860 resultados para Pharmacy assisted support service for street drinkers
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Repeat photography is an efficient, effective and useful method to identify trends of changes in the landscapes. It was used to illustrate long-term changes occurring in the landscapes. In the Northeast of Portugal, landscapes changes is currently driven mostly by agriculture abandonment and agriculture and energy policy. However, there is a need to monitoring changes in the region using a multitemporal and multiscale approach. This project aimed to establish an online repository of oblique digital photography from the region to be used to register the condition of the landscape as recorded in historical and contemporary photography over time as well as to support qualitative and quantitative assessment of change in the landscape using repeat photography techniques and methods. It involved the development of a relational database and a series of web-based services using PHP: Hypertext Preprocessor language, and the development of an interface, with Joomla, of pictures uploading and downloading by users. The repository will make possible to upload, store, search by location, theme, or date, display, and download pictures for Northeastern Portugal. The website service is devoted to help researchers to obtain quickly the photographs needed to apply RP through a developed search engine. It can be accessed at: http://esa.ipb.pt/digitalandscape/.
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Background: Type 1 Diabetes (T1D) management often worsens as children become adolescents. This can be a difficult time for parents as they hand over responsibility of diabetes management to their adolescent. Objectives: To look at the experiences of parents with a child with T1D as they move to adolescence and take more responsibility for their diabetes management. To find out about parents’ experience of support during this transition. Subjects: Three parents of adolescents with T1D. Participants were recruited from the NHS Highland Paediatric Diabetes Service. Methods: Participants took part in a one-to-one semi-structured interview with a researcher. Interpretative Phenomenological Analysis was used to analyse the interviews and find common themes across the interviews. Results: Participants experienced worry throughout their child’s transition to adolescence. They found it difficult to let their child take responsibility for their diabetes but acknowledged that their involvement caused tensions with their adolescent. Participants’ experience was that there were a number of practical adjustments to be made with a diagnosis of T1D and educating the network around their child was important. The participants reported that the diagnosis of T1D had an impact on the whole family and not just the child with the diagnosis. The parents felt well supported medically but said that the amount of time before their first clinic appointment felt too long. All participants had concerns about their adolescent moving to the adult diabetic service. Conclusions: Participants experienced worry relating to aspects of their adolescents T1D that they could not control, but were aware of the tensions caused by trying to keep elements of control. Areas of future research were identified.
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Part 4: Transition Towards Product-Service Systems
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This dissertation studies refugee resettlement in the United States utilizing the Integration Indicator’s framework developed by Ager and Strang for the U.S. context. The study highlights the U.S. refugee admissions program and the policies in the states of Maryland and Massachusetts while analyzing the service delivery models and its effects on refugee integration in these locations. Though immigration policy and funding for refugee services are primarily the domain of the federal government, funds are allocated through and services are delivered at the state level. The Office of Refugee Resettlement (ORR), which operates under the Department of Health and Human Services, was established after the Refugee Act of 1980 to deliver assistance to displaced persons. The ORR provides funds to individual states primarily through The Refugee Social Service and Targeted Assistance Formula Grant programs. Since the inauguration of the ORR three primary models of refugee integration through service delivery have emerged. Two of the models include the publicly/privately administered programs, where resources are allocated to the state in conjunction with private voluntary agencies; and the Wilson/Fish Alternative programs, where states sub-contract all elements of the resettlement program to voluntary agencies and private organizations —in which they can cease all state level participation and voluntary agencies or private organizations contract directly from the ORR in order for all states to deliver refugee services where the live. The specific goals of this program are early employment and economic self-sufficiency. This project utilizes US Census, state, and ORR data in conjunction with interviews of refugee resettlement practitioners involved in the service delivery and refugees. The findings show that delivery models emphasizing job training, English instruction courses, institutional collaboration, and monetary assistance, increases refugee acclimation and adaptation, providing insight into their potential for integration into the United States.
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Part 3: Product-Service Systems
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The focus of this study is an in-service training program rooted in routines-based early intervention and designed to improve the quality of goals and objectives on individualized plans. Participants were local intervention team members and other professionals who worked closely with each team. This training program involved a small number of trainees per group, providing multiple learning experiences across time and various opportunities for self-assessment and monitoring. We investigated (a) the perceptions of the participants about the strengths and weaknesses of the training program, (b) medium-term outcomes of the training with a comparison group, (c) and variables associated with the quality of goals and objectives. This study involved training more than 200 professionals, and results support the effectiveness of the program in improving the quality of goals and objectives, showing the importance of the routines-based interview in producing that improvement.
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Ergosterol, a molecule with high commercial value, is the most abundant mycosterol in Agaricus bisporus L. To replace common conventional extraction techniques (e.g. Soxhlet), the present study reports the optimal ultrasound-assisted extraction conditions for ergosterol. After preliminary tests, the results showed that solvents, time and ultrasound power altered the extraction efficiency. Using response surface methodology, models were developed to investigate the favourable experimental conditions that maximize the extraction efficiency. All statistical criteria demonstrated the validity of the proposed models. Overall, ultrasound-assisted extraction with ethanol at 375 W during 15 min proved to be as efficient as the Soxhlet extraction, yielding 671.5 ± 0.5mg ergosterol/100 g dw. However, with n-hexane extracts with higher purity (mg ergosterol/g extract) were obtained. Finally, it was proposed for the removal of the saponification step, which simplifies the extraction process and makes it more feasible for its industrial transference.
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Tomato is the second most important vegetable crop worldwide and a rich source of industrially interesting antioxidants. Hence, the microwave-assisted extraction of hydrophilic (H) and lipophilic (L) antioxidants from a surplus tomato crop was optimized using response surface methodology. The relevant independent variables were temperature (T), extraction time (t), ethanol concentration (Et) and solid/liquid ratio (S/L). The concentration-time response methods of crocin and β-carotene bleaching were applied, since they are suitable in vitro assays to evaluate the antioxidant activity of H and L matrices, respectively. The optimum operating conditions that maximized the extraction were as follows: t, 2.25 min; T, 149.2 ºC; Et, 99.1 %; and S/L, 45.0 g/L for H antioxidants; and t, 15.4 min; T, 60.0 ºC; Et, 33.0 %; and S/L, 15.0 g/L for L antioxidants. This industrial approach indicated that surplus tomatoes possess a high content of antioxidants, offering an alternative source for obtaining natural value-added compounds. Additionally, by testing the relationship between the polarity of the extraction solvent and the antioxidant activity of the extracts in H and L media (polarity-activity relationship), useful information for the study of complex natural extracts containing components with variable degrees of polarity was obtained.
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The production of natural extracts requires suitable processing conditions to maximize the preservation of the bioactive ingredients. Herein, a microwave-assisted extraction (MAE) process was optimized, by means of response surface methodology (RSM), to maximize the recovery of phenolic acids and flavonoids and obtain antioxidant ingredients from tomato. A 5-level full factorial Box-Behnken design was successfully implemented for MAE optimization, in which the processing time (t), temperature (T), ethanol concentration (Et) and solid/liquid ratio (S/L) were relevant independent variables. The proposed model was validated based on the high values of the adjusted coefficient of determination and on the non-significant differences between experimental and predicted values. The global optimum processing conditions (t=20 min; T=180 ºC; Et=0 %; and S/L=45 g/L) provided tomato extracts with high potential as nutraceuticals or as active ingredients in the design of functional foods. Additionally, the round tomato variety was highlighted as a source of added-value phenolic acids and flavonoids.
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Background Nutritional support is a recognized determinant of outcome in critically ill patients. Development of critical care services in low-income countries has not been accompanied by certain appropriate ancillary services and interventions, such as adequate nutritional support. This study was designed to investigate the experiences of health professionals who have provided nutritional supportive care to critically ill patients admitted to two major central hospitals in Malawi, with the aim of identifying the common practices in nutritional support in these settings. Materials and Methods A cross-sectional study in which 50 health professionals working in intensive care and high dependency units, admitting both adult and pediatric patients, were interviewed using a semi-structured questionnaire. Data were coded and then analyzed using SPSS version 16.0. Responses between the two hospitals were compared using Fisher’s exact test. Results There was no difference in the composition of respondents from the two hospitals. About 60% of respondents had had experience with nutritional supplementation in their patients—mainly enteral. The most commonly used formulations were the “ready-to-use therapeutic feeds,” followed by modified milk. A high percentage of respondents (40%) reported having used dextrose solution as the sole nutritional supplement. Lack of in-service training, nonexistent nutrition protocols pertaining to acutely and critically ill patients, and a lack of clinical nutritionists were the major challenges identified. Conclusion Knowledge of nutrient supplementation was poor among the respondents. The use of ready-to-use therapeutic feeds was quite common, although there is no evidence of its effectiveness in care of acutely critically ill patients. There is a need to establish nutritional support teams in these tertiary hospitals. Clinical nutritionists would ideally help train and play leadership roles in such teams, who would be responsible for assessing patients for their nutritional needs, and ensuring that the feeds provided to patients are appropriate and adequate for their needs.
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This study examines the role of servant leadership in absorptive capacity. Data from manufacturing and service sector organizations found that: a) there was moderation of servant leadership influence on knowledge identification through POS by high need for cognition, b) there was moderation of servant leadership influence on knowledge application through POS by low time pressure, and c) POS mediated relationship between servant leadership and knowledge dissemination. The findings illustrate and support the importance of a comprehensive model integrating servant leadership, POS, and epistemic motivation in determining absorptive capacity.
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Objective: To analyze pharmaceutical interventions that have been carried out with the support of an automated system for validation of treatments vs. the traditional method without computer support. Method: The automated program, ALTOMEDICAMENTOS® version 0, has 925 052 data with information regarding approximately 20 000 medicines, analyzing doses, administration routes, number of days with such a treatment, dosing in renal and liver failure, interactions control, similar drugs, and enteral medicines. During eight days, in four different hospitals (high complexity with over 1 000 beds, 400-bed intermediate, geriatric and monographic), the same patients and treatments were analyzed using both systems. Results: 3,490 patients were analyzed, with 42 155 different treatments. 238 interventions were performed using the traditional system (interventions 0.56% / possible interventions) vs. 580 (1.38%) with the automated one. Very significant pharmaceutical interventions were 0.14% vs. 0.46%; significant was 0.38% vs. 0.90%; non-significant was 0.05% vs. 0.01%, respectively. If both systems are simultaneously used, interventions are performed in 1.85% vs. 0.56% with just the traditional system. Using only the traditional model, 30.5% of the possible interventions are detected, whereas without manual review and only the automated one, 84% of the possible interventions are detected. Conclusions: The automated system increases pharmaceutical interventions between 2.43 to 3.64 times. According to the results of this study the traditional validation system needs to be revised relying on automated systems. The automated program works correctly in different hospitals.
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Studies of strategic HRM have dominated HRM research over the last three decades. Focusing on the HRM-organisation performance relationship, researchers take various themes and perspectives in their approach to strategic HRM. Among these themes, two contrasting approaches of strategic HRM continue to flourish: first, the best practice approach suggests that certain HRM practices will have the same effect irrespective of context and, second, the best fit approach suggests that the choice of HRM practices should be designed in accordance with an organisations’ specific context. While there is little consensus on what constitutes strategic HRM, the most common feature agreed in this field is the notion of the strategic integration; aligning HRM practices with organisations’ overall strategic objectives (vertical fit) and with each other (horizontal fit). Utilising the best fit approach as its theoretical framework, this study examines how vertical and horizontal fit is practised in the Indonesian civil service and what factors likely influence the prevalence of vertical and horizontal fit in the Indonesian civil service context. This study is significant for two important reasons. Firstly, the literature suggests that there are limited studies examining the best fit concept in the civil sector despite its implementation in the private sector positively contributing to organisational performance improvement. Secondly, the study provides enlightenment on how the best fit approach could contribute to performance improvement in the Indonesian civil service. This is in line with the fact that negative images of the Indonesian civil service are continuously highlighted although various HRM reform initiatives have been put in place. To achieve the objectives of the study, the qualitative case study approach accompanied by semi-structured interviews was employed involving 53 senior officials and one focus group discussion from eight Indonesian government agencies, consisting of three central agencies mandated to manage human resources, the National Bureaucratic Reform Team and four line agencies from both central and local governments. Thematic analysis was employed for data analyses and NVIVO software was used to manage the data. The study suggests three main findings. First, various HRM initiatives in relation to the HRM reform have been introduced in the Indonesian civil service differentiating them from the old HRM practices. However, the findings indicate that some HRM policies are still contradicting and hinder vertical and horizontal fit. Second, despite the contradictory policies, vertical and horizontal fit can be seen in the line agencies which have been acknowledged as ‘reformed agencies’. This demonstrates that the line agencies play an important role in aligning HRM practices with the line agencies’ goals and objectives and with one another although they are bounded by HRM policies that are unlikely to support the vertical and horizontal fit concept. Third, factors influencing the prevalence of vertical and horizontal fit include knowledge of contemporary HRM in both central agencies and line agencies, commitment from the line agencies’ leaders, devolvement of HRM to the line agencies and the socio-political and economic environments of the Indonesian civil service. The findings of the study raise policy, practical and theoretical implications. In terms of policy implications, the study highlights the importance of fit in HRM policies to support the achievement of the line agencies’ goals. Therefore, when formulating an HRM policy, the central agencies need to ensure that the HRM policy is linked to line agencies’ goals and to other HRM policies. This is to ensure synchronisation among the policies and thus maximising the achievement of the line agencies’ goals. From the practical perspectives, the study highlights important points which can be learned by the central agencies in carrying out their strategic role with regard to the formulation of HRM policies; by the line agencies in maximising the contribution of HRM to the achievement of the goals and objectives of the agencies through the implementation of the best fit concept, and by the leaders of the agencies in providing continuous support to each of the involved parties in the line agencies and involving the HRM department in all agency’s strategic decision-making. In relation to the theoretical implication, it is clear that the best fit approach is not thoroughly applied due to factors discussed previously. However, this does not mean that the best fit concept cannot be implemented. As argued by McCourt & Ramgutty-Wong (2003), instead of adopting the whole concept of best fit, a modulated approach reflecting the best fit concept, such as selecting individual HRM practices and experimenting with devolution, is possible for civil service organisations which still embrace centralised HRM systems. As demonstrated in the findings, some of the line agencies being studied seem to be ready to adopt the best fit approach given that they have knowledge of the best fit concept, strong support from the top leader, less political intervention and less corruption, collusion, and nepotism practices in their HRM practices.
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Part 3: Product-Service Systems
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The purpose of this presentation is to highlight issues that exist for student nurses who embark on a career in children's nursing at a very young age and subsequently find themselves in a situation where they are expected to deliver high quality care to young people and their families. An introductory sentence indicating the purpose of the presentation: Currently in the UK under the Making a Différence Curriculum (DOH 1999) students can enrol on a single registration programme for Children's Nursing as young as 17.5 years. Children are admitted to hospital onto the children's wards between the ages of 0-16 years (occasionally older). Using Viner's (2003) définition of adolescence as being that period between the ages of ten and twenty-five years when biopsychosocial maturation leads to functional independence in adult iife demonstrates the possibility that both the patients and the nursing students could be undergoing very similar transitional experiences. Historically, in the 1940-50's children were admitted to childrens wards between the ages of 2-12 years. Nurse education at that time tended to be undertaken for first or second level registration in the first instance, followed by post-registration training for specialist areas. Subsequently, the phenomenon of adolescent paediatric nursing students being required to care for adolescents and their families on the children's wards did not exist some 60 years ago. A brief description of the highiights of the présentation: This présentation will focus on adolescent transitions with particular reference to issues that could arise when young students are required to care for young people and their families, particularly when there is a diagnosis of self harm or substance abuse. A summary of findings and/or other relevant information: Preliminary findings have indicated that very young student nurses find caring for adolescents to be particularly challenging. Health issues pertinent to young people appear to présent particular challenges for the students which raises questions in respect of the quality of care that the young people and their families may receive. A conclusion and implications: The following need to be further explored: i) Support within the clinical areas and adequate de-briefing strategies, ii) The efficacy of single registration to children's nursing, iii) Young people and their family's perception of the quality of care they receive from very young students.