Osteoarthritis (OA) is a debilitating chronic illness that can prevent older adults from accomplishing their activities of daily living or ambulate without pain. The project's purpose was to develop and disseminate multidisciplinary educational practice guidelines to nurses for use in older homebound male Veteran's Administration OA patients to improve home-based pain management and self-care preventative strategies. Orem's theory of self-care management constituted the theoretical framework. The design was a quality improvement project and involved formation of 6 panels of interdisciplinary teams who reviewed the American Society of Anesthesiologist (ASA) and Osteoarthritis Research Society International (OARSI) guidelines. The ASA and OARSI guideline components were evaluated via a scoring sheet for pain control and self-management effectiveness for the OA patient. The panels assessed these treatment plans in terms of suitability, tolerance, and patient adherence for inclusion into the educational program. The panel members independently reviewed both sets of guidelines and then convened as a group to share their scores and reach a consensus on these guidelines, in the patient population served. Agreement of 85% among the panel members was needed for inclusion into the practice guideline. Based on the scoring results the panel concluded that the ASA and OARSI guidelines would likely improve pain control, functional ability, and psychological well-being essential to lifestyle modifications and OA symptoms management education program. The social impact of developing nursing practice guidelines for the self-management of OA pain in home-based settings will be manifested in better patient lifestyle and behavior modification leading to better symptom management.

Polypharmacy entails the use of multiple drugs taken at the same time to manage the various comorbidities common among elderly patients. Polypharmacy is associated with increased health care spending due to drug duplication, adverse drug events, and medication noncompliance. Medication reconciliation has been shown to reduce the problems seen with polypharmacy. The purpose of this project was to review published evidence to develop a staff education program on medication reconciliation in a primary care setting and determine the efficacy of the program in relation to staff confidence and knowledge levels concerning medication reconciliation. The project was guided by Nola Pender's health promotion model. The education program was modeled after a medical staff education program on medication reconciliation and included a medication assessment questionnaire and its use when evaluating a patient's medications. The pretest and posttest questionnaire obtained from the education materials was administered to clinical staff at the practice site before and after presenting the education material. Data were analyzed for statistical changes after the education program using a t test. Results showed that participants increased their confidence and knowledge of medication reconciliation from an average score of 2.19 (SD 0.20) before the education to 4.37 (SD 0.12) (p < 0.001) on a 5-point confidence scale after the education. This staff education program will promote positive social change by increasing nurses' knowledge and confidence of medication reconciliation and potentially reducing the incidence of polypharmacy and its negative effects among the elderly patients.

Thesis (MPA.) -- University of Limpopo, 2014 / The study seeks to determine whether the introduction of Performance Management System (PMS) in Mbombela Local Municipality (MLM), Mpumalanga Province has effects on service delivery. Municipalities tend to focus mainly on complying with legislative requirements of having an Integrated Development Plan (IDP) and PMS other than implementing the IDP and PMS to enhance the delivery of services to the community. The annual performance reports of MLM for the financial year 2009/2010 and 2010/2011 indicates performance targets in which some were achieved while in some cases the municipality failed to achieve. The Department of Cooperative Governance and Traditional Affairs (CoGTA) introduced the Performance Management Framework in municipalities with the aim of empowering communities to demand better services and hold municipalities accountable. In this regard a literature review was undertaken. In the literature review, it became evident that communities have displeasure in the delivery of services such as electricity, water, sanitation and roads. Further findings in the study indicate that the introduction PMS in MLM has not led to positive change in the delivery of services. Recommendations made in the study for MLM to enhance service delivery through PMS, include cascading PMS to all employees in MLM, change management and communication strategy. Further issues of alignment and integration of the IDP processes, budget, PMS, monitoring, evaluation and training on the formulation of Key Performance Areas and Key Performance Indicators are recommended.

Thesis (MPA) --University of Limpopo, 2011 / The proposed study intends to establish how procedural the reward system is being implemented in the Limpopo Department of Health and Social Development and whether claims of bias are founded. The study is intended to determine the system’s influence on the organization’s ability to track poor performance and manage it. Also providing a refreshed view of the current pitfalls in the implementation of the program therefore providing indications of remedial action to recover the purpose of the PMDS. To assess the impact of Performance Management practices and explore best implementable practices which lead to effective performance management system and best service delivery by the Limpopo Department of Health and Social Development. Qualitative research approach using interview schedule for HR and line managers was utilised. The findings are that the system can not be linked to employee output but an obvious benefit is employee rewards.

Thesis (MPA.) -- University of Limpopo, 2015 / This study is an investigation of managing the performance of section 57 managers in South Africa, with special reference to municipalities within the Capricorn District Municipality in Limpopo province. This research was necessitated by the fact that even though there has been an adoption of the Performance Management System in order to speed up service delivery and transformation, performance management still remains grossly inadequate, in the South African public sectors especially in local government. This point out that in spite of the existing policy framework governing the management of performance in municipalities, most municipalities in South Africa are still struggling to perform efficiently and effectively. The problem statement provided a foundation within the aim and the objectives were explained. Contextualisation of the study was based on the existing legislative, theoretical and conceptual perspective that apply to performance management. The study also outlined the research method (only qualitative research method was used) and the technique used as a data collection method was the interviews. The researcher presented, analysed and interpreted the research findings where the researcher employed the use of figures and descriptive analysis to present data. In drawing conclusions it became clear that there were problems hampering the performance of Section 57 manager in municipalities within the Capricorn District Municipality. The main problems were identified to be lack of dedicated and qualified personnel to perform the function of PMS, lack of training and rewards to motivate senior managers who far exceed the set targets. Therefore to eliminate these problems recommendations were also suggested to assist municipalities in carrying out their developmental mandate this include among others, proper consideration of training need, continuous evaluation of senior managers performance, and the provision of rewards to employees who performed above the level expected.

This composition proposes and implements a way in which to incorporate the pipe organ into a contemporary instrumental setting. Considering the instrument's wide use in concert halls and its popularity with contemporary music, much of the timbre-based music has evaded incorporating it into its settings; for one reason or another, there are currently no timbre-based works composed for organ and chamber orchestra. By using the process of spectral analysis, this timbre-based composition demonstrates one possible way of doing so by investigating timbre similarities and differences between selected ranks of the organ and selected orchestral instruments and mapping them into pitch structures.

The primary objective of this study was to examine the impact of providing feedback with group counseling upon the employment, symptom distress, interpersonal relationships, social role, and mental health functioning of 30 individuals with disabilities receiving services at a state vocational rehabilitation agency. Utilizing a repeated measures randomized wait-list control trial design, participants were randomly assigned to one of two conditions: treatment (feedback plus group counseling) or treatment-asusual (group counseling only). Each participant completed the Outcome Questionnaire- 45, a measure of mental health, on a weekly basis and attended a group counseling program, 1.5 hours each week, for 10 weeks at one of five different offices within a vocational rehabilitation state agency. Analyses of improved mental health functioning between the experimental and control groups failed to reach statistical significance. Analyses found three statistically significant three-way interactions between time, condition, and public benefits when interpersonal relationships (p=.025); social role performance (p=.021), and mental health functioning (p=.028) were the dependent variables. Participant ratings in the feedback condition for progress made toward employment were significantly higher than those of participants in the treatment-as-usual. Similarly, the proportion of participants employed at the end of the group counseling program was statistically significant and favored the treatment condition. Taken as a whole, results raise the possible importance of public benefits and the use of feedback and group counseling for improving employment outcomes and functioning in the areas of interpersonal relationships, social roles, and overall mental health.

Due to the steady increased in public transportation demand, there is a need to provide more desirable and user-friendly transit systems. Typically, the public transportation timetables are modeled as an assignment problem, which often has objectives such as reducing the cost of operation, minimizing waiting time between transfer points or improving the quality of performance. This research considers the problem of developing synchronized timetables for bus transit systems with fixed routes when a waiting time limit exist at each transfer stops, for the passengers making connections. The objective of this research is to have maximum number of simultaneous arrivals. Different to previous studies, a simultaneous arrival' has been defined as an arrival of buses of different routes at a transfer point such that the time between these arrivals do not exceed the passenger waiting time range associated with the transfer stop. In other words, at each node, an upper bound and a lower bound are set for the arrivals of two buses and these buses are run within this allowable window. The heuristic developed has been modeled as a mixed integer linear programming problem and applied to some real life problems to evaluate the outcomes. The total number of synchronizations obtained by the model was compared to the maximum possible simultaneous arrivals at each node. Results show that a larger number of simultaneous arrivals are obtained when the waiting time ranges are relaxed. Finally some important applications of the proposed model compared to the existing models are presented.

Charles Ives is commonly referred to as the "Father of American Music." The implication is one that Ives himself would agree with, that he wrote purely American ideas from his own environment without reference to other styles or methods, in particular the widespread European tradition. Some composers, like Aaron Copland and Roger Sessions, created an American sonority by incorporating the concepts of musical construction they studied at the Paris Conservatoire. Ives, conversely, received no instruction in Europe, but the techniques so prevalent in the music of the French art song are found in certain songs written by Ives. Though he claimed no European influence, however, he used the late nineteenth century French song style in some of his songs, and he also borrowed tunes from the French composers. This study identifies significant trademarks of eighteenth century French song and the stylistic traits associated with a variety of prominent composers of the time. Ives's childhood musical influences, his church position, and his studies at Yale University will establish a relationship between Ives and the French musical ideas. The primary source for his songs is his collection entitled 114 Songs. Ives gathered his songs and put them into one collection which included Four French Songs. Through the analysis of several songs, including the four French songs written by Ives and three comparisons of songs by Ives with songs by French composers, it becomes evident that Ives was influenced, to a certain extent, by French music and used many techniques of the style.

In 2018, the Cowichan Therapeutic Riding Association (CTRA) connected with the University of Victoria to initiate a research project focusing on social connectedness. Social connectedness is the psychosocial process of belonging that can be developed within a community context. Feelings of social connectedness can reduce depressive symptoms and suicidal thoughts, lessens violence, health compromising behaviours, and the impact of stress and trauma, and is linked to high self-esteem. The aim of this mixed methods case study was to understand the social connectedness of families participating in a community therapeutic riding program. An explanatory sequential mixed methods design was used to investigate social connectedness at the CTRA. Three different perspectives were sought to explore social connectedness at the CTRA; guardians, children, and instructors. Participants completed the quantitative Connectedness to Treatment Setting Scale (CTSS) in Phase 1, and qualitative semi-structured interviews in Phase 2 to follow-up and expand upon findings from Phase 1. Fifteen participants (guardians (n = 12) and instructors (n = 3)) participated in Phase 1 of the study whereas five guardians (including a guardian and child dyad) and two instructors participated in Phase 2 of the study. The CTSS comprised of 10 questions assessed on a 6-point scale (from 1 = Totally disagree to 6 = Totally agree). Frequencies were computed for each question and overall mean scores (+ SD) were computed for guardians and instructors separately. The interview transcripts were coded twice. Initially, a deductive orientational approach guided by seven attributes of social connectedness was used. Then, an inductive approach was used to examine how social connectedness was experienced, fostered, or hindered at the CTRA, as well as suggestions for improvement. The CTSS scores revealed that the vast majority of guardians and instructors felt highly socially connected at the CTRA. The overall mean score of the guardians was 55.3 (SD = 4.5) and 56.7 (SD = 3.1) among the instructors. All seven attributes of social connectedness were represented in the guardians and instructors’ responses however, trust, caring, and reciprocity were the most evident attributes. Two themes emerged from the inductive analysis: effective communication equates with social connectedness and expectations of services. Guardians reported that communication as a team with their instructor, volunteer(s), and the animals positively influenced their families’ social connectedness. The results suggested that social connectedness might be mediating relationships between negative factors preceding a therapeutic riding session and the experience of that lesson. Although the instructors and majority of families were socially connected at the CTRA, guardians had high expectations of the program and wanted the CTRA to foster connections beyond their son/daughters therapeutic riding lesson by organizing opportunities for peer and family relationships. The people and animals at the CTRA contributed heavily to family’s sense of social connectedness. Most families had a desire to connect and form relationships with the people and animals at the CTRA. The CTRA provides a community context that supports the development of social connectedness. / Graduate