Supporting self-management: development and evaluation of a digital resource for adults with asthma

The problem: Around 300 million people worldwide have asthma and prevalence is increasing. Support for optimal self-management can be effective in improving a range of outcomes and is cost effective, but is underutilised as a treatment strategy. Supporting optimum self-management using digital technology shows promise, but how best to do this is not clear. Aim: The purpose of this project was to explore the potential role of a digital intervention in promoting optimum self-management in adults with asthma. Methods: Following the MRC Guidance on the Development and Evaluation of Complex Interventions which advocates using theory, evidence, user testing and appropriate modelling and piloting, this project had 3 phases. Phase 1: Examination of the literature to inform phases 2 and 3, using systematic review methods and focussed literature searching. Phase 2: Developing the Living Well with Asthma website. A prototype (paper-based) version of the website was developed iteratively with input from a multidisciplinary expert panel, empirical evidence from the literature (from phase 1), and potential end users via focus groups (adults with asthma and practice nurses). Implementation and behaviour change theories informed this process. The paper-based designs were converted to the website through an iterative user centred process (think aloud studies with adults with asthma). Participants considered contents, layout, and navigation. Development was agile using feedback from the think aloud sessions immediately to inform design and subsequent think aloud sessions. Phase 3: A pilot randomised controlled trial over 12 weeks to evaluate the feasibility of a Phase 3 trial of Living Well with Asthma to support self-management. Primary outcomes were 1) recruitment & retention; 2) website use; 3) Asthma Control Questionnaire (ACQ) score change from baseline; 4) Mini Asthma Quality of Life (AQLQ) score change from baseline. Secondary outcomes were patient activation, adherence, lung function, fractional exhaled nitric oxide (FeNO), generic quality of life measure (EQ-5D), medication use, prescribing and health services contacts. Results: Phase1: Demonstrated that while digital interventions show promise, with some evidence of effectiveness in certain outcomes, participants were poorly characterised, telling us little about the reach of these interventions. The interventions themselves were poorly described making drawing definitive conclusions about what worked and what did not impossible. Phase 2: The literature indicated that important aspects to cover in any self-management intervention (digital or not) included: asthma action plans, regular health professional review, trigger avoidance, psychological functioning, self-monitoring, inhaler technique, and goal setting. The website asked users to aim to be symptom free. Key behaviours targeted to achieve this include: optimising medication use (including inhaler technique); attending primary care asthma reviews; using asthma action plans; increasing physical activity levels; and stopping smoking. The website had 11 sections, plus email reminders, which promoted these behaviours. Feedback during think aloud studies was mainly positive with most changes focussing on clarification of language, order of pages and usability issues mainly relating to navigation difficulties. Phase 3: To achieve our recruitment target 5383 potential participants were invited, leading to 51 participants randomised (25 to intervention group). Age range 16-78 years; 75% female; 28% from most deprived quintile. Nineteen (76%) of the intervention group used the website for an average of 23 minutes. Non-significant improvements in favour of the intervention group observed in the ACQ score (-0.36; 95% confidence interval: -0.96, 0.23; p=0.225), and mini-AQLQ scores (0.38; -0.13, 0.89; p=0.136). A significant improvement was observed in the activity limitation domain of the mini-AQLQ (0.60; 0.05 to 1.15; p = 0.034). Secondary outcomes showed increased patient activation and reduced reliance on reliever medication. There was no significant difference in the remaining secondary outcomes. There were no adverse events. Conclusion: Living Well with Asthma has been shown to be acceptable to potential end users, and has potential for effectiveness. This intervention merits further development, and subsequent evaluation in a Phase III full scale RCT.

Use of business analysis in beef businesses to direct management practice change for climate adaptation outcomes

Beef businesses in northern Australia are facing increased pressure to be productive and profitable with challenges such as climate variability and poor financial performance over the past decade. Declining terms of trade, limited recent gains in on-farm productivity, low profit margins under current management systems and current climatic conditions will leave little capacity for businesses to absorb climate change-induced losses. In order to generate a whole-of-business focus towards management change, the Climate Clever Beef project in the Maranoa-Balonne region of Queensland trialled the use of business analysis with beef producers to improve financial literacy, provide a greater understanding of current business performance and initiate changes to current management practices. Demonstration properties were engaged and a systematic approach was used to assess current business performance, evaluate impacts of management changes on the business and to trial practices and promote successful outcomes to the wider industry. Focus was concentrated on improving financial literacy skills, understanding the business’ key performance indicators and modifying practices to improve both business productivity and profitability. To best achieve the desired outcomes, several extension models were employed: the ‘group facilitation/empowerment model’, the ‘individual consultant/mentor model’ and the ‘technology development model’. Providing producers with a whole-of-business approach and using business analysis in conjunction with on-farm trials and various extension methods proved to be a successful way to encourage producers in the region to adopt new practices into their business, in the areas of greatest impact. The areas targeted for development within businesses generally led to improvements in animal performance and grazing land management further improving the prospects for climate resilience.

Development of project management procedures for customer project business

Objective of the thesis is to develop project management procedure for chilled beam projects. In organization is recognized that project management techniques could help in large and complex projects. Information sharing have been challenging in projects, so improvement of information sharing is one key topic of the thesis. Academic researches and literature are used to find suitable project management theories and methods. Main theories are related to phases of the project and project management tools. Practical knowledge of project management is collected from two project business oriented companies. Project management tools are chosen and modified to fulfill needs of the beam projects. Result of the thesis is proposed project management procedure, which includes phases of the chilled beam projects and project milestones. Project management procedure helps to recognize the most critical phases of the project and tools help to manage information of the project. Procedure increases knowledge of the project management techniques and tools. It also forms coherent project management working method among the chilled beam project group.

A longitudinal interpretive phenomenological investigation into latent entrepreneurial learning processes: Key implications for entrepreneurial education.

The effectiveness and value of entrepreneurship education is much debated within academic literature. The individual’s experience is advocated as being key to shaping entrepreneurial education and design through a multiplicity of theoretical concepts. Latent, pre-nascent and nascent entrepreneurship (doing) studies within the accepted literature provide an exceptional richness in diversity of thought however, there is a paucity of research into latent entrepreneurship education. In addition, Tolman’s early work shows the existence of cases whereby a novel problem is solved without trial and error, and sees such previous learning situations and circumstances as “examples of latent learning and reasoning”, (Deutsch, 1956, pg115). Latent learning has historically been the cause of much academic debate however, Coon’s (2004, pg260) work refers to “latent (hidden) learning … (as being) … without obvious reinforcement and remains hidden until reinforcement is provided” and thus, forms the working definition for the purpose of this study.

Development of management accounting practices in energy operations in a forest industry Company

The aim of this master’s thesis was to map the management accounting processes and reporting of an internal service unit. The research was conducted in energy services in a forest industry company. Research questions and the results of the study are highly specific for the case unit although some generalizable features of management accounting in internal service units under shared services were searched. The research was carried out as a qualitative action research and a single case study. Internal benchmarking was used to find best practices from other units and to get a comprehensive understanding of the financial processes of the case company. Empirical data for the study was collected with participant observation, interviews of experts and by exploring internal company documents. A literature review was conducted to outline the subject and to support the study. Although the management accounting processes of the case unit were found to be on a good level, some improvement ideas were presented. Results of the research show that the needs of the customers are in the key role in the processes of an internal service unit. Management accounting and reporting need to support the company strategy and management decision-making. To evaluate the performance of the service unit both financial and non-financial measures are needed.

How can science contribute for the sustainable management of natural resource? : Praia da Vitória Bay and Guadiana Estuary, a comparative study

Tese de Doutoramento, Ciências do Ambiente (Ordenamento do Território), 5 de Abril de 2013, Universidade dos Açores.

Fishing effort and fish yield over a 15 year period on Lake Victoria, Uganda: management implications

The National Fisheries Resources Research Institute (NaFIRRI), the Directorate of Fisheries Resources (DiFR), the Local Government fisheries staff and those from the Beach Management Units (BMUs) of the riparian districts to Lake Victoria regularly and jointly conduct Frame and Catch Assessment Surveys. The information obtained is used to guide fisheries management and development. We reveal the trends in the commercial fish catch landings and fishing effort on the Uganda side of Lake Victoria, over a 15 year period (2000-2015) and provide the underlying factors to the observed changes. The contribution of the high value large size species (Nile perch and Tilapia) to the commercial catch of Lake Victoria has significantly reduced while that of the low value small size species, Mukene has increased over a ten year (2005-2015)period. The information is intended to update and sensitize the key stakeholders on the status of the Lake Victoria fisheries. In addition, the information provided is expected to guide policy formulation and management planning by the fisheries managers at all levels including the BMUs and Landing Site Management Committees (LSMCs), the Local government fisheries staff and the Directorate of Fisheries Resources. The information is anticipated to create awareness among the lakeside fisher communities to reverse the current trend in fish declines.

KEY COMPONENTS OF TEAMWORK AND THE SERVICE (TO) YOU (A) (A) DOMESTIC (A) AND EXTERNAL (A)

The article examines a range of components for the customer service from the point of view of marketing.It start with the explanation of several features that are required for a company to crystallize teamwork that finally, after all, will be provided by the success or failure of that company.These features are named: engagement, cooperation, companionship, communication, motivation and leadership.Subsequently, this article presents a section which explores human relationships and conflict management within organizations, with emphasis on attitudes, skills and personality types that present human beings as part of its essence.Finally, this text includes a section that highlights concepts related to customer service and sales techniques that exist today.

A review of weed management in wheat using crop competition

Wheat occupies a principal place in the diet of humans globally, contributing more to our daily calorie and protein intake than any other crop. For this reason, preventing weed induced yield losses in wheat has high significance for world food sustainability. Herbicides and tillage play an important role in weed control, but their use has often unacceptable consequences for humans and the wider environment. Additionally, the range of herbicides effective on key weeds is dwindling due to the evolution of herbicide resistance. Elevating crop competitiveness against weeds, through a combination of wheat breeding and innovative planting design (planting density, row spacing and orientation), has strong potential to reduce weed-induced yield losses in wheat. The last decade of research has provided a solid foundation for the breeding of weed suppressive wheat cultivars, and continued research in this area should be a focus for the future. In the interim, there is cause for optimism that weeds can be effectively suppressed using existing wheat varieties, through careful cultivar selection and choice of planting design. Further research is required to define the nature of relationships between cultivar traits and competitive planting strategies, across diverse weed flora in multiple countries, sites and seasons. Investment in such innovation promises to produce benefits, not only in terms of sustained wheat yields, but also in terms of human and ecosystem health, through ameliorating chemical and sediment contamination, soil degradation, and CO2 pollution.