京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第22723号 / 医博第4641号 / 新制||医||1045(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 篠原 隆司, 教授 溝脇 尚志, 教授 増永 慎一郎 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Purpose of review – This systematic review sought to compare available evidence-based clinical treatment guidelines for all specific eating disorders. Recent findings – Nine evidence-based clinical treatment guidelines were located through a systematic search. The international comparison demonstrated notable commonalities and differences among current evidence-based clinical guidelines for eating disorders. Consistency across guidelines was greatest for treatments with a larger evidence base, while those with a lower evidence base had recommendations that varied considerably. Summary – Evidence-based clinical guidelines represent an important step toward the dissemination and implementation of evidence-based treatments into clinical practice. Despite advances in clinical research on eating disorders, a growing body of literature demonstrates that individuals with eating disorders often do not receive an evidence-based treatment for their disorder. Regarding the dissemination and implementation of evidence-based treatments, current guidelines do endorse the main empirically validated treatment approaches with considerable agreement, but additional recommendations are largely inconsistent. An increased evidence base is critical in offering clinically reliable and consistent guidance for the treatment of eating disorders. Because developing and updating clinical guidelines is time-consuming and complex, an international coordination of guideline development, for example, across the European Union, would be desirable.

Background: Uncompensated vestibular hypofunction results in postural instability, visual blurring with head movement, and subjective complaints of dizziness and/or imbalance. We sought to answer the question, “Is vestibular exercise effective at enhancing recovery of function in people with peripheral (unilateral or bilateral) vestibular hypofunction?” Methods: A systematic review of the literature was performed in 5 databases published after 1985 and 5 additional sources for relevant publications were searched. Article types included meta-analyses, systematic reviews, randomized controlled trials, cohort studies, case control series, and case series for human subjects, published in English. One hundred thirty-five articles were identified as relevant to this clinical practice guideline. Results/Discussion: Based on strong evidence and a preponderance of benefit over harm, clinicians should offer vestibular rehabilitation to persons with unilateral and bilateral vestibular hypofunction with impairments and functional limitations related to the vestibular deficit. Based on strong evidence and a preponderance of harm over benefit, clinicians should not include voluntary saccadic or smooth-pursuit eye movements in isolation (ie, without head movement) as specific exercises for gaze stability. Based on moderate evidence, clinicians may offer specific exercise techniques to target identified impairments or functional limitations. Based on moderate evidence and in consideration of patient preference, clinicians may provide supervised vestibular rehabilitation. Based on expert opinion extrapolated from the evidence, clinicians may prescribe a minimum of 3 times per day for the performance of gaze stability exercises as 1 component of a home exercise program. Based on expert opinion extrapolated from the evidence (range of supervised visits: 2-38 weeks, mean = 10 weeks), clinicians may consider providing adequate supervised vestibular rehabilitation sessions for the patient to understand the goals of the program and how to manage and progress themselves independently. As a general guide, persons without significant comorbidities that affect mobility and with acute or subacute unilateral vestibular hypofunction may need once a week supervised sessions for 2 to 3 weeks; persons with chronic unilateral vestibular hypofunction may need once a week sessions for 4 to 6 weeks; and persons with bilateral vestibular hypofunction may need once a week sessions for 8 to 12 weeks. In addition to supervised sessions, patients are provided a daily home exercise program. Disclaimer: These recommendations are intended as a guide for physical therapists and clinicians to optimize rehabilitation outcomes for persons with peripheral vestibular hypofunction undergoing vestibular rehabilitation.

Conducting risk assessments is a vital part of securing information systems. The task of conducting risk assessments is a time-consuming and costly task for organizations. Thus different security control frameworks have been created to assist in the process. These security control frameworks consists of information about what the organization is supposed to implement to achieve a level of security in their information system. To understand what network hardening solution to use and in what part of the system, an analyst needs to manually use the implementation details gathered from the framework. A security control can be split into different security tiers depending on the amount of security the implementation achieves. The security tiers are defined by the authors of the security control framework. An organization can reduce their cost and time spent on implementing the security by having a tool that parses the information system and creates guidelines based on security controls and parsed data. In this research, we will compare different security controls and based on the findings, investigate hardware, software and configurations that are being used when conducting network hardening. We will evaluate to which extent it is possible to generate guidelines that meet the given security tier, whether it is feasible to apply them and present a prototype that is able to generate guidelines. The different security controls will be compared by analyzing the contents of each control in the frameworks. A comprehensive mapping will be created and based on the information gathered in the mapping, network-hardening implementations will be investigated based on the devices in our experiment environment. With implementations at hand, a tool will be proposed that parses information systems and outputs guidelines that integrate the implementations in a readable format. Experts within the field of system hardening then evaluate the created guidelines in terms of achieving defined security levels. For the comparison, a total of 148 different controls were identified to be related in some way. With 148 controls at hand, the prototype can output 111 different guidelines with different security tier associations. According to the comments from the experts, the proposed guidelines were able to satisfy each security tier. Our prototype displayed that we were able to create guidelines that can meet a given security tier. Although the implementation of each guideline is not automated, identifying what network-hardening implementation should be used is done in an automated fashion and thus allowing organizations to put their spending and time into other organizational interests. \newline / Att utföra riskbedömningar är en nödvändig process när ett informations-system ska säkras. Uppgiften med att utföra riskbedömningar är för organisationer en tidskrävande och dyr process. Därför har olika ramverk för säkerhetskontroller tagits fram för att underlätta denna uppgift. Dessa ramverk innehåller information över vad en organisation behöver implementera för att erhålla en specifik nivå av säkerhet i deras informations-system. Den här säkerhetsnivån varierar beroende på hur mycket säkerhet en implementation tillför. De olika nivåerna definieras av ramverksförfattarna. För att förstå vilka nätverkshärdningar organisationen ska använda samt för vilken del i systemet dessa härdningar ska appliceras, behöver en analytiker manuellt gå igenom implementerings-lösningar i ramverken tillsammans med systemet och på så vis ta fram korrekt härdningsåtgärd för en specifik del i systemet. Syftet med arbetet är att jämföra olika säkerhetskontroller och baserat på resultatet undersöka hur hårdvara, mjukvara och konfigurationer kan användas för att härda nätverket. Vi kommer att utvärdera i vilken utsträckning det är möjligt att generera riktlinjer, huruvida det är möjligt att applicera riktlinjerna och ta fram en prototyp som kan generera riktlinjer. De olika ramverken kommer att jämföras genom att innehållet i deras säkerhetskontroller analyseras. En omfattande mappning kommer att tas fram baserat på analysen och utifrån mappningen kommer ytterliggare implementationer rörande nätverkshädrning analyseras. Med hjälp av implementationerna kommer ett verktyg att föreslås vilket analyserar ett informations-system och som producerar riktlinjer som integrerar implementationerna till ett läsbart format. Dessa riktlinjer undersöks sedan av experter gällande hur väl riktlinjerna uppnår definerade säkerhetsnivåer. Under arbetet identifierades totalt 148 olika säkerhets-kontroller som påvisade likhet med varandra. Med dessa 148 kontroller tillgodo klarade vår prototyp av att producera 111 olika riktlinjer tillhörande olika säkerhetsnivåer beroende på systemet som matades in. Enligt kommentarerna ur granskningen som experterna utförde gick följande att konstatera: riktlinjerna som tas fram genom prototypen kunde upprätthålla varje säkerhetsnivå. Vår prototyp påvisade att det var möjligt att skapa riktlinjer som uppnår en efterfrågad säkerhetsnivå. Även om implementering för varje producerad riktlinje inte är automatiserad så kunde vår prototyp automatisera processen av att avgöra vilken nätverks-härdnings implementation som skulle användas för var riktlinje. Detta tillåter organisationer att lägga mer tid och investeringar i andra organisatoriska intressen.

京都大学 / 新制・課程博士 / 博士(情報学) / 甲第23319号 / 情博第755号 / 新制||情||129(附属図書館) / 京都大学大学院情報学研究科社会情報学専攻 / (主査)教授 吉川 正俊, 教授 田島 敬史, 教授 緒方 広明 / 学位規則第4条第1項該当 / Doctor of Informatics / Kyoto University / DFAM

Background: Small and medium-sized firms (SMEs) have their impact on the environment besides their benefits.  While a business grows, naturally destroying impacts are also growing. SMEs have a variety of barriers to be green and sustainable. There are some simple and non-complicated actions that firms can take, to reduce their destructive impacts on the environment.  This study analyses the existing barriers and focuses on small and medium sizes firms (SMEs) around Jonkoping. Besides, this study includes interviews with successful and sustainable companies and reflects their solutions to overcome those barriers in a different step of the green product lifecycle. Purpose: This is a practical study of how sustainability process in SMEs can drive product lifecycle greener. The purpose of this thesis is to study the existing practical and simple solutions for different environmental sustainability barriers in SMEs which located in Jonkoping region. Also, it goals to reveal solutions which applies by sustainable businesses to overcome to the sustainability barriers. Method: To fulfil the purpose of the thesis, an experimental research design was applied, and the data was provided from in-depth, semi-structured interviews. Ten interviews were conducted with successful businesses in sustainability practice in the Jonkoping region. The data analysis for this study was created by an inductive approach. Conclusion: This study has revealed that the successful green businesses categorizing their barriers into general, segmental, and individual groups. After that, by evaluating the strength of obstacles in different steps of GPL and considering their available resources they plan to apply proper solution. The other main finding in this thesis was a practical framework according to what have been done in our research.

Les développeurs d'applications Web ne sont pas tous des experts. Même s'ils utilisent des méthodes telles que UWE (UML web engineering) et les outils CASE, ils ne sont pas toujours capables de prendre de bonnes décisions concernant le contenu de l'application web, le schéma de navigation et / ou la présentation des informations. La littérature leur fournit de nombreuses lignes directrices (guidelines) pour ces tâches. Cependant, ces connaissances sont disséminées dans de nombreuses sources et non structurées. Dans cette dissertation, nous capitalisons sur les connaissances offertes par ces lignes directrices. Notre contribution est triple: (i) nous proposons un méta-modèle permettant une représentation riche de ces lignes directrices, (ii) nous proposons une grammaire permettant la description des lignes directrices existantes, (iii) sur la base de cette grammaire, nous développons un outil de gestion des lignes directrices . Nous enrichissons la méthode UWE avec cette base de connaissances menant à une approche basée sur la qualité. Ainsi, notre outil enrichit les prototypes existants d'ingénierie logicielle assistée par ordinateur basés sur UWE avec des conseils ad hoc. / Web application developers are not all experts. Even if they use methods such as UWE (UML web engineering) and CASE tools, they are not always able to make good decisions regarding the content of the web application, the navigation schema, and/or the presentation of information. Literature provides them with many guidelines for these tasks. However this knowledge is disseminated in many sources and not structured. In this dissertation, we perform a knowledge capitalization of all these guidelines. The contribution is threefold: (i) we propose a meta-model allowing a rich representation of these guidelines, (ii) we propose a grammar enabling the description of existing guidelines, (iii) based on this grammar, we developed a guideline management tool. We enrich the UWE method with this knowledge base leading to a quality based approach. Thus, our tool enriches existing UWE-based Computer Aided Software Engineering prototypes with ad hoc guidance.

Clinical evidence-based practice guidelines providing recommendations for health care decision making have become vital components of long-term health care practice in the United States. Frequently changing guidelines have complicated nurse practitioners' (NPs) efforts to implement evidence-based practice into the daily care that they provide to patients. The purpose of this project was to develop an evidence-based practice guideline for doctoral-prepared NPs working in long-term care facilities. This project is important because practitioners use practice guidelines to provide patients with the most appropriate, evidence-based care. Kolcaba's comfort theory was used to guide this project. Kolcaba's theory holds that comfort exists in 3 forms: relief, ease, and transcendence. Comfort theory, with its emphasis on physical, psychospiritual, sociocultural, and environmental aspects of comfort, will lead to a proactive, diverse, and multifaceted approach to providing patient care. A complete practice guideline was developed for doctoral-prepared NPs. For the review of the scholarly evidence, an electronic search that yielded 34 articles was completed. Twenty-six of these articles were excluded because the articles were more than 20 years old and/or focused on a specialty. Findings from the 8 articles were used to develop the practice guideline, which was reviewed by an advisory committee of 7 experts. The AGREE tool was used by the advisory committee to provide feedback on the quality of the practice guideline. Implementation of the practice guideline will take place in a facility in Indiana that currently uses 3 NPs. A doctoral-prepared NP will evaluate the practice guideline annually for patient trends including hospital readmission and infection rates.

京都大学 / 0048 / 新制・課程博士 / 博士(社会健康医学) / 甲第20288号 / 社医博第77号 / 社新制||医||9(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 川上 浩司, 教授 一山 智, 教授 伊達 洋至 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DGAM

På Sveriges akutmottagningar ökar vistelsetiden för varje år och väntan på vårdplats kan bli lång. Längre vistelsetider ökar risken för vårdskador såsom trycksår. Vårdskador innebär lidande för patienten, förlänger vårdtiden och leder till ökade kostnader för hälsooch sjukvården. Akutsjuksköterskans preventiva omvårdnadsarbete minskar onödigt lidande och för tidig död. Trots att trycksår till stor del går att förebygga har det varit svårt att minska dess förekomst. Syftet var att beskriva det trycksårspreventiva arbetet inom akutsjukvård samt belysa vilka faktorer som kan påverka utförandet av detta arbete. Som metod valdes litteraturöversikt. Artikelsökningar genomfördes i databaserna PubMed, CINAHL och PsycINFO med sökord som bedömdes kunna svara på syftet. Sökningarna resulterade i att 20 vetenskapliga artiklar publicerade 2008-2017 inkluderades.  Bearbetningen av artiklarna resulterade i tre huvudkategorier: Riskbedömning och dokumentation, Det trycksårspreventiva arbetet och Faktorer som påverkar trycksårsprevention. Resultatet visade på en varierad förekomst av trycksårsprevention inom akutsjukvård, där flera faktorer påverkar dess utförande. Trycksårspreventiva åtgärder reducerar andelen trycksår vilket talar för hur viktigt det är. Slutsatsen var att för ett lyckat implementeringsarbete om trycksårsprevention behöver personal erhålla kunskap och utbildning, ha nära tillgång till trycksårspreventiv utrustning och erhålla feedback på sitt arbete samt stöd från sjukvårdens ledning. / The waiting time at Sweden's emergency departments increases for each year. Longer stays increases the risk of near misses such as pressure ulcers. Near misses in the health care causes suffering for the patient, prolongs hospital stays and leads to increased costs for the health care system. The preventive work of the emergency nurse reduces unnecessary suffering. Although pressure ulcers are preventable, it has been difficult to reduce them. The aim was to describe the pressure ulcer prevention in acute care and to highlight the factors that may affect the performance of different measures. The chosen method was a literature review including 20 articles related to the aim and published 2008-2017. The articles were retrieved from the databases PubMed, CINAHL and PsycINFO. The articles revealed three main categories: Risk assessment and documentation, Pressure ulcer preventive strategies, Factors affecting pressure ulcer prevention. The result showed a varied occurrence of pressure ulcer prevention in acute care, where several factors affect its occurrence. Preventive work reduces pressure ulcers, which proves how important it is. In conclusion a successful implementation of pressure ulcer prevention requires that staff need to receive knowledge and education, have close access to preventive instruments and receive feedback on their work and support from the healthcare management.