Evaluation of integration technology approaches in the healthcare supply chain

Healthcare organisations are increasingly being challenged to look at their operations and find opportunities to improve the quality, efficiency and effectiveness of their supply chain services. In light of this situation, there is an apparent need for healthcare organisations to invest in integration technologies and to achieve the integration of supply chain processes, in order to break up the historical structure characterised by numerous interfaces and the segregation of responsibilities. The aim of this paper is to take an independent look at the healthcare supply chain and identify at different levels the core entities, processes, information flows, and system integration challenges which impede supply chain quality improvements to be realised. Moreover, this paper proposes, from an information systems perspective, a framework for the evaluation of different integration technology approaches, which can be used as a potential guideline tool for assessing integration technology alternatives, in order to add value to a healthcare-supply-chain management system. Copyright © 2007 Inderscience Enterprises Ltd.

Financial risk management for management accountants:Society of Management Accountants Canada, American Institute of Certified Public Accountants and Chartered Institute of Management Accountants

Management accounting guideline

Pathway to clozapine use:a comparison between a patient cohort from New Zealand and a cohort from the United Kingdom

Background and Objective: Clozapine has been available since the early 1990s. Studies continue to demonstrate its superior efficacy in treatment-resistant schizophrenia. Despite this, numerous studies show under-utilisation, delayed access and reluctance by psychiatrists to prescribe clozapine. This retrospective cross-sectional study compared the prescribing of clozapine in two adult cohorts under the care of large public mental health services in Auckland (New Zealand) and Birmingham (United Kingdom) on 31 March 2007. Method: Time from first presentation to clozapine initiation, prior antipsychotics trialled and antipsychotic co-prescribing were compared. Data included demographics, psychiatric diagnosis, co-morbid conditions, year of first presentation, admissions and pharmacological treatment (clozapine dose, start date, prior antipsychotics, co-prescribed antipsychotic). Results: Overall, 664 people were prescribed clozapine (402 Auckland; 262 Birmingham); mean daily dose of 384 mg (Auckland) and 429 mg (Birmingham). 53 % presented after 1990 and the average duration of time before starting clozapine was significantly longer in the Birmingham cohort (6.5 vs. 5.3 years) but this reduced in both cohorts to a 1-year mean in those presenting within the last 3 years. The average number of antipsychotics trialled pre-clozapine for those presenting since 1990 was significantly higher in the Birmingham cohort (4.3 vs. 3.1) but in both cohorts this similarly reduced in those presenting within the last 3 years. Antipsychotic co-prescribing was significantly higher in the Birmingham cohort (22.9 vs. 10.7 %). Conclusions: There is evidence that access to clozapine has improved over time in both cohorts, with a reduction in the duration between presentation and initiation of clozapine and number of different antipsychotics trialled pre-clozapine. These are very positive findings in terms of optimising outcomes with clozapine and are possibly due to the impact of guideline recommendations, increasing clinician, consumer and carer knowledge, and experience with clozapine and funding changes. © 2014 Springer International Publishing.

Long-range and high-resolution correlation optical time-domain reflectometry utilizing an all optical chaotic source

A high resolution optical time domain reflectometry (OTDR) based on an all-fiber chaotic source is demonstrated. We analyze the key factors limiting the operational range of such an OTDR, e.g., integral Rayleigh backscattering and the fiber loss, which degrade the optical signal to noise ratio at the receiver side, and then the guideline for counter-act such signal fading is discussed. The experimentally demonstrated correlation OTDR presents ability of 100km sensing range and 8.2cm spatial resolution (1.2 million resolved points), as a verification of the theoretical analysis. To the best of our knowledge, this is the first time that correlation OTDR measurement is performed over such a long distance with such high precision.

Wireless power and data transfer via a common inductive link using frequency division multiplexing

For wireless power transfer (WPT) systems, communication between the primary side and the pickup side is a challenge because of the large air gap and magnetic interferences. A novel method, which integrates bidirectional data communication into a high-power WPT system, is proposed in this paper. The power and data transfer share the same inductive link between coreless coils. Power/data frequency division multiplexing technique is applied, and the power and data are transmitted by employing different frequency carriers and controlled independently. The circuit model of the multiband system is provided to analyze the transmission gain of the communication channel, as well as the power delivery performance. The crosstalk interference between two carriers is discussed. In addition, the signal-to-noise ratios of the channels are also estimated, which gives a guideline for the design of mod/demod circuits. Finally, a 500-W WPT prototype has been built to demonstrate the effectiveness of the proposed WPT system.

Long-range and high-precision correlation optical time-domain reflectometry utilizing an all-fiber chaotic source

We propose a long range, high precision optical time domain reflectometry (OTDR) based on an all-fiber supercontinuum source. The source simply consists of a CW pump laser with moderate power and a section of fiber, which has a zero dispersion wavelength near the laser's central wavelength. Spectrum and time domain properties of the source are investigated, showing that the source has great capability in nonlinear optics, such as correlation OTDR due to its ultra-wide-band chaotic behavior, and mm-scale spatial resolution is demonstrated. Then we analyze the key factors limiting the operational range of such an OTDR, e. g., integral Rayleigh backscattering and the fiber loss, which degrades the optical signal to noise ratio at the receiver side, and then the guideline for counter-act such signal fading is discussed. Finally, we experimentally demonstrate a correlation OTDR with 100km sensing range and 8.2cm spatial resolution (1.2 million resolved points), as a verification of theoretical analysis.

The experiences of con sultations on oral anticoagula-tion for AF:the importance of qualitative research incardiovascular sciences

Objectives: Multiple-perspective qualitative designs can aid researchersto develop a more multifaceted account of a phenomenon and as aform of triangulation of data. Two interlinking studies aimed toexplore patients’ and physicians’ experiences of atrial fibrillation (AF)and warfarin.Methods: Audio-recorded semistructured individual interviews wereused. Study 1: Three AF patient subgroups were interviewed (n = 11);accepted, refused, or discontinued warfarin. Study 2: Four physiciansubgroups (n = 16): consultant cardiologists, consultant general physi-cians, general practitioners, and cardiology registrars. Data was ana-lyzed using interpretative phenomenological analysis, a qualitativemethodology.Results: Study 1: Three overarching themes comprised patients’ experi-ences: the initial consultation, life after the consultation, and patients’reflections. Patients commented on the reassurance experienced duringthe consultation, but they perceived the decision-making processmostly led by the physician. Lack of education and take-home materi-als during the initial consultation were highlighted. Patients’ uptake ofinformation was influenced by past experiences and knowledge ofstroke and/or bleeding. Study 2: Two overarching themes covered phy-sicians’ experiences: communicating information and challenges withwarfarin prescription for AF. Physicians’ approach to the consultationstyle shifted through a continuum of compliance-adherence-concor-dance during the consultation. Time and the perceived patient trust inthem as the expert led to physicians to adopt a paternalistic approach.Guideline adherence and the need to adopt a multidisciplinaryapproach were pointed out as current challenges.Conclusion: There is a need to target patients’ and physicians’ abilityto communicate with each other in a comprehensible way. This projecthas illustrated the benefit of using a qualitative approach to under-stand the lived experience of the physician–patient consultation.Disclosure of Interest: None declare

A kockázat szerepe a könyvvizsgálatban = The role of risk in external audits

A tanulmány a kockázatnak és a kockázatok felmérésének az éves beszámolók (pénzügyi kimutatások) könyvvizsgálatban betöltött szerepével foglalkozik. A modern könyvvizsgálat – belső és külső korlátainál fogva – nem létezhet a vizsgált vállalkozás üzleti kockázatainak felmérése nélkül. Olyannyira igaz ez, hogy a szakma alapvető szabályait lefektető nemzeti és nemzetközi standardok is kötelező jelleggel előírják az ügyfelek üzleti kockázatainak megismerését. Mindez nem öncélú tevékenység, hanem éppen ez jelenti a könyvvizsgálat kiinduló magját: a kockázatbecslés – a tervezés részeként – az audit végrehajtásának alapja, és egyben vezérfonala. A szerző először bemutatja a könyvvizsgálat és a kockázat kapcsolatának alapvonásait, azt, hogy miként jelenik meg egyáltalán a kockázat problémája a könyvvizsgálatban. Ezt követően a különféle kockázatalapú megközelítéseket tárgyalja, majd néhány főbb elem kiragadásával ábrázolja a kockázatkoncepció beágyazódását a szakmai szabályozásba. Végül – mintegy az elmélet tesztjeként – bemutatja a kockázatmodell gyakorlati alkalmazásának néhány aspektusát. ______ The study examines the role of risk and the assessment of risks in the external audit of financial statements. A modern audit – due to its internal and external limitations – cannot exist without the assessment of the business risk of the entity being audited. This is not a l’art pour l’art activity but rather the very core of the audit. It is – as part of the planning of the audit – a guideline to the whole auditing process. This study has three main sections. The first one explains the connection between audit and risk, the second discusses the different risk based approaches to auditing and the embeddedness of the risk concept into professional regulation. Finally – as a test of theory – some practical aspects of the risk model are discussed through the lens of former empirical research carried out mostly in the US. The conclusion of the study is that though risk based models of auditing have many weaknesses they still result in the most effective and efficient high quality audits.

Fever, methods of fever management, and caretakers' perceptions of pediatric after-hour telephone triage and advice services for children between the ages of twelve months and three years with fever

Despite the frequency with which fevers occur in children ages 1–3 years, lack of knowledge and understanding about the implications of fever and methods of fever management often results in anxiety among caretakers, sometimes prompting them to seek help at nearby emergency departments. Caretakers often look to health care professionals for advice and guidance over the telephone. The purpose of this study was to investigate caretakers' knowledge of the implications of fever, methods of fever management, perceptions of pediatric telephone triage and advice services regarding fever, and the effectiveness of after hour telephone triage directed toward improving the caretakers' ability to manage their child's fever at home. Pre-triage questionnaires were completed by 72 caretakers over the telephone before the triage encounter. Twenty-two of those same caretakers whose children were triaged using the fever guideline completed and returned the mailed post-triage questionnaire. Descriptive statistics were used to analyze responses for the larger pre-intervention group and describe comparisons for the pre and post-triage responses in the smaller sample subset (n = 22). ^

Refinement methods for software architecture design using the software architecture model

Modern software systems are often large and complicated. To better understand, develop, and manage large software systems, researchers have studied software architectures that provide the top level overall structural design of software systems for the last decade. One major research focus on software architectures is formal architecture description languages, but most existing research focuses primarily on the descriptive capability and puts less emphasis on software architecture design methods and formal analysis techniques, which are necessary to develop correct software architecture design. ^ Refinement is a general approach of adding details to a software design. A formal refinement method can further ensure certain design properties. This dissertation proposes refinement methods, including a set of formal refinement patterns and complementary verification techniques, for software architecture design using Software Architecture Model (SAM), which was developed at Florida International University. First, a general guideline for software architecture design in SAM is proposed. Second, specification construction through property-preserving refinement patterns is discussed. The refinement patterns are categorized into connector refinement, component refinement and high-level Petri nets refinement. These three levels of refinement patterns are applicable to overall system interaction, architectural components, and underlying formal language, respectively. Third, verification after modeling as a complementary technique to specification refinement is discussed. Two formal verification tools, the Stanford Temporal Prover (STeP) and the Simple Promela Interpreter (SPIN), are adopted into SAM to develop the initial models. Fourth, formalization and refinement of security issues are studied. A method for security enforcement in SAM is proposed. The Role-Based Access Control model is formalized using predicate transition nets and Z notation. The patterns of enforcing access control and auditing are proposed. Finally, modeling and refining a life insurance system is used to demonstrate how to apply the refinement patterns for software architecture design using SAM and how to integrate the access control model. ^ The results of this dissertation demonstrate that a refinement method is an effective way to develop a high assurance system. The method developed in this dissertation extends existing work on modeling software architectures using SAM and makes SAM a more usable and valuable formal tool for software architecture design. ^

Professional Growth and Performance Appraisals of School Administrators: A Contemporary Model

A sound performance appraisal process for school administrators contains key components in accordance with legislation, board policy and contractual agreements. This paper examines the performance appraisal process for administrators in one Canadian school district that may serve as a guideline for individual educators who are committed with on-going professional development.

A qualitative study of selected fourth -grade teachers' perceptions of the Sunshine State Standards

Despite a history of grappling with educational standards, never before has the federal government attempted to establish explicit national standards for what American children should learn in school. Recently, U.S. educators have developed voluntary national content standards, or explicit expectations of what students should know and be able to do. Not surprisingly, this major curriculum reform has provoked considerable debate. Today, teachers face difficult challenges working towards the implementation of standards. The objective of this study was to describe and explain the perceptions of a selected team of fourth-grade teachers regarding the language arts component of their state's Sunshine State Standards (SSS). The exploratory questions that guided this qualitative study were: (a) How are the SSS perceived by these fourth-grade teachers? (b) In what ways do the SSS affect teachers' self-perceptions? and, (c) To what extent and how do the SSS affect the participants' professional classroom behavior? ^ Direct observations, interviews, analysis of relevant documents and the researcher's critical reflective journal served as the methods of inquiry employed in this qualitative study. Bandura's Teacher Self-Efficacy Scale was used as a tool to help categorize the data specifically related to self-perception. ^ Analysis of the data suggests that participants perceived the SSS as a useful guideline as they taught. The SSS were a decisive factor in teachers' planning. They were the actual guide lines used by teachers to plan their lessons. However, participants did not believe the SSS were attainable by all students or were fair to students with special needs. They also believed there was not sufficient time allocated for the effective implementation of the SSS. This lack of time created pressure among some of the participants and others even felt disempowered regarding the curriculum and the instructional focus implemented during the test preparation time. The SSS negatively affected the participants when they felt constraints during this time, which led to their inability to carry out important activities in their classrooms. Thus, the SSS directly affected the participants' behavior in their classrooms. ^

Site specific growth of metal catalyzed silica nanowires for biological and chemical sensing

In this research the integration of nanostructures and micro-scale devices was investigated using silica nanowires to develop a simple yet robust nanomanufacturing technique for improving the detection parameters of chemical and biological sensors. This has been achieved with the use of a dielectric barrier layer, to restrict nanowire growth to site-specific locations which has removed the need for post growth processing, by making it possible to place nanostructures on pre-pattern substrates. Nanowires were synthesized using the Vapor-Liquid-Solid growth method. Process parameters (temperature and time) and manufacturing aspects (structural integrity and biocompatibility) were investigated. Silica nanowires were observed experimentally to determine how their physical and chemical properties could be tuned for integration into existing sensing structures. Growth kinetic experiments performed using gold and palladium catalysts at 1050°C for 60 minutes in an open-tube furnace yielded dense and consistent silica nanowire growth. This consistent growth led to the development of growth model fitting, through use of the Maximum Likelihood Estimation (MLE) and Bayesian hierarchical modeling. Transmission electron microscopy studies revealed the nanowires to be amorphous and X-ray diffraction confirmed the composition to be SiO2 . Silica nanowires were monitored in epithelial breast cancer media using Impedance spectroscopy, to test biocompatibility, due to potential in vivo use as a diagnostic aid. It was found that palladium catalyzed silica nanowires were toxic to breast cancer cells, however, nanowires were inert at 1μg/mL concentrations. Additionally a method for direct nanowire integration was developed that allowed for silica nanowires to be grown directly into interdigitated sensing structures. This technique eliminates the need for physical nanowire transfer thus preserving nanowire structure and performance integrity and further reduces fabrication cost. Successful nanowire integration was physically verified using Scanning electron microscopy and confirmed electrically using Electrochemical Impedance Spectroscopy of immobilized Prostate Specific Antigens (PSA). The experiments performed above serve as a guideline to addressing the metallurgic challenges in nanoscale integration of materials with varying composition and to understanding the effects of nanomaterials on biological structures that come in contact with the human body.

Mountain lake colony pinewood estate garden historic preservation

Pinewood Estate is a significant resource in the history of the theory and practice of landscape architecture. The purpose of this thesis is to provide a landscape plan to restore the Pinewood Estate to its historic integrity in order to retain and reflect its past. In order to determine the criteria used to establish how and to what period the estate should be restored to, the Secretary of the Interior's Guidelines for the Treatment of Cultural Landscapes was followed. This process involved documenting the existing conditions of the estate. Site inventory and analysis and onsite interviews were conducted. Natural and cultural resources were evaluated. As a case study, McKee Botanical Garden was analyzed and evaluated. The comparison of this case study served as a guideline to determine the best practice for the historical preservation of the estate. Despite the changes in the landscape at Pinewood Estate over the past seventy years, the garden today still retains William Lyman Phillips design criteria. For the garden to continue to keep its historic fabric, rehabilitation was selected to allow for improvements that make possible efficient contemporary use of the estate.

Identificação das políticas de incentivo ao desenvolvimento da energia eólica no Rio Grande do Norte (RN)

Energy is a vital resource for social and economic development. In the present scenario, the search for alternative energy sources has become fundamental, especially after the oil crises between 1973 and 1979, the Chernobyl nuclear accident in 1986 and the Kyoto Protocol in 1997. The demand for the development of new alternative energy sources aims to complement existing forms allows to meet the demand for energy consumption with greater security. Brazil, with the guideline of not dirtying the energy matrix by the fossil fuels exploitation and the recent energy crisis caused by the lack of rains, directs energy policies for the development of other renewable energy sources, complementing the hydric. This country is one of the countries that stand out for power generation capacity from the winds in several areas, especially Rio Grande do Norte (RN), which is one of the states with highest installed power and great potential to be explored. In this context arises the purpose of this work to identify the incentive to develop policies of wind energy in Rio Grande do Norte. The study was conducted by a qualitative methodology of data analysis called content analysis, oriented for towards message characteristics, its informational value, the words, arguments and ideas expressed in it, constituting a thematic analysis. To collect the data interviews were conducted with managers of major organizations related to wind energy in Brazil and in the state of Rio Grande do Norte. The identification of incentive policies was achieved in three stages: the first seeking incentives policies in national terms, which are applied to all states, the second with the questionnaire application and the third to research and data collection for the development of the installed power of the RN as compared to other states. At the end, the results demonstrated hat in Rio Grande do Norte state there is no incentive policy for the development of wind power set and consolidated, specific actions in order to optimize the bureaucratic issues related to wind farms, especially on environmental issues. The absence of this policy hinders the development of wind energy RN, considering result in reduced competitiveness and performance in recent energy auctions. Among the perceived obstacles include the lack of hand labor sufficient to achieve the reporting and analysis of environmental licenses, the lack of updating the wind Atlas of the state, a shortfall of tax incentives. Added to these difficulties excel barriers in infrastructure and logistics, with the lack of a suitable port for large loads and the need for reform, maintenance and duplication of roads and highways that are still loss-making. It is suggested as future work the relationship of the technology park of energy and the development of wind power in the state, the influence of the technology park to attract businesses and industries in the wind sector to settle in RN and a comparison of incentive policies to development of wind energy in the Brazilian states observing wind development in the same states under study.