Going beyond the identification of change facilitators to effectively implement a new model of services: lessons learned from a case example in paediatric rehabilitation

Purpose: To identify facilitators and barriers to service reorganization, how they evolved and interacted to influence change during the implementation of a new service delivery model of paediatric rehabilitation. Methods: Over 3 years, different stakeholders responded to SWOT questionnaires (n = 139) and participated in focus groups (n = 19) and telephone interviews (n = 13). A framework based on socio constructivist theories made sense of the data. Results: Facilitators related to the programme's structure (e.g. funding), the actors (e.g. willingness to test the new service model) and the change management process (e.g. participative approach). Some initial facilitators became barriers (e.g. leadership lacked at the end), while other barriers emerged (e.g. lack of tools). Understanding factor interactions requires examining the multiple actors’ intentions, actions and consequences and their relations with structural elements. Conclusions: Analysing facilitators and barriers helped better understand the change processes, but this must be followed by concrete actions to successfully implement new paediatric rehabilitation models.

Determination of the Maximum Rate of Eccrine Sweat Glands’ Ion Reabsorption Using the Galvanic Skin Conductance to Local Sweat Rate Relationship

Purpose The purpose of the present study was to develop and describe a simple method to evaluate the rate of ion reabsorption of eccrine sweat glands in human using the measurement of galvanic skin conductance (GSC) and local sweating rate (SR). This purpose was investigated by comparing the SR threshold for increasing GSC with following two criteria of sweat ion reabsorption in earlier studies such as 1) the SR threshold for increasing sweat ion was at approximately 0.2 to 0.5 mg/cm2/min and 2) exercise-heat acclimation improved the sweat ion reabsorption ability and would increase the criteria 1. Methods Seven healthy non-heat-acclimated male subjects received passive heat treatment both before and after 7 days of cycling in hot conditions (50% maximum oxygen uptake, 60 min/day, ambient temperature 32°C, and 50% relative humidity). Results Subjects became partially heat-acclimated, as evidenced by the decreased end-exercise heart rate (p<0.01), rate of perceived exhaustion (p<0.01), and oesophageal temperature (p=0.07), without alterations in whole-body sweat loss, from the first to the last day of training. As hypothesised, we confirmed that the SR threshold for increasing GSC was near the predicted SR during passive heating before exercise heat acclimation, and increased significantly after training (0.19 ± 0.09 to 0.32 ± 0.10 mg/cm2/min, p<0.05). Conclusions The reproducibility of sweat ion reabsorption by the eccrine glands in the present study suggests that the relationship between GSC and SR can serve as a new index for assessing the maximum rate of sweat ion reabsorption of eccrine sweat glands in humans.

A psychosocial approach to understanding pilot and controller acceptance of change in ATM, based on three CDA case studies

Next generation ATM systems cannot be implemented in a technological vacuum. The further ahead we look, the greater the likely impact of societal factors on such changes, and how they are prioritised and promoted. The equitable sustainability of travel behaviour is rising on the political agenda in Europe in an unprecedented manner. This paper examines pilot and controller attitudes towards Continuous Descent Approaches (CDAs). It aims to promote a better understanding of acceptance of change in ATM. The focus is on the psychosocial context and the relationships between perceived societal and system benefits. Behavioural change appeared more correlated with such benefit perceptions in the case of the pilots. For the first time in the study of ATM implementation, and acceptance of change, this paper incorporates the Seven Stages of Change model, based on the constructs of the Theory of Planned Behaviour. It employs a principal components (factor) analysis, and further explores the intercorrelations of benefit perceptions, known in psychology as the ‘halo effect’. Disbenefit perceptions may break down this effect, it appears. For implementers of change, this evidence suggests an approach in terms of reinforcing the dominant benefit(s) perceived, for sub-groups within which a halo effect is evident. In the absence of such an effect, perceived disbenefits, such as with respect to workload and capacity, should be off-set against specific, perceived benefits of the change, as far as possible. This methodology could be equally applied to other stakeholders, from strategic planners to the public. The set of three case studies will be extended beyond CDA trials. A set of concise guidelines will be published with a strong focus on practical advice, in addition to continued work enabling a better understanding of the expected, increasing psychosocial contributions to successful and unsuccessful efforts at ATM innovation and change.

Alright: a distinctive pathway of change from the 18th century to the present day

The origins of the vast majority of the words we use in contemporary English go back as far as Old or Middle English. In contrast, alright and all right in their present-day application appear to be the result of a more recent evolution, as there is no evidence of their use, not even in the two-word form, in the published fiction before the 18th century. Furthermore, there are not in the research literature, at least to my knowledge, any previous linguistic studies on this specific subject matter. The present article is simply an attempt to describe the various processes of diachronic change that brought about the emergence of alright.

Introduction: Guinea-Bissau Today - The Irrelevance of the State and the Permanence of Change

African Studies Review, Volume 52, Number 2, pp. 35–

Acredita Portugal: How to improve the implementation rate of entrepreneurial projects?

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics

A wave of change: Labor market and social security impacts of the EU refugee inflow

The recent massive inflow of refugees to the European Union (EU) raises a number of unanswered questions on the economic impact of this phenomenon. To examine these questions, we constructed an overlapping-generations model that describes the evolution of the skill premium and of the welfare benefit level in relevant European countries, in the aftermath of an inflow of asylum-seekers. In our simulation, relative wages of skilled workers increase between 8% and 11% in the period of the inflow; their subsequent time path is dependent on the initial skill premium. The entry of migrants creates a fiscal surplus of about 8%, which can finance higher welfare benefits in the subsequent periods. These effects are weaker in a scenario where refugees do not fully integrate into the labor market.

Contributions towards smart cities : exploring block level census data for the characterization of change in Lisbon

The interest in using information to improve the quality of living in large urban areas and its governance efficiency has been around for decades. Nevertheless, the improvements in Information and Communications Technology has sparked a new dynamic in academic research, usually under the umbrella term of Smart Cities. This concept of Smart City can probably be translated, in a simplified version, into cities that are lived, managed and developed in an information-saturated environment. While it makes perfect sense and we can easily foresee the benefits of such a concept, presently there are still several significant challenges that need to be tackled before we can materialize this vision. In this work we aim at providing a small contribution in this direction, which maximizes the relevancy of the available information resources. One of the most detailed and geographically relevant information resource available, for the study of cities, is the census, more specifically the data available at block level (Subsecção Estatística). In this work, we use Self-Organizing Maps (SOM) and the variant Geo-SOM to explore the block level data from the Portuguese census of Lisbon city, for the years of 2001 and 2011. We focus on gauging change, proposing ways that allow the comparison of the two time periods, which have two different underlying geographical bases. We proceed with the analysis of the data using different SOM variants, aiming at producing a two-fold portrait: one, of the evolution of Lisbon during the first decade of the XXI century, another, of how the census dataset and SOM’s can be used to produce an informational framework for the study of cities.

Stage of change of cigarette smoking in drug dependent patients.

Nicotine cessation programmes in Switzerland, which are commonly based on the stage of change model of Prochaska and DiClemente (1983), are rarely offered to patients with illicit drug dependence. This stands in contrast to the high smoking rates and the heavy burden of tobacco-related problems in these patients. The stage of change was therefore assessed by self-administered questionnaire in 100 inpatients attending an illegal drug withdrawal programme. Only 15% of the patients were in the contemplation or decision stage. 93% considered smoking cessation to be difficult or very difficult. These data show a discrepancy between the motivation to change illegal drug consumption habits and the motivation for smoking cessation. The high proportion of patients remaining in the precontemplation stage for smoking cessation, in spite of their motivation for illicit drug detoxification, may be due to the perception that cessation of smoking is more difficult than illicit drug abuse cessation.

Treatment of genital mycoplasma in colonized pregnant women in late pregnancy is associated with a lower rate of premature labour and neonatal complications.

Mycoplasma hominis and Ureaplasma spp. may colonize the human genital tract and have been associated with adverse pregnancy outcomes such as preterm labour and preterm premature rupture of membranes. However, as these bacteria can reside in the normal vaginal flora, there are controversies regarding their true role during pregnancy and so the need to treat these organisms. We therefore conducted a retrospective analysis to evaluate the treatment of genital mycoplasma in 5377 pregnant patients showing symptoms of potential obstetric complications at 25-37 weeks of gestation. Women presenting with symptoms were routinely screened by culture for the presence of these bacteria and treated with clindamycin when positive. Compared with uninfected untreated patients, women treated for genital mycoplasma demonstrated lower rates of premature labour. Indeed preterm birth rates were, respectively, 40.9% and 37.7% in women colonized with Ureaplasma spp. and M. hominis, compared with 44.1% in uncolonized women (Ureaplasma spp., p 0.024; M. hominis, p 0.001). Moreover, a reduction of neonatal complications rates was observed, with 10.9% of newborns developing respiratory diseases in case of Ureaplasma spp. colonization and 5.9% in the presence of M. hominis, compared with 12.8% in the absence of those bacteria (Ureaplasma spp., p 0.050; M. hominis, p <0.001). Microbiological screening of Ureaplasma spp. and/or M. hominis and pre-emptive antibiotic therapy of symptomatic pregnant women in late pregnancy might represent a beneficial strategy to reduce premature labour and neonatal complications.

Aerobic exercise in adolescence : self-efficacy and stage of change

The purpose of this cross-sectional exploratory study was to examine the relationships among self-efficacy, stage of change, and exercise behaviour in a sample of younger (Grade 9) and older (Grade 12) adolescents. A secondary objective of this study was to apply the transtheoretical model of Stage of Change, as a measure of intention to change, in order to discover the applicability of the model to an adolescent cohort in relation to exercise behaviour. This five-stage model is a self-report measure of an individual's readiness to adopt a new behaviour (e.g., regular exercise). The transtheoretical model incorporates Bandura's self-efficacy factor, which is purported to be a predictive measure of exercise behaviour and a covariant of stage. Exercise behaviour was measured with the Physical Activity Scale, and the University of Rhode Island Change Assessment Scale (URleA) was used to measure the stage of change and self-efficacy variables. The results of this study indicated significant differences between younger and older adolescents, and between males and females in their exercise behaviour. No significant differences were found for grade and gender on stage of change as measured by either a single-item question or a continuous measure of stage. Although grade and gender subgroups were not significantly different in their self-efficacy, significant interaction was found in the grade*gender variable.

Exploring the effects of change on nursing practice in acute ambulatory care settings : a qualitative study

As a result of the current changes taking place in the delivery of acute care services, the emergence of acute ambulatory care (AAC) settings is expanding. According to a literature review, the volume, acuity, and complexity of patient care in these settings is increasing while the time the patients spend under the care of nurses is decreasing. Two forces, hospital downsizing and advancing technology, are identified as the major contributors to the shift in acute care delivery. The effects that these changes are having on the clinical nursing practice of registered nurses working in AAC settings are not known. Given that AAC settings are rapidly expanding, it can be anticipated that the delivery of nursing care will continue to be compressed into a shorter time frame. Therefore, the following qualitative research question was formulated: What are the problems and issues related to clinical nursing practice in acute ambulatory settings? The purpose of this study was to explore the problems and issues associated with change and clinical nursing practice including the educational needs of nurses working in MC settings. Specific objectives of the study included the following: (a) to explore the problems and issues related to nursing practice in select AAC settings; (b) to explore the similarities and differences in perspectives related to role expectation between nurse managers, nurse educators, and staff nurses; and (c) to develop a conceptual framework that will guide the construction of an instrument needed for further research. This study used semistructured individual interviews and focus group sessions to collect data from the three categories of registered nurses. More specifically, data were collected from one nurse manager, two charge nurses, two nurse educators and fifteen staff nurses, working in three different MC settings of a major teaching hospital. Collected data were separately analyzed by the researcher and an external rater following grounded theory methodology. By using open and axial coding, the problems and issues identified by nurses were grouped into several major and minor themes. In final analysis, by using selective coding, the four core themes (intensification, moderation, frustration, and adaptation) were extracted. Each core theme was presented and discussed in relation to hospital downsizing and advancing technology. The relationships among the four core themes were discussed and depicted in a model termed the "Impact and Consequence Model on Nursing Practice in MC Settings." Implications for further research are discussed and research hypotheses, based on the research findings, are presented.

Exploring the experience of the pioneers of change

The world of work with Western society appears to be undergoing a major change. The literature has described this phenomenon as a change from an industrialbased economy to a knowledge-based economy. This change will represent a complete transformation of the world of work; some suggest that everything we have come to accept and know as normal will change. Our present society seems to be in a period of transition. It is a time with many challenges and problems, many of which cannot be solved with thinking patterns from an old industrial-based economy. A fundamental shift in thinking patterns consistent with a new emerging world of work must take place. This change in thinking represents a fundmental shift from traditional and linear ways of seeing the world (worldview), to more holistic ways of seeing the world. In this investigation the word paradigm was used to define how people see their world. A paradigm shift is defined as a change in how a person sees their world: a change from an old to new or different way of viewing the world. Those individuals who are the first to shift their paradigm are called paradigm pioneers. These individuals do not only shift their ways of seeing the world, but they also begin to act and behave in ways consistent with the new paradigm. Thus far the research literature has adequately described the concepts of paradigms and paradigm shifts. However, little is known regarding how people actually and eventually make a shift. As it will be important for each individual to make a personal paradigm shift, then it will be extremely valuable to learn more about the process itself. The purpose of this investigation was to explore these issues in more detail and specifically, describe the experience of paradigm shifts and explore the experience of paradigm pioneers. A qualitative research methodology involving in-depth interviews was used to investigate the experiences of four participants identified as paradigm pioneers. It is interesting to note that the participants in this study did not describe an allencompassing paradigm shift. In fact, each participant, defined a paradigm shift in several different ways. They did relate several examples of paradigm shifts. However, even among these examples, there was a high degree of variability. The findings of this investigation centered upon the participants' experience as pioneers. Each pioneer shared many of the same qualities, the first quality of which described how these pioneers dealt with change. I called this a change-sense quality. The pioneers viewed change in an open and positive manner, and were also aware of change taking place in their world. Finally, they displayed an understanding of change, and a bias to take positive action in the face it. The participants also shared an inner quality. The four pioneers demonstrated a personal purpose and vision, and were selfdirected individuals. They also had an innate curiosity which translated into a love of learning. They also displayed a quality where relationships with others were highly valued. Relationships were important to the pioneers because they played a support role to help them deal with the challenges of being a pioneer. Pioneers also valued relationships because, they relied on others to make change happen. The above mentioned qualities enabled pioneers to be effective in a changing world of work. The findings from this investigation have many implications for research and practice. First, the concept of paradigms and paradigm shifts must be further researched. A great deal more must be learned in order to better understand the kind of shift individuals must make to be effective in the new world of work. Second, the qualities displayed by pioneers are important for all members of the world of work to develop. The qualities shared by pioneers appeared to represent an enduring set of traits that can possibly help individuals deal more positively with uncertainty and rapid change taking place in today's North American world of work.

Rate of recession of Niagara Falls /

Includes bibliographical references.

Orientation of Non-Native 2-Monosubstituted and 2,3-Disubstituted 1,4-Naphthoquinones in the A1 binding site of PSI and the effect on the rate of electron transfer : an electron paramagnetic resonance spectroscopy study

The proce-ss ofoxygenic photosynthesis is vital to life on Earth. the central event in photosynthesis is light induced electron transfer that converts light into energy for growth. Ofparticular significance is the membrane bound multisubunit protein known as Photosystem I (PSI). PSI is a reaction centre that is responsible for the transfer of electrons across the membrane to reduce NADP+ to NADPH. The recent publication ofa high resolution X-ray structure of PSI has shown new information about the structure, in particular the electron transfer cofactors, which allows us to study it in more detail. In PSI, the secondary acceptor is crucial for forward electron transfer. In this thesis, the effect of removing the native acceptor phylloquinone and replacing it with a series of structurally related quinones was investigated via transient electron paramagnetic resonance (EPR) experiments. The orientation of non native quinones in the binding site and their ability to function in the electron transfer process was determined. It was found that PSI will readily accept alkyl naphthoquinones and anthraquinone. Q band EPR experiments revealed that the non-native quinones are incorporated into the binding site with the same orientation of the headgroup as in the native system. X band EPR spectra and deuteration experiments indicate that monosubstituted naphthoquinones are bound to the Al site with their side group in the position occupied by the methyl group in native PSI (meta to the hydrogen bonded carbonyl oxygen). X band EPR experiments show that 2, 3- disubstituted methyl naphthoquinones are also incorporated into the Al site in the same orientation as phylloquinone, even with the presence of a halogen- or sulfur-containing side chain in the position normally occupied by the phytyl tail ofphylloquinone. The exception to this is 2-bromo-3-methyl --.- _. -. - -- - - 4 _._ _ _ - _ _ naphthoquinone which has a poorly resolved spectrum, making determination of the orientation difficuh. All of the non-native quinones studied act as efficient electron acceptors. However, forward electron transfer past the quinone could only be demonstrated for anthraquinone, which has a more negative midpoint potential than phylloquinone. In the case of anthraquinone, an increased rate of forward electron transfer compared to native PSI was found. From these results we can conclude that the rate ofelectron transfer from Al to Fx in native PSI lies in the normal region ofthe Marcus Curve.