This thesis explores the Rapid Recommendations process, a new responsive way of creating clinical practice guidelines. / Healthcare workers rely on clinical practice guidelines to inform their practice. However, most guidelines are not trustworthy when judged by accepted standards and they typically take several years to produce. Guideline trustworthiness is undermined by panel members who often have conflicts of interest, by including representation from only a subset of stakeholders, by failing to examine the entirety of the evidence systematically, and by rapid obsolescence. Further, they are often difficult for users to understand in limited time. Rather than updating guidance on a fixed schedule, the Rapid Recommendations approach involves continuous monitoring of the literature and produces guidelines in response to new potentially practice-changing evidence. A collaborative network of clinicians, methodologists, and patients respond by rapidly producing trustworthy evidence syntheses and guidance. We have identified efficiencies at every step of the guideline development process. The guideline panel does not include anyone with a financial conflict of interest and there are strict limits professional and intellectual conflicts. Systematic reviews are produced on the relative effects of each option, on prognosis, and on patient values and preferences with the explicit intent to inform the question at hand. The panel also considers practical issues. Rapid Recommendations are published in a concise multilayered user-friendly format headed by an interactive infographic that contains all of the necessary information for users need to make informed decisions at the point of care. The guideline is published simultaneously in print and electronically, including decision aids that can be used at the point of care and integrated into electronic medical records. In this thesis, you will find a selection of exemplary publications relevant to the Rapid Recommendations process. We show that a responsive approach to rapid and trustworthy guideline creation is possible. It represents a way forward from the current limitations that plague most current clinical practice guidelines. / Thesis / Candidate in Philosophy / Healthcare workers often decide what to do in practice based on the advice of experts through clinical practice guidelines. However, most clinical practice guidelines are not completely trustworthy. Guideline authors often have conflicts of interest, do not include patients or patient views, and are created so slowly that they rapidly fall into obsolescence. This thesis explores a new way of developing clinical practice guidelines that we call Rapid Recommendations. Instead of creating them on a fixed schedule (i.e., every few years), they are created in response to new studies that might change practice. The scope is limited, and timelines are shorter, meaning that the guidelines are published sooner. The guideline authors include all stakeholders, including patients. None of the authors have any financial interests in the topic, and other conflicts are minimized. The guidelines are published on an expedited basis and in an accessible online multilayered format with infographics. This thesis includes a selection of exemplary publications relevant to the Rapid Recommendations process.

Trustworthy clinical practice guidelines assist health care professionals in selecting the management options that optimize patient health outcomes. The development of trustworthy guidelines requires the consideration of many aspects and the involvement of multiple contributors, often working in groups. The guideline panel plays the key role in the development process as it is responsible for prioritizing topics that should be covered as part of the guideline effort, formulating questions, reviewing the evidence, developing and agreeing on the recommendations, and endorsing the final guideline document. Ensuring transparency throughout the process by appropriately organizing and documenting panel activities is an essential standard that is used to assess the credibility of a developed guideline and its resulting recommendations. The adoption of conceptual frameworks that systematically guides panel members in their decision-making process (e.g. the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision (EtD) frameworks) can aid in the formulation of methodologically sound recommendations. In this dissertation, I used the example of a guideline on diagnosis and treatment of autism spectrum disorders to describe how rigorous research methods can support guideline panels in the development process from early stages to the formulation of recommendations. In another prominent guideline development effort with the American Society of Hematology, I have identified two steps in the process where panel members may benefit from further support and addressed these gaps by conceptualizing and developing novel approaches. The first approach comprises modelling baseline risk estimates for patient-important outcomes when only surrogate data is available. The second approach proposes a method to estimate decision thresholds for judgments on health benefits and harms using the GRADE EtD framework. While these approaches are tailored to address specific guideline panel needs, guideline methodologists could use the underlying concepts to find solutions to aid guideline panels in other steps of the development process. / Thesis / Doctor of Philosophy (PhD) / Clinical practice guidelines assist health care professionals in selecting management options that can best improve the health outcomes of their patients. The development of trustworthy guidelines is a complex process that requires the contribution of several entities. The guideline panel, which typically comprises different experts (clinicians, patient representatives, experts in research methodologies) plays the key role in this process as it is responsible for selecting the most important questions to address in the guideline, reviewing the evidence supporting an option, agreeing on the recommendations, and endorsing the final guideline document. To ensure that the process of developing guidelines is transparent and that the recommendations are credible, it is important that panel activities are well documented and follow rigorous methods. Structured frameworks, such as the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision (EtD) approach, have been developed to systematically guide the panel members and to minimize the error that could be introduced while making decisions. In this thesis, I describe the development of an approach and its application for comprehensive guideline development by the Italian National Health Institute, to describe rigorous guideline development and propose two novel approaches to further assist panel members in enhancing their guideline development. The first of these two enhancements to guideline development describes how to derive a modelled estimate of the risk of having certain health conditions when this data is not directly available in the medical literature. The second of the two enhancements is a method to support guideline panels in judging how substantial the desirable and undesirable effects of health interventions are. Both approaches were tailored to fit specific needs but can be adapted to inform the improvement of other steps in the guideline development process.

Advancements in computer technology are making video conferencing a viable communication medium for desktop computers. These same advancements are changing the structure and means by which information workers conduct business. From a human factors perspective, however, the study of new communication technologies and their relationships with end users presents a challenging research domain. This study employed two diverse research approaches to the problem of reduced video frame rate in desktop video conferencing. In the first study, a psychophysical method was used to evaluate video image quality as a function of frame rate for a series of different scenes. Scenes varied in terms of level of detail, velocity of panning, and content. Results indicate that for most scenes, differences in frame rate become less detectable above approximately 10 frames per second (fps), suggesting a curvilinear relationship between image quality and frame rate. For a traditional conferencing scene, however, a linear increase in frame rate produced a linear improvement in perceived image quality. High detail scenes were perceived to be of lower quality than the low detail scenes, while panning velocity had no effect. In the second study, a collection of research methods known as ethnography was used to examine long-term use of desktop video by collaborators in a real work situation. Participants from a graduate course met each week for seven weeks and worked on a class project under one of four communication conditions: face-to-face, 1 fps, 10 fps, and 25 fps. Dependent measures included interviews, questionnaires, interaction analysis measures, and ethnomethodology. Recommendations are made regarding the utility and expense of each method with respect to uncovering human factors issues in video-mediated collaboration. It is believed that this research has filled a significant gap in the human factors literature of advanced telecommunications and research methodology. / Ph. D.

No / The chapter interrogates the teaching and application of management consultancy as part of an MBA and examines its relevance in management education. Mature and experienced students, many with impressive CVs recording multiple career successes, demand that the core experience of their MBA programmes provide opportunities apply theoretical knowledge in real-life situations. The further opportunity to work with blue-chip clients on projects of strategic importance to the client offers further opportunities to test management thinking and consultancy practise in a robust and challenging manner. Students often have experience of working with consultants previously, but most have little experience of managing and delivering projects for clients within a consultancy framework. The pedagogical challenge is to teach students the true value proposition in consultancy beyond the transactional relationship inherent in answering a question set by the client. The basic process approach moves students from considering consultancy as a phenomenon that ‘happens’ to a client with a solution magically appearing upon project conclusion, to a position where students recognise consultants as a true ‘change agent’, unfreezing clients from previous positions and realising new capabilities (Lewin, 1951). There is an examination of ensuring the relevance of the management consultancy approach to students as part of their MBA journey as well as relevance to the client companies in engaging with the University. There is discussion on how teaching the right approach to management consultancy project management and research-orientated methodology retains the focus on the performance of the client organisation (Applebaum and Steed, 2005). There is consideration of how true impact on client companies is achieved by ensuring legacy forms part of expectation management (Kirk, 2000) with client companies keen to reengage with future MBA student teams. The chapter concludes with a reflection on future development of consultancy within management education, including syllabus co-design with consultancy clients.

Yes / OBJECTIVES: In the English National Health Service, the patient's vital signs are monitored and summarised into a National Early Warning Score (NEWS) to support clinical decision making, but it does not provide an estimate of the patient's risk of death. We examine the extent to which the accuracy of NEWS for predicting mortality could be improved by enhanced computer versions of NEWS (cNEWS). DESIGN: Logistic regression model development and external validation study. SETTING: Two acute hospitals (YH-York Hospital for model development; NH-Northern Lincolnshire and Goole Hospital for external model validation). PARTICIPANTS: Adult (≥16 years) medical admissions discharged over a 24-month period with electronic NEWS (eNEWS) recorded on admission are used to predict mortality at four time points (in-hospital, 24 hours, 48 hours and 72 hours) using the first electronically recorded NEWS (model M0) versus a cNEWS model which included age+sex (model M1) +subcomponents of NEWS (including diastolic blood pressure) (model M2). RESULTS: The risk of dying in-hospital following emergency medical admission was 5.8% (YH: 2080/35 807) and 5.4% (NH: 1900/35 161). The c-statistics for model M2 in YH for predicting mortality (in-hospital=0.82, 24 hours=0.91, 48 hours=0.88 and 72 hours=0.88) was higher than model M0 (in-hospital=0.74, 24 hours=0.89, 48 hours=0.86 and 72 hours=0.85) with higher Positive Predictive Value (PPVs) for in-hospital mortality (M2 19.3% and M0 16.6%). Similar findings were seen in NH. Model M2 performed better than M0 in almost all major disease subgroups. CONCLUSIONS: An externally validated enhanced computer-aided NEWS model (cNEWS) incrementally improves on the performance of a NEWS only model. Since cNEWS places no additional data collection burden on clinicians and is readily automated, it may now be carefully introduced and evaluated to determine if it can improve care in hospitals that have eNEWS systems. / This research was supported by the Health Foundation. The Health Foundation is an independent charity working to improve the quality of healthcare in the UK. This research was also supported by the National Institute for Health Research (NIHR) Yorkshire and Humberside Patient Safety Translational Research Centre (YHPSTRC).

The Mackenzie Delta region of Northwestern Canada is a dynamic environment that is ecologically and culturally significant. This region is experiencing rapid environmental change that is expected to worsen with continued climate warming and additional anthropogenic stressors. In northern regions, conventional environmental monitoring strategies can be hindered by complex and cost prohibitive logistics. In this context of environmental change and uncertainty, there is a critical need to draw on traditional ecological knowledge (TEK) and observations to inform decision-making. In some areas changes in land cover are occurring so rapidly that maintaining an accurate inventory is problematic. Knowledgeable land users are in a unique position to assess changes in regional environmental conditions and inventory cumulative impacts. Environmental decision-making in the Inuvialuit Settlement Region requires Inuvialuit participation in several co-management bodies. The objectives of this project were to develop and field-test a community-based monitoring program that shares Inuvialuit observations with stakeholders in environmental decision-making in a standardized and accessible format. Working with the Hunter and Trapper Committees of Aklavik, Inuvik, and Tuktoyaktuk, the Inuvialuit Joint Secretariat, and the Cumulative Impacts Monitoring Program we (1) adapted a participatory photo-mapping (PPM) method to record Inuvialuit observations of environmental conditions using a strategy consistent with community goals and Inuvialuit culture. In the summer of 2010, we worked with knowledgeable Inuvialuit hunters and land users to document Inuvialuit observations of environmental conditions using digital cameras and hand held GPS units. Subsequently, digital photographs and video footage became the focus of photo-elicitation interviews, which added a detailed narrative to each geo-referenced observation. Following fieldwork and interviews, geo-referenced photos, video, and associated text files were entered into web-based map. Approximately 150 observations were mapped and grouped into 33 themes. Interviews with monitors and a range of potential map users suggest that web-based mapping is an effective way to record and share observations and concerns related to the regional environment. We found that PPM could be very useful for northern researchers, decision-makers, and planners because it can facilitate knowledge transfer among stakeholders, facilitate community consultation, and contribute to environmental impact assessment and monitoring strategies. Our experience suggests that by providing a record of the location and magnitude of anomalous environmental conditions, this monitoring initiative will contribute northern planning and decision-making, and the communication of TEK and observations among northern stakeholders. Overall, this research highlights the effectiveness of using the web-based PPM tool to document and share Inuvialuit observations. A monitoring program built around TEK and observations that are linked to geo-referenced images (and other media) will significantly improve our capacity to detect the impacts of environmental change. (1) Because chapters 2 and 3 were co-authored, plural was used throughout the entire document. / Graduate

abstract: Human experience exists within space; it is the studio for the stories of our lives. Bounded by time, location and personal experience we assign our own meanings and feelings to them, and they become personal, symbolic places: some are unique to us, imagined places where we act out stories or dreams; most are part of the natural world. Most spaces, though, are built or controlled by others; these constructed environments can become places where we may, or may not, like to be. This research examined spaces and places of children's lives through the material worlds of their neighborhoods and schools, focusing on the visible environment outside of the school building. The intersection of school and community, it is a material embodiment of, and evidence toward, how a community's resources are apportioned to important aspects of children's developmental years. These visible representations speak of that society's values and goals for the children for whom they (we) are responsible. This examination used multiple research tools, primarily using visual approaches such as current photographs, archival images and data, descriptive census materials and maps. Historical documents, (many of which are now digitized), as well as other academic literature, local journalistic efforts and school district publications added important materials for analysis. Findings lead to deeper understanding of ways that visible, material worlds of schools and neighborhoods -- past and present - can reflect, and direct the experiences of childhood today, and often mirror those of children past. These visual and narrative approaches contributed to understanding the importance of material evidence in revealing inequity and class differences in ways that children, then, must &ldquodo school &rdquo / Dissertation/Thesis / Doctoral Dissertation Educational Psychology 2014

This dissertation examines the research methods that were used by doctoral students in Public Administration from the period 2000 to 2005. In order to identify the research methods used, it first looked at the purpose of doctoral research in Public Administration. It further identified ten research methods that can be used by doctoral students in Public Administration. When presenting the findings on the purposes of research it was found that 50% of the theses were descriptive and 30% were aimed at developing or improving administrative technology. Three categories were mainly used as units of analyses, namely interventions, organisations and institutions and social actions and events. The units of observations included individuals, official documents and scholarly literature. Of the ten research methods, only four were mostly used; Quantitative1, Hermeneutics, Qualitative1 and Qualitative2. This dissertation also identified that a significant association either exists or do not exist between the chosen variables. / Public Administration / M.A. (Public Administration)

<p>PROBLEM DISCUSSION: Vaggeryd is a small municipality Småland. In addition to its</p><p>strategic position along the main traffic route E4, Vaggeryd is very interesting also because</p><p>of its advanced view on growing of the business sector, in both short and long-term per-</p><p>spective.</p><p>To meet that goal the municipality of Vaggeryd started to invest in “Egenföretagareutbildningen”</p><p>EFU in cooperation with Jönköping International Business School (JIBS). The</p><p>main idea is that students attend the courses that are held by JIBS and during their studies start their own business in a local business incubator called Fenix.</p><p>PURPOSE: To host such education requires a huge amount of energy and resources from</p><p>the municipality, which consequently would like to get answers to questions like “Is it worth investing in the education?” or “What are the results of such education?”</p><p>The aim of this paper is to give the answers to those crucial questions though I believe that</p><p>the time that has passed from the beginning of the education is too short and that the</p><p>number of the students was not large enough to get definitive answers.</p><p>This paper concentrates on a narrow part of the qualitative research methods – an inter-</p><p>view. It is divided into two parts, a theoretical part and the empirical findings.</p><p>FINDINGS: The research showed that six students out of a total of ten from generation 2005 started a new venture, three will take over a family business, and one has not decided</p><p>to start a business yet. Of six students in generation 2003 four have started a business and one of them finished in bankruptcy, one plans to start a business in the future and one does not have a good business idea.</p><p>RECOMMENDATIONS: Answers that the interviews returned gave interesting sugges-</p><p>tions to both the municipality of Vaggeryd and JIBS about how to improve EFU. I would</p><p>emphasise two, I believe, the most important recommendations. First municipality has to</p><p>attract neighbouring municipalities in the EFU project. In addition, a greater effort should be made to help students build a spider’s web of business contacts.</p>

The prevalence of neurodegenerative disease in India is rising. Regenerative medicine (RM) is being developed to treat these conditions. However, despite advances in RM application for neurological disorders (NeuroRM), there is a lack of research on clinical translation of NeuroRM technologies in developing countries. Given that India is one of the first nations to translate in this field, much can be learned on challenges and solutions arising during translation. This study identifies stakeholders involved in such translation and outlines roles of each; it describes India’s regulatory environment concerning NeuroRM translation; and discusses the impact of collaboration in clinical translation. Twenty-three face-to-face interviews with clinicians, researchers and policy-makers within India were undertaken and transcripts subjected to thematic analysis. The study demonstrates that clinical translation of NeuroRM within India is taking place robustly, it identifies barriers and good practices being adopted, and provides recommendations based on participants’ experiences.