Does mode of follow-up influence contraceptive use after medical abortion in a low-resource setting? Secondary outcome analysis of a non-inferiority randomized controlled trial

BACKGROUND: Post-abortion contraceptive use in India is low and the use of modern methods of contraception is rare, especially in rural areas. This study primarily compares contraceptive use among women whose abortion outcome was assessed in-clinic with women who assessed their abortion outcome at home, in a low-resource, primary health care setting. Moreover, it investigates how background characteristics and abortion service provision influences contraceptive use post-abortion. METHODS: A randomized controlled, non-inferiority, trial (RCT) compared clinic follow-up with home-assessment of abortion outcome at 2 weeks post-abortion. Additionally, contraceptive-use at 3 months post-abortion was investigated through a cross-sectional follow-up interview with a largely urban sub-sample of women from the RCT. Women seeking abortion with a gestational age of up to 9 weeks and who agreed to a 2-week follow-up were included (n = 731). Women with known contraindications to medical abortions, Hb < 85 mg/l and aged below 18 were excluded. Data were collected between April 2013 and August 2014 in six primary health-care clinics in Rajasthan. A computerised random number generator created the randomisation sequence (1:1) in blocks of six. Contraceptive use was measured at 2 weeks among women successfully followed-up (n = 623) and 3 months in the sub-set of women who were included if they were recruited at one of the urban study sites, owned a phone and agreed to a 3-month follow-up (n = 114). RESULTS: There were no differences between contraceptive use and continuation between study groups at 3 months (76 % clinic follow-up, 77 % home-assessment), however women in the clinic follow-up group were most likely to adopt a contraceptive method at 2 weeks (62 ± 12 %), while women in the home-assessment group were most likely to adopt a method after next menstruation (60 ± 13 %). Fifty-two per cent of women who initiated a method at 2 weeks chose the 3-month injection or the copper intrauterine device. Only 4 % of women preferred sterilization. Caste, educational attainment, or type of residence did not influence contraceptive use. CONCLUSIONS: Simplified follow-up after early medical abortion will not change women's opportunities to access contraception in a low-resource setting, if contraceptive services are provided as intra-abortion services as early as on day one. Women's postabortion contraceptive use at 3 months is unlikely to be affected by mode of followup after medical abortion, also in a low-resource setting. Clinical guidelines need to encourage intra-abortion contraception, offering the full spectrum of evidence-based methods, especially long-acting reversible methods. TRIAL REGISTRATION: Clinicaltrials.gov NCT01827995.

Exercise and Lifestyle Therapy Improves Weight Maintenance in Young People With Psychosis: A Service Evaluation

INTRODUCTION Young people with psychosis typically have higher rates of premature cardiovascular disease and metabolic disorders compared to non-psychotic peers. This has been primarily due to a sedentary lifestyle, poor diet composition, misuse of harmful substances and higher rates of obesity and smoking. When prescribed obesogenic antipsychotic medication, a weight gain of >12 kg within 2 years is typical. PURPOSE: To examine the benefits of a 12 wk exercise and lifestyle intervention entitled ‘Supporting Health and Promoting Exercise’ (SHAPE) for young people recently diagnosed with psychosis. METHODS Participants (n=26; 8 females; mean age 27.7 ± 5.1) engaged in weekly 45’ education sessions on healthy lifestyle behaviors, including: managing anxiety and depression, mindfulness and relaxation training, substance misuse, smoking cessation, healthy eating and nutritional advice, dental and sexual health care. This was followed by a 45’ exercise session including activities such as circuit and resistance training, yoga, and badminton, led by qualified exercise instructors. Anthropometric data were measured at baseline, 12 wk and 12 month post-intervention. Lifestyle behaviors and clinical measurements, including resting heart rate, blood pressure, total cholesterol, triglycerides, HbA1c and prolactin, were assessed at baseline and 12 months post-intervention as part of their routine clinical care plan. Significant differences over time were assessed using Paired Sample t-tests. RESULTS SHAPE participants (n=26) presented with first episode psychosis (n=11), schizophrenia (n=11), bipolar disorder (n=2), at risk mental state (n=1), and persistent delusion disorder (n=1) of which 52% were prescribed highly obesogenic antipsychotic medications (Clozapine and Olanzepine). Mean baseline data suggests participants were at an increased health risk due to elevated values in mean BMI (70% were overweight or obese), waist circumference, resting heart rate, and triglycerides (see Table 1 & 2). Over 50% reported smoking daily and 85% had elevated resting blood pressure (>120/80 mm Hg). At 12 wk post-intervention, no changes were observed in mean BMI or waist circumference (see Table 1); 19 participants either maintained (mean 0.5 kg: range ± 2 kg) or decreased (mean -5.7 kg: range 2-7 kg) weight; 7 participants increased weight (mean 4.9 kg: range 2.0-9.6 kg). At 12 month post-intervention (n=16), no change was evident in mean BMI, waist circumference, or any other clinical variable (see Table 2). Positive impacts on lifestyle behaviors included 7 participants eating ~400g of fruit/vegetables daily, 2 ceased substance use, 2 ceased alcohol use, 4 ceased smoking and 5 were less sedentary. CONCLUSION At the start of the programme, participants were already at an increased risk for cardiometabolic disorders. Findings suggest that SHAPE supported young people with psychosis to: -attenuate their physical health risk following a 12 wk exercise and lifestyle intervention which were sustained at 12 months follow up. -make positive lifestyle behavior changes leading to sustained improvements in weight maintenance and physical health.

Une étude qualitative sur la nature du service à la clientèle dans les entreprises canadiennes

Le présent travail de recherche porte sur la fonction "Service à la Clientèle" dans les entreprises canadiennes. Il s'agit d'une étude exploratoire dont l'objectif est de tenter d'observer s'il existe, dans l'industrie en général, une tendance ou même une norme pour les activités entreprises par les départements de Service à la Clientèle. Nous regardons également ce qui sous-tend la nécessité de cette fonction et quel rôle stratégique on lui donne. Cette étude a été réalisée à partir de différentes sources bibliographiques, dont la plupart sont des articles récents. Nous avons ensuite fait des entrevues dans douze entreprises différentes avec les personnes responsables du Service. Les résultats de ces entrevues sont présentés sous forme de descriptions détaillées des départements visités. La dernière section du travail porte sur l'analyse des différences et similarités qui ont été observées pour tenter de cerner une convergence dans les pratiques actuelles.

Role of assessment components and recent adverse outcomes in risk estimation and prediction: use of the Short Term Assessment of Risk and Treatability (START) in an adult secure inpatient mental health service

The Short Term Assessment of Risk and Treatability is a structured judgement tool used to inform risk estimation for multiple adverse outcomes. In research, risk estimates outperform the tool's strength and vulnerability scales for violence prediction. Little is known about what its’component parts contribute to the assignment of risk estimates and how those estimates fare in prediction of non-violent adverse outcomes compared with the structured components. START assessment and outcomes data from a secure mental health service (N=84) was collected. Binomial and multinomial regression analyses determined the contribution of selected elements of the START structured domain and recent adverse risk events to risk estimates and outcomes prediction for violence, self-harm/suicidality, victimisation, and self-neglect. START vulnerabilities and lifetime history of violence, predicted the violence risk estimate; self-harm and victimisation estimates were predicted only by corresponding recent adverse events. Recent adverse events uniquely predicted all corresponding outcomes, with the exception of self-neglect which was predicted by the strength scale. Only for victimisation did the risk estimate outperform prediction based on the START components and recent adverse events. In the absence of recent corresponding risk behaviour, restrictions imposed on the basis of START-informed risk estimates could be unwarranted and may be unethical.

Utilisation du logiciel Copilote Insertion pour l'évaluation des gains en employabilité de sujets ayant participé à un Service d'Intégration Socioprofessionnelle.

La situation du marché de l'emploi a subi ces dernières années, des changements de structure en profondeur. Le résultat est qu'au Québec, le taux réel d'inactivité révèle que près d'un adulte sur quatre est sans emploi. Parmi les personnes les plus touchées par ces changements on retrouve celles qui sont sans formation spécifique, sans diplôme ou bien sans expérience de travail. Pour rendre apte au travail cette mam d'oeuvre inactive, le Ministère de l'éducation a mis sur pied au milieu des années 90, une mesure d'aide à l'insertion appelée Services d'Intégration Socioprofessionnelle ou S.I.S. Dans le présent essai, nous avons cherché à évaluer le développement de l'employabilité de participants aux S.I.S. Selon les objectifs visés par le Service, on suppose que chaque personne aura acquis certaines attitudes et aptitudes au travail, susceptible de l'aider à retrouver du travail et de le conserver. Nous avons utilisé la structure de recherche test-retest sur le même échantillon. En effet, chaque participant s'est vu administrer le même questionnaire, au début et à la fin des S.I.S. Nous avons ainsi pu suivre l'évolution des facteurs en causes dans une insertion professionnelle. À cela s'ajoutent des données recueillies dans un journal de bord par l'évaluateur/animateur. Celles-ci sont reprises pour donner un sens dans l'analyse des résultats. La mesure utilisée est le questionnaire informatisé Copilote Insertion version 2.20. Celui-ci fut administré une première fois, à seize personnes présentes en amorce des S.LS. Pour la mesure post, nous avions plus que 8 personnes toujours disponibles et respectant le devis de recherche. Pour ces sujets, nous avons comparé chacun des vingt facteurs de Copilote, ainsi que l'évolution des stratégies d'insertion. Pour chacun d'eux, nous avons pu déterminer lesquels des facteurs d'employabilité évalué par le logiciel, démontraient une progression. Il a été démontré que l'ensemble des participants s'accordait beaucoup de difficulté à surmonter l'image de dépendance et d'incapacité, intériorisé avec l'expérience du chômage. Comme quoi, cette clientèle a à faire face à un certain nombre de deuil non résolu. À ce niveau, la structure des S.I.S semble permettre ce nécessaire recadrage de l'expérience chômage. Nous avons aussi observé que la composition du groupe n'a pas été réalisée en respectant le développement de l'employabilité de chacun des participants. Par conséquent, les plus enthousiasmes ont eu à subir l'inconfort de devoir faire face aux discours démotivant des personnes non-prêtes à s'insérer en emploi. La difficulté de sélectionner des personnes dont les besoins en matière de développement de l'employabilité ne seraient pas homogènes pourrait être surmontée si des activités individuelles personnalisées, sont présentées en alternance avec le travail de groupe. Autre constat réalisé est que malgré le temps passé à l'intérieur des SIS, des participants s'accordent plus de difficultés à la fin qu'au début, pour des facteurs d'employabilités. C'est le cas des facteurs du thème Communication de Copilote. La difficulté de mettre en branle une campagne visant la mise en marché de son potentiel de travail, cela vient confirmer que le participant, bien qu'il ait réalisé un bout du trajet le séparant du monde du travail, qu'il n'est pas parvenu à destination.

Conception mécaniste-empirique des chaussées non revêtues

Dans le contexte où les routes non revêtues sont susceptibles de subir des charges importantes, une méthode rigoureuse pour la conception de ces chaussées basée sur des principes mécanistes-empiriques et sur le comportement mécanique des sols support est souhaitable. La conception mécaniste combinée à des lois d’endommagement permet l’optimisation des structures de chaussées non revêtues ainsi que la réduction des coûts de construction et d’entretien. Le but de ce projet est donc la mise au point d’une méthode de conception mécaniste-empirique adaptée aux chaussées non revêtues. Il a été question tout d’abord de mettre au point un code de calcul pour la détermination des contraintes et des déformations dans la chaussée. Ensuite, des lois d’endommagement empiriques pour les chaussées non revêtues ont été développées. Enfin, les méthodes de calcul ont permis la création d’abaques de conception. Le développement du code de calcul a consisté en une modélisation de la chaussée par un système élastique multi-couches. La modélisation a été faite en utilisant la transformation d’Odemark et les équations de Boussinesq pour le calcul des déformations sous la charge. L’élaboration des fonctions de transfert empiriques adaptées aux chaussées non revêtues a également été effectuée. Le développement des fonctions de transfert s’est fait en deux étapes. Tout d’abord, l’établissement de valeurs seuil d’orniérage considérant des niveaux jugés raisonnables de conditions fonctionnelle et structurale de la chaussée. Ensuite, le développement de critères de déformation admissible en associant les déformations théoriques calculées à l’aide du code de calcul à l’endommagement observé sur plusieurs routes en service. Les essais ont eu lieu sur des chaussées typiques reconstituées en laboratoire et soumises à un chargement répété par simulateur de charge. Les chaussées ont été instrumentées pour mesurer la déformation au sommet du sol d’infrastructure et les taux d’endommagements ont été mesurés au cours des essais.

Online MBPeT dashboard : enabling performance testing as a service in the cloud

In this thesis, tool support is addressed for the combined disciplines of Model-based testing and performance testing. Model-based testing (MBT) utilizes abstract behavioral models to automate test generation, thus decreasing time and cost of test creation. MBT is a functional testing technique, thereby focusing on output, behavior, and functionality. Performance testing, however, is non-functional and is concerned with responsiveness and stability under various load conditions. MBPeT (Model-Based Performance evaluation Tool) is one such tool which utilizes probabilistic models, representing dynamic real-world user behavior patterns, to generate synthetic workload against a System Under Test and in turn carry out performance analysis based on key performance indicators (KPI). Developed at Åbo Akademi University, the MBPeT tool is currently comprised of a downloadable command-line based tool as well as a graphical user interface. The goal of this thesis project is two-fold: 1) to extend the existing MBPeT tool by deploying it as a web-based application, thereby removing the requirement of local installation, and 2) to design a user interface for this web application which will add new user interaction paradigms to the existing feature set of the tool. All phases of the MBPeT process will be realized via this single web deployment location including probabilistic model creation, test configurations, test session execution against a SUT with real-time monitoring of user configurable metric, and final test report generation and display. This web application (MBPeT Dashboard) is implemented with the Java programming language on top of the Vaadin framework for rich internet application development. The Vaadin framework handles the complicated web communications processes and front-end technologies, freeing developers to implement the business logic as well as the user interface in pure Java. A number of experiments are run in a case study environment to validate the functionality of the newly developed Dashboard application as well as the scalability of the solution implemented in handling multiple concurrent users. The results support a successful solution with regards to the functional and performance criteria defined, while improvements and optimizations are suggested to increase both of these factors.

The big four skills: Teachers’ assumptions on measurement of non-native students cognition

The four-skills on tests for young native speakers commonly do not generate correlation incongruency concerning the cognitive strategies frequently reported. Considering the non-native speakers there are parse evidence to determine which tasks are important to assess properly the cognitive and academic language proficiency (Cummins, 1980; 2012). Research questions: It is of high probability that young students with origin in immigration significantly differ on their communication strategies and skills in a second language processing context (1); attached to this first assumption, it is supposed that teachers significantly differ depending on their scientific area and previous training (2). Purpose: This study intends to examine whether school teachers (K-12) as having different origin in scientific domain of teaching and training perceive differently an adapted four-skills scale, in European Portuguese. Research methods: 77 teachers of five areas scientific areas, mean of teaching year service = 32 (SD= 2,7), 57 males and 46 females (from basic and high school levels). Main findings: ANOVA (Effect size and Post-hoc Tukey tests) and linear regression analysis (stepwise method) revealed statistically significant differences among teachers of different areas, mainly between language teachers and science teachers. Language teachers perceive more accurately tasks in a multiple manner to the broad skills that require to be measured in non-native students. Conclusion: If teachers perceive differently the importance of the big-four tasks, there would be incongruence on skills measurement that teachers select for immigrant puppils. Non-balanced tasks and the teachers’ perceptions on evaluation and toward competence of students would likely determine limitations for academic and cognitive development of non-native students. Furthermore, results showed sufficient evidence to conclude that tasks are perceived differently by teachers toward importance of specific skills subareas. Reading skills are best considered compared to oral comphreension skills in non-native students.

Evaluation use within a humanitarian non-governmental organization’s health care user-fee exemption program in West Africa

L’évaluation de l’action humanitaire (ÉAH) est un outil valorisé pour soutenir l’imputabilité, la transparence et l’efficience de programmes humanitaires contribuant à diminuer les inéquités et à promouvoir la santé mondiale. L’EAH est incontournable pour les parties prenantes de programme, les bailleurs de fonds, décideurs et intervenants souhaitant intégrer les données probantes aux pratiques et à la prise de décisions. Cependant, l’utilisation de l’évaluation (UÉ) reste incertaine, l’ÉAH étant fréquemment menée, mais inutilisé. Aussi, les conditions influençant l’UÉ varient selon les contextes et leur présence et applicabilité au sein d’organisations non-gouvernementales (ONG) humanitaires restent peu documentées. Les évaluateurs, parties prenantes et décideurs en contexte humanitaire souhaitant assurer l’UÉ pérenne détiennent peu de repères puisque rares sont les études examinant l’UÉ et ses conditions à long terme. La présente thèse tend à clarifier ces enjeux en documentant sur une période de deux ans l’UÉ et les conditions qui la détermine, au sein d’une stratégie d’évaluation intégrée au programme d’exemption de paiement des soins de santé d’une ONG humanitaire. L’objectif de ce programme est de faciliter l’accès à la santé aux mères, aux enfants de moins de cinq ans et aux indigents de districts sanitaires au Niger et au Burkina Faso, régions du Sahel où des crises alimentaires et économiques ont engendré des taux élevés de malnutrition, de morbidité et de mortalité. Une première évaluation du programme d’exemption au Niger a mené au développement de la stratégie d’évaluation intégrée à ce même programme au Burkina Faso. La thèse se compose de trois articles. Le premier présente une étude d’évaluabilité, étape préliminaire à la thèse et permettant de juger de sa faisabilité. Les résultats démontrent une logique cohérente et plausible de la stratégie d’évaluation, l’accessibilité de données et l’utilité d’étudier l’UÉ par l’ONG. Le second article documente l’UÉ des parties prenantes de la stratégie et comment celle-ci servit le programme d’exemption. L’utilisation des résultats fut instrumentale, conceptuelle et persuasive, alors que l’utilisation des processus ne fut qu’instrumentale et conceptuelle. Le troisième article documente les conditions qui, selon les parties prenantes, ont progressivement influencé l’UÉ. L’attitude des utilisateurs, les relations et communications interpersonnelles et l’habileté des évaluateurs à mener et à partager les connaissances adaptées aux besoins des utilisateurs furent les conditions clés liées à l’UÉ. La thèse contribue à l’avancement des connaissances sur l’UÉ en milieu humanitaire et apporte des recommandations aux parties prenantes de l’ONG.

A cross-sectional survey of 5-year-old children with non-syndromic unilateral cleft lip and palate:the Cleft Care UK study. Part 1: background and methodology

OBJECTIVES: We describe the methodology for a major study investigating the impact of reconfigured cleft care in the United Kingdom (UK) 15 years after an initial survey, detailed in the Clinical Standards Advisory Group (CSAG) report in 1998, had informed government recommendations on centralization. SETTING AND SAMPLE POPULATION: This is a UK multicentre cross-sectional study of 5-year-olds born with non-syndromic unilateral cleft lip and palate. Children born between 1 April 2005 and 31 March 2007 were seen in cleft centre audit clinics. MATERIALS AND METHODS: Consent was obtained for the collection of routine clinical measures (speech recordings, hearing, photographs, models, oral health, psychosocial factors) and anthropometric measures (height, weight, head circumference). The methodology for each clinical measure followed those of the earlier survey as closely as possible. RESULTS: We identified 359 eligible children and recruited 268 (74.7%) to the study. Eleven separate records for each child were collected at the audit clinics. In total, 2666 (90.4%) were collected from a potential 2948 records. The response rates for the self-reported questionnaires, completed at home, were 52.6% for the Health and Lifestyle Questionnaire and 52.2% for the Satisfaction with Service Questionnaire. CONCLUSIONS: Response rates and measures were similar to those achieved in the previous survey. There are practical, administrative and methodological challenges in repeating cross-sectional surveys 15 years apart and producing comparable data.

Forma ecclesiae : Per un cattolicesimo di popolo oggi: “per tutti” anche se non “di tutti”

La radicalité du changement culturel provoque une crise de la forma ecclesiae et introduit la question relative à quelle est la forme de l’Église la plus appropriée à l’annonce de l’évangile. L’Église italienne, que le présent travail a l’intention d’assumer en qualité de point de référence particulier, en est également intéressée: contrairement au passé, même le plus récent, la foi chrétienne n’est plus un patrimoine «de tous». La question se pose puisque, au nom de l’évangile, l’action de l’Église ne peut pas disperser, pourtant, le caractère universel de la foi en soi même (son être «pour tous»). Dans un tel scénario, s’enclenche le but que cette thèse se pose de poursuivre sur le plan de la pensée théologique-pastorale: elle veut accompagner l’Église en son être à l’intérieur de cette tension entre l’instance théologique d’une foi qui est «pour tous» et le donné sociologique dont il émerge qu’elle n’est plus «de tous». Beaucoup de projets contemporaines de réforme pastorale ont l’intention de faire face aux transformations de la culture afin d’empêcher tout injustifiée domestication. Cependant, comme cette thèse essaie à le prouver, ils risquent souvent de suggérer une rupture avec le passé récent du corps ecclésial. Pour eux la référence polémique est représentée par cette figure de «catholicisme populaire» avec qui, dans le contexte de la «civilisation paroissiale», l’expérience chrétienne est réussie à s’enraciner dans le tissu social. Dans ces projets, il est – en effet – assimilé d’une manière restrictive à une sorte de «catholicisme de masse», basé seulement sur des processus religieux de socialisation et d’uniformisation de l’expérience. Au contraire, le but de ce travail consiste en un essai de compréhension renouvelée de cette figure de vie chrétienne. Elle n’est retenue seulement selon la particulière forme historique qu’elle a adoptée dans le demain passé, marqué par une situation d’homogénéité culturelle, d’une Église de peuple, mais aussi comme principe opératoire qui désigne la capacité du christianisme de se réaliser en tant qu’élévation et transfiguration des formes anthropologiques de base. Cette perspective dynamique permet de trouver dans le «catholicisme populaire» un principe écclesio-génétique qui exalte l’interaction entre l’initiative ecclésiale et la sensibilité des croyants, et qui, tout en défendant la qualité théologale de l’expérience chrétienne, ne méprise pas la valeur pédagogique de son enracinement religieux. La dynamique qui préside au «catholicisme populaire», grâce à la confrontation avec une étude sur le terrain, conduit à l’individuation de certaines provocations à propos de la structure du corps ecclésial, en ce qui concerne les représentations, les actions, les sujets et les limites qui le caractérisent. Elles sont transposées de manière à envisager une réforme de l’Église qui s’avère applicable pour le présent et qui cherche à garder le caractère universel-non formel de la foi, c’est à dire son «pour tous».

Utility and safety of invasive (fractional flow reserve) and non-invasive (cardiac magnetic resonance imaging) diagnostic tests in patients with NSTEMI

A prospective randomised controlled clinical trial of treatment decisions informed by invasive functional testing of coronary artery disease severity compared with standard angiography-guided management was implemented in 350 patients with a recent non-ST elevation myocardial infarction (NSTEMI) admitted to 6 hospitals in the National Health Service. The main aims of this study were to examine the utility of both invasive fractional flow reserve (FFR) and non-invasive cardiac magnetic resonance imaging (MRI) amongst patients with a recent diagnosis of NSTEMI. In summary, the findings of this thesis are: (1) the use of FFR combined with intravenous adenosine was feasible and safe amongst patients with NSTEMI and has clinical utility; (2) there was discordance between the visual, angiographic estimation of lesion significance and FFR; (3). The use of FFR led to changes in treatment strategy and an increase in prescription of medical therapy in the short term compared with an angiographically guided strategy; (4) in the incidence of major adverse cardiac events (MACE) at 12 months follow up was similar in the two groups. Cardiac MRI was used in a subset of patients enrolled in two hospitals in the West of Scotland. T1 and T2 mapping methods were used to delineate territories of acute myocardial injury. T1 and T2 mapping were superior when compared with conventional T2-weighted dark blood imaging for estimation of the ischaemic area-at-risk (AAR) with less artifact in NSTEMI. There was poor correlation between the angiographic AAR and MRI methods of AAR estimation in patients with NSTEMI. FFR had a high accuracy at predicting inducible perfusion defects demonstrated on stress perfusion MRI. This thesis describes the largest randomized trial published to date specifically looking at the clinical utility of FFR in the NSTEMI population. We have provided evidence of the diagnostic and clinical utility of FFR in this group of patients and provide evidence to inform larger studies. This thesis also describes the largest ever MRI cohort, including with myocardial stress perfusion assessments, specifically looking at the NSTEMI population. We have demonstrated the diagnostic accuracy of FFR to predict reversible ischaemia as referenced to a non-invasive gold standard with MRI. This thesis has also shown the futility of using dark blood oedema imaging amongst all comer NSTEMI patients when compared to novel T1 and T2 mapping methods.

Communication across cultures? An intercultural approach to customer service in the hotel industry: a study with globally branded hotels in the United Kingdom

In a professional and business-social context such as that of global hotel brands in the United Kingdom, intercultural communication, contacts and relationships are found at the heart of daily operations and of customer service. A large part of the clientele base of hotels in the United Kingdom is formed by individuals who belong to different cultural groups that travel in the country either for leisure or business. At the same time, the global workforce which is recruited in the hotel industry in the United Kingdom is a reality here to stay. Global travelling and labor work mobility are phenomena which have been generated by changes which occur on a socio-economic, cultural and political level due to the phenomenon of globalization. The hotel industry is therefore well acquainted with the essence of different cultures either to be accommodated within hotel premises, as in the case of external customers, or of diversity management where different cultures are recruited in the hotel industry, as in the case of internal customers. This thesis derives from research conducted on eight different global hotel brands in the United Kingdom in particular, with reference to three, four and five star categories. The research aimed to answer the question of how hotels are organized in order to address issues of intercultural communication during customer service and if intercultural barriers arise during the intercultural interaction of hotel staff and global customers. So as to understand how global hotel brands operate the research carried out focused in three main areas relating to each hotel: organizational culture, customer service–customer care and intercultural issues. The study utilized qualitative interviews with hotel management staff and non-management staff from different cultural backgrounds, public space observations between customers and staff during check-in and checkout in the reception area and during dining at the café-bar and restaurant. Thematic analysis was also applied to the official web page of each hotel and to job advertisements to enhance the findings from the interviews and the observations. For the process of analysis of the data interpretive (hermeneutic) phenomenology of Martin Heidegger has been applied. Generally, it was found that hotel staff quite often feel perplexed by how to deal with and how to overcome, for instance, language barriers and religious issues and how to interpret non verbal behaviors or matters on food culture relating to the intercultural aspect of customer service. In addition, it was interesting to find that attention to excellent customer service on the part of hotel staff is a top organizational value and customer care is a priority. Despite that, the participating hotel brands appear to have not yet, realized how intercultural barriers can affect the daily operation of the hotel, the job performance and the psychology of hotel staff. Employees indicated that they were keen to receive diversity training, provided by their organizations, so as to learn about different cultural needs and expand their intercultural skills. The notion of diversity training in global hotel brands is based on the sense that one of the multiple aims of diversity management as a practice and policy in the workplace of hotels is the better understanding of intercultural differences. Therefore global hotel brands can consider diversity training as a practice which will benefit their hotel staff and clientele base at the same time. This can have a distinctive organizational advantage for organizational affairs in the hotel industry, with potential to influence the effectiveness and performance of hotels.

Comparazione performance di un'applicazione enterprise basata su service mesh

Ultimamente si stanno sviluppando tecnologie per rendere più efficiente la virtualizzazione a livello di sistema operativo, tra cui si cita la suite Docker, che permette di gestire processi come se fossero macchine virtuali. Inoltre i meccanismi di clustering, come Kubernetes, permettono di collegare macchine multiple, farle comunicare tra loro e renderle assimilabili ad un server monolitico per l'utente esterno. Il connubio tra virtualizzazione a livello di sistema operativo e clustering permette di costruire server potenti quanto quelli monolitici ma più economici e possono adattarsi meglio alle richieste esterne. Data l'enorme mole di dati e di potenza di calcolo necessaria per gestire le comunicazioni e le interazioni tra utenti e servizi web, molte imprese non possono permettersi investimenti su un server proprietario e la sua manutenzione, perciò affittano le risorse necessarie che costituiscono il cosiddetto "cloud", cioè l'insieme di server che le aziende mettono a disposizione dei propri clienti. Il trasferimento dei servizi da macchina fisica a cloud ha modificato la visione che si ha dei servizi stessi, infatti non sono più visti come software monolitici ma come microservizi che interagiscono tra di loro. L'infrastruttura di comunicazione che permette ai microservizi di comunicare è chiamata service mesh e la sua suddivisione richiama la tecnologia SDN. È stato studiato il comportamento del software di service mesh Istio installato in un cluster Kubernetes. Sono state raccolte metriche su memoria occupata, CPU utilizzata, pacchetti trasmessi ed eventuali errori e infine latenza per confrontarle a quelle ottenute da un cluster su cui non è stato installato Istio. Lo studio dimostra che, in un cluster rivolto all'uso in produzione, la service mesh offerta da Istio fornisce molti strumenti per il controllo della rete a scapito di una richiesta leggermente più alta di risorse hardware.

Machine learning as a service for high energy physics (MLaaS4HEP): a service for ML-based data analyses

With the CERN LHC program underway, there has been an acceleration of data growth in the High Energy Physics (HEP) field and the usage of Machine Learning (ML) in HEP will be critical during the HL-LHC program when the data that will be produced will reach the exascale. ML techniques have been successfully used in many areas of HEP nevertheless, the development of a ML project and its implementation for production use is a highly time-consuming task and requires specific skills. Complicating this scenario is the fact that HEP data is stored in ROOT data format, which is mostly unknown outside of the HEP community. The work presented in this thesis is focused on the development of a ML as a Service (MLaaS) solution for HEP, aiming to provide a cloud service that allows HEP users to run ML pipelines via HTTP calls. These pipelines are executed by using the MLaaS4HEP framework, which allows reading data, processing data, and training ML models directly using ROOT files of arbitrary size from local or distributed data sources. Such a solution provides HEP users non-expert in ML with a tool that allows them to apply ML techniques in their analyses in a streamlined manner. Over the years the MLaaS4HEP framework has been developed, validated, and tested and new features have been added. A first MLaaS solution has been developed by automatizing the deployment of a platform equipped with the MLaaS4HEP framework. Then, a service with APIs has been developed, so that a user after being authenticated and authorized can submit MLaaS4HEP workflows producing trained ML models ready for the inference phase. A working prototype of this service is currently running on a virtual machine of INFN-Cloud and is compliant to be added to the INFN Cloud portfolio of services.