A framework for improving the implementation of process based change

Merged with duplicate record 10026.1/2838 on 03.04.2017 by CS (TIS)This thesis is located within the field of Information Systems implementation. More specifically it focuses within Information Systems at the issues associated with implementation of business proves-based change. There is much evidence, both theoretical and empirical, to suggest that there are a high percentage of Information Systems and Business Process implementation failures (Meredith 1981, Lucas 1981, Walsham 1993, Land et al 1989). The aim of this thesis is twofold. Firstly to analyse the reasons behind the failures in process-based change implementations and secondly to provide a solution that will enable companies to overcome some of the problems and thus reduce the number of these failures. This research is based on a joint project between IBM PSS and the University if Plymouth. The research focuses specifically on the implementation of process-based change occurring in IBM Product Support Services (PSS). PSS is primarily responsible for the maintenance of IBM and non-IBM hardware and software and the selling of services associated with them. In order to understand what happens during implementation the researcher participated in three action research projects. All three projects were part of an IBM world-wide Business Process Re-engineering project called Customer Relationship Management. To ensure the validity of this action research process the researcher has closely followed the guidance compiled by Eden and Huxham. This research will present a framework that has been developed to improve the management of implementation projects. The framework is based on a synthesis of theoretical evidence and empirical findings. The empirical findings have been developed from investigating the reasons for failure in the three action research projects. All findings were analysed using the ‘Grounded Theory’ approach. The framework consists of five dominant themes, which are senior management commitment, analysis of problem situation, project planning and management, proves focus and user involvement. In the researchers view the problem of unsuccessful implementation is a complex one which may only begin to be improved when all the themes are addressed together as a whole. In order to test the themes of the framework a process for application was required. The process developed for using the framework involves applying a focus group at project initiation and questionnaires throughout the course of the project. The purpose of the focus group is to understand the themes of the themes of the framework within the context of the particular problem situation being investigated. The questionnaire is used to audit each theme of the framework to identify potential areas of implementation weakness. T-test analysis is carries out on the questionnaire results to measure whether any changes between questionnaires results are statistically significant. The framework was successfully applied to a fourth project. The T-test results indicated that applying the framework to the project throughout the course of the implementation had significantly improved the implementation. The originality of this research is in the framework and its application. This thesis will describe the history of implementation successes and failures at IBM, survey appropriate implementation theory and describe the synthesis and testing of the framework.IBM UK Ltd

Tourism as heritage: uncovering Hubert Bebb’s tourist vernacular in Gatlinburg.

According to Park visitor statistics Gatlinburg, Tennessee rates as the most heavily visited national park in the United States; as a gateway community and the official entrance to the Great Smoky Mountains National Park, its downtown landscape remains cemented in the minds of many across the nation. Through a context based visual analysis utilizing Maxwell’s two-way stretch theory, the researcher traced the origins and defining characteristics of this Gatlinburg aesthetic – the Tourist Vernacular – that evolved primarily through the work of one architect: Hubert Bebb. Through visual analysis, Bebb emerged as the key architect who, over the course of fifty years, not only created hybrids informed by the existing built environment of Gatlinburg, but inserted a new prototype and subsequent hybrids that came to define much of the downtown landscape. Bebb’s early work sits as a response to the buildings of the settlement school era, established in 1912. With precedents from this development, he augmented materials and forms to buildings in a time when government officials conceptualized and developed the Great Smoky Mountain National Park, authorized in 1926 and formally dedicated in 1940, an era characterized by a boom in construction as a result of increased tourism. His work is most particularly influential in the third quarter of the twentieth century when businesses and community leaders, including Bebb himself, shaped a place image consistent with visitor expectations. Utilizing Bebb’s Tourist Vernacular, designers and business leaders have transformed the built environment in the last several decades. Correspondingly, the aesthetic forms serve as the basis for such visionary changes as “The Greening of Gatlinburg” and the Gatlinburg Vision Statement, alongside the completion of studies and guidelines that affect the physical characteristics and visual aspects of the downtown, calling for authenticity in the evolved Tourist Vernacular. Touching on historical influences, this analysis speaks to a series of stylistic genre in Gatlinburg’s mid-twentieth century commercial buildings, while also linking to work that continues the aesthetics and philosophies of Bebb’s architectural endeavors. The study shows readers glimpses of one community’s evolving architectural lexicon shaped largely by tourist needs and expectations, thus providing a useful approach to other recreational landscapes throughout the nation

Beyond the Frame: A Study in Observational Documentary Ethics

Ethical questions are central to documentary studies. It has long been acknowledged that documentary practices have an ethical dimension for filmmakers, audiences and documentary participants. An ever-expanding body of literature academic, professional and popular speaks of a wide concern to understand and address the ethical issues raised by documentary filmmaking. Documentary ethics is a complex discourse, crossed by multiple and incommensurable obligations, rights and principles. The participant's right to privacy, audiences' right to know and the documentary filmmaker's need to tell a compelling story collide as filmmakers are called to 'weigh up' competing interests. Questions continue to be raised about the possibility of informed consent in documentary practice, appropriate levels of disclosure and the power relationship between filmmaker and participant. Despite the complexity of documentary ethics, this thesis argues that some questions fall beyond current boundaries. Specifically, the experience and meaning of documentary participation have not yet been considered. This research seeks to bring a fresh perspective to questions of ethics in documentary practice through empirical study of the practices and meanings of documentary production. In taking as its object of study documentary practice itself, this study seeks out the voice of the documentary participant, a voice that has too often been a central absence in debate in the ethics of documentary

High background rates of positive tuberculosis-specific interferon-? release assays in a low prevalence region of UK: a surveillance study

Background: Background rates of latent tuberculosis infection in low prevalence regions of Britain are unknown. These would be valuable data for interpreting positive IGRA results, and guiding cost-benefit analyses. The management of a large outbreak of tuberculosis occurring in a rural district hospital provided an opportunity to determine the background rates and epidemiology of IGRA-positivity amongst unselected hospital patients in a low-prevalence region of U.K.Methods: As part of a public health surveillance project we identified 445 individuals exposed to the index cases for clinical assessment and testing by a TB-specific interferon-? release assay (IGRA): T-Spot.TB. Uniquely, an additional comparator group of 191 age-matched individuals without specific recent exposure, but with a similar age distribution and demographic, were recruited from the same wards where exposure had previously occurred, to undergo assessment by questionnaire and IGRA. Results: Rates of IGRA positivity were 8.7% (95%CI, 4.2-13, n=149) amongst unexposed patients, 9.5%(3.0-22, n=21) amongst unexposed staff, 22%(14–29, n=130) amongst exposed patients, 11%(6.1-16, n=142) amongst exposed staff. Amongst the individuals without history of recent exposure to the outbreak, IGRA-positivity was associated with prior TB treatment (OR11, P.04) and corticosteroid use (OR5.9, P.02). Background age-specific prevalences of IGRA-positivity amongst unexposed individuals were: age <40 0%(N/A), age 40–59 15%(12–29), age 60–79 7.0%(1.1-13), age?80 10%(5.9-19).Conclusions: Background rates of IGRA-positivity remain high amongst unselected white-Caucasian hospital inpatients in U.K. These data will aid interpretation of future outbreak studies. As rates peak in the 5th and 6th decade, given an ageing population and increasing iatrogenic immunosuppression, reactivation of LTBI may be a persistent hazard in this population for several decades to come

Recruiting the next generation of rural healthcare practitioners: the impact of an online mentoring program on career and educational goals in rural youth

Introduction: There is increasing recognition that encouraging and supporting rural youth to pursue healthcare careers could be a promising strategy for addressing shortages of rural healthcare practitioners. Although rural students in health science programs often return to their home communities to practice, they continue to be underrepresented in these programs. Geographic isolation and small community sizes create barriers to entry for rural students, including a lack of educational and outreach services and a smaller pool of role models with experience in pursuing health science careers. Online mentoring has the potential to overcome these barriers by connecting rural youth with experienced role models from outside their communities; therefore, we tested whether this type of intervention could be used to increase interest in and guide rural youth towards rural healthcare careers. Methods: From 2016 to 2020, our intervention, Rural eMentoring BC, matched 364 youth in rural British Columbia to near-peer mentors enrolled in health science programs. Through an online platform, dyads discussed career and educational options and pathways through a semistructured curriculum consisting of eight units. To determine the likelihood of mentees pursuing a career in rural health care after participating in the program, we deployed pre- and post-unit surveys that evaluated their interest in the following areas: healthcare careers, post-secondary education, working rurally, and finding allies. After completing the program, 209 mentees were invited to complete a program evaluation, which consisted of short-answer questions intended to capture their overall impressions of the program. Results: After completing the career exploration unit, 63 students (out of the 103 who completed the unit) indicated that they were interested in healthcare careers, compared to 37 before. However, students' attitudes towards post-secondary education and finding allies did not change after completing those units, nor did their opinion of working rurally (although there was no unit dedicated to this topic). Encouragingly though, most already held positive opinions of these areas before entering the program. Of the 41 students who took our program evaluation, most viewed the program and their mentors favorably; discussion topics they found most useful included career exploration, learning life skills, and learning how to prepare for, and what to expect from, post-secondary education. Conclusion: This study suggests that online mentoring can direct rural youths' career interests toward, and provide a refreshing approach to imparting information about, healthcare professions. Although its longitudinal impacts need to be studied, the changes in attitudes and gains in knowledge observed while participating in this program put these students on the right track for eventually transitioning to health science programs. Arming rural youth with the knowledge and motivation to pursue healthcare careers through near-peer mentorship could be a unique strategy for increasing rural student representation in health science programs, and ultimately the number of rural healthcare professionals

Seven-year experience of a primary care antiretroviral treatment programme in Khayelitsha, South Africa.

OBJECTIVES: We report on outcomes after 7 years of a community-based antiretroviral therapy (ART) programme in Khayelitsha, South Africa, with death registry linkages to correct for mortality under-ascertainment. DESIGN: This is an observational cohort study. METHODS: Since inception, patient-level clinical data have been prospectively captured on-site into an electronic patient information system. Patients with available civil identification numbers who were lost to follow-up were matched with the national death registry to ascertain their vital status. Corrected mortality estimates weighted these patients to represent all patients lost to follow-up. CD4 cell count outcomes were reported conditioned on continuous virological suppression. RESULTS: Seven thousand, three hundred and twenty-three treatment-naive adults (68% women) started ART between 2001 and 2007, with annual enrolment increasing from 80 in 2001 to 2087 in 2006. Of 9.8% of patients lost to follow-up for at least 6 months, 32.8% had died. Corrected mortality was 20.9% at 5 years (95% confidence interval 17.9-24.3). Mortality fell over time as patients accessed care earlier (median CD4 cell count at enrolment increased from 43 cells/microl in 2001 to 131 cells/microl in 2006). Patients who remained virologically suppressed continued to gain CD4 cells at 5 years (median 22 cells/microl per 6 months). By 5 years, 14.0% of patients had failed virologically and 12.2% had been switched to second-line therapy. CONCLUSION: At a time of considerable debate about future global funding of ART programmes in resource-poor settings, this study has demonstrated substantial and durable clinical benefits for those able to access ART throughout this period, in spite of increasing loss to follow-up

Developing a COVID-19 Medical Respite Unit for Adults Experiencing Homelessness: Lessons Learned from an Interdisciplinary Community-Academic Partnership

Individuals experiencing homelessness are at particularly high risk for infection, severe illness, and death from COVID19. Local public health initiatives to address the pandemic should include medical respite services for individuals experiencing homelessness with documented or suspected COVID-19 infection, who are well enough to not be admitted to the hospital. We are a group of public health officials, clinicians, academics, and non-profit leaders who partnered with the City of New Haven, Connecticut to develop a COVID-19 medical respite program for people experiencing homelessness in our community. We seek to describe the key processes and challenges inherent to designing the COVID-19 respite including: the balance between patient autonomy and a public health agenda, how to deliver trauma informed, equitable, patient-centered, high quality care with low resources, and approaches to program evaluation.There is no funding specific to this article. This publication was made possible by the Yale National Clinician Scholars Program and by CTSA Grant Number TL1 TR001864 from the National Center for Advancing Translational Science (NCATS), a component of the National Institutes of Health (NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH.https://deepblue.lib.umich.edu/bitstream/2027.42/155396/1/Nash main article.pdfDescription of Nash main article.pdf : Main articl

Histologic Abnormalities in Children with Nonalcoholic Fatty Liver Disease and Normal or Mildly Elevated Alanine Aminotransferase Levels.

Objectives: To investigate the histological spectrum of nonalcoholic fatty liver disease (NAFLD) in children with normal, mildly elevated (26–50 U/L boys, 23–44 U/L girls), or elevated (> 50 boys, > 44 girls) serum alanine aminotransferase (ALT) levels. Study design: The Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN) enrolls children 5–18 years with NAFLD. We analyzed baseline clinical and histological data from 91 children with suspected NAFLD and normal or mildly elevated ALT and liver biopsy within 180 days of ALT, and compared them with 392 children with elevated ALT. Results: Of 91 children, 17 (19%) had normal and 74 (81%) had mildly elevated ALT levels. Overall, 45% of biopsies had ≥ 33% steatosis, lobular inflammation grade was ≥ 2 in 22%, 81% had portal inflammation, 29% had ballooned hepatocytes, 35% had “suspicious/borderline” steatohepatitis, and 8% had definite NASH, 34% had NAFLD activity score (NAS) ≥ 4. Overall, 46% had fibrosis (38% mild/moderate and 8% bridging/cirrhosis). Marked steatosis (50% vs 24%) and fibrosis (54% vs 12%) were significantly more common in mildly elevated vs normal, with no difference in ballooning, inflammation, or NAS ≥ 4. Fibrosis stage 3/4 was seen in none of the children with normal ALT, and in 9% of the mildly elevated and 15% of the elevated. Conclusions: Liver biopsies of children with NAFLD with normal or mildly elevated ALT levels show significant histologic abnormalities, including advanced fibrosis in children with mildly elevated ALT. ALT thus may underestimate liver injury in NAFLD. Appropriate ALT cut-off levels can help identify children at risk for more severe disease

An Assessment of Plant Species Differences on Cellulose Oxygen Isotopes From Two Kenai Peninsula, Alaska Peatlands: Implications for Hydroclimatic Reconstructions

Peat cores are valuable archives of past environmental change because they accumulate plant organic matter over millennia. While studies have primarily focused on physical, ecological, and some biogeochemical proxies, cores from peatlands have increasingly been used to interpret hydroclimatic change using stable isotope analyses of cellulose preserved in plant remains. Previous studies indicate that the stable oxygen isotope compositions (δ18O) preserved in alpha cellulose extracted from specific plant macrofossils reflect the δ18O values of past peatland water and thereby provide information on long-term changes in hydrology in response to climate. Oxygen isotope analyses of peat cellulose (δ18Ocellulose) have been successfully developed from peat cores that accumulate the same species for millennia. However, to fully exploit the potential of this proxy in species-diverse fens, studies are needed that account for the isotopic variations caused by changes in dominant species composition. This study assesses variation in δ18O values among peatland plant species and how they relate to environmental waters in two fens informally named Horse Trail and Goldfin, located on the leeward (dry) and windward (wet) side, respectively, of the climatic gradient across the Kenai Peninsula, Alaska. Environmental water δ18O values at both fens reflect unmodified δ18O values of mean annual precipitation, although at Goldfin standing pools were slightly influenced by evaporation. Modern plant [mosses and Carex spp. (sedges)] δ18Ocellulose values indicate that all Carex spp. are higher (~2.5‰) than those of mosses, likely driven by their vascular structure and ecophysiological difference from non-vascular mosses. Moss δ18Ocellulose values within each peatland are similar among the species, and differences appear related to evaporation effects on environmental waters within hummocks and hollows. The plant taxa-environmental water δ18O differences are applied to the previously determined Horse Trail Fen untreated bulk δ18O record. Results include significant changes to inferred millennial-to-centennial scale hydroclimatic trends where dominant taxa shift from moss to Carex spp., indicating that modern calibration datasets are necessary for interpreting stable isotopes from fens, containing a mix of vascular and nonvascular plants. Accounting for isotopic offsets through macrofossil analysis and modern plant-water isotope measurements opens new opportunities for hydroclimatic reconstructions from fen peatlands