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Secondary infusions are a common and convenient method to administer intermittent infusions unattended through a single IV access using infusion pump technology. Previous studies have indicated that clinicians have a high frequency of committing operation errors while administering secondary infusions, which can cause patient harm. The purpose of this study was to evaluate the safety of secondary infusion practice by identifying and analyzing potential failure modes when delivering secondary infusions on five different smart infusion pumps. Healthcare Failure Mode and Effect Analysis (HFMEA) was used to prioritize potential failure modes that are considered high-risk for each pump. Results showed that four of the five pumps were not able to mitigate physical set-up errors. As well, each pump contributed differently to programming errors due to difference in interface design. Recommendations from this study focused on outlining desired infusion pump features and mitigation strategies to help alleviate high-risk secondary infusion failure modes.

Secondary infusions are a common and convenient method to administer intermittent infusions unattended through a single IV access using infusion pump technology. Previous studies have indicated that clinicians have a high frequency of committing operation errors while administering secondary infusions, which can cause patient harm. The purpose of this study was to evaluate the safety of secondary infusion practice by identifying and analyzing potential failure modes when delivering secondary infusions on five different smart infusion pumps. Healthcare Failure Mode and Effect Analysis (HFMEA) was used to prioritize potential failure modes that are considered high-risk for each pump. Results showed that four of the five pumps were not able to mitigate physical set-up errors. As well, each pump contributed differently to programming errors due to difference in interface design. Recommendations from this study focused on outlining desired infusion pump features and mitigation strategies to help alleviate high-risk secondary infusion failure modes.

Each year, organizations invest billions of dollars in large information systems (IS) that support business processes. These systems are implemented with the hope that they will bring increased efficiency and productivity to operations, decision making, and collaboration, thus strengthening competitive advantage in an increasingly aggressive global marketplace. Unfortunately, empirical evidence demonstrates that despite prodigious investment in these systems, their purported benefits often lag behind expectations, or fail to materialize at all. While many causes may contribute to these failures, a common theme in empirical studies is that information systems are rarely infused into individuals' work practices, thus undermining their benefits to the organization. IS infusion refers to the degree to which the technology is fully integrated into an individual's or organization's work systems. Although theoretical and practical interest in IS infusion is growing, little is understood about the factors that lead to IS infusion at the individual level.This dissertation integrates research and theory in information systems acceptance, adaptation, and infusion to develop a theoretical model of IS infusion at the individual level. To test the model, a survey instrument was developed and tested at the health care facility of a large public university. The revised survey was then deployed at a large technology firm in the northwestern United States, from which 195 individual responses were obtained. Results indicate that adaptation behaviors engaged in by IS users significantly impact the degree to which they infuse the IS in their work. Moreover, these adaptation behaviors are shaped by cognitive appraisals of the IS, which are, in turn, influenced by key acceptance-related IS perceptions.This study contributes to research by integrating previously disparate theories into a holistic framework of individual-level IS infusion. For practice, this research sheds light on specific factors that contribute to IS adaptation and infusion, thereby assisting IS managers to promote these outcomes within their organization.

Der subjektive Tinnitus ist ein Symptom unterschiedlicher Ursachen. Trotz vielversprechender Ansätze und deutlicher Fortschritte beim Verständnis der Pathophysiologie konnte sich bislang keine einheitliche Therapie durchsetzen. Es gibt ein Vielzahl von Therapieansätzen, deren klinische Wirksamkeit häufig nicht ausreichend untersucht sind. Ziel dieser Arbeit war es deshalb, eine Bilanz zur Anwendung des modifizierten antiphlogistisch-rheologischen Stennert-Schemas und des Infusionsschemas mit Procain bei der Behandlung des subjektiven Tinnitus (mit oder ohne begleitende Hörminderung) zu ziehen. Im Rahmen der vorliegenden Arbeit erfolgte deshalb eine retrospektive Auswertung von 281 Patienten, die im Zeitraum vom 01.01.1997 bis 14.12.2000 an der Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde der Universität Würzburg behandelt wurden. In einem zweitem Schritt wurden das modifizierte antiphlogistisch-rheologische Infusionsschema nach Stennert und das Infusionsschema mit Procain gegenüber einem Placebo (NaCl-Infusionen) im Rahmen einer prospektiven Studie untersucht. Dabei handelte es sich um die erste prospektive, randomisierte Doppelblindstudie zum Tinnitus, die verschiedene Infusionsschemata gegenüber einer Placebomedikation untersuchte. In der prospektiven Untersuchung lagen Ergebnisse von 34 Patienten vor, die in der Zeit vom 05.08.1999 bis 20.07.2002 behandelt wurden. Im retrospektiven Kollektiv zeigte sich bei der Behandlung akuter Ohrgeräusche mit dem modifizierten Stennert-Schema bei 45 (21%) der 216 Patienten eine Vollremission und bei 58% (n=125) der Fälle verringerte sich die Tinnituslautheit. In der Procain-Therapiegruppe wurde bei 60% (n=15) der 25 Patienten im retrospektiven Untersuchungsteil eine Abnahme der Tinnituslautheit beobachtet (Vollremission bei 4%; n=1). Bei 40 Patienten der retrospektiven Untersuchung mit chronischem Tinnitus konnte mit dem modifizierten Stennert-Schema bei 50% (n=16) und mit Procaininfusionen bei 63% (n=5) der Patienten eine Verringerung der Tinnituslautheit erzielt werden. Dabei sistierte bei 6% (n=2) der Patienten aus der mod. Stennert-Therapiegruppe das Ohrgeräusch komplett. Die Patienten im retrospektiven Kollektiv mit einer Hörminderung zeigten nach der Therapie mit dem mod. Stennert-Schema eine durchschnittliche Hörerho-lung von 18,7 dB. Bei 29% (n=26) dieser Patienten erholte sich das Hörvermö-gen vollständig und 44% (n=40) hatten eine Teilerholung. In der Procain-Therapiegruppe konnte bei Patienten mit einer Hörminderung eine Besserung in 71% der Fälle (n=5) registriert werden, eine Restitutio ad Integrum wurde nicht beobachtet. Das Hörvermögen erholte sich in dieser Therapiegruppe im Durchschnitt um 20,0 dB. 42 Patienten des retrospektiven Kollektivs, die initial mit dem mod. Stennert-Schema therapiert wurden, unterzogen sich einer Anschlussbehandlung mit Procain. Bei 45% (n=19) der Patienten verringerte sich das Ohrgeräusch, ein Sistieren des Tinnitus trat dabei nicht auf. Auf das Therapieergebnis hatte die Zeitspanne zwischen Symptom- und Therapiebeginn einen hochsignifikanten Einfluss (p=0,00002). Je eher mit der Infusionstherapie begonnen wurde, desto günstiger war die Prognose. Die besten Therapieergebnisse zeigten sich bei Latenzzeiten von weniger als 24 Stunden. Lagen zwischen Symptom- und Therapiebeginn über 28 Tage, zeigten sich Behandlungsergebnisse wie bei einem chronischen Tinnitus. Alio loco vorbehandelte Patienten zeigten schlechtere Therapieergebnisse als Patienten ohne vorherige Therapie (p=0,00003). Bei Patienten mit einem Tinnitusrezidiv lag der Anteil an Vollremissionen deutlich unter dem erstmalig erkrankter Patienten. Dies war statistisch jedoch nicht signifikant. Keinen Ein-fluss auf die Prognose hatten hingegen das Alter und Geschlecht der Patienten. Im prospektiven Untersuchungsteil konnte durch die Infusionstherapie mit dem mod. Stennert-Schema bei 57% (n=8) der 34 Patienten eine Restitutio ad Integrum und bei 43% (n=6) der Fälle eine Teilremission des Tinnitus erzielt werden. In der Procain-Therapiegruppe zeigten 50% (n=4) der Patienten eine Vollremission und 25% (n=2) der Fälle eine Teilremission. In der Kontrollgruppe mit NaCl kam es nur bei 16% (n=2) der Fälle zu einer Vollremission und bei 42% (n=5) der Patienten zu einer Teilremission des Tinnitus. Auch die Veränderung des WHF-Scores konnte die besseren Ergebnisse in der mod. Stennert-Therapiegruppe (Besserung von 15,8 Gra-den) und in der Procain-Therapiegruppe (Besserung von 14,5) darlegen. In der NaCl-Therapiegruppe fand sich nur eine Besserung um 9,8 Grade. 15 Patienten der prospektiven Untersuchung hatten einen Tinnitus und gleichzeitig eine akute Hörminderung. Nach der Infusionstherapie mit dem mod. Stennert-Schema verbesserte sich das Hörvermögen im Durchschnitt um 22,0 dB. In der Procain-Therapiegruppe ergab sich eine durchschnittliche Hörverbesserung um 22,8 dB, und in der NaCl-Therapiegruppe zeigte sich eine Verbesserung des Hörvermögens um 15,4 dB. Die Infusionstherapie mit dem modifizierten antiphlogistisch-rheologischen Stennert-Schemas und dem Infusionsschemas mit Procain waren gut verträg-lich. Nebenwirkungen, die einen Abbruch der Behandlung erfordert hätten, traten nicht auf. Die hier vorgestellten Therapieergebnisse zeigen deutlich, dass das modifizierte antiphlogistisch-rheologische Infusionsschema nach Stennert eine gute Wirksamkeit bei der Behandlung von Ohrgeräuschen hat. Dabei ist diese Wirkung einem Placebo deutlich überlegen. Das Infusionsschema mit Procain stellt eine zusätzliche Therapieoption bei chronischem Tinnitus, sowie als Anschlußbehandlung nach erfolgter Behandlung mit dem modifizierten Stennert-Schema dar. / Subjective tinnitus is a symptom having various causes. In spite of promising approaches and significant progress in the understanding of pathophysiology, no therapy has been able to achieve uniform acceptance. There are many therapeutic approaches, whose clinical effectiveness often have not been sufficiently investigated. The aim of this project was therefore to draw conclusions for the use of the modified antiphlogistic-rheologic Stennert scheme and the infusion scheme using Procain for the treatment of subjective tinnitus (with or without accompanying hearing deficits). Within the scope of the present work, there has been a retrospective evaluation of 281 patients who were treated in the period from 1 January 1997 to 14 December 2000 in the ENT clinics of the University of Würzburg, Germany. In a second step, the modified antiphlogistic-rheologic infusion scheme (according to Stennert) and the infusion scheme using Procain were investigated in comparison to a placebo (NaCl infusions) in the scope of a prospective study. This was the first prospective, randomized double-blind study of tinnitus to investigate different infusion schemes versus a placebo medication. For the prospective investigation, results from 34 patients who were treated in the period from 5 August 1999 to 20 July 2002 were available. The retrospective collection showed a complete remission in 45 (21%) of the 216 patients for treatment of acute tinnitus with the modified Stennert scheme, and in 58% (n=125) of the cases the tinnitus volume was reduced. In the Procain therapy group, a reduction in the tinnitus volume was observed for 60% (n=25) of the 25 patients in the retrospectively investigated section (complete remission for 4%; n=1). For the 40 patients with chronic tinnitus in the retrospective investigation, a reduction in the tinnitus volume was achieved in 50% (n=16) with the modified Stennert scheme, and in 63% (n=5) with Procain infusions. The tinnitus ceased completely for 6% (n=2) of the patients in the modified Stennert group. The patients with hearing deficits in the retrospective collection exhibited an average of 18.7 dB in recovered hearing ability after therapy with the modified Stennert scheme. In 29% (n=26) of these patients, the hearing ability recovered completely, and 44% (n=40) had a partial recovery. In the Procain therapy group, a recovery could be observed in 71% (n=5) of the cases with patients having hearing deficits; a restitutio ad integrum (complete recovery) was not observed. The hearing ability recovered by an average of 20.0 dB in this therapy group. 42 patients in the retrospective collection who were initially treated with the modified Stennert scheme subsequently underwent a treatment with Procain. In 45% (n=19) of the patients the tinnitus decreased, a ceasing of the tinnitus did not occur. The period of time between the onset of symptoms and therapy had a highly significant influence (p=0.00002) on the results of the therapy. As much as the infusion therapy could be started earlier, so was the prognosis improved. The best therapy results occurred with latency periods less than 24 hours. If more than 28 days passed between onset of symptoms and the start of therapy, treatments exhibited results just as for a chronic tinnitus. Patients who had undergone alio loco pre-treatment exhibited worse therapy results than patients without previous treatment (p=0.00003). In patients with a tinnitus relapse, the percentage of complete remissions was significantly lower than for patients with first-time illnesses, although this was statistically insignificant. The age and gender of the patients had no influence on prognoses. In the prospective section of the investigation, a restitutio ad integrum (complete recovery) could be achieved in 57% (n=8) of the 34 patients with the infusion therapy using the modified Stennert scheme, and a partial tinnitus remission in 43% (n=6) of the cases. In the Procain therapy group, 50% (n=4) of the patients exhibited a complete remission, and 25% (n=2) of the cases showed a partial remission. In the control group with NaCl, a complete remission was exhibited in only 16% (n=2) of the cases, and 42% (n=5) of the patients showed a partial tinnitus remission. The improved results were also demonstrated by the alteration of WHF scores in the modified Stennert scheme (improvement of 15.8 degrees) and in the Procain therapy group (improvement of 14.5 degrees). In the NaCl therapy group the improvement was only 9.8 degrees. 15 patients from the prospective investigation had simultaneously tinnitus and an acute hearing deficiency. After infusion therapy with the modified Stennert scheme, the hearing ability was improved by an average of 22.0 dB. In the Procain therapy group, there was an average hearing ability improvement of 22.8 dB, and the NaCl therapy group exhibited an improvement in hearing ability of 15.4 dB. The infusion therapy with the modified antiphlogistic-rheological Stennert scheme and the infusion schemes using Procain were well tolerated. Side effects that would have required a cessation of treatment did not occur. The therapy results presented here clearly show that the modified antiphlogistic-rheological Stennert infusion scheme has good effectiveness for the treatment of tinnitus, and the effect is clearly superior that of a placebo. The infusion scheme using Procain represents an additional therapy option for chronic tinnitus, as well as for subsequent therapy after therapy using the modified Stennert scheme.

[Abstract]: This doctoral dissertation research reports on the exploration of higher education academics’ pedagogical responses to complex societal postindustrialchange. The topic arises from a deep personal interest in processes of societal change and the need for such processes to be in the professional practices ofacademics. The research problem that guides the study is: In what way(s) and to what extent can University instructors be assisted to incorporate change-basedconcepts in their pedagogical practices through application of a conceptual framework for change infusion?In response to the problem, a change infusion model (CIM) arises from an analysis of authoritative literature on change. Change infusion is an educational process that utilises key concepts from theories of change to provide ameaningful context for pedagogical practice in times where pervasive societal transformation is the norm. Gay’s (1995) multiple stages of infusion are of particular importance in the CIM. The generation of the theoretical definition of infusion in the CIM provides practising academics with an explanatory system that enables them to infuse significant elements of change into pedagogicalpractices. In essence, the CIM purports to guide instructors to move beyond teaching about change to teaching for change.The research design includes the cognitive-constructivist theoretical foundations, with particular reference to Dewey (1933), Piaget (1951), Lewin (1951), Schön (1983, 1987), Calderhead (1988), and Patton (2002). Ofparticular importance is the analysis of opinions concerning pedagogical practice of a small number of University practitioners after engaging with theCIM during each of the three stages of trials. The trials utilize the cognitiveconstructivist quality of reflection as a means to link theory to practice.The conclusions from the research support a conceptual model, such as the CIM, for use to teach for change. As a result of the Stage 3 trial research in particular, the conceptual model from the beginning point of the study isrefined, thereby hopefully providing a useful tool for academics in a wide range of contexts and disciplines to respond in meaningful ways to the process ofmajor change that impinge upon them and their work.

The concept service infusion implies that services are being included in a product-centric business to some extent. This movement towards integrating services will change how the business is performed in such a company; in other words, service infusion will lead to changes in the business model. This thesis aims to describe how service infusion affects the business in general and more specific effects in the business model. Volvo Trucks are somewhere in the process of service infusion and have several services offered to the market, such as Dynafleet, fuel advice, and driver training. In 2008, the service driver training was launched on the Romanian market and Volvo Trucks struggled with selling the service for a fee. This led to Volvo Trucks making the decision to start giving away the service for free. The objective of the service driver training was from the begging to sell it for a fee and the transition from service for free to service for fee is the main focus in this thesis. Through an analysis of the theoretical framework chosen for this thesis and a case study performed on Volvo Trucks, four success factors for the transition from free to fee could be identified: deep understanding of customers, show the value of the service, introduce sales commissions, and develop a pricing strategy. All these success factors are chosen to ease the transition from a service for free into a service for fee.

Service encounter is the core of many service industries. Most researches on service encounter pay attentions to the interpersonal interaction in the past. But in recent years, because of the fast development of technology, especially on the use of information technology, it brings the new turning point in enterprises, and it changes the original interpersonal interaction. College education is a kind of high interpersonal interaction service industry. In recent years, web-based instruction became a trend in college education. Therefore, this study attempt to know the change of learning satisfaction after the technology infusion in service encounters from the student¡¦s point of view. Aimed at the student of traditional and web-based instruction respectively and used critical incidence technique (CIT) to collect and analyze the data, we found the satisfaction/ dissatisfaction sources and compared the difference between technology infusion or not. There were five findings in this study. 1. The satisfaction/dissatisfaction factors were categorized to seven sources. They were ¡§learning environment¡¨, ¡§web-based instruction system¡¨, ¡§instructor¡¨, ¡§ peer relationship¡¨, ¡§course¡¨, ¡§interaction¡¨, ¡§entire performance¡¨. 2. Before the technology infusion, ¡§instructor¡¨ is the critical factor to influence satisfaction with service encounter. The teaching attitude, teaching performance, profession and expression ability of instructors will influence learning satisfaction. 3. After the technology infusion, ¡§web-based instruction system¡¨ is the critical factor to influence satisfaction with service encounter. The design, stability, ease of use, speed of data transmission, flexibility of the web-based instruction system will influence learning satisfaction. 4. Whether the technology infusion or not, we found that the importance of ¡§interaction¡¨ did not decrease. 5. Whether the technology infusion or not, ¡§peer relationship¡¨ is the important source of learning satisfaction.

Zugl.: Giessen, Universiẗat, Diss., 2009.

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