Emergency department (ED) use for behavioral-health-associated diagnoses has steadily increased in adult and pediatric populations, accounting for 1 out of every 8 ED visits. The increase in pediatric behavioral health ED visits, combined with limited resources for treatment, has created a challenge for EDs faced with extended boarding and constant observation of this population. The generalized behavioral health guidelines used at the practice site have not been adapted for the pediatric population. This project focused on providing age- and developmentally appropriate best practice guidelines for children under constant observation in the children's emergency department (CED) using Havelock's theory of planned change as the framework. Practice in the CED was compared to best practice recommendations identified in the literature and community standards including workflow, defined roles and responsibilities, addressing the needs of the parent/guardians, and defined outcomes. These best practices were incorporated in a guideline developed to provide age- and developmentally appropriate recommendations. An expert panel comprising the behavioral health nurse manager and children's emergency department nurse manager reviewed the guideline using the AGREE II tool, and the guideline was revised based on the composite results from the 6 domains in the AGREE II tool. Based on these composite results and panel feedback, domain 5 was revised to include an auditing and monitoring plan. In addition to improving the safety and care for the CED patient population, this project also serves to increase awareness of the topic while emphasizing on the need for additional research and evidence-based practice focused on pediatric behavioral health patients.

京都大学 / 0048 / 新制・課程博士 / 博士(理学) / 甲第19264号 / 理博第4119号 / 新制||理||1593(附属図書館) / 32266 / 京都大学大学院理学研究科生物科学専攻 / (主査)教授 古市 剛史, 教授 湯本 貴和, 教授 中村 克樹 / 学位規則第4条第1項該当 / Doctor of Science / Kyoto University / DGAM

A review of the literature indicates that young males, who are unemployed with low levels of education, predominate in populations of pre-trial criminal offenders suspected of having a psychiatric illness, also known as “Observation Patients” according to the Criminal Procedures Act of 1977 in South Africa. Other contributory factors include a history of mental illness and non-compliance on psychiatric medication, a previous forensic history, co-morbid substance abuse and being intoxicated at the time of the offence. Dual diagnosis is considered a key contributor to criminal behaviour in this group of patients. The review of the literature also shows a significant proportion of co-morbid intellectual disability among offenders found to be psychiatrically ill at the time of the criminal event. A previous study conducted 20 years earlier, in 1986 at the Sterkfontein Forensic Psychiatric Unit by Vorster (1986) showed that the typical profile was a single, unemployed, poorly educated male in his twenties, usually with a history of psychiatric treatment. This typical profile confirmed the evidence in the literatures at the time of the study.

Recreational hunters play an important role in managing white-tailed deer (Odocoileus virginianus); however, the potential for deer to alter behaviors to avoid hunters has not been addressed within the risk-allocation hypothesis. I evaluated magnitude (i.e., hunter density) and temporal variation (i.e., time of day and initial and prolonged exposure) in human predation risk on movements, resource selection, and observation rates of 37 adult male deer in southern Oklahoma. Deer recognized human predation risk by increasing diel path complexity and use of security cover with greater hunter density. Moreover, deer reduced movement rates and tortuosity while seeking out areas with security cover during prolonged exposure. However, tortuosity and use of security cover remained elevated with greater hunter density. These alterations in behaviors subsequently led to a decrease in observation rates during prolonged exposure. My results clearly support the predation risk-allocation hypothesis by the behavioral responses observed with greater hunter density.

The purpose of this thesis was to examine hand actions required of nurses and pharmacy assistants involved with chemotherapy drug administration over a work shift, and propose associated risk control strategies. There is a need to evaluate and redesign manual “pushing” and mixing of chemotherapy drugs to prevent musculoskeletal disorders and associated healthcare costs. Muscle activity of the forearm flexor and extensor muscles, and thumb forces, were measured from 5 lab nurses, 5 floor nurses and 5 pharmacy assistants who had their actions recorded throughout their shift. Lab nurses performed an average of 1.85 ± 0.48 hand efforts per min, floor nurses performed 1.62 ± 0.09 per min, while pharmacy assistants performed 5.29 ± 1.27 per min. Syringe use accounted for 17% of the pharmacy assistants’ shift and 12% each for the floor and lab nurses. The tasks of drawing fluid and manually pushing treatment represented 10% of the work day. The left forearm flexors generated the highest activity over the workday and across tasks while only resting for 6% of the workday. The high number of hand efforts, combined with prolonged durations, and lack of muscular rest show evidence of muscular overload over the course of the shift as well as illustrate that the pharmacy assistants are at higher risk for WMSD. The results may also help explain the documented injury statistics and complaints associated with the arm, hand and thumb and support the implementation of a chemotherapy robot to reduce the risk associated with tasks performed by the pharmacy assistants. Further, the findings of this thesis can act as a guide for future evaluation and research of workplaces with similar syringe and hand demands. The risk reducing strategies presented may also be applied to other jobs where hand and syringe use is repetitive and prolonged. / Thesis / Master of Science (MSc)

Under vår egen yrkesverksamma tid som förskollärare har vi inte upplevt observation som vanligt förekommande. Vi blev nyfikna på om vår upplevelse stämmer överens med verkligheten och ville ta reda på hur pedagoger i förskolan arbetar med observation. Vi ville också ta reda på hur en specialpedagogs kompetens, enligt pedagogerna, skulle kunna användas när det gäller observation.Med hjälp av intervju fick vi tio pedagogers syn på vad observation innebär för dem samt hur de använder de olika observationsmetoderna. Vi fick också en bild av vilka förväntningar de hade på hur specialpedagogen kan användas inom området.Studien visar att tidigare forskning på barnobservationer i praktiken i Sverige är obefintlig och att mer aktuell litteratur inom området saknas.Sammanfattningsvis pekar resultaten på att kunskapen om observation skiljer sig från person till person. Studien visar också att observationer inte sker kontinuerligt och tidsbrist är en viktig faktor. Studien visar också att specialpedagogisk kompetens i form av handledning och konkreta metodförslag efterfrågas.

Under vår egen yrkesverksamma tid som förskollärare har vi inte upplevt observation som vanligt förekommande. Vi blev nyfikna på om vår upplevelse stämmer överens med verkligheten och ville ta reda på hur pedagoger i förskolan arbetar med observation. Vi ville också ta reda på hur en specialpedagogs kompetens, enligt pedagogerna, skulle kunna användas när det gäller observation.Med hjälp av intervju fick vi tio pedagogers syn på vad observation innebär för dem samt hur de använder de olika observationsmetoderna. Vi fick också en bild av vilka förväntningar de hade på hur specialpedagogen kan användas inom området.Studien visar att tidigare forskning på barnobservationer i praktiken i Sverige är obefintlig och att mer aktuell litteratur inom området saknas.Sammanfattningsvis pekar resultaten på att kunskapen om observation skiljer sig från person till person. Studien visar också att observationer inte sker kontinuerligt och tidsbrist är en viktig faktor. Studien visar också att specialpedagogisk kompetens i form av handledning och konkreta metodförslag efterfrågas.

Syftet med studien är att identifiera strategier som barn i en syskongrupp på förskolan använder sig av för att förhandla om lekutrymmet i den fria leken samt att analysera förskollärares uppfattningar av och om barns förhandlingsstrategier. Genom observationer och i en fokusgruppsintervju har vi fått svar på forskningsfrågorna: vilka förhandlingsstrategier vi kan se att barnen använder för att få tillträde: vad strategierna leder till: vilka förhandlingsstrategier förskollärarna kan se samt hur förskollärarna arbetar för att motverka exkludering i den fria leken. Materialet i studien har analyserats och diskuterats utifrån tidigare forskning kopplat till hur barn förhandlar i leken, barndomssociologisk teori samt förhandlingsstrategier som barn använder sig av i den fria leken som Corsaro har formulerat. Studiens resultat visar att barn använder sig av olika strategier, det kan vara indirekta och direkta strategier för att få tillträde, för att förneka andra barn tilltäde samt uteslutningsstrategier. Studien visar också att barn använder sig av makt i den fria leken, vilket blev synligt i observationerna i den fria leken och togs även upp i fokusgruppsintervjun med förskollärare. Corsaro (1979) tar i sin forskning upp hur strategier kan leda till negativ eller positiv respons (1979, s. 321). Detta har vi även sett i vår studie men främst hur barn bemöter varandra med negativ respons. I fokusgruppssamtalet fick vi exempel på hur förskolan arbetar förebyggande mot exkludering genom att ha ett stöttande arbetssätt och att vara närvarande som pedagog.

Autonomous agents may not have access to complete information about the state of the environment. For example, a robot soccer player may only be able to estimate the locations of other players not in the scope of its sensors. However, even though all the information needed for ideal decision making cannot be sensed, all that is sensed is usually not needed. The noise and motion of spectators, for example, can be ignored in order to focus on the game field. Standard formulations do not consider this situation, assuming that all the can be sensed must be included in any useful abstraction. This dissertation extends the Markov Decision Process Homomorphism framework (Ravindran, 2004) to partially observable domains, focusing specically on reducing Partially Observable Markov Decision Processes (POMDPs) when the model is known. This involves ignoring aspects of the observation function which are irrelevant to a particular task. Abstraction is particularly important in partially observable domains, as it enables the formation of a smaller domain model and thus more efficient use of the observed features.

Over the years, teachers, administrators, and policy makers have been concerned with optimizing learning for all students. The No Child Left Behind Act put an emphasis on summative assessments, which measure what students have learned. In contrast, formative assessment has been shown in many studies to improve student achievement and motivation because it is applied while students are learning. The purpose of this study was to investigate, for middle and high school mathematics and science instruction, the validity and reliability of a newly developed observation instrument called AssessToday, which is used in a single class period to assess a teacher’s use of short-cycle formative assessment. The content validity of the instrument was supported through an extensive literature review, feedback from experts in the field of formative assessment, and an examination of 98 classroom observations. For assessing reliability of the instrument, inter-rater reliability coefficients were calculated using data collected by trained observers who independently rated teachers during the same class period using three measures: percentage of agreement between raters, Cohen’s kappa, and Fleiss kappa. Cohen’s kappa (N = 36 pairs) ranged from .62 to 1.00 for all observer pairs with an average kappa of .75 for mathematics (n = 16 pairs) and .76 for science (n = 20 pairs). The recommended threshold for kappa is k = .70. An exploratory factor analysis was conducted on the observation data and the determined factors related to the theoretical framework established in the literature. The results affirmed that the instrument is a tool to be utilized in short-cycle formative assessment with middle and high school science and mathematics teachers.