Task sharing within a managed clinical network to improve child health in Malawi

BACKGROUND: Eighty per cent of Malawi's 8 million children live in rural areas, and there is an extensive tiered health system infrastructure from village health clinics to district hospitals which refers patients to one of the four central hospitals. The clinics and district hospitals are staffed by nurses, non-physician clinicians and recently qualified doctors. There are 16 paediatric specialists working in two of the four central hospitals which serve the urban population as well as accepting referrals from district hospitals. In order to provide expert paediatric care as close to home as possible, we describe our plan to task share within a managed clinical network and our hypothesis that this will improve paediatric care and child health.

PRESENTATION OF THE HYPOTHESIS: Managed clinical networks have been found to improve equity of care in rural districts and to ensure that the correct care is provided as close to home as possible. A network for paediatric care in Malawi with mentoring of non-physician clinicians based in a district hospital by paediatricians based at the central hospitals will establish and sustain clinical referral pathways in both directions. Ultimately, the plan envisages four managed paediatric clinical networks, each radiating from one of Malawi's four central hospitals and covering the entire country. This model of task sharing within four hub-and-spoke networks may facilitate wider dissemination of scarce expertise and improve child healthcare in Malawi close to the child's home.

TESTING THE HYPOTHESIS: Funding has been secured to train sufficient personnel to staff all central and district hospitals in Malawi with teams of paediatric specialists in the central hospitals and specialist non-physician clinicians in each government district hospital. The hypothesis will be tested using a natural experiment model. Data routinely collected by the Ministry of Health will be corroborated at the district. This will include case fatality rates for common childhood illness, perinatal mortality and process indicators. Data from different districts will be compared at baseline and annually until 2020 as the specialists of both cadres take up posts.

IMPLICATIONS OF THE HYPOTHESIS: If a managed clinical network improves child healthcare in Malawi, it may be a potential model for the other countries in sub-Saharan Africa with similar cadres in their healthcare system and face similar challenges in terms of scarcity of specialists.

Full-Duplex Spectrum Sharing in Cooperative Single Carrier Systems

We propose cyclic prefix single carrier full-duplex transmission in amplify-and-forward cooperative spectrum sharing networks to achieve multipath diversity and full-duplex spectral efficiency. Integrating full-duplex transmission into cooperative spectrum sharing systems results in two intrinsic problems: 1) the residual loop interference occurs between the transmit and the receive antennas at the secondary relays and 2) the primary users simultaneously suffer interference from the secondary source (SS) and the secondary relays (SRs). Thus, examining the effects of residual loop interference under peak interference power constraint at the primary users and maximum transmit power constraints at the SS and the SRs is a particularly challenging problem in frequency selective fading channels. To do so, we derive and quantitatively compare the lower bounds on the outage probability and the corresponding asymptotic outage probability for max–min relay selection, partial relay selection, and maximum interference relay selection policies in frequency selective fading channels. To facilitate comparison, we provide the corresponding analysis for half-duplex. Our results show two complementary regions, named as the signal-to-noise ratio (SNR) dominant region and the residual loop interference dominant region, where the multipath diversity and spatial diversity can be achievable only in the SNR dominant region, however the diversity gain collapses to zero in the residual loop interference dominant region.

Secure Full-Duplex Small-Cell Networks in a Spectrum Sharing Environment

In this paper, we propose three relay selection schemes for full-duplex heterogeneous networks in the presence of multiple cognitive radio eavesdroppers. In this setup, the cognitive small-cell nodes (secondary network) can share the spectrum licensed to the macro-cell system (primary network) on the condition that the quality-of-service of the primary network is always satisfied subjected to its outage probability constraint. The messages are delivered from one small-cell base station to the destination with the help of full-duplex small-cell base stations, which act as relay nodes. Based on the availability of the network’s channel state information at the secondary information source, three different selection criteria for full-duplex relays, namely: 1) partial relay selection; 2) optimal relay selection; and 3) minimal self-interference relay selection, are proposed. We derive the exact closed-form and asymptotic expressions of the secrecy outage probability for the three criteria under the attack of non-colluding/colluding eavesdroppers. We demonstrate that the optimal relay selection scheme outperforms the partial relay selection and minimal self-interference relay selection schemes at the expense of acquiring full channel state information knowledge. In addition, increasing the number of the full-duplex small-cell base stations can improve the security performance. At the illegitimate side, deploying colluding eavesdroppers and increasing the number of eavesdroppers put the confidential information at a greater risk. Besides, the transmit power and the desire outage probability of the primary network have great influences on the secrecy outage probability of the secondary network. 

Secure Transmission in Spectrum Sharing MIMO Networks with Generalized Antenna Selection over Nakagami-m Channels

In this paper, we investigate the secrecy outage performance of spectrum sharing multiple-input multiple-output networks using generalized transmit antenna selection with maximal ratio combining over Nakagami-m channels. In particular, the outdated channel state information is considered at the process of antenna selection due to feedback delay. Considering a practical passive eavesdropper scenario, we derive the exact and asymptotic closed-form expressions of secrecy outage probability, which enable us to evaluate the secrecy performance with high efficiency and present a new design insight into the impact of key parameters on the secrecy performance. In addition, the analytical results demonstrate that the achievable secrecy diversity order is only determined by the parameters of the secondary network, while other parameters related to primary or eavesdropper’s channels have a significantly impact on the secrecy coding gain. 

Hotel Profit Implications from Rising Wages and Inflation in the U.S.

Macroeconomic models based on the Phillips Curve predict that as the unemployment rate declines toward the long-run, natural rate, the pace of wage and price growth accelerates and inflation rises.1 In this paper I analyze the profitability prospects for the U.S. hotel industry in today’s relatively volatile economic environment, keeping in mind the Phillips Curve’s general principle that inflation and employment have an inverse, but relatively stable short-term relationship. Although employment and economic growth in the U.S. have been uneven in recent months, the unemployment rate has declined to less than 5 percent, which many economists believe is close to the natural rate. Growth in wages and salaries, as measured by the Employment Cost Index, has concurrently been moving upward between 2.5 and 3.0 percent during the past 12 months. At the same time, general inflation remains below levels that might typically be expected this late in the cycle, although core inflation is bumping up against the Federal Reserve’s 2-percent target. If the inflation rate continues to move upward as predicted by Phillips Curve models (and encouraged by the Federal Reserve), rising labor costs and other expenses will exert downward pressure on U.S. business profits. Backward movement up the Phillips Curve (with greater inflation) coincides with an expanding economy. In that scenario, prices of goods and services also will rise in real terms if their supply cannot keep up with demand, and producers have the ability to raise prices (absent fixed-price contracts such as leases).

La sostenibilità dei modelli di business della Sharing Economy: il caso Dimitto.

Questo elaborato ha il fine di approfondire ed esplicitare criticità e leve del sempre crescente fenomeno collaborativo detto Sharing Economy. In appendice il Business Plan della startup Dimitto: progetto svolto durante il corso di Creazione D'Impresa - Riccardo Fini

IT Adoption and Usage in Non-Profit Organizations: a Cross-generational Case Study

A gulf has tended to develop between the adoption and usage of information technology by different generations, at the heart of which is different ways of experiencing and relating to the world around us. This research idea is currently being developed following data collection and feedback is sought on ways forward to enable impact. The research focuses on information technology in the form of multimedia. Multimedia meaning ‘media’ and ‘content’ that uses a combination of different content forms; or electronically integrated communication engaging all or most of the senses (e.g. graphic art, sound, animation and full-motion video presented by way of computer or other electronic means) mainly through presentational technologies. Although multimedia is not new, some organization’s particularly those in the non-profit sector do not always have the technical or financial resources to support such systems and consequently may struggle to adopt and support its usage amongst different generations. However non-profit organizations are being forced to pay more attention to the way they communicate with markets and the public due to the professionalism of communication everywhere in society. The case study used for this study is a church circuit comprising of 15 churches in the Midlands region of the United Kingdom which was selected due to the diverse age groups catered for within this type of non-profit organization. Participants in the study also had a range of skills, experiences and backgrounds which adds to the diversity of the population studied. Data gathered focused on the attitudes and opinions of the adoption and use of multimedia amongst different age groups. 395 questionnaires were distributed, comprising of 11 opinion questions and 4 demographic questions. 83% of the questionnaires were returned, representing 35% of the total circuit membership. Three people from each of the following age categories were also interviewed: 1920 – 1946 (Matures); 1947-1964 (Baby Boomers); 1965-1982 (Generation X); 1983-2004 (Net Generation). Results of the questionnaire and comments from the interviews were found not to tally with the widespread assumption that the younger generation is attracted by the use of multimedia in comparison to the older generation. The highest proportion of those who said that they gain more from a service enhanced by multimedia was from the Baby Boomers. Comments from interviews suggested that: ‘we need to embrace multimedia if we are to attract and retain the younger generation’; ‘multimedia often helps children to remain focused and clarifies the objective of the service’. However, because the younger generations’ world tends to be dominated by computer technology the questionnaire showed that they are more likely to have higher standards when it comes to the use of multimedia, such as identifying higher levels of equipment failing to work and annoying use of sounds compared to older age groups. In comparison problems experienced with multimedia for the Matures age group had the highest percentage of difficulty with the size of letters; the colour of letters and background and the sound not loud enough which is to be expected. Since every organization is unique any type of multimedia adopted and used should be specific to their needs, its stakeholders and the physical building in order to enhance that uniqueness and its needs. Giving thought to whether the type of multimedia is the best method for communicating the message to the particular audience alongside how technical and financial resources are best used can assist in accommodating different age groups that need to be catered for.

Effects of IFRS adoption on the financial statements of Nigerian listed entities: the case of oil and gas companies

On 28 July 2010, the Nigerian Federal Executive Council approved January 1, 2012 as the effective date for the convergence of Nigerian Statement of Accounting Standards (SAS) or Nigerian GAAP (NG-GAAP) with International Financial Reporting Standards (IFRS). By this pronouncement, all publicly listed companies and significant public interest entities in Nigeria were statutorily required to issue IFRS based financial statements for the year ended December, 2012. This study investigates the impact of the adoption of IFRS on the financial statements of Nigerian listed Oil and Gas entities using six years of data which covers three years before and three years after IFRS adoption in Nigeria and other African countries. First, the study evaluates the impact of IFRS adoption on the Exploration and Evaluation (E&E) expenditures of listed Oil and Gas companies. Second, it examines the impact of IFRS adoption on the provision for decommissioning of Oil and Gas installations and environmental rehabilitation expenditures. Third, the study analyses the impact of the adoption of IFRS on the average daily Crude Oil production cost per Barrel. Fourth, it examines the extent to which the adoption and implementation of IFRS affects the Key Performance Indicators (KPIs) of listed Oil and Gas companies. The study further explores the impact of IFRS adoption on the contractual relationships between Nigerian Government and Oil and Gas companies in terms of Joint Ventures (JVs) and Production Sharing Contracts (PSCs) as it relates to taxes, royalties, bonuses and Profit Oil Split. A Paired Samples t-test, Wilcoxon Signed Rank test and Gray’s (Gray, 1980) Index of Conservatism analyses were conducted simultaneously where the accounting numbers, financial ratios and industry specific performance measures of GAAP and IFRS were computed and analysed and the significance of the differences of the mean, median and Conservatism Index values were compared before and after IFRS adoption. Questionnaires were then administered to the key stakeholders in the adoption and implementation of IFRS and the responses collated and analysed. The results of the analyses reveal that most of the accounting numbers, financial ratios and industry specific performance measures examined changed significantly as a result of the transition from GAAP to IFRS. The E&E expenditures and the mean cost of Crude Oil production per barrel of Oil and Gas companies increased significantly. The GAAP values of inventories, GPM, ROA, Equity and TA were also significantly different from the IFRS values. However, the differences in the provision for decommissioning expenditures were not statistically significant. Gray’s (Gray, 1980) Conservatism Index shows that Oil and Gas companies were more conservative under GAAP when compared to the IFRS regime. The Questionnaire analyses reveal that IFRS based financial statements are of higher quality, easier to prepare and present to management and easier to compare among competitors across the Oil and Gas sector but slightly more difficult to audit compared to GAAP based financial statements. To my knowledge, this is the first empirical research to investigate the impact of IFRS adoption on the financial statements of listed Oil and Gas companies. The study will therefore make an enormous contribution to academic literature and body of knowledge and void the existing knowledge gap regarding the impact and implications of IFRS adoption on the financial statements of Oil and Gas companies.

Sharing the vision: representing the matters of concern for design-led fledgling companies in Scotland

Design is being performed on an ever-increasing spectrum of complex practices arising in response to emerging markets and technologies, co-design, digital interaction, service design and cultures of innovation. This emerging notion of design has led to an expansive array of collaborative and facilitation skills to demonstrate and share how such methods can shape innovation. The meaning of these design things in practice can't be taken for granted as matters of fact, which raises a key challenge for design to represent its role through the contradictory nature of matters of concern. This paper explores an innovative, object-oriented approach within the field of design research, visually combining an actor-network theory framework with situational analysis, to report on the role of design for fledgling companies in Scotland, established and funded through the knowledge exchange hub Design in Action (DiA). Key findings and visual maps are presented from reflective discussions with actors from a selection of the businesses within DiA's portfolio. The suggestion is that any notions of strategic value, of engendering meaningful change, of sharing the vision of design, through design things, should be grounded in the reflexive interpretations of matters of concern that emerge.

The relationship between personal cognition, social context, and knowledge sharing in global communities of practice

The purpose of this study was to identify the structural pathways of personal cognition and social context as they influence knowledge sharing behaviors in communities of practice. Based on the existing literature, ten hypotheses and a conceptual model built on the basis of the social cognitive theory were developed regarding the interrelationships of the five constructs: self-efficacy for knowledge sharing, outcome expectations, sense of community, leadership of a community, and knowledge sharing. The data were collected through an online questionnaire from the employees who have participated in communities of practice in a Fortune 100 corporation. A total of 438 usable questionnaires were collected. Overall, three analyses were conducted in order to prove the given hypotheses: (a) hypothesized measurement model fit, (b) relational and influential associations among the constructs, and (c) structural equation model analysis (SEM). In addition, open-ended responses were analyzed. The results presented that (a) hypothesized measurement models were valid and reliable, (b) personal cognitive factors, self-efficacy and outcome expectations for knowledge sharing, were found to be significant predictors of community members’ sense of community and knowledge sharing behaviors, (c) sense of community had the most significant impact on the knowledge sharing, (d) as the perceived social context, sense of community mediated the effects of personal cognition on knowledge sharing behaviors, and (e) personal cognition and social context jointly contributed to knowledge sharing. In brief, all of the hypotheses were positively supported. A conclusive summary is provided along with contributive discussion. Implications and contributions to HRD researchers and practitioners are discussed, and recommendations are provided.

Tacit knowledge sharing: the determination of a methodological approach to explore the intangible.

Introduction. Research design should take into account both (a) the specific nature of the object under scrutiny, and (b) approaches to its study in the past. This is to ensure that informed decisions are made regarding research design in future empirical studies. Here these factors are taken into account with reference to methodological choice for a doctoral study on tacit knowledge sharing, and the extent to tacit knowledge sharing may be facilitated by online tools. The larger study responds to calls for the two domains of knowledge management and human information behaviour to be considered together in terms of their research approaches and theory development. Method. Relevant literature – both domain-specific (knowledge management) and general (research methods in social science) - was identified and analysed to identify the most appropriate approaches for an empirical study of tacit knowledge sharing. Analysis. The analysis shows that there are a number of challenges associated with studying an intangible entity such as tacit knowledge. Quantitative, qualitative and mixed methods have been adopted in prior work on this theme, each with their own strengths and weaknesses. Results. The analysis has informed a decision to adopt a research approach that deploys mixed methods for an inductive case study to extend knowledge of the influence of online tools on tacit knowledge sharing. Conclusion. This work intends to open the debate on methodological choice and routes to implementation for studies that are subject to practical constraints imposed by the context in which they are situated.

Influence of climate variability and stocking strategies on greenhouse gas emissions (GHGE), production and profit of a northern Queensland beef cattle herd

Previous studies of greenhouse gas emissions (GHGE) from beef production systems in northern Australia have been based on models of ‘steady-state’ herd structures that do not take into account the considerable inter-annual variation in liveweight gain, reproduction and mortality rates that occurs due to seasonal conditions. Nor do they consider the implications of flexible stocking strategies designed to adapt these production systems to the highly variable climate. The aim of the present study was to quantify the variation in total GHGE (t CO2e) and GHGE intensity (t CO2e/t liveweight sold) for the beef industry in northern Australia when variability in these factors was considered. A combined GRASP–Enterprise modelling platform was used to simulate a breeding–finishing beef cattle property in the Burdekin River region of northern Queensland, using historical climate data from 1982–2011. GHGE was calculated using the method of Australian National Greenhouse Gas Inventory. Five different stocking-rate strategies were simulated with fixed stocking strategies at moderate and high rates, and three flexible stocking strategies where the stocking rate was adjusted annually by up to 5%, 10% or 20%, according to pasture available at the end of the growing season. Variation in total annual GHGE was lowest in the ‘fixed moderate’ (~9.5 ha/adult equivalent (AE)) stocking strategy, ranging from 3799 to 4471 t CO2e, and highest in the ‘fixed high’ strategy (~5.9 ha/AE), which ranged from 3771 to 7636 t CO2e. The ‘fixed moderate’ strategy had the least variation in GHGE intensity (15.7–19.4 t CO2e/t liveweight sold), while the ‘flexible 20’ strategy (up to 20% annual change in AE) had the largest range (10.5–40.8 t CO2e/t liveweight sold). Across the five stocking strategies, the ‘fixed moderate’ stocking-rate strategy had the highest simulated perennial grass percentage and pasture growth, highest average rate of liveweight gain (121 kg/steer), highest average branding percentage (74%) and lowest average breeding-cow mortality rate (3.9%), resulting in the lowest average GHGE intensity (16.9 t CO2e/t liveweight sold). The ‘fixed high’ stocking rate strategy (~5.9 ha/AE) performed the poorest in each of these measures, while the three flexible stocking strategies were intermediate. The ‘fixed moderate’ stocking strategy also yielded the highest average gross margin per AE carried and per hectare. These results highlight the importance of considering the influence of climate variability on stocking-rate management strategies and herd performance when estimating GHGE. The results also support a body of previous work that has recommended the adoption of moderate stocking strategies to enhance the profitability and ecological stability of beef production systems in northern Australia.

Tanzania: learning, sharing, acting

A workshop held at the coastal town of Bagamoyo during 17—18 August 2015 addressed the role of the SSF Guidelines in meeting the challenges of coastal communities in Tanzania.

La décroissance positive, équitable et inclusive : redéfinition du progrès au profit de l’économie sociale et naturelle au Québec

Le système financier, agricole, économique et social est en crise. Le bilan pessimiste qui se dresse devant nous requiert une attention accrue de la part des dirigeants, mais d’abord et avant tout, de la population. Présentement, les efforts sont mis dans l’atténuation des risques sur l’environnement, dans l’occultation des symptômes et finalement, à dissimuler le problème. Devant la nécessité d’engager une transition vers un nouveau système aux valeurs basées sur le bien commun, l’innovation et les générations futures, où se situe le Québec? L’objectif général de cet essai est de proposer un développement économique alternatif et positif pour pallier les lacunes du système capitaliste actuel. De cette manière, le Québec pourra réellement s’engager dans la voie de la viabilité. Pour ce faire, cet essai convaincra de l’inaptitude du Produit intérieur brut comme seule mesure de progrès des sociétés. Les indicateurs alternatifs permettent de peindre un portrait plus clair et plus fidèle de ce qui se trame en termes de progrès social, économique et naturel. Les bases de l’économie écologique comme les théories de la décroissance et de l’économie stationnaire sont d’une grande aide pour comprendre ce que ces indicateurs essaient de mesurer. C’est pour cela que les indicateurs de développement durable au Québec deviennent un bon champ d’analyse pour la province. Ceux-ci permettent de déterminer où se situe le Québec sur la voie de la viabilité. Les conclusions quantitatives de cette analyse permettent le développement d’une liste d’indicateurs alternatifs qui peuvent réellement dépeindre un portrait adéquat de la société québécoise en terme de viabilité. Les résultats de ces analyses permettent de conclure que le Québec se situe dans la même impasse que beaucoup de sociétés occidentales : l’économie de marché a réussi à empiéter et intégrer des concepts tels que le développement durable pour se transformer en capitalisme vert. C’est ainsi que le pouvoir du changement revient dans les mains de la population qui fait face à cette absorption capitaliste de la politique, de son développement et de la croissance verte. Les nouvelles approches de développement doivent être par le bas, inclusives, positives, collectives, concertées, organisées et par-dessus tout, communiquées et partagées. Il est temps que le Québec fonde son développement sur son capital humain, et le grand potentiel de sa population pour ainsi permettre la croissance de l’économie dite vernaculaire.