Natural disaster and household recovery in the aftermath of hurricane Andrew : a case study of four Hispanic households in South Miami Heights

This thesis explores the aid received by four Hispanic households towards recovery after Hurricane Andrew. The four households resided in South Miami Heights, a suburb of Miami. Through the use of questionnaires, information was gathered on various storm related topics. Because the Cuban community in Miami is influential, the role of the Cuban enclave is studied in relation to the recovery of these households. The influence of an urban environment on the extended family ties of these households is also addressed since the literature argues that these ties are powerful among Hispanics. Results show, that aid primarily came from two sources. Furthermore, the Cuban enclave appears to have had no discernible role in the recovery of these households. Finally, an urban setting did not appear to diminish extended family ties.

The use of cardiac rehabilitation services to aid the recovery of patients with bowel cancer : a pilot randomised controlled trial with embedded feasibility study

This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 4, No. 24. See the NIHR Journals Library website for further project information.

Postoperative Bowel Function and Related Factors in Enhanced Recovery Protocol with Patients Undergoing Hepatectomy

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.

A rehabilitation intervention to promote physical recovery following intensive care: a detailed description of construct development, rationale and content together with proposed taxonomy to capture processes in a randomised controlled trial.

Background: increasing numbers of patients are surviving critical illness, but survival may be associated with a constellation of physical and psychological sequelae that can cause on going disability and reduced health-related quality of life. Limited evidence currently exists to guide the optimum structure, timing, and content of rehabilitation programmes. There is a need to both develop and evaluate interventions to support and expedite recovery during the post-ICU discharge period. This paper describes the construct development for a complex rehabilitation intervention intended to promote physical recovery following critical illness. The intervention is currently being evaluated in a randomised trial (ISRCTN09412438; funder Chief Scientists Office, Scotland). Methods: the intervention was developed using the Medical Research Council (MRC) framework for developing complex healthcare interventions. We ensured representation from a wide variety of stakeholders including content experts from multiple specialties, methodologists, and patient representation. The intervention construct was initially based on literature review, local observational and audit work, qualitative studies with ICU survivors, and brainstorming activities. Iterative refinement was aided by the publication of a National Institute for Health and Care Excellence guideline (No. 83), publicly available patient stories (Healthtalkonline), a stakeholder event in collaboration with the James Lind Alliance, and local piloting. Modelling and further work involved a feasibility trial and development of a novel generic rehabilitation assistant (GRA) role. Several rounds of external peer review during successive funding applications also contributed to development. Results: the final construct for the complex intervention involved a dedicated GRA trained to pre-defined competencies across multiple rehabilitation domains (physiotherapy, dietetics, occupational therapy, and speech/language therapy), with specific training in post-critical illness issues. The intervention was from ICU discharge to 3 months post-discharge, including inpatient and post-hospital discharge elements. Clear strategies to provide information to patients/families were included. A detailed taxonomy was developed to define and describe the processes undertaken, and capture them during the trial. The detailed process measure description, together with a range of patient, health service, and economic outcomes were successfully mapped on to the modified CONSORT recommendations for reporting non-pharmacologic trial interventions. Conclusions: the MRC complex intervention framework was an effective guide to developing a novel post-ICU rehabilitation intervention. Combining a clearly defined new healthcare role with a detailed taxonomy of process and activity enabled the intervention to be clearly described for the purpose of trial delivery and reporting. These data will be useful when interpreting the results of the randomised trial, will increase internal and external trial validity, and help others implement the intervention if the intervention proves clinically and cost effective.

Increased hospital-based physical rehabilitation and information provision after intensive care unit discharge: the RECOVER randomized clinical trial.

Importance: critical illness results in disability and reduced health-related quality of life (HRQOL), but the optimum timing and components of rehabilitation are uncertain. Objective: to evaluate the effect of increasing physical and nutritional rehabilitation plus information delivered during the post–intensive care unit (ICU) acute hospital stay by dedicated rehabilitation assistants on subsequent mobility, HRQOL, and prevalent disabilities. Design, Setting, and Participants: a parallel group, randomized clinical trial with blinded outcome assessment at 2 hospitals in Edinburgh, Scotland, of 240 patients discharged from the ICU between December 1, 2010, and January 31, 2013, who required at least 48 hours of mechanical ventilation. Analysis for the primary outcome and other 3-month outcomes was performed between June and August 2013; for the 6- and 12-month outcomes and the health economic evaluation, between March and April 2014. Interventions: during the post-ICU hospital stay, both groups received physiotherapy and dietetic, occupational, and speech/language therapy, but patients in the intervention group received rehabilitation that typically increased the frequency of mobility and exercise therapies 2- to 3-fold, increased dietetic assessment and treatment, used individualized goal setting, and provided greater illness-specific information. Intervention group therapy was coordinated and delivered by a dedicated rehabilitation practitioner. Main Outcomes and Measures: the Rivermead Mobility Index (RMI) (range 0-15) at 3 months; higher scores indicate greater mobility. Secondary outcomes included HRQOL, psychological outcomes, self-reported symptoms, patient experience, and cost-effectiveness during a 12-month follow-up (completed in February 2014). Results: median RMI at randomization was 3 (interquartile range [IQR], 1-6) and at 3 months was 13 (IQR, 10-14) for the intervention and usual care groups (mean difference, −0.2 [95% CI, −1.3 to 0.9; P = .71]). The HRQOL scores were unchanged by the intervention (mean difference in the Physical Component Summary score, −0.1 [95% CI, −3.3 to 3.1; P = .96]; and in the Mental Component Summary score, 0.2 [95% CI, −3.4 to 3.8; P = .91]). No differences were found for self-reported symptoms of fatigue, pain, appetite, joint stiffness, or breathlessness. Levels of anxiety, depression, and posttraumatic stress were similar, as were hand grip strength and the timed Up & Go test. No differences were found at the 6- or 12-month follow-up for any outcome measures. However, patients in the intervention group reported greater satisfaction with physiotherapy, nutritional support, coordination of care, and information provision. Conclusions and Relevance: post-ICU hospital-based rehabilitation, including increased physical and nutritional therapy plus information provision, did not improve physical recovery or HRQOL, but improved patient satisfaction with many aspects of recovery.

Toxic metal recovery from spent hydroprocessing catalyst

Spent hydroprocessing catalysts (HPCs) are solid wastes generated in refinery industries and typically contain various hazardous metals, such as Co, Ni, and Mo. These wastes cannot be discharged into the environment due to strict regulations and require proper treatment to remove the hazardous substances. Various options have been proposed and developed for spent catalysts treatment; however, hydrometallurgical processes are considered efficient, cost-effective and environmentally-friendly methods of metal extraction, and have been widely employed for different metal uptake from aqueous leachates of secondary materials. Although there are a large number of studies on hazardous metal extraction from aqueous solutions of various spent catalysts, little information is available on Co, Ni, and Mo removal from spent NiMo hydroprocessing catalysts. In the current study, a solvent extraction process was applied to the spent HPC to specifically remove Co, Ni, and Mo. The spent HPC is dissolved in an acid solution and then the metals are extracted using three different extractants, two of which were aminebased and one which was a quaternary ammonium salt. The main aim of this study was to develop a hydrometallurgical method to remove, and ultimately be able to recover, Co, Ni, and Mo from the spent HPCs produced at the petrochemical plant in Come By Chance, Newfoundland and Labrador. The specific objectives of the study were: (1) characterization of the spent catalyst and the acidic leachate, (2) identifying the most efficient leaching agent to dissolve the metals from the spent catalyst; (3) development of a solvent extraction procedure using the amine-based extractants Alamine308, Alamine336 and the quaternary ammonium salt, Aliquat336 in toluene to remove Co, Ni, and Mo from the spent catalyst; (4) selection of the best reagent for Co, Ni, and Mo extraction based on the required contact time, required extractant concentration, as well as organic:aqueous ratio; and (5) evaluation of the extraction conditions and optimization of the metal extraction process using the Design Expert® software. For the present study, a Central Composite Design (CCD) method was applied as the main method to design the experiments, evaluate the effect of each parameter, provide a statistical model, and optimize the extraction process. Three parameters were considered as the most significant factors affecting the process efficiency: (i) extractant concentration, (ii) the organic:aqueous ratio, and (iii) contact time. Metal extraction efficiencies were calculated based on ICP analysis of the pre- and post–leachates, and the process optimization was conducted with the aid of the Design Expert® software. The obtained results showed that Alamine308 can be considered to be the most effective and suitable extractant for spent HPC examined in the study. Alamine308 is capable of removing all three metals to the maximum amounts. Aliquat336 was found to be not as effective, especially for Ni extraction; however, it is able to separate all of these metals within the first 10 min, unlike Alamine336, which required more than 35 min to do so. Based on the results of this study, a cost-effective and environmentally-friendly solventextraction process was achieved to remove Co, Ni, and Mo from the spent HPCs in a short amount of time and with the low extractant concentration required. This method can be tested and implemented for other hazardous metals from other secondary materials as well. Further investigation may be required; however, the results of this study can be a guide for future research on similar metal extraction processes.

Essays on Information Frictions, Prices and Unemployment

I investigate the effects of information frictions in price setting decisions. I show that firms' output prices and wages are less sensitive to aggregate economic conditions when firms and workers cannot perfectly understand (or know) the aggregate state of the economy. Prices and wages respond with a lag to aggregate innovations because agents learn slowly about those changes, and this delayed adjustment in prices makes output and unemployment more sensitive to aggregate shocks. In the first chapter of this dissertation, I show that workers' noisy information about the state of the economy help us to explain why real wages are sluggish. In the context of a search and matching model, wages do not immediately respond to a positive aggregate shock because workers do not (yet) have enough information to demand higher wages. This increases firms' incentives to post more vacancies, and it makes unemployment volatile and sensitive to aggregate shocks. This mechanism is robust to two major criticisms of existing theories of sluggish wages and volatile unemployment: the flexibility of wages for new hires and the cyclicality of the opportunity cost of employment. Calibrated to U.S. data, the model explains 60% of the overall unemployment volatility. Consistent with empirical evidence, the response of unemployment to TFP shocks predicted by my model is large, hump-shaped, and peaks one year after the TFP shock, while the response of the aggregate wage is weak and delayed, peaking after two years. In the second chapter of this dissertation, I study the role of information frictions and inventories in firms' price setting decisions in the context of a monetary model. In this model, intermediate goods firms accumulate output inventories, observe aggregate variables with one period lag, and observe their nominal input prices and demand at all times. Firms face idiosyncratic shocks and cannot perfectly infer the state of nature. After a contractionary nominal shock, nominal input prices go down, and firms accumulate inventories because they perceive some positive probability that the nominal price decline is due to a good productivity shock. This prevents firms' prices from decreasing and makes current profits, households' income, and aggregate demand go down. According to my model simulations, a 1% decrease in the money growth rate causes output to decline 0.17% in the first quarter and 0.38% in the second followed by a slow recovery to the steady state. Contractionary nominal shocks also have significant effects on total investment, which remains 1% below the steady state for the first 6 quarters.

Characterization of the methanol recovery process at Prio Biocombustíveis S. A.

In a industrial environment, to know the process one is working with is crucial to ensure its good functioning. In the present work, developed at Prio Biocombustíveis S.A. facilities, using process data, collected during the present work, and historical process data, the methanol recovery process was characterized, having started with the characterization of key process streams. Based on the information retrieved from the stream characterization, Aspen Plus® process simulation software was used to replicate the process and perform a sensitivity analysis with the objective of accessing the relative importance of certain key process variables (reflux/feed ratio, reflux temperature, reboiler outlet temperature, methanol, glycerol and water feed compositions). The work proceeded with the application of a set of statistical tools, starting with the Principal Components Analysis (PCA) from which the interactions between process variables and their contribution to the process variability was studied. Next, the Design of Experiments (DoE) was used to acquire experimental data and, with it, create a model for the water amount in the distillate. However, the necessary conditions to perform this method were not met and so it was abandoned. The Multiple Linear Regression method (MLR) was then used with the available data, creating several empiric models for the water at distillate, the one with the highest fit having a R2 equal to 92.93% and AARD equal to 19.44%. Despite the AARD still being relatively high, the model is still adequate to make fast estimates of the distillate’s quality. As for fouling, its presence has been noticed many times during this work. Not being possible to directly measure the fouling, the reboiler inlet steam pressure was used as an indicator of the fouling growth and its growth variation with the amount of Used Cooking Oil incorporated in the whole process. Comparing the steam cost associated to the reboiler’s operation when fouling is low (1.5 bar of steam pressure) and when fouling is high (reboiler’s steam pressure of 3 bar), an increase of about 58% occurs when the fouling increases.

Essays on Uncertainty, Imperfect Information, and Investment Dynamics

Understanding how imperfect information affects firms' investment decision helps answer important questions in economics, such as how we may better measure economic uncertainty; how firms' forecasts would affect their decision-making when their beliefs are not backed by economic fundamentals; and how important are the business cycle impacts of changes in firms' productivity uncertainty in an environment of incomplete information. This dissertation provides a synthetic answer to all these questions, both empirically and theoretically. The first chapter, provides empirical evidence to demonstrate that survey-based forecast dispersion identifies a distinctive type of second moment shocks different from the canonical volatility shocks to productivity, i.e. uncertainty shocks. Such forecast disagreement disturbances can affect the distribution of firm-level beliefs regardless of whether or not belief changes are backed by changes in economic fundamentals. At the aggregate level, innovations that increase the dispersion of firms' forecasts lead to persistent declines in aggregate investment and output, which are followed by a slow recovery. On the contrary, the larger dispersion of future firm-specific productivity innovations, the standard way to measure economic uncertainty, delivers the ``wait and see" effect, such that aggregate investment experiences a sharp decline, followed by a quick rebound, and then overshoots. At the firm level, data uncovers that more productive firms increase investments given rises in productivity dispersion for the future, whereas investments drop when firms disagree more about the well-being of their future business conditions. These findings challenge the view that the dispersion of the firms' heterogeneous beliefs captures the concept of economic uncertainty, defined by a model of uncertainty shocks. The second chapter presents a general equilibrium model of heterogeneous firms subject to the real productivity uncertainty shocks and informational disagreement shocks. As firms cannot perfectly disentangle aggregate from idiosyncratic productivity because of imperfect information, information quality thus drives the wedge of difference between the unobserved productivity fundamentals, and the firms' beliefs about how productive they are. Distribution of the firms' beliefs is no longer perfectly aligned with the distribution of firm-level productivity across firms. This model not only explains why, at the macro and micro level, disagreement shocks are different from uncertainty shocks, as documented in Chapter 1, but helps reconcile a key challenge faced by the standard framework to study economic uncertainty: a trade-off between sizable business cycle effects due to changes in uncertainty, and the right amount of pro-cyclicality of firm-level investment rate dispersion, as measured by its correlation with the output cycles.

Selection of optimal operating conditions based on minimum energy consumption for an acrylonitrile recovery unit

The selection of the optimal operating conditions for an industrial acrylonitrile recovery unit was conducted by the systematic application of the response surface methodology, based on the minimum energy consumption and products specifications as process constraints. Unit models and plant simulation were validated against operating data and information. A sensitivity analysis was carried out in order to identify the set of parameters that strongly affect the trajectories of the system while keeping products specifications. The results suggest that energy savings of up to 10% are possible by systematically adjusting operating conditions.

Health information management : What business are we in?

Developments in information technology will drive the change in records management; however, it should be the health information managers who drive the information management change. The role of health information management will be challenged to use information technology to broker a range of requests for information from a variety of users, including he alth consumers. The purposes of this paper are to conceptualise the role of health information management in the context of a technologically driven and managed health care environment, and to demonstrat e how this framework has been used to review and develop the undergraduate program in health information management at the Queensland University of Technology.