A review of patients with advanced cervical cancer presenting to palliative care services at Queen Elizabeth Central Hospital in Blantyre, Malawi

Background Cervical cancer is the commonest cancer affecting women in Malawi, which has the highest rate of this disease in the world. Most cases are diagnosed at an advanced stage. Aim To describe the symptom burden, palliative care interventions, and outcomes of cervical cancer patients who entered care at Tiyanjane Clinic in Blantyre, Malawi, between January and December 2012. Methods We reviewed the case files of 72 patients presenting to our hospital-based palliative care service over one year. Results The mean age was 49.5 years. Twenty-six patients (36%) were HIVpositive and the majority of these (n = 22; 85%) were on antiretroviral medication at presentation to palliative care. Pain (n = 66; 92%), vaginal discharge (n = 44; 61%), and unpleasant odour (n = 37; 51%) were commonly reported. Over a third of patients (n = 26; 36%) reported pain in two or more sites. Fourteen patients (19%) reported vaginal bleeding. Spousal breakdown (through widowhood or divorce) was noted in over half (n = 41; 57%) of all cases. Pain relief was provided to 69 (96%) of the patients (morphine to 40 patients; 56%). Common interventions provided included metronidazole tablets (used vaginally), sanitary items, and counselling. At the end of the study period, 18 patients (25%) were still under the care of palliative services. Conclusions Access to medications such as morphine, metronidazole and tranexamic acid can improve quality of life, even when radiotherapy is limited. Health care teams require necessary skills and training, including how to perform a comprehensive assessment, with an emphasis on the provision of psychosexual counselling, to assist with the complexity of symptoms occurring in this vulnerable group.

A Collaborative IT Network for Three Adriatic Maritime Ports

Part 21: Mobility and Logistics

Collaborative Management of Intermodal Mobility

Part 21: Mobility and Logistics

Projeto InOut Expat

O Projeto InOut Expat foi desenvolvido para apoiar e ajudar os expatriados em fase de mudança para um país estrangeiro, através de uma plataforma eletrónica que oferece os serviços de uma secretária virtual para auxiliar em situações burocráticas e/ou pessoais. Oferece também, formação intercultural focada em cultura/costumes, etiqueta e linguagem não-verbal. O website tem informações gratuitas de todos os países do mundo como, o custo de vida, a língua oficial, o PIB, a capital, a bandeira que são informações facilmente encontradas num motor de busca na internet. Também apresenta links e publicações com noticias, ofertas de emprego e entrevistas a expatriados. Os expatriados envolvidos no projeto estão felizes pela decisão que tomaram em mudar de país, mas a maioria sentiu tristeza, insegurança, choque e outros sentimentos negativos na adaptação ao país de destino, a InOut Expat pretende colmatar estes sentimentos. O projeto está a cumprir o que promete desde fase embrionária. É sem dúvida uma ferramenta útil para quem opta por emigrar ou imigrar, principalmente no auxilio de uma secretária virtual para procurar casa ou trabalho.

Continuous Quality Assurance and Optimisation in Cloud-Based Virtual Enterprises

Part 18: Optimization in Collaborative Networks

O museu virtual Google Art Project : um estudo de caso em contexto de ensino-aprendizagem da educação visual

A educação na arte e pela arte confere a todos os seus intervenientes a estimulação da sua criatividade e da sua consciência cultural, proporcionando meios para se exprimirem e participarem ativamente no mundo que nos rodeia. A integração das tecnologias de informação e comunicação no processo de ensino-aprendizagem veio alargar o papel que a arte pode desempenhar neste processo, promovendo novas formas de aprender, de ensinar e de pensar. Assim, a utilização de ambientes virtuais em contexto educativo tem revelado um enorme potencial, sobretudo ao nível da comunicação e da interação entre alunos e obras de arte. Neste sentido, considerou-se importante desenvolver um estudo de caso em contexto de sala de aula da Educação Visual, promovendo uma aprendizagem baseada na articulação entre a observação, interpretação e análise da obra de arte e o museu virtual. Assim o principal objetivo deste estudo foi avaliar as potencialidades do Google Art Project, enquanto objeto de aprendizagem, na promoção da aprendizagem na área da literacia em artes. Para além disso, procurámos ainda avaliar se a utilização de ferramentas multimédia como o referido Google Art Project e o Quadro Interativo, constituem fatores de motivação na aprendizagem da disciplina de Educação Visual. Do ponto de vista metodológico desenvolvemos uma estratégia baseada na investigação-ação. Procurámos, por um lado, descobrir e compreender o significado de uma realidade vivida por um grupo de alunos e, por outro lado, refletir sobre a prática educativa com o intuito de a melhorar e transformar. Este estudo envolveu cinco turmas do sexto ano do ensino público. Para a recolha de dados utilizámos técnicas baseadas na conversação e na observação, no questionário e nas notas de campo. Os resultados deste estudo revelam que as ferramentas tecnológicas utilizadas podem efetivamente contribuir para a promoção da aprendizagem dos alunos na área da Educação Visual, mais concretamente ao nível do domínio da literacia artística, da representação e da interpretação visual.

Tourism Destination Management: A Collaborative Approach

Part 6: Engineering and Implementation of Collaborative Networks

Orchestrating New Markets Using Cloud Services

Part 5: Service Orientation in Collaborative Networks

Enterprise Collaboration Framework for Managing, Advancing and Unifying the Functionality of Multiple Cloud-Based Services with the Help of a Graph API

Part 5: Service Orientation in Collaborative Networks

Determinants of engagement in virtual social networks in Singapore

The use of virtual social networks (VSNs) has been prevalent among consumers worldwide. Numerous studies have investigated various aspects of VSNs. However, these studies have mainly focused on students and young adults as they were early adopters of these innovative networks. A search of the literature revealed there has been a paucity of research on adult consumers’ use of VSNs. This research study addressed this gap in the literature by examining the determinants of engagement in VSNs among adult consumers in Singapore. The objectives of this study are to empirically investigate the determinants of engagement in VSNs and to offer theoretical insights into consumers’ preference and usage of VSNs. This study tapped upon several theories developed in the discipline of technology and innovation adoption. These were Roger’s Diffusion of Innovation, Theory of Reasoned Action (TRA), Theory of Planned Behavior (TPB), Technology Acceptance Model (TAM), Conceptual Framework of Individual Innovation Adoption by Frambach and Schillewaert (2002), Enhanced Model of Innovation Adoption by Talukder (2011), Extended Unified Theory of Acceptance and Use of Technology (UTAUT2) and the Information Systems (IS) Success Model. The proposed research model, named the Media Usage Model (MUM), is a framework rooted in innovation diffusion and IS theories. The MUM distilled the essence of these established models and thus provides an updated, lucid explanation of engagement in VSNs. A cross-sectional, online social survey was conducted to collect quantitative data to examine the validity of the proposed research model. Multivariate data analysis was carried out on a data set comprising 806 usable responses by utilizing SPSS, and for structural equation modeling AMOS and SmartPLS. The results indicate that consumer attitude towards VSNs is significantly and positively influenced by: three individual factors – hedonic motivation, incentives and experience; two system characteristics – system quality and information quality; and one social factor – social bonding. Consumer demographics were found to influence people’s attitudes towards VSNs. In addition, consumer experience and attitude towards VSNs significantly and positively influence their usage of VSNs. The empirical data supported the proposed research model, explaining 80% of variance in attitude towards VSNs and 45% of variance in usage of VSNs. Therefore, the MUM achieves a definite contribution to theoretical knowledge of consumer engagement in VSNs by deepening and broadening our appreciation of the intricacies related to use of VSNs in Singapore. This study’s findings have implications for customer service management, services marketing and consumer behavior. These findings also have strategic implications for maximizing efficient utilization and effective management of VSNs by businesses and operators. The contributions of this research are: firstly, shifting the boundaries of technology or innovation adoption theories from research on employees to consumers as well as the boundaries of Internet usage or adoption research from students to adults, which is also known as empirical generalization; secondly, highlighting the issues associated with lack of significance of social factors in adoption research; and thirdly, augmenting information systems research by integrating important antecedents for success in information systems.

Negotiation Support for Co-design of Business Services

Part 3: Product-Service Systems

Services Procurement under the WTO’s Agreement on Government Procurement: Whither Market Access?

This paper studies the government procurement of services from foreign suppliers by conducting a statistical analysis of data submitted by Japan and Switzerland to the WTO's Committee on Government Procurement. Using several metrics, the paper examines if the WTO’s Agreement on Government Procurement (GPA) has led to greater market access for foreign suppliers in services procurement. Our results indicate that despite the GPA, the proportions of services contracts awarded to foreigners have declined over time for both countries and in the absence of this decline, the value of services contracts awarded to foreign firms would have been more than 15 times higher in the case of Japan and nearly 68 times more in the case of Switzerland. We also find that for the same services categories, at least the Japanese government is not purchasing as much from abroad as it's private sector is importing from the rest of the world, a finding that further points to the home-bias in that government's public purchase decisions.

Analysing intention and action in mobile banking services

Technological advances at the level of mobile devices are transforming the world. Banking users are able to conduct banking services at any place, and at any time, with m-banking. The purpose of this research is to analyse intention and action in m-banking services. A research model was developed and PLS was used to test the causalities in the proposed model. Our proposal extends the existing models with an assessment of the actual usage of m-banking and of how behavioural intention translates into action. This study found that the main determinants of behavioural intention for m-banking are social influence and relative advantage. Furthermore, perceived risk, lack of information and usage barriers have a negative effect on m- banking behavioural intention. Perceived risks, e-banking use, and behaviour intention are found to be significant antecedents of m-banking use. Gender has a positive and significant influence on m-banking usage, but not on the construction of behavioural intention.

WATER RESOURCES, HEALTH, AND THE SUSTAINABILITY OF INTERVENTIONS TO ACHIEVE WATER AND SANITATION TARGETS OF THE MILLENNIUM DEVELOPMENT GOALS IN A CHANGING WORLD

This dissertation addresses sustainability of rapid provision of safe water and sanitation required to meet the Millennium Development Goals. Review of health-related literature and global statistics demonstrates engineers' role in achieving the MDGs. This review is followed by analyses relating to social, environmental, and health aspects of meeting MDG targets. Analysis of national indicators showed that inadequate investment, poor or nonexistent policies and governance are challenges to global sanitation coverage in addition to lack of financial resources and gender disparity. Although water availability was not found to be a challenge globally, geospatial analysis demonstrated that water availability is a potentially significant barrier for up to 46 million people living in urban areas and relying on already degraded water resources for environmental income. A daily water balance model incorporating the National Resources Conservation Services curve number method in Bolivian watersheds showed that local water stress is linked to climate change because of reduced recharge. Agricultural expansion in the region slightly exacerbates recharge reductions. Although runoff changes will range from -17% to 14%, recharge rates will decrease under all climate scenarios evaluated (-14% to -27%). Increasing sewer coverage may place stress on the readily accessible natural springs, but increased demand can be sustained if other sources of water supply are developed. This analysis provides a method for hydrological analysis in data scarce regions. Data required for the model were either obtained from publicly available data products or by conducting field work using low-cost methods feasible for local participants. Lastly, a methodology was developed to evaluate public health impacts of increased household water access resulting from domestic rainwater harvesting, incorporating knowledge of water requirements of sanitation and hygiene technologies. In 37 West African cities, domestic rainwater harvesting has the potential to reduce diarrheal disease burden by 9%, if implemented alone with 400 L storage. If implemented in conjunction with point of use treatment, this reduction could increase to 16%. The methodology will contribute to cost-effectiveness evaluations of interventions as well as evaluations of potential disease burden resulting from reduced water supply, such as reductions observed in the Bolivian communities.

A virtual agent to sustaining children's engagement in language learning

In this thesis we aimed to explore the potential of gamification - defined as “the use of game elements in non-game contexts” [30] - in increasing children's (aged 5 to 6) engagement with the task. This is mainly due to the fact that our world is living a technological era, and videogames are an example of this engagement by being able to maintain children’s (and adults) engagement for hours straight. For the purpose of limiting complexity, we only addressed the feedback element by introducing it with an anthropomorphic virtual agent (human-like aspect), because research shows that virtual agents (VA’s) can influence behavioural change [17], or even induce emotions on humans both through the use of feedback provided and their facial expressions, which can interpreted in the same way as of humans’ [2]. By pairing the VA with the gamification concept, we wanted to 1) create a VA that is likely to be well-received by children (appearance and behaviour), and 2) have the immediate feedback that games have, so we can give children an assessment of their actions in real-time, as opposed to waiting for feedback from someone (traditional teaching), and with this give students more chances to succeed [32, 43]. Our final system consisted on a virtual environment, where children formed words that corresponded to a given image. In order to measure the impact that the VA had on engagement, the system was developed in two versions: one version of the system was limited to provide a simple feedback environment, where the VA provided feedback, by responding with simple phrases (i.e. “correct” or “incorrect”); for the second version, the VA had a more complex approach where it tried to encourage children to complete the word – a motivational feedback - even when they weren’t succeeding. Lastly we conducted a field study with two groups of children, where one group tested the version with the simple feedback, and the other group tested the ‘motivational’ version of the system. We used a quantitative approach to analyze the collected data that measured the engagement, based on the number of tasks (words) completed and time spent with system. The results of the evaluation showed that the use of motivational feedback may carry a positive effect on engaging children.