Since the democratic election in 1994 and the publishing of the SA Schools Act on the 16th of November 1996 the South African education system has undergone a fundamental transformation. Pupils are regarded as a specific interest group that stands in a partnership relationship with other interest groups (stakeholders) in the school. The principle of partnership advocated by the South African Schools Act invites pupils to partake in and share responsibility for the governance, organising and funding of public schools. To participate in school management pupils have to be part of participative structures. Two such structures for pupil participation and representation exist in South African schools, namely SRC's and the governing body of the school. The aim of this research is to develop a model for pupil participation in the management of schools and specific attention was given to participative management of pupils on the SRC and governing body of the school. In order to operationalize the above mentioned aim an analysis of the nature of participative management by pupils was done on the basis of theoretical approaches to participative management. Participative management by pupils can only be successful if the following participative management techniques namely pupil participation, pupil empowerment, influence. participative decision-making, delegation, democracy, decentralization, committees and meetings are interwoven with the participative management process. Pupil participation can also be successful if the advantages of such participation is realised by all school interest groups. The structure and functioning of pupil participation in the management activities of the school is reviewed firstly by giving attention to the practices of pupil participation in the education systems of a few international countries. This is done by analizing the structure of each education system, the statutory directives for pupil participation and the structures for pupil participation in these education systems. Secondly the managerial involvement of pupils in the management activities of SRC's and the governing bodies of schools was reviewed, while certain lacunas that resulted from the lack of information were addressed by empirical research. As a result of the preceding criteria a model for pupil participation in school management was developed and certain findings and recommendations were derived from it. / Thesis (Ph.D.)--Potchefstroom University for Christian Higher Education, 2000

In a democratic South Africa, a variety of factors are necessary to ensure effective school governance and management. One of these factors is shared decision-making (SDM). SDM is a process of making decisions in a collaborative manner at the school level. Those responsible for implementing a decision must be actively and legitimately involved in making the decision. In South African schools today, SDM is no longer an option. The new framework of SDM is embedded in the South African Schools Act (Act 84 of 1996). According to the Act, parents, learners and teachers should be given the opportunity of participating in decisions on educational matters. In this study, the researcher set out to investigate and explore effective decision-making of secondary school principals in the Thabo Mofutsanayana Education District (THMOED) of the Free State Province. In an endeavour to realize that end, an open-ended questionnaire, individual and focus group interviews were used to collect data. The main aim was to find out how teachers, learners, parents and principals experienced decision-making in their schools. The main findings of this research were that, decisions-making practices in the secondary schools in the THMOED still adhered to pre-democratic formal lines of authority. In other words, the locus of control and decision-making powers resided mainly with the principals, with minimum participation of other stakeholders. Consequently, there were dissatisfactions and concerns raised by the participants. The concerns were directed at the management and included lack of communication, lack of transparency, unacceptable disciplinary procedures, autocratic leadership styles and centralized decision-making. According to the findings, it would appear that democratic models of governance were insufficiently used or overlooked by the principals. Concerns raised by the respondents were a clear indication that much needed to be done to change the mind-set of the principals. / Educational Studies / D.Ed (Education Management)

Educator stress is a major problem worldwide. This study focuses on the role of the principal in the secondary school in providing support and assisting educators manage work-related stress, with particular reference to schools in Kwa-Zulu Natal, South Africa. The problem was investigated by means of a literature study and empirical investigation. The literature identified perspectives on educators' stress, the stress process of the educator and the principal, causes of work-related stress in educators and coping strategies. Furthermore, principals' leadership styles, theories of motivation and causes of principals' stress were discussed. A qualitative inquiry using focus group interviews was undertaken with a small sample of secondary school educators selected by purposeful sampling. Findings suggested that educator stress was caused by a lack of learner discipline; deterioration in educational standards; workload; policy changes; promotion procedures and the principal's leadership style. Based on the findings, recommendations were made for improvement of practice. / Educational Studies / M. Ed. (Education Management)

This study focuses on the South African principals’ perceptions of shared leadership and its relevance for school discipline. In a mainly qualitative investigation, empirical data from ten secondary schools in the Nkangala District of the Mpumalanga Province were collected by means individual interviews and observation. These data were analyzed in accordance with accepted procedures for qualitative data processing. The preponderance of evidence collected in this study indicates that school principals indirectly contribute to school effectiveness and learner achievement through actions they take to influence what happens in the schools and classrooms. The skillful leadership of school principals is a key contributing factor when it comes to explaining successful change, school improvement, or school effectiveness. Schools should provide a stable, caring environment for all learners, irrespective of whether they are working with support or indifference of families. The role of the schools in relation to learners’ cultural and social differences should be supportive. Shared leadership is regarded as the state or quality of mutual influence in which team members disperse the leadership role through the group, participate in the decision-making processes, fulfill functions traditionally reserved for hierarchical leaders, and when appropriate, provide guidance to others to achieve group goals and objectives. The relevant stakeholders should work collaboratively in the education of learners. Principals and educators must understand that their traditional roles have changed and improved organizational teamwork will be fostered by all members of the learning community assuming decision-making roles. For the haul of school improvement school principals have to develop and expand their leadership repertoires. The collaborative process in shared school leadership should offer the opportunity for educators, learners, parents and the other stakeholders to study, to learn about shared leadership and also to share and to enact leadership. The management of discipline in schools is central to effective teaching and learning. A school that does not have an effective discipline policy (that includes strategies and support mechanisms that are available to all the members of the school community) and that does not maintain a climate of sound discipline, will not function as a centre for teaching and learning. The process of implementing a discipline policy should involve collaborative decision-making. All relevant stakeholders of the school community should have the opportunity to participate in the decision-making process. The study confirmed most of the views found in the existing body of knowledge on shared leadership and its relevance for school discipline. In the thesis, detailed attention is paid to the challenges those principals who were interviewed, experienced, and to the perceived origin of those challenges and suggested solutions. To conclude the study, a model for exercising sound school discipline through shared school leadership, including ten strategies to promote the implementation of shared school leadership in secondary schools, were proposed. / Educational Leadership and Management / D. Ed. (Education Management)

No description available.

Für viele Krankheitsbilder und Indikationen ist ein breites Spektrum an Arzneimitteln und Arzneimittelkombinationen verfügbar. Darüber hinaus stellen Therapieziele oft Kompromisse zwischen medizinischen Zielstellungen und Präferenzen und Erwartungen von Patienten dar, um Zufriedenheit und Adhärenz zu gewährleisten. Die Auswahl der optimalen Therapieoption kann daher eine große Herausforderung für den behandelnden Arzt darstellen. Klinische Entscheidungsunterstützungssysteme, die Wirksamkeit oder Risiken unerwünschter Arzneimittelwirkung für Behandlungsoptionen vorhersagen, können diesen Entscheidungsprozess unterstützen und \linebreak Leitlinien-basierte Empfehlungen ergänzen, wenn Leitlinien oder wissenschaftliche Literatur fehlen oder ungeeignet sind. Bis heute sind keine derartigen Systeme verfügbar. Im Rahmen dieser Arbeit wird die Anwendung von Methoden aus der Domäne der Recommender Systems (RS) und des Maschinellen Lernens (ML) in solchen Unterstützungssystemen untersucht. Aufgrund ihres erfolgreichen Einsatzes in anderen Empfehlungssystemen und der einfachen Interpretierbarkeit werden zum einen Nachbarschafts-basierte Collaborative Filter (CF) an die besonderen Anforderungen und Herausforderungen der Therapieempfehlung angepasst. Zum anderen werden ein Modell-basierter CF-Ansatz (SLIM) und ein ML Algorithmus (GBM) erprobt. Alle genannten Ansätze werden anhand eines exemplarischen Therapieempfehlungssystems evaluiert, das auf die Behandlung der Autoimmunkrankheit Psoriasis abzielt. Um das Risiko der Empfehlung kontraindizierter oder gar gesundheitsgefährdender Medikamente zu reduzieren, werden Regeln aus evidenzbasierten Leitlinien und Expertenempfehlungen implementiert, um solche Therapieoptionen aus den Empfehlungslisten herauszufiltern. Insbesondere die Nachbarschafts-basierten CF-Algorithmen zeigen insgesamt kleine durchschnittliche Abweichungen zwischen geschätztem und tatsächlichem Therapie-Outcome. Auch die aus den Outcome-Schätzungen abgeleiteten Empfehlungen zeigen eine hohe Übereinstimmung mit der tatsächlich angewandten Behandlung. Die Modell-basierten Ansätze sind den Nachbarschafts-basierten Ansätzen insgesamt unterlegen, was auf den begrenzten Umfang der verfügbaren Trainingsdaten zurückzuführen ist und die Generalisierungsfähigkeit der Modelle erschwert. Im Vergleich mit menschlichen Experten sind alle untersuchten Algorithmen jedoch hinsichtlich Übereinstimmung mit der tatsächlich angewandten Therapie unterlegen. Eine objektive und effiziente Bewertung des Behandlungserfolgs kann als Voraussetzung für ein erfolgreiches ``Krankheitsmanagement'' angesehen werden. Daher wird in weiteren Untersuchungen für ausgwählten klinische Anwendungen der Einsatz von ML Methoden zur automatischen Quantifizierung von Gesunheitszustand und Therapie-Outcome erprobt. Zusätzlich, als weitere Quelle für Informationen über Therapiewirksamkeiten, wird der Einsatz von Sentiment Analysis Methoden zur Extraktion solcher Informationen aus Medikamenten-Bewertungen untersucht. / Under most medical conditions and indications, a great variety of pharmaceutical drugs and drug combinations are available. Beyond that, trade-offs need to be found between the medical requirements and the patients' preferences and expectations in order to support patients’ satisfaction and adherence to treatments. As a consequence, the selection of an optimal therapy option for an individual patient poses a challenging task to prescribers. Clinical Decision Support Systems (CDSSs), which predict outcome as effectiveness and risk of adverse effects for available treatment options, can support this decision-making process and complement guideline-based decision-making where evidence from scientific literature is missing or inappropriate. To date, no such systems are available. Within this work, the application of methods from the Recommender Systems (RS) domain and Machine Learning (ML) in such decision support systems is studied. Due to their successful application in other recommender systems and good interpretability, neighborhood-based CF algorithms are transferred to the medical domain and are adapted to meet the requirements and challenges of the therapy recommendation task. Moreover, a model-based CF method (SLIM) and a state of the art ML algorithm (GBM) are employed. All algorithms are evaluated in an exemplary therapy recommender system, targeting the treatment of the autoimmune skin disease Psoriasis. In order to reduce the risk of recommending contraindicated or even health-endangering drugs, rules derived from evidence-based guidelines and expert recommendations are implemented to filter such options from the recommendation lists. Especially the neighborhood-based CF algorithms show small average errors between estimated and observed outcome. Also, the recommendations derived from outcome estimates show high agreement with the ground truth. The performance of both model-based approaches is inferior to the neighborhood-based recommender. This is primarily assumed to be due to the limited training data sizes, which renders generalizability of the learned models difficult. Compared with recommendations provided by various experts, all proposed approaches are, however, inferior in terms of agreement with the ground truth. An objective and efficient assessment of treatment response can be regarded a prerequisite for successful ``disease management''. Therefore, the use of ML methods for the automatic quantification of health status and therapy outcome for selected clinical applications is investigated in further experiments. Moreover, as additional source of information about drug effectiveness, the use of Sentiment Analysis, in order to extract such information from drug reviews, is investigated.

No description available.

La rhinosinusite chronique (RSC) est une maladie avec une haute prévalence au Canada et des impacts économiques et individuels importants. Une des options thérapeutiques dans l’algorithme complexe de traitement est la chirurgie endoscopique des sinus (CES), qui est préconisée chez les patients qui ont une réponse insatisfaisante à la thérapie médicale. Le présent mémoire porte sur les critères minimaux nécessaires à l’atteinte du succès en matière de CES. Dans un premier temps, une consultation d’experts en RSC Canadiens provenant de 12 institutions nous a permis d’offrir des définitions du succès acceptable ainsi que du succès optimal du point de vue des prestataires de santé. Dans un deuxième temps, une étude auprès de 22 patients souffrant de RSC nous a permis d’identifier les thèmes importants qui doivent guider le processus décisionnel collaboratif. La première étude a permis de conclure qu’une définition du succès post-opératoire en CES se doit de comporter 2 composantes : un aspect objectif (endoscopie nasale) et un aspect subjectif (test d’issues mesurées par le patient ou questionnaire spécifique). Selon les experts, pour parler de succès optimal il faut une résolution complète des symptômes ainsi qu’un résultat endoscopique parfait. La deuxième étude a permis de démontrer que les patients accordent beaucoup plus d’importance à la résolution du symptôme cardinal qui les a amenés à consulter. Cette dernière étude a également permis une exploration plus large des objectifs et attentes, ainsi que de l’expérience patient en ce qui a trait à la RSC et à la CES. En conclusion, l’évaluation des aspects subjectifs devrait être l’aspect le plus important que les cliniciens évaluent pour parler de succès. Une évaluation de la cavité nasale et des sinus devrait complémenter cette évaluation environ 3 mois après la chirurgie. Ce mémoire inclus des algorithmes pour aider les cliniciens dans l’évaluation du succès opératoire après une CES. / Chronic rhinosinusitis (CRS) is a prevalent, complex disease with important economic and individual impacts. Functional endoscopic sinus surgery (FESS) is widely used treatment for CRS, which is considered in patients with an unsatisfactory response to maximal medical therapy. This thesis examines the different ways clinicians may obtain feedback with regards to post-operative success and aims to offer definitions of acceptable success and optimal success. First, a consultation of Canadian experts in CRS from 12 institutions permitted us to construct definitions of acceptable and optimal success from healthcare providers’ viewpoint. Second, a study in collaboration with 22 patients suffering from CRS allowed us to identify key themes which will facilitate the inclusion of primary stakeholders in shared decision-making. The first study allowed us to conclude that a definition of postoperative success must be based on 2 components: an objective aspect (nasal endoscopy) and a subjective aspect (patient-reported outcome measure or specific questionnaire). According to experts, optimal success requires a complete resolution of symptoms as well as a perfect endoscopic result. With the second study, we demonstrated that patients tend to focus on the resolution of their cardinal symptom. This last study also allowed us to widely explore patients’ objectives and expectations, as well as their experience with CRS and FESS. In conclusion, subjective aspects should be the most important determinants of success after FESS. In addition, an evaluation of the nasal cavity and sinuses should complement the subjective evaluation approximately 3 months after surgery. This thesis includes algorithms to aid clinicians in evaluating the outcome of FESS for patients with CRS.

Bakgrund: Antalet immigrerade kvinnor i Sverige har ökat de senaste åren vilket utmanar barnmorskor i arbetet präglat av språkliga och kulturella barriärer. Dessa barriärer är för immigrerade kvinnor riskfaktorer för ojämlik vård samt högre morbiditet och mortalitet. Barnmorskan kan möjliggöra stödjande kommunikation genom bland annat tolkanvändning, kroppsspråk och närvaro. Kulturella barriärer kräver en för barnmorskan kulturmedveten och öppen inställning till kvinnan och hennes kulturella bakgrund. Syfte: Att beskriva barnmorskors erfarenheter av att stödja kvinnor under förlossning med språkliga och kulturella barriärer. Metod: En kvalitativ induktiv design har använts. Tolv enskilda, semistrukturerade intervjuer genomfördes. En manifest innehållsanalys användes. Resultat:  Fyra huvudkategorier frambringades ur empirin; barnmorskans erfarenheter av språkliga barriärer, barnmorskans erfarenheter av kulturella barriärer, barnmorskans svårigheter att ge vård på lika villkor och önskan för framtiden. Resultatet visade att språkliga barriärer utgjorde ett större hinder än kulturella barriärer i möten med immigrerade kvinnor samt att dessa barriärer försvårade bedrivandet av vård på lika villkor om de ej överbryggades. Stöd för kommunikation beskrevs vara bland annat tolkanvändning och kroppsspråk. En önskan yttrades kring utveckling av hjälpmedel för kommunikation samt implementering av kulturdoula i förlossningsvården. Slutsats: Språkliga barriärer uppges vara svårast att hantera men kommunikation möjliggörs genom tolkanvändning, kroppsspråk och hög närvaro på rummet. Kulturella barriärer beskrivs vara lättare att bemöta men fortsatt kvalitetsarbete krävs för att utveckla hälso- och sjukvårdspersonalens kulturkompetens. / Background: The amount of immigrant women in Sweden has increased which challenges midwives in work affected by linguistic and cultural barriers. These barriers are for immigrant women risk factors for unequal care and higher morbidity and mortality. The midwife can enable supportive communication by using interpreters, body language and by being present. Cultural barriers demand that the midwife is culturally aware and has an open mind towards the woman and her cultural background. Aim: To describe the experiences of midwives supporting women during childbirth with linguistic and cultural barriers. Method: A qualitative inductive design was used. Twelve individual, semistructured interviews were implemented. A manifest content analysis was used. Result: The result brought forth four main categories: the midwife´s experiences of linguistic barriers, the midwife´s experiences of cultural barriers, the midwife´s difficulties regarding equal care and desire for the future. The result showed that linguistic barriers were larger obstacles than cultural barriers in encounters with immigrant women and that these barriers make it difficult to offer equal care if not bridged.  Communication aids were described as using interpreters and body language. A desire was raised regarding developing preexisting tools for communication and implementing cultural bilingual doulas in birth care. Conclusion: Linguistic barriers are said to be the most difficult to manage but are enabled by using interpreters, body language and presence in the room. Cultural barriers are described as more easily managed but continuous quality management is required to develop the cultural competence of the health care staff.