Opportunities for supporting physician continuing professional development (CPD) may exist through careful instructional design and creative use of information and communication technology. The overarching goal of this study was to explore the learning experiences and outcomes of cardiologists participating in a web conference (“webinar”) series to understand the factors that can support webinars in being an appealing and satisfying CPD medium for these learners. Acknowledging that a pedagogically-based framework for program design is a cornerstone of effective CPD (Hutchinson & Estabrooks, 2009; Inan & Lowther, 2007; Casimiro, MacDonald, Thompson, & Stodel, 2009), this study used the W(e)Learn Framework (MacDonald, Stodel, Thompson, & Casimiro, 2009) as a process guide and quality standard for program design, development and delivery. Cardiologists voluntarily participated in an educational webinar series in which they shared their observations and experiences. Informed by the results of a systematic review of physician eLearning design preferences, this dissertation serves as a mechanism to learn about how webinars can be implemented to support learning and practice change within a population of highly specialized physician learners. Methodological approaches included a systematic review of literature examining physician preferences for eLearning design, a case study of webinar implementation, and interviews with cardiologists who participated in the webinars. The findings of the systematic review, the case study and the interviews aligned to characterize key considerations in webinar implementation. Webinar designers must carefully determine program structures, content, and media to create a satisfying learning experience. Cardiologists seek a webinar experience that responds to their professional reality of competing priorities, complex patients, and ambiguous clinical questions. They seek a mix of evidence-based, authentic and challenging content, delivered by credible content experts. The study found that purposefully designed webinars can be a satisfying learning experience for cardiologists with the potential to influence changes in knowledge and practice. The use of an instructional design framework may structure and enrich webinar implementation; this dissertation encourages their use.

Corporal punishment is a controversial form of discipline. To inform the debate on corporal punishment, one of the objectives of the current dissertation was to characterize parental use of this disciplinary strategy and to examine its long-term developmental outcomes. The dissertation drew on data from the National Longitudinal Survey of Children and Youth (NLSCY) to understand potential social change in corporal punishment and to characterize parents who continue to use this strategy. Over a 14-year period (1994-1995 to 2008-2009), results revealed a significant decrease in the use of corporal punishment and other negative strategies (e.g., psychological aggression), as well as a significant increase in the use of positive strategies (e.g., reward/praise and explain/teach). Nevertheless, approximately 25% of Canadian parents still use corporal punishment with children aged 2–11 years; therefore, it remains an issue that merits continued attention. While several socio-demographic factors significantly distinguished parents who use corporal punishment, other more dynamic variables may be important to consider, such as parental stress and their attitudes toward corporal punishment. For the outcomes associated with corporal punishment, NLSCY data revealed that experiences of corporal punishment at 2-3 years are associated with increased externalizing behaviours at 8-9 years. Results also indicated that, within a certain disciplinary context (more hostile and punitive parenting), early corporal punishment is associated with increased externalizing behaviours at 14-15 years, increased internalizing behaviours at 8-9 and 14-15 years, and reduced prosocial behaviours at 8-9 and 14-15 years. Overall, results confirmed that corporal punishment represents a small but non-trivial risk factor for child development. The second objective of the current dissertation was to address one of the central limitations of the existing literature on corporal punishment by clarifying what parents self-label as corporal punishment. Using a sample of 338 Canadian caregivers, the study assessed the relation between responses to a general question on corporal punishment and responses to questions on specific physical disciplinary strategies. Predictors (e.g., cultural norms, attitudes toward and childhood experiences of corporal punishment) of this relation were then investigated. Results suggested that questions such as the one used in the NLSCY may reflect parental use of milder forms of corporal punishment. Results also revealed that some caregivers remain undetected by general questions on corporal punishment. Factors such as attitudes toward corporal punishment can help identify those caregivers who use physically punitive strategies but who do not endorse corporal punishment. Results from the current dissertation offers support for the anti-corporal punishment perspective and calls for the de-legitimatization of this disciplinary strategy across society.

Class of 2017 Abstract / Objectives: Our working hypothesis is that patients who opt in to pharmacist counseling will have a higher medication possession ratio and longer length on therapy than patients who opt out of pharmacist counseling. Methods: Using data extracted from patient’s charts we retrospectively calculated medication possession ratio and length on therapy in relation to the patient receiving or not receiving counseling. Results: The patients analyzed were receiving 8 specific oral oncolytic medications provided by Avella Specialty Pharmacy in 2015. There were no significant differences found in MPR values for any of the 8 oral oncolytic medications included in the study. Iressa (p=0.826), Lonsurf (p=0.392), Stivarga (p=0.838), Zydelig (p=0.633), Zykadia (p=0.077), Tagrisso (p=0.060), Imbruvica (p=0.263) and Tarceva (p=0.326). No statistically significant differences were found in LOT values for any of the 8 oral oncolytic medications included in the study. Iressa (p=0.885), Lonsurf (p=0.868), Stivarga (p=0.326), Zydelig (p=0.502), Zykadia (p=0.212), Tagrisso (p=0.089), Imbruvica (p=0.540), Tarceva (p=0.129). Conclusions: Pharmacist counseling does not appear to affect MPR or LOT for patients taking oral oncolytic medications. Further research is warranted targeting other chronic disease states with complex oral regimens where medication adherence has not already been established from prior therapy options and adequate disease state knowledge.

Background: Referral from the Criminal Justice System (CJS) is a key, common route into drug misuse treatment. It is important to know whether, and how, it impinges on treatment outcome, particularly in relation to motivational states that may influence behaviour change.Aim: To assess the association between motivational state and level of treatment coercion, and the effects of these on treatment engagement and outcome, among a sample of drug misuse treatment seekers in England.Setting: Patients were sampled from 342 community and residential drug misuse treatment services within 94 (of 149) commissioning areas in England during 2006-07. All patients seeking drug misuse treatment at these services were eligible for inclusion. Methods: The Circumstances, Motivation, and Readiness scale provided measures of propensity for treatment including specific sub-scores for circumstances, motivation and readiness for treatment. The degree of referral coercion was categorised according to the level of CJS involvement: CJS referral with a condition of attendance; voluntary CJS (no attendance condition); non-CJS. Predictors of propensity were examined using linear regression, with particular emphasis on level of coercion. The predictive nature of coercion and propensity in relation to treatment uptake and threshold points for duration of treatment retention was examined using logistic regression models. Cox proportional hazard models examined associations with linear measures of treatment duration. Analysis of treatment outcome focussed on changes in: the value of drugs used; severity of dependence score; and level of offending. Relationships between these measures and coercion and propensity were examined using quantile, linear and logistic regression models. These were further supported by longitudinal models, incorporating instrumental variables for continuous outcomes to account for potential time related confounding. Results: No negative association was observed between level of coercive referral and levels of motivation or readiness for treatment and conditional referral was positively associated with motivation at the point of treatment entry. Both readiness for treatment and coercion predicted treatment retention for three months, although previous treatment experience treatment and use of heroin were the most consistent predictors of retention. Increasing pre-treatment motivation predicted greater reduction in the value of drugs used but not changes in the level of offending. Neither propensity sub-scores nor coercive referral predicted change in dependence severity. However, coercion was associated with cessation of offending among opiate /crack users. Conclusions: Propensity and coercion have mutually exclusive effects on different aspects of behaviour change. Coercion can positively affect treatment retention but changes in drug taking behaviour are more strongly associated with level of intrinsic motivation. Assessment of propensity, including its motivational components, at treatment entry could inform treatment delivery but its importance should not overshadow that of other factors, which may exert more important effects. Coercive CJS referral is not detrimental to treatment success and may have particular benefits for specific populations, but the cost effectiveness of diversionary schemes should be considered.

Philosophiae Doctor - PhD / Transforming economic growth into tangible benefits for poor communities appears to have frustrated development practitioners and policy makers. Despite the net positive growth achieved between 1994 and 2014 the face of poverty and inequality remains largely unchanged in South Africa. In such circumstances there is a pressing need for scholars to rethink the social foundations of economic activity and policy (Chang, 2006; Fine, 2001, 2005). One specific line of enquiry that has attracted attention among economists (Stiglitz, 2000; Woolcock, 2001; Fine, 2001) is that of social capital. This thesis seeks understanding of the relationship between social capital and the socioeconomic advancement of poor African/Black residents, particularly those in rural municipalities where there is a lack of financial and other resources. With this in mind, Robert Putnam’s path-breaking theory will be reformulated to explore the relationship during the mid-2000s between social capital, trust, political participation and socioeconomic outcomes in two rural municipalities in the Western Cape province of South Africa, namely Cederberg and Matzikama. The research questions the adequacy of Putnam’s theory of social capital, arguing that it is conceptually simple and inadequate as a description of how membership in social groups (networks) lead to better socioeconomic outcomes in the context of marginal, rural African/Black communities residing in under-capacitated municipalities. The thesis argues that an alternative conceptual framework is required, capable of depicting the complexity of the social processes required to translate social group membership into tangible benefits for poor households, as an explanation of why African/Blacks in Cederberg experienced better socioeconomic outcomes than their counterparts in Matzikama.

No description available.

MURP / Department of Urban and Regional Planning / Current studies reveal that adjacent municipalities can achieve more if they plan and share resources collaboratively. The study assessed the impact of trans-border spatial development cooperation with respect to a twinning agreement signed between the Musina local municipality, South Africa, and the Beitbridge Rural District Council, Zimbabwe in October 2004. It unpacks to the extent to which the twinning agreement objectives were achieved in terms of spatial development. The assessment revolved around six specific objectives using a trans- border twinning performance evaluation survey approach. The assessment of the implementation of the agreement focused on desirable outcomes, inputs in terms of resources, the implementation process involved in terms of effectiveness and efficiency, outputs in terms of targets achieved, impact with respect to where they are now, who needs to do what and when and whether the planning and implementation process was effective. Research questions were investigated using 14 key informant interviews, 347 questionnaires and direct field observations with the aid of an impact evaluation survey approach. The study showed that the challenges faced in municipal twinning agreements range from institutional, structural to financial. It was evident that the Musina-Beitbridge twinning agreement did not have a concrete implementation plan from 2004 to 2016. The spatial planning goals indicated in the twinning document were not achieved. The Joint coordination meetings were no longer being conducted, benchmarking exercises were not conducted, the goals were not time-bound, there was no standalone budget, no central secretariat and lastly, the majority of the local residents were not aware of the twinning’s existence. The study recommended a strategic trans-border implementation framework which addresses initial planning provisions, resource allocation, stakeholder participation and ensuring that targets are achieved as well as mitigating risks.

Introduction: Involvement of the forefoot is common among patients with Rheumatoid Arthritis. It results in severe deformities with significant disabilities. Aim: The aim of this study was to compare and assess in patients with Rheumatoid Arthritis in a South African population the outcomes of severe forefoot deformity reconstruction surgery in the short- to medium-term and in particular focusing on radiological, clinical, and functional outcomes. Patients and Methods: A retrospective review of 19 patients who received reconstructive forefoot surgery for forefoot deformities resulting from Rheumatoid Arthritis was undertaken. They all underwent Modified Hoffman Surgical Reconstruction (first MTPJ fusion and lesser toe resection arthroplasty). The patient records between 2013 and 2016 were reviewed. Pre-operative and post-operative outcome scores were collected. Final postoperative radiographs were analyzed. Patients completed Short Form 36 and AOFAS forefoot scores. Post-operative scores were collected 6 months post-op. Results: There were 19 patients in the study with a minimum 6 months follow up. Of the 19 patients 17 (89.5%) were females and 2 (10.5%) males. The mean age was 54.9 ± 9.6 years (range: 34 – 69 years). Most patient outcomes (SF36, AOS alignment, VAS Pain percentage, and VAS Disability percentage) significantly improved with a p value < 0.05, when comparing the pre-operative versus post-operative variable scores. However, only AOS Alignments showed no significant difference between pre-operative and post-operative scores (p>0.05). Conclusion: Reconstructive forefoot surgery with the Modified Hoffman Surgical Reconstruction provides marked radiological correction, with significant improvements in the quality of life of the cohort of patients.

Emotional labor can be defined as the degree of manipulation of one's inner feelings or outward behavior to display the appropriate emotion in response to display rules or occupational norms. This study concerns the development of an emotional labor model for the hospitality industry that aims at identifying the antecedents and consequences of emotional labor. The study investigates the impact of individual characteristics on the way emotional labor is performed; it investigates the relationships among the different ways of enacting emotional labor and their consequences, and addresses the question of whether organizational characteristics and job characteristics have buffering effects on the perceived consequences of emotional labor, which are emotional exhaustion and job satisfaction. This study involves the rigorous development of a 10 item scale, the Hospitality Emotional Labor Scale, to measure the emotional labor that employees perform. the results of the study conformed to a two-factor structure of emotional labor: emotive dissonance and emotive effort. these two dimensions tap three types of service-acting that employees perform: surface acting, deep acting, and genuine acting. The scale was used to survey 285 hotel employees. Structural equation modeling (SEM) and moderated multiple regression (MMR) were employed to examine the proposed model, as well as to test the hypotheses. It was found that both surface acting (high emotive dissonance) and deep acting (emotive effort) associate positively with job satisfaction and negatively with emotional exhaustion. Genuine acting (low emotive dissonance) was found to associate positively with emotional exhaustion and negatively with job satisfaction. This study did not find strong relationships among the antecedents (affectivity and empathy) and emotional labor factors. Similarly, the proposed moderators (job autonomy and social support) were not found to moderate the relations between emotional labor and its consequences. In sum, this study found that both deep acting and surface acting lead to positive work outcomes, but genuine acting leads to negative work outcomes. The results provide support for prior qualitative studies. Further, deep acting plays an important role in determining employees' work outcomes. Based on these significant research findings, detailed theoretical and practical implications were discussed. / Ph. D.

Objective: The Florida Adult Trauma Triage Criteria (FATTC) define specific parameters concerning injury mechanism and physiologic data that prompt paramedics to initiate a trauma alert and necessitate transport to a trauma center. In the state of Florida, paramedics are also given discretion to bring patients to the trauma center who do not meet those criteria. Our aim was to compare the injury characteristics and outcomes of adult patients who were evaluated in our trauma center after activation due to FATTC criteria vs. paramedic discretion (PD) and to identify predictors of PD. Methods: This retrospective study included all patients 18 years and older evaluated in our trauma center from January 1, 2007, to December 31, 2014. Descriptive statistics were computed for all variables. Bivariate and multivariate analyses were performed to compare demographic, injury severity, and outcome differences between groups. Results: A total of 13,963 patients met FATTC during the study period, and 1,811 were brought in by PD. PD patients had lower injury severity and crude mortality. Regression modeling of demographic and injury variables found that only the combination of older age and higher heart rate predicted PD when both were lower than FATTC alone. Conclusions: While PD patients were less seriously injured and had lower mortality, they experienced similar lengths of stay and resource utilization after presentation. Paramedics may be able to identify patients at risk for poor outcomes who would otherwise not be captured by FATTC.