The author addresses the following objectives: (1) Examines whether a state can withdraw a case upon which an indictment has been made by the International Criminal Court (ICC) (2) Determine and elucidate on the circumstances under which a referral can be withdrawn from ICC jurisdiction. (3) Clarifies whether a referral can be withdrawn if the referring state develops mechanisms for domestic trial of relevant ICC crimes / Thesis (LLM (Human Rights and Democratisation in Africa)) -- University of Pretoria, 2008. / A Dissertation submitted to the Faculty of Law University of Pretoria, in partial fulfilment of the requirements for the degree Masters of Law (LLM in Human Rights and Democratisation in Africa). Prepared under the supervision of Dr.Atangcho Akonumbo, Faculté des Sciences Sociales et de gestion, Université Catholique d’Afrique Centrale, Yaoundé Cameroun / http://www.chr.up.ac.za/ / Centre for Human Rights / LLM

Den svenska hälso- och sjukvårdsbranschen för djur har under 2000-talet expanderat markant. För att driva en konkurrenskraftig verksamhet i en bransch som ständigt utvecklas är det viktigt att organisationen arbetar med förbättringsarbeten för att hålla jämna steg. Syftet med studien är att kartlägga en organisations interna och externa remisshandläggningsprocess med avsikt att synliggöra förbättringsmöjligheter.   I fallstudien har empiriinsamling genomförts med hjälp av litteraturstudie, observationer och intervjuer. Litteraturstudien genomfördes med avsikt att skapa ett teoretiskt ramverk. Observationer och interjuver utfördes med nio av fallklinikens remisshanterande personal i syfte att kartlägga remissprocessen och identifiera eventuella problemområden. Empirin visar att remisshandläggningsprocessen består av fyra delprocesser där det går att identifiera problemområden och förbättringsmöjligheter. Remissprocessen har en grundstruktur men det finns inget standardiserat arbetssätt och därför förekommer individualiserade tillvägagångssätt vid remisshantering. Samtliga respondenter är eniga om att den externa remisshandläggnings­processen fungerar bättre idag jämfört med tidigare. För de interna remisserna finns det ingen vedertagen administrativ process och empirin är inte tillräcklig för att kunna genomföra en processkartläggning.   En förbättringsmöjlighet är att implementera ett standardiserat tillvägagångssätt för remiss­hantering eftersom suboptimering då utesluts vilket effektiviserar den kompletta remisshand­läggningsprocessen. Dessutom skulle standardisering kunna bidra till en förståelse för hela flödet vilket är avgörande för ett lyckat förbättringsarbete. / The Swedish industry in animal health and medical care has expanded significantly during the 2000s. To run a competitive business in an industry that is constantly developing, it is of importance that the organization works with development to keep pace. The purpose of the study is to map the organization’s internal and external referral process with the intention of visualizing improvement opportunities.   In the case study, empirical data was collected with the help of a literature study, observations, and interviews. The literature study was conducted with the intention of creating a theoretical framework. Observations and interviews were performed with nine of the clinic’s referral managing staff to map the referral process and identify any problem areas. Empirical data shows that the referral process consists of four subprocesses where it is possible to identify problem areas and opportunities for improvement. The referral process has a basic structure, but there is no standardized working method and therefore there are individualized approaches when handling referrals. All respondents agree that the external referral process works better today than in the past. For the internal referrals, there is no established administrative process, and the collected empirical data is therefore not sufficient to be able to conduct a process mapping.   An opportunity for improvement is to implement a standardized approach to referral management because suboptimization is then excluded, which streamlines the complete referral process. Furthermore, standardization could contribute to an understanding of the entire flow, which is essential for a successful improvement project. / <p>Examen i vårdadministration, YH-utbildning: 20 Yh-poäng</p>

Magister Chirurgiae Dentium (MChD) / MChD (Oral Pathology) minithesis, Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, University of Western Cape Among malignant lesions, lymphoma ranks second only to squamous cell carcinoma in frequency of occurrence in the head and neck. Lymphomas in HIV patients' are second in frequency to Kaposi's sarcoma as AIDS-defining tumours. About 50% of lymphomas in HIV patients are extranodal and more than half of these occur in the head and neck area. The number, variety and diagnostic complexity of lymphoma cases that have primarily arisen in the head and neck region has steadily increased in the surgical pathology service of the National Health Laboratory Services (NHLS) - Tygerberg. This observation is particularly relevant in the context of increasing HIV infection rates in the population of South Africa as demonstrated by a study in 2006 conducted by the Medical Research Council of South Africa. This is a retrospective study using the records of cases of head and neck lymphomas diagnosed at NHLS-Tygerberg over the last five years. The aim of this study is to investigate the prevalence of head and neck lymphomas (HNL) at NHLS-Tygerberg from January 2002 to December 2006. The objective of this study is to determine the frequency and types of HNL and to determine, if possible, an association between the incidence of HNL and the HIV status of the patients. Trends of prevalence in terms of gender, referral centres, HIV status, age of patients and site of presentation are also examined. The results of this study show an increase in the number of patients with HNL from January 2002 to December 2006. A significant increase is noted in the number of HIV positive patients documented each year, from 17% in 2002 to 33% in 2006. Western Cape- urban (WC-U) remains the largest referral center. A notable increase is seen, each year, in the number of patients referred to Tygerberg-NHLS from the Eastern Cape (EC) and Western Cape- rural (WC-R) areas. A significant number of HIV positive patients are referred from the Eastern Cape and Western Cape rural areas. The average age of disease presentation in the HIV positive group of patients is 35 years with the unknown group being 46 years and the HIV negative group being 54 years. The main categories of lymphoma that presented in HIV positive patients are plasmablastic lymphoma (PBL) and diffuse large B-celllymphoma (DLBCL), which together form 56% of cases. 26% of cases are Hodgkin's lymphoma (HL); the second largest group of HNL cases. Burkitt's lymphoma (BL) consists of 8% of cases. 7% of cases are T-cell lymphomas. 3% of cases are Mantle zone lymphomas. No cases of SLL and Follicular lymphomas (FL) are described in this group of patients. DLBCL and HL form 27% each of the cases in patients with a negative HIV status. A significant number of Follicular lymphomas (15%), small lymphocytic lymphoma (SLL) (9%), MALT (7%), and T-cell lymphomas (8%) are identified. No PBL are seen in this group of patients. The incidence of HNL at NHLS-Tygerberg has increased over the last five years. This trend parallels that seen in other developing countries such as Tanzania, Nigeria, Thailand and India. This increase is possibly due to an increase in the number of referrals to our center, an increase in the overall population of the Western Cape, an increase in the number of HIV positive patients and the high incidence of EBV infection in the general population of the Western Cape. Social issues, such as poverty, lack of adequate education, female dependence on partners, rural communities and the non-availability of anti-retroviral drugs (ARV) and highly active anti-retroviral therapy (HAART) to most of the population that require these drugs, are considered major contributing factors. A trend is noted in the increased number of female patients diagnosed each year with HNL. A predominance of DLBCL was identified in our series. This is consistent with previous reports and studies on HNL. The number of biologically aggressive lymphomas, such as DLBCL, Plasmablastic and Burkitt's lymphomas diagnosed each year, has also significantly increased. These were prevalent mainly in the HIV positive group of patients who were also younger compared to the HIV negative patients. The documented findings of this study will serve as a guideline for the estimation of head & neck lymphoma burden and risk assessment at NHLS- Tygerberg.

In the last decade, the deployment of Electronic Health Records has increased tremendously in many developed countries. This increasing trend intensifies the need for developing countries like South Africa to implement electronic health record systems in state owned hospitals to facilitate e-referral processes to improve health care delivery. The aim of this research was to investigate the current process of patient record keeping, management, and the referral process of patients within the same hospital and to other hospitals and based on the findings compile an Electronic Health Record (EHR) framework to facilitate e- referral processes. This research study was based on a qualitative case study approach. A multiple data collection technique was used which included group interviews, questionnaires, document analysis and informal discussions with the hospital workers. Data were analysed by categorization and thematic approach. The findings obtained from state hospitals indicated that there is no EHR system which accommodates patient health record systems to facilitate e-referral processes. These findings led to a compilation of the Limpopo Electronic Health Record System (LEHRS) to aid e-referral processes in state hospitals. The increasing need for accurate, reliable, available and accessible EHR will be addressed by the implementation of LEHRS as information will be stored in a central database in a useable format and will be easily accessed. / Computing / M. Tech. (Information Technology)

No description available.

No description available.

Socio-culturally diverse students with disabilities are underrepresented in gifted and talented programs. This study investigated the differences in educators' referral and placement decisions based on a students' disability label, socio-economic status (SES), and ethnicity. Two hundred and eighty five educators' (classroom teachers, school counselors, school psychologists, and school social workers) across a Florida school district participated in the study. Educators' were randomly assigned to treatment and control case vignettes that described a student with emotional/behavioral disabled (EBD) and gifted characteristics. Treatment case vignettes explicitly stated the students' disability label, socio-economic status, and ethnicity. Control case vignettes described of the student examined and did not mention the disability label, ethnicity, or socio-economic status of the student. After reading the case vignette, participants responded to a two-item questionnaire that explained their referral and placement decisions of the student described in the vignette. Participants responses to the two item questionnaire were indicated by selecting one of six choices: strongly agree, slightly agree, agree, disagree, slightly disagree, and strongly disagree. Reponses were the dependent variables being measured. A three-way factorial Analysis of Variance (ANOVA) was used to measure the differences in educators' referral and placement decisions based on a student's disability label, socio-economic status, and ethnicity. Results indicate educators' awareness of a students' disability label, socio-economic status, and ethnicity influence referral decisions. Implications are discussed and recommendations for future research are made.

Underrepresentation among those identified for gifted programs has been a concern in the field of gifted education for over a century, affecting students of color, students with disabilities, English language learners, and economically disadvantaged students. Universal screening has emerged as a possible strategy to increase referrals of students from underrepresented populations and to produce gifted population demographics more reflective of total student enrollment. The purpose of this study was to investigate the influence of universal screening measures on the diversity of students found eligible for gifted education services. The study examined the following research questions: 1. What is the relationship between a referral source and the gifted identification of elementary school students? 2. To what extent do universal screening measures influence the diversity of students eligible for gifted education services? This study used existing referral and eligibility data of elementary school students in a medium-sized school district who were administered a universal screening measure during the 2019-2020 school year. Pearson chi-square tests with Yates' continuity correction were used to determine the existence of possible associations between referral source and gifted identification status, and Cramér's V was used as a measure of effect size. Referral rates, accuracy, and effectiveness of referral sources were also computed. Across all demographic groups, universal screeners referred more students than any other referral source, and the highest number of students identified gifted after the full gifted evaluation came from universal screener referrals. Teacher referrals and universal screener referrals produced the most diverse identified gifted results after evaluation. Universal screeners displayed the highest referral rates and were the most accurate and effective referral source across all demographic groups. This study provides the field of gifted education further research on universal screening, and the findings of this study provide educational leaders data to inform practice. Implications for school and district leaders involve multiple stakeholders and address different areas to promote diversity among the gifted student population. The implications center on parent and community engagement, professional learning, best practices in gifted education, and evaluation of gifted identification processes. / Doctor of Education / Historically, students of color, students with disabilities, English language learners, and economically disadvantaged students have been underrepresented in gifted programs. Universal screening has emerged as a potential practice to refer more students from underrepresented populations and consequentially identify a more diverse gifted population, but few studies exist to support adoption of the practice and to justify the financial expense and amount of instructional time devoted to administering the assessments. This study used existing data of elementary school students in a medium-sized school district who were administered a universal screening measure to investigate the influence of universal screening measures on the diversity of students found eligible for gifted education services. Possible associations between referral source and gifted status were determined, and referral rates, accuracy and identification rates, and effectiveness of various referral sources were calculated. Across demographic groups, universal screeners referred more students than any other referral source, and the highest number of students identified gifted after the full gifted evaluation resulted from these referrals. Teacher referrals and universal screener referrals were found to produce the most diverse identified gifted populations after evaluation; universal screeners displayed the highest referral rates and were the most accurate and effective referral source across all demographic groups. This study adds further research on universal screening to the field of gifted education, and the findings of this study provide educational leaders information regarding the effectiveness of universal screening to translate into institutional practice.

Background: Ischaemic heart disease is a diagnostic and therapeutic challenge to most general practitioners. We sought to identify diagnostic characteristics and prognoses of patients in primary care that received exercise electrocardiography (ECG). We compared the ECG test results with respect to probability of subsequent cardiologist referrals. We also aimed to identify determinants for pre-hospital delays and lack of statin treatment before a first-time myocardial infarction (MI). Methods: Setting: Region of Jämtland Härjedalen, Sweden (adult population, approximately 99 000); study period 2010-2014. Patients and study designs: studies I and II: 865 patients referred to exercise ECG. Primary outcome: Incidence of cardiovascular events (I) and cardiologist referrals within six months after exercise ECG (II). Observed outcomes were compared to predictions from multivariable logistic models. Study III: 265 patients with first-time MI. Characteristics were analysed for determinants of pre-hospital delay ≥ 2 hours. Study IV: Survey of 931 patients with first-time MI. Analyses of characteristics associated with rates of statin treatment in patients with previously diagnosed cardiovascular diseases (CVD). Results: Study I: Exercise test results were associated with exertional chest pain, a pathologic ST-T segment on resting ECG, angina diagnosis according to the patient's opinion, and medication for dyslipidaemia. Cardiovascular events occurred in 52.7%, 18.3%, and 2.0% of patients with positive (ST-segment depression &gt;1mm and chest pain indicative of angina), inconclusive (ST depression or chest pain), or negative tests, respectively. Study II: Positive or inconclusive exercise tests were associated with cardiologist referrals. Among patients with positive exercise tests, referral rates decreased with age, after adjusting for co-morbidity. Self-employed women were referred to cardiologic evaluations more often than other employed women. Study III: The first medical contact was a primary care facility for 52.3% of patients. The pre-hospital delay time was ≥ 2 h for 67.0% of patients in primary care and 44.7% of patients that called emergency medical services or were self-referred to hospital. Study IV: Among patients with prior CVD, 34.5% received current statin treatment before for the first MI. Statin treatment rates decreased with age, after adjusting for CVD and diabetes; women ≥70 years old were treated half as often as men of the same age. Conclusions: Clinical characteristics can be used to identify patients at low risk of cardiac events. The prognosis in patients with a negative exercise ECG was benign for six months after the exercise ECG. Exercise tests are important for selecting patients that require cardiologic evaluations. Age, gender, and employment status interacted with rates of referrals for cardiac evaluation. The pre-hospital delay time was considerably prolonged, particularly when primary care was the first medical contact. Only one third of patients with a prior CVD received statin treatment. Pre-MI statin treatment decreased with age, particularly among women ≥70 years old. In making medical decisions, it is necessary to be aware of biases regarding age, gender, and socioeconomic status. Methodologies for case finding and follow-up need to be improved and implemented in clinical practice. Keywords: Exercise ECG, Ischaemic heart disease, Myocardial infarction, Pre-hospital delay, Primary care, Prognosis, Referral, Statins, Secondary prevention / Sammanfattning på svenska: Bakgrund och syfte: Patienter med ischemisk hjärtsjukdom (IHD) utgör en diagnostisk och terapeutisk utmaning för läkare inom primärvården. Arbets-EKG är en vanlig metod vid utredning av patienter som söker till primärvården för besvär som kan vara förorsakade av IHD. Vi undersökte primärvårdspatienter remitterade till arbets-EKG, med avseende på de kliniska karakteristika (egenskaper och symtom) som kunde associeras med resultatet av arbets-EKG och med prognosen inom sex månader efter undersökningen. Vi jämförde arbets-EKG-svaren med avseende på efterföljande remittering för utredning vid hjärtklinik. Vi kartlade även faktorer av betydelse för tidsfördröjningen före sjukhusvård och för sekundärpreventiv behandling med kolesterolsänkande läkemedel (statiner), före insjuknande i hjärtinfarkt. Metod: De studier som ingår i avhandlingsarbetet (studier I-IV) genomfördes i Region Jämtland och Härjedalen, befolkningsunderlag cirka 99 000 personer i åldrar från 20 år och äldre, under åren 2010-2014. Undersökta patienter och studiedesign: Studier I och II: Prospektiv studie av 865 patienter undersökta med arbets-EKG, klassificerade som: positivt arbets-EKG (dynamisk ST-sänkning &gt;1mm under arbetsprov och bröstsmärta typisk för kärlkramp), inkonklusivt (ST-sänkning eller bröstsmärta) eller negativt arbets-EKG. Utfallsvariabler: hjärt-kärlhändelser (instabil kärlkrampssjukdom, hjärtinfarkt, öppen kranskärlsoperation, ballongvidgning av kranskärl och kardiovaskulära dödsfall) (I) och remittering för utredning vid hjärtklinik inom sex månader efter arbets-EKG (II). Observerade hjärt-kärlhändelser jämfördes med förväntat utfall, enligt multivariabla statistiska modeller. Studie III: Retrospektiv studie av 265 patienter med förstagångs hjärtinfarkt, analyserade med avseende på faktorer av betydelse för tid från symtomdebut och till sjukhusvård, med brytpunkten två timmar eller längre tid för vård på sjukhus. Studie IV: Tvärsnittsstudie av 931 patienter med förstagångs hjärtinfarkt. Patienter med tidigare hjärt-kärlsjukdom analyserades med avseende på statinbehandling före hjärtinfarkten. Resultat: Studie I: Faktorer associerade med arbets-EKG-resultatet (positivt eller inkonklusivt svar mot negativt svar) var: ansträngningskorrelerad bröstsmärta före arbetsprovet, ST-T-segmentsförändringar på vilo-EKG, kärlkrampsdiagnos enligt patientens egen bedömning, samt medicinering för förhöjda kolesterolvärden i blodet. Hjärt-kärlhändelser inträffade i 52.7%, 18.3%, och 2.0% bland patienter med positivt, inkonklusivt respektive negativt arbets-EKG. Studie II: Resultatet från arbets-EKG styrde remitteringen av patienter till hjärtklinik, med högre sannolikhet för remiss efter positivt test. Bland patienter med positivt arbets-EKG remitterades färre patienter vid stigande ålder, justerat för tidigare känd hjärt-kärlsjukdom. Egenföretagande kvinnor blev oftare remitterade än andra kvinnor, justerat för ålder, bröstsmärtesymtom och arbets-EKG-svar. Studie III: I 52.3% av samtliga fall var primärvården (personligt besök eller via telefonrådgivning) den första vårdkontakten för patienter med förstagångs hjärtinfarkt. Tidsfördröjningen före sjukhusvård var 2 timmar eller mer bland 67.0% av alla patienter från primärvården och 44.7% bland de patienter som först ringde larmcentralen (112) eller sökte direkt till sjukhusets akutmottagning. Studie IV: Patienter med tidigare konstaterad hjärt-kärlsjukdom hade en pågående statinbehandling i 34.5% av fallen, före insjuknandet i förstagångs hjärtinfarkt. Andelen patienter med pågående statinbehandling avtog med stigande ålder, justerat för diabetes och tidigare hjärt-kärlsjukdom. Kvinnor från 70 år och äldre erhöll statinbehandling hälften så ofta som jämförbara män. Slutsats: Patienter med låg risk för hjärt-kärlhändelser kan identifieras före remittering till arbets-EKG, med hjälp av kliniska karakteristika. Patienter med negativt svar på arbets-EKG har en god prognos, med få hjärt-kärlhändelser inom sex månader efter arbetsprovet. Urvalet av patienter som remitteras för fortsatt hjärtutredning styrs av resultatet från arbets-EKG, men interaktioner mellan ålder, kön och anställningsförhållanden påverkar sannolikheten för remittering. Tiden från symtomdebut och till sjukhusvård var avsevärt fördröjd, särskilt för de patienter som primärt kontaktade primärvården. Endast en tredjedel av alla patienter med tidigare konstaterad hjärt-kärlsjukdom hade en pågående statinbehandling vid hjärtinfarktinsjuknandet. Andelen patienter med pågående statinbehandling avtog med högre ålder, särskilt bland kvinnor från 70 års ålder och äldre. En ökad medvetenhet om hur ålder, kön och social ställning påverkar den medicinska beslutsprocessen är angelägen. Metoder för bättre identifiering och uppföljning av riskpersoner behöver utvecklas och införas i den medicinska verksamheten. Nyckelord och förklaringar: Arbets-EKG (kliniskt arbetsprov på ergometercykel med samtidig EKG-registrering), positivt arbets-EKG (talar för kärlkrampssjukdom), negativt arbets-EKG (talar för frånvaro av sjukdom). EKG (elektrokardiografi), hjärtinfarkt, ischemisk hjärtsjukdom (sjukdomstillstånd med otillräcklig blodtillförsel till hjärtat), sekundärprevention (förhindra återinsjuknande i tidigare genomliden sjukdom).

Background: Poor health costs the Swedish society billions a year and affects every individual who lives with poor health. By a close collaboration between medical doctors, nurses and other health professions there are good opportunities to work with health promotion and for the individual patient’s health.  One way to work with health promotion in health care is to work with Physical activity on referral, FaR®.  Physical activity on referral was created to improve the health among the Swedish population and has been effective against diseases like cardiovascular disease and diabetes. Research has been done on which professional groups that makes the most prescriptions of Physical activity on referral and why patients don’t follow them. Objective: The aim of the study was to investigate the frequency of and the attitude toward prescribing Physical activity on referral, among medical doctors and medical students and to investigate if there were any differences between genders. Method: A web survey was designed and sent to 45 medical doctors at Akademiska Sjukhuset in Uppsala and to 286 medical students in semester 7-9 at Uppsala University. Results: The majority of the participants thought that physical activity had an important role in health promotion and knew about Physical activity on referral. Even though few of the participants had made a prescription of Physical activity on referral, the majority thought that it was an important part in the work with health promotion. The participants thought that more education in Physical activity on referral was needed. The participants prioritized to prescribe Physical activity on referral to patients at risk to get cardiovascular diseases, while patients who were less physical active than the recommendations of Livsmedelsverket got the lowest priority. Conclusion: Physical activity on referral was created to increase physical activity among the Swedish population and to reduce the risk to get diseases that can be related to low physical activity. It is therefore alarming that the participants were less prioritizing patients who were less physical active than the recommendations of Livsmedelsverket when it comes to prescribing Physical activity on referral, than other patients. By medical doctors and nurses working as a team, preventive actions can be taken early and therefore the risk for the individuals to develop secondary diseases can be reduced.