13 research outputs found
The impact of dynamic capabilities on service innovation and business performance : a case study on cram schools
No full text碩士「服務創新」是近年來廣受重視的議題。2007年《BusinessWeek》便為文指出服務創新將是產業界的「下一件大事（next big thing）」。Subramanian and Nilakanta（1996）指出服務創新可以帶來競爭優勢、高的市場占有率、較佳的顧客成長率，提升營運效能，對整體績效有所增益。McMillan et al.（2000）則指出廠商能持續的開發出新產品或服務，是導因於企業所擁有之動態能耐。
近年來由於多元化的教育與少子化的衝擊下，雖促使補教業的興起，但隨著教育環境的改變，國內補教業者不斷藉由服務創新以因應消費者的需求，並維持競爭優勢。但是也有些業者過於注重創新，反而容易輕忽原本核心能力的維持，甚至為了某一項的創新作為而傷害到整體服務品質。
本研究採質化研究，針對大台北地區四家知名大型升學文理補習班進行個案研究，其中分別為以傳統勤教嚴管考試導向的老牌補習班、以學生導向重視差異化授課活潑生動的新銳名師補習班、全面將資訊科技融入教學以效率掛帥的補習班、結合線上與線下虛實整合的補習班等，透過文獻歸納與深度訪談的方式，從動態能耐觀點來探討補教業的服務創新具體作為，進而檢視其對補教業經營績效之影響，以提出具體的研究命題以作為補教業者經營管理上的參考建議。
研究後推導出命題如下:
一、領導者的人格特質與領導風格會影響補習班動態能耐的累積，進而影響補習班的競爭優勢，所以經營者、高階主管，才是補習班培育動態能力的主體。
二、隨時調變人才與資源擷取能力會累積補習班的動態能耐，進而影響補習班的競爭優勢。
三、透過學習型組織的構建可克服補習班的組織思維慣性，有助於動態能耐的建構。
四、健全與公平的獎酬升遷制度可降低補習班人員的流動率，有助於補習班的知識管理系統的建構，增強員工的投入與組織經驗的傳承，有利於動態能力的維持。
五、補習班的動態能耐取決於組織內多種能力的相互依賴，模糊難仿，導致同業難以直接複製套用。
六、對現況不滿或遭受內外部環境的衝擊時，動態能耐則驅動了補習班的組織變革與服務創新作為。
七、從顧客角度出發的價值活動改良，才會形成有利的服務創新，進而提升補習班的經營績效。
在個案訪談中發現，經營者普遍認為「人才是企業最重要的戰略資源」，另外，如何藉由「組織學習」與「重置轉換資源」等概念，具體落實於企業全體員工，改變組織觀念與服務作為，提出以顧客角度出發的價值活動改良，才是影響經營績效之關鍵要素。期望能藉由此研究結論與建議，供後續研究作進一步的探討與驗證。Service innovation has got comprehensive attention in recent years. In 2007, an author in “Business Week” pointed out that service innovation will be the “next big thing” of industries. Subramanian and Nilakanta (1996) noted that service innovation can bring competitive advantages, higher market share, better customers growth rate and improve operational efficiency, and gain overall performance. McMillan et al. (2000) pointed out that manufacturers can continue to develop new products or services is due to the dynamic capability of enterprises.
In recent years, due to the pluralistic education viewpoints and the impact of low birth rate promote the rise of up of cram school. But as the educational environment keeps changing, in order to maintain competitive advantages, the cram schools had pushed innovative services to cope with the needs of market. But some companies had paid too much emphasis on innovation. It is easy to overlook the original core competence .Sometimes even hurt the overall quality of service just because for a particular innovation.
This study is a qualitative research and consists of four well-known large-scale cram schools in Taipei. Those four schools are case 1 using traditional ground-oriented teaching and strict examination, case 2 using veteran to guide teachers and teaching lively by emphasizing individual differences of students, case 3 using the information technology into teaching for getting the overall efficiency, and case 4 using online and offline integration of instructions for the learning situation.
Through in-depth interviews and literature review, with dynamic viewpoints to discuss how the dynamic capability can improve the service innovation , and then explore its impact on cram schools’ performance about teaching, and finally to propose some research proposition as the reference for the cram industry to improve the management.
After studying there are propositions derived as follows:
First, the personality and leadership style of leaders will affect the cumulative dynamic capability of the cram school, and thereby influence the competitive advantages, so that operators, executives, are the subjects of cram school to foster dynamic capabilities.
Second, it is necessary for cram school to modify the talent and resources capturing ability to affect the cumulative dynamic capability, and thereby influence the competitive advantage.
Third, by building a learning organization that can overcome the inertia of organization thinking of cram schools, and then help the construction of dynamic capability.
Fourth, a sound and fair reward and promotion system can reduce staff turnover rate, contribute to the construction of knowledge management system, enhance staff involvement and heritage of organizational experience, and help maintaining the dynamic capabilities.
Fifth, the dynamic capability of cram school depends on the interdependence of multiple abilities within the organization, and as it’s too fuzzy to intimate by other competitors.
Sixth, when facing the shock of the external environment or dissatisfaction with the current situation, the dynamic capability is driven force of the organizational change and service innovation.
Seventh, the improved activities of value with the customer orientation will form a favorable service innovation, thereby enhance operating performance.
By this case, we generally believe that "the talent is the most important strategic resource," In addition, how to implement concepts of " organizational learning "and" reset and translation of resources " on the entire staff and change the organizational and service concept, propose improved value activities , are the key factors of business performance.目 錄 I
圖目錄 III
表目錄 IV
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究問題與目的 11
第三節 研究流程與範圍 12
第二章 文獻探討 14
第一節 補教業的現況與趨勢 14
第二節 動態能耐的意涵 28
第三節 服務創新的意涵 42
第四節 經營績效的意涵 55
第五節 本研究各變項間之相關研究文獻 63
第三章 研究方法 66
第一節 研究架構 66
第二節 研究問題 67
第三節 研究方法之選擇 67
第四節 文獻資料分析法與訪談對象 68
第五節 研究變項之操作性定義與衡量 70
第六節 訪談大綱 72
第七節 本研究效度與信度 74
第四章 訪談記錄與研究發現 75
第一節 訪談個案與負責人簡介 76
第二節 提出研究命題 108
第五章 結論與建議 118
第一節 研究結論與討論 118
第二節 研究貢獻 129
第三節 研究限制與後續研究建議 131
表目錄
表1 近年國內學者對補習班的相關研究 24
表2 動態能耐定義分析表 31
表3 動態能耐衡量構面相關研究 34
表4 近年國內學者對動態能耐的相關研究 40
表5 服務創新定義分析表 44
表6 服務創新衡量構面與相關研究 48
表7 近年國內學者對服務創新的相關研究 49
表8 經營績效的定義分析表 56
表9 經營績效之衡量構面與相關研究 59
表10 近幾年國內學者對補教業經營績效的相關研究 61
表11 個案背景資料 69
表12 本研究效度與信度測試 74
表13 個案A補教機構的基本資料與服務內容表 76
表14 個案B補教機構的基本資料與服務內容表 78
表15 個案C補教機構的基本資料與服務內容表 80
表16 個案D補教機構的基本資料與服務內容表 82
表17 個案補習班的特色與競爭優勢表 87
表18 個案補教機構的動態能力分析表 93
表19 個案補教機構的動態能力細目分析表 94
表20 個案補教機構的創新服務分析表 106
圖目錄
圖1 全國各補習班集體報名學測人數統計圖 3
圖2 全國各縣市補習班異動登記總數統計圖 3
圖3 本研究流程圖 12
圖4 全國總生育率及出生數統計圖 15
圖5 全國各縣市立案補習班數統計圖 18
圖6 全國各縣市立案文理補習班數統計圖 18
圖7 全國各縣市立案文理補習班異動登記統計圖 20
圖8 全國各縣市立案文理補習班數註銷總數統計圖 20
圖9 服務創新模式架構圖 46
圖10 研究架構 66
圖11 個案A補教機構的基本資料與服務內容示意圖 77
圖12 個案B補教機構的基本資料與服務內容示意圖 79
圖13 個案C補教機構的基本資料與服務內容示意圖 81
圖14 個案D補教機構的基本資料與服務內容示意圖 83學號: 703610088, 學年度: 10
Perioperative covert stroke in patients undergoing non-cardiac surgery (NeuroVISION) : a prospective cohort study
No full text2
No full textTHE PALO ALTO TIMES
rt:ai.iMii ti »V
**ll l-lll V*- A TnOMPSOX
I J Mors aad Wiiprl.iuf-
aciscair-Tio** r*tk*_
SI-SO -a Y.trirPaldlB Adianc*. Othai
v.u. S2-00 a V«ar
SI.00 tor Sla tl- ml,.
FRIDAY, DECEMBER 3, 1897
Thanksgiving bus passed with
its usual blessings, and now for a
merry Christmas.
Winlcr brings shudders but
then, there is one consolation—our
water bills are decreased
"Rich in experience" will be the
fortune of tbe majority ojf thc returning Klondike!..
December has dawned and the
merry bells of Saula Claus will be
anxiously waited for by the
children.
It is sincerely hoped" that Ibe
rescue parties will arrive in time
to save the ice-bound whalers from
tbeir perilous position.
Holidays arc beginning tomak
things lively, aud merchants should
bear in mind that now is the
' proper lime to make odverlisirig a
feature.
WOMAN'S COLUMN
.i.iT.u -Y e 1 -.Mr O. ""I TII t»t>.
Tti- til'le-a*. married roufil* in th*
United Stilt—1 liv* ju-li oiii-ide tho town
ol Cape Porpoi**, Mlaa. They ar* Mr.
-in! Mm. J..-.-'.li Manual an.l It.ey have
il lo--ell»*r happily (or aa-renty-one
ytrar*. Their age* are on* tnindrad and
one ami nin.-ty -ight yean reaperlively.
The Sin. * t lira! re, in llerlin, haa Iwn
runted (or len yeara Wginning Septeni-
lier IrfSe, by Trail Naaolta Hnt.r* wlm
will 'eiinducl il uniiraly hy hen-elf,
another instant* o( Ihr lulvatieeinent ol
tier man wotnrn. Family coui.sltea will
I-.1 in thu nla-ih; 1 **|-< rim. tuxl*r tlie m-ts
nianrigeni.nl, antl than will h* nl iiurh
a Icind lhat every aelinol |lrl ran enjoy
tlifiin without a hlnah,"
Friends ol Mii-4.latittAit.latin..o( Hull
House, Chicago, havo lately iirgnl
m bacon*, an ordalaad minUii-r.
is rejKirUil ai Mjlagl "I ''" not y.-l ace
lhe advantage* to my work il I were o
dained. I help prcaihera whenev
Ihpj * tali me lo All plll|iita nil Sunday,
Uti* doe* not Intelleie with' my
hate, 1 have apoketi al J-nltin l.li.y.l
M' Church: I have hel|*t*J |if.
T1ii.ii.rb and oil nm. I can e-i thia any
Sunday, ami am glad lo b* able to help,
Imt I am itol e-ertaln alwut the ad'-atit-
aget to I* gattKhlil 1 war* an urdainnl
preacher."
Tlie wheal queen ,il I'lraaantdale
towtiahip ami. ---rl.-tt*- ul Kurt, c.iuil>.
Kantaa.j* Min* Koaa Parkard. She ha*
hM Hit. -is tie*. I '.laal t.,i.l„-,. ul tflteBt ..III
In* till) acre-. in.tr.* to I-* tlitntictl on
her (arm. A Kanatu pap*, aay* "II
attni* of tl.. ..- titl. .1 It in.I. nl l.iin>- •-
learn o( lntr wh*r.*lKWla and good j i^'t oVmany yaara.
FOR THE HOLIDAYS.
The Fair carries a fine stock of*
toys for the bolidajy trade.
A. M.'Carrel, lhe harness dealer,
has added a line of xmas presents.,
Mctgttirc l(ros„wi!l carry a fine;
line of U>y5 for thc holiday trade.
11 W. Simkins has un display a
fine line of souvenirs which make
In .mt iln I holiday presents.
Nothing makes a finer Christmas
present for Eastern people than al
I--'-. ofTon-nscm)'.'California Glace '
fruits. B. F. 11 Till, the Pharmacist,]
hns them and be also carries a line
stock of Tow use nd's candies.
What lmt. lie-i-n your aipMiaiKia with
fountain peii.7 II yon hafe hail the
n-ni.il amount ol dinfitHit.fariiunyou will
Ik.' i-U'I lo get 11 few ntraiglil |«.iiili'i*> mi
Uwaobjact. Ihai nversl yoari esperi-!
int'iit Siiiikuif. the eiattnni-i. linn I..1111.I
thai th* gold pen points, mail* hv ■
Mabie, Todd A Ban], are Ihe u.oal uni-
It.runl. aalmfai-lur}'. '''lieteeH-carai gold ■
Iridium pointed |»n- uteuMtl exelunive- '
ly In tba 6-ran and Waterman (ounlaiu,
penn. Siiultin- kec|*- over on* hundred'
dollar* worth ul tht-Waterman pena fn
choo** linm.
I r.li.niir.- Hit- Home l-a_ii.tr > who can.
•bi you liral eta** work and t-.ill_ (or and .
deliver twice p*r week. The Stanford
liinri-ity l.niii.itt promptly an*»*rr*.
any |«-*tal eard.
I'.nu li* perauaded into buying liot-;
infill- without reputation or merit—!
('Iiaiiib-ilain'• Pain Halm tt re la no more
mul It-in-nt--lmt l-a.-ii intivrti by
Underwear
Men's,
Women's •'
CnildrenS
K. Vi. CHARLES. M. D.
Il.-n... ..[• j ll.l.l.
Oflice* l-rdyanl Building, I'alo Alto.Cal.
' HEALTH Orl'lCI'H.
— -T - DR. CHARI.I-S W. DECKER
Underwear SSffiU.,.,.
It is to be hoped tbat before the
close of the approaching year our
citi*.cuB will have rejoiced over
the advent of a modern sew
system.
Get yourself in readiness to discard yoitr bad habits and methods.
aud let them be replaced by ones
that will be not only n "credit lo
yourself bul to your fellow beings,
Wc suggest to those who are
making Christmas presents to remember that n years' suliseription
tothe Times would make.n good
present.
Thc display windows of oiir
different merchants ate artistically
sad tastefully arranged, ...id present to the passer-by :. sight Ibat
never fails to -make a favorable
impression.
The discharge of firearms in the
town limits is of frequent occurence of late. The small boy with
bis sling-shot is also n nuisance.
There is an ordinance against
these things which should be en
forced.
Tbe Supreme Court is to be
congratulated upon their.denial
of tbe application of I )nrunt
for a writ of mandate compelling
* Jndgc I'.ih: - to set a date for tbc
hearing of the Minnie Willipius
murder case.
Mr*. A. B, Pa
ll, who
li-rcn mentioned aa
tlm net
Mpe.'.-tor for llie
bin. incern
Cliinluo, hint ga
aad th.
The Call on- Dec. iqth will appear with a "Special New Bra Edi
tion" of sixty pages. It will contain numerous articles on Palo
Alto and also portray prominent
buildings. Iii fact it will take lbe
State lu generally. Tbr baud-
some colored cover will be a -drift
ing feature.
It,Mun.** they may tniiurtlialrly aail Im
thin country. We can «•*■*.lire tl<
tli.-ir voyajp* wintlil Im (ruilh-aa, aa Mn*
Packard L*-*li«vv*-in America lor Americana and Kanriaa [or Kanaai.
ii.i" already
( alreel ut-
district of
. conat'iit nl
Mayor Harrionn to Hit. organi-tati.ih ul
a "Clean City League." The pupil-, nl
tba public at-hnoiH rrlll.ba t-iigibh
Hit-tnlt.-n.liip iu tin-- If,ii'ii,- tin- llBOSt
ailv ot annil.ilton will U- tan-flit lln-in
uli-Tlliey .till lu> aakeel In olwerve tin*
ctindllionot llii'tttreelN ami alley* near
their hniuitt, nml tu nink.' dally repurir.
utml 1 in.I. Tun tn ami rltiea need mil
wail lo beeoiun aa large a* t<hiiagti lie
fnrt*- orgamriiig nml 1 a league. Si ln.nl
children in aevi'i-al Inealilier. have l.-.-n
taught to interenl llii-iima-lfe. in ' .. 1 ■
th.- aiilewalkn and atreela tre* from any
thing <it.cm.ivi-. or injurii.ui.Vacli attend*
ing to a eert-.ni aet-lion. In audi place*
one would not aee lying in front nl tlie
'RR-kitli.e' eti.li lorn from rinil.ipi*.
Mimrliin*** whole rnvrlnj*-*. aup wrap*
per* fr.uii pa|*-r*; along by Irmi -tiiil-
Uinana ami i*i-|-* akin- or ..range peel;
nor, in Hie roadway. Ini- ot broken
glaaa: iheac we«il.l all Im- pitted
proper nvepla.-le.
1'n.li-r tbe title "IVsj.:*- nol lilll*
thing*" ia lold thia atory. a plainlj
dtctMed woman wa* noliteel picking up
-..ii.eiiiui/ in tin* ttrei'l—a )*Mit alum
atrrel where raggeel, l«rrf.teied little
chfldrtn played. The policeman on tin
lieal ».iifl.i-.l her very clnaely and aaw
twraafaral tlmaa atoop. pick up *om*.
11.in.- ..11.! hlil* 11 In hrraiin.it. Finally*,
going In her. with 11 grurt^ voice and
Ihrealening mntiner lie .lenntii.I.-.l,
["What at*, yuu carrying ofl iu ytitti
1 apmnt" Tin* wtMiaa dM nol anawrr at
ii.-'i ami the potnrcn.-in. thinking abe
imiat have fniind mmi'iliing vahtabl*.
ifarsatanad Iwr with .-rr.-at Itahadtdnot
ahow him what ah* had in her apron.
Jrlli** oprnrtl it nud revcahsl a hnmtlul nl
lim.rii nin*. "Whul di. yon w^til nl
that -iliifTT" lie iiNkisl. She replied
thiiught IM like 10 t.i- 11 out of Hi
ail tht
Idn'n'a lift.'
11, e
.1
Oysters in any style at Hi-ninel's
restaurant, *
- .^ ^ »
Orders filled on short notice I >
C. Muller. tbe tailor, opposite Capitol Hold. Redwood City.
An elegant Hne of- ladies' and
children's all wool underwear, al ■
Fishman's. Mayfield.
__uinio«_ Hair Tonic at Larkin's
.-Barbershop, lt will'cure d-ind-
ruff and will .slop your hair from
' falling out. »
DO YOU READ MAOAZINES*
-imkina, the atationer'clabt. tugether i
tlarper'i fX>c* tVntnry [95c] At-!
. Untie [rI&c] Scribner'a |25e| Arena I*-.'***] j
Forum [I'-cl Review ol Reviews i-5c]1
CoaaiopoliUn 110c) MrrCtur*'* tlOc) j
Muaaey-fj , uv and generally'
othera and charge- 60 cent* a month j
.lor Trailing them all. Join the club.
It has been running lour yean and in
not an taxparltaeni.
would L-* uiucli *wei-ti-i if tai'lt'of ...
it mil.I In* ..refill in tatr the hare feet ol
the young -wild lhe weak.
"The limit of life jn brief,
Ti* the reel of llie tSd-ntaM |«al |
Tt* Ihr g..l.l in thr niti-et *kv ;
'Tin tlir Right of a bird on bigli.
. Vet *r may till Die •pan*
With -uiii an inflalt*-grace
Thai the 1 .si will *,iti all time.
The go 1.1 Ibfuugh ihr age* abinr,
And thr bud fit trill and *lraighl
To Ihe lih-r-a ol -Uott'a nan gatr.'
BAZAAR.
Sav* yoor trn crnta, two tula and dollar* ami conir --witd Ihrm with (h
ladieaof theChmtian Church at their
byahr IV.*. 15 and m.
ChrUloiaa pi*r*enta lhat will nil all
from the hatiira iu Ihr granduiolhrr* *
Ju-t thr ph-re lo bring your l-eat git
and Irral hrr to ie*erreaui, home in.i.le
camlie*. and hot taffy.
Nrw Kngl-frt nipper tho l.*<h from S
le*-.?) o'clock. (Couiftia coming 1.1 Ira.,
Tom ale* and clam chowder Hit* evening of the Ifttb.
I'tui't mi-"- thr .l.li..am- ira and thoac
cut*" .*u*m and •am-era In lhe
Japanaae l>ooth.
Good progTwiu each evening. Don't
mlaa tt.
Singers in t-rattutue will enltrtoln tbe
audier-ac*.
li tetter* at the
following ln.1'11 I. ii. Iti.l.*.. Hueneme.
Cal., art* n*Mtanlly la-ing rreeive.1:
"The I-.-.1 r.-nirsly Inr ]..i!i I lu.v.* mi
u". -.1 ia ClinnitHrl-tin'i. I'n in Italtii, nud I
■ay an aflrr having n-.-l it in mv family
for ae-vrrnl yritnt." lt enr-ett rhetliu-i-
liaui, lame luck, ntirmii*. anil iwclling*.
Fnr.iale by Hall's Palo Alto Pintrtimet'.
a ■»-.-»
Washing done id Rodger's Cottage, llotuei Avenue, Block 64.
9*4 W.J. Rohissos
' Have ynu seen Mullet's liew
fall nnd winter slock of ' suits*
They are the vcry latest, aiul his
prices nre down to bed rock.
Ladies OJYKITyl Combination Sails __ . *
' {every size a nd ara dc
Childrens Denton sleepin g gtt rm en ts
FERGUSON & CO.
Importers of Dry Goo-3,Punrnlshlni;a - Millinery*,
Neuo Store NetD Goods
FULLER & CO.
1,1 tl.lt.. t.s
Provisions, Crockery, /"* ...-.-R.-.-.-.t.c
glassware *^.oi octries
Choice Buttor and Eggs a Spoclnlty
Mill Feed. Smoked Meals, Etc.
|JR. tt'.-Ir. ADAMS
nirilKIUHKIlAU'S III-'l'i, STOKE
not us
IO lo I- a.ra. -■ 10 4 a*J 1 it, n p _,.
^ LBERT J. VILLAIN, M. li.
Lata Reaident Phytician and
Surjcaon, Fi-ach Uoapital S. F.
H. I.. LUCAtj
W. MI'ltlilMI
r-,-, j* D 1- l_ ' n 11
Painters and Polishers_>• PanPI' HrHlflinfl
Whitening and Tinting *-_rqpDI [Iflliyilty vm*iMK AND
iiVt'K r: AT €,. t\. I.l I *t** 1*1.1 HHIM. MHU'
|-J 11. I'lLLSBl-RV. M. I). .
lUai-iaidi
SURGEON
■l~R-,.l l!**ainali-4_*i
riif-nriibiii
SALYER & BOHLAND .
uu, .. — ... 4- I., .... _ * B1U IflCC- **«! it'litlieria - ■ i-|,-l. . I.unirr Bantl.
Oil slo
es ami blue
i'.nl;i:i- mi'-
flame beat
Hard war.
WANT AI1S.
HOARD 'AND ROOMS. '
1'lca-aiil omnia teilli U...t.l I ,r a
iin.re -in 1. ni- .it I lie Palo Altti II
Mr*.. (■. Kerne uroprirlnr.
26 West Santa Clara St. SAN JOSE; CAL
Sis to Order pE1*!
i-rnich Clay Id.
/"""( • red ImhiUctnymtlfl
Uriahs!* iHatnu u,,J Diabnu J/,/i,i_,.
Globe tailoring co.
GO V. Santa Cl_r. Si. SM JOSC. CAL
60 HAR11-TI*. PILLSIU'RV. M. 1)
Jl.SO ,
SPECIALTY.
5.00 DISEASES OF. WOMEN AND
. CHILDREN
At lb* IVrkim
uiana-mneiit. N*e*
Trruif* rra-on.tl.te.
Mn. 1
loUM-, under lira
Enr-Ian.l Ikonl.
E. K. THOITS,^'-
Fine ShOcs
LlHITtO WORKINCUEN'I UAK( A 3P.0IAt.TY
A Fur lur at Hat-tier a** Traai. Miof. la -.I-r-Il
lirne am) refi.lrtic-e COT.
av.-. apt) Itryanl I
W'lLLIAM T. RHOADS
AHOHIT-ICT
Poll II-.K1—Tii* hut
itn-fl, nirner of (-liann;
etipie.1 by Pmi, Warn
fully i.iMii-1,,,1. .Luui.i.
IM*. Applt on preiiu-
Palo Alt...
1 lo June 1*,,
ii th* Cai
For rent tiirni.heil
Kmotnlitti Cotlaaa
Aditlttnli. Villa,
. l-'.ii- further pariii-nliirn apply lo;
(.'liat.. K. Ilotliiv*. AreliitectN OflKe
Sianl.ir.l t'tiivercitj*.
H DAT FV ReaI Estate Aiie.it't;^-r:' — *u- * *
i. It. l/j^ll/lvl ,t.-.•.-. .viar-ip -Dx.oo-L.-t . f.iut ii.tu. t tl..
Rons— taa Ra-tit attti Bljill on.Hi. Inatalln-L-nt Plan "iNSURjVN-E
Qpice and Residence Near Denot Palo Alio Cal. < -K" *' **oss'
C. F. THIELE ..-■ .' ij=r:--
■FINE TAILORING »■ .,,;,,.,„.~_„s„ „„.,.„
SUIT -- 12.00UP *'»"• ""• "".-■"■"■.. ' »'Hp^.to*«iT^.*H-*_R
pants 4.00 u p "■ni.'..';;;.ol..l*...,„R,.
Foi I
FOR SALE.
:—A (jettlle enrmi:.- ho.*1
■.tillable fur a lit.ly lo drive. Inquire
Stanford Book Store or aililrrtw-l'. <
lltix MT. I'alo Alto.
I-'.,* Stilt—Tt»o*li.Htaril Inl'le*. al-n oite
lll-1-a 111-- la.i-1.11,- In -1 . All ill |..'lle.t
.iin.iili.m at rea-t.iiitl ralrn. Kor fnlh.-t
parli.'iilar* np'plt* loUM IVaat, Ite.tw.r--a
I'll), t-ahfnrma. I0-29tl
SPECIAL
BARGAINS IN REAL E STATE.
ti.-.iniiiiil home, HtaiiT of
lORooaM. Oawpcf Stnet,
Killi one quarter block of
land, ITieap. ('.-«'.
M**b,
■tight lota U'ebeier Street 50 b*. 150
eru-h. Block tl. ftODeaeh.
Cbanalag bona at Baa Oaijoa. Jl-irre
ttruundi Iti.-liK iiuprntt-al. • ill !-• -..kl
al Ara.rali.*-. 1.1400.
SObacrn aplemlUl -ttxk r«m*li. Lake
Countr, tkt.OO pet acre. .
Jews V. H v sau .Palo Alto- or 19 Moat*
aiii'mery -treet. San FranciM-o.
. .in i i in, Cal.
NOW
.._.. ■ . — ".is tht- sc.tsoii (or.Cegohs -ul Colds
HALL3-TAR1 WILD CHERRY
■\J.\KSIIAI.I. BltACK.
Is Ilia- Best Jouglt 'Alcdlclhc
I'alo Alto. C.I.
Because it is made right here, adapted to \\- ii. kem-oug. r«.«.. St. '<■
the needs of this locality, is not harmful ** * •
and helps every time.
PHYSICIAN AND SURGEON.
I ..i.nou «,. rr.r.t Rat... l-k.i
Hall's Pharmacy """ "r.:"""
.^ *' It. I.t.r l i . . i,..i tt ... t ll al
-.■-..LRPEIRE*
tM;: i-d Km
rjfijaTisT,
CEO. BLAKESLEY LITTLE. D D S
1,000, i
Two atorf l.otnie. tin*
.'JiH-atton. Tcrtni*. MOo.
1 eaah, bal an.** *a.'*f jn>t
In.*nire at Tutu ofli.e. -
Hu it ■*hole or in Iota tii-mt. ihe M. \V
Hi..* n tract i Homer l'.,: l adjolnlni
I'.ii,. \T..t Inqmr.'<il
I . i. -ivis ami :.s are nuMivnlttl in toU
.••...!]_■. -n,l .'^ill-V'ft.-!. r..r l.-ruir*
and unmet .avis*., write to Panl
lialte*. Rakerafield, Cal., owner. U
oppics
ibr narrUBBtldl Mg. -IT- •** lr
I'riiTisiiins.Cnicktrv.Glass- ,„
ware,WoodS \Villnw-«are -^-m. e. xobkis;
UllllAT, CORN, BRAN _ UAKI.liY
Fresh Butter and Eggs a Specialty s,u,y m' ui *""•"""'
OIVE OS A CAU. IX ihr
Palo Alto
P—d., *tIo-14u_. L4-.K., C4HU«.
M-tt .STOR1-.-O.N RAMt.NA 9TRBBT Agr-ta.nt., mc.naniullr -J
Mayfield
accurately dra* n
OFriOB. Nortrmr. mall, palo alt
CPD for teachers and effective schools
No full textPurpose: In Singapore, serious attempts have been made by the Government to develop a many layered, multi-faceted response, changing and adapting to shape long-term and productive responses. Another major societal change that gives impetus to teachers’ staff development in Singapore is the changing scene of Singapore society in terms of social structure, norms, aspirations, behaviours and values. All these mean that Singapore teachers will need to assume responsibility to grow as adult learners by participating actively in different types of CPD activities (Formal, Informal, Self-Directed and Nonformal Activities), to change their mindsets, to think, and to tailor solutions with Principals to school problems in order to succeed in their role as lifelong learners and change agents. The main purpose of this study is to find out teachers' needs, and school and CPD factors that influence their participation in CPD. It is also intended that the empirical data from schools can be integrated with findings from literature, together with the personal philosophy of the writer, into a comprehensive and effective school programme that meets the needs of Singapore primary schools in the 21st century. Design of the Study: The instrument that was used to collect data was self-constructed and designed with input from teachers and information gathered about CPD from literature. Part Two No 2 (1) was adapted from the 'Assessment of Performance of Teaching' (NIE) and from the instrument that was self-developed by the researcher for her M Ed paper (University of Sheffield, 1999) on 'An Induction Programme for Beginning Teachers in Singapore Primary Schools'. The Role of Principals scale and the CPD Activities scale were adapted from readings by Wideen and Andrews (1987) and an instrument used by Fesslar (1990) for his study on Principal and teacher behaviours towards CPD activities. The rest of the questionnaire was self-constructed based on the researchers' literature review. The final questionnaire comprised three main measures: (1) Personal Factors Measure, (2) School Factors Measure, (3) CPD Activities Measure. Personal Factors Measure The Personal Factors Scale was developed to measure teachers' perceptions about their needs or skills by age, gender and years of teaching experience. This comprised thirty-six items on six aspects namely, planning, managing, instructional techniques, interaction, assessing and providing feedback and relations with community. Qualitative data was obtained through an open-ended item on teachers’ perceptions of Personal Qualities of Good Teachers. This would give added information on teachers' perceptions of needs (or skills) as well as knowledge, attitudes and values of teachers that can effectively manage the educational changes
Effect of adequacy of empirical antibiotic therapy for hospital-acquired bloodstream infections on ICU patient prognosis: a causal inference approach using data from the Eurobact2 study
No full textObjectives: Hospital-acquired bloodstream infections (HA-BSI) in the intensive care unit (ICU) are common life-threatening events. We wanted to investigate the association between early adequate antibiotic therapy and 28-day mortality in ICU patients surviving for at least 1 day after the onset of HA-BSI. Methods: We used individual data from a prospective, observational, multicenter, intercontinental cohort study (Eurobact2). We included patients followed for ≥1 day for whom time-to-appropriate treatment was available. We used an adjusted frailty-Cox proportional hazard model to assess the effect of time-to-treatment-adequacy on 28-day mortality. Infection- and patient-related variables identified as confounders by the Directed Acyclic Graph were used for adjustment. Adequate therapy within 24 hours was used for primary analysis. Secondary analyses were performed for adequate therapy within 48 and 72 hours and for identified patient subgroups. Results: Among the 2,418 patients included in 330 centers worldwide, 28-day mortality was 32.8% (n=402/1226) in patients who were adequately treated within 24 hours after HA-BSI onset and 40% (n=477/1192) in inadequately treated patients (p<0.01). Adequacy within 24 hours was more common in young, immunosuppressed patients, and with HA-BSI due to Gram-negative pathogens. Antimicrobial adequacy was significantly associated with 28-day survival (aHR 0.83, 95% CI 0.72-0.96, p=0.01). The estimated population attributable fraction (PAF) of 28-day mortality of inadequate therapy was 9.15% (95% CI 1.9%-16.2%). Conclusions: In patients with HA-BSI admitted in ICU, the PAF of 28-day mortality of inadequate therapy within 24 hours was 9.15%. This estimate should be used when hypothesizing the possible benefit of any intervention aiming at reducing the time-to-appropriate antimicrobial therapy in HA-BSI
Presentation, management, and outcomes of older compared to younger adults with hospital-acquired bloodstream infections in the intensive care unit: a multicenter cohort study
No full textPurpose: Older adults admitted to the intensive care unit (ICU) usually have fair baseline functional capacity, yet their age and frailty may compromise their management. We compared the characteristics and management of older (≥ 75 years) versus younger adults hospitalized in ICU with hospital-acquired bloodstream infection (HA-BSI). Methods: Nested cohort study within the EUROBACT-2 database, a multinational prospective cohort study including adults (≥ 18 years) hospitalized in the ICU during 2019-2021. We compared older versus younger adults in terms of infection characteristics (clinical signs and symptoms, source, and microbiological data), management (imaging, source control, antimicrobial therapy), and outcomes (28-day mortality and hospital discharge). Results: Among 2111 individuals hospitalized in 219 ICUs with HA-BSI, 563 (27%) were ≥ 75 years old. Compared to younger patients, these individuals had higher comorbidity score and lower functional capacity; presented more often with a pulmonary, urinary, or unknown HA-BSI source; and had lower heart rate, blood pressure and temperature at presentation. Pathogens and resistance rates were similar in both groups. Differences in management included mainly lower rates of effective source control achievement among aged individuals. Older adults also had significantly higher day-28 mortality (50% versus 34%, p < 0.001), and lower rates of discharge from hospital (12% versus 20%, p < 0.001) by this time. Conclusions: Older adults with HA-BSI hospitalized in ICU have different baseline characteristics and source of infection compared to younger patients. Management of older adults differs mainly by lower probability to achieve source control. This should be targeted to improve outcomes among older ICU patients
The role of centre and country factors on process and outcome indicators in critically ill patients with hospital-acquired bloodstream infections
No full textPurpose: The primary objective of this study was to evaluate the associations between centre/country-based factors and two important process and outcome indicators in patients with hospital-acquired bloodstream infections (HABSI). Methods: We used data on HABSI from the prospective EUROBACT-2 study to evaluate the associations between centre/country factors on a process or an outcome indicator: adequacy of antimicrobial therapy within the first 24 h or 28-day mortality, respectively. Mixed logistical models with clustering by centre identified factors associated with both indicators. Results: Two thousand two hundred nine patients from two hundred one intensive care units (ICUs) were included in forty-seven countries. Overall, 51% (n = 1128) of patients received an adequate antimicrobial therapy and the 28-day mortality was 38% (n = 839). The availability of therapeutic drug monitoring (TDM) for aminoglycosides everyday [odds ratio (OR) 1.48, 95% confidence interval (CI) 1.03-2.14] or within a few hours (OR 1.79, 95% CI 1.34-2.38), surveillance cultures for multidrug-resistant organism carriage performed weekly (OR 1.45, 95% CI 1.09-1.93), and increasing Human Development Index (HDI) values were associated with adequate antimicrobial therapy. The presence of intermediate care beds (OR 0.63, 95% CI 0.47-0.84), TDM for aminoglycoside available everyday (OR 0.66, 95% CI 0.44-1.00) or within a few hours (OR 0.51, 95% CI 0.37-0.70), 24/7 consultation of clinical pharmacists (OR 0.67, 95% CI 0.47-0.95), percentage of vancomycin-resistant enterococci (VRE) between 10% and 25% in the ICU (OR 1.67, 95% CI 1.00-2.80), and decreasing HDI values were associated with 28-day mortality. Conclusion: Centre/country factors should be targeted for future interventions to improve management strategies and outcome of HABSI in ICU patients
Effect of adequacy of empirical antibiotic therapy for hospital-acquired bloodstream infections on intensive care unit patient prognosis: a causal inference approach using data from the Eurobact2 study
No full textPresentation, management, and outcomes of older compared to younger adults with hospital-acquired bloodstream infections in the intensive care unit: a multicenter cohort study
No full textEpidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study
No full textPurpose: In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials. Methods: We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021. Results: 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp. (20.3%), Escherichia coli (15.8%), and Pseudomonas spp. (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28. Conclusions: HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes
