In America, certain attributes and behaviors become more publicly acceptable and more prominent in personalities as an individual matures in their chosen career path. The elite position in society of medical practitioners has been threatened during the 20th Century by new and increasing market pressures. The main hypotheses addressed in this project is the determination of the directional change of the attitudes that represent professionalism as a physician gains experience in the current medical environment and whether these attitudes change as a result of rural setting or specialization in medical practice. This project will also try to determine the reliability of a Likert scale survey instrument, designed and refined through principals of organization behavior theory in the late 1960s by Richard H. Hall. Using this tool, professional attitudes were measured in an original sample of randomly selected physicians drawn from the membership of a rural medical organization and differences were examined using bivariate analyses. The additional influences of medical tenure, organizational size and discipline specialization were also analyzed using bivariate analysis to determine if life experience (tenure, location and specialty choice) positively affects core attitudes of professionalism in medical practice. Results reflect the changing market environment and population demographic changes in rural medical practice, while also demonstrating a significant difference between physicians practicing solo without the support of a group structure. / Master of Science

Thesis advisor: Paul Gray / Since Fidel Castro rose to power in Cuba over fifty years ago, U.S.-Cuban relations have been defined by mutual hostility. As the hegemon of the Western Hemisphere, the United States has labored to combat this repressive force that threatens democracy only ninety miles from its shores. In this paper, I analyze the embargo against Cuba and the Cuban Medical Professional Parole Program, both of which are U.S. government initiatives intended to weaken the Cuban government. I find that neither of these initiatives has been effective and that the United States’ failure to reevaluate longstanding and unsuccessful policies is detrimental to the populations they are intended to serve. In order to create more effective programs, the United States government must consider human rights in its decisions, continuously follow through with and reevaluate its policies, and ensure that initiatives are in the best interest of all parties involved. / Thesis (BA) — Boston College, 2013. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: International Studies Honors Program. / Discipline: International Studies.

Diss. Linköping : Univ.

The aim of this thesis called "Disciplinary liability of health care professionals, relationship to criminal liability" is to analyse and compare criminal and disciplinary liability in medicine and outline their relationship. Considering its topicality and interdisciplinary character, I found this matter to be very inspiring. Although the medical liability issue seems to be very popular and frequently discussed subject, there are some aspects and problems that need to be sorted out in order to provide the doctors with a minimal standard of legal certainity. The thesis is composed of five chapters, each of them dealing with different aspects of any kind of liability rising out of medical profession. First chapter is subdivided into four parts briefly describing civil, labour, administrative and contractual liability relating to medicine. Chapter two focuses on criminal liability of doctors and composes of eight parts. First two parts reffer to the risk of fault, that any doctor can cause, and the ultima ratio principle. Part three illustrates the conditions of criminal liability. Part four adressess the issue of circumstances excluding illegality in medicine. Part five and six present the nature of medical intervention and define the term of health care professionals. Part seven and eight deals...

This thesis reports on the development of an Australian Government English as a Second Language test for health professionals, the Occupational English Test (OET) , and its validation using Rasch Item Response Theory models. / The test contains sub-tests of the four macroskills, each based on workplace communication tasks. The thesis reports on the creation of test specifications, the trial ling of test materials and the analysis of data from full test sessions. / The main research issues dealt with are as follows: / 1. The nature of the constructs involved in communicative language testing. The term proficiency is analysed, and its relationship to a number of models of communicative competence examined. The difficulty of incorporating into these models factors underlying test performance is identified. / 2. The nature of performance tests. A distinction is introduced between strong and weak senses of the term performance test, and related to the discussion in 1 above. / 3. The content validity of the OET. This is established on the basis of a questionnaire survey, interviews, examination of relevant literature, workplace observation and test data. / 4. The role of classical and Rasch IRT analysis in establishing the qualities of the test. Classical and Rasch IRT analyses are used to establish the basic reliability of the OET sub-tests. The Writing sub-test is shown to be somewhat problematic for raters because of the nature of the writing task involved. Analysis of data from the Reading subtest demonstrates the superiority of the Rasch analysis in the creation of short tests with a specific screening function. / 5. The role of Rasch IRT analysis in investigating the construct and content validity of the test and hence of communicatively-oriented tests in general. Rasch analysis reveals that the sub-tests are satisfactory operationalizations of the constructs 'ESL listening/ speaking/ reading/ writing ability in health professional contexts. For the Speaking and Writing sub-tests, the analysis reveals that responses of raters in categories associated with perceptions of grammatical accuracy have a more important role in the determination of the candidate's total score than was anticipated in the design of the test. This finding has implications for the validity of communicatively oriented tests in general, and illustrates the potential of IRT analysis for the investigation of the construct validity of tests. / 6. The appropriateness of the use of Rasch IRT in the analysis of language tests. The nature of the debate about 'unidimensionality' in Rasch analysis is reviewed. It is argued that the issue has been substantialy misunderstood. Data from the two parts of the Listening sub-test are analysed, and statistical tests are used to confirm the unidimensionality of the data set. It is concluded that Rasch analysis is appropriate for a language test of this type. / 7. The behaviour of raters in the rating of oral and written production in a second language. The findings reported in 5 above suggest that the behaviour of raters is crucial to understanding what is being measured in a communicative test of the productive language skills. / The research demonstrates the value of Rasch IRT analysis in the empirical validation of communicatively oriented language tests, and the potential of large-scale test development projects for theoretical work on language testing.

醫院屬於非營利性機構，不以追求最大利潤為其績效標準，故醫院管理與一般企業管理在本質上便有所不同。在長期觀察醫院的經營情況中，醫院內部長久以來存在於醫療體系與行政體系之間的衝突，成為當今醫院內部重要的管理問題。因此，本研究擬根據醫療體系與行政體系之間的互動情形，歸納出醫院類型的區分構面，希望對於醫院的經營與管理能提供正面而積極的建議。此外，全民健康保險已於民國84年3月1日起正式實施，此一政策對於醫療院所的影響極為深遠，造成台灣醫療生態環境以及醫院管理方式大幅度的改變，並使得業者殷切期盼新的醫院管理之道。 本研究以醫院評鑑等級在地區教學醫院（含）以上的醫院為研究對象。首先透過個案研究，尋找醫院內部互動類型的適當分類構面以及控制機制的選用情形，並提出研究假設。接著再以實證方式，驗證研究假設。經篩選醫院名單後，合格樣本數為112家，回收有效問卷為47份，而檢定結果支持大部分的假設。本研究的具體發現分述如下： 1.醫院可以根據「專業取向」與「行政取向」兩個分類構面，將醫院區分成專業取向較高的「專業取向型」、行政取向較高的「行政取向型」、以及兩者皆高的「互動協調型」三類。 2.互動關係偏向專業取向的「專業取向型」，在全民健康保險實施前，其選用的控制機制，由最高至最低依次為官僚控制機制、文化控制機制、市場控制機制。然而專業取向型醫院在三種控制機制選用之間並無顯著差異，但與其他類型醫院比較，其選用控制機制的絕對值均小於互動協調型。在全民健康保險實施後，其選用的控制機制，由最高至最低依次為官僚控制機制、市場控制機制、文化控制機制。然而專業取向型醫院在三種控制機制選用之間並無顯著差異，但與其他類型醫院比較，其選用控制機制的絕對值亦均小於互動協調型。 3.互動關係最複雜的「互動協調型」，在全民健康保險實施前，其選用的控制機制，由最高至最低依次為官僚控制機制、文化控制機制、市場控制機制，且三種控制機制之間有顯著差異。在全民健康保險實施後，其選用的控制機制，由最高至最低依次為官僚控制機制、市場控制機制、文化控制機制，且三種控制機制之間亦有顯著差異。 4.互動關係偏向行政取向的「行政取向型」，在全民健康保險實施前，其選用的控制機制，以市場控制機制與官僚控制機制同高，其次為文化控制機制，且三種控制機制之間有顯著差異。在全民健康保險實施後，其選用的控制機制，由最高至最低依次為市場控制機制、官僚控制機制、文化控制機制，且三種控制機制之間亦有顯著差異。 由上述研究結果可知，醫院混合採用不同的控制機制。當醫院內部互動關係偏向專業取向時，醫院使用的三種控制機制雖有差異，然其三種控制機制之間的差異並未達顯著水準。當醫院內部互動類型偏向互動協調型時，醫院相對地高度使用標準化的規定與程序，所以互動協調型醫院在官僚控制機制的選用程度上最高。當醫院內部互動類型偏向行政取向時，醫院相對地高度使用可明確衡量的產出，所以行政取向型醫院在市場控制機制的選用程度上最高。 第一章 緒論 第一節 研究動機 第二節 研究問題與研究目的 第三節 研究假定與研究限制 第二章 文獻探討 第一節 醫院概論 第二節 醫院內部互動類型 第三節 控制機制 第四節 醫院內部互動類型與控制機制間的關係 第五節 醫療政策與全民健康保險 第三章 個案分析 第一節 個案研究方法說明 第二節 個案一：甲醫院 第三節 個案二：乙醫院 第四節 個案三：丙醫院 第五節 個案比較分析 第四章 研究方法 第一節 研究架構的建立 第二節 研究變數定義與衡量 第三節 研究假設 第四節 樣本選擇與資料蒐集 第五節 資料分析方法 第六節 問卷的效度與信度 第五章 結果與討論 第一節 樣本描述 第二節 醫院內部互動類型 第三節 醫院內部控制機制 第四節 醫院內部互動類型與控制機制間的關係 第五節 全民健保實施的影響 第六節 假設驗證 第六章 結論與建議 第一節 研究結論 第二節 理論與實務涵義 第三節 後續研究建議 參考文獻 一、中文部份 二、英文部份 附錄 附錄一：醫院起源 附錄二：醫院產品 附錄三：醫院通路 附錄四：醫療品質 附錄五：傳統的醫院分類方法 附錄六：策略觀點的醫院分類方法 附錄七：研究問卷 附錄八：互動類型與權屬別、評鑑等級的關係 附錄九：互動類型與醫院產出的關係 附錄十：控制機制的因素分析 附錄十一：控制機制組合的變化 附錄十二：控制機制的其他影響因素 附錄十三：問卷個別項目分析結果 / Applying control theory, this paper examines the relationship between types of interaction and adoption of control mechanism. After investigating 47 hospitals in Taiwan, we found that there exists strong relationship as described by four hypotheses. Based on “professional orientation” and “administrative orientation”, the hospitals can be classified into three types of interaction, namely, “professional orientation”, “interaction harmony”, and “administrative orientation”. The literature review suggests three types of mechanisms. These mechanisms are market, bureaucratic, and culture control. After empirical survey, this research has three major findings. First, for interaction harmony hospitals, they prefer to adopt bureaucratic control mechanisms, while administrative orientation hospitals prefer to adopt market control mechanisms. As to professional orientation hospitals, there is no significant difference on adoption of three control mechanisms. Second, to compare the intensities of various control mechanisms adopted by different types of hospitals, this study finds that administrative orientation hospital has the highest intensities both on market control and bureaucratic control. As to the adoption of cultural control, there is no significant difference among three kinds of hospitals. Finally, the research finds that the implementation of National Health Insurance has significant impact on the intention of adopting various control mechanisms.