<p>The aims of this thesis were to expand the knowledge about sexual and reproductive health among urban Ugandan youths, living in a slum, and to evaluate the national flow-chart for management of the abnormal vaginal discharge (AVD) syndrome in adolescent girls. Data collection included individual interviews, focus-group discussions and clinical investigations with tests for chlamydia trachomatis (CT), neisseria gonorrhoea (NG), trichomonas vaginalis (TV), syphilis, and HIV infection. Poverty, peer pressure and gender power imbalance were obstacles to safe sexual practices: to abstain from sex, be faithful or to use condoms. Prevalence among the 199 female and 107 male adolescents for CT, NG, TV, syphilis and HIV was 4.5%, 9.0%, 8.0%, 4.0% and 15.2% for females and 4.7%, 5.7%, 0%, 2.8% and 5.8% for males. The national AVD flow-chart had a sensitivity of 61%, a specificity of 38.5% and a positive predictive value (PPV) of 11.6%. A flow-chart using risk factors, rather than symptoms, implicated a sensitivity/specificity and PPV of 82.6%/47% and 17.3% respectively. Socially disadvantaged females had a high risk to be HIV infected and HIV infection was associated to other STIs. Females were more likely than males to have any of the infections studied. Voluntary counselling and testing (VCT) for HIV was considered as helpful in preventing the spread of HIV. Obstacles for testing were: lack of time and money, fear of stigmatisation and fear that the knowledge of HIV positive status could shorten someone's life. An alternative flow-chart for management of AVD among adolescent girls should be evaluated. Girl's opportunities for education and income generating work should be a priority. VCT services for young people should be made accessible in terms of cost, time and quality of counselling.</p>

This thesis focuses on the use of interpreters in Swedish healthcare. The overall aim was to explore how individuals, healthcare professionals and family members experience and perceive the use of interpreters in healthcare. The study design was explorative and descriptive. The thesis included Serbo-Croatian(Bosnian/Croatian/Serbian)speaking individuals(n=17), healthcare professionals(n=24), official documents(n=60)and family members(n=10)of individuals using interpreters in healthcare. Individual interviews, written descriptions, review of official documents in the form of incident reports from a single case study and focus group interviews were used to collect data. Data were analyzed using phenomenography, qualitative content analysis and qualitative data analysis of focus group interviews. The overall finding from all perspectives was the wish to have a qualified interpreter whose role was as a communication aid but also as a practical and informative guide in healthcare. The perception of a qualified interpreter was someone highly skilled in medical terminology, Swedish and individuals’ native language with ability to adapt to different dialects, wearing non-provocative and neutral clothes, of the same gender, with a professional attitude and preferably in personal contact through face-to-face interaction. Besides being a communication aid, the interpreter was perceived as having an important role in helping individuals to find the right way to and within the healthcare system because foreign-born individuals were unable to understand information in healthcare. Another aspect was to have a well-developed organization with good cooperation between the parties involved in the interpretation situation, such as patients, interpreter, interpreter agency, family members and healthcare professionals to offer a good interpretation situation. In conclusion, the use of an interpreter was determined by individual and healthcare situational factors. Individualized holistic healthcare can be achieved by offering and using high-quality interpreters and cooperation within a well-developed interpreter organization.   Keywords: communication, healthcare service, patient-safe quality care, qualitative data collection, qualitative data analysis, users’ perceptions/experiences, utilization of interpreters.

Most of the blood transfusion facilities had adequate space, but lacked some of the basic equipment. Blood collected in these facilities was not adequate to meet the blood needs of the regions. These facilities lacked specialised personnel and some of those practicing blood transfusion were not conversant with blood groups, transfusion reactions and the measures to be taken if a reaction occurs. The findings of this study will be used to strengthen blood transfusion services in these hard to reach regions.

The aims of this thesis were to expand the knowledge about sexual and reproductive health among urban Ugandan youths, living in a slum, and to evaluate the national flow-chart for management of the abnormal vaginal discharge (AVD) syndrome in adolescent girls. Data collection included individual interviews, focus-group discussions and clinical investigations with tests for chlamydia trachomatis (CT), neisseria gonorrhoea (NG), trichomonas vaginalis (TV), syphilis, and HIV infection. Poverty, peer pressure and gender power imbalance were obstacles to safe sexual practices: to abstain from sex, be faithful or to use condoms. Prevalence among the 199 female and 107 male adolescents for CT, NG, TV, syphilis and HIV was 4.5%, 9.0%, 8.0%, 4.0% and 15.2% for females and 4.7%, 5.7%, 0%, 2.8% and 5.8% for males. The national AVD flow-chart had a sensitivity of 61%, a specificity of 38.5% and a positive predictive value (PPV) of 11.6%. A flow-chart using risk factors, rather than symptoms, implicated a sensitivity/specificity and PPV of 82.6%/47% and 17.3% respectively. Socially disadvantaged females had a high risk to be HIV infected and HIV infection was associated to other STIs. Females were more likely than males to have any of the infections studied. Voluntary counselling and testing (VCT) for HIV was considered as helpful in preventing the spread of HIV. Obstacles for testing were: lack of time and money, fear of stigmatisation and fear that the knowledge of HIV positive status could shorten someone's life. An alternative flow-chart for management of AVD among adolescent girls should be evaluated. Girl's opportunities for education and income generating work should be a priority. VCT services for young people should be made accessible in terms of cost, time and quality of counselling.

Shadow shielding is a novel and practical concept for waste heat rejection from lunar surface spacecraft systems. A shadow shield is a light shield that shades the radiator from parasitic thermal radiation emanating from the sun or lunar surface. Radiator size and mass can reduce if the radiator is not required to account for parasitic heat loads in addition to system energy rejection requirements. The lunar thermal environment can be very harsh towards radiative heat rejection. Parasitic heat loads force the radiator to expand in size and mass to compensate. On the Moon, there are three types: surface infrared, solar insulation, and albedo. This thesis tests shadow shielding geometry and its effect on the radiator and nuclear reactor in a reactor-powered Carnot heat engine. Due to the nature of cooling by radiative heat transfer, the maximum shaft work a Carnot system can produce and the minimal required radiator area occurs when the Carnot efficiency is 25%. First, a case for shadow shielding is made using an isothermal, control radiator model in Thermal Desktop. Six radiator temperatures and three latitudes are considered in the tests. Test variables in this section include radiator shapes and shade geometry. The simulations found that shadow shielding is best suited for a low-temperature radiator at the lunar equator. Optimized parabolic shade geometry includes a focus right above or at the top of the radiator and full to three-quarters shade height. The most useful rectangular radiator shape for shadow shielding is that which has a low height and long width. All simulations were conducted using a shade with a 10 kg/m2 area mass. A sensitivity study was conducted for different shade area masses using high and low values found in the literature. The shade is the most useful when the shade's area mass is less than or equal to that of the radiator. If the shade mass is below this threshold, the shade would be applicable to all radiator temperatures tested. Optimized shade and radiator geometry results were then factored into a second model where the radiator is comprised of heat pipes which is similar to radiators from actual system designs. Further simulations were conducted implementing the SAFE-4001 fast fission nuclear reactor design. The study found that shadow shielding allowed the system to use a low-temperature radiator where other configurations were not viable because shadow shielding drastically improves radiative heat transfer from the radiator, but at the consequence of raising radiator mass.

No description available.

<p>This study assesses the present level of household water access and the willingness to pay in South Africa. Although the general literature informs that progress has been made in positing South Africa above the levels found in most African countries, there are some marked inequalities among the population groups and across the provinces, with some performing well and others poorly in this regard. The study looks at the extent to which households differ in terms of water access and willingness to pay according to the province of residence. The study focuses on household heads / male and female, through different social and demographic attributes, by taking account of variables such as age, education&nbsp / attainment, geographic areas, and population group to name but a few. The data used in this study comes from the 2007 General Household Survey (GHS) conducted by Statistics South Africa. The scope is national and employs cross tabulation and logistic regression to establish relationships and the likelihood of living in a household with access to safe&nbsp / drinking water in South Africa. Results presented in this study suggest that the difference is determined by socio- demographic characteristics of each household such as age, gender, population group, level of education, employment status income, dwelling unit, dwelling ownership, living quarters,household size and income. It throws more light as to what needs to be taken into account when considering demand and supply of and priorities for water intervention from the household perspective.</p>

The numerous man-made disasters and natural catastrophes that menace major communities accentuate the need for proper planning for emergency evacuation. Transportation networks in cities evolve over long time spans in tandem with population growth and evolution of travel patterns. In emergencies, travel demand and travel patterns drastically change from the usual everyday volumes and patterns. Given that most US and Canadian cities are already congested and operating near capacity during peak periods, network performance can severely deteriorate if drastic changes in Origin-Destination (O-D) demand patterns occur during or after a disaster. Also, loss of capacity due to the disaster and associated incidents can further complicate the matter. Therefore, the primary goal when a disaster or hazardous event occurs is to coordinate, control, and possibly optimize the utilization of the existing transportation network capacity. Emergency operation management centres face multi-faceted challenges in anticipating evacuation flows and providing proactive actions to guide and coordinate the public towards safe shelters. Numerous studies have contributed to developing and testing strategies that have the potential to mitigate the consequences of emergency situations. They primarily investigate the effect of some proposed strategies that have the potential of improving the performance of the evacuation process with modelling and optimization techniques. However, most of these studies are inherently restricted to evacuating automobile traffic using a certain strategy without considering other modes of transportation. Moreover, little emphasis is given to studying the interaction between the various strategies that could be potentially synergized to expedite the evacuation process. Also, the absence of an accurate representation of the spatial and temporal distribution of the population and the failure to identify the available modes and populations that are captive to certain modes contribute to the absence of multimodal evacuation procedures. Incorporating multiple modes into emergency evacuation has the potential to expedite the evacuation process and is essential to assuring the effective evacuation of transit-captive and special-needs populations . This dissertation presents a novel multimodal optimization framework that combines vehicular traffic and mass transit for emergency evacuation. A multi-objective approach is used to optimize the multimodal evacuation problem. For automobile evacuees, an Optimal Spatio-Temporal Evacuation (OSTE) framework is presented for generating optimal demand scheduling, destination choices and route choices, simultaneously. OSTE implements Dynamic Traffic Assignment (DTA) techniques coupled with parallel distributed genetic optimization to guarantee a near global optimal solution. For transit evacuees, a Multi-Depots, Time Constrained, Pick-up and Delivery Vehicle Routing Problem (MDTCPD-VRP) framework is presented to model the use of public transit vehicles in evacuation situations. The MDTCPD-VRP implements constraint programming and local search techniques to optimize certain objective functions and satisfy a set of constraints. The OSTE and MDTCPD-VRP platforms are integrated into one framework to replicate the impact of congestion caused by traffic on transit vehicle travel times. A proof-of-concept prototype has been tested; it investigates the optimization of a multimodal evacuation of a portion of the Toronto Waterfront area. It also assesses the impact of multiple objective functions on emergency evacuation while attempting to achieve an equilibrium state between transit modes and vehicular traffic. Then, a large-scale application, including a demand estimation model from a regional travel survey, is conducted for the evacuation of the entire City of Toronto. This framework addresses many limitations of existing evacuation planning models by: 1) synergizing multiple evacuation strategies; 2) utilizing robust optimization and solution algorithms that can tackle such multi-dimensional non deterministic problem; 3) estimating the spatial and temporal distribution of evacuation demand; 4) identifying the transit-dependent population; 5) integrating multiple modes in emergency evacuation. The framework presents a significant step forward in emergency evacuation optimization.

The numerous man-made disasters and natural catastrophes that menace major communities accentuate the need for proper planning for emergency evacuation. Transportation networks in cities evolve over long time spans in tandem with population growth and evolution of travel patterns. In emergencies, travel demand and travel patterns drastically change from the usual everyday volumes and patterns. Given that most US and Canadian cities are already congested and operating near capacity during peak periods, network performance can severely deteriorate if drastic changes in Origin-Destination (O-D) demand patterns occur during or after a disaster. Also, loss of capacity due to the disaster and associated incidents can further complicate the matter. Therefore, the primary goal when a disaster or hazardous event occurs is to coordinate, control, and possibly optimize the utilization of the existing transportation network capacity. Emergency operation management centres face multi-faceted challenges in anticipating evacuation flows and providing proactive actions to guide and coordinate the public towards safe shelters. Numerous studies have contributed to developing and testing strategies that have the potential to mitigate the consequences of emergency situations. They primarily investigate the effect of some proposed strategies that have the potential of improving the performance of the evacuation process with modelling and optimization techniques. However, most of these studies are inherently restricted to evacuating automobile traffic using a certain strategy without considering other modes of transportation. Moreover, little emphasis is given to studying the interaction between the various strategies that could be potentially synergized to expedite the evacuation process. Also, the absence of an accurate representation of the spatial and temporal distribution of the population and the failure to identify the available modes and populations that are captive to certain modes contribute to the absence of multimodal evacuation procedures. Incorporating multiple modes into emergency evacuation has the potential to expedite the evacuation process and is essential to assuring the effective evacuation of transit-captive and special-needs populations . This dissertation presents a novel multimodal optimization framework that combines vehicular traffic and mass transit for emergency evacuation. A multi-objective approach is used to optimize the multimodal evacuation problem. For automobile evacuees, an Optimal Spatio-Temporal Evacuation (OSTE) framework is presented for generating optimal demand scheduling, destination choices and route choices, simultaneously. OSTE implements Dynamic Traffic Assignment (DTA) techniques coupled with parallel distributed genetic optimization to guarantee a near global optimal solution. For transit evacuees, a Multi-Depots, Time Constrained, Pick-up and Delivery Vehicle Routing Problem (MDTCPD-VRP) framework is presented to model the use of public transit vehicles in evacuation situations. The MDTCPD-VRP implements constraint programming and local search techniques to optimize certain objective functions and satisfy a set of constraints. The OSTE and MDTCPD-VRP platforms are integrated into one framework to replicate the impact of congestion caused by traffic on transit vehicle travel times. A proof-of-concept prototype has been tested; it investigates the optimization of a multimodal evacuation of a portion of the Toronto Waterfront area. It also assesses the impact of multiple objective functions on emergency evacuation while attempting to achieve an equilibrium state between transit modes and vehicular traffic. Then, a large-scale application, including a demand estimation model from a regional travel survey, is conducted for the evacuation of the entire City of Toronto. This framework addresses many limitations of existing evacuation planning models by: 1) synergizing multiple evacuation strategies; 2) utilizing robust optimization and solution algorithms that can tackle such multi-dimensional non deterministic problem; 3) estimating the spatial and temporal distribution of evacuation demand; 4) identifying the transit-dependent population; 5) integrating multiple modes in emergency evacuation. The framework presents a significant step forward in emergency evacuation optimization.

The purpose of this study is to find existing circumstances in our country and a elder long-term care system of preventing transitions. Through the existing social insurance, for example: health insurance, national pension, labor insurance and the elderly welfare legal in our country, to compare with the other social countries, I hope to use the research analysis to find the problems of policies or legislated process that we need to prevent before the elder long-term care insurance started. Through the generalize analysis and history development of elder long-term care in many countries, use the Constitution and the Administrative Law to examine what Council of Grand Justices about Social Insurance interpretation and compare with the official policy offered by our government. I expect to avoid making mistakes and dispute like before and establishing the elder long-term care system which relieving burdens. After the analysis, I found that all of the advanced countries are almost confronting by problems like aging of population and the birthrate has been decreasing, and also confronting lack of care members and long-term care needed huge monetary payment issues. The key core of all the problems is whether it has enough money to the whole social welfare countries to be successful. Social welfare in democratic countries also face election activities carrying on social welfare politics. Ignoring national finance situations and majority political men were merely thinking off-the-shelf votes. It is priority for elder¡¦s policy but ignores the generation justice issues. Let me worry about whether descendant whom need care, not these elders, are there generations conflict being happened? In my opinion, to solve these problems is strengthening family function. If the whole social and nation wants to be stable, it is important to strengthen the family function. Therefore, the elder long-term care should be considered main family basis, in addition to ought to maintain the elder long-term care system and dualism and co-operate with National Health Insurance to work in coordination. The other elder social insurances have to adjust to unity, includes all kinds of old-age pensions similar nouns. Finally, it should be a definite principle and laws, and decrease indefinite concepts of law and reduce administrative discretion rights regarding pay items, thus it will protect people¡¦s rights instead of incurring damage beyond that could bring supervisory mechanism functions into full play after that.