864 resultados para KM people-centred approach


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Extratropical cyclones produce the majority of precipitation in many regions of the extratropics. This study evaluates the ability of a climate model, HiGEM, to reproduce the precipitation associated with extratropical cyclones. The model is evaluated using the ERA-Interim reanalysis and GPCP dataset. The analysis employs a cyclone centred compositing technique, evaluates composites across a range of geographical areas and cyclone intensities and also investigates the ability of the model to reproduce the climatological distribution of cyclone associated precipitation across the Northern Hemisphere. Using this phenomena centred approach provides an ability to identify the processes which are responsible for climatological biases in the model. Composite precipitation intensities are found to be comparable when all cyclones across the Northern Hemisphere are included. When the cyclones are filtered by region or intensity, differences are found, in particular, HiGEM produces too much precipitation in its most intense cyclones relative to ERA-Interim and GPCP. Biases in the climatological distribution of cyclone associated precipitation are also found, with biases around the storm track regions associated with both the number of cyclones in HiGEM and also their average precipitation intensity. These results have implications for the reliability of future projections of extratropical precipitation from the model.

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Este trabalho trata da interação entre professor e alunos mediante a utilização do texto paradidático intitulado Nosso Universo em aulas de Física, em uma sala de Educação de Jovens e Adultos. Neste artigo é analisado um episódio que articula Ciência, Tecnologia e Sociedade aos aspectos ambientais. Esse episódio aborda o problema do efeito estufa, do buraco na camada de ozônio e da escassez da água. Para a análise, foram elaboradas categorias referentes às argumentações discentes e docente. Os resultados envolvendo o tripé professor/aluno/texto apontam que tais interações propiciaram a motivação e a formação do aluno enquanto indivíduo crítico e reflexivo, em condições de argumentar e atuar criticamente em seu meio social.

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This paper will contend that the post-2015 development agenda presents a major opportunity for Caribbean countries to reverse decades of lagging economic performance and make the transition to balanced, holistic, and people-centred growth and development. The MDGs, while valuable in promoting gains in poverty reduction, health, education, nutrition, and maternal well-being were not tailored to the growth and development needs of the region. This can now be changed by a post-2015 development agenda which goes beyond improving the welfare of citizens by meeting basic needs and enhancing access to primary services. The necessary scaling-up of the MDG framework will require that the sustainable development goals, which will anchor the post- 2015 development agenda, are capable of promoting structural change, competitiveness and output gains while advancing social development and meeting environmental concerns. They must also address the unfinished business of the millennium development goals, primarily in the area of human development.

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Il processo di riforma a carattere europeo che ha condotto alla nascita di uno Spazio Europeo dell’Istruzione Superiore ha conosciuto diverse tappe fondamentali, fra cui, per esempio, la ripartizione in cicli e l’adozione dei crediti ECTS. Una di queste tappe, ossia il passaggio da una pianificazione della didattica basata sui contenuti ad una basata sui risultati dell’apprendimento, ricopre un ruolo di primo piano nel presente progetto di dottorato. Lo studio qui descritto ha esaminato, da un punto di vista sintattico e semantico, un campione di obiettivi e risultati dell’apprendimento di insegnamenti di alcuni corsi di laurea di primo e secondo ciclo, delle scienze umanistiche, in Austria, Germania, Italia e Regno Unito. L’obiettivo del progetto è proporre uno schema per una classificazione a faccette di obiettivi dell’apprendimento denominato FLOC. Tale schema è adottato per classificare gli obiettivi dell’apprendimento di quattro contesti linguistico-culturali (nei paesi summenzionati), dando vita a FLOC-AT, FLOC-DE, FLOC-IT e FLOC-EN. Queste quattro classificazioni forniscono inoltre il contesto per un’analisi contrastiva multilingue fra unità di obiettivi di apprendimento.

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La formazione, in ambito sanitario, è considerata una grande leva di orientamento dei comportamenti, ma la metodologia tradizionale di formazione frontale non è la più efficace, in particolare nella formazione continua o “long-life education”. L’obiettivo primario della tesi è verificare se l’utilizzo della metodologia dello “studio di caso”, di norma utilizzata nella ricerca empirica, può favorire, nel personale sanitario, l’apprendimento di metodi e strumenti di tipo organizzativo-gestionale, partendo dalla descrizione di processi, decisioni, risultati conseguiti in contesti reali. Sono stati progettati e realizzati 4 studi di caso con metodologia descrittiva, tre nell’Azienda USL di Piacenza e uno nell’Azienda USL di Bologna, con oggetti di studio differenti: la continuità di cura in una coorte di pazienti con stroke e l’utilizzo di strumenti di monitoraggio delle condizioni di autonomia; l’adozione di un approccio “patient-centred” nella presa in carico domiciliare di una persona con BPCO e il suo caregiver; la percezione che caregiver e Medici di Medicina Generale o altri professionisti hanno della rete aziendale Demenze e Alzheimer; la ricaduta della formazione di Pediatri di Libera Scelta sull’attività clinica. I casi di studio sono stati corredati da note di indirizzo per i docenti e sono stati sottoposti a quattro referee per la valutazione dei contenuti e della metodologia. Il secondo caso è stato somministrato a 130 professionisti sanitari all’interno di percorso di valutazione delle competenze e dei potenziali realizzato nell’AUSL di Bologna. I referee hanno commentato i casi e gli strumenti di lettura organizzativa, sottolineando la fruibilità, approvando la metodologia utilizzata, la coniugazione tra ambiti clinico-assistenziali e organizzativi, e le teaching note. Alla fine di ogni caso è presente la valutazione di ogni referee.

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Patients commonly visit their primary care physician (PCP) because of body symptoms. However, neither the PCP nor his patient can tell immediately whether or not psychosocial factors play a role in the disease manifestation. If this is the case, only a patient-centred approach and basic knowledge in biopsychosocial skills will help the PCP to diagnose and treat his patient appropriately. This article gives a comprehensive overview on how the PCP can approach patients with psychosomatic diseases (i.e. somatic symptoms exacerbated by psychosocial factors, medically unexplained symptoms, functional somatic syndromes, somatic manifestation of psychiatric diseases). Adopting this approach will allow the PCP to be challenged but not overburdened by, on an average, 30-50% of his patients presenting with psychosomatic symptoms.

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The deep economic recession that hit Sweden and Finland at the beginning of the 90s, and the fall in public revenues and rapidly growing public debts that followed on it, triggered a development of cutbacks and restructuring measures which has resulted in a scientific debate over what this has meant for these countries’ systems of social policy, traditionally resting on the Nordic welfare state paradigm. In this connection, questions of to what extent changes made can be ascribed mainly to the economic constraints posed by the recession at all, or rather, to other more long-term societal trends or phenomena, including globalisation, European integration and/or ideational or ideological shifts among influential (elite) groups, have often been touched upon. Applying an ideas-centred approach, this paper attempts to contribute to the knowledge on the reasoning of influential elite societal groups in social policy issues before, during and after the 90’s recession, by empirically analysing their statements on social security made in the press. A distinction is made between three different levels of proposed policy changes, reaching from minor alterations of single programs to changes of the policy paradigm. Results show that the 1990s did not only mean the emergence of suggestions for minor cutbacks in and alterations of prevailing programmes. The share of suggestions implying de facto a (further) departure from the basic features of the social security system also showed that the model was under continuous pressure throughout the 90s. However, many of the changes suggested were not justified by any clear references to a policy paradigm in either country (or not justified at all). Instead, references to “purely” structural justifications did become more common over time. In this respect, as regards social security, our results cannot confirm the fairly popular notion among many researchers of a clearly ideological attack on the welfare state. However, it remains uncertain whether and to what extent the increased proportion of references to “structural realities” in the 90s should be interpreted as an indication of a change in the idea of what the welfare state is and what the goals behind it are. Results further show that the patterns of the discussion in the two countries studied bore a remarkable resemblance at a general level, whereas there are indications of differences in the driving forces behind suggestions for similar reforms in these two countries.

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STUDY QUESTION To what extent do the management of endometriosis and the symptoms that remain after treatment affect the quality of life in women with the disease? SUMMARY ANSWER Many women with endometriosis had impaired quality of life and continued to suffer from endometriosis-associated symptoms even though their endometriosis has been managed in tertiary care centres. WHAT IS KNOWN ALREADY The existing literature indicates that quality of life and work productivity is reduced in women with endometriosis. However, most studies have small sample sizes, are treatment related or examine newly diagnosed patients only. STUDY DESIGN, SIZE, DURATION A cross-sectional questionnaire-based survey among 931 women with endometriosis treated in 12 tertiary care centres in 10 countries. PARTICIPANTS/MATERIALS, SETTING, METHODS Women diagnosed with endometriosis who had at least one contact related to endometriosis-associated symptoms during 2008 with a participating centre were enrolled into the study. The study investigated the effect of endometriosis on education, work and social wellbeing, endometriosis-associated symptoms and health-related quality of life, by using questions obtained from the World Endometriosis Research Foundation (WERF) GSWH instrument (designed and validated for the WERF Global Study on Women's Health) and the Short Form 36 version 2 (SF-36v2). MAIN RESULTS AND THE ROLE OF CHANCE Of 3216 women invited to participate in the study, 1450 (45%) provided informed consent and out of these, 931 (931/3216 = 29%) returned the questionnaires. Endometriosis had affected work in 51% of the women and affected relationships in 50% of the women at some time during their life. Dysmenorrhoea was reported by 59%, dyspareunia by 56% and chronic pelvic pain by 60% of women. Quality of life was decreased in all eight dimensions of the SF-36v2 compared with norm-based scores from a general US population (all P < 0.01). Multivariate regression analysis showed that number of co-morbidities, chronic pain and dyspareunia had an independent negative effect on both the physical and mental component of the SF-36v2. LIMITATIONS, REASONS FOR CAUTION The fact that women were enrolled in tertiary care centres could lead to a possible over-representation of women with moderate-to-severe endometriosis, because the participating centres typically treat more complex and referred cases of endometriosis. The response rate was relatively low. Since there was no Institute Review Board approval to do a non-responder investigation on basic characteristics, some uncertainty remains regarding the representativeness of the investigated population. WIDER IMPLICATIONS OF THE FINDINGS This international multicentre survey represents a large group of women with endometriosis, in all phases of the disease, which increases the generalizability of the data. Women still suffer from frequent symptoms, despite tertiary care management, in particular chronic pain and dyspareunia. As a result their quality of life is significantly decreased. A patient-centred approach with extensive collaboration across disciplines, such as pain specialists, psychologists, sexologists and social workers, may be a valuable strategy to improve the long-term care of women with endometriosis. STUDY FUNDING/COMPETING INTEREST(S) The WERF EndoCost study is funded by the World Endometriosis Research Foundation (WERF) through grants received from Bayer Schering Pharma AG, Takeda Italia Farmaceutici SpA, Pfizer Ltd and the European Society of Human Reproduction and Embryology. The sponsors did not have a role in the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review or approval of the manuscript. L.H. is the chief executive and T.D. was a board member of WERF at the time of funding. T.D. holds the Merck-Serono Chair in Reproductive Medicine and Surgery, and the Ferring Chair in Reproductive Medicine at the Katholieke Universiteit Leuven in Belgium and has served as consultant/research collaborator for Merck-Serono, Schering-Plough, Astellas and Arresto.

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A simulation-based modelling approach is used to examine the effects of stratified seed dispersal (representing the distribution of the majority of dispersal around the maternal parent and also rare long-distance dispersal) on the genetic structure of maternally inherited genomes and the colonization rate of expanding plant populations. The model is parameterized to approximate postglacial oak colonization in the UK, but is relevant to plant populations that exhibit stratified seed dispersal. The modelling approach considers the colonization of individual plants over a large area (three 500 km x 10 km rolled transects are used to approximate a 500 km x 300 km area). Our approach shows how the interaction of plant population dynamics with stratified dispersal can result in a spatially patchy haplotype structure. We show that while both colonization speeds and the resulting genetic structure are influenced by the characteristics of the dispersal kernel, they are robust to changes in the periodicity of long-distance events, provided the average number of long-distance dispersal events remains constant. We also consider the effects of additional physical and environmental mechanisms on plant colonization. Results show significant changes in genetic structure when the initial colonization of different haplotypes is staggered over time and when a barrier to colonization is introduced. Environmental influences on survivorship and fecundity affect both the genetic structure and the speed of colonization. The importance of these mechanisms in relation to the postglacial spread and genetic structure of oak in the UK is discussed.

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In Striving Towards a Common Language I outline an innovative methodology which consists of three strands encompassing an Indigenous-centred approach based on Indigenous Self-determination (participatory action research), relationship as central to socio-cultural dynamics, and feminist phenomenology. This methodology - which I call Living On the Ground was created in direct concert with 13 Indigenous women elders who were my hosts, teachers and walytja (family) as we worked together to create a dynamic cultural revitalisation project for their community, one of Australia's most remote Aboriginal settlements. I explain the processes I went through as a White Irish-Australian woman living with the women elders and their 11 dogs in a one room tin shed for two years, and tell of how the nexus of land, Ancestors, and the Tjukurrpa (Dreaming) combined with White cultural practices came to inspire a methodology which took the best from Indigenous and (White) feminist ways of knowing and of being. (c) 2005 Z. de Ishtar. Published by Elsevier Ltd. All rights reserved.

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This project explored how consumers in emerging economies evaluate brand extension by using China as a case. Two separate but related studies were conducted, and university students were used as respondents in both the studies. Study one or replication study tested Aaker and Keller's brand extension model in China. Assuming similar methods to Aaker and Keller's, six well-recognised brands were chosen as parent brand and each was extended to three product categories. Totally, 469 respondents completed the survey questionnaire. As each was to evaluate six extensions, this made the cases 2814. The data was analysed using Optimal Least Square regression approach and "residual centred" approach respectively. The result confirmed most of the findings observed in developed countries. Specifically, consumer's attitude towards the extension is primarily driven by the brand affect, the fit between the two product categories, the difficulty of making the extension and moderated via the interactions between the brand affect and the fit variables. Study two refined and extended Aaker and Keller's model by adding new variables and making methodological adjustments. The same stimuli and data analysis techniques as those in the replication were employed. 252 respondents participated in the survey and each evaluated six extensions, making cases 1512. In addition to re-verifying the findings of the replication and providing cross validation to these findings, the extended study found that the image consistency between the parent brand and the extension, the competition intensity of the extension product market were important in determining the success of the extension. Further, consumer differed in evaluating durable extensions and non-durable extensions. The thesis detailed the two studies above, and discussed the findings and their implications by relating to branding literature, to the general situation of the emerging economies as well as the reality of China. It also presented the limitations of the research and the future research directions.

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This research thesis is concerned with the human factors aspects of industrial alarm systems within human supervisory control tasks. Typically such systems are located in central control rooms, and the information may be presented via visual display units. The thesis develops a human, rather than engineering, centred approach to the assessment, measurement and analysis of the situation. A human factors methodology was employed to investigate the human requirements through: interviews, questionnaires, observation and controlled experiments. Based on the analysis of current industrial alarm systems in a variety of domains (power generation, manufacturing and coronary care), it is suggested that often designers do not pay due considerations to the human requirements. It is suggested that most alarm systems have severe shortcomings in human factors terms. The interviews, questionnaire and observations led to the proposal of 'alarm initiated activities' as a framework for the research to proceed. The framework comprises of six main stages: observe, accept, analyse, investigate, correct and monitor. This framework served as a basis for laboratory research into alarm media. Under consideration were speech-based alarm displays and visual alarm displays. Non-speech auditory displays were the subject of a literature review. The findings suggest that care needs to be taken when selecting the alarm media. Ideally it should be chosen to support the task requirements of the operator, rather than being arbitrarily assigned. It was also indicated that there may be some interference between the alarm initiated activities and the alarm media, i.e. information that supports one particular stage of alarm handling may interfere with another.

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In the UK, Open Learning has been used in industrial training for at least the last decade. Trainers and Open Learning practitioners have been concerned about the quality of the products and services being delivered. The argument put forward in this thesis is that there is ambiguity amongst industrialists over the meanings of `Open Learning' and `Quality in Open Learning'. For clarity, a new definition of Open Learning is proposed which challenges the traditional learner-centred approach favoured by educationalists. It introduces the concept that there are benefits afforded to the trainer/employer/teacher as well as to the learner. This enables a focussed view of what quality in Open Learning really means. Having discussed these issues, a new quantitative method of evaluating Open Learning is proposed. This is based upon an assessment of the degree of compliance with which products meet Parts 1 & 2 of the Open Learning Code of Practice. The vehicle for these research studies has been a commercial contract commissioned by the Training Agency for the Engineering Industry Training Board (EITB) to examine the quality of Open Learning products supplied to the engineering industry. A major part of this research has been the application of the evaluation technique to a range of 67 Open Learning products (in eight subject areas). The findings were that good quality products can be found right across the price range - so can average and poor quality ones. The study also shows quite convincingly that there are good quality products to be found at less than 50. Finally the majority (24 out of 34) of the good quality products were text based.

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Aims - Up to 10% of audiology patients report diffi culties hearing speech in noise even though clinical investigation reveals normal hearing thresholds, in other words, no evidence of physical pathology. The diagnostic category applied to these patients is known as King-Kopetzky Syndrome (KKS). This study aimed to gather descriptions of patients' experiences of the clinical encounter involving their KKS diagnosis and analyse the themes of help-seeking, as part of a larger study into the process of coping with medically unexplained hearing diffi culties. Method - A qualitative approach was employed, comprising unstructured interviews in the homes of 25 patients who had attended audiology services (and received a diagnosis of KKS) in Bath and Cardiff. Thematic analysis of transcripts was undertaken, infl uenced by grounded theory techniques. Findings - Informants characterized the clinical encounter as either negative or positive. Negative consultations were those in which patients' illness claims were dismissed and as such not validated. Positive encounters were typifi ed by the provision of meaningful information that reconciled clinical information with the patients' experiences of hearing loss. Conclusion - Successful management of medically unexplained illnesses requires the adoption of a patient-centred approach, rather than focusing on the absence of observable pathology