Effectiveness and safety of cryotherapy after arthroscopic anterior cruciate ligament reconstruction. A systematic review of the literature

Cryotherapy is widely used in rehabilitation; however, its effectiveness after anterior cruciate ligament (ACL) reconstruction remains uncertain. To investigate the effectiveness and safety of cryotherapy following ACL reconstruction through a systematic review, randomized and quasi-randomized clinical trials were searched in the databases: MEDLINE, EMBASE, CENTRAL PEDro, SportDiscus, CINAHL, LILACS (June 2013). the primary outcomes measures were pain, edema and adverse events; the secondary outcomes were knee function, analgesic medication use, range of motion, blood loss, hospital stay, quality of life and patient satisfaction. the methodological quality of studies was evaluated using the Cochrane Collaboration risk-of-bias tool. Ten trials (a total of 573 patients) were included. Results of meta-analysis showed that the use of cold compression devices produced a significant reduction in pain scores 48 h after surgery (p < 0.00001), compared to no cryotherapy. the risk for adverse events did not differ between patients receiving cryotherapy versus no treatment (p = 1.00). the limited evidence currently available is insufficient to draw definitive conclusions on the effectiveness of cryotherapy for other outcomes. There is a need for well designed, good quality randomized trials to answer other questions related to this intervention and increase the precision of future systematic reviews. (C) 2014 Elsevier B.V. All rights reserved.

A review of the effectiveness and meaningfulness of education interventions to enable children, young people and their families to self-care for their gastrostomy tubes in the community.

A systematic review of qualitative and quantitative evidence of the effectiveness and meaningfulness of education interventions to enable children, young people and their families to self-care for their gastrostomy tubes in the community

How to run successful e-internships: a case for organizational learning.

Purpose – The purpose of this paper is to outline unique learning experience that virtual/e-internships can offer small and medium-sized enterprises and start-up organizations. Design/methodology/approach – We interviewed 18 experts on e-internships (interns and managers of internships) across several countries to learn more about the learning experiences for both organizations and interns. The information from these interviews was also used to formulate a number of recommendations. Findings – The interviews provided insights into how e-internships can provide development opportunities for interns, managers and staff within these organizations. One important benefit pertains to the skill development of both interns and managers. The interns get unique working experiences that also benefit the organizations in terms of their creativity, input and feedback. In return, managers get a unique learning experience that helps them expand their project management skills, interpersonal skills and mentoring. Practical implications – We outline a number of recommendations that consider skill development, the benefit of diversity in numerous forms as well as mutual benefits for enterprises and start-ups. Originality/value – The discussion of the various benefits and conditions under which virtual internships will succeed in organizations provide practitioners an insight into the organizational opportunities available to them given the right investment into e-interns and internship schemes.

Evaluating SWICE-R (South West Information for Clinical Effectiveness - Rural). Final report for South West Workforce Development Confederations (Knowledge Resources Development Unit)

Yeoman, A., Durbin, J. & Urquhart, C. (2004). Evaluating SWICE-R (South West Information for Clinical Effectiveness - Rural). Final report for South West Workforce Development Confederations, (Knowledge Resources Development Unit). Aberystwyth: Department of Information Studies, University of Wales Aberystwyth. Sponsorship: South West WDCs (NHS)

On the Effectiveness of Genetic Search in Combinatorial Optimization

In this paper, we study the efficacy of genetic algorithms in the context of combinatorial optimization. In particular, we isolate the effects of cross-over, treated as the central component of genetic search. We show that for problems of nontrivial size and difficulty, the contribution of cross-over search is marginal, both synergistically when run in conjunction with mutation and selection, or when run with selection alone, the reference point being the search procedure consisting of just mutation and selection. The latter can be viewed as another manifestation of the Metropolis process. Considering the high computational cost of maintaining a population to facilitate cross-over search, its marginal benefit renders genetic search inferior to its singleton-population counterpart, the Metropolis process, and by extension, simulated annealing. This is further compounded by the fact that many problems arising in practice may inherently require a large number of state transitions for a near-optimal solution to be found, making genetic search infeasible given the high cost of computing a single iteration in the enlarged state-space.

Effectiveness of Loss labeling in Improving TCP Performance in Wired/Wireless Networks

The current congestion-oriented design of TCP hinders its ability to perform well in hybrid wireless/wired networks. We propose a new improvement on TCP NewReno (NewReno-FF) using a new loss labeling technique to discriminate wireless from congestion losses. The proposed technique is based on the estimation of average and variance of the round trip time using a filter cal led Flip Flop filter that is augmented with history information. We show the comparative performance of TCP NewReno, NewReno-FF, and TCP Westwood through extensive simulations. We study the fundamental gains and limits using TCP NewReno with varying Loss Labeling accuracy (NewReno-LL) as a benchmark. Lastly our investigation opens up important research directions. First, there is a need for a finer grained classification of losses (even within congestion and wireless losses) for TCP in heterogeneous networks. Second, it is essential to develop an appropriate control strategy for recovery after the correct classification of a packet loss.

Building effectiveness communication ratios (BECs): an integrated ‘life-cycle’ methodology for mitigating energy-use in buildings

Current building regulations are generally prescriptive in nature. It is widely accepted in Europe that this form of building regulation is stifling technological innovation and leading to inadequate energy efficiency in the building stock. This has increased the motivation to move design practices towards a more ‘performance-based’ model in order to mitigate inflated levels of energy-use consumed by the building stock. A performance based model assesses the interaction of all building elements and the resulting impact on holistic building energy-use. However, this is a nebulous task due to building energy-use being affected by a myriad of heterogeneous agents. Accordingly, it is imperative that appropriate methods, tools and technologies are employed for energy prediction, measurement and evaluation throughout the project’s life cycle. This research also considers that it is imperative that the data is universally accessible by all stakeholders. The use of a centrally based product model for exchange of building information is explored. This research describes the development and implementation of a new building energy-use performance assessment methodology. Termed the Building Effectiveness Communications ratios (BECs) methodology, this performance-based framework is capable of translating complex definitions of sustainability for energy efficiency and depicting universally understandable views at all stage of the Building Life Cycle (BLC) to the project’s stakeholders. The enabling yardsticks of building energy-use performance, termed Ir and Pr, provide continuous design and operations feedback in order to aid the building’s decision makers. Utilised effectively, the methodology is capable of delivering quality assurance throughout the BLC by providing project teams with quantitative measurement of energy efficiency. Armed with these superior enabling tools for project stakeholder communication, it is envisaged that project teams will be better placed to augment a knowledge base and generate more efficient additions to the building stock.

The Irish credit union movement: member participation and organisational effectiveness

This thesis explores the relationship between organisational effectiveness and member participation in Irish credit unions. It is hypothesised that a positive relationship exists between both variables. Co-operative literature suggests that co-operatives require the involvement of the members in identifying and meeting their own needs in order to be effective organisations. Previous research studies into the issue across a variety of organisational types have shown mixed results. Related research into credit unions is sparse. The primary research undertaken is both quantitative and qualitative in approach. Organisational effectiveness is examined in both quantitative and qualitative terms. Member participation, being an organisational process, is examined in qualitative terms. Indicators of organisational effectiveness, specific to credit unions, are drawn up and form a framework through which effectiveness is examined. A typology and indicators of member participation are also developed and form a framework through which member participation is examined. The case study method is used primarily, to examine organisational effectiveness and member participation in Irish credit unions. A case study of a theoretical credit union, which is based on a composite of good practice in credit unions in Ireland and internationally, is also drawn up to develop the analysis further. The case studies allow an analysis of both organisational effectiveness and member participation, as well as an exploration of the relationship between the two. The findings support the hypothesis that there is a direct relationship between the two variables. In order to be effective, credit unions must involve their members in identifying their needs and in designing services to meet these needs. At present, they do not do this to any large extent. In order to continue to meet the needs of their members and to compete in the financial services sector, credit unions will need to find ways of involving members, drawing on good practice in other co-operatives. This will be critical to their continued success.

Becoming a CEO: an exploration of the theory and practice of effective organisational leadership

This Thesis is an exploration of potential enhancement in effectiveness, personally, professionally and organisationally through the use of Theory as an Apparatus of Thought. Enhanced effectiveness was sought by the practitioner (Subject), while in transition to becoming Chief Executive of his organization. The introduction outlines the content and the structure of the University College Cork DBA. Essay One outlines what Theory is, what Adult Mental Development is and an exploration of Theories held in the Authors past professional practice. Immunity to change is also reflected on. Essay Two looks at the construct of the key Theories used in the Thesis. Prof. Robert Kegan’s Theory of Adult Mental Development was used to aid the generation of insight. The other key Theories used were The Theory of The Business, Theory of the Co‐operative and a Theory of Organisational Leadership. Essay Three explores the application of the key Theories in a professional setting. The findings of the Thesis were that the subject was capable of dealing with increased environmental complexity and uncertainty by using Theory as an Apparatus of Thought, which in turn enhanced personal, professional and organisational effectiveness. This was achieved by becoming more aware of the Theories held by the practitioner, the experiences from the application of those Theories, which then led to greater insight. The author also found that a detailed understanding of the Theory of the Business and a Theory of Leadership would support any new CEO in the challenging early part of their tenure.

Leveraging lessons learned in organizations through implementing practice-based organizational learning and performance improvement - An opportunity for context-based intelligent assistant support (CIAS)

Organizations that leverage lessons learned from their experience in the practice of complex real-world activities are faced with five difficult problems. First, how to represent the learning situation in a recognizable way. Second, how to represent what was actually done in terms of repeatable actions. Third, how to assess performance taking account of the particular circumstances. Fourth, how to abstract lessons learned that are re-usable on future occasions. Fifth, how to determine whether to pursue practice maturity or strategic relevance of activities. Here, organizational learning and performance improvement are investigated in a field study using the Context-based Intelligent Assistant Support (CIAS) approach. A new conceptual framework for practice-based organizational learning and performance improvement is presented that supports researchers and practitioners address the problems evoked and contributes to a practice-based approach to activity management. The novelty of the research lies in the simultaneous study of the different levels involved in the activity. Route selection in light rail infrastructure projects involves practices at both the strategic and operational levels; it is part managerial/political and part engineering. Aspectual comparison of practices represented in Contextual Graphs constitutes a new approach to the selection of Key Performance Indicators (KPIs). This approach is free from causality assumptions and forms the basis of a new approach to practice-based organizational learning and performance improvement. The evolution of practices in contextual graphs is shown to be an objective and measurable expression of organizational learning. This diachronic representation is interpreted using a practice-based organizational learning novelty typology. This dissertation shows how lessons learned when effectively leveraged by an organization lead to practice maturity. The practice maturity level of an activity in combination with an assessment of an activity’s strategic relevance can be used by management to prioritize improvement effort.

At what price? A cost-effectiveness analysis comparing trial of labour after previous caesarean versus elective repeat caesarean delivery

Background: Elective repeat caesarean delivery (ERCD) rates have been increasing worldwide, thus prompting obstetric discourse on the risks and benefits for the mother and infant. Yet, these increasing rates also have major economic implications for the health care system. Given the dearth of information on the cost-effectiveness related to mode of delivery, the aim of this paper was to perform an economic evaluation on the costs and short-term maternal health consequences associated with a trial of labour after one previous caesarean delivery compared with ERCD for low risk women in Ireland.Methods: Using a decision analytic model, a cost-effectiveness analysis (CEA) was performed where the measure of health gain was quality-adjusted life years (QALYs) over a six-week time horizon. A review of international literature was conducted to derive representative estimates of adverse maternal health outcomes following a trial of labour after caesarean (TOLAC) and ERCD. Delivery/procedure costs derived from primary data collection and combined both "bottom-up" and "top-down" costing estimations.Results: Maternal morbidities emerged in twice as many cases in the TOLAC group than the ERCD group. However, a TOLAC was found to be the most-effective method of delivery because it was substantially less expensive than ERCD ((sic)1,835.06 versus (sic)4,039.87 per women, respectively), and QALYs were modestly higher (0.84 versus 0.70). Our findings were supported by probabilistic sensitivity analysis.Conclusions: Clinicians need to be well informed of the benefits and risks of TOLAC among low risk women. Ideally, clinician-patient discourse would address differences in length of hospital stay and postpartum recovery time. While it is premature advocate a policy of TOLAC across maternity units, the results of the study prompt further analysis and repeat iterations, encouraging future studies to synthesis previous research and new and relevant evidence under a single comprehensive decision model.

The effectiveness of using patient-reported outcome measures as quality improvement tools

Aim: To investigate the value of using PROMs as quality improvement tools. Methods: Two systematic reviews were undertaken. The first reviewed the quantitative literature on the impact of PROMs feedback and the second reviewed the qualitative literature on the use of PROMs in practice. These reviews informed the focus of the primary research. A cluster randomised controlled trial (PROFILE) examined the impact of providing peer benchmarked PROMs feedback to consultant orthopaedic surgeons on improving outcomes for hip replacement surgery. Qualitative interviews with surgeons in the intervention arm of the trial examined the view of and reactions to the feedback. Results: The quantitative review of 17 studies found weak evidence to suggest that providing PROMs feedback to professionals improves patient outcomes. The qualitative review of 16 studies identified the barriers and facilitators to the use of PROMs based on four themes: practical considerations, attitudes towards the data, methodological concerns and the impact of feedback on care. The PROFILE trial included 11 surgeons and 215 patients in the intervention arm, and 10 surgeons and 217 patients in the control arm. The trial found no significant difference in the Oxford Hip Score between the arms (-0.7, 95% CI -1.9-0.5, p=0.2). Interviews with surgeons revealed mixed opinions about the value of the PROMs feedback and the information did not promote explicit changes to their practice. Conclusion: It is important to use PROMs which have been validated for the specific purpose of performance measurement, consult with professionals when developing a PROMs feedback intervention, communicate with professionals about the objectives of the data collection, educate professionals on the properties and interpretation of the data, and support professionals in using the information to improve care. It is also imperative that the burden of data collection and dissemination of the information is minimised.

Exploring alternatives for milk quality improvement and more efficient dairy production in a smallholder farming context – case study: Mantaro Valley (Peru)

Consumer demand is revolutionizing the way products are being produced, distributed and marketed. In relation to the dairy sector in developing countries, aspects of milk quality are receiving more attention from both society and the government. However, milk quality management needs to be better addressed in dairy production systems to guarantee the access of stakeholders, mainly small-holders, into dairy markets. The present study is focused on an analysis of the interaction of the upstream part of the dairy supply chain (farmers and dairies) in the Mantaro Valley (Peruvian central Andes), in order to understand possible constraints both stakeholders face implementing milk quality controls and practices; and evaluate “ex-ante” how different strategies suggested to improve milk quality could affect farmers and processors’ profits. The analysis is based on three complementary field studies conducted between 2012 and 2013. Our work has shown that the presence of a dual supply chain combining both formal and informal markets has a direct impact on dairy production at the technical and organizational levels, affecting small formal dairy processors’ possibilities to implement contracts, including agreements on milk quality standards. The analysis of milk quality management from farms to dairy plants highlighted the poor hygiene in the study area, even when average values of milk composition were usually high. Some husbandry practices evaluated at farm level demonstrated cost effectiveness and a big impact on hygienic quality; however, regular application of these practices was limited, since small-scale farmers do not receive a bonus for producing hygienic milk. On the basis of these two results, we co-designed with formal small-scale dairy processors a simulation tool to show prospective scenarios, in which they could select their best product portfolio but also design milk payment systems to reward farmers’ with high milk quality performances. This type of approach allowed dairy processors to realize the importance of including milk quality management in their collection and manufacturing processes, especially in a context of high competition for milk supply. We concluded that the improvement of milk quality in a smallholder farming context requires a more coordinated effort among stakeholders. Successful implementation of strategies will depend on the willingness of small-scale dairy processors to reward farmers producing high milk quality; but also on the support from the State to provide incentives to the stakeholders in the formal sector.

Shipping information pipeline: initial design principles

This paper presents a design science approach to solving persistent problems in the international shipping eco system by creating the missing common information infrastructures. Specifically, this paper reports on an ongoing dialogue between stakeholders in the shipping industry and information systems researchers engaged in the design and development of a prototype for an innovative IT-artifact called Shipping Information Pipeline which is a kind of “an internet” for shipping information. The instrumental aim is to enable information seamlessly to cross the organizational boundaries and national borders within international shipping which is a rather complex domain. The intellectual objective is to generate and evaluate the efficacy and effectiveness of design principles for inter-organizational information infrastructures in the international shipping domain that can have positive impacts on global trade and local economies.

Effectiveness of rescue antiretroviral therapy including intravenously administered zidovudine and foscarnet in a child with HIV-1 enteropathy.

Case Reports