Dissertations / Theses on the topic 'Appropriateness of the change'

It is well accepted by now that most change initiatives are unsuccessful even though more organisations are experiencing change as they fight to retain and improve their competitiveness in the market place. It is against this background of change failure that researchers have looked for new strategies to improve change outcomes. Theoretical models conceptualising the dynamic change process advise on better change strategies, but little empirical evidence has demonstrated that these models are effective in improving change implementation outcomes. Theoretical models were also developed to counter change resistance, but little emphasis has been placed on employee change readiness. Some empirical research on employee change readiness explores employees? perception of organisational readiness, but no empirical research has explored employee readiness from a psychological perspective. That is, how to create change readiness in employees. This thesis has contributed to both the theoretical and empirical understanding of the change readiness model. Firstly, the theoretical readiness for change model Armenakis et al.?s (1993, 2002) was extended by the inclusion of the ?understanding of the change? driver. Secondly, this change readiness model was empirically tested on two distinct organisational changes: organisational restructure and IT change. The extended model is also examined for two change stages of the dynamic process to identify which readiness drivers should be prioritised by change agents. Two online questionnaires were administered eight months apart assessing the responses to three change stages (planning, implementation and post-implementation) of employees ? supervisors and subordinates - of a flat structured organisation in the human resource industry. At the two measurement points 189 and 141 employees returned completed surveys. Six employee readiness drivers were operationalised and regressed against behavioural change intention. The quantitative findings using regression models across two change types and longitudinally did not identify a specific change pattern. However, all six readiness drivers including the ?understanding of the change? driver were influential on employees? behavioural change intention. Furthermore, statistical differences between supervisors and subordinates were identified in the organisational restructure change. The quantitative findings using a triangulation approach with qualitative date including data from two unstructured interviews and employee comments further validated the quantitative findings. The thematic analysis of the employee comments enhanced the findings and identified employee specific concerns including information dissemination of the changes and a level of uncertainty. The findings supported Armenakis et al.?s (1993, 2002) theoretical contribution that change readiness drivers are an important part of the organisational change process explaining why employee do and do not change. The empirical application of readiness change driver evaluation during the dynamic change is supported as it permits change agents to directly monitor employees? readiness perception of a specific change target. This valuable information finds practical utilisation for change agents in providing targeted guidance and support for employees thus facilitating a greater likelihood of a positive change outcome. Implications of these findings and future research opportunities are discussed.

Household air pollution contributes to the premature death of more than 4 million people annually. Improved cookstoves are one technological intervention that can potentially reduce exposure to household air pollution. However, improved cookstove implementation programs need to consider measures to increase sustainability and promote long-term adoption. The objectives of this research were 1) to develop and implement a new ferrocement cookstove for Peña Blanca, a rural indigenous community in the Ngäbe-Bugle region of Panama, 2) to evaluate its potential sustainability in comparison to the most common cooking technologies observed in the community, 3) to prepare a construction manual for the stove to promote future development, and 4) to provide guidelines for applying a holistic approach to improved cookstove projects. A bottom-up, community-driven approach to development focused on integration and capacity building was used to design and implement a ferrocement improved cookstove. A survey was administered to 26 households to understand the familial and environmental health of the community as well as knowledge, opinions, and needs related to cooking practices and improved stoves. Finally, the ferrocement stove developed for this study, along with the three stone fire, the ecojusta stove model, and a gas stove were evaluated both quantitatively and qualitatively using a sustainability assessment framework developed specifically for improved cookstoves. The results of this study suggest that design and implementation of an improved cookstove in the field that incorporates community feedback and provides educational opportunities may produce solutions that are more likely to be sustainable and meet users’ needs. The process allows for design flexibility to reduce smoke and fuel use while incorporating community preferences such as simplicity and ease of use, ability to control heat, stove features and size. Results from conducting household surveys emphasize the importance of a community-based development process that focuses on meeting community-specific challenges and needs. Conditions such as extreme poverty and lack of support structures pose significant challenges and shape community opinions regarding cooking technology and practices. In fact, the community’s desires in this study differ greatly from that found in the established literature. Specifically, 84% of rural Panamanians from this study felt that reducing smoke indoors was important to them. Sustainability evaluations of improved cookstove implementation programs in Panama highlighted common strengths in the needs assessment and implementation project life stages. These programs excelled at involving the community in identifying project needs and participating in the construction of stoves. On the other hand, the post-implementation and follow-up life stages were assessed to be weaker as these programs generally do not perform evaluation and monitoring of stove use and adoption after the implementation stage or continue user education. Additional qualitative analysis from this study suggest that the traditional stove may be the most sustainable and appropriate stove technology at this time for the community if combined with improving education related to family health, the environment, and stove use that results in behavior change. This approach may have the potential to fulfill the goals of improved cookstove programs globally through education and behavior change as an alternative approach to implementing an inappropriate technology. Moreover, an improved stove that is developed in the community that uses local materials and provides educational opportunities that focus on caring for resources and improving stove operator skill is more likely to be sustainable than other options. General guidelines and lessons learned for applying a holistic approach to improved cookstove development in the field include enhancing community understanding through involvement of local leaders, empowering the community in the decision-making process, providing educational opportunities or facilitating the implementation of a technology that is affordable, effective, and that meets users’ diverse needs, or both. As well as evaluating sustainability likelihood by utilizing comprehensive tools such as surveys, stove testing, program assessment frameworks, life cycle assessments, and incorporating results from post-project monitoring and evaluation iteratively until needs are met and exposure to household air pollution and deforestation rates are reduced. The implications of this work are that 1) technology implementation may not be the best solution, similar investments made in education and behavior change may result in equal or greater sustainability early on, 2) the design and implementation of an improved cookstove in the field with high standards for technical design, that reduce emissions, and with flexibility for elements that do not affect performance can result in meeting users’ needs better with higher adoption rates, and 3) a more holistic approach to development using available tools is suspected to result in improved cookstove programs that improve human and environmental health while meeting users’ needs for the long-term.

When the term ‘design object’ is used to refer to artifacts, we presuppose that they can serve mundane functions and provide aesthetic pleasure. In many cases, the visual form of a design object is a result of achieving aesthetic function and practical function. What is the relation between these two functions? In the design process, designers also strike a balance between aesthetic pursuit, utilitarian purpose and other factors, such as environmental protection. What is the balance of these aims (aesthetic aim and the non-aesthetic aims)? My research on this topic suggests that it may be useful to conceive it in terms of appropriateness. The aim of this dissertation is to investigate the relation between aesthetic and non-aesthetic functions in design objects. Another, larger and more fundamental, purpose of this dissertation is to analyze the notion of appropriateness in design through the conceptions of aesthetic value and moral value. The findings of this research contribute to my argument that appropriateness as a property found in design objects is a balance of aesthetic value, functional value and moral value. This unique quality found in design object can be found in many successful universal designs, and it is also part of the reason why this style can prevail for decades. This research also brings two academic disciplines (the studies of design and aesthetics) together. It is something new and timely from which both disciplines could benefit. In addition, the discussion of Wucius Wong’s art, which is part of the analysis of the different functions of design objects, is an original finding which contributes a detailed understanding of Wong’s art and its relation with design concepts. The appropriateness of design is a decision after all things have been considered in the deliberation. It is not necessarily the best and it can be ever changing according to different situations. The investigation of this topic is not aimed at finding an ideal approach to achieve the appropriateness in design, but through the investigation of the relation between aesthetic function and non-aesthetic functions, and the relation of aesthetic value, functional value and moral value of design objects to contribute architects and designers in making an appropriate decision during the design process.

Previous literature on the Europeanization of candidate countries has lacked careful empirical investigations into how the process drives domestic policies to change in line with the EU acquis. Selecting on the least-likely case of Turkey and its refugee and asylum policy, I identify that previous work has assumed that Turkey’s policy shifts have been driven by rationalist cost- benefit calculations of its government. The purpose of this study has been to empirically investigate and trace the mechanisms of Europeanization in the selected case, in order to thereby contribute to knowledge on the process of Europeanization in candidate countries in general, and address to the previous research gap. Given this purpose, I have aimed to produce answers to the research question: how has the EU affected Turkey’s asylum and refugee policy after the declaration of candidacy status? I hypothesize that a rationalist model driven by the EU’s conditionality can indeed explain domestic policy changes in Turkey, but also that an alternative mechanism of socialization has been at play. Tracing the process of Europeanization through secondary sources, the results show that what started with behavioral-adaptation of domestic policy change in alignment with the EU’s laws, norms and demands between 1999 and 2010, between 2011 and 2018 the Turkish asylum and refugee policies started to step away from the push power of the external incentives. Nonetheless, significant domestic policy changes continued, suggesting evidence against the rationalist conditionality model of Europeanization in this period. However, I argue that the results are not strong enough to make the claim Turkey’s domestic policy change was driven by a mechanism of socialization, but rather suggest there has been initiation of a switch between the mechanisms.

It may come as no surprise that Twitter is the most popular social media platform where student athletes, particularly men, post inappropriate content. Male student athletes’ inappropriate tweets have become such a problem for universities, athletic departments, and the NCAA that coaches are forced to place a ban on their players’ social media usage or hire third party monitoring systems. Unfortunately, these reactive responses have not alleviated the problem of athletes differentiating what content is appropriate or inappropriate to tweet on their Twitter accounts. Analysis of the data collected from scholarly journal articles, textbooks, and popular press articles revealed that social media education would be the most effective prevention method to lessen student athletes’ inappropriate tweets. This project uses Dr. Mark Robinson’s approach to Personal Player Development in constructing its two resources—multimedia workshops and an interactive Canvas site. The purpose of this project is for student athletes to be more aware of their social media content by knowing how to post appropriate tweet messages on their personal Twitter accounts in order to enable athletes, especially men, to comprehend why certain tweet messages are classified as inappropriate and, therefore, should never be made public. This project is significant because it proposes a preventative method based on increased social media awareness, as opposed to typical reactionary measures.

Major clients of the construction industry have been found to organise construction work into fewer, but larger, contracts with more transfer of risk and responsibilities in response to a change from a sellers market to a buyers market, and facing a greater choice of procurement methods than ever before. Main contractors and consultants alike are moving towards multidisciplinary teams offering design and management services, challenging single service consultants or contractors and are in competition with each other over who is leading the process. A consolidation of firms at the upper end of the industry can be witnessed in order to access a wider market and new clients, and at the lower end a specialisation into specific skills or locations takes place, while medium sized firms are increasingly struggling to survive. A general procurement model serves to identify the appropriate procurement approach for construction needs, as neither clients or construction service suppliers represent a homogenous market. Clients demands for a ready purchase of design, procurement and management of construction from a single source have been found to be met most appropriately by contractor-led procurement under most, but not all, circumstances, particularly in respect of higher levels of efficiency, cost certainty and punctuality among other benefits. The consequences faced by a contractor in the leading role of the procurement process are significant, especially in terms of integrating and co-ordinating the entire supply chain to the satisfaction of the client and for anticipated repeat business. This is the chief factor of competitive strength for the struggle of long term survival. A classification model of procurement strategies in respect to parameters of supply risk, strategic importance and frequency of spend offers a tool for the appropriate choice of business relationship with different suppliers. It is to be anticipated that the future will see an intensification of the changes in the processes of construction procurement described and analysed, which may vary in extent from one market to another, but not in direction.

Thesis (M.S.)--University of Florida, 2001.
Title from first page of PDF file. Document formatted into pages; contains viii, 138 p.; also contains graphics. Vita. Includes bibliographical references (p. 136-137).

Internal communication is pivotal for the effectiveness of company procedures and ultimately the success of the company. Understanding more about the communicative needs of different employee groups is therefore important in order to convey a message in a satisfying manner to those employees. This explorative study is investigating communication preferences from a stakeholder perspective to find out what influences the appropriateness of using different communication channels when transmitting information to different stakeholder groups. Interviews with employees at different levels and functions at PostNord were conducted and analysed. We conclude that the top level stakeholder prefers face-to-face communication due to complex topics being discussed with a high need for feedback. The stakeholder at the middle organisational level preferred e-mail due to being constantly interrupted and therefore need to access information at later times. The bottom level consisted of two stakeholder groups that had high degree, respectively low degree of customer interaction. They both preferred face-to-face, for reasons that had grounds in strict working schedules and work tasks - they were not given time to take in information properly in any other way than scheduled meetings, and the stakeholder with low customer interaction mostly worked alone which made this stakeholder value meetings with other colleagues.

AIM The purpose of this study is to assess the appropriateness of Justin Martyr‘s apologetical arguments as contained in his genuine works, namely First and Second Apologies and Dialogue with Trypho the Jew, in response to the so-called “five-fold attack” against Christianity in the second century AD. Methodologically, by ‘appropriate‘ in this study is meant ‘suitable‘ or ‘proper,‘ taking into account the rhetorical and literary conventions of second-century Graeco-Roman culture, the contemporary social situation, Justin‘s rhetorical and/or intended audience and his purpose. Would Justin‘s arguments from the point of view of second-century standards have been reasonable, possessing at least a potential for effectiveness, or would they have been either ignored, dismissed without serious consideration, or even worsened the plight for Christians? I believe this work fills a significant gap in our knowledge of Justin, being the first time a comprehensive analysis of the effectiveness, or otherwise, of Justin‘s arguments has been made in one single study. SCOPE This Thesis is divided into six major chapters, plus a Conclusion: (i) In Chapter One I provide a brief introduction discussing how and why the Apologists emerged during the second century AD to meet the challenges of the day, as well as outlining the aim and scope of this study. (ii) In Chapter Two I discuss the nature of Christian Apology, its relationship to petitions to the Roman emperors, and how it compares to other (non-Christian) apologetic, protreptic, educational and missionary discourses. I also examine the rhetorical and literary conventions of the second century Graeco-Roman world and outline how Justin employed rhetoric in his three known works. (iii) In Chapter Three I outline in detail the particular attacks experienced by the Christians in Justin‘s time. (iv) In Chapter Four I examine the questions of intended destination, structure and purposes of Justin‘s apologetical works. (v) In Chapter Five I analyse the appropriateness of Justin‘s apologetical arguments in 1 and 2 Apologies. (vi) In Chapter Six I analyse the appropriateness of Justin‘s apologetical arguments in Dialogue. In all, eight distinct arguments from the Apologies (Behaviour, Beliefs, Due Process, Threat, Similitude, Dependence/Source, Antiquity/Prophecy, Miracles) and four distinct arguments from Dialogue (Superiority, Fulfilled Prophecy, Miracles, True Israel) are outlined in detail and then analysed giving the reasons for and against their appropriateness. CONCLUSIONS In my Conclusion, I argue that all of Justin‘s arguments were appropriate for one or more reasons, with only the argument of Threat in the Apologies being largely inappropriate. At the same time, all his arguments contained notable weaknesses, except for the argument of Similitude. The following table is provided, listing each of Justin‘s apologetical arguments and the number of reasons I give for their respective appropriateness/inappropriateness, together with a yes/no/mixed conclusion in the final column: [Table not shown].This table is simplistic, nevertheless it does illustrate that the question of appropriateness is rarely a simple one, as more often than not there exist simultaneous reasons for and against the appropriateness of any particular argument. How has this study furthered our knowledge and understanding of Justin and his apologetical works? What can we conclude about Justin and his works based on the appropriateness or inappropriateness of his arguments? It is clear that for both the Apologies and Dialogue the strengths of Justin‘s arguments outweigh their weaknesses. The strengths generally pertain to philosophical, religious, or ethical aspects of the works that are presented logically and cogently while the weaknesses, by and large, result from Justin‘s tendency towards arrogance and abuse. Justin wrote very much the way he lived. As a philosopher and skilled debater Justin was not above offending and demeaning those with whom he did not agree if he thought this would increase the reception of his message. His brilliance and arrogance proved to be a lethal combination and led to his ultimate silencing. It perhaps also curtailed the effectiveness of his writings for no change of policy was ever effected during his lifetime, or at least universally implemented.

The six states, that together comprise the Gulf Cooperation Council (GCC), plan to adopt a single currency by 2010. If they are able to enact the necessary policy reforms and devolve some national sovereignty to supranational monetary and statistical institutions, capable of conducting a common monetary policy and managing the 'Gulf dinar", it will undoubtedly become the world’s second most significant currency union. It may also be seen as a viable reserve currency, particularly by neighbouring states, and could even be used to invoice oil sales. The aim of this thesis is two-fold Firstly, it assesses the appropriateness of a currency union for the GCC, against the optimal currency area criteria. It also examines the degree to which the GCC states have implemented the policy prerequisites for currency union, according to the experience of European Monetary Union. Secondly, it undertakes a qualitative cost - benefit analysis of currency union for the GCC as a whole and for each constituent state. This, in part, involves a review of post currency union monetary policy options and political-economy implications. The analysis employs both primary evidence collected through a GCC-wide business survey and from interviews with a panel of regional experts, and secondary evidence from published official sources. This research should add to the ongoing debate on the utility of currency unions in general and assess the validity of employing optimal currency area theory to a region which remains, to a high degree, dependent on oil. It also provides contextually based findings useful to regional policy makers. It concludes that a currency union will have significant benefits, but primarily indirect ones. Conventional benefits such as reduced transaction costs and eliminating exchange rate risks will be outweighed by benefits which will accrue from greater budgetary transparency, increased fiscal discipline and further economic diversification.

The purpose of this study is to discuss the appropriateness of a cognitive approach to Donald Davidson'
s meaning theory. Davidson makes the bold proposal that a truth theory, modified for a natural language, may be treated as a meaning theory for that language. According to Davidson, a meaning theory is an empirical theory. Radical Interpretation is at the center of such an empirical inquiry which places restrictions on the truth theory to make it suitable as a meaning theory without appeal to semantic notions. Davidson&lsquo
s aim in presenting this bold proposal and radical interpretation is to shed light on the concept of meaning, not to define the actual semantic competence of language users. But what Davidson&lsquo
s project does not aim to define is the main thing that a cognitive approach must account for. Whether a truth theory can represent the semantic competence of language users is discussed in this work. It is concluded that, although there is no a priori reason for such a representation claim, the cognitive approach&mdash
with the right assumptions to make the claim testable&mdash
can lead to an empirical research programme.

Research has shown that personality tests are susceptible to faking and that test takers do indeed take advantage of this vulnerability. This faking creates a problem when organizations use personality tests as screening tools for candidates for employment. Among the methods available to detect faking, appropriateness measurement (i.e., examining how well a pattern of responses fit item characteristics) has not been thoroughly investigated. The present study examines whether the two most popular appropriateness indices, Z3 and F2, are capable of detecting response distortion among test takers instructed to answer honestly versus fake. The groups demonstrated differences between overall mean scores, but the appropriateness indices did not successfully detect response distortion between the groups.

According to Metheny (1965), people's impressions of the acceptability of sport for women varies across several factors, including culture and gender. In this study, 206 prospective physical education teachers from Canada and Kenya were questioned about their perceptions of gender appropriateness of various sports. They completed Likert-type questionnaires related to sport/physical activities found in their respective university curricula. For those sports that appeared in both countries, responses were compared (2 x 2 ANOVA) for effects of culture and gender. Gender differences were also addressed within each culture.
Results revealed that Canadian respondents perceived fewer sports to be on the extremes of the male-female continuum than did the Kenyan respondents. Females in both cultures considered more sports to be appropriate for both male and female participation than did their male counterparts. However, Canadian and Kenyan respondents, both male and female, unanimously perceived some sports to be primarily appropriate for males and others primarily appropriate for females.
The study supports Metheny's contention of cultural variance in perceptions of the gender appropriateness of sports. Although many sports that had been considered inappropriate for females in 1964 are today considered to be androgynous, especially by Canadians, some gender stereotyping still remains to be overcome. Implications for physical education teachers are suggested.

Summary 1) Background Drug-eluting stents (DES) reduce in-stent restenosis, hitherto a frequent complication of percutaneous coronary intervention (PCI). Despite the reduction in recurrent symptoms and the need for repeat procedures, only highly selected patient groups with simple coronary lesions were studied in the initial trials, and long-term outcome or safety data were initially limited. The lack of long term data was compounded by reports of late stent thrombosis, potentially threatening the safety of the device. DES are more expensive than bare metal stents (BMS), so there is a significant increase the procedural cost of PCI. The uptake of DES in clinical practice created pressure on healthcare budgets leading to explicit rationing in some countries. This thesis comprises a programme of original work addressing three related aspects of DES use: DES use in clinical practice (Scotland and internationally), “off-label” use of DES and appropriate use of DES (a modified Delphi consensus study). 2) Drug-eluting stent use in clinical practice Relatively little was known about the actual application of DES in clinical practice. Anecdotal accounts suggested there were geographical practice variations within Scotland and internationally. Scottish practice was analysed with the aim of determining whether DES use varied between hospitals and operators within the Scottish NHS beyond the influence of clinical factors. In examining international practice the aim was to show whether the adoption and use of DES varied between countries and to determine whether practice changed after the stent thrombosis controversy. a. Clinical practice variation within Scotland - methods and results Using data from the Scottish Coronary Revascularisation Registry, multi-level logistic regression analysis was performed, analysing for variations in DES use at hospital, operator and patient level. Overall, DES were used in 47.6% of lesions, but varied between hospitals (range 30.6%-61.8%, χ2=341.6, p<0.0001). There was significant between-operator variation in the null model. This was attenuated by the addition of hospital as a fixed effect. Nonetheless, the final model demonstrated significant between-operator variability and between-hospital variation, after case-mix adjustment. b. Drug-eluting stent use internationally - methods and results This study involved collaboration between centres from four countries with established PCI registries: APPROACH Registry (Alberta, Canada), BWGIC (Belgium), Mayo Clinic PCI Registry (USA) and the Scottish Coronary Revascularisation Registry. Customised graphics software was employed to perform trend analysis examining variations in DES use over time, and by clinical sub-group. 178,504 lesions treated between January 2003 and September 2007 were included. In the Mayo Clinic Registry rapid adoption to a peak of 91% DES use for all lesions by late 2004 was observed. Alberta and Scotland showed delayed adoption with lower peak DES use, respectively 56 and 58% of lesions by early 2006. Adoption of DES in Belgium was more gradual and peak use of 35% lower than other registries. Reductions in DES use were seen in all datasets during 2006, though this varied in absolute and relative terms and by clinical sub-group. c. Conclusions Practice variations were found at operator and hospital level within Scotland and between countries internationally. Influences on stent choice in the “real world” are likely to be multi-factorial; on an international level, macro-economic forces exerting their influence through healthcare system regulation, payment systems, level of funding and central control are particularly important. It was also clear from the multilevel study of Scottish practice, however, that a clinical consensus does not exist. 3) “Off-label” use of drug-eluting stents DES are often used for “off-label” indications, untested in RCTs, where observational studies demonstrate complications are higher when compared to “on-label” use. The aim was to determine whether clinical outcomes differ following DES and BMS implantation in a patient cohort defined by DES “off-label” indications. a. Methods and results Patients who underwent coronary stenting for an “off-label” indication between January 2003 and September 2005 in Scotland were included. Clinical outcomes were determined using linkage to national admission and death databases. Propensity scores were calculated using important baseline variables and DES were matched to BMS on a one-to-one basis to provide a fair comparison. The final study population comprised 1,642 well matched patients. Event-free survival was calculated over 24 months using the Kaplan-Meier method. All-cause death was more common following BMS during follow-up. No difference in the rates of MI was noted. Target vessel revascularisation was reduced in patients treated with DES. b. Conclusions The largely reassuring findings of this study should be seen in the context of a subsequent growing body of literature also suggesting similar risks for DES and BMS when compared for both on-label and off-label use. Although the benefits of DES were evident, the absolute reduction in TVR was lower than previously demonstrated in RCTs. 4) Appropriate use of drug-eluting stents - a modified Delphi consensus study Best practice with respect to stent selection during PCI was poorly defined, as evidenced by the lack of detailed clinical guidance on the use of DES and wide practice variation demonstrated. It was not clear whether in any given setting there had been either underuse - potentially forfeiting the benefits of DES, or overuse - where benefits may be outweighed by risks. The aim was to use an expert panel to develop criteria for the appropriate use of DES using the modified Delphi method, to determine the extent to which current practice in Scotland met the appropriateness criteria and to validate the criteria by analysing clinical outcomes a. Methods, results, conclusions Consensus criteria for appropriate DES use were defined using a modified Delphi questionnaire. Expert panelists were used to define levels of appropriate use and were compared to clinical practice. The results suggested that current overall rates of DES use are acceptable. Better targeting of DES to the most appropriate lesions may be possible with the aims of reducing the known geographical inequities and maximising clinical benefit. Finally, using similar methods to chapter 4, it was shown that underuse of DES in appropriate patients was associated with higher levels of target vessel revascularisation without any difference in MI or death.

Employment discrimination cases in the United States of America (USA) are regularly resolved using alternative dispute resolution (ADR) processes, yet critics argue that mediation merely diverts cases away from overburdened courts, neutralises private and societal interests and is unable to equalise differing party resources. The less widespread but increasingly popular use of mediation to resolve discrimination disputes England and Germany calls into question the applicability of American informal justice criticism and appropriateness of mediation in these cases. In this context, the thesis analyses comparatively the value added by mediation to existing resolution means for settling employment discrimination claims in England and Germany, also with a view to explaining the significantly less utilisation of mediation in contrast to the USA. Analytical frameworks offered by the seminal works of Darnaska and Hofstede enable the examination and determination of suitability and prospects of ADR in particular legal systems. The first provides a model to compare procedural systems and the second catalogues organisational preferences in terms of culture. Within these frameworks it will be demonstrated that the above criticism is only applicable with regard to the general principles and practice of mediation which will need addressing should ADR become more embedded in established dispute resolution structures. It is also strongly suggested that mediation is beneficial in employment discrimination cases. Overall, of the two frameworks cultural disputing preferences are more capable to determine the potential success of transplanting new dispute resolution methods and identify process modifications to facilitate utilisation and acceptance. The inclination toward ADR is culturally informed and the existing procedural foundation is but one aspect of disputing culture. Dispute system design, that is developing a bespoke resolution framework for individual organisations, may be one means of changing disputing culture from the bottom-up in contrast to state-imposed mandatory mediation programmes.

It is well known that ,water supply and sanitation remain grosslvdeftcient in low-income districts of cities throughout sub-Saharan Africa, with likely severe negative impacts on health. Most low-income communities depend on non-networked (on-site) sanitation; few African cities have an extensive sewerage system, but nonetheless city-wide sewerage is widely seen as the long-term aim by municipal planners. In recent years, some sanitation specialists have argued that low-cost sewerage can be an appropriate solution for African cities; others that sewerage is inappropriate, because of its high financial cost, requirement for well-resourced local governance, and purportedly negative environmental impacts. Against this backdrop, this thesis sets out to assess whether sewerage can be an appropriate solution for African cities, and if so in what circumstances. An expert opinion survey early in the research indicated that most sanitation specialists consider sewerage to be an appropriate solution in some situations. A meta-analysis of existing health impact studies confirmed that sewerage interventions typically have a substantial positive impact on health. A detailed outcome evaluation of the PAQPUD settled sewerage project in Dakar (Senegal) was performed, and this work was supported by shorter evaluations of sewerage pro-poorness in Accra (Ghana) and Nairobi (Kenya), and by a review of outcome evaluations of previous sewerage projects in African cities. This research concludes that sewerage can certainly be an appropriate solution for high-density low-income districts of African cities; the key requirement is that governance standards and institutional capacity be sufficient to ensure effective planning, implementation and long-term management of a networked sewerage system. Common "environmental" arguments against sewerage (including that it will substantially increase domestic water use) are judged to be over-stated. Capital cost will invariably be higher than for non-networked systems: but in certain habitat types, sewerage may be the only solution that prevents disease. It is difficult to generate geographically generalisable estimates of the lifecycle costs of sewerage, and impossible to achieve generalisable cost-benefit relations: so comparative cost assessments need to be done in specific contexts. The thesis offers recommendations for effective planning and implementation of sewerage programmes serving low-income districts of African cities, stressing the importance of approaches ensuring high connection rates and genuine pro- poor targeting.

Hand and arm gestures are a great way of communication when you don't want to be heard, quieter and often more reliable than whispering into a radio mike. In recent years hand gesture identification became a major active area of research due its use in various applications. The objective of my work is to develop an integrated sensor system, which will enable tactical squads and SWAT teams to communicate when there is absence of a Line of Sight or in the presence of any obstacles. The gesture set involved in this work is the standardized hand signals for close range engagement operations used by military and SWAT teams. The gesture sets involved in this work are broadly divided into finger movements and arm movements. The core components of the integrated sensor system are: Surface EMG sensors, Flex sensors and accelerometers. Surface EMG is the electrical activity produced by muscle contractions and measured by sensors directly attached to the skin. Bend Sensors use a piezo resistive material to detect the bend. The sensor output is determined by both the angle between the ends of the sensor as well as the flex radius. Accelerometers sense the dynamic acceleration and inclination in 3 directions simultaneously. EMG sensors are placed on the upper and lower forearm and assist in the classification of the finger and wrist movements. Bend sensors are mounted on a glove that is worn on the hand. The sensors are located over the first knuckle of each figure and can determine if the finger is bent or not. An accelerometer is attached to the glove at the base of the wrist and determines the speed and direction of the arm movement. Classification algorithm SVM is used to classify the gestures.

Due to the dramatic rate of urbanisation worldwide, sustainability of global cities is called into question, and there is global agreement that making cities more sustainable is a key priority. Greater use of underground space is one such solution, hence wider adoption of Urban Underground Space (UUS) within the urban environment needs consideration. One way to measure the efficiency of these solutions within the urban environment is to provide sustainability credentials through sustainability indicators. However, a detailed review of the current ‘construction sector’ sustainability indicator systems (BREEAM, CEEQUAL, etc.) within this research shows that there is a substantial need for a sustainability indicator tool tailored toward UUS. Hence, a new tool, called USPeAR, is proposed, developed on the basis of the SPeAR® framework system revised and restructured for application on UUS projects. The USPeAR tool includes a series of indicators based on SPeAR®. They have been selected according to the materiality review method introduced by SPeAR® itself. In addition a panel of experts, who are experienced in terms of construction and sustainability, has been surveyed via a questionnaire to inform the development of an appropriate weighting system for the selected indicators. Lastly, a Cost-Benefit Analysis (CBA) method has been combined with USPeAR to identify the most cost-effective solution for the sustainability improvement of a UUS project. The application of the developed tool was demonstrated through two case studies, in the UK and Iran.

Thesis (M.B.A.)--Massachusetts Institute of Technology, Sloan School of Management, 2006.
Includes bibliographical references (leaf 52).
Diversification tools such as modem portfolio theory are used by institutional investors when making asset allocation decisions, which often result in an allocation to the private equity asset class. While some level of diversification within a private equity portfolio, in theory, should produce higher risk-adjusted returns, in practice it is problematic. Through a combination of quantitative analysis of historical private equity returns and qualitative analysis of the investment programs of several large institutional investors with long histories in private equity, the appropriateness and feasibility of targeted diversification is evaluated. The research indicates that the success of private equity investment programs is influenced more by the quality of the managers in the portfolio than by strategic design. Therefore, the ability of investors to access strong performing managers, and to choose not to invest when such access is not possible, is paramount. That said, institutions generally maintain some level of diversification in their portfolios. However, they often do so on an opportunistic basis or within a policy that affords them sufficient flexibility to overweight an area that offers the best expected returns.
by Kathleen R. Browne.
M.B.A.

Cultural competence, mandated by Federal law since 1964, has not been appropriately addressed due to its lack of specifics and the lack of specifics within subsequent mandates. This study was designed to determine specific key elements of cultural and linguistic appropriateness which would "operationalize" cultural competence in the provision of healthcare services. Knowing the elements of cultural and linguistic appropriateness will assist non-Hispanic healthcare providers to remove personal barriers of cultural and linguistic differences for Texas' Hispanic population. The problem of cultural competence gained national focus during the Civil Rights movement of the '60s. Current research revealed that Hispanics continue to have the worst healthcare outcomes of any minority population. Census data reflecting that Hispanics are the fastest growing segment of the population, with Texas having the nation's second largest Hispanic population, make it imperative for healthcare providers to determine methods to improve healthcare for Texas' Hispanic population. A Delphi Technique was used to extract expert opinions from 26 highly qualified, Texas Hispanic healthcare providers regarding the key elements of cultural and linguistic appropriateness for Texas' Hispanic population. The ultimate goal of the research was to determine essential information which would assist non-Hispanic healthcare providers in removing personal barriers of cultural and linguistic appropriateness to the delivery of healthcare services for Texas' Hispanics. Through the approximately 16-month process of the Delphi Technique, the Panel produced 249 distinct elements in 11 groups of cultural appropriateness and 8 groups of linguistic appropriateness. Members of the Panel ranked the groups for importance, indicated the level of agreement/disagreement with each element, and rated each element for its individual importance. This study is important because it is the first time an expert panel of solely Hispanic healthcare providers has spoken collectively about what constitutes cultural and linguistic appropriateness. This research can provide a framework for professional practices, grant providing organizations, or evaluation teams to assess professionals and programs to determine their degree of cultural and linguistic appropriateness. The work can also form the basis for curricula to be used in Texas' healthcare professions preparatory schools or continuing education for practicing healthcare professionals.

As transportation policies are changing to encourage alternative modes of transportation to reduce congestion problems and air quality impacts, more planning organizations are considering or implementing activity-based travel demand models to forecast future travel patterns. The proclivity towards operating activity-based models is the capability to model disaggregate travel data to better understand the model results that are generated with respect to the latest transportation policy implementations. This thesis first examines the differences between the two major modeling techniques used in the United States and then describes the assessment tool that was developed to recommend whether a region should convert to the advanced modeling procedures. This tool consists of parameters that were decided upon based on their known linkages to the advantages of activity-based models.

Introducció. La millora de l’adequació de la pràctica clínica fa referència a l’elecció de proves diagnòstiques, tractaments i altres prestacions que, segons l’evidència científica, tenen més beneficis que riscos, un balanç cost-benefici raonable i s’ajusten a les preferències de les persones i de la societat. Aquest procés inclou identificar i eliminar pràctiques de poc valor i promoure aquelles de valor. Objectius 1. Documentar les iniciatives destinades a millorar l’adequació de la pràctica clínica en l’àmbit mundial; 2. Desenvolupar recursos metodològics que permetin avaluar i millorar l’adequació en l’entorn hospitalari i 3. Analitzar la percepció dels professionals sobre les pràctiques de poc valor i sobre les recomanacions per a eliminar aquestes pràctiques. Mètodes. Vam dur a terme cinc estudis. Per a documentar les iniciatives vam fer una revisió de la literatura. Com a nous recursos metodològics vam crear una pàgina web que permet consultar iniciatives per millorar l’adequació de la pràctica clínica i información d’interés. A més, vam desenvolupar una sèrie d’indicadors basats en revisions sistemàtiques per a avaluar l’adequació en dues àrees de l’entorn hospitalari. Finalment, per a aconseguir el tercer objectiu vam realitzar dues enquestes i dos grups focals amb professionals de medicina i infermeria. Resultats. Amb la cerca vam identificar 22 iniciatives de 10 països, incloent-hi Espanya. Fins a juliol de 2015, aquestes iniciatives havien generat 2.940 recomanacions i anàlisis d’adequació procedents principalment de guies de pràctica clínica i majoritàriament de societats científiques. Vam trobar una gran variabilitat en el rigor metodològic per a desenvolupar aquests recursos i garantir que estiguessin basats en la millor evidència científica disponible. A partir d’aquests resultats vam crear el lloc web Dianasalud.com, que inclou una base de dades amb aquestes iniciatives i les seves recomanacions i anàlisis d’adequació. Vam obtenir 18 indicadors aplicables en l’atenció del part a partir de 303 revisions sistemàtiques (6%) i sis indicadors procedents de 149 revisions (4%) en l’atenció de la malaltia arterial perifèrica. En les enquestes vam trobar un alt grau d’acord amb les recomanacions per a reduir pràctiques de poc valor entre professionals de medicina i infermeria (83% i 96%, respectivament). Aquests creuen que hi ha una bona adherència a aquestes recomanacions a l’hospital (90% i 80%) i les consideren útils (70% i 90%). En els grups focals vam identificar com a principals barreres per a reduir pràctiques de poc valor: medicina defensiva, mala gestió de la incertesa i evidència científica contradictòria. Com a facilitadors destaquen el lideratge positiu i el treball en equip. Conclusions. Les iniciatives més conegudes són aquelles que han produït recomanacions per a eliminar pràctiques de poc valor, provinents de societats científiques. Malgrat les seves importants contribucions, la falta d’una metodologia rigorosa i estandarditzada desperta inquietuds i limita la seva implementació. Respecte als dos recursos metodològics desenvolupats, el lloc web contínua actiu i és consultat sovint. Quant als indicadors, la quantitat que se’n podrien formular està limitada per la falta d’evidència sòlida sobre pràctiques de poc valor i que la seva implementació depèn del grau de detall i la qualitat de la informació clínica. A més de l’evidència científica, la millora de l’adequació implica altres aspectes relacionats amb les creences i actituds dels professionals sanitaris, l’entorn hospitalari i la dinàmica del sistema sanitari i de la societat en general. Aquests aspectes s’han de treballar simultàniament i amb la mateixa intensitat amb la qual es busca assegurar que les iniciatives es basen en la millor evidència disponible.
Introducción. La mejora de la adecuación de la práctica clínica hace referencia a la elección de pruebas diagnósticas, tratamientos y demás prestaciones que, según la evidencia científica, tienen más beneficios que riesgos, un balance coste-beneficio razonable y se ajustan a las preferencias de las personas y la sociedad. Este proceso incluye identificar y eliminar prácticas de poco valor y promover aquellas de valor. Objetivos. 1. Documentar las iniciativas destinadas a mejorar la adecuación de la práctica clínica a nivel mundial; 2. Desarrollar recursos metodológicos que permitan evaluar y mejorar la adecuación a nivel hospitalario y 3. Analizar la percepción de los profesionales sobre las prácticas de poco valor y sobre recomendaciones para eliminar aquellas prácticas. Métodos. Llevamos a cabo cinco estudios. Para documentar las iniciativas hicimos una revisión de la literatura. Como nuevos recursos metodológicos creamos una página web que permite consultar iniciativas para la mejora de la adecuación de la práctica clínica e información de interés. Además, desarrollamos una serie de indicadores basados en revisiones sistemáticas para evaluar la adecuación en dos áreas del entorno hospitalario. Finalmente, para el tercer objetivo realizamos dos encuestas y dos grupos focales con profesionales de medicina y enfermería. Resultados. Con la búsqueda identificamos 22 iniciativas originarias de 10 países, incluyendo España. Hasta julio de 2015, dichas iniciativas habían generado 2940 recomendaciones y análisis de adecuación procedentes principalmente de guías de práctica clínica y mayoritariamente de sociedades científicas. Encontramos una gran variabilidad en el rigor metodológico para desarrollar estos recursos y garantizar sus bases en la mejor evidencia científica disponible. A partir de éstos resultados creamos la página DianaSalud.com que incluye una base de datos con dichas iniciativas y sus recomendaciones y análisis de adecuación. Obtuvimos 18 indicadores aplicables en la atención del parto a partir de 303 revisiones sistemáticas (6%) y seis indicadores a partir de 149 revisiones (4%) en la atención de la enfermedad arterial periférica. En las encuestas encontramos un alto grado de acuerdo con las recomendaciones para reducir prácticas de poco valor entre profesionales de medicina y enfermería (83% y 96% respectivamente), quienes creen que hay una buena adherencia a dichas recomendaciones en el hospital (90% y 80%) y las consideran útiles (70% y 90%). En los grupos focales identificamos como principales barreras para reducir prácticas de poco valor: medicina defensiva, mala gestión de la incertidumbre y evidencia científica contradictoria. Como facilitadores destacan el liderazgo positivo y el trabajo en equipo. Conclusiones. Las iniciativas más conocidas son aquellas que han producido recomendaciones para eliminar prácticas de poco valor, provenientes de sociedades científicas. Pese a sus importantes contribuciones, la falta de una metodología rigurosa y estandarizada para identificar prácticas de poco valor o generar recomendaciones despierta inquietudes y limita su implementación. Con respecto a los dos recursos metodológicos desarrollados, la página web continua activa y es frecuentemente consultada. En cuanto a los indicadores, observamos que la cantidad que podrían formularse está limitada por la falta de evidencia sólida sobre prácticas de poco valor y que su implementación depende del grado de detalle y la calidad de la información clínica. Además de la evidencia científica, la mejora de la adecuación implica otros aspectos relacionados con las creencias y actitudes de los profesionales sanitarios, el entorno hospitalario y la dinámica del sistema sanitario y de la sociedad en general. Estos aspectos deben trabajarse simultáneamente y con la misma intensidad con la que se busca asegurar que las iniciativas se basan en la mejor evidencia científica disponible.
Introduction. Improving the appropriateness of clinical practice refers to the choice of tests, treatments and other interventions that, according to scientific evidence, possess more benefits than risks, a reasonable cost-benefit ratio, and are compatible with the preferences of people and the society. This process includes identifying and eliminating low-value practices and promoting those that are more appropriate. Objectives. 1. to describe the initiatives aimed at improving the appropriateness of clinical practice worldwide; 2. to develop methodological resources that assess and improve appropriateness in the hospital setting; and 3. to analyse the perceptions of health professionals about inappropriate or low-value practices and recommendations to reduce them. Methods. We carried out five studies. To document initiatives of interest, we conducted a literature review. As methodological resources, we developed an open online database for consulting initiatives to improve the appropriateness of clinical practice and other information of interest. We also developed a set of indicators based on systematic reviews to assess appropriateness in two areas of the hospital setting. Finally, to achieve our third objective, we carried out two surveys and two focus groups with doctors and nurses. Results. With the literature review we identified 22 initiatives from 10 countries, including Spain. As of July 2015, these initiatives produced 2,940 outputs in the form of recommendations and appropriateness analyses mainly from clinical practice guidelines and most commonly from scientific societies. We found great variability in the methodological rigor employed to develop these resources and to guarantee that they draw on the best evidence. Based on our search results we created the website DianaHealth.com, which includes a database of the initiatives and their associated recommendations and appropriateness analyses. We obtained 18 indicators applicable on delivery care from 303 systematic reviews (6%) and six indicators on peripheral arterial disease care from 149 reviews (4%). In the surveys, we found a high agreement among doctors and nurses (83% and 96% respectively) with the recommendations for reducing low-value practices. In both groups, professionals believe that there is good adherence to these guidelines in the hospital (90% and 80%) and consider them useful (70% and 90%). In the focus groups we identified defensive medicine, bad management of uncertainty and contradictory scientific evidence as the main barriers to reducing low-value practices. As facilitators, positive leadership and teamwork stand out. Conclusions. The best-known initiatives for improving the appropriateness are those producing recommendations to reduce low-value practices, developed by scientific societies. Despite their important contributions, the lack of a rigorous and standardised methodology for identifying low-value practices or producing recommendations arouses concerns and jeopardises the implementation of their contributions. Regarding the two methodological resources developed in this tehsis work, DianaHealth.com is still active and it is frequently consulted. As for the indicators based on systematic reviews, we found that the number of indicators that could be produced is limited by the lack of solid evidence on low-value practices and their implementation depends on the degree of detail, as well as the quality of clinical information. In addition to employing scientific evidence, improving the appropriateness of clinical practice involves other aspects related to the beliefs and attitudes of healthcare professionals, the hospital environment and the dynamics of the healthcare system and society in general. These aspects should be worked on simultaneously and with the same intensity that should be devoted to ensuring that the initiatives are supported by the best scientific evidence available.

With the ever increasing pregnancy rate of students, people have begun to doubt the effectiveness of the sexuality education in Hong Kong. Some argued that a more comprehensive approach should be adopted while others argue that the more traditional approach is better. However, the voices of students are almost neglected. The aim of this study is to fill this gap and illuminates students’ views on sexuality education in schools and appropriateness of different approaches. In general, students welcome sexuality education as they agree that there is a need for such education; however, there is a big gap between what students want to learn and what the schools are actually teaching... In this research, I would also argue how this gap might be a major obstacle in the implementation of sex education in Hong Kong.
published_or_final_version
Education
Master
Master of Education

Approved for public release; distribution is unlimited
The end of the cold war caused defense budgets to decrease in sharp manner. This trend requires the Navy, as a branch of the DOD, to tighten its controls over spending and become more cost-effective. Since warship procurement is among the most important financial transactions of the Navy, one instrument that might improve the cost-effectiveness of the Navy is the use of cost and performance incentives in warship procurement. This thesis studies the traditional and current theories of incentive contracting. It explains the relationship between the cost-effectiveness, and how the use of incentives can encourage contractors to put in a high level of effort on projects so that the government will benefit more. To define the performance level of a warship, analytical approaches, such as the use of an operations research model with the aid of response surface methodology, and the subjective figures of merit model are discussed. This thesis also presents some views on the principal-agent problem, and it expands the idea fusing the contractor's unobservable effort level as means to determine what type of incentives to offer. To compare the traditional and new concepts of incentives, two specific examples are constructed and examined

Thesis (MTh (Old and New Testament))--University of Stellenbosch, 2006.
The aim of this thesis is to explore the trends that are found in commentaries on the book of Exodus and their appropriateness in the African context. The study also seeks to move from a socio-political understanding of Exodus as liberation theology to the cultural understanding of Exodus as African theology. The following three trends are found in modern commentaries on Exodus as explored by this thesis: • Historical-critical approach – dealing with the world behind the text or author centred criticism. Commentaries found under this group include those of M Noth (1962), TE Fretheim (1990), N Sarna (1991), B S Childs (1977) and WHC Propp (1999). • Literary-critical approach – this deals with the text itself or it is text centred. Commentaries found in this category include: W Brueggemann (1994), J G Janzen (1997) and C Houtman (1993). • Theological-critical approach – deals with the world in front of the text. Commentaries of GV Pixley (1987), J Durham (1987) and G Ashby (1998) are good examples of the latter named approach. Exploration into the study of the above listed three trends and their corresponding modern commentaries show that the commentaries are not fully appropriate in the context of Africa (except Ashby). This is so because the above modern commentaries have not directly addressed the ongoing issues of poverty, political, economic, oppression, marginalization, HIV / AIDS, cultural and social issues, famine, racial and sex discrimination, religious crises, and other epidemics and natural disasters prominently found in Africa - particularly among the third world countries. The modern commentaries mentioned above are indirectly relevant for Africa since the topics which they address, resonate with the readers and interpreters of Exodus in Africa. This resonance is possible if readers and interpreters of Exodus in Africa find similarities between modern commentaries and their own current context. The study also shows that the three trends found in modern commentaries on Exodus are dependent on one another to bring forth a meaningful interpretation. Based on this working relationship between the three trends mentioned above, it is suggested that the three trends should be considered in close connection with one another. Biblical interpretation in Africa must do justice to the literary, historical and theological aspects of the Bible to be meaningful and appropriate in Africa.

New Testament critics tend to regard the speeches in the book of Acts either as primarily accurate accounts or as primarily inventions of the author. In either case, the evidence in the speeches proves these simple categorizations false unless they are heavily qualified. The main hypothesis of this thesis is that the twin goals of artistic and historical appropriateness are suitable and useful conceptual tools for the study of speeches in ancient writers, including those speeches in the book of Acts. This 'two-pronged' appropriateness, suggested by a study of the statements of method in ancient secular writers, seems to account more neatly and comprehensively for the evidence in at least the mission speeches of Paul than alternative understandings of the literary device.

Background: Antibiotic overuse/misuse has been documented in several reports to increase the risk of Clostridioides difficile (C.diff) infection and antibiotic resistance. The older adult population is more prone to use antibiotic medications than any other age group due to decreased immune function, use of urinary catheters, ventilation during hospitalization and other factors. Antibiotic resistance and C.diff are major public health problems. However, studies examining the trends of antibiotic use and the association between the antibiotic use and negative health outcomes among older adults in the outpatient and emergency department settings are limited. Objectives: The main objectives of this dissertation were to: 1) calculate the national antibiotic trends among community-dwelling older adults in the United State; 2) evaluate the antibiotic trends and antibiotic appropriateness among older adult patients visiting the geriatrics clinic and adult internal ambulatory care clinic at VCU Health; and 3) examine the antibiotic trends and antibiotic appropriateness among older adult patients and middle-aged patients visiting the emergency department at VCU Health. Methods: For the first objective, data were obtained from Medical Expenditure Panel survey (MEPS) a nationally representative dataset (2011-2015). Descriptive analyses were conducted and multiple logistic regression was performed to assess the association between the antibiotic use and demographic and sociodemographic characteristics. In the second objective, data were obtained from VCU Health outpatient clinics (geriatrics, and Internal medicine ambulatory care clinic only). Descriptive statistics were calculated and multiple logistic regression was performed to assess the association between antibiotic appropriateness and type of clinics and other demographic characteristics. In the third objective, the emergency department electronic medical records at VCU were used. Trend analysis was performed across the dissertation studies using the Cochran–Armitage test. All variables were considered statistically significant at an α level of 0.05. All the statistical analyses were conducted using the Statistical Analysis Software Version 9.4 (SAS v.9.4), (SAS Institute Inc, Cary, NC). Results: There were 105,762,134 prescriptions dispensed to older adults in the outpatient setting in the US from 2011 to 2015. Antibiotic prescriptions were more common among women (18%) compared to men (12%). White participants received more antibiotics (27%) than African Americans (1.77%) and others (1.4%). Among the 3,515 patients who visited either Geriatrics or Internal Medicine ambulatory clinic at VCU Health from 2012-2017, 1,534 antibiotics were prescribed. Potentially inappropriate antibiotic prescriptions were similar between the two clinics (30% in Geriatrics clinic and 28% in Internal Medicine ambulatory clinic) with p-value of 0.08. In addition, 6,343 middle-aged or older adult patients were dispensed and prescribed an antibiotic in the ED at VCU Health from (2012 to 2017). Eighteen percent of the antibiotic prescriptions received by middle age group were considered potentially inappropriate, compared to 9% among the older adult patient (p < 0.0001). Conclusions: The rate of antibiotic use overall remains unchanged despite the national and international efforts to reduce antibiotic prescriptions and eventually to reduce antibiotic resistance. The changes in the patterns of use in some of the antibiotic categories appear to be driven more by the safety concerns rather than reducing overall use. Future research is needed to strengthen antibiotic stewardship programs for older adults in outpatient settings.

The foundational principles of Holland’s (1985b, 1992, 1997) vocational theory state that career choice is an expression of personality, in that individuals with specific personality types seek out work or learning environments that match their personality types. Furthermore, interest inventories such as the Self-Directed Search (Holland, Powell, & Fritzsche, 1994) can be regarded as personality inventories and used to ensure that individuals find themselves in a working environment that is best suited to their interests and personality type. In addition to instruments that measure interests, Holland also developed dictionaries of occupations coded according to the characteristics and interests of different occupations and working environments, such as the Dictionary of Holland occupational codes (Gottfredson & Holland, 1996). The level of congruence between personality types and occupational types is linked to career satisfaction, stability and achievement. This premise only holds true, however, if the codes for the occupational environment suggested by Holland (1985c) are, in fact, valid. In other words, do the codes suggested by Holland match the personality types of individuals entering or who are already employed in a particular work or learning environment? There have been many studies conducted with regard to the validity of Holland’s prescribed interest typology codes. Spokane, Meier and Catalano (2000) located a large number of empirical studies published since 1985 that relate directly to the validity of Holland’s codes, many of which have suggested that the existing codes may not be valid. There is a scarcity of such research in South Africa, especially with regard to vital and growing occupational fields, such as the ecotourism industry, that are so important to the economic well-being of the country. Consequently, the overall aim of the present study was to explore and describe the interest codes of male and female South African student and working field guides in order to discuss the appropriateness of the occupational codes prescribed by Holland for the field guiding profession. The quantitative design of the study was exploratory-descriptive in nature and made use of the Self-Directed Search Questionnaire (Holland, Fritzsche, & Powell, 1994). The total sample consisted of 100 participants (68 male and 32 female), constituting 40 working field guides and 60 field guide students. Descriptive analyses were conducted with the use of frequency tables, charts, means and standard ix deviations. In addition, Independent sample t-tests were computed in order to describe and compare the mean scores of the interests for males and females, and to compare the mean scores of the interests for student and working field guides. The results of this study suggest that the prescribed occupational code (SRI; Social, Realistic, Investigative) for South African field guides may not be appropriate and that an interest profile such as SREI AC may be more appropriate. These results, in combination with the findings of the research review, suggest the need for a more extensive, cross-cultural study to determine the appropriateness of Holland’s occupational codes for South African occupations, which may lead to a revision of the South African Dictionary of Occupations (Taljaard & von Mollendorf, 1987).

The developmental appropriateness of the English language arts essential elements for kindergarten children in the State of Texas was evaluated by surveying the opinions of thirty-six kindergarten teachers in one school district. A questionnaire was developed using the essential elements so that respondents could record a yes or no opinion and supply additional comments on each essential element. Ninety-seven percent of the teachers responded. The results indicated rates of agreement for developmental appropriateness by the teachers surveyed to be 100% for language, 95% for listening, 94% for speaking and reading and 81% for writing.

Liver resection, or hepatectomy, is a major abdominal surgery performed most often for the removal of malignant tumors of the liver, either primary or metastatic. It is often associated with significant blood loss and therefore, with blood transfusions. While transfusions are common, there is incomplete knowledge of their effects on clinical outcomes. Furthermore, both current practices and best practices in perioperative blood management, including blood product administration, are not well defined. This manuscript-based thesis will examine the clinical impact, current practices, and appropriate use of perioperative red blood cell transfusions for patients undergoing liver resection.

This exegesis examines the context of my studio work submitted for the degree of Doctor of Visual Art at Griffith University in 2004. My art practice reflects my identity, which is complex and many-stranded, but at its core is my identity as a 21st century woman of Torres Strait Islander descent. I also acknowledge multiple heritages and, like many of my contemporaries, I am a descendant of those two thirds of the Torres Strait population who now live on the Australian mainland. Having been born and brought up on the mainland also means that I am connected to, and have been affected by, wider Australian Indigenous issues, particularly those resulting from the alienation and dislocation which stem from colonialism. Therefore, as I draw from both traditional and contemporary modes and theory to explore the appropriateness of my art practice, this exegesis centres on the question: What constitutes culturally appropriate practice for me as a contemporary Torres Strait Island woman?

碩士
國立臺灣大學
數學研究所
100
On behavioural research applications, it often needs to quantify the homogeneity of agreement between responses given by two (or more) raters or between two (or more) measurement devices. For a given object, it can receive different ratings from different raters. The reliability among raters becomes an important issue. In particular, investigators would like to know whether all raters classify objects in a consistent manner. Cohen (1960) proposed kappa coefficient, κ, for correcting the chance agreement among two raters. κ is widely used in literature for quantifying agreement among the raters on a nominal scale. However, Cohen''s kappa coefficient has been criticized for the illness prevalence or base rate in the particular population under study or irrelevant of rater''s rating abilities for latent classes. Gwet (2008) proposed an alternative agreement based on interrater reliability called AC1 statistic, γ1. De Mast (2007) suggested an appropriate chance-corrected interrater agreement coefficient κ* by correcting the agreement due to chance. In this thesis, we use asymptotic analysis to evaluate whether κ or γ1 is a consistent estimate of κ* when both raters adopt random rating model or Gwet''s model (2008) and compare the performances of κ and γ1 with κ*.

碩士
國立臺中教育大學
幼兒教育學系碩士班
106
This study investigated the content change in and the appropriateness for young children of three Disney animated films, including “Snow White and the Seven Dwarfs”, “Mulan”, and “Frozen”. The changes in “male and female roles”, “conveyed values”, and “film background” were examined, and the appropriateness for children was assessed along four dimensions, including “educational value”, “behavioral examples”, “gender view”, and “language”. The subjects were three Disney animated films, including “Snow White and the Seven Dwarfs”, “Mulan”, and “Frozen”. The dialogues and screens in these three films were analyzed using an evaluation checklist and content analysis. 　　Results showed that Disney animated films have changed over time. “Frozen” received more positive ratings than the other two films in all the four dimensions of appropriateness, including “educational value”, “behavioral examples”, “gender view”, and “language”. “Snow White and the Seven Dwarfs” features too much negative content. For example, many scenes contain materials that may cause phobia, fear, and vanity in young children or convey a negative value that the end justifies the means. “Mulan” has a large amount of scenes displaying negative gender views and gender stereotypes. As far as content change is concerned, “male and female roles” have gradually become more balanced, but achieving the goal no matter what it takes and calculation are still the “conveyed values” in these films. The ballroom dancing scene remains the everlasting feature of Disney animated films.

碩士
銘傳大學
公共事務學系碩士在職專班
99
Kinmen county police bureau faces the relationship change across Taiwan strait, the following problem of public security and traffic congestion in Kinmen county need to be solved by changing the hierarchy of police bureau from 2 to 3. This thesis tries to explore the influence of the organizational hierarchy change. This study collects 225 valid samples from Kinmen county police bureaus and uses hierarchical regression to justify the hypotheses we explored. The results show that work involvement positively affects job satisfaction; role ambiguity negatively affects job satisfaction; job satisfaction positively influences affective commitment; job strain and role ambiguity positively influences resistance of organizational change.

RESUMO - Introdução: Os critérios de adequação (Appropriate Use Criteria - AUC) em Ecocardiografia Transtorácica (ETT) foram publicados com o intuito de permitir o uso racional da ecocardiografia, de influenciar decisões clinicas, prestar cuidados de saúde de elevada qualidade e melhorar o outcome dos pacientes. A relação entre a adequação destes e o seu impacto clinico ainda não se encontra largamente estudada. Objectivo: Neste estudo pretendeu-se avaliar o grau de adesão aos AUC em ETT, em diferentes contextos de atendimento e de acordo com diferentes especialidades, bem como o impacto clínico do exame no outcome do paciente, num hospital público terciário no Reino Unido. Metodologia: 859 ETTs realizados consecutivamente no mês de Janeiro de 2014, foram revistos por forma a avaliar a sua adequação e foram classificados como adequados, incertos ou inadequados de acordo com as guidelines de 2011. De seguida os registos dos pacientes foram revistos com o intuito de avaliar o impacto clinico dos ETTs e foram classificados de acordo com uma das 3 seguintes categorias: (1) alteração ativa dos cuidados – por continuação ou descontinuação dos cuidados como resultado do ETT, (2) continuação dos cuidados – sem continuação ou descontinuação dos cuidados, mas comunicação ao paciente dos resultados do ETT, (3) sem alteração dos cuidados – os cuidados ao paciente já estavam a ser aplicados previamente ao resultado do ETT, causa de sintomas já estabelecida no momento da requisição para exame, exame prévio explicativo dos sintomas e sem indicação aguda para novo ETT, terapêutica não alterada ou inexistência de documentação relativa aos achados ecocardiográficos. Pacientes cujos registos não se encontravam disponíveis foram excluídos (259). Todas as classificações foram avaliadas por uma cardiologista independente, sem relação direta com o estudo. Resultados: A nossa amostra apresentou uma média de idades de 63 ± 17 anos, com uma equilíbrio de géneros. A maioria dos exames foi solicitada em contexto de ambulatório (81,4%), pela Cardiologia (50,3%) e pela Medicina Geral e Familiar (13,4%). Relativamente aos achados ecocardiográficos dos exames, 7,6% demonstraram disfunção sistólica do ventrículo esquerdo moderada a grave, 4,0% revelaram doença valvular grave e 5,1% hipertensão pulmonar significativa. Em relação à adequação dos pedidos para ETTs, 76,5% foram adequados, 7,1% inadequados e 12,6% incertos. Relativamente ao impacto clínico dos ETTs, 42,7% dos exames revelaram uma alteração ativa nos cuidados, 15,6% mostraram uma continuação dos cuidados e 11,5% demonstraram não haver alteração nos cuidados. A idade (P=0,05), o contexto de atendimento (P<0,01) e o pedido realizado pela especialidade medicina geral e familiar (MGF) (P=0,02) foram os preditores mais importantes de uma alteração ativa nos cuidados. Numa perspectiva de prestação de cuidados a uma população mais idosa, o contexto de atendimento, a presença de achados ecocardiográficos significativos e a não alteração dos cuidados apresentam uma relação significativa com a idade. Conclusões: Os dados demonstram que quase 8 em cada 10 ETTs foram considerados adequados e que 4 em cada 10 exames não apresentaram alteração ativa dos cuidados.
ABSTRACT - Introduction: The Appropriate Use Criteria (AUC) for Transthoracic Echocardiography (TTE) were published to aim for a rational use of echocardiography, impact physician decisions, provide a high quality care and improve patient outcome. Following this, several studies demonstrated the proper prescription of the exam. However, the relation between the appropriateness of the exam and its clinical impact have not been largely investigated. Objective: The aim of this study was to assess the degree of adherence to the appropriate use criteria for echocardiography, in different contexts of care and according the various existing specialties in a tertiary public hospital in the United Kingdom, as well as the clinical impact of this exams on the patient outcome. Methods: 859 TTE’s performed consecutively during January 2014 were reviewed to assess its appropriateness, and were classified as appropriate, uncertain or inappropriate using the 2011 guidelines. Subsequently, patient’s files were examined to determine the clinical impact of the TTE which was assigned to one of the following three categories: (1) active change in care – escalation or de-escalation in care resulting from TTE, (2) continuation of current care – no escalation or de-escalation of current care, but direct communication provided to patients about TTE results, or (3) no change in care – next step in management already in place before TTE result, Cause of symptoms already known when TTE ordered to define cause, prior TTE showed the same findings without acute indication for the new TTE, no change in therapy or documentation about TTE findings. Patients which files were not available were excluded (259). All classifications were evaluated by a independent cardiologist, with no direct relation to the study. Results: Our sample had a mean age of 63 ± 17 years with a gender balance. The majority of the exams were requested in the outpatients (81.4%) clinic, by cardiologists (50.3%) and general practitioners (13.4%). Regarding the results of the study, in 7.6% there were moderate to severe systolic dysfunction, 4.0% showed severe valvular heart disease and 5.1% significant pulmonary hypertension. Relatively to the appropriateness of the TTE requests, 76.5% were appropriate, 7.1% inappropriate and 12.6% uncertain. Regarding the clinical impact of the TTE’s, 42.7% of the exams had an active change in care, 15.6% a continuation of the care and 11.5% revealed no change in care. Age (P=0.05), outpatient versus inpatient setting (P<0.01) and requests made by general practitioners (P=0.02) were the most important predictors of an active change of care exam. In a perspective of healthcare to a more elderly population, the outpatient versus inpatient setting, the presence of significant echocardiographic findings and the no change in care setting have a significant relation with age. Conclusion: The data concluded that almost 8 out of 10 TTE’s were considered appropriate, and 4 out of 10 exams had no active clinical impact.