acase@tulane.edu / The Zambian Ministry of Health (MOH) National Malaria Control center (NMCC) adopted artemisinin combination therapy (ACT) as a first-line antimalarial drug for uncomplicated malaria in 2003, and included rapid diagnostic testing (RDT) in its case management guidelines to reduce over-diagnosis of malaria and over-prescription of antimalarials. Prior research has highlighted gaps in the malaria case management process in Zambia, especially in diagnosis and treatment. The first paper of this study aimed to build quality indices or indicators for the four components of malaria case management: assessment, diagnosis, treatment and counseling. The Zambia MOH/NMCC conducted a nationally representative health facility survey in 2011 with the Malaria Control and Evaluation Partnership in Africa. The mean assessment quality (percentage of assessment items correctly completed) rate was 49.9%. The diagnostic quality (concordance with gold standard diagnosis) rate was 82.4%, with 86.9% sensitivity and 79.4% specificity. The treatment quality rate (correct treatment for those needing antimalarials and no treatment for patients not needing it) was 89.6%, and the mean counseling quality (percentage of counseling items correctly completed) rate was 48.6%. The second paper investigated factors association with each of the four components of malaria case management. Supervision was significantly associated with assessment and counseling but not diagnosis and treatment. Health facility managing authority was associated with assessment and diagnosis. Availability of blood tests was associated with correct diagnosis, and diagnosis was strongly associated with treatment. Malaria endemicity and availability of IMCI guidelines were associated with counseling quality. The third paper investigated the associated between counseling and patient recall of treatment regimen, and found that they were associated as hypothesized. The Zambia NMCC has improved the quality of malaria case management over previous years, although it is recommended that more health facility surveys are conducted in order to study the change in health worker performance over time. / 1 / Louie Rosencrans

This project examines the medical management of pain and injury in British Olympic sport. By drawing upon the perspectives of health-care providers, it explores key developments such as the professionalisation, formalisation and bureaucratisation of sports medicine and the consequences of such developments on doctors' and physiotherapists' working practices, relationships with each other and on athlete care. A questionnaire about the backgrounds (e.g. the qualifications, experience and methods of recruitment and appointment) was sent to members of the British Olympic Association's Medical Committee and Physiotherapy Forum in November 2007 and in-depth, semi-structured interviews were conducted with 14 doctors and 14 physiotherapists between January and June 2008. Data indicate that attempts to professionalise sports medicine into a medical speciality have created fragmentation and resistance among the various groups involved in athlete care at this level. Whilst clinicians were committed by multi-disciplinary practice overall, data reveal qualitative differences between practitioners who have established themselves within bureaucratic organisations such as the English Institute of Sport (EIS) compared to those who provide largely voluntary medical services via National Governing Bodies of Sport (NGBs). Thus, practitioners in positions of managerial authority were constrained to negotiate the underlying amateur values of numerous sports medicine staff at the same time as striving for a professional ethos. Processes of professionalisation have also impacted upon the inter-professional relations between doctors and physiotherapists and the social organisation of athlete-care. As a consequence of their work setting, clinicians were constrained to adhere to the performance-motivated demands of their athlete and coach clients over longer-term health concerns. Because of their greater orientation towards performance, physiotherapists were able to effectively "compete" with doctors in a number of practice contexts and so claim considerable professional autonomy. This project adds to the existing body of knowledge on the medical practices of sports medicine clinicians in elite level sport and demonstrates the heterogeneity within this area of practice. Furthermore, the thesis highlights the importance of understanding clinicians working practices as a consequence of their particular work setting.

Performance measurement makes up the core of all health care systems in transition. Many countries and institutions monitor different aspects of health care delivery systems for differing purposes. Health care deliverers are compared, rated, and given incentives with respect to their measured performance. However, a global health care domain is currently striving for attaining commonly accepted performance measurement models and base-standards that can be used in information systems. The objective of this thesis is to develop an ontological framework to represent performance measurement and apply this framework to interpret performance measurement studies semantically. More specifically, this study made use of a formal ontology development methodology by utilizing web ontology and semantic web rule languages with description logic in order to develop a commonly accepted health care performance measurement ontology and knowledge base system. In the ontology developed, dimensions, classes, attributes, rules and relationships used in health care delivery and performance measurement domain are defined while forming an initial knowledge base for performance measurement studies and indicators. Furthermore, we applied the developed performance measurement ontology to the knowledge base while driving those related performance indicators for predefined categories. The ontology is evaluated within the features of the Turkish health care system. Health care deliverer categories are identified and by executing inference rules on the knowledge base, related indicators are retrieved. Results are evaluated by domain experts coming from regulatory and care provider institutions. The major benefit of the developed ontology is that it presents a sharable and extensible knowledge base that can be used in the newly emerging performance measurement domain. Moreover, this conceptualization and knowledge base system serve as a semantic indicator search tool that can be used in different health care settings.

The current approach to performance measurement in British Columbia is to select and match performance measures with strategic goals and objectives so that health administrators and decision makers can evaluate the performance of different care sectors (e.g. primary, community and acute care) within the provincial health system. Although this approach offers basic understanding of system performance, it is static and considers the performance of organizational components in isolation from their interrelationships and external influences. The purpose of this research is to enhance the current performance measurement approach in BC by linking health system variables through causal relationships and feedback loops that can impact and lead to health system sustainability. The qualitative system dynamics method was applied to develop a conceptual performance measurement model. Fifteen interviews with stakeholders were conducted at the BC Ministry of Health to validate and improve the pre-validation model. A post-validation model was then created based on the feedback and comments from the 15 interview participants. As a product of this research, the post-validation model, Web of Measures 2.0, will explain how the identified cause and feedback mechanisms both internal and external to the BC health system may help determine policy levers for designing and developing quality improvement initiatives. Although quantitative analysis is out of scope for this research, potential benefits of inputting BC data into the proposed model are discussed at the end of this thesis. / Graduate / 0769 / 0790 / qi.william.yang@gmail.com

Hoje a preocupação quanto às lesões que acometem os atletas de alto rendimento no esporte tem sido motivo de grande investigação e discussão científica. O presente estudo teve como objetivo conhecer e identificar os fatores de risco que colaboraram para as lesões músculoesqueléticas de cinco atletas da modalidade voleibol em uma equipe de alto rendimento, durante duas temporadas de competição. A pesquisa caracteriza-se como estudo de casos, que utilizou como instrumentos de investigação: entrevista, questionário de lesão, registro de dado (planilhas de treinamento), análise documental (prontuários). Os resultados da investigação foram categorizados demonstrando que as cinco atletas foram submetidas ao treinamento de mais de uma categoria durante a fase de formação esportiva e a precocidade no treinamento com equipe adulta, durante as temporadas de 2001/2002 e 2002/2003. As lesões que ocorreram em maior quantidade foram as por sobrecarga e o tempo de afastamento para resolução ou melhora da dor ou da lesão não eram priorizados. A maior parte das lesões ocorreram durante os treinos e o membro inferior foi o mais acometido. / Nowadays the concern related to the injuries that affect the high performance athletes in sports has been the reason of great inquiry and scientific discussion. The present study had as its objective to know and identify the risk factors that contributed to the rawboned muscles injuries of five athlete of the volleyball events in a high performance team, during two seasons of competition. The investigation is characterized as a study cases, that used as research instruments: interview, questionnaire of injury, register of data (training spread sheets), documentary analysis (handbooks). The results of the investigation had been categorized demonstrating that the five athletes had been submitted to the training of more than a category during the sporting formation phase and the precocity in the training with adult team, during the seasons of 2001/2002 and 2002/2003. The injuries that had occurred in bigger amount were the overload ones, and the removal time for resolution or improvement of the pain or injury were not prioritized. Most injuries had occurred during the training and the low member was more affected.

p. 1-77 / Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-05-07T19:36:53Z No. of bitstreams: 1 6666666666666.pdf: 313932 bytes, checksum: 01602d9f39df99bc370c99662eeaebd4 (MD5) / Approved for entry into archive by Maria Creuza Silva(mariakreuza@yahoo.com.br) on 2013-05-13T13:45:11Z (GMT) No. of bitstreams: 1 6666666666666.pdf: 313932 bytes, checksum: 01602d9f39df99bc370c99662eeaebd4 (MD5) / Made available in DSpace on 2013-05-13T13:45:11Z (GMT). No. of bitstreams: 1 6666666666666.pdf: 313932 bytes, checksum: 01602d9f39df99bc370c99662eeaebd4 (MD5) Previous issue date: 2008 / A avaliação de desempenho dos sistemas de saúde das nações vem ganhando importância crescente entre os gestores do setor saúde e o setor acadêmico, sendo considerada como etapa essencial para o planejamento das ações voltadas para garantia da qualidade da atenção e subsidiar decisões que atendam às necessidades da população, constituindo-se uma tecnologia de gestão. Este artigo objetiva conhecer as características atuais do debate sobre a avaliação de desempenho dos sistemas de saúde, por meio da procedência da produção científica, dos atributos relacionados à estrutura, processo e resultado dos sistemas, bem como das opções metodológicas utilizadas para desenvolver estes estudos. A coleta de dados foi realizada por meio das bases de dados indexadas: Medline, Lilacs e Scielo, no período de 1990 a 2007, sendo excluídos da pesquisa os estudos que trataram da avaliação de ações e programas de saúde. Foram analisados os atributos relativos à eficiência, qualidade e efetividade, estando os mesmos relacionados à estrutura, processo e resultado, respectivamente. Os resultados apontam uma tendência de maior preocupação da academia dos países desenvolvidos com o desempenho dos sistemas de saúde, especialmente com os aspectos de qualidade. Entretanto, os sistemas de saúde do Brasil têm dedicado mais espaço à produção científica deste tema. Foram os estudos de avaliação de intervenção, aqueles desenvolvidos em maior número, cuja relação se dá com a estrutura dos sistemas de saúde. Uma maior freqüência de estudos empíricos certamente contribuirá com a institucionalização da avaliação de desempenho, especialmente nos países em desenvolvimento. / Salvador

Hoje a preocupação quanto às lesões que acometem os atletas de alto rendimento no esporte tem sido motivo de grande investigação e discussão científica. O presente estudo teve como objetivo conhecer e identificar os fatores de risco que colaboraram para as lesões músculoesqueléticas de cinco atletas da modalidade voleibol em uma equipe de alto rendimento, durante duas temporadas de competição. A pesquisa caracteriza-se como estudo de casos, que utilizou como instrumentos de investigação: entrevista, questionário de lesão, registro de dado (planilhas de treinamento), análise documental (prontuários). Os resultados da investigação foram categorizados demonstrando que as cinco atletas foram submetidas ao treinamento de mais de uma categoria durante a fase de formação esportiva e a precocidade no treinamento com equipe adulta, durante as temporadas de 2001/2002 e 2002/2003. As lesões que ocorreram em maior quantidade foram as por sobrecarga e o tempo de afastamento para resolução ou melhora da dor ou da lesão não eram priorizados. A maior parte das lesões ocorreram durante os treinos e o membro inferior foi o mais acometido. / Nowadays the concern related to the injuries that affect the high performance athletes in sports has been the reason of great inquiry and scientific discussion. The present study had as its objective to know and identify the risk factors that contributed to the rawboned muscles injuries of five athlete of the volleyball events in a high performance team, during two seasons of competition. The investigation is characterized as a study cases, that used as research instruments: interview, questionnaire of injury, register of data (training spread sheets), documentary analysis (handbooks). The results of the investigation had been categorized demonstrating that the five athletes had been submitted to the training of more than a category during the sporting formation phase and the precocity in the training with adult team, during the seasons of 2001/2002 and 2002/2003. The injuries that had occurred in bigger amount were the overload ones, and the removal time for resolution or improvement of the pain or injury were not prioritized. Most injuries had occurred during the training and the low member was more affected.

Hoje a preocupação quanto às lesões que acometem os atletas de alto rendimento no esporte tem sido motivo de grande investigação e discussão científica. O presente estudo teve como objetivo conhecer e identificar os fatores de risco que colaboraram para as lesões músculoesqueléticas de cinco atletas da modalidade voleibol em uma equipe de alto rendimento, durante duas temporadas de competição. A pesquisa caracteriza-se como estudo de casos, que utilizou como instrumentos de investigação: entrevista, questionário de lesão, registro de dado (planilhas de treinamento), análise documental (prontuários). Os resultados da investigação foram categorizados demonstrando que as cinco atletas foram submetidas ao treinamento de mais de uma categoria durante a fase de formação esportiva e a precocidade no treinamento com equipe adulta, durante as temporadas de 2001/2002 e 2002/2003. As lesões que ocorreram em maior quantidade foram as por sobrecarga e o tempo de afastamento para resolução ou melhora da dor ou da lesão não eram priorizados. A maior parte das lesões ocorreram durante os treinos e o membro inferior foi o mais acometido. / Nowadays the concern related to the injuries that affect the high performance athletes in sports has been the reason of great inquiry and scientific discussion. The present study had as its objective to know and identify the risk factors that contributed to the rawboned muscles injuries of five athlete of the volleyball events in a high performance team, during two seasons of competition. The investigation is characterized as a study cases, that used as research instruments: interview, questionnaire of injury, register of data (training spread sheets), documentary analysis (handbooks). The results of the investigation had been categorized demonstrating that the five athletes had been submitted to the training of more than a category during the sporting formation phase and the precocity in the training with adult team, during the seasons of 2001/2002 and 2002/2003. The injuries that had occurred in bigger amount were the overload ones, and the removal time for resolution or improvement of the pain or injury were not prioritized. Most injuries had occurred during the training and the low member was more affected.

No description available.

Three investigations were conducted in order to investigate the effect of dietary probiotics on tilapia (Oreochromis niloticus) growth performance, intestinal morphology, intestinal microbiology and immunity. The first experiment demonstrated that Bacillus subtilis, Lactobacillus reuteri and Pediococcus acidilactici supplemented individually and as a mixed probiotic (in addition to Enterococcus faecium; AquaStar® Growout) were capable of modulating intestinal microbial populations as determined by culture dependent methods and DGGE. Furthermore, high-throughput sequencing reported that >99% of 16S rRNA reads in the mixed probiotic group belonged to the probiotic genera, predominantly assigned to Enterococcus (52.50%) and Bacillus (45.94%). Tilapia in the mixed probiotic group displayed significantly higher intraepithelial leucocyte (IEL) populations in the mid intestine when compared to the control and L. reuteri treatment. The mixed probiotic also improved microvilli density and had a higher absorptive surface area when compared to the control. In the second trial, after six weeks of supplementing tilapia diets with AquaStar® Growout at 3g kg-1, fish demonstrated significantly higher final weight, weight gain and SGR when compared to that of the control (void of probiotic) treatment or an initial probiotic feed (lasting two weeks) followed by control feeding. Probiotic supplementation at 3g kg-1 also caused an increase in the abundance of intestinal IELs and goblet cells and an up-regulation in the gene expression of intestinal caspase-3, PCNA and HSP70 and immunity genes TLR2, TNFα, IL-1β, TGFβ and IL-10 when compared with the expression of control replicates. These changes were not observed when supplementing tilapia diets with a lower dose (1.5g kg-1), nor when supplementing the probiotic in either a pulsed manner or as an initial feed (two weeks) followed by control feeding. Trial three revealed that the probiotic had a more discrete effect on the intestinal allochthonous microbiota as 16S rRNA reads assigned to probiotic genera only accounted for 5-10% of total reads. Nevertheless, the supplementation of dietary AquaStar® Growout at 3g kg-1 improved the localised immune response in tilapia, through the regulation of immunity genes TLR2, MYD88, NFκB, TNFα, IL-1β, TGFβ and IL-10, larger populations of goblet cells and a higher recruitment of IELs. Furthermore, the probiotic also improved the systemic immune response through the regulation of immunity genes (mentioned above) in the head kidney and significantly higher circulating leucocyte levels in whole blood. The extent of these changes were dependent on the probiotic treatment (i.e. continuously supplemented in feed or alternating weekly between probiotic at 3 g kg-1 and control feeding), the duration of feeding and the parameter investigated. This research demonstrates that B. subtilis, L. reuteri, P. acidilactici and AquaStar® Growout can modulate the intestinal microbiota. In addition, AquaStar® Growout can improve intestinal morphology, growth performance and modulate both the localised and systemic immune responses of tilapia when supplemented through the feed at the appropriate dosage and feeding regime.