Introduction. Low back pain is an important public health problem affecting 70-85% of the population worldwide and is a common cause of work-related disability. At Edendale Hospital, the physiotherapy nursing case load related to the management of low back pain increased from 30% to 45% over the past 3 years. The risk factors for low back pain at Edendale Hospital remain unclear and it is not clear whether low back pain is more prevalent in certain wards. Knowing the risk factors contributing to the prevalence of low back pain at the Hospital will assist nursing and hospital managers to plan appropriate interventions to minimize the occurrence. Methods. An observational cross sectional study with an analytic component was implemented. Data was collected utilizing a self- administered questionnaire to determine the prevalence of low back pain amongst nurses at the Hospital. Bivariate analyses and logistic regressions were performed to determine the risk factors associated with low back pain. Results. The point prevalence of current low back pain was 59%, of chronic low back pain was 47% and occupational low back pain was 57%. Logistic regression revealed bending and working in orthopaedic, surgery, paediatrics, obstetrics and gynaecology is significantly associated with low back pain. Conclusion. Occupational factors are strongly associated with low back pain. Thus workplace interventions are required. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2010.

This study describes a conceptual framework that portrays information system project failures as organizational crises. The main assumption of this study is that such failures will invariably happen and thus there is a need to make them less costly and more beneficial to organizations. To identify the behaviors and factors that influence an organization's ability to effectively manage a project failure, this dissertation reviews the crisis management literature. Based on this review, a three-stage model is formulated. To understand the mechanisms underlying this model, a number of hypotheses (which are informed by a number of related organizational behavior areas) are generated. These hypotheses focus on three key crisis management factors: the organization's ability to promptly detect an impeding failure, its capacity to manage the failure's impacts, and its propensity to learn from it. To empirically assess the validity of the conceptual model, three case studies of Canadian public organizations were conducted. The empirical findings provide strong support to the model's conjectures and indicate that project failures generate several crisis-related behaviors and responses. More specifically, the findings suggest that an organization's proactive preparation for a failure can have a significant moderating effect on its impact. However, the findings clearly show that an organization's ability to promptly detect (and prepare for) a failure is impeded by behaviors that are motivated by escalation of commitment. Such behaviors lead to a prolonged pre-crisis denial period and have a suppressing effect on whistle-blowing, which is pursued as a denial-curtailing strategy by non-management participants. The empirical findings describe both operational and legitimacy tactics used by organizations to cope with the aftermath of a project failure and indicate that credibility restoration is a significant concern during large crises. Finally, the empirical evidence indicates that organizational learning and adaptation are more likely to follow major project failures than less significant ones. This contradicts threat-rigidity arguments and provides support to the failure-induced learning theory.

The term "empowerment" is frequently used by organizational researchers, management practitioners, and consultants. However, despite the popularity of the term, there is a lack of empirical work and no generally accepted definition. As part of a thorough multi-disciplinary literature review, fourteen different conceptualizations for the term empowerment were discovered and classified into four categories: Micro (intra-psychic), Meso (relational-interactive), Macro (structural), and Misnomer (bogus). As a result of this work, both a new definition and a multi-level process model of empowerment are offered. Empowerment is defined here as an enhancing and energizing context specific process that expands an individual's power and feelings of trust, is usually facilitated by another, and results in increased levels of self-esteem, self-efficacy and other characteristics related to personal growth and control, which eventually lead to outcomes such as performance and satisfaction. The proposed multi-level process model postulates that the process of empowerment is driven by changes in information, responsibility, and active belief, and mediated by intra-psychic factors. This model was empirically tested in a between-subject, pre-test, post-test simulation design. Over a period of three weeks 135 graduate students completed a novel application of in-basket exercises, within which an empowerment manipulation was embedded. This manipulation included increasing information, responsibility, and active belief for the empowered manipulation and decreasing these three components for the disempowered manipulation. Multivariate analysis of variance revealed that, as predicted, the manipulation had a significant impact on the three mediating intra-psychic factors (self-efficacy, self-esteem, and locus of control) and an analysis of variance found significant results in the predicted direction on the dependent variable of job satisfaction. Regression analyses revealed the predicted mediation relationship between the intra-psychic variables and the dependent variable of job satisfaction. However, none of the analyses yielded significant results for the performance measures (initiative, sensitivity, planning and organizing, delegation, administrative control, problem analysis, judgement, and decisiveness). Several potential explanations are offered for these results, including a motivational interpretation which focuses on participant's motivation directionality. Theoretical and practical implications for these results are discussed as well as directions for future research.

Compared to grammatical knowledge of language (what to use), the ability to use language appropriately depending on a context (how to use) is termed linguistic pragmatic knowledge. Throughout the elementary school years children developmentally not only acquire pragmatic knowledge but also increase their explicit grasp of pragmatic knowledge. This is termed metapragmatic knowledge. It includes the ability to infer meanings that are not expressed literally. In nonliteral uses of language, the speaker means something different from what is said. Among such nonliteral uses of language are indirect requests and irony. As children's metapragmatic knowledge has a positive relationship with their literate proficiency, on which success in school depends, children can benefit from the development of their metapragmatic knowledge in their academic achievement. The study of bilingualism has shown that bilingualism has a positive effect on children's metalinguistic development. Can metapragmatic knowledge be enhanced by increasing exposure to a second language (L2)? Bilingual pupils were given two tasks in which the children's levels of metapragmatic knowledge were investigated. The measure of metapragmatic knowledge consisted of two assessments: (a) understanding of indirect requests, and (b) understanding of irony. Participants listened to eight short stories in which brief interactions were presented in a multimedia, computer-based format. After each story, participants were asked a set of questions to probe subjects' attributions of the speaker's communicative intent and hearer's interpretation. L2 intensity was positively associated with metapragmatic knowledge measured by comprehension of requests. Conversely, the association between L2 intensity and metapragmatic knowledge measured by comprehension of irony was not necessarily positive. Those who scored higher had positive relationship between L2 intensity and their metapragmatic knowledge whereas those who scored lower had negative relationship between L2 intensity and their metapragmatic knowledge. In summary, L2 intensity is not always positively associated with any type of metapragmatic knowledge. This suggests that a larger amount of exposure to L2 is not necessarily beneficial to children's development of metapragmatic knowledge. Therefore, it is important to consider the levels of children's metapragmatic knowledge when planning an increase of exposure to L2 instruction.

In recent years researchers interested in family decision making have argued for the need to apply a conceptual framework to the study of parental decision making about child-rearing issues. This study is an attempt to construct a theory-based model of parental decision-making strategies. Two theoretical approaches were employed; a structural-developmental approach to provide an understanding of parental cognition, and an information processing approach to the study of decision-making strategies. Previous research has demonstrated that pressure of time and task complexity were important in influencing the selection and use of information. These two factors were manipulated by the researcher. A model of parental decision-making strategies was proposed and tested in a pilot study. The decision was made to reduce the number of variables to those which demonstrated the potential to make a significant contribution to an understanding of parental decision making. These variables were tested in the main study. Sixty mothers participated in the study. They represented a wide range of socio-economic and educational backgrounds as well as number of years of parenting experience and age. Participants completed Newberger’s Level of Parental Awareness Interview and four decision tasks about two childrearing issues. The decision tasks were presented on information boards. The model of parental decision-making strategies was tested using multivariate analysis of variance with repeated measures. Significant effects were obtained for level of parental awareness, pressure of time, task complexity and number of years of formal education. The reduced model explained much of the variance in parental decision-making strategies (71%). Specific hypotheses concerning level of parental awareness and information use were supported. The results inform theory and practice. Support was found for the theory-based model and for Liben’s view of a rapprochement between developmental theory and information-processing theory. Parents with more knowledge about parenting used less information and more variability in their decision making. Support was found for Newberger’s measure and construct. Practical implications for parent education were curricula described.

A cognitive-behavioural theory (CBT) has been put forth to explain hypochondriasis and less extreme forms of health anxiety (Warwick & Salkovskis, 1990). The extent to which less extreme forms of health anxiety are relevant for understanding illness behaviour remains unclear, however. Further, the independence of health anxiety from a more general construct of negative affectivity, as well as response styles is not known. The CBT of health anxiety predicts that in response to illness information health anxious individuals will show a characteristic cognitive (e.g., attend to and misinterpret information) and behavioural (e.g., avoidance and reassurance seeking) response. Although the predictions are supported by clinical observations, rigorous and systematic contrasts of health anxious and non-health anxious individuals to the same objective health related information have not yet been carried out. Further, there are a number of additional issues that need to be clarified with respect to the theory, including: (a) Are there additional cognitive and behavioural responses involved in health anxiety not predicted by the CBT?; (b) Are health anxious individuals deficient in there use of certain adaptive responses to illness information?; and (c) Are the cognitive and behavioural responses shown by health anxious individuals moderated under certain circumstances? In the present study, students scoring either within normal or nonclinically high ranges on a measure of health anxiety underwent a physiological test ostensibly examining risk for medical complications and were randomly assigned to receive positive, negative, or ambiguous test results. They then underwent a cold pressor task ostensibly to examine physiological activity and were asked questions tapping their responses to the diagnostic information and painful procedure. They were also judged for facial expressiveness. Unmistakable support was found for a dysfunctional cognitive (e.g., negative interpretational focus) and behavioural (e.g., reassurance seeking) response style among health anxious individuals. Little support was found for either cognitive or behavioural avoidance in health anxiety. Not anticipated by the CBT, as time went on health anxious individuals became more expressive of their pain; this may have important implications, since increased expressiveness could result in an increase in the felt emotional experience. Adding to the CBT, evidence was found to suggest that health anxious individuals may have a deficit or be deficient in their use of a positive concrete somatic monitoring strategy. Finally, the results suggested that there are statistically and clinically significant differences among nonclinically health anxious individuals and normals that can not be accounted for by differences in negative affectivity or response styles.

A number of investigations have been conducted to examine social cognition and psychopathology among adolescents, yet little is known about the social cognitive reasoning of adolescents identified as having severe behavioral disorders. The purpose of the present study was to explore the social cognitive reasoning of adolescent boys with behavioral disorders in comparison to their peers without behavioral disorders. Group differences were examined with respect to epistemic reasoning and the dimensions of adolescent egocentrism. In addition, the relation between social cognition and social relationships was investigated. Finally, the relation between social cognition and psychopathology was explored. Thirty-one adolescent boys with behavioral disorders and 32 of their peers without behavioral disorders (matched forage, race, and SES) participated in the study. All participants were individually administered measures designed to assess epistemic reasoning, imaginary audience and personal fable ideation (i.e., invulnerability, omnipotence, personal uniqueness), and personal-intimacy and groupintegration with peers and family. In addition, boys with behavioral disorders completed a measure of internalizing, externalizing, and total problem behaviors. Teacher-ratings of problem behaviors were also completed for each participant in the study. Results revealed that adolescent boys with behavioral disorders were lower in epistemic reasoning than were adolescent boys without behavioral disorders. Groups were not found to differ with respect to imaginary audience or personal fable ideation. For boys with behavioral disorders, no relation was found between social cognition and social relationships. In contrast, for boys without behavioral disorders, personal uniqueness was negatively related to group-integration with peers and omnipotence was positively related to group-integration with family. Social cognitive reasoning was found to predict self-reported problem behaviors for boys with behavioral disorders and teacher-re ported problem behaviors for boys without behavioral disorders. Overall, these results suggest the importance of epistemic reasoning in understanding the relation between social cognition and psychopathology.

Background: The purpose of this study is to determine whether precursor events are associated with a post-operative composite outcome in a low-medium risk cardiac surgical population. These precursor events may be promising targets for strategies aimed at quality improvement. Methods: This study was a case control design where the outcome of major adverse events (MACE) was assessed in patients exposed to four intra-operative precursor events. Cases and controls were matched 1:1 using propensity score matching, Univariate comparison of ?1 precursor event in the matched groups was performed. Results: The primary outcome of ?1 precursor event occurred significantly more frequently in the MACE patient group vs the non-MACE patients group (33% vs. 24%; p=0.015). The individual events of bleeding and difficulty weaning from CPB were significantly higher in the MACE group whereas incomplete revascularization/repair and repair/regrafting were not. Conclusion: Quality improvement techniques aimed at mitigating the consequences of precursor events may improve surgical outcomes for these patients.

In this thesis I describe a research study to further our understanding of the role of the evaluator as a facilitator of evaluative inquiry within organizations. I assumed dual roles as both the evaluator and the evaluation-use researcher to examine the effect of my behaviour on the evaluation of a dynamic organization. My approach as the evaluator was influenced by a decade of experience as a practising evaluator and by the insights I gained from my readings of organizational theory and three evaluation theories responsive, participatory, and developmental. My study of the nature, quality, and consequences of the evaluator/stakeholder interactions while participating in the process was anchored by approaches from the fields of educational research and organizational theory informed by complexity science. Using data generated from modifying the traditional case study method, including reflective journal entries related to my decision-making process, I generated critical episodes as a way of understanding the circumstances surrounding shifts in my behaviour. My iterative analysis of the critical episodes and the insights gained from them enabled me to track the transformations of the six personal evaluation principles that guided my evaluator approach and led to the creation of a seventh principle. The cross-case analysis revealed the evaluation process as a non-linear progression whereby the evaluator and the individual stakeholders engaged in establishing trust, fostering collaborations, and promoting learning. This study contributes three implications for evaluation practice including providing empirical data on what it means for an evaluator and individual stakeholder to develop close engagement through evaluative inquiry, bringing to the forefront the value of systematic and purposeful reflection as a means of enhancing the quality of this engagement, and pointing to the importance for evaluators continually integrating past experiences and new theoretical frameworks with understandings gleaned from close engagement. Finally, I posit a new approach documenting the complexity of the influence of the evaluator on shaping organizational and program development within the dynamic context. / Thesis (Ph.D, Education) -- Queen's University, 2008-04-23 13:48:32.287

The purpose of this study was to examine the effectiveness of cased-based learning, writing and peer discussions on learning about digestive diseases in a computer-based learning environment, BioWorld. This method was called the Grand Rounds method. Thirty-one, ninth grade biology students participated in the study. Two classes were randomly selected as the Rounds group and the No Rounds group. All students worked collaboratively in pairs to solve diagnostic problems on BioWorld. The Rounds group then engaged in the Grand Rounds activities while the No Rounds group conducted a web search and solved a final BioWorld problem. Both treatments demonstrated significant knowledge gains of digestive problems from pretest to posttest but the gains were greater in the Rounds group. There were no significant changes from pre to post questionnaire in students' attitudes towards biology or peer work/discussion. The verbal protocols revealed students used diagnostic heuristics while solving cases, and discourse communities emerged among the students. Overall, this study confirms the benefits of written and oral discourse, and authentic learning activities in classrooms.