Resolução de problema de valor no contorno associado ao projeto de reatores de fluxo disperso empregados no tratamento de efluentes

The objective of this work was to develop a numerical method to solve boundary value problems concerning to the use of dispersion model for describing the hydraulic behavior of chemical or biological reactors employed in the wastewater treatment. The numerical method was implemented in FORTRAN language generating a computational program which was applied to solve cases involving reaction kinetics of both integer and fractional orders. The developed method was able to solve the proposed problems evidencing to be a useful tool that provides more accurate design of wastewater treatment reactors

Assessment of health-related quality of life and related factors in patients with chronic liver disease

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Modeling surface-atmosphere exchange of trace gases and energy within and above the Amazon rain forest

Die vorliegende Dissertation untersucht die biogeochemischen Vorgänge in der Vegetationsschicht (Bestand) und die Rückkopplungen zwischen physiologischen und physikalischen Umweltprozessen, die das Klima und die Chemie der unteren Atmosphäre beeinflussen. Ein besondere Schwerpunkt ist die Verwendung theoretischer Ansätze zur Quantifizierung des vertikalen Austauschs von Energie und Spurengasen (Vertikalfluss) unter besonderer Berücksichtigung der Wechselwirkungen der beteiligten Prozesse. Es wird ein differenziertes Mehrschicht-Modell der Vegetation hergeleitet, implementiert, für den amazonischen Regenwald parametrisiert und auf einen Standort in Rondonia (Südwest Amazonien) angewendet, welches die gekoppelten Gleichungen zur Energiebilanz der Oberfläche und CO2-Assimilation auf der Blattskala mit einer Lagrange-Beschreibung des Vertikaltransports auf der Bestandesskala kombiniert. Die hergeleiteten Parametrisierungen beinhalten die vertikale Dichteverteilung der Blattfläche, ein normalisiertes Profil der horizontalen Windgeschwindigkeit, die Lichtakklimatisierung der Photosynthesekapazität und den Austausch von CO2 und Wärme an der Bodenoberfläche. Desweiteren werden die Berechnungen zur Photosynthese, stomatären Leitfähigkeit und der Strahlungsabschwächung im Bestand mithilfe von Feldmessungen evaluiert. Das Teilmodell zum Vertikaltransport wird im Detail unter Verwendung von 222-Radon-Messungen evaluiert. Die ``Vorwärtslösung'' und der ``inverse Ansatz'' des Lagrangeschen Dispersionsmodells werden durch den Vergleich von beobachteten und vorhergesagten Konzentrationsprofilen bzw. Bodenflüssen bewertet. Ein neuer Ansatz wird hergeleitet, um die Unsicherheiten des inversen Ansatzes aus denjenigen des Eingabekonzentrationsprofils zu quantifizieren. Für nächtliche Bedingungen wird eine modifizierte Parametrisierung der Turbulenz vorgeschlagen, welche die freie Konvektion während der Nacht im unteren Bestand berücksichtigt und im Vergleich zu früheren Abschätzungen zu deutlich kürzeren Aufenthaltszeiten im Bestand führt. Die vorhergesagte Stratifizierung des Bestandes am Tage und in der Nacht steht im Einklang mit Beobachtungen in dichter Vegetation. Die Tagesgänge der vorhergesagten Flüsse und skalaren Profile von Temperatur, H2O, CO2, Isopren und O3 während der späten Regen- und Trockenzeit am Rondonia-Standort stimmen gut mit Beobachtungen überein. Die Ergebnisse weisen auf saisonale physiologische Änderungen hin, die sich durch höhere stomatäre Leitfähigkeiten bzw. niedrigere Photosyntheseraten während der Regen- und Trockenzeit manifestieren. Die beobachteten Depositionsgeschwindigkeiten für Ozon während der Regenzeit überschreiten diejenigen der Trockenzeit um 150-250%. Dies kann nicht durch realistische physiologische Änderungen erklärt werden, jedoch durch einen zusätzlichen cuticulären Aufnahmemechanismus, möglicherweise an feuchten Oberflächen. Der Vergleich von beobachteten und vorhergesagten Isoprenkonzentrationen im Bestand weist auf eine reduzierte Isoprenemissionskapazität schattenadaptierter Blätter und zusätzlich auf eine Isoprenaufnahme des Bodens hin, wodurch sich die globale Schätzung für den tropischen Regenwald um 30% reduzieren würde. In einer detaillierten Sensitivitätsstudie wird die VOC Emission von amazonischen Baumarten unter Verwendung eines neuronalen Ansatzes in Beziehung zu physiologischen und abiotischen Faktoren gesetzt. Die Güte einzelner Parameterkombinationen bezüglich der Vorhersage der VOC Emission wird mit den Vorhersagen eines Modells verglichen, das quasi als Standardemissionsalgorithmus für Isopren dient und Licht sowie Temperatur als Eingabeparameter verwendet. Der Standardalgorithmus und das neuronale Netz unter Verwendung von Licht und Temperatur als Eingabeparameter schneiden sehr gut bei einzelnen Datensätzen ab, scheitern jedoch bei der Vorhersage beobachteter VOC Emissionen, wenn Datensätze von verschiedenen Perioden (Regen/Trockenzeit), Blattentwicklungsstadien, oder gar unterschiedlichen Spezies zusammengeführt werden. Wenn dem Netzwerk Informationen über die Temperatur-Historie hinzugefügt werden, reduziert sich die nicht erklärte Varianz teilweise. Eine noch bessere Leistung wird jedoch mit physiologischen Parameterkombinationen erzielt. Dies verdeutlicht die starke Kopplung zwischen VOC Emission und Blattphysiologie.

Facetten emotionaler Expressivität auf Fragebogenebene

Der Dimensionierung emotionaler Expressivität auf Fragebogenebene wurde in zwei Untersuchungen nachgegangen. Gross und John (1998) untersuchten die Items bestehender Fragebogen auf ihre dimensionale Struktur hin und ermittelten die fünf Facetten positive und negative Expressivität, Impulsstärke, Darstellungsfähigkeit (expressive confidence) und Verstellungstendenz (masking), wobei die drei erstgenannten in einem hierarchischen Modell einen engeren Zusammenhang mit einander aufwiesen (Kern-Expressivität) als die beiden anderen. Untersuchung 1 ging den Fragen nach, ob sich die gleichen Dimensionen auch mit deutschen Adaptationen der Fragebogen finden lassen, und ob sich die dimensionale Struktur ändert, wenn weitere Fragebogen aus dem Bereich der Expressivität hinzugenommen werden. Die Dimensionen von Gross und John (1998) konnten nur zum Teil repliziert werden. Dies und die Ergebnisse des erweiterten Itempools führten zur Formulierung eines modifizierten (erweiterten) Modells der Facetten emotionaler Expressivität. In Untersuchung 2 wurden Items für einen Fragebogen zu Facetten emotionaler Expressivität (FFEE) formuliert, welche die im modifizierten Modell spezifizierten Dimensionen erheben sollten. Die drei postulierten übergeordneten Bereiche Kern-Expressivität, soziale Expressivität und kognitive Expressivität konnten auch empirisch gefunden werden. Darüber hinaus differenzierten sich die negativen Items der Kern-Expressivität stärker als die positiven. Die Zusammenhänge mit externen Expressivitäts-Fragebogen, den globalen Persönlichkeitsmerkmalen Extraversion und Neurotizismus und den Angstbewältigungsdimensionen Vigilanz und kognitive Vermeidung bestätigten die Validität des FFEE. Theoretische Implikationen und Ansatzpunkte für weitere Forschungen wurden diskutiert.

Formation of Exchange Rates on the Russian Market: Dynamics and Modelling

Galina Kovaleva. The Formation of the Exchange Rate on the Russian Market: Dynamics and Modelling. The Russian financial market is fast becoming one of the major sectors of the Russian economy. Assets have been increasing steadily, while new market segments and new financial market instruments have emerged. Kovaleva attempted to isolate the factors influencing exchange rates, determine patterns in the dynamic changes to the rouble/dollar exchange rate, construct models of the processes, and on the basis of these activities make forecasts. She studied the significance of economic indicators influencing the rouble/dollar exchange rate at different times, and developed multi-factor econometric models. In order to reveal the inner structure of the financial indicators and to work out ex-post forecasts for different time intervals, she carried out a series of calculations with the aim of constructing trend-cyclical (TC) and harmonic models, and Box and Jenkins models. She found that: 1. The Russian financial market is dependant on the rouble/dollar exchange rate. Its dynamics are formed under the influence of the short-term state treasury notes and government bonds markets, interbank loans, the rouble/DM exchange rate, the inflation rate, and the DM/dollar exchange rate. The exchange rate is influenced by sales on the Moscow Interbank Currency Exchange and the mechanism of those sales. 2. The TC model makes it possible to conduct an in-depth study of the structure of the processes and to make forecasts of the dynamic changes to currency indicators. 3. The Russian market is increasingly influenced by the world currency market and its prospects are of crucial interest for the world financial community.

5-Hydroxytryptamine-4 receptor messenger ribonucleic acid levels and densities in gastrointestinal muscle layers from healthy dairy cows

Serotonin (5-hydroxytryptamine, 5-HT) is involved in gastrointestinal tract (GIT) motor functions through binding to specific receptors located in the GIT walls. The objectives of the current study were to compare mRNA levels and binding sites of 5-HT(4) receptors (5-HTR(4)) in smooth muscle layers from the fundus abomasi, pylorus, ileum, cecum, proximal loop of the ascending colon (PLAC), and external loop of the spiral colon (ELSC) of healthy dairy cows, and to verify whether mRNA and protein expression were correlated. Smooth muscle samples were prepared by scraping the mucosa and submucosa from full-thickness intestinal wall samples. The mRNA levels of 5-HTR(4) were measured by real-time PCR and expressed relative to those of the housekeeping gene glyceraldehyde phosphate dehydrogenase. Binding studies were performed using the 5-HTR(4) antagonist [(3)H]GR113808. The mRNA levels of 5-HTR(4) were affected (P < 0.05) by location along the GIT. The mRNA levels of 5-HTR(4) in the ELSC and the ileum were greater than in the PLAC (P = 0.05 and P = 0.07, respectively) but similar to those of all other locations. The competitive binding of [(3)H]GR113808 to suspended membranes from the fundus abomasi, pylorus, cecum, and ELSC was best fit by a 2-site receptor model, whereas it was best fit by a 1-site receptor model in the ileum and PLAC. The mRNA levels and numbers of 5-HTR(4) were not correlated (r = 0.14; P = 0.71). In conclusion, mRNA and binding sites for 5-HTR(4) are present in the smooth muscle layer of the entire GIT of dairy cows and may play a role with respect to motility. The effects of activation of this receptor subtype may be different among GIT locations due to differences in the amount of high- relative to low-affinity binding sites.

Shear band evolution in Zr/Hf-based bulk metallic glasses under static and dynamic indentations

Bulk metallic glasses (BMGs) exhibit superior mechanical properties as compared with other conventional materials and have been proposed for numerous engineering and technological applications. Zr/Hf-based BMGs or tungsten reinforced BMG composites are considered as a potential replacement for depleted uranium armor-piercing projectiles because of their ability to form localized shear bands during impact, which has been known to be the dominant plastic deformation mechanism in BMGs. However, in conventional tensile, compressive and bending tests, limited ductility has been observed because of fracture initiation immediately following the shear band formation. To fully investigate shear band characteristics, indentation tests that can confine the deformation in a limited region have been pursued. In this thesis, a detailed investigation of thermal stability and mechanical deformation behavior of Zr/Hf-based BMGs is conducted. First, systematic studies had been implemented to understand the influence of relative compositions of Zr and Hf on thermal stability and mechanical property evolution. Second, shear band evolution under indentations were investigated experimentally and theoretically. Three kinds of indentation studies were conducted on BMGs in the current study. (a) Nano-indentation to determine the mechanical properties as a function of Hf/Zr content. (b) Static Vickers indentation on bonded split specimens to investigate the shear band evolution characteristics beneath the indention. (c) Dynamic Vickers indentation on bonded split specimens to investigate the influence of strain rate. It was found in the present work that gradually replacing Zr by Hf remarkably increases the density and improves the mechanical properties. However, a slight decrease in glass forming ability with increasing Hf content has also been identified through thermodynamic analysis although all the materials in the current study were still found to be amorphous. Many indentation studies have revealed only a few shear bands surrounding the indent on the top surface of the specimen. This small number of shear bands cannot account for the large plastic deformation beneath the indentations. Therefore, a bonded interface technique has been used to observe the slip-steps due to shear band evolution. Vickers indentations were performed along the interface of the bonded split specimen at increasing loads. At small indentation loads, the plastic deformation was primarily accommodated by semi-circular primary shear bands surrounding the indentation. At higher loads, secondary and tertiary shear bands were formed inside this plastic zone. A modified expanding cavity model was then used to predict the plastic zone size characterized by the shear bands and to identify the stress components responsible for the evolution of the various types of shear bands. The applicability of various hardness—yield-strength ( H −σγ ) relationships currently available in the literature for bulk metallic glasses (BMGs) is also investigated. Experimental data generated on ZrHf-based BMGs in the current study and those available elsewhere on other BMG compositions were used to validate the models. A modified expanding-cavity model, employed in earlier work, was extended to propose a new H −σγ relationship. Unlike previous models, the proposed model takes into account not only the indenter geometry and the material properties, but also the pressure sensitivity index of the BMGs. The influence of various model parameters is systematically analyzed. It is shown that there is a good correlation between the model predictions and the experimental data for a wide range of BMG compositions. Under dynamic Vickers indentation, a decrease in indentation hardness at high loading rate was observed compared to static indentation hardness. It was observed that at equivalent loads, dynamic indentations produced more severe deformation features on the loading surface than static indentations. Different from static indentation, two sets of widely spaced semi-circular shear bands with two different curvatures were observed. The observed shear band pattern and the strain rate softening in indentation hardness were rationalized based on the variations in the normal stress on the slip plane, the strain rate of shear and the temperature rise associated with the indentation deformation. Finally, a coupled thermo-mechanical model is proposed that utilizes a momentum diffusion mechanism for the growth and evolution of the final spacing of shear bands. The influence of strain rate, confinement pressure and critical shear displacement on the shear band spacing, temperature rise within the shear band, and the associated variation in flow stress have been captured and analyzed. Consistent with the known pressure sensitive behavior of BMGs, the current model clearly captures the influence of the normal stress in the formation of shear bands. The normal stress not only reduces the time to reach critical shear displacement but also causes a significant temperature rise during the shear band formation. Based on this observation, the variation of shear band spacing in a typical dynamic indentation test has been rationalized. The temperature rise within a shear band can be in excess of 2000K at high strain rate and high confinement pressure conditions. The associated drop in viscosity and flow stress may explain the observed decrease in fracture strength and indentation hardness. The above investigations provide valuable insight into the deformation behavior of BMGs under static and dynamic loading conditions. The shear band patterns observed in the above indentation studies can be helpful to understand and model the deformation features under complex loading scenarios such as the interaction of a penetrator with armor. Future work encompasses (1) extending and modifying the coupled thermo-mechanical model to account for the temperature rise in quasistatic deformation; and (2) expanding this model to account for the microstructural variation-crystallization and free volume migration associated with the deformation.

Growth, modification and integration of carbon nanotubes into molecular electronics

Molecules are the smallest possible elements for electronic devices, with active elements for such devices typically a few Angstroms in footprint area. Owing to the possibility of producing ultrahigh density devices, tremendous effort has been invested in producing electronic junctions by using various types of molecules. The major issues for molecular electronics include (1) developing an effective scheme to connect molecules with the present micro- and nano-technology, (2) increasing the lifetime and stabilities of the devices, and (3) increasing their performance in comparison to the state-of-the-art devices. In this work, we attempt to use carbon nanotubes (CNTs) as the interconnecting nanoelectrodes between molecules and microelectrodes. The ultimate goal is to use two individual CNTs to sandwich molecules in a cross-bar configuration while having these CNTs connected with microelectrodes such that the junction displays the electronic character of the molecule chosen. We have successfully developed an effective scheme to connect molecules with CNTs, which is scalable to arrays of molecular electronic devices. To realize this far reaching goal, the following technical topics have been investigated. 1. Synthesis of multi-walled carbon nanotubes (MWCNTs) by thermal chemical vapor deposition (T-CVD) and plasma-enhanced chemical vapor deposition (PECVD) techniques (Chapter 3). We have evaluated the potential use of tubular and bamboo-like MWCNTs grown by T-CVD and PE-CVD in terms of their structural properties. 2. Horizontal dispersion of MWCNTs with and without surfactants, and the integration of MWCNTs to microelectrodes using deposition by dielectrophoresis (DEP) (Chapter 4). We have systematically studied the use of surfactant molecules to disperse and horizontally align MWCNTs on substrates. In addition, DEP is shown to produce impurityfree placement of MWCNTs, forming connections between microelectrodes. We demonstrate the deposition density is tunable by both AC field strength and AC field frequency. 3. Etching of MWCNTs for the impurity-free nanoelectrodes (Chapter 5). We show that the residual Ni catalyst on MWCNTs can be removed by acid etching; the tip removal and collapsing of tubes into pyramids enhances the stability of field emission from the tube arrays. The acid-etching process can be used to functionalize the MWCNTs, which was used to make our initial CNT-nanoelectrode glucose sensors. Finally, lessons learned trying to perform spectroscopic analysis of the functionalized MWCNTs were vital for designing our final devices. 4. Molecular junction design and electrochemical synthesis of biphenyl molecules on carbon microelectrodes for all-carbon molecular devices (Chapter 6). Utilizing the experience gained on the work done so far, our final device design is described. We demonstrate the capability of preparing patterned glassy carbon films to serve as the bottom electrode in the new geometry. However, the molecular switching behavior of biphenyl was not observed by scanning tunneling microscopy (STM), mercury drop or fabricated glassy carbon/biphenyl/MWCNT junctions. Either the density of these molecules is not optimum for effective integration of devices using MWCNTs as the nanoelectrodes, or an electroactive contaminant was reduced instead of the ionic biphenyl species. 5. Self-assembly of octadecanethiol (ODT) molecules on gold microelectrodes for functional molecular devices (Chapter 7). We have realized an effective scheme to produce Au/ODT/MWCNT junctions by spanning MWCNTs across ODT-functionalized microelectrodes. A percentage of the resulting junctions retain the expected character of an ODT monolayer. While the process is not yet optimized, our successful junctions show that molecular electronic devices can be fabricated using simple processes such as photolithography, self-assembled monolayers and dielectrophoresis.

Experimental and modeling study of the filtration and oxidation characteristics of a diesel oxidation catalyst and a catalyzed particulate filter

A diesel oxidation catalyst (DOC) with a catalyzed diesel particulate filter (CPF) is an effective exhaust aftertreatment device that reduces particulate emissions from diesel engines, and properly designed DOC-CPF systems provide passive regeneration of the filter by the oxidation of PM via thermal and NO2/temperature-assisted means under various vehicle duty cycles. However, controlling the backpressure on engines caused by the addition of the CPF to the exhaust system requires a good understanding of the filtration and oxidation processes taking place inside the filter as the deposition and oxidation of solid particulate matter (PM) change as functions of loading time. In order to understand the solid PM loading characteristics in the CPF, an experimental and modeling study was conducted using emissions data measured from the exhaust of a John Deere 6.8 liter, turbocharged and after-cooled engine with a low-pressure loop EGR system and a DOC-CPF system (or a CCRT® - Catalyzed Continuously Regenerating Trap®, as named by Johnson Matthey) in the exhaust system. A series of experiments were conducted to evaluate the performance of the DOC-only, CPF-only and DOC-CPF configurations at two engine speeds (2200 and 1650 rpm) and various loads on the engine ranging from 5 to 100% of maximum torque at both speeds. Pressure drop across the DOC and CPF, mass deposited in the CPF at the end of loading, upstream and downstream gaseous and particulate emissions, and particle size distributions were measured at different times during the experiments to characterize the pressure drop and filtration efficiency of the DOCCPF system as functions of loading time. Pressure drop characteristics measured experimentally across the DOC-CPF system showed a distinct deep-bed filtration region characterized by a non-linear pressure drop rise, followed by a transition region, and then by a cake-filtration region with steadily increasing pressure drop with loading time at engine load cases with CPF inlet temperatures less than 325 °C. At the engine load cases with CPF inlet temperatures greater than 360 °C, the deep-bed filtration region had a steep rise in pressure drop followed by a decrease in pressure drop (due to wall PM oxidation) in the cake filtration region. Filtration efficiencies observed during PM cake filtration were greater than 90% in all engine load cases. Two computer models, i.e., the MTU 1-D DOC model and the MTU 1-D 2-layer CPF model were developed and/or improved from existing models as part of this research and calibrated using the data obtained from these experiments. The 1-D DOC model employs a three-way catalytic reaction scheme for CO, HC and NO oxidation, and is used to predict CO, HC, NO and NO2 concentrations downstream of the DOC. Calibration results from the 1-D DOC model to experimental data at 2200 and 1650 rpm are presented. The 1-D 2-layer CPF model uses a ‘2-filters in series approach’ for filtration, PM deposition and oxidation in the PM cake and substrate wall via thermal (O2) and NO2/temperature-assisted mechanisms, and production of NO2 as the exhaust gas mixture passes through the CPF catalyst washcoat. Calibration results from the 1-D 2-layer CPF model to experimental data at 2200 rpm are presented. Comparisons of filtration and oxidation behavior of the CPF at sample load-cases in both configurations are also presented. The input parameters and selected results are also compared with a similar research work with an earlier version of the CCRT®, to compare and explain differences in the fundamental behavior of the CCRT® used in these two research studies. An analysis of the results from the calibrated CPF model suggests that pressure drop across the CPF depends mainly on PM loading and oxidation in the substrate wall, and also that the substrate wall initiates PM filtration and helps in forming a PM cake layer on the wall. After formation of the PM cake layer of about 1-2 µm on the wall, the PM cake becomes the primary filter and performs 98-99% of PM filtration. In all load cases, most of PM mass deposited was in the PM cake layer, and PM oxidation in the PM cake layer accounted for 95-99% of total PM mass oxidized during loading. Overall PM oxidation efficiency of the DOC-CPF device increased with increasing CPF inlet temperatures and NO2 flow rates, and was higher in the CCRT® configuration compared to the CPF-only configuration due to higher CPF inlet NO2 concentrations. Filtration efficiencies greater than 90% were observed within 90-100 minutes of loading time (starting with a clean filter) in all load cases, due to the fact that the PM cake on the substrate wall forms a very efficient filter. A good strategy for maintaining high filtration efficiency and low pressure drop of the device while performing active regeneration would be to clean the PM cake filter partially (i.e., by retaining a cake layer of 1-2 µm thickness on the substrate wall) and to completely oxidize the PM deposited in the substrate wall. The data presented support this strategy.

Analysis of atmospheric transport and the effects of seasonal and interannual transport variability on measurements made at the Pico Mountain observatory

A non-hierarchical K-means algorithm is used to cluster 47 years (1960–2006) of 10-day HYSPLIT backward trajectories to the Pico Mountain (PM) observatory on a seasonal basis. The resulting cluster centers identify the major transport pathways and collectively comprise a long-term climatology of transport to the observatory. The transport climatology improves our ability to interpret the observations made there and our understanding of pollution source regions to the station and the central North Atlantic region. I determine which pathways dominate transport to the observatory and examine the impacts of these transport patterns on the O3, NOy, NOx, and CO measurements made there during 2001–2006. Transport from the U.S., Canada, and the Atlantic most frequently reaches the station, but Europe, east Africa, and the Pacific can also contribute significantly depending on the season. Transport from Canada was correlated with the North Atlantic Oscillation (NAO) in spring and winter, and transport from the Pacific was uncorrelated with the NAO. The highest CO and O3 are observed during spring. Summer is also characterized by high CO and O3 and the highest NOy and NOx of any season. Previous studies at the station attributed the summer time high CO and O3 to transport of boreal wildfire emissions (for 2002–2004), and boreal fires continued to affect the station during 2005 and 2006. The particle dispersion model FLEXPART was used to calculate anthropogenic and biomass-burning CO tracer values at the station in an attempt to identify the regions responsible for the high CO and O3 observations during spring and biomass-burning impacts in summer.

CHARACTERIZING, ASSESSING AND IMPROVING HEALTHCARE REFERRAL COMMUNICATION

Similar to other health care processes, referrals are susceptible to breakdowns. These breakdowns in the referral process can lead to poor continuity of care, slow diagnostic processes, delays and repetition of tests, patient and provider dissatisfaction, and can lead to a loss of confidence in providers. These facts and the necessity for a deeper understanding of referrals in healthcare served as the motivation to conduct a comprehensive study of referrals. The research began with the real problem and need to understand referral communication as a mean to improve patient care. Despite previous efforts to explain referrals and the dynamics and interrelations of the variables that influence referrals there is not a common, contemporary, and accepted definition of what a referral is in the health care context. The research agenda was guided by the need to explore referrals as an abstract concept by: 1) developing a conceptual definition of referrals, and 2) developing a model of referrals, to finally propose a 3) comprehensive research framework. This dissertation has resulted in a standard conceptual definition of referrals and a model of referrals. In addition a mixed-method framework to evaluate referrals was proposed, and finally a data driven model was developed to predict whether a referral would be approved or denied by a specialty service. The three manuscripts included in this dissertation present the basis for studying and assessing referrals using a common framework that should allow an easier comparative research agenda to improve referrals taking into account the context where referrals occur.

Groundwater age distributions at a public drinking water supply well field derived from multiple age tracers (⁸⁵Kr, ³H/³He, and ³⁹Ar)

Groundwater age is a key aspect of production well vulnerability. Public drinking water supply wells typically have long screens and are expected to produce a mixture of groundwater ages. The groundwater age distributions of seven production wells of the Holten well field (Netherlands) were estimated from tritium-helium (3H/3He), krypton-85 (85Kr), and argon-39 (39Ar), using a new application of a discrete age distribution model and existing mathematical models, by minimizing the uncertainty-weighted squared differences of modeled and measured tracer concentrations. The observed tracer concentrations fitted well to a 4-bin discrete age distribution model or a dispersion model with a fraction of old groundwater. Our results show that more than 75 of the water pumped by four shallow production wells has a groundwater age of less than 20 years and these wells are very vulnerable to recent surface contamination. More than 50 of the water pumped by three deep production wells is older than 60 years. 3H/3He samples from short screened monitoring wells surrounding the well field constrained the age stratification in the aquifer. The discrepancy between the age stratification with depth and the groundwater age distribution of the production wells showed that the well field preferentially pumps from the shallow part of the aquifer. The discrete groundwater age distribution model appears to be a suitable approach in settings where the shape of the age distribution cannot be assumed to follow a simple mathematical model, such as a production well field where wells compete for capture area.

Effect of VEGF treatment on the blood-spinal cord barrier permeability in experimental spinal cord injury: dynamic contrast-enhanced magnetic resonance imaging.

Compromised blood-spinal cord barrier (BSCB) is a factor in the outcome following traumatic spinal cord injury (SCI). Vascular endothelial growth factor (VEGF) is a potent stimulator of angiogenesis and vascular permeability. The role of VEGF in SCI is controversial. Relatively little is known about the spatial and temporal changes in the BSCB permeability following administration of VEGF in experimental SCI. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) studies were performed to noninvasively follow spatial and temporal changes in the BSCB permeability following acute administration of VEGF in experimental SCI over a post-injury period of 56 days. The DCE-MRI data was analyzed using a two-compartment pharmacokinetic model. Animals were assessed for open field locomotion using the Basso-Beattie-Bresnahan score. These studies demonstrate that the BSCB permeability was greater at all time points in the VEGF-treated animals compared to saline controls, most significantly in the epicenter region of injury. Although a significant temporal reduction in the BSCB permeability was observed in the VEGF-treated animals, BSCB permeability remained elevated even during the chronic phase. VEGF treatment resulted in earlier improvement in locomotor ability during the chronic phase of SCI. This study suggests a beneficial role of acutely administered VEGF in hastening neurobehavioral recovery after SCI.

A Longitudinal Study of Mental Health in Emerging Adults

Emerging adulthood is a time of instability. This longitudinal study investigated the relationship between mental health and need satisfaction among emerging adults over a period of five years and focused on gender-specific differences. Two possible causal models were examined: (1) the mental health model, which predicts that incongruence is due to the presence of impaired mental health at an earlier point in time; (2) the consistency model, which predicts that impaired mental health is due to a higher level of incongruence reported at an earlier point in time. Emerging adults (N = 1,017) aged 18–24 completed computer-assisted telephone interviews in 2003 (T1), 2005 (T2), and 2008 (T3). The results indicate that better mental health at T1 predicts a lower level of incongruence two years later (T2), when prior level of incongruence is controlled for. The same cross-lagged effect is shown for T3. However, the cross-lagged paths from incongruence to mental health are marginally associated when prior mental health is controlled for. No gender differences were found in the cross-lagged model. The results support the mental health model and show that incongruence does not have a long-lasting negative effect on mental health. The results highlight the importance of identifying emerging adults with poor mental health early to provide support regarding need satisfaction.

Older patients with low Charlson score and high-risk prostate cancer benefit from radical prostatectomy

INTRODUCTION The aim of the study was to identify the appropriate level of Charlson comorbidity index (CCI) in older patients (>70 years) with high-risk prostate cancer (PCa) to achieve survival benefit following radical prostatectomy (RP). METHODS We retrospectively analyzed 1008 older patients (>70 years) who underwent RP with pelvic lymph node dissection for high-risk prostate cancer (preoperative prostate-specific antigen >20 ng/mL or clinical stage ≥T2c or Gleason ≥8) from 14 tertiary institutions between 1988 and 2014. The study population was further grouped into CCI < 2 and ≥2 for analysis. Survival rate for each group was estimated with Kaplan-Meier method and competitive risk Fine-Gray regression to estimate the best explanatory multivariable model. Area under the curve (AUC) and Akaike information criterion were used to identify ideal 'Cut off' for CCI. RESULTS The clinical and cancer characteristics were similar between the two groups. Comparison of the survival analysis using the Kaplan-Meier curve between two groups for non-cancer death and survival estimations for 5 and 10 years shows significant worst outcomes for patients with CCI ≥ 2. In multivariate model to decide the appropriate CCI cut-off point, we found CCI 2 has better AUC and p value in log rank test. CONCLUSION Older patients with fewer comorbidities harboring high-risk PCa appears to benefit from RP. Sicker patients are more likely to die due to non-prostate cancer-related causes and are less likely to benefit from RP.