Stress, burnout and coping strategies in the emergency and intensive care hospital departments

Doctors and nurses working at the accident and emergency (A&E), and intensive care departments are at risk of burnout. They often spend substantial time in intense interactions with other people, centered on patients? health problems (physical, psychological and social) that may lead to feelings of anger, anxiety and frustration, and eventually to burnout. Burnout is a syndrome of emotional exhaustion, depersonalization and reduced personal accomplishment (Maslach & Jackson, 1981) The purpose of this chapter is to assess work stressors, burnout and stress-coping mechanisms among doctors and nurses at the A&E and intensive care departments. A quantitative design using the survey approach was used to collect data from a sample of 200 participants with a response rate of 71% (n=154) Work stressors were associated with burnout in both doctors and nurses. Workload was the most salient work stressor in the sample. Nurses experienced more stress (M=1.5, SD=0.4) than doctors (M=1.2, SD=0.4) in all the work stressor variables examined. The A&E department was reported as more stressful than the intensive care department. Avoidance-oriented and task-oriented coping were the most and the least frequently reported coping strategies respectively. Additionally, only emotion-oriented coping strategy was significantly different between doctors and nurses, and this strategy was also significantly positively correlated with all the variables in the adapted nursing stress scale, and the three burnout variables. Death and dying was most strongly correlated with emotion-oriented coping. This chapter provides an assessment of stress, burnout and coping experienced by both doctors and nurses within the A&E and intensive care departments. Methods that may mitigate stress in these environments may be adequate staffing, supportive management, stress management programs, as well as improvement in communication strategies between doctors and nurses.

An operational approach to object-oriented software development

The traditional waterfall software life cycle model has several weaknesses. One problem is that a working version of a system is unavailable until a late stage in the development; any omissions and mistakes in the specification undetected until that stage can be costly to maintain. The operational approach which emphasises the construction of executable specifications can help to remedy this problem. An operational specification may be exercised to generate the behaviours of the specified system, thereby serving as a prototype to facilitate early validation of the system's functional requirements. Recent ideas have centred on using an existing operational method such as JSD in the specification phase of object-oriented development. An explicit transformation phase following specification is necessary in this approach because differences in abstractions between the two domains need to be bridged. This research explores an alternative approach of developing an operational specification method specifically for object-oriented development. By incorporating object-oriented concepts in operational specifications, the specifications have the advantage of directly facilitating implementation in an object-oriented language without requiring further significant transformations. In addition, object-oriented concepts can help the developer manage the complexity of the problem domain specification, whilst providing the user with a specification that closely reflects the real world and so the specification and its execution can be readily understood and validated. A graphical notation has been developed for the specification method which can capture the dynamic properties of an object-oriented system. A tool has also been implemented comprising an editor to facilitate the input of specifications, and an interpreter which can execute the specifications and graphically animate the behaviours of the specified systems.

An aspect-oriented and model-driven approach for managing dynamic variability

Constructing and executing distributed systems that can adapt to their operating context in order to sustain provided services and the service qualities are complex tasks. Managing adaptation of multiple, interacting services is particularly difficult since these services tend to be distributed across the system, interdependent and sometimes tangled with other services. Furthermore, the exponential growth of the number of potential system configurations derived from the variabilities of each service need to be handled. Current practices of writing low-level reconfiguration scripts as part of the system code to handle run time adaptation are both error prone and time consuming and make adaptive systems difficult to validate and evolve. In this paper, we propose to combine model driven and aspect oriented techniques to better cope with the complexities of adaptive systems construction and execution, and to handle the problem of exponential growth of the number of possible configurations. Combining these techniques allows us to use high level domain abstractions, simplify the representation of variants and limit the problem pertaining to the combinatorial explosion of possible configurations. In our approach we also use models at runtime to generate the adaptation logic by comparing the current configuration of the system to a composed model representing the configuration we want to reach. © 2008 Springer-Verlag Berlin Heidelberg.

A generative probabilistic oriented wavelet model for texture segmentation

This Letter addresses image segmentation via a generative model approach. A Bayesian network (BNT) in the space of dyadic wavelet transform coefficients is introduced to model texture images. The model is similar to a Hidden Markov model (HMM), but with non-stationary transitive conditional probability distributions. It is composed of discrete hidden variables and observable Gaussian outputs for wavelet coefficients. In particular, the Gabor wavelet transform is considered. The introduced model is compared with the simplest joint Gaussian probabilistic model for Gabor wavelet coefficients for several textures from the Brodatz album [1]. The comparison is based on cross-validation and includes probabilistic model ensembles instead of single models. In addition, the robustness of the models to cope with additive Gaussian noise is investigated. We further study the feasibility of the introduced generative model for image segmentation in the novelty detection framework [2]. Two examples are considered: (i) sea surface pollution detection from intensity images and (ii) image segmentation of the still images with varying illumination across the scene.

Supporting interoperable interpolation: the INTAMAP approach

In many Environmental Information Systems the actual observations arise from a discrete monitoring network which might be rather heterogeneous in both location and types of measurements made. In this paper we describe the architecture and infrastructure for a system, developed as part of the EU FP6 funded INTAMAP project, to provide a service oriented solution that allows the construction of an interoperable, automatic, interpolation system. This system will be based on the Open Geospatial Consortium’s Web Feature Service (WFS) standard. The essence of our approach is to extend the GML3.1 observation feature to include information about the sensor using SensorML, and to further extend this to incorporate observation error characteristics. Our extended WFS will accept observations, and will store them in a database. The observations will be passed to our R-based interpolation server, which will use a range of methods, including a novel sparse, sequential kriging method (only briefly described here) to produce an internal representation of the interpolated field resulting from the observations currently uploaded to the system. The extended WFS will then accept queries, such as ‘What is the probability distribution of the desired variable at a given point’, ‘What is the mean value over a given region’, or ‘What is the probability of exceeding a certain threshold at a given location’. To support information-rich transfer of complex and uncertain predictions we are developing schema to represent probabilistic results in a GML3.1 (object-property) style. The system will also offer more easily accessible Web Map Service and Web Coverage Service interfaces to allow users to access the system at the level of complexity they require for their specific application. Such a system will offer a very valuable contribution to the next generation of Environmental Information Systems in the context of real time mapping for monitoring and security, particularly for systems that employ a service oriented architecture.

Building a holarchy using business process-oriented holonic (PrOH) modeling

The application of systems thinking to designing, managing, and improving business processes has developed a new "holonic-based" process modeling methodology. The theoretical background and the methodology are described using examples taken from a large organization designing and manufacturing capital goods equipment operating within a complex and dynamic environment. A key point of differentiation attributed to this methodology is that it allows a set of models to be produced without taking a task breakdown approach but instead uses systems thinking and a construct known as the "holon" to build process descriptions as a system of systems (i.e., a holarchy). The process-oriented holonic modeling methodology has been used for total quality management and business process engineering exercises in different industrial sectors and builds models that connect the strategic vision of a company to its operational processes. Exercises have been conducted in response to environmental pressures to make operations align with strategic thinking as well as becoming increasingly agile and efficient. This unique methodology is best applied in environments of high complexity, low volume, and high variety, where repeated learning opportunities are few and far between (e.g., large development projects). © 2007 IEEE.

Data driven graphical applications:a fluid approach

The inclusion of high-level scripting functionality in state-of-the-art rendering APIs indicates a movement toward data-driven methodologies for structuring next generation rendering pipelines. A similar theme can be seen in the use of composition languages to deploy component software using selection and configuration of collaborating component implementations. In this paper we introduce the Fluid framework, which places particular emphasis on the use of high-level data manipulations in order to develop component based software that is flexible, extensible, and expressive. We introduce a data-driven, object oriented programming methodology to component based software development, and demonstrate how a rendering system with a similar focus on abstract manipulations can be incorporated, in order to develop a visualization application for geospatial data. In particular we describe a novel SAS script integration layer that provides access to vertex and fragment programs, producing a very controllable, responsive rendering system. The proposed system is very similar to developments speculatively planned for DirectX 10, but uses open standards and has cross platform applicability. © The Eurographics Association 2007.

A semi-oriented radial measure for measuring the efficiency of decision making units with negative data, using DEA

Data Envelopment Analysis (DEA) is a nonparametric method for measuring the efficiency of a set of decision making units such as firms or public sector agencies, first introduced into the operational research and management science literature by Charnes, Cooper, and Rhodes (CCR) [Charnes, A., Cooper, W.W., Rhodes, E., 1978. Measuring the efficiency of decision making units. European Journal of Operational Research 2, 429–444]. The original DEA models were applicable only to technologies characterized by positive inputs/outputs. In subsequent literature there have been various approaches to enable DEA to deal with negative data. In this paper, we propose a semi-oriented radial measure, which permits the presence of variables which can take both negative and positive values. The model is applied to data on a notional effluent processing system to compare the results with those yielded by two alternative methods for dealing with negative data in DEA: The modified slacks-based model suggested by Sharp et al. [Sharp, J.A., Liu, W.B., Meng, W., 2006. A modified slacks-based measure model for data envelopment analysis with ‘natural’ negative outputs and inputs. Journal of Operational Research Society 57 (11) 1–6] and the range directional model developed by Portela et al. [Portela, M.C.A.S., Thanassoulis, E., Simpson, G., 2004. A directional distance approach to deal with negative data in DEA: An application to bank branches. Journal of Operational Research Society 55 (10) 1111–1121]. A further example explores the advantages of using the new model.

Process integration and improvement using systemic diagrams and a human-centred approach

If product cycle time reduction is the mission, and the multifunctional team is the means of achieving the mission, what then is the modus operandi by which this means is to accomplish its mission? This paper asserts that a preferred modus operandi for the multifunctional team is to adopt a process-oriented view of the manufacturing enterprise, and for this it needs the medium of a process map [16] The substance of this paper is a methodology which enables the creation of such maps Specific examples of process models drawn from the product develop ment life cycle are presented and described in order to support the methodology's integrity and value The specific deliverables we have so far obtained are a methodology for process capture and analysis, a collection of process models spanning the product development cycle, and, an engineering handbook which hosts these models and presents a computer-based means of navigating through these processes in order to allow users a better understanding of the nature of the business, their role in it, and why the job that they do benefits the work of the company We assert that this kind of thinking is the essence of concurrent engineering implementation, and further that the systemigram process models uniquely stim ulate and organise such thinking.

Addressing the project implementation challenges in the Saudi Arabian power supply industry: an investigative approach towards improving project delivery

For many decades, the Kingdom of Saudi Arabia has been widely known for being a reliable oil exporter. This fact, however, has not exempted it from facing significant domestic energy challenges. One of the most pressing of these challenges involves bridging the widening electricity supply-demand gap where, currently, the demand is growing at a very fast rate. One crucial means to address this challenge is through delivering power supply projects with maximum efficiency. Project delivery delay, however, is not uncommon in this highly capital-intensive industry, indicating electricity supplies are not coping with the demand increases. To provide a deeper insight into the challenges of project implementation and efficient practice, this research adopts a pragmatic approach by triangulating literature, questionnaires and semi-structured interviews. The research was conducted in the Saudi Arabian power supply industry – Western Operating Area. A total of 105 usable questionnaires were collected, and 28 recorded, semi-structured interviews were conducted, analysed and synthesised to produce a conceptual model of what constitutes the project implementation challenges in the investigated industry. This was achieved by conducting a comprehensive ranking analysis applied to all 58 identified and surveyed factors which, according to project practitioners in the investigated industry, contribute to project delay. 28 of these project delay factors were selected as the "most important" ones. Factor Analysis was employed to structure these 28 most important project delay factors into the following meaningful set of 7 project implementation challenges: Saudi Electricity Company's contractual commitments, Saudi Electricity Company's communication and coordination effectiveness, contractors' project planning and project control effectiveness, consultant-related aspects, manpower challenges and material uncertainties, Saudi Electricity Company's tendering system, and lack of project requirements clarity. The study has implications for industry policy in that it provides a coherent assessment of the key project stakeholders' central problems. From this analysis, pragmatic recommendations are proposed that, if enacted, will minimise the significance of the identified problems on future project outcomes, thus helping to ensure the electricity supply-demand gap is diminished.

The realisation of JSD specifications in object oriented languages

Jackson System Development (JSD) is an operational software development method which addresses most of the software lifecycle either directly or by providing a framework into which more specialised techniques can fit. The method has two major phases: first an abstract specification is derived that is in principle executable; second the specification is implemented using a variety of transformations. The object oriented paradigm is based on data abstraction and encapsulation coupled to an inheritance architecture that is able to support software reuse. Its claims of improved programmer productivity and easier program maintenance make it an important technology to be considered for building complex software systems. The mapping of JSD specifications into procedural languages typified by Cobol, Ada, etc., involves techniques such as inversion and state vector separation to produce executable systems of acceptable performance. However, at present, no strategy exists to map JSD specifications into object oriented languages. The aim of this research is to investigate the relationship between JSD and the object oriented paradigm, and to identify and implement transformations capable of mapping JSD specifications into an object oriented language typified by Smalltalk-80. The direction which the transformational strategy follows is one whereby the concurrency of a specification is removed. Two approaches implementing inversion - an architectural transformation resulting in a simulated coroutine mechanism being generated - are described in detail. The first approach directly realises inversions by manipulating Smalltalk-80 system contexts. This is possible in Smalltalk-80 because contexts are first class objects and are accessible to the user like any other system object. However, problems associated with this approach are expounded. The second approach realises coroutine-like behaviour in a structure called a `followmap'. A followmap is the results of a transformation on a JSD process in which a collection of followsets is generated. Each followset represents all possible state transitions a process can undergo from the current state of the process. Followsets, together with exploitation of the class/instance mechanism for implementing state vector separation, form the basis for mapping JSD specifications into Smalltalk-80. A tool, which is also built in Smalltalk-80, supports these derived transformations and enables a user to generate Smalltalk-80 prototypes of JSD specifications.

Information management and the holistic, process-oriented enterprise

This research examines the role of the information management process within a process-oriented enterprise, Xerox Ltd. The research approach is based on a post-positive paradigm and has resulted in thirty-five idiographic statements. The three major outcomes are: 1. The process-oriented holistic enterprise is an organisation that requires a long-term management commitment to its development. It depends on the careful management of people, tasks, information and technology. A complex integration of business processes is required and this can be managed through the use of consistent documentation techniques, clarity in the definition of process responsibilities and management attention to the global metrics and the centralisation of the management of the process model are critical to its success. 2. The role of the information management process within the context of a process-oriented enterprise is to provide flexible and cost-effective applications, technological, and process support to the business. This is best achieved through a centralisation of the management of information management and of the process model. A business-led approach combined with the consolidation of applications, information, process, and data architectures is central to providing effective business and process-focused support. 3. In a process oriented holistic enterprise, process and information management are inextricably linked. The model of process management depends heavily on information management, whilst the model of information management is totally focused around supporting and creating the process model. The two models are mutually creating - one cannot exist without the other. There is a duality concept of process and information management.

Person-oriented and process-oriented teachers : an investigation of the links between ESOL teachers' personal belief systems and approaches to teaching

This thesis looks to two traditions in research into language teaching, teacher beliefs and classroom interaction, in order to investigate the question: Do teachers of ESOL have an identifiable and coherent system of beliefs about teaching and learning that may account for different approaches to teaching? A qualitative approach to research is taken, following a case study tradition, in order to carry out an in-depth study into the beliefs of six ESOL teachers. Five teachers participated in an initial pilot study and two subsequently became the main case studies for the research. The beliefs of a sixth teacher were then investigated to verify the findings. Semi-structured interviews and classroom observations were carried out with all the teachers. The teachers in the study were found to have personal belief systems that cohere around two orientations to teaching and learning - a person orientation and a process orientation. Moreover, the findings suggest that underlying the orientations is the perception that teachers have of their teacher identity, in terms of whether this is seen as a separate identity or as part of their personality. It is suggested that the two orientations may offer a powerful tool for teacher education as it is increasingly recognised that, in order to be effective, teacher educators must take into account the beliefs that teachers bring with them to training and development programmes. An initial investigations into the teachers’ classroom behaviour suggests that while their methodologies approach may be very similar there are fundamental differences in their interactions patterns and these differences may be a result of their own orientation. However, while teachers’ personal belief systems undoubtedly underlie their approach to teaching, further research is needed to establish the extent and the nature of the relationship between orientation and classroom interaction.

White identities:a critical sociological approach

The study of white ethnicities is becoming increasingly important in the social sciences. This book provides a critical introduction to the topic. Whiteness has traditionally been seen as "ethnically transparent" - the marker against which other ethnicities are measured. This analysis is clearly incorrect, but only recently have many race and ethnicity scholars moved away from focusing on ethnic minorities and instead oriented their studies around the construction of white identities. Simon Clarke and Steve Garner's book is designed to guide students as they explore how white identities are forged using both sociological and psycho-social ideas. Including an excellent survey of the existing literature and original research from the UK, this book will be an invaluable guide for sociology students taking modules in race and ethnicity. Show More Show Less

Knowledge management in knowledge intensive service networks:a strategic management approach

Purpose – The main purpose of this paper is to analyze knowledge management in service networks. It analyzes the knowledge management process and identifies related challenges. The authors take a strategic management approach instead of a more technology-oriented approach, since it is believed that managerial problems still remain after technological problems are solved. Design/methodology/approach – The paper explores the literature on the topic of knowledge management as well as the resource (or knowledge) based view of the firm. It offers conceptual insights and provides possible solutions for knowledge management problems. Findings – The paper discusses several possible solutions for managing knowledge processes in knowledge-intensive service networks. Solutions for knowledge identification/generation, knowledge application, knowledge combination/transfer and supporting the evolution of tacit network knowledge include personal and technological aspects, as well as organizational and cultural elements. Practical implications – In a complex environment, knowledge management and network management become crucial for business success. It is the task of network management to establish routines, and to build and regularly refresh meta-knowledge about the competencies and abilities that exist within the network. It is suggested that each network partner should be rated according to the contribution to the network knowledge base. Based on this rating, a particular network partner is a member of a certain knowledge club, meaning that the partner has access to a particular level of network knowledge. Such an established routine provides strong incentives to add knowledge to the network's knowledge base Originality/value – This paper is a first attempt to outline the problems of knowledge management in knowledge-intensive service networks and, by so doing, to introduce strategic management reasoning to the discussion.