Costs of managing urinary and faecal incontinence in a sub-acute care facility: A "bottom-up" approach

Aims: To measure accurately the direct costs of managing urinary and faecal incontinence in the sub-acute care setting. Materials and Methods: Prospective observational study was undertaken in two sub-acute care units in a metropolitan hospital. A consecutive series of 29 consecutive patients with urinary and/or faecal incontinence, who were in-patients in a geriatric rehabilitation or subacute neurologic unit underwent routine timed voiding protocol, as per usual care. Face-to-face bedside recordings of all incontinence care, with detailed cost analysis, were undertaken. Results: A total of 3,621 occasions of continence care were costed. The median time per 24 hr spent caring for incontinence per patient was 109 min (interquartile range 88-140). Isolated urinary incontinence episodes occurred in 28 patients (96.5%), mixed urinary/faecal incontinence episodes observed in 79.3%, and episodes of pure faecal incontinence were seen in 62%. The median costs of incontinence care in the sub-acute setting was $49AU per 24 hr, the major share ($41) spent on staff wages. The incontinence tasks of toileting assistance, pad changes, bed changes and catheter care were spread evenly across the three 8 hr shifts of duty. Conclusions: As our population demographics include an increasingly greater portion of the elderly, for whom long term institutional care is becoming relatively more scarce, provision of care in the sub-acute unit that may allow rehabilitation and return to home warrants scrutiny. This is the first study that delineates the costs of managing urinary and faecal incontinence in the sub-acute care setting. Such costs are substantial and place a heavy burden upon night-time carets. (C) 2004 Wiley-Liss, Inc.

Surveillance as a technique of power in physical education

This paper analyses surveillance as a technique of power in the culture of physical education, including its impact upon the health of teachers. Additionally, gendered aspects of surveillance are investigated because physical education is an important location in and through which bodies are inscribed with gendered identities. The embodied nature of physical educators' work renders the body as particularly significant in patterns of privilege and domination. The research was guided by Michel Foucault's work and poststructural feminist perspectives on the importance of power in social life. At nine schools across two international research sites, the functioning of surveillance was evidenced through the multi-directional workings of power in top-down, lateral, and bottom-up configurations. Data indicated that surveillance occurred on, through and about bodies. It had a strong gender dimension as the male gaze inscribed both female teachers' and students' bodies with value and competence. In terms of teachers' health, as well as responses to surveillance on a physical and emotional level, the workings of power were also influential in shaping teachers' identities.

Confirmation: Increasing resource availability for transactional workflows

The notion of compensation is widely used in advanced transaction models as means of recovery from a failure. Similar concepts are adopted for providing transaction-like behaviour for long business processes supported by workflows technology. In general, it is not trivial to design compensating tasks for tasks in the context of a workflow. Actually, a task in a workflow process does not have to be compensatable in the sense that the forcibility of reverse operations of the task is not always guaranteed by the application semantics. In addition, the isolation requirement on data resources may make a task difficult to compensate. In this paper, we first look into the requirements that a compensating task has to satisfy. Then we introduce a new concept called confirmation. With the help of confirmation, we are able to modify most non-compensatable tasks so that they become compensatable. This can substantially increase the availability of shared resources and greatly improve backward recovery for workflow applications in case of failures. To effectively incorporate confirmation and compensation into a workflow management environment, a three level bottom-up workflow design method is introduced. The implementation issues of this design are also discussed. (C) 2003 Elsevier Science Inc. All rights reserved.

Progress in silicon-based quantum computation

We review progress at the Australian Centre for Quantum Computer Technology towards the fabrication and demonstration of spin qubits and charge qubits based on phosphorus donor atoms embedded in intrinsic silicon. Fabrication is being pursued via two complementary pathways: a 'top-down' approach for near-term production of few-qubit demonstration devices and a 'bottom-up' approach for large-scale qubit arrays with sub-nanometre precision. The 'top-down' approach employs a low-energy (keV) ion beam to implant the phosphorus atoms. Single-atom control during implantation is achieved by monitoring on-chip detector electrodes, integrated within the device structure. In contrast, the 'bottom-up' approach uses scanning tunnelling microscope lithography and epitaxial silicon overgrowth to construct devices at an atomic scale. In both cases, surface electrodes control the qubit using voltage pulses, and dual single-electron transistors operating near the quantum limit provide fast read-out with spurious-signal rejection.

A framework of lessons learned from community-based marine reserves and its effectiveness in guiding a new coastal management initiative in the Philippines

Community-based coastal resource management has been widely applied within the Philippines. However, small-scale community-based reserves are often inefficient owing to management inadequacies arising because of a lack of local support or enforcement or poor design. Because there are many potential pitfalls during the establishment of even small community-based reserves, it is important for coastal managers, communities, and facilitating institutions to have access to a summary of the key factors for success. Reviewing relevant literature, we present a framework of lessons learned during the establishment of protected areas, mainly in the Philippines. The framework contains summary guidance on the importance of (1) an island location, (2) small community population size, (3) minimal effect of land-based development, (4) application of a bottom-up approach, (5) an external facilitating institution, (6) acquisition of title, (7) use of a scientific information database, (8) stakeholder involvement, (9) the establishment of legislation, (10) community empowerment, (11) alternative livelihood schemes, (12) surveillance, (13) tangible management results, (14) continued involvement of external groups after reserve establishment, and (15) small-scale project expansion. These framework components guided the establishment of a community-based protected area at Danjugan Island, Negros Occidental, Philippines. This case study showed that the framework was a useful guide that led to establishing and implementing a community-based marine reserve. Evaluation of the reserve using standard criteria developed for the Philippines shows that the Danjugan Island protected area can be considered successful and sustainable. At Danjugan Island, all of the lessons synthesized in the framework were important and should be considered elsewhere, even for relatively small projects. As shown in previous projects in the Philippines, local involvement and stewardship of the protected area appeared particularly important for its successful implementation. The involvement of external organizations also seemed to have a key role in the success of the Danjugan Island project by guiding local decision-makers in the sociobiological principles of establishing protected areas. However, the relative importance of each component of the framework will vary between coastal management initiatives both within the Philippines and across the wider Asian region.

Climate change and marine plankton

Understanding how climate change will affect the planet is a key issue worldwide. Questions concerning the pace and impacts of climate change are thus central to many ecological and biogeochemical studies, and addressing the consequences of climate change is now high on the list of priorities for funding agencies. Here, we review the interactions between climate change and plankton communities, focusing on systematic changes in plankton community structure, abundance, distribution and phenology over recent decades. We examine the potential socioeconomic impacts of these plankton changes, such as the effects of bottom-up forcing on commercially exploited fish stocks (i.e. plankton as food for fish). We also consider the crucial roles that plankton might have in dictating the future pace of climate change via feedback mechanisms responding to elevated atmospheric CO2 levels. An important message emerges from this review: ongoing plankton monitoring programmes worldwide will act as sentinels to identify future changes in marine ecosystems.

A study of the lagged relationships among safety climate, safety motivation, safety behavior, and accidents at the individual and group levels

The authors measured perceptions of safety climate, motivation, and behavior at 2 time points and linked them to prior and subsequent levels of accidents over a 5-year period. A series of analyses examined the effects of top-down and bottom-up processes operating simultaneously over time. In terms of top-down effects, average levels of safety climate within groups at I point in time predicted subsequent changes in individual safety motivation. Individual safety motivation, in turn, was associated with subsequent changes in self-reported safety behavior. In terms of bottom-up effects, improvements in the average level of safety behavior within groups were associated with a subsequent reduction in accidents at the group level. The results contribute to an understanding of the factors influencing workplace safety and the levels and lags at which these effects operate.

Toy model for a relational formulation of quantum theory

In the absence of an external frame of reference-i.e., in background independent theories such as general relativity-physical degrees of freedom must describe relations between systems. Using a simple model, we investigate how such a relational quantum theory naturally arises by promoting reference systems to the status of dynamical entities. Our goal is twofold. First, we demonstrate using elementary quantum theory how any quantum mechanical experiment admits a purely relational description at a fundamental. Second, we describe how the original non-relational theory approximately emerges from the fully relational theory when reference systems become semi-classical. Our technique is motivated by a Bayesian approach to quantum mechanics, and relies on the noiseless subsystem method of quantum information science used to protect quantum states against undesired noise. The relational theory naturally predicts a fundamental decoherence mechanism, so an arrow of time emerges from a time-symmetric theory. Moreover, our model circumvents the problem of the collapse of the wave packet as the probability interpretation is only ever applied to diagonal density operators. Finally, the physical states of the relational theory can be described in terms of spin networks introduced by Penrose as a combinatorial description of geometry, and widely studied in the loop formulation of quantum gravity. Thus, our simple bottom-up approach (starting from the semiclassical limit to derive the fully relational quantum theory) may offer interesting insights on the low energy limit of quantum gravity.

Managing knowledge in tourism planning: How to assess your capability

This paper explores the theme of strategic planning in a State Tourism Organization (STO) from a knowledge management perspective. It highlights the value of knowledge in strategy making and the importance of an organisation's knowledge management agenda in facilitating a strategic planning process. In particular, it considers the capability of an STO to implement knowledge management as the key to a successful strategic planning exercise. In order to develop greater insight into the factors that impact on planning competence, the key aim of this paper is to develop a framework on which the capability of a STO to implement a knowledge-based agenda in strategic planning can be assessed. Research on knowledge management in the field of tourism is limited and there is little practical account of the application of knowledge management principles in tourism planning. Further, there is no apparent tool or instrument that allows for the assessment of an STO's capability to implement knowledge management in planning initiatives. Based on a literature review, a three-point framework of assessment is developed. The three elements of the framework are identified as: 1. Integration of knowledge management objectives with strategic imperatives; 2. A planning approach that balances top-down (outcome focused) with bottom-up (process focused) planning processes; and 3. Organisational capacity, including leadership, people and culture, process, technology, content and continuous improvement. The framework is tested through application to a practical case study - a planning initiative undertaken by a leading tourism STO in Australia. The results demonstrate that the framework is a useful means to evaluate organisational capability in knowledge-led strategic planning exercises and would be of practical value as a point of reference for future knowledge- based strategic planning projects. Copyright © by The Haworth Press, Inc. All rights reserved.

Developing a research framework for understanding the social realities, with special reference to Sri Lankan entrepreneurs

This paper identifies and examines issues of relevance for increasing effectiveness of entrepreneurial management research. These issues emerged from research into entrepreneurial behaviour and underlying motivations in Sri Lanka. Understanding of socially- and culturally-bound social actors, social actions and social outputs in entrepreneurial activity requires context-sensitivity, expressed through cognisance of institutional characteristics, the interface between cultural values and business, and historical and cultural forces which impact on entrepreneurship. We suggest that this requires exploration through bottom-up translations of actions consistent with the beliefs and values of the actors involved, employing qualitative methodology to ground the reality of human behaviour in deep-rooted cultural and social contexts. Thorough interpretation of holistic case studies that are capable of capturing the actors' viewpoints brings appropriate insights to the field of entrepreneurship.

Building Community Coalitions for the Promotion of Physical Activity: 10,000 Steps Rockhampton

The 10,000 Steps Rockhampton project is a multi-strategy community-wide, physical activity intervention based on the simultaneous implementation of five strategies, each identified as 'best practice' for the promotion of physical activity. Several community partners were engaged to develop and implement the strategies during the first eighteen months of the project. These included: the local media (TV, newspaper and radio); the local Division of General Practice and other health professional groups; the Heart Foundation and ‘Just Walk It’; the local council; and several large worksites. A local physical activity task force was also formed to administer a 'micro-grants' scheme, and to guide the development of community based strategies. The presentation will focus on the critical elements involved in developing and maintaining relationships with community partners. These include identification and ‘courting’ of potential partners, strategies for keeping them engaged, and the challenges of maintaining the balance between ‘top-down’ (evidence-based) and ‘bottom-up’ (community-driven) strategies. Data on implementation and uptake of the key strategies will also be presented. These include: 1) process data on the number of health