Supporting self-management: development and evaluation of a digital resource for adults with asthma

The problem: Around 300 million people worldwide have asthma and prevalence is increasing. Support for optimal self-management can be effective in improving a range of outcomes and is cost effective, but is underutilised as a treatment strategy. Supporting optimum self-management using digital technology shows promise, but how best to do this is not clear. Aim: The purpose of this project was to explore the potential role of a digital intervention in promoting optimum self-management in adults with asthma. Methods: Following the MRC Guidance on the Development and Evaluation of Complex Interventions which advocates using theory, evidence, user testing and appropriate modelling and piloting, this project had 3 phases. Phase 1: Examination of the literature to inform phases 2 and 3, using systematic review methods and focussed literature searching. Phase 2: Developing the Living Well with Asthma website. A prototype (paper-based) version of the website was developed iteratively with input from a multidisciplinary expert panel, empirical evidence from the literature (from phase 1), and potential end users via focus groups (adults with asthma and practice nurses). Implementation and behaviour change theories informed this process. The paper-based designs were converted to the website through an iterative user centred process (think aloud studies with adults with asthma). Participants considered contents, layout, and navigation. Development was agile using feedback from the think aloud sessions immediately to inform design and subsequent think aloud sessions. Phase 3: A pilot randomised controlled trial over 12 weeks to evaluate the feasibility of a Phase 3 trial of Living Well with Asthma to support self-management. Primary outcomes were 1) recruitment & retention; 2) website use; 3) Asthma Control Questionnaire (ACQ) score change from baseline; 4) Mini Asthma Quality of Life (AQLQ) score change from baseline. Secondary outcomes were patient activation, adherence, lung function, fractional exhaled nitric oxide (FeNO), generic quality of life measure (EQ-5D), medication use, prescribing and health services contacts. Results: Phase1: Demonstrated that while digital interventions show promise, with some evidence of effectiveness in certain outcomes, participants were poorly characterised, telling us little about the reach of these interventions. The interventions themselves were poorly described making drawing definitive conclusions about what worked and what did not impossible. Phase 2: The literature indicated that important aspects to cover in any self-management intervention (digital or not) included: asthma action plans, regular health professional review, trigger avoidance, psychological functioning, self-monitoring, inhaler technique, and goal setting. The website asked users to aim to be symptom free. Key behaviours targeted to achieve this include: optimising medication use (including inhaler technique); attending primary care asthma reviews; using asthma action plans; increasing physical activity levels; and stopping smoking. The website had 11 sections, plus email reminders, which promoted these behaviours. Feedback during think aloud studies was mainly positive with most changes focussing on clarification of language, order of pages and usability issues mainly relating to navigation difficulties. Phase 3: To achieve our recruitment target 5383 potential participants were invited, leading to 51 participants randomised (25 to intervention group). Age range 16-78 years; 75% female; 28% from most deprived quintile. Nineteen (76%) of the intervention group used the website for an average of 23 minutes. Non-significant improvements in favour of the intervention group observed in the ACQ score (-0.36; 95% confidence interval: -0.96, 0.23; p=0.225), and mini-AQLQ scores (0.38; -0.13, 0.89; p=0.136). A significant improvement was observed in the activity limitation domain of the mini-AQLQ (0.60; 0.05 to 1.15; p = 0.034). Secondary outcomes showed increased patient activation and reduced reliance on reliever medication. There was no significant difference in the remaining secondary outcomes. There were no adverse events. Conclusion: Living Well with Asthma has been shown to be acceptable to potential end users, and has potential for effectiveness. This intervention merits further development, and subsequent evaluation in a Phase III full scale RCT.

A avaliação das escolas: efeitos da avaliação externa nas dinâmicas de autoavaliação da escola

No contexto educativo português existem, atualmente, orientações legais para que as escolas sejam, por um lado, sujeitas a processos de avaliação externa e, por outro, induzidas a criar mecanismos de autoavaliação. Embora a escola seja, pelo menos em parte, um “locus de produção normativa”, na prática não tem sido fácil o diálogo entre a avaliação externa e os processos de mudança e melhoria, através da autoavaliação institucional. Num contexto onde as politicas nem sempre criam os estímulos e as condições adequadas, a ação organizacional em torno dos processos avaliativos acaba por refletir o jogo dos atores. Face à “natureza política” da avaliação, as escolas e os seus atores recorrem a “soluções organizacionais” que lhes permitem, em função dos interesses e dos objetivos individuais e organizativos, gerir as pressões e as expetativas do seu meio institucional. O presente trabalho pretende encontrar respostas sobre os efeitos do programa de avaliação externa das escolas (AEE) nas dinâmicas de autoavaliação e nos planos de ação para a melhoria da escola. Trata-se de uma investigação inserida numa matriz de cariz essencialmente qualitativo que opta pelo estudo de casos múltiplos. A informação foi recolhida através de várias fontes: observação direta, grupo focal (focus group), entrevistas, inquérito por questionário e análise documental. Os resultados tendem a evidenciar que as organizações educativas, nas respostas às prescrições externas para a avaliação e melhoria da escola recorrem a estratégias e táticas plurais, de tal modo que as mudanças que ocorrem, mais do que respostas à necessidade de eficácia e melhoria interna da escola, traduzem-se em processos de adaptação, que variam consoante as tensões existentes entre o contexto institucional e o ambiente competitivo onde as escolas estão inseridas; Abstract: The Evaluation of Schools: Effects of External Evaluation in the dynamics of Self-evaluation of Schools In the Portuguese educational context, there are currently legal guidelines for schools to be subject to external evaluation process, on the one hand, and on the other hand induced to create self-assessment mechanisms. Although the school is at least partly a "normative production locus", in practice the dialogue between the external evaluation and the processes of change and improvement through institutional self-assessment has not been easy. In a context where the policies do not always create the incentives and the right conditions, the organizational action around the evaluative process ends up reflecting the set of actors. Before the "political nature" of the evaluation, the schools and their actors recur to "organizational solutions" that allow them, in the interests of individual and organizational goals, to manage the pressures and expectations of its institutional environment. This work aims at finding answers to the effects of the External Schools Evaluation (ESE) programme, in the dynamics of self-evaluation and action plans for the improvement of school. It is an investigation inserted into an oriented matrix, essentially of qualitative nature that opts for multiple case studies. The information was collected through various sources: direct observation, focus group, interviews, questionnaire survey and document analysis. The results tend to show that educational organizations, in response to the external requirements for assessing and improving, use plural strategies and tactics. Similarly, the changes that occur in the structures, processes and practices, more than answers to the need for efficiency and indoor improvement of the school, result into adjustment processes, that change according to the existing tensions between the institutional context and the competitive environment where schools are located.

Análisis de posicionamiento en el sector de servicios de hosterías en el Valle de Yunguilla y propuesta de diseño de un plan estratégico de marketing para la hostería “Los Cisnes” en el periodo 2015-2018

El proyecto está enfocado al desarrollo de un Plan Estratégico aplicado a Hostería “Los Cisnes”. Tiene como objetivo contribuir con el desarrollo organizacional de la empresa, hacer frente a la competencia con la finalidad de prestar un servicio de calidad.Para la consecución de lo mencionado anteriormente se realizó un esquema que contempla lo siguiente: Se Expone conceptos y definiciones básicos de marketing que se necesitarán a lo largo del desarrollo del proyecto para el entendimiento del mismo.Se realizó el estudio del sector mediante encuestas y entrevistas aplicadas a personas que hacen uso del servicio de hostería y a los administradores de estos establecimientos. Para la obtención de resultados se utilizó el programa SPSS donde se emplearon variables e indicadores. Se estableció un ranking de acuerdo al catastro de establecimientos otorgado por el Ministerio de Turismo, encontrándose Hostería Los Cisnes en el tercer lugar, esto de acuerdo a la encuesta aplicada por las autoras del trabajo de titulación. Se desarrolló la situación actual de la empresa mediante herramientas como: análisis del micro-entrono y macro-entorno, análisis FODA, matriz EFI, matriz EFE, matriz BCG. Se desarrolló el Plan Estratégico de Marketing que contempla: misión, visión, objetivos, implementación de estrategias, planes de acción y presupuestos, es decir, está formado por todos los recursos necesarios para posicionamiento de la empresa.Finalmente se presenta las conclusiones y recomendaciones que fortalezcan la realización de las estrategias planteadas y que a la vez determinen resultados óptimos para la hostería.

Improving IT process management through value stream mapping approach: A case study

Value-Stream mapping (VSM) is a helpful tool to identify waste and improvement areas. It has emerged as a preferred way to support and implement the lean approach. While lean principles are well-established and have broad applicability in manufacturing, their extension to information technology is still limited. Based on a case study approach, this paper presents the implementation of VSM in an IT firm as a lean IT improvement initiative. It involves mapping the current activities of the firm and identifying opportunities for improvement. After several interviews with employees who are currently involved in the process, current state map is prepared to describe the existing problem areas. Future state map is prepared to show the proposed improvement action plans. The achievements of VSM implementation are reduction in lead time, cycle time and resources. Our finding indicates that, with the new process change, total lead time can be reduced from 20 days to 3 days – 92% reduction in overall lead time for database provisioning process.

Estado de las enfermedades raras que cursan con discapacidad intelectual en Colombia

Las enfermedades raras o huérfano son una problemática que ha tomado mucha importancia en el contexto mundial del presente siglo, estas se han definido como crónicas, de difícil tratamiento de sus síntomas y con baja prevalencia en la población; muchas de estas enfermedades cursan con varios tipos de discapacidad, siendo el objetivo del presente trabajo el enfocarse en aquellas enfermedades raras que cursan con discapacidad intelectual. Para poder profundizar en estas enfermedades se realizó una revisión teórica sobre las enfermedades raras, así como de la discapacidad psíquica y su importancia a nivel mundial y nacional. A partir de estas definiciones, se revisaron en profundidad 3 enfermedades raras que cursan con discapacidad intelectual en el contexto colombiano, como son: el síndrome de Rett, el síndrome de Prader-Willi y el síndrome de X frágil. En cada una de estas enfermedades además se explicaron los tipos de diagnóstico, intervención, prevención, grupos de apoyo y tipos de evaluación que más se usan en el contexto nacional

Plan de Mercadeo FORTEACERO S.A.S

FORTEACERO S.A.S es una empresa con sede en Bogotá, creada en el año 2012 como filial de la empresa ESCAYOLA Ltda., dedicada a la fabricación de perfiles, masilla, pintura y comercialización de productos para la construcción liviana, dentro de los que se incluyen drywall, PVC y los elementos necesarios para su instalación. Por el crecimiento y dinamismo del mercado al cual pertenece esta empresa, la organización vio la necesidad de crear un plan de mercadeo para identificar a partir de este oportunidades y planes de acción, con el propósito de tener un mejor desempeño en el mercado mediante el incremento en ventas y reconocimiento para la empresa por parte de los clientes y los competidores. El objetivo de este plan de mercadeo es incrementar las ventas en un 28% por medio de estrategias que se describen puntualmente en este documento.

Percepción de los trabajadores acerca de la seguridad en el trabajo en una empresa del sector de gas natural en Casanare

Introducción: La percepción puede ser considerada principalmente como un grupo de procesos internos en las personas que genera en los observadores una representación mental del entorno. Percibir es adelantarse al suceso, a lo que puede llegar a suceder, determinando lo que puede ser un peligro a nuestra seguridad y salud. Objetivo: El presente estudio tiene como objetivo determinar la percepción de los trabajadores acerca de la seguridad en el trabajo en áreas de procesos automatizados y mecánicas en una empresa del sector de gas natural en el departamento de Casanare, Colombia 2016. Metodología: Se llevó a cabo un estudio de corte transversal en 50 trabajadores de una empresa del sector de gas natural en Casanare. Se uttilizó el Cuestionario nórdico NOSACQ-50-Spanish, instrumento validado para evaluar la percepción acerca de la seguridad y salud en el lugar de trabajo. Se incluyeron variables sociodemográficas, laborales y las relacionadas con la percepción de la seguridad en el lugar del trabajo. Para el análsiis estadistico se calcularon medidas de tendencia central y de dispersión. El estudio de la percepción de seguridad tuvo como puntos de corte: < 2,5 mala percepción y > 2,5 buena percepción. Se emplearon pruebas de asociación X2 o test exacto de Fisher (valores esperados <5) y medidas de asociación OR con sus intervalos de confianza del 95% y se usaron modelos de regresión lineal. Resultados: El total de trabajadores fue de 50 personas, el 76% correspondió al sexo masculino y la mayor distribución se presentó en áreas mecánicas con 52% frente al 48% que se encontró en áreas automatizadas. Se halló asociación estadísticamente significativa entre las variables sociodemográficas área/sexo (Pr = 0,016), indicando que a los trabajadores de sexo femenino se les ubican en el área mecánica mientras que los de sexo masculino, laboran en todas las áreas sin darle relevancia al género. También se encontró asociación con las variables área/año de nacimiento (Pr =0.022), indicando que en el área automatizada se dejan profesionales con promedio de edad de 32 años, por el tipo de requisitos en competencias que exigen para ejecutar las labores. Para las demás variables ocupacionales que evaluaron la percepción de seguridad frente al trabajo, no se encontró asociación significativa. Conclusión: Los resultados permiten realizar acciones en pro de mejorar la percepción de los trabajadores dentro de la organización. Se podrán desarrollar programas de seguridad y salud en el trabajo, que respondan de manera efectiva a los peligros laborales detectados.

Empregabilidade e inserção no mercado de trabalho das comunidades ciganas em Portugal e Espanha

A investigação desenvolvida é sobre a empregabilidade e inserção no mercado de trabalho da comunidade cigana portuguesa. Deste ponto de vista, a investigação recai sobre o processo desenvolvido de integração social nas últimas décadas onde se questiona, os Planos de Ação para a Inclusão das Comunidades Ciganas e o seu impacto na vida socioprofissional das mesmas. Para o efeito, será realizado um estudo comparado entre Portugal e Espanha no que concerne ao processo de integração social das comunidades ciganas. Estudos recentes do Instituto Português de Administração e Marketing (IPAM) referem que o emprego é mais difícil de conseguir para pessoas deficientes e pessoas ciganas (os cegos lideram a tabela com 71,6 por cento, seguindo-se a etnia cigana com 47,3).1 Um dos principais obstáculos que se tem verificado em relação à inserção no mercado de trabalho é consequência do problema da discriminação institucional (direta ou indireta)2, relutância por parte das próprias entidades responsáveis pela implementação do desenvolvimento dos programas de emprego. Devido à importância do exercício da cidadania no processo de integração social, realizar-se à uma parte empírica dedicada ao movimento associativo em Portugal e Espanha, de modo a perceber qual o seu envolvimento na definição da política social e respetivas prioridades em relação ao emprego e defesa dos direitos humanos. No quadro da compreensão, será desenvolvido uma investigação qualitativa e quantitativa, com recurso à aplicação de inquérito junto de dirigentes/representantes de ONG´S Ciganas nos dois países, no que concerne à participação/representação das mesmas, na definição de estratégias de intervenção social tendo em conta a politica social nacional e as orientações da União Europeia como é exemplo, a Estratégia Nacional Para a Integração da Comunidade Cigana; EMPLOYABILITY AND INTEGRATION IN THE LABOUR MARKET OF THE GYPSY IN PORTUGAL AND SPAIN Abstract: The research carried out is on employability and inclusion in the Community Portuguese Gypsy labor market. From this point of view, the investigation lies with the developed process of social integration in recent decades where it questions the Action Plans for Inclusion of Roma communities and their impact on the socio-professional life of the community Gypsy. For this purpose, a comparative study between Portugal and Spain regarding the process of social integration of Roma will be held. Recent studies of the Portuguese Institute of Administration and Marketing (IPAM), indicate that employment is more difficult to achieve for disable people and Roma people (the blind lead the table with 71.6 percent, followed by 47%). One of the main obstacles that has been seen in relation to the insertion in the labor market is a result of the problem of institutional discrimination (direct or indirect), reluctance by the very entities responsible for implementing the development of employment programs. Because of the importance of citizenship in the social integration process, carried out the empirical part dedicated to the associative movement in Portugal and Spain, in order to understand what their involvement in the definition of social policy and respective priorities in relation to employment and defense of human rights. In the context of understanding, a qualitative research will be developed, using the application survey of leaders / representatives of NGOs Roma in both countries, with respect to participation / representation of the same in the definition of social intervention strategies taking into account national social policy and the guidelines of the European Union as example, the national Strategy for the Integration of Roma Community.

Digital-based interventions for teams in the workplace

This research project investigated a digital workplace intervention based on team coaching and social network visualisation. The investigation was carried out through four studies. Study 1 was a systematic literature review with a realist synthesis approach about workplace digital interventions at multiple levels, highlighting the need for more research about group-level digital workplace interventions. Study 2 was a qualitative needs assessment exercise that verified the fit between the targeted organisations and the selected intervention. Following the tailored implementation of the intervention, Study 3 analysed recipients’ positive perceptions of intervention characteristics, with usability and integrity being appreciated the most, and acceptability being appreciated the least. While the intervention was considered usable and recipients felt valued during sessions, training did not fully meet their expectations. Also, recipients’ perceptions did not change from second to fourth session, suggesting they remained stably satisfied with the intervention over time. Finally, Study 4 tested two relevant Context-Mechanism-Outcome (CMO) configurations and suggested that teams implementing action plans developed during training might need less support from immediate managers to coordinate collective efforts and accomplish collective performance. Moreover, peer support towards training transfer was confirmed as a relevant contextual factor contributing to intervention effectiveness. Overall, this multifaceted and complex research project offers a nuanced examination of team-level digital interventions within the contemporary workplace, unveiling valuable insights and opportunities for further refinement and application.

A practical framework for the generation and selection of strategic plans of action, The relevance of timeframe considerations and a systems thinking approach

The paper proposes a methodology especially focused on the generation of strategic plans of action, emphasizing the relevance of having a structured timeframe classification for the actions. The methodology explicitly recognizes the relevance of long-term goals as strategic drivers, which must insure that the complex system is capable to effectively respond to changes in the environment. In addition, the methodology employs engineering systems techniques in order to understand the inner working of the system and to build up alternative plans of action. Due to these different aspects, the proposed approach features higher flexibility compared to traditional methods. The validity and effectiveness of the methodology has been demonstrated by analyzing an airline company composed by 5 subsystems with the aim of defining a plan of action for the next 5 years, which can either: improve efficiency, redefine mission or increase revenues.

Naval researches, or, A candid inquiry into the conduct of Admirals Byron, Graves, Hood, and Rodney : in the action off Grenada, Chesapeak, St. Christopher's, and of the ninth and twelfth of April 1782 : being a refutation of the plans and statements of Mr. Clerk, Rear Admiral Ekins, and others : founded on authentic documents or actual observation /

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