Organizations normally introduce and implement changes in their respective departments. The general assumption is that the changes are meant for the improvement of operations, efficiencies and cost control measures, among other things. This research project was prompted by the fact that Eskom is introducing Shared Services within its Transactional Procurement and Supply Chain Management. It is important that this study is undertaken, through a survey, involving top executives, upper and middle management, as well as operational employees. Perceptions of the inherent successes or failures the new system might have on Eskom as an organization will be ascertained. Perceived difficulties will make the results more interesting, in that the sampling methodology used has to be compatible with the targeted research market. The results of the survey are important for sharing with Eskom’s management as the findings have a direct bearing on the improvement of the project. Whether Eskom should proceed or not with the introduction of Shared Service within the Transactional Procurement and Supply Chain Management is the problem statement of this research project. Although this project is meant for a particular market sector in the organization, the consequences of the benefits accrued and/or losses incurred will reverberate throughout the whole organization as it has multiple independent transactional procurement and supply chain outfits running in all their departments in South Africa. Whether the previous dispensation was beneficial or not, is subject to what is referred to as the ‘burning platform’ in Chapter 1. The researcher was an Eskom employee at the time of the research project, and the project was aimed at looking at Eskom’s corporate challenges. The survey was conducted conveniently among Eskom employees comprising two sets of respondents: executive management and operational employees drawn from upper and middle management together with supervisory and front staff. Convenience Sampling was done among what was believed to be the employees within the value chains of Procurement and the Supply Chain. The survey results have shown the distinct difference between the perceptions of the executive management and operational employees in that the former are more supportive of the project and well aware of its introduction, while the opposite is true for the operational employees. There was also a marked agreement noted where both responding groups regard the current set-up within the procurement and supply chain management as being fraught with problems. Both groups also agree that this section does not yield the required results. These research findings are significant for Eskom’s management to take note for benefits to accrue by virtue of a buy-in from the different stakeholders. The Eskom employees are expected to implement, manage and improve the efficiencies within the Procurement and Supply Chain Department, and this research project can be taken to have served as an unofficial but important research tool on behalf of the company. / Thesis (M.Com.)-University of KwaZulu-Natal, Westville, 2011.

A six week parent-child shared reading intervention targeting children's emergent literacy and emotion knowledge was implemented for 33 Head Start home-based families. This pilot study tested the hypothesis that the nominal addition of social emotional components to an evidenced-based shared reading intervention (dialogic reading) would result in additive effects in regards to parent and child outcomes. The study utilized a pre-post test design involving random assignment of families to one of two treatment groups. Both groups received the standard dialogic reading intervention, while parents in the DR ES (dialogic reading plus emotion skills) received an additional nominal dose of training in how to be nurturing towards their child during reading and how to use the story as a catalyst to talking about emotions. Differential effects between the two interventions were not found. Specifically, no clinically significant group effects were found for children's print concepts knowledge and emotion knowledge (emotion labeling and perspective taking) at post-test. Similarly, no effects emerged for parents' reading related behaviors, namely, application of verbal prompts, and displayed warmth. Effect sizes, as measured by eta squared, were also consistently low for all dependent measures, ranging from .00 for children's perspective taking and parents' displayed warmth to .03 for parent verbal prompts. Significant time effects emerged for all outcome variables with the exception of parent warmth, with effect sizes ranging from d = 0.31 (parent warmth) to d = 1.31 (parents' dialogic reading prompts), with an average effect size of d = 0.61. This study is the first to explore the potential impact of combining emotional content into the dialogic reading intervention. It refocuses attention on the contexts that promote children's school readiness skills. Results suggest that the potential benefits of dialogic reading extend beyond parent and children reading related skills, and may include children's emotional development. Findings warrant further investigation of interventions that support parents in maximizing the benefits of shared reading.

Diabetes is emerging as a major threat to health, with global economic and social implications. Recent research has shown that the morbidity and mortality associated with diabetes can be reduced by timely and effective treatment. However, unless people with diabetes have access to this treatment, the impact of diabetes will continue to rise. This thesis therefore explores the current standards of care which people with diabetes receive. It also looks at factors likely to impact on delivery of diabetes care. Studies were conducted at two levels. In the studies described in Chapters 2 and 3, general data applicable to all or nearly all patients with diabetes were collected. This approach substantially eliminates selection bias but precludes the ability to examine clinical outcomes. In the other studies, detailed in Chapters 4, 5 and 6, specific aspects of diabetes care pertaining to more select groups of diabetic subjects were examined. This approach allows clinical parameters to be examined in more detail but is more subject to selection bias. It is hoped that the combination of these two approaches provides a more balanced view of the topic under examination. In Australia, the Medicare Program, a single government controlled universal health insurance fund, provides access to medical services for all residents. Medicare occasions of service data therefore represent the most comprehensive source of information regarding health service utilisation in Australia. The data does not account for people receiving diabetes care through public hospital based services. However, a survey of public hospitals within NSW (n=198), described in Chapter 2, showed that the number of individuals in this category is relatively small and represents only 5.2% of the diabetic population. Using Medicare item codes, and with the permission and assistance of the Commonwealth Department of Health and Aged Care, data were extracted on attendance to medical practitioners and utilisation of diabetes related procedures for people living in New South Wales (NSW) for the individual years between 1993 to 1997. All data were stratified by the presence of diabetes, gender and age group. Individuals were deemed to have diabetes if an HbA1c, which can only be ordered for a person with known diabetes, had been performed over the 5-year period and the sample size adjusted for the incidence of diabetes. Once adjusted, the number of people with diabetes in NSW for the individual years 1993 to 1997 were 143,920, 156,234, 168,216, 177,280 and 185,780. Comparison with 1996 census data confirmed a 91.7% capture of the total NSW population (5,495,900/5,995,545 individuals). The data were retrieved for NSW as a whole and for individual postcodes. Postcodes were then classified by population density as either major urban, urban or rural. On average over the study period, persons with diabetes accounted for 3.1% of the population but they used 5.5% of general practitioner services. As seen in Chapter 2, a large proportion of people with diabetes were also under the care of specialists and consultant physicians, up to 51.2% and 41.8% respectively, a 3 to 4 fold increase when compared with their non-diabetic counterparts. In regard to geographical location, once adjusted for age and gender, the odds ratio of attending a specialist was only slightly higher for people with diabetes living in areas of high population density when compared to people with diabetes living in rural areas. This ratio reached as high as 1.85 in regard to attendance to consultant physicians (Chapter 3). The odds ratio for the non-diabetic population was similar indicating that the difference in access to consultant physicians was not disease specific. Analysis of results showed that despite the increase in service utilisation, large proportions of people with diabetes were not routinely monitored in regard to diabetes and its complications across the State. By 1997, HbA1c was still not performed in over 40% of people with diabetes each year and only 11.6% of the diabetic population had undergone microalbuminuria estimation. Interestingly, the differences in levels of monitoring between rural and urban areas were surprisingly small. Monitoring of diabetes and its complications did improve in all parts of the State over the study period. However, the greatest improvement was seen in rural areas, despite rural patients having fewer attendances to general practitioners and fewer patients attending specialist care. In the face of finite resources and the rising prevalence of diabetes, an increasing number of patients will need to rely on general practitioners to provide diabetes care regardless of where they live. A 'shared care' approach which encourages and supports general practitioners to manage patients with diabetes, while giving them access to specialist services for those patients that require them, is increasingly being advocated as a way of maximising efficacy while minimising costs. Yet if health care professionals leave undone what they think is done by others, shared care can become neglected care. Chapter 4 reports a detailed audit of 200 randomly selected shared care patients who were assessed on two or more occasions. This study showed that the majority of specialist treatment recommendations are implemented by general practitioners. Doctors formally registered with the Diabetes Shared Care Programme and those who write longer referral letters were more likely to implement recommendations than their counterparts. Moreover, the average HbA1c and the complication profile of these patients were similar to those found in various studies around the world. This suggests that diabetes can be well managed by a shared care approach that is adequately integrated. To overcome the problem that data is lacking on those patients that did not return for specialist review, a further 200 shared care patients who were lost to follow up from the shared care system were traced. Information regarding whether treatment recommendations had been implemented was sought from both the referring doctor and the patient. Overall, information on 182 of the 200 patients could be obtained. As discussed in Chapter 5, comparison of the returned and non returned patients' demographic and clinical profiles at time of their initial specialist review showed that general practitioners differentiated between the 'more complicated' patients, choosing to re-refer those with macrovascular disease, while maintaining the care of 'less complicated' patients. Re-referral for specialist review was also dependent on the patient remaining under the care of their original doctor. Encouragingly, general practitioners seemed to take a more active role in the non-returned group. They included more details regarding type and duration of diabetes in the referral letters of patients who were not re-referred for specialist review. They also implemented more treatment recommendations in the non-returned group, with the difference in implementation rate for metabolic recommendations reaching statistical significance. This study also showed that movement of patients between doctors raises concern regarding continuity of care. The multi-factorial nature of diabetes means that best practice is not easily accommodated within a single appointment. Thus continuity of care becomes an important issue. To assess the current status, 479 consecutive patients referred to the Royal Prince Alfred Hospital Diabetes Centre in a 6-month period were recruited and underwent a detailed clinical assessment. They were also questioned regarding the number of general practitioners they attended and the length of time they had been under the care of the referring doctor. The results outlined in Chapter 6 showed that the majority of people with diabetes (87.7%) attended only one general practitioner and had been under the care of that doctor medium to long term. Younger patients, who were relatively healthy apart from the presence of diabetes, were more likely to attend several general practitioners or have changed their general practitioner within the last year. This lack of continuity had little difference on acute outcomes such as glycaemic and blood pressure control. Appropriately, continuity of care increased with increasing age and the increasing prevalence of diabetes complications, mainly macrovascular disease. These studies indicate that further efforts are required to improve the overall standard of diabetes care within Australia. At present there is a heavy dependency on specialist services. As the population ages and the number of people with diabetes increases, much of this burden will fall on general practitioners, as is already evident in rural areas. When provided with appropriate support and infrastructure, general practitioners are able to maintain standards of care through referral of patients with more complex medical problems and by maintaining the degree of continuity appropriate to the patient's needs. However, the collection of relevant information to monitor future trends in diabetes services provision is important. As shown in this thesis, Medicare data represents an easy and cost effective method with which to do so.

Thesis (M.H.A.)--University of Michigan, 1967.

Thesis (M.H.A.)--University of Michigan, 1969.

Thesis (Ph. D.)--University of Washington, 1997. / Vita. Includes bibliographical references (leaves [117]-125).

Thesis (Ph. D.)--University of Canterbury, 2008. / Typescript (photocopy). Includes bibliographical references (leaves 216-239). Also available via the World Wide Web.

Thesis (Ph. D.)--Drexel University, 2003. / Includes abstract and vita. Includes bibliographical references (leaves 85-89).

Thesis (M.H.A.)--University of Michigan, 1967.

Thesis (M.H.A.)--University of Michigan, 1969.