Telemedicine Distance Mentoring of Healthcare Students

The healthcare system is facing a challenge similar to other industries in maintaining an adequately trained home care workforce in a time when government funding for educational geriatrics programs is limited, and academic centers are emphasizing faculty productivity that may limit their time dedicated to teaching and training healthcare students. [See PDF for complete abstract]

SONIA REGINA PRADO

A dissertação teve como objetivo principal estudar como uma Instituição de Ensino Superior Privada (IES) atuante no Brasil tem crescido pós Lei de Diretrizes e Bases (LDB) de 1996 até 2015, por meio da análise do curso de bacharelado em Administração de Empresas, nas modalidades: presencial, EAD e Flex (semipresencial). Para este fim, foi realizada uma pesquisa exploratória, de caráter qualitativo baseada no método do estudo de caso. Para coleta de evidências foram analisados relatórios corporativos (Annual Report, Relatórios Internos e outros documentos), entrevistas baseadas em roteiro semiestruturado com gestores da IES privada e observações. Dentre os principais achados, verificou-se que as principais estratégicas de crescimento da IES privada estudada se basearam em fusões e aquisições de outras IES, abertura de novos polos de EAD, na abertura de novas unidades próprias, bem como em inovações em várias dimensões da organização. Os programas governamentais de financiamento aos alunos também são fortes contribuintes para este crescimento, como o Fundo de Financiamento ao Estudante do Ensino Superior (FIES) e o Programa Universidade para Todos (Prouni). Com essa nova realidade, o ensino superior privado recebeu incentivo e facilitação para o seu crescimento, a um ritmo acelerado. Consequentemente pode-se concluir que a IES privada estudada adotou as seguintes estratégias de crescimento: Expansão orgânica com fusões/ aquisições de Instituições menores, com desenvolvimento de planos para todos os campi Brasil; Greenfield (por meio de solicitação de autorização de novas unidades e/ou cursos) em cidades sem possibilidades de aquisições/fusões, e aumentando o número de vagas/ matriculas nas unidades já existentes, aderiu aos programas do governo e também cuidou da evasão por meio de: Seguro educacional; gestão preparada para atender necessidades do discente; Sistema de Ensino com currículos integrados nacionalmente; Intercâmbio de alunos e professores entre as diversas unidades em todas as regiões do país e padronização dos processos.

The ECB’s QE: Time to break the doom loop between banks and their governments. CEPS Policy Brief No. 328, March 2015

The recent crises have shown that the eurozone countries’ government debt is not immune to default. Applying a large-exposure requirement also to eurozone government debt would be a logical measure towards breaking the bank-government doom loop, given the low probability and high loss-given government default. But what would be the impact of the application of the large-exposure requirement on the banking sector as well as on government funding? This CEPS Policy Brief presents the results of a simulation exercise performed for 109 systemic banks in the eurozone, showing that their eurozone government debt portfolios would have to decrease by 3.2% or €63 billion, if a 50% of own-funds cap would be applied on large exposures. The eurozone central banks’ demand for sovereign bonds under the extended asset purchase programme further creates momentum to start gradually implementing the restriction.

The Dilemmas of Diffusion: Institutional Transfer & the Remaking of Vocational Training Practices in Eastern Germany, CES Germany & Europe Working Papers, No. 05.10, 1996

Through a case study of the diffusion of the celebrated West Gennan "dual system" of vocational training to the territory of the fonner German Democratic Republic, we develop the argument that local sociopolitical relations matter crucially for the successful transfer and implementation of institutional arrangements. Notwithstanding massive levels of government funding, the presence of complementary supports, and the concerted efforts of Ger­many's social partners, the dual system is experiencing significant difficulties in the new federal states of the East. These difficulties are not due simply to the particular politics of unification (the wholesale transfer of West German institutions whether or not they were appropriate to Eastern Germany) nor even simply to the paucity of dynamic private firms capable of and willing to train new apprentices. The difficulties stem also from the under­ lying weaknesses of the East German sociopolitical infrastructure on which the entire dual system rests. This. hy­ pothesis is elaborated and substantiated through a range of data on training in the East and especially through the use of detailed case studies of Leipzig and Chemrutz.

ESTRATÉGIAS DE EXPANSÃO DE INSTITUIÇÕES DE ENSINO SUPERIOR PRIVADAS NO BRASIL: ESTUDO DE CASO DO CURSO DE BACHARELADO EM ADMINISTRAÇÃO

A dissertação teve como objetivo principal estudar como uma Instituição de Ensino Superior Privada (IES) atuante no Brasil tem crescido pós Lei de Diretrizes e Bases (LDB) de 1996 até 2015, por meio da análise do curso de bacharelado em Administração de Empresas, nas modalidades: presencial, EAD e Flex (semipresencial). Para este fim, foi realizada uma pesquisa exploratória, de caráter qualitativo baseada no método do estudo de caso. Para coleta de evidências foram analisados relatórios corporativos (Annual Report, Relatórios Internos e outros documentos), entrevistas baseadas em roteiro semiestruturado com gestores da IES privada e observações. Dentre os principais achados, verificou-se que as principais estratégicas de crescimento da IES privada estudada se basearam em fusões e aquisições de outras IES, abertura de novos polos de EAD, na abertura de novas unidades próprias, bem como em inovações em várias dimensões da organização. Os programas governamentais de financiamento aos alunos também são fortes contribuintes para este crescimento, como o Fundo de Financiamento ao Estudante do Ensino Superior (FIES) e o Programa Universidade para Todos (Prouni). Com essa nova realidade, o ensino superior privado recebeu incentivo e facilitação para o seu crescimento, a um ritmo acelerado. Consequentemente pode-se concluir que a IES privada estudada adotou as seguintes estratégias de crescimento: Expansão orgânica com fusões/ aquisições de Instituições menores, com desenvolvimento de planos para todos os campi Brasil; Greenfield (por meio de solicitação de autorização de novas unidades e/ou cursos) em cidades sem possibilidades de aquisições/fusões, e aumentando o número de vagas/ matriculas nas unidades já existentes, aderiu aos programas do governo e também cuidou da evasão por meio de: Seguro educacional; gestão preparada para atender necessidades do discente; Sistema de Ensino com currículos integrados nacionalmente; Intercâmbio de alunos e professores entre as diversas unidades em todas as regiões do país e padronização dos processos.

The missing ingredient:inter-municipal cooperation and central-local relations in the UK

The thrust of the argument presented in this chapter is that inter-municipal cooperation (IMC) in the United Kingdom reflects local government's constitutional position and its exposure to the exigencies of Westminster (elected central government) and Whitehall (centre of the professional civil service that services central government). For the most part councils are without general powers of competence and are restricted in what they can do by Parliament. This suggests that the capacity for locally driven IMC is restricted and operates principally within a framework constructed by central government's policy objectives and legislation and the political expediencies of the governing political party. In practice, however, recent examples of IMC demonstrate that the practices are more complex than this initial analysis suggests. Central government may exert top-down pressures and impose hierarchical directives, but there are important countervailing forces. Constitutional changes in Scotland and Wales have shifted the locus of central- local relations away from Westminster and Whitehall. In England, the seeding of English government regional offices in 1994 has evolved into an important structural arrangement that encourages councils to work together. Within the local government community there is now widespread acknowledgement that to achieve the ambitious targets set by central government, councils are, by necessity, bound to cooperate and work with other agencies. In recent years, the fragmentation of public service delivery has affected the scope of IMC. Elected local government in the UK is now only one piece of a complex jigsaw of agencies that provides services to the public; whether it is with non-elected bodies, such as health authorities, public protection authorities (police and fire), voluntary nonprofit organisations or for-profit bodies, councils are expected to cooperate widely with agencies in their localities. Indeed, for projects such as regeneration and community renewal, councils may act as the coordinating agency but the success of such projects is measured by collaboration and partnership working (Davies 2002). To place these developments in context, IMC is an example of how, in spite of the fragmentation of traditional forms of government, councils work with other public service agencies and other councils through the medium of interagency partnerships, collaboration between organisations and a mixed economy of service providers. Such an analysis suggests that, following changes to the system of local government, contemporary forms of IMC are less dependent on vertical arrangements (top-down direction from central government) as they are replaced by horizontal modes (expansion of networks and partnership arrangements). Evidence suggests, however that central government continues to steer local authorities through the agency of inspectorates and regulatory bodies, and through policy initiatives, such as local strategic partnerships and local area agreements (Kelly 2006), thus questioning whether, in the case of UK local government, the shift from hierarchy to network and market solutions is less differentiated and transformation less complete than some literature suggests. Vertical or horizontal pressures may promote IMC, yet similar drivers may deter collaboration between local authorities. An example of negative vertical pressure was central government's change of the systems of local taxation during the 1980s. The new taxation regime replaced a tax on property with a tax on individual residency. Although the community charge lasted only a few years, it was a highpoint of the then Conservative government policy that encouraged councils to compete with each other on the basis of the level of local taxation. In practice, however, the complexity of local government funding in the UK rendered worthless any meaningful ambition of councils competing with each other, especially as central government granting to local authorities is predicated (however imperfectly) on at least notional equalisation between those areas with lower tax yields and the more prosperous locations. Horizontal pressures comprise factors such as planning decisions. Over the last quarter century, councils have competed on the granting of permission to out-of-town retail and leisure complexes, now recognised as detrimental to neighbouring authorities because economic forces prevail and local, independent shops are unable to compete with multiple companies. These examples illustrate tensions at the core of the UK polity of whether IMC is feasible when competition between local authorities heightened by local differences reduces opportunities for collaboration. An alternative perspective on IMC is to explore whether specific purposes or functions promote or restrict it. Whether in the principle areas of local government responsibilities relating to social welfare, development and maintenance of the local infrastructure or environmental matters, there are examples of IMC. But opportunities have diminished considerably as councils lost responsibility for services provision as a result of privatisation and transfer of powers to new government agencies or to central government. Over the last twenty years councils have lost their role in the provision of further-or higher-education, public transport and water/sewage. Councils have commissioning power but only a limited presence in providing housing needs, social care and waste management. In other words, as a result of central government policy, there are, in practice, currently far fewer opportunities for councils to cooperate. Since 1997, the New Labour government has promoted IMC through vertical drivers and the development; the operation of these policy initiatives is discussed following the framework of the editors. Current examples of IMC are notable for being driven by higher tiers of government, working with subordinate authorities in principal-agent relations. Collaboration between local authorities and intra-interand cross-sectoral partnerships are initiated by central government. In other words, IMC is shaped by hierarchical drivers from higher levels of government but, in practice, is locally varied and determined less by formula than by necessity and function. © 2007 Springer.

Public R&D policies and private R&D investment:a survey of the empirical evidence

The importance of R&D investment in explaining economic growth is well documented in the literature. Policies by modern governments increasingly recognise the benefits of supporting R&D investment. Government funding has, however, become an increasingly scarce resource in times of financial crisis and economic austerity. Hence, it is important that available funds are used and targeted effectively. This paper offers the first systematic review and critical discussion of what the R&D literature has to say currently about the effectiveness of major public R&D policies in increasing private R&D investment. Public policies are considered within three categories, R&D tax credits and direct subsidies, support of the university research system and the formation of high-skilled human capital, and support of formal R&D cooperations across a variety of institutions. Crucially, the large body of more recent literature observes a shift away from the earlier findings that public subsidies often crowd-out private R&D to finding that subsidies typically stimulate private R&D. Tax credits are also much more unanimously than previously found to have positive effects. University research, high-skilled human capital, and R&D cooperation also typically increase private R&D. Recent work indicates that accounting for non-linearities is one area of research that may refine existing results. © 2014 John Wiley & Sons Ltd.

Managerial work roles of health care executives in the changing environment of academic medical centers

The current U.S. health care system faces numerous environmental challenges. To compete and survive, health care organizations are developing strategies to lower costs and increase efficiency and quality. All of these strategies require rapid and precise decision making by top level managers. The purpose of this study is to determine the relationship between the environment, made up of unfavorable market conditions and limited resources, and the work roles of top level managers, specifically in the settings of academic medical centers. Managerial work roles are based on the ten work roles developed by Henry Mintzberg, in his book, The Nature of Managerial Work (1973). ^ This research utilized an integrated conceptual framework made up of systems theory in conjunction with role, attribution and contingency theories to illustrate that four most frequently performed Mintzberg's work roles are affected by the two environment dimensions. The study sample consisted of 108 chief executive officers in academic medical centers throughout the United States. The methods included qualitative methods in the form of key informants and case studies and quantitative in the form of a survey questionnaire. Research analysis involved descriptive statistics, reliability tests, correlation, principal component and multivariate analyses. ^ Results indicated that under the market condition of increased revenue based on capitation, the work roles increased. In addition, under the environment dimension of limited resources, the work roles increased when uncompensated care increased while Medicare and non-government funding decreased. ^ Based on these results, a typology of health care managers in academic medical centers was created. Managers could be typed as a strategy-formulator, relationship-builder or task delegator. Therefore, managers who ascertained their types would be able to use this knowledge to build their strengths and develop their weaknesses. Furthermore, organizations could use the typology to identify appropriate roles and responsibilities of managers for their specific needs. Consequently, this research is a valuable tool for understanding health care managerial behaviors that lead to improved decision making. At the same time, this could enhance satisfaction and performance and enable organizations to gain the competitive edge . ^

Landscape of fear: A social history of the missile during the early years of the Cold War, 1950–1965

The missile's significance has been central to national security since the Soviet launching of Sputnik, and became increasingly important throughout the years of the Cold War. Much has been written about missile technology, but little has been written about how the development and deployment of this weapon affected Americans. The missile was developed to both deter war but also to win war. Its presence, however, was not always reassuring. Three areas of the United States are studied to evaluate the social implications of the missile during these pivotal years: San Francisco, home of multiple Nike installations; of Cape Canaveral, Florida, the nation's primary missile test center; the Great Plains, the location of the largest ICBM concentration in the country. Interviews were conducted, tours of facilities were taken, and local newspapers were reviewed. In conjunction with national newspapers and magazines and public opinion polls, this information provided a local social context for missile history. Nationally and locally, Americans both feared and praised the new technology. They were anxious for government funding in their cities and often felt that the danger the missile brought to their communities by making it as a Soviet target was justified in the larger cause for national security.

Analysis of Housing Partnerships using the Balanced Scorecard framework

Housing Partnerships (HPs) are collaborative arrangements that assist communities in the delivery of affordable housing by combining the strengths of the public and private sectors. They emerged in several states, counties, and cities in the eighties as innovative solutions to the challenges in affordable housing resulting from changing dynamics of delivery and production. ^ My study examines HPs with particular emphasis upon the identification of those factors associated with the successful performance of their mission of affordable housing. I will use the Balanced Scorecard (BSC) framework in this study. The identification of performance factors facilitates a better understanding of how HPs can be successful in achieving their mission. The identification of performance factors is significant in the context of the current economic environment because HPs can be viewed as innovative institutional mechanisms in the provision of affordable housing. ^ The present study uses a mixed methods research approach, drawing on data from the IRS Form 990 tax returns, a survey of the chief executives of HPs, and other secondary sources. The data analysis is framed according to the four perspectives of BSC: the financial, customer, internal business, and learning and growth. Financially, revenue diversification affects the financial health of HPs and overall performance. Although HPs depend on private and government funding, they also depend on service fees to carry out their mission. From a customer perspective, the HPs mainly serve low and moderate income households, although some serve specific groups such as seniors, homeless, veterans, and victims of domestic violence. From an internal business perspective, HPs’ programs are oriented toward affordable housing needs, undertaking not only traditional activities such as construction, loan provision, etc., but also advocacy and educational programs. From an employee and learning growth perspective, the HPs are small in staff size, but undertake a range of activities with the help of volunteers. Every part of the HP is developed to maximize resources, knowledge, and skills in order to assist communities in the delivery of affordable housing and related needs. Overall, housing partnerships have played a key role in affordable housing despite the housing market downturn since 2006. Their expenses on affordable housing activities increased despite the decrease in their revenues.^

Advanced Placement and American education: A Foucauldian analysis of the Advanced Placement Program of the college board

Advanced Placement is a series of courses and tests designed to determine mastery over introductory college material. It has become part of the American educational system. The changing conception of AP was examined using critical theory to determine what led to a view of continual success. The study utilized David Armstrong's variation of Michel Foucault's critical theory to construct an analytical framework. Black and Ubbes' data gathering techniques and Braun and Clark's data analysis were utilized as the analytical framework. Data included 1135 documents: 641 journal articles, 421 newspaper articles and 82 government documents. ^ The study revealed three historical ruptures correlated to three themes containing subthemes. The first rupture was the Sputnik launch in 1958. Its correlated theme was AP leading to school reform with subthemes of AP as reform for able students and AP's gaining of acceptance from secondary schools and higher education. The second rupture was the Nation at Risk report published in 1983. Its correlated theme was AP's shift in emphasis from the exam to the course with the subthemes of AP as a course, a shift in AP's target population, using AP courses to promote equity, and AP courses modifying curricula. The passage of the No Child Left Behind Act of 2001 was the third rupture. Its correlated theme was AP as a means to narrow the achievement gap with the subthemes of AP as a college preparatory program and the shifting of AP to an open access program. ^ The themes revealed a perception that progressively integrated the program into American education. The AP program changed emphasis from tests to curriculum, and is seen as the nation's premier academic program to promote reform and prepare students for college. It has become a major source of income for the College Board. In effect, AP has become an agent of privatization, spurring other private entities into competition for government funding. The change and growth of the program over the past 57 years resulted in a deep integration into American education. As such the program remains an intrinsic part of the system and continues to evolve within American education. ^

Landscape of fear : a social history of the missile during the early years of the cold war, 1950-1965

The missile's significance has been central to national security since the Soviet launching of Sputnik, and became increasingly important throughout the years of the Cold War. Much has been written about missile technology, but little has been written about how the development and deployment of this weapon affected Americans. The missile was developed to both deter war but also to win war. Its presence, however, was not always reassuring. Three areas of the United States are studied to evaluate the social implications of the missile during these pivotal years: San Francisco, home of multiple Nike installations; of Cape Canaveral, Florida, the nation's primary missile test center; the Great Plains, the location of the largest ICBM concentration in the country. Interviews were conducted, tours of facilities were taken, and local newspapers were reviewed. In conjunction with national newspapers and magazines and public opinion polls, this information provided a local social context for missile history. Nationally and locally, Americans both feared and praised the new technology. They were anxious for government funding in their cities and often felt that the danger the missile brought to their communities by making it as a Soviet target was justified in the larger cause for national security.

Do R&D strategies in high-tech sectors differ from those in low-tech sectors? An alternative approach to testing the pooling assumption

Most studies investigating the determinants of R&D investment consider pooled estimates. However, if the parameters are heterogeneous, pooled coefficients may not provide reliable estimates of individual industry effects. Hence pooled parameters may conceal valuable information that may help target government tools more efficiently across heterogeneous industries. There is little evidence to date on the decomposition of the determinants of R&D investment by industry. Moreover, the existing work does not distinguish between those R&D determinants for which pooling may be valid and those for which it is not. In this paper, we test the pooling assumption for a panel of manufacturing industries and find that pooling is valid only for output fluctuations, adjustment costs and interest rates. Implementing the test results into our model, we find government funding is significant only for low-tech R&D. Foreign R&D and skilled labour matter only in high-tech sectors. These results suggest important implications for R&D policy.

Advanced Placement and American Education: A Foucauldian Analysis of the Advanced Placement Program of the College Board

Advanced Placement is a series of courses and tests designed to determine mastery over introductory college material. It has become part of the American educational system. The changing conception of AP was examined using critical theory to determine what led to a view of continual success. The study utilized David Armstrong’s variation of Michel Foucault’s critical theory to construct an analytical framework. Black and Ubbes’ data gathering techniques and Braun and Clark’s data analysis were utilized as the analytical framework. Data included 1135 documents: 641 journal articles, 421 newspaper articles and 82 government documents. The study revealed three historical ruptures correlated to three themes containing subthemes. The first rupture was the Sputnik launch in 1958. Its correlated theme was AP leading to school reform with subthemes of AP as reform for able students and AP’s gaining of acceptance from secondary schools and higher education. The second rupture was the Nation at Risk report published in 1983. Its correlated theme was AP’s shift in emphasis from the exam to the course with the subthemes of AP as a course, a shift in AP’s target population, using AP courses to promote equity, and AP courses modifying curricula. The passage of the No Child Left Behind Act of 2001 was the third rupture. Its correlated theme was AP as a means to narrow the achievement gap with the subthemes of AP as a college preparatory program and the shifting of AP to an open access program. The themes revealed a perception that progressively integrated the program into American education. The AP program changed emphasis from tests to curriculum, and is seen as the nation’s premier academic program to promote reform and prepare students for college. It has become a major source of income for the College Board. In effect, AP has become an agent of privatization, spurring other private entities into competition for government funding. The change and growth of the program over the past 57 years resulted in a deep integration into American education. As such the program remains an intrinsic part of the system and continues to evolve within American education.

The evolution and performance of river basin management in the Murray-Darling Basin

We explore bioregional management in the Murray-Darling Basin (MDB) in Australia through the institutional design characteristics of the MDB River Basin Organization (RBO), the actors and organizations who supported and resisted the establishment of the RBO, and the effectiveness of the RBO. During the last 25 years, there has been a major structural reform in the MDB RBO, which has changed from an interstate coordinating body to an Australian government agency. Responsibility for basin management has been centralized under the leadership of the Australian government, and a comprehensive integrated Basin plan has been adopted. The driving forces for this centralization include national policy to restore river basins to sustainable levels of extraction, state government difficulties in reversing overallocation of water entitlements, the millennium drought and its effects, political expediency on the part of the Australian government and state governments, and a major injection of Australian government funding. The increasing hierarchy and centralization of the MDB RBO does not follow a general trend toward multilevel participative governance of RBOs, but decentralization should not be overstated because of the special circumstances at the time of the centralization and the continuing existence of some decentralized elements, such as catchment water plans, land use planning, and water quality. Further swings in the centralization–decentralization pendulum could occur. The MDB reform has succeeded in rebalancing Basin water allocations, including an allocation for the environment and reduced diversion limits. There are some longer term risks to the implementation of reform, including lack of cooperation by state governments, vertical coordination difficulties, and perceived reductions in the accountability and legitimacy of reform at the local level. If implementation of the Basin plan is diverted or delayed, a new institution, the Commonwealth Environmental Water Holder, can play a major role in securing and coordinating environmental water supplies.