<p> <b>Background:</b> The widespread use of mammography, and its lack of specificity in younger women with denser breasts, increases the potential for a large number of biopsies and surgeries performed in women without breast cancer. Once a suspicious breast lesion is identified with mammography, the use of minimally-invasive breast biopsy (MIBB) as the initial tissue acquisition method for diagnosis is widely supported and advocated as best practice. This research focused on the utilization of MIBB techniques and surgical breast procedures to diagnose image-detected suspicious breast lesions, particularly those lesions ultimately diagnosed as benign, in an effort to better understand the quality and cost implications unnecessary surgical care. <b>Methods: </b> This retrospective cohort study evaluated the practice patterns of a variety of physicians in multiple facilities and physician offices across the country for MIBB and open surgical procedures to diagnose image-detected suspicious breast lesions among a cohort of well-insured women younger than 65 years old and eligible for TRICARE (the U.S. military's health benefit). Additionally, mean total costs were calculated to estimate the cost advantages of one initial tissue acquisition procedure versus another and how these costs were impacted by final diagnosis. <b>Results:</b> In total, 80 percent of the episodes began with the less-invasive MIBB, and 20 percent began with an open surgical procedure. Approximately 77 percent of the episodes using MIBB as the initial diagnostic technique were ultimately diagnosed as benign, as compared to a benign diagnosis in 82 percent of episodes initially utilizing open surgical biopsy and in 20 percent of episodes where other definitive surgery was the initial procedure. In total, potentially unnecessary surgery accounted for 15 percent of all cases requiring follow-up biopsy after abnormal mammography. The strongest predictors for the initial use of an open surgical procedure to diagnose a suspicious breast lesion that was ultimately diagnosed as benign were a lesion indicating benign atypia after diagnosis, patient age younger than 40 years old, a military physician performing the initial procedure, and a physician in the Midwest performing the initial procedure. On average, the excess cost associated with the use of surgical biopsy over MIBB as the initial procedure was 3 percent (ranging from 3 to 30 percent), but increased to 70 percent (ranging from 70 to 235 percent) for episodes ultimately diagnosed as benign. <b>Conclusions:</b> The use of surgical procedures to diagnose suspicious breast lesions is declining as the appropriate use of less-invasive MIBB techniques is growing. However, the variation in the utilization of these diagnostic techniques, particularly among younger women and among certain groups of physicians, results in a large number of women undergoing inappropriate surgical diagnosis of suspicious lesions that are ultimately diagnosed as benign. Policies are needed that promote the dissemination of comparative information to physicians about practice patterns, the use and monitoring of physician-level measures of compliance with care standards, payment policies that incentivize physician-level decision-making for high-value care, and balanced information sharing between physicians and patients about the harms and benefits of mammography screening.</p>

<p> The purpose of this project was to identify and create a program that would meet the needs of a target population, identify potential funding sources, and write a grant to fund a program at St. Mary's Hospital in Long Beach, California. An examination of the literature expanded knowledge about the challenges homeless individuals face. Homeless individuals commonly receive inadequate medical care and often access more costly acute care services due to limited resources, discrimination, and cost. Housing and case management services after discharge from a hospital setting can help improve health care outcomes and reduce costly services.</p><p> The program was designed to provide specialized discharge planning services to homeless individuals being discharged from St. Mary's Hospital. The California Wellness Foundation was chosen for this grant based on the program areas of the funder. The actual submission and/or funding of this proposal was not a requirement for completion of this project.</p>

Growing concerns regarding sustainability have led the construction sector to adopt various policy instruments for reducing the impacts caused by construction activities. One such policy instrument includes impact assessment, which enables the construction sector to evaluate the environmental consequences of proposed developments at project (environmental impact assessment) and strategic (strategic environmental assessment) level. In recent years, the construction sector has also adopted green public procurement, which is a process whereby contracting authorities aim to procure services and products that meet environmental requirements. In certain contexts, green public procurement has extended to sustainable public procurement, which involves the incorporation of both environmental and social considerations in the procurement of services and products. Promoting sustainability in the constructor sector is a significant challenge. This challenge is primarily due to the requirement of high levels of cooperation among project stakeholders, on the one hand, and a lack of coordination between project planning and implementation on the other hand. Therefore, procurement plays a significant role as it establishes the tone for the interaction between contracting authorities and contractors. The overall aim of this thesis is to bolster the knowledge of promoting sustainability in the construction sector, with the specific aim of analysing the ways in which policy instruments such as environmental impact assessment and green public procurement can be reinforced to improve the coordination between planning and the implementation of sustainability considerations. This thesis conceptualises an inter-link between impact assessment and green public procurement, and identifies the opportunities to develop the inter-link. It is appropriate to plan for green public procurement at the pre-decision phase of an environmental impact assessment. The inter-link can be strengthened by involving contractors in planning for green and sustainable public procurement. One way to involve contractors is with the aid of competitive dialogue procedure, which is a procurement procedure that allows contracting authorities to hold discussions with contractors regarding the authority’s requirements. This study strengthens the conceptualisation that competitive dialogue procedure can facilitate green and sustainable public procurement. The various elements in a competitive dialogue procedure can enable the contracting authorities to ensure the consistency between the weight for environmental considerations in contract award criteria and the relevant preferences. This thesis also discusses key concerns for progress towards sustainable public procurement, which includes among others the incorporation of sustainability values in procurement decisions. In addition, this study identified certain discourses on future trends for green and sustainable public procurement. The discourses provide an opportunity for reflection, and thereby indicate that analytical support is required to develop criteria in a way that enables the evaluation of sustainable public procurement against the background of sustainability and justice regarding natural capital. Innovation must be promoted with a focus on sustainability values. Moreover, green or sustainable public procurement must be discussed between contracting authorities and contractors in light of its contribution to sustainability. / <p>QC 20140509</p>

The recent shooting of unarmed teenager Michael Brown by police officer Darren Wilson in Ferguson, Missouri rekindled the age-old debate of how the authority of the state to enact the law and guard public safety, specifically in terms of police use of deadly force, ought to properly be balanced against citizens’ rights. The social consequences of this incident illustrate the profound importance of policy governing this issue. This thesis provides an analysis of the governing Supreme Court precedent which informs this issue, as well as the state statutes of Missouri and the police department regulations of Ferguson, Seattle, Denver, and New Hampshire which govern the police use of deadly force. The application of these standards to varying scenarios of the Ferguson shooting serves to demonstrate how these standards operationalize and highlights the discrepancies that exist across jurisdictions in terms of restricting and evaluating police use of deadly force. Ultimately, ambiguity in the current standards, incongruities and difficulties in their implementation, as well as significant concerns of inherent injustice lead to the conclusion that the police use of deadly force should be limited to instances in which such force is necessary to protect human life or prevent serious physical injury.

This research was done to find out if engineering oral presentations (EOPs) are a genre, if there are systematic differences between EOPs delivered by native speakers (NSs) and non-native speakers (NNSs) of English, if there are systematic differences between EOPs delivered by novices and experts and, if the engineering discourse community (DC) members have beliefs concerning what constitute 'good' EOPs. One engineering seminar and four engineering conferences carried out in Malaysia and the UK between March and September 1994 were participated. From this participant observation exercise, 100 questionnaires were gathered and responses analysed; sixty-eight EOPs delivered by NSs and NNSs were transcribed and analysed using Genre Analysis frameworks. Results from the analysis of EOPs were counterchecked with the responses in the questionnaires. It was found that EOPs did have describable characteristics which qualify them as a genre; There were few differences between EOPs delivered by NSs and NNSs of English because the latter tend to follow the former; There were describable differences between EOPs delivered by experts and novices. The engineering DC members did have their genre expectations but not all of their beliefs concerning what constitute 'good' EOPs were possible to materialise in actual occasions because of certain unavoidable constraints. These constraints were found to be affecting the variants of the genre more than the invariants. These variant-invariant elements were found to be related to the characteristics of exemplars, prototypes, prestige markers and the patterns of imitations of NNSs and novices of the engineering DC members. 'Ecological validity' was pointed out to be one of the ways of achieving the reliability and the validity of the research. Potential teaching implications were also discussed. Unavoidable limitations of the research were pointed out and finally immediate and longer term research projects have been identified.

This thesis emerged as a result from the desire to know how the Public Service of Malaysia is coping up with the demands of quality services from the public. The Public Service, in meeting the aspirations of the Government, on providing quality services to the public, has introduced a number of quality programmes. In spite of this positive move to inculcate a quality work culture among the Public Service employees, the public is said to be still complaining about public services. In this situation, investigations are required to determine the true status of the level of quality of services delivered by the Public Service. These investigations involved measuring service quality and the SERVQUAL instrument of measuring service quality, which has been tested for its reliability, has been introduced. After obtaining the measurements, shown in the form of service quality gaps, further investigations was carried out to identify the cause of the service quality gaps. It was discovered that service quality can be affected by the internal service gaps and in this case, the service performance gap is the main cause of the service quality gap. Further investigations narrowed down the cause of the service quality gap to performance appraisal. Therefore insight was gained about the improper implementation of performance appraisal which can affect quality. The invaluable findings obtained from the thesis about the Public Service prompted suggestions to be made about ways of improving quality services delivered by the Public Service.

<p> The report, <i>A Crucible Moment,</i> published in 2012 by the National Task Force on Civic Learning and Democratic Engagement described a crisis in higher education surrounding the lack of civic learning and engagement opportunities for students. This crisis has led to decreased political participation and a general lack of knowledge in civics education (National Task Force on Civic Learning and Democratic Engagement, 2012). Educating students for citizenship in America's colleges and universities will assist with sustaining the country's democracy by engendering a sense of civic responsibility in young adults that will last throughout their lifetime. This qualitative case study examined the relationship between two institutions of higher education (IHEs) and AmeriCorps programs to determine how the partnerships operated and whether they addressed the recommendations for higher education cited in <i>A Crucible Moment. </i> </p><p> IHEs are using <i>A Crucible Moment</i> as a guiding document to think about civic learning and democratic engagement. While many are in the process of creating new initiatives and programs to address those issues, this study focuses on two existing programs that may provide a framework for strategically integrating civic engagement into higher education using a readily available government resource&mdash;AmeriCorps. With recent budget cuts impacting education, it is difficult for many IHEs to obtain additional funding to support initiatives directly related to student learning. As a result, finding resources to implement civic learning and democratic engagement opportunities that are often perceived as tangential to the education process is nearly impossible. AmeriCorps, now in its 20^th year of implementation, has had a steady stream of funding and bipartisan support from the government over the years. IHEs that sponsor an AmeriCorps program have the potential to civically engage students and promote mutually beneficial community partnerships. </p><p> Using inteorganizational collaboration theory as a framework, I examined two different models of IHE-AmeriCorps partnerships. Based on the levels of collaboration, I was able to assess the degree to which these types of partnerships could be feasible at distinctly different IHEs given their organizational structure and resources. Although the findings of this research are not generalizable, they provide insights into how IHE-AmeriCorps partnerships operate and demonstrate that, in the cases examined, they do implement the key recommendations of <i> A Crucible Moment.</i> As a result, an IHE-AmeriCorps partnership could be an effective and relatively inexpensive way for an IHE to enhance their civic engagement opportunities.</p>

This thesis points out the transformation in the visions of architectural institutions about architecture-public dialogue, the interrelations of architect-client to architecture-the public, in a historical perspective. It states that architecture center as a phenomenon has been emerged with the transformation of the consideration of the functions of architectural institutions from merely guaranteeing competence and integrity to stimulating awareness, accessibility, participation and collaboration of both professionals and the public, in order to achieve increasing the quality of built environment and the quality of life. This thesis aims to make an evaluation of the role of architecture centers in that stimulating importance of the formation of architecture-public dialogue as a two way interaction between architecture and the public in a cultural dialectical sense, and achieving this formation. This thesis come to the point in that an architectural institute that has undertaken these new functions is named as architecture center, in some countries such as England, Scotland and the Netherlands. Some of architecture centers in these counties are analyzed by means of an analytical survey. In addition, the functions of the Chamber of Architects of Turkey are analyzed in light of the transformation in the visions of architectural institutions in the world. Besides, Arkitera Architecture Center is analyzed as an example of an architecture center from Turkey. This thesis concludes in that architectural institutions will have undertaken a key role in the formation of architecture-public dialogue as a two way interaction by means of analyzing the studies of architecture centers as a model.

This research investigated core business conflict that occurs amongst government agencies when working together in regional development projects and initiatives. The intent is to develop methods to manage this conflict and so enhance the delivery of regional development outcomes. The research problem explored is: ‘Government Department core business – managing the impact of potential conflicts on regional development projects and programs’The research involves three discipline areas – Government and governance, public sector management practices, and regional development. Government agency (GA) core business is determined by Government and delivered using public sector management practices that have shaped individual agency’s strategic plans, processes and systems for core business delivery. Regional development involves multiple agencies delivering their core business outcomes that contribute to regional development. Due to the focus by each agency on their own core business, core business conflict can occur when agencies work together.A literature review did not uncover literature or research about GA core business conflict, therefore this is a new area of investigation. The literature studies and reports investigated and discussed a related area – issues and impediment to Whole-of- Government (WOG) and ‘joined-up’ government initiatives.A qualitative inquiry methodology is used to build knowledge about this new area. The sample of participants is drawn from GAs’ staff who are involved in regional development projects and programs, or projects and programs that contribute to regional development. Data collection is through interviews and surveys with GAs’ representatives from 18 agencies, across three levels of Government and from two distinctly different regions (coastal and inland).Two aspects of core business conflict are investigated – fundamental core business conflict that involves the underpinning philosophy and ideology of an agency, and functional/operational core business conflicts that include the strategic plans, policies, procedures and systems involved in delivery of core business, which also influence the design of program and project guidelines, and determine funding and staff resourcing.Research findings contribute new knowledge and expand current knowledge regarding challenges and barriers to agencies working together. Findings also enhance the application of approaches and tools to facilitate effective WOG and collaborative agency work.The research has resulted in a ‘process’ model to resolve the research problem that applies a holistic and comprehensive operational approach to addressing core business conflict. The ‘process’ model builds on the research findings and draws on information and tools from the literature.The research has implications for theory, policy and practice in the three discipline areas involved in the research problem and as a new area investigated, has generated further research opportunities.

This research investigated core business conflict that occurs amongst government agencies when working together in regional development projects and initiatives. The intent is to develop methods to manage this conflict and so enhance the delivery of regional development outcomes. The research problem explored is: ‘Government Department core business – managing the impact of potential conflicts on regional development projects and programs’The research involves three discipline areas – Government and governance, public sector management practices, and regional development. Government agency (GA) core business is determined by Government and delivered using public sector management practices that have shaped individual agency’s strategic plans, processes and systems for core business delivery. Regional development involves multiple agencies delivering their core business outcomes that contribute to regional development. Due to the focus by each agency on their own core business, core business conflict can occur when agencies work together.A literature review did not uncover literature or research about GA core business conflict, therefore this is a new area of investigation. The literature studies and reports investigated and discussed a related area – issues and impediment to Whole-of- Government (WOG) and ‘joined-up’ government initiatives.A qualitative inquiry methodology is used to build knowledge about this new area. The sample of participants is drawn from GAs’ staff who are involved in regional development projects and programs, or projects and programs that contribute to regional development. Data collection is through interviews and surveys with GAs’ representatives from 18 agencies, across three levels of Government and from two distinctly different regions (coastal and inland).Two aspects of core business conflict are investigated – fundamental core business conflict that involves the underpinning philosophy and ideology of an agency, and functional/operational core business conflicts that include the strategic plans, policies, procedures and systems involved in delivery of core business, which also influence the design of program and project guidelines, and determine funding and staff resourcing.Research findings contribute new knowledge and expand current knowledge regarding challenges and barriers to agencies working together. Findings also enhance the application of approaches and tools to facilitate effective WOG and collaborative agency work.The research has resulted in a ‘process’ model to resolve the research problem that applies a holistic and comprehensive operational approach to addressing core business conflict. The ‘process’ model builds on the research findings and draws on information and tools from the literature.The research has implications for theory, policy and practice in the three discipline areas involved in the research problem and as a new area investigated, has generated further research opportunities.