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This is a research-based thesis building upon the study conducted over the past two years with Dr. Elizabeth English on the Buoyant Foundation Project (BFP). The BFP is currently developing an amphibious foundation system to retrofit vernacular wooden ‘shotgun’ houses in the Lower Ninth Ward in New Orleans. This neighbourhood was chosen because of its unique cultural heritage and the severe, but recoverable, damage incurred in the aftermath of Hurricane Katrina. The BFP system will allow homes to float when flooding occurs, rising and descending vertically to avoid flood damage. It provides an alternative solution to permanent static elevation, the mitigation strategy currently recommended by the United States federal government. The thesis will demonstrate how the Buoyant Foundation Project is a culturally supportive, technically feasible, economical, sustainable and resilient form of flood mitigation for post-Katrina New Orleans.

In this thesis research, we investigate the usability of hand-held display (Tablet PC) and wearable head-mounted display (Google Glass) interfaces and their effect on doctor-patient interaction during clinical ward round in the hospital. We looked at existing literature to identify existing research about our topic. Using a User Centered Interaction Design process we developed a prototype hybrid system that used both a hand-held and head-mounted display. An evaluation of this prototype with a hand-held system and a paper based interface was performed in a simulated patient room with 20 doctors and 5 patients. The participants were observed, surveyed, and interviewed about their experiences. Generally, the patients had a high satisfaction rate and felt the interfaces were not causing the doctors to lose focus on them. The doctors found the hand-held display by itself and existing paper-based interface to be the most usable and least distracting interfaces for accessing patient information during clinical ward rounds.

The Constitution of South Africa, 1996, requires local government to be democratic and accountable to local communities. Municipalities are also constitutionally bound to encourage the involvement of the communities in the affairs of local government. Section 152 of the Constitution of South Africa, 1996, sets out the rights of communities to be involved in the affairs of local government.Participation is not only about communicating information and addressing the needs of the community. Participation is also about building partnerships with the community, being accountable to the community, allowing the community to take part in policy decisions, capacitating the community to understand their rights and obligations as citizens, and allowing the community to participate actively in social, political and economic affairs. Local government as a sphere of government closest to the peopleplays a critical role in advancing the participation of the community. Chapter 4 of the Municipal Structures Act of 1998 requires that municipalities should establish ward committees in order to enhance participatory democracy. Ward committees were therefore established, as community structures, to play a role in advocating needs, aspirations, potentials and problems of the community. However, studies appear to be critical on the functionality of ward committees and argue that most ward committees are not functioning as intended. The purpose of the study is to establish whether MatlosanaLocal Municipality has created the environment for active participation through the ward committee system in order to enhance participatory democracy. Thestudy further investigates whether the ward committees are functioning as intended and according to what the law requires. The researcher used a qualitative method to determine how Matlosana Local Municipality uses the ward committee system to enhance participatory democracy. The investigation revealed a number of challenges facing the ward committees which hinder their effectiveness. However, recommendations are recommended to assist the management of the municipality in making the system more effective. / Thesis (M. Development and Management)--North-West University, Potchefstroom Campus, 2012

The Constitution of South Africa, 1996, requires local government to be democratic and accountable to local communities. Municipalities are also constitutionally bound to encourage the involvement of the communities in the affairs of local government. Section 152 of the Constitution of South Africa, 1996, sets out the rights of communities to be involved in the affairs of local government.Participation is not only about communicating information and addressing the needs of the community. Participation is also about building partnerships with the community, being accountable to the community, allowing the community to take part in policy decisions, capacitating the community to understand their rights and obligations as citizens, and allowing the community to participate actively in social, political and economic affairs. Local government as a sphere of government closest to the peopleplays a critical role in advancing the participation of the community. Chapter 4 of the Municipal Structures Act of 1998 requires that municipalities should establish ward committees in order to enhance participatory democracy. Ward committees were therefore established, as community structures, to play a role in advocating needs, aspirations, potentials and problems of the community. However, studies appear to be critical on the functionality of ward committees and argue that most ward committees are not functioning as intended. The purpose of the study is to establish whether MatlosanaLocal Municipality has created the environment for active participation through the ward committee system in order to enhance participatory democracy. Thestudy further investigates whether the ward committees are functioning as intended and according to what the law requires. The researcher used a qualitative method to determine how Matlosana Local Municipality uses the ward committee system to enhance participatory democracy. The investigation revealed a number of challenges facing the ward committees which hinder their effectiveness. However, recommendations are recommended to assist the management of the municipality in making the system more effective. / Thesis (M. Development and Management)--North-West University, Potchefstroom Campus, 2012

Bakgrunn: Norskehelsemyndigheter anbefaler i tråd med WHO / UNICEF at spedbarn bør få morsmelk som eneste næring i de første seks levemånedene. Ammingen bør opprettholdes gjennom hele det første leveåret samtidig med at fast føde introduseres. Rutiner ved føde-/ barselavdelingene har stor innvirkning på etablering og varighet av ammingen. Bruk av tilleggsnæring uten medisinsk grunnkan føretil at færre mødre fullammer og at de har en kortere ammeperiode. Mål: Studere endring av rutiner som fremmer amming ved norske fødeenheter med et spesielt fokus på perioden1991-2009, rett før og etter lanseringen av Mor-barn-vennlig initiativ (MBVI). Beskrive situasjonen med den fortløpende registreringen av amming og spedbarn som får tilleggsnæring ved landets fødeenheter. Metode: Ammeundersøkelsen som er gjennomført hvert 9. år, er en deskriptiv tverrsnitt studie. Fødeenhetene besvarte et tilsendt spørreskjema med spørsmål om avdelingens ammerutiner for det forutgående år, retrospektivt. En fortløpende registreringpå tilsendt registreringsskjema, av amming og bruk av tillegg til 20 friske, fullbårne barn ved hver fødeenhet, tilsammen 984 barn, ble gjort prospektivt. Resultat: Fødeenhetenes rutinerhar i hovedsak endret seg i tråd med helsemyndighetenes anbefalinger, bortsett frapraksis med å gi tilleggsnæring til friske, fullbårne barn som skal ammes. Registreringen av amming og bruk av tilleggbekrefter svarene fra Ammeundersøkelsen. 30 % av de registrerte barna fikk tilleggsnæring minst en gang under barseloppholdet, og de fleste fikk det av en ikke medisinsk grunn. Konklusjon: Unødig bruk av tilleggsnæring er en indikator på at avdelingens ammepraksis ikke fungerer tilfredsstilende. / Background: In concurrence with the World Health Organization and UNICEF, Norwegian health authorities recommend exclusive breastfeeding for infants during the first six months of life. Thereafter, recommendations suggest the continuance of breastfeeding for the first year of life, while introducing complementary food. Routines in maternity wards have a huge impact on the establishment and duration of breastfeeding. Consequently, supplemental nutrition that lacks medical justification may reduce exclusive breastfeeding, and associates with early termination of breastfeeding. Objective: This study aimed to examine changes in maternity ward routines with regard to breastfeeding, focusing particularly on the period between 1991 and 2009, immediately before and after Norway launched the Baby-Friendly Hospital Initiative. In addition we examined the continuous registration of breastfeeding and the provision of breast-milk substitutes in the maternity units. Methods: Norway conducts a descriptive and cross-sectional National Breastfeeding Survey (Ammeundersøkelsen) every 9th year. The 53 head midwifes responded retrospectively to a questionnaire about their units’ breastfeeding practices the preceding year. In addition each unit registered breastfeeding and the use of breast milk substitutes for 20 healthy term infants, a total of 984 infants, prospectively. Results: Except for non-medical use of breast-milk substitutes, changes in breastfeeding routines mostly adhered to health authority recommendations. The registration of breastfeeding and breast-milk substitutes confirms our findings. Thirty percent of registered babies received breast-milk substitutes at least once during their stay in the maternity ward, and most received a substitute due to a non-medical reason. Conclusion: The use of breast-milk substitutes for non-medical reasons indicates that hospitals’ breastfeeding routines are not satisfactory. / <p>ISBN 978-91-86739-97-3</p>

Thesis (doctoral)--University of Stockholm, 1985. / Extra t.p. with thesis statement inserted. Includes bibliographical references (p. [157]-166).

Introdução: Avaliar o impacto das intervenções em saúde passa a ser obrigação, principalmente, daqueles que são responsáveis pelas decisões em saúde. Entre estes, estão os profissionais que prescrevem e determinam tratamentos, atuando como fontes geradoras de despesa, bem como os gestores, que devem garantir a melhor aplicação de recursos e ampliação do atendimento à população. A escassez de recursos tem levado os sistemas de saúde do mundo inteiro a incorporar metodologias de avaliação econômica para a tomada de decisão. Entre as demandas crescentes da população está a necessidade de transplantes, entre os quais o transplante de medula óssea (TMO). Um procedimento de alto custo, pela grande utilização de recursos no tratamento, tempo elevado de internação, além do investimento em prevenção de desfechos aos quais estes pacientes ficam sujeitos: infecções, rejeição ao enxerto e mortalidade. Objetivos: Este estudo tem como propósito avaliar a relação de custobenefício da criação de uma unidade de ambiente protegido (UAP) destinada a pacientes hematológicos submetidos a TMO em um hospital universitário brasileiro. Identificar os custos da criação e manutenção da UAP, estimar os custos associados à realização de transplantes de medula óssea em pacientes portadores de doenças hematológicas bem como os benefícios da implantação desta unidade em relação à freqüência de ocorrência de agravos de morbidade e mortalidade. Delineamento: Quase-experimento. Métodos: Trata-se de um estudo retrospectivo, onde a população é formada por coorte de pacientes adultos que realizaram TMO entre 5 de janeiro de 2004 e 7 de maio de 2007 – denominado Período 1 (P1) – e 4 de junho de 2007 e 18 de março de 2008 – denominado Período 2 (P2). Para a identificação do custo do paciente foram analisados todos os recursos utilizados por este a partir de sua primeira internação para a realização do transplante e as posteriores, num período de até seis meses de acompanhamento, considerando: custo da unidade de internação; nutrição; recursos de Serviços de Apoio ao Diagnóstico e Tratamento (SADT); custo em nota de sala; custos de procedimentos realizados; hemoterapia; oxigenoterapia; medicamentos utilizados; nutrição parenteral; radioterapia e quimioterapia. Para efeitos de comparação todos os custos foram ajustados para jan/08. Para medir o impacto assistencial, foram pesquisados desfechos como ocorrência de infecções e doença do enxerto contra o hospedeiro (DECH). Resultados: Foram analisadas 166 pacientes e 233 internações no período pré-intervenção enquanto no período posterior foram analisados 45 pacientes e 58 internações hospitalares. O custo mediano por paciente foi de R$ 43.087,81 em P1 e R$ 37.303,87 em P2 (p= 0,466), esse mesmo custo quando estratificado por tipo de transplante resultou em redução de R$ 122.944,69 para R$ 100.555,48 em casos alogênicos (p=0,011) e mantevese igual em casos autólogos, sendo R$ 28.453,05 em P1 e R$ 28.305,24 em P2 (p=0,237). O índice de proteção da UAP sobre a variável infecção hospitalar, demonstrado através da razão de densidade de incidências foi de 0,83 (IC de 95% 0,56 a 1,23) e a taxa de infecção foi reduzida de 2,08% para 1,75%, sendo observada uma redução de 0,17 na incidência da mesma. A mortalidade na internação de realização do transplante foi reduzida de 0,16 em P1 para 0,11 em P2 e o índice de reinternação, de 0,40 para 0,28, respectivamente. Conclusão: A intervenção realizada no tratamento de pacientes submetidos a TMO, internação em UAP, demonstrou uma redução de 13% no custo mediano dos pacientes. O resultado por tipo de TMO demonstrou-se fortemente custo-benéfico nos casos alogênicos, aqueles considerados de maior complexidade e custo. Os dados de infecção, mortalidade e reinternação sugerem uma intervenção eficaz quando analisada sob a perspectiva dos desfechos assistenciais. Do ponto de vista econômico, também foi observado resultado favorável à intervenção em estudo, ainda que o mesmo também não tenha apresentado força estatística. / Objective: To evaluate the cost-benefit of creating a protected environment (PE) ward for hematological patients undergoing bone marrow transplantation (BMT) at Hospital de Clínicas de Porto Alegre (HCPA), public school hospital with 740 beds, located in Southern Brazil. Methods: A retrospective study, quasi-experimental design, with a population made up of cohort of adult patients who underwent BMT from Jan/2004 to May/2007 (P1) and Jun/2007 to Mar/2008 (P 2). Cost information was obtained by identifying the resources used by patients from the query of the computerized system of HCPA. To measure the impact of care, outcomes, such as occurrence of infections and mortality were investigated. Results: We analyzed 166 patients and 233 admissions in the preintervention while in the later period 45 patients and 58 hospitalizations were investigated. The median cost per patient was R$ 43.087,81 in P1 and R$ 37.303,87 in P2 (p = 0.466). This same cost when stratified by type of transplant resulted in a reduction from R$ 122.944,69 to R$ 100.555,48 in allogeneic cases (p = 0.011) and remained the same in autologous cases, of which R $ 28,453.05 in P1 and R $ 28,305.24 in P2 (p = 0.237). The index of protection of the PE on the variable infection, shown through the ratio of incidence density was 0.83 (CI 95% 0.56 to 1.23) and the rate of infection was reduced from 2.08% to 1.75%, and a reduction of 0.17 in its incidence was seen. The level of mortality on hospital stay during the transplantation was reduced from 0.16 in P1 to 0.11 in P2 and the rate of rehospitalization, 0.40 to 0.28, respectively. Conclusion: The intervention performed in the treatment of patients undergoing bone marrow transplantation, hospitalization in PE ward, showed a 13% reduction in the average cost of patients, although this difference was not considered statistically significant. The result by type of BMT showed strongly cost-beneficial in allogeneic cases, those considered of greater complexity and cost. The data of infection, mortality and reinteração suggest an effective intervention when viewed from the perspective of welfare outcomes. From the economic point of view, it was also observed a favorable outcome to the intervention under study, although it has not presented statistical power.

There are high expectations regarding mobile technology and how it can be used to promote improvements in the quality and efficiency in healthcare. There appears to be a gap between the goals and strategy on the macro level and the micro level experiences of the usage of mobile devices among healthcare professionals.   The purpose of this study is to examine the perceptions, experiences and expectations of nursing care providers at two wards with regards to the recently implemented mobile platform COSMIC Nova Ward and other related IT artefacts. Special emphasis has been on COSMIC Nova Ward Tablet, a part of COSMIC Nova Ward, facilitated in iPad MINIs. It is designed to act as a tool to facilitate the provision of care and has been introduced at both the wards during a pilot project. Even though the two wards are similar in both practice and structure, the pilot project resulted in failure at one of the wards and a relative success at the other.   A comparative case study of the perceptions, experiences and expectations of the nursing personnel at the two wards was conducted in order to highlight the differences in the outcomes of the pilot project. By reflexively comparing these with theory, it was concluded that there are several factors other than adequacy of the IT system that determine the outcome of the implementation of a mobile platform in a clinical setting.   These findings were then compared with existing legislation and policies, in order to identify potential discrepancies between the nursing personnel’s usage of IT with the regional and national goals and strategy. It was then determined that there needs to be a clear connection between the usage of IT and the goals and strategy within healthcare.

Till the present-day the problems of the professional pressure have been explored above all in the field of the EMS nevertheless the inquiry in the field of urgent reception was and still is the field much less explored. In the thesis three aims were specified: To evaluate the most stressing situations of the urgent reception. To compare the stressful aspects of the paramedics at the places of urgent reception with EMS. To suggest the ways of managing stress at the urgent reception. Two inquiry questions were asked to fulfill the aims of the work: Are the paramedics working at the urgent reception able to describe stressing factors? Are the stressing situations same when working at the urgent reception and at the EMS? The inquiry was realized by the collection and analyses of the data while the collection of the data was realized by the qualitative form, by the method of semi-structured dialogues. The dialogues were led with 14 middle medical workers who worked at the position of paramedics. The choice of the workers was random, some of them worked at the urgent reception in Prague, in the Motol Teaching Hospital, in the Střešovice Central Military Hospital and in Královské Vinohrady Teaching Hospital. The questions were ranked into four areas. The first area dealt with the stressing factors and their comparison with the EMS. The respondents were asked why they find their work more difficult and in which it is easier then working at the EMS. Futher which situations they perceive as the most difficult for their psychical balance, if they face some fear in their service or if they are afraid of anything. In the second area we tried to go back with the respondents to the subsequences of the situations they experienced during their service. We traced the situations with which they feel to be influenced at the urgent reception and what kind of situations they were. The third area regarded the professional intervention. Here we found out if the respondents needed the help of the professional psychologist. Consequently if they have a psychologist at their disposal within the framework of their workplace. Lastly the respondents should express their opinion about the professional psychologist in the context of their profession. In the last forth area we dealt with the managing of stress. In this area we found out if the respondents try to cope with the stress load during their service or if they go back to such situations. Then the respondents were to answer if they have some kind of active relaxation and how often they practise this kind of relaxation. Then there was time to answer questions regarding the problems of smoking, alcohol and drugs. Thanks to the determination supported by the inquiry that the most demanding situations at the urgent reception regard death or serious health condition of a young man or a child, it was possible to state the proposion that the paramedics working at the urgent reception were able to describe the stressing factors they deal with. From the results it was also possible to state that the stressing situations at the urgent reception and EMS vary. Also it is necessary to remark that although the stressing situations and their perception vary in specific details, the perception of the demandingness of the work at the urgent reception can be subjective.The results also showed that some respondents found their work easier than working at the EMS. But the paramedics of these two subjects agreed in perceiving the most stressing situation the serious heath condition and death of young people and children. This thesis could be used in praxis to create a conception of a preventive and intervention program as an instrument of managing stress coming out of these results and the mentioned points. It would be only necessary to modify them in the area of urgent reception and in the situations which the respondents find demanding.