It is important to have well-trained and qualified laboratory professionals. Seventy percent of patient care is based on decisions made from laboratory results, yet there is a growing shortage of medical technologists. Although some baby boomers are delaying retirement, worsening of the shortage crisis is inevitable. Retention of medical technologists has become more important than recruitment. The purpose of this study was to identify and evaluate innovative retention strategies used by clinical laboratory managers throughout the United States. A significant finding of this study was the lack of qualified medical technologists entering the ranks of laboratory managers. This study identified a need for a more defined career path and more recognition of the importance of laboratory scientists. It is recommended that studies be undertaken to examine the opinions of hospital and medical group practice administrators as well as the view of medical technologists regarding retention strategies that are proven to be effective.

The Academic Pathway to Teaching (APT) licensure was introduced in 2016 to expand the supply of teachers in Utah. Since then, there has been no formal evaluation of the licensure or the teachers teaching with an APT license. The goals of this study were to explore the effects of the APT licensure on teacher turnover in Utah and to analyze how mentoring experience and teacher self-efficacy were related to the attrition of this population of teachers. This mixed-methods study used data from the Utah State Board of Education to calculate rates of teacher turnover of APT candidates (N=456) for each cohort and school year from 2016-17 to 2017-18. In addition, a survey was sent to current and previous APT candidates with questions on mentoring, self- efficacy, and opinions of the licensure. By their second year of teaching, 41% of the 2016-17 cohort had left teaching in Utah or moved schools. The 2017-18 cohort had a teacher turnover rate of 16%. Although analyses of variance of survey items found no relationship between self- efficacy and attrition, they did find that APT candidates who were still teaching had significantly more frequent and impactful mentoring experiences. Furthermore, data from the open-ended survey responses supported these findings and identified another variable related to the success of APT candidates: previous teaching experience. Although this study is limited by a small survey respondent group of APT candidates who had left teaching (N=13), the implications of this research can shape inform policy decisions regarding alternative certification in Utah.

This dissertation investigates the consequences of supply chain disruptions in pharmaceutical supply chains. Across different studies, I examine various impacts of pharmaceutical supply chain disruptions on buyer’s behavior, medication errors, and market share. In Chapter 1, coauthored with Anita Carson, Erin Fox, and Rena Conti, we demonstrate the stockpiling behaviors of buyers during the early phase of the COVID-19 pandemic. Leveraging a quasi-experimental design on IQVIA’s National Sales Perspectives™ data, we show that the sales volume of essential medicines related to U.S. hospital-based COVID-19 treatment concentrated only for the first two months of the pandemic. After these two months, the sales volume of drugs for COVID-19 treatment decreases significantly despite a nationwide increase in COVID-19-related hospitalizations. In Chapter 2, coauthored with Anita Carson and Rena Conti, we examine the impact of a hurricane that decimated the factories of major producers of heparin, an important drug used frequently in hospitals. Using a natural experiment, we find that the hurricane-related pharmaceutical supply chain disruption increased medication error rates of heparin. In addition, we find significant spillover effects. The supply chain disruption increased the medication error rates of a substitute drug. In Chapter 3, coauthored with Anita Carson and Rena Conti, we study how long it takes to recover the market share after the supply chain disruptions using a new metric we propose, Time to Recover Market Share. We explore the differential effects by the brand type of products, the competition level in markets, and the duration of the supply disruptions. With the extensive global supply chain disruptions that we are facing today, understanding their potential consequences is significant. This dissertation advances our understanding of the different impacts of supply chain disruptions and provides practical implications for supply chain members to build resilient supply chains and minimize the effects of supply chain disruptions.

This paper investigated the effects of panic buying induced by the Covid-19 pandemic on groceries' Consumer Price Index (CPI) within Sweden. The years of interest are mainly 2020 to 2021. However, the thesis also looks into years before the pandemic, specifically 2018-2019. The use of years before the pandemic, is to understand better how the CPI of selected groceries behaves in ordinary years and see if changes in CPI from 2020 to 2021 were out of the ordinary. The paper discusses different economic behaviours, specifically looking into how times of crisis affect consumer behaviour. To better understand how CPI for the chosen groceries behaves, graphs were created to show how the CPI values of the goods change over the years. Secondly, two regression analyses were performed in STATA to test whether there are any correlation between panic buying and changes in the CPI values for the chosen groceries. The results given from the graphs indicated that there could be some relationship between panic buying and CPI changes. However, once the regression analyses had been performed, the results showed no correlation between panic buying and changes in CPI for the chosen groceries. This result is not unexpected, as there can be a variety of reasons behind why panic buying did not induce any abnormal changes in CPI for the goods. These reasons are discussed further later on in the thesis as well.

No / Supply chain resilience has been suggested to curb the impact of disruptions on supply chains. While this proposition seems coherent in theory, empirical evidence supporting this is limited, as existing literature has centred on exploring the impact of supply chain resilience on disruptions which are based on set time frames, non-supply chain specific as well as examining non-dynamic disruptive events. This study contends that resilience strategies are dynamic and as such their applications within supply chains differ. Therefore examining the impact of resilience will be appropriate on a dynamic disruption within a specific supply chain. In view of this, the paper examines through existing literature the applicability of agility within the pharmaceutical supply chain when dynamic disruptions like drug shortages occur. The study finds alertness, accessibility, connectivity and visibility as dimensions of supply chain agility that are capable of reducing the impact of drug shortages.

In spite of an ever-growing supply of metals, actors have long feared metal shortages. This thesis – departing from an understanding that metals scarcity is not an objective geological fact, but an experience, a fear of a shortage – explores why business and state actors have experienced metals as scarce and how they coped with scarcity from 1870 to 2015. The underlying reasons for scarcity experiences originated in high prices, a lack of substitutes, domestic unavailability, limited infrastructure and increased demand. In the view of businesses and the state, a shortage of metals could hinder successful industrialization. Defining metals as scarce was a first step in their attempts to ensure access through exploration, recycling, substitution, and trade agreements. This dissertation presents five case studies which provide insights into three selected aspects of metals scarcity that have been overlooked in previous studies. First, while small countries experienced and coped with metals scarcity in a similar way to large nations, they were more vulnerable because of their dependence on transnational flows controlled by larger countries. Yet if they remained neutral in international conflicts, they could enjoy other opportunities to import resources than their larger rivals. Second, industries experienced metals scarcity before World War I; with the onset of the Second Industrial Revolution, at the very latest, new technologies were often dependent on metals which had never before been used commercially – there were not yet any extraction systems in place. However, once these metals began to circulate, state actors became aware of the international traffic and began to classify certain metals as critical. Thirdly, technological change has affected – and been affected by – metals scarcity. If a metal was scarce, manufacturers were likely to embark on a different path to production. Inversely, sometimes new technologies were able to alleviate perceptions of scarcity. / <p>QC 20171206</p>

The need for Registered Nurses (RNs) in the long-term care of older people is being questioned, particularly in the context of nursing shortages, while suggestions for 'professionalising' Care Assistant (CA) roles are emerging. Despite ongoing debates about the importance of their work, research has so far been unable to provide an evidence-base for the outcomes of the work of either RNs or CAs in UK care homes. Using a multi-method interpretive approach, adopting a structure-process-outcome framework and grounded in the philosophical hermeneutics of Hans-Georg Gadamer, this qualitative research sought to illuminate the distinct contributions made by RNs and CAs to outcomes for older people in care homes. RNs and CAs from around the UK contributed 'significant' examples of their work for Phase 1 of the study and Phase 2 comprised researcher fieldwork (observation, interviews and documentary analysis) in three care homes around England. Participants included RNs, CAs, older residents, relatives, home managers and professionals working in the homes. The findings offer a rich and detailed analysis of the realities of the work, much of which takes place 'behind closed doors' and has been described to a limited extent in the literature. They suggest that the CAs' daily support helps residents to function and to feel valued, and that close, reciprocal, family-type relationships develop. The health knowledge and clinical expertise of good RNs is critical in determining residents' health outcomes, particularly in the long-term, and RNs' 24-hour 'perceptual presence' can make life or death differences in acute or emergency situations. RNs also influence the environment, atmosphere and quality of care in the home. In the context of the literature, the findings offer new insights into the role and contribution of RNs and CAs, the outcomes of their work and the priorities of residents. The study produced new models of RN and CA roles in care homes, encompassing dimensions not previously acknowledged in the literature or their job descriptions, and a new framework within which the outcomes of care for older people could be evaluated. The research offers a positive image of work with older people in independent sector care homes.

As a traditional country of immigration, New Zealand has often looked outside of its borders for its population composition and as a result 19 percent of New Zealand's current population were born overseas. In recent times, immigration has been used by successive governments as a means of countering severe skills shortages and off-setting a declining birth rate. While attention in the media, public and to some extent in academic circles has been largely focused on the increasing volume of immigrants to New Zealand from Asian countries, migration from Europe has often been overlooked and yet it remains an important component of the New Zealand's migration flows. This thesis explores this stream of migration - from the member states of the European Union to New Zealand - by examining the specific case study of contemporary European Union migration to the Canterbury region, incorporating migrants who live, work and study in Canterbury. The thesis used surveys and in-depth interviews in addition to secondary data to investigate the composition of the European Union migrant population in Canterbury, as well as exploring the motivations and experiences of these migrants. Conceptualising the motivations of contemporary migrants from the EU to New Zealand is difficult, due to a multiplicity of theories and frameworks surrounding the topic of migration. As such, this thesis suggests a three level framework drawn from in order to better understand the motivations of target population. Although the experiences of the surveyed migrants were largely positive, some difficulties were noted, particularly while seeking work and building friendships with New Zealanders. Finally, this thesis proposes a number of recommendations at a policy and academic level which may assist in furthering understandings of the important but often ignored group of European Union migrants in New Zealand.

Vaccines have greatly contributed to the control of vaccine preventable diseases. The adoption of the Decade of Vaccines (DoV) by the World Health Assembly in 2011 is an indication of how the global community values the benefits of vaccines. Efforts by many countries to introduce new vaccines are a significant move towards attaining this vision. However, new vaccines put strain on vaccine supply chains. The immunization programme in South Africa has similar challenges, with indications of vaccine stock outs in clinics since the introduction of three new vaccines in 2009. This study set out to establish the status of availability of vaccines in Tshwane government clinics and associated factors. Method: A cross-sectional study was conducted in a sample of randomly selected government clinics in Tshwane health district of Gauteng province. Data was collected using a structured measurement instrument during a visit to each of the participating clinics. Data was collated and analysed using excel based software. Results: A total of 31 clinics participated. In the preceding 12 months, clinics experienced vaccine stock outs, especially of the 3 new vaccines: pneumococcal conjugate vaccine (PCV), rotavirus (RV) vaccine and Pentaxim ®. These were also out of stock for a long duration; for over 2 weeks in a majority of clinics. The causes of vaccine stock outs were: poor management of stock, depot out of stock, unreliable deliveries, lack of pharmacy assistants, and limited fridge capacity. Further burdening the situation is the emergency ordering system that does not function effectively. Conclusion: Significant vaccine shortages occur in Tshwane government clinics. It is recommended that the vaccine supply chain should be restructured and overhauled with the use of advances in technology. Urgent measures should be taken to address the identified causes of stock outs including ensuring reliable deliveries of stock and emergency orders.

Flera svenska storstadsregioner har börjat nå taket för nätkapacitet i elnäten, ett problem som även kallas kapacitetsbrist. Problemet med kapacitetsbrist grundar sig i de förändringar som sker för elproduktionen, med exempelvis en ökande grad av förnyelsebar, intermittent elproduktion, och förändringar i efterfrågan i och med samhällets ökande grad av elektrifiering. För att hantera och överkomma kapacitetsbrist har elnätsbolag traditionellt sett byggt ut elnätet för att därmed har möjlighet att leverera effekt under årets alla dagar, en metod som har långa ledtider och har höga investeringskostnader. Den accelererade problematiken kring kapacitetsbrist sätter ett förändringstryck på elsystemet och i synnerhet elnätsbolagen att hantera problemet. Ett alternativ till att hantera kapacitetsbrist är för elnätsbolag att upphandla flexibilitetstjänster. Det är en lösning som anses som resurseffektiv och samhällsekonomisk i förhållande till konventionell nätutbyggnad. Flexibilitet i elsystemet innebär aktörers medvetna förändring i elproduktion eller efterfrågan av effekt som avser att stabilisera elsystemet. Genom en flexibilitetsmarknad kan elnätsbolag ge aktörer incitament att erbjuda sin flexibilitet mot betalning och därmed hantera kapacitetsbrist när det behövs.  I det här examensarbetet har syftet varit att studera flexibilitetsmarknaders roll i att överkomma kapacitetsbrist i lokala elnät och vad konceptet innebär för möjligheter och utmaningar på aktörsnivå och övergripande marknadsnivå. Genom kvalitativa forskningsmetoder, semi-strukturerade intervjuer, litteratur- och dokumentstudier, har författarna kartlagt kunskapsläget om flexibilitetsmarknader och konceptets innebörd för enskilda aktörer. Examensarbetet presenterar även ett teoretiskt ramverk av ekonomisk teori som syftar till att ge större förståelse för marknadens etableringsprocess och vilka eventuella marknadsmisslyckanden som riskerar att ske. En förstudie har genomförts där två aktiva projekt, CoordiNet och Sthlmflex, av flexibilitetsmarknader i Sverige har studerats för att identifiera insikter om flexibilitetsmarknaders möjligheter och utmaningar. Vidare utfördes en semi-strukturerad intervjustudie med 15 olika företag i Göteborg, en region som ännu inte har en flexibilitetsmarknad, för att studera olika aktörers drivkrafter och hinder för att medverka på en flexibilitetsmarknad. Företagen var kategoriserade i fem olika segment; industrier, hamnindustrier, fastighetsbolag, elnätsbolag och aggregatorer. Resultatet från förstudien visar på att de existerande flexibilitetmarknaderna har varit viktiga för deltagande aktörer att lära sig förstå hur de bör arbeta med en flexibilitetsmarknad som en del av verksamheten. Det har visat sig existera ett antal utmaningar i projekten som exempelvis bristfällig kommunikation, avsaknad av automatiserade processer och låg likviditet på marknaderna. I intervjustudien kunde det urskiljas att de flesta industrier, hamnindustrier och fastighetsbolag har flexibilitetsresurser och potential för att medverka som leverantörer på en flexibilitetsmarknad. Hos samma segment identifierades dock hinder gällande bristen på teknisk utrustning för att kunna erbjuda flexibilitet och en osäkerhet kring ersättningsnivån som kan väntas från flexibilitetmarknaden för flexibilitetsleverantörer. Elnätsbolag ser flexibilitetsmarknader som ett bra alternativ till att hantera kapacitetsbrist och att potentialen är stor för framtiden. Aggregatorer tros ha en betydande roll på flexibilitetsmarknader och vara en möjliggörare för aktörer med mindre resurser och begränsad kunskap. Totalt var 12 av 15 tillfrågade företagen intresserade av att delta på en flexibilitets-marknad i Göteborg. Utifrån teori kan flexibilitetsmarknader ses som en innovativ marknad och att etableringsprocessen innebär olika marknadsstabiliserande aktioner. Flexibilitetsmarknader innebär även ett behov av innovativa affärsmodeller för marknadsaktörerna. Med hänsyn till hinder och utmaningar som identifierats hos flexibilitetsmarknaderna under examensarbetet existerar risker för eventuella marknadsmisslyckanden, orsakade av asymmetrisk information, transaktionskostnader, begränsad rationalitet och externaliteter. / Several Swedish metropolitan regions have begun facing issues regarding the capacity in the power grid, a problem that is also known as capacity shortage. The problem of capacity shortage is based on several changes within the power system, for example, an increasing degree of renewable, intermittent electricity production, and society's increasing degree of electrification. In order to manage capacity shortages, power grid companies have traditionally expanded the power grid to be able to deliver power during all hours of the year, a method that has long lead times and high investment costs. The accelerated problem of capacity shortages puts pressure for change in the power system, and in particular the power grid companies to deal with the problem. An alternative in managing capacity shortages is for power grid companies to purchase flexibility services. It is a solution that is referred to as a more sustainable, resource efficient and socio-economic in relation to conventional power grid expansion. Flexibility in the power system can be seen as changes in the electricity production or the demand for power that intends to stabilize the power system. In a flexibility market, power grid companies can give companies incentives to offer their flexibility against payment and thus handle capacity shortages when needed. The purpose of the thesis has been to study the role of flexibility markets in overcoming capacity shortages in local power grids, and the concept’s opportunities and challenges for different actors and from a market perspective. Through qualitative research methods, semi-structured interviews, literature- and document studies, the authors have mapped the state of knowledge about flexibility markets and the concept's meaning for the power system. The thesis also presents a theoretical framework of economic theory that aims to provide a greater understanding of the market's establishment process and what possible market failures that are likely to occur. A pre-study has been carried out where two projects, CoordiNet and Sthlmflex, of flexibility markets in Sweden have been studied to identify insights into the concept’s opportunities and challenges. Furthermore, a semi-structured interview study was conducted with 15 different companies in Gothenburg, a region that does not yet have a flexibility market, to study companies’ drivers and obstacles to participate in a flexibility market. The companies were categorized into five different segments: industries, port industries, real estate companies, power grid companies and aggregators. The results from the pre-study show that the existing flexibility markets have been important for participating players to understand how they should integrate a flexibility market as a part of their businesses. It has been shown that there are several challenges in the flexibility projects, such as inadequate communication, lack of automated processes and low liquidity on the markets. In the interview study, it could be discerned that most industries, port industries and real estate companies have flexibility resources and potential to participate as flexibility providers in a flexibility market. In the same segments, obstacles were identified regarding the lack of technical equipment to be able to offer flexibility and an uncertainty about the level of remuneration that can be expected from the flexibility market for flexibility providers. Power grid companies sees flexibility markets as a good alternative for managing capacity shortages and that the potential is great for the future. Aggregators are believed to play a significant role in flexibility markets and be an enabler for companies with smaller flexibility resources and limited knowledge. In total, 12 of the 15 companies surveyed were interested in participating in a flexibility market in Gothenburg. Based on theory, a flexibility market can be seen as an innovative market and that the establishment process involves various market stabilizing actions. Flexibility markets also imply a need for innovative business models for market participants. Regarding the obstacles and challenges identified in the flexibility markets during the thesis, there are risks of market failure caused by asymmetric information, high transaction costs, bounded rationality, and externalities.