Current evidence on integrated treatment for serious mental disorder and substance misuse

Substance misuse in people with serious mental disorders is common and has a wideranging negative impact. The multiplicity of problems suggests that this comorbidity is better conceptualized as a type of complex disorder than by ‘dual diagnosis’. Problems with sequential and parallel treatments have led to the development of integrated approaches, with one practitioner or team addressing both the substance use and mental disorder. These treatments are typically characterized by motivation enhancement, minimizing treatment-related stress, emphasizing harm reduction as well as abstinence, and assertive outreach. A review of published randomized trials demonstrates that superior effects to controls are rarely consistent across treatment foci and over time. While motivational interventions assist engagement, more intervention is usually required for integrated treatment programs to improve long-term outcomes more than control conditions. More intensive case management does not consistently improve impact, but extended cognitive-behavioral therapies have promise. Suggestions for maximizing treatment effects and improving research evidence are provided.

Integrated Diagnosis and Prognosis Model for High Pressure LNG Pump

In condition-based maintenance (CBM), effective diagnostics and prognostics are essential tools for maintenance engineers to identify imminent fault and to predict the remaining useful life before the components finally fail. This enables remedial actions to be taken in advance and reschedules production if necessary. This paper presents a technique for accurate assessment of the remnant life of machines based on historical failure knowledge embedded in the closed loop diagnostic and prognostic system. The technique uses the Support Vector Machine (SVM) classifier for both fault diagnosis and evaluation of health stages of machine degradation. To validate the feasibility of the proposed model, the five different level data of typical four faults from High Pressure Liquefied Natural Gas (HP-LNG) pumps were used for multi-class fault diagnosis. In addition, two sets of impeller-rub data were analysed and employed to predict the remnant life of pump based on estimation of health state. The results obtained were very encouraging and showed that the proposed prognosis system has the potential to be used as an estimation tool for machine remnant life prediction in real life industrial applications.

Optimizing construction planning schedules by virtual prototyping enabled resource analysis

The inherent uncertainty and complexity of construction work make construction planning a particularly difficult task for project managers due to the need to anticipate and visualize likely future events. Conventional computer-assisted technology can help but is often limited to the constructability issues involved. Virtual prototyping, however, offers an improved method through the visualization of construction activities by computer simulation — enabling a range of ‘what-if’ questions to be asked and their implications on the total project to be investigated. This paper describes the use of virtual prototyping to optimize construction planning schedules by analyzing resource allocation and planning with integrated construction models, resource models, construction planning schedules and site-layout plans. A real-life case study is presented that demonstrates the use of a virtual prototyping enabled resource analysis to reallocate space, logistic on access road and arrange tower cranes to achieve a 6-day floor construction cycle.

Intelligent urban management systems : online decision support systems for ubiquitous cities

A successful urban management support system requires an integrated approach. This integration includes bringing together economic, socio-cultural and urban development with a well orchestrated, transparent and open decision making mechanism. The chapter emphasizes the importance of integrated urban management to better tackle the climate change, and to achieve sustainable urban development and sound urban growth management. This chapter introduces recent approaches on urban management systems, such as intelligent urban management systems, that are suitable for ubiquitous cities. The chapter discusses the essential role of online collaborative decision making in urban and infrastructure planning, development and management, and advocates transparent, fully democratic and participatory mechanisms for an effective urban management system that is particularly suitable for ubiquitous cities. This chapter also sheds light on some of the unclear processes of urban management of ubiquitous cities and online collaborative decision making, and reveals the key benefits of integrated and participatory mechanisms in successfully constructing sustainable ubiquitous cities.

End-of-life care pathways for improving outcomes in caring for the dying (Review)

Background In many clinical areas, integrated care pathways are utilised as structured multidisciplinary care plans which detail essential steps in caring for patients with specific clinical problems. Particularly, care pathways for the dying have been developed as a model to improve the end-of-life care of all patients. They aim to ensure that the most appropriate management occurs at the most appropriate time and that it is provided by the most appropriate health professional. Clinical pathways for end-of-life care management are used widely around the world and have been regarded as the gold standard. Therefore, there is a significant need for clinicians to be informed about the utilisation of end-of-life care pathways with a systematic review. Objectives To assess the effects of end-of-life care pathways, compared with usual care (no pathway) or with care guided by another end-of-life care pathway across all healthcare settings (e.g. hospitals, residential aged care facilities, community). Search strategy The Cochrane Register of controlled Trials (CENTRAL), the Pain, Palliative and Supportive Care Review group specialised register,MEDLINE, EMBASE, review articles and reference lists of relevant articles were searched. The search was carried out in September 2009. Selection criteria All randomised controlled trials (RCTs), quasi-randomised trial or high quality controlled before and after studies comparing use versus non-use of an end-of-life care pathway in caring for the dying. Data collection and analysis Results of searches were reviewed against the pre-determined criteria for inclusion by two review authors. Main results The search identified 920 potentially relevant titles, but no studies met criteria for inclusion in the review. Authors’ conclusions Without further available evidence, recommendations for the use of end-of-life pathways in caring for the dying cannot be made. RCTs or other well designed controlled studies are needed for evaluating the use of end-of-life care pathways in caring for dying people.

Substance misuse in patients with schizophrenia : Epidemiology and management

Substance misuse in individuals with schizophrenia is very common, especially in young men, in communities where use is frequent and in people receiving inpatient treatment. Problematic use occurs at very low intake levels, so that most affected people are not physically dependent (with the exception of nicotine). People with schizophrenia and substance misuse have poorer symptomatic and functional outcomes than those with schizophrenia alone. Unless there is routine screening, substance misuse is often missed in assessments. Service systems tend to be separated, with poor inter-communication, and affected patients are often excluded from services because of their comorbidity. However, effective management of these disorders requires a fully integrated approach because of the close inter-relationship of the disorders. Use of atypical antipsychotics may be especially important in this population because of growing evidence (especially on clozapine and risperidone) that nicotine smoking, alcohol misuse and possibly some other substance misuse is reduced. Several pharmacotherapies for substance misuse can be used safely in people with schizophrenia, but the evidence base is small and guidelines for their use are necessarily derived from experience in the general population.

Open standards-based system integration for asset management decision support

Over the last decade, system integration has grown in popularity as it allows organisations to streamline business processes. Traditionally, system integration has been conducted through point-to-point solutions – as a new integration scenario requirement arises, a custom solution is built between the relevant systems. Bus-based solutions are now preferred, whereby all systems communicate via an intermediary system such as an enterprise service bus, using a common data exchange model. This research investigates the use of a common data exchange model based on open standards, specifically MIMOSA OSA-EAI, for asset management system integration. A case study is conducted that involves the integration of processes between a SCADA, maintenance decision support and work management system. A diverse number of software platforms are employed in developing the final solution, all tied together through MIMOSA OSA-EAI-based XML web services. The lessons learned from the exercise are presented throughout the paper.

Integrated Bayesian network frameworks for modelling complex ecological issues

Ecological problems are typically multi faceted and need to be addressed from a scientific and a management perspective. There is a wealth of modelling and simulation software available, each designed to address a particular aspect of the issue of concern. Choosing the appropriate tool, making sense of the disparate outputs, and taking decisions when little or no empirical data is available, are everyday challenges facing the ecologist and environmental manager. Bayesian Networks provide a statistical modelling framework that enables analysis and integration of information in its own right as well as integration of a variety of models addressing different aspects of a common overall problem. There has been increased interest in the use of BNs to model environmental systems and issues of concern. However, the development of more sophisticated BNs, utilising dynamic and object oriented (OO) features, is still at the frontier of ecological research. Such features are particularly appealing in an ecological context, since the underlying facts are often spatial and temporal in nature. This thesis focuses on an integrated BN approach which facilitates OO modelling. Our research devises a new heuristic method, the Iterative Bayesian Network Development Cycle (IBNDC), for the development of BN models within a multi-field and multi-expert context. Expert elicitation is a popular method used to quantify BNs when data is sparse, but expert knowledge is abundant. The resulting BNs need to be substantiated and validated taking this uncertainty into account. Our research demonstrates the application of the IBNDC approach to support these aspects of BN modelling. The complex nature of environmental issues makes them ideal case studies for the proposed integrated approach to modelling. Moreover, they lend themselves to a series of integrated sub-networks describing different scientific components, combining scientific and management perspectives, or pooling similar contributions developed in different locations by different research groups. In southern Africa the two largest free-ranging cheetah (Acinonyx jubatus) populations are in Namibia and Botswana, where the majority of cheetahs are located outside protected areas. Consequently, cheetah conservation in these two countries is focussed primarily on the free-ranging populations as well as the mitigation of conflict between humans and cheetahs. In contrast, in neighbouring South Africa, the majority of cheetahs are found in fenced reserves. Nonetheless, conflict between humans and cheetahs remains an issue here. Conservation effort in South Africa is also focussed on managing the geographically isolated cheetah populations as one large meta-population. Relocation is one option among a suite of tools used to resolve human-cheetah conflict in southern Africa. Successfully relocating captured problem cheetahs, and maintaining a viable free-ranging cheetah population, are two environmental issues in cheetah conservation forming the first case study in this thesis. The second case study involves the initiation of blooms of Lyngbya majuscula, a blue-green algae, in Deception Bay, Australia. L. majuscula is a toxic algal bloom which has severe health, ecological and economic impacts on the community located in the vicinity of this algal bloom. Deception Bay is an important tourist destination with its proximity to Brisbane, Australia’s third largest city. Lyngbya is one of several algae considered to be a Harmful Algal Bloom (HAB). This group of algae includes other widespread blooms such as red tides. The occurrence of Lyngbya blooms is not a local phenomenon, but blooms of this toxic weed occur in coastal waters worldwide. With the increase in frequency and extent of these HAB blooms, it is important to gain a better understanding of the underlying factors contributing to the initiation and sustenance of these blooms. This knowledge will contribute to better management practices and the identification of those management actions which could prevent or diminish the severity of these blooms.

Automated centralised separation management with onboard decision support

This paper proposes a novel automated separation management concept in which onboard decision support is integrated within a centralised air traffic separation management system. The onboard decision support system involves a decentralised separation manager that can overrule air traffic management instructions under certain circumstances. This approach allows the advantages of both centralised and decentralised concepts to be combined (and disadvantages of each separation management approach to be mitigated). Simulation studies are used to illustrate the potential benefits of the combined separation management concept.

Capabilities for strategic infrastructure asset management

Infrastructure organisations are operating in an increasingly challenging business environment as a result of globalisation, privatisation and deregulation. Under such circumstances, asset managers need to manage their infrastructure assets effectively in order to contribute to the overall performance of their organisation. In an external business environment that is constantly changing, extant literature on strategic management advocates a resourced--�]based view (RBV) approach that focuses on factors internal to the organisation such as resources and capabilities to sustain organisation performance. The aim of this study is to explore the core capabilities needed in the management of infrastructure assets. Using a multiple case study research strategy focusing on transport infrastructure, this research firstly examines the goals of infrastructure asset management and their alignment with broader corporate goals of an infrastructure organisation. It then examines the strategic infrastructure asset management processes that are needed to achieve these goals. The core capabilities that can support the strategic infrastructure asset management processes are then identified. This research produced a number of findings. First, it provided empirical evidence that asset management goals are being pursued with the aim of supporting the broader business goals of infrastructure organisations. Second, through synthesising the key asset management processes deemed necessary to achieve the asset management goals, a strategic infrastructure asset management model is proposed. Third, it identified five core capabilities namely stakeholder connectivity, cross-functional, relational, technology absorptive and integrated information management capability as central to executing the strategic infrastructure asset management processes well. These findings culminate in the development of a capability model to improve the performance of infrastructure assets.

Sustainable infrastructure assets : capability for infrastructure capacity management

Building for a sustainable environment requires sustainable infrastructure assets. Infrastructure capacity management is the process of ensuring optimal provision of such infrastructure assets. Effectiveness in this process will enable the infrastructure asset owners and its stakeholders to receive full value on their investment. Business research has shown that an organisation can only achieve business value when it has the right capabilities. This paradigm can also be applied to infrastructure capacity management. With limited access to resources, the challenge for infrastructure organisations is to identify and develop core capabilities to enable infrastructure capacity management. This chapter explores the concept of capability and identifies the core capability needed in infrastructure capacity management. Through a case study of the Port of Brisbane, this chapter shows that infrastructure organisations must develop their intelligence gathering capability to effectively manage the capacity of their infrastructure assets.

A decision support system for sustainable urban development : the integrated land use and transportation indexing model

Broad, early definitions of sustainable development have caused confusion and hesitation among local authorities and planning professionals. This confusion has arisen because loosely defined principles of sustainable development have been employed when setting policies and planning projects, and when gauging the efficiencies of these policies in the light of designated sustainability goals. The question of how this theory-rhetoric-practice gap can be filled is the main focus of this chapter. It examines the triple bottom line approach–one of the sustainability accounting approaches widely employed by governmental organisations–and the applicability of this approach to sustainable urban development. The chapter introduces the ‘Integrated Land Use and Transportation Indexing Model’ that incorporates triple bottom line considerations with environmental impact assessment techniques via a geographic, information systems-based decision support system. This model helps decision-makers in selecting policy options according to their economic, environmental and social impacts. Its main purpose is to provide valuable knowledge about the spatial dimensions of sustainable development, and to provide fine detail outputs on the possible impacts of urban development proposals on sustainability levels. In order to embrace sustainable urban development policy considerations, the model is sensitive to the relationship between urban form, travel patterns and socio-economic attributes. Finally, the model is useful in picturing the holistic state of urban settings in terms of their sustainability levels, and in assessing the degree of compatibility of selected scenarios with the desired sustainable urban future.

Challenges in land use planning around Australian airports

The privatization of major Australian airports in the late 1990s unleashed an unprecedented development wave as corporate lessees implemented ambitious business plans. While planning and environmental regulations governing on-airport development were significantly enhanced, there has been national disquiet about a governance regime that remains under the auspices of the federal government and is not effectively integrated into state and local decision-making machinery. Tensions in major airport regions have been exacerbated by the building of highly conspicuous non-aeronautical developments approved with no determining input by local decision-makers as well as the growing pressures on off-airport locations for aviation-related development. This paper canvasses this context and overviews the evolving structure of planning controls for Australia’s privatized federal airports. A range of issues surfacing through the National Aviation Policy Review process in 2008–2009 is described.

The ethics of regional water planning : planning and management of water resources in a growth region

Abstract Providing water infrastructure in times of accelerating climate change presents interesting new problems. Expanding demands must be met or managed in contexts of increasingly constrained sources of supply, raising ethical questions of equity and participation. Loss of agricultural land and natural habitats, the coastal impacts of desalination plants and concerns over re-use of waste water must be weighed with demand management issues of water rationing, pricing mechanisms and inducing behaviour change. This case study examines how these factors impact on infrastructure planning in South East Queensland, Australia: a region with one of the developed world’s most rapidly growing populations, which has recently experienced the most severe drought in its recorded history. Proposals to match forecast demands and potential supplies for water over a 20 year period are reviewed by applying ethical principles to evaluate practical plans to meet the water needs of the region’s activities and settlements.