Thesis (Ph. D.)--University of Texas at Austin, 1998. / Vita. Includes bibliographical references (leaves 189-200). Available also in a digital version from Dissertation Abstracts.

Class of 2016 Abstract / Objectives: The specific aims of this study were: 1) describe the frequency of off-label medication use in pediatric discharge medication regimens, 2) compare the frequency of FDA-approved and off-label medication use in pediatric discharge medication regimens, and 3) identify potential patient-specific risk factors, including use off-label use of medications, associated with 90-day readmission. Methods: This was a retrospective chart review of pediatric patients admitted to a tertiary academic medical center during a 6-month period. Inclusion criteria included age less than 18 years of age and admission between January 1, 2014 and June 30, 2014. Exclusion criteria included admission for oncology chemotherapy, admitted < 24 hours, admission to NICU only and patient expiration prior to discharge. Data collection included patient demographics, types and number of medications, and FDA approved and off-label indication of medications. Data analyses were completed on STATA 11.0 (College Station, TX) including student t-test/Mann Whitney U and Chi square/Fisher Exact test with a priori of α= 0.05. Results: A total of 706 admissions were included in the study. There were no significant differences in demographic characteristics between groups (readmitted within 90 days of discharge vs. not readmitted within 90 days of discharge) except sex (males vs. females, 56.3% vs. 44.2%, p=0.034). Length of hospital stay was significantly higher in subjects readmitted within 90 days of discharge compared to those who were not (8.55 ± 12.5 vs. 3.79 ± 4.43 days, p<0.001). Number of medications at discharge (7.31 ± 5.92 vs. 2.91 ± 2.93, p<0.001) and total number of non-FDA approved medications (3.16 ± 3.81 vs. 1.12 ± 1.44, p<0.001) were all significantly higher in subjects readmitted within 90 days of discharge compared to those who were not. The percentages of patients taking medications related to cardiovascular (6.1% vs. 2.4%, p=0.002), electrolytes and nutrition (12.2% vs. 8.5%, p=0.007), and gastrointestinal (19.2% vs. 14.3%, p=0.004) disorders were significantly higher in the subjects readmitted within 90 days of discharge compared to those who were not. Additonally, subjects readmitted within 90 days of discharge (versus those not readmitted within 90 days) demonstrated less use of medications related to neurology (17.7% vs. 25.8%, p<0.001) and respiratory (16.4% vs. 21.4%, p=0.008) disorders. A significantly higher percentage of subjects whose third party payor was Medicaid, were readmitted within 90-days of discharge (69.7% vs. 58.3, p=0.045). Conclusions: In comparing several characteristics of pediatric patients readmitted to a tertiary medical center within 90 days of discharge versus those who were not, it was noted that several factors may be associated with readmission, including: sex, length of initial hospital stay, third-party payor, and the number of medications as well as the types of medication a patient takes. Future research may be warranted to further investigate these potential patient-specific factors in helping identify children at increased risk for readmission and develop more effective approaches to patient education, discharge planning, and continuity of care to reduce preventable readmission.

Lors de ce travail de thèse, les mécanismes de double ionisation d’une molécule d’eau bien orientée dans l’espace par impact électronique ont été étudiés. Des sections efficaces cinq et quatre fois différentielles en angle ont été calculées et analysées en géométrie coplanaire. L’étude théorique a été effectuée en utilisant l’approximation de Born au premier ordre où l’état initial est décrit au moyen des fonctions d’ondes mono-centrique. Les contributions de chaque état final au processus de double ionisation, c’est-à-dire, les électrons de la cible sont éjectés d’une même orbitale moléculaire et/ou de deux orbitales différentes, ont été étudiées et comparées en terme de forme et d’amplitude. L’effet d’orientation de la molécule cible sur les sections efficaces quintuplement différentielles est clairement observé pour le processus (e, 3-1e) ainsi que celui de (e, 3e). En outre, pour les orientations particulières étudiées, nous avons identifié les différents mécanismes responsables de la double ionisation de la molécule d’eau, à savoir, le mécanisme Shake Off ainsi que le mécanisme à deux étapes TS1 / In this work, double ionization mechanisms of oriented water molecules by electron impact have been studied. Five and forth fold differential cross sections in angle have been calculated and analyzed in a coplanar geometry. The theoretical investigation is performed within the first born approximation by describing the initial molecular state by means of single-center wave functions. The contributions of each final state to the double-ionization process, i.e., with target electrons ejected from similar and/or different molecular subshells, are studied and compared in terms of shape and magnitude. Strong dependence of the fivefold differential cross sections on the molecular target orientation is clearly observed in (e, 3-1e) as well as (e, 3e) channels. Furthermore, for the particular target orientations investigated, different mechanisms involved in the double ionization of water molecule, namely, the direct shake-off process as well as the two-step1 process

Målet med den här undersökningen har varit att se om fastigheten Orkestern 1 går att koppla off-grid och om det är ekonomiskt försvarbart eller om en on-grid lösning är bättre. Förutsättningarna är goda med ett stort tak med plats för solpaneler i öst-västlig riktning och en årsmedelvind på 4 m/s. Då huset är nybyggt och välisolerat är även energiförbrukning låg. För att kunna beräkna hur mycket energi som ska produceras i form av värme och el med hjälp av solceller, vindkraftverk, pelletskamin och dieselverk upprättas en energibalans och energifördelning med hjälp av transmission och ventilationsberäkningar. Lagring av energi görs i form av pellets, batteri och biodiesel. Simuleringsprogrammet för solceller Polysun används för att beräkna produktion av solel över varje månad på året. Diagram upprättas över året indelat i månader där det framgår hur stort energibehovet är och visar hur stor del varje energiproducent har varje månad. En pay-off kalkyl görs för att se om det är ekonomiskt lönsamt och för att kunna jämföra mellan två olika off-grid system. Pay-off kalkylen används också för att jämföra mellan off-grid och on-grid system. Resultatet landar i att on-grid systemet är ekonomiskt hållbart medan off-grid systemet inte är det men är ändå fullt genomförbart. / The main target of this examination has been to see if the real estate Orkestern 1 has the possibility to go off-grid and if it is economical defendable or if on-grid solution is a better way to go. The prerequisites are good with a large roof to place solar panels to the east and west, a yearly average windspeed at 4 m/s and a low energy consumption because the house is new built and well insulated. To calculate how much energy that must be produced in form of heat and electricity with solar cells, windmills, pellet stove and diesel generator an energy balance and an energy distribution will be prepared with help of calculations of transmission and ventilation loses. Storage of energy will be done in form of pellets, battery and biodiesel. The simulation program for solar panels Polysun is used to calculate the produced solar energy for each month on the year. Diagram is prepared for each month to see the need of energy and how much every energy producer is delivering. A straight pay-off calculation is done to see if there are any economic benefits and to compare between off-grid and on-grid systems. The result will be that on-grid system is better economical but still the off-grid system is doable.

OFFSET ON BUSINESS TRANSACTIONS Topic of this thesis is set-off in commercial relations. It is structured in three main chapters which deal with the most relevant issues and problems related to set-off in commercial relations. Not only it analyzes the current state of law and case law but tries to interpret Act No 89/2012 Coll., New Civil Code. First part of the thesis aims at the preconditions for set-off. Firstly, the possibility of set-off of foreign currency claims in New Civil Code is discussed. It also reflects upon the long standing discussion of set-off of due rights against rights which are not due. Then it proceeds to new precondition for set-off - certainty of rights. Author of this thesis argues that such precondition refers to reasonable doubts as to the existence and value of the right. Second part of the thesis deals with set-off of two or more rights and obligations. Author analyzes problematic aspects of current case law which en bloc excludes such possibility with the result that notice of set-off has to be overly specific. Controversy of the current case law, moreover, lies in the fact that it contradicts the previous case law which (in the author's view correctly) do not excessively distinguish between set-off and performance of the obligations. Admittedly, some author's...

RWTH, Diss.--Aachen, 2007.

Abstract Miscommunication or omission of critical patient information contributes to preventable medical errors that result in 98,000 patient deaths each year. The hand-off communication process creates a critical time for the patient as necessary information for the continuity of care must be communicated. The purpose of this practice project was to evaluate the nurses' perception of the current hand-off communication process before and after an educational intervention and implementation of the I-5 Verification of Information Tool. Registered nurses were asked to complete a pre survey of their perception of the current hand-off communication process, followed by an educational power point describing the I-5 Verification of Information Tool. Participants utilized the I-5 Verification of Information Tool during hand-off over a 3-week period, and then were asked to complete a post survey to evaluate the nurses' perception of the hand-off process including of the I-5 Verification of Information Tool. A paired t test was used to determine if there was a difference in the nurses' perception of the current hand-off communication process before and after an educational intervention and implementation of the I-5 Verification of Information Tool. Although there was no statistically significant difference in the pre- and post-survey scores, post survey results demonstrated clinical significance. This project has implications for positive social change by addressing nurse communication as a method to improve the quality of hand-off reports, which has the potential to reduce medical errors and improve patient outcomes.

Det är vanligt att företag genomför omstruktureringar. Spin-offs har blivit ett vanligare sätt för svenska företag att strukturera sig sedan lex ASEA instiftades och sedan dess har det genomförts hundratals spin-offs. Syftet med uppsatsen är att komparativt undersöka tre företag som har genomfört spin-offs mellan 2016-2022 och undersöka förklaringar till resultatet av spin-offs. Utifrån studiens analysmodell identifieras centrala faktorer som påverkar utfallet av en spin-off. Dessa är motiv, process och relation till moderbolag. För att besvara frågeställningen har en komparativ fallstudie baserad på semistrukturerade intervjuer gjorts. Den insamlade intervjudatan utgör tillsammans med sekundärdata från respektive företag grunden till studiens resultat. Studien finner att det finns likheter och skillnader i hur faktorer påverkar spin-offs resultat bland de undersökta företagen. Tydliga motiv, en välformulerad process för genomförandet och en god relation till moderbolaget har varit avgörande för i vilken utsträckning företag uppnått ett lyckat resultat av en spin-off. Företags kvalitet på affärsstrategi och förståelse för processen samt tidigare erfarenhet av omstrukturering och överföring av en tydlig struktur och påverkan av marknadsförhållanden har vidare identifierats som viktiga komponenter som påverkat resultatet.

In antibiotic therapy design, conventional wisdom holds that higher antibiotic dosages always leads to the observation of fewer bacterial cells, resulting in a monotonic decay in cell number as a function of increasing antibiotic dose; accordingly, throughout this thesis, we will call this phenomenon a monotone dose-response profile. When we analysed the evolution of antibiotic resistance mediated by the multi-drug efflux pump AcrAB-TolC in Escherichia coli to study if such a monotone dose-response is maintained at all times, our analysis showed that higher dosages can, in fact, lead to higher bacterial loads. This is because selection for drug resistance is mediated by the duplication of the genes, AcrAB-TolC, that encode the aforementioned efflux pump. As explained in detail below, our work highlights the idea that Darwinian selection on additional copies of AcrAB-TolC is a non-linear function of antibiotic dose and that the observed transition from monotone to non-monotone dose-response is a consequence of AcrAB-TolC being strongly selected at very specific dosages. We term this phenomenon an ‘evolutionary hotspot’. Next, we extended the above experimental system to solid media to study how selection on resistance mediated by AcrAB-TolC leads to a ‘spatio-genomic patterning’ effect that we call a ‘bullseye’. Using a bespoke culture device developed as part of this PhD, we show that spatial selection on resistance also depends non-linearly on the distance of the cell from an antibiotic source, and that the non-linearity can be multi-modal as a function of distance, and therefore also of antibiotic dose. This result also contradicts the aforementioned principle that higher antibiotic dosages necessarily lead to fewer bacterial cells. Following on from this, we then studied the ability of microbial competitors for resources to modulate the antibiotic sensitivity of a particular strain of E. coli, namely Tets , using a range of multi-species experiments. We measured the sensitivity to antibiotics of Tets both with, and without, one bacterial or fungal competitor. When that competitor was equally sensitive to the antibiotic, we observed that Tets was less sensitive to it, in part due to an ‘antibiotic sinking’ effect carried out by the competitor strain. However, when the competitor was not sensitive to the antibiotic, Tets was, accordingly, more sensitive than in the absence of competition. In this latter case, the competitor seemed to reduce the growth of Tets by carbon theft as part of a phenomenon known as ‘competitive suppression’. Moreover, this ecological effect is one that synergises with the action of the antibiotic. Finally, we turned to a study of an ecological trade-off motivated by ribosome-binding antibiotics. So, by manipulating the content of ribosomal RNA in the E. coli cell, a large and essential molecule that is bound by antibiotics such as tetracycline or erythromycin, we could subsequently manipulate what is known as a metabolic trade-off between growth rate and growth yield. The latter is the number of cells produced per molecule of carbon found in the extracellular environment of the bacterial population. Using glucose as carbon source we therefore constructed an empirical fitness landscape that shows how the optimum number of ribosomal rRNA operons depends on extracellular glucose concentration. Whilst this study does not relate directly to the presence of an antibiotic, it does show that by altering the number of operons in a manner that is known to affect antibiotic susceptibility, we can also mediate important growth parameters like cell yield, aka efficiency, and growth rate.

Bakgrund: Företag söker ständigt nya sätt att designa effektivare flödeskedjor och för att säkerställa lönsamhet eftersträvas en minskning av kostnader inom produktion, transport och lager. Då lagerrelaterade kostnader står för en stor del av företags totala logistikkostnader har det kommit att stå i fokus för kostnadsminskande aktiviteter. Att minska kostnaderna relaterade till lager och samtidigt erhålla en önskad servicegrad benämns lagerstyrning. Ett sätt att uppnå bättre lagerstyrning är att lokalisera slöseri som kan finnas inom dagens styrning. Detta kan göras genom att upprätta en processkartläggning för att därigenom lokalisera och minimera eller eliminera det slöseri som identifieras genom olika förbättringsåtgärder. Syfte: Syftet med denna avhandling är att beskriva Gotlandsäggs nuvarande lagerstyrning av äggförpackningar och vilka kostnader det leder till för företaget. Därefter kommer eventuella slöserier i den nuvarande lagerstyrningen av äggförpackningar att identifieras för att sedan lägga fram förslag för hur lagerstyrningen kan förbättras med målet att minska kostnaderna för företaget samtidigt som önskad servicenivå uppnås. Metod: Studien är en kvalitativ fallstudie på företaget Gotlandsägg ABs förpackningsanläggning i Ruda. Denna har antagit en deduktiv forskningsansats med ett positivistiskt synsätt. Datainsamling har gjorts av både primärdata i form av strukturerade, semistrukturerade och ostrukturerade intervjuer med personal på Gotlandsägg samt sekundärdata som samlats in från Gotlandsäggs system, Linnéuniversitetets databas och tillgänglig litteratur. Slutsats: Studien har beskrivit Gotlandsäggs nuvarande påfyllningsprocess av äggförpackningar genom att upprätta en processkartläggning och fastställt den definierbara årliga kostnaden för lagerstyrningen. Den nuvarande styrningen innebär att förpackningar lagerhålls länge och därmed binder kapital vilket ökar lagerföringskostnaderna. Genom kartläggningen identifierades slöseri i form av en aktivitet som inte var värdeskapande, nyttjandet av ett manuellt lagersaldo, samt slöseri i form av väntan på digitalt lagersaldo och väntan på manuella beräkningar inför beordring. Gotlandsäggs onödiga lagerhållning fastställdes även som ett slöseri och orsakerna till de olika slöserierna identifierades och presenterades i olika Ishikawadiagram. Förbättringsförslagen som studien resulterade i innebar att avskaffa det manuella lagersaldot och att möjliggöra direkt tillgång av det digitala lagersaldot på förpackningsanläggningen i Ruda. Genom att investera i ett system kopplat till det digitala lagersaldot där beräkningarna inför beordring görs automatiskt skulle slöseriet i form av väntan minska. En excelmodell togs även fram som en förbättringsåtgärd till dess att en investering i ett automatiskt system kan göras. För påfyllningar rekommenderades Gotlandsägg att fortsätta beordra fulla transporter men med lägre kvantiteter för varje enskild artikel. En ABC-klassificering genomfördes därför för att underlätta styrningen genom att fokusera på de artiklar som binder mest kapital. Vidare rekommenderades tillämpningen av en högre lagerränta för att undvika onödig lagerhållning i framtiden. / Background: Companies are constantly seeking new ways to design more efficient supply chains and, to ensure profitability, seeks to reduce the costs of production, transportation and inventory. Because inventory related costs account for a large part of the company's total logistics costs, it has come to be the focus of many cost reduction activities. To reduce costs related to inventory while obtaining a desired service level is referred to as inventory control. One way to achieve better inventory control is to locate waste that may exist in the current control. This can be done by establishing a process mapping in order to identify and minimize or eliminate the waste that was identified by giving suggestions of improvement. Purpose: The purpose of this study is to describe Gotlandsägg’s current inventory control of packages for eggs and what costs it results in. Possible waste is then identified in the current inventory control of packages to further on present suggestions on how the inventory control can improve with the goal of reducing costs while still achieve a desired service level. Method: The following essay is a qualitative case study, performed on the company Gotlandsägg AB's packaging plant in Ruda. The study has adopted a deductive standpoint with a positivistic approach. The collection of data contains both primary data, which have been collected through unstructured, structured and semi-structured interviews with staff of Gotlandägg, and secondary data that have been collected from Gotlandsäggs intern systems, Linnaeus University's database and other available literature. v Conclusion: The study has described Gotlandsäggs current replenishment process of their packages for eggs by establishing a process mapping and determined the definable annual cost of inventory management. The current inventory control leads to that the packages are stored for a long time and therefore results in large amounts of tied up capital which increases inventory carrying costs. The process mapping further defined waste in a form of activity that did not create any value to the process, the use of manual inventory levels, as well as waste in the form of waiting for the digital inventory balance and manual calculations to be made before ordering could be performed. Gotlandsägg’s excessive inventory was also identified as a type of waste and the reasons for the types of waste was presented in different Ishikawa-diagrams. The suggestions for improvements concluded to eliminate the manual inventory levels and to allow direct access of the digital inventory levels at the packaging plant in Ruda. By investing in a system that is linked to the inventory levels, where calculations for ordering are made automatically, the waste of waiting could be minimized. An excel model was developed as an improvement until investments in an automated system can be made. For the refills of items, its recommended to control the packaging types in different ways but that all articles should be ordered in minimum order quantity as far as possible. As regarding transport, Gotlandsägg should continue to order full transports but with lower quantities of each article. An ABC-classification was therefore carried out to facilitate the control and to focus on the articles responsible for the most tied up capital. It was also recommended to adopt a higher inventory rate to avoid excessive inventory in the future.