A technology diffusion perspective of Enterprise Resource Planning across European Small and Medium Enterprises: from determinants to Use to Value

Tese apresentada como requisito parcial para obtenção do grau de Doutor em Gestão de Informação

Fluoroscopic-Guided Radial Endobronchial Ultrasound Without Guide Sheath For Peripheral Pulmonary Lesions: A Safe And Efficient Combination.

BACKGROUND: Several guidelines recommend computed tomography scans for populations with high-risk for lung cancer. The number of individuals evaluated for peripheral pulmonary lesions (PPL) will probably increase, and with it non-surgical biopsies. Associating a guidance method with a target confirmation technique has been shown to achieve the highest diagnostic yield, but the utility of bronchoscopy with radial probe endobronchial ultrasound using fluoroscopy as guidance without a guide sheath has not been reported. METHODS: We conducted a retrospective analysis of bronchoscopy with radial probe endobronchial ultrasound using fluoroscopy procedures for the investigation of PPL performed by experienced bronchoscopists with no specific previous training in this particular technique. Operator learning curves and radiological predictors were assessed for all consecutive patients examined during the first year of application of the technique. RESULTS: Fifty-one PPL were investigated. Diagnostic yield and visualization yield were 72.5 and 82.3% respectively. The diagnostic yield was 64.0% for PPL ≤20mm, and 80.8% for PPL>20mm. No false-positive results were recorded. The learning curve of all diagnostic tools showed a DY of 72.7% for the first sub-group of patients, 81.8% for the second, 72.7% for the third, and 81.8% for the last. CONCLUSION: Bronchoscopy with radial probe endobronchial ultrasound using fluoroscopy as guidance is safe and simple to perform, even without specific prior training, and diagnostic yield is high for PPL>and ≤20mm. Based on these findings, this method could be introduced as a first-line procedure for the investigation of PPL, particularly in centers with limited resources.

The capillary supply of human skeletal muscle in health and disease

BACKGROUND: Capillaries function to provide a surface area for nutrient and waste exchange with cells. The capillary supply of skeletal muscle is highly organized, and therefore, represents an excellent choice to study factors regulating diffusion. Muscle is comprised of three specific fibre types, each with specific contractile and metabolic characteristics, which influence the capillary supply of a given muscle; in addition, both environmental and genetic factors influence the capillary supply, including aging, physical training, and various disease processes. OBJECTIVE: The present study was undertaken to develop and assess the functionality of a data base, from which virtual experiments can be conducted on the capillary supply of human muscle, and the adaptations of the capillary bed in muscle to various perturbations. METHODS: To create the database, an extensive search of the literature was conducted using various search engines, and the three key words - "capillary, muscle, and human". This search yielded 169 papers from which the data for the 46 variables on the capillary supply and fibre characteristics of muscle were extracted for inclusion in the database. A series of statistical analyses (ANOVA) were done on the capillary database to examine differences in skeletal muscle capillarization and fibre characteristics between young and old individuals, between healthy and diseased individuals, and between untrained, endurance trained, endurance welltrained, and resistance trained individuals, using SAS. RESULTS: There was a significantly higher capillarization in the young compared to the old individuals, in the healthy compared to the diseased individuals, and in the endurance-trained and endurance well-trained compared to the untrained individuals. CONCLUSIONS: The results of this study support the conclusion that the capillary supply of skeletal muscle is closely regulated by factors aimed at optimizing oxygen and nutrient supply and/or waste removal in response to changes in muscle mass and/or metabolic activity.

Adolescent girls and mathematics: classroom performance, attitudes toward mathematics and perceptions of parental attitudes /

The purpose of this study was to determine the extent to which gender differences exist in student attitudes toward mathematics and in their performance in mathematics at the Grade Seven and Eight level. The study also questioned how parents influence the attitudes of this grade level of male and female students toward mathematics. Historically, the literature has demonstrated gender differences in the attitudes of students toward mathematics, and in parental support for classroom performance in mathematics. This study was an attempt to examine these differences at one senior public school in the Peel Board of Education. One hundred three Grade Seven and Eight students at a middle school in the Peel Board of Education volunteered to take part in a survey that examined their attitudes toward mathematics, their perceptions of their parents' attitudes toward mathematics and support for good performance in the mathematics classroom, parental expectations for education and future career choices. Gender differences related to performance levels in the mathematics classroom were examined using Pearson contingency analyses. Items from the survey that showed significant differences involved confidence in mathematics and confidence in writing mathematics tests, as well as a belief in the ability to work on mathematics problems. Male students in both the high and low performance groups demonstrated higher levels of confidence than the females in those groups. Female students, however, indicated interest in careers that would require training and knowledge of higher mathematics. Some of the reasons given to explain the gender differences in confidence levels included socialization pressures on females, peer acceptance, and attribution of success. Perceived parental support showed no significant differences across gender groups or performance levels. Possible explanations dealt with the family structure of the participants in the study. Studies that, in the past, have demonstrated gender differences in confidence levels were supported by this study, and discussed in detail. Studies that reported on differences in parental support for student performance, based on the gender of the parent, were not confirmed by this study, and reasons for this were also discussed. The implications for the classroom include: 1) build on the female students' strengths that will allow them to enjoy their experiences in mathematics; 2) stop using the boys as a comparison group; and 3) make students more aware of the need to continue studying mathematics to ensure a wider choice of future careers.

Cooperative learning and elaborative interrogation: effects on children's learning

This experimental study examined the effects of cooperative learning and a question-answering strategy called elaborative interrogation ("Why is this fact true?") on the learning of factual information about familiar animals. Retention gains were compared across four study conditions: elaborative-interrogation-plus-cooperative learning, cooperative-learning, elaborative-interrogation, and reading-control. Sixth-grade students (n=68) were randomly assigned to the four conditions. All participants were given initial training and practice in cooperative learning procedures via three 45-minute sessions. After studying 36 facts about six animals, students' retention gains were measured via immediate free recall, immediate matched association, 30-day, and GO-day matched association tests. A priori comparisons were made to analyze the data. For immediate free recall and immediate matched association, significant differences were found between students in the three experimental conditions versus those in the control condition. Elaborative-interrogation and elaborativeinterrogation- plus-cooperative-learning also promoted longterm retention (measured via 30-day matched association) of the material relative to repetitive reading with elaborative-interrogation promoting the most durable gains (measured via GO-day matched association). The relationship between the types of elaborative responses and probability of subsequent retention was also examined. Even when students were unable to provide adequate answers to the why questions, learning was facilitated more so than repetitive reading. In general, generation of adequate elaborations was associated with greater probability of recall than was provision of inadequate answers. The findings of the study demonstrate that cooperative learning and the use of elaborative interrogation, both individually and collaboratively, are effective classroom procedures for facilitating children's learning of new information.

A study of the role learning and socialization during the transition from teacher to elementary school administrator

This thesis examined the role transition from an elementary teacher to an elementary principal. In particular, the training and socialization process of becoming an elementary principal was explored through the study of the hierarchical and political structure of a southern Ontario school board, and how this influenced the learning experiences of new elementary principals. A qualitative methodology, with a grounded theory design, was employed to investigate this process through interviews with 10 participants to examine their experiences and role learning occurs during their development. Specifically, participants perspective shifts, developmental experiences, understanding of group culture, and expansion of a board profile were highlighted in the data. One of the compelling results of the study was the degree to which principals of aspiring administrators influence the socialization of their subordinates. The beliefs and practices of the school principal determine the socialization orientation that teachers and vice-principals will experience during role learning. The results of this study also imply that role orientation needs to be understood as a continuum between custodial and innovative role assumption. Varying degrees of custodianship or innovation depended on the context of the administrative placement and the personal attributes of administrative candidates. Principals who are willing to share responsibilities, who are good communicators, and who wish to develop a collaborative relationship with their viceprincipals are the individuals the participants in this study described as making the best mentors.

Neuromuscular adaptations in endurance-trained boys and men

Competitive sports participation in youth is becoming increasingly more common in the Western world. It is widely accepted that sports participation, specifically endurance training, is beneficial for physical, psychomotor, and social development of children. The research on the effect of endurance training in children has focused mainly on healthrelated benefits and physiological adaptations, particularly on maximal oxygen uptake. However, corresponding research on neuromuscular adaptations to endurance training and the latter's possible effects on muscle strength in youth is lacking. In children and adults, resistance training can enhance strength and mcrease muscle activation. However, data on the effect of endurance training on strength and neuromuscular adaptations are limited. While some evidence exists demonstrating increased muscle activation and possibly increased strength in endurance athletes compared with untrained adults, the neuromuscular adaptations to endurance training in children have not been examined. Thus, the purpose of this study was to examine maximal isometric torque and rate of torque development (RID), along with the pattern of muscle activation during elbow and knee flexion and extension in muscle-endurancetrained and untrained men and boys. Subjects included 65 males: untrained boys (n=18), endurance-trained boys (n=12), untrained men (n=20) and endurance-trained men (n=15). Maximal isometric torque and rate of torque development were measured using an isokinetic dynamometer (Biodex III), and neuromuscular activation was assessed using surface electromyography (SEMG). Muscle strength and activation were assessed in the dominant arm and leg, in a cross-balanced fashion during elbow and knee flexion and extension. The main variables included peak torque (T), RTD, rate of muscle activation (Q30), Electro-mechanical delay (EMD), time to peak RTD and co-activation index. Age differences in T, RTD, electro-mechanical delay (EMD) and rate of muscle activation (Q30) were consistently observed in the four contractions tested. Additionally, Q30, nonnalized for peak EMG amplitude, was consistently higher in the endurancetrained men compared with untrained men. Co-activation index was generally low in all contractions. For example, during maximal voluntary isometric knee extension, men were stronger, had higher RTD and Q30, whether absolute or nonnalized values were used. Moreover, boys exhibited longer EMD (64.8 ± 18.5 ms vs. 56.6 ± 15.3 ms, for boys and men respectively) and time to peak RTD (112.4 ± 33.4 ms vs. 100.8 ± 39.1 ms for boys and men, respectively). In addition, endurance-trained men had lower T compared with untrained men, yet they also exhibited significantly higher nonnalized Q30 (1.9 ± 1.2 vs. 1.1 ± 0.7 for endurance-trained men and untrained men, respectively). No training effect was apparent in the boys. In conclusion, the findings demonstrate muscle strength and activation to be lower in children compared with adults, regardless of training status. The higher Q30 of the endurance-trained men suggests neural adaptations, similar to those expected in response to resistance training. The lower peak torque may su9gest a higher relative involvement oftype I muscle fibres in the endurance-trained athletes. Future research is required to better understand the effect of growth and development on muscle strength and activation patterns during dynamic and sub-maximal isometric contractions. Furthennore, training intervention studies could reveal the effects of endurance training during different developmental stages, as well as in different muscle groups.

A case study investigation of the learning needs of the Niagara grape and wine community

The Niagara Grape and Wine Community (NGWC) is an industry that has undergone rapid change and expansion as a result of changes in governmental regulations and consumer preferences. As a result of these changes, the demands of the wine industry workforce have changed to reflect the need to implement new strategies and practices to remain viable and competitive. The influx of people into the community with little or no prior practical experience in grape growing (viticulture) or winemaking (oenology) has created a need for additional training and learning opportunities to meet workforce needs. This case study investigated the learning needs of the members of this community and how these needs are currently being met. The barriers to, and the opportunities for, members acquiring new knowledge and developing skills were also explored. Participants were those involved in all levels of the industry and sectors (viticulture, processing, and retail), and their views on needs and suggestions for programs of study were collected. Through cross analyses of sectors, areas of common and unique interest were identified as well as formats for delivery. A common fundamental component was identified by all sectors - any program must have a significant applied component or demonstration of proficiency and should utilize members as peer instructors, mentors, and collaborators to generate a larger shared collective of knowledge. Through the review of learning organizations, learning communities, communities of practices, and learning networks, the principles for the development of a Grape and Wine Learning Network to meet the learning needs of the NGWC outside of formal institutional or academic programs were developed. The roles and actions of members to make such a network successful are suggested.

The Bombardier, and Pocket Gunner, 7th Edition- 1813

A practical military manual for officers in the Royal Regiment of Artillery. It combines training and field service manuals with lists of equipment, weights, dimensions, and equipment accuracy and performance.

Accommodating College ESL Learner Communication Needs: Perceptions, Policies, and Practices

The purpose of this qualitative inquiry was to determine how the Practical Nursing and Pharmacy Technician programs in one southern Ontario community college could more effectively accommodate ESL learners' communication needs. The literature review examined (a) linguistic issues, such as language testing and second-language learning theories, (b) organizational matters, such as ESL curriculum and teacher training, and (c) affective issues, such as motivation for second-language learning, learning styles, and the student-teacher relationship. I gathered perceptual data from the programs' administrators, faculty members, and ESL learners. Eleven participants took part in individual interviews or a focus group session. The results suggest that ESL learners need assistance with discipline-specific vocabulary and cultural nuances. College ESL learners' weak communicative competence, together with misleading acceptance standards for ESL learners and limited support available to faculty members and to students, decrease opportunities for successful completion of the programs. The results point to re-assessment of the college's admission policies and procedures, program evaluation practices that consider the needs of ESL learners, discipline-specific language support, and strategies to enhance the ESL student-teacher relationship. The study highlights theory relating to ESL learners' self-perception and engagement, as well as the importance of including the voice of college ESL learners in educational research. The results suggest that despite ESL learners' perseverance in completing their studies, power imbalances remain. The college has yet to implement organizational strategies such as discipline-specific communications and ESL courses and extended language support that could meet the communication needs of ESL learners in the two programs.

A Narrative Study of Patient Encounter Accounts of Physicians, Nurses, and Medical Receptionists after Two Decades of a Paradigm of Patient-Centered Care

Despite recent well-known advancements in patient care in the medical fields, such as patient-centeredness and evidence-based medicine and practice, there is rather less known about their effects on the particulars of clinician-patient encounters. The emphasis in clinical encounters remains mostly on treatment and diagnosis and less on communicative competency or engagement for medical professionals. The purpose of this narrative study was to explore interactive competencies in diagnostic and therapeutic encounters and intake protocols within the context of the physicians’, nurses’, and medical receptionists’ perspectives and experiences. Literature on narrative medicine, phenomenology and medicine, therapeutic relationships, cultural and communication competency, and non-Western perspectives on human communication provided the guiding theoretical frameworks for the study. Three data sets including 13 participant interviews (5 physicians, 4 nurses, and 4 medical receptionists), policy documents (physicians, nurses, and medical receptionists) and a website (Communication and Cultural Competency) were used. The researcher then engaged in triangulated analyses, including N-Vivo, manifest and latent, Mishler’s (1984, 1995) narrative elements and Charon’s (2005, 2006a, 2006b, 2013) narrative themes, in recursive, overlapping, comparative and intersected analysis strategies. A common factor affecting physicians’ relationships with their clients was limitation of time, including limited time (a) to listen, (b) to come up with a proper diagnosis, and (c) to engage in decision making in critical conditions and limited time for patients’ visits. For almost all nurse participants in the study establishing therapeutic relationships meant being compassionate and empathetic. The goals of intake protocols for the medical receptionists were about being empathetic to patients, being an attentive listener, developing rapport, and being conventionally polite to patients. Participants with the least iv amount of training and preparation (medical receptionists) appeared to be more committed to working narratively in connecting with patients and establishing human relationships as well as in listening to patients’ stories and providing support to narrow down the reason for their visit. The diagnostic and intake “success stories” regarding patient clinical encounters for other study participants were focused on a timely securing of patient information, with some acknowledgement of rapport and emapathy. Patient-centeredness emerged as a discourse practice, with ambiguous or nebulous enactment of its premises in most clinical settings.

Do Neuro-Muscular Adaptations Occur in Endurance-Trained Boys and Men?

Most research on the effects of endurance training has focused on endurance training's health-related benefits and metabolic effects in both children and adults. The purpose of this study was to examine the neuromuscular effects of endurance training and to investigate whether they differ in children (9.0-12.9 years) and adults (18.4-35.6 years). Maximal isometric torque, rate of torque development (RTD), rate of muscle activation (Q30), electromechanical delay (EMD), and time to peak torque and peak RTD were determined by isokinetic dynamometry and surface electromyography (EMG) in elbow and knee flexion and extension. The subjects were 12 endurance-trained and 16 untrained boys, and 15 endurance-trained and 20 untrained men. The adults displayed consistently higher peak torque, RTD, and Q30, in both absolute and normalized values, whereas the boys had longer EMD (64.7+/-17.1 vs. 56.6+/-15.4 ms) and time to peak RTD (98.5+/-32.1 vs. 80.4+/-15.0 ms for boys and men, respectively). Q30, normalized for peak EMG amplitude, was the only observed training effect (1.95+/-1.16 vs. 1.10+/-0.67 ms for trained and untrained men, respectively). This effect could not be shown in the boys. The findings show normalized muscle strength and rate of activation to be lower in children compared with adults, regardless of training status. Because the observed higher Q30 values were not matched by corresponding higher performance measures in the trained men, the functional and discriminatory significance of Q30 remains unclear. Endurance training does not appear to affect muscle strength or rate of force development in either men or boys.

Determining the Effectiveness of the Therapeutic Recreation Specialist - Certified Training at Baycrest Health Sciences

The purpose of this study was to determine the effectiveness of the “Champion” training of the Therapeutic Recreation Specialist – Certified (TRSC) at Baycrest Health Sciences (BHS). BHS recently implemented a new model for Therapeutic Recreation Services that employs the model of champion for implementation of both best and next practices within the organization. This mixed methods study used both case study and program evaluation in order to understand whether the training that comprised of five different topics allowed the six participants to develop the skills needed to be champions. The results supported that learning did occur during the training and that the experience was positive for the participants. The overall finding from this study is that while the training was useful, the participants did not feel confident about utilizing these skills without further training; hence, this training can only be considered an introduction to the concepts presented.

Teachers’ Beliefs and Perceptions of Bullying and Bullying Prevention Initiatives

While bullying prevention programs appear to be decreasing the number of bullying incidents overseas, bullying prevention programs here in Canada have not been proving as effective. Evaluations of bullying prevention programs often focus on the outcomes and neglect to examine the training regimen for teachers. As teachers are on the front lines of bullying prevention programs, the current study explored teachers’ beliefs about the various types of bullying, their perceptions of their own abilities (e.g., teacher bullying prevention efficacy (TBPE), self-concept, and theory of mind) to implement bullying prevention initiatives, and how the school climate may influence their efficacy beliefs. Participants in the current study were 61 Canadian teachers (n = 51 women), predominantly from Ontario. Participating teachers represented all elementary division levels (primary, junior, and intermediate). Participants’ teaching experience ranged from zero years of teaching (pre-service) to 28 years of experience (M = 10.50, SD = 7.35). It was found that participants reported a relatively high TBPE score, which was related to their likely intervention in cyberbullying situations but not for other forms of bullying situations. It was found that teachers were most likely to intervene in physical bullying than verbal, relational, and cyberbullying, respectively. TBPE was influenced by the school climate. Teachers’ scores on the theory of mind scale was not a significant indicator of any teachers’ bullying beliefs. Analyses exploring the relationship between bullying beliefs and self-concept, morality predicted teachers TBPE scores and the likelihood of intervention. Teachers’ recommendations for bullying prevention training and school bullying prevention programs were explored. Results are discussed in terms of implications for practice and future research.

Sustaining Health Care Practice Change: The Experience of Best Practice Spotlight Organizations Implementing and Sustaining RNAO Best Practice Guidelines

Sustainability of change for improvement initiatives has been widely reported as a global challenge both within and outside health care settings. The purpose of this study was to examine the extent to which factors related to staff training and involvement, staff behaviour, and clinical leaders’ and senior leaders’ engagement and support impact the long term sustainability of practice changes for BPSO health care organizations who have implemented Registered Nursing Association of Ontario’s (RNAO) Best Practice Guidelines. Semi structured interviews with eleven organizational leaders’ from ten health care organizations were conducted to explore the unique experiences, views and perspectives on factors related to staff, clinical leaders and senior leaders and their involvement and impact on the long term sustainability of clinical practice changes within organizations who had implemented Registered Nursing Association of Ontario’s (RNAO) Best Practice Guidelines (BPGs). The interviews were coded and analyzed using thematic content analysis. Further analysis identified patterns and themes in relation to: 1. The National Health Service (NHS) Sustainability Model which was used as the theoretical framework for this research; and 2. Organizations found to have sustained practice changes longer term verses organizations that did not. Six organizations were found to have sustained practice changes while the remaining four were found to have been unsuccessful in their efforts to sustain the changes. Five major findings in relation to sustainability emerged from this study. First is the importance of early and sustained engagement and frontline staff, managers, and clinical leaders in planning, implementation and ongoing development of BPGs through use of working groups and champions models. Second is the importance of ongoing provision of formal training, tools and resources to all key stakeholders during and after the implementation phase and efforts made to embed changes in current processes whenever possible to ensure sustainability. Third is to ensure staff and management are receptive to the proposed change(s) and/or have been given the necessary background information and rationale so they understand and can support the need for the change. Fourth is the need for early and sustained fiscal and human resources dedicated to supporting BPG implementation and the ongoing use of the BPGs already in place. Fifth is ensuring clinical leaders are trusted, influential, respected and seen as clinical resources by frontline staff. The significance of this study lies in a greater understanding of the influence and impact of factors related to staff on the long term sustainability of implemented practice changes within health care organizations. This study has implications for clinical practice, policy, education and research in relation to sustainability in health care.