Factors affecting adherence to use of hip protectors amongst residents of nursing homes - A correlation study

Background: Hip protectors are protective pads designed to cover the greater trochanter and attenuate or disperse the force of a fall sufficiently to prevent a hip fracture. Promising results from randomised controlled trials in nursing homes have resulted in hip protectors being widely recommended in the health care literature and in national guidelines. Objectives: The objectives of the study were to identify characteristics of individual residents, and the organisational features of the homes in which they live, which may affect adherence to wearing hip protectors. Design: An observational, correlation study designed to identify factors related to adherence. Setting: Forty nursing and residential homes in the UK. Participants: 1346 residents of the homes who were not confined to bed and with no pressure sore on the hip. Methods: The introduction of an evidence-based policy to offer Safehips hip protectors to residents free of charge and with support from a nurse facilitator. Adherence to wearing the hip protectors was observed over 72 weeks. Results: Initial acceptance of the hip protectors was 37.2%. Continued adherence was 23.9% at 24 weeks; 23.2% at 48 weeks; and 19.9% at 72 weeks. Greater adherence was associated with the following individual resident characteristics: a greater degree of dependency (95% CI 1.39 - m3.78) and cognitive impairment (95% CI 1.01 - 2.98); being male rather than female (95% CI 1.06 - 2.48). Greater adherence was also associated with the following organisational characteristics of homes: fewer changes of senior manager during the study period (95% CI 1.01 - 8.51), and being resident in a home with a resident profile showing a greater proportion of residents with a higher degree of dependency (95% CI 1.04 - 1.27). There was wide a variation in the degree of success in implementation between homes (adherence of 0 - 100% at 24 weeks). Conclusions: Those implementing a policy of introducing hip protectors into nursing and residential homes should consider targeting residents with cognitive impairment. Such residents are at greater risk of hip fracture and appear to be more likely to continue wearing hip protectors. Those charged with implementing changes inpractice or policy should consider how the context for implementation can be optimised to increase the likelihood of success.

Using CORBA's advanced services to enhance the integrity of QoS management programmable networks

The development of wideband network services and the new network infrastructures to support them have placed much more requirements on current network management systems. Issues such as scalability, integrity and interoperability have become more important. Existing management systems are not flexible enough to support the provision of Quality of Service (QoS) in these dynamic environments. The concept of Programmable Networks has been proposed to address these requirements. Within this framework, CORBA is regarded as a middleware technology that can enable interoperation among the distributed entities founds in Programmable Networks. By using the basic CORBA environment in a heterogeneous network environment, a network manager is able to control remote Network Elements (NEs) in the same way it controls its local resources. Using this approach both the flexibility and intelligence of the overall network management can be improved. This paper proposes the use of two advanced features of CORBA to enhance the QoS management in a Programmable Network environment. The Transaction Service can be used to manage a set of tasks, whenever the management of elements in a network is correlated; and the Concurrency Service can be used to coordinate multiple accesses on the same network resources. It is also shown in this paper that proper use of CORBA can largely reduce the development and administration of network management applications.

Risk assessment of E-Commerce projects using evidential reasoning

The purpose of this study is to develop a decision making system to evaluate the risks in E-Commerce (EC) projects. Competitive software businesses have the critical task of assessing the risk in the software system development life cycle. This can be conducted on the basis of conventional probabilities, but limited appropriate information is available and so a complete set of probabilities is not available. In such problems, where the analysis is highly subjective and related to vague, incomplete, uncertain or inexact information, the Dempster-Shafer (DS) theory of evidence offers a potential advantage. We use a direct way of reasoning in a single step (i.e., extended DS theory) to develop a decision making system to evaluate the risk in EC projects. This consists of five stages 1) establishing knowledge base and setting rule strengths, 2) collecting evidence and data, 3) determining evidence and rule strength to a mass distribution for each rule; i.e., the first half of a single step reasoning process, 4) combining prior mass and different rules; i.e., the second half of the single step reasoning process, 5) finally, evaluating the belief interval for the best support decision of EC project. We test the system by using potential risk factors associated with EC development and the results indicate that the system is promising way of assisting an EC project manager in identifying potential risk factors and the corresponding project risks.

Analysing orchestrations with risk profiles and angel-daemon games

In this paper game theory is used to analyse the effect of a number of service failures during the execution of a grid orchestration. A service failure may be catastrophic in that it causes an entire orchestration to fail. Alternatively, a grid manager may utilise alternative services in the case of failure, allowing an orchestration to recover, A risk profile provides a means of modelling situations in a way that is neither overly optimistic nor overly pessimistic. Risk profiles are analysed using angel and daemon games. A risk profile can be assigned a valuation through an analysis of the structure of its associated Nash equilibria. Some structural properties of valuation functions, that show their validity as a measure for risk, are given. Two main cases are considered, the assessment of Orc expressions and the arrangement of a meeting using reputations.

Co-design of Distributed Systems Using Skeleton and Autonomic Management Abstractions

We discuss how common problems arising with multi/many core distributed architectures can he effectively handled through co-design of parallel/distributed programming abstractions and of autonomic management of non-functional concerns. In particular, we demonstrate how restricted patterns (or skeletons) may be efficiently managed by rule-based autonomic managers. We discuss the basic principles underlying pattern+manager co-design, current implementations inspired by this approach and some result achieved with proof-or-concept, prototype.

A Web-Service Based Approach for Software Sharing

A Web-service based approach is presented which enables geographically dispersed users to share software resources over the Internet. A service-oriented software sharing system has been developed, which consists of shared applications, client applications and three types of services: application proxy service, proxy implementation service and application manager service. With the aids of the services, the client applications interact with the shared applications to implement a software sharing task. The approach satisfies the requirements of copyright protection and reuse of legacy codes. In this paper, the role of Web-services and the architecture of the system are presented first, followed by a case study to illustrate the approach developed.

Understanding New Product Project Performance

Purpose – The purpose of this paper is to summarize the accumulated body of knowledge on the performance of new product projects and provide directions for further research. Design/methodology/approach – Using a refined classification of antecedents of new product project performance the research results are meta-analyzed in the literature in order to identify the strength and stability of predictor-performance relationships. Findings – The results reveal that 22 variables have a significant relationship with new product project performance, of which only 12 variables have a sizable relationship. In order of importance these factors are the degree of organizational interaction, R&D and marketing interface, general product development proficiency, product advantage, financial/business analysis, technical proficiency, management skill, marketing proficiency, market orientation, technology synergy, project manager competency and launch activities. Of the 34 variables 16 predictors show potential for moderator effects. Research limitations/implications – The validity of the results is constrained by publication bias and heterogeneity of performance measures, and directions for the presentation of data in future empirical publications are provided. Practical implications – This study helps new product project managers in understanding and managing the performance of new product development projects. Originality/value – This paper provides unique insights into the importance of predictors of new product performance at the project level. Furthermore, it identifies which predictor-performance relations are contingent on other factors.

Cognitive-behavioural interventions for children who have been sexually abused

Background: Despite differences in how it is defined, there is a general consensus amongst clinicians and researchers that the sexual abuse of children and adolescents (’child sexual abuse’) is a substantial social problem worldwide. The effects of sexual abuse manifest in a wide range of symptoms, including fear, anxiety, post-traumatic stress disorder and various externalising and internalising behaviour problems, such as inappropriate sexual behaviours. Child sexual abuse is associated with increased risk of psychological problems in adulthood. Cognitive-behavioural approaches are used to help children and their non-offending or ’safe’ parent tomanage the sequelae of childhood sexual abuse. This review updates the first Cochrane review of cognitive-behavioural approaches interventions for children who have been sexually abused, which was first published in 2006.

Objectives: To assess the efficacy of cognitive-behavioural approaches (CBT) in addressing the immediate and longer-term sequelae of sexual abuse on children and young people up to 18 years of age.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2011 Issue 4); MEDLINE (1950 to November Week
3 2011); EMBASE (1980 to Week 47 2011); CINAHL (1937 to 2 December 2011); PsycINFO (1887 to November Week 5 2011); LILACS (1982 to 2 December 2011) and OpenGrey, previously OpenSIGLE (1980 to 2 December 2011). For this update we also searched ClinicalTrials.gov and the International Clinical Trials Registry Platform (ICTRP).

Selection criteria: We included randomised or quasi-randomised controlled trials of CBT used with children and adolescents up to age 18 years who had experienced being sexually abused, compared with treatment as usual, with or without placebo control.

Data collection and analysis: At least two review authors independently assessed the eligibility of titles and abstracts identified in the search. Two review authors independently extracted data from included studies and entered these into Review Manager 5 software. We synthesised and presented data in both written and graphical form (forest plots).

Main results: We included 10 trials, involving 847 participants. All studies examined CBT programmes provided to children or children and a nonoffending parent. Control groups included wait list controls (n = 1) or treatment as usual (n = 9). Treatment as usual was, for the most part, supportive, unstructured psychotherapy. Generally the reporting of studies was poor. Only four studies were judged ’low risk of bias’ with regards to sequence generation and only one study was judged ’low risk of bias’ in relation to allocation concealment. All studies were judged ’high risk of bias’ in relation to the blinding of outcome assessors or personnel; most studies did not report on these, or other issues of bias. Most studies reported results for study completers rather than for those recruited.

Depression, post-traumatic stress disorder (PTSD), anxiety and child behaviour problems were the primary outcomes. Data suggest that CBT may have a positive impact on the sequelae of child sexual abuse, but most results were not statistically significant. Strongest evidence for positive effects of CBT appears to be in reducing PTSD and anxiety symptoms, but even in these areas effects tend to be 'moderate’ at best. Meta-analysis of data from five studies suggested an average decrease of 1.9 points on the Child Depression Inventory immediately after intervention (95% confidence interval (CI) decrease of 4.0 to increase of 0.4; I2 = 53%; P value for heterogeneity = 0.08), representing a small to moderate effect size. Data from six studies yielded an average decrease of 0.44 standard deviations on a variety of child post-traumatic stress disorder scales (95% CI 0.16 to 0.73; I2 = 46%; P value for heterogeneity = 0.10). Combined data from five studies yielded an average decrease of 0.23 standard deviations on various child anxiety scales (95% CI 0.3 to 0.4; I2=0%; P value for heterogeneity = 0.84). No study reported adverse effects.

Authors’ conclusions: The conclusions of this updated review remain the same as those when it was first published. The review confirms the potential of CBT to address the adverse consequences of child sexual abuse, but highlights the limitations of the evidence base and the need for more carefully conducted and better reported trials.

Beyond Sex, Bond and Star Wars : Exhibition Data from the Southampton Odeon 1972-1980

This article uses the personal ledgers of a cinema manager to explore programming and film exhibition at the Southampton Odeon in the 1970s. The detailed accounts provide a rare insight into cinema exhibition and challenge the notion that 1970s cinema was all about sex, violence, horror and exploitation, suggesting instead that audiences at this cinema, favoured very different fare.

Enhancing family physician capacity to deliver quality palliative home care:An end-of-life, shared-care model

PROBLEM BEING ADDRESSED: Family physicians face innumerable challenges to delivering quality palliative home care to meet the complex needs of end-of-life patients and their families. OBJECTIVE OF PROGRAM: To implement a model of shared care to enhance family physicians' ability to deliver quality palliative home care, particularly in a community-based setting. PROGRAM DESCRIPTION: Family physicians in 3 group practices (N = 21) in Ontario's Niagara West region collaborated with an interprofessional palliative care team (including a palliative care advanced practice nurse, a palliative medicine physician, a bereavement counselor, a psychosocial-spiritual advisor, and a case manager) in a shared-care partnership to provide comprehensive palliative home care. Key features of the program included systematic and timely identification of end-of-life patients, needs assessments, symptom and psychosocial support interventions, regular communication between team members, and coordinated care guided by outcome-based assessment in the home. In addition, educational initiatives were provided to enhance family physicians' knowledge and skills. CONCLUSION: Because of the program, participants reported improved communication, effective interprofessional collaboration, and the capacity to deliver palliative home care, 24 hours a day, 7 days a week, to end-of-life patients in the community.

LIBERO:A framework for autonomic management of multiple non-functional concerns

We describe a lightweight prototype framework (LIBERO) designed for experimentation with behavioural skeletons-components implementing a well-known parallelism exploitation pattern and a rule-based autonomic manager taking care of some non-functional feature related to pattern computation. LIBERO supports multiple autonomic managers within the same behavioural skeleton, each taking care of a different non-functional concern. We introduce LIBERO-built on plain Java and JBoss-and discuss how multiple managers may be coordinated to achieve a common goal using a two-phase coordination protocol developed in earlier work. We present experimental results that demonstrate how the prototype may be used to investigate autonomic management of multiple, independent concerns. © 2011 Springer-Verlag Berlin Heidelberg.

John Rich as Opera Patron

This article traces the sustained support that theatre manager John Rich offered to operatic endeavours in 18th-century London. Rich effectively entered the contemporary discourse regarding the valid definition of opera through the kinds of works he supported, and also through the prefatory comments to two works staged at his theatre.

Public management, Peace-building and Creating Change: Shifting the Lens of Analysis from the Macro to the Micro

Considerable time, research money and expertise has been spent exploring the complex reality of ethno nationalist conflict and the role that public management plays in supporting the transition from violent conflict to stability, order and prosperity (Esman 1999; Guelke and Milton-Edwards 2000; Brinkerhoff 2005; Brinkerhoff, Wetterberg et al. 2012; Rao 2014). However, there seems to be a gap in relation to the practical challenges of managing change within, through and beyond such conflict. This paper aims to begin the process of putting a framework around the real experience of public management in conflict and transition by shifting the lens of analysis from macros concerns about sequencing interventions (Rao 2014) and legitimate requirements of security, stability and service delivery (Brinkerhoff, Wetterberg et al. 2012) to a micro analysis of the attitudes, behaviours, challenges and compromises held and faced by those public servants on the front line of conflict management and conflict transformation processes. Using senior managers as the unit of analysis and Northern Ireland as an embryonic case study, this paper discusses the links between ethno nationalist societal conflict, public sector reform and manager behaviour. In doing so, it highlights some initial data from an early pilot study into the experiences of individuals in significant public service roles at various stages of the NI conflict / peace process and draws some tentative conclusions about the viability of a wider study.

The Management of Long-Term Sickness Absence in Large Public Sector Healthcare Organisations: A Realist Evaluation Using Mixed Methods

Purpose The success of measures to reduce long-term sickness absence (LTSA) in public sector organisations is contingent on organisational context. This realist evaluation investigates how interventions interact with context to influence successful management of LTSA. Methods Multi-method case study in three Health and Social Care Trusts in Northern Ireland comprising realist literature review, semi-structured interviews (61 participants), Process-Mapping and feedback meetings (59 participants), observation of training, analysis of documents. Results Important activities included early intervention; workplace-based occupational rehabilitation; robust sickness absence policies with clear trigger points for action. Used appropriately, in a context of good interpersonal and interdepartmental communication and shared goals, these are able to increase the motivation of staff to return to work. Line managers are encouraged to take a proactive approach when senior managers provide support and accountability. Hindering factors: delayed intervention; inconsistent implementation of policy and procedure; lack of resources; organisational complexity; stakeholders misunderstanding each other’s goals and motives. Conclusions Different mechanisms have the potential to encourage common motivations for earlier return from LTSA, such as employees feeling that they have the support of their line manager to return to work and having the confidence to do so. Line managers’ proactively engage when they have confidence in the support of seniors and in their own ability to address LTSA. Fostering these motivations calls for a thoughtful, diagnostic process, taking into account the contextual factors (and whether they can be modified) and considering how a given intervention can be used to trigger the appropriate mechanisms.

A mixed methods study of the work patterns of full-time nurse practitioners in nursing homes

Aims and objectives: The aim of this study was to explore the integration of the nurse practitioner role in Canadian nursing homes to enable its full potential to be realised for resident and family care. The objective was to determine nurse practitioners' patterns of work activities. 

Background: Nurse practitioners were introduced in Canadian nursing homes a decade ago on a pilot basis. In recent years, government and nursing home sector interest in the role has grown along with the need for data to inform planning efforts. 

Design: The study used a sequential mixed methods design using a national survey followed by case studies. 

Methods: A national survey of nurse practitioners included demographic items and the EverCare Nurse Practitioner Role and Activity Scale. Following the survey, case studies were conducted in four nursing homes. Data were collected using individual and focus group interviews, document reviews and field notes. 

Results: Twenty-three of a target population of 26 nurse practitioners responded to the survey, two-thirds of whom provided services in nursing homes with one site and the remainder in nursing homes with as many as four sites. On average, nurse practitioners performed activities in communicator, clinician, care manager/coordinator and coach/educator subscales at least three to four times per week and activities in the collaborator subscale once a week. Of the 43 activities, nurse practitioners performed daily, most were in the clinician and communicator subscales. Case study interviews involved 150 participants. Findings complemented those of the survey and identified additional leadership activities. 

Conclusion: Nurse practitioners undertake a range of primary health care and advanced practice activities which they adapt to meet the unique needs of nursing homes. Relevance to clinical practice: Knowledge of work patterns enables nursing homes to implement the full range of nurse practitioner roles and activities to enhance resident and family care.