Background There is an increasing rate of cesarean section globally. Both low and high cesarean section rates are associated with maternal and neonatal mortality and morbidities. In Nicaragua, the rate of cesarean section is beyond the WHO recommendation of 10% to 15%. Aim The aim of this study was to evaluate the costs-effectiveness of elective caesarean section when compared with vaginal delivery in hospital in Nicaragua, a lower-middle income setting. Methods A 3 months prospective cohort study was conducted in a hospital in León, Nicaragua, from 1st May 2010 to 31st July 2010. Two questionnaires were used to obtain data, one on costs and maternal complications after delivery, and the other on postpartum complications. A descriptive analysis regarding maternal and neonatal outcomes, and a cost-effectiveness analysis were conducted comparing elective cesarean section with vaginal delivery, followed by a sensitivity analysis regarding change on rates of elective cesarean section. Results The cesarean section rate was 37.9%, and the elective cesarean section rate was 21%. The percentage of live births was 99.6% in elective cesarean section group and 98.9% in vaginal delivery group. Cesarean section had both positive and negative influences on maternal complications and postpartum complications. The costs of elective cesarean section was higher than vaginal delivery ($66 compared to $39.36). For one more live birth, 3805.71 US dollars were needed. Conclusion The maternal outcomes of cesarean section need to be improved. With the increasing cesarean section rates, more medical resources are needed in the future.

The specific purposes of this study were to measure the changes in self-insight, dogmatic attitudes, Dominance and Change variables on the Edwards Personal Preference Schedule, and discrimination variables on the Carkhuff Discrimination Scale subsequent to personal group counseling experiences and their relationships to other measures believed to be indicative of counselor effectiveness.

An abundance of theories exists on what constitutes appropriate team leadership; What seems to be lacking is how the "followers" react when exposed to their tenets. This particular study involves testing a contemporary model (Stewart & Manz, 1995) via interview statements that seem to indicate that a certain form of team leadership is taking place. Once determined, the effectiveness of the leadership "style" that is in effect is assessed using ten different performance dimensions to determine if that style is successful (or detrimental) in any of those areas. Leadership "tools" from other theories and models are examined as well.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

This research addressed the question: "Which factors predict the effectiveness of healthcare teams?" It was addressed by assessing the psychometric properties of a new measure of team functioning with the use of data collected from 797 team members in 61 healthcare teams. This new measure is the Aston Team Performance Inventory (ATPI) developed by West, Markiewicz and Dawson (2005) and based on the IPO model. The ATPI was pilot tested in order to examine the reliability of this measure in the Jordanian cultural context. A sample of five teams comprising 3-6 members each was randomly selected from the Jordan Red Crescent health centers in Amman. Factors that predict team effectiveness were explored in a Jordanian sample (comprising 1622 members in 277 teams with 255 leaders from healthcare teams in hospitals in Amman) using self-report and Leader Ratings measures adapted from work by West, Borrill et al (2000) to determine team effectiveness and innovation from the leaders' point of view. The results demonstrate the validity and reliability of the measures for use in healthcare settings. Team effort and skills and leader managing had the strongest association with team processes in terms of team objectives, reflexivity, participation, task focus, creativity and innovation. Team inputs in terms of task design, team effort and skills, and organizational support were associated with team effectiveness and innovation whereas team resources were associated only with team innovation. Team objectives had the strongest mediated and direct association with team effectiveness whereas task focus had the strongest mediated and direct association with team innovation. Finally, among leadership variables, leader managing had the strongest association with team effectiveness and innovation. The theoretical and practical implications of this thesis are that: team effectiveness and innovation are influenced by multiple factors that must all be taken into account. The key factors managers need to ensure are in place for effective teams are team effort and skills, organizational support and team objectives. To conclude, the application of these findings to healthcare teams in Jordan will help improve their team effectiveness, and thus the healthcare services that they provide.

Online learning in K-12 education is becoming a familiar option for students. By the end of 2011, all 50 states and the District of Columbia offered some form of online learning as an option for some students (Watson, Murin, Vashaw, Gemin, & Rapp, 2011). Online courses are appealing to students for a variety of reasons. The five most common reasons schools are currently offering online courses are for: meeting the needs of specific groups of students; offering courses not otherwise available; offering AP or college level courses; permitting students who failed a course to take it again; and reducing scheduling conflicts for students (Picciano & Seaman, 2010). (P. 9) Schools often implement online programs, choosing from a variety of options, without the research necessary to guide these decisions. The purpose of this research was to conduct a cost-effectiveness analysis of two online learning programs, commercially acquired and teacher-developed, used in a school division. The goal was to establish which program was a better choice with consideration to both cost and effectiveness. I used Levin and McEwan’s (2001) cost-effectiveness analysis to find (1) the cost per class taken, (2) the effectiveness, measured by courses passed and Virginia Standards of Learning tests passed, and (3) the cost-effectiveness ratio for both of the online programs. The ingredients method, suggested by Levin and McEwan (2001) was implemented with the use of cost worksheets to gather and itemize the costs associated with the each program. Only three courses were offered in both programs and used for comparison. Effectiveness data was based on students’ grade at the end of the online course and the end of course SOL test if applicable. Each effectiveness measure was used together with the cost total to calculate a cost-effectiveness ratio (CER) for each of the online learning programs. The cost-effectiveness analysis for passing the class revealed no difference between the two programs. The stalemate highlights the important findings of the research as the details in spending and methods of implementation of each program. The school system of interest benefits from the detailed itemization of costs, which identified areas for modification to the programs. The implication for schools looking to initiate an online program is the well-informed leader having detailed information on the costs involved and options for design. The difference in the cost-effectiveness ratio for the measurement of passing the SOL test was dramatically different. The commercially available program’s cost-effectiveness ratio was double that for the teacher-developed program. The implications for the school division in the research were to evaluate the alignment of a commercial program to state standards and to examine the ability of the online program to meet the goals of the school.

Currently, nationwide efforts are being made to help policymakers, construction professionals and consumers become more aware of the benefits of incorporating sustainable energy principles in residential building design and construction (Miller 1996). Any success in applying these principles is the result of effective communication by design professionals to builders and homeowners in understanding cost benefit tradeoffs for using sustainable energies in homes. The Gordon and Janice Plumblee Residence, located on 1742 Routh Road in Burlington, NC, is an example of how passive solar-heating design elements, along with simple conventional construction techniques, have created a comfortable, affordable, and low-energy consumption home. This report evaluates the passive solar and energy conservative elements incorporated in the Plumblee Home and quantifies the significance of each element energy contribution. A model of the thermal performance of the home is compared to the actual performance. The accuracy of the model is verified. The modeling software is used to perform a sensitivity study of the thermal performance. An analysis of the construction methods and materials used is presented.

No description available.

D.Phil. / The success of an organisation depends on the mental capability of a comparatively small number of highly proficient knowledge workers who innovate and clarify the business processes others must act on (Zemke, 2004). Many organisations utilise knowledge worker expertise to create a competitive advantage, but this expertise is not incorporated into the business processes and routine operations of the organisation. Organisational design does not create the conditions under which an organisation can optimise knowledge worker expertise (Grant, 1996). As a consequence, when the knowledge worker leaves the organisation, the knowledge created is lost and the competitive advantage is not sustainable. One of the foremost objectives of an organisation must be to optimise knowledge worker expertise to produce new products, services or ways of working for sustaining competitive advantage (Gold, Malhotra & Segards, 2001). Organisational design continues to be seen as the process of assembling and fine-tuning an organisation’s structure to achieve its goal. Much has been written about knowledge, knowledge management, the knowledge-based organisation and the knowledge worker. However, current organisational design methodologies do not place emphasis on the optimisation of knowledge worker expertise (Grant, 1996). For knowledge workers to contribute sufficiently to the production of new products, services or ways of working, consideration must be given to their motivation. Despite all our achievements in technology and product improvements, knowledge workers are not thriving in the organisations they work for because organisations are not clear about where knowledge workers fit and how their contribution is valued. Covey (2004) asserts that managers are still applying the Industrial Age control model to knowledge workers. For an organisation to succeed in the new economy, knowledge workers must be intrinsically motivated so that they can reach new heights of fulfilment (Covey, 2004).

M.A. (Clinical Psychology) / This study was undertaken in an attempt to validate the hypothesis that anxious subjects who ingested diazepam (Valium) and were subjected to a helplessness inducing situation,would become more depressed and more hopeless than people who were subjected to the same situation and obtained anxiety relief by means of a response-contingent behaviour - a muscle relaxation exercise. Twenty-nine male and female students were selected from the undergraduate and post-graduate student population at the Rand Afrikaans University on the basis of scores on the IPAT Anxiety Scale and the Beck Depression Inventory. The subjects were randomly assigned to one of the three experimental groups and the one control group and were subjected to the helplessness inducing situation. A wide spectrum of measures were performed and the results subjected to analyses of variance. The results indicated support for the hypothesis that people who received response contingent anxiety relief became less depressed than people who obtained non-response-contingent anxiety relief. No support was found for the hopelessness construct. The lack of results of this were discussed in terms of the effectiveness of the measuring instruments and that hopelessness and helplessness might be different concepts.