Background: Care of premature infants is challenging for health care professionals. When the preterm infant is separated from its mother the parent-child interaction is impeded. In the last few decades, there has been increasing interest in the effectiveness of massage as an intervention to counter the negative physiological, clinical and behavioral consequences of prematurity and the neonatal intensive care unit environment. Aims: To establish the effectiveness of moderate pressure massage from evidence in the literature and to then explore the cultural, organisational and contextual factors that may act as facilitators and/or barriers for its future implementation in Lebanon. Methods: This thesis utilizes a two-step approach. Two literature reviews were undertaken to establish recent evidence on moderate pressure massage. A qualitative exploratory investigation was adopted as no articles were found that elucidated the contextual barriers and facilitators for massage implementation in the neonatal intensive care unit. The normalization process theory was used as a sensitizing framework to understand implementation issues and address the observed difficulties in implementing new interventions in clinical settings. This study was also concerned with context and culture as moderate pressure massage is not practiced in the Lebanese neonatal intensive care units. A purposive sample of Lebanese health care professionals and parents were recruited from three university hospitals with data generated through focus group discussions and observational notes. Framework analysis was used for the analysis and interpretation of the findings. The study drew on the principles and practice of ethnographic approaches. Findings: The findings from the two literature reviews only revealed randomized control trials that observed mostly the short-term physiological and psychological effects of moderate pressure massage. There were no studies that examined the organizational and contextual issues that need to be understood before any trial could be designed in the neonatal intensive care unit setting. The evidence from this review suggested there is a need to explore the views of health care professionals and parents on the practice of massage in the neonatal intensive care units to provide insight into the subsequent design of an intervention study that would be culturally sensitive, appropriate, and acceptable in practice. The findings from the qualitative study then revealed that despite the participants’ interest in implementing massage intervention, parents’ participation in the neonatal intensive care unit is almost absent except for breastfeeding. Participants in both groups, parents and health care professionals, highlighted the parents’ fear and anxiety. In general, nurses are in charge and parents are passive observers. Transportation difficulties, unavailability of helpful staff, and fear were reported as major barriers to parent-implemented infant moderate pressure massage; health care professionals highlighted staff attitude and resistance, workload and time constraints. Communication, gradual implementation, encouragement and support were identified by parents as potential facilitators. In comparison, having extra staff and a protocol for teaching nurses, training parents and openness to innovation were the main potential facilitators of implementation identified by health care professionals. Conclusion: This study helped to reveal the potential challenges of applying such a complex intervention as moderate pressure massage by the parents in the neonatal intensive care unit. Adopting infant massage in the Lebanese neonatal intensive care unit without preparation of health care professionals and parents would be premature. Good communication between parents and health care providers is a key element to facilitate early bonding and parent-infant interaction. Missing the opportunity to involve parents in neonatal intensive care unit care puts the family in a difficult situation to adapt to the new challenges after discharge. The findings of this study will advance current knowledge in understanding the factors that determine applicability, acceptability and feasibility of massage implementation in the neonatal intensive care unit setting. It will also assist and inform the design of future randomized control trials. The noramalization process theory was a valuable lens to guide the process of inquiry and to make sense of the emergent findings from this exploratory qualitative study.

In the effort to reduce the release of harmful gases associated with the transportation sector, Plug-in Electric Vehicles (PEV) have been deployed on the account of zero-tail pipe emissions. With electrification of transport it is imperative to address the electrical grid emissions during vehicle charging by motivating the use of distributed generation. This thesis employs optimal charging strategies based on solar availability and electrical grid tariffs to minimize the cost of retrofitting an existing parking lot with photovoltaic (PV) and PEV infrastructure. The optimization is cast as a unit-commitment problem using the CPLEX optimization tool to determine the optimal charge scheduling. The model determines the optimal capacity of system components and assesses the techno-economic feasibility of PV infrastructure in the microgrid by minimizing the net present cost (NPC) in two case studies: Victoria, BC and Los Angeles, CA. It was determined that due to a relatively low grid tariff and scarcity of solar irradiation, it is not economically feasible to install solar panels and coordination of charging reduces the operating cost by 11% in Victoria. Alternatively, with a high grid tariff and abundance of solar radiation, it shown that Los Angeles is a promising candidate for PV installations. With the implementation of a charging coordination scheme in this region, NPC savings of 8-16% are simulated with the current prices of solar infrastructure. Additionally, coordinated charging was assessed in conjunction with various commercial buildings posing as a base load and it was determined that the effects of coordination were more prominent with smaller base loads. / Graduate

FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / Os recÃm-nascidos (RN) com malformaÃÃo congÃnita (MC) requerem dos profissionais de enfermagem atenÃÃo e cuidados especÃficos e individualizados. O estudo objetivou avaliar a prevalÃncia dos recÃm-nascidos com malformaÃÃes congÃnitas em instituiÃÃes pÃblicas e a assistÃncia de enfermagem prestada a essas crianÃas internadas na Unidade Neonatal (UN) nas primeiras 24 horas de vida. Estudo descritivo, transversal, quantitativo, realizado em trÃs Unidades Neonatais de instituiÃÃes hospitalares (A, B e C) de Fortaleza, Brasil. A amostra foi composta de 159 recÃm-nascidos, sendo 75 na instituiÃÃo A; 44 na B; e 40 na C. Os dados foram coletados em 2012, de janeiro a junho em A e B, e de marÃo a agosto em C. Investigou-se prontuÃrios e documentos nas unidades referidas e, posteriormente, eles foram registrados em formulÃrios prÃprios contendo variÃveis maternas e neonatais, apÃs a aprovaÃÃo pelos ComitÃs de Ãtica. Os resultados revelaram prevalÃncia de 3,3%, 2,1% e 3,6% de RN malformados nas instituiÃÃes, respectivamente. Da amostra, 53% eram masculinos, 57% com 37 a 41,6 semanas gestacionais, 52% pesando entre 2.500g e 3999g, 66% com estatura de 39 a 49 cm, Apgar no 1Â(60%) e 5Â(79%) minutos de sete a dez. Dentre as terapias implementadas ao RN, sobressaÃram-se oxigenoterapia sob Oxi-hood (42%); Dieta zero (37%); hidrataÃÃo venosa (36%); punÃÃo de acesso venoso central para infusÃes (44%); manuseio de trÃs em trÃs horas (89%) e nÃo realizaram cirurgias no perÃodo (75%). Dentre os curativos, o local destacado foi a regiÃo sacral (54%) e a cobertura com compressa estÃril (21%). As malformaÃÃes congÃnitas diagnosticadas foram categorizadas conforme classificaÃÃo do CID â 10, prevalecendo aquelas pertencentes ao Sistema Osteomuscular (30%) e Sistema Nervoso Central (SNC) (21,1%), ressaltando o PÃ torto congÃnito, Polidactilia, Hidrocefalia e Mielomeningocele. Destacaram-se as malformaÃÃes isoladas (61%) e os registros de cuidados de enfermagem envolvendo exames (24,4%) e oxigenoterapia (16,9%). Ocorreram associaÃÃes estatisticamente significantes entre as categorias de malformaÃÃes e algumas variÃveis especÃficas: (MC do SNC) x (IG, Terapia Medicamentosa); (MC do olho, ouvido, face, pescoÃo) x (IG, Uso de drogas e Escolaridade); (MC Aparelho CirculatÃrio) x (Uso de drogas e Terapia Medicamentosa); (MC Aparelho RespiratÃrio) x (Idade materna e Uso de drogas); (Fenda labial ou palatina) x (Idade materna e Uso de drogas); (Outras MC do Aparelho Digestivo) x (Modalidade VentilatÃria, Forma de NutriÃÃo e Cirurgia); (MC dos ÃrgÃos Genitais) x (Sexo, Renda familiar e Forma de NutriÃÃo); (MC Osteomuscular) x (NÃmero de GestaÃÃes e Modalidade VentilatÃria); (Outras MC) x (IG e Peso); e (Anomalias CromossÃmicas) x (Idade materna), todos com p<0,05. Concluiu-se que ainda se faz prevalente o nÃmero de MC em RN e que a equipe de enfermagem implementa cuidados de acordo com as condiÃÃes clÃnicas, da patologia e equilÃbrio hemodinÃmico de cada RN e nÃo especificamente para cada tipo de malformaÃÃo. / The newborns (NB) with congenital malformation (CM) requires from nursing professionals the performance of specific and individualized care. This study aimed at evaluating the prevalence of newborns with congenital malformation in public institutions and the nursing care provided to these children admitted to the Neonatal Unit (NU) in the first 24 hours of life. This is a descriptive, cross-sectional and quantitative study, which was conducted in three Neonatal Units of hospitals (A, B, C) from the city of Fortaleza-CE/Brazil. The sample was composed of 159 newborns; from which 75 belong to institution A; 44 to B; and 40 to C. The data were collected in 2012, from January to June in A and B, and from March to August in C. Records and documents were investigated in the aformentioned units and, subsequently, they were recorded in the proper forms containing maternal and neonatal variables, after approval by the Ethical Committee. Results showed prevalence of 3.3%, 2.1% and 3.6% of malformed newborns in the institutions, respectively. Of the sample, 53% were male, 57% with 37 to 41,6 gestation weeks, 52% weighing between 2,500 g and 3999g, 66% with height 39-49 cm, Apgar score at 1st (60%) and 5th (79%) minutes from seven to ten. Among the implemented therapies to the NB, it should be highlighted oxygenotherapy in Oxy-hood (42%); Zero diet (37%); intravenous hydration (36%); central venous access puncture for infusions (44%); handling for every three hours (89%) and did not undergo surgery throughout the period (75%). Among the dressings, the highlighted location was the sacral region (54%) and the coverage with sterile compress (21%). The diagnosed congenital malformations were categorized according to the classification of the ICD â 10, prevailing those ones belonging to the Musculoskeletal System (30%) and to the Central Nervous System (CNS) (21.1%) highlighting the Congenital clubfoot, Polydactyly, Hydrocephalus and Myelomeningocele. It should also be highlighted the isolated malformations (61%) and the nursing care records involving examinations (24.4%) and oxygenotherapy (16.9%). There were statistically significant associations between the malformations categories and some specific variables: (CM of the CNS) x (GI, Drug Therapy) (CM of the eye, ear, face, neck) x (GI, Drug use and Schooling); (CM of the Circulatory System) x (Maternal age and Drug use) (CM of the Respiratory System) x (Drug use and Drug therapy); (Cleft-lip and palate) x (Maternal age and Drug use); (Others CM of the Digestive System) x (Ventilation modality and Nutrition and Surgery forms); (CM of the Genitalia) x (Gender, Family Income and Nutrition form); (Musculoskeletal CM) x (Number of pregnancies and Ventilation modality); (Others CM) x (GI and weight), and (Chromosomal Abnormalities) x (Maternal age), all with p <0.05. We have concluded that the number of NB with CM it is still prevalent and the nursing staff implements the healthcare according to the clinical conditions, pathology and hemodynamic balance of each NB and not specifically for each type of malformation.

A verificação de forma independente do cálculo de dose e de unidades monitoras num plano de tratamento de IMRT é um passo importante nos procedimentos de garantia de qualidade da técnica em questão. Atualmente este verificação é baseada apenas em medidas experimentais demoradas e trabalhosas. Neste trabalho foi desenvolvido uma metodologia de cálculo de unidades monitoras de forma independente como uma nova ferramenta para garantir a qualidade e exatidão dos tratamentos de IMRT. Os valores encontrados se aproximam bastante dos valores calculados pelo sistema de planejamento utilizado, de forma que o algoritmo de cálculo desenvolvido apresentou uma concordância dentro de ± 1,8 % para uma geometria simples. Após diversos testes e com os níveis de ação devidamente estabelecidos, a verificação independente da unidade monitora para planos de tratamento de IMRT se tornará uma ferramenta efetiva e eficiente no controle de qualidade que ajuda a identificar e reduzir possíveis erros de tratamento em radioterapia. Como contribuição original deste trabalho, assegura-se aos serviços de Radioterapia a utilização da metodologia desenvolvida como ferramenta de controle de qualidade em tratamentos com IMRT. Em especial aos serviços que não dispõem de recursos econômicos para adquirirem softwares comercialmente disponíveis para o cálculo independente da unidade monitora. / Independent verification of dose calculations and monitor units settings of IMRT treatment plans is an important step in the quality assurance procedure for IMRT technique. At present, the verification is mainly based on experimental measurements, which are time consuming and laborious. In this work an independent methodology of monitor units calculation was developed as a new tool for IMRT treatments quality and precision assurance. The values found are near those calculated by the treatment planning system used, in a manner that the calculation algorithm demonstrated ± 1,8 % concordance in a simple geometry with the system. After several tests and the levels of action well established, the independent monitor units verification for IMRT treatment plans will become an effective and efficient tool in quality assurance, helping identification and the reduction of possible mistakes in radiotherapy treatments. To radiotherapy services is assured the use of the developed methodology as a tool of quality control in IMRT treatments as an original contribution of this work, specially those that do not dispose financial resources to acquire commercially available independent monitor unit calculus software.

Audit and feedback (A&F), provision of performance data, can be an effective means to change behaviour. We hypothesize that A&F may be useful in the complex environment of critical care to address routine ordering behaviours. This thesis describes a systematic review assessing the use and effectiveness of A&F for the improvement of intensive care unit laboratory test and transfusion ordering and an analysis of how these interventions adhere to recent suggestions for best practice. The review identified relatively few published studies, almost all of which involved multi-component interventions; these were generally found to be moderately effective. Through development of an evaluation tool, we found recent suggestions for best practice may be underutilized in existing A&F interventions. This work has identified several priorities for future research to aid in the optimization of critical care A&F interventions aimed at improving test and transfusion ordering.

In my dissertation, I investigate the effects of budget-constraints in multi-unit auctions. This is done in three parts. First, I analyze a case where all bidders have a common budget constraint. Precisely, I analyze an auction where two units of an object are sold at two simultaneous, sealed bid, first-price auctions, to bidders who have demand for both units. Bidders differ with respect to their valuations for the units. All bidders have an identical budget constraint which binds their ability to spend in the auction. I show that if valuation distribution is atom-less, then their does not exist any symmetric equilibrium in this auction game. In the second and third parts of my thesis, I analyze the sale of licenses for the right to drill for oil and natural gas in the Outer Continental Shelf (OCS) of the United States. These sales are conducted using simultaneous sealed-bid first-price auctions for multiple licenses, each representing a specific area (called a tract). Using aspects of observed bidding-behavior, I first make a prima facie case that bidders are budget-constrained in these auctions. In order to formalize this argument, I develop a simple extension of the standard model (where bidders differ in their valuations for the objects) by incorporating (random) budgets for the bidders. The auction-game then has a two-dimensional set of types for each player. I study the theoretical properties of this auction, assuming for simplicity that two units are being sold. I show that this game has an equilibrium in pure strategies that is symmetric with respect to the players and with respect to the units. The strategies are essentially pure in the sense that each bidder-type has a unique split (up to a permutation) of his budget between the two auctions. I then characterize the equilibrium in terms of the bid-distribution and iso-bid curves in the value-budget space. I derive various qualitative features of this equilibrium, among which are: (1) under mild assumptions, there always exist bidder-types who submit unequal bids in equilibrium, (2) the equilibrium is monotonic in the sense that bidders with higher valuations prefer more unequal splits of their budgets than bidders with lower valuations and the same budget-level. With a formal theory in place, I carry out a quantitative exercise, using data from the 1970 OCS auction. I show that the model is able to match many aspects of the data. (1) In the data, the number of tracts bidders submit bids on is positively correlated with budgets (an R² of 0.84), even though this relationship is non-monotonic; my model is able to capture this non-monotonicity, while producing an R² of 0.89 (2) In the data, the average number of bids per tract is 8.21; for the model, this number is 10.09. (3) Auction revenue in the data was $1.927 billion; the model produced a mean revenue of $1.944 billion

This paper studies the effects of auction mechanisms on the average price of auction results of Shanghai car license plate from 2004 to 2018. We construct two linear regression models and find that an iterated multi-unit auction has a lower efficiency than a seal-bid discriminatory multi-unit auction. We also find that the pre-set price-ceiling is positively correlated with the average winning price. These results suggest that the government can potentially manipulate auction results through the design of the auction mechanism, and through the setting of warning price as a price ceiling.

In the classical case we make use of Pells equation to compute units in the ring OF. Consider the parallel to the classical case and the quadratic field extension that creates the ring OK. We use the generalized Pell's equation to find the units in this ring since they are solutions. Through the use of continued fractions we may further characterize this ring and compute its units.

v anglickém jazyce Theoretical and Practical Aspect of Unit-linked Insurance Abstract United-linked insurance (ULI) is the most widely sold type of life insurance in the Czech Republic; frequently, however, this product is sold to clients without respecting their investment profile and financial needs (mis-selling); mis-selling, in turn, results in the loss of confidence in the system of financial distribution and its efficiency. Even though the current legislation offers tools to mitigate mis-selling (not only) of ULI, in practice such legal regulation proves to be insufficient. The causes of this relate to both the distributors and their customers, as well as to the financial products themselves. Behavioural research has proven marked shortcomings in the economic and legal understanding of a human being as a homo economicus, i.e. as a rationally acting agent. A number of studies evidence that people oftentimes demonstrate limited rationality, which negatively impacts financial distribution, in that these cognitive errors may be purposefully and skilfully abused by distributors who use their marketing and sales strategies to the clients' disadvantage. In this respect, this thesis analyses the current financial-political customer protection doctrines; the status of the ULI customer protection,...

Anxiety is a common problem for patients with cancer. Anxiety may have a negative impact on decision making and overall emotional well being of patients and may be related to the uncertainties faced by people with cancer. This study examined the relationship between uncertainty in illness and anxiety in patients with cancer. The sample consisted of 30 patients, predominantly males (n=23), being treated as outpatients in the Clinical Research Unit at a National Cancer Institute designated cancer center in Florida. After agreeing to participate, patients completed the State-Trait Anxiety Inventory as well as Mishel's Uncertainty in Illness Scale. Participants' ages ranged from 21 to 86, with a mean age of 64 years. Forty percent of the patients completed high school, 30% had some college education and almost 30% had a bachelor's degree or higher. Almost 47% of the sample had melanoma, other patients had renal cancer (n=3), or pancreatic cancer (n=2), acute myeloid leukemia (n=2), sarcoma (n=2), lung cancer (n=2), myeloma (n=2), chronic myeloid leukemia (n=1), glioblastoma (n=1), and rectal cancer (n=1). Seventy percent of the patients had stage IV disease. The results of the study showed a significant positive relationship between uncertainty and both state anxiety (r=0.52, p=0.00.) and trait anxiety (r=0.61, p=0.000). A significant positive relationship was also found between the uncertainty subscale of ambiguity and both, state anxiety (r=0.538, p=0.002) and trait anxiety (r=0.56, p=0.001). Both state anxiety (r=0.39, p=0.034) and trait anxiety (r=0.64, p=0.000) were positively related to the uncertainty subset of inconsistency. Although the sample size was small and not demographically diverse, the findings of this study are supportive of previous studies. The implications of this study in nursing are significant because they examine two emotional aspects that evidently exist among cancer patients, and that very likely cause distress to this population. The findings of this study suggest that additional focus in uncertainty and anxiety should take place in the clinical outpatient setting.