A multi-dimensional framework of interactive value formation within complex, prolonged and technology-based self-services

Firms attempt to co-create superior perceived value and/or avoid value co-destruction. There is, however, no guarantee of success especially within the consumption of complex, prolonged and technology-based self-services. In such services, the process of value co-creation and co-destruction may operate simultaneously to generate a multitude of tensions in each direction. As such, a multitude of interacting factors maybe at play during this interactive value formation (IVF) process. Adopting a grounded theory approach and in-depth interviews of users of such services, the author investigates for the first time the IVF process during an indirect service interaction process and introduce the role of operant resources as mediators during the inter-play between value co-creation and co-destruction process, i.e. during the IVF process. This study’s findings also identify factors that reduce and increase IVF intensity (customers’ subjective perception of the extent of effort and time invested in the IVF process), suggesting strategies to mitigate IVF intensity. This is meaningful since high IVF intensity results in value co-destruction and low level of loyalty while low IVF intensity might bring about value co-creation and high level of loyalty. Therefore, managers who offer complex, prolonged and TBSSs, especially wellness apps should, for instance, not only position services with low IVF intensity which can generate self-efficacy, but also encourage users to involve in more resource integration activities to achieve medium/high level of resource integration, hence higher value co-created and consequently increasing level of loyalty. This study represents an initial foray into the complexity between co-creation and co-destructive factors during prolonged and complex services

Player agency in interactive narrative: audience, actor & author

The question motivating this review paper is, how can computer-based interactive narrative be used as a constructivist learn- ing activity? The paper proposes that player agency can be used to link interactive narrative to learner agency in constructivist theory, and to classify approaches to interactive narrative. The traditional question driving research in interactive narrative is, ‘how can an in- teractive narrative deal with a high degree of player agency, while maintaining a coherent and well-formed narrative?’ This question derives from an Aristotelian approach to interactive narrative that, as the question shows, is inherently antagonistic to player agency. Within this approach, player agency must be restricted and manip- ulated to maintain the narrative. Two alternative approaches based on Brecht’s Epic Theatre and Boal’s Theatre of the Oppressed are reviewed. If a Boalian approach to interactive narrative is taken the conflict between narrative and player agency dissolves. The question that emerges from this approach is quite different from the traditional question above, and presents a more useful approach to applying in- teractive narrative as a constructivist learning activity

Developing an Intervention Toolbox for the Common Health Problems in the Workplace

Development of the Health ↔ Work Toolbox is described. The toolbox aims to reduce the workplace impact of common health problems (musculoskeletal, mental health, and stress complaints) by focusing on tackling work-relevant symptoms. Based on biopsychosocial principles this toolbox supplements current approaches by occupying the zone between primary prevention and healthcare. It provides a set of evidence-informed principles and processes (knowledge + tools) for tackling work-relevant common health problems. The toolbox comprises a proactive element aimed at empowering line managers to create good jobs, and a ‘just in time’ responsive element for supporting individuals struggling with a work-relevant health problem. The key intention is helping people with common health problems to maintain work participation. The extensive conceptual and practical development process, including a comprehensive evidence review, produced a functional prototype toolbox that is evidence based and flexible in its use. End-user feedback was mostly positive. Moving the prototype to a fully-fledged internet resource requires specialist design expertise. The Health ↔ Work Toolbox appears to have potential to contribute to the goal of augmenting existing primary prevention strategies and healthcare delivery by providing a more comprehensive workplace approach to constraining sickness absence

Effect of obesity on dolutegravir exposure in Black Southern African adults living with HIV

Background: Dolutegravir, a component of the preferred first-line antiretroviral therapy (ART) regimen has been associated with increased weight gain, which is markedly higher when combined with tenofovir alafenamide (TAF), the newer tenofovir prodrug instead of tenofovir disoproxil fumarate (TDF). South Africa has a high prevalence of obesity, especially among women. Understanding dolutegravir exposure in the patients with obesity is important for dose optimisation. Aims: We compared the pharmacokinetic parameters of dolutegravir in Southern African adults living with HIV with and without obesity. Methods: Blood samples were collected at various time points over a 24 hour-period for dolutegravir assays. Non-compartmental analysis was conducted and geometric mean ratios (GMRs), with 90% confidence intervals (CIs), were generated to compare dolutegravir pharmacokinetic parameters between the groups. Regression analyses to assess predictors of dolutegravir exposure were done. Results: 40 participants were enrolled, 26 were women and 10 had obesity. Dolutegravir area under the concentration-time curve to 24-hours (AUC0-24hr) and the maximum concentrations (Cmax) were marginally lower in participants with obesity: GMR 0.91 (90% CI, 0.71-1.16) and GMR 0.86 (90% CI, 0.68-1.07), respectively. In a multivariate linear regression analysis adjusting for age, sex, body mass index (BMI), creatinine clearance and randomisation arm (TAF or TDF), a unit increase in BMI was associated with 1.2% lower dolutegravir AUC0-24h, (P = 0.035). Conclusion: Dolutegravir exposure was marginally lower in participants with obesity, but this is not clinically significant. Our findings suggest that there is no need to dose adjust dolutegravir in people with obesity

Changing practice in dementia care in the community: developing and testing evidence-based interventions, from timely diagnosis to end of life (EVIDEM)

Background Dementia has an enormous impact on the lives of individuals and families, and on health and social services, and this will increase as the population ages. The needs of people with dementia and their carers for information and support are inadequately addressed at all key points in the illness trajectory. Methods The Unit is working specifically on an evaluation of the impact of the Mental Capacity Act 2005, and will develop practice guidance to enhance concordance with the Act. Phase One of the study has involved baseline interviews with practitioners across a wide range of services to establish knowledge and expectations of the Act, and to consider change processes when new policy and legislation are implemented. Findings Phase 1, involving baseline interviews with 115 practitioners, identified variable knowledge and understanding about the principles of the Act. Phase 2 is exploring everyday decision-making by people with memory problems and their carers