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No description available.

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No description available.

The health care system within the United States is in a state of transition. The industry, confronted with a variety of new technologies, new ways of organizing, spiraling costs, diminishing service quality and new actors, is changing, almost on a daily basis. Reports issued by the Institute of Medicine raise quality issues such as avoidable errors and underuse/overuse of services; other studies document regional variation in care. Improvement in the quality of care, according to health care experts is accomplished through measuring and comparing performance, but there are a number of disparate actors involved in this endeavor. Through a network of both public and private actors, collaboration on the development of a set of national performance measures is underway. Organizations such as the National Quality Forum (NQF), the Agency for Healthcare Research and Quality (AHRQ), the Centers for Medicare & Medicaid Services (CMS) and other have formed networks to develop and standardize performance measurement systems that can distinguish between quality services and substandard ones. While there is some available research about the processes involved in performance measurement system design, there is little known about the factors that influence the development and work of the network, particularly the selection of hospital performance measures. This dissertation explored the development of a national performance measurement system for hospitals, using an institutional rational choice perspective and actor-network theory as frameworks for discussion. Through qualitative research methods such as direct observation, interviews, participant observations and document review, a theoretically informed case study of the NQF's Hospital Steering Committee was performed, to address the following questions: How is a national performance measurement system developed and what is the role of federal agencies (e.g., AHRQ and CMS) in the process? / Ph. D.

Using a Systems Theory approach allows a person to analyze the intertwined elements of the drug development system and the potential influences of the environment. Thomas Hughes's Large Technological Systems (LTS) Theory is one that could be used for this purpose; however, it falls short in its ability to address the complexity of current day regulatory environments. This dissertation provides a critical analysis of Hughes's LTS Theory and his phases of evolution as they apply to the United States (U.S.) system for biologic drug research, development and labeling. It identifies and explains potential flaws with Hughes's LTS Theory and provides suggested improvements. As an alternative approach, this dissertation explores the concept of "techno-regulatory system" where government regulators play an integral part in system innovations and explains why such systems do not always follow Hughes's model. Finally, this dissertation proposes a hybrid version of Hughes's systems approach and uses it to explain the changes that occurred in the drug approval system in response to the push for, opposition, and inclusion of, pediatric research in drug development during the period 1950-2003. / Ph. D.

The Army-sponsored Institute for Soldier Nanotechnologies (ISN) was an entrepreneurial research institute established at the Massachusetts Institute of Technology (MIT) in 2002. Using Science and Technology Studies (STS) concepts from Actor-Network Theory, I study the founding era of this twenty-first century laboratory-based community, from 2002-2007. Actor-Network concepts of enrollment and translation, described by Bruno Latour, and heterogeneous engineering, described by John Law, are used as I 'follow the actors' founding this emergent institution. The operationalization of translation is traced through four case studies, structured around Defense funding constructs and Science and Technology communities: 6.0 Founding the Institute; 6.1 Building Basic Research Networks; 6.2 Shaping Applied Research for Cancer Research and Science Education to include non-users; and 6.3 Student Prototyping Teams Accelerating ISN Research for Traumatic Brain Injuries (TBI). Scientists, engineers, and transitioners partnered in new ways to transition innovative technologies to improve human protection, with soldiers as the first of many users. Using public information, I used qualitative and quantitative methodologies to assess the actor networks and research portfolio changes. These historical case studies extend STS with operationalization of translation and a new dynamic of bi-directional actor enrollment, as research teams transitioned nanotechnologies and prototypes. / Doctor of Philosophy / The Institute for Soldier Nanotechnologies (ISN) was an Army-sponsored entrepreneurial research institute established at the Massachusetts Institute of Technology (MIT) in 2002. This historical study examines the founding era, rarely described for start-up organizations. Science and Technology Studies (STS) concepts of Actor-Network Theory enrollment and translation are traced through four case studies: Founding the Institute; Building Basic Research Networks; Shaping Applied Research for Cancer Research and Science Education to include non-users; and Student Prototyping Teams Accelerating Research for Traumatic Brain Injuries (TBI). The scientists, engineers, and transitioners partnered in new ways to transition technologies to improve human protection, with soldiers as the first of many users. Using public information, I provide qualitative and quantitative methodologies to assess the social networks of actors, as well as the composition and changes in the research portfolio. These case studies show what the ISN members did and how the small teams innovated, operationalizing translation through enrollment, and transitioning nanotechnologies and other prototypes.

Syllabi are an integral part of any college experience and an understanding for how the genre functions on a rhetorical level is an under-researched area in the field of higher education. Using the tools of rhetorical analysis—looking at language and genre structures—I gathered a selection of 25 First-Year Writing syllabi within the Department of English at Virginia Tech to help address this concern of a lack of research. Using qualitative research methods—specifically those dealing with language and genre coding—I worked through my syllabi selection to ascertain how the genre functions rhetorically. Using Mary Louise Pratt's idea of the "contact zone" as well as Rhetorical Genre Theories and Actor-Network Theory, I argue that beginning with an understanding for how the genre of syllabi function rhetorically will also help us understand how the genre can be communicative, in the sense that it sends a message, as well as performative. / Master of Arts / Syllabi are an integral part of any college experience and an understanding for how the genre functions on a rhetorical level is an under-researched area in the field of higher education. Using the tools of rhetorical analysis—looking at language and genre structures—I gathered a selection of 25 First-Year Writing syllabi within the Department of English at Virginia Tech to help address this concern of a lack of research. Using qualitative research methods—specifically those dealing with language and genre coding—I worked through my syllabi selection to ascertain how the genre functions rhetorically. Using Mary Louise Pratt’s idea of the “contact zone” as well as Rhetorical Genre Theories and Actor-Network Theory, I argue that beginning with an understanding for how the genre of syllabi function rhetorically will also help us understand how the genre can be communicative, in the sense that it sends a message, as well as performative.

As a prominent female composer educated at the court of Louis the XIV, Elizabeth-Claude Jacquet de La Guerre already has a notable place in history. Among her compositions are a dozen cantatas based on Biblical texts. As most of her male counterparts primarily composed secular cantatas set to mythological texts, Jacquet de La Guerre’s sacred cantatas stand out as anomalous in the repertoire. Questions arise as to where they were performed and why they were written. The main barrier to this knowledge is the lack of primary sources on her daily life. This study proposes a new methodology to reevaluate Jacquet de La Guerre’s role in developing the French cantata form as a unique genre, further clarify the function and value of her sacred cantatas, and reconsider their place in the canon. Traditional methodologies in historical musicology, though foundational and valuable, by nature obscure relevant insight and appreciation of these works, which defy traditional categorization. To fill in the gaps in primary sources and broaden and deepen our understanding of French sacred cantatas and Jacquet de La Guerre’s work, this study uses Bruno Latour’s Actor-Network Theory, a sociological and philosophical model for describing and assembling information, in combination with Steven Feld’s series of qualitative, ethnographic questions for music evaluation, a sociomusicological and ethnomusicological model introduced in his article “Sound Structure as Social Structure.” In doing so, this study markedly diverges in perspective from traditional musicological and theoretical approaches. The goal of this methodology is to first reexamine Jacquet de La Guerre scholarship as a check for inherited assumptions or unconscious bias in the approach and then proceed with critical inquiry in this fresh space to unpack the function and value of her sacred cantatas. This study sheds light on the relatively rare and currently underperformed sacred cantata form in eighteenth century France, using Jacquet de La Guerre’s sacred cantatas as a case study. It finds that Jacquet de La Guerre’s sacred cantatas were experimental, progressive, and intellectual in form; likely meant for entertainment, edification, and instruction in function; and highly regarded in value. The methodology described and then employed in this study takes considerable strides in reassessing Jacquet de La Guerre’s activity as both a respected intellectual and celebrated composer in early modern France, in highlighting her role in developing the French cantata form, in clarifying the function and value of her sacred cantatas, and in demonstrating how this reassembled knowledge creates more informed and compelling performances of her music. / 2026-09-25T00:00:00Z

IT is often seen as a solution to many problems concerning effectiveness in organizations. Information systems within the healthcare sector is often viewed as medical devices rather than just systems or services. These medical devices are thoroughly regulated by laws, standards and certifications. In this study I participated in an innovative project that aimed to bring new life and use to the old fashioned patient journal by giving it a visual representation through the use of an avatar. I aimed to study the effects of regulators connected with the patient journal as a source of information for the innovative project. I drew upon Actor-network theory as a theoretical lens to trace the patient journal and connect it with regulatory aspects important to innovative projects such as the studied scenario. I also aimed to research the possibilities and obstacles provided with today’s IT-climate in Swedish healthcare. I found that regulatory aspects according to Actor-network theory proved to be an actor that stabilizes the network that is the innovative project. Certain regulatory aspects such as quality management standards provided support for unifying the vision concerning the innovation. Further the regulatory aspects proved to be an actor that can shift power between project developers and external actors. The regulatory aspects did not show any significant effect on the innovation or its original vision. These aspects did however show proof of being a heavy provider of project complexity and experience concerning these aspects was shown to be hard to find. I also found that there are two distinct ways for an innovator to realize a vision within Swedish healthcare, the healthcare way and the patient way, these two ways are represented in a model framework for future research. Last but not least I presented a framework for future IT-architecture based on modern technology and the results found in this study.