CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Muitas dificuldades sÃo encontradas na implementaÃÃo de classificaÃÃes de enfermagem na prÃtica clÃnica. Destaca-se a falta de familiaridade dos enfermeiros com os sistemas de classificaÃÃo e as dificuldades na tomada de decisÃo diagnÃstica associadas Ãs deficiÃncias no processo de raciocÃnio diagnÃstico. Assim, estudos que desenvolvam ferramentas tecnolÃgicas como as Ãrvores de decisÃo (AD) podem contribuir para agilizar a tomada de decisÃo diagnÃstica e facilitar o uso destes fenÃmenos. Objetivou-se gerar Ãrvores de decisÃo baseadas em probabilidades condicionais para auxÃlio na inferÃncia diagnÃstica de DesobstruÃÃo ineficaz de vias aÃreas (DIVA) e PadrÃo respiratÃrio ineficaz (PRI) em crianÃas com infecÃÃo respiratÃria aguda (IRA). Estudo transversal desenvolvido com o intuito de identificar dados para que pudessem ser utilizados na geraÃÃo de Ãrvores de decisÃo com boa aplicabilidade clÃnica. Realizou-se avaliaÃÃo respiratÃria de 249 crianÃas com diagnÃstico mÃdico de IRA no perÃodo de janeiro a abril de 2011. Estes dados serviram de base para determinaÃÃo das caracterÃsticas definidoras (CD) dos diagnÃsticos de enfermagem (DE) em estudo. As CD foram enviadas para dois enfermeiros diagnosticadores para o processo de inferÃncia diagnÃstica. A maior parte das crianÃas era do sexo masculino (55,8%). Pneumonia (79,9%) foi a principal IRA encontrada e Asma (17,7%), a principal comorbidade. DIVA esteve presente em 89,2% dos casos e PRI em 65,5%. As CD de DIVA com maior prevalÃncia foram: âTosse ineficazâ (91,3%), âRuÃdos adventÃcios respiratÃriosâ (77,1%), âDispneiaâ (69,3%), âMudanÃas na frequÃncia respiratÃriaâ (56,6%), âOrtopneiaâ (54,2%) e âExpectoraÃÃoâ (32,1%). Jà para PRI, as CD mais prevalentes foram: âAlteraÃÃes na profundidade respiratÃriaâ (73,9%), âDispneiaâ (68,3%), âTaquipneiaâ (57,0%),âOrtopneiaâ (54,2%) e âUso da musculatura acessÃria para respirarâ (51,8%). Utilizaram-se trÃs algoritmos para geraÃÃo de AD: CHi-square Automatic Interaction Detection (CHAID), Classification and Regression Trees (CRT) e Quick, Unbiased, Efficient Statistical Tree (QUEST). As AD foram submetidas à validaÃÃo cruzada para que se avaliasse o poder de prediÃÃo dessas. Desenvolveram-se trÃs AD para auxÃlio na inferÃncia diagnÃstica de DIVA, trÃs para PRI e trÃs para diferenciaÃÃo destes diagnÃsticos. Para DIVA, a AD com maior poder de prediÃÃo foi a desenvolvida pelo mÃtodo CHAID. Jà para PRI, os valores de prediÃÃo foram similares para os trÃs mÃtodos de crescimento das Ãrvores. Para diferenciaÃÃo diagnÃstica, a Ãrvore gerada pelo mÃtodo CRT obteve melhor poder de prediÃÃo (86,4%). Acredita-se que a implementaÃÃo das Ãrvores de decisÃo pode ajudar a tornar as inferÃncias destes dois diagnÃsticos mais acuradas. Entretanto esta relaÃÃo necessita ser aprofundada, aplicando-se as AD geradas em outras populaÃÃes. Conclui-se que a utilizaÃÃo de tecnologias como as AD pode ser valorosa tanto na prÃtica clÃnica como no ensino de diagnÃsticos de enfermagem.

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Review of Lincoln and the Decision for War: The Northern Response to Secession. Chapel Hill:University of North Carolina Press,2008, 2010. 388 pp. ISBN-13: 978-0-8078-7154-6.

A portion of teachers in the United States educational system don'€™t use data to inform and improve their instruction resulting in actionable change. A gap exists between teachers having and interpreting data and making meaning in such a way that leads to actionable change in instruction. The purpose of this case study was to investigate how teachers used data to alter instruction and identify factors that inhibited or supported teachers in using data to drive instructional practice. This study was guided by Ackoff'€™s theory of action cycle, which included interaction, dialogue, data discoveries, and team response to data. The research questions asked how teams used data and what factors inhibited and supported the use of data. Three teams were observed. Eleven classroom teachers, the building principal and the district professional development director were interviewed. The teacher team criteria included that teachers met weekly and used, at a minimum, common formative assessments. The school and district mission, vision and value statements were collected as artifacts to see how these documents supported the use of data. Open and axial coding exposed themes and patterns. Results indicated that teachers commonly omitted one or more phases in a data cycle; however, when teachers worked through all phases of a data cycle, actionable change in instruction resulted, and factors that both inhibited and supported teacher use of data to guide instruction were evident throughout all aspects of the study. The project, a white paper, summarized the study and provided research-based recommendations based on the study. These recommendations focus on building teacher capacity and relationships. This study may generate social change through educational equity. Equity is achieved when teachers use data to inform instruction so that learners of all abilities may have access to learning.

The current study sought to examine the factors that influence the decisions of lll Appalachian high school students regarding college attendance. Using Bronfenbrenner' s ecological systems theory of human development (1986) as a theoretical basis, direct and indirect influences of environmental factors upon the academic aspirations of Appalachian youth were examined using survey methodology. Results indicated that predictors of college attendance for Appalachian students are not significantly different from those of students elsewhere. Variables reflective of individual academic preparation were most salient in predicting college aspirations for both males and females. Other important predictors included parent education, parent occupation, and socioeconomic status. Several analyses suggested that family and peer influences may be more salient for male students than female students. Implications of the results for educators and clinicians working with Appalachian youth were discussed.

This study aimed to demonstrate how negative affect is linked with stereotypic thinking in hiring decisions made in everyday situations. Participants (n = 788) will be randomly assigned to each condition. Each participant will be given a neutral emotion inducing picture or an anger emotion inducing picture, followed by either a white or black candidate resume with the same qualifications, and then asked how likely they are to hire the candidate. Results would most likely suggest that anger leads to increased stereotypic thinking in hiring decisions. Future studies may decide to investigate 1) a wider array of negative emotions and 2) a more diverse set of candidates (e.g. examining effects of gender or race).

The current study explored the impact of intellectual versus physical affirmations received over Instagram, either directly or indirectly, on females’ physical acceptance, intellectual pursuits during leisure and financial decision making. A total of 256 female students of the Claremont Colleges were recruited through advertisement of the study on the colleges’ designated Facebook page, and flyers posted around the campuses. The longitudinal, quasi- experimental study used a 2 (Type of Affirmation: Physical or Intellectual) x 2 (Mode of Exposure: Feed or Direct Message) x 3 (Phase: 1, 2, 3) fully crossed factorial design. Participants who voluntarily agreed to participate were randomly assigned to one of the four conditions. Participants exposed to physical affirmations, via Instagram’s direct messaging feature, reported significantly lower levels of physical acceptance, were less likely to engage in intellectual activities during leisure, and made financial decisions that reflected a greater desire to attend to their appearance than to their intellect, compared to participants exposed to physical affirmations, via feed. The opposite pattern of interaction was found for participants exposed to intellectual affirmations. The results support previous psychological literature on social role theory, stereotype threat, self-objectification theory, social comparison theory, and affirmation theory. The implications of this study concern female leadership development, specifically how exposure to intellectual affirmations over social media has the potential to attenuate the negative effects living in a patriarchal society has on females.

The purpose of this study is to examine the use of ERP and outputs by six decision-makers in one SME manufacturing organization and provide artifacts targeted to improve their pricing decisions. Through elaborated action design research, we collect data to diagnosis decision-makers concerns and identify decision making biases and errors. Using insights and collaboration, we design, implement and evaluate seven artifacts targeted to minimize four biases identified – overconfidence bias, optimistic bias, planning fallacy and representativeness. The data collected during the diagnosis phase reveals that concerns fell into three primary themes: data, human interfaces, and cognitive bias. The seven combined artifacts implemented have a positive impact minimizing bias in this organization. This research reveals how artifacts such as policies, procedures, processes, reports and system modules help SME decision-makers mitigate cognitive biases and errors. Additionally, this study confirms that the eADR process can be an effective means of implementing incremental changes, evaluating impacts and increasing engagement in this environment. Limitations of this study include concurrent introduction of artifacts, single SME organization and embedded nature of the researcher.

Purpose – The purpose of this project was to extrapolate knowledge of successful leadership practices, determine what led to and nurtured what became an integrated organizational culture and identify any decisions and/or transformational events that re-defined Moffitt Cancer Center’s (MCC) course or helped propel it to levels far beyond what was originally imagined. The aims of this study were discovery of the foundational factors and events that significantly impacted the creation, growth and evolution of the center, making MCC an institution of transformational change that had achieved state and national prominence. Design – This was an exploratory study guided by a qualitative phenomenological research methodology using an interpretivist approach. Data was derived from twenty one-on-one interviews with people who had the specific knowledge and expertise necessary to obtain a better understanding of the leadership, culture and transformational events that transformed MCC into the institution that it is today. Interviewees included former and current MCC executive leaders, board members and key program directors, as well as the founder and two other former Speakers of the Florida House of Representatives. A literature review was conducted to explore founders, visionary leadership, organizational culture, and transformational organizations. Findings – Key findings included discovery of the factors and events that impacted MCC’s growth and success. The interview process revealed three foundational factors pertaining to visionary leadership qualities of the founder and others, a mission-based culture and four transformational events that set MCC on a course of independence and self-governance. The literature review, with an emphasis on founders, visionary leadership, culture and transformational institutions, revealed useful information to draw comparisons and differences in the historical context of MCC’s growth and impact. Value – MCC, created in Florida statute, existed as a private not-for-profit entity that, statutorily, served as an instrumentality of the state. As such, it had an interestingly distinct role as a hybrid organization that served a public and private sector need; while, very specifically, serving the cancer research and care needs of patients throughout the state and beyond. While the previously mentioned business literary research works are plentiful in the private and public sectors, a gap exists for hybrid organizations such as MCC. Future research could focus on organization founders who did not become part of the executive leadership structure.

This thesis explores the impact of hepatitis C on women’s childbearing decisions and experiences of motherhood. A partial grounded theory approach was used, in which 34 women living with hepatitis C participated in semi-structured interviews to determine the direct and indirect effects of hepatitis C on their own personal decisions regarding childbearing and to describe their lived experiences of motherhood. The qualitative interview data were analysed thematically, in which common themes were identified and explored.¶ Three key areas are explored: women’s social experience of hepatitis C; hepatitis C and childbearing decisions; and the meaning of motherhood for women with hepatitis C.¶ The interviews revealed that living with hepatitis C had direct effects on the childbearing decisions of women. The direct effects of the virus which impacted on women’s childbearing decisions included poor physical and emotional hepatitis C related health, the perceived risk of vertical transmission of hepatitis C, concerns their future hepatitis C related health might impact upon their mothering abilities, and childbearing can conflict with treatment for hepatitis C. However, of greater importance to these women, appeared to be the indirect effects of living with a virus which is so highly stigmatised within our society. In particular, hepatitis C is closely associated with injecting drug use, which means these women are often assumed to possess the stereotypical characteristics associated with injecting drug users. As a result, they experience widespread medical discrimination and social rejection. Hepatitis C also impacts indirectly upon a wide range of factors that most women in contemporary society take into consideration in their childbearing decisions, for example, available social support, financial security and age.¶ The experiences reported by these women are discussed in terms of their concordance or discord with prevailing theories of deviance, stigma and the social construction of motherhood. The interview data, considered in light of such theories reveal that possibly the greatest impact that hepatitis C can have upon women is to prevent them from achieving a legitimate adult female status through childbearing and becoming a ‘good mother’.¶ The implications of these findings are discussed in terms of public health and social policy.