Global ETD Search

1	Chronic Care Management to Improve Adherence: A Comparison of Approaches in the Care of Diabetes Gervais, Mary Ellen 16 June 2010 (has links) Managing chronic conditions is seen as the public health challenge of the 21st century. The number of Americans with chronic conditions is expected to rise to 157 million by 2020. Diabetes prevalence and costs contribute to the growing problem. Diabetes was the seventh leading cause of death in 2006. Nationally, the cost of diabetes is expected to be $138 billion in 2020. Diabetes leads to multiple and significant complications. The desired outcomes of management of chronic conditions are improvement in clinical status, avoidance of complications, prevention of co-morbid conditions and avoidance of the costs associated with complications. In the 1990s, disease management programs were implemented in an attempt to effectively manage chronic conditions. The primary approach in these programs focuses on individual-level interventions. Despite these efforts, poor outcomes exist. As a result, other approaches to diabetes management are being explored. This study examines a system-level approach to diabetes management versus an individual level one. The system level approach is based on full implementation of the Chronic Care Model, framed in Social Ecology Theory. This retrospective, non-experimental study explores changes in adherence to select diabetes screening guidelines based on the approach to adopted by two health plans. Analyses were conducted on adherence to LDL, A1c, retinopathy and nephropathy screening 2 ½ years after program implementation. In addition, logistic regression analyses were conducted on the predictive impact of approach to chronic care management in relation to changes in adherence. Other variables known to impact health behaviors were factored into the analysis. There were two main findings of the study. The first is that for each of the screenings, there was a statistically significant difference between participants in the two plans. Comparisons of changes in adherence by approach from before implementation to after implementation resulted in a small number of subjects in some cells which can lead to accepting the null hypothesis when it is false. The second is that approach to management was associated with changes in adherence to three of the four screenings. The logistic models, however, account for less than 23% of the variance in adherence, a moderate effect size. Chronic Care Management CCM Diabetes Social Ecology Theory Medicine and Health Sciences
2	Using Ecological Lens to Explore a One-to-one Laptop Program Integration in Classrooms with English Language Learners in an Urban Middle School Turgut, Guliz January 2012 (has links) Thesis advisor: Lillie Richardson Albert / Currently, one of the most popular technology initiatives used in schools to prepare information- and technology-literate students is one-to-one laptop programs. However, limited research studies have investigated factors involved in laptop programs' integration process in schools from various participant perspectives by specifically focusing on ELL students and their needs. Through an ecological lens, this study investigated a one-to-one laptop program integrated into ESL classrooms in an urban middle school, which sustained the program for 6 years. The study included multiple perspectives of various school community members to capture an accurate account of factors necessary for the program's implementation and continuation. This study used a qualitative, single-case research design with exploratory purposes to investigate the multi-level nature of a one-to-one laptop program. Ecology was used as a lens to interpret data and show the relations between living (biotic) and nonliving (abiotic) factors in the program. In-depth data was collected through interviews, classroom observations, field notes, and archives. Collected data were analyzed through constructivist grounded theory using open, axial, and selective coding. The study demonstrated that multiple factors interact with each other and impact the laptop initiative in ESL classrooms. These factors and their interaction were visually represented as a conceptual model. Factors identified in findings were discussed under three main themes: financial, technical and leadership factors. Findings related to financial factors indicated that technical issues increased over the years due to the financial problems, which influenced the instructional use of laptops unfavorably and amplified doubts about the future of the program. Results related to leadership highlighted the importance of having multiple leaderships and allowing the participation of various school members in the decision making process. Results also showed that the federal mandates on achievement influenced the laptop program by changing the vision of the school from teaching with technology to improving instruction and achievement scores on standardized tests. Finally, findings emphasized the importance of including ESL leadership in the laptop program from the very beginning to adjust it to the needs of ESL students. Implications for teachers, administrators, educational researchers, policy makers, and future research are discussed. / Thesis (PhD) — Boston College, 2012. / Submitted to: Boston College. Lynch School of Education. / Discipline: Teacher Education, Special Education, Curriculum and Instruction. ecology theory English language learners middle urban school one-to-one laptop program ubiquitous computing
3	I thought we weren't in Spain : the emergence of authenticity in a foreign language classroom Whitehead, Sarah Jey 01 September 2015 (has links) This study is based upon the idea that foreign language (FL) classrooms exist apart from their target language communities. While historically, this has been a geographic truth, divides between FL learners and native speakers may also reflect symbolic social distance. Given the symbolic, if not geographic, isolation of the FL classroom from the real world, this study presumes that a challenge inherent to the endeavor of FL education is that the authentic, real-world language and culture under study are, by definition, not naturally present in the FL classroom. This study considers how this challenge, referred to as the challenge of authenticity, is managed in one FL classroom. Seven eighth-grade students and their teacher comprise Classroom 204, a beginning Spanish FL classroom at a private school in the southwest U.S. This qualitative case study uses classroom observations, audio-recordings, classroom artifacts, and participant interviews as data to consider not only how authenticity is imported, imagined, and conjured by participants in Classroom 204, but how authenticity is assigned value therein. Data is analyzed largely with discourse analysis of transcripts of classroom talk about (and classroom talk that constituted) various facets of authenticity, value, and the real world. Ecology theory serves as a broad theoretical lens through which to understand (and accept) the complexity inherent to the social phenomena being researched. Benedict Anderson's (1991) theory of imagined communities is adopted to understand the boundaries that delineate the inside of the FL classroom from the outside, and Bourdieu's (1992) notion of symbolic capital is used to understand the ways by which authenticity becomes valuable (and, conversely, how that which is valuable becomes authentic). Findings suggest that, while participants are largely oriented to real-world manifestations of Spanish language and culture, authenticity is not most present in Classroom 204 in the form of stuff imported from elsewhere. Rather, authenticity emerges out of the highly local, socially-immediate interactions and value systems unique to Classroom 204. Suggestions for both pedagogy and future research focus on approaches that acknowledge and capitalize on the power of local authenticity in the FL classroom, as cultivated by local social actors. / text Foreign language education Spanish Discourse analysis Authenticity Imagined communities Ecology theory Symbolic capital Cultural appropriation
4	Salt. Fat. Acid. Heat. Media. Chea, Nila January 2020 (has links) According to Samin Nosrat’s (2017) best-selling cookbook, salt, fat, acid and heat are key to cooking good food. At the same time, the process of making food has never been more connected with media. Given how intertwined food and media are today, I also add media to the list of ingredients. Food has become a popular topic in traditional media, as well as on new digital platforms. Since there is already a large body of research on food media texts, this thesis concentrates on food media related practices in the everyday life and the convergence between traditional and digital food media. For this study, a mixed-method approach was chosen, which included a questionnaire and a subsequent in-depth interview for the participants. The qualitative analysis of the data builds on a theoretical framework which draws first and foremost on Couldry’s (2004) Practice Theory which is complemented by Foth & Hearn’s (2007) Communication Ecology Theory to organize the practices. The food media practices of the study participants illustrated how embedded media have become in everyday practices and explained the convergence between traditional and digital food media. At the same time, the results brought media power dynamics to light and demonstrated that even media, that seems innocent at first, has to be consumed with a critical eye. food media practice theory communication ecology theory everyday life media power Social Sciences Samhällsvetenskap
5	A Case Study Analysis among Former Urban Gifted High School Dropouts Camper, Bradley 01 January 2019 (has links) The dropout social problem has been the focus of researchers, business and community leaders, and school staffs for decades. Despite possessing significant academic high school capabilities, some gifted students drop out of school. The research problem for this study includes, how and why former gifted urban high school students chose to drop out. The conceptual framework for this case study is Bronfenbrenner's human ecology theory. The purpose of this study was to gain an understanding of what lead former gifted urban students to dropping out of high school. Using purposive sampling, 4 participants, two men and two women, were selected for semi-structured interviews. The sample included an African-American, Filipino, Caucasian, and Haitian/Cuban/Syrian, whose ages ranged from 38-77 years old. The semi-structured interviews were analyzed using first, second, and pattern coding. The resulting themes were (a) family discord, (b) school not interesting, and (c) no role model, and (d) minimum family participation. The former gifted high school students' dropout experiences were rooted in the microsystem perspective of the human ecology theory. The implications for social change from this study findings may help inform those who manage and teach gifted programs about the mindsets of students in gifted services. dropouts gifted students human ecology theory microsystem thematic coding Social and Behavioral Sciences
6	Vad är det viktigaste i pojkars utveckling inom fotboll? : Ur ett miljöperspektiv Johansson, Martin, Wahlman, Anders January 2015 (has links) Syfte Syftet med uppsatsen är att försöka få reda på ny kunskap om vad som kan vara den optimala miljön för en fotbollsspelare på pojksidan. Tanken med studien är också att jämföra hur kulturen i Stockholm och Halmstad ser ut gällande prestige, högsta serie, selektering, specialisering, föräldrar, värdering av att vinna i ung ålder, tränarens roll, faciliteter och vad har föreningarna för möjlighet gällande träningstimmar (bilaga 4). Dessa faktorer kan vara avgörande i varje individs utveckling. Frågeställningar Vad är en optimal miljö för en pojkfotbollsspelare att utvecklas i? Vad är skillnaderna och likheterna mellan miljön i Stockholm och Halmstad? Metod Detta är en kvalitativ studie bestående av intervjuer med en semistrukturell intervjuguide. Tre spelare från Stockholm och tre spelare från Halmstad har intervjuats och de svar som framkommit har analyserats och diskuterats med hjälp av tidigare forskning inom ämnena: faciliteter, familj, tränare, filosofi & kultur, skador, status i skola och nyckeln till framgång. Resultat Resultaten visade på att alla individer är olika, och att det som hjälper en person att slå igenom och ta sig till landslaget kanske inte fungerar för en annan. Flertalet intervjupersoner har lyft familjen som den viktigaste faktorn för att de ska ha lyckats, medan andra har lyft fram deras inre motivation som den avgörande faktorn för deras fotbollsspelande. Gällande plantider så fanns det betydligt fler i Halmstad än i Stockholm sommartid, men under vintern så var det Stockholm som hade flest tider och detta berodde på tillgängligheten till konstgräsplaner. Slutsats I studien så har svaren från intervjupersonerna analyserats och mikrosystemet var den delen som ansågs vara viktigast av stegen ur utvecklingsekologin. Då genom att du måste känna en trygghet i den närmiljö du har. Att hela tiden känna att du kan lita på någon och få feedback från dessa personer. Detta kan både fälla eller stärka en spelare. Vissa spelare passar bättre in med mer regler medan andra passar in med fria tyglar. Här gäller det för spelarna att hitta sin egna väg att gå. De andra nivåerna påverkar givetvis också människan, men i den här studien fann vi mikronivån den viktigaste nivån. Tränarlänkfotboll
7	Excise taxation to protect our planet: a point of view from students in the global North : A case from Södertörn University, Sweden Wallenborg, Angelique, Eriksson, Amanda January 2018 (has links) Background: Flying is a mode of travel used mainly by the wealthier part of the planets’ inhabitants, while it is the poor parts of the world that suffer the consequences from climate change the most. Coping with climate change is one of the largest challenges of the century, especially for low-income developing countries. Important stakeholders have realized that it’s a global responsibility to lower the anthropogenic impact on the climate. Political ecology will be used to place the problem with unequal distribution of consequences in a larger context, while environmental economics will be used to examine the flight tax implemented in Sweden on April 1st2018. Purpose: Toexamine student’s attitudes towards excise taxation as an incentive to reduce emissions from air traffic, and whether there was a difference in attitudes between students from different disciplines. Research question: What are Swedish students’ attitudes towards excise tax onflights to reduce emissions? Is there adifference in attitude towards the flight tax depending on the students’ field of studies? Method: Quantitative approach with questionnaire responses as the main empirical data material for analysis. Conclusion: A majority of students participating were positive towards the newly implemented flight tax. Students from an environmental discipline were positive to a greater extent than other students. Flight tax Swedish excise tax Anthropogenic climate change Political Ecology Theory Environmental economics. Social Sciences Samhällsvetenskap Earth and Related Environmental Sciences Geovetenskap och miljövetenskap
8	Social franchising in emerging markets : a multi-perspective approach in the education sector of Pakistan / La franchise sociale dans les marchés émergents : une approche multi -perspective dans le secteur de l'éducation au Pakistan Warraich, Muhammad Akib 20 October 2017 (has links) Cette thèse étudie les principales caractéristiques, le développement, les dimensions sociales, les avantages ainsi que les défis de la franchise dans le secteur de l'éducation au Pakistan. En outre, les résultats de notre étude montrent que la franchise de l'éducation au Pakistan fonctionne essentiellement comme une forme de franchise sociale. L'étude illustre également comment la dimension sociale de la franchise, dans le paysage éducatif pakistanais, est contrebalancée avec le côté commercial de cette pratique. Une approche qualitative multi-perspective a été adoptée. Cela a consisté à mener et à enregistrer 44 entretiens approfondis avec les franchiseurs, les franchisés, les enseignants, les employés du réseau, les parents, les étudiants et les représentants du gouvernement. Les données secondaires ont été collectées sur les sites Web des franchiseurs. Les données ont été transcrites et analysées par NVivo. Nos résultats mettent en évidence un lien entre l'émergence de la franchise sociale et la performance des établissements d'enseignement du secteur public. Nos résultats montrent également que les réseaux de franchises d'éducation au Pakistan ont eu une contribution significative sur le plan social, dans la mesure où, les taux d'alphabétisation ont augmenté et que les inégalités entre les sexes ont été réduites. Cela peut, par conséquent, être considéré comme une forme de franchise sociale. Certaines caractéristiques des réseaux de franchises éducatives au Pakistan sont les mêmes que celles de la franchise dans des secteurs plus traditionnels tels que les hôtels et les restaurants. Il est intéressant de noter que la fourniture de la marque, du transfert de savoir-faire, de l'assistance et de la formation, ainsi que l'uniformité du réseau, ont été aussi importants que dans les secteurs traditionnels de franchise. Les résultats suggèrent par ailleurs que les utilisateurs et le public ont une perception positive de la franchise dans le secteur de l'éducation et cela est considéré comme une meilleure alternative par rapport aux autres options disponibles. / This study investigates the main characteristics, development, social dimensions, benefits and the challenges of franchising in the education sector of Pakistan. Furthermore, it highlights that education franchising in Pakistan is mainly operating as a form of social franchising. The study also discusses how the social dimension of education franchising in Pakistan is counterbalanced with the commercial side of this business. A multi-perspective qualitative approach was adopted. This involved conducting and recording 44 in-depth interviews with franchisors, franchisees, school teachers, network employees, parents, students and government officials. Secondary data was collected from franchisor websites. Data was transcribed and analyzed by NVivo. The findings suggest a link between the emergence of social franchising and the performance of public sector educational institutions. Moreover, findings elaborate that education franchising networks in Pakistan have made a significant social contribution by increasing literacy rates and reducing gender inequalities. Therefore, it can be considered as a form of social franchising. Some characteristics of educational franchise networks in Pakistan are the same as those of franchising in more traditional sectors such as hotels and restaurants. Interestingly, the provision of brand name, transfer of know-how, assistance and training, as well as network uniformity, were found to be just as important as they are in traditional franchising sectors. The findings also suggest that users and public have a positive perception of franchising in the education sector and it is regarded as a better alternative as compared to other available options. Franchise sociale Théorie du capital social Théorie des réseaux sociaux Secteur de l'éducation Marchés émergents Pakistan Qualitative Social franchising Organizational ecology theory Social capital theory Social network theory Education sector Emerging markets Pakistan Qualitative approach
9	A Longitudinal Examination of How Hospital Provision of Home Health Services Changed after the Implementation of the Balanced Budget Act of 1997: Does Ownership Matter? Chou, Tiang-Hong 01 January 2009 (has links) By using a natural experiment approach and longitudinal national hospital data, this study sheds light on the objective functions of hospitals with different ownership forms by comparing their relative reductions in HH provision after the implementation of the BBA. The empirical findings reveal that for-profit hospitals behave differently as compared to public and private nonprofit hospitals, due to their different operational objectives. While the response of for-profit hospitals is consistent with the profit-maximizer model, both public and private nonprofit ownership types behave consistently in accordance with the model of two-good producers whose objective is to maximize market outputs for meeting the health care needs of the community, given the break-even requirement. This finding provides support for the tax exemption the United States government has granted private nonprofit hospitals. Although the response patterns of the nonprofit ownership types are in general similar, this study found that, contrary to expectation, religious hospitals were more likely than secular nonprofit hospitals to have reduced HH provision after the BBA. Further studies are needed to explore the difference in operational behaviors between these two ownership types. Built on previous related studies and applying a more comprehensive set of independent and control variables with improved data sources, this study is able to examine the effects of certain organizational and market factors on hospital offering of HH care pre-BBA and the change in the provision of HH care in the six years following the implementation of the BBA. Hospital proportion of Medicare patients, hospital size, total profit margin, case mix index, elderly density in the market are found to be positive determinants of a hospital’s likelihood of offering HH care. However, these organizational and market factors, in general, play a non-significant role in influencing hospitals’ changes in HH care provision after the implementation of the BBA. In the study, explanations and implications of these finding are discussed. Finally, potential limitations to this study and opportunities for future research are addressed. Hospital Ownership Religious hospital Secular Nonprofit Hospital Objective Function Home Health Care Balanced Budget Act of 1997 Multi-theoretical Framework Resource Dependence Theory Transaction Cost Economics Institutional Theory Population Ecology Theory Weisbrod's Nonprofit Model Policy Analysis Health and Medical Administration Medicine and Health Sciences
10	Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital Lucas, D. Pulane 24 April 2013 (has links) Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures allow a growing number of medical treatments to take place on an outpatient basis. Hospitals face growing competition from ambulatory surgery centers (ASCs). The competitive threats posed by ASCs are important, given that inpatient surgery has been the cornerstone of hospital services for over a century. Additional research is needed to understand how surgical volume shifts between and within acute care general hospitals (ACGHs) and ASCs. This study investigates how medical technology within the hospital industry is changing medical services delivery. The main purposes of this study are to (1) test Clayton M. Christensen’s theory of disruptive innovation in health care, and (2) examine the effects of disruptive innovation on appendectomy, cholecystectomy, and bariatric surgery (ACBS) utilization. Disruptive innovation theory contends that advanced technology combined with innovative business models—located outside of traditional product markets or delivery systems—will produce simplified, quality products and services at lower costs with broader accessibility. Consequently, new markets will emerge, and conventional industry leaders will experience a loss of market share to “non-traditional” new entrants into the marketplace. The underlying assumption of this work is that ASCs (innovative business models) have adopted laparoscopy (innovative technology) and their unification has initiated disruptive innovation within the hospital industry. The disruptive effects have spawned shifts in surgical volumes from open to laparoscopic procedures, from inpatient to ambulatory settings, and from hospitals to ASCs. The research hypothesizes that: (1) there will be larger increases in the percentage of laparoscopic ACBS performed than open ACBS procedures; (2) ambulatory ACBS will experience larger percent increases than inpatient ACBS procedures; and (3) ASCs will experience larger percent increases than ACGHs. The study tracks the utilization of open, laparoscopic, inpatient and ambulatory ACBS. The research questions that guide the inquiry are: 1. How has ACBS utilization changed over this time? 2. Do ACGHs and ASCs differ in the utilization of ACBS? 3. How do states differ in the utilization of ACBS? 4. Do study findings support disruptive innovation theory in the hospital industry? The quantitative study employs a panel design using hospital discharge data from 2004 and 2009. The unit of analysis is the facility. The sampling frame is comprised of ACGHs and ASCs in Florida and Wisconsin. The study employs exploratory and confirmatory data analysis. This work finds that disruptive innovation theory is an effective model for assessing the hospital industry. The model provides a useful framework for analyzing the interplay between ACGHs and ASCs. While study findings did not support the stated hypotheses, the impact of government interventions into the competitive marketplace supports the claims of disruptive innovation theory. Regulations that intervened in the hospital industry facilitated interactions between ASCs and ACGHs, reducing the number of ASCs performing ACBS and altering the trajectory of ACBS volume by shifting surgeries from ASCs to ACGHs. Disruptive Disruptive Innovation Theory Disruptive Transformations Disruptive Innovation Innovation Technology Technological Innovation Medical Innovation Medical Technology Medical Advancement Laparoscopy Laparoscopic Surgery open surgery appendectomy cholecystectomy bariatric surgery weight loss surgery appendectomies cholecystectomies inpatient outpatient ambulatory ambulatory surgery ambulatory surgery center acute care general hospital hospital acute care hospital general hospital health care healthcare hospital industry health care industry Clayton Christensen Clayton M Christensen Michael Porter Harvard Business School Virginia Commonwealth University CMS Health policy public policy public administration organizational theory organization theory Population Ecology Theory Competitive Strategy policy analysis John Kimberly Organization Size Structural Inertia liability of smallness health spending health care cost specialty medical facility open system niche width dynamic outpatient department technology shift surgical setting surgical setting shift medical facility shift substitution threat health system system level analysis Ecological Approach hospital trends ambulatory surgery trends reimbursement rate Medicare CMS coverage decision P J DiMaggio DiMaggio and Powell w w Powell Hannan and Freeman M T Hannan Organizational change minimally invasive surgery less invasive surgery Prospective Payment System Outpatient Prospective Payment System entreprenuerial physician health care organization health care management Roice Luke Carl Ameringer new technology surgical utilization elective surgery Medicare Payment Advisory Commission MedPAC coverage decision trends in surgery abdominal surgery surgical variation physician-owned physician ownership physician autonomy outpatient clinic utilization trends unnecessary surgery Pfeffer Salancik technology diffusion redefining health care interdisciplinary research health care delivery panel design diffusion of hospital technology state variation regional variation local health care market government intervention medical facility health care capacity focused factory advances in health care physician organization relationship hospital competition medical specialization hospital expansion medical arms race integrated care integrated health system J E Wennberg health care transformation reimbursement scheme surgical volume Florida Wisconsin policy making health policy analysis competitive dynamics center of excellence intervening factor service line competition service-line competition surgical reimbursement innovative business model innovative technology environmental influence established firm new market entrant patient safety sophisticated technology Harvard Divinity School Social and Behavioral Sciences

Search results