A pragmatic 2 × 2 × 2 factorial cluster randomized controlled trial of educational outreach visiting and case conferencing in palliative care—methodology of the Palliative Care Trial [ISRCTN 81117481]

The demand for palliative care is increasing, yet there are few data on the best models of care nor well-validated interventions that translate current evidence into clinical practice. Supporting multidisciplinary patient-centered palliative care while successfully conducting a large clinical trial is a challenge. The Palliative Care Trial (PCT) is a pragmatic 2 x 2 x 2 factorial cluster randomized controlled trial that tests the ability of educational outreach visiting and case conferencing to improve patient-based outcomes such as performance status and pain intensity. Four hundred sixty-one consenting patients and their general practitioners (GPs) were randomized to the following: (1) GP educational outreach visiting versus usual care, (2) Structured patient and caregiver educational outreach visiting versus usual care and (3) A coordinated palliative care model of case conferencing versus the standard model of palliative care in Adelaide, South Australia (3:1 randomization). Main outcome measures included patient functional status over time, pain intensity, and resource utilization. Participants were followed longitudinally until death or November 30, 2004. The interventions are aimed at translating current evidence into clinical practice and there was particular attention in the trial's design to addressing common pitfalls for clinical studies in palliative care. Given the need for evidence about optimal interventions and service delivery models that improve the care of people with life-limiting illness, the results of this rigorous, high quality clinical trial will inform practice. Initial results are expected in mid 2005. (c) 2005 Elsevier Inc. All rights reserved.

Technology transfer and Chinese government policy:opportunities and implications for business

State-owned enterprises in China have been given greater autonomy and responsibility, have freer access to foreign technology, and are being encouraged to form groups to gain from rationalization and integration. This article uses case studies to identify the key strategic issues that affect the commercial viability of foreign technology acquisition by state-owned enterprises within the context of enterprise reforms. All the case study enterprises used technology transfer to develop new or improved products. Technologies acquired as parts of subcontracting arrangements and well-established technologies to produce end-use products are easier to manage and operate profitably. However, the latter type of technology has been imported by numerous enterprises and has led to fierce competition and industy restructuring. Importing capital-intensive and complex technology to produce major components for products, such as cars, is more difficult and requires closer coordination with customers and suppliers.

The planning and management of health for development:a model for Zimbabwe

In this thesis, I view the historical background of Zimbabwe to show the patterns of traditional life that existed prior to settlerism. The form, nature, pace and impact of settlerism and colonialism up to the time of independence are also discussed to show how they affected the health of the population and the pace of development of the country. The political, social and economic underdevelopment of the African people that occurred in Zimbabwe prior to independence was a result of deliberate, politically motivated and controlled policy initiatives. These led to inequatable, inadequate, inappropriate and inaccessible health care provision. It is submitted that since it was the politics that determined the pace of underdevelopment, it must be the politics that must be at the forefront of the development strategy adopted. In the face of the amed conflict that existed in Zimbabwe, existing frameworks of analyses are shown to be inadequate for planning purposes because of their inability to provide indications about the stability of future outcomes. The Metagame technique of analysis of options is proposed as a methology that can be applied in such situations. It rejects deterministic predicative models as misleading and advocates an interactive model based on objective and subjective valuation of human behaviour. In conclusion, the search for stable outcomes rather than optimal and best solutions strategies is advocated in decision making in organisations of all sizes.

Acquisition and management of technology in Malaysian companies

This thesis is about the acquisition and diffusion of imported technology. Writers in the field of technology development in developing countries have always recognised that technical progress depends on the diffusion of imported technology and its applications to the provision of products and processes (Rosemberg, 1982). Despite the massive importation of technology by Malaysian companies, little effort has been made to study and understand the diffusion system in local companies. This study analyses: The problems associated with the acquisition of technology, highlighting the technology strategies adopted by the suppliers of technology; the diffusion pattern and key characteristics of the diffusion process; and major factors affecting the diffusion of technology. The policy implications are examined and the framework to manage the diffusion process within the enterprises is suggested. The findings indicated that the diffusion process is not one of passive acceptance but involves systematic efforts to acquire and diffuse the imported technology. A strong system of diffusion in companies had enabled a rapid diffusion of imported technology resulting in higher levels of technical capability. On the other hand, weakness in the company's diffusion system led to limited diffusion and slow technical progress. Characteristics of diffusion system are analysed and discussed extensively. The thesis attempts to develop the idea of `in-house system of diffusion' associated with the acquisition and development of imported technology. It argues for the development ofa stronger theoretical framework on the diffusion and development of technology particularly in countries like Malaysia which relies extensively on the importation of foreign technology.

Budgeting, budgetary control and management information in the highways departments

The need for an adequate information system for the Highways Departments in the United Kingdom has been recognised by the report of a committee presented to the Minister of Transport in 1970, (The Marshall Report). This research aims to present a comprehensive information system on a sound theoretical basis which should enable the different levels of management to execute their work adequately. The suggested system presented in this research covers the different functions of the Highways Department, and presents a suggested solution for problems which may occur during the planning and controlling of work in the different locations of the Highways Department. The information system consists of:- 1. A coding system covering the cost units, cost centres and cost elements. 2. Cost accounting records for the cost units and cost centres. 3. A budgeting and budgetary control system covering, the different planning methods and procedures which are required for preparing the capital expenditure budget, the improvement and maintenance operation flexible budgets and programme of work, the plant budget, the administration budget, and the purchasing budget. 4. A reporting system which ensures that the different levels of management are receiving relevant and timely information. 5. The flow of documents which covers the relationship between the prime documents, the cost accounting records, budgets, reports and their relation to the different sections and offices within the department. A comprehensive cost units, cost centres, and cost elements codes together with a number of examples demonstrating the results of the survey, and examples of the application and procedures of the suggested information system have been illustrated separately as appendices. The emphasis is on the information required for internal control by management personnel within the County Council.

Time for action? Elementary engineering education - Challenging teachers, policy makers and parents

Grounded in the findings of a three year exploratory student whereby teachers' and policy makers' perceptions of elementary level engineering education were analysed, this paper focuses upon three strands of engineering education activity: Pedagogy: Practice, and: Policy. Taking into account the challenges associated with introducing engineering education at an elementary level across the UK, the paper critiques the role played by the 'competition model' in promoting engineering to children and 4 to 11 years. In considering the 'added value' that appropriately developed engineering education activities can offer in the classroom the discussion argues that elementary level engineering has the potential to reach across the curriculum, offering context and depth in many different areas. The paper concludes by arguing that by introducing the discipline to children at a foundational level, switching on their 'Engineering Imaginations' and getting them to experience the value and excitement of engineering, maths and applied science a new "Educational Frontier" will be forged. © American Society for Engineering Education, 2014.

Versenyképesség és civil szerepvállalás a közigazgatás és a közszolgáltatások fejlesztésében (Competitiveness and civil contribution to the development of public administration and public services)

Az utóbbi évtizedek nemzetközi trendjei azt mutatják, hogy a civil szervezetek és a nonprofit szolgáltatók számottevő hatást gyakorolnak a versenyképesség alakulására. Ez a tanulmány azokat a formális és informális mechanizmusokat tekinti át, amelyeken keresztül a civil társadalom befolyásolja a közintézményi döntéseket és azok gyakorlati megvalósítását, hozzájárul a „government”-tôl a „governance” irányába való elmozduláshoz. Szintén képet ad arról az átalakulási folyamatról, amely a közszolgáltatások területén zajlik, s amelyből egyre markánsabban rajzolódik ki a közösségi kezdeményezésen alapuló, társadalmi ellenőrzés alatt működő nonprofit szolgáltatók és az állami szereplők közötti partneri viszony kialakulásának tendenciája. ____________ The international trends of the last decades have revealed that civil society organisations and nonprofit service providers have a significant impact on competitiveness. This paper gives an overview of the formal and informal mechanisms operated by civil society in order to keep public administration accountable, to influence public decisions and their implementation, thus moving from “government” towards “governance”. It also analyses the transition of public services, the more and more noticeable signs of an emerging partnership between the grassroots, community controlled service providing nonprofit organisations and the government actors.

Influence, policy formation, and higher education in Florida: 1989--1994

This study examined the perceptions of state governmental officials and administrators from the state university system, community college system, and independent institutions concerning the ability of various groups to influence state-level higher education policy formation. The study was conducted in Florida for the period 1989-94. Florida has a history of legislative involvement in higher education, a unique system of state universities and community colleges, and a limited number of private institutions of higher education. This study was grounded in the works of Mortimer and McConnell (1978), Millett (1987), Marshall, Mitchell, and Wirt (1989) and Finitfer, Baldwin, and Thelin (1991).^ The study represented the application of an embedded, single-case design. A survey was the primary collection instrument. Respondents were asked questions concerning: (a) personal involvement in higher education, (b) perceptions of the ability of various groups to influence higher education policy, (c) the names of particular individuals considered key players in higher education policy formation, (d) important state-level documents, (e) personal knowledge of key areas of policy formation, and (f) emerging higher education issues in Florida. Quantitative and qualitative methods were used to analyze the different sections of the survey.^ The findings indicated that a power and influence hierarchy exists among the various groups that attempt to influence higher education policy and that this hierarchy is recognized by state government officials and higher education administrators. While an analysis of variance of the various groups revealed a few differences between state government officials and higher education personnel, the high overall agreement was an important finding. Leading members of the legislature, especially the Chair of the Senate Higher Education Committee, and key staff members, especially from the Senate Ways & Means Committee, were considered the most influential. Representatives from higher education institutions and research organizations were considered among the least influential. Emerging issues identified by the respondents included: (a) the political nature of state-level policy formation, (b) the role of legislative staff, (c) the competition for state moneys, (d) legislative concern for state-wide budgetary efficiency, and (e) legislative attempts to define quality and supervise academic program development for higher education. ^

Best Management Practices in Green Lodging Defined and Explained

Best management practices in green lodging are sustainable or “green” business strategies designed to enhance the lodging product from the perspective of owners, operators and guests. For guests, these practices should enhance their experience while for owners and operators, generate positive returns on investments. Best management practices in green lodging typically starts with a clear understanding of each lodging firm’s role in society, its impact on the environment and strategies developed to mitigate negative environmental externalities generated from the production of lodging goods and services. Negative externalities of hotel operations manifest themselves in energy and water usage, waste generation and air pollution. Hence, best management practices in green lodging are dynamic, cost effective, innovative, stakeholder driven and environmentally sound technical and behavioral solutions that attempt to ameliorate or eliminate the negative environmental externalities associated with lodging operations, while simultaneously generate positive returns on green investments. Thus, best management practices in green lodging should reduce lodging firms’ operating costs, increase guest satisfaction, reduce or eliminate the negative environmental impacts associated with hotel operations while simultaneously enhance business operations.

Reference Points: Hotel Management Training In The United States and Europe

Different cultures and historical precedents produce a broad range of influences on the training of hotel managers in Europe and the United States. The author isolates a certain number of facts the nature of which clarify an understanding of two attitudes which complement each other to the benefit of their common objective - efficient professional training.

Past, Present, and Future: The Food Service Industry and Its Changes

In the article - Past, Present, and Future: The Food Service Industry and Its Changes - by Brother Herman E. Zaccarelli, International Director, Restaurant, Hotel and Institutional Management Institute at Purdue University, Brother Zaccarelli initially states: “Educators play an important role in the evolution of the food service industry. The author discusses that evolution and suggests how educators can be change agents along with management in that evolutionary progression.” The author goes on to wax philosophically, as well as speak generically about the food service industry; to why it offers fascinating and rewarding careers. Additionally, he writes about the influence educators have on students in this regard. “Educators can speak about how the food service industry has benefited them both personally and professionally,” says Brother Zaccarelli. “We get excited about alerting students to the many opportunities and, in fact, serve as “salespersons” for the industry to whoever (school administrators, legislators, and peers in the educational institution) will listen.” Brother Zaccarelli also speaks to growth and changes in food service, and even more importantly about the people and faces behind everything that food service, and hospitality in general comprise. The author will have you know, that people are what drive an educator. “What makes the food service industry so great? At the heart of this question's answer is people: the people whom it serves in institutional and commercial operations of all types; the people who work within it; the people who provide the goods, services, and equipment to it; the people who study it,” says Brother Zaccarelli. “All of these groups have, of course, a vested personal and/or professional interest in seeing our industry improve.” Another concept the author would like you to absorb, and it’s even more so true today than yesterday, is the prevalence of convergence and divergence within food service. For food service and beyond, it is the common denominators and differences that make the hospitality-food service industry so dynamic and vibrant. These are the winds of change presented to an educator who wants to have a positive impact on students. The author warns that the many elements involved in the food service industry conspire to erode quality of service in an industry that is also persistently expanding, and whose cornerstone principles are underpinned by service itself. “The three concerns addressed - quality, employees, and marketing - are intimately related,” Brother Zaccarelli says in stripping-down the industry to bare essentials. He defines and addresses the issues related to each with an eye toward how education can reconcile said issues.

Marketing A Hospitality Program And Its Product

In his dialogue entitled - Marketing A Hospitality Program and Its Product - Jürgen Chopard, Dr. es Sciences (Economics) Director, Centre International de Glion, Glion, Switzerland, Dr. Chopard initially offers: “The recruitment of qualified personnel is extremely difficult in an industry with a poor image; where career paths are not well defined. The author discusses the employment of marketing management techniques to improve the positioning of hospitality education and create a more attractive perception of the hotel industry.” As outlined in the above paragraph, Dr. Chopard vectors-in on marketing strategies from two standpoints; the educational side with its focus on curriculum, and the larger, industry side with its emphasis on public perception and service. These are not necessarily, nor should they be viewed as disparate elements. “ Although some professionals may see schools of hospitality education catering to two markets, students on one hand and industry on the other, in fact, their needs should be viewed as the same and hence a single market,” Dr. Chopard says to bolster his assertion. “The marketing concept is a management orientation that holds that the key task of the organization is to determine the needs and wants of target markets and to adapt the organization to delivering the desired satisfactions more effectively and efficiently than its competitor,” the author confides, with an attribution. From these information/definition leanings, Dr. Chopard continues on a path that promotes the Centre International de Glion, Glion, Switzerland, which he is affiliated with. Why, because they endorse the same principles he is explaining to you. That’s not a bad thing. Essentially, what Dr. Chopard wants you to know is, education and business management are synonymous and therefore should share the same marketing designs and goals. “It is hard to believe that as critically important a sector as education does not use for its own management the techniques which it teaches and which have largely been proved in other fields,” the author provides as counterpoint. Since pedagogical needs so closely relate to the more pragmatic needs of the industry in general, these elements should seek to compliment and engage each other, in fact, collaboration is imperative, Dr. Chopard expresses a priori. “The cooperation of future employers is indispensable in the preparation of the product, so that it is capable of providing the expected services. The need for close relations between training establishments and the hotel and catering industry seems obvious,” Dr. Chopard says. The author reveals some flaws in hospitality marketing strategy, and then contrasts these against how a successful strategy could/should be implemented.