Chronic low-back pain is a prevalent and costly problem for many adults in the United States. Currently, multidisciplinary treatment approaches are the treatment of choice for this problem. A meta-analysis was conducted on 43 published studies to describe the nature of these programs, the patients involved in them, treatment efficacy at discharge and follow-up, and possible relationships between these characteristics and outcome. Results show that these programs were often in university medical settings, with an emphasis on active patient participation. Common treatment approaches included physical therapy, skills training, medication management, supportive therapy, and behavior modification. Patients involved in these programs tended to be middle-aged, married, unemployed, and high-school educated, with an average pain duration of about five years. It was concluded that patients do show improvement at treatment completion (at least one-half standard deviation change) in physical fitness, reported distress levels, daily activity, and medication usage. At follow-up improvement over pre-treatment levels was still evidenced in reported distress levels, medication usage, mood, fitness levels, daily activities, and health perceptions. Results of correlational analyses suggest that the more impaired patients in these studies tended to show greater improvement. Data also suggest that patient dropouts rates were negatively correlated to medication usage and mood over time. Thus, improvements in these areas may be artifacts due to patient drop-out rates. Multidisciplinary treatment programs were found to be generally effective in promoting more adaptive functioning in their patients . However, it is recommended that closer attention be given to attrition rates and other potential sources of bias to maximize confidence in treatment effectiveness.

This work proposes a new method for using reduced order models in lieu of high fidelity analysis during the sensitivity analysis step of gradient based design optimization. The method offers a reduction in the computational cost of finite difference based sensitivity analysis in that context. The method relies on interpolating reduced order models which are based on proper orthogonal decomposition. The interpolation process is performed using radial basis functions and Grassmann manifold projection. It does not require additional high fidelity analyses to interpolate a reduced order model for new points in the design space. The interpolated models are used specifically for points in the finite difference stencil during sensitivity analysis. The proposed method is applied to an airfoil shape optimization (ASO) problem and a transport wing optimization (TWO) problem. The errors associated with the reduced order models themselves as well as the gradients calculated from them are evaluated. The effects of the method on the overall optimization path, computation times, and function counts are also examined. The ASO results indicate that the proposed scheme is a viable method for reducing the computational cost of these optimizations. They also indicate that the adaptive step is an effective method of improving interpolated gradient accuracy. The TWO results indicate that the interpolation accuracy can have a strong impact on optimization search direction.

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<p dir="ltr">This thesis details the development of a multidisciplinary design analysis (MDA) framework intended to evaluate a rocket-powered, reusable hypersonic vehicle. In particular, the analysis framework computes the design closure of a coupled system resembling Stratolaunch Systems’ Talon-A reusable hypersonic test vehicle. The resulting analysis framework differs from available literature due to its focus upon payload-related design considerations. The presented framework, too, avoids the use of proprietary technical information and/or export-controlled analysis tools. The framework’s geometric analysis, for example, employs a reverse-engineered geometry resembling Talon-A. An open-source aerothermal package, too, was selected to evaluate the vehicle’s aerothermodynamic characteristics. Quick-to-implement methods were prioritized to expedite the development of the MDA framework. Notably, a regression-based structural analysis model was used, as well as an interpolative thermal protection system (TPS) sizing procedure. A quasi-steady trajectory model, too, was implemented within the MDA framework, to determine the vehicle’s mission performance. The resulting analysis takes the form of a six-discipline MDA framework that can calculate, among other parameters, the vehicle’s cruise duration. Initial design closure results for a vehicle resembling Talon-A, using an assumed TPS size, are currently available. These results report an estimated total vehicle mass within thirty percent of Talon-A’s true gross mass, as well as a cruise duration of approximately 445 seconds. These design closure results were also evaluated under a perturbed specific impulse of ±10%, with a resulting change in cruise duration of ±12.3%. Results for a cruise-condition design exploration procedure were also obtained within a simplified, sequential analysis chain. These design exploration results report a maximum cruise lift-to-drag ratio of approximately four. Future work has been identified, too, including the integration of more rigorous analysis tools for use within future iterations of the MDA framework. Notably, these tools include an open-source optimal control library, as well as a physics-based TPS sizing tool</p>

Published Article / In their research as well as their teaching, universities of technology (UoTs) expect to be infused by the application of technology and to be integrally related to the world of work. At the same time, research at UoTs is characteristically innovatory, in the specific sense of transforming research discoveries into products or services that are user-oriented and commercially viable. Since practical problems and user needs do not respect disciplinary boundaries it follows, firstly, that such research at a UoT will in some sense not respect disciplinary boundaries, i.e. it will have to connect, cross, or integrate traditional disciplines. This paper seeks accordingly conceptually to differentiate the relevant senses of multi-, inter- and trans-disciplinary (MIT) research. It then characterises the fourteen current research programmes at Central University of Technology (CUT) in these regards, comparing the findings from interviews with the programme leaders with the insights of the authors. Secondly, in that most research at UoTs is also expected to be innovatory, it is demanded of researchers that they also master the skill of researching the feasible applications of findings, developing products, and envisaging commercialisation; and handing the stakeholder relationships that arise in these interactions. The interviews further indicate the extent to which the respective programmes have moved down the MIT road. They also reveal that the challenges that are faced by the programmes are overwhelming generic rather than specifically MIT-related. Some strategic recommendations are extracted from the findings.

Background: Effective communication is key to team working in healthcare. It can be negatively impacted upon by existing cultures, logistical challenges, role confusion, and a lack of collaborative approaches to practice. Clinical guidelines recommend using the International Classification of Functioning, Disability and Health (ICF) to aid communication within stroke teams. Yet no empirical evidence exists on the process or outcomes of such implementation. Aims: This project aimed to explore ways the ICF could be used with an acute stroke service and identify key learning from the implementation process. Methods: Using an action research framework, iterative cycles were used within exploratory, innovatory and reflective phases. Content analysis was used to map patient notes’ entries to ICF categories. Thematic analysis was undertaken, using a model of immersion and crystallisation, on data generated via interview and focus group, e-mail communications, minutes from meetings, field notes and a reflective diary. Descriptive statistics were used to analyse quantitative questionnaire data. Data from all sources were combined to determine key findings. Findings: Participants chose to develop an ICF-based team transfer of care report with an ICF glossary to aid completion. Five overall themes were determined; the need to: (1) adopt the ICF in ways that met local service needs; and (2) adapt the ICF language and format. Once implemented, the ICF: (3) fostered communication within and beyond the stroke team; (4) promoted holistic thinking; and (5) helped to clarify team roles. Conclusions: These are the first empirical findings within stroke services that demonstrate how to make the ICF a clinical reality. Participants needed to adapt and own the ICF to adopt it. When implemented, it enabled specific team communication challenges to be overcome. The use of action research to implement the ICF has facilitated sustained change and improvements to communication, thus benefiting patient care.

O trabalho voltado à saúde tem recebido uma atenção especial em dois enfoques: a humanização do atendimento e a formação de equipes multidisciplinares. A primeira propõe a valorização da dimensão psicossocial do atendimento, processo amplo, complexo, que passa pela quebra de protocolos, como a relação de autoridade entre profissional e paciente; a formação de equipes multidisciplinares encontra dificuldades inerentes ao caráter racional das ciências especializadas, que fragmenta o saber, perdendo a visão de totalidade. Promover a humanização e o trabalho multidisciplinar, foi a proposta de uma equipe atuando em uma academia de ginástica, criada para atender portadores de HIV/Aids. Formada por alunos e profissionais da Educação Física, Fisioterapia, Nutrição e Psicologia, a equipe reunia-se para discutir aspectos técnicos e psicossociais referentes ao atendimento. O presente estudo teve como objetivo identificar elementos relacionados à apropriação do trabalho, produção de conhecimento derivado do atendimento prestado, e seus desdobramentos para a formação do profissional envolvido. Entrevistas individuais, realizadas junto aos participantes da equipe, permitiram a identificação de conteúdos referentes à avaliação do trabalho realizado, cujos significados foram, posteriormente, agrupados em categorias temáticas: a) Integração, cujos conteúdos se referiam à interação na equipe e desta com as pessoas atendidas; b) Produção do Conhecimento, envolvendo elementos para a construção do saber dentro da equipe, enquanto produto da apropriação da experiência informal ou acadêmica; c) Avaliação, enquanto crítica e autocrítica sobre o trabalho realizado, em função de metas não atingidas ou relacionadas ao trabalho multidisciplinar; d) Perspectivas, ou propensões para a continuidade das atividades, sejam no programa ou na carreira profissional. Tais categorias temáticas, enquanto elementos subsidiários á criação de um background para o atendimento humanizado em saúde, apontam para necessidades de mudanças importantes nos processos de formação em saúde, envolvendo formas de apropriação do trabalho no interior das equipes multidisciplinares. / The work directed to health has received special attention in two approaches: the humanization of health service and the formation of multidisciplinary teams. The first one is considered to ad value to the psychosocial service, a wide and complex process which goes through protocol breaks, such as, the relation between professionals and patients; the formation of multidisciplinary teams finds difficulties inherent to the rational aspect of specialized sciences, that breaks up knowledge, losing the global vision. To promote the humanization and multidisciplinary approach was the proposal of a team working in a health club, established to take care of HIV/Aids patients. Created by students and professionals from Physical Education, Physiotherapy, Nutrition and Psychology, the team congregated itself to discuss technical and psychosocial aspects referring to the service. The present study had as a purpose, to identify elements related to the appropriation of work, knowledge production derived from the service, and its developments to the formation of involved professionals. Individual interviews, carried through the team´s participants, allowed the identification of contents referred to the evaluation of work covered, whose meanings were, later, grouped in thematic categories: a) Integration, whose contents related to the teams interaction and its interaction with the people taken care of; b) Knowledge production, involving elements to the construction of knowledge in the team, while a result of the appropriation of informal academic experience; c) Evaluation, while critical and self-critical on the carried work, either as a matter of unreached goals or not related to multidisciplinary work; d) Perspectives, or propensities for the continuity of the activities, either in the program or in the professional career. Such thematic categories, while subsidiary elements to the creation of a humanized service background in health, point to necessary and important changes in the process of health formation, involving forms of appropriation work inside the multidisciplinary teams.

Masters in Public Administration - MPA / Government to Government (G2G) partnerships between countries in the BRICS partnerships have significantly increased and with it, the need for more effective strategic management and operational coordination but also for evidence-based decision-making. In this process, improved KM, as well as M&E of outcomes and impacts has become prominent and essential requirements for evidence-based decision-making. The Millennium Development Goals (MDGs) emphasise the need for a global partnership for development with a focus on a new development paradigm that emphasise results, partnership, coordination, and accountability (Picciotto, 2002:3). Subsequently, the 2030 Agenda for Sustainable Development further strengthened the importance of the global partnership in the implementation of the Sustainable Development Goals (SDGs), recognises that the implementation of the SDGs is a challenge for governments and therefore seeks to strengthen the global partnership by calling upon all stakeholders to take part in implementing the SDGs. In this context, the study investigated the need for knowledge management (KM) as well as Monitoring & Evaluation (M&E) systems in G2G partnerships such as the partnership of Shandong China (PRC) and the Western Cape Government (WCG) in South Africa. This study focused on the sport management aspects of such a partnership, although such systems may also be relevant to economic, tourism and other partnerships programmes. The research investigation focused on the relevance of KM and M&E systems in sport management on G2G partnerships, as well as the possible benefits of such systems. Readiness Assessments for the establishment of KM and M&E systems were conducted with respect to the Shandong -Western Cape Government (WCG) in PRC and South Africa. The research methodology consisted of a qualitative approach and a case study was developed of the Sport Exchange Programme (SEP) as a component of the partnership between Shandong PRC and Western Cape Government (WCG) South Africa. The research included a desktop study of primary documentation including the formal agreements, Memorandum of understanding (MoU), regulations and programme annual reports, semi-structured interviews with officials and public sector managers of both governments in PRC and South Africa, as well as focus group discussion, interviews with specialists and experts were also conducted.

This research addressed change management and learning in a multidisciplinary addictions chronic care environment in order to prepare for shared care planning within an electronic health record. It used a Developmental Work Research approach and was able to use insights from Bernstein’s theory of knowledge structures, Bakhtin’s work on social language and a Critical Realism approach to address weaknesses in the base Activity Theory approach. In these ways problems concerning fragmented, demarcated silo working across clinical and non-clinical addictions services could be examined. The objective of the study was to identify tensions and contradictions in working environments and to engage multidisciplinary workers in a collaborative change laboratory environment via the use of co-configuration and expansive learning. The working group examined past and current practice and were able to formulate new forms of practice, based on the use of a shared care plan tool, to address identified problems and national policy aims. It was able to use the aforementioned theoretical insights to illuminate the multiple utility of the shared care plan tool as a pedagogic device. This enabled the production of new practice possibilities, paradigms and planning to be undertaken, and the consideration of these within the context of ‘real time’ multidisciplinary activity within a forthcoming national IT system. This research has explored, identified and formulated new practice to improve multidisciplinary working between clinical and non-clinical workers across diverse sectors. This will have significant health and cost benefit gains for clients, workers and organisations as well as translating policy aims into effective practice. The next stage will be to manage the roll-out of the forthcoming IT system using the theoretical and methodological developments crafted in this research endeavour.

Genetic Algorithms (GAs) are powerful tools to solve large scale design optimization problems. The research interests in GAs lie in both its theory and application. On one hand, various modifications have been made on early GAs to allow them to solve problems faster, more accurately and more reliably. On the other hand, GA is used to solve complicated design optimization problems in different applications. The study in this thesis is both theoretical and applied in nature. On the theoretical side, an improved GA�Evolution Direction Guided GA (EDG-GA) is proposed based on the analysis of Schema Theory and Building Block Hypothesis. In addition, a method is developed to study the structure of GA solution space by characterizing interactions between genes. This method is further used to determine crossover points for selective crossover. On the application side, GA is applied to generate optimal tolerance assignment plans for a series of manufacturing processes. It is shown that the optimal tolerance assignment plan achieved by GA is better than that achieved by other optimization methods such as sensitivity analysis, given comparable computation time.