Thesis advisor: Barbara E. Wolfe / Postoperative cognitive dysfunction (POCD) is characterized by a decline in cognitive performance following anesthesia and surgery and is a major cause of morbidity and mortality in the postoperative period. Moreover, studies suggest that patients who develop POCD may be at higher risk for cognitive decline later in life. POCD is of critical importance in relation to independent living, need for care, personal and economic cost, and quality of life. The majority of studies to date examine risk factors, prevalence, and complications associated with POCD. There is a lack of effective intervention strategies being developed to promote improved cognitive processing in this patient population. The primary aim of this study was to examine the feasibility and acceptability of a cognitive training intervention (CTI) for postoperative cardiac surgical patient. Feasibility was examined by conducting an attrition analysis to compare percent of attrition between intervention and control groups. A chi-square was conducted to answer the research question examining the difference between groups on attrition from study. Acceptability was examined by the administration of a "feasibility and acceptability" questionnaire, which was a 15-item questionnaire specific to the intervention. Fifteen one-sample t tests were used to determine acceptability of the intervention in the treatment population. The secondary purpose of the study was to investigate the preliminary effect of the CTI on cognitive outcomes following cardiac surgery. A randomized controlled, single-blind, repeated measures design was used to test the hypothesis that following cardiac surgery, patients who receive a 6-week CTI when compared with those who receive usual care will demonstrate a significantly greater improvement in cognitive status when comparing discharge scores to scores at 6 weeks and 3 months postoperatively. Collection of data from 53 patients who underwent cardiac surgery was conducted from May 2008 to January 2010 at Catholic Medical Center in Manchester, NH. Factorial Analyses of Variance were conducted to answer the research question assessing the effectiveness of a cognitive training intervention (CTI) on cognitive outcomes following cardiac surgery. However given assumptions of ANOVA were violated and non parametric statistics including two Kruskall Wallis H tests for independent samples at each assessment period as well as two Wilcoxon's signed ranks tests for related samples for each group were conducted. The results of the chi-square were not significant, x2(1) = 0.95, p = .329, suggesting no relationship exists between withdrawn participants and group. After Bonferroni adjustment the results of the fifteen one-sample t tests on the feasibility questionnaire (Q1-Q15) for the intervention group reveal questions 2-8, 10, 14 and 15 have a larger mean compared to the neutral median value of 3.0, suggesting that participants tended toward a high level of acceptability over neutrality. Wilcoxon signed rank test on TICS scores by control group and time period (posttest vs. six week follow up and posttest vs. three month follow up) revealed a significant main effect by time period, p< .01 at both time periods. Wilcoxon signed rank test on TICS scores by experimental group and time period (posttest vs. six week follow up and posttest vs. three month follow up) revealed a significant main effect by time period, p< .01 at both time periods. Kruskall Wallis test at six week follow up and three month follow up by group (control vs. experimental) was not significant, x2 (1) = 0.01, p = .934, and x2 (1) = 0.02, p = .891 respectively suggesting no statistical difference at six week follow up by group. The Wilcoxon signed rank on TICS by group and time period (six week follow up vs. 3 month follow up) was not significant (p=.274) and the Kruskall Wallis test at three month follow up by group (control vs. experimental) was not significant, x2 (1) = 0.02, p = .891, suggesting no statistical difference at three month follow up by group. The results of this study suggest that a CTI is feasible to conduct and acceptable to patients following cardiac surgery. Results of the preliminary effect of the CTI suggest that cognitive performance improves over a six-week period following cardiac surgery independent of the CTI and there are no significant changes from the six-week to the three-month period. Preliminary findings yield further inquiry into cognitive enhancing interventions in the cardiac surgical patient. / Thesis (PhD) — Boston College, 2010. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Background: Having a diagnosis of schizophrenia is associated with employment difficulties, high mortality rates, substantial family burden and impoverished quality of life and it costs between 1.5 to 3 per cent of the total expenditure on national health care (Knapp et al 2004). However social functioning and participation can have a protective impact on mental health of people with a diagnosis of psychosis (Stain et al 2013). Method: A systematic and phased approach to complex intervention development was undertaken involving: (1) A systematic review of effectiveness and (2) a feasibility study, designed to explore and test the key uncertainties of an effectiveness study, was conducted in two phases. This involved the development of an occupational therapy intervention specification and a feasibility study for a pragmatic randomised controlled trial (RCT). It utilised the Developing and evaluating complex interventions guidelines (MRC 2008). A task analysis approach was applied to extrapolate occupational therapy theory, practice and outcomes for the intervention specification (Gitlin 2013). The feasibility study was carried out across two centres. It used the intervention specification and included both study and process outcomes. The primary outcome was participation in activities of everyday life and the secondary outcomes were health-related quality of life and self-reported experience of occupational performance and satisfaction with occupational performance. Service user and carer involvement was integrated into the method. Results: The systematic review highlighted that there was no evidence of effectiveness for individualised client-centred occupational therapy interventions on participation in activities of everyday life or quality of life/ health related quality of life. The methodological quality of the effectiveness studies was generally low and details provided regarding interventions made replication difficult. The feasibility study recruited less people (n=20) than planned (n=64). However the outcomes of self-reported experience of occupational performance (p=.002) and satisfaction with occupational performance (p=.001) and self-evaluated transition (SET) (p=.026) improved with occupational therapy and were found to be statistically significant (p < .05). The intervention specification captured 98% of occupational therapy provided and was shown to have good utility for research and practice purposes. Conclusion: An intervention specification that reflects practice and has utility has been developed. Methods of measuring fidelity and adherence of occupational therapy have been designed and tested. Knowledge about how occupational therapy enables participation has advanced. The essential preparatory work to address the previously key uncertainties in a pragmatic RCT has been completed and the foundations for the next stage — a larger pragmatic RCT — have been put in place.

PURPOSE: Doppler renal resistive index (RRI) has emerged in the last decade as a useful prognostic indicator for transient (fluid responsive) and persistent acute kidney injury (AKI). The determinants of RRI are largely systemic and recent studies confirm that RRI measurement could also be a useful early marker for sub-clinical AKI and post procedural AKI risk. This study aimed to determine the feasibility of RRI measurement in an Emergency Department (ED) resuscitation room setting using a point­of­care ultrasound system. METHODS: In this prospective single centre study, RRI measurement was attempted in 20 non-consecutive patients (meeting the inclusion criteria) by a single expert sonographer. RRI measurements were evaluated against context specific feasibility criteria and target outcomes. RESULTS: 20 patients (11 male, 9 female) were recruited to the study. Age of patients ranged from 33 years to 91 years (mean 62.3 years). Adequate visualisation of both kidneys was achieved in 60% of patients (n=12). In patients where it was not possible to achieve adequate views of both kidneys (n=8), limiting technical factors were shortness of breath (SOB) (n=6), high BMI (n=2). At least one measurement of RRI was achieved in 70% of patients (n=14). However, in 9 of these patients (64.3%) the Doppler spectral traces achieved were substandard and did not meet the measurement criteria for RRI as specified in the study protocol. In 30% of patients (n=6) no usable spectral trace was achieved and it was not possible to measure RRI. SOB was noted as a technical difficulty in 60% of patients (n=12) including three for whom RRI measurements were achieved. In 9 patients (45%) SOB was recorded as the primary reason for failure to acquire a usable Doppler trace. All criteria for RRI measurements were met in only 3 patients (15%). CONCLUSION: Measurement of RRI was not feasible in patients requiring resuscitation room care using a current point of care ultrasound system. If RRI is to play a useful role in this high priority patient group, adaptation of the available technology is required to mitigate the problem of image blur due to patient breathing movement.

Cílem diplomové práce je analyzovat současnou situaci na hotelových investičních trzích a pomocí metody dedukce určit faktory ovlivňující rozhodování o umístění hotelové investice. Druhým cílem této práce je charakterizovat teorii oceňování hotelových projektů tak, jak ji zachycuje česká i zahraniční literatura a následně tuto teorii aplikovat na konkrétní hotelový projekt.

This thesis describes the individual aspects of retail entrepreneurship of a small enterprise using the knowledge of large retail entrepreneurs. It introduces the business strategy of a clothing retail shop in Prague with an innovative business model, evaluates the external environment of the enterprise and its influence on the industry, outlines the procedures for managing specific areas of the operation and evaluates the feasibility of the enterprise utilizing a break even analysis and a cash flow forecast based on predefined criteria.

CoordenaÃÃo de AperfeÃoamento de Pessoal de NÃvel Superior / This work proposes a methodology for feasibility study of the distribution of natural gas to remote areas without access through a backbone pipeline. In recent years, one can observe a strong increase in the participation of natural gas as input in energy supply all around the world, including Brazil. The State of CearÃ, in the Northeastern Brazil, shows nowadays a natural gas supply superavit of about four million cubic meters per day. Present natural gas distribution in Cearà State occurs only in Fortaleza Metropolitan area. Although there are in the State many important urban development poles with significant potential to consume natural gas they cannot count yet with necessary supply equipments of that power input as gas pipeline. This is an important problem because wood fuel is largely used in the countryside notwithstanding its damage to the environment. All over the world the attendance of secondary markets with natural gas has been supported by trucks or trains lines as a first step before implementing a pipeline. This work aims to propose and apply a methodology to find the economic and logistics feasibility to distribute natural gas to remote regions. Such a methodology makes use of discrete choice demand forecasting technique using both revealed and stated preference data as well as the capacity facility location problem modelling and conventional indicators of economic feasibility. A case study is discussed involving the CRAJUBAR region of Cearà State. The work aims to contribute in identification of scenarios in which one can have feasible situations of energy input substitution. / Esta dissertaÃÃo propÃe uma metodologia para estudo de viabilidade da distribuiÃÃo secundÃria de gÃs natural em regiÃes afastadas de redes primÃrias de gasodutos. Diante da seguranÃa de fornecimento do gÃs natural apresentada atualmente no paÃs e no Mundo, a sua participaÃÃo na matriz energÃtica vem se intensificando nos Ãltimos anos. O Estado do Cearà apresenta superavit na oferta equivalente a quatro milhÃes de metros cÃbicos por dia de gÃs. Atualmente, a distribuiÃÃo do gÃs natural, nesse Estado, à realizada apenas na RegiÃo Metropolitana de Fortaleza, sendo que no interior se encontram importantes polos de desenvolvimento, como a RegiÃo do CRAJUBAR com uma base industrial com potencial de consumo de gÃs natural, que poderia levar à substituiÃÃo do uso principalmente de lenha no processo produtivo das empresas e, tambÃm, poderia propiciar a interiorizaÃÃo do uso do energÃtico em regiÃes ainda nÃo atendida por gasodutos. O atendimento aos consumidores de gÃs natural tem ocorrido por meio da utilizaÃÃo de distribuiÃÃo secundÃria (gasoduto virtual) indutora de mercado. Assim o objetivo deste estudo reside em propor e aplicar uma metodologia de determinaÃÃo da viabilidade da distribuiÃÃo secundÃria do gÃs natural para regiÃes nÃo atendidas por gasodutos, instrumentada pelo uso de tÃcnicas de previsÃo de demanda, de otimizaÃÃo de custos e de planilha eletrÃnica na determinaÃÃo da viabilidade econÃmica. O trabalho busca contribuir na identificaÃÃo de cenÃrios viÃveis de substituiÃÃo energÃtica para o uso do gÃs natural na regiÃo em estudo.

Para se avaliar as possibilidades de expansão dos serviços municipais de saúde no Paraná procurou-se, primeiramente, fazer um diagnóstico do conjunto de serviços existentes no Estado. Em seguida foram pesquisadas as variáveis envolvidas com as possibilidades de expansão e realizado um estudo de caso sobre os serviços da Prefeitura Municipal de Londrina, que se constituem na rede municipal mais antiga do Paraná. Concluiu-se que existem varáveis favoráveis à municipalização como índices razoavelmente elevados de população aglomerada, distribuição territorial bastante homogênea dos maiores municípios, boa capilaridade da rede de unidades sanitárias do Estado e conjuntura politicamente favorável. Os principais entraves detectados encontram-se na área financeira, como a estrutura tributária nacional e o perfil de arrecadação do tesouro do Estado, bem como os percentuais de recursos do Estado destinados à área da saúde. Quanto ao município de Londrina a análise dos serviços reforça a idéia de viabilidade da municipalização e oferece dados que poderão orientar futuros serviços semelhantes. / The evaluation of the possible expansion of municipal health services began, initially, with a diagnosis existing health services throughout the state of Parana. At a second stage certain variables thought to be relevant to this possible expansion were analyzed. It was felt that there are variables favouring the locally-based expansion including the reasonably high indicators of population clusters, homogeneous territorial distribution of the larger cities, the wide distribution of the state sanitary units network, favorable political circumstances. The main obstacles encountered are in the financial sector, including the structure of the Brazilian rates and taxes, and the organization of collection by the state treasury as well as the resource percentages destinated for health by the state government. The study above is illustrated by a case-study that involves health services of the city of Londrina, wich are among the oldest in the state of Paraná, in the south of Brazil. This analysis of the health services of the city of Londrina has led to a reinforcement of the viability of expansion at a local level and offer data which may serve as a model for similar services in the future. xiii

O objetivo deste trabalho foi delimitar índices de rentabilidade, tais como Taxa Interna de Retorno - TIR, Valor Presente Líquido - VPL e payback, para duas alternativas de traçado de alcoodutos selecionadas pela equipe do trabalho de UNICA et al. (2006), além de analisar se tais projetos são economicamente viáveis diante das demais alternativas de investimentos disponíveis aos agentes envolvidos. Um importante exercício foi a análise de sensibilidade do projeto à alteração de variáveis tais como valor dos investimentos, tarifa e volume captado pelo duto. Foi realizada, ainda, uma comparação entre os índices de rentabilidade obtidos no trabalho de UNICA et al. (2006) e aqueles calculados nesta dissertação. Os principais dados necessários à análise de viabilidade das alternativas selecionadas (Dutovias Conchas/ Paulínia/Campo Limpo/Santos e Conchas/Paulínia/São Sebastião) tais como extensões dos dutos, investimentos necessários, período do projeto, início das operações, tarifa cobrada pelo transporte do etanol, capacidade dos dutos, gastos com operação e manutenção e custo de capital também foram obtidos do trabalho de UNICA et al. (2006). Diante dos dados obtidos, o método escolhido para a avaliação do investimento foi o do Fluxo de Caixa Descontado FCD. Os resultados obtidos sinalizaram que diante da estrutura de investimentos, tarifa dutoviária e capacidade modular dos dutos estabelecidos inicialmente para os projetos pela equipe da UNICA, nenhum dos traçados selecionados apresenta índices de rentabilidade satisfatórios em relação à realidade de mercado. Portanto, pode-se concluir que para projetos dessa natureza, que são essenciais para o desenvolvimento da infraestrutura econômica do Brasil, são realmente necessários subsídios por parte do governo, além da participação massiva da iniciativa privada, caracterizando a necessidade de Parcerias Público-Privadas PPP. / The goal of this work was to delimit profitability indexes, as such Internal Rate of Return IRR, Net Present Value NPV and payback, for two alternatives of ethanol pipelines grids selected by UNICAs et al. (2006) working group, and to analyze if these projects are economically feasible in comparison with other investment alternatives that are available for the involved agents. The sensitivity analysis of the project in relation to some variables changes, as the investment values, tariff and volume transported through the pipeline, was an important exercise. It was also done a comparison among the resulting profitability indexes of UNICAs et al. (2006) work and those calculated in this dissertation. The main data necessary to the feasibility analysis of the selected alternatives (Conchas/Paulínia/Campo Limpo/Santos and Conchas/Paulínia/São Sebastião pipelines) as pipelines extension, necessary investments, project period, start of operations, charged tariff for ethanol transportation, pipelines capacity, operations and maintenance spending and cost of capital was also obtained in UNICA et al. (2006) work. Considering the available data, the Discounted Cash Flow DCF method was selected to make the investments evaluation. The results indicate that, considering the investment structure, pipeline tariff and modular capacity of the pipelines initially determined to the projects by UNICAs team, none of the selected grids have satisfactory profitability indexes in relation to market reality. So, it is possible to conclude that, in case of projects of this nature, which are essential to the economic and infrastructure development in Brazil, governmental subsidies are necessary, in addition to private initiative massive participation, characterizing the need of Public- Private Partnerships - PPP.

yes / This systematic review of reviews aims to investigate how brief interventions (BIs) are defined, whether they increase physical activity, which factors influence their effectiveness, who they are effective for, and whether they are feasible and acceptable. We searched CINAHL, Cochrane database of systematic reviews, DARE, HTA database, EMBASE, MEDLINE, PsycINFO, Science Citation Index-Expanded and Social Sciences Citation Index, and Scottish Intercollegiate Guidelines Network from their inception until May 2015 to identify systematic reviews of the effectiveness of BIs aimed at promoting physical activity in adults, reporting a physical activity outcome and at least one BI that could be delivered in a primary care setting. A narrative synthesis was conducted. We identified three specific BI reviews and thirteen general reviews of physical activity interventions that met the inclusion criteria. The BI reviews reported varying definitions of BIs, only one of which specified a maximum duration of 30 min. BIs can increase self-reported physical activity in the short term, but there is insufficient evidence about their long-term impact, their impact on objectively measured physical activity, and about the factors that influence their effectiveness, feasibility and acceptability. Current definitions include BIs that are too long for primary care consultations. Practitioners, commissioners and policy makers should be aware of this when interpreting evidence about BIs, and future research should develop and evaluate very brief interventions (of 5 min or less) that could be delivered in a primary care consultation. / Citation sent on from Donna. Emailed Laura Lamming for final draft 16/03/2017 -sm

With an ever increasing concern for the environment, different methods of managing organic waste on dairy farms have been explored and analyzed. Anaerobic digestion has long been a popular method of managing organic waste. Its popularity stems from the potential to decrease greenhouse gases, improve air quality and provide a source of additional revenue for the farm. Problems with implementing anaerobic digestion arise from high failure rates, high start-up costs and continuous maintenance and equipment replacement. Subsidies for the initial investment and improved technology have increased the possibility of large-scale dairy farms to adopt anaerobic digestion. Due to economies of scale large-scale dairy farms are more able to adopt anaerobic digestion, but small-scale dairies struggle to finance the investment, maintain the digester system and provide sufficient organic waste to continuously feed the microorganisms inside the digester system. The increasing impact of urbanization greatly impacts the demand for anaerobic digestion on small-scale farms to mitigate the negative effects of organic waste produced by dairy farms. Dr. Conly Hansen at Utah State University suggested we use an IBR digester model to analyze the feasibility of adopting anaerobic digestion on small-scale farms. The IBR digester system is more conducive to small-scale dairies located in regions with varying temperature (i.e., Utah), and may be the solution to mitigate the negative effects of organic farm waste. Dr. Donald McMahon also suggested we analyze the potential of implementing a digester on a dairy farm that produces artisan cheese. We predicted that this would improve the feasibility due to the need to dispose of whey from the cheese production. To determine the feasibility of implementing a digester system on a small-scale dairy farm the net present value and the internal rate of return were calculated to estimate the success of the investment. These financial measures were calculated from equipment price quotes, estimations from the literature review and from using estimated annual receipts and costs for a dairy farm, artisan cheese plant and anaerobic digester system. The feasibility also depends on the success of marketing the products produced from the digester system and the farmer’s participation in incentive programs for digester systems. The products produced vary from electricity to waste disposal services, and marketing an array of diverse products and services is important to the success of the digester system. The feasibility determined by this study was estimated using generalized assumptions from various sources and should be analyzed by individual operations to determine specific farm feasibility.