There is limited engagement with research based evidence among senior managers within the NHS, and a failure to consistently integrate research findings into the decision making process. While much is known about the decision making and information behaviour of clinical staff and policy makers, there is little knowledge of this for senior non-clinical managers within the NHS. There is also a lack of clarity on how best to facilitate and integrate research evidence into the decision making process and a lack of research regarding the context of non-clinical healthcare managers working in the NHS. This study addresses these shortcomings through in-depth analysis in a case study approach. Data was collected through semi-structured interview, questionnaire and observed scenario work. This data was analysed to increase knowledge and understanding of the current information behaviour and decision making practices of non-medical senior management staff working within the NHS in England. Several key barriers to research utilisation were identified in the analysis of the data. These barriers included insufficient information literacy skills in the cohort, shortcomings with the published research papers, a culture which was focused on achieving politically set targets, and a lack of defined processes to decision making. To address these barriers an embedded librarian and a SharePoint based knowledge management system were implemented and evaluated. Evaluation of these interventions concluded that an embedded librarian was effective in increasing and supporting evidence informed decision making. This provides a practical example of an effective service development which should be considered for implementation across the NHS and wider healthcare community. The study also recommends that, to increase use of their output, researchers need to include more explicit information on the implementation and financial elements of their findings rather than a narrow focus on the intervention outcome. In addition, findings showed the target driven culture of the NHS create an environment that stifles evidence informed decision making. To address this barrier the study recommends that the NHS adopts methods of quality assurance and metrics which place an emphasis on measures of process. This study contributes to theory by exploring the information behaviour of a specific group which have been overlooked in previous research, and contributes new understanding of mechanisms for knowledge translation and interactions between the research based evidence and decision making processes in the context of NHS non-clinical management.

There is no evidenced-based research on prevention of upper extremity lymphedema following breast cancer treatment. General guidelines have been identified from a basic understanding of the lymphatic system and are considered to be prudent advice for prevention. Cause of lymphedema is hypothesized to be multifactorial and time of onset is widely varied. Exogenous risk factors leading to lymphedema are the removal and destruction of lymph nodes; however, not all women develop lymphedema following axillary lymph node dissection. Co-morbid conditions such as obesity, diabetes, and hypertension are cited as possible endogenous risk factors. Several studies identify hypertension as a significance endogenous risk factor resulting in increased capillary filtration causing an increase in the fluid load on an already compromised lymph drainage system. This retrospective chart review was designed to compare systolic blood pressure in two matched groups to determine if there is a difference between groups. The study population included 147 stage II and III breast cancer patients. after receiving IRB approval, charts of patients with a diagnosis code of lymphedema (n=19) were identified from the 147 possible charts. A matching sample of 18 women without lymphedema was assembled. Vital sign records were then reviewed and 3 measures of systolic blood pressure were used from a time period of two to 15 moths after lymph node dissection. Results revealed mean age and number of lymph nodes removed in the two groups were equivalent. No significant difference in systolic blood pressure was found between the two groups. However, the study was limited by the lack of chart data on the variables of lymphedema and systolic blood pressure. This pilot study pointed out adjustments needed to capture a more diverse sample. Other limitations such as missing demographic data on race, number of participants treated with radiation to the axilla and records of ambulatory blood pressure should be included in future studies.

The biological need for lighting by an individual differs from the merely visual purpose, such as viewing objects and doing work or movement. Lack of adequate daylight for biological stimulation can lead to health problems, for e.g. imbalanced circadian rhythm. The importance of daylight is vital for hospital patients who are mostly physically and/or psychologically stressed. As, many patients stay indoors for 24 hours, they might be vulnerable to the lack of daylight which is necessary for health reasons. Hence, for hospital patients, daylight can be a strong therapeutic environmental design element to ensure good health and accelerate clinical recovery. The complex relationship between daylight environment and individuals responses are not fully understood. Controversy results that are debated by the previous researchers, has made the implementation of daylighting strategies in the architectural design of hospital in-patient rooms critical, mainly for therapeutic purpose. Strong evidence needs to be established that can build confidence to both architects and policy makers to use daylight for therapeutic purpose and integration of therapeutic effect of daylight to in-patient room architecture is necessary as well. This thesis provides information to architects (with examples) for incorporation of therapeutic effect of daylight in the design of in-patient rooms to reduce patient length of stay (LoS) in hospitals. A triangulation research method was applied in this work, where theories were developed qualitatively and tested quantitatively. Literature review was carried out to establish the potential effect of daylight on patient health. Retrospective field investigations were conducted to establish the quantitative relationship between daylight intensity and patient LoS inside in-patient rooms by developing Multiple Linear Regression (MLR) models under a general hospital environment. Using the daylighting goal to enhance therapeutic benefit for hospital patients, referred from literature and verified from field investigation data, a daylight design concept (sky window configurations) was developed and evaluated by prospective simulation study, and found better compared to traditional standard hospital window configurations, in order to enhance therapeutic benefit for hospital patients. A dynamic annual Climate-Based Daylight Modelling (CBDM) method that uses RADIANCE (backward) raytracer combined with a daylight coefficient approach considering Perez all weather sky luminance model (i.e. DAYSIM), was used for simulation analysis. This thesis develops strategies for architects to incorporate therapeutic effect of daylight in the architectural design of hospital in-patient rooms, including guidelines to support architectural decisions in case of conflicting situations, and to identify the range of daylight intensities within which patient LoS is expected to be reduced. The strategies also consider the ultraviolet radiation (UVR) protections and discuss the challenges of climate change for daylight researchers for the incorporation of therapeutic effect of daylight in the design of hospital in-patient rooms. The thesis provides a contribution to knowledge by establishing strong evidence of quantitative relationship between daylight and LoS, and by presenting new architectural forms for hospital in-patient room design as one of the possible ways to incorporate therapeutic effect of daylight in the design of hospital in-patient rooms effectively. It is expected that the research will encourage and help architects and policy makers to incorporate therapeutic effect of daylight in the design of hospital in-patient rooms, efficiently.

There are notable differences between the dominant Western medical model of health and the model of CAM, and looking at these differences may provide a greater understanding around doctors’ views towards CAM and its place in the wider health system. The purpose of this dissertation is to provide a systematic literature review into how doctors view complementary and alternative medicine, and to see if this has changed since the 1970s through to 2009. A systematic review of the literature was conducted, mainly using online original research Journal articles from medical databases. The internet was the main tool used in locating data, and literature was included or excluded based on relevance. This was evaluated on the relevance of time period, such as 1970, subject, such as chiropractic, or theme, such as attitudes of doctors to CAM. Literature from the 1970s was scarce on this research question, but this review noted a significant increase in literature on this topic since the 1990s, identifying this research area as a relatively new field of study, with much potential for further exploration into beliefs and attitudes of doctors towards CAM. Scientific research papers that were published highlighted a strong emphasis towards doctors’ requirement for further scientific research on the efficacy of CAM. Randomised controlled trials (RCTs) were the preferred method of testing; however this review also discusses appropriate methodology to test both CAM and doctors’ views and beliefs. The difference between the Western medical model and the CAM model highlights the differences between both concepts; from which this author provides a possible interpretation of doctors’ indifferent views towards CAM using the psychological theory of cognitive dissonance (Festinger, 1957). This theory suggests that a person cannot hold two conflicting beliefs simultaneously, without the presence of cognitive ‘dissonance.’ “The existence of dissonance, being psychologically uncomfortable, will motivate the person to try to reduce the dissonance and achieve consonance” (Festinger, 3: 1957). This systematic review then provides a discussion around how this could explain doctors’ views towards CAM. . This then leads to the question of whether ‘successful integration of Western medicine and CAM is therefore possible’? The systematic review concludes with the highlighting of important issues in regard to the study design and methodology on effectively testing CAM, and on effectively testing doctors’ beliefs: also, the issues around integration and further scientific literature on CAM in a bid to potentially reduce the ‘moderate tone of answering’ that is reported in the literature in regard to doctors’ views towards CAM.

Eine evidenzbasierte Gestaltung von Studium und Lehre, wie sie heute normativ eingefordert wird, bedarf des integrierten Zusammenwirkens von Qualitätsmanagement und Hochschuldidaktik – aber gibt es dieses in der Praxis? Mit Blick auf die allgemeine Befundlage, aber auch anhand einer eigenen empirischen Untersuchung zeigt der Beitrag diesbezüglich auf, dass Qualitätsmanagement und Hochschuldidaktik als weitgehend desintegrierte Funktionsbereiche wahrgenommen werden und Evidenzbasierung in der Praxis folglich keinen sehr hohen Stellenwert genießt. Ausgehend von einer Ursachenanalyse wird auf die dysfunktionalen, aber auch auf die funktionalen Auswirkungen dieser Separierung aufmerksam gemacht.

In order to better assist practitioners and better serve persons with autism spectrum disorders (ASD) and their families, it is vital for professionals to systematically evaluate the existing body of literature and synthesize its scientific evidence, so that the efficacy of research can be translated to evidence-based practices (EBPs) (Wheeler, 2007; Zhang & Wheeler, 2011). This research synthesis evaluated adherence to EBP standards and analyzed the effectiveness of gluten-free and casein-free (GFCF) diets for individuals with ASD. Four hundred and seventy articles were screened among peer-reviewed journals in English language published through 2010 using the Academic Search Complete search database. Twenty-three studies were selected, and the researchers used a systematic analysis model developed by Mayton, Wheeler, Menendez, and Zhang (2010) to investigate the degree of adherence to specific evidence-based practice standards. In addition, the study utilized quality indicators proposed by (a) Horner et al. (2005) for single-subject design studies and (b) Gersten et al. (2005) for group experimental design, to evaluate the efficacy of GFCF diet interventions. Results of this synthesis indicated that the efficacy of GFCF diet interventions for individuals with ASD is inconclusive, and the field needs better controlled studies to provide the scientific evidence base for the intervention.

Informed by institutional ethnography, and taking the problematic from disjunctures in teacher/participants’ experience between actual practice and official policy, this study is an intertextual analysis of print/electronic documents pertaining to students ‘at risk.’ It unpacks the Student Success Strategy in Ontario secondary schools as organized around discourses on risk and safety. Discriminatory classing and racializing processes construct students ‘at risk’ in ways that reproduce socio-economic inequities through premature streaming into pathways geared to post-secondary destinations: university, college, apprenticeship and work. This study questions the accounting logic that reduces education to skills training in workplace literacy/numeracy, and contradicts the official ‘success’ story that promotes Ontario as a model of large-scale educational change. The follow-up intertextual analyses reveal ideological circles that promote ‘evidence-based research’ and ‘evidence-informed practice,’ while actually gearing education to improving ‘results’ on large-scale standardized tests and manufacturing consent for government policies. Questions arise about the lack of transparency and selective use of educational research. A web of behind-the-scenes activities are made visible at public policy think-tanks (e.g. Canadian Council on Learning; Canadian Language and Literacy Research Network), and two little-researched bodies in educational governance — the Council of Ministers of Education Canada (CMEC) and OECD. Although invisible to teachers, the infrastructure for the Student Success Strategy is the Ontario School Information System (OnSIS); this web-enabled data-management technology has built-in capacity to profile students ‘at risk’ and to instigate accountability and surveillance over teachers’ work, with implications for re-regulating teaching practice towards test scores and aggregate statistics. With the intention of transforming education towards genuine equity, and linking the re-organization of social relations in large-scale reform locally, nationally and globally, this study contributes to critical scholarship on the effects of reform policies on people’s lives and extends knowledge of how translocal text-mediated ruling relations operate in education.

Informed by institutional ethnography, and taking the problematic from disjunctures in teacher/participants’ experience between actual practice and official policy, this study is an intertextual analysis of print/electronic documents pertaining to students ‘at risk.’ It unpacks the Student Success Strategy in Ontario secondary schools as organized around discourses on risk and safety. Discriminatory classing and racializing processes construct students ‘at risk’ in ways that reproduce socio-economic inequities through premature streaming into pathways geared to post-secondary destinations: university, college, apprenticeship and work. This study questions the accounting logic that reduces education to skills training in workplace literacy/numeracy, and contradicts the official ‘success’ story that promotes Ontario as a model of large-scale educational change. The follow-up intertextual analyses reveal ideological circles that promote ‘evidence-based research’ and ‘evidence-informed practice,’ while actually gearing education to improving ‘results’ on large-scale standardized tests and manufacturing consent for government policies. Questions arise about the lack of transparency and selective use of educational research. A web of behind-the-scenes activities are made visible at public policy think-tanks (e.g. Canadian Council on Learning; Canadian Language and Literacy Research Network), and two little-researched bodies in educational governance — the Council of Ministers of Education Canada (CMEC) and OECD. Although invisible to teachers, the infrastructure for the Student Success Strategy is the Ontario School Information System (OnSIS); this web-enabled data-management technology has built-in capacity to profile students ‘at risk’ and to instigate accountability and surveillance over teachers’ work, with implications for re-regulating teaching practice towards test scores and aggregate statistics. With the intention of transforming education towards genuine equity, and linking the re-organization of social relations in large-scale reform locally, nationally and globally, this study contributes to critical scholarship on the effects of reform policies on people’s lives and extends knowledge of how translocal text-mediated ruling relations operate in education.

Made available in DSpace on 2015-05-14T12:36:48Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 4346482 bytes, checksum: 66ecee23f8ca75e6ea5bba135cfa9a42 (MD5) Previous issue date: 2014-01-22 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Background: With the growing popularity of cloud computing, an challenge seen in this discipline is the management of faults that may occur in such big infrastructures that, because of its size, has a greater chance of ocurring faults, errors and failures. A work that maps the solutions already created by researchers efficiently should help visualizing gaps over those research fields. Aims: This work aims to find research gaps in the cloud computing and fault management domains, aside from building a social network of researchers in the area. Method: We conducted a systematic mapping study to collect, filter and classify scientific works in this area. The 4535 scientific papers found on major search engines were filtered and the remaining 166 papers were classified according to a taxonomy described in this work. Results: We found that IaaS is most explored in the selected studies. The main dependability functions explored were Tolerance and Removal, and the attributes were Reliability and Availability. Most papers had been classified by research type as Solution Proposal. Conclusion: This work summarizes and classifies the research effort conducted on fault management in cloud computing, providing a good starting point for further research in this area. / Fundamentação: Com o grande crescimento da popularidade da computação em nuvens, observa-se que um desafio dessa área é gerenciar falhas que possam ocorrer nas grandes infra-estruturas computacionais construídas para dar suporte à computação como serviço. Por serem extensas, possuem maior ocorrência de faltas, falhas e erros. Um trabalho que mapeie as soluções já criadas por pesquisadores de maneira simples e eficiente pode ajudar a visualizar oportunidades e saturações nesta área de pesquisa. Objetivos: Este trabalho visa mapear de forma sistemática todo o esforço de pesquisa aplicado ao gerênciamento de faltas em computação em nuvem de forma a facilitar a identificação de áreas pouco exploradas e que pode eventualmente representar novas oportunidades de pesquisa. Metodologia: Para este trabalho utiliza-se a metodologia de pesquisa baseada em evidências, através do método de mapeamento sistemático, sendo a pesquisa construída em três etapas de seleção de estudos. Método: Conduzimos um mapeamento sistemático para coletar, filtrar e classificar trabalhos científicos na área. Foram inicialmente coletados 4535 artigos científicos nos grandes engenhos de busca que, após três etapas de filtragem, acabaram sendo reduzidos a 166 artigos. Estes artigos restantes foram classificados de acordo com a taxonomia definida neste trabalho. Resultados: Observa-se que IaaS é a área mais explorada nos estudos selecionados. As funções de gerência de falhas mais exploradas são Tolerância e Remoção, e os atributos são Confiabilidade e Disponibilidade. A maioria dos trabalhos foram classificados como tipo de pesquisa de Proposta de Solução. Conclusão: Este trabalho sumariza e classifica o esforço de pesquisa conduzido em Gerenciamento de Faltas em Computação em Nuvens, provendo um ponto de partida para pesquisas futuras nesta área.