In 2004, the Saudi Higher Education Supreme Council (HESC) established the National Commission for Academic Accreditation and Assessment (NCAAA). According to the Secretary General of the NCAAA, introducing this system at the national level was essential for economic and social development in Saudi Arabia. The emergence of the NCAAA represents the central focus of this thesis, specifically in relation to the NCAAA’s role in improving the educational process in Saudi higher education institutions (HEIs). The overarching objective was to explore and describe the present engagement within Saudi higher education with the recommendations made by the NCAAA directed towards the enhancement of the quality of student learning, with the intention of identifying whether the attributes of the Saudi higher education system were consistent with these recommendations. This overarching objective was further divided into the following three more specific objectives: a) To explore administrators’ (i.e. faculty deans’) perceptions of the extent to which the recommendations made by the NCAAA have been adopted in two public Saudi universities. b) To explore teachers’ perceptions of their practice, considering comparisons between the two institutions. c) To explore the students’ experiences, again considering comparisons between the two institutions. The above objectives drove the data collection process, and these data constituted the empirical base of the study. The research was conducted in two public universities located in two geographically distinct provinces of Saudi Arabia. Data were collected from three groups of stakeholders, including senior administrators, teachers and students. This was done by means of individual interviews with 11 senior administrators and the collection of survey data from 78 teachers and 430 students, who were recruited from 11 faculties across the two institutions. Semi-structured interviews with senior administrators focused on their personal views and opinions of the educational process with respect to student learning, in order to identify the extent to which their faculty/unit was engaged with the NCAAA recommendations. The questions in the teacher and student surveys were derived from the recommendations published by the NCAAA with regard to the improvement of the educational process, and focused on their teaching practice and learning experiences respectively. The qualitative analysis of the administrators’ data suggested some differences in terms of how the two institutions engaged with the NCAAA’s recommendations and thus I adopted a comparative approach to the analysis of the teachers’ and students’ responses. A factor analysis was carried out to further clarify the themes present in the surveys from the perspectives of both teachers and students, and descriptive analyses were then used to explore the extent of resonance with the recommendations of the NCAAA. Inferential statistics were applied to investigate any differences between the two institutions against the outlined themes. The administrators’ responses at both institutions indicated that there was room for improvement in adopting the NCAAA’s recommendations. While the perceptions of teachers at both institutions seemed to suggest compliance with these recommendations, the statements of the students were more congruent with those of the administrators. The findings of the study indicate that there is yet some way to go towards the realisation of the aspirations of the NCAAA. They further suggest the desirability of a greater degree of student involvement in the evaluation of the quality of the educational process. Finally, the transformation of a series of recommendations for quality enhancement into a culture of quality within an individual institution is a process that can be expected to take some time. The study, while indicating a degree of commitment to, and espousal of, the recommendations of the NCAAA, suggests that there is some considerable way to go before this will be seen to impact directly and significantly on the student experience.

Digitized by Kansas Correctional Industries

Os aceleradores lineares representam a mais importante, prática e versátil produtores de raios-X de alta energia em radioterapia. O comportamento funcional destes equipamentos pode variar devido a defeitos eletrônicos, falhas de componentes ou rupturas mecânicas, ou então podem variar devido ao deterioramento e envelhecimento de seus componentes. A manutenção da qualidade dos tratamentos depende essencialmente da estabilidade dos aceleradores e do controle de qualidade das instituições para monitorar desvios nos parâmetros do feixe. O objetivo deste trabalho consiste em avaliar e analisar a estabilidade do fator de calibração dos aceleradores lineares, bem como os demais parâmetros dosimétricos normalmente incluídos em um programa de controle de qualidade em radioterapia. A média dos fatores de calibração dos aceleradores para o período de aproximadamente quatro anos para os Clinacs 600C e 6EX foram (0,998 ± 0,012) e (0,996 ± 0,014), respectivamente. Para o Clinac 2100CD de 6 MV e 15 MV foi (1,008 ± 0,009) e (1,006 ± 0,010), respectivamente, em um período de aproximadamente quatro anos. Através de análises estatísticas nos três aceleradores lineares verificou-se que os coeficientes de variação dos fatores de calibração apresentaram valores inferiores a 2% o que mostra uma homogeneidade nos dados. Através do cálculo da distribuição normal dos fatores de calibração, verificou-se que para os Clinacs 600C e 2100CD, é esperada uma probabilidade de que em mais de 90% dos casos os valores estejam dentro dos limites aceitáveis segundo o protocolo TG-142, enquanto que para o Clinac 6EX é esperado em torno de 85% uma vez que esse acelerador apresentou diversas trocas de componentes. Os valores do TPR20,10 dos três aceleradores são praticamente constantes e dentro dos limites aceitáveis segundo o protocolo TG-142. Pode-se concluir que um estudo detalhado dos dados do fator de calibração dos aceleradores e do TPR20,10 a partir de um ponto de vista quantitativo, é extremamente útil em um programa de garantia de qualidade. / The linear accelerators represent the most important, practical and versatile source of ionizing radiation in radiotherapy. These functional characteristics influence the geometric and dosimetric accuracy of therapeutic doses applied to patients. The performance of this equipment may vary due to electronic defects, component failures or mechanical breakdowns, or may vary due to the deterioration and aging of components. Maintaining the quality of care depends on the stability of the accelerators and quality control of the institutions to monitor deviations in the parameters of the beam. The aim of this study is to assess and analyze the stability of the calibration factor of linear accelerators, as well as the other dosimetric parameters normally included in a program of quality control in radiotherapy. The average calibration factors of the accelerators for the period of approximately four years for the Clinac 600C and Clinac 6EX were (0,998 ± 0,012) and (0,996 ± 0,014), respectively. For the Clinac 2100CD 6 MV and 15 MV was (1,008 ± 0,009) and (1,006 ± 0,010), respectively, in a period of approximately four years. Statistical analysis of the three linear accelerators was found that the coefficient of variation of calibration factors had values below 2% which shows a consistency in the data. By calculating the normal distribution of calibration factors, we found that for the Clinac 600C and Clinac 2100CD, is an expected probability that more than 90% of cases the values are within acceptable limits according to the TG-142, while for the Clinac 6EX is expected around 85% since this had several exchanges of accelerator components. The values of TPR20,10 of three accelerators are practically constant and within acceptable limits according to the TG-142. It can be concluded that a detailed study of data from the calibration factor of the accelerators and TPR20,10 from a quantitative point of view, is extremely useful in a quality assurance program.

La Tunisie connaît une progression notable de ses dépenses de santé et de l’espérance de vie des tunisiens. Mais ces résultats vont de pair avec des inégalités dans l’accès aux soins, motivant une réforme de l’assurance maladie mise en place en 2007. Les principaux changements visent une amélioration de la couverture pour les maladies chroniques et une généralisation de l’assurance pour l’offre de soins privée. Cette thèse de micro-économétrie appliquée examine l’impact de la réforme sur l’accès aux soins et le reste à charge des individus. Les évaluations sont réalisées sur des enquêtes visant plusieurs milliers d’individus en 2005 et 2010. On présente les motivations de la réforme, avant d’analyser le choix d’assurance et son influence sur le recours aux fournisseurs de soins publics ou privés en 2010, après la réforme. Une évaluation de cette réforme a été analysée à l’aide de l’approche de différences de différences. Au total, les résultats obtenus montrent que cette réforme semble avoir atteint plusieurs de ses objectifs : amélioration de l’accès aux soins pour les affiliés à la Caisse Nationale de Sécurité Sociale (CNSS), meilleur accès aux soins privés, baisse des restes à charges et des dépenses catastrophiques pour les personnes affectées d’une maladie chronique. / Tunisia experiences a noticeable growth in health expenditures and in Tunisians’ life expectancy. However, there are inequalities in health care access that motivated a reform of the health insurance which took place in 2007. The main changes were the improvement of the coverage for chronic diseases and the expansion of the access to insurance for care provided in the private sector. This PhD uses a micro econometric approach to examine the impact of this reform on access to health care and the out of pocket (OOP) born by individuals. The estimations are implemented on two surveys realized in 2005 and 2010 and relative to several thousand individuals. We first present the motivations of the reform. Then we analyze the individual insurance choice and its influence on the use of public or private care providers in 2010, i.e. after the reform. To evaluate this reform, we use a double difference approach. In total, our results show that the 2007 reform has attained many of its objectives: improvement of health care access for National Social Security Fund’s (NSSF) members, better access for private health care, decrease of OOP and catastrophic health expenses for individuals with chronic diseases.

The healthcare industry, and more specifically the nursing home sector, is changing operations and services due to a healthcare mandates and enactment of the 2010 Affordable Care Act. Such changes are termed quality assurance performance improvements (QAPI), to receive government subsidies and indemnification compensations. The purpose of this single case study was to explore effective strategies implemented by 4 healthcare leaders to comply with QAPI regulations. Total quality management theory was the conceptual framework used in this study. Data were collected through semistructured, open-ended, face-to-face interviews with 4 participants who serve in a management capacity at an organization located in northwest Missouri. Member checking was used to strengthen the credibility and trustworthiness of the interpretation of the participants' responses. The emergent themes from the study were (a) quality planning using systematic and strategic approaches, (b) quality control using business instruments and tools to measure performance and progress, (c) quality assurance through internal and external systematic analysis, and (d) quality improvements using an integrated systems approach. The implications for positive social change include the potential optimization of care provided to consumers in nursing homes by identifying best practices and strategies healthcare and business professionals have used to modify their business processes and operations.

Une assurance indicielle est proposée en réponse à l'augmentation des sécheresses impactant les prairies. Elle se base sur un indice de production fourragère (IPF) obtenu à partir d'images satellitaires de moyenne résolution spatiale pour estimer l'impact de l'aléa dans une zone géographique définie. Le principal enjeu lié à la mise en place d'une telle assurance réside dans la bonne estimation des pertes subies. Les travaux de thèse s’articulent autour de deux objectifs : la validation de l'IPF et la proposition d'amélioration de cet indice. Un protocole de validation est construit pour limiter les problèmes liés à l'utilisation de produit de moyenne résolution et au changement d’échelle. L'IPF, confronté à des données de référence de différentes natures, montre de bonnes performances : des mesures de production in situ (R² = 0,81; R² = 0,71), des images satellitaires haute résolution spatiale (R² = 0,78 - 0,84) et des données issues de modélisation (R² = 0,68). Les travaux permettent également d'identifier des pistes d'amélioration pour la chaîne de traitement de l'IPF. Un nouvel indice, basé sur une modélisation semiempirique combinant les données satellitaires avec des données exogènes relatives aux conditions climatiques et à la phénologie des prairies, permet d'améliorer la précision des estimations de production de 18,6 %. L’ensemble des résultats obtenus ouvrent de nombreuses perspectives de recherche sur le développement de l'IPF et ses potentiels d'application dans le domaine assurantiel.

A series of on-farm quality assurance schemes for red meat producers across Australia were developed in the late 1990s in response to increasing global demands for greater accountability within the whole food. The Cattlecare and Flockcare schemes were introduced in 1996 and 1998, respectively, to provide mechanisms for producers to demonstrate that their livestock were free of potential chemical residues, and that they had taken measures to prevent injury or stress to livestock. These schemes were independently audited codes of practice. After several years there was some dissatisfaction with the levels of adoption of these schemes, especially Flockcare. By 2001 just over 5% of all cattle producers and just over 1% of all sheep producers had implemented on-farm quality assurance. This covered nearly 16% of all cattle and 2% of all sheep in Australia, indicating that the larger than average producers were implementing quality assurance. Based on previous studies and anecdotal evidence that there were few current benefits for producers, the aims of this study were to identify the reasons for slow uptake and to quantify factors affecting implementation of on-farm quality assurance in the red meat industry. Surveys of "adopters" and "nou-adopters" of these schemes were developed and implemented in 2000 and 2001. Producers were approached initially by phone and given the options of completing the survey over the phone, by mail or by fax. / Three hundred and forty-seven Cattlecare producers (9% of all certified Cattlecare producers) and 142 Flockcare producers (22% of certified Flockcare producers) across Australia were initially approached. A total of 382 adopter surveys were completed. The level of interest from adopters was remarkable, with a 75% completion rate from telephone approaches and only 9 direct refusals. These producers had over 1.3 million cattle and 0.9 million sheep covered by quality assurance schemes. This represented 5% of the total cattle population (27% of certified cattle) and less than 1% of all sheep (26% of certified sheep) in Australia at that time. There was an extremely large variation in the size of properties surveyed, which reflected the structure of the industry. The producers were asked about what motivated them to implement quality assurance, what were the problems, where could it be improved, how much time and money had they invested specifically into implementing quality assurance, what benefits had they gained (financial and other), how it had changed their management or product offered for sale, and their opinion on various issues associated with quality assurance and food safety. In addition 133 non-adopter surveys were also completed to provide a control data set. These producers had over 0.12 million cattle and 0.48 million sheep on their properties. In general, it was much harder to persuade these producers to participate. It was estimated that about 60% of producers approached refused to participate. These producers were asked similar questions; except that they were asked to estimate (if they could) how much time and money it would take to implement quality assurance. Unfortunately, most of these producers were uninterested or knew little about quality assurance and were reluctant to estimate these values, so the data for these producers was very limited. / Analysis of the adopter data indicated the adoption rates between regions and schemes were significantly different. A benefit cost analysis was completed for the adopters based on estimated time and money invested into quality assurance and the tangible benefits gained from selling certified animals. The resulting net benefits were calculated as annual equivalent annuities. Only about 30% of adopters had gained any tangible benefit, and only half of these (15% of the total analysed producers) had a positive net benefit, and these were all cattle producers. Description of time, effort and money spend by adopting producers was most representative using median values due to the extreme data from some producers. Overall, implementation took a median of 13 days in the initial year and 6 days in subsequent years per property, and the median cost was $1,200 in the initial year and $500 in subsequent years. This investment of time and money equated to a median cost of $875 per year. The median net financial loss per year from adopting quality assurance was $660 per property or $2 per 100 DSE of livestock managed. Producers indicated that they were implementing quality assurance to gain financial and market benefits; but, with only 15% of producers gaining a positive net benefit, some producers were disappointed with the schemes. However they did report improvements in product (15% of producers) or management practices (90% had at least one). / Improvements in product included livestock were free from chemical residues, cattle were dehorned and yards had been improved so bruising was reduced. Improvements in management practices included improved record keeping, chemical control and livestock handling. While producers mostly believed it was the right thing to do for the industry, they indicated that they would need to be rewarded for their efforts at some stage. Adopters and non-adopters had different motives for implementing quality assurance. Peer pressure, market advantage and increased returns (27%, 26% and 18% of producers, respectively) were cited as the three major prompts for adopters. All the other categories of reasons for adoption were not business-based, but more emotional. Non-adopters, however, cited increased returns, market advantage and supply chain pressure (44%, 7% and 6%, respectively) as possible prompts to implement quality assurance. Difficulties in adoption actually experienced by adopters were also different to the difficulties anticipated by non-adopters. Paperwork, actually getting to implementing it and the extra time demands (19%, 13% and 12%, respectively) were the major difficulties for adopters, while time, in costs and paperwork (19%, 16% and 12%, respectively) were the anticipated difficulties for non-adopters. / Twenty-four percent of adopters had not had any difficulties, while 16% of non- adopters anticipated no difficulties. Simplification of initial paperwork, increased demand for quality assured livestock and a need to promote the schemes and the associated benefits to producers were the three highest ranking categories of suggested improvements by adopters. Non-adopters indicated similar issues but in a different order - a need to promote the schemes and the associated benefits to producers, simplification of initial paperwork and the process of implementation. Grouping producers based on inputs, attitudes, investment or any combination of these indicators failed to provide a statistically significant prediction of the net benefit or loss for a new adopter. The only way to identify or predict which producers would gain a positive net benefit was to focus on the methods of selling livestock. Selling direct to processors either over the hook, with forward contracts or privately appeared to be the only way to gain financial benefits from implementing quality assurance on-farm.

This qualitative, descriptive study explored physiotherapists' experience of participating in peer review in public and private health services in New Zealand. Peer review is a professional activity where one health practitioner evaluates the practice of another. Accordingly, much professional effort has been expended on developing peer review systems and implementing review processes, yet the benefits of peer review are uncertain. A changing legislative environment where producing evidence of ongoing professional development is required, has provided impetus for this study given the limited research to support the use of peer review in this context. While the literature identifies competing focuses on professional development and accountability, there is lack of clarity about which model of peer review is being implemented in this country and which might serve the profession better. This study is a first step in clarifying the issues by identifying the personal, professional and organisational factors that influence health professionals' participation in peer review. The methodology consisted of a qualitative descriptive approach situated within a post positivist paradigm. Seven physiotherapists working in the New Zealand health system who had participated in a peer review process within the last 3 years participated in this study. Semi structured interviews were conducted, guided by broad questions relating to central themes identified during an extensive literature review. Interviews were then audio taped and transcribed verbatim to form the data. Transcripts were analysed by assigning content labels to units of text that seemed to encapsulate one complete thought or idea. The labelled groups were analysed into sub themes. Finally, the general themes that arose were described. Findings indicate that while peer review systems have been developed and are carried out as prescribed, therapists lack clarity about the intended outcomes. While recognising the benefits of receiving feedback on practice, many manage the review process to maintain positive working relationships and ensure their practice is favourably reviewed. The strategies they employ and the consequences of managing peer review in these ways are described. Current peer review processes in New Zealand do not provide reliable information about competence to practice. Neither do they fully achieve their potential as a professional development tool. Therefore, the professional emphasis and effort on peer review needs to be revisited. The findings highlight the need for consultation amongst individual physiotherapists, physiotherapy managers, physiotherapy professional organisations, and the registration board, to negotiate whether regulatory or professional development needs will drive peer review processes in New Zealand in the future.

Cette thèse propose quatre chapitres indépendants sur l'assurance, la prévention des risques, et les politiques publiques associées à ces marchés. Le chapitre 1 s'intéresse au choix de prévention dans un marché agricole en équilibre partiel dans un contexte de marchés contingents incomplets. Sous des hypothèses typiques de ces marchés (faibles élasticités prix et revenu, aversion au risque), il est montré que l'équilibre concurrentiel se caractérise par un niveau de prévention inférieur à l'optimum social. Cette sous-prévention peut être corrigé par une aide publique à la prévention. Le chapitre 2 analyse les choix de prix et de capital interne des firmes d'assurance dans un contexte d'oligopole. Considérant un jeu à deux étapes avec choix de capital puis concurrence en prix, il est montré que le capital interne a un coût stratégique pour les firmes, ce qui conduit à un niveau de capital à l'équilibre inférieur à l'optimum social. La régulation publique du capital est rediscutée dans ce contexte de concurrence imparfaite. Le chapitre 3 est une analyse économétrique de la demande d'assurance et de pesticides menée sur un panel non cylindré d'exploitations agricoles françaises de la Meuse sur la période 1993-2004. Les résultats mettent en évidence la simultanéité des choix d'assurance et de pesticides et permettent de caractériser les variables explicatives de ces choix. Ces résultats sont mis en perspective dans le contexte actuel des réformes des politiques agricoles. Le chapitre 4 s'intéresse à l'influence des préférences sociales sur les choix de prévention dans le cadre d'un modèle de dilemme de Samaritain sous l'hypothèse spécifique d'agents présentant une aversion mutuelle à l'inégalité.

<p>Examensarbetet är utfört på uppdrag av Generic Systems i syfte att bl.a. utreda begreppet Information Assurance (IA) utifrån given definition (IA is the process of establishing trust for the information we use in our business). Fokus kom att hamna på taktiska militära ledningssystem inklusive ingående individer.</p><p>Det finns ett stort behov av en sådan här studie av flera anledningar bl.a. eftersom det just nu pågår ett paradigmskifte; från förvaltar- till förbrukarattityd och från <i>need to know</i> till <i>need to share</i>. Det innebär alltså att ett helt nytt synsätt på information håller på att växa fram</p><p>Första slutsatsen som drog var att IA är ett verkligt multidisciplinärt ämne som kräver djupa kunskaper inom många och vitt skilda områden t.ex. systemvetenskap, datasäkerhet och organisationsteori. En annan slutsats jsom drogs var att för att en användare ska känna tilltro till information måste tre grundkrav vara uppfyllda: användaren måste ha förtroende för systemet som förmedlar informationen, informationen i sig måste uppvisa vissa kvaliteter och slutligen påverkar egenskaper hos användaren den upplevda tilltron.</p><p>Med utgångspunkt i Försvarsmaktens behov så visade det sig att de centrala förändringarna som krävs för att uppnå effekten IA bland annat är ökat fokus på användbarhet i systemutvecklingen och flexiblare individanpassad utbildning. Utbildningen måste tillse såväl tillräcklig teknisk kompetens som säkerhetsmedvetande hos personalen. Andra delar som bör förändras är informationsarkitekturen; ökad separation mellan datamodell och informationsmodell är önskvärd.</p>