170 resultados para Hospital Logistics, Complex Systems, Waste Management, Nutritional Support, Nutrition Screening, Nutritional Risk, Outsourcing


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The number of office building retrofit projects is increasing. These projects are characterised by processes which have a close relationship with waste generation and therefore demand a high level of waste management. In a preliminary study reported separately, we identified seven critical factors of on-site waste generation in office building retrofit projects. Through semi-structured interviews and Interpretive Structural Modelling, this research further investigated the interrelationships among these critical waste factors, to identify each factor’s level of influence on waste generation and propose effective solutions for waste minimization. “Organizational commitment” was identified as the fundamental issue for waste generation in the ISM system. Factors related to plan, design and construction processes were found to be located in the middle levels of the ISM model but still had significant impacts on the system as a whole. Based on the interview findings and ISM analysis results, some practical solutions were proposed for waste minimization in building retrofit projects: (1) reusable and adaptable fit-out design; (2) a system for as-built drawings and building information; (3) integrated planning for retrofitting work process and waste management; and (4) waste benchmarking development for retrofit projects. This research will provide a better understanding of waste issues associated with building retrofit projects and facilitate enhanced waste minimization.

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Healthy governance systems are key to delivering sound environmental management outcomes from global to local scales. There are, however, surprisingly few risk assessment methods that can pinpoint those domains and sub-domains within governance systems that are most likely to influence good environmental outcomes at any particular scale, or those if absent or dysfunctional, most likely to prevent effective environmental management. This paper proposes a new risk assessment method for analysing governance systems. This method is then tested through its preliminary application to a significant real-world context: governance as it relates to the health of Australia's Great Barrier Reef (GBR). The GBR exists at a supra-regional scale along most of the north eastern coast of Australia. Brodie et al (2012 Mar. Pollut. Bull. 65 81-100) have recently reviewed the state and trend of the health of the GBR, finding that overall trends remain of significant concern. At the same time, official international concern over the governance of the reef has recently been signalled globally by the International Union for the Conservation of Nature (IUCN). These environmental and political contexts make the GBR an ideal candidate for use in testing and reviewing the application of improved tools for governance risk assessment. © 2013 IOP Publishing Ltd.

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This is a case study of a young university striving to generate and sustain a vibrant Research Training culture. The university’s research training framework is informed by a belief in a project management approach to achieving successful research candidature. This has led to the definition and reporting of key milestones during candidature. In turn, these milestones have generated a range of training programs to support Higher Degree Research (HDR) students to meet these milestones in a timely fashion. Each milestone focuses on a specific set of skills blended with supporting the development of different parts of the doctoral thesis. Data on student progress and completion has provided evidence in highlighting the role that the milestones and training are playing in supporting timely completion. A university-wide reporting cycle generated data on the range of workshops and training provided to Higher Degree Research students and supervisors. The report provided details of thesis topic and format, as well as participation in research training events and participant evaluation of those events. Analysis of the data led to recommendations and comments on the strengths and weaknesses of the current research training program. Discussion considered strategies and drivers for enhancements into the future. In particular, the paper reflects on the significant potential role of centrally curated knowledge systems to support HDR student and supervisor access, and engagement and success. The research training program was developed using blended learning as a model. It covered face-to-face workshops as well as online modules. These were supplemented by web portals that offered a range of services to inform and educate students and supervisors and included opportunities for students to interact with each other. Topics ranged from the research life cycle, writing and publication, ethics, managing research data, managing copyright, and project management to use of software and the University’s Code of Conduct for Research. The challenges discussed included: How to reach off campus students and those studying in external modes? How best to promote events to potential participants? How long and what format is best for face-to-face sessions? What online resources best supplement face-to-face offerings? Is there a place for peer-based learning and what form should this take? These questions are raised by a relatively young university seeking to build and sustain a vibrant research culture. The rapid growth in enrolments in recent years has challenged previous one-to-one models of support. This review of research training is timely in seeking strategies to address changing research training support capacity and student needs. Part of the discussion will focus on supervisory training, noting that good supervision is the one remaining place where one-to-one support is provided. Ensuring that supervisors are appropriately equipped to address student expectations is considered in the context of the research training provisions. The paper concludes with reflection on the challenges faced, and recommended ways forward as the number of research students grows into the future.

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This paper provides a three-layered framework to monitor the positioning performance requirements of Real-time Relative Positioning (RRP) systems of the Cooperative Intelligent Transport Systems (C-ITS) that support Cooperative Collision Warning (CCW) applications. These applications exploit state data of surrounding vehicles obtained solely from the Global Positioning System (GPS) and Dedicated Short-Range Communications (DSRC) units without using other sensors. To this end, the paper argues the need for the GPS/DSRC-based RRP systems to have an autonomous monitoring mechanism, since the operation of CCW applications is meant to augment safety on roads. The advantages of autonomous integrity monitoring are essential and integral to any safety-of-life system. The autonomous integrity monitoring framework proposed necessitates the RRP systems to detect/predict the unavailability of their sub-systems and of the integrity monitoring module itself, and, if available, to account for effects of data link delays and breakages of DSRC links, as well as of faulty measurement sources of GPS and/or integrated augmentation positioning systems, before the information used for safety warnings/alarms becomes unavailable, unreliable, inaccurate or misleading. Hence, a monitoring framework using a tight integration and correlation approach is proposed for instantaneous reliability assessment of the RRP systems. Ultimately, using the proposed framework, the RRP systems will provide timely alerts to users when the RRP solutions cannot be trusted or used for the intended operation.

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Our objective is to analyze the effectiveness, against the illegal disposal of waste, of a licensing system that has been introduced in a waste management policy. We theoretically find enforcement leverage in the licensing system, and then examine the theoretical result empirically. The results suggest that extending liability to disposers, which forms the basis of the enforcement leverage, deters illegal disposal more effectively than increasing penalties for illegal disposal. We also obtain evidence of transboundary movement of illegal disposal, and find how the court determines penalties for illegal disposal.

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Background: Pediatric nutrition risk screening tools are not routinely implemented throughout many hospitals, despite prevalence studies demonstrating malnutrition is common in hospitalized children. Existing tools lack the simplicity of those used to assess nutrition risk in the adult population. This study reports the accuracy of a new, quick, and simple pediatric nutrition screening tool (PNST) designed to be used for pediatric inpatients. Materials and Methods: The pediatric Subjective Global Nutrition Assessment (SGNA) and anthropometric measures were used to develop and assess the validity of 4 simple nutrition screening questions comprising the PNST. Participants were pediatric inpatients in 2 tertiary pediatric hospitals and 1 regional hospital. Results: Two affirmative answers to the PNST questions were found to maximize the specificity and sensitivity to the pediatric SGNA and body mass index (BMI) z scores for malnutrition in 295 patients. The PNST identified 37.6% of patients as being at nutrition risk, whereas the pediatric SGNA identified 34.2%. The sensitivity and specificity of the PNST compared with the pediatric SGNA were 77.8% and 82.1%, respectively. The sensitivity of the PNST at detecting patients with a BMI z score of less than -2 was 89.3%, and the specificity was 66.2%. Both the PNST and pediatric SGNA were relatively poor at detecting patients who were stunted or overweight, with the sensitivity and specificity being less than 69%. Conclusion: The PNST provides a sensitive, valid, and simpler alternative to existing pediatric nutrition screening tools such as Screening Tool for the Assessment of Malnutrition in Pediatrics (STAMP), Screening Tool Risk on Nutritional status and Growth (STRONGkids), and Paediatric Yorkhill Malnutrition Score (PYMS) to ensure the early detection of hospitalized children at nutrition risk.

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Purpose – The purpose of this paper is to examine empirically, an industry development paradox, using embryonic literature in the area of strategic supply chain management, together with innovation management literature. This study seeks to understand how, forming strategic supply chain relationships, and developing strategic supply chain capability, influences beneficial supply chain outcomes expected from utilizing industry-led innovation, in the form of electronic business solutions using the internet, in the Australian beef industry. Findings should add valuable insights to both academics and practitioners in the fields of supply chain innovation management and strategic supply chain management, and expand knowledge to current literature. Design/methodology/approach – This is a quantitative study comparing innovative and non-innovative supply chain operatives in the Australian beef industry, through factor analysis and structural equation modeling using PAWS Statistical V18 and AMOS V18 to analyze survey data from 412 respondents from the Australian beef supply chain. Findings – Key findings are that both innovative and non-innovative supply chain operators attribute supply chain synchronization as only a minor indicator of strategic supply chain capability, contrary to the literature; and they also indicate strategic supply chain capability has a minor influence in achieving beneficial outcomes from utilizing industry-led innovation. These results suggest a lack of coordination between supply chain operatives in the industry. They also suggest a lack of understanding of the benefits of developing a strategic supply chain management competence, particularly in relation to innovation agendas, and provides valuable insights as to why an industry paradox exists in terms of the level of investment in industry-led innovation, vs the level of corresponding benefit achieved. Research limitations/implications – Results are not generalized due to the single agribusiness industry studied and the single research method employed. However, this provides opportunity for further agribusiness studies in this area and also studies using alternate methods, such as qualitative, in-depth analysis of these factors and their relationships, which may confirm results or produce different results. Further, this study empirically extends existing theoretical contributions and insights into the roles of strategic supply chain management and innovation management in improving supply chain and ultimately industry performance while providing practical insights to supply chain practitioners in this and other similar agribusiness industries. Practical implications – These findings confirm results from a 2007 research (Ketchen et al., 2007) which suggests supply chain practice and teachings need to take a strategic direction in the twenty-first century. To date, competence in supply chain management has built up from functional and process orientations rather than from a strategic perspective. This study confirms that there is a need for more generalists that can integrate with various disciplines, particularly those who can understand and implement strategic supply chain management. Social implications – Possible social implications accrue through the development of responsible government policy in terms of industry supply chains. Strategic supply chain management and supply chain innovation management have impacts to the social fabric of nations through the sustainability of their industries, especially agribusiness industries which deal with food safety and security. If supply chains are now the competitive weapon of nations then funding innovation and managing their supply chain competitiveness in global markets requires a strategic approach from everyone, not just the industry participants. Originality/value – This is original empirical research, seeking to add value to embryonic and important developing literature concerned with adopting a strategic approach to supply chain management. It also seeks to add to existing literature in the area of innovation management, particularly through greater understanding of the implications of nations developing industry-wide, industry-led innovation agendas, and their ramifications to industry supply chains.

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Background Ascites, the most frequent complication of cirrhosis, is associated with poor prognosis and reduced quality of life. Recurrent hospital admissions are common and often unplanned, resulting in increased use of hospital services. Aims To examine use of hospital services by patients with cirrhosis and ascites requiring paracentesis, and to investigate factors associated with early unplanned readmission. Methods A retrospective review of the medical chart and clinical databases was performed for patients who underwent paracentesis between October 2011 and October 2012. Clinical parameters at index admission were compared between patients with and without early unplanned hospital readmissions. Results The 41 patients requiring paracentesis had 127 hospital admissions, 1164 occupied bed days and 733 medical imaging services. Most admissions (80.3%) were for management of ascites, of which 41.2% were unplanned. Of those eligible, 69.7% were readmitted and 42.4% had an early unplanned readmission. Twelve patients died and nine developed spontaneous bacterial peritonitis. Of those eligible for readmission, more patients died (P = 0.008) and/or developed spontaneous bacterial peritonitis (P = 0.027) if they had an early unplanned readmission during the study period. Markers of liver disease, as well as haemoglobin (P = 0.029), haematocrit (P = 0.024) and previous heavy alcohol use (P = 0.021) at index admission, were associated with early unplanned readmission. Conclusion Patients with cirrhosis and ascites comprise a small population who account for substantial use of hospital services. Markers of disease severity may identify patients at increased risk of early readmission. Alternative models of care should be considered to reduce unplanned hospital admissions, healthcare costs and pressure on emergency services.

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Background Randomised controlled trials may be of limited use to evaluate the multidisciplinary and multimodal interventions required to effectively treat complex patients in routine clinical practice; pragmatic action research approaches may provide a suitable alternative. Methods A multiphase, pragmatic, action research based approach was developed to identify and overcome barriers to nutritional care in patients admitted to a metropolitan hospital hip-fracture unit. Results Four sequential action research cycles built upon baseline data including 614 acute hip-fracture inpatients and 30 purposefully sampled clinicians. Reports from Phase I identified barriers to nutrition screening and assessment. Phase II reported post-fracture protein-energy intakes and intake barriers. Phase III built on earlier results; an explanatory mixed-methods study expanded and explored additional barriers and facilitators to nutritional care. Subsequent changes to routine clinical practice were developed and implemented by the treating team between Phase III and IV. These were implemented as a new multidisciplinary, multimodal nutritional model of care. A quasi-experimental controlled, ‘before-and-after’ study was then used to compare the new model of care with an individualised nutritional care model. Engagement of the multidisciplinary team in a multiphase, pragmatic action research intervention doubled energy and protein intakes, tripled return home discharge rates, and effected a 75% reduction in nutritional deterioration during admission in a reflective cohort of hip-fracture inpatients. Conclusions This approach allowed research to be conducted as part of routine clinical practice, captured a more representative patient cohort than previously reported studies, and facilitated exploration of barriers and engagement of the multidisciplinary healthcare workers to identify and implement practical solutions. This study demonstrates substantially different findings to those previously reported, and is the first to demonstrate that multidisciplinary, multimodal nutrition care reduces intake barriers, delivers a higher proportional increase in protein and energy intake compared with baseline than other published intervention studies, and improves patient outcomes when compared with individualised nutrition care. The findings are considered highly relevant to clinical practice and have high translation validity. The authors strongly encourage the development of similar study designs to investigate complex health problems in elderly, multi-morbid patient populations as a way to evaluate and change clinical practice.

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Supplying peak energy demand in a cost effective, reliable manner is a critical focus for utilities internationally. Successfully addressing peak energy concerns requires understanding of all the factors that affect electricity demand especially at peak times. This paper is based on past attempts of proposing models designed to aid our understanding of the influences on residential peak energy demand in a systematic and comprehensive way. Our model has been developed through a group model building process as a systems framework of the problem situation to model the complexity within and between systems and indicate how changes in one element might flow on to others. It is comprised of themes (social, technical and change management options) networked together in a way that captures their influence and association with each other and also their influence, association and impact on appliance usage and residential peak energy demand. The real value of the model is in creating awareness, understanding and insight into the complexity of residential peak energy demand and in working with this complexity to identify and integrate the social, technical and change management option themes and their impact on appliance usage and residential energy demand at peak times.

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Utilities worldwide are focused on supplying peak electricity demand reliably and cost effectively, requiring a thorough understanding of all the factors influencing residential electricity use at peak times. An electricity demand reduction project based on comprehensive residential consumer engagement was established within an Australian community in 2008, and by 2011, peak demand had decreased to below pre-intervention levels. This paper applied field data discovered through qualitative in-depth interviews of 22 residential households at the community to a Bayesian Network complex system model to examine whether the system model could explain successful peak demand reduction in the case study location. The knowledge and understanding acquired through insights into the major influential factors and the potential impact of changes to these factors on peak demand would underpin demand reduction intervention strategies for a wider target group.

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The world and its peoples are facing multiple, complex challenges and we cannot continue as we are (Moss, 2010). Earth‘s “natural capital” - nature‘s ability to provide essential ecosystem services to stabilize world climate systems, maintain water quality, support secure food production, supply energy needs, moderate environmental impacts, and ensure social harmony and equity – is seriously compromised (Gough, 2005; Hawkins, Lovins & Lovins, 1999). To further summarize, current rates of resource consumption by the global human population are unsustainable (Kitzes, Peller, Goldfinger & Wackernagel, 2007) for human and non-human species, and for future generations. Further, continuing growth in world population and global political commitment to growth economics compounds these demands. Despite growing recognition of the serious consequences for people and planet, little consideration is given, within most nations, to the social and environmental issues that economic growth brings. For example, Australia is recognised as one of the developed countries most vulnerable to the impacts of climate change. Yet, to date, responses (such as carbon pricing) have been small-scale, fragmented, and their worth disputed, even ridiculed. This is at a time referred to as ‘the critical decade’ (Hughes & McMichael, 2011) when the world’s peoples must make strong choices if we are to avert the worst impacts of climate change.

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This article describes research conducted for the Japanese government in the wake of the magnitude 9.0 earthquake and tsunami that struck eastern Japan on March 11, 2011. In this study, material stock analysis (MSA) is used to examine the losses of building and infrastructure materials after this disaster. Estimates of the magnitude of material stock that has lost its social function as a result of a disaster can indicate the quantities required for reconstruction, help garner a better understanding of the volumes of waste flows generated by that disaster, and also help in the course of policy deliberations in the recovery of disaster-stricken areas. Calculations of the lost building and road materials in the five prefectures most affected were undertaken. Analysis in this study is based on the use of geographical information systems (GIS) databases and statistics; it aims to (1) describe in spatial terms what construction materials were lost, (2) estimate the amount of infrastructure material needed to rehabilitate disaster areas, and (3) indicate the amount of lost material stock that should be taken into consideration during government policy deliberations. Our analysis concludes that the material stock losses of buildings and road infrastructure are 31.8 and 2.1 million tonnes, respectively. This research approach and the use of spatial MSA can be useful for urban planners and may also convey more appropriate information about disposal based on the work of municipalities in disaster-afflicted areas.

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Improvements in the effectiveness and efficiency of supply-side waste management are necessary in many countries. In Japan, municipalities with limited budgets have delayed the introduction of new waste-management technologies. Thus, the central government has used subsidies to encourage municipalities to adopt certain new technologies to improve waste-management efficiency. In this study, we measure the efficiency of waste management and explore how technology is related to technical efficiency. We find that municipalities are likely to adopt less-efficient technologies and that the central government's policies are likely to promote inefficient technology adoption by local governments.