess nutrient movement into the streams. / Master of Natural Resources

The aim of this thesis was to identify and assess the nitrogen balance due to the field of nutritional support, body composition, energy expenditure, utilization of nutritional substrates and their changes during the hospitalization. Nitrogen balance was determined in 12 men and one woman (age 44 ± 16,4 years) with multiple injuries (ISS 40 ± 11) in the ICU based on 2 measurements in the time interval of 1-7 days, as the difference between the received and the ecrected nitrogen. The energy expenditure and nutritional substrate utilization nutritional indirect calorimetry, body composition analysis and blood chemistry laboratory were examined at patients. Correlation analysis revealed dependence between nitrogen balance and other monitored parameters and also dependence on the length of their trauma. Total protein intake averaged 1,40 ± 0,69 g.kg-1 .d-1 . At this dose were recorded negative values of nitrogen balance in the first measurement of the 9-patients and in the second measurement of the whole group. In this work also the results of uptake of parenteral and enteral route were compared. In practice, significant correlations were found between total uptake and energy expenditure (p = 6,31.10-3 ; r = 0,6) in the first measurement, and on the other hand negative correlation during the second...

Analysis of anticoagulant utilization in the Czech republic in the period from 2007 to 2016 Author: Zuzana Hochelová1 Supervisor: PharmDr. Eva Zimčíková, Ph.D.1 Consultant: PharmDr. Kateřina Malá, Ph.D.1 1 Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Králové, Charles University, Czech Republic Introduction: Anticoagulants are drugs that reduce blood clotting and prevent the formation of blood clots. In the Czech Republic - antagonists of vitamin K-warfarin, direct oral inhibitors of factor Xa-rivaroxaban, apixaban, edoxaban, direct oral inhibitors trombin - dabigatran, parenteral anticoagulants - heparin, low-molecular heparin, fondaparinux, oral and parenteral hirudin are used. Objective: The objective of this diploma thesis was to assess the consumption of oral and parenteral anticoagulants in the Czech Republic from 01. 01. 2007 to 31. 12. 2016, based on the data from the State Institute of Drug Control (SIDC). Methods: ATC/DDD methodology was applied. The research consisted of a retrospective analysis of the SIDC database. All oral and parental anticoagulants approved in the CR were included in the study. Drug utilization was calculated as number of defined daily doses per thousands of inhabitants per day (DID). The data on the number of residents was acquired from...

Evolutionary algorithms are often used for hard optimization problems. Solving time of this problems is long, so we want effective parallelization for this algorithms. Unfortunately, classical methods of parallelization do not work very well in cases where the individual evaluations of problems take significantly different times. In this project, we will try to extend the evolu- tionary algorithm with interleaving generations, which offers a better use of computational resources than classical parallel evolutionary algorithms, by speculative evaluation. Speculative evaluation means the estimation of an in- dividual's fitness function and the prediction of the following steps, which we will use later in the case of a correct estimate. We compare the algorithm with speculative evaluation with the original version in a series of experi- ments and we look at the effect of accuracy in the speculative step on the performance of the algorithm. 1

Many individuals, especially those in rural areas, experience barriers to accessing medical care. Some barriers are attitudinal and represent perceived quality of care, such as patient satisfaction; however, some rural residents report elevated patient satisfaction scores, regardless of limited access to these services. Identifying how perceived need for medical care is related to patient satisfaction has not been previously explored. Using an online survey to collect data from a national sample (n=535), the current study used the Patient Satisfaction Questionnaire-Short Form (PSQ-18) and a single-item measure of perceived need to examine the association between these two variables, and further, whether rural status, measured by a single-item measure, moderated this association. Results indicated a significant negative correlation between patient satisfaction and perceived need, r(423)=-.12, p=.012. Although the overall moderation model was significant, F(5, 388)=7.10, p<.001, perceived need was not significantly associated with patient satisfaction, b=-.14, p=.20, and rurality status did not significantly moderate the relationship, F(1, 388)=.44, p=.51, ��R2=0.01. However, the covariates of income, b=.11, p<.001, and sexual orientation, b=.23, p=.01, significantly predicted patient satisfaction. This study identified an association between patient satisfaction with perceived need for medical care that has not been previously explored, although this relationship was no longer significant in a larger model, indicating other important factors likely influence this relationship and contribute to the elevated satisfaction scores identified in some rural areas. The lack of moderation by rurality may be due to consistently high barriers to accessing care across all regions of the United States; while rural areas certainly experience unique barriers to care, the barriers present in urban environments may be significant enough that level of rurality in itself does not significantly affect the relationship between perceived need and patient satisfaction. Furthermore, this study highlights the importance of social determinants of health in patients’ perceptions of quality of care. Sexual orientation and income emerged as significant predictors of patient satisfaction, in that higher satisfaction was associated with those who identified as heterosexual and had higher income, consistent with previous literature. Further investigation is necessary to determine the reasons why these relationships exist; however, it is important to acknowledge that individuals with low-income and who identify as sexual minorities experience stigma and discrimination in healthcare settings. These negative experiences with healthcare likely influence perceptions and health disparities that exist within these individuals and may directly impact patient satisfaction levels, which may be influential to these findings.

Formic acid (FA) has been considered as one of the most promising materials for hydrogen storage today. The catalytic decarboxylation of formic acid ideally leads to the formation of CO2 and H2, and such CO2/H2 mixtures can be successfully applied in fuel cells. A large number of transition-metal based homogeneous catalysts with high activity and selectivity have been reported for the formic acid decarboxylation. In this presentation, we report ruthenium and rhodium complexes containing an N, N′-diimine ligand for the selective decomposition of formic acid to H2 and CO2 in water in the absence of any organic additives. Among them, the Ru complex could provide a TOF (turnover frequency) of 12 000 h–1 and a TON (turnover number) of 350 000 at 90 °C in the HCOOH/HCOONa aqueous solution. In addition to that, efficient production of high-pressure H2 and CO2 (24.0 MPa (3480 psi)) was achieved through the decomposition of formic acid with no formation of CO by this Ru complex. Moreover, well-defined ruthenium (II) PN3P pincer complexes were also developed for the reversible reaction-hydrogenation of carbon dioxide. Excellent product selectivity and catalytic activity with TOF and TON up to 13,000 h-1 and 33,000, respectively, in a THF/H2O biphasic system were achieved. Notably, effective conversion of carbon dioxide from the air into formate was conducted in the presence of an amine, allowing easy product separation and catalyst recycling.

Objective: To examine the associations of suicide in the second half of life with medical and psychiatric illness, functional limitations, and reported use of inpatient, ambulatory, and home health care services. Method:A retrospective case-control design was used to compare 86 people over age 50 years who died by suicide with a comparison group of 86 living community participants that were individually matched on age, gender, race, and county of residence. Results: Suicide decedents had more Axis I diagnoses, including current mood and anxiety disorders, worse physical health status, and greater impairment in functional capacity. They were more likely to have required psychiatric treatment, medical, or surgical hospitalization in the last year, and visiting nurse or home health aide services. In a multivariate model, the presence of any active Axis I disorder and any impairment in instrumental activities of daily living (IADL) made independent contributions to suicide risk. Conclusions: Mental illness, physical illness, and associated functional impairments represent domains of risk for suicide in this age group. In addition to individuals with psychiatric illness, those with severe or comorbid physical illness and functional disability who require inpatient and home care services should be targeted for screening and preventive interventions.