The exercise of autonomy and self-regulation is seen in the literature as one of the basic criteria of professionalism. Since in modern states Medicine has generally been the occupational grouping which has most completely attained that status, it is seen as the model or archetype of professionalism. This study focuses on just one aspect of medical autonomy, that relating to the right of medical professionals to be accountable only to their fellow professionals as far as the maintenance of practice standards are concerned. In this thesis, the theory underlying this system of "peer review" is examined and then its application during the course of the 20th century is traced in one particular jurisdiction, that of the State of New South Wales in Australia. The reason for the focus on NSW is that in this jurisdiction, medical autonomy existed and was exercised in a particularly pure and powerful form after it was instituted in 1900. However, it was also in NSW that for the first time anywhere in the world, an institutional challenge to medical disciplinary autonomy emerged with the establishment in 1984 of the "Complaints Unit" of the Department for Health. The thesis of this study is that as a result of this development, which within a comparatively short space of time led to the emergence of a system of "co-regulation" of medical discipline, medical disciplinary autonomy and peer review had within a decade, been so severely challenged as to be almost extinct in this State. In the light of theoretical frameworks provided by Weber, Habermas and the American scholar Robert Alford, the study examines the long drawn out struggle to institute medical autonomy in NSW in the 19th century, its entrenchment by subsequent legislation over the next eight decades and the "counter-attack" staged by the emergent forces of consumerism, supported by the forces of the ideology of "Public Interest Law" in the last two decades of the century. The study concludes with a discussion of the implications for definitions of professionalism which might result from the loss by Medicine in NSW, of its right to exclusive control of medical discipline and the consequent disappearance of medical peer review.

Backpacks are used by more than 90% of schoolchildren worldwide and over 40 million students in the United States on a regular basis. The carriage of loaded backpacks is associated with kinematic and physiological changes, as well as complaints of neck and back pain. Since a history of backpain in childhood is the strongest predictor of having musculoskeletal discomfort and back pain as an adult, development of back pain due to backpack use is of prognostic concern. The purpose of this dissertation was to examine the effects of backpack weights (up to 20% body weight (BW)) on children’s posture, subjective complaints of pain and perceived exertion, and walking endurance. A secondary goal was to examine the data to identify and recommend a weight limit for backpacks carried by elementary school children based on the results. In Chapter 2, we performed a preliminary study designed to examine the effects of loaded backpacks on forward head posture in school children. The results of this study found that forward head posture increased with both backpack weight and condition. The greatest differences were noted at the 15% and 20%BW backpack loads with initial loading, but after 6 minutes of walking the forward head posture was similar for all backpack loads. In Chapter 3, we conducted a study to evaluate multiple postural angles and the subjective complaints of pain and perceived exertion/fatigue in children to determine the effects of both the weight and time spent carrying loaded backpacks up to 20%BW. Subjects showed significant changes in all measures including the Six Minute Walk Test (6MWT), OMNI Walk/Run Scale of perceived exertion/fatigue and subjective complaints of pain, as well as the postural angles of Craniovertebral Angle, Forward Trunk Lean, and Pelvic Tilt. Subjects demonstrated immediate and significant changes in forward head posture, forward trunk lean, and pelvic tilt while wearing backpacks weighing 10%, 15% and 20%BW, but the 10%BW backpack resulted in the least amount of change. This study also found that these postural angles changed additionally after walking 6 minutes while carrying the loaded backpacks. Subjects also demonstrated decreased 6MWT distances and increased reports of perceived exertion and pain after carrying backpacks weighing 10%, 15% and 20%BW. In Chapter 4, we discussed the clinical implications of this research. It was determined that backpack loads weighing 10%, 15% and 20%BW of a child’s body weight result in immediate changes in posture, which continue to increase after walking six minutes with the loaded backpack. The backpack loads significantly impacted the children’s walking endurance as well as their reports of perceived exertion/fatigue and regional pain. This study found that of the loads tested, the 10%BW resulted in the least amount of change in all outcome measures. However, the 10%BW load was not innocuous, as it still created significant changes in posture and subjective complaints. Backpack weight limit guidelines need to be written to protect children from carrying backpacks weighing more than 10% body weight.

Syftet med arbetet är att kartlägga och att finna möjligheter till förbättringar i projektflödet. Arbetet berör de delar av företaget som befinner sig i ett tidigt skede av projektflödet eftersom ändringar i dessa skeden kan göras till en liten kostnad. Informationsinsamling har skett genom fria samtal, dock med vissa förberedda frågor. Information har inhämtats från flera delar av projektflödet så som försäljning, projektledning och konstruktion. Vi har kommit fram till att det är värt att lägga mer resurser på förbättringsarbete och se över ansvarsfördelningen för detta. Man bör även se över reklamationerna som till antalet är för många och många av felen är likartade. / The main purpose of this thesis is to survey and find possibilities of improvements in the project flow. The report only touches the parts of the company which are located in the early parts of the project flow, hence alterations can be made at a low cost. The gathering of information was made by open conversations, with some prepared questions. The information has been gathered from several parts of the company such as sales, project management, and construction et cetera. We consider it to be profitable to increase the resources in the improvement work. The company should also investigate the distribution of responsibility in the work of improvement. The complaints are too many and many of the faults are similar.

Consumerfinance serves as the source of financial stability and uplifts the economicand social status of the household. This research is based on qualitative studyand up to some extent on quantitative base too. The major objective of thisstudy is to gain insights of consumer financing in Pakistan from a consumerperspective. At the same time, the study investigates and analyzes the defined rulesand regulations for banks and for consumers during the time of obtaining theloans from banks and well as from other financial institutions. Interestingly,during the process of investigation, the study encounters a lot of constraintsand dissatisfaction perceived by tits customers. Hence the report seeks outthose issues and challenges that are hindering to meet customer demand forsound consumer finance. The report is duly influenced by the Central Bank(State Bank of Pakistan), which is responsible and obliged to secure theinterests of the consumers.

Titel:                        Missnöjeshantering i banker - En fallstudie av Sala Sparbank Seminariedatum:    19 januari, 2012 Institution:              Akademin för hållbar samhälls- och teknikutveckling, Mälardalens  Högskola Nivå:                        Magisteruppsats i företagsekonomi, 15 hp Författare:              Odhiambo Opee och Charlotte Skinnar Handledare:            Carl G Thunman Nyckelord:              Klagomål, banker, missnöje, Word-of-Mouth, Sala Sparbank Syfte:                       Syftet med denna uppsats är att beskriva missnöjeshantering hos Sala Sparbank. Uppsatsen undersöker hur studieobjektets missnöjeshantering överensstämmer med en egenutvecklad modell för missnöjeshantering. Resultatet av uppsatsen förväntas utmynna i en reviderad modell för missnöjeshantering samt att utreda om Sala Sparbank kan förbättra sin missnöjeshantering. Metod:                     En egen modell utvecklades utifrån den teori som samlats genom litteratursökning i artiklar, böcker och olika internetsidor. Modellen och teorin låg sedan till grund för de tre fokusgruppintervjuer som genomfördes. Resultatet bearbetades genom ”klipp och klistra” metoden och analyserades sedan utifrån modellen. Med hjälp av resultatet från undersökningen kunde en reviderad modell utformas och även ge förbättringsförslag till Sala Sparbank. Slutsats:                   Sala Sparbank har en bra klagomålshantering. Det som skulle kunna utvecklas är ett enkelt rapportsystem för att få mer statistik över kundernas missnöjen, detta underlag kan sedan användas för att underlätta uppföljning och utbildning av anställda. De behöver även tydligare kommunikation om villkor, räntor och internetbanken. Dessutom bör klagomålsansvarige bli mer insatt i den information som insamlas på Facebook-sidan och den funktion som söker klagomål på internet. Då Sala Sparbank är en mindre bank behöver modellens ”frontline” även inkludera andra personer i banken än enbart de som möter kunder dagligen, exempelvis VD. / Title:                        Dissatisfaction Management in Banks- A case study of Sala Sparbank Seminar date:         January 19TH 2012 Institution:              School of Sustainable development of society and technology, Mälardalen University Level:                       Master thesis in business, 15 ECTS Authors:                  Odhiambo Opee and Charlotte Skinnar Tutor:                      Carl G Thunman    Keywords:              Complaints, banks, dissatisfaction, Word-of-Mouth, Sala Sparbank Purpose:                  The purpose with this thesis is to describe the dissatisfaction handling process in Sala Sparbank. The thesis examines how the object of the study managing dissatisfaction in accordance with a proprietary model for handling dissatisfaction. The result of the thesis is expected to culminate in a revised model for handling dissatisfaction and also to investigate if Sala Sparbank can improve its dissatisfaction management. Method:                   A proprietary model was developed based on the theory gathered through a literature search of articles, books and various internet sites. The model and the theory formed the basis of the three focus group interviews conducted. The results were processed through the “copy paste” method and then analyzed by the model. Using the results of the survey a revised model were developed and also suggestions on improvement for Sala Sparbank. Conclusion:             Sala Sparbank has a good dissatisfaction management. They could develop a simple reporting system to get more statistics on customers’ dissatisfaction, this data can then be used to facilitate monitoring and employee training. They also need clearer communication about terms, rates and online banking. Furthermore, the complaints manager needs to more familiar with the information collected on the Facebook page and the function the searches complaints on the internet. Since Sala Sparbank is a smaller bank, the model’s “frontline” also include other persons in the bank rather than only those that meet customers daily, including the CEO.

<p>This report is all about quality improvement work with focusing on nonconformities routines. The purpose is to improve the process of nonconformity routines and to identify the most important issues and causes behind nonconformity routines in order to have good quality of the products and satisfied customer to achieve continuous improvement. This project is conducted at a case study at the case company GMV Sweden AB producing lifts and their components. The problem in the case company is how the case company is handling nonconformity routines which consist currently of two streams one for problems in production which leads to internal nonconformities and another is handling customer complaints. The author visits the case company to collect essential information for this work and performs face-to-face user interviews, Q&A via email. The knowledge gained on different quality tools in author's education on Terotechnology department forms the basis of this research. The author plans to solve the problem by analyzing, mapping the existing processes and using different quality tools. The author analysis is based on theoretical and empirical facts, also different quality tools like process mapping, cause effect diagram, flowchart has been used to identify the problem and relevant suggestions have been proposed to improve their current situation. In the results and conclusions the author has explain the various improvement techniques and suggestions to handle internal nonconformities and customer complaints. The author believes by implementing the suggested improved model company can address their quality issues, which will improve the productivity to a greater extent and enable them to achieve their goal of continuous improvement.</p>

Thesis (M.S.)--Naval Postgraduate School, 2002. / Thesis advisor(s): Ron B. Tudor, James M. Barnard. Includes bibliographical references (p. 47-49). Also available online.

The quality of care in nursing homes has been evaluated from many varying perspectives, but few studies have analyzed quality in light of complaints made to state survey agencies by residents, their family members, or other individuals interacting with the nursing home. This study analyzed complaints, investigation of complaint allegations, and complaint-related deficiency citations to determine their effect, if any, on the quality of care in nationwide nursing homes. Using the Online Survey Certification and Reporting (OSCAR) survey dataset for facility characteristics and the complaint investigation dataset for outcomes of complaint investigation, analyses conducted included descriptives, correlations, conceptual mapping for complaint-related deficiencies, chi-square tests of independence, t-tests, and generalized estimating equations. At baseline, approximately 66% of nursing homes were for-profit and roughly 53% belonged to a chain membership, while the average percent of residents receiving Medicaid for care reimbursement was 60%. Results indicated that nursing homes differed significantly by profit status and chain membership on whether a complaint was received and whether a deficiency citation was issued following a complaint investigation. Additionally, certain facility and resident-aggregated characteristics, as indicated by odds ratios, were associated with an increase in the likelihood of receiving a complaint or a complaint-related citation. With respect to facility characteristics, for-profit nursing homes and those nursing homes belonging to a chain membership were found to have more complaints and more complaint-related deficiency citations than nonprofit nursing homes and non-chain facilities. Resident-aggregated characteristics, such as a nursing home having more residents restrained, more residents with a catheter, or more residents with a diagnosis of depression, indicated a greater likelihood of receiving a complaint or complaint-related deficiency citation in longitudinal analyses. While additional research could aid in interpreting the effect of complaints on quality of care in nursing homes, study results indicate several facility and resident-aggregated factors that may aid in better understanding of quality of care and improve the training of surveyors and nursing home staff to improve quality of care for residents.

published_or_final_version / Sociology / Master / Master of Social Sciences

Disertaciniame darbe nagrinėjama depresija sergančių asmenų savijauta ir subjektyvus gyvenimo vertinimas stacionarinio gydymo laikotarpiu, šių reiškinių sąsaja bei pokyčiai gydymo metu. Siekiama atskleisti subjektyvaus asmens savo ligos ir sveikatos vertinimo svarbą prognozuojant sveikimo nuo depresijos rezultatus. Darbe siekiama detaliai išanalizuoti depresija sergančių asmenų savijautos struktūrą, taip pat patikrinti prielaidą, kad subjektyvus gyvenimo vertinimas gali būti laikomas psichikos sveikatos išteklių rodikliu. Teorinėms darbo prielaidoms patikrinti gydymo pradžioje ir pabaigoje buvo ištirti 195 depresija sergantys asmenys besigydantys psichiatrijos stacionare, naudojant klausimyną depresijos pokyčiams vertinti (Pranckevičienė, Goštautas, 2007), Pasaulinės sveikatos organizacijos gyvenimo kokybės klausimyną (PSOGK – Trumpas) ir kitas papildomas metodikas. Statistinė rezultatų analizė atskleidė, kad depresija sergančių asmenų savijauta yra daugiakomponentė ir psichologinių bei somatinių savijautos komponentų išskyrimas yra naudingas analizuojant depresija sergančių asmenų sveikimą stacionarinio gydymo laikotarpiu. Subjektyvus gyvenimo vertinimas neprognozuoja gydymo rezultatų, tačiau yra tinkamas subjektyvus visuminės sveikatos matas, nes gerai parodo funkcines ir kognityvines depresijos pasekmes, t.y. pasikeitusį suvokimą. Tyrimas iliustruoja psichologinės pagalbos svarbą stacionarinio depresijos gydymo laikotarpiu. / The study analyses patients’ subjective complaints and subjective evaluation of life, and seeks to evaluate changes and relationships of these phenomena during inpatient treatment of depression, stressing the importance of subjective experience in understanding the burden of the illness, resources for recovery and treatment outcomes. The study seeks to analyze the structure of depressed patients’ subjective complaints, as well as to evaluate the utility of the subjective evaluation of life for treatment outcome evaluation. 195 depressed inpatients were assessed at the beginning of the treatment and at the time of discharge, using measures of subjective depressive complaints (Pranckevičienė, Goštautas, 2007), subjective quality of life (WHOQOL-Bref) and other clinical and social-demographic data. The results of the study show that additional attention to psychological and somatic components of patients’ subjective complaints is useful and compliments the analysis of depressed inpatients’ recovery process. The subjective evaluation of life should be interpreted as a more generic measure of consequences of depression, but not as a measure of depressed inpatient’s recovery resources. The results validate the need of psychological interventions during inpatient treatment.