Challenges of managing medications for older people at transition points of care

In clinical practice, pharmacists play a very important role in identifying and correcting medication discrepancies as older patients move across transition points of care. With increasing complexity of health care needs of older people, these discrepancies are likely to increase. The major concern with identifying and correcting medication discrepancies is that medication reconciliation is considered a retrospective problem – that is, dealing with medication discrepancies after they have occurred. It is argued here that a more proactive stance should be taken where doctors, nurses and pharmacists collectively work together to prevent medication discrepancies from happening in the first place. Improved involvement of patients and family members will help to facilitate better management of medications across transition points of care. Efficient use of information technology aids, such as electronic medication reconciliation tools, should also assist with organizational systems problems associated with the working culture, heavy workloads, and staff and skill mix of health professionals.

DNA mismatch repair and the transition to hormone independence in breast and prostate cancer

The molecular basis for the progression of breast and prostate cancer from hormone dependent to hormone independent disease remains a critical issue in the management of these two cancers. The DNA mismatch repair system is integral to the maintenance of genomic stability and suppression of tumorigenesis. No firm consensus exists regarding the implications of mismatch repair (MMR) deficiencies in the development of breast or prostate cancer. However, recent studies have reported an association between mismatch repair deficiency and loss of specific hormone receptors, inferring a potential role for mismatch repair deficiency in this transition. An updated review of the experimental data supporting or contradicting the involvement of MMR defects in the development and progression of breast and prostate cancer will be provided with particular emphasis on their implications in the transition to hormone independence.

Violence and Commemoration in the New Northern Ireland: Space, Memory and Management

On June 27th 2012, the Deputy First Minister of Northern Ireland and former IRA commander, Martin McGuinness shook hands with Queen Elizabeth II for the first time at an event in Belfast. For many the gesture symbolised the consolidation of Northern Ireland's transition to peace, the meeting of cultures and traditions, and hope for the future. Only a few weeks later however violence spilled onto the streets of north and west Belfast following a series of commemorative parades, marking a summer of hostilities. Those hostilities spread into a winter of protest, riot and discontent around flags and emblems and a year of tensions and commemorative-related violence marked again by a summer of rioting and protest in 2013. Outwardly these examples present two very different pictures of the 'new' Northern Ireland; the former of a society moving forward and putting the past behind it and the latter apparently divided over and wedded to different constructions of the past. Furthermore they revealed two very different 'places', the public handshake in the arena of public space; the rioting and fighting occurring in spaces distanced from the public sphere. This paper has also illustrated the difficulties around the ‘public management’ of conflict and transition as many within public agencies struggle with duties to uphold good relations and promote good governance within an environment of political strife, hostility and continuing violence.

This paper presents the key findings and implications of an exploratory project funded by the Arts and Humanities Research Council, explored the phenomenon of commemorative-related violence in Northern Ireland. We focus on 1) why the performance or celebration of the past can sometimes lead to violence in specific places; 2) map and analyse the levels of commemorative related violence in the past 15 years and 3) look at the public management implications of both conflict and transition at a strategic level within the public sector.

Historical Dialogue and Memory in Organisational Transition: the case of the Police in Northern Ireland

During Northern Ireland’s transition towards peace the role of the police as an actor in the conflict has been a key point of contention. As such, the reform of policing has been central to conflict transformation. Within this process, the role of dialogue about what policing had been and could be in the future has been vital. Such institutional post violence change processes have been hugely significant in illustrating both organisational resistance to change and the need for transitions to be powerfully manoeuvred through complex, political, organisational and cultural processes (Buchanan and Badham 1999; Pettigrew 2012). The radical and reforming nature of policing transition (Murphy 2013) has been both organisationally challenging (requiring significant transformational leadership, resourcing and external engagement from wider civic society) and politically unusual. Indeed, in a society emerging from violence the NI police are the only public sector organisation to have engaged structurally and culturally in understanding the point at which their core roles intersected with the ‘management’ of the conflict in NI generally. This paper presents an analysis of the role of historical dialogue in organisational change process, using the RUC / PSNI case. It proposes that historical dialogue is not just an external, societal process but also an internal organisational process and as such, has implications for managing institutional change in societies emerging from conflict. In doing so, it builds theoretical links between literature on conflict transformation and that on organisational memory and empirically explores messaging internal to the RUC before and during the four main periods of organisational change (Murphy 2013), with dialogue aimed at an external audience. It offers an analysis of how historical dialogue itself impacts on and is impacted by the organisational realities of change itself.

Challenge of transition in the socio-professional insertion of youngsters with neurodisabilities

Patients with neurodisabilities require early management, continuing into adulthood. Thus, transition services were implemented in hospitals. To have a better support when they enter into adult life, it is useful to know the problems that they could face. The aim of this study is to evaluate their activities and to assess their insertion problems in the professional world. It is based on medical records of patients, aged 16 to 25 years, followed in the transition clinic of young adults in the Neurorehabilitation services of a tertiary centre. From 387 patients of the paediatric consultation, there are 267 patients (69%), included 224 with neurodevelopmental diseases and 43 with neuromuscular diseases. Nearly half of them (46.8%) were in a protected environment, 37.08% studied and 3.4% worked. Paradoxically, only 29.2% reported work problems. These results highlight the need to increase the integration of young adults with neuromotor disorders in the labor market.

Learning achievements of farmers during the transition to market-oriented organic agriculture in rural Uganda

Organic agriculture requires farmers with the ability to develop profitable agro-enterprises on their own. By drawing on four years of experiences with the Enabling Rural Innovation approach in Uganda, we outline how smallholder farmers transition to organic agriculture and, at the same time, increase their entrepreneurial skills and competences through learning. In order to document this learning we operationalised the Kirkpatrick learning evaluation model, which subsequently informed the collection of qualitative data in two study sites. Our analysis suggests that the Enabling Rural Innovation approach helps farmers to develop essential capabilities for identifying organic markets and new organic commodities, for testing these organic commodities under varying organic farm management scenarios, and for negotiating contracts with organic traders. We also observed several obstacles that confront farmers’ transition to organic agriculture when using the Enabling Rural Innovation approach. These include the long duration of agronomic experimentation and seed multiplication, expensive organic certification procedures and the absence of adequate mechanism for farmers to access crop finance services. Despite prevailing obstacles we conclude that the Enabling Rural Innovation approach provides a starting point for farmers to develop entrepreneurial competences and profitable agro-enterprises on their own.

Lean Transition of Emerging Industrial Capability

This volume of the final report documents the technical work performed from December 1998 through December 2002 under Cooperative Agreement F33615-97-2-5153 executed between the U.S. Air Force, Air Force Research Laboratory, Materials and Manufacturing Directorate, Manufacturing Technology Division (AFRL/MLM) and the McDonnell Douglas Corporation, a wholly-owned subsidiary of The Boeing Company. The work was accomplished by The Boeing Company, Phantom Works, Huntington Beach, St. Louis, and Seattle; Ford Motor Company; Integral Inc.; Sloan School of Management in the Massachusetts Institute of Technology; Pratt & Whitney; and Central State University in Xenia, Ohio and in association with Raytheon Corporation. The LeanTEC program manager for AFRL is John Crabill of AFRL / MLMP and The Boeing Company program manager is Ed Shroyer of Boeing Phantom Works in Huntington Beach, CA. Financial performance under this contract is documented in the Financial Volume of the final report.

Stages of organizational transformation in transition economies: A dynamic capabilities approach

How do organizations previously dominated by the state develop dynamic capabilities that would support their growth in a competitive market economy? We develop a theoretical framework of organizational transformation that explains the processes by which organizations learn and develop dynamic capabilities in transition economies. Specifically, the framework theorizes about the importance of, and inter-relationships between, leadership, organizational learning, dynamic capabilities, and performance over three stages of transformation. Propositions derived from this framework explain the pre-conditions enabling organizational learning, the linkages between types of learning and functions of dynamic capabilities, and the feedback from dynamic capabilities to organizational learning that allows firms in transition economies to regain their footing and build long-term competitive advantage. We focus on transition contexts, where these processes have been magnified and thus offer new insights into strategizing in radically altered environments.

Transitions towards co-management: the process of marine resource management devolution in three east African countries

Communities are increasingly empowered with the ability and responsibility of working with national governments to make decisions about marine resources in decentralized co-management arrangements. This transition toward decentralized management represents a changing governance landscape. This paper explores the transition to decentralisation in marine resource management systems in three East African countries. The paper draws upon expert opinion and literature from both political science and linked social-ecological systems fields to guide exploration of five key governance transition concepts in each country: (1) drivers of change; (2) institutional arrangments; (3 institutional fit; (4) actor interactions; and (5) adaptive management. Key findings are that decentralized management in the region was largely donor-driven and only partly tranferred power to local stakeholders. However, increased accountability created a degree of democracy in regards to natural resource governance that was not previously present. Additionally, increased local-level adaptive management has emerged in most systems and, to date, this experimental management has helped to change resource user's views from metaphysical to more scientific cause-and-effect attribution of changes to resource conditions.

The persistent challenge of encouraging public participation in the low-carbon transition

In order to address the growing urgency of issues around environmental and resource limits, there is a clear need to develop policies that promote changes in behavior and the ways in which society both views and consumes goods and services. However, there is an argument to suggest that, in order to develop effective policies in this area, we need to move beyond a narrow understanding of ‘how individuals behave’ in order to cultivate a more nuanced approach that encompasses behavioral influences in different societies, contexts and settings. In this opinion article we therefore draw on a range of our own recent comparative research studies in order to provide fresh insights into the continued problem of how to engage people individually and collectively in establishing more sustainable, low-carbon societies.

New animals, new landscapes and new worldviews: the Iron Age to Roman transition at Fishbourne

Anthropologists and cultural geographers have long accepted that animals play an important role in the creation of human cultures. However, such beliefs are yet to be embraced by archaeologists, who seldom give zooarchaeological data much consideration beyond the occasional economic or environmental reconstruction. In an attempt to highlight animal remains as a source of cultural information, this paper examines the evidence for the changing relationship between people and wild animals in Iron Age and Roman southern England. Special attention is given to ‘exotic’ species — in particular fallow deer, domestic fowl and the hare — whose management increased around AD 43. In Iron Age Britain the concept of wild game reserves was seemingly absent, but the post-Conquest appearance of new landscape features such as vivaria, leporaria and piscinae indicates a change in worldview from a situation where people seemingly negotiated with the ‘wilderness’ and ‘wild things’ to one where people felt they had the right or the responsibility to bring them to order. Using Fishbourne Roman Palace as a case study, we argue that wild and exotic animals represented far more than gastronomic treats or symbols of Roman identity, instead influencing the way in which people engaged with, traversed and experienced their surroundings.

On identity reformation and local transition: a case from Poland

Purpose – The purpose of this paper is to explore and understand the process of successful introduction of total quality management (TQM) in Poland and the way in which it impacted on identity of Polish managers. Design/methodology/approach – The study is based on a combination of ethnographic research and repertory grid interviews. Findings – The process of TQM introduction and implementation is examined through the application of translation as a model incorporating cultural and socio-economical dimensions in addition to individual and organizational levels that shaped the development of TQM in Poland. It then draws on the idea of fantasy as theorized in Lacanian psychoanalysis in order to incorporate the unconscious element of translation process which is missing from Latour’s theorization and which forms an important aspect of adoption of new technology and the emergence of a new post-transition generation of managers in Poland. The paper argues that a complex combination of contextual factors, amongst them the notion of fantasy shaped the process of translation of TQM to Poland, the identity formation of Polish managers and to the emergence of a new post-transition generation of managers in Poland. Originality/value – This paper contributes to the literature on the post-command transition by illustrating this process through the fantasy of total quality management explored in a specific socio-cultural and geographical context and by combining the idea of Latour’s translation with Lacanian fantasy.

Public debt management, monetary policy and financial institutions

Despite the large size of the Brazilian debt market, as well the large diversity of its bonds, the picture that emerges is of a market that has not yet completed its transition from the role it performed during the megainflation years, namely that of providing a liquid asset that provided positive real returns. This unfinished transition is currently placing the market under severe stress, as fears of a possible default from the next administration grow larger. This paper analyzes several aspects pertaining to the management of the domestic public debt. The causes for the extremely large and fast growth ofthe domestic public debt during the seven-year period that President Cardoso are discussed in Section 2. Section 3 computes Value at Risk and Cash Flow at Risk measures for the domestic public debt. The rollover risk is introduced in a mean-variance framework in Section 4. Section 5 discusses a few issues pertaining to the overlap between debt management and monetary policy. Finally, Section 6 wraps up with policy discussion and policy recommendations.

Performance of supplemented heifers on Marandu grass pastures in the wet-to-dry transition and dry seasons

The objective of the present study was to evaluate the characteristics of the sward canopy of Marandu grass during the rainy season, the wet-to-dry transition and the dry seasons, between March and September 2004, under intermittent grazing, and to correlate those characteristics with the performance of crossbred heifers receiving mineral supplements ad libitum or protein supplements. The experiment consisted of a randomized block design with three blocks (set of 13 paddocks), each containing five crossbred heifers per experimental unit, totaling 15 replicates. The heifers were given protein supplements daily in individual stalls and received an average 4 g/kg/day of the supplement during the rainy season and 5 g/kg/day during the dry season. Their weight gain was assessed monthly. The pasture structure was assessed through destructive sampling, and the bromatological composition of esophageal extrusa samples was also assessed. Analysis of variance was used to assess performance, and regression analysis was used to evaluate the sward canopy characteristics in relation to the months of the year. A cluster procedure was used to determine the similarity between the months of the year under assessment. Two different groups were formed for pasture evaluation: one group including the months of March to July and another group including the months of August and September. The first group exhibited a better canopy structure than the second group. This fact was corroborated by the animal performance, which was lower during the months of the second group. Low-intake protein supplementation was effective in increasing the performance of the grazing heifers. Pasture structure is critical for animal performance in a grazing environment, regardless of the type of supplementation.