The purpose of this study is to supply additional case material for analysis and study by the potential and beginning foreman. Since it would be impossible to cover all possible situations, only selected cases are presented. The selected cases illustrate problems in foreman-to-employee relationships, foreman-to-foreman and staff-groups relationships, and foreman-to-superior relationships. In the interest of clarity, each case was analyzed as to key points covered or contained, principles illustrated by the case, and recommendations derived from the analysis.

Les études de pharmacoépidémiologie consistent à étudier l’effet de médicaments en vie réelle, et sont menées de plus en plus souvent sur bases de données médico-administratives. Ce sont principalement des études observationnelles, et sont donc soumises à des biais liés à des facteurs de confusion. Ces facteurs ne sont pas toujours recueillis dans les bases de données médico-administratives qui sont implémentées à d’autres fins que la recherche. Des plans expérimentaux self-controlled designs (où le patient est son propre témoin, et dont les principaux sont le case-crossover et le self-controlled case-series) permettent d’étudier l’effet transitoire d'expositions brèves sur des évènements à début brutal. Ils sont soumis à certaines conditions d’application. Ils ont la particularité de réaliser des comparaisons sur différentes périodes plutôt que sur différents groupes de patients, permettant ainsi de prendre en compte des facteurs de confusion, y compris non mesurés, et qui ne varient pas entre les périodes observées. Ces méthodes ont montré leur utilité pour pallier l’absence de randomisation, et leur utilisation est recommandée quand leurs conditions d’application sont remplies. Nous avons étudié la fréquence d’utilisation des self-controlled designs en pharmacoépidémiologie sur bases de données, les opportunités manquées d’utilisation et leur usage approprié au regard de leurs conditions d’application, ainsi que la qualité de l’information rapportée dans les articles. Nous avons montré que leur utilisation est rare, que 15% des articles correspondent à des situations d’opportunité où ces méthodes auraient pu être implémentées, que 34% des case-crossover et 13% des self-controlled case-series étaient appliqué de façon inapproprié, et que pour 16% des articles la méthode aurait pu être adaptée pour être valide. Un usage plus approprié permettrait de contribuer à l’investigation en pharmacoépidémiologie tout en bénéficiant des avantages de ces méthodes en particulier sur bases de données de santé. / Pharmacoepidemiology consists in the study of efficacy or safety of drugs in real life, with the use more and more frequently of medico-administrative databases. Study designs are generally observational, thus they are prone to confounding bias. Confounders are not systematically collected in databases, which are implemented for other purposes than research. Self-controlled designs (mainly represented by case-crossover and self-controlled case-series, and in which the patient acts as his own control), have been developed for the study of intermittent exposure with short-term effect on abrupt onset event. They require that validity assumptions being fulfilled. They consist in the comparison over different periods, rather than different groups of patients, thus allowing for confounding factors, also if not measured, which are invariant over observed periods. Such designs have been proved useful in observational studies in the absence of randomization, and their implementation is recommended in case of validity assumptions are fulfilled. We studied their frequency of use in pharmacoepidemiology in healthcare databases, missed opportunities for use, inappropriate use with respect to validity assumptions, as well as quality of reporting. We showed that self-controlled designs are rarely used, that opportunity for use was founds in 15% of articles where such methods could have been implemented, that 34% of case-crossover and 13% of self-controlled case series were inappropriately used, and that the method could have been adapted to be valid in 16% of articles. A more appropriate use of self-controlled designs could contribute to improve investigation in pharmacoepidemiology, while beneficiating from their advantages, especially in healthcare databases.

Background: Undiagnosed chronic obstructive pulmonary disease (COPD) and asthma remain prevalent health issues. The current global and Canadian prevalence reported for obstructive lung disease do not reflect the true prevalence since undiagnosed cases remain missed and uncounted. Spirometry testing is viewed as the current gold standard for diagnosing obstructive lung disease. However, barriers associated with inaccessibility and underuse have contributed to undiagnosed lung disease. While guidelines advise against spirometry for asymptomatic persons, active case-finding for persons at-risk and those presenting with symptoms has been recommended. Given early treatment and management has the potential to improve health-related quality of life and reduce the progression of lung decline, identifying undiagnosed lung disease is critical to preventing adverse health outcomes. To date, this marks the first study to incorporate both obstructive lung diseases into a single-case finding instrument. Objective: To develop and validate a case-finding questionnaire to identify undiagnosed COPD and asthma in community-dwelling adults, and to prospectively evaluate reliability and predictive performance. Methods: This study uses data obtained from the Undiagnosed Chronic Obstructive Pulmonary Disease and Asthma Population (UCAP) study from June 2017 to March 2020. Eligible participants were >18 years, had a history of chronic respiratory symptoms, and had no previous physician diagnosis of obstructive lung disease. Presence of obstructive lung disease was confirmed with spirometry. Multinomial logistic regression and recursive partitioning were used to develop a case-finding questionnaire. Predictors available from six questionnaires completed during spirometry visit. Diagnostic accuracy of the models was used to evaluate performance. Risk score externally validated in a cohort of participants recruited between October 2020 and January 2021 at study sites open during the COVID-19 pandemic. Results: Derivation cohort included 1615 participants, with 136 ultimately diagnosed with asthma and 195 diagnosed with COPD. A 13-item questionnaire was developed using logistic regression: age, pack-years of cigarette smoking, wheeze, cough, sleep, chest tightness, level of tiredness, physical activity limitation, occupational exposure, primary or second-hand smoke exposure, frequency of chest attacks, and salbutamol medication. Internal validation showed an area under the curve (AUC) of 0.79 (0.70-0.90) for COPD and 0.64 (0.45-0.80) for asthma. At a predicted probability of greater than or equal to 6%, specificity was 17% for no OLD, sensitivity was 91% for asthma, and sensitivity was 96% for COPD. External cohort included 74 subjects, with 8 diagnosed with COPD and 6 diagnosed with asthma. The AUC for COPD was 0.89 (95% CI: 0.62-0.90) and AUC was 0.65 (95% CI: 0.63-0.72) for asthma. Sensitivity was 100% for both asthma and COPD, specificity was 13%, and positive predictive value was 23%. Conclusion: The 13-item case-finding questionnaire was shown to be reliable and with modest predictive ability in identifying COPD and asthma. Prospective evaluation with the UCAP study is still ongoing to recruit a larger sample to re-evaluate predictive performance.

This thesis reports the results of a prospective multicentred case-control study of mesothelioma carried out in South Africa. The objectives of the study were: 1) to examine asbestos exposure of cases in detail with respect to source, risk occupations, fibre type and duration; 2) to determine relative risks for level (certainty) of exposure (definite, probable, possible, unlikely), for category of exposure (occupational, environmental), and for fibre type and skin colour; 3) to determine whether cases without recall of exposure were exposed to other non-asbestos putative agents; 4) to investigate the possible protective effect of certain dietary components. Previous studies of mesothelioma in South Africa had, with the exception of one incidence study, focused on particular occupational or case material, exposure data had been gathered in a non-systematic way, often indirectly from surrogates, and non-asbestos agents had not been investigated. In this case-control study these issues are all addressed. In addition, special efforts were made to minimise potential sources of bias (e.g. interviewer bias) and so to furnish reliable effect estimates. The study incorporated the following methodological features: 1) a prospective approach to gather exposure and dietary information directly from the cases and controls in life and so avoid the use of surrogates for this information; 2) the study was multicentred with study teams established in six cities, each with a major referral hospital, to maximise nation-wide coverage; 3) information was gathered with interviewers blind (at least at the beginning of the study) to study objectives and case control status at the time of the interview; 4) rigorous pathologic review was used to establish the diagnosis of mesothelioma; 5) two controls were selected for each case, a cancer and a non-cancer patient matched for hospital, sex, age and skin colour; 6) in analysis the case control datasets were treated separately (i.e cases and cancer controls, and cases and non-cancer controls were treated as two separate datasets). One hundred and twenty three cases were accepted into the study. No case was documented with purely chrysotile exposure nor exposure to a putative non-asbestos cause of the tumour without some evidence of asbestos exposure. A minimum of 22 cases (18%) had exclusively environmental exposure, 20 were from the NW Cape (a crocidolite mining region). Fifty eight percent had occupational exposure, three of whom had mined amosite. The relative risks associated environmental exposure in the NW Cape were larger than for environmental exposure in the NE Transvaal: 21.9 versus 7.1 for the cancer control dataset and 50.9 versus 12.0 for the medical control dataset. Increasing consumption of carotene rich fruit was found to be protective for mesothelioma when adjusted for asbestos exposure. The results confirm the high disease burden due to occupational exposure, the importance of environmental exposure in the crocidolite mining area of the NW Cape, the relative paucity of cases linked to amosite, the rarity of chrysotile cases, and are consistent with the view that there is a fibre gradient in mesotheliomagenic potential for South African asbestos with crocidolite > amosite > chrysotile. The evidence for a protective effect of carotene rich fruit is new in the South African context.

The purpose of this study was to investigate the life of one child who has been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). The definition of ADHD has become very broad and many children are being treated according to the label of ADHD. This study investigated the life of one eight year old boy from conception until present in order to understand the child as an individual. The research was framed in developmental contextualism and developmentally appropriate practice in a case study approach. In depth interviews and observations formed the data for the case. The study case demonstrated the need to focus on the child as an individual, and not just the label of ADHD. Recommendations were made for parenting and teaching, as well as for future research. / Master of Science

This group project represented an attempt to study some factors pertaining to the formation of a system of case classification in a county public welfare agency, Multnomah County Public Welfare Commission, Portland, Oregon. The classification tool was a Case Planning Schedule intended to encourage diagnostic thinking on the part of the caseworker and to enhance planning and service for the client. The focus of the study was limited to two areas: (1) whether or not the use of the Schedule resulted in agreement among caseworkers in classification and in consistency on prognoses, (2) the attitudes of the caseworkers in various departments toward the Case Classification Program and the Case Planning Schedule. Background for the study involved a search of the literature surrounding new approaches to the problems of "multi-problem families" and public assistance caseloads. Consideration was given to agency structure and the circumstances surrounding the creation of the Oregon Program for Case Classification. Five main hypotheses were tested. With one a comparison was made between classification and prognostication of cases with and without a case classification Schedule. The other testable hypotheses were dealt with by administration of an interviewing schedule designed to gather data regarding staff attitudes toward the Program and the Schedule. Appropriate statistical tests of significance were employed and a content analysis was used in connection with an open-ended attitudinal question. Qualitative and quantitative findings were consistent in demonstrating that caseworkers tended to be favorable toward the intent of the Program but critical toward implementation procedures. Divergent viewpoints were shown in comparing responses of workers by categories of work-load assignments departmental assignments, and length of service in the agency. These findings suggest that additional research include an evaluation of the validity of such systems.

Until quite recently "tourism" was principally a feature of, and was largely confined to, the developed countries. During the past two decades, however, tourism has become an income earning alternative to the many Third World countries, and many have capitalized on the industry which has become known as a "passport to development." In recent years the situation has worsened for these former exporters of primary agricultural products. These products are suffering from the general fall in world commodity prices and competition from larger and more efficient agricultural producers. In addition, the world economic impact has been translated to ever-burgeoning foreign debt crisis and the further deterioration of balance of payments. The need for foreign currency has been intensified by the new export promotion policies which are replacing import substitution as the dominant development policy in Third World manufacturing. Tourism under these circumstances is a mixed blessing, and until very recently economists have pondered tourism's contribution carefully and have applied a wide range of theories to a description of the benefits of extended tourism business. In addition, with the new surge in tourism literature not only have the economic benefits of tourism been questioned, but tourism's social, cultural, and environmental impacts have become major issues of contention. The complex matrix of advantages and disadvantages ensures that governments must face an unenviable task of trying to weigh gains from new income and employment against certain less direct and long-term losses. While tourism on the one hand is blessed as the passport to development," on the other hand it has been characterized as a force which destroys uncomprehendingly and unintentionally cultural values and social customs. In order to enhance and secure the positive influences of tourism in the long run and ensure its sustainability as an alternative means of income, an elaborated national tourism policy is required. An effective policy would guide the industry through certain development plans in accordance with the overall national development policies. The current study suggests that Turkey's tourism development was subject to various deliberate influences and spontaneous dynamics without a prior policy formulation in the form of a national tourism policy. This study further suggests that the tourist boom of 1980s caught the government and private sector by surprise because of the lack of pre-planning or policy research. This is obvious when one examines the tourism organization and administration which is centrally controlled and implemented. The interaction between various levels of government is a critical point. This study also suggests that Turkey's position as a new tourist destination related positively to its new export promotion policies or the shift from an import substitution industrialization (lSI) economy to an export-oriented growth (XOG) economy. To note, motivations to develop tourism in Turkey are first, to gain foreign exchange, and second, to establish that Turkey represents a politically stable environment for foreign investment. However, the lack of a national tourism policy has confined the industry to only a "short term economic gain" objective which has ruled out any effort to measure its net economic value instead of gross economic revenue. Furthermore the "planning" process has remained limited to physical planning to the detriment of social, environmental, and territorial planning. The lack of regional planning with goals to reduce disparities are obvious signs of the failure of planning in the tourism sector. Therefore, this study suggests that tourism has not been employed in a fashion to alleviate or minimize spatial inequalities, but rather the trend has been to its intensification. "Domestic tourism" has been neglected in terms of policy and planning, and social tourism, will likely disappear because many will not be able to afford the uncontrolled tourist prices in the new crowded tourist centers. The result of the study, suggests that tourism development cannot be separated from the "development" ideologies and theories which are translated to policies in the national level. In order to achieve a better understanding of tourism's role within the national development policy, one needs to examine the extension of analysis beyond the core periphery relation which is manifested in "dependency theory." The new international division of labor will most likely devise a new pattern for capital accumulation. This new process has been manifested in "dependent development" which produced new formations (i.e., NICs) or "semiperipheral" economies. In order for tourism to be a viable economic and social sector, it must overcome the disadvantages of "dependent development." The prime task of this study was to examine the complex nature of the tourism industry in Turkey as it relates to the government's effort to tourism development. The study reveals that the government's involvement in the tourism industry was hampered by an impasse in development strategies and ideologies due to the retreatment from the etatist philosophy to the export oriented/privatization scenario. This resulted in a distortion characterized by inactivity in tourism (i.e., the absence of a national tourism policy. Tourism was perceived as a short-term remedy to the lack of foreign capital as an invisible sector (replacing worker's remittances from abroad). All told, the tourism industry, regardless of its myriad potentials, was confined to a few enclave developments as directed by market forces rather than as a derivative of formal planning decisions. The government's role remains passive at this point despite a requirement for active intervention in tourism activity_

Indiana University-Purdue University Indianapolis (IUPUI) / Petroleum is undoubtedly one of the most valuable commodities in the world with an annual production worth billions of dollars, and an attempt to relate it to the slow economic performance of a country may seem far-fetched. Studies on sub-Saharan countries that produce oil have often viewed the country’s ability to govern oil from an institutionalist lens. This Thesis aims to explore the governance and management of oil resources in African states since this is the focal point between the oil-rich countries and the international community. By using a political settlement framework, I seek to further the “resource curse” discourse by challenging the new institutionalist theory which fails to adequately address the Dutch disease problem. I compare the political settlement between Ghana and Kenya and explore the dynamics of power and politics and how this relationship shapes the functionality of institutions. My analysis of the current political settlement in Kenya that is dynamic in nature, suggests that acceptable levels of elite commitment and bureaucratic capability are unlikely to be reached hence making Kenya prone to the Dutch Disease.

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