China is now the main supplier in the generic pharmaceutical and bulk drugs supply market. The low-cost sourcing of raw materials from domestic manufacturers allows Chinese pharmaceutical companies to be competitive. Purchasing becomes strategic importance to the overall business performance through the implementation of concrete purchasing practices. This thesis is mainly to study the capsule purchasing practices in Chinese pharmaceutical companies. Three objectives are proposed in order to achieve the purpose: 1) Describe the capsule purchasing procedures of the companies; 2) Compare and analyse similarities and differences of their purchasing procedures; 3) Give acceptable reasons for these similarities and differences. These objectives are fulfilled on the basis of the developed van Weele’s purchasing procedure model and the factors integrated in purchasing. In this multiple-case study, qualitative approach is utilized in order to describe and interpret the how and why questions. The unstructured face-to face interviews are used. The study finds that the capsule purchasing strategy in Chinese pharmaceutical companies is at the stage of supply management and this may induct the raw material purchasing strategy in Chinese pharmaceutical industry.

Experiencing trauma in childhood can have a pervasive impact on child development. There is evidence to suggest that non verbal creative therapies aid the processing of traumatic memories and therefore present as a child centred treatment option for children who have experienced trauma. Art therapy is known to be an effective intervention for children who have experienced trauma however the outcomes of delivering art therapy interventions in specific contexts are not yet well researched. The present study sought to investigate the efficacy of school based art therapy as an intervention for children who have experienced psychological trauma. The study explores what areas of adjustment are achievable and how school based art therapy contributes to this adjustment. A multiple case study analysis was conducted to explore the experiences of three pupils who had attended art therapy interventions at their schools. Each case study used semi structured interviews, post intervention, to gather the views of the pupil, art therapist, a member of school staff and the pupil‘s parent / guardian. The data was analysed using thematic analysis and the results are presented as thematic network maps. The cross case synthesis revealed that after attending school based art therapy the pupils demonstrated positive adjustment in a range of areas. The thematic analysis suggested that the pupils had a greater understanding of themselves, increased resilience skills and a belief in a positive future. School based art therapy was found to be a wholly child centred therapeutic experience for the pupils, with the data suggesting that this child centred experience was facilitated by the process of the therapy, the non verbal creative art making and the context of delivery. This study provides the initial evidence to suggest that school based art therapy is an effective intervention for children who have experienced developmental trauma and presents avenues for future research.

Research has shown self-concept to be a significant influence of later success in life, yet studies have rarely focused on the perceptions of students in all educational placements and achievements – specifically, those identified as gifted and with a learning disability (G/LD) (Rudasill, Capper, Foust, Callahan, & Albaugh, 2009). Adopting a qualitative case study approach, and guided by the Marsh/Shavelson model of self-concept (1985) and the Social Identity Theory (1986), this study explored 1) how G/LD students perceive the development of his or her self-concept over time and 2) how labelling and educational placement interact with the development of self-concept. A Body Biography and a discussion/ semi-structured interview were used to explore these questions with eight English-speaking post-secondary G/LD students. During the discussion/ semi-structured interview, participants discussed their completed Body Biography and responded to questions focused on self-perceptions of educational placement, labels, social identity, group membership, and self-concept. Findings of the study revealed that participants tended to perceive the gifted and LD components of the G/LD identification as separate components, rather than as a whole identification; participants appeared to consider themselves as part of a gifted in-group when reflecting upon their strengths and within a LD in-group when reflecting upon their weaknesses; and educational placement experiences exerted a strong influence upon participants’ self-concepts, depending on how well they perceived their educational placement experiences met their academic needs. Overall, the domains of self-concept were very closely related to one another, with academic, social, and emotional self-concepts being the most influenced by identification, labels, and educational placement. The findings from this study support the notion that each G/LD student is unique and there is no singular best method of identification, nor is there one specific educational path that meets the educational needs of all G/LD students.

Many international graduate students serve as teaching assistants at US universities. As teaching assistants, they carry out significant responsibilities such as leading lab sessions, grading student work, holding office hours, and proctoring exams. When these international teaching assistants (ITAs) cross national boundaries to teach at US universities, they may experience significant differences in the educational cultures. Teaching in a new educational culture offers ITAs both challenges and opportunities for growth. To better understand the experiences of this population within engineering, data were collected from seven engineering ITAs using a multiple-case study approach with each ITA representing a case. Data were collected in the form of weekly reflections and in-person interviews at the beginning, middle, and end of the semester, at an R1 university representative of national averages in terms of international graduate student population in the US. The participant pool represented diversity in the form of nationality, gender, prior teaching experience with the same course, and engineering discipline. Data were analyzed using both a priori codes and inductive coding emerging from the data, with particular attention given to experiences specific to engineering. Based on data analysis, codebooks were developed that operationalize ITAs' experiences and navigational strategies in the context of engineering. While illuminating the intersections of ITAs' teaching experiences with their international and GTA identities, the results point to the complexity and variations in participants' experiences based on various social and contextual factors such as gender, cultural background, prior exposure to the English language, prior engagement with the course material, and interaction with the teaching team. The results point to several contributions, and implications for engineering departments and universities, faculty, and ITAs to better engage ITAs in the process of undergraduate engineering education. In terms of contributions, this study uses intersectionality, a critical framework, which accounts for the complexity of engineering ITAs' experiences to provide systematic accounts of their experiences and navigational strategies while illuminating the nuances related to social, cultural, and disciplinary identities. Implications for the engineering departments and universities include creating an educational environment that values the cultural and linguistic diversity brought by ITAs, and collaborating with ITAs to organize training programs that help ITAs strengthen their communication, workload management, and intercultural skills; those for faculty include helping ITAs manage their teaching and research requirements by allowing for flexibility in ITAs' schedules, and treating ITAs as budding colleagues by using ITAs' existing pedagogical knowledge and scaffolding them when needed; those for ITAs include resisting the institutional pressure to "fit" into the US educational norms by using the pedagogical and cultural knowledge they bring from their home countries to better support student learning, and develop students' intercultural skills; and those for undergraduate students include engaging with ITAs to learn the engineering course content and simultaneously develop intercultural competence. / Ph. D.

Psychology researchers have been gathering information regarding the positive effects of forgiveness, demonstrating that they contribute to better overall physical and emotional wellbeing. Individuals who have suffered a transgression can remain in a place of destructive anger and resentment for years. Long-term, these negative states can have deleterious effects emotionally, physically, and socially. Understanding how to help those who are suffering move past their victimization can have a positive impact. It is therefore important to conduct research to better understand forgiveness through the lived experience of individuals who have experienced some form of victimization. Using evolutionary psychology as the theoretical framework, the motivations for revenge and forgiveness become clearer. The goal of this multiple case study was to examine an individual's process of forgiveness and how it was achieved following the experience of a significant transgression. Nine participants agreed to participate in an in-depth semi-structured interview; this purposeful sample of individuals who had suffered either criminal victimization or interpersonal betrayal, and who had gone through the forgiveness process were selected for this study. The data analysis plan followed Braun and Clarke's six-step thematic analysis guide to classify, analyze, and report the themes that emerged from the data collected. The findings highlighted the processes whereby forgiveness is achieved, A total of six themes were identified: forgiveness perspectives, resentments and anger, safety, motivations, mediators, and resilience/personal growth. The most notable mediators in the process of forgiveness among participants were compassion/empathy and receiving an acknowledgement or explanation/sincere apology from the offender. In conclusion, this research attempts to bring about positive social change by supporting practitioners in helping the populations they serve, as well as further other important research on forgiveness.

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Bakgrunn: Det er avdekket at pasienter med komplekse behov og kroniske lidelser har behov for mer integrerte helsetjenester en de har fått. Samhandlingsreformen fremmer at dagens helsevesen må desentraliseres for å gi integrerte tjenester til denne pasientgruppen. Hensikt: Formålet med denne studien var å avdekke hva som er avgjørende for en bærekraftigbehandlingskjede til personer med komplekse og langvarige lidelser. Metode: Forskningen er et multiple case study med to case; diagnosegruppene Schizofreni ogKOLS. Undersøkelsen ble gjennomført i to middels store norske kommuner og deres respektive regionale sykehus. Det ble gjenomført 10 semi-strukturerte intervju med påfølgende innholdsanalyse. Funn fra intervjuene og dokumentanalysen ble triangulert. Resultat: Avgjørende for bærekraftige behandlingskjeder er: Organisasjonsstruktur: Interorganisatorisk behandlingskjede, med minimum nivå av lenket interaksjon, fundamentert på samarbeidsavtale. Interaksjonsnivået og bruk av IP var høyest innen for psykisk helse sektoren. Ingen av behandlingskjedene har multidisiplinære team som har myndighet til situasjonstilpasning avtjenestene; Organisasjonskultur: Det var ett multidisiplinært grenseoverskridende team, som var utenlederstøtte relatert til felles målsetninger og felles styrende idéer og løsning på samhandlingsutfordringer eller fokus på utvikling av helhetlige behandlingskjeder, spesielt fellesoppgavene; Utviklingsmulighet gjennom støttende nasjonal policy og statlige virkemidler; og Utviklingsfokus Det manglet avklaring på lederansvar for utvikling av behandlingskjeder og prioritering av ressurser til utvikling i form av personell, økonomi og tid. Konklusjon: Studien viser at det er avgjørende med adekvat organisasjonsstruktur med samhandlingssoner for både multidisiplinære grenseoverskridende team med tilstrekkelig interaksjonog myndighet til å gi situasjonstilpassede tjenester, og et ledernivå med fokus på lederstøtte for de multidisiplinære teamene. En altruistisk holdning i lederskapet kan bidra til støttende strukturer somfelles styrende ideer og målsetninger. Det er nødvendig med et tydelig fokus på utvikling av tjenester der det er tjenestetomme rom, og spesielt på fellesoppgaver og løsing av samhandlingsutfordringer,.Det er også viktig for behandlingskjedens bærekraft at ledere prioriterer tilstrekkelig ressurser til utviklingen av behandlingskjeder og bruker mulighetene gjennom de statlige virkemidlene.En integrert helsetjeneste er ennå ikke et faktum i de undersøkte behandlingskjedene, men viktige steg er tatt i retning av å oppfylle Samarbeidsreformens målsetning. / Background: Evidence shows that patients with complex and chronic illnesses need greater coordination of their healthcare services. The Coordination Reform claims that health care services must be decentralized to give integrated care to these patients Purpose: This study aimed to determine the crucial factors for sustainable chains of care for persons with complex and chronic diseases. Method: This study was organized as a multiple case study involving two diagnosis groups for schizophrenia and chronic obstructive pulmonary disease. Research was conducted in two mid-sized Norwegian municipalities, each connected to separate regional hospitals. It was conducted 10 semistructured interviews. Findings from interviews and document analysis were triangulated. Result: Integrated chains of care depend on four factors. Organizational structure needed organizational chains of treatment with a minimum level of linked interaction, based on contracts.The level of interaction was higher, and the use of Individual Plans was more common within the mental health sector. In our study, neither chain of care had a mandate to adjust services according tochanging needs. In organizational culture, we identified one inter-organizational team, which lacked necessary leadership support to identify common goals, and lacked governing ideas or leadership to solve the challenges or focus on developing integrated chains of care. Supporting policies andgovernmental incentives enabled development opportunities. Finally, we identified a lack of development focus (i.e., appointed responsibility for the development of integrated health care and the allocation and management of resources for personnel, time, and economy). Conclusion: We determined that an adequate organizational structure for interaction is crucial to creating zones of interaction for multi-disciplinary teams with adequate interaction and authority to adjust health services according to need. We also determined a need for leadership to focus on supporting multidisciplinary teams. Leadership with altruistic attitudes may inspire and strengthen supporting structures such as common governing ideas and goals. When voids exist in the chain of care, clearly focused service development and problem solving is crucial, especially for interorganizational treatment. Sustainability of the chain of care requires leaders prioritize development regarding the allocation of adequate resources, using the possibilities within the national regulations and incentives. An integrated chain of care was not yet in place for the cases studied here, butimportant steps have been taken towards fulfilling the goals of the Norwegian Coordination reform. / <p>ISBN 978-91-982282-1-2</p>

Background: Sweden is the home to many successful startups. The lack of IT-developers causes companies to use offshore outsourcing to realize their ideas. In research, there are studies on what needs to be done to outsource successfully. Researchers and practitioners argue that different perspectives on the impact of success need to be considered. Many studies show that the quality of the partnership relationship between customer and supplier is essential for the success of an outsourcing project. However, there are little studies on how success in outsourcing for a start-up comes about in the pre start-up phase and from which factors this depends. Purpose: This research has the purpose to understand why software startups outsource offshore in the pre-startup phase and how success can be achieved in these outsourcing projects. The partnership relationship has an influence on the success of outsourcing and is influenced by several factors. This research aims to find critical success factors in the pre start-up phase for offshore outsourcing. Method: To find answers to our research questions a multiple case study within 9 Swedish start-ups was conducted. Therefore, we collected all data through semi-structured interviews based on an interview guide. The critical success factors in outsourcing in the pre start-up phase were analyzed using content analysis methods. Conclusion: Our results show that outsourcing was an essential business step for all the examined software start-ups in order to realize their idea. In most cases, tactical reasons like availability of resources and costs savings were why start-ups chose to outsource software development to a provider abroad. The quick confirmation of ideas was another important aspect for some start-ups:  "fail fast and fail cheap". All investigated factors play a role in offshoring success, but communication, which directly influences trust, has the biggest influence on outsourcing success in the pre start-up phase of a firm. All other success factors influence the trust between client and vendor, which has a positive influence on the outsourcing success. It turns out that factors such as performance become more relevant in a more mature phase of the business.

In the modern society, chronic diseases have become the leading causes of death. With early recognition and proper management, however, many of the complications from chronic diseases could be prevented or delayed. Taking such a proactive approach in managing a population often requires the use of team-based approaches and delegation of certain clinical and nonclinical tasks to nonphysician team members. This three-study dissertation used a combination of methods to explore contextual factors that influence primary care teamwork and physician-pharmacist collaboration. The first study quantitatively examined baseline barriers and facilitators of physician-pharmacist collaboration in clinics participating in the Collaboration Among Pharmacists and Physicians To Improve Outcomes Now (CAPTION) Trial. Pharmacist expertise and clinic staff support were found to be the most important facilitators for physicians, while insurance reimbursement and task design factors were important for pharmacists. The second study characterized clinic personnel experience participating in the CAPTION trial and explored determinants of disease state control. Higher proportions of indigent and minority populations and higher baseline pharmacy structure scores were found to be associated with lower blood pressure control. The third study qualitatively examined organizational influences on primary care team effectiveness and the roles of pharmacists in a separate sample of primary care clinics. A lack of organizational rewards for teamwork in primary care was identified and pharmacists were integrated into clinic workflow in various degrees. These findings will be informative for practice managers and health care professionals seeking to redesign their practice to meet increasing needs of patients with chronic diseases.