This study applies the metaphor of two-level games to generate explanations of how and why President Reagan chose to appoint Edward J. Perkins ambassador to South Africa. It explored the relationship between national and international factors that may have influenced Reagan's decision, as well as his policy preferences, beliefs and values. International factors included U.S.-South Africa relations, alliances, international organizations, and transnational movements for human rights and racial equality. Among the domestic factors were the dynamics between the executive and legislative branches of government, interest groups, and activism. National and international politics and policies overlapped in four areas' "strategic interests, race, morality, and national values. Analysis of the evidence suggests that while international events were an important part of the context of the decision, domestic politics and the President's own views had the most influence on the decision. The Perkins appointment exemplified how a personnel selection might reaffirm national reconciliation of opposing views on race, ethnicity, democratic values and national interests. / Ph. D.

I en tid där teknologins inflytande omformar vårt samhälle och vår förståelse för människans naturblir det alltmer nödvändigt att utforska djupet av våra interaktioner inom sjukvården. Genom att granska skillnader och likheter mellan digitala och traditionella vårdmöten kan vi bättre förstå inte bara hur teknologin påverkar oss, utan också hur den formar vårt samspel med vårdgivare och sjukvården som helhet. Denna studie syftar till att genom kvalitativa intervjuer med vårdsökare utforska upplevelserna av både fysiska och digitala vårdmöten samt analysera de kommunikativa utmaningar som uppstår i varje kontext. Genom tillämpning av en socialpsykologisk ansats undersöktes hur kommunikation och motivation påverkar vårdsökares beteenden och upplevelser i dessa möten. Tio semistrukturerade intervjuer genomfördes med vårdtagare som har erfarenhet av både traditionell och digital vård. Resultaten visar att deltagarna upplever digitala kommunikationskanaler som smidig och flexibel, men betonar samtidigt vikten av personlig kontakt. Utmaningar i den digitala kommunikationen inkluderar tekniska problem och svårigheter med att förmedla fysiska besvär och icke-verbal kommunikation, samt språkbarriärer. Studien identifierade även utmaningar relaterade till motivation, såsom bristande engagemang för digitala vårdmöten och svårigheter att upprätthålla kontinuerligt deltagande på grund av tekniska eller personliga hinder. Slutligen framhävs vikten av att individanpassa vården för att skapa tillfredsställande möten och främja en positiv utveckling inom sjukvårdens digitalisering. / In an era where the influence of technology reshapes our society and our understanding of human nature, it becomes increasingly necessary to explore the depth of our interactions within healthcare. By examining the differences and similarities between digital and traditional healthcare encounters, we can better comprehend not only how technology affects us but also how it shapes our interaction with healthcare providers and the healthcare system as a whole. This study aims to explore, through qualitative interviews with healthcare seekers, the experiences of both physical and digital healthcare encounters, while analyzing the communicative challenges that arise in each context. Applying a social psychological approach, the study investigated how communication and motivation influence the behaviors and experiences of healthcare seekers in these encounters. Ten semi-structured interviews were conducted with participants experienced in both traditional and digital healthcare. Findings indicate that participants perceive digital communication channels as smooth and flexible, while also emphasizing the importance of personal contact. Challenges in digital communication include technical issues, difficulties in conveying physical discomfort and non-verbal cues, as well as language barriers. The study also identified challenges related to motivation, such as a lack of engagement in digital healthcare encounters and difficulties in sustaining continuous participation due to technical or personal obstacles. Finally, the importance of individualizing healthcare to create satisfactory encounters and promote positive development within healthcare digitalization is emphasized.

This thesis considers three physician scheduling problems in health care systems. Specifically, we focus on improvements to current physician scheduling practices through the use of mathematical modeling. In the first part of the thesis, we present a physician shift scheduling problem focusing on maximizing continuity of care (i.e., ensuring that patients are familiar with their treating physicians, and vice versa). We develop an objective scoring method for measuring the continuity of a physician schedule and combine it with a mixed integer programming model. We apply our methods to the problem faced in the pediatric intensive care unit at Children's Healthcare of Atlanta at Egleston, and show that our schedule generation approach outperforms manual methods for schedule construction, both with regards to solution time and continuity. The next topic presented in this thesis focuses on two scheduling problems: (i) the assignment of residents to rotations over a one-year period, and given that assignment, (ii) the scheduling of residents' night and weekend shifts. We present an integer programming model for the assignment of residents to rotations such that residents of the same type receive similar educational experiences. We allow for flexible input of parameters and varying groups of residents and rotations without needing to alter the model constraints. We present a simple model for scheduling 1st-year residents to night and weekend shifts. We apply these approaches to problems faced in the Department of Surgery Residency Program at Emory University School of Medicine. Rotation assignment is made more efficient through automated schedule generation, and the shift scheduling model allows us to highlight infeasibilities that occur when shift lengths exceed a certain value, and we discuss the impact of duty hour restrictions under limitations of current scheduling practices. The final topic of this thesis focuses on the assignment of physicians to various tasks while promoting equity of assignments and maximizing space utilization. We present an integer programming model to solve this problem, and we apply this model to the physician scheduling problem faced in the Department of Gynecology and Obstetrics at Emory University Hospital and generate high quality solutions very quickly.

Missed appointments by patients are a major problem for health care professionals. To combat this issue, some optometrists use a pre-appointing system in which patients are scheduled for an annual exam a year after their initial visit. Prior to that subsequent appointment, clinic staff often try to contact the patient to confirm the appointment. This study examined baseline levels of appointment keeping, analyzed existing processes for pre-appointing patients, and introduced a revised process package to improve appointment keeping at an eye care clinic. This package included training, mailed postcard reminders and two phone call reminders. Results indicate appointment keeping by pre-appointed patients increased over baseline. The intervention was also shown to be cost-beneficial.

As compared to pediatric and older adult cancer patients, young adults are the only oncology group that has not demonstrated an increase in survival rates. Low treatment adherence rates have been one explanation for this discrepancy, although this hypothesis has not been explored specifically. Guided by the biopsychosocial model of health and wellness, this study compared the treatment adherence rates of 46 young adult cancer patients (ages 18-39 years) to 46 older adult cancer patients (ages 40 years and older). Adherence was measured by a dichotomized variable, as yes/no, adhering to radiation treatment and follow-up appointments recommended by the physician, 95% of the time. Additionally, gender and race were explored in relationship to adherence to radiation treatment and follow-up appointments. Demographic data were first extracted from the Cancer Registry of a Midwestern Hospital. Then radiation appointments and follow-up appointments were examined for each patient, in paper and/or computerized charts, to determine adherence rates. McNemar's test was used to compare young adults and older adult oncology patients' adherence rates, and Chi-square analysis was used to explore gender and race in relationship to adherence. Results indicated a lower adherence rate to follow-up appointments for younger adults as compared to older adults, with older adults adhering 3 -½ times more than younger adults. Gender was also related to follow-up appointment adherence, with males adhering better than females. This study contributes to positive social change by increasing the knowledge base of healthcare providers on adherence rates of young adult patients and reducing the dollars spent on treatment for re occurrences.

Limited time is an important constraint and resource that is fundamental to governing. This dissertation studies the connection between limited time and political power in three different contexts. / Government

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Thesis (M.B.M. 1976) from the Department of Commerce, University of Adelaide.

THESIS (D.N.P. (Doctor of Nursing Practice))--School of Nursing, University of San Francisco, 2010. / Converted to PDF files from various formats. Includes bibliographical references.

abstract: Chronic illness can be a stressful experience that requires coping and support. In the last twenty years, Shared Medical Appointments (SMAs) were developed in U.S. healthcare as a response to the rising rates and challenges of chronic disease management. Due to the infancy of the SMA model, however, little is known or understood about the benefits of group medical care for patients. To date, scholars have not explored or systematically observed the communicative aspects of the SMA model. Communal coping, a theoretical framework that foregrounds group interaction and communication, offers a pragmatic lens for exploring how patients collectively cope with the stressors of chronic illness in the context of SMAs. Using qualitative methods, I conducted participant observation of SMAs at a Veterans Affairs hospital to analyze the communicative, transactional nature of communal coping as it unfolded among heart failure patients, family members, and providers in context. I also conducted interviews with SMA attendees. Analysis is based on 56 hours of fieldwork and 14 hours of interviews. Findings of this dissertation revealed group members who attended heart failure SMAs engaged in communal coping to manage the stressors of chronic illness. Group members moved through four primary phases of the communal coping process: (1) establish a communal coping orientation; (2) discuss shared stressors; (3) engage in cooperative action; and (4) practice communal reflexivity. Findings suggest patients become empowered by group interaction during SMAs as they move through each phase of the communal coping process. This dissertation also highlights various communicative strategies providers' use during SMAs to facilitate communal coping and group interaction. Theoretically, this dissertation expands upon existing knowledge of communal coping by exploring how individuals embody and socially construct the communal coping process. Specifically, this dissertation extends past models of communal coping with the addition of the communal reflexivity phase and through conceptualizing communal coping as a facilitated process of empowerment. Pragmatically, this research also offers insight to the benefits patients derive from attending SMAs, such as reduced feelings of stigma and isolation and improved motivation. / Dissertation/Thesis / Doctoral Dissertation Communication Studies 2015