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.

Ultrasonic wave reflection measurements on self-compacting pastes and concretes

The objective of this study was to extend the use of combined longitudinal (P-wave) and shear (S-wave) ultrasonic wave reflection (UWR) to monitor the setting and stiffening of self-compacting pastes and concretes. An additional objective was to interpret the UWR responses of various modified cement pastes. A polymeric buffer with acoustic impedance close to that of cement paste, high impact polystyrene, was chosen to obtain sensitive results from the early hydration period. Criteria for initial and final set developed by our group in a prior study were used to compute setting times by UWR. UWR results were compared with standard penetration measurements. Stiffening behavior and setting times for normal cement pastes, pastes modified with mineral and chemical admixtures, self-compacting pastes, and concretes were explored using penetration resistance, S-wave and P-wave reflection. All three methods showed that set times of pastes varied linearly with w/c, that superplasticizer and fly ash delayed the set times of pastes, and that differences in w/cm, sp/cm, and fa/cm could be detected. Final set times determined from UWR correlated well with those from penetration resistance. Initial set times from S-wave reflection did not correlate very well with those from penetration resistance. Final set times from P-wave and S-wave reflection were roughly the same. Pastes with different chemical admixtures were tested, and the effects of these admixtures on stiffening were determined using UWR. Self-compacting concretes were studied using UWR, and their response and setting times were largely similar to that of corresponding self-compacting pastes. The P-wave reflection response was explored in detail, and the phenomenon of partial debonding and the factors affecting it were explained. Partial debonding is probably caused by autogenous shrinkage at final set, and was controlled and limited by water. The extent of partial debonding was higher with the transducers placed on the side as opposed to the bottom, and the S-wave transducer seemed to promote debonding in the P-wave reflection, whereas the P-wave transducer seemed to reduce debonding in the S-wave reflection. Simultaneous formwork pressure testing and UWR were performed; however, no clear correlation was seen between the two properties.

Conhecimentos sobre o HPV e cancro do colo do útero nos adolescentes

O Cancro do Colo do Útero (CCU) é uma das principais causas de morte por neoplasia nas mulheres, em todo o mundo. A principal etiologia do CCU é a infeção persistente pelas estirpes oncogénicas do Vírus do Papiloma Humano (HPV) (Ferreira, 2013). Esta temática é de grande interesse para a Saúde Pública por se tratar de uma infeção que na maioria dos casos se apresenta de forma assintomática, afetando ambos os sexos (Leite, Lisboa, & Azevedo, 2011). O presente trabalho tem como objetivos avaliar os conhecimentos dos alunos do Ensino Secundário do Agrupamento de escolas Emidio Garcia, em Bragança, sobre o HPV e CCU e conhecer os dados referentes à cobertura vacinal da população do Concelho de Bragança, relativamente à vacina do HPV no ano de 2014. O estudo efetuado é de tipologia observacional-descritivo e correlacional, de paradigma quantitativo através de um processo sistemático de recolha de dados, num plano transversal. Numa amostra de 196 alunos do ensino secundário do Agrupamento de escolas Emídio Garcia em Bragança, com base num erro amostral de 5%, com um nível de confiança de fidelidade de 95%, classificada como amostra não probabilística, acidental/ocasional. O instrumento de recolha de dados utilizado foi um questionário da autoria de Diana Ramada e Rui Medeiros, validado e devidamente autorizado. As principais conclusões do estudo relativamente aos conhecimentos sobre esta temática por parte dos alunos, revelam que o maior conhecimento reside nos mais jovens com idades compreendidas entre os 15 e 16 anos em relação aos alunos de 18 e 19 anos. São alunos que estão bem informados no que diz respeito às manifestações e aos fatores de risco da infeção por HPV, conscientes de que afeta tanto o sexo feminino com o masculino e que os indivíduos do sexo masculino podem ser portadores assintomáticos. Reconhecem que a infeção pelo vírus do HPV é curável e que a persistência desta infeção pode provocar CCU. Existe uma lacuna relativamente ao HPV ser o agente mais comum das IST, em que 93,4% dos inquiridos respondeu ser o HIV. Revelam desconhecimento relativamente à localização e modos de transmissão deste vírus. Manifestaram interesse por adquirir e aprofundar conhecimentos, assinalando a escola e os profissionais de saúde como centro de informação. Existe, no entanto, um aspeto positivo a concluir, ao se verificar que a vacinação tem uma grande adesão e que é cumprido o esperado pelo Plano Nacional de Vacinação, diminuindo o risco de infeção por HPV e em consequência reduzindo a incidência do CCU, por infeção persistente de HPV.

The quality of rapid HIV testing in South Africa: an assessment of testers’ compliance.

Background: The aim of this study was to assess the quality of rapid HIV testing in South Africa. Method: A two-stage sampling procedure was used to select HCT sites in eight provinces of South Africa. The study employed both semi-structured interviews with HIV testers and observation of testing sessions as a means of data collection. In total, 63 HCT sites (one HIV tester per site) were included in the survey assessing qualification, training, testing practices and attitudes towards rapid tests. Quantitative data was analysed using descriptive statistics and qualitative data was content analysed. Results: Of the 63 HIV testers, 20.6% had a nursing qualification, 14.3% were professional counsellors, 58.7% were lay HIV counsellors and testers and 6.4% were from other professions. Most HIV testers (87.3%) had had a formal training in testing, which ranged between 10-14 days, while 6 (9.5%) had none. Findings revealed sub-standard practices in relation to testing. These were mainly related to non-adherence to testing algorithms, poor external quality control practices, poor handling and communication of discordant results. Conclusion: Quality of HIV rapid testing may be highly compromised through poor adherence to guidelines as observed in our study.

Employment testing online, offline, and over the phone: implications for e-assessment

This research investigated faking across test administration modes in an employment testing scenario. For the first time, phone administration was included. Participants (N = 91) were randomly allocated to testing mode (telephone, Internet, or pen-and-paper). Participants completed a personality measure under standard instructions and then under instructions to fake as an ideal police applicant. No significant difference in any faked personality domains as a function of administration mode was found. Effect sizes indicated that the influence of administration mode was small. Limitations and future directions are considered. Overall, results indicate that if an individual intends to fake on a self-report test in a vocational assessment scenario, the electronic administration mode in which the test is delivered may be unimportant.

Essays on mixed-frequency data : forecasting and unit root testing

Doutoramento em Economia

Sex-Positive Curricula: An Investigation of the Relationship Between Physical Fitness, Self-Concept and Sexual Functioning

Despite the well-recognized benefits of exercise, Americans are gaining weight in astounding proportions and levels of physical activity are on the decline. The purpose of this study was to investigate a relationship between physical fitness, self-concept and sexual health. There is a dearth of knowledge on this relationship specifically in the context of sex-negative curricula, which is the dominate discourse in the United States. One hundred and thirty-three participants between the ages of 18 - 50 volunteered for fitness testing and data collection. Physical fitness was assessed through body fat, resting metabolic rate, cardiovascular endurance, muscular strength, muscular endurance and flexibility. Self-reported exercise was measured using the International Physical Activity Questionnaire. Self-concept was measured by the Six Factor Self-Concept Scale, which presented a total self-concept score and as six individual concepts of self (likability, morality, task accomplishment, giftedness, power and vulnerability). Additionally, sexual function was measured by Derogatis Interview for Sexual Functioning and presented as both an aggregate score and five separate constructs of sexual functioning (fantasy/cognition, arousal, orgasm, behavior/experience, and drive/desire). Questions pertaining to sexual partners, sex education, and demographic information were also included. The results of the General Linear Model indicated significant relationships between physical fitness, self-concept and total sexual functioning. The sexual behavior/experience of men was predicted by body fat percentage and flexibility. In women, behavior/experience was predicted by body fat percentage and arousal was predicted by cardiovascular endurance. Total self-concept was related to muscular endurance. When men were isolated in the analysis, likability was positively related to sexual behavior/experience, and task accomplishment was inversely related to sexual behavior/experience. In women, giftedness was related to cognition/fantasy, arousal, orgasm and total sexual functioning. No relationships were found between physical fitness and the number of sexual partners in men; however, both muscular strength and the power self-concept were significantly related to number of sexual partners in women. As a result of these findings, women may be inclined to exercise to improve arousal and sexual functioning. Furthermore, educators should note the findings of a positive relationship between physical and psychological health and sexual well-being because they provide support for the development and adoption of sex-positive curricula that incorporate potential benefits of sexual activity.

Self-healing thermal annealing: surface morphological restructuring control of GaN nanorods

With advances in nanolithography and dry etching, top-down methods of nanostructuring have become a widely used tool for improving the efficiency of optoelectronics. These nano dimensions can offer various benefits to the device performance in terms of light extraction and efficiency, but often at the expense of emission color quality. Broadening of the target emission peak and unwanted yellow luminescence are characteristic defect-related effects due to the ion beam etching damage, particularly for III–N based materials. In this article we focus on GaN based nanorods, showing that through thermal annealing the surface roughness and deformities of the crystal structure can be “self-healed”. Correlative electron microscopy and atomic force microscopy show the change from spherical nanorods to faceted hexagonal structures, revealing the temperature-dependent surface morphology faceting evolution. The faceted nanorods were shown to be strain- and defect-free by cathodoluminescence hyperspectral imaging, micro-Raman, and transmission electron microscopy (TEM). In-situ TEM thermal annealing experiments allowed for real time observation of dislocation movements and surface restructuring observed in ex-situ annealing TEM sampling. This thermal annealing investigation gives new insight into the redistribution path of GaN material and dislocation movement post growth, allowing for improved understanding and in turn advances in optoelectronic device processing of compound semiconductors.

Self-report depressive symptoms do not directly predict suicidality in nonclinical individuals: Contributions toward a more psychosocial approach to suicide risk

Although suicidality is associated with mental illness in general and depression in particular, many depressed individuals do not attempt suicide and some individuals who attempt to or do die by suicide do not present depressive symptoms. This article aims to contribute to a more psychosocial approach to understanding suicide risk in nonclinical populations. In advocating a psychosocial perspective rather than a depression-focused approach, this article presents four diverse studies that demonstrate sampling and measurement invariance in findings across different populations and specific measures. Study 1 tests the mediation effects of 2 interpersonal variables, thwarted belongingness and perceived burdensomeness, in the association between depressive symptoms and recent suicidality. Studies 2 and 3 evaluate the contribution of hopelessness and psychache, beyond depressive symptoms, to suicidality. Study 4 tests the contribution of life events behind depressive symptoms, and other relevant sociodemographic and clinical variables, to the estimation of “future suicidality.” Overall, results demonstrate that depressive symptoms do not directly predict suicidality in nonclinical individuals, but that other psychosocial variables mediate the association between depressive symptoms and suicidality or predict suicidality when statistically controlling for depressive symptoms. The article contributes to understanding some of the nonpsychopathological factors that potentially link depressive symptoms to suicide risk and that might themselves contribute to suicidality, even when controlling for depressive symptoms.

Testing a Theory-Based Model of Suicidality in a Community Sample

The aim of the present study is to test a theory-based model of suicide in a low-risk nonclinical sample. A community sample of convenience of 200 adults, 102 men and 98 women, responded to the Depressive Experiences Questionnaire, the Center for the Epidemiologic Studies of Depression Scale, the Psychache Scale, the Interpersonal Needs Questionnaire, and the Suicide Behaviors Questionnaire Revised. The hypothesized structural equation model, including trait dimensions of self-criticism and neediness, and state dimensions of depression, psychache, perceived burdensomeness, and thwarted belongingness, fit the observed data well and significantly explained 49% of the variance of suicidality.

Testing the effectiveness of phytoscreening to monitor shallow groundwater contamination by chlorinated ethenes

The research presented herein aims to investigate the strengths and weaknesses of a relatively new technique called phytoscreening. Parallel to the well-known phytoremediation, it consists of exploiting the absorbing potential of trees to delineate groundwater contamination plumes, especially for chlorinated ethenes (i.e., PCE, TCE, 1,2-cis DCE, and VC). The latter are prevalent contaminants in groundwater but their fate and transport in surface ecosystems, such as trees, are still poorly understood and subjected to high variability. Moreover, the analytical validity of tree-coring is still limited in many countries due to a lack of knowledge of its application opportunities. Tree-cores are extracted from trunks and generally analyzed by gas chromatography/mass spectrometry. A systematic review of former literature on phytoscreening for chlorinated ethenes is presented in this PhD thesis to evaluate the factors influencing the effectiveness of the technique. Besides, we tested the technique by probing eight sites contaminated by chlorinated ethenes in Italy (Emilia-Romagna) in different hydrogeological and seasonal settings. We coupled the technique with the assessment of gaseous-phase concentrations directly on-site, inserting detector tubes or a photoionization detector in the tree-holes left by the coring tool. Finally, we applied rank order statistic analysis on field data along with literature data to assess under which conditions phytoscreening should be applied to either screen or monitor environmental contamination issues. A relatively high correlation exists between tree-core and groundwater concentrations (Spearman’s ρ > 0.6), being higher for compounds with higher sorption, for sites with shallower and thinner aquifers, and when sampling specific tree types with standardized sampling and extraction protocols. These results indicate the opportunities for assessing the occurrence, type, and concentration of solvents directly from the stem of trees. This can reduce the costs of characterization surveys, allowing rapid identification of hotspots and plume direction and thus optimizing the drilling of boreholes.

Development and testing of methodologies for the control and diagnosis of innovative combustion systems

In pursuit of aligning with the European Union's ambitious target of achieving a carbon-neutral economy by 2050, researchers, vehicle manufacturers, and original equipment manufacturers have been at the forefront of exploring cutting-edge technologies for internal combustion engines. The introduction of these technologies has significantly increased the effort required to calibrate the models implemented in the engine control units. Consequently the development of tools that reduce costs and the time required during the experimental phases, has become imperative. Additionally, to comply with ever-stricter limits on 〖"CO" 〗_"2" emissions, it is crucial to develop advanced control systems that enhance traditional engine management systems in order to reduce fuel consumption. Furthermore, the introduction of new homologation cycles, such as the real driving emissions cycle, compels manufacturers to bridge the gap between engine operation in laboratory tests and real-world conditions. Within this context, this thesis showcases the performance and cost benefits achievable through the implementation of an auto-adaptive closed-loop control system, leveraging in-cylinder pressure sensors in a heavy-duty diesel engine designed for mining applications. Additionally, the thesis explores the promising prospect of real-time self-adaptive machine learning models, particularly neural networks, to develop an automatic system, using in-cylinder pressure sensors for the precise calibration of the target combustion phase and optimal spark advance in a spark-ignition engines. To facilitate the application of these combustion process feedback-based algorithms in production applications, the thesis discusses the results obtained from the development of a cost-effective sensor for indirect cylinder pressure measurement. Finally, to ensure the quality control of the proposed affordable sensor, the thesis provides a comprehensive account of the design and validation process for a piezoelectric washer test system.

Low-density Three-dimensional Foam Using Self-reinforced Hybrid Two-dimensional Atomic Layers.

Low-density nanostructured foams are often limited in applications due to their low mechanical and thermal stabilities. Here we report an approach of building the structural units of three-dimensional (3D) foams using hybrid two-dimensional (2D) atomic layers made of stacked graphene oxide layers reinforced with conformal hexagonal boron nitride (h-BN) platelets. The ultra-low density (1/400 times density of graphite) 3D porous structures are scalably synthesized using solution processing method. A layered 3D foam structure forms due to presence of h-BN and significant improvements in the mechanical properties are observed for the hybrid foam structures, over a range of temperatures, compared with pristine graphene oxide or reduced graphene oxide foams. It is found that domains of h-BN layers on the graphene oxide framework help to reinforce the 2D structural units, providing the observed improvement in mechanical integrity of the 3D foam structure.

[gait Speed, Grip Strength And Self-rated Health Among The Elderly: Data From The Fibra Campinas Network, São Paulo, Brazil].

The article seeks to investigate patterns of performance and relationships between grip strength, gait speed and self-rated health, and investigate the relationships between them, considering the variables of gender, age and family income. This was conducted in a probabilistic sample of community-dwelling elderly aged 65 and over, members of a population study on frailty. A total of 689 elderly people without cognitive deficit suggestive of dementia underwent tests of gait speed and grip strength. Comparisons between groups were based on low, medium and high speed and strength. Self-related health was assessed using a 5-point scale. The males and the younger elderly individuals scored significantly higher on grip strength and gait speed than the female and oldest did; the richest scored higher than the poorest on grip strength and gait speed; females and men aged over 80 had weaker grip strength and lower gait speed; slow gait speed and low income arose as risk factors for a worse health evaluation. Lower muscular strength affects the self-rated assessment of health because it results in a reduction in functional capacity, especially in the presence of poverty and a lack of compensatory factors.

Self-reported Diabetes In Older People: Comparison Of Prevalences And Control Measures.

The objective of this study was to analyze the prevalence of diabetes in older people and the adopted control measures. Data regarding older diabetic individuals who participated in the Health Surveys conducted in the Municipality of Sao Paulo, SP, ISA-Capital, in 2003 and 2008, which were cross-sectional studies, were analyzed. Prevalences and confidence intervals were compared between 2003 and 2008, according to sociodemographic variables. The combination of the databases was performed when the confidence intervals overlapped. The Chi-square (level of significance of 5%) and the Pearson's Chi-square (Rao-Scott) tests were performed. The variables without overlap between the confidence intervals were not tested. The age of the older adults was 60-69 years. The majority were women, Caucasian, with an income of between > 0.5 and 2.5 times the minimum salary and low levels of schooling. The prevalence of diabetes was 17.6% (95%CI 14.9;20.6) in 2003 and 20.1% (95%CI 17.3;23.1) in 2008, which indicates a growth over this period (p at the limit of significance). The most prevalent measure adopted by the older adults to control diabetes was hypoglycemic agents, followed by diet. Physical activity was not frequent, despite the significant differences observed between 2003 and 2008 results. The use of public health services to control diabetes was significantly higher in older individuals with lower income and lower levels of education. Diabetes is a complex and challenging disease for patients and the health systems. Measures that encourage health promotion practices are necessary because they presented a smaller proportion than the use of hypoglycemic agents. Public health policies should be implemented, and aimed mainly at older individuals with low income and schooling levels. These changes are essential to improve the health condition of older diabetic patients.