Behavior change theory, content and delivery of interventions to enhance adherence in chronic respiratory disease: A systematic review

Background: We sought to describe the theory used to design treatment adherence interventions, the content delivered, and the mode of delivery of these interventions in chronic respiratory disease. Methods: We included randomized controlled trials of adherence interventions (compared to another intervention or control) in adults with chronic respiratory disease (8 databases searched; inception until March 2015). Two reviewers screened and extracted data: post-intervention adherence (measured objectively); behavior change theory, content (grouped into psychological, education and self-management/supportive, telemonitoring, shared decision-making); and delivery. “Effective” studies were those with p < 0.05 for adherence rate between groups. We conducted a narrative synthesis and assessed risk of bias. Results: 12,488 articles screened; 46 included studies (n = 42,91% in OSA or asthma) testing 58 interventions (n = 27, 47% were effective). Nineteen (33%) interventions (15 studies) used 12 different behavior change theories. Use of theory (n = 11,41%) was more common amongst effective interventions. Interventions were mainly educational, self-management or supportive interventions (n = 27,47%). They were commonly delivered by a doctor (n = 20,23%), in face-to-face (n = 48,70%), one-to-one (n = 45,78%) outpatient settings (n = 46,79%) across 2–5 sessions (n = 26,45%) for 1–3 months (n = 26,45%). Doctors delivered a lower proportion (n = 7,18% vs n = 13,28%) and pharmacists (n = 6,15% vs n = 1,2%) a higher proportion of effective than ineffective interventions. Risk of bias was high in >1 domain (n = 43, 93%) in most studies. Conclusions: Behavior change theory was more commonly used to design effective interventions. Few adherence interventions have been developed using theory, representing a gap between intervention design recommendations and research practice.

Refugios de fuego de Austrocedrus chilensis y su función en la expansión del bosque sobre el matorral en el noroeste de la Patagonia

El fuego modula la dinámica de la vegetación, favoreciendo distintas estrategias de persistencia y recolonización. Especies de reproducción obligada por semilla dependen de características ambientales para persistir, como de refugios los cuales tienen atributos biofísicos que disminuyen la severidad del fuego, permitiendo su supervivencia y dispersión post-fuego. Mientras que hay especies que mediante órganos de reserva pueden persistir y rebrotar. El objetivo de esta tesis es desarrollar y validar un modelo conceptual de dinámica sucesional entre comunidades vegetales de distinta historia de vida en paisajes propensos al fuego. En el noroeste de Patagonia, matorrales rebrotantes y bosques de Austrocedrus chilensis (ciprés) responden diferencialmente al fuego generando un ciclo sucesional. Estudié características de remanentes de ciprés, su potencial de dispersión hacia la matriz y las interacciones entre rebrotantes y ciprés en el tiempo. Encontré que los remanentes de ciprés ocurren en refugios donde la alta relación roca/vegetación disminuiría la severidad del fuego. Los cipreses revelaron mayor crecimiento en refugios que en la matriz, aunque exhibieron severas reducciones durante años secos. Este compromiso entre supervivencia al fuego y vulnerabilidad a la sequía implicaría que la funcionalidad de los refugios podría reducirse ante incrementos en la severidad de estos eventos. La dispersión de semillas de ciprés desde refugios presentó un kernel de cola gorda, indicando posibilidad de dispersión a largas distancias y rápida expansión. Aunque el establecimiento de plántulas de ciprés incrementó ante la presencia de rebrotantes, el posterior crecimiento del ciprés estuvo suprimido por al menos 15 años hasta que superaron la competencia de las rebrotantes. Los refugios de fuego son clave para la persistencia y recolonización del ciprés, pero la competencia con las rebrotantes en la matriz estaría enlenteciendo el proceso sucesional, lo que podría aumentar la probabilidad de incendio y modificar el curso sucesional hacia un estadio dominado por rebrotantes.

Indicadores de alerta de las crisis bancarias

En los últimos 20 años se han visto perturbaciones considerables en el sector financiero de muchos países. Los episodios más graves han sido tal vez los observados en algunos mercados emergentes. Los problemas del sistema bancario que comenzaron a mediados de los años noventa en algunos países asiáticos (entre ellos Corea, Indonesia y Tailandia) también han puesto en evidencia el riesgo de contagio regional. En América Latina se produjeron severas crisis bancarias en Chile y Colombia durante los años ochenta, y en México y Venezuela en la primera parte de los años noventa. Las crisis bancarias, sin embargo, no ocurren solamente en las economías con mercados emergentes. Se han observado profundas perturbaciones del sistema bancario en Estados Unidos a mediados de los * Autorizado por la revista Finanzas Y Desarrollo años ochenta y principios de los noventa, en los países nórdicos a principios de los años noventa, y más recientemente en Japón. Es fundamental encontrar indicadores básicos que sirvan de alerta de las crisis bancarias incipientes y comprender la dinámica de éstas, sobre todo en el actual comercio de la globalización financiera.

Las funciones mediadoras de los materiales impresos elaborados por los docentes de lengua castellana en tres instituciones educativas distritales de Bogotá

Tesis (Maestría en Docencia). -- Universidad de la Salle. Facultad de Ciencias de la Educación. Maestría en Docencia, 2015

Las funciones mediadoras de los materiales impresos elaborados por los docentes de lengua castellana en tres instituciones educativas distritales de Bogotá

Tesis (Maestría en Docencia). -- Universidad de la Salle. Facultad de Ciencias de la Educación. Maestría en Docencia, 2015

Sense-making in theory and practice: a metatheoretical foundation and application for health information seeking

This thesis attempts to provide deeper historical and theoretical grounding for sense-making, thereby illustrating its applicability to practical information seeking research. In Chapter One I trace the philosophical origins of Brenda Dervin’s theory known as “sense making,” reaching beyond current scholarship that locates the origins of sense-making in twentieth-century Phenomenology and Communication theory and find its rich ontological, epistemological, and etymological heritage that dates back to the Pre-Socratics. After exploring sense-making’s Greek roots, I examine sense-making’s philosophical undercurrents found in Hegel’s Phenomenology of Spirit (1807), where he also returns to the simplicity of the Greeks for his concept of sense. With Chapter Two I explore sense-making methodology and find, in light of the Greek and Hegelian dialectic, a dialogical bridge connecting sense-making’s theory with pragmatic uses. This bridge between Dervin’s situation and use occupies a distinct position in sense-making theory. Moreover, building upon Brenda Dervin’s model of sense-making, I use her metaphors of gap and bridge analogy to discuss the dialectic and dialogic components of sense making. The purpose of Chapter Three is pragmatic – to gain insight into the online information-seeking needs, experiences, and motivation of first-degree relatives (FDRs) of breast cancer survivors through the lens of sense-making. This research analyses four questions: 1) information-seeking behavior among FDRs of cancer survivors compared to survivors and to undiagnosed, non-related online cancer information seekers in the general population, 2) types of and places where information is sought, 3) barriers or gaps and satisfaction rates FDRs face in their cancer information quest, and 4) types and degrees of cancer information and resources FDRs want and use in their information search for themselves and other family members. An online survey instrument designed to investigate these questions was developed and pilot tested. Via an email communication, the Susan Love Breast Cancer Research Foundation distributed 322,000 invitations to its membership to complete the survey, and from March 24th to April 5th 10,692 women agreed to take the survey with 8,804 volunteers actually completing survey responses. Of the 8,804 surveys, 95% of FDRs have searched for cancer information online, and 84% of FDRs use the Internet as a sense-making tool for additional information they have received from doctors or nurses. FDRs report needing much more information than either survivors or family/friends in ten out of fifteen categories related to breast and ovarian cancer. When searching for cancer information online, FDRs also rank highest in several of sense-making’s emotional levels: uncertainty, confusion, frustration, doubt, and disappointment than do either survivors or friends and family. The sense-making process has existed in theory and praxis since the early Greeks. In applying sense–making’s theory to a contemporary problem, the survey reveals unaddressed situations and gaps of FDRs’ information search process. FDRs are a highly motivated group of online information seekers whose needs are largely unaddressed as a result of gaps in available online information targeted to address their specific needs. Since FDRs represent a quarter of the population, further research addressing their specific online information needs and experiences is necessary.

Evaluación del uso de diferentes concentraciones de Acaricida Comercial en el control de Varroa (Varroa destructor), en apiario infestado

En nuestro país la explotación de la abeja Apis mellifera, se ve afectada por un gran número de enfermedades y plagas. En la actualidad la enfermedad que mayormente afecta a los apicultores es el acaro varroa (Varroa destructor ), que es un parásito externo. Por lo que se hace necesario buscar métodos alternos para el control de esta; como la utilización de productos químicos y naturales. En esta investigación la principal finalidad es comprobar, la efectividad del producto químico acaricida Amitraz, en diferentes dosificaciones: 1cc de Amitraz por 750 ml de agua, 2cc de Amitraz por 750 ml de agua, 3 cc de Amitraz por 750 ml de agua; a excepción de un tratamiento que no poseía ninguna dosis. La investigación se realizó en un apiario ubicado en el cantón el Paraisal Jurisdicción del municipio de Jucuapa Departamento de Usulután. Propiedad del Sr. Hansy Gregorio Gómez Díaz, Se evaluaron cuatro tratamientos: T0 sin ninguna aplicación de Amitraz T1 1cc de Amitraz, T2 2cc de Amitraz, T3 3cc de Amitraz. Todas las dosificaciones fueron diluidas en 750 ml de agua; el diseño estadístico que se utilizó fue un bloque completamente al azar con 5 repeticiones por tratamiento las variables evaluadas fueron: Porcentaje de infestación y eficiencia del producto Amitraz (número de ácaros muertos)

The cellular and mechanistic study of nisin inhibition of bacillus anthracis spore outgrowth, nisin alteration of infection, and native producer immunity

A critical step during Bacillus anthracis infection is the outgrowth of germinated spores into vegetative bacilli that proliferate and disseminate rapidly within the host. An important challenge exists for developing chemotherapeutic agents that act upon and kill B. anthracis immediately after germination initiation when antibiotic resistance is lost, but prior to the outgrowth into vegetative bacilli, which is accompanied by toxin production. Chemical agents must also function in a manner refractive to the development of antimicrobial resistance. In this thesis we have identified the lantibiotics as a class of chemotherapeutics that are predicted to satisfy these two criteria. The objective of this thesis was to evaluate the efficacy of nisin, a prototypical lantibiotic, in prevention of outgrowth of germinated B. anthracis spores. Like all lantibiotics, nisin is a ribosomally translated peptide that undergoes post-translational modification to form (methyl)lanthionine rings that are critical for antimicrobial activity. Our studies indicate that nisin rapidly inhibits the in vitro outgrowth of germinated B. anthracis Sterne 7702 spores. Although germination initiation was shown to be essential for nisin-dependent antimicrobial activity, nisin did not inhibit or promote germination initiation. Nisin irreversibly killed germinated spores by blocking the establishment of a membrane potential and oxidative metabolism, while not affecting the dissolution of the outer spore structures. The membrane permeability of the spore was increased by nisin, but germinated spores did not undergo full lysis. Nisin was demonstrated to localize to lipid II, which is the penultimate precursor for cell wall biogenesis. This localization suggests two possible independent mechanisms of action, membrane pore formation and inhibition of peptidoglycan synthesis. Structure-activity studies with a truncated form of nisin lacking the two C-terminal (methyl)lanthionine rings and with non-pore forming mutants indicated that membrane disruption is essential for nisin-dependent inhibition of spore outgrowth to prevent membrane potential establishment. Finally, utilizing an in vitro infection model, it was shown that nisin reduced the viability of B. anthracis spores within an infection resulting in increased survival of immune cells while reducing infection-mediated cytokine expression. Fluorescence microscopy indicated that nisin localizes with spores within phagosomes of peritioneal macrophages in germinating conditions. These data demonstrate the effectiveness of nisin, as a model lantibiotic, for preventing spore outgrowth. It is speculated that nisin targeting of lipid II, resulting in membrane perturbations, may be effective at inhibiting the outgrowth of spores prepared from bacteria across a number of species.

Guía práctica para la realización de una Auditoría de Recursos Humanos en El Hospital Nacional “Dr. Jorge Arturo Mena” de Santiago De María Usulután

Este proyecto de Tesis se desarrolla en la Institución Hospital Nacional "Dr. Jorge Arturo Mena", municipio de Santiago de María, departamento de Usulután, el cual consta con doscientos diez empleados, dicha institución presta servicios de salud en atención ambulatoria, asimismo atención hospitalaria. Una auditoría de Recursos Humanos, es parte de una auditoría administrativa, la cual tiene como objetivo evaluar procesos, así como grado de cumplimiento de los objetivos establecidos por la institución. Una de las circunstancias que radica en la institución es el funcionamiento inadecuado del Recurso Humano y el Control del mismo, esto ocasiona que el empleado incumpla con Normas, Leyes y sus Reglamentos respectivos, así mismo, este incumplimiento pone en riesgo las condiciones laborales de los mismos. Para evaluar el Hospital se realizó una Guía Práctica para la realización de una Auditoría de Recursos Humanos en dicha institución para que sirva como base para el Hospital detectando así las posibles deficiencias, asimismo, sirve al ente fiscalizador de las Instituciones Públicas, la Corte de Cuentas de la República. Este proyecto va enfocado para las oficinas contables, como una guía para la realización de Auditoría de Recursos Humanos que sirva como base para la realización de la misma. Así mismo, va dirigida al sector docente y estudiantes de las diferentes universidades como material pedagógico en el desarrollo y práctica de la auditoría. El objetivo principal de este proyecto de Tesis es ser una herramienta para evaluar si se cumplieron con políticas y objetivos establecidos por la institución y además para la toma de decisiones con el fin de controlar, organizar y manejar el Recurso Humano eficientemente. Además, facilitará a que la administración cumpla con las obligaciones establecidas en normas, leyes y reglamentos.

Status of Endangered and Threatened Sand Area Species of the Illinois Flora

This study was undertaken to determine the distribution and habitat requirements of many of the endangered and threatened plant species associated with the sand deposits of Illinois. Approximately 70 species of endangered and threatened plants are known to grow in these deposits. The habitat fidelity and natural community types were determined for 40 of these species that are restricted to these glacial drift sand habitats. Plant community types, associated species, moisture requirements, and other data concerning each of the plant species were determined by reviewing the pertinent literature, searching the Illinois Department of Natural Resources Natural Heritage Database, through discussions with botanists and natural heritage biologists, examination of herbarium specimens, and our studies of the vegetation of the Illinois sand deposits. Throughout the course of these studies, most of the nature preserves, state parks, and identified natural areas in the sand regions were visited on numerous occasions and vegetation surveys undertaken. The information presented in this paper could allow rare plant conservation in Illinois to become more proactive by encouraging the selection of sites where in situ conservation efforts could be conducted by state, local, and nongovernmental organizations.

Host jumps shaped the diversity of extant rust fungi (Pucciniales)

* The aim of this study was to determine the evolutionary time line for rust fungi and date key speciation events using a molecular clock. Evidence is provided that supports a contemporary view for a recent origin of rust fungi, with a common ancestor on a flowering plant. * Divergence times for > 20 genera of rust fungi were studied with Bayesian evolutionary analyses. A relaxed molecular clock was applied to ribosomal and mitochondrial genes, calibrated against estimated divergence times for the hosts of rust fungi, such as Acacia (Fabaceae), angiosperms and the cupressophytes. * Results showed that rust fungi shared a most recent common ancestor with a mean age between 113 and 115 million yr. This dates rust fungi to the Cretaceous period, which is much younger than previous estimations. Host jumps, whether taxonomically large or between host genera in the same family, most probably shaped the diversity of rust genera. Likewise, species diversified by host shifts (through coevolution) or via subsequent host jumps. This is in contrast to strict coevolution with their hosts. * Puccinia psidii was recovered in Sphaerophragmiaceae, a family distinct from Raveneliaceae, which were regarded as confamilial in previous studies.

Microlepidoptera of Illinois hill prairies

Among insects, which are the most diverse eukaryotic group on earth, Lepidoptera is one of four enormously diverse orders, with approximately 10,000 described species in North America. Within the order, Nearctic “microlepidoptera,” which represent an overwhelmingly large percentage of diversity within the order, remain poorly known despite their ecological importance in many plant communities. In this thesis, I undertook several studies of microlepidoptera diversity in a natural community type (hill prairie) and a managed community type (biofuel feedstock). In two Illinois hill prairies differing in size, latitude, and plant composition, alpha diversity of Pyraloidea and Tortricidae was similar, but the prairies were found to support different sets of species of these moth groups. It is concluded that the similarity in alpha diversity occurs because the larger prairie supports primarily a complement of moth species that feed as larvae on prairie plants (especially species of Asteraceae and Fabaceae), whereas the moths collected in the small prairie represent relatively few prairie-associated species, plus a large component of species that feed as larvae on deciduous trees that surround the prairie. This agrees with the finding of high beta diversity of moths between the sites, which reflects a high level of larval hostplant specificity in most species of Pyraloidea and Tortricidae. Based on published information plus observations made on microlepidoptera collected during the course of this study, 31 families of basal microlepidoptera were reviewed with an aim toward evaluating the likelihood of their including species that are dependent on tallgrass prairie. Of these families, 12 were evaluated as possible, and two as likely or certain, to include prairie-dependent species. In a comparison of moth diversity in light-trap samples from corn, miscanthus, switchgrass, and native prairie, alpha diversity was highest in prairie and was higher in switchgrass than in the other two biofuel crops. Moth species complements generally were similar among the biofuel crops, and prairie shared higher species complementarity with switchgrass than with corn or miscanthus. These findings suggest that large-scale conversion of land to biofuel crops may, to a substantial degree, detrimentally affect arthropod biodiversity, with a resulting loss of valuable arthropod-derived ecosystem services both within the cropping systems and in the surrounding landscape. During the course of this study, rearing efforts yielded two species of moths of the family Gelechiidae, both of which are monophagous leaf feeders on leadplant, Amorpha canescens (Fabaceae). Because these moths are restricted to tallgrass prairie, they are likely to be of interest to conservation biologists. In the interest of naming the moths to facilitate communication regarding them, and to augment our taxonomic knowledge of their respective genera, the moths are described, and diagnoses are provided to differentiate them from similar, related species.