The paradox of using tacit and explicit knowledge: Strategies to face dilemnas

Jasimuddin, Sajjad, Klein, Jonathan, and Connell, Con, 'The paradox of using tacit and explicit knowledge: Strategies to face dilemnas', Management Decision (2005) 43(1) pp.102-112 RAE2008

Communication practices in physician decision-making for an unstable critically ill patient with end-stage cancer.

BACKGROUND: Shared decision-making has become the standard of care for most medical treatments. However, little is known about physician communication practices in the decision making for unstable critically ill patients with known end-stage disease. OBJECTIVE: To describe communication practices of physicians making treatment decisions for unstable critically ill patients with end-stage cancer, using the framework of shared decision-making. DESIGN: Analysis of audiotaped encounters between physicians and a standardized patient, in a high-fidelity simulation scenario, to identify best practice communication behaviors. The simulation depicted a 78-year-old man with metastatic gastric cancer, life-threatening hypoxia, and stable preferences to avoid intensive care unit (ICU) admission and intubation. Blinded coders assessed the encounters for verbal communication behaviors associated with handling emotions and discussion of end-of-life goals. We calculated a score for skill at handling emotions (0-6) and at discussing end of life goals (0-16). SUBJECTS: Twenty-seven hospital-based physicians. RESULTS: Independent variables included physician demographics and communication behaviors. We used treatment decisions (ICU admission and initiation of palliation) as a proxy for accurate identification of patient preferences. Eight physicians admitted the patient to the ICU, and 16 initiated palliation. Physicians varied, but on average demonstrated low skill at handling emotions (mean, 0.7) and moderate skill at discussing end-of-life goals (mean, 7.4). We found that skill at discussing end-of-life goals was associated with initiation of palliation (p = 0.04). CONCLUSIONS: It is possible to analyze the decision making of physicians managing unstable critically ill patients with end-stage cancer using the framework of shared decision-making.

A run-time configurable software architecture for self-managing systems

This paper describes a highly flexible component architecture, primarily designed for automotive control systems, that supports distributed dynamically- configurable context-aware behaviour. The architecture enforces a separation of design-time and run-time concerns, enabling almost all decisions concerning runtime composition and adaptation to be deferred beyond deployment. Dynamic context management contributes to flexibility. The architecture is extensible, and can embed potentially many different self-management decision technologies simultaneously. The mechanism that implements the run-time configuration has been designed to be very robust, automatically and silently handling problems arising from the evaluation of self- management logic and ensuring that in the worst case the dynamic aspects of the system collapse down to static behavior in totally predictable ways.

Towards Cloud-Based Knowledge Capturing Based on Natural Language Processing

Paper presented at the Cloud Forward Conference 2015, October 6th-8th, Pisa

The use of process simulation methods in support of organisational learning in availability contracting

Traditional business models in the aerospace industry are based on a conventional supplier to customer relationship based on the design, manufacture and subsequent delivery of the physical product. Service provision, from the manufacturer's perspective, is typically limited to the supply of procedural documentation and the provision of spare parts to the end user as the product passes through the latter stages of its intended lifecycle. Challenging economic and political conditions have resulted in end users re-structuring their core business activities, particularly in the defence sector. This has resulted in the need for original equipment manufacturers (OEMs) to integrate and manage support service activities in partnership with the customer to deliver platform availability. This improves the probability of commercial sustainability for the OEM through shared operational risks while reducing the cost of platform ownership for the customer. The need for OEMs to evolve their design, manufacture and supply strategies by focusing on customer requirements has revealed a need for reconstruction of traditional internal behaviours and design methodologies. Application of organisational learning is now a well recognised principle for innovative companies to achieve long term growth and sustained technical development, and hence, greater market command. It focuses on the process by which the organisation's knowledge and value base changes, leading to improved problem solving ability and capacity for action. From the perspective of availability contracting, knowledge and the processes by which it is generated, used and retained, become primary assets within the learning organisation. This paper will introduce the application of digital methods to asset management by demonstrating how the process of learning can benefit from a digital approach, how product and process design can be integrated within a virtual framework and finally how the approach can be applied in a service context.

Factors influencing patients with stage 5 chronic kidney disease to opt for conservative management: a practitioner research study

Aims and objectives. This study explored decision-making experiences of patients with stage 5 chronic kidney disease when opting for conservative management of their renal failure.

Background. Dialysis is an invasive treatment, and for some older patients, there is an associated treatment burden of dialysis-related symptoms. An alternative choice is conservative management, but little is known about those who make this decision and how they are supported through the process.

Design. Qualitative practitioner research study.

Method. Data were generated from nine patients' naturally occurring clinic consultations with a renal clinical nurse specialist between May 2010 - July 2010. Interviews were transcribed verbatim and findings fed back at three multi-disciplinary meetings to check for relevance and resonance. Common themes were identified and codes applied.

Results. Patients reported age and having to travel three times a week to hospital for dialysis as reasons not to opt for treatment. Others felt well without dialysis not wanting to upset the 'status quo' or to burden loved ones. Most felt equipped to make the decision following explanation and discussion with the clinical nurse specialist in the renal clinic.

Conclusions. Patients opting for conservative management give numerous reasons for this including old age, travel limitations, feeling well without dialysis and not wanting to be a burden, but appear content with their decision. One-to-one discussions with the clinical nurse specialist appear helpful during the decision-making process presenting an opportunity for advancing nursing roles in the chronic kidney disease service.

Relevance to clinical practice. Understanding patients' reasons for refusing dialysis assists in supporting until death. There is an opportunity for developing nursing practice to meet the multi-faceted needs of this group.

“Boundary-setting as a core activity in complex public systems”

Title: Boundary-setting as a core activity in complex public systems
Authors: Joanne Murphy & Mary Lee Rhodes

The definition of the boundary of a system is at the core of any systems approach (Midgley 2000; 2003). By defining boundaries we enable – and delimit – the range of outcomes sought and the actions and resources that can be brought to bear. In complex adaptive systems (CAS) analysis, the conceptualisaion and definition of boundaries is particularly challenging as they are constantly undergoing redefinition through agent action, interaction and entry/exit. (Rhodes et al 2011). The concept of ‘boundaries’ appears regularly in a wide range of literature around public management, administration, geopolitics, regeneration and organisational development. Discussions around boundaries focus on many things from concrete physical manifestations and barriers, to virtual interfaces between one organisational unit and another, or even entirely theoretical demarcations between different schools of thought (Kaboolian, 1998, Levi-Faur, 2004, Agranoff & McGuire, 2004).

However, managing ‘beyond’ such boundaries is a routinely recurring aspiration that transcends sectors and local concerns. Unsurprisingly then, there is an increasing understanding of the need to acknowledge and manage such boundaries (whether they be physical, social or organisational) within public management as a discipline (Currie et al 2007, Fitzsimmons and White, 1997, Murtagh, 2002). This paper explores the impact of boundaries on public management strategic decision-making in the sectors of urban regeneration and healthcare. In particular, it focuses on demarcations to physical space, communal identity and within professional relationships in these sectors.

The first section describes the research that gave rise to the paper and the cases examined. Next we briefly define what we mean by boundaries. We explore issues that have emerged from our analysis of urban regeneration and health care singularly, before looking at how the concept of boundaries is a recurrent concern across the sectors. The main contribution of the paper is an exploration of how a CAS lens can bring a new insight into the concept of boundaries and decision-making in the two sets of case studies. This discussion will concentrate on initial conditions, bifurcation and adaptation as key CAS factors in relation to boundaries. We conclude with a brief discussion on the benefits of a CAS lens to an analysis of boundaries in public management decision-making.
References:

Agranoff, R. and McGuire, M. (2003) Collaborative Public Management: Strategies for Local Government. Washington, DC: Georgetown Univ. Press.

Currie, G., Lockett, A. (2007) “A critique of transformational leadership: moral, professional & contingent dimensions of leadership within public services organizations”. Human Relations 60: 341-370.

Fitzsimmons and White, (1997) "Crossing boundaries: communication between professional groups", Journal of Management in Medicine, Vol. 11 Iss: 2, pp.96 – 101

Kaboolian, L. (1998) “The New Public Management: Challenging the Boundaries of the Management vs. Administration Debate” Public Administration Review Vol. 58, No. 3 pp.189-193

Levi-Faur D. and Vigoda-Gadot Eran (eds) (2004) International Public Policy and Management: Policy Learning Beyond Regional, Cultural and Political Boundaries, Marcel Dekker,
Midgley, G. (ed) (2003) Systems Thinking. London: Sage Publications

Midgley, G. (2000) Systemic Intervention: Philosophy, Methodology and Practice. New York, NY: Kluwer.

Murtagh, B. (2002). The Politics of Territory: Policy and Segregation in Northern Ireland. Basingstoke, Palgrave.

Rhodes, ML, Joanne Murphy, Jenny Muir, John Murray (2011) Public Management & Complexity Theory: Richer Decision Making in Irish Public Services, UK: Routledge

Research-informed design, management and maintenance of infrastructure slopes: development of a multi-scalar approach

The UK’s transport infrastructure is one of the most heavily used in the world. The performance of these networks is critically dependent on the performance of cutting and embankment slopes which make up £20B of the £60B asset value of major highway infrastructure alone. The rail network in particular is also one of the oldest in the world: many of these slopes are suffering high incidents of instability (increasing with time). This paper describes the development of a fundamental understanding of earthwork material and system behaviour, through the systematic integration of research across a range of spatial and temporal scales. Spatially these range from microscopic studies of soil fabric, through elemental materials behaviour to whole slope modelling and monitoring and scaling up to transport networks. Temporally, historical and current weather event sequences are being used to understand and model soil deterioration processes, and climate change scenarios to examine their potential effects on slope performance in futures up to and including the 2080s. The outputs of this research are being mapped onto the different spatial and temporal scales of infrastructure slope asset management to inform the design of new slopes through to changing the way in which investment is made into aging assets. The aim ultimately is to help create a more reliable, cost effective, safer and more resilient transport system.

Gestão da sustentabilidade nas organizações: uma nova metodologia

O presente trabalho pretende auxiliar o processo de consolidação do conceito de sustentabilidade no seio das organizações. Partindo de ferramentas de gestão e avaliação já existentes, esta tese sugere a sua integração numa única metodologia, ultrapassando desse modo as limitações e potenciando as suas capacidades enquanto ferramentas isoladas. O modelo proposto para o Sistema de Gestão da Sustentabilidade (SGS) integra assim: o conceito de melhoria contínua característico dos sistemas de gestão normalizados; a capacidade de tradução da perspetiva estratégica da gestão para o plano operacional, característica do Business Scorecard (BSC); e, por fim, a avaliação emergética é ainda utilizada como uma ferramenta de avaliação da sustentabilidade de sistemas. Um objetivo secundário desta tese prende-se com o desenvolvimento de um procedimento para a realização da análise emergética de um sistema. Depois de analisada a literatura referente à utilização da análise emergética, identificou-se como necessária a definição de um procedimento normalizado, adotando um conjunto de tarefas e um formato de apresentação de resultados que permita disseminar o conceito e tornar a ferramenta mais “utilizável”. Por outro lado, procurou-se dotar o procedimento com um conjunto de indicações que permitem ultrapassar limitações e inconvenientes apontados pelos críticos mas também utilizadores do método, nomeadamente: problemas de dupla contagem, cálculo da incerteza da análise e critérios de qualidade da informação utilizada. O modelo dos sistemas de gestão normalizados apresenta um papel central na metodologia proposta. O conceito de “melhoria contínua” afigura-se como fundamental num sistema que pretende implementar o conceito “desenvolvimento sustentável” e avaliar o seu desempenho à luz do mesmo. Assim, o ciclo Plan-Do-check-Act (PDCA) deve ser utilizado para implementar o SGS de acordo com uma Política para a Sustentabilidade que a organização deve desenvolver. Definida a Política, o modelo baseia-se então no ciclo PDCA: fase de planeamento; fase de implementação; fase de verificação; e fase de revisão. É na fase de planeamento do SGS que se sugere a introdução das outras duas ferramentas: a análise emergética (AEm) e o BSC. A fase de planeamento do modelo de SGS proposto neste trabalho foi aplicada à Universidade de Aveiro (UA), incluindo a definição de uma Política para a Sustentabilidade e o planeamento estratégico e operacional. A avaliação emergética à UA foi realizada recorrendo ao procedimento desenvolvido nesta tese e permitiu caracterizar e avaliar os fluxos de recursos que a “alimentam” sob uma só unidade, atribuindo deste modo graus de importância aos diferentes recursos utilizados. A informação representa 96% do total de recursos utilizados na UA, quando avaliados sob o ponto de vista emergética. Para além da informação, os fluxos financeiros representam a maior fatia do orçamento emergético da UA, grande parte dos quais serve para sustentar os serviços prestados pelo corpo docente da UA. Analisando valores históricos de 3 indicadores de desempenho emergético, observa-se que a UA não regista uma evolução positiva em nenhum dos indicadores: a emergia utilizada nos edifícios tem-se mantido mais ou menos constante; a retribuição emergética da UA para a sociedade, avaliada sobre a forma de diplomados, tem diminuído; e a relação emergética entre professores e alunos tem também diminuído, facto que pode refletir-se na qualidade dos “produtos” da UA. Da aplicação do SGS à UA regista-se: a adequabilidade do ciclo PDCA à implementação de um SGS; a capacidade da AEm “obrigar” a organização a adotar uma abordagem sistémica da sua atividade, resultando numa visão mais aprofundada da sua relação com o contexto ambiental, económico e social em que se insere; a importância da visão estratégica e da sua tradução em termos operacionais na fase de planeamento de um SGS; e, por fim, a capacidade de adaptação e dupla funcionalidade (implementação e avaliação) do modelo de SGS proposto. A metodologia de SGS proposta nesta tese, sendo direcionada para todo o tipo de organizações, não se desvirtua quando aplicada ao contexto específico das instituições de ensino superior e permite implementar e avaliar o conceito “desenvolvimento sustentável” nas quatro dimensões da universidade (Educação, Investigação, Operação; Relação com as partes interessadas).

Toxicogenomics of natural and anthropogenic effectors in eleutheroembryos

The introduction of chemicals into the environment by human activities may represent a serious risk to environmental and human health. Environmental risk assessment requires the use of efficient and sensitive tools to determine the impact of contaminants on the ecosystems. The use of zebrafish for the toxicity assessment of pharmaceuticals, drugs, and pollutants, is becoming well accepted due to zebrafish unique advantages for the screening of compounds for hazard identification. The aim of the present work is to apply toxicogenomic approaches to identify novel biomarkers and uncovered potential modes of action of classic and emergent contaminants able to disrupt endocrine systems, such as the Retinoic Acid Receptor, Retinoid X Receptor and the Aryl Hydrocarbon Receptor. This study relies on different nuclear and cytosolic protein receptors and other conditional (ligand- or stress- activated) transcriptional factors that are intimately involved in the regulation of defensome genes and in mechanisms of chemical toxicity. The transcriptomic effects of organic compounds, endogenous compounds, and nanoparticles were analysed during the early stages of zebrafish development. Studying the gene expression profiles of exposed and unexposed organisms to pollutants using microarrays allowed the identification of specific gene markers and to establish a "genetic code" for the tested compounds. Changes in gene expression were observed at toxicant concentrations that did not cause morphological effects. Even at low toxicant concentrations, the observed changes in transcript levels were robust for some target genes. Microarray responses of selected genes were further complemented by the real time quantitative polymerase chain reaction (qRT-PCR) methodology. The combination of bio-informatic, toxicological analyses of differential gene expression profiles, and biochemical and phenotypic responses across the treatments allowed the identification of uncovered potential mechanisms of action. In addition, this work provides an integrated set of tools that can be used to aid management-decision making by improving the predictive capability to measure environmental stress of contaminants in freshwater ecosystems. This study also illustrates the potential of zebrafish embryos for the systematic, large-scale analysis of chemical effects on developing vertebrates.

Decentralizing IP mobility management in future networks

The massive adoption of sophisticated mobile devices and applications led to the increase of mobile data in the last decade, which it is expected to continue. This increase of mobile data negatively impacts the network planning and dimension, since core networks are heavy centralized. Mobile operators are investigating atten network architectures that distribute the responsibility of providing connectivity and mobility, in order to improve the network scalability and performance. Moreover, service providers are moving the content servers closer to the user, in order to ensure high availability and performance of content delivery. Besides the e orts to overcome the explosion of mobile data, current mobility management models are heavy centralized to ensure reachability and session continuity to the users connected to the network. Nowadays, deployed architectures have a small number of centralized mobility anchors managing the mobile data and the mobility context of millions of users, which introduces issues related to performance and scalability that require costly network mechanisms. The mobility management needs to be rethought out-of-the box to cope with atten network architectures and distributed content servers closer to the user, which is the purpose of the work developed in this Thesis. The Thesis starts with a characterization of mobility management into well-de ned functional blocks, their interaction and potential grouping. The decentralized mobility management is studied through analytical models and simulations, in which di erent mobility approaches distinctly distribute the mobility management functionalities through the network. The outcome of this study showed that decentralized mobility management brings advantages. Hence, it was proposed a novel distributed and dynamic mobility management approach, which is exhaustively evaluated through analytical models, simulations and testbed experiments. The proposed approach is also integrated with seamless horizontal handover mechanisms, as well as evaluated in vehicular environments. The mobility mechanisms are also speci ed for multihomed scenarios, in order to provide data o oading with IP mobility from cellular to other access networks. In the pursuing of the optimized mobile routing path, a novel network-based strategy for localized mobility is addressed, in which a replication binding system is deployed in the mobility anchors distributed through the access routers and gateways. Finally, we go further in the mobility anchoring subject, presenting a context-aware adaptive IP mobility anchoring model that dynamically assigns the mobility anchors that provide the optimized routing path to a session, based on the user and network context. The integration of dynamic and distributed concepts in the mobility management, such as context-aware adaptive mobility anchoring and dynamic mobility support, allow the optimization of network resources and the improvement of user experience. The overall outcome demonstrates that decentralized mobility management is a promising direction, hence, its ideas should be taken into account by mobile operators in the deployment of future networks.

Da criatividade linguística à tradução : uma abordagem das unidades polilexicais em Mia Couto

Tese de doutoramento, Linguística (Linguística Aplicada), Universidade de Lisboa, Faculdade de Letras, 2015

Abordagem da segurança, higiene e saúde na organização e gestão escolar

A escola é o centro de convergência que justifica e fundamenta os recursos alocados ao sistema educativo. Durante o normal funcionamento das escolas, as condições de segurança, salubridade dos edifícios e equipamentos devem ser previstas e mantidas para garantir a salvaguarda da saúde e bem-estar dos seus ocupantes. A responsabilidade sobre estas questões encontra-se transferida para os Órgãos de Gestão dos estabelecimentos educativos. Neste âmbito efectuou-se um estudo que objectivou caracterizar a organização e a gestão escolar, no contexto da segurança, higiene e saúde; conhecer a forma da organização e da gestão da emergência nos estabelecimentos de ensino e o grau de satisfação dos gestores escolares relativamente aspectos relacionados com a Segurança, Higiene e Saúde. Neste sentido, foi aplicado um inquérito por questionário on-line, dirigido aos directores dos agrupamentos de escolas e escolas únicas da Região Norte de Portugal. Na generalidade os resultados obtidos demonstraram que ao nível da organização e gestão da emergência é evidenciada alguma preocupação, constatando-se no entanto, que nem todas as escolas possuam delegado de segurança, algumas não possuem plano de segurança, apenas metade evidenciou a existência de projectos educativos em áreas relacionadas com a temática e não existe ainda uma participação efectiva no seio escolar por parte da comunidade. Os gestores escolares, relativamente ao grau de satisfação, referiram as condições das infra-estruturas e estado de conservação dos estabelecimentos escolares, como factores de maior descontentamento. Percepcionou-se que a gestão escolar é centrada nos problemas do quotidiano, não existindo uma planificação ou um programa legitimado de segurança, higiene e saúde a longo prazo. A análise à actuação do gestor escolar face à segurança e higiene, não pode efectuar-se alheia e separadamente do actual regime de autonomia, administração e gestão dos estabelecimentos públicos da educação pré-escolar e dos ensinos básico e secundário, porque o desempenho dos diferentes actores no processo educativo é por si condicionada. Cabe ao gestor escolar, na figura do Director(a) consagrar a segurança, higiene e saúde integradas na dinâmica escolar, promovendo um ambiente escolar mais saudável e seguro.