The purpose of this project was to evaluate the effectiveness of adopting clinical care bundles for the enhanced recovery program (ERP) at the project site. The practice-focused questions explored whether care bundles from the enhanced recovery program (ERP) would achieve positive postoperative patient care experiences when compared to the traditional surgical care pathways. The concepts, models, method, and theories used for this project include the Iowa model, the plan-do-study-act model, lean methodology, Donabedian's framework, and Watson's theory of caring. The sources of evidence included the facility site analysis report to evaluate surgical inpatient complications, morbidity, and mortality rates. Over 100 items related to surgical postoperative inpatient details were retrieved from the facility site database. Using descriptive analysis of 31 postoperative surgical inpatients' demographics, body mass index data, 30-day readmission, and comorbidities, the findings indicated that the ERP is an efficient, cost-effective program with positive postoperative inpatient outcomes in comparison to traditional surgical care pathways. The impact of the evaluation of the ERP predominately improves patient outcomes, which is a positive social change to postoperative inpatients, families, clinical staff, and the project site operational and clinical performance. The implications of this study for nursing practice and positive social change include standardization of quality and patient safety in a dynamic healthcare environment.

Introduction: Hysterectomy is the most common major gynecological operation in the Western World and approximately 5000 benign hysterectomies are performed in Sweden every year. Consequently it is a surgical procedure that affects many women. The procedure comprises challenges concerning perioperative health care, perceived postoperative symptoms, quality of life aspects and health economics. The concept of fast track is a multimodal strategy to reduce hormonal surgical stress response and achieve an enhanced postoperative recovery and is today considered to be evidence based in relation to colorectal surgery. Spinal anesthesia, as an important part of fast track, provides benefits of extended effect on analgesia and reduced postoperative morbidity. It is reasonable to believe that employing the strategies of fast track including spinal anesthesia could also provide substantial benefits for women requiring surgical removal of the uterus. Aims: To determine whether duration of hospital stay, presence and intensity of postoperative symptoms, duration of sick leave and cost-effectiveness differ between women undergoing benign fast track abdominal hysterectomy in spinal anesthesia with intrathecal morphine (SA) and in standard general anesthesia (GA). Material & Methods: 180 women participated in this open randomized multicenter study with five participating hospitals in the southeast region of Sweden. One hundred and sixty two completed the study; 82 women were randomized to SA and 80 to GA. A fast track model comprising premedication without sedatives, intravenous fluid regulation, analgesics based on non-opioids, pre-emptive antiemetic therapy, early enteral nutrition and mobilization and standard criteria for discharge were used. End points were duration of hospital stay, use of analgesics, perceived postoperative symptoms, occurrence of postoperative complications, duration of sick leave and health economic evaluations. Results: Duration of hospital stay did not differ between the two modes of anesthesia. Vomiting and pruritus occurred significantly more often after SA. Complication rates did not differ between groups. Women with SA experienced less overall discomfort and had a reduced need for opioids postoperatively. Abdominal pain, drowsiness and fatigue occurred less often and with lower intensity among the women in the SA group. Health related quality of life improved faster and the duration of sick leave was shorter in women after SA. Total costs (hospital costs plus costs for productivity loss) were lower for the SA group. Within the first 29 days after hysterectomy the women in the SA group gained more QALYs than women in the GA group. Conclusions: The duration of hospitalisation after fast track abdominal hysterectomy was less than 50 hours and mode of anesthesia did not influence this. SA displayed considerable advantages regarding postoperative symptoms and recovery. SA was considered cost-effective in comparison with GA due to lower total costs and more QALYs gained. Our study indicates that SA should be recommended as the first choice of anesthesia in benign abdominal hysterectomy.

Magister Scientiae - MSc / Text communication is often perceived as lacking some components of communication that are essential in sustaining interaction or conversation. This interaction incoherency tends to make text communication plastic. It is traditionally devoid of intonation, pitch, gesture, facial expression and visual or auditory cues. Nevertheless, Instant Messaging (IM), a form of text communication is on the upward uptake both on PCs and on mobile handhelds. There is a need to rubberise this plastic text messaging to improve co-presence for text communications thereby improving synchronous textual discussion, especially on handheld devices. One element of interaction is gesture, seen as a natural way of conversing. Attaining some level of interaction naturalism requires improving synchronous communication spontaneity, partly achieved by enhancing input mechanisms. To enhance input mechanisms for interactive text-based chat on mobile devices, there is a need to facilitate gesture input. Enhancement is achievable in a number of ways, such as input mechanism redesigning and input offering adaptation. This thesis explores affective gesture mode on interface redesign as an input offering adaptation. This is done without a major physical reconstruction of handheld devices. This thesis presents a text only IM system built on Session Initiation Protocol (SIP) and SIP for Instant Messaging and Presence Leveraging Extensions (SIMPLE). It was developed with a novel user-defined hotkey implemented as a one-click context menu to "fast-track" text-gestures and emoticons. A hybrid quantitative and qualitative approach was taken to enable data triangulation. Results from experimental trials show that an Affective Gesture (AG) approach improved IM chat spontaneity/response. Feedback from the user trials affirms that AG hotkey improves chat responsiveness, thus enhancing chat spontaneity.

No description available.

The purpose of this study was to compare patients who underwent on- vs. off-pump coronary artery bypass surgery managed with a fast-track protocol. Between September 2012 and December 2018, n = 3505 coronary artery bypass surgeries were managed with a fast-track protocol in our specialized post-anesthesia care unit. Propensity score matching was applied and resulted in two equal groups of n = 926. There was no significant difference in ventilation time (on-pump 75 (55–120) min vs. off-pump 80 (55–120) min, p = 0.973). We found no statistically significant difference in primary fast-track failure in on-pump (8.2% (76)) vs. off-pump (6% (56)) groups (p = 0.702). The secondary fast-track failure rate was comparable (on-pump 12.9% (110) vs. off-pump 12.3% (107), p = 0.702). There were no significant differences between groups in regard to the post-anesthesia care unit, the intermediate care unit, and the hospital length of stay. Postoperative outcome and complications were also comparable, except for a statistically significant difference in PACU postoperative blood loss in on-pump (234 mL) vs. off-pump (323 mL, p < 0.0001) and red blood cell transfusion (11%) and (5%, p < 0.001), respectively. Our results suggest that on- and off-pump coronary artery bypass surgery in fast-track settings are comparable in terms of ventilation time, fast-track failure rate, and postoperative complications rate.

Ce mémoire porte sur la délégation législative en faveur de l'Exécutif, du pouvoir de taxer du Congrès américain. Il s'agit de déterminer si le fait de déléguer des pouvoirs législatifs en matière commerciale consiste en une abdication des prérogatives législatives qui ont été conférées au Congrès par la Constitution. Afin de vérifier ce postulat, nous allons étudier dans quelles circonstances le Congrès a délégué ses pouvoirs pendant la période qui s'étendit de 1920 à 1993. Nous constaterons que les délégations s'effectuèrent dans des situations bien particulières, qui nécessitaient des solutions urgentes et inédites. Et l'histoire nous démontrera qu'elles ont débuté dans des moments tels le blocus de 1810, la Crise de 1929, la Grande Dépression, la Deuxième Guerre mondiale, et finalement les nouvelles réalités économiques des années 1970. Nous étudierons les procédures employées comme le Reciprocal Trade Agreement Act (RTAA), et le Fast-Track Trade Implementing Authority, plutôt connu sous le nom de fast-track, des arrangements institutionnels utilisés pour déléguer, qui ont assuré et assurent le contrôle des membres du Congrès. Au fil des années, le Congrès sut donc s'adapter aux nouvelles situations de tel sorte qu'il amorça un tournant activiste en 1988. En effet, le Congrès manifesta son implication en exigeant que ses volontés soient respectées et institua le Reverse Fast-Track, un droit de veto que le Congrès peut exercer à tout moment de la durée du fast-track, Ainsi en déléguant ses pouvoirs tout en assurant un droit de regard au travers des structures institutionnelles qui ont été établies, le Congrès a pu garder la main haute dans la direction que prend la politique commerciale américaine. Avant de commencer, nous voudrions signaler que nous n'avons pas retenu la version française des articles de la Constitution américaine par souci de fidélité au texte original. Également, certains mots et acronymes anglais ont été traduits pour fins de compréhension mais par la suite ils ont repris la forme anglaise. Dans la même ligne de pensée, le mot comité au lieu de commission a été employé pour traduire Committee.

The study explored the extent of women’s economic empowerment for sustainable livelihoods through the Fast Track Land Reform Programme (FTLRP) in Zimbabwe, focusing on three wards in the Makoni district. The study addressed the paucity of information on the usefulness of land redistribution on women’s improved food security and disposable income. Using a qualitative case study, the researcher purposefully selected thirty female land beneficiaries to participate in focus group discussions and five land officers from government departments to be interviewed as key informants. Findings reveal that the FTLRP generally meant that men accessed more land than women. Women’s livelihood initiatives were hampered by their failure to access sufficient support from the government and external partners. Despite the government signing various charters purported to support women’s empowerment, there is still a lot to be done to achieve it. / Lolu cwaningo lwaluhlola izinga lwamandla okuthuthukiswa komnotho kwabesifazane ukuze kube nokuphila okusimeme ngokusebenzisa Uhlelo Lokusheshiswa Kokuguqulwa Komhlaba eZimbabwe, lugxile ezigcemeni ezintathu eMkhandlwini waseMakoni. Lolu cwaningo lwethula ukuntuleka kolwazi ngokubaluleka kokubuyiswa komhlaba kabusha okumayelana nokuvikelwa kokuthuthukiswa nokuphepha kokudla kwabesifazane nokuthola imali engenayo. Ukusebenzisa ucwaningo lwesigameko olubhekene nobungako bento, umcwaningi wakhetha ngenhloso abazuzi noma abahlomuli besifazane bomhlaba abangamashumi amathathu ukuba babambe iqhaza ezigxoxweni zeqembu ezigxile kokuthize kanye nenhlolokhono nezikhulu zomhlaba ezinhlanu ezivela eminyangweni kahulumeni njengabantu ababalulekile. Kuye kwatholakala ukuthi Uhlelo Lokusheshiswa Kokuguqulwa Komhlaba luchaza ukuthi abesilisa yibona abahlomula kakhulu ukudlula abesifazane. Izindlela zokuphila zabesifazane zavinjelwa ukwehluleka kwabo ekutholeni uxhaso olwanele oluvela kuhulumeni kanye nabambisane nabo abangaphandle. Ngaphandle kokuba uhulumeni asayinde incwadi ewumqulu enikezelana ngelungelo noma amandla okubhekiswe ekusekeleni kokuxhaswa kokuthukiswa kwabesifazane, kuningi okusamelwe kwenziwe ukufezekisa lombono. / Esi sifundo saqwalasela ubungakanani bokuxhotyiswa kwabafazi ngamandla ezoqoqosho abawanikwa ngenkqubo ekuthiwa yiFast Track Land Reform Programme (FTLRP) eZimbabwe, kugxininiswa kwiiwadi ezintathu ezikwisithili saseMakoni. Esi sifundo salungisa ukunqaba kolwazi olumalunga nokuba luncedo konikezelo lomhlaba malunga nokuphuculwa kokuqinisekiswa kokutya nemivuzo yabafazi. Ngokusebenzisa isifundo esigxila kumgangatho ngokuthatha imizekelo yeemeko ezithile, umphandi wakhetha ngononophelo abafazi abangamashumi abathathu nababenikwe umhlaba, wabasebenzisa kwiingxoxo zamaqela, waqhuba udliwano ndlebe namagosa eSebe lezemihlaba. Okwafunyaniswayo kwadiza ukuba ngokweFTLRP amadoda afumana umhlaba omninzi ngaphezu kwabafazi. Intlalo nempilo yabafazi iqhwaleliswa kukungafumani kwabo inkxaso eyaneleyo kurhulumente nakumaqabane karhulumente angaphandle. Nangona urhulumente etyikitya izivumelwano ezininzi ezithi uxhobisa abafazi, kusekuninzi ekufuneka kwenziwe ukuze iphumelele loo njongo. / Development Studies / M.A. (Development Studies)

The thesis focuses on the social policy dimension of Zimbabwe’s Fast Track Land Reform Programme (FTLRP). Interrogating land reform in the context of Transformative Social Policy (TSP) is a critical lacuna in Zimbabwe’s land reform and dominant social policy literature, implying the absence of a wider vision of social policy. This vision emphasises the consideration of the five tasks of social policy (production, redistribution, reproduction, protection and social cohesion); and acknowledges the symbiotic link between social policy and development. The thesis asks, how did the FTLRP and land occupations unfold; what is the new agrarian structure and, forms of social organisation in the aftermath of the fast track land reform; and how has the programme played out in relation to redistribution, production, social protection, reproduction and social cohesion? The thesis is based on a qualitative-dominant mixed methods research approach, and is complemented by predominantly quantitative data gathered by the African Institute for Agrarian Studies (AIAS), now Sam Moyo African Institute for Agrarian Studies (SMAIAS); and a sample of 150 A1 land beneficiaries drawn from Dalkeith, Whynhill and St Lucia Farms. Using grounded empirical data gathered in an eight (8) months-long ethnography in Zvimba district, Mashonaland West Province; and transcending ideological and epistemological debates, the thesis argues that, despite shortcomings, the fast track land reform is a crucial social policy ‘instrument’ with immense potential to transform lives. Across the district, land is a core economic, social and political resource that is central in enhancing wellbeing. The centrality of land reform in transforming lives is hampered mainly by land use and production constraints, and as the study results show, this dimension has the least positive outcomes. Diverse targeted support services that are mainly crystallised around land use and production, value chains and markets, are essential. If the farmers are appropriately supported, the benefits of land reform are potentially immense. Overall, land reform must be understood as a transformative social policy initiative and fast track is the case study for demonstrating this. The thesis contributes primarily to approaches and literature on land reform and social policy. / Sociology / D. Lit. et Phil. (Sociology)

This thesis explores questions of gender equality in social welfare theory; methodologies; approaches and policymaking in the Global South in the context of land reforms. This stems from the realisation that gender equality issues in social welfare are increasingly receiving greater attention in the context of the Global North and less in the South. By adopting a Transformative Social Policy framework, the research departs from hegemonic livelihoods, poverty reduction and the ‘classical models’ of land reforms often designed from the mould of the neoliberal discourse of individual tenure to focus on land reform as a relational question. Empirical data was gathered using a sequential explanatory mixed-methods approach involving survey questionnaires; in-depths interviews; focus group discussions; key informant interviews and field observations. A total of 105 randomly selected households, comprising 56 male-headed households (MHHs) and 49 female-headed households (FHHs) participated in the quantitative component of the study, comprising a control group of nonland reform beneficiaries. Additionally, 30 purposively selected in-depths interviews comprising 20 FHHs and 10 MHHs were conducted in resettlement study sites. Findings from this this study indicates that despite the country’s depressed economic environment and the effects of climate change, transfer of land enhanced the productive capacities of individuals and rural households, including those headed by females. At micro-level, in-kind transfer of land to rural households proved to be a more superior social protection measure compared to either food or cash transfer. However, social relations and institutions proved resistant to change, posing a greater obstacle to social transformation. And more importantly, from a social reproductive perspective, the same land reform that enhanced the productive capacities of women, inadvertently, increased their social reproductive work with implications on the welfare of women relative to men. The thesis makes a contribution to social policy debates in Africa, which hitherto have been dominated by the introduction of cash transfers as witnessed in many countries across the continent. The transformative social policy approach brings novelty to the study of land reforms. By Conceptualising gender as a relational and social construct, the study adds knowledge on the nexus between gender, land reform and welfare using the Fast Track Land Reform Programme (FTLRP) as reference. With the FTLRP––as a leftist policy in a liberalised economy––there is a need for the government to re-align its social and economic policies to avoid inconsistencies in the country’s development path. On the gender front there is need to legislate resettlement areas as outside the jurisdiction of traditional structures; promulgate statutory instruments dealing with land and setting up designated land claims courts linked right up to the Constitutional Court. Specifically, for Chiredzi, there is a need to establish a corporate body to administer the affairs of Mkwasine following the pulling out of the Estate. Keywords: gender, land reforms, water reforms, transformative / Sociology / Ph. D. (Sociology)