Boundaries in Action : An Activity-theoretical Study of Development, Learning, and Change in Health Care Organization for Patients with Multiple and Chronic Illnesses

This study examines boundaries in health care organizations. Boundaries are sometimes considered things to be avoided in everyday living. This study suggests that boundaries can be important temporally and spatially emerging locations of development, learning, and change in inter-organizational activity. Boundaries can act as mediators of cultural and social formations and practices. The data of the study was gathered in an intervention project during the years 2000-2002 in Helsinki in which the care of 26 patients with multiple and chronic illnesses was improved. The project used the Change Laboratory method that represents a research assisted method for developing work. The research questions of the study are: (1) What are the boundary dynamics of development, learning, and change in health care for patients with multiple and chronic illnesses? (2) How do individual patients experience boundaries in their health care? (3) How are the boundaries of health care constructed and reconstructed in social interaction? (4) What are the dynamics of boundary crossing in the experimentation with the new tools and new practice? The methodology of the study, the ethnography of the multi-organizational field of activity, draws on cultural-historical activity theory and anthropological methods. The ethnographic fieldwork involves multiple research techniques and a collaborative strategy for raising research data. The data of this study consists of observations, interviews, transcribed intervention sessions, and patients' health documents. According to the findings, the care of patients with multiple and chronic illnesses emerges as fragmented by divisions of a patient and professionals, specialties of medicine and levels of health care organization. These boundaries have a historical origin in the Finnish health care system. As an implication of these boundaries, patients frequently experience uncertainty and neglect in their care. However, the boundaries of a single patient were transformed in the Change Laboratory discussions among patients, professionals and researchers. In these discussions, the questioning of the prevailing boundaries was triggered by the observation of gaps in inter-organizational care. Transformation of the prevailing boundaries was achieved in implementation of the collaborative care agreement tool and the practice of negotiated care. However, the new tool and practice did not expand into general use during the project. The study identifies two complementary models for the development of health care organization in Finland. The 'care package model', which is based on productivity and process models adopted from engineering and the 'model of negotiated care', which is based on co-configuration and the public good.

Accountable to everyone, or to no one? Perspectives on the accountability of Australian private ancillary funds

This thesis explores perspectives on the accountability of Private Ancillary Funds (PAFs), a type of Australian endowed philanthropic foundation. Privately established for a public benefit purpose, with limited formal accountability requirements, there are differing and sometimes conflicting perspectives on the nature and scope of PAF accountability. Through in-depth interviews with managers and trustees of 10 PAFs, forms and relationships of PAF accountability are uncovered. Findings reveal accountability for PAFs does not necessarily include public disclosure or transparency. However, engagement with accountability for a PAF results in greater impact and satisfaction for those involved.

Optimization models for expanding a railway’s theoretical capacity

Changing the topology of a railway network can greatly affect its capacity. Railway networks however can be altered in a multitude of different ways. As each way has significant immediate and long term financial ramifications, it is a difficult task to decide how and where to expand the network. In response some railway capacity expansion models (RCEM) have been developed to help capacity planning activities, and to remove physical bottlenecks in the current railway system. The exact purpose of these models is to decide given a fixed budget, where track duplications and track sub divisions should be made, in order to increase theoretical capacity most. These models are high level and strategic, and this is why increases to the theoretical capacity is concentrated upon. The optimization models have been applied to a case study to demonstrate their application and their worth. The case study evidently shows how automated approaches of this nature could be a formidable alternative to current manual planning techniques and simulation. If the exact effect of track duplications and sub-divisions can be sufficiently approximated, this approach will be very applicable.

Type II beta-turn conformation of pivaloyl-L-prolyl-alpha-aminoisobutyryl-N-methylamide: Theoretical, spectroscopic, and X-ray studies

Pivaloyl-L-Pro-Aib-N-methylamide has been shown to possess one intramolecular hydrogen bond in (CD3)2SO solution, by 1H-nmr methods, suggesting the existence of beta -turns, with Pro-Aib as the corner residues. Theoretical conformational analysis suggests that Type II beta-turn conformations are about 2 kcal mol-1 more stable than Type III structures. A crystallographic study has established the Type II beta-turn in the solid state. The molecule crystallizes in the space group P21 with a = 5.865 Å, b = 11.421 Å, c = 12.966 Å, beta = 97.55°, and Z = 2. The structure has been refined to a final R value of 0.061. The Type II -turn conformation is stabilized by an intramolecular 4 1 hydrogen bond between the methylamide NH and the pivaloyl CO group. The conformational angles are Pro = -57.8°, Pro = 139.3°, Aib = 61.4°, and Aib = 25.1°. The Type II beta-turn conformation for Pro-Aib in this peptide is compared with the Type III structures observed for the same segment in larger peptides.

Theoretical study of the optimum performance of a two-phase flow CO2 gasdynamic laser

Theoretical optimization studies of the performance of a combustion driven premixed two-phase flow gasdynamic laser are presented. The steady inviscid nonreacting quasi-one-dimensional two-phase flow model including appropriate finite rate vibrational kinetic rates has been used in the analysis. The analysis shows that the effect of the particles on the optimum performance of the two-phase laser is very small. The results are presented in graphical form. Applied Physics Letters is copyrighted by The American Institute of Physics.

Pulsatile blood flow in a stenosed arteryâ a theoretical model

Abstract is not available.

Theoretical studies on the conformation of beta-D-N-acetyl neuraminic acid (sialic acid)

The possible conformations of sialic acid were analysed using semi-empirical potential functions. The solid state conformation has approx. 0.2 kcal/mol higher energy than the minimum energy conformation. These studies suggest that in solution sialic acid may exist preponderantly in two different conformations which differ in the orientation of the terminal hydroxymethyl group of glycerol side-chain. The present model is consistent with 1H- and 13C-NMR data, but differs from the earlier models.

Reflective perspectives: Negotiations at and within the borders of cultural difference: A post-qualitative inquiry of cultural hybridity within third space enunciations

This research explores the in-between space of intercultural collaboration between Aboriginal and Torres Strait Islander peoples and non-Indigenous peoples in Australia. Using critical and third space theories and a post-qualitative inquiry, I examine negotiations of cultural difference through articulated moments of intercultural collaboration in order to inform intercultural pedagogical practices. This research also explores how ideology, imbued through discourse, has the power to enforce or challenge cultural and social domination. This in turn creates cultural hegemony, a process whereby a particular social and cultural group has the power to influence the thoughts, expectations and behaviours of a particular society.

Theoretical Maximum Limits on Power-Handling Capacity of HVDC Cables

In the case of an ac cable, power transmission is limited by the length of the cable due to the capacitive reactive current component. It is well known that high-voltage direct current (HVDC) cables do not have such limitations. However, insulation-related thermal problems pose a limitation on the power capability of HVDC cables. The author presents a viable theoretical development, a logical extension to Whitehead's theory on thermal limitations of the insulation. The computation of the maximum power-carrying capability of HVDC cables subject to limits on the maximum operable temperature of the insulation is presented. The limitation on the power-carrying capability is closely associated with the electrothermal insulation failure. The effect of environmental interaction by way of external thermal resistance, an important aspect, is also considered in the formulations. The Lagrange multiplier method has been used to handle the ensuing optimization problem. The theory is based on an accepted theory of thermal breakdown in insulation and is an important and a coherent extension of great significance.

Yhdessä ajattelu ja osallistuminen : Interventiotutkimus yhteistoiminnallisen oppimisen kehittymisestä kahdessa alakoulun pienryhmässä

Participation and social modes of thinking - An intervention study on the development of collaborative learning in two primary school small groups This study explores the thinking together -intervention programme in three primary school classes. The object of the intervention was to teach pupils to use exploratory talk in small group collaboratory learning. Exploratory talk is a type of talk in which joint reasoning is made explicit. Research has shown that exploratory talk can improve mathematics and science learning, argumentative skills and competence in reasoning tests. The object of this study was to investigate the theory of social modes of thinking which the intervention program is based on. I tried to find out how the thinking together -intervention programme suits the Finnish context. Therefore my study is part of an international research project of interventions that have been implemented for example in Great-Britain and in Mexico. One essential drawback in former research made on thinking together -approach is that the nature of participation has not been studied properly. In this study I also examine how the nature of participation develops in small groups. In addition to that I aim to develope a theoretical framework which includes both the perspectives of the social modes of thinking and the nature of participation. The perspective of this study is sociocultural. The research material consists of video recordings of collaborative learning tasks of two small groups. In groups there were pupils of age groups 9 - 11. I study the nature of participation using both qualitative and quantitative methods. Quantitative methods include for example IR-analysis method and counting of turns at talk and words. I also use qualitative content analysis to analyze both the nature of participation and social modes of thinking. As a result of my study I found out that the interaction of the other group was leadership based and in the other group the interaction was without leadership relations. In both groups the participation was quantitatively more symmetrical in the end of the intervention. In the group in which the interaction was leadership based the participation of the pupils was more symmetrical. Exploratory talk was found more in the group without leadership relations, but in both groups the amount of exploratory talk was increased during the intervention. Leadership based interaction was further divided into interaction of alienating and inclusive leadership according to how symmetrical the participation was in the dialogue. Exploratory talk was found only when the leadership was inclusive or the interaction was without leadership relations. The main result of the study was that the exploratory talk was further divided into four subcategories according to the nature of participation. In open and inclusive exploratory talk all group members participated initiatively and their initiatives were responded by others. In closed and uneven exploratory talk some group members couldn't participate properly. Therefore it cannot be said that exploratory talk guarantees symmetrical participation. The nature of participation must be investigated separately.

Reformin implementaatio - Michael Fullanin teoriaan perustuva muutosteoreettisten tekijöiden sisällönanalyyttinen tarkastelu Kelpo-kehittämistoiminnan kunnallisten koordinaattoreiden puheessa

The educational reform, launched in Finland in 2008, concerns the implementation of the Special Education Strategy (Opetusministeriö 2007) under an improvement initiative called Kelpo. One of the main proposed alterations of the Strategy relates to the support system of comprehensive school pupils. The existed two-level model (general and special support) is to be altered by the new three-level model (general, intensified and special support). There are 233 municipalities involved nationwide in the Kelpo initiative, each of which has a municipal coordinator as a national delegate. The Centre for Educational Assessment [the Centre] at the University of Helsinki, led by Professor Jarkko Hautamäki, carries out the developmental assessment of the initiative’s developmental process. As a part of that assessment the Centre interviewed 151 municipal coordinators in November 2008. This thesis considers the Kelpo initiative from Michael Fullan’s change theory’s aspect. The aim is to identify the change theoretical factors in the speech of the municipal coordinators interviewed by the Centre, and to constitute a view of what the crucial factors in the reform implementation process are. The appearance of the change theoretical factors, in the coordinators’ speech, and the meaning of these appearances are being considered from the change process point of view. The Centre collected the data by interviewing the municipal coordinators (n=151) in small groups of 4-11 people. The interview method was based on Vesala and Rantanen’s (2007) qualitative attitude survey method which was adapted and evolved for the Centre’s developmental assessment by Hilasvuori. The method of the analysis was a qualitative theory-based content analysis, processed using the Atlas.ti software. The theoretical frame of reference was grounded on Fullan’s change theory and the analysis was based on three change theoretical categories: implementation, cooperation and perspectives in the change process. The analysis of the interview data revealed spoken expressions in the coordinators’ speech which were either positively or negatively related to the theoretical categories. On the grounds of these change theoretical relations the existence of the change process was observed. The crucial factors of reform implementation were found, and the conclusion is that the encounter of the new reform-based and already existing strategies in school produces interface challenges. These challenges are particularly confronted in the context of the implementation of the new three-level support model. The interface challenges are classified as follows: conceptual, method-based, action-based and belief-based challenges. Keywords: reform, implementation, change process, Michael Fullan, Kelpo, intensified support, special support

Principles to guide sustainable implementation of extended-scope-of-practice physiotherapy workforce redesign initiatives in Australia: Stakeholder perspectives, barriers, supports, and incentives

Sustainable implementation of new workforce redesign initiatives requires strategies that minimize barriers and optimize supports. Such strategies could be provided by a set of guiding principles. A broad understanding of the concerns of all the key stakeholder groups is required before effective strategies and initiatives are developed. Many new workforce redesign initiatives are not underpinned by prior planning, and this threatens their uptake and sustainability. This study reports on a cross-sectional qualitative study that sought the perspectives of representatives of key stakeholders in a new workforce redesign initiative (extended-scope-of-practice physiotherapy) in one Australian tertiary hospital. The key stakeholder groups were those that had been involved in some way in the development, management, training, funding, and/or delivery of the initiative. Data were collected using semistructured questions, answered individually by interview or in writing. Responses were themed collaboratively, using descriptive analysis. Key identified themes comprised: the importance of service marketing; proactively addressing barriers; using readily understood nomenclature; demonstrating service quality and safety, monitoring adverse events, measuring health and cost outcomes; legislative issues; registration; promoting viable career pathways; developing, accrediting, and delivering a curriculum supporting physiotherapists to work outside of the usual scope; and progression from "a good idea" to established service. Health care facilities planning to implement new workforce initiatives that extend scope of usual practice should consider these issues before instigating workforce/model of care changes. © 2014 Morris et al.

The modes of binding methyl-alpha (and beta)-D-glucopyranosides and some of their derivatives to concanavalin A--a theoretical approach

The probable modes of binding of Methyl--alpha (and beta)-D-glucopyranosides and some of their derivatives to concanavalin A have been proposed from theoretical studies. Theory predicts that beta-MeGlcP can bind to ConA in three different modes whereas alpha-MeGlcP can bind only in one mode. beta-MeGlcP in its most favourable mode of binding differs from alpha-MeGlcP in its alignment in the active-site of the lectin where it binds in a flipped or inverted orientation. Methyl substitution at the C-2 atom of the alpha-MeGlcP does not significantly affect the possible orientations of the sugar in the active-site of the lectin. Methyl substitution at C-3 or C-4, however, affects the allowed orientations drastically leading to the poor inhibiting power of Methyl-3-O-methyl-alpha-D-glucopyranoside and the inactivity of Methyl-4-O-methyl-alpha-D-glycopyranoside. These studies suggest that the increased activity of the alpha-MeGlcP over beta-MeGlcP may be due to the possibility of formation of better hydrogen bonds and to hydrophobic interactions rather than to steric factors as suggested by earlier workers. These models explain the available NMR and other binding studies.

Theoretical investigations of the two-bond proton-carbon-13 coupling constants. Angular variations of the couplings involving carboxyl carbon

A formulation has been developed using perturbation theory to evaluate the π-contribution to the nuclear spin coupling constants involving nuclei at least one of which is an unsaturated center. This fromulation accounts for the π-contribution in terms of the core polarization and one-center exchange at the π-center. The formulation developed together with the Dirac vector model and Penney-Dirac bond-order formalisms was employed to calculate the geminal (two-bond) proton coupling constants of carboxyl carbons in α-disubstituted acetic acids. The calculated coupling constants were found to have an orientational dependence. The results of the calculation are in good agreement with the experimental values.