The physical classroom environment : roles, conceptions, and preferences

The problem addressed in this thesis is that a considerable proportion of students around the world attend school in inadequate facilities, which is detrimental for the students’ learning outcome. The overall objective in this thesis is to develop a methodology, with a novel approach to involve teachers, to generate a valuable basis for decisions regarding design and improvement of physical school environment, based on the expressed needs for a specific school, municipality, or district as well as evidence from existing research. Three studies have been conducted to fulfil the objective: (1) a systematic literature review and development of a theoretical model for analysing the role of the physical environment in schools; (2) semi structured interviews with teachers to get their conceptions of the physical school environment; (3) a stated preference study with experimental design as an online survey. Wordings from the transcripts from the interview study were used when designing the survey form. The aim of the stated preference study was to examine the usability of the method when applied in this new context of physical school environment. The result is the methodology with a mixed method chain where the first step involves a broad investigation of the specific circumstances and conceptions for the specific school, municipality, or district. The second step is to use the developed theoretical model and results from the literature study to analyse the results from the first step and transform them in to a format that fits the design of a stated preference study. The final step is a refined version of the procedure of the performed stated preference study.

Evaluation of Mobile Telephone Text Message Reminders for People with Antipsychotic Medication

Nonadherence to treatment is a worldwide problem among people with severe mental disorders. Patient treatment adherence may be supported with simple reminding methods e.g. text message reminders. However, there is limited evidence of its benefits. Intervention evaluation is essential in mHealth research. Therefore, this evaluative study was conducted. This study aimed to evaluate text message reminder use in encouraging patients’treatment adherence among people with antipsychotic medication. The data were collected between September 2011 and December 2013. First, a systematic literature review revealed that text message reminders were widely used in healthcare. However, its impacts were conflicting. Second, a sub-sample (n = 562) analysis showed that patients preferred humorous text message reminders and preferred to receive them in the morning, at the beginning of the week. Age, gender and marital status seemed to have different effects on the preferred amount and timing of the selected reminders. Third, a cross-sectional survey revealed that people with antipsychotic medication (n = 408) expressed overall satisfaction towards the reminder system. Finally, the evaluative design showed that patient recruitment for a randomized controlled trial concerning people with antipsychotic medication was challenging due to low rates of eligible participants. Follow-up drop-out rates varied depending on the data collection method. Participants’ demographic characteristics were associated with the risk of dropping out from the trial. This study suggests that text messages are a potential reminder system in healthcare services among people with antipsychotic medication. More research is needed to gain a comprehensive picture of the impacts and effectiveness of text message reminders.

Proprioception in ankle sprain from exercises and bandages

Ankle sprains are the most common injuries in sports, usually causing damage to the lateral ligaments. Recurrence has as usual result permanent instability, and thus loss of proprioception. This fact, together with residual symptoms, is what is known as chronic ankle instability, CAI, or FAI, if it is functional. This problem tries to be solved by improving musculoskeletal stability and proprioception by the application of bandages and performing exercises. The aim of this study has been to review articles (meta-analisis, systematic reviews and revisions) published in 2009-2015 in PubMed, Medline, ENFISPO and BUCea, using keywords such as “sprain instability”, “sprain proprioception”, “chronic ankle instability”. Evidence affirms that there does exist decreased proprioception in patients who suffer from CAI. Rehabilitation exercise regimen is indicated as a treatment because it generates a subjective improvement reported by the patient, and the application of bandages works like a sprain prevention method limiting the range of motion, reducing joint instability and increasing confidence during exercise. As podiatrists we should recommend proprioception exercises to all athletes in a preventive way, and those with CAI or FAI, as a rehabilitation programme, together with the application of bandages. However, further studies should be generated focusing on ways of improving proprioception, and on the exercise patterns that provide the maximum benefit.

Representing Variability in Software Architecture

Software Architecture is a high level description of a software intensive system that enables architects to have a better intellectual control over the complete system. It is also used as a communication vehicle among the various system stakeholders. Variability in software-intensive systems is the ability of a software artefact (e.g., a system, subsystem, or component) to be extended, customised, or configured for deployment in a specific context. Although variability in software architecture is recognised as a challenge in multiple domains, there has been no formal consensus on how variability should be captured or represented. In this research, we addressed the problem of representing variability in software architecture through a three phase approach. First, we examined existing literature using the Systematic Literature Review (SLR) methodology, which helped us identify the gaps and challenges within the current body of knowledge. Equipped with the findings from the SLR, a set of design principles have been formulated that are used to introduce variability management capabilities to an existing Architecture Description Language (ADL). The chosen ADL was developed within our research group (ALI) and to which we have had complete access. Finally, we evaluated the new version of the ADL produced using two distinct case studies: one from the Information Systems domain, an Asset Management System (AMS); and another from the embedded systems domain, a Wheel Brake System (WBS). This thesis presents the main findings from the three phases of the research work, including a comprehensive study of the state-of-the-art; the complete specification of an ADL that is focused on managing variability; and the lessons learnt from the evaluation work of two distinct real-life case studies.

Global environmental change: local perceptions, understandings, and explanations

Global environmental change (GEC) is an increasingly discussed phenomenon in the scientific literature as evidence of its presence and impacts continues to grow. Yet, while the documentation of GEC is becoming more readily available, local perceptions of GEC— particularly in small-scale societies—and preferences about how to deal with it, are still largely overlooked. Local knowledge and perceptions of GEC are important in that agents make decisions (including on natural resource management) based on individual perceptions. We carried out a systematic literature review that aims to provide an exhaustive state-of-the-art of the degree to and manner in which the study of local perceptions of change are being addressed in GEC research. We reviewed 126 articles found in peer-reviewed journals (between 1998 and 2014) that address local perceptions of GEC. We used three particular lenses of analysis that are known to influence local perceptions, namely (i) cognition, (ii) culture and knowledge, and (iii) possibilities for adaptation.We present our findings on the geographical distribution of the current research, the most common changes reported, perceived drivers and impacts of change, and local explanations and evaluations of change and impacts. Overall, we found the studies to be geographically biased, lacking methodological reporting, mostly theory based with little primary data, and lacking of indepth analysis of the psychological and ontological influences in perception and implications for adaptation. We provide recommendations for future GEC research and propose the development of a “meta-language” around adaptation, perception, and mediation to encourage a greater appreciation and understanding of the diversity around these phenomena across multiple scales, and improved codesign and facilitation of locally relevant adaptation and mitigation strategies.

Social media to support collaboration in the product life cycle of SMEs

Abstract : The use of social media tools to support small and medium-sized enterprises (SME) to support their business activities throughout the product life cycle (PLC) phases represents an interesting opportunity. SMEs operate in very competitive environments, and face significant challenges primarily caused by their size disadvantage. By nature, social media tools and platforms can enable them to overcome some of these challenges, as they are often very inexpensive, familiar and easy to use, allowing them to reach large audiences they would not be able to reach with traditional and expensive marketing initiatives. To provide solutions to this problem, this research identified three main objectives. The first objective was to draw a picture of the existing academic literature on the use of social media tools in the PLC context to better understand how these tools were studied and used in businesses, and for what purpose. Second, this research aimed at understanding how SMEs actually use social media tools to support their different business activities to identify the gap between academic research and actual business practices. Finally, based on the findings highlighted from the previous objectives, this research aimed at developing theory on this topic by proposing a conceptual framework of customer engagement enabled by social media. The conceptual framework aimed at answering general questions that emerged from the initial two objectives: Why do some SMEs use social media to support customer engagement, while others do not? Why do firms use different social media tools to support their customer engagement initiatives? Why does the scope of customer engagement initiatives (i.e., across different PLC phases) vary between SMEs? What are the potential outcomes of conducting customer engagement initiatives for the organizing firms? In order to achieve these research objectives, the methodology employed for this research is threefold. First, a systematic literature review was performed in order to properly understand how the use of social media tools in the PLC context had been studied. The final results consisted of 78 academic articles which were analyzed based on their bibliometric information and their content. Second, in order to draw the contrast between the academic publications and managerial reality of SMEs, six semi-structured interviews were conducted to understand how these firms actually use social media to support different activities in each of the PLC phases. Third, five additional semi-structured interviews were performed to gather a deeper understanding of this phenomenon and generate theory to support the proposed conceptual framework. The conceptual framework focuses on the degree of customer engagement, which is comprised of the scope (PLC phases) of customer engagement and the technology (social media tools) employed to support these initiatives. Two sets of antecedents were examined, firm motivators and firm impediments, as they could both potentially affect the scope and the social media tools used to support customer engagement initiatives. Finally, potential customer engagement outcomes for SMEs developing these initiatives were also examined. The semi-structured interviews lasted approximately 25-35 minutes, and were performed using an interview grid consisting of 24 open-ended questions. The interview grid was developed based on the findings of the systematic literature review, and this qualitative approach allowed for a rich understanding of the interviewed SMEs’ use of social media tools to support and engage customers in their different PLC activities. The main results highlighted by this project demonstrate that this field is relatively recent and sees constant increase in research interest since 2008. However, most of the academic research focuses on the use of social media tools to support innovation activities during the new product development process, while the interviewed firms almost exclusively used the tools to engage customers in the later phases of the PLC, primarily for promotion, customer service support, and business development activities. Interestingly, the interviewed firms highlighted several benefits of using social media tools to engage customers, some of which could help them overcome certain size disadvantages previously mentioned. These firms are in need of further guidelines to properly implement such initiatives and reap the expected benefits. Results suggest that SMEs are far behind both large companies and academic research in their use of social media to engage customers in different business activities. The proposed conceptual framework serves as a great tool to better understand their reality and eventually better support them in their social media and customer engagement efforts. However, this framework needs to be further developed and improved. This research project provides a 360-degree view of the phenomenon of the use of social media to support customer engagement for SMEs, by providing both a thorough systematic review of the academic research and an understanding of the managerial reality of SMEs behind this phenomenon. From this analysis, a conceptual framework is then proposed and serves as a stepping stone for future researchers who are interested in developing theory in this field.

Adapting the social-ecological system framework for urban stormwater management: the case of green infrastructure adoption

Stormwater management has long been a critical societal and environmental challenge for communities. An increasing number of municipalities are turning to novel approaches such as green infrastructure to develop more sustainable stormwater management systems. However, there is a need to better understand the technological decision-making processes that lead to specific outcomes within urban stormwater governance systems. We used the social-ecological system (SES) framework to build a classification system for identifying significant variables that influence urban stormwater governance decisions related to green infrastructure adoption. To adapt the framework, we relied on findings from observations at national stormwater meetings in combination with a systematic literature review on influential factors related to green infrastructure adoption. We discuss our revisions to the framework that helped us understand the decision by municipal governments to adopt green infrastructure. Remaining research needs and challenges are discussed regarding the development of an urban stormwater SES framework as a classification tool for knowledge accumulation and synthesis.

The Views of Young People about an Intervention Programme Designed to Support Them with Exam Related Anxiety and Stress

Both preparing for and sitting exams can be extremely stressful for children and young people. Whilst the research within the area of exam anxiety acknowledges the detrimental impact that it can have on individuals, much of the research has been completed with university students. Limited research has been carried out with children and young people. In addition to this, there is also little research that has been completed in order to understand which interventions are helpful in reducing exam anxiety in young people. The systematic literature review highlighted that much of the research employed quantitative techniques. This means young people’s views and experiences of exam anxiety has largely been unexplored. The EPS service in which the TEP currently works is a partially traded service. Some of the schools that had bought a service level agreement requested support for certain pupils that were experiencing exam anxiety. The EPS service therefore delivered an intervention called ‘beating exam anxiety together’ (further details of this intervention can be found within chapter 1). Seven semi-structured interviews were carried out with GCSE students who took part in the ‘beating exam anxiety together’ intervention. The purpose of the interviews was to understand more about young people’s views on exam anxiety, and also their experiences of the intervention in which they took part. The research highlighted the possible detrimental impact of exam anxiety on young people in terms of their mental health, and also how able they feel to prepare for their exams. The results of the research interestingly showed that young people experience high levels of pressure from school teachers and also their parents. Furthermore, students reported that they didn't know how to revise. The results revealed that young people feel that the way in which exams are spoken about in schools is largely negative. As a result of this, the researcher suggested that it may be helpful to shift the narrative around the way in which exams are currently spoken about. In addition to this, the results indicate that the intervention was largely helpful in improving young people’s well being and their ability to be able to manage exam anxiety.

Using Action Research to Develop My Solution-Focused Practice in Collaboration with Year 6 And 7 Pupils When Discussing Their Behavioural Self-Regulation at School

This action research study aimed to develop the researcher's use of solutionfocused techniques when working with Year 6 and 7 pupils’ self-regulation. A systematic literature review highlighted an evidence base that demonstrated the efficacy of solution-focused methods when working with this population. The researcher’s intention was to add to the body of Educational Psychology practice-based evidence in this area. The researcher recruited eight participants from primary and secondary school provisions. Solution-focused techniques were systematically trialled in partnership with the pupils and were modified through an action research cycle. Semistructured interviewing provided participants the opportunity to critically evaluate the researcher’s solution-focused practice. Thematic Analysis was used to assess feedback in order to adapt the delivery of solution-focused techniques. Developments to practice explored within this study included modifications to the use of the six core components of Solution Focused Brief Therapy. Adaptations have the potential to inform the use of these solution-focused approaches with other educational practitioners.

A MODEL FOR EVALUATING IMPACT OF BUSINESS PROCESS MANAGEMENT IN ORGANIZATIONAL PERFORMANCE

Business Process Management (BPM) is able to organize and frame a company focusing in the improvement or assurance of performance in order to gain competitive advantage. Although it is believed that BPM improves various aspects of organizational performance, there has been a lack of empirical evidence about this. The present study has the purpose to develop a model to show the impact of business process management in organizational performance. To accomplish that, the theoretical basis required to know the elements that configurate BPM and the measures that can evaluate the BPM success on organizational performance is built through a systematic literature review (SLR). Then, a research model is proposed according to SLR results. Empirical data will be collected from a survey of  larg and mid-sized industrial and service companies headquartered in Brazil. A quantitative analysis will be performed using structural equation modeling (SEM) to show if the direct effects among BPM and organizational performance can be considered statistically significant. At the end will discuss these results and their managerial and cientific implications.Keywords: Business process management (BPM). Organizational performance. Firm performance. Business models. Structural Equation Modeling. Systematic Literature Review.

A Haptic System for Depicting Mathematical Graphics for Students with Visual Impairments

When teaching students with visual impairments educators generally rely on tactile tools to depict visual mathematical topics. Tactile media, such as embossed paper and simple manipulable materials, are typically used to convey graphical information. Although these tools are easy to use and relatively inexpensive, they are solely tactile and are not modifiable. Dynamic and interactive technologies such as pin matrices and haptic pens are also commercially available, but tend to be more expensive and less intuitive. This study aims to bridge the gap between easy-to-use tactile tools and dynamic, interactive technologies in order to facilitate the haptic learning of mathematical concepts. We developed an haptic assistive device using a Tanvas electrostatic touchscreen that provides the user with multimodal (haptic, auditory, and visual) output. Three methodological steps comprise this research: 1) a systematic literature review of the state of the art in the design and testing of tactile and haptic assistive devices, 2) a user-centered system design, and 3) testing of the system’s effectiveness via a usability study. The electrostatic touchscreen exhibits promise as an assistive device for displaying visual mathematical elements via the haptic modality.

Polymyalgia Rheumatica (PMR) Special Interest Group at OMERACT 11: outcomes of importance for patients with PMR

We worked toward developing a core outcome set for clinical research studies in polymyalgia rheumatica (PMR) by conducting (1) patient consultations using modified nominal group technique; (2) a systematic literature review of outcome measures in PMR; (3) a pilot observational study of patients presenting with untreated PMR, and further discussion with patient research partners; and (4) a qualitative focus group study of patients with PMR on the meaning of stiffness, using thematic analysis. (1) Consultations included 104 patients at 4 centers. Symptoms of PMR included pain, stiffness, fatigue, and sleep disturbance. Function, anxiety, and depression were also often mentioned. Participants expressed concerns about diagnostic delay, adverse effects of glucocorticoids, and fear of relapse. (2) In the systematic review, outcome measures previously used for PMR include pain visual analog scores (VAS), morning stiffness, blood markers, function, and quality of life; standardized effect sizes posttreatment were large. (3) Findings from the observational study indicated that asking about symptom severity at 7 AM, or "on waking," appeared more relevant to disease activity than asking about symptom severity "now" (which depended on the time of assessment). (4) Preliminary results were presented from the focus group qualitative study, encompassing broad themes of stiffness, pain, and the effect of PMR on patients' lives. It was concluded that further validation work is required before a core outcome set in PMR can be recommended. Nevertheless, the large standardized effect sizes suggest that pain VAS is likely to be satisfactory as a primary outcome measure for assessing response to initial therapy of PMR. Dissection of between-patient heterogeneity in the subsequent treatment course may require attention to comorbidity as a potential confounding factor.

Heart failure in young adults

Heart failure (HF) is a major health concern affecting 15 million people in Europe and around 900 000 people in the U.K. HF predominantly affects the elderly, with the mean age of patients with a diagnosis of HF between 70 and 80 years. Most previous HF studies have accordingly focused on older patients. Although HF is less common in younger adults (<65 years), 15% to 20% of patients hospitalised with HF are younger than 60 years of age. Very few studies have described the characteristics of younger adults with HF and its outcome. The aims of this thesis are to describe the clinical characteristics of younger adults with HF, explore the epidemiology of HF in younger adults and determine their short- and long-term outcomes. This was made possible by access multiple databases consisting of large patient cohorts with HF. The first chapter is a systematic literature review of younger adults with HF. Gaps in the current literature were identified and the thesis focused on some of these. The CHARM study allows detail characterisations of younger adults with HF. It recorded characteristics of patients with HF, including symptoms and signs of HF, electrocardiographic changes, chest radiographic findings, and also left ventricular ejection fraction. HF hospitalisations and its precipitating factors were also recorded systematically. Younger adults were more likely to have a third heart sound and hepatomegaly, but less likely to have pulmonary crackles and peripheral oedema. Similarly, radiological findings in younger adults were less likely to show interstitial pulmonary oedema or pleural effusion. Interestingly, younger adults aged <40 years not only have similar HF hospitalisation rate to older patients, however during their presentation with decompensated HF, they were less likely to have clinical pulmonary oedema and radiological signs of HF. Physicians managing younger adults with HF need to be aware of this. Younger adults were also less compliant with medications and lifestyle restriction resulting in hospitalisation with decompensated HF. Fortunately, despite these challenges, mortality rates in younger adults with HF were lower compared to older patients. To further substantiate the findings from the CHARM study, the MAGGIC study, a meta-analysis consists of over 40 000 patients with HF from large observational studies and randomised controlled trials, was examined. In both databases, the commonest aetiology of HF in younger adults was dilated cardiomyopathy. The ejection fraction was the lowest in younger adults. Similar to the CHARM study, mortality rates in younger adults were lower compared to older patients. However, in the MAGGIC study, by stratifying mortality into patients with preserved ejection fraction and with reduced ejection fraction, younger patients with preserved ejection fraction have a much lower mortality rate compared to patients with reduced ejection fraction. Findings from clinical trials are not always reflective of the real life clinical practice. The U.K. Clinical Practice Research Datalink (CPRD), a large and well-validated primary care database with 654 practices contributing information into the database representing approximated 8% of the U.K. population, is a rich dataset offering a unique opportunity to examine the characteristics, treatments, and outcomes of younger adults with HF in the community. In contrast to the CHARM and MAGGIC studies, younger adults aged <40 years were stratified into 20-29 and 30-39 years in the CPRD analysis. This is possible due to the larger number of younger adults with HF. Further stratifying the younger age groups demonstrated heterogeneity among younger adults with HF. In contrast to previous data showing younger adults have lower co-morbidities, the proportions of depression, chronic kidney disease, asthma, and any connective tissue disease were high among patients aged 20-29 years in the analysis from the CPRD. Surprisingly, the treatment rates for angiotensin converting enzyme (ACE) inhibitor, and aldosterone antagonist were the lowest in patients aged 20-29 years. With the exception of patients aged ≥80 years, treatment rate with beta-blocker was also the lowest in patients aged 20-29 years. With over two decades of follow up, long-term mortality rates in younger adults with HF can be determined. The mortality rates continued to decline from 1988 to 2011. Physicians managing younger adults with HF can now use this contemporary data to provide prognostic information to patients and their family. A hospital administrative database is the logical next platform to explore younger adults with HF. The Alberta Ministry of Health database links an outpatient database to a hospitalisation database providing ample data to examine the relationship between outpatient clinic visits and hospital admissions in younger adults with HF. Following a diagnosis of HF in the outpatient setting, younger adults were admitted to the hospital with decompensated HF much sooner than older patients. Younger adults also presented to emergency department more frequently following their first hospitalisation for HF. In conclusion, this thesis presented the characteristics and outcomes of younger adults with HF, and helped to extend our current understanding on this important topic. I hope the data presented here will benefit not only physicians looking after younger adults with HF, but also patients and their family.

HEALTHCARE INFORMATION SYSTEMS INTEGRATION USING SOA

The growing pressure to increase the quality of health services, as well as reducing costs, has caused healthcare organizations to increase the use of Information and Communication Technologies (ICT) through the development and adoption of Healthcare Information Systems (HIS). However, the need for exchange of information between HIS and between organizations has also increased, resulting in the problem of interoperability. This problem is considered complex, but the use of Service Oriented Architecture (SOA) appears as a good way to address this issue. This paper presents a systematic review, performed in order to find out how and in which contexts SOA is being used to ensure the interoperability of HIS.

STRESS AND INTERNATIONAL ENTREPRENEURHSIP: The dark side of international entrepreneurship

Entrepreneurship attracts people with high job satisfaction and financial independence. Unfortunately, being deceived by this image, people do not pay attention to side effects of entrepreneurship. This ignorance usually turns into devastating results for entrepreneur’s health and venture performance. Therefore, it is required to seek ways to avoid these situations. The interest of the study lies in understanding of stress influence on international entrepreneurs by considering stress as a negative side effect of international entrepreneurship. To cover the concept of entrepreneurial stress completely, the study was divided into three section presented by following research questions: 1. What are the antecedents of entrepreneurial stress? 2. What are the consequences of entrepreneurial stress? 3. What coping strategies are applied to address entrepreneurial stress? Systematic literature review has been chosen as scientific approach to answer above questions due to the reason that it enables to minimise inconsistencies of both concepts of international entrepreneurship and stress. This method has afforded an opportunity to distinguish such stress causes as role conflict, overload, and ambiguity. Additionally, the study has covered the notion of stress moderators. The author argues that entrepreneurial traits, venture environment, and social support can have influence on degree of stress perception. Further, it has been proven that unaddressed stress could lead to reduction of entrepreneur’s psychological and physiological health. It should be taken into consideration that degree of both job satisfaction and performance would depend on the level of perceived stress. The last part of study emphasises the coping strategies. The author argues that it is important for an international entrepreneur to comprehend his or her and others’ emotions in order to overcome negative consequences of stress. In addition, the author suggests that an international entrepreneur needs to practise job sharing to reduce the amount of work to be completed. Moreover, it is believed that job sharing can help to overcome work-family conflict that prevails among entrepreneurs. The author anticipates that results of study can be beneficial for entrepreneurs who aim to achieve great results.