Behavioral Perspectives on Organizational Change: Practice Adoption, Product Culling, and Technological Search

This dissertation explores the complex process of organizational change, applying a behavioral lens to understand change in processes, products, and search behaviors. Chapter 1 examines new practice adoption, exploring factors that predict the extent to which routines are adopted “as designed” within the organization. Using medical record data obtained from the hospital’s Electronic Health Record (EHR) system I develop a novel measure of the “gap” between routine “as designed” and routine “as realized.” I link this to a survey administered to the hospital’s professional staff following the adoption of a new EHR system and find that beliefs about the expected impact of the change shape fidelity of the adopted practice to its design. This relationship is more pronounced in care units with experienced professionals and less pronounced when the care unit includes departmental leadership. This research offers new insights into the determinants of routine change in organizations, in particular suggesting the beliefs held by rank-and-file members of an organization are critical in new routine adoption. Chapter 2 explores changes to products, specifically examining culling behaviors in the mobile device industry. Using a panel of quarterly mobile device sales in Germany from 2004-2009, this chapter suggests that the organization’s response to performance feedback is conditional upon the degree to which decisions are centralized. While much of the research on product exit has pointed to economic drivers or prior experience, these central finding of this chapter—that performance below aspirations decreases the rate of phase-out—suggests that firms seek local solutions when doing poorly, which is consistent with behavioral explanations of organizational action. Chapter 3 uses a novel text analysis approach to examine how the allocation of attention within organizational subunits shapes adaptation in the form of search behaviors in Motorola from 1974-1997. It develops a theory that links organizational attention to search, and the results suggest a trade-off between both attentional specialization and coupling on search scope and depth. Specifically, specialized unit attention to a more narrow set of problems increases search scope but reduces search depth; increased attentional coupling also increases search scope at the cost of depth. This novel approach and these findings help clarify extant research on the behavioral outcomes of attention allocation, which have offered mixed results.

Utilisation d’un modèle de co-culture cellulaire pour l’évaluation in vitro du transport inverse du cholestérol

De nouveaux modèles cellulaires in vitro par transfert de milieu et par coculture ont été mis au point afin d’évaluer la capacité des HDL à éliminer l’excès de cholestérol des tissus périphériques et de le transporter vers le foie afin d’être excrété par le foie, un processus nommé le transport inverse du cholestérol (TIC). Le système cellulaire par transfert in vitro où des macrophages J774 sont gorgés de LDL acétylées et marqués au 3H-cholestérol a été préalablement établi afin de mesurer par scintillation l’efflux de cholestérol marqué vers le milieu de culture contenant des accepteurs de cholestérol. Ce milieu conditionné est transféré sur des cellules HepG2 afin d’étudier l’influx du cholestérol marqué. Ce dernier nous permet d’observer un transport de cholestérol de 25 % hors des J774 et un transport de 39 000 cpm dans les HepG2 en utilisant un milieu contenant 2 % de sérums humains mis en commun. Une stimulation des cellules J774 par l’AMPc augmente l’efflux et l’influx d’environ 45 %. Des tests de preuve de concept ont été effectués sur le système cellulaire par co-culture qui utilise des chambres de Boyden où les J774 sont localisées au fond d’un puits et les HepG2 dans un insert, et où le milieu est partagé entre les deux types cellulaires. On a déterminé qu’une confluence densité de 60 000 cellules/cm2 sur un insert constitué d’une membrane de polyester avec des pores de 3,0 μm, sans autre revêtement, permet d’observer un influx spécifique au sérum d’environ 6 000 cpm associés aux cellules HepG2, où 50 % des comptes radioactifs sont dans les cellules et l’autre moitié présente à la surface cellulaire.

Bienestar psicológico, optimismo y resiliencia en mujeres con cáncer de mama

Objective: To evaluate the relationship between Perceived Psychological well-being, Optimism and Resilience in women survivors of breast cancer.Method: The sample was composed of 30 women diagnosed with breast cancer who were undergoing adjuvant treatment in Oncology Units General Hospital of Jerez de la Frontera and the University Hospital Puerta del Mar (Cadiz). The average age was 47.47 years (SD = 6,356) and the average of months from diagnosis of the disease was 9.93 (SD = 8,541). Scale of Psychological Well-being administered Perceived Ryff (1989), the Life Orientation Test Revised (LOT-R) Scheier, Carver and Bridges (1994) and the Scale of Resilience Wagnild and Young (1993) to assess psychological well-being the dispositional optimism and resilience respectivelyResults: Descriptive analyzes show that women diagnosed with breast cancer have levels of psychological well-being, dispositional optimism and higher than the average values provided by Resilience scales. On the other hand, regression analyses revealed that only some of the dimensions of resilience allowed to explain and predict some dimensions of psychological wellbeing, not dispositional optimism.Conclusions: The results seem to confirm the idea that if the capacity of women with breast moderate negative affect generated by the diagnosis itself and the consequences of their cancer treatment works and to promote their adaptation to the new situation we can contribute to increasing psychological well-being.

Implementing change in practice: Part 2- the change process

Pain management in premature and sick babies has long been recognisedas a vital component of neonatal care; however practices pertaining to painassessment and administration of analgesia remain variable in Neonatal Units(NNU). Sucrose has been identified as an effective agent in reducing pain during minorpainful procedures in premature babies but the uptake has been modest.This article (part 2) follows on from an earlier article on evidence to support theimplementation of sucrose administration as a measure for pain relief for minorprocedures (part 1) and will centre on practice-based change in the NNU and reflecton the strategies used as well as the effectiveness of the proposed change. A theoreticalchange model will be used as a framework to help unpack the influencesinherent within the change process.

No second chance: the experiences of junior neonatal nurses in providing end-of-life care for babies and families in the NNU

Background

An infant’s death is acutely stressful for parents and professionals. Little is known about junior nurses’ experiences providing end-of-life care in Neonatal Units (NNU).

Objectives

To better understand junior nurses’ experiences providing end-of-life care in NNU, the study explored the challenges and opportunities inherent in their practice relating to providing such care to babies and their families.

Methods

Neonatal nurses (n=12) with less than 3 years’ experience who were undergoing a neonatal education programme participated. Two focus groups were convened each with 6 nurses. The Ethics Committee at the relevant University approved the study. Nominal Group Technique (NGT) was used in the focus groups to build consensus around the challenges faced by junior nurses, alongside suggested developments in improving future care provision. Primary analysis involved successive rounds of ranking and decision making whilst secondary analysis involved thematic analysis.

Results

The study identified the pressures these nurses felt in having only one chance to ‘get it right’ for the infants and their families. They perceived the need for further ‘education and training’ highlighting that improved education provision would include both additional courses and internal training sessions. Greater ‘support’ from mentors themselves more experienced in this aspect of care within the NNU was identified as important in addressing issues around confidence building and skill development.

Conclusions

The results highlight junior nurses’ need for specific education and mentorship around end-of-life care for babies. This presentation will outline the implications for practice, education and further research.

Revising Devotion: the role of wooden sculptures in affecting painting and devotion in the Late Medieval period in Italy (XII-XV century)

Thesis (Ph.D.)--University of Washington, 2016-06

Reconciling History and International Law: Territorial and Maritime Claims in the South China Sea and East China Sea

High-ranking Chinese military officials are often quoted in international media as stating that China cannot afford to lose even an inch of Chinese territory, as this territory has been passed down from Chinese ancestors. Such statements are not new in Chinese politics, but recently this narrative has made an important transition. While previously limited to disputes over land borders, such rhetoric is now routinely applied to disputes involving islands and maritime borders. China is increasingly oriented toward its maritime borders and seems unwilling to compromise on delimitation disputes, a transition mirrored by many states across the globe. In a similar vein, scholarship has found that territorial disputes are particularly intractable and volatile when compared with other types of disputes, and a large body of research has grappled with producing systematic knowledge of territorial conflict. Yet in this wide body of literature, an important question has remained largely unanswered - how do states determine which geographical areas will be included in their territorial and maritime claims? In other words, if nations are willing to fight and die for an inch of national territory, how do governments draw the boundaries of the nation? This dissertation uses in-depth case studies of some of the most prominent territorial and maritime disputes in East Asia to argue that domestic political processes play a dominant and previously under-explored role in both shaping claims and determining the nature of territorial and maritime disputes. China and Taiwan are particularly well suited for this type of investigation, as they are separate claimants in multiple disputes, yet they both draw upon the same historical record when establishing and justifying their claims. Leveraging fieldwork in Taiwan, China, and the US, this dissertation includes in-depth case studies of China’s and Taiwan’s respective claims in both the South China Sea and East China Sea disputes. Evidence from this dissertation indicates that officials in both China and Taiwan have struggled with how to reconcile history and international law when establishing their claims, and that this struggle has introduced ambiguity into China's and Taiwan's claims. Amid this process, domestic political dynamics have played a dominant role in shaping the options available and the potential for claims to change in the future. In Taiwan’s democratic system, where national identity is highly contested through party politics, opinions vary along a broad spectrum as to the proper borders of the nation, and there is considerable evidence that Taiwan’s claims may change in the near future. In contrast, within China’s single-party authoritarian political system, where nationalism is source of regime legitimacy, views on the proper interpretation of China’s boundaries do vary, but along a much more narrow range. In the dissertation’s final chapter, additional cases, such as South Korea’s position on Dokdo and Indonesia’s approach to the defense of Natuna are used as points of comparison to further clarify theoretical findings.

Labour stress in nursing

Based on evidence found during the empirical study we can affirm that the nursing profession is affected by work stress. Objective: Evaluate stress and engagement levels among nurses in health units in Portugal and Spain and describe the stress-generating factors among the surveyed nurses. Methods: A comparative study on a transversal level. Sample of 867 nurses (504 Portuguese, 363 Spanish), female 83.6 % (78.6 % in Portugal, 90.6 % in Spain) and average age of 37. 77.2 % of the Portuguese and 39.4 % of the Spanish nurses work on average 40 hours per week. 60.6 % and 57.7 % of the Spanish and Portuguese respectively have exercised their profession for 10 years. Pamela Gray-Toft’s Nurs- ing Stress Scale (1981) [1] and Schaufeli & Bakker’s Utrecht Work En- gagement Scale (2003) [2] were used. Results: Globally, Portuguese nurses experience higher stress levels although the difference with Spanish nurses is not statistically significant. There are statistically significant differences between Portugal and Spain in “Lack of help from colleagues” and also in the psychological domain in general. Concerning Engagement, there are statistically significant differences in the three dimensions, the p-value of the Student t-test was under 5 %, highlighting that Spanish nurses are more vigorous, dedicated and absorbed by their work. Conclusions: Portuguese nurses perceive more psychological stress and mention having less help from colleagues. Spanish nurses feel more vigorous, dedicated and absorbed by their work.

Utilisation d’un modèle de co-culture cellulaire pour l’évaluation in vitro du transport inverse du cholestérol

De nouveaux modèles cellulaires in vitro par transfert de milieu et par coculture ont été mis au point afin d’évaluer la capacité des HDL à éliminer l’excès de cholestérol des tissus périphériques et de le transporter vers le foie afin d’être excrété par le foie, un processus nommé le transport inverse du cholestérol (TIC). Le système cellulaire par transfert in vitro où des macrophages J774 sont gorgés de LDL acétylées et marqués au 3H-cholestérol a été préalablement établi afin de mesurer par scintillation l’efflux de cholestérol marqué vers le milieu de culture contenant des accepteurs de cholestérol. Ce milieu conditionné est transféré sur des cellules HepG2 afin d’étudier l’influx du cholestérol marqué. Ce dernier nous permet d’observer un transport de cholestérol de 25 % hors des J774 et un transport de 39 000 cpm dans les HepG2 en utilisant un milieu contenant 2 % de sérums humains mis en commun. Une stimulation des cellules J774 par l’AMPc augmente l’efflux et l’influx d’environ 45 %. Des tests de preuve de concept ont été effectués sur le système cellulaire par co-culture qui utilise des chambres de Boyden où les J774 sont localisées au fond d’un puits et les HepG2 dans un insert, et où le milieu est partagé entre les deux types cellulaires. On a déterminé qu’une confluence densité de 60 000 cellules/cm2 sur un insert constitué d’une membrane de polyester avec des pores de 3,0 μm, sans autre revêtement, permet d’observer un influx spécifique au sérum d’environ 6 000 cpm associés aux cellules HepG2, où 50 % des comptes radioactifs sont dans les cellules et l’autre moitié présente à la surface cellulaire.

De MARC a CEPAL o cualquier otro formato y viceversa

El propósito de este artículo es práctico: enseñar al usuario de Winisis a reformatear las bases de datos diseñadas e implementadas en cualquier formato, normalizado o no, convirtiéndolas al formato de interés de la unidad de información.Winisis es un paquete que permite utilizar cualquier nomenclatura en la definición de las etiquetas que identifican los campos. Este aspecto es una ventaja y una desventaja porque permite libertad en la selección del formato a utilizar, pero, se generan una gran diversidad de formatos en las unidades de información, dificultando la compatibilidad en los sistemas automatizados de catalogación, la normalización y la transferencia efectiva de la información entre unidades de información.Algunos problemas que enfrentan los bibliotecólogos en su trabajo cotidiano al normalizar la información son por ejemplo:a) la diversidad de bases de datos sin normalización, b) la variación entre formatos, c) los diferentes números, etiquetas y nombres de los campos que integran las bases de datos, e incluso bases de datos creadas con diferentes versiones de Microisis; d) un catálogo automatizado en un formato sin normalización; e) para la participación en una red y exige la reconversión del catálogo al formato común de la red. En algunos casos se ha optado por digitar de nuevo la información en el nuevo formato, sin embargo, ante esta situación, Microisis y Winisis dispone de un recurso denominado "Tabla de Selección de Campos para reformateo".

Al Redescubrimiento de los Usuarios en las Unidades de Información

Se presenta una serie de ideas en relación con la nueva concepción que deben seguir las empresas y por lo tanto las Unidades de Información, respecto al cliente, tomando como marco de referencia o fundamento la Teoría de Sistemas.Se concluye entre otras cosas, que el usuario es la razón de ser de nuestras organizaciones y será él quien última instancia decidirá la existencia o extinción de éstas.

Ethical aspects of children’s perceptions of information-giving in care

The aim of this study was to identify key aspects in the exchange of information and to determine how nurses communicate news to hospitalised children. For this study, we applied the critical incident technique with 30 children aged between 8 and 14 years. Data were collected in paediatric units in a hospital in Alicante (Spain) using participant observation and semi-structured interviews. The analysis yielded three main categories: the children’s reaction to the information, nursing staff behaviour as a key aspect in the exchange of information and communication of news as well as children’s experience. This article emphasises the need to promote children’s consent and participation in nursing interventions. An analysis of these aspects will verify whether children’s rights are being respected and taken into account in order to promote children’s well-being and adaptation to hospitalisation.

Corrosion of stainless steel components in seawater reverse osmosis desalination plants-investigations on adapted internal cathodic protection

Stainless steel is widely used in seawater reverse osmosis units (SWRO) for both good mechanical and corrosion resistance properties. However, many corrosion failures of stainless steel in SWRO desalination units have been reported. These failures may often be attributed to un-adapted stainless steel grade selection and/or to the particular aggressive seawater conditions in "warm" regions (high ambient temperature, severe biofouling, etc.). Cathodic protection (CP) is a well-known efficient system to prevent corrosion of metallic materials in seawater. It is successfully used in the oil and gas industry to protect carbon steel structures exposed in open-sea. However, the specific service conditions of SWRO units may seriously affect the efficiency of such anti-corrosion system (high flow rates, large stainless steel surfaces affected by biofouling, confinement limiting protective cathodic current flow, etc.). Hence, CP in SWRO units should be considered with special care and modeling appears as useful tool to assess an appropriate CP design. However, there is a clear lack of CP data that could be transposed to SWRO service conditions (i.e. stainless steel, effect of biofouling, high flow rate, etc.). From this background a Join Industry Program was initiated including laboratory exposures, field measurements in a full scale SWRO desalination plant, and modeling work using PROCOR software. The present paper reviews the main parameters affecting corrosion of stainless steel alloys in seawater reverse osmosis units. CP on specific stainless steel devices was investigated in order to assess its actual efficiency for SWRO units. Severe environmental conditions were intentionally used to promote corrosion on the tested stainless steel products in order to evaluate the efficiency of CP. The study includes a modeling work aiming at predicting and designing adapted CP protection to modeled stainless steel units. An excellent correlation between modeling work and field measurements was found.

Reformas na gestão hospitalar:análise dos efeitos da empresarialização

Tese de Doutoramento em Ciências Sociais na Especialidade de Administração da Saúde

A national referral of an integrated network of continuing care a study case

This study aims to characterize the National Long-Term Care Network (NL-TCN) users. The Portuguese National Health Service, was restructured in 2006 with the creation of the National Long-Term Care Network to respond to new health and social needs concerning the continuity of care. Objectives- Analyse the sociodemographic profile of the network users and the review of hospital, local and regional management procedures. Methods-we used various methods of observational or experimental nature (data processing and presentation of results with the program Statistical Package for Social Sciences, version 20, descriptive statistics (frequencies, crosstabs and test chi-square)). The Pearson correlation test showed a positive correlation between time procedures at the local and regional management and hospital’s length of stay. Results- from a sample of 805 cases, 595 (74%) were admitted in the NL-TCN, a rate lower than the national average (86%). Almost half of the sample was admitted in Rehabilitation Units (46%), while nationally the highest number of admissions was in Home Care Teams (30%). The average time from hospital referral to network admission was 9.73 days with a positive correlation between referred network management procedures and hospital length of stay. Conclusions- For specialized units, the maximum waiting times were for the Long-Term and Support Units (mean 30.27 days) and the minimum waiting times were for Home Care Teams (mean 5.57 days). The average time between the local and regional management was 3.59 days. Almost 90% of referrals were orthopaedics, internal medicine and neurology and Network users were mostly elderly (average 75 years old), female and married. Most users were admitted to inpatient units (78%) and only 15% remained in their home town.