Typescript (photocopy). / Digitized by Kansas Correctional Industries

Typescript (photocopy). / Digitized by Kansas Correctional Industries

Typescript (photocopy). / Digitized by Kansas Correctional Industries

The primary purpose of this dissertation was to understand if emergency department utilization patterns are associated with subsequent drug overdose death. Specifically, it was hypothesized that that increasing emergency department (ED) utilization (as measured by such indices as two or more visits in 72-hours, two or more visits in a 30-day period, four or more visits in a 365-day period) was associated with increasing risk of fatal unintentional drug overdose compared with patients without two or more visits in a given time frame. Using ED data from the New York State Department of Health's (NYSDOH) Statewide Planning and Research Cooperative System (SPARCS) for the years 2006-2010 linked with unintentional fatal prescription drug overdose data from death certificates and medical examiner case files from the New York City Department of Health and Mental Hygiene (NYC DOHMH) and the NYSDOH for the years 2006-2010, a retrospective dynamic cohort of ED encounter data was conducted. In the first study, the patient population consisted of 1,755,734 New York State residents who were 18-64 years of age and had selected diagnoses on their entry visit. Extended Cox proportional hazards regression models were conducted to estimate the association of ED utilization patterns and subsequent drug overdose death. Compared to time periods in which patients had no visits within a year, patients who had 3, 4-10, or > 10 visits in a year had elevated risks of prescription drug overdose death after adjustment for demographic characteristics: 3 visits (adjusted hazard ratio (aHR 4.77, 95% CI 3.60, 6.15)), 4 - 10 (aHR 7.39, 95%CI 5.81, 9.41), and > 10 ED (aHR 18.37, 95% CI 13.38, 25.23). ED utilization patterns are strong predictors of subsequent overdose death. Understanding the timing of overdose death in relation to ED utilization is essential to recognizing which patients to target with overdose prevention interventions. Identifying time-periods of increased risk may be used as an indicator for developing prediction tools to classify patients at increased risk for overdose.

This dissertation analyzes the effects of community violence on health care service utilization and access in Mexico. Given the widespread effects of violence, there is good reason to believe that health service delivery might be affected, but it is largely unknown. This study looks at potential channels through which violence may impact the supply and demand of health care services in Mexico, through qualitative and quantitative methods. It posits that violence can have heterogeneous effects on service utilization and provides a deeper exploration of factors that may have negative and positive effects on service utilization. Supply-side effects point towards deterring effects of violence in service utilization out of fear of travel and fear among medical staff to go to their workplaces or shortening the hours of operation out of fear of exposure. Mixed effects logistic regression models reveal demand-side effects through a significant increase in health care service utilization as violence increases possibly related to worsening health (e.g. through stress or other mechanisms), which may drive individuals to seek more services. In sensitivity analysis, increased primary care service utilization as a result of an increase in the homicide rate remains significant when predictors of service use such as having a chronic condition, insurance status and urban areas are included in the models. Qualitative findings also reveal an increased demand for mental health services at the primary care level as a result of increased community violence. Findings underscore the importance of access to outpatient services and mental health services at the primary care level in contexts of high violence. The significant increase in the use of outpatient service utilization point towards potentially protective behaviors driving the increase of use of services as violence increases. This analysis highlights the responsibility and need for providing safe access to medical services in contexts of violence that may translate to natural disasters or other man-made conflicts.

The objective of this thesis was to investigate the effect of age and feeding length on phytase efficacy in broiler chickens during the starter phase. Two studies were carried out to evaluate this objective.<br>Study 1 was a randomized complete block design with 4 × 5 factorial arrangements of treatments. There were four diets; a positive control (PC), negative control (NC) and two phytase supplemented diets with inclusion levels of 1,000 and 2,000 phytase units/kg. There were five age and duration of feeding groups; Three 2-d feeding lengths terminated at d 8, 14, and 22 (d 6 to 8, d 12 to 14, and d 20 to 22), a 5-d feeding length terminated at d 14 (d 9 to 14) and a 16-d feeding length terminated on d 22 (d 6 to 22). Growth performance and sample collections were collected at the end of each phase i.e. d 8, 14 and 22. There was a difference (P < 0.01) in weight gain, feed intake, and feed efficiency between birds fed the PC diets and birds fed the NC diets across all groups as birds on the NC diets had lower performance (P < 0.05) than birds on the PC diet. However, birds fed the phytase supplemented diets had higher (P < 0.05) growth performance compared with birds fed the NC diet across all groups. Similarly, phosphorus (P) and calcium (Ca) digestibility and retention of birds fed the NC were lower (P < 0.05) as compared with birds fed the PC diet while birds fed the phytase supplemented diets had higher mineral digestibility and retention (P < 0.05) compared with birds on the NC diet. Age effect was evaluated by comparing the performance of birds fed the experimental diets for 2 d until d 8, 14, and 22. Birds fed until d 14 had the highest impact of the NC diet on mineral utilization, and the largest improvement of phytase on mineral utilization as compared with birds fed until d 8 and 22. Similarly, when feeding length effect was considered, birds fed for a shorter period had greater response to phytase (P < 0.05) on nutrient utilization than birds fed for a longer period at d 14 and 22. Tibia ash was higher (P < 0.05) in birds fed phytase supplemented diets for a longer period (i.e. 16 d) compared with birds fed or 2 or 5 d. The results from this study observed that age and duration of feeding influenced phytase efficacy especially in younger birds fed for a short period. However, it could not be determined if feeding birds for a short period at different ages in the starter phase would have a similar effect.<br>In study 2, the effects of age and feeding low P diets to birds for a short period of time on phytase efficacy and super dosing were evaluated at two critical points in the starter phase. This study had 3 × 2 × 2 factorial arrangements of treatments comprising 3 diets; a PC, NC, and a NC with phytase supplemented at 2,000 phytase units/kg; and 2 ages (i.e d 14 and 22) and 2 feeding lengths (i.e 2-d and 5-d). Thus, birds were fed the experimental diets from d 12 to 14, 9 to 14, 20 to 22, and 17 to 22 respectively. Results observed were similar to the first study. Birds fed the NC diet had lower (P < 0.01) performance as compared with birds fed the PC diets across all age and feeding length groups. Similarly, birds fed diets with the super dose level of phytase had greater growth performance (P < 0.01) compared with birds fed the NC diets. When age effect was considered, birds fed for 2 or 5 d until d 14 had the greatest improvements of phytase on nutrient utilization and bone mineralization compared with birds fed for both periods until d 22. When effect of feeding was considered, birds fed for 2-d at both ages had greater responses to phytase in performance and nutrient utilization compared with birds fed for 5-d at both ages. Plasma myo-inositol was higher (P < 0.01) in birds fed the super dose level of phytase compared with birds fed the NC diet.<br>In summary, we could conclude that the efficacy of phytase both at 1,000 and 2,000 FTU/kg was higher in birds fed for 2 d until d 14 as compared with the other groups. This could potentially help in designing studies to evaluate new phytase products or for comparing the efficacy of phytase from various sources. Feeding broiler chickens during the suggested time phase would potentially reveal the maximum efficacy of the phytase product.<br>

Made available in DSpace on 2015-04-22T22:10:46Z (GMT). No. of bitstreams: 1 leand.pdf: 1294573 bytes, checksum: d10eb21cbecb9685945b11331d660860 (MD5) Previous issue date: 2010-02-08 / The production line concept introduction by Henry Ford, brought a great enhancement in the resource usage efficiency and transformation during the industrial process. Afterwards Ohno (1988) presented that during the industrial process all the waste should be removed from the process. Ohno also explains that waste is any activity that do not aggregate value in the final product. As a production test do not aggregate value, it simply ensure the product reliability, this paper has the purpose to develop a methodology to evaluate, identify and reduce the longest tests time of an electronic test sequence without decrease the product quality. Based on the instrument driver s utilization is possible to identify opportunities points to be executed concurrently (parallelism). The execution of two or more tests in parallel make possible the time reduction of the whole product test. One baseline of times and results were created to act as a benchmark and based on statistical process control indexes such as result mean and standard deviation and also the test acceptance limits cpk index, it will be possible to confirm the methodology efficacy and efficiency. Besides the methodology, the paper also refers the analysis and automation tools that were created during the time optimization project. / A introdução do conceito de linha de montagem por Henry Ford, trouxe um grande avanço à eficiência do uso dos recursos e transformações durante o processo fabril. Mais tarde com Ohno (1988), mostrou-se que durante o processo fabril, todo o desperdício deve ser removido do processo. Ohno ainda explica que desperdício é toda atividade que não agrega valor ao produto final. Como o teste de produção não agrega valor ao produto final, apenas garante a confiabilidade do mesmo, o presente trabalho tem como objetivo desenvolver uma metodologia para identificar e reduzir os tempos de testes mais demorados de uma sequência de testes de produtos eletrônicos sem que seja diminuída a qualidade dos produtos. Baseado na análise da utilização dos instrumentos dos testes é possível a identificação dos pontos candidatos a serem executados concorrentemente (paralelismo). A execução de dois ou mais testes em paralelo nas sequências torna possível a redução do tempo total de testes do produto. Um histórico dos tempos e resultados foi catalogado para através da utilização de índices estatísticos como a média e o desvio padrão dos resultados, juntamente com o índice Cpk dos limites dos testes, poder comprovar não só a eficiência, mas também a eficácia da metodologia. Além da metodologia, o trabalho também cita as ferramentas de análise e automação de redução de tempos de testes que foram desenvolvidas ao longo do projeto. A metodologia se mostrou eficaz e não apenas os tempos de testes foram reduzidos, mas, também, os resultados se mostraram igualmente confiáveis.

Water resources located in more than one country are complex systems governed by customary international law embodied in a rule known as equitable and reasonable utilisation, a recent development in international law not yet been applied by an international tribunal to resolve a dispute or to allocate transboundary water resources between countries. Water scarcity on a global scale has reached critical proportions with 1.1 billion people without access to sufficient safe water for personal and domestic use; over half that number depend on transboundary watercourses that will disappear over the next century. Conflicts of use over shared water resource have the potential to escalate into armed conflict; certainty in the peaceful means to avoid and resolve disputes is needed. The thesis examines international procedural practice and jurisprudence applying equitable principles in a case study to illustrate how equitable and reasonable utilisation may be applied by an international tribunal. The survey of international practice will inform States about procedural options for dispute avoidance and resolution in disputes over the use of transboundary water resources.

Orientador: Orivaldo Arf / Banca: Marco Eustáquio de Sá / Banca: Salatier Buzetti / Banca: Carlos Alexandre Costa Crusciol / Banca: Sebastião Ferreira Lima / Resumo: Com o objetivo de avaliar a influência dos sistemas de manejo do solo, doses de nitrogênio em cobertura e da inoculação de sementes com Azospirillum brasilense no arroz de terras altas cultivado após diferentes coberturas vegetais sobre as características agronômicas e componentes de produção da cultura do arroz de terras altas, o trabalho foi desenvolvido, durante os anos agrícolas de 2011/12 e 2012/13 em área experimental da Fazenda de Ensino, Pesquisa e Extensão da Universidade Estadual Paulista, no município de Selvíria (MS). O solo do local é do tipo Latossolo Vermelho-Escuro de textura argilosa, sob vegetação de cerrado. O trabalho é constituído por três subprojetos envolvendo sistemas de manejos do solo, doses de nitrogênio e, presença e ausência de inoculação de sementes com A. brasilense sobre as coberturas vegetais milheto (subprojeto 1), crotalária (subprojeto 2) e o consórcio milheto + crotalária (subprojeto 3). Pode-se concluir que, a massa seca da parte aérea do arroz aumentou com a inoculação de sementes com A. brasilense em função da cobertura vegetal e do manejo do solo. Houve redução do número de panículas por m2 reduziu nas doses 0 e 80 kg ha-1 de nitrogênio em sucessão ao milheto, e aumento na dose de 120 kg ha-1 em sucessão a crotalária e o milheto + crotalária. A massa de 100 grãos aumentou com a inoculação de sementes em sucessão ao milheto na dose de 40 kg ha-1 de nitrogênio. A produtividade aumentou linearmente pela maior disponibilidade de nitrogênio em cobertura, independente do manejo do solo e da cobertura vegetal. Em sucessão ao milheto não houve influencia da inoculação de sementes, porém, em sucessão a crotalária e o milheto + crotalária, maiores produtividades são obtidas no SPD e com doses de nitrogênio de 80 e 120 kg ha-1 / Abstract: In order to evaluate the influence of soil management systems, nitrogen levels in coverage and seed inoculation with Azospirillum brasilense in upland rice grown after different cover crops on agronomic characteristics and rice crop production components highlands, the study was conducted during the growing seasons of 2011/12 and 2012/13 in the experimental area of the Teaching Farm and Research of the Universidade Estadual Paulista, in Selvíria (MS). The soil is of type Ferralsol epi-eutrophic Alic and clayey, originally under savannah vegetation. The average annual rainfall is 1,330 mm, the average annual temperature is 25 ° C and the relative humidity of annual mean air of 66%. The work consists of three sub-projects involving soil managements systems, nitrogen levels and presence or absence of seed inoculation with Azospirillum brasilense on the cover crops millet (subproject 1), hemp (subproject 2) and millet consortium + sunnhemp (subproject 3). It can be concluded that the dry weight of shoots of rice increased linearly with inoculation with Azospirillum brasilense seeds in function of plant cover in succession and soil management. There was a reduction in the number of panicles per m2 reduced the doses 0 and 80 kg ha-1 of nitrogen in succession to millet, and increased 120 kg ha-1 in succession to sun hemp and millet + sunnhemp. The mass of 100 grains increased by inoculation of seeds in succession to millet in the dose of 40 kg ha-1 of nitrogen. Productivity increased linearly by the greater availability of nitrogen in coverage, regardless of soil management and plant cover. In succession to millet no influence seed inoculation, however, in succession to sun hemp and millet + crotalária highest yields are obtained in the SPD and nitrogen doses of 80 and 120 kg ha-1 / Doutor

ABSTRACT In the United States, Hispanics have the same prevalence of mental illness as any other group however researchers have found that they are less likely to seek mental health services. This population’s lack of mental health utilization is due to various barriers hindering the population’s need for help, a substantial for social work practitioners. To better understand the factors that lead up to that, the current study explored and identified perceptions toward seeking and receiving mental health services among Hispanic members. Using a qualitative data collection, ten participants were interviewed to elicit their perceptions about mental health services ranging from what they believed addressed their lack of seeking services and what they thought about services. Data analysis revealed five core themes among the participants’ responses: Closeness to Family as a reason for people not seeking professional help. Another theme found was environment as a reason for Mental Illness making them feel that there is no need to seek services since they can simply remove the environmental stressor and the illness will seize to exist. Existing support systems were found such as involvement in church as a form of therapy, they talked about their faith providing them a form of support for stressors. Shared culture was a theme that was found to be a necessity for therapy, they felt they did not seek services because they felt mental health practitioners would not validate their culture. The final theme was access and that theme encompassed : not knowing mental health services existed in their community, to lack of Spanish speaking clinicians. The recognition of these themes could potentially guide social work practitioners’ when they are trying to engage the Hispanic community to receive mental health services. Social workers can be aware of the obstacles toward engaging this population into professional therapy, by having an understanding of what they believe about therapy and helping to alleviate or use some of those perceptions as a form of engagement and validating existing strengths that the population has causing them to feel professional services are not needed.