Global ETD Search

391	"Dreaming of electric sheep" Les cycles techno-économiques du système mondial et le développement technoscientifique en Équateur : sources et limites du projet postnéolibéral ( 2007 – 2016 ) / "Dreaming of electric sheep" The techno-economic cycles of the global system and the techno-scientifique development in Ecuador : the origins and limits of the postneoliberal projetc ( 2007 – 2016 ) Chavez, Henry 15 September 2017 (has links) Sur la base d’une étude historique des rapports entre les cycles techno-économiques du système mondial et le processus de transformation économique, politique et idéologique d’un pays périphérique comme l’Équateur, cette recherche présente une analyse critique sur le processus de développement du champ technoscientifique de ce pays et le projet de modernisation postnéolibéral mis en place par son gouvernement entre 2007-2017. L’exposition est organisée en deux parties. La première analyse les rapports entre les transformations techno-économiques mondiales et les cycles économiques et politiques locaux ; les rapports entre ces cycles, les vagues de modernisation du système d’éducation supérieure équatorien et la reproduction des élites locales ; et enfin, les rapports entre ces deux derniers et le processus de développement scientifique, technologique et industriel du pays. La deuxième partie est consacrée à l'étude en détail du dernier de ces cycles, caractérisé par la mise en place du projet postnéolibéral de modernisation technoscientifique. Cette étude se focalise particulièrement sur trois projets : la réforme de l’éducation supérieure, le programme de bourses d’étude à l’étranger et le projet de construction de Yachay, une ville dédiée à la science, à la technologie et à l’innovation. Les résultats de ces analyses dévoilent le caractère idéologique de ces projets, conçus et dirigés par un même réseau d’intellectuels et financés par l’essor des exportations de matières premières qui a accompagné cette phase ascendante du cycle périphérique. Enfermés dans leur quête idéologique d’un modèle de développement alternatif et les contraintes imposées par les processus de transformation du système mondial, ces acteurs ont fini par produire un projet de modernisation contradictoire basé sur une abstraction empirique adaptée à leurs besoins de légitimation politique. La fin de l’essor économique a dévoilé les limites de ce projet idéologique dont les résultats concrets sont une plus lourde bureaucratie, le gaspillage des ressources publiques et l’accumulation de pouvoir. Nous suggérons que ce résultat est un effet du décalage entre les cycles de transformation à la périphérie et au centre du système mondial et du processus de reconfiguration global liée à la montée de l’influence chinoise et au déploiement de la dernière vague de transformations techno-économiques. Cette recherchée s’inscrit ainsi dans la lignée de réflexion sur les transformations du système mondial. / Based on a historical study of the relationship between the techno-economic cycles of the global system and the economic, political and ideological transformations in Ecuador, this research presents a critical analysis of the development process of the technoscientific field in this country and the post-neoliberal modernization project implemented by its government between 2007-2017. The thesis has two parts. The first one develops an analysis on three levels: the relationships between the global techno-economic cycles and the political and economic transformations in Ecuador; the relationships between these transformations, the waves of modernization of the Ecuadorian higher education system and the reproduction of local elites; and the relationship between the latter and the scientific, technological and industrial development of the country. The second part presents a detailed study of the last cycle, characterized by the implementation of the post-neoliberal project of technoscientific modernization. This study focuses, particularly, on three projects: the higher education reform, the scholarship program for studies abroad and the Yachay technopole project. These analysis results reveal the ideological character of these projects, designed and directed by the same network of intellectuals and financed by the rise of commodity exports which accompanied this upward phase of the peripheral cycle. Trapped in their ideological quest for an alternative development model and the constraints imposed by the transformation processes of the global system, these actors have finally produced a contradictory modernization project based on an empirical abstraction adapted to their needs for political legitimization. The end of the economic upswing has unveiled the limits of this ideological project whose concrete results are a heavier bureaucracy, waste of public resources and the accumulation of power. We suggest that this result is an effect of the three interrelated processes: the gap between the transformation cycles at the periphery and at the center of the global system, the global reconfiguration linked to the rise of Chinese influence and the deployment of the latest techno-economic wave of innovation. This research aims thus to contribute to the debate on the historical transformations of the global system. Cycles économiques Science Technologie Éducation supérieure Équateur Postnéoliberalisme Systèmes mondiaux Rapports centre - périphérie Innovation technologique Yachay Bourses d'étude à l'étranger Réforme universitaire Circulation des savoirs Formation des élites Pôles d'innovation Paradigme technoéconomique Idéologie Economical cycles Science Technology Higher education Ecuador Postneoliberalism Global systems Center-Periphery relations Technological innovation Yachay International scholarship University reform Knowledge circulation Training of elites Technopoles Technology parks Ideology Techno-Economic paradigms
392	Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital Lucas, D. Pulane 24 April 2013 (has links) Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures allow a growing number of medical treatments to take place on an outpatient basis. Hospitals face growing competition from ambulatory surgery centers (ASCs). The competitive threats posed by ASCs are important, given that inpatient surgery has been the cornerstone of hospital services for over a century. Additional research is needed to understand how surgical volume shifts between and within acute care general hospitals (ACGHs) and ASCs. This study investigates how medical technology within the hospital industry is changing medical services delivery. The main purposes of this study are to (1) test Clayton M. Christensen’s theory of disruptive innovation in health care, and (2) examine the effects of disruptive innovation on appendectomy, cholecystectomy, and bariatric surgery (ACBS) utilization. Disruptive innovation theory contends that advanced technology combined with innovative business models—located outside of traditional product markets or delivery systems—will produce simplified, quality products and services at lower costs with broader accessibility. Consequently, new markets will emerge, and conventional industry leaders will experience a loss of market share to “non-traditional” new entrants into the marketplace. The underlying assumption of this work is that ASCs (innovative business models) have adopted laparoscopy (innovative technology) and their unification has initiated disruptive innovation within the hospital industry. The disruptive effects have spawned shifts in surgical volumes from open to laparoscopic procedures, from inpatient to ambulatory settings, and from hospitals to ASCs. The research hypothesizes that: (1) there will be larger increases in the percentage of laparoscopic ACBS performed than open ACBS procedures; (2) ambulatory ACBS will experience larger percent increases than inpatient ACBS procedures; and (3) ASCs will experience larger percent increases than ACGHs. The study tracks the utilization of open, laparoscopic, inpatient and ambulatory ACBS. The research questions that guide the inquiry are: 1. How has ACBS utilization changed over this time? 2. Do ACGHs and ASCs differ in the utilization of ACBS? 3. How do states differ in the utilization of ACBS? 4. Do study findings support disruptive innovation theory in the hospital industry? The quantitative study employs a panel design using hospital discharge data from 2004 and 2009. The unit of analysis is the facility. The sampling frame is comprised of ACGHs and ASCs in Florida and Wisconsin. The study employs exploratory and confirmatory data analysis. This work finds that disruptive innovation theory is an effective model for assessing the hospital industry. The model provides a useful framework for analyzing the interplay between ACGHs and ASCs. While study findings did not support the stated hypotheses, the impact of government interventions into the competitive marketplace supports the claims of disruptive innovation theory. Regulations that intervened in the hospital industry facilitated interactions between ASCs and ACGHs, reducing the number of ASCs performing ACBS and altering the trajectory of ACBS volume by shifting surgeries from ASCs to ACGHs. Disruptive Disruptive Innovation Theory Disruptive Transformations Disruptive Innovation Innovation Technology Technological Innovation Medical Innovation Medical Technology Medical Advancement Laparoscopy Laparoscopic Surgery open surgery appendectomy cholecystectomy bariatric surgery weight loss surgery appendectomies cholecystectomies inpatient outpatient ambulatory ambulatory surgery ambulatory surgery center acute care general hospital hospital acute care hospital general hospital health care healthcare hospital industry health care industry Clayton Christensen Clayton M Christensen Michael Porter Harvard Business School Virginia Commonwealth University CMS Health policy public policy public administration organizational theory organization theory Population Ecology Theory Competitive Strategy policy analysis John Kimberly Organization Size Structural Inertia liability of smallness health spending health care cost specialty medical facility open system niche width dynamic outpatient department technology shift surgical setting surgical setting shift medical facility shift substitution threat health system system level analysis Ecological Approach hospital trends ambulatory surgery trends reimbursement rate Medicare CMS coverage decision P J DiMaggio DiMaggio and Powell w w Powell Hannan and Freeman M T Hannan Organizational change minimally invasive surgery less invasive surgery Prospective Payment System Outpatient Prospective Payment System entreprenuerial physician health care organization health care management Roice Luke Carl Ameringer new technology surgical utilization elective surgery Medicare Payment Advisory Commission MedPAC coverage decision trends in surgery abdominal surgery surgical variation physician-owned physician ownership physician autonomy outpatient clinic utilization trends unnecessary surgery Pfeffer Salancik technology diffusion redefining health care interdisciplinary research health care delivery panel design diffusion of hospital technology state variation regional variation local health care market government intervention medical facility health care capacity focused factory advances in health care physician organization relationship hospital competition medical specialization hospital expansion medical arms race integrated care integrated health system J E Wennberg health care transformation reimbursement scheme surgical volume Florida Wisconsin policy making health policy analysis competitive dynamics center of excellence intervening factor service line competition service-line competition surgical reimbursement innovative business model innovative technology environmental influence established firm new market entrant patient safety sophisticated technology Harvard Divinity School Social and Behavioral Sciences

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Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital