Global ETD Search

1	Enabling Multi-Site, Tailored Feedback Interventions to Reduce Low-Value Test Ordering: A Systematic Approach Podolsky, Eyal 28 October 2021 (has links) Introduction: Innovations in modern medicine have led to the development of many effective laboratory tests for diagnosis and monitoring of disease. However, research suggests that 20-50% of tests may be inappropriately ordered. Test-ordering intervention development experts i.e. those staff at individual institutions who are tasked with designing different approaches to improving test-ordering practice, often have large datasets on the test-ordering practices within their jurisdiction as part of clinical care, but often have no clear guidance on how to choose which tests are worthy of intervention. These staff can include both clinicians and knowledge translation experts working in separately or in tandem to improve test-ordering behaviours at their institutions. The overall aim of this research is to build a prioritization framework to assist healthcare organizations in deciding which tests are worth targeting for intervention. Methods: The first stage of this project was a scoping review of the literature, the purpose of which was to determine the factors and processes used by intervention developers to choose which tests to target for intervention. Identification of these articles allowed for the descriptive analysis of the factors and processes reported in making the test-ordering decisions. The second stage involved semi-structured interviews with intervention development experts and contains information on their experiences with measuring and prioritizing among factors, as well as which processes they found to be most effective in making the decision on which tests to target for intervention. Results: By exploring all relevant guideline statements and related empirical studies, we gathered a wide range of factors to consider when deciding which test(s) to target for intervention. Overall, we identified 18 factors in our review and 30 in our interviews, highlighting the potential complexity of these decisions. While our studies were not the first to demonstrate that targeting tests is complex and that many factors must go into the decision of deciding which tests to target, our work has identified the most comprehensive range of factors available. We also explored processes reported by the studies that led to these decisions. Of the nine processes identified in our review, some were identified in a majority of cases (literature review, followed by clinical standard-implicit and consensus process), and other processes far more infrequently. Our interviews with relevant stakeholders demonstrated that the interviewees used 18 unique processes to decide which tests to target for intervention and helped to prioritize among the processes that are most effective in making these decisions. Conclusion: The current work prepares the way to develop a framework designed to help intervention developers choose which tests can most efficiently result in improved test-ordering processes. After additional interviews to ensure saturation of themes, we will be able to proceed with framework development, perhaps involving a consensus process of all relevant stakeholders. We hope to widely distribute our framework to assist intervention development experts working in a wide variety of milieus to help them decide which tests are worth targeting for intervention such that their respective institutions can provide the highest quality of care to patients. Laboratory Testing Low-value Scoping Review Semi-Structured Interview
2	Vitamin D in Human Health and Performance: The Pursuit of Evidence-Based Practice in an Era of Scientific Uncertainty Rockwell, Michelle S. January 2019 (has links) Background: Calciferol (vitamin D) is an essential nutrient that can be synthesized in the skin upon exposure to ultraviolet-B (UVB) light, or obtained through dietary and supplement sources. Traditionally known for its role in bone metabolism, vitamin D is currently described as a pleiotropic hormone with genomic and non-genomic roles in most body tissues. Clinical practice guidelines related to vitamin D are inconsistent and controversial. The purpose of this dissertation was to describe current patterns of vitamin D-related clinical care in a variety of settings, and to evaluate the impact of vitamin D supplements on the health and performance of collegiate athletes, a group with high prevalence of low vitamin D (LVD). Methods: This dissertation consists of five studies: 1) a scoping review of the health services literature related to clinical management of vitamin D; 2) a retrospective analysis of clinical care following non-indicated vitamin D testing using electronic health record (EHR) data from a regional health system; 3) a survey study to assess vitamin D-related practices among National Collegiate Athletic Association (NCAA) Division I programs; 4) an open clinical trial to evaluate the efficacy of a specific vitamin D supplement protocol in treating collegiate basketball athletes with LVD; and 5) a randomized, double-blind clinical trial to determine health and performance effects of vitamin D supplements in collegiate swimmers participating in fall season training. Results: Substantial inconsistency in vitamin D-related care was observed throughout the first three studies. Exponential increases in vitamin D testing and treatment, and associated costs, were identified in the U.S. and several other countries. A high proportion of this care was considered non-indicated (i.e., counter to professional guidelines). A lower rate of non-indicated vitamin D-related services was conducted within the health system we studied, but a cascade of low value services followed non-indicated vitamin D testing. Vitamin D testing was regularly performed by more than 65% of NCAA programs. In basketball athletes, 10 weeks of daily vitamin D3 supplements (5000 or 10,000 IU based on initial vitamin D status) improved serum 25-hydroxyvitamin D [25(OH)D], the common biomarker of vitamin D status. In swimmers, a vitamin D supplement protocol (5,000 IU vitamin D3 daily for 12 weeks) was efficacious in attenuating a seasonal decline in 25(OH)D compared with placebo. Swimmers taking vitamin D supplements also showed greater improvements in strength, power, and fat free mass. In both athlete studies, taking vitamin D supplements was associated with higher free testosterone concentration. Conclusions: The provision of evidence-based care related to vitamin D is complicated by contradictory clinical practice guidelines, resulting in inconsistent and sometimes, non-indicated care. Focused research on specific populations at high-risk for LVD can inform best practices. Our results suggest that taking vitamin D supplements is an efficacious strategy for athletes to improve 25(OH)D, especially when UVB exposure is low, and to enhance strength and power in collegiate swimmers. / Ph.D. / Vitamin D is known as the “sunshine vitamin” since it can be synthesized by the human body when exposed to specific wavelengths of ultraviolet-B (UVB) light. Some foods and dietary supplements also contain vitamin D. A relationship between vitamin D and bone health is well-established, but emerging research has also associated vitamin D status with a number of different diseases and health problems, including cancer, cardiovascular disease, autoimmune conditions, and depression. Unfortunately, this research is currently inconclusive, and healthcare providers’ professional guidelines related to vitamin D are highly variable. Thus, providing evidence-based care related to vitamin D is complicated. This dissertation consists of a series of three research studies that describe healthcare providers’ vitamin D-related care considering the uncertain landscape, and two research studies that explore the role of vitamin D in collegiate athletes. We chose athletes since a high proportion of them have deficient or insufficient vitamin D status, and because some research has shown that this low vitamin D status affects athletic performance. Results of these studies showed that vitamin D-related health services such as blood testing have increased dramatically over the past 15 years, as have costs associated with these services. Opportunities to improve consistency and quality of care were observed in multiple settings. In the athlete studies, a high rate of vitamin D deficiency and insufficiency was observed among basketball athletes, and we identified vitamin D supplement treatment protocol effective in improving vitamin D status. In addition, swimmers who took vitamin D supplements performed better on strength and conditioning tests than those who took placebo supplements. A favorable relationship between testosterone concentrations and vitamin D status was shown in both basketball athletes and swimmers. Continuing to conduct research focused on specific populations can help healthcare providers develop consistent, high quality, evidence-based care related to vitamin D. Low Value Care Screening 25-Hydroxyvitamin D Supplement Athlete
3	Lactic acid production by immobilized Rhizopus oryzae in a rotating fibrous bed bioreactor Thongchul, Nuttha 06 January 2005 (has links) No description available. Engineering, Chemical Lactic acid fungal morphology immobilization low-value substrates oxygen limitation shaving-off growth control spore germination
4	Stanovení transferové ceny u manažerských služeb / Setting Transfer Price for Management Fees Pevná, Daniela January 2021 (has links) The master´s thesis deals with the issue of setting transfer prices for management services between associated enterprises. The thesis contains a theoretical definition of basic concepts and analysis of legislation. The content of the analytical part of the thesis is the analysis of the current state and analysis of case law. The theoretical background is applied in the practical part to a model example which is determined by setting transfer price for management services between internal associated enterprises.
5	A point-prevalence survey of antimicrobial utilisation within New Brunswick hospitals to focus antimicrobial stewardship efforts and decrease low-value care Brideau-Laughlin, Diane 09 1900 (has links) No description available. prévalence ponctuelle utilisation des antimicrobiens utilisation appropriée soins sans valeur antimicrobial stewardship point prevalence survey antimicrobial utilization appropriateness of utilization low-value care
6	Hidden In Plain Sight: Development And Testing Of A Model To Evaluate Political Leadership Tactics Citron, Albert 01 January 2013 (has links) This thesis analyzes the kinds of verbal and nonverbal signals elites manifest to show leadership qualities. Launching from Max Weber’s conceptual framework of charisma as a power term and Harold Lasswell’s study of propaganda, this study takes a multidisciplinary approach to studying political leadership with elements of communication methodology and an ontological basis in evolutionary psychology. The study’s goal is to offer a framework for defining and evaluating the diverse signal patterns employed by political elites in three real-life situations. These are the Malta Summit, the 1992 Virginia Presidential Debate, and the 2012 South Carolina Republican Presidential Primary. The cases were chosen because they display a diverse set of signal variations during different types of interactions. The three case studies are evaluated by measuring frequency and patterns of occurrence of the five different interaction constructs (indicator of interest, indicator of disinterest, demonstration of high value, demonstration of low value, and compliance testing) to explain different interaction patterns. A simple frequency distribution of the different signals during a given interaction is used to display the empirical findings and to compare patterns across the case studies. This study reveals that the presence of DLV (demonstration of low value) signals weaken an elite’s position in relation to other elites and the public while the presence of DHV (demonstration of high value) signals strengthen an elite’s position. It is largely the presence, absence, and frequency of these two signals that determines who conveys leadership qualities effectively regardless of leadership style. Studying the signaling patterns of political elites would allow scholars to understand better the kinds of signal patterns and signal frequencies that are used in different types of leadership styles and norm ranges for signals including for political elites belonging to different cultures and subcultures Verbal nonverbal signals leadership qualities elites communication facework theory elite signals evolutionary psychology dlv dhv iod ioi indicator of interest indicator of disinterest demonstration of high value demonstration of low value compliance International Relations Political Science
7	De grundläggande rättsprinciperna vid direktupphandling : HFD 2018 ref. 60 och EU-rätten / The General Principles of Swedish Direct Awards : HFD 2018 ref. 60 and EU Law Lignell, Elias January 2022 (has links) This thesis examines the general principles in European Union (EU) public procurement law, as they apply to Swedish direct awards of low value, outside the scope of the EU procurement directives. A combination of Swedish and EU legal methodology is used to investigate two overarching themes. Firstly, the two different legal bases of the general principles, in the light of the Court of Justice of the EU’s definition of cross-border interest, as well as the Swedish implementation. Secondly, the central substantive consequences imposed by the principles on direct awards. The only national precedent on the subject, HFD 2018 ref. 60 of the Supreme Administrative Court, is both utilised and criticised against the backdrop of EU law to paint a picture of the principles’ inner workings in a direct award context. Pertaining to the first theme, an analysis of the applicability of EU primary law on direct awards is undertaken in order to distinguish the legal bases of the principles. If a contract is of certain cross-border interest, the general principles flow directly from EU law. In the absence of such an interest, the principles are exclusively based in Swedish law, which nationally extends the EU principles to all procurement (gold-plating). Overall, contracts valued below a quarter of the applicable EU directive threshold usually lack certain cross-border interest, unless there are concrete indications of the opposite. As a result, most direct awards fall outside the scope of EU law. An awareness of the legal bases of the principles is relevant to avoid breaches of EU primary law. It is argued that the Swedish gold-plated implementation of the general principles causes unnecessary uncertainty, and that separate national principles should be introduced outside the scope of EU primary law. As for the second theme, a thorough analysis concludes that the principles do not prohibit direct awards given without any exposure to competition, as long as the contracts are of low enough value. Direct awards can therefore be conducted through direct contact with a single supplier, in accordance with the legislative aims of the procedure. This may not be the case for social and other specific services of relatively high value. Nonetheless, the principles still affect direct awards, for instance in prohibiting flagrant cases of differential treatment without objective justification, based in arbitrary or corrupt decision-making. Unfortunately, these requirements are able to be circumvented due to the wide discretion given to procuring entities. On the other hand, if a direct award procedure is voluntarily advertised, the principles have greater practical significance. Still, the requirements in such cases are more lenient than in ordinary procurement procedures. public procurement government procurement direct award Sweden general principles legal principles EU law primary law CJEU ECJ certain cross-border interest threshold gold plating procedure competition low value contract offentlig upphandling upphandlingsrätt LOU LUF direktupphandling grundläggande rättsprinciper grundläggande principer allmänna principer upphandlingsrättsliga principer principer för direktupphandling upphandlingsprinciperna HFD 2018 ref. 60 EU-rätt primärrätt överskjutande implementering bestämt gränsöverskridande intresse kravet på insyn likabehandlingsprincipen icke-diskriminering proportionalitetsprincipen öppenhetsprincipen konkurrensprincipen olikbehandling likabehandling nationella principer frivillig annonsering direkttilldelning icke-direktivstyrd direktupphandlingsgräns tröskelvärde lågt värde anbudsinfordran konkurrensutsättning icke-konkurrensutsatt 19 a kap 19 a kap. 8 § rättsmedel överprövning obligatoriska krav sammanblandning EUF-fördraget FEUF EU-domstolen EU-rättslig metod rättsdogmatisk metod effet utile teleologisk tolkning affärsmässighet handlingsfrihet rättssäkerhet korruption Law Juridik Law (excluding Law and Society)

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