A biography:fabrications in the life of an ERP package

This paper provides an account of the way Enterprise Resource Planning (ERP) systems change over time. These changes are conceptualized as a biographical accumulation that gives the specific ERP technology its present character, attributes and historicity. The paper presents empirics from the implementation of an ERP package within an Australasian organization. Changes to the ERP take place as a result of imperatives which arise during the implementation. Our research and evidence then extends to a different time and place where the new release of the ERP software was being 'sold' to client firms in the UK. We theorize our research through a lens based on ideas from actor network theory (ANT) and the concept of biography. The paper seeks to contribute an additional theorization for ANT studies that places the focus on the technological object and frees it from the ties of the implementation setting. The research illustrates the opportunistic and contested fabrication of a technological object and emphasizes the stability as well as the fluidity of its technologic. Copyright © 2007 SAGE.

Herbal medicines:physician's recommendation and clinical evaluation of St.John's Wort for depression

Why some physicians recommend herbal medicines while others do not is not well understood. We undertook a survey designed to identify factors, which predict recommendation of herbal medicines by physicians in Malaysia. About a third (206 out of 626) of the physicians working at the University of Malaya Medical Centre ' were interviewed face-to-face, using a structured questionnaire. Physicians were asked about their personal use of, recommendation of, perceived interest in and, usefulness and safety of herbal medicines. Using logistic regression modelling we identified personal use, general interest, interest in receiving training, race and higher level of medical training as significant predictors of recommendation. St. John's wort is one of the most widely used herbal remedies. It is also probably the most widely evaluated herbal remedy with no fewer than 57 randomised controlled trials. Evidence from the depression trials suggests that St. John's wort is more effective than placebo while its comparative efficacy to conventional antidepressants is not well established. We updated previous meta-analyses of St. John's wort, described the characteristics of the included trials, applied methods of data imputation and transformation for incomplete trial data and examined sources of heterogeneity in the design and results of those trials. Thirty randomised controlled trials, which were heterogeneous in design, were identified. Our meta-analysis showed that St. John's wort was significantly more effective than placebo [pooled RR 1.90 (1.54-2.35)] and [Pooled WMD 4.09 (2.33 to 5.84)]. However, the remedy was similar to conventional antidepressant in its efficacy [Pooled RR I. 0 I (0.93 -1.10)] and [Pooled WMD 0.18 (- 0.66 to 1.02). Subgroup analyses of the placebo-controlled trials suggested that use of different diagnostic classifications at the inclusion stage led to different estimates of effect. Similarly a significant difference in the estimates of efficacy was observed when trials were categorised according to length of follow-up. Confounding between the variables, diagnostic classification and length of trial was shown by loglinear analysis. Despite extensive study, there is still no consensus on how effective St. lohn's wort is in depression. However, most experts would agree that it has some effect. Our meta-analysis highlights the problems associated with the clinical evaluation of herbal medicines when the active ingredients are poorly defined or unknown. The problem is compounded when the target disease (e.g. depression) is also difficult to define and different instruments are available to diagnose and evaluate it.

Foundations of an intervention package to improve communication in residential care settings:a mixed methods study

Background: The prevalence of hearing loss is considerably higher in individuals in residential care than in people within the community-dwelling population, and yet hearing aids and hearing services are relatively underused. Care staff have a key role in supporting access to services. Objectives: This study identifies staff perspectives on hearing loss and their views about potential hearing service improvements. Study design: A four-stage mixed methods study was used, made up of qualitative interviews, observation, a survey and a stakeholder involvement meeting. Results: The qualitative stages indicated that staff were concerned about their levels of interaction with residents. Staff considered maximizing communication as part of their professional role. The quantitative survey indicated that these views were widely held by staff, and the stakeholder stage identified the need for social support and dedicated staff training opportunities. Conclusion: Care home staff regard communication as a shared issue. Future interventions could enhance access to hearing services and provide care home staff with training in hearing loss and hearing aid management. © 2013 Informa Healthcare.

A comparison of antibiotic prescribing indicators and medicines management scoring in secondary care

Poster: - Robust prescribing indicators analogous to those used in primary care are not available currently in NHS hospital trusts - The Department of Health has recently implemented a scheme for self-assessment scoring medicines management processes (maximum 23) in NHS hospitals - There is no clear relationship between average values for two antibiotic prescribing indicators obtained in ten NHS hospital trusts in the West Midlands - There is no clear relationship between either indicator value and the corresponding self-assessment medicines management score - This study highlights the difficulties involved in assessing the medicines management processes in NHS hospitals; better medicines management evaluation systems are needed

The New Software Package for Dynamic Hierarchical Clustering for Circles Types of Shapes

In data mining, efforts have focused on finding methods for efficient and effective cluster analysis in large databases. Active themes of research focus on the scalability of clustering methods, the effectiveness of methods for clustering complex shapes and types of data, high-dimensional clustering techniques, and methods for clustering mixed numerical and categorical data in large databases. One of the most accuracy approach based on dynamic modeling of cluster similarity is called Chameleon. In this paper we present a modified hierarchical clustering algorithm that used the main idea of Chameleon and the effectiveness of suggested approach will be demonstrated by the experimental results.

Patient experiences of serious adverse drug reactions and their attitudes to medicines:a qualitative study of survivors of Stevens-Johnson syndrome and toxic epidermal necrolysis in the UK

Background: Adverse drug reactions (ADRs) cause significant morbidity and mortality and account for around 6.5% of hospital admissions. Patient experiences of serious ADRs and their long-term impact on patients' lives, including their influence on current attitudes towards medicines, have not been previously explored. Objective: The aim of the study was to explore the experiences, beliefs, and attitudes of survivors of serious ADRs, using drug-induced Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) as a paradigm. Methods: A retrospective, qualitative study was undertaken using detailed semi-structured interviews. Fourteen adult survivors of SJS and TEN, admitted to two teaching hospitals in the UK, one the location of a tertiary burns centre, were interviewed. Interview transcripts were independently analysed by three different researchers and themes emerging from the text identified. Results: All 14 patients were aware that their condition was drug induced, and all but one knew the specific drug(s) implicated. Several expressed surprise at the perceived lack of awareness of the ADR amongst healthcare professionals, and described how the ADR was mistaken for another condition. Survivors believed that causes of the ADR included (i) being given too high a dose of the drug; (ii) medical staff ignoring existing allergies; and (iii) failure to monitor blood tests. Only two believed that the reaction was unavoidable. Those who believed that the condition could have been avoided had less trust in healthcare professionals. The ADR had a persisting impact on their current lives physically and psychologically. Many now avoided medicines altogether and were fearful of becoming ill enough to need them. © 2011 Adis Data Information BV. All rights reserved. Conclusions: Life-threatening ADRs continued to affect patients’ lives long after the event. Patients’ beliefs regarding the cause of the ADR differed, and may have influenced their trust in healthcare professionals and medicines. We propose that clear communication during the acute phase of a serious ADR may therefore be important.

Demographic, Behavioral and Perceptual Comparisons of U.S Visitor Experience with Group Package Tours and Free Independent Travel to China

U.S. visitor demand for the China travel experience is anticipated to rise significantly through 2105, causing the Chinese government to employ 100 million service providers over the next six years and raising concern about service delivery and perceptions of the on-site China experience. In an effort to better understand these issues concerning U.S. visitors, this study investigated two specific types of U.S. travelers to China: Group Package Tour (GPT) visitors and Free Independent Travel (FIT) visitors. Results indicated that GPT visitors were more likely to be older and have higher household income than FIT visitors. Four trip-related characteristics of GPT and FIT visitors were found to be significantly different, with GPT visitors showing higher levels of satisfaction with the overall China on-site travel experience.

The Effectiveness of an Intervention Package on Math Computation

Abstract: Four second-grade students participated in a B-A-B withdrawal single-subject design experiment. The intervention package implemented consisted of three components: self-monitoring, performance feedback, and reinforcers. Participants completed math probes across phases. Accuracy and productivity was recorded and calculated. Results demonstrated the intervention package improved accuracy and productivity for all participants.

The effects of audio cueing and an instructions, feedback and praise package on the distribution of teacher praise to students of differing on-task levels

In an audio cueing system, a teacher is presented with randomly spaced auditory signals via tape recorder or intercom. The teacher is instructed to praise a child who is on-task each time the cue is presented. In this study, a baseline was obtained on the teacher's praise rate and the children's on-task behaviour in a Grade 5 class of 37 students. Children were then divided into high, medium and low on-task groups. Followinq baseline, the teacher's praise rate and the children's on-task behaviour were observed under the following successively implemented conditions: (l) Audio Cueing 1: Audio cueing at a rate of 30 cues per hour was introduced into the classroom and remained in effect during subsequent conditions. A group of consistently low on-task children were delineated. (2) Audio Cueing Plus 'focus praise package': Instructions to direct two-thirds o£ the praise to children identified by the experimenter (consistently low on-task children), feedback and experimenter praise for meeting or surpassing the criterion distribution of praise ('focus praise package') were introduced. (3) Audio Cueing 2: The 'focus praise package' was removed. (4) Audio Cueing Plus 'increase praise package': Instructions to increase the rate of praise, feedback and experimenter praise for improved praise rates ('increase praise package') were introduced. The primary aims of the study were to determine the distribution of praise among hi~h, medium and low on-task children when audio cueinq was first introduced and to investigate the effect of the 'focus praise package' on the distribution of teacher praise. The teacher distributed her praise evenly among the hiqh, medium and low on-task groups during audio cueing 1. The effect of the 'focus praise package' was to increase the percentage of praise received by the consistently low on-task children. Other findings tended to suggest that audio cueing increased the teacher's praise rate. However, the teacher's praise rate unexpectedly decreased to a level considerably below the cued rate during audio cueing 2. The 'increase praise package' appeared to increase the teacher's praise rate above the audio cueing 2 level. The effect of an increased praise rate and two distributions of praise on on-task behaviour were considered. Significant increases in on-task behaviour were found in audio cueing 1 for the low on-task group, in the audio cueing plus 'focus praise package' condition for the entire class and the consistently low on-task group and in audio cueing 2 for the medium on-task group. Except for the high on-task children who did not change, the effects of the experimental manipulations on on-task behaviour were e quivocal. However, there were some indications that directing 67% of the praise to the consistently low on-task children was more effective for increasing this group's on-task behaviour than distributing praise equally among on-task groups.