Using protocols in ICU practice. Engaging the staff.

Aims/Purpose: Protocols are evidenced-based structured guides for directing care to achieve improvements. But translating that evidence into practice is a major challenge. It is not acceptable to simply introduce the protocol and expect it to be adopted and lead to change in practice. Implementation requires effective leadership and management. This presentation describes a strategy for implementation that should promote successful adoption and lead to practice change.
Presentation description: There are many social and behavioural change models to assist and guide practice change. Choosing a model to guide implementation is important for providing a framework for action. The change process requires careful thought, from the protocol itself to the policies and politics within the ICU. In this presentation, I discuss a useful pragmatic guide called the 6SQUID (6 Steps in QUality Intervention Development). This was initially designed for public health interventions, but the model has wider applicability and has similarities with other change process models. Steps requiring consideration include examining the purpose and the need for change; the staff that will be affected and the impact on their workload; and the evidence base supporting the protocol. Subsequent steps in the process that the ICU manager should consider are the change mechanism (widespread multi-disciplinary consultation; adapting the protocol to the local ICU); and identifying how to deliver the change mechanism (educational workshops and preparing staff for the changes are imperative). Recognising the barriers to implementation and change and addressing these locally is also important. Once the protocol has been implemented, there is generally a learning curve before it becomes embedded in practice. Audit and feedback on adherence are useful strategies to monitor and sustain the changes.
Conclusion: Managing change successfully will promote a positive experience for staff. In turn, this will encourage a culture of enthusiasm for translating evidence into practice.

Lost at sea: Genetic, oceanographic and meteorological evidence for storm-forced dispersal

[EN] For many species, there is broad-scale dispersal of juvenile stages and/or long-distance migration of individuals and hence the processes that drive these various wide-ranging move- ments have important life-history consequences. Sea turtles are one of these paradigmatic long-distance travellers, with hatchlings thought to be dispersed by ocean currents and adults often shuttling between distant breeding and foraging grounds. Here, we use multi- disciplinary oceanographic, atmospheric and genetic mixed stock analyses to show that juvenile turtles are encountered ‘downstream’ at sites predicted by currents. However, in some cases, unusual occurrences of juveniles are more readily explained by storm events and we show that juvenile turtles may be displaced thousands of kilometres from their expected dispersal based on prevailing ocean currents.

Lost at sea: Genetic, oceanographic and meteorological evidence for storm-forced dispersal

[EN] For many species, there is broad-scale dispersal of juvenile stages and/or long-distance migration of individuals and hence the processes that drive these various wide-ranging move- ments have important life-history consequences. Sea turtles are one of these paradigmatic long-distance travellers, with hatchlings thought to be dispersed by ocean currents and adults often shuttling between distant breeding and foraging grounds. Here, we use multi- disciplinary oceanographic, atmospheric and genetic mixed stock analyses to show that juvenile turtles are encountered ‘downstream’ at sites predicted by currents. However, in some cases, unusual occurrences of juveniles are more readily explained by storm events and we show that juvenile turtles may be displaced thousands of kilometres from their expected dispersal based on prevailing ocean currents.

Public Perceptions of the Midwest's Pavements - Executive Summary: Iowa

This report summarizes Iowa results of a five year, Pooled Fund study involving the Wisconsin, Iowa, and Minnesota Departments of Transportation (DOTs) designed to 1) assess the public's perceptions of the DOTs' pavement improvement strategies and 2) develop customer-based thresholds of satisfaction with pavements on rural two lane highways in each state as related to the DOTs' physical indices, such as pavement ride and condition. The primary objective was to seek systematic customer input to improve the DOTs' pavement improvement policies by 1) determining how drivers perceive the DOTs' pavements in terms of comfort and convenience but also in terms of other tradeoffs the DOTs had not previously considered, 2) determining relationships between perceptions and measured pavement condition thresholds (including a general level of tolerance of winter ride conditions in two of the states), and 3) identifying important attributes and issues that may not have been considered in the past. Secondary objectives were 1) to provide a tool for systematic customer input in the future and 2) to provide information which can help structure public information programs. A University of Wisconsin-Extension survey lab conducted the surveys under the direction of a multi-disciplinary team from Marquette University. Approximately 4500 drivers in the 3 states participated in the 3 phases of the project. Researchers conducted 6 focus groups in each state, approximately 400 statewide telephone interviews in each state and 700-800 targeted telephone interviews in each state. Approximately 400 winter ride interviews were conducted in Wisconsin and Minnesota. A summary of the method for each survey is included. In Phase I, focus groups were conducted with drivers to get an initial indication of what the driving public believes in regards to pavements and to frame issues for inclusion in the more representative statewide surveys of drivers conducted in Phase II. Phase II interviews gathered information about improvement policy tradeoff issues and about preliminary thresholds of improvement in terms of physical pavement indices. In Phase III, a two step recruitment and post-drive interview procedure yielded thresholds of ride and condition index summarized for each state. Results show that, in general, the driving public wants longer lasting pavements and are willing to pay for them. They want to minimize construction delay, improve entire sections of highway at one time but they dislike detours, and prefer construction under traffic even if it stretches out construction time. Satisfaction with pavements does not correlate directly to a high degree with physical pavement indices, but was found instead to be a complex, multi-faceted phenomenon. A psychological model was applied to explain satisfaction to a respectable degree for the social sciences. Results also indicate a high degree of trust in the 3 DOTs which is enhanced when the public is asked for input on specific highway segments. Conclusions and recommendations include a 3-step methodology for other state studies.

Tackling Ageing Continence through Theory, Tools & Technology (TACT3)

The complexity of issues surrounding continence management, have been investigated by a UK multi-disciplinary research team working under the project title Tackling Ageing Continence through Theory Tools and Technology (TACT3). The team comprising engineers, chemists, health researchers, designers and social anthropologists is funded by the New Dynamics of Ageing Programme, ‘a seven year multidisciplinary research initiative with the ultimate aim of improving quality of life of older people. The programme is a unique collaboration between five UK Research Councils , and is the largest and most ambitious research programme on ageing ever mounted in the UK’ (www.newdynamics.group.shef.ac.uk). The TACT3 project comprises four work packages that are individually managed by members of the research team. One work package focuses solely on knowledge transfer of the research outputs and the management of the overall project. Another work package, entitled ‘Challenging Environmental Barriers’ has focused on the barriers in the built environment that prevent older people with continence concerns from participating in wider social life, namely access to publicly available toilet facilities. We also have a work package entitled ‘Improving Continence Interventions and Services’ which is exploring patient, carer and service providers experiences in receiving and delivering National Health Service (NHS) continence management treatments. The fourth workpackage ‘Developing Assistive Technologies’ has worked with users to develop devices that promote confidence, improve health and therefore may facilitate greater social interaction for older people with continence management concerns.

Evolution of an Interactive Online Magazine for Students, Academics and Expert Practitioners to Engage Students in ESD

Urgency to embed awareness of sustainability principles and practice across society, and need for digital literacy and advocacy for sustainability are reshaping ESD. These, together with developments in learning and teaching, demand new tools to support implementation of project-based learning and more interactive approaches. This investigation explores the evolution of susthingsout.com, an online magazine for students, academics and expert practitioners, developed by the University of Worcester. This comprises two parts; the first, a private site specifically for students involved in sustainability learning on-campus; the second, an open-access site developed to deliver sustainability information and good practice across campus, community and not-for-profit and commercial organisations. This paper involves only the private site i.e. the equivalent of an in-house VLE specifically designed to support the teaching of sustainability to multi-disciplinary first and second year undergraduate students. It reports on the progress of the VLE, following three years of use and initial improvements, in terms of the student support and engagement, as well as considering the practical issues affecting these. The results fall into four categories of pedagogical, operational, cultural and external factors, which are synthesised to capture and share emerging knowledge of good practice offering insights to other developers of online sustainability materials.

Understanding sound art practice: a multidisciplinary approach

Sound art has a fragmented scholarship struggling to find appropriate terminology to understand and explain itself. In this context the practitioner’s perspective is often marginalised. This thesis seeks to develop new perspectives on contemporary sound practice, informed by a multi-disciplinary approach to auditory scholarship and interviews with Australian sound practitioners. The model that emerges describes an ecology of contemporary sound art where practitioners continually negotiate disciplinary and institutional boundaries while articulating distinctive models of listening and conceptions of sound. This thesis proposes a theoretical approach to sound art that recognises its interdisciplinarity as well as a distinctive engagement with the embodied experience of sound and listening.

Context-awareness privacy in data communications

Internet users consume online targeted advertising based on information collected about them and voluntarily share personal information in social networks. Sensor information and data from smart-phones is collected and used by applications, sometimes in unclear ways. As it happens today with smartphones, in the near future sensors will be shipped in all types of connected devices, enabling ubiquitous information gathering from the physical environment, enabling the vision of Ambient Intelligence. The value of gathered data, if not obvious, can be harnessed through data mining techniques and put to use by enabling personalized and tailored services as well as business intelligence practices, fueling the digital economy. However, the ever-expanding information gathering and use undermines the privacy conceptions of the past. Natural social practices of managing privacy in daily relations are overridden by socially-awkward communication tools, service providers struggle with security issues resulting in harmful data leaks, governments use mass surveillance techniques, the incentives of the digital economy threaten consumer privacy, and the advancement of consumergrade data-gathering technology enables new inter-personal abuses. A wide range of fields attempts to address technology-related privacy problems, however they vary immensely in terms of assumptions, scope and approach. Privacy of future use cases is typically handled vertically, instead of building upon previous work that can be re-contextualized, while current privacy problems are typically addressed per type in a more focused way. Because significant effort was required to make sense of the relations and structure of privacy-related work, this thesis attempts to transmit a structured view of it. It is multi-disciplinary - from cryptography to economics, including distributed systems and information theory - and addresses privacy issues of different natures. As existing work is framed and discussed, the contributions to the state-of-theart done in the scope of this thesis are presented. The contributions add to five distinct areas: 1) identity in distributed systems; 2) future context-aware services; 3) event-based context management; 4) low-latency information flow control; 5) high-dimensional dataset anonymity. Finally, having laid out such landscape of the privacy-preserving work, the current and future privacy challenges are discussed, considering not only technical but also socio-economic perspectives.

Design, modelling, simulation and integration of cyber physical systems: methods and applications

The main drivers for the development and evolution of Cyber Physical Systems (CPS) are the reduction of development costs and time along with the enhancement of the designed products. The aim of this survey paper is to provide an overview of different types of system and the associated transition process from mechatronics to CPS and cloud-based (IoT) systems. It will further consider the requirement that methodologies for CPS-design should be part of a multi-disciplinary development process within which designers should focus not only on the separate physical and computational components, but also on their integration and interaction. Challenges related to CPS-design are therefore considered in the paper from the perspectives of the physical processes, computation and integration respectively. Illustrative case studies are selected from different system levels starting with the description of the overlaying concept of Cyber Physical Production Systems (CPPSs). The analysis and evaluation of the specific properties of a sub-system using a condition monitoring system, important for the maintenance purposes, is then given for a wind turbine.

Violence against Women Policy and Practice in Uganda - Promoting Justice within the Context of Patriarchy

The goal of this study was to understand how and whether policy and practice relating to violence against women in Uganda, especially Uganda’s Domestic Violence Act of 2010, have had an effect on women’s beliefs and practices, as well as on support and justice for women who experience abuse by their male partners. Research used multi-sited ethnography at transnational, national, and local levels to understand the context that affects what policies are developed, how they are implemented, and how, and whether, women benefit from these. Ethnography within a local community situated global and national dynamics within the lives of women. Women who experience VAW within their intimate partnerships in Uganda confront a political economy that undermines their access to justice, even as a women’s rights agenda is working to develop and implement laws, policies, and interventions that promote gender equality and women’s empowerment. This dissertation provides insights into the daily struggles of women who try to utilize policy that challenges duty bearers, in part because it is a new law, but also because it conflicts with the structural patriarchy that is engrained in Ugandan society. Two explanatory models were developed. One explains factors relating to a woman’s decision to seek support or to report domestic violence. The second explains why women do and do not report DV. Among the findings is that a woman is most likely to report abuse under the following circumstances: 1) her own, or her children’s survival (physical or economic) is severely threatened; 2) she experiences severe physical abuse; or, 3) she needs financial support for her children. Research highlights three supportive factors for women who persist in reporting DV. These are: 1) the presence of an “advocate” or support 2) belief that reporting will be helpful; and, 3) lack of interest in returning to the relationship. This dissertation speaks to the role that anthropologists can play in a multi-disciplinary approach to a complex issue. This role is understanding – deeply and holistically; and, articulating knowledge generated locally that provides connections between what happens at global, national and local levels.

The effect of ecological changes in Lake Victoria on the present trophic characteristics of Oreochromis niloticus in relation to the species' role as a stabilizing factor of biomanipulation

The Lake Victoria ecosystem has experienced such a profound ecological change that Oreochromis niloticus - an introduced species, is the only important cichlid (out of the original 250 + spp) left in the lake. It is the basis of an important commercial fishery which is intensely exploited by sophisticated methods. An investigation of its feeding habits at present indicates that the species could also playa major role in the energy flux of the lake. Fisheries management in Lake Victoria will thus require multi-disciplinary studies which reflect a total ecosystem approach.

Optimising plant bed performance through adaptive research with the Australian sweetpotato industry

A key driver of Australian sweetpotato productivity improvements and consumer demand has been industry adoption of disease-free planting material systems. On a farm isolated from main Australian sweetpotato areas, virus-free germplasm is annually multiplied, with subsequent 'pathogen-tested' (PT) sweetpotato roots shipped to commercial Australian sweetpotato growers. They in turn plant their PT roots into specially designated plant beds, commencing in late winter. From these beds, they cut sprouts as the basis for their commercial fields. Along with other intense agronomic practices, this system enables Australian producers to achieve worldRSQUOs highest commercial yields (per hectare) of premium sweetpotatoes. Their industry organisation, ASPG (Australian Sweetpotato Growers Inc.), has identified productivity of mother plant beds as a key driver of crop performance. Growers and scientists are currently collaborating to investigate issues such as catastrophic plant beds losses; optimisation of irrigation and nutrient addition; rapidity and uniformity of initial plant bed harvests; optimal plant bed harvest techniques; virus re-infection of plant beds; and practical longevity of plant beds. A survey of 50 sweetpotato growers in Queensland and New South Wales identified a substantial diversity in current plant bed systems, apparently influenced by growing district, scale of operation, time of planting, and machinery/labour availability. Growers identified key areas for plant bed research as: optimising the size and grading specifications of PT roots supplied for the plant beds; change in sprout density, vigour and performance through sequential cuttings of the plant bed; optimal height above ground level to cut sprouts to maximise commercial crop and plant bed performance; and use of structures and soil amendments in plant bed systems. Our ongoing multi-disciplinary research program integrates detailed agronomic experiments, grower adaptive learning sites, product quality and consumer research, to enhance industry capacity for inspired innovation and commercial, sustainable practice change.

Using an end-of-life care pathway in acute stroke: a mixed methods study of decision-making and care experiences

Background: The evidence base on end-of-life care in acute stroke is limited, particularly with regard to recognising dying and related decision-making. There is also limited evidence to support the use of end-of-life care pathways (standardised care plans) for patients who are dying after stroke. Aim: This study aimed to explore the clinical decision-making involved in placing patients on an end-of-life care pathway, evaluate predictors of care pathway use, and investigate the role of families in decision-making. The study also aimed to examine experiences of end-of-life care pathway use for stroke patients, their relatives and the multi-disciplinary health care team. Methods: A mixed methods design was adopted. Data were collected in four Scottish acute stroke units. Case-notes were identified prospectively from 100 consecutive stroke deaths and reviewed. Multivariate analysis was performed on case-note data. Semi-structured interviews were conducted with 17 relatives of stroke decedents and 23 healthcare professionals, using a modified grounded theory approach to collect and analyse data. The VOICES survey tool was also administered to the bereaved relatives and data were analysed using descriptive statistics and thematic analysis of free-text responses. Results: Relatives often played an important role in influencing aspects of end-of-life care, including decisions to use an end-of-life care pathway. Some relatives experienced enduring distress with their perceived responsibility for care decisions. Relatives felt unprepared for and were distressed by prolonged dying processes, which were often associated with severe dysphagia. Pro-active information-giving by staff was reported as supportive by relatives. Healthcare professionals generally avoided discussing place of care with families. Decisions to use an end-of-life care pathway were not predicted by patients’ demographic characteristics; decisions were generally made in consultation with families and the extended health care team, and were made within regular working hours. Conclusion: Distressing stroke-related issues were more prominent in participants’ accounts than concerns with the end-of-life care pathway used. Relatives sometimes perceived themselves as responsible for important clinical decisions. Witnessing prolonged dying processes was difficult for healthcare professionals and families, particularly in relation to the management of persistent major swallowing difficulties.

Agent based simulation as a novel decision support tool for retail managers

Intelligent agents offer a new and exciting way of understanding the world of work. We apply agent-based simulation to investigate a set of problems in a retail context. Specifically, we are working to understand the relationship between human resource management practices and retail productivity. Our multi-disciplinary research team draws upon expertise from work psychologists and computer scientists. Our research so far has led us to conduct case study work with a top ten UK retailer. Based on our case study experience and data we are developing a simulator that can be used to investigate the impact of management practices (e.g. training, empowerment, teamwork) on customer satisfaction and retail productivity.

Modelling and simulating retail management practices: a first approach

Multi-agent systems offer a new and exciting way of understanding the world of work. We apply agent-based modeling and simulation to investigate a set of problems in a retail context. Specifically, we are working to understand the relationship between people management practices on the shop-floor and retail performance. Despite the fact we are working within a relatively novel and complex domain, it is clear that using an agent-based approach offers great potential for improving organizational capabilities in the future. Our multi-disciplinary research team has worked closely with one of the UK’s top ten retailers to collect data and build an understanding of shop-floor operations and the key actors in a department (customers, staff, and managers). Based on this case study we have built and tested our first version of a retail branch agent-based simulation model where we have focused on how we can simulate the effects of people management practices on customer satisfaction and sales. In our experiments we have looked at employee development and cashier empowerment as two examples of shop floor management practices. In this paper we describe the underlying conceptual ideas and the features of our simulation model. We present a selection of experiments we have conducted in order to validate our simulation model and to show its potential for answering “what-if” questions in a retail context. We also introduce a novel performance measure which we have created to quantify customers’ satisfaction with service, based on their individual shopping experiences.