Patients’ and health professionals’ views and experiences of atrial fibrillation and oral-anticoagulant therapy:a qualitative meta-synthesis

Objective - Atrial fibrillation (AF) patients are prescribed oral-anticoagulant (OAC) therapy, often warfarin, to reduce stroke risk. We explored existing qualitative evidence about patients’ and health professionals’ experiences of OAC therapy. Methods - Systematic searches of eight bibliographic databases were conducted. Quality was appraised using the Critical Appraisal Skills Programme tool and data from ten studies were synthesised qualitatively. Results - Four third-order constructs, emerged from the final step in the analysis process: (1) diagnosing AF and the communication of information, (2) deciding on OAC therapy, (3) challenges revolving around patient issues, and (4) healthcare challenges. Synthesis uncovered perspectives that could not be achieved through individual studies. Conclusion - Physicians’ and patients’ experiences present a dichotomy of opinion on decision-making, which requires further exploration and changes in practice. Outcomes of workload pressure on both health professionals and patients should be investigated. The need for on-going support and education to patients and physicians is critical to achieve best practice and treatment adherence. Practice implications - Such research could encourage health professionals to understand and attend better to the needs and concerns of the patient. Additionally these findings can be used to inform researchers and healthcare providers in developing educational interventions with both patients and health professionals.

Development and trialling of a behavioural intervention for patients with atrial fibrillation initiating oral anticoagulation:the 'treat' study

Purpose: Atrial fibrillation (AF) is the most common heart arrhythmia and is associated with an increased risk of stroke. Stroke risk is commonly treated with oral anticoagulation (OAC) with a narrow therapeutic range (INR 2.0 to 3.0); which is poorly controlled in practice. Barriers to adherence include poor knowledge, and inaccurate perceptions surrounding illness and medications. Trial registration: ISRCTN93952605. Systematic review: Seven trials of educational, self-monitoring and decision aid interventions were included in a systematic review. Pooled analysis suggested education OR, 95% CI 7.89 (5.54-10.24) and self monitoring OR (95% CI) 5.47(2.55-8.39) significantly improve TTR; whereas decision aids are no more effective in reducing decision conflict than usual care, OR (95% CI) -0.10 (-0.17 to -0.02). Intervention development: The intervention was theoretically-driven (utilising the common sense and beliefs about medication models) and developed with expert patient feedback. Described using behavioural change techniques, the one-off group session included an educational booklet, ‘expert-patient’ focussed DVD, and worksheet. Methods: Ninety seven warfarin-naïve AF patients were randomised to receive the intervention (n=43), or usual care (n=54). The primary endpoint was time within therapeutic range (TTR), secondary endpoints included knowledge, quality of life (AF-QoL-18), beliefs about medication (BMQ), illness perceptions (IPQ-B), and anxiety and depression (HADS). Results: Intervention group had significantly higher TTR than usual care (78.5% vs. 66.7%; p=0.01). Knowledge changed significantly across time (F (3, 47) = 6.4; p<0.01), but not between groups (F (1, 47) = 3.3; p = 0.07). At six months knowledge predicted TTR (r=0.245; p=0.04). Illness concern negatively correlated with TTR (r= - 0.199; p=0.05). General Harm scores at one month predicted TTR (F (1, 72) = 4.08; p=0.048). There were significant differences in emotional representations (F (3, 49) = 3.3 (3, 49); p= 0.03), anxiety (F (3, 46) = 25.2; p<0.01) and depression (F (3, 46) = 37.7; p<0.01) across time. Conclusion: A theory-driven educational intervention can improve TTR in AF patients and potentially reduce the risk of adverse clinical outcomes. Improving education provision for AF patients is essential to ensure efficacious treatment.

A comparative analysis of cultural value orientations of Polish and Turkish employees:implications for international human resource management

This study empirically compares and contrasts the cultural value orientations of employees from Poland and Turkey by testing the compatibility of their values in three stages through seven cultural dimensions. The first phase of the study deals with the assessment of inter-country cultural value differences; the second phase investigates the intra-country cultural dynamics between selected demographic groups; and the third phase examines the inter-country cultural differences among the selected demographic groups of employees. The research has been conducted adopting the Maznevski, DiStephano, and Nason's (1995) version of cultural perspectives questionnaire with a sample of 744 (548 Polish and 196 Turkish) respondents. The results show significant cultural differences between Poland and Turkey, a presence of cultural dynamics among certain demographic groups within the country, and a mixture of convergence and divergence in the value systems of certain demographic groups both within and between the two nation(s). The research findings convey important messages to international human resource strategists in order for them to employ an effective and rational employment policy and business negotiation approach(es) to effectively operate in these countries. It also highlights that diversity of cultural values not only requires viewing each of them through cultural dimensions at a macro-level with a cross-country reference, but also requires monitoring their dynamics at the micro-level with reference to controlled demographic groups. © 2013 Taylor & Francis.

Professional standards research:job satisfaction and innovation

Job satisfaction is a significant predictor of organisational innovation – especially where employees (including shop-floor workers) experience variety in their jobs and work in a single-status environment. The relationship between job satisfaction and performance has long intrigued work psychologists. The idea that "happy workers are productive workers" underpins many theories of performance, leadership, reward and job design. But contrary to popular belief, the relationship between job satisfaction and performance at individual level has been shown to be relatively weak. Research investigating the link between job satisfaction and creativity (the antecedent to innovation) shows that job dissatisfaction promotes creative outcomes. The logic is that those who are dissatisfied (and have decided to stay with the organisation) are determined to change things and have little to lose in doing so (see JM George & J Zhou, 2002). We were therefore surprised to find in the course of our own research into managerial practices and employee attitudes in manufacturing organisations that job satisfaction was a highly significant predictor of product and technological innovation. These results held even though the research was conducted longitudinally, over two years, while controlling for prior innovation. In other words, job satisfaction was a stronger predictor of innovation than any pre-existing orientation organisations had towards working innovatively. Using prior innovation as a control variable, as well as a longitudinal research design, strengthened our case against the argument that people are satisfied because they belong to a highly innovative organisation. We found that the relationship between job satisfaction and innovation was stronger still where organisations showed that they were committed to promoting job variety, especially at shop-floor level. We developed precise instruments to measure innovation, taking into account the magnitude of the innovation both in terms of the number of people involved in its implementation, and how new and different it was. Using this instrument, we are able to give each organisation in our sample a "score" from one to seven for innovation in areas ranging from administration to production technology. We found that much innovation is incremental, involving relatively minor improvements, rather than major change. To achieve sustained innovation, organisations have to draw on the skills and knowledge of employees at all levels. We also measured job satisfaction at organisational level, constructing a mean "job satisfaction" score for all organisations in our sample, and drawing only on those companies whose employees tended to respond in a similar manner to the questions they were asked. We argue that where most of the workforce experience job satisfaction, employees are more likely to collaborate, to share ideas and aim for high standards because people are keen to sustain their positive feelings. Job variety and single-status arrangements further strengthen the relationship between satisfaction and performance. This makes sense; where employees experience variety, they are exposed to new and different ideas and, provided they feel positive about their jobs, are likely to be willing to try to apply these ideas to improve their jobs. Similarly, staff working in single-status environments where hierarchical barriers are reduced are likely to feel trusted and valued by management and there is evidence (see G Jones & J George, 1998) that people work collaboratively and constructively with those they trust. Our study suggests that there is a strong business case for promoting employee job satisfaction. Managers and HR practitioners need to ensure their strategies and practices support and sustain job satisfaction among their workforces to encourage constructive, collaborative and creative working. It is more important than ever for organisations to respond rapidly to demands of the external environment. This study shows the positive association between organisational-level job satisfaction and innovation. So if a happy workforce is the key to unlocking innovation and organisations want to thrive in the global economy, it is vital that managers and HR practitioners pay close attention to employee perceptions of the work environment. In a world where the most innovative survive it could make all the difference.

Digital Preservation and Access to Cultural and Scientific Heritage: Presentation of the KT-DigiCult-BG Project

The fast development and wide application of digital methods, combined with broadened access to the Internet and falling computing costs, have created intense interest in electronic presentation and access to cultural and scientific heritage resources. Information technologies have offered cultural institutions new opportunities for the presentation of their holdings, which are now made accessible not only to the specialists, but also to the citizens and interested parties worldwide. The paper presents an overview of the Bulgarian experience in the field of digital preservation and access and on-going work on the project “Knowledge Transfer for the Digitisation of Scientific and Cultural Heritage to Bulgaria” (MTKD-CT-2004-509754) supported by the Marie Curie programme of the FP6 of the EC.

Symmetric and Asymmetric Gaps in Some Fields of Formal Power Series

2000 Mathematics Subject Classification: 03E04, 12J15, 12J25.

CEO power, government monitoring, and bank dividends

We investigate the role of CEO power and government monitoring on bank dividend policy for a sample of 109 European listed banks for the period 2005-2013. We employ three main proxies for CEO power: CEO ownership, CEO tenure, and unforced CEO turnover. We show that CEO power has a negative impact on dividend payout ratios and on performance, suggesting that entrenched CEOs do not have the incentive to increase payout ratios to discourage monitoring from minority shareholders. Stronger internal monitoring by board of directors, as proxied by larger ownership stakes of the board members, increases performance but decreases payout ratios. These findings are contrary to those from the entrenchment literature for non-financial firms. Government ownership and the presence of a government official on the board of directors of the bank, also reduces payout ratios, in line with the view that government is incentivized to favor the interest of bank creditors before the interest of minority shareholders. These results show that government regulators are mainly concerned about bank safety and this allows powerful CEOs to distribute low payouts at the expense of minority shareholders.

Linguistic Corpora as International Cultural Heritage: The Corpus of Bulgarian and Ukrainian Parallel Texts

The paper relates about our ongoing work on the creation of a corpus of Bulgarian and Ukrainian parallel texts. We discuss some differences in the approaches and the interpretation of some concepts, as well as various problems associated with the construction of our corpus, in particular the occasional ‘nonparallelism’ of original and translated texts. We give examples of the application of the parallel corpus for the study of lexical semantics and note the outstanding role of the corpus in the lexicographic description of Ukrainian and Bulgarian translation equivalents. We draw attention to the importance of creating parallel corpora as objects of national as well as global cultural heritage.

Intercultural Learning and Entrepreneurship

Report published in the Proceedings of the National Conference on "Education and Research in the Information Society", Plovdiv, May, 2014

The role of individualism and collectivism as predictors of attributions for unethical work behavior: An empirical examination across two culturally diverse groups

This dissertation addresses how the cultural dimensions of individualism and collectivism affect the attributions people make for unethical behavior at work. The moderating effect of ethnicity is also examined by considering two culturally diverse groups: Hispanics and Anglos. The sample for this study is a group of business graduate students from two universities in the Southeast. A 20-minute survey was distributed to master's degree students at their classroom and later on returned to the researcher. Individualism and collectivism were operationalized as by a set of attitude items, while unethical work behavior was introduced in the form of hypothetical descriptions or scenarios. Data analysis employed multiple group confirmatory factor analysis for both independent and dependent variables, and subsequently multiple group LISREL models, in order to test predictions. Results confirmed the expected link between cultural variables and attribution responses, although the role of independent variables shifted, due to the moderating effect of ethnicity, and to the nuances of each particular situation. ^

A comparison of the impact of trained media specialists and untrained media personnel in junior colleges in the Republic of China

From educational, communications, psychological, and technical points of view, the renovation of pedagogy in media education is based upon the promotion of "educational technology." The promotion of educational technology relies upon the appropriate availability and knowledge of different educational media made available by the trained media personnel.^ In the past three decades most of the junior colleges in Taiwan set up educational media centers to help students learn through the use of media which enables them to obtain optimum benefits in a short time. What are the roles the media personnel play in the media center? What responsibilities have they to bear in the center? What differences are there when a trained and untrained media personnel are presented in junior colleges media center in Taiwan? What do the trained and untrained media personnel feel toward the importance of each media service in the area of media center's administration, media production, specialized media duties, and the training of staff in media use? These are the questions addressed in this study.^ Through the study of the related literature and a survey conducted in the junior colleges in Taiwan, recommendations are offered to provide improvement of the services and training of media specialists in Taiwan that are appropriate for a changing work and environment. These recommendations are for media specialists to be formally trained to effectively serve the changing needs of school library media so as to make optimal use of media in the junior colleges. ^

Latin America: Nuclear Capabilities, Intentions and Threat Perceptions

Three key states are relevant in considering future nuclear proliferation in Latin America: Argentina, Brazil, and Venezuela. Argentina and Brazil are critical because of their relatively advanced nuclear capabilities. For historical and geopolitical reasons, neither Argentina nor Brazil is likely to reactive nuclear weapons programs. Venezuela’s President, Hugo Chávez, has repeatedly demonstrated interest in developing a nuclear program, yet Venezuela lacks any serious nuclear expertise. Even if it had the managerial and technological capacity, the lead-time to develop an indigenous nuclear program would be measured in decades. Acquisition of nuclear technology from international sources would be difficult because members of the Nuclear Suppliers Group would insist on safeguards, and potential non-Nuclear Suppliers Group (NSG) suppliers are highly surveilled, risking the exposure of such a program before Venezuela could put a deterrent into place. While South American states have historically opposed nuclear weapons, their acquisition by Brazil and Argentina would lead to little more than diplomatic condemnation. Brazil and Argentina are both geopolitically satisfied powers that are deeply embedded in a regional security community. On the other hand, Venezuela under President Chávez is perceived as a revisionist power seeking a transformation of the international system. Venezuelan acquisition of nuclear weapons would be met with alarm by the United States and Colombia, and it would prompt nuclear weapons development by Brazil and possibly Argentina, more for reasons of preserving regional leadership and prestige than for fear of a Venezuelan threat.

Development and verification of control and protection strategies in hybrid AC/DC power systems for smart grid applications

Modern power networks incorporate communications and information technology infrastructure into the electrical power system to create a smart grid in terms of control and operation. The smart grid enables real-time communication and control between consumers and utility companies allowing suppliers to optimize energy usage based on price preference and system technical issues. The smart grid design aims to provide overall power system monitoring, create protection and control strategies to maintain system performance, stability and security. This dissertation contributed to the development of a unique and novel smart grid test-bed laboratory with integrated monitoring, protection and control systems. This test-bed was used as a platform to test the smart grid operational ideas developed here. The implementation of this system in the real-time software creates an environment for studying, implementing and verifying novel control and protection schemes developed in this dissertation. Phasor measurement techniques were developed using the available Data Acquisition (DAQ) devices in order to monitor all points in the power system in real time. This provides a practical view of system parameter changes, system abnormal conditions and its stability and security information system. These developments provide valuable measurements for technical power system operators in the energy control centers. Phasor Measurement technology is an excellent solution for improving system planning, operation and energy trading in addition to enabling advanced applications in Wide Area Monitoring, Protection and Control (WAMPAC). Moreover, a virtual protection system was developed and implemented in the smart grid laboratory with integrated functionality for wide area applications. Experiments and procedures were developed in the system in order to detect the system abnormal conditions and apply proper remedies to heal the system. A design for DC microgrid was developed to integrate it to the AC system with appropriate control capability. This system represents realistic hybrid AC/DC microgrids connectivity to the AC side to study the use of such architecture in system operation to help remedy system abnormal conditions. In addition, this dissertation explored the challenges and feasibility of the implementation of real-time system analysis features in order to monitor the system security and stability measures. These indices are measured experimentally during the operation of the developed hybrid AC/DC microgrids. Furthermore, a real-time optimal power flow system was implemented to optimally manage the power sharing between AC generators and DC side resources. A study relating to real-time energy management algorithm in hybrid microgrids was performed to evaluate the effects of using energy storage resources and their use in mitigating heavy load impacts on system stability and operational security.

Environment for Future Conference Centers: Perception of Managers

Socio-cultural, economic, political, and technological trends are likely to impact the future conference center industry. This article is based on a survey of the members of the International Association of Conference Centers; it identifies the perceptions of conference center executives of future industry trends and provides them with environmental information so that they can better plan for management in the future.