Background: Long-term care nurses are in a pivotal position to be augmenting the quality of life for residents and improving the death and dying experience for residents, their family members and surrogate decision makers. Currently there is a paucity of literature that acknowledges the experiences of long-term care nurses and their involvement with end-of-life decision making and care. Purpose: To describe long-term care nurses’ perceptions of factors that influence their communication with end-of-life surrogate decision makers and the kind of support they need to support this discussion. Method: A descriptive study using mixed-methods convergent design was used to obtain responses from a sample of 30 long-term care nurses. An online survey included questions to obtain quantitative data and open-ended questions for short responses. Results from both sets of data were brought together and compared during the analysis phase. Results: The findings of this study highlight the personal factors of the nurse, the characteristics of the surrogate decision maker, contextual factors, situational related inputs, and the support desired by long-term care nurses. Participants rated factors according to importance in their experiences of communicating with surrogate decision makers. Seven themes were inductively derived from the analysis: 1) selected or appointed as surrogate makes a difference, 2) strong trusting bond between nurse-resident and nurse-family, 3) being too close to see resident’s wishes, 4) interdisciplinary team agreement, 5) living will as a communication roadmap, 6) peaceful environment, and 7) the need to create emotional distance. Long-term care nurses also identified the types of support they seek or need to be effective in communicating with end-of-life care surrogate decision makers. Conclusion: As the numbers of the older population continue to increase, the demand for nurses to develop expertise in caring for dying residents and communicating with them, their family members, and surrogate decision makers will increase. Understanding their experiences and providing support to long-term care nurses may strengthen their capacity to communicate about death and dying and their delivery of quality end-of-life care to residents.

This thesis proposes a novel algorithm to optimize multi-modal, nonlinear, black-box objective functions for electric power system design using an electromagnetic transients (EMT) simulator. The algorithm discovers multiple local optimal solutions for a given complex power system, and then generates accurate surrogate models of an objective function around each discovered local optimal solution. These surrogate models represent the local behaviour of the objective function that can be used in the subsequent stages of sensitivity analyses. Using surrogate models instead of intensive transient simulation during sensitivity analysis reduces computational intensity and simulation time. This makes the proposed algorithm particularly suited for optimization of computationally expensive black-box functions. The stages of the algorithm can be implemented independently and hence the computations can be done in parallel. Therefore, the algorithm is implemented in a parallel environment to gain significant speed-up in the design of electric power systems. Comparative studies in terms of objective function evaluation and computation time are provided. Using several multi-modal benchmark objective functions, the superiority of the proposed algorithm compared to other recently developed algorithms is demonstrated. Additionally, the application of the algorithm in the design process of complex electric power system demonstrated through several examples. The case studies show that the parallelized algorithm provides computational savings up to 39 times compared to the conventional sequential approach. / May 2016

The measurement of turbidity is currently conducted using a variety of methodologies for different applications, primarily using calibration standards composed of formazin, a material which can be difficult to obtain, short-lived, and toxic. The discrepancies between the various measurement methods lead to unreliability in sharing meaningful data across applications, and the deficiencies of the primary calibration standard make it difficult to conduct measurements in appropriate-technology environments. This research focused on examining the current methodologies and synthesizing new materials to use as calibration standards. The selection criteria for these materials were such as to ensure longevity, stability in solution, and ease of creation. Results showed that dilutions of dissolved sodium chloride yielded parabolic regression curves of comparable accuracy to formazin, which could be used for device calibration. These standards can be easily and safely synthesized in appropriate-technology settings. The use of fluorescent materials as calibration standards was also investigated, and the implications of the characteristic curves of turbidity versus solute concentration are discussed.

Os transplantes de células germinativas e enxertos de testículo podem ser aplicados na reprodução de espécies comerciais e na conservação de espécies ameaçadas de extinção. No entanto, a maior limitação dos transplantes está na sua limitada eficiência, devido à baixa porcentagem de hospedeiros capazes de gerar gametas derivados do doador e da rejeição de enxertos de testículo alogênicos após poucas semanas de sua implantação. O sistema imunológico dos hospedeiros podem estar envolvidos na baixa de eficiência dos transplantes e na rejeição dos enxertos. Desta forma, este trabalho buscou verificar se a administração de drogas imunossupressoras como o tacrolimus e ciclosporina em emulsão poderiam ser utilizados para prolongar a viabilidade de enxertos de testículo em trutas arco-íris. Na primeira parte, experimentos in vitro com leucócitos do sangue periférico demonstraram que ambos o tacrolimus e a ciclosporina impedem a proliferação celular mesmo sob estímulo proliferativo da concanavalina. Nos ensaios in vivo, ambas as doses de tacrolimus (0,5 e 1,5 mg/kg) e a mais baixa de ciclosporina (20 mg/kg) inibiram significativamente a expressão de il2 no rim cefálico três dias após a injeção. Já a dose de 40 mg/kg de ciclosporina inibiu a expressão de il2 por até sete dias após a injeção. Na segunda parte, enxertos alogênicos de testículo foram realizados em animais tratados semanalmente com emulsões de tacrolimus. As análises histológicas (coloração H.E.) e as de RT-PCR (vasa e txdnc6) demonstraram a presença de espermatogônias na primeira semana e indicaram a presença de espermátides/espermatócitos na quinta semana, respectivamente, em alguns animais do grupo tratado com a dose de 0,5 mg/kg de tracrolimus. No grupo tratado com a dose mais alta de tacrolimus (1,5 mg/kg) e no grupo controle (sem imunossupressor), células germinativas ou marcadores destas não foram detectados. Estes resultados, portanto, fazem do tacrolimus um imunossupressor promissor para utilização em enxertos alogênicos e também em transplantes de células germinativas de truta arco-íris. A administração concomitante de um outro imunossupressor conjugado ao tacrolimus (na baixa dosagem) para inibir duas ou mais vias de ativação do sistema imunológico, conforme utilizado em transplantes de órgãos em humanos, pode ser uma alternativa para otimizar os efeitos imunossupressivos nos animais receptores. / Germ cell transplantation and testis graft can be applied for the reproduction of commercial or endangered species. However, mechanisms of rejection from the host immune system might limit the production of surrogate gametes and progeny after transplantation and induce rejection of testis allografts within few weeks. In this work, we aimed to administer immunosuppressants-containing emulsions in order to verify whether they are capable to prevent immune rejection and promote testis allograft survival in rainbow trout. In the first part of this study, it was demonstrated in vitro that tacrolimus and cyclosporine were able to inhibit leucocyte proliferation even under concanavalin-induced mitotic stimulation. In in vivo experiments, both dosage of tacrolimus (0,5 and 1,5 mg/kg) and a lower of cyclosporine (20 mg/kg) inhibited significantly the expression of il2 in head kidney at three days post-injection. A higher dosage of cyclosporine (40 mg/kg) was able to inhibit il2 expression for up to seven days post-injection. In the second part, testis allografts were conducted in fish treated weekly with tacrolimus-containing emulsions. Histological (H.E. staining) and RT-PCR (vasa and txdnc6) analysis demonstrated the presence of spermatogonias in the first week and indicated the presence of spermatids/spermatocytes in the fifth week, respectively, in some animals treated with 0,5 mg/kg of tacrolimus. In the group treated with the highest tacrolimus dose (1,5 mg/kg) and in the control group (without immunosupressant), no germ cells or their respective markers were detected. These results suggest that tacrolimus comprise a promising immunosuppressant, with applications to testis allografts or germ cell transplantation in rainbow trout. Co-administration combining tacrolimus (at lower dose) with other immunosuppressive drugs for inhibiting more than two activation pathways of the immune system, as done in human organ transplantation, can be an alternative to optimize the immunossupressive effects in host organisms.

As metodologias para a síntese de processos, baseadas em otimização de superestruturas, mostram-se mais poderosas do que as baseadas no projeto em heuríticas, já que levam em consideração as inúmeras possibilidades de construção do processo. É pratica comum a utilização de modelos simplificados (como modelos de rendimento), na representação dos equipamentos dentro destas superestruturas, uma vez que a utilização de modelos fenomenológicos tornar-se-ia inviável, devido aos tempos computacionais e à dificuldade técnica de se programar os módulos e propriedades termodinâmicas de um simulador comercial, dentro de uma plataforma de otimização como o GAMS. Modelos com alta precisão, que não requerem grandes tempos computacionais, reduzidos ou de superfície de resposta, aproximam modelos fenomenológicos e podem ser introduzidos em problemas de síntese, obtendo soluções mais precisas. Neste trabalho, foram construídos modelos reduzidos para dois processos comumente encontrados em sistemas de tratamento de efluentes de refinarias de petróleo: uma torre de resfriamento e um stripper de vapor. Os dados utilizados para a correlação dos modelos reduzidos foram gerados, através da simulação de modelos semi-fenomenológicos ou fenomenológicos destes equipamentos. É proposta uma metodologia original para gerar modelos reduzidos, que diferentemente dos trabalhos anteriores em que se utilizam modelos reduzidos tipo caixa preta, emprega-se um modelo reduzido tipo caixa cinza para a representação da coluna de stripper, o que aumenta a capacidade de correlação do modelo ao conjunto de dados, resultando em menores erros de predição. Dois tipos clássicos de modelos reduzidos foram utilizados dentro dos modelos caixa-cinza: um modelo baseado em redes neurais e um modelo polinomial. Ambos mostraram-se capazes de representar o modelo fenomenológico com pequenos erros e permitindo resolver o problema de síntese em um tempo computacional razoável (da ordem de 10 segundos). Nota-se também que são obtidas várias soluções ótimas locais que diferem ligeiramente de acordo com a abordagem utilizada, mas que qualitativamente correspondem a um mesmo conjunto de soluções. / The superstructure optimization-based methodologies for process synthesis can be more powerful than the heuristic based methodologies, because they cope the many possibilities in order to design the process. It is common practice to use simplified models (efficiency-based models), in the representation of equipment in the superstructures, because the use of phenomenological models would be unfeasible due the high computational time and the technical difficulties in order to program module and thermodynamics properties packages of commercial simulators, into an optimization platform as GAMS. High accuracy models, which do not require large computational time, can be obtained using different types of surrogate or response surface, approximate phenomenological models of the system and can be introduced into the synthesis problems, leading to more precise solutions. In this work, surrogate models were built for two processes usually found in water treatment networks in petroleum refineries: a cooling tower and a steam stripper. The data sets used for fitting the surrogate model were generated by the semi-phenomenological or the first principles model of those equipment. An original methodology for generating surrogate model is proposed that differently of previous works (which make use of black box surrogate models) uses gray box models to represents de stripper column. This approach improves the correlation capacity of the surrogate model to the set data and reduces the prediction errors. Finally, two classic surrogate models were used inside the gray-box models: a neural network based model and a polynomial model. The results showed that both are able to represent the phenomenological model with small errors to solve the synthesis problem in a short computational time (which not exceed in a magnitude of 10 seconds). It is noticed also that many local solutions are obtained, these differ slightly depending on the approach used, but qualitatively represent the same set of solutions.

Thesis advisor: Pamela J. Grace / Significance/Background: Surrogate decision-makers (SDMs) take part in 1.5 million end-of-life (EOL) decisions per year. Most find the role burdensome, often do not make decisions concordant with patients' wishes, and many suffer negative psychological aftereffects. Specific Aims: 1) Identify and describe the psychological processes of recent SDMs for adults at EOL in the intensive care unit (ICU) and 2) develop a theoretical model of SDMs' psychological processes. Methods/Analysis: Descriptive, multiple case study research design using a cognitive task analysis (CTA) interviewing approach. Participants completed an in-depth semi-structured CTA interview and a demographic form. Verbatim transcribed interviews were encoded and analyzed until theoretical saturation was met. Results: Nineteen SDMs (female=11) with a mean age of 59 years (± 11) who made decisions for patients (mean age, 67±13 years) who died in the ICU completed interviews. Data analysis yielded 27 psychological processes representing the hypothesized theoretical links amongst 20 individual psychological concepts. The PREDICAMENTS model (Psychology, Reasoning, and Ethics Demonstrated In Choices about the Acceptability of Medical Treatments and Patient Conditions Encountered in Life Threatening Situations) of surrogate decision-making was assembled from these psychological processes and concepts. The model depicts a complex web of psychological processes wherein SDMs ultimately express acceptance or rejection of medical treatments and/or the patient's physical condition based on their perception of the acceptability (or lack thereof) of medical treatments and/or the patient's physical condition. Conclusions: The PREDICAMENTS model offers an initial picture of the underlying psychological processes operating in SDMs decision-making. Implications for Practice and Research: The PREDICAMENTS model can be used to assess and understand SDMs' thought processes, emotions, and ethical concerns. Further research is needed to test and corroborate constructs and linkages in this model with the aim of developing decision support interventions. Ethicists need to discuss the implications of this descriptive theoretical model for the normative ethical standards expected of SDMs. / Thesis (PhD) — Boston College, 2013. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Atrial fibrillation (AF) is a troublesome disease often overlooked by more serious myocardial infarctions. Up until now, there has been very little or no use of high order spectral techniques in order to evaluate the organization of the atrium during AF. Cross-bicoherence algorithm can be used alongside a surrogate data threshold in order to determine significant phase coupling interactions, giving rise to an organizational metric. This proposed algorithm is used to show rotigaptide, a gap junction coupling drug, significantly increases the organization of the atria during episodes of AF due to improvement of cell-to-cell coupling.

Trata-se de uma pesquisa qualitativa com base nos Estudos Culturais, em sua vertente pós-estruturalista. O objetivo foi analisar publicações de jornais, livros, sites e revistas que veicularam reportagens sobre Gestação de Substituição, para conhecer os discursos que circularam na mídia sobre a temática. Gestação de Substituição está dentre as técnicas que compõem o conjunto da reprodução assistida que combina a fertilização in vitro com a implantação do embrião (com o material genético de outrem) no útero da mãe substituta. Para tanto, foram analisadas reportagens cujo tema central eram histórias de sujeitos que participaram do processo de Gestação de Substituição. A análise desse corpus foi fundamentada nas ferramentas propostas por Michel Foucault, especialmente de discurso, enunciado e arquivo. Assumindo a mídia como artefato cultural que nos subjetiva e instiga determinados modos de vida, pretendi realizar uma das possíveis leituras dessas reportagens. Da análise emergiram três marcadores: nos Contos de fadas: uma estratégia discursiva midiática, observei que as histórias são contadas respeitando determinados enredos das tradicionais histórias infantis, posicionando os sujeitos participantes da Gestação de Substituição como heróis. Em Mães substitutas: sujeitos forjados pelos discursos midiático, biomédico e moral, as análises apontaram que os pais biológicos admiram tais mulheres por gestar o filho de outrem. No marcador, A família feliz: uma instituição social reorganizada discursivamente, destacou que as mães biológicas podem vivenciar a gestação, uma gravidez possível e o amor materno. Portanto, minha proposta foi (re)pensar e fazer outras e novas perguntas sobre o tema e suscitar reflexões que possam contribuir para a assistência em saúde dos sujeitos envolvidos no processo de Gestação de Substituição. E, neste sentido, procurar fornecer subsídios para que a Enfermagem (re)pense suas práticas para atender as demandas dessas novas famílias. / This is a qualitative research based on Cultural Studies, in its poststructuralist dimension. The objective was to analyze publications of newspapers, books, websites and magazines that have provided reports on Surrogacy to know the speeches that have circulated in the media about the theme. Surrogacy is among the techniques that make up assisted reproduction that combines in vitro fertilization with the implantation of the embryo (with the genetic material of another) in the uterus of the surrogate mother. For that we have analyzed reports whose central theme were stories of subjects who participated in the process of Surrogacy. The analysis of this corpus was based on the tools proposed by Michel Foucault, especially discourse, statement and archive. Assuming the media as a cultural artifact that subjective and instigates certain ways of life, I intended to carry out one of the possible readings of these reports. From the analysis emerged three markers: In Fairy Tales: a media discursive strategy I observed that the stories are told respecting certain scenarios of the traditional children's stories, positioning the subjects participating in the Surrogacy as heroes. In Surrogate mothers: subjects forged by the media, biomedic and moral discourses, the analyses pointed out those biological parents admire such women for gestating the child of another. In the bookmark, The Happy Family: a social institution discursively reorganized, emphasized that biological mothers can experience gestation, a possible pregnancy and maternal love. Therefore, my proposal was to (re)think and make other and new questions on this topic and to raise reflections that could contribute to the health care of the subjects involved in the Surrogacy process. And, in this sense, seek to provide subsidies for Nursing to (re)think their practices to meet the demands of these new families.

Alguns peixes carnívoros, como o salmão e a truta, são produzidos mundialmente com rações nutricionalmente completas contendo elevados níveis de farinha e óleo de peixe em função da excelente qualidade nutricional destes ingredientes. A estagnação dos estoques pesqueiros e a demanda crescente por estes ingredientes fazem com que o custo com alimentação de peixes carnívoros seja cada vez mais elevado. Nutricionistas vêm então buscando substituir a farinha e o óleo de peixe nas dietas comerciais, sem prejudicar o desempenho dos peixes confinados. O dourado, Salminus brasiliensis, é um Characiforme ictiófago neotropical de grande porte que apresenta um grande potencial para a aquicultura: excelente qualidade de carne e boa aceitação do mercado consumidor, refletidos em elevado valor comercial, sendo ainda procurado para a pesca esportiva. Entretanto, os estudos sobre o uso da espécie em piscicultura comercial são ainda rudimentares. Os objetivos deste estudo foram avaliar o desempenho do dourado alimentado com dietas contendo a farinha de vísceras em substituição à farinha de peixe e determinar o nível máximo de substituição da farinha de peixes que permitisse a maximização do lucro. O experimento foi realizado em um sistema de recirculação de água com controle de temperatura (26,78 ± 2,21 ºC), oxigênio dissolvido (6,44 ± 1,03 mg L-1), pH (7,40 ± 0,28) e amônia total (<= 0,25 mg L-1). Juvenis de dourado (12,00 ± 0,58 g) foram distribuídos em 24 caixas de polietileno de 300 L (12 peixes por caixa) em um delineamento inteiramente casualizado (n=4), aclimatados às condições de criação e dietas por 10 dias, submetidos a jejum de 24 horas, pesados, medidos e então alimentados em duas refeições diárias por 66 dias com rações extrudadas, nutricionalmente completas (40% de proteína digestível e 4020 kcal kg-1 de energia digestível), com níveis crescentes de farinha de vísceras de aves (0, 20, 40, 60, 80, 100%) em substituição à fonte dietética de proteína, a farinha de peixe. Ao final do período experimental foi feita a biometria para cálculo das seguintes variáveis de desempenho: peso médio final, ganho de peso médio, taxa de crescimento específico, consumo de ração, taxa alimentar, sobrevivência, índice de conversão alimentar, taxa de eficiência proteica, valor produtivo da proteína, eficiência de retenção de energia e maximização do lucro. Embora as variáveis estudadas não apresentassem diferenças significativas (P>0,05), foi observada a presença de dados influentes ou atípicos, que viciaram os resultados da regressão. Para diminuir a influência destes dados na curva da regressão, foi adotado o método da regressão robusta. A análise de maximização do lucro determinou que o nível ótimo de substituição de farinha de peixe por farinha de vísceras de aves foi de 33,29 %. / Carnivorous fish such as trout and salmon are raised on complete feeds, containing large quantities of fish oil and fishmeal, the best quality feed ingredient there is. The stagnation of natural fish stocks and the increasing demand for such feedstuffs makes the cost of carnivorous fish diets increasingly high. Nutritionists are thus in search of alternative ingredients to replace fishmeal in commercial diets without hampering fish performance. The dourado, Salminus brasiliensis, is a Neotropical, large ichthyophagous Characin, highly regarded for fish farming and sport fishing alike because of its prized flesh, high acceptance and market value. However, studies on the farming and husbandry of dourado are still rudimentary. This study evaluates the performance of dourado fed diets formulated to contain increasing levels of poultry byproduct meal in replacement of fish meal and determining the maximum level of replacement of fishmeal that maximizes profit. Trial was set up in a closed loop system, controlled temperature (26.78 ± 2.21 ºC), dissolved oxygen (6.44 ± 1.03 mg L-1), pH (7.40 ± 0.28), and total ammonia (<= 0.25 mg L-1). Juvenile fish were stocked in 24 tanks (300 L, 12 fish per tank) in a completely randomized design (n=4), acclimatized to system conditions and experimental diets for 10 days, fasted for 24 hours, weighted, measured and then fed twice a day for 66 days with extruded, nutritionally complete diets (40% digestible protein and 4020 kcal kg-1 digestible energy), formulated to contain increasing levels of poultry byproduct meal (0, 20, 40, 60, 80, 100) as surrogate protein source to fish meal. At the end of feeding period, fish were measured and weighted (final average weight ) to allow determining average weight gain, specific growth rate, feed consumption, feed conversion rate, protein efficiency rate, productive value of protein, energy retention rate, survival rate and profit maximization. Performance parameters did not differ (P>0.05), so to decrease the effects of influent data, the robust regression method was used and the profit maximization analysis revealed that replacing 33.29% of dietary fishmeal by poultry byproduct meal maximizes profit in the farming of dourado.

Orientador: Silvio Alexandre de Araújo / Banca: Reinaldo Morabito Neto / Banca: Franklina Maria Bragion de Toledo / Resumo: Este trabalho consiste numa extensão do estudo de um problema de dimensionamento de lotes com custo de transporte feito por Norden e Velde [53], onde a produção dos itens é transportada, em paletes, para um armazém. O transporte é feito por uma empresa terceirizada sob um contrato com os seguintes custos pré-estabelecidos: um custo fixo de contrato, um custo para o transporte de um determinado volume de paletes e um custo adicional para paletes extras. O problema foi estendido, no presente trabalho, considerando restrições de capacidade e a possibilidade de atrasos no atendimento a demanda. Nosso objetivo é propor um modelo matemático para o problema estendido e desenvolver dois métodos heurísticos de resolução. Tais métodos são baseados em dois tipos de relaxação: relaxação Lagrangiana e relaxação Lagrangiana/Surrogate. Os resultados obtidos pelas heurísticas são comparados com os resultados obtidos pelo pacote de otimização CPLEX 10.0. Além disso, é feita uma comparação entre os métodos heurísticos. / Abstract: This work consist of an extension of a study of the capacitated lot-sizing problems with transportation cost by Norden and Velde [53], where the production of itens is transported into pallets to an warehouse. The transportation is executed by another company, under a contract with the following transportation cost established: a fixed contract cost, a transportation cost for determined quantity of pallets and an additional cost for extra pallets. The problem was extended, in this work, considering capacity constraint and backlogging. Our objective is to propose a mathematical model for the extended problem and to develop two heuristics methods of resolution. The methods are based on two types of relaxation: Lagrangian relaxation and Lagrangian/Surrogate relaxation. The results obtained by heuristics are compared with the results obtained by CPLEX 10.0. Furthermore, a comparison between the heuristics is made. / Mestre