The access to higher education has been massively expanding which has impacted on quality of education, assessment system, learning environment, teaching and learning approaches at classroom level. In encountering with the massification, Cambodian and Thai governments are struggling to provide students with excellent academic performance and employable graduates in the competitive labor market of today. English language was one of the key tools for the students to acquire knowledge and skills for the national, regional and international marketplace. This research aims to provide comparative understanding of how undergraduates learn and achieve their academic outcomes through English curriculum in the contexts of Cambodia and Thailand. The objectives of the study are to compare levels, relationships and predictability of learning approaches and learning outcomes achieved by the undergraduate students. The total samples of 186 key informants were the undergraduate students from Cambodia (n=97) and Thailand (n=89) who enrolled in year 3, 4 and fresh graduates of English major in two respective universities. The data collection method was gathered through a self-rating online survey employing RASI and CEQ questionnaires to measure the perceptions. The descriptive data, correlation coefficients, and multiple linear regression were used for the comparative data analysis. The study yielded different levels of learning approaches and similar degrees of learning outcomes in the two groups. The students from Cambodia gained higher level of utilizing deep approach to learning (M=3.79) and they were found to achieve higher GPA on average (67%). The finding not only indicated similar significant relationships (p<.05) between the models in each group but also showed different levels of influences on students’ learning achievement. The strongest predictor of learning outcomes (R2=.34) was explained by deep approach to learning for Cambodian group whereas the learning outcomes for Thai group (R2=.47) were predicted by strategic and deep approaches to learning. The study also suggested that teachers and relevant educational actors encourage students to use deep and strategic approaches while demotivating surface approach to learning in order for the students to achieve better learning outcomes both qualitatively and quantitatively so that they acquire competitive qualification for their future career goals.

This study is essentially a representation of my lived experience of my professional development as a teacher from the moment of my enrollment in a teacher education programme through my initial appointment as a professional teacher and my continued post graduate studies in education while being a teacher. However, I was faced with the challenge that I had no prior experience of the newly adopted Outcomes Based Education system which I will need to operate in when qualified. This drawback made me even more determined to make a success of my career. I therefore decided to engage in a qualitative participatory action research study to ensure that I will continually improve my OBE practices in a scholarly way. The study conveys the challenges I faced as a student teacher in a career path of initial teacher education aggravated by an unfamiliar education dispensation, my subsequent initiation into my career as a professional teacher, and my quest to remain a scholarly practitioner by enrolling for post graduate teacher education studies. I may have found a way in which effective continual professional development in a scholarly way may be available to every teacher besides that of formal post graduate studies. / Dissertation (MEd)--University of Pretoria, 2011. / Curriculum Studies / unrestricted

Parental interference in high conflict divorce cases continues to evoke much debate among mental health professionals in the forensic psychology field. Although over the past thirty years, some empirical studies have been conducted regarding the long-term psychological impact of adults that experienced parental interference as children, few studies have examined the impact that this phenomenon has on children during and immediately following divorce proceedings. The present study utilized an original data set that was collected with fifty-five families (e.g., mother, father, and oldest child) from de-identified reports completed by two private Court-appointed licensed clinical-forensic psychologists. The overarching purpose of the present study was to gain further insight into identifying the impact that parental interference had on the psychological functioning within the identified sample. Moreover, the first purpose of this paper sought to highlight the specific domains that children and adolescents are negatively affected by as a result of parental interference within the present sample. Overall, results yielded no significant differences between groups regarding reported (self, teacher, and parent report) elevations on BASC-2 outcomes for children and adolescents. However, the results of a step-wise regression analysis suggested that female children and adolescents were more likely to have mothers rate them highly on the anxiety scale of the BASC-2. Limitations and suggestions for future research were discussed.

Increased adoption of health information systems in clinical practice has set a foundation for use of this data for Business Intelligence (BI). BI is the use of specialized tools to collect, analyze, and present organizational data to operational leaders in user-friendly formats to support organizational objectives. This is a routine component of management practice in sectors such as finance and manufacturing but has not yet reached its full potential in the health sector where limited availability of BI systems and factors such as data quality, complexity, and access to data have been identified as barriers. Correspondingly, there are no established conceptual models for measuring successful adoption of BI in the health sector. This dissertation study proposes a Business Intelligence Benefits Model for Health derived from frameworks used in other sectors and establishes health sector measures for two foundational constructs, BI Assimilation and Health System Organizational Performance. Through an online Delphi consensus process involving 25 Canadian health leadership panelists from four provinces, the study establishes a total of 30 concept measures for these constructs. Only seven (23.3%) of the concepts identified by the panelists in the study are reflected in an established non-health sector framework, the Business Value of BI Model, validating the need for sector specific measures. The study also compares priorities between leadership groups: top management team versus operational managers; and, leaders with a nursing related portfolio versus those without. The comparisons demonstrate variations among these groups but consistency in requirements overall. Establishing these BI constructs for healthcare is a precursor to measuring BI success and informs priorities and approaches for BI implementation as well as further instrument development. / Graduate

This thesis is comprised of three chapters that empirically examine two important areas in health economics: access to health care and health outcomes. The first chapter explores the impact of health care utilization on unmet health care needs (UHC) using four biennial confidential master files (2001-2010) of the Canadian Community Health Survey and applying an instrumental variables (IV) approach to deal with the endogeneity of health care utilization. The presence of drug insurance and the number of physicians in each health region are used to identify the causal effect. I find a clear and robustly negative relationship between health care use and unmet health care needs; individuals who are more likely to report unmet health care needs are those who use the health care system less frequently. One more visit to a family doctor, specialist or a medical doctor on average, decreases the probability of having unmet health care needs by 7.1, 4.6 and 2.8 percentage points, respectively. Further analysis by sub groups reveals that the impact of health care utilization on UHC is larger for females in comparison to males, rural residents in comparison to urban dwellers and those with low household income rather than high. The second chapter of this thesis examines whether the presence of the unmet health-care (UHC) needs has an adverse effect on health outcomes using the National Population Health Survey, a nationally representative longitudinal data set spanning 18 years. I pay close attention to the potential endogeneity of this problem. Five direct and indirect measures of health-related outcomes are examined. I find clear and robust evidence that the presence of UHC either two-years previously or anytime in the past, affects negatively the current health of the individual – controlling for a host of other influences. For instance, reporting UHC in the previous cycle reduces the probability of being in excellent or very good health and in good mental health, respectively by 8.1 and 1.2 percentage points; it reduces the HUI3 score by 2.9 percentage points and increases the expected number of medications used by 11%. Further analysis by looking at the effect of UHC when it was due to accessibility reasons, reveal that the effect of UHC because of accessibility reasons on health outcomes is larger than the one of the overall UHC, but the difference is small in general. Finally, the third chapter of this thesis examines the link between social networks and access to health care utilization, focusing particularly on the probability of having a regular family doctor. Unlike previous work that uses cross sectional data, I use panel data from the National Population Health survey to control for unobserved heterogeneity. Access to a regular family doctor is modeled using the dynamic random effects probit model, which makes it possible to explore the dynamics of access to a regular family doctor– for instance, the role played by past access status to a family doctor in predicting current access. In particular, I use the dynamic random effects probit model that controls for both unobserved heterogeneity and for initial conditions effects. I find robust evidence of a highly statistically significant relationship between social capital and the probability of having a regular family doctor. Although the marginal effects are modest, the results from all model specifications show that there is clear evidence that individuals with high levels of tangible, affection, emotional, social interaction, who live with spouse only or with spouse and children are more likely to have a regular family doctor, whereas those living alone are less likely to have a regular family doctor. The results also reveal that past access to a family doctor is an important determinant for both current and future access. The predicted probability of having a regular family doctor is about 18 percentage points (or 20%) higher for individuals who had a family doctor in the previous period, relative to those who did not. In addition, I find that unobserved heterogeneity accounts for about 25% of the variation in accessing a regular family doctor and is significantly correlated with the access to a family doctor over my long panel.

Class of 2017 Abstract / Objectives: The objective of this retrospective cohort chart review was to evaluate the safety and efficacy of extended infusion beta-lactam regimens as part of treatment of acute CF pulmonary exacerbations in adults and pediatric patients. Methods: Inclusion criteria: adult and pediatric patients (age 1 month or older) with CF diagnosis who were admitted to BUMC-T for acute pulmonary CF exacerbation, and who received meropenem, imipenem, aztreonam, piperacillin-tazobactam, and or cefepime during their hospitalization (between 1/1/2011 and 10/30/2015). Exclusion criteria: pregnant women and admissions less than 24 hours. The two groups evaluated were patients receiving treatment (group 1) prior to extend infusion practices (Jan 2011 – Dec 2012) and (group 2) after implementation of extend infusion practices (Jan 2013 – Oct 2015). Data was collected from medical records using both the Sunrise Clinical Manager and EPIC electronic medical record systems. The data was then analyzed for differences in efficacy outcomes (e.g., length of hospitalization, lung function, return to baseline lung function), changes in renal and hepatic function, incidence of documented adverse drug effects, and potential factors associated with increased risk for changes in renal or hepatic function with use of extended infusion beta‐lactam regimens. Results: Pending. Efficacy outcomes: - length of hospitalization - improvement in lung function - return to baseline lung function Safety outcomes: - changes in renal and hepatic function - incidence of documented adverse drug effects - potential factors associated with increased risk for changes in renal or hepatic function Conclusions: Pending. As this study is being conducted at one academic medical center, conclusions may not be generalizable to other institutions.

Safety training and safety climate are widely researched topics in the area of safety management. Safety training, as one of the safety interventions, is believed to be an antecedent of safety climate improvement within organisations. The rapid advancement in the safety management field has also raised many questions, mainly regarding the roles of safety training and safety climate within organisations. Recent literature has viewed safety climate as a mediating variable between organisational policies and practices (such as safety training) and safety outcomes. Nevertheless, to date far too few attempts have been made to empirically study the impacts and influence of safety training on safety climate change and to subsequently improve safety outcomes over a period of time, especially in developing countries like Malaysia. To facilitate the expansion of current theoretical perspectives, the research attempts to improve our understanding of safety training's impact on achieving a positive safety culture (via safety climate changes), particularly with regard to improved safety outcomes over a period of time. A quantitative approach, using a longitudinal panel design, was employed for the purpose of data collection. The results were based on two data collections carried out in a Malaysian manufacturing plant in 2008 and 2009. The response rate was 83 percent (N=330) in Time 1, 2008 and 98 percent (N=402) in Time 2, 2009. The findings of this study revealed that there was a significant improvement in all safety training impact subscales indicating that employees' perceived their level of safety knowledge and skill transfer, safe work practices, and their understanding of safety and risk to all be higher in Time 2. The findings of this study also revealed significant improvements in the safety climate dimensions related to Management Attitude and Management Action, indicating that the management role has been viewed as crucial in improving and supporting employees' and organisations' safety. Over a period of time the positive correlation between safety training and safety climate became stronger with a significance difference of .005, where in Time 1, r=.740 and in Time 2, r=.745. This finding adds to the theoretical proposition that safety training is an antecedent to improving safety climate. Similarly, safety outcomes have significantly improved over a period of time and have a negative correlation with safety training and safety climate. Overall, the current study has gone some way towards enhancing our understanding of safety training impacts and its influence on safety climate, particularly with regard to the improvement of safety outcomes. However, this study has thrown up a number of questions that are in need of further investigation. The need for further research to investigate the effectiveness of specific safety training intervention with the addition of motivational factors, and its relation to safety climate over a period of time in various industries, remain crucial.

Depuis une dizaine d’années, la thérapeutique de pulpotomie totale est proposée dans la littérature pour le traitement pérenne de l’inflammation pulpaire des dents permanentes matures. De nombreuses publications de type essai clinique, étude de cohorte, série de cas ou revue systématique rapportent des résultats convergents qui placent la pulpotomie totale comme une alternative au traitement endodontique conventionnel. Cependant, la procédure reste peu enseignée, la variabilité méthodologique des études, les influences potentielles des fabricants de matériaux et les interprétations dogmatiques peuvent constituer un frein à la diffusion de cette thérapeutique. Des arguments complémentaires semblent nécessaires pour que les cliniciens, les enseignants et les chercheurs puissent appuyer leurs pratiques de soins, d’enseignements et de recherches selon la démarche fondée sur la preuve. Cette thèse constitue une démarche réflexive essentielle à la compréhension des phénomènes qui régissent la guérison à long terme de l’inflammation pulpaire et aux choix méthodologiques qui permettront d’évaluer cette guérison. Ce travail interroge les données bibliographiques pour argumenter les trois questions suivantes : 1°) Pourquoi et comment la pulpotomie totale peut-elle être considérée comme une thérapeutique de l’inflammation pulpaire ; 2°) Quelles procédures doit-on respecter et quels matériaux peut-on utiliser pour considérer la pulpotomie totale comme une thérapeutique à part entière ? 3°) Quels critères peut-on utiliser pour évaluer le succès d’une pulpotomie totale sur dents permanentes ? Ce travail bibliographique est complété par une étude expérimentale au cours de laquelle la fiabilité et la stabilité d’un guide de lecture des images radiologiques ont été vérifiées afin de proposer un outil de formation susceptible d’être appliqué lors de l’évaluation des résultats de la pulpotomie totale. / Full pulpotomy is a therapeutic in which the coronal pulp portion is removed surgically followed by the capping of the remaining radicular pulp. During the last decade, this therapeutic has been reinvestigated as a definitive treatment of pulp pathologies in mature permanent teeth. Converging datas from published studies suggested that full pulpotomy could be recognized as an alternative to root canal treatment. Furthermore, few clinical trials and a meta analysis aimed to evaluate the effect of initial pulp state or pulp capping material on the success of this treatment. However, large variations in the methodology of the studies, potential influence of laboratories of materials and endodontic dogmas are the major obstacles to the promotion of this therapeutic. An evidence-based approach is necessary because incorporates the best evidence in making decisions. This strategy will help clinicians, teachers and researchers to include full pulpotomy in a daily practice This thesis consists to question the scientific literature in order to answer three following questions: 1) Why and how the full pulpotomy should be considered as a treatment of pulp pathologies ? 2) Which procedures could be applied for full pulpotomy ? 3) Which criteria’s could be used to evaluate the outcomes of full pulpotomy ? These literature reviews are completed with an experimental study about an enriched version of a practical guide for the interpretation of PAI score. Its reliability and reproducibility were verified among French undergraduate students. This practical guide will be a useful tool in evaluation of outcomes in endodontics.

<p>Care of patients with chronic conditions is complicated and usually includes large number of healthcare providers. Understanding the team structure and networks of healthcare providers help to make informed decisions for health policy makers and design of wellness programs by identifying the influencers in the network. This work presents a novel approach to assess the collaboration of healthcare providers involved in the care of patients with chronic conditions and the impact on patient outcomes. </p> <p>In the first study, we assessed a patient population needs, preventive service utilization, and impact of an onsite clinic as an intervention on preventive service utilization patterns over a three-year period. Classification models were developed to identify groups of patients with similar characteristics and healthcare utilization. Logistic regression models identified patient factors that impacted their utilization of preventive health services in the onsite clinic vs. other providers. Females had higher utilizations compared to males. Type of insurance coverages, and presence of diabetes/hypertension were significant factors that impacted utilization. The first study framework helps to understand the patient population characteristics and role of specific providers (onsite clinic), however, it does not provide information about the teams of healthcare providers involved in the care process. </p> <p>Considering the high prevalence of diabetes in the patient cohort of study 1, in the second study, we followed the patient cohort with diabetes from study 1 and extracted their healthcare providers over a two-year period. A framework based on the social network analysis was presented to assess the healthcare providers’ networks and teams involved in the care of diabetes. The relations between healthcare providers were generated based on the patient sharing relations identified from the claims data. A multi-scale community detection algorithm was used to identify groups of healthcare providers more closely working together. Centrality measures of the social network identified the influencers in the overall network and each community. Mail-order and retail pharmacies were identified as central providers in the overall network and majority of communities. This study presented metrics and approach for assessment of provider collaboration. To study how these collaborative relations impact the patients, in the last study, we presented a framework to assess impacts of healthcare provider collaboration on patient outcomes. </p> <p>We focused on patients with diabetes, hypertension, and hyperlipidemia due to their similar healthcare needs and utilization. Similar to the second study, social network analysis and a multi-scale community detection algorithm were used to identify networks and communities of healthcare providers. We identified providers who were the majority source of care for patients over a three-year period. Regression models using generalized estimating equations were developed to assess the impact of majority source of care provider community-level centrality on patient outcomes. Higher connectedness (higher degree centrality) and higher access (higher closeness centrality) of the majority source of care provider were associated with reduced number of inpatient hospitalization and emergency department visits. </p> <p>This research proposed a framework based on the social network analysis that provides metrics for assessment of care team relations using large-scale health data. These metrics help implementation experts to identify influencers in the network for better design of care intervention programs. The framework is also useful for health services researchers to assess impact of care teams’ relations on patient outcomes. </p> <br> <p> </p>

Since the advent of antiretroviral therapy (ART), few studies have examined how mother-child relationships relate to physical and mental health in HIV+ and demographically-similar uninfected mothers. The present three studies investigated the relationships of mother-child relationship quality (MCRQ: measured qualitatively with autobiographical narratives) with HIV status, domestic violence, substance use, childcare burden, self-silencing, and mental and physical health outcomes. Health outcomes were measured at two time points, concurrent with the autobiographical narratives (T1) and 11 months later (T2). Participants were recruited from the Chicago Women’s Interagency HIV Study and included 87 HIV+ mothers and 38 demographically matched HIV‒ mothers (M age=43.8, SD=9.4) who were primarily African American (89.6%) and low income. Study 1 used analyses of covariance to examine relationships between MCRQ and concurrent HIV status, self-reported self-silencing, substance use, domestic violence, caregiving (i.e., number of children and time spent caregiving) and childcare burden (i.e., mother’s opinion of parenting, perceived difficulty of parenting, help received from children). Relative to HIV‒ mothers, HIV+ mothers spent fewer hours caregiving and cared for fewer children. Negative mother-child relationships related to higher substance use and self-silencing, and positive mother-child relationships related to more time caregiving and more children cared for. In Study 2, multiple and logistic regressions were used to examine MCRQ as predicting T1 and T2 self-reported depression symptoms and health-related quality of life among HIV+ and HIV‒ mothers, and self-reported ART adherence and viral load and CD4+ counts assessed through blood specimens in HIV+ mothers. Negative MCRQ predicted higher depression symptoms at T1, as well as lower health-related quality of life at T1 and T2. Positive MCRQ predicted lower viral load at T1. Study 3 examined the potential moderation of MCRQ on the relationship between time spent caregiving and health indicators in HIV+ and HIV‒ mothers. At higher levels of positive and negative MCRQ, more hours caring for children related to better odds of being 95% adherent to ART medications at T1. Together these studies suggest that mother-child relationships are integrally related to the health of HIV+ and HIV− mothers and may be important areas to consider in treating this population. / 2020-12-11T00:00:00Z