Longitudinal investigation of wandering behavior in department of veterans affairs nursing home care units

Objectives To explore the extent of and factors associated with male residents who change wandering status post nursing home admission. Design Longitudinal design with secondary data analyses. Admissions over a 4-year period were examined using repeat assessments with the Minimum Data Set (MDS) to formulate a model understanding the development of wandering behavior. Setting One hundred thirty-four Veterans Administration (VA) nursing homes throughout the United States. Participants: Included 6673 residents admitted to VA nursing homes between October 2000 and October 2004. Measurements MDS variables (cognitive impairment, mood, behavior problems, activities of daily living and wandering) included ratings recorded at residents’ admission to the nursing home and a minimum of two other time points at quarterly intervals. Results The majority (86%) of the sample were classified as non wanderers at admission and most of these (94%) remained non wanderers until discharge or the end of the study. Fifty one per cent of the wanderers changed status to non wanderers with 6% of these residents fluctuating in status more than two times. Admission variables associated with an increased risk of changing status from non-wandering to wandering included older age, greater cognitive impairment, more socially inappropriate behavior, resisting care, easier distractibility, and needing less help with personal hygiene. Requiring assistance with locomotion and having three or more medical comorbidities were associated with a decreased chance of changing from non-wandering to wandering status. Conclusion A resident’s change from non-wandering to wandering status may reflect an undetected medical event that affects cognition, but spares mobility.

Nursing and Midwifery Services Strategic Directions, 2011-2015

This document presents the newly updated strategic directions for strengthening nursing and midwifery services (SDNM) for the period 2011–2015. Complementing and building on the 2002–2008 SDNM, it seeks to provide policymakers, practitioners and other stakeholders at every level with a flexible framework for broad-based, collaborative action to enhance the capacity of nurses and midwives to contribute to: * universal coverage * people-centred health care * policies affecting their practice and working conditions, and the * scaling up of national health systems to meet global goals and targets. The SDNM for 2011–2015 draws on several key World Health Assembly resolutions, and are underpinned by the associated global policy recommendations and codes of practice. (1,2) After two years of extensive research and consultation, a SDNM task force was developed, and a consensus on a range of specific activities revolving around 13 objectives in five interrelated key results areas (KRAs), was achieved: n health system and service strengthening n policy and practice * education, training and career development * workforce management and * partnership. Stakeholders, although free to prioritize certain parts of the framework to meet their own particular needs, are encouraged to adhere to the cornerstone of collaborative action, namely the common goal enshrined in the core SDNM 2011–2015 vision statement: improved health outcomes for individuals, families and communities through the provision of competent, culturally sensitive, evidence-based nursing and midwifery services.

Towards an integrated model of information behavior

Information behavior models generally focus on one of many aspects of information behavior, either information finding, conceptualized as information seeking, information foraging or information sense-making, information organizing and information using. This ongoing study is developing an integrated model of information behavior. The research design involves a 2-week-long daily information journal self-maintained by the participants, combined with two interviews, one before, and one after the journal-keeping period. The data from the study will be analyzed using grounded theory to identify when the participants engage in the various behaviors that have already been observed, identified, and defined in previous models, in order to generate useful sequential data and an integrated model.

Reading nineteenth century schoolbooks online : user behavior in a digitized special collection

Special collections, because of the issues associated with conservation and use, a feature they share with archives, tend to be the most digitized areas in libraries. The Nineteenth Century Schoolbooks collection is a collection of 9000 rarely held nineteenth-century schoolbooks that were painstakingly collected over a lifetime of work by Prof. John A. Nietz, and donated to the Hillman Library at the University of Pittsburgh in 1958, which has since grown to 15,000. About 140 of these texts are completely digitized and showcased in a publicly accessible website through the University of Pittsburgh’s Library, along with a searchable bibliography of the entire collection, which expanded the awareness of this collection and its user base to beyond the academic community. The URL for the website is http://digital.library.pitt.edu/nietz/. The collection is a rich resource for researchers studying the intellectual, educational, and textbook publishing history of the United States. In this study, we examined several existing records collected by the Digital Research Library at the University of Pittsburgh in order to determine the identity and searching behaviors of the users of this collection. Some of the records examined include: 1) The results of a 3-month long user survey, 2) User access statistics including search queries for a period of one year, a year after the digitized collection became publicly available in 2001, and 3) E-mail input received by the website over 4 years from 2000-2004. The results of the study demonstrate the differences in online retrieval strategies used by academic researchers and historians, archivists, avocationists, and the general public, and the importance of facilitating the discovery of digitized special collections through the use of electronic finding aids and an interactive interface with detailed metadata.

Extending Alexander’s ecological dominance-social competition model : information behavior adaptation

Alexander’s Ecological Dominance and Social Competition (EDSC) model currently provides the most comprehensive overview of human traits in the development of a theory of human evolution and sociality (Alexander, 1990; Finn, Geary & Ward, 2005; Irons, 2005). His model provides a basis for explaining the evolution of human socio-cognitive abilities. Our paper examines the extension of Alexander’s model to incorporate the human trait of information behavior in synergy with ecological dominance and social competition as a human socio-cognitive competence. This paper discusses the various interdisciplinary perspectives exploring how evolution has shaped information behavior and why information behavior is emerging as an important human socio-cognitive competence. This paper outlines these issues, including the extension of Spink and Currier’s (2006a,b) evolution of information behavior model towards a more integrated understanding of how information behaviors have evolved (Spink & Cole, 2006).

Ecology and behavior of first instar larval Lepidoptera

Neonate Lepidoptera are confronted with the daunting task of establishing themselves on a food plant. The factors relevant to this process need to be considered at spatial and temporal scales relevant to the larva and not the investigator. Neonates have to cope with an array of plant surface characters as well as internal characters once the integument is ruptured. These characters, as well as microclimatic conditions, vary within and between plant modules and interact with larval feeding requirements, strongly affecting movement behavior, which may be extensive even for such small organisms. In addition to these factors, there is an array of predators, pathogens, and parasitoids with which first instars must contend. Not surprisingly, mortality in neonates is high but can vary widely. Experimental and manipulative studies, as well as detailed observations of the animal, are vital if the subtle interaction of factors responsible for this high and variable mortality are to be understood. These studies are essential for an understanding of theories linking female oviposition behavior with larval survival, plant defense theory, and population dynamics, as well as modern crop resistance breeding programs.

Interfacial debonding behavior of composite beam/plates with PZT patch

This paper studies interfacial debonding behavior of composite beams which include piezoelectric materials, adhesive and host beam. The focus is put on crack initiation and growth of the piezoelectric adhesive interface. Closed-form solutions of interface stresses and energy release rates are obtained for adhesive layer in the piezoelectric composite beams. Finite element analyses have been carried out to study the initiation and growth of interfaces crack for piezoelectric beams with interface element by ANSYS, in which the interface element of FE model is based on the cohesive zone models to characterize the fracture behavior of the interfacial debonding. The results have been compared with analystical solution, and the influence of different geometry and material parameters on the interfacial behavior of piezoelectric composite beams have been discussed.

Project managers and technical change : curriculum development in strategic technology management

Traditional business approaches do not take account of the rapid technological developments underpinning today's world. Further understanding the role of technology and its efficient management to build and maintain a competitive edge in business can allow project managers to more successfully manage organisations, and to adapt to and capitalise on, today’s rapidly changing environment. Strategic Technology Management links engineering, science and management principles to identify, choose, and implement the most effective means of attaining compatibility between internal skills and resources of an organisation and its competitive, economic and social environment. This paper reviews the rationale and the development of a new Strategic Technology Management subject in QUT’s Master of Project Management program. It discusses recent developments in the area of technology management from an international perspective, provides details of the curriculum developed and discusses the experience of completing two years of teaching the new program.

Strategic alliances in building construction : a tender evaluation tool for the public sector

Building construction is a highly competitive and risky business. This competitiveness is compounded where conflicting objectives amongst contracting and subcontracting firms set the stage for an adversarial and potentially destructive business relationship. Clients, especially those from the public sector, need broader tender evaluation criteria to complement the traditional focus on bid price. There is also a need for change in the construction industry—not only to a more cooperative approach between the constructing parties—but also from a confrontationist attitude to a more harmonious relationship between all stakeholders in providing constructed facilities. A strategic alliance is a cooperative relationship between two or more organisations that forms part of their overall strategies, and contributes to achieving their major goals and objectives. Strategic alliances in building construction may provide a useful tool to assist public sector construction managers evaluate tenders and concurrently encourage more cooperative relationships amongst construction stakeholders. This paper begins with an overview of the Australian building construction industry, then reviews the existing strategic alliance literature and describes an analysis framework comprising six attributes of strategic alliances for application to construction organisations—trust, commitment, interdependence, cooperation, communication, and joint problem solving. These attributes are currently being used to collect data from 70 building construction firms in Queensland to assess their respective levels of strategic alliance. Given the trend towards broader indicators of construction firm performance, these attributes are proposed as a tool for use in the tender evaluation process for public works.

Innovation networks in the construction arena : the strategic management of mixed enterprises

The building and construction sector is one of the five largest contributors to the Australian economy and is a key performance component in the economy of many other jurisdictions. However, the ongoing viability of this sector is increasingly reliant on its ability to foster and transfer innovated products and practices. Interorganisational networks, which bring together key industry stakeholders and facilitate the flows of information, resources and trust necessary to secure innovation, have emerged as a key growth strategy within this and other arenas. The blending of organisations, resources and purposes creates new, hybrid institutional forms that draw on a mix of contract, structure and interpersonal relationship as integration processes. This paper argues that hybrid networked arrangements, because they incorporate relational elements, require management strategies and techniques that not always synonymous with conventional management approaches, including those used within the building and construction sector. It traces the emergence of the Construction Innovation Project in Australia as a hybrid institutional arrangement moulding public, private and academic stakeholders of the building and construction industry into a coherent collective force aimed at fostering innovation and its application within all levels of the industry. Specifically, the paper examines the Construction Innovation Project to ascertain the impact of relational governance and its management to harness and leverage the skills, resources and capacities of members to secure innovative outcomes. Finally, the paper offers some prospects to guide the ongoing work of this body and any other charged with a similar integrative responsibility.

Mechanical Behavior of Articular Cartilage After Osteochondral Autograft Transfer in an Ovine Model

BACKGROUND: Grafting of autologous hyaline cartilage and bone for articular cartilage repair is a well-accepted technique. Although encouraging midterm clinical results have been reported, no information on the mechanical competence of the transplanted joint surface is available. HYPOTHESIS: The mechanical competence of osteochondral autografts is maintained after transplantation. STUDY DESIGN: Controlled laboratory study. METHODS: Osteochondral defects were filled with autografts (7.45 mm in diameter) in one femoral condyle in 12 mature sheep. The ipsilateral femoral condyle served as the donor site, and the resulting defect (8.3 mm in diameter) was left empty. The repair response was examined after 3 and 6 months with mechanical and histologic assessment and histomorphometric techniques. RESULTS: Good surface congruity and plug placement was achieved. The Young modulus of the grafted cartilage significantly dropped to 57.5% of healthy tissue after 3 months (P < .05) but then recovered to 82.2% after 6 months. The aggregate and dynamic moduli behaved similarly. The graft edges showed fibrillation and, in some cases (4 of 6), hypercellularity and chondrocyte clustering. Subchondral bone sclerosis was observed in 8 of 12 cases, and the amount of mineralized bone in the graft area increased from 40% to 61%. CONCLUSIONS: The mechanical quality of transplanted cartilage varies considerably over a short period of time, potentially reflecting both degenerative and regenerative processes, while histologically signs of both cartilage and bone degeneration occur. CLINICAL RELEVANCE: Both the mechanically degenerative and restorative processes illustrate the complex progression of regeneration after osteochondral transplantation. The histologic evidence raises doubts as to the long-term durability of the osteochondral repair.

Strategic management of technology in construction : a framework and case study

This case study analyzes a firm's technology strategy for its fit or match with the requirements of the industry environment in which it operates. Understanding the relationships between market characteristics and technology strategies can assist managers in making complex and difficult decisions regarding their use of technology to improve competitive performance. Using the technology strategy framework, managers can map their own capabilities for comparison with the more appropriate or superior approach to technology in that industry environment. Alternatively, firms seeking to transition from one industry niche or environment to another could identify and move to acquire the required capabilities. The dynamics of industry competition, both domestic and international, emphasize the need for improved management of the strategic fit between technical capabilities and industry environment.

Long-term effects of hydrogel properties on human chondrocyte behavior

Hydrogels provide a 3-dimensional network for embedded cells and offer promise for cartilage tissue engineering applications. Nature-derived hydrogels, including alginate, have been shown to enhance the chondrocyte phenotype but are variable and not entirely controllable. Synthetic hydrogels, including polyethylene glycol (PEG)-based matrices, have the advantage of repeatability and modularity; mechanical stiffness, cell adhesion, and degradability can be altered independently. In this study, we compared the long-term in vitro effects of different hydrogels (alginate and Factor XIIIa-cross-linked MMP-sensitive PEG at two stiffness levels) on the behavior of expanded human chondrocytes and the development of construct properties. Monolayer-expanded human chondrocytes remained viable throughout culture, but morphology varied greatly in different hydrogels. Chondrocytes were characteristically round in alginate but mostly spread in PEG gels at both concentrations. Chondrogenic gene (COL2A1, aggrecan) expression increased in all hydrogels, but alginate constructs had much higher expression levels of these genes (up to 90-fold for COL2A1), as well as proteoglycan 4, a functional marker of the superficial zone. Also, chondrocytes expressed COL1A1 and COL10A1, indicative of de-differentiation and hypertrophy. After 12 weeks, constructs with lower polymer content were stiffer than similar constructs with higher polymer content, with the highest compressive modulus measured in 2.5% PEG gels. Different materials and polymer concentrations have markedly different potency to affect chondrocyte behavior. While synthetic hydrogels offer many advantages over natural materials such as alginate, they must be further optimized to elicit desired chondrocyte responses for use as cartilage models and for development of functional tissue-engineered articular cartilage.

Strategic technology management : case study development in innovative building products

National and international competition demands that Australian organisations become more competent at making the strategic technological decisions that impact their future in the international business economy. A new subject unit, Management of Technology is now offered in the popular Master of Project Management and Master of Business Administration programs at the Queensland University of Technology. This cross-disciplinary subject provides students with a theoretical foundation and practical tools to improve the efficiency and competitiveness of technically-oriented organisations. Applied case studies—shown to be the most appropriate mode of learning for mature-age students—form an integral component of the teaching program. In the first offerings of this subject during 1995 and 1996, American case studies were used. QUT has now supported the development of Australian case study packages for technology management through its Teaching and Learning Grants Scheme. The first case developed—Inland Oil Refiners’ Microstill Project—was completed in early 1996. A newly developed case—Automated Door Opening System for Wheelchair Access—is currently being completed. This case (comprising case study documentation and video presentation) tracks a cross-disciplinary product development driven by legislative and community pressures. It also reinforces the importance of personal relationships in the technology and business development that has taken this young Brisbane-based company from its embryonic beginnings on the Queensland Cultural Centre in 1994 to a national and export-focussed organisation in 1997. This paper reviews the need to develop Australian case material in Management of Technology, discusses the case study documentation and supporting video developed, and application of the case study approach in this teaching initiative in QUT’s Master of Project Management and Master of Business Administration programs.