A proposed systems approach to the evaluation of integrated palliative care

Background. There is increasing global interest in regional palliative care networks (PCN) to integrate care, creating systems that are more cost-effective and responsive in multi-agency settings. Networks are particularly relevant where different professional skill sets are required to serve the broad spectrum of end-of-life needs. We propose a comprehensive framework for evaluating PCNs, focusing on the nature and extent of inter-professional collaboration, community readiness, and client-centred care. Methods. In the absence of an overarching structure for examining PCNs, a framework was developed based on previous models of health system evaluation, explicit theory, and the research literature relevant to PCN functioning. This research evidence was used to substantiate the choice of model factors. Results. The proposed framework takes a systems approach with system structure, process of care, and patient outcomes levels of consideration. Each factor represented makes an independent contribution to the description and assessment of the network. Conclusions. Realizing palliative patients' needs for complex packages of treatment and social support, in a seamless, cost-effective manner, are major drivers of the impetus for network-integrated care. The framework proposed is a first step to guide evaluation to inform the development of appropriate strategies to further promote collaboration within the PCN and, ultimately, optimal palliative care that meets patients' needs and expectations. © 2010 Bainbridge et al; licensee BioMed Central Ltd.

Robust food supply supply chains:An integrated framework for vulnerability assessment and disturbance management

The operation of supply chains (SCs) has for many years been focused on efficiency, leanness and responsiveness. This has resulted in reduced slack in operations, compressed cycle times, increased productivity and minimised inventory levels along the SC. Combined with tight tolerance settings for the realisation of logistics and production processes, this has led to SC performances that are frequently not robust. SCs are becoming increasingly vulnerable to disturbances, which can decrease the competitive power of the entire chain in the market. Moreover, in the case of food SCs non-robust performances may ultimately result in empty shelves in grocery stores and supermarkets.
The overall objective of this research is to contribute to Supply Chain Management (SCM) theory by developing a structured approach to assess SC vulnerability, so that robust performances of food SCs can be assured. We also aim to help companies in the food industry to evaluate their current state of vulnerability, and to improve their performance robustness through a better understanding of vulnerability issues. The following research questions (RQs) stem from these objectives:
RQ1: What are the main research challenges related to (food) SC robustness?
RQ2: What are the main elements that have to be considered in the design of robust SCs and what are the relationships between these elements?
RQ3: What is the relationship between the contextual factors of food SCs and the use of disturbance management principles?
RQ4: How to systematically assess the impact of disturbances in (food) SC processes on the robustness of (food) SC performances?
To answer these RQs we used different methodologies, both qualitative and quantitative. For each question, we conducted a literature survey to identify gaps in existing research and define the state of the art of knowledge on the related topics. For the second and third RQ, we conducted both exploration and testing on selected case studies. Finally, to obtain more detailed answers to the fourth question, we used simulation modelling and scenario analysis for vulnerability assessment.
Main findings are summarised as follows.
Based on an extensive literature review, we answered RQ1. The main research challenges were related to the need to define SC robustness more precisely, to identify and classify disturbances and their causes in the context of the specific characteristics of SCs and to make a systematic overview of (re)design strategies that may improve SC robustness. Also, we found that it is useful to be able to discriminate between varying degrees of SC vulnerability and to find a measure that quantifies the extent to which a company or SC shows robust performances when exposed to disturbances.
To address RQ2, we define SC robustness as the degree to which a SC shows an acceptable performance in (each of) its Key Performance Indicators (KPIs) during and after an unexpected event that caused a disturbance in one or more logistics processes. Based on the SCM literature we identified the main elements needed to achieve robust performances and structured them together to form a conceptual framework for the design of robust SCs. We then explained the logic of the framework and elaborate on each of its main elements: the SC scenario, SC disturbances, SC performance, sources of food SC vulnerability, and redesign principles and strategies.
Based on three case studies, we answered RQ3. Our major findings show that the contextual factors have a consistent relationship to Disturbance Management Principles (DMPs). The product and SC environment characteristics are contextual factors that are hard to change and these characteristics initiate the use of specific DMPs as well as constrain the use of potential response actions. The process and the SC network characteristics are contextual factors that are easier to change, and they are affected by the use of the DMPs. We also found a notable relationship between the type of DMP likely to be used and the particular combination of contextual factors present in the observed SC.
To address RQ4, we presented a new method for vulnerability assessments, the VULA method. The VULA method helps to identify how much a company is underperforming on a specific Key Performance Indicator (KPI) in the case of a disturbance, how often this would happen and how long it would last. It ultimately informs the decision maker about whether process redesign is needed and what kind of redesign strategies should be used in order to increase the SC’s robustness. The VULA method is demonstrated in the context of a meat SC using discrete-event simulation. The case findings show that performance robustness can be assessed for any KPI using the VULA method.
To sum-up the project, all findings were incorporated within an integrated framework for designing robust SCs. The integrated framework consists of the following steps: 1) Description of the SC scenario and identification of its specific contextual factors; 2) Identification of disturbances that may affect KPIs; 3) Definition of the relevant KPIs and identification of the main disturbances through assessment of the SC performance robustness (i.e. application of the VULA method); 4) Identification of the sources of vulnerability that may (strongly) affect the robustness of performances and eventually increase the vulnerability of the SC; 5) Identification of appropriate preventive or disturbance impact reductive redesign strategies; 6) Alteration of SC scenario elements as required by the selected redesign strategies and repeat VULA method for KPIs, as defined in Step 3.
Contributions of this research are listed as follows. First, we have identified emerging research areas - SC robustness, and its counterpart, vulnerability. Second, we have developed a definition of SC robustness, operationalized it, and identified and structured the relevant elements for the design of robust SCs in the form of a research framework. With this research framework, we contribute to a better understanding of the concepts of vulnerability and robustness and related issues in food SCs. Third, we identified the relationship between contextual factors of food SCs and specific DMPs used to maintain robust SC performances: characteristics of the product and the SC environment influence the selection and use of DMPs; processes and SC networks are influenced by DMPs. Fourth, we developed specific metrics for vulnerability assessments, which serve as a basis of a VULA method. The VULA method investigates different measures of the variability of both the duration of impacts from disturbances and the fluctuations in their magnitude.
With this project, we also hope to have delivered practical insights into food SC vulnerability. First, the integrated framework for the design of robust SCs can be used to guide food companies in successful disturbance management. Second, empirical findings from case studies lead to the identification of changeable characteristics of SCs that can serve as a basis for assessing where to focus efforts to manage disturbances. Third, the VULA method can help top management to get more reliable information about the “health” of the company.
The two most important research opportunities are: First, there is a need to extend and validate our findings related to the research framework and contextual factors through further case studies related to other types of (food) products and other types of SCs. Second, there is a need to further develop and test the VULA method, e.g.: to use other indicators and statistical measures for disturbance detection and SC improvement; to define the most appropriate KPI to represent the robustness of a complete SC. We hope this thesis invites other researchers to pick up these challenges and help us further improve the robustness of (food) SCs.

Writing and science connections : integrated instruction and assessment

Learning to write is a daunting task for many young children. The purpose of this study was to examine the impact of a combined approach to writing instruction and assessment on the writing performance of students in two grade 3 classes. Five forms and traits of writing were purposefully connected during writing lessons while exhibiting links to the four strands of the grade 3 Ontario science curriculum. Students then had opportunities to engage in the writing process and to self-assess their compositions using either student-developed (experimental group/teacher-researcher's class) or teachercreated (control group/teacher-participant's class) rubrics. Paired samples t-tests revealed that both the experimental and control groups exhibited statistically significant growth from pretest to posttest on all five integrated writing units. Independent samples t-tests showed that the experimental group outperformed the control group on the persuasive + sentence fluency and procedure + word choice writing tasks. Pearson product-moment correlation r tests revealed significant correlations between the experimental group and the teacher-researcher on the recount + ideas and report + organization tasks, while students in the control group showed significant correlations with the teacher-researcher on the narrative + voice and procedure + word choice tasks. Significant correlations between the control group and the teacher-participant were evident on the persuasive + sentence fluency and procedure + word choice tasks. Qualitative analyses revealed five themes that highlighted how students' self-assessments and reflections can be used to guide teachers in their instructional decision making. These findings suggest that educators should adopt an integrated writing program in their classrooms, while working with students to create and utilize purposeful writing assessment tools.

The use of artificial intelligence algorithms to guide surgical treatment of adolescent idiopathic scoliosis

La scoliose idiopathique de l’adolescent (SIA) est une déformation tri-dimensionelle du rachis. Son traitement comprend l’observation, l’utilisation de corsets pour limiter sa progression ou la chirurgie pour corriger la déformation squelettique et cesser sa progression. Le traitement chirurgical reste controversé au niveau des indications, mais aussi de la chirurgie à entreprendre. Malgré la présence de classifications pour guider le traitement de la SIA, une variabilité dans la stratégie opératoire intra et inter-observateur a été décrite dans la littérature. Cette variabilité s’accentue d’autant plus avec l’évolution des techniques chirurgicales et de l’instrumentation disponible. L’avancement de la technologie et son intégration dans le milieu médical a mené à l’utilisation d’algorithmes d’intelligence artificielle informatiques pour aider la classification et l’évaluation tridimensionnelle de la scoliose. Certains algorithmes ont démontré être efficace pour diminuer la variabilité dans la classification de la scoliose et pour guider le traitement. L’objectif général de cette thèse est de développer une application utilisant des outils d’intelligence artificielle pour intégrer les données d’un nouveau patient et les évidences disponibles dans la littérature pour guider le traitement chirurgical de la SIA. Pour cela une revue de la littérature sur les applications existantes dans l’évaluation de la SIA fut entreprise pour rassembler les éléments qui permettraient la mise en place d’une application efficace et acceptée dans le milieu clinique. Cette revue de la littérature nous a permis de réaliser que l’existence de “black box” dans les applications développées est une limitation pour l’intégration clinique ou la justification basée sur les évidence est essentielle. Dans une première étude nous avons développé un arbre décisionnel de classification de la scoliose idiopathique basé sur la classification de Lenke qui est la plus communément utilisée de nos jours mais a été critiquée pour sa complexité et la variabilité inter et intra-observateur. Cet arbre décisionnel a démontré qu’il permet d’augmenter la précision de classification proportionnellement au temps passé à classifier et ce indépendamment du niveau de connaissance sur la SIA. Dans une deuxième étude, un algorithme de stratégies chirurgicales basé sur des règles extraites de la littérature a été développé pour guider les chirurgiens dans la sélection de l’approche et les niveaux de fusion pour la SIA. Lorsque cet algorithme est appliqué à une large base de donnée de 1556 cas de SIA, il est capable de proposer une stratégie opératoire similaire à celle d’un chirurgien expert dans prêt de 70% des cas. Cette étude a confirmé la possibilité d’extraire des stratégies opératoires valides à l’aide d’un arbre décisionnel utilisant des règles extraites de la littérature. Dans une troisième étude, la classification de 1776 patients avec la SIA à l’aide d’une carte de Kohonen, un type de réseaux de neurone a permis de démontrer qu’il existe des scoliose typiques (scoliose à courbes uniques ou double thoracique) pour lesquelles la variabilité dans le traitement chirurgical varie peu des recommandations par la classification de Lenke tandis que les scolioses a courbes multiples ou tangentielles à deux groupes de courbes typiques étaient celles avec le plus de variation dans la stratégie opératoire. Finalement, une plateforme logicielle a été développée intégrant chacune des études ci-dessus. Cette interface logicielle permet l’entrée de données radiologiques pour un patient scoliotique, classifie la SIA à l’aide de l’arbre décisionnel de classification et suggère une approche chirurgicale basée sur l’arbre décisionnel de stratégies opératoires. Une analyse de la correction post-opératoire obtenue démontre une tendance, bien que non-statistiquement significative, à une meilleure balance chez les patients opérés suivant la stratégie recommandée par la plateforme logicielle que ceux aillant un traitement différent. Les études exposées dans cette thèse soulignent que l’utilisation d’algorithmes d’intelligence artificielle dans la classification et l’élaboration de stratégies opératoires de la SIA peuvent être intégrées dans une plateforme logicielle et pourraient assister les chirurgiens dans leur planification préopératoire.

Towards the development of a project decision support framework for adoption of an integrated building information model using a model server

This chapter discusses an action research study towards the development of a decision framework to support a fully integrated multi disciplinary Building Information Model (BIM) using a Model Server. The framework was proposed to facilitate multi disciplinary collaborative BIM adoption through, informed selection of a project specific BIM approach and tools contingent upon project collaborators’ readiness, tool capabilities and workflow dependencies. The aim of the research was to explore the technical concerns in relation to Model Servers to support multi disciplinary model integration and collaboration; however it became clear that there were both technical and non technical issues that needed consideration. The evidence also suggests that there are varying levels of adoption which impacts upon further diffusion of the technologies. Therefore the need for a decision framework was identified based on the findings from an exploratory study conducted to investigate industry expectations. The study revealed that even the market leaders who are early technology adopters in the Australian industry in many cases have varying degrees of practical experiential knowledge of BIM and hence at times low levels of confidence of the future diffusion of BIM technology throughout the industry. The study did not focus on the benefits of BIM implementation as this was not the intention, as the industry partners involved are market leaders and early adopters of the technology and did not need convincing of the benefits. Coupled with this there are various other past studies that have contributed to the ‘benefits’ debate. There were numerous factors affecting BIM adoption which were grouped in to two main areas; technical tool functional requirements and needs, and non technical strategic issues. The need for guidance on where to start, what tools were available and how to work through the legal, procurement and cultural challenges was evidenced in the exploratory study. Therefore a BIM decision framework was initiated, based upon these industry concerns. Eight case studies informed the development of the framework and a summary of the key findings is presented. Primary and secondary case studies from firms that have adopted a structured approach to technology adoption are presented. The Framework consists of four interrelated key elements including a strategic purpose and scoping matrix, work process mapping, technical requirements for BIM tools and Model Servers, and framework implementation guide. The BIM framework was presented in draft format again to key industry stakeholders and considered in comparison with current best practice BIM adoption to further validate the framework. There was no request to change any part of the Framework. However, it is an ongoing process and it will be presented again to industry through the various project partners. The Framework may be refined within the boundaries of the action research process as an ongoing activity as more experiential knowledge can be incorporated.

An integrated management systems approach to corporate sustainability

Purpose – This paper seeks to describe an integrated management systems (IMS) approach for the integration of corporate sustainability into business processes.
Design/methodology/approach – An extensive review of published literature was conducted. Building on existing research, the paper presents an original framework for structuring the integration of corporate sustainability with existing business infrastructure. The framework is supported by a detailed set of diagnostic questions to help guide the process. Both the framework and the diagnostic questions are based on the “Plan-Do-Check-Act” cycle of continuous improvement.
Findings – The paper highlights the need for a systematic means to integrate sustainability into business processes. Building on that point, the paper illustrates how an IMS approach can be used to structure the entire process of managing, measuring, and assessing progress towards corporate sustainability.
Practical implications – The paper should be of interest to both practitioners and researchers. The framework and diagnostic questions will help guide decision makers through the process of building sustainability into their core business infrastructure. Since the framework and diagnostic questions provide the flexibility to accommodate specific organizational contexts, it is anticipated that they will have wide applicability.
Originality/value – The paper makes several contributions. The framework provides a systematic approach to corporate sustainability that has not been elaborated on in previous publications. The unique set of diagnostic questions provides a means to evaluate the extent to which corporate sustainability has been integrated into an organization.

Nurses' perceptions of using an evidence-based care bundle for initial emergency nursing management of patients with severe traumatic brain injury: A qualitative study.

Evidence to guide initial emergency nursing care of patients with severe traumatic brain injury (TBI) in Thailand is currently not available in a useable form. A care bundle was used to summarise an evidence-based approach to the initial emergency nursing management of patients with severe TBI and was implemented in one Thai emergency department. The aim of this study was to describe Thai emergency nurses' perceptions of care bundle use. A descriptive qualitative study was used to describe emergency nurses' perceptions of care bundle use during the implementation phase (Phase-One) and then post-implementation (Phase-Two). Ten emergency nurses participated in Phase-One, while 12 nurses participated in Phase-Two. In Phase-One, there were five important factors identified in relation to use of the care bundle including quality of care, competing priorities, inadequate equipment, agitated patients, and teamwork. In Phase Two, participants perceived that using the care bundle helped them to improve quality of care, increased nurses' knowledge, skills, and confidence. Care bundles are one strategy to increase integration of research evidence into clinical practice and facilitate healthcare providers to deliver optimal patient care in busy environments with limited resources.

A practical guide to the application of the IUCN Red List of Ecosystems criteria

The newly developed IUCN Red List of Ecosystems is part of a growing toolbox for assessing risks to biodiversity, which addresses ecosystems and their functioning. The Red List of Ecosystems standard allows systematic assessment of all freshwater, marine, terrestrial and subterranean ecosystem types in terms of their global risk of collapse. In addition, the Red List of Ecosystems categories and criteria provide a technical base for assessments of ecosystem status at the regional, national, or subnational level. While the Red List of Ecosystems criteria were designed to be widely applicable by scientists and practitioners, guidelines are needed to ensure they are implemented in a standardized manner to reduce epistemic uncertainties and allow robust comparisons among ecosystems and over time. We review the intended application of the Red List of Ecosystems assessment process, summarize 'best-practice' methods for ecosystem assessments and outline approaches to ensure operational rigour of assessments. The Red List of Ecosystems will inform priority setting for ecosystem types worldwide, and strengthen capacity to report on progress towards the Aichi Targets of the Convention on Biological Diversity. When integrated with other IUCN knowledge products, such as the World Database of Protected Areas/Protected Planet, Key Biodiversity Areas and the IUCN Red List of Threatened Species, the Red List of Ecosystems will contribute to providing the most complete global measure of the status of biodiversity yet achieved.

An integrated approach to evaluate emerging contaminants in drinking water

The chemical stock of emerging contaminants in Brazilian drinking water is of great interest due to the poor water quality at surface water intakes. In addition, little is known about the effect of some contaminants, such as endocrine disrupting chemicals (EDCs), which may be present in both raw and treated water. The aim of this work was to evaluate selected emerging contaminants in Brazilian waters using both chemical and biological analyses. Sampling sites were established in different municipalities based upon raw water quality data. Estrone, 17 beta-estradiol, estriol, 17 alpha-ethinylestradiol, bisphenol A, 4-n-octylphenol and 4-n-nonylphenol were determined in the samples by liquid chromatography-tandem mass spectrometry. A yeast assay using a Saccharomyces cerevisiae bioluminescent bioreporter was used to evaluate the estrogenic activity of the water samples. The first integrated results revealed similarities between the two individual approaches, since higher values for the bioassay were accompanied by significant concentrations of some selected compounds in surface water samples. No estrogenicity was observed for drinking water samples. Our results also indicate that the usual paradigm of evaluating water quality by measuring selected EDCs in a given water sample via chemical analysis, needs to be reviewed since the observed estrogenicity of a water sample is now a better guiding parameter to the selection of samples and substances to be chemically investigated in further analysis. So far, the data bank produced in this work, i.e., the comparison between chemical burden and observed estrogenicity, is not yet sufficiently robust to fully guide this decision. (C) 2011 Elsevier B.V. All rights reserved.

A guide to sparkology: the taxonomy of elementary cellular Ca2+ signaling events

Since the discovery of the Ca(2+) spark as an elementary event of cellular Ca(2+) signaling almost 15 years ago, the family of newly described Ca(2+) signal entities has been ever growing. While scientists working in Ca(2+) signaling may have maintained an overview over the specifics of this nomenclature, those outside the field often make the complaint that they feel hopelessly lost. With the present review we collect and summarize systematic information on the many Ca(2+) signaling events described in a variety of tissues and cells, and we emphasize why and how each of them has its own importance. Most of these signals are taking place in the cytosol of the respective cells, but several events have been recorded from intracellular organelles as well, where they may serve their own specific functions. Finally, we also try to convey an integrated view as to why cellular microdomain signaling is of fundamental biological importance.

The use of mechanisms and modes of toxic action in integrated testing strategies: the report and recommendations of a workshop held as part of the European Union OSIRIS Integrated Project

This report on The Potential of Mode of Action (MoA) Information Derived from Non-testing and Screening Methodologies to Support Informed Hazard Assessment, resulted from a workshop organised within OSIRIS (Optimised Strategies for Risk Assessment of Industrial Chemicals through Integration of Non-test and Test Information), a project partly funded by the EU Commission within the Sixth Framework Programme. The workshop was held in Liverpool, UK, on 30 October 2008, with 35 attendees. The goal of the OSIRIS project is to develop integrated testing strategies (ITS) fit for use in the REACH system, that would enable a significant increase in the use of non-testing information for regulatory decision making, and thus minimise the need for animal testing. One way to improve the evaluation of chemicals may be through categorisation by way of mechanisms or modes of toxic action. Defining such groups can enhance read-across possibilities and priority settings for certain toxic modes or chemical structures responsible for these toxic modes. Overall, this may result in a reduction of in vivo testing on organisms, through combining available data on mode of action and a focus on the potentially most-toxic groups. In this report, the possibilities of a mechanistic approach to assist in and guide ITS are explored, and the differences between human health and environmental areas are summarised.

Advances in understanding energy consumption behavior and the governance of its change - Outline of an integrated framework

Transforming today’s energy systems in industrialized countries requires a substantial reduction of the total energy consumption at the individual level. Selected instruments have been found to be effective in changing people’s behavior in single domains. However, the so far weak success story on reducing overall energy consumption indicates that our understanding of the determining factors of individual energy consumption as well as of its change is far from being conclusive. Among others, the scientific state of the art is dominated by analyzing single domains of consumption and by neglecting embodied energy. It also displays strong disciplinary splits and the literature often fails to distinguish between explaining behavior and explaining change of behavior. Moreover, there are knowledge gaps regarding the legitimacy and effectiveness of the governance of individual consumption behavior and its change. Against this backdrop, the aim of this paper is to establish an integrated interdisciplinary framework that offers a systematic basis for linking the different aspects in research on energy related consumption behavior, thus paving the way for establishing a better evidence base to inform societal actions. The framework connects the three relevant analytical aspects of the topic in question: (1) It systematically and conceptually frames the objects, i.e. the energy consumption behavior and its change (explananda); (2) it structures the factors that potentially explain the energy consumption behavior and its change (explanantia); (3) it provides a differentiated understanding of change inducing interventions in terms of governance. Based on the existing states of the art approaches from different disciplines within the social sciences the proposed framework is supposed to guide interdisciplinary empirical research.

Draft PC-TARE user's guide.

Cover title.

Fast-tracking middle schooling reform: A model for the integrated curriculum

To participate effectively in the post-industrial information societies and knowledge/service economies of the 21st century, individuals must be better-informed, have greater thinking and problem-solving abilities, be self-motivated; have a capacity for cooperative interaction; possess varied and specialised skills; and be more resourceful and adaptable than ever before. This paper reports on one outcome from a national project funded by the Ministerial Council on Education, Employment Training and Youth Affairs, which investigated what practices, processes, strategies and structures best promote lifelong learning and the development of lifelong learners in the middle years of schooling. The investigation linked lifelong learning with middle schooling because there were indications that middle schooling reform practices also lead to the development of lifelong learning attributes, which is regarded as a desirable outcome of schooling in Australia. While this larger project provides depth around these questions, this paper specifically reports on the development of a three-phase model that can guide the sequence in which schools undertaking middle schooling reform attend to particular core component changes. The model is developed from the extensive analysis of 25 innovative schools around the nation, and provides a unique insight into the desirable sequences and time spent achieving reforms, along with typical pitfalls that lead to a regression in the reform process. Importantly, the model confirms that schooling reform takes much more time than planners typically expect or allocate, and there are predictable and identifiable inhibitors to achieving it.

Doing business research:a guide to theory and practice

For anyone involved in developing a research project, this textbook provides an integrated, accessible and humorous account that explains why research methods are the way they are and how they do what they do. Unrivalled in its nature Doing Business Research addresses the research project as a whole and provides: - essential detail of philosophical and theoretical matters that are crucial to conceptualising the nature of methodology - a pragmatic guide to why things are important and how they are important - a huge range of things to consider that the reader can use to develop their research project further - a resource book, providing extensive suggested reading to help the researcher do their research.