The Hospital Study of the City of Houston and Harris County

In 1941 the Texas Legislature appropriated $500,000 to the Board of Regents of the University of Texas to establish a cancer research hospital. The M. D. Anderson Foundation offered to match the appropriation with a grant of an equal sum and to provide a permanent site in Houston. In August, 1942 the Board of Regent of the University and the Trustees of the Foundation signed an agreement to embark on this project. This institution was to be the first one in the medical center, which was incorporated in October, 1945. The Board of Trustees of the Texas Medical Center commissioned a hospital survey to: - Define the needed hospital facilities in the area - Outline an integrated program to meet these needs - Define the facilities to be constructed - Prepare general recommendations for efficient progress The Hospital Study included information about population, hospitals, and other health care and education facilities in Houston and Harris County at that time. It included projected health care needs for future populations, education needs, and facility needs. It also included detailed information on needs for chronic illnesses, a school of public health, and nursing education. This study provides valuable information about the general population and the state of medicine in Houston and Harris County in the 1940s. It gives a unique perspective on the anticipated future as civic leaders looked forward in building the city and region. This document is critical to an understanding of the Texas Medical Center, Houston and medicine as they are today. SECTIONS INCLUDE: Abstract The Abstract was a summary of the 400 page document including general information about the survey area, community medical assets, and current and projected medical needs which the Texas Medical Center should meet. The 123 recommendations were both general (e.g., 12. “That in future planning, the present auxiliary department of the larger hospitals be considered inadequate to carry an added teaching research program of any sizable scope.”) and specific (e.g., 22. That 14.3% of the total acute bed requirement be allotted for obstetric care, reflecting a bed requirement of 522 by 1950, increasing to 1,173 by 1970.”) Section I: Survey Area This section basically addressed the first objective of the survey: “define the needed hospital facilities in the area.” Based on the admission statistics of hospitals, Harris County was included in the survey, with the recognition that growth from out-lying regional areas could occur. Population characteristics and vital statistics were included, with future trends discussed. Each of the hospitals in the area and government and private health organizations, such as the City-County Welfare Board, were documented. Statistics on the facilities use and capacity were given. Eighteen recommendations and observations on the survey area were given. Section II: Community Program This section basically addressed the second objective of the survey: “outline an integrated program to meet these needs.” The information from the Survey Area section formed the basis of the plans for development of the Texas Medical Center. In this section, specific needs, such as what medical specialties were needed, the location and general organization of a medical center, and the academic aspects were outlined. Seventy-four recommendations for these plans were provided. Section III: The Texas Medical Center The third and fourth objectives are addressed. The specific facilities were listed and recommendations were made. Section IV: Special Studies: Chronic Illness The five leading causes of death (heart disease, cancer, “apoplexy”, nephritis, and tuberculosis) were identified and statistics for morbidity and mortality provided. Diagnostic, prevention and care needs were discussed. Recommendations on facilities and other solutions were made. Section IV: Special Studies: School of Public Health An overview of the state of schools of public health in the US was provided. Information on the direction and need of this special school was also provided. Recommendations on development and organization of the proposed school were made. Section IV: Special Studies: Needs and Education Facilities for Nurses Nursing education was connected with hospitals, but the changes to academic nursing programs were discussed. The needs for well-trained nurses in an expanded medical environment were anticipated to result in significant increased demands of these professionals. An overview of the current situation in the survey area and recommendations were provided. Appendix A Maps, tables and charts provide background and statistical information for the previous sections. Appendix B Detailed census data for specific areas of the survey area in the report were included. Sketches of each of the fifteen hospitals and five other health institutions showed historical information, accreditations, staff, available facilities (beds, x-ray, etc.), academic capabilities and financial information.

A technological framework based on automatic messaging for improving adherence of diabetic patients

En todo el mundo se ha observado un crecimiento exponencial en la incidencia de enfermedades crónicas como la hipertensión y enfermedades cardiovasculares y respiratorias, así como la diabetes mellitus, que causa un número de muertes cada vez mayor en todo el mundo (Beaglehole et al., 2008). En concreto, la prevalencia de diabetes mellitus (DM) está aumentando de manera considerable en todas las edades y representa un serio problema de salud mundial. La diabetes fue la responsable directa de 1,5 millones de muertes en 2012 y 89 millones de años de vida ajustados por discapacidad (AVAD) (OMS, 2014). Uno de los principales dilemas que suelen asociarse a la gestión de EC es la adherencia de los pacientes a los tratamientos, que representa un aspecto multifactorial que necesita asistencia en lo relativo a: educación, autogestión, interacción entre los pacientes y cuidadores y compromiso de los pacientes. Medir la adherencia del tratamiento es complicado y, aunque se ha hablado ampliamente de ello, aún no hay soluciones “de oro” (Reviews, 2002). El compromiso de los pacientes, a través de la participación, colaboración, negociación y a veces del compromiso firme, aumentan las oportunidades para una terapia óptima en la que los pacientes se responsabilizan de su parte en la ecuación de adherencia. Comprometer e involucrar a los pacientes diabéticos en las decisiones de su tratamiento, junto con expertos profesionales, puede ayudar a favorecer un enfoque centrado en el paciente hacia la atención a la diabetes (Martin et al., 2005). La motivación y atribución de poder de los pacientes son quizás los dos factores interventores más relevantes que afectan directamente a la autogestión de la atención a la diabetes. Se ha demostrado que estos dos factores desempeñan un papel fundamental en la adherencia a la prescripción, así como en el fomento exitoso de un estilo de vida sana y otros cambios de conducta (Heneghan et al., 2013). Un plan de educación personalizada es indispensable para proporcionarle al paciente las herramientas adecuadas que necesita para la autogestión efectiva de la enfermedad (El-Gayar et al. 2013). La comunicación efectiva es fundamental para proporcionar una atención centrada en el paciente puesto que influye en las conductas y actitudes hacia un problema de salud ((Frampton et al. 2008). En este sentido, la interactividad, la frecuencia, la temporalización y la adaptación de los mensajes de texto pueden promover la adherencia a un régimen de medicación. Como consecuencia, adaptar los mensajes de texto a los pacientes puede resultar ser una manera de hacer que las sugerencias y la información sean más relevantes y efectivas (Nundy et al. 2013). En este contexto, las tecnologías móviles en el ámbito de la salud (mHealth) están desempeñando un papel importante al conectar con pacientes para mejorar la adherencia a medicamentos recetados (Krishna et al., 2009). La adaptación de los mensajes de texto específicos de diabetes sigue siendo un área de oportunidad para mejorar la adherencia a la medicación y ofrecer motivación a adultos con diabetes. Sin embargo, se necesita más investigación para entender totalmente su eficacia. Los consejos de texto personalizados han demostrado causar un impacto positivo en la atribución de poder a los pacientes, su autogestión y su adherencia a la prescripción (Gatwood et al., 2014). mHealth se puede utilizar para ofrecer programas de asistencia de autogestión a los pacientes con diabetes y, al mismo tiempo, superar las dificultades técnicas y financieras que supone el tratamiento de la diabetes (Free at al., 2013). El objetivo principal de este trabajo de investigación es demostrar que un marco tecnológico basado en las teorías de cambios de conducta, aplicado al campo de la mHealth, permite una mejora de la adherencia al tratamiento en pacientes diabéticos. Como método de definición de una solución tecnológica, se han adoptado un conjunto de diferentes técnicas de conducta validadas denominado marco de compromiso de retroacción conductual (EBF, por sus siglas en inglés) para formular los mensajes, guiar el contenido y evaluar los resultados. Los estudios incorporan elementos del modelo transteórico (TTM, por sus siglas en inglés), la teoría de la fijación de objetivos (GST, por sus siglas en inglés) y los principios de comunicación sanitaria persuasiva y eficaz. Como concepto general, el modelo TTM ayuda a los pacientes a progresar a su próxima fase de conducta a través de mensajes de texto motivados específicos y permite que el médico identifique la fase actual y adapte sus estrategias individualmente. Además, se adoptan las directrices del TTM para fijar objetivos personalizados a un nivel apropiado a la fase de cambio del paciente. La GST encierra normas que van a ponerse en práctica para promover la intervención educativa y objetivos de pérdida de peso. Finalmente, los principios de comunicación sanitaria persuasiva y eficaz aplicados a la aparición de los mensajes se han puesto en marcha para aumentar la efectividad. El EBF tiene como objetivo ayudar a los pacientes a mejorar su adherencia a la prescripción y encaminarlos a una mejora general en la autogestión de la diabetes mediante mensajes de texto personalizados denominados mensajes de retroacción automáticos (AFM, por sus siglas en inglés). Después de una primera revisión del perfil, consistente en identificar características significativas del paciente basadas en las necesidades de tratamiento, actitudes y conductas de atención sanitaria, el sistema elige los AFM personalizados, los aprueba el médico y al final se transfieren a la interfaz del paciente. Durante el tratamiento, el usuario recopila los datos en dispositivos de monitorización de pacientes (PMD, por sus siglas en inglés) de una serie de dispositivos médicos y registros manuales. Los registros consisten en la toma de medicación, dieta y actividad física y tareas de aprendizaje y control de la medida del metabolismo. El compromiso general del paciente se comprueba al estimar el uso del sistema y la adherencia del tratamiento y el estado de los objetivos del paciente a corto y largo plazo. El módulo de análisis conductual, que consiste en una serie de reglas y ecuaciones, calcula la conducta del paciente. Tras lograr el análisis conductual, el módulo de gestión de AFM actualiza la lista de AFM y la configuración de los envíos. Las actualizaciones incluyen el número, el tipo y la frecuencia de mensajes. Los AFM los revisa periódicamente el médico que también participa en el perfeccionamiento del tratamiento, adaptado a la fase transteórica actual. Los AFM se segmentan en distintas categorías y niveles y los pacientes pueden ajustar la entrega del mensaje de acuerdo con sus necesidades personales. El EBF se ha puesto en marcha integrado dentro del sistema METABO, diseñado para facilitar al paciente diabético que controle sus condiciones relevantes de una manera menos intrusiva. El dispositivo del paciente se vincula en una plataforma móvil, mientras que una interfaz de panel médico permite que los profesionales controlen la evolución del tratamiento. Herramientas específicas posibilitan que los profesionales comprueben la adherencia del paciente y actualicen la gestión de envíos de AFM. El EBF fue probado en un proyecto piloto controlado de manera aleatoria. El principal objetivo era examinar la viabilidad y aceptación del sistema. Los objetivos secundarios eran también la evaluación de la eficacia del sistema en lo referente a la mejora de la adherencia, el control glucémico y la calidad de vida. Se reclutaron participantes de cuatro centros clínicos distintos en Europa. La evaluación del punto de referencia incluía datos demográficos, estado de la diabetes, información del perfil, conocimiento de la diabetes en general, uso de las plataformas TIC, opinión y experiencia con dispositivos electrónicos y adopción de buenas prácticas con la diabetes. La aceptación y eficacia de los criterios de evaluación se aplicaron para valorar el funcionamiento del marco tecnológico. El principal objetivo era la valoración de la eficacia del sistema en lo referente a la mejora de la adherencia. En las pruebas participaron 54 pacientes. 26 fueron asignados al grupo de intervención y equipados con tecnología móvil donde estaba instalado el EBF: 14 pacientes tenían T1DM y 12 tenían T2DM. El grupo de control estaba compuesto por 25 pa cientes que fueron tratados con atención estándar, sin el empleo del EBF. La intervención profesional tanto de los grupos de control como de intervención corrió a cargo de 24 cuidadores, entre los que incluían diabetólogos, nutricionistas y enfermeras. Para evaluar la aceptabilidad del sistema y analizar la satisfacción de los usuarios, a través de LimeSurvey, se creó una encuesta multilingüe tanto para los pacientes como para los profesionales. Los resultados también se recopilaron de los archivos de registro generados en los PMD, el panel médico profesional y las entradas de la base de datos. Los mensajes enviados hacia y desde el EBF y los archivos de registro del sistema y los servicios de comunicación se grabaron durante las cinco semanas del estudio. Se entregaron un total de 2795 mensajes, lo que supuso una media de 107,50 mensajes por paciente. Como se muestra, los mensajes disminuyen con el tiempo, indicando una mejora global de la adherencia al plan de tratamiento. Como se esperaba, los pacientes con T1DM recibieron más consejos a corto plazo, en relación a su estado. Del mismo modo, al ser el centro de T2DM en cambios de estilo de vida sostenible a largo plazo, los pacientes con T2DM recibieron más consejos de recomendación, en cuanto a dietas y actividad física. También se ha llevado a cabo una comparación de la adherencia e índices de uso para pacientes con T1DM y T2DM, entre la primera y la segunda mitad de la prueba. Se han observado resultados favorables para el uso. En lo relativo a la adherencia, los resultados denotaron una mejora general en cada dimensión del plan de tratamiento, como la nutrición y las mediciones de inserción de glucosa en la sangre. Se han llevado a cabo más estudios acerca del cambio a nivel educativo antes y después de la prueba, medidos tanto para grupos de control como de intervención. Los resultados indicaron que el grupo de intervención había mejorado su nivel de conocimientos mientras que el grupo de control mostró una leve disminución. El análisis de correlación entre el nivel de adherencia y las AFM ha mostrado una mejora en la adherencia de uso para los pacientes que recibieron los mensajes de tipo alertas, y unos resultados no significativos aunque positivos relacionados con la adherencia tanto al tratamiento que al uso correlacionado con los recordatorios. Por otra parte, los AFM parecían ayudar a los pacientes que no tomaban suficientemente en serio su tratamiento en el principio y que sí estaban dispuestos a responder a los mensajes recibidos. Aun así, los pacientes que recibieron demasiadas advertencias, comenzaron a considerar el envío de mensajes un poco estresante. El trabajo de investigación llevado a cabo al desarrollar este proyecto ofrece respuestas a las cuatro hipótesis de investigación que fueron la motivación para el trabajo. • Hipótesis 1 : es posible definir una serie de criterios para medir la adherencia en pacientes diabéticos. • Hipótesis 2: es posible diseñar un marco tecnológico basado en los criterios y teorías de cambio de conducta mencionados con anterioridad para hacer que los pacientes diabéticos se comprometan a controlar su enfermedad y adherirse a planes de atención. • Hipótesis 3: es posible poner en marcha el marco tecnológico en el sector de la salud móvil. • Hipótesis 4: es posible utilizar el marco tecnológico como solución de salud móvil en un contexto real y tener efectos positivos en lo referente a indicadores de control de diabetes. La verificación de cada hipótesis permite ofrecer respuesta a la hipótesis principal: La hipótesis principal es: es posible mejorar la adherencia diabética a través de un marco tecnológico mHealth basado en teorías de cambio de conducta. El trabajo llevado a cabo para responder estas preguntas se explica en este trabajo de investigación. El marco fue desarrollado y puesto en práctica en el Proyecto METABO. METABO es un Proyecto I+D, cofinanciado por la Comisión Europea (METABO 2008) que integra infraestructura móvil para ayudar al control, gestión y tratamiento de los pacientes con diabetes mellitus de tipo 1 (T1DM) y los que padecen diabetes mellitus de tipo 2 (T2DM). ABSTRACT Worldwide there is an exponential growth in the incidence of Chronic Diseases (CDs), such as: hypertension, cardiovascular and respiratory diseases, as well as diabetes mellitus, leading to rising numbers of deaths worldwide (Beaglehole et al. 2008). In particular, the prevalence of diabetes mellitus (DM) is largely increasing among all ages and constitutes a major worldwide health problem. Diabetes was directly responsible for 1,5 million deaths in 2012 and 89 million Disability-adjusted life year (DALYs) (WHO 2014). One of the key dilemmas often associated to CD management is the patients’ adherence to treatments, representing a multi-factorial aspect that requires support in terms of: education, self-management, interaction between patients and caregivers, and patients’ engagement. Measuring adherence is complex and, even if widely discussed, there are still no “gold” standards ((Giardini et al. 2015), (Costa et al. 2015). Patient’s engagement, through participation, collaboration, negotiation, and sometimes compromise, enhance opportunities for optimal therapy in which patients take responsibility for their part of the adherence equation. Engaging and involving diabetic patients in treatment decisions, along with professional expertise, can help foster a patient-centered approach to diabetes care (Martin et al. 2005). Patients’ motivation and empowerment are perhaps the two most relevant intervening factors that directly affect self-management of diabetes care. It has been demonstrated that these two factors play an essential role in prescription adherence, as well as for the successful encouragement of a healthy life-style and other behavioural changes (Heneghan et al. 2013). A personalised education plan is indispensable in order to provide the patient with the appropriate tools needed for the effective self-management of the disease (El-Gayar et al. 2013). Effective communication is at the core of providing patient-centred care since it influences behaviours and attitudes towards a health problem (Frampton et al. 2008). In this regard, interactivity, frequency, timing, and tailoring of text messages may promote adherence to a medication regimen. As a consequence, tailoring text messages to patients can constitute a way of making suggestions and information more relevant and effective (Nundy et al. 2013). In this context, mobile health technologies (mHealth) are playing significant roles in improving adherence to prescribed medications (Krishna et al. 2009). The tailoring of diabetes-specific text messages remains an area of opportunity to improve medication adherence and provide motivation to adults with diabetes but further research is needed to fully understand their effectiveness. Personalized text advices have proven to produce a positive impact on patients’ empowerment, self-management, and adherence to prescriptions (Gatwood et al. 2014). mHealth can be used for offering self-management support programs to diabetes patients and at the same time surmounting the technical and financial difficulties involved in diabetes treatment (Free et al. 2013). The main objective of this research work is to demonstrate that a technological framework, based on behavioural change theories, applied to mHealth domain, allows improving adherence treatment in diabetic patients. The framework, named Engagement Behavioural Feedback Framework (EBF), is built on top of validated behavioural techniques to frame messages, guide the definition of contents and assess outcomes: elements from the Transtheoretical Model (TTM), the Goal-Setting Theory (GST), Effective Health Communication (EHC) guidelines and Principles of Persuasive Technology (PPT) were incorporated. The TTM helps patients to progress to a next behavioural stage, through specific motivated text messages, and allow clinician’s identifying the current stage and tailor its strategies individually. Moreover, TTM guidelines are adopted to set customised goals at a level appropriate to the patient’s stage of change. The GST was used to build rules to be applied for enhancing educational intervention and weight loss objectives. Finally, the EHC guidelines and the PPT were applied to increase the effectiveness of messages. The EBF aims to support patients on improving their prescription adherence and persuade them towards a general improvement in diabetes self-management, by means of personalised text messages, named Automatic Feedback Messages (AFM). After a first profile screening, consisting in identifying meaningful patient characteristics based on treatment needs, attitudes and health care behaviours, customised AFMs are selected by the system, approved by the professional, and finally transferred into the patient interface. During the treatment, the user collects the data into a Patient Monitoring Device (PMD) from a set of medical devices and from manual inputs. Inputs consist in medication intake, diet and physical activity, metabolic measurement monitoring and learning tasks. Patient general engagement is checked by estimating the usage of the system and the adherence of treatment and patient goals status in the short and the long term period. The Behavioural Analysis Module, consisting in a set of rules and equations, calculates the patient’s behaviour. After behavioural analysis is accomplished, the AFM library and the dispatch setting are updated by the AFM Manager module. Updates include the number, the type and the frequency of messages. The AFMs are periodically supervised by the professional who also participates to the refinement of the treatment, adapted to the current transtheoretical stage. The AFMs are segmented in different categories and levels and patients can adjust message delivery in accordance with their personal needs. The EBF was integrated to the METABO system, designed to facilitate diabetic patients in managing their disease in a less intrusive approach. Patient device corresponds in a mobile platform, while a medical panel interface allows professionals to monitoring the treatment evolution. Specific tools allow professional to check patient adherence and to update the AFMs dispatch management. The EBF was tested in a randomised controlled pilot. The main objective was to examine the feasibility and acceptance of the system. Secondary objectives were also the assessment of the effectiveness of system in terms of adherence improvement, glycaemic control, and quality of life. Participants were recruited from four different clinical centres in Europe. The baseline assessment included demographics, diabetes status, profile information, knowledge about diabetes in general, usage of ICT platforms, opinion and experience about electronic devices and adoption of good practices with diabetes. Acceptance and the effectiveness evaluation criteria were applied to evaluate the performance of the technological framework. The main objective was the assessment of the effectiveness of system in terms of adherence improvement. Fifty-four patients participated on the trials. Twenty-six patients were assigned in the intervention group and equipped with mobile where the EBF was installed: 14 patients were T1DM and 12 were T2DM. The control group was composed of 25 patients that were treated through a standard care, without the usage of the EBF. Professional’s intervention for both intervention and control groups was carried out by 24 care providers, including endocrinologists, nutritionists, and nurses. In order to evaluate the system acceptability and analyse the users’ satisfaction, an online multi-language survey, using LimeSurvey, was produced for both patients and professionals. Results were also collected from the log-files generated in the PMDs, the professional medical panel and the entries of the data base. The messages sent to and from the EBF and the log-files of the system and communication services were recorded over 5 weeks of the study. A total of 2795 messages were submitted, representing an average of 107,50 messages per patient. As demonstrated, messages decrease over time indicating an overall improvement of the care plan’s adherence. As expected, T1DM patients were more loaded with short-term advices, in accordance with their condition. Similarly, being the focus of T2DM on long-term sustainable lifestyle changes, T2DM received more reminders advices, as for diet and physical activity. Favourable outcomes were observed for treatment and usage adherences of the intervention group: for both the adherence indices, results denoted a general improvement on each care plan’s dimension, such as on nutrition and blood glucose input measurements. Further studies were conducted on the change on educational level before and after the trial, measured for both control and intervention groups. The outcomes indicated the intervention group has improved its level of knowledge, while the control group denoted a low decrease. The correlation analysis between the level of adherences and the AFMs showed an improvement in usage adherence for patients who received warnings message, while non-significantly yet even positive indicators related to both treatment and usage adherence correlated with the Reminders. Moreover, the AFMs seemed to help those patients who did not take their treatment seriously enough in the beginning and who were willing to respond to the messages they received. Even though, patients who received too many Warnings, started to consider the message dispatch to be a bit stressful. The research work carried out in developing this research work provides responses to the four research hypothesis that were the motivation for the work: •Hypothesis 1: It is possible to define a set of criteria to measure adherence in diabetic patients. •Hypothesis 2: It is possible to design a technological framework, based on the aforementioned criteria and behavioural change theories, to engage diabetic patients in managing their disease and adhere to care plans. •Hypothesis 3: It is possible to implement the technological framework in the mobile health domain. •Hypothesis 4: It is possible to use the technological framework as a mobile health solution in a real context and have positive effects in terms of diabetes management indicators. The verification of each hypothesis allowed us to provide a response to the main hypothesis: The Main Hypothesis is: It is possible to improve diabetic adherence through a mHealth technological framework based on behavioural change theories. The work carried out to answer these questions is explained in this research work. The framework was developed and applied in the METABO project. METABO is an R&D project, co-funded by the European Commission (METABO 2008) that integrates mobile infrastructure for supporting the monitoring, management, and treatment of type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) patients.

La Península Ibérica en el transporte masivo de mercancías entre Europa y África : futuras autopistas del mar

La competitividad del transporte de mercancías depende del estado y funcionamiento de las redes existentes y de sus infraestructuras, no del modo de transporte. En concreto, la rentabilidad o la reducción de los costes de producción del transporte marítimo se vería incrementado con el uso de buques de mayor capacidad y con el desarrollo de plataformas portuarias de distribución o puertos secos, ya que el 90% del comercio entre la Unión Europea y terceros países se realiza a través de sus puertos a un promedio de 3,2 billones de toneladas de mercancías manipuladas cada año y el 40% del tráfico intraeuropeo utiliza el transporte marítimo de corta distancia. A pesar de que los puertos europeos acogen anualmente a más de 400 millones de pasajeros, los grandes desarrollos se han producido en los puertos del norte de Europa (Róterdam, Amberes, Ámsterdam). Los países del Sur de Europa deben buscar nuevas fórmulas para ser más competitivos, ya sea mediante creación de nuevas infraestructuras o mediante refuerzo de las existentes, ofreciendo los costes de los puertos del Norte. El fomento del transporte marítimo y fluvial como alternativa al transporte por carretera, especialmente el transporte marítimo de corta distancia, ha sido impulsado por la Comisión Europea (CE) desde 2003 a través de programas de apoyo comunitario de aplicación directa a las Autopistas del Mar, a modo de ejemplo, cabría citar los programas Marco Polo I y II, los cuales contaron con una dotación presupuestaria total de 855 millones de euros para el período 2003 – 2013; en ese período de tiempo se establecieron objetivos de reducción de congestión vial y mejora del comportamiento medio ambiental del sistema de transporte de mercancías dentro de la comunidad y la potenciación de la intermodalidad. El concepto de Autopista del Mar surge en el Libro Blanco de Transportes de la Comisión Europea “La política europea de transportes de cara al 2010: La hora de la verdad” del 12 de diciembre de 2001, en el marco de una política europea para fomento y desarrollo de sistemas de transportes sostenibles. Las Autopistas del Mar consisten en rutas marítimas de corta distancia entre dos puntos, de menor distancia que por vía terrestre, en las que a través del transporte intermodal mejoran significativamente los tiempos y costes de la cadena logística, contribuyen a la reducción de accidentes, ruidos y emisiones de CO2 a la atmósfera, permite que los conductores pierdan horas de trabajo al volante y evita el deterioro de las infraestructuras terrestres, con el consiguiente ahorro en mantenimiento. La viabilidad de una Autopista del Mar depende tanto de factores de ubicación geográficos, como de características propias del puerto, pasando por los diferentes requerimientos del mercado en cada momento (energéticos, medio ambientales y tecnológicos). Existe un elemento nuevo creado por la Comisión Europea: la red transeuropea de transportes (RTE-T). En el caso de España, con sus dos accesos por los Pirineos (La Junquera e Irún) como únicos pasos terrestres de comunicación con el continente y con importantes limitaciones ferroviarias debido a los tres anchos de vía distintos, le resta competitividad frente al conjunto europeo; por el contrario, España es el país europeo con más kilómetros de costa (con más de 8.000 km) y con un emplazamiento geográfico estratégico, lo que le convierte en una plataforma logística para todo el sur de Europa, por lo que las Autopistas del Mar tendrán un papel importante y casi obligado para el desarrollo de los grandes corredores marítimos que promueve Europa. De hecho, Gijón y Vigo lo han hecho muy bien con sus respectivas líneas definidas como Autopistas del Mar y que conectan con el puerto francés de Nantes-Saint Nazaire, ya que desde ahí los camiones pueden coger rutas hacia el Norte. Paralelamente, la Unión Europea ha iniciado los pasos para el impulso de la primera Autopista del Mar que conectará España con el mercado de Reino Unido, concretamente los Puertos de Bilbao y Tilbury. Además, España e Italia sellaron un acuerdo internacional para desarrollar Autopistas del Mar entre ambos países, comprometiéndose a impulsar una docena de rutas entre puertos del litoral mediterráneo español y el italiano. Actualmente, están en funcionando los trayectos como Barcelona-Génova, Valencia-Civitavecchia y Alicante- Nápoles, notablemente más cortos por mar que por carretera. Bruselas identificó cuatro grandes corredores marítimos que podrían concentrar una alta densidad de tráfico de buques, y en dos de ellos España ya tenía desde un principio un papel crucial. La Comisión diseñó el 14 de abril de 2004, a través del proyecto West-Mos, una red de tráfico marítimo que tiene como vías fundamentales la denominada Autopista del Báltico (que enlaza Europa central y occidental con los países bálticos), la Autopista de Europa suroriental (que une el Adriático con el Jónico y el Mediterráneo más oriental) y también la Autopista de Europa occidental y la Autopista de Europa suroccidental (que enlazan España con Reino Unido y la Francia atlántica y con la Francia mediterránea e Italia, respectivamente). Para poder establecer Autopistas del Mar entre la Península Ibérica y el Norte de Europa primará especialmente la retirada de camiones en la frontera pirenaica, donde el tráfico pesado tiene actualmente una intensidad media diaria de 8.000 unidades, actuando sobre los puntos de mayor congestión, como por ejemplo los Alpes, los Pirineos, el Canal de la Mancha, las carreteras fronterizas de Francia y Euskadi, y proponiendo el traslado de las mercancías en barcos o en trenes. Por su parte, para contar con los subsidios y apoyos europeos las rutas seleccionadas como Autopistas del Mar deben mantener una serie de criterios de calidad relacionados con la frecuencia, coste “plataforma logística a plataforma logística”, simplicidad en procedimientos administrativos y participación de varios países, entre otros. Los estudios consideran inicialmente viables los tramos marítimos superiores a 450 millas, con un volumen de unas 15.000 plataformas al año y que dispongan de eficientes comunicaciones desde el puerto a las redes transeuropeas de autopistas y ferrocarril. Otro objetivo de las Autopistas del Mar es desarrollar las capacidades portuarias de forma que se puedan conectar mejor las regiones periféricas a escala del continente europeo. En lo que a Puertos se refiere, las terminales en los muelles deben contar con una línea de atraque de 250 m., un calado superior a 8 m., una rampa “ro-ro” de doble calzada, grúas portainer, y garantizar operatividad para un mínimo de dos frecuencias de carga semanales. El 28 de marzo de 2011 se publicó el segundo Libro Blanco sobre el futuro del transporte en Europa “Hoja de ruta hacia un espacio único europeo de transporte: por una política de transportes competitiva y sostenible”, donde se definió el marco general de las acciones a emprender en los próximos diez años en el ámbito de las infraestructuras de transporte, la legislación del mercado interior, la reducción de la dependencia del carbono, la tecnología para la gestión del tráfico y los vehículos limpios, así como la estandarización de los distintos mercados. Entre los principales desafíos se encuentran la eliminación de los cuellos de botella y obstáculos diversos de nuestra red europea de transporte, minimizar la dependencia del petróleo, reducir las emisiones de GEI en un 60% para 2050 con respecto a los niveles de 1990 y la inversión en nuevas tecnologías e infraestructuras que reduzcan estas emisiones de transporte en la UE. La conexión entre la UE y el norte de África provoca elevados niveles de congestión en los puntos más críticos del trayecto: frontera hispano-francesa, corredor del Mediterráneo y el paso del estrecho. A esto se le añade el hecho de que el sector del transporte por carretera está sujeto a una creciente competencia de mercado motivada por la eliminación de las barreras europeas, mayores exigencias de los cargadores, mayores restricciones a los conductores y aumento del precio del gasóleo. Por otro lado, el mercado potencial de pasajeros tiene una clara diferenciación en tipos de flujos: los flujos en el período extraordinario de la Operación Paso del Estrecho (OPE), enfocado principalmente a marroquíes que vuelven a su país de vacaciones; y los flujos en el período ordinario, enfocado a la movilidad global de la población. Por tanto, lo que se pretende conseguir con este estudio es analizar la situación actual del tráfico de mercancías y pasajeros con origen o destino la península ibérica y sus causas, así como la investigación de las ventajas de la creación de una conexión marítima (Autopista del Mar) con el Norte de África, basándose en los condicionantes técnicos, administrativos, económicos, políticos, sociales y medio ambientales. The competitiveness of freight transport depends on the condition and operation of existing networks and infrastructure, not the mode of transport. In particular, profitability could be increased or production costs of maritime transport could be reduced by using vessels with greater capacity and developing port distribution platforms or dry ports, seeing as 90% of trade between the European Union and third countries happens through its ports. On average 3,2 billion tonnes of freight are handled annualy and 40% of intra-European traffic uses Short Sea Shipping. In spite of European ports annually hosting more than 400 million passengers, there have been major developments in the northern European ports (Rotterdam, Antwerp, Amsterdam). Southern European countries need to find new ways to be more competitive, either by building new infrastructure or by strengthening existing infrastructure, offering costs northern ports. The use of maritime and river transport as an alternative to road transport, especially Short Sea Shipping, has been driven by the European Commission (EC) from 2003 through community support programs for the Motorways of the Sea. These programs include, for example, the Marco Polo I and II programs, which had a total budget of 855 million euros for the period 2003-2013. During this time objectives were set for reducing road congestion, improving the environmental performance of the freight transport system within the community and enhancing intermodal transport. The “Motorway of the Sea” concept arises in the European Commission’s Transport White Paper "European transport policy for 2010: time to decide" on 12 December 2001, as part of a European policy for the development and promotion of sustainable transport systems. A Motorway of the Sea is defined as a short sea route between two points, covering less distance than by road, which provides a significant improvement in intermodal transport times and to the cost supply chain. It contributes to reducing accidents, noise and CO2 emissions, allows drivers to shorten their driving time and prevents the deterioration of land infrastructure thereby saving on maintenance costs. The viability of a Motorway of the Sea depends as much on geographical location factors as on characteristics of the port, taking into account the different market requirements at all times (energy, environmental and technological). There is a new element created by the European Commission: the trans-European transport network (TEN-T). In the case of Spain, with its two access points in the Pyrenees (La Junquera and Irun) as the only land crossings connected to the mainland and major railway limitations due to the three different gauges, it appears less competitive compared to Europe as a whole. However, Spain is the European country with the most kilometers of coastline (over 8,000 km) and a strategic geographical location, which makes it a logistics platform for the all of Southern Europe. This is why the Motorways of the Sea will have an important role, and an almost necessary one to develop major maritime corridors that Europe supports. In fact, Gijon and Vigo have done very well with their respective sea lanes defined as Motorways of the Sea and which connect with the French port of Nantes-Saint Nazaire, as from there trucks can use nort-heading routes. In parallel, the European Union has taken the first steps to boost the first Motorway of the Sea linking Spain to the UK market, specifically the ports of Bilbao and Tilbury. Furthermore, Spain and Italy sealed an international agreement to develop Motorways of the Sea between both countries, pledging to develop a dozen routes between ports on the Spanish and Italian Mediterranean coasts. Currently, there are sea lanes already in use such as Barcelona-Genova, Valencia-Civitavecchia and Alicante-Naples, these are significantly shorter routes by sea than by road. Brussels identified four major maritime corridors that could hold heavy concentrate shipping traffic, and Spain had a crucial role in two of these from the beginning. On 14 April 2004 the Commission planned through the West-Mos project, a network of maritime traffic which includes the essential sea passages the so-called Baltic Motorway (linking Central and Western Europe with the Baltic countries), the southeast Europe Motorway (linking the Adriatic to the Ionian and eastern Mediterranean Sea), the Western Europe Motorway and southwestern Europe Motorway (that links Spain with Britain and the Atlantic coast of France and with the French Mediterranean coast and Italy, respectively). In order to establish Motorways of the Sea between the Iberian Peninsula and Northern Europe especially, it is necessary to remove trucks from the Pyrenean border, where sees heavy traffic (on average 8000 trucks per day) and addressing the points of greatest congestion, such as the Alps, the Pyrenees, the English Channel, the border roads of France and Euskadi, and proposing the transfer of freight on ships or trains. For its part, in order to receive subsidies and support from the European Commission, the routes selected as Motorways of the Sea should maintain a series of quality criteria related to frequency, costs "from logistics platform to logistics platform," simplicity in administrative procedures and participation of several countries, among others. To begin with, studies consider viable a maritime stretch of at least 450 miles with a volume of about 15,000 platforms per year and that have efficient connections from port to trans-European motorways and rail networks. Another objective of the Motorways of the Sea is to develop port capacity so that they can better connect peripheral regions across the European continent. Referring ports, the terminals at the docks must have a berthing line of 250 m., a draft greater than 8 m, a dual carriageway "ro-ro" ramp, portainer cranes, and ensure operability for a minimum of two loads per week. On 28 March 2011 the second White Paper about the future of transport in Europe "Roadmap to a Single European Transport Area – Towards a competitive and resource efficient transport system" was published. In this Paper the general framework of actions to be undertaken in the next ten years in the field of transport infrastructure was defined, including internal market legislation, reduction of carbon dependency, traffic management technology and clean vehicles, as well as the standardization of different markets. The main challenges are how to eliminate bottlenecks and various obstacles in our European transport network, minimize dependence on oil, reduce GHG emissions by 60% by 2050 compared to 1990 levels and encourage investment in new technologies and infrastructure that reduce EU transport emissions. The connection between the EU and North Africa causes high levels of congestion on the most critical points of the journey: the Spanish-French border, the Mediterranean corridor and Gibraltar Strait. In addition to this, the road transport sector is subject to increased market competition motivated by the elimination of European barriers, greater demands of shippers, greater restrictions on drivers and an increase in the price of diesel. On the other hand, the potential passenger market has a clear differentiation in type of flows: flows in the special period of the Crossing the Straits Operation (CSO), mainly focused on Moroccans who return home on vacation; and flows in the regular session, focused on the global mobile population. Therefore, what I want to achieve with this study is present an analysis of the current situation of freight and passengers to or from the Iberian Peninsula and their causes, as well as present research on the advantages of creating a maritime connection (Motorways of the Sea) with North Africa, based on the technical, administrative, economic, political, social and environmental conditions.

El nuevo escenario global y un modelo de negocio para la industria naval militar del 2025

Los retos y oportunidades a los que se enfrentan las organizaciones y administraciones de las primeras décadas del siglo XXI se caracterizan por una serie de fuerzas perturbadoras como la globalización, el avance de las tecnologías emergentes y el desequilibrio económico, que están actuando como impulsores de la transformación del mercado. La acción conjunta de estos factores está obligando a todas las empresas industriales a tener que trabajar con mayores y más exigentes niveles de productividad planteándose continuamente como mejorar y lograr satisfacer los requerimientos de los clientes. De esta situación surge la necesidad de volver a plantearse de nuevo ¿quién es el cliente?, ¿qué valora el cliente? y ¿cómo se pueden generan beneficios sostenibles? La aplicación de esta reflexión a la industria naval militar marca los objetivos a los que esta tesis doctoral busca dar respuesta. El primer objetivo, de carácter general, consiste en la definición de un modelo de negocio sostenible para la industria naval militar del 2025 que se adapte a los requisitos del cliente y al nuevo escenario político, económico, social, tecnológico y ambiental que rodea esta industria. El segundo objetivo, consecuencia del modelo general, trata de desarrollar una metodología para ejecutar programas de apoyo al ciclo de vida del “buque militar”. La investigación se estructura en cuatro partes: en la primera se justifica, por un lado, la necesidad del cambio de modelo y por otro se identifican los factores estructurantes para la definición del modelo. La segunda parte revisa la literatura existente sobre uno de los aspectos básicos para el nuevo modelo, el concepto Producto-Servicio. La tercera parte se centra totalmente en la industria naval militar estudiando los aspectos concretos del sector y, en base al trabajo de campo realizado, se identifican los puntos que más valoran las Marinas de Guerra y como estas gestionan al buque militar durante todo su ciclo de vida. Por último se presentan los principios del modelo propuesto y se desarrollan los pilares básicos para la ejecución de proyectos de Apoyo al Ciclo de Vida (ACV). Como resultado de la investigación, el modelo propuesto para la industria naval militar se fundamenta en once principios: 1. El buque militar (producto de alto valor añadido) debe ser diseñado y construido en un astillero del país que desarrolla el programa de defensa. 2. El diseño tiene que estar orientado al valor para el cliente, es decir, se tiene que diseñar el buque militar para que cumpla su misión, eficaz y eficientemente, durante toda su vida operativa, asegurando la seguridad del buque y de las personas y protegiendo el medio ambiente de acuerdo con las regulaciones vigentes. 3. La empresa debe suministrar soluciones integrales de apoyo al ciclo de vida al producto. 4. Desarrollar y mantener las capacidades de integración de sistemas complejos para todo el ciclo de vida del buque militar. 5. Incorporar las tecnologías digitales al producto, a los procesos, a las personas y al propio modelo de negocio. 6. Desarrollar planes de actuación con el cliente domestico a largo plazo. Estos planes tienen que estar basados en tres premisas: (i) deben incluir el ciclo de vida completo, desde la fase de investigación y desarrollo hasta la retirada del buque del servicio; (ii) la demanda debe ser sofisticada, es decir las exigencias del cliente, tanto desde la óptica de producto como de eficiencia, “tiran” del contratista y (iii) permitir el mantenimiento del nivel tecnológico y de las capacidades industriales de la compañía a futuro y posicionarla para que pueda competir en el mercado de exportación. 7. Impulsar el sector militar de exportación mediante una mayor actividad comercial a nivel internacional. 8. Fomentar la multilocalización ya que representa una oportunidad de crecimiento y favorece la exportación posibilitando el suministro de soluciones integrales en el país destino. 9. Reforzar la diplomacia institucional como palanca para la exportación. 10. Potenciar el liderazgo tecnológico tanto en producto como en procesos con políticas activas de I + D+ i. 11. Reforzar la capacidad de financiación con soluciones innovadoras. El segundo objetivo de esta tesis se centra en el desarrollo de soluciones integrales de Apoyo al Ciclo de Vida (ACV). La metodología planteada trata de minimizar la brecha entre capacidades y necesidades a lo largo de la vida operativa del barco. Es decir, el objetivo principal de los programas de ACV es que la unidad conserve durante toda su vida operativa, en términos relativos a las tecnologías existentes, las capacidades equivalentes a las que tendrá cuando entre en servicio. Los ejes de actuación para conseguir que un programa de Apoyo al Ciclo de Vida cumpla su objetivo son: el diseño orientado al valor, la ingeniería de Apoyo al Ciclo de Vida, los proyectos de refresco de tecnología, el mantenimiento Inteligente y los contratos basados en prestaciones. ABSTRACT On the first decades of the 21st century, organizations and administrations face challenges and come across opportunities threatened by a number of disruptive forces such as globalization, the ever-changing emerging technologies and the economic imbalances acting as drivers of the market transformation. This combination of factors is forcing all industrial companies to have more and higher demanding productivity levels, while bearing always in mind how to improve and meet the customer’s requirements. In this situation, we need to question ourselves again: Who is the customer? What does the customer value? And how can we deliver sustainable economic benefits? Considering this matter in a military naval industry framework sets the goals that this thesis intends to achieve. The first general goal is the definition of a new sustainable business model for the 2025 naval industry, adapted to the customer requirements and the new political, economic, social, technological and environmental scenario. And the second goal that arises as a consequence of the general model develops a methodology to implement “warship” through life support programs. The research is divided in four parts: the first one justifies, on the one hand, the need to change the existing model and, on the other, identifies the model structural factors. On the second part, current literature regarding one of the key issues on the new model (the Product-Service concept) is reviewed. Based on field research, the third part focuses entirely on military shipbuilding, analyzing specific key aspects of this field and identifying which of them are valued the most by Navies and how they manage through life cycles of warships. Finally, the foundation of the proposed model is presented and also the basic grounds for implementing a Through Life Support (TLS) program are developed. As a result of this research, the proposed model for the naval industry is based on eleven (11) key principles: 1. The warship (a high added value product) must be designed and built in a shipyard at the country developing the defense program. 2. Design must be customer value oriented, i.e.warship must be designed to effectively fulfill its mission throughout its operational life, ensuring safety at the ship and for the people and protecting the environment in accordance with current regulations. 3. The industry has to provide integrated Through Life Support solutions. 4. Develop and maintain integrated complex systems capabilities for the entire warship life cycle. 5. Introduce the product, processes, people and business model itself to digital technologies. 6. Develop long-term action plans with the domestic customer. These plans must be based on three premises: (i) the complete life cycle must be included, starting from the research and development stage throughout the ship’s disposal; (ii) customer demand has to be sophisticated, i.e. customer requirements, both from the efficiency and product perspective, "attract" the contractor and (iii) technological level and manufacturing capabilities of the company in the future must be maintained and a competitive position on the export market has to be achieved. 7. Promote the military exporting sector through increased international business. 8. Develop contractor multi-location as it entails an opportunity for growth and promote export opportunities providing integrated solutions in the customer's country. 9. Strengthen institutional diplomacy as a lever for export. 10. Promote technological leadership in both product and processes with active R & D & I policies (Research & Development & Innovation) 11. Strengthen financing capacity through innovative solutions. The second goal of this thesis is focused on developing integrated Through Life Support (TLS) solutions. The proposed methodology tries to minimize the gap between needs and capabilities through the ship operational life. It means, the main TLS program objective is to maintain the ship’s performance and capabilities during operational life, in relative terms to current technologies, equivalent to those the ship had when it entered service. The main actions to fulfill the TLS program objectives are: value-oriented design, TLS engineering, technology updating projects, intelligent maintenance and performance based contracts.

411 Newsletter Spring 2015 Issue 2

Career and Academic Support Service Newsletter Spring 2015 Issue 2

411 Newsletter Spring 2015 Issue 1

Career and Academic Support Service Newsletter Spring 2015 Issue 1.

Análise de práticas de compras sustentáveis aplicada à indústria química brasileira.

No contexto organizacional, o departamento de suprimentos exerce papel fundamental na melhoria dos desempenhos sociais e ambientais de uma cadeia. Dentre as atividades desempenhadas pela função de suprimentos está a seleção de fornecedores na qual são definidos os critérios utilizados para a escolha de um fornecedor. Sendo assim, pode-se afirmar que a função de suprimentos é capaz de estender a sua cadeia requerimentos econômicos, sociais e ambientais. Como objeto desse trabalho foi selecionada a indústria química, uma vez que trata-se de uma indústria base para diversas outras atividades econômicas e com grande importância na economia brasileira. Além disso, é um segmento marcado por acidentes ambientais bem como programas de apoio ambiental e social mundialmente reconhecidos como o Responsible Care. Diante desse contexto, esse trabalho buscou propor um modelo conceitual de seleção de fornecedores que incorpore critérios sociais e ambientais para a indústria química. A partir da revisão de literatura, elaborou-se a proposta de um modelo conceitual capaz de abranger organizações compradoras em diferentes níveis de maturidade para incorporação de critérios sociais e ambientais em seu processo de seleção de fornecedores. A primeira etapa proposta no modelo consiste na utilização de ferramentas simples como listagens, nessa primeira etapa o objetivo é proteger a organização compradora de um comportamento não adequado por parte do fornecedor à legislação pertinente. A segunda etapa do modelo consiste no desenvolvimento de uma base gerencial, estabelecimento de critérios sociais e ambientais e utilização de certificações para seleção de fornecedores. Através do método survey, por correio eletrônico, entre abril a setembro do ano de 2015, objetivou-se compreender as atitudes dos responsáveis por formular e implementar as estratégias de compras em direção às compras sustentáveis. A pesquisa demonstrou que há descompasso entre estratégia e execução no sentido de incorporar as perspectivas sociais e ambientais em um processo de seleção de fornecedores. O estudo indicou que as organizações ainda se encontram em estágios iniciais de seleção do fornecedor e compras em se tratando da inclusão de uma perspectiva socioambiental. As ações apresentam-se mais em termos de políticas e documentações, do que em nível operacional.

Reducing dependence on big brother:Higher Education looks for innovative funding opportunities

This paper presents innovative programs that business schools can utilize to reduce dependence on public funds. A review of the literature shows the theoretical and empirical foundation of higher education funding dilemmas. While higher education is moving towards a global ambition, scarcity hinders governments to fully support programs long-term; thus, cost-sharing and cost-shifting measures must occur for higher education to support current programs. In this study, we examine two universities (one U.S. and one U.K.) and provide practical summaries of programs that have provided additional funds. We show that diversity of funding sources is essential for survival of higher education institutions. Market forces require competition to reduce higher education operational costs while providing students and corporate clients an a la carte educational experience.

Effects of the current financial and economic crisis on the rural landscape as well as the agri-food sector in Europe and Central Asia

This paper reviews the expected effects of the current financial crisis and subsequent recession on the rural landscape, in particular the agri-food sector in Europe and Central Asia (ECA) on the basis of the structure of the rural economy and of different organisations and institutions. Empirical evidence suggests that the crisis has hit the ECA region the hardest. Agriculture contributes about 9% to gross domestic product (GDP) for the ECA region as a whole with 16% of the population being employed in the agricultural sector. As far as the impact of the financial crisis on the agri-food sector is concerned, there are a few interconnected issues: (1) reduction in income elastic food demand and commodity price decline, (2) loss of employment and earnings of rural people working in urban centres, implying also costly labour reallocation, (3) rising rural poverty originating mainly from lack of opportunities in the non-farm sector and a sizable decline of international remittances, (4) tightening of agricultural credit markets, and the (5) collapse of sectoral government support programs and social safety-net measures in many countries. The paper reveals how the crisis hit farming and broader agri-business differently in general and in the ECA sub-regions.

Does hope matter? The influence of dispositional hope on persistence in a developmental writing course

The purpose of this study was to determine hope’s unique role, if any, in predicting persistence in a developmental writing course. Perceived academic self-efficacy was also included as a variable of interest for comparison because self-efficacy has been more widely studied than hope in terms of its non-cognitive role in predicting academic outcomes. A significant body of research indicates that self-efficacy influences academic motivation to persist and academic performance. Hope, however, is an emerging psychological construct in the study of non-cognitive factors that influence college outcomes and warrants further exploration in higher education. This study examined the predictive value of hope and self-efficacy on persistence in a developmental writing course. The research sample was obtained from a community college in the southeastern United States. Participants were 238 students enrolled in developmental writing courses during their first year of college. Participants were given a questionnaire that included measures for perceived academic self-efficacy and hope. The self-efficacy scale asked participants to self-report on their beliefs about how they cope with different academic tasks in order to be successful. The hope scale asked students to self-report on their beliefs about their capability to initiate action towards a goal (“agency”) and create a plan to attain these goals (“pathways”). This study utilized a correlational research design. A statistical association was estimated between hope and self-efficacy as well as the unique variance contributed by each on course persistence. Correlational analysis confirmed a significant relationship between hope and perceived academic self-efficacy, and a Fisher’s z-transformation confirmed a stronger relationship between the agency component of hope and perceived academic self-efficacy than for the pathways component. A series of multinomial logistic regression analyses were conducted to assess if (a) perceived self-efficacy and hope predict course persistence, (b) hope independent of self-efficacy predicts course persistence, and (c) if including the interaction of perceived self-efficacy and hope predicts course persistence. It was found that hope was only significant independent of self-efficacy. Some implications for future research are drawn for those who lead and coordinate academic support initiatives in student and academic affairs.

Engagement experiences of Hispanic Generation 1.5 English language learners at a Massachusetts community college

Hispanic Generation 1.5 students are foreign-born, U.S. high school graduates who are socialized in the English dominant K-12 school system while still maintaining the native language and culture at home (Allison, 2006; Blumenthal, 2002; Harklau, Siegal, & Losey, 1999; Rumbault & Ima, 1988). When transitioning from high school to college, these students sometimes assess into ESL courses based on their English language abilities, and because of this ESL placement, Hispanic Generation 1.5 students might have different engagement experiences than their mainstream peers. Engagement is a critical factor in student success and long-term retention because students’ positive and negative engagement experiences affect their membership and sense of belonging at the institution. The purpose of this study was to describe the engagement and membership experiences of Hispanic Generation 1.5 students’ at a Massachusetts community college. This study employed naturalistic inquiry within an embedded descriptive case study design that included three units of analysis: the students’ engagement experiences in (a) ESL courses, (b) developmental courses, and (c) mainstream courses. The main source of data was in-depth interviews with Hispanic Generation 1.5 students at Commonwealth of Massachusetts Community College. Criterion sampling was used to select the interview participants, ensuring that all participants were native Spanish speakers and were taking or had taken at least one ESL course at the institution. The study findings show that these Hispanic Generation 1.5 students at the college did not perceive peer engagement as critical to academic success. Most times the participants avoided peer engagement outside of the classroom, especially with fellow Hispanic students, who they felt would deter them from their English language development and general academic work. Engagement with ESL faculty and ESL academic support staff played the most critical role in the participants’ sense of belonging and success, and students who were required to engage with faculty and academic support staff outside of the classroom were the most satisfied with their educational experiences. While the participants were all disappointed with some aspect of their ESL placement, they valued the ESL engagement experiences more than the engagement experiences while completing developmental and credit coursework.

Does Hope Matter? The Influence of Dispositional Hope on Persistence in a Developmental Writing Course

The purpose of this study was to determine hope’s unique role, if any, in predicting persistence in a developmental writing course. Perceived academic self-efficacy was also included as a variable of interest for comparison because self-efficacy has been more widely studied than hope in terms of its non-cognitive role in predicting academic outcomes. A significant body of research indicates that self-efficacy influences academic motivation to persist and academic performance. Hope, however, is an emerging psychological construct in the study of non-cognitive factors that influence college outcomes and warrants further exploration in higher education. This study examined the predictive value of hope and self-efficacy on persistence in a developmental writing course. The research sample was obtained from a community college in the southeastern United States. Participants were 238 students enrolled in developmental writing courses during their first year of college. Participants were given a questionnaire that included measures for perceived academic self-efficacy and hope. The self-efficacy scale asked participants to self-report on their beliefs about how they cope with different academic tasks in order to be successful. The hope scale asked students to self-report on their beliefs about their capability to initiate action towards a goal (“agency”) and create a plan to attain these goals (“pathways”). This study utilized a correlational research design. A statistical association was estimated between hope and self-efficacy as well as the unique variance contributed by each on course persistence. Correlational analysis confirmed a significant relationship between hope and perceived academic self-efficacy, and a Fisher’s z-transformation confirmed a stronger relationship between the agency component of hope and perceived academic self-efficacy than for the pathways component. A series of multinomial logistic regression analyses were conducted to assess if (a) perceived self-efficacy and hope predict course persistence, (b) hope independent of self-efficacy predicts course persistence, and (c) if including the interaction of perceived self-efficacy and hope predicts course persistence. It was found that hope was only significant independent of self-efficacy. Some implications for future research are drawn for those who lead and coordinate academic support initiatives in student and academic affairs.

Managing the multiplicities of graduate level education! Are Master’s students’ expectations matched by their experiences?

With rapid increases in student fees reflecting moves towards a QUASI Market model of Higher Education in the UK and across much of the Western World[1], many universities find themselves having to meet progressively higher levels of student expectations[2]. This is particularly the case at undergraduate level, where increases in fees over the past decade have far exceeded inflation. Yet with so much attention on ‘consumer savvy’ undergraduates, the question of whether Master’s level students’ expectations are matched by their experiences is one which remains largely unanswered. Grounded in an empirically grounded approach to learning and teaching developed by the paper authors[3], this paper sets out to being to answer this question. In doing so it makes a distinctive contribution to debates about graduate level engineering education and concludes with a number of recommendations. Discussion: The ‘MSc: Managing Expectations’ Project analyses the expectations and experiences of Graduate level Engineering Management Students over a two year period. Focusingon the ‘student experience’, three main concepts are identified as being particular relevant to enhancing learning [3]: Relationships: Variety: Synergy. Relationships: Based on empirical research, the significance of Relationships within the academic environment is discussed with particular attention being paid to the value of students’ social and academic support networks, including academic tutoring. Variety: Grounded in a statistical analysis of ‘engagement data’ together with survey and interview findings, the concept of variety critically examines students’ perspectives and experiencesof different approaches to learning and teaching. Synergy: Possibly the most important concept discussed within this paper, the need for constructively aligned curriculum is extended to reflect the students’ apriori knowledge and experienceas well as employer and societal demands and expectations. The conclusion brings the different concepts within the discussion together, providing a set of practical recommendations for colleagues working both at graduate and undergraduate level. References 1.Gibbs, P. (2001) "Higher education as a market: a problem or solution?." Studies in Higher Education 26. 1. pp. 85-94. 2.Tricker, T., (2005) Student Expectations-How do we measure up. University of Sheffield. Available from: http://www.persons.org.uk/tricker%20paper.pdf Accessed 9/10/14 3.Clark, R. & Andrews, J. (2014). Relationships, Variety & Synergy [RVS]: The Vital Ingredients for Scholarship in Engineering Education? A Case-Study. European Journal of Engineering Education. 39.6. pp. 585-600.

Challenges in the Management of Geriatric Obesity in High Risk Populations.

The global prevalence of obesity in the older adult population is growing, an increasing concern in both the developed and developing countries of the world. The study of geriatric obesity and its management is a relatively new area of research, especially pertaining to those with elevated health risks. This review characterizes the state of science for this "fat and frail" population and identifies the many gaps in knowledge where future study is urgently needed. In community dwelling older adults, opportunities to improve both body weight and nutritional status are hampered by inadequate programs to identify and treat obesity, but where support programs exist, there are proven benefits. Nutritional status of the hospitalized older adult should be optimized to overcome the stressors of chronic disease, acute illness, and/or surgery. The least restrictive diets tailored to individual preferences while meeting each patient's nutritional needs will facilitate the energy required for mobility, respiratory sufficiency, immunocompentence, and wound healing. Complications of care due to obesity in the nursing home setting, especially in those with advanced physical and mental disabilities, are becoming more ubiquitous; in almost all of these situations, weight stability is advocated, as some evidence links weight loss with increased mortality. High quality interdisciplinary studies in a variety of settings are needed to identify standards of care and effective treatments for the most vulnerable obese older adults.