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Thesis (Ph. D.)--Florida State University, 2004. / Advisor: Dr. Ralph S. Brower, Florida State University, College of Social Sciences, Dept. Public Administration and Policy. Title and description from dissertation home page (viewed Sept. 24, 2004). Includes bibliographical references.

This research aims to identify and evaluate the systemic factors which may be related to decrease in Grade 6 learner’s achievement in Mozambique between 2000 and 2007, looking for possible changes in Educational Effectiveness over that period. SACMEQ III learner results from Grade 6 Reading and Mathematics showed an overall mean decrease from 2000 to 2007. The main research question addressed in this study is: What are the systemic contextual factors associated with decrease in achievement in Reading and Mathematics between 2000 and 2007 in Mozambique? The conceptual framework underpinning this research presents the education system in terms of inputs, processes and outputs (Howie, 2002). Hierarchical Linear Models, based on trend design approach (Nilsen, & Gustafsson, 2014) was used to assess the variation in learner achievement decrease associated with changes in schools inputs and processes. The findings suggest that school-level factors linked to inputs and antecedents have a strong effect on the decrease in learner’s achievement, compared to the processes and practices. Moreover, learners’ background factors, specifically parent’s education and use of language of instruction at home, seem to be the crucial factors associated with learner achievement decrease. When school level variables related to parent’s education, use of language of instruction at home, are included in the model, the amount of variation accounted for, showed an increase (from 23.5 % to 37.7 %,). One can argue that the variation accounted for variables such as parents’ education, whilst use of language of instruction could be indicative of changes in learner’s intake composition between 2000 and 2007. Implications of these findings on the assumptions for large scale assessment studies in developing countries, such as Mozambique, are key issues. For instance, a question could be raised about the “trend” assumption of large scale assessment: To what extent can the trend level of achievement be measured where the learner’s intake composition is changing over the time? In the SACMEQ studies a stronger longitudinal design is needed to investigate how both school and intake factors influence achievement. / Thesis (PhD)--University of Pretoria, 2017. / Science, Mathematics and Technology Education / PhD / Unrestricted

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The primary goal of this study was to develop a theoretically based, parsimonious framework for the examination of the relationships between executive characteristics, strategy and performance. In order to achieve this goal, prior literature examining the linkages between executive characteristics and strategy and executive characteristics and performance was integrated to derive two broad theoretical propositions. The first proposition stated that different managerial profiles would be associated with different strategic postures. The rationale for this proposition was derived from previous empirical and theoretical evidence which suggests that since different strategies emphasize different organizational competences, they can be best implemented by managers who have skills compatible with these competences. Building on this logic, the second proposition suggested that a fit between managerial profiles and organizational strategy would enhance performance. This proposition stems from the behavioral literature which argues that the characteristics of managers influence their perception of the environment and consequently their decision-making. Thus, if managerial decisions are not compatible with the strategy and consequently the competences of the organization, performance will suffer. In order to test these propositions each of the three constructs were operationalized in a multidimensional manner. Strategy was conceptualized in terms of the Miles & Snow (1978) typology which delineates comprehensive and internally consistent postures of organizational behavior encompassing their structures and processes. The executive characteristics construct was operationalized through five demographic dimensions each of which had been found significant in previous research. Finally, performance was operationalized to include the separate market based and efficiency goals of the different strategies. The data used to perform the empirical test were obtained from objective, secondary sources to control for the effects of perceptual bias which plagues researchers who use self-report data. The measures of strategic orientation and performance were standardized through the use of ratios to limit the unwanted variation introduced by differences in organizational size. The research site was restricted to a single industry containing relatively homogeneous firms, to control for spurious results that can occur due to the different environmental factors that operate in different industries. The manuscript includes detailed descriptions of the theoretical literature from which the research was conceived, the results obtained and the conclusions derived. The primary contributions of this study were the integration of two distinct research streams, and the development of a broadly applicable model which is a useful platform for the future study of strategic leadership. / Ph. D.

Musculoskeletal complaints are one of the most common reasons for visits to medical and chiropractic professionals in the United States, and spine-related symptoms in particular comprise the largest share of these complaints. Spine-related conditions increase as people age, having implications for rising disability and consequent spending by Medicare and Medicaid on increased health services use and long-term services and support. Chiropractic is one type of treatment used by older adults with these types of health problems. Covered by Medicare since 1972, chiropractic spinal manipulation is allowed for the express purpose to arrest the progression of functional decline or restore and possibly improve patient function. No studies, however, have examined whether chiropractic use by Medicare beneficiaries has indeed arrested functional decline, delayed disability, or restored health. The purpose of this dissertation research is to examine the comparative effectiveness of chiropractic use relative to no treatment and alternative medical care on the health and functional trajectories of community-dwelling older adults. I also examine the comparative effect of chiropractic on satisfaction with care. This is accomplished through the use of two longitudinal surveys with representative Medicare populations linked to Medicare provider claims. The first analysis examines the long-term comparative effect of chiropractic relative to no use and alternative care on functional decline, self-rated health decline, and the onset of additional depressive symptoms in a cohort of older Medicare beneficiaries, both with and without back conditions. The second study examines the effect of chiropractic compared to medical only episodes of care on health and functional decline in an older adult population with uncomplicated back conditions over a two-year period. The third and final study examines the comparative effect of chiropractic relative to medical care only on one-year changes in function, self-rated health, and satisfaction with care in a nationally representative age-eligible Medicare population with spine-related musculoskeletal conditions. Study results suggest that chiropractic has a consistently protective effect when compared to routine alternative medical care against decline in function among older adults with spine-related conditions, both over the long-term and the short-term. Chiropractic also has a comparative protective effect against decline in self-rated health in the short-term, but has no differential effect on the onset of depressive symptoms either in the short-term or long-term . Medicare beneficiaries using chiropractic for spine-related health conditions are relatively more satisfied than those using medical care only with the information provided to them about their condition, and with follow-up care provided after the initial visit. This research is the first of its kind to examine the comparative effectiveness of chiropractic relative to other usual sources of care for Medicare beneficiaries, in general and specifically among those with spine-related conditions, finding that chiropractic use has a comparatively beneficial effect on function, health, and satisfaction with care. The results have important policy implications for clinicians, patients, and Medicare because of the potential to shift clinical practice away from technologically intense and expensive treatments toward therapies like chiropractic spinal manipulation that demonstrate a comparative advantage in preserving health and function among older adults.

This dissertation consists of two empirical papers and one methods paper. The first two papers use quasi-experimental methods to evaluate the impact of universal health insurance reform in Massachusetts (MA) and Thailand and the third paper evaluates the validity of a quasi-experimental method used in comparative effectiveness research (CER).

Independent and supplementary prescribing are the two main forms of non-medical prescribing (NMP) that have been practised in the UK since 2006. Most available studies have qualitatively investigated the impact of NMP, especially in primary care. This may be due to the fact that prescriptions are issued mainly by general practitioners in primary care. This PhD thesis aimed at investigating the clinical effectiveness of independent pharmacist and diabetes specialist nurse (DSN) prescribers in the management of patients with type 2 diabetes at outpatient clinics in hospitals. A literature review was firstly conducted to explore the current research on NMP around the world and the UK. A systematic review of the previously published randomised control trials (RCT) and non-RCT studies that focused on prescribing interventions of nurses and pharmacist was also conducted to explore the impact of their prescribing interventions in treating type 2 diabetes using HbA1c level as the primary outcome. A programme of work of three retrospective comparative database analytical studies was then carried out to investigate the impact of independent NMPs in type 2 diabetes care. This programme of work used electronic medical records of patients attending outpatient clinics of diabetes centres in two teaching hospitals in Manchester; one employed an independent pharmacist and the other employed DSN prescribers. A group of subjects seen by an NMP in place of a doctor during the study period were the study group and the control group were those who seen only by doctors. The primary outcome was the average yearly change of HbA1c amongst the two groups. Secondary outcomes were yearly change of total cholesterol, blood pressure and serum creatinine as well as body mass index. Five statistical models, which included multivariable regression, propensity score matching and sensitivity analyses, were utilised to control for confounding effects, and the nature of selection bias in the retrospectively comparative effectiveness research using secondary database resources. A total of 330 patients seen by a team including a pharmacist versus 975 by doctors only between January 2006 and January 2013 at one site; and 656 by a team including DSNs versus 3,746 patients seen by doctors only between January 2007 to December 2013 at the other. The studies found both prescribing pharmacists and DSNs are capable of achieving at least non-inferior improvements in diabetes outcome compared to doctors. The pharmacist achieved a mean 0.01% reduction in HbA1c level versus doctors who achieved slight increase (p<0.4). DSNs also achieved a mean 0.07% reduction compared to doctors. However, after adjustment with multivariate and propensity score as well as with propensity score matching, there were no significant differences between the two groups. These findings were consistent with the findings in the systemic review. Although an RCT is the only method that by definition would produce unbiased treatment effects, the use of propensity score methods here, have reduced the potential for bias that may remain unaccounted for in multivariate models without propensity scores. Adjusting for propensity scores using two different methods also gives more confidence that the results are as unbiased as possible. Nonetheless, caution in generalising the results is necessary because of the retrospective nature of the studies and deficiencies in the database used.

M.Cur. / A staffing programme does not exist in a private hospital that compiles with the criteria cost effectiveness and quality nursing care. For this reason a study was undertaken to develop a staffing programme that would facilitate cost-effectiveness as well as quality nursing care. The nursing managers' role is not only to maintain cost-effectiveness but also to facilitate wholeness in patients and nursing staff. To achieve wholeness an exploratory. descriptive instrumental study was conducted and the Nursing Theory of Wholeness was used as a foundation for this study. Various research techniques were used such as scheduled observation, a structured questionnaire, nursing audit and a semi structured interviewing technique to quantify results. An analysis was conducted retrospectively to verify the statistical significance of a cost effective staffing programme. A staffing programme was designed consisting of seven steps to provide a basis for validity and reliability of the programme. The staffing programme proved to be cost-effective and proved to be statistically significant and shows a significant difference on a I% significance level (p = <0,003). The most important conclusion made is that valid, reliable staffing programme was designed for a nursing service in the private hospital. The staffing programme proved to be easily comprehended, useful, and relevant to its purpose. Cost-effectiveness was proved. A patient questionnaire was implemented to test the construct quality nursing. Partial validity of the construct quality nursing was confirmed.

BACKGROUND:Integrative medicine (IM) is a patient-centered, healing-oriented clinical paradigm that explicitly includes all appropriate therapeutic approaches whether they originate in conventional or complementary medicine (CM). While there is some evidence for the clinical and cost-effectiveness of IM practice models, the existing evidence base for IM depends largely on studies of individual CM therapies. This may in part be due to the methodological challenges inherent in evaluating a complex intervention (i.e., many interacting components applied flexibly and with tailoring) such as IM.METHODS/DESIGN:This study will use a combination of observational quantitative and qualitative methods to rigorously measure the health and healthcare utilization outcomes of the University of Arizona Integrative Health Center (UAIHC), an IM adult primary care clinic in Phoenix, Arizona. There are four groups of study participants. The primary group consists of clinic patients for whom clinical and cost outcomes will be tracked indicating the impact of the UAIHC clinic (n=500). In addition to comparing outcomes pre/post clinic enrollment, where possible, these outcomes will be compared to those of two matched control groups, and for some self-report measures, to regional and national data. The second and third study groups consist of clinic patients (n=180) and clinic personnel (n=15-20) from whom fidelity data (i.e., data indicating the extent to which the IM practice model was implemented as planned) will be collected. These data will be analyzed to determine the exact nature of the intervention as implemented and to provide covariates to the outcomes analyses as the clinic evolves. The fourth group is made up of patients (n=8) whose path through the clinic will be studied in detail using qualitative (periodic semi-structured interviews) methods. These data will be used to develop hypotheses regarding how the clinic works.DISCUSSION:The US health care system needs new models of care that are more patient-centered and empower patients to make positive lifestyle changes. These models have the potential to reduce the burden of chronic disease, lower the cost of healthcare, and offer a sustainable financial paradigm for our nation. This protocol has been designed to test whether the UAIHC can achieve this potential.TRIAL REGISTRATION:Clinical Trials.gov NCT01785485.