The process of implementing a new baby-friendly hospital initiative for nurses: a grounded theory study

Maternity nursing practice is changing across Canada with the movement toward becoming “baby friendly.” The World Health Organization (WHO) recommends the Baby-Friendly Hospital Initiative (BFHI) as a standard of care in hospitals worldwide. Very little research has been conducted with nurses to explore the impact of the initiative on nursing practice. The purpose of this study, therefore, was to examine the process of implementing the BFHI for nurses. The study was carried out using Corbin and Strauss’s method of grounded theory. Theoretical sampling was employed, which resulted in recruiting and interviewing 13 registered nurses whose area of employment included neonatal intensive care, postpartum, and labour and delivery. The data analysis revealed a central category of resisting the BFHI. All of the nurses disagreed with some of the 10 steps to becoming a baby-friendly hospital as outlined by the WHO. Participants questioned the science and safety of aspects of the BFHI. Also, participants indicated that the implementation of this program did not substantially change their nursing practice. They empathized with new mothers and anticipated being collectively reprimanded by management should they not follow the initiative. Five conditions influenced their responses to the initiative, which were (a) an awareness of a pro-breastfeeding culture, (b) imposition of the BFHI, (c) knowledge of the health benefits of breastfeeding, (d) experiential knowledge of infant feeding, and (e) the belief in the autonomy of mothers to decide about infant feeding. The identified outcomes were moral distress and division between nurses. The study findings could guide decision making concerning the implementation of the BFHI.

Guiding stakeholders to participate in Marine Strategy Framework implementation

Large marine areas and regional seas present a challenge in terms of management. They are often bordered by numerous maritime jurisdictions; with multi-use and multi-sector environments; involving varying governance arrangements; and generation of sufficient levels of data to best inform decision-makers. Marine management at the regional scale involves a range of mechanisms and approaches to ensure all relevant stakeholders have an opportunity to engage in the process; and these approaches can differ in their legal and regulatory conditions. At present, no such comparable structures exist at the transnational level for the ecosystem-based management of the Celtic Sea. Against this backdrop, a participative process, involving representatives from differing sectors of activity in the Celtic Sea spanning four Member States, was established for the purpose of identifying realistic and meaningful management principles in line with the goals of the Marine Strategy Framework Directive.

Documenting the Contextualization and Implementation of mhGAP-HIG in Post-earthquake Nepal

Background: The burden of mental health is increased in humanitarian settings, and needs to be addressed in emergency situations. The World Health Organization has recently released the mental health Global Action Programme Humanitarian Intervention Guide (mhGAP-HIG) in order to scale up mental health service delivery in humanitarian settings through task-shifting. This study aims to evaluate, contextualize and identify possible barriers and challenges to mhGAP-HIG manual content, training and implementation in post-earthquake Nepal.

Methods: This qualitative study was conducted in Kathmandu, Nepal. Key informant interviews were conducted with fourteen psychiatrists involved in a mhGAP-HIG Training of Trainers and Supervisors (ToTS) in order to assess the mhGAP-HIG, ToTS training, and the potential challenges and barriers to mhGAP-HIG implementation. Themes identified by informants were supplemented by process notes taken by the researcher during observed training sessions and meetings.

Results: Key themes emerging from key informant interviews include the need to take three factors into account in manual contextualization: culture, health systems and the humanitarian setting. This includes translation of the manual into the local language, adding or expanding upon conditions prevalent in Nepal, and more consideration to improving feasibility of manual use by non-specialists.

Conclusion: The mhGAP-HIG must be tailored to specific humanitarian settings for effective implementation. This study shows the importance of conducting a manual contextualization workshop prior to training in order to maximize the feasibility and success in training health care workers in mhGAP.

A facilities maintenance management process based on degradation prediction using sensed data

Energy efficiency and user comfort have recently become priorities in the Facility Management (FM) sector. This has resulted in the use of innovative building components, such as thermal solar panels, heat pumps, etc., as they have potential to provide better performance, energy savings and increased user comfort. However, as the complexity of components increases, the requirement for maintenance management also increases. The standard routine for building maintenance is inspection which results in repairs or replacement when a fault is found. This routine leads to unnecessary inspections which have a cost with respect to downtime of a component and work hours. This research proposes an alternative routine: performing building maintenance at the point in time when the component is degrading and requires maintenance, thus reducing the frequency of unnecessary inspections. This thesis demonstrates that statistical techniques can be used as part of a maintenance management methodology to invoke maintenance before failure occurs. The proposed FM process is presented through a scenario utilising current Building Information Modelling (BIM) technology and innovative contractual and organisational models. This FM scenario supports a Degradation based Maintenance (DbM) scheduling methodology, implemented using two statistical techniques, Particle Filters (PFs) and Gaussian Processes (GPs). DbM consists of extracting and tracking a degradation metric for a component. Limits for the degradation metric are identified based on one of a number of proposed processes. These processes determine the limits based on the maturity of the historical information available. DbM is implemented for three case study components: a heat exchanger; a heat pump; and a set of bearings. The identified degradation points for each case study, from a PF, a GP and a hybrid (PF and GP combined) DbM implementation are assessed against known degradation points. The GP implementations are successful for all components. For the PF implementations, the results presented in this thesis find that the extracted metrics and limits identify degradation occurrences accurately for components which are in continuous operation. For components which have seasonal operational periods, the PF may wrongly identify degradation. The GP performs more robustly than the PF, but the PF, on average, results in fewer false positives. The hybrid implementations, which are a combination of GP and PF results, are successful for 2 of 3 case studies and are not affected by seasonal data. Overall, DbM is effectively applied for the three case study components. The accuracy of the implementations is dependant on the relationships modelled by the PF and GP, and on the type and quantity of data available. This novel maintenance process can improve equipment performance and reduce energy wastage from BSCs operation.

Gaussian Process Kernels for Cross-Spectrum Analysis in Electrophysiological Time Series

Multi-output Gaussian processes provide a convenient framework for multi-task problems. An illustrative and motivating example of a multi-task problem is multi-region electrophysiological time-series data, where experimentalists are interested in both power and phase coherence between channels. Recently, the spectral mixture (SM) kernel was proposed to model the spectral density of a single task in a Gaussian process framework. This work develops a novel covariance kernel for multiple outputs, called the cross-spectral mixture (CSM) kernel. This new, flexible kernel represents both the power and phase relationship between multiple observation channels. The expressive capabilities of the CSM kernel are demonstrated through implementation of 1) a Bayesian hidden Markov model, where the emission distribution is a multi-output Gaussian process with a CSM covariance kernel, and 2) a Gaussian process factor analysis model, where factor scores represent the utilization of cross-spectral neural circuits. Results are presented for measured multi-region electrophysiological data.

The implementation of a literacy intervention 'Station Teaching' in infant classes in Irish primary schools

Background: I conducted my research in the context of The National Literacy Strategy (DES, 2011), which maintains that every young person should be literate and it outlines targets for improving literacy in schools from 2011 to 2020. There has been much debate on the teaching of literacy and in particular the teaching of reading. Clark (2014) outlines how learning to read should be a developmental language process and that the approaches in the early years of schooling will colour the children’s motivation and their perception of reading as a purposeful activity. The acquisition of literacy begins in the home but this study focuses on the implementation of a literacy intervention Station Teaching in the infant classes in primary school. Station Teaching occurs when a class is divided into four or five small groups of pupils and they receive intensive tuition at four or five different Stations with the help of Support teachers: New Reading, Familiar Reading, Phonics, Writing and Oral Language. Research Questions: These research questions frame my study: How is Station Teaching implemented? What is the experience of the intervention Station Teaching from the participants’ point of view: teachers, pupils, parents? What notion of literacy is Station Teaching facilitating? Methods: I chose a pragmatic parallel mixed methods design as suggested by Mertens (2010). I collected and analysed both the quantitative and qualitative data to answer the study’s research questions. In the study the quantitative data were collected from a questionnaire issued to 21 schools in Ireland. I used Excel as a data management package and thematic analysis to analyse and present the data in themes. I collected qualitative data from a case study in a school. This data included observations of two classes over a period of a year; interviews with teachers, pupils and parents; children’s drawings, photographs, teachers’ diaries and video evidence. I analysed and presented the evidence from the qualitative data in themes. Main Findings: There are many skills and strategies that are essential to effective literacy teaching in the early years including phonological awareness, phonics, vocabulary, fluency, comprehension and writing. These skills can be taught during Station Teaching. Early intervention in the early years is essential to pupils’ acquisition of literacy. The expertise of the teacher is key to improving the literacy achievement of pupils Teachers and pupils enjoy participating in ST. Pupils are motivated to read and engage in meaningful activities during ST. Staff collaboration is vital for ST to succeed ST facilitates small group work and teachers can differentiate accordingly while including all pupils in the groups. Pupils’ learning is extended in ST but extension activities need to be addressed in the Writing Station. More training should be provided for teachers on the implementation of ST and more funding for resources should be available to schools Significant contribution of the work: The main significance of the study includes: insights into the classroom implementation of Station Teaching in infant classes and extensive research into characteristics of an effective teacher of literacy.

Design and Implementation of Tools for STM Studies in UHV and at the Solid-Liquid Interface

This thesis presents details of the design and development of novel tools and instruments for scanning tunneling microscopy (STM), and may be considered as a repository for several years' worth of development work. The author presents design goals and implementations for two microscopes. First, a novel Pan-type STM was built that could be operated in an ambient environment as a liquid-phase STM. Unique features of this microscope include a unibody frame, for increased microscope rigidity, a novel slider component with large Z-range, a unique wiring scheme and damping mechanism, and a removable liquid cell. The microscope exhibits a high level of mechanical isolation at the tunnel junction, and operates excellently as an ambient tool. Experiments in liquid are on-going. Simultaneously, the author worked on designs for a novel low temperature, ultra-high vacuum (LT-UHV) instrument, and these are presented as well. A novel stick-slip vertical coarse approach motor was designed and built. To gauge the performance of the motor, an in situ motion sensing apparatus was implemented, which could measure the step size of the motor to high precision. A new driving circuit for stick-slip inertial motors is also presented, that o ffers improved performance over our previous driving circuit, at a fraction of the cost. The circuit was shown to increase step size performance by 25%. Finally, a horizontal sample stage was implemented in this microscope. The build of this UHV instrument is currently being fi nalized. In conjunction with the above design projects, the author was involved in a collaborative project characterizing N-heterocyclic carbene (NHC) self-assembled monolayers (SAMs) on Au(111) films. STM was used to characterize Au substrate quality, for both commercial substrates and those manufactured via a unique atomic layer deposition (ALD) process by collaborators. Ambient and UHV STM was then also used to characterize the NHC/Au(111) films themselves, and several key properties of these films are discussed. During this study, the author discovered an unexpected surface contaminant, and details of this are also presented. Finally, two models are presented for the nature of the NHC-Au(111) surface interaction based on the observed film properties, and some preliminary theoretical work by collaborators is presented.

An Examination of Current Approaches to Integrative Indigenous and Western Knowledge System Implementation in Water Research and Management: A Case Study Encompassing the Colonized Geographies of Canada, Australia, New Zealand, and the United States

The commodification of natural resources and the pursuit of continuous growth has resulted in environmental degradation, depletion, and disparity in access to these life-sustaining resources, including water. Utility-based objectification and exploitation of water in some societies has brought us to the brink of crisis through an apathetic disregard for present and future generations. The ongoing depletion and degradation of the world’s water sources, coupled with a reliance on Western knowledge and the continued omission of Indigenous knowledge to manage our relationship with water has unduly burdened many, but particularly so for Indigenous communities. The goal of my thesis research is to call attention to and advance the value and validity of using both Indigenous and Western knowledge systems (also known as Two-Eyed Seeing) in water research and management to better care for water. To achieve this goal, I used a combined systematic and realist review method to identify and synthesize the peer-reviewed, integrative water literature, followed by semi-structured interviews with first authors of the exemplars from the included literature to identify the challenges and insights that researchers have experienced in conducting integrative water research. Findings suggest that these authors recognize that many previous attempts to integrate Indigenous knowledges have been tokenistic rather than meaningful, and that new methods for knowledge implementation are needed. Community-based participatory research methods, and the associated tenets of balancing power, fostering trust, and community ownership over the research process, emerged as a pathway towards the meaningful implementation of Indigenous and Western knowledge systems. Data also indicate that engagement and collaborative governance structures developed from a position of mutual respect are integral to the realization of a given project. The recommendations generated from these findings offer support for future Indigenous-led research and partnerships through the identification and examination of approaches that facilitate the meaningful implementation of Indigenous and Western knowledge systems in water research and management. Asking Western science questions and seeking Indigenous science solutions does not appear to be working; instead, the co-design of research projects and asking questions directed at the problem rather than the solution better lends itself to the strengths of Indigenous science.

Design and implementation of generalized topologies of time-interleaved variable bandpass Σ−Δ modulators

In this thesis, novel analog-to-digital and digital-to-analog generalized time-interleaved variable bandpass sigma-delta modulators are designed, analysed, evaluated and implemented that are suitable for high performance data conversion for a broad-spectrum of applications. These generalized time-interleaved variable bandpass sigma-delta modulators can perform noise-shaping for any centre frequency from DC to Nyquist. The proposed topologies are well-suited for Butterworth, Chebyshev, inverse-Chebyshev and elliptical filters, where designers have the flexibility of specifying the centre frequency, bandwidth as well as the passband and stopband attenuation parameters. The application of the time-interleaving approach, in combination with these bandpass loop-filters, not only overcomes the limitations that are associated with conventional and mid-band resonator-based bandpass sigma-delta modulators, but also offers an elegant means to increase the conversion bandwidth, thereby relaxing the need to use faster or higher-order sigma-delta modulators. A step-by-step design technique has been developed for the design of time-interleaved variable bandpass sigma-delta modulators. Using this technique, an assortment of lower- and higher-order single- and multi-path generalized A/D variable bandpass sigma-delta modulators were designed, evaluated and compared in terms of their signal-to-noise ratios, hardware complexity, stability, tonality and sensitivity for ideal and non-ideal topologies. Extensive behavioural-level simulations verified that one of the proposed topologies not only used fewer coefficients but also exhibited greater robustness to non-idealties. Furthermore, second-, fourth- and sixth-order single- and multi-path digital variable bandpass digital sigma-delta modulators are designed using this technique. The mathematical modelling and evaluation of tones caused by the finite wordlengths of these digital multi-path sigmadelta modulators, when excited by sinusoidal input signals, are also derived from first principles and verified using simulation and experimental results. The fourth-order digital variable-band sigma-delta modulator topologies are implemented in VHDL and synthesized on Xilinx® SpartanTM-3 Development Kit using fixed-point arithmetic. Circuit outputs were taken via RS232 connection provided on the FPGA board and evaluated using MATLAB routines developed by the author. These routines included the decimation process as well. The experiments undertaken by the author further validated the design methodology presented in the work. In addition, a novel tunable and reconfigurable second-order variable bandpass sigma-delta modulator has been designed and evaluated at the behavioural-level. This topology offers a flexible set of choices for designers and can operate either in single- or dual-mode enabling multi-band implementations on a single digital variable bandpass sigma-delta modulator. This work is also supported by a novel user-friendly design and evaluation tool that has been developed in MATLAB/Simulink that can speed-up the design, evaluation and comparison of analog and digital single-stage and time-interleaved variable bandpass sigma-delta modulators. This tool enables the user to specify the conversion type, topology, loop-filter type, path number and oversampling ratio.

A process-based Knowledge Management framework supported by ARIS Enterprise Modelling architecture

Knowledge and its management have been respectively accepted as a critical resource and a core business competency. Despite that literature proves the existence of a gap between the theoretical considerations of Knowledge Management (KM) and their efficient application. Such lacking, we argue, derives from the missing link between a framework of Knowledge Management and the particular methods and guidelines of its implementation. In an attempt to bridge this gap, an original, process- based holistic Knowledge Management framework is proposed, aiming to address the problem of knowledge management application and performance by utilising a set of well accepted Enterprise Modelling (EM) methods and tools.

What's in it for us? A case study research about micro sense making processes through the eyes of front line employees, during culture change implementation

Abstract How employees make sense of change is a very complex process. Recently, academics have neglected to research sense making activities in a micro culture implementation context, through the eyes of front line employees. In contrast to a macro view, a micro perspective limits researchers to only look at an individual, departmental or group level. By doing so, we can zoom in on the details of sense making processes that employees use in their daily work life. A macro (organisational) view is based on the notion that there is a general integrated culture that can be found in all organisational units and departments. It is assumed that culture can be researched by using the entire organisation as one single research entity. This thesis challenges this assumption. In case of planned change it is usually the management community who are in charge of the change intervention. Because of their formal hierarchical position, they have the power to abort or initiate change programs. It is perhaps therefore that researchers tend to be focused on the management community rather than on lower level organisational members, such as front line employees. Apart from the micro view, scholars also neglected to research culture change implementation through the eyes of front line employees. This thesis is an attempt to fill these two gaps that currently exists in academic change management publications. The main research question is therefore: From a micro point of view how do front-line employees make sense of the impact of culture change, during the implementation phase? This thesis starts with a literature review which exposes the two main gaps. The most important outcome of this review is that only 2% of the research articles dealt with culture implementation, through the eyes of front line employees. A conceptual research model is built on the integrated sense making theory of Weber and Manning (2001) and the micro variables of Raelin and Cataldo (2011). These theories emphasize elements of sense making in a daily working context. It is likely that front line employees can identify themselves with research elements such as tasks, skills practices, involvement and behaviour. Front line employees were selected, because as lower level organisational members they are usually the change recipients. They are further away from the change initiating scene (usually the management of an organisation) and form a potential sense making ‘hotspot’ that could provide new academic insights. In order to carry out the primary research, two case organisations were selected in the leisure industry. A participative case study research method was chosen. This meant that the researcher worked in the concerning departments of the case organisations. The goal was to observe and interview front line employees, while they were performing their jobs. The most important advantage of this approach is that the researcher temporarily becomes one with the organisation and is therefore able to acquire both formal and informal narratives that front line employees use during sense making activities. It was found that front line employees make sense of organisational change by using a practical approach. They make sense of the change program by carrying out new tasks, developing new skills and sharing best practices. The most noticeable conclusion was that sense making activities predominantly take place at an individual level in relation to change acceptance. Organisational members tend to create a mental equation in order to weigh the advantages against the disadvantages. They evaluate whether the concerning change program is beneficial to them or not. For future research a sense making scheme model is suggested that is based on two methods: an introspection and an action method.

A process evaluation of a cluster randomised trial to reduce potentially inappropriate prescribing in older people in primary care (OPTI-SCRIPT study)

Background
The OPTI-SCRIPT cluster randomised controlled trial (RCT) found that a three-phase multifaceted intervention including academic detailing with a pharmacist, GP-led medicines reviews, supported by web-based pharmaceutical treatment algorithms, and tailored patient information leaflets, was effective in reducing potentially inappropriate prescribing (PIP) in Irish primary care. We report a process evaluation exploring the implementation of the intervention, the experiences of those participating in the study and lessons for future implementation.

Methods
The OPTI-SCRIPT trial included 21 GP practices and 196 patients. The process evaluation used mixed methods. Quantitative data were collected from all GP practices and semi-structured interviews were conducted with GPs from intervention and control groups, and a purposive sample of patients from the intervention group. All interviews were transcribed verbatim and analysed using a thematic analysis.

Results
Despite receiving a standardised academic detailing session, intervention delivery varied among GP practices. Just over 70 % of practices completed medicines review as recommended with the patient present. Only single-handed practices conducted reviews without patients present, highlighting the influence of practice characteristics and resources on variation. Medications were more likely to be completely stopped or switched to another more appropriate medication when reviews were conducted with patients present. The patient information leaflets were not used by any of the intervention practices. Both GP (32 %) and patient (40 %) recruitment rates were modest. For those who did participate, overall, the experience was positively viewed, with GPs and patients referring to the value of medication reviews to improve prescribing and reduce unnecessary medications. Lack of time in busy GP practices and remuneration were identified as organisational barriers to future implementation.

Conclusions
The OPTI-SCRIPT intervention was positively viewed by both GPs and patients, both of whom valued the study’s objectives. Patient information leaflets were not a successful component of the intervention. Academic detailing and medication reviews are important components in changing PIP, and having patients present during the review process seems to be a more effective approach for decreasing PIP.

An investigation of routes to cancer diagnosis in 10 international jurisdictions, as part of the International Cancer Benchmarking Partnership: survey development and implementation

Objectives This paper describes the methods used in the International Cancer Benchmarking Partnership Module 4 Survey (ICBPM4) which examines time intervals and routes to cancer diagnosis in 10 jurisdictions. We present the study design with defining and measuring time intervals, identifying patients with cancer, questionnaire development, data management and analyses.
Design and setting Recruitment of participants to the ICBPM4 survey is based on cancer registries in each jurisdiction. Questionnaires draw on previous instruments and have been through a process of cognitive testing and piloting in three jurisdictions followed by standardised translation and adaptation. Data analysis focuses on comparing differences in time intervals and routes to diagnosis in the jurisdictions.
Participants Our target is 200 patients with symptomatic breast, lung, colorectal and ovarian cancer in each jurisdiction. Patients are approached directly or via their primary care physician (PCP). Patients’ PCPs and cancer treatment specialists (CTSs) are surveyed, and ‘data rules’ are applied to combine and reconcile conflicting information. Where CTS information is unavailable, audit information is sought from treatment records and databases.
Main outcomes Reliability testing of the patient questionnaire showed that agreement was complete (κ=1) in four items and substantial (κ=0.8, 95% CI 0.333 to 1) in one item. The identification of eligible patients is sufficient to meet the targets for breast, lung and colorectal cancer. Initial patient and PCP survey response rates from the UK and Sweden are comparable with similar published surveys. Data collection was completed in early 2016 for all cancer types.
Conclusion An international questionnaire-based survey of patients with cancer, PCPs and CTSs has been developed and launched in 10 jurisdictions. ICBPM4 will help to further understand international differences in cancer survival by comparing time intervals and routes to cancer diagnosis.

Parading through the Peace Process:Anthropology, Governance and Crisis in Northern Ireland

Because the authors both did work on the North Ireland parades, they became integrally involved as fieldworking anthropologists in the monitoring of these events, and in the creation of policy for their management. They detail how they worked with individuals and groups at every level, from protestors on the street up to the Secretary of State for the region. Later funded to examine legal and policing approaches to protests in other countries, especially South Africa, they show how they used this comparative knowledge to urge the implementation of measures which appear to have led to a diminution of violence in the parades. Finally, they assess their own contribution to the peace process in terms of contingency, timing, luck, flexibility, and industry.

Erweiterung des Dokumentenservers DSpace: Internationalisierung und Implementation des URN-Systems zur permanenten Dokumentenadressierung

At first a small overview is given about the disposition of document ser- vers in the scientific publication process. Then, institutional repositories are introduced by their key features and the benefits of establishing them as a central repository in the university context. A specific solution was chosen on behalf of the requirements of the Uni- versity Library of Kassel, Germany. The software Dspace was chosen but needs to be extended by • internationalization • use of the urn:nbn scheme as persisten identifier. DSpace’s features are shortly described, followed by the process of rever- se engeneering to achieve requirements needed for the implementation of the missing functionality. Adjacent tasks implement the needed featu- res using SUN’s Standard Tag Library for internationalization and some modifications in two classes for use of the urn:nbn scheme as persistent identifier. At the end, a short view on the future of institutional repositories is taken, furthermore some local long-term objectives on DSpace are dis- cussed.