Unintended Consequences of Strategies Implemented in Canadian Healthcare Organizations to Reduce Wait Times for Elective Hip and Knee Surgeries

Introduction: En réponse aux exigences du gouvernement fédéral en ce qui concerne les temps d'attente pour les chirurgies électives d’hanche et du genou, les Organismes Canadiens de santé ont adopté des stratégies de gestion pour les listes d'attente. Cependant, il n'existe pas actuellement aucune information disponible concernant les effets imprévus, positive ou négative, de ces stratégies. Méthodologie: Un modèle qui a été construit est tombé en panne la gestion de la chirurgie d’hanche et du genou en différentes étapes, afin d'identifier les effets imprévus possibles pour chaque étape; le modèle a été validé auprès d'un panel d'experts. Cette étude a choisi quatre études de cas en fonction de leur durabilité: un cas qui a été durable, un cas qui a été modérément durable, et deux cas peu probable d'être durable. Dans cette étude qualitative, nous avons mené 31 entretiens semi-structurés entre Novembre 2010 et Juin 2011 avec les gestionnaires, les infirmières, les thérapeutes et les chirurgiens impliqués dans la gestion des stratégies du temps d’attente pour les chirurgies électives d’hanche et du genou. Les quatre cas ont été sélectionnés à partir de trois provinces / régions. Nous avons analysé les conséquences non intentionnelles aux niveaux systémique et organisationnelle en utilisant les stratégies dans chaque contexte. Enregistrements des entrevues ont été transcrits mot à mot et soumis à l'analyse du cadre. Résultats: Les effets négatifs sont la précarité des stratégies en raison du non-récurrente financement, l'anxiété chez les patients qui ne sont pas prêts pour la chirurgie, une redistribution du temps de chirurgie vers l’orthopédie au détriment des autres interventions chirurgicales, tensions entre les chirurgiens et entre les orthopédistes et anesthésistes, et la pression sur le personnel dans le bloc opératoire et postopératoire. Conclusion: La stratégie d’implémentation aux niveaux national et local devrait prendre en compte les conséquences potentielles, positives et négatives. Il y a des conséquences inattendues à chaque niveau de l'organisation des soins de santé. Individuellement et collectivement, ces conséquences peuvent positivement et négativement affecter les résultats. Par conséquent, la planification de la santé doit analyser et prendre en compte les conséquences inattendues en termes de bonnes résultats inattendues, compromis et les conséquences négatives afin d'améliorer les résultats.

A generic polynomial solution for the differential equation of hypergeometric type and six sequences of orthogonal polynomials related to it

In this work, we present a generic formula for the polynomial solution families of the well-known differential equation of hypergeometric type s(x)y"n(x) + t(x)y'n(x) - lnyn(x) = 0 and show that all the three classical orthogonal polynomial families as well as three finite orthogonal polynomial families, extracted from this equation, can be identified as special cases of this derived polynomial sequence. Some general properties of this sequence are also given.

Effect of management strategies on the performance of ruminant livestock production systems and the safety of plant and animal products in the city of Sikasso, Mali

The regional population growth in West Africa, and especially its urban centers, will bring about new and critical challenges for urban development policy, especially in terms of ensuring food security and providing employment for the growing population. (Peri-) urban livestock and vegetable production systems, which can contribute significantly to these endeavours, are limited by various constraints, amongst them limited access to expensive production factors and their (in)efficient use. To achieve sustainable production systems with low consumer health risks, that can meet the urban increased demand, this doctoral thesis determined nutrient use efficiencies in representative (peri-) urban livestock production systems in three West African cities, and investigated potential health risks for consumers ensuing from there. The field study, which was conducted during July 2007 to December 2009, undertook a comparative analysis of (peri-) urban livestock production strategies across 210 livestock keeping households (HH) in the three West African cities of Kano/Nigeria (84 HH), Bobo Dioulasso/Burkina Faso (63 HH) and Sikasso/Mali (63 HH). These livestock enterprises were belonging to the following three farm types: commercial gardening plus field crops and livestock (cGCL; 88 HH), commercial livestock plus subsistence field cropping (cLsC; 109 HH) and commercial gardening plus semi-commercial livestock (cGscL; 13 HH) which had been classified in a preceding study; they represented the diversity of (peri-) urban livestock production systems in West Africa. In the study on the efficiency of ruminant livestock production, lactating cowsand sheep herd units were differentiated based on whether feed supplements were offered to the animals at the homestead (Go: grazing only; Gsf: mainly grazing plus some supplement feeding). Inflows and outflows of nutrients were quantified in these herds during 18 months, and the effects of seasonal variations in nutrient availability on animals’ productivity and reproductive performance was determined in Sikasso. To assess the safety of animal products and vegetables, contamination sources of irrigated lettuce and milk with microbiological contaminants, and of tomato and cabbage with pesticide residues in (peri-) urban agriculture systems of Bobo Dioulasso and Sikasso were characterized at three occasions in 2009. Samples of irrigation water, organic fertilizer and ix lettuce were collected in 6 gardens, and samples of cabbage and tomato in 12 gardens; raw and curdled milk were sampled in 6 dairy herds. Information on health risks for consumers of such foodstuffs was obtained from 11 health centers in Sikasso. In (peri-) urban livestock production systems, sheep and goats dominated (P<0.001) in Kano compared to Bobo Dioulasso and Sikasso, while cattle and poultry were more frequent (P<0.001) in Bobo Dioulasso and Sikasso than in Kano. Across cities, ruminant feeding relied on grazing and homestead supplementation with fresh grasses, crop residues, cereal brans and cotton seed cake; cereal grains and brans were the major ingredients of poultry feeds. There was little association of gardens and livestock; likewise field cropping and livestock were rarely integrated. No relation existed between the education of the HH head and the adoption of improved management practices (P>0.05), but the proportion of HH heads with a long-term experience in (peri-) urban agriculture was higher in Kano and in Bobo Dioulasso than in Sikasso (P<0.001). Cattle and sheep fetched highest market prices in Kano; unit prices for goats and chicken were highest in Sikasso. Animal inflow, outflow and dairy herd growth rates were significantly higher (P<0.05) in the Gsf than in the Go cattle herds. Maize bran and cottonseed expeller were the main feeds offered to Gsf cows as dry-season supplement, while Gsf sheep received maize bran, fresh grasses and cowpea pods. The short periodic transhumance of Go dairy cows help them maintaining their live weight, whereas Gsf cows lost weight during the dry season despite supplement feeding at a rate of 1506 g dry matter per cow and day, resulting in low productivity and reproductive performance. The daily live weight gains of calves and lambs, respectively, were low and not significantly different between the Go and the Gsf system. However, the average live weight gains of lambs were significantly higher in the dry season (P<0.05) than in the rainy season because of the high pressure of gastrointestinal parasites and of Trypanosoma sp. In consequence, 47% of the sheep leaving the Go and Gsf herds died due to diseases during the study period. Thermo-tolerant coliforms and Escherichia coli contamination levels of irrigation water significantly exceeded WHO recommendations for the unrestricted irrigation of vegetables consumed raw. Microbial contamination levels of lettuce at the farm gate and the market place in Bobo Dioulasso and at the farm gate in Sikasso were higher than at the market place in Sikasso (P<0.05). Pesticide residues were detected in only one cabbage and one tomato sample and were below the maximum residue limit for consumption. Counts of thermo-tolerant coliforms and Escherichia coli were higher in curdled than in raw milk (P<0.05). From 2006 to x 2009, cases of diarrhea/vomiting and typhoid fever had increased by 11% and 48%, respectively, in Sikasso. For ensuring economically successful and ecologically viable (peri-) urban livestock husbandry and food safety of (peri-) urban foodstuffs of animal and plant origin, the dissemination and adoption of improved feeding practices, livestock healthcare and dung management are key. In addition, measures fostering the safety of animal products and vegetables including the appropriate use of wastewater in (peri-) urban agriculture, restriction to approve vegetable pesticides and the respect of their latency periods, and passing and enforcement of safety laws is required. Finally, the incorporation of environmentally sound (peri-) urban agriculture in urban planning by policy makers, public and private extension agencies and the urban farmers themselves is of utmost importance. To enable an efficient (peri-) urban livestock production in the future, research should concentrate on cost-effective feeding systems that allow meeting the animals’ requirement for production and reproduction. Thereby focus should be laid on the use of crop-residues and leguminous forages. The improvement of the milk production potential through crossbreeding of local cattle breeds with exotic breeds known for their high milk yield might be an accompanying option, but it needs careful supervision to prevent the loss of the local trypanotolerant purebreds.

An integrated assessment of resource use strategies in the Borana pastoral system of southern Ethiopia

In the pastoral production systems, mobility remains the main technique used to meet livestock’s fodder requirements. Currently, with growing challenges on the pastoral production systems, there is urgent need for an in-depth understanding of how pastoralists continue to manage their grazing resources and how they determine their mobility strategies. This study examined the Borana pastoralists’ regulation of access to grazing resources, mobility practices and cattle reproductive performances in three pastoral zones of Borana region of southern Ethiopia. The central objective of the study was to contribute to the understanding of pastoral land use strategies at a scale relevant to their management. The study applied a multi-scalar methodological approach that allowed zooming in from communal to individual herd level. Through participatory mapping that applied Google Earth image print out as visual aid, the study revealed that the Borana pastoralists conceptualized their grazing areas as distinctive grazing units with names, borders, and specific characteristics. This knowledge enables the herders to communicate the condition of grazing resources among themselves in a precise way which is important in management of livestock mobility. Analysis of grazing area use from the participatory maps showed that the Borana pastoralists apportion their grazing areas into categories that are accessed at different times of the year (temporal use areas). This re-organization is an attempt by the community to cope with the prevailing constraints which results in fodder shortages especially during the dry periods. The re-organization represents a shift in resource use system, as the previous mobility practice across the ecologically varied zones of the rangelands became severely restricted. Grazing itineraries of 91 cattle herds for over 16 months obtained using the seasonal calendar interviews indicated that in the areas with the severest mobility constraints, the herders spent most of their time in the year round use areas that are within close proximity to the settlements. A significant change in mobility strategy was the disallowing of foora practice by the communities in Dirre and Malbe zones in order to reduce competition. With the reduction in mobility practices, there is a general decline in cattle reproductive parameters with the areas experiencing the severest constraints showing the least favourable reproductive performances. The study concludes that the multi-scalar methodology was well suited to zoom into pastoral grazing management practices from communal to individual herd levels. Also the loss of mobility in the Borana pastoral system affects fulfilment of livestock feed requirements thus resulting in reduced reproductive performances and herd growth potentials. While reversal of the conditions of the situations in the Borana rangelands is practically unfeasible, the findings from this research underscore the need to protect the remaining pastoral lands since the pastoral production system remains the most important livelihood option for the majority of the Borana people. In this regards the study emphasises the need to adopt and domesticate regional and international policy frameworks such as that proposed by the African Union in 2010.

On the exhaustiveness of truncation and dropping strategies in many-to-many matching markets

We consider two–sided many–to–many matching markets in which each worker may work for multiple firms and each firm may hire multiple workers. We study individual and group manipulations in centralized markets that employ (pairwise) stable mechanisms and that require participants to submit rank order lists of agents on the other side of the market. We are interested in simple preference manipulations that have been reported and studied in empirical and theoretical work: truncation strategies, which are the lists obtained by removing a tail of least preferred partners from a preference list, and the more general dropping strategies, which are the lists obtained by only removing partners from a preference list (i.e., no reshuffling). We study when truncation / dropping strategies are exhaustive for a group of agents on the same side of the market, i.e., when each match resulting from preference manipulations can be replicated or improved upon by some truncation / dropping strategies. We prove that for each stable mechanism, truncation strategies are exhaustive for each agent with quota 1 (Theorem 1). We show that this result cannot be extended neither to group manipulations (even when all quotas equal 1 – Example 1), nor to individual manipulations when the agent’s quota is larger than 1 (even when all other agents’ quotas equal 1 – Example 2). Finally, we prove that for each stable mechanism, dropping strategies are exhaustive for each group of agents on the same side of the market (Theorem 2), i.e., independently of the quotas.

¿Qué entienden los jóvenes universitarios por monogamia y sexo sin penetración, como estrategias preventivas de la transmisión sexual del virus del SIDA? = What university students understand by monogamy and sex without penetration as preventive strategies of sexual transmission of AIDS virus?

Monogamy and sex without penetration are behaviors recommended by the WHO to avoid AIDS virus sexual transmission. Seven hundred and fifty university students from 18 to 25 years (67.7% women) were surveyed and they were asked to give a maximum of three free definitions of the words monogamy and sex without penetration to prevent AIDS virus sexual transmission. Their participation was voluntary and anonymous. Although the majority of the answers was correct, there was a considerable percentage of wrong answers, either for monogamy (3.7% masturbation; 2.1% to have many partners; 0.9% homosexual relations), or for sex without penetration (20.5% oral sex; 1.1% anal coitus; 0.8% coitus without orgasm; 0.4% coitus interruptus). Some definitions or examples differ by gender. The amount of wrongs or incomplete answers put researchers on the alert about insufficient preventive knowledge in a population with a high educational level

Inclusion, social networks and resilience: strategies, practices and outcomes for disabled children and their families

This paper explores the strategies of service providers and the benefits reported by disabled children and their parents/carers in three Children's Fund programmes in England. Based on National Evaluation of the Children's Fund research, we discuss how different understandings of ‘inclusion’ informed the diverse strategies and approaches service providers adopted. While disabled children and families perceived the benefits of services predominantly in terms of building individual children's resilience and social networks, the paper highlights the need for holistic approaches which have a broad view of inclusion, support children's networks and tackle disabling barriers within all the spheres of children's lives.

Impacts of climate change on in-stream nitrogen in a lowland chalk stream: An appraisal of adaptation strategies

The impacts of climate change on nitrogen (N) in a lowland chalk stream are investigated using a dynamic modelling approach. The INCA-N model is used to simulate transient daily hydrology and water quality in the River Kennet using temperature and precipitation scenarios downscaled from the General Circulation Model (GCM) output for the period 1961-2100. The three GCMs (CGCM2, CSIRO and HadCM3) yield very different river flow regimes with the latter projecting significant periods of drought in the second half of the 21st century. Stream-water N concentrations increase over time as higher temperatures enhance N release from the soil, and lower river flows reduce the dilution capacity of the river. Particular problems are shown to occur following severe droughts when N mineralization is high and the subsequent breaking of the drought releases high nitrate loads into the river system. Possible strategies for reducing climate-driven N loads are explored using INCA-N. The measures include land use change or fertiliser reduction, reduction in atmospheric nitrate and ammonium deposition, and the introduction of water meadows or connected wetlands adjacent to the river. The most effective strategy is to change land use or reduce fertiliser use, followed by water meadow creation, and atmospheric pollution controls. Finally, a combined approach involving all three strategies is investigated and shown to reduce in-stream nitrate concentrations to those pre-1950s even under climate change. (c) 2006 Elsevier B.V. All rights reserved.

Phyto-activity of biocides used to manipulate herbivory: tests of three pesticides on fourteen plant species

1. We tested three pesticides used for field manipulations of herbivory for direct phytoactive effects on the germination and growth of 14 herbaceous plant species selected to provide a range of life-history strategies and functional groups. 2. We report three companion experiments: (A) Two insecticides, chlorpyrifos (granular soil insecticide) and dimethoate (foliar spray), were applied in fully-factorial combination to pot-germinated individuals of 12 species. (B) The same fully-factorial design was used to test for direct effects on the germination of four herbaceous legumes. (C) The molluscicide, metaldehyde, was tested for direct effects on the germination and growth of six plant species. 3. The insecticides had few significant effects on growth and germination. Dimethoate acted only on growth stimulating Anisantha sterilis, Sonchus asper and Stellaria graminea. In contrast, chlorpyrifos acted on germination increasing the germination of Trifolium dubium and Trifolium pratense. There was also a significant interactive effect of chlorpyrifos and dimethoate on the germination of T pratense. However, all. effects were relatively small in magnitude and explanatory power. The molluscicide had no significant effect on plant germination or growth. 4. The small number and size of direct effects of the pesticides on plant performance is encouraging for the use of these pesticides in manipulative experiments on herbivory, especially for the molluscicide. However, a smatt number of direct (positive) effects of the insecticides on some plant species need to be taken into account when interpreting field manipulations of herbivory with these compounds, and emphasises the importance of conducting tests for direct phyto-active effects. (C) 2004 Elsevier GmbH. All rights reserved.

Exploring options for managing strategies for pea-barley intercropping using a modeling approach

A modeling Study was carried out into pea-barley intercropping in northern Europe. The two objectives were (a) to compare pea-barley intercropping to sole cropping in terms of grain and nitrogen yield amounts and stability, and (b) to explore options for managing pea-barley intercropping systems in order to maximize the biomass produced and the grain and nitrogen yields according to the available resources, such as light, water and nitrogen. The study consisted of simulations taking into account soil and weather variability among three sites located in northern European Countries (Denmark, United Kingdom and France), and using 10 years of weather records. A preliminary stage evaluated the STICS intercrop model's ability to predict grain and nitrogen yields of the two species, using a 2-year dataset from trials conducted at the three sites. The work was carried out in two phases, (a) the model was run to investigate the potentialities of intercrops as compared to sole crops, and (b) the model was run to explore options for managing pea-barley intercropping, asking the following three questions: (i) in order to increase light capture, Would it be worth delaying the sowing dates of one species? (ii) How to manage sowing density and seed proportion of each species in the intercrop to improve total grain yield and N use efficiency? (iii) How to optimize the use of nitrogen resources by choosing the most suitable preceding crop and/or the most appropriate soil? It was found that (1) intercropping made better use of environmental resources as regards yield amount and stability than sole cropping, with a noticeable site effect, (2) pea growth in intercrops was strongly linked to soil moisture, and barley yield was determined by nitrogen uptake and light interception due to its height relative to pea, (3) sowing barley before pea led to a relative grain yield reduction averaged over all three sites, but sowing strategy must be adapted to the location, being dependent on temperature and thus latitude, (4) density and species proportions had a small effect on total grain yield, underlining the interspecific offset in the use of environmental growth resources which led to similar total grain yields whatever the pea-barley design, and (5) long-term strategies including mineralization management through organic residue supply and rotation management were very valuable, always favoring intercrop total grain yield and N accumulation. (C) 2009 Elsevier B.V. All rights reserved.

Adaptation to climate change and variability: farmer responses to intra-seasonal precipitation trends in South Africa

We describe the nature of recent (50 year) rainfall variability in the summer rainfall zone, South Africa, and how variability is recognised and responded to on the ground by farmers. Using daily rainfall data and self-organising mapping (SOM) we identify 12 internally homogeneous rainfall regions displaying differing parameters of precipitation change. Three regions, characterised by changing onset and timing of rains, rainfall frequencies and intensities, in Limpopo, North West and KwaZulu Natal provinces, were selected to investigate farmer perceptions of, and responses to, rainfall parameter changes. Village and household level analyses demonstrate that the trends and variabilities in precipitation parameters differentiated by the SOM analysis were clearly recognised by people living in the areas in which they occurred. A range of specific coping and adaptation strategies are employed by farmers to respond to climate shifts, some generic across regions and some facilitated by specific local factors. The study has begun to understand the complexity of coping and adaptation, and the factors that influence the decisions that are taken.

Facile strategies for the synthesis and crystallization of linear trinuclear nickel(II)-Schiff base, complexes with carboxylate bridges: Tuning of coordination geometry and magnetic properties

Three new linear trinuclear nickel(II) complexes, [Ni-3(salpen)(2)(OAc)(2)(H2O)(2)]center dot 4H(2)O (1) (OAc = acetate, CH3COO-), [Ni-3(salpen)(2)(OBz)(2)] (2) (OBz=benzoate, PhCOO-) and [Ni-3(salpen)(2)(OCn)(2)(CH3CN)(2)] (4) (OCn = cinnamate, PhCH=CHCOO-), H(2)salpen = tetradentate ligand, N,N'-bis(salicylidene)-1,3-pentanediamine have been synthesized and characterized structurally and magnetically. The choice of solvent for growing single crystal was made by inspecting the morphology of the initially obtained solids with the help of SEM study. The magnetic properties of a closely related complex, [Ni-3(salpen)(2)(OPh)(2)(EtOH)] (3) (OPh = phenyl acetate, PhCH2COO-) whose structure and solution properties have been reported recently, has also been studied here. The structural analyses reveal that both phenoxo and carboxylate bridging are present in all the complexes and the three Ni(II) atoms remain in linear disposition. Although the Schiff base ligand and the syn-syn bridging bidentate mode of the carboxylate group remain the same in complexes 1-4, the change of alkyl/aryl group of the carboxylates brings about systematic variations between six- and five-coordination in the geometry of the terminal Ni(II) centres of the trinuclear units. The steric demand as well as hydrophobic nature of the alkyl/aryl group of the carboxylate is found to play a crucial role in the tuning of the geometry. Variable-temperature (2-300 K) magnetic susceptibility measurements show that complexes 1-4 are antiferromagnetically coupled (J = -3.2(1), -4.6(1). -3.2(1) and -2.8(1) cm(-1) in 1-4, respectively). Calculations of the zero-field splitting parameter indicate that the values of D for complexes 1-4 are in the high range (D = +9.1(2), +14.2(2), +9.8(2) and +8.6(1) cm(-1) for 1-4, respectively). The highest D value of +14.2(2) and +9.8(2) cm(-1) for complexes 2 and 3, respectively, are consistent with the pentacoordinated geometry of the two terminal nickel(II) ions in 2 and one terminal nickel(II) ion in 3. (C) 2009 Elsevier Ltd. All rights reserved.

Tales of the expected: investigating the rhetorical strategies of innovation champions

Innovation continues to be high on the agenda in construction. It is widely considered to be an essential prerequisite of improved performance both for the sector at large and for individual firms. Success stories dominate the parts of the academic literature that rely heavily on the recollections of key individuals. A complementary interpretation focuses on the way innovation champions in hindsight interpret, justify and legitimize the diffusion of innovations. Emphasis is put on the temporal dimension of interpretation and how this links to rhetorical strategies and impression management tactics. Rhetorical theories are drawn upon to analyse the accounts given by innovation champions in seven facilities management organizations. In particular, the three persuasive appeals in classic rhetoric are used to highlight the rhetorical justifications mobilized in the descriptions of what took place. The findings demonstrate the usefulness of rhetorical theories in complementing studies of innovation.

Alternative strategies for activation of the natural lactoperoxidase system in cows' milk: trials in Tanzania

Thiocyanate content and lactoperoxidase activity of individual cow's milk of different breeds were determined, and the effects of different lactoperoxidase system (LP-s) activation strategies were compared. Lactoperoxidase activity varied significantly between Friesian and both Ayrshire and Tanzania Short Horn Zebu (TSHZ), but differences between Ayrshire and TSHZ were not significant. There was no significant variation in SCN- content between breeds. The LP-s was activated using three strategies based on SCN-: namely; equal concentrations of SCN- and H2O2 (7:7, 10:10, 15 :15 mg/l), excess SCN- concentrations (15:10, 20:10, 25:10 mg SCN-: H2O2/I), and excess H2O2 concentrations (10:15, 10:20, 10:25 mg SCN-: H2O2/I), plus a fourth strategy based on I- (15 : 15 mg I- : H2O2/I). The keeping quality (KQ) was assessed using pH, titratable acidity, clot on boiling and alcohol stability tests. All activation strategies enhanced the shelf life of milk (typically increasing KQ from around 10 to around 20 h), but it was clear that the effectiveness of the LP-s depends on the type and concentrations of the activators of the system. The LP-s activated using I- as an electron donor was more effective than the LP-s activated using SCN- as an electron donor, increasing the KQ by a further 6-8 h compared with SCN-.

A generic model of Exergy Assessment of the Environmental Impact for the Building Lifecycle

A generic model of Exergy Assessment is proposed for the Environmental Impact of the Building Lifecycle, with a special focus on the natural environment. Three environmental impacts: energy consumption, resource consumption and pollutant discharge have been analyzed with reference to energy-embodied exergy, resource chemical exergy and abatement exergy, respectively. The generic model of Exergy Assessment of the Environmental Impact of the Building Lifecycle thus formulated contains two sub-models, one from the aspect of building energy utilization and the other from building materials use. Combined with theories by ecologists such as Odum, the paper evaluates a building's environmental sustainability through its exergy footprint and environmental impacts. A case study from Chongqing, China illustrates the application of this method. From the case study, it was found that energy consumption constitutes 70–80% of the total environmental impact during a 50-year building lifecycle, in which the operation phase accounts for 80% of the total environmental impact, the building material production phase 15% and 5% for the other phases.