Measuring horizontal integration among health care providers in the community: An examination of a collaborative process within a palliative care network

In many countries formal or informal palliative care networks (PCNs) have evolved to better integrate community-based services for individuals with a life-limiting illness. We conducted a cross-sectional survey using a customized tool to determine the perceptions of the processes of palliative care delivery reflective of horizontal integration from the perspective of nurses, physicians and allied health professionals working in a PCN, as well as to assess the utility of this tool. The process elements examined were part of a conceptual framework for evaluating integration of a system of care and centred on interprofessional collaboration. We used the Index of Interdisciplinary Collaboration (IIC) as a basis of measurement. The 86 respondents (85% response rate) placed high value on working collaboratively and most reported being part of an interprofessional team. The survey tool showed utility in identifying strengths and gaps in integration across the network and in detecting variability in some factors according to respondent agency affiliation and profession. Specifically, support for interprofessional communication and evaluative activities were viewed as insufficient. Impediments to these aspects of horizontal integration may be reflective of workload constraints, differences in agency operations or an absence of key structural features.

Constitutional Principles and Horizontal Effects: Kücükdeveci revisited

While German labour lawyers were still awaiting the German Constitutional Court’s final verdict on the principles established by the Mangold case, the Court of Justice of the European Union re-visited the question what exactly are the effects of Directive 2000/78 and the constitutional principle of non-discrimination on grounds of age. This article analyses the constitutional relevance of this case in two respects. First, it argues that the Court has accepted neither direct horizontal effects of directives nor direct effects of constitutional principles, but rather - much more cautiously - reiterated the rule that directives on constitutional principles such as non-discrimination can exclude the application of national legislation in horizontal cases. The article also demonstrates that this cautious approach has succeeded in convincing the German Constitutional Court that the Mangold judgment was not ultra vires. Consequently, the claim challenging that judgment was dismissed and a constitutional crisis avoided.

Developing management capability within a horizontal supply chain in performance measurement deployment and evolution: A Dynamic Capabilities and Goal Theory perspective

Complex collaboration in rapidly changing business environments create challenges for management capability in Utility Horizontal Supply Chains (UHSCs) involving the deploying and evolving of performance measures. The aim of the study is twofold. First, there is a need to explore how management capability can be developed and used to deploy and evolve Performance Measurement (PM), both across a UHSC and within its constituent organisations, drawing upon a theoretical nexus of Dynamic Capability (DC) theory and complementary Goal Theory. Second, to make a contribution to knowledge by empirically building theory using these constructs to show the management motivations and behaviours within PM-based DCs. The methodology uses an interpretive theory building, multiple case based approach (n=3) as part of a USHC. The data collection methods include, interviews (n=54), focus groups (n=10), document analysis and participant observation (reflective learning logs) over a five-year period giving longitudinal data. The empirical findings lead to the development of a conceptual framework showing that management capabilities in driving PM deployment and evolution can be represented as multilevel renewal and incremental Dynamic Capabilities, which can be further understood in terms of motivation and behaviour by Goal-Theoretic constructs. In addition three interrelated cross cutting themes of management capabilities in consensus building, goal setting and resource change were identified. These management capabilities require carefully planned development and nurturing within the UHSC. 

Absorbance enhancement in microplate wells for improved-sensitivity biosensors

A generic optical biosensing strategy was developed that relies on the absorbance enhancement phenomenon occurring in a multiple scattering matrix. Experimentally, inserts made of glass fiber membrane were placed into microplate wells in order to significantly lengthen the trajectory of the incident light through the sample and therefore increase the corresponding absorbance. Enhancement factor was calculated by comparing the absorbance values measured for a given amount of dye with and without the absorbance-enhancing inserts in the wells. Moreover, the dilution of dye in solutions with different refractive indices (RI) clearly revealed that the enhancement factor increased with the ΔRI between the membrane and the surrounding medium, reaching a maximum value (EF>25) when the membranes were dried. On this basis, two H2O2-biosensing systems were developed based on the biofunctionalization of the glass fiber inserts either with cytochrome c or horseradish peroxidase (HRP) and the analytical performances were systematically compared with the corresponding bioassay in solution. The efficiency of the absorbance-enhancement approach was particularly clear in the case of the cytochrome c-based biosensor with a sensitivity gain of 40 folds and wider dynamic range. Therefore, the developed strategy represents a promising way to convert standard colorimetric bioassays into optical biosensors with improved sensitivity.

Distribución horizontal de la anchoveta peruana con relación a variables ambientales en el período 1986 - 2000

Se analizó la distribución horizontal de la anchoveta Engraulis ringens utilizando sistemas de información geográfica. Los datos fueron obtenidos de los cruceros de evaluación hidroacústica de recursos pelágicos realizados durante los veranos de 1986 al 2000. Los resulitados indican que la distribución horizontal de la anchoveta está asociada a parámetros oceanográficos superficiales del mar, como rangos de temperatura, salinidad y clorofila a; sin embargo,parece ser que el parámetro más importante es la salinidad.

Horizontal and vertical distributions of zooplanckton numbers and biomass off the coast of Peru

Estudio de las distribuciones horizontales y verticales del zooplancton a lo largo de una línea desde cerca de la costa hasta el borde de la plataforma.

Distribución horizontal de los Amphipoda (crustacea) en el mar peruano durante el fenómeno "El niño" verano 1983

Los anfípodos hepéridos son microcrustáceos marinos que tienen un rol importante en la ecología trófica de especies pesqueras, se caracterizan por su voraz comportamiento predador sobre otros componentes del zooplancton (NELSON, 1979) y debido a su abundancia constituyen una fuente de alimento para niveles tróficos superiores (ALVAREZ y VIÑAS, 1994). El área de estudio comprende desde 03°29.80´S hasta los 12°54.50´S, abarcando los perfiles de Puerto Pizarro, Cabo Blanco, Talara, Paita, Punta Falsa, Pimentel, Chicama, Salaverry, Chimbote, Huarmey, Supe, Guacho, Chancay, Callao, Pucusana y Cerro Azul, cubriendo de esta manera la parte norte y centro del litoral peruano hasta las 100 millas náuticas de la costa y 50 metros de profundidad. Se determinan 34 especies de anfípodos, con 26 nuevos registros para el país y 2 especies nuevas. La familia Hyperridae es la que registra mayor representatividad a nivel específico destacando por su abundancia las especies Hyperioides sibaginis e Hyperietta vossleri. El presente trabajo, contribuye principalmente a ampliar el conocimiento de especies de anfípodos y asociarlas con las características ambientales, así las especies Vibilia chuni, Partaphronima gracilis, Hemithiphys tenuimanuss, Euscelus robustus y Schizoscelus ornatus, se encuentran relacionados con salinidades que fluctuan entre 34.8 y 35.1‰ y temperaturas de 25.4 hasta 28.2°C, rangos correspondientes a aguas de mezcla de Aguas Ecuatoriales Superficiales (AES) y Aguas Subtropicales superficiales (ASS).

Correcting Interdevice Bias of Horizontal White-to-White and Sulcus-to-Sulcus Measures Used for Implantable Collamer Lens Sizing.

PURPOSE: To assess the agreement and repeatability of horizontal white-to-white (WTW) and horizontal sulcus-to-sulcus (STS) diameter measurements and use these data in combination with available literature to correct for interdevice bias in preoperative implantable collamer lens (ICL) size selection. DESIGN: Interinstrument reliability and bias assessment study. METHODS: A total of 107 eyes from 56 patients assessed for ICL implantation at our institution were included in the study. This was a consecutive series of all patients with suitable available data. The agreement and bias between WTW (measured with the Pentacam and BioGraph devices) and STS (measured with the HiScan device) were estimated. RESULTS: The mean spherical equivalent was -8.93 ± 5.69 diopters. The BioGraph measures of WTW were wider than those taken with the Pentacam (bias = 0.26 mm, P < .01), and both horizontal WTW measures were wider than the horizontal STS measures (bias >0.91 mm, P < .01). The repeatability (Sr) of STS measured with the HiScan was 0.39 mm, which was significantly reduced (Sr = 0.15 mm) when the average of 2 measures was used. Agreement between the horizontal WTW measures and horizontal STS estimates when bias was accounted for was г = 0.54 with the Pentacam and г = 0.64 with the BioGraph. CONCLUSIONS: Large interdevice bias was observed for WTW and STS measures. STS measures demonstrated poor repeatability, but the average of repeated measures significantly improved repeatability. In order to conform to the US Food and Drug Administration's accepted guidelines for ICL sizing, clinicians should be aware of and account for the inconsistencies between devices.