Background and objectives There has been a steady annual increase in the number of deliveries performed at Chris Hani Baragwanath Hospital in recent years. A 2004 audit found that approximately one third of deliveries conducted at the hospital were of women who had referred themselves and were low risk and as such did not require delivery at a specialist centre. A triage down-referral system back to midwife obstetric units was implemented in 2008 to address the problem of low-risk self-referrals at the hospital. This study was conducted after the establishment of the triage system to find out whether the establishment of the triage system had been accompanied by a decrease in the proportion of self-referred women presenting to Chris Hani Baragwanath Hospital in labour, and to assess delivery outcomes in these patients. Literature review The literature review was conducted using Pubmed and MDConsult using the key words self referral, triage, gatekeeper, low-risk pregnancy, maternity / labour and referral systems. Relevant references were accessed via the University of the Witwatersrand eJournal portal. Appropriate articles cited by other authors were also reviewed. Appropriate websites were also used and referenced. Methods This was a retrospective descriptive study which included all women presenting in labour to the hospital maternity admissions area. The study population was clinical case-files of all births that were admitted in labour from 1 May to 31 May 2010. A simple random sample of these files was drawn. Results One hundred and eighty two intra-partum admissions were sampled. Thirty-five (19%) of these women were self-referred. Seven out of the 35 (20%) required caesarean sections. Five more (14%) needed oxytocin augmentation of labour, and one more (3%) had a vacuum delivery. Twenty women (57%) did not develop any complications during labour and could have been delivered at their midwife obstetrics units. During the month of the study, the triage down-referral system attended to 171 women and down-referred 83 (49%). Conclusion The establishment of a triage down- referral system has been accompanied by a curtailment in the number of low-risk pregnancies presenting self-referred at the referral hospital labour ward, compared with the audit in 2004.

Typescript (photocopy). / Digitized by Kansas Correctional Industries

Abstract Human resource is the most valuable and prominent property to a company. No matter in what aspect, human resource is fundamental to the development and implementation of programs and plans to support the overall growth of the company. Hence, how to find the most competent employees through proper sources is what the business entity needs to consider about. The sources to find qualified employees include human resource website, newspapers, schools, governmental agencies for employment services, employment exhibition, referral, and transition. Reviewing the past researchs of human resource, most of them focus on recruitment and staffing, but few to deal with referral employment. However, in Taiwan where interpersonal relationship is highly valued and recommended, the recruitment of employees through referral is very common. Therefore, this research aimed at the referral. Furthermore, the research also aimed to find out in what kind of relationship between the referral and introducer, the referral would have a preferable and better performance. Would the same working experience with the present job that referrals had serve as a critical variable affecting the performance? The results reveal that the turnover rate of referral is much lower than those hired personnel through other sources. Referrals generally have better performances at work when they were co-workers with the introducers in their former jobs. The finding also shows that referrals also have better performance when they came from the related industries related to the present jobs. Key words : performance , recruiting sources, referral, turnover rate

Office disciplinary referrals (ODR) and classroom exclusions among students from minority backgrounds have been a persistent concern for decades. The purpose of this dissertation was to assess disciplinary characteristics of American Indian students in special education. More specifically, the purpose was to determine (a) the rate at which American Indian students in special education programs received ODRs in comparison to students in special education programs of differing races/ethnicities significantly represented in the population, (b) the rate at which American Indian boys in special education programs received ODRs in comparison to American Indian girls in special education programs, (c) the rate at which American Indian students in special education programs received ODRs in comparison to American Indian students who were not in special education programs, (d) the specific types of ODRs American Indian students in special education received, and (e) the impact race/ethnicity had on administrative decisions stemming from behavior violations. Logistic regression was used to examine ODRs for 10,469 students from kindergarten through 12th grade in two Southwestern public school districts with a large combined American Indian population (23.2%). Results indicated that although American Indian students in special education are less likely to obtain an ODR than Caucasian students in special education, and those ODRs are most often given for defiance, disrespect, and noncompliance, American Indian students in special education are still more likely to be given out-of-school suspensions and expulsions as an administrative consequence, than Caucasian students also in special education. Additionally, American Indian boys in special education were referred more than four times higher than American Indian girls in special education. Implications for practice and directions for future research which highlight culturally responsive disciplinary practices are provided.

No description available.

Background: Many Australians do not meet recommended levels of physical activity and GPs can play an important role in addressing this. Objectives: To evaluate the effectiveness of an exercise referral scheme, in patients referred by their general practitioner (GP). Design: A pre post evaluation with measurement of outcomes immediately post intervention (five weeks) and again at six months. Intervention: The 42 patients that agreed to participate in the study took part in an initial fitness and lifestyle assessment with an exercise physiologist. They then undertook ten exercise sessions over a period of five weeks, following an individually prescribed exercise program. At the completion of the ten exercise sessions, participants were reassessed (fitness and lifestyle) by the exercise physiologist. This was repeated again six months after they completed the intervention. Main outcomes measured: The primary outcomes measured were changes in self reported physical activity and associated markers including cardiovascular fitness. Secondary outcomes measured include changes in physiological and anthropometric measures, behavioural risk factors (dietary behaviour, alcohol consumption and smoking) and quality of life. Patient well-being (using SF12), patient satisfaction and GP satisfaction with the program was also assessed. Results: There was a large withdrawal of participants. Results have been presented in terms of outcome frequency at each assessment point. There was an 18% increase (from baseline) in the proportion of participants achieving the Australian physical activity guidelines and a 31% increase between baseline and the six month follow-up assessment in those that completed the program. There were statistically significant improvements in cardiovascular fitness measures and small improvements in some physiological, anthropometric, dietary behaviours and general well being measures. Conclusions: The results of this study suggest that referral to a community based leisure centre for supervised exercise, supported by a written exercise prescription by an exercise physiologist, may be effective in increasing physical activity levels short and long term in those that complete the program. Exercise referrals can form part of national strategies to increase physical activity, particularly for primary care.

Thesis (M. Med. Sc.)--University of Hong Kong, 2005. / Also available in print.

Thesis (M. Med. Sc.)--University of Hong Kong, 2005.

The purpose of this study was to detect Turkish pre-service elementary school teachers' perceptions of giftedness and factors affecting their referral decisions through eleven profiles (scenarios) originally created by five experts in the field of gifted education and semi-structured interview questions created for this study. The original profiles were translated from English to Turkish and adapted to be more relevant to Turkish culture. These profiles were named as Student Profiles Survey in this study. The profiles were varied based on characteristics embedded in each profile and I was able to create eight versions (pile) of the Student Profiles Survey. Profiles in each version (pile) of Student Profiles Survey differed from each other based on the characteristics embedded in each profile. Participants of the study were Turkish pre-service elementary school teachers who were attending two colleges of Education at Gaziantep University, namely Gaziantep College of Education and Nizip College of Education. A total of 204 Turkish pre-service elementary school teachers participated in the study and filled out the different versions of Student Profiles Survey. Approximately 25 pre-service teachers filled out each version of Student Profiles Survey. In addition, 16 of the pre-service teachers were asked for a follow-up interview. The convergent parallel mixed-methods design was used to shed light on the research questions. The findings from quantitative and qualitative analyses were combined to support each other and to better investigate Turkish pre-service elementary school teachers' perceptions of giftedness and factors affecting their referral decisions. The results of this study indicated that Profile 11 was the most appropriate and Profile 4 was the least appropriate profile for Turkish pre-service elementary school teachers' perceptions of giftedness. Turkish pre-service elementary school teachers explained their reasons for including the students in the profiles to gifted education programs mostly based on the personal, academic, and social characteristics of the students embedded in the profiles but they did not often referred students' characteristics when they were explaining their reasons for exclusion. Rather than explaining their reasons based on characteristics of the students, Turkish pre-service teachers increased their expectations and created excuses to underestimate the potentials of the students in the profiles when they were asked to explain their reasons for exclusion. The results of factorial ANOVAs indicated that Turkish pre-service elementary school teachers' referral decisions were influenced by the following factors: Students’ and pre-service teachers’ gender, students' ability areas, personality traits of the students, words describing the student, and students' length of passion.

Magister Public Health - MPH / Background: Malnutrition in children under the age of 5 years is a global public Health problem. The UNICEF report states that 10.9 million children under five die in developing countries each year due to malnutrition. According to the Zambia Demographic and Health Survey of 2008 malnutrition is one of the main childhood illnesses in Zambia with almost 50% of the under five children being stunted. The referral system in Zambia is organized in a way that starts at the Primary Health Care (PHC) level within the community and managed by the Community Health Workers (CHW). At this level, Community Health Workers screen and identify children that have childhood illnesses which require treatment and they refer them to the Rural Health Centre (RHC). When the problem cannot be handled at the RHC level the child is referred to the district hospital or provincial hospital level within a particular province. However, most children with malnutrition arrive late at the hospital for treatment. Some of them die soon after admission. It was not clear what prevent the mothers from bringing these children early to the hospital for treatment. Methods: The main aim of the study was to explore factors that are associated with detection and referral of malnourished children from Primary Health Care (PHC) at community level to the Health centres in Kalomo district. The study was conducted in Kanchele community of Kalomo in Southern Province of Zambia. Kanchele is a rural community with most basic services such as health facilities not being easily accessed. The study focused on two PHCs which had the highest prevalence of malnutrition. All participants were asked to sign a consent form after the purpose of study had been explained to them. They were informed that all information would be treated with confidentiality and that participation was voluntary and that they had the right to chose not to participate in the study. Furthermore each participant was asked if they agreed to maintain the confidentiality of the information discussed by participants and researchers during the focus group session. The study was qualitative in nature and focus group discussions were conducted with mothers or caregivers of children under five years, community members who have lived in the community for more than one year and community health workers who have also worked in the community for more than one year. Focus group discussions were used to collect data from mothers and community members. While in-depth interviews were used to collect data from CHWs and nutrition group leaders working at the PHC and community leaders. The data collected from the focus group discussions was analysed using thematic approach. Barriers or hindrances to rehabilitating a malnourished child mentioned by the respondents included lack of knowledge on malnutrition, failure to link malnutrition to poor feeding and bad health seeking habits, poor response to referral as a result of a system which is not supported with adequate resource such as transport, a system that does not support parents with food in-case of the child being hospitalised, the current hospital system only provides food to the patient. The failure by health staff to see that malnutrition is a key childhood disease. Data from this study will be used to develop interventions to improve the management of malnourished children. Conclusion: The study shows that mothers and community members are misinformed about the causes and treatment of malnutrition. It also clearly showed that traditional healers and grandparents played an important role in the diagnosis and treatment of malnourished children in this community. Interventions to improve identification and referral of these malnourished children needs to taken into consideration.