Development of the Andalusian Registry of Patients Receiving Community Case Management, for the follow-up of people with complex chronic diseases.

Background: Complex chronic diseases are a challenge for the current configuration of Health services. Case management is a service frequently provided for people with chronic conditions and despite its effectiveness in many outcomes, such as mortality or readmissions, uncertainty remains about the most effective form of team organization, structures, and the nature of the interventions. Many processes and outcomes of case management for people with complex chronic conditions cannot be addressed with the information provided by electronic clinical records. Registries are frequently used to deal with this weakness. The aim of this study was to generate a registry-based information system of patients receiving case management to identify their clinical characteristics, their context of care, events identified during their follow-up, interventions developed by case managers, and services used. Methods and design: The study was divided into three phases, covering the detection of information needs, the design and its implementation in the healthcare system, using literature review and expert consensus methods to select variables that would be included in the registry. Objective: To describe the essential characteristics of the provision of ca re lo people who receive case management (structure, process and outcomes), with special emphasis on those with complex chronic diseases. Study population: Patients from any District of Primary Care, who initiate the utilization of case management services, to avoid information bias that may occur when including subjects who have already been received the service, and whose outcomes and characteristics could not be properly collected. Results: A total of 102 variables representing structure, processes and outcomes of case management were selected for their inclusion in the registry after the consensus phase. Total sample was composed of 427 patients, of which 211 (49.4%) were women and 216 (50.6%) were men. The average functional level (Barthel lndex) was 36.18 (SD 29.02), cognitive function (Pfeiffer) showed an average of 4.37 {SD 6.57), Chat1son Comorbidity lndex, obtained a mean of 3.03 (SD 2.7) and Social Support (Duke lndex) was 34.2 % (SD 17.57). More than half of patients include in the Registry, correspond lo immobilized or transitional care for patients discharged from hospital (66.5 %). The patient's educational level was low or very low (50.4%). Caregivers overstrain (Caregiver stress index), obtained an average value of 6.09% (SD 3.53). Only 1.2 % of patients had declared their advanced directives, 58.6 had not defined the tutelage and the vast majority lived at home 98.8 %. Regarding the major events recorded at RANGE Registry, 25.8 % of the selected patients died in the first three months, 8.2 % suffered a hospital admission at least once time, 2.3%, two times, and 1.2% three times, 7.5% suffered a fall, 8.7% had pressure ulcer, 4.7% had problems with medication, and 3.3 % were institutionalized. Stroke is the more prevalent health problem recorded (25.1%), followed by hypertension (11.1%) and COPD (11.1%). Patients registered by NCMs had as main processes diabetes (16.8%) and dementia (11.3 %). The most frequent nursing diagnoses referred to the self-care deficit in various activities of daily living. Regarding to nursing interventions, described by the Nursing Intervention Classification (NIC), dementia management is the most used intervention, followed by mutual goal setting, caregiver and emotional support. Conclusions: The patient profile who receive case management services is a chronic complex patient with severe dependence, cognitive impairment, normal social support, low educational level, health problems such as stroke, hypertension or COPD, diabetes or dementia, and has an informal caregiver. At the first follow up, mortality was 19.2%, and a discrete rate of readmissions and falls.

Development of an innovative non rule-based energy management strategy for a Hybrid Electric Vehicle, structured for predictive driving controls based on external information knowledge

Recently, the interest of the automotive market for hybrid vehicles has increased due to the more restrictive pollutants emissions legislation and to the necessity of decreasing the fossil fuel consumption, since such solution allows a consistent improvement of the vehicle global efficiency. The term hybridization regards the energy flow in the powertrain of a vehicle: a standard vehicle has, usually, only one energy source and one energy tank; instead, a hybrid vehicle has at least two energy sources. In most cases, the prime mover is an internal combustion engine (ICE) while the auxiliary energy source can be mechanical, electrical, pneumatic or hydraulic. It is expected from the control unit of a hybrid vehicle the use of the ICE in high efficiency working zones and to shut it down when it is more convenient, while using the EMG at partial loads and as a fast torque response during transients. However, the battery state of charge may represent a limitation for such a strategy. That’s the reason why, in most cases, energy management strategies are based on the State Of Charge, or SOC, control. Several studies have been conducted on this topic and many different approaches have been illustrated. The purpose of this dissertation is to develop an online (usable on-board) control strategy in which the operating modes are defined using an instantaneous optimization method that minimizes the equivalent fuel consumption of a hybrid electric vehicle. The equivalent fuel consumption is calculated by taking into account the total energy used by the hybrid powertrain during the propulsion phases. The first section presents the hybrid vehicles characteristics. The second chapter describes the global model, with a particular focus on the energy management strategies usable for the supervisory control of such a powertrain. The third chapter shows the performance of the implemented controller on a NEDC cycle compared with the one obtained with the original control strategy.

The effectiveness of an online workshop on behavior management as a professional development tool for teachers

The current study examines the effects of an online workshop pertaining to classroom behavior management on teacher self-efficacy, attitudes, motivation, knowledge, and practices. In addition, information about teacher utilization of the Internet, their opinions about professional development, and experiences with classroom management were collected. Participants included 57 1 st through 5th grade special and regular education teachers. Eligible teachers were those who teach an academic subject and had at least one child in the classroom they considered as disruptive. Teachers were randomized to either a training or waitlist group. Classroom observations of teacher practices and questionnaires were utilized. Teachers in the training group participated in two assessment points, baseline and post-workshop, and received access to the online course immediately following the baseline assessment. Teachers in the waitlist group participated in three assessment points, baseline, post-workshop, and follow-up, and received access to the online course immediately following the post-workshop assessment. Findings show that all teachers had access to the Internet at home and at school and used it on a daily basis. The majority of teachers indicated having some past training on all the techniques that were presented in the online workshop. All teachers expressed satisfaction with the workshop, indicating that it should be offered again. Post-workshop, findings showed significant group differences in knowledge with a large effect for the training group scoring higher than the waitlist group on a quiz. Secondly, group differences in self-efficacy, knowledge, and attitudes with teachers’ past-training as a moderator, was examined. Past-training was not found to be a significant moderator of self-efficacy, knowledge, or attitudes. However, the main effect for training group was significant for attitudes. In addition, teacher attitudes, but not knowledge and self-efficacy, significantly predicted motivation to implement. Next, the moderating effect of barriers on motivation and classroom management skill implementation was examined. Barriers were not found to be a significant moderator. Lastly, the training group was observed to be significantly more effective at giving commands compared to the waitlist group. The current study demonstrates the potential of a low-intensity online workshop on classroom management to enhance the accessibility of teacher professional development. ^

Development of an intervention to support medication management in patients with multimorbidity in primary care

The overarching aim of this thesis was to develop an intervention to support patient-centred prescribing in the context of multimorbidity in primary care. Methods A range of research methods were used to address different components of the Medical Research Council, UK (MRC) guidance on the development and evaluation of complex interventions in health care. The existing evidence on GPs’ perceptions of the management of multimorbidity was systematically reviewed. In qualitative interviews, chart-stimulated recall was used to explore the challenges experienced by GPs when prescribing for multimorbid patients. In a cross-sectional study, the psychosocial issues that complicate the management of multimorbidity were examined. To develop the complex intervention, the Behaviour Change Wheel (BCW) was used to integrate behavioural theory with the findings of these three studies. A feasibility study of the new intervention was then conducted with GPs. Results The systematic review revealed four domains of clinical practice where GPs experienced difficulties in multimorbidity. The qualitative interview study showed that GPs responded to these difficulties by ‘satisficing’. In multimorbid patients perceived as stable, GPs preferred to ‘maintain the status quo’ rather than actively change medications. In the cross-sectional study, the significant association between multimorbidity and negative psychosocial factors was shown. These findings informed the development of the ‘Multimorbidity Collaborative Medication Review and Decision-making’ (MY COMRADE) intervention. The intervention involves peer support: two GPs review the medications prescribed to a complex multimorbid patient together. In the feasibility study, GPs reported that the intervention was appropriate for the context of general practice; was widely applicable to their patients with multimorbidity; and recommendations for optimising medications arose from all collaborative reviews. Conclusion Applying theory to empirical data has led to an intervention that is implementable in clinical practice, and has the potential to positively change GPs’ behaviour in the management of medications for patients with multimorbidity.

Extending the Simple Knowledge Organization System for Concept Management in Vocabulary Development Applications

In this article, we describe the development of an exten- sion to the Simple Knowledge Organization System (SKOS) to accommodate the needs of vocabulary devel- opment applications (VDA) managing metadata schemes and requiring close tracking of change to both those schemes and their member concepts. We take a neo- pragmatic epistemic stance in asserting the need for an entity in SKOS modeling to mediate between the abstract concept and the concrete scheme. While the SKOS model sufficiently describes entities for modeling the current state of a scheme in support of indexing and search on the Semantic Web, it lacks the expressive power to serve the needs of VDA needing to maintain scheme historical continuity. We demonstrate prelimi- narily that conceptualizations drawn from empirical work in modeling entities in the bibliographic universe, such as works, texts, and exemplars, can provide the basis for SKOS extension in ways that support more rig- orous demands of capturing concept evolution in VDA.

Development of a responsive fisheries management system for the Portuguese crustacean bottom trawl fishery: Lessons learnt

A prototype for a Responsive Fisheries Management System (RFMS) was developed in the context of the European FP7 project EcoFishMan and tested on the Portuguese crustacean trawl fishery. Building on Results Based Management principles, RFMS involves the definition of specific and measurable objectives for a fishery by the relevant authorities but allows resource users the freedom to find ways to achieve the objectives and to provide adequate documentation. Taking into account the main goals of the new Common Fisheries Policy, such as sustainable utilization of the resources, end of discards and unwanted catches, a management plan for the Portuguese crustacean trawl fishery was developed in cooperation with the fishing industry, following the process and design laid out in the RFMS concept. The plan considers biological, social and economic goals and assigns a responsibility for increased data collection to the resource users. The performance of the plan with regard to selected indicators was evaluated through simulations. In this paper the process towards a RFMS is described and the lessons learnt from the interaction with stakeholders in the development of an alternative management plan are discussed. (C) 2014 Elsevier Ltd. All rights reserved.

Organizational Cooperation and Knowledge Management in Research and Development Organizations

Organizational Cooperation (OC) is a current concept that responds to the growing interdependence among individuals and teams. Likewise, Knowledge Management (KM) accompanies specialization in all sectors of human activity. Most KM processes are cooperation-intensive, and the way both constructs relate to each other is relevant in understanding organizations and promoting performance. The present paper focuses on that relationship. The Organizational Cooperation Questionnaire (ORCOQ) and the Short form of the Knowledge Management Questionnaire (KMQ-SF) were applied to 639 members of research and development (R&D) organizations (Universities and Research Institutes). Descriptive, correlational, linear multiple regression and multivariate multiple regression analyses were performed. Results showed significant positive relationships between the ORCOQ and all the KMQ-SF dimensions. The prediction of KMQ-SF showed a large effect size (R2 = 62%). These findings will impact on how KM and OC are seen, and will be a step forward in the development of this field.

Social competence and career development: validation of a scale with secondary students

This paper presents a validation study of the Perceived Social Competence in Career Scale (SCCarS). The sample included 571 adolescents, 283 girls (49.6%) and 287 boys (50.3%), aged 14 to 25 years old (ì=16.33±1.41), 10th and 11th grade students attending secondary schools in the northern, central and southern Portugal. Exploratory factor analysis indicates the presence of eight factors, with eigenvalues superior to 1.00, explaining 79.16% of the total variance of the items. Confirmatory factor analysis provided support to the factorial structure of eight factors, with adequate fit indices (X2/df=4.229, CFI= 0.909, GFI= 0.869, RMSEA= 0.079, p= 0.000). These results are consistent with the factorial structure found in previous studies carried out with Portuguese samples from 8th grade. Implications are drawn related to the need for further study of the psychometric characteristics of the SCCarS with young people from different age groups

Development of super early genotypes for the dry bean (Phaseolus vulgaris) as affected by nitrogen management.

The super early genotypes (SEG) of dry bean (Phaseolus vulgaris L.) have a shorter life cycle (65-75 days) when compared with the season length of traditional cultivars (90-100 days). Timing of nitrogen top-dressing fertilization could be different because of this reduction in length of the SEG life cycle. This study aimed at characterizing, by using growth analysis and vegetation index, super early genotypes of dry bean development as affected by timing of nitrogen application. Field experiments were conducted in the 2014 and 2015 growing seasons in central Brazil with a randomized block experimental design with split plots scheme and four replicates. The plots comprised the dry bean genotypes (Colibri ? check cultivar, CNFC 15873, CNFC 15874, and CNFC 15875), and subplots comprised applications of N at different timings: 90 kg of N at sowing, 90 kg N at top-dressing; 45 kg of N at sowing plus 45 kg at top-dressing, with urea as the source of N. We also used a control treatment without N application. The CNFC 15874 super early genotype of dry bean had the higher grain yield (2776 kg ha-1) and differed from the CNFC 15873 genotype (2492 kg ha-1). Nitrogen fertilization allowed higher grain yield (2619 kg ha-1, when applied N at sowing, 2605 kg ha-1, when applied N at sowing and at top-dressing, and 2680 kg ha-1, when applied N at top-dressing) than the control, 2360 kg ha-1 (no N fertilization). The time of N fertilization in super early genotype of dry bean did not affect grain yield.

Professional Autonomy. Key Competence for Teachers in Commercial Education

The way in which the teaching autonomy is materialized, considered as part of the path traveled by the teaching community on their way to become owners of the disciplinary knowledge and the required pedagogical competencies to practice their role has motivated this paper.  For success, Commercial Education requires the urgent transformation of the teaching role and the development of key competences to promote interdisciplinary integration, academic and administrative leadership and the use of contemporary pedagogies.  The level of awareness reached by the teaching group about the impact of the learning that is promoted within the educational context will allow the empowerment of the knowledge that comes from the relationship between theory and practice-key element for professional autonomy.

Development and Validation of a Model-Based Combustion Controller for Water Injection Management

This manuscript reports the overall development of a Ph.D. research project during the “Mechanics and advanced engineering sciences” course at the Department of Industrial Engineering of the University of Bologna. The project is focused on the development of a combustion control system for an innovative Spark Ignited engine layout. In details, the controller is oriented to manage a prototypal engine equipped with a Port Water Injection system. The water injection technology allows an increment of combustion efficiency due to the knock mitigation effect that permits to keep the combustion phasing closer to the optimal position with respect to the traditional layout. At the beginning of the project, the effects and the possible benefits achievable by water injection have been investigated by a focused experimental campaign. Then the data obtained by combustion analysis have been processed to design a control-oriented combustion model. The model identifies the correlation between Spark Advance, combustion phasing and injected water mass, and two different strategies are presented, both based on an analytic and semi-empirical approach and therefore compatible with a real-time application. The model has been implemented in a combustion controller that manages water injection to reach the best achievable combustion efficiency while keeping knock levels under a pre-established threshold. Three different versions of the algorithm are described in detail. This controller has been designed and pre-calibrated in a software-in-the-loop environment and later an experimental validation has been performed with a rapid control prototyping approach to highlight the performance of the system on real set-up. To further make the strategy implementable on an onboard application, an estimation algorithm of combustion phasing, necessary for the controller, has been developed during the last phase of the PhD Course, based on accelerometric signals.

The role of Proteasome in the development, maintenance and management of Chronic Pain

In chronic pain, opioids represent the gold standard analgesics, but their use is hampered by the development of several side effects, as development of analgesic tolerance and opioid-induced hyperalgesia. Evidence showed that many molecular mechanisms (changes in opioid receptors, neurotransmitter release, and glia/microglia activation) are involved in their appearance, as well as in chronic pain. Recently, a crucial role has been proposed for oxidative stress and proteasome in chronic pain and in treatment-related side effects. To better elucidate these aspects, the aim of this PhD thesis was to investigate the effects of opioids on cell oxidative stress, antioxidant enzymatic machinery and proteasome expression and activity in vitro. Also, the involvement of proteasome in the development of chronic pain conditions was investigated utilizing an experimental model of oxaliplatin-induced neuropathy (OXAIN), in vivo. Data showed that morphine, fentanyl, buprenorphine and tapentadol alter differently ROS production. The ROS increasing effect of morphine is not shared by the other opioids, suggesting that the different pharmacological profile could influence this parameter. Moreover, these drugs produced different alterations of β2trypsin-like and β5chymotrypsin-like activities. In fact, while morphine and fentanyl increased the proteolytic activity after prolonged exposure, a different picture was observed for buprenorphine and tapentadol, suggesting that the level of MOR agonism could be strongly related with proteasome activation. In vivo studies revealed that rats treated with oxaliplatin showed a significant increase in β5, in the thalamus (TH) and somatosensory cortex (SSCx). Moreover, a selective up-regulation of β5 and LMP7 subunit gene expression was assessed in the SSCx. Furthermore, our study revealed that oprozomib, a selective β5 inhibitor normalized the spinal prodynorphin gene expression upregulation induced by oxaliplatin, and reverted mechanical/thermal allodynia and mechanical hyperalgesia in oxaliplatin-treated rats. These results underline the role of proteasome in the OXAIN and suggest new pharmacological targets to counteract it.

Development of predictive energy management strategies for hybrid electric vehicles supported by connectivity

Nowadays, the spreading of the air pollution crisis enhanced by greenhouse gases emission is leading to the worsening of the global warming. In this context, the transportation sector plays a vital role, since it is responsible for a large part of carbon dioxide production. In order to address these issues, the present thesis deals with the development of advanced control strategies for the energy efficiency optimization of plug-in hybrid electric vehicles (PHEVs), supported by the prediction of future working conditions of the powertrain. In particular, a Dynamic Programming algorithm has been developed for the combined optimization of vehicle energy and battery thermal management. At this aim, the battery temperature and the battery cooling circuit control signal have been considered as an additional state and control variables, respectively. Moreover, an adaptive equivalent consumption minimization strategy (A-ECMS) has been modified to handle zero-emission zones, where engine propulsion is not allowed. Navigation data represent an essential element in the achievement of these tasks. With this aim, a novel simulation and testing environment has been developed during the PhD research activity, as an effective tool to retrieve routing information from map service providers via vehicle-to-everything connectivity. Comparisons between the developed and the reference strategies are made, as well, in order to assess their impact on the vehicle energy consumption. All the activities presented in this doctoral dissertation have been carried out at the Green Mobility Research Lab} (GMRL), a research center resulting from the partnership between the University of Bologna and FEV Italia s.r.l., which represents the industrial partner of the research project.

Development of Optimal Energy Management Strategies for a Hybrid Boat

The present work proposes different approaches to extend the mathematical methods of supervisory energy management used in terrestrial environments to the maritime sector, that diverges in constraints, variables and disturbances. The aim is to find the optimal real-time solution that includes the minimization of a defined track time, while maintaining the classical energetic approach. Starting from analyzing and modelling the powertrain and boat dynamics, the energy economy problem formulation is done, following the mathematical principles behind the optimal control theory. Then, an adaptation aimed in finding a winning strategy for the Monaco Energy Boat Challenge endurance trial is performed via ECMS and A-ECMS control strategies, which lead to a more accurate knowledge of energy sources and boat’s behaviour. The simulations show that the algorithm accomplishes fuel economy and time optimization targets, but the latter adds huge tuning and calculation complexity. In order to assess a practical implementation on real hardware, the knowledge of the previous approaches has been translated into a rule-based algorithm, that let it be run on an embedded CPU. Finally, the algorithm has been tuned and tested in a real-world race scenario, showing promising results.

Development And Characterization Of Microsatellite Loci For Tabebuia Cassinoides (bignoniaceae).

Tabebuia cassinoides (Lam.) DC., popularly known as caxeta, is a tree species that belongs to the plant family Bignoniaceae. This species is endemic to the Brazilian Atlantic Forest and is widely exploited commercially. To date, little is known about its genetic structure, preventing the establishment of adequate management plans for this taxon. The objective of this study was to construct a microsatellite-enriched genomic library for T. cassinoides to select polymorphic loci, and standardize polymerase chain reaction amplification conditions. Of the 15 loci examined, 5 were polymorphic. The number of alleles per locus ranged from 2 to 8, with a mean of 4.4. The microsatellite loci described here represent the basis for detailed population genetic studies of this species, which will greatly contribute for the development of better conservation strategies for this taxon.