Global practice experience: A useful lens for understanding patient and staff perceptions of successful integration of health information technology in primary care

Making healthcare comprehensive and more efficient remains a complex challenge. Health Information Technology (HIT) is recognized as an important component of this transformation but few studies describe HIT adoption and it's effect on the bedside experience by physicians, staff and patients. This study applied descriptive statistics and correlation analysis to data from the Patient-Centered Medical Home National Demonstration Project (NDP) of the American Academy of Family Physicians. Thirty-six clinics were followed for 26 months by clinician/staff questionnaires and patient surveys. This study characterizes those clinics as well as staff and patient perspectives on HIT usefulness, the doctor-patient relationship, electronic medical record (EMR) implementation, and computer connections in the practice throughout the study. The Global Practice Experience factor, a composite score related to key components of primary care, was then correlated to clinician and patient perspectives. This study found wide adoption of HIT among NDP practices. Patient perspectives on HIT helpfulness on the doctor-patient showed a suggestive trend that approached statistical significance (p = 0.172). Clinicians and staff noted successful integration of EMR into clinic workflow and their perception of helpfulness to the doctor-patient relationship show a suggestive increase also approaching statistical significance (p=0.06). GPE was correlated with clinician/staff assessment of a helpful doctor-patient relationship midway through the study (R 0.460, p = 0.021) with the remaining time points nearing statistical significance. GPE was also correlated to both patient perspectives of EMR helpfulness in the doctor-patient relationship (R 0.601, p = 0.001) and computer connections (R 0.618, p = 0.0001) at the start of the study. ^

La evolución del paisaje fluvial en la confluencia de los ríos Tajo y Jarama

La tesis doctoral que se presenta realiza un análisis de la evolución del paisaje fluvial de las riberas de los ríos Tajo y Jarama en el entorno de Aranjuez desde una perspectiva múltiple. Contempla y conjuga aspectos naturales, tales como los hidrológicos, geomorfológicos y ecológicos; también culturales, como la regulación hidrológica y la gestión del agua, las intervenciones en cauce y márgenes, la evolución de la propiedad y los cambios de usos del suelo, fundamentalmente. Este análisis ha permitido identificar el sistema de factores, dinámico y complejo, que ha creado este paisaje, así como las interrelaciones, conexiones, condicionantes y dependencias de los descriptores paisajísticos considerados. Por ejemplo, se han estudiado las relaciones cruzadas observadas entre dinámica fluvial-propiedad de la tierra-estado de conservación, cuestiones que hasta la fecha no habían sido tratadas, evaluadas o cuantificadas en otros trabajos dedicados a esta zona. La investigación se ha organizado en tres fases fundamentales que han dado lugar a los capítulos centrales del documento (capítulos 2, 3 y 4). En primer lugar, se ha realizado una caracterización de los factores, naturales y culturales, que organizan el paisaje de este territorio eminentemente fluvial (geomorfología, factores climáticos e hidrológicos, vegetación, propiedad de la tierra y elementos culturales de significación paisajística). A continuación, se ha realizado el estudio de la evolución del paisaje fluvial mediante el análisis de diversos elementos, previamente identificados y caracterizados. Para ello se han procesado imágenes aéreas correspondientes a cinco series temporales así como varios planos antiguos, obteniendo una amplia base de datos que se ha analizado estadísticamente. Finalmente, se han contrastado los resultados parciales obtenidos en los capítulos anteriores, lo que ha permitido identificar relaciones causales entre los factores que organizan el paisaje y la evolución de los elementos que lo constituyen. También, interconexiones entre factores o entre elementos. Este método de trabajo ha resultado muy útil para la comprensión del funcionamiento y evolución de un sistema complejo, como el paisaje de la vega de Aranjuez, un territorio con profundas y antiguas intervenciones culturales donde lo natural, en cualquier caso, siempre subyace. Es posible que la principal aportación de este trabajo, también su diferencia más destacada respecto a otros estudios de paisaje, haya sido mostrar una visión completa y exhaustiva de todos los factores que han intervenido en la conformación y evolución del paisaje fluvial, destacando las relaciones que se establecen entre ellos. Esta manera de proceder puede tener una interesante faceta aplicada, de tal manera que resulta un instrumento muy útil para el diseño de planes de gestión de este territorio fluvial. No en vano, una parte sustancial de la vega del Tajo-Jarama en Aranjuez es un Lugar de Importancia Comunitaria (LIC) y su posterior e ineludible declaración como Zona de Especial Conservación (ZEC) de la Red Natura 2000, de acuerdo con lo establecido en la Directiva 92/43/CE, exige la elaboración de un Plan de Gestión que, en gran medida, podría nutrirse de lo presentado, analizado e interpretado en este trabajo. En este sentido, conviene señalar la conciencia ya asumida de considerar, por su carácter integrador de la realidad territorial, el paisaje como elemento clave para la gestión adecuada de la naturaleza y el territorio. Por otra parte, se considera que los resultados de esta Tesis Doctoral permitirían plantear medidas para la puesta en valor de un paisaje sobresaliente, cuyos límites sobrepasan con creces los que en la actualidad conforman el Paisaje Cultural declarado por la UNESCO. En suma, el análisis de este espacio fluvial realizado con la profundidad y amplitud que permite el método de trabajo seguido puede utilizarse para el diseño de estrategias que dirijan la evolución de este territorio en una línea que garantice su conservación global en términos paisajísticos, patrimoniales y ecológicos, permitiendo además, de este modo, su uso equilibrado como recurso económico, cultural o educativo. This doctoral thesis shows an analysis of fluvial landscape evolution from multiple perspectives on the banks of Tagus and Jarama rivers, around Aranjuez. The thesis contemplates and combines natural features, such as hydrological, geomorphological and ecological features, as well as cultural features, like hydrological regulation and water management, interventions in channels and margins, changes in ownership and land use changes, mainly. This analysis has allowed to identify the factors system, dynamic and complex, that this landscape has created, as well as the interrelationships, connections, constraints and dependencies among considered landscape descriptors. For example, we have studied the relationships observed among fluvial dynamics- land ownership -conservation status, issues not addressed, assessed or quantified up to now in other works about this area. The research is organized into three major phases that led to the paper's central chapters (Chapters 2, 3 and 4). First, there has been a characterization of the factors, both natural and cultural, that organize the landscape of this predominantly fluvial area (geomorphology, climate and hydrological factors, vegetation, land and cultural elements of landscape significance). Then, it was made to study of fluvial landscape evolution by analyzing various elements previously identified and characterized. Aerial images were processed for five series and several old maps, obtaining an extensive database, that has been analyzed statistically. Finally, we have contrasted the partial results obtained in the previous chapters, making it possible to identify causal relationships between the factors that organize the landscape and the evolution of the elements that constitute it. This working method has been very useful for understanding the operation and evolution of a complex system, as the landscape of the Vega de Aranjuez, a territory with deep and ancient cultural interventions where anyway, nature feature always lies. It is possible that the main contribution of this work, also its most prominent difference compared with other studies of landscape, has been to show a complete and exhaustive view of all factors involved in the formation and evolution of the fluvial landscape, highlighting the relationships established among them. This approach could have an interesting applied facet, so that is a very useful tool for designing management plans on this river territory. Not surprisingly, a substantial part of the valley of the Tagus-Jarama in Aranjuez is a Site of Community Importance (SCI) and their subsequent and inevitable declaration as Special Area of Conservation (SAC) of the Natura 2000 network, in accordance with the provisions Directive 92/43/EC, requires the development of a management plan that largely could draw on what was presented, analyzed and interpreted in this paper. In this regard, it should be noted conscience and assumed to consider, on the inclusiveness of territorial reality, the landscape as a key element for the proper management of nature and territory. On the other hand, it is considered that the results of this thesis allow to propose measures for enhancement of outstanding scenery, which go well beyond the boundaries that currently the Cultural Landscape declared by UNESCO. In sum, the analysis of this river area made with the depth and breadth that enables working method can be used to design strategies that address the evolution of this territory in a line that guarantees global conservation landscape terms, heritage and ecological, also, allowing its use as a balancing economic, cultural or educational resource.

Recepción, audiencias y consumo cultural en Venezuela (período: 2000-2011)

Analizamos el estado del arte de los estudios de recepción, audiencias y consumo cultural en Venezuela durante el período 2000-2011. Examinamos enfoques teóricos sobre el campo de la recepción mediática y cultural, desde las propuestas conceptuales de Aguirre, Barrios y Hernández Díaz. Se pudo constatar, en esta revisión documental, que los estudios de recepción en Venezuela abordan cuatro campos de estudio: 1) Educación para la recepción. 2) Influencia de la televisión. 3) Ciber-recepción. 4) Consumo cultural.

The future imagined: Exploring fiction as a means of reflecting on today’s Grand Societal Challenges and tomorrow’s options

European science policy (so-called Horizon 2020) is guided by Grand Societal Challenges (GSCs) with the explicit aim of shaping the future. In this paper we propose an innovative approach to the analysis and critique of Europe’s GSCs. The aim is to explore how speculative and creative fiction offer ways of embodying, telling, imagining, and symbolising ‘futures’, that can provide alternative frames and understandings to enrich the grand challenges of the 21st century, and the related rationale and agendas for ERA and H2020. We identify six ways in which filmic and literary representations can be considered creative foresight methods (i.e. through: creative input, detail, warning, reflection, critique, involvement) and can provide alternative perspectives on these central challenges, and warning signals for the science policy they inform. The inquiry involved the selection of 64 novels and movies engaging with notions of the future, produced over the last 150 years. Content analysis based on a standardised matrix of major themes and sub-domains, allows to build a hierarchy of themes and to identify major patterns of long-lasting concerns about humanity’s future. The study highlights how fiction sees oppression, inequality and a range of ethical issues linked to human and nature’s dignity as central to, and inseparable from innovation, technology and science. It concludes identifying warning signals in four major domains, arguing that these signals are compelling, and ought to be heard, not least because elements of such future have already escaped the imaginary world to make part of today’s experience. It identifies areas poorly defined or absent from Europe's science agenda, and argues for the need to increase research into human, social, political and cultural processes involved in techno-science endeavours.

Insights from Native American Veterans on Developing a Patient-Centered, Integrative Model for Mental Health Services

Thesis (Master's)--University of Washington, 2016-06

Cultural and gender influences on age identification

Age identification plays a significant role in young adults" mass, interpersonal, intergenerational, and intercultural communication. This research examines cultural and gender influences on young people's age identity by measuring the social age identity of male and female young adult members of five cultures varying in individualism/collectivism (Laos, Thailand, Spain, Australia, and the U.S.A.). We found cultural influences on age identity to be both unexpected in nature and modest in effect. American and Laotian respondents had similar and nominally higher levels of age identity than Australian, Thai, and Spanish respondents, with all having a markedly different age identities than those of Japanese respondents as reported by other researchers. No direct effect for gender on age identity emerged, though American females were more age identified than all other respondents. Across cultures, the social identity scale was found to be a reasonably adequate measure of age identity.

Seeing music performance: Visual influences on perception and experience

Drawing from ethnographic, empirical, and historical/cultural perspectives, we examine the extent to which visual aspects of music contribute to the communication that takes place between performers and their listeners. First, we introduce a framework for understanding how media and genres shape aural and visual experiences of music. Second, we present case studies of two performances, and describe the relation between visual and aural aspects of performance. Third, we report empirical evidence that visual aspects of performance reliably influence perceptions of musical structure (pitch related features) and affective interpretations of music. Finally, we trace new and old media trajectories of aural and visual dimensions of music, and highlight how our conceptions, perceptions and appreciation of music are intertwined with technological innovation and media deployment strategies.

Cultural orientations and preference for HRM policies and practices:the case of Oman

This study empirically examines the influence of cultural orientations on employee preferences of human resource management (HRM) policies and practices in Oman. Data were collected from 712 employees working in six large Omani organizations. The findings indicate that there is a number of differences among Omani employees regarding value orientations due especially to age, education and work experience. The findings show a strong orientation towards mastery, harmony, thinking and doing, and a weak orientation towards hierarchy, collectivism, subjugation and human nature-as-evil. The results demonstrate a clear link between value orientations and preferences for particular HRM policies and practices. Group-oriented HRM practices are preferred by those who scored high on collectivism and being orientations, and those who scored low on thinking and doing orientations. Hierarchy-oriented HRM practices are preferred by those scoring high on hierarchy, subjugation and human nature-as-bad orientations, and those scoring low on thinking and mastery orientations. Finally, preference for loose and informal HRM practices was positively associated with being, and negatively associated with thinking, doing and harmony orientations. The theoretical and practical implications of these findings are discussed in detail.

The essentials of teamworking:international perspectives

The team, rather than the individual, is increasingly seen as the building block of organizations and a key source of competitive advantage. Despite this, not enough is understood about how to build successful teams in modern organizations. The Essentials of Teamworking broadens this understanding by offering a selection of key chapters on teamwork from the International Handbook of Organizational Teamwork and Cooperative Working. This concise paperback edition reveals the complexity of teamwork and offers empirically based guidance on how teamwork can be effectively developed in modern organizations. Bringing together leading international scholars, The Essentials of Teamworking offers challenging perspectives on teamwork that will inform future research and practice. It is an invaluable resource for professionals, researchers and students alike.

Preface

This edited book is intended for use by students, academics and practitioners who take interest in the outsourcing and offshoring of information technology and business services and processes. The book offers a review of the key topics in outsourcing and offshoring, populated with practical frameworks that serve as a tool kit for practitioners, academics and students. The range of topics covered in this book is wide and diverse, and represents both client and supplier perspectives on sourcing of global services. Various aspects related to the decision making process (e.g., asset transfer), learning mechanisms and organizational practices for managing outsourcing relationships are discussed in great depth. Contemporary sourcing models, including cloud services, are examined. Client dependency on the outsourcing provider, and social aspects, such as identity, are discussed in detail. Furthermore, resistance in outsourcing and failures are investigated to derive lessons as to how to avoid them and improve efficiency in outsourcing. Topics discussed in this book combine theoretical and practical insights regarding challenges that both clients and vendors face. Case studies from client and vendor organizations are used extensively throughout the book. Last but not least, the book examines current and future trends in outsourcing and offshoring, placing particular attention on the centrality of innovation in sourcing arrangements, and how innovation can be realized in outsourcing. The book is based on a vast empirical base brought together through years of extensive research by leading researchers in information systems, strategic management and operations.

Perface

This book contains 13 papers from the 7th Workshop on Global Sourcing, held in Val d'Isere, France, during March 11-14, 2013, which were carefully reviewed and selected from 40 submissions. They are based on a vast empirical base brought together by leading researchers in information systems, strategic management, and operations. This volume is intended for students, academics, and practitioners interested in research results and experiences on outsourcing and offshoring of information technology and business processes. The topics discussed represent both client and supplier perspectives on sourcing of global services, combine theoretical and practical insights regarding challenges that both clients and vendors face, and include case studies from client and vendor organizations.

Developing user involvement in a UK cancer network:professionals’ and users’ perspectives

This paper explores the results of a consensus development exercise that explored diverse perspectives and sought to identify key principles for the development of user involvement in a cancer network. The exercise took place within one of 34 UK cancer networks and was a collaboration between the NHS, two universities and two voluntary sector organizations. The paper explores professionals’ and users’ perspectives on user involvement with reference to the current sociopolitical context of user participation. British policy documents have placed increasing emphasis on issues of patient and public participation in the evaluation and development of health services, and the issue of lay participation represents an important aspect of a critical public health agenda. The project presented here shows that developing user involvement may be a complex task, with lack of consensus on key issues representing a significant barrier. Further, the data suggest that professional responses can partly be understood in relation to specific occupational standpoints and strategies that potentially allow professionals to define and limit users’ involvement. The implications of these findings and the impact of the consensus development process itself are discussed.

Multinationality and performance: The role of cultural dissimilarity

The purpose of this research was to examine the influence of cultural dissimilarity on the relationship between multinationality and performance. Both direct and indirect effects were studied. In addition, the form of the multinationality-performance relationship was investigated.^ Five indicators of cultural dissimilarity were developed on the basis of Hofstede's cultural dimensions. Performance was measured along two dimensions--financial and operational. Multinationality was operationalized as the ratio of foreign sales to total sales. Secondary data was used for all variables in the study. The sample of firms comprised multinationals based in the United States from four global industries--chemicals, computers and office equipment, electrical and electrical goods, and drugs and pharmaceuticals.^ Regression analyses using pooled cross-section/time-series data indicated that the relationship between multinationality and performance is curvilinear. No direct effects of cultural dissimilarity on performance were found. However, the results show a moderating effect of cultural dissimilarity on the multinationality-performance relationship. The direction of this effect was positive for four of the five cultural dissimilarity measures. ^

Global factors affecting women's participation in leadership

This dissertation is a multi-level, cross-cultural study of women in leadership conducted with both macro-society data and individual-level data aggregated to the country level. The research questions are, “What macro and micro forces are hindering or advancing women into business or political leadership?” “How do these forces impact the level of women's involvement in business and political leadership in a particular country?” Data was collected from 10 secondary sources, available for 213 countries, and includes about 300 variables for business leadership (N=115) and political leadership (N=181). To date, most women in leadership research has been Western- or US-based, and little rigorous empirical, multi-level research has been done across countries. The importance of cross-cultural studies on women in leadership stems from the potential to better understand why some countries have more women in positions of both business and political leadership; and the factors that affect women's involvement in such positions in different countries. A “Levels of Women's Participation in Leadership” country model is tested using cluster and discriminant analyses. Results indicate that the factors that affect women?s participation in leadership in countries with fewer women leaders are different from the factors that affect women's participation in countries with high levels of participation. This dissertation proposes that initiatives to increase participation of women in leadership need to consider the relevant factors that significantly affect countries at certain Levels of Women's Participation in Leadership. ^