Chronic disease management: a qualitative study investigating the barriers, facilitators and incentives perceived by Swiss healthcare stakeholders.

BACKGROUND: Chronic disease management has been implemented for some time in several countries to tackle the increasing burden of chronic diseases. While Switzerland faces the same challenge, such initiatives have only emerged recently in this country. The aim of this study is to assess their feasibility, in terms of barriers, facilitators and incentives to participation. METHODS: To meet our aim, we used qualitative methods involving the collection of opinions of various healthcare stakeholders, by means of 5 focus groups and 33 individual interviews. All the data were recorded and transcribed verbatim. Thematic analysis was then performed and five levels were determined to categorize the data: political, financial, organisational/ structural, professionals and patients. RESULTS: Our results show that, at each level, stakeholders share common opinions towards the feasibility of chronic disease management in Switzerland. They mainly mention barriers linked to the federalist political organization as well as to financing such programs. They also envision difficulties to motivate both patients and healthcare professionals to participate. Nevertheless, their favourable attitudes towards chronic disease management as well as the fact that they are convinced that Switzerland possesses all the resources (financial, structural and human) to develop such programs constitute important facilitators. The implementation of quality and financial incentives could also foster the participation of the actors. CONCLUSIONS: Even if healthcare stakeholders do not have the same role and interest regarding chronic diseases, they express similar opinions on the development of chronic disease management in Switzerland. Their overall positive attitude shows that it could be further implemented if political, financial and organisational barriers are overcome and if incentives are found to face the scepticism and non-motivation of some stakeholders.

Management of faecal incontinence and constipation in adults with central neurological diseases.

BACKGROUND: People with neurological disease have a much higher risk of both faecal incontinence and constipation than the general population. There is often a fine line between the two conditions, with any management intended to ameliorate one risking precipitating the other. Bowel problems are observed to be the cause of much anxiety and may reduce quality of life in these people. Current bowel management is largely empirical with a limited research base. OBJECTIVES: To determine the effects of management strategies for faecal incontinence and constipation in people with neurological diseases affecting the central nervous system. SEARCH STRATEGY: We searched the Cochrane Incontinence Group Specialised Trials Register (searched 26 January 2005), the Cochrane Central Register of Controlled Trials (Issue 2, 2005), MEDLINE (January 1966 to May 2005), EMBASE (January 1998 to May 2005) and all reference lists of relevant articles. SELECTION CRITERIA: All randomised or quasi-randomised trials evaluating any types of conservative or surgical measure for the management of faecal incontinence and constipation in people with neurological diseases were selected. Specific therapies for the treatment of neurological diseases that indirectly affect bowel dysfunction were also considered. DATA COLLECTION AND ANALYSIS: Two reviewers assessed the methodological quality of eligible trials and two reviewers independently extracted data from included trials using a range of pre-specified outcome measures. MAIN RESULTS: Ten trials were identified by the search strategy, most were small and of poor quality. Oral medications for constipation were the subject of four trials. Cisapride does not seem to have clinically useful effects in people with spinal cord injuries (three trials). Psyllium was associated with increased stool frequency in people with Parkinson's disease but did not alter colonic transit time (one trial). Prucalopride, an enterokinetic did not demonstrate obvious benefits in this patient group (one study). Some rectal preparations to initiate defaecation produced faster results than others (one trial). Different time schedules for administration of rectal medication may produce different bowel responses (one trial). Mechanical evacuation may be more effective than oral or rectal medication (one trial). There appears to be a benefit to patients in one-off educational interventions from nurses. The clinical significance of any of these results is difficult to interpret. AUTHORS' CONCLUSIONS: There is still remarkably little research on this common and, to patients, very significant condition. It is not possible to draw any recommendation for bowel care in people with neurological diseases from the trials included in this review. Bowel management for these people must remain empirical until well-designed controlled trials with adequate numbers and clinically relevant outcome measures become available.

An Empirical Study on Faculty Perceptions and Teaching Practices of Wikipedia

Some faculty members from different universities around the world have begun to use Wikipedia as a teaching tool in recent years. These experiences show, in most cases, very satisfactory results and a substantial improvement in various basic skills, as well as a positive influence on the students' motivation. Nevertheless and despite the growing importance of e-learning methodologies based on the use of the Internet for higher education, the use of Wikipedia as a teaching resource remains scarce among university faculty.Our investigation tries to identify which are the main factors that determine acceptance or resistance to that use. We approach the decision to use Wikipedia as a teaching tool by analyzing both the individual attributes of faculty members and the characteristics of the environment where they develop their teaching activity. From a specific survey sent to all faculty of the Universitat Oberta de Catalunya (UOC), pioneer and leader in online education in Spain, we have tried to infer the influence of these internal and external elements. The questionnaire was designed to measure different constructs: perceived quality of Wikipedia, teaching practices involving Wikipedia, use experience, perceived usefulness and use of 2.0 tools. Control items were also included for gathering information on gender, age, teaching experience, academic rank, and area of expertise.Our results reveal that academic rank, teaching experience, age or gender, are not decisive factors in explaining the educational use of Wikipedia. Instead, the decision to use it is closely linked to the perception of Wikipedia's quality, the use of other collaborative learning tools, an active attitude towards web 2.0 applications, and connections with the professional non-academic world. Situational context is also very important, since the use is higher when faculty members have got reference models in their close environment and when they perceive it is positively valued by their colleagues. As far as these attitudes, practices and cultural norms diverge in different scientific disciplines, we have also detected clear differences in the use of Wikipedia among areas of academic expertise. As a consequence, a greater application of Wikipedia both as a teaching resource and as a driver for teaching innovation would require much more active institutional policies and some changes in the dominant academic culture among faculty members.

PRODUCT DATA MANAGEMENT FOR FINNISH SMALL AND MEDIUM-SIZED MANUFACTURING ENTERPRISES - Towards a viable information system concept

Product Data Management (PDM) systems have been utilized within companies since the 1980s. Mainly the PDM systems have been used by large companies. This thesis presents the premise that small and medium-sized companies can also benefit from utilizing the Product Data Management systems. Furthermore, the starting point for the thesis is that the existing PDM systems are either too expensive or do not properly respond to the requirements SMEs have. The aim of this study is to investigate what kinds of requirements and special features SMEs, operating in Finnish manufacturing industry, have towards Product Data Management. Additionally, the target is to create a conceptual model that could fulfill the specified requirements. The research has been carried out as a qualitative case study, in which the research data was collected from ten Finnish companies operating in manufacturing industry. The research data is formed by interviewing key personnel from the case companies. After this, the data formed from the interviews has been processed to comprise a generic set of information system requirements and the information system concept supporting it. The commercialization of the concept is studied in the thesis from the perspective of system development. The aim was to create a conceptual model, which would be economically feasible for both, a company utilizing the system and for a company developing it. For this reason, the thesis has sought ways to scale the system development effort for multiple simultaneous cases. The main methods found were to utilize platform-based thinking and a way to generalize the system requirements, or in other words abstracting the requirements of an information system. The results of the research highlight the special features Finnish manufacturing SMEs have towards PDM. The most significant of the special features is the usage of project model to manage the order-to-delivery –process. This differs significantly from the traditional concepts of Product Data Management presented in the literature. Furthermore, as a research result, this thesis presents a conceptual model of a PDM system, which would be viable for the case companies interviewed during the research. As a by-product, this research presents a synthesized model, found from the literature, to abstract information system requirements. In addition to this, the strategic importance and categorization of information systems within companies has been discussed from the perspective of information system customizations.

The association of faculty's teaching philosophy and teaching behaviour, and critical thinking and self- direction in learning

The intent in this study was to investigate in what ways teachers· beliefs about education and teaching are expressed in the specific teaching behaviours they employ, and whether teaching behaviours, as perceived by their students, are correlated with students· critical thinking and self-directed learning. To this end the relationships studied were: among faCUlty members· philosophy of teaching, locus of control orientation, psychological type, and observed teaching behaviour; and among students· psychological type, perceptions of teaching behaviour, self-directed learning readiness, and critical thinking. The overall purpose of the study was to investigate whether the implicit goals of higher education, critical thinking and self-direction, were actually accounted for in the university classroom. The research was set within the context of path-goal theory, adapted from the leadership literature. Within this framework, Mezirow·s work on transformative learning, including the influences of Habermas· writings, was integrated to develop a theoretical perspective upon which to base the research methodology. Both qualitative and quantitative methodologies were incorporated. Four faCUlty and a total of 142 students participated in the study. Philosophy of teaching was described through faCUlty interviews and completion of a repertory grid. Faculty completed a descriptive locus of control scale, and a psychological type test. Observations of their teaching behaviour were conducted. Students completed a Teaching Behaviour Assessment Scale, the Self-Directed Learning Readiness Scale, a psychological type test, and the Watson-Glaser Critical Thinking Appraisal. A small sample of students were interviewed. Follow-up discussions with faculty were used to validate the interview, observation, teaching behaviour, and repertory grid data. Results indicated that some discrepancies existed between faculty's espoused philosophy of teaching and their observed teaching behaviour. Instructors' teaching behaviour, however, was a function of their personal theory of practice. Relationships were found between perceived teaching behaviour and students· self-directed learning and critical thinking, but these varied across situations, as would be predicted from path-goal theory. Psychological type of students and instructor also accounted for some of the variability in the relationships studied. Student psychological type could be shown as a partial predictor of self-directed learning readiness. The results were discussed in terms of theory development and implications for further research and practice.

Processing, procurement and marketing of pepper with particular reference to co-operative sector

The present Study is designed to gather, record and analyse data on history of pepper, pepper production, procurement and marketing with particular reference to Kerala. The main emphasis is given to study the'role of cooperative sector with regard to procurement and export efforts and also the services rendered by cooperative sector agencies under MARKETFED and NAFED to pepper trade. The scope of the Study covers the botany, methods of cultivation, fertilizer application, pest control management and other related aspects of pepper. Taking into consideration Kerala's supremacy in pepper cultivation and production, detailed study of its production, procurement, internal and export marketing with reference to Kerala has been given importance. As Kerala accounts for 96 per cent1 of the pepper cultivation and 94 per cent of the pepper production, the present study is entirely confined to Kerala

Investigating the effects of predator removal and habitat management on nest success and breeding population size of a farmland passerine: a case study

Passerines are especially vulnerable to predation at the pre-independence stage. Although the role of nest success in British farmland passerine declines is contentious, improvement in nest success through sympathetic management could play a role in their reversal. Because habitat is known to interact with predation, management options for mitigation will need to consider effects of nest predation. We present results from an observational study of a population of Common Blackbird Turdus merula on a farm which has experienced a range of agri-environment and game-management options, including a period with nest predator control, as a case study to address some of these issues. We used an information theoretic model comparison procedure to look for evidence of interactions between habitat and nest predation, and then asked whether habitat management and nest predator abundances could explain population trends at the site through their effects on nest success. Interactions were detected between measures of predator abundance and habitat variables, and these varied with nest stage - habitat within the vicinity of the nest appeared to be important at the egg stage, and nest-placement characteristics were important at the nestling stage. Although predator control appeared to have a positive influence on Blackbird breeding population size, the non-experimental set-up meant we could not eliminate other potential explanations. Variation in breeding population size did not appear to be influenced by variation in nest success alone. Our study demonstrates that observational data can only go so far in detection of such effects, and we discuss how it might be taken further. Agri-environment and game-management techniques are likely to influence nest predation pressure on farmland passerines, but the patterns, mechanisms and importance to population processes remain not wholly understood.

Investigating the effects of predator removal and habitat management on nest success and breeding population size of a farmland passerine: a case study

Passerines are especially vulnerable to predation at the pre-independence stage. Although the role of nest success in British farmland passerine declines is contentious, improvement in nest success through sympathetic management could play a role in their reversal. Because habitat is known to interact with predation, management options for mitigation will need to consider effects of nest predation. We present results from an observational study of a population of Common Blackbird Turdus merula on a farm which has experienced a range of agri-environment and game-management options, including a period with nest predator control, as a case study to address some of these issues. We used an information theoretic model comparison procedure to look for evidence of interactions between habitat and nest predation, and then asked whether habitat management and nest predator abundances could explain population trends at the site through their effects on nest success. Interactions were detected between measures of predator abundance and habitat variables, and these varied with nest stage - habitat within the vicinity of the nest appeared to be important at the egg stage, and nest-placement characteristics were important at the nestling stage. Although predator control appeared to have a positive influence on Blackbird breeding population size, the non-experimental set-up meant we could not eliminate other potential explanations. Variation in breeding population size did not appear to be influenced by variation in nest success alone. Our study demonstrates that observational data can only go so far in detection of such effects, and we discuss how it might be taken further. Agri-environment and game-management techniques are likely to influence nest predation pressure on farmland passerines, but the patterns, mechanisms and importance to population processes remain not wholly understood.

Online data processing consent under EU law: a theoretical framework and empirical evidence from the UK

This article analyses the results of an empirical study on the 200 most popular UK-based websites in various sectors of e-commerce services. The study provides empirical evidence on unlawful processing of personal data. It comprises a survey on the methods used to seek and obtain consent to process personal data for direct marketing and advertisement, and a test on the frequency of unsolicited commercial emails (UCE) received by customers as a consequence of their registration and submission of personal information to a website. Part One of the article presents a conceptual and normative account of data protection, with a discussion of the ethical values on which EU data protection law is grounded and an outline of the elements that must be in place to seek and obtain valid consent to process personal data. Part Two discusses the outcomes of the empirical study, which unveils a significant departure between EU legal theory and practice in data protection. Although a wide majority of the websites in the sample (69%) has in place a system to ask separate consent for engaging in marketing activities, it is only 16.2% of them that obtain a consent which is valid under the standards set by EU law. The test with UCE shows that only one out of three websites (30.5%) respects the will of the data subject not to receive commercial communications. It also shows that, when submitting personal data in online transactions, there is a high probability (50%) of incurring in a website that will ignore the refusal of consent and will send UCE. The article concludes that there is severe lack of compliance of UK online service providers with essential requirements of data protection law. In this respect, it suggests that there is inappropriate standard of implementation, information and supervision by the UK authorities, especially in light of the clarifications provided at EU level.

Error, reproducibility and sensitivity: a pipeline for data processing of Agilent oligonucleotide expression arrays

Background: Expression microarrays are increasingly used to obtain large scale transcriptomic information on a wide range of biological samples. Nevertheless, there is still much debate on the best ways to process data, to design experiments and analyse the output. Furthermore, many of the more sophisticated mathematical approaches to data analysis in the literature remain inaccessible to much of the biological research community. In this study we examine ways of extracting and analysing a large data set obtained using the Agilent long oligonucleotide transcriptomics platform, applied to a set of human macrophage and dendritic cell samples. Results: We describe and validate a series of data extraction, transformation and normalisation steps which are implemented via a new R function. Analysis of replicate normalised reference data demonstrate that intrarray variability is small (only around 2 of the mean log signal), while interarray variability from replicate array measurements has a standard deviation (SD) of around 0.5 log(2) units (6 of mean). The common practise of working with ratios of Cy5/Cy3 signal offers little further improvement in terms of reducing error. Comparison to expression data obtained using Arabidopsis samples demonstrates that the large number of genes in each sample showing a low level of transcription reflect the real complexity of the cellular transcriptome. Multidimensional scaling is used to show that the processed data identifies an underlying structure which reflect some of the key biological variables which define the data set. This structure is robust, allowing reliable comparison of samples collected over a number of years and collected by a variety of operators. Conclusions: This study outlines a robust and easily implemented pipeline for extracting, transforming normalising and visualising transcriptomic array data from Agilent expression platform. The analysis is used to obtain quantitative estimates of the SD arising from experimental (non biological) intra- and interarray variability, and for a lower threshold for determining whether an individual gene is expressed. The study provides a reliable basis for further more extensive studies of the systems biology of eukaryotic cells.

An integrated study of urban microclimates in Chongqing, China: historical weather data, transverse measurement and numerical simulation

Chongqing is the largest central-government-controlled municipality in China, which is now under going a rapid urbanization. The question remains open: What are the consequences of such rapid urbanization in Chongqing in terms of urban microclimates? An integrated study comprising three different research approaches is adopted in the present paper. By analyzing the observed annual climate data, an average rising trend of 0.10◦C/decade was found for the annual mean temperature from 1951 to 2010 in Chongqing,indicating a higher degree of urban warming in Chongqing. In addition, two complementary types of field measurements were conducted: fixed weather stations and mobile transverse measurement. Numerical simulations using a house-developed program are able to predict the urban air temperature in Chongqing.The urban heat island intensity in Chongqing is stronger in summer compared to autumn and winter.The maximum urban heat island intensity occurs at around midnight, and can be as high as 2.5◦C. In the day time, an urban cool island exists. Local greenery has a great impact on the local thermal environment.Urban green spaces can reduce urban air temperature and therefore mitigate the urban heat island. The cooling effect of an urban river is limited in Chongqing, as both sides of the river are the most developed areas, but the relative humidity is much higher near the river compared with the places far from it.

Board of directors and top management team: a study on CEO relative power and financial return

Best corporate governance practices published in the primers of Brazilian Securities and Exchange Commission and the Brazilian Corporate Governance Institute promote board independence as much as possible, as a way to increase the effectiveness of governance mechanism (Sanzovo, 2010). Therefore, this paper aims at understanding if what the managerial literature portraits as being self-evident - stricter governance, better performance - can be observed in actual evidence. The question answered is: do companies with a stricter control and monitoring system perform better than others? The method applied in this paper consists on comparing 116 companies in respect to the their independence level between top management team and board directors– being that measured by four parameters, namely, the percentage of independent outsiders in the board, the separation of CEO and chairman, the adoption of contingent compensation and the percentage of institutional investors in the ownership structure – and their financial return measured in terms return on assets (ROA) from the latest Quarterly Earnings release of 2012. From the 534 companies listed in the Stock Exchange of Sao Paulo – Bovespa – 116 were selected due to their level of corporate governance. The title “Novo Mercado” refers to the superior level of governance level within companies listed in Bovespa, as they have to follow specific criteria to assure shareholders ´protection (BM&F, 2011). Regression analyses were conducted in order to reveal the correlation level between two selected variables. The results from the regression analysis were the following: the correlation between each parameter and ROA was 10.26%; the second regression analysis conducted measured the correlation between the independence level of top management team vis-à-vis board directors – namely, CEO relative power - and ROA, leading to a multiple R of 5.45%. Understanding that the scale is a simplification of the reality, the second part of the analysis transforms all the four parameters into dummy variables, excluding what could be called as an arbitrary scale. The ultimate result from this paper led to a multiple R of 28.44%, which implies that the combination of the variables are still not enough to translate the complex reality of organizations. Nonetheless, an important finding can be taken from this paper: two variables (percentage of outside directors and percentage of institutional investor ownership) are significant in the regression, with p-value lower than 10% and with negative coefficients. In other words, counter affirming what the literature very often portraits as being self-evident – stricter governance leads to higher performance – this paper has provided evidences to believe that the increase in the formal governance structure trough outside directors in the board and ownership by institutional investor might actually lead to worse performance. The section limitations and suggestions for future researches presents some reasons explaining why, although supported by strong theoretical background, this paper faced some challenging methodological assumptions, precluding categorical statements about the level of governance – measured by four selected parameters – and the financial return in terms of financial on assets.

Does absorptive capacity affect project performance? A study based on project management practices, organization learning, and knowledge

The literature has emphasized that absorptive capacity (AC) leads to performance, but in projects its influences still unclear. Additionally, the project success is not well understood by the literature, and AC can be an important mechanism to explain it. Therefore, the purpose of this study is to investigate the effect of absorptive capacity on project performance in the construction industry of São Paulo State. We study this influence through potential and realized absorptive capacity proposed by Zahra and George (2002). For achieving this goal, we use a combination of qualitative and quantitative research. The qualitative research is based on 15 interviews with project managers in different sectors to understand the main constructs and support the next quantitative phase. The content analysis was the technique used to analyze those interviews. In quantitative phase through a survey questionnaire, we collected 157 responses in the construction sector with project managers. The confirmatory factor analysis and hierarchical linear regression were the techniques used to assess the data. Our findings suggest that the realized absorptive capacity has a positive influence on performance, but potential absorptive capacity and the interactions effect have no influence on performance. Moreover, the planning and monitoring have a positive impact on budget and schedule, and customer satisfaction while risk coping capacity has a positive impact on business success. In academics terms, this research enables a better understanding of the importance of absorptive capacity in the construction industry and it confirms that knowledge application in processes and routines enhances performance. For management, the absorptive capacity enables the improvements of internal capabilities reflected in the increased project management efficiency. Indeed, when a company manages project practices efficiently it enhances business and project performance; however, it needs initially to improve its internal abilities to enrich processes and routines through relevant knowledge.

The Brazilian Seismographic Integrated Systems (BRASIS): Infrastructure and data management

In geophysics and seismology, raw data need to be processed to generate useful information that can be turned into knowledge by researchers. The number of sensors that are acquiring raw data is increasing rapidly. Without good data management systems, more time can be spent in querying and preparing datasets for analyses than in acquiring raw data. Also, a lot of good quality data acquired at great effort can be lost forever if they are not correctly stored. Local and international cooperation will probably be reduced, and a lot of data will never become scientific knowledge. For this reason, the Seismological Laboratory of the Institute of Astronomy, Geophysics and Atmospheric Sciences at the University of São Paulo (IAG-USP) has concentrated fully on its data management system. This report describes the efforts of the IAG-USP to set up a seismology data management system to facilitate local and international cooperation. © 2011 by the Istituto Nazionale di Geofisica e Vulcanologia. All rights reserved.

Microsurgical management of large intra-and extracranial calvarial meningiomas

Objective: Based on the largest series reported of giant intra- and extracranial calvarial meningiomas (GIECM) the purpose of the present study was to characterize the treatment and outcome data associated with patients operated on GIECM and to describe our experience in the management of this rare and therapeutically demanding tumour entity. Methods: The data of 12 patients (7/12 males, 5/12 females) with surgically treated GIECM at the University Hospitals Aachen and Bern between 1994 and 2011 were retrospectively analyzed. The mean patient age was 58 years (range, 22 to 78 years). Symptom distribution included extracranial swelling (12/12), seizures (5/12), headache (4/12), gait disturbance (3/12), dizziness (2/12), and impaired vision (1/12). GIECM were located frontal (6/12), temporal (3/12), parietal, fronto-parietal, and parieto-occipital (1/12 each). Microsurgical resection with acrylic-augmented cranioplasty was performed in all patients and 11/12 patients received dural repair with synthetic (7/11) or autologous (4/11) patch grafts. Surgical excision in two stages with primary removal of the extracranial meningioma component was undertaken in 2/12 patients, whereas preoperative embolization and postoperative radiotherapy were applied in 1/12 patient each. Results: In contrast to intradural meningiomas GIECM mainly affect male patients at a comparatively younger age. GIECM could be completely (9/12) or subtotally (3/12) resected. Surgical-associated complications included minor CSF leak (6/12), wound healing disturbance (3/12), venous engorgement, and haemorrhage (2/12 each), requiring reoperation in 3/12 cases. Histopathological examination revealed meningothelial (6/12), atypical (4/12), and transitional (1/12) GIECM. 10/12 patients exhibited excellent postoperative clinical outcome, 1/12 patient each deteriorated or died of pulmonary embolism. Conclusions: The operative management of GIECM is challenging, carries a substantial risk, and demands special strategies because of the large tumour size, anatomical involvement of scalp, calvaria, meninges, brain or vascular structures, and more frequent atypical histology. Although microsurgical resection with cranioplasty and mostly dural grafting usually results in a good clinical outcome, the potential complication rate is markedly higher when compared to smaller meningiomas without extracranial component. Preoperative embolization and staging of surgical resection are possible additional therapeutic options.