Microbes fulfill important ecosystem functions by contributing as drivers of global nutrient cycles. Their distribution patterns are mainly controlled by environmental heterogeneities. So far, little is known about the mode of action of particular environmental drivers on the microbiota, particularly in low productivity habitats. The aim of this thesis was to investigate the relationships between local environmental drivers and the microbial responses at the level of communities, individuals and realized function, using three structurally different model habitats sharing the feature of overall low productivity. Using a hypothesis-based approach and extensive 16S rRNA amplicon mapping of bacterioplankton colonizing the polar Southern Ocean, I identified how the seasonal formation of open-water polynyas and coupled phytoplankton production affected the diversity of surface bacterial communities and resulted in a cascading effect influencing the underlying dark polar water masses. Additional laboratory experiments, with cultures exposed to light, resulted in reduction in alpha diversity and promoted opportunistic populations with most bacterial populations thriving in the cultures typically reflected the dominants in situ. Furthermore it was experimentally tested how induced cyclic water table fluctuations shaping environmental heterogeneity in a constructed wetland on temporal scale, by directly affecting redox conditions. Twelve months of water table fluctuations resulted in enhanced microbial biomass, however a shift in community composition did not lead to a significant increase in pollutant removal efficiency when compared to a static control wetland. I detected phyla that have previously been proposed as key players in anaerobic benzene break-down using a protocol that was developed for single cell activity screening using isotope-substrate uptake and microautoradiography combined with taxonomic identification based on fluorescent in situ hybridization targeting the 16S rRNA. Eventually, I provide an example of how anthropogenic pollution with polyaromatic hydrocarbons induced a strong environmental filtering on intrinsic microbial communities in lake sediments. In conclusion, my studies reveal that microorganisms residing in low productivity habitats are greatly influenced by environmental heterogeneity across both spatial and temporal scales. However, such variation in community composition or overall abundance does not always translate to altered community function.

Background and Objectives: Antipsychotic medications (APMs) are used for the treatment of behavioural symptoms of dementia. The use of APMs among residents of long-term care facilities (LTCFs), who have a high probability of dementia, is correspondingly high, and has been linked to adverse patient outcomes. The study objectives were to: (a) describe facility variation in APM discontinuation rates, (b) test the association between time to APM discontinuation and patient and facility explanatory variables, and (c) conduct a sensitivity analysis about the effect of changes in the measurement of APM discontinuation on variable associations. Methods: The study used a population-based retrospective cohort design. Saskatchewan’s (SK) administrative health databases for the period from April 1, 2004 to March 31, 2011 were the data sources. The study cohort included all seniors (≥65 years of age) with a first admission to a SK LTCF and an APM dispensation on or after the admission date. Discontinuation was defined as a 70-day gap after the last APM dispensation. Patient-level explanatory variables included socio-demographics, comorbidity, prior medication exposure, behavioural and cognitive status, and health services utilization. Facility-level explanatory variables included size, location, licensing status, and type. Percentage discontinuation across facilities was descriptively analyzed. Cox proportional hazards regression models with adjustment for clustering of patients within LCTFs were used to test associations with time to discontinuation. A sensitivity analysis of APM discontinuation was conducted by shortening (35 days) and lengthening (105 days) the time from last dispensation. Results: Among all residents eligible to be cohort members 35.7% were dispensed an APM. A total of 19.5% of the 8358 cohort members discontinued APMs in the observation period. The Kaplan-Meier estimate of the median time to discontinuation was 6.5 years. Demographic, comorbidity, behavioural, and drug exposure variables were most strongly associated with APM discontinuation. Discontinuation was not associated with facility characteristics. Variable associations were insensitive to the definition of APM discontinuation, but changed over time. Conclusion: Discontinuation of APMs is low, despite high rates of utilization over long periods of time. Patient characteristics are associated with APM discontinuation, but not facility characteristics, suggesting that LCTFs are applying consistent approaches to patient management. However, low levels of discontinuation suggest that there may be a need for health care providers to regularly review the prescribing, dispensing, and administration of APMs to LTCF residents in order to ensure appropriate use of these pharmaceuticals.

I vårdverksamhet för patienter med komplexa vårdbehov är teamarbete en vanlig arbetsform. I forskning om mångprofessionellt teamarbete i vården beskrivs fördelar med organisationsformen, samtidigt som svårigheter påtalas somden mångprofessionella sammansättningen kan medföra. Inom forskningen har man dock i liten utsträckning undersökthuruvida de patientinsatser som görs av mångprofessionella vårdteam verkligen präglas av teamens breda kompetens. Manredovisar heller någon övergripande teoretisk modell som beskriver faktorer betydelsefulla för utfallet av vårdteams arbete ibemärkelsen mångdimensionalitet. Syftet med detta arbete har varit att undersöka i vilken utsträckning patientarbetet i mångprofessionella psykiatriska teampräglas av teamets samlade kompetens, samt på vilket sätt de olika professionerna bidrar till grad av mångdimensionalitet ipatientarbetet. Ett syfte har också varit att undersökta vad som kan vara viktiga påverkansfaktorer för utnyttjandet av densamlade kompetensen i psykiatriska team. Två empiriska studier har genomförts. Den första studien syftade till att ge en bild av grad av mångdimensionalitet ipatientarbetet, samt av på vilket sätt de olika professionerna bidrar med sin kompetens. I denna studie observeradesvuxenpsykiatriska teams arbete under behandlingskonferens. Resultatet av observationsstudien visade att de studeradeteamen hade svårigheter att under hela diskussionen belysa patienterna på ett mångsidigt sätt – diskussionen dominerades avdet sociala perspektivet. Till denna dominans av det sociala perspektivet bidrog alla professionerna. Resultatet pekade ävenpå ett underutnyttjande främst av omvårdnadspersonalen men även av kuratorerna under behandlingskonferens. Vidarevisade resultatet att en mycket stor del av diskussionsutrymmet ägnades åt att beskriva patienten och en mycket liten del åtanalys- och beslutsprocessen. Till dominansen av det beskrivande momentet bidrog alla professionerna. Den andra studien syftade till att belysa vad som kan vara viktiga påverkansfaktorer för huruvida patientarbetet ipsykiatriska team får en mångdimensionell prägel. I denna studie intervjuades personal från psykiatrin, och utgångspunkt förintervjuerna var resultatet från observationsstudien. De förklaringar intervjugrupperna lämnade till det sociala perspektivetsdominans och till dominansen av det beskrivande momentet handlade om behov hos medlemmar i psykiatriska team av attkänna sig delaktiga och jämlika, samt av att relationerna i teamet skall vara konfliktfria. Ett underutnyttjande avomvårdnadspersonal samt kuratorer förklarade man med ett hierarkiskt förhållande mellan medlemmar i psykiatriska team. Sammanfattningsvis kan sägas att resultatet av de två studierna pekar mot att relationella aspekter av teamarbetet samt etthierarkiskt förhållande mellan professionerna kan begränsa psykiatriska teams möjlighet till att under behandlingskonferensbelysa patientärenden på ett mångsidigt sätt, samt till fullo utnyttja teamets samlade kompetens. / In the healthcare sector, multi professional teamwork is a common way to organize health care services in areas where thepatients care need is multidimensional. Described in literature are several advantages of the multi professional approach inproducing high quality care. Also shown is that problems might arise from the professional diversity of a team. Research onteamwork in health care settings shows that little is known of whether health care teams make full use of their multiprofessional competence when designing patient care. There is also no overall theoretical framework describing importantfactors influencing the possibilities of a health care teams to make full use of their competence. The aim of this thesis was to investigate how psychiatric teams make use of their multi professional competence indesigning patient care. To meet the aims of this thesis two empirical studies where conducted. The aim of the first study was to investigate to what extent patient care was designed in a multi professional way, an inwhat way the different profession contributed to a multi professional designed care. Multi professional psychiatric teamswhere observed during treatment conference. The results indicate that when discussing patient care, the observed teams to alarge extent did not view the patients in a multidimensional way. The main focus was on the social aspect of patients and thiswas something that all the professions contributed to. The result also showed that when the discussions were viewed as awhole, and during the phase of describing the patient, clinical nurses took part in the discussions to a lesser extent than didthe other professions. Results also showed that the observed teams to very a large extent used the discussions for describingthe patients in relation to analyzing causes of symptoms and deciding interventions. In the second study four group interviews where conducted to investigate what might influence the psychiatric teams'ability to use its multi professional competence when designing patient care. Participating in the interviews where physicians,social workers, clinical nurses and psychologists. To a large extent the explanations suggested for the domination of thesocial perspective concerned relational aspects of team work. The interview groups described team members´ need to feelthat they participate in the discussions and understand what is said, that all team members are considered equal and thatconflicts are avoided. The same kinds of explanations were given for the fact that the observed teams to a large extent usedthe discussions for describing the patients in relation to analyzing causes and deciding interventions. Hierarchy in psychiatricteams was the most frequently used explanation to the fact that clinical nurses took part in the discussions to a lesser extentthan did the other professions. To summarize — the results indicate that relational aspects of team work and a hierarchic situation in psychiatric teamsmight impede on the psychiatric teams’ ability to draw on its multi professional competence.

Thesis (M.Ing. (Development and Management))--North-West University, Potchefstroom Campus, 2009.

This study introduces an evaluation of the downstream utilization of oxygen produced by the hybrid sulfur process (HYS). Both technical and economic aspects were considered in the production of primarily synthesis gas and hydrogen. Both products could increase the economic potential of the hybrid sulfur process. Based on an assumed 500MWt pebble bed modular nuclear reactor, the volume of hydrogen and oxygen produced by the scaled down HYS was found to be 121 and 959 ton per day respectively. The partial oxidation plant (POX) could produce approximately 1840 ton synthesis gas per day based on the oxygen obtained from the HYS. The capital cost of the POX plant is in the order of $104 million (US dollars, Base year 2008). Compared to the capital cost of the HYS, this seems to be a relatively small additional investment. The production cost varied from a best case scenario $9.21 to a worst case scenario of $19.36 per GJ synthesis gas. The profitability analysis conducted showed favourable results, indicating that under the assumed conditions, and with 20 years of operation, a NPV of $87 mil. and an IRR of 19.5% could be obtained, for the assumed base case. The economic sensitivity analysis conducted, provided insight into the upper and lower limitations of favourable operation. The second product that could be produced was hydrogen. With the addition of a water gas shift and a pressure swing adsorption process to the POX, it was found that an additional 221 ton of hydrogen per day could be produced. The hydrogen could be produced in the best case at $2.34/kg and in the worst case at $3.76/kg. The investment required would be in the order of $50 million. The profitability analysis for the base case analysis predicts an NPV of $206 million and a high IRR of 23.0% under the assumed conditions. On financial grounds it therefore seemed that the hydrogen production process was favourable. The thermal efficiency of the synthesis gas production section was calculated and was in good agreement with that obtained from literature. The hydrogen production section’s thermal efficiency was compared to that of steam methane reforming of natural gas (SMR) and it was found that the efficiencies were comparable but the SMR process was superior. The hydrogen production capacity of the HYS process was increased by a factor of 1.83. This implied that for every 1 kg of hydrogen produced by the HYS an additional 1.83 kg was produced by the proposed process addition. This lowers the cost of hydrogen produced by the HYS from $6.83 to the range of approximately $3.93 - $4.85/kg. In the event of a global hydrogen economy, traditional production methods could very well be supplemented with new and innovative methods. The integration of the wellknown methods incorporated with the new nuclear based methods of hydrogen production and chemical synthesis could facilitate the smooth transition from fossil fuel based to environmentally friendly methods. This study presents one possible integration method of nuclear based hydrogen production and conventional processing methods. This process is technically possible, efficient and economically feasible. / Thesis (M.Ing. (Nuclear Engineering))--North-West University, Potchefstroom Campus, 2009.

Child trauma exposure (CTE) is an important public health concern in the U.S.; more than two-thirds of children report experiencing a traumatic event by the age of 16. CTE may have important acute and long-term physiological, developmental, behavioral, and psychological implications if not addressed. Trauma-focused cognitive behavioral therapy (TF-CBT) is the gold standard for treatment of child trauma and is well-supported for resulting in significant decreases in negative mental health outcomes associated with CTE. Despite the efficacy of evidence-based interventions such as TF-CBT, many children do not receive treatment due to a variety of contextual, logistical, and interpersonal barriers. This mixed-methods exploratory study examines possible predictors of enrollment and completion of TF-CBT, specifically parental trauma exposure, at a community organization that serves abused and traumatized children in the metro Atlanta area. Data were collected during individual assessments consisting of a computer survey and semi-structured interview (n=41). Data analysis focused on parental trauma exposure, and qualitative interviews were examined for common themes regarding intentions for their child’s enrollment and completion of services. Results indicated that caregivers of children referred to services had relatively high (56.1%) rates of trauma exposure. Results from logistical regression indicate that parents with a trauma history were 10.5 times more likely to have a child enroll in therapy. These results indicate that parents with personal trauma histories may be more committed to their child receiving services, therefore public health efforts aimed towards educating parents without trauma histories may be beneficial.

Thesis (M.Ing. (Development and Management))--North-West University, Potchefstroom Campus, 2009.

This study introduces an evaluation of the downstream utilization of oxygen produced by the hybrid sulfur process (HYS). Both technical and economic aspects were considered in the production of primarily synthesis gas and hydrogen. Both products could increase the economic potential of the hybrid sulfur process. Based on an assumed 500MWt pebble bed modular nuclear reactor, the volume of hydrogen and oxygen produced by the scaled down HYS was found to be 121 and 959 ton per day respectively. The partial oxidation plant (POX) could produce approximately 1840 ton synthesis gas per day based on the oxygen obtained from the HYS. The capital cost of the POX plant is in the order of $104 million (US dollars, Base year 2008). Compared to the capital cost of the HYS, this seems to be a relatively small additional investment. The production cost varied from a best case scenario $9.21 to a worst case scenario of $19.36 per GJ synthesis gas. The profitability analysis conducted showed favourable results, indicating that under the assumed conditions, and with 20 years of operation, a NPV of $87 mil. and an IRR of 19.5% could be obtained, for the assumed base case. The economic sensitivity analysis conducted, provided insight into the upper and lower limitations of favourable operation. The second product that could be produced was hydrogen. With the addition of a water gas shift and a pressure swing adsorption process to the POX, it was found that an additional 221 ton of hydrogen per day could be produced. The hydrogen could be produced in the best case at $2.34/kg and in the worst case at $3.76/kg. The investment required would be in the order of $50 million. The profitability analysis for the base case analysis predicts an NPV of $206 million and a high IRR of 23.0% under the assumed conditions. On financial grounds it therefore seemed that the hydrogen production process was favourable. The thermal efficiency of the synthesis gas production section was calculated and was in good agreement with that obtained from literature. The hydrogen production section’s thermal efficiency was compared to that of steam methane reforming of natural gas (SMR) and it was found that the efficiencies were comparable but the SMR process was superior. The hydrogen production capacity of the HYS process was increased by a factor of 1.83. This implied that for every 1 kg of hydrogen produced by the HYS an additional 1.83 kg was produced by the proposed process addition. This lowers the cost of hydrogen produced by the HYS from $6.83 to the range of approximately $3.93 - $4.85/kg. In the event of a global hydrogen economy, traditional production methods could very well be supplemented with new and innovative methods. The integration of the wellknown methods incorporated with the new nuclear based methods of hydrogen production and chemical synthesis could facilitate the smooth transition from fossil fuel based to environmentally friendly methods. This study presents one possible integration method of nuclear based hydrogen production and conventional processing methods. This process is technically possible, efficient and economically feasible. / Thesis (M.Ing. (Nuclear Engineering))--North-West University, Potchefstroom Campus, 2009.

Epidemiological studies have shown that disparities in mental health service utilization still exist among ethnic minority groups in the United States. This study looks specifically at the lay referral system and what factors influence the likelihood of an individual referring a friend to mental health services. Since college student populations have fewer barriers than most to seeking treatment, 60 Asian American and 49 White American college students were sampled for the purposes of this study. They evaluated one of four vignettes in which cultural competency of the potential therapist and type of symptoms being presented were manipulated. Though there was no significant interaction found, implications of the current findings and corrections to the methodology for future research are discussed.

Darbo tikslas: nustatyti, vaistinėse besilankančių pacientų, lipidų apykaitos sutrikimo profilaktikai ir gydymui rekomenduojamų vaistinių preparatų ir maisto papildų suvartojimo tendencijas. Uždaviniai: 1) išanalizuoti statinų grupės preparatų suvartojimą Lietuvoje 2005-2012 metais, naudojant tarptautinę, PSO patvirtintą, vaistų suvartojimo ATC/DDD metodiką ir gautus rezultatus palyginti su kitomis ES šalimis, 2) įvertinti, vaistinėse besilankančių pacientų, lipidogramos rodiklius ir jų dinamiką, vartojant antilipideminius vaistus ir maisto papildus, 3) įvertinti lipidų apykaitos sutrikimo profilaktikai ir gydymui rekomenduojamų vaistų ir maisto papildų atitikimą tarptautinėms rekomendacijoms (NCEP ATP III). Metodika: vaistų, kurie priklauso C10AA (HMG KoA reduktazės inhibitorių) ir C10BX (HMG KoA reduktazės inhibitorių, kitų derinių) pogrupiams, suvartojimas buvo analizuojamas ATC/DDD metodika, išreiškiant duomenis DDD/1000 gyventojų per dieną (DDD/1000 gyv/d). Vaistinėje besilankančių pacientų lipidogramos rodikliai ir vartojami vaistai/maisto papildai buvo vertinami atliekant anketinę apklausą. Surinktų duomenų statistinė analizė atlikta naudojant SPSS programinį paketą, 17,0 versiją. Rezultatai: statinų suvartojimas Lietuvoje padidėjo nuo 3,873 DDD/1000 gyv/d 2005 m. iki 12,787 DDD/1000 gyv/d 2012 m., o išlaidos išaugo nuo 6,19 mln Lt 2005 m. iki 9,12 mln Lt 2012 m. Anketinėje apklausoje dalyvavo 358 pacientai, kurie vaistinėje įsigijo vaistus ir/ar maisto papildus lipidų... [toliau žr. visą tekstą] / Objective of the work: to determine the usage tendencies of the medicinal products and food supplements recommended for prevention and treatment of the disorder of lipid metabolism to the patients coming to the pharmacies. Tasks: 1) to analyze the usage of the products of statin group in Lithuania in 2005-2012 using the international, WHO approved methodology of the medicine usage ATC/DDD, and to compare the results with other EU States, 2) to assess the indexes of lipidogram and their dynamics of the patients coming to the pharmacies, who use antilipidemic medicine and food supplements, 3) to assess the conformity of the medicinal products and food supplements recommended for prevention and treatment of the disorder of lipid metabolism to the international guidelines (NCEP ATP III). Methodology: the usage of the medicine that belongs to the sub-groups of C10AA (HMG CoA reductase inhibitors) and C10BX (Other combinations) was analyzed by the ATC/DDD methodology expressing the data as DDD/1000 inhabitants per day (DDD/1000 inhabitants/d). The indexes of lipidogram and the medicine/food supplements used by the patients coming to the pharmacies were assessed using the survey by questionnaires. The statistical analysis of the collected data was done using the SPSS program package, version 17.0. Results: the usage of statins in Lithuania increased from 3,873 DDD/1000 inhabitants/d in 2005 until 12,787 DDD/1000 inhabitants/d in 2012, while the expenses for statins increased from 6... [to full text]