Appraisal of the quality of care of older people with cognitive impairment presenting to emergency departments

The medical records of 273 patients 75 years and older were reviewed to evaluate quality of emergency department (ED) care through the use of quality indicators. One hundred fifty records contained evidence of an attempt to carry out a cognitive assessment. Documented evidence of cognitive impairment (CI) was reported in 54 cases. Of these patients, 30 had no documented evidence of an acute change in cognitive function from baseline; of 26 patients discharged home with preexisting CI (i.e., no acute change from baseline), 15 had no documented evidence of previous consideration of this issue by a health care provider; and 12 of 21 discharged patients who screened positive for cognitive issues for the first time were not referred for outpatient evaluation. These findings suggest that the majority of older adults in the ED are not receiving a formal cognitive assessment, and more than half with CI do not receive quality of care according to the quality indicators for geriatric emergency care. Recommendations for improvement are discussed.

Archival analysis of enterprise resource planning systems : the current state and future directions

Research on Enterprise Resource Planning (ERP) Systems is becoming a well-established research theme in Information Systems (IS) research. Enterprise Resource Planning Systems, given its unique differentiations with other IS applications, have provided an interesting backdrop to test and re-test some of the key and fundamental concepts in IS. While some researchers have tested well-established concepts of technology acceptance, system usage and system success in the context of ERP Systems, others have researched how new paradigms like cloud computing and social media integrate with ERP Systems. Moreover, ERP Systems provided the context for cross disciplinary research such as knowledge management, project management and business process management research. Almost after two-decades since its inception in IS research, this paper provides a critique of 198 papers published on ERP Systems since 2006-2012. We observe patterns on ES research, provide comparisons to past studies and provide future research directions.

Climate change and reduction of emissions of greenhouse gases from ships : an appraisal

Article 2(2) of the Kyoto Protocol imposes an obligation only on certain developed countries, working through the International Maritime Organisation (IMO), to pursue the reduction of greenhouse gas (GHG) emissions from marine bunker fuels. The IMO recently took the initiative to adopt a new legal instrument for the reduction of shipgenerated greenhouse gas emissions. Some developing countries have suggested that the proposed IMO initiative should strictly adhere to Article 2(2) of the Kyoto Protocol and the principle of Common but Differentiated Responsibility (CBDR). Against this backdrop, this article intends to review the extent to which it is possible to propose an international legal instrument for the reduction of GHG emissions from marine bunker fuels which is applicable only to ships from developed countries considering the complex characteristics of the international shipping industry. This article also examines how far this approach is justifiable even within the framework of the CBDR principle.

Matrix metalloproteinase localisation by in situ-RT-PCR in archival human breast biopsy material

Utilising archival human breast cancer biopsy material we examined the stromal/epithelial interactions of several matrix metalloproteinases (MMPs) using in situ-RT-PCR (IS-RT-PCR). In breast cancer, the stromal/epithelial interactions that occur, and the site of production of these proteases, are central to understanding their role in invasive and metastatic processes. We examined MT1-MMP (MMP-14, membrane type-1-MMP), MMP-1 (interstitial collagenase) and MMP-3 (stromelysin-1) for their localisation profile in progressive breast cancer biopsy material (poorly differentiated invasive breast carcinoma (PDIBC), invasive breast carcinomas (IBC) and lymph node metastases (LNM)). Expression of MT1-MMP, MMP-1 and MMP-3 was observed in both the tumour epithelial and surrounding stromal cells in most tissue sections examined. MT1-MMP expression was predominantly localised to the tumour component in the pre-invasive lesions. MMP-1 gene expression was relatively well distributed between both tissue compartments, while MMP-3 demonstrated highest expression levels in the stromal tissue surrounding the epithelial tumour cells. The results demonstrate the ability to distinguish compartmental gene expression profiles using IS-RT-PCR. Further, we suggest a role for MT1-MMP in early tumour progression, expression of MMP-1 during metastasis and focal expression pattern of MMP-3 in areas of expansion. These expression profiles may provide markers for early breast cancer diagnoses and present potential therapeutic targets.

Detection of mRNA levels for the estrogen alpha, estrogen beta and androgen nuclear receptor genes in archival breast cancer tissue

Previous studies in our laboratory have shown association of nuclear receptor expression and histological breast cancer grade. To further investigate these findings, it was the objective of this study to determine if expression levels of the estrogen alpha, estrogen beta and androgen nuclear receptor genes varied in different breast cancer grades. RNA extracted from paraffin embedded archival breast tumour tissue was converted into cDNA and cDNA underwent PCR to enable quantitation of mRNA expression. Expression data was normalised against the 18S ribosomal gene multiplex and analysed using ANOVA. Analysis indicated a significant alteration of expression for the androgen receptor in different cancer grades (P=0.014), as well as in tissues that no longer possess estrogen receptor alpha proteins (P=0.025). However, expression of estrogen receptors alpha and beta did not vary significantly with cancer grade (P=0.057 and 0.622, respectively). Also, the expression of estrogen receptor alpha or beta did not change, regardless of the presence of estrogen receptor alpha protein in the tissue (P=0.794 and 0.716, respectively). Post-hoc tests indicate that the expression of the androgen receptor is increased in estrogen receptor negative tissue as well as in grade 2 and grade 3 tumours, compared to control tissue. This increased expression in late stage breast tumours may have implications to the treatment of breast tumours, particularly those lacking expression of other nuclear receptor genes.

Detection of mRNA for nuclear receptor co-activators 1 and 3 in archival breast cancer tissue and surrounding stroma : a tissue expression study

Before the age of 75 years, approximately 10% of women will be diagnosed with breast cancer, one of the most common malignancies and a leading cause of death among women. The objective of this study was to determine if expression of the nuclear receptor coactivators 1 and 3 (NCoA1 and NCoA3) varied in breast cancer grades. RNA was extracted from 25 breast tumours and transcribed into cDNA which underwent semi-quantitative polymerase chain reaction, normalised using 18S. Analysis indicated that an expression change for NCoA1 in cancer grades and estrogen receptor alpha negative tissue (P= 0.028 and 0.001 respectively). NCoA1 expression increased in grade 3 and estrogen receptor alpha negative tumours, compared to controls. NCoA3 showed a similar, but not significant, trend in grade and a non-significant decrease in estrogen receptor alpha negative tissues. Expression of NCoA1 in late stage and estrogen receptor alpha negative breast tumours may have implications to breast cancer treatment, particularly in the area of manipulation of hormone signalling systems in advanced tumours.

Expression of glucocorticoid and progesterone nuclear receptor genes in archival breast cancer tissue.

BACKGROUND: Previous studies in our laboratory have shown associations of specific nuclear receptor gene variants with sporadic breast cancer. In order to investigate these findings further, we conducted the present study to determine whether expression levels of the progesterone and glucocorticoid nuclear receptor genes vary in different breast cancer grades. METHODS: RNA was extracted from paraffin-embedded archival breast tumour tissue and converted into cDNA. Sample cDNA underwent PCR using labelled primers to enable quantitation of mRNA expression. Expression data were normalized against the 18S ribosomal gene multiplex and analyzed using analysis of variance. RESULTS: Analysis of variance indicated a variable level of expression of both genes with regard to breast cancer grade (P = 0.00033 for glucocorticoid receptor and P = 0.023 for progesterone receptor). CONCLUSION: Statistical analysis indicated that expression of the progesterone nuclear receptor is elevated in late grade breast cancer tissue.

Developing a framework for subcontractor appraisal using a balanced scorecard

Subcontractors contribute significantly to construction projects and their performance can seriously affect over-all project success. It is crucial, therefore, to appraise the performance of subcontractors to ensure they satisfy the client's expectations and project requirements. To increase the transparency and accuracy of subcontractor appraisal, the baseline and target performance levels should be set at the outset so that the appraisers and those being appraised realize exactly what standards are to be achieved. The balanced scorecard, being a powerful tool for performance appraisal, offers a potentially good approach for modeling the subcontractor appraisal process. In this paper, an approach to developing a balanced scorecard subcontractor appraisal model is proposed and demonstrated through a questionnaire survey administered in Hong Kong and from which the baseline and target performance levels for large-scale skilled subcontractors are identified. A case example is used to illustrate the operation of the model. Finally, a means by which the model may be validated is demonstrated through the use of field experts. The results demonstrate the feasibility of developing a balanced scorecard model that can help improve the transparency of subcontractor appraisal despite the baseline and target performance levels changing according to the project characteristics, subcontractor categories and size.

Evolving a synergistic approach to road safety : an appraisal of the project management, stakeholder engagement and change facilitation (PSC) approach by means of two case studies

Existing research and best practice were utilized to develop the Project Management, Stakeholder Engagement and Change Facilitation (PSC) approach to road safety infrastructure projects. Two case studies involving Queensland Transport and Main Roads demonstrated that use of the PSC has potential to create synergies for projects undertaken by multi-disciplinary road safety groups, and to complement Safe System projects and philosophy. The case studies were the North West Road Safety Alliance project, and the implementation of Road Safety Audit policy, and utilised a mix of qualitative and quantitative methods including interviews and surveys.

Improving information in project appraisal using hedonic pricing : a case study of marina berthing charges

Hedonic pricing techniques can be used to generate quantitative information useful to the project appraiser at various stages of the project cycle, most notably project formulation and investment appraisal. To illustrate, a hedonic pricing model is applied to marina berthing charges in England and Wales. The technique determines the relevant marina facilities that are reflected in marina rental price. The contribution of the key marina facilities is expressed in monetary terms as the contribution to cost per overall rental price per foot.

Children's emotions and multimodal appraisal of places : walking with the camera

This sensory ethnography explores the affordances and constraints of multimodal design to represent emotions and appraisal associated with experiencing local places. Digital video production, walking with the camera, and the use of a think-aloud protocol to reflect on the videos, provided an opportunity for the primary school children to represent their emotions and appraisal of places multimodally. Applying a typology from Martin and White's (2005) framework for the Language of Evaluation, children's multimodal emotional responses to places in this study tended toward happiness, security, and satisfaction. The findings demonstrate an explicit connection between children's emotions in response to local places through video, while highlighting the potential for teachers to use digital filmmaking to allow children to reflect actively on their placed experiences and represent their emotional reactions to places through multiple modes.

Archival analysis of service desk research: New perspectives on design and delivery

ur analysis of service desk studies shows the extent to which researchers have neglected important aspects of service desk design and delivery. The observations are made through an archival analysis of 58 peer reviewed publications in top tier outlets. Our analysis led to the development of a generic framework which identified three themes in service desk design: (1) user groups, (2) support models, and; (3) technology types And two themes in service desk delivery: (1) direction of delivery, and; (2) executive support level. This paper makes a twofold contribution to service desk research. First, it provides an understanding of service desk functions and the challenges faced by organisations in delivering those functions. Second, it identifies established and emerging areas in the service desk field. This archival analysis is the first attempt to systematically analyse the service desk literature.

An archival analysis of green information technology: The current state and future directions

This thesis provides a review of 199 papers published on Green IT/IS between 2007−2014, in order to present taxonomy of segments in Green IT/IS publications, where the segments are later used for multiple analyses to facilitate future research and to provide a retrospective analysis of existing knowledge and gaps thereof. This research also attempts to make a unique contribution to our understanding of Green IT/IS, by consolidating papers it observes current patterns of literature through approach analysis and segmentation, as well as allocating studies to the technology, process, or outcome (TPO) stage. Highlighting the necessity of a consolidated approach, these classification systems have been combined into a TPO matrix so that the studies could be arranged according to which stage of the Green IT/IS cycle they were focused on. We believe that these analyses will provide a solid platform from which future Green IT/IS research can be launched.