Abstract: Background: Chronic obstructive pulmonary disease (COPD) and asthma have a high prevalence and disease burden. Blended self-management interventions, which combine eHealth with face-to-face interventions, can help reduce the disease burden. Objective: This systematic review and meta-analysis aims to examine the effectiveness of blended self-management interventions on health-related effectiveness and process outcomes for people with COPD or asthma. Methods: PubMed, Web of Science, COCHRANE Library, Emcare, and Embase were searched in December 2018 and updated in November 2020. Study quality was assessed using the Cochrane risk of bias (ROB) 2 tool and the Grading of Recommendations, Assessment, Development, and Evaluation. Results: A total of 15 COPD and 7 asthma randomized controlled trials were included in this study. The meta-analysis of COPD studies found that the blended intervention showed a small improvement in exercise capacity (standardized mean difference [SMD] 0.48; 95% CI 0.10-0.85) and a significant improvement in the quality of life (QoL; SMD 0.81; 95% CI 0.11-1.51). Blended intervention also reduced the admission rate (relative ratio [RR] 0.61; 95% CI 0.38-0.97). In the COPD systematic review, regarding the exacerbation frequency, both studies found that the intervention reduced exacerbation frequency (RR 0.38; 95% CI 0.26-0.56). A large effect was found on BMI (d=0.81; 95% CI 0.25-1.34); however, the effect was inconclusive because only 1 study was included. Regarding medication adherence, 2 of 3 studies found a moderate effect (d=0.73; 95% CI 0.50-0.96), and 1 study reported a mixed effect. Regarding self-management ability, 1 study reported a large effect (d=1.15; 95% CI 0.66-1.62), and no effect was reported in that study. No effect was found on other process outcomes. The meta-analysis of asthma studies found that blended intervention had a small improvement in lung function (SMD 0.40; 95% CI 0.18-0.62) and QoL (SMD 0.36; 95% CI 0.21-0.50) and a moderate improvement in asthma control (SMD 0.67; 95% CI 0.40-0.93). A large effect was found on BMI (d=1.42; 95% CI 0.28-2.42) and exercise capacity (d=1.50; 95% CI 0.35-2.50); however, 1 study was included per outcome. There was no effect on other outcomes. Furthermore, the majority of the 22 studies showed some concerns about the ROB, and the quality of evidence varied. Conclusions: In patients with COPD, the blended self-management interventions had mixed effects on health-related outcomes, with the strongest evidence found for exercise capacity, QoL, and admission rate. Furthermore, the review suggested that the interventions resulted in small effects on lung function and QoL and a moderate effect on asthma control in patients with asthma. There is some evidence for the effectiveness of blended self-management interventions for patients with COPD and asthma; however, more research is needed. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42019119894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=119894
In the aviation sector, communication problems have contributed into 70% to 80% of safety occurrences. However, to date we haven’t depicted which communication aspects have affected aviation safety most frequently.Based on literature, we developed a tool which includes communication characteristics related to actors, signal, coder, channel, decoder, direction, timing, distance, predictability and interference. After achieving inter-rater reliability, the tool was used to analyse 103 safety investigation reports that correspond to events occurred in various regions and which included in total 256 communication problems. The results suggest that communication between humans and representation media, visual and audio signalling and decoding, air-transmitted messages, and verbal, unidirectional, local and synchronous communication contributed most frequently into safety events. Statistical tests showed that the frequencies of most of those characteristics were significantly different across regions, time periods, types of operations and event severity.The tool developed can be used by different organizations and industry sectors to distil and analyse data from mandatory and voluntary reports and identify weak communication areas. Depending on the findings, analysts might need to alert designers of technical systems, inform management of organizations, warn end-users about most frequent pitfalls, modify/enrich communication training and steer research efforts.
The academic and professional attention to the large synergies hidden in horizontal collaborations is increasing. This study attempts to address the impact of collaborative transport on transportation lead-time and lead-time variability through empirically investigating a group of SMEs involved in a collaborative distribution network. Data was collected for seven pre-cooperation and eight cooperative orders over a period of 14 months. The results of Mann-Whitney U-test show a significant average reduction of 30.8% in the duration of lead times. Lead-time variability was also found to be reduced as the result of changes in the coefficient of variances and the Bartlett’s test for homogeneity of variances. Horizontal collaboration in transport could eventually lead to reduced lead times and lower variability of lead time which results in reduced supply chain costs. This can be achieved by means of direct routing and avoiding multi-transshipment routes which reduces the uncertainty and variability by diminishing the number of stages in the transport chain. Thus, effective lead-time management is considered a source of competitive advantage as it can reduce supply chain costs by lowering inventory levels, but is also capable of improving performance and customer service by offering improved product quality service levels.
