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.

The thesis deals with psychosocial aspect of premature birth, to which our society does not still pay the attention they would deserve. The aim of the thesis is to emphasise the need to provide specialized psychosocial care to families with prematurely born children within a neonatology ward and to evaluate the possibilities to apply the role of a social worker to provision of such care. The thesis is conceived as a qualitative research. The techniques of semi-structured interview and data content analysis were applied on data collection. The research sample consisted of 11 specialists of various professions involved in the care about prematurely born children and their families. The work partly continues in the research of 2007 where I dealt with the psychosocial issues of premature births from the point of view of parents of prematurely born children. The research results definitely confirmed that striving for creating a conception of specialist psychology care forming a link between health care staff and parents is necessary. Such care should be based on the following forms of assistance so as it supports family function and child{\crq}s healthy development: provision of crisis intervention, support of early relation between the mother (parents) and the child, support and strengthening parent competences, advisory on care about a prematurely born child or perhaps a handicapped child, social law counselling, mediation of related services, support of sharing experience among parents. A social worker is fully competent to provide such care. As the research shows no unified legislation dealing with his/her activities within a multidisciplinary team of a neonatology ward exists. The Social Service Act defines the conditions for the profession; separate activity would probably be subject to special regulations dealing with the activity of a social worker in hospitals. The work may be useful to all professionals pushing for rendering complex care about families of prematurely born children, i.e. care naturally involving specialist psychological care.

The ward sister round presents an integral part of the nursing profession. The ward sister round comprises a regular visit of the nurse directly at the patient´s bed. Its objective consists in determining and satisfying the unsaturated needs of patients, further in ensuring and providing a high quality and efficiency nursing care in a close link with medical care. Nursing handover can be divided into two main sections: written and oral handover. The oral handover takes place directly in the patients´/clients´ room under the use of nursing documentation. Its advantage consists in the direct involvement of the patient/client in the handover process. The written handover is then entered by the nurses into the Handover Book. The significance of my diploma work consists in increasing the nurses´ standard of knowledge related to the modernization of ward sister rounds and nursing handover as an integral part of the nursing profession.

abstract: Electric power systems are facing great challenges from environmental regulations, changes in demand due to new technologies like electric vehicle, as well as the integration of various renewable energy sources. These factors taken together require the development of new tools to help make policy and investment decisions for the future power grid. The requirements of a network equivalent to be used in such planning tools are very different from those assumed in the development of traditional equivalencing procedures. This dissertation is focused on the development, implementation and verification of two network equivalencing approaches on large power systems, such as the Eastern Interconnection. Traditional Ward-type equivalences are a class of equivalencing approaches but this class has some significant drawbacks. It is well known that Ward-type equivalents "smear" the injections of external generators over a large number of boundary buses. For newer long-term investment applications that take into account such things as greenhouse gas (GHG) regulations and generator availability, it is computationally impractical to model fractions of generators located at many buses. A modified-Ward equivalent is proposed to address this limitation such that the external generators are moved wholesale to some internal buses based on electrical distance. This proposed equivalencing procedure is designed so that the retained-line power flows in the equivalent match those in the unreduced (full) model exactly. During the reduction process, accommodations for special system elements are addressed, including static VAr compensators (SVCs), high voltage dc (HVDC) transmission lines, and phase angle regulators. Another network equivalencing approach based on the dc power flow assumptions and the power transfer distribution factors (PTDFs) is proposed. This method, rather than eliminate buses via Gauss-reduction, aggregates buses on a zonal basis. The bus aggregation approach proposed here is superior to the existing bus aggregation methods in that a) under the base case, the equivalent-system inter-zonal power flows exactly match those calculated using the full-network-model b) as the operating conditions change, errors in line flows are reduced using the proposed bus clustering algorithm c) this method is computationally more efficient than other bus aggregation methods proposed heretofore. A critical step in achieving accuracy with a bus aggregation approach is selecting which buses to cluster together and how many clusters are needed. Clustering in this context refers to the process of partitioning a network into subsets of buses. An efficient network clustering method is proposed based on the PTDFs and the data mining techniques. This method is applied to the EI topology using the "Saguaro" supercomputer at ASU, a resource with sufficient memory and computational capability for handling this 60,000-bus and 80,000-branch system. The network equivalents generated by the proposed approaches are verified and tested for different operating conditions and promising results have been observed. / Dissertation/Thesis / Ph.D. Electrical Engineering 2012

Abstract The purpose of this study was to describe and explain the care of older people with dementia in surgical wards from the viewpoints of the patients and their close relatives, nursing staff and physicians. The study was conducted in two stages. The first stage of the study was conducted with a qualitative approach, collecting the data from older people with dementia (n=7), their close relatives (n=5), nursing staff (n=19) and physicians (n=9) using individual and group interviews. The data were analysed using inductive content analysis. The approach in the second stage was quantitative: data were collected with a questionnaire from the nursing staff (n=191). The data were analysed using descriptive statistics as well as explorative factor analysis. The nursing staff stated that responding to the physical, psychological and social needs of patients with dementia requires more effort and time than usual. The nursing staff pointed out that they did not have all the required know-how to provide good care for older people with dementia. The nursing staff with longer work experience indicated doing nothing more often than other nursing staff when encountering challenge behaviour of a patient with dementia. Concerns about well-being of a patient and feeling shame about patient’s behavioural symptoms were causing exhaustion among close relatives. Relatives expected some time for personal dialogue and support from the nursing staff. The patients experienced that they did not get enough information about their own care. The study provides new information that can be used to develop the care of older people with dementia in hospital environment. The results can be utilized in basic, further and updating education in the field of health care. / Tiivistelmä Tutkimuksen tarkoituksena oli kuvata ja selittää ikääntyvän muistisairaan potilaan hoitotyötä kirurgisella vuodeosastolla muistisairaiden potilaiden, omaisten, hoitohenkilökunnan ja lääkäreiden näkökulmasta. Tutkimus toteutettiin kahdessa vaiheessa. Ensimmäisen vaiheen lähestymistapa oli kvalitatiivinen eli laadullinen, ja aineisto kerättiin kirurgisilla vuodeosastoilla olevilta muistisairailta potilailta (n=7), omaisilta (n=5), hoitohenkilökunnalta (n=19) ja lääkäreiltä (n=9) yksilö-, pari- ja ryhmähaastatteluina. Aineisto analysoitiin induktiivisella sisällön analyysilla. Tutkimuksen toisen vaiheen lähestymistapa oli kvantitatiivinen eli määrällinen, ja aineisto kerättiin kyselylomakkeella kirurgisilla vuodeosastoilla työskentelevältä hoitohenkilökunnalta (n=191). Aineisto analysoitiin käyttäen kuvailevan tilastotieteen menetelmiä sekä eksploratiivista faktorianalyysia. Ikääntyvän muistisairaan potilaan hoitotyössä korostui fyysiseen, psyykkiseen ja sosiaaliseen avuntarpeeseen vastaaminen, joka vaati keskimääräistä enemmän aika- ja henkilöstöresursseja. Hoitohenkilökunta toi esille, ettei heillä ollut tarvittavaa tieto-taitoa muistisairaiden potilaiden hoitamiseen. Hoitajat, joilla oli pitkä työkokemus reagoivat muistisairaan potilaan käytösoireisiin muita hoitajia välinpitämättömämmin. Huoli potilaan voinnista ja häpeän tunne potilaan käytösoireista aiheuttivat puolestaan omaisen uupumista. Omaiset kaipasivatkin henkilökunnalta keskusteluapua ja tukea. Potilaat taas kokivat, etteivät he saaneet tarpeeksi tietoa hoitoaan koskevista asioita. Tutkimuksella tuotetaan uutta tietoa, jonka avulla voidaan kehittää ikääntyvän muistisairaan potilaan hoitotyötä sairaalaympäristössä. Tuloksia voidaan hyödyntää terveydenhuoltoalan perus-, jatko- ja täydennyskoulutuksessa.

Bakgrund: Det är vanligt att kvinnor under en vaginal förlossning drabbas av grad II-bristning. I barnmorskans ansvarsområde ingår att handlägga dessa bristningar. Forskning visar att det finns begränsat med rutiner kring dessa bristningar och att fokus ofta ligger på grad III- och grad IV-bristningar trots att även grad II-bristningar kan ge långtidskomplikationer. Syfte: Syftet var att beskriva barnmorskans erfarenhet av handläggning vid uppkommen grad II-bristning. Metod: Semistrukturerade individuella intervjuer genomfördes med åtta barnmorskor verksamma vid en mellanstor förlossningsavdelning i Mellansverige. Kvalitativ innehållsanalys användes för att analysera materialet. Resultat: Fyra kategorier och två underkategorier identifierades. Kategorierna var Information, Kollegialt stöd, Behov av uppföljning och Undersökning och underkategorierna Strategier för återkoppling och Dokumentation. Slutsats: Det framkom en osäkerhet hos barnmorskorna gällande diagnostisering och suturering av grad II-bristning. Detta gällde främst de barnmorskor med minst yrkeserfarenhet. Barnmorskorna uttryckte också en önskan om bättre återkoppling på de bristningar de suturerat samt en bättre uppföljning för de kvinnor som fått en grad II-bristning. Resultatet visade även att barnmorskorna informerar kvinnorna på olika sätt gällande deras bristning. Inga tydliga rutiner finns gällande vilken information som ska ges eller på vilket sätt. Klinisk tillämpbarhet: Studiens resultat syftar till att skapa ökad kunskap och riktlinjer kring grad II-bristningar. Ytterligare forskning skulle kunna beröra information i samband med bristningen och när den är bäst att ge. / Background: Many women sustain a second-degree tear when giving birth vaginally. The work field of a midwife includes managing these injuries. There is limited research regarding this field and the focus tend to be on third- and fourth-degree tears, even though second-degree tears may also result in long-term complications. Aim: The aim was to investigate the midwife’s experience of managing second-degree tears. Method: Eight semi-structured individual interviews were conducted with midwives working at a medium large maternity ward located in the middle of Sweden. Qualitative content analysis was used to analyze the material. Results: Four categories and two subcategories were identified. The categories were: Information, The support of colleagues, The need for follow-ups and Physical examination and the subcategories were: Feedback strategies and Documentation. Conclusion: The result show that midwives feel insecure when managing second-degree tears, especially the midwives with less experience. The midwives also requested more feedback from the women they sutured regarding their second-degree tears and the midwives also wished for a better follow-up for the women with second-degree tears. The result also showed that the midwives give different information to women regarding their tears. No pronounced routines were found regarding what information to give and in what way. Clinical application: The results of the study aim to increase the knowledge and to develop routines regarding second-degree tears. More knowledge is needed about information given about the tear and when it is the best time to give information.

LL.M. / This research is a comparative study of the provisions for guardianship and custody, including maintenance of the South African common law and customary law. In customary law the emphasis is on the law of the Bafokeng people which is a tribe chosen as group of the research. The purpose of this research is to analyze the provisions of guardianship, custody and maintenance applicable to these legal systems. The analysis is divided as follows: • Guardianship and custody: (i) during the marriage; after divorce; after death of parent(s); of an extra-marital child. • Maintenance of children: (i) during the marriage; after divorce; after death of parent(s); born outside marriage (extra-marital children). The objective is to highlight the similarities and differences between the provisions of these legal systems and to come up with the conclusion whether the one is more favourable than the other in catering for the needs and interests of its subjects. The conclusion will be governed by the following issues: • Which legal system caters for the interests of its subjects? • Which legal system accords with the provisions of the Constitution Act? • Which legal system protects the interests of the child best? Having come to that conclusion, the researcher aims at indicating laws which should be considered for reform.

Magister Commercii - MCom / The aim is to deepen the South African democracy at all levels of government. However, as local government is “the closest to the people” it is regarded by government as the most appropriate sphere to implement participatory democracy mechanisms. Pertaining to this, ward committees were introduced as the main participatory vehicle of local governance and in addition, the government has also implemented alternative instruments such as izimbizos and the integrated development planning (IDP) process to engage citizens in local governance.

The aim of this thesis is to provide an introduction to the work of writer and journalist Harriet Ward, resident in the Eastern Cape from 1842 to 1848. She was a prolific correspondent to various periodicals published both in South Africa and in London. It would be true to say, to judge from the evidence, that she fulfilled a need felt by the British public for information on life and events in South Africa, and that she became the trusted guide of the middle-class reader. Her range covers reports from the frontiers of war, journalistic articles, memoirs, short stories, novels, autobiography, and editions of other writers' work. After the publication of her articles on the Seventh Frontier War (1846-7), she was recognised and respected as a commentator on the situation at the Eastern Cape, an unusual role for a woman at this time. She was also amongst the foremost victorian women writers published from the early eighteen forties until the end of the eighteen-fifties. Harriet Ward has left a vivid historical and sociological account of the Cape frontier, and her observations and judgements provide a hitherto virtually unknown perspective on an important part of South African history and letters. What makes her even more interesting, as this study seeks to show, is that she was far from conventional in her response to her new environment, both as as a woman and as a representative of a colonialist power. The record she has left of her thoughts on the people, landscape and situations of the time has the capacity to surprise the post-colonial literary critic and historian. Her struggle to find a discursive mode in which to express her consciousness of the oppression, patriarchal and colonial, of the marginalised, whether woman, indigene, Afrikaner, or creole, reveals a significantly transgressive or subversive response to the issues of the day. In re-discovering Harriet Ward, we are forced to reassess our assumptions regarding the period of colonial history to which she was a witness.

Cluster analysis is one of the classification methods of multivariate statistical analysis. The task of this analysis is to classify the objects into clusters so that objects inside these clusters are as similar as possible. The aim of this study is to evaluate the success of the classification of objects using six hierarchical cluster analysis methods. To reflect the distance between the objects, are used squared Euclidean and Mahalanobis distances. The success methods are evaluated through the information, which cluster the object belongs to, and this information is already contained in the data files. This thesis pointed out that the Ward's method is one of the most successful hierarchical method in a classification of objects into clusters. This method has been more successful in sorting objects than the other hierarchical methods, both in the case of leaving the correlated variables in the data file as well as removing them. The results of this work show that the highest success of classification objects into clusters is when the data set is cleaned of correlated variables. If the data file is not cleaned, the methods reach better results when the distance between objects is measured by Euclidean metric.