The dissemination and implementation of national asthma guidelines in south africa: the use of outcome mapping

Asthma is an important chronic inflammatory disorder with significant morbidity and mortality in South Africa. The development of national asthma guidelines by the South African Thoracic Society and National Asthma Education Programme has been one approach to try and improve the quality of care. The impact of previous guidelines has been limited and therefore it is hoped that the newly revised 2007 guidelines will have a more effective approach to dissemination, implementation and evaluation. Outcome mapping (OM) is one approach to integrated planning, monitoring and evaluation of projects that intend to contribute to change in complex systems. It has a structured, systematic and logical approach that focuses on changes in behaviour, actions or relationships in the people or organizations that the project is working with. OM has three stages - intentional design, outcome/performance monitoring and evaluation - which are described in this article and illustrated with reference to the Asthma Guideline Implementation Project (AGIP). In the intentional design stage the AGIP created a vision and mission statement to guide the project and then identified seven boundary partners. For each boundary partner the AGIP defined the project's outcome challenge and a series of progress markers to monitor achievement of the outcome. Following this the AGIP conceptualized the strategies and organizational practices that will be engaged with to realize the outcomes. In the monitoring stage the AGIP will regularly document and reflect on the progress markers, strategies and organizational practices using pre-determined structured journals. In the evaluation stage there is the opportunity to plan the evaluation of key aspects of the project in more depth. In the AGIP project the team engaged with the development of a doctoral research project to evaluate the process of implementation in private and public primary care settings in the Cape Town metropole. This article describes the methodology of Outcome Mapping and illustrates this in relation to the Asthma Guidelines Implementation Project. The methodology has the potential to be applied in many other development projects and is also congruent with action research. It is hoped that the readers will find this approach useful in their own settings

A Trapped Field of 17.6 T in Melt-Processed, Bulk Gd-Ba-Cu-O Reinforced with Shrink-Fit Steel

The ability of large grain, REBa$_{2}$Cu$_{3}$O$_{7-\delta}$ [(RE)BCO; RE = rare earth] bulk superconductors to trap magnetic field is determined by their critical current. With high trapped fields, however, bulk samples are subject to a relatively large Lorentz force, and their performance is limited primarily by their tensile strength. Consequently, sample reinforcement is the key to performance improvement in these technologically important materials. In this work, we report a trapped field of 17.6 T, the largest reported to date, in a stack of two, silver-doped GdBCO superconducting bulk samples, each of diameter 25 mm, fabricated by top-seeded melt growth (TSMG) and reinforced with shrink-fit stainless steel. This sample preparation technique has the advantage of being relatively straightforward and inexpensive to implement and offers the prospect of easy access to portable, high magnetic fields without any requirement for a sustaining current source.Comment: Updated submission to reflect licence change to CC-BY. This is the "author accepted manuscript" and is identical in content to the published versio

Self-Control in Cyberspace: Applying Dual Systems Theory to a Review of Digital Self-Control Tools

Many people struggle to control their use of digital devices. However, our understanding of the design mechanisms that support user self-control remains limited. In this paper, we make two contributions to HCI research in this space: first, we analyse 367 apps and browser extensions from the Google Play, Chrome Web, and Apple App stores to identify common core design features and intervention strategies afforded by current tools for digital self-control. Second, we adapt and apply an integrative dual systems model of self-regulation as a framework for organising and evaluating the design features found. Our analysis aims to help the design of better tools in two ways: (i) by identifying how, through a well-established model of self-regulation, current tools overlap and differ in how they support self-control; and (ii) by using the model to reveal underexplored cognitive mechanisms that could aid the design of new tools.Comment: 11.5 pages (excl. references), 6 figures, 1 tabl

Guideline for the management of acute asthma in adults: 2013 update

Acute asthma attacks (asthma exacerbations) are increasing episodes of shortness of breath, cough, wheezing or chest tightness associated with a decrease in airflow that can be quantified and monitored by measurement of lung function (peak expiratory flow (PEF) or forced expiratory volume in the 1st second) and requiring emergency room treatment or admission to hospital for acute asthma and/or systemic glucocorticosteroids for management. The goals of treatment are to relieve hypoxaemia and airflow obstruction as quickly as possible, restore lung function, and provide a suitable plan to avoid relapse. Severe exacerbations are potentially life-threatening and their treatment requires baseline assessment of severity, close monitoring, and frequent reassessment using objective measures of lung function (PEF) and oxygen saturation. Patients at high risk of asthma-related death require particular attention. First-line therapy consists of oxygen supplementation, repeated administration of inhaled short-acting bronchodilators (beta-2-agonists and ipratropium bromide), and early systemic glucocorticosteroids. Intravenous magnesium sulphate and aminophylline are second- and third-line treatment strategies, respectively, for poorly responding patients. Intensive care is indicated for severe asthma that is not responsive to first-line treatment. Antibiotics are only indicated when there are definite features of bacterial infection. Factors that precipitated the acute asthma episode should be identified and preventive measures implemented. Acute asthma is preventable with optimal control of chronic asthma

Effects of systematic asymmetric discounting on physician-patient interactions: a theoretical framework to explain poor compliance with lifestyle counseling

BACKGROUND: This study advances the use of a utility model to model physician-patient interactions from the perspectives of physicians and patients. PRESENTATION OF THE HYPOTHESIS: In cases involving acute care, patient counseling involves a relatively straightforward transfer of information from the physician to a patient. The patient has less information than the physician on the impact the condition and its treatment have on utility. In decisions involving lifestyle changes, the patient may have more information than the physician on his/her utility of consumption; moreover, differences in discounting future health may contribute significantly to differences between patients' preferences and physicians' recommendations. TESTING THE HYPOTHESIS: The expectation of differences in internal discount rate between patients and their physicians is discussed. IMPLICATIONS OF THE HYPOTHESIS: This utility model provides a conceptual basis for the finding that educational approaches alone may not effect changes in patient behavior and suggests other economic variables that could be targeted in the attempt to produce healthier behavior

Affordances, constraints and information flows as ‘leverage points’ in design for sustainable behaviour

Copyright @ 2012 Social Science Electronic PublishingTwo of Donella Meadows' 'leverage points' for intervening in systems (1999) seem particularly pertinent to design for sustainable behaviour, in the sense that designers may have the scope to implement them in (re-)designing everyday products and services. The 'rules of the system' -- interpreted here to refer to affordances and constraints -- and the structure of information flows both offer a range of opportunities for design interventions to in fluence behaviour change, and in this paper, some of the implications and possibilities are discussed with reference to parallel concepts from within design, HCI and relevant areas of psychology

Common Scaling Patterns in Intertrade Times of U. S. Stocks

We analyze the sequence of time intervals between consecutive stock trades of thirty companies representing eight sectors of the U. S. economy over a period of four years. For all companies we find that: (i) the probability density function of intertrade times may be fit by a Weibull distribution; (ii) when appropriately rescaled the probability densities of all companies collapse onto a single curve implying a universal functional form; (iii) the intertrade times exhibit power-law correlated behavior within a trading day and a consistently greater degree of correlation over larger time scales, in agreement with the correlation behavior of the absolute price returns for the corresponding company, and (iv) the magnitude series of intertrade time increments is characterized by long-range power-law correlations suggesting the presence of nonlinear features in the trading dynamics, while the sign series is anti-correlated at small scales. Our results suggest that independent of industry sector, market capitalization and average level of trading activity, the series of intertrade times exhibit possibly universal scaling patterns, which may relate to a common mechanism underlying the trading dynamics of diverse companies. Further, our observation of long-range power-law correlations and a parallel with the crossover in the scaling of absolute price returns for each individual stock, support the hypothesis that the dynamics of transaction times may play a role in the process of price formation.Comment: 8 pages, 5 figures. Presented at The Second Nikkei Econophysics Workshop, Tokyo, 11-14 Nov. 2002. A subset appears in "The Application of Econophysics: Proceedings of the Second Nikkei Econophysics Symposium", editor H. Takayasu (Springer-Verlag, Tokyo, 2003) pp.51-57. Submitted to Phys. Rev. E on 25 June 200