Living with and beyond cancer: the role of Holistic Needs Assessment and care planning.

Due to earlier diagnosis and more effective treatment, increasing numbers of people can be expected to live with and beyond cancer. Yet for many, survival might be characterised by physical and psychological morbidity, decreased functional status and disability, which may increase as the length of time from the completion of treatment extends. However, careful integrated assessment and relevant and acceptable care planning can mitigate these effects; people can be helped and supported in self-management and ultimately enabled to live full and productive lives in a manner that is acceptable to them.

Sustainable Value Added - ein neues Maß des Nachhaltigkeitsbeitrags von Unternehmen am Beispiel der Henkel KGaA

This article introduces a new approach to measure corporate contributions to sustainability called Sustainable Value Added. Existing approaches to measure sustainability are based on a comparative assessment of environmental and social burdens and can thus be characterised as burden-based approaches. However, these approaches suffer from severe limitations as a comparative assessment and aggregation of all relevant environmental and social burdens fails in practice. In contrast to these burden-based approaches Sustainable Value Added is value-based. It determines the value that is created by the reduced or increased use of different environmental and social resources. For this purpose the use of environmental and social resources is valued at their opportunity cost. Sustainable Value Added allows an integrated assessment of the economic, environmental, and social performance of a company and expresses the corporate contribution to sustainability in a single monetary indicator. This article explains the theoretical background of Sustainable Value Added, relates it to existing approaches to measure sustainability, and - using the example of Henkel KGaA - demonstrates its practical applicability.

Influence of Different European Cements (CEM) on the Hydration of Cover-Zone Concrete during the Curing and Post Curing Periods

The durability of reinforced concrete structures depends, in the main, on the performance of the cover-zone concrete as it is this which protects the steel from the external environment. This paper focusses on the use of discretised electrical property measurements to study depth-related features during both the curing and post-curing period thereby allowing an integrated assessment of the protective properties of the cover region. In the current work, use is made of a small, multi-electrode array embedded within the surface 75mm of concrete specimens. Concretes were manufactured with different European cements (CEM) and water/binder ratios representing mixes which satisfied the minimum requirements for a range of environmental exposure classes including exposure to chlorides. Electrical resistance measurements were taken over a period in excess of 300 days which showed on-going hydration, pozzolanic reaction and pore-structure refinement; in addition, in the post-curing period, when exposed to a cyclic chloride ponding regime, measurements could be used to study the convective zone and ionic enrichment of the surface layer.

Robust food supply supply chains:An integrated framework for vulnerability assessment and disturbance management

The operation of supply chains (SCs) has for many years been focused on efficiency, leanness and responsiveness. This has resulted in reduced slack in operations, compressed cycle times, increased productivity and minimised inventory levels along the SC. Combined with tight tolerance settings for the realisation of logistics and production processes, this has led to SC performances that are frequently not robust. SCs are becoming increasingly vulnerable to disturbances, which can decrease the competitive power of the entire chain in the market. Moreover, in the case of food SCs non-robust performances may ultimately result in empty shelves in grocery stores and supermarkets.
The overall objective of this research is to contribute to Supply Chain Management (SCM) theory by developing a structured approach to assess SC vulnerability, so that robust performances of food SCs can be assured. We also aim to help companies in the food industry to evaluate their current state of vulnerability, and to improve their performance robustness through a better understanding of vulnerability issues. The following research questions (RQs) stem from these objectives:
RQ1: What are the main research challenges related to (food) SC robustness?
RQ2: What are the main elements that have to be considered in the design of robust SCs and what are the relationships between these elements?
RQ3: What is the relationship between the contextual factors of food SCs and the use of disturbance management principles?
RQ4: How to systematically assess the impact of disturbances in (food) SC processes on the robustness of (food) SC performances?
To answer these RQs we used different methodologies, both qualitative and quantitative. For each question, we conducted a literature survey to identify gaps in existing research and define the state of the art of knowledge on the related topics. For the second and third RQ, we conducted both exploration and testing on selected case studies. Finally, to obtain more detailed answers to the fourth question, we used simulation modelling and scenario analysis for vulnerability assessment.
Main findings are summarised as follows.
Based on an extensive literature review, we answered RQ1. The main research challenges were related to the need to define SC robustness more precisely, to identify and classify disturbances and their causes in the context of the specific characteristics of SCs and to make a systematic overview of (re)design strategies that may improve SC robustness. Also, we found that it is useful to be able to discriminate between varying degrees of SC vulnerability and to find a measure that quantifies the extent to which a company or SC shows robust performances when exposed to disturbances.
To address RQ2, we define SC robustness as the degree to which a SC shows an acceptable performance in (each of) its Key Performance Indicators (KPIs) during and after an unexpected event that caused a disturbance in one or more logistics processes. Based on the SCM literature we identified the main elements needed to achieve robust performances and structured them together to form a conceptual framework for the design of robust SCs. We then explained the logic of the framework and elaborate on each of its main elements: the SC scenario, SC disturbances, SC performance, sources of food SC vulnerability, and redesign principles and strategies.
Based on three case studies, we answered RQ3. Our major findings show that the contextual factors have a consistent relationship to Disturbance Management Principles (DMPs). The product and SC environment characteristics are contextual factors that are hard to change and these characteristics initiate the use of specific DMPs as well as constrain the use of potential response actions. The process and the SC network characteristics are contextual factors that are easier to change, and they are affected by the use of the DMPs. We also found a notable relationship between the type of DMP likely to be used and the particular combination of contextual factors present in the observed SC.
To address RQ4, we presented a new method for vulnerability assessments, the VULA method. The VULA method helps to identify how much a company is underperforming on a specific Key Performance Indicator (KPI) in the case of a disturbance, how often this would happen and how long it would last. It ultimately informs the decision maker about whether process redesign is needed and what kind of redesign strategies should be used in order to increase the SC’s robustness. The VULA method is demonstrated in the context of a meat SC using discrete-event simulation. The case findings show that performance robustness can be assessed for any KPI using the VULA method.
To sum-up the project, all findings were incorporated within an integrated framework for designing robust SCs. The integrated framework consists of the following steps: 1) Description of the SC scenario and identification of its specific contextual factors; 2) Identification of disturbances that may affect KPIs; 3) Definition of the relevant KPIs and identification of the main disturbances through assessment of the SC performance robustness (i.e. application of the VULA method); 4) Identification of the sources of vulnerability that may (strongly) affect the robustness of performances and eventually increase the vulnerability of the SC; 5) Identification of appropriate preventive or disturbance impact reductive redesign strategies; 6) Alteration of SC scenario elements as required by the selected redesign strategies and repeat VULA method for KPIs, as defined in Step 3.
Contributions of this research are listed as follows. First, we have identified emerging research areas - SC robustness, and its counterpart, vulnerability. Second, we have developed a definition of SC robustness, operationalized it, and identified and structured the relevant elements for the design of robust SCs in the form of a research framework. With this research framework, we contribute to a better understanding of the concepts of vulnerability and robustness and related issues in food SCs. Third, we identified the relationship between contextual factors of food SCs and specific DMPs used to maintain robust SC performances: characteristics of the product and the SC environment influence the selection and use of DMPs; processes and SC networks are influenced by DMPs. Fourth, we developed specific metrics for vulnerability assessments, which serve as a basis of a VULA method. The VULA method investigates different measures of the variability of both the duration of impacts from disturbances and the fluctuations in their magnitude.
With this project, we also hope to have delivered practical insights into food SC vulnerability. First, the integrated framework for the design of robust SCs can be used to guide food companies in successful disturbance management. Second, empirical findings from case studies lead to the identification of changeable characteristics of SCs that can serve as a basis for assessing where to focus efforts to manage disturbances. Third, the VULA method can help top management to get more reliable information about the “health” of the company.
The two most important research opportunities are: First, there is a need to extend and validate our findings related to the research framework and contextual factors through further case studies related to other types of (food) products and other types of SCs. Second, there is a need to further develop and test the VULA method, e.g.: to use other indicators and statistical measures for disturbance detection and SC improvement; to define the most appropriate KPI to represent the robustness of a complete SC. We hope this thesis invites other researchers to pick up these challenges and help us further improve the robustness of (food) SCs.

Spatial and Temporal Changes in Soil Organic Carbon Assessment using an Integrated Geostatistical and Compositional Data Analysis Approach

The Irish and UK governments, along with other countries, have made a commitment to limit the concentrations of greenhouse gases in the atmosphere by reducing emissions from the burning of fossil fuels. This can be achieved (in part) through increasing the sequestration of CO2 from the atmosphere including monitoring the amount stored in vegetation and soils. A large proportion of soil carbon is held within peat due to the relatively high carbon density of peat and organic-rich soils. This is particularly important for a country such as Ireland, where some 16% of the land surface is covered by peat. For Northern Ireland, it has been estimated that the total amount of carbon stored in vegetation is 4.4Mt compared to 386Mt stored within peat and soils. As a result it has become increasingly important to measure and monitor changes in stores of carbon in soils. The conservation and restoration of peat covered areas, although ongoing for many years, has become increasingly important. This is summed up in current EU policy outlined by the European Commission (2012) which seeks to assess the relative contributions of the different inputs and outputs of organic carbon and organic matter to and from soil. Results are presented from the EU-funded Tellus Border Soil Carbon Project (2011 to 2013) which aimed to improve current estimates of carbon in soil and peat across Northern Ireland and the bordering counties of the Republic of Ireland.
Historical reports and previous surveys provide baseline data. To monitor change in peat depth and soil organic carbon, these historical data are integrated with more recently acquired airborne geophysical (radiometric) data and ground-based geochemical data generated by two surveys, the Tellus Project (2004-2007: covering Northern Ireland) and the EU-funded Tellus Border project (2011-2013) covering the six bordering counties of the Republic of Ireland, Donegal, Sligo, Leitrim, Cavan, Monaghan and Louth. The concept being applied is that saturated organic-rich soil and peat attenuate gamma-radiation from underlying soils and rocks. This research uses the degree of spatial correlation (coregionalization) between peat depth, soil organic carbon (SOC) and the attenuation of the radiometric signal to update a limited sampling regime of ground-based measurements with remotely acquired data. To comply with the compositional nature of the SOC data (perturbations of loss on ignition [LOI] data), a compositional data analysis approach is investigated. Contemporaneous ground-based measurements allow corroboration for the updated mapped outputs. This provides a methodology that can be used to improve estimates of soil carbon with minimal impact to sensitive habitats (like peat bogs), but with maximum output of data and knowledge.

A Reliability Assessment Approach For Integrated Transportation and Electrical Power Systems Incorporating Electric Vehicles

With the increasing utilization of electric vehicles (EVs), transportation systems and electrical power systems are becoming increasingly coupled. However, the interaction between these two kinds of systems are not well captured, especially from the perspective of transportation systems. This paper studies the reliability of integrated transportation and electrical power system (ITES). A bidirectional EV charging control strategy is first demonstrated to model the interaction between the two systems. Thereafter, a simplified transportation system model is developed, whose high efficiency makes the reliability assessment of the ITES realizable with an acceptable accuracy. Novel transportation system reliability indices are then defined from the view point of EV’s driver. Based on the charging control model and the transportation simulation method, a daily periodic quasi sequential reliability assessment method is proposed for the ITES system. Case studies based on RBTS system demonstrate that bidirectional charging controls of EVs will benefit the reliability of power systems, while decrease the reliability of EVs travelling. Also, the optimal control strategy can be obtained based on the proposed method. Finally, case studies are performed based on a large scale test system to verify the practicability of the proposed method.

Technology Assessment for a Complex Aircraft System using Technology Scenarios

Military decision makers need to understand and assess the benefits and consequences of their decisions in order to make cost efficient, timely, and successful choices. Technology selection is one such critical decision, especially when considering the design or retrofit of a complex system, such as an aircraft. An integrated and systematic methodology that will support decision-making between technology alternatives and options while assessing the consequences of such decisions is a key enabler. This paper presents and demonstrates, through application to a notional medium range short takeoff and landing (STOL) aircraft, one such enabler: the Technology Impact Forecasting (TIF) method. The goal of the TIF process is to explore both generic, undefined areas of technology, as well as specific technologies, and assess their potential impacts. This is actualized through the development and use of technology scenarios, and allows the designer to determine where to allocate resources for further technology definition and refinement, as well as provide useful design information. The paper particularly discusses the use of technology scenarios and demonstrates their use in the exploration of seven technologies of varying technology readiness levels.

An exploration of small business Website optimization: Enablers, influencers and an assessment approach

The literature reveals a need for more integrated research contributions to small business Internet adoption and theoretical development. There is also a need for these developments to relate more closely to effective, or optimized, use of web applications in business processes and growth. To address this, and building upon recent integrated theoretical developments, the aim of this study is to explore the determinants and outcomes relating to small business Website optimization. Five determining variables isolated from recent theoretical developments relate to small business Website adoption outcomes. Utilizing an optimization rating instrument with these variables a methodological approach produced four key findings. From these findings we develop an optimization model and focus important contributions as propositions. These propositions provide a new understanding of the enablers and influencers of small business Website optimization and a basis for research to develop further insights in this area.

Assessment of the impedance cardiogram recorded by an automated external defibrillator during clinical cardiac arrest

OBJECTIVE: To assess the impedance cardiogram recorded by an automated external defibrillator during cardiac arrest to facilitate emergency care by lay persons. Lay persons are poor at emergency pulse checks (sensitivity 84%, specificity 36%); guidelines recommend they should not be performed. The impedance cardiogram (dZ/dt) is used to indicate stroke volume. Can an impedance cardiogram algorithm in a defibrillator determine rapidly circulatory arrest and facilitate prompt initiation of external cardiac massage?

DESIGN: Clinical study.

SETTING: University hospital.

PATIENTS: Phase 1 patients attended for myocardial perfusion imaging. Phase 2 patients were recruited during cardiac arrest. This group included nonarrest controls.

INTERVENTIONS: The impedance cardiogram was recorded through defibrillator/electrocardiographic pads oriented in the standard cardiac arrest position.

MEASUREMENTS AND MAIN RESULTS: Phase 1: Stroke volumes from gated myocardial perfusion imaging scans were correlated with parameters from the impedance cardiogram system (dZ/dt(max) and the peak amplitude of the Fast Fourier Transform of dZ/dt between 1.5 Hz and 4.5 Hz). Multivariate analysis was performed to fit stroke volumes from gated myocardial perfusion imaging scans with linear and quadratic terms for dZ/dt(max) and the Fast Fourier Transform to identify significant parameters for incorporation into a cardiac arrest diagnostic algorithm. The square of the peak amplitude of the Fast Fourier Transform of dZ/dt was the best predictor of reduction in stroke volumes from gated myocardial perfusion imaging scans (range = 33-85 mL; p = .016). Having established that the two pad impedance cardiogram system could detect differences in stroke volumes from gated myocardial perfusion imaging scans, we assessed its performance in diagnosing cardiac arrest. Phase 2: The impedance cardiogram was recorded in 132 "cardiac arrest" patients (53 training, 79 validation) and 97 controls (47 training, 50 validation): the diagnostic algorithm indicated cardiac arrest with sensitivities and specificities (+/- exact 95% confidence intervals) of 89.1% (85.4-92.1) and 99.6% (99.4-99.7; training) and 81.1% (77.6-84.3) and 97% (96.7-97.4; validation).

CONCLUSIONS: The impedance cardiogram algorithm is a significant marker of circulatory collapse. Automated defibrillators with an integrated impedance cardiogram could improve emergency care by lay persons, enabling rapid and appropriate initiation of external cardiac massage.

A proposed systems approach to the evaluation of integrated palliative care

Background. There is increasing global interest in regional palliative care networks (PCN) to integrate care, creating systems that are more cost-effective and responsive in multi-agency settings. Networks are particularly relevant where different professional skill sets are required to serve the broad spectrum of end-of-life needs. We propose a comprehensive framework for evaluating PCNs, focusing on the nature and extent of inter-professional collaboration, community readiness, and client-centred care. Methods. In the absence of an overarching structure for examining PCNs, a framework was developed based on previous models of health system evaluation, explicit theory, and the research literature relevant to PCN functioning. This research evidence was used to substantiate the choice of model factors. Results. The proposed framework takes a systems approach with system structure, process of care, and patient outcomes levels of consideration. Each factor represented makes an independent contribution to the description and assessment of the network. Conclusions. Realizing palliative patients' needs for complex packages of treatment and social support, in a seamless, cost-effective manner, are major drivers of the impetus for network-integrated care. The framework proposed is a first step to guide evaluation to inform the development of appropriate strategies to further promote collaboration within the PCN and, ultimately, optimal palliative care that meets patients' needs and expectations. © 2010 Bainbridge et al; licensee BioMed Central Ltd.

An Integrated Sensing System for Monitoring the Corrosion Activity in Concrete Blocks Exposed at Hangzhou Bay Bridge

This paper discusses the importance of integrated sensing systems comprising techniques that give different types of data from a structure exposed to the marine environment so that its service life could reliably be predicted. For this purpose, a novel sensor combination was designed and installed in concrete panels which were exposed to Hangzhou Bay Bridge in China. The integrated sensor probe was used to monitor the cover concrete as well as the reinforcement. The sensor probes were connected to a monitoring station, which enabled access and control of the data remotely from Belfast, UK. The initial data obtained from the monitoring station gives interesting information on the early age properties of concrete and distinct variations in these properties with different types of concrete. This paper also reports the variation in electrical properties of different concrete samples and environmental data in response to the marine exposure condition at Hangzhou bay bridge.

Temporary tattoos:a novel OSCE assessment tool

Background: There are many issues regarding the use of real patients in objective structured clinical examinations (OSCEs). In dermatology OSCE stations, standardised patients (SPs) with clinical photographs are often used. Temporary transfer tattoos can potentially simulate skin lesions when applied to an SP. This study aims to appraise the use of temporary malignant melanoma tattoos within an OSCE framework. Method: Within an 11-station OSCE, a temporary malignant melanoma tattoo was developed and applied to SPs in a 'skin lesion' OSCE station. A questionnaire captured the opinions of the candidate, SP and examiners, and the degree of perceived realism of each station was determined. Standard post hoc OSCE analysis determined the psychometric reliability of the stations. Results: The response rates were 95.9 per cent of candidates and 100 per cent of the examiners and SPs. The 'skin lesion' station achieved the highest realism score compared with other stations: 89.0 per cent of candidates felt that the skin lesion appeared realistic; only 28 per cent of candidates had ever seen a melanoma before in training. The psychometric performance of the melanoma station was comparable with, and in many instances better than, other OSCE stations. Discussion: Transfer tattoo technology facilitates a realistic dermatology OSCE station encounter. Temporary tattoos, alongside trained SPs, provide an authentic, standardised and reliable experience, allowing the assessment of integrated dermatology clinical skills.