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Almond, Paul. „The enforcement of work related fatality cases“. Thesis, University of Birmingham, 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.494489.
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Stanley, Sharon A. R. „Regional mass fatality management in pandemic surge“. Thesis, Monterey, Calif. : Naval Postgraduate School, 2008. http://edocs.nps.edu/npspubs/scholarly/theses/2008/Dec/08Dec%5FStanley.pdf.
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Thesis (M.A. in Security Studies (Homeland Security and Defense))--Naval Postgraduate School, December 2008.Thesis Advisor(s): Richter, Anke ; Supinski, Stanley B. "December 2008." Description based on title screen as viewed on February 2, 2009. Includes bibliographical references (p. 179-189). Also available in print.
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Öström, Mats. „Vehicle-related injuries : with emphasis on fatality prevention“. Doctoral thesis, Umeå universitet, Rättsmedicin, 1993. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-101291.
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According to WHO, Sweden should aim to reduce unintentional fatalities, particularly vehicle-related injuries, by 25% by the year 2000. The aim of this thesis was to analyze vehicle-related injuries and injury events, especially the contributory effects of alcohol and disease and the injury reducing capacity of helmets and airbags in order to point out some preventive measures. Alcohol: Alcohol is the main contributing factor in fatal traffic crashes. In a study on 121 traffic fatalities in Washtenaw County, Michigan, USA, different sources of data for alcohol involvement were compared. In police reports alcohol involvement was found in 51% of the fatalities, in autopsy reports in 63%, and in hospital emergency records in 91%. To avoid bias in the estimation of the fraction of alcohol-related fatalities, it is important to routinely investigate all severe and fatally injured cases in traffic crashes, ideally as soon as possible after the crash. In a study on traumatic car fatalities (n=597) in northern Sweden, 58% of the single vehicle (SV) drivers were inebriated (multi-vehicle, MV 10%), the mean blood alcohol concentration (BAC) was 1.9 g /l (MV 1.6 g/1), and liver steatosis was found in 37% of the cases (MV 2%). Increased BAC was associated with fatty liver, indicating chronic alcohol abuse. To reduce injuries among these types of victims, passive protection is of great importance. Disease: Autopsied drivers (n=126) in northern Sweden who had died from natural causes in traffic were studied. This fraction was 25% of all driver fatalities. Cardiovascular causes of death were found in 96% of the deceased. Neither the victims nor other occupants suffered severe traumatic injuries. A minority of the victims had experienced previous symtoms of disease. Further restriction of individuals with, for example, cardiovascular diseases would probably have no significant impact on traffic safety since at present the identification of high-risk individuals is difficult. Helmets: Head injuries in 948 injured bicyclists, including 105 fatalities, were analysed. Head/face injuries were found in 64% of the fatal and 38% of the nonfatal cases with a median age of 55 years and 18 years, respectively. Head trauma was mostly blunt with only a few severe face injuries. Of the nonfatal cases with head injuries, 48% might have had an injury reduction effect if a bicycle helmet had been used, compared with 67% of the fatalities with head injuries. A helmet with a hard shell, chin cover, accurate retention system, that reduces rotation and translation impact is recommended. To increase helmet use among bicyclists, a law is probably the most effective measure as has been shown for motorcyclists. However, head injuries were less frequent among snowmobile riders than among bicyclist and motorcyclist riders, and in most cases the snowmobile riders with head injuries but without helmet had broken other traffic laws, indicating that in this crash category there was a low compliance to compulsary laws. Airbags: In a field study of car crashes where an airbag deployed, the effectiveness of the bag, as well as injuries to the skin and eye from the deployment of the bag, is reported. In laboratory tests with airbag deployment on human volunteers, tethering was found to eliminate skin abrasion within a distance of 250-300 mm. At a distance of 225 mm, the folding technique had the optimal influence on abrasions followed by a marginal effect of tethering. However, injuries due to airbag deployment must be considered as negligible compared with the airbag's role in reduction of severe and fatal injuries.Diss. (sammanfattning) Umeå : Umeå universitet, 1993, härtill 7 uppsatser.
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Xu, Ying, und 徐穎. „Statistical analysis of the infectivity and fatality of an emerging epidemic“. Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B42182323.
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Gale, Matthew Valence. „De Chirico, the enigma of fatality : a contextualized interpretation, 1906-26“. Thesis, Courtauld Institute of Art (University of London), 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.286233.
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McDonald, Rebecca Louise. „Context, latency and the value of preventing a statistical cancer fatality“. Thesis, University of Newcastle upon Tyne, 2014. http://hdl.handle.net/10443/2391.
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This thesis contributes to the state of understanding about the value of latent health and fatality risk reductions, focussing on the effects of context and latency on the Value of Preventing a Statistical Cancer Fatality (VSLCAN) relative to road accident fatalities. The conceptual, methodological and empirical contributions are derived from two stated preference studies. The studies are designed to explore how the VSLCAN is driven by the context effect, which includes dread of the cause ‘cancer’ and the effects of illness prior to fatality; and the latency (delay) effect which depends upon time preferences and risk preferences. Study 1 develops a Risk-Risk survey protocol, and the resulting central tendency and regression analysis verify that the context of cancer increases the VSL and that latency decreases it. The relativity between VSLCAN and the road accident VSL is then summarised into a simple relationship where the offsetting influences of context and latency are parameterised. This novel tool has the potential to enhance the comparability and evaluation of a wide range of existing and future VSL studies involving context and latency effects through the elicitation of key underlying parameters such as the context premium and effective discount rate. As such it represents a significant methodological contribution. Study 2 focusses directly on two aspects of the latency effect. These relate to risk and time preferences, explored in Studies 2a and 2b respectively. Delayed outcomes are inherently risky, so the exploration of latent outcomes requires controlling for risk preferences. Study 2a develops a theoretical and empirical framework for eliciting risk aversion proxies in the domain of health, which have not previously been fully developed in the literature. The method extends the classic Holt-Laury risk preference elicitation framework into a new domain- health risks- and the method is implemented successfully in Study 2. This chapter therefore makes both conceptual and methodological contributions through clarifying the utility theoretic basis of a health risk aversion measure and then developing a way to elicit such a measure in surveys. Study 2b uses the novel VSLCAN:VSL relationship developed in Study 1 to elicit exponential discount rates from Risk-Risk data comparing latent cancer and road accident risks. Regression analysis performed on these rates on a sample and individual level, provides strong evidence to suggest that a non-standard (sub-additive) discounting model is the most descriptively accurate discounting assumption for this sample. It provides the first evidence regarding sub-additive discounting in the domain of health and fatality risk.
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Xu, Ying. „Statistical analysis of the infectivity and fatality of an emerging epidemic“. Click to view the E-thesis via HKUTO, 2009. http://sunzi.lib.hku.hk/hkuto/record/B42182323.
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Vicherat-Stoffel, Béatrice. „Le soin de soi : apprenance et agentivité en santé au mitan de la vie“. Thesis, Paris 10, 2017. http://www.theses.fr/2017PA100050/document.
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Notre système de santé subit des pressions constantes pour réduire et rationnaliser ses dépenses. Dans un tel contexte, modifier durablement les comportements individuels constitue un enjeu de taille. Plus que jamais, l’individu est invité à devenir acteur de sa santé en s’autorégulant tout au long de sa vie. Pour autant, c’est dans un monde complexe où les univers de référence s’effritent, qu’il doit désormais être en capacité d’agir. Ces dernières années, Internet a investi le champ de la santé, modifiant le rapport au savoir médical. Le médecin n’est plus perçu comme le seul détenteur de savoir et de pouvoir. Chacun souhaite dorénavant prendre une part active dans la gestion de sa santé, brouillant ainsi les lignes de partage entre savoir profane et savoir expert.Notre travail de recherche interroge la capacité des individus à exercer un contrôle sur leur santé. Notre objectif est de comprendre comment ce pouvoir d’agir sur soi se construit au fil du temps puis se déploie au gré des évènements biographiques. Notre démarche vise donc la compréhension du phénomène de l’autorégulation de la santé, dont il s’agit de rendre intelligible le fonctionnement. De ce fait, ce sont des entretiens biographiques qui ont été menés auprès de vingt-quatre individus au mitan de leur vie. Cette enquête a permis de mettre en lumière un modèle d’analyse et de compréhension des comportements de santé et surtout de poser des hypothèses de recherche que nous avons pu éprouver sur une population plus importante dans le cadre d’une deuxième enquête quantitative portant sur 451 individus. Grâce à cette double approche méthodologique nous sommes en mesure de constater que les comportements de santé peuvent s’analyser en considérant conjointement trois facteurs que sont le rapport de l’individu au savoir, son rapport au médecin et son rapport à la fatalitéOur healthcare system is under constant pressure to reduce spending. In such a context, more than ever, bringing about lasting change to individuals' behavior is a key issue. In this regard, all individuals are urged to become lifelong, self-regulated contributors to their own health maintenance. However, the context in which people are encouraged to take on this role is extremely complex. Internet has become part of the healthcare scene and changed the way people think about healthcare and gain access to medical knowledge. Doctors are no longer believed to be the only people who possess knowledge and power in the field. Everyone now wants to have an active hand in managing their own health, which blurs the boundaries between lay and expert knowledge. Our research explores people's ability to exercise control over their own health. Our objective is to understand how this self-determining power develops over time and is exercised in accordance with life events. Our approach thus aims to understand the self-regulation of health as an intelligible phenomenon. Biographical interviews were conducted with twenty-four middle-aged individuals. This survey not only provides a model of analysis and understanding of health-related behavior, but also puts forward hypotheses that were tested on a larger population as part of a second quantitative study involving 451 participants. Given this two-pronged methodological approach, we observe that people's healthcare-related behavior can indeed be analyzed in light of three joint factors, namely the individual's relationship to knowledge, doctors, and fatality
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Liu, Danping. „Semiparametric methods in generalized linear models for estimating population size and fatality rate“. Click to view the E-thesis via HKUTO, 2005. http://sunzi.lib.hku.hk/hkuto/record/B36164598.
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Pride, Rebecca K. M. „Simulation of automotive accidents resulting in fatality due to blunt traumatic aortic rupture“. Thesis, University of Nottingham, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.602384.
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The purpose of this project was to identify a set of boundary conditions for the initiation of blunt traumatic aortic rupture (BTAR) in terms of thoracic accelerations and forces, to use in a later hypothesised creation of a fully dynamic finite element cardiovascular model. A secondary aim of the project was to look into the potential mechanism of the BTAR injury. The injury was researched by investigating past vehicle collisions, as such an injury is commonly seen in these situations. Occupant medical records and police collision records were used in order to simulate the specifics of the collisions, in terms of the occupant, vehicle interior and collision characteristics, with computer modelling software. The software allowed both validation of the simulation, by correlation of simulated injury with observed injury, as well as direct reading of the required thoracic forces and accelerations. The forces were found to range between 1427 - 2140 N and found to be predominantly unidirectional; and the accelerations were found to range between 2080 - 3476 m S- 2, again being largely unidirectional. No singular mechanism of BTAR was identified, however each collision did rule out at least one hypothesis. This confirms the multivariate hypothesis put forward, but also limits it to a small number of combinations rather than the whole spectrum. -
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Liu, Danping, und 劉丹平. „Semiparametric methods in generalized linear models for estimating population size and fatality rate“. Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2005. http://hub.hku.hk/bib/B36164598.
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Yotsui, Saki. „Fatality Modeling of Tsunami Disaster Taking into Account Geographical Factors and Demographic Components“. Kyoto University, 2018. http://hdl.handle.net/2433/232442.
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Filipets, O. O. „Endocrine comorbidity and ischemic stroke: the impact on stroke severity and case fatality“. Thesis, БДМУ, 2021. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/18741.
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Almutairi, Omar Eid. „Characteristics of Injury and Fatality of Run-Off-Road Crashes on Ohio Roadways“. University of Dayton / OhioLINK, 2013. http://rave.ohiolink.edu/etdc/view?acc_num=dayton1375310572.
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Gupta, Kailash. „Seeking Information After the 2010 Haiti Earthquake: a Case Study in Mass-fatality Management“. Thesis, University of North Texas, 2013. https://digital.library.unt.edu/ark:/67531/metadc271823/.
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The 2010 earthquake in Haiti, which killed an estimated 316,000 people, offered many lessons in mass-fatality management (MFM). The dissertation defined MFM in seeking information and in recovery, preservation, identification, and disposition of human remains. Specifically, it examined how mass fatalities were managed in Haiti, how affected individuals sought information about fatalities, and what needs motivated them. Data from 28 in-depth, partially structured interviews, conducted during two field visits ending 21 weeks after the earthquake, were included in a case study. The data analysis revealed the MFM was severely inadequate. One interviewee, a senior UN official, stated, "There was no fatality management." The analysis also indicated a need to learn whereabouts of the deceased motivated individuals to visit spots the deceased were last seen at. It sought to illumine information-seeking practices, as discussed in the works of J. David Johnson and others, by developing a new model of information flow in MFM. In addition, it reaffirmed Donald Case and Thomas Wilson's theoretical proposition – that need guides any seeking of information – in the case of Haiti. Finally, it produced recommendations regarding future directions in MFM for emergency managers and information scientists, including possible use of unidentified body parts in organ transplants. Overall, the dissertation, which was supported by two grants of the National Science Foundation, attempted to add to relatively scanty literature in information seeking in MFM.
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Traut, Rachel Lynn. „A social demographic study of the likelihood of sustaining an occupational fatality resulting in death“. [College Station, Tex. : Texas A&M University, 2007. http://hdl.handle.net/1969.1/ETD-TAMU-1380.
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Zhao, Dong. „Exploring Construction Safety and Control Measures through Electrical Fatalities“. Diss., Virginia Tech, 2015. http://hdl.handle.net/10919/71712.
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Globally, construction is considered a hazardous industry with a disproportionate amount of fatal and non-fatal injuries as compared to other industries. Electrocution is named as one of the "fatal four" causes for construction injuries by the Occupational Safety and Health Administration (OSHA). In the United States, an average of 47.9% electrical fatalities occurred in the construction industry from 2003 to 2012, according to the U.S. Department of Labor. These fatalities include both electrical workers and non-electrical workers. Such a disproportionate rate suggests a need of research to improve construction safety and reduce injuries due to electrocution. However, there is a lack of understanding of causation mechanisms surrounding fatal accidents by electrocution using a systems approach; and there is a disconnection between the mechanism of fatal electrocution accidents and the associated control measures, which may lead to less effective prevention in construction.
This dissertation has three objectives, including: (a) establishing a sociotechnical system model that reflects the electrocution occurrence in the U.S. construction industry and identify the associations among its internal subsystems; (b) determining specific electrocution patterns and associated mechanism constraints; and (c) examining hierarchy of control (HOC) measures and determining their appropriateness.
Findings from his research include: (a) the identification of three system patterns of electrocution in construction work systems and the associations between personnel, technological, organizational/managerial subsystems, and the internal and external environment for each of the three patterns, using a macroergonomics framework; (b) the identification of five features of work, and map out their decision-making chains, critical decision-making points and constraints, as an interpretation of electrocution mechanisms in the workplace; and (c) revealing that behavioral controls remain prevalent in electrical hazard mitigation even though the knowledge of construction safety and health has increased in the past decades, and that the effectiveness of controls is not statistically different by construction type nor occupation.
Based on these findings, the research also suggests corresponding mitigation recommendations that construction managers shall strictly follow HOC rules by giving priority to higher level of controls and upgrading the industry's prevention strategy by introducing more technological innovations and encouraging prevention through design (PtD) strategies.Ph. D.
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Kern, Edward William. „Public Safety at Low-Head Dams: Fatality Database And Physical Model of Staggered Deflector Retrofit Alternative“. BYU ScholarsArchive, 2014. https://scholarsarchive.byu.edu/etd/3984.
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Low-head dams can cause dangerous currents near the downstream face of the structure. Fatalities at low-head dams are poorly documented. This thesis introduces a website with an interactive map and database of fatalities at low-head dams in the United States. The purpose of the web site is to generate interest among the general public to increase support to remediate dangerous structures and to serve as a tool for public education. The user interface allows the general public to browse fatal incidents by geographic location and to read incident circumstances. The site allows submission of public contributions including all metadata needed to characterize the incident. The database is structured to include documentation verifying each entry. The site can be viewed at http://krcproject.groups.et.byu.net. The danger is due to a uniform channel-wide countercurrent which causes upstream directed surface velocities. Previously, few inexpensive retrofit alternatives have been studied which prevent the uniform countercurrent. This thesis investigates two cost-effective retrofit options: (1) a channel wide horizontal flow deflector and (2) staggered flow deflectors. The channel wide flow deflectors cause uniform downstream directed surface velocities for a narrow range of tailwater elevations. The staggered flow deflectors prevent the uniform countercurrent for a wide range of tailwater elevations.
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Godfrey, Jodi Anne. „Risk-Taking Characteristics as Explanatory Variables in Variations of Fatality Rates in the Southeastern United States“. Scholar Commons, 2015. https://scholarcommons.usf.edu/etd/5483.
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Traffic fatalities accounted for 1.24 million lives lost in 2013 worldwide, and almost 33 thousand of those fatalities were in the U.S. in 2013. The southeastern region of the nation stands out for continuously having higher fatality rates per mile driven than the national average. If one can establish compelling relationships between various factors and fatality rates, then policies and investments can be targeted to increase the safety on the network by focusing on policies that mitigate those factors. In this research effort risk-taking characteristics are explored. These factors have not been as comprehensively reviewed as conventional factors such as vehicle and facility conditions associated with safety. The hypothesis assumes if a person exhibits risk-taking behavior, that risk-taking behavior is not limited to only one aspect of risk, but is likely to occur in multiple facets of the person's life. Some of the risk-taking characteristics explored include credit score, safety belt use, smoking and tobacco use, drug use, mental health, educational attainment, obesity, and overall general health characteristics. All risk-taking characteristics with the exception of mental health were found to have statistically significant correlations with fatality rates alone. However, when a regression model was formed to estimate fatality rates by risk-taking characteristics, only four risk-taking characteristics - credit score, educational attainment, overall poor health, and seat belt use were found to be statistically significant at an integrated level with other demographic characteristics such as unemployment levels and population born is state of residency. By identifying at-risk population segments, education, counseling, enforcement, or other strategies may be deployed to help improve travel safety.
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Roberts, Calpurnyia Bonyka Heiss Gerardo. „The association between socioeconomic position over the life-course and incident heart failure and its case fatality“. Chapel Hill, N.C. : University of North Carolina at Chapel Hill, 2008. http://dc.lib.unc.edu/u?/etd,2143.
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Thesis (Ph. D.)--University of North Carolina at Chapel Hill, 2008.Title from electronic title page (viewed Feb. 17, 2009). "... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of Epidemiology from the School of Public Health." Discipline: Epidemiology; Department/School: Public Health.
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Hermansson, Jonas. „Shift work and cardiovascular disease“. Licentiate thesis, Mittuniversitetet, Institutionen för hälsovetenskap, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:miun:diva-17466.
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Shift work is a work schedule being the opposite of normal daytime work, often defined as working time outside normal daytime hours (06:00 to 18:00). In recent years, shift work has been associated with an increased risk of numerous chronic conditions including for example cardiovascular disease, some types of cancer, type II diabetes, and the metabolic syndrome. While some studies on the association between shift work and chronic disease have found results supporting it, others have not. Therefore, more research is needed to clarify potential associations.The aim of this thesis was to further study the proposed association between shift work and cardiovascular disease. This was addressed by performing two studies, one analysing if shift workers had an increased risk of ischemic stroke compared to day workers. The other study analysed whether shift workers had an increased risk of short-term mortality (case fatality) after a myocardial infarction compared to day workers. The studies were performed using logistic regression analysis in two different case-control databasesThe findings from the first study indicated that shift workers did not have an increased risk of ischemic stroke. The findings from the second study showed that male shift workers had an increased risk of death within 28 days after a myocardial infarction; the results did not indicate an increased risk for female shift workers. The results from both studies were adjusted for both behavioural and medical risk factors without affecting the results. The findings from this thesis provide new evidence showing that male shift workers have an increased risk of death 28 days after a myocardial infarction, however more research is needed to clarify and characterise any such potential associations.
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Soares, Maria João de Sousa. „An avian relative fatality risk index for Iberian species on wind farms based on zero inflated count models“. Master's thesis, Universidade de Aveiro, 2014. http://hdl.handle.net/10773/13866.
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Mestrado em Biologia AplicadaClimate change is one of the greatest threats towards humankind and wildlife. This consciousness motivated the search for alternatives that could contribute to mitigate climate change. Betting on renewable energies seems to be a winning strategy adopted worldwide in order to reduce greenhouse gas emissions responsible for global climate alterations and to improve nations’ energy independency. However, nowadays, these energy usages still have negative impacts, mostly on wildlife. Wind energy is even considered the greatest unintended human impact on avifauna. In this context, the aim of this thesis was to increase the knowledge about wind farms impacts on avifauna, which variables influence birds’ fatalities by collision with wind turbines and birds’ vulnerability. Models based on excessive zero counts were tested to understand which variables influence birds’ fatalities assessed on 25 Portuguese wind farms. This allowed to estimate the probability of mortality observation per species. The information obtained was used to build the fatality risk index that also considered the vulnerability factors, which give information of species conservation concern and resilience. Those indexes allow to prioritise the existing and limited conservation efforts on more vulnerable species. Models and indexes are also important for improving knowledge about wind energy impacts on wildlife and what can lead to reduce them, in order to achieve a sustainable and greener future.
As alterações climáticas são uma das maiores ameaças para a Humanidade e para a vida selvagem. A consciência sobre a importância destas questões motivou a procura de alternativas, com intuito de mitigar estas alterações globais, causadas nomeadamente pelos gases de efeitos de estufa. Assim, as energias renováveis apresentam-se como uma possível estratégia vencedora a adotar, de forma a reduzir as emissões destes gases e levar à independência energética. No entanto, o uso destas energias renováveis ainda apresenta impactes negativos, especialmente para os ecossistemas. A energia eólica é inclusivamente considerada uma das maiores causas não intencionais de origem antropogénica para a mortalidade adicional de aves. Neste contexto, esta dissertação tem como os principais objetivos o desenvolvimento do conhecimento relativo aos impactes da energia eólica, quais as variáveis que influenciam a mortalidade de aves respeitante à colisão com as turbinas eólicas assim como as variáveis que afetam a vulnerabilidade das espécies. Foram testados modelos de contagem com excesso de zeros para compreender a influência das variáveis nas observações de mortalidade em 25 parques eólicos portugueses. A partir destes modelos foi possível estimar a probabilidade de observação de mortalidade para cada uma das espécies estudadas, provocada por colisão com eólicas. Esta informação foi ainda utilizada de forma a desenvolver um índice de risco de fatalidade com base nestas estimativas, assim como em fatores elucidativos da vulnerabilidade das espécies, nomeadamente o seu estatuto de conservação e resiliência. Desta forma é então possível direcionar esforços e recursos para a preservação das espécies com maior vulnerabilidade e prioridade de conservação. Este tipo de modelos e índices é ainda fundamental para incrementar o conhecimento sobre os impactes da energia eólica na vida selvagem e para compreender quais as medidas que podem ser tomadas para os reduzir e, assim, garantir um futuro mais verde e sustentável para todas as formas de vida.
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Hamdan, Huda. „Racial/Ethnic Differences in Fatality Rates from Motor Vehicle Crashes: An Analysis from a Behavioral and Cultural Perspective“. VCU Scholars Compass, 2013. http://scholarscompass.vcu.edu/etd/2984.
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Ethnic/racial minorities in the United States are overrepresented in fatalities from motor vehicle crashes (MVC). Growing evidence indicates that there are differences among racial/ethnic groups in risk of involvement in fatal crashes. Based on previous research, numerous factors may be involved in high racial/ethnic fatality rates from MVCs, including failure to use safety equipment, driving while under the influence of alcohol/drug, red light running, and speeding. Using data from the Office of the Chief Medical Examiner (OCME) and the FR300P Police Crash Report, this project explores differences in variables associated with traffic safety behavior and traffic law obedience between non-White and White road users (drivers, passengers, and pedestrians). Results indicate that there is a significant association between race/ethnicity and driving while under the influence of alcohol/drugs (DUI). Those endeavoring to develop more effective traffic safety prevention and education programs may consider the effect of social/cultural factors in future efforts.
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Vijay, Sianne Diana. „The Impact of Criminal Justice Interventions and Social Policies on Family Violence: Theory and Evidence“. Scholar Commons, 2016. http://scholarcommons.usf.edu/etd/6599.
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In 2014, the Child Protective Services received 3.6 million referrals alleging child abuse and neglect, of which, 702,000 children were victims of abuse and neglect and an estimated 1,580 children died due to maltreatment. In addition to this appalling toll, the welfare effects of child victimization are substantial. Evidence suggests that compared to demographically similar adults who were non-victims, adults with documented histories of maltreatment are more likely to engage in criminal behavior; have adverse mental and physical health problems such as depression, addiction and post-traumatic stress disorder; and have lower levels of education and earnings. These essays contribute toward the understanding of the consequences of two very distinctive policies – mandatory arrest and medical marijuana laws – and their impact on child maltreatment.
An important and controversial question in criminal justice policy concerns whether aggressive sanctions, such as mandatory arrest policies, serve as effective deterrents to familial violence. Chapter 1 provides a theoretical framework that models child abuse in which I allow for a strategic interaction between the child and his or her abuser. The comparative statics yield clear predictions of the impact of sanctions on child maltreatment – as the cost and probability of external interventions rise, the probability of violence falls. I follow this theoretical analysis with an empirical investigation of the impact of mandatory arrest policies on child victimization. I find a statistically significant and positive relationship between states that have implemented mandatory arrest laws and reported child maltreatment rates. This may seem surprising; however there are two explanations for the results. The likely explanation is that reporting of maltreatment increased in states mandating arrest; alternatively, recidivism may have increased in these states. Evidence from the OLS estimates for the reporting of abuse and child fatality rates (a proxy for the true incidence of child abuse), demonstrates that the increase in maltreatment is not due to recidivism but, in fact, more people reporting abuse to the police and Child Protective Services. The most important result that emerges from the data, however, is that while reported abuse increases in states with mandatory arrest laws, the true incidence of maltreatment actually falls. The ultimate goal of this paper is to stimulate further theoretical and empirical research that focuses on child abuse and prevention, thus enhancing an understanding of how sanctions influence child victimization.
The next chapter looks at one potential risk factor for child maltreatment –marijuana use and liberalization –using evidence from medical marijuana laws (MMLs). Chapter 2 begins by extending the current MML-crime literature by providing a comprehensive evaluation of the impact of MMLs implemented at the state level on reported child victimization rates. I show that specific modes of medical marijuana regulation differentially influence the magnitude of reported incidences of child abuse, a finding which sheds new light on the current literature. More specifically, using fixed effects analysis applied to data from the National Child Abuse and Neglect Database System (NCANDS) and the Uniform Crime Reports (UCR), I show that states that allow for home cultivation in addition to decriminalizing its use see a further increase in the magnitude of reported incidences of child maltreatment rates.
Since completing my dissertation, I have continued to investigate into issues that have implications for both theory and practice in my field. To that extent, I plan to analyze the slowly developing public sphere –a platform where culture and social change rely on both media and conversation.
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Collins, Courtney E. „Gender Differences in Choice of Procedure and Case Fatality Rate for Elderly Patients with Acute Cholecystitis: A Masters Thesis“. eScholarship@UMMS, 2015. http://escholarship.umassmed.edu/gsbs_diss/806.
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Background: Treatment decisions for elderly patients with gallbladder pathology are complex. Little is known about what factors go into treatment decisions in this population. We used Medicare data to examine gender-based differences in the use of cholecystectomy vs. cholecystostomy tube placement in elderly patients with acute cholecystitis.
Methods: We queried a 5% random sample of Medicare data (2009-2011) for patients >65 admitted for acute cholecystitis (by ICD-9 code) who subsequently underwent a cholecystectomy and/or cholecystostomy tube placement. Demographic information (age, race), clinical characteristics (Elixhauser index, presence of biliary pathology), and hospital outcomes (case fatality rate, length of stay, need for ICU care) were compared by gender. A multivariable model was used to examine predictors of cholecystectomy vs. cholecystostomy tube placement.
Results: Of 4063 patients admitted with cholecystitis undergoing the procedures of interest just over half (58%) were women. The majority of patients (93%) underwent cholecystectomy. Compared to women, men were younger (average age 76 vs. 78, p value < 0.01) and had few comorbidities (average Elixhauser 1.2 vs. 1.4 p value < 0.01). Case fatality rate was similar between men (2.5%) and women (2.4% p value 0.48). A higher percentage of men spent time in the ICU (36%) compared to women (31% p value < 0.01). On multivariable analysis men were 30% less likely to undergo cholecystectomy (OR 0.69, 95% CI 0.53-0.91).
Conclusion: Elderly men are less likely than elderly women to undergo cholecystectomy for acute cholecystitis despite being younger with less co morbidity and are more likely to spend time in the ICU. More research is needed to determine whether a difference in treatment is contributing to the higher rate of ICU utilization in elderly men with acute cholecystitis.
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Setpally, Rajarshi. „Estimation of driver fatality ratio using computational modeling and objective measures based on vehicle intrusion ratio in head-on collisions“. Thesis, Wichita State University, 2010. http://hdl.handle.net/10057/3743.
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In the last decade, the increase in usage of light trucks and vans (LTVs) has resulted in an
increase in fatal injuries to the occupants of passenger cars for truck-car accidents, because of the
aggressive nature of LTVs. To study the aggressive behavior of LTVs, National Traffic Highway
Safety Administration (NHTSA) has developed an aggressivity metric (AM) for different
vehicles in a specific impact configuration. These AM however does not produce consistent
estimates when specific vehicle-to-vehicle impact categories are studied. Hence, NHTSA has
introduced a Driver Fatality Ratio (DFR), based on the Fatality Analysis Reporting System
(FARS) and General Estimating System (GES) crash Involvement statistics, which has produced
good estimates of the aggressive behavior of vehicles in crashes.
The DFR proposed by NHTSA is based on the statistical data, which makes it difficult to
evaluate DFR for other vehicle categories (e.g., crossovers, etc.), which are relatively new in the
market as they do not have sufficient crash statistics. This research work proposes a new
methodology based on computational reconstruction of impact crashes and objective measures to
predict the DFR for any vehicle. The objective measures considered include the ratios of
maximum intrusion, peak acceleration, and weight for the two vehicles in head-on collisions.
Factors which directly influence fatal injuries to the occupants are identified and studied to
develop a relation between these objective measures to the DFR. The proposed method is then
validated for a range of LTVs against a passenger car, and is then used to predict the DFR for a
cross category vehicle, a light pick-up truck, and a full-size car. Factors which influence these
objective measures in predicting the DFR are discussed. Results from this study indicate that the
ratio of intrusions produces a better estimate of the DFR and can be utilized in predicting fatality
ratios for head-on collisions.Thesis (M.S.)--Wichita State University, College of Engineering, Dept. of Mechanical Engineering.
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Chamberlain, Samuel Seamore. „Development of a physics of failure model and quantitative assessment of the fire fatality risk of compressed natural gas bus cylinders“. College Park, Md. : University of Maryland, 2004. http://hdl.handle.net/1903/1711.
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Thesis (Ph. D.) -- University of Maryland, College Park, 2004.Thesis research directed by: Reliability Engineering. Title from t.p. of PDF. Includes bibliographical references. Published by UMI Dissertation Services, Ann Arbor, Mich. Also available in paper.
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Asaria, Perviz. „An analysis of the variation in event rates, case fatality and mortality of Acute Coronary Syndrome across English districts, 2006-2010“. Thesis, Imperial College London, 2016. http://hdl.handle.net/10044/1/60165.
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Ischaemic heart disease (IHD) is a leading cause of hospitalisation, mortality and healthcare spending in the industrialised world. Wide temporal, spatial and social class variations show that high IHD mortality is not inevitable. The temporal decline in IHD in the UK and other industrialised countries since the 1960’s and 1970’s has been decomposed into that caused by reductions in population risk which affect event rate versus that caused by changes in case fatality which can potentially be ameliorated by the health system. The persistent Northern excess in IHD mortality in England has not been studied in the same way. This is because there is no national database of IHD events and thus no systematic way to assess sub-national variation. I focused on the acute, life-threatening component of IHD – acute coronary syndrome (ACS). I constructed a national data set of ACS events using routine hospitalisation and mortality data and estimated ACS event rates, mortality and case fatality for each of the 354 English Local Authority Districts using a Bayesian spatial model to smooth away unwarranted variability. I decomposed spatial variation in ACS mortality into its constituent components of event rates and case fatality. 60-80% of the between district variation in mortality is due to variation in event rates depending on age and sex, and an additional 15-30% is due to variation in case fatality. Further, the proportion of events resulting in an out-of-hospital ACS death has more impact on differences in case fatality than do deaths following hospitalisation. These findings have important implications for directing health policies aimed at reducing ACS burden and addressing regional inequalities in health in England.
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Naji, Jamil Abdul-Rabb. „Road accident analysis in Yemen : the identification of shortcomings in road accident data, data adjustment, cost and development of road fatality model“. Thesis, University of South Wales, 1996. https://pure.southwales.ac.uk/en/studentthesis/road-accident-analysis-in-yemen(8586c669-4709-4b2c-9d83-45003bc5d0bf).html.
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The true extent of the road accident problem in Yemen is questionable. Some agencies and citizens believe that the safety situation in Yemen is very critical while others disagree with this belief. Both sides however, agree that the road accident problem in Yemen is such that it requires considerable attention. Since Yemen has no history in road safety research and since there is no reliable road accident data in the country, making final judgements on the situation is difficult unless supported by adequate research. The aim of the present research is to provide a better understanding of the road accident problem in the Yemen. This can be made by investigation of the real dimensions of the road accident problem. This includes the identification of the shortcomings in road accident data, the cost of road accidents and modelling road accident fatalities.
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Powell, Anne Terese. „A Retrospective Study of the Opioid Epidemic and Fentanyl Related Overdose Fatality Cases in a Florida West Coast Medical Examiner District Population“. Scholar Commons, 2019. https://scholarcommons.usf.edu/etd/7892.
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Opioids are scheduled by the propensity for misuse and abuse with a high rate of dependency and risk of fatal overdose. Opioids can be divided into different classes, including, natural, synthetic, and semi-synthetic. Opiates are naturally occurring and come directly from the opium poppy plant; whereas the semi synthetics opioids are chemical modifications of the poppy plant. Synthetic opioids attach to the opioid receptor but contain no part of the poppy plant. The increased variety and frequency in opioid prescriptions contributed to an opioid epidemic in the United States which is still on going.
According to the CDC, the opioid epidemic has occurred in three waves. The first wave of the epidemic began in the 1990’s with the increase in opioid prescription pain medication overdoses. The second wave began around 2010 when heroin overdoses became more prevalent. This was followed by a sharp uptick in fentanyl deaths beginning around the year 2013, indicating the start of the third wave. The opioid epidemic has had a huge cost to society, not just due to deaths but also because of lost productivity, medical expenses and judicial system costs (Florence, Zhou, Luo, & Xu, 2016). To best design and implement strategies to combat this issue, an understanding of the population effected is needed. Since many public health policies are implemented at the regional level, knowing the characteristics and demographics of the epidemic at the local level is important. This study evaluates trends in drug related death cases in the Florida District 6 Medical Examiner Office (MEO) from the calendar years 2011 through 2016.
Specifically, it focuses on opioids and the role of fentanyl in overdose related mortality. Additional attention is given to fentanyl and fentanyl analog related deaths. Fentanyl analogs present challenges from an analytical toxicology perspective. Fentanyl analogs can be difficult to detect. Two sets of data from each calendar year were obtained from the MEO. This data was collated, standardized and then statistically analyzed.
It was determined that there was not a significant difference in month of the year or the day of the week that drug related fatalities occurred. The time of day was statistically significant with more drug related mortalities occurring during the hours of 8:00am and 4:00pm. When assessing mortality rates, Pinellas and Pasco county demonstrated differences. Pasco county has higher overall mortality for opioid related deaths. Pinellas county has almost twice the number of the opioid, fentanyl, related overdose fatalities. Racial demographics, divided into White, Black, and Asian populations, demonstrated that the White population is disproportionally affected by fentanyl drug related mortality. Binary logistic regression showed that fentanyl and heroin tend to co-occur, and that ethanol, hydrocodone, methadone, morphine, and oxycodone do not usually co-occur with fentanyl in drug related fatalities.
These data help elucidate trends in the opioid epidemic at a regional level. There are differences between Pinellas and Pasco county; with the former having more fentanyl related drug deaths and the latter having more opioid related drug deaths over the six years analyzed. An interesting result is derived from the binary logistic regression. It is shown here that fentanyl and heroin tend to co-occur together. It is also shown that ethanol, hydrocodone, morphine, oxycodone, and methadone do not co-occur with fentanyl related overdose cases. Notably, methadone has the strongest negative association with fentanyl related overdoses.
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Lolliot, Rachel. „Mécanismes de la fatalité et construction d'un élan vital dans les nouvelles de Theodor Storm et de Guy de Maupassant“. Thesis, Reims, 2015. http://www.theses.fr/2015REIML004/document.
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La nouvelle étant un récit bref, elle est à même de représenter le tragique de l'existence : elle attrape sur le vif tous les événements de la vie et les présente dans une économie restreinte. Theodor Storm et Guy de Maupassant ne manquent pas à cette règle et proposent des récits marqués par l'empire de la fatalité. Celle-ci est la manifestation du destin et/ ou du hasard qui transparaissent à travers la description de paysages réalistes et à travers la mise en avant d'objets clé qui entraînent avec eux la décrépitude des personnages. La technique narrative est également au service de la mise en scène de ce déterminisme, ainsi, l'un et l'autre auteur se permettent d'enchâsser les histoires, de revenir en arrière dans la narration pour mieux faire peser le poids du destin et/ ou du hasard afin de souligner que chacun fonctionne comme un mécanisme à ressort se déroulant tragiquement. Pourtant, même si tout laisse supposer le contraire, ces nouvelles ne sont pas qu'imprégnées de pessimisme. En effet, de cette fatalité empreinte de destin et/ ou de hasard se dégage un élan vital caractéristique de la pensée philosophique et sociale du XIXe siècle. Le destin et/ ou le hasard est en fait l'expression aveugle d'une volonté qui détermine le choix des personnages. Aussi ces nouvelles mettent-elles l'accent sur l'illusion du libre arbitre des personnages qui pensent pouvoir se déterminer eux-mêmes. De là, l'élan créatif issu de l'écriture permet une suspension de ce déterminisme. Ainsi, ce sont ces mécanismes de la fatalité qui sont démontés dans ce travail afin de repérer cet élan vital, salvateur et libérateur propre à la conception philosophique et littéraire du XIXe siècleA short story is a brief narrative and therefore can represent the tragic of existence : it catches on the spot all the events of life and presents them in a restricted economy. Theodor Storm and Guy de Maupassant obey the rule and offer narratives marked by fatality, which is the demonstration of fate and/ or chance shown through the description of realistic landscapes and through the emphasis of key objects which pull with them the decline of the characters. The narrative technique also serves the fabrication of this determinism. So, both authors allow themselves to intersperse stories, to go back into the narration, so that the weigh of fate and/ or chance is heavier and works as a spring mechanism taking place tragically. Nevertheless, even if everything suggests the opposite, these short stories are not so pessimistic. Indeed, a life force typical of the philosophical and social thinking of the 19th century arises from this fatality marked with fate and/ or chance. Fate and/ or chance is in fact the blind expression of a will which determines the choice of characters. So these short stories emphasize the illusion of characters' free will who think they can decide of their life. From there, the creative impulse stemming from the writing allows a interruption of this determinism. So, it is those mechanisms of fate that are defused in this work to observe this saving and liberatoring life force, inherent to the philosophic and literary concept of the XIXth century
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Eriksson, Marie. „Aspects on stroke outcome : survival, functional status, depression and sex differences in Riks-Stroke, the National Quality Register for Stroke Care“. Doctoral thesis, Umeå universitet, Folkhälsa och klinisk medicin, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-1649.
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Stroke is a major cause of death and disability worldwide. In Sweden, about 30 000 strokes occur each year. The aim of this thesis was to analyse survival, functional outcome and self-reported depression after stroke, and to explore possible differences between men and women in stroke care and outcome. These studies were based on Riks-Stroke, the Swedish national quality register for stroke care. Information on background variables and treatment were collected during the hospital stay. The patient’s situation and outcome after stroke were followed-up after 3 months. Long term survival was retrieved from the Swedish Population Register (Folkbokföringen). Possible sex-differences in stroke care and outcome 3 months after stroke were explored in 24 633 strokes, registered during 2006. In conscious patients, the proportions treated at stroke units were similar for men and women. Men and women had equal chance to receive thrombolytic therapy or secondary prevention with oral anticoagulants. Compared to men, women were less likely to develop pneumonia, but more likely to experience deep venous thromboses and fractures during hospital stay. Women had worse 3-month survival and functional outcome, differences that were explained by their higher age and impaired level of consciousness on admission. Women felt more depressed and perceived their health as worse than men did. Women were also less satisfied with the care they had received in the hospital. The agreement between self-reported functional outcome 3 months after stroke and the commonly used modified Rankin Scale (mRS) was explored in 555 stroke survivors from 4 hospitals during May-September 2005. Riks-Stroke’s self-reported questions classified 76% of the patients into correct mRS grade. The association between functional outcome 3 months after stroke and 3-year survival was assessed in 15 959 men and women who had had a stroke during 2001-2002. Patients with estimated mRS grades 3, 4 and 5 had hazard ratios for death of 1.7, 2.5 and 3.8, respectively, as compared with patients with lower grades, 0-2. Depressed mood, male sex, high age, diabetes, smoking, antihypertensive therapy at onset and atrial fibrillation were also identified as predictors of poor survival. Self-reported depression 3 months after stroke and use of antidepressants were analysed in 15 747 stroke survivors from 2002. Fourteen percent felt depressed 3 months after stroke. Female sex, age <65, previous stroke, living alone or in institution, or being dependent in activities of daily living (ADL) were factors associated with self-reported depression. At the follow-up, 22% of the men and 28% of the women were using antidepressant medication, which were approximately twice as many as in the general population. Still, 8% of all patients in Riks-Stroke reported depressive mood but no treatment with antidepressants. In conclusion, men and women with stroke in Sweden experience similar treatment and outcome in most aspects. Patient-reported functional outcome can be reliably transformed to a standard disability scale. Impaired functional outcome three months after stroke is an independent predictor of poor long-term survival. Depressive mood is common after stroke and is associated with poor survival and impaired functional outcome.
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Russo, Mauricio Bastos. „ViolÃncia no TrÃnsito "Ã Moda Brasileira": InseguranÃa, Letalidade e Impunidade“. Universidade Federal do CearÃ, 2012. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=8619.
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CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel SuperiorNa Ãltima dÃcada a frota brasileira de veÃculos quase dobrou de tamanho. Ao mesmo tempo, a cada ano, aumenta o nÃmero de vÃtimas decorrentes de acidentes de trÃnsito no Brasil. O objetivo desta tese à compreender como as condiÃÃes socioeconÃmicas e culturais contribuem com a violÃncia no trÃnsito. Embora este seja um problema comum a todos os paÃses na modernidade, em alguns casos, como no Brasil, o maior problema nÃo à o nÃmero total de acidentes, mas o percentual letal destes. Ao contrÃrio dos paÃses desenvolvidos, no Brasil, a maior parte dos automÃveis de passeio, tipo de veÃculo que mais se envolve em acidente de trÃnsito com vÃtimas, nÃo dispÃem de equipamentos de seguranÃa bÃsicos, como airbags e freios ABS, essÃncias para evitar que o acidente se torne fatal. Soma-se a isto a incapacidade do Estado em regular adequadamente o ambiente social do trÃnsito. A falta de puniÃÃo dos infratores, desde infraÃÃes leves, como o estacionamento em local proibido, a casos mais graves como o homicÃdio no trÃnsito, incentiva as prÃticas ilegais. Problemas no aprendizado dos condutores e na obtenÃÃo da Carteira Nacional de HabilitaÃÃo (CHN) permitem que milhares de motoristas nÃo qualificados circulem nas ruas e estradas brasileiras. Nosso crescimento econÃmico nÃo foi acompanhado por um processo que transformasse os condutores em indivÃduos capazes de respeitar a alteridade dos demais participantes do sistema de trÃnsito. O trÃnsito ainda à para alguns um espaÃo privilegiado, que deveria respeitar a hierarquia social existente, que entra em conflito com aqueles que consideram este um espaÃo democrÃtico
The Brazilian car fleet almost doubled its size in the last decade. At the same time, the number of victims from car accidents rises every year. This thesis aims at understanding how economic and cultural conditions contribute to violence caused by cars. In spite of the fact that this is a common issue in every country nowadays, in some cases, such as it happens in Brazil, the problem is not the total number of car accidents but their lethal percentage. In Brazil, contrary to what is seen in developed countries, most automobiles, a kind of vehicle most frequently involved in accidents with victims, do not offer basic safety equipment, such as airbags and anti-lock braking system (ABS) which are major deterrent of fatalities. One should add to this the stateâs inability to regulate properly the social environment created for vehicles. Exemption from punishment for violators, ranging from light infractions, such as parking at unauthorized places, to more serious ones, such as homicides fired by car accidents foments illegal practices. Problems involving training of new drivers and issuing of a driverâs license release thousands of unauthorized drivers to take Brazilian streets and roads. The countryâs economic development did not create an equal process of transformation that allowed drivers to changing into individuals capable of respecting alterity involving other users of the transit system. Transit is still a privileged space for some who do not respect the existing social hierarchy and who defy those who consider driving a car an exercise of democracy.
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Bendall, William Bryson. „Retrospective Analysis of Injuries Sustained In Vehicle Front‐ and Back‐Overs in a Level I Pediatric Trauma Center“. Thesis, The University of Arizona, 2017. http://hdl.handle.net/10150/623628.
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A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.Motor vehicle accidents involving pedestrians are some of the most common and lethal forms of injury for children in the United States. Among younger children, a common mechanism of action for severe trauma is when a vehicle runs over the child in a forward or backward motion at low speed resulting in a blunt crush injury. This typically occurs in non‐traffic settings including driveways, sidewalks, and roadways. Such incidents have been referred to in many different ways in the literature but for the purposes of this paper will be referred to as low speed vehicle run‐overs. This is a retrospective chart review carried out at Phoenix Children’s Hospital in affiliation with the University of Arizona College of Medicine‐Phoenix that categorizes and examines the injuries sustained by patients involved in low speed vehicle runovers occurring between December 2007 and August 2013. Fifty‐five pediatric patients were included with a median age of 24 months and 6 of these patients were fatally injured. Internal injuries were common overall and significantly more common in children ≤24months. Over half of the cohort sustained fractures, with a 24% incidence of skull fractures. All fatalities were the result of traumatic brain injury. Twenty percent of victims required operative intervention. It was concluded that the severity of these types of incidents varies from minimal to life threatening and best care requires close and thorough evaluation by the trauma and emergency department teams.
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Nielsen, Detlef. „Safety and working conditions in international merchant shipping : a study of fatal occupational accidents and a survey of world-wide fatality statistics of merchant seafarers“. Thesis, Cardiff University, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.250492.
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Price, Lesley. „An exploration of the relationship between socio-economic factors and occupational major injury and fatality rates in the administrative districts of Great Britain 1999-2001“. Thesis, Glasgow Caledonian University, 2006. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.688251.
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Löfmark, Ulrika. „Stroke with a focus in the elderly : from a gender and socioeconomic perspective“. Doctoral thesis, Umeå universitet, Folkhälsa och klinisk medicin, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-1099.
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Stroke is one of the leading causes of death and disability in Sweden and in the Western world. Despite this, stroke with focus on elderly is a field where few studies have been conducted from a gender and socioeconomic perspective. The objectives in this thesis were to analyse from a gender, age and socioeconomic perspective how women were affected by stroke compared with men. The focus was on what it meant for elderly women and men to live with stroke and to explore various gender constructions among men and women. The study also included aspects such as incidence, medical treatment and case fatality after stroke. Both quantitative and qualitative methods were used. During a two-year period (15 October 2000–14 October 2002), uniform information was collected for all cases of first-ever and recurrent (>28 days) stroke occurring in people of all ages living the region of Umeå, admitted to the University Hospital. Five different registers were used to achieve maximum coverage; the Riks-Stroke (RS) register, the Hospital Discharge Register (HDR), the Cause of Death Register, the northern Sweden WHO MONICA study, and one case-finding study in nursing homes and homes for elderly performed for this thesis. For the qualitative study a maximum variation sampling procedure was used to retrieve participants for in-depth interviews in a follow-up study. Nine women and seven men were interviewed about their experiences of treatment and care after suffering a stroke, as well as about their perceptions and experiences of help from others (health care personnel, relatives and home help personnel). The first-ever incidence of stroke was higher among low-educated than high educated men and women. Our study showed that there was an education-related age-dependent difference in stroke incidence, where elderly women had the highest incidence of stroke. The 28-day case fatality was shown to be associated with low educational level in patients above 75 years, after controlling for sex, risk factors and acute care variables. The elderly stroke patients experienced subordination in their contacts with health care personnel and the medical context. The participants used different ways to negotiate in the subordinate position, and some of these negotiations were interpreted as being gendered. We have also shown how the elderly stroke patients minimized their own needs of help, strove for independence and accepted help. The men and the women differed in their perceptions and experiences of help from others. Also, the participants expressed multiple types of needs. The elderly stroke patients’ perceptions and experiences of help from others must be studied in relation to their life circumstances and expectations from society. Further analyses of the patients’ perceptions and experiences of help from others were interpreted as being different examples of constructions of masculinities and femininities. Stroke with a focus on the elderly is a field where few studies have been conducted from a gender and socioeconomic perspective. With further community-based stroke incidence studies including elderly men and women and with the development of appropriately targeted interventions, the burden of stroke in the population could be reduced. More research is needed where both qualitative and quantitative methods are used, as this can provide a richer and perhaps more authentic description of the issue under investigation.
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Nilsson, Philip, und Sebastian Nilsson. „Application of Poisson Regression on Traffic Safety“. Thesis, KTH, Matematisk statistik, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-168201.
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This study presents a model that explains the traffic fatality by exploring the Poisson regression model using two types of explanatory variables – referred to as internal and external factors. Internal factors contain variables closely linked to traffic safety, such as speed limits and belt usage (Strandroth et al., 2012), whereas external factors comprise a set of variables that the Swedish Transport Administration cannot control, such as the economy and demographic change (Wiklund et al., 2012). The purpose of the study is to evaluate the impact that internal and external factors have on the traffic fatality. This is done by modeling the traffic fatality using internal factors and then assessing the contribution of adding external factors in the regression model with a forward variable selection strategy. This study uses Swedish traffic fatality data as monthly statistics. The main characteristics of the data are that fatalities have generally decreased with time. Also, the data is characterized by a long term cyclical pattern as well as a yearly cyclical pattern. For the purpose of modeling the impact of internal factors, a model inspired by Brüde (1995) has been adopted, using the variable time as the only explanatory variable. It is concluded that internal factors can be used to significantly explain the general trend of the development of traffic fatalities. The variables chosen to represent external factors were economic development, traffic exposure, demographic development and seasonal trend. The study concludes that the variables economic development, traffic exposure and demographic development significantly contribute to explain the long term cyclical trends, indicating that traffic fatality is a complex multivariate system where no single variable can solely explain its dynamics. The external factor seasonal trend has the most impact of the examined external factors and explains the yearly cyclical pattern by itself. The model presented in this study shows high explanatory power and overall good fit to fatality data, making it a promising tool for statistical analysis of factors contributing to fatality. Especially for the Swedish Transport Administration, the impact of external factors can be evaluated statistically. This study leaves room for further research to assess the impact of additional external factors as well as evaluating the model’s predictive power, both of interest to the Swedish Transport Administration.Denna studie presenterar en modell som förklarar dödsfall i trafiken genom tillämpning av Poissonregression där två typer av förklaringsvariabler använts – interna och externa faktorer. Interna faktorer innefattar variabler som är direkt knutna till trafiksäkerhet, såsom hastighetsbegränsningar och användande av säkerhetsbälte (Strandroth et al., 2012). Externa faktorer är variabler som Trafikverket inte kan kontrollera, såsom landets ekonomi och demografiska förändringar (Wiklund et al., 2012). Syftet med denna studie är att evaluera påverkan av interna och externa faktorer på dödsfall i vägtrafik. Detta görs genom att analysera hur väl interna faktorer förklarar dödsfall i vägtrafik och sedan undersöka förbättringen av att införa externa faktorer som förklaringsvariabler genom användande av en forward variable selection-strategi. Denna studie använder månatlig data över dödsfall i svensk trafik. Dessa data karaktäriseras av en nedgående trend. Dynamiken av dödsfall visar på ett långt cykliskt mönster samt ett kortare, årligt mönster. I syfte att modellera påverkan av interna faktorer har en modell inspirerad av Brüde (1995) tillämpats. Denna modell använder enbart variabeln tid som förklaringsvariabel. Studien konstaterar att interna faktorer kan användas för att signifikant beskriva en generell trend för utvecklingen av dödsfall i vägtrafik. Variablerna som har valts att representera externa faktorer är ekonomisk utveckling, trafikarbete, demografi samt en säsongstrend. Studien konstaterar att variablerna ekonomisk utveckling, trafikarbete och demografi beskriver det långa cykliska mönstret, vilket tyder på att dödsfall i vägtrafik är av komplex natur och kan inte beskrivas av en ensam variabel. Den externa faktorn säsongstrend förbättrar modellen mest av de externa faktorerna och kan ensam förklara det kortsiktiga cykliska mönstret. Den modell som presenteras i denna studie har hög förklaringsgrad och en överlag bra modellanpassning, vilket gör den till ett lovande verktyg för statistisk analys av faktorer bidragande till dödsfall i trafiken. Modellen är av särskilt intresse för Trafikverket då den tillåter statistisk utvärdering av externa faktorers påverkan. Denna studie lämnar utrymme för framtida forskning att utvärdera påverkan av ytterligare externa faktorer samt att evaluera modellens förmåga att prognostisera framtida antal dödsfall i vägtrafik, vilka båda är intresseområden för Trafikverket.
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RUSSO, Maurício Bastos. „Violência no trânsito "À Moda Brasileira": insegurança, letalidade e impunidade“. www.teses.ufc.br, 2012. http://www.repositorio.ufc.br/handle/riufc/6304.
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RUSSO, Maurício Bastos. Violência no trânsito "À Moda Brasileira": Insegurança, Letalidade e Impunidade. 2012. 226f. – Tese (Doutorado) – Universidade Federal do Ceará, Programa de Pós-graduação em Sociologia, Fortaleza (CE), 2012.Submitted by Márcia Araújo (marcia_m_bezerra@yahoo.com.br) on 2013-10-22T11:57:43Z No. of bitstreams: 1 2012-TESE-MBRUSSO.pdf: 4517841 bytes, checksum: afdf394b86e051afb2174f40fb5696ed (MD5)
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The Brazilian car fleet almost doubled its size in the last decade. At the same time, the number of victims from car accidents rises every year. This thesis aims at understanding how economic and cultural conditions contribute to violence caused by cars. In spite of the fact that this is a common issue in every country nowadays, in some cases, such as it happens in Brazil, the problem is not the total number of car accidents but their lethal percentage. In Brazil, contrary to what is seen in developed countries, most automobiles, a kind of vehicle most frequently involved in accidents with victims, do not offer basic safety equipment, such as airbags and anti-lock braking system (ABS) which are major deterrent of fatalities. One should add to this the state’s inability to regulate properly the social environment created for vehicles. Exemption from punishment for violators, ranging from light infractions, such as parking at unauthorized places, to more serious ones, such as homicides fired by car accidents foments illegal practices. Problems involving training of new drivers and issuing of a driver’s license release thousands of unauthorized drivers to take Brazilian streets and roads. The country’s economic development did not create an equal process of transformation that allowed drivers to changing into individuals capable of respecting alterity involving other users of the transit system. Transit is still a privileged space for some who do not respect the existing social hierarchy and who defy those who consider driving a car an exercise of democracy.
Na última década a frota brasileira de veículos quase dobrou de tamanho. Ao mesmo tempo, a cada ano, aumenta o número de vítimas decorrentes de acidentes de trânsito no Brasil. O objetivo desta tese é compreender como as condições socioeconômicas e culturais contribuem com a violência no trânsito. Embora este seja um problema comum a todos os países na modernidade, em alguns casos, como no Brasil, o maior problema não é o número total de acidentes, mas o percentual letal destes. Ao contrário dos países desenvolvidos, no Brasil, a maior parte dos automóveis de passeio, tipo de veículo que mais se envolve em acidente de trânsito com vítimas, não dispõem de equipamentos de segurança básicos, como airbags e freios ABS, essências para evitar que o acidente se torne fatal. Soma-se a isto a incapacidade do Estado em regular adequadamente o ambiente social do trânsito. A falta de punição dos infratores, desde infrações leves, como o estacionamento em local proibido, a casos mais graves como o homicídio no trânsito, incentiva as práticas ilegais. Problemas no aprendizado dos condutores e na obtenção da Carteira Nacional de Habilitação (CHN) permitem que milhares de motoristas não qualificados circulem nas ruas e estradas brasileiras. Nosso crescimento econômico não foi acompanhado por um processo que transformasse os condutores em indivíduos capazes de respeitar a alteridade dos demais participantes do sistema de trânsito. O trânsito ainda é para alguns um espaço privilegiado, que deveria respeitar a hierarquia social existente, que entra em conflito com aqueles que consideram este um espaço democrático
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Koneru, Lakshmi Venkata Sai Praneeth Chowdary. „Prediction of accident severity and driver fatality ratios in side impact accidents for different target and bullet cars based on the FMVSS 214 and US-NCAP test conditions“. Thesis, Wichita State University, 2013. http://hdl.handle.net/10057/10635.
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There have been many studies on side impact accidents, crashworthiness of car structures and occupant protection and safety. These studies have focused on either development of better car interiors, belts, airbag safety and seating system for passengers or on more energy absorbing car structures and stronger materials to withstand the accident. The National Highway Traffic Safety Administration (NHTSA) has developed metric method to quality and study the aggressive behavior of Light trucks and Vans (LTV's). One of the methods include driver fatality ratio (DFR) and Accident Safety (AS) by considering statistical data which was obtained from the accidents. The present research work proposes a computational method utilizing nonlinear finite element (FE) modeling of side impact crashes based on Federal Motor Vehicle Safety Standard (FMVSS) 214 and the United States New Car Assessment Program (USNCAP) conditions of several bullet and target vehicles. A computational finite element crash simulation methodology is initialized in this study include twelve cases, in which there are three target cars struck from side by four different bullet cars. The target cars include the Dodge Neon, Geo Metro and Toyota Yaris; and the bullet cars include the Dodge Caravan, Ford Econoline, Ford Explorer and Chevy S-10. The intrusions of the bullet and target cars are captured at specific locations. A scheme is then utilized to estimate the DFR based on the ratio of the bullet and target car intrusions, as well as the ratio of the accelerations at the driver seats corresponding to the two cars. The estimated DFR has been compared to the statistical DFR based on the accident data, and shown to provide reasonable correlation. The target vehicles in this study have been changed from the older models to a new model in order to observe any influence on the predicted DFR. The methodology presented here can be used in the design stage of new cars in order to improve the occupant protection and survivability of the passengers in the designed vehicles.Thesis (M.S.)--Wichita State University, College of Engineering, Dept. of Mechanical Engineering
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Groomes, Joshua Benjamin. „The Impact of the United States Army Nurses Corps on the United States Army Fatality Rate in the Mediterranean and European Theater of Operations during World War II“. Digital Commons @ East Tennessee State University, 2021. https://dc.etsu.edu/etd/3980.
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World War II was the most devastating war in human history in terms of loss of life. The Japanese attack on Pearl Harbor on December 7, 1941, plunged the United States into war. Less than seven thousand military nurses were on active duty at the time of the attack. By the end of the war, there were over fifty-thousand active-duty nurses. The army nurses performed under fire in field and evacuation hospitals, on hospital trains and ships, and as flight nurses on medical evacuation transport aircraft. The skill and dedication of the Army Nurses Corps insured a 95% survival rate for the wounded soldiers who received medical care in a field or evacuation hospital. Two hundred and one nurses lost their lives during World War II and sixty-seven nurses were captured and held as prisoners of war. Sixteen hundred medals, citations and commendations attest to the nurses’ courage and dedication.
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Kužniece, Ingrida. „Epidermiology and Treatment of Tuberculosis in Liepaja (Latvia) 1993-2002“. Thesis, Nordic School of Public Health NHV, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:norden:org:diva-3244.
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Aim To describe the epidemiology of tuberculosis in the city of Liepaja during the last 27 years and the management of patients with tuberculosis during the period 1993-2002; to identify problems in tuberculosis management relevant to increasing level of morbidity and the registered high levels of drug-resistance. Material and methods The cases were all persons reported with tuberculosis in 1975-2002. The data sources were the yearly Health Statistics books at the Latvian Office of Medical Statistics. The study used data from the available 655 individual patient records from Liepaja Tuberculosis Dispensery and TB Register of 1993 – 2002. Information was extracted selectively and extraction sheets containing the variables of interest were developed. The incidence differences according to sex and age, possible clustering of patients in high-risk living areas of the city, differences in occupation of the patients were studied. The differences of time from disease symptoms to diagnosis, as well as investigation data, treatment regimens, the proportions of treatment outcomes were analysed. Analysis was done using EPI-INFO programme for statistical analysis. Results In the 1980s tuberculosis was under control in Latvia and the incidence was at the European average level. After Latvia had regained independence in 1991, with economical and political disruption and changes in the health care system, TB incidence and mortality in the country increased rapidly as well as in Liepaja. Although not very high compared to global TB rates, there was great concern about TB control in Latvia. In addition, the emergence of drug resistance and multi-drug resistant bacteria made the TB epidemic more serious. The TB incidence increase in children suggested that there was quite a big number of undetected cases of TB. Tuberculosis control and early detection activities were not integrated into the PHC system. Treatment results of TB were quite poor and showed high proportions of interruptions, defaults, relapses. The tuberculosis control Programme in Latvia and Liepaja put much effort into the improvement of the epidemiological situation with TB, focusing on TB control activities and management during the period 1993-2002. The incidence of tuberculosis in Liepaja was higher than in Latvia, particularly in some living areas in the city, and above endemic level. Mortality rate in average was higher as in the whole country. The proportion of socially sensitive groups (children, unemployed, pensioners, disabled) comprised more than 50 % of the tuberculosis incidence. Incidence among medical staff was higher than in general population in the all professional groups. Medical delay of diagnosis decreased, but early detection of tuberculosis was not fully integrated in PHC system. There were quite big differences in numbers of MDR-TB in years 1993-2002. DOTS was introduced in Liepaja five years later than in Latvia –in year 2000 and strategy was not fully successful. The number of positive treatment outcomes increased, but the registered numbers of treatment relapses and defaults were higher than in Latvia . Conclusions The situation with regard to tuberculosis development and tuberculosis management in Liepaja during the period under study was unfavourable. Particularly : the incidence and mortality rates, much variation in the diagnostic process, results of treatment ,a high proportion of MDR-TB , unsatisfactory links between local government, family doctors and medical professionals and multi-sectoral collaboration in TB control activities , the objectives set up by WHO for DOTS treatment were not reachedISBN 91-7997-139-3
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Ngomane, L. N. (Lindokuhle Matrue). „The impact of indoor residual spraying (IRS) on malaria prevalence between 2001 and 2009 in Mpumalanga province, South Africa“. Diss., University of Pretoria, 2012. http://hdl.handle.net/2263/24853.
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Background Malaria remains a serious epidemic threat in the Lowveld region of Mpumalanga Province. In order to appropriately target interventions to achieve substantial reductions in malaria morbidity and mortality, there is a need to assess the impact of current control interventions such as indoor residual spraying (IRS) for vector control. This study aimed to assess long-term changes in the burden of malaria in Mpumalanga Province during the past eight years (2001-2009) and whether IRS and climate variability had an effect on these changes. Methods All malaria cases and deaths notified to the Malaria Control Programme, Department of Health was reviewed for the period 2001 to 2009. Data were retrieved from the provincial Integrated Malaria Information System (IMIS) database. Climate and population data were obtained from the South Africa Weather Service and Statistics South Africa, respectively. Descriptive statistics were computed to determine any temporal changes in malaria morbidity and mortality. Autoregressive integrated moving average (ARIMA) models were developed to assess the effect of climatic factors on malaria. Results Within the eight-year period of the study, a total of 35,191 cases and 164 deaths-attributed to malaria were notified in Mpumalanga Province. There was a significant decrease in the incidence of malaria in Mpumalanga Province from 385 in 2001/02 to 50 cases per 100,000 population in 2008/09 (P < 0.005). The overall incidence and case fatality rates were 134 cases per 100,000 and 0.54%, respectively. Malaria incidence and case fatality rate by gender showed significant differences, higher in males than in L.M. Ngomane University of Pretoria, 2012 iv females (166.9 versus 106.4; P < 0.001; CFR 0.41% versus 0.55%). The incidence of malaria increased from age 5-14 years (70), reaching a peak at age 25-34 years (190), declining thereafter (50 in those >65 years). Mortality due to malaria was higher in those >65 years, the mean CFR reaching a 2.1% peak. Almost half (47.8%) of the notified cases originated from Mozambique and Mpumalanga Province itself constituted 50.1%. The distribution of malaria varied across the districts, highest in Ehlanzeni district (96.5%), lowest in Nkangala (<1%) and Gert Sibande (<1%). A notable decline in malaria case notification was observed following the increased IRS coverage from 2006/07 to 2008/09 malaria seasons. A distinct seasonal transmission pattern was found to be significantly related to changes in rainfall patterns (P = 0.007). Conclusion Decades of continuous IRS with insecticides have proved to be successful in reducing the burden of malaria morbidity and mortality in Mpumalanga Province between 2001 and 2009. A decline of above 50% in malaria morbidity and mortality was observed following expanded IRS coverage. These results highlight the need to continue with IRS together with other control strategies until interruption in local malaria transmission is completely achieved and alternative vector control strategies implemented. Efforts need to be directed towards the control of imported cases, interruption of local transmission and focus on research into sustainable and cost-effective combination of control interventions.Dissertation (MSc)--University of Pretoria, 2012.
School of Health Systems and Public Health (SHSPH)
Unrestricted
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Samaké, Famahan. „Le naturalisme Zolien dans Les Rougon-Macquart : une fatalité de la sexualité“. Thesis, University of South Wales, 2003. https://pure.southwales.ac.uk/en/studentthesis/le-naturalisme-zolien-dans-les-rougonmacquart-une-fatalite-de-la-sexualite(3704063f-5f92-47b4-87a5-59598651a50c).html.
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My proposed PhD, titled Zola's Naturalism in The Rougon-Macquart: The Fatality of Sexuality, aims to study the basics of the naturalistic novel in the second half of the nineteenth-century France. Firstly, I have looked back at previous critical studies that were dedicated to the themes of sexuality and/or fatality in Zola's writing. This introductory chapter helped me understand how far critics have gone and what a long way we still have to go before we can fully appreciate the importance of these themes in the context of naturalism. Throughout the twenty novels that make The Rougon-Macquart series, I studied the fictional characters in their being, their appearance and their evolution in space and time. I therefore investigated whether or not these characters were masters or slaves of their space and time and beyond that, what influences they had on each other. Afterwards, I questioned the fecundity of the theme of sexuality in Zola's work to find out both the aspects of originality in his writing and his contribution to the modern novel. Nevertheless, I have criticized Zola on a wider angle as an emeritus writer with his own "weaknesses". Methodologically, I have largely used the semiotics approach along with psychoanalysis due to the specificity of sexuality. Despite the wide range of critical studies on Zola's novels, in my sense, most of them have so far failed to tackle naturalism at its foundations, i.e. sexuality. In fact, if one attempted to free The Rougon-Macquart from the theme of sexuality, neither the Rougon-Macquart family would exist nor the twenty novels they generated. Studying sexuality therefore appeared to be essential to the understanding of the naturalistic theory. However, and surprisingly so, most of Zola's critics have avoided that inescapable theme, perhaps more likely for reasons of decency rather than for scientific ones. It is in such context that I have decided that it was time to bring it to light for the sake of truth about the knowledge of Zola.
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Masuda, Eliana Tiemi. „Doença meningocócica: indicadores de gravidade e sua importância para vigilância e assistência médico-hospitalar“. Universidade de São Paulo, 2009. http://www.teses.usp.br/teses/disponiveis/6/6132/tde-21092009-110647/.
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Objetivos: Descrever o comportamento da Doença Meningocócica (DM) focalizando aspectos clínicos e seus desfechos, analisar o possível impacto da descentralização da assistência hospitalar, investigando também fatores associados à sua gravidade no município de São Paulo (SP), de 1986 a 2004. Metodologia: Trata-se de um estudo de corte transversal com componente descritivo e analítico, abrangendo o período de 1986 a 2004. A população de estudo abrange pacientes de DM, residentes no município de SP, notificados à vigilância. Os dados foram obtidos junto à vigilância passiva da DM e ao Instituto Adolfo Lutz de São Paulo. A descrição da doença foi efetuada segundo aspectos relativos ao tempo, espaço e pessoa. Para a investigação dos fatores associados à gravidade da DM tomou-se como variável dependente o óbito por DM e como variável independente, as exposições de interesse. Elas foram investigadas por meio das estimativas das odds ratio não ajustadas e ajustadas pela regressão logística não condicional, com os respectivos intervalos de confiança de 95 por cento. Resultados: Foram confirmados 10.087 casos de DM no município de São Paulo, durante o período de interesse. No pico epidêmico de 1995, a taxa de incidência média da DM foi de 8,1 casos/100.000 habitantes (hab), a mortalidade de 1,8 casos/hab/ano e letalidade média de 22 por cento. Crianças menores de quatro anos foram as mais atingidas, constituindo 54 por cento dos casos, principalmente entre os menores de um ano, com taxa de incidência média de 60,1/100000 casos/hab. Em 1986, o Hospital Especializado atendia 83 por cento dos casos e os Assistenciais apenas 12 por cento. No final do período estudado (2004), com a descentralização do serviço, o Hospital Especializado passou a atendeu 22 por cento dos casos e 71 por cento dos casos os Assistenciais. O Hospital Especializado manteve a letalidade anual dos casos de DM constante durante todo período, em torno de 11 por cento. A letalidade 15 dos Hospitais Assistenciais foi diminuindo gradativamente ao longo do período, inicialmente com 60 por cento e terminando com 16 por cento. Conclusão: A identificação de fatores associados à gravidade da DM e a repercussão da assistência hospital podem contribuir na melhoria das condutas clínicas, e subsidiar políticas públicas e intervenções de saúde públicaObjectives: To describe the behavior of meningococcal disease (MD) focusing on clinical features and outcomes, analyze the potential impacts of decentralization of hospital care, also investigating factors associated with the severity of MD in São Paulo (SP) city, from 1986 to 2004. Methods: This is a cross-sectional study with descriptive and analytical component covering the period 1986 to 2004. The population of the study was inhabitants in SP city, registered in the surveillance system. The data were obtained from the surveillance system of the DM MD and the Adolfo Lutz Institute of São Paulo. The descriptive analysis was presented by aspects of the time, space and person. The investigation of factors associated with the severity of the MD, it was considered as dependent variable death, and as independent variable, the exposure of interest. They were investigated by unadjusted and adjusted odds ratios by unconditional logistic regression, with their confidence intervals of 95 per cent. Results: There were 10,087 confirmed cases of MD in SP city, from 1986 to 2004. In epidemic peak (1995), the average rate of incidence of MD was 8.1 cases/100000 inhabitants (inhabit), the mortality rate was 1.8 cases/inhab/year and average case fatality rate (CFR) was of 22 per cent. Children under four years were the highest risk, representing 54 per cent of cases, especially among children under one year with average incidence rate of 60.1/100000 cases/inhab. In 1986, the specialized hospital cared 83 per cent of cases and non-specialized hospital only 12 per cent. At the end of the period studied (2004), with the decentralization of service, the specialized hospital has attended 22 per cent and 71 per cent of cases by the non-specialized. The referential hospital represented an annual CFR of MD constant in over time, around 11 per cent. The CFR of non-specialized hospital has been decreasing gradually 17 over the period, initially with 60 per cent and ending with 16 per cent. Conclusion: The identification of factors associated with the severity of DM and the impact of decentralization of the hospitals care can help in improving the clinical procedures, and support public policies and public health interventions
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Benyera, Oscar. „Outcomes in malnourished children at a tertiary hospital in Swaziland : post implementation of the WHO treatment guidelines“. Diss., University of Pretoria, 2013. http://hdl.handle.net/2263/33347.
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Background. Swaziland adopted the World Health Organization’s (WHO) guidelines for the inpatient treatment of severely malnourished children in 2007 to reduce case -fatality rates for childhood malnutrition. However, no follow-up studies have been conducted to determine the reduction in the case -fatality rate post-implementation of the guidelines.
Objectives. To determine the case -fatality rate for childhood malnutrition post-implementation of the WHO treatment guidelines and determine the level of adherence to the guidelines at Mbabane Government Hospital.
Methods. A retrospective observational study was undertaken. All children under 5 years admitted for inpatient treatment of malnutrition between January 2010 and December 2011 had their demographic-, anthropometric- and clinical characteristics recorded and analysed, as well as the outcome of admission.
Results. Of the 227 children admitted during the study period, 179 (64.6%) were severely malnourished and 98 (35.4%) had moderate malnutrition. One-hundred-and-eleven children died during admission, an overall case -fatality rate of 40.1%. Mortality was significantly higher among severely malnourished children compared to those with moderate malnutrition, (46.9% vs 27.6%, OR 3.0 (95% CI 1.7 to 5.3)). Comorbid pneumonia and gastroenteritis were significant predictors of mortality – , OR 2.0 (95% CI 1.2 to 3.4) and 1.9 (95% CI 1.1 to 3.2) respectively.
Conclusion. Case -fatality rates for childhood malnutrition remain high, despite adoption of the WHO treatment guidelines. A need exists for improved adherence to the WHO guidelines and periodic clinical audits to reduce deaths from childhood malnutrition to meet the WHO mortality target of less than 5% and improve child survival.Dissertation (MSc)--University of Pretoria, 2013.
gm2014
Clinical Epidemiology
unrestricted
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Buckingham, Judith Isabel. „Patterns of violence in intimate relationships: a critical examination of legal responses“. University of Canterbury. Law, 2006. http://hdl.handle.net/10092/849.
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In this thesis, red flags for dangerousness/lethality established from domestic violence and homicide research provided the social framework for an examination of legal responses to violence in intimate heterosexual relationships. The research investigated these gendered, structural patterns of violence and the effectiveness of criminal justice interventions in keeping victims safe. Agency interactions with offenders and victims prior to women's deaths were reviewed in selected cases. Criminal law constructions of violence in intimate relationships were evaluated for their recognition and understanding of primary risk factors for dangerousness/lethality. The research found major red flags remain invisible in criminal law stereotypes of violence between intimates. The significance of these risk factors for dangerousness/lethality is therefore overlooked, misunderstood and even misrepresented in defence of violent offenders. Although the aim of the Domestic Violence Act 1995 is to ensure effective protection for victims, the study found a significant number of women (and sometimes other family members and children) experience further sub-lethal and lethal violence following legal interventions with perpetrators. Lacking a principled policy foundation, central focus on victim safety and clear framework for interventions, legal responses are internally incoherent and inconsistent with New Zealand Family Violence Prevention Strategy. The New Zealand government has committed to principled domestic violence intervention and consistency in law and policy. This will require: a) legislative reform; b) public and professional education on the dynamics of violent relationships, including the interrelationship between sublethal and lethal assaults; and c) monitoring of criminal justice interventions to improve accountability. Until this is accomplished, stories of abused women and their children, including informal attempts to seek help and contact with state and community agencies will continue to be dishonoured by a legal system which silences their voices and fails to learn lessons from their injuries and deaths.
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Paulikas, Marius J. „POTENTIAL TORNADO VULNERABILITY VARIANCE OVER A 24-HOUR CYCLE FOR AN URBAN METROPOLITAN REGION“. Kent State University / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=kent1427463367.
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Tay, Yi Yang. „New technologies and applications in energy-absorbing cellular materials, airbag pre-deployment, injury prediction to out-of position occupants, and estimation of driver fatality ratio, for enhancing passive safety of road vehicles in side-impact accidents“. Thesis, Wichita State University, 2014. http://hdl.handle.net/10057/10985.
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The automotive industry is repeatedly tasked with improving vehicles structural strength, optimizing active and passive safety features, reducing occupant injury potential, and hitting lean manufacturing goals. The challenge is to find solutions to reduce production and research costs, and to maximize the vehicle's capability in protecting its occupants in the event of an accident. The influence of impact loading on the dynamic responses of vehicle structures and occupants require special consideration in the field of vehicle crashworthiness. The main goal of this study is to address the fundamental aspect on the impact injury biomechanics of vehicle occupants and safety performance of vehicle structures, and the development of various new technologies aimed at enhancing the passive safety of road vehicles in side-impact accidents. Four case studies related to the dissipation of crash energy, impact injury biomechanics, injury prediction model and pre-crash sensing algorithm form the basis of this thesis. The application examples include the investigation of pre-deploying airbags as a potential solution in reducing occupants' injuries at higher speed side-impact crashes; examination of the vehicle structural responses with the inclusion of high-energy absorbing cellular materials within the door panels in side-impact accidents; development of injury prediction model to out-of-position occupants from frontal- and side- airbags using Design-of-Experiment methodologies; and the estimation of the relative driver fatality risks of two colliding vehicles using some quantitative measurements. A detailed methodology is developed for each application, and the results present several new technologies that can be implemented to enhance the safety performance of road vehicles. These goals are achieved through the use of finite element approaches, multi-body dynamic analyses and Design-of-Experiment statistical methods.Thesis (M.S.)--Wichita State University, College of Engineering, Dept. of Mechanical Engineering
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Stavrou, Eftyhia P. „Vision, functional and cognitive determinants of motor vehicle incidents in older drivers“. Thesis, Queensland University of Technology, 2006. https://eprints.qut.edu.au/28503/1/Efty_Stavrou_Thesis.pdf.
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Background: The proportion of older individuals in the driving population is predicted to increase in the next 50 years. This has important implications for driving safety as abilities which are important for safe driving, such as vision (which accounts for the majority of the sensory input required for driving), processing ability and cognition have been shown to decline with age. The current methods employed for screening older drivers upon re-licensure are also vision based. This study, which investigated social, behavioural and professional aspects involved with older drivers, aimed to determine:
(i) if the current visual standards in place for testing upon re-licensure are effective in reducing the older driver fatality rate in Australia;
(ii) if the recommended visual standards are actually implemented as part of the testing procedures by Australian optometrists; and
(iii) if there are other non-standardised tests which may be better at predicting the on-road incident-risk (including near misses and minor incidents) in older drivers than those tests recommended in the standards.
Methods: For the first phase of the study, state-based age- and gender-stratified numbers of older driver fatalities for 2000-2003 were obtained from the Australian Transportation Safety Bureau database. Poisson regression analyses of fatality rates were considered by renewal frequency and jurisdiction (as separate models), adjusting for possible confounding variables of age, gender and year.
For the second phase, all practising optometrists in Australia were surveyed on the vision tests they conduct in consultations relating to driving and their knowledge of vision requirements for older drivers.
Finally, for the third phase of the study to investigate determinants of on-road incident risk, a stratified random sample of 600 Brisbane residents aged 60 years and were selected and invited to participate using an introductory letter explaining the project requirements. In order to capture the number and type of road incidents which occurred for each participant over 12 months (including near misses and minor incidents), an important component of the prospective research study was the development and validation of a driving diary. The diary was a tool in which incidents that occurred could be logged at that time (or very close in time to which they occurred) and thus, in comparison with relying on participant memory over time, recall bias of incident occurrence was minimised. Association between all visual tests, cognition and scores obtained for non-standard functional tests with retrospective and prospective incident occurrence was investigated.
Results: In the first phase,rivers aged 60-69 years had a 33% lower fatality risk (Rate Ratio [RR] = 0.75, 95% CI 0.32-1.77) in states with vision testing upon re-licensure compared with states with no vision testing upon re-licensure, however, because the CIs are wide, crossing 1.00, this result should be regarded with caution. However, overall fatality rates and fatality rates for those aged 70 years and older (RR=1.17, CI 0.64-2.13) did not differ between states with and without license renewal procedures, indicating no apparent benefit in vision testing legislation.
For the second phase of the study, nearly all optometrists measured visual acuity (VA) as part of a vision assessment for re-licensing, however, 20% of optometrists did not perform any visual field (VF) testing and only 20% routinely performed automated VF on older drivers, despite the standards for licensing advocating automated VF as part of the vision standard. This demonstrates the need for more effective communication between the policy makers and those responsible for carrying out the standards. It may also indicate that the overall higher driver fatality rate in jurisdictions with vision testing requirements is resultant as the tests recommended by the standards are only partially being conducted by optometrists. Hence a standardised protocol for the screening of older drivers for re-licensure across the nation must be established.
The opinions of Australian optometrists with regard to the responsibility of reporting older drivers who fail to meet the licensing standards highlighted the conflict between maintaining patient confidentiality or upholding public safety. Mandatory reporting requirements of those drivers who fail to reach the standards necessary for driving would minimise potential conflict between the patient and their practitioner, and help maintain patient trust and goodwill.
The final phase of the PhD program investigated the efficacy of vision, functional and cognitive tests to discriminate between at-risk and safe older drivers. Nearly 80% of the participants experienced an incident of some form over the prospective 12 months, with the total incident rate being 4.65/10 000 km. Sixty-three percent reported having a near miss and 28% had a minor incident.
The results from the prospective diary study indicate that the current vision screening tests (VA and VF) used for re-licensure do not accurately predict older drivers who are at increased odds of having an on-road incident. However, the variation in visual measurements of the cohort was narrow, also affecting the results seen with the visual functon questionnaires. Hence a larger cohort with greater variability should be considered for a future study. A slightly lower cognitive level (as measured with the Mini-Mental State Examination [MMSE]) did show an association with incident involvement as did slower reaction time (RT), however the Useful-Field-of-View (UFOV) provided the most compelling results of the study. Cut-off values of UFOV processing (>23.3ms), divided attention (>113ms), selective attention (>258ms) and overall score (moderate/ high/ very high risk) were effective in determining older drivers at increased odds of having any on-road incident and the occurrence of minor incidents.
Discussion:
The results have shown that for the 60-69 year age-group, there is a potential benefit in testing vision upon licence renewal. However, overall fatality rates and fatality rates for those aged 70 years and older indicated no benefit in vision testing legislation and suggests a need for inclusion of screening tests which better predict on-road incidents.
Although VA is routinely performed by Australian optometrists on older drivers renewing their licence, VF is not. Therefore there is a need for a protocol to be developed and administered which would result in standardised methods conducted throughout the nation for the screening of older drivers upon re-licensure. Communication between the community, policy makers and those conducting the protocol should be maximised. By implementing a standardised screening protocol which incorporates a level of mandatory reporting by the practitioner, the ethical dilemma of breaching patient confidentiality would also be resolved.
The tests which should be included in this screening protocol, however, cannot solely be ones which have been implemented in the past. In this investigation, RT, MMSE and UFOV were shown to be better determinants of on-road incidents in older drivers than VA and VF, however, as previously mentioned, there was a lack of variability in visual status within the cohort. Nevertheless, it is the recommendation from this investigation, that subject to appropriate sensitivity and specificity being demonstrated in the future using a cohort with wider variation in vision, functional performance and cognition, these tests of cognition and information processing should be added to the current protocol for the screening of older drivers which may be conducted at licensing centres across the nation.