Factors influencing the success of rural cataract surgery programs in China:The study of hospital administration and relative productivity (SHARP)

PURPOSE. To explore factors potentially influencing the success or failure of rural Chinese hospitals in increasing cataract surgical output and quality. METHODS. Focus groups (FGs, n = 10) were conducted with hospital administrators, doctors, and nurses at 28 county hospitals in Guangdong Province. Discussions explored respondents' views on increasing surgical volume and quality and improving patient satisfaction. Respondents numerically ranked possible strategies to increase surgical volume and quality and patient satisfaction. FG transcripts were independently coded by two reviewers utilizing the constant comparative method following the grounded theory approach, and numerical responses were scored and ranked. RESULTS. Ten FGs and 77 ranking questionnaires were completed by 33 administrators, 23 doctors, and 21 nurses. Kappa values for the two coders were greater than 0.7 for all three groups. All groups identified a critical need for enhanced management training for hospital directors. Doctors and nurses suggested reducing surgical fees to enhance uptake, although administrators were resistant to this. Although doctors saw the need to improve equipment, administrators felt current material conditions were adequate. Respondents agreed that patient satisfaction was generally high, and did not view increasing patient satisfaction as a priority. CONCLUSIONS. Our findings highlight agreements and disagreements among the three stakeholder groups about improving surgical output and quality, which can inform strategies to improve cataract programs in rural China. Respondents' beliefs about high patient satisfaction are not in accord with other studies in the area, highlighting a potential area for intervention. © 2013 The Association for Research in Vision and Ophthalmology, Inc.

Beach quality assessment and management in the Sotavento (Eastern) Algarve, Portugal

The purpose of this study on beach quality assessment and management was to evaluate the quality of five beaches in the Algarve Sotavento region of Portugal and to identify beach users’ preferences and priorities regarding their visit to a beach. The Algarve is one of the country’s most internationally known regions and it is generally perceived as a major tourist destination. Because of the increasing level of tourists, there is a specific need to address beach quality, as overcrowding can result in excessive litter, reduce water quality and consequently reduce the socio-economic value of the area. The main methodology for the evaluation of the beach quality in this pilot project was the Bathing Area Registration and Evaluation framework (BARE), which recognizes five beach types (rural, remote, resort, urban and village) through five main priority issues of concern to beach users (water quality, scenery, litter, safety, facilities) and evaluates the beach quality, ranging from one (low) to five (high) stars. After overall bathing area classification, Quarteira-Vilamoura, Ilha do Farol, Ilha Deserta and Ilha da Armona received three-star rating and Quinta do Lago site obtained a one-star rating. The quantitative research data on beach users’ preferences and priorities was obtained through administration of 50 questionnaires per beach and showed that beach users at all sites expressed the need for improved cleanliness, safety and facilities on the beach. The BARE framework, together with the questionnaire surveys, allowed the identification of management priorities required to improve the quality of individual beaches and therefore increase income from tourism.

Evolution or extinction? Reflections on the future of research in educational leadership and management

Consideration of the quality, relevance and utility of research in educational leadership and management has been a growing concern of researchers, policy-makers and practitioners, but there is little agreement about its current state or priorities for development. The article reflects on the key criticisms that have been made of research in educational leadership and management in this issue, and elsewhere. It considers how we might begin to devise better ways of understanding its audiences, judging its quality and identifying priorities for the future. It argues that the research reflects its capture by those with particular interests or values, and impacts in ways which are complex and indirect. If educational leadership and management research is to be secure in its perceived value and contribution in the future, several developments are needed, including a greater emphasis on interdisciplinarity, an expansion of the range of methodologies, particularly qualtitative studies; and these shifts must be evident in training researchers as well as in the conduct of research.

Recent trends in UK Government policy on the provision and management of leisure facilities

Since the first election victory of the Thatcher administration in 1979, Britain has witnessed a cultural transformation from the municipal socialism of the post-World War 2 Welfare State to a form of post-industrial entrepreneurialism. This has had a profound effect on all aspects of civil society, not least the redefinition of the role of active leisure from the 1950s evocation of 'Sport For All' to the market rationality of the 1980s. The transformation has signalled a shift from government support for active leisure as an element of citizen rights to the use of leisure to promote the government's interest in legitimating a new social order based not on rights but on means. Thus access to active living is no longer a societal goal for all, but a discretionary consumer good, the consumption of which signifies 'active' citizenship. It furthermore signifies differentiation from the growing mass of 'deviants' who are unwilling or unable to embrace this new construction of citizenship and are, therefore, increasingly denied access to active living and, hence, active citizenship.

Construction contracts: law and management. 4th edition

This is a fully revised edition of the UK’s leading textbook on the law governing construction contracts and the management and administration of those contracts. Although the legal principles involved are an aspect of general contract law, the practical and commercial complexities of the construction industry have increasingly made this a specialist area. This new edition has been brought up to date with recent cases and developments in the law as it stands at March 2007. The basic approach of the book has been retained. Rather than provide a commentary on standard-form contracts, our approach is to introduce the general principles that underlie contracts in construction, illustrating them by reference to the most important standard forms currently in use. Some of the common standard-form contracts have been revised since the previous edition, and the text has been revised to take account of these changes. Practitioners (consultants, builders, clients and lawyers) will find this an extremely useful source of reference, providing in-depth explanations for all of the features found in contemporary construction contracts, with reasons. A unique feature of this book is the way that it brings together the relevant principles of law with the practical issues arising in construction cases. It is a key text for construction undergraduates and postgraduates as well as for those taking the RIBA Part III and CIOB Part II examinations.

Observation of pain assessment and management- the complexities of clinical practice

• Pain assessment and management are complex issues that embrace physiological, emotional, cognitive, and social dimensions.

• This observational study sought to investigate nurse–patient interactions associated with pain assessment and management in hospitalized postsurgical patients in clinical practice settings.

• Twelve field observations were carried out on Registered Nurses' activities relating to pain with their assigned patients. All nurses were involved in direct patient care in one surgical unit of a metropolitan teaching hospital in Melbourne, Australia. Six observation times were identified as key periods for activities relating to pain, which included change of shift and high activity periods. Each observation period lasted 2 hours and was examined on two occasions.

• Four major themes were identified as barriers to effective pain management: nurses' responses to interruptions of activities relating to pain, nurses' attentiveness to patient cues of pain, nurses' varying interpretations of pain, and nurses' attempts to address competing demands of nurses, doctors and patients.

• These findings provide some understanding of the complexities impacting on nurses' assessment and management of postoperative pain. Further research using this observational methodology is indicated to examine these influences in more depth. This knowledge may form the basis for developing and evaluating strategic intervention programmes that analyse nurses' management of postoperative pain and, in particular, their administration of opioid analgesics.

Aesthetic dimensions of educational administration and leadership

The Aesthetic Dimensions of Educational Administration and Leadership provides an aesthetic critique of educational administration and leadership. It demonstrates the importance of aesthetics on all aspects of the administrative and leadership world: the ways ideas and ideals are created, how their expression is conveyed, the impact they have on interpersonal relationships and the organizational environment that carries and reinforces them, and the moral boundaries or limits that can be established or exceeded.

The book is divided into three sections.
Section I examines various philosophical traditions in aesthetics as they inform administrative life, focussing on major modern traditions arising from Kant, romanticism and Nietzsche, Collingwood, the pragmatic school, and critical theory.
Section II explores four aesthetic sources for administrative critique - architecture, literature, film, and movement - as they serve both to understand the social construction of administration and leadership and provide a critique of values, roles, power and authority.
Section III examines more topical and applied problems of charisma, heroism, and authority in practice, concluding with a discussion of the aesthetic analysis of politics and power within the context of contemporary educational administration and leadership theory.

While presenting a significant departure from conventional studies in the field, the international contributors reflect a continuity of thought on the creation, use and abuse of administrative and leadership authority from the writings of Plato through to contemporary theory. This book should appeal to school administrators and leaders and those aspiring to these roles.

Pandemic containment and management

In a pandemic, nurses will be the first health care contact for the general public in most cases. This clinical update provides information about the influenza virtus and its modes of transmission. The update will describe the principles of containment and management that will be important to understand in the event of a pandemic occurring.

Malnutrition: significance, prevalence and management of the hospitalised surgery patient

Malnutrition is prevalent and poorly diagnosed in hospitalised patients, with high rates of malnutrition seen in surgical patients. The administration of a specialised immuno-nutrition supplement is beneficial for malnourished patients undergoing gastrointestinal surgery, and a multidisciplinary team approach improves nutritional care for patients.

Brazilian consensus on gastroesophageal reflux disease: Proposals for assessment, classification, and management

The Brazilian Consensus on Gastroesophageal Reflux Disease considers gastroesophageal reflux disease to be a chronic disorder related to the retrograde flow of gastroduodenal contents into the esophagus and/or adjacent organs, resulting in a variable spectrum of symptoms, with or without tissue damage. Considering the limitations of classifications currently in use, a new classification is proposed that combines three criteria - clinical, endoscopic, and pH-metric - providing a comprehensive and more complete characterization of the disease. The diagnosis begins with the presence of heartburn, acid regurgitation, and alarm manifestations (dysphagia, odynophagia, weight loss, GI bleeding, nausea and/or vomiting, and family history of cancer). Also, atypical esophageal, pulmonary, otorhinolaryngological, and oral symptoms may occur. Endoscopy is the first approach, particularly in patients over 40 yr of age and in those with alarm symptoms. Other exams are considered in particular cases, such as contrast radiological examination, scyntigraphy, manometry, and prolonged pH measurement. The clinical treatment encompasses behavioral modifications in lifestyle and pharmacological measures. Proton pump inhibitors in manufacturers' recommended doses are indicated, with doubling of the dose in more severe cases of esophagitis. The minimum time of administration is 6 wk. Patients who do not respond to medical treatment, including those with atypical manifestations, should be considered for surgical treatment. Of the complications of gastroesophageal reflux disease, Barrett's esophagus presents a potential development of adenocarcinoma; biopsies should be performed, independent of Barrett's esophagus extent or location. In this regard the designation short Barrett's is not important in terms of management and prognosis. © 2002 by Am. Coll. of Gastroenterology.

Pain in photodynamic therapy: mechanism of action and management strategies

Photodynamic therapy involves administration of a photosensitizing drug and its subsequent activation by irradiation with a light source at wavelengths matching the absorption spectrum of the photosensitizer. In many countries around the world, topical photodynamic therapy has been approved for treatment of cutaneous oncologic conditions such as actinic keratosis, Bowen's disease, and superficial basal cell carcinoma. Multicenter, randomized, controlled studies have confirmed its efficacy and superior cosmetic outcomes compared to conventional therapies. Nevertheless, this therapeutic method presents some adverse effects, such as erythema, edema, pigmentation, pustules, and pain. There is no doubt that pain is the most severe of the adverse effects, being sometimes responsible for definitive treatment interruption. The pain mechanism has not yet been fully understood, which makes complete pain control a challenge to be conquered. In spite of that, this literature review presents some useful pain management strategies as well as the most important pain-related factors in photodynamic therapy.

ADAM: Administration and Deployment of Adhoc Mesh Networks

Costly on-site node repairs in wireless mesh networks (WMNs) can be required due to misconfiguration, corrupt software updates, or unavailability during updates. We propose ADAM as a novel management framework that guarantees accessibility of individual nodes in these situations. ADAM uses a decentralised distribution mechanism and self-healing mechanisms for safe configuration and software updates. In order to implement the ADAM management and self-healing mechanisms, an easy-to-learn and extendable build system for a small footprint embedded Linux distribution for WMNs has been developed. The paper presents the ADAM concept, the build system for the Linux distribution and the management architecture.

Perceptions of water conditions and management in the Sonora River Basin, Sonora, Mexico

The effects of climate change are expected to be very severe in arid regions. The Sonora River Basin, in the northwestern state of Sonora, Mexico, is likely to be severely affected. Some of the anticipated effects include precipitation variability, intense storm events, higher overall temperatures, and less available water. In addition, population in Sonora, specifically the capital city of Hermosillo, is increasing at a 1.5% rate and current populations are near 700,000. With the reduction in water availability and an increase in population, Sonora, Mexico is expected to experience severe water resource issues in the near future. In anticipation of these changes, research is being conducted in an attempt to improve water management in the Sonora River Basin, located in the northwestern part of Sonora. This research involves participatory modeling techniques designed to increase water manager awareness of hydrological models and their use as integrative tools for water resource management. This study was conducted as preliminary research for the participatory modeling grant in order to gather useful information on the population being studied. This thesis presents research from thirty-four in-depth interviews with water managers, citizens, and agricultural producers in Sonora, Mexico. Data was collected on perceptions of water quantity and quality in the basin, thoughts on current water management practices, perceptions of climate change and its management, experience with, knowledge of, and trust in hydrological models as water management tools. Results showed that the majority of interviewees thought there was not enough water to satisfy their daily needs. Most respondents also agreed that the water available was of good quality, but that current management of water resources was ineffective. Nearly all interviewees were aware of climate change and thought it to be anthropogenic. May reported experiencing higher temperatures, precipitation changes, and higher water scarcity and attributed those fluctuations to climate change. 65% of interviewees were at least somewhat familiar with hydrological models, though only 28% had ever used them or their output. Even with model usage results being low, 100% of respondents believed hydrological models to be very useful water management tools. Understanding how water, climate change, and hydrological models are perceived by this population of people is essential to improving their water management practices in the face of climate change.

Family Business in Mexico: Responses to Human Resource Limitations and Management Succession

Indigenous firms in Mexico, as in most developing countries, take the shape of family businesses. Regardless of size, the most predominant ones are those owned and managed by one or more families or descendent families of the founders. From the point of view of economics and business administration, family business is considered to have variety of limitations when it seeks to grow. One of the serious limitations is concerning human resource, which is revealed at the time of management succession. Big family businesses in Mexico deal with human resource limitations adopting measures such as the education and training of the successors, the establishment of management structure that makes control by the owner family possible and divisions of roles among the owner family members, and between the owner family members and the salaried managers. Institutionalization is a strategy that considerable number of family businesses have adopted in order to undergo the succession process without committing serious errors. Institutionalization is observed in such aspects as the establishment of the requisite condition to be met by the candidate of future successor and the screening by an institution which is independent of the owner family. At present these measures allow for the continuation of family businesses in an extremely competitive environment.