Fewer patients are able to die at home than would wish to do so. A literature review showed that palliative home care patients are more likely to die at home than others. However, findings may be due to case mix differences, as variables which are positively associated with home death, are also positively associated with access to palliative home care. The thesis investigated the impact of a hospice at home (HAH) service on place of death. An observational, case control study compared 121 patients referred to HAH with 206 patients not referred. Multivariate logistic regression analysis showed that HAH care was strongly positively associated with home death. However, case mix effects could not be discounted. A randomised controlled trial (RCT) compared 186 patients allocated to HAH care with 43 controls. Analysis was intention to treat. Intervention patients were not significantly more likely to die at home than control patients (67% versus 58%). The RCT suffered loss of power and dilution of the treatment effect. Post hoc multivariate logistic regression analysis showed a positive association between actual HAH input and home death. However, this association was no stronger than that between less intensive home care services and home death. Concerns about case mix effects remained. Content analysis of professional and family carers' explanations of endstage inpatient admissions for RCT patients suggested such admissions were mainly perceived to result from factors unrelated to insufficient home care. While some patients may have benefited from added home support, this may not have affected place of death. Additional home care introduced on top of good existing provision, among patients who are already likely to die at home, may have little impact on home deaths. Careful consideration of service aims, target group, other health service context is required before introduction of further hospice at home services.

La presente investigación fue abordada mediante una metodología cualitativa con enfoque estudio de caso, se planteó como objetivo describir, analizar y comprender la forma en que la enfermera aplica la valoración en el cuidado de la persona hospitalizada Servicio de Cirugía Hospital Regional Docente Las Mercedes. La recolección de datos se realizó a través de una entrevista semiestructurada y test de likert cuya muestra se determinó mediante saturación y redundancia, y muestreo por conveniencia, logrando aplicarlos a 6 profesionales de enfermería. El análisis de datos basado en Bardin y Andrade (2006); obteniéndose como categorías: La valoración: Acciones más allá de los protocolos, Aspectos subjetivos y objetivos de la valoración, y Perspectivas paradigmáticas para la valoración. La cientificidad de los resultados estuvo garantizado por los criterios de: confiabilidad, validez y triangulación; los principios éticos de beneficencia, respeto y justicia. Concluyendo, que la aplicabilidad registrada resulta de diferencias entre lo ideal y real en cuanto a la valoración de enfermería. Durante la formación académica se inculcan los pasos exhaustivos para su aplicación, sin embargo en la práctica diaria surgen nuevas percepciones, perspectivas y enfoques, realizándola de manera más rápida, reflejando la priorización de la parte física de la persona o centrándose en las de mayor dependencia y prioridad; por la existencia de factores que dificultan una valoración ideal: disponibilidad de un ambiente que garantice el respeto de la intimidad, el tiempo, gran demanda de pacientes y cumplir múltiples funciones a la vez. / Tesis

This research study investigated a new conceptual design for a modular structural configuration incorporating storage for Liquefied Natural Gas (LNG) within the base of the platform structure. The structure, referred to as a modified gravity base concrete structure (MGBCS), was envisioned specifically to be constructed at a suitable site off the coast of Kuwait. Coastal offshore bathometric information, environmental data and existing data on onshore facilities were examined in the site selection portion of the study. A finite element model of the MGBCS was developed using an industry standard finite element code that allows preliminary sizes of structural models to meet appropriate design codes. A variety of parametric and design load scenarios were investigated. This research tackles some preliminary issues that are adequate for an initial evaluation of the proposed design concept. The proposed design concept needs a lot more scrutiny in order to be sufficiently developed as a concept where it can be confirmed as a truly viable concept and investment. It was confirmed that quartering sea conditions, waves approaching at a 45 degree angle, are the most critical scenarios for the terminal based on maximum values and ranges of shears and moments. In addition, there are several interesting issues in this concept that should be further looked at for this design to be further developed. The limitations of our study must be mitigated in future designs if the proposed design concept is to be carried to the implementation stage.

We have chosen to write our thesis within a transport company. The work was carried out at DHL activities in Uppsala. DHL is one of the leading transport companies worldwide. Our interest lies in more efficient and advanced transportation and terminals, as globalization and new trends require effective solutions. The aim of our work is to explain the need for information technology applications in road haulage and associated terminal operations. Furthermore, we analyses terminal and applied information technology. Finally, we give suggestions on possible improvements to the process of IT applications in the future. Selected methods based on literature search, interviews and observations are used. We did a contextual inquiry i.e. we tried to observe what is being done, and at the same time, we asked the user come with explanations of what they have done. The questions varied during the research because the atmosphere was dynamic so that the constancy and coherence are not important to us. Globalization requires effective and dynamic transport and management in the terminal operations. The assumption for Transport Company to be competitive on the market is the introduction of information technology. The most common way to identify the goods of the terminal is the use of barcodes. Furthermore there are several different methods such as RFID, 3G, RFID, combined with satellite and NGWS, but these methods are considered expensive. The future is in real-time information and an unlimited visibility that could be achieved with new trends in information technology. RFID will replace bar code identification with the price of RFID tags. A combination of 3G RFID with GPS and introducing NGWC in the future will be a prerequisite for unlimitedly comprehensive view, safe transportation and permanent access to information.

This research study investigated a new conceptual design for a modular structural configuration incorporating storage for Liquefied Natural Gas (LNG) within the base of the platform structure. The structure, referred to as a modified gravity base concrete structure (MGBCS), was envisioned specifically to be constructed at a suitable site off the coast of Kuwait. Coastal offshore bathometric information, environmental data and existing data on onshore facilities were examined in the site selection portion of the study. A finite element model of the MGBCS was developed using an industry standard finite element code that allows preliminary sizes of structural models to meet appropriate design codes. A variety of parametric and design load scenarios were investigated. This research tackles some preliminary issues that are adequate for an initial evaluation of the proposed design concept. The proposed design concept needs a lot more scrutiny in order to be sufficiently developed as a concept where it can be confirmed as a truly viable concept and investment. It was confirmed that quartering sea conditions, waves approaching at a 45 degree angle, are the most critical scenarios for the terminal based on maximum values and ranges of shears and moments. In addition, there are several interesting issues in this concept that should be further looked at for this design to be further developed. The limitations of our study must be mitigated in future designs if the proposed design concept is to be carried to the implementation stage.

Thesis (Ph. D.)--University of Texas at Austin, 2001. / Vita. Includes bibliographical references (leaves 223-234). Available also in a digital version from Dissertation Abstracts.

No description available.

La investigación de tipo cuantitativo con abordaje cuasi experimental tuvo por objetivo determinar la efectividad de dicho programa, como hipótesis elaboradas se consideraron al programa de apoyo como efectivo o no efectivo, la muestra fue de 15 padres con un hijo entre 1 y 17 años, con enfermedad terminal. Los instrumentos utilizados fueron: Non-Death Version of The Grief Experience Inventory y Jalowiec Coping Scale, los cuáles fueron traducidos al idioma español y sometidos a validación por juicio de expertos y alfa de Cronbach, que fue igual a 0,6; es decir contó con una confiabilidad aceptable. El análisis de datos, las tablas estadísticas y la prueba t para comprobar hipótesis se realizaron en el programa estadístico SPSS versión 15. Los resultados evidenciaron que en el programa de apoyo se obtuvo un cambio significativo en los participantes. En el inventario de experiencia de duelo, se evidenciaron tres escalas sin variación significativa entre el primer y segundo momento, estas escalas son: Ansiedad ante la muerte, alteración del sueño y pérdida de apetito. En la escala de afrontamiento de Jalowiec predomina en el segundo momento la escala de confrontación del problema y el afrontamiento paliativo. Como resultado final podemos decir que el programa de apoyo fue efectivo en los padres. Se consideraron los criterios de rigor ético de Sgreccia y de rigor científico.

Research into doctor patient communication and their roles is reviewed. Two series of semi-structured interviews with general practitioners (e.p.e) and patients separately are reported. In the first, 4 g. p. s each selected 6 patients for 3 groups; terminally ill with knowledge, terminally ill without, and chronic controls. Content analysis of patient transcripts revealed differences in frequency of utterances classed as showing knowledge. Differences between groups and qualitative analysis of all interviews, verified g.p.s’ categorisation. Knowledge was not simply absent or present, since all groups show awareness, but differ in the degree to which the nature of illness is openly acknowledged. One g.p. reported routinely informing patients, but others did not, although agreed this is occasionally appropriate. A typology of methods g.p.s and patients use to control information exchange is proposed. g.p.s' role formulations appear to underpin their reported communicative behaviour. 22 g.p.s were interviewed in the second series. Again they were asked to select patients, but few did this within the time allotted: therefore analysis focused upon g.p.s. Content analysis of interviews splits g.p.s into "informers" and "non informers". Qualitative analysis of g.p.s’ reported communication strategies suggests that underlying this simple dichotomy is a continuum from revelation through passive response to concealment. Strategies are implemented by various tactics; e.g. euphemism, uncertainty, denial, evasion, prompting questions. Differences in reported intentions and behaviour are interpreted by recourse to g.p.s' descriptions of their role during terminal care. Those who conceal attempt to maintain the Parsonian curative physician role and are reluctant to classify patients as terminal. Those who reveal try to abandon this role for one modelled on that of counsellor. Nearly all experience role ambiguity and attempt to resolve this in ways predicted by role theory.

The implications of travel time uncertainty on the operational efficiency of airport terminals have until now not been examined. With the forecast growth in congestion levels predicted for all modes of transport, not only will travel time uncertainty increase but its impact may increase also. The first part of this thesis covers the analysis of two passenger surveys conducted at Manchester Airport and Birmingham Airport. These surveys had the objective of providing evidence to support or dispute the belief that air travellers react to travel time uncertainty. The research identifies that passengers do react by allowing margins of safety for their access journeys, and that this change in behaviour will modify the arrival distribution patterns at airports. The second part of this thesis examines how airport passenger flows could be altered by a change in the arrival distribution of originating passengers at airport terminals. Three airports - Manchester, Birmingham and East Midlands International - are modelled using a simulation tool and tested to assess how a shift in arrival distribution affects queuing and peak passenger volumes within the airport terminal. The findings of this thesis show that airport passenger terminal operational efficiency is affected by access journey time uncertainty. It also identifies that passenger decision making can only be explained by various combinations of factors. Possible methods of minimising the effects of travel time uncertainty are considered. The advantages and disadvantages of access journey time uncertainty for airports and airlines are discussed. It concludes that, to be successful in overcoming negative aspects, both parties must provide a service that results in customer satisfaction. This is the only sure way to maintain their respective revenue levels and secure their future in what is becoming an increasingly competitive industry.