La thérapie cognitive-comportementale dans le traitement du TDAH chez l'adulte: état des connaissances

Essai doctoral présenté à la Faculté des Arts et des Sciences en vue de l'obtention du grade de doctorat en psychologie clinique (D.psy.)

Health Knowledge, Attitudes, and Practices among Street Children in LMICs

Background: Worldwide, it is estimated that there are up to 150 million street children. Street children are an understudied, vulnerable population. While many studies have characterized street children’s physical health, few have addressed the circumstances and barriers to their utilization of health services.

Methods: A systematic literature review was conducted to understand the barriers and facilitators that street children face when accessing healthcare in low and middle income countries. Six databases were used to search for peer review literature and one database and Google Search engine were used to find grey literature (theses, dissertations, reports, etc.). There were no exclusions based on study design. Studies were eligible for inclusion if the study population included street children, the study location was a low and middle income country defined by the World Bank, AND whose subject pertained to healthcare.

In addition, a cross-sectional study was conducted between May 2015 and August 2015 with the goal of understanding knowledge, attitudes, and health seeking practices of street children residing in Battambang, Cambodia. Time location and purposive sampling were used to recruit community (control) and street children. Both boys and girls between the ages of 10 and 18 were recruited. Data was collected through a verbally administered survey. The knowledge, attitudes and health seeking practices of community and street children were compared to determine potential differences in healthcare utilization.

Results: Of the 2933 abstracts screened for inclusion in the systematic literature review, eleven articles met all the inclusion criteria and were found to be relevant. Cost and perceived stigma appeared to be the largest barriers street children faced when attempting to seek care. Street children preferred to receive care from a hospital. However, negative experiences and mistreatment by health providers deterred children from going there. Instead, street children would often self treat and/or purchase medicine from a pharmacy or drug vendor. Family and peer support were found to be important for facilitating treatment.

The survey found similar results to the systematic review. Forty one community and thirty four street children were included in the analysis. Both community and street children reported the hospital as their top choice for care. When asked if someone went with them to seek care, both community and street children reported that family members, usually mothers, accompanied them. Community and street children both reported perceived stigma. All children had good knowledge of preventative care.

Conclusions: While most current services lack the proper accommodations for street children, there is a great potential to adapt them to better address street children’s needs. Street children need health services that are sensitive to their situation. Subsidies in health service costs or provision of credit may be ways to reduce constraints street children face when deciding to seek healthcare. Health worker education and interventions to reduce stigma are needed to create a positive environment in which street children are admitted and treated for health concerns.

La thérapie cognitive-comportementale dans le traitement du TDAH chez l'adulte: état des connaissances

Essai doctoral présenté à la Faculté des Arts et des Sciences en vue de l'obtention du grade de doctorat en psychologie clinique (D.psy.)

Proposta de implementação de uma metodologia SMED numa metalomecânica

O presente trabalho é o resultado de um projecto experimental que teve como principal objetivo a redução dos tempos de setup, através da implementação da metodologia Single Minute Exchange of Die (SMED) em equipamentos de eletroerosão (EDM) por fio e penetração. Para garantir o sucesso da implementação, após uma revisão bibliográfica centrada no tema SMED, estabelece-se uma metodologia, numa lógica de melhoria contínua análoga a um ciclo PDCA. A metodologia estabelecida envolve as seguintes fases: caracterização da situação inicial, observação, recolha de dados, análise dos dados e implementação SMED. A caracterização da situação inicial visa qualificar a situação encontrada e identificar a zona de atuação - equipamentos em estudo. A observação do processo produtivo é suportada pela ferramenta fluxograma do processo, por sua vez, a recolha de dados visa a avaliação inicial e nessa perspectiva recorre-se à abordagem OEE. Na fase de análise dos dados são introduzidas as ferramentas de análise VSM e diagrama de causa e efeito que auxiliam a identificação de um conjunto de acções de melhoria, a realizar previamente à fase de implementação SMED, culminando assim uma fase PRÉ-SMED. Reunidas as condições ideais iniciou-se a implementação efectiva da metodologia SMED obtendo-se reduções do tempo total de setup superiores a 60%. O presente estudo permite concluir que podem surgir diferenças significativas em diversas aplicações SMED, enfatizando a importância de uma fase PRÉ-SMED de modo a potenciar os resultados alcançados com uma implementação SMED.

Promoting oral health in adults with learning disability

Introduction: It is complex to define learning disabilities, there is no single universal definition used; there are different interpretations and definitions used for learning disabilities in different countries and communities. Primarily, the term “learning disability” sometimes used as “learning difficulties” is a term widely used in UK. There are various types and degree of severity of learning disabilities depending upon the extent of disorder. Though different definitions used all over the world, its types and classification coupled with their health and oral health needs are discussed in this review. Objectives:  To review the background literature on definitions of learning disabilities and health needs of this population.  To review literature on individual clinical preventive intervention to determine the effectiveness in promoting oral health amongst adults in learning disabilities.  To review literature in relation to community based preventive dental measures.  To determine the interventions in this areas are appropriate to support policy and practice and if these interventions establish good evidence to suggest that the oral health needs of adults with learning disabilities are met or not.  To make recommendations in implementing future preventive oral health interventions for adults with learning disabilities. Methodology: It was develop a comprehensive narrative synthesis of previously published literature from different sources and summarizes the whole research in a particular area identifying gap of knowledge. It provides a broad perspective of a subject and supports continuing education. It also is directed to inform policy and further research. It is a qualitative type of research with a broad question and critical analysis of literature published in books, article and journals. The research question evaluated on PICOS criteria is: Effectiveness of preventive dental interventions in adults with learning disabilities. The research question clearly defines the PICOS i.e. participants, interventions, comparison, outcome and study design. The Cochrane database of systematic reviews (CDSR), Database of Abstracts of Reviews of effects (DARE) through York University and National institute of Health and Clinical Excellence (NICE) was searched to identify need of this review. There was no literature review found on the preventive dental interventions found hence, justifying this review. The guidance used in this review is from York University and methods opted for search of literature is based on the following: Type of participants, interventions, outcome measure, studies and search. The review of literature; author search; systematic and narrative reviews, through the following electronic databases via UFP library services: Pub-Med, Medline, EMBASE, CINHAL, Google scholar; Science Direct; Social and Medicine. A comprehensive search of all available literature from 1990-2015, including systematic reviews, policy documents and some guideline documents was done. Internet resource used to access; Department of Health, World Health Organization, Disability World, Disability Rights Commission, the Stationery office, MENCAP, Australian Learning Disability Association. The literature search was carried out with single word, combined words and phrases, authors' names and the title of literature search. Results: It is primarily looking at the oral health interventions available for adults with learning disabilities in clinical settings and the community measures observed over a period of 25 years 1990-2015. There were 7of the clinical intervention studies and one community based intervention study was added in this review. Conclusion: There is a gap of knowledge identified in not having ample research in the area of preventive dental interventions in adults with learning or intellectual disabilities and there is a need of more research, studies need to be of a better quality and a special consideration is required in the community settings where maintenance of oral hygiene for this vulnerable group of society is hugely dependent on their caregivers. Though, the policy and guideline directs on the preventive dental interventions of adults with LD there still a gap evident in understanding and implication of the guidance in practice by the dental and care support team. Understanding learning disabilities and to identify their behavior, compliance and oral health needs is paramount for all professionals working with or for them at each level.

Literature Review Value Alignment Process for Project Delivery

The objective of the project “Value Alignment Process for Project Delivery” is to provide a catalyst and tools for reform in the building and construction industry to transform business-as-usual performance into exceptional performance. The outcomes of this project will be beneficial to not only the construction industry, but to the community as a whole because a more sophisticated industry can deliver more effective use of assets, financing, operating and maintenance of facilities to suit the community’s needs. The research project consists of a study into best practice project delivery and the development of a suite of products, resources and services to guide project teams towards the best approach for a specific project. These resources will be focused on promoting the principles that underlie best practice project delivery, rather than on identifying a particular delivery system. The need for such tools and resources becomes more and more acute as the environment within which the construction industry operates becomes more and more complex, and as business and political imperatives shift to encompass or represent diverse stakeholder interests. To this end, this literature review looks at why it is essential to achieve transformation in the Australian construction industry in the context of its importance to the Australian economy. It seeks to investigate the concepts of ‘alignment’ and value’ as they pertain to construction industry processes and relationships. It comprehensively reviews drivers of project excellence and best practice project delivery principles and looks at how clients approach selection of project delivery systems. It critiques existing project delivery strategies and gives an overview of recent best practice initiatives. The literature review represents a milestone against the Project Agreement and forms a foundation document for this research project

Literature review

This research aims to improve the economic and environmental sustainability of the construction & demolition waste and precast concrete supply chains through the development, trial and evaluation of an innovative public sector supply chain management strategy. The long-term goals are to improve competitive behaviour and market sector performance and improve business process efficiency and effectiveness of public sector program delivery by influencing policy development, changing organisational behaviour and implementation development to achieve more economic and environmental sustainable markets.

Literature review

There are many studies that reveal the nature of design thinking and the nature of conceptual design as distinct from detailed or embodiment design. The results can assist in our understanding of how the process of design can be supported and how new technologies can be introduced into the workplace. Existing studies provide limited information about the nature of collaborative design as it takes place on the ground and in the actual working context. How to provide appropriate and effective of support for collaborative design information sharing across companies, countries and heterogeneous computer systems is a key issue. As data are passed between designers and the computer systems they employ, many exchanges are made. These exchanges may be used to establish measures of the benefits that new support systems can bring. Collaboration support tools represent a fast growing section of the commercial software market place and a reasonable range of products are available. Many of them offer significant application to design for the support of distributed meetings by the provision of video and audio communications and the sharing of information, including collaborative sketching. The tools that specifically support 3D models and other very design specific features are less common and many of those are in prototype stages of development. A key question is to find viable ways of combining design information visualisation support with the collaboration support technologies that can be seen today. When collaborating, different views will need to be accessible at different times to all the collaborators. The architects may want to explain some ideas on their model, the structural engineers on their model and so on. However, there are issues of ownership when the structural engineer wants to manipulate the architect’s model and vice versa. The modes of working, synchronous or asynchronous may have a bearing as in a synchronous session there is control of what is happening.

Generic skills in design teams : literature review

Recent developments in networked three dimensional (3D) virtual worlds, and the proliferation of high bandwidth communications technology, have the potential to dramatically improve collaboration in the construction industry. This research project focuses on the early stages of a construction project in which the models for the project are developed and revised. The project investigates three aspects of collaboration in virtual environments: 1. The processes that enable effective collaboration using high bandwidth information communication technology (ICT); 2. The models that allow for multiple disciplines to share their views in a synchronous virtual environment; 3. The generic skills used by individuals and teams when engaging with high bandwidth information communication technology. The third aspect of the project, listed above, led by the University of Newcastle, explores the domain of People and the extent to which they contribute to the effectiveness of virtual teams. This report relates, primarily, to this aspect.

Report : review of the literature : maintenance and rehabilitation costs for roads (Risk-based Analysis)

Realistic estimates of short- and long-term (strategic) budgets for maintenance and rehabilitation of road assessment management should consider the stochastic characteristics of asset conditions of the road networks so that the overall variability of road asset data conditions is taken into account. The probability theory has been used for assessing life-cycle costs for bridge infrastructures by Kong and Frangopol (2003), Zayed et.al. (2002), Kong and Frangopol (2003), Liu and Frangopol (2004), Noortwijk and Frangopol (2004), Novick (1993). Salem 2003 cited the importance of the collection and analysis of existing data on total costs for all life-cycle phases of existing infrastructure, including bridges, road etc., and the use of realistic methods for calculating the probable useful life of these infrastructures (Salem et. al. 2003). Zayed et. al. (2002) reported conflicting results in life-cycle cost analysis using deterministic and stochastic methods. Frangopol et. al. 2001 suggested that additional research was required to develop better life-cycle models and tools to quantify risks, and benefits associated with infrastructures. It is evident from the review of the literature that there is very limited information on the methodology that uses the stochastic characteristics of asset condition data for assessing budgets/costs for road maintenance and rehabilitation (Abaza 2002, Salem et. al. 2003, Zhao, et. al. 2004). Due to this limited information in the research literature, this report will describe and summarise the methodologies presented by each publication and also suggest a methodology for the current research project funded under the Cooperative Research Centre for Construction Innovation CRC CI project no 2003-029-C.

Barriers to e-business adoption in construction: international literature review

The adoption of e-business by the Australian construction industry lags other service and product industries. It is assumed that slow adoption rate does not reflect the maturity of the technology but is due to adoption barriers peculiar to the nature of construction. This paper examines impediments to the uptake of e-business nationally and internationally. A systematic and extensive literature search of barriers (also referred to as obstacles, impediments or hindrances) to adoption has been undertaken and the findings discussed in this paper. This review included more that 200 documents and these have been published in a searchable database as part of a larger research initiative funded by the Cooperative Research Centre for Construction Innovation. The influence of levels of e-business maturity seen in other sectors such as retail, tourism and manufacturing was also captured and a number of major barriers were identified some including: privacy, trust, uncertainty of financial returns, lack of reliable measurement, fraud, lack of support and system maintenance. A total of 23 barriers were assessed in terms of impact to organisational type and size across reviewed documents. With this information it was possible to develop a reference framework for measuring maturity levels and readiness to uptake e-business in construction. Results have also shown that barriers to e-business adoption work differently according to organisational type and culture. Areas of training and people development need to be addressed. This would include a more sensitive approach to the nature of construction organisations, especially to those small and medium enterprises. Raising levels of awareness and creating trust for on-line collaboration are other aspects that need attention, which current studies confirm as lacking. An empirical study within construction, to validate these findings, forms the subsequent phase of this research.

The role of decision-maker preferences in tenancy selection of CBD office accommodation – preliminary literature review

The literature and anecdotal evidence suggests that that there is more to tenancy selection (firm location) than the profit maximisation drive that traditional neo-classical economic location theory suggests. In the first instance these models assume property markets are rational and perfectly competitive; the CBD office market is clearly neither rational nor perfectly competitive. This fact alone relegates such models to the margins of usefulness for an industry that seeks to satisfy tenant demand in order to optimise returns on capital invested. Acknowledgment of property market imperfections are universally accepted to the extent that all contemporary texts discuss the lack of a coherent centralised market place and incomplete and poorly disseminated information processes as fundamental inadequacies which characterise the property market inefficiencies. Less well researched are the facets of the market which allow the observer to determine market activity to be significantly irrational. One such facet is that of ‘decision maker preferences’. The decision to locate a business operation at one location as opposed to another seems ostensibly a routine choice based on short, medium and long term business objectives. These objectives are derived from a process of strategic planning by one or more individuals whose goal is held to be to optimise outcomes which benefit the business (and presumably those employed within it). However the decision making processes appear bounded by how firms function, the institutional context in which they operate, as well as by opportunistic behaviour by individual decision makers who allow personal preferences to infiltrate and ‘corrupt’ the process. In this way, history, culture, geography, as well as institutions all become significant to the extent that these influence and shape individual behaviour which in turn determine the morphology of individual preferences, as well as providing a conduit for them to take effect. This paper exams historical and current literature on the impact of individual behaviour in the decision making process within organisations as a precursor to an investigation of the tenancy decision making process within the CBD office market. Literature on the topic falls within a number of research disciplines, philosophy, psychology and economics to name a few.