Since the systems of health insurance of the whole people were run in March of the 84th year of the Republic of China, it is very near to offer medical treatment to the best patient in the whole world, the highly free right to choose of seeking medical advice, and high-quality medical care. But cause the expense expenditure of the hospital to rise continuously, is strong in protecting the office as because in conformity with the financial situation, pursue a lot of financial retrenchment policies successively, cause uncertainty and complexity of the medical industry's environment. Especially pay the system so far the total value of the hospital, decline in the development in economy of the whole world depressedly, domestic aging of population, unemployment increase, medical resources are insufficient day by day and strong in assuaring the financial affairs are left pressingly, the central health insurance bureau is paid the system and controls the cost, adjust and pay the standard progressively, towards pay, standardize while being single, so reform pay medical the intersection of institutes and way pay system for TW-DRGSs ' diagnose related group in hospital ' stage by stage year by year from January of 1999. Made in Singapore after setting out on a journey, future so long as medical resource more close part will be sorted out into the same class, in accordance with kinds of Diseases, operation, age, gender, amalgamate condition classification such as disease, divide into groups according to the weight grade of the condition, pay by norm, is lower than lower limit, will adopt and verify that declare the way, that is to say ' pay the system with severity and reward '. The government implements the policy purpose of ' TW-DRGSs ', except the efficiency of serving for raising medical treatment, reduce the waste, also can improve patient, look after quality and curative effect, let the intersection of hospital and the intersection of cost and optimization, but the implementation of DRG will cause the suitable impact of the hospital, may aggravate looking after and financial responsibility and risk of the medical organization. But hospital attribute( Set objectives, the intersection of role and localization, organization and the intersection of power and responsibility and structure,etc.) Different, the hospital faces being strong in assuaring that it and because will be different to pay the financial pressure that the system changes in conformity with ways, except army's hospital in the country shoulders the country and looks after soldier's healthy policy responsibility, pay attention to managing the performance even more. So because should be strong in assuaring that it will be different to pay measure and efficiency that the system's changing takes and lowers costs to some extent, and these differences will react on the manifestation of financial performance indicators such as its medical care amount, income and interests,etc.. Satisfied how to promote the financial performance of the hospital, give consideration to operations objective, medical care quality and patient of the hospital at the same time, key factor that will be managed continuously forever for the hospital. Until ' diagnose related group in hospital ', first serious the intersection of case and clinical route standardize, influence clinical the intersection of route and standardization make, act as, in hospital number for the first time, so this research institute builds the systematic dynamics model constructed, the ones that chose the first stage to implement 155 items of TW-DRGSs were in hospital in days, the hospital TW-DRGSs case number, take bed rate and satisfaction in hospital etc., these influence each other the simulation of the relation value adopts Table function to imitate. And Table function which this research institute puts forward passes the true data in often operation course on ordinary days of case hospital, observe and experience judgement or relevant literature consult materials of income, performance its weigh the intersection of indicator and system can represent the intersection of country and the intersection of army and the intersection of hospital and case only, can't prove why the other scale hospitals are appropriate; And this research is paid and imitated according to the systematic way of case hospital alone, as system way may present different results not simultaneously. Expect to give the case hospital some suggestions in managing, managing and is made with the clinical route through this research, the colleagues of staff of different levels work satisfiedly in safeguarding patient's whole rights and interests, courtyard, promote the quality of medical care, the purpose of this research: (1)Make use of system of macroscopic think way, canvass the intersection of case and hospital, implement, good for, protect TW-DRGSs at the system, the influence that the management in hospital stays runs to the case hospital for a long time, and can assist the case hospital to find the optimum management effect. (2)Set up systematic dynamics way, imitate the intersection of case and hospital, divide into annual to implement, good for, protect TW-DRGSs, in hospital management of day to the intersection of hospital and revenue and expenditure, medical behavior and influence to cure the desease relation at the system stage by stage. The concrete suggestion of this research is as follows: (1) Control and manage number in hospital, increase the turnover rate of the sick bed (2) Set up all kinds of disease clinical guiding or clinical routes (3) Improve the hospitalization cost and declare benefit (4) Research of project development at one's own expense

Recent legislation in South Africa has changed education considerably, particularly in the move towards inclusive education. Previous educational provision in South Africa, as in many countries, assigned many learners with learning difficulties to segregated settings. Such placements tended to be based on the psycho-medical, intelligence-testing model of identifying learning difficulties. Much research has queried the effectiveness of this approach. However, as no alternative model has been researched, it was decided to research the effectiveness of using an ecosystemic approach in conjunction with a collaborative consultancy model as a method for identifying learning needs in high school learners in a South African public secondary school. Various methods of qualitative data collection were used during the intervention, and comparative analysis was employed to analyse the data. The findings of this study suggest that an ecosystemic approach used together with a collaborative consultancy approach to identify and understand learning diversity is a viable process in inclusive education contexts. However, it is acknowledged that a considerable body of research needs to be achieved before this finding can be considered conclusive. In addition, certain constraints to using this approach were acknowledged, and these include the time, expertise and money needed to facilitate the process successfully.

Ao longo das últimas décadas, o declínio organizacional despertou interesse de pesquisadores em função da necessidade de se compreender a dinâmica organizacional por uma perspectiva oposta ao crescimento. Esse desejo surge em função da crescente dificuldade das grandes organizações em conseguir manter sua posição competitiva: acredita-se que a perpetuação do bom desempenho depende cada vez mais de quão adaptáveis estas organizações são às turbulências do ambiente de negócios. Porém, esta flexibilidade não depende apenas da capacidade de antecipar as mudanças estratégicas, mas também de como a sua estrutura organizacional está estabelecida e da sua capacidade empreendedora. Assim, pelo fato da teoria do declínio organizacional ser relativamente recente, inúmeras definições taxonômicas ainda precisam ser debatidas, além de se ressaltar a necessidade de explorar melhor o próprio conceito do declínio e compreender sua origem. Considerando este contexto, o presente trabalho desenvolve um modelo de diagnóstico do declínio organizacional, cujo objetivo central é identificar o estágio de declínio das organizações. Para cumprir com este propósito, estudos de casos múltiplos foram aplicados em empresas do segmento automobilísticos (montadoras), tanto pelo fato de estarem presentes no Brasil há vários ciclos econômicos quanto por se depararem com uma intensa necessidade de reavaliação do modelo de negócio nos últimos anos. Para a definição dos constructos que compõem o arcabouço teórico, foi realizada uma análise bibliométrica e, posteriormente, uma análise cienciométrica, de modo a permitir a compreensão da estrutura cognitiva da teoria do declínio organizacional, a partir da qual foi desenvolvida uma proposta aqui denominada modelo 3E, pois contempla as seguintes dimensões: Estratégia, Estrutura e Empreendedorismo. Os resultados obtidos validam o modelo proposto e permitem inferir não apenas a situação do setor automobilístico, mas também posicionar cada montadora em seu estágio de declínio correspondente com base em uma análise temporal da organização: passado, presente e futuro. Como efeito colateral, o modelo oferece um roteiro para verificar a coerência da estrutura à estratégia, a eficiência da estrutura organizacional e também a capacidade empreendedora destas organizações em definir o horizonte estratégico adequado. / Along the latest decades, organizational decline raised interest on the part of scholars due to the need of understanding the organizational dynamics from a perspective opposed to growth. This occurs in function of the increasing difficulty of large organizations in managing to keep their competitive position; the perpetuation of good performance is believed to depend more and more on how adaptable these organizations are to the turbulences of the business environment. However, this flexibility does not only depend on the capacity of anticipating strategic changes, but also on how their organizational structure is established and on their entrepreneurial capacity. Hence, once the organizational decline theory is relatively recent, a number of taxonomic definitions still have to be discussed before the need to better explore the very concept of decline and understanding its source is felt. Considering this context, a model for diagnosing organizational decline is developed herein, the central goal of which is to identify the organizations decline stage. To meet this goal, multiple case studies were conducted in organizations in the automotive sector (assemblers), both for the fact of their being present in Brazil along several economic cycles and for their facing an intense need to reassess their business model in the last years. For defining the constructs composing the theoretical framework, a bibliometric analysis was conducted and, later, a scientometric analysis, so as to allow understanding the cognitive structure of the organizational decline theory, from which a proposal was developed and denominated 3E model here, contemplating the following dimensions: Strategy, Structure and Entrepreneurship (which start with an E in Portuguese). The results validate the model proposed and allow inferring not only the automotive sector scenario, but also placing each assembler in its corresponding decline stage based on a temporal analysis of the organization: past, present and future. As a side effect, the model provides a script for verifying the adherence of the structure to the strategy, the efficiency of the organizational structure, as well as the entrepreneurial capacity of these organizations in defining an adequate strategic horizon.

Osteoporosis is a metabolic bone disease that needs to be properly diagnosed. The current diagnosing procedure of osteoporosis is based on the mineral density of bones measured by common methods such as dual energy X-ray absorptiometry (DXA). However, due to the deficiencies and limitations of these common methods, investigations on the utilization of other non-invasive diagnosing methods have been executed. For instance, using vibration measurements seems to be a promising technique in diagnosing metabolic bone diseases such as osteoporosis and also in monitoring fracture healing. Throughout this study, bone structural modal parameters obtained from vibrations experiments with decreasing mineral density are examined and therefore, it is aimed to find a new approach to detect osteoporosis or progressing osteoporosis by investigating a relation between structural dynamic properties and mineral density of bone. The main advantage of this study is that loss factor, which is an inherit property of bone, is investigated since in the previous studies mainly the changes in natural frequency of bones with the state of osteoporosis is examined. In this thesis, both in vitro and in vivo experiments are carried out on human tibia specimens. The measured frequency response functions (FRFs) are analyzed using modal identification techniques to extract the modal parameters of the human tibia. The results obtained from in vitro experiments show that loss factor may be a powerful tool in diagnosing osteoporosis, however due to the difficulties encountered in the case of in vivo experiments makes the use of this parameter as a diagnosing tool difficult. It is also seen from in vivo experiments that there is a weak correlation between the natural frequencies of tibia and BMD measurements of patients. Therefore, in order to investigate the parameters affecting the natural frequencies of tibia, finite element (FE) model of human tibial bone is constructed. Using this FE model tibia, the effect of boundary conditions of experiments and geometry of the bone on natural frequencies of bone is examined. These analyses show that the effect of both boundary conditions and geometry of tibia is very high. Therefore, it is concluded that if the necessary conditions are satisfied, the using natural frequency information of tibia seems to be a possible and practical method that can be used to detect progressing osteoporosis. Also, using the FE model of tibia, the changes of natural frequencies of tibia with the variation in elastic modulus are investigated.

Background Due to population growth, aging, urbanisation, increasing prevalence of obesity and physical inactivity, diabetes mellitus (DM) has become one of the most important and prevalent chronic diseases. Glycated haemoglobin A1c (HbA1c) assessment is currently being used all over to monitor glycaemic control as a cornerstone of diabetes care. It might also be a useful screening tool for non–insulin dependent DM, also known as type 2 DM (T2DM). Elevated HbA1c can be linked with long–term risk of cardiovascular complications. Aim The aim of the study was to determine whether HbA1c can be used as reliable screening tool for early detection of T2DM in an African population. Methods This study was a cross–sectional study and was part of the South African, North–West Province (SANWP) leg of the 12–year Prospective Urban and Rural Epidemiological (PURE) study. Baseline data was collected from March to December 2005. A total of 2010 volunteers were recruited from randomly selected households. Data was collected on socio–demographic characteristics, physical activity, dietary intakes, blood pressure and anthropometry. HbA1c, fasting plasma glucose (FPG), liver enzymes and HIV status were determined. Ethical approval for the PURE study was obtained in July 2004. Oral glucose tolerance tests (OGTT) were also done for a sub–group of 465 subjects. The Statistical Consultation Services of the North–West University were consulted to analyse data with SPSS 17.0 and STATISTICA 9.0. Results The HbA1c values within the diabetic FPG groups were 7.46% for men and 8.08% for women. HbA1c values increased significantly progressively from the normal FPG groups to the groups with impaired FPG and the diabetic FPG groups for both men and women. No significant increases were found in HbA1c between the OGTT groups (normal 2 hour plasma glucose (PG), impaired 2–hour PG and diabetic 2–hour PG). Total cholesterol, triglycerides, body mass index and FPG increased significantly and high–density lipoprotein cholesterol decreased significantly with an increase in HbA1c values in men and women. In addition, systolic blood pressure increased significantly in women with increased HbA1c. Thus, with an increase in HbA1c, an increase in the number of risk factors was observed. When using HbA1c and FPG in combination, 43 subjects of the whole population were detected with having a risk of developing T2DM. However, when considering the commonality of subjects identified to be diabetic or at risk by the OGTT, FPG and HbA1c individually, only one subject was identified by all the methods as having diabetes or being at risk to develop diabetes. Discussion and conclusions An increase in HbA1c and FPG was associated with an increase in risk factors and therefore with metabolic syndrome (MS). MS is associated with an increased risk of developing T2DM and therefore it can be concluded that HbA1c was useful for detecting in this population individuals at increased risk of developing T2DM. The use of FPG and HbA1c in combination was considered a better screening tool when compared to HbA1c alone. Factors other than what were measured in this study might be the cause of the unexpected results obtained in the participants with impaired OGTT. / Thesis (M.Sc. (Nutrition))--North-West University, Potchefstroom Campus, 2011.

Background Due to population growth, aging, urbanisation, increasing prevalence of obesity and physical inactivity, diabetes mellitus (DM) has become one of the most important and prevalent chronic diseases. Glycated haemoglobin A1c (HbA1c) assessment is currently being used all over to monitor glycaemic control as a cornerstone of diabetes care. It might also be a useful screening tool for non–insulin dependent DM, also known as type 2 DM (T2DM). Elevated HbA1c can be linked with long–term risk of cardiovascular complications. Aim The aim of the study was to determine whether HbA1c can be used as reliable screening tool for early detection of T2DM in an African population. Methods This study was a cross–sectional study and was part of the South African, North–West Province (SANWP) leg of the 12–year Prospective Urban and Rural Epidemiological (PURE) study. Baseline data was collected from March to December 2005. A total of 2010 volunteers were recruited from randomly selected households. Data was collected on socio–demographic characteristics, physical activity, dietary intakes, blood pressure and anthropometry. HbA1c, fasting plasma glucose (FPG), liver enzymes and HIV status were determined. Ethical approval for the PURE study was obtained in July 2004. Oral glucose tolerance tests (OGTT) were also done for a sub–group of 465 subjects. The Statistical Consultation Services of the North–West University were consulted to analyse data with SPSS 17.0 and STATISTICA 9.0. Results The HbA1c values within the diabetic FPG groups were 7.46% for men and 8.08% for women. HbA1c values increased significantly progressively from the normal FPG groups to the groups with impaired FPG and the diabetic FPG groups for both men and women. No significant increases were found in HbA1c between the OGTT groups (normal 2 hour plasma glucose (PG), impaired 2–hour PG and diabetic 2–hour PG). Total cholesterol, triglycerides, body mass index and FPG increased significantly and high–density lipoprotein cholesterol decreased significantly with an increase in HbA1c values in men and women. In addition, systolic blood pressure increased significantly in women with increased HbA1c. Thus, with an increase in HbA1c, an increase in the number of risk factors was observed. When using HbA1c and FPG in combination, 43 subjects of the whole population were detected with having a risk of developing T2DM. However, when considering the commonality of subjects identified to be diabetic or at risk by the OGTT, FPG and HbA1c individually, only one subject was identified by all the methods as having diabetes or being at risk to develop diabetes. Discussion and conclusions An increase in HbA1c and FPG was associated with an increase in risk factors and therefore with metabolic syndrome (MS). MS is associated with an increased risk of developing T2DM and therefore it can be concluded that HbA1c was useful for detecting in this population individuals at increased risk of developing T2DM. The use of FPG and HbA1c in combination was considered a better screening tool when compared to HbA1c alone. Factors other than what were measured in this study might be the cause of the unexpected results obtained in the participants with impaired OGTT. / Thesis (M.Sc. (Nutrition))--North-West University, Potchefstroom Campus, 2011.

Ao longo das últimas décadas, o declínio organizacional despertou interesse de pesquisadores em função da necessidade de se compreender a dinâmica organizacional por uma perspectiva oposta ao crescimento. Esse desejo surge em função da crescente dificuldade das grandes organizações em conseguir manter sua posição competitiva: acredita-se que a perpetuação do bom desempenho depende cada vez mais de quão adaptáveis estas organizações são às turbulências do ambiente de negócios. Porém, esta flexibilidade não depende apenas da capacidade de antecipar as mudanças estratégicas, mas também de como a sua estrutura organizacional está estabelecida e da sua capacidade empreendedora. Assim, pelo fato da teoria do declínio organizacional ser relativamente recente, inúmeras definições taxonômicas ainda precisam ser debatidas, além de se ressaltar a necessidade de explorar melhor o próprio conceito do declínio e compreender sua origem. Considerando este contexto, o presente trabalho desenvolve um modelo de diagnóstico do declínio organizacional, cujo objetivo central é identificar o estágio de declínio das organizações. Para cumprir com este propósito, estudos de casos múltiplos foram aplicados em empresas do segmento automobilísticos (montadoras), tanto pelo fato de estarem presentes no Brasil há vários ciclos econômicos quanto por se depararem com uma intensa necessidade de reavaliação do modelo de negócio nos últimos anos. Para a definição dos constructos que compõem o arcabouço teórico, foi realizada uma análise bibliométrica e, posteriormente, uma análise cienciométrica, de modo a permitir a compreensão da estrutura cognitiva da teoria do declínio organizacional, a partir da qual foi desenvolvida uma proposta aqui denominada modelo 3E, pois contempla as seguintes dimensões: Estratégia, Estrutura e Empreendedorismo. Os resultados obtidos validam o modelo proposto e permitem inferir não apenas a situação do setor automobilístico, mas também posicionar cada montadora em seu estágio de declínio correspondente com base em uma análise temporal da organização: passado, presente e futuro. Como efeito colateral, o modelo oferece um roteiro para verificar a coerência da estrutura à estratégia, a eficiência da estrutura organizacional e também a capacidade empreendedora destas organizações em definir o horizonte estratégico adequado. / Along the latest decades, organizational decline raised interest on the part of scholars due to the need of understanding the organizational dynamics from a perspective opposed to growth. This occurs in function of the increasing difficulty of large organizations in managing to keep their competitive position; the perpetuation of good performance is believed to depend more and more on how adaptable these organizations are to the turbulences of the business environment. However, this flexibility does not only depend on the capacity of anticipating strategic changes, but also on how their organizational structure is established and on their entrepreneurial capacity. Hence, once the organizational decline theory is relatively recent, a number of taxonomic definitions still have to be discussed before the need to better explore the very concept of decline and understanding its source is felt. Considering this context, a model for diagnosing organizational decline is developed herein, the central goal of which is to identify the organizations decline stage. To meet this goal, multiple case studies were conducted in organizations in the automotive sector (assemblers), both for the fact of their being present in Brazil along several economic cycles and for their facing an intense need to reassess their business model in the last years. For defining the constructs composing the theoretical framework, a bibliometric analysis was conducted and, later, a scientometric analysis, so as to allow understanding the cognitive structure of the organizational decline theory, from which a proposal was developed and denominated 3E model here, contemplating the following dimensions: Strategy, Structure and Entrepreneurship (which start with an E in Portuguese). The results validate the model proposed and allow inferring not only the automotive sector scenario, but also placing each assembler in its corresponding decline stage based on a temporal analysis of the organization: past, present and future. As a side effect, the model provides a script for verifying the adherence of the structure to the strategy, the efficiency of the organizational structure, as well as the entrepreneurial capacity of these organizations in defining an adequate strategic horizon.

No description available.

Faraday rotation is a process by which the position angle (PA) of background linearly polarized light is rotated when passing through an ionized and magnetized medium. The effect is sensitive to the line-of-sight magnetic field in conjunction with the electron density. This contribution highlights diagnostic possibilities of inferring the magnetic field (or absence thereof) in and around wind-blown bubbles from the Faraday effect. Three cases are described as illustrations: a stellar toroidal magnetic field, a shocked interstellar magnetic field, and an interstellar magnetic field within an ionized bubble.

This qualitative research study used art to illuminate the experiences of therapists who work and diagnose children who have experienced trauma. Previous literature informed the current study by exploring the history of trauma-related diagnoses in the DSM (Diagnostic Statistical Manual of Mental Disorders), literature related to complex trauma and developmental trauma, and the art therapy research related to treating and diagnosing trauma. This study used interview methodology to acquire firsthand accounts of therapists currently working with and diagnosing children who have experienced trauma, and were asked to create art to help illustrate their experiences. Analyzing the participants artwork and interview transcriptions allowed for four themes to emerge: Child’s perspective, Therapist’s perspective, Caregiver’s perspective, and Administrative Process. Further investigation into these themes revealed several findings: the limitations of the administrative process, developmental inconsistency, and the lack of a developmental understanding of death related to the DSM-5 criteria. This research also suggests that art can be used as a tool to help access the child’s perspective, and provide the therapist with a more comprehensive understanding of the child’s world.