Surgeons regularly make changes in their practice to ensure they are providing high quality patient care. This includes the process of learning and safely integrating new skills, techniques and technologies into practice. When faced with the challenge of integrating a new surgical procedure into practice, surgeons must determine when they are ready to overcome the associated risks. This study sought to understand how surgeons experience risk when learning and integrating a new procedure into practice. A modified constructivist, grounded theory approach was utilized. Eighteen surgeons were purposively sampled from two Canadian academic medical institutions. Semi-structured interviews were conducted and interpreted through constant comparative analysis. Emergent themes were identified and a conceptual framework was developed for understanding the surgeon experience associated with adopting and integrating a new procedure into practice. Regardless of personal risk tolerance, surgeons described a similar approach to learning and implementing new skills. The experience of risk was one of several factors that affected their adoption of new techniques. They also described being influenced by individual, personality-driven factors, logistical considerations and the culture inherent to their departmental, institutional, professional and societal contexts. A framework for understanding the surgeon experience when adopting and integrating new skills was constructed. The complex, nuanced multifactorial interplay between a surgeon’s individual willingness to engage risk, his/her motivations and the systemic and cultural factors that serve to facilitate or hinder the implementation of a new surgical skill is at the core of this experience. An increased awareness of these factors highlights the challenges that surgeon face in adopting new procedures and may lead to the development of policies which support surgeons learning and implementing new skills, techniques and technologies while maximizing patient safety.

La construction des réseaux moléculaires à partir de résultats expérimentaux, ainsi que leur analyse en vue d'en exhiber des propriétés émergentes, sont deux tâches fondamentales de la biologie des systèmes. Avec l'augmentation du nombre de données expérimentales, elles ne peuvent plus être réalisées manuellement. Partant de ce constat, un certain nombre de méthodes bioinformatiques visant à les automatiser ont été développées.En parallèle du développement des méthodes, un certain nombre de standards ont vu le jour. Parmi ceux-ci, la Standard Biology Graphical Notation (SBGN) se compose de trois langages permettant la représentation des réseaux moléculaires.Les deux langages SBGN les plus couramment utilisés sont SBGN-PD pour la représentation des réseaux de réactions, et SBGN-AF pour celle des graphes d'influences. La notation SBGN, en plus de standardiser la représentation des réseaux, donne l'ensemble des concepts de la biologie des systèmes qui sont le plus souvent utilisés pour exprimer les connaissances du domaine.C'est dans ce cadre général que se placent l'ensemble de nos travaux. Nous avons développé un ensemble de méthodes pour la construction des réseaux moléculaires et l'analyse de leur dynamique. L'ensemble des méthodes que nous proposons reposent sur des formalismes qualitatifs, tels que la logique ou les réseaux d'automates. Ces formalismes on non seulement des bases théoriques solides, mais peuvent aussi être utilisés par de nombreux logiciels.L'ensemble de nos méthodes reposent également sur les concepts biologiques fournis par le standard SBGN, et peuvent ainsi être intégrées dans un même cadre théorique.Nous introduisons d'abord deux ensembles de prédicats qui permettent de traduire n'importe quel réseau SBGN-PD ou SBGN-AF sous la forme d'atomes instanciés. Nous montrons ensuite comment ces deux ensembles peuvent être utilisés pour raisonner automatiquement sur des réseaux moléculaires, en proposant une méthode de transformation automatique des réseaux de signalisation SBGN-PD en graphes d'influences SBGN-AF.Nous présentons ensuite une méthode de construction des réseaux de signalisation à partir de résultats expérimentaux, basée sur la logique du premier ordre. Cette méthode formalise et automatise le raisonnement réalisé par les biologistes à l'aide de règles de raisonnement explicites. Contrairement aux méthodes développées jusqu'à maintenant, celle que nous présentons prend en compte un grand nombre de types d'expériences, tout en permettant la reconstruction de mécanismes moléculaires précis.Puis nous montrons une nouvelle méthode pour le calcul des traces finies et des points attracteurs de réseaux Booléens modélisant des réseaux SBGN-AF et paramétrés à l'aide de principes généraux. Notre méthode repose sur l'utilisation de programmes logiques normaux du premier ordre, qui formalisent ces principes généraux.Enfin, nous proposons deux nouvelles sémantiques qualitatives pour le calcul de la dynamique des réseaux de réactions SBGN-PD, exprimées à l'aide de réseaux d'automates. La première de ces sémantiques étend la sémantique Booléenne des réseaux de réactions en prenant en compte les inhibitions. Quant à la deuxième, elle introduit le concept d'histoire (story) qui offre un nouveau point de vue sur les réseaux de réactions, en permettant de modéliser différents états physiques d'une même entité moléculaire par une seule variable.L'ensemble des méthodes que nous avons développées montrent comment les formalismes qualitatifs, et en particulier la logique, peuvent être utilisés pour raisonner à partir des relations représentées par les réseaux moléculaires, afin de découvrir de nouvelles connaissances en biologie des systèmes. / Two fundamental tasks of Systems Biology are the construction of molecular networks from experimental data, and their analysis with a view to discovering their emergent properties. With the increase of available experimental data, these two tasks can no longer be realized by hand. Based on this observation, numerous bioinformatics methods aiming at the automation of these two task have been developped.In parallel, standards aiming at defining and organizing terms of systems biology, or representing networks and mathematical models, have been developped. Among these standards, the Standard Biology Graphical Notation is composed of three languages that allow the representation of molecular networks. The two main SBGN languages are SBGN-PD for the representation of reaction networks, and SBGN-AF for the representation of influence graphs. The SBGN notation not only standardizes the representation of networks, but also gives the concepts of systems biology that are most often used to express knowledge of the field.Our work takes its root in this general background. We have developped a number of methods to construct molecular networks and analyze their dynamics. All the methods that we propose are based on qualitative formalisms, such as logics or automata networks. These formalisms have solid theoretical bases and can be used by numerous pieces of software. All our methods also rely on the biological concepts given by the SBGN standard, and can therefore be blended in the same theoretical framework.First, we introduce two sets of predicates that allow to translate any SBGN-PD or SBGN-AF network into a set of ground atoms. Then, we show how these sets of predicates can be used to reason on networks, by proposing a transformation method of SBGN-PD signaling networks into SBGN-AF influence graphs.Second, we present a first-order logic based method to construct signaling networks from experimental results. This method formalizes and automatizes biologists' reasoning using explicit reasoning rules.On the contrary to existing methods, it allows to take into account numerous types of experimental results while reconstructing precise molecular mecanisms.Third, we show a new method to compute the finite traces and attractor points of Boolean networks that model SBGN-AF networks and that are parameterized using general principles.Finally, we introduce two new qualitative semantics for the computation of the dynamics of SBGN-PD reaction networks. These semantics are expressed using automata networks. The first semantics extends the classical Boolean semantics by taking into account inhibitions. As to the second one, it relies on the concept of story which introduces a new point of view on reaction networks. Indeed, it allows to model different physical states of the same molecular entity using a unique variable.All the methods that we have developped show how qualitative formalisms can be used to reason on the relations represented by molecular networks in order to discorver new knowledge in systems biology.

Objective: This study was designed to better understand perceived barriers and facilitators to providing medication therapy management (MTM) services by pharmacists who recently provided telephonic MTM services to home health care patients. These services were provided as part of a randomized, controlled trial (RCT) to develop suggested quality improvement strategies for future service design. Design: This was a qualitative study. A semi-structured individual interview format was used to elicit responses. Setting: Interviews were conducted by phone with participants. Participants: All pharmacists who recently provided telephonic MTM services as a part of an RCT participated in this study. Interventions: Pharmacists were asked questions regarding their perceptions of the services, training opportunities, patient perceptions of the services, interactions with physicians, and suggestions for improvement. General demographic information was collected for each pharmacist and summarized using descriptive statistics. Interview data were analyzed using inductive qualitative methods to reveal key themes related to facilitators and barriers of MTM services in home health care patients. Main Outcome Measures: The main outcome measures were major themes identified from pharmacist interviews pertaining to barriers, facilitators, and quality improvement strategies for telephonic MTM delivery. Results: A total of four pharmacists (i.e., 100% of those who participated in the prior RCT) were interviewed. Several themes emerged from the analysis, including: communication and relationships, coordinating care and patient self-management, logistics, professional fulfillment, service delivery and content, and training opportunities. Conclusions: This study provides possible strategies to overcome barriers and facilitate service provision for future telephonic MTM services.

No description available.

Thesis advisor: Lisa S. Cahill / Weaving qualitative interview analysis together with ethical inquiry, this project traces the trajectories of Catholic women and couples who hope to form families but contend with infertility and consider whether and how to treat it. Motivating this study is the challenge of balancing individual agency with the role of powerful social forces that shape agency. Examining and critiquing the social forces that shape the circumstances in which Catholic women and couples in the U.S. contend with infertility, this dissertation demonstrates how agential freedom is conditioned by familial, clinical, and ecclesial cultures and structures. It harnesses sociological tools and theological resources to argue for an account of agency that prioritizes critical engagement of contextual factors and suggests that the Church as a moral teacher ought to support the cultivation of this agency. Chapter one challenges the model of moral agency found in magisterial teachings that oppose the use of contraception and reproductive technologies, which suggests that lay Catholics ought to obey magisterially prescribed norms regardless of context. The chapter argues that the magisterial model of moral agency does not adequately account for the role of context in shaping agency, and it instead proposes an account of contextually situated agency that resonates with Pope Francis’ prioritization of contextual realties in his apostolic exhortation Amoris Laetitia. The second chapter demonstrates how various social forces, including structures supporting heterosexual marriage, cultural ideals related to biological childbearing, and ecclesial structures of marital formation all contribute to U.S. Catholic couples’ family formation choices and can intensify burdens of infertility. The chapter proposes a reorientation of Catholic support for families centered on justice in relationships and Christian discipleship instead of family structure. The third chapter examines how cultural ideals related to childbearing, the medicalization of infertility, and social location all contribute to shaping how Catholic women in the U.S. make sense of infertility. Contesting the cultural notion that women are responsible for infertility with reference to a criterion of justice, it describes infertility as a kind of biological bad luck also shaped by systemic forces. Structural injustices related to sexism and racism in healthcare function to distribute the bad luck of infertility unjustly based on societal vulnerabilities, which constitutes a kind of social sin. The fourth chapter considers how two different understandings of Catholic identity shape treatment trajectories of Catholics contending with infertility toward either secular fertility clinics or Catholic clinics. It then examines these two clinical settings, demonstrating how contextual pressures shape how Catholics make treatment choices and underscoring how Catholic moral commitments can support moral agents’ resistance to these pressures. Its final section considers the social forces at work in adoption and fostering. The final chapter turns to the role of the Church in supporting the moral agency of Catholics making decisions regarding family formation and infertility treatment. After analyzing and critiquing the dominant ideals found in Catholic and secular support group settings, it suggests that synodal commitments of mutual listening and inclusive dialogue can support the development of new structures of moral discernment in the Church. It concludes by considering how the social witness of the Church can contribute to the transformation of sinful social forces that constrain the freedom of women and couples contending with infertility. / Thesis (PhD) — Boston College, 2023. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Theology.

This dissertation explores the presentational strategies the Toronto Police Service (TPS) used to respond to three controversies involving its relationship with marginalized and racialized communities - the removal of the TPS from the Toronto Pride parade; the investigation of the serial killer case involving Bruce McArthur; and the Black Lives Matter protests of the summer of 2020. Using an interpretive approach and a variety of conceptual frameworks derived from Goffman’s work on impression management and applying a grounded theory methodology combined with qualitative media analysis (QMA), the dissertation identifies the image management strategies the TPS adopted in each case. The findings show that the strategies were context specific in the sense that they were directed to the precise criticisms being leveled at the TPS in each case. However, there were common themes across the cases which involved acknowledging a problematic past and committing to corrective actions in the future. The main difference in strategies had to do with the degree to which the TPS was prepared to push back on the claims made against the organization and defend its actions. The dissertation speaks to the broader question of how police organizations are attempting to negotiate their legitimacy in a climate where social media has made police-citizen encounters more visible and where recent high profile incidents involving police violence and abuse of power have shaken public confidence and threatened police legitimacy. I argue that taken together, the TPS responses offer a glimpse into how one police organization is seeking to defend its legitimacy by projecting an image of the kind of police service it is aspiring to become, particularly in relation to the marginalized and racialized communities it serves. / Dissertation / Doctor of Philosophy (PhD) / This dissertation explores how the Toronto Police Service (TPS) responded to three controversies involving its relationship with marginalized and racialized communities - the removal of the TPS from the Toronto Pride parade; the investigation of the serial killer case involving Bruce McArthur; and the Black Lives Matter protests of the summer of 2020. Using an interpretivist approach and qualitative methods the dissertation identifies the image management strategies the TPS adopted in each case and discusses similarities and differences. The analysis contributes to a better understanding of how the police attempt to negotiate their legitimacy with communities with which they have traditionally had problematic relationships in a context where the increased visibility of police violence has created a legitimacy crisis.

Yes / Background Pilot studies can play an important role in qualitative studies. Methodological and practical issues can be shaped and refined by undertaking pilots. Personal development and researchers’ competence are enhanced and lessons learned can inform the development and quality of the main study. However, pilot studies are rarely published, despite their potential to improve knowledge and understanding of the research. Aim To present the main lessons learned from undertaking a pilot in a qualitative PhD study. Discussion This paper draws together lessons learned when undertaking a pilot as part of a qualitative research project. Important methodological and practical issues identified during the pilot study are discussed including access, recruitment, data collection and the personal development of the researcher. The resulting changes to the final study are also highlighted. Conclusion Sharing experiences of and lessons learned in a pilot study enhances personal development, improves researchers’ confidence and competence, and contributes to the understanding of research.

No description available.

Yes / Aim: To explore how men with penile cancer construct humour in relation to their diagnosis and treatment. Background: Functionalist, relief and incongruity theories attempt to account for humour but there is a dearth of empirical evidence in nursing care. This is particularly so in relation to a condition like penile cancer where some nurses think that humour in their interactions with patients would be inappropriate. Design: The study employed a participative, mixed-qualitative-methods design. Method: Focus groups and patient-conducted interviews were both used during a one-day ‘pilot workshop’ in March 2011. The data were initially analysed using framework analysis. This paper explores the theme of humour in depth. Findings: Humour helped participants make light of their condition, which meant that they could laugh about the consequences of treatment (‘laughing about urination’) and build rapport with health professionals (‘humour with health professionals’). Nevertheless, the use of humour was less important than the treatment of their cancer (‘humour discounted’) and there was a fear that they would be subject to ridicule because of their condition (‘fear of ridicule’). Conclusion: The findings suggest a combination of functionalist, relief and incongruity theories of humour; the emotions these men experience are contained (functionalist) and released (relief) through humorous interaction, and the potential for comedy lies in an incongruity between what is expected socially and the experiences of these men, for example around expectations that men use urinals in public toilets. Nurses should continue to use humour to build rapport with patients, should they judge this to be appropriate although they may want to avoid jokes about sexual and urinary functioning until after treatment. / National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG-0808-17158).

No / This paper examines previous approaches to the identification and measurement of strategic flexibility and concludes that the use of quantitative methods alone cannot capture the essence of such a complex and intangible subject. It is reasoned that a holistic approach to research design should be adopted when carrying out particular categories of production management research. A research design used to investigate the concept of strategic flexibility in manufacturing industry is briefly outlined as an illustration. The role of the case study within this and the contribution it was able to make to the investigation is described.