Factors contributing to fecal incontinence in older people and outcome of routine management in home, hospital and nursing home settings

Objective: Fecal loading, cognitive impairment, loose stools, functional disability, comorbidity and anorectal incontinence are recognized as factors contributing to loss of fecal continence in older adults. The objective of this project was to assess the relative distribution of these factors in a variety of settings along with the outcome of usual management. Methods: One hundred and twenty adults aged 65 years and over with fecal incontinence recruited by convenience sampling from four different settings were studied. They were either living at home or in a nursing home or receiving care on an acute or rehabilitation elderly care ward. A structured questionnaire was used to elicit which factors associated with fecal incontinence were present from subjects who had given written informed consent or for whom assent for inclusion in the study had been obtained. Results: Fecal loading (Homes 6 [20%]; Acute care wards 17 [57%]; Rehabilitation wards 19 [63%]; Nursing homes 21 [70%]) and functional disability (Homes 5 [17%]; Acute care wards 25 [83%]; Rehabilitation wards 25 [83%]; Nursing homes 20 [67%]) were significantly more prevalent in the hospital and nursing home settings than in those living at home (P < 0.01). Loose stools were more prevalent in the hospital setting than in the other settings (Homes 11 [37%]; Acute care wards 20 [67%]; Rehabilitation wards 17 [57%]; Nursing homes 6 [20%]) (P < 0.01). Cognitive impairment was significantly more common in the nursing home than in the other settings (Nursing homes 26 [87%], Homes 5 [17%], Acute care wards 13 [43%], Rehabilitation wards 14 [47%]) (P < 0.01). Loose stools were the most prevalent factor present at baseline in 13 of the 19 (68%) subjects whose fecal incontinence had resolved at 3 months. Conclusion: The distribution of the factors contributing to fecal incontinence in older people living at home differs from those cared for in nursing home and hospital wards settings. These differences need to be borne in mind when assessing people in different settings. Management appears to result in a cure for those who are not significantly disabled with loose stools as a cause for their fecal incontinence, but this would need to be confirmed by further research.

Change management in practice: an ethnographic study of changes to contract requirements on a hospital project

Changes to client requirements are inevitable during construction. Industry discourse is concerned with minimizing and controlling changes. However, accounts of practices involved in making changes are rare. In response to calls for more research into working practices, an ethnographic study of a live hospital project was undertaken to explore how changes are made. A vignette of a meeting exploring the investigation of changes illustrates the issues. This represents an example from the ethnographic fieldwork, which produced many observations. There was a strong emphasis on using change management procedures contained within the contract to investigate changes, even when it was known that the change was not required. For the practitioners, this was a way of demonstrating best practice, transparent and accountable decision-making regarding changes. Hence, concerns for following procedures sometimes overshadowed considerations about whether or not a change was required to improve the functionality of the building. However, the procedures acted as boundary objects between the communities of practice involved on the project by coordinating the work of managing changes. Insights suggest how contract procedures facilitate and impede the making of changes, which can inform policy guidance and contract drafting.

Science-based conservation and management in wetland archaeology: the example of Sutton Common, UK

This paper addresses the perception of different wetlands in and around the Humber estuary in the Bronze Age. Combining past and current research, it will be argued that the perception of intertidal wetlands was nearly diametrically opposed to the perception of riverine floodplains. This contrasting perception is reflected in the material culture of the Bronze Age, and may be explained through the particular manner in which landscapes changed following marine transgressions. This work was largely undertaken within the framework of the Humber Wetlands Survey, an integrated archaeological and palaeoenvironmental research programme funded by English Heritage since 1992

Information and knowledge management in complex systems

16th IFIP WG8.1 International Conference on Informatics and Semiotics in Organisations, ICISO 2015

A sustainable agricultural landscape for Australia: A review of interlacing carbon sequestration, biodiversity and salinity management in agroforestry systems

Transformation of the south-western Australian landscape from deep-rooted woody vegetation systems to shallow-rooted annual cropping systems has resulted in the severe loss of biodiversity and this loss has been exacerbated by rising ground waters that have mobilised stored salts causing extensive dry land salinity. Since the original plant communities were mostly perennial and deep rooted, the model for sustainable agriculture and landscape water management invariably includes deep rooted trees. Commercial forestry is however only economical in higher rainfall (>700 mm yr−1) areas whereas much of the area where biodiversity is threatened has lower rainfall (300–700 mm yr−1). Agroforestry may provide the opportunity to develop new agricultural landscapes that interlace ecosystem services such as carbon mitigation via carbon sequestration and biofuels, biodiversity restoration, watershed management while maintaining food production. Active markets are developing for some of these ecosystem services, however a lack of predictive metrics and the regulatory environment are impeding the adoption of several ecosystem services. Nonetheless, a clear opportunity exists for four major issues – the maintenance of food and fibre production, salinisation, biodiversity decline and climate change mitigation – to be managed at a meaningful scale and a new, sustainable agricultural landscape to be developed.

Customer retention management in the recession

The purpose of this article is to explore customer retention strategies and tactics implemented by firms in recession. Our investigations show just how big a challenge many organizations face in their ability to manage customer retention effectively. While leading organizations have embedded real-time customer life cycle management, developed accurate early warning systems, price elasticity models and ‘deal calculators’, the organizations we spoke to have only gone as far as calculating the value at risk and building simple predictive models.

Human resource allocation management in multiple projects using sociometric techniques

This article describes a new application of key psychological concepts in the area of Sociometry for the selection of workers within organizations in which projects are developed. The project manager can use a new procedure to determine which individuals should be chosen from a given pool of resources and how to combine them into one or several simultaneous groups/projects in order to assure the highest possible overall work efficiency from the standpoint of social interaction. The optimization process was carried out by means of matrix calculations performed using a computer or even manually, and based on a number of new ratios generated ad-hoc and composed on the basis of indices frequently used in Sociometry.

Earnings management in firms seeking to be acquired

Empirical evidence regarding accrual-based earnings management around mergers and acquisitions has been setting-specific as far as target firms are concerned. This might be due to the fact that target firms cannot always anticipate an acquisition proposal, and thus lack the motive and the time necessary to manage their earnings in order to facilitate or impede the deal. In this paper, we provide clear evidence of downward earnings management by a sample of target firms that have both time and motive to engage in such actions. These are firms that publicly announce their intention to be acquired. Publicly ‘seeking a buyer’ represents a rather unusual corporate event, and we find that these firms engage in downward earnings management in the years surrounding the ‘announcement year’. To some extent, this result is explained by overrepresentation of low performance and growth among these firms, and it can be interpreted under alternative explanations. Furthermore, we show that such downward earnings management negatively affects the probability for a ‘seeking buyer’ firm to secure an acquisition within a reasonable amount of time, a possible indication of efficient diligence by prospective buyers having a preference for firms ‘seeking buyer’ with no informationally obscure earnings.