Patients who have chronic diseases are often readmitted to the hospital within 30 days of being discharged. In the United States preventable hospital readmissions cost approximately $12-$17.4 billion annually. The Institute of Healthcare Improvement [IHI] has identified one key measure for reducing preventable readmissions and that is a timely post hospital follow-up visit. Although this seems to be a simple task, studies have revealed that as many as one-third of patients discharged from the hospital are not following up with their primary care provider. In North Dakota the percentages of patients with chronic diseases such as heart failure, chronic obstructive pulmonary disease, type 2 diabetes, and pneumonia have steadily increased over the last several years. A North Dakota critical access hospital report revealed a high percentage of patients with a chronic disease are being readmitted within 30 days. Identifying barriers to care in North Dakota can help to reduce the rate of readmission within the state. This study seeks to identify perceived barriers as observed by primary care nurse practitioners to improve patient outcomes and reduce hospital readmission rates.

Background: Procurement as a main part in supply chain management is supported through information technology traditionally. With the usage of Internet and e-commerce technologies, procurement is experiencing a revolution from a conventional paper-based process to e-procurement. E-procurement is increasingly becoming recognized due to its abilities to improve the management of business operation, which in supply chain allows organizations to take use of Internet source to procure indirect and direct materials, and handle value-added service such as quality validation. However, although e-procurement solutions are adopted by many industries currently, no previous study is about e-procurement adoption in Swedish food companies. Purpose: The purpose of this thesis is to study the adoption of e-procurement from the perspective of Swedish food wholesalers. Through exploring the e-procurement adoptions with the aspects of benefits, strategies and barriers in three food wholesale companies, similarities and differences in these three aspects are analyzed to find the current situations in e-procurement adoption settings in Swedish food wholesale companies. Method: This thesis was conducted by using qualitative semi-structured interviews, and a deductive approach. Both primary and secondary data are collected. Three sampling examples are involved in for a multiple and holistic case study. Conclusion: Through the study of this thesis, the most important benefits with e-procurement adoption that Swedish food wholesalers can perceive include planning control, time savings and cost savings. With e-procurement solutions, accurate data information can better forecast demands of customers. However, cost savings could only be achieved obviously after adopting e-procurement more than three years. Almost all food wholesale companies use both direct and indirect purchases with e-procurement adoption. Also, independent portal or online trading communities are not the mainstream for food wholesalers. Swedish food wholesalers play the role in both buy-side and sell-side, and webshops are owned by all of them. As for e-procurement approach, wait and see approach with e-procurement adoption are more attractive for Swedish food wholesalers from a strategic perspective. Aggressive approach could be used for the food wholesale companies that are in development stage. After researching, the most serious barriers for Swedish food wholesalers could be low assurances with problems such as suppliers standards, services or delivery capabilities, two or more systems with overlapped functions, and unstable e-procurement systems.

<p>It is said that eco innovation is the future of Europe’s competitiveness and by that Swedish companies face an exciting opportunity within the field of clean tech. This industry is expected to continue growing worldwide but Swedish companies still have a low export rate even though they have great potential due to their advanced technology. The purpose of this paper is to study the development of firms marketing strategies regarding product-market scope and differentiation and the impact of external conditions. The study will concentrate on the development of Swedish clean-tech firm’s marketing strategies in the U.S.</p><p>How the perception of competition is impacting entrant firms’ market strategies has been scrutinized with help from a model developed by the authors based on perception of barriers and incumbent’s market strategies.</p><p>The findings derived from three case companies claim that there is a relationship between the perception of barriers and incumbent’s market strategies on entrant firms’ market strategy. This implies that relying on advanced technology is not enough to become successful in new markets and that a successful market strategy is dependent on more than the product itself. The entrant firm must consider its situation and its options with help from their knowledge about barriers and incumbent’s market strategies.</p><p> </p><p><strong>Key words:</strong> Strategy, clean tech, barriers, product/market scope</p> / Svenska miljöteknikföretags marknadsexpansion

9 pp. / Termites are considered Arizona's number one urban pest. All termites can be placed into 3 broad categories based on their habitat: damp-wood, dry-wood and subterranean. In Arizona, damp-wood and dry wood termites are not major wide spread problems but can be under selected conditions. Subterranean termites on the other hand are considered one of our major urban pests. Detection of the presence of termites in many cases can be difficult to do. A discussion of construction practices is presented to keep termites from invading your home. Control technologies such as a pre and post-treatment using a termiticide, physical barriers and baiting systems are presented.

Problem: There is a lack of knowledge about women who are screened for breast cancer, have an abnormal finding on mammogram, and then do not return in a timely manner for diagnostics and treatment. Lack of follow- up likely constitutes delayed treatment and poorer outcomes. Delays may result in later entry into the health system with advanced disease, more extensive and expensive care, burdening resources. Late stage breast cancer likely results in poorer health outcomes or early death.Purpose and Aims: The purpose of this research is to describe contextual characteristics at the health delivery level as well as individual characteristics of women with abnormal mammography, and their association with use of follow- up health services. Particularly, this research examines the differences between women who are early and late responders after an abnormal mammogram.Population: The participants were a convenience sample of 380 women who participated in mobile breast cancer screening. A subset of women with inconclusive or abnormal mammogram findings was the focus of analysis.Methods: This research utilized a descriptive design with quantitative data collection through participant survey at mobile mammogram screening events in multiple urban and rural Arizona sites. Participants requiring further health care were followed by chart review. Analysis of correlations with the outcome variable: time to first follow- up appointment for recommended health care in women with abnormal mammograms was conducted.Findings: Data indicated the time to the first follow- up appointment ranged from 1- 110 days with follow- up for 77.4% of participants within 60 days, 6.5% within 60-90 days, and 16.1% without follow- up after 90 days. Significant relationships between contextual and individual characteristics and follow- up were found. Categories included organizational health system characteristics of geographic location, clinical breast exam and shared case management; individual characteristics of beliefs including value of health care; finance including out of pocket costs and perceptions of financial assistance; perceived needs including breast symptoms; and satisfaction with the last health visit and mammograms in general.Implications: Recognition of barriers to follow- up after breast cancer screening is important for development of interventions to improve outcomes and has implications for screening and treatment management programs, community health centers and private practice. Health disparity related to screening without adequate options for access to health care is ethically untenable. Nurses are well positioned to reduce barriers to health care.

According to the policy on Inclusive Education, teachers are increasingly expected to play a community and pastoral role in order to, in this way, be able to measure up to the needs of learners who are experiencing barriers to learning (such as, for example, self-mutilation). This study was undertaken to determine what knowledge and skills teachers have at their disposal to identify self-mutilators in inclusive classrooms and to provide basic aid to these learners. By means of a literature study, self-mutilation was elucidated, and attention was paid to an explanation of what exactly self-mutilation involved, the forms of self-mutilation, the causes of self-mutilation, self-mutilation and related conditions, and the characteristics of the self-mutilator. Linked to this, the focus was on the extent to which the teacher is capable of identifying self-mutilators in inclusive classrooms and providing basic aid to them. Focus was also placed on the community and pastoral role of the teacher, the teacher’s experience of inclusive education, and the National Strategy with regard to the Screening, Identification, Assessment, and Support of learners who experience barriers to learning. A full description of various therapeutic approaches and aid programmes that can be undertaken with self-mutilators concluded the literature review. This literature review indicated a gap regarding the availability of training programmes for South-African teachers without training or background knowledge of Psychology, to assist them in identifying self-mutilators and providing basic aid to self-mutilators. Quantitative descriptive research was used to gather data from teachers by means of a questionnaire with open and closed items. In this particular study, 319 teachers were purposively and randomly chosen from 16 secondary schools (eight Ex Model C schools and eight Township schools) from Districts D2 and D12 in the Krugersdorp/Roodepoort area of the Gauteng Department of Education. On the one hand, the questionnaire determined teachers‟ knowledge and skills with regard to the nature of, reasons for and characteristics of self-mutilation in inclusive classrooms, and whether they possessed skills to provide basic aid to self-mutilators. On the other hand, it was also determined by means of open questions how the teachers become aware of self-mutilators, the type of training they received to provide basic aid to self-mutilators, what they viewed being the influence of self-mutilation on teaching and learning and on emotional and social development, their views of the pastoral role of the teacher as well as what their attitude/view was with regard to the possible implementation of a training programme to identify self-mutilators in inclusive classrooms and to provide basic aid to them. Furthermore, the open questions explored the availability of support structures to teachers to assist them in identifying self-mutilators and providing basic aid to these learners, as well as the opportunities that teachers create for learners to talk about their problems. Results indicated that the teachers who took part in the study did not have adequate knowledge and skills at their disposal regarding the identification of, and provision of basic aid to self-mutilators. They were however in favour of the implementation of a training programme that would enable them to identify self-mutilators and provide basic aid to them. On the basis of the data obtained through the questionnaire, and in accordance with the literature, a training programme was developed. In the absence of training programmes for the support of teachers in the identification of, and aid to self-mutilators in South African schools, this study makes a distinct contribution. / PhD, Educational Psychology, North-West University, Vaal Triangle Campus, 2012

Aim and research question: The aim of this study is to investigate how high skilled foreign intellectual individuals are integrated in the job market in Gävle city. The research questions are: How does the job situation for foreign born graduates look like in Gävle city today? What factors and barriers affect the integration of high skilled foreign born graduates on the job market in Gävle city? Method: In our study the data was collected by open questionnaires and interviews as well as from different databases. The respondents consisted of foreign born graduates, politicians, representatives from the private and public sector. Although the data collection was mostly of qualitative nature some quantitative tools are used in this study such as charts and pie charts to give a more common view of the sampled group’s responses. The way we choose to work on the study was in an deductive manner as we started out in observations and later try to explain them with theory. When trying to find these theories we used textbooks and scientific articles to gather explanations by different authors.Results and conclusions: Our main findings where that the main barrier for the employers towards foreign born graduates is failure to communicate with them because of culture crash. The second most common barrier named by employers is the language. The third most common problem is related to contact networks. From the graduate point of view the first thing they name is lack of information as their biggest problem. The second most common problem for graduates is the language and the third most common problem they name discrimination which according to us is an effect of culture crash. Our conclusion and recommendation is that to help employers seeking qualified personal, and to help foreign born graduates to look for the right jobs, i.e. encourage these two streams to meet. There is work needed to be done in two directions the employers need to be informed with more relevant information about cultural background of foreign born graduates and for the public sector to provide better orientation to the foreign born graduates in the Swedish system. We have through our respondents learned that there indeed exists a level of brain waste. The theoretical implication from this study is that the research adds to strengthen existing theories. When talking about culture, according to the respondents it is important that an employer has a knowledge of diversity. Culture and language has been confirmed as barriers towards the job market by all respondents. The study also confirmed factors which hinders integration of foreign born graduates to the job market. These factors are: Hazards, disadvantages and integration containing lack of information, lack of guidance, proper job seeking tools, stereotypes and discrimination. The study shows a low priority of social integration among the foreign born respondents, versus learning the Swedish language and looking for jobs in Gävle city.   Key words: integration, job market, barriers, culture, language, foreign, Sweden

Telemedicine delivers healthcare between geographically separated locations using medical expertise supported by communication technology. Physicians and specialists from one site can provide diagnosis, treatment and consultation to patients at a remote site. This makes the use of telemedicine particularly affective in rural and remote areas that have limited access to healthcare services. This study identifies the factors that affect the use and adoption of telemedicine in developing countries and rural areas in general, taking the Hashemite Kingdom of Jordan and the Syrian Arab Republic as cases studies. We have developed two guideline frameworks to be applied to telemedicine projects at the pre- implementation phase. The main purpose of the guideline frameworks is to assess the readiness of the Jordanian and Syrian health care system to use telemedicine and to assist any healthcare provider who is considering implementing a telemedicine project in either of these two countries. The guideline framework can be transferred and applied to any other country for which similar circumstances apply. Our guideline frameworks are based on interviews with key stakeholders including doctors, technicians, engineers, and decision makers, and administering questionnaires to further key stakeholders including patients, ensuring that we gain opinion from people from different backgrounds and with different roles in the healthcare system. Our research has identified specific key issues which inhibit the use of telemedicine: poor technology infrastructure; lack of funding; lack of IT education; insufficient training for clinicians; doctors’ resistance; patients’ resistance; and lack of knowledge about healthcare and technology. This work provides a clear idea of the current readiness in both countries and proposes two guideline frameworks that will aid the use of telemedicine. Their dissemination will create awareness and spread knowledge, which will help the decision makers to appreciate the potential role of telemedicine and help them to facilitate the process of introduction and so spread telemedicine in both Jordan and Syria.

The purpose of this study was to identify perceived barriers to faculty participation in distance education courses in a 4-year university. The literature review was divided into four general areas, each of which may act as a barrier to faculty participation; training, administrators, rewards/compensation, and faculty characteristics/demographics. The research population consisted of 570 faculty and 59 administrators from the eight UNT schools/colleges. Dr. Kristin Betts developed the survey instrument in 1998 for similar research conducted at the George Washington University. Analysis of the collected data revealed that there was no statistically significant relationship found between faculty characteristics and faculty participation in distance education. Faculty participants and administrators disagreed on which factors, from a list of 34 items, had motivated faculty to participate in distance education. Nonparticipants and administrators disagreed on which of the factors, if not available, would be barriers to faculty participation in distance education. Participants and nonparticipants disagreed regarding the level to which selected rewards and compensations had motivated faculty to participate, and the lack of which would inhibit faculty participation in distance education. Finally, 71% of the participants had participated or planned to participate in distance education training compared to only 33% of the nonparticipants. It is obvious that administrators and faculty do not place the same level of importance on motivational or inhibiting factors that may affect faculty participation in distance education. These results indicate that additional research should be accomplished to determine the basis for the disagreement among the three groups.

Heart failure (HF) is a chronic condition affecting older adults. It is estimated over 5.8 million Americans are currently diagnosed with HF, with an anticipated increase to seven million by 2030. HF patients are faced not only with the physical symptoms, but also with emotional tolls, and socioeconomic burdens related to HF. Low income and rural facilities, which lack financial resources, are at greater risk for closure if there are concerns of loss of reimbursement. Hospitals are now challenged to prevent readmissions and to avoid penalties associated with HF admission within the 30-day window. Incorporating various interventions have shown improvements in readmission rates. Nurse practitioners and registered nurses can serve as patient educators regarding topics such as diagnoses, procedures, disease monitoring, medications, and medication side effects. In most hospitals, RNs at patients' bedside are at the forefront of providing HF patients discharge instructions and education, which should include symptom recognition and management. The aim of this project inquiry was to assess the knowledge of HF education and perceived barriers to providing HF education by nurses and nurse practitioners, such that improved transition of care for patients in the rural health setting can occur.