Polychlorinated biphenyls (PCBs) are persistent organic pollutants, which were banned several decades ago but still exist in the environment, posing a threat to human health. Previously, joint sealants containing PCBs were used in construction. In this study, the long-term PCB-contaminated soils were from a residential area in Västerås Municipality, where the PCBs have been leaching from buildings to the soil for several years. The objective of this thesis is to investigate the feasibility of using plants to remove PCBs from the contaminated soil at a greenhouse scale, and to use a site-specific guideline model for the risk assessment of this contaminated site. After a literature review, four plant species were selected for the greenhouse cultivation including alfalfa (Medicago sativa L.), white clover (Trifolium repens L.), horseradish (Armoracia rusticana L.) and tobacco (Nicotiana tobacum L.). The plants cultivated in the greenhouse were maintained for 92 days and then the concentrations of PCBs in the initial and remediated soils were analyzed by GC-MS. The results indicate that the selected plant species can enhance the removal of high chlorinated PCBs from soils. In the risk assessment, the contents of PCBs in soils were higher than the calculated site-specific guideline, which means it is urgent to implement measures for protecting residents’ health.

Chinese floating population residents' underprivileged living status and intensified social tension are becoming the two major issues inside their community living settlements. The thesis research holds the position that urban open space can enhance Chinese floating population's quality of life and also contribute to the social capital within their living settlement. It is critical to create the open space system that brings great social and health benefits to the group. Literature reviews reveal floating population's characteristics such as existing and potential leisure activities and leisure places. Contemporary thinking on urban open space qualities, benefits and typologies were reviewed to determine which types of open space are of value to this population. Specific qualities and corresponding benefits of floating population community open spaces, which are closely related to the group's characteristics, are identified. Findings from the literature reviews were used to develop open space design guidelines specific to government sponsored floating population settlement areas. Planning and site design level design guidelines address social and health benefits for the floating population residents. Types of open space and their spatial distributions are identified at the planning level. At the site design level, place-based design guidelines were developed for three major open space categories: the daily use spaces around dwelling units, the streets, and the plaza/squares. Under each category, design strategies were developed to promote desirable open space qualities inside the floating population settlement area, and descriptive design objectives are proposed to achieve these qualities. The design guidelines connect the group's demographic, leisure and work characteristics to open space typologies, qualities and respective benefits, and provide recommendations for the open space design of Chinese floating population community. These design guidelines offer planners and site designers a new tool to guide planning and site design decisions of floating population community open space. / Master of Landscape Architecture

Philosophiae Doctor - PhD / Literature on post-operative pain indicates that post-operative pain is inadequately managed in many countries including Ghana. Little was also known about post-operative pain (POP) response and management in Ghana. This study sought to describe post-operative pain response and management among Ghanaian surgical nurses and post-operative patients within the medico-socio-cultural context. It also explored factors that influenced POP response and management and subsequently aimed to develop clinical guidelines within which post-operative pain could be managed in the medico-socio-cultural context. Research questions answered included: „what are the factors influencing post-operative pain responses among surgical patients and nurses; what clinical guidelines would be appropriate to guide post-operative pain management within the medico-socio-cultural context of Ghana?‟The study was designed as a multi-step focused ethnography which allowed the exploration of a specific sub-culture such as the surgical environment. The philosophical underpinnings of ethnography permit the investigator to use different data collection methods to fully understand the phenomenon investigated. Data collection during the ethnographic exploration phase involved individual interviews, clinical observations, and review of patients‟ clinical charts. At the stage of guideline development, data was collected through participant/expert review, systematic literature review, and consensus forum. Participants were sampled purposively and included 53 interview participants, 27 expert reviewers, and 29 consensus panel members. Also, there were 16 sections of clinical observation and review of 44 charts. The participants included nurses, patients and their relatives, the multidisciplinary team, key informants, experts, and stakeholders. The study was conducted at the Korle-Bu Teaching Hospital (KBTH) and Ridge Hospital, in Accra, Ghana. Appropriate ethical clearance was sought and individual informed consent was obtained.Concurrent analysis of data was done applying the principles of thematic content analysis and data was managed with NVivo 9. Themes that emerged from the patients‟ data were subjectivism which described pain dimensions and expressions and factors that influenced patients‟ pain experience were psycho-socio-cultural factors such as personal inclinations and socio-cultural background; and health system factors such as personnel attitude and health financing.The study also found that nurses perceived POP as an individual phenomenon and responded to pain by administering analgesics and by employing non-pharmacologic measures such as positioning and reassurance. Factors that influenced the nurses‟ pain response were individual factors such as commitment, discretion, and fear of addiction; and organizational factors such as organizational laxity and challenges of teamwork. Patients‟ relatives were also influenced by empathy, faith, and commitment to care for their post-operative patients. The multidisciplinary team and key informants were influenced by knowledge and experience in their respective specialty areas. Subsequently, the clinical guideline developed had four dimensions which highlighted patient and family education,effective teamwork, effective leadership and monitoring, and use of contemporary evidence for POP management.The study recommended that health professionals should be conscious of the subjectivenature of pain and they should educate and involve the patient on pain management decisions. Also, hospital leadership and the multidisciplinary team should be actively involved in pain management.

In the United States, one in every 100 adults is confined to a correctional facility. Approximately 60% of inmates have an alcohol use disorder (AUD). When compared to the general population, inmates are twice as likely to have AUD. As they are unable to readily access alcohol, inmates entering a correctional facility with AUD are at high risk for the lethal alcohol withdrawal syndrome (AWS). AWS is preventable and yet correctional nurses process new inmates without an evidence-based clinical practice guideline (CPG) to assess for AUD, the prerequisite for AWS. The purpose of this project was to develop an evidence-based CPG with implementation algorithm to guide the inmate assessment for AUD. The ACE star model of knowledge transformation guided the project, the AGREE II was used to develop the CPG, and the Delphi technique was used to evaluate the final CPG with algorithm. Nationally, 20 correctional health experts were identified and asked to participate in the Delphi expert panel, although 11 experts agreed to participate only 9 completed the evaluation. The experts were correctional health experts, nurses and physicians, from different regions of the United States. The resulting CPG satisfied all 23-items of the AGREE II. Through 2 Delphi panel rounds, all participants recommended the CPG with minor modifications (6 experts recommended as presented while the 3 recommended with modifications). At the project conclusion, all 9 experts agreed the CPG will help improve the identification, referral, and management of inmates with AUD. This project contributes to positive social change as the CPG addresses a serious problem, AUD with possible AWS, in a vulnerable population. The CPG may be generalizable for use in other correctional facilities.

No description available.

<p><strong>Introduction:</strong> In Ontario alone, an estimated 6,700 people (3,000 women; 3,700 men) will die of lung cancer in 2011 (Canadian Cancer Society, 2011). A diagnosis of cancer is associated with complex decisions; the array of choices of cancer treatments brings about hope, but also anxiety over which treatment is best suited for the individual patient (Blank, Graves, Sepucha et al., 2006). The overall cancer experience depends on the quality of this decision (Blank et al., 2006). Clinical practice guidelines are knowledge translation tools to facilitate treatment decision-making. In Ontario, guidelines have been developed and disseminated with the purpose to inform clinical decisions, improve evidence based practice, and to reduce unwanted practice variation in the province. But has this been achieved? To study this issue, the purpose of the current study was to gain an in-depth understanding and develop a theoretical framework of how Ontario physicians are making treatment decisions with their non-small cell lung cancer patients. The following research questions guided the study: (a) How do physicians make treatment decisions with their stage II, stage IIIA and stage IIIB non-small cell lung cancer patients in Ontario? (b) How do knowledge translation tools, such as Cancer Care Ontario guidelines, influence the decision-making process?</p> <p><strong>Methods:</strong> A qualitative approach of grounded theory, following a social constructivist paradigm outlined by Kathy Charmaz (2006), was used in this study. 21 semi-structured interviews were conducted; 16 interviews with physicians and 5 with health care administrators. The method of analysis integrated grounded theory philosophy to identify the treatment decision-making process in non-small cell lung cancer, from the physician perspective.</p> <p><strong>Findings:</strong> The theory depicts the treatment decision-making process to involve five key “guides” (or factors) to inform the treatment-decision making process: the unique patient, the unique physician, the family, the clinical team, and the clinical evidence.</p> <p><strong>Conclusion:</strong> Decision-making roles in lung cancer are complex and nuanced. The use of evidence, such as, clinical practice guidelines, is one of many considerations. Information from a large number of sources and a wide array of factors, people, emotions, preferences, clinical expertise, experiences, and clinical evidence informs the dynamic process of treatment decision-making. This theory of the treatment decision-making process (from the physician perspective) has implications relevant to treatment decision-making research, theory development, and guideline development for non-small cell lung cancer.</p> / Master of Science (MSc)

1 januari 2015 infördes en ny paragraf i plan- och bygglagen som säger att de kommuner som avser att ingå exploateringsavtal ska upprätta riktlinjer som anger förutsättningarna för hur dessa avtal skrivs. Riktlinjerna ska ange vilka mål som finns samt hur kostnader, intäkter och andra åtaganden ska fördelas mellan parterna som ingår avtalet. Drygt ett år har gått sedan den nya bestämmelsen infördes och flera av landets kommuner har nu upprättat dessa dokument. Studien syftar till att undersöka hur landets kommuner hittills tillämpat regeln i plan- och bygglagen 6 kap. 39 §. Avsikten är att kartlägga vilka kommuner som har antagit riktlinjer för exploateringsavtal, vad dessa riktlinjer innehåller, hur de är utformade samt vilka åtaganden, intäkts- och kostnadsfördelningar som tydliggörs i dem. Sveriges samtliga 290 kommuner har kontaktats varav 193 kommuner har svarat på frågan om de antagit riktlinjer eller inte. De riktlinjer som har tagits med i studien är de som författarna tillhandahållit mellan datumen 2016-03-16 och 2016-04-16 och som antagits efter lagändringens ikraftträdande, det vill säga efter 2015-01-01. Totalt tillhandahölls 37 antagna riktlinjer. Texten i riktlinjerna kan enligt studien delas upp i följande tre huvudkategorier: - Generell informativ text som inte enbart är knuten till kommunen i fråga - Kommunspecifik informativ text - Text som tydliggör hur kostnader och andra åtaganden ska fördelas mellan kommun och exploatör i exploateringsavtal Den sistnämnda av de tre huvudkategorierna kan delas upp i ytterligare 33 underkategorier för att belysa vilka åtaganden och kostnadsfördelningar som tas upp i de olika riktlinjerna. Studien tyder på att flera kommuner har börjat tillämpa plan- och bygglagen 6 kap. 39 §. Riktlinjernas innehåll och omfattning skiljer sig åt mellan kommunerna. Slutligen tyder resultatet på att de flesta kommuner i sina riktlinjer tydliggör vilka åtaganden och kostnadsfördelningar som gäller mellan kommunen och exploatören vid ingående av ett exploateringsavtal. Ett fåtal av kommunerna tydliggör inte i riktlinjerna vem av kommunen och exploatören som kommer få bekosta eller vidta en åtgärd utan beskriver endast vilka poster av kostnader och andra åtaganden som kommer att behandlas vid själva ingåendet av exploateringsavtal. Ingen av de undersökta riktlinjerna behandlar intäktsfördelning, vilket riktlinjerna ska enligt plan- och bygglagen 6 kap. 39 §. / In 1 January 2015 a new paragraph was added to the Swedish planning and building act (PBL). According to the new paragraph, Swedish municipalities, are obliged to establish special guidelines for Land Development Agreements. Almost a year has passed since the new law was incorporated and today has several of the Swedish municipalities adopted the guidelines. The aim of the study is to investigate how the Swedish municipalities, so far, has applied PBL 6:39. The study intends to investigate which of the municipalities that has adopted guidelines, what these guidelines contains, how they are designed and which commitments, gains and costs they regulate. All 290 municipalities were contacted and 193 of them responded wheter they had adopted guidelines or not. The study contains of those guidelines that the authors recieved between 2016-03-16 and 2016-04-16. The study do only refers to guidelines, adopted after 2015-01-01. Totally 37 guidelines were received. According to this study, the texts of the received guidelines could be subdivided into three main categories: - General informative text - Informative text about the municipalities - Text about commitments, benefits and costs The last category was later on divided into 33 subcategories. The study shows that several municipalities have started to apply the new paragraph, but not yet all of them. Finally, most guidelines divides the commitments, gains and costs between the municipality and the land developer. But a few of them only make it clear which commitments, benefits and costs the municipality intends to regulate in a Land Management Agreement. None of the guidelines regulate benefits from land development, even though they are supposed to, according to PBL 6:39.

Die Fragestellung dieser Arbeit ist ob derzeit angebotene e-Government Systeme von älteren Nutzern angenommen werden und wie solche aufgebaut werden müssen, damit diese Nutzergruppe solche Systeme als eine nützliche Alternative zu Behördengängen annimmt. In unserer Forschung haben wir erforscht wie solche Anwendungen, welche von der Verwaltung für die gesamte Bevölkerung angeboten werden, aufgebaut werden sollten, damit diese von der gesamten Bevölkerung erfolgreich genutzt werde können. Zur Beantwortung dieser Fragestellung wurde eine dreistufige Forschung durchgeführt, welche an das ISO 9241-210 Entwicklungsmodell angelehnt ist. Die Forschung wurde parallel in Deutschland und Ungarn in Kooperation mit dem Fraunhofer FOKUS, dem Bundesministerium des Innern, der Bundesdruckerei und der Corvinus Universität Budapest durchgeführt. In der ersten Phase wurden die Erwartungen und Vorkenntnisse der Zielgruppe erforscht um die Eckpunkte und Prämissen festlegen zu können. Diese Erkenntnisse ermöglichten in der zweiten Phase die fundierte Auswahl einer Anwendung, welche als Basis für Nutzertests genutzt werden konnte. Die Testanwendung war das AusweisApp des elektronischen Personalausweises. Bei diesen Tests wurden die Nutzerfehler erfasst und die Akzeptanz durch die ASQ Methode gemessen. Anhand der gewonnen Erkenntnisse konnte die Guideline IGUAN entwickelt werden, welche eine standardisierte Herangehensweise zur Akzeptanzsteigerung darstellt. Dieses Konzept beinhaltet neben den speziellen, an ältere Nutzer angepassten Anforderungen, einem Kriterienkatalog, sowie die Abbildung der Prozesse wodurch eine Erhöhung der Akzeptanz für Ältere ermöglicht wird. In der dritten Phase der Forschung konnte die Guideline durch eine iterative Prototypentwicklung evaluiert und geprüft werden. Wir konnten beweisen, dass Verbesserungen beim Interface e-Government Anwendungen an die alternde Gesellschaft näher bringen, die Motivation erhöhen und das Nutzerempfinden nachhaltig verbessern. / Our research focuses on the question of acceptance of current e-government systems by elderly users. It describes how such systems should be designed and offered for this user group in order to provide an acceptable alternative to offline processes. In order to answer our research question, the research was structured into three phases along the development model of the ISO 9241-210. This enabled to identify not only the main factors of acceptance, but also the expectations of elderly users. Our research was conducted in parallel in Germany and Hungary in cooperation with the Fraunhofer FOKUS, the Federal Ministry of Interior, the Bundesdruckerei and the Corvinus University Budapest. The first phase of our research provided results about the expectations and previous experience of the users with e-government systems. This set the premises for the next phases of our research and provided us with information about the theoretical acceptance of systems by the age group. The results made it possible to select an application in the second phase, which was used as a model in the remaining phases. The selected application was the AusweisApp of the electronic ID card. The test measured the encountered errors and the acceptance of the system with the ASQ method. The obtain results allowed us to develop a generalised solution, the IGUAN guideline. This guideline makes a standardised approach to the usability improvement process possible. It contains the special requirements of elderly users, and a catalogue of criteria, which helps to develop an application in line with the set requirements. The third phase of our research was used a proof of concept for the IGUAN. The guideline was evaluated and tested with an iterative prototyping. We could therefore demonstrate that improvements in the interface make e-government application possible which are perceived useful and easy to use by elderly users. These improvements will measurably increase the user motivation and experience.

In 2007, the Canadian Paediatric Society (CPS) released a guideline aimed at preventing complications of neonatal jaundice through universal screening and guidelines for follow-up and treatment. This thesis investigates the impact of implementation of the CPS guideline on health services utilization at a population level in Ontario. First, we surveyed all Ontario hospitals providing maternal-newborn services to determine if and when they had implemented universal bilirubin screening, and to gather information about the organization of services to provide follow-up and treatment, and about the factors that influenced screening implementation. Then we conducted two population-based cohort studies using linked administrative health data to evaluate the association between 1) the implementation of universal bilirubin screening and phototherapy use (during and following birth hospitalization) length of stay (LOS), jaundice-related emergency department (ED) visits and readmissions; and 2) universal bilirubin screening implementation and access to recommended follow-up care by socio-economic status (SES). By 2012, the majority of Ontario hospitals had implemented universal bilirubin screening. There is heterogeneity in how hospitals organize services, but a notable trend towards hospital-based post-discharge care. Screening was associated with an increase in phototherapy during hospitalization at birth (relative risk (RR) 1.32, 95% confidence interval (CI) 1.09-1.59), and a decrease in jaundice-related ED visits (RR 0.79, 95% CI 0.64-0.96), but no statistically significant difference in phototherapy after discharge, length of stay, or jaundice-related readmissions after accounting for pre-existing temporal trends in healthcare service use and other patient socio-demographic and hospital characteristics. Implementation of the universal bilirubin screening in Ontario was associated with a modest increase in rates of early follow-up (adjusted RR 1.11, CI 1.0014-1.22, p=0.0468), but most babies were not seen within the recommended timeframe. Babies of lowest SES were least likely to receive recommended follow-up, and disparities in follow-up increased following universal bilirubin screening implementation. En 2007, la Société canadienne de pédiatrie (SCP) a publié une directive visant à la prévention des complications de l'ictère néonatal par le dépistage universel et des lignes directrices pour le suivi et le traitement. Cette thèse étudie l'impact de la mise en œuvre de la directive SCP sur l'utilisation des services de santé à niveau de population de l'Ontario. Tout d'abord, nous avons interrogé tous les hôpitaux de l'Ontario offrant des services de santé maternelle-nouveau-né afin de déterminer si et quand ils avaient mis en œuvre le dépistage universel de la bilirubine, et à recueillir des informations sur l'organisation des services pour assurer un suivi et de traitement, et sur les facteurs qui ont influencé la mise en œuvre de dépistage. Ensuite, nous avons mené deux études de cohorte basée sur la population à partir de données administratives sur la santé pour évaluer 1 ) l'association entre la mise en œuvre du dépistage de la bilirubine universel et la photothérapie utilisation lors de l'hospitalisation à la naissance, la photothérapie après avoir sortie de l'hôpital, la durée du séjour, le service des urgences liées à la jaunisse et des réadmissions liées à la jaunisse; et 2 ) l'association entre la mise en œuvre du dépistage universel et l'accès aux soins de suivi recommandés et si cela différait entre les quintiles de statut socioéconomique. En 2012, la majorité des hôpitaux de l'Ontario a mis en œuvre le dépistage universel de la bilirubine. Il existe une hétérogénéité de la façon dont les hôpitaux organisent des services, mais une tendance notable vers les soins post-décharge en milieu hospitalier. Le dépistage a été associé à une augmentation de la photothérapie pendant l'hospitalisation à la naissance (risque relatif (RR) de 1,32, intervalle de confiance 95 % (IC 95 %) de 1,09 à 1,59), et une diminution des visites à l'urgence liées à la jaunisse (RR 0,79, IC 95 % 0,64 à 0,96), mais aucune différence statistiquement significative dans la photothérapie après la sortie , la durée du séjour , ou réadmissions liées jaunisse - après comptabilisation des tendances temporelles pré- existants dans l'utilisation des services de soins de santé et d'autres caractéristiques socio- démographiques des patients et caractéristiques de l'hôpital. La mise en œuvre de le dépistage universel en Ontario a été associée à une légère augmentation des taux de suivi précoce (RR ajusté 1,11; IC de 1,0014 à 1,22; p = 0,0468), mais la plupart des bébés n'ont pas été vues dans les délais recommandés. Les bébés de statut socioéconomique faibles étaient moins susceptibles de recevoir de soins de suivi recommandés et les disparités dans le suivi ont augmenté suite à la mise en œuvre du dépistage universel de la bilirubine.

The purpose of this study was to describe the characteristics and findings of antimalarial drug efficacy studies conducted in Ethiopia and to use the findings to formulate recommendations for antimalarial drug efficacy monitoring and use of evidence to inform antimalarial treatment policy for the Ethiopian setting. This study reviewed 44 antimalarial efficacy studies conducted in Ethiopia from 1974 to 2011. The analysis of results indicated that chloroquine as the first-line antimalarial drug for the treatment of malaria due to Plasmodium falciparum had a 22% therapeutic failure in 1985. Chloroquine was replaced with sulfadoxine-pyrimethamine in 1998, more than 12 years later, when its therapeutic failure had reached 65%. Sulfadoxinepyrimethamine at the time of its introduction had a treatment failure of 7.7%; it was replaced after seven years in 2004 by artemether-lumefantrine; by then its treatment failure had reached 36%. The WHO recommends the replacement of a first-line antimalarial drug when more than 10% of treatment failure is reported. The replacement drug should have a therapeutic efficacy of more than 95%; while the change itself should be completed within two years. The prolonged delay to replace failing antimalarial drugs in Ethiopia seems to have been influenced mainly by the lack of systematic antimalarial drug efficacy data collection and pragmatic use of the data and evidence gathered.Almost eight years after its introduction, isolated studies show that the efficacy of artemether-lumefantrine has decreased from 99% in 2003 to around 96.3% in 2008. Though this decrease is not statistically significant (chi-square 1.5; P=0.22) and has not reached the threshold of 10%, it is plausible that its efficacy may drop further. This is mainly due to regulatory provisions in the country that allow marketing of oral artemisinin mono-therapies that are not recommended for malaria treatment, use of less effective antimalarial combination drugs in the neighboring countries and widespread drug quality problems. The situation calls for and this study recommends the establishment of stringent drug efficacy monitoring and early warning system and alignment of the antimalarial drug regulatory practices with recommendations of the WHO. / Health Studies / D. Litt. et Phil. (Health Studies)