Reinvigorating and redesigning early intervention in psychosis services for young people in Auckland

RESUMO: Auckland tem sido pioneira na implementação de modelos de Intervenção Precoce em Psicose. No entanto, esta organização do serviço não mudou nos últimos 19 anos. Segundo os dados obtidos da utilização do serviço, no período de 1996 -2012 foram atendidos 997 doentes, que tinham um número médio de 89 contactos (IQR: 36-184), com uma duração média de 62 horas de contactos (IQR: 24-136). Estes doentes passaram um número médio de 338 dias (IQR: 93-757) em contacto com o programa. 517 doentes (52%) não necessitaram de internamento no hospital, e os que foram internados, ficaram uma mediana de 124 dias no hospital (IQR: 40-380). Os doentes asiáticos tiveram um aumento de 50% de probabilidade de serem internados no hospital. Este relatório inclui 15 recomendações para orientar as reformas para o serviço e, nomeadamente, delinear a importância de uma visão organizacional e dos seus componentes-chave. As recomendações incluem o reforço da gestão e da liderança numa estrutura de equipe mais integrada, com recursos dedicados a melhorar a consciencialização da comunidade, a educação e deteção precoce, bem como a capacidade de receber referenciações diretas. Os Indicadores Chave de Desempenho devem ser estabelecidos, mas os Exames de Estado Mental em risco, devem ser removidos. Auckland deve manter a faixa etária alvo atual. A duração do serviço deve ser aumentada para um mínimo de três anos, com a opção de aumentá-la para cinco anos. A proporção de gestor de cuidados para os doentes deve ser preconizada em 1:15, enquanto o pessoal de apoio não-clínico deve ser aumentado. Os psiquiatras devem ter uma carga de trabalho de cerca de 80 doentes por equivalente de tempo completo. Um serviço local de prestação de cuidados deve ser desenvolvido com, nomeadamente, intervenções culturais para responder às necessidades da população multicultural de Auckland. A capacidade de investigação deve ser incorporada no Serviço de Intervenção Precoce em Psicoses. Qualquer alteração deverá envolver contacto com todas as partes interessadas, e a Administração Regional de Saúde deve comprometer-se em tempo, recursos humanos e políticos para apoiar e facilitar a mudança do sistema, investindo de forma significativa para melhor servir a comunidade Auckland.----------------------------------- ABSTRACT: Auckland has been pioneering in the adoption of Early Intervention in Psychosis models but the design of the service has not changed in 19 years. In service utilisation data from 997 patients seen from 1996 -2012, patients had a median number of 89 contacts (IQR: 36-184), with a median duration of 62 hours of contact (IQR: 24-136). Patients spent a median number of 338 days (IQR: 93-757) in contact with the program. 517 patients (52%) did not require admission to hospital, and those who did spent a median of 124 days in hospital (IQR: 40-380). Asian patients had a 50% increased chance of being admitted to hospital. This report includes 15 recommendations to guide reforms to the service, including outlining the importance of vision and key components. It recommends strengthened managerial leadership and a more integrated team structure with dedicated resources for improved community awareness, education and early detection as well as the capacity to take direct referrals. Key Performance Indicators (KPIs) should be established but At Risk Mental States should be excluded. Auckland should maintain the current target age range. The duration of service should be increased to a minimum of three years, with the option to extend this to five years. The ratio of care co-ordinator to patients should be capped at 1:15 whilst non-clinical supporting staff should be increased. Psychiatrists should have a caseload of about 80 per FTE. A local Service Delivery framework should be developed, as should cultural interventions to meet the needs of the multicultural population of Auckland. Research capacity should be incorporated into the fabric of Early Intervention in Psychosis Services. Any changes should involve consultation with all stakeholders, and the DHB should commit to investing time, human and political resources to support and facilitate meaningful system change to best serve the Auckland community.

A behavioral perspective on the effects of using performance measurement systems in the companies: Evidence from a case study

The effects of PMSs on the people’s behaviour represent a high degree of relevance in the context of an organization performance and success. Thus, motivational and behavioural consequences of performance measurements are far from being totally understood (Franco-Santos et al., 2012). This work project (WP) purposes going further regarding the consequences/effects on people’s behaviour of using PMSs in organizations. The researcher conducted 11 interviews to managers during a nine-month internship as a controller in a Portuguese multi-national company. The evidence from this WP suggests that the way how managers understand a PMS determines a lot the way how they behave. Data also supports that PMSs influences in several ways motivation, perceptions, participation and job-related stress of managers.

Perception of organizational politics and the effect of authenticity and affective commitment on deviance and task performance in contact centers

This study aimed to understand employees’ reactions to organizational politics in Contact Centers. Drawing from a sample of 187 supervisor-employee dyads, we studied the relationship between employees’ perceptions of organizational politics and supervisor-rated task performance and deviance, and mediation effects by authenticity at work and affective commitment. Results indicate that workers tend to react to workplace politics with deviant behavior and worse task performance. We found that the relationship between perceived politics and task performance was mediated by authenticity. The relationship between perceived politics and supervisor-rated deviance was mediated by affective commitment to the organization. Implications for management are discussed.

Performance management practices in Portugal.

Performance management and assessment has returned to the forefront of the public debate in Portugal, at the same time that some international studies point Portugal as a country with bad management practices, highlighting performance management practices. Despite all this attention, there is little information about how those practices are applied in the country. This research’s goal is to assess why performance management systems and practices are so poorly applied in Portugal. To achieve this goal we studied employees’ perception about the topic and diagnose the associated problems. The methodology comprised inductive and qualitative research, in the form of interviews with employees from different professions, industries, hierarchies, and ages. Our findings suggest that performance management failure is related with a procedural problem with three different dimensions: Insufficient Planning, Process & Integrity Issues, and Non-Meritocratic Logic. By exposing the different components of the Portuguese performance management problem, we shed light into the topic and allow organizations to understand and face their performance management systems’ flaws.

The relationship between the education level of successor's and the firm performance in German publicly listed family firms- an empirical analysis

The purpose of this thesis is to investigate how far the education level of the second or third generation of publicly traded German family firms affects the post-succession firm performance. By conducting a correlational and regression design, the aim is to examine how several variables influence the performance of family firms. Performance measures, for example ROA and Tobin’s q and variables, like Education level and succession periods, examine analytically that a positive succession trend will occur. However, with the used model, only a less rigid model shows empirical evidence.

How could marketing automation impact the business performance of Comexposium?

Comexposium continues to exhibit strong growth through global acquisition of key events. However, the company identified the need to increase the renewal rate of its exhibitors. In order to do so, Comexposium determined marketing automation software could have enormous value. However, the company currently does not have the appropriate data to determine to specific returns the software could provide. Thus, this report focused on assessing the impact of marketing automation on the business performance of a B2B enterprise and the best methods to implement and measure it. The main findings were that the software could be of immense value to Comexposium, if the company is ready to invest in internal resources and take the time to adapt to the changes the tool will incur.

Humble leadership and team voice

This study examines the direct and indirect effects of humble leadership on team voice. Although the relationship between leadership styles and voice is widely investigated, humble leadership and team voice, both relatively new constructs, remained out of sight. Drawing upon social interdependence theory, information exchange, team psychological safety, and team-efficacy are proposed to mediate the relationship between humble leadership and team voice. Research is conducted at the team-level analysis and involved 209 team members from 52 teams in 21 companies collected through a snowball sample. Results were provided by the SPSS macro PROCESS using the regression-based approach and bootstrapping techniques. Findings showed that humble leadership is positively related to team voice. Furthermore, findings supported the mediating effect of information exchange. However, no support was given for the mediating effects of team psychological safety and team-efficacy. Theoretical and practical implications of the findings are addressed.

Development of foam one-part geopolymers with enhanced thermal insulation performance and low carbon dioxide emissions

Buildings are responsible for more than 40% of the energy consumption and greenhouse gas emissions. Thus, increasing building energy efficiency is one the most cost-effective ways to reduce emissions. The use of thermal insulation materials could constitute the most effective way of reducing heat losses in buildings by minimising heat energy needs. These materials have a thermal conductivity factor, k (W/m.K) lower than 0.065 while other insulation materials such as aerated concrete can go up to 0.11. Current insulation materials are associated with negative impacts in terms of toxicity. Polystyrene, for example contains anti-oxidant additives and ignition retardants. In addition, its production involves the generation of benzene and chlorofluorocarbons. Polyurethane is obtained from isocyanates, which are widely known for their tragic association with the Bhopal disaster. Besides current insulation materials releases toxic fumes when subjected to fire. This paper presents experimental results on one-part geopolymers. It also includes global warming potential assessment and cost analysis. The results show that only the use of aluminium powder allows the production mixtures with a high compressive strength however its high cost means they are commercially useless when facing the competition of commercial cellular concrete. The results also show that one-part geopolymer mixtures based on 26%OPC +58.3%FA +8%CS +7.7%CH and 3.5% hydrogen peroxide constitute a promising cost efficient (67 euro/m3), thermal insulation solution for floor heating systems with low global warming potential of 443 KgCO2eq/m3.

Performance of a fly ash geopolymeric mortar for coating of ordinary portland cement concrete exposed to harsh chemical environments

Premature degradation of ordinary Portland cement (OPC) concrete infrastructures is a current and serious problem with overwhelming costs amounting to several trillion dollars. The use of concrete surface treatments with waterproofing materials to prevent the access of aggressive substances is an important way of enhancing concrete durability. The most common surface treatments use polymeric resins based on epoxy, silicone (siloxane), acrylics, polyurethanes or polymethacrylate. However, epoxy resins have low resistance to ultraviolet radiation while polyurethanes are sensitive to high alkalinity environments. Geopolymers constitute a group of materials with high resistance to chemical attack that could also be used for coating of concrete infrastructures exposed to harsh chemical environments. This article presents results of an experimental investigation on the resistance to chemical attack (by sulfuric and nitric acid) of several materials: OPC concrete, high performance concrete (HPC), epoxy resin, acrylic painting and a fly ash based geopolymeric mortar. Three types of acids, each with high concentrations of 10%, 20% and 30%, were used to simulate long term degradation by chemical attack. The results show that the epoxy resin had the best resistance to chemical attack, irrespective of the acid type and acid concentration.

Post-operating performance of cross-delisted firms from U.S. stock exchanges

We investigate the long-term performance of cross-delisted firms from U.S. stock markets. Using a sample of foreign firms listed and delisted from U.S. stock exchange markets over 2000-2012, we examine the operating performance and the long-run stock returns performance of firms post-cross-delisting. Our results suggest that cross-delisted firms have less growth opportunities than matched cross-listed firms in the long run. Moreover, firms that cross-delist after the passage of Rule 12h-6 of 2007 exhibit a significant decline in operating performance. In contrast, before the adoption of the Rule 12h-6, cross-delisted firms seem to be affected by the cost of a U.S. listing in the precross -delisting period. In addition, we provide evidence that cross-delisted firms underperform their cross-listed peers; cross-delisted firms experience negative average abnormal returns, especially in the post-delisting period.

Assessment of the performance of steel fibre reinforced self-compacting concrete in elevated slabs

The reinforcement mechanisms at the cross section level assured by fibres bridging the cracks in steel fibre reinforced self-compacting concrete (SFRSCC) can be significantly amplified at structural level when the SFRSCC is applied in structures with high support redundancy, such is the case of elevated slab systems. To evaluate the potentialities of SFRSCC as the fundamental material of elevated slab systems, a ¼ scale SFRSCC prototype of a residential building was designed, built and tested. The extensive experimental program includes material tests for characterizing the relevant properties of SFRSCC, as well as structural tests for assessing the performance of the prototype at serviceability and ultimate limit conditions. Three distinct approaches where adopted to derive the constitutive laws of the SFRSCC in tension that were used in finite element material nonlinear analysis to evaluate the reliability of these approaches in the prediction of the load carrying capacity of the prototype.

High performance fiber reinforced concrete for the shear reinforcement: experimental and numerical research

High performance fiber reinforced concrete (HPFRC) is developing rapidly to a modern structural material with unique rheological and mechanical characteristics. Despite applying several methodologies to achieve self15 compacting requirements, some doubts still remain regarding the most convenient strategy for developing a HPFRC. In the present study, an innovative mix design method is proposed for the development of high17 performance concrete reinforced with a relatively high dosage of steel fibers. The material properties of the developed concrete are assessed, and the concrete structural behavior is characterized under compressive, flexural and shear loading. This study better clarifies the significant contribution of fibers for shear resistance of concrete elements. This paper further discusses a FEM-based simulation, aiming to address the possibility of calibrating the constitutive model parameters related to fracture modes I and II.

Evaluation of the bond performance in FRP-brick components re-bonded after initial delamination

The bond behavior between Fiber Reinforced Polymers (FRPs) and masonry substrates has been the subject of many studies during the last years. Recent accelerated aging tests have shown that bond degradation and FRP delamination are likely to occur in FRP-strengthened masonry components under hygrothermal conditions. While an investigation on the possible methods to improve the durability of these systems is necessary, the applicability of different bond repair methods should also be studied. This paper aims at investigating the debonding mechanisms after repairing delaminated FRP-strengthened masonry components. FRP-strengthened brick specimens, after being delaminated, are repaired with two different adhesives: a conventional epoxy resin and a highly flexible polymer. The latter is used as an innovative adhesive in structural applications. The bond behavior in the repaired specimens is investigated by performing single-lap shear bond tests. Digital image correlation (DIC) is used for deeper investigation of the surface deformation and strains development. The effectiveness of the repair methods is discussed and compared with the strengthened specimens.

Performance de populações de Milho (Zea Mays L.) em terras altas sob cerrado no Centro-sul do estado do Tocantins, Brasil1

No estado do Tocantins, o cultivo de milho em "terras altas sob cerrado" apresenta níveis de produtividade variáveis, cuja média não ultrapassa 2 t/ha. Fatores de solo, como acidez, baixos teores de Ca, Mg, Ρ e Κ e matéria orgânica, concorrem para reduzir as produtividades. O desenvolvimento de materiais genéticos melhorados busca contribuir na superação dessas limitações. Como atividade inicial em um programa de melhoramento genético, o presente estudo avaliou um total de 160 populações de milho, nas safras 1994/95, 1995/96 e 1998/99, nos municípios de Pedro Afonso e Gurupi, em termos de produtividade de grãos (PG), altura da planta (AP), altura da espiga (AE) e dias para florescimento feminino (FF). Para PG, os efeitos de populações foram significativos em todas as avaliações, ocorrendo produtividades entre 1,59 t/ ha a 7,46 t/ha. Destacaram-se as populações IAPAR 51, EGO 17, CMS 08, CMS 50, COMPOSTO TERRAS BAIXAS, TAIÚBA, TAITINGA, CMS 28, CMS 15 e SIKALQ, em Pedro Afonso, e K9201, CMS 39, BR 105 e CMS 03, em Gurupi, com produtividades acima de 5 t/ha. As diferenças nas performances produtivas e agronômicas em Pedro Afonso e Gurupi, juntamente com efeitos significativos das interações populações χ locais, alertam para a condução de programas de melhoramento específicos para cada local.