Health service pathways for patients with chronic leg ulcers : identifying effective pathways for facilitation of evidence based wound care

Background: Chronic leg ulcers cause long term ill-health for older adults and the condition places a significant burden on health service resources. Although evidence on effective management of the condition is available, a significant evidence-practice gap is known to exist, with many suggested reasons e.g. multiple care providers, costs of care and treatments. This study aimed to identify effective health service pathways of care which facilitated evidence-based management of chronic leg ulcers. Methods: A sample of 70 patients presenting with a lower limb leg or foot ulcer at specialist wound clinics in Queensland, Australia were recruited for an observational study and survey. Retrospective data were collected on demographics, health, medical history, treatments, costs and health service pathways in the previous 12 months. Prospective data were collected on health service pathways, pain, functional ability, quality of life, treatments, wound healing and recurrence outcomes for 24 weeks from admission. Results: Retrospective data indicated that evidence based guidelines were poorly implemented prior to admission to the study, e.g. only 31% of participants with a lower limb ulcer had an ABPI or duplex assessment in the previous 12 months. On average, participants accessed care 2–3 times/week for 17 weeks from multiple health service providers in the twelve months before admission to the study clinics. Following admission to specialist wound clinics, participants accessed care on average once per week for 12 weeks from a smaller range of providers. The median ulcer duration on admission to the study was 22 weeks (range 2–728 weeks). Following admission to wound clinics, implementation of key indicators of evidence based care increased (p<0.001) and Kaplan-Meier survival analysis found the median time to healing was 12 weeks (95% CI 9.3–14.7). Implementation of evidence based care was significantly related to improved healing outcomes (p<0.001). Conclusions: This study highlights the complexities involved in accessing expertise and evidence based wound care for adults with chronic leg or foot ulcers. Results demonstrate that access to wound management expertise can promote streamlined health services and evidence based wound care, leading to efficient use of health resources and improved health.

Reduced motor facilitation during action observation in schizophrenia : a mirror neuron deficit?

Impairments in social cognitive functioning are well documented in schizophrenia, however the neural basis of these deficits is unclear. A recent explanatory model of social cognition centers upon the activity of mirror neurons, which are cortical brain cells that become active during both the performance and observation of behavior. Here, we test for the first time whether mirror neuron functioning is reduced in schizophrenia. Fifteen individuals with schizophrenia or schizoaffective disorder and fifteen healthy controls completed a transcranial magnetic stimulation (TMS) experiment designed to assess mirror neuron activation. While patients demonstrated no abnormalities in cortical excitability, motor facilitation during action observation, putatively reflecting mirror neuron activity, was reduced in schizophrenia. Dysfunction within the mirror neuron system may contribute to the pathophysiology of schizophrenia.

Co-creating stories in social learning systems : The role of community media and cultural organisations in disseminating knowledge

This paper investigates how community based media organisations are co-creative storytelling institutions, and how they learn to disseminate knowledge in a social learning system. Organisations involved in story co-creation are learning to create in fluid environments.They are project based, with a constant turnover of volunteers or staff. These organisations have to meet the needs of their funding bodies and their communities to remain sustainable. Learning is seen as dialogical, and this is also reflected in the nature of storytelling itself. These organisations must learn to meet the needs of their communities, who in turn learn from the organisation’s expertise in a facilitated setting. This learning is participatory and collaborative, and is often a mix of virtual and offline interaction. Such community-based organisations sit in the realm of a hybrid-learning environment; they are neither a formal educational institution like a college, nor do their volunteers produce outcomes in a professional capacity. Yet, they must maintain a certain level of quality outcomes from their contributors to be of continued value in their communities. Drawing from a larger research study, one particular example is that of the CitizenJ project. CitizenJ is hosted by a state cultural centre, and partnered with publishing partners in the community broadcasting sector. This paper explores how this project is a Community of Practice, and how it promotes ethical and best practice, meets contributors’ needs, emphasises the importance of facilitation in achieving quality outcomes, and the creation of projects for wider community and public interest.

Information encountering on social media and tacit knowledge sharing

The purpose of this paper is to investigate how social media may support information encountering (i.e., where individuals encounter useful and interesting information while seeking or browsing for some other information) and how this may lead to facilitation of tacit knowledge creation and sharing. The study employed a qualitative survey design that interviewed twenty-four physicians who were active users of social media to better understand the phenomenon of information encountering on social media. The data was analysed using the thematic analysis approach. The study found six main ways through which social media supports information encountering. Furthermore, drawing upon knowledge creation theories, the study concluded that information encountering on social media facilitates tacit knowledge creation and sharing among individuals. The study provides new directions for further empirical investigations to examine whether information encountering on social media actually leads to tacit knowledge creation and sharing. The findings of the study may also provide opportunities for users to adopt social media effectively or gain greater value from social media use.

Constructing and negotiating entrepreneurial agency : A social psychological approach to entrepreneurship discourse in the farm context

Entrepreneurship, understood as the autonomous, effective pursuit of opportunities regardless of resources, is currently subject to a multitude of interests, expectations, and facilitation efforts. On the one hand, such entrepreneurial agency has broad appeal to individuals in Western market democracies and resonates with their longing for an autonomous, personally tailored, meaningful, and materially rewarding way of life. On the other hand, entrepreneurship represents a tempting and increasingly popular means of governance and policy making, and thus a model for the re-organization of a variety of societal sectors. This study focuses on the diffusion and reception of entrepreneurship discourse in the context of farming and agriculture, where pressures to adopt entrepreneurial orientations have been increasingly pronounced while, on the other hand, the context of farming has historically enjoyed state protection and adhered to principles that seem at odds with aspects of individualistic entrepreneurship discourse . The study presents an interpretation of the psychologically and politically appealing uses of the notion of entrepreneurial agency , reviews the historical and political background of the current situation of farming and agriculture with regard to entrepreneurship, and examines their relationships in four empirical studies. The study follows and develops a social psychological, situated relational approach that guides the qualitative analyses and interpretations of the empirical studies. Interviews with agents from the farm sector aim to stimulate evaluative responses and comments on the idea of entrepreneurship on farms. Analysis of the interview talk, in turn, detects the variety of evaluative responses and argumentative contexts with which the interviewees relate themselves to the entrepreneurship discourse and adopt, use, resist, or reject it. The study shows that despite the pressures towards entrepreneurialism, the diffusion of entrepreneurship discourse and the construction of entrepreneurial agency in farm context encounter many obstacles. These obstacles can be variably related to aspects dealing with the individual agent, the action situation, the characteristics of the action itself, or to the broader social, institutional and cultural context. Many aspects of entrepreneurial agency, such as autonomy, personal initiative and achievement orientation, are nevertheless familiar to farmers and are eagerly related to one s own farming activities. The idea of entrepreneurship is thus rarely rejected outright. The findings highlight the relational and situational preconditions for the construction of entrepreneurial agency in the farm context: When agents demonstrate entrepreneurial agency, they do so by drawing on available and accessed relational resources characteristic of their action context. Likewise, when agents fail or are reluctant to demonstrate entrepreneurial agency, they nevertheless actively account for their situation and demonstrate personal agency by drawing on the relational resources available to them.

Política y religión en la ayuda social del peronismo

Resumen: La laicidad de las instituciones de ayuda social durante el peronismo, pretende ser revisada, a partir de las características de los hogares de tránsito de la Fundación Eva Perón. Se ha hecho hincapié en la entrega o facilitación de bienes materiales pero poco o nada se ha dicho, de la labor netamente religiosa que se llevó adelante en ellos y de la impronta moral que tuvieron estas instituciones. Este trabajo propone repensar algunos aspectos y capturar algunos matices de la relación entre el peronismo y la Iglesia Católica. También, describir y analizar la manera en que se impartió la actividad religiosa en la institución benefactora por excelencia del gobierno, la FEP.

Social structure and underwater behavior of harbor seals in southern Monterey Bay, California

To understand harbor seal social and mating strategies, I examined site fidelity, seasonal abundance and distribution, herd integrity, and underwater behavior of individual harbor seals in southern Monterey Bay. Individual harbor seals (n = 444) were identified by natural markings and represented greater than 80% of an estimated 520 seals within this community. Year to year fidelity of individual harbor seals to southern Monterey Bay coastline was 84% (n = 388), and long-term associations (>2 yrs) among individuals were common (>40%). Consistent with these long-term associations, harbor seals were highly social underwater throughout the year. Underwater social behavior included three primary types: (1) visual and acoustic displays, such as vocalizing, surface splashing, and bubble-blowing; (2) playful or agonistic social behavior such as rolling, mounting, attending, and biting; and (3) signal gestures such as head-thrusting, fore-flipper scratch~ng, and growling. Frequency of these types of behavior was related to seal age, gender, season, and resource availability. Underwater behavior had a variety of functions, including promotion of learning and social development, reduction of aggression and preservation of social bonds by maintaining social hierarchy, and facilitation of mate selection during breeding season. Social behavior among adult males was significantly correlated with vocalization characteristics (r = 0.99, X2 = 37.7, p = 0.00087), indicating that seals may assess their competition based on underwater vocalization displays and adopt individual strategies for attracting females during breeding season based on social status. Individual mating strategies may include defending underwater territories, using scramble tactics, and developing social alliances. (PDF contains 105 pages)

Addressing the cognitive and social influence inhibitors during the ideation stages of technology roadmapping workshops

Technology roadmapping workshops are essentially a social mechanism for exploring, creating, shaping and implementing ideas. The front-end of a roadmapping session is based on brainstorming in order to tap into the group's diverse knowledge. The aim of this idea stimulation activity is to capture and share as many perspectives as possible across the full scope of the area of interest. The premise to such group brainstorming is that the sharing and exchange of ideas leads to cognitive stimulation resulting in a greater overall group idea generation performance in terms of the number, variety and originality of ideas. However, it must be recognized that the ideation stage in a roadmapping workshop is a complex psychosocial phenomenon with underlying cognitive and social processes. Thus, there are downsides to group interactions and these must be addressed in order to fully benefit from the power of a roadmapping workshop. This paper will highlight and discuss the key cognitive and social inhibitors involved. These include: production blocking, evaluation apprehension, free riding/social loafing, low norm setting/matching. Facilitation actions and process adjustments to counter such negative factors will be identified so as to provide a psychosocial basis for improving the running of roadmapping workshops. © 2009 PICMET.

Self-regulated learning and social media – a ‘natural’ alliance? Evidence on students’ self-regulation of learning, social media use and student-teacher relationship

Article is available at: http://www.tandfonline.com/doi/full/10.1080/17439884.2015.1064953.

Beyond the artefact and techno-centricity: towards process-centric understanding of architecture - alternative facilitation strategies and proposals

The artefact and techno-centricity of the research into the architecture process needs to be counterbalanced by other approaches. An increasing amount of information is collected and used in the process, resulting in challenges related to information and knowledge management, as this research evidences through interviews with practicing architects. However, emerging technologies are expected to resolve many of the traditional challenges, opening up new avenues for research. This research suggests that among them novel techniques addressing how architects interact with project information, especially that indirectly related to the artefacts, and tools which better address the social nature of work, notably communication between participants, become a higher priority. In the fields associated with the Human Computer Interaction generic solutions still frequently prevail, whereas it appears that specific alternative approaches would be particularly in demand for the dynamic and context dependent design process. This research identifies an opportunity for a process-centric and integrative approach for architectural practice and proposes an information management and communication software application, developed for the needs discovered in close collaboration with architects. Departing from the architects’ challenges, an information management software application, Mneme, was designed and developed until a working prototype. It proposes the use of visualizations as an interface to provide an overview of the process, facilitate project information retrieval and access, and visualize relationships between the pieces of information. Challenges with communication about visual content, such as images and 3D files, led to a development of a communication feature allowing discussions attached to any file format and searchable from a database. Based on the architects testing the prototype and literature recognizing the subjective side of usability, this thesis argues that visualizations, even 3D visualizations, present potential as an interface for information management in the architecture process. The architects confirmed that Mneme allowed them to have a better project overview, to easier locate heterogeneous content, and provided context for the project information. Communication feature in Mneme was seen to offer a lot of potential in design projects where diverse file formats are typically used. Through empirical understanding of the challenges in the architecture process, and through testing the resulting software proposal, this thesis suggests promising directions for future research into the architecture and design process.

Canada/U.S. border crossing: facilitation and constraint

Abstract The aim of this research project is to draw on accounts of experiences ofborder crossing and regulation at the Canada/U.S. border at Niagara in order to illuminate the dynamics of differentiation and inequality at this site. The research is informed by claims that the world is turning into a global village due to transnational flows oftechnology, infonnation, capital and people. Much of the available literature on globalization shows that while the transfer of technology, information, and capital are enhanced, the transnational movement of people is both facilitated and constrained in complex and unequal ways. In this project, the workings of facilitation and constraint were explored through an analysis often interviews with people who had spent a substantial portion oftheir childhood (e.g. 5 years) in a Canadian border community. The interviewees were at the time ofthe research between the ages of 19 and 25. Because most ofthe respondents were 'white' Canadians of working to upper middle class status, my focus was to explore how 'whiteness' as privilege may translate into enhanced movement across borders and how 'white' people may internalize and enjoy this privilege but may often deny its reality. I was also interested in how inequality is perceived, understood, and legitimated by these relatively privileged people. My analysis ofthe ten accounts ofborder crossing and regulation suggests that differentially situated people experience border crossing differently. An important finding is that while relatively privileged border crossers perceived and often problernatized differential treatment based on external factors such as physical appearance, and especially race, most did not challenge such treatment but rather saw it as acceptable. These findings are located within newer literature that addresses the increasing securitization ofborders and migration in western societies.

Reduced cortico-motor facilitation in a normal sample with high traits of autism

Recent research in social neuroscience proposes a link between mirror neuron system (MNS) and social cognition. The MNS has been proposed to be the neural mechanism underlying action recognition and intention understanding and more broadly social cognition. Pre-motor MNS has been suggested to modulate the motor cortex during action observation. This modulation results in an enhanced cortico-motor excitability reflected in increased motor evoked potentials (MEPs) at the muscle of interest during action observation. Anomalous MNS activity has been reported in the autistic population whose social skills are notably impaired. It is still an open question whether traits of autism in the normal population are linked to the MNS functioning. We measured TMS-induced MEPs in normal individuals with high and low traits of autism as measured by the autistic quotient (AQ), while observing videos of hand or mouth actions, static images of a hand or mouth or a blank screen. No differences were observed between the two while they observed a blank screen. However participants with low traits of autism showed significantly greater MEP amplitudes during observation of hand/mouth actions relative to static hand/mouth stimuli. In contrast, participants with high traits of autism did not show such a MEP amplitude difference between observation of actions and static stimuli. These results are discussed with reference to MNS functioning.

Population, social equity and changing production patterns

Includes bibliography

Trade Facilitation: Promoting Trade as an Engine of Growth Using Information and Communication Technologies (ICTS)

Three factors define the main difficulties faced by developing countries in the area of trade facilitation: (i) limited understanding and use by governments and business (especially SMEs) of trade facilitation and of ICT tools and techniques; (ii) developing countries' limited capacity for policy analysis and inadequate policy instruments for the implementation of trade facilitation, and (iii) inadequate policy coordination for negotiation on trade facilitation. These obstacles tend to reduce countries' development opportunities and to increase the costs of general economic development and social welfare.The United Nations, through its five regional commissions, is launching a project that seeks to disseminate the benefits of trade facilitation and the standards, tools and requirements for its successful implementation. The project will focus on trade facilitation promoted by: (a) enhanced knowledge and understanding of governments and business regarding trade facilitation and the role of ICT; (b) enhanced use of ICT by SMEs in trade facilitation, and (c) national capacity-building for trade facilitation negotiations.

Trade Facilitation and Paperless Trade Implementation Survey 2015

The Global Survey on Trade Facilitation and Paperless Trade Implementation 2014-2015 is a global effort led by the Economic and Social Commission for Asia and the Pacific (ESCAP) in collaboration with the other four United Nations Regional Commissions, namely, the Economic Commission for Latin America and the Caribbean (ECLAC), the Economic and Social Commission for Western Asia (ESCWA), the Economic Commission for Africa (ECA) and the Economic Commission for Europe (UNECE). The goal of the Global Survey is to gather information from the member states of the respective Regional Commissions on trade facilitation and paperless trade measures and strategies implemented at the national and regional levels. The results of the survey will enable countries and development partners to better understand and monitor progress on trade facilitation, support evidence-based public policies, share best practices and identify capacity building and technical assistance needs.