(Re)conceptualizing Neoliberal Health Discourses as Constitutive Relationships

Over the last several decades, a neoliberal shift in medical practice from institutional treatment to self-care and prevention has moved many engagements with medical authority figures out of the clinic and into society more broadly. In this context, medical authority has become more complex and difficult to locate as Western medical knowledges and practices have dispersed and intermingled with a range of other health informations and forms of healthcare. As a result, this dissertation uses a constitutive rhetorical approach to locate and examine contemporary forms of medical authority by interrogating the relationship between health subjects and medical authority in neoliberal health discourses. Rather than treat health discourses as fixed asymmetrical texts by which health subjects are either disciplined or empowered, I argue that analyzing these discourses as constitutive relationships by interrogating how health subjects and various forms of medical authority interact with and constitute each other through these texts reveals a more nuanced understanding of how both authority and subjectivity are negotiated and sustained in these contemporary neoliberal sites of engagement. The three case studies in this dissertation explore diverse ways health subjectivity and medical authority are interactively constituted through various health discourses. In analyzing American Girl’s The Care & Keeping of You advice books, the daytime talk show The Dr. Oz Show, and user engagement with Fitbit activity trackers as constitutive relationships, this dissertation illustrates the emergence of a complex understanding of the relationship between subjectivity and authority. I suggest that a relational approach allows us to move beyond analyzing how health subjects are constituted as they align themselves with health discourses, to examine how health subjects also participate in constituting medical authority as they engage in various forms of interaction. Indeed, reconceptualizing how medical authority emerges from and participates in various interactions with health subjects both expands our understanding of neoliberal health discourses as well as develops a more nuanced approach to critiquing health subject’s sustained engagement with these increasingly ubiquitous texts

Patient and Family Engagement in Addressing Hospital Patient Safety Concerns: Experiences, Attitudes and Patient Safety Engagement Comfort Levels of Recently Hospitalized Patients

Introduction Patient engagement involves the behaviors of patients, family members, and health professionals (i.e., doctors, nurses, and other healthcare staff) in a collaborative partnership to improve health and healthcare. It also constitutes organizational structures policies and procedures designed to foster and promote the active inclusion of patients and family members in health services delivery. Patient engagement is associated with enriched patient experience, patient safety and clinical effectiveness. An evidence base is essential for its translation from a conceptual framework to tangible programs that can be pragmatically implemented in healthcare delivery systems. However, little is known about how individual level factors, healthcare staff behaviors within hospital work systems and hospital characteristics support engagement, influence patients’ engagement comfort, and the impact on patients’ experience of care. The intent of this doctoral dissertation is to perform a secondary analysis of the Consumers Union Patient and Family Engagement Survey to examine three key research questions: Which aggregated patient and hospital characteristics are associated with hospital staff behaviors that support patient engagement? Which aggregated patient and hospital characteristics are associated with patients’ level of comfort with engagement around safety issues during their hospital stay? What are the effects of hospital professional patient engagement behaviors and patients’ level of comfort with engagement around safety issues during their hospital stay on the patients’ experience of care? Literature Review The Multidimensional Framework for Patient and Family Engagement in Health and Healthcare, developed by Carman et al., delineates the levels at which engagement can and should take place. This includes direct care, organizational design and governance across an engagement continuum that includes consultation, involvement as well as partnership and shared leadership. Patient engagement behaviors are rooted in self-efficacy (i.e., activation) but also in perceived norms and consequences. They are also influenced by organizational, socio-demographic, socio-cultural, and task-related factors. Patient experience of care is shown to be positively associated with varied degrees of technical quality, patient safety, clinical effectiveness, patient-provider communication and treatment adherence. This doctoral dissertation focuses on the direct care level of engagement and studies the experiences, attitudes and patient engagement comfort of recently hospitalized patients. Methods I completed a secondary analysis of the probability-based, nationally representative Consumers Union Patient and Family Engagement Survey final data set. The study sample included non-institutionalized individuals’, age 25 to 75 residing in the United States who had at least one hospitalization in the last six months. I used the weighted sample of individual respondents in the secondary analysis to represent the population of interest in the United States. I used exploratory factor analysis as a data reduction technique to examine outcomes of interest. I explored the underlying factor structure of the 22 observed variables (i.e., 11 hospital staff behaviors and patients’ engagement comfort with those same 11 behaviors), and the correlation between the observed variables and the factors (i.e., factor loadings). I analyzed factor loadings, the proportion of variance explained by each factor, and any common factors. Principal component analysis was used to assess the amount of variance in the observed hospital staff behaviors and patient engagement comfort variables. Outcome variable selection included hospital professional pain assessment and patient identification behaviors, patient engagement comfort with pain assessment and patient identification, and patients’ likelihood to recommend the hospital to a family member or friend. Logistic and ordinal logistic regression analyses were used to assess outcome variable relationships while controlling for each independent variable of interest. Complex survey data techniques and unvariate, bivariate and regression analyses were completed using SAS software. Results The sample was fairly evenly split between male (47%) and females (53%). The mean age was 53 and median was 50 years. Greater than 60% of respondents were White, non-Hispanic, 53% were married. Most were hospitalized in metropolitan, non-teaching hospitals with greater than 100 beds. Greater than 50% were hospitalized for a surgical admission and 56% had more than one previous hospitalization. The majority of respondents reported hospital professionals performed pain assessment and patient identification rather routinely. Higher proportions of these behaviors were reported by older patients, age 45 years plus, white, non-Hispanic, married, college educated patients who had advocate support during hospitalization. Logistic regression analysis showed that having a high school education was associated with a 0.31 odds of reporting pain assessment hospital engagement compared to those with a Bachelor’s degree or higher (p=0.02). Being admitted for a medical admission was associated with a 0.37 odds of reporting pain assessment hospital engagement compared to those admitted for surgery (p=0.02). These results were statistically significant in the logistic regression model (p\u3c0.05). Most respondents indicated they were comfortable with patient engagement. Greater than 80% of patients reported they were either very comfortable or comfortable with pain assessment and patient identification engagement. Most were older age, 45 plus years, married, and college educated. Ordinal logistic regression analysis showed having three previous hospital admissions was associated with a 0.55 odds of reporting feeling comfortable with pain assessment engagement compared to those with four or more previous hospital admissions (p=0.04). Results were statistically significant (p\u3c0.05). The following results were also statistically significant in the patient identification ordinal logistic regression model. Being female was associated with a 0.55 odds of reporting feeling comfortable with patient identification engagement compared to males (p=\u3c0.01). Having improved health status was associated with a 1.89 odds of reporting feeling comfortable with patient identification engagement compared to those whose health status worsened in the past year (p=0.05). Greater than 80% of patients indicated they would definitely recommend the hospital to a family member or friend. The majority of these patients were older, 55 plus years, married, had advocate support during hospitalization, and had not experienced a medical error during their most recent hospitalization. Ordinal logistic regression analysis showed not having experienced one or more medical errors during the index (i.e., most recent hospitalization) was associated with a 2.00 odds of reporting they would recommend the hospital to a family member or friend compared to patients who reported they had experienced one or more medical errors during their most recent hospitalization (p=\u3c0.01). Results were statistically significant in the ordinal logistic regression model (p\u3c0.05). Conclusion This doctoral study attempted to fill an evidence gap around factors that influence comfort with patient engagement, measurement of hospital professional behaviors that support engagement and their impact on the patient experience of care. Study findings provide supporting evidence that patents perceive hospital professionals often proactively engage patients in pain assessment and patient identification. The analysis reinforced the role socio-demographic factors play in patient engagement. Logistic regression analysis showed that having a medical (i.e., non-surgical) hospital admission was positively associated with patient’s comfort with pain assessment engagement. Having only a high school education was negatively associated feeling comfortable with pain assessment engagement. With regard to gender, female and improved health status in the past 12 months, were positively associated with patient’s comfort with patient identification engagement. It also confirmed the statistically significant medical error experience on patients’ overall experience of care. Findings also support that patients’ admission type matters, particularly to pain assessment. Ultimately these findings can be used to identify opportunities to improve the nature of the patient-health professional relationship toward greater degrees of collaboration and engagement, particularly related to safety and quality of care. It addresses limited evidence as to what precisely patients’ feel comfortable doing when it comes to patient engagement. Future patient engagement research should focus on actual patient engagement behaviors, characteristics of engagement and continued evidence around measure development

INTEGRATING THE CRITICAL SUCCESS FACTORS (CSF) OF CUSTOMER RELATIONSHIP MANAGEMENT (CRM), CUSTOMER SATISFACTION AND CUSTOMER RETENTION IN THE OIL AND GAS SECTOR: THE CASE OF UAE-ADNOC

Customer Relationship Management (CRM) is a complex and revolutionary strategic management concept that aims at integrating organisational functions to present consumers with a single face of the organization. To this end, the presentation of this face of the company must be agreed upon by the multi-functional teams in the organization, especially regarding what the face of the organization is and/or how it should be presented. A number of critical success factors must apply if the implementation of CRM is to succeed. This study investigated the possibility of integrating the critical success factors (CSF) of customer relationship management (CRM), customer satisfaction and customer retention in the oil and gas sector in the United Arab Emirates. It was proposed to culminate in a framework/model for successfully implementing CRM and/or to provide an integrative perspective on the critical success factors of doing so in an international customer context in the UAE oil and gas industry. The present empirical study of this industry would help fill the current gap in explorations of the role of CRM and its applicability to both the UAE and other fuel exporting countries and could be used by CSF/enablers for successful CRM Implementation. CRM has proved useful in several industries, including banking, hospitality, healthcare and retailing. The research hypothesized that CRM, by virtue of aiming to develop and consolidate the vendor-to-customer relationship, could also be successfully implemented in the oil and gas sector to ensure sustainability, competitive advantage and higher levels of customer retention and satisfaction. The research and its hypotheses used data from on UAE’s leading oil and gas entity – Abu Dhabi National Oil Company (ADNOC), which often deals in local and international business-to-business transactions. Critical path analysis and confirmatory factor analysis were used to conduct the study. The critical path analysis revealed that, of all the dependent variables, human factors were essential to the successful implementation of CRM and critical for determining the quality of transactions and relations. This justifies the contention of previous scholars that CRM promotes the usefulness of technology and human resources in the study of consumer behaviour in delivering more value to consumers if their preferences can be identified. Overall, the research found that, although CRM allows consumer behaviour to be studied, its success depends on building relationships with consumers viii based on identified preferences and unique behaviours. The study is implicatively useful for marketing and management practitioners in the oil and gas industry from fuel exporting countries which deal specifically with B2B international customers and seek to leverage CRM tools and strategies to attain competitive advantage

The influence of sustainability in project management practices in the building sector

La durabilité est un objectif adopté de manière croissante (et un concept globalement accepté) qui affecte - et réciproquement qui est affecté par - le processus de réalisation du projet de construction. Étant donné que le secteur du bâtiment se voit de plus en plus forcé d'adopter la durabilité dans les processus organisationnels, les chercheurs du domaine ont apporté des connaissances pour améliorer la performance de bâtiments dits « verts », en mettant l'accent souvent sur les technologies, les matériaux et les outils de gestion de l'environnement. Les praticiens se sont généralement concentrés sur l'augmentation de l'efficacité, de manière globale considérée comme une réduction de l'utilisation de l'eau, de l’énergie et d'autres ressources. Cependant, on constate que les connaissances demeurent encore insuffisantes existent encore sur les processus requis dans la mise en œuvre des principes de la durabilité elle-même. Ainsi, cette thèse vise à créer une compréhension détaillée de la manière dont les pratiques liées à la durabilité influencent la gestion du projet et les processus organisationnels dans les projets de construction. La recherche repose sur cinq études de cas de projets de construction récents situés à Montréal qui ont adopté des principes de durabilité. Les données comprennent 14 entretiens avec des experts en durabilité, gestion de projet et construction, ainsi que 24 entretiens avec des professionnels impliqués dans les cinq projets sélectionnés. Plus de 200 documents liés aux projets, des communiqués de presse, et des documents des politiques organisationnelles du donneur d’ouvrage ont été étudiés, et comparés aux informations obtenues à partir des entrevues et des observations sur le terrain. Les données ont été analysées à l'aide d'une série de diagrammes et de techniques de cartographie visant à révéler l'évolution de la structure de la Multi-Organisation Temporaire (MOT) et des pratiques de durabilité dans les études de cas. Les résultats révèlent que la durabilité facilite le processus d'alignement entre la gestion du projet et la stratégie de l’organisation. Ils montrent également que l’adoption des certifications « vertes » dans les projets de construction génère souvent une série de tensions qui influencent les processus et les pratiques de gestion de projet. De plus, l'étude révèle que les parties prenantes adoptent une multiplicité d'approches à la durabilité, et que ces approches changent au cours des différentes étapes du projet, générant alors des tensions supplémentaires entre les parties prenantes. Cette recherche suggère que, pour adopter des pratiques de durabilité dans le secteur de la construction, il est urgent de passer des approches linéaires, normatives et axées sur les produits à une approche plus holistique, ouverte et centrée sur les processus. Contrairement à la conviction commune, les résultats montrent que la durabilité n'est pas une approche homogène appliquée aux projets de construction et que la diversité d’approches génère un impact significatif sur la performance du projet. Il est donc nécessaire de bien comprendre les différentes approches des parties prenantes ainsi que leurs évolutions dans les phases du projet. D'un point de vue pratique, les résultats de cette étude peuvent être mobilisés par les gestionnaires de projet pour éviter les conflits entre les parties prenantes, pour réduire les tensions entre les approches managériales, pour faciliter l'innovation et la collaboration, ainsi que pour transformer les tensions en opportunités d'amélioration de la qualité des projets.Sustainability is an increasingly adopted objective (and an overarching concept) that affects, and is affected by, every aspect of the construction project process. As the building sector is increasingly forced to adopt sustainability in organizational processes, researchers within the field have provided knowledge to improve “green” building performance, focusing on technologies, materials, and environmental management tools. Practitioners have usually focused on increasing efficiency, typically seen as reductions in the use of energy, water and other resources. However, insufficient knowledge still exists about the processes required in the effective implementation of sustainability principles. This dissertation seeks to create a comprehensive understanding of how sustainability principles influence project management and organizational processes in building projects. The research is based on five case studies of recent Montreal located building projects that have implemented sustainability principles. First-hand data included 14 Interviews with experts in sustainability, project management, and construction, as well as 24 interviews with professionals involved in the five projects. More than 200 project documents, press releases, and policy documents from the client organizations were studied and compared with the information obtained from the interviews and observations. The data was analyzed through a series of diagrams and mapping techniques that aimed at revealing the evolution of both the structure of the temporary multi-organization (TMO) and the sustainability practices within the case studies. Findings reveal that sustainability enables the alignment process between project management and business strategy. They also show that the implementation of “green” certifications in building projects often generates a series of tensions that influence project management processes and practices. Moreover, the study reveals that stakeholders adopt a multiplicity of sustainability approaches and that these approaches change during different stages of the project, generating additional tensions between stakeholders. The investigation suggests that in order to adopt sustainability practices in the building sector there is an urgent need to shift from linear, regulatory, and product-centred approaches to a more holistic, open, and process-centred approach. Contrary to common belief, results show that sustainability is not a homogeneous approach applied to building projects and that the diversity of approaches has a significant impact on project performance. There is, therefore, a need to fully understand different stakeholder approaches as well as their evolution in the project phases. From a practical point of view, results from this study can be used by project managers to avoid conflicts between stakeholders, reduce tensions between managerial approaches, facilitate innovation and collaboration, and transform tensions into opportunities for project quality enhancement

Leadership Development: Continuous Improvement through Character Assessment

One of the keys to personal development is self-awareness as assessed by instruments such as the Myers-Briggs Type Indicator (MBTI) and the NEO PI-R, both of which are widely accepted reliable and valid indicators and measures of personality type. However, assessing the part of personality known as character presents challenges that are not adequately addressed by today\u27s popular instruments leaving information needed for development incomplete or unavailable. An instrument that provides a reliable and valid assessment of character for leadership and personal development purposes could be very valuable. Qualitative methods were used for this study to investigate leaders\u27 perceptions of the utility of using an existing instrument, the Temperament and Character Inventory (TCI), to enhance character awareness for the purposes of personal and professional growth and improving leadership skills. This study demonstrates that the TCI can be useful for enhancing such skills and development by helping leaders improve their self-awareness through character assessment. This study included two groups of respondents, the seven member executive group and the three member coaching group. The executive group completed the TCI, received feedback and assistance in developing an action plan, and each participant was interviewed to determine to what extent the TCI and this process was useful to them for improving self-awareness of character and for identifying ways they desired to improve their personal and professional skills. The coaching group participated by both completing their personal TCI process, and by working with selected executive group participants and the researcher in interpreting the executive participants\u27 TO results and advising on action plans. The coaching participants were interviewed to determine their perceptions of the extent to which the TCI and this process were useful to them personally and useful to the executive participants they coached. Additionally, the coaching group was asked to recommend specific training approaches, methods and improvements to make the overall process more effective. This study demonstrated that the TCI and the methods used in the study can be useful for leadership development to those committed to professional and personal growth by using character assessment as part of a personal continuous improvement program. Some participants qualified their endorsement of the TCI and the process used for the study by suggesting changes

Water Equity and Security in Detroit's Water and Sewer District

Ensuring access to drinking water and wastewater service is a nationwide policy challenge. Across the United States access is increasingly insecure for many people and places. In this report we comply with scholarship and legal precedent that defines access to include access to residential in-home service, quality service that serves environmental and personal health,and affordable service.Water security is a term in this report used to describe the presence of structural, systemic, and institutional arrangements that ensure everyone has consistent access to drinking water and wastewater services. Water insecurity looks different in the humid east than in the arid west, different in the Midwest from the South, different between urban, suburban, or rural.However different water insecurity problems look at the local level, they are the result of similar institutional, systemic, and structural problems. This is a study of the what persistent water insecurity looks like in the service area of Detroit's drinking and wastewater system (DWSD) and specific places within that system, notably Detroit

Assessment of lateral erosion in three agriculture- dominated Minnesota streams: measurement tools, and factors affecting erosion rates

University of Minnesota M.S. thesis.May 2017. Major: Bioproducts/Biosystems Science Engineering and Management. Advisors: Gary Sands, Chris Lenhart. 1 computer file (PDF); ix, 163 pages.Statewide, 14 percent of Minnesota’s impaired waters are listed for excessive turbidity. In-channel and near-channel erosion are commonly considered major contributors to Midwestern turbidity problems. This research sought to determine the primary drivers of channel erosion in the Elm Creek, Buffalo River and Whitewater River watersheds, with a goal of informing guidance and policy on in-channel and near-channel erosion control practices. Of special interest was whether a woody- or herbaceous- dominated riparian corridor was more stable. First, the definitions, history, and some stream erosion variables are explained. The variables were limited to a brief review of the effects of soil, chemistry, vegetation, hydrology and stream size characteristics. The three study watersheds were introduced. Second, two GIS-based lateral erosion tools (DNR Static Lateral Migration Tool and BBE Dynamic Lateral Migration Tool) and a common field-based methods (BANCS) were compared. The dataset allowed comparison of results from three tools and multiple users on three streams. The DNR Static Lateral Migration Tool was applied to three streams by one user, and to the Whitewater River by a second. The BBE Dynamic Lateral Migration Tool was applied to the Buffalo River by a third user. The BANCS tool was applied to three streams by a group of users, and to the Whitewater River by another group. The reach breaks for the DNR Static Lateral Migration Tool were chosen to allow comparison of erosion rates to reach-specific variables. The reach breaks for the BBE Dynamic Lateral Migration Tool were at set distances. Generally, the erosion rates across all tools, user groups and streams were between 0 and 0.6 meters (0 and 2 feet) per year, though some results were higher. All GIS-based tools and users returned erosion rates near or under 1.2 meters (4 feet) per year, with maximum BANCS results near 1.8 meters (6 feet) per year or more. The erosion data allowed for customization of a stream bank erosion prediction graph for comparable Minnesota streams. Third, using GIS, the lateral erosion rates of nearly 240 reaches of the three streams were compared to other stream characteristics. These characteristics included vegetation type, eroded area, reach length, valley length, sinuosity, water surface slope, low bank slope, high bank slope, water surface elevation, low bank elevation, high bank elevation, low bank height, high bank height, bankfull width, radius of curvature, near bank stress, stream mile (size), curve count, curve length, wetland presence, geomorphology, soils, and erosion to bankfull ratio. Of the measurements available to a GIS-user, near bank stress, and stream size were most correlated to erosion rate in these systems. Finally, a few of the values associated with Minnesota’s water economy are linked to the costs of preventative policy, and reactive restorations. Due to the local need for an accurate picture of erosion drivers and erosion rates, and for an efficient restoration prioritization tool, the University of Minnesota partnered with the Minnesota Department of Agriculture. The work can inform policy and restoration efforts

2018-2019

Contains information on courses and class descriptions as well as campus resources at Collin College.https://digitalcommons.collin.edu/catalogs/1030/thumbnail.jp

Air Force Institute of Technology Research Report 2019

This Research Report presents the FY19 research statistics and contributions of the Graduate School of Engineering and Management (EN) at AFIT. AFIT research interests and faculty expertise cover a broad spectrum of technical areas related to USAF needs, as reflected by the range of topics addressed in the faculty and student publications listed in this report. In most cases, the research work reported herein is directly sponsored by one or more USAF or DOD agencies. AFIT welcomes the opportunity to conduct research on additional topics of interest to the USAF, DOD, and other federal organizations when adequate manpower and financial resources are available and/or provided by a sponsor. In addition, AFIT provides research collaboration and technology transfer benefits to the public through Cooperative Research and Development Agreements (CRADAs). Interested individuals may discuss ideas for new research collaborations, potential CRADAs, or research proposals with individual faculty using the contact information in this document