Analyzing change in medication use - statistical approaches

The objective of this study was to gain an understanding of the effects of population heterogeneity, missing data, and causal relationships on parameter estimates from statistical models when analyzing change in medication use. From a public health perspective, two timely topics were addressed: the use and effects of statins in populations in primary prevention of cardiovascular disease and polypharmacy in older population. Growth mixture models were applied to characterize the accumulation of cardiovascular and diabetes medications among apparently healthy population of statin initiators. The causal effect of statin adherence on the incidence of acute cardiovascular events was estimated using marginal structural models in comparison with discrete-time hazards models. The impact of missing data on the growth estimates of evolution of polypharmacy was examined comparing statistical models under different assumptions for missing data mechanism. The data came from Finnish administrative registers and from the population-based Geriatric Multidisciplinary Strategy for the Good Care of the Elderly study conducted in Kuopio, Finland, during 2004–07. Five distinct patterns of accumulating medications emerged among the population of apparently healthy statin initiators during two years after statin initiation. Proper accounting for time-varying dependencies between adherence to statins and confounders using marginal structural models produced comparable estimation results with those from a discrete-time hazards model. Missing data mechanism was shown to be a key component when estimating the evolution of polypharmacy among older persons. In conclusion, population heterogeneity, missing data and causal relationships are important aspects in longitudinal studies that associate with the study question and should be critically assessed when performing statistical analyses. Analyses should be supplemented with sensitivity analyses towards model assumptions.

Curriculum R & D: Incubating change in higher education

This mixed methods study examined incubation as a strategy for curricular change. The purpose was to examine the characteristics and effectiveness of curriculum incubation from a faculty perspective. The conceptual frame for this study proposed combining a grounded theory of incubation with concepts from organizational creativity to explain incubator processes. Findings concluded that while the incubator did engage is typical practices of nurturing, testing, and refining ideas, the salient characteristics of the incubator were most closely related to concepts of organizational creativity. The incubator examined in this study was in formative stages of development and data offered a thin slice of evidence supporting incubation as a mechanism of curricular change. Further study is warranted

Adapting to change in contemporary Irish and Scottish culture: fiction to film

Abstract available: p. [ii]-[iii].

Assessment of change in psychoanalysis : Another way of using the change after psychotherapy scales

A systematic method is presented whereby material from a full course of psychoanalytic treatment is analyzed to assess changes and identify patterns of change. Through an analysis of session notes, changes were assessed using the CHange After Psychotherapy scales (CHAP; Sandell 1987a), which evaluate changes in five rating variables (symptoms, adaptive capacity, insight, basic conflicts, and extratherapeutic factors). Change incidents were identified in nearly every session. Early in the analysis, relatively more change incidents related to insight were found than were found for the other types of change. By contrast, in the third year and part of the fourth year, relatively more change incidents related to basic conflicts and adaptive capacity were found. While changes related to symptoms occurred throughout the course of treatment, such changes were never more frequent than other types of change. A content analysis of the change incidents allowed a determination of when in the treatment the patient's main conflicts (identified clinically) were overcome. A crossing of quantitative data with clinical and qualitative data allowed a better understanding of the patterns of change.

Experiences of care and adjustment to change in caregivers of children with autoimmune encephalitis: an interpretative phenomenological analysis

Background: Autoimmune encephalitis (AE) occurs in response to an antibody-mediated central nervous system disease and can lead to significant neurodisability. Prior research on family adjustment has described a reciprocal relationship between caregiver functioning, distress and clinical outcome in parents and children with encephalitis. There has been no previous research exploring the experiences of caregivers with a child with AE. Aims: To explore the perspectives of parents and/or caregivers with a child diagnosed with AE regarding (i) their own adjustment from hospital admission to post-discharge, and (ii) their experiences of care and service provision. Methods: A purposive sampling approach was used. Five parents of children with AE participated in a semi-structured interview exploring their experiences of caring for their child and service provision during acute care and post-discharge. Interpretative Phenomenological Analysis (IPA) was used to analyse the transcripts. Main findings and conclusions: Four shared super-ordinate themes with related subthemes emerged: (a) uncertainty, (b) managing our recovery, (c) changes in my child, (d) experiences of service provision. Participants reported emotional distress, often underpinned by recurrent experiences of uncertainty, and ‘loss’ of the previous child, and mediated by coping strategies and social support. While an overall positive experience of inpatient services was reported, parents often perceived post-discharge services as lacking in co-ordination, communication and formal follow-up, resulting in unmet support needs. Implications and recommendations for services, practitioners and future research are discussed.

The Return of Institutions. On the Latest Change in the Research on Social and Economic Development

The paper describes the latest change in the research on social and economic development of states. This change is characterized mainly by a strong emphasis put on the role of institutions as key instruments of reducing the development gap between countries. It is argued that in the years after 1989 institutions have disappeared from mainstream academia and major intellectual debates because of: (1) the widespread belief in global convergence of capitalism and (2) the modernization theory which prevailed in the social science in the 1990s. The article indicates that institutions were once again brought into focus as a result of (1) a wider debate about the institutional sources of growth and development sparked by Acemoglu and Robinson’s Why Nations Fail, (2) the beginning of the global economic crisis of 2008 triggered by the fall of American investment bank Lehman Brothers (3) diversified consequences of the economic crisis seen all over Europe and the USA which illustrate (4) the institutional varieties of capitalism.

Household language, residential segregation and social mobility: continuity and change in eThekwini, South Africa

This article uses South African census data for 1996, 2001 and 2011 to explore the relationship between language and social mobility in the metropolitan region of eThekwini (including what was previously known as Durban). We focus particular attention on variables selected to shed light on residential segregation and social mobility, such as education level, income, race and in-migration. Data on adults at ward level (using 2011 ward boundaries) in eThekwini is used to develop a comparative spatial context for this analysis. Our main finding is that English appears in eThekwini to be the household language of the social elite as well as the language of upward mobility and empowerment.

Incremental revolution: Organizational change in highly turbulent environments

Established models for understanding organizational change processes seem inadequate for explaining changes undergone by organizations facing highly turbulent environments. We propose an alternative model that depicts change as constant regeneration rather than revolutionary episodes. We then propose a set of structures and processes that facilitate this constant regeneration.

Culture change in a museum: An action research analysis

The move of a museum in the western United States to larger quarters resulted in an increase in visitors and requests for tours. To respond to the greater number of tours, new volunteers (docents) were recruited and trained. But conflicts arose between the old and new docents. As Docent Chair, one of the authors worked with the Curator of Education to understand the culture change faced by the old docent group and integrate the old and new docent groups. This paper analyzes the culture change using Lewin’s Action Research model. The success of the culture integration was demonstrated when the old and new docents moved away from «this is how it should be done…» to «this is what I see…» in speaking about an event or problem. The language and perception changes were steps toward building a common meaning.

Assessing student perceptions and comprehension of climate change in portuguese higher education institutions

The higher education system has a critical role to play in educating environmentally aware and participant citizens about global climate change. Yet, few studies have focused on higher education students’ knowledge and attitudes about this issue. This study aims to contribute to a comprehensive understanding of views and attitudes about climate change issues, across the postgraduate student population in three universities—the on Campus University of Porto and University of Coimbra, and the distance learning Universidade Aberta, Portugal. We surveyed university students and graduates from three master programs in environmental sciences targeting their knowledge, attitudes and behaviour on climate change issues, and their views of the role that their master degree had on it. A majority of the respondents believed that climate change is factual, and is largely human-induced; and a majority expressed concerns about climate change. Still, the surveyed students hold some misconceptions about basic causes and consequences of climate change. Further research is necessary to comprehend the university postgraduate students’ population, so that curricula programs can be adapted to grant consensus on scientific knowledge about climate change, and an active engagement of the graduate citizens, as part of the solution for climate change problems.

Vulnerabilities, impacts and adaptations to climate change in the agricultural sector and agricultural soils.

2009

Leading change in higher education. The role of transformational and stakeholder management

Summary…iii Samenvatting . iv Resumen . vii Acknowledgments ix Table of Contents. xi List of tables xiii List of figures . xiii CHAPTER I General Introduction 2 CHAPTER II Transformational leadership and stakeholder management in library change . 47 CHAPTER III Successful change: the role of transformational leadership and stakeholder management in universities ... 73 CHAPTER IV Transformational leadership and stakeholder management: A multiple case study in Latin American universities . 111 CHAPTER V General Discussion 149 APPENDIX . 169 REFERENCES . 179

Preserving and interpreting the mining company office : landscape, space and technological change in the management of the copper industry

The purpose of this research is to examine the role of the mining company office in the management of the copper industry in Michigan’s Keweenaw Peninsula between 1901 and 1946. Two of the largest and most influential companies were examined – the Calumet & Hecla Mining Company and the Quincy Mining Company. Both companies operated for more than forty years under general managers who were arguably the most influential people in the management of each company. James MacNaughton, general manager at Calumet and Hecla, worked from 1901 through 1941; Charles Lawton, general manager at Quincy Mining Company, worked from 1905 through 1946. In this case, both of these managers were college-educated engineers and adopted scientific management techniques to operate their respective companies. This research focused on two main goals. The first goal of this project was to address the managerial changes in Michigan’s copper mining offices of the early twentieth century. This included the work of MacNaughton and Lawton, along with analysis of the office structures themselves and what changes occurred through time. The second goal of the project was to create a prototype virtual exhibit for use at the Quincy Mining Company office. A virtual exhibit will allow visitors the opportunity to visit the office virtually, experiencing the office as an office worker would have in the early twentieth century. To meet both goals, this project used various research materials, including archival sources, oral histories, and material culture to recreate the history of mining company management in the Copper Country.

Cognitive Competence and Life Course Change in Multi-Problem Adolescents

The dissertation reports on two studies. The purpose of Study I was to develop and evaluate a measure of cognitive competence (the Critical Problem Solving Skills Scale – Qualitative Extension) using Relational Data Analysis (RDA) with a multi-ethnic, adolescent sample. My study builds on previous work that has been conducted to provide evidence for the reliability and validity of the RDA framework in evaluating youth development programs (Kurtines et al., 2008). Inter-coder percent agreement among the TOC and TCC coders for each of the category levels was moderate to high, with a range of .76 to .94. The Fleiss’ kappa across all category levels was from substantial agreement to almost perfect agreement, with a range of .72 to .91. The correlation between the TOC and the TCC demonstrated medium to high correlation, with a range of r(40)=.68, p Study II reports an investigation of a positive youth development program using an Outcome Mediation Cascade (OMC) evaluation model, an integrated model for evaluating the empirical intersection between intervention and developmental processes. The Changing Lives Program (CLP) is a community supported positive youth development intervention implemented in a practice setting as a selective/indicated program for multi-ethnic, multi-problem at risk youth in urban alternative high schools in the Miami Dade County Public Schools (M-DCPS). The 259 participants for this study were drawn from the CLP’s archival data file. The study used a structural equation modeling approach to construct and evaluate the hypothesized model. Findings indicated that the hypothesized model fit the data (χ2 (7) = 5.651, p = .83; RMSEA = .00; CFI = 1.00; WRMR = .319). My study built on previous research using the OMC evaluation model (Eichas, 2010), and the findings are consistent with the hypothesis that in addition to having effects on targeted positive outcomes, PYD interventions are likely to have progressive cascading effects on untargeted problem outcomes that operate through effects on positive outcomes.