Rozprawy doktorskie na temat „Area health management model”

The health care industry in the United States is increasingly pressured to improve safety and quality performance and increase revenue. In response, many health care institutions are moving to redesign their processes and practices in an effort to decrease costs and provide safer, higher quality, and more efficient care. The purpose of this paper is to document the Lean implementation strategy and progress in implementation at a large teaching health care organization undergoing Lean transformation in order to understand enterprise transformation strategies and the impact of leadership involvement on culture development and Lean implementation. Through direct observations and involvement and transformation activities, the methodology for Lean transformation and progress in implementation were documented and analyzed. The organization employed an outside consultant to assist with transformation activities, and underwent a three-pronged approach to implementation, which included model area development, team member problem solving training, and management-led problem solving activities. It was found that leadership involvement was lacking, especially at the highest levels, and the organization struggled to build the culture necessary to support transformation and develop an operational model area, though successes were realized in efforts to train employees in Toyota’s 8-Step Problem Solving method and in management-led problem solving activities.

Healthcare reforms and restructuring have been a global phenomenon since the early 1980s. The major structural reforms in the healthcare system in New South Wales (NSW) including the introduction and implementation of the area health management model (1986), the senior executive service (1989) and performance agreements (1990), heralded a new era in management responsibility and accountability. It is believed that the reforms, the process of the reforms, and the instability brought about by the reforms may have not only resulted in the change of senior healthcare management practices, but also in the change of competencies required for senior healthcare managers in meeting the challenges in the new era. However, limited studies have been conducted which examined how health reforms affected its senior health executive workforce and the above changes. Moreover, no study on senior healthcare managers has focused specifically on NSW after the major reforms were implemented. The purpose of this research was to examine how reforms in the NSW Health public sector affected its senior health executive workforce between 1990 and 1999 in terms of their roles and responsibilities, the competencies required, and the challenges they faced. This study, from a broad perspective, aimed to provide an overview of the NSW reforms, the forces behind the reforms and the effects the reforms may have had on senior health managers as predicted by the national and international literature. This study also explored the changes to the senior health executive workforce in the public sector during the period of rapid change in the 1990s and has provided indications of the managerial educational needs for future senior healthcare managers. Both quantitative and qualitative data have been collected by this study using triangulated methods including scientific document review and analyses, a postal questionnaire survey, and in-depth telephone interviews. The findings from the two quantitative methods informed and guided the development of the open-ended questions and overall focus of the telephone interviews. This study found differences in the characteristics and employment-related aspects between this study and previous studies in the 1980s and 1990s, and identified four major tasks, twelve key roles and seven core competencies required by senior health executives in the NSW Health public sector between 1990 and 1999. The study concludes that the demographic characteristics and the roles and responsibilities of the NSW Health senior executive workforce since the reforms of the 1980s have changed. This study also identified seven major obstacles and difficulties experienced by senior health executives and suggested that during the introduction and implementation of major healthcare reforms in NSW since 1986, barriers created by the ‘system’ prevented the achievement of its full potential benefits. Although this study did not focus on detailed strategies on how to minimise the negative impact of the health reforms on the senior health executives or maximise the chance of success in introducing new changes to the system, some suggestions are proposed. Most significantly, the study has developed a clear analytical framework for understanding the pyramidal relationships between tasks, roles and competencies and has developed and piloted a new competency assessment approach for assessing the core competencies required by senior health managers. These significant findings indicate the need for a replication of the study on an Australia-wide scale in order to extend the generalisability of the results and test the reliability and validity of the new competency assessment approach at various management levels in a range of healthcare sectors. This is the first study acknowledging the impact of the introduction of the area health management model, the senior executive service and performance agreements in the NSW public health system through an original insight into the personal experiences of the senior health executives of the reforms and examination of the major tasks that senior health executives performed and relevant essential competencies required to perform these tasks. The possible solutions identified in this study can guide the development of strategies in providing better support to senior healthcare managers when large-scale organisational changes are proposed in the future.

Healthcare reforms and restructuring have been a global phenomenon since the early 1980s. The major structural reforms in the healthcare system in New South Wales (NSW) including the introduction and implementation of the area health management model (1986), the senior executive service (1989) and performance agreements (1990), heralded a new era in management responsibility and accountability. It is believed that the reforms, the process of the reforms, and the instability brought about by the reforms may have not only resulted in the change of senior healthcare management practices, but also in the change of competencies required for senior healthcare managers in meeting the challenges in the new era. However, limited studies have been conducted which examined how health reforms affected its senior health executive workforce and the above changes. Moreover, no study on senior healthcare managers has focused specifically on NSW after the major reforms were implemented. The purpose of this research was to examine how reforms in the NSW Health public sector affected its senior health executive workforce between 1990 and 1999 in terms of their roles and responsibilities, the competencies required, and the challenges they faced. This study, from a broad perspective, aimed to provide an overview of the NSW reforms, the forces behind the reforms and the effects the reforms may have had on senior health managers as predicted by the national and international literature. This study also explored the changes to the senior health executive workforce in the public sector during the period of rapid change in the 1990s and has provided indications of the managerial educational needs for future senior healthcare managers. Both quantitative and qualitative data have been collected by this study using triangulated methods including scientific document review and analyses, a postal questionnaire survey, and in-depth telephone interviews. The findings from the two quantitative methods informed and guided the development of the open-ended questions and overall focus of the telephone interviews. This study found differences in the characteristics and employment-related aspects between this study and previous studies in the 1980s and 1990s, and identified four major tasks, twelve key roles and seven core competencies required by senior health executives in the NSW Health public sector between 1990 and 1999. The study concludes that the demographic characteristics and the roles and responsibilities of the NSW Health senior executive workforce since the reforms of the 1980s have changed. This study also identified seven major obstacles and difficulties experienced by senior health executives and suggested that during the introduction and implementation of major healthcare reforms in NSW since 1986, barriers created by the ‘system’ prevented the achievement of its full potential benefits. Although this study did not focus on detailed strategies on how to minimise the negative impact of the health reforms on the senior health executives or maximise the chance of success in introducing new changes to the system, some suggestions are proposed. Most significantly, the study has developed a clear analytical framework for understanding the pyramidal relationships between tasks, roles and competencies and has developed and piloted a new competency assessment approach for assessing the core competencies required by senior health managers. These significant findings indicate the need for a replication of the study on an Australia-wide scale in order to extend the generalisability of the results and test the reliability and validity of the new competency assessment approach at various management levels in a range of healthcare sectors. This is the first study acknowledging the impact of the introduction of the area health management model, the senior executive service and performance agreements in the NSW public health system through an original insight into the personal experiences of the senior health executives of the reforms and examination of the major tasks that senior health executives performed and relevant essential competencies required to perform these tasks. The possible solutions identified in this study can guide the development of strategies in providing better support to senior healthcare managers when large-scale organisational changes are proposed in the future.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Public Health
Faculty of Health
Full Text

Este estudo pretende analisar os benefícios decorrentes da implementação da Plataforma de Dados da Saúde. Esta plataforma consiste num registo de saúde electrónico de carácter nacional que permite a partilha de informação entre os diversos stakeholders através de diferentes portais. O Portal do Profissional permite o acesso dos diferentes profissionais de saúde ao registo clínico do utente. O principal objetivo deste trabalho é identificar e descrever os benefícios do Portal do Profissional da Plataforma de Dados de Saúde usando o Modelo de Gestão de Benefícios da Cranfield School of Management. A recolha de dados decorreu em 2012 e 2013 durante e após a implementação da plataforma. Os resultados obtidos demonstraram que o Portal do Profissional permite melhorar a qualidade da informação e o desempenho organizacional, aumenta a eficiência dos cuidados prestados e reduz os erros médicos. Contudo, é necessária uma análise mais detalhada de quantificação e acompanhamento dos benefícios para garantir a sua realização; ### ABSTRACT: Benefits Evaluation of Portuguese Health Record – Health Professional Area This study analyses the benefits of the implementing of the Portuguese Health Record. The Portuguese Health Record constitutes the national health record data sharing facility and provides information through different Portals/Areas to different stakeholders. The Health Professional Area provides access to patient clinical data. Main purpose of this work identify and describe the benefits of the Health Professional Area of the Portuguese Health Record using the Benefits Management Model of Cranfield School of Management. Data were collect in 2012 and 2013 during and after the implementation. The analysis demonstrate that Health Professional Area can provide an improvement in the quality of information and organizational performance, increase in efficiency of healthcare and reduction in medical errors. However, a more detailed analysis of quantification and monitoring of the benefits is required to ensure its realization.

Forests affect climate by absorbing CO₂ but also by altering albedo, latent heat flux, and sensible heat flux. In this study we used the Community Earth System Model to assess the biophysical effect of North American temperate forests on climate and how this effect changes with location, tree type, and forest management. We calculated the change in annual temperature and energy balance associated with afforestation with either needle leaf evergreen trees (NET) or broadleaf deciduous trees (BDT) and between forests with high and low leaf-area indices (LAI). Afforestation from crops to forests resulted in lower albedo and higher sensible heat flux but no consistent difference in latent heat flux. Forests were consistently warmer than crops at high latitudes and colder at lower latitudes. In North America, the temperature response from afforestation shifted from warming to cooling between 34° N and 40° N for ground temperature and between 21° N and 25° N for near surface air temperature. NET tended to have lower albedo, higher sensible heat flux and warmer temperatures than BDT. The effect of tree PFT was larger than the effect of afforestation in the south and in the mid-Atlantic. Increasing LAI, a proxy for increased management intensity, caused a cooling effect in both tree types, but NET responded more strongly and albedo decreased while albedo increased for BDT. Our results show that forests' location, tree type, and management intensity can have nearly equal biophysical effects on temperature. A forest will have maximum biophysical cooling effect if it is in the south, composed of broadleaf PFT, and is managed to maximize leaf area index.
Master of Science

Thesis (S.M.)--Massachusetts Institute of Technology, System Design and Management Program, 2008.
Includes bibliographical references (p. 52, 2-7 (2nd group)).
Decreasing population, high crime rate, and limited economic opportunities are all symptoms of urban decline. These characteristics are, unfortunately, evident in major cities and small towns. Local municipalities in these cities and towns with the aid of state and federal government have attempted to reverse urban decline through the traditional approach of urban renewal. Their idea was to create low cost housing to attract people back to urban areas. Their approach has shown mixed results with most attempts having no effect on the deterioration. The goal of this thesis is to propose a higher system approach to answer urban decline through the application of new technology, wireless mesh networks. A wireless mesh network can provide improved security, public safety, new economic opportunities, and a bridge that crosses the digital divide. Married to the appropriate applications, a wireless mesh network creates a business model that is both favorable and sustainable. More importantly, the business model brings about the human capital necessary for urban revitalization.
by Nhan Tu Chiang.
S.M.

Data required for the surveillance of the population of small areas and the implementation and evaluation of health preventive programmes are usually obtained from surveys conducted within each relevant small area. The substantial cost of local surveys has encouraged the search for other methods of obtaining the required information. One alternative consists of using small area estimators. Despite extensive applications of these procedures in diverse fields, guidelines concerning their use for the prediction of health variables are still lacking. In an effort to explore the applicability of small area estimators to the prediction of health parameters of Quebec's health areas, we conducted two empirical evaluations of these methods. Using data from Canadian surveys, estimates of health variables were produced for several Quebec's areas according to different techniques of small area estimation. The estimates were compared to a "standard" for each area and health variable, on the basis of average mean square error percents and Spearman correlations. Synthetic, regression-sample, and empirical Bayes estimators were evaluated. We observed that the more variable a health characteristic was among areas, the more difficult it was to predict accurately. While no small area estimator performed uniformly well for all the variables considered, the linear regression-sample estimators were generally at advantage according to the different criteria of evaluation. In the studied context, no gain was obtained by using more sophisticated procedures like the empirical Bayes estimators.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado.
The importance of an occupational health and safety management system (OHSMS) in a mining contract allows the establishment of guidelines to prevent and mitigate accidents that may occur in mines and in exploration areas. Such guidelines are integrated to ensure compliance with regulations with respect to the mining activity (DS 024-2016-EM). For developing a model, the literature was initially reviewed (scientific articles and research studies were used as the background), development techniques were established, and an OHSMS was proposed, with prior evaluation from the contractor. Subsequently, this study presents the general requirements, planning, implementation, verification, and the corresponding review by the appropriate authority. Finally, the model is established, supported by tables that will report the current state of the company and the implementation process. This study concludes with the execution of OHSMS in case of mining contracts.

Water management is a global challenge. Important facts of current concern in the water sector are: water scarcity threatened by the increasing consumption, safe drinking water supply resources threatened by climate changes and pollutants discharged from anthropogenic activities; and the accelerated urbanisation demanding adequate water supply together with the increasing wastewater generated by the growing urban population. These issues are becoming an imperative need that could be effectively addressed through adaptive water management strategies for the sustainable development of the societies worldwide. Metropolitan areas exemplify the rapid increase of urban population within a relative small area, which consequently results in the overexploitation of water supplies. Together with this overexploitation, human health could be threatened due to the water-health nexus in terms of water quality and quantity. The specific case study of this research: the Metropolitan Area of Merida (MAM) in Yucatan, Mexico has been analysed in order to exemplify the use of a decision maker’s tool to improve public health through the identification of major water pollutants and correlate them with waterborne diseases documented in epidemiologic statistics. The focus of this research was on two indicator contaminants: Faecal coliforms as microbial indicator of water quality, representing the non-conservative pollutants, and nitrate as chemical indicator of water quality, an example of a conservative pollutant that may persists in the groundwater for decades. Seven engineering interventions have been tested to identify most suitable management strategies through the following steps: 1. Quantify pollutants in the aquifer with the Sustainable Integrated Water Management Model (SIWMM), using a system dynamics approach; 2. Outcomes of the model served to quantify a) Public health risks posed from faecal coliforms through Quantitative Microbial Risk Assessment (QMRA), and b) Economic savings associated with pollutants reduction, 3. Develop cost benefit analysis of selected interventions, and 4. Identify the most suitable intervention in order to assist decision makers to cope with a sustainable supply of safe water and an integrated water management. The model framework developed in this thesis identifies the installation of soil absorption systems into septic tanks at household level, and installation of treatment plants for livestock wastewater as the most cost-benefit interventions of substantial positive impacts on groundwater quality and public health and, in addition, economic benefits.

L'objet de cette thèse est d'étudier les liens qui existent entre les déséquilibres macroéconomiques et les crises, et de voir dans quelles mesures leur prise en compte peut aider une meilleure gestion des crises dans les pays de la zone euro. Les différents chapitres de cette thèse tentent d'apporter des réponses à trois questions importantes : Quels sont les indicateurs macro-financiers qui pourraient aider à mieux anticiper les épisodes de stress budgétaire dans les pays de la zone euro ? Quelles seraient les conséquences de la mise en place d'un système de garantie des dépôts bancaires sur les variables macroéconomiques et sur le comportement des investisseurs, investisseurs qui tiendraient compte du risque de défaut souverain ? Dans quelle mesure une meilleure qualité des institutions, de la gouvernance pourrait-elle aider à améliorer la croissance de long terme d'une économie contrainte sur le marché international des capitaux ? En retenant une approche de court terme, les deux premiers chapitres montrent l'importance de la confiance des marchés dans l'analyse du lien entre déséquilibres macroéconomiques et crises. Dans le troisième chapitre, nous adoptons une perspective de plus long terme pour analyser les effets de cette confiance des marchés sur la dynamique de la croissance. Notre approche est à la fois théorique et empirique. L'approche théorique se base sur les modèles DSGE (modèles d'équilibre général stochastiques dynamiques et la modélisation d'une crise dans une petite économie ouverte. L'approche empirique se focalise sur les modèles Probit/Logit sur données de panel et sur un modèle d'alerte fondé sur des signaux avancés (early warning indicators)
This dissertation consists of three essays on how macro-financial imbalances precede crises and to what extent their consideration can help better management of crises in the Eurozone countries. The different chapters of this thesis, try to answer three important questions : What are the macro-financial imbalances that exposed the Euro area countries to fiscal stress before the outbreak of the debt crises in Europe? What are the impacts of sovereign default and deposit guarantee on macroeconomic variables and on the behavior of investors ? To what extent could better institutions/governance help to improve the long-term growth in a constrained economy on the international capital market ? Using a short-term approach, the first two chapters show the importance of market confidence in analysis of the link between macroeconomic imbalances and crises. In the third chapter, we adopt a long-term perspective to analyze the effects of this market confidence on the dynamics of growth. Our approach is both theoretical and empirical. The theoretical approach is based on the DSGE models (dynamic stochastic general equilibrium models) and the modeling of a crisis in a small open economy (SOE). The empirical approach focuses on Probit/Logit models for panel data and on Signal model based on early warning indicators

Formulary decision-makers must make choices based upon the safety, efficacy, and projected budgetary impact of medications. Models used to predict cost impacts are rarely assessed to determine how accurately they predict treatment cost changes. The purpose of this research was to assess the ability of a decision analytic based deterministic model and a regression analytic based stochastic model to predict the average diabetes-specific costs incurred by a managed care organization during the 12 month period following the addition of metformin to an HMO formulary. The ability of the stochastic model to predict the average diabetes-related costs and total health care costs was also assessed. The deterministic model, a decision tree, was constructed within an equilibrium framework using literature-based probabilities and internal costs to predict the expected diabetes-specific costs. The estimate of the total diabetes-specific cost impact came within 5% of the actual costs. The model underestimated the diabetes-specific medical costs (predicted was 73% of actual) and overestimated the diabetes-specific pharmacy costs (predicted was 258% of actual). A regression model was constructed using medical and pharmacy claims data to predict the expected diabetes-specific, diabetes-related and total health care costs. The average total cost estimates produced by the total health care cost model were within 7% of the actual average costs incurred. The diabetes-related and diabetes-specific cost models produced estimates that were within 12% and 18% of the actual costs incurred, respectively. The total, diabetes-related, and diabetes-specific average medical costs produced by the regression models were within 6%, 50%, and 46% of the actual costs respectively. The total, diabetes-related, and diabetes-specific average pharmacy costs were within 20%, 45%, and 49% of the actual costs respectively. Further research is needed to determine the best way to construct a model to estimate the economic impact of adding a medication to the formulary. A decision tree constructed with internal data should be used to predict the disease-specific economic impact of adding a medication to the formulary when only medical and pharmacy claims data from the previous year are available. A regression model should be used to predict the total health care cost impact.

This quantitative study was an evaluation of the effectiveness of the online Training Home software program, designed for use with a national nonprofit business model. This study was undertaken because nonprofits have a difficult time resourcing training. If the Training Home program can deliver a comprehensive training program for minimal cost, then a nonprofit will be better able to deliver on the nonprofit’s stated mission. For this study, six research questions centered on measuring the helpfulness of the program, the difference in job function training, improved knowledge of a national nonprofit, and perception of the Training Home program between those that had and or had not used the program. Additionally, cost per unit of training, the number of training vignettes delivered, time spent in training, ease of use by supervisors, and staff ratings of the effectiveness of the training home program. The population studied was the 450 staff at one affiliate of the national nonprofit. This staff group consisted of a mix of genders, ages, and education levels. This study used archival data gathered over the 2013, 2014, and 2015 calendar years and was analyzed using multivariate regression and descriptive analyses. The cost and number of training vignettes delivered in a 24-month period were compared to determine whether the Training Home program was a more cost-effective delivery model than the prior system for the year before the study. Analyses indicate that the Training Home program delivered more training to staff at a lower cost per unit of training when compared to the units of training delivered in the prior model. Supervisors and staff reported the program to be effective in knowledge management and tracking and the training of all staff. The study had positive results for the sample studied. It would be beneficial for any future studies to expand the sample size into other geographic regions.

An important part for projects, organizations etc. is to have a good system of how to manage information so that it´s constantly updated, accurate and available for all affected operators. Current degree project is performed on behalf of the IT-company Eurostep AB who has developed a software named Share-A-space for information management and they are now interested to see if there are any demands for Share-A-space in the field of urban development. During the degree project, a model was built using Share-A-space and the model is called CIM (City Information Model). The objective with the degree project was to investigate how information is managed today at the Administration of Urban Development, Stadsbyggnadsförvaltningen, at Eskilstuna municipality and if CIM would facilitate their work. A deeper investigation was made to locate where processes can be more efficient and how functions that CIM contains would be helpful. The degree project contains a literature study, a case study and a result where the literature study contains an environment monitoring, today’s visions of a future coherent digital work approach within municipalities and procedures for urban development. The case study contains information how Eskilstuna municipality is managing information, it also contains a description of how the model was built. The result contain information of how the model operates and the responds from interviews performed after a presentation of the model at the municipality. This degree project concludes that CIM in some ways definitely could be a valid alternative in the municipal work. The municipality didn’t see any benefits by having access to all technical information regarding all specific objects in the city. Processes would on the other hand, become more efficient and CIM would be a helpful tool in planning processes and contribute to make the municipal work more transparent. There were functions in CIM, especially the function to “travel in time”, that was considered extra useful for the employees at the municipality when planning the city but also for private residence to receive a greater understanding of future plans. To implement CIM would, on the other hand, be a resource demanding process which the municipality can´t perform at the moment without receiving financial support.

Over the past three decades, globalisation and rapid technological advances have fundamentally changed socio-economic structure and have widespread impacts on the nature of work and workplace health (U. Beck, 2000; Bertucci & Alberti, 2004; Bhalla, 1996; Chu & Dwyer, 2002). They have led to fierce global competition, altered the nature of work and exposed employees to new health risks (Chu & Dwyer, 2002; Stitzel & Jarvisalo, 1997). Fierce market competition demands enterprises and industries to build new competencies, restructure and improve productivity and efficiency. Associated with these changes are increased work pressures, weakening commitment to occupational health and safety, and many negative impacts on workers’ health (G. Breucker, 2006; Missler & Theuringer, 2003; WHO, 2003). Evidence shows that the world is facing growing burden of work related fatalities, injuries and diseases, particularly a dramatic increase of work stress. As part of the global community, Taiwan has also encountered similar workplace challenges in the rapidly changing environment. It also has to confront with increasing costs from the burden of work-related injuries and diseases and to find appropriate ways to deal with the serious problems (Council of Labour Affairs Taiwan, 2003, 3005; IOSH, 2002). As the success of organisations relies on having well-qualified, motivated and healthy employees, it is essential to seek effective means to protect and promote the health of the working population (ENWHP, 2005). The integrative workplace health promotion (IWHM) model emerging in the 1990s, is regarded as a comprehensive means to address multiple determinants of health and promote employee health (G. Breucker, 2006; Chu, 2003b; WHO-WPRO, 1999). There have been a great number of international successful examples demonstrating the benefits from implementing the IWHM programs (ENWHP, 2002; Chu, Breucker, Harris, & et al., 2000). In response to these workplace challenges and new occupational health risks, Taiwan has followed the international trend to initiate a series of workplace health promotion (WHP) programs since 2001 (Bureau of Health Promotion Taiwan, 2006). However, a preliminary study revealed that many WHP projects in Taiwan have met with difficulties in encouraging employee participation and sustainable development of the programs. These results were not surprising as the majority of the WHP programs in Taiwan tended to narrowly focused on physical activities, weight control and smoking cessation, while ignoring employee needs and problems relevant to specific workplace concerns (Bureau of Health Promotion, 2003; Hsu, Chang, Peng, & Chen, 2002; Hsu, Chen, & Wu, 2004). In this regard, the comprehensive IWHM which aims to meet employee health needs and improve organisational environment may present an effective means for Taiwan to address complex workplace health issues and to create healthy and sustainable workplaces. This research aims to investigate the applicability of the IWHM model in Taiwan to deal with workplace health problems. Apart from reviewing literature and relevant case studies from international communities and in Taiwan, this study conducted a small scale pilot study and a comprehensive needs assessment at selected workplaces in Taiwan as an experiment to test the applicability of the IWHM model. In practice, this research project targeted the civil servants working at the Liming governmental community in Taichung, Taiwan as the research subject. It involves a combination of qualitative and quantitative methods for data collection and analysis. A variety of data collection techniques including in-depth interviews, focus groups, participant observations, secondary data analysis and questionnaire surveys are used to investigate the workplace health and safety problems and the staff’s health needs. A triangulation technique is used to compare and contrast the different sources of information. The findings indicated that the IWHM model is applicable in the Liming community in terms of feasible methodological approaches using a needs-based program development and implementation process, and positive program outcomes such as stair improvement to prevent falls and the establishment of long-term health management, meaningful participation, practical program activities and holistic evaluation. For potential program sustainability, this project has involved employee representatives in program implementation and taking in charge of the ongoing program activities, and has managed to establish interdepartmental partnership to address common workplace health issues. Even though this research project has not made great progress, it has been moving toward meeting the project objectives and the organisations’ needs. From the Liming experience, this research provided recommendations for future development of WHP in Taiwan including: 1) develop national policies to define clear responsibilities in WHP development at different levels; 2) establish appropriate capacity building and training programs; 3) develop practical guidelines and tools tailored to suit Taiwan’s local conditions and needs; 4) set up effective evaluation and quality management system; 5) provide a professional or technical support team to assist workplaces or industries with the development and implementation of WHP programs.

The price of industrial progress is the potential for exposure of an increasingly informed public to chemical hazards in the environment. Of particular concern are acute exposures to chemical incidents, where problematic health risk assessments have highlighted the lack of expertise and resources available to support public health professionals in Wales responsible for protecting the health of populations. A systematic literature review of chemical incident databases, public health surveillance systems and major chemical incidents worldwide was used to guide the development of the first active, multi-agency community-based public health surveillance system for acute chemical incidents to be undertaken in Europe. A total of 642 acute chemical incidents were reported in Wales from all sources over a three year period. Of the 270 incidents reported by the primary source, chemical spills were the most frequently reported type of incident (28%) and operational industrial sites the most common location (25%). Of the estimated 238,000 people exposed, 528 reported symptoms in a total of 57 incidents. A single chemical was implicated in 86% of the incidents. Shortfalls were identified in the current expertise and resources available to public health professionals in Wales, leading to the development of a public health management model for acute chemical incidents. Model development took place in the context of United Kingdom - wide initiatives and involved the conduct of structured interviews with 41 organisations with interests in the field. The model selected for Wales was implemented on 1 February 1997 and comprised three levels of operation: (a) accountability for the protection of public health vested in health authorities at the local level; (b) a subscription-based front-line advisory and support unit to those authorities; (c) and a centrally funded national co-ordinating centre to provide the necessary evidence-base through programmes of surveillance, training, and emergency planning.

Over the past three decades, globalisation and rapid technological advances have fundamentally changed socio-economic structure and have widespread impacts on the nature of work and workplace health (U. Beck, 2000; Bertucci & Alberti, 2004; Bhalla, 1996; Chu & Dwyer, 2002). They have led to fierce global competition, altered the nature of work and exposed employees to new health risks (Chu & Dwyer, 2002; Stitzel & Jarvisalo, 1997). Fierce market competition demands enterprises and industries to build new competencies, restructure and improve productivity and efficiency. Associated with these changes are increased work pressures, weakening commitment to occupational health and safety, and many negative impacts on workers’ health (G. Breucker, 2006; Missler & Theuringer, 2003; WHO, 2003). Evidence shows that the world is facing growing burden of work related fatalities, injuries and diseases, particularly a dramatic increase of work stress. As part of the global community, Taiwan has also encountered similar workplace challenges in the rapidly changing environment. It also has to confront with increasing costs from the burden of work-related injuries and diseases and to find appropriate ways to deal with the serious problems (Council of Labour Affairs Taiwan, 2003, 3005; IOSH, 2002). As the success of organisations relies on having well-qualified, motivated and healthy employees, it is essential to seek effective means to protect and promote the health of the working population (ENWHP, 2005). The integrative workplace health promotion (IWHM) model emerging in the 1990s, is regarded as a comprehensive means to address multiple determinants of health and promote employee health (G. Breucker, 2006; Chu, 2003b; WHO-WPRO, 1999). There have been a great number of international successful examples demonstrating the benefits from implementing the IWHM programs (ENWHP, 2002; Chu, Breucker, Harris, & et al., 2000). In response to these workplace challenges and new occupational health risks, Taiwan has followed the international trend to initiate a series of workplace health promotion (WHP) programs since 2001 (Bureau of Health Promotion Taiwan, 2006). However, a preliminary study revealed that many WHP projects in Taiwan have met with difficulties in encouraging employee participation and sustainable development of the programs. These results were not surprising as the majority of the WHP programs in Taiwan tended to narrowly focused on physical activities, weight control and smoking cessation, while ignoring employee needs and problems relevant to specific workplace concerns (Bureau of Health Promotion, 2003; Hsu, Chang, Peng, & Chen, 2002; Hsu, Chen, & Wu, 2004). In this regard, the comprehensive IWHM which aims to meet employee health needs and improve organisational environment may present an effective means for Taiwan to address complex workplace health issues and to create healthy and sustainable workplaces. This research aims to investigate the applicability of the IWHM model in Taiwan to deal with workplace health problems. Apart from reviewing literature and relevant case studies from international communities and in Taiwan, this study conducted a small scale pilot study and a comprehensive needs assessment at selected workplaces in Taiwan as an experiment to test the applicability of the IWHM model. In practice, this research project targeted the civil servants working at the Liming governmental community in Taichung, Taiwan as the research subject. It involves a combination of qualitative and quantitative methods for data collection and analysis. A variety of data collection techniques including in-depth interviews, focus groups, participant observations, secondary data analysis and questionnaire surveys are used to investigate the workplace health and safety problems and the staff’s health needs. A triangulation technique is used to compare and contrast the different sources of information. The findings indicated that the IWHM model is applicable in the Liming community in terms of feasible methodological approaches using a needs-based program development and implementation process, and positive program outcomes such as stair improvement to prevent falls and the establishment of long-term health management, meaningful participation, practical program activities and holistic evaluation. For potential program sustainability, this project has involved employee representatives in program implementation and taking in charge of the ongoing program activities, and has managed to establish interdepartmental partnership to address common workplace health issues. Even though this research project has not made great progress, it has been moving toward meeting the project objectives and the organisations’ needs. From the Liming experience, this research provided recommendations for future development of WHP in Taiwan including: 1) develop national policies to define clear responsibilities in WHP development at different levels; 2) establish appropriate capacity building and training programs; 3) develop practical guidelines and tools tailored to suit Taiwan’s local conditions and needs; 4) set up effective evaluation and quality management system; 5) provide a professional or technical support team to assist workplaces or industries with the development and implementation of WHP programs.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
Griffith School of Environment
Faculty of Environment and Planning
Full Text

Degree awarded (2003): DPhPH, Health Services Management and Leadership, George Washington University
Abstract Community partnerships are an increasingly popular strategy for improving community health. This popularity is based less on evidence than on rhetoric. This research developed and tested a systems model of partnership to improve the practice of collaboration in public health. Basing the need for partnerships on the multi-sectoral nature of health, the model used open systems theory to set out requirements for partnership. Institutional theory suggested that problems faced by partnerships may result from partners meeting requirements for legitimacy. Change is, therefore, required, both in organizations and in their institutional environment. Using exploratory case studies, the study design involved site visits to two community health partnerships (West Virginia Community Voices and Healthy New Orleans). Mixed qualitative methods included semi-structured interviews, focus groups, and document review. Analysis involved interpreting informants responses in terms of evidence representing the model and for new elements. Evidence from practice suggested several revisions to the model. One involved applying a typology of organizational affiliation, with partnership toward one end of the continuum. Use of this typology permitted an extension of the model to understand the form of affiliation practiced by Community Voices and of Healthy New Orleans. Multiple opportunities to network and build coalitions in Community Voices led to increased chances of success in achieving health improvement goals. Networking opportunities for individual volunteers led to an informal Healthy New Orleans organization. Results of this research led to an analytic fit between the two sites and the community health partnership model. Recommendations are offered for practice, research, and for funding agencies. With further research, the model can be used to develop practical tools to guide and assess partnerships as a strategy to improve health, as well as to identify environmental barriers to partnership and strategies for change.
Advisory Committee: Kathleen Maloy JD PhD (Chair), Vincent Lafronza ScD, Chris Johnson EdD

In the healthcare environment, various types of patient information are stored in electronic format. This prevents the re-entering of information that was captured previously. In the past this information was stored on paper and kept in large filing cabinets. However, with the technology advancements that have occurred over the years, the idea of storing patient information in electronic systems arose. This led to a number of electronic health information systems being created, which in turn led to an increase in possible security risks. Any organization that stores information of a sensitive nature must apply information security principles in order to ensure that the stored information is kept secure. At a basic level, this entails ensuring the confidentiality, integrity and availability of the information, which is not an easy feat in today’s distributed and networked environments. This paved the way for organized standardization activities in the areas of information security and information security management. Throughout history, there have been practices that were created to help “standardize” industries of all areas, to the extent that there are professional organizations whose main objective it is to create such standards to help connect industries all over the world. This applies equally to the healthcare environment, where standardization took off in the late eighties. Healthcare organizations must follow standardized security measures to ensure that patient information stored in health information systems is kept secure. However, the proliferation in standards makes it difficult to understand, adopt and deploy these standards in a coherent manner. This research, therefore, proposes a standards-based security model for health information systems to ensure that such standards are applied in a manner that contributes to securing the healthcare environment as a whole, rather than in a piecemeal fashion.

Traditional nursing homes are based on a model that can limit a resident’s ability to make basic choices, minimize opportunities to direct their own lives, and ultimately destroy the human spirit. As an alternative to the traditional model, the household model is an arrangement in which small groups of residents direct their daily lives in a shared home setting (a household), supported by a decentralized self-led service team of frontline professionals empowered to be responsive to the residents’ needs. While many frontline nursing staff members are advocates of the need for change, it is also common for them to react negatively toward the process of household model implementation. The purpose of this qualitative study was to examine nurse aides’ and licensed nurses’ reactions to household model implementation. Sixteen semi-structured interviews were transcribed verbatim, divided into 524 units of meaning, and coded using concepts of Oreg, Vakola, and Armenakis’ (2011) theoretical model, derived from 60 years of qualitative studies on change recipients’ reactions to organizational change. In this model, employee reactions are a function of antecedents, categorized as pre-change (individual characteristics and internal context) and change antecedents (change process, perceived benefit/harm, and change content). Antecedents influence affective, cognitive, and behavioral reactions to change and, subsequently, lead to change consequences, including work-related and personal consequences. Two trained independent coders reviewed transcripts and achieved 70% agreement. Explicit reactions accounted for 48% of comments, followed by antecedents (27%) and change consequences (25%). Most common antecedents were related to change process (71%), perceived benefit/harm (24%), and change recipient characteristics (4%). Study participants reported difficulties with cross training, initial experiences of hardship and fear, confusion over the new model, and perceptions that it would be harmful to staff members and residents. Although experiences improved over time, some staff members, who self-identified as positive individuals, still reported perceived harm and engaged in resistant behaviors. Explicit reactions to change were behavioral (41%), cognitive (33%), and affective (26%). Most staff members supported household model implementation through their actions. They communicated with each other to learn and to cope with change. While three staff members actively resisted changes, they still supported at least some aspects of the household model. Cognitive and affective reactions were mixed, ranging from excitement and happiness to fear, nervousness, and frustration. Core household model components were received as positive, especially for residents. Concerns regarding work accounted for 94% of all reported organizational change consequences and included insufficient household staffing, harder working conditions, insufficient time to get everything done (or to do it well), and widespread feelings of isolation. The theoretical model for analyzing organizational change proved to be useful in understanding nursing staff members’ reactions to household model implementation and for identifying proactive steps to manage this change. Ongoing education is recommended to ensure staff members follow through with changes over time and to reduce confusion and perceptions of harm. The household model may need to be staffed at a higher level, at least initially, to maintain the same quality of care as in the traditional care delivery model. Ongoing team training within each household can serve to improve operations and balance responsibilities of blended roles. Due to the decentralized environments, potential feelings of isolation among residents and staff members are anticipated, which can be alleviated through regular multi-household gatherings.

Estuaries require sufficient quantity, quality and appropriate timing of freshwater inflow, referred to as environmental flow requirements, to ensure adequate health and functioning. In South Africa the environmental flow requirements of estuaries is determined using Resource Directed Measures (RDM). The present health and importance of an estuary must be considered when determining the ecological flow required to maintain an estuary in its desired state. An Estuarine Health Index that quantifies changes in abiotic and biotic components from natural conditions to present day is used. Health of biotic components is assessed according to changes in species richness, abundance and community composition. There has, however, been debate regarding the calculation of these attributes. In particular, for macrophytes, the inclusion of all habitat within the Estuarine Functional Zone (i.e. 5 m topographical contour) would affect the health and changes over time determined in past assessments. This is due to different areas being included as different areas would be included The aim of this study was to test the validity and suggest improvements to South Africa’s RDM macrophyte health score determination. The health of macrophytes were assessed at varying levels of intensity from desktop studies to thorough field studies. Rapid field studies provided a visual estimate of macrophyte health; while the intermediate and comprehensive assessments quantified change by mapping the distribution of macrophyte habitats from aerial photographs. These approaches were applied to the 64 estuaries within the Mvoti-Mzimkulu Water Management Area (WMA 11), situated in KwaZulu-Natal (KZN) on the subtropical east coast. Historically, these estuaries have supported restricted macrophyte habitats. Consequently, estuaries that presently or historically supported range limited habitats such as mangroves and swamp forest are considered important. Submerged macrophytes are scarce in KZN estuaries due to siltation and low turbidity and thus estuaries supporting this macrophyte habitat are also important. Based on available literature important estuaries were highlighted and selected for field studies. Transects spanning from the estuary water channel to the boundary of the EFZ provided a generalised distribution of KZN vegetation along an elevation gradient. The transition from estuarine to terrestrial vegetation can be used to improve the current EFZ boundaries, as estuarine area has been found to occur outside of the 5 m contour in some estuaries. Results from the desktop assessment indicated that most of the estuaries are moderately modified. There was a 50 % similarity in the macrophyte health scores determined by the desktop assessment to the 2011 National Biodiversity Assessment (NBA). Field studies mostly confirmed the desktop assessment aside from seven estuaries that had different scores. There has been a significant loss of macrophyte habitat with 100% loss of certain habitats from 9 of the 22 estuaries for which there were field assessments. Submerged macrophytes were not found at any of the estuaries that were assessed in the field. Black mangroves, Bruguiera gymnorrhiza (L.) Lam., were rediscovered at Ngane Estuary, however the few individuals could not be considered a ‘mappable’ community (i.e. <0.5 ha). Mtamvuna and Mkomazi estuaries both supported small stands of mangroves that, compared to data from 2006, appeared healthy. Macrophyte habitats and surrounding coastal forest matched the species composition described in the Vegetation Map of South Africa. The freshwater mangrove or Powder puff tree, Barringtonia racemosa (L.) Roxb, was not abundant in the estuaries. It was only found at four (Damba, Fafa, Little Amanzimtoti and Mvoti) of the estuaries that were assessed in the field. Important estuaries, from a botanical perspective, included some of the larger estuaries such as Mgeni, Durban Bay and Sipingo. Smaller, healthier estuaries that presently support mangrove and swamp forest habitat were also identified as important from a botanical perspective. Macrophyte habitats have mainly been lost due to non-flow related pressures. Sugarcane cultivation occurred within the floodplain of 25% of the estuaries. Nutrient enrichment was evident for 12.5% of the estuaries and reed encroachment was evident for 27% of estuaries for which there were field assessments. Development, aside from the N2 road bridges, was evident for 40% of the estuaries assessed in the field. Invasive plant species, including aquatic invasive plants, were present in all estuaries assessed in the field. The extent of invasive plant species was related to the degree of disturbance and surrounding land use pressures. The Mkomazi and Mvoti estuaries that were assessed at a comprehensive level, as they have earmarked for further water abstraction, had the poorest macrophyte health scores. The macrophyte health of these estuaries was much lower than previously determined by the NBA. The decline in health was attributed to the removal of macrophyte habitat for sugarcane cultivation and development as well as displacement by invasive plant species. The areas covered by the macrophyte habitats also differed from the NBA highlighting the importance of updated mapping and ground truthing. Largely differing macrophyte health scores were produced when attributes were calculated using different combinations of macrophyte habitats. Results indicate that only macrophyte habitats and no other floodplain vegetation should be included when calculating abundance. All macrophyte habitats, physical habitats and floodplain should be incorporated when calculating community composition. The minimum of these attributes is used as the overall macrophyte health score as a precautionary approach is followed. Scoring of health is subjective and the only benchmark for determining the most appropriate method is comparion with previous RDM studies. This study illustrates the need for a standardised RDM scoring method that is presented in a manner that ensures the same results irregardless of the speciliast conducting the study. The updated estuary health and importance scores for WMA 11 are necessary to inform management, particularly as few of the estuaries receive formal protection. In conclusion, this study contributed to the limited knowledge of the estuaries of WMA 11 and assisted in determining appropriate methods for assessing the health and importance of estuary macrophytes.

Despite the level of organizational investment in training and performance improvement, little is known about the use of different models of case management as interventions for the ever-increasing health care issues in the United States. Based on Van Tiem, Moseley, and Dessinger's Performance Improvement/Human Performance Technology model, this case study used qualitative semi-structured interviews and quantitative archival aggregate patient data to answer the following research questions: RQ1. How did the implementation of the triad model of case management process improvement change case management processes and implementation methods? RQ1a. What happens to key performance indicators (cost of service, patient satisfaction, and quality of care) when the triad model of case management process improvement is implemented? RQ2. How did acceptance and resistance to a new case management model manifest themselves during the implementation of the triad model of case management process improvement intervention? Seven hospital employees answered questions regarding possible resistance to change during the implementation phase of this model of case management. Data analysis included comparisons of the participants’ responses regarding cost of care, quality of care, and satisfaction with services to quantitative archival measures of those variables. Mean comparisons of all three areas, cost of service, quality of care, and satisfaction with services, revealed that differences before and after implementation of the triad model were not significant. Participant interviews provided general indications that cost of service, quality of care, and satisfaction with services improved with the intervention of the triad model of case management. Participants generally also approved of the change to the triad model of case management following an initial period of concern about work disparity, which resolved with the separation of utilization review and case manager job duties. Recommendations for future research include waiting beyond the time frame used in this study to assess for change and further evaluating possible resistance to change in an organization using emerging trends in human performance technology (HPT) and the completed HPT process.

Public health was once synonymous with environmental health. However, as living conditions improved the two fields diverged. Environmental factors are again re-emerging as hazards human health. Increasing global reliance on agricultural and veterinary chemicals (AgVets) over recent decades has is now a serious public health concern. Evidence of their toxicity has prompted international efforts to minimize, monitor and manage exposure risks. Direct involvement of the primary health care workforce is seen as critical to this process, yet little data exists on the health burden on Australian rural communities imposed by these chemicals. The study presented here attempts to explore the impact of these chemicals on two rural communities in Victoria, and ascertain the how the existing primary heath care system responds to AgVet exposure issues. Health determinants are complex, and inter-related, and the client �provider interface is not an entity acting in isolation from other frameworks. The provider-client service relationship has evolved against a background of legislation and provider training. Many external factors also impinge, such as the structure and focus of the health sector, and Australia�s systematic approach to environmental and chemical management. Examination of this underlying infrastructure in Australia provided the background against which the issue of exposure to agricultural and veterinary chemicals was explored. A brief summary of international developments in this area served to provide insight as to what interventions may be introduced to address the issue of chemical exposure. A CATI (Computer Assisted Telephone Interview) survey of 1050 households sought the perspectives from two Victorian agricultural communities to gather self-reported AgVet exposure patterns and health data, and whether respondents perceived their health problems were linked to exposure. Respondents were also asked to comment on the primary health care service experiences from local providers, and which services they preferred to seek for health advice. Perspectives were then sought from all primary health care providers servicing these communities. Information was sought on their level of expertise in diagnosing, and managing exposure related illness, via face-to-face interviews, focus groups and paper surveys. The study revealed rural communities have a long history of hazardous exposure to toxic AgVets. Awareness of toxicity risks is growing, yet further scope exists to improve safe handling of chemicals. High levels of illnesses known be associated with AgVet exposure exist among rural populations. Many believe their own ill-health is linked to exposure, and express strong dissatisfaction with the apparent lack of environmental health expertise especially among their GPs. Health providers demonstrated limited understanding of the health impacts of AgVet exposure. The lack of environmental health expertise among the existing primary health care workforce means that health conditions associated with exposure to AgVets are not being identified, and the absence of health intelligence hampers health planning. In Australia, the health, environment and primary industries sectors function in effect, as distinct silos, with little cross-fertilisation. The United States has combined its agricultural chemical legislative authority to develop a focus on human health, establish direct links, and biomonitoring programs to protect human heath. The U.S. has also developed environmental health expertise at the primary health care level to address community needs as they arise. Strategies are required in Australia to connect the environment, chemical management and health portfolios, with respect to the emerging environmental issues of chemical exposure. There is a need also in Australia to inject environmental health capacity into the primary health care practice.

Abstract Cold is a very common physical risk factor in workplaces in circumpolar regions. Cold has many detrimental effects on human health and performance, and on the safety, quality and productivity of work. In this study a systematic general Cold Risk Management Model was developed, applied and evaluated. The model can be integrated in a company’s or an organization’s occupational safety, health, environment and quality (SHEQ) management systems and practices in workplaces. The Cold Risk Management Model and methods were later included in ISO 15743 Ergonomics of the thermal environment – Cold workplaces – Risk assessment and management. The Cold Risk Management Model and methods were applied in two case company’s SHEQ systems and practices in the fields of construction and maritime administration and services. Based on the case studies, the concrete cold risk management activities and the personnel training campaign resulted in immediate positive results and improved attitudes towards further development. At the national level, working in the cold was estimated to increase personnel costs in the construction industry annually by €50M, which is 3% of the industry’s annual personnel costs. This study also showed that the Cold Risk Management Model and methods are profitable. In the case construction company, the savings achieved by cold risk management activities at a construction site were 2.5 time the costs of those activities. A follow-up study in the case company in the field of maritime administration and services showed that implementation and dissemination of the Cold Risk Management Model and methods require systematic work also after the initial development process. The implementation process could and should be enhanced by early establishment of organization-wide guidelines, visible concrete actions, a training campaign and use of necessary external experts. This study also presents a Safety Management Matrix Model for analyzing development and implementation activities during the process time span
Tiivistelmä Kylmä on yksi yleisimmistä työympäristön riskitekijöistä pohjoisissa oloissamme. Kylmästä aiheutuu haittaa ihmisen toimintakyvylle ja terveydelle sekä työn turvallisuudelle, laadulle ja tuottavuudelle. Tässä väitöstutkimuksessa kehitettiin systemaattinen kylmäriskien hallintamalli osaksi yrityksen työterveys- ja työturvallisuus-, ympäristö- ja laatujohtamisjärjestelmiä (SHEQ). Kehitetty kylmäriskien hallintamalli menetelmineen on nykyisin osa standardia ”SFS-EN ISO 15743 Lämpöolojen ergonomia. Kylmät työpaikat. riskin arviointi ja hallinta”. Kylmäriskien hallintamallia ja sen menetelmiä sovellettiin ja edelleen kehitettiin kahdessa tapausyrityksessä rakennusalalla sekä merenkulun tukipalveluissa. Konkreettisista kehittämistoimenpiteistä ja henkilöstön koulutuksesta koettiin tapausyrityksissä saadun välitöntä hyötyä, ja ne johtivat positiivisiin asenteisiin jatkokehittämistyötä kohtaan. Tutkimuksessa arvioitiin kylmätyön myös lisäävän rakennusalan henkilöstökustannuksia vuosittain 50 miljoonalla eurolla, mikä oli 3 % alan vuotuisista palkkakustannuksista. Tapaustutkimuksen avulla osoitettiin, että kylmänhaittojen hallinta on kannattavaa. 20 henkilön rakennustyömaalla kylmänhaittojen hallinnalla saavutettavat säästöt olivat 2,5-kertaiset toimenpiteistä aiheutuneisiin kuluihin verrattuina. Merenkulun tukipalvelujen alalla toimivassa tapausyrityksessä tehdyn seurantatutkimuksen mukaan kylmäriskien hallintamallin käyttöönotto ja levittäminen yrityksessä vaatii kuitenkin aikaa ja systemaattista työtä. Mallin käyttöönottoa ja levittämistä voidaan tutkimuksen perusteella nopeuttaa kehittämistyön näkyvyydellä ja konkreettisuudella, koulutuksella, organisaatiotasoisten ohjeiden laatimisella aikaisessa vaiheessa sekä erityisesti asiantuntijatuen saatavuudella koko implementointivaiheen ajan. Tutkimuksessa syntyi myös turvallisuusjohtamismatriisi työkaluksi kehittämistyön suunnitteluun ja arviointiin

Coastal urban settlements require a special planning approach since they bring the concepts of &ldquo
urban&rdquo
and &ldquo
coastal&rdquo
together. In relation to the specific contents of these concepts, there are also different models of management plans. &ldquo
Urban Disaster Risk Management&rdquo
and &ldquo
Integrated Coastal Zone Management&rdquo
are two of them. Urban Disaster Risk Management model deals with the planning and management problems of urban settlements in the case of disaster risk conditions. Likewise, Integrated Coastal Zone Management model focuses on the whole coastal area and deals with the sustainable use and protection of all types of coastal resources. However, in case of urban coastal settlements, these models of management plans can be valid together, can overlap, and they can even conflict with each other. In this thesis study, these two models of management plan and their coexistence are considered. A Coastal Area Assessment Model is set up and applied for Iskenderun case. This model provides a detailed spatial analysis opportunity in planning and management of coastal urban settlement. Therefore the model offers a significant input for the planning process through determining urban and coastal risks at the same time. Coastal Area Assessment Model is a tool which takes both Urban Disaster Risk Management and Integrated Coastal Zone Management models&rsquo
concerns into account and evaluates the coastal settlement in terms of urban risk sectors and coastal management issues. This study also introduces an approach on classification of the coastal areas and coastal urban settlements while setting up the Coastal Area Assessment Model. Coastal Area Assessment Model becomes an advantageous tool since it has significant contributions to the planning process by making a simple risk analysis and guiding the proper utilization and protection of the population, built environment, and resources of the coastal areas. Risk sectors, coastal management issues, critical and prior intervention areas of a coastal urban settlement are easily determined, and preparation of development plans of a coastal settlement is guided by the implementation of Coastal Area Assessment Model. In addition to these, general principles on planning and management of coastal settlements are determined by the implementation of the model for the implementation conditions of Urban Disaster Risk Management model, Integrated Coastal Zone Management model, and the Coastal Area Assessment Model in Turkey are also discussed and presented.

The purpose of this study was to compare and contrast four age cohorts to determine: (a) if they have any preexisting knowledge about The Blue Zones Power 9 lessons for longevity, (b) if they are currently practicing any of the Power 9 lessons, and (c) to what extent they intend to adopt all or some of the Power 9 lessons in the future. The Transtheoretical Model of Behavior Change (DiClemente & Prochaska, 1982) guided exploration of the respondents’ adoption of the Power 9 lessons. There were four significant findings in this study. Physical activity and stress relief had similar results in that both the youngest and oldest age cohorts’ expressed higher frequencies than the two middle age cohorts. Wine consumption and adoption/intention to adopt the Power 9 also had similar results, demonstrating that as age increased, so did the frequency of wine consumption and adoption/intention to adopt the Power 9.

This study was conducted to investigate the requirements for the spatial modelling of current and future water demand in the Berg River Water Management Area in the Western Cape of South Africa in order to produce a prototype model from which annual water requirements could be computed and spatially visualised. To accomplish this the spatial distribution of water demand within the study area was first investigated. The data required to perform spatial water demand modelling of diverse land uses and socio-economic activities were evaluated. Finally, the question of improving spatial water demand modelling at the catchment scale was considered from both a systems design and a technical perspective. The resulting model consists of two main modules; one performing a rudimentary monthly soil water balance to obtain monthly and annual irrigation requirements, and another applying preconfigured determinant layers derived from land use to town zone layers in order to determine annual urban water use intensities per areal unit. The resulting model prototype follows a sequential workflow based on a series of components that combine to produce a spatial overview of water use intensity within the study area. Water demand was found to be predominantly irrigated agriculture in the upper reaches of the Berg (mainly wine grape) and was found to be dominated by intensive industrial users in the central and lower reaches. The model was designed so that new data could be introduced in order to expand the system where required, as well as allowing for updated datasets to be incorporated as they become available. Due to the uncertainties inherent in the modelling and approximation of real world phenomena, the importance of establishing a set of structured, stable, predefined user requirements and system specifications were noted as a fundamental requirement for improving model development and design efficiency and ensuring model validity. It was further found that incorporating additional datasets, covering parameters related to the system, may serve to improve model accuracy, but could easily lead to compounded errors if not correctly parameterised or adequately validated.

PONTIFÍCIA UNIVERSIDADE CATÓLICA DO RIO DE JANEIRO
COORDENAÇÃO DE APERFEIÇOAMENTO DO PESSOAL DE ENSINO SUPERIOR
PROGRAMA DE SUPORTE À PÓS-GRADUAÇÃO DE INSTS. DE ENSINO
O presente estudo, Saúde, Organizações Sociais e Trabalho, apresenta reflexões que apontam para uma perspectiva de desconstrução do modelo de atendimento à saúde enquanto sistema único, além da consolidação de um novo modelo de gestão das políticas públicas, que altera as relações de trabalho e, consequentemente, a correlação de forças sociais, que interfere na construção da política de saúde. A discussão sobre a política de saúde tem se conformado como uma das questões mais tratadas no âmbito da questão social no Brasil. Neste contexto, a saúde está atrelada às configurações das relações sociais na sociedade, sendo parte e expressão da estrutura macrossocietária e suas transformações históricas. No Estado do Rio de Janeiro, o loteamento das urgências e emergências hospitalares, em sua maioria, sob gestão das Organizações Sociais, revela a lógica de subordinação da saúde às relações sociais estabelecidas pelo capitalismo, suscitando contradições entre público e privado, que colocam em xeque a linguagem pública inerente aos direitos sociais e trabalhistas, em nome dos ideais mercantilistas. Nosso objetivo, portanto, consiste em contribuir para a compreensão dos determinantes da política de saúde na atualidade e a conformação dos modelos de gestão privada na administração dos serviços públicos, e consequentemente, seus rebatimentos sobre os profissionais de saúde, em um contexto de profunda precarização e exploração da classe trabalhadora.
This study presents, Health, Social Organizations and Work, reflections pointing to a deconstruction perspective of the health care model as a single system, and the consolidation of a new management model, amending labor relations and consequently the balance of social forces that interfere in the construction of health policy. The discussion on health policy has resigned as one of the most discussed issues in the social question in Brazil. In this context, health is linked to the settings of social relations in society, being part and expression of corporate macro structure and your historical transformations. In the state of Rio de Janeiro, the allotment emergency room and hospital emergencies, mostly under the management of social organizations, reveals the health subordination of logic to the social relations of capitalism, raising contradictions between public and private, posing in check public language inherent to social rights on behalf of mercantilist ideals. Our aim therefore is to contribute to the understanding of the determinants of health policy at the present time and the conformation of private management models in the management of public services, and consequently, its repercussions on health professionals in a context of deep insecurity and exploitation of the working class.

Colombia is a developing country with high mortality rates from trauma. The Valle de Aburra region centred around the city of Medellin has particularly high rates of intentional trauma. Improving emergency medical services could reduce mortality rates.
At the time of this investigation, there was no pre-hospital emergency care services in the Valle de Aburra. Thus, this thesis examines predictors of mortality from a case series of 1395 persons presenting to the Emergency department of the Hospital Universitario San Vicente de Paul (HUSVP). Overall mortality for this series was 9.31% and 37.5% of these deaths were retrospectively identified as preventable. Mortality for injuries involving the central nervous system (CNS) was higher at 14.4%. Using the TRISS method, higher than expected death rates were noted from pedestrian-motor vehicle incidents and trauma associated with firearms use.
Determinants of mortality and length of stay were identified using logistic regression. These included factors associated with the mechanism and site of injury and also with the process of care, both pre-hospital and in-hospital.
Based on these identified determinants, policies for integrated pre-hospital and hospital emergency care in the Valle de Aburra can be developed. Regionalizing these services could be expected to reduce both mortality rates and preventable deaths.

Thesis (Ph. D.)--West Virginia University, 2008.
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To better understand the value of those who engage in environmental stewardship of natural areas, we studied volunteer steward's motivation to participate, their sustainable behaviors and attitudes toward stewardship-related constructs. Specifically, we designed and conducted a survey of volunteers who work as stewards in urban natural areas in Portland, Oregon. We hypothesize that as volunteer frequency increases: participants will be more motivated to participate for environmental reasons, volunteers will be more likely to feel a strong connection to the stewardship site, participants will be more likely to engage in public pro-environmental behaviors, and their level of environmental literacy will increase. Participants were sampled using a face-to-face survey methodology over the course of late winter and spring of 2012 during 18 different Portland Parks and Recreation sponsored stewardship events. We examined the motivations, attitudes and behaviors of the volunteers, and devised appropriate management implications for those organizing volunteer efforts. We equated a three-tiered typology of environmental literacy, based upon the frequency of volunteer participation, and analyzed our survey data using a principal component analysis, generalized linear models, and a qualitative coding analysis. The most frequent participants showed a higher likelihood of participation in public environmental behaviors, whereas participants at all frequency levels were also likely to participate in private environmental behaviors, such as removing invasive plants in one's yard. Volunteers across all frequencies of participation were motivated to engage in stewardship events by a desire to help the environment. By understanding volunteers' motivations and linked behaviors, park managers may gain insights about the recruitment, retention, and messaging of volunteers upon whom they may depend to achieve restoration goals. We recommend considering volunteers' motivations and benefits derived from participation in messaging to recruit and retain volunteers. Additionally, park managers should take advantage of educational opportunities linked to stewardship events, such as training programs and chances for volunteer mentorship.

In this thesis, we focus on the so-called spectrum management's joint problem: efficient allocation of primary and secondary channels in channel bonding wireless local area networks (WLANs). From IEEE 802.11n to more recent standards like 802.11ax and 802.11be, bonding channels together is permitted to increase transmissions' bandwidth. While such an increase favors the potential network capacity and the activation of higher transmission rates, it comes at the price of reduced power per Hertz and accentuated issues on contention and interference with neighboring nodes. So, if WLANs were per se complex deployments, they are becoming even more complicated due to the increasing node density and the new technical features required by novel highly bandwidth-demanding applications. This dissertation provides an in-depth study of channel allocation and channel bonding in WLANs and discusses the suitability of solutions ranging from heuristic-based to reinforcement learning (RL)-based. To characterize channel bonding in saturated WLANs, we first propose an analytical model based on continuous-time Markov networks (CTMNs). This model relies on a novel, purpose-designed algorithm that generates CTMNs from spatially distributed scenarios, where nodes are not required to be within the carrier sense range of each other. We identify the key factors affecting the throughput and fairness of different channel bonding policies and expose critical interrelations among nodes in the spatial domain. By extending the analytical model to support unsaturated regimes, we highlight the benefits of allocating channels as wide as possible all together with adaptive policies to cope with unfair situations. Apart from the analytical model, this thesis relies on simulations to generalize channel bonding in dense scenarios while avoiding costly, sometimes unfeasible, experimental testbeds. Unfortunately, existing wireless network simulators tend to be too simplistic or too computational demanding. That is why we develop the Komondor wireless network simulator, with the essential advantage over other well-known simulators lying in its high event processing rate. We then deviate from analytical models and simulations and tackle real measurements through the Wi-Fi All-Channel Analyzer (WACA), the first system specifically designed to simultaneously measure the energy in all the 24 bondable Wi-Fi channels at the 5 GHz band. With WACA, we perform a first-of-its-kind spectrum measurement in areas including urban hotspots, residential neighborhoods, universities, and even a football match in Futbol Club Barcelona’s Camp Nou stadium. Our experimental findings reveal the underpinning factors controlling throughput gain, from which we highlight the inter-channel correlation. %We show the significance of the gathered dataset for finding new insights, which would not be possible otherwise, given that simple channel occupancy models severely underestimate the potential gains. As for solution proposals, we first cover heuristic-based approaches to find satisfactory configurations quickly. In this regard, we propose dynamic-wise (DyWi), a lightweight, decentralized, online primary channel selection algorithm for dynamic channel bonding. DyWi improves the expected WLAN throughput by considering not only the occupancy of the target primary channel but also the activity in the secondary channels. Even when assuming significant delays due to primary channel switching, simulations reveal important throughput and delay improvements. Finally, we identify machine learning (ML) approaches applicable to the spectrum management problem in WLANs and justify why model-free RL suits it the most. In particular, we put the focus on the adequate performance of stateless variations of RL and anticipate multi-armed bandits as the right solution since i) we need fast adaptability to suit user experience in dynamic Wi-Fi scenarios and ii) the number of multichannel configurations a network can adopt is limited; thus, agents can fully explore the action space in a reasonable time.
En aquesta tesi ens centrem en el problema conjunt de la gestió de l'espectre: assignació de canals primaris i secundaris a xarxes d'àrea local sense fils (WLAN) amb channel bonding. Des de l'estàndard IEEE 802.11n fins a estàndards més recents com el 802.11ac, el 802.11ax i el 802.11be, s'han anat proposant amplades de banda més grans per permetre agrupar canals, augmentant així l'amplada de banda total per transmissió. Tot i que aquest augment en l'amplada de banda afavoreix la capacitat potencial de les xarxes, suportant així els requeriments de les noves aplicacions Wi-Fi, també redueix la potència per Hertz i accentua els problemes de contenció i interferència entre nodes veïns. En resum, si les xarxes WLANs ja eren complexes per se, s'estan tornant encara més complexes a causa de l'augment de la densitat de nodes i de les noves prestacions incloses als darrers estàndards. Primer proposem un model analític basat en xarxes Markov en temps continu (CTMN) per caracteritzar channel bonding en WLANs saturades. Aquest model es basa en un nou algorisme que genera CTMNs a partir d'escenaris distribuïts espaialment, on no és necessari que els nodes estiguin dins del rang de contenció de la resta. Identifiquem els factors claus que afecten el rendiment i l'equitat de les diferents polítiques de channel bonding i mostrem l'existència d'interrelacions crítiques entre nodes en forma de reacció en cadena. D'això se'n desprèn que no hi ha una política channel bonding òptima única per a cada escenari. En ampliar el model analític per donar suport a règims no saturats, destaquem els avantatges d'assignar els canals tan amplis com sigui possible a les WLAN i implementar polítiques d'accés adaptatiu per fer front a les situacions que poden aparèixer tant en termes de rendiment com d'equitat. A part dels models analítics, aquesta tesi es basa en simulacions per generalitzar escenaris evitant costosos bancs de proves experimentals, de vegades inviables. Malauradament, els simuladors de xarxes sense fils existents solen ser massa simplistes o molt costosos computacionalment. És per això que desenvolupem el simulador de xarxes sense fils Komondor, concebut com una eina de codi obert accessible (llesta per utilitzar) per a la investigació de xarxes sense fils. L’avantatge essencial de Komondor respecte d’altres simuladors sense fils coneguts rau en la seva elevada velocitat de processament d’esdeveniments. A continuació ens desviem de models analítics i simulacions i abordem mesures reals a través del Wi-Fi All-Channel Analyzer (WACA), el primer sistema que mesura simultàniament l'energia de tots els 24 canals que permeten channel bonding a la banda Wi-Fi dels 5 GHz. Amb WACA, realitzem un estudi únic de localitzacions que inclouen nuclis urbans, barris residencials, universitats i fins i tot un partit a al Camp Nou, un estadi ple amb 98.000 aficionats i 12.000 connexions Wi-Fi simultànies. Les dades experimentals revelen els factors fonamentals que controlen el guany de rendiment, a partir dels quals ressaltem la correlació entre canals. També mostrem la importància del conjunt de dades recopilades per trobar nous factors claus, que d'una altra manera no seria possible, atès que els models d'ocupació de canals simples subestimen els guanys potencials. Pel que fa a solucions, primer discutim propostes basades en heurístiques per trobar configuracions satisfactòries ràpidament. En aquest sentit, proposem dinàmicament (DyWi), un algorisme de selecció de canal primari en línia, descentralitzat i eficient per xarxes channel bonding. DyWi millora el rendiment esperat tenint en compte no només l’ocupació del canal primari objectiu, sinó també l’activitat dels canals secundaris. Fins i tot quan suposem retards significatius a causa del canvi de canal primari, observem millores importants en termes de rendiment i retard. Finalment, identifiquem els enfocaments d’aprenentatge automàtic (o machine learning) aplicables al problema de la gestió de l’espectre a les WLAN i justifiquem per què l'aprenentatge del tipus reinforcement learning (RL) és el més adient. En particular, ens centrem en el rendiment adequat de les variacions d'RL sense estats i proposem multi-armed bandits com la solució adequada, ja que i) necessitem una adaptabilitat ràpida per millorar l’experiència d’usuari en escenaris Wi-Fi dinàmics i ii) el nombre de configuracions multicanal que una xarxa pot adoptar és limitat; per tant, els agents poden explorar completament l’espai d’acció en un temps raonable.

Thesis (S.M.)--Massachusetts Institute of Technology, Dept. of Aeronautics and Astronautics, 2002.
Includes bibliographical references (p. 235-236).
The space industry plans to develop new reusable launch vehicles. The new vehicles will need advanced, new guidance and control systems. Since 1996 Draper Laboratory has been developing the next generation guidance and control for reusable launch vehicles in which guidance and control is integrated into one correlated system. Draper's research of integrated guidance and control originated with a single loop multivariable control scheme using time-invariant linear quadratic regulator theory. The research has since evolved into the use of model predictive control theory. The main focus of this thesis is the theory and design of model predictive control for entry of aerospace vehicles. The goal is to develop design criteria and guidelines explaining how to select the model predictive control parameters: prediction horizon, simulation rates, and weighting matrices. A secondary goal is to tightly couple an onboard trajectory generation algorithm with the model predictive controller to improve tracking performance and robustness. Favorable tracking is achieved through two model predictive control architectures, which are discussed. The first architecture has an inner loop stability augmentation system with model predictive control used as an outer loop. The second architecture replaces the inner and outer loops with a single model predictive controller. The two architectures demonstrate the flexibility of model predictive control to adapt to new vehicles; the model predictive control may be used to augment an existing inner loop or may be used as a stand-alone controller. The design focuses primarily on the architecture without a stability augmentation system.
by Robert C. LePome, II.
S.M.

A finite element groundwater flow model was used to support a hydrologic assessment for a study area in the Lower San Pedro River Basin which contains the Bingham Cienega. Consolidated sedimentary rocks associated with an extension of the Catalina Core Complex truncate the floodplain aquifer system in the study area. The elevated water table produced by this "hardrock" results in spring discharge at the cienega and a locally gaining reach of the San Pedro River. The steady -state model suggests that recharge (and discharge) components for the floodplain aquifer sum to 3.10 cfs. Mountain front recharge, underflow, and stream leakage are the primary recharge mechanisms, while stream leakage, evapotranspiration, spring flow, and underflow out are sources for groundwater discharge. A steady -oscillatory model was used to account for seasonal periodicity in the system's boundary conditions. Monthly variation in the evapotranspiration rate was offset primarily by storage changes in the aquifer. Due to a lack of measured hydrologic data within the study area, results from the model simulations are only preliminary. Model development and the subsequent sensitivity analyses have provided insight into what type of data needs to be collected. Head measurements are most needed in the area just downstream from Bingham Cienega. The mountain front recharge and evapotranspiration rates are shown to be highly sensitive parameters in the model; improved estimation of these values would be helpful. Spring discharge would be a valuable calibration tool if it could be accurately measured. A more extensive record of stream baseflow in the San Pedro River should be established. After more hydrologic data is collected, the model could be recalibrated so as to better represent the system. Eventually, this tool may be used in direct support of management and/or restoration decisions.

This study utilized secondary data to understand weight-loss behaviors in obese adult women with hypertension. There are multifactorial reasons for obesity. This study attempted to clarify why people cannot lose weight and why many often regain weight. The gap in the literature relates to why the concepts such as perception of risk, benefits, and obstacles to action have not been found to cause individuals to achieve weight loss or to maintain weight loss. Secondary data were used from the NHANES dataset, a weighted dataset representative of the U.S. population. The sample used in this study included 411 obese hypertensive women over the age of 18. In all, six years of data from 2009–2014 were derived from the National Health and Nutrition Examination Survey (NHANES) dataset. Perception about the obstacles an individual confronts can be a barrier to successful weight loss. If an individual thinks success cannot be attained, efforts to lose weight will fail. Hierarchical regression analysis was used to assess the variables. The results indicated that only perception of weight acted as a cue to action for losing weight. That is, the perception of weight was the only statistically significant finding of reasons obese hypertensive women initiate weight loss efforts. Recommendations for future research include an investigation of the perception of weight status and body habitus, and to assess what triggers a poor perception of weight and body habitus as a cue to action to lose weight.

The thesis draws on historical and social policy perspectives to examine the factors influencing development and change in alcohol treatment policy between 1950 and 1990. The study uses data from primary and secondary documentation and from taped interviews. Three themes are highlighted as particularly relevant to an examination of policy trends. The first of these is the emergence and evolution of a `policy community'. Spearheaded by psychiatrists in the 1960s, the `policy community' broadened to include other professional groups and the voluntary sector by the 1990s. The second theme concerns the role of research in influencing the nature and direction of treatment policy. The study indicates increasing use of research as the rationale for policy and illustrates the move towards a `contractor' relationship between research workers and policy makers. The final theme deals with the influence on policy of ideological frames and changing conceptualisations of the alcohol problem. Two major shifts were important for treatment, the re-discovery of the disease concept of alcoholism in the 1950s and the emergence of a new public health model of alcohol problems in the 1970s. Within these broad themes, the study includes an examination of tensions - between different professional perspectives, between government departments with differing responsibilities, between different ideologies - and of moves to secure consensus in the formulation and implementation of treatment policy. The final chapter addresses shifts in thinking from the re-emergence of a `disease' model of alcoholism in the 1950s, to a `consumptionist' (population-based) model in the 1970s, towards a `harm reduction' approach to alcohol problems management in the 1990s. The thesis concludes that over the past forty years competing paradigms of the alcohol problem have emerged and gained policy salience within particular historical-social contexts in the search for policy consensus to manage the problematic aspects of alcohol consumption.

Thesis (MBA) -- Stellenbosch University, 2011.
A company’s primary goal is to make money. Simple as it may seem, this is not always easily achieved, and sustainability of the business may be a serious challenge. In an effort to make a profit, important aspects of safety, health, environment and quality (SHEQ) may sometimes be neglected. Some small and medium-sized enterprises (SME) merely do not have the understanding or the capacity to address all the important aspects of SHEQ, thereby placing the company under potential financial and legal risks. A survey was conducted in SMEs based in the Durban area to ascertain their level of legislative and voluntary system standard awareness and implementation. The questionnaire responses indicated that general awareness of legislation such as the Occupational Health and Safety Act, the Compensation for Occupational Injuries and Diseases Act, the National Environmental Management Act and voluntary system standards such as ISO 9001, ISO 14001 and OHSAS 18001 was relatively good, on the whole. However, implementation of the mandatory environmental requirements associated with the National Environmental Management Act was low, as was the implementation of the voluntary standards. Management and implementation of SHEQ responsibilities and requirement in larger organisations may be divided amongst various discipline specialists. However, in the SME these various disciplines may be the responsibility of one person, and often this person is the managing director. As such, this individual may not always have adequate time or understanding of the legal requirements of SHEQ aspects. There may also be a lack of understanding of the potential cost implications in not managing SHEQ aspects, and similarly budgeting requirements of managing SHEQ aspects appropriately. This research report introduces and summarises key SHEQ legislation and voluntary management system standards, such as the Occupational Health and Safety Act, the National Environmental Management Act, local bylaws, and introduces the ISO 9001, ISO 14001 and OHSAS 18001. Since some characteristics of the disciplines of health and safety, environment and quality may overlap, combining these into an integrated management system has merit. Such an integrated system can save the company time and money. This research report reviews some pertinent business requirements associated with SHEQ and presents an integrated management system guideline for the SME business owner. Business management, today, needs to learn from past business management developments. Successful and sustainable business management is not only about making a profit, but also incorporates a significant human resource management focus, health and safety assurance, the mitigation of potential environmental impacts from operations, whilst ensuring that quality standards of products and services are competitive.

This thesis examines the role of limited English proficiency (LEP) as a contributing significant barrier to the mental health access for Chinese living in America. The literature purports that language barriers do present significant challenges to providing timely and effective mental health services worldwide. Additionally, studies highlight two reoccurring themes on the mental health of Chinese Americans, including their underutilization of mental health services and the premature termination of treatment in comparison to other nonminority clients. Using the 2009 dataset from the California Health Interview Survey (CHIS) 2009 Adult Questionnaire, data was analyzed and it was concluded that a relationship exists between mental health status and language proficiency. Further study is necessary to determine where it may be best for health professionals to invest their efforts in the mental health care of this deserving population. It would behoove organizations, communities, and health care leaders to peer deeper into the interconnected relationship between mental health utilization and language proficiency.

Thesis (S.M.)--Massachusetts Institute of Technology, System Design and Management Program, 2009.
Includes bibliographical references (leaves 57-60).
The medical care of space crews is the primary limiting factor in the achievement of long-duration space missions. (Nicogossian 2003) The goal of this thesis was to develop a model of long-duration human space flight astronaut health and a medical supply demand model in support of such missions. This model will be integrated into an existing comprehensive interplanetary supply chain management and logistics architecture simulation and optimization tool, SpaceNet. The model provides two outputs, Alphah and Mass, for each set of input variables. Alphah is an estimate of crew health and is displayed as a percentage. Mass is a measure of medical consumables expended during the mission and is displayed in kilograms. We have demonstrated that Alphah is a function of three scaling parameters, the type of mission, duration of mission, and gender of crew. The type of mission and gender are linked to radiation fatality data published by NASA and mission duration correlates to predicted incidence of illness and injury and linked to the model through published US Navy submarine crew medical data. The mass of medical consumables (MMC) expended increases with the number of crew, the duration of the mission and the distance of the mission away from the earth. The degree of medical expertise on-board is not necessarily related to a change in consumption of medical supplies but perhaps to a better outcome for the individual infirmed crew member.
(cont.) We have determined that there is no information to incorporate gender into this aspect of the model and that the ages of the crewmembers would also have a negligible effect. Risk was investigated as an additional independent driver in the calculations. This parameter defined as likelihood of a medical event multiplied by impact to the mission, is in line with current NASA planning processes. Although the equations don't currently incorporate this parameter, implementation in subsequent versions of the model would allow for a more granular description of medical supply mass (i.e. laboratory and diagnostic, imaging, medications, surgical supplies, telemedicine and expert systems equipment) needed to support long-duration human operations in space. The framework of SpaceNet does not currently allow for this level of detail but future version of the software would likely develop and integrate this capability.
by Albert Assad.
S.M.

In rural areas of South Africa, there is a lack of education and implementation of menstrual hygiene management. The purpose of the study was to evaluate the suitability and hygienic safety of the menstrual cup used by girls and young women who have harsh living conditions. The study was performed in uMkhanyakude, KZN, South Africa, where the menstrual cup was introduced. The evaluation of the menstrual cup and the usage of it was carried out through interviews, forms, discussions and observations. Finally, the results from the follow-up was compiled to adapt the menstrual cup to the environment of rural areas of South Africa. It appeared that culture related problems were those which made the menstrual cup hard to implement. To minimize these issues, an idea was developed in the form of a model of a kit with a menstrual cup, a kettle and an informatory book.
WoMensCup

Thesis (S.M. in Engineering and Management)--Massachusetts Institute of Technology, Engineering Systems Division, System Design and Management Program, 2012.
Cataloged from PDF version of thesis.
Includes bibliographical references (p. 90-94).
Radiology is a medical specialty that employs imaging to diagnose and treat disease. It has long been an advance user of technology to capture, store, share, and use images electronically. In 2009, President Obama signed into law a measure, the HITECH Act (part of the stimulus package), that incentivizes healthcare providers to use electronic health records (EHR) in care delivery to improve quality, efficiency, safety, and reduce cost. The meaningful use (MU) program's Stage 1 requirements (part of HITECH Act) did not include imaging requirements, leading to confusion among radiologists and other specialties with regard to what MU offers to and requires of them. This thesis attempts to clarify the contribution radiology can make to MU by understanding radiology as a system, including its surrounding issues and its drivers, using Stage 1 MU requirements, data from qualitative research, and results from analysis. It answers the following question: Should Radiologists be considered part of the care team, leveraging EHR for meaningful use and hence eligible for incentive payments? It does so via the following methods: a) Discussing in detail current issues surrounding radiology systems from quality, safety, efficiency, and cost perspectives; b) Discussing MU in the context of radiology and reviewing what is missing in it for radiologists; c) Providing deeper systems analysis of current behaviors and why they have this form at this time; and d) Explaining how MU objectives can help to overcome many current issues and ultimately help to improve health outcomes. Specific changes to MU criteria to achieve these benefits are recommended. This thesis employs systems concepts and tools including system architecture and system dynamics for research and analysis to understand the system and derive hypotheses. A system dynamics model is used to analyze current drivers in imaging and to clarify the impact MU can have on these drivers. Thesis conclusions are supported by the analysis performed using the model as well as information gathered through industry interviews, online articles, academic and industry journals, and blogs.
by Palani Perumal.
S.M.in Engineering and Management

Health and safety management forms part of the overall risk management of medical institutions, and deals with the responsibility of an organisation to provide a risk free environment for all who are exposed to the activities of such medical institutions. Affected people include health care workers, contractors, visitors, and patients. Medical institutions, and hospitals specifically, are uniquely distinct from other industries in that they employ highly skilled staff with specific specialised knowledge. These institutions are also increasingly making use of complex technology that requires specialist staff to operate medical machines and equipment. These specific aspects are accounted for in this research. The overall purpose of this research is to determine the need for an alternative approach to the management of health and safety in medical institutions. An appropriate model will be developed that can be integrated into the existing health and safety management system. The research methodology for this study comprises the following steps: Firstly, the health and safety environment was researched in relation to all stakeholders, external and internal, that are affected by medical institutions’ activities. The effect of these activities, and how it influences health and safety management, was evaluated in a South African context. Secondly, the overall risk management approach of medical institutions and the effect of organisational culture were researched to determine the effect on health and safety performance. Thirdly, a questionnaire was sent to selected staff of five hospitals in the Eastern and Western Cape to determine their perception and experience of health and safety management. Quantitative data on incidents in Netcare Hospitals were obtained, and a comparison of the questionnaire studies was done to determine the need for a health and safety model. The final step of this study entailed the development of a health and safety model using legislative requirements and the needs identified in the research. A proposal is made to integrate specialist functions and departments into the existing health and safety management system, in order to strengthen the managerial capabilities of such a system. The importance of improving the safety and compliance culture is indicated.

碩士
高雄醫學大學
行為科學研究所
92
Asthma is one of the most common diseases among children and adults. Because of rising morbidity, mortality and medical costs all over the world, asthma becomes a very important issue. Taiwan is no exception. Bureau of National Health Insurance（BNHI） sets up the quality based payment system, a disease management system to improve payment of asthma, in order to raise the quality of taking care of these patients. The system has been practiced for two years. Therefore, it probably has made certain effect on regional hospital management. This study including difficulties and the responding strategies taken by the study objects, so as to make up the deficiencies of previous quantitative studies, to truly reflect workers’ experiences, and try to dialogue with current policies and systems, in order to offer some references to policy makers and service providers for further planning of asthma disease management. The subjects of the study are regional hospitals having practiced the asthma disease management for one year. The multimethod includes participant observation, depth interview, and related materials from medical institutions to seeking trustworthiness. The following points are significant findings of the study. First, the content of the management of asthma patients include setting up a work team, specialists of management asthma, set up management styles of asthma patients, intervention of related medical education, using information system to management asthma patients, strengthening effective information connections of medical resources, and the assessment of the result of asthma patients. Second, the gaps exist between the policy —makers and practical ways of hospitals, for example, a incomplete assessment of asthma severity, there are not use a personal best peak expiratory flow to measure patients’ lung function, the wrong opportunity of using IgE, an unclear definition of quality assessment indicator of the asthma disease management system, unmatched criterion of the asthma disease management care stepwise and hospital practice, the problem of BNHI Medical Claims, different opinions of the rule of asthma disease management. The following are the problems of exiting management system of asthma. For instance, work teams are not centered on patients, specialists of management asthma lack sufficient training, using information system to management asthma patients is not common, patients education must include culture factor, and insufficient follow-up assessments of asthma patients. The above results suggest to policy-makers and hospitals. First, policy-makers should establish a more thorough clinic criterion of asthma patients, redesign the referral system, re-assess the current payment, increase the communication channels of policy-makers and hospitals, and gather all information. Second, in hospitals, it is important to set up a work team centered on patients with intervention of health education, indicate education skills, and supportive information systems.