Resource utilization and cost analyses of home-based palliative care service provision:The Niagara West End-of-Life Shared-Care Project

Background: Increasing emphasis is being placed on the economics of health care service delivery - including home-based palliative care. Aim: This paper analyzes resource utilization and costs of a shared-care demonstration project in rural Ontario (Canada) from the public health care system's perspective. Design: To provide enhanced end-of-life care, the shared-care approach ensured exchange of expertise and knowledge and coordination of services in line with the understood goals of care. Resource utilization and costs were tracked over the 15 month study period from January 2005 to March 2006. Results: Of the 95 study participants (average age 71 years), 83 had a cancer diagnosis (87%); the non-cancer diagnoses (12 patients, 13%) included mainly advanced heart diseases and COPD. Community Care Access Centre and Enhanced Palliative Care Team-based homemaking and specialized nursing services were the most frequented offerings, followed by equipment/transportation services and palliative care consults for pain and symptom management. Total costs for all patient-related services (in 2007 CAN) were 1,625,658.07 - or 17,112.19 per patient/117.95 per patient day. Conclusion: While higher than expenditures previously reported for a cancer-only population in an urban Ontario setting, the costs were still within the parameters of the US Medicare Hospice Benefits, on a par with the per diem funding assigned for long-term care homes and lower than both average alternate level of care and hospital costs within the Province of Ontario. The study results may assist service planners in the appropriate allocation of resources and service packaging to meet the complex needs of palliative care populations. © 2012 The Author(s).

Risk factors for falls and injuries in a long-term care facility in Ontario

Objective: To identify risk factors for falls and injuries among seniors living in a long-term care facility. Method: Case-control study of 335 residents living at St. Joseph's Villa, Dundas, Ontario. Cases were defined as residents who fell between July 1, 1996 and June 30, 1997; controls were those who did not fall. To identify risk factors for injury, cases were defined as those with completed incident injury forms and controls as those without. Results: The most important risk factors for falls included: having fallen in the past three months; residing in a secured unit; living in the facility for two or more years; having the potential to cause injury to others; and having an illness, disease or behaviour that may cause a fall. The most important risk factor for injury among those who fell was altered mental state. Conclusion: The risk factors identified may be helpful to those planning falls prevention initiatives within long-term care settings.

Towards Utilizing Model-Driven Engineering of Composite Applications for Business Performance Analysis

Composite Applications on top of SAPs implementation of SOA (Enterprise SOA) enable the extension of already existing business logic. In this paper we show, based on a case study, how Model-Driven Engineering concepts are applied in the development of such Composite Applications. Our Case Study extends a back-end business process which is required for the specific needs of a demo company selling wine. We use this to describe how the business centric models specifying the modified business behaviour of our case study can be utilized for business performance analysis where most of the actions are performed by humans. In particular, we apply a refined version of Model-Driven Performance Engineering that we proposed in our previous work and motivate which business domain specifics have to be taken into account for business performance analysis. We additionally motivate the need for performance related decision support for domain experts, who generally lack performance related skills. Such a support should offer visual guidance about what should be changed in the design and resource mapping to get improved results with respect to modification constraints and performance objectives, or objectives for time.

Assessment of the solubility and bioaccessibility of arsenic in realgar wine using a simulated gastrointestinal system

Consumption of arsenic (As) wine is a traditional activity during the classic Chinese festival of Duanwu, colloquially known worldwide as the Dragon Boat Day. Arsenic wine is drunk on the morning of the fifth day of the fifth lunar calendar month to commemorate the death of Qu Yuan, a famed Chinese poet who drowned himself in protest of a corrupt government, and to protect against ill fortune. Although realgar minerals are characteristically composed of sparingly soluble tetra-arsenic tetra-sulfides (As(4)S(4)), purity does vary with up to 10% of As being present as non-sulfur bound species, such as arsenate (As(v)) and arsenite (As(III)). Despite, the renewed interest in As speciation and the bioaccessibility of the active As components in realgar based Chinese medicines, little is known about the safety surrounding the cultural practice of drinking As wine. In a series of experiments the speciation and solubility of As in a range of wines were investigated. Furthermore, a simulated gastrointestinal system was employed to predict the impact of digestive processes on As bioavailability. The predominant soluble As species found in all the wines were As(III) and As(v). Based on typical As wine recipes employing 0.1 g realgar mL(-1) wine, the concentration of dissolved As ranged from ca. 100 to 400 mg L(-1) depending on the ethanol content of the preparation: with the As solubility found to be higher in wines with a lower proportion of ethanol. Based on a common 100 mL measure of wine with a concentration of 400 mg As L(-1), the amount of soluble As would equate to around half of the acute minimal lethal dose for adults. This is likely an underestimate of the bioaccessible concentration, as a three-fold increase in bioaccessibility could be observed in the intestinal phase based on the results from the stimulated gastrointestinal system. (C) 2011 Elsevier B.V. All rights reserved.

A cultural practice of drinking realgar wine leading to elevated urinary arsenic and its potential health risk

Toasting friends and family with realgar wines and painting children's foreheads and limbs with the leftover realgar/alcohol slurries is an important customary ritual during the Dragon Boat Festival (DBF); a Chinese national holiday and ancient feast day celebrated throughout Asia. Realgar is an arsenic sulfide mineral, and source of highly toxic inorganic arsenic. Despite the long history of realgar use during the DBF, associated risk to human health by arsenic ingestion or percutaneous adsorption is unknown. To address this urine samples were collected from a cohort of volunteers who were partaking in the DBF festivities. The total concentration of arsenic in the wine consumed was 70 mg L(-1) with all the arsenic found to be inorganic. Total arsenic concentrations in adult urine reached a maximum of ca. 550 mu g L(-1) (mean 220.2 mu g L(-1)) after 16 h post-ingestion of realgar wine, while face painting caused arsenic levels in children's urine to soar to 100 mu g L(-1) (mean 85.3 mu g L(-1)) 40 h after the initial paint application. The average concentration of inorganic arsenic in the urine of realgar wine drinkers on average doubled 16 h after drinking, although this was not permanent and levels subsided after 28 h. As would be expected in young children, the proportions of organic arsenic in the urine remained high throughout the 88-h monitoring period. However, even when arsenic concentrations in the urine peaked at 40 h after paint application, concentrations in the urine only declined slightly thereafter, suggesting pronounced longer term dermal accumulation and penetration of arsenic. Drinking wines blended with realgar or using realgar based paints on children does result in the significant absorption of arsenic and therefore presents a potentially serious and currently unquantified health risk. (C) 2011 Elsevier Ltd. All rights reserved.

Human resource management practices in the multinational company: A test of system, societal, and dominance effects

Does the use of HRM practices by multinational companies (MNCs) reflect their national origins or are practices similar regardless of context? To the extent that practices are similar, is there any evidence of global best standards? The authors use the system, societal, and dominance framework to address these questions through analysis of 1,100 MNC subsidiaries in Canada, Ireland, Spain, and the United Kingdom. They argue that this framework offers a richer account than alternatives such as varieties of capitalism. The study moves beyond previous research by differentiating between system effects at the global level and dominance effects arising from the diffusion of practices from a dominant economy. It shows that both effects are present, as are some differences at the societal level. Results suggest that MNCs configure their HRM practices in response to all three forces rather than to some uniform global best practices or to their national institutional contexts.

Determinants of WTP for Prosecco wine: A latent class regression with attitudinal responses

Purpose – Under investigation is Prosecco wine, a sparkling white wine from North-East Italy.
Information collection on consumer perceptions is particularly relevant when developing market
strategies for wine, especially so when local production and certification of origin play an important
role in the wine market of a given district, as in the case at hand. Investigating and characterizing the
structure of preference heterogeneity become crucial steps in every successful marketing strategy. The
purpose of this paper is to investigate the sources of systematic differences in consumer preferences.
Design/methodology/approach – The paper explores the effect of inclusion of answers to
attitudinal questions in a latent class regression model of stated willingness to pay (WTP) for this
specialty wine. These additional variables were included in the membership equations to investigate
whether they could be of help in the identification of latent classes. The individual specific WTPs from
the sampled respondents were then derived from the best fitting model and examined for consistency.
Findings – The use of answers to attitudinal question in the latent class regression model is found to
improve model fit, thereby helping in the identification of latent classes. The best performing model
obtained makes use of both attitudinal scores and socio-economic covariates identifying five latent
classes. A reasonable pattern of differences in WTP for Prosecco between CDO and TGI types were
derived from this model.
Originality/value – The approach appears informative and promising: attitudes emerge as
important ancillary indicators of taste differences for specialty wines. This might be of interest per se
and of practical use in market segmentation. If future research shows that these variables can be of use
in other contexts, it is quite possible that more attitudinal questions will be routinely incorporated in
structural latent class hedonic models.

Country-of-origin effects on Russian wine consumers

In recent years, Russia has experienced significant economic growth. The wine industry is among those most affected by increases in disposable income. As a consequence, Russian wine importers have widened the range at the upper end of the quality spectrum. In the current scenario, some key questions arise concerning consumer attitudes toward wine and the way it is perceived in this evolving market. This article attempts to investigate such concerns through a choice experiment approach conducted by means of a questionnaire-based survey submitted to 388 Russian households located in the country's three largest cities (Moscow, Saint Petersburg, and Novosibirsk). In the experiment, respondents were asked to choose their favorite wine among seven dry red wines. The stated choices are analyzed using a random utility model to obtain an estimation of the price effect through a triangular distribution. Our results indicate the presence of three distinct market segments in the Russian wine market: a segment with only high-quality, highly priced Italian and French wines, a medium-quality segment currently limited to Spanish wines, and a much lower quality segment of wines in which demand for alcohol is essentially satisfied.

Sparkling wine choice from supermarket shelves: the impact of certification of origin and production practices

We report the results of a study based on revealed and stated preference data on choice of Prosecco wines in retail stores close to the origin of production in Northern Italy. Emphasis is placed on ability to reconcile the utility structure of stated preference data with that underlying revealed preference data. We extend the analysis to cover nonattendance of key attributes, such as price and certification of origin, while controlling for the large range of brand effects.

Early Implementation of Building Information Modeling into a Cold-Formed Steel Company: Providing Novel Project Management Techniques and Solutions to Industry

The ability of building information modeling (BIM) to positively impact projects in the AEC through greater collaboration and integration is widely acknowledged. This paper aims to examine the development of BIM and how it can contribute to the cold-formed steel (CFS) building industry. This is achieved through the adoption of a qualitative methodology encompassing a literature review, exploratory interviews with industry experts, culminating in the development of e-learning material for the sector. In doing so, the research team have collaborated with one of the United Kingdom’s largest cold-formed steel designer/fabricators. By demonstrating the capabilities of BIM software and providing technical and informative videos in its creation, this project has found two key outcomes. Firstly, to provide invaluable assistance in the transition from traditional processes to a fully collaborative 3D BIM as required by the UK Government under the “Government Construction Strategy” by 2016 in all public sector projects. Secondly, to demonstrate BIM’s potential not only within CFS companies, but also within the AEC sector as a whole. As the flexibility, adaptability and interoperability of BIM software is alluded to, the results indicate that the introduction and development of BIM and the underlying ethos suggests that it is a key tool in the development of the industry as a whole.