Telemedicine offers an alternative referral strategy for fetal cardiology but is currently only used for ‘high-risk’ pregnancies. A case-study of a cost-consequences analysis comparing telemedicine to direct referral to a perinatal cardiologist is initially presented, which highlights that for high risk women for whom telemedicine was considered no cardiac anomalies were missed using either referral method. In the light of a review of the literature on the economics of telemedicine, three of the key methodological issues (of selection bias, of patient costs and using quality-adjusted life years (QALYs)) are explored to demonstrate how the case study analysis could be improved. Pregnant women were selected for referral based on their characteristics and risk factors; thus the cost and effects for the two groups may have been biased. Various methods identified in the literature are applied to the case study to reduce selection bias, but the analysis presented is unable to determine which method is best, given a number of limitations including the small sample size. The analysis is extended to include estimated total patient costs. However, when patient costs are added to the total costs of pregnancy, they did not substantially increase the overall cost. The results presented provide a guideline for future researchers and pregnant women of the likely costs during pregnancy. Given that the majority of missed cardiac anomalies were amongst low risk women, a decision analytical model is developed looking at the lifetime costs and QALYs of introducing telemedicine screening for pregnant women whose unborn babies are at a low risk of congenital heart disease. The analysis shows that offering telemedicine to all low risk women is the dominant strategy. The thesis demonstrates, within the constraints of existing data, that it would be cost-effective to provide telemedicine as part of an antenatal screening programme for all low risk women, and this would help prevent future ‘missed anomalies’.

Thesis (Ph. D.)--University of California, San Diego, 2010. / Title from first page of PDF file (viewed March 29, 2010). Available via ProQuest Digital Dissertations. Vita. Includes bibliographical references.

Approved for public release, distribution is unlimited / Recruiting is the most challenging peacetime assignment for any United States Marine. It involves many internal and external factors that are generally beyond the control of recruiting personnel. In particular, Recruiting Station (RS) Commanding Officers are subject to intense pressure to make their assigned recruiting goals or be relieved from duty. It is thus critical for the Marine Corps Recruiting Command (MCRC) to select only the best-qualified officers to serve as recruiting commanders. This thesis has three main objectives: (1) analyze the current screening and selection process used by MCRC since fiscal 1996; (2) evaluate whether this process is more effective than the previous method; and (3) determine if the process can be improved. To accomplish these goals, the study reviews MCRC's responsibilities, policies, procedures, and rationale in determining the required characteristics of a successful RS Commanding Officer. The methodology relies on a literature review, personal interviews with individuals from all recruiting command levels, and descriptive data on RS Commanding Officers from fiscal 1990 through fiscal 2003. The results suggest that the current screening and selection process is effective and an improvement over the previous system. Recruiting commanders are more experienced, more diverse, and more suited to the task, based on several indicators. Recommendations are offered to change common perceptions of the current process as a "selection board." / Captain, United States Marine Corps

The thesis examines factors that influence sustainability and success of microfinance institutions in Ghana. The topic is important, particularly in poverty stricken Africa, where microfinance institutions play a significant role in supporting governments' initiatives to reduce/alleviate poverty. The developed model is tested using data collected from 14 face-to-face interviews and 114 questionnaires. The data is analysed using different techniques- descriptive statistics, cross-tabulations and regression analysis. The research design and scale of the study are appropriate to both the problem addressed and doctoral level research. A number of factors in the model developed were found to be influencing the sustainability and success of microfinance institutions. A model was proposed that seeks to offer an explanation of sustainability and success of Microfinance Institutions in Ghana. The proposed model identified five categories being: institutional characteristics, agency costs, business strategy, environment/governance and success. Single factor analysis established positive relationships between sustainability and all the five factors but placed more emphasis on three out of the five factors namely; success, business strategy and environment/ governance. Multiple factor analysis established no significant differences in the sustainability with respect to the type of MFI, ownership and source of funding. Multiple Regression which allows for the testing of theories or models established a significant relationship between the Operational Self Sufficiency (OSS) and the predictors, especially the drop-out rate of clients and average loans. The Subsidy Dependence Index (SDI) was calculated for the various types of MFIs and the result was a high dependency ratio especially among the FNGOs. Though the dependency is on the decline, it is very slow indicating that most MFIs will depend on subsidies for a very long time to come. Finally it was observed that the relatively high interest rates charged by most of the MFIs tended to defeat the purpose for which the microfinance movement came about. Not only did the study confirm the research model, but it also revealed that most owners did not exhibit a deep sense of involvement and used general knowledge to practice in Ghana. The study concluded that success factors, business strategy, and environment/governance were the most critical of the sustainability factors in Ghana. It is therefore important that managers develop institutional capacities especially in managing the agency problem effectively if they have to be sustainable and successful.

The thesis examines factors that influence sustainability and success of microfinance institutions in Ghana. The topic is important, particularly in poverty stricken Africa, where microfinance institutions play a significant role in supporting governments¿ initiatives to reduce/alleviate poverty. The developed model is tested using data collected from 14 face-to-face interviews and 114 questionnaires. The data is analysed using different techniques- descriptive statistics, cross-tabulations and regression analysis. The research design and scale of the study are appropriate to both the problem addressed and doctoral level research. A number of factors in the model developed were found to be influencing the sustainability and success of microfinance institutions. A model was proposed that seeks to offer an explanation of sustainability and success of Microfinance Institutions in Ghana. The proposed model identified five categories being: institutional characteristics, agency costs, business strategy, environment/governance and success. Single factor analysis established positive relationships between sustainability and all the five factors but placed more emphasis on three out of the five factors namely; success, business strategy and environment/ governance. Multiple factor analysis established no significant differences in the sustainability with respect to the type of MFI, ownership and source of funding. Multiple Regression which allows for the testing of theories or models established a significant relationship between the Operational Self Sufficiency (OSS) and the predictors, especially the drop-out rate of clients and average loans. The Subsidy Dependence Index (SDI) was calculated for the various types of MFIs and the result was a high dependency ratio especially among the FNGOs. Though the dependency is on the decline, it is very slow indicating that most MFIs will depend on subsidies for a very long time to come. Finally it was observed that the relatively high interest rates charged by most of the MFIs tended to defeat the purpose for which the microfinance movement came about. Not only did the study confirm the research model, but it also revealed that most owners did not exhibit a deep sense of involvement and used general knowledge to practice in Ghana. The study concluded that success factors, business strategy, and environment/governance were the most critical of the sustainability factors in Ghana. It is therefore important that managers develop institutional capacities especially in managing the agency problem effectively if they have to be sustainable and successful.