Prospective memory rehabilitation for adults with traumatic brain injury: A compensatory training programme

Primary objective: To describe a prospective memory rehabilitation programme based on a compensatory training approach and report the results of three case studies. Research design: Programme evaluation using pre-and post-intervention assessments and telephone follow-up. Methods and procedures: Three participants with traumatic brain injury completed 8 weeks of training with 1 - 2 hour individual sessions. Assessments were formal prospective memory assessment, self-report and measures of diary use. Experimental interventions: Intervention aimed to identify potential barriers, establish self-awareness of memory deficits, introduce a customized compensatory tool, a cueing system and organizational strategies. A significant other was involved in training to assist generalization. Main outcomes and results: All three participants improved on formal prospective memory assessment and demonstrated successful diary use after the programme. Self-report of prospective memory failure fluctuated and may reflect increased self-awareness. Conclusion: A compensatory approach may be useful in improving prospective memory performance following TBI.

Longitudinal research designs in Music Therapy: Recommendations from a study of people with dementia.

Longitudinal research studies in music therapy are not frequently reported within the music therapy literature despite the need for these within the discipline. This article aims to encourage music therapists to undertake longitudinal research, by providing information on aspects of this type of research design. The authors discuss some advantages of longitudinal research approaches, and present the challenges expected to be faced by those conducting longitudinal research studies. Reflections on the authors' experiences in investigating long term effects of music therapy on people with dementia are described, along with recommendations as to how future researchers might address or accommodate some of these challenges

The effects of a song-singing programme on the affective speaking intonation of people with traumatic brain injury

Primary objective: To examine changes in the relationship between intonation, voice range and mood following music therapy programmes in people with traumatic brain injury. Research design: Data from four case studies were pooled and effect size, ANOVA and correlation calculations were performed to evaluate the effectiveness of treatment. Methods and procedures: Subjects sang three self-selected songs for 15 sessions. Speaking fundamental frequency, fundamental frequency variability, slope, voice range and mood were analysed pre- and post-session. Results: Immediate treatment effects were not found. Long-term improvements in affective intonation were found in three subjects, especially in fundamental frequency. Voice range improved over time and was positively correlated with the three intonation components. Mood scale data showed that immediate effects were in the negative direction whereas there weres increases in positive mood state in the longer-term. Conclusions: Findings suggest that, in the long-term, song singing can improve vocal range and mood and enhance the affective intonation styles of people with TBI.

Determinants in the development of advanced nursing practice: a case study of primary-care settings in Hong Kong

Different factors have been shown to influence the development of models of advanced nursing practice (ANP) in primary-care settings. Although ANP is being developed in hospitals in Hong Kong, China, it remains undeveloped in primary care and little is known about the factors determining the development of such a model. The aims of the present study were to investigate the contribution of different models of nursing practice to the care provided in primary-care settings in Hong Kong, and to examine the determinants influencing the development of a model of ANP in such settings. A multiple case study design was selected using both qualitative and quantitative methods of data collection. Sampling methods reflected the population groups and stage of the case study. Sampling included a total population of 41 nurses from whom a secondary volunteer sample was drawn for face-to-face interviews. In each case study, a convenience sample of 70 patients were recruited, from whom 10 were selected purposively for a semi-structured telephone interview. An opportunistic sample of healthcare professionals was also selected. The within-case and cross-case analysis demonstrated four major determinants influencing the development of ANP: (1) current models of nursing practice; (2) the use of skills mix; (3) the perceived contribution of ANP to patient care; and (4) patients' expectations of care. The level of autonomy of individual nurses was considered particularly important. These determinants were used to develop a model of ANP for a primary-care setting. In conclusion, although the findings highlight the complexity determining the development and implementation of ANP in primary care, the proposed model suggests that definitions of advanced practice are appropriate to a range of practice models and cultural settings. However, the findings highlight the importance of assessing the effectiveness of such models in terms of cost and long-term patient outcomes.

Treating dysarthria following traumatic brain injury: Investigating the benefits of commencing treatment during post-traumatic amnesia in two participants

Primary objective: The aims of this preliminary study were to explore the suitability for and benefits of commencing dysarthria treatment for people with traumatic brain injury (TBI) while in post-traumatic amnesia ( PTA). It was hypothesized that behaviours in PTA don't preclude participation and dysarthria characteristics would improve post-treatment. Research design: A series of comprehensive case analyses. Methods and procedures: Two participants with severe TBI received dysarthria treatment focused on motor speech deficits until emergence from PTA. A checklist of neurobehavioural sequelae of TBI was rated during therapy and perceptual and motor speech assessments were administered before and after therapy. Main outcomes and results: Results revealed that certain behaviours affected the quality of therapy but didn't preclude the provision of therapy. Treatment resulted in physiological improvements in some speech sub-systems for both participants, with varying functional speech outcomes. Conclusions: These findings suggest that dysarthria treatment can begin and provide short-term benefits to speech production during the late stages of PTA post-TBI.

Diabetes as a tracer condition in international benchmarking of health systems

OBJECTIVE - To assess the performance of health systems using diabetes as a tracer condition. RESEARCH DESIGN AND METHODS - We generated a measure of case-fatality among young people with diabetes Using the mortalily-to-incidence ratio (M/I ratio) for 29 industrialized countries using published data on diabetes incidence and mortality. Standardized incidence rates for ages 0-14 years were extracted from the World Health Organization DiaMond Study for the period 1990-1994; data on death from diabetes for ages 0-39 years were obtained from the World Health Organization Mortality database and converted into age-standardized death rates for the period 1994-1998, using the European standard population. RESULTS - The MA ratio varied > 10-fold. These relative differences appear similar to those observed in cohort studies of mortality among young people with type I diabetes in five countries. A sensitivity analysis showed that using plausible assumptions about potential overestimation of diabetes as a cause of death and underestimation of incidence rates in the U.S. yields an M/I ratio that would still be twice as high as in the U.K. or Canada. CONCLUSIONS - The M/I ratio for diabetes provides a means of differentiating countries on quality of care for people with diabetes. It is solely an indicator of potential problems, a basis for Stimulating more detailed assessments of whether such problems exist, and what can be done to address them.

The rapid screen of concussion: An evaluation of the non-word repetition test for use in mTBI research

Primary objectives: (1) To investigate the Nonword Repetition test (NWR) as an index of sub-vocal rehearsal deficits after mild traumatic brain injury (mTBI); (2) to assess the reliability, validity and sensitivity of the NWR; and (3) to compare the NWR to more sensitive tests of verbal memory. Research design: An independent groups design. Methods and procedures: Study 1 administered the NWR to 46 mTBI and 61 uninjured controls with the Rapid Screen of Concussion (RSC). Study 2 compared mTBI, orthopaedic and uninjured participants on the NWR and the Hopkins Verbal Learning Test (HVLT-R). Main outcomes and results: The NWR did not improve the diagnostic accuracy of the RSC. However, it is reliable and indexes sub-vocal rehearsal speed. These findings provide evidence that although the current form of the NWR lacks sensitivity to the impact of mTBI, the development of a more sensitive test of sub-vocal rehearsal deficits following mTBI is warranted.

CONTRIBUIÇÃO DOS CURSOS SUPERIORES DE TECNOLOGIA NA EDUCAÇÃO PROFISSIONAL DO TRABALHADOR BRASILEIRO

Os Cursos Superiores de Tecnologia são um tipo específico de graduação (tecnólogo), com características próprias, entre as quais, a focalização na especialização dos seus currículos e duração mais curta objetivando uma formação mais rápida. A graduação tecnológica vem sendo amplamente difundida no país desde a segunda metade da década de 1990, após a promulgação da lei no 9.394/96 LDB, e por uma série de decretos, portarias e pareceres do MEC/CNE. Entre as principais metas e objetivos do PNE para a educação superior, se destacam: diversificação do sistema superior de ensino para atender clientelas com demandas específicas de formação; articulação entre currículo e mercado de trabalho; financiamento e gestão; criação de políticas de acesso à educação superior que facilitem o ingresso de alunos provenientes de grupos de maior vulnerabilidade educacional; crescimento da oferta de educação superior para a faixa etária de 18 a 24 anos. O presente estudo tem por objetivo refletir e debater a contribuição dos CSTs na educação profissional do trabalhador brasileiro dentro das perspectivas do PNE. O estudo se fundamenta no método qualitativo, com base numa pesquisa exploratória e descritiva, caracterizada como estudo de caso único, através da pesquisa de campo realizada com alunos em formação e com egressos do Curso de Eletrônica Industrial da Faculdade de Tecnologia Senai Anchieta, na cidade de São Paulo. Para alcançar seus objetivos, o estudo foi dividido em duas etapas: a primeira faz uma análise das variáveis que caracterizam o perfil do aluno em formação buscando identificar sua percepção quanto à escolha pelo CST, conhecimento sobre essa modalidade de ensino e as expectativas futuras da profissão. Na segunda parte, o estudo faz uma análise da percepção do egresso acerca das habilidades e competências adquiridas durante a formação, o grau de satisfação com salário e plano de carreira, e a aceitação profissional do tecnólogo pelo mercado de trabalho. No estudo realizado com alunos em formação constatou-se que os índices de evasão escolar das primeiras turmas do curso foram elevados, sendo apontadas como principais causas as dificuldades de conciliação entre o horário de estudo com a do trabalho e as dificuldades econômicas familiares. O perfil do aluno em formação na IES em estudo é majoritariamente da faixa etária entre 18 e 24 anos; do gênero masculino; egresso do ensino médio feito em escola pública; morador em bairro periférico e natural de cidade da RMSP; o próprio aluno é responsável pelo pagamento das mensalidades; não houve interferência de terceiros na sua escolha pelo CST; tem percepção favorável quanto à empregabilidade futura como tecnólogo. A pesquisa com egressos apontou que os mesmos tem percepção favorável quanto à formação profissional recebida, exceto o fato de não terem atendido disciplinas que desenvolvessem competências gerenciais e de negócios; quanto à empregabilidade e perspectivas de carreira mostraram preocupação na valorização profissional do tecnólogo pelo mercado de trabalho; declararam estar insatisfeitos quanto ao salário recebido; quanto à educação continuada reconheceram ser esse o processo que os manterão atualizados profissionalmente. Como conclusão da pesquisa, há recomendação para estudos futuros na sondagem de outras possíveis causas da evasão escolar com alunos dos cursos com outros eixos temáticos e de IES públicas. Igualmente, aponta-se para a necessidade da proposta curricular da IES em estudo oferecer, além das disciplinas técnicas, outras que desenvolvam competências e habilidade em gestão de pessoas e negócios.

O DESAFIO DA GESTÃO POR COMPETÊNCIAS NO TERCEIRO SETOR: O CASO DO PROJETO MENINOS E MENINAS DE RUA

A ação reduzida do Estado brasileiro com relação ao atendimento das necessidades das crianças e adolescentes em situação de rua dá espaço para a atuação de novos atores sociais. Alguns destes têm como objetivo promover a cidadania do país, como os participantes do terceiro setor: ONGs que enfrentam diversos obstáculos para realizar suas missões. Dentre estes desafios encontra-se a gestão de pessoas. O presente trabalho propõe a análise da gestão de pessoas e a construção participativa de um modelo de competências em uma Organização Não Governamental Projeto Meninos e Meninas de Rua, a partir da combinação das metodologias qualitativas de estudo de caso único e pesquisa-ação, tendo como embasamento a Gestão Social. A pesquisa de campo foi desenvolvida por meio de diferentes fontes de evidências: entrevistas, questionários, observação, análise de documentos e registros e artefatos físicos, que permitiu a construção participativa de um modelo com cinco (5) competências essenciais/institucionais: Diagnóstico e Planejamento, Alinhamento Institucional, Comunicação, Resiliência e Defesa, Garantia e Promoção de Direitos, tendo como foco deste trabalho o olhar para os Educadores Sociais que atuam na instituição.

GESTÃO DO CONHECIMENTO TÁCITO: ESTUDO DE CASOS MÚLTIPLOS NA ÁREA DE DESENVOLVIMENTO DE PRODUTOS DE EMPRESAS DO SETOR AUTOMOBILÍSTICO DO ABC PAULISTA.

O presente estudo buscou a compreensão dos motivos que levam as empresas pesquisadas do setor automobilístico a gerir o conhecimento tácito, mediados pela gestão do conhecimento, na área de gestão de desenvolvimento de produtos. As questões de pesquisa que este estudo objetivou responder foram: Como empresas estudadas utilizam o conhecimento tácito para se tornarem mais eficientes e eficazes nas atividades/ operações? De que forma o conhecimento tácito é percebido na organização por parte dos funcionários e gestores? Para responder a estas perguntas houve a investigação de duas empresas do setor automobilístico, na área de desenvolvimento de produtos. Como base teórica para o desenvolvimento do presente estudo autores como Davenport e Prusak (1998), Nonaka e Takeuchi (1997) e Choo (2006) orientam esta pesquisa. A pesquisa abrange duas empresas do ramo automobilístico na região do ABC Paulista, com equivalência no número de funcionários e porte. Dentre os entrevistados há funcionários e gestores de áreas de gestão de projetos e produtos. A metodologia aplicada ao estudo foi de caráter qualitativo por meio de pesquisa exploratória-descritiva, sendo que o método de coleta de dados se deu a partir de entrevistas semiestruturadas. O estudo investigou quais as práticas usadas para a conversão do conhecimento, fatores facilitadores e fatores dificultadores para a conversão do conhecimento e as principais contribuições da aplicação das práticas e iniciativas voltadas gerir o conhecimento tácito, sob a ótica dos gestores e funcionários. Através do presente estudo pode-se verificar que existe a preocupação com a gestão do conhecimento nas empresas estudadas e que há práticas diversas relativas ao conhecimento tácito e que as formas de disseminação deste conhecimento são distintas. Algumas das práticas são os cursos de especialização, brainstorming e lesson learned e conversas informais. Nos fatores facilitadores há a troca de informação entre os pares, reuniões semanais, equipes multidisciplinares/ multifuncionais. Nos fatores dificultadores há a indicação de questões comportamentais, acúmulo de funções e tempo para partilhar informações.

Using grounded theory for theory building in operations management research:a study on inter-firm relationship governance

Purpose – Qualitative theory building approaches, such as grounded theory method (GTM), are still not very widespread and rigorously applied in operations management (OM) research. Yet it is agreed that more systematic observation of current industrial phenomena is necessary to help managers deal with their problems. The purpose of this paper is to provide an example to help guide other researchers on using GTM for theory building in OM research. Design/methodology/approach – A GTM study in the German automotive industry consisting of 31 interviews is followed by a validation stage comprising a survey (110 responses) and a focus group. Findings – The result is an example of conducting GTM research in OM, illustrated by the development of the novel collaborative enterprise governance framework for inter-firm relationship governance in the German automotive industry. Research limitations/implications – GTM is appropriate for qualitative theory building research, but the resultant theories need further testing. Research is necessary to identify the transferability of the collaborative enterprise governance concept to other industries than automotive, to other organisational areas than R&D and to product and service settings that are less complex and innovative. Practical implications – The paper helps researchers make more informed use of GTM when engaging in qualitative theory building research in OM. Originality/value – There is a lack of explicit and well-informed use of GTM in OM research because of poor understanding. This paper addresses this deficiency. The collaborative enterprise governance framework is a significant contribution in an area of growing importance within OM.

A longitudinal study of the diffusion of the ISO/IEC information resource dictionary system standard (IRDS.)

The IRDS standard is an international standard produced by the International Organisation for Standardisation (ISO). In this work the process for producing standards in formal standards organisations, for example the ISO, and in more informal bodies, for example the Object Management Group (OMG), is examined. This thesis examines previous models and classifications of standards. The previous models and classifications are then combined to produce a new classification. The IRDS standard is then placed in a class in the new model as a reference anticipatory standard. Anticipatory standards are standards which are developed ahead of the technology in order to attempt to guide the market. The diffusion of the IRDS is traced over a period of eleven years. The economic conditions which affect the diffusion of standards are examined, particularly the economic conditions which prevail in compatibility markets such as the IT and ICT markets. Additionally the consequences of the introduction of gateway or converter devices into a market where a standard has not yet been established is examined. The IRDS standard did not have an installed base and this hindered its diffusion. The thesis concludes that the IRDS standard was overtaken by new developments such as object oriented technologies and middleware. This was partly because of the slow development process of developing standards in traditional organisations which operate on a consensus basis and partly because the IRDS standard did not have an installed base. Also the rise and proliferation of middleware products resulted in exchange mechanisms becoming dominant rather than repository solutions. The research method used in this work is a longitudinal study of the development and diffusion of the ISO/EEC IRDS standard. The research is regarded as a single case study and follows the interpretative epistemological point of view.

The knowledge-based perspective of risk management in healthcare organisations

The aim of this research is to investigate how risk management in a healthcare organisation can be supported by knowledge management. The subject of research is the development and management of existing logs called "risk registers", through specific risk management processes employed in a N.H.S. (Foundation) Trust in England, in the U.K. Existing literature on organisational risk management stresses the importance of knowledge for the effective implementation of risk management programmes, claiming that knowledge used to perceive risk is biased by the beliefs of individuals and groups involved in risk management and therefore is considered incomplete. Further, literature on organisational knowledge management presents several definitions and categorisations of knowledge and approaches for knowledge manipulation in the organisational context as a whole. However, there is no specific approach regarding "how to deal" with knowledge in the course of organisational risk management. The research is based on a single case study, on a N.H.S. (Foundation) Trust, is influenced by principles of interpretivism and the frame of mind of Soft Systems Methodology (S.S.M.) to investigate the management of risk registers, from the viewpoint of people involved in the situation. Data revealed that knowledge about risks and about the existing risk management policy and procedures is situated in several locations in the Trust and is neither consolidated nor present where and when required. This study proposes a framework that identifies required knowledge for each of the risk management processes and outlines methods for conversion of this knowledge, based on the SECI knowledge conversion model, and activities to facilitate knowledge conversion so that knowledge is effectively used for the development of risk registers and the monitoring of risks throughout the whole Trust under study. This study has theoretical impact in the management science literature as it addresses the issue of incomplete knowledge raised in the risk management literature using concepts of the knowledge management literature, such as the knowledge conversion model. In essence, the combination of required risk and risk management related knowledge with the required type of communication for risk management creates the proposed methods for the support of each risk management process for the risk registers. Further, the indication of the importance of knowledge in risk management and the presentation of a framework that consolidates knowledge required for the risk management processes and proposes way(s) for the communication of this knowledge within a healthcare organisation have practical impact in the management of healthcare organisations.

A critical language study of Tanzanian presidential Kiswahili political oratory

The thesis discusses the result of a critical language study (CLS) of Tanzanian Presidential Kiswahili political oratory (TPKPO). The CLS was motivted by the belief that one of the principal contributions that linguists could make to the survival and development of their societies is to adopt what Shapiro (1990:12) paraphrasing Foucault (1977) has callled "a commitment to a form of inquiry aimed at the continuous disruption of the structures of "intelligibility" upon which some of the prevailing hegemonic political prejudices and biases are based. Faifclough's (1989) ideas regarding the need for and how to conduct CLS were dapted to suit the specific goal of the curren study which was to determine the inter and intra speker vriation within contemporary Tanzanian Kiswahili political discourse taking the oratory ex-president J. K. Nyerere and tha of Prersident A. H. Mwinyi as a case in point. The results of the study, which adopted a largely ethnographic research design, permit one to make two important observations about TPKPO.

Comparative risk of microalbuminuria and proteinuria in UK residents of south Asian and white European ethnic background with type 2 diabetes:a report from UKADS

Objective - This study investigated and compared the prevalence of microalbuminuria and overt proteinuria and their determinants in a cohort of UK resident patients of white European or south Asian ethnicity with type 2 diabetes mellitus. Research design and methods - A total of 1978 patients, comprising 1486 of south Asian and 492 of white European ethnicity, in 25 general practices in Coventry and Birmingham inner city areas in England were studied in a cross-sectional study. Demographic and risk factor data were collected and presence of microalbuminuria and overt proteinuria assessed. Main outcome measures - Prevalences of microalbuminuria and overt proteinuria. Results - Urinary albumin:creatinine measurements were available for 1852 (94%) patients. The south Asian group had a lower prevalence of microalbuminuria, 19% vs. 23% and a higher prevalence of overt proteinuria, 8% vs. 3%, X2?=?15.85, 2df, P?=?0.0004. In multiple logistic regression models, adjusted for confounding factors, significantly increased risk for the south Asian vs. white European patients for overt proteinuria was shown; OR (95% CI) 2.17 (1.05, 4.49), P?=?0.0365. For microalbuminuria, an interaction effect for ethnicity and duration of diabetes suggested that risk for south Asian patients was lower in early years following diagnosis; OR for SA vs. WH at durations 0 and 1 year were 0.56 (0.37, 0.86) and 0.59 (0.39, 0.89) respectively. After 20 years’ duration, OR?=?1.40 (0.63, 3.08). Limitations - Comparability of ethnicity defined groups; statistical methods controlled for differences between groups, but residual confounding may remain. Analyses are based on a single measure of albumin:creatinine ratio. Conclusions - There were significant differences between ethnicity groups in risk factor profiles and microalbuminuria and overt proteinuria outcomes. Whilst south Asian patients had no excess risk of microalbuminuria, the risk of overt proteinuria was elevated significantly, which might be explained by faster progression of renal dysfunction in patients of south Asian ethnicity.