Blended/hybrid learning, a combination of face to face and online learning to deliver instruction, is growing in popularity at institutions of higher education, and may lead to many benefits for students, faculty, and administrators. However, the implementation of blended learning (BL) is a complex process. Although the move towards BL adoption is generally accepted by faculty, questions still remain when it comes to adopting and implementing standards across institutions. Given this problem, this integrative literature review was conducted to identify possible factors that impact the process of implementing BL smoothly and successfully at higher education institutions. The purpose of this study was to identify related institutional factors from empirical studies published from 2000 to 2020. Findings from this study may offer institutions a guide to effectively create, execute, and assess BL programs and courses. The study provides recommendations that may be impactful for decision-makers at Saudi higher education institutions. / Doctor of Philosophy / Blended/hybrid learning, a combination of face to face and online learning to deliver instruction, has become popular at universities because it provides advantages for students, faculty members, and the university itself. However, the implementation of blended learning (BL) is a challenging process, and in many instances there is not enough guidance available to assist universities through the process. For this reason, this study has been conducted with the goal of identifying possible factors relating to implementing BL smoothly and successfully at universities. Findings from this study may offer institutions a guide to effectively create, execute, and assess BL programs and courses. The study provides recommendations that may be impactful for decision-makers at Saudi universities

Implementation and uptake of novel and cost-effective medicines can improve patient health outcomes and healthcare efficiency. However, the relative uptake of new medicines recommended by the National Institute for Health and Care Excellence often lags behind other comparative countries’ health systems. One example is the uptake of direct oral anticoagulants (DOACs) for stroke prevention in atrial fibrillation, which was slow and had a high level of unexplained variation across different health economies in England. This research aimed to explore barriers and enablers to the uptake of DOACs from the perspectives of patients, healthcare professionals, and key stakeholders by conducting systematic and narrative reviews and semi-structured interviews. Data collected from 21 patients, 23 healthcare professionals, and 23 key stakeholders recruited from three different health economies was analysed using the Framework method. The findings identified a range of intersecting factors acting as barriers and/or enablers to the uptake DOACs. While there were a wide range of experiences and views, an agreement between patients and healthcare professionals/key stakeholders on several identified factors was observed. Attributes of the innovation, characteristics of patients and prescribers, local health economy readiness for change, implementation process, and external health system context were suggested as influences. Mapping of the findings to the Diffusion of Innovations in Service Organisations model identified 11 components for a future toolkit development to facilitate uptake of nationally recommended new medicines. This thesis highlighted the role of patients, consideration of all costs associated with new medicines, and compatibility with the health economy’s care model impact on the uptake.

As a response to the increased awareness of digital banking together with the Covid-19 pandemic, digital banking has emerged as a true contender to traditional banking in Malaysia. Digital banking services (DBS) serves as a technological advancement to enhance the usefulness and access of all banking features. In order to successfully implement DBS, the awareness of customers’ personal attributes is of significance. Therefore, this study contributes by zooming in on young customers in Malaysia and investigates their intention to use DBS in general as well as highlighting differences between the two specific core banking services deposit and loan. To assess this, the research adopts a quantitative deductive approach, building a conceptual framework upon previous technology adoption theories such as Technology acceptance model (TAM), Diffusion of innovation (DOI) and Unified theory of acceptance and use of technology (UTAUT). Furthermore, data was collected through a survey answered by 432 Malaysian students in Kuala Lumpur and analyzed through PLS-SEM and MGA.  The study found five significant drivers directly or indirectly influencing the intention to use DBS. While some of these drivers had been tested previously, the study developed a fresh constellation of drivers which to the best of the authors’ knowledge had not been tested previously. The analysis demonstrates distinct differences in the relationships between drivers for digital deposit and loan services. Overall, these results provide valuable insights for financial institutions seeking to enhance their digital banking offerings and cater to the preferences of young customers in Malaysia.

A comprehensive literature review was undertaken in order to define and assess the sustainability and resiliency characteristics associated with grass-based and confinement dairy farming. Primarily as a result of reduced input costs, grass-based dairy farming often enhances profitability over confinement systems, especially on small farms. Further, conversion of tilled soil to permanent pasture has been shown to significantly reduce harmful sediment and nutrient transport into waterways. Perennial forage also acts as a carbon sink, curtailing or even negating a grass-based farm's carbon footprint. Finally, social benefits derived from enhanced nutrition and higher quality of life are also associated with grass-based dairy farming. Given that policy goals of the State of Vermont include both bolstering farm viability and reducing farm-related runoff, two questions are then raised. What is the most effective way to incentivize the adoption of rotational grazing in Vermont? And what types of farms are best suited to its use? A series of interviews with dairy experts and farmers was conducted as a preliminary investigation into these questions. This qualitative evidence suggested that farmers generally adopted grass-based dairying after observing a peer's success with the method, suggesting that a key leverage point may be peer-based learning. A behavioral economics game was developed to evaluate the role of peer networks in facilitating decision-making under conditions of uncertainty. A computerized game platform simulated networks of small dairy farm enterprises, with participants acting as farm managers. Treatments varied the size of peer networks, as well as the inclusion of a perfectly-performing automated 'seed player.' Participants could base their decisions upon the successes of their peers. They received a cash incentive based on their farms' performance. Results indicated that players with higher numbers of peers made better economic decisions on average. The inclusion of a 'seed player' within a network, which modeled the ideal behavior, also facilitated better decision-making. Both of these correlations were statistically significant. Furthermore, the shape of the 'diffusion curve' of new adoptees confirmed literature on the dynamics of innovation diffusion. Public policy implications from this work include an increased focus on facilitating peer-to-peer learning among farmers where Best Management Practice adoption is a policy goal. To further evaluate the potential for peer learning to facilitate positive change, the Dairy Farm Transitions Agent Based Model (DFTABM) was developed. The model was calibrated using existing datasets along with the qualitative and quantitative results described above. It forecasts effects on farm profitability, attrition, and soil loss arising from varying assumptions about peer network connectivity, peer emulation, macroeconomic trends, and agri-environmental policy. Nine experimental treatments were assessed. Overall, it was found that high rates of emulation coupled with high rates of connectivity'especially targeted connectivity among smaller farms'yielded the best balance of farm viability and reduction in soil loss. The establishment of a performance-based tax credit had no clear correlation with the resulting soil loss figures predicted by the model. Policy implications from this study include the finding that direct payment schemes for reduction in environmental harm may not always have their intended effects, whereas policies that enhance peer-to-peer learning opportunities, especially among the proprietors of smaller farms, may present an effective and relatively affordable means by which to bolster farm profitability while also reducing environmental degradation.

Despite a Presidential Order in 2004 that launched national incentives for the use of health information technology, specifically the Electronic Health Record (EHR), adoption of the EHR has been slow. This study attempts to quantify factors associated with adoption of the EHR and Computerized Provider Order Entry (CPOE) by combining multiple organizational theories and empirical studies. The study is conducted in two phases. The primary phase of this study identifies and evaluates the effects of external environmental and internal organizational factors on healthcare organizations to adopt the EHR. From secondary data, twelve IVs (df=19) are chosen based on existing models and literature. Logistic regression is used to determine the association between the environmental factors and EHR adoption. The secondary phase of this study examines the adoption of five variations of CPOE using the same IVs from phase one. This EHR component of CPOE is chosen due to its promotion as a solution to help cross the quality chasm (IOM, 2001). Secondary data are analyzed and logistic regression is used to quantify the association between the factors of EHR adoption and CPOE adoption. Eleven of the twelve IVs are significant between the two phases (p<.1). This study uses data from 2009 because the HITECH Act was passed that year and significant government incentives were offered for those health care organizations (HCOs) that meet the qualifications of meaningful use. This study serves as a baseline for future studies, extends the work of other empirical studies, and fills a gap in the literature concerning factors associated with the adoption of the EHR and specific dimensions of CPOE. The Kruse Theory developed is strongly based in literature and reflects complexity commensurate with the health care industry.

Artificial intelligence (AI) continues to gain traction and is increasingly reshaping the media and marketing communications field. While significant research has been conducted on the impact of AI in other fields, there is little empirical evidence on how AI is affecting the customer journey. The present study explored both organizations’ current use of AI tools and how customer perceptions about AI affect AI usage and adoption through the lens of diffusion of innovation theory. The research was conducted using mixed-method qualitative research. In-depth interviews and a case study content analysis were conducted to collect and analyze the data. The results suggest that consumer perceptions about AI impact levels of adoption when AI is recognized, but there appears to be cognitive dissonance regarding what constitutes AI and complicit acceptance of some of its benefits. Companies in different geographical locations have different levels of AI adoption along the diffusion of innovation stages.

O presente trabalho tem como objetivo apresentar o resultado da análise e identificação de padrões e comportamentos de postagens na rede social Twitter monitorando um termo específico em um período definido de tempo. Após a extração e tratamento dos dados obtidos do Twitter, explicitando dentre as postagens quais são oriundas de usuários geradores de notícias, foram analisadas informações de topologia da rede de usuários do experimento, inclusive com o detalhamento das informações de propagação e duração das postagens: dados e comportamentos os quais buscamos reproduzir utilizando simulação por agentes / The present work aims to present the result of the analysis and identification of patterns and behaviors of Twitter posts monitoring a specific term in a period. After the extraction and treatment of the data obtained from Twitter, emphasizing among the posts which are generated from news agency users, were analyzed the topology information about the network of users of the experiment, including details of propagation information and duration of the posts: data and behaviors that we seek to reproduce using agent simulation

No contexto dos sistemas complexos, o presente trabalho investiga 3 estratégias de precificação:(1)desnatação,(2) penetração e (3)aprendizado, na difusão de carros elétricos em diferentes contextos.Por meio da modelagem baseada em agentes com 100.000 entidades autônomas, o primeiro modelo testa três situações relacionados à demanda energética:(1)desabastecimento,(2)estabilidade e (3)crescimento moderado da demanda.A forte escassez de energia estimulou a rápida migração dos agentes aos carros elétricos. As três estratégias de precificação exibiram resultados similares em termos de faturamento e % na participação do mercado, no entanto a estratégia de penetração foi capaz de capturar uma parcela maior do mercado em menor tempo.No segundo modelo,3 diferentes comportamentos sociais são aplicadas aos agentes: (1)conservador,(2)racional e (3) social,em diferentes proporções afim de avaliar a influência da composição social na dinâmica difusora.No que concerne ao faturamento e % na participação do mercado, o segundo modelo detectou diferenças estatisticamente significativas para cada estratégia de precificação.Em sociedades proeminentemente conservadoras, as três estratégias não apresentaram indícios de diferença significativa no tocante relação ao faturamento,% na participação final do mercado e taxa de adoção média.Sociedades compostas majoritariamente por agentes racionais, apresentaram a mais rápida convergência aos carros elétricos,sendo este, o veículo mais caro.Isto se deve à percepção positiva do custo/benefício ao longo prazo.O maior faturamento é proveniente das sociedades compostas preponderantemente por agentes com atitudes sociais dado à compra e troca mais recorrente entre diferentes veículos no decorrer das interações.A estratégia de desnatação demonstrou maior versatilidade ao exibir performance superior com maior regularidade no que tange em faturamento em todas as composições sociais testadas.A estratégia de penetração exibiu índices maiores em taxa de adoção e faturamento em redes compostas integralmente por agentes com comportamentos sociais iguais,mas não foi possível detectar este padrão em redes parciais. Por fim, a estratégia de aprendizado apresentou o menor faturamento em todos os cenários, no entanto, sua taxa de adoção similar à estratégia de penetração, pode ser a estratégia de precificação mais crível e eficiente para empresas iniciantes / In the context of complex systems,the following research investigated 3 pricing strategies:(1)skimming,(2)penetration and (3)learning, at electric car diffusion in several different scenarios. Through the agent-based modelling with 100.000 autonomous entities, the first model tested 3 situations related to energy demand:(1)severe shortage,(2)stability and (3)moderate growing of demand. The strong shortage of energy forced an fast-paced migration of agents towards the electric cars. The 3 strategies showed up similar results in terms revenues and market share, however the penetration strategy was able to capture a large part of the market faster than others. At the second model, 3 different social behaviors were implemented in each agent:(1)conservative,(2)rational and (3)social,in different proportions in order to assess social composition and its influence in the innovation diffusion process. Revenue and market share as concerned,the second model detected significant statistic difference for each pricing strategy. For societies predominantly conservative, all strategies did not show significant differences evidences regarding to revenue,market share and average adoption rate. Societies comprised mostly of rational agents presented the quickest convergence to electric cars, which it is the most expensive car. This is because a positive perception of benefits over cost in the long term.The largest revenue were derived from societies primarily composed of agents with social behaviors due to recurrent purchase and exchange between different vehicles over the interactions. Skimming strategy demonstrated greater versatility by displaying superior performance more regularly in terms of revenue in every social composition simulated. Penetration strategy exhibited highest rates of adoption and revenue in social networks composed entirely of agents with same social behavior, but it was not possible to detect such pattern at partial social networks. Finally, the learning strategy reported the lowest revenues at every scenario, none the less, its rate of adoption was equivalent to penetrations strategy rates, this strategy could be the most feasible and efficient to startups and small companies

Pulse oximeters are low-cost, easy to use, and effective at detecting hypoxemia (low blood oxygen levels), a common complication of bronchiolitis, asthma, and pneumonia, the leading infectious cause of death in children worldwide. However, pulse oximeters are often unavailable in lowincome settings, and if available, often underused, yet little research investigates why. In this thesis, I examine pulse oximeter implementation in low-income settings, focusing on Kenyan hospitals as a case study, and using a mixed-methods approach. I conducted a systematic literature review, examining how pulse oximeter use with children at admission to hospital impacts health outcomes; I then conducted quantitative analyses of 28,000 children admitted to seven Kenyan hospitals to determine with which children pulse oximeters are used, and pulse oximetry's impact on treatment provision; these analyses informed the qualitative research component, for which I conducted interviews with 30 healthcare workers (HCWs) and staff in 14 Kenyan hospitals and employed theoretical frameworks to determine how HCWs decide whether to use pulse oximeters, and the barriers to pulse oximetry. I found that pulse oximeter use varies substantially between and within Kenyan hospitals over time. After adjusting for case-mix and signs of illness severity, HCWs were most likely to use pulse oximeters with children with a very high respiratory rate, indrawing and/or who were not alert; children who obtained a pulse oximeter reading were more likely to be prescribed oxygen than if a pulse oximeter was not used; and children with a reading below 90% were more likely to be prescribed oxygen than those with higher readings, suggesting that HCW decision-making is influenced by international and national guidelines. However, HCWs sometimes cannot use pulse oximeters when they intend to, because of insufficient pulse oximeter availability, largely due to inefficient and confusing procurement processes and repair delays. Furthermore, HCWs sometimes use pulse oximeters incorrectly or misinterpret their results, because of insufficient training. Pulse oximeter promotion programme planners can use the recommendations I provide to effectively target barriers to pulse oximeter uptake in low-income settings. Increased pulse oximetry implementation could enable early detection of hypoxemia, improving accurate diagnosis, and supporting prompt, effective treatment, which could help reduce mortality in children needing oxygen, in line with Sustainable Development Goal 3.

As fístulas broncopleurais habitualmente decorrem de procedimentos cirúrgicos de ressecção pulmonar por diversas etiologias, com incidência na literatura de 0% a 28%, e mortalidade de 16% a 72%, sendo mais frequente em homens, e nos casos de pneumonectomia do que em lobectomia. As deiscências totais de coto brônquico apresentam indicação de tratamento cirúrgico, porém a condição clínica destes pacientes geralmente é precária com alto risco anestésico e cirúrgico. Os tratamentos endoscópicos de fístulas broncopleurais até então descritos foram utilizados apenas em fístulas parciais menores que 8 milímetros. Objetivo: Este estudo propõe-se a avaliar a viabilidade do tratamento endoscópico de fístulas totais de coto brônquico utilizando o dispositivo oclusor de defeitos septais cardíacos Occlutech-Fígulla®. Casuística e métodos: Foram incluídos pacientes com fistula broncopleural total secundária a ressecção pulmonar. Os pacientes foram submetidos inicialmente à broncoscopia para avaliação e medida da fístula e a uma cintilografia pulmonar de inalação para documentação do padrão inicial de vazamento. A colocação do dispositivo foi feita através da broncoscopia realizada sob sedo-analgesia com o paciente em ventilação espontânea com suplementação de oxigênio. Os pacientes foram acompanhados durante 12 meses e avaliados quanto à cobertura do dispositivo por tecido cicatricial, fechamento do trajeto fistuloso e desenvolvimento de complicações relacionadas como o deslocamento do dispositivo, lesões de estruturas adjacentes e desenvolvimento de infecção. As análises descritivas dos dados quantitativos com distribuição normal foram apresentadas através das médias acompanhadas dos respectivos desvios padrão. Os dados sem distribuição normal foram apresentados através de suas medianas com os respectivos intervalos interquartil 25-75%. A análise inferencial utilizou a Análise de Variância de Medidas Repetidas para os dados com distribuição normal e os testes não-paramétricos Anova de Friedman para os dados que não apresentavam distribuição normal. Foi considerada uma probabilidade de erro do tipo I (alfa) de 0,05. Resultados: Foram selecionados nove pacientes com predomínio do sexo masculino (77,8%), com média de idade de 45 ±11,1 anos, com ressecções motivadas em sua maioria por sequelas de doença infecciosa (78%), com predomínio de pneumonectomia direita (66,6%), com fístulas que apresentavam diâmetro de 6 a 17 mm. Do grupo de 9 pacientes tratados tivemos três casos de fechamento completo, dois casos de fechamento parcial, duas falhas sendo uma por deslocamento e retirada do dispositivo e outra por retirada ao término do período de seguimento com permanência dos sintomas e dois óbitos não relacionados. Durante o período de acompanhamento não evidenciamos complicações infecciosas ou lesão de estruturas adjacentes relacionadas à permanência do dispositivo. Conclusão: O dispositivo para tratamento de defeitos do septo atrial pode ser uma alternativa no tratamento endoscópico de fístulas totais de coto brônquico, funcionando como tratamento definitivo em alguns casos e servindo como suporte nos pacientes que aguardam melhora das condições clínicas para uma intervenção cirúrgica tardia com menor risco. Não foram detectados eventos graves como infecções ou lesão vascular relacionados à presença do dispositivo / Bronchopleural fistulas are possible complications following lung resection procedures for different etiologies. The reported incidence is 0 % to 28%, and the related mortality is 16% to 72%. More frequently in men and pneumonectomy cases than lobectomy cases. Total dehiscence of the bronchial stump should be treated by surgical interventions; however, the clinical status of these patients is generally poor with high anesthetic and surgical risks. Endoscopic treatment of bronchopleural fistulas previously described were used only in 8mm or smaller partial fistulas. Objective To evaluate the endoscopic treatment of total bronchial stump fistulas using the Occlutech - Fígulla®, a device used to close cardiac septal defects. Patients and methods: We select patients with total bronchial stump fistula. Patients underwent bronchoscopy for local fistula evaluation and an inhalation lung scintigraphy for the initial leak parameter documentation. The placement of the device was made by bronchoscopy performed under sedation - analgesia with the patient in spontaneous ventilation with oxygen supplementation. Patients were followed for 12 months and assessed for scar tissue coverage device, fistula closure and development of related complications such as displacement device, adjacent structures lesions and infection. The descriptive analysis of quantitative data with normal distribution were presented through the mean along with the related standard deviations. Non-normal distribution data were presented by their medians with their respective interquartile ranges 25-75 %. The inferential analysis used Repeated Measures Analysis of Variance for data with normal distribution and non-parametric tests of Friedman ANOVA to data with nonnormal distribution. It was considered an error probability of a type I (alfa) 0.05. Results: This study evaluated nine patients with a males predominance (77.8% ) with mean age of 45 ± 11.1 years with resections for sequelae of infectious disease (78%), predominantly right pneumonectomy (66.6% ), with fistulas diameter ranging from 6 to 17 mm. The group of 9 patients had three cases of complete closure, two cases of partial closure, two failures one per displacement and removal of the device another for withdrawal at the end of follow-up with persistence of symptoms and two unrelated death. During the follow-up period was not detect complications such as infections or injury to adjacent structures related to the device. Conclusion: The device for treatment of atrial septal defects can be an alternative to the endoscopic treatment of total fistula bronchial stump, functioning as definitive treatment in some cases and serving as a support for patients awaiting improvement of clinical conditions for a later surgical intervention with lower risk. No severe events were detected as infections or vascular injury related to the device