The Asian soybean rust (ASR), caused by the fungus Phakopsora pachyrhizi, may promote significant damages in soybean crop. The disease is mainly controlled by sequential applications of fungicides following a calendarbased system. However, this practice disregards the weather favorability to recommend spraying to ASR control. The proposition of fungicide schemes to make the ASR control more efficient can be reached by the use of diseasewarning systems. Thus, the current study aimed to assess the performance of different disease-warning systems to determine better fungicide spraying schemes for the ASR control. The experiment was conducted in Piracicaba, SP, Ponta Grossa, PR, Campo Verde and Pedra Preta, MT, Brazil, over the 2014/2015 and 2015/2016 soybean growing seasons. The treatments were: Unsprayed check treatment; Calendar-based sprays in a 14-day interval from R1 stage (CALEND); Disease warning system based on rainfall data with less conservative threshold (PREC_1 - 80% severity cut-off); and more conservative threshold (PREC_2 - 50% severity cut-off); Disease warning system based on air temperature and leaf wetness duration with less conservative threshold (TLWD_1 - 6 lesions cm-2) and more conservative threshold (TLWD_2 - 9 lesions cm-2). The results confirmed that weather conditions in the field trials were favorable to ASR progress. Among the weather elements correlated to severity leaf wetness duration, cumulative rainfall and air temperature during leaf wetness duration influenced positively the ASR. By testing warning systems to control ASR it ones was evidenced that those based on rainfall data presented highest performances. PREC_2 showed a high performance considering all sowing dates; whereas, PREC_1 was better treatment during sowing dates between October and November. The TLWD diseasewarning systems, with both thresholds, overestimated the ASR, recommending more sprays compared to other treatments. Empirical models were efficient for estimation of LWD in Ponta Grossa, Campo Verde and Pedra Preta. High performances in estimating LWD were identified by using number of hours with relative humidity above 90% (NHRH>=90%), being these able to be use as input in the disease-warning systems (RMSE less than 2.0 h). The profitability of use rainfall based warning systems was conditioned by variations in the rainfalls regimes at the studied sites. PREC_1 and PREC_2 presented the highest relative yield gains in relation to CALEND during the period with the highest rainfalls in Piracicaba, Campo Verde and Pedra Preta. However, in Ponta Grossa, the rainfall based warning systems were not effective to control ASR. / A ferrugem asiática da soja (ASR), causada pelo fungo Phakopsora pachyrhizi, pode ocasionar elevados prejuízos às lavouras de soja. O controle da doença é realizado por meio de aplicações sequenciais de fungicidas em sistema calendarizado. Este, por sua vez, não considera a favorabilidade climática para recomendar pulverizações. A proposição de esquemas de pulverização mais eficientes pode ser obtida pelo uso de sistemas de alerta fitossanitário. Assim, objetivou-se avaliar o desempenho de diferentes sistemas de alerta fitossanitário, visando à determinação de esquemas de pulverização de defensivos químicos para o controle de ASR nos estados de São Paulo, Paraná e Mato Grosso, Brasil. O experimento foi conduzido em Piracicaba, SP, Ponta Grossa, PR, Campo Verde e Pedra Preta, MT, Brasil ao longo das safras de 2014/2015 e 2015/2016. Os tratamentos foram: Testemunha (sem aplicação); Aplicações calendarizadas a partir de R1, espaçadas em 14 dias (CALEND); Sistema de alerta baseado em dados de chuva limiar menos conservador (PREC_1 - 80% de severidade) e mais conservador (PREC_2 - 50% de severidade); Sistema de alerta baseado em dados de temperatura do ar e a duração do período de molhamento foliar com limiar menos conservador (TDPM_1 - 6 lesões cm2) e com limiar menos conservador (TDPM_2 - 9 lesões cm2). Os resultados obtidos confirmaram que as condições meteorológicas nas localidades estudadas foram favoráveis para o progresso da ASR. Verificou-se que a duração do período de molhamento foliar (DPM), temperatura do ar durante o molhamento e chuva acumulada influenciaram positivamente a ASR. Ao testar os sistemas de alerta no controle de ASR verificou-se que aqueles baseados em dados de chuva apresentaram os melhores desempenhos. O PREC_2 apresentou melhor desempenho em análise geral considerando todas as épocas de semeadura, ao passo que PREC_1 foi melhor quando em semeadura de outubro a novembro. Os sistemas TDPM, com ambos os limiares de ação, superestimaram os valores de ASR acusando um número maior de pulverizações comparada aos demais tratamentos. Modelos empíricos mostraram ser eficientes na estimação da DPM em Ponta Grossa, Campo Verde e Pedra Preta. Estimações pelo método de número de horas com umidade relativa acima de 90% (NHUR>=90%) apresentaram RMSE menor que 2,0 h viabilizando o uso da DPM estimada como variável de entrada de sistema de alerta. A rentabilidade do uso dos sistemas de alerta baseado em dados de chuva foi condicionada às variações no regime dessa variável nas localidades estudadas. PREC_1 e PREC_2 apresentaram maior ganho de produtividade em relação à CALEND durante o período com maior índice pluviométrico nas localidades de Piracicaba, Campo Verde e Pedra Preta. Em contrapartida os sistemas de alerta não foram efetivos no controle de ASR em Ponta Grossa.

Submitted by William Justo Figueiro (williamjf) on 2015-08-20T19:00:53Z No. of bitstreams: 1 24e.pdf: 2612397 bytes, checksum: b639cb23c503f86dd9560fcf6386dde4 (MD5) / Made available in DSpace on 2015-08-20T19:00:53Z (GMT). No. of bitstreams: 1 24e.pdf: 2612397 bytes, checksum: b639cb23c503f86dd9560fcf6386dde4 (MD5) Previous issue date: 2013 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / PROSUP - Programa de Suporte à Pós-Gradução de Instituições de Ensino Particulares / De acordo com a Organização Mundial de Saúde, doenças cardíacas, doenças respiratórias crônicas, câncer e diabetes são as doenças crônicas não transmissíveis mais comuns, assim como uma das principais causas da mortalidade no mundo. Nesses casos é necessário mais do que o engajamento do paciente no auxílio ao cuidado destas doenças. O apoio da comunidade e das organizações de saúde também é desejável. Estes devem apoiar os pacientes em suas atividades de autogerenciamento, fazendo-os sentirem-se confiantes e motivados. A computação ubíqua dá condições para ajudar os pacientes de doenças crônicas na gestão de suas atividades, oferecendo-lhes apoio a qualquer hora, em qualquer lugar. O presente trabalho apresenta o U’Ductor, um modelo para cuidado ubíquo de doenças crônicas não transmissíveis, cujo objetivo é facilitar a integração entre pacientes e recursos da comunidade e organizações de saúde. O U’Ductor dá um passo a frente em relação aos trabalhos estudados ao integrar pacientes, membros da comunidade e organizações de saúde, e recursos da comunidade e organizações de saúde. Tais características não foram exploradas nos trabalhos estudados da maneira como é feita no U’Ductor. Um protótipo do modelo foi avaliado por pacientes crônicos que deram pareceres positivos em relação a sua aplicabilidade nas atividades de cuidado de doenças crônicas não transmissíveis. / Accordingly with the World Health Organization, heart disease, chronic respiratory diseases, cancer and diabetes are the most common non-communicable diseases and one of the leading causes of the mortality in the world. In such cases we need more than patient engagement to help to control of the disease, community and health organizations support is also desirable. These roles must support the patients self-management activities, making them feel confident and motivated. This support can be accomplished by ubiquitous computing. The ubiquitous computing gives conditions to help chronic diseases patients in the management of their activities, offering support to them anytime, anywhere. This work presents U’Ductor, a model for supporting ubiquitous non-communicable disease care, whose goal is to help the integration between patient and community resources. The U’Ductor gives a step forward in relation to the studied related works by integrating patients, community resources and community members. Those features were not completely explored in the studied works in the way it’s employed in U’Ductor. An implementation of the model was evaluated by chronic patients, which had given a positive feedback about it.

Introduction: The studies reported in this thesis investigated a number of patient orientated aspects of its current diagnosis, management and treatment in Kuwait. A comprehensive literature survey is presented with a detailed critical analysis of the very limited number of published material relevant to type 2 diabetes in Kuwait is also provided. A concise list of aims and objectives is also provided. Methodology: The methodology used to derive knowledge of the present situation from the patient perspective, was a series of relevant questions, devised based on the internationally used diabetes Michigan questionnaire. Face to face interviews were used throughout for both patients and medical staff. Suitable data analysis was performed. Results: A pilot study consulted 10 Kuwaiti and 10 non-Kuwaiti patients, and after analysis of their data it was found to be reliable, appropriate and capable of being analysed and so was extended to a larger study of 109 diabetic patients. These 109 diabetic patients were studied in thirteen clinics distributed throughout Kuwait. Two groups of patients were studied – Kuwaiti nationals and non-Kuwaitis both of whom were treated at these clinics during their residency in Kuwait. 38 questions were asked including demographics, medical treatment, monitoring of their disease, physiological consequences and dietary aspects. The major findings were that patients considered two major areas could be improved to enhance the treatment of their disease. The first was to improve the degree of empathy shown to them by the medical/nursing staff and secondly to provide simple practical advice on exercise, dietary considerations and renal aspects of their disease. More comprehensive findings are presented in the thesis but many of these were minor compared with these two major aspects. Also presented are interviews with the medical staff in Kuwait who treat diabetic patients and the problems they face when treating their disease. The opinions and views of selected ophthalmologists and renal specialists are also presented. Medical views were also sought in the UK- Ascot Rehabilitation above their experiences treating diabetic patients from Kuwait. Another aspect of the study was to interview Kuwaiti nationals who had been sent to a clinic in Ascot, UK for the treatment of the serious consequences of their conditions. Many of these were had type 2 diabetes and their views and perspectives of their treatment in Kuwait were gathered as being representative of the long term treatment of this condition. Discussions and Conclusions: The thesis discusses in some detail all the results which were obtained and concludes with a series of recommendations which could be taken to improve the treatment of type 2 diabetes in Kuwait.

Management of chronic disease requires a different service delivery model from that of acute illness. The uninsured population experience poorer health status and increased incidence of chronic disease than do the insured population. The purpose of this study was to identify the supports and barriers present in providing chronic disease management to patients at Ohio free clinics. Wagner's theory of chronic disease management served as the theoretical lens. The sequential, exploratory mixed methods study collected data from 13 free clinics belonging to the Ohio Association of Free Clinics (OAFC). Quantitative questions focused on processes in clinics with high and low fidelity to the chronic care model (CCM) determined by the Assessment of Chronic Illness Care (ACIC) survey. A backwards stepwise logistic regression was used. The quantitative analysis determined the 3 highest and lowest scoring clinics on the ACIC survey who then participated in a 2 tiered multi-case study series. Qualitative questions examined supports present in high fidelity clinics and barriers present in clinics with low fidelity. Qualitative findings identified 5 support areas that centered on progressive vision and patient-centered care themes that existed in high fidelity clinics. Four barriers were identified in low fidelity clinics that focused on the theme of capacity building. These findings provide evidence to guide the OAFC's work in improving adherence to the CCM constructs, thereby elevating the quality of care to the uninsured with chronic disease to the level of those providers governed by accrediting organizations. Changes in quality of care may result in an improvement to the health status of the individual and the communities in which they live.

Previous researchers have identified that participation in a pulmonary rehabilitation program improves health outcomes yet, continuation in a weekly maintenance program yielded mixed results. Self-management programs have had reported use in chronic obstructive pulmonary disease (COPD). A meta analysis has identified that no self-management program had evaluated the effect of this type of intervention on the functional status of the participant with COPD. Reduced functional status is well reported as an indicator of disease progression in COPD. Adjuvant therapies for people with COPD need to demonstrate an effect in this domain. The Stanford model chronic disease self-management program (CDSMP) had been reported as a program that may optimise the health of people with chronic health conditions. However, its utility has not been formally evaluated for people with COPD. There have not been any reports of a comparison of the Stanford model CDSMP with pulmonary rehabilitation via a randomised controlled study in COPD. Aim: To compare and evaluate the health outcomes from participation in nurse ledwellness-promoting interventions conducted in the ambulatory care setting of a metropolitan hospital. Participants were randomised to either a six-week behavioural intervention: the Stanford model CDSMP or, a six-week pulmonary rehabilitation program and results compared to usual care (a historical control group). The efficacy of the interventions was measured at week seven and repeated at week 26 and 52. Following the week seven evaluation, the pulmonary rehabilitation program participants were rerandomised to usual care or, weekly maintenance pulmonary rehabilitation for 18 weeks and, followed up until the study completion at week 52.Little is reported about the costs of care for people with COPD in Australia. This study prospectively evaluated the costs of the interventions and health resource for the 52 weeks and undertook a cost utility analysis. Methods: Walking tests (The Incremental Shuttle Walking Test) and questionnaires asking participants about their health related quality of life, mood status, dyspnoea and self efficacy were assessed prior to randomisation to either six week intervention and repeated at weeks 7, 26 and 52. The implementation of these adjuvant therapies enabled all costs associated with the interventions to be prospectively examined and compared. Results: During the two years of recruitment 252 people (54% males) with a mean age 71 years (SD 11, range 39-93 years) were referred to the study. Student’s ttests identified that there were no statistically significant differences (P=0.16) between all those referred by age and gender as compared to all those admitted to Hospital A with an exacerbation of COPD. Ninety-seven people (51% male) with a mean age of 68 years (SD 9, range 39-87 years) agreed to participate in the study. Follow up in the study continued for 12 months following enrolment with only a modest level of attrition by week seven (3%) and week 52 (25%). Following the six-week interventions, both the pulmonary rehabilitation and CDSMP groups recorded statistically significant increases in functional capacity, self-efficacy and health related quality of life.Functional performance was additionally evaluated in the intervention arms with participants wearing pedometers for the six-week period of the interventions. There were no statistically significant differences between steps per week (P=0.15) and kilometres per week (P=0.17) walked between these two groups in functional performance. The Spearman rho statistic identified no statistically significant relationship between functional performance and the severity of COPD (rs (33) = 0.19, P = 0.26). No significant correlation between functional capacity and functional performance was identified (rs (32) = 0.19, P = 0.29). This suggests that other factors contribute to daily functional performance. The largest cost of care for people with COPD has been reported to be unplanned admissions due to an exacerbation of COPD.In this study there were no statistically significant differences between the three intervention groups in the prospective measurement of ambulatory care visits, Emergency Department presentations and admissions to hospital. The calculation of costs illuminated the costs of care in COPD are greater than the population norm. In addition, maintenance pulmonary rehabilitation generated a greater quality adjusted life year (QALY) than a six-week program. Despite the strength of the participants preferences (as measured by the QALY) for maintenance PRP, there were no significant differences in use of hospital resources throughout the study period by the three intervention groups, which suggests some degree of equivalence.

Background Inner strength has been described as an important phenomenon in association with disease management, health, and ageing. To increase the knowledge of the phenomenon of inner strength, a meta-theoretical analysis was performed which resulted in a model of Inner Strength where inner strength comprises four interrelated and interacting dimensions; connectedness, creativity, flexibility, and firmness. The model was used in this thesis as a theoretical framework. Aim The overall purpose of this thesis was to develop and validate an inner strength scale, describe inner strength among an older population, and elucidate its significance for experience of health, despite disease and adversities. Methods The studies had quantitative approaches with cross-sectional designs (I-III) and a qualitative approach with narrative interviews (IV). Studies I-IV was part of the GErontological Regional DAtabase (GERDA) Botnia project. In study I, the participants (n = 391, 19-90 years old) were mostly from northern Sweden. In studies II and III, the participants (n = 6119, 65, 70, 75 and 80 years old) were from Sweden and Finland, and in study IV the participants (n = 12, 67-82 years old) were from Västerbotten County. Data was analysed using principal component analysis and confirmatory factor analysis (CFA), various statistics, structural equation modelling, and qualitative content analysis. Results In study I, the Inner Strength Scale (ISS) was developed and psychometrically tested. An initial 63-item ISS was reduced to a final 20-item ISS. A four-factor solution based on the four dimensions of inner strength was supported, explaining 51% of the variance, and the CFA showed satisfactory goodness-of-fit. In study II, ISS scores in relation to age, gender and culture showed the highest mean ISS score among the 65-year-olds, with a decrease in mean score for every subsequent age (70, 75, and 80 years). Women had slightly higher mean ISS scores than men, and there were minor differences between the regions in Sweden and Finland. In study III, a hypothesis was proposed and subsequently supported in the results where inner strength was found to partially mediate in the relationship between disease and self-rated health. The bias-corrected bootstrap, estimating the mediating indirect effect was significant and the test of goodness-of-fit was satisfactory. In study IV, from the narratives of inner strength it was found that inner strength comprised feelings of being connected and finding life worth living. Having faith in oneself and one’s possibilities and facing and taking an active part in the situation were also expressed. Finally, coming back and finding ways to go forward in life were found to be essential aspects of inner strength. Conclusions The newly developed ISS is a reliable and valid instrument that captures a broad perspective of inner strength. Basic data about inner strength in a large population of old people in Sweden and Finland is provided, showing the highest mean ISS score among the 65-year-olds. Inner strength among old people is a resource for experience of health, despite disease and adversities. This thesis contributes to increase knowledge of the phenomenon of inner strength and provide evidence for the importance of inner strength for old people’s wellbeing. Increased knowledge of the four dimensions of inner strength; connectedness, creativity, flexibility and firmness, is proposed to serve as an aid for health care professionals in their efforts to identify where the need of support is greatest and to find interventions that promotes and strengthen inner strength. / Bakgrund Inre styrka har beskrivits som ett viktigt fenomen associerat till att hantera sjukdom, till hälsa och åldrande. För att öka kunskapen om fenomenet inre styrka genomfördes en metateoretisk analys som resulterade i en Inre Styrka modell där inre styrka omfattar fyra samverkande dimensioner; samhörighet, kreativitet, flexibilitet och fasthet. Modellen har använts i denna avhandling som ett teoretiskt ramverk. Syfte Det övergripande syftet med denna avhandling var att utveckla och testa en skala som mäter inre styrka, beskriva inre styrka i en population av äldre, och att belysa dess betydelse för upplevelsen av hälsa, trots sjukdom 0ch motgångar. Metod Studierna som genomfördes hade kvantitativ ansats med tvärsnittsdesign (I-III) och kvalitativ ansats med narrativa intervjuer (IV).  Alla studier var en del av GErontologiska Regionala DAtabas (GERDA) Botnia projektet. Deltagarna i studie I (n= 391, 19-90 år) var mestadels från norra delarna av Sverige. I studierna II och III var deltagarna (n=6119, 65, 70, 75 och 80 år) från Sverige och Finland. I studie IV var deltagarna (n=12, 67-82 år) från Västerbotten. Data analyserades med hjälp av principalkomponentanalys och konfirmatorisk faktor analys (CFA), varierande statistik, strukturell ekvationsmodellering, och kvalitativ innehållsanalys. Resultat I studie I utvecklades och testades Inre Styrka Skalan (ISS). En inledande 63 frågors ISS reducerades till en slutlig 20 frågors ISS. Baserad på de fyra dimensionerna av inre styrka bekräftades en fyrafaktors lösning med 51 % förklaringsgrad och CFA visade ett tillfredställande goodness-of-fit. I studie II beskrevs inre styrka i relation till ålder, kön och kultur. Det högsta totala ISS medelvärdet skattades bland 65-åringarna med lägre medelvärden för varje efterföljande ålder (70, 75 och 80 år). Kvinnor skattade ett något högre totalt ISS medelvärde än män och det var inte några större skillnader mellan regionerna i Sverige och Finland. I studie III bekräftades den hypotes som lagts fram, att inre styrka kan mediera i relationen mellan sjukdom och upplevelsen av hälsa. Bias-corrected bootstrap visade en signifikant indirekt effekt i relationen mellan sjukdom och upplevelsen av hälsa, medierad av inre styrka, och test av modellens goodness-of-fit var tillfredsställande. I studie IV, utifrån berättelserna om inre styrka visade det sig att inre styrka omfattar känslor av samhörighet och att finna livet värt att leva. Att ha tillit till sig själv och sina möjligheter, och att kunna möta och ta aktiv del i situationen beskrevs också. Slutligen, att komma igen och hitta vägar att gå vidare i livet var viktiga aspekter av inre styrka.  Slutsatser Den nyutvecklade Inre Styrka Skalan är ett reliabelt och valitt instrument som fångar ett brett perspektiv av inre styrka. Basdata om inre styrka i en stor population äldre i Sverige och Finland har presenterats, och visar det högsta ISS medelvärdet bland 65-åringarna. Inre styrka bland äldre är en resurs för upplevelsen av hälsa, trots sjukdom och motgångar. Denna avhandling bidrar till att öka kunskapen om fenomenet inre styrka och ger evidens för att inre styrka har en viktig betydelse för äldres välbefinnande. Ökad kunskap om de fyra dimensionerna av inre styrka; samhörighet, kreativitet, flexibilitet, och fasthet, föreslås kunna vara en hjälp för vårdpersonal i deras arbete att identifiera var behovet av stöd är störst och att sätta in insatser som främjar och stärker inre styrka. / GErontologiska Regionala DAtabas (GERDA) Botnia projektet

The management process of chronic diseases is longitudinal in nature. Patient records in electronic format provide information at the point of care and support decision-making processes. In our research, we analyzed the clinical pragmatics of Chronic Disease Management (CDM) and formulated a knowledge model to develop Ontology-based EMR. Our research involved knowledge abstraction, knowledge modeling, and ontology engineering. We applied the Knowledge Management approach to knowledge sources including medical literature, the Chronic Care Model (CCM), CPR Ontology and HL-7 RIM. We studied CDM in detail to abstract conceptual knowledge involved in the process of CDM. The abstracted knowledge was modeled into a formal model called CD-EMR Model. We adapted Methontology and developed an OWL-based ontology from the CD-EMR Model. We evaluated the ontology by instantiating longitudinal clinical cases of chronic diseases. CD-EMR ontology allows (a) computerization of longitudinal patient records, (b) semantic interoperability, and (c) reasoning for clinical decision support.

In 2002 federal funds, known as the Primary Care Health Transition Fund (PCHTF) were transferred to the provinces to experiment with different models of health services delivery in primary care. The Northern Health Authority used the fund to implement a Chronic Disease Management Community Collaborative using the Institute for Healthcare Improvement Breakthrough Series and the British Columbia (B.C.) Expanded Chronic Care Model. Included in the Chronic Care Model is an information systems component that enables a population-based approach using guidelines and data to plan, organize, monitor and deliver care for patients with chronic illnesses. In British Columbia a secure web based system, known as the Chronic Disease Management (CDM) Toolkit was developed by the Ministry of Health and made accessible to all physicians in the province to facilitate CDM by collaboratives and individual general practitioners (GPs). Technology acceptance is a mature concept in the information systems literature, and models of technology acceptance are important in health care with the increasing deployment of information systems to support clinical and management work processes. Understanding what variables influence clinicians to use appropriate technology could promote the diffusion of technology in health care. The Unified Theory of Acceptance and Use of Technology (UTAUT) is a recent (2003) model that consolidates eight models of technology acceptance that are prominent in the information systems literature. The UTAUT analysis revealed that social influence, usefulness, and facilitating conditions are important variables for the acceptance of new technology. With some adaptations to fit the health care context, the UTAUT was found to be an effective tool to measure CDM Toolkit acceptance in the Northern Health Authority. The field observations highlighted salient issues not captured by the UTAUT, including security certificate implementation, access and confidentiality, physician participation, data entry, flow sheets, infrastructure and training.

Thesis (Ph. D.)--University of Toronto, 2005. / Includes bibliographical references (leaves 109-115).

Thesis (Ph.D. in Nursing) -- University of Colorado Denver, 2007. / Typescript. Includes bibliographical references (leaves 154-162). Free to UCD affiliates. Online version available via ProQuest Digital Dissertations;