Дисертації з теми "Medical and Health Sciences not elsewhere classified"

This action research project examines the researcher’s journey of establishing a therapeutic relationship with a child with autism spectrum disorder during her practicum. Children with ASD present difficulty in communication and social relationship skills. As a student in training with a limited experience, the researcher had uncertainty and low confidence with regard to her clinical and professional skills which affected her work. In this project, the researcher has examined her own process of music therapy with a child with ASD and shows how she was able to improve her practice and therefore establish meaningful and effective therapeutic relationships with this client population and obtain valuable learning through the training. The study was conducted at a dedicated therapy centre in New Zealand where the researcher was in placement. A total of seven, thirty-minute weekly individual music therapy sessions and four supervision sessions were employed. This process was adapted into the design of action cycles which involved the repeated process of planning, action and evaluation. In-depth analysis of the researcher’s work was carried out throughout the cycles, using clinical notes, journal excerpts, supervision notes and video recordings of the sessions. The findings suggest that the researcher was able to improve her practice while attempting to build a therapeutic relationship with the client. Various clinical and personal issues arose such as uncertainty about improvisation, and lack of confidence in professional skills including communicating with parents, which led to disjunction and burnout symptoms. Discussions in supervision aided in in-depth reflection of the researcher’s work as well as emotional support. The researcher could ultimately develop ‘internal supervisor’ and was able to use independent strategies to help develop her work. Implications for training include making personal therapy a compulsory course requirement, providing training on professional skills, and student support groups. Future research may investigate the effectiveness of verbal input in music therapy and the emotional stages of parents.

Understanding public attitudes towards using animals for medical experimentation and the issues that cause public concern is of importance scientifically, economically and ethically. Although national opinion poll data appear to provide enough evidence to propose the hypothesis that 'the majority of people in Britain support animal research' it is clear from reviewing the literature that the attitudes of young people have not been adequately explored. Furthermore, the ethical considerations and scientific understanding underpinning such attitudes are also poorly understood. It is also clear that we have little comprehension of how ethnic minority groups in our society view animal experimentation (AE). The aim of this study is therefore to acquire a contemporary, comprehensive understanding of young people's perceptions of AL This is pursued by means of a custom made questionnaire that also seeks to explore knowledge/understanding and values/belief systems within a cross-cultural context. Qualitative aspects of the study, both verbal and pictorial, enrich the quantitative data generated, allowing a unique insight into how young people articulate their attitudes towards AE. The findings from this study reveal that young people hold a diverse array of attitudes towards AE. Their support is dependent on animal species, which for non-Islamic respondents appears to be based on traditional Western considerations of phylogenic hierarchy. For Islamic respondents, however, attitudes towards certain animals diverge from this phylogenic classification, being driven instead perhaps by traditional cultural relationships with animals. Cross-cultural differences of how animals are viewed were also apparent when value typologies were measured. Scales to assess the human-animal bond and instrumental attitudes towards animals demonstrate that Islamic respondents have a less emotional attachment to animals, viewing them more instrumentally. The human-animal relationship scales reveal no such differences. Young people appear to have a poor knowledge base regarding issues surrounding AE and have a negative image of animal welfare within research facilities. These perceptions correlate with attitudes towards AE and hence suggest that there is a need for greater communication between scientists and lay people regarding this issue. When compared with other scales measuring instrumental uses of animals, Islamic respondents supported AE to a lesser extent than might have been expected, which may reflect a lower level of general medical understanding. Gaining a greater understanding of young people's perceptions of AE is not only important in its own right but may also be of general benefit in the arena of public understanding of science. The recommendations from this study therefore suggest routes to strengthen scientific communication in regard to the issue of AB that might also be applicable to more general areas of science.

The research presented here analyses and compares textual narratives generated within policy, scholarly and popular media to discern how the sexuality or intimacy needs of people categorised as ‘learning disabled’ have been historically and more recently managed in Australia and the United Kingdom. The research uses a modified critical discourse analytical approach which, in order to clarify the distinct role of power in the construction of discourses of sexuality, is mediated by the more recent ideas of progressive phronesis offered by Flyvbjerg (1998a; 2001). The analysis identifies three broad stages in the historical development of the discourses about the sexuality of learning disabled people. The first phase was prior to the 1800s, when these people were labelled non-derogatorily as ‘idiots’, and perceived as childlike, innocent and asexual. The second stage was in the 1800s when, with the emergence of scientific rationality and medicalisation, so-called idiots became medicalised and categorised as ‘feeble-minded’ or ‘moral imbeciles’. This thesis demonstrates that, during this period, an emphasis on sexual self-denial, anxieties about venereal disease and non-procreative erotic pleasure helped to inform discourses of eugenics and learning disabled people became perceived as a sexual threat to the society. This underpinned policies of sexual control through institutionalisation, gender segregation and sterilisation. The third period in the development of discourses relating to the sexuality of learning disabled people paralleled the ‘sexual revolution’ of the late- 1900s and the move towards deinstitutionalisation and human rights. This analysis shows that, although the principle of ‘sexual freedom’ was ostensibly incorporated in modern policy discourse, the sexuality of learning disabled people continues to be influenced by significant barriers of sexual intolerance, demonstrated by continuing practices of sexual segregation, sterilisation, criminal labelling and imprisonment. The analysis indicates that a discourse of sexuality, which has legitimised the control and management of learning disabled people in varying forms since the Enlightenment, continues to be encountered in policy and popular narratives. Robust sexuality awareness and education programs for carers of these people, and society in general, are necessary so that intimacy and/or sexual desires are accepted as a normal need for all human beings.

Basketball teams typically undergo extensive training and competition demands across the season. Accordingly, it is becoming regular practice for basketball coaches and performance staff to implement monitoring programs to quantify external and internal loading in players during the season. As part of monitoring programs, it is essential to consider scheduling factors that may impact player loads across the regular season. In this regard, the impact of scheduling factors, such as game location, opposition ability, and fixture density, on player loads needs to be considered to precisely coordinate training schedules and appropriately manage player recovery in basketball teams. Thus, the aim of this research was to develop an evidence-based framework for use in practice to guide weekly training load prescription considering scheduling factors in basketball through: (i) conducting a systematic review to identify the precise impact of different scheduling factors on player loads in team sports; (ii) developing a framework that guides training load prescription across the regular season while factoring in prominent scheduling factors in basketball; and (iii) comparing the recommendations of the developed framework to training loads naturally prescribed in practice to a semi-professional basketball team. Ultimately, the number of games played in the current, previous, and subsequent weeks, days between games across subsequent weeks, and travel requirements were identified as the predominant scheduling factors to be considered in the TrAining load Recommendations based on weekly Game schEduling in baskeTball (TARGET) framework when planning weekly training loads for basketball players. In the TARGET framework, each scheduling factor is scored separately for each week of the season based on the team schedule. The overall score for each week in the TARGET framework is determined by summing the scores for all scheduling factors in that week to indicate schedule difficulty and guide training load prescription. The TARGET framework was retrospectively applied in practice to assess its utility and the extent to which coaching staff in a semi-professional basketball team may naturally consider scheduling factors when planning weekly team training loads. In this way, the weekly overall score in the TARGET framework was correlated with the weekly team training load prescribed across two regular seasons in a semi-professional, Australian basketball team. Accumulated PlayerLoadTM was measured using microsensors to quantify weekly team training load. The small, positive relationships (season one: r = 0.13; season two: r = 0.11) between weekly overall score in the TARGET framework scores and weekly team training load across two seasons suggest coaching staff of the investigated team tended to increase training load as schedule difficulty increased each week. Contrary to these findings, we expected coaching staff to reduce weekly team training loads as schedule difficulty increased, which suggests scheduling factors may not be adequately considered by some basketball coaching staff in real world contexts when planning team training loads across the regular season. The TARGET framework provides basketball coaches and performance staff with an easy-to-use, efficient, practical tool to inform weekly team training load prescription during the regular season. Furthermore, the ability to consider key scheduling factors in a prospective manner once the game schedule and travel plans are known for basketball teams, enables the TARGET framework to be used proactively to plan weekly training loads across the season.

The story behind this research project begins in 1962 when, at age 11, I developed an eating disorder and began to keep a diary. The themes and threads that bind the story together, however, began to weave a pattern almost as soon as I was born. In early childhood, the world through my eyes comprised a small, beautiful valley adjoining the Mitchell River National Park in Victoria, Australia. I lived on a dairy farm with my parents and sister. For my first 11 years, my home had no electricity, television or Internet, but my days were full. The farm, river and adjacent bushland provided a natural outdoors playground, seeding my imagination. Indoors, on rainy days and at night by lantern-light, at the solid oak kitchen table, I would ask my mother for pen and paper and write a note or two about my day. A friendship with words was already taking hold.

This dissertation examines the way in which the role and function of remote area nurses (RANs) employed by the Australian Inland Mission (AIM), was established and developed during the years 1923 to 1953 at Birdsville in far south-west Queensland. In a geographically remote and technologically isolated environment, registered trained nurses in the absence of any other on-site medical or allied health personnel, provided the only formal health service to the people of Birdsville and the surrounding district. A unique feature of the AIM'S nursing service is that it was designed to meet the holistic health needs of isolated white people and apart from strictly clinical services, did not include the local indigenous population. In effect, the nurses' role and function developed within a framework of institutional racism. Free of the rigid hierarchical constraints and structures experienced during this time period by their metropolitan colleagues, the RANs at Birdsville developed their role and function within the broader context of this remote community's culture. In such a small community as Birdsville, community dynamics and politics based on the concepts of class, religion and ethnicity were considerably heightened. Within this environment, the ability of the nurses to effectively carry out their role and function for all of the community, was at times severely challenged and restricted. Essentially, the nurses shared with the community harsh climatic and living conditions which were exacerbated at times by the AIM'S inability to raise sufficient funds to adequately support their nursing staff. The nurses' professional isolation although apparent throughout the period under study, was most acute in the first few years prior to the installation of a pedal radio transceiver at Birdsville. During these early years their extended scope of clinical practice was established. However, it is demonstrated within the dissertation that even with improved communication and aviation technology, a high degree of autonomy in their clinical decision-making was maintained and incorporated into a culture of remote area nursing.

In the skeletal muscle cell membrane, the voltage gated chloride channel, CIC-1, maintains as unusually high resting membrane conductance and thereby prevents myotonic skeletal muscle disease. Protein crystallization experiments with bacterial CIC proteins, provide the information for the three dimensional (3D) structure of CIC chloride channels.
PhD Doctorate

The way in which we perceive and interpret the causes of situations is likely to have a profound influence on our subsequent behaviour. It has been well established that the experience of anger is likely to systematically influence the cognitive processing style and cognitive skills that the individual will use in understanding, and responding to, interpersonal situations. One important process that may be affected by the regular experience of intense anger (trait anger), is the dispositional propensity to attempt to understand the thoughts, feelings, and point of view of another person in an interpersonal interaction (i.e., perspective taking). A study was conducted to test this theoretical hypothesis. In addition, the study attempted to examine the influence of perspective taking on anger experience, control, and expression.

Aluminum (Al) is the third most abundant metal on the earth’s surface. An association of Al with Alzheimer’s disease has been suggested, but, given limited human evidence, is controversial. It is possible that exploration of long-term, or cumulative, exposure to Al will help clarify this debate. Therefore, our study hypothesis was that occupational exposure to Al, particularly long-term exposure, is associated with adverse cognitive and olfactory outcomes.

Biomarkers are important tools in epidemiologic research; however, the reliability and quality of various biomarkers may vary. Therefore, in Chapter 2, we reviewed current evidence on Al biomarkers with the goal to synthesize current understanding regarding their utility for use in research. Our review evaluated 78 papers which discussed various biomarkers of Al exposure. Limited evidence is currently available for Al in nails, hair, breastmilk, saliva and semen. Although they have more daily variation than other biomarkers, blood Al concentrations may differentiate between exposed and non-exposed groups. Unlike blood Al, Al concentrations in both urine and bone are not subject to daily fluctuations. Bone Al appears able to quantify long term Al exposure. Therefore, the use of in vivoneutron activation analysis (IVNAA), a novel bone biomarker, can potentially represent cumulative Al exposure.

In Chapter 3, we evaluated the hypothesis that the correlation between bone and CEI measurements will be higher than the correlation between bone with fingernail. A cross-sectional cohort of 61 ferroalloy and manufacturing factory workers from Zunyi, China were used in this secondary analysis. Correlations of bone Al with other Al measures (fingernail and cumulative exposure index (CEI)) were assessed for 43 of the factory workers who had bone Al samples. Fingernail samples were analyzed using inductively coupled plasma mass spectrometry. Bone measurements were taken with a compact IVNAA developed by our research team. CEI was calculated as CEI_i=, where C_iis estimated Al exposure based on job title (low/medium/high) and Y_iis the years employed. The CEI was calculated for the prior 5, 10, 15, 20 years and lifetime work history. Median Al values were: 34.4 mg/g (IQR=46) fingernail; 15 mg/g (IQR=28) bone; and 26 (IQR=21) total CEI. Adjusting for age and education, the linear regression model suggests that bone Al is reflective of 15 years of exposure based off the significant association between bone Al and 15-year CEI (b=0.91, p<0.02). Other models with CEI were not statistically significant.

In Chapter 4, we evaluated the association between bone, CEI and fingernail Al measurements with olfactory and cognitive function. The relationship between cognitive and olfactory function was compared with bone Al (N=43), fingernail Al (FnAl) (N=56), 5 year Al CEI and lifetime Al CEI (N=61) measurements. Olfactory function was assessed with the University of Pennsylvania Smell Identification Test and cognitive function was assessed with the WHO/UCLA Auditory Verbal Learning Test (AVLT). Verbal fluency was assessed using Fruit Naming and Animal Naming. Additional variables were assessed via questionnaire. Linear regression models, adjusted for age, education, current alcohol consumption and current smoking status, showed a significant association between higher BnAl and higher recall on the AVLT interference list (b=0.04, 95% Confidence interval (CI)=0.01, 0.08) and higher 5-year CEI with higher recall on the fifth AVLT trial (b=-0.23, 95% CI=-0.45, -0.01). No significant association between FnAl and lifetime CEI with olfactory and cognitive function was observed.

In Chapter 5, we explored the potential for interactions of Al with another metal to impact the potential association of Al with cognitive and olfactory function. Interaction models used the natural log of fingernail Al with each of copper (Cu), manganese (Mn), lead (Pb) and zinc (Zn) for the 56 male workers. The linear regression models controlled for age, education current alcohol consumption, current smoking status, and all five fingernail metals. Higher ln(FnMn) was associated with lower recall for several AVLT trials. The interaction term for ln(FnAl) and ln(FnZn) was significantly associated with AVLT Trial 1 (β= 1.99, 95% CI=0.07, 3.93), AVLT Trial 5 (β= 2.71, 95% CI= 0.02, 5.41) and AVLT average (β=2.11, 95% CI=0.01, 4.21).

Overall, this research presents valuable information regarding noninvasive, in vivoassessment of BnAl and its relationship with other Al biomarkers and measures of cognitive function. To the best of our knowledge, this is the largest study to use INVAA BnAl measurements to quantify long-term aluminum exposures within an occupational population, the first to compare BnAl with an estimate of cumulative Al exposure. Additionally, we are not aware of prior studies which have examined the interaction of fingernail metals, including Al, with olfactory and cognitive tests. Our results suggest BnAl is significantly associated with the prior 15-years of Al exposure and that IVNAA to assess BnAl can be used in field epidemiology studies. For our study, there was limited evidence of an association of BnAl and 5-year CEI with cognitive function. Most comparisons did not show any evidence of an association of Al with cognitive or olfactory function, but a statistically significant interaction between Al and Zn with some measures of cognitive function was observed. It is recommended that our findings be confirmed with larger studies.

It is mandated that all Australian hospitals employ a means of detecting patient deterioration, and in doing so, most have chosen to adopt Early Warning Scores (EWS). Over the past three decades, many variations of EWSs have been developed and tested in larger regional/metropolitan hospitals. However, there is a paucity of evidence as to which EWS is most effective in predicting deterioration events in small, poorly resourced regional/rural hospitals. The aim of this study was to inform small, poorly resourced regional/rural hospitals on the selection of the best EWS or class of EWS, to augment patient safety within their context. This multi-phase retrospective case-controlled study compared the efficiency of 12 existing EWSs using patient data from two small regional private hospitals (Phase 1). Outcomes from Phase 1 informed Phase 2 and the development of a new EWS for use in poorly resourced regional private hospitals. The new EWS was then validated using two independent patient cohorts from small, poorly resourced regional/rural public hospitals (n=7) and large, well-resourced public regional/metropolitan hospitals (n=6). Results showed that in small regional private hospitals, the aggregated weighted EWS, called Compass, was most effective in identifying deteriorating patients with an Area under the Receiver Operator Characteristic Curve (AUROC) of 0.747 (CI 0.73-0.76). However, Compass had a low sensitivity of 0.44, meaning that less than 50% of the deteriorating patients achieved an emergency call score. Given the suboptimal efficiency of the 12 EWSs tested, a new, more efficient EWS was developed. The first step in developing a new EWS involved determining the ability of the vital signs in predicting patient deterioration. While vital signs are good indicators of patient deterioration, no single vital sign was found to predict patient outcomes strongly. A rapid heart rate and the need for supplementary oxygen were identified as the best indicators of an impending clinical deterioration event in this patient cohort. Based on these findings, a new combination EWS, called MOD-6 was then developed. This was achieved by adding a single trigger component to Compass, extending the existing vital sign trigger threshold ranges and incorporating a graduated weighted scale for supplementary oxygen use. The new combination EWS, MOD-6, was 20% more effective than Compass when used in poorly resourced regional private hospitals. However, when validating the new MOD-6 using two independent patient cohorts from the public sector, the MOD-6 EWS was no more effective than existing EWSs. This study has produced evidence that EWSs are used differently in large, well-resourced regional/metropolitan hospitals compared to poorly resourced regional/rural hospitals. In the well-resourced hospitals, there is evidence that the EWSs are being used to identify clinical deterioration events, reactively using the EWS scores to guide the escalation of patient care. At the small, poorly resourced hospitals, the EWSs appear to be used proactively to predict patient deterioration and prevent adverse patient events. At these small regional/rural hospitals, staff appear to respond early to changes in the patients’ vital signs, transferring patients out to a better resource facility before triggering an emergency threshold score on the EWS. In conclusion, an aggregated weighted EWS, such as Compass, or a combination EWS such as the new MOD-6 EWS should be considered for implementation in the small, poorly resourced private hospitals. The best indicators of patients requiring transfer out to a higher level of care in this patient cohort are the use of supplementary oxygen and those with tachycardia. Findings from this research will inform nursing practice in small, poorly resourced regional/rural hospitals and positively contribute to patient safety.

This thesis describes a series of studies in which ultrasound was used to measure muscle activity around the shoulder. The preliminary studies used professional musicians as subjects because the chronic nature of their problems with shoulder muscles offered an opportunity to test the usefulness of ultrasound in a changing physical environment. Once protocols, reliability, validity and sensitivity to change were established, the main study focused on ?normal? subjects in order to explore ?normal? variability.

Lipids and sodium (²³Na) are two essential components of the human body. They play a role in almost all biological systems. However, an increase in their levels is associated with metabolic diseases. The elevation of their contents can cause similar health disorders. Examples of prevalent disorders that share an increase of musculoskeletal lipids and ²³Na are hypertension and diabetes. However, the relationship between in vivo lipid and sodium levels in pathophysiology has not been studied enough and therefore is still unclear. Additionally, the available quantification methods to facilitate such a study may not be practical. They are either invasive, not sensitive enough, or require an impractical measurement time.

Therefore, in this work, our aims were to develop practical in vivo methods to quantify the absolute sodium concentration as well as the concentration of each lipid component individually, and to study the correlation between them within the skeletal muscles.

Since lipids and ²³Na have different nuclear magnetic resonance properties, their quantification by magnetic resonance (MR) techniques face different challenges. Thus, we optimized different MR spectroscopic imaging (MRSI) techniques for lipids and ²³Na.

Our proposed proton MRSI was able to provide eight lipid fat fraction (FF) maps representing each musculoskeletal lipid component (fatty acid) detected by our MRSI technique, and demonstrated a superior sensitivity compared to the conventional MR imaging methods.

For ²³Na, our developed ²³Na-MRSI was able to measure and map the absolute ²³Na concentration with values agreeing with those reported previously in biopsy studies, and with a high repeatability (CV < 6 %) within significantly shorter acquisition time compared to other available techniques.

Finally, the ²³Na concentration and the fat fractions of each lipid component within healthy skeletal muscles were measured and correlated using our developed MRSI methods. Our findings suggest a positive regional relationship between ²³Na and lipids and negative correlation between ²³Na and BMI under healthy conditions.

This qualitative thesis uses discourse analysis to examine parental resistance towards medical treatment of critically ill children. It is an investigation of the 'mobile and transitory' discourses at play in instances of resistance between parents, physicians and nurses within health care institutions, and an examination of the consequences of resistance through providing alternative ways of perceiving and therefore understanding these disagreements. The philosophical perspectives, methodology and methods used in this thesis are underpinned by selected ideas taken from the works of Michel Foucault and Pierre Bourdieu and supported by relevant literature in the fields of media, law, children, parenting, caring, serious childhood illness, medicine and nursing. The thesis obtains information from a variety of texts that includes established literature (such as medical, sociological, legal, academic and philosophical), newspaper articles, radio or television interviews, internet sources, court reports and proceedings, legal experts and other commentators - and 15 interview based texts, where the focus is on analyses of narratives of parents, doctors and nurses. In the texts gathered for this thesis, there are noticeable differences between the personal experience discourses of parents, the 'in-between' discourses of nurses, and the disciplined discourses of physicians. This thesis brings these discourses into conversation with each other suggesting that parental resistance does not occur because of an infrequent and unusual set of circumstances where a few socially isolated and/or 'difficult' parents disagree with the treatment desires of paediatric physicians. Instead, it is argued that from an examination of interview based texts, parental resistance is an omnipresent but transitory occurrence that affects many of the interactions between the parents of seriously ill children and clinical staff. It is maintained that within these interactions, the seeds of this resistance are sown in both critical decision making situations and in everyday occurrences between doctors, nurses and parents within healthcare institutions. Contributing factors to parental resistance include the use of power games by staff, the language of medicine, forms of symbolic violence, the presence or absence of trust between parents and medical staff, the effects of medical habitus, and challenges to the parental role and identity. Overall, it is proposed in this thesis that parents who resist treatment for their seriously ill child are not exceptions to the normative patient-physician relationship. Instead an analysis of their discourses and practices is able to illuminate the complex interactions between patients and medical conventions. It is therefore possible to see parents who resist medical advice not as peripheral to the medical encounter but as examples of how patient-physician relationships come to be codified, constructed and crafted through everyday discourses and practices within health care settings.

The thesis proposes and defends a maxim which can serve as a foundation and guideline for professional ethics in nursing, the maxim that nurses should act so far as possible to promote patient's self-determination. The thesis is informed by philosophical ethics and by knowledge of professional nursing practice.

Introduction: The purpose of this study was firstly to investigate whether 8 weeks of whole body vibration (WBV) training was an acceptable form of exercise for patients with Multiple Sclerosis (MS) and secondly what effect it may have on measures of functional capacity. Methods: Fifteen participants with MS volunteered for WBV training three times a week on a commercialised Galileo Sport™ vibration machine with an oscillating platform. Training consisted of two four week blocks based on an increasing stimulus training programme (overload principle). The first fours weeks involving five sets of 1-min WBV with 1-min rest in between with increasing vibration frequency (15-25Hz, 2.6mm-4.1mm amplitude); the second four weeks training increased to eight sets of 1-min WBV (15-20Hz, 6.1mm amplitude). Functional performance measures (Timed up and Go, Standing Balance, Functional Reach and Timed walk) and quality of life questionnaire (SF-36) were conducted prior to training, at 4 weeks, 8 weeks and 2 weeks (10wk) following the completion of the training. Results: The 10m walk test showed significant improvements at the 2m, 8m and 10m measure between pre vs. 8wk (P<0.05) and pre vs.10wk (P<0.05). Timed up and Go demonstrated a significant time effect (P<0.05). Standing balance showed significant improvements at pre and 4 week (p<0.05) and pre and 10 week (p<0.05). Conclusions: This is the first study to investigate WBV as an exercise training modality for MS patients. It was shown that not only is WBV training safe, well tolerated by MS patients but it also improved standing balance and walking speed in MS patients.

The objective of research is to develop a computer simulation modeltoprovide a means to effectively and efficiently reduce medication errors associated with points of distribution sitesby identifying and manipulating screeners with a high probability of generating errors.Points of distribution sites are used to rapidly distribute chemoprophylaxis to a large population in response to a pandemic event or a bioterrorism attack. Because of the nature of therapid response, points of distribution sites require the use of peer-trained helpers who volunteer their services.The implications are that peer-trained helperscould have a variety of experience or education levels. Thesefactors increase the risk of medical errors. Reducing medical errors is accomplished through changing the means in which healthcare providers are trained and focusing on a team approach to healthcare delivery. Computer simulations have been used in the past to identify sources of inefficiency and potential of error. Data for the model werecollected over the course of two semesters. Of the 349 data points collected from the first semester, only 137 data points were usable for the purposes of modelbuilding. When the experiment was conducted again for the second semester, similar results werefound. The control simulation was run 20 times with each screener generating errors with a probability of 0.101 following a Bernoulli distribution. The variable simulation was run 30 times with each screener generating the same probability of errors; however, the researcher identified the screeners generating the errors and immediately stopped them from processing additional agents once they reached five errors. An ANOVA was conducted on the percent errors generated from each simulation run. The results of the ANOVA showedsignificant difference between individuals within the groups. A simulation model wasbuilttoreflect the differences in medical error rates between screeners. By comparing the results of the simulation as the screeners are manipulated in the system, the model can be used to show how medical errors can be reduced in points of distribution sites

Training and development programmes should form an important part of human resource management functions within all organisations. Such programmes are needed whenever organisational goals and objectives can be furthered by improved employee performance. In order to provide suitable content within these programmes, precise information about the training needs of staff must be obtained. In this study a survey instrument was developed and used for the determination of professional development needs of staff in a higher education institution undergoing major organisational change.

"The use of CATI methods for conducting population health surveys is an enduring and popular practice. Although it is one of the most reliable ways to collect data, there is a range of sampling and non sampling errors which can potentially affect the abiliity of CATI surveys to provide accurate results. This thesis examined the impact of a particular type of non-sampling error - question order effects - in CATI surveys. Two studies were conducted one which examined order effects in data collected using a standard health survey instrument designed to measure and classify physical activity behaviour, and one which examined order effects in data collected using two question blocks designed to evaluate health related knowledge and attitudes"--Abstract.

This study of four domestic abattoirs in South Australia with Quality Assurance programmes in place established the size of bacterial populations that could be expected on pig carcasses on entry to abattoir dressing floors at pre-evisceration, the extent of contamination occurring during carcass dressing, and the effect of chilling on these populations. Analysis was conducted for salmonellae, Escherichia coli, Total Viable Count, and pseudomonads. Exterior swabbing was compared to swabbing of corresponding interior sites which are sterile initially. The interior swabbing sites were found to be a more reliable measure of contamination during the dressing process than the swabbing of already contaminated exterior sites. During the identification of some of the points of carcass contamination, the effectiveness of end-of-work foam cleaning programmes used at abattoir dressing floors and their relationship to the potential for airborne contamination of carcasses was examined and found to be positive. Operators' work tools and hands were identified as sources of interior carcass contamination combined with failure of operators to adhere to Standard Operating Procedures (SOPs) during carcass dressing, especially those related to hand and forearm washing at appropriate times. Foot-operated full-immersion hot water units for operators' knives and steels were designed and installed at two abattoirs to give operators access to physically and biologically clean work tools throughout carcass dressing.
PhD Doctorate

Since the late 1970s, biomedical researchers have heavily invested in the development of portable insulin pumps that allow people with Type 1 Diabetes (T1D) to carry several days-worth of insulin to be injected on an as-needed basis. That means fewer needles and syringes, making regular insulin injections less time consuming and troublesome. As insulin pump use has become more widespread over the past twenty years among people with T1D, the social and cultural effects of using these medical devices on their everyday experiences have become both increasingly apparent for individuals yet consistently absent from social and cultural studies of the disease.

In this dissertation, I explore the technological, medical, and cultural networks of insulin pump treatment to identify the role(s) these biomedicalized treatment acts play in the structuring of people, their bodies, and the cultural values constructed around various medical technologies. As I will show, insulin pump treatment alters people’s bodies and identities as devices become integrated as co-productive actors within patient-users’ biological and social systems. By analyzing personal interviews and digital media produced by people with T1D alongside archival materials, this study identifies compulsory patterns in the practices, structures, and narratives related to insulin pump use to center chapters around the productive (and sometimes stifling) relationship between people, bodies, technologies, and American culture.

By analyzing the layered and intersecting sites of insulin pump treatment together, this project reveals how medical technologies, health identities, bodies, and cultures are co-constructed and co-defined in ways that bind them together—mutually constitutive, medically compelled, cultural and social. New bodies and new systems, I argue, come with new (in)visibilities, and while this new technologically-produced legibility of the body provides unprecedented management of the symptoms and side-effects of the disease, it also brings with it unforeseen social consequences that require changes to people’s everyday lives and practices.