Many countries, including Nepal, have been affected with highly pathogenic avian influenza (HPAI) outbreaks. There have been human mortalities in some countries and large numbers of poultry either died or were culled due to HPAI. The overall objective of this thesis was to improve our understanding of the epidemiology and economics of avian influenza (AI), and particularly HPAI, in Nepal. We determined the seroprevalence of and risk factors for AI virus antibodies presence in ducks in Kathmandu, Nepal. The estimated true prevalence of AI viruses (AIV) antibodies was 27.2% [95% Confidence Interval (CI): 24.6- 29.5]. Age of the ducks was identified as the only risk factor for AIV seropositivity. Ducks older than one year were more likely to be seropositive compared to ducks less than six months of age [Odds Ratio= 2.17 (95% CI: 1.07- 4.39)]. This study provided baseline information about seroprevalence of AIVs in Kathmandu that will benefit further research to differentiate the subtypes of AIVs circulating in Kathmandu. We also evaluated alternatives to the current control program (CCP) for HPAI in Nepal. The considered alternatives were: (i) absence of control measures (ACM) and (ii) vaccinating 60% of the domestic poultry flock twice per year. Cost-benefit analysis approach was used to evaluate the economic feasibility of the programs. In terms of the benefit-cost ratio, our findings indicated that there is a return of 1.96 dollars for every dollar spent in the CCP compared to ACM. The net present value of the CCP versus ACM was US$ 989,918. The vaccination program yielded a return of 2.41 dollars for every dollar spent when compared to the CCP. The net present value of vaccination versus implementing the CCP was US$ 13,745,454. These results support a continued investment into the CCP rather than ceasing to implement government regulated control measures and suggest that vaccination may be an even better control alternative. In summary, our studies have highlighted the value of epidemiologic and economic analysis in research of AI. Our results are expected to lead to an improved understanding and awareness of AI in Nepal and to formulation of better control strategies.

The primary purpose of this study is to investigate whether the effect of group identity on individuals' willingness to cooperate is moderated by benefit asymmetry (i.e., mutual cooperation may benefit some group members more than others). I conduct an experiment in which participants act as group members for a hypothetical company. Consistent with expectations, I find that a strong group identity promotes employees' cooperation rates, but only in situations in which benefits resulting from mutual cooperation are symmetric. When the benefits are asymmetric, employees' willingness to cooperate depends on whether they are disadvantaged or advantaged as well as the level of group identity. Specifically, the disadvantaged employees are less likely to cooperate when group identity is high. In contrast, the advantaged ones' willingness to cooperate is unaffected by the level of group identity. Results of my study suggest that, in situations of benefit asymmetry, inducing a high level of group identity may have unintended negative consequences on group performance as well as organizational productivity.

This study addressed the use of benefit levers to develop a guide for an operational plan for spread of best practices in the health system of South Africa. Using the best evidence to inform practice is the cornerstone of quality patient care. Besides uptake and implementation, spreading best practices is crucial as this provides more patients with evidence-informed care and to improve practice and health (care) outcomes. However, spread of best practices is not always effectively done. An example includes Kangaroo Mother Care (KMC) as this best practice is translated for practice and implemented on a limited scale; spread to the whole system seems to be problematic. Various factors can be used to facilitate the spread of best practices. Edwards and Grinspun identified four benefit levers which create the tipping point towards successful adoption, implementation and spread of evidence: alignment, permeation plans, leadership for change, and supporting and reinforcing structures. However, little is known about these benefit levers and it remains unclear what the use of benefit levers for system-wide spread would entail, specifically for other contexts as the model (including the benefit levers) has never been operationalised (Edwards & Grinspun, 2011:19). The overall aim of this study entails therefore the development of a guide for an operational plan, formulating the use of benefit levers in the spread of best practices. To achieve this aim the following objectives for this study were set: 1. To explore and describe characteristics of benefit levers to facilitate spread of best practices. 2. To develop a guide for an operational plan to use benefit levers for the spread of best practices. This study was embedded in the postmodern paradigm, whereby the systems theory was used as a theoretical framework. The first objective was achieved by two steps. Firstly, an integrative literature review of concept clarification of the four benefit levers was done. Secondly, semi-structured individual interviews were conducted with key informants from a variety of levels of the health system involved in the spread of KMC in South Africa. Findings were used to achieve objective two. A draft guide for an operational plan was developed, based on the findings of the individual interviews. A logic model was used as format. This guide was refined by experts using the Delphi technique. The Delphi involved two rounds. From the feedback of the first round of the Delphi, a logic model which provides a graphic outlook of the guide, was suggested and refined in the second round, together with the guide. Further, after the Delphi, a template useable for practice was derived from the guide. The guide, logic model and template could help organisations or departments planning to spread best practices in a certain context (e.g. South Africa), to develop an operational plan, where these benefit levers are considered. This is crucial as currently best practices (such as Kangaroo Mother Care) are often not spread on a system-wide basis to improve practice. The guide will therefore be made accessible to health care workers and researchers in South Africa Finally, conclusions were drawn, the research was evaluated, limitations were identified and recommendations were formulated for nursing practice, education and research. Overall, it can be concluded that for effective spread of best practices the benefit levers alignment, permeation plans, leadership for change and supporting and reinforcing structures are required. Further, specifically regarding the objectives and steps of this study the following conclusions can be made: • Literature/studies about leadership for change and supporting and reinforcing structures was found, but regarding alignment and permeation plans, limited rigorous literature was found (Objective 1 – Step 1). • Key informants involved in the spread of a specific best practice (Kangaroo Mother Care) could see the value of benefit levers used for the spread of best practices in the South African health system (Objective 1 – Step 2). • Benefit levers were found useful for development of a guide for an operational plan to spread best practices. This guide will be made accessible to be used by healthcare organisations and departments in South Africa (Objective 2 – Steps 1 and 2). / Thesis (PhD (Nursing))--North-West University, Potchefstroom Campus, 2013

This study addressed the use of benefit levers to develop a guide for an operational plan for spread of best practices in the health system of South Africa. Using the best evidence to inform practice is the cornerstone of quality patient care. Besides uptake and implementation, spreading best practices is crucial as this provides more patients with evidence-informed care and to improve practice and health (care) outcomes. However, spread of best practices is not always effectively done. An example includes Kangaroo Mother Care (KMC) as this best practice is translated for practice and implemented on a limited scale; spread to the whole system seems to be problematic. Various factors can be used to facilitate the spread of best practices. Edwards and Grinspun identified four benefit levers which create the tipping point towards successful adoption, implementation and spread of evidence: alignment, permeation plans, leadership for change, and supporting and reinforcing structures. However, little is known about these benefit levers and it remains unclear what the use of benefit levers for system-wide spread would entail, specifically for other contexts as the model (including the benefit levers) has never been operationalised (Edwards & Grinspun, 2011:19). The overall aim of this study entails therefore the development of a guide for an operational plan, formulating the use of benefit levers in the spread of best practices. To achieve this aim the following objectives for this study were set: 1. To explore and describe characteristics of benefit levers to facilitate spread of best practices. 2. To develop a guide for an operational plan to use benefit levers for the spread of best practices. This study was embedded in the postmodern paradigm, whereby the systems theory was used as a theoretical framework. The first objective was achieved by two steps. Firstly, an integrative literature review of concept clarification of the four benefit levers was done. Secondly, semi-structured individual interviews were conducted with key informants from a variety of levels of the health system involved in the spread of KMC in South Africa. Findings were used to achieve objective two. A draft guide for an operational plan was developed, based on the findings of the individual interviews. A logic model was used as format. This guide was refined by experts using the Delphi technique. The Delphi involved two rounds. From the feedback of the first round of the Delphi, a logic model which provides a graphic outlook of the guide, was suggested and refined in the second round, together with the guide. Further, after the Delphi, a template useable for practice was derived from the guide. The guide, logic model and template could help organisations or departments planning to spread best practices in a certain context (e.g. South Africa), to develop an operational plan, where these benefit levers are considered. This is crucial as currently best practices (such as Kangaroo Mother Care) are often not spread on a system-wide basis to improve practice. The guide will therefore be made accessible to health care workers and researchers in South Africa Finally, conclusions were drawn, the research was evaluated, limitations were identified and recommendations were formulated for nursing practice, education and research. Overall, it can be concluded that for effective spread of best practices the benefit levers alignment, permeation plans, leadership for change and supporting and reinforcing structures are required. Further, specifically regarding the objectives and steps of this study the following conclusions can be made: • Literature/studies about leadership for change and supporting and reinforcing structures was found, but regarding alignment and permeation plans, limited rigorous literature was found (Objective 1 – Step 1). • Key informants involved in the spread of a specific best practice (Kangaroo Mother Care) could see the value of benefit levers used for the spread of best practices in the South African health system (Objective 1 – Step 2). • Benefit levers were found useful for development of a guide for an operational plan to spread best practices. This guide will be made accessible to be used by healthcare organisations and departments in South Africa (Objective 2 – Steps 1 and 2). / Thesis (PhD (Nursing))--North-West University, Potchefstroom Campus, 2013

ACE inhibitors have been widely used in the treatment of certain diseases of the cardiovascular system, the major use being hypertension, since all ACE inhibitors are prescribed for its treatment. ACE inhibitors is also used in the treatment of congestive heart failure. The angiotensin-converting enzyme (ACE) converts angiotensin 1 into angiotensin I1 and also stimulates the production of aldosterone (a hormone produced in the adrenal glands that influences salt and water retention by the kidneys, increasing blood volume and blood pressure). The cost benefit, cost-effectiveness and cost utility of ACE inhibitors have not been established. The objective of the study was to review and analyse the cost of ACE inhibitors by using a medical aid claims database. Data for the study population consisted of all prescriptions containing one or more ACE inhibitor combinations and were extracted from the central database of Interpharm datasystems for a period of one year, from 1 January 2001 to 31 December 2001. A total of 1 475 532 prescriptions containing a total of 2 953 244 ACE inhibitor items represented the study population. Through the analysis of the general medicine utilisation patterns that were obtained from the medicine claims database, it became evident that ACE inhibitor utilisation contributes considerably to the total prevalence and cost of all the medicine items available on the database. It constituted a total prevalence of 4,62% (n =1 475 532) of all the prescriptions and a total prevalence of 2,31% (n =2 953 244) for all the medicine items in the prescriptions with a cost of 3,65% (n =R379 91 1 472,OO). It was concluded that in the analysis of ACE inhibitors according to the innovator/generic classification, the majority of ACE inhibitors prescribed during the twelve-month period were for the innovator product, with a prevalence of 82,56% (n =68 162) and a cost of 89,11% (n =R13 863 080, 90). The utilisation of the generic ACE inhibitors, with a prevalence of 17,44% (n =68 162) and at a cost of 10,89% (n =R13 863 080, 90), was under-utilised. If the total number of prescriptions containing innovator ACE inhibitors could be generically substituted, (37,54%) R5 204 392,68 in cost expenditure could be saved over a twelve-month period. However, the fact that not all the innovator ACE inhibitors have generic equivalents available must be taken into account. If only the prescriptions containing ACE inhibitor items that have generic equivalents were to be substituted with their generic equivalents, R899 751.29(6.5%) would be saved. This was found by adding all the costs saved by substituting innovator drugs with their generics. Consequently, it can be concluded that the extensive use of the innovator ACE inhibitors could mean an exceptional increase in the cost expenditure associated with ACE inhibitor therapy. In completion of the study, recommendations were formulated as an aim to optimise the utilisation of ACE inhibitor generic equivalents. / Thesis (M. Pharm.)--North-West University, Potchefstroom Campus, 2004.

Children under the age of 18 are the largest age group of people who live in poverty in America. This paper focuses on early intervention programs and how they can help ameliorate the negative effects of poverty. Previous research has demonstrated the negative effects of poverty, such as lower academic performance and achievement and more behavioral problems. Various risk factors for poverty, such as single parents, low maternal education, and lack of resources, and their role in the design of early intervention programs will be explained. The Perry Preschool Project (PPP), Head Start, the Chicago Child-Parent Center (CPC) Program, and the Carolina Abecedarian Project and their effects on child outcomes will be analyzed. Cost-benefit analyses for each early intervention program, as well as future considerations for public policy, will be discussed in this paper.

The aim of this research is to propose a sociotechnical framework to identify stakeholders involved in information systems and the benefit and barriers to the adoption of such systems. The proposed framework (BEBAF) would help to acknowledge the potential problematic areas for the implementation and adoption of information systems for each actor or social group and to be able to offer solutions based on the potential benefits for each of them. Precursors of BEBAF are social construction of technology (SCOT) and stakeholder identification process. Two case studies in the healthcare contexts, one in the UK and one in Spain, have been conducted in this dissertation using a qualitative approach to provide a rich picture of the influences on e-Health, and the users and organisational response to those influences. Both case studies aimed to support chronically ill patients at home or in nursing homes. BEBAF was then applied to both case studies. Among the most important implications are that those systems hold the promise for improving the quality of life of patients with chronic conditions, providing a better control over the disease. However, their impact on the organisational structures, the lack of funding and the difficulties of alignment of all the actors involved are relevant constraints to their adoption into the mainstream healthcare services. The main contributions of this thesis are: first, the definition and evaluation of a socio-technical framework to investigate IS adoption. Apart from the two closure mechanisms proposed by SCOT, BEBAF proposes a new closure mechanism by reinterpretation of benefits. In turn, the application of the framework has led to identify an extensive list of barriers and benefits for the adoption of e-Health systems with some suggested solutions. Another outcome is a comprehensive list of stakeholders involved in the adoption of such systems.

Risk management is composed of three major elements viz., hazard identification, risk estimation and risk evaluation. The aim of hazard identification and risk estimation is to identify the outcomes from risk, the magnitude of the associated con&quences from risk, and the estimation of the probabilities of these outcomes. Previous work focused on hazard identification and risk estimation and identified the relatively high risks associated with playing professional football. By adhering to the risk management process, the aim of this thesis was to determine the significance of these high risks to football clubs and their players. A theoretical framework was designed to evaluate the influence of player injury on the financial and playing performance of professional football clubs. This framework was also used to assess, through use of cost benefit analysis, the practicalities of investing in suitable injury prevention strategies, to reduce the risks to football clubs and their players. Former professional footballers were surveyed to investigate the long-term medical and socioeconomic consequences associated with the high risks of playing professional football. The results identified the high financial costs associated with player injury on professional football clubs. Although the high risks of player injury have a relatively minor effect on teamperformance of the Premier League clubs, this effect still has a relatively major influence on the financial performance of the club. In contrast, the influence of player injury to teamperformance was relatively major for Division I and Division 2 clubs, but this had a relatively minor effect on financial performance. The application of cost benefit analysis to the investment of specialist personnel to reduce the risks of injury demonstrated that the proposals were practicable for Premier League and Division I clubs only. In addition, it was also demonstrated that the high risks associated with playing professional football have a significant influence on the long-term well-being of foriner players. One-third of former players had been medically diagnosed osteoarthritic in a lower limb joint. The majority of players also perceived that injury had a negative influence on their present and future welfare. The results demonstrate that the consequences associated with the relatively high acute injury risk also have a significant effect on the financial and playing performance of football clubs and the future welfare of their players.

A more rapid and widespread use and implementation of technology in construction often fails since its benefits and limitations remain somewhat unclear. Project control is one of the most variable and time consuming task of construction project managers and superintendents, and yet continues to be mostly a manual task. Controlling tasks such as tracking and updating project schedules can be assisted through remotely operating technology such as hi-resolution cameras that can provide construction management and other users with imaging feeds of job site activities. Although construction cameras have been around for many years the costs, benefits, and barriers of their use have not been investigated nor quantified in detail. Subsequently, definitions and understanding vary widely, making it difficult for decision makers at the organizational level to decide on the investment in camera technology. This thesis reviews the status of hi-resolution cameras and their present use in construction. Results of a multi-phased survey to industry professionals were collected in order to identify benefits and barriers and develop a cost-benefit model that can be used for implementation technology in construction.

The primary aim of this thesis was to conduct a longitudinal study, to investigate the quality of life (QOL) in a large sample of people diagnosed with colorectal cancer (CRC), immediately post-diagnosis and one-year later. Various measures were utilised to capture the multifaceted concept of QOL, including psychological distress, satisfaction with life, positive affect and cancer-related quality of life. The investigation was conducted within Lazarus and Folkman’s stress and coping framework. Specifically, this research aimed to test the utility of the stress and coping framework in the context of CRC, and to explore the role of benefit-finding within the context of the stress and coping model components. One thousand, eight hundred participants (1078 men and 722 women) with a CRC diagnosis duration of 1 to 12 months, completed a telephone interview and written questionnaire, assessing demographics, disease/treatment characteristics, threat appraisal, social support, optimism, coping, benefit-finding and quality of life domains, at approximately five- and 12-months post-diagnosis. To identify CRC-specific coping strategies, the Coping with Colorectal Cancer measure was developed in the initial study. The eight factor structure was confirmed, and the subscales (Positive Perceptual Change; Religion/Spirituality; Rumination; Acceptance; Humour; Palliative; Seeking Social Support; and Lifestyle Reorganisation) found to have reliability and preliminary criterion-related validity within the context of the stress and coping framework. As predicted, regression analyses showed that, after controlling for demographics, disease/treatment characteristics and stress/coping variables, the coping subscales uniquely predicted Time 1 QOL outcomes, with Seeking Social Support continuing to predict Time 2 Positive Affect. In the second study, the benefit-finding domains specific to those with CRC were identified, and relationships with quality of life outcomes assessed, to determine the inclusion of benefit-finding in the path model. Based on completed data from 1757 of the initial 1800 participants, confirmatory factor analyses revealed three domains of benefit-finding: Personal Growth; Interpersonal Growth and Acceptance. As hypothesised, regressions analyses found that benefit-finding domains at Time 1 was associated with Time 1 QOL outcomes, specifically, Positive Affect and Cancer-related Quality of Life (both the aggregate score and its Social/Family, Functional and Colorectal Cancer-specific Well-being subscales). Time 1 Personal Growth also predicted Time 1 Psychological Distress. After controlling for Time 1 Positive Affect, Personal Growth continued to predict Time 2 Positive Affect. The final study drew on the results of the first two studies, which informed the coping strategies and benefit-finding domains to be included in regression analyses initially, and then, structural equation modelling. The final study included 1276 complete data sets of the initial 1800 participants. Parameters of the initial hypothesised model of the stress and coping framework, including relationships with benefit-finding (based on empirical findings) failed to fit the model to the data. After several revisions, the analysis revealed that the final model fit the data, where stress, coping and benefit-finding accounted for 63% of the variance in Time 1 QOL. The model showed that threat appraisal, coping resources, avoidant coping and benefit-finding directly impacted on Time 1 QOL, while threat appraisal, social support and approach coping directly impacted on benefit-finding. In this study, the approach coping strategies included in the path model could also be conceptualised as meaning-based coping strategies, as they appeared to facilitate a meaning-making process. However, benefit-finding, which some researchers have suggested is also a meaning-based coping strategy, had differential relationships with stress, coping and outcome variables, compared with the approach coping strategies. These results indicate that benefit-finding is an empirically distinct construct in the context of CRC. Finally, in this study, the impact of stress, coping and benefit-finding on Time 2 QOL, was indirect, being mediated by Time 1 QOL outcomes. The accumulated findings of these three studies have extended the cancer coping and benefit-finding research by revealing new relations between stress, coping and benefit-finding and QOL in a mixed-gender, older population with CRC. There are implications for measurement of, and theory building around benefit-finding. Finally, these studies inform the development of clinical interventions to enhance the quality of life in the short- and longer-term for individuals diagnosed with CRC.