Thesis (M.H.A.)--University of Michigan, 1965.

Thesis (M.H.A.)--University of Michigan, 1965.

Made available in DSpace on 2014-06-11T19:28:04Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-01-22Bitstream added on 2014-06-13T20:36:55Z : No. of bitstreams: 1 varallo_fr_me_arafcf.pdf: 2844690 bytes, checksum: 3c22713b3171e234e431e8c9717a455d (MD5) / Reações Adversas a Medicamentos (RAM) são um importante problema de saúde pública, pois reduzem a qualidade de vida do paciente e geram gastos desnecessários aos hospitais. Por isso, o presente estudo estimou a prevalência de internações hospitalares por possível RAM, identificou o perfil demográfico dos pacientes acometidos, bem como os fármacos e as possíveis RAM mais frequentemente relacionadas com as internações hospitalares. Para tanto, realizou-se um estudo observacional e transversal na clínica médica de um hospital de ensino, entre os meses de agosto a dezembro de 2008. Os pacientes foram entrevistados sobre os sintomas/queixas/motivos de internação que os levaram ao hospital e quais medicamentos utilizaram nos 15 dias prévios à internação. Durante o período do estudo, observou-se que a internação hospitalar estava relacionada com possível RAM em 115 pacientes (46,4%), sendo a maioria mulheres e não-idosos. Os fármacos mais frequentemente relacionados com a internação foram os que atuam nos sistemas: cardiovascular (48,7%), digestório (22,9%) e nervoso central (14,1%). Quanto ao tipo de receituário dos medicamentos responsáveis por RAM, 90,9% eram sob prescrição, sendo que 9,4% eram sujeitos a controle especial e 9,1% eram isentos de prescrição. Dos medicamentos responsáveis pelas internações, 58% pertenciam à lista RENAME. Em relação aos idosos, 43,9% utilizaram medicamentos impróprios, os quais foram possivelmente responsáveis pela internação de 29,2% pacientes. As manifestações clínicas das RAM mais comuns foram: do aparelho digestório (23,0%), dos aparelhos respiratório (20,2%) e circulatório (14,6%), além de sintomas, sinais e achados anormais de exames clínicos e laboratoriais (20,2%). Apenas a polimedicação foi detectada como fator de risco para internações por possível RAM. Estudos farmacoepidemiológicos como este... / Adverse Drug Reaction (ADR) is an important public health concern, because they decrease the patient’s quality of life and raise the unnecessary expenditure for the hospital. The purpose of this study was to: 1) assess the prevalence of ADR-related admission; 2) identify the demographic characteristics of the patients with ADR; 3) identify the main drugs and the ADR more often associated with hospitalization. A cross-sectional observational study was performed. It was conducted in an internal medicine ward in a teaching hospital and the data was collected from August 2008 to December 2008. The patients were interviewed about their symptoms, complaints, and causes of hospitalization, which were responsible to the hospital admission and what were the drugs used 15 days prior the hospitalization. During the period of the study, it was observed ADR-related admission in 115 (46.4%) patients; the majority was woman and no-elderly. Medications that were commonly involved in these cases were those acting on the cardiovascular (48.7%), gastrointestinal (22.9%) and nervous system (14.1%). Regarding the type of prescription medicines, 90.6% were under prescription, of these 9.4% still were subjected to special control, and 9.1% were non-prescription drugs. 58.0% medicines ADR-related admission belonged to RENAME’s list. Considering the elderly people, 43.9% of them used inappropriate drugs, which were possibly responsible for hospitalization in 29.2% patients. The clinical manifestations of RAM most commonly associated with the hospitalization were: gastrointestinal system (23.0%), abnormal findings in clinical and laboratory tests (20.2%), respiratory system (20.2%) and circulatory system (14.6%). Only polipharmacy was detected as a risk factor for ADR-related admission. The present pharmacoepidemiological study shows the need of patient’s therapeutic monitoring in the first... (Complete abstract click electronic access below)

In recent years, wireless mesh networking has attracted a growing interest due to its inherent flexibility, scalability, and reliability. The IEEE 802.16 standard, commonly known as worldwide interoperability for microwave access (WiMAX), is the latest technology that enables broadband wireless access over long distances. WiMAX, which emerges as a wireless alternative to cable and digital subscriber line (DSL), is an ideal candidate to serve as the infrastructure for large scale wireless mesh networks. This thesis focuses on the quality of service (QoS) provisioning techniques in WiMAX-based metropolitan area mesh networks. We study the connection admission control (CAC) and routing issues in the design and operation of wireless multihop mesh networks. We propose a joint CAC and routing scheme for multiple service classes with the objective to maximize the overall revenue from all carried connections. Connection-level QoS constraints such as handoff connection dropping probability can be guaranteed within a threshold. Multiple service classes can be prioritized by imposing different reward rates. We apply optimization techniques to obtain the optimal CAC policies. The optimality criterion is the long-run average reward. We demonstrate that the proposed scheme can the maximum revenue obtainable by the system under QoS constraints. We show that the optimal joint policy is a randomized policy, i.e., connections are admitted to the system with some probabilities when the system is in certain states. Simulation results illustrate that the proposed scheme meets our design goals and outperforms the existing scheme. / Applied Science, Faculty of / Electrical and Computer Engineering, Department of / Graduate

Each year, hospitalizations from long-term care (LTC) settings occur, in part, due to underdeveloped nursing assessment skills, ineffective communication with primary care providers (PCPs), and delayed intervention. Through staff development nursing education, the quality and timeliness of care can be improved. The practice question that guided this doctoral project focused on whether evidence-based research information would assist in decreasing LTC-to-hospital admission rates through improved nursing assessment skills and better communication with PCPs. Using the logic model, the effectiveness of a program was evaluated and the impact of interventions on a predicted outcome was determined. Sources of evidence included obtaining best practice research information from scholarly nursing journals and official nursing websites. Analytical strategies included a review of the literature to examine data from nursing journals, websites, and other publication sources in addition to the use of a synthesis matrix that classified different ideas rated by the Cochrane Consumer Network. The findings of this project might contribute to positive social change by fostering improved patient assessments, enhanced communication with PCPs, early intervention, and decreased LTC-to-hospital admission rates through the improvement of nursing practice policy.

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Voice over DSL (VoDSL) is a technology that enables the transport of data and multiple voice calls over a single copper-pair. VoDSL employs packet voice technology instead of the traditional circuit switched voice. Voice over ATM (VoATM) and Voice over IP (VoIP) are the two main alternatives for carrying voice packets over DSL. ATM is currently the preferred technology, since it offers the advantage of ATM's built-in Quality of Service (QoS) mechanisms. IP, on the other hand, cannot provide QoS guarantees in its traditional form. IP QoS mechanisms have been evolved only in the recent years. VoIP has gained popularity in the core networks. If it could replace VoATM in the access networks, it would open the door for end-to-end IP telephony that would result in major cost savings. In this thesis, we propose a VoIP-based VoDSL architecture that provides QoS guarantees comparable to those offered by ATM in the DSL access network. Our QoS architecture supports Premium and Regular service categories for voice traffic and the Best-Effort service category for data traffic. Voice and data packets are placed in separate output queues at the bottleneck link. The Weighted Fair Queuing algorithm in used to schedule voice and data packets for transmission over the bottleneck link. Fragmentation of large data packets reduces the waiting time for voice packets in the link. We also propose a new admission control mechanism called Admission Control by Implicit Signaling. This mechanism takes advantage of application layer signaling by mapping it to the IP header. The router can infer the resource requirements for the connection by looking at certain field in the IP header of the application layer signaling packets. This eliminates the need for an explicit signaling protocol. We evaluate the performance of our QoS architecture by means of a simulation study. Our primary metrics are the end-to-end delay of voice packets across the access network and the bandwidth consumed by a voice call. Our results show that the end-to-end delays of voice packets in our VoIP architecture are comparable to that in the VoATM architecture. ACIS limits the number of voice calls admitted into the premium service class and provides guaranteed service to those calls under all loads. It also provides acceptable service to regular calls under light loads. We also show that PPP is a better choice than ATM as a Layer 2 protocol for our VoIP architecture. PPP offers the advantages of low bandwidth requirement and interleaving of voice packets in between fragments of large data packets during transmission over the bottleneck link. We conclude that our VoIP architecture would be suitable for future VoDSL deployments. / Master of Science

This dissertation examines recurrent patterns in the interaction between psychiatric patients and the systems of knowledge and power that constitute them as patients. These patterns are traced both in the historical migmti::m of patients into and out of the asylum, and in the language used by doctors and patients to account for such migration. Transcripts of interviews with patients and case notes written by doctors are subjected to new forms of quantitative analysis and this is used together with qualitative interpretation to reveal the ways in which disciplinary power operates through confession and surveillance to constitute psychiatric subjects in the tension between freedom and incarceration. / Psychology / D.Litt. et Phil. (Psychology)

published_or_final_version / Public Administration / Master / Master of Social Sciences

This research responds to the problem of minority teacher under-representation within North America’s increasingly diverse urban school systems. It weaves together what is known about educational equity, teacher education admission policy, and policy implementation to explore the research question, “How did equity-based admission policy shape candidate diversification in an urban Canadian teacher education program?” The conceptual framework grounds this study within organizational culture and describes how culture both shapes and is shaped by interactions between structure and agency. The conceptual question asks, “How did institutional norms and individual will work to support or constrain equitable candidate diversification?” Data collection occurred during private interviews with members of three organizational groups: Policymakers, policy implementers, and policy beneficiaries. Policymakers were senior administrators with several years’ experience in their respective positions. Policy implementers were admission personnel, ad hoc faculty, and field-based educators. The policy beneficiaries were candidates who self-identified as future French and Physics teachers, and as members of Aboriginal, Disabled, Gendered/Invisible, and Racialized/Visible minorities. Data analysis was an iterative process of applying demographic, thematic, and editorial coding to the interview transcripts. Discussion highlighted several themes that shaped the admission process: External admission policy context, Faculty of Education Equity Policy, admission policy instrumentation, qualification precedence and weighting, academic qualifications, non-academic identity-based and experience-based qualifications, admission policy gaps, and last-minute Policy disclosure. It also addressed admission personnel recruitment, training, and performance during candidate personal information form assessment. Significant findings emerged in the areas of preservice program partnerships, candidate support services, qualification transparency, labeling of identity-based candidate characteristics, and admission personnel training. Research applicability extends to consecutive and concurrent teacher education programs, other tertiary professional licensing programs, and multi-site qualitative research projects. Recommendations for policy and practice target teacher education admission, policy implementation, and equity policy development.