This diploma thesis deals with motivation of entrepreneurs to carry on business in the field of language education and motivation for development of business activity. The theoretical part of the thesis defines fundamental concepts of motivation and entrepreneurship as well as other concepts linked to the self-management of entrepreneurs. The practical part of the work focuses on research conducted firstly through personal interviews with the founders of language schools and secondly through a questionnaire survey of teachers of foreign languages doing business under a trade license. Data are collected based on this research and their subsequent analysis leads to the evaluation of business motivation and its comparison between these two groups of entrepreneurs. Conclusion of the work then includes own proposals aiming to increase the motivation in the business activity.

Undergraduate male and female students enrolled in an introductory behavior analysis course with minimal instruction on self-management were given modified exploratory logs to use in a self-management project. Students self-monitored behavior via the log, constructed their own interventions, and reported changes in behavior and extent of success in a write up at course end. Changes in self-reported descriptions in the logs as well as the written results of a pre and post survey of emotional responses were counted. Successful self-management project interventions were reported by most students. Correspondence between planned and actual events increased. Negative reinforcement procedures characterized most students' intervention. Correspondence between events at pre and post and actual log reports was highest at post.

Autonomic computing is a paradigm that aims at reducing administrative overhead by using autonomic managers to make applications self-managing. To better deal with large-scale dynamic environments; and to improve scalability, robustness, and performance; we advocate for distribution of management functions among several cooperative autonomic managers that coordinate their activities in order to achieve management objectives. Programming autonomic management in turn requires programming environment support and higher level abstractions to become feasible. In this thesis we present an introductory part and a number of papers that summaries our work in the area of autonomic computing. We focus on enabling and achieving self-management for large scale and/or dynamic distributed applications. We start by presenting our platform, called Niche, for programming self-managing component-based distributed applications. Niche supports a network-transparent view of system architecture simplifying designing application self-* code.  Niche provides a concise and expressive API for self-* code. The implementation of the framework relies on scalability and robustness of structured overlay networks. We have also developed a distributed file storage service, called YASS, to illustrate and evaluate Niche. After introducing Niche we proceed by presenting a methodology and design space for designing the management part of a distributed self-managing application in a distributed manner. We define design steps, that includes partitioning of management functions and orchestration of multiple autonomic managers. We illustrate the proposed design methodology by applying it to the design and development of an improved version of our distributed storage service YASS as a case study. We continue by presenting a generic policy-based management framework which has been integrated into Niche. Policies are sets of rules that govern the system behaviors and reflect the business goals or system management objectives. The policy based management is introduced to simplify the management and reduce the overhead, by setting up policies to govern system behaviors. A prototype of the framework is presented and two generic policy languages (policy engines and corresponding APIs), namely SPL and XACML, are evaluated using our self-managing file storage application YASS as a case study. Finally, we present a generic approach to achieve robust services that is based on finite state machine replication with dynamic reconfiguration of replica sets. We contribute a decentralized algorithm that maintains the set of resource hosting service replicas in the presence of churn. We use this approach to implement robust management elements as robust services that can operate despite of churn. / QC 20100520

Title: Improving Diabetes Self-Management Education and Support (DSMES) Referrals in the Primary Care Setting Authors: Stephanie Sossong and Dr. Jean Hemphill, College of Nursing, East Tennessee State University, Johnson City, TN. Purpose: The purpose of this quality improvement project is to implement a standardized referral process to DSMES in primary care. DSMES decreases complications from T2DM and reduces healthcare costs. However, patients diagnosed with T2DM are referred <7% of the time. Aim: To assure that patients diagnosed with T2DM receive referrals to an accredited DSMES program. Processes: Baseline data of the number of patients with T2DM referred to DSMES was collected from a primary care clinic for 4 weeks. An educational in-service highlighting the benefits of DSMES, guidelines for referrals, and the process improvement was presented to providers and medical assistants. Data regarding referrals to DSMES after the process implementation will be collected for 4 weeks, numbers will be compared to pre-implementation data and reported using percent frequency. The IRB determined that the activities of this project are not defined as research involving human subjects. Results: The results of this project have not been determined yet, however; the expected outcome is an increased number of referrals to DSMES. Limitations: The limitations of this project include a small sample size and a short length of study. Conclusions: Implementing a standardized referral process in primary care increases referral rates to DSMES. This is important because DSMES has been proven to reduce diabetes related complications, healthcare spending, and prevalence of other comorbidities.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Stroke is one of the leading causes of death and disability in the world. Stroke patients often place significant cost on the health care systems, due to long periods of care. Health care professionals play a key role in self-management as they work closely with stroke patients and patients can give insight into outcomes and during and post rehabilitation.

Diabetes, a major public health challenge in St. Kitts, has been a focus of international public health community research. Although researchers have demonstrated that diabetes self-management education is a cost-effective strategy for the prevention of diabetes-related complications, they have yet to establish whether there is adequate education occurring in treatment settings with diabetic patients. The purpose of the study was to implement and evaluate the short-term effectiveness of a diabetes self-management education intervention on diabetes-related knowledge and accepted behavioral changes to decrease risk for complications. Based on a self-care approach, this education intervention was designed to improve diabetes-related knowledge and self-management behaviors. To test and evaluate the pre and post intervention effect, a convenience sample of 15 patients diagnosed with Type 2 diabetes attending a scheduled diabetic clinic completed the Diabetes Knowledge Test and a researcher-designed sociodemographic survey, which included self-report of blood glucose self-monitoring and foot care behaviors. The results of these analyses indicated that the participants’ knowledge level increased (p = < .001). However, Chisquare and Fisher’s exact tests determined no significant changes in the participants’ self management behaviors. The results may be attributed to the short time frame of the intervention. The implications for positive social change include opportunities to improve inter-professional collaboration in programs that will create positive effects on diabetic self care and reduce the incidence of negative health outcomes. Furthermore, the use of a self-care approach by health care professionals could be a key factor in strengthening diabetes knowledge, engagement, and self-management for Type 2 diabetic patients.

Over 26 million U.S. citizens have a form of arthritis; osteoarthritis (OA) is the most common form. Self-efficacy (SE) is defined as a psychological construct which identifies an individual's confidence when performing a behavior. SE is deemed a vital judge of self-management (SM) in those with OA. The purpose of this evidence-based practice, quality improvement project was to improve SE in OA patients. The identified gap in nursing practice was the lack of SE in OA patients. The project question asked whether a toolkit with information regarding SE in OA can improve SE of management of disease-associated symptoms in adults with OA as evidenced by improved Arthritis Self-Efficacy Scale (ASES) scores pre- to post-program. Concepts and theory used to inform the doctoral project were SE, pain, SM and OA, and Bandura's theory of SE. The sources of evidence were obtained from a variety of peer-reviewed journals related to OA management, and the outcome was measured using the ASES. Thirty-five participants (16 males and 19 females) with a mean age of 62 from a physical medicine and rehabilitation clinic in San Antonio, Texas participated in the project. The National Institute of Arthritis and Musculoskeletal and Skin Disorders 2015 Handout on Health: OA was used as the SE OA toolkit. Mean scores from pre- and post-program were tabulated and compared to determine the outcome. Results showed improved ASES levels by 11.84%. Implications for nursing practice and positive social change include the enhancement of SE levels, which can improve compliance in SM by use of a toolkit and further as policy implementation for OA patients to improve SE and SM abilities.

Chronic obstructive pulmonary disease (COPD) signifies a significant public health challenge that is both avoidable and treatable. There was no standardized education offered to the COPD population at the practice location. The scope of the project encompassed standardizing education by developing a self-management packet for the COPD patients. The goal of this project was to examine how the development of a standardized COPD self-management packet enhances the quality of care and strategizes reducing 30-day readmissions compared to nonstandardized delivery of education. Orem's self-care theory and Bandura's self-efficacy concept were used to explain the principle of self-management, while Rosswurm and Larrabee's evidence-based practice model was used to guide practice change. The U.S. Prevention Service Task Force's level of evidence hierarchy was chosen to categorize the strengths and weaknesses of the evidence referenced for this project. Postdevelopment surveys using the Likert scale were distributed to the facility's COPD committee, and a 70% response rate of strongly agreed to all questions was achieved. There were no adverse responses, and the packet was approved unanimously. Based on the positive responses, the packet will be easily adapted and beneficial in practice. The recommendation is to pilot the packet on the medical-surgical unit and follow-up postdischarge with phone calls to ascertain patients' perspective of the packet. Utilization of the education packet will lead to positive social change by affording the stakeholders self-management awareness and positive outcome measures including reducing the COPD 30-day readmission rate, curtailing economic strains, and promoting positive patient-centered relationships.

Asthma is a chronic airway inflammatory disease that is characterized by reversible airway obstruction due to hyper-responsiveness of the tracheobronchial tree. The condition disproportionately affects male children, females, and the aged globally, and its prevalence keeps rising despite being a preventable condition in terms of relapse. Most asthmatic patients receive care in primary care settings. Various health agencies have developed asthma management guidelines to improve the quality of asthma care; however, in some cases, adherence to these guidelines is substandard. The overarching aim of this study was to determine whether primary care providers manage asthma in line with the available guidelines. A qualitative systematic review was conducted by searching for journal articles published between 2005 and 2016 relating to guideline use in primary care management of asthma. Twenty-nine primary studies evaluating adherence to asthma management guidelines were included. The collected data were analyzed through thematic data analysis techniques, and various themes emerged with regard to the research questions. Generally, the findings suggest that there is a mismatch between what is needed by patients/caregivers and what is currently provided by primary care providers (PCPs) in primary care settings and that asthma management guidelines are only partially followed or not used. Emerging themes were classified into 3 main categories: physician-, patient-, and institution-related barriers. The study provides recommendations on how adherence to asthma management can be improved.

The purpose of the present study was to investigate whether a self-evaluation procedure paired with a token economy would be effective in reducing the off-task and talk-out behavior of behaviorally disordered and learning disabled high school students in a resource classroom. The study also examined the effects of the seIf evaluation procedures when monitored by regular education peers on target students' behavior in their regular education English class . In addition to improving classroom behavior, another purpose of the study was to examine the effectiveness of the self-evaluation procedures when paired with an academic goal-setting component on academic variables in both the resource and regular education classrooms. The results revealed that student behavior generally improved after self-evaluation procedures were taught in the resource room and that improved behavior generalized to the regular class once peers implemented the matching component of the self-management procedures. As a group, students' average rate of off-task behavior decreased 17% in the resource room and 35% in the regular class. Averages rates of talk-outs for the group were reduced by 6% in the resource room and 24% in the regular class. Gains in academic performance were observed in both the special and regular classrooms. An increase in the number of assignments completed was observed following the implementation of the self-management procedures across all subjects in the special education class, as was an increase in the overall percentage of those assignments that were correct. Similarly, the percent complete on assignments in the regular class increased on the average 20% while the percent correct increased 24% following the implementation of the matching procedures.