Self-management of coronary heart disease in angina patients after percutaneous coronary intervention: A mixed methods study.

After having elective percutaneous coronary intervention (PCI) patients are expected to self-manage their coronary heart disease (CHD) by modifying their risk factors, adhering to medication and effectively managing any recurring angina symptoms but that may be ineffective. Objective: Explore how patients self-manage their coronary heart disease (CHD) after elective PCI and identify any factors that may infl uence that. Design and method: This mixed methods study recruited a convenience sample of patients (n=93) approximately three months after elective PCI. Quantitative data were collected using a survey and were subject to univariate, bivariate and multi-variate analysis. Qualitative data from participant interviews was analysed using thematic analysis. Findings: After PCI, 74% of participants managed their angina symptoms inappropriately. Younger participants and those with threatening perceptions of their CHD were more likely to know how to effectively manage their angina symptoms. Few patients adopted a healthier lifestyle after PCI. Qualitative analysis revealed that intentional non-adherence to some medicines was an issue. Some participants felt unsupported by healthcare providers and social networks in relation to their self-management. Participants reported strong emotional responses to CHD and this had a detrimental effect on their self-management. Few patients accessed cardiac rehabilitation.

Mindfulness-Based Cognitive Therapy for older people in a community setting: a mixed methods feasibility study

Rationale: In line with complex intervention development, this research takes a systematic approach to examining the feasibility and acceptability of delivering Mindfulness-Based Cognitive Therapy (MBCT) to older people who experience symptoms of depression. Methods: A mixed methods approach was adopted in line with recommendations made by the MRC Complex Intervention Development framework. Quantitative and qualitative methods were combined by administering questionnaires as well as conducting post intervention interviews. A number of trial feasibility factors were examined such as recruitment and attrition rates. Qualitative data was analysed using Braun and Clarke’s thematic analysis framework. Results: Nine participants started the MBCT intervention and six completed the 8-week programme. The results suggest that MBCT for older people is feasible and acceptable. Participants reported improved mindfulness skills. Participants responded positively to being asked to take part in research and appeared to particularly value the group delivery format of the intervention. Conclusions: MBCT is both feasible and acceptable for older people experiencing symptoms of depression. Further research is required with larger sample sizes to allow for more robust statistical exploration of outcome measures, including mechanisms of change.

Using an end-of-life care pathway in acute stroke: a mixed methods study of decision-making and care experiences

Background: The evidence base on end-of-life care in acute stroke is limited, particularly with regard to recognising dying and related decision-making. There is also limited evidence to support the use of end-of-life care pathways (standardised care plans) for patients who are dying after stroke. Aim: This study aimed to explore the clinical decision-making involved in placing patients on an end-of-life care pathway, evaluate predictors of care pathway use, and investigate the role of families in decision-making. The study also aimed to examine experiences of end-of-life care pathway use for stroke patients, their relatives and the multi-disciplinary health care team. Methods: A mixed methods design was adopted. Data were collected in four Scottish acute stroke units. Case-notes were identified prospectively from 100 consecutive stroke deaths and reviewed. Multivariate analysis was performed on case-note data. Semi-structured interviews were conducted with 17 relatives of stroke decedents and 23 healthcare professionals, using a modified grounded theory approach to collect and analyse data. The VOICES survey tool was also administered to the bereaved relatives and data were analysed using descriptive statistics and thematic analysis of free-text responses. Results: Relatives often played an important role in influencing aspects of end-of-life care, including decisions to use an end-of-life care pathway. Some relatives experienced enduring distress with their perceived responsibility for care decisions. Relatives felt unprepared for and were distressed by prolonged dying processes, which were often associated with severe dysphagia. Pro-active information-giving by staff was reported as supportive by relatives. Healthcare professionals generally avoided discussing place of care with families. Decisions to use an end-of-life care pathway were not predicted by patients’ demographic characteristics; decisions were generally made in consultation with families and the extended health care team, and were made within regular working hours. Conclusion: Distressing stroke-related issues were more prominent in participants’ accounts than concerns with the end-of-life care pathway used. Relatives sometimes perceived themselves as responsible for important clinical decisions. Witnessing prolonged dying processes was difficult for healthcare professionals and families, particularly in relation to the management of persistent major swallowing difficulties.

La convivialità urbana nei quartieri di Milano, Bologna e Roma. Un'analisi mixed-methods sulle Social Streets

Le Social Street sono gruppi di vicini di casa che vogliono ricreare legami di convivialità avendo notato un indebolimento delle relazioni sociali nei loro quartieri. Nascono come gruppi online, tramite la piattaforma Facebook, per materializzarsi in incontri offline andando a costruire legami conviviali grazie pratiche di socialità, inclusività e gratuità. Questa Tesi ha come obiettivo l’analisi dei profili socio-demografici degli Streeter e dei quartieri coinvolti per comprendere come sia possibile creare convivialità e come la variabile urbana intervenga in questi processi. Inoltre, si vuole comprendere le dinamiche di attaccamento al quartiere, gli interessi portati avanti dagli Streeter, il loro profilo civico e il posizionamento di quest’esperienza rispetto all’associazionismo tradizionale. Per perseguire l’obiettivo della ricerca, sono state studiate le tre città che vedono la maggiore presenza di Social Street: Milano, Bologna, Roma. La ricerca ha previsto sia un’analisi degli Streeter grazie a un questionario online replicato in tutti i contesti. Inoltre, sono state realizzate 131 interviste ad amministratori e fondatori di Social Street e condotte osservazioni etnografiche e netnografiche. I risultati mostrano come gli Streeter siano appartenenti alle classi medio-alte, tra trenta e cinquanta anni, che hanno sperimentato la mobilità tra un quartiere e l’altro o tra diversi contesi nazionali ed internazionali e trovano nelle Social Street un modo per creare legami di vicinato che hanno perso nei loro trasferimenti. Gli stessi quartieri dove si diffondono le Social Street sono agiati e vi è una buona corrispondenza tra Streeter e modello della centralità sociale elaborato da Milbrath (1965) per cui anche la partecipazione civica è molto sentita tra gli aderenti alle Social Street. Il contributo di questa Tesi al dibattito sociologico risiede nell’aver offerto un’analisi empirica di un’azione collettiva a livello urbano, quella delle Social Street, mostrando come vi sia circolarità tra azione e contesto grazie all’azione mutualistica conviviale.

Coronary CT angiography using 64 detector rows: methods and design of the multi-centre trial CORE-64

Multislice computed tomography (MSCT) for the noninvasive detection of coronary artery stenoses is a promising candidate for widespread clinical application because of its non-invasive nature and high sensitivity and negative predictive value as found in several previous studies using 16 to 64 simultaneous detector rows. A multi-centre study of CT coronary angiography using 16 simultaneous detector rows has shown that 16-slice CT is limited by a high number of nondiagnostic cases and a high false-positive rate. A recent meta-analysis indicated a significant interaction between the size of the study sample and the diagnostic odds ratios suggestive of small study bias, highlighting the importance of evaluating MSCT using 64 simultaneous detector rows in a multi-centre approach with a larger sample size. In this manuscript we detail the objectives and methods of the prospective ""CORE-64"" trial (""Coronary Evaluation Using Multidetector Spiral Computed Tomography Angiography using 64 Detectors""). This multi-centre trial was unique in that it assessed the diagnostic performance of 64-slice CT coronary angiography in nine centres worldwide in comparison to conventional coronary angiography. In conclusion, the multi-centre, multi-institutional and multi-continental trial CORE-64 has great potential to ultimately assess the per-patient diagnostic performance of coronary CT angiography using 64 simultaneous detector rows.

Initial dilemmas in IST research: design science and design research, a clarification of concepts

The inter-disciplinarity of information systems, applied discipline and activity of design, and the study from different paradigms perspectives explains the diversity of problems addressed. The context is broad and includes important issues beyond technology, as the application, use, effectiveness, efficiency and their organizational and social impacts. In design science, the research interest is in contributing to the improvement of the processes of the design activity itself. The relevance of research in design science is associated with the result obtained for the improvement of living conditions in organizational, inter-organizational and Society contexts. In the research whose results are artifacts, the adoption of design research as a process of research is crucial to ensure discipline, rigor and transparency. Based on a literature review, this paper clarifies the terms of design science and design research. This is the main motivation for presenting this paper, determinant for the phase in research in technologies and information systems which are the three research projects presented. As a result the three projects are discussed in relation to the concepts of design science and design research.

The mixed impact of design thinking on business collaborations

The present work project investigates the implications of design thinking on an interbusiness collaborative project, unveiling both the benefits and fragilities that derive from the use of such methodology within the mentioned context. The study is organized in two parts. The first one starts with a literature review on the two relevant frames of reference – design thinking and business collaboration. It proceeds to the creation of a conceptual framework to assess the potential value of the design-based approach. The second part focuses on the practical application of to the newly developed instrument to the inTRAIN project – R&D for railway interiors.

Methods of Design and Testing of Real Time Systems

Teollusuussovelluksissa vaaditaan nykyisin yhä useammin reaaliaikaista tiedon käsittelyä. Luotettavuus on yksi tärkeimmistä reaaliaikaiseen tiedonkäsittelyyn kykenevän järjestelmän ominaisuuksista. Sen saavuttamiseksi on sekä laitteisto, että ohjelmisto testattava. Tämän työn päätavoitteena on laitteiston testaaminen ja laitteiston testattavuus, koska luotettava laitteistoalusta on perusta tulevaisuuden reaaliaikajärjestelmille. Diplomityössä esitetään digitaaliseen signaalinkäsittelyyn soveltuvan prosessorikortin suunnittelu. Prosessorikortti on tarkoitettu sähkökoneiden ennakoivaa kunnonvalvontaa varten. Uusimmat DFT (Desing for Testability) menetelmät esitellään ja niitä sovelletaan prosessorikortin sunnittelussa yhdessä vanhempien menetelmien kanssa. Kokemukset ja huomiot menetelmien soveltuvuudesta raportoidaan työn lopussa. Työn tavoitteena on kehittää osakomponentti web -pohjaiseen valvontajärjestelmään, jota on kehitetty Sähkötekniikan osastolla Lappeenrannan teknillisellä korkeakoululla.

Beyond pure public and pure private management models: Mixed firms in the European Airport Industry

The use of private funding and management enjoys an increasing trend in airports. The literature has not paid enough attention to the mixed management models in this industry, although many European airports take the form of mixed firms or Institutional PPP, where ownership is shared between public and private sectors. We examine the determinants of the degree of private participation in the European airport sector. Drawing on a sample of the 100 largest European airports we estimate a multivariate equation in order to determine the role of airport characteristics, fiscal variables and political factors on the extent of private involvement. Our results confirm the alignment between public and private interests in PPPs. Fiscal constraints and market attractiveness promote private participation. Integrated governance models and the share of network carriers prevent the presence of private ownership, while the degree of private participation appears to be pragmatic rather than ideological.

Public and Private Production in a Mixed Delivery System: Regulation, Competition and Costs

Academics and policy makers are increasingly shifting the debate concerning the best form of public service provision beyond the traditional dilemma between pure public and pure private delivery modes, because, among other reasons, there is a growing body of evidence that casts doubt on the existence of systematic cost savings from privatization, while any competition seems to be eroded over time. In this paper we compare the relative merits of public and private delivery within a mixed delivery system. We study the role played by ownership, transaction costs, and competition on local public service delivery within the same jurisdiction. Using a stochastic cost frontier, we analyze the public-private urban bus system in the Barcelona Metropolitan Area. Our results suggest that private firms tendering the service have higher delivery costs than those incurred by the public firm, especially when transaction costs are taken into account. Tenders, therefore, do not help to reduce delivery costs. Our results suggest that under a mixed delivery scheme, which permits the co-existence of public and private production, the metropolitan government and the regulator can use private delivery to contain costs in the public firm and, at the same time, benefit from the greater flexibility of private firms for dealing with events not provided for under contract.

Research framework for the connection between environmental collaboration and firm performance

This thesis focuses on collaborative activities with regard to environmental issues both within the firm and outside the firm with the key suppliers and customers, i.e. internal and external environmental collaboration. Integrating environmental thinking into supply chain management has received increasing interest in recent years. The relational view and the natural resource-based-view together suggest that environmental capabilities can be built jointly with supply chain partners and used to gain sustained competitive advantage. Several studies have been undertaken to analyse the connection between environmental activities and firm performance but most studies have taken only economic performance into account. This study pays attention also to two other dimensions of firm performance, intra-firm supply chain performance and environmental performance, and aims at presenting the linkages between them and environmental collaboration. This thesis creates a research framework for the connections between environmental collaboration and firm performance and suggests approaches to analyse these. In order to find out the key concepts and their relationship, an extensive literature review is conducted. The research framework proposes a positive connection between internal and external environmental collaboration and all three dimensions of firm performance. In addition, environmental performance and intra-firm supply chain performance are expected to contribute positively to economic performance. Hence, firms are suggested to benefit from environmental collaboration both within the firm and outside the firm. Empirical testing of the developed research framework is out of the scope of this study. However, this thesis proposes using a mixed methods research approach, including survey research and multiple case studies. Finland State of Logistics 2012 survey commissioned by the Finnish Ministry of Transport and Communications and conducted by Turku School of Economics is used as an example of data for the quantitative phase. The applicability of these two methods is discussed at a general level and with regard to analysing the research framework developed in the thesis. Future research will aim at the development of the research framework and the methods in order to confirm the connection between environmental collaboration and firm performance.

Finnish perceptions on management accounting systems: towards an upgraded sophistication model

This study is based on a large survey study of over 1500 Finnish companies’ usage, needs and implementation difficulties of management accounting systems. The study uses quantitative, qualitative and mixed methods to answer the research questions. The empirical data used in the study was gathered through structured interviews with randomly selected companies of varying sizes and industries. The study answers the three research questions by analyzing the characteristics and behaviors of companies working in Finland. The study found five distinctive groups of companies according to the characteristics of their cost information and management accounting system use. The study also showed that the state of cost information and management accounting systems depends on the industry and size of the companies. It was found that over 50% of the companies either did not know how their systems could be updated or saw systems as inadequate. The qualitative side also highlighted the needs for tailored and integrated management accounting systems for creating more value to the managers of companies. The major inhibitors of new system implementation were the lack of both monetary and human resources. Through the use of mixed methods and design science a new and improved sophistication model is created based on previous research results combined with the information gathered from previous literature. The sophistication model shows the different stages of management accounting systems in use and what companies can achieve with the implementation and upgrading of their systems.

Perception des personnes âgées à l'égard de la vidéosurveillance intelligente pour leur soutien à domicile

Introduction : Au sein de la population vieillissante, les chutes à domicile représentent une problématique importante (1 personne âgée/3 chute au moins 1 fois/année). Pour détecter automatiquement les chutes en respectant la vie privée, une technologie novatrice a été développée : la vidéosurveillance intelligente. Objectif : Explorer la perception et la réceptivité des personnes âgées concernant l’introduction de cette nouvelle technologie, à domicile. Méthodologie : Trente personnes âgées ont participé à une entrevue structurée (devis mixte). Une analyse de contenu (données qualitatives) et des analyses descriptives (données quantitatives) ont été effectuées puis combinées. Résultats : 93,4% des participants sont favorables (ou partiellement) à la vidéosurveillance intelligente et 43,3% l’utiliserait pour le sentiment de sécurité et la confidentialité procurés. Conclusion : Le contexte de vie des personnes âgées influence leur perception et réceptivité envers la vidéosurveillance intelligente. Il s’agit maintenant d’évaluer cette technologie dans divers milieux de vie.

Facteurs associés à l'alimentation traditionnelle au sein de trois communautés cries du Nord du Québec

Cette étude propose d’identifier les facteurs affectant la consommation d’aliments traditionnels à travers une perspective écologique, afin de réduire les taux de prévalence élevés de maladies chroniques et ralentir la forte diminution de consommation d’aliments traditionnels chez les Cris du nord québécois. Pour ce faire, une méthode mixte « sequential explanatory », fut utilisée, combinant quatre groupes focus (n=23) et une régression logistique (n=374) à partir de données secondaires issues de trois études transversales. Selon les résultats de la régression logistique: l’âge, chasser, marcher, le niveau d’éducation et la communauté de résidence étaient associées à une consommation d’aliments traditionnelle trois fois/semaine (p<0,05). Subséquemment, des groupes focus vinrent enrichir et contredire ces résultats. Par exemple : les participants étaient en désaccord avec le fait qu’il n’y avait aucune association entre les aliments traditionnels et l’emploi. Ils croyaient que les personnes sans emploi ont plus d’opportunités pour aller chasser mais peu d’argent pour couvrir les dépenses et inversement pour ceux avec emploi. Ce double effet aurait possiblement fait disparaître l’association dans la régression logistique. Suite aux groupes focus, plusieurs facteurs furent identifiés et distribués dans un modèle écologique suggérant que la consommation d’aliments traditionnels est principalement influencée par des facteurs sociaux, communautaires et environnementaux et ne se limite pas aux facteurs individuels. En conclusion, afin de promouvoir l’alimentation traditionnelle, quatre suggestions de priorités d’action sont proposées. L’alimentation traditionnelle doit faire partie des stratégies de santé publique pour réduire les taux de maladies chroniques et améliorer le bien-être des populations autochtones.