Health system context and implementation of evidence-based practices-development and validation of the Context Assessment for Community Health (COACH) tool for low- and middle-income settings

Background: The gap between what is known and what is practiced results in health service users not benefitting from advances in healthcare, and in unnecessary costs. A supportive context is considered a key element for successful implementation of evidence-based practices (EBP). There were no tools available for the systematic mapping of aspects of organizational context influencing the implementation of EBPs in low- and middle-income countries (LMICs). Thus, this project aimed to develop and psychometrically validate a tool for this purpose. Methods: The development of the Context Assessment for Community Health (COACH) tool was premised on the context dimension in the Promoting Action on Research Implementation in Health Services framework, and is a derivative product of the Alberta Context Tool. Its development was undertaken in Bangladesh, Vietnam, Uganda, South Africa and Nicaragua in six phases: (1) defining dimensions and draft tool development, (2) content validity amongst in-country expert panels, (3) content validity amongst international experts, (4) response process validity, (5) translation and (6) evaluation of psychometric properties amongst 690 health workers in the five countries. Results: The tool was validated for use amongst physicians, nurse/midwives and community health workers. The six phases of development resulted in a good fit between the theoretical dimensions of the COACH tool and its psychometric properties. The tool has 49 items measuring eight aspects of context: Resources, Community engagement, Commitment to work, Informal payment, Leadership, Work culture, Monitoring services for action and Sources of knowledge. Conclusions: Aspects of organizational context that were identified as influencing the implementation of EBPs in high-income settings were also found to be relevant in LMICs. However, there were additional aspects of context of relevance in LMICs specifically Resources, Community engagement, Commitment to work and Informal payment. Use of the COACH tool will allow for systematic description of the local healthcare context prior implementing healthcare interventions to allow for tailoring implementation strategies or as part of the evaluation of implementing healthcare interventions and thus allow for deeper insights into the process of implementing EBPs in LMICs.

Estudos de caso : implantação de sistemas ERP - uma análise crítica à luz da metodologia de Project Management

Este documento constitui-se em uma dissertação de mestrado, requisito parcial para a obtenção do grau de Mestre em Gestão Empresaria e Pública. Este estudo procura mostrar que a adoção dessa nova tecnologia através de projetos de implantação de sistema de ERP não só mudam processos administrativos como também produtos, serviços e estruturas organizacionais e que a sua implantação se constitui em um grande projeto que envolve um número considerável de recursos e tempo das organizações. Este estudo procurar mostrar também que os impactos que tais projetos trazem, são mais fortemente sentidos ou não pela organização de acordo com uma série de fatores, entre eles, a resistência à mudança e o quanto a organização está preparada para enfrentar essas mudanças, o medo da perda do emprego pela adoção de uma nova tecnologia, problemas com a falta de comunicação das mudanças, questões relacionadas à cultura organizacional vigente, a falta de envolvimento da alta administração, entre outras. Para gerenciar todas essas variáveis, as organizações modernas adotam técnicas para garantir o sucesso da implantação dessas novas tecnologias. o estudo aqui proposto tem como objetivo determinar até que ponto a utilização de metodologias e de técnicas de Project Management é o suficiente para que esses projetos alcancem o sucesso esperado pelas organizações. A quantidade de variáveis que influenciam o resultado de um projeto são muitas e cada uma delas possui um papel importante que deve ser avaliado. As conclusões desta pesquisa demonstram que o sucesso de um projeto nem sempre se resume a atingir os objetivos inicialmente propostos, relativos ao cumprimento do prazo, escopo e custo de um projeto, conforme define a metodologia de Project Management. Outros aspectos considerados por essa metodologia, se melhor ou pior aplicados, também contribuem para o sucesso ou fracasso de um projeto de implantação de um sistema de ERP sendo o seu fracasso traduzido ou não, no cumprimento do prazo, do escopo inicialmente previsto ou no custo inicialmente calculado. Outros aspectos que não apenas a aplicação correta da metodologia de Project Management contribuem para os resultados alcançados pelo projeto.

Lean management and innovation in operational efficiency: the EGR project implemented by Pirelli Tyre Brazil in Santo André plant

O trabalho tem como objetivo avaliar e descrever analiticamente a implementação de práticas de manufatura enxuta pela Pirelli Pneus no seu complexo industrial da América Latina. Além de uma descrição estruturada e ampla dos princípios de produção de Toyota e fundamentos teóricos do Lean thinking, uma ênfase especial será dedicada ao projeto EGR (Especialistas em Gestão da Rotina), como uma ferramenta estratégica para ser usada pela empresa multinacional italiana no futuro próximo, de modo a alcançar um resultado mais eficaz e eficiente na gestão da rotina diária. Este projeto, que representa um componente significativo do Pirelli Manufacturing System (PMS) e, principalmente, voltado para supervisores e gestores de plantas, consiste principalmente em ajudar a empresa a desenvolver a capacidade empresarial para avaliar corretamente o gap potencial existente entre os resultados atuais e os esperados, para tanto entender os desvios, bem como as causas subjacentes, e melhorar continuamente o desempenho da empresa por meio da padronização de processos e redução de desperdicios. Esses objetivos podem ser perseguidos, atuando em dois meios essenciais: habilidades técnicas e comportamentais de liderança para apoiar cada equipe de projeto; uma maior eficácia na gestão de indicadores de desempenho nas diferentes unidades de fábrica, de acordo com KPIs estabelecidos no nível central pelo Head Quarter. Além disso, a investigação será focada na experiência peculiar da planta de Santo André, onde o EGR começou como piloto, com o objetivo de captar as alterações relevantes (no lado organizacional e econômico) que este projeto trouxe para a empresa, através da realização de pesquisa de campo e entrevistas, que são orientados a recolher provas, considerações e opiniões de todos os principais atores envolvidos.

Interactive music visualization: implementation, realization and evaluation

This thesis describes all process of the development of music visualization, starting with the implementation, followed by realization and then evaluation. The main goal is to have to knowledge of how the audience live performance experience can be enhanced through music visualization. With music visualization is possible to give a better understanding about the music feelings constructing an intensive atmosphere in the live music performance, which enhances the connection between the live music and the audience through visuals. These visuals have to be related to the live music, furthermore has to quickly respond to live music changes and introduce novelty into the visuals. The mapping between music and visuals is the focus of this project, in order to improve the relationship between the live performance and the spectators. The implementation of music visualization is based on the translation of music into graphic visualizations, therefore at the beginning the project was based on the existent works. Later on, it was decided to introduce new ways of conveying music into visuals. Several attempts were made in order to discover the most efficient mapping between music and visualization so people can fully connect with the performance. Throughout this project, those attempts resulted in several music visualizations created for four live music performances, afterwards it was produced an online survey to evaluate those live performances with music visualization. In the end, all conclusions are presented based on the results of the online survey, and also is explained which music elements should be depicted in the visuals, plus how those visuals should respond to the selected music elements.

Project and Development of ErgoCoIn Version 2.0

Usability evaluation (UE) methods may have several purposes: identify and diagnose usability problems; evaluate the implementation, comparing the one under evaluation with other systems, and also perform acceptance test. These methods are usually expensive, time-consuming and complex. In this context, the ErgoCoIn 1.0 has being used as an accessible system that can be used by several people all over the world, even if they are not usability experts or evaluators. This paper aims to present a new version of this environment considering that its basic objective is to propose a higher quality for the questions. Additionally, a new presentation questionnaire window small enough to be used both in web browsers and mobile devices is proposed.

An evaluative study of the implementation of domestic violence legislation: Antigua and Barbuda, St. Kitss

Includes bibliography

Logistics observatories and regional integration indicators: the Mesoamerica project

This FAL Bulletin analyses the development of logistics observatories and the construction of regional integration indicators in Latin America and the Caribbean. To this end, it examines experiences, in the region and worldwide, in relation to the construction of indicators and presents a set of policy recommendations for proper implementation. The Mesoamerica Project is used as a case study to construct a set of indicators for logistics infrastructures.

Barriers related to non-adherence in a mammography breast-screening program during the implementation period in the interior of São Paulo State, Brazil

Mammography is the best exam for early diagnosis of breast cancer. Developing countries frequently have a low income of mammography and absence of organized screening. The knowledge of vulnerable population and strategies to increase adherence are important to improve the implementation of an organized breast-screening program. A mammography regional-screening program was implemented in a place around 54.238 women, aged 40-69 years old. It was proposed to perform biannual mammography free of cost for the women. We analyze the first 2 years of the implementation of the project. Mammography was realized in 17.964 women. 42.1% of the women hadn't done de mammography in their lives and these women were principally from low socio-economic status (OR=2.99), low education (OR=3.00). The best strategies to include these women were mobile unit (OR=1.43) and Family Health Program (OR=1.79). The incidence of early breast tumors before the project was 14.5%, a fact that changed to 43.2% in this phase. Multivariate analysis showed that the association of illiterate and the mobile unit achieve more women who had not performed mammography in their lives. The strategies to increase adherence to mammography must be multiple and a large organization is necessary to overpass the barriers related to system health and education.

The standpoint of professionals on the presence and demands of men on the healthcare services: perspectives for the analysis of the implementation of the Comprehensive Healthcare Policy for Men

In 2009, the Brazilian Comprehensive Healthcare Policy for Men (PNAISH) was launched in Brazil, seeking to reduce morbidity and mortality in this population group. This article strives to analyze the conceptions that health professionals have about the specific demands and behaviors of the male population served by the healthcare services. The data analyzed are part of a larger research project, the objective of which was to evaluate the initial actions of the implementation of PNAISH. Ethnographic observations in 11 health services and semi-structured interviews were conducted with 21 health professionals. From the perspective of health professionals, the presence of men in the healthcare services is still limited. According to them, it is comprised of two types of clients: workers and the elderly. The male behavior characteristics - haste, objectivity, fear and resistance - and the difficulty faced by health services in receiving this population are the main factors that drive men away from health services. Although the concept of gender is central to PNAISH, it is only triggered by healthcare professionals in order to justify the social standards expected in terms of men's behavior. The attribution of men's behavior to cultural factors ultimately obscures the relations of power that underlie gender relations.

Rural development and communication: a community media project in Uttar Pradesh (India)

Loaded with 16% of the world’s population, India is a challenged country. More than a third of its citizens live below the poverty line - on less than a dollar a day. These people have no proper electricity, no proper drinking water supply, no proper sanitary facilities and well over 40% are illiterates. More than 65% live in rural areas and 60% earn their livelihood from agriculture. Only a meagre 3.63% have access to telephone and less than 1% have access to a computer. Therefore, providing access to timely information on agriculture, weather, social, health care, employment, fishing, is of utmost importance to improve the conditions of rural poor. After some introductive chapters, whose function is to provide a comprehensive framework – both theoretical and practical – of the current rural development policies and of the media situation in India and Uttar Pradesh, my dissertation presents the findings of the pilot project entitled “Enhancing development support to rural masses through community media activity”, launched in 2005 by the Department of Mass Communication and Journalism of the Faculty of Arts of the University of Lucknow (U.P.) and by the local NGO Bharosa. The project scope was to involve rural people and farmers from two villages of the district of Lucknow (namely Kumhrava and Barhi Gaghi) in a three-year participatory community media project, based on the creation, implementation and use of a rural community newspaper and a rural community internet centre. Community media projects like this one have been rarely carried out in India because the country has no proper community media tradition: therefore the development of the project has been a challenge for the all stakeholders involved.

Multitemporal analysis of satellite imagery: implementation of a land evolution model in ALCS (ATSR LAND CLASSIFICATION SYSTEM)

In this report it was designed an innovative satellite-based monitoring approach applied on the Iraqi Marshlands to survey the extent and distribution of marshland re-flooding and assess the development of wetland vegetation cover. The study, conducted in collaboration with MEEO Srl , makes use of images collected from the sensor (A)ATSR onboard ESA ENVISAT Satellite to collect data at multi-temporal scales and an analysis was adopted to observe the evolution of marshland re-flooding. The methodology uses a multi-temporal pixel-based approach based on classification maps produced by the classification tool SOIL MAPPER ®. The catalogue of the classification maps is available as web service through the Service Support Environment Portal (SSE, supported by ESA). The inundation of the Iraqi marshlands, which has been continuous since April 2003, is characterized by a high degree of variability, ad-hoc interventions and uncertainty. Given the security constraints and vastness of the Iraqi marshlands, as well as cost-effectiveness considerations, satellite remote sensing was the only viable tool to observe the changes taking place on a continuous basis. The proposed system (ALCS – AATSR LAND CLASSIFICATION SYSTEM) avoids the direct use of the (A)ATSR images and foresees the application of LULCC evolution models directly to „stock‟ of classified maps. This approach is made possible by the availability of a 13 year classified image database, conceived and implemented in the CARD project (http://earth.esa.int/rtd/Projects/#CARD).The approach here presented evolves toward an innovative, efficient and fast method to exploit the potentiality of multi-temporal LULCC analysis of (A)ATSR images. The two main objectives of this work are both linked to a sort of assessment: the first is to assessing the ability of modeling with the web-application ALCS using image-based AATSR classified with SOIL MAPPER ® and the second is to evaluate the magnitude, the character and the extension of wetland rehabilitation.

First Ramsey-type mass measurements with ISOLTRAP and design studies of the new PENTATRAP project

Der Einsatz von Penningfallen in der Massenspektrometrie hat zu einem einmaligen Genauigkeitssprung geführt. Dadurch wurden Massenwerte verschiedenster Atome zu wichtigen Eingangsparametern bei immer mehr physikalischen Fragestellungen. Die Massenspektrometrie mit Hilfe von Penningfallen basiert auf der Bestimmung der freien Zyklotronfrequenz eines Ions in einem homogenen Magnetfeld νc=qB/(2πm). Sie wird mit Flugzeitmethode (TOF-ICR) bestimmt, wobei eine relative Massenungenauigkeit δm/m von wenigen 10^-9 bei Nukliden mit Lebensdauern von <500 ms erreicht wird. Dies wurde durch die im Rahmen dieser Arbeit erstmals in der Penningfallen-Massenspektrometrie eingesetzten Ramsey-Methode möglich. Dabei werden zeitlich separierte, oszillierenden Feldern zur resonanten Ionenanregung genutzt, um die Frequenzmessung durch die Flugzeitmethode zu verbessern. Damit wurden am Penningfallenmassenspektrometer ISOLTRAP an ISOLDE/CERN die Massen der Nuklide 26,27Al und 38,39Ca bestimmt. Alle Massen wurden in die „Atomic Mass Evaluation“ eingebettet. Die Massenwerte von 26Al und 38Ca dienten insbesondere zu Tests des Standardmodells. Um mit Massenwerten fundamentale Symmetrien oder die Quantenelektrodynamik (QED) in extremen Feldern zu testen wurde ein neues Penningfallenprojekt (PENTATRAP) für hochpräzise Massenmessungen an hochgeladenen Ionen konzipiert. In dieser Doktorarbeit wurde vornehmlich die Entwicklung der Penningfallen betrieben. Eine Neuerung bei Penningfallenexperimenten ist dabei die permanente Beobachtung des Magnetfeldes B und seiner zeitlichen Fluktuationen durch so genannte „Monitorfallen“.

Implementation of enhanced biological phosphorus removal (ebpr) wastewater treatment processes enriched with different microbial communities

The EBPR (Enhanced Biological Phosphorus Removal) is a type of secondary treatment in WWTPs (WasteWater Treatment Plants), quite largely used in full-scale plants worldwide. The phosphorus occurring in aquatic systems in high amounts can cause eutrophication and consequently the death of fauna and flora. A specific biomass is used in order to remove the phosphorus, the so-called PAOs (Polyphosphate Accumulating Organisms) that accumulate the phosphorus in form of polyphosphate in their cells. Some of these organisms, the so-called DPAO (Denitrifying Polyphosphate Accumulating Organisms) use as electron acceptor the nitrate or nitrite, contributing in this way also to the removal of these compounds from the wastewater, but there could be side reactions leading to the formation of nitrous oxides. The aim of this project was to simulate in laboratory scale a EBPR, acclimatizing and enriching the specialized biomass. Two bioreactors were operated as Sequencing Batch Reactors, one enriched in Accumulibacter, the other in Tetrasphaera (both PAOs): Tetrasphaera microorganisms are able to uptake aminoacids as carbon source, Accumulibacter uptake organic carbon (volatile fatty acids, VFA). In order to measure the removal of COD, phosphorus and nitrogen-derivate compounds, different analysis were performed: spectrophotometric measure of phosphorus, nitrate, nitrite and ammonia concentrations, TOC (Total Organic Carbon, measuring the carbon consumption), VFA via HPLC (High Performance Liquid Chromatography), total and volatile suspended solids following standard methods APHA, qualitative microorganism population via FISH (Fluorescence In Situ Hybridization). Batch test were also performed to monitor the NOx production. Both specialized populations accumulated as a result of SBR operations; however, Accumulibacter were found to uptake phosphates at higher extents. Both populations were able to remove efficiently nitrates and organic compounds occurring in the feeding. The experimental work was carried out at FCT of Universidade Nova de Lisboa (FCT-UNL) from February to July 2014.

Design and implementation of the ESEO spacecraft simulator

The thesis work is developed under the European Student Earth Orbiter (ESEO) project supported by the European Space Agency (ESA) in order to help prepare a well-qualified space-engineering workforce for Europe's future. In the following chapters we are going to analyse how to simulate some ESEO subsystem. First of all, the Thermal Subsystem that evaluates the temperature evolution of on-board instruments. For this purpose, simulating also the orbital and attitude dynamics of the spacecraft, it is necessary in order to evaluate external environmental fluxes. The Power Subsystem will be the following step and it models the ability of a spacecraft to produce and store electrical energy. Finally, we will integrate in our software a block capable of simulating the communication link between the satellite and the Ground Station (GS). This last step is designed and validated during the thesis preparation.

Effect of implementing project-based education in high school physics : file folder bridge engineering

Project-based education and portfolio assessments are at the forefront of educational research. This research follows the implementation of a project-based unit in a high school physics class. Students played the role of an engineering firm who designed, built and tested file folder bridges. The purpose was to determine if projectbased learning could improve student attitude toward science and related careers like engineering. Teams of students presented their work in a portfolio for a final assessment of the process of designing, building and testing their bridges.