700 resultados para new knowledge for advancing practice in pain management


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PURPOSE: Myopia is a global public health issue; however, no information exists as to how potential myopia retardation strategies are being adopted globally. METHODS: A self-administrated, internet-based questionnaire was distributed in six languages, through professional bodies to eye care practitioners globally. The questions examined: awareness of increasing myopia prevalence, perceived efficacy and adoption of available strategies, and reasons for not adopting specific strategies. RESULTS: Of the 971 respondents, concern was higher (median 9/10) in Asia than in any other continent (7/10, p<0.001) and they considered themselves more active in implementing myopia control strategies (8/10) than Australasia and Europe (7/10), with North (4/10) and South America (5/10) being least proactive (p<0.001). Orthokeratology was perceived to be the most effective method of myopia control, followed by increased time outdoors and pharmaceutical approaches, with under-correction and single vision spectacles felt to be the least effective (p<0.05). Although significant intra-regional differences existed, overall most practitioners 67.5 (±37.8)% prescribed single vision spectacles or contact lenses as the primary mode of correction for myopic patients. The main justifications for their reluctance to prescribe alternatives to single vision refractive corrections were increased cost (35.6%), inadequate information (33.3%) and the unpredictability of outcomes (28.2%). CONCLUSIONS: Regardless of practitioners' awareness of the efficacy of myopia control techniques, the vast majority still prescribe single vision interventions to young myopes. In view of the increasing prevalence of myopia and existing evidence for interventions to slow myopia progression, clear guidelines for myopia management need to be established.

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A személyazonosság-menedzsment napjaink fontos kutatási területe mind elméleti, mind gyakorlati szempontból. A szakterületen megvalósuló együttműködés, elektronikus tudásáramoltatás és csere hosszú távon csak úgy képzelhető el, hogy az azonos módon történő értelmezést automatikus eszközök támogatják. A szerző cikkében azokat a kutatási tevékenységeket foglalja össze, amelyeket - felhasználva a tudásmenedzsment, a mesterséges intelligencia és az információtechnológia eszközeit - a személyazonosság-menedzsment terület fogalmi leképezésére, leírására használt fel. Kutatási célja olyan közös fogalmi bázis kialakítása volt személyazonosság-menedzsment területre, amely lehetővé teszi az őt körülvevő multidimenzionális környezet kezelését. A kutatás kapcsolódik a GUIDE kutatási projekthez is, amelynek a szerző résztvevője. ______________ Identity management is an important research field from theoretical and practical aspects as well. The task itself is not new, identification and authentication was necessary always in public administration and business life. Information Society offers new services for citizens, which dramatically change the way of administration and results additional risks and opportunities. The goal of the demonstrated research was to formulate a common basis for the identity management domain in order to support the management of the surrounding multidimensional environment. There is a need for capturing, mapping, processing knowledge concerning identity management in order to support reusability, interoperability; to help common sharing and understanding the domain and to avoid inconsistency. The paper summarizes research activities for the identification, conceptualisation and representation of domain knowledge related to identity management, using the results of knowledge management, artificial intelligence and information technology. I utilized the experiences of Guide project, in which I participate. The paper demonstrates, that domain ontologies could offer a proper solution for identity management domain conceptualisation.

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A dolgozat a beszállítónak az innovációban játszott szerepével kapcsolatos irodalmat rendszerezi, egy olyan kutatási keret kialakítása érdekében, amely túltekint a beszállítók innovációban szűken értelmezett szerepén. A szakirodalom elsősorban a beszállítók termékinnovációban játszott szerepével foglalkozik, ugyanakkor a beszerzési feladatok között számos más beszállítói kapcsolat menedzsmentje is szerepel, amelyek indirekt módon, de jelentős hatással lehetnek a vállalati versenyképesség alakulására. Célunk, építve az irodalom elemzés eredményeire és a Versenyképesség Kutatás adatainak elemzésére egy olyan keret kialakítása, melynek során ez a szerep és az ehhez alkalmazható eszközrendszer feltárható. _______________ This paper provides a literature review in order to build a theoretic framework which describes a broadened role of purchasing in innovation management. Literature deals in detail with the role of suppliers in new product development, however the role of purchasing in this process seldom is in focus. Our paper highlights those supplier relationships, which in an indirect way, but also support innovation, and through new solutions promote competitiveness. Built on literature results and survey data of Competitiveness Research Program of CUB, our aim was to initiate a research framework, in which it is possible to describe purchasing role in innovation and which may support identifying the appropriate means to be used.

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Long-term survival and growth depends on the firm’s ability to exploit its current competencies while exploring fundamentally new ones. Finding the balance between exploration and exploitation is called ambidexterity in the literature. This paper is a comprehensive review of organizational ambidexterity theory. Creating and maintaining the capacity to simultaneously pursue these contradictory activities is an extremely difficult managerial challenge. Although, several aspects are well-researched, especially structural and leadership solutions in large, multinational enterprises, but little is known about: (1) how ambidexterity forms in earlier growth stages? (2) What are the key drivers and elements of organizational context that makes organizations able to become ambidextrous? (3) What is the role of different managerial levels in this formation process? Reviewing the literature, in this article the author would like to introduce the paradox of exploration and exploitation, the tensions and different aspects of ambidexterity, the fields current stage and some important research gaps.

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In - Appraising Work Group Performance: New Productivity Opportunities in Hospitality Management – a discussion by Mark R. Edwards, Associate Professor, College of Engineering, Arizona State University and Leslie Edwards Cummings, Assistant Professor, College of Hotel Administration University of Nevada, Las Vegas; the authors initially provide: “Employee group performance variation accounts for a significant portion of the degree of productivity in the hotel, motel, and food service sectors of the hospitality industry. The authors discuss TEAMSG, a microcomputer based approach to appraising and interpreting group performance. TEAMSG appraisal allows an organization to profile and to evaluate groups, facilitating the targeting of training and development decisions and interventions, as well as the more equitable distribution of organizational rewards.” “The caliber of employee group performance is a major determinant in an organization's productivity and success within the hotel and food service industries,” Edwards and Cummings say. “Gaining accurate information about the quality of performance of such groups as organizational divisions, individual functional departments, or work groups can be as enlightening...” the authors further reveal. This perspective is especially important not only for strategic human resources planning purposes, but also for diagnosing development needs and for differentially distributing organizational rewards.” The authors will have you know, employee requirements in an unpredictable environment, which is what the hospitality industry largely is, are difficult to quantify. In an effort to measure elements of performance Edwards and Cummings look to TEAMSG, which is an acronym for Team Evaluation and Management System for Groups. They develop the concept. In discussing background for employees, Edwards and Cummings point-out that employees - at the individual level - must often possess and exercise varied skills. In group circumstances employees often work at locations outside of, or move from corporate unit-to-unit, as in the case of a project team. Being able to transcend individual-to-group mentality is imperative. “A solution which addresses the frustration and lack of motivation on the part of the employee is to coach, develop, appraise, and reward employees on the basis of group achievement,” say the authors. “An appraisal, effectively developed and interpreted, has at least three functions,” Edwards and Cummings suggest, and go on to define them. The authors do place a great emphasis on rewards and interventions to bolster the assertion set forth in their thesis statement. Edwards and Cummings warn that individual agendas can threaten, erode, and undermine group performance; there is no - I - in TEAM.

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The global prevalence of obesity in the older adult population is growing, an increasing concern in both the developed and developing countries of the world. The study of geriatric obesity and its management is a relatively new area of research, especially pertaining to those with elevated health risks. This review characterizes the state of science for this "fat and frail" population and identifies the many gaps in knowledge where future study is urgently needed. In community dwelling older adults, opportunities to improve both body weight and nutritional status are hampered by inadequate programs to identify and treat obesity, but where support programs exist, there are proven benefits. Nutritional status of the hospitalized older adult should be optimized to overcome the stressors of chronic disease, acute illness, and/or surgery. The least restrictive diets tailored to individual preferences while meeting each patient's nutritional needs will facilitate the energy required for mobility, respiratory sufficiency, immunocompentence, and wound healing. Complications of care due to obesity in the nursing home setting, especially in those with advanced physical and mental disabilities, are becoming more ubiquitous; in almost all of these situations, weight stability is advocated, as some evidence links weight loss with increased mortality. High quality interdisciplinary studies in a variety of settings are needed to identify standards of care and effective treatments for the most vulnerable obese older adults.

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Background: Sickle Cell Disease (SCD) is a genetic hematological disorder that affects more than 7 million people globally (NHLBI, 2009). It is estimated that 50% of adults with SCD experience pain on most days, with 1/3 experiencing chronic pain daily (Smith et al., 2008). Persons with SCD also experience higher levels of pain catastrophizing (feelings of helplessness, pain rumination and magnification) than other chronic pain conditions, which is associated with increases in pain intensity, pain behavior, analgesic consumption, frequency and duration of hospital visits, and with reduced daily activities (Sullivan, Bishop, & Pivik, 1995; Keefe et al., 2000; Gil et al., 1992 & 1993). Therefore effective interventions are needed that can successfully be used manage pain and pain-related outcomes (e.g., pain catastrophizing) in persons with SCD. A review of the literature demonstrated limited information regarding the feasibility and efficacy of non-pharmacological approaches for pain in persons with SCD, finding an average effect size of .33 on pain reduction across measurable non-pharmacological studies. Second, a prospective study on persons with SCD that received care for a vaso-occlusive crisis (VOC; N = 95) found: (1) high levels of patient reported depression (29%) and anxiety (34%), and (2) that unemployment was significantly associated with increased frequency of acute care encounters and hospital admissions per person. Research suggests that one promising category of non-pharmacological interventions for managing both physical and affective components of pain are Mindfulness-based Interventions (MBIs; Thompson et al., 2010; Cox et al., 2013). The primary goal of this dissertation was thus to develop and test the feasibility, acceptability, and efficacy of a telephonic MBI for pain catastrophizing in persons with SCD and chronic pain.

Methods: First, a telephonic MBI was developed through an informal process that involved iterative feedback from patients, clinical experts in SCD and pain management, social workers, psychologists, and mindfulness clinicians. Through this process, relevant topics and skills were selected to adapt in each MBI session. Second, a pilot randomized controlled trial was conducted to test the feasibility, acceptability, and efficacy of the telephonic MBI for pain catastrophizing in persons with SCD and chronic pain. Acceptability and feasibility were determined by assessment of recruitment, attrition, dropout, and refusal rates (including refusal reasons), along with semi-structured interviews with nine randomly selected patients at the end of study. Participants completed assessments at baseline, Week 1, 3, and 6 to assess efficacy of the intervention on decreasing pain catastrophizing and other pain-related outcomes.

Results: A telephonic MBI is feasible and acceptable for persons with SCD and chronic pain. Seventy-eight patients with SCD and chronic pain were approached, and 76% (N = 60) were enrolled and randomized. The MBI attendance rate, approximately 57% of participants completing at least four mindfulness sessions, was deemed acceptable, and participants that received the telephonic MBI described it as acceptable, easy to access, and consume in post-intervention interviews. The amount of missing data was undesirable (MBI condition, 40%; control condition, 25%), but fell within the range of expected missing outcome data for a RCT with multiple follow-up assessments. Efficacy of the MBI on pain catastrophizing could not be determined due to small sample size and degree of missing data, but trajectory analyses conducted for the MBI condition only trended in the right direction and pain catastrophizing approached statistically significance.

Conclusion: Overall results showed that at telephonic group-based MBI is acceptable and feasible for persons with SCD and chronic pain. Though the study was not able to determine treatment efficacy nor powered to detect a statistically significant difference between conditions, participants (1) described the intervention as acceptable, and (2) the observed effect sizes for the MBI condition demonstrated large effects of the MBI on pain catastrophizing, mental health, and physical health. Replication of this MBI study with a larger sample size, active control group, and additional assessments at the end of each week (e.g., Week 1 through Week 6) is needed to determine treatment efficacy. Many lessons were learned that will guide the development of future studies including which MBI strategies were most helpful, methods to encourage continued participation, and how to improve data capture.

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Background: Pain management is a cornerstone of palliative care. The clinical issues encountered by physicians when managing pain in patients dying with advanced dementia, and how these may impact on prescribing and treatment, are unknown. Aim: To explore physicians’ experiences of pain management for patients nearing the end of life, the impact of these on prescribing and treatment approaches, and the methods employed to overcome these challenges. Design: Qualitative, semi-structured interview study exploring: barriers to and facilitators of pain management, prescribing and treatment decisions, and training needs. Thematic analysis was used to elicit key themes. Settings/Participants: Twenty-three physicians, responsible for treating patients with advanced dementia approaching the end of life, were recruited from primary care (n=9), psychiatry (n=7) and hospice care (n=7). Results: Six themes emerged: diagnosing pain, complex prescribing and treatment approaches, side-effects and adverse events, route of administration, importance of sharing knowledge and training needs. Knowledge exchange was often practised through liaison with physicians from other specialties. Cross-specialty mentoring, and the creation of knowledge networks were believed to improve pain management in this patient population. Conclusions: Pain management in end-stage dementia is complex, requiring cross-population of knowledge between palliative care specialists and non-specialists, in addition to collateral information provided by other health professionals and patients’ families. Regular, cost- and time-effective mentoring and ongoing professional development are perceived to be essential in empowering physicians to meet clinical challenges in this area.

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Thesis (Ph.D.)--University of Washington, 2016-08

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Résumé: Cette recherche s'est réalisée dans une institution chinoise de formation des adultes. Il existe très peu d'études présentant la pratique de l'enseignement et de l'apprentissage en Chine. Aussi, il semble que cette étude de cas puisse être utile. Elle porte sur le personnel de formation en administration économique dans un centre de formation de Tianjin. Le but premier de cette recherche est de décrire ce qui se fait à cet institut de formation des adultes. Les aspects couverts vont de la sélection du contenu de formation et des modalités d'enseignement jusqu'à la compréhension de l'enseignement et de l'apprentissage. À partir de l'expérience des professeurs de ce centre de Tianjin, cette étude cherche précisément à décrire leurs perceptions et leurs attitudes en regard d'un enseignement centré sur l'apprentissage et développé selon un mode de collaboration. Les fondements théoriques retenus s'inspirent des conceptions andragogiques de Knowles, de celles de Brookfield qui ont trait aux rôles des formateurs et formatrices d'adultes et de Conti qui présente une conception de l'enseignement qui se développe selon un mode de collaboration. Les données sont été retenues à la suite d'interviews et de questionnaires. Ce dernier instrument a été administré à 70 professeurs de formation aux adultes. Les résultats obtenus sont décrits et analysés. Les principaux éléments indiquent que la pratique actuelle de formation des adultes à ce centre de Tianjin ne tient pas compte des principes de l'éducation des adultes présenté selon un mode de collaboration. La formation est centrée sur l'enseignement. Il est à souhaiter que cette recherche contribuera à développer une meilleure compréhension de l'enseignement et de l'apprentissage en Chine tel que perçus par les formateurs et formatrices. Quelques suggestions de recherche complémentaires sont proposées à la fin.||Abstract: The present study grew out of one Chinese adult institute. Relatively few works are available that present a view of what actually happens in Chinese adult teaching and learning practice. Accordingly, it is believed that a case study on Tianjin Institute of Training Economic Management Personnel (TITEMP) which has been working for years in varions forms of adult programs, will be very useful addition to the knowledge of Chinese adult teaching and learning. The primary purpose of the present study is to serve as an introduction to one Chinese adult institute (TITEMP) in terms of characteristics of teaching, including selecting teaching content and teaching pattern, and to expand the understanding of Chinese adult teaching and learning. Based on the experiences of teachers at TITEMP, the study seeks to investigate the issues of teacher's perceptions and attitudes of teaching and learning to obtain implications toward learning-centred and collaborative mode. The theoretical foundations include andragogical conceptions (Knowles), roles of adult teachers (Brookfield), and conceptions of collaborative teaching and learning mode (Conti). The main sources of data are: the interviews and results of the questionnaire. Questionnaire responses from 70 teachers with knowledge of adult teaching and learning are described and interpreted. The general findings of the study are that the existing adult teaching practice at TITEMP does not adequately account for the principles of adult learning in a collaborative mode with adult students. Adult learning is teaching-centred. Some suggestions for further research are offered. It is hoped and believed that this research will contribute to a better understanding of Chinese adult teaching and learning in general, more particularly to the empirical study of the teachers from teaching and learning perspective in a Chinese adult higher learning setting. The research findings will be used as basis for the exploration of Chinese adult teaching.

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The goal of this study was to understand how and whether policy and practice relating to violence against women in Uganda, especially Uganda’s Domestic Violence Act of 2010, have had an effect on women’s beliefs and practices, as well as on support and justice for women who experience abuse by their male partners. Research used multi-sited ethnography at transnational, national, and local levels to understand the context that affects what policies are developed, how they are implemented, and how, and whether, women benefit from these. Ethnography within a local community situated global and national dynamics within the lives of women. Women who experience VAW within their intimate partnerships in Uganda confront a political economy that undermines their access to justice, even as a women’s rights agenda is working to develop and implement laws, policies, and interventions that promote gender equality and women’s empowerment. This dissertation provides insights into the daily struggles of women who try to utilize policy that challenges duty bearers, in part because it is a new law, but also because it conflicts with the structural patriarchy that is engrained in Ugandan society. Two explanatory models were developed. One explains factors relating to a woman’s decision to seek support or to report domestic violence. The second explains why women do and do not report DV. Among the findings is that a woman is most likely to report abuse under the following circumstances: 1) her own, or her children’s survival (physical or economic) is severely threatened; 2) she experiences severe physical abuse; or, 3) she needs financial support for her children. Research highlights three supportive factors for women who persist in reporting DV. These are: 1) the presence of an “advocate” or support 2) belief that reporting will be helpful; and, 3) lack of interest in returning to the relationship. This dissertation speaks to the role that anthropologists can play in a multi-disciplinary approach to a complex issue. This role is understanding – deeply and holistically; and, articulating knowledge generated locally that provides connections between what happens at global, national and local levels.

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Employees are the human capital which, to a great extent, contributes to the success and development of high-performance and sustainable organizations. In a work environment, there is a need to provide a tool for tracking and following-up on each employees' professional progress, while staying aligned with the organization’s strategic and operational goals and objectives. The research work within this Thesis aims to contribute to improve employees' selfawareness and auto-regulation; two predominant research areas are also studied and analyzed: Visual Analytics and Gamification. The Visual Analytics enables the specification of personalized dashboard interfaces with alerts and indicators to keep employees aware of their skills and to continuously monitor how to improve their expertise, promoting simultaneously behavioral change and adoption of good-practices. The study of Gamification techniques with Talent Management features enabled the design of new processes to engage, motivate, and retain highly productive employees, and to foster a competitive working environment, where employees are encouraged to be involved in new and rewarding activities, where knowledge and experience are recognized as a relevant asset. The Design Science Research was selected as the research methodology; the creation of new knowledge is therefore based on an iterative cycle addressing concepts such as design, analysis, reflection, and abstraction. By collaborating in an international project (Active@Work), funded by the Active and Assisted Living Programme, the results followed a design thinking approach regarding the specification of the structure and behavior of the Skills Development Module, namely the identification of requirements and the design of an innovative info-structure of metadata to support the user experience. A set of mockups were designed based on the user role and main concerns. Such approach enabled the conceptualization of a solution to proactively assist the management and assessment of skills in a personalized and dynamic way. The outcomes of this Thesis aims to demonstrate the existing articulation between emerging research areas such as Visual Analytics and Gamification, expecting to represent conceptual gains in these two research fields.

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The fibroblast growth factor (FGF) family consists of 22 evolutionarily and structurally related proteins (FGF1 to FGF23; with FGF15 being the rodent ortholog of human FGF19). Based on their mechanism of action, FGFs can be categorized into intracrine, autocrine/paracrine and endocrine subgroups. Both autocrine/paracrine and endocrine FGFs are secreted from their cells of origin and exert their effects on target cells by binding to and activating specific single-pass transmembrane tyrosine kinase receptors (FGFRs). Moreover, FGF binding to FGFRs requires specific cofactors, namely heparin/heparan sulfate proteoglycans or Klothos for autocrine/paracrine and endocrine FGF signaling, respectively. FGFs are vital for embryonic development and mediate a broad spectrum of biological functions, ranging from cellular excitability to angiogenesis and tissue regeneration. Over the past decade certain FGFs (e.g. FGF1, FGF10, FGF15/FGF19 and FGF21) have been further recognized as regulators of energy homeostasis, metabolism and adipogenesis, constituting novel therapeutic targets for obesity and obesity-related cardiometabolic disease. Until recently, translational research has been mainly focused on FGF21, due to the pleiotropic, beneficial metabolic actions and the relatively benign safety profile of its engineered variants. However, increasing evidence regarding the role of additional FGFs in the regulation of metabolic homeostasis and recent developments regarding novel, engineered FGF variants have revitalized the research interest into the therapeutic potential of certain additional FGFs (e.g. FGF1 and FGF15/FGF19). This review presents a brief overview of the FGF family, describing the mode of action of the different FGFs subgroups, and focuses on FGF1 and FGF15/FGF19, which appear to also represent promising new targets for the treatment of obesity and type 2 diabetes.

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The thesis describes three studies concerning the role of the Economic Preference set investigated in the Global Preference Survey (GPS) in the following cases: 1) the needs of women with breast cancer; 2) pain undertreament in oncology; 3) legal status of euthanasia and assisted suicide. The analyses, based on regression techniques, were always conducted on the basis of aggregate data and revealed in all cases a possible role of the Economic Preferences studied, also resisting the concomitant effect of the other covariates that were considered from time to time. Regarding individual studies, the related conclusion are: 1) Economic Preferences appear to play a role in influencing the needs of women with breast cancer, albeit of non-trivial interpretation, statistically "resisting" the concomitant effect of the other independent variables considered. However, these results should be considered preliminary and need further confirmation, possibly with prospective studies conducted at the level of the individual; 2) the results show a good degree of internal consistency with regard to pro-social GPS scores, since they are all found to be non-statistically significant and united, albeit only weakly in trend, by a negative correlation with the % of pain undertreated patients. Sharper, at least statistically, is the role of Patience and Willingness to Take Risk, although of more complex empirical interpretation. 3) the results seem to indicate an obvious role of Economic Preferences, however difficult to interpret empirically. Less evidence, at least on the inferential level, emerged, however, regarding variables that, based on common sense, should play an even more obvious role than Economic Preferences in orienting attitudes toward euthanasia and assisted suicide, namely Healthcare System, Legal Origin, and Kinship Tightness; striking, in particular, is the inability to prove a role for the dominant religious orientation even with a simple bivariate analysis.

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Ill-conditioned inverse problems frequently arise in life sciences, particularly in the context of image deblurring and medical image reconstruction. These problems have been addressed through iterative variational algorithms, which regularize the reconstruction by adding prior knowledge about the problem's solution. Despite the theoretical reliability of these methods, their practical utility is constrained by the time required to converge. Recently, the advent of neural networks allowed the development of reconstruction algorithms that can compute highly accurate solutions with minimal time demands. Regrettably, it is well-known that neural networks are sensitive to unexpected noise, and the quality of their reconstructions quickly deteriorates when the input is slightly perturbed. Modern efforts to address this challenge have led to the creation of massive neural network architectures, but this approach is unsustainable from both ecological and economic standpoints. The recently introduced GreenAI paradigm argues that developing sustainable neural network models is essential for practical applications. In this thesis, we aim to bridge the gap between theory and practice by introducing a novel framework that combines the reliability of model-based iterative algorithms with the speed and accuracy of end-to-end neural networks. Additionally, we demonstrate that our framework yields results comparable to state-of-the-art methods while using relatively small, sustainable models. In the first part of this thesis, we discuss the proposed framework from a theoretical perspective. We provide an extension of classical regularization theory, applicable in scenarios where neural networks are employed to solve inverse problems, and we show there exists a trade-off between accuracy and stability. Furthermore, we demonstrate the effectiveness of our methods in common life science-related scenarios. In the second part of the thesis, we initiate an exploration extending the proposed method into the probabilistic domain. We analyze some properties of deep generative models, revealing their potential applicability in addressing ill-posed inverse problems.