Medication -related adverse events in older people with dementia:causes and possible solutions

This submission for a PhD by previously published work is based upon six publications in peer reviewed journals, reflecting a 9-year research programme. My research has shown, in a coherent and original way, the difficulty in treating people with dementia with safe and effective medication whilst providing research-founded guidance to develop mechanisms to optimise medication choice and minimise iatrogenic events. A wide range of methods, including systematic reviews, meta-analysis, randomised controlled trials (RCTs), quantitative research and mixed methods were used to generate the data, which supported the exploration of three themes. The first theme, to understand the incidence and causes of medication errors in dementia services, identified that people with dementia may be more susceptible to medication-related iatrogenic disease partly due to inherent disease-related characteristics. One particular area of concern is the use of anti-psychotics to treat the Behavioural and Psychological Symptoms of Dementia (BPSD). The second and third themes, respectively, investigated a novel pharmacological and health services intervention to limit anti-psychotic usage. The second phase found that whilst the glutamate receptor blocker memantine showed some promise, further research was clearly required. The third phase found that anti-psychotic usage in dementia may be higher than official figures suggest and that medication review linking primary and secondary care can limit such usage. My work has been widely cited, reflecting a substantial contribution to the field, in terms of our understanding of the causes of, and possible solutions to limit, medication-related adverse events in people with dementia. More importantly, this work has already informed clinical practice, patients, carers and policy makers by its demonstrable impact on health policy. In particular my research has identified key lines of enquiry for future work and for the development of my own personal research programme to reduce the risk associated with medication in this vulnerable population.

Sexuality and Christianity:understanding the attitudes and negotiations of young adults in the UK

Christianity has historically incorporated numerous strands of thinking on sexuality; in some cases, problematizing sexuality through the endorsement of celibacy and asceticism while at other historical and contextual moments, marriage and procreation become ideals (Price 2006). Contemporary Christians negotiate many sexual scripts (including ‘secular’ ones), but ‘appropriate’ Christian sexuality is still usually defined in terms of monogamy, the containment of sex within marriage, and heterosexuality. This chapter will explore the attitudes, beliefs and practices toward sexuality of young Christian women and men aged between 18 and 25 and living in the UK, based on a qualitative and quantitative research project entitled Religion, Youth and Sexuality: A Multi-faith Exploration, which utilized questionnaires, in-depth interviews and video diaries. The chapter will consider the variations in attitude between young people from different Christian denominations in relation to three themes: sex outside of marriage, celibacy and monogamy.

An exploration of pharmacy-specific reasons for non-adherence to prescribed medicines in a socioeconomically deprived, ethnically diverse UK cohort

Methods - Ethical approval for the study was granted by both the local National Health Service (NHS) Research Ethics Committee (REC) and Aston University’s REC. Seven focus groups were conducted between October and December 2011 in medical or community settings within inner-city Birmingham (UK). Discussions were guided by a theme plan which was developed from key themes identified by a literature review and piloted via a Patient Consultation Group. Each focus group had between 3 and 7 participants. The groups were digitally recorded and subsequently transcribed verbatim. The transcriptions were then subjected to thematic analysis via constant comparison in order to identify emerging themes. Results - Participants recognised the pharmacist as an expert source of advice about prescribed medicines, a source they frequently felt a need to consult as a result of the inadequate supply of medicines information from the prescriber. However, an emerging theme was a perception that pharmacists had an oblique profit motive relating to the supply of generic medicines with frequent changes to the ‘brand’ of generic supplied being attributed to profit-seeking by pharmacists. Such changes had a negative impact on the patient’s perceived efficacy of the therapy which may make non-adherence more likely. Conclusions - Whilst pharmacists were recognised as medicines experts, trust in the pharmacist was undermined by frequent changes to generic medicines. Such changes have the potential to adversely impact adherence levels. Further, quantitative research is recommended to examine if such views are generalisable to the wider population of Birmingham and to establish if such views impact on adherence levels.

The influence of culture and market orientation on services brands:insights from Irish banking and retail firms

Purpose: This paper aims to examine the influence of the culture of the service firm on its interpretation of the role of the brand and on the development and implementation of its brand values. Design/methodology/approach: A grounded theory approach was used. Interviews were conducted with 20 managers within two leading banking firms in Ireland and two leading grocery retailers in Ireland. Findings: The development of the brand, and its role within the firm, is closely related to the firm's culture. The research shows obstacles and opportunities created by the cultural context of firms wishing to disseminate and embed a set of brand values. The paper presents an "involvement model" of brand values implementation and outlines changes required to implement brand values. Research limitations/implications: The study was bound by access to firms, and managers' availability. The authors sought an insight into the relationship between each firm's culture and its brands. They advocate quantitative research to further investigate the findings within these service sectors and to test proposed antecedents (transformational leadership, employee involvement) and outcomes (employee-based brand equity and consumer-based brand equity) of values adoption. Practical implications: The paper identifies aspects of retail and banking cultures which support or detract from brand development. In particular, it presents the learnings from successful brand values implementation in a clan culture, aspects of which are applicable across other cultures. Originality/value: The paper provides valuable insights into the role of the brand within the service firm and the positive and negative influence of context on brand values and their development and implementation. © Emerald Group Publishing Limited.

A hazai kis- és közepes vállalatok szociokulturális beállítódása a hofstede-dimenziók mentén = The socio-cultural attitudes of the Hungarianc small and medium enterprises along the Hofstede dimensions

A kis- és közepes vállalkozások (KKV-k) kutatása viszonylag új, és emiatt meglehetősen feltáratlan terület, bár a megjelenő tudományos cikkek és eredmények száma és minősége évről évre jól érzékelhetően nő (Collinson – Shaw, 2001). A KKV-kutatások igen fontos sajátossága továbbá, hogy kifejezetten interdiszciplináris terület, megközelíthető a menedzsment, az innovációkutatás, a marketing, a szervezetszociológia, de akár a pszichológia felől is. Több kutatás is felveti a szociokulturális háttér jelentőségének kérdését KKV-k esetében. A szerzők kutatásuk során kvantitatív felmérést végeztek 200 vállalkozó körében a Hofstedeskála (Hofmeister et al., 2008) felhasználásával, melynek eredményeként kiderült, hogy a KKV-vezetők beállítódása jelentősen különbözik mind a hazai nagyvállalati vezetőktől, mind az általános lakosságtól. Jelen tanulmányunkban bemutatjuk azokat a Hofstede-dimenziókat, amelyek mentén karakteres különbségek jelentkeztek a vállalkozók és a nagyvállalati vezetők, valamint a társadalom összessége között. Az eredmények alapján határozottan kirajzolódnak olyan „vállalkozói” gondolkodásmódbeli sajátosságok, mint a nagyobb versenyszellem, a közvetlenebb, kevésbé hierarchikus működési stílus, a rendkívül erős, rövid távú orientáció, valamint a kockázatvállalás rendhagyóan alacsony foka. _____ Although there has been an increasing academic attention towards small and medium-sized enterprises, it is still a novel research area with a number of unanswered questions. It is also an especially interdisciplinary field as it can be approached from various viewpoints such as management, innovation, marketing, organization sociology or even psychology. Different academic disciplines have studied the influence of socio-cultural factors and concluded that they are relevant aspects of entrepreneurial activity. This paper presents the results of the authors’ quantitative research which aimed at finding patterns in the software of the minds of SME managers where they applied Hofstede’s cultural scale (Hofmeister et al., 2008). Drawing upon data from 200 Hungarian SMEs, the results indicate they have different attitude and way of thinking compared to large company managers and to the general Hungarian population. This paper points out the relevant Hofstede dimensions where significant differences have been revealed. The main finding of the study is that managers of small and medium businesses have a special mindset which can be characterized with higher level competitiveness, more direct and less hierarchic operation, extremely high level of short term orientation and low level of risk taking

The impact of creative organizational climate on the innovation activity of medical devices manufacturing firms in Hungary

The purpose of this study was to empirically investigate the impact of creative organizational climate on the innovation activity of medical devices manufacturing firms in Hungary. We applied a combined qualitative and quantitative research model, focusing on two firm’s case studies that are active in the above mentioned sector and differ to a substantial degree in their innovation activities. The connection between innovative climate and innovation was analyzed by comparing their organizational climate and perceptions of organizational members of innovation activities. Our findings revealed that classical models of creative organizational climate explain only partially the differences, although on the level of individual perceptions of climate and innovativeness we can find some connections. We found one factor that differentiated the two firms in terms of organizational climate in the predicted direction: the amount, quality, sincerity and depth of debates going on in the organization. The level of challenge (high involvement, commitment and challenging goals) and the time devoted to think about new ideas and innovative solutions (idea time) turned out to be contrary to the expectations based on previous research – although these results are less significant statistically. The results trigger further research into the sources of competitiveness in the Hungarian medical devices manufacturing sector.

Does management capacity increase organizational performance? An empirical analysis of public housing agencies

Since the 1990s, scholars have paid special attention to public management’s role in theory and research under the assumption that effective management is one of the primary means for achieving superior performance. To some extent, this was influenced by popular business writings of the 1980s as well as the reinventing literature of the 1990s. A number of case studies but limited quantitative research papers have been published showing that management matters in the performance of public organizations. ^ My study examined whether or not management capacity increased organizational performance using quantitative techniques. The specific research problem analyzed was whether significant differences existed between high and average performing public housing agencies on select criteria identified in the Government Performance Project (GPP) management capacity model, and whether this model could predict outcome performance measures in a statistically significant manner, while controlling for exogenous influences. My model included two of four GPP management subsystems (human resources and information technology), integration and alignment of subsystems, and an overall managing for results framework. It also included environmental and client control variables that were hypothesized to affect performance independent of management action. ^ Descriptive results of survey responses showed high performing agencies with better scores on most high performance dimensions of individual criteria, suggesting support for the model; however, quantitative analysis found limited statistically significant differences between high and average performers and limited predictive power of the model. My analysis led to the following major conclusions: past performance was the strongest predictor of present performance; high unionization hurt performance; and budget related criterion mattered more for high performance than other model factors. As to the specific research question, management capacity may be necessary but it is not sufficient to increase performance. ^ The research suggested managers may benefit by implementing best practices identified through the GPP model. The usefulness of the model could be improved by adding direct service delivery to the model, which may also improve its predictive power. Finally, there are abundant tested concepts and tools designed to improve system performance that are available for practitioners designed to improve management subsystem support of direct service delivery.^

Globalization and the public provision of higher education: Empirical evidence from selected countries

This research study was designed to examine the relationship between globalization as measured by the KOF index, its related forces (economic, political, cultural and technological) and the public provision of higher education. This study is important since globalization is increasingly being associated with changes in critical aspects of higher education. The public provision of education was measured by government expenditure and educational outcomes; that is participation, gender equity and attainment. The study utilized a non-experimental quantitative research design. Data collected from secondary sources for 139 selected countries was analyzed. The countries were geographically distributed and included both developed and developing countries. The choice of countries for inclusion in the study was based on data availability. The data, which was sourced from international organizations such as the United Nations and the World Bank, were examined for different time periods using five year averages. The period covered was 1970 to 2009.^ The relationship between globalization and the higher education variables was examined using cross sectional regression analysis while controlling for economic, political and demographic factors. The major findings of the study are as follows. For the two spending models, only one revealed a significant relationship between globalization and education with the R 2 s ranging from .222 to .448 over the period. This relationship was however negative indicating that as globalization increased, spending on higher education declined. However, for the education outcomes models, this relationship was not significant. For the sub-indices of globalization, only the political dimension showed significance as shown in the spending model. Political globalization was significant for six periods with R2 s ranging from .31 to .52.^ The study concluded that the results are mixed for both the spending and outcome models. It also found no robust effects of globalization on government education provision. This finding is not surprising given the existing literature which sees mixed results on the social impact of globalization.^

Lei Maria da Penha: da convivência com as práticas do sistema de justiça no submédio do Vale do São Francisco

The inequalities that mark the women’s lives in societies around the world have been the subject of intense discussion by the feminist movement, with developments in questioning about possibilities of full citizenship. In this scenario the Brazilian feminist movement has achieved steadily, in recent decades, an effort to participate in the formulation of the public policy agenda, as well as the realization of demands to institutionalize the legal parameters as regulations for the issue of violence against women. On the grounds of social justice, many discourses are made with a focus on reframing the institutional role of the state in the areas of constitutional law and criminal law. Considering these discourses, proposals were reformulated and the action of the state was resized, what ended in the enactment of Law 11,340 / 2006 (Maria da Penha Law), with a great impact on the Brazilian criminal justice system. Taking this perspective as its starting point, this research is focused on understanding the struggles for access to the legal field regarding the implementation of the Maria da Penha Law. This qualitative and quantitative research analyses the way the social practices and social representations which involve activists of the feminist movement and operators from the justice system are established in Juazeiro/ BA and Petrolina/PE before the institutional reshuffles of the state. As a result, it was revealed that, despite inconsistencies in the performance of the criminal justice system, the positioning of feminist activism is grounded on the assumption.

Qualidade dos serviços hoteleiros: percepções dos turistas de negócios de Teresina-PI

Business tourism is one of tourist segments with different market characteristics in relation to others segmentations, such as low seasonality, there is no requirement of natural attractions, it serves as destination projection and it generates profitable larger numbers. Due to the context around business travels, the hotel so many times has a fundamental whole among the elements of the production chain in this segmentation. Business tourism in Teresina is the primary segmentation of the capital, since it represents almost 70% of hotel demand; hence this research has as objective to evaluate through the perceptions of business travelers, the level of quality services of hotels of Teresina. The research is exploratory and descriptive, of functionalist character. This study is characterized by qualitative and quantitative research, supported by a basis of methodological pluralism. For primary data collection was performed applying a suitable research instrument of SERVPERF model (Service Performance). The universe of this study were Teresina's accommodations, restricted to only those that fit in hotel category and it was inside metropolitan area of Teresina. The study subjects were business travelers who were hosted in these hotels. For the analysis, it was considered certain factors: descriptive analysis, factor analysis, correlation matrix analysis of the variables; It was still compiling a graphic of lexicons obtained in the survey about respondent's the notion of quality of vision in the hotel service; Finally, qualitative analysis was based on the theories of marketing, targeting and quality of tourism services applied. The results show that the Teresina hotel service is on a regular average, especially for Reliability and Safety dimensions were highlighted. Whereas, the factor analysis showed the emergence of two factors to explain "Empathy" dimension, one of this is about the organization and the other one is about consumer. And by Lexicometria was possible to observe the importance to the customer of other variables such as: personal aspects, price and location for this tour segmentation.

A relação entre memória de trabalho e competência leitora em crianças em risco de transtorno de aprendizagem do Projeto Acerta: um estudo exploratório

Reading and writing are essential rights, which involve individual and social aspects; in addition, these skills are important when it comes to socio economic and political development, critical thinking and an active participation in society (UNESCO 2005). From a neurobiological standpoint, our brain is not prepared for reading, and this practice must be deliberately acquired via instructional guidance (DEHAENE 2009). However, reading disorders and deficits within executive functions, such as low working memory capacity, can make reading arduous. The aim of this study is to investigate the development of reading skills within 45 third grade students from public schools in the city of Natal – RN and its connection to working memory capacity, through information gathered from the Provinha Brasil, data generated from working memory tasks (Portuguese version of AWMA - Automated Working Memory Assessment) and fluid intelligence measures RAVEN. Based on this main objective, we attempted to answer the following research questions: (a) What are the correlations between working memory and reading scores?; (b) What characterizes the relationship between working memory capacity and the risk of reading disabilities amongst the participants in this study?; Following a quantitative research methodology, the Provinhas Brasil from 3rd grade students belonging to the six public schools members of Project ACERTA - Avaliação de Crianças em Risco de Transtornos de Aprendizagem (CAPES/OBEDUC)- were analyzed and compared to the scores from the working memory tests and the fluid intelligence ones. Results indicate that reading skills within children at risk of reading disabilities are directly linked to working memory capacity, especially with regards to the phonological component. It is also evident that the participants with less working memory capacity show more difficulties in the reading abilities that demand interpretation skills. Thus, we intend to contribute to the discussion regarding the diagnosis of reading disabilities and possible intervention strategies.

A relação entre memória de trabalho e competência leitora em crianças em risco de transtorno de aprendizagem do Projeto Acerta: um estudo exploratório

Reading and writing are essential rights, which involve individual and social aspects; in addition, these skills are important when it comes to socio economic and political development, critical thinking and an active participation in society (UNESCO 2005). From a neurobiological standpoint, our brain is not prepared for reading, and this practice must be deliberately acquired via instructional guidance (DEHAENE 2009). However, reading disorders and deficits within executive functions, such as low working memory capacity, can make reading arduous. The aim of this study is to investigate the development of reading skills within 45 third grade students from public schools in the city of Natal – RN and its connection to working memory capacity, through information gathered from the Provinha Brasil, data generated from working memory tasks (Portuguese version of AWMA - Automated Working Memory Assessment) and fluid intelligence measures RAVEN. Based on this main objective, we attempted to answer the following research questions: (a) What are the correlations between working memory and reading scores?; (b) What characterizes the relationship between working memory capacity and the risk of reading disabilities amongst the participants in this study?; Following a quantitative research methodology, the Provinhas Brasil from 3rd grade students belonging to the six public schools members of Project ACERTA - Avaliação de Crianças em Risco de Transtornos de Aprendizagem (CAPES/OBEDUC)- were analyzed and compared to the scores from the working memory tests and the fluid intelligence ones. Results indicate that reading skills within children at risk of reading disabilities are directly linked to working memory capacity, especially with regards to the phonological component. It is also evident that the participants with less working memory capacity show more difficulties in the reading abilities that demand interpretation skills. Thus, we intend to contribute to the discussion regarding the diagnosis of reading disabilities and possible intervention strategies.

Uma proposta de indicadores para o acompanhamento de alunos em projetos de desenvolvimento colaborativo de software com foco no desenvolvimento de habilidades transversais

Soft skills and teamwork practices were identi ed as the main de ciencies of recent graduates in computer courses. This issue led to a realization of a qualitative research aimed at investigating the challenges faced by professors of those courses in conducting, monitoring and assessing collaborative software development projects. Di erent challenges were reported by teachers, including di culties in the assessment of students both in the collective and individual levels. In this context, a quantitative research was conducted with the aim to map soft skill of students to a set of indicators that can be extracted from software repositories using data mining techniques. These indicators are aimed at measuring soft skills, such as teamwork, leadership, problem solving and the pace of communication. Then, a peer assessment approach was applied in a collaborative software development course of the software engineering major at the Federal University of Rio Grande do Norte (UFRN). This research presents a correlation study between the students' soft skills scores and indicators based on mining software repositories. This study contributes: (i) in the presentation of professors' perception of the di culties and opportunities for improving management and monitoring practices in collaborative software development projects; (ii) in investigating relationships between soft skills and activities performed by students using software repositories; (iii) in encouraging the development of soft skills and the use of software repositories among software engineering students; (iv) in contributing to the state of the art of three important areas of software engineering, namely software engineering education, educational data mining and human aspects of software engineering.

Uma proposta de indicadores para o acompanhamento de alunos em projetos de desenvolvimento colaborativo de software com foco no desenvolvimento de habilidades transversais

Soft skills and teamwork practices were identi ed as the main de ciencies of recent graduates in computer courses. This issue led to a realization of a qualitative research aimed at investigating the challenges faced by professors of those courses in conducting, monitoring and assessing collaborative software development projects. Di erent challenges were reported by teachers, including di culties in the assessment of students both in the collective and individual levels. In this context, a quantitative research was conducted with the aim to map soft skill of students to a set of indicators that can be extracted from software repositories using data mining techniques. These indicators are aimed at measuring soft skills, such as teamwork, leadership, problem solving and the pace of communication. Then, a peer assessment approach was applied in a collaborative software development course of the software engineering major at the Federal University of Rio Grande do Norte (UFRN). This research presents a correlation study between the students' soft skills scores and indicators based on mining software repositories. This study contributes: (i) in the presentation of professors' perception of the di culties and opportunities for improving management and monitoring practices in collaborative software development projects; (ii) in investigating relationships between soft skills and activities performed by students using software repositories; (iii) in encouraging the development of soft skills and the use of software repositories among software engineering students; (iv) in contributing to the state of the art of three important areas of software engineering, namely software engineering education, educational data mining and human aspects of software engineering.

ANTECEDENTES DO COMPROMETIMENTO ORGANIZACIONAL DOS FUNCIONÁRIOS DE CORRETORAS DE SEGUROS E SEGURADORAS

O objetivo principal deste trabalho é compreender quais fatores influenciam no comprometimento de corretoras de seguros e seguradoras, e mais especificamente: a) medir e comparar os indicadores de comprometimento dos funcionários de corretoras de seguros e seguradoras em três dimensões (afetiva, instrumental e normativa); b) analisar quais os fatores que mais influenciam cada dimensão do comprometimento no setor de seguros; c) comparar as diferenças e semelhanças dos fatores que influenciam o comprometimento em seguradoras e em corretoras. O público-alvo é formado pelos profissionais do mercado de seguros que atuam em corretoras de seguros ou seguradoras. A pesquisa foi realizada em duas partes: quantitativa e qualitativa. Os dados da pesquisa quantitativa foram colhidos por meio da escala do modelo multidimensional do comprometimento afetivo, instrumental e normativo (Meyer & Allen, 1991), aplicada em 188 participantes. Os dados da análise de comparação de médias pelo teste T-Student não apontaram diferença estatisticamente significativa. A segunda parte, qualitativa, envolveu 11 entrevistas com funcionários do setor a fim de identificar os motivos que levam os funcionários a desenvolver o comprometimento com cada um dos dois tipos de organizações do mercado de seguros. Os dados da pesquisa obtidos foram analisados utilizando-se a técnica de análise de conteúdo e resultaram no modelo de antecedentes do comprometimento organizacional do setor de seguros. Foi constatado que os antecedentes do comprometimento afetivo em corretoras de seguros são formados pelo clima organizacional, pela percepção de justiça e pelas políticas de recursos humanos, e que as políticas de recursos humanos predizem o comportamento instrumental. Nas seguradoras, constatou-se que os antecedentes do comprometimento afetivo são o clima organizacional, a percepção de suporte e as políticas de recursos humanos, e que as políticas de recursos humanos predizem os comprometimentos instrumental e normativo. Esses resultados contribuem significativamente para a gestão de pessoas do setor de seguros no Brasil.