Exploring Australian intensive care physicians clinical judgement during donation after cardiac death : an exploratory qualitative study

BACKGROUND: Donation after Cardiac Death (DCD) is one possible solution to the world wide organ shortage. Intensive care physicians are central to DCD becoming successful since they are responsible for making the clinical judgements and decisions associated with DCD. Yet international evidence shows health care professionals have not embraced DCD and are often reluctant to consider it as an option for patients. PURPOSE: To explore intensive care physicians' clinical judgements when selecting a suitable DCD candidate. METHODS: Using interpretative exploratory methods six intensive care physicians were interviewed from three hospital sites in Australia. Following verbatim transcription, data was subjected to thematic analysis. FINDINGS: Three distinct themes emerged. Reducing harm and increasing benefit was a major focus of intensive care physicians during determination of DCD. There was an acceptance of DCD if there was clear evidence that donation was what the patient and family wanted. Characteristics of a defensible decision reflected the characteristics of sequencing, separation and isolation, timing, consensus and collaboration, trust and communication to ensure that judgements were robust and defensible. The final theme revealed the importance of minimising uncertainty and discomfort when predicting length of survival following withdrawal of life-sustaining treatment. CONCLUSION: DCD decisions are made within an environment of uncertainty due to the imprecision associated with predicting time of death. Lack of certainty contributed to the cautious and collaborative strategies used by intensive care physicians when dealing with patients, family members and colleagues around end-of-life decisions, initiation of withdrawal of life-sustaining treatment and the discussion about DCD. This study recommends that nationally consistent policies are urgently needed to increase the degree of certainty for intensive care staff concerning the DCD processes.

Managing risk in process-aware information systems

This research contributes a fully-operational approach for managing business process risk in near real-time. The approach consists of a language for defining risks on top of process models, a technique to detect such risks as they eventuate during the execution of business processes, a recommender system for making risk-informed decisions, and a technique to automatically mitigate the detected risks when they are no longer tolerable. Through the incorporation of risk management elements in all stages of the lifecycle of business processes, this work contributes to the effective integration of the fields of Business Process Management and Risk Management.

Managing knowledge for asset management : shifting from process to relational frames

The purpose of this paper is to review existing knowledge management (KM) practices within the field of asset management, identify gaps, and propose a new approach to managing knowledge for asset management. Existing approaches to KM in the field of asset management are incomplete with the focus primarily on the application of data and information systems, for example the use of an asset register. It is contended these approaches provide access to explicit knowledge and overlook the importance of tacit knowledge acquisition, sharing and application. In doing so, current KM approaches within asset management tend to neglect the significance of relational factors; whereas studies in the knowledge management field have showed that relational modes such as social capital is imperative for ef-fective KM outcomes. In this paper, we argue that incorporating a relational ap-proach to KM is more likely to contribute to the exchange of ideas and the devel-opment of creative responses necessary to improve decision-making in asset management. This conceptual paper uses extant literature to explain knowledge management antecedents and explore its outcomes in the context of asset man-agement. KM is a component in the new Integrated Strategic Asset Management (ISAM) framework developed in conjunction with asset management industry as-sociations (AAMCoG, 2012) that improves asset management performance. In this paper we use Nahapiet and Ghoshal’s (1998) model to explain antecedents of relational approach to knowledge management. Further, we develop an argument that relational knowledge management is likely to contribute to the improvement of the ISAM framework components, such as Organisational Strategic Manage-ment, Service Planning and Delivery. The main contribution of the paper is a novel and robust approach to managing knowledge that leads to the improvement of asset management outcomes.

Advanced computer simulation of the milling process

Process modelling is an integral part of any process industry. Several sugar factory models have been developed over the years to simulate the unit operations. An enhanced and comprehensive milling process simulation model has been developed to analyse the performance of the milling train and to assess the impact of changes and advanced control options for improved operational efficiency. The developed model is incorporated in a proprietary software package ‘SysCAD’. As an example, the milling process model has been used to predict a significant loss of extraction by returning the cush from the juice screen before #3 mill instead of before #2 mill as is more commonly done. Further work is being undertaken to more accurately model extraction processes in a milling train, to examine extraction issues dynamically and to integrate the model into a whole factory model.

Exploring location-dependency in process modeling

Purpose – Context-awareness has emerged as an important principle in the design of flexible business processes. The goal of the research is to develop an approach to extend context-aware business process modeling toward location-awareness. The purpose of this paper is to identify and conceptualize location-dependencies in process modeling. Design/methodology/approach – This paper uses a pattern-based approach to identify location-dependency in process models. The authors design specifications for these patterns. The authors present illustrative examples and evaluate the identified patterns through a literature review of published process cases. Findings – This paper introduces location-awareness as a new perspective to extend context-awareness in BPM research, by introducing relevant location concepts such as location-awareness and location-dependencies. The authors identify five basic location-dependent control-flow patterns that can be captured in process models. And the authors identify location-dependencies in several existing case studies of business processes. Research limitations/implications – The authors focus exclusively on the control-flow perspective of process models. Further work needs to extend the research to address location-dependencies in process data or resources. Further empirical work is needed to explore determinants and consequences of the modeling of location-dependencies. Originality/value – As existing literature mostly focusses on the broad context of business process, location in process modeling still is treated as “second class citizen” in theory and in practice. This paper discusses the vital role of location-dependencies within business processes. The proposed five basic location-dependent control-flow patterns are novel and useful to explain location-dependency in business process models. They provide a conceptual basis for further exploration of location-awareness in the management of business processes.

Standard business reporting in Australia : efficiency, effectiveness, or both?

The benefits of using eXtensible Business Reporting Language (XBRL) as a business reporting standard have been widely canvassed in the extant literature, in particular, as the enabling technology for standard business reporting tools. One of the key benefits noted is the ability of standard business reporting to create significant efficiencies in the regulatory reporting process. Efficiency-driven cost reductions are highly desirable by data and report producers. However, they may not have the same potential to create long-term firm value as improved effectiveness of decision making. This study assesses the perceptions of Australian business stakeholders in relation to the benefits of the Australian standard business reporting instantiation (SBR) for financial reporting. These perceptions were drawn from interviews of persons knowledgeable in XBRL-based standard business reporting and submissions to Treasury relative to SBR reporting options. The combination of interviews and submissions permit insights into the views of various groups of stakeholders in relation to the potential benefits. In line with predictions based on a transaction-cost economics perspective, interviewees who primarily came from a data and report-producer background mentioned benefits that centre largely on asset specificity and efficiency. The interviewees who principally came from a data and report-consumer background mentioned benefits that centre on reducing decision-making uncertainty and decision-making effectiveness. The data and report consumers also took a broader view of the benefits of SBR to the financial reporting supply chain. Our research suggests that advocates of SBR have successfully promoted its efficiency benefits to potential users. However, the effectiveness benefits of SBR, for example, the decision-making benefits offered to investors via standardised reports, while becoming more broadly acknowledged, remain not a priority for all stakeholders.

Detecting approximate clones in business process model repositories

Empirical evidence shows that repositories of business process models used in industrial practice contain significant amounts of duplication. This duplication arises for example when the repository covers multiple variants of the same processes or due to copy-pasting. Previous work has addressed the problem of efficiently retrieving exact clones that can be refactored into shared subprocess models. This article studies the broader problem of approximate clone detection in process models. The article proposes techniques for detecting clusters of approximate clones based on two well-known clustering algorithms: DBSCAN and Hi- erarchical Agglomerative Clustering (HAC). The article also defines a measure of standardizability of an approximate clone cluster, meaning the potential benefit of replacing the approximate clones with a single standardized subprocess. Experiments show that both techniques, in conjunction with the proposed standardizability measure, accurately retrieve clusters of approximate clones that originate from copy-pasting followed by independent modifications to the copied fragments. Additional experiments show that both techniques produce clusters that match those produced by human subjects and that are perceived to be standardizable.

Score-level multibiometric fusion based on Dempster-Shafer theory incorporating uncertainty factors

While existing multi-biometic Dempster-Shafer the- ory fusion approaches have demonstrated promising perfor- mance, they do not model the uncertainty appropriately, sug- gesting that further improvement can be achieved. This research seeks to develop a unified framework for multimodal biometric fusion to take advantage of the uncertainty concept of Dempster- Shafer theory, improving the performance of multi-biometric authentication systems. Modeling uncertainty as a function of uncertainty factors affecting the recognition performance of the biometric systems helps to address the uncertainty of the data and the confidence of the fusion outcome. A weighted combination of quality measures and classifiers performance (Equal Error Rate) are proposed to encode the uncertainty concept to improve the fusion. We also found that quality measures contribute unequally to the recognition performance, thus selecting only significant factors and fusing them with a Dempster-Shafer approach to generate an overall quality score play an important role in the success of uncertainty modeling. The proposed approach achieved a competitive performance (approximate 1% EER) in comparison with other Dempster-Shafer based approaches and other conventional fusion approaches.

Critical linguistics in the early years : exploring functions of language through sophisticated picture books and process drama strategies

In this chapter we describe a critical fairytales unit taught to 4.5 to 5.5 year olds in a context of intensifying pressure to raise literacy achievement. The unit was infused with lessons on reinterpreted fairytales followed by process drama activities built around a sophisticated picture book, Beware of the Bears (MacDonald, 2004). The latter entailed a text analytic approach to critical literacy derived from systemic functional linguistics (Halliday, 1978; Halliday & Matthiessen, 2004). This approach provides a way of analysing how words and discourse are used to represent the world in a particular way and shape reader relations with the author in a particular field (Janks, 2010).