Introdução: Prever a capacidade de resposta a fluidos continua sendo um desafio para os médicos que lidam com pacientes instáveis hemodinamicamente. A utilização de parâmetros estáticos, como pressão venosa central (PVC) tem sido usada por décadas, mas não é confiável, evidências robustas sugerem que seu uso deve ser abandonado. Ao longo dos últimos 15 anos, foram desenvolvidos vários testes dinâmicos, baseados no princípio de alteração da pré-carga cardíaca, usando as interações coração-pulmão, e, consequentemente do débito cardíaco. A elevação passiva das pernas (EPP), a infusão de pequenos volumes de fluidos, a variação da pressão de pulso (ΔPP), as variações nos diâmetros de grandes veias tem sido muito utilizados para avaliação de fluidoresponsividade (FR), neste contexto. Objetivo: Analisar e comparar medidas estáticas e dinâmicas antes, após EPP e após infusão de SF, verificando qual delas apresentam melhor FR. Métodos: Trinta e um pacientes instáveis hemodinamicamente e sob ventilação mecânica (VM) foram incluídos no estudo. Foram avaliados VTIFAO, VTIFMi, IDVCI, ΔPP, PVC, PAM antes de qualquer intervenção, após EPP e após infusão de 500ml SF. As variações dos parâmetros foram calculados para todos os pacientes. Resultados: Após EPP e infusão de SF o VTIFAO aumentou em 10% ou mais em 14 (45%) e 18 (58%) pacientes respectivamente, definidos como FR. A EPP previu a capacidade de resposta a fluidos com uma sensibilidade de 77,7%, especificidade de 100%, valor preditivo positivo de 100% e probabilidade de falso positivo de 0%. O parâmetro utilizado como padrão para FR foi o VTIFAO após SF. A PVC, o IDVCI, o ΔPP, PAM e avaliação médica não se mostraram capazes de avaliar adequadamente FR. Conclusão: Em pacientes instáveis hemodinamicamente e sob VM, a EPP foi capaz de avaliar FR com adequada sensibilidade e especificidade, podendo ser usada com segurança, antes da administração de fluidos. / Introduction: Predictig fluid responsiveness remains a constant challenge for physicians dealing with hemodynamically unstable patients. The use of static parameters, such as central venous pressure (CVP), although used for decades is not a trustworthy source, and the suggestion derived from more robust evidence suggests that the use of such should be abandoned. Over the last 15 years, various dynamic tests have been developed based on the principle of altering the cardiac preload, by using the heart-lung interactions and consequently cardiac output. Hence, Passive Leg Raising (PLR), the intake of small amounts of fluid, the variation of pulse pressure, variations in the diameter of large veins have all been widely used for evaluating fluid responsiveness (FR), within this context. Objective: The underlying objective behind this study was to test, if the non-invasive evaluation with transthoracic echocardiography, the Subaortic velocity time integral (VTI), the Distensibility Index of the Inferior Vena Cava (dIVC), the mitral velocity time integral (MTI), the (CVP) and the change in pulse pressure (ΔPP) after (PLR) and fluid infusion (500ml of saline solution) are able to predict the responsiveness of fluid therapy. Methods: Thirty one hemodynamically unstable patients, under mechanical ventilation (MV) were included in the study. Evaluations were made of VTI, MTI, DIVC), ΔPP and CVP before any intervention, after PLR and after infusion of 500ml saline solution. The variations of the parameters were calculated for all patients. Results: After PLR and infusion of saline solution, the VTI increased by 10% or more in 14 (45%) and 18 (58%) patients, respectively, defined as fluid responders. The PLR predicted a response capacity to fluids with a sensibility of 77,7%, specificity of 100%, a positive predictive value of 100% and a false positive probability of 0%. The CVP, dIVC, ΔPP, PAM and the medical evaluation were not capable of providing an adequate FR evaluation. Conclusion: In hemodynamically unstable patients under MV, PLR were capable of precisely predicting the capacity of FR. / Dissertação (Mestrado)

To a large extent, business-customer interactions are acted out on digital meeting places. When the possibilities for businesses to engage in face-to-face interactions decrease, relationship building and customer service becomes more of a challenge. Digital services are easily duplicated by competitors and with standardization of interfaces and products, customers tend to switch more frequently between providers. One area where the creation and maintenance of loyal customers appears to be highly relevant is the domain of e-banking. Studies have shown that by personalizing the experience for the user, customer loyalty can be enhanced. Existing methods of interface adaptation shifts the responsibility for the resulting user experience design from the designer to either the user or the system. However, research shows that handing over responsibility for the design to the user can damage the user experience. Furthermore, we argue that as long as computers cannot translate the meaning of what a human communicates, and understand the motivation that lies behind her actions, human designers and researchers need to own the responsibility for designing user experiences. Responsive web design differ from the concept of user responsiveness in the way that it is not truly responsive to the user but to the technical device that is used. Following a design science research methodology, this paper presents the development of a conceptual framework for user responsive user experience design (URUXD) that aims to strengthen the bond between user and provider by enabling a more relevant and personalized user experience. The conceptual framework introduces a way to design user responsive information systems that could be useful in domains where the user audience is large and diverse, as in the case of e-banking. A personalized user experience is enabled by transcending the current use of personas as design tools to also involve them in categorizing real-time users through the use of personas as mapping tools. Multiple persona sets are incorporated in the framework which gives the user experience designer the possibility of designing a holistic user experience for each persona set. The framework thus enables the incorporation of multiple GUI designs in an information system that is user responsive, without the risk of violating usability principles. / Interaktionen mellan företag och kund sker nuförtiden oftast på digitala mötesplatser. När möjligheten för företag att träffa kunden öga mot öga minskar blir det en utmaning att skapa nära affärsrelationer och förmedla bra kundservice. Med konkurrenter som enkelt kopierar digitala tjänster och med en standardisering av gränssnitt och tjänster tenderar kunder att oftare byta leverantör. Inom e-banking framstår därför skapande och upprätthållande av lojala kunder som högst relevant. Genom att personifiera användarupplevelsen kan kundlojaliteten förbättras. Befintliga metoder för gränssnittsadaption lämnar över ansvaret för den resulterande designen från designern till antingen användaren eller systemet. Men, om ansvaret för designen tilldelas användaren kan resultatet bli i en skadad användarupplevelse. Så länge datorer inte kan översätta meningen bakom vad en människa kommunicerar eller skapa en förståelse för en användares bakomliggande motivation till varför hen utför handlingar, måste mänskliga designers inneha ansvaret för designen av användarupplevelsen. Vidare skiljer sig responsiv webbdesign från konceptet användarresponsivitet i meningen att responsiv webbdesign inte är direkt responsiv mot användaren utan snarare mot den tekniska apparat som används. Genom att följa en design science forskningsmetodik utvecklades ett konceptuellt ramverk för design av användarresponsiva användarupplevelser (user responsive user experience design (URUXD)). Målet var att stärka bandet mellan användare och leverantör genom att möjliggöra en mer relevant och personifierad användarupplevelse. Det konceptuella ramverket introducerar ett sätt att designa användarresponsiva informationssystem vilket kan vara användbart i domäner där användargruppen är stor och heterogen, vilket är fallet för e-banking. En personifierad användarupplevelse möjliggörs genom att utöka det befintliga användningsområdet för designverktyget personas till att även inkludera dem som mappningssverktyg för att kategorisera användare i realtid. Multipla persona sets införlivas i ramverket vilket skapar möjlighet för designern att skapa en holistisk användarupplevelse för varje enskilt persona set. Det konceptuella ramverket möjliggör därigenom för multipla gränssnittdesigns för ett informationssystem som därmed blir användarresponsivt, utan att underminera principer för användbarhet.

Cette recherche traite de la réactivité des parlementaires français vis-à-vis de leur circonscription.Ce faisant, notre thèse investit l’aspect dyadique de la représentation politique qui a été largementignoré par la littérature française et offre ainsi un nouveau regard sur la variété des activités desdéputés français tant à Paris qu’en circonscription. En s’inspirant des écrits du néoinstitutionnalismedes choix rationnels, notre thèse vise à mettre en lumière les déterminantsinstitutionnels de la réactivité vis-à-vis de la circonscription ainsi que les logiques qui sous-tendentles pratiques de représentation. En surmontant le descriptivisme de beaucoup d’études à ce sujetet à l’aide de solides matériaux empiriques, nous montrons que le territoire d’élection affectegrandement le comportement des députés tant dans le contenu que sur la forme des activités. Lacirconscription et les attentes différenciées des citoyens agissent de manière systématique sur lamanière dont les députés mènent leur mandat. / This research deals with French MPs responsiveness. This dissertation studies the dyadicrepresentation in the French Assemblée nationale which was largely neglected by scholars. It givesthus a new insight on the diversity of French MPs activities both in Paris and in their district.Following the arguments of the rational choice new institutionalism, our dissertation aims tohighlight the institutional determinants of MPs responsiveness toward their district and the logicsthat underlie their practices of representations. By overcoming the descriptiveness of many studiesand thanks to original and solid empirical data, we show that the characteristics of the districtstrongly affect both the kind and the content of MPs activities. The district and the various citizens’expectations systematically affect the way French MPs conceive their mandate.

Indicators of quality early intensive behavioral intervention (EIBI) include comprehensive interventions, adequately trained staff, high rates of effective instruction delivery, happy interactions between children and their teachers, and socially valid outcomes. When these are in place, high quality EIBI is more likely to increase progress that children with autism make during treatment. When not in place, progress is not as likely, as rapid, or as meaningful. To date, there is limited research regarding the correlation between these indicators of high-quality EIBI and the degree to which their effects are meaningful to direct consumers. The purpose of this methodological study was to compare direct, quantitative measures of teaching interactions (child initiations, teacher initiations, child affect, teacher affect) with qualitative measures (stakeholder ratings of teacher effectiveness, amount of opportunities for interaction and interest in the child) of teaching interactions to determine what sets the occasion for expert stakeholders to describe a teaching interaction as effective, quality therapy.

This master's thesis offers comprehensive perspective of good governance concept in a theoretical level as well as from a practical point of view with emphasis on the Czech Republic. The objective of the thesis is to investigate the theoretical background of the good governance concept and its basic principles, focused on dealing with the concept in the Czech Republic. The work also provides the assessment of the critical points associated with the good governance concept implementation and attempts to provide the possible solutions to eliminate these points. Thirteen research interviews were conducted with the public administration staff members and the leading experts in the field to analyze the current state of good governance in the Czech Republic. Thematic analysis was utilized for this purpose and results have shown that good governance is not broadly applied yet. Besides the apparent issues such as problems with human resources, communication, politicization of public administration, departmentalism or absence of long-term vision, the key obstacle to implementation of the good governance concept in the Czech Republic seems to be low level of cultural and social standards.

South Africa is a developing country that contends with a serious skills deficit that hampers its economic growth prospects. To address this skills deficit particularly at intermediate level, the government identified the public Further Education and Training (FET) College sector to serve as a medium to counter the challenge. Subsequent to the aforementioned decision by the government, political and financial support was pledged to the sector. Legislation that is attributed to the sector was also enacted and amended to capacitate the sector to perform optimally. The focus of this research was the capability of the public FET College sector in the province of Gauteng to respond credibly and qualitatively to the skills needs of the province‟s labour markets. Thus, the primary purpose was to evaluate the role that the sector in the province plays to address the skills shortage. The research design for the study was triangulation in nature, encompassing qualitative and quantitative methods. Nine public FET colleges, six companies and the Indlela Training Centre were sampled for gathering information regarding the responsiveness, articulation and efficiency of the province‟s public FET College sector. Students, lecturers, HODs and company‟s skills development managers were interviewed and sampled for the completion of questionnaires. Some significant differences in perceptions relating to the role played by the province‟s public FET college sector in addressing the skills shortage were found. Findings indicated that the massive financial and political support pledged to the sector by the government did not translate into efficiency, credibility and responsiveness nor capacitate the sector. In terms of the findings employers are skeptical about the quality of graduates that the province‟s public FET colleges ect or produces. Further, it was found that the sector‟s lecturers are inappropriately qualified and this contributes to the inefficiency of the sector in performing optimally. The lack of a formal skills development partnership between the sector and the labour markets hampers the articulation and the responsiveness of the sector to the skills needs of labour market. However, the current development whereby all the skills development institutions have been placed under one department has the potential to add value to the skills development landscape, particularly the public FET College sector. / Educational Leadership and Management / D. Ed. (Educational Management)

No description available.

Background Iron deficiency (ID) is the world‟s most prevalent micronutrient deficiency and predominantly affects developing countries, also South Africa. In areas with low fish consumption and high n-6 PUFA vegetable oil intake, there is a risk for having inadequate n-3 PUFA status. Both iron and n-3 PUFA play important roles in the immune response, and supplementation is a strategy to alleviate deficiencies. However, little is known about potential interactive effects between concurrent iron and n-3 PUFA supplementation on the immune system. This is also important in the context that iron supplementation may be unsafe and may increase morbidity and mortality. Aim The overall aim of this thesis was to assess the effects of iron and docosahexaenoic (DHA)/eicosapentaenoic acid (EPA) supplementation, alone and in combination, on the immune system of ID children. More specifically, these effects were investigated on the occurrence and duration of illness and school-absenteeism due to illness, peripheral blood mononuclear cell (PBMC), red blood cell (RBC) and plasma total phospholipid fatty acid composition, iron status, fatty acid-derived immune modulators and targeted PBMC gene expression. Furthermore, association of PBMC, RBC and plasma total phospholipid fatty acid composition with allergic disease, were also examined. Design In a 2-by-2 factorial, randomised, double-blind, placebo-controlled trial, South African children (n = 321, aged 6–11 y) were randomly assigned to receive oral supplements of either 1) iron (50 mg as ferrous sulphate) plus placebo; 2) DHA/EPA (420/80 mg) plus placebo; 3) iron plus DHA/EPA (420/80 mg); or 4) placebo plus placebo for 8.5 mo, four times per week. Absenteeism and illness symptoms were recorded and biochemical parameters for compliance as well as parameters fundamental to immune function were assessed at baseline and endpoint. Furthermore, in a cross-sectional design, associations of allergic disease with baseline fatty acid composition of PBMC, RBC and plasma were examined. Results The combination of iron and DHA/EPA significantly attenuated respiratory illness caused by iron supplementation. DHA/EPA supplementation alone improved respiratory symptoms at school, but increased headache-related absenteeism. DHA/EPA and iron supplementation individually tended to increase and decrease anti-inflammatory DHA and EPA-derived mediators, respectively. Furthermore the anti-inflammatory DHA-derived immune mediator, 17HDHA was higher in the DHA/EPA plus placebo and iron plus DHA/EPA groups than in the iron plus placebo group. Also, the pro-inflammatory arachidonic acid (AA)-derived modulators (5- and 15-hydroxyeicosapentaenoic acid) were significantly lower in the iron plus DHA/EPA group compared to the placebo plus placebo groups. In the study population, 27.2% of the children had allergic disease and AA in PBMC phospholipids was significantly lower in the allergic children than in the non-allergic children. In RBC phospholipids dihomo-gamma-linolenic acid (DGLA) and the ratio of DGLA: linoleic acid (LA) correlated negatively and the n-6:n-3 PUFA ratio positively with total immunoglobulin E (tIgE). Furthermore, trans-C18:1n-9, tended to be higher in the allergic group. Conclusion DHA/EPA prevented respiratory illness caused by iron supplementation and although DHA/EPA on its own reduced respiratory morbidity when the children were present at school, surprisingly it increased the likelihood of being absent with headache and fever. The biochemical findings compliment the clinical results and support previous observations about DHA/EPA supplementation to reduce inflammation, but add to the current knowledge base that a relatively high oral dose of non-haem iron modulates circulating lipid-derived immune modulators and related gene expression. Furthermore, when supplementing with iron and DHA/EPA combined, in this ID population with low fish intake, the anti-inflammatory effect of DHA/EPA is maintained concurrently with attenuation of respiratory morbidity. This finding support the notion that excess iron (probably as non-transferrin bound iron) becomes available for pathogens and is probably why we found that iron increased respiratory infectious morbidity. The improved clinical outcome with combined supplementation seems to be related to increased lipid-mediator synthesis gene expression and the availability of DHA/EPA, leading to a more pro-resolving profile and enhanced immune competence. Overall these results give better insight into immune function and infectious morbidity in relation to n-3 PUFA and iron status and treatment, as well as the possible association of fatty acid status with allergic disease in young South-African school children. / PhD (Nutrition), North-West University, Potchefstroom Campus, 2015

Background Iron deficiency (ID) is the world‟s most prevalent micronutrient deficiency and predominantly affects developing countries, also South Africa. In areas with low fish consumption and high n-6 PUFA vegetable oil intake, there is a risk for having inadequate n-3 PUFA status. Both iron and n-3 PUFA play important roles in the immune response, and supplementation is a strategy to alleviate deficiencies. However, little is known about potential interactive effects between concurrent iron and n-3 PUFA supplementation on the immune system. This is also important in the context that iron supplementation may be unsafe and may increase morbidity and mortality. Aim The overall aim of this thesis was to assess the effects of iron and docosahexaenoic (DHA)/eicosapentaenoic acid (EPA) supplementation, alone and in combination, on the immune system of ID children. More specifically, these effects were investigated on the occurrence and duration of illness and school-absenteeism due to illness, peripheral blood mononuclear cell (PBMC), red blood cell (RBC) and plasma total phospholipid fatty acid composition, iron status, fatty acid-derived immune modulators and targeted PBMC gene expression. Furthermore, association of PBMC, RBC and plasma total phospholipid fatty acid composition with allergic disease, were also examined. Design In a 2-by-2 factorial, randomised, double-blind, placebo-controlled trial, South African children (n = 321, aged 6–11 y) were randomly assigned to receive oral supplements of either 1) iron (50 mg as ferrous sulphate) plus placebo; 2) DHA/EPA (420/80 mg) plus placebo; 3) iron plus DHA/EPA (420/80 mg); or 4) placebo plus placebo for 8.5 mo, four times per week. Absenteeism and illness symptoms were recorded and biochemical parameters for compliance as well as parameters fundamental to immune function were assessed at baseline and endpoint. Furthermore, in a cross-sectional design, associations of allergic disease with baseline fatty acid composition of PBMC, RBC and plasma were examined. Results The combination of iron and DHA/EPA significantly attenuated respiratory illness caused by iron supplementation. DHA/EPA supplementation alone improved respiratory symptoms at school, but increased headache-related absenteeism. DHA/EPA and iron supplementation individually tended to increase and decrease anti-inflammatory DHA and EPA-derived mediators, respectively. Furthermore the anti-inflammatory DHA-derived immune mediator, 17HDHA was higher in the DHA/EPA plus placebo and iron plus DHA/EPA groups than in the iron plus placebo group. Also, the pro-inflammatory arachidonic acid (AA)-derived modulators (5- and 15-hydroxyeicosapentaenoic acid) were significantly lower in the iron plus DHA/EPA group compared to the placebo plus placebo groups. In the study population, 27.2% of the children had allergic disease and AA in PBMC phospholipids was significantly lower in the allergic children than in the non-allergic children. In RBC phospholipids dihomo-gamma-linolenic acid (DGLA) and the ratio of DGLA: linoleic acid (LA) correlated negatively and the n-6:n-3 PUFA ratio positively with total immunoglobulin E (tIgE). Furthermore, trans-C18:1n-9, tended to be higher in the allergic group. Conclusion DHA/EPA prevented respiratory illness caused by iron supplementation and although DHA/EPA on its own reduced respiratory morbidity when the children were present at school, surprisingly it increased the likelihood of being absent with headache and fever. The biochemical findings compliment the clinical results and support previous observations about DHA/EPA supplementation to reduce inflammation, but add to the current knowledge base that a relatively high oral dose of non-haem iron modulates circulating lipid-derived immune modulators and related gene expression. Furthermore, when supplementing with iron and DHA/EPA combined, in this ID population with low fish intake, the anti-inflammatory effect of DHA/EPA is maintained concurrently with attenuation of respiratory morbidity. This finding support the notion that excess iron (probably as non-transferrin bound iron) becomes available for pathogens and is probably why we found that iron increased respiratory infectious morbidity. The improved clinical outcome with combined supplementation seems to be related to increased lipid-mediator synthesis gene expression and the availability of DHA/EPA, leading to a more pro-resolving profile and enhanced immune competence. Overall these results give better insight into immune function and infectious morbidity in relation to n-3 PUFA and iron status and treatment, as well as the possible association of fatty acid status with allergic disease in young South-African school children. / PhD (Nutrition), North-West University, Potchefstroom Campus, 2015

台灣地區的民主化過程一直是中外學者注視的焦點。在長期實行民選地方政府或地方自治的台灣，真正是一個民主的社會嗎？在解嚴、動戡時期終止前，很容易回答，由於沒有組黨自由，中央民代選舉只是部分的增額改選，台灣的全國政治並不能達到民主社會的基本標準。但是，地方選舉則是長期地、完整地在舉行，要回答台灣地方是否民主，仍很難輕易地給予答案。地方民主是如此複雜、多樣化的面貌，如何才算達成地方民主？本論文基本上是以Leach和Percy-Smith所提出的地方民主的四個面向為標準，此即：1、課責性；2、回應性；3、參與性；4、代表性；進而探討。 筆者研究後發現：第一，從台北市的民主經驗來看，代表性應該不是問題的癥結；所謂的代表性是否意味著該和R. A. Dahl所言的，和社會人口或職業的結構相符合？在地方民主上來看，由於社會的多元化，以及要求民意代表的專業及高學歷背景，代表社會結構的多元民主（polyarchy）是否值得再強調？可以深思。第二，從台北市的民主經驗來看，參與性應該是地方民主很重要的一項指標。如何讓民眾更直接的參與到民主政治中，除了選舉之外，應該有更多的、直接的交換意見的平台或管道，例如公民投票、公民論壇、協調會等等。第三，地方民主的參與和地方政府的回應性夾雜在一塊，民眾參與到政策討論的領域中，政府也加入予以回應。所以，地方民主中，回應性與參與性似乎呈現某種程度的關聯性。第四，不論是參與性、回應性等民主的程度，都與政府能力有關，似乎地方政府解決問題的能力越高，民眾就越會表現出對於地方政府做為的參與，以及政策的回應。