This thesis investigates the mechanisms that might be used to determine the rights and obligations of Turkey, Syria and Iraq to govern the Tigris and Euphrates River Basin (TERB) in accordance with the international water law. In particular, it advocates for the protection of Iraq?s equitable rights through the establishment of a legal and institutional framework for joint use of the TERB. As a contribution towards addressing the issues of transboundary water law at the TERB level, this thesis explores the possibilities for potential cooperation between the three riparian States of the TERB through forming a legally binding treaty under the auspices of contemporary international water law. From this perspective, the thesis hypothesises that international law provides a solid basis on which the State of Iraq can rely on for achieving its legal entitlements to the equitable and reasonable use of the TERB. In this context, the thesis first examines international law in order to establish how it applies to the TERB. Next, the thesis considers how the legal positions of the riparian States can be determined under international law. When the aforesaid requirements are met, the thesis makes recommendations on how international water law can strengthen the legal framework for equitable joint use of the TERB. The thesis offers the methodology and analytical framework that deals with different relevant issues covered within the scope of the thesis. Later on, water uses within the TERB are discussed, followed by a literature review of publications on contemporary Middle East transboundary water conflict and cooperation. Afterwords, the thesis examines the applicable international law and international water law to the riparian States of the TERB. Finally, it explores the legal regime of the inter-State relationships in order to foster improved transboundary water management of the TERB.

Bakgrund: Demenssjukdomar är en växande sjukdomsgrupp i samhället. I Sverige beräknas att mellan 130–150 tusen personer lever med en demenssjukdom. Demens går inte att bota utan det går enbart att bromsa upp förloppet med hjälp av läkemedel. Personer som drabbas av demenssjukdomar får oftast många följdsjukdomar som i förlängningen leder till döden. Med hjälp av dator och tv-spelsanvändning kan demenssjukdomen bromsas med kognitiv träning. Syfte: Syftet har varit att undersöka nyttan av dator och tv-spelsanvändningsområden inom demensvården. Metod: Studien genomfördes som en litteraturöversikt där fjorton vetenskapliga artiklar inkluderades. Sökningar har gjordes via databaserna Pubmed, Cinahl och Psycinfo. De inkluderade artiklarna har analyserats där likheter och skillnader har jämförts. Resultat: Resultatet visade att teknologin kan påverka personers kognitiva funktion, fysiska hälsa samt psykiska hälsa. Dator och tv-spelsanvändning har flera positiva effekter så som förbättrad kognitiv förmåga, ökad självständighet och bevarande av egna intressen. Slutsats: Datorer och tv-spel har fördelaktiga effekter hos personer som lider av en demenssjukdom. Bland annat upptäcktes förbättringar i den psykiska, fysiska och kognitiva förmågan i de granskade studierna. Då ämnet är nytt krävs ytterligare forskning inom ämnet. / Background: Dementia is a growing disease in the society. In Sweden there are approximately 130-150 thousand people living with dementia. There is no cure for dementia, and with pharmaceuticals you can only prolong the decease. People who suffer from dementia tend to have other illnesses prior to the main dementia. These complications often lead to death. With the usage of videogames and computergames where the user is utilizing the body and bodymovement as a tool for progress there are beneficial effects to the motor skills and cognitive functions for the elderly living with dementia and cognitive decline. Aim: The purpose of this study was to investigate the utilization of computers and video games in the dementia care. Method: Done as a literature review where 14 articles was included. Searches have been made through databases Pubmed, Cinahl and Psycinfo. The 14 articles where systematically analyzed and differences and similarities were compared between the articles Results: Four categories were made, physical health, psychological health, cognitive function and usability of technology by the dementia suffers. Conclusions: Computer and videogames utilization have beneficial effects for the people who suffers from dementia. Enhanced physical, psychological and cognitive function were found in the studies. Due to the relatively new subject further research is required in the area.

Typescript. / Digitized by Kansas Correctional Industries

Digitized by Kansas Correctional Industries

Typescript (photocopy). / Digitized by Kansas Correctional Industries

Os progressos na terapêutica medicamentosa têm sido notáveis, porém estudos da sua utilização e dos efeitos desejáveis ou indesejáveis necessitam ser amplamente desenvolvidos. O presente estudo averiguou a utilização de medicamentos, descrevendo o perfil de prescrição e dispensação de antimicrobianos com foco em custos no HCFMRP-USP, revelando a topografia dos gastos conforme sua utilização nos diversos setores e ao longo de um período. Objetivo: Estudar o perfil de utilização de medicamentos antimicrobianos através da análise de dados provenientes de sistema informatizado de prescrição e dispensação do HCFMRP-USP. Metodologia: A partir de banco de dados geral de prescrição e dispensação de itens de medicamentos no HCFMRP-USP, foi criado um banco de dados específico de itens de antimicrobianos (antibacterianos, antifúngicos, antivirais e antiparasitários) prescritos individualmente aos pacientes internados e a eles dispensados, no período de 2013 a 2015. As análises foram realizadas através do programa Excel®, versão 2007, pacote Office, Microsoft. Resultados: Os antimicrobianos representaram, em média, 12% dos itens prescritos totais e 16%, em média, dos itens dispensados. 30 itens antimicrobianos de maior custo do hospital correspondem a 97,48% dos custos e a 20,54% da dispensação; o item que mais custa ao hospital, dentre todas as classes analisadas é a Anfotericina B lipossomal (42,55%); Dos antibióticos, a classe que mais custa ao hospital são os cabapenens (22,94%), seguidos das tetraciclinas (21,69%) e polimixinas (15,85%) e as classes mais dispensadas são as cefalosporinas (30,03%), penicilinas (16,72%) e carbapenens (16,59%). CIDs mais registrados: Z380, I120 e Z383. Em média, 33,5 pacientes são responsáveis pelos gastos com antimicrobianos. Os centros de custos que mais gastam são Enf. Hematologia, pediatria e CTI. Já os que mais dispensam são UETDI, Ortopedia e moléstias infecciosas. Conclusões: O HCFMRP-USP tem como um dos seus maiores custos variáveis os medicamentos, em especial os antimicrobianos. Assim, a geração de informações através de EUM auxilia a tomadas de decisões estratégicas e gerenciais. Este trabalho só foi possível devido à prescrição informatizada, que possibilita o registro de todos os dados de prescrição e dispensação. / Advances in drug therapy have been remarkable, but studies of their use and the desirable or undesirable effects need to be fully developed. The present study investigated the use of drugs, describing the prescription profile and dispensing antimicrobials focusing on costs, at HCFMRP- USP, revealing the topography spending as their use in the various sectors and over a period. Objectives: To study the profile of use of antimicrobial drugs through analysis of data from the computerized system of prescribing and dispensing of HCFMRP- USP. Methodology: From general database of prescription and dispensing of medicines items in HCFMRP- USP, a specific database of antimicrobials items (antibacterial, antifungal, antiviral and antiparasitic) was created, individually prescribed to hospitalized patients and they exempt, from 2013 to 2015. Analyses were performed using Excel®, version 2007, Office suite, Microsoft. Results: The antimicrobial represented, on average, 12% of the total prescribed items and 16% on average of dispensed items. 30 antimicrobials items of higher cost of hospital correspond to 97.48% of the costs and 20.54% of the dispensation; the item that costs more to the hospital, among all analyzed classes is the liposomal amphotericin B (42.55%); From antibiotics, the class that more costs the hospital are cabapenens (22.94%), followed by tetracyclines (21.69%) and polymyxins (15.85%) and the most dispensed classes are cephalosporins (30.03%), penicillins (16.72%) and carbapenems (16.59%). ICDs (International Code Diseases) more registered: Z380, Z383 and I120. On average, 33.5 patients are responsible for spending on antimicrobials. Cost centers that spend more are Enf. Hematology, pediatrics and CTI. But those who dispense more are UETDI, orthopedics and infectious diseases. Conclusions: HCFMRP- USP has as one of its major cost variables medicines, especially antibiotics. Thus, the generation of information and through the use of these medications study aids taken strategic and management decisions. This work was only possible because of the computerized prescription, which allows the registration of all prescription and dispensing data in the system.

Little is known about the psychotherapy utilization, presenting concerns, and outcome differences between Black international and African American university students. The aim of this research is to identify potential similarities and differences between the two groups, as well as potential differences between the aforementioned groups and white students. This study examined archival data collected over the course of a 17-year period that focused on experiences of African-American, Black international, and White students at a large university in the Rocky Mountain West, United States. More specifically, archival data were analyzed to identify differences between the aforementioned groups of students in regard to psychotherapy utilization, presenting concerns, distress levels endorsed at intake, and distress levels endorsed at termination. Results indicate significant differences between African-American, Black international, and White student groups in terms of the maximum number of psychotherapy sessions attended and length of treatment in days. We found significant differences between these groups of students on several items assessed in the Presenting Problem Checklist and the Family Concerns Survey. We found no significant difference between African-American, Black international, and White student groups in the severity of presenting distress as measured by the Outcome Questionaire-45. We found a significant difference between groups in treatment improvement as measured by change scores on the Outcome Questionaire-45, with White students experiencing the greatest change, followed by Black international students and African-Americans. Possible explanations and implications for practice will be discussed in the body of the paper.

Integrated primary care (IPC) may help palliate the demand for mental health services and barriers to such care. There are varying degrees of integration (Blount, 2003; Doherty, 1995; Strosahl, 1998), with suppositions that certain patients may fare better in certain levels/models of IPC than in others (Doherty, McDaniel, & Baird, 1996; Mauer, 2006). No research to date has examined the interface between levels of care and patient behavioral and physical health demands, hence the aim of the current study. The current study utilized Mauer’s (2006) Four Quadrant Model to ascertain patient differences in behavioral and physical health demands and utilization across three levels of care: co-located, integrated, and a hybrid (receipt of both colocated and integrated care) for a general adult population within a community-based nurse practitioner-led FQHC. Total time spent in behavioral health treatment, total number of behavioral health sessions, number of presenting behavioral health concerns at baseline, and number of behavioral health no-shows and cancellations since baseline, differed significantly across the levels of integration. Number of past-year medical visits, number of chronic illnesses, and number of active medications at baseline did not differ significantly between groups, indicating that patient differences between levels of care were based more on behavioral health variations than physical variables. Moreover, patients were no more or less likely to be represented in one level/model of care over another based on patient quadrants, or combinations of high and low physical and behavioral health demands. This study is the first to our knowledge to examine the intersect of patient quadrants and levels/models of IPC. Future research should examine the intersect and impact of level/model of care and patient behavioral and physical health demands on outcome.

The aim of the Reading First grant program was to (a) increase quality and consistency of instruction in K-3 classrooms; (b) conduct timely and valid assessments of student reading growth in order to identify students experiencing reading difficulties; and (c) provide high quality, intensive interventions to help struggling readers catch up with their peers (Torgesen, 2002). In the State of Florida, school districts must incorporate the use of an assessment tool called the Dynamic Indicators of Basic Early Literacy Skills (DIBELS) to qualify for Reading First grant funding. Though DIBELS has been found to be a valid and reliable assessment for screening, monitoring, and evaluating student outcomes in early literacy skills, very little discussion or research has been conducted concerning teacher use and attitudes about DIBELS within a Reading First program. The present study involved a qualitative analysis of teachers' perceptions and use of the DIBELS within a Reading First context. Fourteen teachers (seven kindergarten and seven first grade teachers), Reading Coaches, non-teaching Specialists, and DIBELS experts participated in the present study. Results were aggregated for comparisons across multiple data sources. Results suggest teacher's perceptions may not be easily classified on a simple dichotomous range; rather their reported benefits and concerns on the use of the DIBELS were found to be varied and highly situational. Results were further interpreted in the context of research literature on data utilization and analysis in schools.

Escalating health care costs in the military health system are not sustainable long term. Regular physical activity has been shown to improve health and reduce health care costs. Military members serving in the United States Air Force (USAF) are encouraged to maintain physical fitness year-round and undergo mandatory physical fitness assessments (PFAs) annually. The purpose of this quantitative correlational study was to determine the nature of the relationship between the timing of the PFA and health care utilization (HU) by active duty service members assigned to the United Kingdom's USAF military treatment facility. Donabedian's framework and the logic process model were used to design the study. Archived fitness and health care utilization data were obtained on 361 military members. Findings indicated a strong, positive correlation between the timing of the PFA and HU, which was strongest during the PFA month. Monthly HU 6 months prior to PFA was compared using a 1-way repeated measures ANOVA. Findings indicated a significant difference between T-1 (PFA month), T-2 (1 month prior to PFA), and T-5 (5 months prior to PFA). Paired-samples t tests demonstrated a statistically significant increase in HU from T-5 to T-2. Although findings are not generalizable, they signal a need for further study to evaluate HU variability between populations, to identify at-risk groups, and to inform health and fitness policies that affect the readiness and retention of military members. The DNP project may promote interdisciplinary collaboration between health care providers and senior military leadership, innovation in health care delivery, and evidence-based and cost-conscious policies.