928 resultados para Diagnoses-Related Groups (DRG)


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The work presented in this dissertation focused on the development and characterisation of novel cocrystals that incorporated the thioamide, amide and imide functional groups. A particular emphasis was placed on the characterisation of these cocrystals by single crystal X-ray diffraction methods. In Chapter One a summary of the intermolecular interactions utilised in this work and a short review of the solid state and multicomponent systems is provided. A brief introduction to the ways in which different multicomponent systems can be distinguished, crystal engineering strategies and a number of cocrystal applications highlights the importance the understanding of intermolecular interactions can have on the physical and chemical properties of crystalline materials. Chapter Two is the first Results and Discussion chapter and includes an introduction that is specific to the chapter. The main body of this work focuses on the primary aromatic thioamide functional group and its propensity to cocrystallise with a number of sulfoxides. Unlike the amide functional group, thioamides are not commonly employed in cocrystallisation studies. This chapter presents the first direct comparison between the cocrystallisation abilities of these two functional groups and the intermolecular hydrogen bonding interactions present in the cocrystal structures are examined. Chapter Three describes the crystal landscape of a short series of secondary aromatic amides and their analogous thioamides. Building on the results obtained in Chapter Two, a cocrystal screen of the secondary thioamides with the sulfoxide functional group was carried out in order to determine the effect removing a hydrogen bond had on the supramolecular synthons observed in the cocrystals. These secondary thioamides are also utilised in Chapter Four, which examines their halogen bonding capabilities with two organoiodine coformers: 1,2- and 1,4-diiodotetrafluorobenzene. Chapter Five explores the cocrystallisation abilities of three related cyclic imides as coformers for cocrystallisation with a range of commonly used coformers. Chapter Six is an overall conclusions chapter that highlights the findings of the results presented in Chapters Two to Five. Chapter Seven details the instrument and experimental data for the compounds and cocrystals discussed in the Results and Discussion Chapters. The accompanying CD contains all of the crystallographic data in .cif format for the novel single crystal structures characterised in this work.

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The pulsed decline and eventual extinction of 51 species of elongate, cylindrical deep-sea benthic foraminifera (Stilostomellidae, Pleurostomellidae, and some Nodosariidae) occurred at intermediate water depths (1145-2168 m, Sites 980 and 982) in the northern North Atlantic during the mid-Pleistocene transition (MPT, 1.2-0.6 Ma). In the early Pleistocene, prior to their disappearance, these species comprised up to 20% of the total abundance of the benthic foraminiferal assemblage at 2168 m, but up to only 2% at 1145 m. The MPT extinction of 51 species represents ?20% of the total benthic foraminiferal diversity at bathyal depths in the North Atlantic (excluding the myriad of small unilocular forms). The extinction rate during the MPT was approximately 10 species per 0.1 myr, being one or two orders of magnitude greater than normal background turnover rates of deep-sea benthic foraminifera. Comparison of the precise timings of declines and disappearances (= highest occurrences) of each species shows that they were often diachronous between the two depths. The last of these species to disappear in the North Atlantic was Pleurostomella alternans at ~0.679 and ~0.694 Ma in Sites 980 and 982, respectively, which is in good agreement with the previously documented global "Stilostomella extinction" datum within the period 0.7-0.58 Ma. Comparison with similar studies in intermediate depth waters in the Southwest Pacific Gateway indicates that ~61% of the extinct species were common to both regions, and that although the pattern of pulsed decline was similar, the precise order and timing of the extinction of individual species were mostly different on opposite sides of the world. Previous studies have indicated that this extinct group of elongate, cylindrical foraminifera lived infaunally and had their greatest abundances in poorly ventilated, lower oxygen environments. This is supported by our study where there is a strong positive correlation (r = ~+ 0.8) between the flux of the extinction group and low-oxygen/high organic input species (such as Uvigerina, Bulimina and Bolivina) during the MPT, suggesting a close relationship with lower oxygen levels and high food supply to the sea floor. The absolute abundance, flux, and number of the extinction group of species show a progressive withdrawal pattern with major decreases occurring in cold periods with high d13C values. This might be related to increasing chemical ventilation of glacial intermediate water.

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The continental shelf adjacent to the Río de la Plata (RdlP) exhibits extremely complex hydrographic and ecological characteristics which are of great socioeconomic importance. Since the long-term environmental variations related to the atmospheric (wind fields), hydrologic (freshwater plume), and oceanographic (currents and fronts) regimes are little known, the aim of this study is to reconstruct the changes in the terrigenous input into the inner continental shelf during the late Holocene period (associated with the RdlP sediment discharge) and to unravel the climatic forcing mechanisms behind them. To achieve this, we retrieved a 10 m long sediment core from the RdlP mud depocenter at 57 m water depth (GeoB 13813-4). The radiocarbon age control indicated an extremely high sedimentation rate of 0.8 cm per year, encompassing the past 1200 years (AD 750-2000). We used element ratios (Ti / Ca, Fe / Ca, Ti / Al, Fe / K) as regional proxies for the fluvial input signal and the variations in relative abundance of salinity-indicative diatom groups (freshwater versus marine-brackish) to assess the variability in terrigenous freshwater and sediment discharges. Ti / Ca, Fe / Ca, Ti / Al, Fe / K and the freshwater diatom group showed the lowest values between AD 850 and 1300, while the highest values occurred between AD 1300 and 1850. The variations in the sedimentary record can be attributed to the Medieval Climatic Anomaly (MCA) and the Little Ice Age (LIA), both of which had a significant impact on rainfall and wind patterns over the region. During the MCA, a weakening of the South American summer monsoon system (SAMS) and the South Atlantic Convergence Zone (SACZ), could explain the lowest element ratios (indicative of a lower terrigenous input) and a marine-dominated diatom record, both indicative of a reduced RdlP freshwater plume. In contrast, during the LIA, a strengthening of SAMS and SACZ may have led to an expansion of the RdlP river plume to the far north, as indicated by higher element ratios and a marked freshwater diatom signal. Furthermore, a possible multidecadal oscillation probably associated with Atlantic Multidecadal Oscillation (AMO) since AD 1300 reflects the variability in both the SAMS and SACZ systems.

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Objectives: Elevated shame and dissociation are common in dissociative identity disorder (DID) and chronic posttraumatic stress disorder (PTSD) and are part of the constellation of symptoms defined as complex PTSD. Previous work examined the relationship between shame, dissociation, and complex PTSD and whether they are associated with intimate relationship anxiety, relationship depression, and fear of relationships. This study investigated these variables in traumatized clinical samples and a nonclinical community group.

Method: Participants were drawn from the DID (n = 20), conflict-related chronic PTSD (n = 65), and nonclinical (n = 125) populations and completed questionnaires assessing the variables of interest. A model examining the direct impact of shame and dissociation on relationship functioning, and their indirect effect via complex PTSD symptoms, was tested through path analysis.

Results: The DID sample reported significantly higher dissociation, shame, complex PTSD symptom severity, relationship anxiety, relationship depression, and fear of relationships than the other two samples. Support was found for the proposed model, with shame directly affecting relationship anxiety and fear of relationships, and pathological dissociation directly affecting relationship anxiety and relationship depression. The indirect effect of shame and dissociation via complex PTSD symptom severity was evident on all relationship variables.

Conclusion: Shame and pathological dissociation are important for not only the effect they have on the development of other complex PTSD symptoms, but also their direct and indirect effects on distress associated with relationships.

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Background: Interventions to increase cooking skills (CS) and food skills (FS) as a route to improving overall diet are popular within public health. This study tested a comprehensive model of diet quality by assessing the influence of socio-demographic, knowledge- and psychological-related variables alongside perceived CS and FS abilities. The correspondence of two measures of diet quality further validated the Eating Choices Index (ECI) for use in quantitative research.
Methods: A cross-sectional survey was conducted in a quota-controlled nationally representative sample of 1049 adults aged 20–60 years drawn from the Island of Ireland. Surveys were administered in participants’ homes via computer-assisted personal interviewing (CAPI) assessing a range of socio-demographic, knowledge- and psychological-related variables alongside perceived CS and FS abilities. Regression models were used to model factors influencing diet quality. Correspondence between 2 measures of diet quality was assessed using chi-square and Pearson correlations.
Results: ECI score was significantly negatively correlated with DINE Fat intake (r = -0.24, p < 0.001), and ECI score was significantly positively correlated with DINE Fibre intake (r = 0.38, p < 0.001), demonstrating a high agreement. Findings indicated that males, younger respondents and those with no/few educational qualifications scored significantly lower on both CS and FS abilities. The relative influence of socio-demographic, knowledge, psychological variables and CS and FS abilities on dietary outcomes varied, with regression models explaining 10–20 % of diet quality variance. CS ability exerted the strongest relationship with saturated fat intake (β = -0.296, p < 0.001) and was a significant predictor of fibre intake (β = -0.113, p < 0.05), although not for healthy food choices (ECI) (β = 0.04, p > 0.05).
Conclusion: Greater CS and FS abilities may not lead directly to healthier dietary choices given the myriad of other factors implicated; however, CS appear to have differential influences on aspects of the diet, most notably in relation to lowering saturated fat intake. Findings suggest that CS and FS should not be singular targets of interventions designed to improve diet; but targeting specific sub-groups of the population e.g. males, younger adults, those with limited education might be more fruitful. A greater understanding of the interaction of factors influencing cooking and food practices within the home is needed.

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Purpose – Employee turnover entails considerable costs and is a major problem for the construction industry. By creating an extensive framework, this study aims to examine whether perceived work-related factors affect turnover intention in South Korean construction companies. Research design – The paper is based on the results of a questionnaire of 136 employees that was conducted and provided by a Korean construction company. Research hypotheses were tested via correlation analyses. The most influencing work-related factors, as well as differences among job levels, were determined by multiple regression analyses. Findings – Communication, immediate leaders, organizational commitment, and organizational pride substantially affect turnover intentions. All of these factors can be considered as relational factors. The most influencing factors differ among job levels. Discussion/practical implications – Immediate leaders should be aware of their role in retaining employees and enhance communication, organizational commitment and pride. This study shows how the importance of certain variables differs for groups of employees. Theoretical implications/limitations– This study is based on a sample of employees from a Korean construction company. Therefore, the generalizability of the findings has to be tested. Future research should test the proposed framework with other factors or resources. Originality/value – This study shed light on the turnover subject in the South Korean construction industry. It shows that different factors can influence turnover intention among job levels. A framework was created, which is based on 16 work-related factors including organizational factors, HRM practices and job attitudes.

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Purpose – Employee turnover entails considerable costs and is a major problem for the construction industry. By creating an extensive framework, this study aims to examine whether perceived work-related factors affect turnover intention in South Korean construction companies. Research design – The paper is based on the results of a questionnaire of 136 employees that was conducted and provided by a Korean construction company. Research hypotheses were tested via correlation analyses. The most influencing work-related factors, as well as differences among job levels, were determined by multiple regression analyses. Findings – Communication, immediate leaders, organizational commitment, and organizational pride substantially affect turnover intentions. All of these factors can be considered as relational factors. The most influencing factors differ among job levels. Discussion/practical implications – Immediate leaders should be aware of their role in retaining employees and enhance communication, organizational commitment and pride. This study shows how the importance of certain variables differs for groups of employees. Theoretical implications/limitations– This study is based on a sample of employees from a Korean construction company. Therefore, the generalizability of the findings has to be tested. Future research should test the proposed framework with other factors or resources. Originality/value – This study shed light on the turnover subject in the South Korean construction industry. It shows that different factors can influence turnover intention among job levels. A framework was created, which is based on 16 work-related factors including organizational factors, HRM practices and job attitudes.

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Individual learning is important, as it is both a precursor and an outcome of learning in organisations. Job-related learning is driven by external factors (e.g., the demands of the job) and internal factors (i.e., the personality of the individual). The study examined whether need for achievement moderates the relationship between job-demand for learning and job-related learning. Data were obtained from 153 full-time, white-collar employees from a range of industries. Hierarchical regression analysis using the product term revealed that need for achievement moderates the relationship between job-demand for learning and job-related learning. Specifically, although job-demand for learning is correlated positively to job-related learning for both the high and the low need for achievement groups, this correlation is stronger amongst the high group. The findings are discussed in terms of their implications for future research and practice.

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This is a pre-copyedited, author-produced PDF of a chapter accepted for publication in the European Centre for Minority Issues and The European Academy Bozen/Bolzano (eds), European Yearbook of Minority Issues, Volume 12, 2013 (Brill, 2015). The version of record is available at: http://www.brill.com/publications/european-yearbook-minority-issues In reviewing the activities of relevant UN human rights institutions, bodies and mechanisms this chapter identifies and examines some of the main issues that have emerged regarding minority rights during the year 2013. It notably analyses how the UN has focused particular attention on the situation and the rights of religious minorities, as well as on the elaboration of the post-2015 development agenda. The chapter also reviews activities in other issue areas important for minorities such as language, education, combatting racism, hatred and intolerance, and the prevention of genocide and mass atrocities. It highlights developments with regard to specific groups such as Roma, people living with Albinism and Dalits. It also examines some of the urgent situations that have arisen from conflicts which have targeted minorities across the globe.

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The quotient of a finite-dimensional Euclidean space by a finite linear group inherits different structures from the initial space, e.g. a topology, a metric and a piecewise linear structure. The question when such a quotient is a manifold leads to the study of finite groups generated by reflections and rotations, i.e. by orthogonal transformations whose fixed point subspace has codimension one or two. We classify such groups and thereby complete earlier results by M. A. Mikhaîlova from the 70s and 80s. Moreover, we show that a finite group is generated by reflections and) rotations if and only if the corresponding quotient is a Lipschitz-, or equivalently, a piecewise linear manifold (with boundary). For the proof of this statement we show in addition that each piecewise linear manifold of dimension up to four on which a finite group acts by piecewise linear homeomorphisms admits a compatible smooth structure with respect to which the group acts smoothly. This solves a challenge by Thurston and confirms a conjecture by Kwasik and Lee. In the topological category a counterexample to the above mentioned characterization is given by the binary icosahedral group. We show that this is the only counterexample up to products. In particular, we answer the question by Davis of when the underlying space of an orbifold is a topological manifold. As a corollary of our results we generalize a fixed point theorem by Steinberg on unitary reflection groups to finite groups generated by reflections and rotations. As an application thereof we answer a question by Petrunin on quotients of spheres.

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Patients’ bowel dysfunction is a major factor that weakens the results of surgical care as it can cause pain and weaken patients’ rehabilitation. Bowel dysfunction is a common postoperative problem, yet most incidents remain undocumented. The nursing profession has a significant role in enhancing the bowel function postoperatively. However, studies of postoperative bowel function after hepatectomy are scarce and somewhat incongruous. Enhanced recovery protocols are innovative models of care aiming for better outcomes of surgical care. Enhanced recovery protocols can improve gastrointestinal function after surgery, yet patients are also known to be satisfied with their care. The aim was to investigate if postoperative bowel function day varies between patients in terms of age, gender, ASA score, type of surgery, histology, patients’ experienced pain and experienced satisfaction three days after discharge and three months after operation in patients undergoing hepatectomy. The goal was to produce information for basis of scientific research, to give nurses in clinical setting more tools to work with hepatectomy patients undergoing enhanced recovery protocol and to produce information to nurse managers to use in process management of patients undergoing enhanced recovery protocol. The design of this study is descriptive. Data was collected retrospectively from hepatectomy patients (n = 134) undergoing enhanced recovery protocol within the first year of enhanced recovery protocol implementation. The data was based on registers and analyzed statistically. Mean age of patients was 62 years and mean day of discharge was 4. Main (n = 72) histology of the patients was colorectal liver metastases. Mean bowel function day was 3. Most of the patients were very satisfied or satisfied with the care three days after discharge (99%) and three months (90%) after operation. Most of the patients (72%) experienced moderate pain three days after discharge, but three months after operation 47% of the patients did not experience pain and 48% experienced moderate pain. There were no statistically significant differences in bowel function between different age groups, genders, ASA score groups or histologies. Neither were there statistically significant differences in postoperative bowel function in terms of experienced satisfaction or pain. There were statistically significant differences in postoperative bowel function between different types of surgery (p < 0.01). Nurses should take into consideration hepatectomy patients’ type of surgery and pay special attention in supporting major open hepatectomy patients’ postoperative bowel function. Nurses should educate patients undergoing major open hepatectomy about prolonged postoperative bowel function.

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The burden of chronic diseases such as cancer is increasing in low and middle income countries around the globe. Nepal, one of the world’s poorest countries, is no exception to this trend, with lung cancer as the leading causes of cancer deaths. Despite this, limited data is available on the environmental and behavioral risk factors that contribute to the lung cancer etiology in Nepal. The objectives of this dissertation are to: 1) investigate the ethnic differences in consumption of local tobacco products and their role in lung cancer risk in Nepal; 2) evaluate urinary metabolite of 1,3-butadiene as a biomarker of exposure to combustion related household air pollution (CRHAP); 3) investigate the association between CRHAP exposure and lung cancer risk using urinary metabolite of 1,3-butadiene as a biomarker of exposure; 4) investigate the association between CRHAP exposure and lung cancer risk using questionnaire based measure of exposure. Lung cancer cases (n=606) and frequency matched controls (N=606) were recruited from B.P. Koirala Memorial Cancer Hospital. We obtained biological samples and information on lifestyles including cooking habits and type of fuels used. We used liquid chromatograph tandem mass spectrometer (LC-MS/MS) to quantify urinary metabolites of 1,3-butadiene in urine samples. We employed a combination of logistic and linear regression models to detect any exposure-disease associations while controlling for known confounding variables. Overall, we found that ethnic groups in Nepal use different tobacco products that have different differing cancer potency -we observed the highest odds ratios for the traditional tobacco products. The biomarker analysis showed strong evidence that monohydroxybutyl mercapturic acid is associated with biomass fuel use among participants. However, we did not find significant association between urinary MHMBA and lung cancer risk. When we used questionnaire based measure of exposure to household air pollution, we observed significant, dose-response associations between CRHAP exposure and lung cancer risk, particularly among never-smokers. Our results show that important role of local tobacco products in lung cancer risk in Nepal. Furthermore, we demonstrate that CRHAP exposure is a risk factor for lung cancer risk, independent of tobacco smoking.

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The real-quaternionic indicator, also called the $\delta$ indicator, indicates if a self-conjugate representation is of real or quaternionic type. It is closely related to the Frobenius-Schur indicator, which we call the $\varepsilon$ indicator. The Frobenius-Schur indicator $\varepsilon(\pi)$ is known to be given by a particular value of the central character. We would like a similar result for the $\delta$ indicator. When $G$ is compact, $\delta(\pi)$ and $\varepsilon(\pi)$ coincide. In general, they are not necessarily the same. In this thesis, we will give a relation between the two indicators when $G$ is a real reductive algebraic group. This relation also leads to a formula for $\delta(\pi)$ in terms of the central character. For the second part, we consider the construction of the local Langlands correspondence of $GL(2,F)$ when $F$ is a non-Archimedean local field with odd residual characteristics. By re-examining the construction, we provide new proofs to some important properties of the correspondence. Namely, the construction is independent of the choice of additive character in the theta correspondence.

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Among insects, which are the most diverse eukaryotic group on earth, Lepidoptera is one of four enormously diverse orders, with approximately 10,000 described species in North America. Within the order, Nearctic “microlepidoptera,” which represent an overwhelmingly large percentage of diversity within the order, remain poorly known despite their ecological importance in many plant communities. In this thesis, I undertook several studies of microlepidoptera diversity in a natural community type (hill prairie) and a managed community type (biofuel feedstock). In two Illinois hill prairies differing in size, latitude, and plant composition, alpha diversity of Pyraloidea and Tortricidae was similar, but the prairies were found to support different sets of species of these moth groups. It is concluded that the similarity in alpha diversity occurs because the larger prairie supports primarily a complement of moth species that feed as larvae on prairie plants (especially species of Asteraceae and Fabaceae), whereas the moths collected in the small prairie represent relatively few prairie-associated species, plus a large component of species that feed as larvae on deciduous trees that surround the prairie. This agrees with the finding of high beta diversity of moths between the sites, which reflects a high level of larval hostplant specificity in most species of Pyraloidea and Tortricidae. Based on published information plus observations made on microlepidoptera collected during the course of this study, 31 families of basal microlepidoptera were reviewed with an aim toward evaluating the likelihood of their including species that are dependent on tallgrass prairie. Of these families, 12 were evaluated as possible, and two as likely or certain, to include prairie-dependent species. In a comparison of moth diversity in light-trap samples from corn, miscanthus, switchgrass, and native prairie, alpha diversity was highest in prairie and was higher in switchgrass than in the other two biofuel crops. Moth species complements generally were similar among the biofuel crops, and prairie shared higher species complementarity with switchgrass than with corn or miscanthus. These findings suggest that large-scale conversion of land to biofuel crops may, to a substantial degree, detrimentally affect arthropod biodiversity, with a resulting loss of valuable arthropod-derived ecosystem services both within the cropping systems and in the surrounding landscape. During the course of this study, rearing efforts yielded two species of moths of the family Gelechiidae, both of which are monophagous leaf feeders on leadplant, Amorpha canescens (Fabaceae). Because these moths are restricted to tallgrass prairie, they are likely to be of interest to conservation biologists. In the interest of naming the moths to facilitate communication regarding them, and to augment our taxonomic knowledge of their respective genera, the moths are described, and diagnoses are provided to differentiate them from similar, related species.

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Introduction: Baseline severity and clinical stroke syndrome (Oxford Community Stroke Project, OCSP) classification are predictors of outcome in stroke. We used data from the ‘Tinzaparin in Acute Ischaemic Stroke Trial’ (TAIST) to assess the relationship between stroke severity, early recovery, outcome and OCSP syndrome. Methods: TAIST was a randomised controlled trial assessing the safety and efficacy of tinzaparin versus aspirin in 1,484 patients with acute ischaemic stroke. Severity was measured as the Scandinavian Neurological Stroke Scale (SNSS) at baseline and days 4, 7 and 10, and baseline OCSP clinical classification recorded: total anterior circulation infarct (TACI), partial anterior circulation infarct (PACI), lacunar infarct (LACI) and posterior circulation infarction (POCI). Recovery was calculated as change in SNSS from baseline at day 4 and 10. The relationship between stroke syndrome and SNSS at days 4 and 10, and outcome (modified Rankin scale at 90 days) were assessed. Results: Stroke severity was significantly different between TACI (most severe) and LACI (mildest) at all four time points (p<0.001), with no difference between PACI and POCI. The largest change in SNSS score occurred between baseline and day 4; improvement was least in TACI (median 2 units), compared to other groups (median 3 units) (p<0.001). If SNSS did not improve by day 4, then early recovery and late functional outcome tended to be limited irrespective of clinical syndrome (SNSS, baseline: 31, day 10: 32; mRS, day 90: 4); patients who recovered early tended to continue to improve and had better functional outcome irrespective of syndrome (SNSS, baseline: 35, day 10: 50; mRS, day 90: 2). Conclusions: Although functional outcome is related to baseline clinical syndrome (best with LACI, worst with TACI), patients who improve early have a more favourable functional outcome, irrespective of their OCSP syndrome. Hence, patients with a TACI syndrome may still achieve a reasonable outcome if early recovery occurs.