Influence of socioeconomic factors on delays, management and outcome amongst patients with acute myocardial infarction undergoing primary percutaneous coronary intervention.

The outcome after primary percutaneous coronary intervention (pPCI) for ST-elevation myocardial infarction (STEMI) is strongly affected by time delays. In this study, we sought to identify the impact of specific socioeconomic factors on time delays, subsequent STEMI management and outcomes in STEMI patients undergoing pPCI, who came from a well-defined region of the French part of Switzerland. A total of 402 consecutive patients undergoing pPCI for STEMI in a large tertiary hospital were retrospectively studied. Symptom-to-first-medical-contact time was analysed for the following socioeconomic factors: level of education, origin and marital status. Main exclusion criteria were: time delay beyond 12 hours, previous treatment with fibrinolytic agents or patients immediately referred for coronary artery bypass graft surgery. Therefore, 222 patients were finally included. At 1 year, there was no difference in mortality between the different socioeconomic groups. Furthermore, there was no difference in management characteristics between them. Symptom-to-first-medical-contact time was significantly longer for patients with a low level of education, Swiss citizens and unmarried patients, with median differences of 23 minutes, 18 minutes and 13 minutes, respectively (p <0.05). Nevertheless, no difference was found regarding in-hospital management and clinical outcome. This study demonstrates that symptom-to-first-medical-contact time is longer amongst people with a lower educational level, Swiss citizens and unmarried people. Because of the low mortality rate in general, these differences in delays did not affect clinical outcomes. Still, tertiary prevention measures should particularly focus on these vulnerable populations.

Regional differences in self-reported screening, prevalence and management of cardiovascular risk factors in Switzerland.

BACKGROUND: In Switzerland, health policies are decided at the local level, but little is known regarding their impact on the screening and management of cardiovascular risk factors (CVRFs). We thus aimed at assessing geographical levels of CVRFs in Switzerland.¦METHODS: Swiss Health Survey for 2007 (N = 17,879). Seven administrative regions were defined: West (Leman), West-Central (Mittelland), Zurich, South (Ticino), North-West, East and Central Switzerland. Obesity, smoking, hypertension, dyslipidemia and diabetes prevalence, treatment and screening within the last 12 months were assessed by interview.¦RESULTS: After multivariate adjustment for age, gender, educational level, marital status and Swiss citizenship, no significant differences were found between regions regarding prevalence of obesity or current smoking. Similarly, no differences were found regarding hypertension screening and prevalence. Two thirds of subjects who had been told they had high blood pressure were treated, the lowest treatment rates being found in East Switzerland: odds-ratio and [95% confidence interval] 0.65 [0.50-0.85]. Screening for hypercholesterolemia was more frequently reported in French (Leman) and Italian (Ticino) speaking regions. Four out of ten participants who had been told they had high cholesterol levels were treated and the lowest treatment rates were found in German-speaking regions. Screening for diabetes was higher in Ticino (1.24 [1.09 - 1.42]). Six out of ten participants who had been told they had diabetes were treated, the lowest treatment rates were found for German-speaking regions.¦CONCLUSIONS: In Switzerland, cardiovascular risk factor screening and management differ between regions and these differences cannot be accounted for by differences in populations' characteristics. Management of most cardiovascular risk factors could be improved.

Relating leadership, thinking styles, self-concept, motivation and stress management in education

Seventy-five principals and vice-.wincipals from public elementary and secondary schools in Hamilton, Ontario, Canada participated in this study. Participants provided ,information concerning their thinking styles, motivations, and the physical effects of stress. This information was examined to find out how satisfaction-oriented, and how security-oriented the thinking styles of the participants were. Second, the data were analysed to see how the thinking style orientations related to life style habits and the effects of stress. The satisfaction-oriented thinking styles scored higher than all of the security-oriented thinking styles by a wide margin with a small preference for the satisfaction-people-oriented styles labelled humanistic-helpful, and affiliative as opposed to the satisfaction-task-oriented styles labeled achievement, and self-actualizing. Although all eight of the security-oriented thinking styles scored well below all of the satisfaction-oriented thinking styles on the Life Styles Inventory, the perfectionistic style scored higher than all of the security-oriented styles by an impressive margin. The next highest scores were recorded by a cluster of three passive-defensive people-oriented thinking styles labeled approval, conventional, and dependent. The competitive style scored lower, and the styles labeled avoidance, oppositional, and power scored the lowest of all the defensive-security-oriented styles. These findings suggest that principals and vice-principals see themselves as relaxed, flexible, and satisfied with their ability to adapt to the stress levels they experience in their lives; however, there was some support for medical research findings that suggest that specific security-oriented thinking styles are associated with emotional stresses that contribute to the development of specific lifestyle habits, physical symptoms, and illnesses. Although the number of females in this study provides very limited generalizability, the findings of this study suggest that high achieving females tend to develop satisfaction-growth styles to a higher level than males, and they tend to use security-oriented styles to a lesser degree than males.

Impact of Information Communication Technology (ICT) on Professional Development and Educational Needs of Library Professionals in the Universities of Kerala

The shift from print to digital information has a high impact on all components of the academic library system in India especially the users, services and the staff. Though information is considered as an important resource, the use of ICT tools to collect and disseminate information has been in a slow pace in majority of the University libraries This may be due to various factors like insufficient funds, inadequate staff trained in handling computers and software packages, administrative concerns etc. In Kerala, automation has been initiated in almost all University libraries using library automation software and is under different stages of completion. There are not much studies conducted about the effects of information communication technologies on the professional activities of library professionals in the universities in Kerala. It is important to evaluate whether progress in ICT has had any impact on the library profession in these highest educational institutions. The aim of the study is to assess whether the developments in information communication technologies have any influence on the library professionals’ professional development, and the need for further education and training in the profession and evaluate their skills in handling developments in ICT. The total population of the study is 252 including the permanently employed professional library staff in central libraries and departmental libraries in the main campuses of the universities under study. This is almost a census study of the defined population of users. The questionnaire method was adopted for collection of data for this study, supplemented by interviews of Librarians to gather additional information. Library Professionals have a positive approach towards ICT applications and services in Libraries, but majority do not have the opportunities to develop their skills and competencies in their work environment. To develop competitive personnel in a technologically advanced world, high priority must be given to develop competence in ICT applications, library management and soft skills in library professionals, by the University administrators and Library associations. Library science schools and teaching departments across the country have to take significant steps to revise library science curriculum, and incorporate significant changes to achieve the demands and challenges of library science profession.

IR: Knowledge Creation, Knowledge Management and Knowledge Dissemination

Open access iiiovemerit and open source software movement plays an important role in creation of knowledge, knowledge management and knowledge dissemination. Scholarly communication and publishing are increasingly taking place in the electronic environment. With a growing proportion of the scholarly record now existing only in digital format, serious issues regarding access and preservation are being raised that are central to future scholarship. Institutional Repositories provide access to past. present and future scholarly literature and research documentation; ensures its preservation; assists users in discovery and use; and offers educational programs to enable users to develop lifelong literacy. This paper explores these aspects on how IR of Cochin University of Science & Technology supports scientific community for knowledge creation. knowledge Management, and knowledge dissemination.

Perspectives of Urban Growth Management and Sustainable Development In West Bank, Hebron District as a case Study

The main objective of this PhD research study is to provide a perspective on the urban growth management and sustainable development in Palestine, and more specifically in Hebron district as a case study. Hebron is located 36 km south of Jerusalem, with an overall population size of around 600,000 people living in a total area around1246km2. Hebron is the biggest Palestinian district that has 16 municipalities and 154 localities. The research discusses and analyzes the urban planning system, economical and environmental policies and the solution required to manage and integrate the development elements to develop a sustainable development plan for Hebron. The research provides answers for fundamental questions such as what kind and definition of sustainable development are applicable to the Palestinian case?. What are the sustainability problems there and how the Israeli occupation and unstable political condition affect the sustainable development in Palestine? What are the urban growth management and sustainability policies and actions required from government, public and privets sector in Palestine? The fast urban growth in Palestine is facing many problems and challenges due to the increase in the population size and the resulting impact of this increase including, but not limited to, the demand of new houses, need for more infrastructure services, demands on new industrial, commercial, educational and health projects, which in turn reduces the area of agricultural lands and threatens the natural resources and environment. There are also other associated sustainability problems like the absence of effective plans or regulations that control urban expansion, the absence of sufficient sustainable development plans at the national levels for the district, new job requirements, Israeli restrictions and occupation for more than 60 years, existence of construction factories near residential areas, poor public awareness and poor governmental funds for service projects and development plans. The study consists of nine chapters. Chapter One includes an introduction, study objectives, problems and justifications, while Chapter Two has a theoretical background on sustainability topic and definitions of sustainability. The Palestinian urban planning laws and local government systems are discussed in Chapter Three and the methodology of research is detailed in Chapter Four. As for Chapter Five, it provides a general background on Hebron District including demographical and economical profiles, along with recommendations related to sustainable development for each profile Chapter Six addresses the urban environment, sustainability priorities and policies required. Chapter Seven discusses and analyzes infrastructure services including transportation, water and wastewater. As for Chapter Eight, it addresses the land use, housing and urban expansion beside the cultural heritage, natural heritage with relevant sustainable development polices and recommendations. Finally, Chapter Nine includes a conclusion and comprehensive recommendations integrating all of urban and sustainability event in one map. Hebron has a deep history including a rich cultural heritage aged by thousands of years, with 47% of Hebron district population under 14 years old. Being the biggest Palestinian district, Hebron has thousands of industrial and economical organizations beside a large agricultural sector at Palestine level. This gives Hebron a potential to play major roles in developing a national sustainability plan, as the current urban planning system in Palestine needs urgent reform and development to fulfill the sustainability requirement. The municipalities and ministers should find permanent financial aid for urban planning and development studies so as to face future challenges. The Palestinian government can benefit from available local human resources in development projects; hence Palestinian people have sufficient qualifications in most sectors. The Palestinian people also can invest in the privet sector in Palestine in case businessmen have been encouraged and clear investment laws and plans have been developed. The study provides recommendations associated to the sustainable development in Palestine in general and Hebron, as a case study, in specific. Recommendations include increasing the privet sector as well as the public involvement in urban growth management, and stopping unplanned urban expansion, subjecting granting building permits of new projects to the no-harm environmental impact assessment, increasing the coordination and cooperation between localities and central bodies, protection and renovation of old cites and green areas, increasing the quality and quantity of infrastructure services, establishing district urban planning department to coordinate and organize urban planning and sustainable development activities. Also, among recommendations come dividing Hebron into three planning and administrative areas (north, central and south), and dividing the sustainable development and implementation period (2010 to 2025) into three main phases. Finally, the study strongly recommends benefiting from the same urban development plans in similar districts at national and international levels, also to use new technologies and information systems in urban planning process.

Multidimensional Adaptations for Open Learning Management Systems

Our work is focused on alleviating the workload for designers of adaptive courses on the complexity task of authoring adaptive learning designs adjusted to specific user characteristics and the user context. We propose an adaptation platform that consists in a set of intelligent agents where each agent carries out an independent adaptation task. The agents apply machine learning techniques to support the user modelling for the adaptation process

INFO2009 Group 3, FlowerPower - Educational video about DRM

This video contains an overall description of DRM as an introduction, and a discussion about the controversy around DRM techniques.

Metode.Bach : método para la toma de decisiones académicas y profesionales en el Bachillerato. 'Metode.Bach : method for educational and vocational decisions making within Bachillerato'.

Resumen tomado de la publicación. Con el apoyo económico del departamento MIDE de la UNED

WREN: electronic management system for facilities management

This paper describes a case study of an electronic data management system developed in-house by the Facilities Management Directorate (FMD) of an educational institution in the UK. The FMD Maintenance and Business Services department is responsible for the maintenance of the built-estate owned by the university. The department needs to have a clear definition of the type of work undertaken and the administration that enables any maintenance work to be carried out. These include the management of resources, budget, cash flow and workflow of reactive, preventative and planned maintenance of the campus. In order to be more efficient in supporting the business process, the FMD had decided to move from a paper-based information system to an electronic system, WREN, to support the business process of the FMD. Some of the main advantages of WREN are that it is tailor-made to fit the purpose of the users; it is cost effective when it comes to modifications on the system; and the database can also be used as a knowledge management tool. There is a trade-off; as WREN is tailored to the specific requirements of the FMD, it may not be easy to implement within a different institution without extensive modifications. However, WREN is successful in not only allowing the FMD to carry out the tasks of maintaining and looking after the built-estate of the university, but also has achieved its aim to minimise costs and maximise efficiency.

Educational and psychosocial programmes for adolescents with diabetes: approaches, outcomes and cost-effectiveness

Diabetes incurs heavy personal and health system costs. Self-management is required if complications are to be avoided. Adolescents face particular challenges as they learn to take responsibility for their diabetes. A systematic review of educational and psychosocial programmes for adolescents with diabetes was undertaken. This aimed to: identify and categorise the types of programmes that have been evaluated; assess the cost-effectiveness of interventions; identify areas where further research is required. Sixty-two papers were identified and Subjected to a narrative review. Generic programmes focus on knowledge/skills, psychosocial issues, and behaviour/self-management. They result in modest improvements across a range of outcomes but improvements are often not sustained, suggesting a need for continuous support, possibly integrated into normal care. In-hospital education at diagnosis confers few advantages over home treatment. The greatest returns may be obtained by targeting poorly controlled individuals. Few studies addressed resourcing issues and robust cost-effectiveness appraisals are required to identify interventions that generate the greatest returns on expenditure. (C) 2004 Elsevier Ireland Ltd. All rights reserved.

Protocol for the PINCER trial: a cluster randomised trial comparing the effectiveness of a pharmacist-led IT-based intervention with simple feedback in reducing rates of clinically important errors in medicines management in general practices

Background: Medication errors are an important cause of morbidity and mortality in primary care. The aims of this study are to determine the effectiveness, cost effectiveness and acceptability of a pharmacist-led information-technology-based complex intervention compared with simple feedback in reducing proportions of patients at risk from potentially hazardous prescribing and medicines management in general (family) practice. Methods: Research subject group: "At-risk" patients registered with computerised general practices in two geographical regions in England. Design: Parallel group pragmatic cluster randomised trial. Interventions: Practices will be randomised to either: (i) Computer-generated feedback; or (ii) Pharmacist-led intervention comprising of computer-generated feedback, educational outreach and dedicated support. Primary outcome measures: The proportion of patients in each practice at six and 12 months post intervention: - with a computer-recorded history of peptic ulcer being prescribed non-selective non-steroidal anti-inflammatory drugs - with a computer-recorded diagnosis of asthma being prescribed beta-blockers - aged 75 years and older receiving long-term prescriptions for angiotensin converting enzyme inhibitors or loop diuretics without a recorded assessment of renal function and electrolytes in the preceding 15 months. Secondary outcome measures; These relate to a number of other examples of potentially hazardous prescribing and medicines management. Economic analysis: An economic evaluation will be done of the cost per error avoided, from the perspective of the UK National Health Service (NHS), comparing the pharmacist-led intervention with simple feedback. Qualitative analysis: A qualitative study will be conducted to explore the views and experiences of health care professionals and NHS managers concerning the interventions, and investigate possible reasons why the interventions prove effective, or conversely prove ineffective. Sample size: 34 practices in each of the two treatment arms would provide at least 80% power (two-tailed alpha of 0.05) to demonstrate a 50% reduction in error rates for each of the three primary outcome measures in the pharmacist-led intervention arm compared with a 11% reduction in the simple feedback arm. Discussion: At the time of submission of this article, 72 general practices have been recruited (36 in each arm of the trial) and the interventions have been delivered. Analysis has not yet been undertaken.

Annual CREMRU-JCI survey of corporate estate management practices in Europe and North America: 1993-1997

This paper summarizes the results of the 1993, 1994, 1995, 1996 and 1997 surveys of chief real estate officers (CREO) from major organizations in Europe and North America. Since 1997 the annual survey is being undertaken jointly by the Corporate Real Estate Management Research Unit (CREMRU) and Johnson Controls Incorporate (JCI). The annual survey has been supported by the International Development Research Council (IDRC) and the International Association of Corporate Real Estate Executives (NACORE International), two leading professional associations concerned with this field of professional activity. The emphasis of this summary is on two aspects of the survey: the incidence of corporate real estate management (CREM) policies, functions and activities; and the assessment of knowledge or skills relevant to the CREM function in the future. Both are of paramount interest to the educational institutions concerned with CREM on both sides of the Atlantic. This includes the educational organs of international organizations concerned with corporate real estate, such as IDRC and NACORE, which play increasingly important roles in the education of their members. The CREMRUJCI annual survey will hopefully offer a useful tool in the international educational effort in this field

PINCER trial: a cluster randomised trial comparing the effectiveness and cost-effectiveness of a pharmacist-led IT-based intervention with simple feedback in reducing rates of clinically important errors in medicines management in general practices

Background: Medication errors in general practice are an important source of potentially preventable morbidity and mortality. Building on previous descriptive, qualitative and pilot work, we sought to investigate the effectiveness, cost-effectiveness and likely generalisability of a complex pharm acist-led IT-based intervention aiming to improve prescribing safety in general practice. Objectives: We sought to: • Test the hypothesis that a pharmacist-led IT-based complex intervention using educational outreach and practical support is more effective than simple feedback in reducing the proportion of patients at risk from errors in prescribing and medicines management in general practice. • Conduct an economic evaluation of the cost per error avoided, from the perspective of the National Health Service (NHS). • Analyse data recorded by pharmacists, summarising the proportions of patients judged to be at clinical risk, the actions recommended by pharmacists, and actions completed in the practices. • Explore the views and experiences of healthcare professionals and NHS managers concerning the intervention; investigate potential explanations for the observed effects, and inform decisions on the future roll-out of the pharmacist-led intervention • Examine secular trends in the outcome measures of interest allowing for informal comparison between trial practices and practices that did not participate in the trial contributing to the QRESEARCH database. Methods Two-arm cluster randomised controlled trial of 72 English general practices with embedded economic analysis and longitudinal descriptive and qualitative analysis. Informal comparison of the trial findings with a national descriptive study investigating secular trends undertaken using data from practices contributing to the QRESEARCH database. The main outcomes of interest were prescribing errors and medication monitoring errors at six- and 12-months following the intervention. Results: Participants in the pharmacist intervention arm practices were significantly less likely to have been prescribed a non-selective NSAID without a proton pump inhibitor (PPI) if they had a history of peptic ulcer (OR 0.58, 95%CI 0.38, 0.89), to have been prescribed a beta-blocker if they had asthma (OR 0.73, 95% CI 0.58, 0.91) or (in those aged 75 years and older) to have been prescribed an ACE inhibitor or diuretic without a measurement of urea and electrolytes in the last 15 months (OR 0.51, 95% CI 0.34, 0.78). The economic analysis suggests that the PINCER pharmacist intervention has 95% probability of being cost effective if the decision-maker’s ceiling willingness to pay reaches £75 (6 months) or £85 (12 months) per error avoided. The intervention addressed an issue that was important to professionals and their teams and was delivered in a way that was acceptable to practices with minimum disruption of normal work processes. Comparison of the trial findings with changes seen in QRESEARCH practices indicated that any reductions achieved in the simple feedback arm were likely, in the main, to have been related to secular trends rather than the intervention. Conclusions Compared with simple feedback, the pharmacist-led intervention resulted in reductions in proportions of patients at risk of prescribing and monitoring errors for the primary outcome measures and the composite secondary outcome measures at six-months and (with the exception of the NSAID/peptic ulcer outcome measure) 12-months post-intervention. The intervention is acceptable to pharmacists and practices, and is likely to be seen as costeffective by decision makers.