Because of the expense associated with hospital admissions, the use of observation status has grown. One of the most consistently measured outcomes in observation is the patient length of stay (LOS). Research supports the positive impact that nurse practitioners (NP) have on LOS when added to other service lines that could be applied to observation. Banner Desert Medical Center (BDMC) is currently attempting to decrease their observation LOS. Adding acute care nurse practitioners (ACNP) to the care delivery model is a potential intervention. The purpose of this project was to develop an executive summary to inform staff of current evidence that supports the addition of ACNPs to observation. Then, via a survey, the project aimed to determine the level of staff support by identifying the Transtheoretical Model of Change (TTM) Stage of Change and to recommend appropriate stage-matched interventions for staff based on TTM processes of change. The 10 Likert scale survey questions were adapted from two validated TTM surveys. The final question asked for the pros and cons of the intervention to determine the Decisional Balance (DB). The registered nurse (RN) cohort demonstrated consistently strong support for the proposed intervention with an average mean response of 6.57 on affirmative questions and a correspondingly low average mean of 2.2 on negative questions. When compared to the RN cohort, the physician cohort had lower mean responses with an average of 4.29 on every affirmative, a higher average mean response of 3.85 on the negatively worded questions. The DB for RNs was 19 pros to two cons. The DB for physicians was eight cons to three pros. These finding reflect that nurses are in the Preparation Stage of Change and are ready to move forward with adding ACNPs. An appropriate stage-matched intervention for registered nurses would be the development of change teams. In contrast, the physician cohort is in the Precontemplation stage and is not ready to proceed with adding ACNPs. Appropriate stage-matched interventions for physicians would include facilitating consciousness-raising activities such as an open forum to communicating information about the proposed change and to explore concerns and questions regarding the intervention.

This thesis investigates the problem of commencement of insolvency proceedings, content of an insolvency petition, the effects of insolvency proceedings and the decission about insolvency petition. In connection with the filing of insolvency petition focuses on issues of international jurisdiction. The paper also analyzed the empirical data relating to insolvency proposals. The aim is examining whether the current legal system of commencement insolvency proceedings can be misuse and whether the legal framework of international jurisdiction can be misuse. There are also examine various possibilities of misuse legislation. Also, the thesis focuses on the possible regulatory considerations.

The thesis analyses the influence of reimbursement regulatory fee for hospitalization which was introduced in regional hospitals in 2009 in Czech Republic. The difference in difference analysis was used to research the possible relationship between reimbursement of the fee and length of hospitalization in acute care hospitals and in after-care facilities. In acute care the influence was 0,5-1 % of the length and in after-care facilities between 8-12 %. This relationship may be biased because of introduction of DRG system which may decrease the length of stay and may be differently distributed between treatment and control group.

This dissertation examines the antecedents and consequences of a fairly new construct in academic literature termed brand citizenship behavior. Constructs explored in the proposed model include brand identity, brand communication, internal marketing, brand pride, brand commitment, intention to stay and job satisfaction. A sample of 241 associates was surveyed at a large retail organization and key demographic variables were captured. Results indicate a causal relationship between internal marketing and brand citizenship behavior as well brand pride. While a causal link between brand citizenship behavior and brand commitment was not supported overall, permutations indicate causality among part time associates. Brand pride was found to mediate the relationship between brand citizenship behavior and brand commitment.

A popularização do GPS tem gerado uma massiva quantidade de dados que são organizados em trajetórias geográficas. Trajetórias geográficas são sequências ordenadas de coordenadas geográficas que representam um caminho de um objeto móvel. Para melhorar a compreensão destas trajetórias, são detectados locais de maior importância que são chamados de pontos de permanência, que indicam que um usuário permaneceu neste local por um tempo significativo. Pontos de permanência são comumente transformados em vértices de redes geolocalizadas para facilitar a mineração de trajetórias, a transformação é feita agrupando pontos geograficamente próximos. Porém, é pouco discutido na literatura a qualidade destas redes. Portanto, este projeto aborda esta lacuna e apresenta duas novas abordagens para construção de redes sociais geolocalizadas a partir de pontos de permanência. A abordagem proposta utiliza a fase de contração do paradigma multinível para realizar a transformação de pontos de permanência em vértices de redes. A fase de contração contrai uma rede original iterativamente até ser obtida uma rede solução, a contração leva em conta a estrutura topológica da rede. Os resultados mostram que as novas abordagens conseguem representar com maior precisão, por meio de redes geolocalizadas, o mundo real. / The popularization of GPS has generated a massive amount of geographic data organized in raw trajectories. Raw trajectories are ordered sequences of geographic coordinates that represent a path of a moving object. To improve the understanding of raw trajectories, important places, referred to as stay points, are detected. They indicate that a user has remained in this correspondent place for a significant time. Stay points are commonly turned into vertices of location-based networks to facilitate trajectory mining, the turning into vertices is done by grouping geographically close points. Nonetheless, to the best of our knowledge, there is a lack of studies addressing the quality of these networks. This piece of research addresses this gap and presents two new approaches to using stay points for building location-based social networks. The proposed approach uses the contraction phase of the multilevel partitioning to turned stay points into vertices. The contraction phase contracts an original network iteratively until a solution network is obtained, the contraction is done considering the topological structure of the network. The results show that the new approaches are able to represent more accurately, through location-based networks, the real world.

Cette thèse de doctorat, réalisée sous la direction du Pr. Catherine Hellemans, est issue d’un projet de recherche interdisciplinaire financé par l’Université Libre de Bruxelles et intitulé « Mobilisations professionnelles et engagements personnels dans le travail contemporain :les nouvelles tensions des espaces de qualification ».Les carrières contemporaines sont depuis quelques années considérées comme des carrières sans frontières, qui se déploient à travers de multiples organisations, professions et cadres culturels. En raison notamment des transformations du marché du travail, la mobilité professionnelle – définie comme une transition de rôle professionnel impliquant un changement de position, de tâches et/ou de responsabilités – marque de plus en plus les parcours professionnels. Elle est devenue pour les organisations une stratégie empreinte de réactivité et de flexibilité.Nos recherches visaient à déterminer les enjeux de la mobilité, c’est-à-dire, les raisons pour lesquelles elles sont entreprises par les organisations et les individus, et leurs conséquences. Plus précisément, il s’agissait d’établir la mesure dans laquelle une mobilité, en tenant compte de ses caractéristiques (volontaire ou non ;réussie ou non), influence ou non l’engagement au travail du travailleur, son implication à l’égard de l’organisation, son sentiment de bien-être, et son attitude à l’égard de futures mobilités. Les études ont été menées au sein de trois secteurs d’activités :le secteur bancaire, le secteur infirmier et le secteur de la recherche universitaire. Ce sont les mobilités inter- et intra-organisationnelles qui étaient au coeur de nos investigations dans les deux premiers secteurs, et les mobilités internationales dans le troisième.Les résultats ont mis en évidence que les différents types de mobilité sont liés à des enjeux relativement distincts et que, de manière générale, une mobilité organisée dans de bonnes conditions peut être un levier motivationnel. L’évolution des carrières lance vraisemblablement de nouveaux défis aux travailleurs, aux organisations et à nos sociétés. / Doctorat en Sciences psychologiques et de l'éducation / info:eu-repo/semantics/nonPublished

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Background: Sleep is one of mankind's basic needs and important for the experience of health, as well as essential for the patient's ability to recover. Lack of sleep has a negative effect on the ability to recover from the consequences of illness. Patients states that they have a negative quality of sleep during hospital stay. Aim: The aim of this study was to describe factors that influencing the night sleep of patients during hospital stay. Method: An overview of the literature was performed. Six quantitative, three qualitative and two mixed-method studies were included. Results: Two main categories emerged, which were; Environmental factors and physical- and psychological factors. The result showed that patients experienced environmental factor such as noise and lights, comfort and routines. Physical- and psychological factors experienced by patients was symptoms, anxiety and thoughts and also nurse's bedside manners. Conclusion: Nurses bedside manners have significant importance for patient's ability to experience a quality sleep. The result shows that factors affecting patients sleep are possible to influence and alter in order to enable best possible sleep for patients during hospital stay.

The purpose of this study was to identify the characteristics of cancer patients and the most frequently chosen nursing diagnoses, outcomes and interventions chosen for care plans from a large Midwestern acute care hospital. In addition the patients' outcome change scores and length of stay from the four oncology specialty units are investigated. Donabedian's structure-process-outcome model is the framework for this study. This is a descriptive retrospective study. The sample included a total of 2,237 patients admitted on four oncology units from June 1 to December 31, 2010. Data were retrieved from medical records, the nursing documentation system, and the tumor registry center. Demographics showed that 63% of the inpatients were female, 89% were white, 53 % were married and 26% were retired. Most patients returned home (82%); and 2% died in the hospital. Descriptive analysis identified that the most common nursing diagnoses for oncology inpatients were Acute Pain (78%), Risk for Infection (31%), and Nausea (26%). Each cancer patient had approximately 3.1 nursing diagnoses (SD=2.5), 6.3 nursing interventions (SD=5.1), and 3.7 nursing outcomes (SD=2.9). Characteristics of the patients were not found to be related to LOS (M=3.7) or outcome change scores for Pain Level among the patients with Acute Pain. Specifically, 88% of patients retained or improved outcome change scores. The most common linkage of NANDA-I, NOC, and NIC (NNN), a set of standardized nursing terminologies used in the study that represents nursing diagnoses, nursing-sensitive patient outcomes and nursing interventions, prospectively, was Acute Pain--Pain Level--Pain Management. Pain was the dominant concept in the nursing care provided to oncology patients. Risk for Infection was the most frequent nursing diagnosis in the Adult Leukemia and Bone Transplant Unit. Patients with both Acute Pain and Risk for Infection may differ among units; while the traditional study strategies rarely demonstrate this finding. Identifying the pattern of core diagnoses, interventions, and outcomes for oncology nurses can direct nursing care in clinical practice and provide direction for future research tot targets areas of high impact and guide education and evaluation of nurse competencies.

京都大学 / 新制・課程博士 / 博士(社会健康医学) / 甲第23118号 / 社医博第114号 / 新制||社医||11(附属図書館) / 京都大学大学院医学研究科社会健康医学系専攻 / (主査)教授 佐藤 俊哉, 教授 森田 智視, 教授 黒田 知宏 / 学位規則第4条第1項該当 / Doctor of Public Health / Kyoto University / DFAM