A growing demand for services and expensive innovative technologies is threatening the sustainability of healthcare systems worldwide. Decision makers in this environment struggle to set priorities appropriately, particularly because they lack consensus about which values should guide their decisions; this is because there is no agreement on best practices in priority setting. Decision makers (or ‘leaders’) who want to evaluate priority setting have little guidance to let them know if their efforts were successful t. While approaches exist that are grounded in different disciplines, there is no way to know whether these approaches lead to successful priority setting. The purpose of this thesis is to present a conceptual framework and an evaluation tool for successful priority setting. The conceptual framework is the result of the synthesis of three empirical studies into a framework of ten separate but interconnected elements germane to successful priority setting: stakeholder understanding, shifted priorities/reallocation of resources, decision making quality, stakeholder acceptance and satisfaction, positive externalities, stakeholder engagement, use of explicit process, information management, consideration of values and context, and revision or appeals mechanism. The elements specify both quantitative and qualitative dimensions of priority setting and relate to both process and outcome aspects. The evaluation tool is made up of three parts: a survey, interviews, and document analysis, and specifies both quantitative and qualitative dimensions and relates to both procedural and substantive dimensions of priority setting. The framework and the tool were piloted in a meso-level urban hospital. The pilot test confirmed the usability of the tool as well as face and content validity (i.e., the tool measured relevant features of success identified in the conceptual framework). The tool can be used by leaders to evaluate and improve priority setting.

In Ontario, access to publicly funded home care services is managed by Community Care Access Centres (CCACs). CCAC case managers are responsible for assessing all potential clients and prioritizing the allocation of services. The objectives of this thesis were to: 1) describe the types of decisions made by CCAC organizations and by individual case managers concerning the allocation of nursing, personal support and homemaking services to long-term adult clients with no mental health issues; and 2) to describe and assess the factors and values that influence these decisions. We conducted two case studies in which qualitative data were collected through 39 semi-structured interviews and a review of relevant documents from an urban and a rural area CCAC. A modified thematic analysis was used to identify themes related to the types of priority setting decisions and the associated factors and values. An internet-based survey was then designed based on these results and answered by 177 case managers from 8 of the 14 CCACs. The survey contained discrete choice experiments to examine the relative importance of client attributes and values to prioritization choices related to personal support and homemaking services, as well as questions that examined case managers’ attitudes towards priority setting. We found that both the rural and the urban CCACs utilized similar forms of priority setting and that case managers made the majority of these decisions during their daily interactions with clients. Numerous client, CCAC, and external factors related to the values of safety, independence and client-focused care were considered by case managers during needs assessment and service plan development. The relative importance of the selected client attributes in defining need for personal support and homemaking services was tested and found to be significantly affected by the location of the case manager (rural or urban area), years of experience in home care, and recent experience providing informal care. Case managers allocated services in the spirit of equal service for equal need and in consideration of operational efficiency. We also identified a number of case manager-related, client-related and external factors that interfered with the achievement of horizontal equity.

Priority setting for expensive biopharmaceuticals is one of the most important challenges for publicly funded health systems. One of the drivers of rising healthcare expenditures is pharmaceuticals (i.e., drugs). Moreover, people are living longer and their expectation of, and demand for, health care, drugs, and services are continually increasing. The overall aim of this research was to describe and evaluate reimbursement decisions for six expensive biopharmaceuticals across five countries in order to ascertain if the processes were legitimate and fair. I conducted qualitative case studies of six expensive biopharmaceuticals in order to describe and evaluate the priority setting activities of eight committees across five countries, including Canada, England and Wales, Australia, Israel and the United States. Data sources included: 1) 32 documents and 2) 56 interviews with informants. The recommendations process of each committee partially met the four conditions of ‘accountability for reasonableness’. My main finding is that, while a number of values were considered by committees when making reimbursement decisions, committees tended to focus on values of evidence, effectiveness and efficiency, but not the full range of relevant values. Thus, these contexts did not fully meet the conditions of legitimacy and fairness. I have provided an in-depth description of the eight committees’ priority setting activities regarding the study drugs, as well as committee members’, patients’ and industry representatives’ views regarding the process. I developed practical guidance for leaders for improving reimbursement decisions for expensive biopharmaceuticals, the implementation of which would enhance the fairness and legitimacy of priority setting. This study has demonstrated that in order to create a fair and legitimate drug reimbursement process, we need to ensure the incorporation of a wide range of values, and the involvement of multiple stakeholder groups within the deliberative and appeals/revisions processes.

High voltage transmission system availability and system security are key performance criteria for electricity utilities worldwide. System disturbances need to be cleared quickly and accurately in order to minimise the impact of faults and to facilitate speedy system restoration. In this context, the South African utility, Eskom has maintained a process of refreshing protective relaying technology as older equipment becomes obsolete and is no longer capable of meeting the utility’s requirements. The difficulties which a process of equipment renewal presents the organisation with include the risk of incorrectly applying the newer technologies within the complex electrical network. The application of new technology is affected by the complexities of the newer technology with respect to the older, more familiar technologies. Some of the difficulties can be addressed with revised commissioning procedures or the use of modern test equipment. Enhanced relay algorithms and settings calculation methodologies can however not be simplified. Protective relay maloperations cannot always be completely avoided and when they do occur, these must be investigated and addressed to prevent future recurrences. The research covered by this dissertation focuses on a number of protective relay maloperations on transmission lines using impedance protection algorithms. The research undertaken identifies the previously unidentified causes of the maloperations and describes a relay settings solution for improving the accuracy of the protective relays. The methodology that was followed in the research covers the following aspects: • Identification and highlighting of some of the protection relay maloperations that occurred during system faults, • Review of the fundamental principles involved in system fault analysis, • Comprehensive study of the theory involved in the calculation of an overhead line conductor self and mutual-inductance, as well as the calculation of the positive, negative and zero sequence impedances of an overhead line, • Brief evaluation of the effect of load impedance on relay measurements and the impact on fault clearing operation, • Analysis of the theoretical operation of various numerical relays during singlephase- to-earth faults in radial and meshed (complex) network conditions, • Mathematical calculations using typical Newton-Raphson methods to study the impact of resistive single-phase-to-earth faults on the voltage and current measurements at the relaying position with the exclusion of the capacitive components between conductors and conductors and earth, • Comparison and evaluation of mathematical calculations and system studies using network simulation software which included all steady state network parameters, • Review and analysis of actual system faults that had been previously analysed without definitive conclusion. The faults were re-analysed in an attempt to correlate findings with the hypothesis of the research, • Comparison of the performance of protective relay impedance charactersitics using positive sequence domain versus loop domain analysis techniques. This study concluded that significant benefits can be achieved by analysing system faults and relay operation using loop quantities in primary impedance values as opposed to positive sequence or apparent impedance quantities in secondary values. The inherent differences between the positive or apparent impedance characteristics of the relays are nullified when considered in the loop impedance domain, provided that the relays reach settings were calculated correctly. The study also showed that load current cannot be ignored when calculating settings as it has significant impact on the actual impedance measured during fault conditions. It is therefore crucial that when relays from different manufacturers are being used to protect the same circuit that the differences between the relays and the subsequent measurements are clearly understood and compensated for. Finally relay setting changes have been proposed for implementation based on the findings of this research. The combination of the theory, network simulations and secondary injections performed on the relays all correlate and therefore validate the research. It is left for the utility and or users of these relays to evaluate the results of this research and implement the necessary changes as applicable. / Thesis (MSc (Electrical Engineering))--North-West University, Potchefstroom Campus, 2012

The objectives of this research were investigate the lived experiences of school-going learners who are HIV-positive; and develop ecosystemic management strategies to help learners who are HIV-positive. The literature research investigation revealed that HIV/AIDS is not just a health problem but also attacks the education system itself. Demand for education is dropping and changing, many educators are ill and dying, and the trauma of loss associated with HIV/AIDS is entrenched in South African classrooms. The HIV/AIDS pandemic has a traumatic impact on all educators and learners. The work of educators both those who are HIV positive and those who have developed full-blown AIDS will be compromised by periods of illness. The pandemic thrives on sexual violence, male domination and child abuse in South Africa. It is the ecosystemic paradigm that helps in seeing the connecting link between family-school-community-society-world or school and peers and this helps in providing a more useful synergistic focus than trying to work in isolation with discrete segments of a microsystem for example, with an individual in isolation. Management strategies for dealing with HIV/AIDS include the notion that achieving sustainability requires bringing together a variety of legitimate stakeholders, drawing on a variety of accepted bodies of knowledge, to negotiate a learning path based on a series of conflict resolutions within ecological constraints. Continual learning based on free flow of information and mutual respect, and investment in effective management of HIV/AIDS are keys to success. The empirical research investigation revealed that psychologically disturbed, emotional well-being, spiritual well-being, physical well-being, social life, their scholastic performance, daily routine, there is a change in their behaviour or health after the HIV- positive status has been revealed, they fear of death, their academic performance at school is affected by absenteeism and lack of concentration, there is absence of strategies to assist learners who are absent frequently because of illness, they loose valued level of functioning, lack assistance at school, fear being discriminated or ridiculed, there is absence v of measures to deal with discrimination at school, there is a lack of information on HIV/AIDS, learners fear disclosing to friends and teachers, there is a lack of communication between parents and infected learners about issues regarding HIV/AIDS. Educators are also affected emotionally, spiritually and physically. They become affected socially and they do not cope with the impact of HIV. The level of communicating the HIV/AIDS pandemic within the schools is low, the principals are not doing much as leaders to supplement this low level of communicating about HIV/AIDS, school policies on HIV/AIDS in these schools do not address issues of support for learners and educators who are incapacitated because of HIV/AIDS, there is no monitoring tool used in these schools to ensure HIV-policy adherence, principals in these schools do not ensure that educators teach learners about matters pertaining to HIV/AIDS, health programmes in these schools do not assist learners living with HIV/AIDS within the school and the level of accepting and accommodating infected learners and the personnel in these schools is low. The level of involvement of community members in matters pertaining to HIV/AIDS in these schools is low. An ecosysternic management system is proposed in this research vi / Thesis (M.Ed.)--North-West University, Vaal Triangle Campus, 2008.

The institutions of the European Union (EU) have been involved in football-related matters for more than 30 years without having a direct competence in sport. This apparent paradox is the starting point of this thesis, which investigates the origin, development and consequences of EU policies on football. The EU interventions in football issues are examined through a conceptual framework based on models of agenda-setting and multilevel governance. This thesis draws on qualitative research through primary sources, mainly semi-structured interviews and official documents. The most important policy initiatives and decisions of the EU on football matters can be grouped under three headings: freedom of movement for workers, football broadcasting and football governance. EU institutions did not become involved in football matters by their own volition, but as a result of their responsibilities to adjudicate in legal disputes related to freedom of movement for workers and competition policy. The commercialisation of professional football especially over the last few decades generated internal conflicts in the governance of football that were only resolved with recourse to the European Court of Justice (ECJ). The EU has acted as an alternative policy venue for football stakeholders wishing to challenge the decisions of football federations. Thus, the EU and football appear as two systems of multilevel governance that have coexisted in parallel for some time but have since clashed as a result of the instrumentalisation of EU venues by football stakeholders. The policies of the EU on football are a compromise between two different visions of the game. Whereas football was initially introduced onto the EU agenda only in economic terms through the ECJ and the Commission, the EU has subsequently developed a more holistic and nuanced vision of football that takes into account its wider social and cultural values. The intervention of the Member States and the European Parliament, at the request of football governing bodies, facilitated the further evolution of EU policies on football. As a result of all these processes, the authority of federations such as the international football federation (Fédération Internationale de Football Association, FIFA) and the Union of European Football Associations (UEFA) has been diffused in favour of a horizontal network of governance that includes representatives from players, clubs and leagues.

No description available.

After the attacks in Paris on November 13th 2015, the movement Anonymous has declared a cyber war to terrorist group ISIS that claimed responsibility for these attacks. According to Klein (2015) Anonymous has earlier been framed by the news media as malicious prankster, because their choice of targets did not align with western standards. However, ISIS can be seen as a common enemy of the West. As such, what is the effect of this newly chosen target on the representation of the movement in the media? Departing from this question, this thesis aims to research whether the attributes in use to represent Anonymous in the news media have normatively changed due to the taking on of a common western enemy. In fulfilling this aim, 21 articles published before and 21 articles published after the public declared war on ISIS on November 13th have been analysed based upon second level agenda setting theory. Focus is placed upon the attributes that describe Anonymous in the news media agenda and how these normatively evaluate the movement. In doing so, findings of this analysis present a change in the evaluation of the movement towards a more positive depiction.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Obstructive sleep apnea (OSA) is a condition characterized by upper airway obstruction during sleep causing intermittent hypoxia and nighttime awakening. It is a common condition in the United States that is often undiagnosed. It is a significant risk factor for decreased daytime productivity, quality of life, cardiovascular disease, and death. The current gold standard for diagnosis of OSA is laboratory‐based polysomnography (PSG). While PSG is necessary for the diagnosis and monitoring of OSA, many patients have limited access to PSG due to wait times at PSG laboratories or economic or geographic limitations. Portable sleep monitoring has been studied as a possible solution for patients who do not have access to timely PSG. This study aimed to use the Zephyr BioHarness 3, a chest‐worn physical activity monitor that records movement and physiologic data in real‐time, to detect apnea events in patients with suspected OSA undergoing single‐night laboratory PSG. Twenty patients underwent single‐night laboratory‐based PSG while simultaneously wearing the Zephyr BioHarness 3. The Zephyr BioHarness 3 data was analyzed using three methods. First, apnea events were identified in 10‐second windows of Zephyr data via support vector machine, logistic regression, and neural network (sensitivity = 76.0 ± 0.3%, specificity = 62.7 ± 0.2%, accuracy = 63.7 ± 0.1%). Second, apnea events were identified using the mean, median, and variance of the 10‐second windows (sensitivity = 72.3 ± 0.3%, specificity = 69.4 ± 0.1%), accuracy 69.6 ± 0.1%). Third, apnea events were identified using phase‐space transformation of the Zephyr BioHarness 3 data (sensitivity = 76.9 ± 0.3%, specificity = 77.9 ± 0.1 %, accuracy = 77.9 ± 0.1%). The Zephyr BioHarness shows initial promise as a possible OSA screening tool for patients suspected of OSA but who lack access to timely laboratory‐based PSG.

This dissertation critically examines how U.S. print media sought to represent the realities of decolonizing and newly independent countries in West Africa by focusing on pivotal events and charismatic leaders from the “non” vote in Guinea in 1958 to the radical appeal of Amilcar Cabral in Guinea-Bissau in 1973. The framing and agenda setting of mainstream media coverage turned leaders and events into metonyms not only for peoples and nations but also for Africa and Africans as a whole. However, the complexities of West Africa, such as political rivalry in the Congo or civil war in Nigeria, troubled such representations. Thus this dissertation tracks the widening of coverage and opening up of representations in African American and New Left print media in a time of global unrest as well as Cold War.