Implementation of a quality care management system for patients with arthritis of the hip and knee

The Orthopaedic Unit of the Repatriation General Hospital (RGH) in Adelaide, South Australia has implemented a quality care management system for patients with arthritis of the hip and knee. The system not only optimises conservative management but ensures that joint replacement surgery is undertaken in an appropriate and timely manner. This new service model addresses identified barriers to service access and provides a comprehensive, coordinated strategy for patient management. Over 4 years the model has reduced waiting times for initial outpatient assessment from 8 to 3 months and surgery from 18 to 8 months, while decreasing length of stay from 6.3 to 5.3 days for hips and 5.8 to 5.3 days for knees. The service reforms have been accompanied by positive feedback from patients and referring general practitioners in relation to the improved coordination of care and enhanced efficiency in service delivery.

What is known about the topic? Several important initiatives both overseas and within Australia have contributed significantly to the development of this model of care. These include the UK National Health Service ‘18 weeks’ Project, the Western Canada Waiting List Project, the New Zealand priority criteria project, the Queensland Health Orthopaedic Physiotherapy Screening Clinic, and most importantly the Melbourne Health–University of Melbourne Orthopaedic Waiting List Project where a wide range of models were explored across Victorian hospitals from 2005 and the Multi-Attribute Prioritisation Tool (MAPT) was developed, validated and tested. This project became the Osteoarthritis Hip and Knee Service (OAHKS) and was operationalised in the Victorian healthcare system from 2012. These initiatives examined and addressed various aspects of management systems for patients with arthritis of the hip and knee in their particular setting.

What does this paper add? The development of this system is an extension of what is already known and is the first to encompass a comprehensive and coordinated strategy across all stages of the care management pathway for this patient group. Their management extends from the initial referral to development and implementation of a management plan, including surgery if assessed as necessary and organisation of long-term post operative follow up as required. By detailing the elements, key processes and measurable outcomes of the service redesign this paper provides a model for other institutions to implement a similar initiative.

What are the implications for practitioners? An important aspect of the design process was practitioner acceptance and engagement and the ability to improve their capacity to deliver services within an efficient and effective model. Intrinsic to the model’s development was assessment of practitioner satisfaction. Data obtained including practitioner surveys indicated an increased level of both satisfaction with the redesigned management service, and confidence in it to deliver its intended improvements.

Analysing stakeholder-associated risks in green buildings : a social network analysis method

In the research of risk associated with developing energy and water efficient green buildings, previous studies had mainly focused on "what the risks are and how the risks may impact on project objectives", which were from an inward looking self-perspective and treated the risks in isolation from one another. While intensive research efforts have been dedicated to risk identification, assessment, classification, prioritisation and mitigation, a research gap exists, that is previous studies had ignored the fact that most risks are interrelated and associated with internal or external project stakeholders. To remedy the gap, this current research developed and presented a SNA (Social Network Analysis) based stakeholder-associated risk analysis method to assess risks in green buildings and the interactions between the risks. A case study has been conducted to demonstrate and validate this method. This research contributes to the development of a new theory to model the interdependent and interactive relationships of risks by using SNA as a methodology. This research should broaden project managers' awareness of the influential risks in green building and enhance their ability to perceive, understand, assess, and mitigate the risks in an effective and efficient way, thereby achieving higher performance in strategic risk management and stakeholder communication in green building development.

Estimating the proportion of metabolic health outcomes attributable to obesity: a cross-sectional exploration of body mass index and waist circumference combinations

BACKGROUND: Recent evidence suggests that a substantial subgroup of the population who have a high-risk waist circumference (WC) do not have an obese body mass index (BMI). This study aimed to explore whether including those with a non-obese BMI but high risk WC as 'obese' improves prediction of adiposity-related metabolic outcomes.

METHODS: Eleven thousand, two hundred forty-seven participants were recruited. Height, weight and WC were measured. Ten thousand, six hundred fifty-nine participants with complete data were included. Adiposity categories were defined as: BMI(N)/WC(N), BMI(N)/WC(O), BMI(O)/WC(N), and BMI(O)/WC(O) (N = non-obese and O = obese). Population attributable fraction, area under the receiver operating characteristic curve (AUC), and odds ratios (OR) were calculated.

RESULTS: Participants were on average 48 years old and 50 % were men. The proportions of BMI(N)/WC(N), BMI(N)/WC(O), BMI(O)/WC(N) and BMI(O)/WC(O) were 68, 12, 2 and 18 %, respectively. A lower proportion of diabetes was attributable to obesity defined using BMI alone compared to BMI and WC combined (32 % vs 47 %). AUC for diabetes was also lower when obesity was defined using BMI alone (0.62 vs 0.66). Similar results were observed for all outcomes. The odds for hypertension, dyslipidaemia, diabetes and CVD were increased for those with BMI(N)/WC(O) (OR range 1.8-2.7) and BMI(O)/WC(O) (OR 1.9-4.9) compared to those with BMI(N)/WC(N).

CONCLUSIONS: Current population monitoring, assessing obesity by BMI only, misses a proportion of the population who are at increased health risk through excess adiposity. Improved identification of those at increased health risk needs to be considered for better prioritisation of policy and resources.

The 'club' cell and behavioural and physiological responses to chemical alarm cues in the Nile tilapia

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

“João e Maria”: uma observação psicanalítica sobre a experiência de crianças em situação de abrigamento

Tendo em vista a importância do ambiente, das relações afetivas e dos efeitos negativos da privação materna nos primeiros anos de vida para o desenvolvimento infantil, a presente pesquisa buscou compreender a experiência de crianças em situação de abrigamento. Para tanto, foram observadas duas crianças, na faixa etária de 23 a 31 meses, de nomes fictícios João e Maria, cujas histórias de vida proporcionaram uma analogia com o conto “João e Maria” dos Irmãos Grimm. As observações foram realizadas em um abrigo estadual, que acolhe crianças de zero a seis anos de idade, na cidade de Belém-PA. As sessões ocorreram duas vezes por semana, com duração de uma hora, durante cinco meses, a partir da aplicação do Método Bick de Observação de Bebês, em seus três momentos distintos: observação, anotação e supervisão em grupo. Os resultados foram organizados em três categorias: 1) O ambiente de cuidado de João e Maria, 2) João e Maria revelados por suas peripécias, e 3) Encontros com a observadora-narradora, sendo esses três eixos analisados com base na perspectiva psicanalítica winnicottiana. Na primeira categoria, foram apresentados fragmentos da história de vida de João e Maria, além de aspectos referentes aos cuidados recebidos nesse contexto, que estiveram permeados, principalmente, por carência de afeto e ausência na priorização das necessidades reais, no tempo e ritmo das crianças, possivelmente em função da dinâmica institucional. Na segunda categoria, foram abordadas as brincadeiras de João e Maria, associadas especialmente ao contato corporal e à relação de cuidados envolvendo seus pares e a observadora, cuja temática mais frequente foi da alimentação. Na terceira e última categoria, foram apresentados os sentimentos, as dificuldades e o aprendizado da observadora, bem como, a sua mobilização interna diante da história de vida das duas crianças e das particularidades do ambiente. Portanto, foi constatado que João e Maria buscavam cuidar e serem cuidados, o que, em sua maioria, envolvia contato corporal e afetivo; mostraram-se disponíveis no contato com o outro e se permitiram criar vínculos afetivos, aspectos saudáveis e positivos para o desenvolvimento infantil. Indubitavelmente, o entendimento da teoria winnicottiana e a utilização do Método Bick de Observação de Bebês contribuíram para a compreensão da experiência de João e Maria e colaboraram significativamente para uma apreensão da realidade dessas crianças e dos seus contextos de desenvolvimento.

Plant invasions research in Latin America: fast track to a more focused agenda

While many developed countries have invested heavily in research on plant invasions over the last 50 years, the immense region of Latin America has made little progress. Recognising this, a group of scientists working on plant invasions in Latin America met in Chile in late 2010 to develop a research agenda for the region based on lessons learned elsewhere. Our three main findings are as follows. (1) Globalisation is inevitable, but the resultant plant introductions can be slowed or prevented by effective quarantine and early intervention. Development of spatially explicit inventories, research on the invasion process and weed risk assessments can help prioritise and streamline action. (2) Eradication has limited application for plants and control is expensive and requires strict prioritisation and careful planning and evaluation. (3) Accepting the concept of novel ecosystems, new combinations of native and introduced species that no longer depend on human intervention, may help optimise invasive species management. Our vision of novel ecosystem management is through actions that: (a) maintain as much native biodiversity and ecosystem functionality as possible, (b) minimise management intervention to invasives with known impact, and (c) maximise the area of intervention. We propose the creation of a Latin American Invasive Plants Network to help focus the new research agenda for member countries. The network would coordinate research and training and establish funding priorities, develop and strengthen tools to share knowledge, and raise awareness at the community, governmental and intergovernmental levels about the social, economic and environmental costs of plant invasions.

The SOLUTIONS project: challenges and responses for present and future emerging pollutants in land and water resources management.

SOLUTIONS (2013 to 2018) is a European Union Seventh Framework Programme Project (EU-FP7). The project aims to deliver a conceptual framework to support the evidence-based development of environmental policies with regard to water quality. SOLUTIONS will develop the tools for the identification, prioritisation and assessment of those water contaminants that may pose a risk to ecosystems and human health. To this end, a new generation of chemical and effect-based monitoring tools is developed and integrated with a full set of exposure, effect and risk assessment models. SOLUTIONS attempts to address legacy, present and future contamination by integrating monitoring and modelling based approaches with scenarios on future developments in society, economy and technology and thus in contamination. The project follows a solutions-oriented approach by addressing major problems of water and chemicals management and by assessing abatement options. SOLUTIONS takes advantage of the access to the infrastructure necessary to investigate the large basins of the Danube and Rhine as well as relevant Mediterranean basins as case studies, and puts major efforts on stakeholder dialogue and support. Particularly, the EU Water Framework Directive (WFD) Common Implementation Strategy (CIS) working groups, International River Commissions, and water works associations are directly supported with consistent guidance for the early detection, identification, prioritisation, and abatement of chemicals in the water cycle. SOLUTIONS will give a specific emphasis on concepts and tools for the impact and risk assessment of complex mixtures of emerging pollutants, their metabolites and transformation products. Analytical and effect-based screening tools will be applied together with ecological assessment tools for the identification of toxicants and their impacts. The SOLUTIONS approach is expected to provide transparent and evidence-based candidates or River Basin Specific Pollutants in the case study basins and to assist future review of priority pollutants under the WFD as well as potential abatement options.

Balancing realism and vision - The prospects of EU-Israel relations in times of change and uncertainty. European Policy Brief, 28 May 2015

In this joint EPC-FSD Policy Brief, Andrea Frontini and Eran Etzion assess the state of play and the future prospects of EU-Israel relations in the light of recent domestic and regional political developments. They argue that, despite frequent cacophony and recurring stalemates, the EU-Israel partnership still has the potential to pursue shared strategic objectives. The two sides have to realign their relations, taking into account new realities and common challenges in the Middle East and Northern Africa region, and the current state of the Middle East Peace Process. More careful differentiation and stronger prioritisation of the policy dossiers at stake are urgently needed. An autonomous but joined up review of the overall relationship, guided by courage, pragmatism and stronger strategic direction, is crucial in order to move ahead.

Fiji mapped mangrove ecosystem service rankings in GeoJSON format

Incorporating the values of the services that ecosystems provide into decision making is becoming increasingly common in nature conservation and resource management policies, both locally and globally. Yet with limited funds for conservation of threatened species and ecosystems there is a desire to identify priority areas where investment efficiently conserves multiple ecosystem services. We mapped four mangrove ecosystems services (coastal protection, fisheries, biodiversity, and carbon storage) across Fiji. Using a cost-effectiveness analysis, we prioritised mangrove areas for each service, where the effectiveness was a function of the benefits provided to the local communities, and the costs were associated with restricting specific uses of mangroves. We demonstrate that, although priority mangrove areas (top 20%) for each service can be managed at relatively low opportunity costs (ranging from 4.5 to 11.3% of overall opportunity costs), prioritising for a single service yields relatively low co-benefits due to limited geographical overlap with priority areas for other services. None-the-less, prioritisation of mangrove areas provides greater overlap of benefits than if sites were selected randomly for most ecosystem services. We discuss deficiencies in the mapping of ecosystems services in data poor regions and how this may impact upon the equity of managing mangroves for particular services across the urban-rural divide in developing countries. Finally we discuss how our maps may aid decision-makers to direct funding for mangrove management from various sources to localities that best meet funding objectives, as well as how this knowledge can aid in creating a national mangrove zoning scheme.

Targeting genetic resource conservation in widespread species: a case study of Cedrela odorata L.

Conservation of genetic resources is a recognised necessity for the long term maintenance of evolutionary potential. Effective assessment and implementation Strategies are required to permit rapid evaluation and protection of resources. Here we use information from the chloroplast, total genome and quantitative characters assayed across wide-ranging populations to assess genetic resources in a Neotropical tree, Cedrela odorata. A major differentiation identified for organelle, total genomic and quantitative variation was found to coincide with an environmental gradient across Costa Rica. However, a major evolutionary divergence between the Yucatan region and Honduras/Nicaragua identified within the chloroplast genome was not differentiated using quantitative characters. Based on these and other results, a three-tiered conservation genetic prioritisation process is recommended. In order of importance, and where information is available, conservation units should be defined using quantitative (expressed genes), nuclear (genetic connectivity) and organellar (evolutionary) measures. Where possible, information from range wide and local scale studies should be combined and emphasis should be placed on coincidental disjunctions for two or more measures. However, if only rapid assessments of diversity are possible, then assessment of organelle variation provides the most cautious assessment of genetic resources, at least for C. odorata, and can be used to propose initial conservation units. When considering effective implementation of genetic resource management strategies a final tier should be considered, that of landuse/geopolitical divisions. (C) 2004 Elsevier B.V. All rights reserved.

Spatial and temporal definition of Ochlerotatus camptorhynchus (Thomson) (Diptera : Culicidae) in the Gippsland Lakes system of eastern Victoria

The confirmed vector of Ross River virus, Ochlerotatus camptorhynchus (Thomson), is the dominant mosquito species inhabiting saline marshes in coastal Victoria. This paper re-examines previously published data on Oc. camptorhynchus, plus additional data collected since that time, and provides greater spatial and temporal definition of Oc. camptorhynchus numbers at seven sites across the Gippsland Lakes system of eastern Victoria. A total of 357 672 Oc. camptorhynchus was captured from 1188 trap-nights across the seven trap sites during trapping seasons from 1990 to 2001. The dominance of Oc. camptorhynchus across the seven sites averaged 75%, with significant differences in mean abundance of Oc. camptorhynchus found between all trap sites. Significant differences in monthly abundance of Oc. camptorhynchus were observed for Wellington Shire. Increase in populations of Oc. camptorhynchus was associated with increases in rainfall at all trap sites, higher minimum temperatures at two of the seven trap sites, and wind speed at one trap site. Prioritisation of mosquito control may be applied based on spatial and temporal factors according to the findings of this study.

Use of CLIMEX modelling to identify prospective areas for exploration to find new biological control agents for prickly acacia

Selection of biocontrol agents that are adapted to the climates in areas of intended release demands a thorough analysis of the climates of the source and release sites. We present a case study that demonstrates how use of the CLIMEX software can improve decision making in relation to the identification of prospective areas for exploration for agents to control the woody weed, prickly acacia Acacia nilotica ssp. indica in the arid areas of north Queensland.

Obstacles and solutions to maximising urban biodiversity throughout the lifecycles of major developments in England

Thus far, achieving net biodiversity gains through major urban developments has been neither common nor straightforward - despite the presence of incentives, regulatory contexts, and ubiquitous practical guidance tools. A diverse set of obstructions, occurring within different spatial, temporal and actor hierarchies, are experienced by practitioners and render the realisation of maximised biodiversity, a rarity. This research aims to illuminate why this is so, and what needs to be changed to rectify the situation. To determine meaningful findings and conclusions, capable of assisting applied contexts and accommodating a diverse range of influences, a ‘systems approach’ was adopted. This approach led to the use of a multi-strategy research methodology, to identify the key obstructions and solutions to protecting and enhancing biodiversity - incorporating the following methods: action research, a questionnaire to local government ecologists, interviews and personal communications with leading players, and literature reviews. Nevertheless, ‘case studies’ are the predominant research method, the focus being a ‘nested’ case study looking at strategic issues of the largest regeneration area in Europe ‘the Thames Gateway’, and the largest individual mixeduse mega-development in the UK (at the time of planning consent) ‘Eastern Quarry 2’ - set within the Gateway. A further key case study, focussing on the Central Riverside development in Sheffield, identifies the merits of competition and partnership. The nested cases, theories and findings show that the strategic scale - generally relating to governance and prioritisation - impacts heavily upon individual development sites. It also enables the identification of various processes, mechanisms and issues at play on the individual development sites, which primarily relate to project management, planning processes, skills and transdisciplinary working, innovative urban biodiversity design capabilities, incentives, organisational cultures, and socio-ecological resilience. From these findings a way forward is mapped, spanning aspects from strategic governance to detailed project management.

Undermining patient and public engagement and limiting its impact:the consequences of the Health and Social Care Act 2012 on collective patient and public involvement

Patient and public involvement has been at the heart of UK health policy for more than two decades. This commitment to putting patients at the heart of the British National Health Service (NHS) has become a central principle helping to ensure equity, patient safety and effectiveness in the health system. The recent Health and Social Care Act 2012 is the most significant reform of the NHS since its foundation in 1948. More radically, this legislation undermines the principle of patient and public involvement, public accountability and returns the power for prioritisation of health services to an unaccountable medical elite. This legislation marks a sea-change in the approach to patient and public involvement in the UK and signals a shift in the commitment of the UK government to patient-centred care. © 2013 John Wiley & Sons Ltd.

Supply chain management resources, capabilities and execution

This paper identifies inter- and intra-organisational management resources that determine the level of execution of inter-firm alliance supply chain management (SCM). By drawing on network and resource-based view theories, a conceptual model proposes the effects of SCM resources and capabilities as influencing factors on SCM execution. The model was tested using survey data from studies conducted in two European supply chain environments. Variance-based structural equation modelling confirmed the hypothesised hierarchical order of three proposed antecedents: internal SCM resources affect joint SCM resources, which in turn influence collaborative SCM-related processes and finally SCM execution. An importance-performance analysis for both settings shows that providing and investing in internal SCM resources should be a priority when aiming to increase SCM execution. The theoretical contribution of this paper lies in confirming that the improvement of SCM execution follows a clear pathway featuring internal supply chain resources as one of the main drivers. The practical implications of this research include the development of a prioritisation list of measures that elevate SCM execution in the two country settings. © 2014 © 2014 Taylor & Francis.