The significant behavioral aspects of adopted children within successful adoption in Romania

The human behavior is giving the entire picture of a person. The behavior is based on a complex combination of personal innate factors, experience and education and the social network within which the individual is integrated. Each moment the complex individual factors face external and internal environmental aspects which in turn, generate proactive and retroactive reactions. The adoption process is an important and challenging social experiment, bringing to the adopted child a new affiliation, social network, experiences and educational standards. This comes in his/her life after the trauma of losing his biological affiliation and social and emotional support. Which are the significant characteristics of the adopted child's behavior? Which are the behavioral characteristics of the adoptive child that guarantee the success of the domestic adoptions in Romania? These are the questions we are going to answer here based on the research done within FISAN(6) project. The 32 children, 11-16 years old, adopted by Romanian families, during the early ages (0-4 years), were evaluated with complex evaluation tools for children and parents. The adoptive families participating in the research live in the Western counties of Romania.Successful adoption is defined as secure attachment of the adopted child. The conclusions emphasize the importance of: the pro-social behavior, the loving behavior showed to the parents, the assertive behavior, the differentiations between parents and people outside the family, and between the two parents, and the humor. These behaviors displayed by the adopted children are the ingredients of a successful integration within the adoptive family.

Factors influencing the adoption of an innovation: an examination of the uptake of the Canadian Heart Health Kit (HHK)

BACKGROUND: There is an emerging knowledge base on the effectiveness of strategies to close the knowledge-practice gap. However, less is known about how attributes of an innovation and other contextual and situational factors facilitate and impede an innovation's adoption. The Healthy Heart Kit (HHK) is a risk management and patient education resource for the prevention of cardiovascular disease (CVD) and promotion of cardiovascular health. Although previous studies have demonstrated the HHK's content validity and practical utility, no published study has examined physicians' uptake of the HHK and factors that shape its adoption. OBJECTIVES: Conceptually informed by Rogers' Diffusion of Innovation theory, and Theory of Planned Behaviour, this study had two objectives: (1) to determine if specific attributes of the HHK as well as contextual and situational factors are associated with physicians' intention and actual usage of the HHK kit; and (2), to determine if any contextual and situational factors are associated with individual or environmental barriers that prevent the uptake of the HHK among those physicians who do not plan to use the kit. METHODS: A sample of 153 physicians who responded to an invitation letter sent to all family physicians in the province of Alberta, Canada were recruited for the study. Participating physicians were sent a HHK, and two months later a study questionnaire assessed primary factors on the physicians' clinical practice, attributes of the HHK (relative advantage, compatibility, complexity, trialability, observability), confidence and control using the HHK, barriers to use, and individual attributes. All measures were used in path analysis, employing a causal model based on Rogers' Diffusion of Innovations Theory and Theory of Planned Behaviour. RESULTS: 115 physicians (follow up rate of 75%) completed the questionnaire. Use of the HHK was associated with intention to use the HHK, relative advantage, and years of experience. Relative advantage and the observability of the HHK benefits were also significantly associated with physicians' intention to use the HHK. Physicians working in solo medical practices reported experiencing more individual and environmental barriers to using the HHK. CONCLUSION: The results of this study suggest that future information innovations must demonstrate an advantage over current resources and the research evidence supporting the innovation must be clearly visible. Findings also suggest that the innovation adoption process has a social element, and collegial interactions and discussions may facilitate that process. These results could be valuable for knowledge translation researchers and health promotion developers in future innovation adoption planning.

Three essays in Swiss corporate governance

This dissertation is a combination of three relatively independent chapters on the subject of corporate governance. Corporate governance is presently at the epicenter of the global financial crisis. The lack of regulation and the misalignment of objectives have greatly contributed to the major crisis we are now in. Most governance research has been conducted in the United States in a context of widely held corporations and great executive power. It does not reflect the variety of situations around the world and we question the validity of this model in other contexts. The aim of this dissertation is to look at other governance models, in particular the Swiss corporate governance not only from a practical point of view, but also from a multi-theoretical approach. Traditional corporate governance literature has focused on the Anglo-American model that mainly follows the agency theory (Jensen and Meckling, 1976) in a shareholder-manager context, and overlooked other approaches. We focus on three different aspects of corporate governance using three different theories. First, we look at the ownership type of various corporations, using the agency theory in a context where issues between shareholders predominate over the typical shareholder-manager relationship. Second, we explore the adoption process of several governance mechanisms that, due to changes in legislation, has taken place in Switzerland since 2002. We use the institutional theory (DiMaggio and Powell, 1983), in a context where the environmental pressures are particularly high. Finally, we spotlight the board of directors as a key element of the governance of publicly listed corporations. Particularly, we focus on the independence of the board of directors, using a combination of the agency and resource dependence theories (Pfeffer, 1972; Pfeffer and Salancik, 1978).

The forced adoption of a fast-track appraisal process for a breast cancer treatment in UK

Trastuzumab (Herceptin ®, Roche) is approved in UK for the treatment of the metastatic breast cancer since 2001. As of 2005, concomitantly with the publication of 3 studies that showed it produces a 50% reduction of the recurrence rates of breast cancer, trastuzumab started to be prescribed in the earlt adjuvant treatrnent of this disease. Und June 2006, trastuzumab did not have both: 1) regulatory approval and 2) NICE [National Institute for Health and Clinical Excellence] recommendation for the use in early stages of breast cancer. During the period until June 2006, the trastuzumab use in those patients was not reimbursed and because the cost of trastuzumab is equal with the yearly UK average income, most of patients could not self fund their treatrnent. Before the publication of the final NICE guidance, the new data of trastuzumab in early breast cancer raised enormous patient and professional interest and expectations. A great volume of public and professional pressure was generated to transcend a system by which Primary Care Trusts can reimburse a treatment only after a formal guidance was issued. This paper draw on a case study depicting and analyzing the process by which regulatory approval and NICE recommendations were achieved in a record time and how trastuzumab became a standard treatment on early adjuvant breast cancer. According to the data we gathered in this work we were witnessing one of the fastest processes of adoption of a health care technology since the creation of NICE, in 1999. This study addresses the following research question: How and why does the adoption pattern of trastuzumab differ from the rational decision-making model of the reimbursement process in UK? [Author, p. 4]

Essays on the principles and adoption of entreprise-wide architecture

Enterprise-wide architecture has become a necessity for organizations to (re)align information technology (IT) to changing business requirements. Since a city planning metaphor inspired enterprise-wide architecture, this dissertation's research axes can be outlined by similarities between cities and enterprises. Both are characterized as dynamic super-systems that need to address the evolving interest of various architecture stakeholders. Further, both should simultaneously adhere to a set of principles to guide the evolution of architecture towards the expected benefits. The extant literature on enterprise-wide architecture not only disregards architecture adoption's complexities but also remains vague about how principles guide architecture evolution. To bridge this gap, this dissertation contains three interrelated research streams examining the principles and adoption of enterprise-wide architecture. The first research stream investigates organizational intricacies inherent in architecture adoption. It characterizes architecture adoption as an ongoing organizational adaptation process. By analyzing organizational response behaviors in this adaptation process, it also identifies four archetypes that represent very diverse architecture approaches. The second research stream ontologically clarifies the nature of architecture principles along with outlining new avenues for theoretical contributions. This research stream also provides an empirically validated set of principles and proposes a research model illustrating how principles can be applied to generate expected architecture benefits. The third research stream examines architecture adoption in multinational corporations (MNCs). MNCs are Specified by unique organizational characteristics that constantly strive for balancing global integration and local responsiveness. This research stream characterizes MNCs' architecture adoption as a continuous endeavor. This endeavor tries to constantly synchron ize architecture with stakeholders' beliefs about how to balance global integration and local responsiveness. To conclude, this dissertation provides a thorough explanation of a long-term journey in Which organizations learn over time to adopt an effective architecture approach. It also clarifies the role of principles to purposefully guide the aforementioned learning process. - L'Architecture d'Entreprise (AE) est devenue une nécessité pour permettre aux organisations de (ré)aligner les technologies de l'information (TI) avec les changements en termes de besoins métiers. En se basant sur la métaphore de la planification urbaine dont l'AE s'est inspirée, cette dissertation peut être présentée comme une comparaison entre les villes et les entreprises; les deux sont des super-systèmes dynamiques ayant besoin de répondre aux intérêts d'acteurs divers et variés en constants évolution. De plus, les deux devraient souscrire simultanément à un ensemble de principes afin de faire converger l'évolution de l'architecture vers les bénéfices attendus. La littérature sur l'AE, non seulement ne prend pas en considération les complexités de l'adoption d'architecture, mais aussi reste vague sur la manière dont les principes guident l'évolution de l'architecture. Pour pallier ce manque, cette dissertation est composée de trois volets de recherche étroitement liés examinant les principes et l'adoption de l'AE. Le premier volet examine la complexité organisationnelle inhérente à l'adoption de l'architecture. Il caractérise l'adoption de l'architecture en tant que processus d'adaptation continu. En analysant le comportement organisationnel en réponse à ce processus d'adaptation, ce volet distingue quatre archétypes représentant la diversité des approches de l'architecture. Le deuxième volet de recherche clarifie de manière ontologique la nature des principes d'architecture et envisage les contributions théoriques futures possibles. Cet axe de recherche fournit aussi un ensemble de principes, validés de manière empirique, et propose un modèle de recherche illustrant la manière dont ces principes peuvent être appliqués afin de générer les bénéfices attendus de l'architecture. Le troisième volet examine l'adoption de l'architecture dans les entreprises multinationales. Ces dernières possèdent des caractéristiques organisationnelles uniques et sont constamment à la recherche d'un équilibre entre une intégration globale et une flexibilité locale tout en prenant en compte les convictions des divers acteurs sur la manière d'atteindre cet équilibre. Pour conclure, cette dissertation fournit une explication sur le long voyage au cours duquel les entreprises apprennent à adopter une approche d'architecture efficace. Elle clarifie aussi le rôle des principes dans l'accompagnement de ce processus d'apprentissage.

Adoption of the Healthy Heart Kit by Alberta family physicians

OBJECTIVE: The Healthy Heart Kit (HHK) is a risk management and patient education kit for the prevention of cardiovascular disease (CVD) and the promotion of CV health. There are currently no published data examining predictors of HHK use by physicians. The main objective of this study was to examine the association between physicians' characteristics (socio-demographic, cognitive, and behavioural) and the use of the HHK. METHODS: All registered family physicians in Alberta (n=3068) were invited to participate in the "Healthy Heart Kit" Study. Consenting physicians (n=153) received the Kit and were requested to use it for two months. At the end of this period, a questionnaire collected data on the frequency of Kit use by physicians, as well as socio-demographic, cognitive, and behavioural variables pertaining to the physicians. RESULTS: The questionnaire was returned by 115 physicians (follow-up rate = 75%). On a scale ranging from 0 to 100, the mean score of Kit use was 61 [SD=26]. A multiple linear regression showed that "agreement with the Kit" and the degree of "confidence in using the Kit" was strongly associated with Kit use, explaining 46% of the variability for Kit use. Time since graduation was inversely associated with Kit use, and a trend was observed for smaller practices to be associated with lower use. CONCLUSION: Given these findings, future research and practice should explore innovative strategies to gain initial agreement among physicians to employ such clinical tools. Participation of older physicians and solo-practitioners in this process should be emphasized.

Network governance and the domestic adoption of soft rules

European regulatory networks (ERNs) are in charge of producing and disseminating non-bindings standards, guidelines and recommendations in a number of important domains, such as banking and finance, electricity and gas, telecommunications, and competition regulation. The goal of these soft rules is to promote 'best practices', achieve co-ordination among regulatory authorities and ensure the consistent application of harmonized pro-competition rules across Europe. This contribution examines the domestic adoption of the soft rules developed within the four main ERNs. Different factors are expected to influence the process of domestic adoption: the resources of regulators; the existence of a review panel; and the interdependence of the issues at stake. The empirical analysis supports hypotheses about the relevance of network-level factors: monitoring and public reporting procedures increase the final level of adoption, while soft rules concerning highly interdependent policy areas are adopted earlier.

Binge eating in binge eating disorder: a break-down of emotion regulatory process?

Current explanatory models for binge eating in binge eating disorder (BED) mostly rely onmodels for bulimianervosa (BN), although research indicates different antecedents for binge eating in BED. This studyinvestigates antecedents and maintaining factors in terms of positive mood, negative mood and tension in asample of 22 women with BED using ecological momentary assessment over a 1-week. Values for negativemood were higher and those for positive mood lower during binge days compared with non-binge days.During binge days, negative mood and tension both strongly and significantly increased and positive moodstrongly and significantly decreased at the first binge episode, followed by a slight though significant, andlonger lasting decrease (negative mood, tension) or increase (positive mood) during a 4-h observation periodfollowing binge eating. Binge eating in BED seems to be triggered by an immediate breakdown of emotionregulation. There are no indications of an accumulation of negative mood triggering binge eating followed byimmediate reinforcing mechanisms in terms of substantial and stable improvement of mood as observed inBN. These differences implicate a further specification of etiological models and could serve as a basis fordeveloping new treatment approaches for BED.

Streamlining the medication process improves safety in the intensive care unit.

BACKGROUND: Multiple interventions were made to optimize the medication process in our intensive care unit (ICU). 1 Transcriptions from the medical order form to the administration plan were eliminated by merging both into a single document; 2 the new form was built in a logical sequence and was highly structured to promote completeness and standardization of information; 3 frequently used drug names, approved units, and fixed routes were pre-printed; 4 physicians and nurses were trained with regard to the correct use of the new form. This study was aimed at evaluating the impact of these interventions on clinically significant types of medication errors. METHODS: Eight types of medication errors were measured by a prospective chart review before and after the interventions in the ICU of a public tertiary care hospital. We used an interrupted time-series design to control the secular trends. RESULTS: Over 85 days, 9298 lines of drug prescription and/or administration to 294 patients, corresponding to 754 patient-days were collected and analysed for the three series before and three series following the intervention. Global error rate decreased from 4.95 to 2.14% (-56.8%, P < 0.001). CONCLUSIONS: The safety of the medication process in our ICU was improved by simple and inexpensive interventions. In addition to the optimization of the prescription writing process, the documentation of intravenous preparation, and the scheduling of administration, the elimination of the transcription in combination with the training of users contributed to reducing errors and carried an interesting potential to increase safety.

New perspectives in the use of ink evidence in forensic science: Part I. Development of a quality assurance process for forensic ink analysis by HPTLC

The level of information provided by ink evidence to the criminal and civil justice system is limited. The limitations arise from the weakness of the interpretative framework currently used, as proposed in the ASTM 1422-05 and 1789-04 on ink analysis. It is proposed to use the likelihood ratio from the Bayes theorem to interpret ink evidence. Unfortunately, when considering the analytical practices, as defined in the ASTM standards on ink analysis, it appears that current ink analytical practices do not allow for the level of reproducibility and accuracy required by a probabilistic framework. Such framework relies on the evaluation of the statistics of the ink characteristics using an ink reference database and the objective measurement of similarities between ink samples. A complete research programme was designed to (a) develop a standard methodology for analysing ink samples in a more reproducible way, (b) comparing automatically and objectively ink samples and (c) evaluate the proposed methodology in a forensic context. This report focuses on the first of the three stages. A calibration process, based on a standard dye ladder, is proposed to improve the reproducibility of ink analysis by HPTLC, when these inks are analysed at different times and/or by different examiners. The impact of this process on the variability between the repetitive analyses of ink samples in various conditions is studied. The results show significant improvements in the reproducibility of ink analysis compared to traditional calibration methods.

Cerebrospinal fluid antimicroglial antibodies in Alzheimer disease: a putative marker of an ongoing inflammatory process.

Immunocompetent microglia play an important role in the pathogenesis of Alzheimer's disease (AD). Antimicroglial antibodies in the cerebrospinal fluid (CSF) in clinically diagnosed AD patients have been previously recorded. Here, we report the results of the analysis of the CSF from 38 autopsy cases: 7 with definite AD; 14 with mild and 10 with moderate Alzheimer's type pathology; and 7 controls. Antimicroglial antibodies were identified in 70% of patients with definite AD, in 80% of patients with moderate and in 28% of patients with mild Alzheimer's type pathology. CSF antimicroglial antibodies were not observed in any of the control cases. The results show that CSF antimicroglial antibodies are present in the majority of patients with definite AD and also in cases with moderate Alzheimer's type changes. They may also indicate dysregulation of microglial function. Together with previous observations, these findings indicate that compromised immune defense mechanisms play an important role in the pathogenesis of AD.

Reforms of the pre-graduate curriculum for medical students: the Bologna process and beyond.

For several years, all five medical faculties of Switzerland have embarked on a reform of their training curricula for two reasons: first, according to a new federal act issued in 2006 by the administration of the confederation, faculties needed to meet international standards in terms of content and pedagogic approaches; second, all Swiss universities and thus all medical faculties had to adapt the structure of their curriculum to the frame and principles which govern the Bologna process. This process is the result of the Bologna Declaration of June 1999 which proposes and requires a series of reforms to make European Higher Education more compatible and comparable, more competitive and more attractive for Europeans students. The present paper reviews some of the results achieved in the field, focusing on several issues such as the shortage of physicians and primary care practitioners, the importance of public health, community medicine and medical humanities, and the implementation of new training approaches including e-learning and simulation. In the future, faculties should work on several specific challenges such as: students' mobility, the improvement of students' autonomy and critical thinking as well as their generic and specific skills and finally a reflection on how to improve the attractiveness of the academic career, for physicians of both sexes.

Toward a comprehensive conceptualization of business organizations and their members from a sensemaking perspective. Lessons learned from Picassoâeuro?s cubism

Until recently, much of the discussion regarding the type of organization theory needed in management studies focused on normative vs. descriptive roles of management science. Some authors however noticed that even a descriptive theory can have a normative impact. Among others, management theories are used by practitioners to make sense of their identity and roles in given contexts, and so guide their attitude, decision process, and behavior. The sensemaking potential of a theory might in this view represent an important element for predicting the adoption of a theory by practitioners. Accordingly, theories are needed which better grasp the increased complexity of today's business environment in order to be more relevant for practitioners. This article proposes a multi-faceted perspective of organizations. This implies leaving a simplistic view of organizations and building a 'cubist' conception. Picasso's cubism paintings are characterized by the use of multiple perspectives within a single drawing. Similarly, I argue here that managers must learn not only to add multiple responsibilities in their work, but to develop an integrated conception of their managerial identity and of their organizations in which the multiple social and economic dimensions are enmeshed. Social entrepreneurship is discussed as illustration of typical multi-faceted business.

Macrophages induce neutrophil apoptosis through membrane TNF, a process amplified by Leishmania major.

Neutrophils are recruited to the site of parasite inoculation within a few hours of infection with the protozoan parasite Leishmania major. In C57BL/6 mice, which are resistant to infection, neutrophils are cleared from the site of s.c. infection within 3 days, whereas they persist for at least 10 days in susceptible BALB/c mice. In the present study, we investigated the role of macrophages (MPhi) in regulating neutrophil number. Inflammatory cells were recruited by i.p. injection of either 2% starch or L. major promastigotes. Neutrophils were isolated and cultured in the presence of increasing numbers of MPhi. Extent of neutrophil apoptosis positively correlated with the number of MPhi added. This process was strictly dependent on TNF because MPhi from TNF-deficient mice failed to induce neutrophil apoptosis. Assays using MPhi derived from membrane TNF knock-in mice or cultures in Transwell chambers revealed that contact with MPhi was necessary to induce neutrophil apoptosis, a process requiring expression of membrane TNF. L. major was shown to exacerbate MPhi-induced apoptosis of neutrophils, but BALB/c MPhi were not as potent as C57BL/6 MPhi in this induction. Our results emphasize the importance of MPhi-induced neutrophil apoptosis, and membrane TNF in the early control of inflammation.