The purpose of this study was to determine whether radiologists could accurately assess osteopenia on chest plain films. Two chest radiologists evaluated lateral chest films from 100 patients (80 female and 20 male), ranging in age from 16 to 86 years, for osteopenia and its associated findings. Intra- and interobserver agreement was determined using weighted kappa statistics, and accuracy was assessed by making comparisons to bone mineral density as measured by the non-invasive gold standard of dual-energy x-ray absorptiometry (DXA). Overall, radiologists were good at identifying signs of late, but not early, disease. Intraobserver consistency was substantial for fish vertebrae (Kw1=0.638; Kw2=0.0.712) with moderate interobserver agreement (Kw=0.45). Similarly for wedged vertebrae, intraobserver consistency was substantial to moderate (Kw1=0.654; Kw2=0.533) with substantial interobserver agreement (Kw=0.622). These radiographic signs correlated with true disease as shown by high specificity values. Therefore, this study indicates that if osteopenia is suspected (i.e., there is a wedge or fish vertebra) or its associated features are seen on a CXR, it is crucial for radiologists to comment on it. The literature suggests that referring physicians do not pay attention to such findings in radiology reports. Radiologists could effect change in clinical treatment by not burying these findings in the report body, but instead putting it in the impression, along with a recommendation that the finding be followed up with DXA. Because effective interventions for women with osteoporosis exist, the results of this study will contribute to a major change in the practice of chest radiology and improve womens health by preventing the devastating disability associated with osteoporosis.

Thesis (Ph. D.)--University of Missouri-Columbia, 1999. / Typescript. Vita. Includes bibliographical references (leaves 92-136). Also available on the Internet.

When referring physicians decide to refer their patients to specialist care, they rarely, if ever, make a referral decision with the benefit of having access to all of the desirable information. It is therefore highly unlikely that the referring physician will make the optimal choice of specialist for that particular referral. A specialist selection optimization algorithm was developed to guarantee that the “right specialist” for each patient’s referral was chosen. The specialist selection optimization algorithm was developed based on feedback from over 120 users of the e-referral program. The developed algorithm was simulated, tested, and validated in MATLAB. Results from the MATLAB simulation demonstrate that the algorithm functioned as it was designed to. The developed algorithm provides referring physicians with an unprecedented level of support for their decision of which specialist to refer their patient to.

When referring physicians decide to refer their patients to specialist care, they rarely, if ever, make a referral decision with the benefit of having access to all of the desirable information. It is therefore highly unlikely that the referring physician will make the optimal choice of specialist for that particular referral. A specialist selection optimization algorithm was developed to guarantee that the “right specialist” for each patient’s referral was chosen. The specialist selection optimization algorithm was developed based on feedback from over 120 users of the e-referral program. The developed algorithm was simulated, tested, and validated in MATLAB. Results from the MATLAB simulation demonstrate that the algorithm functioned as it was designed to. The developed algorithm provides referring physicians with an unprecedented level of support for their decision of which specialist to refer their patient to.

Thesis (Ph. D.)--Victoria University (Melbourne, Vic.), 2006. / Includes bibliographical references.

Thesis (Ph. D.)--University of Missouri-Columbia, 1999. / Typescript. Vita. Includes bibliographical references (leaves 92-136). Also available on the Internet.

Thesis (M.A.)--Ball State University, 2008. / Title from PDF t.p. (viewed on Sept. 01, 2009). Research paper (M.A.), 3 hrs. Includes bibliographical references (p. 39-42).

Com o objetivo de estudar o processo de referência de pacientes que procuram um Hospital Universitário, pela primeira vez e analisar algumas características destes pacientes e as inter relações entre a localização do domicílio, a utilização de outros serviços, as dificuldades e facilidades apresentadas pelos pacientes, para procurar o Hospital, foram investigados todos os pacientes que procuraram um Hospital Universitário. O trabalho foi realizado no período de cinco semanas de outubro e novembro de 1983, a saber: de 3 a 7, 17 a 21 e 24 a 27 de outubro e de 7 a 11 e 21 a 25 de novembro. Através de entrevistas foi preenchido um formulário com questões sobre características do paciente tais como: sexo, idade, nível de instrução; ocupação, local de residência, gravidade dos sinais e sintomas que os levaram a procurar o Hospital, motivo da demanda, distância do domicílio ao Hospital, utilização de outros serviços, tipos de encaminhamento. A hipótese diagnóstica foi obtida do prontuário do paciente, após a consulta. Foram estudados 1.601 pacientes, sendo 59,53 por cento do sexo feminino e 40,47 por cento do sexo masculino. A maior concentração de pacientes pertence ao grupo etário de 15 a 24 anos (24,49 por cento ), seguido pelo de 25 a 34 anos (17,86 por cento ). O nível de instrução mostrou-se bastante baixo, uma vez que, 54,63 por cento tinha o primeiro grau incompleto e 30 por cento analfabetos. A ocupação que apareceu com maior freqüência foi as donas de casa (43,94 por cento ), seguida pelos agricultores (15,51 por cento ), trabalhadores dos serviços dos desportos e das diversões (13, 64 por cento ). Como Hospital Regional 46,34 por cento dos pacientes procedem da região de Ribeirão Preto e 37,48 por cento do próprio município, onde está localizado. A procedência de pacientes na zona rural aumenta proporcionalmente, em relação à urbana a medida que se afasta do município de Ribeirão Preto. De maneira geral, os pacientes da zona urbana procuram mais precocemente o Hospital, quando residem mais próximo dele. A maioria dos pacientes que residem próximo e procuram o Hospital é portador de sinais e sintomas considerado leve, aumentando a proporção de sinais e sintomas graves entre os pacientes que residem mais distantes do Hospital. 32,57 por cento dos pacientes portadores de sinais e sintomas leves e 25,12 por cento dos portadores de sinais e sintomas graves não procuraram outro serviço, antes de demandarem ao Hospital e informaram não ter procurado outro serviço, por falta de recursos para pagar assistência médica e não confiar no Centro de Saúde. Dentre os pacientes que procuram outros serviços antes, apenas 54,4 O por cento foram referidos para o Hospital e 87,36 por cento destes não receberam orientação para, após o atendimento no Hospital, retornarem a seu serviço de origem. O fluxo de pacientes ao Hospital diminuiu paulatinamente, no decorrer da semana. As doenças do sistema nervoso e dos órgãos dos sentidos ocupam o primeiro lugar entre as hipóteses diagnósticas dos pacientes que procuram o Hospital, pela primeira vez. Dos 1601 pacientes atendidos, 14,74 por cento não foram registrados, conforme rotina estabelecida pelo Hospital, podendo gerar estatísticas imperfeitas. O estudo do processo de referência ao Hospital mostrou-se importante para o conhecimento das características dos pacientes, das inter relações com os outros serviços e das peculiaridades própria do Hospital, como subsídio para organização da assistência à saúde. / With the objective to study the process of referral of patients who look for a University Hospital for the first time and to analyze some characteristics of these patients and the interrelationships between the location of their homes, the use of other services and the difficulties or the facilitation met by the patient to contact the hospital, all the patients who looked for a University Hospital were investigated. The study was conducted over a period of five weeks from October 3 to 7, 17 to 21 and 24 to 27 and from November 7 to 11 and 21 to 25, 1983. Each patient was interviewed and a form was filled out with answers to questions of the characteristics of the patient such as sex, age, level of education, occupation, place of residence, seriousness of the signs and symptoms that led him to look for the Hospital, reason for the demand, distance of the residence from the Hospital, type of referrals. The diagnostic hypothesis was taken from the patient\'s medical record after his medical visit. A total of 1601 patients were studied; 59.53 per cent were women and 40.43 per cent were males. Most patient were concentrated in the 15 to 24 year age range (24.49 per cent ), followed by the 25 to 34 year age range (17.86 per cent ). The level of education was quite low, since 54.63 per cent had not completed elementary school and 30 per cent were illiterate. The most frequent types of occupation were: housewife (43.94 per cent ), followed by rural workers (15.51 per cent ) and by workers in suports and amusement services (13.64 per cent ). Since this is a Regional Hospital, 46.34 per cent of the patients were from the Ribeirão Preto region and 37.48 per cent from the town itself in which the Hospital is located. The origin of patients from the rural zone increased proportionally in relation to the urban zone with the distance from Ribeirão Preto. In general, the patients from the urban zone look earlier for the Hospital when they live closer to it. Most of the patients living close to the Hospital had signs and symptoms considered mild, with an increase in the proportion of serious signs and symptans anong the patients who live farther away from the Hospital. 32.57 per cent of the patients with mild signs and symptoms and 25.12 per cent of the patients with serious signs and symptoms did not look for any other service before contacting the Hospital and informed that they had not lookes for other services because of lack of money to pay for medical assistance and because they did not trust the health center. Among the patients who had previously looked for other services, 54.40 per cent were referred to the Hospital and 87.36 per cent of these did not receive guidance to return to the original service after being attended at the Hospital. The flow of patients to the Hospital decreased little by little with each passing week. Diseases of the nervous system and of the sensory organs occupied first place among the diagnostic hypotheses for the patients who looked for the Hospital for the first time. Of 1601 patients attended, l4.74 per cent were not registered according to the routine established by the Hospital, a fact that may give rise to imperfet statistics. The study of the process of referral to the Hospital proved to be important in terms of learning about the characteristics of the patients, the interrelationships with the other services and the peculiarities of the Hospital, as an aid in organizing health assistance.

Doctor Legum - LLD / The main contributor of situations before the International Criminal Court (hereinafter ICC) has been state parties that have referred situations on their own territory to the ICC through “self-referral”. This study examines the concept of self-referral tracing the history of voluntary deferral by states of their jurisdiction over international crimes up to the enactment of the Rome Statute. The study finds that states were historically reluctant to have international crimes committed on their territory handled by other bodies or states. The self-referrals under the ICC regime are therefore a novelty in international criminal law. The legality of the act of self-referral under the Rome Statute is also examined and it is concluded that self-referrals are provided for within the Statute, although their legality has been questioned. The study establishes that self-referrals have seen unprecedented cooperation by territorial states but have also been selective in nature, targeting only non-state actors (rebel groups) .The study further compares the ICC’s handling of two other situations (Kenya and Darfur) which were triggered by antagonistic proprio motu and UN Security Council referrals respectively. The ultimate collapse of cases arising out of the Kenyan situation plus the suspension of investigations in Darfur due to non-cooperation is significant when compared with the relative successes registered with self-referred situations. The study concludes that whereas self-referrals may involve concessions to the territorial state like non-prosecution of state actors, this is a necessary evil to ensure successful investigations and prosecutions of international crimes. I recommend at the end of the study that in order to shield the office of the ICC Prosecutor from the diplomacy, dirty international politics and compromises at play in securing referrals as well as cooperation during the entire prosecution process, there should be a separate organ of the ICC handling investigations and interactions with states.

The purpose of the research has been to explore perceptions of supervisors regarding their referral role within the Employee Assistance Programme (EAP). Traditionally supervisors are expected to identify troubled employees and refer them to the EAP. Therefore, the study will help in identifying perceptions on the part of the supervisors and improve knowledge as to how they perceive their referral role within the EAP. The researcher did an exploratory study in this qualitative applied research, since her intention was to gain understanding of the perceptions of supervisors regarding their referral role within the EAP. It is the aim of the qualitative approach to understand the meaning that individuals attach to their everyday lives. The population consisted of 30 EAP client companies of The Careways Group in Gauteng. The researcher interviewed 12 respondents from three client companies, who had 20% or fewer supervisory referrals. The 12 respondents were selected as the sample through non-probability sampling, utilizing a purposive sampling method. Five of the respondents were working for Nashua Mobile, four were working for Computer Share and three were working for New Vaal. The empirical data was gathered by means of a semi-structured interview schedule. A tape recorder was used to record the interviews and put data into transcripts. All respondents signed an informed consent form (Appendix D). An in-depth literature review was conducted about the benefits of an EAP, types of referrals, responsibilities of a supervisor, resistance to utilise the EAP and addressing supervisors’ referral problems. Findings indicate that supervisors need comprehensive training regarding the EAP, which should also be linked with other management trainings. Supervisors believe that they are the key figures in implementing the programme because they work closely with employees, but they are not confident enough to implement the programme due to lack of knowledge. Supervisors indicated that the EAP plays a minimal role as a management tool and there is a need to re-position the programme based on the needs of the organisation. There is a general view that as the needs of the organisations is changing, so should the focus of the EAP. / Dissertation (MSW)--University of Pretoria, 2008. / Social Work and Criminology / unrestricted