M.Com. (Business Management) / The purpose of the present study was to investigate the perceptions of medical practitioners towards managed health care and its implications for patient care. The study population was the medical practitioners in the northern suburbs of Johannesburg. A questionnaire was distributed to 224 medical practitioners in the northern suburbs of Johannesburg. The total number of the respondents was 81 with 53% being general practitioners and 47% being specialists. The findings of the study indicated that the majority of respondents perceived managed healthcare to have a negative impact on doctor-patient relationship, the ability to carry out their ethical obligations towards the patients, and that the limitations implemented by managed health care have a negative impact on the quality of care. The respondents also perceived managed healthcare to be consistent in reducing unnecessary procedures and reducing the expenditure. Recommendations made to remedy the situation include introducing a topic of managed health care as part of undergraduate studies to empower practitioners before they start a private practice. It would be advisable to include medical practitioners to help reform the strategies that will enable medical practitioners to carry out their ethical obligations towards the patients and to deliver quality care to the patients. The study concluded that medical practitioners hold negative perceptions towards managed health care and perceive managed health care to impact the quality of care negatively.

Please read the abstract in the section 00front of this document / Dissertation (MA (Publishing))--University of Pretoria, 2007. / Information Science / unrestricted

This thesis focuses on exploring the concept of managed realignment as a potential climate change adaptation strategy in Sweden. The empirics is based on the qualitative case study research within three Swedish municipalities of Trelleborg, Halmstad and Karlstad. The concept of territorial governance was used as the analysis framework for the empirical data. The aim of this thesis is to contribute to further research on managed realignment in Sweden, point out on current constraints and potentials of managed realignment within Swedish context and the current needs for making it a potential climate adaptation strategy in Sweden.

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This project will show how a computer-based information management system can be used by elementary school teachers. Using a desktop database manager software, FileMaker Pro, this project will describe how technology can help a classroom teacher manage information through an application model.

This study investigates the effects of a participative-type management approach termed self-managed work teams (SMWTs) and work spillover into the family environment. The perspective of isomorphism by Aldous (1969), and Rapoport and Rapoport (1965), was used as a paradigm to examine both positive and negative effects of the work-family relationship. A total of 76 employees from the Department of Defense's Quality Division was used in the regression analysis, due to recent transitions into SMWTs. Results reported overwhelming support for the perspective of isomorphism: over 40% of the variation in positive work spillover was explained by SWMT characteristics. Communication with other teams was the single most important factor found to have a significant effect on positive work spillover.

The main object of this thesis is a design of the project with the utilization of project management principles in the chosen company. Company SynopsIS Technologies, a.s. is developing and selling a software solution for advocacy and law offices. The starting point of the entire process of designing is the strategic analysis of the current state of the company, analysis of the external environment and business field of the company. The main object is a designed project of the change, which will be used for project management in order to successfully reach set goals and minimize the risks of the project. A designed solution is using the support of Microsoft Project Professional 2016 software.

Managed aquifer recharge (MAR) is widely applied for sustainable groundwater management. Despite its apparent simplicity, the evaluation of MAR schemes can be challenging especially with regard to feasibility assessment, planning but also operation. The absence of proper evaluation methods hinders the optimal operational management, reduces the level of public trust and raises questions about the impact of MAR on the affected ecosystem. The development of appropriate tools could help water utilities to maximize the use of groundwater while satisfying physical, financial, and sustainability constraints. As overall objective, the application of new and advanced tools can increase the understanding of the underlying processes and in that way increase the confidence in MAR and foster the successful implementation of MAR schemes. The thesis consists of three main parts which objectives are to: 1) understand the role of modelling in MAR and identify information gaps by a review of available modelling studies; 2) increase the availability of efficient database and analytical tools including their development and web-based implementation; and 3) improve and contribute to new advances in numerical modelling of MAR. A survey of conducted modelling studies, mainly based on numerical methods, revealed that groundwater flow models are most frequently applied to assess MAR schemes. Modelling objectives comprise the planning and optimization of the design and operation of a MAR facility as well as its impact on the groundwater system. Simulations help to assess the achievable recovery efficiency and occurring geochemical processes to minimize the risk of failure of a planned facility, also with regard to long-term impacts. Furthermore, site-selection and the influence of MAR on seawater intrusion are frequently analysed by modelling. The literature review served as a basis for the MAR model selection tool which enables, dependent on objectives, methods and model types, to extract suitable models and case studies. Based on analytical equations to determine groundwater mounding, saltwater intrusion or the pumping-induced river drawdown, further tools were developed and compiled on a web-based platform for easy access and utilization. The web-based applications can be used as screening tools to assess MAR-related issues. For a more detailed analysis, numerical models represent useful instruments to analyse MAR schemes on various scales. On regional scale, the feasibility of MAR implementation at proposed locations is often a challenging question due to the lack of detailed knowledge of the local groundwater system and its response to MAR. Consequently, an approach combining numerical groundwater flow modelling and GIS-based multi-criteria decision-analysis (MCDA) was formulated and subsequently tested for the city centre of Hanoi, Vietnam. The results indicate that MAR could help to reduce the local overexploitation of groundwater and stop land subsidence. For existing MAR schemes on local scale, the residence time in the subsurface is a critical parameter determining e.g. the removal of pathogens. As the influence of viscosity on the seasonal residence time is not fully clear, a numerical groundwater flow and heat transport model was set up for a MAR scheme in Berlin, Germany to evaluate the seasonal impact of viscosity. The results suggest that the consideration of viscosity in the numerical modelling scheme has an influence on the subsurface travel time and results in shorter residence times. At point scale, clogging represents a critical issue with regard to the long-term viability of a MAR scheme which is frequently neglected in numerical models. The numerical unsaturated flow model HYDRUS-1D/2D was enhanced to enable the simulation of time-variable hydraulic conductivities as an approximation of clogging. With the help of the time-variable scaling factor in combination with the reservoir boundary condition, the increasing water head in the laboratory aquifer well and infiltration basin due to clogging was reproduced. The presented tools and numerical modelling approaches are useful to assess a wide range of MAR-specific issues, to manage the risks associated with implementation and operation and improve the overall performance and reliability of MAR schemes. Through the application of suitable data-based, analytical and numerical tools, the thesis contributes to the perception of MAR as a suitable and reliable technique for water resource management.:1 INTRODUCTION 1 2 ASSESSMENT OF MANAGED AQUIFER RECHARGE THROUGH MODELLING 11 3 WEB-BASED EMPIRICAL AND ANALYTICAL TOOLS FOR INITIAL MAR-RELATED ASSESSMENT 29 4 MANAGED AQUIFER RECHARGE FEASIBILITY ASSESSMENT USING GIS-BASED SUITABILITY MAPPING AND NUMERICAL MODELLING 53 5 INFLUENCE OF VISCOSITY ON THE SEASONAL RESIDENCE TIME DURING MAR OPERATION 73 6 SIMULATION OF HYDRAULIC CONDUCTIVITY CHANGES OVER TIME DURING MAR OPERATION 91 7 SCIENTIFIC IMPLICATIONS AND RESEARCH PERSPECTIVES...113 Bibliography 117 A Appendix 143 / Grundwasseranreicherung (engl. Managed Aquifer Reharge, MAR) wird oftmals für ein nachhaltiges Grundwassermanagement eingesetzt. Trotz der scheinbaren Einfachheit von MAR, kann die Bewertung insbesondere in Bezug auf Machbarkeitsstudien, Planung, aber auch Betrieb herausfordernd sein. Das Fehlen geeigneter Bewertungsmethoden hindert ein optimales Betriebsmanagement, reduziert das Vertrauen der Öffentlichkeit und wirft Fragen über die Auswirkungen von MAR auf das betroffene Ökosystem auf. Die Entwicklung geeigneter Instrumente könnte daher Wasserversorgern helfen, die Nutzung des Grundwassers zu maximieren und gleichzeitig physische, finanzielle und nachhaltige Bedingungen einzuhalten. Als übergeordnetes Ziel kann die Anwendung neuer und fortschrittlicher Instrumente das Verständnis für die zugrunde liegenden Prozesse verbessern und so das Vertrauen in MAR stärken und die erfolgreiche Umsetzung von MAR-Anlagen fördern. Die Arbeit besteht aus drei Hauptteilen, deren Ziele es sind: 1) die Rolle der Modellierung von MAR zu verstehen und Informationslücken durch eine Überprüfung der verfügbaren Modellierungsstudien zu identifizieren; 2) die Verfügbarkeit effizienter datenbankbasierter und analytischer Instrumente einschließlich ihrer Entwicklung und webbasierten Implementierung zu erhöhen; und 3) mit Hilfe von neuen Fortschritten die numerische Modellierung von MAR-Anlagen zu verbessern und zu unterstützen. Eine Literaturrecherche bereits durchgeführter Modellierungsstudien, die vor allem auf numerischen Modellen beruhen, ergab, dass Grundwasserströmungsmodelle am häufigsten zur Beurteilung von MAR-Anlagen eingesetzt werden. Die Modellierungsziele umfassen die Planung und Optimierung des Aufbaus und des Betriebs einer MAR-Anlage sowie deren Auswirkungen auf das Grundwassersystem. Simulationen helfen, die erreichbare Rückgewinnungseffizienz und die auftretenden geochemischen Prozesse zu beurteilen, um das Ausfallrisiko einer geplanten Anlage auch im Hinblick auf langfristige Auswirkungen zu minimieren. Darüber hinaus wird die Standortauswahl und der Einfluss von MAR auf das Eindringen von Meerwasser häufig durch Modellierung analysiert. Die Literaturrecherche diente als Grundlage für das MAR-Modellauswahl-Tool, bei dem in Abhängigkeit von Zielen, Methoden und Modelltypen geeignete Modelle und Fallstudien extrahiert werden können. Weitere Werkzeuge, die auf analytischen Gleichungen zur Bestimmung von Grundwasseraufwölbung, Salzwasserintrusion oder der pumpinduzierten Durchflussreduzierung im Fließgewässer basieren, wurden entwickelt und auf der webbasierten INOWAS-Plattform für einen einfachen Zugang und Nutzung zusammengestellt. Die webbasierten Anwendungen können als Screening-Instrumente zur Beurteilung von MAR-bezogenen Problemen eingesetzt werden. Für eine detailliertere Analyse stellen numerische Modelle nützliche Instrumente zur Analyse von MAR-Anlagen auf verschiedenen Skalen dar. Auf regionaler Ebene ist die Machbarkeit der Umsetzung von MAR an den vorgeschlagenen Standorten oft eine schwierige Frage, da das lokale Grundwassersystem und seine Reaktion auf die Anwendung von MAR nicht hinreichend bekannt sind. Dazu wurde ein Ansatz entwickelt, der numerische Grundwasserströmungsmodellierung und GIS-basierte multikriterielle Entscheidungsanalyse (MCDA) kombiniert, um die Machbarkeit und mögliche Auswirkungen der MAR-Implementierung zu bewerten. Der kombinierte Ansatz wurde im Stadtzentrum von Hanoi, Vietnam, getestet, wo die Ergebnisse darauf hindeuten, dass MAR dazu beitragen könnte, die lokale Übernutzung zu reduzieren und die Bodensenkung zu stoppen. Auf lokaler Ebene bei bestehenden MAR-Systemen ist die Verweilzeit im Untergrund ein kritischer Parameter, der z.B. die Entfernung von Krankheitserregern bestimmt. Da der Einfluss von Viskosität auf die saisonale Verweildauer nicht eindeutig ist, wurde für eine MAR-Anlage in Berlin ein numerisches Grundwasserströmungs- und Wärmetransportmodell erstellt, um die saisonalen Auswirkungen des Prozesses zu bewerten. Die Ergebnisse deuten darauf hin, dass Viskosität einen Einfluss auf die unterirdische Verweilzeit hat und zu einer Verkürzung der Aufenthaltszeiten führt. Auf kleiner Skala stellt die Kolmatierung ein wichtiges Thema dar, das den Erfolg eines MAR-Systems erheblich bestimmt, jedoch in numerischen Modellen häufig vernachlässigt wird. Das numerische ungesättigte Strömungsmodell HYDRUS-1D/2D wurde erweitert, um die Simulation von zeitlich variablen hydraulischen Leitfähigkeiten als vereinfachte Näherung von Kolmatierung zu ermöglichen. Mit Hilfe des zeitlich variablen Skalierungsfaktors in Kombination mit der Speicherrandbedingung konnte der im Labor gemessene, durch Kolmatierung verursachte, ansteigende Wasserspiegel im Brunnen und Infiltrationsbecken reproduziert werden. Die vorgestellten Werkzeuge und numerischen Modellierungsansätze sind nützlich, um eine breite Palette von MAR-spezifischen Fragen zu bewerten, um die mit der Implementierung und dem Betrieb verbundenen Risiken zu managen und die Gesamtleistung und Zuverlässigkeit von MAR-Anlagen zu verbessern. Durch den Einsatz geeigneter empirischer, analytischer und numerischer Werkzeuge trägt die Arbeit dazu bei, dass MAR als eine geeignete und zuverlässige Technik für das Wasserressourcenmanagement angesehen wird.:1 INTRODUCTION 1 2 ASSESSMENT OF MANAGED AQUIFER RECHARGE THROUGH MODELLING 11 3 WEB-BASED EMPIRICAL AND ANALYTICAL TOOLS FOR INITIAL MAR-RELATED ASSESSMENT 29 4 MANAGED AQUIFER RECHARGE FEASIBILITY ASSESSMENT USING GIS-BASED SUITABILITY MAPPING AND NUMERICAL MODELLING 53 5 INFLUENCE OF VISCOSITY ON THE SEASONAL RESIDENCE TIME DURING MAR OPERATION 73 6 SIMULATION OF HYDRAULIC CONDUCTIVITY CHANGES OVER TIME DURING MAR OPERATION 91 7 SCIENTIFIC IMPLICATIONS AND RESEARCH PERSPECTIVES...113 Bibliography 117 A Appendix 143

The primary objective of the project was to survey audiologists in clinical practice setting to determine the amount of time taken to perform various audiologic tests using Current Procedural Terminology, (CPT) codes to define these tests and if these CPT codes were felt to be adequate. Audiologists were also asked to respond regarding possible impact and reimbursement changes in their clinical practices related to managed care. Responses of audiologists were analyzed to determine: a) adequacy of CPT codes; b)average time to perform various audiologic tests; c) impact managed care onclinical practice; and d) changes in reimbursement as a result of managed care. The survey was designed to determine the type of work setting, typical job duty, average monthly caseload and hours per day spent on patient care for each respondent. The survey with a cover letter explaining the purpose was mailed to 93 audiologists in clinical setting in the state of Florida. Five were returned undeliverable, and 39 of the remaining 88 were returned either completed or partially completed. The survey results revealed over 71% of the audiologists felt the current CPT codes were adequate. Time spent performing traditional audiologic tests, such as comprehensive audiometric evaluations and impedance testing, was fairly consistent. Greater time variability occurred in tests used to determine vestibular function. Over three-quarters of the respondents believed managed care has had a negative impact on their clinical practices, while 11% believe they have been positively impacted. Approximately 82% of the audiologists have had reductions in reimbursement as a result of managed care, while 10% have seen no change and 5% have enjoyed slightly greater reimbursement.

Thesis (M.A. (Nursing Science)) -- University of Limpopo, 2019 / Quality health care includes availability, accessibility, affordability, acceptability, competence of health care providers, reducing waiting time, ensuring privacy and confidentiality, ensuring safety and security, and reducing mortality and morbidity. Despite many initiatives made by the National Department of Health through the Minister of Health, provision of quality health care services remains a serious challenge in South Africa, especially in the public rural clinics. Communities from rural areas face many challenges at the public healthcare clinics such as poor infrastructure, attitudes from staff, old equipment, insufficient medicines, dirty healthcare sectors, and longer waiting times, which has led to provision of poor health care services. Methodology A quantitative research approach was used to conduct this study. The study was conducted in the Capricorn District of the Limpopo Province. Three municipalities; namely Blouberg, Lepelle-Nkumpi and Aganang, were selected from the five municipalities located in the Capricorn District because they are predominantly rural. A simple random sampling applying fish bowl method was used to select the public clinics in each municipality. A cross-sectional study design was used to conduct the study. Only professional nurses were selected to participate in this study. Data were collected using a structured self-administered questionnaire, over a period of three months. A total of 155 professional nurses were selected because they met the selection criteria. The response rate was 100% because all the 155 questionnaires distributed were completed. Data were analysed using the Statistical Package for Social Sciences program version 22.0 with the assistance of the University of Limpopo statistician. Results The findings of the study indicated that only 3 (2%) of the clinics operated for 24 hours, 72 (46%) operated for 8 hours and 80 (52%) operated for 12 hours. The majority of the professional nurses 123 (83%) said that the clinics are overwhelmed by large numbers of patients, whereas 26 (17%) of the professional nurses said that the clinics are not overwhelmed by large numbers of patients. Very few 29 (19%) professional nurses were satisfied with the salary they were paid, whereas the majority 124 (80%) were not satisfied with salary they were paid, and only 2 (1%) were unsure. Recommendations Recommendations were made to improve the quality of healthcare services in the public rural clinics: The Department of Health should review the salaries they pay professional nurses in rural clinics, particularly the Occupational Specific Dispensation, and they should be given a higher salary. Furthermore, the government should increase the salaries of nurses working in the public rural clinics to at least 10% higher than those in urban clinics within the next 5 years to attract more nurses to the public rural clinics. The Limpopo Provincial Department of Health should liaise with the treasury department to provide realistic budget to accommodate the population. Conclusion The findings of this study revealed the factors related to the provision of quality health care services at the selected public clinics in the rural areas of the Capricorn District, Limpopo Province. The study was limited to public clinics in the rural areas; therefore, the findings of this study cannot be generalised to the clinics that did not participate in the study. Keywords: Quality, healthcare services, public rural clinics.