Uptake of a free coronary heart disease risk screening programme in community pharmacy: the Healthy Heart Assessment service

Introduction Health promotion (HP) aims to enhance good health while preventing ill-health at three levels of activity; primary (preventative), secondary (diagnostic) and tertiary (management).1 It can range from simple provision of health education to ongoing support, but the effectiveness of HP is ultimately dependent on its ability to influence change. HP as part of the Community Pharmacy Contract (CPC) aims to increase public knowledge and target ‘hard-to-reach’ individuals by focusing mainly on primary and tertiary HP. The CPC does not include screening programmes (secondary HP) as a service. Coronary heart disease (CHD) is a significant cause of morbidity and mortality in the UK. While there is evidence to support the effectiveness of some community pharmacy HP strategies in CHD, there is paucity of research in relation to screening services.2 Against this background, Alliance Pharmacy introduced a free CHD risk screening programme to provide tailored HP advice as part of a participant–pharmacist consultation. The aim of this study is to report on the CHD risk levels of participants and to provide a qualitative indication of consultation outcomes. Methods Case records for 12 733 people who accessed a free CHD risk screening service between August 2004 and April 2006 offered at 217 community pharmacies were obtained. The service involved initial self-completion of the Healthy Heart Assessment (HHA) form and measurement of height, weight, body mass index, blood pressure, total cholesterol and highdensity lipoprotein levels by pharmacists to calculate CHD risk.3 Action taken by pharmacists (lifestyle advice, statin recommendation or general practitioner (GP) referral) and qualitative statements of advice were recorded, and a copy provided to the participants. The service did not include follow-up of participants. All participants consented to taking part in evaluations of the service. Ethical committee scrutiny was not required for this service development evaluation. Results Case records for 10 035 participants (3658 male) were evaluable; 5730 (57%) were at low CHD risk (<15%); 3636 (36%) at moderate-to-high CHD risk (≥15%); and 669 (7%) had existing heart disease. A significantly higher proportion of male (48% versus 30% female) participants were at moderate- to-high risk of CHD (chi-square test; P < 0.005). A range of outcomes resulted from consultations. Lifestyle advice was provided irrespective of participants’ CHD risk or existing disease. In the moderate-to-high-risk group, of which 52% received prescribed medication, lifestyle advice was recorded for 62%, 16% were referred and 34% were advised to have a re-assessment. Statin recommendations were made in 1% of all cases. There was evidence of supportive and motivational statements in the advice recorded. Discussion Pharmacists were able to identify individuals’ level of CHD risk and provide them with bespoke advice. Identification of at-risk participants did not automatically result in referrals or statin recommendation. One-third of those accessing the screening service had moderate-to-high risk of CHD, a significantly higher proportion of whom were men. It is not known whether these individuals had been previously exposed to HP but presumably by accessing this service they may have contemplated change. As effectiveness of HP advice will depend among other factors on ability to influence change, future consultations may need to explore patients’ attitude towards change in relation to the Trans Theoretical Model4 to better tailor HP advice. The high uptake of the service by those at moderate-to-high CHD risk indicates a need for this type of screening programme in community pharmacy, perhaps specifically to reach men who access medical services less.

Key drivers of frontline employee generation of ideas for customer service improvement

Anchored in the service-dominant logic and service innovation literature, this study investigates the drivers of employee generation of ideas for service improvement (GISI). Employee GISI focuses on customer needs and providing the exact service wanted by customers. GISI should enhance competitive advantage and organizational success (cf. Berry et al. 2006; Wang and Netemeyer 2004). Despite its importance, there is little research on the idea generation stage of the service development process (Chai, Zhang, and Tan 2005). This study contributes to the service field by providing the first empirical evaluation of the drivers of GISI. It also investigates a new explanatory determinant of reading of customer needs, namely, perceived organizational support (POS), and an outcome of POS, in the form of emotional exhaustion. Results show that the major driver of GISI is reading of customer needs by employees followed by affective organizational commitment and job satisfaction. This research provides several new and important insights for service management practice by suggesting that special care should be put into selecting and recruiting employees who have the ability to read customer needs. Additionally, organizations should invest in creating work environments that encourage and reward the flow of ideas for service improvement

Dual semiosis analysis model managing customer-focused service innovation

Customers will not continue to pay for a service if it is perceived to be of poor quality, and/or of no value. With a paradigm shift towards business dependence on service orientated IS solutions [1], it is critical that alignment exists between service definition, delivery, and customer expectation, businesses are to ensure customer satisfaction. Services, and micro-service development, offer businesses a flexible structure for solution innovation, however, constant changes in technology, business and societal expectations means an iterative analysis solution is required to i) determine whether provider services adequately meet customer segment needs and expectations, and ii) to help guide business service innovation and development. In this paper, by incorporating multiple models, we propose a series of steps to help identify and prioritise service gaps. Moreover, the authors propose the Dual Semiosis Analysis Model, i.e. a tool that highlights where within the symbiotic customer / provider semiosis process, requirements misinterpretation, and/or service provision deficiencies occur. This paper offers the reader a powerful customer-centric tool, designed to help business managers highlight both what services are critical to customer quality perception, and where future innovation

The concept of e-service from a social interaction perspective

Today’s e-services are complex phenomenon consisting of several different e-services linked together. The e-services are provided by IT systems and presented to customers through user interfaces. Within web design research criteria are laid out for the design of good user interfaces, but one problem is that these analyses are performed without a service focus. This lack of service focus can result in the designed user interfaces providing indistinct service concepts, especially where several e-services are intertwined with each other.In order to design IT system interfaces, we have to be clear about which e-services are provided by the IT system and how these e-services are related to each other. This paper presents a framework for the analysis of user interfaces in terms of focused e-service, service environment and two types of intertwined e-services; related e-services and interrelating e-services. The analyses are exemplified by an Internet based e-marketplace. The paper discusses how the framework can be combined with ordinary web design criteria and how it can be used for e-service development.

Desenvolvimento de membranas porosas de alumina para fins de tratamento de efluente industrial têxtil

Textile production has been considered as an activity of high environmental impact due to the generation of large volumes of waste water with high load of organic compounds and strongly colored effluents, toxic and difficult biodegradability. This thesis deals with obtaining porous alumina ceramic membranes for filtration of textile effluent in the removal of contaminants, mainly color and turbidity. Two types of alumina with different particle sizes as a basis for the preparation of formulation for mass production of ceramic samples and membranes. The technological properties of the samples were evaluated after using sintering conditions: 1,350ºC-2H, 1,450ºC-30M, 1,450ºC-2H, 1,475ºC-30M and 1,475ºC-2H. The sintered samples were characterized by XRD, XRF, AG, TG, DSC, DL, AA, MEA, RL, MRF-3P, SEM and Intrusion Porosimetry by Mercury. After the characterization, a standard membrane was selected with their respective sintering condition for the filterability tests. The effluent was provided by a local Textile Industry and characterized at the entry and exit of the treatment plant. A statistical analysis was used to study the effluent using the following parameters: pH, temperature, EC, SS, SD, oil and grease, turbidity, COD, DO, total phosphorus, chlorides, phenols, metals and fecal coliform. The filtered effluent was evaluated by using the same parameters. These results demonstrate that the feasibility of the use of porous alumina ceramic membranes for removing contaminants from textile effluent with improved average pore size of 0.4 micrometre (distribution range varying from 0,025 to 2.0 micrometre), with total porosity of 29.66%, and average percentages of color removal efficiency of 89.02%, 92.49% of SS, turbidity of 94.55%, metals 2.70% (manganese) to 71.52% (iron) according to each metal and COD removal of 72.80%

Dinámicas territoriales en el frente portuario de la microregión de Zárate y Campana en las últimas dos décadas

Este trabajo es parte de un Proyecto de Incentivos de mayor envergadura. En esta oportunidad, se presenta el análisis realizado sobre las dinámicas del sector industrial y los espacios portuarios de la microregión de Zárate y Campana haciendo énfasis en las tensiones territoriales resultantes durante la etapa neoliberal y neodesarrollista iniciada en el año 2002. La elección de estas ciudades se debió a que han mostrado en los últimos años un dinamismo superior a la media de la región y conforman un importante polo industrial y portuario. En los períodos analizados se pudo observar que recibieron grandes inversiones en industria, servicios e infraestructuras de parte de firmas trasnacionales y del Estado, en sus diversos niveles jurisdiccionales, que ayudaron a consolidar su liderazgo en la Región Metropolitana de Buenos Aires y redefinir su posición a diferentes escalas. Pasaron así a integrar un nuevo espacio geoeconómico, por su inserción en cadenas productivas globales en el contexto del Mercosur

Dinámicas territoriales en el frente portuario de la microregión de Zárate y Campana en las últimas dos décadas

Este trabajo es parte de un Proyecto de Incentivos de mayor envergadura. En esta oportunidad, se presenta el análisis realizado sobre las dinámicas del sector industrial y los espacios portuarios de la microregión de Zárate y Campana haciendo énfasis en las tensiones territoriales resultantes durante la etapa neoliberal y neodesarrollista iniciada en el año 2002. La elección de estas ciudades se debió a que han mostrado en los últimos años un dinamismo superior a la media de la región y conforman un importante polo industrial y portuario. En los períodos analizados se pudo observar que recibieron grandes inversiones en industria, servicios e infraestructuras de parte de firmas trasnacionales y del Estado, en sus diversos niveles jurisdiccionales, que ayudaron a consolidar su liderazgo en la Región Metropolitana de Buenos Aires y redefinir su posición a diferentes escalas. Pasaron así a integrar un nuevo espacio geoeconómico, por su inserción en cadenas productivas globales en el contexto del Mercosur

Dinámicas territoriales en el frente portuario de la microregión de Zárate y Campana en las últimas dos décadas

Este trabajo es parte de un Proyecto de Incentivos de mayor envergadura. En esta oportunidad, se presenta el análisis realizado sobre las dinámicas del sector industrial y los espacios portuarios de la microregión de Zárate y Campana haciendo énfasis en las tensiones territoriales resultantes durante la etapa neoliberal y neodesarrollista iniciada en el año 2002. La elección de estas ciudades se debió a que han mostrado en los últimos años un dinamismo superior a la media de la región y conforman un importante polo industrial y portuario. En los períodos analizados se pudo observar que recibieron grandes inversiones en industria, servicios e infraestructuras de parte de firmas trasnacionales y del Estado, en sus diversos niveles jurisdiccionales, que ayudaron a consolidar su liderazgo en la Región Metropolitana de Buenos Aires y redefinir su posición a diferentes escalas. Pasaron así a integrar un nuevo espacio geoeconómico, por su inserción en cadenas productivas globales en el contexto del Mercosur

Development of Robotized Laser Welding Applications for Joining Thin Sheets

Laser Welding (LW) is more often used in manufacturing due to its advantages, such as accurate control, good repeatability, less heat input, opportunities for joining of special materials, high speed, capability to join small dimension parts etc. LW is dedicated to robotized manufacturing, and the fabrication cells are using various level of flexibility, from specialized robots to very flexible setups. This paper features several LW applications using two industrially-scaled manufacturing cells at UPM Laser Centre (CLUPM) of Polytechnical University of Madrid (Universidad Politécnica de Madrid). The one dedicated to Remote Laser Welding (RLW) of thin sheets for automotive and other sectors uses a CO2 laser of 3500 W. The second has a high flexibility, is based on a 6-axis ABB robot and a Nd:YAG laser of 3300 W, and is meant for various laser processing methods, including welding. After a short description of each cell, several LW applications experimented at CLUPM and recently implemented in industry are briefly presented: RLW of automotive coated sheets, LW of high strength automotive sheets, LW vs. laser hybrid welding (LHW) of Double Phase steel thin sheets, and LHW of thin sheets of stainless steel and carbon steel (dissimilar joints). The main technological issues overcame and the critical process parameters are pointed out. Conclusions about achievements and trends are provided.

Renewable energy infrastructure. A challenge for Venezuelan industrial construction

The relevance of renewable energy has grown significantly in our global society. Important efforts are oriented to sustain it. Renewable energy depends on different technical, financial environmental and social complex processes. From the point of view of industrial construction sector this research evaluates some of the current trends in energy generation and use in Venezuela as well as environmental consequences and risks that derive from these. Additionally, authors highlight the importance of infrastructure as key issue to sustain renewable energy generation and use. The study present references of some energy renewable projects in process in Venezuela and the main problems that constrain their performance. Conclusions evidence the complex nature of industrial construction and suggest the need to improve industrial construction competitivenes as a strategy oriented to enhance renewable energy offer in the country. Additionally it is proposed to all stakeholders to work toghether to correct the conditions that currently limit industrial construction development. This is part of ongoing research.

Contribution to flexible service coordination in mobile prosumer environments

Este trabajo de Tesis se desarrolla en el marco de los escenarios de ejecución distribuida de servicios móviles y contribuye a la definición y desarrollo del concepto de usuario prosumer. El usuario prosumer se caracteriza por utilizar su teléfono móvil para crear, proveer y ejecutar servicios. Este nuevo modelo de usuario contribuye al avance de la sociedad de la información, ya que el usuario prosumer se transforma de creador de contenidos a creador de servicios (estos últimos formados por contenidos y la lógica para acceder a ellos, procesarlos y representarlos). El objetivo general de este trabajo de Tesis es la provisión de un modelo de creación, distribución y ejecución de servicios para entorno móvil que permita a los usuarios no programadores (usuarios prosumer), pero expertos en un determinado dominio, crear y ejecutar sus propias aplicaciones y servicios. Para ello se definen, desarrollan e implementan metodologías, procesos, algoritmos y mecanismos adaptables a dominios específicos, para construir entornos de ejecución distribuida de servicios móviles para usuarios prosumer. La provisión de herramientas de creación adaptadas a usuarios no expertos es una tendencia actual que está siendo desarrollada en distintos trabajos de investigación. Sin embargo, no se ha propuesto una metodología de desarrollo de servicios que involucre al usuario prosumer en el proceso de diseño, desarrollo, implementación y validación de servicios. Este trabajo de Tesis realiza un estudio de las metodologías y tecnologías más innovadoras relacionadas con la co‐creación y utiliza este análisis para definir y validar una metodología que habilita al usuario para ser el responsable de la creación de servicios finales. Siendo los entornos móviles prosumer (mobile prosumer environments) una particularización de los entornos de ejecución distribuida de servicios móviles, en este trabajo se tesis se investiga en técnicas de adaptación, distribución, coordinación de servicios y acceso a recursos identificando como requisitos las problemáticas de este tipo de entornos y las características de los usuarios que participan en los mismos. Se contribuye a la adaptación de servicios definiendo un modelo de variabilidad que soporte la interdependencia entre las decisiones de personalización de los usuarios, incorporando mecanismos de guiado y detección de errores. La distribución de servicios se implementa utilizando técnicas de descomposición en árbol SPQR, cuantificando el impacto de separar cualquier servicio en distintos dominios. Considerando el plano de comunicaciones para la coordinación en la ejecución de servicios distribuidos hemos identificado varias problemáticas, como las pérdidas de enlace, conexiones, desconexiones y descubrimiento de participantes, que resolvemos utilizando técnicas de diseminación basadas en publicación subscripción y algoritmos Gossip. Para lograr una ejecución flexible de servicios distribuidos en entorno móvil, soportamos la adaptación a cambios en la disponibilidad de los recursos, proporcionando una infraestructura de comunicaciones para el acceso uniforme y eficiente a recursos. Se han realizado validaciones experimentales para evaluar la viabilidad de las soluciones propuestas, definiendo escenarios de aplicación relevantes (el nuevo universo inteligente, prosumerización de servicios en entornos hospitalarios y emergencias en la web de la cosas). Abstract This Thesis work is developed in the framework of distributed execution of mobile services and contributes to the definition and development of the concept of prosumer user. The prosumer user is characterized by using his mobile phone to create, provide and execute services. This new user model contributes to the advancement of the information society, as the prosumer is transformed from producer of content, to producer of services (consisting of content and logic to access them, process them and represent them). The overall goal of this Thesis work is to provide a model for creation, distribution and execution of services for the mobile environment that enables non‐programmers (prosumer users), but experts in a given domain, to create and execute their own applications and services. For this purpose I define, develop and implement methodologies, processes, algorithms and mechanisms, adapted to specific domains, to build distributed environments for the execution of mobile services for prosumer users. The provision of creation tools adapted to non‐expert users is a current trend that is being developed in different research works. However, it has not been proposed a service development methodology involving the prosumer user in the process of design, development, implementation and validation of services. This thesis work studies innovative methodologies and technologies related to the co‐creation and relies on this analysis to define and validate a methodological approach that enables the user to be responsible for creating final services. Being mobile prosumer environments a specific case of environments for distributed execution of mobile services, this Thesis work researches in service adaptation, distribution, coordination and resource access techniques, and identifies as requirements the challenges of such environments and characteristics of the participating users. I contribute to service adaptation by defining a variability model that supports the dependency of user personalization decisions, incorporating guiding and error detection mechanisms. Service distribution is implemented by using decomposition techniques based on SPQR trees, quantifying the impact of separating any service in different domains. Considering the communication level for the coordination of distributed service executions I have identified several problems, such as link losses, connections, disconnections and discovery of participants, which I solve using dissemination techniques based on publish‐subscribe communication models and Gossip algorithms. To achieve a flexible distributed service execution in mobile environments, I support adaptation to changes in the availability of resources, while providing a communication infrastructure for the uniform and efficient access to resources. Experimental validations have been conducted to assess the feasibility of the proposed solutions, defining relevant application scenarios (the new intelligent universe, service prosumerization in hospitals and emergency situations in the web of things).

Service capacity reserve under uncertainty by hospital's ER's analogies: a practical model for car services

El objetivo de esta investigación consiste en definir un modelo de reserva de capacidad, por analogías con emergencias hospitalarias, que pueda ser implementado en el sector de servicios. Este está específicamente enfocado a su aplicación en talleres de servicio de automóviles. Nuestra investigación incorpora la incertidumbre de la demanda en un modelo singular diseñado en etapas que agrupa técnicas ARIMA, teoría de colas y simulación Monte Carlo para definir los conceptos de capacidad y ocupación de servicio, que serán utilizados para minimizar el coste implícito de la reserva capacidad necesaria para atender a clientes que carecen de cita previa. Habitualmente, las compañías automovilísticas estiman la capacidad de sus instalaciones de servicio empíricamente, pero los clientes pueden llegar bajo condiciones de incertidumbre que no se tienen en cuenta en dichas estimaciones, por lo que existe una diferencia entre lo que el cliente realmente demanda y la capacidad que ofrece el servicio. Nuestro enfoque define una metodología válida para el sector automovilístico que cubre la ausencia genérica de investigaciones recientes y la habitual falta de aplicación de técnicas estadísticas en el sector. La equivalencia con la gestión de urgencias hospitalarias se ha validado a lo largo de la investigación en la se definen nuevos indicadores de proceso (KPIs) Tal y como hacen los hospitales, aplicamos modelos estocásticos para dimensionar las instalaciones de servicio de acuerdo con la distribución demográfica del área de influencia. El modelo final propuesto integra la predicción del coste implícito en la reserva de capacidad para atender la demanda no prevista. Asimismo, se ha desarrollado un código en Matlab que puede integrarse como un módulo adicional a los sistemas de información (DMS) que se usan actualmente en el sector, con el fin de emplear los nuevos indicadores de proceso definidos en el modelo. Los resultados principales del modelo son nuevos indicadores de servicio, tales como la capacidad, ocupación y coste de reserva de capacidad, que nunca antes han sido objeto de estudio en la industria automovilística, y que están orientados a gestionar la operativa del servicio. ABSTRACT Our aim is to define a Capacity Reserve model to be implemented in the service sector by hospital's emergency room (ER) analogies, with a practical approach to passenger car services. A stochastic model has been implemented using R and a Monte Carlo simulation code written in Matlab and has proved a very useful tool for optimal decision making under uncertainty. The research integrates demand uncertainty in a unique model which is built in stages by implementing ARIMA forecasting, Queuing Theory and a Monte Carlo simulation to define the concepts of service capacity and occupancy, minimizing the implicit cost of the capacity that must be reserved to service unexpected customers. Usually, passenger car companies estimate their service facilities capacity using empirical methods, but customers arrive under uncertain conditions not included in the estimations. Thus, there is a gap between customer’s real demand and the dealer’s capacity. This research sets a valid methodology for the passenger car industry to cover the generic absence of recent researches and the generic lack of statistical techniques implementation. The hospital’s emergency room (ER) equalization has been confirmed to be valid for the passenger car industry and new process indicators have been defined to support the study. As hospitals do, we aim to apply stochastic models to dimension installations according to the demographic distribution of the area to be serviced. The proposed model integrates the prediction of the cost implicit in the reserve capacity to serve unexpected demand. The Matlab code could be implemented as part of the existing information technology systems (ITs) to support the existing service management tools, creating a set of new process indicators. Main model outputs are new indicators, such us Capacity, Occupancy and Cost of Capacity Reserve, never studied in the passenger car service industry before, and intended to manage the service operation.