Reducing the time before consulting with symptoms of lung cancer:a randomised controlled trial in primary care

Background: Most individuals with lung cancer have symptoms for several months before presenting to their GP. Earlier consulting may improve survival. Aim: To evaluate whether a theory-based primary care intervention increased timely consulting of individuals with symptoms of lung cancer. Design and setting: Open randomised controlled trial comparing intervention with usual care in two general practices in north-east Scotland. Method: Smokers and ex-smokers aged ≥55 years were randomised to receive a behavioural intervention or usual care. The intervention comprised a single nurse consultation at participants' general practice and a self-help manual. The main outcomes were consultations within target times for individuals with new chest symptoms (≤3 days haemoptysis, ≤3 weeks other symptoms) in the year after the intervention commenced, and intentions about consulting with chest symptoms at 1 and 6 months. Results: Two hundred and twelve participants were randomised and 206 completed the trial. The consultation rate for new chest symptoms in the intervention group was 1.19 (95% confidence interval [CI] = 0.92 to 1.53; P = 0.18) times higher than in the usual-care group and the proportion of consultations within the target time was 1.11 (95% CI = 0.41 to 3.03; P = 0.83) times higher. One month after the intervention commenced, the intervention group reported intending to consult with chest symptoms 31 days (95% CI = 7 to 54; P = 0.012) earlier than the usual care group, and at 6 months this was 25 days (95% CI = 1.5 to 48; P = 0.037) earlier. Conclusion: Behavioural intervention in primary care shortened the time individuals at high risk of lung disease intended to take before consulting with new chest symptoms (the secondary outcome of the study), but increases in consultation rates and the proportions of consultations within target times were not statistically significant. © British Journal of General Practice.

Designing in a group:how does knowing each other influence design projects

This paper presents a study of engineering design groups that seeks to explain how knowing other participants can influence processes and outcomes in design projects. Research in this paper contributes a framework to approach understanding how interpersonal relationships influence group processes and outcomes. This acknowledges that engineering design is achieved through individuals working in groups. First a temporal perspective is introduced to understand how individuals (through interpersonal relationships), group processes and outcomes influence each other; secondly identity is presented as a theme to focus on how knowing other participants identity influences group processes and outcomes. Within this framework it is recognised that engineering design has different levels of complexity of which two aspects are considered: design type and design setting. These aspects place different demands on a project group and its members and this structure provides an opportunity for cross case analysis to generalise findings.

From art for arts sake to art as means of knowing:a rationale for advancing arts-based methods in research, practice and pedagogy

This paper advances a philosophically informed rationale for the broader, reflexive and practical application of arts-based methods to benefit research, practice and pedagogy. It addresses the complexity and diversity of learning and knowing, foregrounding a cohabitative position and recognition of a plurality of research approaches, tailored and responsive to context. Appreciation of art and aesthetic experience is situated in the everyday, underpinned by multi-layered exemplars of pragmatic visual-arts narrative inquiry undertaken in the third, creative and communications sectors. Discussion considers semi-guided use of arts-based methods as a conduit for topic engagement, reflection and intersubjective agreement; alongside observation and interpretation of organically employed approaches used by participants within daily norms. Techniques span handcrafted (drawing), digital (photography), hybrid (cartooning), performance dimensions (improvised installations) and music (metaphor and structure). The process of creation, the artefact/outcome produced and experiences of consummation are all significant, with specific reflexivity impacts. Exploring methodology and epistemology, both the "doing" and its interpretation are explicated to inform method selection, replication, utility, evaluation and development of cross-media skills literacy. Approaches are found engaging, accessible and empowering, with nuanced capabilities to alter relationships with phenomena, experiences and people. By building a discursive space that reduces barriers; emancipation, interaction, polyphony, letting-go and the progressive unfolding of thoughts are supported, benefiting ways of knowing, narrative (re)construction, sensory perception and capacities to act. This can also present underexplored researcher risks in respect to emotion work, self-disclosure, identity and agenda. The paper therefore elucidates complex, intricate relationships between form and content, the represented and the representation or performance, researcher and participant, and the self and other. This benefits understanding of phenomena including personal experience, sensitive issues, empowerment, identity, transition and liminality. Observations are relevant to qualitative and mixed methods researchers and a multidisciplinary audience, with explicit identification of challenges, opportunities and implications.

Acceptability of Lean Six Sigma in a developing economy:results from exploratory research in Nigerian consulting companies

The application of Lean Six Sigma (LSS) varies in different regions of the world in terms of both level of understanding and acceptability. Employing a qualitative methodological approach, this paper aims to explore factors hindering the acceptability of the LSS initiative in organizations and list factors required for successful application and implementation in a developing economy from the perspective of LSS consultants. Using Nigeria as a case study, primary data were collected though a number of semi-structured interviews with representatives of leading continuous improvement consultancy firms in Nigeria. Finding draws out links between major factors such as drivers and motivation, LSS performance, marketability and challenges to the acceptability and applicability of LSS in Nigeria. Further findings highlight major factors such as lack of management buy-in, level of awareness, certification driven market, Nigerian environment and culture, etc as problems that hinder successful implementation of LSS in Nigeria. This paper contributes to the theoretical foundation of critical success factors required for the implementation of Lean Six Sigma, with results from the experience of a developing economy.

Take the "Con" Out of Consulting in the Food Service Industry

Consultants can help a food service operator with almost any problem which needs solving. Howeve6 the manager must "manage" the consultant. The author offers a design for planning for hiring and evaluating the work of anyone given the job of analyzing existing systems and diagnosing problems.

Strategic Management of Resources for International Business Operations in Small Consulting Firms - People, Processes and Tools in Managing International operations

Research on strategic management of resources for small consulting firms which are international or planning to operate internationally is scarce or not existing at all. It is however important to start generating the theories that will support managers in their decision making and planning. This thesis investigates how do small management consulting firms manage their internal and external resources while operating in international markets. Throughout the study, aspects related to internal and external resources management as well as management strategies in these firms have been examined in relations to firm’s internationalisation activities. A qualitative analysis was carried out whereby four small consulting firms in Export Management Consulting, Integration Services Consulting-, Software Development Consulting- and Business Solutions Consulting companies were interviewed. In order to generate the holistic understanding of the study, the thesis writer selected Value Enhanced Collaborative Working (VECW) model as an analysis framework. The model focuses on people, processes and tools as key elements that small consulting firms consider when thinking about managing their international operations. The findings of the thesis reveal that, internal and external resources in the interviewed consulting firms are viewed similarly, but managed differently depending on the nature and size of the firm. Firm’s management strategies concentrate on the adequate utilisation of the employees' motivation and experiences, effective stakeholders' management, various administrative evaluation processes and tools, the ability to realise useful networks, constant improvement through employee trainings, employees and customers’ feedbacks as well as enhanced freedom in order to support employees’ creativity. Further research to examine functional administrative tools and tools that small consulting firms could use to assess their resource capabilities when planning to become international would benefit the smaller businesses in terms of resources management and certainty in planning.

KNOWING THE ENEMY: NAZI FOREIGN INTELLIGENCE IN WAR, HOLOCAUST, AND POSTWAR

“Knowing the Enemy: Nazi Foreign Intelligence in War, Holocaust and Postwar,” reveals the importance of ideologically-driven foreign intelligence reporting in the wartime radicalization of the Nazi dictatorship, and the continued prominence of Nazi discourses in postwar reports from German intelligence officers working with the U.S. Army and West German Federal Intelligence Service after 1945. For this project, I conducted extensive archival research in Germany and the United States, particularly in overlooked and files pertaining to the wartime activities of the Reichssicherheitshauptamt, Abwehr, Fremde Heere Ost, Auswärtiges Amt, and German General Staff, and the recently declassified intelligence files pertaining to the postwar activities of the Gehlen Organization, Bundesnachrichtendienst, and Foreign Military Studies Program. Applying the technique of close textual analysis to the underutilized intelligence reports themselves, I discovered that wartime German intelligence officials in military, civil service, and Party institutions all lent the appearance of professional objectivity to the racist and conspiratorial foreign policy beliefs held in the highest echelons of the Nazi dictatorship. The German foreign intelligence services’ often erroneous reporting on Great Britain, the Soviet Union, the United States, and international Jewry simultaneously figured in the radicalization of the regime’s military and anti-Jewish policies and served to confirm the ideological preconceptions of Hitler and his most loyal followers. After 1945, many of these same figures found employment with the Cold War West, using their “expertise” in Soviet affairs to advise the West German Government, U.S. Military, and CIA on Russian military and political matters. I chart considerable continuities in personnel and ideas from the wartime intelligence organizations into postwar West German and American intelligence institutions, as later reporting on the Soviet Union continued to reproduce the flawed wartime tropes of innate Russian military and racial inferiority.

Business Process Management and Process Mining within a Real Business Environment: An Empirical Analysis of Event Logs Data in a Consulting Project

Il presente elaborato esplora l’attitudine delle organizzazioni nei confronti dei processi di business che le sostengono: dalla semi-assenza di struttura, all’organizzazione funzionale, fino all’avvento del Business Process Reengineering e del Business Process Management, nato come superamento dei limiti e delle problematiche del modello precedente. All’interno del ciclo di vita del BPM, trova spazio la metodologia del process mining, che permette un livello di analisi dei processi a partire dagli event data log, ossia dai dati di registrazione degli eventi, che fanno riferimento a tutte quelle attività supportate da un sistema informativo aziendale. Il process mining può essere visto come naturale ponte che collega le discipline del management basate sui processi (ma non data-driven) e i nuovi sviluppi della business intelligence, capaci di gestire e manipolare l’enorme mole di dati a disposizione delle aziende (ma che non sono process-driven). Nella tesi, i requisiti e le tecnologie che abilitano l’utilizzo della disciplina sono descritti, cosi come le tre tecniche che questa abilita: process discovery, conformance checking e process enhancement. Il process mining è stato utilizzato come strumento principale in un progetto di consulenza da HSPI S.p.A. per conto di un importante cliente italiano, fornitore di piattaforme e di soluzioni IT. Il progetto a cui ho preso parte, descritto all’interno dell’elaborato, ha come scopo quello di sostenere l’organizzazione nel suo piano di improvement delle prestazioni interne e ha permesso di verificare l’applicabilità e i limiti delle tecniche di process mining. Infine, nell’appendice finale, è presente un paper da me realizzato, che raccoglie tutte le applicazioni della disciplina in un contesto di business reale, traendo dati e informazioni da working papers, casi aziendali e da canali diretti. Per la sua validità e completezza, questo documento è stata pubblicato nel sito dell'IEEE Task Force on Process Mining.

Desmoid tumor in patients with familial adenomatous polyposis

CONTEXT: Desmoid tumors constitute one of the most important extraintestinal manifestations of familial adenomatous polyposis. The development of desmoids is responsible for increasing morbidity and mortality rates in cases of familial adenomatous polyposis. OBJECTIVES: To evaluate the occurrence of desmoid tumors in familial adenomatous polyposis cases following prophylactic colectomy and to present patient outcome. METHODS: Between 1984 and 2008, 68 patients underwent colectomy for familial adenomatous polyposis at the School of Medical Sciences Teaching Hospital, University of Campinas, SP, Brazil. Desmoid tumors were found in nine (13.2%) of these patients, who were studied retrospectively by consulting their medical charts with respect to clinical and surgical data. RESULTS: Of nine patients, seven (77.8%) were submitted to laparotomy for tumor resection. Median age at the time of surgery was 33.9 years (range 22-51 years). Desmoid tumors were found in the abdominal wall in 3/9 cases (33.3%) and in an intra-abdominal site in the remaining six cases (66.7%). Median time elapsed between ileal pouch-anal anastomosis and diagnosis of desmoid tumor was 37.5 months (range 14-60 months), while the median time between colectomy with ileorectal anastomosis and diagnosis was 63.7 months (range 25-116 months). In 6/9 (66.7%) patients with desmoid tumors, the disease was either under control or there was no evidence of tumor recurrence at a follow-up visit made a mean of 63.1 months later (range 12-240 months). CONCLUSIONS: Desmoid tumors were found in 13.2% of cases of familial adenomatous polyposis following colectomy; therefore, familial adenomatous polyposis patients should be followed-up and surveillance should include abdominal examination to detect signs and symptoms. Treatment options include surgery and clinical management with antiestrogens, antiinflammatory drugs or chemotherapy.

Knowing your allies: Medical education and interprofessional exposure

Collaborative, team-based, interprofessional approaches to patient management are becoming increasingly recognized as beneficial to health outcomes. This project aimed to develop interprofessional skills among 134 third year medical students that were of clinical educational value to the students, and through activities that directly benefited the rural health professionals in their daily work. Placements were undertaken during a six week rural clinical attachment, mainly throughout South-West Queensland. Pre- and post-placement self-report questionnaires completed by both students and health professionals were used to evaluate the project. Results showed that over 80% of the health professional group reported the medical student placements were useful. Similarly, almost 80% of medical students reported positive changes in their attitude to other health professionals from the placement, and 91% indicated they had derived clinical educational benefit from their interprofessional activity. Despite difficulties due to poor communication between the various parties involved, the project proved successful in improving medical students' skills, knowledge and perceptions concerning interprofessional practice, through a placement and educational project which delivered practical benefits to rural health professionals and rural communities.

Review of "Comorbidity, disability and the need for treatment for DSM-IV psychiatric disorders in an insured population"

Background: This study presents estimates of 12 month and current prevalences of DSM-IV disorders, and the related comor-bidity, disability and service utilization, derived from a national probability sample in Australia. Methods: The DSM-IV psychiatric disorders among persons aged 18 and over in the Australian population were assessed with data collected by lay interviewers using the Composite International Diagnostic Interview, other screening interviews and measures of disability and service utilization. The response rate was 78.1% and the final sample size was 10,641 adults. Results: Close to 20% reported at least one twelve month disorder and 13% a disorder current within the past 30 days. ICD-10 diagnoses were also derived, DSM-IV was the more conservative classification whether or not the new clinical significance criteria was applied. Major depression, any personality disorder, and alcohol dependence were the three most common twelve month disorders, generalized anxiety disorder replaced alcohol dependence as the third most common current disorder. The sexes has similar rates of any disorder, but women had higher rates of affective and anxiety disorders, men higher rates of substance use disorders. Prevalence of most disorders declined with age and education, and were lower among those employed or married. Respondents whose symptoms met criteria for three or more disorders in the past year had greatly increased rates of disability and of mental health consultations. The affective and somatoform disorders were associated with the highest rates of disability. Only 36% of people with a mental disorder this year had consulted for a mental problem, and most had seen a general practitioner. We identified those with a current disorder who were disabled or multiply comorbid - only half had consulted and of those who had not, more than half said they did not need treatment. Conclusions: The 12 month prevalence was lower than reported in the US National Comorbidity Survey but method factors might account for this. The relationships between prevalence and demographic variables, and between comorbidity, disability and service utilization were similar to those found in the US survey. Australia has a national health insurance scheme with total coverage and access to medical help is available to all, commonly at little or no cost. We identify the high rate of not consulting among those with a current disorder, and additional disability or multiple comorbidity, as an important public health problem. Kessler argued for more research on barriers to professional help seeking. This report reinforces his conclusion and shows that economic barriers are not the dominant issue.

Human immunodeficiency virus test-seeking blood donors in a large blood bank in Sao Paulo, Brazil

BACKGROUND: Persons with human immunodeficiency virus (HIV) risk behaviors are excluded from donation to reduce the risk of transfusion-transmitted infection. Persons donating to be tested for HIV may therefore deny risk behaviors. STUDY DESIGN AND METHODS: A random sample of donors completed a survey on motivations, knowledge, and attitudes on the screening process. Donors were considered test seekers if they agreed with two statements ""I think that blood donation is a good, fast, and anonymous way to get my blood tested"" and ""I donate to get my test results."" This study was conducted from June to November 2006 at the largest blood bank in Sao Paulo, Brazil. RESULTS: Of 3061 participants, 208 (7%) were test seekers. They tended to be male and had a lower educational level. They were more likely to have incorrect knowledge about blood safety (e.g., not knowing that a unit can test antibody negative and still transmit infection, 60% vs. 42%, p = 0.02), express dissatisfaction with screening questions (e.g., feeling that important questions were not asked, 14% vs. 5%, p < 0.01), and concur that donors do not answer questions truthfully (e.g., donors have more sexual partners than they admit, 29% vs. 18%, p < 0.01). Test seekers were more likely to believe that it is acceptable to donate blood to get tested for HIV (41% vs. 10%, p < 0.01). CONCLUSIONS: Test-seeking motivation, coupled with low knowledge of window period risk, is counter to improving blood safety and to donor prevention needs. Donor education needs to be improved along with availability of appropriate HIV counseling and testing.

Changes in conceptions of learning for indigenous Australian university students

Background. Conceptions of learning have been investigated for students in higher. education in different countries. Some studies found that students' conceptions change and develop over time while others have found no changes. Investigating conceptions of learning for Australian Aboriginal and Torres Strait Islander university students is a relatively new area of research. Aims. This study set out to investigate conceptions of learning for Aboriginal and Torres Strait Islander university students during the first two years of their undergraduate degree courses in three Australian universities. Conceptions for each year were compared. Knowing, more about learning as conceived by this cultural group may facilitate more productive higher educational experiences. Sample. The sample comprised 17 students studying various degrees; Il were male and 6 were female. Ages ranged from 18 to 48 years; mean age was 26 years. Method. This was a phenomenographic, longitudinal study. Individual semistructured interviews were conducted each year to ascertain students' conceptions of learning. Conceptions for second year were derived independently of those From first year. A comparative analysis then took place to determine ally changes. Results. These students held conceptions of learning that were similar to those of other university students; however there were some intrinsic differences. On a group level, conceptions changed somewhat over the two years as did core conceptions reported by some individual students. Some students also exhibited a greater awareness of learning during their second year that resulted in three dimensions of changed awareness. Conclusions. We believe the changed conceptions and awareness resulted from learning at university where there is some need to understand and explain phenomena in relation to theory. This brought about new understandings which allowed students to see their own learning in a relational sense.