Background: Youth and young adults have the highest incidence and prevalence of mental health issues, and most do not receive the services they need. Mental health is an essential component of wellness, and primary care providers (PCPs) serve a critical role in promoting mental well-being, identifying problems, facilitating and coordinating services, and managing and monitoring mental health outcomes. Many barriers exist to incorporating mental health into routine primary care for adolescents, and little is known about the specific nature of the obstacles that impede the quality improvement process related to integrating mental and physical health and how to overcome them. Objectives: The purpose of this DNP project was to gain insight into the PCP role, exploring perceptions, current practices, and barriers related to screening, identifying, and managing adolescent mental health needs, understand the challenges and opportunities, and guide future quality improvement projects that reflect and respond to the needs of adolescents in the local community in effective and sustainable ways. Methods: The project was designed as a needs assessment, and conducted as an anonymous 20 question survey that was distributed to 13 local PCPs that routinely provide primary care services to the community’s adolescent population. Results: Nine of the surveys were completed and returned. Time constraints and competing demands were dominant concepts, reported as primary barriers to screening, collaboration with mental health professionals, and addressing mental health in general. The participants articulated the need for high-quality professional mental health involvement, improved collaboration, inter-professional development, and inter-agency cooperation to successfully promote mental health and provide excellent care that improves outcomes. They also displayed an interest in innovative solutions and organizational restructuring to better coordinate mental health services. Conclusion: This project offered preliminary insight into the challenges faced by PCPs addressing adolescent mental health in primary care, and generated ideas for further exploration to guide quality improvement initiatives designed to support the providers' capacity to incorporate mental health into routine care, and contribute to the community’s efforts in promoting mental health for local youth. PCPs occupy esteemed roles in the community, and their perspectives and insight are invaluable.

ABSTRACT Globalisation and a continuous advancement in technology have necessitated a need for employees to be trained and re-trained. The purpose of this study was to determine the factors that influence learner participation in the Adult Basic Education and Training programmes offered at the Johannesburg Department of City Power (Reuven). These include factors such as motivation, retention and barriers experienced by adult learners that are pertinent to learner participation. Data for the study was collected from ABET level 3 and 4 learners by means of semi-structured interviews and focus group discussions. The following emerged as pertinent factors influencing learner participation at City Power: a) personal development, b) language, c) support structures, d) the standby/shift system and e) remuneration.

The purpose of this thesis is to explore and understand the ‘localisation’ phenomenon from a geographical, cultural, technical and governmental theme to help explain why the level of local content in the oil and gas engineering and technical services private sector tends to flatten out at specific engineering and management skillsets in order to balance quality and delivery of the service and maintain operational excellence. Five research objectives were developed to achieve the research aim to provide a clear understanding, from a corporate strategic perspective, of the drivers and perceived barriers to successful localisation. For the purposes of this thesis, the term "localisation" is understood to mean “when a local national is filling a required job sufficiently competently to fulfil organisational needs” (Potter 1989). Due to the nature of investigation, this study adopted a qualitative inquiry. Thus, a mix of qualitative data collection methods were used such as document, experienced observation, and interviews with senior managers at the corporate strategic level of the business. An interview guide was developed from a conceptual framework generated from the literature review. The study targeted an ‘elite’ sample of oil and gas executives/ managers who are considered role models in the case study organisation. This study argues that a form of grounded theory/qualitative inquiry is adopted during data analysis using open, axial, and selective coding, leading to an evolved conceptual framework of localisation drivers and barriers. In addition to a thematic analysis, an integrated view from the researcher as an experienced observer resulted in a validated conceptual framework. This framework provides a holistic set of factors that must be considered, and understood, from a corporate strategic perspective as being directly influential in achieving successful localisation of a subsidiary part of the business. It is found that four of the five objectives were met and objective five partially achieved which identified an opportunity for further research to investigate and develop weightings across the four localisation barrier themes to determine an optimised balance of cost, delivery, and local content to maintain the desired operational excellence in the oil and gas services contractor industry. The study appears to have a contribution to knowledge through the evolving conceptual framework of localisation and provides the first holistic view of both localisation drivers and barriers relevant to oil and gas services contractors. A methodological contribution is worth noting since the researcher acted as an experienced observer during the process of this research. No doubt, industrial experience of the research and his access to the senior management has been one of the key contributing factors to a successful completion of the study. Finally, one can argue that this study has made contribution to the policy makers who provided access to the researcher. The findings of this study will provide a better and clear understanding of localisation and its drivers and barriers.

Nas últimas décadas, muitos países têm visto o uso automotivo de biocombustíveis como uma contribuição para soluções importantes, como aumento da eficiência energética, da flexibilidade e da diversificação das fontes de energia disponíveis; resposta à questão de segurança energética; promoção do uso de fontes energéticas renováveis e menos agressivas ao meio ambiente, especialmente com relação à necessidade de redução dos Gases de Efeito Estufa e aproveitamento das vantagens comparativas do país, com a promoção do desenvolvimento e da exportação de novas tecnologias e produtos. O Brasil é pioneiro na produção e utilização do etanol e, aliando-se ao aquecimento do mercado interno, existe a expectativa de aumento das exportações desse combustível, mantendo o Brasil como líder no mercado internacional. Este trabalho identifica e analisa os entraves que envolvem as perspectivas de exportação de etanol brasileiro, através do estudo dos potenciais mercados, seus programas de utilização do etanol combustível e suas barreiras tarifárias e não tarifárias, como as medidas protecionistas contra produtos estrangeiros, os subsídios aos produtores domésticos e as certificações, que podem retardar o estabelecimento do etanol como commodity e, ainda, impedir o seu crescimento no comércio internacional. / In recent decades, many countries have seen the use of biofuels in light vehicles as a contribution to important steps: to increase energy efficiency and the flexibility and diversification of available energy resources; to respond to the challenge of energy security; to promote the use of renewable and less environmentally harmful energy resources, especially with regard to the need to reduce GHG emissions and exploit the countrys comparative advantages; and to promote the development and export of new technologies and products. Brazil is a pioneer in the production and use of ethanol, and in addition to the expansion of its domestic market for this fuel, exports are expected to rise, so that Brazil will retain its leading position in the international market. This study identifies and analyzes future challenges to Brazilian ethanol exports by studying potential markets, their fuel ethanol programs, their tariff and non-tariff barriers, their protectionist measures against foreign products, their subsidies for domestic producers, and their certifications, which may delay the consolidation of ethanol as a commodity and impede its growth in international trade.

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Shared decision making (SDM) is rarely used in pediatric clinical practice. The purpose of this dissertation was to explore factors influencing SDM implementation in pediatric clinical practice. We conducted three studies that were guided by the Ottawa Model of Research Use (OMRU): Study 1 was a systematic review using Cochrane methods and the Mixed Methods Appraisal Tool to determine pediatric SDM barriers and facilitators from multiple perspectives. Eighty studies, of low to high quality, were included. At each OMRU level, frequently cited barriers were: option features (decision), poor quality information (innovation), emotional state (adopter), power relations (relational), and insufficient time (environment). Frequently cited facilitators were: lower stake decisions (decision), agreement with SDM (adopter), high quality information (innovation), trust and respect (relational), and SDM tools/resources (environment). Across participant types, frequently cited barriers were: insufficient time (healthcare providers (HCP)), option features (parents), power imbalances (children), and HCPs’ SDM skills (observers). Frequently cited facilitators were: good quality information (HCPs) and agreement with SDM (parents/children). Study 2 was a post-test design that evaluated SDM knowledge and acceptability of learners who completed the Ottawa Decision Support Tutorial (ODST). Most learners were HCPs (62%). Overall, ODST learners had a median knowledge test score of 8/10 (IQR = 7-9; n=6604) and 90% reported good or excellent impressions (n=4276) after completing the tutorial. Few learners suggested improvements. Study 3 used mixed methods to evaluate pediatric HCPs’ perceived SDM barriers and facilitators after training (ODST plus workshop). Participants completed a SDM barrier survey (n=60; 88% response rate) and semi-structured interview (n=11). Their intention to use SDM was high (mean score = 5.6/7, SD=0.8). However, 90% of respondents reported minimal SDM use after training. Main barriers were lack of buy-in (adopter level) and time constraints (environmental level). Healthcare providers wanted a team-based approach to SDM training (training level). Adopters face numerous and diverse barriers to SDM use, before and after SDM training. Pediatric HCPs who completed the ODST were knowledgeable about SDM. Despite positive intentions, training alone was insufficient to achieve routine SDM use. These findings can inform intervention development to promote SDM implementation in pediatric clinical practice.

The U.S. Customs Border Patrol reported a total of 67,339 children crossed the Mexican border illegally into the Unites States in the 2014 fiscal year. The Office of Refugee Resettlement found 34% came from Honduras, 32% from Guatemala and 29% from El Salvador. The United States has been strained with the task of finding, providing and funding adequate housing, health care and education amongst other things for these minors while they wait for court immigration proceedings. The purpose of this research was to explore the barriers social and human service agencies face in finding a safe, stable and nurturing environment for Central American unaccompanied undocumented minors in the United States. A qualitative method to understand the phenomenon was taken. This study revealed six common themes: 1) barriers in providing a safe, stable and nurturing environment was lack of the English language in the children and stigma surrounding immigration 2) barriers in education were lack of English language, financial situation and lack of transcripts or history of the child’s educational background, 3) barriers in health care was the limited access to health care 4) barriers in housing were crowded living situation, lack of affordable housing and placement in foster care, 5) barriers in language were the child’s limited knowledge of the English language, lack of bilingual providers, lack of educational material in Spanish, child’s limited knowledge of Spanish language, 6) other barriers not inquired about were the participants lack of knowledge of available resources for the children and the child’s immigration status.

The research presented on this paper examined the impact that the number of barriers have towards the delay in getting treatment among the Latino population. Participants (N=31) at Family Solution Collaborative, answered questions presented to them via a self-administered questionnaire that contained questions that examined types of barriers and how they impact mental health services. An independent sample t-test was conducted assessing generation status and the sum of perceived barriers. A Pearson correlation, design was used, for the purpose of searching for a relationship between the number of years in the U.S. and age with the sum of perceived barriers. Results for all test conducted showed no significance between all variables. In conclusion, although findings for this study did not support past research it is important to address the limitations to continue to develop culturally appropriate programs to help reduce the disparity of Latinos within mental health services.

Heart failure (HF) is an escalating chronic disorder that impacts patients, families, and society. HF necessitates efficient transition of care and complex self-care knowledge in a population often burdened with low health literacy and high readmission rates. The purpose of this project was to improve transition of discharged HF patients from a Level 1 trauma system in a mostly rural area of South Carolina to its affiliated nurse-led HF clinic. The no-show rate for initial visits to the health care system's outpatient HF clinic by postdischarge patients was 59%. Using Henderson's need theory and Stevens's knowledge transformation model for theoretical guidance, a quality improvement project was conducted to identify factors related to no-show behavior in initial HF clinic visits using a retrospective chart audit of the first 50 no-show patients in a 90-day period. Data were collected from the electronic medical record and analyzed through descriptive statistics. Frequently noted factors were lack of literacy screening, use of assistive devices, and access issues related to distance to travel and transportation to the HF clinic. Recommendations included mandatory literacy level screening on admission, integration of an evidence-based health literacy screening tool into the electronic record, use of satellite HF clinic services, and consideration of a mobile HF clinic on wheels to better serve the rural population. Social change is expected to occur in this vulnerable population through these efforts to address health literacy issues and increase access to clinic care after hospital discharge.

The thesis was based on a unique opportunity to compare the perceptions of participants before and after a scenario planning project conducted in a water utility. The researcher was able to explore the perceptions of the participants of scenario planning as a change agent directly, and so address a concern in some of the literature that much of the body of knowledge on scenario planning has been filtered through the viewpoints of scenario planning practitioners. Through the use of an adapted grounded theory approach, the perceptions of the participants emerged independently of a pre-conceived theoretical framework and explanations of the outcomes of the process were developed from this data. As well, the assumptions behind the practice of scenario planning were explored and from this a theory for scenario planning was developed. This was effected while constant comparison of concepts emerging from the data was in progress and provided a theoretical framework for the discussion of the empirical research. In this case scenario planning was perceived more as an instrument than as an agent of change, with a role of setting a framework for the strategic conversation in the subsequent phases of the change initiative. The outcomes of the research illustrated that uncertainties internal to the organisation had affected the implementation of change. In particular the conceptual ecologies of people in the organisation were not explored in depth, and this perpetuated a driving force for the future of the organisation that was not merely uncertain but remained unknowable. It was concluded that whether a scenario planning project achieved its objectives was matter of perception, with evaluation differing depending on the viewpoint taken. / Change of mind-set was not necessarily needed for a change of strategic direction, which could be explained using a political metaphor. However, for cultural change to be effected, there was a need for operatives to identify with it. It was concluded from this case that unless change and/or the change process were adapted to resonate with the world views of the operatives, it was unlikely it would become embedded in the organisation and may be resisted. Conceptual ecologies needed to be explored for this adaptation to occur.