Ikääntyneen voimavaraistumista tukeva potilasohjaus päivystysosastolla kotiutumisen yhteydessä

Lisääntyvä ikääntyneiden määrä asettaa vaatimuksia terveydenhuollon järjestämiselle niin Suomessa kuin maailmanlaajuisestikin. Ikääntyneiden monialaiset ongelmat yhdessä perussairauksien kanssa muodostavat monimutkaisen kokonaisuuden, joka voi johtaa avun hakemiseen päivystyksestä. Ikääntyneiden hoidossa esiintyvät erityispiirteet, hoidettavien kognitiivisen toimintakyvyn heikkeneminen, lyhentyneet hoitoajat ja hoidon painopisteen siirtyminen kotiin vaativat hoitohenkilökuntaa yhä enenevässä määrin kiinnittämään huomiota potilasohjaukseen. Tutkimuksen tarkoituksena oli kuvata päivystysosastolta kotiutuvien ikääntyneiden ja sairaanhoitajien välisten ohjauskeskusteluiden rakennetta ja sisältöä. Tavoitteena oli tuottaa tietoa siitä, mitä voimavaraistumista tukevia piirteitä ja tiedon osa-alueita esiintyy ohjauskeskusteluissa. Tutkimuksen aineisto kerättiin ei-osallistuvalla havainnoinnilla videoimalla päivystysosastolta kotiutuvien ikääntyneiden ohjaustilanteita (n=22) syksyllä 2015. Osallistuneiden potilaiden keski-ikä oli 79 vuotta. Aineisto analysoitiin deduktiivisella sisällönanalyysilla. Ohjauskeskustelun rakenteesta etsittiin voimavaraistumista tukevia piirteitä ja sisältöä analysoitiin kuuden voimavaraistumista tukevan tiedon osa-alueen pohjalta (biofysiologinen, toiminnallinen, kokemuksellinen, sosiaalinen, eettinen ja taloudellinen). Ohjauskeskustelujen alussa ei asetettu ohjauksen tavoitteita tai arvioitu ikääntyneiden aikaisemman tiedon tasoa. Ohjauskeskustelut etenivät pääosin hoitajien määrittäminä. Ikääntyneet kysyivät vähemmän kysymyksiä ja heidän yksisanaisten puheenvuorojensa määrä oli suurempi kuin hoitajilla. Ikääntyneiden osallistumista ohjauskeskusteluun ei myöskään tuettu. Kysymyksen esitettyään hoitajat antoivat ikääntyneille mahdollisuuden vastata, mutta eivät varmistaneet, olivatko nämä ymmärtäneet ohjauksen. Ohjauskeskusteluiden sisältöä tarkasteltaessa tietoa ikääntyneille välitettiin pääasiassa biofysiologisen tiedon osa-alueelta (tietoa hoidosta ja oireista). Toiseksi eniten tietoa välitettiin ikääntyneille toiminnallisen tiedon osa-alueelta (liikkuminen ja kotona selviytyminen) ja sosiaalisen tiedon osa-alueelta (omaisten osallistuminen hoitoon). Taloudellisen tiedon osa-alue jäi aineistossa pieneksi. Tutkimuksen tulokset osoittavat tarvetta kiinnittää huomiota ohjauskeskusteluiden rakenteeseen ja sisältöön etenkin hoidettaessa ikääntyneitä, joilla on monitahoisia terveysongelmia. Tutkimuksesta saatavaa tietoa voidaan hyödyntää suunniteltaessa ja toteuttaessa ikääntyneiden potilasohjausta päivystyksessä sekä suunniteltaessa sairaanhoitajien potilasohjauskoulutusta.

O ciclo de vendas, atendimento e satisfação do cliente

Mestrado em Gestão e Empreendedorismo

Serial killer: il database mondiale

Lo studio dei serial killer, quanto mai complesso e poliedrico, è reso difficoltoso, in parte, anche dall’attuale progresso, che ha portato questi soggetti devianti ad evolversi notevolmente sia in termini di astuzia (staging) che di mobilità. Tutto ciò dimostra che negli omicidi seriali, nonostante l'importante lavoro da parte di alcuni studiosi che sono riusciti a proporre contributi teorici di notevole importanza, è particolarmente frequente la c.d. “cecità di collegamento” fra omicidi perpetrati dalla medesima persona, ma in parti diverse nel mondo. È, quindi, indispensabile la costruzione di una banca dati mondiale che consenta a tutte le forze di polizia di avere sempre a disposizione informazioni raccolte sulla scena del crimine relativamente ad omicidi particolarmente aberranti e privi di un particolare movente. Sarà quindi compito del profiler, con strumenti di supporto creati ad hoc e tecnologicamente avanzati, reperire sulla scena del crimine queste informazioni attraverso una metodologia chiara e condivisa, che saranno, grazie alla banca dati, messe a disposizione di tutte le forze di polizia. The complex and multisided study of serial killers is partly made difficult by the current level of progress that has led these deviant people to evolve in relation to the aspects of shrewdness (concerning the staging) and mobility. Despite the important work of some scholars who proposed important theories, all this shows that, concerning serial murders, it is still particularly frequent not to pay attention to links among homicides committed by the same person but in different parts of the world. It is therefore crucial to develop a worldwide database that allows all police forces to access information collected on crime scenes of murders which are particularly absurd and committed without any apparent reason. It will then be up to the profiler, through ad hoc and technologically advanced tools, to collect this information on the crime scene that would be made available to all police forces thanks to the worldwide database.

O ouro branco abre caminho: o algodão e a modernização do espaço urbano da Cidade da Parahyba (1850-1924)

The present research deals with the modernization process of the Cidade da Parahyba2, between 1850 and 1924, and its relation with the cotton economy, which represented the main source of wealth accumulation for both the private and the public sectors throughout the First Republic. This study on urban history was developed by focusing on the understanding of the city s spatial formation, and despite its emphasis on the economic aspects involved, other factors that also contribute to the development of the social life were not put aside. The modernization process of the Cidade da Parahyba was also analyzed during the period established for the study according to a chronological and thematic approach that established comparisons with the financial situation of the State, whenever this was necessary, with special attention to the contribution of the cotton economy to the State´s revenues. It was possible to detect a lack of financial help and loans from the federal and municipal administrations for finishing several public works already underway in the capital, since the federal funds allocated to the State of Parahyba do Norte were rather employed in emergency works against droughts and in agricultural development. One can then conclude that the financial resources required for the urban interventions were withdrawn from the State s treasury itself, resources that were collected mainly from activities such as cotton exportation and cotton trading. Another factor shows the interdependence between the urban remodeling and the cotton economy: during the years marked by great droughts or by hard plagues on the cotton plantations, cotton production decreased, as well as the State s finances. The first measures taken by the State s administrators were to halt all projects of urban remodeling in progress in the Cidade da Parahyba, which was, clearly, the most privileged city by the State s presidents during the period analyzed. 2 The city of João Pessoa was named Cidade da Parahyba, a designation that remained until September 1930, when it received its present-day name in order to pay homage to the president of the State, João Pessoa Cavalcanti de Albuquerque, murdered in the city of Recife in August of that same year. At that time, the State of Paraíba was known as Parahyba do Norte. Since this work is limited to a period of time comprised within the First Republic, the names employed respect the terms used in those days

'Don't stop': re-thinking the function of endings in narrative television

This thesis argues that the study of narrative television has been limited by an adherence to accepted and commonplace conceptions of endings as derived from literary theory, particularly a preoccupation with the terminus of the text as the ultimate site of cohesion, structure, and meaning. Such common conceptions of endings, this thesis argues, are largely incompatible with the realities of television’s production and reception, and as a result the study of endings in television needs to be re-thought to pay attention to the specificities of the medium. In this regard, this thesis proposes a model of intra-narrative endings, islands of cohesion, structure, and meaning located within television texts, as a possible solution to the problem of endings in television. These intra-narrative endings maintain the functionality of traditional endings, whilst also allowing for the specificities of television as a narrative medium. The first two chapters set out the theoretical groundwork, first by exploring the essential characteristics of narrative television (serialisation, fragmentation, duration, repetition, and accumulation), then by exploring the unique relationship between narrative television and the forces of contingency. These chapters also introduce the concept of intra-narrative endings as a possible solution to the problems of television’s narrative structure, and the medium’s relationship to contingency. Following on from this my three case studies examine forms of television which have either been traditionally defined as particularly resistant to closure (soap opera and the US sitcom) or which have received little analysis in terms of their narrative structure (sports coverage). Each of these case studies provides contextual material on these televisual forms, situating them in terms of their narrative structure, before moving on to analyse them in terms of my concept of intra-narrative endings. In the case of soap opera, the chapter focusses on the death of the long running character Pat Butcher in the British soap EastEnders (BBC, 1985-), while my chapter on the US sitcom focusses on the varying levels of closure that can be located within the US sitcom, using Friends (NBC, 1993-2004) as a particular example. Finally, my chapter on sports coverage analyses the BBC’s coverage of the 2012 London Olympics, and focusses on the narratives surrounding cyclists Chris Hoy and Victoria Pendleton. Each of these case studies identifies their chosen events as intra-narrative endings within larger, ongoing texts, and analyses the various ways in which they operate within those wider texts. This thesis is intended to make a contribution to the emerging field of endings studies within television by shifting the understanding of endings away from a dominant literary model which overwhelmingly focusses on the terminus of the text, to a more televisually specific model which pays attention to the particular contexts of the medium’s production and reception.

A Wel(l)come development: research funders and open access

This paper discusses the implications of the Wellcome Trust agreement with Blackwell, OUP and Springer in which authors of accepted papers are able to pay an open-access publication charge to make their article freely available online. In bringing together flexible licence terms and clear funding streams, the agreement has the potential to be used as a way of migrating towards possible new business models for journal publishing. It also has the potential, if implemented more widely, to deliver greater open access in such a way as to work in the interests of a broad range of stakeholders.

Estimating the demand curve for sustainable use of pesticides from contingent-valuation data

Stated-preference valuation techniques are often used to assess consumers' willingness-to-pay for food items produced in farming systems that adopt a sustainable use of pesticides (SUP). We propose an innovative valuation methodology in which dichotomous-choice contingent valuation is used to estimate the demand curve (price-quantity relationship) for such food items where price means price premium for the SUP output, quantity is the probability of choosing SUP and the conventional food product is kept available in the market at the current market price. This methodology can be used to evaluate market differentiation as a policy option to promote the SUP. The methodology is tested with data from a sample of urban consumers of fruits and vegetables in Portugal. The estimated demand curve is used to define the price level maximizing the total premium revenue for the SUP sector as a whole. This optimal level of the price premium is €77.55 (or 163% of the value of the monthly basket of fruits and vegetables at current prices). Adopting the optimal price premium will decrease the number of consumers of SUP food by 54%. The reduction is even higher for low income consumers (80%) leaving them more exposed to the risks of pesticide use.

Restoration ecology of coastal lagoons: new methods for the prediction of ecological trajectories and economic valuation

Conservation of the seven lagoons of the Palavas complex (southern France) has been severely impaired by nutrient over-enrichment during at least four decades. The effluents of the Montpellier wastewater treatment plant (WWTP) represented the main nutrient input. To improve the water quality of these lagoons, this WWTP was renovated and upgraded and, since the end of 2005, its effluents have been discharged 11 km offshore into the Mediterranean (total investment €150 M). Possibilities of ecosystem restoration as part of a conservation programme were explored by a focus group of experts. Their tasks were: (i) to evaluate the impact of the reduction of the nutrient input; (ii) if necessary, to design additional measures for an active restoration programme; and (iii) to predict ecosystem trajectories for the different cases. Extension of Magnoliophyta meadows can be taken as a proxy for ecosystem restoration as they favour the increase of several fish (seahorse) and bird (ducks, swans, herons) species, albeit they represent a trade-off for greater flamingos. Additional measures for active ecosystem restoration were only recommended for the most impaired lagoon Méjean, while the least impaired lagoon Ingril is already on a trajectory of spontaneous recovery. A multiple contingent valuation considering four different management options for the Méjean lagoon was used in a pilot study based on face-to-face interviews with 159 respondents. Three levels of ecosystem restoration were expressed in terms of recovery of Magnoliophyta meadows, including their impact on emblematic fish and avifauna. These were combined with different options for access (status quo, increasing access, increasing access with measures to reduce disturbance). The results show a willingness of local populations to pay per year about €25 for the highest level of ecological restoration, while they were only willing to allocate about €5 for additional footpaths and hides.

Solvency considerations in the gamma-omega surplus model

Ce mémoire de maîtrise traite de la théorie de la ruine, et plus spécialement des modèles actuariels avec surplus dans lesquels sont versés des dividendes. Nous étudions en détail un modèle appelé modèle gamma-omega, qui permet de jouer sur les moments de paiement de dividendes ainsi que sur une ruine non-standard de la compagnie. Plusieurs extensions de la littérature sont faites, motivées par des considérations liées à la solvabilité. La première consiste à adapter des résultats d’un article de 2011 à un nouveau modèle modifié grâce à l’ajout d’une contrainte de solvabilité. La seconde, plus conséquente, consiste à démontrer l’optimalité d’une stratégie de barrière pour le paiement des dividendes dans le modèle gamma-omega. La troisième concerne l’adaptation d’un théorème de 2003 sur l’optimalité des barrières en cas de contrainte de solvabilité, qui n’était pas démontré dans le cas des dividendes périodiques. Nous donnons aussi les résultats analogues à l’article de 2011 en cas de barrière sous la contrainte de solvabilité. Enfin, la dernière concerne deux différentes approches à adopter en cas de passage sous le seuil de ruine. Une liquidation forcée du surplus est mise en place dans un premier cas, en parallèle d’une liquidation à la première opportunité en cas de mauvaises prévisions de dividendes. Un processus d’injection de capital est expérimenté dans le deuxième cas. Nous étudions l’impact de ces solutions sur le montant des dividendes espérés. Des illustrations numériques sont proposées pour chaque section, lorsque cela s’avère pertinent.

Valoración económica de la reducción del ruido por tráfico vehicular: una aplicación para Medellín (Colombia)

El objetivo de este trabajo es la determinación de los beneficios económicos que obtendrían los hogares de zonas residenciales en la ciudad de Medellín (Colombia) por la reducción del ruido por tráfico vehicular. Para tal propósito se utilizó el método de valoración contingente en combinación con información de percepción de calidad acústica de los hogares. Este enfoque permitió estimar la disponibilidad a pagar esperada por la reducción de un decibel en los niveles de ruido a los cuales están expuestos los hogares. Los resultados demuestran que si  se aplica para la ciudad un programa, política o proyecto que logre una reducción generalizada de 5 decibeles en el ruido por tráfico vehicular los beneficios económicos agregados ascienden a 397 millones de pesos colombianos al año. El estudio concluye que estos resultados generan conocimiento importante para hacer más efectiva la toma de decisiones en el marco de políticas regionales con respecto a la gestión de la reducción del ruido por tráfico vehicular. 

Traitement des émotions évoquées par les expressions faciales, vocales et musicales à la suite d’un traumatisme craniocérébral

Le traitement des émotions joue un rôle essentiel dans les relations interpersonnelles. Des déficits dans la reconnaissance des émotions évoquées par les expressions faciales et vocales ont été démontrés à la suite d’un traumatisme craniocérébral (TCC). Toutefois, la majorité des études n’ont pas différencié les participants selon le niveau de gravité du TCC et n’ont pas évalué certains préalables essentiels au traitement émotionnel, tels que la capacité à percevoir les caractéristiques faciales et vocales, et par le fait même, la capacité à y porter attention. Aucune étude ne s’est intéressée au traitement des émotions évoquées par les expressions musicales, alors que la musique est utilisée comme méthode d’intervention afin de répondre à des besoins de prise en charge comportementale, cognitive ou affective chez des personnes présentant des atteintes neurologiques. Ainsi, on ignore si les effets positifs de l’intervention musicale sont basés sur la préservation de la reconnaissance de certaines catégories d’émotions évoquées par les expressions musicales à la suite d’un TCC. La première étude de cette thèse a évalué la reconnaissance des émotions de base (joie, tristesse, peur) évoquées par les expressions faciales, vocales et musicales chez quarante et un adultes (10 TCC modéré-sévère, 9 TCC léger complexe, 11 TCC léger simple et 11 témoins), à partir de tâches expérimentales et de tâches perceptuelles contrôles. Les résultats suggèrent un déficit de la reconnaissance de la peur évoquée par les expressions faciales à la suite d’un TCC modéré-sévère et d’un TCC léger complexe, comparativement aux personnes avec un TCC léger simple et sans TCC. Le déficit n’est pas expliqué par un trouble perceptuel sous-jacent. Les résultats montrent de plus une préservation de la reconnaissance des émotions évoquées par les expressions vocales et musicales à la suite d’un TCC, indépendamment du niveau de gravité. Enfin, malgré une dissociation observée entre les performances aux tâches de reconnaissance des émotions évoquées par les modalités visuelle et auditive, aucune corrélation n’a été trouvée entre les expressions vocales et musicales. La deuxième étude a mesuré les ondes cérébrales précoces (N1, N170) et plus tardives (N2) de vingt-cinq adultes (10 TCC léger simple, 1 TCC léger complexe, 3 TCC modéré-sévère et 11 témoins), pendant la présentation d’expressions faciales évoquant la peur, la neutralité et la joie. Les résultats suggèrent des altérations dans le traitement attentionnel précoce à la suite d’un TCC, qui amenuisent le traitement ultérieur de la peur évoquée par les expressions faciales. En somme, les conclusions de cette thèse affinent notre compréhension du traitement des émotions évoquées par les expressions faciales, vocales et musicales à la suite d’un TCC selon le niveau de gravité. Les résultats permettent également de mieux saisir les origines des déficits du traitement des émotions évoquées par les expressions faciales à la suite d’un TCC, lesquels semblent secondaires à des altérations attentionnelles précoces. Cette thèse pourrait contribuer au développement éventuel d’interventions axées sur les émotions à la suite d’un TCC.

States' Responding Behavior in Conflict: Asymmetric Response and Strategic Conflict Avoidance

State responses to external threats and aggression are studied with focus on two different rationales: (1) to make credible deterrent threats to avoid being exploited, and (2) to minimize the risk of escalation to unwanted war. Given external aggression, the target state's responding behavior has three possibilities: concession (under-response), reciprocation, and escalation. This study focuses on the first two possibilities and investigates how the strategic nature of crisis interaction can explain the intentional choice of concession or avoidance of retaliation. I build a two-level bargaining model that accounts for the domestic bargaining situation between the leader and the challenger for each state. The model's equilibrium shows that the responding behavior is determined not only by inter-state level variables (e.g. balance of power between two states, or cost of war that each state is supposed to pay), but also the domestic variables of both states. Next, the strategic interaction is rationally explained by the model: as the responding state believes that the initiating state has strong domestic challenges and, hence, the aggression is believed to be initiated for domestic political purposes (a rally-around-the-flag effect), the response tends to decrease. The concession is also predicted if the target state leader has strong bargaining power against her domestic challengers \emph{and} she believes that the initiating leader suffers from weak domestic standing. To test the model's prediction, I conduct a lab experiment and case studies. The experimental result shows that under an incentivized bargaining situation, individual actors are observed to react to hostile action as the model predicts: if the opponent is believed to suffer from internally driven difficulties, the subject will not punish hostile behavior of the other player as severely as she would without such a belief. The experiment also provides supporting evidence for the choice of concession: when the player finds herself in a favorable situation while the other has disadvantages, the player is more likely to make concessions in the controlled dictator game. Two cases are examined to discuss how the model can explain the choice of either reciprocation or concession. From personal interviews and fieldwork in South Korea, I find that South Korea's reciprocating behavior during the 2010 Yeonpyeong Island incident is explained by a combination of `low domestic power of initiating leader (Kim Jong-il)' and `low domestic power of responding leader (Lee Myung-bak).' On the other hand, the case of EC-121 is understood as a non-response or concession outcome. Declassified documents show that Nixon and his key advisors interpreted the attack as a result of North Korea's domestic political instabilities (low domestic power of initiating leader) and that Nixon did not have difficulties at domestic politics during the first few months of his presidency (high domestic power of responding leader).

Comprehensive economic and financial analysis of the enterprise activity: approaches, methods and implementation

This thesis intends to analyse the performance and the efficiency of companies and to identify the key factors that may explain it. A comprehensive analysis based on a set of economic and financial ratios was studied as an instrument which provides information on enterprise performance and its efficiency. It was selected a sample with 15 enterprises: 7 Portuguese and 8 Ukrainian ones, belonging to several industries. Financial and non-financial data was collected for 6 years, during the period of 2009 to 2014. Research questions that guided this work were: Are the enterprises efficient/profitable? What factors influence enterprises’ efficiency/performance? Is there any difference between Ukrainian and Portuguese enterprises’ efficiency/performance, which factors have more influence? Which industrial sector is represented by more efficient/profitable enterprises? The main results showed that in average enterprises were efficient; comparing by states Ukrainian enterprises are more efficient; industries have similar level of efficiency. Among factors that influence ATR positively are fixed and current assets turnover ratios, ROA; negatively influencing are EBITDA margin and liquidity ratio. There is no significant difference between models by country. Concerning profitability, enterprises have low performance level but in comparison of countries Ukrainian enterprises have better profitability in average. Regarding the industry sector, paper industry is the most profitable. Among factors influencing ROA are profit margin, fixed asset turnover ratio, EBITDA margin, Debt to equity ratio and the country. In case of profitability both countries have different models. For Ukrainian enterprises is suggested to pay attention on factors of Short-term debt to total debt, ROA, Interest coverage ratio in order to be more efficient; Profit margin and EBITDA margin to make their performance better. For Portuguese enterprises for improving efficiency the observation and improvement of fixed assets turnover ratio, current assets turnover ratio, Short-term financial debt to total debt, Leverage Ratio, EBITDA margin is suggested; for improving higher profitability track fixed assets turnover ratio, current assets turnover ratio, Debt to equity ratio, Profit margin and Interest coverage ratio is suggested.

Editorial

When editing the last newsletter of 1982 the Library Unit of the Faculty of Arts, is pleased to pay a farewell tribute to our coordinator Mr., Deyanira Sequeira, who is the founder of the School of Library Science at the University.She has been a tireless fighter for the professional advancement of members of the unit and the improvement of academic quality that exists in each and every one of the courses and teaching programs.We express our sincere appreciation for the work he did in the Unit Library for the benefit of the career of students, those who work with her, at the National University and the country in general.

A relação entre o direito e a teoria econômica na jurisprudência do cade sobre tabelas médicas

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Direito, Programa de Pós-Graduação em Direito, 2015.