Improving the management of behaviour that challenges associated with dementia in care homes:protocol for pharmacy-health psychology intervention feasibility study

INTRODUCTION: The inappropriate use of antipsychotics in people with dementia for behaviour that challenges is associated with an estimated 1800 deaths annually. However, solely focusing on antipsychotics may transfer prescribing to other equally dangerous psychotropics. Little is known about the role of pharmacists in the management of psychotropics used to treat behaviours that challenge. This research aims to determine whether it is feasible to implement and measure the effectiveness of a combined pharmacy-health psychology intervention incorporating a medication review and staff training package to limit the prescription of psychotropics to manage behaviour that challenges in care home residents with dementia. METHODS/ANALYSIS: 6 care homes within the West Midlands will be recruited. People with dementia receiving medication for behaviour that challenges, or their personal consultee, will be approached regarding participation. Medication used to treat behaviour that challenges will be reviewed by the pharmacist, in collaboration with the general practitioner (GP), person with dementia and carer. The behavioural intervention consists of a training package for care home staff and GPs promoting person-centred care and treating behaviours that challenge as an expression of unmet need. The primary outcome measure is the Neuropsychiatric Inventory-Nursing Home version (NPI-NH). Other outcomes include quality of life (EQ-5D and DEMQoL), cognition (sMMSE), health economic (CSRI) and prescribed medication including whether recommendations were implemented. Outcome data will be collected at 6 weeks, and 3 and 6 months. Pretraining and post-training interviews will explore stakeholders' expectations and experiences of the intervention. Data will be used to estimate the sample size for a definitive study. ETHICS/DISSEMINATION: The project has received a favourable opinion from the East Midlands REC (15/EM/3014). If potential participants lack capacity, a personal consultee will be consulted regarding participation in line with the Mental Capacity Act. Results will be published in peer-reviewed journals and presented at conferences.

User-centred ontology learning for knowledge management

Automatic ontology building is a vital issue in many fields where they are currently built manually. This paper presents a user-centred methodology for ontology construction based on the use of Machine Learning and Natural Language Processing. In our approach, the user selects a corpus of texts and sketches a preliminary ontology (or selects an existing one) for a domain with a preliminary vocabulary associated to the elements in the ontology (lexicalisations). Examples of sentences involving such lexicalisation (e.g. ISA relation) in the corpus are automatically retrieved by the system. Retrieved examples are validated by the user and used by an adaptive Information Extraction system to generate patterns that discover other lexicalisations of the same objects in the ontology, possibly identifying new concepts or relations. New instances are added to the existing ontology or used to tune it. This process is repeated until a satisfactory ontology is obtained. The methodology largely automates the ontology construction process and the output is an ontology with an associated trained leaner to be used for further ontology modifications.

Inventory parameter management and focused continuous improvement for repetitive batch manufacturers

What this thesis proposes is a methodology to assist repetitive batch manufacturers in the adoption of certain aspects of the Lean Production principles. The methodology concentrates on the reduction of inventory through the setting of appropriate batch sizes, taking account of the effect of sequence dependent set-ups and the identification and elimination of bottlenecks. It uses a simple Pareto and modified EBQ based analysis technique to allocate items to period order day classes based on a combination of each item's annual usage value and set-up cost. The period order day classes the items are allocated to are determined by the constraints limits in the three measured dimensions, capacity, administration and finance. The methodology overcomes the limitations associated with MRP in the area of sequence dependent set-ups, and provides a simple way of setting planning parameters taking this effect into account by concentrating on the reduction of inventory through the systematic identification and elimination of bottlenecks through set-up reduction processes, so allowing batch sizes to reduce. It aims to help traditional repetitive batch manufacturers in a route to continual improvement by: Highlighting those areas where change would bring the greatest benefits. Modelling the effect of proposed changes. Quantifying the benefits that could be gained through implementing the proposed changes. Simplifying the effort required to perform the modelling process. It concentrates on increasing flexibility through managed inventory reduction through rationally decreasing batch sizes, taking account of sequence dependent set-ups and the identification and elimination of bottlenecks. This was achieved through the development of a software modelling tool, and validated through a case study approach.

Knowledge management applied to enterprise risk management

Risk and knowledge are two concepts and components of business management which have so far been studied almost independently. This is especially true where risk management (RM) is conceived mainly in financial terms, as for example, in the financial institutions sector. Financial institutions are affected by internal and external changes with the consequent accommodation to new business models, new regulations and new global competition that includes new big players. These changes induce financial institutions to develop different methodologies for managing risk, such as the enterprise risk management (ERM) approach, in order to adopt a holistic view of risk management and, consequently, to deal with different types of risk, levels of risk appetite, and policies in risk management. However, the methodologies for analysing risk do not explicitly include knowledge management (KM). This research examines the potential relationships between KM and two RM concepts: perceived quality of risk control and perceived value of ERM. To fulfill the objective of identifying how KM concepts can have a positive influence on some RM concepts, a literature review of KM and its processes and RM and its processes was performed. From this literature review eight hypotheses were analysed using a classification into people, process and technology variables. The data for this research was gathered from a survey applied to risk management employees in financial institutions and 121 answers were analysed. The analysis of the data was based on multivariate techniques, more specifically stepwise regression analysis. The results showed that the perceived quality of risk control is significantly associated with the variables: perceived quality of risk knowledge sharing, perceived quality of communication among people, web channel functionality, and risk management information system functionality. However, the relationships of the KM variables to the perceived value of ERM are not identified because of the low performance of the models describing these relationships. The analysis reveals important insights into the potential KM support to RM such as: the better adoption of KM people and technology actions, the better the perceived quality of risk control. Equally, the results suggest that the quality of risk control and the benefits of ERM follow different patterns given that there is no correlation between both concepts and the distinct influence of the KM variables in each concept. The ERM scenario is different from that of risk control because ERM, as an answer to RM failures and adaptation to new regulation in financial institutions, has led organizations to adopt new processes, technologies, and governance models. Thus, the search for factors influencing the perceived value of ERM implementation needs additional analysis because what is improved in RM processes individually is not having the same effect on the perceived value of ERM. Based on these model results and the literature review the basis of the ERKMAS (Enterprise Risk Knowledge Management System) is presented.

Perceptions of earnings management:the effect of national culture

Manipulating, or "managing," reported earnings is a temptation faced by every accountant and corporation around the world. This study investigates whether national culture influences perceptions of the acceptability of earnings management. Participants from eight countries evaluated 13 vignettes describing various earnings management practices (Merchant & Rockness, 1994). Our results demonstrate considerable variation in perceptions across nations to the earnings management scenarios, providing strong evidence that the practice of earnings management was not perceived similarly in all countries. Using Hofstede’s (1991) cultural indices, we find that the differences in aggregate perceptions across countries were not closely associated with any of the cultural dimensions examined. We do, however, find that perceptions of earnings manipulations involving the timing of operating decisions were associated with both the Power Distance Index and the Masculinity Index.

Human resource management in foreign-owned subsidiaries:China versus India

This study examines the HRM practices and the role played by the HR department in foreign-owned units located in China and India. The study of 170 Western-owned subsidiaries analyses the extent to which the HRM practices associated with the local professionals and managerial-level employees resemble those of local firms versus those of the (main) Western parent organization, and investigates the degree to which the unit's HR department was perceived to play a strategic role. The results indicate clear differences between HRM characteristics in Western-owned units in China and India, and suggest that the use of expatriates and the background of the HR managers are important determinants of subsidiary HRM.

When in Rome ... ?:Human resource management and the performance of foreign firms operating in India

Purpose: The purpose of the paper is to examine the kind of HRM practices being implemented by overseas firms in their Indian subsidiaries and also to analyze the linkage between HRM practices and organizational performance. Design/methodology/approach: The paper utilizes a mixture of both quantitative and qualitative techniques via personal interviews in 76 subsidiaries. Findings: The results show that while the introduction of HRM practices from the foreign parent organization is negatively associated with performance, local adaption of HRM practices is positively related with the performance of foreign firms operating in India. Research limitations/implications: The main limitations include data being collected by only one respondent from each firm, and the relatively small sample size. Practical implications: The key message for practitioners is that HRM systems do improve organizational performance in the Indian subsidiaries of foreign firms, and an emphasis on the localization of HRM practices can further contribute in this regard. Originality/value: This is perhaps the very first investigation of its kind in the Indian context. © Emerald Group Publishing Limited.

An integrative framework for determining cross-national human resource management practices

Currently, debate in the area of cross-national human resource management (HRM) suggests that both “culture-bound” and “culture-free” factors and variables are important determinants of HRM policies and practices. HRM is presented as being context-specific and it is argued that with the growth of new markets world-wide, and increased levels of competition and globalization of business, there is a strong need for more cross-national HRM studies. However, the literature shows the absence of an integrated framework, which can help to highlight the different role that context-specific facets of HRM practices play. The nature of different determinants in different national and regional settings is rarely analyzed. This paper develops an integrated framework. It delineates the main distinctive facets associated with national factors, contingent variables, and organizational and human resource (HR) strategies and policies, that may be used to evaluate cross-national comparative HRM policies and practices.

Career management practices in India:an empirical study

This paper examines and discusses the developments in the field of career management, bringing in the international perspective. In particular, the paper explores career management practices in 108 Indian organizations. A factor analysis procedure suggested five groups of practices: formal planning, formal active management, developmental, career stages and assessment. These are found to be associated with certain organizational and cultural characteristics. The research has both theoretical and practical implications.

Knowledge management in a New Zealand tree farming company:Ambiguity and resistance to the "technology solution"

Purpose - Managers at the company attempt to implement a knowledge management information system in an attempt to avoid loss of expertise while improving control and efficiency. The paper seeks to explore the implications of the technological solution to employees within the company. Design/methodology/approach - The paper reports qualitative research conducted in a single organization. Evidence is presented in the form of interview extracts. Findings - The case section of the paper presents the accounts of organizational participants. The accounts reveal the workers' reactions to the technology-based system and something of their strategies of resistance to the system. These accounts also provide glimpses of the identity construction engaged in by these knowledge workers. The setting for the research is in a knowledge-intensive primary industry. Research was conducted through observation and interviews. Research limitations/implications - The issues identified are explored in a single case-study setting. Future research could look at the relevance of the findings to other settings. Practical implications - The case evidence presented indicates some of the complexity of implementation of information systems in organizations. This could certainly be seen as more evidence of the uncertainty associated with organizational change and of the need for managers not to expect an easy adoption of intrusive IT solutions. Originality/value - This paper adds empirical insight to a largely conceptual literature. © Emerald Group Publishing Limited.

Brilliant mistake! Essays on incidents of management mistakes and mea culpa

Purpose – The purpose of this paper is to examine students’ perceptions of managerial mistakes and why (and why not) managers admit mistakes. Design/methodology/approach – This paper provides a reflective account of how students’ perceive management mistakes and deal with admitting “mea culpa” – “I am to blame”. Findings – The findings show a range of attitudes: they highlight the intermingling pressures associated with the cultural environment and mistakes; they identify media characteristics and its influences on mistakes and mea culpa; they highlight ceremonial processes and tasks that shape and influence the declaration of mea culpa; and they identify how the psychology and sociology of mistakes confronts and affects students. Taken together, the study highlights the varying degrees of wariness that is carried forward by the students from vicariously learning about management mistakes. Originality/value – This paper links up with recent discussions on retail failure and retail pedagogy. It is hoped that this paper will encourage more academics to address, and engage with, management mistakes creatively in their teaching.

Being female doing gender:narratives of women in education management

The paper explores gender relations in academia and discusses how gender is constructed within academic institutions. It is based upon the study of a business school, part of a British university. The construction of gender relations within this institution was of special interest because the majority of managerial roles were occupied by women. All female academic managers (dean, associate deans and heads of department) and a random selection of female and male academics were interviewed. The process of construction of gender relations is investigated through the analysis of the discrepancy between the ‘masculine culture’ of high education institutions and the dominance of women managers within this organization. It is suggested that the numerical dominance of women managers may create tensions between their individual identities as women and their managerial identities, due to the predominance of masculine practices and values within the organization. Additionally, it emerged that the maintenance of masculine ideals and practices is also associated with downplaying women’s achievements.

The Proinflammatory Environment in Potential Heart and Lung Donors: Prevalence and Impact of Donor Management and Hormonal Therapy

BACKGROUND: Brain stem death can elicit a potentially manipulable cardiotoxic proinflammatory cytokine response. We investigated the prevalence of this response, the impact of donor management with tri-iodothyronine (T3) and methylprednisolone (MP) administration, and the relationship of biomarkers to organ function and transplant suitability. METHODS: In a prospective randomized double-blinded factorially designed study of T3 and MP therapy, we measured serum levels of interleukin-1 and -6 (IL-1 and IL-6), tumor necrosis factor-alpha (TNF-alpha), C-reactive protein, and procalcitonin (PCT) levels in 79 potential heart or lung donors. Measurements were performed before and after 4 hr of algorithm-based donor management to optimize cardiorespiratory function and +/-hormone treatment. Donors were assigned to receive T3, MP, both drugs, or placebo. RESULTS: Initial IL-1 was elevated in 16% donors, IL-6 in 100%, TNF-alpha in 28%, CRP in 98%, and PCT in 87%. Overall biomarker concentrations did not change between initial and later measurements and neither T3 nor MP effected any change. Both PCT (P =0.02) and TNF-alpha (P =0.044) levels were higher in donor hearts with marginal hemodynamics at initial assessment. Higher PCT levels were related to worse cardiac index and right and left ventricular ejection fractions and a PCT level more than 2 ng x mL(-1) may attenuate any improvement in cardiac index gained by donor management. No differences were observed between initially marginal and nonmarginal donor lungs. A PCT level less than or equal to 2 ng x mL(-1) but not other biomarkers predicted transplant suitability following management. CONCLUSIONS: There is high prevalence of a proinflammatory environment in the organ donor that is not affected by tri-iodothyronine or MP therapy. High PCT and TNF-alpha levels are associated with donor heart dysfunction. (C) 2009 Lippincott Williams & Wilkins, Inc.

Establishing a framework for dynamic risk management in 'intelligent' aero-engine control

The behaviour of control functions in safety critical software systems is typically bounded to prevent the occurrence of known system level hazards. These bounds are typically derived through safety analyses and can be implemented through the use of necessary design features. However, the unpredictability of real world problems can result in changes in the operating context that may invalidate the behavioural bounds themselves, for example, unexpected hazardous operating contexts as a result of failures or degradation. For highly complex problems it may be infeasible to determine the precise desired behavioural bounds of a function that addresses or minimises risk for hazardous operation cases prior to deployment. This paper presents an overview of the safety challenges associated with such a problem and how such problems might be addressed. A self-management framework is proposed that performs on-line risk management. The features of the framework are shown in context of employing intelligent adaptive controllers operating within complex and highly dynamic problem domains such as Gas-Turbine Aero Engine control. Safety assurance arguments enabled by the framework necessary for certification are also outlined.

Plant ecology of lowland Alnus Glutinosa woodlands:The management implications of species composition, requirements and distribution

Wet woodlands have been recognised as a priority habitat and have featured in the UK BAP since 1994. Although this has been acknowledged in a number of UK policies and guidelines, there is little information relating to their detailed ecology and management. This research, focusing on lowland Alnus glutinosa woodlands, aimed to address this data paucity through the analysis of species requirements and to develop a methodology to guide appropriate management for this habitat for the benefit of wildlife. To achieve these aims data were collected from 64 lowland Alnus glutinosa woodlands and a review of the literature was undertaken to identify species associated with the target habitat. The groundflora species found to be associated with lowland Alnus glutinosa woodland were assessed in relation to their optimal environmental conditions (Ellenberg indicator values) and survival strategies (Grime CSR-Strategy) to determine the characteristics (Characters of a Habitat; CoaHs) and range of intra-site conditions (Niches of a Habitat; NoaH). The methodologies, using CSR and Ellenberg indicator values in combination, were developed to determine NoaHs and were tested both quantitatively and qualitatively at different lowland Alnus glutinosa sites. The existence of CoaHs and NoaHs in actual sites was verified by detailed quadrat data gathered at three Alnus glutinosa woodlands at Stonebridge Meadows, Warwickshire, UK and analysed using TWINSPAN and DCA ordination. The CoaHs and NoaHs and their component species were confirmed to have the potential to occur in a particular woodland. Following a literature search relating to the management of small wet woodlands within the UK, in conjunction with the current research, broad principles and strategies were identified for the management of lowland Alnus glutinosa woodland. Using the groundflora composition, an innovative procedure is developed and described for identifying the potential variation within a particular site and determining its appropriate management. Case studies were undertaken on distinct woodlands and the methodology proved effective.