As harmful as the financial crisis of 2007-2009 was, some organizations professed some benefits as a result; “we know our risks better,” “we can better manage risks.” Many of the organizations that hailed such positives undoubtedly had what would generally be considered sound risk management systems/practices (RMS). So, what happened? What prevented organizations RMS from perhaps better mitigating risk during the recent financial crisis than was the case? Said another way, “what are barriers to effective risk management?” This study proposes a risk governance framework (RGF) that helps distinguish phases of RMS, and is grounded in Risk principles versus a controls based foundation that many view as part of the current problem with RMS. Based on our survey of 41 Risk Managers (RM) and 96 Regulators (REG), we obtained perspectives on barriers to effective risk management including barriers to effective risk management leading up to the financial crisis of 2007-2009, the importance of Risk principles, and suggestions to improve the effectiveness of RMS. We also obtained RM and REG perspectives of the impacts to RMS from our banking environment providing a type of “insurance,” impacts to RMS due to perceptions of the state of the financial/economic environment, how complete must phases of RMS be, compensation practices and its impacts to RMS, and the notion of quantitative/qualitative methods in current RMS. Leading up to the financial crisis of 2007-2009, identified barriers to effective risk management include a lack of risk culture and under estimating risks. Some suggestions to improve RMS include improving the risk function and developing more dynamic, forwarding looking and preemptive risk management tools and techniques that blend quantitative and qualitative methods. The proposed RGF and the rich context on barriers to effective risk management obtained from our study may help practitioners and academia alike in considering ways to analyze and improve RMS.

African American families of youth with Attention-deficit/hyperactivity disorder (ADHD) traditionally have lower rates of ADHD treatment compared to nonminority groups. These treatment disparities underscore the importance of better understanding the barriers to treatment for these families. Therefore, in a sample of 67 African American caregivers of children with ADHD, the current study examined (1) factors that predict barriers to treatment for African American families of children with ADHD and (2) whether caregiver impairment mediates comorbid behavior problems and barriers to treatment for African American youth with ADHD. Analyses revealed that caregiver impairment predicted barriers to treatment and mediated the relationship between comorbid behavior problems and barriers to treatment. These findings highlight how caregiver impairment may play a significant role in preventing African American families from engaging in ADHD treatment for their child. Furthermore, targeting caregiver impairment in treatment may be particularly beneficial for African American families of youth with ADHD.

The aim of this thesis is to describe perceived barriers and drivers and analyze its impact on the implementation of strategies among food retailers in order to reduce food waste. On supply chain, food retailers are in the powerful position, communicating both consumers and suppliers. Existing literatures and our findings show that food retailers engage mostly in strategies to prevent and re-use food waste. The methodology used in this thesis is qualitative research through single case study design in order to gain valuable insights from food retailers and develop the existing theories. The empirical date is collected through semi-structured interviews with a store manager, the head of logistics and a project manager and environmental ambassador, Karin Bildsten. The findings had formed several learning points. First, in this case the major barrier is lack of resources in financial and knowledge terms in order to implement strategies. Second, consumers have a strong impact on the implementation of strategies, playing both as drivers and barriers. Lastly, environmental consideration of employees is a strong driver as well as positive response from society toward implementing different strategies. This research intended to give inspiration to other researchers into this new field of research. The authors concluded with practical recommendations to food retailers as well as some advices to different stakeholders.

The global problems of climate change, by the emissions of CO2 have over the past decenniums, led to a development of new innovations of renewable energy technologies, with the goal to phase out fossil fuels such as coal and oil. Many forms of renewable energy have already solved part of the energy consumption problems, but there are still large energy intensive industries that rely heavily on fossil fuels. One possible renewable product that could phase out fossil fuels in these industries is the black pellet, which is a processed bioenergy product. If commercialized, the black pellet could change major parts of the industry, thus making it a radical innovation.   One alternative to produce the black pellet is by using the torrefaction technology. The torrefaction technology has a historical record of many failed introductions. The step from pilot production to full scale commercialization is problematic in many ways, especially for a smaller developer. This study is focusing on the external commercialization problems for a radical innovation, the product black pellet and the technology torrefaction. The thesis aim to understand which these external barriers are for a torrefaction developer in Sweden and to answer our research question:   “What is the industry specific external barrier for a new entry-firm to commercialize black pellet with torrefaction technology?”   The theoretical framework is structured in two parts. The first one has a broad focus of theories regarding external barriers for commercialization of radical innovations, with a focus on small- and medium size enterprises. The second part focuses on general effects of industry structure and these two parts are combined in a conceptual theoretical framework. The findings in the study are based on empirical data collected through a total of six interviews with a supplier of torrefaction and black pellet, potential customers and market experts in Sweden.   The study’s analysis combines the theoretical and empirical data together with the industrial chapter, to create an understanding of the external barriers to commercialize black pellet with torrefaction technology. From the analysis we have understood many barriers, which could be summarized in four main barriers; lack of credibility, political incitements, strategic leadership and the costs of commercialization.   The answer to our research question, regarding the industry specific external barrier within the case of torrefaction and black pellet, is that black pellet and especially the torrefaction technology suffers from a lack of credibility by the actors in the market. From this answer, we have contributed with extended theoretical insights, that failures by previous actors create an external barrier for the current and future actors in their commercialization of a new technology.

Generally, immigrants face different challenges adapting to their new environment while starting a new life in the new environment. One of these problems is related to employment as they find it difficult finding jobs in their host countries. A number of them are often jobless or having jobs that do not correspond with their educational qualification. This is one of the factors that influence the earnings of immigrants in the Swedish labour market. This study focused on the factors influencing the underutilization of immigrant’s foreign educational credentials in the Swedish labour market. The study is based on human capital theory, cultural shock theory and discrimination theory. Through qualitative research design, rich detailed data about the phenomenon was collected from participants that participated in the study. Findings of the study revealed that the two major factors that influence the underutilization of immigrant’s foreign educational credential in the Swedish labour market are structural factors and individual factors (lack of social network with Swedish natives, inability to fluently communicate in Swedish, and loss of professional knowledge due to lack of practice).

Classic studies in the Sociology of the Professions have explored knowledge barriers across traditional forms of professionalism, quintessentially represented by medical doctors, lawyers, and university professors. Thus, the impact of distinctive professional identities and communal boundaries on processes of knowledge sharing have been well documented. More recently, however, many scholars have suggested that those classical analyses need to be revisited and reassessed (see for e.g. the recent call for papers of Teelken and colleagues at EGOS 2011, cf. also Evetts, 2006; Noordegraaf, 2007) in the light of three contemporary trends: a changing context of professional practice, the associated erosion of classic forms of professionalism, and the emergence of new forms. While classical studies have laid the foundation of our understanding of the conditions that render knowledge sharing across more established forms of professionalism problematic, the processes and potential barriers across more novel and hybrid forms are less clear (cf. Noordegraaf, 2007). In order to address this gap, this thesis presents a comparative investigation of expert knowledgesharing across professional boundaries in four cross-occupational teams in the English National Health Service; two of them primarily composed of established professionals and two of hybrid professionals. By analysing these two types of cross-occupational teams, this thesis’ contribution is the identification of a different configuration of knowledge barriers affecting the sharing of knowledge within the two forms of professionalism. These findings further highlight the existence of two very different ecologies of (inter) professional knowledge within established and hybrid forms of professionalism. First, distinctive knowledge bases underlie professional practice and interaction in established and hybrid forms of professionalism. For established forms knowledge is more substantive and disciplinary based, whereas for hybrid forms it is general and situated, and characterized by a syncretic use of different disciplines, theories, and information. Second, the types of indeterminacies that permeate the two types of ecologies also vary. While the more established forms of professionalism face higher levels of ambiguity (semantic indeterminacy), the more transient and hybrid forms of professionalism face higher levels of uncertainty (de re indeterminacy). Finally, the nature of professional boundaries is different between these two types. While in established forms of professionalism boundaries are relatively well defined, and hence recognizable; in hybrids forms they are vague and transient.

Bakgrund: Många sjukdomar och behandlingar inverkar på sexuell och reproduktiv hälsa och/eller funktion [SRHF]. Sjuksköterskor [SSK] har ansvar att lyfta detta med patienter, enligt lag samt nationella styrdokument. Patientens rättigheter innefattar erhålla adekvat och tillräcklig information för att delaktigt kunna ta informerade beslut om sin vård. Trots detta uppger SSK och patienter att samtalet inte förs. Syfte: Litteraturöversiktens syfte är att belysa vilka påverkande faktorer SSK upplever i att diskutera sexuell- och reproduktiv hälsa och funktion med patienter. Metod: En allmän litteraturöversikt baserad på sex kvalitativa och fyra kvantitativa artiklar. De analyserades sedan med hjälp av innehållsanalys. Resultat: En kombination av flera faktorer påverkar SSK i att samtala om SRHF. Dessa har identifierats och kategoriserats. ”Rädsla för obekväm stämning” är ett latent tema som genomsyrar resten av de identifierade kategorierna ”Utbildning och självförtroende” ”Någon annans ansvar” ”Attityder till patientens sexualitet” ”Vårdrelationen och vårdmiljön” och ”Kultur och normer”. Slutsats: SSK avsexualiserar patienten som en lättare utväg. Att fortsätta ignorera patienters SRHF kommer inte hjälpa SSK lindra patienters lidande. Klinisk betydelse: Dessa identifierade faktorer är inget nytt. Diskussionen belyser dock nya aspekter av SSK maktroll i frågan. Förhoppningsvis kan litteraturöversikten inspirera till förändring och vidare forskning. / Background: Many diseases and treatments may affect one’s sexual and reproductive health and/or function [SRHF]. Nurses have responsibility raising the subject with patients by law and national guidelines. Patients’ rights include partaking of correct and enough information to make informed decisions regarding treatment. In spite this patients and nurses state the subject is not broached enough. Aim: The aim is to describe what affecting factors nurses’ experience in discussing SRHF with patients. Method: A general literature review based on six qualitative and four quantitative articles. The articles were analyzed through content analysis. Result: A combination of multiple factors affect nurses’ conversations about SRHF. These have been identified and categorized. “Fear of uncomfortable atmosphere” is a latent theme throughout the other categories “Education and confidence” “Someone else’s responsibility” “Attitudes towards patients’ sexuality”. “Care relationship and ward environment” and “Culture and norms”. Conclusion: The nurses’ desexulization of the patient is an easy way out. Ignoring SRHF will not enable nurses to relieve patients’ suffering. Clinical significance: These identified factors are nothing new. The discussion enlighten new aspects of the nurses’ role of authority in this. Hopefully this review may inspire change and further research.

Substance use disorders (SUDs) are often comorbid with other psychopathology such as mood disorders, anxiety disorders, and personality disorders. While some research suggests individuals with comorbid psychopathology are more likely to seek substance use treatment than those with independent disorders, other studies have also shown many individuals with dual diagnoses still never seek treatment. Moreover, few studies have tried to elucidate the underlying structure of SUD treatment rejection, and instead examined it in more simplistic terms. In addition, studies have tended to examine the impact of individual disorders on treatment rejection, but have not incorporated an empirically supported approach to conceptualizing psychopathology in terms of comorbidity between broad latent dimensions referred to as internalizing (e.g., depression, anxiety) and externalizing (e.g., antisocial personality disorder, polysubstance use) psychopathology. Modeling psychopathology in terms of internalizing and externalizing psychopathology is becoming a prominent approach to understanding mental disorders, yet little research to date has investigated the effects these broad dimensions have on SUD treatment rejection. The current study utilized latent variable modeling techniques to (1) determine the latent structure of SUD treatment rejection in a large U.S. sample, and investigate whether treatment rejection is a multidimensional construct; and (2), to explore the ability of internalizing psychopathology, externalizing psychopathology, and personality pathology to predict the SUD treatment rejection factor(s). The current study relied on use of a general population sample of 43,093 individuals from the first wave of National Institute on Alcohol Abuse and Alcoholism's National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) study. Support was found for the hypothesis that SUD treatment rejection would be a multidimensional construct.  Exploratory structural equation modeling indicated a three-factor model best fit the data. Operational definitions and clinical implications of these three treatment rejection factors ("Objective barriers," "Psychological barriers," and "Self-focused barriers") are discussed. Among internalizing psychopathology, externalizing psychopathology, and personality pathology, structural equation modeling identified internalizing psychopathology as the most robust predictor of these three factors for alcohol treatment rejection (n = 1063), indicating endorsement of treatment barriers increased as levels of internalizing psychopathology increased. This pattern also held true for externalizing psychopathology, while personality pathology only negatively predicted objective treatment barriers.  For drug treatment rejection (n = 562), only internalizing psychopathology significantly predicted the treatment rejection factors, indicating treatment endorsement of drug treatment barriers increased as levels of internalizing psychopathology increased. Implications of these findings and directions for future research are discussed.

The Institute of Medicine report of 2011 defined Transgender Specific Health Needs as one of four priority research areas. While there is research asserting that health care providers (HCPs) do not have adequate training in providing competent care to transgender patients, there are no studies to date assessing HCPs' gender identity attitudes and their willingness to learn the Standards of Care (SOC) developed for this patient population. According to the Agency for Health Care Research and Quality, as of 2010, 52% of Nurse Practitioners (NPs) were practicing in primary care settings. As more than half of NPs practice in primary care and transgender patients often initially present their gender concerns to their primary care provider, this study focuses on the NP population. This study describes a sample of NPs' attitudes towards gender variance, as well as their perceived need and interest in learning the SOC as published by the World Professional Association for Transgender Health. Multi-state purposive sampling of NP professional organizations was conducted. Two conservative and two progressive states' professional organizations were included in the sample. The states were randomly assigned within both geopolitical groups to intervention or control with the use of a random numbers table. Comparisons between geopolitical groups and between control and intervention groups cannot be made due to low response rates of all states. The majority of this small sample of NPs agreed that they needed and wanted additional training in transgender health care. Future research with representative sample sizes is needed to better understand provider-sided barriers to caring for this marginalized patient population.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.