Shared-decision making in designing new healthcare environments : ready to take off for improved quality

Background Successful implementation of new methods and models of healthcare to achieve better patient outcomes and safe, person-centered care is dependent on the physical environment of the healthcare architecture in which the healthcare is provided. Thus, decisions concerning healthcare architecture are critical because it affects people and work processes for many years and requires a long-term financial commitment from society. In this paper, we describe and suggest several strategies (critical factors) to promote shared-decision making when planning and designing new healthcare environments. Discussion This paper discusses challenges and hindrances observed in the literature and from the authors extensive experiences in the field of planning and designing healthcare environments. An overview is presented of the challenges and new approaches for a process that involves the mutual exchange of knowledge among various stakeholders. Additionally, design approaches that balance the influence of specific and local requirements with general knowledge and evidence that should be encouraged are discussed. Summary We suggest a shared-decision making and collaborative planning and design process between representatives from healthcare, construction sector and architecture based on evidence and end-users’ perspectives. If carefully and systematically applied, this approach will support and develop a framework for creating high quality healthcare environments.

A conceptual model for sport services marketing research : integrating quality, value and satisfaction

This paper advances our understanding of the relationship between quality, value and satisfaction in the context of spectator sport services. This is achieved through an analysis and examination of relevant secondary data culminating in a conceptual model Although extensive research has been conducted in the three separate areas of quality, value and satisfaction, to date no work has been reported attempting to develop macro models that capture the concepts and their potential interrelationships. Such macro models could enhance the communication and stimulate further research for sport marketing scholars. This paper proposes a model apposite for further research and in the process leads to the potential confirmation, rejection or, indeed, adaptation of the conceplualization of sport services.

Moving from the quality of life concept to a theory

BACKGROUND: The Special Interest Quality of Life Group has updated its set of statements defining the quality of life (QOL) construct to reflect emerging areas of agreement and the framework for understanding better the QOL construct.
METHOD: This article examines the major areas currently under discussion involving the objective-subjective dichotomy, needs, and core domains.
RESULTS: It is concluded that while the new statements constitute a significant advance, further progress requires testable theory. In order to facilitate such future research, a conceptual model is proposed that distinguishes causal and indicator variables within the framework of a homeostatic management system.
CONCLUSION: Several lines of empirical investigation are suggested to test this and similar theoretical models with a view to taking our conceptualization of QOL to the next level.

Quantitative microbial risk assessment models for consumption of raw vegetables irrigated with reclaimed water

Quantitative microbial risk assessment models for estimating the annual risk of enteric virus infection associated with consuming raw vegetables that have been overhead irrigated with nondisinfected secondary treated reclaimed water were constructed. We ran models for several different scenarios of crop type, viral concentration in effluent, and time since last irrigation event. The mean annual risk of infection was always less for cucumber than for broccoli, cabbage, or lettuce. Across the various crops, effluent qualities, and viral decay rates considered, the annual risk of infection ranged from 10–3 to 10–1 when reclaimed-water irrigation ceased 1 day before harvest and from 10–9 to 10–3 when it ceased 2 weeks before harvest. Two previously published decay coefficients were used to describe the die-off of viruses in the environment. For all combinations of crop type and effluent quality, application of the more aggressive decay coefficient led to annual risks of infection that satisfied the commonly propounded benchmark of ≤10–4, i.e., one infection or less per 10,000 people per year, providing that 14 days had elapsed since irrigation with reclaimed water. Conversely, this benchmark was not attained for any combination of crop and water quality when this withholding period was 1 day. The lower decay rate conferred markedly less protection, with broccoli and cucumber being the only crops satisfying the 10–4 standard for all water qualities after a 14-day withholding period. Sensitivity analyses on the models revealed that in nearly all cases, variation in the amount of produce consumed had the most significant effect on the total uncertainty surrounding the estimate of annual infection risk. The models presented cover what would generally be considered to be worst-case scenarios: overhead irrigation and consumption of vegetables raw. Practices such as subsurface, furrow, or drip irrigation and postharvest washing/disinfection and food preparation could substantially lower risks and need to be considered in future models, particularly for developed nations where these extra risk reduction measures are more common.

Concepts, models and analyses of electronic demolition of buildings

The demolition of building structures produces enormous amounts of waste materials. In most current demolition projects, a great number of demolished materials are directly sent to landfill after their primary usage due to the difficulties in finding their next usage immediately. At the same time, because of limited supply of second-hand materials, new and high quality materials are used in construction projects whose design standards can be fitted using the secondary or used materials. However, this is an inefficient method to reduce waste because off the flow nature of the current waste-exchange systems and the demolition procedure. The recent concept using deconstruction rather than destruction for demolishing a constructed facility fails to achieve widespread understanding or acceptance due to various practical limitations. In this paper, for the purpose of envisaging the deconstruction implementations in practice and promoting cascading usages of construction materials, the concept of electronic demolition (e-Demotion, eDemolition) is put forward for the first time. E-demolition is a virtual demolition approach by which the demolition information, progress and outputs are operated before the physical demolition. Furthermore, the authors set up the essential models to implement electronic demolition of buildings from the viewpoints of demolition progress, business, and information. Each model is demonstrated in accord with the conventional demolition practice and subject to the ideal deconstruction implementation. Following the electronic demolition of a real project, the physical demolition can be anticipated with a minimum of construction waste emission.

Conceptualization, measurement, and application of quality of life for persons with intellectual disabilities: report of an international panel of experts

In this article a number of issues involving the concept of quality of life as applied to persons with intellectual disabilities are summarized, and a number of agreed-upon principles regarding its conceptualization, measurement, and application are presented. We realize that the concepts and models presented in this article will vary potentially from country to country, and even from area to area within countries. The cross-cultural understanding of the concept of quality of life is in its infancy, and we hope that the discourses resulting from the material presented in this article will facilitate both cross-cultural understanding and collaborative work. The article reflects current thought about the conceptualization, measurement, and application of this increasingly important and widely used concept in the field of intellectual disabilities and sets the stage for its continuing development.

Quality of internal control procedures : antecedents and moderating effect on organisational justice and employee fraud

Purpose – This study aims to bring together theoretical concepts from the organizational justice, internal control and fraud literature to develop two distinct models relating to employee fraud and the quality of internal control procedures (ICP), respectively.

Design/methodology/approach – Survey data from 64 Australian firms were used to develop the two models. The first model was tested using a logistic regression analysis, and the second model was tested using a multiple regression analysis.

Findings – The first model reveals that the quality of ICP has a moderating effect on the relationship between perceptions of organizational justice and employee fraud. The second model indicates that ICP quality is significantly and positively related to three key organizational factors: the corporate ethical environment, the extent of risk management training of staff, and the internal audit (IA) activity level.

Practical implications – Risk management strategies relating to employee fraud will need to pay greater attention to organizational factors that affect both perceptions of justice at the workplace and ICP quality, including fostering a more ethical and equitable work environment, increasing IA activities and staff training in risk management.

Originality/value – Using the fraud triangle framework, this study extends previous literature by providing empirical evidence on the role of organizational justice and ICP regarding employee fraud.

Towards development of a quality cost model for automotive stamping

The current work used discrete event simulation techniques to model the economics of quality within an actual automotive stamping plant. Automotive stamping is a complex, capital intensive process requiring part-specific tooling and specialised machinery. Quality control and quality improvement is difficult in the stamping environment due to the general lack of process understanding and the large number to interacting variables. These factors have prevented the widespread use of statistical process control. In this work, a model of the quality control techniques used at the Ford Geelong Stamping plant is developed and indirectly validated against results from production. To date, most discrete event models are of systems where the quality control process is clearly defined by the rules of statistical process control. However, the quality control technique used within the stamping plant is for the operator to perform a 100% visual inspection while unloading the finished panels. In the developed model, control is enacted after a cumulative count of defective items is observed, thereby approximating the operator who allows a number of defective panels to accumulate before resetting the line. Analysis of this model found that the cost sensitivity to inspection error is dependent upon the level of control and that the level of control determines line utilisation. Additional analysis of this model demonstrated that additional inspection processes would lead to more stable cost structures but these structures many not necessarily be lower cost. The model was subsequently applied to investigate the economics of quality improvement. The quality problem of panel blemishes, induced by slivers (small metal fragments), was chosen as a case stuffy. Errors of 20-30% were observed during direct validation of the cost model and it was concluded that the use of discrete event simulation models for applications requiring high accuracy would not be possible unless the production system was of low complexity. However, the model could be used to evaluate the sensitivity of input factors and investigating the effects of a number of potential improvement opportunities. Therefore, the research concluded that it is possible to use discrete event simulation to determine the quality economics of an actual stamping plant. However, limitations imposed by inability of the model to consider a number of external factors, such as continuous improvement, operator working conditions or wear and the lack of reliable quality data, result in low cost accuracy. Despite this, it still can be demonstrated that discrete event simulation has significant benefits over the alternate modelling methods.

Water quality modelling of the Barwon Water Supply System

An existing computer model (QUAL2E) was adapted to simulate the flow and water quality of the Barwon Water Supply System, the major water supply system for Geelong. Various water quality parameters were modelled and options reviewed for improving the water quality in this System.

Comparing multiple discrepancies theory to affective models of subjective wellbeing

The Subjective Wellbeing (SWB) literature is replete with competing theories detailing the mechanisms underlying the construction and maintenance of SWB. The current study aimed to compare and contrast two of these approaches: multiple discrepancies theory (MDT) and an affective-cognitive theory of SWB. MDT posits SWB to be the result of perceived discrepancies between multiple standards of comparison. By contrast, affective-cognitive theory asserts that SWB is primarily influenced by trait affect, and indirectly influenced by personality and cognition through trait affect. Participants comprised 387 individuals who responded to the 5th longitudinal survey of the Australian Unity Wellbeing Index. Results of Structural Equation Modelling (SEM) indicated the poorest fit to the data for the MDT model. The affective-cognitive model also did not provide a good fit to the data. A purely affective model provided the best fit to the data, was the most parsimonious, and explained 66% of variance in SWB.

Longer guts and higher food quality increase energy intake in migratory swans

1.  Within the broad field of optimal foraging, it is increasingly acknowledged that animals often face digestive constraints rather than constraints on rates of food collection. This therefore calls for a formalization of how animals could optimize food absorption rates.

2.  Here we generate predictions from a simple graphical optimal digestion model for foragers that aim to maximize their (true) metabolizable food intake over total time (i.e. including nonforaging bouts) under a digestive constraint.

3.  The model predicts that such foragers should maintain a constant food retention time, even if gut length or food quality changes. For phenotypically flexible foragers, which are able to change the size of their digestive machinery, this means that an increase in gut length should go hand in hand with an increase in gross intake rate. It also means that better quality food should be digested more efficiently.

4.  These latter two predictions are tested in a large avian long-distance migrant, the Bewick's swan (Cygnus columbianus bewickii), feeding on grasslands in its Dutch wintering quarters.

5.  Throughout winter, free-ranging Bewick's swans, growing a longer gut and experiencing improved food quality, increased their gross intake rate (i.e. bite rate) and showed a higher digestive efficiency. These responses were in accordance with the model and suggest maintenance of a constant food retention time.

6.  These changes doubled the birds’ absorption rate. Had only food quality changed (and not gut length), then absorption rate would have increased by only 67%; absorption rate would have increased by only 17% had only gut length changed (and not food quality).

7.  The prediction that gross intake rate should go up with gut length parallels the mechanism included in some proximate models of foraging that feeding motivation scales inversely to gut fullness. We plea for a tighter integration between ultimate and proximate foraging models.

Family relationship quality and early alcohol use : evidence for gender-specific risk processes

Objective: Family characteristics (relationship quality, parental behaviors, and attitudes relating to alcohol use) are known to influence alcohol use in the mid-teen years, and there is evidence that family characteristics have different influences on mid-teen girls versus boys. This study examined child gender differences in the association of family relationship quality, parental disapproval of children's alcohol use, and parental alcohol use with early adolescent alcohol use.

Method: Grade 6 and 8 students (modal age 11 and 13, respectively; N = 6,837; 52.6% female) were recruited from 231 schools across three Australian states. Hypotheses were tested using two-level ordinal logistic regression (individuals nested within schools). The main dependent measure was lifetime frequency of early adolescent alcohol consumption. Independent variables included mother's/father's alcohol use, closeness, conflict, and disapproval of adolescent alcohol use. Control variables included sensation seeking, peer alcohol use, and socioeconomic disadvantage.

Results: The key findings were that for the young age group (Grade 6), emotional closeness to the parent of the opposite sex was protective. Family conflict was associated with females' drinking in both age groups but not males' drinking.

Conclusions: There was evidence of gender differences in the epidemiology of family relationship quality and early alcohol use. Social developmental models may need revision to account for these child gender differences. Gender-specific family dynamics may be an important consideration for family-oriented prevention strategy.

Suitability of chlorine bulk decay models for planning and management of water distribution systems

Effective disinfection planning and management in large, complex water distribution systems requires an accurate network water quality model. This model should be based on reaction kinetics, which describes disinfectant loss from bulk water over time, within experimental error. Models in the literature were reviewed for their ability to meet this requirement in real networks. Essential features were identified as accuracy, simplicity, computational efficiency, and ability to describe consistently the effects of initial chlorine dose, temperature variation, and successive rechlorinations. A reaction scheme of two organic constituents reacting with free chlorine was found to be necessary and sufficient to provide the required features. Recent release of the multispecies extension (MSX) to EPANET and MWH Soft's H2OMap Water MSX network software enables users to implement this and other multiple-reactant bulk decay models in real system simulations.

Statistical models for cancer screening

This paper reviews the application of statistical models to planning and evaluating cancer screening programmes. Models used to analyse screening strategies can be classified as either surface models, which consider only those events which can be directly observed such as disease incidence, prevalence or mortality, or deep models, which incorporate hypotheses about the disease process that generates the observed events. This paper focuses on the latter type. These can be further classified as analytic models, which use a model of the disease to derive direct estimates of characteristics of the screening procedure and its consequent benefits, and simulation models, which use the disease model to simulate the course of the disease in a hypothetical population with and without screening and derive measures of the benefit of screening from the simulation outcomes. The main approaches to each type of model are described and an overview given of their historical development and strengths and weaknesses. A brief review of fitting and validating such models is given and finally a discussion of the current state of, and likely future trends in, cancer screening models is presented.