Economic evaluation of latent tuberculosis infection screening among health care workers in Houston

Since interferon-gamma release assays (IGRAs) were introduced in the 2000's, tuberculin skin testing (TST) and IGRAs have been used in various latent tuberculosis infection (LTBI) screening settings. IGRAs are laboratory-based tests and are considered not to be affected by previous Bacille de Calmette et Guérin (BCG) vaccination; however, they are more costly when compared directly with TST, which does not require specimen processing in a laboratory. This study aimed to examine TST and two types of IGRAs, QuantiFERON-TB Gold in Tube (QFT-GIT) and T-SPOT. TB (TSPOT), from an economic viewpoint. Firstly, a systematic literature review was conducted to identify cost related analyses of LTBI screening. Secondly, specific cost information detailing each test's items and labor was collected from an LTBI screening program of health care workers in Houston, and the cost of each test was computed. Thirdly, using the computed cost estimate of each test, cost-effectiveness analyses were conducted to compare TST and IGRAs.^ A literature search showed that a limited number of studies have been conducted, but the IGRA's economic advantages were common among studies. Cost analyses showed that IGRAs were much more costly than TST. The results were consistent with previous studies. In cost-effectiveness analyses, where test cost and consequential TB-related cost were considered, IGRAs showed variable advantages over TST depending on the targeted population. When only non BCG-vaccinated people were considered, TST was the least costly option among the three tests. On the other hand, when only BCG-vaccinated people were considered, IGRAs were less costly options. These results were mostly consistent even with varying assumption parameters.^ IGRAs can be more costly than TST, but their economic disadvantages are alleviated when the target population was BCG-vaccinated. Based on current knowledge, IGRAs may be recommended in a population where the BCG history is mixed. Additional studies are needed to better understand IGRA's reliability among low-incidence and low-risk populations in which background TB prevalence is low.^

Providing a consensus definition for the term "Smart Product"

The term "Smart Product" has become commonly used in recent years. This is because there has been an increasing interest in these kinds of products as part of the consumer goods industry, impacting everyday life and industry. Nevertheless, the term "Smart Product" is used with different meanings in different contexts and application domains. The use of the term "Smart Product" with different meanings and underlying semantics can create important misunderstandings and dissent. The aim of this paper is to analyze the different definitions of Smart Product available in the literature, and to explore and analyze their commonalities and differences, in order to provide a consensus definition that satisfies, and can therefore be used by, all parties. To embrace the identified definitions, the concept of "Smart Thing" is introduced. The methodology used was a systematic literature review. The definition is expressed as an ontology.

Analysing the complexity of the model-based decision making processes within the industrial management context

PURPOSE The decision-making process plays a key role in organizations. Every decision-making process produces a final choice that may or may not prompt action. Recurrently, decision makers find themselves in the dichotomous question of following a traditional sequence decision-making process where the output of a decision is used as the input of the next stage of the decision, or following a joint decision-making approach where several decisions are taken simultaneously. The implication of the decision-making process will impact different players of the organization. The choice of the decision- making approach becomes difficult to find, even with the current literature and practitioners’ knowledge. The pursuit of better ways for making decisions has been a common goal for academics and practitioners. Management scientists use different techniques and approaches to improve different types of decisions. The purpose of this decision is to use the available resources as well as possible (data and techniques) to achieve the objectives of the organization. The developing and applying of models and concepts may be helpful to solve managerial problems faced every day in different companies. As a result of this research different decision models are presented to contribute to the body of knowledge of management science. The first models are focused on the manufacturing industry and the second part of the models on the health care industry. Despite these models being case specific, they serve the purpose of exemplifying that different approaches to the problems and could provide interesting results. Unfortunately, there is no universal recipe that could be applied to all the problems. Furthermore, the same model could deliver good results with certain data and bad results for other data. A framework to analyse the data before selecting the model to be used is presented and tested in the models developed to exemplify the ideas. METHODOLOGY As the first step of the research a systematic literature review on the joint decision is presented, as are the different opinions and suggestions of different scholars. For the next stage of the thesis, the decision-making process of more than 50 companies was analysed in companies from different sectors in the production planning area at the Job Shop level. The data was obtained using surveys and face-to-face interviews. The following part of the research into the decision-making process was held in two application fields that are highly relevant for our society; manufacturing and health care. The first step was to study the interactions and develop a mathematical model for the replenishment of the car assembly where the problem of “Vehicle routing problem and Inventory” were combined. The next step was to add the scheduling or car production (car sequencing) decision and use some metaheuristics such as ant colony and genetic algorithms to measure if the behaviour is kept up with different case size problems. A similar approach is presented in a production of semiconductors and aviation parts, where a hoist has to change from one station to another to deal with the work, and a jobs schedule has to be done. However, for this problem simulation was used for experimentation. In parallel, the scheduling of operating rooms was studied. Surgeries were allocated to surgeons and the scheduling of operating rooms was analysed. The first part of the research was done in a Teaching hospital, and for the second part the interaction of uncertainty was added. Once the previous problem had been analysed a general framework to characterize the instance was built. In the final chapter a general conclusion is presented. FINDINGS AND PRACTICAL IMPLICATIONS The first part of the contributions is an update of the decision-making literature review. Also an analysis of the possible savings resulting from a change in the decision process is made. Then, the results of the survey, which present a lack of consistency between what the managers believe and the reality of the integration of their decisions. In the next stage of the thesis, a contribution to the body of knowledge of the operation research, with the joint solution of the replenishment, sequencing and inventory problem in the assembly line is made, together with a parallel work with the operating rooms scheduling where different solutions approaches are presented. In addition to the contribution of the solving methods, with the use of different techniques, the main contribution is the framework that is proposed to pre-evaluate the problem before thinking of the techniques to solve it. However, there is no straightforward answer as to whether it is better to have joint or sequential solutions. Following the proposed framework with the evaluation of factors such as the flexibility of the answer, the number of actors, and the tightness of the data, give us important hints as to the most suitable direction to take to tackle the problem. RESEARCH LIMITATIONS AND AVENUES FOR FUTURE RESEARCH In the first part of the work it was really complicated to calculate the possible savings of different projects, since in many papers these quantities are not reported or the impact is based on non-quantifiable benefits. The other issue is the confidentiality of many projects where the data cannot be presented. For the car assembly line problem more computational power would allow us to solve bigger instances. For the operation research problem there was a lack of historical data to perform a parallel analysis in the teaching hospital. In order to keep testing the decision framework it is necessary to keep applying more case studies in order to generalize the results and make them more evident and less ambiguous. The health care field offers great opportunities since despite the recent awareness of the need to improve the decision-making process there are many opportunities to improve. Another big difference with the automotive industry is that the last improvements are not spread among all the actors. Therefore, in the future this research will focus more on the collaboration between academia and the health care sector.

Barriers to the adoption of photovoltaic systems: The state of the art

Although photovoltaic (PV) systems have become much more competitive, the diffusion of PV systems still remains low in comparison to conventional energy sources. What are the current barriers hindering the diffusion of PV systems? In order to address this, we conducted an extensive and systematic literature review based on the Web of Science database. Our state-of-the-art review shows that, despite the rapid development and maturity of the technology during the past few years, the adoption of PV systems still faces several barriers. The wide adoption of PV systems-either as a substitute for other electricity power generation systems in urban areas or for rural electrification-is a challenging process. Our results show that the barriers are evident for both low- and high-income economies, encompassing four dimensions: sociotechnical, management, economic, and policy. Although the barriers vary across context, the lessons learned from one study can be valuable to others. The involvement of all stakeholders-adopters, local communities, firms, international organizations, financial institutions, and government-is crucial to foster the adoption.

Sistemas de gestão integrados como indutor para a sustentabilidade: uma análise do impacto no desempenho das organizações baseado no Triple Bottom Line.

O objetivo deste trabalho é analisar o impacto dos Sistemas de Gestão Integrados (SGI) no desempenho organizacional sob a óptica do Triple Bottom Line (TBL), verificando se esta implementação auxilia a empresa a se tornar mais sustentável. A abordagem multi-método utilizada está dividida em três partes. A primeira compreende uma revisão sistemática da literatura, tendo como base a abordagem bibliométrica. A base de dados escolhida para a seleção dos artigos que compõem a amostra foi a ISI Web of Knowledge (Web of Science). As análises conduzidas sugerem lacunas na literatura a serem pesquisadas de modo a relacionar a integração dos sistemas de gestão como meio para as organizações tornarem-se mais sustentáveis, auxiliando assim na elaboração de um modelo teórico e das hipóteses de pesquisa. Os resultados parciais obtidos ressaltam a lacuna na literatura de estudos nessa área, principalmente que contemplem a dimensão social do Triple Bottom Line. Lacunas na literatura foram identificadas também no que se refere à análise do impacto da adoção dessas abordagens normativas no desempenho organizacional. A segunda etapa da metodologia é composta por estudos de casos múltiplos em empresas de diferentes setores e que tenham implantado sistemas de gestão de maneira integrada. Os resultados obtidos mostram que a certificação auxilia no desenvolvimento de ações sustentáveis, resultando em impactos econômicos, ambientais e sociais positivos. Nesta etapa, testou-se o modelo e as hipóteses levantadas na abordagem bibliométrica. A terceira etapa da metodologia é composta por análises estatísticas de dados secundários extraídos da revista Exame ?Maiores e Melhores\'. Os dados do ano de 2014 das empresas foram tratados por meio do software MINITAB 17 ®. Por meio do teste de mediana de mood, as amostras foram testadas e apresentaram diferenças estatisticamente significativas para o desempenho das empresas em diferentes setores. De maneira geral, as empresas com SGI apresentam melhor desempenho econômico do que as demais. Com a mesma base de dados, utilizando o modelo de equações estruturais e o software Smart PLS 2.0, criou-se um diagrama de caminhos analisando os constructos (SGI) com variáveis de desempenho (Endividamento, Lucratividade, Patrimônio, Crescimento e Retorno). O modelo de equações estruturais testado apresentou força para a relação entre SGI com Endividamento, Lucratividade, Patrimônio e Crescimento. As diferentes metodologias apresentadas contribuíram para responder a hipótese e afirmar com base na amostra deste trabalho que o SGI leva as empresas a terem melhor desempenho econômico, ambiental e social (baseado no TBL).

Microfoundations of strategic management: Toward micro–macro research in the resource-based theory

Over the last few years, a new stream of research has emerged in the field of strategic management which focuses on the analysis of its microfoundations. This line of research analyzes strategic topics examining their foundations rooted in individual actions and interactions. The main purpose of this paper is to examine this emerging literature of microfoundations, indicating its usefulness and main characteristics. Through a systematic literature review, this paper contributes to the field by identifying the main areas studied, the benefits and potential of this approach, and some limitations and criticisms. Moreover, the paper studies how the integration of micro and macro aspects in strategy research may be carried out, examining several works that use a multilevel approach. Some methodological approaches that may help to effect this integration are indicated. These aspects will be analyzed in relation to the resource-based theory.

Singularidades da intervenção psicológica nos cuidados paliativos

Relatório de Prática Clínica apresentado à Escola Superior de Saúde Dr. Lopes Dias do Instituto Politécnico de Castelo Branco para cumprimento dos requisitos necessários à obtenção do grau de Mestre em Cuidados Paliativos, realizada sob a orientação científica da Diretora da ESALD Doutora Ana Paula Gonçalves Antunes Sapeta, do Instituto Politécnico de Castelo Branco, e orientação científica do Assistente Convidado pela Escola Superior de Saúde Dr. Lopes Dias, Mestre Eduardo Manuel Neves Oliveira Carqueja.

Quantifying epistemic actions in human-computer interaction

As digital systems move away from traditional desktop setups, new interaction paradigms are emerging that better integrate with users’ realworld surroundings, and better support users’ individual needs. While promising, these modern interaction paradigms also present new challenges, such as a lack of paradigm-specific tools to systematically evaluate and fully understand their use. This dissertation tackles this issue by framing empirical studies of three novel digital systems in embodied cognition – an exciting new perspective in cognitive science where the body and its interactions with the physical world take a central role in human cognition. This is achieved by first, focusing the design of all these systems on a contemporary interaction paradigm that emphasizes physical interaction on tangible interaction, a contemporary interaction paradigm; and second, by comprehensively studying user performance in these systems through a set of novel performance metrics grounded on epistemic actions, a relatively well established and studied construct in the literature on embodied cognition. The first system presented in this dissertation is an augmented Four-in-a-row board game. Three different versions of the game were developed, based on three different interaction paradigms (tangible, touch and mouse), and a repeated measures study involving 36 participants measured the occurrence of three simple epistemic actions across these three interfaces. The results highlight the relevance of epistemic actions in such a task and suggest that the different interaction paradigms afford instantiation of these actions in different ways. Additionally, the tangible version of the system supports the most rapid execution of these actions, providing novel quantitative insights into the real benefits of tangible systems. The second system presented in this dissertation is a tangible tabletop scheduling application. Two studies with single and paired users provide several insights into the impact of epistemic actions on the user experience when these are performed outside of a system’s sensing boundaries. These insights are clustered by the form, size and location of ideal interface areas for such offline epistemic actions to occur, as well as how can physical tokens be designed to better support them. Finally, and based on the results obtained to this point, the last study presented in this dissertation directly addresses the lack of empirical tools to formally evaluate tangible interaction. It presents a video-coding framework grounded on a systematic literature review of 78 papers, and evaluates its value as metric through a 60 participant study performed across three different research laboratories. The results highlight the usefulness and power of epistemic actions as a performance metric for tangible systems. In sum, through the use of such novel metrics in each of the three studies presented, this dissertation provides a better understanding of the real impact and benefits of designing and developing systems that feature tangible interaction.

Enfermeiro de Saúde Familiar e a comunicação: transição para a parentalidade

Relatório de Estagio apresentado para obtenção do grau de Mestre na área de Enfermagem de Saúde Familiar

Um olhar sobre o desenvolvimento das crianças em idade pré-escolar - Uma perspectiva da intervenção do enfermeiro

Relatório de Estágio apresentado para a obtenção do grau de Mestre em Enfermagem de Saúde da Criança e do Jovem

Les approches de synthèse exploratoire dans le domaine de la santé

Contexte: Les approches de synthèse exploratoire (ou scoping studies) font actuellement l’objet de confusion dans leur appellation, définition et but. Elles continuent aussi de manquer de description méthodologique suffisante ou de détails sur le processus de l’analyse de données. Objectif : Cette synthèse exploratoire fait le point des connaissances sur les approches de synthèse exploratoire utilisées en santé. Plus spécifiquement, ses objectifs sont : 1) d’examiner le volume et l’étendue des synthèses exploratoires ainsi que les domaines d’étude dans lesquels elles ont été conduites; 2) de faire l’inventaire de leurs définitions, buts, forces et faiblesses; et 3) et de faire l’inventaire des approches méthodologiques existantes. Méthodes : Une recherche systématique des synthèses exploratoires a été entreprise jusqu’en avril 2014 dans les bases de données Medline, PubMed, ERIC, PsycINFO, CINAHL, EMBASE, EBM Reviews/Cochrane. Des critères d’inclusion et d’exclusion ont été appliqués afin de ne retenir que des études de langue française et anglaise présentant des définitions, méthodes et écarts de connaissances sur les synthèses exploratoires, ainsi que celles les comparant à d’autres types de revues de littérature. Deux reviseurs ont examiné de façon indépendante les références pertinentes. Une grille d’extraction des données a été conçue afin de recueillir pour chacune des études, les données contextuelles, les étapes méthodologiques ainsi que les définitions, buts et limites des synthèses exploratoires. Les données ont été répertoriées et classées afin de dresser un portrait global des approches de synthèses exploratoires dans un format narratif et tabulaire. Résultats : Sur deux cent cinquante-deux références identifiées, quatre-vingt-douze références pertinentes ont été retenues. Les synthèses exploratoires ont été publiées par 6 pays dans 10 domaines d’études et 73 journaux. Elles ont pour finalité d’être à la fois un support aux connaissances, une aide à la décision et un préalable à une revue systématique de littérature. Cinq auteurs ont été cités en référence et huit autres ont publié sur leur méthodologie. Elles ont 3 étapes importantes de réalisation dont la revue de littérature, la consultation des parties prenantes et la synthèse globale avec ou sans validation des résultats. Les synthèses exploratoires utilisent une méthode systématique, pas toujours exhaustive et sans évaluation formelle des études incluses Des notions claires portant sur leur définition, buts, forces et faiblesses ont été identifiées. Conclusion : Nous suggérons que de nouvelles études soient entreprises afin d’asseoir complètement cette méthode et dégager des lignes directrices pour les chercheurs qui s’y intéresseront.

Histaminergic modulation in Tourette syndrome

Introduction: Tourette syndrome is a neurodevelopmental disorder characterized by multiple motor tics and at least one vocal/phonic tic. Clinical phenotypes show a wide variability, often incorporating behavioral symptoms. The exact pathophysiology of Tourette syndrome is unknown, however genetic vulnerability and alterations in dopaminergic neurotransmission have consistently been reported. Other biochemical pathways, including histaminergic neurotransmission, are likely to be involved but have received relatively little attention until recently. Areas covered: We conducted a systematic literature review focusing on the role of histaminergic neurotransmission and its pharmacological modulation in Tourette syndrome. We identified a number of relevant original studies published over the last five years, mainly focusing on genetic aspects. Expert opinion: There is converging evidence from recent studies supporting the hypothesis that histaminergic neurotransmission may play a role in the pathophysiology of Tourette syndrome. Most studies focused on the role of the histidine decarboxylase gene and the potential usefulness of histidine decarboxylase knockout mice as an experimental model for studying neurochemical function in Tourette syndrome. There have been no large scale studies assessing the use of histaminergic medications in the management of Tourette syndrome. This would be an important area for future research, with direct implications for the clinical management of selected phenotypes.

The influence of marketing factors and substance characteristics on pharmaceutical sales in a state-controlled prescriptions pharmaceuticals market

The present dissertation investigates the influence of brand as well as substance-related marketing attributes on prescription pharmaceutical sales within a state-controlled market. For this purpose, a systematic literature review was conducted in the first instance, during which knowledge about the most relevant research within this field was gathered. Consequently, over 538 publications were reviewed and indicated as being potentially relevant, leading to an eventual count of 98 core publications. However, most of these studies had been conducted in the mainly unrestricted US market. These findings were then summarised and statistically evaluated. In a second step, based on the literature review, a qualitative study, containing focus and Delphi groups, was then performed. The participants in these studies were involved in pharmaceutical marketing within a state-controlled prescriptions pharmaceuticals market. Consequently, the findings were slightly different to those derived by the systematic literature review. Based on this second step, seven hypotheses were proposed. In the third step, these hypotheses were tested, using collected data and a secondary market dataset provided by a market research institute. A statistical analysis was then performed, applying descriptive as well as multiple regression analytical methods. The evaluation of the results resulted in a conceptual model of physician targeting, leading to several theoretical, methodological and managerial implications.

Exploring the experiences of nurses who care for children who have Acute Life Threatening Events (ALTE) in hospital

This thesis presents a program of work designed to explore and describe what the experience of caring for a child who has an Acute Life Threatening Event (ALTE) is like for the nurses. An ALTE may include a cardiac arrest, respiratory arrest or unplanned admission for a ward to the Paediatric Intensive Care unit. Using the MRC framework for the development of complex interventions, this information was then coupled with theory to develop the PREPARE and SUPPORT interventions. Given the wide-ranging and exploratory nature of this research, a pragmatic, mixed design approach was used to address the aims and objectives of the thesis. The mixed design approach included: a systematic literature review; international survey of practice; interviews with nurses and doctors using Interpretative Phenomenological Analysis; development, refinement and evaluation of interventions during a feasibility study. Two studies were identified through the systematic review which aimed to evaluate the effectiveness of debriefing. The studies did not provide evidence to support the use of these interventions within healthcare. The international survey of practice demonstrated hospitals were using interventions to both prepare and support nurses for these events. The preparatory interventions were clinically focused and the majority of the supportive interventions included a debrief. The interventions were not being evaluated for effectiveness. The interviews conducted with nurses and doctors provided insight into what that experience was like for the participants. Using the MRC framework, this evidence was coupled with theory to develop the PREPARE and SUPPORT interventions. A multidisciplinary working party used an iterative process to refine and evaluate the interventions and study procedures were explored through a feasibility study. The pragmatic, mixed design approach demonstrated how the empirical evidence was coupled with theory and clinical expertise to develop interventions for use within the healthcare environment.

Gamification for servitization

The study described in this paper has set out to explore gamification from a servitization perspective to understand the opportunities and research challenges. A systematic literature review has been conducted to capture key characteristics of differing forms of gamification processes in a servitization context. The findings of our study focus on two area: (1) structural, organization’s physical bricksand-mortar attribute and (2) infrastructural, policies and practices in how structural aspects of servitization are to be managed. Six key findings are presented and collectively these contribute to our understanding of the broader gamification technologies that can help to transform servitization. The contribution of our research is twofold. First it captures a set of theoretical framework for analysing gamification in servitization context. Second, it provide an in-depth roadmap in how gamification can be applied to target major challenges in servitization.