Master of Public Health - MPH / Background: The largest focus areas for the department of health is ensuring access to quality healthcare. The district health system (DHS) model remains the vehicle used by the district managers to deliver on the health department’s goals, objectives and priority focus areas. Strengthening the district health system platform is therefore important to the department to improve access and quality of care to the clients serviced in the province. The district hospitals play a fundamental role since they support primary health care (PHC) and serve as the entry point to more specialised care. The efficient management of beds in the district hospitals is the key in ensuring access to care and preventing bed blocking. Bed Utilisation Rate (BUR) and Average Length of Stay (ALOS) are indicators used to measure the efficiency of hospital beds. This study provides a description of the trends in bed utilisation within the inpatient wards of eight district hospitals in the Cape Town metro district in the 2016-2017 financial period. Methodology: To analyse and compare wards a quantitative approach was used. Inpatient ward activity reports for eight district hospitals were accessed from the department of health’s routine data collection repository. A total of fifty-five wards were compared across small and large hospitals for BUR and ALOS during the financial year period 1 April 2016 to 31 March 2017. Data entry was done in MS EXCEL and analyses were done using STATA 11.0.

A Casa dos Sonhos, objeto desta pesquisa, é uma casa ideal. Ao longo do seu ciclo de vida, cada pessoa vai construindo sua própria experiência humana, seus valores e seus símbolos, a partir dos conhecimentos que ela própria vai selecionando para si, de tudo aquilo que o universo lhe oferece. Ao longo da vida, no seu dia-a-dia, as pessoas vão experimentando necessidades, que geram anseios e aspirações. Desse complexo sistema de símbolos, valores, anseios, aspirações e necessidades começa a surgir a idealização de espaços adequados para a realização de cada uma das atividades cotidianas. São aspirações nem sempre bem definidas, independentes umas das outras, às vezes inconciliáveis. Empreender a produção de uma casa sob medida é, sem dúvida, uma tarefa extremamente complexa. Ainda que muitos se resignem a adquirir pronta a sua casa própria, porquê cada ser humano parece sempre desejar criar a sua própria casa, sob medida para seus valores, suas aspirações e suas necessidades? Utilizando meios e métodos da Avaliação Pós-Ocupação (APO) do Ambiente Construído, que considera fundamentalmente o ponto de vista dos usuários, esta pesquisa investiga as motivações e o processo de produção de uma residência idealizada, planejada e realizada por uma família, sob medida para as suas necessidades, as suas aspirações, os seus valores e os seus símbolos. Este trabalho se fundamenta em entrevistas realizadas com membros de trinta famílias que produziram a sua Casa dos Sonhos, em Alphaville, um complexo residencial, empresarial e comercial situado na Região Metropolitana da Capital do Estado de São Paulo. / The Dream Home that is the purpose of this research is an ideal house. Through the human life cycle, every human being builds its own human experience, values, and symbols from the achievements that each one selects from everything the universe offers. Along their life, through the day-by-day activities, people experience and realize needs that generate expectations and desires. From this complex set of symbols values and needs emerges the idealization of adequate space to perform each one of the day-by-day activities. Most of the time, these needs are not quite clear and works independently and also frequently are not compatible. Entrepreneurs a tailor made home is a very complex task. Although most of the people have to acquire shelf houses, why everyone desires to create their own tailor made dream houses that reach their values, symbols, expectations and needs? Where comes this desire for a personalized home from? Using methods and techniques of Post-Occupancy Evaluation (POE), which considers fundamentally users point of view, this research investigates motivation and the production process of an idealized, planned and built house by a family, intending to fulfill their needs, desires, values and symbols. This work is based on research and interviews with 30 families that have built their own dream home in Alphaville, a residential complex located on the suburban area of the city of São Paulo - Brazil.

Les structures des urgences (SU) sont une porte d'entrée importante de l'hôpital, fortes d'un personnel dont les capacités progressent et aidées par un plateau technique hospitalier de qualité. Dès son arrivée en SU, la prise en charge du patient s'inscrit dans un circuit qui a pour objectif l'optimisation des soins. Ce circuit patient peut être ralenti ou altéré lorsqu'il y a une surcharge de la SU, c'est-à-dire lorsque les capacités de celle-ci sont dépassées par le nombre de patients en attente d'être vu, d'évaluation, de traitement et de place d'hospitalisation. La surcharge des SU est associée à de nombreux effets indésirables et il est démontré que l'origine de cette surcharge est multifactorielle. Pour y trouver des solutions, il convient d'examiner la surcharge dans la globalité de l'institution hospitalière et du système de soins. L'objectif de ce travail est de décrire le circuit du patient de son arrivée en SU jusqu'à son départ et, parfois, son retour. Chaque article de ce travail, constituant autant d'étapes dans le circuit patient, place en perspective la surcharge de la SU ou de l'institution dans sa globalité. Cet ensemble d'articles souligne la complexité de la problématique et la nécessaire mobilisation de toute l'institution pour y répondre. / Emergency departments (ED) are an important front gate of the hospital with strong skill staff and helped by a high quality technical platform. After his/her arrival at the hospital, the patient follow a pathway which aims to optimize the healthcare. This patient's pathway may be slowed down or alter when there is an overcrowding of the ED, when capacities are exceeded by the number of patients to be seen, evaluated, treated, and to hospitalize. ED overcrowding is associated with many adverse effects and it is shown that the origin of this overcrowding is multifactorial. To find solutions, we must observe overcrowding in the whole of the hospital institution and of the healthcare system. The aim of this thesis is to describe the patient's pathway from his/her arrival at the ED to his/her departure, and sometimes his/her come back. Each article of this thesis represents a step of the patient's pathway. Then, the overcrowding of the ED, or of the hospital, is studied in its entirety. This collection of articles highlights the complexity of the issue and the need to mobilize the whole institution to respond.

A Casa dos Sonhos, objeto desta pesquisa, é uma casa ideal. Ao longo do seu ciclo de vida, cada pessoa vai construindo sua própria experiência humana, seus valores e seus símbolos, a partir dos conhecimentos que ela própria vai selecionando para si, de tudo aquilo que o universo lhe oferece. Ao longo da vida, no seu dia-a-dia, as pessoas vão experimentando necessidades, que geram anseios e aspirações. Desse complexo sistema de símbolos, valores, anseios, aspirações e necessidades começa a surgir a idealização de espaços adequados para a realização de cada uma das atividades cotidianas. São aspirações nem sempre bem definidas, independentes umas das outras, às vezes inconciliáveis. Empreender a produção de uma casa sob medida é, sem dúvida, uma tarefa extremamente complexa. Ainda que muitos se resignem a adquirir pronta a sua casa própria, porquê cada ser humano parece sempre desejar criar a sua própria casa, sob medida para seus valores, suas aspirações e suas necessidades? Utilizando meios e métodos da Avaliação Pós-Ocupação (APO) do Ambiente Construído, que considera fundamentalmente o ponto de vista dos usuários, esta pesquisa investiga as motivações e o processo de produção de uma residência idealizada, planejada e realizada por uma família, sob medida para as suas necessidades, as suas aspirações, os seus valores e os seus símbolos. Este trabalho se fundamenta em entrevistas realizadas com membros de trinta famílias que produziram a sua Casa dos Sonhos, em Alphaville, um complexo residencial, empresarial e comercial situado na Região Metropolitana da Capital do Estado de São Paulo. / The Dream Home that is the purpose of this research is an ideal house. Through the human life cycle, every human being builds its own human experience, values, and symbols from the achievements that each one selects from everything the universe offers. Along their life, through the day-by-day activities, people experience and realize needs that generate expectations and desires. From this complex set of symbols values and needs emerges the idealization of adequate space to perform each one of the day-by-day activities. Most of the time, these needs are not quite clear and works independently and also frequently are not compatible. Entrepreneurs a tailor made home is a very complex task. Although most of the people have to acquire shelf houses, why everyone desires to create their own tailor made dream houses that reach their values, symbols, expectations and needs? Where comes this desire for a personalized home from? Using methods and techniques of Post-Occupancy Evaluation (POE), which considers fundamentally users point of view, this research investigates motivation and the production process of an idealized, planned and built house by a family, intending to fulfill their needs, desires, values and symbols. This work is based on research and interviews with 30 families that have built their own dream home in Alphaville, a residential complex located on the suburban area of the city of São Paulo - Brazil.

Master of Science / Department of Horticulture and Natural Resources / Adam A. Ahlers / The muskrat (Ondatra zibethicus) is an economically and ecologically important furbearer species that occupy wetlands throughout North America. However, populations across the United States (US) are declining and there is little evidence as to the cause of this decline. Wetlands in the upper Midwest, US, are shifting into more homogeneous vegetation states due to an invasive hybrid cattail species, Typha x glauca (hereafter ‘T. x glauca’), outcompeting native vegetation. This hybrid cattail species is now an abundant potential resource for muskrats and has outcompeted native wetland vegetation. I investigated how landscape composition and configuration affected multiscale habitat use by muskrats during the summers of 2016 – 2017. Additionally, I assessed how fetch (impact of wind and wave action), a process dictated by large-scale landscape configuration, influenced muskrat habitat use at a local-scale representing a resource patch. I randomly selected 71 wetland sites within Voyageurs National Park, Minnesota, and used presence/absence surveys to assess site occupancy by muskrats. Each year, multiple surveys were conducted at each site and I used multiseason occupancy modeling to investigate how both local and landscape factors affect site occupancy and turnover. I predicted a positive relationship between local-scale (2 ha) sites, characterized by shallower and less open water, and muskrat occupancy and colonization rates. I also predicted increased occupancy probabilities and colonization rates in wetlands that contain higher amounts of T. x glauca. However, I expected the amount of fetch at each site to negatively influence site occupancy probabilities and colonization rates. At the landscape-scale (2 km), I expected habitat use by muskrats to be positively related to the percentage of T. x glauca and area of wetlands surrounding sites. At the local-scale, muskrats occupied wetlands that contained shallower water depths and less open water. As predicted, site occupancy probabilities were greater in areas with greater amounts of T. x glauca coverage. My results revealed a cross-scale interaction between the severity of fetch impacts and percent of T. x glauca coverage at sites. Muskrats were more likely to colonize areas with greater fetch impacts if there was also greater coverage of T. x glauca at these sites. At the landscape-scale, site-occupancy probabilities were positively influenced by the percent of open water and landscape heterogeneity surrounding each site. My study was the first to document how invasive T. x glauca populations can mitigate negative effects that high wave intensity may have on muskrat spatial distributions. I was also the first to identify multiscale factors affecting the spatial distribution of muskrats in lacustrine ecosystems.

Nearly extirpated from the Central Appalachians, USA by the mid-1900s as a result of human persecution, loss of forests, and absence of large mammal carrion, remnant populations of common ravens (Corvus corax) have recolonized portions of their historical range. One such area of recolonization is southeastern Kentucky where the species is listed as state threatened. Southeastern Kentucky appears to have extensive suitable breeding habitat, but raven records remain relatively rare with sightings and a few nests being confirmed during the past three decades. Because little is known about local ecology or population status of this reclusive corvid in Kentucky, I assessed distribution and occupancy of ravens in available cliff habitat to quantify factors that affect detectability of ravens, identify landscape attributes important to raven breeding locations at multiple scales, and develop a protocol for monitoring occupancy of potential raven breeding habitats in Kentucky. Based on surveys of 23 cliff sites during 2009–2010, I found that ravens are highly detectable (p=0.90 (95% CI = 0.81–0.95)) at known occupied cliff sites, suggesting a survey effort consisting of two visits, each lasting one hour, will enable occupancy to be determined with 95% confidence. Using this and the habitat information associated with occupancy (cliff area and horizontal strata orientation), a monitoring protocol was developed and initiated in 2011 that should be useful to wildlife managers and land stewards interested in long-term monitoring, management, and conservation of common ravens in Kentucky’s cliff habitat.

Changes in land use such as mountaintop removal mining with valley fills (MTR/VF) affect chemical, physical, and hydrological properties of headwater streams. Although numerous stream taxa have experienced significant declines from MTR/VF, stream salamanders appear to be particularly sensitive. Yet, the specific mechanism(s) responsible for the population declines has eluded researchers. We sampled salamander assemblages across a continuous specific conductivity (SC) gradient in southeastern Kentucky and estimated occupancy rates and abundance estimates along this gradient. We also examined the diet of larval and adult salamanders to determine if autochthony (A/T prey), total prey volume, and body condition is influenced by SC. As SC increased, occupancy and abundance declined consistently among all salamander species and life stages. Diet composition explained the declines; for example, larval salamanders experienced a 12−fold decline in autochthony, a 4.2−fold decline in total prey volume, and a rapid decline in body condition as SC increased. Our results indicate that SC indirectly affects stream salamander populations by eliminating an adequate availability of aquatic prey for salamanders, which in turn lead may lead to reduced population persistence in streams with elevated SC.

This project aimed to reanalyse two large historical data sets from two different locations in New Zealand (Fiordland in the South Island and Pureora Forest Park in the North Island). The data describe populations of mice (Mus musculus), rats (Rattus rattus and R. norvegicus), and stoats (Mustela erminea) collected using standard monitoring techniques from five distinct types of forest habitat. The new analysis methods selected were an index of patchiness and Site Occupancy analysis. The objectives of the analysis were (1) to evaluate whether the patchiness index and Site Occupancy analysis methods might contribute to improved protocols for monitoring small mammal populations in the future, and (2) to use formal tests of five hypotheses to evaluate two of the assumptions made by the conventional density index often used in small mammal studies. I describe the results of the analyses for each species, including any problems encountered (such as the inability of the Site Occupancy method to analyse very sparse data sets). I also describe the results pooled from each of the two study locations and potential consequences for small mammal monitoring and control. This analysis has suggested that in most cases the density index is not a rigorous measure of small mammal populations. However, both the index of patchiness and Site Occupancy analysis provided useful, new information about these populations of rodents and stoats, despite the fact that these historical data sets were not designed for use with modern methods of analysis. Please note: some figures and tables were printed separately and added to the thesis as unnumbered pages. These can be found in the file 03Plates_and_Tables.pdf.

The newly built Dell Children’s Medical Center in Austin, Texas was designed with an understanding of the healing power of nature. A perspective randomized design with pre-post measures Post-Occupancy Evaluation (POE) was conducted to test whether the hospital’s Healing Garden had an effect on the stress levels of parents of pediatric hospital patients. Participants were asked to sit and relax in the Healing Garden for ten-minutes. Two differing interior spaces, one with views to nature and one without views to nature, were tested as comparisons. Data was collected in the form of surveys and behavioral observation. Results indicate that the Healing Garden reduced the stress of parents at a greater rate than the two interior spaces included in the study. However, the two interior spaces did not differ in their stress reducing effects despite one having views to nature. Comments from parents indicated a slight stress relieving effect by simply leaving their patient’s room. These research findings should be used to encourage parents and other adult family members to use the hospital’s gardens to reduce stress felt from their patient’s medical treatment. Further studies need to be conducted to provide more conclusive data.

The newly built Dell Children’s Medical Center in Austin, Texas was designed with an understanding of the healing power of nature. A perspective randomized design with pre-post measures Post-Occupancy Evaluation (POE) was conducted to test whether the hospital’s Healing Garden had an effect on the stress levels of parents of pediatric hospital patients. Participants were asked to sit and relax in the Healing Garden for ten-minutes. Two differing interior spaces, one with views to nature and one without views to nature, were tested as comparisons. Data was collected in the form of surveys and behavioral observation. Results indicate that the Healing Garden reduced the stress of parents at a greater rate than the two interior spaces included in the study. However, the two interior spaces did not differ in their stress reducing effects despite one having views to nature. Comments from parents indicated a slight stress relieving effect by simply leaving their patient’s room. These research findings should be used to encourage parents and other adult family members to use the hospital’s gardens to reduce stress felt from their patient’s medical treatment. Further studies need to be conducted to provide more conclusive data.