abstract: ABSTRACT Leadership in Energy and Environmental Design (LEED) is a non-governmental organization of U.S. Green Building Council (USGBC) which promotes a sustainable built environment with its rating systems. One of the building segments which it considers is healthcare, where it is a challenge to identify the most cost-effective variety of complex equipments, to meet the demand for 24/7 health care and diagnosis, and implement various energy efficient strategies in inpatient hospitals. According to their “End Use Monitoring” study, Hospital Energy Alliances (HEA), an initiative of U.S. Department of Energy (DOE), reducing plug load reduces hospital energy consumption. The aim of this thesis is to investigate the extent to which realistic changes to the building envelope, together with HVAC and operation schedules would allow LEED credits to be earned in the DOE–hospital prototype. The scope of this research is to specifically investigate the inpatient block where patient stays longer. However, to obtain LEED credits the percentage cost saving should be considered along with the end use monitoring. Several steps have been taken to identify the optimal set of the end use results by adopting the Whole Building Energy Simulation option of the LEED Energy & Atmosphere (EA) pre– requisite 2: Minimum Energy Performance. The initial step includes evaluating certain LEED criteria consistent with ASHRAE Standard 90.1–2007 with the constraint that hospital prototype is to be upgraded from Standard 2004 to Standard 2007. The simulation method stipulates energy conservation measures as well as utility costing to enhance the LEED credits. A series of simulations with different values of Light Power Density, Sizing Factors, Chiller Coefficient of Performance, Boiler Efficiency, Plug Loads and utility cost were run for a variety of end uses with the extreme climatic condition of Phoenix. These assessments are then compared and used as a framework for a proposed interactive design decision approach. As a result, a total of 19.4% energy savings and 20% utility cost savings were achieved by the building simulation tool, which refer to 5 and 7 LEED credits respectively. The study develops a proper framework for future evaluations intended to achieve more LEED points. / Dissertation/Thesis / M.S. Built Environment 2012

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / This research aims to point which would the place that fandoms could occupy inside the production process managed by culture industries inside the convergence culture context. So, we chose the Brittish TV Show “Doctor Who” as a starting point because it has a lot of features of the convergence culture presented by the authors we used and also because of its longevity and adaptability during all these 50 years on air. Then, we bring up the concept of convergence culture based on Aquino (2012) who proposes a theoretical triad ir order to comprehend this issue: technology, society and culture. So, we add the economic feature to her statement through an approach that values the “Theoretical Interdisciplinarity” (KLEIN, 2010) intending to include a general overview. Only after that we come up with a generic model that includes fans and, at last, we chose two of the biggest Brazilian fandoms to instace this model. A content analys based on the entire production of both groups in Twitter during November 2013 was made. This was the period when the Doctor Who 50-year anniversary was emphasized by BBC and it was inside Twitter that Brazilian fans respondend to that when they got mobilized for the annyversary especial showing at the movies. So, through a combination of content analysis (BARDIN, 1995) and interviews with the fandom leaders, we could find that the generic model could be applicable in both specific cases and thet the cultural industries players hás been proposing new strategies that, at the same time, pitch in with the maintenance of a productive cicle managed by them but also opens to fandom a role as an intermediary instance capable of guide the consumption of the other audiences. / Esta pesquisa tem a intenção de situar o lugar que os fandoms podem ocupar dentro do processo de produção coordenado pelas indústrias culturais no contexto da cultura da convergência. Para isto, escolhemos a série britânica "Doctor Who" como ponto de partida, pois, dada sua adaptabilidade ao longo dos mais de 50 anos do ar, ela tem se adaptado com muita eficácia ao contexto da cultura da convergência. O segundo passo foi levantar o conceito de convergência a partir da proposta de Aquino (2012) que aborda a temática a partir de um tripé teórico: tecnologia, sociedade e cultura. A partir desse ponto, o que propomos é adicionar o aspecto da economia à ideia da autora através de uma abordagem que preza pela “interdiscipliniridade teórica” (KLEIN, 2010) na tentativa de compreender a questão de uma forma mais geral e só então é que propomos o nosso modelo. Por último então escolhemos os dois maiores fandoms brasileiros da série para ilustrar esse modelo através de uma análise de conteúdo dos seus perfis no Twitter. Foi possível perceber também que em novembro de 2013 a BBC intensificou a divulgação de material promocional em relação ao aniversário de 50 anos, sobretudo relacionado ao especial a ser exibido no cinema e, com isso, a mobilização dos fãs acompanhou o mesmo movimento, por isso este foi o período escolhido para ser detalhado. Definidos os parâmetros, utilizamos uma aliança entre análise de conteúdo (BARDIN, 1995) e entrevistas com os administradores dos grupos a fim de constatar a aplicabilidade do modelo proposto para nesses casos em específico e que os players das indústrias culturais têm proposto novas estratégias que, ao mesmo tempo contribuem para a manutenção de um ciclo produtivo comandado por eles, abre espaço para a inserção dos fandoms como uma espécie de instância intermediária capaz de guiar o consumo das audiências.

Although there is extensive research on children’s exposure to intimate partner violence and its impacts, there is very little information available with respect to how child protection workers assess the risks posed to children by the negative parenting associated with battering and how these workers intervene to protect children. This case study therefore sought to understand how child protection workers accounted for the parenting of men who batter in their assessments of child safety and in their service plans. It explores in detail how mothers and child protection workers conceptualize and describe the parenting attitudes and behaviours of the men who came to the attention of MCFD due to battering, how protection workers assessed children’s safety in light of the parenting behaviours and examines the types of child welfare responses or interventions that were utilized in order to deal with these challenges. Results show that despite the level of understanding on the part of the child protection workers’ with regard to the links between the perpetration of intimate partner violence and negative parenting approaches, these fathers’ parenting was largely overlooked in the child safety assessment and service delivery plans. Thus, it is recommended that child welfare policies draw robust links between the perpetration of intimate partner violence and negative parenting approaches and provide child protection workers with the safety assessment tools and clear direction to assess the parenting behaviours of fathers who batter their children’s mothers. / Graduate

Background: Syphilis infection has recently resurfaced as a significant public health problem. Although there has been a tremendous amount of research on the epidemiology of syphilis, there has been limited work done to synthesize the extensive body of research and systematically estimate patterns of disease within high-risk groups in the Americas. The purpose of this systematic review and meta-analysis is to (1) summarize recent patterns of syphilis infection in North and South America among four high-risk groups (MSM, transgender women, sex workers, and incarcerated individuals) from 1980 to 2016, (2) identify and differentiate regional geographic epidemiologic characteristics, and (3) compare the epidemics of the economically developed countries of North America from the developing countries and public health systems of Latin America and the Caribbean. Methods/design: Primary studies reporting syphilis prevalence and/or incidence in at least one of the four high-risk groups will be identified from Medline/PubMed, Embase, Lilacs, SciELO, The Cochrane Library, Web of Science, Scopus, ProQuest, CINAHL, Clase, and Periódica, as well as "gray" literature sources (conference abstracts, country reports, etc.). Studies published from 1980 through 2016 will be included. Data will be extracted from studies meeting inclusion and exclusion criteria and a random effects meta-analysis of prevalence and incidence estimates will be conducted. Heterogeneity, risk of bias, and publication bias will be assessed. Pooled prevalence and incidence estimates will be calculated for comparisons based on geographic region, risk factors, and time period. Discussion: Our systematic review and meta-analysis aims to contribute to an improved understanding of global epidemiologic patterns of syphilis infection in most-at-risk populations. Through systematic classification of the existing literature, and comparison of disease patterns across regional, temporal and socio-behavioral differences, we hope to improve public health surveillance and improve efforts to control the spread of disease across the Americas. Systematic review registration: PROSPERO CRD42016047306.

Master of Public Health - MPH / Background: Severe acute malnutrition contributes disproportionately to child mortality rates despite availability of the WHO protocol, “Ten Steps”, to guide hospital management. Auditing morbidity and mortality rates of malnourished children at hospitals is useful to measure the effectiveness of hospital-based management compared to standards advocated by the WHO protocol. The study aimed to assess the adequacy of clinical management practices for severely malnourished children admitted to three district hospitals in the Western Cape as compared to the WHO guidelines. Objectives: To describe prognostic indicators on admission such as clinical severity of malnutrition and co-morbidities such as HIV, TB, diarrhoea and pneumonia. To assess the management practices of severe malnutrition against the key principles of management during the stabilisation phase as outlined by the WHO guidelines. To describe the number of severely malnourished children who were treated for or died due to preventable complications (hypothermia, hypoglycaemia, dehydration, over-hydration, infection, electrolyte imbalance). Methodology: A retrospective, descriptive study based on a folder review of medical records of 83 severely malnourished children admitted to the Stellenbosch, Helderberg and Eersteriver hospitals from September 2009 to June 2011 was done. viii Structured data collection was undertaken to capture data to allow assessment of the clinician’s management practices, and the adequacy thereof in implementing the first six steps of the WHO protocol guidelines. Results The predominant co-morbidities in the sample were diarrhoea in 51% ofcases and pneumonia in 33%. Thirteen percent were HIV infected, 28% of the sample had TB. Clinical signs were poorly documented by clinicians. The highest percentage of adequate management practices was for treatment of infections with 90% of patients receiving antibiotics. The second best management practice was for treatment of electrolyte and micronutrient deficiency. Hypoglycaemia and hypothermia were poorly managed as children developed these complications in the hospitals and yet these complications were still left untreated. Nineteen percent of the sample needed transfer to a specialist hospital. Conclusion The study concludes that overall management practices for children admitted with severe acute malnutrition to three district hospitals in the Western Cape was poor and often did not adhere to the WHO guidelines. Doctors showed poor understanding of the need for accurate assessment and monitoring in order to reduce the mortality risk of these patients.

Syftet med studien har varit att öka kunskapen om hur utredande socialsekreterare ser på fenomenet barn som upplever våld mellan närstående och hur deras tolkningar förhåller sig till de lagar och riktlinjer som finns gällande barn som upplever våld. Studien har genomförts genom kvalitativa semistrukturerade intervjuer med sex yrkesverksamma barn- eller ungdomsutredare, vilka alla arbetar för socialtjänsten på förvaltningar inom Stockholm stad eller i kranskommuner till Stockholm. Intervjuerna har gett ett material som sedan analyserats mot Michael Lipskys teori om Street level bureaucracy, samt tidigare forskning. Studiens resultat visar att de socialsekreterare som intervjuats ser allvarligt på det faktum att barn upplever våld mellan närstående. Samtliga respondenter anser att barn som upplever våld mellan närstående själva är offer för psykisk misshandel. Dock framkommer det i studien att våldet i sig av vissa respondenter anses få för stort utrymme i arbetet, de menar att våldet kan vara ett uttryck för andra missförhållanden som riskerar att missas om allt för mycket fokus läggs vid att enbart utreda våldet. Vad gäller hur studiens respondenter förhåller sig till lagar och riktlinjer visar studiens resultat att kännedomen om riktlinjer är låg. Respondenterna uttrycker ingen avsaknad av rutiner och de argumenterar om eventuella för- och nackdelar vad gäller införandet av rutiner i deras arbete. Socialsekreterarna är överens om att arbetet genomsyras av individuella bedömningar och att det inte går att göra generaliseringar i arbetet. De menar att för att kunna utföra arbetet på ett tillfredställande sätt är det individuella synsättet en förutsättning. / The purpose of the study has been to increase the knowledge of investigative social workers view on the phenomenon of children who experience violence between related people and how their interpretations relate to the laws and guidelines that apply to children who experience violence. The study has been conducted through qualitative semi structured interviews with six professional children or youth investigators, all of whom work for social services at administrations in Stockholm city or in cranes to Stockholm. The interviews have given a material that has been analyzed against Michael Lipsky's theory of Street level bureaucracy, as well as previous research. The results of the study show that the social workers interviewed seriously look at the fact that children experience violence between their relatives. All respondents believe that children who experience violence between their relatives themselves are victims of mental abuse. However, it appears in the study that violence in itself is considered by some respondents to get too much space in their work, they argue that violence can be an expression of other misconceptions that are likely to be missed if too much focus is placed solely on investigating the violence. As regards how the respondents respond to laws and guidelines, the study results show that the knowledge about guidelines is low. Respondents express no lack of routines and they argue for pros and cons regarding the introduction of routines in their work. The social workers agree that the work is permeated by individual assessments and that generalizations at work not can be done. They say that in order to be able to perform the work satisfactorily, the individual approach is a prerequisite.

Bakgrund: WHO:s checklista är avsedd för operationskliniker världen över som vill reducera komplikationer i samband med operativa ingrepp. Studier har visat att checklistan inte bara förbättrade patientsäkerheten utan också bidrog till bättre teamarbete och kommunikation mellan personal. Få studier finns om hur patienter som är vakna under operation påverkas av att man använder checklista. Syfte: Syftet med denna pilotstudie var att belysa hur ett antal operationssjuksköterskor upplevde att använda checklistan inför vaken patient. Metod: En pilotstudie med kvalitativ ansats där datainsamlingen genomfördes i form av halvstrukturerade intervjuer med tre operationssjuksköterskor. Det samlade intervjumaterialet analyserades med hjälp av kvalitativ innehållsanalys. Resultatet: Resultatet presenterades utifrån sex kategorier som beskrev hur operationssjuksköterskorna upplevde att använda checklistan inför vaken patient; Anpassning, Information, Kommunikation, Obehag, Oro och Säkerhet. Slutsats: Operationssjuksköterskorna upplevde säkerheten i arbetet kring patienten som den viktigaste aspekten med att använda checklista. Samtidigt var man dock tveksam till att använda den inför vaken patient. Detta beskrevs i form av oro för patienten och en egen obehags-känsla. Operationssjuksköterskorna funderade kring möjligheter med förändringar i en sådan situation, exempelvis genom information om checklistan preoperativt, att tala tyst eller vid sidan om patienten. Inga tydliga förslag gavs om hur checklistan skulle anpassas till vaken patient. / Background: The WHO checklist is intended for operating clinics around the world to reduce the number of complications combined with surgery. Studies have shown that the checklist not only does improve patient safety but also contributes to better teamwork and communication between staff. Little is known how the checklist affects non sedated patients undergoing surgery. Aim: The aim of this study was to illustrate how a couple of theatre nurses experience the use of checklist in presents of non sedated patient. Method: The study hade a qualitative approach and semistructured interviews were made involving three theatre nurses. The collected material was analyzed by content analysis. Result: The result was presented six categories describing how the theatre nurses experienced using the checklist in presents of non sedated patient; adjustment, information, communication, anxiety, discomfort, safety. Conclusions: The theatre nurses experienced safety as the most important issue in using the checklist. At the same time they were doubtful to use it in presents of non sedated patients. They described it as a feeling of discomfort and an unpleasant feeling that they felt. The theatre nurses suggested that more preoperative information conserning the checklist and other adjustments could make it easier to use the checklist in front of non sedated patients. However, they gave no specific suggestions how to adjust the checklist to non sedated patients.

The motif of “the Prophet like Moses” plays an important role in John’s Gospel. This motif is from the promise of God about the eschatological Prophet who will disclose God’s will to the people in Dt 18:15, 18. The background of this motif is basically to be found in Dt 18:15, 18. The promise of God about this Prophet has a deep relationship with the Word of God. The reason, firstly, is that Dt 18:15, 18 indicates it. Secondly, the definition of a prophet is not a miracle worker or a soothsayer, but the deliverer of the Word of God. It is also used in the OT. Various people (Elijah, Jeremiah, Isaiah and Ezekiel) used the prophetic fomula of Dt 18:15, 18. The next step to study this motif is to find allustions to Dt 18:15, 18 in John’s Gospel. It can be divided into two groups. The one group is concerned with the word “prophet” that might presume “the Prophet like Moses” (Jn 1:21, 25, 45, 5:46, 6:14, 7:40, and 52). The other is concerned with the prophetic formula that was related to the Word of God (Jn 3:34, 5:19, 30, 8:26, 28, 40, 12:49, 14:10, 31, 16:13, 17:8, and 17:14). These allusions indicate that this motif is related to several Christological titles (the Christ, the Logos, the Son of God). The Christ was used in juxtaposition with the Prophet in John’s Gospel. The concept of the Christ is joined to the concept of the Prophet. In the case of the Logos, Jesus is the perfect “Prophet like Moses”, because he is a deliverer of the Word of God as well as the Word of God himself. In the case of the Son of God, Jesus knows the Father face to face like Moses, but perfectly, because the Son and the Father is one in John’s Gospel. John uses the motif of “the Prophet like Moses” in Dt 18:15, 18 as the connecting link between the Christological titles. The reason is firstly that it is the Prophet promised by God. Secondly, in the history of redemption, many people expected this Prophet. Lastly in Jesus’ era, this Prophet was considered to be the eschatological figure who would clarify the Son’s coming into the world as the Word of God. / Dissertation (MTh)--University of Pretoria, 2009. / New Testament Studies / unrestricted

Bakgrund: År 2008 gav Världshälsoorganisationen (WHO) ut en checklista för säker kirurgi. Syftet med denna checklista var att öka patientsäkerheten. Efter införandet av checklistan har antalet dödsfall och komplikationer efter kirurgi minskat. Flera studier visar att checklista inte följs fullt ut trots det goda resultatet. Det finns dock få studier som har undersökt följsamheten till den sista fasen i checklistan, signout. Syfte: Att beskriva operationsteamets följsamhet till signout. Metod: Studien genomfördes som en icke-deltagande observationsstudie med kvantitativ, deskriptiv ansats. Med hjälp av ett observationsformulär genomfördes totalt 24 observationer på två operationsenheter. Resultat: Följsamheten till signout var medelgod, 42 %. Vissa delmoment kontrollerades mer frekvent än andra och några berördes inte alls. Operatören var den som initierade i mer än hälften av observationerna och anestesisjuksköterskan hade högst frekvens i pausning. Slutsats: Vid initiering, pausning och specifika delmoment var det främst operatören som utmärkte sig. Här sågs ett tydligt samband av operatörens roll i studiens resultat. Det finns skillnad mellan den dokumenterade och den faktiska följsamheten till checklistan. För att öka följsamheten och därmed patientsäkerheten, behövs tydligare riktlinjer kring vem som ska ansvara och när signout ska genomföras. / Background: In 2008, the World Health Organization (WHO) released a checklist for safe surgery. The purpose of this checklist was to increase patient safety. Since the introduction of the checklist mortality and complications after surgery has decreased. Several studies show that the checklist is not fully followed despite the good results. However, there are few studies that have examined compliance with the final phase of the checklist, signout. Aim: To describe the surgical team's compliance to signout. Method: The study was conducted as a non-participant observational study with a quantitative, descriptive strategy. Using an observation form, a total of 24 observations were performed on two operating units. Result: The signout compliance was average, 42%. Some sub-parts were checked more frequently than others and some were not confirmed at all. The surgeon was the one who initiated in more than half of the observations and the anesthesia nurse had the highest frequency at pausing. Conclusion: In the initiation, pause and specific sub-parts, it was mainly the surgeon who distinguished himself. Here, a clear connection was seen between the surgeon's role and the result of the study. There is a difference between the documented and the actual compliance to the checklist. To increase compliance and thereby patient safety, clearer guidelines are needed regarding who should be responsible and when to start signout.

This study assessed the relationship of variables from the Theory of Planned Behavior (TPB) with intentions to use condoms at next sex and action planning for condom use for main partners and for casual partners among an online of men who have sex with men (MSM) in a Midwestern state. The purpose of this study was to investigate variables of TPB among an online sample of HIV negative, Midwestern MSM and assess significant predictors of intentions separately by casual partners and main partners. Next, action planning was assessed as a potential variable to address the intention-behavior gap. The sample was recruited through an online social networking site, a lesbian, gay, bisexual, transgender (LGBT) - themed statewide newspaper and website. Participants completed an online survey that took 15-20 minutes to complete. Items assessed variables related to the TPB as well as action planning, stages of change, alternative strategies to reduce risk of HIV, and demographic variables including age, urban or rural residence, and HIV status. The results revealed that all TPB variables were strongly, significantly related for both casual and for main partners. The final regression models to predict intentions to use condoms at next sex accounted for 62% of the variance for main partners and 68% for casual partners. The regression models to predict action planning differed by partner type. For main partners, perceived behavioral control and intentions were significant predictors and explained 40% of the variance in action planning. For casual partners, self-efficacy was the significant predictor in the final model and explained 72% of the variance. Potential reasons for the differences in models by partner type for action planning are offered. Action planning is suggested as a potential mediating variable between intention and behavior that requires further research. Implications for HIV prevention interventions with MSM are discussed in light of reduced funding for low incidence states.