Adoption of a sedation scoring system and sedation guideline in an intensive care unit

Aim. The paper presents a study assessing the rate of adoption of a sedation scoring system and sedation guideline. Background. Clinical practice guidelines including sedation guidelines have been shown to improve patient outcomes by standardizing care. In particular sedation guidelines have been shown to be beneficial for intensive care patients by reducing the duration of ventilation. Despite the acceptance that clinical practice guidelines are beneficial, adoption rates are rarely measured. Adoption data may reveal other factors which contribute to improved outcomes. Therefore, the usefulness of the guideline may be more appropriately assessed by collecting adoption data. Method. A quasi-experimental pre-intervention and postintervention quality improvement design was used. Adoption was operationalized as documentation of sedation score every 4 hours and use of the sedation and analgesic medications suggested in the guideline. Adoption data were collected from patients' charts on a random day of the month; all patients in the intensive care unit on that day were assigned an adoption category. Sedation scoring system adoption data were collected before implementation of a sedation guideline, which was implemented using an intensive information-giving strategy, and guideline adoption data were fed back to bedside nurses. After implementation of the guideline, adoption data were collected for both the sedation scoring system and the guideline. The data were collected in the years 2002-2004. Findings. The sedation scoring system was not used extensively in the pre-intervention phase of the study; however, this improved in the postintervention phase. The findings suggest that the sedation guideline was gradually adopted following implementation in the postintervention phase of the study. Field notes taken during the implementation of the sedation scoring system and the guideline reveal widespread acceptance of both. Conclusion. Measurement of adoption is a complex process. Appropriate operationalization contributes to greater accuracy. Further investigation is warranted to establish the intensity and extent of implementation required to positively affect patient outcomes.

Genetic and environmental influences on dentofacial structures and oral health: studies of Australian twins and their families

Our studies of the teeth and faces of Australian twins commenced at the School of Dentistry, The University of Adelaide in the early 1980s. There are now over 900 pairs of twins enrolled in our continuing investigations, together with 1200 relatives. There are 3 main cohorts of participants. The first cohort comprises around 300 pairs of teenage twins for whom various records have been collected, including dental casts, facial photographs, finger and palm prints and information on laterality, including handedness. The second cohort comprises around 300 pairs of twins who have been examined at 3 stages of dental development from approximately 4 years of age to about 14 years: at primary, mixed, and permanent dentition (excluding 3rd molars) stages. The most recent study of tooth emergence and oral health, for which we are currently recruiting twins, will provide a third cohort of around 500 twin pairs aged from around birth to 3 to 4 years of age. Our broad aim in these studies has been to improve our understanding of how genetic and environmental factors contribute to variation in dental and facial features, and to oral health. We have also used our data to investigate aspects of the determination of laterality, particularly the fascinating phenomenon of mirror imaging. We plan to maximize the use of the longitudinal data and DNA we have collected, and continue to collect, by performing genome-wide scans for putative genetic linkage peaks for a range of dental features, and then to test for association between a series of likely candidate genes and our phenotypes.

Stakeholder concerns about Australia's mental health care system

There is growing community and professional concern that the Australian mental health care system requires substantial reform. In response to these concerns, a Senate Select Committee on Mental Health has been commissioned to conduct an inquiry into the provision of mental health services. The current study involved a content analysis of 725 submissions received by the Committee, and highlighted significant areas for reform. People with mental illness face difficulties in accessing mental health care, the care they do receive is of varying quality and poorly coordinated, and necessary services from other sectors, such as housing, are lacking. These problems may be exacerbated for particular groups with complex needs or heightened levels of vulnerability. The system requires reorienting towards the consumers and carers it is designed to serve, and needs stronger governance, higher levels of accountability and improved monitoring of quality. These findings are discussed in the context of the recent acknowledgement of mental health as an issue by the Council of Australian Governments (COAG), which has called for an action plan to be prepared for its consideration by June 2006.

AS RELAÇÕES ENTRE SATISFAÇÃO NO TRABALHO, COMPROMETIMENTO ORGANIZACIONAL AFETIVO E INTENÇÃO DE ROTATIVIDADE: UM ESTUDO EM UMA MINERADORA DE DIAMANTES EM ANGOLA

Muito se tem investigado sobre os antecedentes de intenção de rotatividade. Dentre as possíveis variáveis com capacidade de se relacionar aos planos dos trabalhadores deixarem a organização destacam-se: satisfação no trabalho e comprometimento organizacional afetivo. O presente estudo teve como objetivo geral analisar as relações entre estas três variáveis; satisfação no trabalho, comprometimento organizacional afetivo e intenção de rotatividade. Ligando-se aos objetivos através dos seus estímulos internos ou externos, desvendados no estudo em uma mineradora de diamantes em Angola onde foram analisadas as relações entre as três variáveis. Participaram na pesquisa 151 trabalhadores, todos de nacionalidade angolana selecionados aleatoriamente em diferentes áreas da mesma empresa. Após aplicação do questionários com três medidas validadas e precisas, o tratamento dos dados, todos de natureza numérica, foi processado pelo software estatístico Statistical Package for the Social Science SPSS, versão 19.0 para Windows. Apurou-se que a idade media dos participantes era de 38,34 (DP = 8,42) anos, sendo a maioria do sexo masculino, solteira, com o nível médio completo, não exercendo cargo de chefia, pertencendo ao grupo (GP - III) um total de 89 (58,9 %), realizando grande parte do seu trabalho com outra pessoa ou em grupo, com tempo de trabalho variando entre 1 (um) e 16 anos. Os resultados descritivos indicam que os trabalhadores detêm um quadro de satisfação no trabalho, com satisfações maiores proporcionadas pelo número de vezes e oportunidades de serem promovidos, com a capacidade profissional de seus chefes, no entendimento encontrado entre si e na maneira como são tratados pelos seus chefes; e menores com o tipo de amizade, confiança e espírito de colaboração demonstrada pelos seus colegas de trabalho, assim como com a capacidade absorvida e o salário se comparado com o quanto trabalha. O quadro do comprometimento organizacional afetivo demonstra maior afeto as questões relacionadas a empresa em fazer o empregado sentir-se orgulhoso e contente com ela. Análises de correlação pelo r de Pearson informaram índices negativos e significativos entre as duas variáveis e intenção de rotatividade. Tais resultados informam que o plano de deixar a empresa onde trabalham é cada vez menor à medida que se elevam os níveis de satisfação no trabalho e comprometimento organizacional afetivo.

RESPONSABILIDADE SOCIAL, PREGAÇÃO E EDUCAÇÃO: TENSÕES MISSIOLÓGICAS NO PROJETO MISSIONÁRIO DA IGREJA METODISTA EM TERRAS BRASILEIRAS

Esta pesquisa, Responsabilidade Social, Pregação e Educação: tensões missiológicas no projeto missionário da Igreja Metodista em terras brasileiras, tem como objetivo analisar as ações missionárias da Igreja Metodista do período de sua implantação até o final do período referente ao 18° Concílio Geral (2006-2011). A análise resgatou a tríade Responsabilidade Social, Pregação e Educação como uma marca identitária do movimento wesleyano e que esse princípio missionário nem sempre foi seguido pelo metodismo brasileiro. Notou-se também que a tríade serviu, em momentos decisivos, como elemento norteador do projeto missionário. Isso é percebido no período da implantação, bem como na constituição do Plano para Vida e Missão (PVM). Em que pese que as ações missionárias no metodismo brasileiro nem sempre foram providas de uma reflexão teológica sistemática, a tríade Responsabilidade Social, Pregação e Educação sempre funcionou como eixos essenciais da missão e de forma indissociável. Não foram poucos os momentos em que o projeto missionário metodista enfrentou tensões na sua execução. O ímpeto pelo crescimento numérico e expansão geográfica, muitas vezes, ofuscou a fidelidade à tríade. Nessa trajetória de pesquisa está construída em quatro capítulos, nos quais se busca a superação de uma compreensão histórica equivocada e faz-se necessário que o projeto missionário assuma os elementos essenciais da tríade como marco regulatório da missão metodista. As repetitivas opções equivocadas não colaboram com a nova compreensão de missão. O resultado da pesquisa encoraja futuras análises para que o metodismo assuma o papel de agente de Deus na missio Dei e para que o seu envolvimento missionário mantenha fidelidade à tríade Responsabilidade Social, Pregação e Educação.

A TV digital e o setor industrial tecnológico brasileiro

O presente estudo disserta sobre o papel da indústria, com foco nos fabricantes de televisores e sua participação na implantação e desenvolvimento da TV Digital no Brasil, como os primeiros atores desse cenário a apontar o norte para a viabilização de um modelo de negócio para a Televisão Digital (TVD) e Televisão Digital Interativa (TVDI): a TV Conectada e a TV Inteligente. Faz um levantamento histórico do tema desde o Governo FHC, passando pelo Governo Lula até o atual Governo Dilma. O texto apresenta os desafios técnico, político e econômico dessa implementação. Pretende identificar os acertos e enganos dos atores envolvidos nesse cenário, montado para a implementação do sistema digital da TV brasileira. Ressalta os interesses, nem sempre harmônicos, de todos os envolvidos: do capital, com foco no lucro; do governo, com seus acordos políticos, muitas vezes contrapondo ao cumprimento de seu papel de representante dos interesses da maioria da população brasileira; e da dinâmica científico tecnológico-industrial, que necessita de campo fértil, propício e contínuo para se desenvolver.(AU)

ESTRATÉGIAS DE EXPANSÃO DE INSTITUIÇÕES DE ENSINO SUPERIOR PRIVADAS NO BRASIL: ESTUDO DE CASO DO CURSO DE BACHARELADO EM ADMINISTRAÇÃO

A dissertação teve como objetivo principal estudar como uma Instituição de Ensino Superior Privada (IES) atuante no Brasil tem crescido pós Lei de Diretrizes e Bases (LDB) de 1996 até 2015, por meio da análise do curso de bacharelado em Administração de Empresas, nas modalidades: presencial, EAD e Flex (semipresencial). Para este fim, foi realizada uma pesquisa exploratória, de caráter qualitativo baseada no método do estudo de caso. Para coleta de evidências foram analisados relatórios corporativos (Annual Report, Relatórios Internos e outros documentos), entrevistas baseadas em roteiro semiestruturado com gestores da IES privada e observações. Dentre os principais achados, verificou-se que as principais estratégicas de crescimento da IES privada estudada se basearam em fusões e aquisições de outras IES, abertura de novos polos de EAD, na abertura de novas unidades próprias, bem como em inovações em várias dimensões da organização. Os programas governamentais de financiamento aos alunos também são fortes contribuintes para este crescimento, como o Fundo de Financiamento ao Estudante do Ensino Superior (FIES) e o Programa Universidade para Todos (Prouni). Com essa nova realidade, o ensino superior privado recebeu incentivo e facilitação para o seu crescimento, a um ritmo acelerado. Consequentemente pode-se concluir que a IES privada estudada adotou as seguintes estratégias de crescimento: Expansão orgânica com fusões/ aquisições de Instituições menores, com desenvolvimento de planos para todos os campi Brasil; Greenfield (por meio de solicitação de autorização de novas unidades e/ou cursos) em cidades sem possibilidades de aquisições/fusões, e aumentando o número de vagas/ matriculas nas unidades já existentes, aderiu aos programas do governo e também cuidou da evasão por meio de: Seguro educacional; gestão preparada para atender necessidades do discente; Sistema de Ensino com currículos integrados nacionalmente; Intercâmbio de alunos e professores entre as diversas unidades em todas as regiões do país e padronização dos processos.

Rule induction for data exploration

This paper describes how the statistical technique of cluster analysis and the machine learning technique of rule induction can be combined to explore a database. The ways in which such an approach alleviates the problems associated with other techniques for data analysis are discussed. We report the results of experiments carried out on a database from the medical diagnosis domain. Finally we describe the future developments which we plan to carry out to build on our current work.

A co-ordinated business object approach for supporting tactical level management decisions

The proliferation of data throughout the strategic, tactical and operational areas within many organisations, has provided a need for the decision maker to be presented with structured information that is appropriate for achieving allocated tasks. However, despite this abundance of data, managers at all levels in the organisation commonly encounter a condition of ‘information overload’, that results in a paucity of the correct information. Specifically, this thesis will focus upon the tactical domain within the organisation and the information needs of management who reside at this level. In doing so, it will argue that the link between decision making at the tactical level in the organisation, and low-level transaction processing data, should be through a common object model that used a framework based upon knowledge leveraged from co-ordination theory. In order to achieve this, the Co-ordinated Business Object Model (CBOM) was created. Detailing a two-tier framework, the first tier models data based upon four interactive object models, namely, processes, activities, resources and actors. The second tier analyses the data captured by the four object models, and returns information that can be used to support tactical decision making. In addition, the Co-ordinated Business Object Support System (CBOSS), is a prototype tool that has been developed in order to both support the CBOM implementation, and to also demonstrate the functionality of the CBOM as a modelling approach for supporting tactical management decision making. Containing a graphical user interface, the system’s functionality allows the user to create and explore alternative implementations of an identified tactical level process. In order to validate the CBOM, three verification tests have been completed. The results provide evidence that the CBOM framework helps bridge the gap between low level transaction data, and the information that is used to support tactical level decision making.

Orthodox Christianity and Nationalism:an introduction

On the morning of January 5, 1859, at the end of the liturgy in the Orthodox cathedral in Iaşi, the capital of the principality of Moldavia, Father Neofit Scriban addressed the congregation. He had given many sermons in the cathedral; however, on this par tic u lar date Father Neofit faced an unusual audience. Among the faithful who regularly worshipped at the relics of Saint Parascheva, the protector of Moldavia, were the members of the assembly who would decide the future of the principality. They had a specific mission: to elect a new prince, a key figure in their plan to unite Moldavia with the neighboring principality of Wallachia. Father Neofit, a supporter of the unionist cause and fully aware of the significance of the moment, stated: Brethren, Jesus Christ has said that "For where two or three have gathered together in My name, I am there in their midst." You, Brethren, are not two, or three, but a real gathering in the name of God. God is in your midst. You are here in the name of the Romanian nation [and] the Romanian nation is in your midst. On the flag under which you have assembled, the flag of the Romanian nation, great events, the Romanian faith, unity, are written in large letters. The church, which is founded on faith, blesses the flag of this faith⋯. You, Brethren, through the faith of the Romanian nation, by remaining faithful to this flag, will find the same strength as the church [finds] in its own saints. The faith of the Romanian nation was not, is not, and will not be anything else, but the unity of all Romanians in a single state, the only anchor of salvation, the only port in which the national boat could be saved from surrounding waves. You, Brethren, have gathered here in the church of Stephen the Great; looking at the altar that he raised to the God of your parents, I think that, through this [altar], you will be able to enter into the wishes of this hero of our nation. You, [remember that] by leaving this place, you are leaving [in order to fulfill] a great gesture that for many centuries has been lost for us; you are about to elect a successor to this great hero; therefore, as his true sons, you could not be anything other than the true expression of his wishes. Myself, [as] last year, from this altar, I said and I will continue to say that this great hero has told us that "the God of our parents will send us a Redeemer who will heal our wounds and accomplish our wishes." May your chosen leader today be the redeemer expected by the Romanian nation. May he heal its wounds and achieve its wishes. Therefore, Brethren, may your election today be that of a real Messiah of Romania. God and the world are looking at you, the church is blessing you and the whole Romanian nation is waiting for you!1 A few hours after Father Neofit's sermon, the assembly elected Alexandru Ioan Cuza to be the prince of the principality of Moldavia; a few days later, on January 24, 1859, the assembly of the neighboring principality of Wallachia decided that Cuza should also be their prince, thus confirming the unification of the two states. A new country was inscribed on the map of Southeastern Europe, titled "The United Principalities of Wallachia and Moldavia," also known as "The United Romanian Principalities".

Investigating factors influencing local government decision makers while adopting integration technologies (IntTech)

The emergence of innovative and revolutionary Integration Technologies (IntTech) has highly influenced the local government authorities (LGAs) in their decision-making process. LGAs that plan to adopt such IntTech may consider this as a serious investment. Advocates, however, claim that such IntTech have emerged to overcome the integration problems at all levels (e.g. data, object and process). With the emergence of electronic government (e-Government), LGAs have turned to IntTech to fully automate and offer their services on-line and integrate their IT infrastructures. While earlier research on the adoption of IntTech has considered several factors (e.g. pressure, technological, support, and financial), inadequate attention and resources have been applied in systematically investigating the individual, decision and organisational context factors, influencing top management's decisions for adopting IntTech in LGAs. It is a highly considered phenomenon that the success of an organisation's operations relies heavily on understanding an individual's attitudes and behaviours, the surrounding context and the type of decisions taken. Based on empirical evidence gathered through two intensive case studies, this paper attempts to investigate the factors that influence decision makers while adopting IntTech. The findings illustrate two different doctrines - one inclined and receptive towards taking risky decisions, the other disinclined. Several underlying rationales can be attributed to such mind-sets in LGAs. The authors aim to contribute to the body of knowledge by exploring the factors influencing top management's decision-making process while adopting IntTech vital for facilitating LGAs' operational reforms.

Manageable Workflows for Processing Parallel Sequencing Data

ACM Computing Classification System (1998): D.2.11, D.1.3, D.3.1, J.3, C.2.4.

A vállalati logisztikai költségek a magyarországi kis- és középvállalkozások körében végzett felmérés tükrében (Corporate logistics costs of the Hungarian small- and medium-sized enterprises)

A cikk a magyarországi kis- és középvállalkozások logisztikai költségeit vizsgálja a nemzetközi kutatások tükrében és a 2009-es közel kétezer hazai KKV-re kiterjedő „Vállalkozások helyzetének felmérése” alapján. A hazai logisztikai költségeket leginkább a vállalatméret és az ágazat befolyásolja. A magyarországi kis- és középvállalkozások ki nem szervezett szállítási és raktározási tevékenységei a hazai fuvarozóknak és raktárszolgáltatóknak jelentős piacbővülést jelenthetnének. Ez azonban csak látens piacbővülés, mivel a hazai KKV-k nem tervezik, hogy szállítási és raktározási tevékenységeiket nagyobb arányban szervezzék ki. Ez részben azzal magyarázható, hogy a feldolgozóipari, mezőgazdasági és kereskedő kis- és középvállalkozások viszonylag nagy arányban tekintik a logisztikát alapvető képességnek. Nemzetközi viszonylatban a magyarországi KKV-k magas logisztikai költségszintekkel szembesülnek, melynek mérséklésével az adminisztrációs terhek csökkentéséhez hasonló megtakarítást lehetne elérni. ____ This article examines total logistics costs and its components of the Hungarian small- and medium-sized enterprises in the light of international researches. It shows that company-size and its sector are the most important drivers of logistics costs and its components according to „Survey of position of enterprises”, which covered nearly 2000 Hungarian SMEs in 2009. It also proves that transport and warehousing demand of the Hungarian SMEs means a significant market growth for national carriers and warehouse providers. It is only a latent growth, because the Hungarian SMEs do not plan to outsource their transport and warehouse activities in a greater extent. The relative high level of logistics as a core competence among processing industry, agriculture and trade SMEs can be a partial explanation to this. The Hungarian small- and medium-sized enterprises face with high logistics costs in international comparison. Its reduction may bring similar savings as reduction of administrative burdens.

Az erősödő állami szerepvállalás értékelése a magyarországi elektronikus hírközlő hálózati fejlesztésekben (Evaluation of the increasingstate’s rolein the electronic communications network development in Hungary)

Az elektronikus hírközlő hálózat rohamszerű fejlesztésének igénye az elektronikus szolgáltatások széles körű elterjedésével az állami döntéshozókat is fejlesztéspolitikai koncepciók kidolgozására és azok végrehajtására ösztönzi. Az (információs) társadalom fejlődése és az ennek alapjául szolgáló infokommunikációs szolgáltatások használata alapvetően függ a szélessávú infrastruktúra fejlesztésétől, az elektronikus hírközlő hálózat elérésének lehetőségétől. Az állami szerepvállalási hajlandóság 2011-től kezdődően jelentősen megnőtt az elektronikus hírközlési területen. Az MVM NET Zrt. megalapítása, a NISZ Zrt. átszervezése, a GOP 3.1.2-es pályázat és a 4. mobilszolgáltató létrehozásának terve mind mutatják a kormányzat erőteljes szándékát a terület fejlesztésére. A tanulmányban bemutatásra kerül, hogy az állam milyen beavatkozási eszközökkel rendelkezik az elektronikus hírközlő hálózat fejlesztésének ösztönzésére. A szerző ezt követően a négy, jelentős állami beavatkozás elemzését végzi el annak vizsgálatára, hogy megfelelő alapozottsággal született-e döntés az állami szerepvállalásról. _____ With the widespread use of the Internet, the need for the rapid development of the digital communication networks has prompted government policy makers also to conceptualize and implement development policy. The advancement of the (information) society and the use of information communication technology as a prerequisite of it are fundamentally determined by the development of broadband infrastructure and whether broadband access to the digital telecommunication network is available. The propensity of the government to play a bigger role in the field of electronical communication has increased significantly from 2011. The setup of MVM NET Zrt. / Hungarian Electricity NET Ltd./, the realignment of NISZ Zrt. / National Info communication Services Company Limited by Shares - NISZ Ltd./, the GOP 3.1.2. tender and the plan to enable a new, i.e. the fourth mobile network operator to enter the market all indicate the robust intention of the government to develop this field. The study shows the tools of government intervention for the incentive of the development of the electronical communication network. Then the author analyses the four main government interventions to examine whether the decision on the role of the state was adequately well-founded.

Social construction of Geographic Information Systems. (Volumes I and II)

Geographic Information Systems (GIS) is an emerging information technology (IT) which promises to have large scale influences in how spatially distributed resources are managed. It has had applications in the management of issues as diverse as recovering from the disaster of Hurricane Andrew to aiding military operations in Desert Storm. Implementation of GIS systems is an important issue because there are high cost and time involvement in setting them up. An important component of the implementation problem is the "meaning" different groups of people who are influencing the implementation give to the technology. The research was based on the theory of (theoretical stance to the problem was based on the) "Social Construction of Knowledge" systems which assumes knowledge systems are subject to sociological analysis both in usage and in content. An interpretive research approach was adopted to inductively derive a model which explains how the "meanings" of a GIS are socially constructed. The research design entailed a comparative case analysis over two county sites which were using the same GIS for a variety of purposes. A total of 75 in-depth interviews were conducted to elicit interpretations of GIS. Results indicate that differences in how geographers and data-processors view the technology lead to different implementation patterns in the two sites.