Diss.--Mannheim, 2002. / Bibliogr. p. 195-212.

The South African government has placed great emphasis on SMMEs being the group that could assist in steering the economy. It reviewed the measure of introducing women to the mainstream economy, as a marginalised group that are a majority in numbers, but a minority in the economy due to circumstances surrounding their traditional role and especially due to the constraints of the previous regime. The current government has introduced sweeping reforms through regulations aimed at preferential procurement of female-owned companies, but regardless of all government's initiatives female owned companies still struggle to compete with their male counterparts in the construction industry. The research problem questions the processes and systems put in place to alter the social, political and economic climate in South Africa that created a new cycle of opportunities and threats for the different stakeholders. It gave rise to hidden occlusions based on gender and race that need to be addressed. Frustrations such as those found in the empowerment initiatives of BEE that resulted in the decline of standards and an increase in the disadvantaged groups trapped into worse liabilities are worth mentioning. The literature review has produced important recommendations that when implemented may resolve the flaws that tend to create opportunities for unintended parties. Issues such as motivational factors, collaboration between partners, sound partnering relationships and establishing an organisational culture will assist role players to take stock, enable them to make a turn-around, view challenges in terms of concealed manifestations and ultimately effectively address said challenges. / Thesis (MBA) North-West University, Mafikeng Campus, 2012

Service learning is a pedagogy designed to teach democratic skills to prepare students to become civically engaged members of society. One of the challenges in the field of service learning is to demonstrate the effectiveness of this pedagogy. Common methodological problems include small sample sizes, difficulty differentiating correlation from causation, self-selection bias, and use of primarily qualitative and experiential outcome measures. The literature review failed to reveal any quantitative scales designed for the health professions. The purpose of this study was to develop and test a quantitative scale to measure service learning outcomes among health professions students, before and after an academic service learning activity. Phase 1 of the study, the development phase, involved an extensive review of the literature to develop the conceptual framework and identify the operational indicators to be measured. Items were adapted from existing scales that were consistent with the personal and social responsibility dimensions and found to possess at least minimally acceptable reliability and validity. Items were adapted to add the health professions perspective which resulted in the preliminary twenty-two item scale, divided into four subscales: Civic Responsibility, Self-Efficacy Toward Service, Civic Participation, and Social Justice Attitudes. Psychometric testing of this preliminary PSR Scale was done in 3 studies. Study 1 involved evaluation of content validity with subject matter experts utilizing a Content Validity Index. The scale was modified based on the results of the CVI and recommendations of the subject matter experts. The S-CVI/Ave for the entire scale was .84 suggesting content validity of the PSR Scale. Study 2 utilized principal components analysis of the subscales to validate the dimensions and operational indicators. Data was constrained to four factors which accounted for 60.56% of the total variance. Items with factor loadings less than 0.4 were deleted. Cronbach’s alpha coefficient was calculated for internal consistency. Based on these results, the scale was further revised by deleting items that decreased the Cronbach’s alpha. This resulted in a 16 item scale, containing four subscales, each with four items. The Cronbach’s alpha for the entire revised scale PSR Scale was .94. Study 3 involved testing the final 16 item version for sensitivity. Wilcoxon signed rank analysis revealed statistically significant changes pre and post service learning activity in the Civic Participation Subscale. Civic Participation Subscale items that were significant included “volunteering time to support my community”, “being involved in programs and activities that improve my community”, and “being involved in activities that improve the health of my community”. These findings suggest that participation in a service learning activity can increase civic participation. Psychometric testing of the Personal and Social Responsibility Scale (PSR) support preliminary validity, reliability and sensitivity of the instrument and the premise, consistent with prior research that changes in civic participation can occur as a result of service learning. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2018. / FAU Electronic Theses and Dissertations Collection

This thesis describes some models that attempt to forecast the number of occupied beds due to emergency admissions each day in an acute general hospital. Hospital bed managers have two conflicting demands: they must not only ensure that at all times they have sufficient empty beds to cope with possible emergency admissions but they must fill as many empty beds as possible with people on the waiting list. This model is important as it could help balance these two conflicting demands. The research is based on data from a district general and a postgraduate teaching hospital in South East London. Several tests indicate that emergency bed occupancy may have a nonlinear underlying data generating process. Therefore, both linear models and nonlinear models have been fitted to the data. At horizons up to 14 days, it was found that there was no statistically significant difference in the errors from the linear and nonlinear models. However at the 35 day forecast horizon the linear model gives the best forecast and tests indicate errors from this model are within 4% of mean occupancy. It is noted that a Markov Switching model gave very good forecasts of up to 4 days into the future. A search of the literature found no previous research that tested emergency bed occupancy for nonlinearities. The thesis ends with a gravity model to predict the change in number of Accident and Emergency (A&E) attendances following the relocation of an A&E Department in South East London.

The role of community pharmacy (CP) in health promotion has developed over the last decade and a half following the introduction of the new National Health Service (NHS) plan in 2000. CPs have been turned into healthy living centres where individuals can access a variety of services designed to prevent disease and promote health. In 2005, three types of pharmacy service were introduced; essential, advanced and enhanced (currently known as locally commissioned). Enhanced pharmacy services were provided by Primary Care Trusts (PCTs) (until 2010) based on local needs identified by PCTs. In 2010, the Government decided to abolish the PCTs by 1‘"t April 2013; hence, PCTs entered a transition phase between 2010 and April 2013. By February 2011, each PCT was required to publish Pharmaceutical Needs Assessment (PNA) report regarding the provision and need for pharmacy services. The national commissioned vascular and sexual health enhanced pharmacy services in England are Stop Smoking Service (SSS), NHS health check, Emergency Hormonal Contraception (EHC) and chlamydia screening and treatment services. In 2012, the Healthy Living Pharmacy (HLP) scheme, which was piloted in Portsmouth PCT, was expanded to 30 PCTs known as HLP pathfinder PCTs. The aim of this research was to identify the correlation between needs, provision and uptake of vascular and sexual health pharmacy services at a PCT and CP level. It also aimed to investigate whether the provision of those services was cost effective. Finally, it aimed to determine the impact of the introduction of the HLP scheme on the provision and uptake of those services. At a PCT level, the PNA reports were used to identify the CP provision of SSS, EHC service and chlamydia screening service for the financial year 2009/2010. The local need for SSS (prevalence of smoking adults) and EHC services (rates of teenage pregnancy) were obtained from Health Profiles for each PCT. The need for chlamydia screening service (prevalence of positive chlamydia infection) was obtained from the National Chlamydia Service Programme (NCSP). Uptake and cost attributed to provision of those services for the financial year 2009/2010 were obtained from a short questionnaire targeted the public health leads for the related services in PCTs where the provision of services and the needs were identified. Simple cost-effectiveness analyses were performed on CP SSS and CP EHC provision, based on identified uptake and cost. At a CP level, a cross-sectional survey was conducted on 1 249 CPs in 28 PCTs across England in 2013. PCTs were chosen based on provision of SSS, EHC and chlamydia screening service identified in the PNA reports. 7 PCTs out of 28 PCTs were HLP pathfinder PCTs. CPs were allocated to one of five groups based on deprivation. The response rates for SSS, EHC and chlamydia screening surveys were 30% (42/138), 30% (42/139) and 19% (21/111) respectively. Data analysis identified that the need for SSS and EHC services were highly correlated with deprivation, with Spearman's rank correlation coefficients (rho) of 0.76 and 0.83 respectively (both P 0.001). The correlation between deprivation and the need for a chlamydia service was weak (rho = 0.25, P = 0.009). Higher number of CPs per 25 000 population were observed in more deprived PCTs (rho = 0.63, P < 0.001). CP provision (percentage of CPs offering a service out of total CPs in a PCT) of SSS, EHC and chlamydia service did not correlate with needs. The uptake of SSS, EHC and the chlamydia screening service did not correlate with increasing need or deprivation. However, pharmacists in areas of higher need dealt with a greater number of clients in relation to SSS and EHC services to meet their local needs, with rho of 0.4 and P of 0.01 in case of SSS and Pearson's correlation coefficient (R) of 0.36 and P of 0.02 in case of EHC. A cost-effective analysis of CP SSS provision found it to be cost effective when compared to no intervention based on NHS perceptive and the incremental cost per Quality Adjusted Life Year (QALY) gained. was £1 511. Similarly, the CP EHC service was also found to be cost effective with an NHS saving of £689 per unintended pregnancy prevented. The response rate for the CP survey was 19.3% (241/1 249). No significant differences were identified in terms of provision or uptake of SSS, EHC, chlamydia screening and NHS health check services between CPs with different deprivation neighbourhoods. 18.5% (31/168) of the respondent community pharmacists were working in HLPs. The uptake of SSS through HLPs (median = 6) was higher than that through non-HLPs (median = 4; P = 0.02)._Playing a more active role in health promotion was cited as the main driver for pharmacists to adopt an HLP scheme. Respondent pharmacists indicated that the introduction of an HLP scheme had improved public awareness of vascular and sexual health services available in CPs and they suggested the use of social media websites to further improve public awareness. Lack of time and the provision of similar services via other providers were considered the main barriers. Local Authorities should increase the provision of vascular and sexual health pharmacy services to meet the needs of their localities. They should use the latest technology to improve public awareness regarding availability of those services in CPs.

The re-conceptualisation of stroke unit provision towards acute and hyperacute care has been a relatively recent development in the United Kingdom. This hermeneutic phenomenological study aimed to explore how the acute stroke unit (ASU) experience, as the phenomenon of interest, was meaningfully lived from a human lifeworld perspective. Eight participants: four stroke survivors and four healthcare practitioners: took part in semi-structured interviews, and if they agreed, an optional creative element. Interviews were recorded then transcribed. Detailed hermeneutic analysis drawing on interpretative phenomenological analysis (IPA) was undertaken firstly on each person’s account, and then across the collective from each perspective. An additional close textual reading was developed for one stroke survivor and one healthcare practitioner. A particular feature of the analysis was its influence in generating an innovative graphic interpretation of the research findings. The stroke survivors experienced the ASU as a lived space in two differentiated forms. The ASU holding space, through the spatial practices of nurses, and others, including similar others (patients), was understood to provide them with protection and safe haven; holding them intimately but also at a distance, so that they could think, make sense, plan and work towards transition. The transitional space of the ASU was experienced by three of them in more disparate ways, and represented how they transitioned their self (for protection, necessity and for recovery) in response to the stroke, the hospital space and the spatial practices of the ASU. The healthcare practitioners experienced the ASU as a space that they produced and appropriated for themselves and others. This was intertwined with their work as existential project; through their relationships with others, and their contribution to patients’ transitional work, they were understood to experience authenticity and belonging. This project was always in the making, and was undertaken amidst the day-to-day pressures on the unit. As a result, three of the health practitioners looked to make sense, navigate, and survive the vulnerability they experienced in relation to their meaningful work, as part of their ASU experience. Further synthesis of these two horizonal1 perspectives elucidated 3 key areas of new insight and understanding: the spatiality of the lived experience of the acute stroke unit, suffering and thriving as a human being, and the intertwining of multiple selves in time and place. The implications of this new knowledge for clinical practice, education, and research are further discussed in this thesis.

While in agreement with the perceived wisdom that events during World War Two were responsible for many social changes for women in Australia, the thesis disagrees with the implication in existent Queensland women’s historiography that these changes affected women equally in all parts of the State. Research undertaken in Central Queensland provides evidence that, although some similarities existed, the conservative forces in this region restricted the liberating effect of such changes. It also addresses the subject of Queensland difference, and argues that the rural patriarchal economy sustained the notion of rigid gender and class differences in Central Queensland. It maintains that this affected women in regional Queensland to a far greater extent than those in the Brisbane metropolitan area because of the lack of secondary wartime industry and the masculine nature of rural industry. Additionally , in opposition to the widely held belief there was universal post-war financial security the thesis argues that poverty did exist. In particular it addresses the subjects of rising inflation and what has been termed the Social Security Poverty Group, basing conclusions on statistical evidence, oral evidence, and secondary and documentary sources.

Publicly financed dental care has recently increased its profile as a health policy issue in Canada. The media have championed the challenges experienced by low-income groups in accessing dental care. Governments across the country have responded with targeted funds. Social concern has even promoted the Canadian Medical Association to call for the inclusion of dental care within Medicare, and in changing a policy position that is over one hundred years old, the Canadian Dental Association now recommends that governments establish a dental safety net for all disadvantaged Canadians. In this environment, important questions have emerged: Why did Canada never incorporate dental care into Medicare? How have governments been involved in dental care? What are governments doing now? What are the disparities in oral health and dental care? What gaps exist in the system? What does the profession think? What does the public think? Through a document review, administrative survey, expenditure trend analysis, and public and professional opinion surveys, this dissertation answered these questions with the aim of clarifying the many issues that surround publicly financed dental care in Canada. It appears that dental care was not included in Medicare due to material and ideological reasons; namely decreases in dental caries and human resource limitations, the belief in viable options to large-scale service delivery, and the belief that maintaining one’s oral health and the ability to seek out dental care are individual responsibilities, not social ones. As such, there has developed in policy and programming a predilection to support dental care for children, for social assistance recipients, for seniors, and for select marginalised groups, or those groups where personal responsibility is not totalising. There is also a bias, developed over the last thirty years, towards structuring publicly financed dental care in private ways. This has resulted in a system that has certain biases, inconsistencies, and gaps, such that it cannot clearly and fully respond to current disparities. It is in the conciliation of public and private approaches to care that publicly financed dental care can achieve a stable footing and a clear direction forward.

Publicly financed dental care has recently increased its profile as a health policy issue in Canada. The media have championed the challenges experienced by low-income groups in accessing dental care. Governments across the country have responded with targeted funds. Social concern has even promoted the Canadian Medical Association to call for the inclusion of dental care within Medicare, and in changing a policy position that is over one hundred years old, the Canadian Dental Association now recommends that governments establish a dental safety net for all disadvantaged Canadians. In this environment, important questions have emerged: Why did Canada never incorporate dental care into Medicare? How have governments been involved in dental care? What are governments doing now? What are the disparities in oral health and dental care? What gaps exist in the system? What does the profession think? What does the public think? Through a document review, administrative survey, expenditure trend analysis, and public and professional opinion surveys, this dissertation answered these questions with the aim of clarifying the many issues that surround publicly financed dental care in Canada. It appears that dental care was not included in Medicare due to material and ideological reasons; namely decreases in dental caries and human resource limitations, the belief in viable options to large-scale service delivery, and the belief that maintaining one’s oral health and the ability to seek out dental care are individual responsibilities, not social ones. As such, there has developed in policy and programming a predilection to support dental care for children, for social assistance recipients, for seniors, and for select marginalised groups, or those groups where personal responsibility is not totalising. There is also a bias, developed over the last thirty years, towards structuring publicly financed dental care in private ways. This has resulted in a system that has certain biases, inconsistencies, and gaps, such that it cannot clearly and fully respond to current disparities. It is in the conciliation of public and private approaches to care that publicly financed dental care can achieve a stable footing and a clear direction forward.

In nineteenth-century Upper Canada (Ontario), professional work was a primary means by which men could improve their social status and class position. As increasing numbers of men sought entry into these learned occupations, current practitioners sought new ways of securing prominent positions in their chosen professions and asserting themselves as having expertise. This dissertation studies the activities and experiences of the five physicians who, as the first medical superintendents (head physicians) at the Provincial Lunatic Asylum, Toronto from 1840 to 1865, sought such enhanced professional status. Opened in January 1841 as a public welfare institution, the Toronto asylum was housed initially in a former jail; in 1850 it was relocated to a permanent building on Queen Street West. During the asylum’s first twenty-five years of operation physicians Drs. William Rees, Walter Telfer, George Hamilton Park, John Scott, and Joseph Workman successively held the position of medical superintendent at the institution. Given the often insecure status of physicians working in private practice, these doctors hoped that government employment at the asylum would bring greater stability and prestige by establishing them as experts in the treatment of insanity. Yet professional growth in Upper Canada during the Union period (1840-1867) occurred within the context of the colony’s rapidly changing socio-political culture and processes of state development, factors that contributed to the ability of these doctors to “professionalize” as medical superintendents. Rees, Telfer, Park, and Scott would never realize enhanced status largely due to the constraints of Upper Canada’s Georgian social culture in the 1840s and early 1850s. During the 1850s, however, demographic, political, and religious changes in the colony brought about a cultural transition, introducing social values that were more characteristically Victorian. For Joseph Workman, whose beliefs more reflected the new Victorian culture, this cultural shift initially involved him in professional conflicts brought about by the social tensions occurring as part of the transition. Nevertheless, by the 1860s, changes in government led to the development of new legislation and departmentalization of welfare and the public service that led him to gain recognition as a medical expert in a unique field.