Critical Success Factors for Transfer-Operate-Transfer Urban Water Supply Projects in China

Over the years, build-operate-transfer (BOT) has continuously attracted research interests. Many studies on BOT have been carried out. Variations of BOT such as build-own-operate-transfer and build-own-operate have also been reported in some relevant publications. However, few investigations thus far have been conducted for transfer-operate-transfer (TOT). Therefore, there is a knowledge gap in this particular field. TOT is a new model that is suitable for existing infrastructure and public utility projects formerly funded by the governments and currently operated by state-owned enterprises. It refers to the transfer of a running public project to a foreign business or domestic private entity. Based on four case studies carried out in the Chinese water supply industry, this paper examines why there is an increasing need for TOT projects and identifies the distinctive features of TOT practice in China. This is followed by an introduction of a framework of critical success factors (CSFs) for TOT projects. The most important factors include project profitability, asset quality, fair risk allocation, competitive tendering, internal coordination within government, employment of professional advisors, corporate governance, and government supervision. The identification of CSFs provides a useful guidance to project parties planning to participate in TOT practice.

Philadelphia-Negative Classical Myeloproliferative Neoplasms: Critical Concepts and Management Recommendations From European LeukemiaNet

We present a review of critical concepts and produce recommendations on the management of Philadelphia-negative classical myeloproliferative neoplasms, including monitoring, response definition, first-and second-line therapy, and therapy for special issues. Key questions were selected according the criterion of clinical relevance. Statements were produced using a Delphi process, and two consensus conferences involving a panel of 21 experts appointed by the European LeukemiaNet (ELN) were convened. Patients with polycythemia vera (PV) and essential thrombocythemia (ET) should be defined as high risk if age is greater than 60 years or there is a history of previous thrombosis. Risk stratification in primary myelofibrosis (PMF) should start with the International Prognostic Scoring System (IPSS) for newly diagnosed patients and dynamic IPSS for patients being seen during their disease course, with the addition of cytogenetics evaluation and transfusion status. High-risk patients with PV should be managed with phlebotomy, low-dose aspirin, and cytoreduction, with either hydroxyurea or interferon at any age. High-risk patients with ET should be managed with cytoreduction, using hydroxyurea at any age. Monitoring response in PV and ET should use the ELN clinicohematologic criteria. Corticosteroids, androgens, erythropoiesis-stimulating agents, and immunomodulators are recommended to treat anemia of PMF, whereas hydroxyurea is the first-line treatment of PMF-associated splenomegaly. Indications for splenectomy include symptomatic portal hypertension, drug-refractory painful splenomegaly, and frequent RBC transfusions. The risk of allogeneic stem-cell transplantation-related complications is justified in transplantation-eligible patients whose median survival time is expected to be less than 5 years.

A strategy to identify critical appraisal criteria for primary mixed-method studies

The practice of mixed-methods research has increased considerably over the last 10 years. While these studies have been criticized for violating quantitative and qualitative paradigmatic assumptions, the methodological quality of mixed-method studies has not been addressed. The purpose of this paper is to identify criteria to critically appraise the quality of mixed-method studies in the health literature. Criteria for critically appraising quantitative and qualitative studies were generated from a review of the literature. These criteria were organized according to a cross-paradigm framework. We recommend that these criteria be applied to a sample of mixed-method studies which are judged to be exemplary. With the consultation of critical appraisal experts and experienced qualitative, quantitative, and mixed-method researchers, further efforts are required to revise and prioritize the criteria according to importance.

The relationship between breastfeeding and postpartum weight change-a systematic review and critical evaluation

Pregnancy and the postpartum period is a time of increased vulnerability for retention of excess body fat in women. Breastfeeding (BF) has been shown to have many health benefits for both mother and baby; however, its role in postpartum weight management is unclear. Our aim was to systematically review and critically appraise the literature published to date in relation to the impact of BF on postpartum weight change, weight retention and maternal body composition. Electronic literature searches were carried out using MEDLINE, EMBASE, PubMed, Web of Science, BIOSIS, CINAHL and British Nursing Index. The search covered publications up to 12 June 2012 and included observational studies (prospective and retrospective) carried out in BF mothers (either exclusively or as a subgroup), who were 2 years postpartum and with a body mass index (BMI) >18.5 kg m(-2), with an outcome measure of change in weight (including weight retention) and/or body composition. Thirty-seven prospective studies and eight retrospective studies were identified that met the selection criteria; studies were stratified according to study design and outcome measure. Overall, studies were heterogeneous, particularly in relation to sample size, measurement time points and in the classification of BF and postpartum weight change. The majority of studies reported little or no association between BF and weight change (n=27, 63%) or change in body composition (n=16, 89%), although this seemed to depend on the measurement time points and BF intensity. However, of the five studies that were considered to be of high methodological quality, four studies demonstrated a positive association between BF and weight change. This systematic review highlights the difficulties of examining the association between BF and weight management in observational research. Although the available evidence challenges the widely held belief that BF promotes weight loss, more robust studies are needed to reliably assess the impact of BF on postpartum weight management.International Journal of Obesity advance online publication, 20 August 2013; doi:10.1038/ijo.2013.132.

Quality Management and Managerialism in Healthcare:: A Critical Historical Survey

Quality Management and Managerialism in Healthcare creates a comprehensive and systematic international survey of various perspectives on healthcare quality management together with some of their most pertinent critiques. Chapter one starts with a general discussion of the factors that drove the introduction of management paradigms into public sector and health management contexts in the mid to late 1980s. Chapter two explores the rise of risk awareness in medicine; which, prior to the 1980s, stood largely in isolation to the implementation of managerial performance targets. Chapter three investigates the widespread adoption of performance management and clinical governance frameworks during the 1980s and 1990s. This is followed by Chapters four and five which examine systems based models of patient safety and the evidence-based medicine movement as exemplars of managerial perspectives on healthcare quality. Chapter six discusses potential future avenues for the development of alternative perspectives on quality of care which emphasise workforce involvement. The book concludes by reviewing the factors which have underpinned the managerialist trajectory of healthcare management over the past decades and explores the potential impact of nascent technologies such as 'connected health' and 'telehealth' on future developments.

A critical ethnography of communication processes involving the management of oral chemotherapeutic agents by patients with a primary diagnosis of colorectal cancer: study protocol

Aim
To describe the protocol used to examine the processes of communication between health professionals, patients and informal carers during the management of oral chemotherapeutic medicines to identify factors that promote or inhibit medicine concordance.

Background
Ideally communication practices about oral medicines should incorporate shared decision-making, two-way dialogue and an equality of role between practitioner and patient. While there is evidence that healthcare professionals are adopting these concordant elements in general practice there are still some patients who have a passive role during consultations. Considering oral chemotherapeutic medications, there is a paucity of research about communication practices which is surprising given the high risk of toxicity associated with chemotherapy.

Design
A critical ethnographic design will be used, incorporating non-participant observations, individual semi-structured and focus-group interviews as several collecting methods.

Methods
Observations will be carried out on the interactions between healthcare professionals (physicians, nurses and pharmacists) and patients in the outpatient departments where prescriptions are explained and supplied and on follow-up consultations where treatment regimens are monitored. Interviews will be conducted with patients and their informal carers. Focus-groups will be carried out with healthcare professionals at the conclusion of the study. These several will be analysed using thematic analysis. This research is funded by the Department for Employment and Learning in Northern Ireland (Awarded February 2012).

Discussion
Dissemination of these findings will contribute to the understanding of issues involved when communicating with people about oral chemotherapy. It is anticipated that findings will inform education, practice and policy.

Barriers to Subcontracted Labor Productivity in Urban Development Projects: An On-site Project Management Perspective

Considering the confined and complex nature of urban construction projects, labor productivity is one of the key factors attributing to project success. With the proliferation of sub-contracted labor, there is a necessity to consider the ramifications of this practice to the sector. This research aims to outline how project managers can optimise productivity levels of sub-contracted labor in urban construction projects, by addressing the barriers that most restrict these efficiency levels. A qualitative research approach is employed, incorporating semi-structured interviews based on three case studies from an urban context. The results are scrutinised using mind mapping software and accompanying analytical techniques. The findings from this research indicate that the effective on-site management of sub-contracted labor has a significant impact on the degree of success of an urban development project. The two core barriers to sub-contracted labor productivity are; 1) ineffective supervision of sub-contracted labor, and 2) lack of skilled sub-contracted labor. The implication of this research is that on-site project management play an integral role in the level of productivity achieved by sub-contracted labor in urban development projects. Therefore, on-site management situated in urban, confined construction sites, are encouraged to take heed of the findings herein and address the barriers documented. The value of this research is obtained through consideration of the critical factors; construction management professionals can mitigate such barriers, in order to optimise subcontracted labor productivity on-site.

Application of disturbance management principles in fresh food supply chains

The desire for more robust supply chains has led to a growth in theoretical and practical interest in the application of both preventive and impact reductive disturbance management principles. This application should ultimately lead to less vulnerable and more competitive supply chains. Based on the extant literature we identify fresh food supply chain's contextual factors (products, processes, supply chain networks and supply chain business environment) and their corresponding characteristics, as well as the main disturbance management principles used. To analyse their influence on the selection and application of disturbance management principles in fresh food supply chains we conducted three case studies. In each case we collected data on the relevant contextual factors, disturbance management principles applied and company background. As an underlying methodology, we first conduct within-case analysis and then expand the analyses to a cross-case context. Based on the findings from these case studies, propositions are built concerning the nature of contextual factors and their characteristics, and their influence on the selection and application of disturbance management principles in fresh food supply chains. Our main findings are related to the identification of contextual characteristics of fresh food supply chains that are either critical vulnerability sources, critical enablers or conditionals and as such require, facilitate or condition selection and application of disturbance management principles.

Management of polycythaemia vera: a critical review of current data

Polycythaemia vera (PV) is a chronic blood cancer; its clinical features are dominated by myeloproliferation (erythrocytosis, often leucocytosis and/or thrombocytosis) and a tendency for thrombosis and transformation to myelofibrosis or acute myeloid leukaemia. In the past 10 years the pathophysiology of this condition has been defined as JAK/STAT pathway activation, almost always due to mutations in JAK2 exons 12 or 14 (JAK2 V617F). In the same time period our understanding of the optimal management of PV has expanded, most recently culminating in the approval of JAK inhibitors for the treatment of PV patients who are resistant or intolerant to therapy with hydroxycarbamide. It has also been demonstrated that life expectancy for many patients with PV is not normal, nor is their quality of life. We critically explore these findings and discuss their impact. In addition, we highlight persisting gaps in our current management strategy; for example, what is the optimal first line cytoreductive therapy and, indeed, which patients need cytoreductive drugs.