BACKGROUND: Although collaborative team models (CTM) improve care processes and health outcomes, their diffusion poses challenges related to difficulties in securing their adoption by primary care clinicians. The objectives of this study are to understand: (1) how the perceived characteristics of a CTM influenced clinicians' decision to adopt -or not- the model; and (2) the model’s diffusion process. METHODS: We conducted a longitudinal case study based on the Diffusion of Innovations Theory. First, diffusion curves were developed for all 175 primary care physicians (PCPs) and 59 nurses practicing in one borough of Paris. Second, semi-structured interviews were conducted with a representative sample of 40 PCPs and 15 nurses to better understand the implementation dynamics. RESULTS: Diffusion curves showed that 3.5 years after the start of the implementation, 100% of nurses and over 80% of PCPs had adopted the CTM. The dynamics of the CTM’s diffusion were different between the PCPs and the nurses. The slopes of the two curves are also distinctly different. Among the nurses, the critical mass of adopters was attained faster, since they adopted the CTM earlier and more quickly than the PCPs. Results of the semi-structured interviews showed that these differences in diffusion dynamics were mostly founded in differences between the PCPs' and the nurses' perceptions of the CTM’s compatibility with norms, values and practices and its relative advantage (impact on patient management and work practices). Opinion leaders played a key role in the diffusion of the CTM among PCPs. CONCLUSION: CTM diffusion is a social phenomenon that requires a major commitment by clinicians and a willingness to take risks; the role of opinion leaders is key. Paying attention to the notion of a critical mass of adopters is essential to developing implementation strategies that will accelerate the adoption process by clinicians. Key-words: primary care, primary care physician, nurses, chronic disease, collaboration, health service research, diffusion of innovation.
Affective presence is a novel personality construct that describes the tendency of individuals to make their interaction partners feel similarly positive or negative. We adopt this construct, together with the input-process-output model of teamwork, to understand how team leaders influence team interaction and innovation performance. In 2 multisource studies, based on 350 individuals working in 87 teams of 2 public organizations and 734 individuals working in 69 teams of a private organization, we tested and supported hypotheses that team leader positive affective presence was positively related to team information sharing, whereas team leader negative affective presence was negatively related to the same team process. In turn, team information sharing was positively related to team innovation, mediating the effects of leader affective presence on this team output. The results indicate the value of adopting an interpersonal individual differences approach to understanding how affect-related characteristics of leaders influence interaction processes and complex performance in teams. (PsycINFO Database Record
Every year, a large number of children in the United States enter the foster care system. Many of them are eventually reunited with their biological parents or quickly adopted. A significant number, however, face long-term foster care, and some of these children are eventually adopted by their foster parents. The decision by foster parents to adopt their foster child carries significant economic consequences, including forfeiting foster care payments while also assuming responsibility for medical, legal, and educational expenses, to name a few. Since 1980, U.S. states have begun to offer adoption subsidies to offset some of these expenses, significantly lowering the cost of adopting a child who is in the foster care system. This article presents empirical evidence of the role that these economic incentives play in foster parents' decision of when, or if, to adopt their foster child. We find that adoption subsidies increase adoptions through two distinct price mechanisms: by lowering the absolute cost of adoption, and by lowering the relative cost of adoption versus long-term foster care.
- IEEE/ACM transactions on computational biology and bioinformatics / IEEE, ACM
- Published almost 5 years ago
In order to further improve the performance of tumor clustering from bio-molecular data, we introduce the fuzzy theory into the cluster ensemble framework for tumor clustering from bio-molecular data, and propose four kinds of hybrid fuzzy cluster ensemble frameworks, named as HFCEF-I, HFCEF-II, HFCEF-III and HFCEF-IV respectively, to identify samples which belong to different types of cancers. The difference between HFCEF-I and HFCEF-II is that they adopt different ensemble generator approaches to generate a set of fuzzy matrices in the ensemble. Specifically, HFCEF-I applies the affinity propagation algorithm (AP) to perform clustering on the sample dimension, and generates a set of fuzzy matrices in the ensemble based on the fuzzy membership function and base samples selected by AP. HFCEF-II adopts AP to perform clustering on the attribute dimension, generates a set of subspaces, and obtains a set of fuzzy matrices in the ensemble by performing fuzzy c-means on subspaces. Compared with HFCEF-I and HFCEF-II, HFCEF-III and HFCEF-IV consider the characteristics of HFCEF-I and HFCEF-II. HFCEF-III combines HFCEF-I and HFCEF-II in a serial way, while HFCEF-IV integrates HFCEF-I and HFCEF-II in a concurrent way.
Previous studies show that the healthcare industry lags behind many other economic sectors in the adoption of information technology. The purpose of this study is to understand differences in structural characteristics between providers that do and that do not adopt Health Information Technology (HIT) applications. Publicly available secondary data were used from three sources: American Hospital Association (AHA) annual survey, Healthcare Information and Management Systems Society (HIMSS) analytics annual survey, and Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) databases. Fifty-two information technologies were grouped into three clusters: clinical, administrative, and strategic decision making ITs. Negative binomial regression was applied with adoption of technology as the dependent variables and eight organizational and contextual factors as the independent variables. Hospitals adopt a relatively larger proportion of administrative information technology as compared to clinical and strategic IT. Large size, urban location and HMO penetration were found to be the most influential hospital characteristics that positively affect information technology adoption. There are still considerable variations in the adoption of information technology across hospitals and in the type of technology adopted. Organizational factors appear to be more influential than market factors when it comes to information technology adoption. The future research may examine whether the Electronic Health Record (EHR) Incentive Program in 2011 would increase the information technology uses in hospitals as it provides financial incentives for HER adoptions and uses among providers.
We examined the associations between attachment-related symptoms (symptoms of reactive attachment disorder (RAD), symptoms of disinhibited social engagement disorder (DSED), and clinging) and later psychological problems among international adoptees. The study population comprised internationally adopted children (591 boys and 768 girls, 6-15 years) from the ongoing Finnish Adoption (FinAdo) study. Data were gathered with self-administered questionnaires both from adoptive parents and from adoptees aged over 9 years. Attachment-related symptoms were measured using of a short (8-item) questionnaire and later behavioral/emotional problems were assessed using the Child Behavior Checklist (CBCL) and the Five to Fifteen (FTF) scale for attention-deficit/hyperactivity disorder (ADHD) symptoms. RAD and DSED symptom subscales were associated with an increased risk of emotional and behavioral problems and ADHD. Especially the mixed type of attachment-related symptoms was strongly associated with later emotional and behavioral problems.
The aversive state of social exclusion can result in a broad range of cognitive deficits. Being unable or unmotivated to process relevant information, we assumed that social exclusion would also affect the success of persuasive attempts. We hypothesized that socially excluded people would adopt attitudes regardless of persuasion quality. In three studies using different manipulations of social exclusion and persuasion, we showed that participants who were socially excluded adopted persuasive messages regardless of argument quality. In contrast, this undifferentiated response was not shown by socially included participants who were more persuaded by high compared to low quality arguments. In Study 3, we moreover revealed that this pattern could only be replicated in reliable situations, that is, when the communicator appeared credible. These findings support the assumption that social exclusion can lead to reduced processing of information. (136 of 150 words).
Adoption of innovations, products or online services is commonly interpreted as a spreading process driven to large extent by social influence and conditioned by the needs and capacities of individuals. To model this process one usually introduces behavioural threshold mechanisms, which can give rise to the evolution of global cascades if the system satisfies a set of conditions. However, these models do not address temporal aspects of the emerging cascades, which in real systems may evolve through various pathways ranging from slow to rapid patterns. Here we fill this gap through the analysis and modelling of product adoption in the world’s largest voice over internet service, the social network of Skype. We provide empirical evidence about the heterogeneous distribution of fractional behavioural thresholds, which appears to be independent of the degree of adopting egos. We show that the structure of real-world adoption clusters is radically different from previous theoretical expectations, since vulnerable adoptions-induced by a single adopting neighbour-appear to be important only locally, while spontaneous adopters arriving at a constant rate and the involvement of unconcerned individuals govern the global emergence of social spreading.
Socialized wolves' relationship with humans is a much debated, but important question in light of dog domestication. Earlier findings reported no attachment to the caretaker at four months of age in a Strange Situation Test, while recently attachment to the caretaker was reported at a few weeks of age in a similar paradigm. To explore wolf-human relationship, we analysed behaviours of hand reared, extensively socialized wolves towards four visitor types: foster-parents, close acquaintances, persons met once before, and complete strangers during a greeting episode. As hypothesized, in the greeting context subjects showed more intense and friendly behaviour towards foster-parents, than other visitor types, which may reflect familiarity and affinity. However, differences were more pronounced in the group situation (at six months of age) than in the individual situation (at 12 and 24 months), suggesting that unique status of foster parents may become less distinct as wolves get older, while exploration of novel social agents is expressed more with older age. Fear related behaviour patterns were only found in the individual situation, mainly displayed towards strangers. We showed that, in case of extensively socialized wolves, distinctive affiliation and affinity towards the foster parent prevails into adulthood.
This paper compares the strength of intergenerational transmission of body mass index (BMI) and obesity in a sample of adoptees relative to a matched sample of biological children with similar observable characteristics. We find that BMI and obesity are strongly correlated among biological parent-child pairs, but there are no significant intergenerational associations in these health traits among adoptive parent-child pairs. The intergenerational elasticity of BMI for children to their parents is 0.2 in the matched biological sample, but indistinguishable from zero for adopted children with a standard error more than three times as large as the coefficient. Under reasonable assumptions, these findings indicate that the intergenerational transmission of BMI and obesity occurs primarily through genetic mechanisms. Additional analyses of transmission rates by parental gender and among step-parents and step-children support this conclusion. The role of determinants of BMI and obesity in the household environment in relation to our findings is discussed. Given the negative consequences of obesity on earnings and other economic measures, our results suggest that the genetic transmission of weight problems contributes substantially to intergenerational persistence in economic outcomes.