Sample records for changing healthcare environment

  1. Health technology assessment (HTA): definition, role and use in the changing healthcare environment. (United States)

    Gallio, D; Berto, P


    The increasing availability of health care technology--boosted by considerable advances in areas like biotechnology, biomaterials, surgical techniques and computer technology--has accompanied burgeoning health care costs, and for this reason an increasing number of subjects (clinicians, health product makers, regulators, patients, hospitals, managers, payers, government leaders) demand for well-founded information to support decisions about development, adoption, acquisition and use of new and existing technologies. Technology assessment is a form of policy research that identifies policy issues, assesses the impact of alternative courses of action, and presents findings. This article is aimed at describing the historical development, reviewing the various definition and classifications, illustrating the purposes Fnd actors of Health Technology Assessment and its possible applications in the current healthcare scenario.

  2. Architecture Capabilities to Improve Healthcare Environments (United States)

    Ebrahimi, Ali; Mardomi, Karim; Hassanpour Rahimabad, Kasra


    Background The physical environment of healthcare buildings has great importance in issues such as patient safety, functional efficiency, user satisfaction, healthcare outcomes, and energy and resources consumption. Objectives The present study assesses physical environments of Iranian healthcare buildings. Materials and Methods This study was performed using a descriptive-analytical method. Data collection was carried out via a written questionnaire. Results Based on the findings of this study, "functional efficiency", "user satisfaction", "environmental issues", "patient safety”, “accountability in incidents and disasters", and "flexibility" are regarded as the most issues in the country's hospitals. Also, none of the parameters is "without any problem" and has a "desirable status". Conclusions According to the responses, all of the healthcare buildings in this research had flaws in their physical environment, which require attention. Thus, it is necessary to review and pay more attention to the architecture of the country's healthcare buildings. PMID:24350145

  3. Social media disruptive change in healthcare : Responses of healthcare providers?

    NARCIS (Netherlands)

    Smailhodzic, E.; Boonstra, A.; Langley, D.J.


    Social media represent specific types of technologies that are end-user driven and end-users are able to drive disruptive change giving little time to organizations to react. With rapid and powerful emergence of social media communities in healthcare, this sector is faced with new and alternative

  4. Social media disruptive change in healthcare : responses of healthcare providers

    NARCIS (Netherlands)

    Smailhodzic, Edin; Boonstra, Albert; Langley, David

    Social media represent specific types of technologies that are end-user driven and end-users are able to drive disruptive change giving little time to organizations to react. With rapid and powerful emergence of social media communities in healthcare, this sector is faced with new and alternative

  5. An Architecture for Health Information Exchange in Pervasive Healthcare Environment

    NARCIS (Netherlands)

    Cardoso de Moraes, J.L.; Lopes de Souza, Wanderley; Ferreira Pires, Luis; Francisco do Prado, Antonio; Hammoudi, S.; Cordeiro, J.; Maciaszek, L.A.; Filipe, J.


    This paper presents an architecture for health information exchange in pervasive healthcare environments meant to be generally applicable to different applications in the healthcare domain. Our architecture has been designed for message exchange by integrating ubiquitous computing technologies,

  6. Lean healthcare from a change management perspective. (United States)

    van Rossum, Lisa; Aij, Kjeld Harald; Simons, Frederique Elisabeth; van der Eng, Niels; Ten Have, Wouter Dirk


    Purpose - Lean healthcare is used in a growing number of hospitals to increase efficiency and quality of care. However, healthcare organizations encounter problems with the implementation of change initiatives due to an implementation gap: the gap between strategy and execution. From a change management perspective, the purpose of this paper is to increase scientific knowledge regarding factors that diminish the implementation gap and make the transition from the "toolbox lean" toward an actual transformation to lean healthcare. Design/methodology/approach - A cross-sectional study was executed in an operating theatre of a Dutch University Medical Centre. Transformational leadership was expected to ensure the required top-down commitment, whereas team leadership creates the required active, bottom-up behavior of employees. Furthermore, professional and functional silos and a hierarchical structure were expected to impede the workforce flexibility in adapting organizational elements and optimize the entire process flow. Findings - The correlation and regression analyses showed positive relations between the transformational leadership and team leadership styles and lean healthcare implementation. The results also indicated a strong relation between workforce flexibility and the implementation of lean healthcare. Originality/value - With the use of a recently developed change management model, the Change Competence Model, the authors suggest leadership and workforce flexibility to be part of an organization's change capacity as crucial success factor for a sustainable transformation to lean healthcare.

  7. An investigation into the challenges facing the future provision of continuing professional development for allied health professionals in a changing healthcare environment

    International Nuclear Information System (INIS)

    Gibbs, Vivien


    This paper outlines current challenges facing healthcare providers and education providers in trying to ensure Allied Health Professionals (AHPs) are fit for practice, in a climate driven by financial constraints and service improvement directives from the Department of Health (DH). Research was undertaken in 2009 to investigate the current provision of Continuing Professional Development (CPD) in the southwest region of England. The purpose was to define exactly what problems existed with this provision, and to propose changes which could be implemented in order to ensure that the provision meets the needs of stakeholders in future years.

  8. Integrated Environment for Ubiquitous Healthcare and Mobile IPv6 Networks (United States)

    Cagalaban, Giovanni; Kim, Seoksoo

    The development of Internet technologies based on the IPv6 protocol will allow real-time monitoring of people with health deficiencies and improve the independence of elderly people. This paper proposed a ubiquitous healthcare system for the personalized healthcare services with the support of mobile IPv6 networks. Specifically, this paper discusses the integration of ubiquitous healthcare and wireless networks and its functional requirements. This allow an integrated environment where heterogeneous devices such a mobile devices and body sensors can continuously monitor patient status and communicate remotely with healthcare servers, physicians, and family members to effectively deliver healthcare services.

  9. Greening healthcare: practicing as if the natural environment really mattered. (United States)

    Irvine, Katherine N; Warber, Sara L


    enhanced through the experience of greater interconnectedness, which occurs when interacting with the natural world. The literature reviewed provides evidence to support the intuitive belief that interaction with the natural world is a vital part of biopsychosocial-spiritual well-being. Incorporating the natural world into healthcare could provide health benefits and improve the design of healthcare facilities. Applied more broadly to society, this knowledge may change the way we approach public health, guard and manage natural resources, and design environments for human use.

  10. Cochrane review abstracts: The psychological effects of the physical healthcare environment on healthcare personnel

    NARCIS (Netherlands)

    Dijkstra, K.; Pieterse, Marcel E.


    Background: The physical healthcare environment is capable of affecting patients. This concept of 'healing environments' refers to the psychological impact of environmental stimuli through sensory perceptions. It excludes more physiological effects such as those produced by ergonomic (i.e. fall

  11. The psychological effects of the physical healthcare environment on healthcare personnel.

    NARCIS (Netherlands)

    Tanja-Dijkstra, Karin; Pieterse, Marcel E.


    The physical healthcare environment is capable of affecting patients. This concept of 'healing environments' refers to the psychological impact of environmental stimuli through sensory perceptions. It excludes more physiological effects such as those produced by ergonomic (i.e. fall prevention) or

  12. The psychological effects of the physical healthcare environment on healthcare personnel

    NARCIS (Netherlands)

    Dijkstra, K.; Pieterse, Marcel E.


    Background: The physical healthcare environment is capable of affecting patients. This concept of 'healing environments' refers to the psychological impact of environmental stimuli through sensory perceptions. It excludes more physiological effects such as those produced by ergonomic (i.e. fall

  13. Design research and the globalization of healthcare environments. (United States)

    Shepley, Mardelle McCuskey; Song, Yilin


    Global healthcare practice has expanded in the past 20 years. At the same time the incorporation of research into the design process has gained prominence as a best practice among architects. The authors of this study investigated the status of design research in a variety of international settings. We intended to answer the question, "how pervasive is healthcare design research outside of the United States?" The authors reviewed the international literature on the design of healthcare facilities. More than 500 international studies and conference proceedings were incorporated in this literature review. A team of five research assistants searched multiple databases comparing approximately 16 keywords to geographic location. Some of those keywords included: evidence-based design, salutogenic design, design research, and healthcare environment. Additional articles were gathered by contacting prominent researchers and asking for their personal assessment of local health design research studies. While there are design researchers in most parts of the world, the majority of studies focus on the needs of populations in developed countries and generate guidelines that have significant cost and cultural implications that prohibit their implementation in developing countries. Additionally, the body of literature discussing the role of culture in healthcare environments is extremely limited. Design researchers must address the cultural implications of their studies. Additionally, we need to expand our research objectives to address healthcare design in countries that have not been previous considered. © 2014 Vendome Group, LLC.

  14. Succeeding in a disruptive healthcare environment. (United States)

    Kaufman, Kenneth; Grube, Mark E


    A greater level of consumerism in health care is leading to market dislocations that involve the shift of services to outpatient settings and to web-based and mobile modes of care. Hospitals and health systems risk losing market share and clinical and financial viability if they do not adjust their business models to account for these changes. When planning for such a transformation, organizations should commit to a new view of health care, invest in consumer-centric outpatient and virtual strategies, use new metrics to gauge success, and create a blueprint as a guide.

  15. Professional relations in sport healthcare: workplace responses to organisational change. (United States)

    Malcolm, Dominic; Scott, Andrea


    This article examines the impact of organisational changes in UK elite sport on the professional relations among and between different healthcare providers. The article describes the processes by which demand for elite sport healthcare has increased in the UK. It further charts the subsequent response within medicine and physiotherapy and, in particular, the institutionalisation of sport-specific sub-disciplines through the introduction of specialist qualifications. Drawing on semi-structured interviews with 14 doctors and 14 physiotherapists, the article argues that organisational changes have led to intra-professional tensions within both professional groups but in qualitatively different forms reflecting the organisational traditions and professional identities of the respective disciplines. Organisational changes promoting multi-disciplinary healthcare teams have also fostered an environment conducive to high levels of inter-professional cooperation though significant elements of inter-professional conflict remain. This study illustrates how intra-professional relations are affected by specialisation, how legitimation discourses are used by different professions, and how intra- and inter-professional conflict and cooperation should be seen as highly interdependent processes. Copyright © 2010 Elsevier Ltd. All rights reserved.

  16. Supporting nurses' transition to rural healthcare environments through mentorship. (United States)

    Rohatinsky, Noelle K; Jahner, Sharleen


    The global shortage of rural healthcare professionals threatens the access these communities have to adequate healthcare resources. Barriers to recruitment and retention of nurses in rural facilities include limited resources, professional development opportunities, and interpersonal ties to the area. Mentorship programs have been used to successfully recruit and retain rural nurses. This study aimed to explore (i) employee perceptions of mentorship in rural healthcare organizations, (ii) the processes involved in creating mentoring relationships in rural healthcare organizations, and (iii) the organizational features supporting and inhibiting mentorship in rural healthcare organizations. This study was conducted in one rural health region in Saskatchewan, Canada. Volunteer participants who were employed at one rural healthcare facility were interviewed. A semi-structured interview guide that focused on exploring and gaining an understanding of participants' perceptions of mentorship in rural communities was employed. Data were analyzed using interpretive description methodology, which places high value on participants' subjective perspective and knowledge of their experience. All seven participants were female and employed as registered nurses or licensed practical nurses. Participants recognized that the rural environment offered unique challenges and opportunities for the transition of nurses new to rural healthcare. Participants believed mentorships facilitated this transition and were vital to the personal and professional success of new employees. Specifically, their insights indicated that this transition was influenced by three factors: rural community influences, organizational influences, and mentorship program influences. Facilitators for mentorships hinged on the close working relationships that facilitated the development of trust. Barriers to mentorship included low staff numbers, limited selection of volunteer mentors, and lack of mentorship

  17. Design requirements for ubiquitous computing environments for healthcare professionals. (United States)

    Bång, Magnus; Larsson, Anders; Eriksson, Henrik


    Ubiquitous computing environments can support clinical administrative routines in new ways. The aim of such computing approaches is to enhance routine physical work, thus it is important to identify specific design requirements. We studied healthcare professionals in an emergency room and developed the computer-augmented environment NOSTOS to support teamwork in that setting. NOSTOS uses digital pens and paper-based media as the primary input interface for data capture and as a means of controlling the system. NOSTOS also includes a digital desk, walk-up displays, and sensor technology that allow the system to track documents and activities in the workplace. We propose a set of requirements and discuss the value of tangible user interfaces for healthcare personnel. Our results suggest that the key requirements are flexibility in terms of system usage and seamless integration between digital and physical components. We also discuss how ubiquitous computing approaches like NOSTOS can be beneficial in the medical workplace.

  18. Leading change in health-care quality with the Institute for Healthcare Improvement Open School. (United States)

    Patel, Eva; Nutt, Sarah L; Qureshi, Imran; Lister, Sue; Panesar, Sukhmeet S; Carson-Stevens, Andrew


    The Institute for Healthcare Improvement Open School for Health Professions is an international organization that provides the next generation of health-care leaders with the skills to lead improvement in health care. This article discusses how doctors can get involved and implement change at their hospital.

  19. Evolution in changing environments

    NARCIS (Netherlands)

    Gorter, Florien A.


    Directional environmental change in the form of global climate change and human-induced pollution is one of the most pressing problems facing society today. While species can sometimes adapt to such change by means of phenotypic plasticity and range shifts, there is considerable concern that

  20. Decision making in high-velocity environments: implications for healthcare. (United States)

    Stepanovich, P L; Uhrig, J D


    Healthcare can be considered a high-velocity environment and, as such, can benefit from research conducted in other industries regarding strategic decision making. Strategic planning is not only relevant to firms in high-velocity environments, but is also important for high performance and survival. Specifically, decision-making speed seems to be instrumental in differentiating between high and low performers; fast decision makers outperform slow decision makers. This article outlines the differences between fast and slow decision makers, identifies five paralyses that can slow decision making in healthcare, and outlines the role of a planning department in circumventing these paralyses. Executives can use the proposed planning structure to improve both the speed and quality of strategic decisions. The structure uses planning facilitators to avoid the following five paralyses: 1. Analysis. Decision makers can no longer afford the luxury of lengthy, detailed analysis but must develop real-time systems that provide appropriate, timely information. 2. Alternatives. Many alternatives (beyond the traditional two or three) need to be considered and the alternatives must be evaluated simultaneously. 3. Group Think. Decision makers must avoid limited mind-sets and autocratic leadership styles by seeking out independent, knowledgeable counselors. 4. Process. Decision makers need to resolve conflicts through "consensus with qualification," as opposed to waiting for everyone to come on board. 5. Separation. Successful implementation requires a structured process that cuts across disciplines and levels.

  1. Applications of electron beam technology for healthcare and environment

    International Nuclear Information System (INIS)

    Varshney, Lalit


    Radiation technology has matured from lab scale to industrial scale in many areas of interests to industry, healthcare, agriculture and environment. Some of the well established applications include radiation sterilization, wires and cable, composites for automobiles, radiation surface curing, nanomaterials, hydrogels and special materials for nuclear and aerospace industry, radiation treatment of effluents, sewage sludge etc. These applications are as a result of characteristics of high energy radiation like gamma and electron beams which are able to deliver energy directly at molecular level. Unlike nuclear based radiations, electron beam accelerator technology is amenable to easy acceptance by public as well has capability to manipulate processes and product treatment to produce varieties of advanced/smart materials for healthcare and environment. Faster dose rates and depth profiling are the important characteristics of electron beam technology which gives it an edge over gamma radiation processing. Department of Atomic Energy has an ambitious program to indigenously develop accelerator technology and utilize them for national progress. In the presentation some important applications of radiation technology will be discussed. (author)

  2. Physician-Pharmacist collaboration in a pay for performance healthcare environment. (United States)

    Farley, T M; Izakovic, M


    Healthcare is becoming more complex and costly in both European (Slovak) and American models. Healthcare in the United States (U.S.) is undergoing a particularly dramatic change. Physician and hospital reimbursement are becoming less procedure focused and increasingly outcome focused. Efforts at Mercy Hospital have shown promise in terms of collaborative team based care improving performance on glucose control outcome metrics, linked to reimbursement. Our performance on the Centers for Medicare and Medicaid Services (CMS) post-operative glucose control metric for cardiac surgery patients increased from a 63.6% pass rate to a 95.1% pass rate after implementing interventions involving physician-pharmacist team based care.Having a multidisciplinary team that is able to adapt quickly to changing expectations in the healthcare environment has aided our institution. As healthcare becomes increasingly saturated with technology, data and quality metrics, collaborative efforts resulting in increased quality and physician efficiency are desirable. Multidisciplinary collaboration (including physician-pharmacist collaboration) appears to be a viable route to improved performance in an outcome based healthcare system (Fig. 2, Ref. 12).

  3. Changing MFTF vacuum environment

    International Nuclear Information System (INIS)

    Margolies, D.; Valby, L.


    The Mirror Fusion Test Facility (MFTF) vacuum vessel will be about 60m long and 10m in diameter at the widest point. The allowable operating densities range from 2 x 10 9 to 5 x 10 10 particles per cc. The maximum leak rate of 10 - 6 tl/sec is dominated during operation by the deliberately injected cold gas of 250 tl/sec. This gas is pumped by over 1000 square meters of cryopanels, external sorption pumps and getters. The design and requirements have changed radically over the past several years, and they are still not in final form. The vacuum system design has also changed, but more slowly and less radically. This paper discusses the engineering effort necessary to meet these stringent and changing requirements. Much of the analysis of the internal systems has been carried out using a 3-D Monte Carlo computer code, which can estimate time dependent operational pressures. This code and its use will also be described

  4. Changing MFTF vacuum environment

    International Nuclear Information System (INIS)

    Margolies, D.; Valby, L.


    The Mirror Fusion Test Facility (MFTF) vaccum vessel will be about 60m long and 10m in diameter at the widest point. The allowable operating densities range from 2 x 10 9 to 5 x 10 10 particles per cc. The maximum leak rate of 10 -6 tl/sec is dominated during operation by the deliberately injected cold gas of 250 tl/sec. This gas is pumped by over 1000 square meters of cryopanels, external sorbtion pumps and getters. The design and requirements have changed radically over the past several years, and they are still not in final form. The vacuum system design has also changed, but more slowly and less radically. This paper discusses the engineering effort necessary to meet these stringent and changing requirements. Much of the analysis of the internal systems has been carried out using a 3-D Monte Carlo computer code, which can estimate time dependent operational pressures. This code and its use will also be described

  5. Message generation facilities for interoperability in pervasive healthcare environments

    NARCIS (Netherlands)

    Cardoso de Moraes, J.L.; Lopes de Souza, Wanderley; Ferreira Pires, Luis; do Prado, Antonio Francisco

    Novel information and communication technologies enable the construction of systems that allow the provision of new healthcare services anywhere, at any time, and to anyone. Since these healthcare systems may offer their healthcare records in different electronic formats, the openEHR foundation

  6. Islam and the healthcare environment: designing patient rooms. (United States)

    Kopec, D A K; Han, Li


    Islam and the Muslim population are often the source of much misunderstanding and media-influenced misconceptions. Muslim patients who enter the healthcare environment are often weak and likely to experience feelings of vulnerability. Because of the complex and interwoven nature of culture and religion in a person's identity, it is important to consider patient belief systems and values when designing a patient's immediate environment. Through an exploration of literature related to culture and diversity and the beliefs and value system of the Muslim population, the authors were able to identify flexible design initiatives that could accommodate an array of cultural and spiritual practices. Islam and the Muslim population were chosen as the points of reference for this study because of the strong influence of the religion on the culture, and because of the many nuances that differ from the dominant culture within the United States. From these points of reference, a hypothetical design was developed for a patient room that considers differing notions of privacy, alternatives for cultural and religious practices, and ways to include symbolic meaning derived from attributes such as color.

  7. Climate change, environment and development


    Okereke, Chukwumerije; Massaquoi, Abu-Bakar S.


    Climate change, a quintessential environmental problem, is generally recognised as the most important development challenge in the 21st century (IPCC, 2014). In addition to acknowledging its many significant direct consequences, climate change is increasingly used to frame discussions on other important global challenges, such as health, energy and food security. This chapter provides understanding of the intricate and complex relationship between climate change, environment and development.

  8. Transformational change in healthcare: an examination of four case studies. (United States)

    Charlesworth, Kate; Jamieson, Maggie; Davey, Rachel; Butler, Colin D


    Objectives Healthcare leaders around the world are calling for radical, transformational change of our health and care systems. This will be a difficult and complex task. In this article, we examine case studies in which transformational change has been achieved, and seek to learn from these experiences. Methods We used the case study method to investigate examples of transformational change in healthcare. The case studies were identified from preliminary doctoral research into the transition towards future sustainable health and social care systems. Evidence was collected from multiple sources, key features of each case study were displayed in a matrix and thematic analysis was conducted. The results are presented in narrative form. Results Four case studies were selected: two from the US, one from Australia and one from the UK. The notable features are discussed for each case study. There were many common factors: a well communicated vision, innovative redesign, extensive consultation and engagement with staff and patients, performance management, automated information management and high-quality leadership. Conclusions Although there were some notable differences between the case studies, overall the characteristics of success were similar and collectively provide a blueprint for transformational change in healthcare. What is known about the topic? Healthcare leaders around the world are calling for radical redesign of our systems in order to meet the challenges of modern society. What does this paper add? There are some remarkable examples of transformational change in healthcare. The key factors in success are similar across the case studies. What are the implications for practitioners? Collectively, these key factors can guide future attempts at transformational change in healthcare.

  9. Design Quality in the Context of Healthcare Environments: A Scoping Review. (United States)

    Anåker, Anna; Heylighen, Ann; Nordin, Susanna; Elf, Marie


    We explored the concept of design quality in relation to healthcare environments. In addition, we present a taxonomy that illustrates the wide range of terms used in connection with design quality in healthcare. High-quality physical environments can promote health and well-being. Developments in healthcare technology and methodology put high demands on the design quality of care environments, coupled with increasing expectations and demands from patients and staff that care environments be person centered, welcoming, and accessible while also supporting privacy and security. In addition, there are demands that decisions about the design of healthcare architecture be based on the best available information from credible research and the evaluation of existing building projects. The basic principles of Arksey and O'Malley's model of scoping review design were used. Data were derived from literature searches in scientific databases. A total of 18 articles and books were found that referred to design quality in a healthcare context. Design quality of physical healthcare environments involves three different themes: (i) environmental sustainability and ecological values, (ii) social and cultural interactions and values, and (iii) resilience of the engineering and building construction. Design quality was clarified herein with a definition. Awareness of what is considered design quality in relation to healthcare architecture could help to design healthcare environments based on evidence. To operationalize the concept, its definition must be clear and explicit and able to meet the complex needs of the stakeholders in a healthcare context, including patients, staff, and significant others.

  10. Processes of change used by healthcare workers to participate in ...

    African Journals Online (AJOL)

    The aim of this study was to identify processes of change that healthcare workers (HCWs) use to progress from one stage of physical activity (PA) to another. This was a retrospective quantitative descriptive design involving 163 HCWs who were previously exposed to different education and motivation to exercise for a ...

  11. Physicians with MBA degrees: change agents for healthcare improvement. (United States)

    Lazarus, Arthur


    Increasingly, physicians gravitating toward the fields of quality improvement and healthcare management are seeking MBA degrees to supplement their medical training. Approximately half of all U.S. medical schools offer combined MD-MBA degrees, and numerous executive MBA programs exist for physicians in practice. Physicians who enter management are considered change agents for healthcare improvement, yet they receive little support and encouragement from their medical teachers and practicing colleagues. This situation can be rectified by placing greater value on the role of business-trained physicians and subsidizing their tuition for business school.

  12. A novel approach to developing applications in the pervasive healthcare environment through the use of archetypes

    NARCIS (Netherlands)

    Cardoso de Moraes, J.L.; Lopes de Souza, Wanderley; Ferreira Pires, Luis; Tricai Cavalini, Luciana; do Prado, Antonio Francisco; Murgante, B.; Misra, S.; Carlini, M.; Torre, C.M.; Nguyen, H.Q.; Taniar, D.; Apduhan, B.O.; Gervasi, O.

    Pervasive Healthcare focuses on the use of new technologies, tools, and services, to help patients to play a more active role in the treatment of their conditions. Pervasive Healthcare environments demand a huge amount of information exchange, and specific technologies has been proposed to provide

  13. Healthcare (United States)

    Carnevale, Anthony P.; Smith, Nicole; Gulish, Artem; Beach, Bennett H.


    This report, provides detailed analyses and projections of occupations in healthcare fields, and wages earned. In addition, the important skills and work values associated with workers in those fields of healthcare are discussed. Finally, the authors analyze the implications of research findings for the racial, ethnic, and class diversity of the…

  14. Health behavior change in hearing healthcare: a discussion paper

    Directory of Open Access Journals (Sweden)

    Vinaya K. C. Manchaiah


    Full Text Available Health behavior change (HBC refers to facilitating changes to habits and/or behavior related to health. In healthcare practice, it is quite common that the interactions between practitioner and patient involve conversations related to HBC. This could be mainly in relation to the practitioner trying to directly persuade the patients to make some changes in their health behavior. However, the patients may not be motivated to do so as they do not see this change as important. For this reason, direct persuasion may result in a breakdown of communication. In such instances, alternative approaches and means of indirect persuasion, such as empowering the patient and their family members, could be helpful. Furthermore, there are several models and/or theories proposed which explain the health behavior and also provide a structured framework for health behavior change. Many such models/approaches have been proven effective in facilitating HBC and health promotion in areas such as cessation of smoking, weight loss and so on. This paper provides an overview of main models/theories related to HBC and some insights into how these models/approaches could be adapted to facilitate behavior change in hearing healthcare, mainly in relation to: i hearing help-seeking and hearing-aid uptake; and ii hearing conservation in relation to music-induced hearing loss (MIHL. In addition, elements of current research related to this area and future directions are highlighted.

  15. Model of care for a changing healthcare system: are there foundational pillars for design? (United States)

    Booker, Catriona; Turbutt, Adam; Fox, Robyn


    Currently, healthcare organisations are being challenged to provide optimal clinical services within budget limitations while simultaneously being confronted by aging consumers and labour and skill shortages. Within this dynamic and changing environment, the ability to remain responsive to patient needs while managing these issues poses further challenges. Development or review of the model of care (MOC) may provide a possible solution to support efficiencies in service provision. Although MOC are not readily understood or appreciated as an efficiency strategy, they can be more easily explained by considering several recurring pillars when developing or redesigning an MOC. Generic and recurring foundational pillars include integrated care models, team functioning and communication, leadership, change management and lean thinking. These foundational pillars should be incorporated into the development and application of MOC in order to achieve desired outcomes. However, sustainability requires continuous review to enable improvement and must be integrated into routine business. Moreover, successful review of MOC requires collaboration and commitment by all stakeholders. Leaders are critical to motivating clinicians and stakeholders in the review process. Further, it is imperative that leaders engage stakeholders to commit to support the agreed strategies designed to provide efficient and comprehensive healthcare services. Redesign of MOC can significantly improve patient care by applying the agreed strategies. In the current healthcare environment, these strategies can favourably affect healthcare expenditure and, at the same time, improve the quality of interprofessional health services.

  16. An intelligent tele-healthcare environment offering person-centric and wellness-maintenance services. (United States)

    Abidi, S S


    Worldwide healthcare delivery trends are undergoing a subtle paradigm shift--patient centered services as opposed to provider centered services and wellness maintenance as opposed to illness management. In this paper we present a Tele-Healthcare project TIDE--Tele-Healthcare Information and Diagnostic Environment. TIDE manifests an 'intelligent' healthcare environment that aims to ensure lifelong coverage of person-specific health maintenance decision-support services--i.e., both wellness maintenance and illness management services--ubiquitously available via the Internet/WWW. Taking on an all-encompassing health maintenance role--spanning from wellness to illness issues--the functionality of TIDE involves the generation and delivery of (a) Personalized, Pro-active, Persistent, Perpetual, and Present wellness maintenance services, and (b) remote diagnostic services for managing noncritical illnesses. Technically, TIDE is an amalgamation of diverse computer technologies--Artificial Intelligence, Internet, Multimedia, Databases, and Medical Informatics--to implement a sophisticated healthcare delivery infostructure.

  17. Healthcare students' evaluation of the clinical learning environment and supervision - a cross-sectional study. (United States)

    Pitkänen, Salla; Kääriäinen, Maria; Oikarainen, Ashlee; Tuomikoski, Anna-Maria; Elo, Satu; Ruotsalainen, Heidi; Saarikoski, Mikko; Kärsämänoja, Taina; Mikkonen, Kristina


    The purpose of clinical placements and supervision is to promote the development of healthcare students´ professional skills. High-quality clinical learning environments and supervision were shown to have significant influence on healthcare students´ professional development. This study aimed to describe healthcare students` evaluation of the clinical learning environment and supervision, and to identify the factors that affect these. The study was performed as a cross-sectional study. The data (n = 1973) were gathered through an online survey using the Clinical Learning Environment, Supervision and Nurse Teacher scale during the academic year 2015-2016 from all healthcare students (N = 2500) who completed their clinical placement at a certain university hospital in Finland. The data were analysed using descriptive statistics and binary logistic regression analysis. More than half of the healthcare students had a named supervisor and supervision was completed as planned. The students evaluated the clinical learning environment and supervision as 'good'. The students´ readiness to recommend the unit to other students and the frequency of separate private unscheduled sessions with the supervisor were the main factors that affect healthcare students` evaluation of the clinical learning environment and supervision. Individualized and goal-oriented supervision in which the student had a named supervisor and where supervision was completed as planned in a positive environment that supported learning had a significant impact on student's learning. The clinical learning environment and supervision support the development of future healthcare professionals' clinical competence. The supervisory relationship was shown to have a significant effect on the outcomes of students' experiences. We recommend the planning of educational programmes for supervisors of healthcare students for the enhancement of supervisors' pedagogical competencies in supervising students in

  18. Does social marketing provide a framework for changing healthcare practice? (United States)

    Morris, Zoë Slote; Clarkson, Peter John


    We argue that social marketing can be used as a generic framework for analysing barriers to the take-up of clinical guidelines, and planning interventions which seek to enable this change. We reviewed the literature on take-up of clinical guidelines, in particular barriers and enablers to change; social marketing principles and social marketing applied to healthcare. We then applied the social marketing framework to analyse the literature and to consider implications for future guideline policy to assess its feasibility and accessibility. There is sizeable extant literature on healthcare practitioners' non-compliance with clinical guidelines. This is an international problem common to a number of settings. The reasons for poor levels of take up appear to be well understood, but not addressed adequately in practice. Applying a social marketing framework brings new insights to the problem." We show that a social marketing framework provides a useful solution-focused framework for systematically understanding barriers to individual behaviour change and designing interventions accordingly. Whether the social marketing framework provides an effective means of bringing about behaviour change remains an empirical question which has still to be tested in practice. The analysis presented here provides strong motivation to begin such testing.

  19. Exploring the Impact of Toxic Attitudes and a Toxic Environment on the Veterinary Healthcare Team. (United States)

    Moore, Irene C; Coe, Jason B; Adams, Cindy L; Conlon, Peter D; Sargeant, Jan M


    The objective of this qualitative study was to compare veterinarians' and Registered Veterinary Technicians' (RVT's) perceptions of the veterinary healthcare team with respect to the impact of toxic attitudes and a toxic environment. Focus group interviews using a semi-structured interview guide and follow up probes were held with four veterinarian groups (23 companion animal veterinarians) and four Registered Veterinary Technician groups (26 RVTs). Thematic analysis of the discussions indicated both veterinarian and RVT participants felt team members with manifestations of toxic attitudes negatively impacted veterinary team function. These manifestations included people being disrespectful, being resistant to change, always wanting to be the "go to person," avoiding conflict, and lacking motivation. When conflict was ignored, or when people with toxic attitudes were not addressed, a toxic environment often resulted. A toxic environment sometimes manifested when "broken communication and tension between staff members" occurred as a result of employees lacking confidence, skills, or knowledge not being managed properly. It also occurred when employees did not feel appreciated, when there was difficulty coping with turnover, and when there were conflicting demands. The presence of people manifesting a toxic attitude was a source of frustration for both veterinarian and RVT participants. Prompt and consistent attention to negative behaviors is recommended to reduce the development of a toxic environment.

  20. Strategy implementation and organizational change in healthcare organizations - a distributed change leadership perspective

    DEFF Research Database (Denmark)

    Holm, Anna B.; Ulhøi, John Parm

    This paper examines some theoretical underpinnings of distributed leadership and its ability to serve as change leadership during the process of major organizational changes in healthcare organizations. The study was initiated as part of a larger research project on distributed leadership (DL......) in the healthcare sector, financed by a research grant addressing both empirical and theoretical questions. The paper clarifies the relationship between distributed leadership and change leadership, and more specifically, the characteristics of distributed leadership in the change leadership process. We also...... propose a distributed change leadership (DCL) model that permits further development of research design and empirical studies of DCL. On a more general side, with this paper we shed more light on some aspects of leadership patterns in healthcare, where there is a distinct gap....

  1. Reforming primary healthcare: from public policy to organizational change. (United States)

    Gilbert, Frédéric; Denis, Jean-Louis; Lamothe, Lise; Beaulieu, Marie-Dominique; D'amour, Danielle; Goudreau, Johanne


    Governments everywhere are implementing reform to improve primary care. However, the existence of a high degree of professional autonomy makes large-scale change difficult to achieve. The purpose of this paper is to elucidate the change dynamics and the involvement of professionals in a primary healthcare reform initiative carried out in the Canadian province of Quebec. An empirical approach was used to investigate change processes from the inception of a public policy to the execution of changes in professional practices. The data were analysed from a multi-level, combined contextualist-processual perspective. Results are based on a longitudinal multiple-case study of five family medicine groups, which was informed by over 100 interviews, questionnaires, and documentary analysis. The results illustrate the multiple processes observed with the introduction of planned large-scale change in primary care services. The analysis of change content revealed that similar post-change states concealed variations between groups in the scale of their respective changes. The analysis also demonstrated more precisely how change evolved through the introduction of "intermediate change" and how cycles of prescribed and emergent mechanisms distinctively drove change process and change content, from the emergence of the public policy to the change in primary care service delivery. This research was conducted among a limited number of early policy adopters. However, given the international interest in turning to the medical profession to improve primary care, the results offer avenues for both policy development and implementation. The findings offer practical insights for those studying and managing large-scale transformations. They provide a better understanding of how deliberate reforms coexist with professional autonomy through an intertwining of change content and processes. This research is one of few studies to examine a primary care reform from emergence to implementation

  2. Cybersecurity and privacy issues for socially integrated mobile healthcare applications operating in a multi-cloud environment. (United States)

    Al-Muhtadi, Jalal; Shahzad, Basit; Saleem, Kashif; Jameel, Wasif; Orgun, Mehmet A


    Social media has enabled information-sharing across massively large networks of people without spending much financial resources and time that are otherwise required in the print and electronic media. Mobile-based social media applications have overwhelmingly changed the information-sharing perspective. However, with the advent of such applications at an unprecedented scale, the privacy of the information is compromised to a larger extent if breach mitigation is not adequate. Since healthcare applications are also being developed for mobile devices so that they also benefit from the power of social media, cybersecurity privacy concerns for such sensitive applications have become critical. This article discusses the architecture of a typical mobile healthcare application, in which customized privacy levels are defined for the individuals participating in the system. It then elaborates on how the communication across a social network in a multi-cloud environment can be made more secure and private, especially for healthcare applications.

  3. The Impact of Environmental Design on Doffing Personal Protective Equipment in a Healthcare Environment: A Formative Human Factors Trial. (United States)

    Herlihey, Tracey A; Gelmi, Stefano; Cafazzo, Joseph A; Hall, Trevor N T


    OBJECTIVE To explore the impact of environmental design on doffing personal protective equipment in a simulated healthcare environment. METHODS A mixed-methods approach was used that included human-factors usability testing and qualitative questionnaire responses. A patient room and connecting anteroom were constructed for testing purposes. This experimental doffing area was designed to overcome the environmental failures identified in a previous study and was not constructed based on any generalizable hospital standard. RESULTS In total, 72 healthcare workers from Ontario, Canada, took part in the study and tested the simulated doffing area. The following environmental design changes were tested and were deemed effective: increasing prominence of color-coded zones; securing disinfectant wipes and hand sanitizer; outlining disposal bins locations; providing mirrors to detect possible contamination; providing hand rails to assist with doffing; and restricting the space to doff. Further experimentation and iterative design are required with regard to several important features: positioning the disposal bins for safety, decreasing the risk of contamination and user accessibility; optimal positioning of mirrors for safety; communication within the team; and positioning the secondary team member for optimal awareness. Additional design suggestions also emerged during this study, and they require future investigation. CONCLUSIONS This study highlights the importance of the environment on doffing personal protective equipment in a healthcare setting. Iterative testing and modification of the design of the environment (doffing area) are important to enhancing healthcare worker safety. Infect Control Hosp Epidemiol 2017;38:712-717.

  4. Healthcare professional behaviour change using technological supports: A realist literature review


    Chris Keyworth; Jo Hart; Chris A. Armitage


    Background Changing healthcare professional behaviour is fundamental to effective patient management. Recent systematic reviews examining healthcare professional behaviour change interventions (such as audit and feedback) suggest that technological support is likely to be crucial in helping healthcare professionals to improve patient outcomes. However we know little about the effectiveness of technological support interventions, and whether the design of technological support interventions...

  5. The role of the surface environment in healthcare-associated infections. (United States)

    Weber, David J; Anderson, Deverick; Rutala, William A


    This article reviews the evidence demonstrating the importance of contamination of hospital surfaces in the transmission of healthcare-associated pathogens and interventions scientifically demonstrated to reduce the levels of microbial contamination and decrease healthcare-associated infections. The contaminated surface environment in hospitals plays an important role in the transmission of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), Clostridium difficile, Acinetobacter spp., and norovirus. Improved surface cleaning and disinfection can reduce transmission of these pathogens. 'No-touch' methods of room disinfection (i.e., devices which produce ultraviolet light or hydrogen peroxide) and 'self-disinfecting' surfaces (e.g., copper) also show promise to decrease contamination and reduce healthcare-associated infections. Hospital surfaces are frequently contaminated with important healthcare-associated pathogens. Contact with the contaminated environment by healthcare personnel is equally as likely as direct contact with a patient to lead to contamination of the healthcare provider's hands or gloves that may result in patient-to-patient transmission of nosocomial pathogens. Admission to a room previously occupied by a patient with MRSA, VRE, Acinetobacter, or C. difficile increases the risk for the subsequent patient admitted to the room to acquire the pathogen. Improved cleaning and disinfection of room surfaces decreases the risk of healthcare-associated infections.

  6. Perfect match? Generation Y as change agents for information communication technology implementation in healthcare. (United States)

    Yee, Kwang Chien; Miils, Erin; Airey, Caroline


    The current healthcare delivery model will not meet future healthcare demands. The only sustainable healthcare future is one that best leverages advances in technology to improve productivity and efficiency. Information communication technology (ICT) has, therefore, been touted as the panacea of future healthcare challenges. Many ICT projects in healthcare, however, fail to deliver on their promises to transform the healthcare system. From a technologist's perspective, this is often due to the lack of socio-technical consideration. From a socio-cultural perspective, however, there is often strong inertia to change. While the utilisation of user-centred design principles will generate a new wave of enthusiasm among technologists, this has to be matched with socio-cultural changes within the healthcare system. Generation Y healthcare workers might be the socio-cultural factor required, in combination with new technology, to transform the healthcare system. Generation Y has generated significant technology-driven changes in many other industries. The socio-cultural understanding of generation Y healthcare workers is essential to guide the design and implementation of ICT solutions for a sustainable healthcare future. This paper presents the initial analysis of our qualitative study which aims to generate in-depth conceptual insights of generation Y healthcare workers and their view of ICT in healthcare. Our results show that generation Y healthcare workers might assist future ICT implementation in healthcare. This paper, however, argues that significant changes to the current healthcare organisation will be required in order to unleash the full potential of generation Y workers and ICT implementation. Finally, this paper presents some strategies to empower generation Y workers as change agents for a sustainable future healthcare system.

  7. Mentor experiences of international healthcare students' learning in a clinical environment: A systematic review. (United States)

    Mikkonen, Kristina; Elo, Satu; Tuomikoski, Anna-Maria; Kääriäinen, Maria


    Globalisation has brought new possibilities for international growth in education and professional mobility among healthcare professionals. There has been a noticeable increase of international degree programmes in non-English speaking countries in Europe, creating clinical learning challenges for healthcare students. The aim of this systematic review was to describe mentors' experiences of international healthcare students' learning in a clinical environment. The objective of the review was to identify what influences the success or failure of mentoring international healthcare students when learning in the clinical environment, with the ultimate aim being to promote optimal mentoring practice. A systematic review was conducted according to the guidelines of the Centre for Reviews and Dissemination. Seven electronic databases were used to search for the published results of previous research: CINAHL, Medline Ovid, Scopus, the Web of Science, Academic Search Premiere, Eric, and the Cochrane Library. Search inclusion criteria were planned in the PICOS review format by including peer-reviewed articles published in any language between 2000 and 2014. Five peer-reviewed articles remained after the screening process. The results of the original studies were analysed using a thematic synthesis. The results indicate that a positive intercultural mentor enhanced reciprocal learning by improving the experience of international healthcare students and reducing stress in the clinical environment. Integrating international healthcare students into work with domestic students was seen to be important for reciprocal learning and the avoidance of discrimination. Many healthcare students were found to share similar experiences of mentoring and learning irrespective of their cultural background. However, the role of a positive intercultural mentor was found to make a significant difference for international students: such mentors advocated and mediated cultural differences and

  8. A secure RFID mutual authentication protocol for healthcare environments using elliptic curve cryptography. (United States)

    Jin, Chunhua; Xu, Chunxiang; Zhang, Xiaojun; Zhao, Jining


    Radio Frequency Identification(RFID) is an automatic identification technology, which can be widely used in healthcare environments to locate and track staff, equipment and patients. However, potential security and privacy problems in RFID system remain a challenge. In this paper, we design a mutual authentication protocol for RFID based on elliptic curve cryptography(ECC). We use pre-computing method within tag's communication, so that our protocol can get better efficiency. In terms of security, our protocol can achieve confidentiality, unforgeability, mutual authentication, tag's anonymity, availability and forward security. Our protocol also can overcome the weakness in the existing protocols. Therefore, our protocol is suitable for healthcare environments.

  9. The effectiveness of strategies to change organisational culture to improve healthcare performance: a systematic review. (United States)

    Parmelli, Elena; Flodgren, Gerd; Beyer, Fiona; Baillie, Nick; Schaafsma, Mary Ellen; Eccles, Martin P


    Organisational culture is an anthropological metaphor used to inform research and consultancy and to explain organisational environments. In recent years, increasing emphasis has been placed on the need to change organisational culture in order to improve healthcare performance. However, the precise function of organisational culture in healthcare policy often remains underspecified and the desirability and feasibility of strategies to be adopted have been called into question. The objective of this review was to determine the effectiveness of strategies to change organisational culture in order to improve healthcare performance. We searched the following electronic databases: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, Sociological Abstracts, Web of Knowledge, PsycINFO, Business and Management, EThOS, Index to Theses, Intute, HMIC, SIGLE, and Scopus until October 2009. The Database of Abstracts of Reviews of Effectiveness (DARE) was searched for related reviews. We also searched the reference lists of all papers and relevant reviews identified, and we contacted experts in the field for advice on further potential studies. We considered randomised controlled trials (RCTs) or well designed quasi-experimental studies (controlled clinical trials (CCTs), controlled before and after studies (CBAs), and interrupted time series (ITS) analyses). Studies could be set in any type of healthcare organisation in which strategies to change organisational culture in order to improve healthcare performance were applied. Our main outcomes were objective measures of professional performance and patient outcome. The search strategy yielded 4,239 records. After the full text assessment, two CBA studies were included in the review. They both assessed the impact of interventions aimed at changing organisational culture, but one evaluated the impact on work-related and personal outcomes while the other measured clinical outcomes. Both were at high risk of

  10. The effectiveness of strategies to change organisational culture to improve healthcare performance. (United States)

    Parmelli, Elena; Flodgren, Gerd; Schaafsma, Mary Ellen; Baillie, Nick; Beyer, Fiona R; Eccles, Martin P


    Organisational culture is an anthropological metaphor used to inform research and consultancy and to explain organisational environments. Great emphasis has been placed during the last years on the need to change organisational culture in order to pursue effective improvement of healthcare performance. However, the precise nature of organisational culture in healthcare policy often remains underspecified and the desirability and feasibility of strategies to be adopted has been called into question. To determine the effectiveness of strategies to change organisational culture in order to improve healthcare performance.To examine the effectiveness of these strategies according to different patterns of organisational culture. We searched the following electronic databases for primary studies: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, Sociological Abstracts, Web of Knowledge, PsycINFO, Business and Management, EThOS, Index to Theses, Intute, HMIC, SIGLE, and Scopus until October 2009. The Database of Abstracts of Reviews of Effectiveness (DARE) was searched for related reviews. We also searched the reference lists of all papers and relevant reviews identified, and we contacted experts in the field for advice on further potential studies. We considered randomised controlled trials (RCTs) or well designed quasi-experimental studies, controlled clinical trials (CCTs), controlled before and after studies (CBAs) and interrupted time series analyses (ITS) meeting the quality criteria used by the Cochrane Effective Practice and Organisation of Care Group (EPOC). Studies should be set in any type of healthcare organisation in which strategies to change organisational culture in order to improve healthcare performance were applied. Our main outcomes were objective measures of professional performance and patient outcome. At least two review authors independently applied the criteria for inclusion and exclusion criteria to scan titles and

  11. Designing healthcare information technology to catalyse change in clinical care

    Directory of Open Access Journals (Sweden)

    William Lester


    Full Text Available The gap between best practice and actual patient care continues to be a pervasive problem in our healthcare system. Efforts to improve on this knowledge_performance gap have included computerised disease management programs designed to improve guideline adherence. However, current computerised reminder and decision support interventions directed at changing physician behaviour have had only a limited and variable effect on clinical outcomes. Further, immediate pay-for-performance financial pressures on institutions have created an environmentwhere disease management systems are often created under duress, appended to existing clinical systems and poorly integrated into the existing workflow, potentially limiting their realworld effectiveness. The authors present a review of disease management as well as a conceptual framework to guide the development of more effective health information technology (HIT tools for translating clinical information into clinical action.

  12. Climate change consequences for the indoor environment

    NARCIS (Netherlands)

    Ariës, M.B.C.; Bluyssen, P.M.


    Scientists warn us about climate change and its effects on the outdoor environment. These effects can have significant consequences for the indoor environment, also in the Netherlands. Climate changes will affect different aspects of the indoor environment as well as the stakeholders of that indoor

  13. Changing the game; some thoughts on future healthcare demands, technology, nursing and interprofessional education. (United States)

    Garrett, Bernard M


    This editorial discusses the conclusions of a number of high-profile reports on the future of healthcare provision, and healthcare professional education. The need for the realignment of service provision, regulation, interdisciplinary healthcare and supporting education is discussed in the context of rapid technological and social change. Copyright © 2012 Elsevier Ltd. All rights reserved.

  14. Physical therapists' perception of workplace ethics in an evolving health-care delivery environment: a cross-sectional survey. (United States)

    Cantu, Roberto


    Physical therapists are trained and obligated to deliver optimal health care and put patients first above all else. In the changing health-care environment, health-care organizations are grappling with controlling cost and increasing revenues. Moral distress may be created when physical therapists' desire to provide optimal care conflicts with their organization's goals to remain financially viable or profitable. Moral distress has been associated with low perception of ethical environment, professional burnout, and high turnover in organizations. This study identified groups who may be vulnerable to low perception of organizational ethical environment and identified self-reported strategies to remedy these perceptions. An ethics environment questionnaire was mailed to a random sample of 1200 physical therapists in Georgia. Respondents (n = 340) were analyzed by age, workplace setting, and position in organization. Therapists working in skilled nursing/assisted living environments scored the lowest on the questionnaire and voiced concerns regarding their ethical work environments. Owners and executives perceived their organizations to be more ethical than front-line clinicians. Respondent concerns included high productivity standards, aggressive coding/billing policies, decreased reimbursement, and increased insurance regulation. Possible solutions included more frequent communication between management and clinicians about ethics, greater professional autonomy, and increased training in business ethics and finance.

  15. Implementing change: staff experiences of changes to prison mental healthcare in England and Wales. (United States)

    Caulfield, Laura S; Twort, Hannah


    Stemming from substantial criticism during the late twentieth and early twenty-first century, the UK government and HM Prison Service developed a number of policies and protocols aimed at improving the state of prison mental healthcare. While it is difficult to fault the purpose of the government's intentions, criticism has continued relating to problems with the implementation of government led change within the prison system. Existing research leads people to question whether policies are being implemented as intended; and if not, why not? The only clear way to answer these questions is to ask those involved in the actual implementation of these recommendations within the prison service. This paper aims to answer these questions. This paper documents findings from a national survey of senior mental healthcare staff working in prisons in England and Wales. Staff were surveyed about their views on the implementation of recommendations from recent key government documents, their perceptions of prison mental healthcare versus community mental healthcare, and their views on the relationship between HM Prison Service and the National Health Service. While many staff report improvements in prison mental healthcare, many have struggled with the implementation of new ways of working and the findings here suggest there is still some way to go towards providing offenders in prison with effective and appropriate care. Where effective ways of implementing change were identified, these are discussed. Listening to the experiences of the staff involved in prison healthcare has helped identify where implementation of changes could be improved and thus highlights where support might best be targeted in future.

  16. Old Theories versus Changing Environment, (United States)


    necessary. According to Herzberg, the classical approach to motivating personnel has con - ? cermed itself with the employee’s environment or the...factors will keep him from complaining; however, they will not make him work harder or more effec- tively. It’s sort of the "gold-plated sweatshop

  17. E-commerce in healthcare: changing the traditional landscape. (United States)

    Aggarwal, A K; Travers, S


    The healthcare industry, with more than one trillion dollars in revenue, accounts for about one-seventh of the U.S. economy. A significant portion of this revenue is lost to escalating healthcare system costs. This article examines the shortcomings of the traditional healthcare delivery system in terms of information flow, communication standards, case collections, and IT spending. It makes the case that e-commerce has the ability to transact some healthcare business more efficiently and cost-effectively. With the Internet as a delivery platform, several models offer improvement over the status quo.

  18. Links among high-performance work environment, service quality, and customer satisfaction: an extension to the healthcare sector. (United States)

    Scotti, Dennis J; Harmon, Joel; Behson, Scott J


    Healthcare managers must deliver high-quality patient services that generate highly satisfied and loyal customers. In this article, we examine how a high-involvement approach to the work environment of healthcare employees may lead to exceptional service quality, satisfied patients, and ultimately to loyal customers. Specifically, we investigate the chain of events through which high-performance work systems (HPWS) and customer orientation influence employee and customer perceptions of service quality and patient satisfaction in a national sample of 113 Veterans Health Administration ambulatory care centers. We present a conceptual model for linking work environment to customer satisfaction and test this model using structural equations modeling. The results suggest that (1) HPWS is linked to employee perceptions of their ability to deliver high-quality customer service, both directly and through their perceptions of customer orientation; (2) employee perceptions of customer service are linked to customer perceptions of high-quality service; and (3) perceived service quality is linked with customer satisfaction. Theoretical and practical implications of our findings, including suggestions of how healthcare managers can implement changes to their work environments, are discussed.

  19. Agent-Oriented Privacy-Based Information Brokering Architecture for Healthcare Environments

    Directory of Open Access Journals (Sweden)

    Abdulmutalib Masaud-Wahaishi


    Full Text Available Healthcare industry is facing a major reform at all levels—locally, regionally, nationally, and internationally. Healthcare services and systems become very complex and comprise of a vast number of components (software systems, doctors, patients, etc. that are characterized by shared, distributed and heterogeneous information sources with varieties of clinical and other settings. The challenge now faced with decision making, and management of care is to operate effectively in order to meet the information needs of healthcare personnel. Currently, researchers, developers, and systems engineers are working toward achieving better efficiency and quality of service in various sectors of healthcare, such as hospital management, patient care, and treatment. This paper presents a novel information brokering architecture that supports privacy-based information gathering in healthcare. Architecturally, the brokering is viewed as a layer of services where a brokering service is modeled as an agent with a specific architecture and interaction protocol that are appropriate to serve various requests. Within the context of brokering, we model privacy in terms of the entities ability to hide or reveal information related to its identities, requests, and/or capabilities. A prototype of the proposed architecture has been implemented to support information-gathering capabilities in healthcare environments using FIPA-complaint platform JADE.

  20. Agent-oriented privacy-based information brokering architecture for healthcare environments. (United States)

    Masaud-Wahaishi, Abdulmutalib; Ghenniwa, Hamada


    Healthcare industry is facing a major reform at all levels-locally, regionally, nationally, and internationally. Healthcare services and systems become very complex and comprise of a vast number of components (software systems, doctors, patients, etc.) that are characterized by shared, distributed and heterogeneous information sources with varieties of clinical and other settings. The challenge now faced with decision making, and management of care is to operate effectively in order to meet the information needs of healthcare personnel. Currently, researchers, developers, and systems engineers are working toward achieving better efficiency and quality of service in various sectors of healthcare, such as hospital management, patient care, and treatment. This paper presents a novel information brokering architecture that supports privacy-based information gathering in healthcare. Architecturally, the brokering is viewed as a layer of services where a brokering service is modeled as an agent with a specific architecture and interaction protocol that are appropriate to serve various requests. Within the context of brokering, we model privacy in terms of the entities ability to hide or reveal information related to its identities, requests, and/or capabilities. A prototype of the proposed architecture has been implemented to support information-gathering capabilities in healthcare environments using FIPA-complaint platform JADE.

  1. Changing international environments, business environments and energy environments

    Energy Technology Data Exchange (ETDEWEB)

    Kubo, Shunsuke


    Japan has grown up to an economic superpower with more than 10% of the world GNP. This means that Japan should bear a role to be a member to explore and contribute to the world of the future. In order to attain this, it is necessary to examine how the enterprises which are promoting and leading the Japanese economy are changing. It is also important to consider what Japan can contribute to the world, on the basis of the past experience as a minor power in the natural resources and the energy. (4 figs, 1 tab)

  2. Robots, multi-user virtual environments and healthcare: synergies for future directions. (United States)

    Moon, Ajung; Grajales, Francisco J; Van der Loos, H F Machiel


    The adoption of technology in healthcare over the last twenty years has steadily increased, particularly as it relates to medical robotics and Multi-User Virtual Environments (MUVEs) such as Second Life. Both disciplines have been shown to improve the quality of care and have evolved, for the most part, in isolation from each other. In this paper, we present four synergies between medical robotics and MUVEs that have the potential to decrease resource utilization and improve the quality of healthcare delivery. We conclude with some foreseeable barriers and future research directions for researchers in these fields.

  3. A Benchmarking Analysis of Open-Source Business Intelligence Tools in Healthcare Environments

    Directory of Open Access Journals (Sweden)

    Andreia Brandão


    Full Text Available In recent years, a wide range of Business Intelligence (BI technologies have been applied to different areas in order to support the decision-making process. BI enables the extraction of knowledge from the data stored. The healthcare industry is no exception, and so BI applications have been under investigation across multiple units of different institutions. Thus, in this article, we intend to analyze some open-source/free BI tools on the market and their applicability in the clinical sphere, taking into consideration the general characteristics of the clinical environment. For this purpose, six BI tools were selected, analyzed, and tested in a practical environment. Then, a comparison metric and a ranking were defined for the tested applications in order to choose the one that best applies to the extraction of useful knowledge and clinical data in a healthcare environment. Finally, a pervasive BI platform was developed using a real case in order to prove the tool viability.

  4. Versatile, immersive, creative and dynamic virtual 3-D healthcare learning environments: a review of the literature. (United States)

    Hansen, Margaret M


    The author provides a critical overview of three-dimensional (3-D) virtual worlds and "serious gaming" that are currently being developed and used in healthcare professional education and medicine. The relevance of this e-learning innovation for teaching students and professionals is debatable and variables influencing adoption, such as increased knowledge, self-directed learning, and peer collaboration, by academics, healthcare professionals, and business executives are examined while looking at various Web 2.0/3.0 applications. There is a need for more empirical research in order to unearth the pedagogical outcomes and advantages associated with this e-learning technology. A brief description of Roger's Diffusion of Innovations Theory and Siemens' Connectivism Theory for today's learners is presented as potential underlying pedagogical tenets to support the use of virtual 3-D learning environments in higher education and healthcare.

  5. An international survey of cleaning and disinfection practices in the healthcare environment. (United States)

    Kenters, Nikki; Gottlieb, Thomas; Hopman, Joost; Mehtar, Shaheen; Schweizer, Marin L; Tartari, Ermira; Huijskens, E G W; Voss, Andreas


    Antimicrobial resistance has become an urgent global health priority. Basic hygiene practices and cleaning and disinfection of the hospital environment are key in preventing pathogen cross-transmission. To our knowledge no studies have assessed the worldwide differences in cleaning and disinfection practices in healthcare facilities. The electronic survey described here was developed in order to evaluate differences in healthcare facility cleaning practices around the world. The International Society of Antimicrobial Chemotherapy (ISAC, formerly ISC), Infection Prevention and Control work group developed a survey with 30 multiple-choice questions. The questions were designed to assess the current cleaning practices in healthcare settings around the world. A total of 110 healthcare professionals, representing 23 countries participated in the online survey. In 96% of the facilities a written cleaning policy was present. Training of cleaning staff occurred in 70% of the facilities at the start of employment. Cleaning practices and monitoring of these practices varied. In summary, the survey enabled assessment and recognition of widely differing global practices in approaches to environmental cleaning and disinfection. Development of guideline recommendations for cleaning and disinfection could improve practices and set minimum standards worldwide. Copyright © 2018 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  6. Lean healthcare from a change management perspective: the role of leadership and workforce flexibility

    NARCIS (Netherlands)

    van Rossum, L.; Aij, K.H.; Simons, F.; van der Eng, N.; ten Have, W.D.


    Purpose – Lean healthcare is used in a growing number of hospitals to increase efficiency and quality of care. However, healthcare organizations encounter problems with the implementation of change initiatives due to an implementation gap: the gap between strategy and execution. From a change

  7. Organizational Change and How It Affects Healthcare Employees: A Study on Employee Resistance to Change in Electronic Medical Record Implementation (United States)

    Adeyemi, Oluwakemi A.


    The purpose of the exploratory qualitative study was to explore the strategies for reducing employee resistance to Electronic Medical Record (EMR) technology changes in a healthcare organization during implementation. The study focused on EPIC as the EMR application. Ten healthcare participants who had experienced a change to EMR were selected in…

  8. Achieving and sustaining profound institutional change in healthcare: case study using neo-institutional theory. (United States)

    Macfarlane, Fraser; Barton-Sweeney, Cathy; Woodard, Fran; Greenhalgh, Trisha


    Change efforts in healthcare sometimes have an ambitious, whole-system remit and seek to achieve fundamental changes in norms and organisational culture rather than (or as well as) restructuring the service. Long-term evaluation of such initiatives is rarely undertaken. We report a secondary analysis of data from an evaluation of a profound institutional change effort in London, England, using a mixed-method longitudinal case study design. The service had received £15 million modernisation funding in 2004, covering multiple organisations and sectors and overseen by a bespoke management and governance infrastructure that was dismantled in 2008. In 2010-11, we gathered data (activity statistics, documents, interviews, questionnaires, site visits) and compared these with data from 2003 to 2008. Data analysis was informed by neo-institutional theory, which considers organisational change as resulting from the material-resource environment and three 'institutional pillars' (regulative, normative and cultural-cognitive), enacted and reproduced via the identities, values and activities of human actors. Explaining the long-term fortunes of the different components of the original programme and their continuing adaptation to a changing context required attention to all three of Scott's pillars and to the interplay between macro institutional structures and embedded human agency. The paper illustrates how neo-institutional theory (which is typically used by academics to theorise macro-level changes in institutional structures over time) can also be applied at a more meso level to inform an empirical analysis of how healthcare organisations achieve change and what helps or hinders efforts to sustain those changes. Copyright © 2013 Elsevier Ltd. All rights reserved.

  9. Changing business environment: implications for farming


    Malcolm, Bill


    The natural, technological, economic, political and social environment in which farmers farm constantly changes. History has lessons about change in agriculture and about farmers coping with change, though the future is unknowable and thus always surprising. The implication for farm operation is to prepare, do not predict.

  10. A secure RFID authentication protocol for healthcare environments using elliptic curve cryptosystem. (United States)

    Zhao, Zhenguo


    With the fast advancement of the wireless communication technology and the widespread use of medical systems, the radio frequency identification (RFID) technology has been widely used in healthcare environments. As the first important protocol for ensuring secure communication in healthcare environment, the RFID authentication protocols derive more and more attentions. Most of RFID authentication protocols are based on hash function or symmetric cryptography. To get more security properties, elliptic curve cryptosystem (ECC) has been used in the design of RFID authentication protocol. Recently, Liao and Hsiao proposed a new RFID authentication protocol using ECC and claimed their protocol could withstand various attacks. In this paper, we will show that their protocol suffers from the key compromise problem, i.e. an adversary could get the private key stored in the tag. To enhance the security, we propose a new RFID authentication protocol using ECC. Detailed analysis shows the proposed protocol not only could overcome weaknesses in Liao and Hsiao's protocol but also has the same performance. Therefore, it is more suitable for healthcare environments.

  11. An integrated healthcare system for personalized chronic disease care in home-hospital environments. (United States)

    Jeong, Sangjin; Youn, Chan-Hyun; Shim, Eun Bo; Kim, Moonjung; Cho, Young Min; Peng, Limei


    Facing the increasing demands and challenges in the area of chronic disease care, various studies on the healthcare system which can, whenever and wherever, extract and process patient data have been conducted. Chronic diseases are the long-term diseases and require the processes of the real-time monitoring, multidimensional quantitative analysis, and the classification of patients' diagnostic information. A healthcare system for chronic diseases is characterized as an at-hospital and at-home service according to a targeted environment. Both services basically aim to provide patients with accurate diagnoses of disease by monitoring a variety of physical states with a number of monitoring methods, but there are differences between home and hospital environments, and the different characteristics should be considered in order to provide more accurate diagnoses for patients, especially, patients having chronic diseases. In this paper, we propose a patient status classification method for effectively identifying and classifying chronic diseases and show the validity of the proposed method. Furthermore, we present a new healthcare system architecture that integrates the at-home and at-hospital environment and discuss the applicability of the architecture using practical target services.

  12. Patient-centred improvements in health-care built environments: perspectives and design indicators. (United States)

    Douglas, Calbert H; Douglas, Mary R


    To explore patients' perceptions of health-care built environments, to assess how they perceived health-care built facilities and designs. To develop a set of patient-centred indicators by which to appraise future health-care designs. Qualitative and quantitative methodologies, including futures group conferencing, autophotographic study, novice-expert exchanges and a questionnaire survey of a representative sample of past patients. The research was carried out at Salford Royal Hospitals NHS Trust (SRHT), Greater Manchester, UK, selected for the study because of planned comprehensive redevelopment based on the new NHS vision for hospital care and service delivery for the 21st century. Participants included 35 patients who took part in an autophotographic study, eight focus groups engaged in futures conferencing, a sample of past inpatients from the previous 12 months that returned 785 completed postal questionnaires. The futures group provided suggestions for radical improvements which were categorized into transport issues; accessibility and mobility; ground and landscape designs; social and public spaces; homeliness and assurance; cultural diversity; safety and security; personal space and access to outside. Patients' autophotographic study centred on: the quality of the ward design, human interactions, the state and quality of personal space, and facilities for recreation and leisure. The novices' suggestions were organized into categories of elemental factors representing patient-friendly designs. Experts from the architectural and surveying professions and staff at SRHT in turn considered these categories and respective subsets of factors. They agreed with the novices in terms of the headings but differed in prioritizing the elemental factors. The questionnaire survey of past patients provided opinions about ward designs that varied according to where they stayed, single room, bay ward or long open ward. The main concerns were limitation of private space

  13. Implications of climate change (global warming) for the healthcare system. (United States)

    Raffa, R B; Eltoukhy, N S; Raffa, K F


    Temperature-sensitive pathogenic species and their vectors and hosts are emerging in previously colder regions as a consequence of several factors, including global warming. As a result, an increasing number of people will be exposed to pathogens against which they have not previously needed defences. We illustrate this with a specific example of recent emergence of Cryptococcus gattii infections in more temperate climates. The outbreaks in more temperate climates of the highly virulent--but usually tropically restricted--C. gattii is illustrative of an anticipated growing challenge for the healthcare system. There is a need for preparedness by healthcare professionals in anticipation and for management of such outbreaks, including other infections whose recent increased prevalence in temperate climates can be at least partly associated with global warming. (Re)emergence of temperature-sensitive pathogenic species in more temperate climates will present new challenges for healthcare systems. Preparation for outbreaks should precede their occurrence. © 2012 Blackwell Publishing Ltd.

  14. Antarctic climate change and the environment (United States)


    This volume provides a comprehensive, up-to-date account of how the physical and biological : environment of the Antarctic continent and Southern Ocean has changed from Deep Time until : the present day. It also considers how the Antarctic environmen...

  15. Interoperability in healthcare: major challenges in the creation of the enterprise environment (United States)

    Lindsköld, L.; Wintell, M.; Lundberg, N.


    There is today a lack of interoperability in healthcare although the need for it is obvious. A new healthcare enterprise environment has been deployed for secure healthcare interoperability in the Western Region in Sweden (WRS). This paper is an empirical overview of the new enterprise environment supporting regional shared and transparent radiology domain information in the WRS. The enterprise environment compromises 17 radiology departments, 1,5 million inhabitants, using different RIS and PACS in a joint work-oriented network and additional cardiology, dentistry and clinical physiology departments. More than 160 terabytes of information are stored in the enterprise repository. Interoperability is developed according to the IHE mission, i.e. applying standards such as Digital Imaging and Communication in Medicine (DICOM) and Health Level 7 (HL7) to address specific clinical communication needs and support optimal patient care. The entire enterprise environment is implemented and used daily in WRS. The central prerequisites in the development of the enterprise environment in western region of Sweden were: 1) information harmonization, 2) reuse of standardized messages e.g. HL7 v2.x and v3.x, 3) development of a holistic information domain including both text and images, and 4) to create a continuous and dynamic update functionality. The central challenges in this project were: 1) the many different vendors acting in the region and the negotiations with them to apply communication roles/profiles such as HL7 (CDA, CCR), DICOM, and XML, 2) the question of whom owns the data, and 3) incomplete technical standards. This study concludes that to create a workflow that runs within an enterprise environment there are a number of central prerequisites and challenges that needs to be in place. This calls for negotiations on an international, national and regional level with standardization organizations, vendors, health management and health personnel.

  16. The challenges of leading change in health-care delivery from the front-line. (United States)

    Byers, Vivienne


    The public sector is facing turbulent times and this challenges nurses, who are expected to serve both patient interests and the efficiency drives of their organisations. In the context of implementing person-centred health policy, this paper explores the evolving role of front-line nurses as leaders and champions of change. Nurses can be seen to have some autonomy in health-care delivery. However, they are subject to systems of social control. In implementing person-centred policy, nurses can be seen to be doing the best they can within a constrained environment. A survey of nursing practice in person-centred health-policy implementation is presented. Despite much being written about managing health-professional resistance to policy implementation, there is a gap between what is being asked of nurses and the resources made available to them to deliver. In this milieu, nurses are utilising their discretion and leading from the front-line in championing change. Empowering nurses who seek to lead patient involvement could be the key to unlocking health-care improvement. Health services tend to be over-managed and under-led and there is a need to harness the potential of front-line nurses by facilitating leadership development through appropriate organisational support. © 2015 John Wiley & Sons Ltd.

  17. FASB (Financial Accounting Standards Board) proposal changes retiree healthcare benefit accounting. (United States)

    Grimaldi, P L; Bertko, J M


    The Financial Accounting Standards Board (FASB) recently issued an exposure draft (ED) of a standard that would change the way organizations account for their employees' post-retirement healthcare benefits. According to the ED, organizations would have to switch from cash accounting to accrual accounting for post-retirement benefits as well as record their retiree healthcare liabilities on their balance sheets by 1992.

  18. Competencies Required for Healthcare Information Technology to Be an Effective Strategic Business Change Partner (United States)

    Davalos, Eugenia


    One of the core strategies to transform the United States national healthcare system is the implementation of key technologies such as the electronic patient medical record. Such key technologies improve patient care and help the organization gain competitive advantage. With a high demand for strategic and operational change, healthcare providers…

  19. Climate Change: Science, Health and the Environment

    Centers for Disease Control (CDC) Podcasts

    Climate Change: Science, Health and the Environment Howard Frumkin, MD, DrPH, Director of CDC's National Center for Environmental Health/Agency for Toxic Substances and Disease Registry, discusses the science of climate change, the potential for shifts in the natural world to affect our wellbeing, and the challenges of emerging issues in environmental health.

  20. Distributed, signal strength-based indoor localization algorithm for use in healthcare environments. (United States)

    Wyffels, Jeroen; De Brabanter, Jos; Crombez, Pieter; Verhoeve, Piet; Nauwelaers, Bart; De Strycker, Lieven


    In current healthcare environments, a trend toward mobile and personalized interactions between people and nurse call systems is strongly noticeable. Therefore, it should be possible to locate patients at all times and in all places throughout the care facility. This paper aims at describing a method by which a mobile node can locate itself indoors, based on signal strength measurements and a minimal amount of yes/no decisions. The algorithm has been developed specifically for use in a healthcare environment. With extensive testing and statistical support, we prove that our algorithm can be used in a healthcare setting with an envisioned level of localization accuracy up to room revel (or region level in a corridor), while avoiding heavy investments since the hardware of an existing nurse call network can be reused. The approach opted for leads to very high scalability, since thousands of mobile nodes can locate themselves. Network timing issues and localization update delays are avoided, which ensures that a patient can receive the needed care in a time and resources efficient way.

  1. Programming secure mobile agents in healthcare environments using role-based permissions. (United States)

    Georgiadis, C K; Baltatzis, J; Pangalos, G I


    The healthcare environment consists of vast amounts of dynamic and unstructured information, distributed over a large number of information systems. Mobile agent technology is having an ever-growing impact on the delivery of medical information. It supports acquiring and manipulating information distributed in a large number of information systems. Moreover is suitable for the computer untrained medical stuff. But the introduction of mobile agents generates advanced threads to the sensitive healthcare information, unless the proper countermeasures are taken. By applying the role-based approach to the authorization problem, we ease the sharing of information between hospital information systems and we reduce the administering part. The different initiative of the agent's migration method, results in different methods of assigning roles to the agent.

  2. Healthcare in the UK: understanding continuity and change

    National Research Council Canada - National Science Library

    Greener, Ian


    ... of the 1960s The 1970s The 1980s The 1990s The 2000s Conclusion 39 39 39 50 57 58 60 63 66 71 four the double-bed Introduction The relationship between the state and the medical profession The deelopment of the double-bed relationship Deelopments in the 1950s The 1960s and the first organisational reform of the NHS 75 75 77 81 81 84 Healthcar...

  3. Work load and management in the delivery room: changing the direction of healthcare policy. (United States)

    Sfregola, Gianfranco; Laganà, Antonio Simone; Granese, Roberta; Sfregola, Pamela; Lopinto, Angela; Triolo, Onofrio


    Nurse staffing, increased workload and unstable nursing unit environments are linked to negative patient outcomes including falls and medication errors on medical/surgical units. Considering this evidence, the aim of our study was to overview midwives' workload and work setting. We created a questionnaire and performed an online survey. We obtained information about the type and level of hospital, workload, the use of standardised procedures, reporting of sentinel and 'near-miss' events. We reported a severe understaffing in midwives' work settings and important underuse of standard protocols according to the international guidelines, especially in the South of Italy. Based on our results, we strongly suggest a change of direction of healthcare policy, oriented to increase the number of employed midwives, in order to let them fulfil their duties according to the international guidelines (especially one-to-one care). On the other hand, we encourage the adoption of standardised protocols in each work setting.

  4. Frameworks for change in healthcare organisations: a formative evaluation of the NHS Change Model. (United States)

    Martin, Graham P; Sutton, Elizabeth; Willars, Janet; Dixon-Woods, Mary


    Organisational change in complex healthcare systems is a multifaceted process. The English National Health Service recently introduced a 'Change Model' that seeks to offer an evidence-based framework for guiding change. We report findings from a formative evaluation of the NHS Change Model and make recommendations for those developing the Model and its users. The evaluation involved 28 interviews with managers and clinicians making use of the Change Model in relation to a variety of projects. Interviews were fully transcribed and were analysed using an approach based on the Framework method. Participants saw the Change Model as valuable and practically useful. Fidelity to core principles of the Model was variable: participants often altered the Model, especially when using it to orchestrate the work of others. In challenging organisational contexts, the Change Model was sometimes used to delegitimise opposition rather than identify shared purpose among different interest groups. Those guiding change may benefit from frameworks, guidance and toolkits to structure and inform their planning and activities. Participants' experiences suggested the Change Model has much potential. Further work on its design and on supporting materials may optimise the approach, but its utility rests in particular on organisational cultures that support faithful application. © The Author(s) 2013 Reprints and permissions:]br]

  5. Success factors for strategic change initiatives: a qualitative study of healthcare administrators' perspectives. (United States)

    Kash, Bita Arbab; Spaulding, Aaron; Johnson, Christopher E; Gamm, Larry


    Success factors related to the implementation of change initiatives are well documented and discussed in the management literature, but they are seldom studied in healthcare organizations engaged in multiple strategic change initiatives. The purpose of this study was to identify key success factors related to implementation of change initiatives based on rich qualitative data gathered from health leader interviews at two large health systems implementing multiple change initiatives. In-depth personal interviews with 61 healthcare leaders in the two large systems were conducted and inductive qualitative analysis was employed to identify success factors associated with 13 change initiatives. Results from this analysis were compared to success factors identified in the literature, and generalizations were drawn that add significantly to the management literature, especially to that in the healthcare sector. Ten specific success factors were identified for the implementation of change initiatives. The top three success factors were (1) culture and values, (2) business processes, and (3) people and engagement. Two of the identified success factors are unique to the healthcare sector and not found in the literature on change models: service quality and client satisfaction (ranked fourth of 10) and access to information (ranked ninth). Results demonstrate the importance of human resource functions, alignment of culture and values with change, and business processes that facilitate effective communication and access to information to achieve many change initiatives. The responses also suggest opportunities for leaders of healthcare organizations to more formally recognize the degree to which various change initiatives are dependent on one another.

  6. Climate Change: Science, Health and the Environment

    Centers for Disease Control (CDC) Podcasts


    Climate Change: Science, Health and the Environment Howard Frumkin, MD, DrPH, Director of CDC's National Center for Environmental Health/Agency for Toxic Substances and Disease Registry, discusses the science of climate change, the potential for shifts in the natural world to affect our wellbeing, and the challenges of emerging issues in environmental health.  Created: 4/10/2007 by CDC National Center for Environmental Health.   Date Released: 4/13/2007.

  7. Patients’ experience of important factors in the healthcare environment in oncology care

    Directory of Open Access Journals (Sweden)

    Helle Wijk


    Full Text Available Background and objective. The aim of this study was to describe what factors of the healthcare environment are perceived as being important to patients in oncology care. Design. A qualitative design was adopted using focus group interviews. Setting and participants. The sample was 11 patients with different cancer diagnoses in an oncology ward at a university hospital in west Sweden. Results. Analysis of the patients’ perceptions of the environment indicated a complex entity comprising several aspects. These came together in a structure consisting of three main categories: safety, partnership with the staff, and physical space. The care environment is perceived as a complex entity, made up of several physical and psychosocial aspects, where the physical factors are subordinated by the psychosocial factors. It is clearly demonstrated that the patients’ primary desire was a psychosocial environment where they were seen as a unique person; the patients wanted opportunities for good encounters with staff, fellow patients, and family members, supported by a good physical environment; and the patients valued highly a place to withdraw and rest. Conclusions. This study presents those attributes that are valued by cancer patients as crucial and important for the support of their well-being and functioning. The results show that physical aspects were subordinate to psychosocial factors, which emerged strongly as being the most important in a caring environment.

  8. Organizational Adaptation: Managing in Complexly Changing Environments. (United States)

    Zammuto, Raymond F.

    A model of strategic adaptation that focuses on how organizations adapt to both conditions of growth and decline is presented. The theoretical structure underlying the model is considered, with attention to organizations, niches, and environments, as well as environmental change and evolving niches. The model attempts to reconcile the perspectives…

  9. Exploring the Healthcare Environment and Associations with Clinical Outcomes of People Living with HIV/AIDS. (United States)

    Hawk, Mary; Coulter, Robert W S; Egan, James E; Friedman, Mackey Reuel; Meanley, Steven; Fisk, Stuart; Watson, Courtney; Kinsky, Suzanne


    Despite three decades of dramatic treatment breakthroughs in antiretroviral regimens, clinical outcomes for people living with HIV vary greatly. The HIV treatment cascade models the stages of care that people living with HIV go through toward the goal of viral suppression and demonstrates that <30% of those living with HIV/AIDS in the United States have met this goal. Although some research has focused on the ways that patient characteristics and patient-provider relationships contribute to clinical adherence and treatment success, few studies to date have examined the ways that contextual factors of care and the healthcare environment contribute to patient outcomes. Here, we present qualitative findings from a mixed-methods study to describe contextual and healthcare environment factors in a Ryan White Part C clinic that are associated with patients' abilities to achieve viral suppression. We propose a modification of Andersen's Behavioral Model of Health Services Utilization, and its more recent adaptation developed by Ulett et al., to describe the ways that clinic, system, and provider factors merge to create a system of care in which more than 86% of the patient population is virally suppressed.

  10. Resilience of primary healthcare professionals working in challenging environments: a focus group study. (United States)

    Matheson, Catriona; Robertson, Helen D; Elliott, Alison M; Iversen, Lisa; Murchie, Peter


    The modern primary healthcare workforce needs to be resilient. Early research framed professional resilience as avoiding 'burnout'; however, more recent literature has introduced the concept of positive adaptation to professional challenges, which results in individuals thriving in their role. To explore what primary health professionals working in challenging environments consider to be characteristics of resilience and what promotes or challenges professional resilience. A qualitative focus group in north east Scotland. Five focus groups were held with 20 health professionals (six GPs, nine nurses, four pharmacists, and a practice manager) based in rural or deprived city areas in the north east of Scotland. Inductive thematic analysis identified emerging themes. Personal resilience characteristics identified were optimism, flexibility and adaptability, initiative, tolerance, organisational skills, being a team worker, keeping within professional boundaries, assertiveness, humour, and a sense of self-worth. Workplace challenges were workload, information overload, time pressures, poor communication, challenging patients, and environmental factors (rural location). Promoters of professional resilience were strong management support, teamwork, workplace buffers, and social factors such as friends, family, and leisure activities. A model of health professional resilience is proposed that concurs with existing literature but adds the concept of personal traits being synergistic with workplace features and social networks. These facilitate adaptability and enable individual health professionals to cope with adversity that is inevitably part of the everyday experience of those working in challenging healthcare environments. © British Journal of General Practice 2016.

  11. Antimicrobial biocides in the healthcare environment: efficacy, usage, policies, and perceived problems. (United States)

    Maillard, Jean-Yves


    Biocides are heavily used in the healthcare environment, mainly for the disinfection of surfaces, water, equipment, and antisepsis, but also for the sterilization of medical devices and preservation of pharmaceutical and medicinal products. The number of biocidal products for such usage continuously increases along with the number of applications, although some are prone to controversies. There are hundreds of products containing low concentrations of biocides, including various fabrics such as linen, curtains, mattresses, and mops that claim to help control infection, although evidence has not been evaluated in practice. Concurrently, the incidence of hospital-associated infections (HAIs) caused notably by bacterial pathogens such as methicillin-resistant Staphylococcus aureus (MRSA) remains high. The intensive use of biocides is the subject of current debate. Some professionals would like to see an increase in their use throughout hospitals, whereas others call for a restriction in their usage to where the risk of pathogen transmission to patients is high. In addition, the possible linkage between biocide and antibiotic resistance in bacteria and the role of biocides in the emergence of such resistance has provided more controversies in their extensive and indiscriminate usage. When used appropriately, biocidal products have a very important role to play in the control of HAIs. This paper discusses the benefits and problems associated with the use of biocides in the healthcare environment and provides a constructive view on their overall usefulness in the hospital setting.

  12. What role does performance information play in securing improvement in healthcare? a conceptual framework for levers of change. (United States)

    Levesque, Jean-Frederic; Sutherland, Kim


    Across healthcare systems, there is consensus on the need for independent and impartial assessment of performance. There is less agreement about how measurement and reporting performance improves healthcare. This paper draws on academic theories to develop a conceptual framework-one that classifies in an integrated manner the ways in which change can be leveraged by healthcare performance information. A synthesis of published frameworks. The framework identifies eight levers for change enabled by performance information, spanning internal and external drivers, and emergent and planned processes: (1) cognitive levers provide awareness and understanding; (2) mimetic levers inform about the performance of others to encourage emulation; (3) supportive levers provide facilitation, implementation tools or models of care to actively support change; (4) formative levers develop capabilities and skills through teaching, mentoring and feedback; (5) normative levers set performance against guidelines, standards, certification and accreditation processes; (6) coercive levers use policies, regulations incentives and disincentives to force change; (7) structural levers modify the physical environment or professional cultures and routines; (8) competitive levers attract patients or funders. This framework highlights how performance measurement and reporting can contribute to eight different levers for change. It provides guidance into how to align performance measurement and reporting into quality improvement programme. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  13. The value of information for decision-making in the healthcare environment. (United States)

    Shabtai, Itamar; Leshno, Moshe; Blondheim, Orna; Kornbluth, Jonathan


    With their ever-growing importance and usability, the healthcare sector has been investing heavily in medical information systems in recent years, as part of the effort to improve medical decision-making and increase its efficiency through improved medical processes, reduced costs, integration of patients' data, etc. In light of these developments, this research aims to evaluate the contribution of information technology (IT) to improving the medical decision-making processes at the point of care of internal medicine and surgical departments and to evaluate the degree to which IT investments are worthwhile. This has been done by assessing the value of information to decision-makers (physicians) at the point of care by investigating whether the information systems improved the medical outcomes. The research included three steps (after a pilot study)--the assessment of the subjective value of information, the assessment of the realistic value of information, and the assessment of the normative value of information, the results of each step being used as the starting assumptions for the following steps. Following a discussion and integration of the results from the various steps, the results of the three assessment stages were summarized in a cost-effectiveness analysis and an overall return on investment (ROI) analysis. In addition, we tried to suggest IT strategies for decision-makers in the healthcare sector on the advisability of implementing such systems as well as the implications for managing them. This research is uniquely pioneering in the manner in which it combines an assessment of the three kinds of measures of value of information in the healthcare environment. Our aim in performing it was to contribute to researchers (by providing additional insight into the fields of decision theory, value of information and medical informatics, amongst others), practitioners (by promoting efficiency in the design of new medical IS and improving existing IS), physicians

  14. How people who self-harm negotiate the inpatient environment: the mental healthcare workers perspective. (United States)

    Thomas, J B; Haslam, C O


    WHAT IS KNOWN ABOUT THE SUBJECT?: Self-harm plays a function, commonly in the form of distress management. There has been little focussed exploration of how individuals who use self-harm to manage distress cope when prevented from self-harm in an inpatient environment and how staff respond to this issue. This paper uses the experiences of mental health staff to add to the existing knowledge that self-harm has a functional role and supports the notion that interventions for self-harm should focus on the origins of distress. It describes the potential consequences that focussing on prevention of self-harm as opposed to actually managing distress may have on service-users, how staff attempt to manage these consequences and factors that may impact on staff interventions to prevent further distress/harm. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The findings suggest that mental healthcare staff should aim to understand the function of self-harm, use this understanding to develop an individualized care plan with the aim of managing distress and identify barriers to the effectiveness of the interventions so they can be worked around. Introduction Literature describes self-harm as functional and meaningful. This creates difficulties for service-users detained in an inpatient environment where self-harm is prevented. Aim Mental healthcare staff were interviewed to build on existing evidence of issues with the prevention approach and explore, from a staff perspective, how self-harm prevention impacts on service-users, how they manage distress and how this impacts on staff and their approach to care. Methods Qualitative methods were used to allow unexpected themes to arise. Ten semi-structured interviews were carried out with mental healthcare staff and thematically analysed. Findings and discussion The findings provide new evidence on the benefits and limitations of the inpatient environment for individuals who self-harm. Findings indicate that being unable to self-harm can

  15. Nanoporous aerogel as a bacteria repelling hygienic material for healthcare environment. (United States)

    Oh, Jun Kyun; Kohli, Nandita; Zhang, Yuanzhong; Min, Younjin; Jayaraman, Arul; Cisneros-Zevallos, Luis; Akbulut, Mustafa


    Healthcare-associated infections (HAIs) caused by pathogenic bacteria are a worldwide problem and responsible for numerous cases of morbidity and mortality. Exogenous cross-contamination is one of the main mechanisms contributing to such infections. This work investigates the potential of hydrophobically modified nanoporous silica aerogel as an antiadhesive hygienic material that can inhibit exogenous bacterial contamination. Nanoporous silica aerogels were synthesized via sol-gel polymerization of tetraethyl orthosilicate and hydrophobized using trimethylsilyl chloride. Bacterial adhesion characteristics were evaluated via dip-inoculation in suspensions of Gram-negative Escherichia coli O157:H7 and Gram-positive Staphylococcus aureus. The attachment of E. coli O157:H7 and S. aureus to hydrophobic nanoporous silica aerogel (HNSA) was found to be significantly lower than that to hydrophilic and hydrophobic nonporous silica materials: 99.91% (E. coli O157:H7) and 99.93% (S. aureus) reduction in comparison to hydrophilic nonporous silica, and 82.95% (E. coli O157:H7) and 84.90% (S. aureus) reduction in comparison to hydrophobic nonporous silica. These results suggest that the use of HNSA as surfaces that come into contact with bacterial pathogens in the healthcare environment can improve bacterial hygiene, and therefore may reduce the rate of HAIs.

  16. Nanoporous aerogel as a bacteria repelling hygienic material for healthcare environment

    International Nuclear Information System (INIS)

    Oh, Jun Kyun; Akbulut, Mustafa; Kohli, Nandita; Jayaraman, Arul; Zhang, Yuanzhong; Min, Younjin; Cisneros-Zevallos, Luis


    Healthcare-associated infections (HAIs) caused by pathogenic bacteria are a worldwide problem and responsible for numerous cases of morbidity and mortality. Exogenous cross-contamination is one of the main mechanisms contributing to such infections. This work investigates the potential of hydrophobically modified nanoporous silica aerogel as an antiadhesive hygienic material that can inhibit exogenous bacterial contamination. Nanoporous silica aerogels were synthesized via sol–gel polymerization of tetraethyl orthosilicate and hydrophobized using trimethylsilyl chloride. Bacterial adhesion characteristics were evaluated via dip-inoculation in suspensions of Gram-negative Escherichia coli O157:H7 and Gram-positive Staphylococcus aureus. The attachment of E. coli O157:H7 and S. aureus to hydrophobic nanoporous silica aerogel (HNSA) was found to be significantly lower than that to hydrophilic and hydrophobic nonporous silica materials: 99.91% (E. coli O157:H7) and 99.93% (S. aureus) reduction in comparison to hydrophilic nonporous silica, and 82.95% (E. coli O157:H7) and 84.90% (S. aureus) reduction in comparison to hydrophobic nonporous silica. These results suggest that the use of HNSA as surfaces that come into contact with bacterial pathogens in the healthcare environment can improve bacterial hygiene, and therefore may reduce the rate of HAIs. (paper)

  17. Construction and application of an intelligent air quality monitoring system for healthcare environment. (United States)

    Yang, Chao-Tung; Liao, Chi-Jui; Liu, Jung-Chun; Den, Walter; Chou, Ying-Chyi; Tsai, Jaw-Ji


    Indoor air quality monitoring in healthcare environment has become a critical part of hospital management and policy. Manual air sampling and analysis are cost-inhibitive and do not provide real-time air quality data and response measures. In this month-long study over 14 sampling locations in a public hospital in Taiwan, we observed a positive correlation between CO(2) concentration and population, total bacteria, and particulate matter concentrations, thus monitoring CO(2) concentration as a general indicator for air quality could be a viable option. Consequently, an intelligent environmental monitoring system consisting of a CO(2)/temperature/humidity sensor, a digital plug, and a ZigBee Router and Coordinator was developed and tested. The system also included a backend server that received and analyzed data, as well as activating ventilation and air purifiers when CO(2) concentration exceeded a pre-set value. Alert messages can also be delivered to offsite users through mobile devices.

  18. Psychosocial work environment factors and weight change

    DEFF Research Database (Denmark)

    Gram Quist, Helle; Christensen, Ulla; Christensen, Karl Bang


    BACKGROUND: Lifestyle variables may serve as important intermediate factors between psychosocial work environment and health outcomes. Previous studies, focussing on work stress models have shown mixed and weak results in relation to weight change. This study aims to investigate psychosocial...... factors outside the classical work stress models as potential predictors of change in body mass index (BMI) in a population of health care workers. METHODS: A cohort study, with three years follow-up, was conducted among Danish health care workers (3982 women and 152 men). Logistic regression analyses...... predicted weight loss among men. Associations were generally weak, with the exception of quality of leadership, age, and cohabitation. CONCLUSION: This study of a single occupational group suggested a few new risk factors for weight change outside the traditional work stress models....

  19. Hypoxia in the changing marine environment

    International Nuclear Information System (INIS)

    Zhang, J; Cowie, G; Naqvi, S W A


    The predicted future of the global marine environment, as a combined result of forcing due to climate change (e.g. warming and acidification) and other anthropogenic perturbation (e.g. eutrophication), presents a challenge to the sustainability of ecosystems from tropics to high latitudes. Among the various associated phenomena of ecosystem deterioration, hypoxia can cause serious problems in coastal areas as well as oxygen minimum zones in the open ocean (Diaz and Rosenberg 2008 Science 321 926–9, Stramma et al 2008 Science 320 655–8). The negative impacts of hypoxia include changes in populations of marine organisms, such as large-scale mortality and behavioral responses, as well as variations of species distributions, biodiversity, physiological stress, and other sub-lethal effects (e.g. growth and reproduction). Social and economic activities that are related to services provided by the marine ecosystems, such as tourism and fisheries, can be negatively affected by the aesthetic outcomes as well as perceived or real impacts on seafood quality (STAP 2011 (Washington, DC: Global Environment Facility) p 88). Moreover, low oxygen concentration in marine waters can have considerable feedbacks to other compartments of the Earth system, like the emission of greenhouse gases to the atmosphere, and can affect the global biogeochemical cycles of nutrients and trace elements. It is of critical importance to prediction and adaptation strategies that the key processes of hypoxia in marine environments be precisely determined and understood (cf Zhang et al 2010 Biogeosciences 7 1–24). (synthesis and review)

  20. Hypoxia in the changing marine environment (United States)

    Zhang, J.; Cowie, G.; Naqvi, S. W. A.


    The predicted future of the global marine environment, as a combined result of forcing due to climate change (e.g. warming and acidification) and other anthropogenic perturbation (e.g. eutrophication), presents a challenge to the sustainability of ecosystems from tropics to high latitudes. Among the various associated phenomena of ecosystem deterioration, hypoxia can cause serious problems in coastal areas as well as oxygen minimum zones in the open ocean (Diaz and Rosenberg 2008 Science 321 926-9, Stramma et al 2008 Science 320 655-8). The negative impacts of hypoxia include changes in populations of marine organisms, such as large-scale mortality and behavioral responses, as well as variations of species distributions, biodiversity, physiological stress, and other sub-lethal effects (e.g. growth and reproduction). Social and economic activities that are related to services provided by the marine ecosystems, such as tourism and fisheries, can be negatively affected by the aesthetic outcomes as well as perceived or real impacts on seafood quality (STAP 2011 (Washington, DC: Global Environment Facility) p 88). Moreover, low oxygen concentration in marine waters can have considerable feedbacks to other compartments of the Earth system, like the emission of greenhouse gases to the atmosphere, and can affect the global biogeochemical cycles of nutrients and trace elements. It is of critical importance to prediction and adaptation strategies that the key processes of hypoxia in marine environments be precisely determined and understood (cf Zhang et al 2010 Biogeosciences 7 1-24).

  1. Hand hygiene and healthcare system change within multi-modal promotion: a narrative review. (United States)

    Allegranzi, B; Sax, H; Pittet, D


    Many factors may influence the level of compliance with hand hygiene recommendations by healthcare workers. Lack of products and facilities as well as their inappropriate and non-ergonomic location represent important barriers. Targeted actions aimed at making hand hygiene practices feasible during healthcare delivery by ensuring that the necessary infrastructure is in place, defined as 'system change', are essential to improve hand hygiene in healthcare. In particular, access to alcohol-based hand rubs (AHRs) enables appropriate and timely hand hygiene performance at the point of care. The feasibility and impact of system change within multi-modal strategies have been demonstrated both at institutional level and on a large scale. The introduction of AHRs overcomes some important barriers to best hand hygiene practices and is associated with higher compliance, especially when integrated within multi-modal strategies. Several studies demonstrated the association between AHR consumption and reduction in healthcare-associated infection, in particular, meticillin-resistant Staphylococcus aureus bacteraemia. Recent reports demonstrate the feasibility and success of system change implementation on a large scale. The World Health Organization and other investigators have reported the challenges and encouraging results of implementing hand hygiene improvement strategies, including AHR introduction, in settings with limited resources. This review summarizes the available evidence demonstrating the need for system change and its importance within multi-modal hand hygiene improvement strategies. This topic is also discussed in a global perspective and highlights some controversial issues. Copyright © 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  2. Productivity changes in OECD healthcare systems: bias-corrected Malmquist productivity approach. (United States)

    Kim, Younhee; Oh, Dong-Hyun; Kang, Minah


    This study evaluates productivity changes in the healthcare systems of 30 Organization for Economic Co-operation and Development (OECD) countries over the 2002-2012 periods. The bootstrapped Malmquist approach is used to estimate bias-corrected indices of healthcare performance in productivity, efficiency and technology by modifying the original distance functions. Two inputs (health expenditure and school life expectancy) and two outputs (life expectancy at birth and infant mortality rate) are used to calculate productivity growth. There are no perceptible trends in productivity changes over the 2002-2012 periods, but positive productivity improvement has been noticed for most OECD countries. The result also informs considerable variations in annual productivity scores across the countries. Average annual productivity growth is evenly yielded by efficiency and technical changes, but both changes run somewhat differently across the years. The results of this study assert that policy reforms in OECD countries have improved productivity growth in healthcare systems over the past decade. Countries that lag behind in productivity growth should benchmark peer countries' practices to increase performance by prioritizing an achievable trajectory based on socioeconomic conditions. For example, relatively inefficient countries in this study indicate higher income inequality, corresponding to inequality and health outcomes studies. Although income inequality and globalization are not direct measures to estimate healthcare productivity in this study, these issues could be latent factors to explain cross-country healthcare productivity for future research. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  3. The gap between behavioral risk status and willingness to change behavior among healthcare professionals. (United States)

    Kasila, K; Hallman, M; Kautiainen, H; Vanhala, M; Kettunen, T


    This study explored behavioral health risk factors among healthcare professionals and investigated the at-risk persons' satisfaction with their health habits and ongoing change attempts. The study was based on a cross-sectional web-based survey directed at the nurses and physicians ( N = 1233) in Finnish healthcare. Obesity, low physical activity, smoking, and risky alcohol drinking were used as behavioral health risk factors. In all, 70% of the participants had at least one behavioral risk factor, and a significant number of at-risk persons were satisfied with their health habits and had no ongoing change process. Good self-rated health and good self-rated work ability were significantly associated with whether a participant had a behavioral health risk factor. Overall, unhealthy behaviors and a lack of ongoing change attempts were commonly observed among healthcare professionals. Work in healthcare is demanding, and healthy lifestyles can support coping. Thus, healthy lifestyle programs should also be targeted to healthcare professionals.

  4. Culturally and linguistically diverse healthcare students' experiences of learning in a clinical environment: A systematic review of qualitative studies. (United States)

    Mikkonen, Kristina; Elo, Satu; Kuivila, Heli-Maria; Tuomikoski, Anna-Maria; Kääriäinen, Maria


    Learning in the clinical environment of healthcare students plays a significant part in higher education. The greatest challenges for culturally and linguistically diverse healthcare students were found in clinical placements, where differences in language and culture have been shown to cause learning obstacles for students. There has been no systematic review conducted to examine culturally and linguistically diverse healthcare students' experiences of their learning in the clinical environment. This systematic review aims to identify culturally and linguistically diverse healthcare students' experiences of learning in a clinical environment. The search strategy followed the guidelines of the Centre of Reviews and Dissemination. The original studies were identified from seven databases (CINAHL, Medline Ovid, Scopus, Web of Science, Academic Search Premiere, Eric and Cochrane Library) for the period 2000-2014. Two researchers selected studies based on titles, abstracts and full texts using inclusion criteria and assessed the quality of studies independently. Twelve original studies were chosen for the review. The culturally and linguistically diverse healthcare students' learning experiences were divided into three influential aspects of learning in a clinical environment: experiences with implementation processes and provision; experiences with peers and mentors; and experiences with university support and instructions. The main findings indicate that culturally and linguistically diverse healthcare students embarking on clinical placements initially find integration stressful. Implementing the process of learning in a clinical environment requires additional time, well prepared pedagogical orientation, prior cultural and language education, and support for students and clinical staff. Barriers to learning by culturally and linguistically diverse healthcare students were not being recognized and individuals were not considered motivated; learners experienced the

  5. Soft qualities in healthcare. Method and tools for soft qualities design in hospitals' built environments. (United States)

    Capolongo, S; Bellini, E; Nachiero, D; Rebecchi, A; Buffoli, M


    The design of hospital environments is determined by functional requirements and technical regulations, as well as numerous protocols, which define the structure and system characteristics that such environments need to achieve. In order to improve people's well-being and the quality of their experience within public hospitals, design elements (soft qualities) are added to those 'necessary' features. The aim of this research has been to experiment a new design process and also to create health care spaces with high environmental quality and capable to meet users' emotional and perceptual needs. Such needs were investigated with the help of qualitative research tools and the design criteria for one of these soft qualities - colour - were subsequently defined on the basis of the findings. The colour scheme design for the new San Paolo Hospital Emergency Department in Milan was used as case study. Focus groups were fundamental in defining the project's goals and criteria. The issues raised have led to believe that the proper procedure is not the mere consultation of the users in order to define the goals: users should rather be involved in the whole design process and become co-agents of the choices that determine the environment characteristics, so as to meet the quality requirements identified by the users themselves. The case study has shown the possibility of developing a designing methodology made by three steps (or operational tools) in which users' groups are involved in the choices, loading to plan the environments where compliance with expectations is already implied and verified by means of the process itself. Thus, the method leads to the creation of soft qualities in Healthcare.

  6. A scoping review on bio-aerosols in healthcare and the dental environment.

    Directory of Open Access Journals (Sweden)

    Charifa Zemouri

    Full Text Available Bio-aerosols originate from different sources and their potentially pathogenic nature may form a hazard to healthcare workers and patients. So far no extensive review on existing evidence regarding bio-aerosols is available.This study aimed to review evidence on bio-aerosols in healthcare and the dental setting. The objectives were 1 What are the sources that generate bio-aerosols?; 2 What is the microbial load and composition of bio-aerosols and how were they measured?; and 3 What is the hazard posed by pathogenic micro-organisms transported via the aerosol route of transmission?Systematic scoping review design. Searched in PubMed and EMBASE from inception to 09-03-2016. References were screened and selected based on abstract and full text according to eligibility criteria. Full text articles were assessed for inclusion and summarized. The results are presented in three separate objectives and summarized for an overview of evidence.The search yielded 5,823 studies, of which 62 were included. Dental hand pieces were found to generate aerosols in the dental settings. Another 30 sources from human activities, interventions and daily cleaning performances in the hospital also generate aerosols. Fifty-five bacterial species, 45 fungi genera and ten viruses were identified in a hospital setting and 16 bacterial and 23 fungal species in the dental environment. Patients with certain risk factors had a higher chance to acquire Legionella in hospitals. Such infections can lead to irreversible septic shock and death. Only a few studies found that bio-aerosol generating procedures resulted in transmission of infectious diseases or allergic reactions.Bio-aerosols are generated via multiple sources such as different interventions, instruments and human activity. Bio-aerosols compositions reported are heterogeneous in their microbiological composition dependent on the setting and methodology. Legionella species were found to be a bio-aerosol dependent hazard

  7. Educating Medical Laboratory Technologists: Revisiting Our Assumptions in the Current Economic and Health-Care Environment

    Directory of Open Access Journals (Sweden)

    Regina Linder


    Full Text Available Health care occupies a distinct niche in an economy struggling to recover from recession. Professions related to the care of patients are thought to be relatively resistant to downturns, and thus become attractive to students typically drawn to more lucrative pursuits. Currently, a higher profile for clinical laboratory technology among college students and those considering career change results in larger and better prepared applicant pools. However, after decades of contraction marked by closing of programs, prospective students encounter an educational system without the capacity or vigor to meet their needs. Here discussed are some principles and proposals to allow universities, partnering with health-care providers, government agencies, and other stakeholders to develop new programs, or reenergize existing ones to serve our students and patients. Principles include academic rigor in biomedical and clinical science, multiple points of entry for students, flexibility in format, cost effectiveness, career ladders and robust partnerships.

  8. Self-employed nurses as change agents in healthcare: strategies, consequences, and possibilities. (United States)

    Wall, Sarah


    The purpose of this paper is to report on ethnographic research that investigated how self-employed nurses perceive the contemporary healthcare field, what attributes they possess that facilitate their roles as change agents, what strategies they use to influence change, and what consequences they face for their actions, thus contributing to what is known about organizational change in institutionalized settings such as healthcare. Focussed ethnography was used to explore self-employed nurses' work experiences and elucidate the cultural elements of their social contexts, including customs, ideologies, beliefs, and knowledge and the ways that these impact upon the possibilities for change in the system. These self-employed nurses reflected on the shortcomings in the healthcare system and took entrepreneurial risks that would allow them to practice nursing according to their professional values. They used a number of strategies to influence change such as capitalizing on opportunities, preparing themselves for innovative work, managing and expanding the scope of nursing practice, and building new ideas on foundational nursing knowledge and experience. They had high job satisfaction and a strong sense of contribution but they faced significant resistance because of their non-traditional approach to nursing practice. Despite dramatic restructuring in the Canadian healthcare system, the system remains physician-centered and hospital-based. Nursing's professional potential has been largely untapped in any change efforts. Self-employed nurses have positioned themselves to deliver care based on nursing values and to promote alternative conceptions of health and healthcare. This study offers a rare exploration of this unique form of nursing practice and its potential to influence health system reform.

  9. Experiential learning and cognitive tools: The impact of simulations on conceptual change in continuing healthcare education

    NARCIS (Netherlands)

    Reeves, Thomas; Reeves, Patricia; McKenney, Susan


    Reeves, T. C., Reeves, P. M., & McKenney, S. (2013). Experiential learning and cognitive tools: The impact of simulations on conceptual change in continuing healthcare education. In J. M. Spector, B. B. Lockee, S. E. Smaldino, & M. Herring (eds.), Learning, problem solving, and mindtools: Essays in

  10. A Study of Transformational Change at Three Schools of Nursing Implementing Healthcare Informatics (United States)

    Cornell, Revonda Leota


    The "Health Professions Education: A Bridge to Quality" (IOM, 2003) proposed strategies for higher education leaders and faculty to transform their institutions in ways that address the healthcare problems. This study provides higher education leaders and faculty with empirical data about the processes of change involved to implement the…

  11. Stress-reducing effects of indoor plants in the built healthcare environment: The mediating role of perceived attractiveness

    NARCIS (Netherlands)

    Dijkstra, K.; Pieterse, Marcel E.; Pruyn, Adriaan T.H.


    Objective: Natural elements in the built healthcare environment have shown to hold potential stress-reducing properties. In order to shed light on the underlying mechanism of stress-reducing effects of nature, the present study investigates whether the stress-reducing effects of indoor plants occur

  12. Stress-reducing effects of indoor plants in the built healthcare environment : The mediating role of perceived attractiveness

    NARCIS (Netherlands)

    Dijkstra, K.; Pieterse, Marcel E.; Pruyn, A.Th.

    Objective: Natural elements in the built healthcare environment have shown to hold potential stress-reducing properties. In order to shed light on the underlying mechanism of stress-reducing effects of nature, the present study investigates whether the stress-reducing effects of indoor plants occur

  13. Climate Change Resilience in the Urban Environment (United States)

    Kershaw, Tristan


    Between 1930 and 2030, the world's population will have flipped from 70% rural to 70% urban. While much has been written about the impacts of climate change and mitigation of its effects on individual buildings or infrastructure, this book is one of the first to focus on the resilience of whole cities. It covers a broad range of area-wide disaster-level impacts, including drought, heatwaves, flooding, storms and air quality, which many of our cities are ill-adapted to cope with, and unless we can increase the resilience of our urban areas then much of our current building stock may become uninhabitable. Climate Resilience in Urban Environments provides a detailed overview of the risks for urban areas, including those risks to human health as well as to building integrity, the physical processes involved, and presents key information in which way the risks can be reduced and urban areas made more resilient.

  14. Colonization of patients, healthcare workers, and the environment with healthcare-associated Staphylococcus epidermidis genotypes in an intensive care unit: a prospective observational cohort study. (United States)

    Widerström, Micael; Wiström, Johan; Edebro, Helén; Marklund, Elisabeth; Backman, Mattias; Lindqvist, Per; Monsen, Tor


    During the last decades, healthcare-associated genotypes of methicillin-resistant Staphylococcus epidermidis (HA-MRSE) have been established as important opportunistic pathogens. However, data on potential reservoirs on HA-MRSE is limited. The aim of the present study was to investigate the dynamics and to which extent HA-MRSE genotypes colonize patients, healthcare workers (HCWs) and the environment in an intensive care unit (ICU). Over 12 months in 2006-2007, swab samples were obtained from patients admitted directly from the community to the ICU and patients transferred from a referral hospital, as well as from HCWs, and the ICU environment. Patients were sampled every third day during hospitalization. Antibiotic susceptibility testing was performed according to EUCAST guidelines. Pulsed-field gel electrophoresis and multilocus sequence typing were used to determine the genetic relatedness of a subset of MRSE isolates. We identified 620 MRSE isolates from 570 cultures obtained from 37 HCWs, 14 patients, and 14 environmental surfaces in the ICU. HA-MRSE genotypes were identified at admission in only one of the nine patients admitted directly from the community, of which the majority subsequently were colonized by HA-MRSE genotypes within 3 days during hospitalization. Almost all (89%) of HCWs were nasal carriers of HA-MRSE genotypes. Similarly, a significant proportion of patients transferred from the referral hospital and fomites in the ICU were widely colonized with HA-MRSE genotypes. Patients transferred from a referral hospital, HCWs, and the hospital environment serve as important reservoirs for HA-MRSE. These observations highlight the need for implementation of effective infection prevention and control measures aiming at reducing HA-MRSE transmission in the healthcare setting.

  15. Changes and specificities in health behaviors among healthcare students over an 8-year period (United States)

    Delay, J.; Grigioni, S.; Déchelotte, P.; Ladner, J.


    Background Healthcare students are future health care providers and serve as role models and coaches to enhance behaviors for healthy lifestyles. However healthcare students face multiple stressors that could lead to adopting risk behaviors. Objectives To assess the changes in health risk factors among healthcare students between 2007 and 2015, and to identify specific health behaviors based on the curriculum in a population of healthcare students: Methods Two cross sectionnal studies were conducted in 2007 and 2015 among nursing, medical, pharmacy, and physiotherapy students (Rouen, France). During compulsory courses and examination sessions students filled self-administered questionnaires on socio-demographic characteristics and behavior as: tobacco smoking, alcohol consumption, cannabis consumption, eating disorders, regular practice of sport, perceived health, stress and use of psychotropic drugs. Results 2,605 healthcare students were included (1,326 in 2007 and 1,279 in 2015), comprising 1,225 medical students (47.0%), 738 nursing students (28.3%), 362 pharmacy students (13.9%), and 280 physiotherapy students (10.8%). Between 2007 and 2015, occasional binge drinking and regular practice of sport increased significantly among healthcare students, respectively AOR = 1.48 CI95% (1.20–1.83) and AOR = 1.33 CI95% (1.11–1.60), regular cannabis consumption decreased significantly, AOR = 0.32 CI95% (0.19–0.54). There was no change in smoking or overweight/obese. There was a higher risk of frequent binge drinking and a lower risk of tobacco smoking in all curricula than in nursing students. Medical students practiced sport on a more regular basis, were less overweight/obese, had fewer eating disorders than nursing students. Conclusion Our findings demonstrate a stable frequency of classic behaviors as smoking but a worsening of emerging behaviors as binge drinking among healthcare students between 2007 and 2015. Health behaviors differed according to healthcare

  16. Natural gas -- The changing competitive environment

    International Nuclear Information System (INIS)

    Walker, M.G.


    Owners and senior managers don't have to be reminded that the business is getting tougher. Prices aren't behaving as expected, and they are becoming more volatile. Costs are increasing. The futures market is here to stay, not to mention swaps and options. FERC Order 636 is another complicating factor. Whether you are a producer, marketer, pipeline or an LDC, the structure of the market is changing. The answer to the following questions is quite often -- no: Is your company in a position to offer your customers the services they want? Is your company comfortable using hedges? Do you always know your level of risk? Can your company easily track daily positions and P/L and thoughtfully analyze the various business lines? While not all of the above concerns stem from increased price volatility, Order 636 and complexity resulting from the use of more sophisticated risk control instruments, many of them do. There's a cultural change occurring and companies that want to be market leaders must not just ''learn to live'' with this, but install a management process that thrives in this environment. Understanding the meaning of this goal is the focus of this paper

  17. Analysis of exposure to electromagnetic fields in a healthcare environment: simulation and experimental study. (United States)

    de Miguel-Bilbao, Silvia; Martín, Miguel Angel; Del Pozo, Alejandro; Febles, Victor; Hernández, José A; de Aldecoa, José C Fernández; Ramos, Victoria


    Recent advances in wireless technologies have lead to an increase in wireless instrumentation present in healthcare centers. This paper presents an analytical method for characterizing electric field (E-field) exposure within these environments. The E-field levels of the different wireless communications systems have been measured in two floors of the Canary University Hospital Consortium (CUHC). The electromagnetic (EM) conditions detected with the experimental measures have been estimated using the software EFC-400-Telecommunications (Narda Safety Test Solutions, Sandwiesenstrasse 7, 72793 Pfullingen, Germany). The experimental and simulated results are represented through 2D contour maps, and have been compared with the recommended safety and exposure thresholds. The maximum value obtained is much lower than the 3 V m(-1) that is established in the International Electrotechnical Commission Standard of Electromedical Devices. Results show a high correlation in terms of E-field cumulative distribution function (CDF) between the experimental and simulation results. In general, the CDFs of each pair of experimental and simulated samples follow a lognormal distribution with the same mean.

  18. Improving hand hygiene compliance in healthcare settings using behavior change theories: reflections. (United States)

    Al-Tawfiq, Jaffar A; Pittet, Didier


    Although hand hygiene is the most effective method for preventing healthcare-associated infections, hand hygiene practice falls short in many healthcare facilities. The compliance rate is mostly linked to system design and easily accessible hand hygiene products. System change, healthcare worker motivation, and complex behavioral considerations seem to play a significant role. This article discusses the application of behavioral theories in hand hygiene promotion in a theoretical manner. The program relies on the transtheoretical model (TTM) of health behavior change, John Keller's (ARCS) Model of Motivational Design, and the theory of planned behavior (TPB). Thus, the program links attitudes and behavior to hand hygiene promotion. The TTM of health behavior change helps to tailor interventions to predict and motivate individual movement across the pathway to change. A program could be based on this theory with multiple intercalations with John Keller's ARCS and the TPB. Such a program could be strengthened by linking attitudes and behavior to promote hand hygiene. The program could utilize different strategies such as organization cultural change that may increase the attention as well as fostering the movement in the ARCS stages. In addition, modeling TPB by creating peer pressure, ability to overcome obstacles, and increasing knowledge of the role of hand hygiene may lead to the desired outcome. The understanding and application of behavior change theories may result in an effective program to improve awareness and raise intention and thus may increase the potential for success of hand hygiene promotion programs.

  19. Changing Job Satisfaction, Absenteeism, and Healthcare Claims Costs In a Hospital Culture (United States)

    Newsome, Misty; Pearsall, Cynthia; Ryan, Teresa; Starlin, Pamela


    received training (Table and Figure) HeartMath participants demonstrated a lower overall absenteeism rate (P = 0), resulting in a $94,794 savings over a 3-year period. Cultural and financial returns on investment were demonstrated using these indicators. Table Healthcare Claims Costs HeartMath vs Non-HeartMath Participants HeartMath Non-HeartMath HeartMath Non-HeartMath Year PMPM PMPM PMPY PMPY 2007 $143.92 $310.88 $1727.09 $3730.53 2008 $250.93a $304.40 $3011.10a $3652.82 2009 $159.70 $285.29b $1916.37 $3423.56 Abbreviations: PMPM, per member per month; PMPY, per member per year. a HeartMath claims expense excludes five outlier claims in excess of $20 000 for conditions that could not have been avoided using HeartMath. b Non-HeartMath participants’ total claims expenses excludes six outlier cases with payments > $125 000. Figure Employee opinion survey: Impact of HeartMath Training, over all scores. Conclusion: Investing in HeartMath training and ongoing practice has proven to be a wise decision and continues to be valuable when initiating new concepts in a stressful, changing environment. Sustainability is key to long-term success and true cultural change. Continued employee training of the HeartMath tools and the continued use of the tools enriches the program planning and implementation of new initiatives at Fairfield Medical Center.

  20. [Digital health as a motor for change towards new healthcare models and the relationship between patients and healthcare professionals. Disruption of healthcare processes]. (United States)

    Garcia-Cuyàs, Francesc; de San Pedro, Marc; Martínez Roldan, Jordi


    We find ourselves at the end of an era of asymmetry in the domain of health information where the majority of this data is in the hands of the healthcare system. Increasingly, the public are calling for a more central role in the new paradigm that enables them to duly exercise their right of access to their health data while availing of more reliable and safer technologies which contribute to the management of their condition and promote healthy lifestyles. So far, the TIC Salud strategic plan has been developed independently from the Generalitat de Catalunya Health Department's Healthcare Plan, which sets out health policy strategy in Catalonia. However, from its initial design stage the new Healthcare Plan (2016- 2020) envisages incorporating a new strategic Information and communications technology (ICT) line called "Digital Health". Incorporating ICT into the Health Plan will allow these technologies to become integral part of all strategic healthcare processes, acting as a driving force for a shift towards a new healthcare models and an innovative relationship between the public and healthcare professionals. The Digital Health implies a disruption in itself, by way of the convergence of several technologies and their positive impact on health and healthcare procedures, by way of the public's access to information concerning their health, and by creating new opportunities for promoting health and the salutogenic paradigm which empowers people to develop their health, welfare and quality of life. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  1. Using the dual-level modeling approach to developing applications in the pervasive healthcare environment

    NARCIS (Netherlands)

    Cardoso de Moraes, J.L.; Lopes de Souza, Wanderley; Ferreira Pires, Luis; Cavalini, Luciana Tricai; do Prado, Antonio Francisco


    Health information technology is the area of IT involving the design, development, creation, use and maintenance of information systems for the healthcare industry. Automated and interoperable healthcare information systems are expected to lower costs, improve efficiency and reduce error, while also

  2. Online virtual patients - A driver for change in medical and healthcare professional education in developing countries? (United States)

    Dewhurst, David; Borgstein, Eric; Grant, Mary E; Begg, Michael


    The development of online virtual patients has proved to be an effective vehicle for pedagogical and technological skills transfer and capacity building for medical and healthcare educators in Malawi. A project between the University of Edinburgh and the University of Malawi has delivered more than 20 collaboratively developed, virtual patients, contextualised for in-country medical and healthcare education and, more significantly, a cadre of healthcare professionals skilled in developing digital resources and integrating these into their emerging curricula. The process of engaging with new approaches to teaching and delivering personalised, context sensitive content via a game-informed, technology-supported process has contributed to the ability of healthcare educators in Malawi to drive pedagogical change, meet the substantial challenges of delivering new curricula, cope with increasing student numbers and promote teacher professional development. This initial phase of the project has laid the foundation for a broader second phase that focuses on promoting curriculum change, developing educational infrastructure and in-country capacity to create, and integrate digital resources into education and training across multi-professional groups and across educational levels.

  3. Black carbon emission reduction strategies in healthcare industry for effective global climate change management. (United States)

    Raila, Emilia Mmbando; Anderson, David O


    Climate change remains one of the biggest threats to life on earth to date with black carbon (BC) emissions or smoke being the strongest cause after carbon dioxide (CO 2 ). Surprisingly, scientific evidence about black carbon emissions reduction in healthcare settings is sparse. This paper presents new research findings on the reduction of black carbon emissions from an observational study conducted at the UN Peacekeeping Operations (MINUSTAH) in Haiti in 2014. Researchers observed 20 incineration cycles, 30 minutes for each cycle of plastic and cardboard sharps healthcare waste (HCW) containers ranged from 3 to 14.6 kg. The primary aim was to determine if black carbon emissions from healthcare waste incineration can be lowered by mainstreaming the use of cardboard sharps healthcare waste containers instead of plastic sharps healthcare waste containers. Similarly, the study looks into whether burning temperature was associated with the smoke levels for each case or not. Independent samples t-tests demonstrated significantly lower black carbon emissions during the incineration of cardboard sharps containers (6.81 ± 4.79% smoke) than in plastic containers (17.77 ± 8.38% smoke); a statistically significant increase of 10.96% smoke (95% Confidence Interval ( CI) [4.4 to 17.5% smoke], p = 0.003). Correspondingly, lower bottom burner temperatures occurred during the incineration of cardboard sharps containers than in plastic (95% Cl [16 to 126°C], p = 0.014). Finally, we expect the application of the new quantitative evidence to form the basis for policy formulation, mainstream the use of cardboard sharps containers and opt for non-incineration disposal technologies as urgent steps for going green in healthcare waste management.

  4. Synthetic hardware performance analysis in virtualized cloud environment for healthcare organization. (United States)

    Tan, Chee-Heng; Teh, Ying-Wah


    The main obstacles in mass adoption of cloud computing for database operations in healthcare organization are the data security and privacy issues. In this paper, it is shown that IT services particularly in hardware performance evaluation in virtual machine can be accomplished effectively without IT personnel gaining access to actual data for diagnostic and remediation purposes. The proposed mechanisms utilized the hypothetical data from TPC-H benchmark, to achieve 2 objectives. First, the underlying hardware performance and consistency is monitored via a control system, which is constructed using TPC-H queries. Second, the mechanism to construct stress-testing scenario is envisaged in the host, using a single or combination of TPC-H queries, so that the resource threshold point can be verified, if the virtual machine is still capable of serving critical transactions at this constraining juncture. This threshold point uses server run queue size as input parameter, and it serves 2 purposes: It provides the boundary threshold to the control system, so that periodic learning of the synthetic data sets for performance evaluation does not reach the host's constraint level. Secondly, when the host undergoes hardware change, stress-testing scenarios are simulated in the host by loading up to this resource threshold level, for subsequent response time verification from real and critical transactions.

  5. Mining the management literature for insights into implementing evidence-based change in healthcare. (United States)

    Harlos, Karen; Tetroe, Jacqueline; Graham, Ian D; Bird, Madeleine; Robinson, Nicole


    We synthesized the management and health literatures for insights into implementing evidence-based change in healthcare drawn from industry-specific data. Because change principles based on evidence often fail to be translated into organizational practice or policy, we sought studies at the nexus of organizational change and knowledge translation. We reviewed five top management journals to identify an initial pool of 3,091 studies, which yielded a final sample of 100 studies. Data were abstracted, verified by the original authors and revised before entry into a database. We employed a systematic narrative synthesis approach using words and text to distill data and explain relationships. We categorized studies by varying levels of relevance for knowledge translation as (1) primary, direct; (2) intermediate; and (3) secondary, indirect. We also identified recurring categories of change-related organizational factors. The current analysis examines these factors in studies of primary relevance to knowledge translation, which we also coded for intervention readiness to reflect how readily change can be implemented. Preliminary Results centred on five change-related categories: Tailoring the Intervention Message; Institutional Links/Social Networks; Training; Quality of Work Relationships; and Fit to Organization. In particular, networks across institutional and individual levels appeared as prominent pathways for changing healthcare organizations. Power dynamics, positive social relations and team structures also played key roles in implementing change and translating it into practice. We analyzed journals in which first authors of these studies typically publish, and found evidence that management and health sciences remain divided. Bridging these disciplines through research syntheses promises a wealth of evidence and insights, well worth mining in the search for change that works in healthcare transformation. Copyright © 2012 Longwoods Publishing.

  6. Systematic review on embracing cultural diversity for developing and sustaining a healthy work environment in healthcare. (United States)

    Pearson, Alan; Srivastava, Rani; Craig, Dianna; Tucker, Donna; Grinspun, Doris; Bajnok, Irmajean; Griffin, Pat; Long, Leslye; Porritt, Kylie; Han, Thuzar; Gi, Aye A


    Objectives  The objective of this review was to evaluate evidence on the structures and processes that support development of effective culturally competent practices and a healthy work environment. Culturally competent practices are a congruent set of workforce behaviours, management practices and institutional policies within a practice setting resulting in an organisational environment that is inclusive of cultural and other forms of diversity. Inclusion criteria  This review included quantitative and qualitative evidence, with a particular emphasis on identifying systematic reviews and randomised controlled trials. For quantitative evidence, other controlled, and descriptive designs were also included. For qualitative evidence, all methodologies were considered. Participants were staff, patients, and systems or policies that were involved or affected by concepts of cultural competence in the nursing workforce in a healthcare environment. Types of interventions included any strategy that had a cultural competence component, which influenced the work environment, and/or patient and nursing staff in the environment. The types of outcomes of interest to this review included nursing staff outcomes, patient outcomes, organisational outcomes and systems level outcomes. Search strategy  The search sought both published and unpublished literature written in the English language. A comprehensive three-step search strategy was used, first to identify appropriate key words, second to combine all optimal key words into a comprehensive search strategy for each database and finally to review the reference lists of all included reviews and research reports. The databases searched were CINAHL, Medline, Current Contents, the Database of Abstracts of Reviews of Effectiveness, The Cochrane Library, PsycINFO, Embase, Sociological Abstracts, Econ lit, ABI/Inform, ERIC and PubMed. The search for unpublished literature used Dissertation Abstracts International. Methodological

  7. Exploring the impact of toxic attitudes and a toxic environment on the veterinary healthcare team

    Directory of Open Access Journals (Sweden)

    Irene eMoore


    Full Text Available AbstractThe objective of this qualitative study was to compare veterinarians’ and Registered Veterinary Technicians’ (RVT’s perceptions of the veterinary health care team with respect to the impact of toxic attitudes and a toxic environment. Focus group interviews using a semi-structured interview guide and follow up probes were held with 4 veterinarian groups (23 companion animal veterinarians and 4 Registered Veterinary Technician groups (26 RVTs. Thematic analysis of the discussions indicated both veterinarian and RVT participants felt team members with toxic attitudes negatively impacted veterinary team function. These attitudes included people being disrespectful, being resistant to change, always wanting to be the go to person, avoiding conflict, and lacking motivation. When conflict was ignored, or when people with toxic attitudes were not addressed, a toxic environment often resulted. A toxic environment sometimes manifested when broken communication and tension between staff members occurred as a result of employees lacking confidence, skills, or knowledge not being managed properly. It also occurred when employees did not feel appreciated, when there was difficulty coping with turnover, and when there were conflicting demands.The presence of people with a toxic attitude was a source of frustration for both veterinarian and RVT participants. Prompt and consistent attention to negative behaviors is recommended to reduce the development of a toxic environment.

  8. How changes to Irish healthcare financing are affecting universal health coverage. (United States)

    Briggs, Adam D M


    In 2010, the World Health Organisation (WHO) published the World Health Report - Health systems financing: the path to universal coverage. The Director-General of the WHO, Dr Margaret Chan, commissioned the report "in response to a need, expressed by rich and poor countries alike, for practical guidance on ways to finance health care". Given the current context of global economic hardship and difficult budgetary decisions, the report offered timely recommendations for achieving universal health coverage (UHC). This article analyses the current methods of healthcare financing in Ireland and their implications for UHC. Three questions are asked of the Irish healthcare system: firstly, how is the health system financed; secondly, how can the health system protect people from the financial consequences of ill-health and paying for health services; and finally, how can the health system encourage the optimum use of available resources? By answering these three questions, this article argues that the Irish healthcare system is not achieving UHC, and that it is unclear whether recent changes to financing are moving Ireland closer or further away from the WHO's ambition for healthcare for all. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  9. Leading Healthcare Change Across the Care Continuum: An Interview With Dr Kenneth Rempher. (United States)

    Murphy, Lyn Stankiewicz; Joseph, M Lindell


    Kenneth Rempher, PhD, MBA, CENP, RN, is the chief nursing officer for the University of Iowa (UI) Hospitals and Clinics. In his 20-year career, he has distinguished himself as a visionary healthcare leader. Colleagues describe Dr Rempher as a strong, transformational leader, guiding the UI enterprise through a time of uncertainty and change. This interview by the CGEAN provides insight to his leadership style, successes, and ideas on the future of care delivery.

  10. Interventions for sustained healthcare professional behaviour change: a protocol for an overview of reviews. (United States)

    Dombrowski, Stephan U; Campbell, Pauline; Frost, Helen; Pollock, Alex; McLellan, Julie; MacGillivray, Steve; Gavine, Anna; Maxwell, Margaret; O'Carroll, Ronan; Cheyne, Helen; Presseau, Justin; Williams, Brian


    Failure to successfully implement and sustain change over the long term continues to be a major problem in health and social care. Translating evidence into routine clinical practice is notoriously complex, and it is recognised that to implement new evidence-based interventions and sustain them over time, professional behaviour needs to change accordingly. A number of theories and frameworks have been developed to support behaviour change among health and social care professionals, and models of sustainability are emerging, but few have translated into valid and reliable interventions. The long-term success of healthcare professional behavioural change interventions is variable, and the characteristics of successful interventions unclear. Previous reviews have synthesised the evidence for behaviour change, but none have focused on sustainability. In addition, multiple overlapping reviews have reported inconsistent results, which do not aid translation of evidence into practice. Overviews of reviews can provide accessible succinct summaries of evidence and address barriers to evidence-based practice. We aim to compile an overview of reviews, identifying, appraising and synthesising evidence relating to sustained social and healthcare professional behaviour change. We will conduct a systematic review of Cochrane reviews (an Overview). We plan to systematically search the Cochrane Database of Systematic Reviews. We will include all systematic reviews of randomised controlled trials comparing a healthcare professional targeted behaviour change intervention to a standard care or no intervention control group. Two reviewers will independently assess the eligibility of the reviews and the methodological quality of included reviews using the ROBIS tool. The quality of evidence within each comparison in each review will be judged based on the GRADE criteria. Disagreements will be resolved through discussion. Effects of interventions will be systematically tabulated and the

  11. Healthcare restructuring and hierarchical alignment: why do staff and managers perceive change outcomes differently? (United States)

    Walston, Stephen L; Chou, Ann F


    Healthcare organizations have undergone major change efforts in the past decade. Sustained change is related to continued alignment among organizational participants and may fail with incongruent perceptions of change. This study identifies factors contributing to the alignment in perceptions of organizational change outcomes between executives and all other employees. The sample included 10 hospitals with survey responses from 421 executives and other employees. Using hierarchical linear modeling (HLM), perceptual alignment was modeled at the first level as a function of goal commitment, goal clarity, goal acceptance, goal specificity, staff participation, available skill set, and knowledge and at the second level as organizational size. Descriptive statistics showed employee perception of outcomes differed among personnel levels. HLM results showed that goal specificity, appropriate staff training, reward incentives, effective communication, information sharing, and organization's ability to sustain changes induced perceptual alignment in change outcomes. Staff involvement in designing change efforts increased perceptual misalignment, whereas involvement during implementation and maintenance phases increased alignment. This research uses cross-sectional data from 10 hospitals. Data were gathered from surveys that may have recall bias as hospitals were surveyed at different times after the implementation of their restructuring. Our findings enhance the understanding of processes and mechanisms that enable healthcare organizations to align organizational participants' efforts during change. Results suggest that decision-makers should create incentives to encourage innovative practices, institute effective communication mechanisms, selectively disseminate information, and involve participants in implementing and maintaining changes to achieve intended outcomes. ORIGINALITY/VALUE OF ARTICLE: This article provides unique insight into the importance and causes of

  12. How motivated are patients with type 2 diabetes to change their lifestyle? A survey among patients and healthcare professionals. (United States)

    Linmans, Joris J; Knottnerus, J André; Spigt, Mark


    It is unknown to what extend patients with type 2 diabetes mellitus (T2DM) in primary care are motivated to change their lifestyle. We assessed the level of motivation to change lifestyle and the agreement for that level between patients and healthcare professionals. Patients with T2DM (150) filled in a questionnaire to assess the level of motivation to change their lifestyle, using a single question with three answer options. We investigated the agreement for this level between these patients and their healthcare professionals (12 professionals). In addition, we investigated and compared the level of physical activity as indicated by the patients and the healthcare professionals. A large part of the patients reported to have a deficient physical activity level (35% according to patients, 47% according to healthcare professionals, kappa 0.32) and were not motivated to change their lifestyle level (29% according to patients, 43% according to healthcare professionals, kappa 0.13). Patients tended to overestimate their physical activity and their motivation to change in comparison with their healthcare professionals. Patients with T2DM in primary care should increase their physical activity level. Healthcare professionals often do not know whether patients are motivated to change their lifestyle, and should therefore assess motivation regularly to optimize lifestyle management. Copyright © 2015 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

  13. Optimizing learning in healthcare: how Island Health is evolving to learn at the speed of change. (United States)

    Gottfredson, Conrad; Stroud, Carol; Jackson, Mary; Stevenson, R Lynn; Archer, Jana


    Healthcare organizations are challenged with constrained resources and increasing service demands by an aging population with complex care needs. Exponential growth in competency requirements also challenges staff's ability to provide quality patient care. How can a healthcare organization support its staff to learn "at or above the speed of change" while continuing to provide the quality patient care? Island Health is addressing this challenge by transforming its traditional education model into an innovative, evidence-based learning and performance support approach. Implementation of the methodology is yielding several lessons learned, both for the internal Learning and Performance Support team, and for what it takes to bring a new way of doing business into an organization. A key result is that this approach is enabling the organization to be more responsive in helping staff gain and maintain competencies.

  14. Innovation in the Era of Experience: The Changing Role of Users in Healthcare Innovation

    Directory of Open Access Journals (Sweden)

    Alexandre Trigo


    Full Text Available This article provides an extensive literature review on the changing role of users in innovation, with a particular focus on the healthcare sector. Users have been specifically analyzed by many scholars worldwide due to their significant role as a source of innovation beyond the traditional assumption which considers customers as mere passive adopters of products and services. The increasing, but still scarce, number of studies on this topic has demonstrated the benefits of patient involvement and how a close and continuous relationship between patients and practitioners can lead to permanent cycles of improvements and innovation in healthcare outcomes. In addition to a user-centered approach, innovative patients are actively developing new solutions for their own treatments, likewise for other patients with similar diseases.

  15. Climate Change, Indoor Environment and Health (United States)

    Climate change is becoming a driving force for improving energy efficiency because saving energy can help reduce the greenhouse gas emissions that contribute to climate change. However, it is important to balance energy saving measures with ventilation...

  16. Equipping providers with principles, knowledge and skills to successfully integrate behaviour change counselling into practice: a primary healthcare framework. (United States)

    Vallis, M; Lee-Baggley, D; Sampalli, T; Ryer, A; Ryan-Carson, S; Kumanan, K; Edwards, L


    There is an urgent need for healthcare providers and healthcare systems to support productive interactions with patients that promote sustained health behaviour change in order to improve patient and population health outcomes. Behaviour change theories and interventions have been developed and evaluated in experimental contexts; however, most healthcare providers have little training, and therefore low confidence in, behaviour change counselling. Particularly important is how to integrate theory and method to support healthcare providers to engage in behaviour change counselling competently. In this article, we describe a general training model developed from theory, evidence, experience and stakeholder engagement. This model will set the stage for future evaluation research on training needed to achieve competency, sustainability of competency, as well as effectiveness/cost-effectiveness of training in supporting behaviour change. A framework to support competency based training in behaviour change counselling is described in this article. This framework is designed to be integrative, sustainable, scalable and capable of being evaluated in follow-up studies. Effective training in behaviour change counselling is critical to meet the current and future healthcare needs of patients living with, or at risk of, chronic diseases. Increasing competency in establishing change-based relationships, assessing and promoting readiness to change, implementing behaviour modification and addressing psychosocial issues will be value added to the healthcare system. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  17. Preface. Forest ecohydrological processes in a changing environment. (United States)

    Xiaohua Wei; Ge Sun; James Vose; Kyoichi Otsuki; Zhiqiang Zhang; Keith Smetterm


    The papers in this issue are a selection of the presentations made at the second International Conference on Forests and Water in a Changing Environment. This special issue ‘Forest Ecohydrological Processes in a Changing Environment’ covers the topics regarding the effects of forest, land use and climate changes on ecohydrological processes across forest stand,...

  18. Legal Research in a Changing Information Environment

    African Journals Online (AJOL)


    opportunities for research into constitutional issues, constitutional development and the relationship ... Legal research is a fundamental skill in the legal profession.9 Although all areas of law do not require ..... 1999 Legal RSQ 78. 56 In the print information environment lawyers use standard citation formats, e.g. X v Z 1999.

  19. Leadership and transformational change in healthcare organisations: a qualitative analysis of the North East Transformation System. (United States)

    Erskine, Jonathan; Hunter, David J; Small, Adrian; Hicks, Chris; McGovern, Tom; Lugsden, Ed; Whitty, Paula; Steen, Nick; Eccles, Martin Paul


    The research project 'An Evaluation of Transformational Change in NHS North East' examines the progress and success of National Health Service (NHS) organisations in north east England in implementing and embedding the North East Transformation System (NETS), a region-wide programme to improve healthcare quality and safety, and to reduce waste, using a combination of Vision, Compact, and Lean-based Method. This paper concentrates on findings concerning the role of leadership in enabling tranformational change, based on semi-structured interviews with a mix of senior NHS managers and quality improvement staff in 14 study sites. Most interviewees felt that implementing the NETS requires committed, stable leadership, attention to team-building across disciplines and leadership development at many levels. We conclude that without senior leader commitment to continuous improvement over a long time scale and serious efforts to distribute leadership tasks to all levels, healthcare organisations are less likely to achieve positive changes in managerial-clinical relations, sustainable improvements to organisational culture and, ultimately, the region-wide step change in quality, safety and efficiency that the NETS was designed to deliver. © The Author(s) 2013 Reprints and permissions:

  20. Applying psychological frameworks of behaviour change to improve healthcare worker hand hygiene: a systematic review. (United States)

    Srigley, J A; Corace, K; Hargadon, D P; Yu, D; MacDonald, T; Fabrigar, L; Garber, G


    Despite the importance of hand hygiene in preventing transmission of healthcare-associated infections, compliance rates are suboptimal. Hand hygiene is a complex behaviour and psychological frameworks are promising tools to influence healthcare worker (HCW) behaviour. (i) To review the effectiveness of interventions based on psychological theories of behaviour change to improve HCW hand hygiene compliance; (ii) to determine which frameworks have been used to predict HCW hand hygiene compliance. Multiple databases and reference lists of included studies were searched for studies that applied psychological theories to improve and/or predict HCW hand hygiene. All steps in selection, data extraction, and quality assessment were performed independently by two reviewers. The search yielded 918 citations; seven met eligibility criteria. Four studies evaluated hand hygiene interventions based on psychological frameworks. Interventions were informed by goal setting, control theory, operant learning, positive reinforcement, change theory, the theory of planned behaviour, and the transtheoretical model. Three predictive studies employed the theory of planned behaviour, the transtheoretical model, and the theoretical domains framework. Interventions to improve hand hygiene adherence demonstrated efficacy but studies were at moderate to high risk of bias. For many studies, it was unclear how theories of behaviour change were used to inform the interventions. Predictive studies had mixed results. Behaviour change theory is a promising tool for improving hand hygiene; however, these theories have not been extensively examined. Our review reveals a significant gap in the literature and indicates possible avenues for novel research. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.

  1. Resilience of livestock to changing environments (United States)

    The Breeding and Genetics Symposium titled “Resilience of Livestock to Changing Environments” was held at the Joint Annual Meeting, July 19–24, 2016, Salt Lake City, UT. The objective of the symposium was to provide a broad overview of recent research on the effects of changing environmental conditi...

  2. The paradox of lean in healthcare: Stable processes in a reactive environment

    DEFF Research Database (Denmark)

    Nielsen, Anders Paarup; Edwards, Kasper


    a limited set of tools has been used and the productivity gains are limited focusing on peripheral activities and not the core medical activities. This apparent problem with lean in health care is hypothesized to be caused by 1) the nature of healthcare work, 2) the rationality and notion of validity among...

  3. Demographics and the Changing National Security Environment

    National Research Council Canada - National Science Library


    .... Long- term fertility trends, urbanization, migration, and changes in the ethnic composition and age profile of populations can influence the likelihood and nature of conflict among and within nations...

  4. Value for money of changing healthcare services? Economic evaluation of quality improvement (United States)

    Severens, J



 There are many instances of perceived or real inefficiencies in health service delivery. Both healthcare providers and policy makers need to know the impact and cost of applying strategies to change the behaviour of individuals or organisations. Quality improvement or implementation research is concerned with evaluating the methods of behavioural change. Addressing inefficiencies in healthcare services raises a series of issues, beginning with how inefficiency itself should be defined. The basic concepts of cost analysis and economic evaluations are explained and a model for working through the economic issues of quality improvement is discussed. This model combines the costs and benefits of corrected inefficiency with the costs and degree of behavioural change achieved by a quality improvement method in the policy maker's locality. It shows why it may not always be cost effective for policy makers to address suboptimal behaviour. Both the interpretation of quality improvement research findings and their local application need careful consideration. The limited availability of applicable quality improvement research may make it difficult to provide robust advice on the value for money of many behavioural quality improvement strategies. PMID:14532369

  5. Development, energy, environment: changing the paradigm

    International Nuclear Information System (INIS)


    A first set of contributions comments the various risks and challenges which are to be faced in terms of energy, climate and environment: the deadlock of present 'laisser-faire' policies, recent findings in climate science in 2005, oil as the reason of a possible economic crisis in developing countries, recent evolution of energy systems. The next set of contributions discusses the possible solutions and their limits: CO 2 capture and sequestration in coal plants, nuclear renaissance, renewable energies, hydro-electricity, CO 2 capture by biomass, energy sobriety, urban morphology and transports in emerging cities, integration of service demand with energy supply, energy decentralized production

  6. The use of external change agents to promote quality improvement and organizational change in healthcare organizations: a systematic review. (United States)

    Alagoz, Esra; Chih, Ming-Yuan; Hitchcock, Mary; Brown, Randall; Quanbeck, Andrew


    External change agents can play an essential role in healthcare organizational change efforts. This systematic review examines the role that external change agents have played within the context of multifaceted interventions designed to promote organizational change in healthcare-specifically, in primary care settings. We searched PubMed, CINAHL, Cochrane, Web of Science, and Academic Search Premier Databases in July 2016 for randomized trials published (in English) between January 1, 2005 and June 30, 2016 in which external agents were part of multifaceted organizational change strategies. The review was conducted according to PRISMA guidelines. A total of 477 abstracts were identified and screened by 2 authors. Full text articles of 113 studies were reviewed. Twenty-one of these studies were selected for inclusion. Academic detailing (AD) is the most prevalently used organizational change strategy employed as part of multi-component implementation strategies. Out of 21 studies, nearly all studies integrate some form of audit and feedback into their interventions. Eleven studies that included practice facilitation into their intervention reported significant effects in one or more primary outcomes. Our results demonstrate that practice facilitation with regular, tailored follow up is a powerful component of a successful organizational change strategy. Academic detailing alone or combined with audit and feedback alone is ineffective without intensive follow up. Provision of educational materials and use of audit and feedback are often integral components of multifaceted implementation strategies. However, we didn't find examples where those relatively limited strategies were effective as standalone interventions. System-level support through technology (such as automated reminders or alerts) is potentially helpful, but must be carefully tailored to clinic needs.

  7. Use of geographic indicators of healthcare, environment and socioeconomic factors to characterize environmental health disparities. (United States)

    Padilla, Cindy M; Kihal-Talantikit, Wahida; Perez, Sandra; Deguen, Severine


    An environmental health inequality is a major public health concern in Europe. However just few studies take into account a large set of characteristics to analyze this problematic. The aim of this study was to identify and describe how socioeconomic, health accessibility and exposure factors accumulate and interact in small areas in a French urban context, to assess environmental health inequalities related to infant and neonatal mortality. Environmental indicators on deprivation index, proximity to high-traffic roads, green space, and healthcare accessibility were created using the Geographical Information System. Cases were collected from death certificates in the city hall of each municipality in the Nice metropolitan area. Using the parental addresses, cases were geocoded to their census block of residence. A classification using a Multiple Component Analysis following by a Hierarchical Clustering allow us to characterize the census blocks in terms of level of socioeconomic, environmental and accessibility to healthcare, which are very diverse definition by nature. Relation between infant and neonatal mortality rate and the three environmental patterns which categorize the census blocks after the classification was performed using a standard Poisson regression model for count data after checking the assumption of dispersion. Based on geographic indicators, three environmental patterns were identified. We found environmental inequalities and social health inequalities in Nice metropolitan area. Moreover these inequalities are counterbalance by the close proximity of deprived census blocks to healthcare facilities related to mother and newborn. So therefore we demonstrate no environmental health inequalities related to infant and neonatal mortality. Examination of patterns of social, environmental and in relation with healthcare access is useful to identify census blocks with needs and their effects on health. Similar analyzes could be implemented and considered

  8. Healthcare Information Technology (HIT) in an Anti-Access (A2) and Area Denial (AD) Environment (United States)


    point for multiple sites to connect to each other so radiologists can read diagnostic images by managing firewall connections. The idea of multiple...learn from them.41 Although IBM’s Watson isn’t living up to the hype just yet, the artificial intelligent ( AI ) computer system is a precursor for a...on the ground can control a UAV with two passengers in it; one technician and one AI healthcare machine (Medical IBM Watson). Once the UAV lands

  9. Layer breeding programmes in changing production environments

    NARCIS (Netherlands)



    The housing and management of laying hens and their productivity has gone through enormous developments in the last century. Housing has changed from free-range systems, via battery cages to a variety of loose housing and different types of battery cages, and back to outdoor access systems.

  10. Protecting healthcare workers in an acute care environment during epidemics: lessons learned from the SARS outbreak

    Directory of Open Access Journals (Sweden)

    John Casken


    Full Text Available During the 2002-2003 the SARS outbreak resulted in 8,450 illnesses and 812 deaths. Out of these documented cases 1706 were among healthcare workers (HCWsThe purpose of this paper is to focus on and examine the details of infection control (IC measures and which of these measures appear to be the most effective in stopping disease spread. Historically, HCWs have had poor compliance with the use of IC measures prior to the SARS outbreak. A number of lessons were learned from the SARS epidemic that should be incorporated into healthcare institutions policies and procedures. They include the following: an emphasis on the correct and immediate use of IC measures; an increased focus on HCWs recognizing early perceived threats; healthcare institutions should mandate routine in-house education with periodic updates on IC measures; administrators need to acknowledge and encourage role models among staff; engineeringcontrols should be put in place to protect staff from pathogens; and finally, there should be clear and constant communication between administration and staff.

  11. An empirical study to determine factors that motivate and limit the implementation of ICT in healthcare environments. (United States)

    Gururajan, Raj; Hafeez-Baig, Abdul


    The maturity and usage of wireless technology has influenced health services, and this has raised expectations from users that healthcare services will become more affordable due to technology growth. There is increasing evidence to justify this expectation, as telehealth is becoming more and more prevalent in many countries. Thus, health services are now offered beyond the boundaries of traditional hospitals, giving rise to many external factors dictating their quality. This has led us to investigate the factors that motivate and limit the implementation of ICT applications in the healthcare domain. We used a mixed method approach with the qualitative aspects leading the quantitative aspects. The main reason for this approach was to understand and explore the domain through the qualitative aspects as we could be part of the discussion. Then we conducted a quantitative survey to extract more responses in order to justify the claims explored in the qualitative process. We found that there are a number of internal and external factors influencing ICT adoption in the healthcare environment so that services can be provided via ICT tools. These factors were grouped under factors contributing to improved outcomes, efficiency and the management of technology. We conceptualised that these three groups of factors drive ICT implementation to assure health services. The main lesson learned from this research was that Information Systems discipline needs to urgently consider health informatics as a serious growth area. We also found that as IS researchers, we need to 'mix' with the health environment in order to understand the environment and then develop suitable methods to answer posited research questions.

  12. Malaria healthcare policy change in Kenya: implications on sales and marketing of antimalarials. (United States)

    Ngure, Peter K; Nyaoke, Lorraine; Minja, David


    Malaria healthcare policy change in Kenya aimed at improving the control of malaria but faced a number of challenges in implementation related to marketing of the drugs. This research investigated the effect of the change of the national malaria policy on drug sales and strategic marketing responses of antimalarial pharmaceutical companies in Kenya. A descriptive cross-sectional design was employed to describe the existing state of antimalarials market in Kenya after the change of the malaria healthcare policy. Policy change did result in an increase in the sales of Coartem®. Novartis Pharma recorded a 97% growth in sales of Coartem® between 2003 and 2004. However, this increase was not experienced by all the companies. Further, SPs (which had been replaced as first-line therapy for malaria) registered good sales. In most cases, these sales were higher than the sales of Coartem®. Generally, the sales contribution of SPs and generic antimalarial medicines exceeded that of Coartem® for most distributors. The most common change made to marketing strategies by distributors (62.5%) was to increase imports of antimalarials. A total of 40% of the manufacturers preferred to increase their budgetary allocation for marketing activities. In view of the fact that continued sale of SP drugs and limited availability of AL poses the risk of increasing the incidence of malaria in Kenya, it is therefore, recommended that pharmacy surveillance systems be strengthened to ensure drugs that have been rendered non-viable or that prescription-only medicines are not sold contrary to the national guidelines.

  13. Healthcare waste management during disasters and its effects on climate change: Lessons from 2010 earthquake and cholera tragedies in Haiti. (United States)

    Raila, Emilia M; Anderson, David O


    Despite growing effects of human activities on climate change throughout the world, and global South in particular, scientists are yet to understand how poor healthcare waste management practices in an emergency influences the climate change. This article presents new findings on climate change risks of healthcare waste disposal during and after the 2010 earthquake and cholera disasters in Haiti. The researchers analysed quantities of healthcare waste incinerated by the United Nations Mission in Haiti for 60 months (2009 to 2013). The aim was to determine the relationship between healthcare waste incinerated weights and the time of occurrence of the two disasters, and associated climate change effects, if any. Pearson product-moment correlation coefficient indicated a weak correlation between the quantities of healthcare waste disposed of and the time of occurrence of the actual emergencies (r (58) = 0.406, p = 0.001). Correspondingly, linear regression analysis indicated a relatively linear data trend (R 2 = 0.16, F (1, 58) = 11.42, P = 0.001) with fluctuating scenarios that depicted a sharp rise in 2012, and time series model showed monthly and yearly variations within 60 months. Given that the peak healthcare waste incineration occurred 2 years after the 2010 disasters, points at the need to minimise wastage on pharmaceuticals by improving logistics management. The Government of Haiti had no data on healthcare waste disposal and practised smoky open burning, thus a need for capacity building on green healthcare waste management technologies for effective climate change mitigation.

  14. Department Chairs as Change Agents: Leading Change in Resistant Environments (United States)

    Gaubatz, Julie A.; Ensminger, David C.


    Change process research often discusses barriers that impede organizational change (e.g., Banta, 1997; Cavacuiti and Locke, 2013; Mutchler, 1990; Stewart et al., 2012); however, no empirical research has addressed how behaviors established in leadership models counteract these barriers. This study explored these two interconnected constructs of…

  15. The changing winds of atmospheric environment policy

    International Nuclear Information System (INIS)

    Murray, Frank


    Highlights: ► Changes in atmosphere policies over several decades are analysed. ► Direct regulation is less effective and been complemented by other instruments. ► Policy approaches are more complex and integrated and the scale of the issues has evolved. ► The role of stakeholders has grown and the corporate sector has assumed increased responsibility. ► Governance arrangements have become more complex, multilevel and polycentric. -- Abstract: Atmospheric environmental policies have changed considerably over the last several decades. Clearly the relative importance of the various issues has changed over half a century, for example from smoke, sulphur dioxide and photochemical smog being the top priorities to greenhouse gases being the major priority. The traditional policy instrument to control emissions to the atmosphere has been command and control regulation. In many countries this was successful in reducing emissions from point sources, the first generation issues, and to a lesser extent, emissions from mobile and area sources, the second generation issues, although challenges remain in many jurisdictions. However once the simpler, easier, cheaper and obvious targets had been at least partially controlled this form of regulation became less effective. It has been complemented by other instruments including economic instruments, self-regulation, voluntarism and information instruments to address more complex issues including climate change, a third generation issue. Policy approaches to atmospheric environmental issues have become more complex. Policies that directly focus on atmospheric issues have been partially replaced by more integrated approaches that consider multimedia (water, land, etc.) and sustainability issues. Pressures from stakeholders for inclusion, greater transparency and better communication have grown and non-government stakeholders have become increasingly important participants in governance. The scale of the issues has evolved

  16. Changing the food environment: the French experience. (United States)

    Chauliac, Michel; Hercberg, Serge


    The French National Nutrition and Health Program was launched in 2001. To achieve its objectives, 2 main preventive strategies were identified: 1) provide information and education to help individuals make healthy food and physical activity choices; and 2) improve the food and physical environment so that making healthy choices is easier. School regulations have been established to improve the nutritional quality of meals served to children and adolescents, and vending machines have been banned. Since 2007, companies in France's food industry have had the option of signing the national government's "Charte d'engagement volontaire de progrès nutritionnel" (charter of commitments to nutritional improvements) which aims to benefit all consumers. A standard reference document, developed by public authorities as the basis for decisions made by a committee of experts in the food industry, aims to validate the voluntary commitments made by companies to improve the nutrient content of the foods they produce. There is strict follow-up. A Food Quality Observatory was created in 2009 to monitor the nutrient quality of the food supply in France. Various results show the positive impact of these actions.

  17. Fostering Entrepreneurship in a Changing Business Environment

    Directory of Open Access Journals (Sweden)

    Laurentiu Tachiciu


    Full Text Available Entrepreneurship is the cornerstone of a modern competitive economy. Because of the economic and social importance attributed to entrepreneurship, every country has adopted policies aiming to encourage and to support entrepreneurial attitudes and behaviors. Despite the fact that the set of public policy measures is very similar across countries and regions, the outcomes are different. The differences can be observed not only in quantitative terms (i.e. number of newly established ventures, but also in qualitative terms (i.e. proportion of innovative firms, intensity of knowledge and technological level, degree of internationalization etc.. Indeed, entrepreneurship takes different forms ranging from an alternative to employment (self-employed to creation of innovative, competitive and fast growing enterprises. It is also recognized the corporate entrepreneurship, the social entrepreneurship and even the entrepreneurship in the public sector. Different forms of entrepreneurship have a different impact in terms of general progress. Scholars have shown that context is an important factor explaining the variability of entrepreneurship outcomes, calling for a better understanding of the business environment influence on the intensity and quality of the entrepreneurial activity.

  18. The environment and directed technical change: comment

    International Nuclear Information System (INIS)

    Hourcade, Jean-Charles; Pottier, Antonin; Espagne, Etienne


    This paper discusses the growth model with environmental constraints recently presented in (Acemoglu et al., 2011) which focuses on the redirection of technical change by climate policies with research subsidies and a carbon tax. First, Acemoglu et al.'s model and chosen parameters yield numerical results that do not support the conclusion that ambitious climate policies can be conducted 'without sacrificing (much or any) long-run growth'. Second, they select unrealistic key parameters for carbon sinks and elasticity of substitution. We find that more realistic parameters lead to very different results. Third, the model leads to an unrealistic conclusion when used to analyse endogenous growth, suggesting specification problems. (authors)

  19. Response of Sphagna to the changing environment

    Energy Technology Data Exchange (ETDEWEB)

    Vasander, H. [Helsinki Univ. (Finland). Dept. of Forest Ecology; Jauhiainen, J.; Silvola, J. [Joensuu Univ. (Finland). Dept. of Biology; Karsisto, M. [Finnish Forest Research Inst., Vantaa (Finland)


    During last decade, considerable interest has been focused to assess the influence of human activities on ecosystems. The increasing trend in the atmospheric concentration of CO{sub 2} has been predicted to continue till the next century and the amount of nitrogen deposition in the northern hemisphere has increased markedly. Substantial interest has been focused on predicting how these changes will affect on plants. Most boreal mire ecosystems are dominated by mosses of the genus Sphagnum, the litter of which constitutes the main component in the peat deposits and is an important CO{sub 2} sink via peat formation. Since virtually nothing was known about the growth response of peat mosses to elevated concentrations of CO{sub 2} and alerting changes in species composition were detected in the sensitive ombrotrophic mire vegetation under increased N deposition in central Europe, this study was established. Laboratory experiments focused on measurements of the patterns of growth, production and plant metabolism at increased CO{sub 2} and N deposition levels in peat moss species. Long term field experiments were established to study the growth response and spatial competition of two interacting Sphagnum species under the increased nitrogen deposition levels

  20. Response of Sphagna to the changing environment

    Energy Technology Data Exchange (ETDEWEB)

    Vasander, H [Helsinki Univ. (Finland). Dept. of Forest Ecology; Jauhiainen, J; Silvola, J [Joensuu Univ. (Finland). Dept. of Biology; Karsisto, M [Finnish Forest Research Inst., Vantaa (Finland)


    During last decade, considerable interest has been focused to assess the influence of human activities on ecosystems. The increasing trend in the atmospheric concentration of CO{sub 2} has been predicted to continue till the next century and the amount of nitrogen deposition in the northern hemisphere has increased markedly. Substantial interest has been focused on predicting how these changes will affect on plants. Most boreal mire ecosystems are dominated by mosses of the genus Sphagnum, the litter of which constitutes the main component in the peat deposits and is an important CO{sub 2} sink via peat formation. Since virtually nothing was known about the growth response of peat mosses to elevated concentrations of CO{sub 2} and alerting changes in species composition were detected in the sensitive ombrotrophic mire vegetation under increased N deposition in central Europe, this study was established. Laboratory experiments focused on measurements of the patterns of growth, production and plant metabolism at increased CO{sub 2} and N deposition levels in peat moss species. Long term field experiments were established to study the growth response and spatial competition of two interacting Sphagnum species under the increased nitrogen deposition levels

  1. Sensitizing health-care workers and trainees to create a nondiscriminatory health-care environment for surgical care of HIV-Infected patients

    Directory of Open Access Journals (Sweden)

    Deeptiman James


    Full Text Available Background: Occupational risk of human immunodeficiency virus (HIV transmission creates barriers in the surgical health care of patients with HIV infection. Poor awareness, prevalent misconceptions, and associated stigma lead to discrimination against HIV-infected patients. This study was carried out to assess effectiveness of a “HIV awareness program” (HAP to educate and motivate health-care workers to provide equitable and ethical health care to HIV-infected patients. Methodology: An interventional study was conducted at a secondary level mission hospital in Central India from April 2014 to August 2015. Change in knowledge, awareness, and attitude following a multimedia “HAP” was analyzed with a “pre- and posttest design.” Seventy-four staffs and trainees participated in the program. Z-test and t-test were used to check the statistical significance of the data. Results: The mean pretest score was 19.31 (standard deviation [SD]: 6.0, 95% confidence interval [CI]: 17.923–20.697 and the mean posttest score was 30.84 (SD: 4.8, 95% CI: 29.714–31.966. This difference was statistically significant at the 5% level with P < 0.001. Conclusions: “HAP” was effective in changing the knowledge, awareness, and attitude of the staffs and trainees of the secondary hospital toward surgical care of HIV-infected patients.

  2. Essays in energy, environment and technological change (United States)

    Zhou, Yichen Christy

    This dissertation studies technological change in the context of energy and environmental economics. Technology plays a key role in reducing greenhouse gas emissions from the transportation sector. Chapter 1 estimates a structural model of the car industry that allows for endogenous product characteristics to investigate how gasoline taxes, R&D subsidies and competition affect fuel efficiency and vehicle prices in the medium-run, both through car-makers' decisions to adopt technologies and through their investments in knowledge capital. I use technology adoption and automotive patents data for 1986-2006 to estimate this model. I show that 92% of fuel efficiency improvements between 1986 and 2006 were driven by technology adoption, while the role of knowledge capital is largely to reduce the marginal production costs of fuel-efficient cars. A counterfactual predicts that an additional 1/gallon gasoline tax in 2006 would have increased the technology adoption rate, and raised average fuel efficiency by 0.47 miles/gallon, twice the annual fuel efficiency improvement in 2003-2006. An R&D subsidy that would reduce the marginal cost of knowledge capital by 25% in 2006 would have raised investment in knowledge capital. This subsidy would have raised fuel efficiency only by 0.06 miles/gallon in 2006, but would have increased variable profits by 2.3 billion over all firms that year. Passenger vehicle fuel economy standards in the United States will require substantial improvements in new vehicle fuel economy over the next decade. Economic theory suggests that vehicle manufacturers adopt greater fuel-saving technologies for vehicles with larger market size. Chapter 2 documents a strong connection between market size, measured by sales, and technology adoption. Using variation consumer demographics and purchasing pattern to account for the endogeneity of market size, we find that a 10 percent increase in market size raises vehicle fuel efficiency by 0.3 percent, as compared

  3. Asian Urban Environment and Climate Change: Preface. (United States)

    Hunt, Julian; Wu, Jianping


    The Asian Network on Climate Science and Technology (, in collaboration with Tsinghua University, held a conference on environmental and climate science, air pollution, urban planning and transportation in July 2015, with over 40 Asian experts participating and presentation. This was followed by a meeting with local government and community experts on the practical conclusions of the conference. Of the papers presented at the conference a selection are included in this special issue of Journal of Environmental Science, which also reflects the conclusions of the Paris Climate meeting in Dec 2015, when the major nations of the world agreed about the compelling need to reduce the upward trend of adverse impacts associated with global climate change. Now is the time for urban areas to work out the serious consequences for their populations, but also how they should work together to take action to reduce global warming to benefit their own communities and also the whole planet! Copyright © 2017. Published by Elsevier B.V.

  4. Students perceive healthcare as a valuable learning environment when accepted as a part of the workplace community. (United States)

    Hägg-Martinell, Ann; Hult, Håkan; Henriksson, Peter; Kiessling, Anna


    The healthcare system is complex and the education of medical and nursing students is not always a priority within it. However, education offered at the point of care provides students with opportunities to apply knowledge, and to develop the necessary skills and attitudes needed to practice their future profession. The major objective of this study was to identify students' views of generic aspects of the healthcare environment that influences their progress towards professional competence. We collected free text answers of 75 medical students and 23 nursing students who had completed an extensive questionnaire concerning their learning in clinical wards. In order to obtain richer data and a deeper understanding, we also interviewed a purposive sample of students. Qualitative content analysis was conducted. We identified three themes: (1) How management, planning and organising for learning enabled content and learning activities to relate to the syllabus and workplace, and how this management influenced space and resources for supervision and learning; (2) Workplace culture elucidated how hierarchies and communication affected student learning and influenced their professional development and (3) Learning a profession illustrated the importance of supervisors' approaches to students, their enthusiasm and ability to build relationships, and their feedback to students on performance. From a student perspective, a valuable learning environment is characterised as one where management, planning and organising are aligned and support learning. Students experience a professional growth when the community of practice accepts them, and competent and enthusiastic supervisors give them opportunities to interact with patients and to develop their own responsibilities.

  5. Gaseous and air decontamination technologies for Clostridium difficile in the healthcare environment. (United States)

    Davies, A; Pottage, T; Bennett, A; Walker, J


    The recent data for hospital-acquired infections suggest that infection rates for meticillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile are beginning to decrease. However, while there is still pressure to maintain this trend, the resistance of C. difficile spores to standard detergents continues to present a problem for many UK hospitals trying to prevent its spread or control outbreaks. Alternative disinfection technologies such as gaseous decontamination are currently being marketed to the healthcare sector as an alternative/supplement to manual disinfection, and have been shown to be effective in reducing environmental contamination. When used correctly, they offer a complementary technology to manual cleaning that increases the probability of an effective reduction in viability and provides a comparatively uniform distribution of disinfectant. Three gaseous decontamination technologies are examined for their suitability in reducing environmental contamination with C. difficile: gaseous hydrogen peroxide, chlorine dioxide and ozone. Air decontamination and UV-based technologies are also briefly described. We conclude that while there is a role to play for these new technologies in the decontamination of ward surfaces contaminated with C. difficile, the requirement for both a preclean before use and the limited 'in vivo' evidence means that extensive field trials are necessary to determine their cost-effectiveness in a healthcare setting. Copyright © 2010 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved.


    Directory of Open Access Journals (Sweden)

    Elena DOVAL


    Full Text Available The changes in organizations appear as a reaction to the organizational environment changes. In order to manage these changes successfully, the managers need to anticipate and design alternative strategies by preparing different options.  Nevertheless, the complexity of the global environment forces the managers to adopt strategies for their organizations that are facilitating the creation of new strategic competences and competitive advantages to face the environmental rapid changes. In this context, this paper is aiming to illustrate the main directions the change management may consider to change the organization strategies in order to harmonize them to the external environment, such as: integration versus externalization, flexible specialization and flexible organization, standardization versus adaptation, market segmentation, relationship building and maintaining and communication integration.  However, the new strategies are based on a changed attitude of the managers towards the competitive advantage that is dynamic and focused on creation rather then to operations.

  7. [Austerity policies and changes in healthcare use patterns. SESPAS report 2014]. (United States)

    Urbanos Garrido, Rosa; Puig-Junoy, Jaume


    This article analyzes the main changes in healthcare use patterns in Spain related to the economic recession and to the measures taken to address it. The impact of the reform of drug copayment is examined; the number of prescriptions has decreased, although the effects of this reform on adherence, access to necessary and effective treatments, and health, are still unknown. This article also describes how waiting times and waiting lists for surgery have increased in recent years, as has the population's dissatisfaction with the national health system. Analysis of microdata from the Spanish national health surveys for 2006 and 2011/12 show that the economic recession is deterring the use of uncovered dental visits among the lowest social class. We recommend clearer definition of the role played by copayments within the national health system, and focussing on those who most need healthcare in order to prevent the more socioeconomically advantaged collectives from consuming a larger share of available services after the cuts. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

  8. Rethinking Healthcare Transitions and Policies: Changing and Expanding Roles in Transitional Care (United States)

    Moreño, Patricienn K.


    The breakdown of care transitions between various healthcare facilities, providers, and services is a major issue in healthcare, and accounts for over US$15 billion in healthcare expenditures annually. The transition between inpatient care and home care is a very delicate period where, too often, chronically ill patients get worse and wind up back…

  9. Climate change adaptation of the built environment – an examination

    DEFF Research Database (Denmark)

    Majgaard Krarup, Jonna


    phenomena. This is why the term 'environmental changes' might be more accurate than climate change. ‘Environmental changes’ suggests that climate changes ought to be understood as extensive environmental changes, with an impact on the built environment. Following this, it is no longer sufficient only...... to assess for example a building, and anthropogenic impacts on the environment, also the impact of the environment on installations, and on the human activities must be included in the analysis and assessments. Based on observations and investigations into climate change adaptation in DK and abroad......In a Danish context, climate changes are primarily manifested in an interaction between modified wind and precipitation patterns, increasing temperature and a rising sea level. The individual factors often act together and are reinforced in interaction with already known natural and cultural...

  10. An ICT-Based Platform to Monitor Protocols in the Healthcare Environment. (United States)

    Rorís, Víctor M Alonso; Gago, Juan M Santos; Sabucedo, Luis Álvarez; Merino, Mateo Ramos; Valero, Javier Sanz


    Procedures from the healthcare domain involve highly critical actions as they may pose a risk for patients' life. Therefore, a large effort is devoted to the standardization in clinical praxis and to the control of quality for these protocols in order to minimize hazards. In this line, this work is compelled to provide an ICT-based support to carry out these controls in a simple and effective manner. Using a methodology based on HACCP and taking advantage of Semantic tools, a holistic platform of services for traceability and control of processes has been designed and implemented. The applied paradigm is based on the use of Control Points as singular points to generate traces using observations and measures relevant for the processes considered. Based on those, it is possible to offer services for advanced querying and knowledge inference. The local deployment just requires regular mobile phones or tablets making this solution cost-effective and easily replicable.

  11. Let’s be effective, let the patients talk! Does ‘patient intelligence’ have an effect on improvements in quality within the healthcare environment?

    Directory of Open Access Journals (Sweden)

    Nadine van Dongen


    Full Text Available Nadine van DongenVan Dongen Research Ltd, London, UKAbstract: This paper examines the interaction of patients within the context of efficiency in the pharmaceutical environment. Measurements of quality standards in healthcare are reviewed with an emphasis on the question of whether ‘patient intelligence’ can improve quality standards in healthcare. Something given particular consideration is the ethical point of view versus the business point of view, in relation to the integration of patients into the decision-making process of a healthcare organization. The paper focuses on the formal and informal reasons for involvement of patients in corporate and/or market access strategies for healthcare organizations.Keywords: healthcare, decision-making process, efficiency, patient intelligence, patients

  12. Public health safety and environment in inadequate hospital and healthcare settings: a review. (United States)

    Baguma, D


    Public health safety and environmental management are concerns that pose challenges worldwide. This paper briefly assesses a selected impact of the environment on public health. The study used an assessment of environmental mechanism to analyse the underlying different pathways in which the health sector is affected in inadequate hospital and health care settings. We reviewed the limited available evidence of the association between the health sector and the environment, and the likely pathways through which the environment influences health. The paper also models the use of private health care as a function of costs and benefits relative to public care and no care. The need to enhancing policies to improve the administration of health services, strengthening interventions on environment using international agreements, like Rio Conventions, including measures to control hospital-related infection, planning for human resources and infrastructure construction development have linkage to improve environment care and public health. The present study findings partly also demonstrate the influence of demand for health on the environment. The list of possible interventions includes enhancing policies to improve the administration of health services, strengthening Rio Conventions implementation on environmental concerns, control of environmental hazards and public health. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  13. Change Management and its Influence in the Business Environment

    Directory of Open Access Journals (Sweden)

    Dr.Sc. Berim Ramosaj


    Full Text Available The changes that are happening in businesses dictate the changes in all kinds of needed resources to develop the organization. The environment in which the organizations operate is in constant change and becomes more and more unpredictable. Managing these changes is a challenge that all enterprises face. The rapid changes that are happening in business are increasing the need to manage these changes. Enterprises have to develop and use different kinds of management models so that they can grow their performance in order to ensure a competitive position in the market. The changes in enterprises sometimes are not accepted by the organization employees, and seem to have negative effects towards them (exemption from work, reduction of working hours, reduction of income. Changes have negative and positive effects. Successful and rational managers can achieve having successful changes and minimizing the negative effects that come due to changes. Changes are vital for organizations so that they can replace the old plans and models with new and successful ones. In this paper we talk about the role and importance of managing the changes, the types of changes, models of changes, the resistance against changes and also the obtained results of the paper are introduced. Literature was used to support the research in the study field, and based on that to explain the role of changes in the business environment. There are quantitative methods and an inductive analysis used in this paper.

  14. Public Agility and Change in a Network Environment

    Directory of Open Access Journals (Sweden)

    Tom van Engers


    Full Text Available Preparing for change is increasingly core business for governmental organizations. The networked society and the increasing connectedness of governmental organizations have as much impact on the complexity of the change process as the complexities of the corpus of law. Change is not only driven by changes in the law; changes in the organization’s environment often create a need to redesign business processes, reallocate roles and responsibilities, and reorder tasks. Moreover, preparations for change are not limited to the internal processes and systems of these organizations. Propagation of changes to network partners and redesign of network arrangements can be an enormous challenge. In the AGILE project, we develop a design method, distributed service architecture, and supporting tools that enable organizations - administrative and otherwise - to orchestrate their law-based services in a networked environment. This paper explains the Agile approach and describes some of its key principles.

  15. Health survey of U.S. long-haul truck drivers: work environment, physical health, and healthcare access. (United States)

    Apostolopoulos, Yorghos; Sönmez, Sevil; Shattell, Mona M; Gonzales, Clifford; Fehrenbacher, Caitlin


    While trucking in industrialized nations is linked with driver health afflictions, the role of trucking in U.S. truckers' health remains largely unknown. This paper sheds light on links between the trucking work environment and drivers' physical health. Using a cross-sectional design, 316 truckers were enrolled in the Healthy Trucker Survey. Questions included work history, physical and mental health, and healthcare access. PASW 18 was used to examine patterns among factors. 316 truckers participated. Respondents were mainly full-time, long-haul drivers with over 5 years of experience, and who spent over 17 days on the road per month. While almost 75% described their health as good, 83.4% were overweight/obese, 57.9% had sleeping disturbances, 56.3% fatigue, 42.3% musculoskeletal disorders, and about 40% cardiovascular disease concerns. About 33% had no health insurance, 70% had no regular healthcare visits, 24.4% could not afford insurance, and 42.1% took over-the-counter drugs when sick, while 20.1% waited to reach home for medical care. Exercise facilities were unavailable in over 70% of trucking worksites and 70% of drivers did not exercise regularly. The trucking occupation places drivers at high risk for poor health outcomes. Prospective studies are needed to delve into how continued exposure to trucking influences the progression of disease burden.

  16. Healthcare Providers' Formative Experiences with Race and Black Male Patients in Urban Hospital Environments. (United States)

    Plaisime, Marie V; Malebranche, David J; Davis, Andrea L; Taylor, Jennifer A


    We explored health providers' formative personal and professional experiences with race and Black men as a way to assess their potential influence on interactions with Black male patients. Utilizing convenience sampling with snowballing techniques, we identified healthcare providers in two urban university hospitals. We compared Black and White providers' experiences based on race and level of training. We used the Gardener's Tale to conceptualize how racism may lead to racial health disparities. A semi-structured interview guide was used to conduct in-person interviews (n = 16). Using the grounded theory approach, we conducted three types of coding to examine data patterns. We found two themes reflective of personally mediated racism: (1) perception of Black males accompanied by two subthemes (a) biased care and (b) fear and discomfort and (2) cognitive dissonance. While this latter theme is more reflective of Jones's internalized racism level, we present its results because its novelty is compelling. Perception of Black males and cognitive dissonance appear to influence providers' approaches with Black male patients. This study suggests the need to develop initiatives and curricula in health professional schools that address provider racial bias. Understanding the dynamics operating in the patient-provider encounter enhances the ability to address and reduce health disparities.

  17. Beyond Relational: A Database Architecture and Federated Query Optimization in a Multi-Modal Healthcare Environment (United States)

    Hylock, Ray Hales


    Over the past thirty years, clinical research has benefited substantially from the adoption of electronic medical record systems. As deployment has increased, so too has the number of researchers seeking to improve the overall analytical environment by way of tools and models. Although much work has been done, there are still many uninvestigated…

  18. A conceptual model for assessing the internal environment of a healthcare organization. (United States)

    Asubonteng, P


    By understanding the opportunities and threats in the external environment and relating them to the organization's internal strengths and weaknesses, strategic managers can determine the distinctive competence of the organization. Distinctive competence refers to the strengths that will give an organization a competitive advantage.

  19. The Changing Information Needs of Users in Electronic Information Environments. (United States)

    Kebede, Gashaw


    Focuses on the information needs of users that are changing as a results of changes in the availability of information content in electronic form. Highlights the trend and nature of the physical form in which information content is currently being made available for users' access and use in electronic information environments. (Author/LRW)

  20. Business environment change and decision making mechanism of nuclear generators

    International Nuclear Information System (INIS)

    Yamashita, Hiroko


    Change magnitude of business environment for Japanese nuclear generators is significant. It is rapidly growing in the last several years. There are possibilities that the change might impact to management model of nuclear generators. In the paper, the impact to management model, especially, decision making mechanism of the generators is discussed. (author)

  1. Evolving information systems: meeting the ever-changing environment

    NARCIS (Netherlands)

    Oei, J.L.H.; Proper, H.A.; Falkenberg, E.D.


    To meet the demands of organizations and their ever-changing environment, information systems are required which are able to evolve to the same extent as organizations do. Such a system has to support changes in all time-and application-dependent aspects. In this paper, requirements and a conceptual

  2. The European Gaucher Alliance: a survey of member patient organisations' activities, healthcare environments and concerns. (United States)

    Žnidar, Irena; Collin-Histed, Tanya; Niemeyer, Pascal; Parkkinen, Johanna; Lauridsen, Anne-Grethe; Zariņa, Sandra; Cohen, Yossi; Manuel, Jeremy


    The European Gaucher Alliance (EGA) was established in 1994 and constituted in 2008 as an umbrella group supporting patient organisations for Gaucher disease. Every two years, the EGA conducts a questionnaire survey of member associations to help develop its priorities and annual work programme. Results of the latest survey are presented. Between June 2012 and April 2013, the 36 members and associate members of the EGA were asked to complete a questionnaire detailing membership numbers, disease specific treatments used by patients, means of access to treatment, availability of treatment centres and home infusions, sources of support for patients with Gaucher disease, patient organisations' activities, collaborations, funding sources and any issues of concern. Questionnaires completed in 2012 were revised in January 2013 and responses analysed between July and September 2013. Thirty three members returned data on one or more questions. Findings identified inequalities in access to treatment both within and between members' countries. Three of 27 countries, for which data were available, relied totally on humanitarian aid for treatment and 6% of untreated patients in 20 countries were untreated because of funding issues, a situation many feared would worsen with deteriorating economic climates. Access to treatment and reimbursement represented 45% of members' concerns, while 35% related to access to specialist treatment centres, home infusions and doctors with expertise in Gaucher disease. Member associations' main activities centred on patient support (59% of responses) and raising awareness of Gaucher disease and patients' needs amongst the medical community, government and healthcare decision makers and the general public (34% of responses). Twenty one (78% of respondents) indicated they were the only source of help for Gaucher disease patients in their country. For many, activities were constrained by funds; two members had no external funding source. Activities

  3. NOSTOS: a paper-based ubiquitous computing healthcare environment to support data capture and collaboration. (United States)

    Bång, Magnus; Larsson, Anders; Eriksson, Henrik


    In this paper, we present a new approach to clinical workplace computerization that departs from the window-based user interface paradigm. NOSTOS is an experimental computer-augmented work environment designed to support data capture and teamwork in an emergency room. NOSTOS combines multiple technologies, such as digital pens, walk-up displays, headsets, a smart desk, and sensors to enhance an existing paper-based practice with computer power. The physical interfaces allow clinicians to retain mobile paper-based collaborative routines and still benefit from computer technology. The requirements for the system were elicited from situated workplace studies. We discuss the advantages and disadvantages of augmenting a paper-based clinical work environment.

  4. Extending the role of a healthcare digital library environment to support orthopaedic research. (United States)

    Miles-Board, Timothy; Carr, Leslie; Wills, Gary; Power, Guillermo; Bailey, Christopher; Hall, Wendy; Stenning, Matthew; Grange, Simon


    A digital archive, together with its users and its contents, does not exist in isolation; there is a cycle of activities which provides the context for the archive's existence. In arguing for the broadening of the traditional view of digital libraries as merely collections towards the processes of collecting and deploying, we have developed an extend ed digital library environment for orthopaedic surgeons which bridges the gap between the undertaking of experimental work and the dissemination of its results through electronic publication.

  5. The changing nature of relationships between parents and healthcare providers when a child dies in the paediatric intensive care unit. (United States)

    Butler, Ashleigh E; Hall, Helen; Copnell, Beverley


    To explore bereaved parents' interactions with healthcare providers when a child dies in a paediatric intensive care unit. Although most children admitted to a paediatric intensive care unit will survive, 2-5% will die during their stay. The parents of these children interact and form relationships with numerous healthcare staff during their child's illness and death. Although previous studies have explored the parental experience of child death in intensive care generally, the nature of their relationships with healthcare providers during this time remains unknown. This study used a constructivist grounded theory approach. Data were collected via semi-structured, audio-recorded interviews with 26 bereaved parents from four paediatric intensive care units over 18 months in 2015-2016. Constant comparative analysis and theoretical memos were used to analyse the data. The theory "Transitional togetherness" demonstrates the changing nature of the parent-healthcare provider relationship across three key phases of the parents' journey. Phase one, "Welcoming expertise," focuses on the child's medical needs, with the healthcare provider dominant in the relationship. Phase two, "Becoming a team," centres around the parents' need to recreate a parental role and work collaboratively with healthcare providers. Finally, "Gradually disengaging" describes the parents' desire for the relationship to continue after the child's death as a source of support until no longer needed. Findings from this study offer valuable insights into the changing nature of the parent-healthcare provider relationship and highlight the key foci of the relationship at each stage of the parental journey. © 2017 John Wiley & Sons Ltd.

  6. Perspectives on the changing healthcare system: teaching systems-based practice to medical residents

    Directory of Open Access Journals (Sweden)

    Johanna Martinez


    Full Text Available Purpose: The Accreditation Council for Graduate Medical Education restructured its accreditation system to be based on educational outcomes in six core competencies. Systems-based practice is one of the six core competencies. The purpose of this report is to describe Weill Cornell Medical College's Internal Medicine Residency program curriculum for systems-based practice (SBP and its evaluation process. Methods: To examine potential outcomes of the POCHS curriculum, an evaluation was conducted, examining participants': (1 knowledge gain; (2 course ratings; and (3 qualitative feedback. Results: On average, there was a 19 percentage point increase in knowledge test scores for all three cohorts. The course was rated overall highly, receiving an average of 4.6 on a 1–5 scale. Lastly, the qualitative comments supported that the material is needed and valued. Conclusion: The course, entitled Perspectives on the Changing Healthcare System (POCHS and its evaluation process support that systems-based practice is crucial to residency education. The course is designed not only to educate residents about the current health care system but also to enable them to think critically about the risk and benefits of the changes. POCHS provides a framework for teaching and assessing this competency and can serve as a template for other residency programs looking to create or restructure their SBP curriculum.

  7. Towards changing healthcare workers' behaviour: a qualitative study exploring non-compliance through appraisals of infection prevention and control practices. (United States)

    Shah, N; Castro-Sánchez, E; Charani, E; Drumright, L N; Holmes, A H


    Improving behaviour in infection prevention and control (IPC) practice remains a challenge, and understanding the determinants of healthcare workers' (HCWs) behaviour is fundamental to develop effective and sustained behaviour change interventions. To identify behaviours of HCWs that facilitated non-compliance with IPC practices, focusing on how appraisals of IPC duties and social and environmental circumstances shaped and influenced non-compliant behaviour. This study aimed to: (1) identify how HCWs rationalized their own behaviour and the behaviour of others; (2) highlight challenging areas of IPC compliance; and (3) describe the context of the working environment that may explain inconsistencies in IPC practices. Clinical staff at a National Health Service hospital group in London, UK were interviewed between December 2010 and July 2011 using qualitative methods. Responses were analysed using a thematic framework. Three ways in which HCWs appraised their behaviour were identified through accounts of IPC policies and practices: (1) attribution of responsibilities, with ambiguity about responsibility for certain IPC practices; (2) prioritization and risk appraisal, which demonstrated a divergence in values attached to some IPC policies and practices; and (3) hierarchy of influence highlighted that traditional clinical roles challenged work relationships. Overall, behaviours are not entirely independent of policy rules, but often an amalgamation of local normative practices, individual preferences and a degree of professional isolation. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  8. Preparing for climate change impacts in Norway's built environment

    International Nuclear Information System (INIS)

    Robert Lisoe, K.; Aandahl, G.; Eriksen, S.; Alfsen, K.


    This paper provides an overview of the Norwegian climate policy and of the practical implications of preparing Norway for climate change, with special emphasis on the challenges confronting the built environment. Although the Norwegian government has been relatively proactive in instituting measures aimed at halting global climate change, less attention has been paid to the challenge of adapting to climate change. The global climate system is likely to undergo changes, regardless of the implementation of abatement policies under the Kyoto Protocol or other regimes. The full range of impacts resulting from these changes is still uncertain; however, it is becoming increasingly clear that adaptation to climate change is necessary and inevitable within several sectors. The potential impacts of climate change in the built environment are now being addressed. Both the functionality of the existing built environment and the design of future buildings are likely to be altered by climate change impacts, and the expected implications of these new conditions are now investigated. However, measures aimed at adjustments within individual sectors, such as altering the criteria and codes of practice for the design and construction of buildings, constitute only a partial adaptation to climate change. In order to adapt effectively, larger societal and intersectoral adjustments are necessary. (author)

  9. Agile development as a change management approach in Healthcare Innovation Projects

    NARCIS (Netherlands)

    Velthuijsen, Hugo; Balje, Jan; Carter, Anke


    Although many pilots with new eHealth products have been developed, only very few of these products reach widespread adoption within healthcare organisations. The literature mentions a wide range of bottlenecks for the acceptance of new technology in the healthcare industry, among which insufficient

  10. Improvising in the Vulnerable Encounter: Using Improvised Participatory Theatre in Change for Healthcare Practice (United States)

    Larsen, Henry; Friis, Preben; Heape, Chris


    Healthcare practitioners are often presented with vulnerable encounters where their professional experience is insufficient when dealing with patients who suffer from illnesses such as chronic pain. How can one otherwise understand chronic pain and develop practices whereby medical healthcare practitioners can experience alternative ways of doing…

  11. The role of the physical environment in conversations between people who are communication vulnerable and health-care professionals: a scoping review. (United States)

    Stans, Steffy E A; Dalemans, Ruth J P; de Witte, Luc P; Smeets, Hester W H; Beurskens, Anna J


    The role of the physical environment in communication between health-care professionals and persons with communication problems is a neglected area. This study provides an overview of factors in the physical environment that play a role in communication during conversations between people who are communication vulnerable and health-care professionals. A scoping review was conducted using the methodological framework of Arksey and O'Malley. The PubMed, PsycINFO, CINAHL and Cochrane Library databases were screened, and a descriptive and thematic analysis was completed. Sixteen publications were included. Six factors in the physical environment play a role in conversations between people who are communication vulnerable and health-care professionals: (1) lighting, (2) acoustic environment, (3) humidity and temperature, (4) setting and furniture placement, (5) written information, and (6) availability of augmentative and alternative communication (AAC) tools. These factors indicated barriers and strategies related to the quality of these conversations. Relatively small and simple strategies to adjust the physical environment (such as adequate lighting, quiet environment, providing pen and paper) can support people who are communication vulnerable to be more involved in conversations. It is recommended that health-care professionals have an overall awareness of the potential influence of environmental elements on conversations. Implications for rehabilitation The physical environment is an important feature in the success or disturbance of communication. Small adjustments to the physical environment in rehabilitation can contribute to a communication-friendly environment for conversations with people who are communication vulnerable. Professionals should consider adjustments with regard to the following factors in the physical environment during conversations with people who are communication vulnerable: lighting, acoustic environment, humidity and temperature, setting

  12. An IoT-Based Computational Framework for Healthcare Monitoring in Mobile Environments

    Directory of Open Access Journals (Sweden)

    Higinio Mora


    Full Text Available The new Internet of Things paradigm allows for small devices with sensing, processing and communication capabilities to be designed, which enable the development of sensors, embedded devices and other ‘things’ ready to understand the environment. In this paper, a distributed framework based on the internet of things paradigm is proposed for monitoring human biomedical signals in activities involving physical exertion. The main advantages and novelties of the proposed system is the flexibility in computing the health application by using resources from available devices inside the body area network of the user. This proposed framework can be applied to other mobile environments, especially those where intensive data acquisition and high processing needs take place. Finally, we present a case study in order to validate our proposal that consists in monitoring footballers’ heart rates during a football match. The real-time data acquired by these devices presents a clear social objective of being able to predict not only situations of sudden death but also possible injuries.

  13. An IoT-Based Computational Framework for Healthcare Monitoring in Mobile Environments. (United States)

    Mora, Higinio; Gil, David; Terol, Rafael Muñoz; Azorín, Jorge; Szymanski, Julian


    The new Internet of Things paradigm allows for small devices with sensing, processing and communication capabilities to be designed, which enable the development of sensors, embedded devices and other 'things' ready to understand the environment. In this paper, a distributed framework based on the internet of things paradigm is proposed for monitoring human biomedical signals in activities involving physical exertion. The main advantages and novelties of the proposed system is the flexibility in computing the health application by using resources from available devices inside the body area network of the user. This proposed framework can be applied to other mobile environments, especially those where intensive data acquisition and high processing needs take place. Finally, we present a case study in order to validate our proposal that consists in monitoring footballers' heart rates during a football match. The real-time data acquired by these devices presents a clear social objective of being able to predict not only situations of sudden death but also possible injuries.


    Directory of Open Access Journals (Sweden)

    Tomasz Wołowiec


    Full Text Available Local government units (LGU are nowadays facing the very difficult and complicated task of making reasonable decisions regarding the transforming of SPZOZs into capital companies. First, it seems necessary to carry out a simulation of costs and advantages of the assumed models and solutions together with an analysis of advantages and disadvantages of the new legal and organisational forms. The aim of this paper is to assess whether the process of transforming SPZOZs into capital companies is purposeful and reasonable, and to define a way to prepare hospitals for functioning in an altered legislative environment. The paper draws attention to the fact that transformation itself does not guarantee that the results achieved by the given entity will automatically improve. The transformation can bring financial advantages for the newly created company and the local government, from the subsidies and remissions in accordance with art. 197 of the act on medical activity. Yet the conditions for getting such help are quite restrictive and not in every situation can financial help from the central budget be counted on. Such aid could help improve the financial standing of a hospital considerably. Also, it must be remembered that a hospital transformed into a capital company acquires the capacity to go bankrupt. If the new entity generates a loss, it may result in the owner having to raise the initial capital in order to avoid filing a bankruptcy petition by the company. In practice, the financial consequences for the local government are the same as in the case of having to cover losses. The difference lies in the continuity of the provided medical services.

  15. The case for regulatory reform in the business and healthcare environments. (United States)

    Younis, Mustafa Z; Barhem, Belal; Hamidi, Samir; Inungu, Joseph; Prater, Gwendolyn S; O'Keefe, Arthur


    Government regulations affect corporations and consumers on a daily basis. For example, environmental and safety regulations in the workplace are administrated by the Occupational Safety and Health Administration (OSHA) under the Department of Labor. OSHA sets and enforces standards in work environment to ensure the safety and health of workers. Other regulatory agencies, such as the National Highway and Transportation Agency (NHTSA), oversee the transportation and the safety of the automobile and truck industry. The U.S. Food and Drug Administration (FDA) plays a major role in approving new drugs on the market and in monitoring drug safety, and it has the power to remove drugs from the market if they are proved to be safety and health problems to the public. However, the mere existence of these regulations often causes impediments to businesses, and the extent of their ultimate usefulness is examined and analyzed in this paper

  16. Is the public healthcare sector a more strenuous working environment than the private sector for a physician? (United States)

    Heponiemi, Tarja; Kouvonen, Anne; Sinervo, Timo; Elovainio, Marko


    The present study examined the differences between physicians working in public and private health care in strenuous working environments (presence of occupational hazards, physical violence, and presenteeism) and health behaviours (alcohol consumption, body mass index, and physical activity). In addition, we examined whether gender or age moderated these potential differences. Cross-sectional survey data were compiled on 1422 female and 948 male randomly selected physicians aged 25-65 years from The Finnish Health Care Professionals Study. Logistic regression and linear regression analyses were used with adjustment for gender, age, specialisation status, working time, managerial position, and on-call duty. Occupational hazards, physical violence, and presenteeism were more commonly reported by physicians working in the public sector than by their counterparts in the private sector. Among physicians aged 50 years or younger, those who worked in the public sector consumed more alcohol than those who worked in the private sector, whereas in those aged 50 or more the reverse was true. In addition, working in the private sector was most strongly associated with lower levels of physical violence in those who were older than 50 years, and with lower levels of presenteeism among those aged 40-50 years. The present study found evidence for the public sector being a more strenuous work environment for physicians than the private sector. Our results suggest that public healthcare organisations should pay more attention to the working conditions of their employees.

  17. Confronting the Consequences of a Permanent Changing Environment

    Directory of Open Access Journals (Sweden)

    Raluca Ioana Vosloban


    Full Text Available Businesses and governments choose how they wish to deal with change. Whether this change is organizational, technological, political, financial etc or even individual pursuing actions as usual is likely to lead to a downward path. The authors of this paper are giving a set of tools for confronting and understanding the consequences of this era of permanent changes by building strengths and seeking opportunities within organizations (private or public and within family (including friends. The work environment and the personal life of the individual have a common point which is adaptability, coping efficiently with changes, a demanded ability of the 3rd millennium human being.

  18. Changes in healthcare-associated Staphylococcus aureus bloodstream infections after the introduction of a national hand hygiene initiative. (United States)

    Barnett, Adrian G; Page, Katie; Campbell, Megan; Brain, David; Martin, Elizabeth; Rashleigh-Rolls, Rebecca; Halton, Kate; Hall, Lisa; Jimmieson, Nerina; White, Katherine; Paterson, David; Graves, Nicholas


    Interventions that prevent healthcare-associated infection should lead to fewer deaths and shorter hospital stays. Cleaning hands (with soap or alcohol) is an effective way to prevent the transmission of organisms, but rates of compliance with hand hygiene are sometimes disappointingly low. The National Hand Hygiene Initiative in Australia aimed to improve hand hygiene compliance among healthcare workers, with the goal of reducing rates of healthcare-associated infection. We examined whether the introduction of the National Hand Hygiene Initiative was associated with a change in infection rates. Monthly infection rates for healthcare-associated Staphylococcus aureus bloodstream infections were examined in 38 Australian hospitals across 6 states. We used Poisson regression and examined 12 possible patterns of change, with the best fitting pattern chosen using the Akaike information criterion. Monthly bed-days were included to control for increased hospital use over time. The National Hand Hygiene Initiative was associated with a reduction in infection rates in 4 of the 6 states studied. Two states showed an immediate reduction in rates of 17% and 28%, 2 states showed a linear decrease in rates of 8% and 11% per year, and 2 showed no change in infection rates. The intervention was associated with reduced infection rates in most states. The failure in 2 states may have been because those states already had effective initiatives before the national initiative's introduction or because infection rates were already low and could not be further reduced.

  19. [Animals' clever adaptation strategy for seasonal changes in environment]. (United States)

    Ikegami, Keisuke; Yoshimura, Takashi


    Organisms living outside of tropical zones experience seasonal changes in environment. Organisms are using day length as a calendar to change their physiology and behavior such as seasonal breeding, hibernation, migration, and molting. A comparative biology approach revealed underlying mechanisms of vertebrate seasonal reproduction. Here we review the current understanding of vertebrate seasonal reproduction. We Aso describe the involvement of tissue-specific post-translational modification in functional diversification of a hormone.

  20. The Changing Fiscal Environment for Academic Veterinary Medicine. (United States)

    Zimmel, Dana N; Lloyd, James W


    The fiscal environment for academic veterinary medicine has changed substantially over the past 50 years. Understanding the flux of state and federal government support and the implications for student debt, academic programs, and scholarly work is critical for planning for the future. The recent precipitous decline in public funding highlights the urgent need to develop and maintain an economically sustainable model that can adapt to the changing landscape and serve societal needs.

  1. Antimicrobial resistance in healthcare, agriculture and the environment: the biochemistry behind the headlines. (United States)

    Venter, Henrietta; Henningsen, Michael L; Begg, Stephanie L


    The crisis of antimicrobial resistance (AMR) is one of the most serious issues facing us today. The scale of the problem is illustrated by the recent commitment of Heads of State at the UN to coordinate efforts to curb the spread of AMR infections. In this review, we explore the biochemistry behind the headlines of a few stories that were recently published in the public media. We focus on examples from three different issues related to AMR: (i) hospital-acquired infections, (ii) the spread of resistance through animals and/or the environment and (iii) the role of antimicrobial soaps and other products containing disinfectants in the dissemination of AMR. Although these stories stem from three very different settings, the underlying message in all of them is the same: there is a direct relationship between the use of antimicrobials and the development of resistance. In addition, one type of antimicrobial could select for cross-resistance to another type and/or for multidrug resistance. Therefore, we argue the case for increased stewardship to not only cover clinical use of antibiotics, but also the use of antimicrobials in agriculture and stewardship of our crucially important biocides such as chlorhexidine. © 2017 The Author(s). Published by Portland Press Limited on behalf of the Biochemical Society.

  2. Sudden transition and sudden change from open spin environments

    International Nuclear Information System (INIS)

    Hu, Zheng-Da; Xu, Jing-Bo; Yao, Dao-Xin


    We investigate the necessary conditions for the existence of sudden transition or sudden change phenomenon for appropriate initial states under dephasing. As illustrative examples, we study the behaviors of quantum correlation dynamics of two noninteracting qubits in independent and common open spin environments, respectively. For the independent environments case, we find that the quantum correlation dynamics is closely related to the Loschmidt echo and the dynamics exhibits a sudden transition from classical to quantum correlation decay. It is also shown that the sudden change phenomenon may occur for the common environment case and stationary quantum discord is found at the high temperature region of the environment. Finally, we investigate the quantum criticality of the open spin environment by exploring the probability distribution of the Loschmidt echo and the scaling transformation behavior of quantum discord, respectively. - Highlights: • Sudden transition or sudden change from open spin baths are studied. • Quantum discord is related to the Loschmidt echo in independent open spin baths. • Steady quantum discord is found in a common open spin bath. • The probability distribution of the Loschmidt echo is analyzed. • The scaling transformation behavior of quantum discord is displayed

  3. Asymmetric competition impacts evolutionary rescue in a changing environment. (United States)

    Van Den Elzen, Courtney L; Kleynhans, Elizabeth J; Otto, Sarah P


    Interspecific competition can strongly influence the evolutionary response of a species to a changing environment, impacting the chance that the species survives or goes extinct. Previous work has shown that when two species compete for a temporally shifting resource distribution, the species lagging behind the resource peak is the first to go extinct due to competitive exclusion. However, this work assumed symmetrically distributed resources and competition. Asymmetries can generate differences between species in population sizes, genetic variation and trait means. We show that asymmetric resource availability or competition can facilitate coexistence and even occasionally cause the leading species to go extinct first. Surprisingly, we also find cases where traits evolve in the opposite direction to the changing environment because of a 'vacuum of competitive release' created when the lagging species declines in number. Thus, the species exhibiting the slowest rate of trait evolution is not always the most likely to go extinct in a changing environment. Our results demonstrate that the extent to which species appear to be tracking environmental change and the extent to which they are preadapted to that change may not necessarily determine which species will be the winners and which will be the losers in a rapidly changing world. © 2017 The Author(s).

  4. Evidence Accumulation and Change Rate Inference in Dynamic Environments. (United States)

    Radillo, Adrian E; Veliz-Cuba, Alan; Josić, Krešimir; Kilpatrick, Zachary P


    In a constantly changing world, animals must account for environmental volatility when making decisions. To appropriately discount older, irrelevant information, they need to learn the rate at which the environment changes. We develop an ideal observer model capable of inferring the present state of the environment along with its rate of change. Key to this computation is an update of the posterior probability of all possible change point counts. This computation can be challenging, as the number of possibilities grows rapidly with time. However, we show how the computations can be simplified in the continuum limit by a moment closure approximation. The resulting low-dimensional system can be used to infer the environmental state and change rate with accuracy comparable to the ideal observer. The approximate computations can be performed by a neural network model via a rate-correlation-based plasticity rule. We thus show how optimal observers accumulate evidence in changing environments and map this computation to reduced models that perform inference using plausible neural mechanisms.

  5. Transmission of Staphylococcus aureus between health-care workers, the environment, and patients in an intensive care unit: a longitudinal cohort study based on whole-genome sequencing. (United States)

    Price, James R; Cole, Kevin; Bexley, Andrew; Kostiou, Vasiliki; Eyre, David W; Golubchik, Tanya; Wilson, Daniel J; Crook, Derrick W; Walker, A Sarah; Peto, Timothy E A; Llewelyn, Martin J; Paul, John


    Health-care workers have been implicated in nosocomial outbreaks of Staphylococcus aureus, but the dearth of evidence from non-outbreak situations means that routine health-care worker screening and S aureus eradication are controversial. We aimed to determine how often S aureus is transmitted from health-care workers or the environment to patients in an intensive care unit (ICU) and a high-dependency unit (HDU) where standard infection control measures were in place. In this longitudinal cohort study, we systematically sampled health-care workers, the environment, and patients over 14 months at the ICU and HDU of the Royal Sussex County Hospital, Brighton, England. Nasal swabs were taken from health-care workers every 4 weeks, bed spaces were sampled monthly, and screening swabs were obtained from patients at admission to the ICU or HDU, weekly thereafter, and at discharge. Isolates were cultured and their whole genome sequenced, and we used the threshold of 40 single-nucleotide variants (SNVs) or fewer to define subtypes and infer recent transmission. Between Oct 31, 2011, and Dec 23, 2012, we sampled 198 health-care workers, 40 environmental locations, and 1854 patients; 1819 isolates were sequenced. Median nasal carriage rate of S aureus in health-care workers at 4-weekly timepoints was 36·9% (IQR 35·7-37·3), and 115 (58%) health-care workers had S aureus detected at least once during the study. S aureus was identified in 8-50% of environmental samples. 605 genetically distinct subtypes were identified (median SNV difference 273, IQR 162-399) at a rate of 38 (IQR 34-42) per 4-weekly cycle. Only 25 instances of transmission to patients (seven from health-care workers, two from the environment, and 16 from other patients) were detected. In the presence of standard infection control measures, health-care workers were infrequently sources of transmission to patients. S aureus epidemiology in the ICU and HDU is characterised by continuous ingress of distinct

  6. Perceptions of negative health-care experiences and self-reported health behavior change in three racial and ethnic groups. (United States)

    Schwei, Rebecca J; Johnson, Timothy P; Matthews, Alicia K; Jacobs, Elizabeth A


    Our two study objectives were: (1) to understand the relationship between the perception of a previous negative health-care experience and race/ethnicity, and how socio-demographic, access-to-health-care, and self-reported health variables modified this relationship; and (2) to assess how many behaviors participants reported changing as a result of experiencing a perceived negative health-care experience, which behaviors they changed, and if there were differences in patterns of change across racial/ethnic groups. We conducted a cross-sectional survey of a convenience sample of 600 African-American, Mexican-Hispanic, and white adults in socioeconomically diverse neighborhoods in Chicago, IL. We used multivariable logistic regression to analyze the relationship between a perceived negative health-care experience in the last 5 years and race/ethnicity. We summed and then calculated the percentage of people who changed each of the 10 behaviors and evaluated whether or not there were differences in behavior change across racial/ethnic groups. More than 32% of participants reported a perceived negative health-care experience in the past 5 years. Participants who had a bachelor's degree or above (OR: 2.95, 95%CI: 1.01-8.63), avoided needed care due to cost (OR: 1.84, 95%CI: 1.11-3.06), or who reported fair/poor health (OR: 3.58, 95%CI: 1.66-7.80) had significantly increased odds of reporting a negative health-care experience. Of these people, 88% reported 'sometimes/always' changing at least one health-seeking behavior. There were no racial/ethnic differences in reporting negative experiences or in patterns of behavior change. Race/ethnicity was not related to reporting a perceived negative health-care experience or reported patterns of behavior change in response to that experience. However, those who avoided care due to cost were more highly educated, or who indicated poorer health status reported having a negative experience more often. Our findings suggest that the

  7. Thermal sensation and thermal comfort in changing environments

    NARCIS (Netherlands)

    Velt, K.B.; Daanen, H.A.M.


    It is the purpose of this study to investigate thermal sensation (TS) and thermal comfort (TC) in changing environments. Therefore, 10 subjects stayed in a 30 °C, 50% relative humidity for 30 min in summer clothes and then moved to a 20 °C room where they remained seated for 30 min (Hot to Reference

  8. Climate Change Impacts on the Built Environment in Nigeria ...

    African Journals Online (AJOL)

    The populations, infrastructure and ecology of cities are at risk from the impacts of climate change which affect urban ventilation and cooling, urban drainage and flood risk and water resources. Built areas exert considerable influence over their local climate and environment, and urban populations are already facing a ...

  9. Review: The impact of changing human environment and climate ...

    African Journals Online (AJOL)

    The impact of human-induced climate change through industrialization with the consequent depletion of the ozone layer of the environment is now observed to compromise the sustainability of human development as it threatens the ecological support system on which life depends in addition to encouraging the emergence ...

  10. Academic Training: Climate change and challenges for the environment / POSTPONED!!!

    CERN Multimedia

    Françoise Benz


    2004-2005 ACADEMIC TRAINING PROGRAMME LECTURE SERIES 20, 21, 22 June 20, 21, 22 June, from 11:00 to 12:00 – Main Auditorium, bldg. 500 Climate change and challenges for the environment C. SCHLUECHTER / Univ. Bern, CH The Academic Training is postponed.

  11. The quality of political news in a changing media environment

    NARCIS (Netherlands)

    Jacobi, C.A.


    What do ongoing changes in the media environment, notably the perceived popularization of news and the shift towards individualized online media, mean for political news quality, both in terms of what it is, as well as how we measure it? This dissertation firstly argues, based on a literature review

  12. How has the extent of institutional mental healthcare changed in Western Europe? Analysis of data since 1990. (United States)

    Chow, Winnie S; Priebe, Stefan


    It has been suggested that since 1990, de-institutionalisation of mental healthcare in Western Europe has been reversed into re-institutionalisation with more forensic beds, places in protected housing services and people with mental disorders in prisons. This study aimed to identify changes in the numbers of places in built institutions providing mental healthcare in Western Europe from 1990 to 2012, and to explore the association between changes in psychiatric bed numbers and changes in other institutions. Data were identified from 11 countries on psychiatric hospital beds, forensic beds, protected housing places and prison populations. Fixed effects regression models tested the associations between psychiatric hospital beds with other institutions. The number of psychiatric hospital beds decreased, while forensic beds, places in protected housing and prison populations increased. Overall, the number of reduced beds exceeded additional places in other institutions. There was no evidence for an association of changes in bed numbers with changes in forensic beds and protected housing places. Panel data regression analysis showed that changes in psychiatric bed numbers were negatively associated with rising prison populations, but the significant association disappeared once adjusted for gross domestic product as a potential covariate. Institutional mental healthcare has substantially changed across Western Europe since 1990. There are ongoing overall trends of a decrease in the number of psychiatric hospital beds and an increase in the number of places in other institutions, including prisons. The exact association between these trends and their drivers remains unclear. More reliable data, information on the characteristics of patients in different institutions, long-term pathway analyses and effectiveness studies are required to arrive at evidence-based policies for the provision of institutional mental healthcare. Published by the BMJ Publishing Group Limited

  13. An ontological framework for requirement change management in distributed environment

    International Nuclear Information System (INIS)

    Khatoon, A.; Hafeez, Y.; Ali, T.


    Global Software Development (GSD) is getting fame in the software industry gradually. However, in GSD, multiple and diverse stakeholders are involved in the development of complex software systems. GSD introduces several challenges, i.e. physical distance, time zone, culture difference, language barriers. As requirements play a significant role in any software development. The greatest challenge in GSD environment is to maintain a consistent view of the system even if the requirements change. But at the same time single change in the requirement might affect several other modules. In GSD different people use terms and have different ways of expressing the concepts for which people at remote sites are unable to get uniformity regarding the semantics of the terms. In a global environment requires effective communication and coordination. However, to overcome inconsistencies and ambiguities among the team members and to make the team members aware of the consistent view, a shared and common understanding is required. In this paper an approach beneficial to software industry has been proposed, focusing on changing requirements in a Global Software Development environment. A case study has been used for the evaluation of the proposed approach. Therefore, Requirements change management process has been improved by applying the approach of the case study. The proposed approach is beneficial to the software development organizations where frequent changes occur. It guided the software industry to provide the common understandings to all the development teams residing in remote locations. (author)

  14. Change in the family food environment is associated with positive dietary change in children. (United States)

    Hendrie, Gilly; Sohonpal, Gundeep; Lange, Kylie; Golley, Rebecca


    The family food environment is an important influence in the development of children's dietary habits. Research suggests that influences of current dietary behaviour and behaviour change may differ. The aims of this paper were to: (1) investigate the association between the food environment at baseline and change in children's saturated fat intake; and (2) to explore whether a change in the food environment was associated with a change in children's saturated fat intake. Secondary analysis of a 12 week cluster randomised controlled trial in 133 4-13 year old children. Families were randomly allocated to parental education regarding changing to reduced-fat dairy foods or a comparison non-dietary behaviour. The interventions were family focused. Parents received education from a dietitian in 3x30 minute sessions to facilitate behaviour change. Parents completed a comprehensive questionnaire capturing three domains of the food environment--Parent knowledge and attitudes; shaping practices; and behaviours and role modelling. Children's dietary intake was assessed via multiple 24-hour recalls at baseline and week 12. Changes in the family food environment and primary outcome (saturated fat) were calculated. Hierarchical linear regression models were performed to explore the association between baseline and change in food environment constructs and change in saturated fat intake. Standardised Beta are presented (pchange in saturated fat. An increase in nutrition knowledge (β=-0.2), perceived responsibility (β=-0.3) and restriction (β=-0.3) from baseline to week 12 were associated with greater reduction in saturated fat intake. The present study was one of the first to quantify changes in the family food environment, and identify a number of factors which were associated with a positive dietary change. Because interventions focus on behaviour change, the findings may provide specific targets for intervention strategies in the future. Australia New Zealand Clinical

  15. The impact of the social and physical environments on parent-healthcare provider relationships when a child dies in PICU: Findings from a grounded theory study. (United States)

    Butler, Ashleigh E; Copnell, Beverley; Hall, Helen


    This study explores the influences of the paediatric intensive care environment on relationships between parents and healthcare providers when children are dying. It forms part of a larger study, investigating parental experiences of the death of their child in intensive care. Constructivist grounded theory. Four Australian paediatric intensive care units. Audio-recorded, semi-structured interviews were conducted with twenty-six bereaved parents. Data were analysed using the constant comparison and memoing techniques common to grounded theory. The physical and social environment of the intensive care unit influenced the quality of the parent-healthcare provider relationship. When a welcoming, open environment existed, parents tended to feel respected as equal and included members of their child's care team. In contrast, environments that restricted parental presence or lacked resources for parental self-care could leave parents feeling like 'watchers', excluded from their child's care. The paediatric intensive care unit environment either welcomes and includes parents of dying children into the care team, or demotes them to the status of 'watcher'. Such environments significantly influence the relationships parents form with healthcare staff, their ability to engage in elements of their parental role, and their experiences as a whole. Copyright © 2017 Elsevier Ltd. All rights reserved.

  16. Critical perspectives on changing media environments in the Global South

    DEFF Research Database (Denmark)

    Nielsen, Poul Erik

    the changes in the media landscape continuously alter the power balance between state, civil society and market. At the meso level, these changes will be discussed in relation to the development of the different media and of a variety of new locally specific media environments, which create new spaces......The main aim of this article is to give a general overview and theoretically discuss how significant changes in the media landscapes in Global South countries alter existing spaces and create new spaces for political and socio-cultural exchange, thus changing the complex interrelationship between...... media and society. Knowing that media is only one of many aspects in current societal changes, the focus will be more on the interrelationship between media and society and less on other aspects like globalization, education and political reforms. At the macro level, the article will discuss how...

  17. The DIII-D Computing Environment: Characteristics and Recent Changes

    International Nuclear Information System (INIS)

    McHarg, B.B. Jr.


    The DIII-D tokamak national fusion research facility along with its predecessor Doublet III has been operating for over 21 years. The DIII-D computing environment consists of real-time systems controlling the tokamak, heating systems, and diagnostics, and systems acquiring experimental data from instrumentation; major data analysis server nodes performing short term and long term data access and data analysis; and systems providing mechanisms for remote collaboration and the dissemination of information over the world wide web. Computer systems for the facility have undergone incredible changes over the course of time as the computer industry has changed dramatically. Yet there are certain valuable characteristics of the DIII-D computing environment that have been developed over time and have been maintained to this day. Some of these characteristics include: continuous computer infrastructure improvements, distributed data and data access, computing platform integration, and remote collaborations. These characteristics are being carried forward as well as new characteristics resulting from recent changes which have included: a dedicated storage system and a hierarchical storage management system for raw shot data, various further infrastructure improvements including deployment of Fast Ethernet, the introduction of MDSplus, LSF and common IDL based tools, and improvements to remote collaboration capabilities. This paper will describe this computing environment, important characteristics that over the years have contributed to the success of DIII-D computing systems, and recent changes to computer systems

  18. Impact of recurrent changes in the work environment on nurses' psychological well-being and sickness absence. (United States)

    Verhaeghe, Rik; Vlerick, Peter; Gemmel, Paul; Van Maele, Georges; De Backer, Guy


    This paper is a report of a study of how the occurrence and appraisal of recurrent changes in the work environment of hospital nurses affect psychological well-being (i.e. job satisfaction, eustress and distress) and absence through illness. Many researchers have demonstrated the impact of major organizational changes on employees' psychological well-being, but only a few have focused on the permanent consequences in work conditions. In a contemporary healthcare setting, an increased number of recurrent operational changes has become a normal characteristic of nurses' work environment. Specific work situations have frequently been associated with occupational stress, whereas employees' appraisal of recurrent changes as stressors and their relation to psychological well-being and health outcomes (i.e. sickness absence) have been dismissed. A cross-sectional questionnaire survey was conducted in 2003 with 2094 Registered Nurses in 10 general hospitals. Logistic regressions were used to investigate the impact on psychological well-being and prospectively measured rates of sickness absence (frequency and duration). The occurrence of changes in the work environment (in the past 6 months) had had a negative impact on staff psychological well-being. Nurses who had been confronted with changes scored statistically significantly higher for distress. Changes appraised as threatening were negatively related to job satisfaction and eustress, and positively related to distress and sickness absence (frequency and duration). Changes appraised as challenging were positively related to job satisfaction and eustress but had no impact on distress and sickness absence. Future research should take into consideration the impact of the occurrence and appraisal of recurrent changes in the work environment of healthcare employees (i.e. Registered Nurses) on psychological well-being and sickness absence. This should also be considered by managers when dealing with these nursing workforce


    Directory of Open Access Journals (Sweden)

    Marcin Olkiewicz


    Full Text Available The role of Medical Tourism in the process of a complex satisfaction of the prosumers and the impact played in the organizational and functional changes in the Polish healthcare system. The analysis of the literature on the subject as well as an analysis of the documentation were the inspiration to write this work. The main emphasis was put on stating the conditions stimulating the development of this sector of the economy as well as the risk factors determining the quality of process changes in the healthcare system (functioning of public hospitals. To approximate the characteristics of the involved risk within the framework of health tourism functioning in the conditions of a market economy. Selected research methods allowed to present the motives behind undertaken actions of both the regulators as well as participants of the health tourism. Polish accession to the EU was an important impulse changing the way of thinking about health tourism in healthcare as well as, what is important, changes in the institutional and financial policy in Poland. In order to meet health-oriented demands of a prosumer, there should be a coordinated and effective informational system, aimed at improving the quality, reliability, availability of information concerning health tourism.

  20. Human activities and climate and environment changes: an inevitable relation

    International Nuclear Information System (INIS)

    Sanchez, Aretha


    The human interference in the environment and the consequent climate change is today a consensus. The climate change can be local, regional and global. The global climate change is mainly caused by the greenhouse gases, and consequently the climate change intervenes in the environment. The interference cycle emerges in several forms and results in several consequences. However, the Global Warming has certainly the most import global impact. The main cause of the increase in the temperature (Greenhouse Effect) is the intensive use of the fossil fuels. Thus, to minimize the climatic changes actions are necessary to reduce, to substitute and to use with more efficient the fossil fuels. Looking at the past, the old agriculturists may have released greenhouse gases since thousand years ago, thus, modifying slowly but in significant form the earth climate much before the Industrial Age. If this theory is confirmed, its consequences would be decisive for the man history in the planet. For example, in parts of the North America and Europe the current temperatures could be even four Celsius degrees smaller. This change in temperature is enough to hinder agricultural used of these regions and consequently to diminish the human development. The main focus of this work is to perform a retrospective in some of civilizations who collapse due to environmental problems and make a historical description of the human activities (agriculture and livestock) since the primordium of the man up to the Industrial Age, aiming at the man interference on the natural dynamics of the global climate and the environment. This work will show through data comparisons and inferences that the gases emissions from these activities had a significant magnitude comparatively by the emissions after the Industrial Age. It is also demonstrated that the climate and environment interference was inevitable because the human evolution was caused by these activities. Another important point of this work is to

  1. Testing take-the-best in new and changing environments. (United States)

    Lee, Michael D; Blanco, Gabrielle; Bo, Nikole


    Take-the-best is a decision-making strategy that chooses between alternatives, by searching the cues representing the alternatives in order of cue validity, and choosing the alternative with the first discriminating cue. Theoretical support for take-the-best comes from the "fast and frugal" approach to modeling cognition, which assumes decision-making strategies need to be fast to cope with a competitive world, and be simple to be robust to uncertainty and environmental change. We contribute to the empirical evaluation of take-the-best in two ways. First, we generate four new environments-involving bridge lengths, hamburger prices, theme park attendances, and US university rankings-supplementing the relatively limited number of naturally cue-based environments previously considered. We find that take-the-best is as accurate as rival decision strategies that use all of the available cues. Secondly, we develop 19 new data sets characterizing the change in cities and their populations in four countries. We find that take-the-best maintains its accuracy and limited search as the environments change, even if cue validities learned in one environment are used to make decisions in another. Once again, we find that take-the-best is as accurate as rival strategies that use all of the cues. We conclude that these new evaluations support the theoretical claims of the accuracy, frugality, and robustness for take-the-best, and that the new data sets provide a valuable resource for the more general study of the relationship between effective decision-making strategies and the environments in which they operate.

  2. Precision Security: Integrating Video Surveillance with Surrounding Environment Changes

    Directory of Open Access Journals (Sweden)

    Wenfeng Wang


    Full Text Available Video surveillance plays a vital role in maintaining the social security although, until now, large uncertainty still exists in danger understanding and recognition, which can be partly attributed to intractable environment changes in the backgrounds. This article presents a brain-inspired computing of attention value of surrounding environment changes (EC with a processes-based cognition model by introducing a ratio value λ of EC-implications within considered periods. Theoretical models for computation of warning level of EC-implications to the universal video recognition efficiency (quantified as time cost of implication-ratio variations from λk to λk+1, k=1,2,… are further established. Imbedding proposed models into the online algorithms is suggested as a future research priority towards precision security for critical applications and, furthermore, schemes for a practical implementation of such integration are also preliminarily discussed.

  3. Changing the Environment Based on Empowerment as Intrinsic Motivation

    Directory of Open Access Journals (Sweden)

    Christoph Salge


    Full Text Available One aspect of intelligence is the ability to restructure your own environment so that the world you live in becomes more beneficial to you. In this paper we investigate how the information-theoretic measure of agent empowerment can provide a task-independent, intrinsic motivation to restructure the world. We show how changes in embodiment and in the environment change the resulting behaviour of the agent and the artefacts left in the world. For this purpose, we introduce an approximation of the established empowerment formalism based on sparse sampling, which is simpler and significantly faster to compute for deterministic dynamics. Sparse sampling also introduces a degree of randomness into the decision making process, which turns out to beneficial for some cases. We then utilize the measure to generate agent behaviour for different agent embodiments in a Minecraft-inspired three dimensional block world. The paradigmatic results demonstrate that empowerment can be used as a suitable generic intrinsic motivation to not only generate actions in given static environments, as shown in the past, but also to modify existing environmental conditions. In doing so, the emerging strategies to modify an agent’s environment turn out to be meaningful to the specific agent capabilities, i.e., de facto to its embodiment.

  4. Climate change on arctic environment, ecosystem services and society (CLICHE) (United States)

    Weckström, J.; Korhola, A.; Väliranta, M.; Seppä, H.; Luoto, M.; Tuittila, E.-S.; Leppäranta, M.; Kahilainen, K.; Saarinen, J.; Heikkinen, H.


    The predicted climate warming has raised many questions and concerns about its impacts on the environment and society. As a respond to the need of holistic studies comprising both of these areas, The Academy of Finland launched The Finnish Research Programme on Climate Change (FICCA 2011-2014) in spring 2010 with the main aim to focus on the interaction between the environment and society. Ultimately 11 national consortium projects were funded (total budget 12 million EUR). Here we shortly present the main objectives of the largest consortium project "Climate change on arctic environment, ecosystem services and society" (CLICHE). The CLICHE consortium comprises eight interrelated work packages (treeline, diversity, peatlands, snow, lakes, fish, tourism, and traditional livelihoods), each led by a prominent research group and a team leader. The research consortium has three main overall objectives: 1) Investigate, map and model the past, present and future climate change-induced changes in central ecosystems of the European Arctic with unprecedented precision 2) Deepen our understanding of the basic principles of ecosystem and social resilience and dynamics; identify key taxa, structures or processes that clearly indicate impending or realised global change through their loss, occurrence or behaviour, using analogues from the past (e.g. Holocene Thermal Maximum, Medieval Warm Period), experiments, observations and models 3) Develop adaptation and mitigation strategies to minimize the adverse effects of climate change on local communities, traditional livelihoods, fisheries, and tourism industry, and promote sustainable development of local community structures and enhance the quality of life of local human populations. As the project has started only recently no final results are available yet. However, the fieldwork as well as the co-operation between the research teams has thus far been very successful. Thus, the expectations for the final outcome of the project

  5. The impact of medical tourism on the quality of organizational and functional changes in the Polish healthcare system


    Olkiewicz, Marcin


    The role of Medical Tourism in the process of a complex satisfaction of the prosumers and the impact played in the organizational and functional changes in the Polish healthcare system. The analysis of the literature on the subject as well as an analysis of the documentation were the inspiration to write this work. The main emphasis was put on stating the conditions stimulating the development of this sector of the economy as well as the risk factors determining the quality of pro...

  6. Perceptual classification in a rapidly-changing environment


    Summerfield, Christopher; Behrens, Timothy E.; Koechlin, Etienne


    Humans and monkeys can learn to classify perceptual information in a statistically optimal fashion if the functional groupings remain stable over many hundreds of trials, but little is known about categorisation when the environment changes rapidly. Here, we used a combination of computational modelling and functional neuroimaging to understand how humans classify visual stimuli drawn from categories whose mean and variance jumped unpredictably. Models based on optimal learning (Bayesian mode...

  7. Recreation and tourism induced changes in northern boreal environments


    Kangas, K. (Katja)


    Abstract The popularity of nature-based tourism has increased worldwide and peripheral areas with conservational value, like protected areas, are attractive destinations. The recreational use and construction of tourism facilities can cause environmental degradation and decrease the conservational and recreational value of areas if not well planned and managed. The aim of this thesis was to improve our knowledge of recreation and tourism induced changes in northern boreal environments. Dir...

  8. Postprandial changes in the exhalation of radon from the environment

    International Nuclear Information System (INIS)

    Rundo, J.; Markun, F.; Plondke, N.J.


    The exhalation of radon originally inhaled from the home environment and dissolved in body fluids and tissues has been studied serially for periods of several hours in six persons. The observation of a pronounced postprandial peak in the rate of exhalation of radon shows that the similar peak observed in the exhalation of radon produced from radium in vivo results from the flushing of a reservoir in soft tissue and not from a change in the fraction lost from bone

  9. Sustainability of biomass utilisation in changing operational environment - SUBICHOE

    Energy Technology Data Exchange (ETDEWEB)

    Soimakallio, S. [VTT Technical Research Centre of Finland, Espoo (Finland)], email:


    The main objective of the project was to assist in strategic decision-making of public administration and companies, as regards the most sustainable use of biomass, by taking into account the changing operational environment. This project continued the work of the BIOVAIKU project by exploring in more details the most critical issues identified in sustainability assessment. These include the need to develop assessment methods and criteria in particular for land use and land-use change due to biomass cultivation and harvesting and indirect impacts due to resource competition.

  10. Motion direction estimation based on active RFID with changing environment (United States)

    Jie, Wu; Minghua, Zhu; Wei, He


    The gate system is used to estimate the direction of RFID tags carriers when they are going through the gate. Normally, it is difficult to achieve and keep a high accuracy in estimating motion direction of RFID tags because the received signal strength of tag changes sharply according to the changing electromagnetic environment. In this paper, a method of motion direction estimation for RFID tags is presented. To improve estimation accuracy, the machine leaning algorithm is used to get the fitting function of the received data by readers which are deployed inside and outside gate respectively. Then the fitted data are sampled to get the standard vector. We compare the stand vector with template vectors to get the motion direction estimation result. Then the corresponding template vector is updated according to the surrounding environment. We conducted the simulation and implement of the proposed method and the result shows that the proposed method in this work can improve and keep a high accuracy under the condition of the constantly changing environment.

  11. Detection of child abuse by Dutch preventive child-healthcare doctors and nurses : Has it changed?

    NARCIS (Netherlands)

    Reijneveld, S.A.; de Meer, G.; Wiefferink, C.H.; Crone, M.R.

    Abstract Objective Child maltreatment (i.e., abuse and neglect) is a major cause of child morbidity and death. It is a principal topic in community child-healthcare services yet little is known about the actual detection of suspected cases. We examined trends in this detection, as well as the

  12. iMAGE cloud: medical image processing as a service for regional healthcare in a hybrid cloud environment. (United States)

    Liu, Li; Chen, Weiping; Nie, Min; Zhang, Fengjuan; Wang, Yu; He, Ailing; Wang, Xiaonan; Yan, Gen


    To handle the emergence of the regional healthcare ecosystem, physicians and surgeons in various departments and healthcare institutions must process medical images securely, conveniently, and efficiently, and must integrate them with electronic medical records (EMRs). In this manuscript, we propose a software as a service (SaaS) cloud called the iMAGE cloud. A three-layer hybrid cloud was created to provide medical image processing services in the smart city of Wuxi, China, in April 2015. In the first step, medical images and EMR data were received and integrated via the hybrid regional healthcare network. Then, traditional and advanced image processing functions were proposed and computed in a unified manner in the high-performance cloud units. Finally, the image processing results were delivered to regional users using the virtual desktop infrastructure (VDI) technology. Security infrastructure was also taken into consideration. Integrated information query and many advanced medical image processing functions-such as coronary extraction, pulmonary reconstruction, vascular extraction, intelligent detection of pulmonary nodules, image fusion, and 3D printing-were available to local physicians and surgeons in various departments and healthcare institutions. Implementation results indicate that the iMAGE cloud can provide convenient, efficient, compatible, and secure medical image processing services in regional healthcare networks. The iMAGE cloud has been proven to be valuable in applications in the regional healthcare system, and it could have a promising future in the healthcare system worldwide.

  13. A case study: Integrated work environment and organizational change

    Energy Technology Data Exchange (ETDEWEB)

    Heubach, J.G.; Montgomery, J.C.; Weimer, W.C. [Pacific Northwest Lab., Richland, WA (United States); Heerwagen, J.H. [Battelle Seattle Research Center, WA (United States)


    The failure to integrate environmental and organizational interventions may help explain the lack of success of many change efforts. The high rate of failure for change efforts (50% to 90% failure rates) has been noted by many writers. While specific causes of failure are diverse, a common theme has been failure to consider the organization as a system. That is, either significant aspects of the organization were ignored during the intervention or potential impacts of changes on the elements were overlooked or underestimated. Our own training, technical literature, and professional culture lead us to limited understandings of complex organizations. Change agents must consider all relevant components of organizational performance if interventions are to be meaningful and successful. This study demonstrated the value of an integrated organizational intervention involving redesign of the physical environment, introduction of a new information system, work process improvement, and extended organizational development intervention. The outcomes were extremely positive. The cost of improvement efforts was found to be recaptured within a short time, easily justifying the expenditures. One conclusion from the study is that integrated interventions are very powerful. Integrating improvement of the physical environment with organizational development and technological innovation greatly enhances the likelihood of achieving a successful intervention.

  14. Putting E-government to work in healthcare environment: a multiregional project funded by the Italian Innovation & Technology Ministry. (United States)

    Ballardini, Luigi; Germagnoli, Fabio; Pagani, Marco; Picchi, Marco; Stoppini, Andrea; Cristiani, Paolo


    In 2002, the Italian Ministry of Innovation promoted a national bid for e-government projects. Specifically it allocated a budget of 120 M euro. One of the four project approved in healthcare sector was the "Information, Care ("Assistenza" in Italian) and healthcare Education by the Web" (IAEW), with a global budget of 2580 k euro, partially financed by Ministry with a quota of 830 k euro. The project involves 12 medical structures (both national excellences centers and local regional hospitals) located in two different Region of North Italy, dealing with two different healthcare regional systems (Lombardia and Emilia-Romagna), with potentially 3 millions of users.

  15. Leading change to create a healthy and satisfying work environment. (United States)

    Sanders, Carolyn L; Krugman, Mary; Schloffman, Danielle H


    Nurse executives must take a leadership role in creating a healthy work environment for nurses and all disciplines. Engaging in partnerships and empowering clinical nurses to construct the solutions to barriers that may stand in the way of the goal of a satisfied and healthy workforce are important strategies toward success. This publication outlines many projects a 3-time Magnet-designated academic hospital has implemented, working with our shared leadership councils, to meet the standards for a healthy work environment. These initiatives, from the unit to the hospital level, included standardizing a culture change of uninterrupted meal breaks, the creation of intensive care unit Zen rooms, strategies to better manage increased patient volumes, best practices for facility design, enhancing physician-nurse relations, and a hospital wellness program. Data were benchmarked against national nurse and employee surveys to compare progress and report outcomes. Two important nursing organization structures that have contributed to the success of a healthy and satisfied nursing work environment include UEXCEL, a longstanding clinical nurse professional practice program, and the hospital's 11-year participation in the University HealthSystem Consortium/American Association of Colleges of Nursing National Post-Baccalaureate Nurse Residency Program. A highly engaged, well-educated, and committed nursing workforce, nurtured by a strong leadership team, has created a positive work environment characterized by low turnover and high retention.

  16. Strategies for healthcare information systems

    NARCIS (Netherlands)

    Stegwee, R.A.; Spil, Antonius A.M.


    Information technologies of the past two decades have created significant fundamental changes in the delivery of healthcare services by healthcare provider organizations. Many healthcare organizations have been in search of ways and strategies to keep up with continuously emerging information

  17. Leading change in healthcare Anthony L Suchman , David J Sluyter and Penelope R Williamson Leading change in healthcare Radcliffe £35 362pp 9781846194481 1846194482 [Formula: see text]. (United States)


    WHEN A book promises to offer an alternative to the 'antiquated and psychologically unsophisticated theories' that have underpinned the leadership of change programmes to date, you can expect the interest of any forward-thinking manager, clinician or academic in the field to be piqued.

  18. Changes in working conditions for home healthcare workers and impacts on their work activity and on their emotions

    Directory of Open Access Journals (Sweden)

    Corinne Van De Weerdt


    Full Text Available Home healthcare is steadily growing in many countries. Nevertheless, it is known that home healthcare workers are frequently exposed to a variety of potentially serious occupational hazards. Working conditions have changed to become more emotionally and physically demanding on workers. Emotional labor is increasingly high in this profession. Time pressure is increasingly common. This paper describes an ergonomic study analyzing the working conditions of nursing assistants and nurses, as well as the impacts of their work in terms of job satisfaction, emotions at work, relationships with the others, and occupational stress. The study shows that changing working conditions are making it increasingly difficult for home healthcare workers to do their work properly. We can confirm that such workers use strategies to try to cope. They use individual strategies to preserve the relational dimension of their work activity. These strategies are specifically centered around preserving the relationships with patients, and coping with the demands of the job. The study also shows that workers use strategies to express emotions and to conceal them from others. Finally, the paper presents the recommendations that were discussed with the manager and workers for improving working conditions and that led to practical proposals: e.g. implementing certain items of equipment better suited to difficult care, encouraging assistance between workers when operations so require through appropriate organizational measures, extending emotion-focused work discussion groups with management involvement.

  19. Change in the family food environment is associated with positive dietary change in children

    Directory of Open Access Journals (Sweden)

    Hendrie Gilly


    Full Text Available Abstract Background The family food environment is an important influence in the development of children’s dietary habits. Research suggests that influences of current dietary behaviour and behaviour change may differ. The aims of this paper were to: (1 investigate the association between the food environment at baseline and change in children’s saturated fat intake; and (2 to explore whether a change in the food environment was associated with a change in children’s saturated fat intake. Method Secondary analysis of a 12 week cluster randomised controlled trial in 133 4-13 year old children. Families were randomly allocated to parental education regarding changing to reduced-fat dairy foods or a comparison non-dietary behaviour. The interventions were family focused. Parents received education from a dietitian in 3x30minute sessions to facilitate behaviour change. Parents completed a comprehensive questionnaire capturing three domains of the food environment – Parent knowledge and attitudes; shaping practices; and behaviours and role modelling. Children’s dietary intake was assessed via multiple 24-hour recalls at baseline and week 12. Changes in the family food environment and primary outcome (saturated fat were calculated. Hierarchical linear regression models were performed to explore the association between baseline and change in food environment constructs and change in saturated fat intake. Standardised Beta are presented (p Results After adjustments for child and family demographics, higher levels of perceived food availability (β=-0.2 at baseline was associated with greater reduction in saturated fat intake, where as higher perceived responsibility (β=0.2, restriction (β=0.3 and pressure to eat (β=0.3 were associated with lesser change in saturated fat. An increase in nutrition knowledge (β=-0.2, perceived responsibility (β=-0.3 and restriction (β=-0.3 from baseline to week 12 were associated with greater reduction in

  20. Cropping Systems and Climate Change in Humid Subtropical Environments

    Directory of Open Access Journals (Sweden)

    Ixchel M. Hernandez-Ochoa


    Full Text Available In the future, climate change will challenge food security by threatening crop production. Humid subtropical regions play an important role in global food security, with crop rotations often including wheat (winter crop and soybean and maize (summer crops. Over the last 30 years, the humid subtropics in the Northern Hemisphere have experienced a stronger warming trend than in the Southern Hemisphere, and the trend is projected to continue throughout the mid- and end of century. Past rainfall trends range, from increases up to 4% per decade in Southeast China to −3% decadal decline in East Australia; a similar trend is projected in the future. Climate change impact studies suggest that by the middle and end of the century, wheat yields may not change, or they will increase up to 17%. Soybean yields will increase between 3% and 41%, while maize yields will increase by 30% or decline by −40%. These wide-ranging climate change impacts are partly due to the region-specific projections, but also due to different global climate models, climate change scenarios, single-model uncertainties, and cropping system assumptions, making it difficult to make conclusions from these impact studies and develop adaptation strategies. Additionally, most of the crop models used in these studies do not include major common stresses in this environment, such as heat, frost, excess water, pests, and diseases. Standard protocols and impact assessments across the humid subtropical regions are needed to understand climate change impacts and prepare for adaptation strategies.

  1. Sustainability of Biomass Utilisation in Changing operational Environment - SUBICHOE

    Energy Technology Data Exchange (ETDEWEB)

    Soimakallio, S.; Hongisto, M.; Koponen, K. (VTT Technical Research Centre of Finland, Espoo (Finland)), e-mail: (and others)


    Sustainability is a multi-faceted and challenging target, but at the same time a crucial issue to assess when setting policies and targets for the future. The main objective of the SUBICHOE project is to assist public administration and companies in strategic decision- making in the most sustainable use of biomass, by taking into account the changing operational environment. The project aimed to assess how the sustainability criteria, in particular those set by the EC, ensure the sustainability of biofuels from short and long term perspectives. The project is carried out jointly by VTT Technical Research Centre of Finland, Finnish Environment Institute SYKE, MTT Agrifood Research Finland, Finnish Forest Research Institute (Metla) and The Government Institute for Economic Research (VATT). The work plan of the project is divided into four Work Packages. In this article, a summary of main findings of the project is presented. (orig.)

  2. Environment Changes Genetic Effects on Respiratory Conditions and Allergic Phenotypes

    DEFF Research Database (Denmark)

    Song, Yong; Schwager, Michelle J; Backer, Vibeke


    The prevalence of asthma and allergic diseases is disproportionately distributed among different populations, with an increasing trend observed in Western countries. Here we investigated how the environment affected genotype-phenotype association in a genetically homogeneous, but geographically...... separated population. We evaluated 18 single nucleotide polymorphisms (SNPs) corresponding to 8 genes (ADAM33, ALOX5, LT-α, LTC4S, NOS1, ORMDL3, TBXA2R and TNF-α), the lung function and five respiratory/allergic conditions (ever asthma, bronchitis, rhinitis, dermatitis and atopy) in two populations of Inuit......-phenotype associations relating to bronchitis and allergy susceptibility are dependent on the environment and that environmental factors/lifestyles modify genetic predisposition and change the genetic effects on diseases....

  3. Holistic Leadership-Nursing's Unique Contribution to Healthcare. (United States)

    Clarke, Pamela N; Bleich, Michael R


    This dialogue is focused on holistic leadership from the perspective of a well-known leader in nursing. He frames the changing healthcare environment and nursing's unique contribution on the interprofessional team.

  4. Climate change, living environment and ways of life

    International Nuclear Information System (INIS)

    Jaervelae, M.; Wilenius, M.


    The research project 'Climate Change, Living Environment and Way of Life' is focused on the social concepts of risks and of proposed policies related to global environmental problems as seen by representatives of various social groups. Drawing on the social-scientific methodology and applying its concept apparatus, the research project focuses on two central problems in the field of contemporary environmental research. Firstly, with the way in which environmental problems influence people's values and attitudes. Secondly, with the question of how people seek to act and to show solidarity towards new generations by means of environmental policies or by protecting nature within the framework of their private ways of life

  5. U.S. NGL supply in the changing environment

    International Nuclear Information System (INIS)

    Billings, F.


    This paper discusses the outlook for domestic NGL supply, demand for natural gas liquids in the US, and review a couple of key drivers of natural gas liquids demand; ethylene production and capacity and Gross Domestic Product (GDP) growth. The author reviews historical US NGL production in key supply areas over the past five years, as well as look forward through the year 2000. Then briefly touch on the recent activity, specifically the types of consolidations, changing the environment in the gas gathering, gas processing and natural gas liquids industry and its impact on future NGL markets

  6. Academic Training: Climate change and challenges for the environment

    CERN Multimedia

    Françoise Benz


    2005-2006 ACADEMIC TRAINING PROGRAMME LECTURE SERIES 14, 15, 16 November from 11:00 to 12:00 - TH Auditorium, bldg. 4 Climate change and challenges for the environment by C. Schlüchter / Institut für Geologie, Univ. Bern, CH Climate change as seen by a geologist Glaciers are an integrated part of the high altitudes and the high latitudes of our planet. They are sensitive to temperature and moisture changes and adjust their mass balances accordingly. By doing so they interact with their substratum, the geological basement and they produce characteristic imprints of their presence, their variability and their disappearance. In glacial geology and paleoglaciology such imprints of former glaciers are carefully recorded, mapped and, hopefully, dated in order to obtain amplitude and periodicity records of their changes - as forced by changing climate, as we believe. In the upcoming lectures three aspects will be discussed: the last glaciation in the Swiss Alps. A reconstruction is shown based on fieldwor...

  7. Designing for Change: Interoperability in a scaling and adapting environment (United States)

    Yarmey, L.


    The Earth Science cyberinfrastructure landscape is constantly changing. Technologies advance and technical implementations are refined or replaced. Data types, volumes, packaging, and use cases evolve. Scientific requirements emerge and mature. Standards shift while systems scale and adapt. In this complex and dynamic environment, interoperability remains a critical component of successful cyberinfrastructure. Through the resource- and priority-driven iterations on systems, interfaces, and content, questions fundamental to stable and useful Earth Science cyberinfrastructure arise. For instance, how are sociotechnical changes planned, tracked, and communicated? How should operational stability balance against 'new and shiny'? How can ongoing maintenance and mitigation of technical debt be managed in an often short-term resource environment? The Arctic Data Explorer is a metadata brokering application developed to enable discovery of international, interdisciplinary Arctic data across distributed repositories. Completely dependent on interoperable third party systems, the Arctic Data Explorer publicly launched in 2013 with an original 3000+ data records from four Arctic repositories. Since then the search has scaled to 25,000+ data records from thirteen repositories at the time of writing. In the final months of original project funding, priorities shift to lean operations with a strategic eye on the future. Here we present lessons learned from four years of Arctic Data Explorer design, development, communication, and maintenance work along with remaining questions and potential directions.

  8. Changes seen in the environment report from Uusimaa Regional Environment Centre

    International Nuclear Information System (INIS)

    Enckell, E.; Airola, H.; Tornivaara-Ruikka, R.; Villa, L.; Salasto, R.


    This publication describes the environmental changes and the influencing factors occurring within the administrative regions of the Uusimaa Regional Environment Centre. The quality of the environment can be judged as satisfying in regards to both the mental and physical health of humans. Areas have a steady trend of a relatively high growth in population density, while the efficiency of land use in new settlements is low. Traffic and the travel distances are on the rise. A considerable part of the population lives in areas where the noise standards are violated, despite control measures. Waste management, water distribution and sewage networks are under continuous development. In regards to the nature, the situation in some parts is of great concern. The manifold of the nature, cultural landscapes and culturally valuable buildings and sites are threatened. The living space of flora and fauna is continuing to decrease and change. The risks caused by human activities in groundwater areas are increasing. For these reasons the implementation of protection programs is important. Emissions from point sources to the water and air have significantly decreased. Yet, the impacts of air quality deprivation can still be seen in some cities and in the vicinity of some industrial sites. The eutrophication have essentially changed the ecology and fishstocks; however, the water quality has improved in many places. Regarding the above issues, as well as some other topics, included in the report are 16 theme maps 66 pictures. However, the report states that the monitoring and reporting of the environmental quality should be improved. (orig.)

  9. The Hillsborough disaster: how it has changed UK healthcare law. Part 1. (United States)

    Griffith, Richard

    The 25th anniversary of the Hillsborough Stadium disaster was commemorated this year with memorial services and a toll of bells to remember the 96 who died that day. Their legacy is largely seen in safe, modern, all-seat stadia but it endures beyond football. Court cases resulting from the aftermath of the tragedy have helped shape healthcare law in the UK and in a short series of articles Richard Griffith highlights the impact the Hillsborough disaster has had, beginning with the development of the law in relation to psychiatric injury arising from another's negligent act.

  10. Providing healthcare services on-the-fly using multi-player cooperation game theory in Internet of Vehicles (IoV environment

    Directory of Open Access Journals (Sweden)

    Neeraj Kumar


    Full Text Available Internet of Vehicles (IoV is a leading technology of the present era. It has gained huge attention with respect to its implementation in wide variety of domains ranging from traffic safety to infotainment applications. However, IoV can also be extended to healthcare domain, where the patients can be provided healthcare services on-the-fly. We extend this novel concept in this paper and refer it as “Healthcare services on-the-fly”. The concept of game theory has been used among the vehicles to access the healthcare services while traveling. The vehicles act as players in the game and tend to form and split coalitions to access these services. Learning automata (LA act as the players for interaction with the environment and take appropriate actions based on reward and penalty. Apart from this, Virtual Machine (VM scheduling algorithm for efficient utilization of resources at cloud level has also been formulated. A stochastic reward net (SRN-based model is used to represent the coalition formation and splitting with respect to availability of resources at cloud level. The performance of the proposed scheme is evaluated using various performance evaluation metrics. The results obtained prove the effectiveness of the proposed scheme in comparison to the best, first, and random fit schemes.

  11. The provincial health office as performance manager: change in the local healthcare system after Thailand's universal coverage reforms. (United States)

    Intaranongpai, Siranee; Hughes, David; Leethongdee, Songkramchai


    This paper examines the implementation of Thailand's universal coverage healthcare reforms in a rural province, using data from field studies undertaken in 2003-2005 and 2008-2011. We focus on the strand of policy that aimed to develop primary care by allocating funds to contracting units for primary care (CUPs) responsible for managing local service networks. The two studies document a striking change in the balance of power in the local healthcare system over the 8-year period. Initially, the newly formed CUPs gained influence as 'power followed the money', and the provincial health offices (PHOs), which had commanded the service units, were left with a weaker co-ordination role. However, the situation changed as a new insurance purchaser, the National Health Security Office, took financial control and established regional outposts. National Health Security Office outposts worked with PHOs to develop rationalised management tools-strategic plans, targets, KPIs and benchmarking-that installed the PHOs as performance managers of local healthcare systems. New lines of accountability and changed budgetary systems reduced the power of the CUPs to control resource allocation and patterns of services within CUP networks. Whereas some CUPs fought to retain limited autonomy, the PHO has been able to regain much of its former control. We suggest that implementation theory needs to take a long view to capture the complexity of a major reform initiative and argue for an analysis that recognises the key role of policy networks and advocacy coalitions that span national and local levels and realign over time. Copyright © 2012 John Wiley & Sons, Ltd.

  12. Macrocognition in the Healthcare Built Environment (mHCBE): A Focused Ethnographic Study of "Neighborhoods" in a Pediatric Intensive Care Unit. (United States)

    O'Hara, Susan; Klar, Robin Toft; Patterson, Emily S; Morris, Nancy S; Ascenzi, Judy; Fackler, James C; Perry, Donna J


    The objectives of this research were to describe the interactions (formal and informal), in which macrocognitive functions occur and their location on a pediatric intensive care unit, to describe challenges and facilitators of macrocognition using space syntax constructs (openness, connectivity, and visibility), and to analyze the healthcare built environment (HCBE) using those constructs to explicate influences on macrocognition. In high reliability, complex industries, macrocognition is an approach to develop new knowledge among interprofessional team members. Although macrocognitive functions have been analyzed in multiple healthcare settings, the effect of the HCBE on those functions has not been directly studied. The theoretical framework, "macrocognition in the healthcare built environment" (mHCBE) addresses this relationship. A focused ethnographic study was conducted including observation and focus groups. Architectural drawing files used to create distance matrices and isovist field view analyses were compared to panoramic photographs and ethnographic data. Neighborhoods comprised of corner configurations with maximized visibility enhanced team interactions as well as observation of patients, offering the greatest opportunity for informal situated macrocognitive interactions (SMIs). Results from this study support the intricate link between macrocognitive interactions and space syntax constructs within the HCBE. These findings help increase understanding of how use of the framework of Macrocognition in the HCBE can improve design and support adaptation of interprofessional team practices, maximizing macrocognitive interaction opportunities for patient, family, and team safety and quality.

  13. Lean in healthcare from employees' perspectives. (United States)

    Drotz, Erik; Poksinska, Bozena


    The purpose of this paper is to contribute toward a deeper understanding of the new roles, responsibilities, and job characteristics of employees in Lean healthcare organizations. The paper is based on three cases studies of healthcare organizations that are regarded as successful examples of Lean applications in the healthcare context. Data were collected by methods including interviews, observations, and document studies. The implementation of Lean in healthcare settings has had a great influence on the roles, responsibilities, and job characteristics of the employees. The focus has shifted from healthcare professionals, where clinical autonomy and professional skills have been the guarding principles of patient care, to process improvement and teamwork. Different job characteristics may make it difficult to implement certain Lean practices in healthcare. Teamwork and decentralization of authority are examples of Lean practices that could be considered countercultural because of the strong professional culture and uneven power distribution, with doctors as the dominant decision makers. Teamwork, value flow orientation, and company-wide involvement in CI were associated with positive effects on the organizations' working environment, staff development, and organizational performance. In order to succeed with Lean healthcare, it is important to understand and recognize the differences in job characteristics between Lean manufacturing and healthcare. This paper provides insights into how Lean implementation changes the roles, responsibilities, and job characteristics of healthcare staff and the challenges and implications that may follow from this.

  14. Healthcare Data Analytics on the Cloud

    Directory of Open Access Journals (Sweden)

    Indrajit Bhattacharya


    Full Text Available Meaningful analysis of voluminous health information has always been a challenge in most healthcare organizations. Accurate and timely information required by the management to lead a healthcare organization through the challenges found in the industry can be obtained using business intelligence (BI or business analytics tools. However, these require large capital investments to implement and support the large volumes of data that needs to be analyzed to identify trends. They also require enormous processing power which places pressure on the business resources in addition to the dynamic changes in the digital technology. This paper evaluates the various nuances of business analytics of healthcare hosted on the cloud computing environment. The paper explores BI being offered as Software as a Service (SaaS solution towards offering meaningful use of information for improving functions in healthcare enterprise. It also attempts to identify the challenges that healthcare enterprises face when making use of a BI SaaS solution.

  15. Individuals’ changes in their lifestyle to build a sustainable environment

    Directory of Open Access Journals (Sweden)

    Matheus Lacerda Viana


    Full Text Available The unsustainable use of natural resources is not a current issue and it began since the Agricultural Revolution, which characterizes the change in the relationship between man and nature. The first major environmental impacts emerged and as a result of this new way of life that went from nomadism to sedentary lifestyles, there was an increase of human productive capacity and the emergence of other crafts that were not directly related to food production. This paper provides a complete definition of the key concepts, suggest a few alternatives which people can apply on their daily lives, and relate them to the framework that rules sustainability. The main arguments for this work are that citizens in the developed world can reduce the pressure being placed on the state of the environment and contribute to sustainable development by saving energy and water, reducing waste, and choosing a transportation which emits less pollutants.

  16. Research progress on expansive soil cracks under changing environment. (United States)

    Shi, Bei-xiao; Zheng, Cheng-feng; Wu, Jin-kun


    Engineering problems shunned previously rise to the surface gradually with the activities of reforming the natural world in depth, the problem of expansive soil crack under the changing environment becoming a control factor of expansive soil slope stability. The problem of expansive soil crack has gradually become a research hotspot, elaborates the occurrence and development of cracks from the basic properties of expansive soil, and points out the role of controlling the crack of expansive soil strength. We summarize the existing research methods and results of expansive soil crack characteristics. Improving crack measurement and calculation method and researching the crack depth measurement, statistical analysis method, crack depth and surface feature relationship will be the future direction.

  17. Academic Training: Climate change and challenges for the environment / POSTPONED!!!

    CERN Multimedia

    Françoise benz


    2004-2005 ACADEMIC TRAINING PROGRAMME LECTURE SERIES 20, 21, 22 June 20, 21, 22 June, from 11:00 to 12:00 - Main Auditorium, bldg. 500 Climate change and challenges for the environment C. SCHLUECHTER / Univ. Bern, CH The seminar is postponed. ENSEIGNEMENT ACADEMIQUE ACADEMIC TRAINING Françoise Benz 73127 If you wish to participate in one of the following courses, please discuss with your supervisor and apply electronically directly from the course description pages that can be found on the Web at: or fill in an 'application for training' form available from your Divisional Secretariat or from your DTO (Divisional Training Officer). Applications will be accepted in the order of their receipt.

  18. Sustainability of biomass utilisation in changing operational environment - SUBICHOE

    Energy Technology Data Exchange (ETDEWEB)

    Soimakallio, S.; Hongisto, M.; Koponen, K.; Sokka, L. (VTT Technical Research Centre of Finland, Espoo (Finland)), Email:; Antikainen, R.; Manninen, K. (Finnish Environment Inst. SYKE, Helsinki (Finland)); Thun, R.; Sinkko, T. (MTT Agrifood Research Finland, Jokioinen (Finland)); Pasanen, K. (Finnish Forest Research Inst., Joensuu (Finland))


    Sustaibability is a multi-faceted and challenging target, but at the same time a crucial issue to assess when setting policies and targets for the future. The main objective of the SUBICHOE project is to assist in strategic decision- making of public administration and companies, as regards the most sustainable use of biomass, by taking into account the changing operational environment. In the project the sustainability of biofuels and the criteria, in particular those set by the EC, for ensuring that set requirements can and will be fulfilled are being assessed from short and long term perspectives. The project is carried out jointly by VTT Technical Research Centre of Finland, Finnish Environment Institute SYKE, MTT Agrifood Research Finland, Finnish Forest Research Institute (Metla) and The Government Institute for Economic Research (VATT). The project started in June 2009 and it is scheduled to be finalised in June 2011. The work plan of the project is divided into four Work Packages. In this article, a summary of a critical view on the requirements and challenges related to the implementation of the RES Directive is also provided based on the main findings of the WP1. (orig.)

  19. Making change last: applying the NHS institute for innovation and improvement sustainability model to healthcare improvement. (United States)

    Doyle, Cathal; Howe, Cathy; Woodcock, Thomas; Myron, Rowan; Phekoo, Karen; McNicholas, Chris; Saffer, Jessica; Bell, Derek


    The implementation of evidence-based treatments to deliver high-quality care is essential to meet the healthcare demands of aging populations. However, the sustainable application of recommended practice is difficult to achieve and variable outcomes well recognised. The NHS Institute for Innovation and Improvement Sustainability Model (SM) was designed to help healthcare teams recognise determinants of sustainability and take action to embed new practice in routine care. This article describes a formative evaluation of the application of the SM by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Northwest London (CLAHRC NWL). Data from project teams' responses to the SM and formal reviews was used to assess acceptability of the SM and the extent to which it prompted teams to take action. Projects were classified as 'engaged,' 'partially engaged' and 'non-engaged.' Quarterly survey feedback data was used to explore reasons for variation in engagement. Score patterns were compared against formal review data and a 'diversity of opinion' measure was derived to assess response variance over time. Of the 19 teams, six were categorized as 'engaged,' six 'partially engaged,' and seven as 'non-engaged.' Twelve teams found the model acceptable to some extent. Diversity of opinion reduced over time. A minority of teams used the SM consistently to take action to promote sustainability but for the majority SM use was sporadic. Feedback from some team members indicates difficulty in understanding and applying the model and negative views regarding its usefulness. The SM is an important attempt to enable teams to systematically consider determinants of sustainability, provide timely data to assess progress, and prompt action to create conditions for sustained practice. Tools such as these need to be tested in healthcare settings to assess strengths and weaknesses and findings disseminated to aid development. This

  20. Hospital customer service in a changing healthcare world: does it matter? (United States)

    Howard, J


    The healthcare industry is undergoing a rapid transformation to meet the ever-increasing needs and demands of the patient population. Employers and health plans such as HMOs are demanding better service and higher quality care, and hospitals are trying to tackle reimbursement cutbacks, streamline services, and serve a diverse population. Hospitals have begun to realize that to overcome these obstacles and meet the needs of the health care plans and consumers, they must focus on the demands of the customer. Customer service initiatives increase patient satisfaction and loyalty and overall hospital quality, and many hospitals have found that consumer demands can be met through initiating and maintaining a customer service program. This article describes how the administrator can create, implement, and manage customer service initiatives within the hospital.

  1. Changing the smoking habit: prevalence, knowledge and attitudes among Umbrian hospital healthcare professionals. (United States)

    Pianori, D; Gili, A; Masanotti, G


    Health care professionals should work against smoking habit to promote a correct life style. This study aimed to evaluate smoking prevalence and attitudes towards tobacco among Umbrian hospital professionals in a period between 2006 and 2015, since the approbation of the law that ban smoking in hospitals and all public areas in 2003. A cross-sectional study was carried out using a questionnaire administered in 2006, 2011 and 2015 to healthcare professionals. It consists of 53 multiple-choice questions. Potential predictors of current smoking habits were evaluated using univariate and multivariate logistic regression. The sample included 475 healthcare professionals. Current smokers constituted 34.53% of the sample and no significant difference (p = 0.257) emerged in prevalence over time (33.74% in 2006; 36.02% in 2011 and 33.77% in 2015). The risk of being a smoker increased by not considering the smoking habit as the main cause of preventable deaths (OR = 2.25; 95% CI: 1.47- 3.45). The strongest risk factor, which was significant in both models (p Smoking" law (OR = 18.90; 95% CI: 2.43-147.71; adjusted OR = 22.10; 95% CI: 1.85-264.78). The hospital staff has higher prevalence of smoking than the general population. The No Smoking law alone has been shown to be inadequate. Effective results can be achieved only by a common strategy and shared intervention programmes that are based on a workplace health promotion strategy. That for the moment has demonstrated to give interesting outcomes in modifying deep-rooted behaviour patterns.

  2. Promoting professional behaviour change in healthcare: what interventions work, and why? A theory-led overview of systematic reviews. (United States)

    Johnson, Mark J; May, Carl R


    Translating research evidence into routine clinical practice is notoriously difficult. Behavioural interventions are often used to change practice, although their success is variable and the characteristics of more successful interventions are unclear. We aimed to establish the characteristics of successful behaviour change interventions in healthcare. We carried out a systematic overview of systematic reviews on the effectiveness of behaviour change interventions with a theory-led analysis using the constructs of normalisation process theory (NPT). MEDLINE, CINAHL, PsychINFO and the Cochrane Library were searched electronically from inception to July 2015. Primary and secondary care. Participants were any patients and healthcare professionals in systematic reviews who met the inclusion criteria of having examined the effectiveness of professional interventions in improving professional practice and/or patient outcomes. Professional interventions as defined by the Cochrane Effective Practice and Organisation of Care Review Group. Success of each intervention in changing practice or patient outcomes, and their mechanisms of action. Reviews were coded as to the interventions included, how successful they had been and which NPT constructs its component interventions covered. Searches identified 4724 articles, 67 of which met the inclusion criteria. Interventions fell into three main categories: persuasive; educational and informational; and action and monitoring. Interventions focusing on action or education (eg, Audit and Feedback, Reminders, Educational Outreach) acted on the NPT constructs of Collective Action and Reflexive Monitoring, and reviews using them tended to report more positive outcomes. This theory-led analysis suggests that interventions which contribute to normative restructuring of practice, modifying peer group norms and expectations (eg, educational outreach) and relational restructuring, reinforcing modified peer group norms by emphasising the

  3. Dental Education Required for the Changing Health Care Environment. (United States)

    Fontana, Margherita; González-Cabezas, Carlos; de Peralta, Tracy; Johnsen, David C


    To be able to meet the demands for care in 2040, dental graduates will need to address challenges resulting from the rapidly changing health care environment with knowledge and sets of skills to build on current standards and adapt to the future. The purposes of this article are to 1) analyze key challenges likely to evolve considerably between now and 2040 that will impact dental education and practice and 2) propose several sets of skills and educational outcomes necessary to address these challenges. The challenges discussed include changes in prevalence of oral diseases, dental practice patterns, materials and technologies, integrated medical-dental care, role of electronic health records, cultural competence, integrated curricula, interprofessional education, specialty-general balance, and web/cloud-based collaborations. To meet these challenges, the dental graduate will need skills such as core knowledge in basic and clinical dentistry, technical proficiency, critical thinking skills for lifelong learning, ethical and professional values, ability to manage a practice, social responsibility, and ability to function in a collegial intra- and interprofessional setting. Beyond the skills of the individual dentist will be the need for leadership in academia and the practice community. Academic and professional leaders will need to engage key constituencies to develop strategic directions and agendas with all parties pointed toward high standards for individual patients and the public at large. This article was written as part of the project "Advancing Dental Education in the 21 st Century."

  4. Modeling adaptation of wetland plants under changing environments (United States)

    Muneepeerakul, R.; Muneepeerakul, C. P.


    An evolutionary-game-theoretic approach is used to study the changes in traits of wetland plants in response to environmental changes, e.g., altered patterns of rainfall and nutrients. Here, a wetland is considered as a complex adaptive system where plants can adapt their strategies and influence one another. The system is subject to stochastic rainfall, which controls the dynamics of water level, soil moisture, and alternation between aerobic and anaerobic conditions in soil. Based on our previous work, a plant unit is characterized by three traits, namely biomass nitrogen content, specific leaf area, and allocation to rhizome. These traits control the basic functions of plants such as assimilation, respiration, and nutrient uptake, while affecting their environment through litter chemistry, root oxygenation, and thus soil microbial dynamics. The outcome of this evolutionary game, i.e., the best-performing plant traits against the backdrop of these interactions and feedbacks, is analyzed and its implications on important roles of wetlands in supporting our sustainability such as carbon sequestration in biosphere, nutrient cycling, and repository of biodiversity are discussed.

  5. Enhancing the Australian healthcare sector's responsiveness to environmental sustainability issues: suggestions from Australian healthcare professionals. (United States)

    Dunphy, Jillian L


    Identify strategies to implement change across the Australian healthcare sector to better support social and natural environments. Methods. Qualitative analysis of semi-structured interviews with Australian healthcare professionals. Interviewees described multiple barriers to implementing change and numerous strategies to overcome these barriers. They argued that action must be taken at the individual and systemic levels to produce substantial and effective change. The strategies recommended fall into four main categories: altering workplace cultures and professional identities, community engagement, political activity, and change from within. The overarching goals of these strategies are to reduce negative impacts on the natural environment, and increase social equity within and across generations. By implementing the strategies described, a more cohesive effort to address sustainability issues across the sector can be made. This may improve local and global health, within current and future generations. WHAT IS KNOWN ABOUT THE TOPIC? Healthcare has a significant impact on the natural and social environments, which in turn have a significant impact upon health and healthcare. WHAT DOES THIS PAPER ADD? This paper describes strategies to alter healthcare to better support environmental sustainability. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? Collective implementation of the described strategies may allow a more cohesive and effective response across the Australian healthcare sector, to enhance local and global health for current and future generations.

  6. Power plant construction contracting in a changing regulatory environment

    International Nuclear Information System (INIS)

    Person, J.C.


    The 1965 blackout in the Northeast provided the wake-up call that spawned in unprecedented program of power plant construction by electric utilities. This building program began in the late 1960s and continued unabated through the 1970s. Beginning in the late 1970s, state regulators began in era of 'prudence' reviews which disallowed as imprudent significant portions of the costs of certain nuclear units being brought on line at the time. This regulatory experience brought about a fundamental change in the way in which utilities evaluated the need for additional capacity. This paper explores construction contracting trends in light of recent developments in the relationship between the electric utility and the state regulator. It is within this context that the utility decides: (1) whether to build, buy, or save; and (2) if the decision is to build, which project planning and administration considerations will maximize the utility's ability to incorporate project costs into the ratebase. In order to put these issues into their proper perspective, this paper first presents a brief overview of the prudence decisions of the past, and the chilling effect of these decisions generally on new project planning. The paper next focuses on the recent changes to the post-construction prudence review model, including the introduction of pre-approval arrangements and rolling prudence reviews. Following that will be a survey of new construction spending decisions in light of these changes. After an analysis of the bases for the prudence disallowances of the past and the application of the lessons learned from these disallowances to contract planning and administration issues of today, the paper will close with a discussion of the relative advantages and disadvantages of the most commonly used contract delivery methods in today's regulatory environment

  7. Dynamics and life histories of northern ungulates in changing environments (United States)

    Hendrichsen, D. K.


    Regional climate and local weather conditions can profoundly influence life history parameters (growth, survival, fecundity) and population dynamics in northern ungulates (Post and Stenseth 1999, Coulson et al. 2001). The influence is both direct, for example through reduced growth or survival (Aanes et al. 2000, Tyler et al. 2008), and indirect, for example through changes in resource distribution, phenology and quality, changes which subsequently influence consumer dynamics (Post et al. 2008). By comparing and contrasting data from three spatially independent populations of ungulates, I discuss how variation in local weather parameters and vegetation growth influence spatial and temporal dynamics through changes in life history parameters and/or behavioural dynamics. The data originate from long term (11-15 years) monitoring data from three populations of ungulates in one subarctic and two high Arctic sites; semi-domesticated reindeer (Rangifer tarandus tarandus) in northern Norway, Svalbard reindeer (R. t. platyrhynchus) on Spitsbergen and muskoxen (Ovibos moschatus) in Northeast Greenland. The results show that juvenile animals can be particularly vulnerable to changes in their environment, and that this is mirrored to different degrees in the spatio-temporal dynamics of the three populations. Adverse weather conditions, acting either directly or mediated through access to and quality of vegetation, experienced by young early in life, or even by their dams during pregnancy, can lead to reduced growth, lower survival and reduced reproductive performance later in life. The influence of current climatic variation, and the predictions of how local weather conditions may change over time, differs between the three sites, resulting in potentially different responses in the three populations. Aanes R, Saether BE and Øritsland NA. 2000. Fluctuations of an introduced population of Svalbard reindeer: the effects of density dependence and climatic variation. Ecography

  8. Changes in Healthcare Spending After Diagnosis of Comorbidities Among Endometriosis Patients: A Difference-in-Differences Analysis. (United States)

    Epstein, Andrew J; Soliman, Ahmed M; Davis, Matthew; Johnson, Scott J; Snabes, Michael C; Surrey, Eric S


    We sought to characterize changes in healthcare spending associated with the onset of 22 endometriosis-related comorbidities. Women aged 18-49 years with endometriosis (N = 180,278) were extracted from 2006-2015 de-identified Clinformatics ® DataMart claims data. For 22 comorbidities, comorbidity patients were identified on the basis of having a first comorbidity diagnosis after their initial endometriosis diagnosis. Controls were identified on the basis of having no comorbidity diagnosis and were matched 1:1 to comorbidity patients on demographics and baseline spending. Total medical and pharmacy spending was measured during 12 months before and after each patient's index date (first comorbidity diagnosis for comorbidity patients, and equal number of days after earliest endometriosis claim for controls). Pre-post spending differences were compared using difference-in-differences linear regression. Total and comorbidity-related cumulative spending per patient for all endometriosis patients were calculated annually for the 5 years following endometriosis diagnosis. The number of endometriosis patients with each comorbidity varied between 121 for endometrial cancer and 16,177 for fatigue. Healthcare spending increased significantly with the onset of eight comorbidities: breast cancer, ovarian cancer, pregnancy complications, systemic lupus erythematosus/rheumatoid arthritis/Sjogren's/multiple sclerosis, infertility, uterine fibroids, ovarian cyst, and headache [p endometriosis patient, of which between 11% and 23% was attributable to comorbidity-related medical claims. For all but one of the 22 comorbidities associated with endometriosis, comorbidity onset was associated with a relative increase in total healthcare spending. AbbVie Inc.

  9. Towards a sustainable Asia. Environment and climate change

    Energy Technology Data Exchange (ETDEWEB)



    This series of books are the output of the research project called ''Sustainable Development in Asia (SDA)'', which was initiated by the Association of Academies of Sciences in Asia (AASA). They are comprised of one synthesis report, which entitled ''Towards a Sustainable Asia: Green Transition and Innovation'', and four thematic reports on natural resources, energy, the environment and climate change, and culture from particular perspectives of agriculture. They aim to: (1) investigate common sustainability issues faced by all Asian countries, including population increase, poverty alleviation, pollution control, ecological restoration, as well as regional problems, such as water shortage in West and Central Asia, energy security in Northeast Asia, development model and transformation in East Asia; (2) analyze and summarize of best practices towards sustainable development in Asia; (3) bring forward suggestions and policy options for promoting green transition, system innovation and sustainable development of Asia. With best practice guidelines for a sustainable Asia, this series of reports, for the first time systematically address the common challenges and regional problems in regard to Asia's natural resources use, pollution reduction and climate protection, sustainable energy development, and innovations for environment-friendly and culture-compatible agriculture. They will provide handy and useful information to researchers, government policy makers and the general public who have concerns about Asia's sustainable development. AASA is a scientific and technological organization in Asia, established in 2000, comprising of 26 member academies all over Asia. Its vision is to provide a forum for the discussion of all issues relevant to science and technology development and its application on national level within Asia. (orig.)

  10. Tools for estimating VMT reductions from built environment changes. (United States)


    Built environment characteristics are associated with walking, bicycling, transit use, and vehicle : miles traveled (VMT). Developing built environments supportive of walking, bicycling, and transit use : can help meet state VMT reduction goals. But ...

  11. The Worldviews Network: Transformative Global Change Education in Immersive Environments (United States)

    Hamilton, H.; Yu, K. C.; Gardiner, N.; McConville, D.; Connolly, R.; "Irving, Lindsay", L. S.


    Our modern age is defined by an astounding capacity to generate scientific information. From DNA to dark matter, human ingenuity and technologies create an endless stream of data about ourselves and the world of which we are a part. Yet we largely founder in transforming information into understanding, and understanding into rational action for our society as a whole. Earth and biodiversity scientists are especially frustrated by this impasse because the data they gather often point to a clash between Earth's capacity to sustain life and the decisions that humans make to garner the planet's resources. Immersive virtual environments offer an underexplored link in the translation of scientific data into public understanding, dialogue, and action. The Worldviews Network is a collaboration of scientists, artists, and educators focused on developing best practices for the use of immersive environments for science-based ecological literacy education. A central tenet of the Worldviews Network is that there are multiple ways to know and experience the world, so we are developing scientifically accurate, geographically relevant, and culturally appropriate programming to promote ecological literacy within informal science education programs across the United States. The goal of Worldviews Network is to offer transformative learning experiences, in which participants are guided on a process integrating immersive visual explorations, critical reflection and dialogue, and design-oriented approaches to action - or more simply, seeing, knowing, and doing. Our methods center on live presentations, interactive scientific visualizations, and sustainability dialogues hosted at informal science institutions. Our approach uses datasets from the life, Earth, and space sciences to illuminate the complex conditions that support life on earth and the ways in which ecological systems interact. We are leveraging scientific data from federal agencies, non-governmental organizations, and our

  12. New solutions for personalised health management: citizens' needs, healthcare changes, and market perspectives round table debate. (United States)

    Olsson, Silas; Hofmann, Isa; Brambilla, Piero Maria; Jacobsson, Ulf; Kennedy, Paul; Roca, Josep; Schmitt, Karl-Jürgen; Wyke, Alexandra


    The aim with the round table was to give additional inputs and views to the specific technology oriented presentations focusing on issues dealing with the need, patients' view, the use and the business opportunities relating to wearable eHealth systems for personalised health management. Wearable eHealth systems for personalised health management are targeting citizens, patients at health risks and patients enrolled in open care or home care for monitoring, treatment or follow up. The developments so far show promises for these group categories, and in addition, could support developments in health care organisations and systems. However, the ethical issues and data privacy nature have to be seriously taken into account. The market is not yet developed, and this is the situation both in Europe and in the US. To be able to give the customers solid product information a standardised test bed for new equipment and services might speed up the market development. In the round table discussion it was highlighted that one has to differ between needs and demands. Needs are related to the prevalence of the diseases, the health risks, etc. Demands are more related to market developments and customers' willingness to pay for the new products and services. Further, technical interoperability was seen as a fundamental prerequisite for market acceptance. As wearable eHealth systems for personalised health management differ completely from traditional way of deliver healthcare, new reimbursement systems have to be developed and implemented.

  13. Changes in government spending on healthcare and population mortality in the European union, 1995-2010: a cross-sectional ecological study. (United States)

    Budhdeo, Sanjay; Watkins, Johnathan; Atun, Rifat; Williams, Callum; Zeltner, Thomas; Maruthappu, Mahiben


    Economic measures such as unemployment and gross domestic product are correlated with changes in health outcomes. We aimed to examine the effects of changes in government healthcare spending, an increasingly important measure given constrained government budgets in several European Union countries. Multivariate regression analysis was used to assess the effect of changes in healthcare spending as a proportion of total government expenditure, government healthcare spending as a proportion of gross domestic product and government healthcare spending measured in purchasing power parity per capita, on five mortality indicators. Additional variables were controlled for to ensure robustness of data. One to five year lag analyses were conducted. European Union countries 1995-2010. Neonatal mortality, postneonatal mortality, one to five years of age mortality, under five years of age mortality, adult male mortality, adult female mortality. A 1% decrease in government healthcare spending was associated with significant increase in all mortality metrics: neonatal mortality (coefficient -0.1217, p = 0.0001), postneonatal mortality (coefficient -0.0499, p = 0.0018), one to five years of age mortality (coefficient -0.0185, p = 0.0002), under five years of age mortality (coefficient -0.1897, p = 0.0003), adult male mortality (coefficient -2.5398, p = 0.0000) and adult female mortality (coefficient -1.4492, p = 0.0000). One per cent decrease in healthcare spending, measured as a proportion of gross domestic product and in purchasing power parity, was both associated with significant increases (p < 0.05) in all metrics. Five years after the 1% decrease in healthcare spending, significant increases (p < 0.05) continued to be observed in all mortality metrics. Decreased government healthcare spending is associated with increased population mortality in the short and long term. Policy interventions implemented in response to the financial crisis may be associated with worsening

  14. The orthopaedist's role in healthcare system governance. (United States)

    Probe, Robert A


    Historically, physicians as participants in healthcare governance were shunned because of perceived potential for conflict of interest. This maxim is being revisited as health systems begin to appreciate the value presented by physician leaders. This overview of the orthopaedist's role in healthcare governance will be addressed in three sections: first to identify the need for change in American healthcare, second to examine the role that physicians should play in governing over this inevitable change, and third to outline strategies for effective participation for those physicians wishing to play a role in healthcare governance. The PubMed data set was queried applying the search commands "governance AND (healthcare OR hospital) AND (doctor OR physician OR surgeon)" for the time period 1969 to 2012. In addition, the bibliographies of relevant articles were reviewed. This search strategy returned 404 titles. Abstract and article review identified 19 relevant to the topic. Bibliographic review identified five more articles of relevance forming the foundation for this review. The delivery of American health care will require change to face current economic realities. Organizations that embrace this change guided by the insight of physician governors are well positioned to recognize the simultaneous improvement in value and quality. Although few physicians are formally trained for these roles, multiple paths to becoming effective governors are available. In this environment of rapid change in healthcare delivery, the medical insight of physician leadership will prove invaluable. Governing bodies should reach out to talented physicians and administratively talented physicians should rise to this challenge.

  15. Shifting the balance of power? Culture change and identity in an English health-care setting. (United States)

    McDonald, Ruth


    A recurring theme in Government policy documents has been the need to change the culture of the NHS in order to deliver a service "fit for the twenty-first century". However, very little is said about what constitutes "culture" or how this culture change is to be brought about. This paper seeks to focus on an initiative aimed ostensibly at "empowering" staff in an English Primary Care Trust as a means of changing organisational culture. It presents findings from an ethnographic study which suggests that this attempt at "culture change" is aimed at manipulating the behaviour and values of individual employees and may be interpreted as a process of changing employee identity. Employees reacted in different ways to the empowerment initiative, with some resisting attempts to shape their identity and others actively engaging in projects to bring their unruly self into line with the ideal self to which they were encouraged to aspire. The challenges presented by the need to respond to conflicting Government policies created tensions between individuals and conflicts of allegiance and identity within individual members of staff. Alternative forms of self-hood did not merely replace existing identities, but interacted with them, often uncomfortably. The irony is that, whilst Government seeks to promote culture change, the frustrations created by its top-down target-driven regime acted to mitigate the transformational and reconstitutive effects of a discourse of empowerment aimed at achieving this change.

  16. Verification ghosts. The changing political environment of the IAEA

    International Nuclear Information System (INIS)

    Redden, K.J.


    Six years ago, Dr. Hans Blix wrote in the IAEA Bulletin of a 'general optimism about further arms control and verification.' At the time, world events warranted such a prognosis; the IAEA was riding a wave of momentum after its instrumental role in the roll-back of the South African nuclear weapons program and bringing Ukraine, Belarus, and Kazakhstan into the Nuclear Non Proliferation Treaty (NPT) as non-nuclear-weapon States. The NPT's indefinite extension was only two years old, and the most pressing challenges, while recognizable, were somewhat stagnant. Today, some tidings elicit similar optimism. The IAEA's increasing efforts to combat terrorism and the decision by Member States to depart from nearly 20 years of zero real growth budgetary policy are remarkable testaments to the Agency's adaptability and credibility in the face of new threats. And with the worldwide frenzy over terrorism and redoubled phobia of weapons of mass destruction (WMD), the Agency garners public attention now as never before. Emblematic of this recent upsurge in political attention, US President George W. Bush's annual State of the Union address in 2003 mentioned supporting the IAEA as a specific priority of his administration, the first mention of the Agency in that speech since President Eisenhower in 1961 lauded its creation under 'Atoms for Peace'. Such visibility portends a future with prospects for overcoming bureaucratic inertia and effecting significant changes to the Agency's benefit. But with that visibility has come an uncertainty about the IAEA's role in world affairs. Despite being able to resolve most benign problems more easily, the Agency must operate in an environment haunted by the non-proliferation analogue of Charles Dickens' triumvirate specters: the ghosts of verification challenges past, present and future -namely, the cessation of UN-mandated inspections in Iraq, the difficulties ensuring compliance in North Korea and Iran, and the need to maintain the IAEA

  17. Taimyr Reindeer and Environmental Change: Monitoring Wild Reindeer Migration in Changing Natural and Social Environments (United States)

    Petrov, A. N.


    The Taimyr Reindeer Herd (TRH) is both the largest and the longest monitored wild reindeer herd in Eurasia. An important part of Arctic ecosystems and Indigenous livelihood, wild reindeer have been continuously monitored for almost 50 years. During this time, herds have exhibited large changes in size and these changes have been recorded in almost all herds across the animal's range. An increasing number of wild reindeer in the Soviet times was followed by a significant population loss in the last decade. In addition, recent monitoring revealed substantial shifts in the distribution of wild populations. The decline in wild reindeer is likely related to natural cycles and changes in the Arctic environment caused by climate variability and anthropogenic activity. This study investigates patterns and possible drives of reindeer population dynamics in space and time. We identify key climatic factors, possible relationships with biomass dynamics, as well as with hunting practices and other human impacts.

  18. Healthcare professional behaviour change using technological supports: A realist literature review

    Directory of Open Access Journals (Sweden)

    Chris Keyworth


    Thirteen of the 19 (68% studies using computerised decision support showed positive effects; 8 of the 12 (67% studies using reminders alone showed positive effects. One of 3 (33% studies using diagnostic/risk assessment tools showed positive effects. Only two (4% of the fifty studies identified were informed by recognised behaviour change theories in the design of the intervention, both of which showed positive effects in changing professional behaviour. O

  19. Augmented Personalized Health: How Smart Data with IoTs and AI is about to Change Healthcare. (United States)

    Sheth, Amit; Jaimini, Utkarshani; Thirunarayan, Krishnaprasad; Banerjee, Tanvi


    Healthcare as we know it is in the process of going through a massive change - from episodic to continuous, from disease focused to wellness and quality of life focused, from clinic centric to anywhere a patient is, from clinician controlled to patient empowered, and from being driven by limited data to 360-degree, multimodal personal-public-population physical-cyber-social big data driven. While ability to create and capture data is already here, the upcoming innovations will be in converting this big data into smart data through contextual and personalized processing such that patients and clinicians can make better decisions and take timely actions for augmented personalized health. This paper outlines current opportunities and challenges, with a focus on key AI approaches to make this a reality. The broader vision is exemplified using three ongoing applications (asthma in children, bariatric surgery, and pain management) as part of the Kno.e.sis kHealth personalized digital health initiative.

  20. Board Governance: Transformational Approaches Under Healthcare Reform. (United States)

    Zastocki, Deborah K


    Previous successes of healthcare organizations and effective governance practices in the pre-reform environment are not predictive of future success. Healthcare has been through numerous phases of growth and development using tried-and-true strategies. The challenge is that our toolbox does not contain what is needed to build the future healthcare delivery systems required in the post-reform world. Healthcare has had a parochial focus at the local level, with some broadening of horizons at the state and national levels. But healthcare delivery is now a global issue that requires a totally different perspective, and many countries are confronting similar issues. US healthcare reform initiatives have far-reaching implications. Compounding the reform dynamics are the simultaneously occurring, gamechanging accelerants such as enabling information technologies and mobile health, new providers of healthcare, increased consumer demands, and limited healthcare dollars, to name a few. Operating in this turbulent environment requires transformational board, executive, and physician leadership because traditional ways of planning for incremental change and attempting to time those adjustments can prove disastrous. Creating the legacy healthcare system for tomorrow requires governing boards and executive leadership to act today as they would in the desired future system. Boards need to create a culture that fosters.innovation with a tolerance for risk and some failure. To provide effective governance, boards must essentially develop new skills, expertise, and ways of thinking. The rapid rate of change requires board members to possess certain capabilities, including the ability to deal with ambiguity and uncertainty while demonstrating flexibility and adaptability, all with a driving commitment to metrics and results. This requires development plans for both individual members and the overall board. In short, the board needs to function differently, particularly regarding the

  1. A position paper on how cost and quality reforms are changing healthcare in America: focus on nutrition. (United States)

    Rosen, Barry S; Maddox, P J; Ray, Nancy


    Healthcare spending in the United States is the highest in the world, yet quality indicators such as life expectancy and infant mortality lag other countries. U.S. reforms are under way to lower costs and raise quality of care, notably the Patient Protection and Affordable Care Act (PPACA). Value-based purchasing (VBP) and programs for reducing the incidence of hospital-acquired conditions (HACs) and hospital readmissions represent initial changes. With these programs, overarching themes are to coordinate care during and beyond hospitalization and to ensure that physicians and hospitals are aligned in their treatment strategies. Hospital malnutrition represents a large, hidden, and costly component of medical care; hospital administrators and caregivers alike must harness the benefits of nutrition as a vital component of healthcare. Medical, nursing, and allied health training programs must find places in their curricula to increase awareness of nutrition and promote knowledge of best-practice nutrition interventions. Hospitals use dietitians and nutrition support teams as critical members of the patient care team, but more work needs to be done to disseminate and enforce best nutrition practices. Such training, nutrition interventions, and practice changes can help prevent and treat malnutrition and thus help avert HACs, reduce hospital readmissions, lower infection and complication rates, and shorten hospital stays. Nutrition care is an effective way to reduce costs and improve patient outcomes. This article calls hospital executives and bedside clinicians to action: recognize the value of nutrition care before, during, and after hospitalization, as well as develop training programs and policies that promote nutrition care.

  2. Ecotones in a changing environment: Workshop on ecotones and global change

    Energy Technology Data Exchange (ETDEWEB)

    Risser, P.G.


    The Scientific Committee on Problems of the Environment (SCOPE) has organized an international project to synthesize and advance current theory on the influence of ecotones, or transition zones between ecosystems, on biodiversity and flows of energy, nutrients, water, and project is other materials between ecosystems. In particular, the entire project is designed to evaluate the influence of global climate change and land-use practices on biodiversity and ecological flows associated with ecotones, and will assess the feasibility of monitoring ecotones as early indicators of global change. The later stages of the project will recommend landscape management strategies for ecotones that produce desirable patterns of biodiversity and ecological flows. The result of the project--a comprehensive body of information on the theory and management of biodiversity and ecological flows associated with ecotones--will be part of the planning for research to be carried out under the International Geosphere-Biosphere Program.

  3. The impact of business environment changes on recent costing techniques

    Institute of Scientific and Technical Information of China (English)



    1.Introduction The acceleration of globalization and the prosperity of information technology benefit business a great deal.But with the speeding up of economic development,firms are facing more and more pressure from various aspects of their business.The heated debate is on about whether traditional management accounting practices and techniques are irrelevant to the current business environment and this essay will explore the causes for using some traditional management accounting practices and techniques in the current business environment are inappropriate and put forward some contemporary management accounting techniques which is relevant to the current business environment.Thus,the essay will be divided into three sections to discuss the traditional management accounting practices and techniques and contemporary management accounting techniques in current business environment.

  4. Arctic alpine ecosystems and people in a changing environment

    National Research Council Canada - National Science Library

    Ørbæk, Jon Børre


    ... for the population structures and the interaction between species. These changes may also have socio-economic effects if the changes affect the bio-production, which form the basis for the marine and terrestrial food chains. The book is uniquely multidisciplinary and provides examples of various aspects of contemporary environmental change in arctic and ...

  5. Adjusting to future demands in healthcare: Curriculum changes and nursing students' self-reported professional competence. (United States)

    Theander, Kersti; Wilde-Larsson, Bodil; Carlsson, Marianne; Florin, Jan; Gardulf, Ann; Johansson, Eva; Lindholm, Christina; Nordström, Gun; Nilsson, Jan


    Nursing competence is of significant importance for patient care. Newly graduated nursing students rate their competence as high. However, the impact of different designs of nursing curricula on nursing students' self-reported nursing competence areas is seldom reported. To compare newly graduated nursing students' self-reported professional competence before and after the implementation of a new nursing curriculum. The study had a descriptive comparative design. Nursing students, who graduated in 2011, having studied according to an older curriculum, were compared with those who graduated in 2014, after a new nursing curriculum with more focus on person-centered nursing had been implemented. A higher education nursing program at a Swedish university. In total, 119 (2011 n=69, 2014 n=50) nursing students responded. Nursing students' self-reported professional competencies were assessed with the Nurse Professional Competence (NPC) scale. There were no significant differences between the two groups of nursing students, who graduated in 2011 and 2014, respectively, with regard to age, sex, education, or work experience. Both groups rated their competencies as very high. Competence in value-based nursing was perceived to be significantly higher after the change in curriculum. The lowest competence, both in 2011 and 2014, was reported in education and supervision of staff and students. Our findings indicate that newly graduated nursing students - both those following the old curriculum and the first batch of students following the new one - perceive that their professional competence is high. Competence in value-based nursing, measured with the NPC scale, was reported higher after the implementation of a new curriculum, reflecting curriculum changes with more focus on person-centered nursing. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Use of an Innovative Personality-Mindset Profiling Tool to Guide Culture-Change Strategies among Different Healthcare Worker Groups. (United States)

    Grayson, M Lindsay; Macesic, Nenad; Huang, G Khai; Bond, Katherine; Fletcher, Jason; Gilbert, Gwendolyn L; Gordon, David L; Hellsten, Jane F; Iredell, Jonathan; Keighley, Caitlin; Stuart, Rhonda L; Xuereb, Charles S; Cruickshank, Marilyn


    Important culture-change initiatives (e.g. improving hand hygiene compliance) are frequently associated with variable uptake among different healthcare worker (HCW) categories. Inherent personality differences between these groups may explain change uptake and help improve future intervention design. We used an innovative personality-profiling tool (ColourGrid®) to assess personality differences among standard HCW categories at five large Australian hospitals using two data sources (HCW participant surveys [PS] and generic institution-wide human resource [HR] data) to: a) compare the relative accuracy of these two sources; b) identify differences between HCW groups and c) use the observed profiles to guide design strategies to improve uptake of three clinically-important initiatives (improved hand hygiene, antimicrobial stewardship and isolation procedure adherence). Results from 34,243 HCWs (HR data) and 1045 survey participants (PS data) suggest that HCWs were different from the general population, displaying more individualism, lower power distance, less uncertainty avoidance and greater cynicism about advertising messages. HR and PS data were highly concordant in identifying differences between the three key HCW categories (doctors, nursing/allied-health, support services) and predicting appropriate implementation strategies. Among doctors, the data suggest that key messaging should differ between full-time vs part-time (visiting) senior medical officers (SMO, VMO) and junior hospital medical officers (HMO), with SMO messaging focused on evidence-based compliance, VMO initiatives emphasising structured mandatory controls and prestige loss for non-adherence, and for HMOs focusing on leadership opportunity and future career risk for non-adherence. Compared to current standardised approaches, targeted interventions based on personality differences between HCW categories should result in improved infection control-related culture-change uptake. Personality

  7. Use of an Innovative Personality-Mindset Profiling Tool to Guide Culture-Change Strategies among Different Healthcare Worker Groups.

    Directory of Open Access Journals (Sweden)

    M Lindsay Grayson

    Full Text Available Important culture-change initiatives (e.g. improving hand hygiene compliance are frequently associated with variable uptake among different healthcare worker (HCW categories. Inherent personality differences between these groups may explain change uptake and help improve future intervention design.We used an innovative personality-profiling tool (ColourGrid® to assess personality differences among standard HCW categories at five large Australian hospitals using two data sources (HCW participant surveys [PS] and generic institution-wide human resource [HR] data to: a compare the relative accuracy of these two sources; b identify differences between HCW groups and c use the observed profiles to guide design strategies to improve uptake of three clinically-important initiatives (improved hand hygiene, antimicrobial stewardship and isolation procedure adherence.Results from 34,243 HCWs (HR data and 1045 survey participants (PS data suggest that HCWs were different from the general population, displaying more individualism, lower power distance, less uncertainty avoidance and greater cynicism about advertising messages. HR and PS data were highly concordant in identifying differences between the three key HCW categories (doctors, nursing/allied-health, support services and predicting appropriate implementation strategies. Among doctors, the data suggest that key messaging should differ between full-time vs part-time (visiting senior medical officers (SMO, VMO and junior hospital medical officers (HMO, with SMO messaging focused on evidence-based compliance, VMO initiatives emphasising structured mandatory controls and prestige loss for non-adherence, and for HMOs focusing on leadership opportunity and future career risk for non-adherence.Compared to current standardised approaches, targeted interventions based on personality differences between HCW categories should result in improved infection control-related culture-change uptake. Personality

  8. Gene by Environment Research to Prevent Externalizing Problem Behavior : Ethical Questions Raised from a Public Healthcare Perspective

    NARCIS (Netherlands)

    Chhangur, Rabia R.; Weeland, Joyce; Matthys, Walter; Overbeek, Geertjan


    The main public health advantages of examining gene by environment interactions (i.e., G x E) in externalizing behavior lie in the realm of personalized interventions. Nevertheless, the incorporation of genetic data in randomized controlled trials is fraught with difficulties and raises ethical

  9. Gene by environment research to prevent externalizing problem behavior: Ethical questions raised from a public healthcare perspective

    NARCIS (Netherlands)

    Chhangur, R.R.; Weeland, J.; Matthys, W.; Overbeek, G.


    The main public health advantages of examining gene by environment interactions (i.e., G × E) in externalizing behavior lie in the realm of personalized interventions. Nevertheless, the incorporation of genetic data in randomized controlled trials is fraught with difficulties and raises ethical

  10. Evidence for change in depositional environment in the Arabian Sea

    Digital Repository Service at National Institute of Oceanography (India)

    Rao, P.S.; Rao, Ch.M.

    Sediments of late Pleistocene and Holocene periods, from a 12 m long core collected at a depth of 3627 m from the Arabian Sea, have been studied in order to understand the depositional environment. Sub-samples selected at 5 cm and occasionally at 10...

  11. Lactic acid bacteria in a changing legislative environment

    NARCIS (Netherlands)

    Feord, J.


    The benefits of using lactic acid bacteria in the food chain, both through direct consumption and production of ingredients, are increasingly recognised by the food industry and consumers alike. The regulatory environment surrounding these products is diverse, covering foods and food ingredients,

  12. Constant Change: The Ever-Evolving Personal Learning Environment (United States)

    Torres Kompen, Ricardo; Monguet, Josep Ma.; Brigos, Miguel


    There are several definitions for the term "personal learning environment" (PLE); in this article, PLE refers to a group of web technologies, with various degrees of integration and interaction, that helps users and learners manage the flow of information that relates to the learning process, the creation of knowledge, and the…

  13. Planning Intentionally for Children's Outdoor Environments: The Gift of Change (United States)

    Rosenow, Nancy


    When the author was a child 50 years ago, nobody planned her outdoor environment. Her home was close to flower-filled meadows that she could explore freely, and her preschool and elementary school classrooms opened onto beautiful woodlands that children used as an important part of their day-to-day learning. The last time she visited her old…

  14. Stormy Weather in Healthcare

    DEFF Research Database (Denmark)

    Clemensen, Jane; Jakobsen, Pernille Ravn; Myhre Jensen, Charlotte


    and healthcare professionals, by a dominant paradigm. We suggest a shift in focus from valuing the neo-liberal approach, to focus on care by linking an Ecology of Care (EoC) approach to the healthcare context, as EoC can be used as a complementary philosophy to help change the paradigm and thereby secure...

  15. Northern hydrology and water resources in a changing environment

    International Nuclear Information System (INIS)

    Kane, D.L.


    The role that climatic change may play in altering various components of the hydrologic cycle in Arctic regions is discussed. The hydrologic setting of these regions is first described, noting the importance of subsurface freezing and thawing on hydrologic pathways and the lack of incorporation of soil freezing and thawing into climate models. Major processes of interest in the relation between climate change and hydrology are the timing and magnitude of fluxes entering and leaving a basin: precipitation, evaporation and transpiration, and runoff. The active layer of the soil could be drastically increased by only a few degrees of surface warming. The natural hydrologic cycle has considerable yearly variation, tending to mask any hydrologic changes caused by climatic change. There are too many unknowns at present for an adequate prediction of the impact of climate change on the hydrologic cycle. The biggest uncertainty is how the timing and quantity of precipitation is going to change. This quantity could be altered by any major changes in vegetation, which would be closely related to the amount of warming. In hydrologic scenarios where air temperature rises 4 degree C over 50 y, under stable, high, and low precipitation conditions, there are no significant changes in hydrologic response. 24 refs., 6 figs

  16. Agents of Change: Studies on the Policy Environment for Small ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Agents of Change presents the results of an international conference held in Africa. It provides practical solutions and suggestions for real change. It discusses national strategies for small enterprises, examines legal, regulatory, and tax reform, and makes proposals on how to improve competitiveness and access to credit.

  17. Climate Change and Societal Response: Livelihoods, Communities, and the Environment (United States)

    Molnar, Joseph J.


    Climate change may be considered a natural disaster evolving in slow motion on a global scale. Increasing storm intensities, shifting rainfall patterns, melting glaciers, rising sea levels, and other manifold alterations are being experienced around the world. Climate has never been constant in any location, but human-induced changes associated…

  18. Sugarcane ethanol: contributions to climate change mitigation and the environment

    NARCIS (Netherlands)

    Zuurbier, P.J.P.; Vooren, van de J.G.


    Climate change is a challenge facing human life. It will change mobility and asks for new energy solutions. Bioenergy has gained increased attention as an alternative to fossil fuels. Energy based on renewable sources may offer part of the solution. Bio ethanol based on sugar cane offers advantages

  19. Change management in library environments: A comparative study ...

    African Journals Online (AJOL)

    The purpose of the study was to examine change management in public and private university libraries in Ghana, identify possible problems in order to make recommendations to enhance future change assignments. The study adopted the survey approach as the research design. The Statistical Package for Social ...

  20. An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes (United States)

    Flodgren, Gerd; Eccles, Martin P; Shepperd, Sasha; Scott, Anthony; Parmelli, Elena; Beyer, Fiona R


    Background There is considerable interest in the effectiveness of financial incentives in the delivery of health care. Incentives may be used in an attempt to increase the use of evidence-based treatments among healthcare professionals or to stimulate health professionals to change their clinical behaviour with respect to preventive, diagnostic and treatment decisions, or both. Financial incentives are an extrinsic source of motivation and exist when an individual can expect a monetary transfer which is made conditional on acting in a particular way. Since there are numerous reviews performed within the healthcare area describing the effects of various types of financial incentives, it is important to summarise the effectiveness of these in an overview to discern which are most effective in changing health professionals’ behaviour and patient outcomes. Objectives To conduct an overview of systematic reviews that evaluates the impact of financial incentives on healthcare professional behaviour and patient outcomes. Methods We searched the Cochrane Database of Systematic Reviews (CDSR) (The Cochrane Library); Database of Abstracts of Reviews of Effectiveness (DARE); TRIP; MEDLINE; EMBASE; Science Citation Index; Social Science Citation Index; NHS EED; HEED; EconLit; and Program in Policy Decision-Making (PPd) (from their inception dates up to January 2010). We searched the reference lists of all included reviews and carried out a citation search of those papers which cited studies included in the review. We included both Cochrane and non-Cochrane reviews of randomised controlled trials (RCTs), controlled clinical trials (CCTs), interrupted time series (ITSs) and controlled before and after studies (CBAs) that evaluated the effects of financial incentives on professional practice and patient outcomes, and that reported numerical results of the included individual studies. Two review authors independently extracted data and assessed the methodological quality of each

  1. Movers and stayers: Novel assemblages in changing environments (United States)

    Hobbs, Richard L.; Valentine, Leonie E.; Standish, Rachel J.; Jackson, Stephen T.


    How species will respond to ongoing climate and other change is of increasing concern.Most attention is given to how species move or are moved, but many species stay.Understanding the dynamics of new species combinations is essential for successful conservation in a changing climate.Increased attention to species movement in response to environmental change highlights the need to consider changes in species distributions and altered biological assemblages. Such changes are well known from paleoecological studies, but have accelerated with ongoing pervasive human influence. In addition to species that move, some species will stay put, leading to an array of novel interactions. Species show a variety of responses that can allow movement or persistence. Conservation and restoration actions have traditionally focused on maintaining or returning species in particular places, but increasingly also include interventions that facilitate movement. Approaches are required that incorporate the fluidity of biotic assemblages into the goals set and interventions deployed.

  2. Why healthcare providers merge. (United States)

    Postma, Jeroen; Roos, Anne-Fleur


    In many OECD countries, healthcare sectors have become increasingly concentrated as a result of mergers. However, detailed empirical insight into why healthcare providers merge is lacking. Also, we know little about the influence of national healthcare policies on mergers. We fill this gap in the literature by conducting a survey study on mergers among 848 Dutch healthcare executives, of which 35% responded (resulting in a study sample of 239 executives). A total of 65% of the respondents was involved in at least one merger between 2005 and 2012. During this period, Dutch healthcare providers faced a number of policy changes, including increasing competition, more pressure from purchasers, growing financial risks, de-institutionalisation of long-term care and decentralisation of healthcare services to municipalities. Our empirical study shows that healthcare providers predominantly merge to improve the provision of healthcare services and to strengthen their market position. Also efficiency and financial reasons are important drivers of merger activity in healthcare. We find that motives for merger are related to changes in health policies, in particular to the increasing pressure from competitors, insurers and municipalities.

  3. Factors Influencing Healthcare Service Quality

    Directory of Open Access Journals (Sweden)

    Ali Mohammad Mosadeghrad


    Full Text Available Background The main purpose of this study was to identify factors that influence healthcare quality in the Iranian context. Methods Exploratory in-depth individual and focus group interviews were conducted with 222 healthcare stakeholders including healthcare providers, managers, policy-makers, and payers to identify factors affecting the quality of healthcare services provided in Iranian healthcare organisations. Results Quality in healthcare is a production of cooperation between the patient and the healthcare provider in a supportive environment. Personal factors of the provider and the patient, and factors pertaining to the healthcare organisation, healthcare system, and the broader environment affect healthcare service quality. Healthcare quality can be improved by supportive visionary leadership, proper planning, education and training, availability of resources, effective management of resources, employees and processes, and collaboration and cooperation among providers. Conclusion This article contributes to healthcare theory and practice by developing a conceptual framework that provides policy-makers and managers a practical understanding of factors that affect healthcare service quality.

  4. Does accreditation stimulate change? A study of the impact of the accreditation process on Canadian healthcare organizations

    Directory of Open Access Journals (Sweden)

    Shabah Abdo


    Full Text Available Abstract Background One way to improve quality and safety in healthcare organizations (HCOs is through accreditation. Accreditation is a rigorous external evaluation process that comprises self-assessment against a given set of standards, an on-site survey followed by a report with or without recommendations, and the award or refusal of accreditation status. This study evaluates how the accreditation process helps introduce organizational changes that enhance the quality and safety of care. Methods We used an embedded multiple case study design to explore organizational characteristics and identify changes linked to the accreditation process. We employed a theoretical framework to analyze various elements and for each case, we interviewed top managers, conducted focus groups with staff directly involved in the accreditation process, and analyzed self-assessment reports, accreditation reports and other case-related documents. Results The context in which accreditation took place, including the organizational context, influenced the type of change dynamics that occurred in HCOs. Furthermore, while accreditation itself was not necessarily the element that initiated change, the accreditation process was a highly effective tool for (i accelerating integration and stimulating a spirit of cooperation in newly merged HCOs; (ii helping to introduce continuous quality improvement programs to newly accredited or not-yet-accredited organizations; (iii creating new leadership for quality improvement initiatives; (iv increasing social capital by giving staff the opportunity to develop relationships; and (v fostering links between HCOs and other stakeholders. The study also found that HCOs' motivation to introduce accreditation-related changes dwindled over time. Conclusions We conclude that the accreditation process is an effective leitmotiv for the introduction of change but is nonetheless subject to a learning cycle and a learning curve. Institutions invest

  5. Adapting Evaluations of Alternative Payment Models to a Changing Environment. (United States)

    Grannemann, Thomas W; Brown, Randall S


    To identify the most robust methods for evaluating alternative payment models (APMs) in the emerging health care delivery system environment. We assess the impact of widespread testing of alternative payment models on the ability to find credible comparison groups. We consider the applicability of factorial research designs for assessing the effects of these models. The widespread adoption of alternative payment models could effectively eliminate the possibility of comparing APM results with a "pure" control or comparison group unaffected by other interventions. In this new environment, factorial experiments have distinct advantages over the single-model experimental or quasi-experimental designs that have been the mainstay of recent tests of Medicare payment and delivery models. The best prospects for producing definitive evidence of the effects of payment incentives for APMs include fractional factorial experiments that systematically vary requirements and payment provisions within a payment model. © Health Research and Educational Trust.

  6. Distributed Denial of Service Attack Source Detection Using Efficient Traceback Technique (ETT) in Cloud-Assisted Healthcare Environment. (United States)

    Latif, Rabia; Abbas, Haider; Latif, Seemab; Masood, Ashraf


    Security and privacy are the first and foremost concerns that should be given special attention when dealing with Wireless Body Area Networks (WBANs). As WBAN sensors operate in an unattended environment and carry critical patient health information, Distributed Denial of Service (DDoS) attack is one of the major attacks in WBAN environment that not only exhausts the available resources but also influence the reliability of information being transmitted. This research work is an extension of our previous work in which a machine learning based attack detection algorithm is proposed to detect DDoS attack in WBAN environment. However, in order to avoid complexity, no consideration was given to the traceback mechanism. During traceback, the challenge lies in reconstructing the attack path leading to identify the attack source. Among existing traceback techniques, Probabilistic Packet Marking (PPM) approach is the most commonly used technique in conventional IP- based networks. However, since marking probability assignment has significant effect on both the convergence time and performance of a scheme, it is not directly applicable in WBAN environment due to high convergence time and overhead on intermediate nodes. Therefore, in this paper we have proposed a new scheme called Efficient Traceback Technique (ETT) based on Dynamic Probability Packet Marking (DPPM) approach and uses MAC header in place of IP header. Instead of using fixed marking probability, the proposed scheme uses variable marking probability based on the number of hops travelled by a packet to reach the target node. Finally, path reconstruction algorithms are proposed to traceback an attacker. Evaluation and simulation results indicate that the proposed solution outperforms fixed PPM in terms of convergence time and computational overhead on nodes.

  7. Changing the Food Environment: The French Experience12


    Chauliac, Michel; Hercberg, Serge


    The French National Nutrition and Health Program was launched in 2001. To achieve its objectives, 2 main preventive strategies were identified: 1) provide information and education to help individuals make healthy food and physical activity choices; and 2) improve the food and physical environment so that making healthy choices is easier. School regulations have been established to improve the nutritional quality of meals served to children and adolescents, and vending machines have been bann...

  8. Electric system reliability considerations in a changing utility environment

    International Nuclear Information System (INIS)

    Kramer, R.A.


    The utility industry is presently experiencing a number of diverse factors which may alter the way that it operates and in many cases the way in which it is configured. These factors reflect a variety of circumstances including increased competitive pressures and political perception. While many of these changes may result in long term economic and service benefits to the industry and customer alike, it is important to recognize the desirability of orderly change. There is need to implement change in a reasoned manner. In this paper technical as well as economic and political considerations are addressed

  9. Climate Change Impacts on the Built Environment in Nigeria

    African Journals Online (AJOL)


    global climate change and the urgent need for energy efficient infrastructure and .... may be the use of floodplain maps to steer development away from flood prone ..... Hayhoe K, Wake C, Huntington T, Luo L, Schwartz M, Sheffield J,. Wood E ...

  10. Assessing and managing stressors in a changing marine environment. (United States)

    Chapman, Peter M


    We are facing a dynamic future in the face of multiple stressors acting individually and in combination: climate change; habitat change/loss; overfishing; invasive species; harmful algal blooms/eutrophication; and, chemical contaminants. Historic assessment and management approaches will be inadequate for addressing risks from climate change and other stressors. Wicked problems (non-linear, complex, competing risks and benefits, not easily solvable), will become increasingly common. We are facing irreversible changes to our planetary living conditions. Agreed protection goals and considering both the negatives (risks) and the positives (benefits) of all any and all actions are required, as is judicious and appropriate use of the Precautionary Principle. Researchers and managers need to focus on: determining tipping points (alternative stable points); maintaining ecosystem services; and, managing competing ecosystem services. Marine (and other) scientists are urged to focus their research on wicked problems to allow for informed decision-making on a planetary basis. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. A look at the changing environment along the Indian coasts

    Digital Repository Service at National Institute of Oceanography (India)

    Desai, B.N.; Das, V.K.

    Increased human activity along the Indian coastline has exerted pressure on its morphology and ecology. The factors responsible for morphological changes like subsidence, rising sea level, storms, storm surges, sediment input from rivers, sediment...

  12. Climate change, adaptation and the environment in central Vietnam

    DEFF Research Database (Denmark)

    Bruun, Ole; Casse, Thorkil


    There is an urgent need for integrated approaches, such as the building of environmental management into climate change responses, addressing the total impact of livelihood stresses in social vulnerability perspectives, and ensuring that overall adaptation policies adequately address social justice...

  13. 670 investigating changes in coastal environment using internet

    African Journals Online (AJOL)


    investigation of land use/land cover (LU/LC) changes. The results obtained tend ... mainstay of the people. (marine, tourism and fishing activities) has been adversely affected. ... can refer to biotic and abiotic features, including soil, topography,.

  14. Uncertainty and learning in a strategic environment. Global climate change

    International Nuclear Information System (INIS)

    Baker, Erin


    Global climate change is rife with uncertainties. Yet, we can expect to resolve much of this uncertainty in the next 100 years or so. Therefore, current actions should reflect the value of flexibility. Nevertheless, most models of climate change, particularly game-theoretic models, abstract from uncertainty. A model of the impacts of uncertainty and learning in a non-cooperative game shows that the level of correlation of damages across countries is crucial for determining optimal policy

  15. Lean healthcare. (United States)

    Weinstock, Donna


    As healthcare organizations look for new and improved ways to reduce costs and still offer quality healthcare, many are turning to the Toyota Production System of doing business. Rather than focusing on cutting personnel and assets, "lean healthcare" looks to improve patient satisfaction through improved actions and processes.

  16. Knowledge Sharing Mechanism: Enabling C2 to Adapt to Changing Environments

    National Research Council Canada - National Science Library

    Harvie, David P


    .... The common nemesis to successfully developing solutions in these environments is change. The challenge of any complex problem solving process is the balance of adapting to multiple changes while keeping focused on the overall desired solution...

  17. The political economy of austerity and healthcare: cross-national analysis of expenditure changes in 27 European nations 1995-2011. (United States)

    Reeves, Aaron; McKee, Martin; Basu, Sanjay; Stuckler, David


    Why have patterns of healthcare spending varied during the Great Recession? Using cross-national, harmonised data for 27 EU countries from 1995 to 2011, we evaluated political, economic, and health system determinants of recent changes to healthcare expenditure. Data from EuroStat, the IMF, and World Bank (2013 editions) were evaluated using multivariate random- and fixed-effects models, correcting for pre-existing time-trends. Reductions in government health expenditure were not significantly associated with magnitude of economic recessions (annual change in GDP, p=0.31, or cumulative decline, p=0.40 or debt crises (measured by public debt as a percentage of GDP, p=0.38 or per capita, p=0.83)). Nor did ideology of governing parties have an effect. In contrast, each $100 reduction in tax revenue was associated with a $2.72 drop in health spending (95% CI: $1.03-4.41). IMF borrowers were significantly more likely to reduce healthcare budgets than non-IMF borrowers (OR=3.88, 95% CI: 1.95 -7.74), even after correcting for potential confounding by indication. Exposure to lending from international financial institutions, tax revenue falls, and decisions to implement cuts correlate more closely than underlying economic conditions or orientation of political parties with healthcare expenditure change in EU member states. Copyright © 2013 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  18. The Future of Nonproliferation in a Changed and Changing Environment: A Workshop Summary

    International Nuclear Information System (INIS)

    Dreicer, M.


    The Center for Global Security Research and Global Security Principal Directorate at Lawrence Livermore National Laboratory convened a workshop in July 2016 to consider ''The Future of Nonproliferation in a Changed and Changing Security Environment.'' We took a broad view of nonproliferation, encompassing not just the treaty regime but also arms control, threat reduction, counter-roliferation, and countering nuclear terrorism. We gathered a group of approximately 60 experts from the technical, academic, political, defense and think tank communities and asked them what and how much can reasonably be accomplished in each of these areas in the 5 to 10 years ahead. Discussion was on a not-for-attribution basis. This document provides a summary of key insights and lessons learned, and is provided to help stimulate broader public discussion of these issues. It is a collection of ideas as informally discussed and debated among a group of experts. The ideas reported here are the personal views of individual experts and should not be attributed to Lawrence Livermore National Laboratory.

  19. The Future of Nonproliferation in a Changed and Changing Environment: A Workshop Summary

    Energy Technology Data Exchange (ETDEWEB)

    Dreicer, M. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)


    The Center for Global Security Research and Global Security Principal Directorate at Lawrence Livermore National Laboratory convened a workshop in July 2016 to consider “The Future of Nonproliferation in a Changed and Changing Security Environment.” We took a broad view of nonproliferation, encompassing not just the treaty regime but also arms control, threat reduction, counter-­proliferation, and countering nuclear terrorism. We gathered a group of approximately 60 experts from the technical, academic, political, defense and think tank communities and asked them what—and how much—can reasonably be accomplished in each of these areas in the 5 to 10 years ahead. Discussion was on a not-­for-­attribution basis. This document provides a summary of key insights and lessons learned, and is provided to help stimulate broader public discussion of these issues. It is a collection of ideas as informally discussed and debated among a group of experts. The ideas reported here are the personal views of individual experts and should not be attributed to Lawrence Livermore National Laboratory.

  20. Development of the virtual research environment for analysis, evaluation and prediction of global climate change impacts on the regional environment (United States)

    Okladnikov, Igor; Gordov, Evgeny; Titov, Alexander; Fazliev, Alexander


    Description and the first results of the Russian Science Foundation project "Virtual computational information environment for analysis, evaluation and prediction of the impacts of global climate change on the environment and climate of a selected region" is presented. The project is aimed at development of an Internet-accessible computation and information environment providing unskilled in numerical modelling and software design specialists, decision-makers and stakeholders with reliable and easy-used tools for in-depth statistical analysis of climatic characteristics, and instruments for detailed analysis, assessment and prediction of impacts of global climate change on the environment and climate of the targeted region. In the framework of the project, approaches of "cloud" processing and analysis of large geospatial datasets will be developed on the technical platform of the Russian leading institution involved in research of climate change and its consequences. Anticipated results will create a pathway for development and deployment of thematic international virtual research laboratory focused on interdisciplinary environmental studies. VRE under development will comprise best features and functionality of earlier developed information and computing system CLIMATE (, which is widely used in Northern Eurasia environment studies. The Project includes several major directions of research listed below. 1. Preparation of geo-referenced data sets, describing the dynamics of the current and possible future climate and environmental changes in detail. 2. Improvement of methods of analysis of climate change. 3. Enhancing the functionality of the VRE prototype in order to create a convenient and reliable tool for the study of regional social, economic and political consequences of climate change. 4. Using the output of the first three tasks, compilation of the VRE prototype, its validation, preparation of applicable detailed description of

  1. Prevention of healthcare-associated infections in general practice: Current practice and drivers for change in a French study

    Directory of Open Access Journals (Sweden)

    M Gignon


    Full Text Available Purpose: The fight against Healthcare-associated infections is a public health priority and a major challenge for the safety and quality of care. The objective was to assess hygiene in general practitioners′ (GPs′ office and identify barriers to and drivers for better practice. Materials and Methods: We performed a cross-sectional study in which a questionnaire was sent to a randomly selected, representative sample of 800 GPs. We used a self-administered questionnaire. The first part assessed current practice and the second part focused on barriers and motivating factors for better practice. We performed a descriptive statistical analysis of the responses to closed questions and a qualitative analysis of the responses to open-ended questions. Results: Only a third of the GPs were aware of the current guidelines. Disposable equipment was used by 31% of the GPs. For the remainder, only 38% complied with the recommended procedures for sterilisation or disinfection. Seventy-two percent of the GPs washed their hands between consultations in the office. A significant minority of physicians disregarded the guidelines by never wearing gloves to perform sutures (11%, treat wounds (10%, fit intrauterine devices (18% or perform injections (18%. The main barriers to good practice were the high cost of modifications and lack of time/space. Two third of the GPs did not intend to change their practices. The drivers for change were pressure from patients (4.8 on a scale of 1 to 7, inspection by the health authorities (4.8 and the fear of legal action (4.4. Conclusions: Our results show that there are significant differences between current practice and laid-down professional guidelines. Policies for improvement of hygiene must take into account barriers and motivating factors.

  2. Alternative indicators for monitoring the quality of a continuous intervention program on antibiotic prescribing during changing healthcare conditions. (United States)

    Bantar, C; Franco, D; Heft, C; Vesco, E; Arango, C; Izaguirre, M; Alcázar, G; Boleas, M; Oliva, M E


    We recently published on the impact of a four-phase hospital-wide intervention program designed to optimize the quality of antibiotic use, where a multidisciplinary team (MDT) could modify prescription at the last phase. Because health care quality was changing during the last 5 years (late 1999 to early 2004), we developed certain indicators to monitor the quality of our intervention over time. Different periods were defined as baseline (pre-intervention), initial intervention-active control, pre-crisis control, crisis control, post-crisis control and end of crisis control. Major indicators were rates of prescription modification by the MDT; prescription for an uncertain infection and a novel index formula (RIcarb) to estimate the rationale for carbapenem use. We assessed 2115 antimicrobial prescriptions. Modification of prescription rate was 30% at the beginning and decreased thereafter up to stable levels. Rate of prescriptions ordered for cases of both uncertain infection and unknown source of infection decreased significantly after intervention (i.e. from baseline to active control). In contrast, a doubling of culture-directed prescriptions was observed between these periods. RIcarb values lower and higher than 60% (modal, cut-off) were assumed as carbapenem overuse and underuse, respectively. Overuse was observed at the pre-intervention, while pronounced underuse was shown during the crisis (RIcarb, 45% and 87%, respectively). The present study demonstrates that certain indicators, other than the widely adopted impact outcomes, are a suitable tool for monitoring the quality of a continuous, long-term, active intervention on antimicrobial prescribing practice, especially when applied in a changing healthcare setting.


    Directory of Open Access Journals (Sweden)

    Nebojša Maksimović


    Full Text Available Determining acceptable strategic goals requires analysis of the position of a sports organization within the sport world and wider business environment. A range of trends may affect development prospects and business activities of an organization. There are possibilities of population fluctuation (e.g. purchase power of winter sports practitioners, trends of economy, technological development, and legislation (e.g. prohibition of tobacco and alcohol advertisements, or activities of special interest groups (e.g. development of violence in sport. After clarifying its mission and goals, management of a sports organization reveals that some factors are important, while series of others are not

  4. Skill mix change between general practitioners, nurse practitioners, physician assistants and nurses in primary healthcare for older people: a qualitative study. (United States)

    Lovink, Marleen H; van Vught, Anneke J A H; Persoon, Anke; Schoonhoven, Lisette; Koopmans, Raymond T C M; Laurant, Miranda G H


    More and more older adults desire to and are enabled to grow old in their own home, regardless of their physical and mental capabilities. This change, together with the growing number of older adults, increases the demand for general practitioners (GPs). However, care for older people lacks prestige among medical students and few medical students are interested in a career in care for older people. Innovative solutions are needed to reduce the demand for GPs, to guarantee quality of healthcare and to contain costs. A solution might be found in skill mix change by introducing nurse practitioners (NPs), physician assistants (PAs) or registered nurses (RNs). The aim of this study was to describe how skill mix change is organised in daily practice, what influences it and what the effects are of introducing NPs, PAs or RNs into primary healthcare for older people. In total, 34 care providers working in primary healthcare in the Netherlands were interviewed: GPs (n = 9), NPs (n = 10), PAs (n = 5) and RNs (n = 10). Five focus groups and 14 individual interviews were conducted. Analysis consisted of open coding, creating categories and abstraction. In most cases, healthcare for older people was only a small part of the tasks of NPs, PAs and RNs; they did not solely focus on older people. The tasks they performed and their responsibilities in healthcare for older people differed between, as well as within, professions. Although the interviewees debated the usefulness of proactive structural screening on frailty in the older population, when implemented, it was also unclear who should perform the geriatric assessment. Interviewees considered NPs, PAs and RNs an added value, and it was stated that the role of the GP changed with the introduction of NPs, PAs or RNs. The roles and responsibilities of NPs, PAs and RNs for the care of older people living at home are still not established. Nonetheless, these examples show the potential of these professionals. The

  5. Healthcare waste management: current practices in selected healthcare facilities, Botswana. (United States)

    Mbongwe, Bontle; Mmereki, Baagi T; Magashula, Andrew


    Healthcare waste management continues to present an array of challenges for developing countries, and Botswana is no exception. The possible impact of healthcare waste on public health and the environment has received a lot of attention such that Waste Management dedicated a special issue to the management of healthcare waste (Healthcare Wastes Management, 2005. Waste Management 25(6) 567-665). As the demand for more healthcare facilities increases, there is also an increase on waste generation from these facilities. This situation requires an organised system of healthcare waste management to curb public health risks as well as occupational hazards among healthcare workers as a result of poor waste management. This paper reviews current waste management practices at the healthcare facility level and proposes possible options for improvement in Botswana.

  6. Effect of climatic change on surface environments in the typical region of Horqin Sandy Land

    Institute of Scientific and Technical Information of China (English)


    The town of Agura,a typical region in Horqin Sandy Land,was selected as the study area in this paper.Using 12 remote sensing images and climatic data from the past 20 years,the effects of climate change on surface environments were analyzed.The impact indices of climatic factors,along with their corresponding ranks,were used to characterize the responses of different types of surface environments to climate change.Results show that in the past 20 years,the surface environments of the study area have been deteriorating.Furthermore,there is a positive relationship between the changes in surface environments and those in climatic factors.Various climatic factors influence surface environments in different ways and at different levels.The most sensitive factor is relative humidity,followed by precipitation and evaporation.Overall,moisture is the key factor that affects the changes in surface environments of arid and semi-arid areas.

  7. Climatic Change and the Future of the Human Environment. (United States)

    Kotlyakov, Vladimir M.


    Evaluates the latest glaciological and oceanological data and demonstrates a strict correlation between global changes of temperature and gas composition of the atmosphere over the last climatic cycle. Concludes that global warming may not create an environmental crisis but will alter drastically the life people lead. (MJP)

  8. A Case Study of Implications and Applications of Standardized Nomenclature for Asset Management in Healthcare (United States)

    DeFrancesco, Jennifer A.


    Healthcare organizations strive to adapt to the continuous change in what has become a fast-paced, high technology environment. Many organizations are charged to find efficiencies to better manage medical device assets. Increasingly, healthcare leaders opt to adopt a standardized medical device nomenclature under the purview of a set of national…

  9. Climate change, marine environments, and the US Endangered species act. (United States)

    Seney, Erin E; Rowland, Melanie J; Lowery, Ruth Ann; Griffis, Roger B; McClure, Michelle M


    Climate change is expected to be a top driver of global biodiversity loss in the 21st century. It poses new challenges to conserving and managing imperiled species, particularly in marine and estuarine ecosystems. The use of climate-related science in statutorily driven species management, such as under the U.S. Endangered Species Act (ESA), is in its early stages. This article provides an overview of ESA processes, with emphasis on the mandate to the National Marine Fisheries Service (NMFS) to manage listed marine, estuarine, and anadromous species. Although the ESA is specific to the United States, its requirements are broadly relevant to conservation planning. Under the ESA, species, subspecies, and "distinct population segments" may be listed as either endangered or threatened, and taking of most listed species (harassing, harming, pursuing, wounding, killing, or capturing) is prohibited unless specifically authorized via a case-by-case permit process. Government agencies, in addition to avoiding take, must ensure that actions they fund, authorize, or conduct are not likely to jeopardize a listed species' continued existence or adversely affect designated critical habitat. Decisions for which climate change is likely to be a key factor include: determining whether a species should be listed under the ESA, designating critical habitat areas, developing species recovery plans, and predicting whether effects of proposed human activities will be compatible with ESA-listed species' survival and recovery. Scientific analyses that underlie these critical conservation decisions include risk assessment, long-term recovery planning, defining environmental baselines, predicting distribution, and defining appropriate temporal and spatial scales. Although specific guidance is still evolving, it is clear that the unprecedented changes in global ecosystems brought about by climate change necessitate new information and approaches to conservation of imperiled species. El

  10. HESS Opinions: Hydrologic predictions in a changing environment: behavioral modeling

    Directory of Open Access Journals (Sweden)

    S. J. Schymanski


    Full Text Available Most hydrological models are valid at most only in a few places and cannot be reasonably transferred to other places or to far distant time periods. Transfer in space is difficult because the models are conditioned on past observations at particular places to define parameter values and unobservable processes that are needed to fully characterize the structure and functioning of the landscape. Transfer in time has to deal with the likely temporal changes to both parameters and processes under future changed conditions. This remains an important obstacle to addressing some of the most urgent prediction questions in hydrology, such as prediction in ungauged basins and prediction under global change. In this paper, we propose a new approach to catchment hydrological modeling, based on universal principles that do not change in time and that remain valid across many places. The key to this framework, which we call behavioral modeling, is to assume that there are universal and time-invariant organizing principles that can be used to identify the most appropriate model structure (including parameter values and responses for a given ecosystem at a given moment in time. These organizing principles may be derived from fundamental physical or biological laws, or from empirical laws that have been demonstrated to be time-invariant and to hold at many places and scales. Much fundamental research remains to be undertaken to help discover these organizing principles on the basis of exploration of observed patterns of landscape structure and hydrological behavior and their interpretation as legacy effects of past co-evolution of climate, soils, topography, vegetation and humans. Our hope is that the new behavioral modeling framework will be a step forward towards a new vision for hydrology where models are capable of more confidently predicting the behavior of catchments beyond what has been observed or experienced before.

  11. Mobile work: Ergonomics in a rapidly changing work environment. (United States)

    Honan, Meg


    Places of work have been completely transformed by innovations in mobile work tools and ever-present access to internet data. This article characterizes use patterns and provides preliminary considerations for productive and comfortable use of common mobile devices. Two surveys described trends in mobile work. In the first, ergonomics professionals who oversee programs reported common mobile devices, their users and what data is accessed. The second, an end user survey, explored common activities performed on mobile devices, duration of use and locations where mobile work is common. The survey results provide a baseline data point for the status of mobile work in early 2014. Research indicates that additional risks have been introduced to the neck, thumbs and hands when using mobile devices. Possible trends regarding device use and work locations emerge. Intervention studies provide some direction for the practitioner. Practical strategies are outlined to reduce exposure intensity and duration. Contemporary mobile work presents tremendous change and opportunity for ergonomists and researchers to keep pace with fitting the changing models of work to the person. Continued research is needed on current mobile device use patterns to better understand ergonomic risk exposure in this rapidly changing realm.

  12. Agricultural nutrient loadings to the freshwater environment: the role of climate change and socioeconomic change (United States)

    Xie, Hua; Ringler, Claudia


    Human activities, in particular agricultural production, interfere with natural cycles of nutrient elements, nitrogen (N) and phosphorus (P), leading to growing concerns about water quality degradation related to excessive nutrient loadings. Increases in agricultural production in response to population growth and wealth generation further increase risks associated with nutrient pollution. This paper presents results from projections of nutrient exports from global agricultural crop and pasture systems to the water environment generated using a process-based modeling approach. Brazil, China, India and the United States account for more than half of estimated global N and P loadings in the base year. Each country boasts large agriculture centers where high calculated loading values are found. Rapid growth in global agricultural nutrient loadings is projected. Growth of agricultural pollution loading is fastest in the group of low-income developing countries and loading growth rates also vary substantially with climate change scenario. Counter measures need to be taken to address the environmental risks associated with the projected rapid increase of agricultural nutrient loadings.

  13. The involvement of community leaders in healthcare, the environment and sanitation in áreas of social vulnerability. (United States)

    Juliano, Ester Feche Guimarães de Arruda; Malheiros, Tadeu Fabrício; Marques, Rui Cunha


    The main purpose of this article is to identify access to: social assistance inclusion programs; assistance from health agents; public water supply services; and water saving practices, in areas of irregular occupation in Brazil. A stratified random sampling technique by clusters was adopted with a simple sampling strategy. In the universe of 14,079 households, 68 community leaders were identified, representing 6,800 households on average, in a normalized distribution (mean zero, standard deviation 1), deemed to include situations covering 96% of the cases with a margin of error of + or - 1% of the average. The theoretical approach proposes a reflection and verification through questionnaires on the mechanisms of exclusion. Poverty perpetuates the vicious circle of inequality, risks to health and the environment, and it is necessary that these should be considered in the policies and procedures for urban expansion. As a conclusion, various challenges were identified for serving areas of social-environmental vulnerability - the needs to: improve the low quality of health and water services in subnormal agglomerations; modify the behavior of the population accessing the networks in a clandestine manner; and to put inclusive governance mechanisms in place.

  14. Breeding blueberries for a changing global environment: a review (United States)

    Lobos, Gustavo A.; Hancock, James F.


    Today, blueberries are recognized worldwide as one of the foremost health foods, becoming one of the crops with the highest productive and commercial projections. Over the last 100 years, the geographical area where highbush blueberries are grown has extended dramatically into hotter and drier environments. The expansion of highbush blueberry growing into warmer regions will be challenged in the future by increases in average global temperature and extreme fluctuations in temperature and rainfall patterns. Considerable genetic variability exists within the blueberry gene pool that breeders can use to meet these challenges, but traditional selection techniques can be slow and inefficient and the precise adaptations of genotypes often remain hidden. Marker assisted breeding (MAB) and phenomics could aid greatly in identifying those individuals carrying adventitious traits, increasing selection efficiency and shortening the rate of cultivar release. While phenomics have begun to be used in the breeding of grain crops in the last 10 years, their use in fruit breeding programs it is almost non-existent. PMID:26483803

  15. Breeding blueberries for a changing global environment: a review

    Directory of Open Access Journals (Sweden)

    Gustavo A. Lobos


    Full Text Available Today, blueberries are recognized worldwide as one of the foremost health foods, becoming one of the crops with the highest productive and commercial projections. Over the last hundred years, the geographical area where highbush blueberries are grown has extended dramatically into hotter and drier environments. The expansion of highbush blueberry growing into warmer regions will be challenged in the future by increases in average global temperature and extreme fluctuations in temperature and rainfall patterns. Considerable genetic variability exists within the blueberry gene pool that breeders can use to meet these challenges, but traditional selection techniques can be slow and inefficient and the precise adaptations of genotypes often remain hidden. Marker assisted breeding (MAB and phenomics could aid greatly in identifying those individuals carrying adventitious traits, increasing selection efficiency and shortening the rate of cultivar release. While phenomics have begun to be used in the breeding of grain crops in the last 10 years, their use in fruit breeding programs it is almost non-existent.

  16. Exploring the changing learning environment of the gross anatomy lab. (United States)

    Hopkins, Robin; Regehr, Glenn; Wilson, Timothy D


    The objective of this study was to assess the impact of virtual models and prosected specimens in the context of the gross anatomy lab. In 2009, student volunteers from an undergraduate anatomy class were randomly assigned to study groups in one of three learning conditions. All groups studied the muscles of mastication and completed identical learning objectives during a 45-minute lab. All groups were provided with two reference atlases. Groups were distinguished by the type of primary tools they were provided: gross prosections, three-dimensional stereoscopic computer model, or both resources. The facilitator kept observational field notes. A prepost multiple-choice knowledge test was administered to evaluate students' learning. No significant effect of the laboratory models was demonstrated between groups on the prepost assessment of knowledge. Recurring observations included students' tendency to revert to individual memorization prior to the posttest, rotation of models to match views in the provided atlas, and dissemination of groups into smaller working units. The use of virtual lab resources seemed to influence the social context and learning environment of the anatomy lab. As computer-based learning methods are implemented and studied, they must be evaluated beyond their impact on knowledge gain to consider the effect technology has on students' social development.

  17. Change and Innovation Leadership in an Industrial Digital Environment

    Directory of Open Access Journals (Sweden)

    Steude Dietrich H.


    Full Text Available With the high pace of digital innovation processes the risk of digital disruption increases for industrial companies. However, the progress in industrial digitalization accelerates the decision processes and relieves management from routine work. It gives room for creative management challenges like change and innovation processes. Team-oriented methods like Design Thinking are becoming a crucial part of the innovation culture. Industrial leadership must find current ways that are linked to creativity and to a coordinated human interaction. The article ties together the relevant literature and innovative ideas of digital tools, agile methodology and consequences for a flexible organizational structure.

  18. A Comment on the environment and directed technical change

    Energy Technology Data Exchange (ETDEWEB)

    Greaker, Mads; Heggedal, Tom-Reiel


    The major claim in Acemoglu, Aghion, Bursztyn and Hemous (2012) (AABH) is that subsidies for research and development of clean technologies are more important than carbon taxes when dealing with climate change. However, they – unconventionally – assume that a patent only lasts for one period. In this note we introduce long-lived patents into the AABH model. This makes the role of a research subsidy for clean technologies in AABH far less crucial and reestablishes the role of the carbon tax. This is good news as it is far easier to tax emissions than to pick the right technologies to subsidize.(Author)

  19. On the world's ice ages and changing environments

    International Nuclear Information System (INIS)

    Eronen, M.; Olander, H.


    All known ice ages during the earth's history are reviewed. The oldest glaciation occurred around 2.3 billion years ago, followed by a series of large glaciations 950-650, 450-430 and 310-270 million years ago. Continental drift played a major role in these long-term climatic changes. The present Quaternary ice age actually began 17 million years ago, when a large ice mass grew over Antarctica. A detailed account is given of the climatic fluctuations during the Quaternary period (over 2.5 million years). Different stratigraphic records, and the relationship of climatic variations to orbital forcing are discussed. Large environmental changes took place in the course of the climate oscillations. Large ice sheets waxed and waned, global sea-levels fluctuated, forests disappeared from many regions during cold times and advanced during favourable times. The ice masses depressed the earth's crust markedly, and this then rose rapidly when the ice melted. The extent of glacial erosion is also discussed. Finally the postglacial climatic history of the earth is described and the consequences of the possible greenhouse effect are considered.(orig.)

  20. Payer Negotiations in the New Healthcare Environment: How to Prepare for and Succeed in a Value-Based World. (United States)

    Howrigon, Ron


    Because of their involvement with the Affordable Care exchanges, the national insurance companies have reported significant financial losses. As a result, there will soon be significant payer pressure to reduce medical expenses. To succeed in future negotiations with the payers, medical practices must understand the needs of the payers and then play to those needs. The author is a former managed care executive with more than 25 years of experience managing provider networks and implementing payer strategies for some of the largest payers in the United States. In this article, he outlines important things medical practices should be doing to prepare for the new world of value-based contracting. Medical practices that embrace this change and work hard to evolve with the future are the ones that are going to survive and succeed.

  1. Change in ocean subsurface environment to suppress tropical cyclone intensification under global warming (United States)

    Huang, Ping; Lin, I. -I; Chou, Chia; Huang, Rong-Hui


    Tropical cyclones (TCs) are hazardous natural disasters. Because TC intensification is significantly controlled by atmosphere and ocean environments, changes in these environments may cause changes in TC intensity. Changes in surface and subsurface ocean conditions can both influence a TC's intensification. Regarding global warming, minimal exploration of the subsurface ocean has been undertaken. Here we investigate future subsurface ocean environment changes projected by 22 state-of-the-art climate models and suggest a suppressive effect of subsurface oceans on the intensification of future TCs. Under global warming, the subsurface vertical temperature profile can be sharpened in important TC regions, which may contribute to a stronger ocean coupling (cooling) effect during the intensification of future TCs. Regarding a TC, future subsurface ocean environments may be more suppressive than the existing subsurface ocean environments. This suppressive effect is not spatially uniform and may be weak in certain local areas. PMID:25982028

  2. Diversity changes of microbial communities into hospital surface environments. (United States)

    Yano, Rika; Shimoda, Tomoko; Watanabe, Reina; Kuroki, Yasutoshi; Okubo, Torahiko; Nakamura, Shinji; Matsuo, Junji; Yoshimura, Sadako; Yamaguchi, Hiroyuki


    Previous works have demonstrated considerable variability in hospital cleanliness in Japan, suggesting that contamination is driven by factors that are currently poorly controlled. We undertook 16S rRNA sequence analysis to study population structures of hospital environmental microbiomes to see which factor(s) impacted contamination. One hundred forty-four samples were collected from surfaces of three hospitals with distinct sizes ("A": >500 beds, "B": 100-500 beds, "C": diversity changes of hospital environmental microbiomes with a skewed population, presumably by medical staff pushing NWs or sinks shared by patients or visitors. Copyright © 2017 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  3. Adaptive wetland management in an uncertain and changing arid environment

    Directory of Open Access Journals (Sweden)

    Rebekah Downard


    Full Text Available Wetlands in the arid western United States provide rare and critical migratory bird habitat and constitute a critical nexus within larger social-ecological systems (SES where multiple changing land-use and water-use patterns meet. The Bear River Migratory Bird Refuge in Utah, USA, presents a case study of the ways that wetland managers have created adaptive management strategies that are responsive to the social and hydrological conditions of the agriculture-dominated SES within which they are located. Managers have acquired water rights and constructed infrastructure while cultivating collaborative relationships with other water users to increase the adaptive capacity of the region and decrease conflict. Historically, water management involved diversion and impoundment of water within wetland units timed around patterns of agricultural water needs. In the last 20 years, managers have learned from flood and drought events and developed a long-term adaptive management plan that specifies alternative management actions managers can choose each year based on habitat needs and projected water supply. Each alternative includes habitat goals and target wetland water depth. However, wetland management adapted to agricultural return-flow availability may prove insufficient as population growth and climate change alter patterns of land and water use. Future management will likely depend more on negotiation, collaboration, and learning from social developments within the SES than strictly focusing on water management within refuge boundaries. To face this problem, managers have worked to be included in negotiations with regional water users, a strategy that may prove instructive for other wetland managers in agriculture-dominated watersheds.

  4. Climate Change and Integrodifference Equations in a Stochastic Environment. (United States)

    Bouhours, Juliette; Lewis, Mark A


    Climate change impacts population distributions, forcing some species to migrate poleward if they are to survive and keep up with the suitable habitat that is shifting with the temperature isoclines. Previous studies have analysed whether populations have the capacity to keep up with shifting temperature isoclines, and have mathematically determined the combination of growth and dispersal that is needed to achieve this. However, the rate of isocline movement can be highly variable, with much uncertainty associated with yearly shifts. The same is true for population growth rates. Growth rates can be variable and uncertain, even within suitable habitats for growth. In this paper, we reanalyse the question of population persistence in the context of the uncertainty and variability in isocline shifts and rates of growth. Specifically, we employ a stochastic integrodifference equation model on a patch of suitable habitat that shifts poleward at a random rate. We derive a metric describing the asymptotic growth rate of the linearised operator of the stochastic model. This metric yields a threshold criterion for population persistence. We demonstrate that the variability in the yearly shift and in the growth rate has a significant negative effect on the persistence in the sense that it decreases the threshold criterion for population persistence. Mathematically, we show how the persistence metric can be connected to the principal eigenvalue problem for a related integral operator, at least for the case where isocline shifting speed is deterministic. Analysis of dynamics for the case where the dispersal kernel is Gaussian leads to the existence of a critical shifting speed, above which the population will go extinct, and below which the population will persist. This leads to clear bounds on rate of environmental change if the population is to persist. Finally, we illustrate our different results for butterfly population using numerical simulations and demonstrate how

  5. Healthcare Robotics


    Riek, Laurel D.


    Robots have the potential to be a game changer in healthcare: improving health and well-being, filling care gaps, supporting care givers, and aiding health care workers. However, before robots are able to be widely deployed, it is crucial that both the research and industrial communities work together to establish a strong evidence-base for healthcare robotics, and surmount likely adoption barriers. This article presents a broad contextualization of robots in healthcare by identifying key sta...

  6. An evolving systems-based methodology for healthcare planning. (United States)

    Warwick, Jon; Bell, Gary


    Healthcare planning seems beset with problems at all hierarchical levels. These are caused by the 'soft' nature of many of the issues present in healthcare planning and the high levels of complexity inherent in healthcare services. There has, in recent years, been a move to utilize systems thinking ideas in an effort to gain a better understanding of the forces at work within the healthcare environment and these have had some success. This paper argues that systems-based methodologies can be further enhanced by metrication and modeling which assist in exploring the changed emergent behavior of a system resulting from management intervention. The paper describes the Holon Framework as an evolving systems-based approach that has been used to help clients understand complex systems (in the education domain) that would have application in the analysis of healthcare problems.

  7. The healthy options for nutrition environments in schools (Healthy ONES group randomized trial: using implementation models to change nutrition policy and environments in low income schools

    Directory of Open Access Journals (Sweden)

    Coleman Karen J


    Full Text Available Abstract Background The Healthy Options for Nutrition Environments in Schools (Healthy ONES study was an evidence-based public health (EBPH randomized group trial that adapted the Institute for Healthcare Improvement’s (IHI rapid improvement process model to implement school nutrition policy and environmental change. Methods A low-income school district volunteered for participation in the study. All schools in the district agreed to participate (elementary = 6, middle school = 2 and were randomly assigned within school type to intervention (n = 4 and control (n =4 conditions following a baseline environmental audit year. Intervention goals were to 1 eliminate unhealthy foods and beverages on campus, 2 develop nutrition services as the main source on campus for healthful eating (HE, and 3 promote school staff modeling of HE. Schools were followed across a baseline year and two intervention years. Longitudinal assessment of height and weight was conducted with second, third, and sixth grade children. Behavioral observation of the nutrition environment was used to index the amount of outside foods and beverages on campuses. Observations were made monthly in each targeted school environment and findings were presented as items per child per week. Results From an eligible 827 second, third, and sixth grade students, baseline height and weight were collected for 444 second and third grade and 135 sixth grade students (51% reach. Data were available for 73% of these enrolled students at the end of three years. Intervention school outside food and beverage items per child per week decreased over time and control school outside food and beverage items increased over time. The effects were especially pronounced for unhealthy foods and beverage items. Changes in rates of obesity for intervention school (28% baseline, 27% year 1, 30% year 2 were similar to those seen for control school (22% baseline, 22% year 1, 25% year 2 children

  8. Drought early warning and risk management in a changing environment (United States)

    Pulwarty, R. S.


    Drought has long been recognized as falling into the category of incremental but long-term and cumulative environmental changes, also termed slow-onset or creeping events. These event types would include: air and water quality decline, desertification processes, deforestation and forest fragmentation, loss of biodiversity and habitats, and nitrogen overloading, among others. Climate scientists continue to struggle with recognizing the onset of drought and scientists and policy makers continue to debate the basis (i.e., criteria) for declaring an end to a drought. Risk-based management approaches to drought planning at the national and regional levels have been recommended repeatedly over the years but their prototyping, testing and operational implementation have been limited. This presentation will outline two avenues for disaster risk reduction in the context of drought (1) integrated early warning information systems, and (2) linking disaster risk reduction to climate change adaptation strategies. Adaptation involves not only using operational facilities and infrastructure to cope with the immediate problems but also leaving slack or reserve for coping with multiple stress problems that produce extreme impacts and surprise. Increasing the 'anticipatability' of an event, involves both monitoring of key indicators from appropriate baseline data, and observing early warning signs that assumptions in risk management plans are failing and critical transitions are occurring. Illustrative cases will be drawn from the IPCC Special Report on Managing the Risks of Extreme Events and Disasters (2011), the UN Global Assessment of Disaster Risk Reduction (2011) and implementation activities in which the author has been engaged. Most drought early warning systems have tended to focus on the development and use of physical system indicators and forecasts of trends and thresholds. We show that successful early warning systems that meet expectations of risk management also have

  9. Self-reported changes in quality of life among people with multiple sclerosis who have participated in treatments based on collaboration between conventional healthcare providers and CAM practitioners

    DEFF Research Database (Denmark)

    Bjerre, Liv; Henningsen, Inge Biehl; Skovgaard, Lasse


    Aim of the study: This study assesses the changes in self-reported quality of life (QoL) from hospitalisation to 18 months later among people with multiple sclerosis (MS) who have participated in treatments based on collaboration between conventional healthcare providers and CAM practitioners...... interventions by a team of five healthcare providers and five CAM practitioners. The outcome measure was a change in QoL (measured as the difference in total score and sub-scores on the Functional Assessment of Multiple Sclerosis (FAMS) QoL scale). Results: From hospitalisation and through an 18-month period....... Materials and methods: A pre- and post-test evaluation design including an intervention group and a comparison group was employed in this study. 142 people with MS were analysed in the intervention group and 142 in the comparison group. Each person in the intervention group was treated with combined...

  10. Strengthening CERN and particle physics in a changing global environment

    CERN Multimedia


    As we welcome Romania as our 22nd Member State in late July, now is a good time to reflect on the geographical enlargement process that was initiated in 2010.   Let me begin by setting the context. CERN operates in an increasingly complex and globalised world. Political and economic developments in the European neighbourhood and well beyond can have an impact on our work – directly or indirectly, in the short term or in a much longer perspective. We need to anticipate that change as far as we can, while also being agile enough to meet the challenges that we do not expect. The UK’s EU referendum on 23 June is a case in point. Because CERN is an organisation founded to facilitate cooperation across borders, Brexit is an uncomfortable truth to many of us. It is, nevertheless, the outcome of the political processes of one of our founding Member States, and is something we must respect. Whatever direction the UK now takes, we will be working with the country’s particle ph...

  11. Changing healthcare practitioners’ and teachers’ views about lesbian, gay, bisexual and transgender (LGBT) medical, health and social care


    Davy, Zowie


    In the UK there is a crisis in the provision of healthcare for LGBT people. This is due, in part, by the lack of focused medical, health and social care curricula content about LGBT healthcare generally. Teaching has tended to position heterosexuality and gender normativity—people conforming to social standards of what is ‘appropriate’ feminine and masculine behavior—as the primary context in which health and illness is viewed. Models of health care that promote these views of sexuality and g...

  12. Protective environment for hematopoietic cell transplant (HSCT) recipients: The Infectious Diseases Working Party EBMT analysis of global recommendations on health-care facilities. (United States)

    Styczynski, Jan; Tridello, Gloria; Donnelly, J Peter; Iacobelli, Simona; Hoek, Jennifer; Mikulska, Malgorzata; Aljurf, Mahmoud; Gil, Lidia; Cesaro, Simone


    International guidelines on protective environment for HSCT recipients proposed a set of 10 global recommendations in 2009 on protective environment (GRPE) concerning hospital room design and ventilation. The EBMT Infectious Diseases Working Party undertook a survey on the status on protective environment for HSCT recipients with the aim of surveying current practices and their agreement with GRPE recommendations. The questionnaire consisted of 37 questions divided into 5 sections about filtration, air changes, maintenance, and the protective environment in rooms and the surrounding unit. Overall, 177 centres (response rate 33%) from 36 countries responded, indicating that 99.4% of patient rooms were equipped with HEPA filters, but only 48.6% of the centre's staff were aware of, and could confirm, regular replacement of filters based on manufacturers' recommendations. Well-sealed rooms were used in terms of windows (70.6%), ceilings (35%), and plumbing pipes (51.4%). The sensor monitors in the patient room used to determine when the HEPA filters require changing were installed only in 18.1% of centres. Only 1 centre fulfilled all 10 GRPE recommendations, while 62 centres fulfilled the 3 level "A" recommendations. In conclusion, HEPA-filtered rooms are available in almost all centres, while fewer centres fulfilled other requirements. Knowledge on the details and maintenance of protective environments in the HSCT setting was inadequate, reflecting a lack of communication between the health personnel involved, hospital infection control and the hospital maintenance services.

  13. Understanding Coral's Short-term Adaptive Ability to Changing Environment (United States)

    Tisthammer, K.; Richmond, R. H.


    Corals in Maunalua Bay, Hawaii are under chronic pressures from sedimentation and terrestrial runoffs containing multiple pollutants as a result of large scale urbanization that has taken place in the last 100 years. However, some individual corals thrive despite the prolonged exposure to these environmental stressors, which suggests that these individuals may have adapted to withstand such stressors. A recent survey showed that the lobe coral Porites lobata from the `high-stress' nearshore site had an elevated level of stress ixnduced proteins, compared to those from the `low-stress,' less polluted offshore site. To understand the genetic basis for the observed differential stress responses between the nearshore and offshore P. lobata populations, an analysis of the lineage-scale population genetic structure, as well as a reciprocal transplant experiment were conducted. The result of the genetic analysis revealed a clear genetic differentiation between P. lobata from the nearshore site and the offshore site. Following the 30- day reciprocal transplant experiment, protein expression profiles and other stress-related physiological characteristics were compared between the two populations. The experimental results suggest that the nearshore genotype can cope better with sedimentation/pollutants than the offshore genotype. This indicates that the observed genetic differentiation is due to selection for tolerance to these environmental stressors. Understanding the little-known, linage-scale genetic variation in corals offers a critical insight into their short-term adaptive ability, which is indispensable for protecting corals from impending environmental and climate change. The results of this study also offer a valuable tool for resource managers to make effective decisions on coral reef conservation, such as designing marine protected areas that incorporate and maintain such genetic diversity, and establishing acceptable pollution run-off levels.

  14. Organizational change, psychosocial work environment, and non-disability early retirement

    DEFF Research Database (Denmark)

    Breinegaard, Nina; Jensen, Johan Høy; Bonde, Jens Peter


    Objective: This study examines the impact of organizational change and psychosocial work environment on non-disability early retirement among senior public service employees. Methods: In January and February 2011, Danish senior public service employees aged 58–64 years (N=3254) from the Capital...... psychosocial work environment contribute to non-disability early retirement among senior public service employees, measured at work-unit level....... Region of Denmark responded to a survey assessing psychosocial work environment (ie, social capital, organizational justice, and quality of management). Work-unit organizational changes (ie, change of management, merging, demerging, and relocation) were recorded from January 2009 to March 2011. Weekly...

  15. The cricket and the ant : Organizational trade-offs in changing environments

    NARCIS (Netherlands)

    Peli, Gabor; Bruggeman, Jeroen


    Organizations face trade-offs when they adopt strategies in changing resource environments. The type of trade-off depends on the type of resource change. This paper offers an organizational trade-off model for quantitative resource changes. We call it the "Cricket and Ant" (CA) model, because the

  16. The Representation of Human-Environment Interactions in Land Change Research and Modelling

    NARCIS (Netherlands)

    Verburg, P.H.; Manfredo, M.J.; Vaske, J.J.; Rechkemmer, A.; Duke, E.A.


    Land change is the result of multiple human-environment interactions operating across different scales. Land change research needs to account for processes ranging from global trade of food and energy to the local management of land resources at farm and landscape level. Land change has a pronounced

  17. Economic viability of Stratified Medicine concepts: An investor perspective on drivers and conditions that favour using Stratified Medicine approaches in a cost-contained healthcare environment. (United States)

    Fugel, Hans-Joerg; Nuijten, Mark; Postma, Maarten


    Stratified Medicine (SM) is becoming a natural result of advances in biomedical science and a promising path for the innovation-based biopharmaceutical industry to create new investment opportunities. While the use of biomarkers to improve R&D efficiency and productivity is very much acknowledged by industry, much work remains to be done to understand the drivers and conditions that favour using a stratified approach to create economically viable products and to justify the investment in SM interventions as a stratification option. In this paper we apply a decision analytical methodology to address the economic attractiveness of different SM development options in a cost-contained healthcare environment. For this purpose, a hypothetical business case in the oncology market has been developed considering four feasible development scenarios. The article outlines the effects of development time and time to peak sales as key economic value drivers influencing profitability of SM interventions under specific conditions. If regulatory and reimbursement challenges can be solved, decreasing development time and enhancing early market penetration would most directly improve the economic attractiveness of SM interventions. Appropriate tailoring of highly differentiated patient subgroups is the prerequisite to leverage potential efficiency gains in the R&D process. Also, offering a better targeted and hence ultimately more cost-effective therapy at reimbursable prices will facilitate time to market access and allow increasing market share gains within the targeted populations. Copyright © 2016 Elsevier B.V. All rights reserved.

  18. Quantifying the contribution of changes in healthcare expenditures and smoking to the reversal of the trend in life expectancy in the Netherlands. (United States)

    Peters, Frederik; Nusselder, Wilma J; Reibling, Nadine; Wegner-Siegmundt, Christian; Mackenbach, Johan P


    Since 2001 the Netherlands has shown a sharp upturn in life expectancy (LE) after a longer period of slower improvement. This study assessed whether changes in healthcare expenditure (HCE) explain this reversal in trends in LE. As an alternative explanation, the impact of changes in smoking behavior was also evaluated. To quantify the contribution of changes in HCE to changes in LE, we estimated a health-production function using a dynamic panel regression approach with data on 19 OECD countries (1980-2009), accounting for temporal and spatial correlation. Smoking-attributable mortality was estimated using the indirect Peto-Lopez method. As compared to 1990-1999, during 2000-2009 LE in the Netherlands increased by 1.8 years in females and by 1.5 years in males. Whereas changes in the impact of smoking between the two periods made almost no contribution to the acceleration of the increase in LE, changes in the trend of HCE added 0.9 years to the LE increase between 2000 and 2009. The exceptional reversal in the trend of LE and HCE was not found among the other OECD countries. This study suggests that changes in Dutch HCE, and not in smoking, made an important contribution to the reversal of the trend in LE; these findings support the view that investments in healthcare are increasingly important for further progress in life expectancy.

  19. Changes in healthcare utilization and costs associated with sildenafil therapy for pulmonary arterial hypertension: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Berger Ariel


    Full Text Available Abstract Background Little is known concerning the degree to which initiation of sildenafil for pulmonary arterial hypertension (PAH impacts patterns of healthcare utilization and costs. Methods Using a large US health insurance claims database, we identified all patients with evidence of PAH (ICD-9-CM diagnosis codes 416.0, 416.8 who received sildenafil between 1/1/2005 and 9/30/2008. Date of the first-noted prescription for sildenafil was designated the “index date,” and claims data were compiled for all study subjects for 6 months prior to their index date (“pretreatment” and 6 months thereafter (“follow-up”; patients with incomplete data during either of these periods were excluded. Healthcare utilization and costs were then compared between pretreatment and follow-up for all study subjects. Results A total of 567 PAH patients were identified who began therapy with sildenafil and met all other study entry criteria. Mean (SD age was 52 (10 years; 73% were women. Healthcare utilization was largely unchanged between pretreatment and follow-up, the only exceptions being decreases in the mean number of emergency department visits (from 0.7 to 0.5 per patient; p  Conclusions The cost of sildenafil therapy may be partially offset by reductions in other healthcare costs.

  20. Changing the food environment: the effect of trained volunteers on mealtime care for older people in hospital. (United States)

    Roberts, Helen C


    This review will describe the evidence for changing the hospital environment to improve nutrition of older people, with particular emphasis on the role of additional mealtime assistance. Poor nutrition among older people in hospital is well recognised in many countries and is associated with poor outcomes of hospital care including increased mortality and longer lengths of stay. Factors recognised to contribute to poor dietary intake include acute illness, co-morbidities, cognitive impairment, low mood and medication. The hospital environment has also been scrutinised with reports from many countries of food being placed out of reach or going cold because time-pressured ward and catering staff often struggle to help an increasingly dependent group of patients at mealtimes. Routine screening in hospital for people at risk of under nutrition is recommended. Coloured trays and protected mealtimes are widespread although there is relatively little evidence for their impact on dietary intake. Volunteers can be trained to sfely give additional mealtime assistance including feeding to older patients on acute medical wards. They can improve the quality of mealtime care for patients and nursing staff although the evidence for improved dietary intake is mixed. In conclusion, improving the nutrition of older patients in hospital is challenging. Initiatives such as routine screening, the use of coloured trays, protected mealtimes and additional mealtime assistance can work together synergistically. Volunteers are likely to be increasingly important in an era when healthcare systems are generally limited in both financial resources and the ability to recruit sufficient nursing staff.

  1. Seagrasses under threat: Understanding the resilience of temperate seagrass meadows in a changing environment

    NARCIS (Netherlands)

    Soissons, L.M.


    Despite being highly valuable ecosystems, seagrass meadows are threatened worldwide, mostly by human activities. In order to preserve seagrass meadows from collapse, we need to better understand their resilience in a changing environment. By means of various

  2. The Central Role of Physician Leadership for Driving Change in Value-Based Care Environments. (United States)

    Lustig, Adam; Ogden, Michael; Brenner, Robert W; Penso, Jerry; Westrich, Kimberly D; Dubois, Robert W


    has achieved 72% hypertension control for at-risk patients and continues work towards the 80% campaign goal. The implementation of the Measure Up/Pressure Down campaign by CHC and SMG provides some valuable lessons. To further explore important aspects of successfully implementing the Measure Up/Pressure Down campaign in real-world settings, 6 key themes were identified that drove quality improvement and may be helpful to other organizations that implement similar quality improvement initiatives: (1) transitioning to value-based payments, (2) creating an environment for success, (3) leveraging program champions, (4) sharing quality data, (5) promoting care team collaboration, and (6) leveraging health information technology. The strategies employed by SMG and CHC, such as leveraging data analysis to identify at-risk patients and comparing physician performance, as well as identifying leaders to institute change, can be replicated by an ACO or a managed care organization (MCO). An MCO can provide data analysis services, sparing the provider groups the analytic burden and helping the MCO build a more meaningful relationship with their providers. No outside funding supported this project. The authors declare no conflicts of interest. The authors are members of the Working Group on Optimizing Medication Therapy in Value-Based Healthcare. Odgen is employed by Cornerstone Health Care; Brenner is employed by Summit Medical Group; and Penso is employed by American Medical Group Association. Lustig, Westrich, and Dubois are employed by the National Pharmaceutical Council, an industry-funded health policy research organization that is not involved in lobbying or advocacy. Study concept and design were contributed by Lustig, Penso, Westrich, and Dubois. Lustig, Ogden, Brenner, and Penso collected the data, and data interpretation was performed by all authors. The manuscript was written primarily by Lustig, along with the other authors, and revised by Lustig, Penso, Westrich, and

  3. Landscape changes in the environment due to military actions and their epidemic risks

    Directory of Open Access Journals (Sweden)

    Krushelnitsky A.D.


    Full Text Available The article considers the influence of the military-ecological and man-caused-anthropogenic factors on the environment state and natural processes. Epidemic risks and consequences resulted from landscapic changes of the environment which arise as a result of war and destruction of ecosystems are described.

  4. Changes in School Competitive Food Environments after a Health Promotion Campaign (United States)

    Green, Sarah H.; Mallya, Giridhar; Brensinger, Colleen; Tierney, Ann; Glanz, Karen


    Background: Schools can reduce student access to competitive foods and influence healthy food choices by improving the school nutrition environment. This study describes changes in competitive nutrition environments in 100 K-8 schools participating in the Philadelphia Campaign for Healthier Schools. Methods: Interviews with school staff were used…

  5. Environment

    DEFF Research Database (Denmark)

    Valentini, Chiara


    The term environment refers to the internal and external context in which organizations operate. For some scholars, environment is defined as an arrangement of political, economic, social and cultural factors existing in a given context that have an impact on organizational processes and structures....... For others, environment is a generic term describing a large variety of stakeholders and how these interact and act upon organizations. Organizations and their environment are mutually interdependent and organizational communications are highly affected by the environment. This entry examines the origin...... and development of organization-environment interdependence, the nature of the concept of environment and its relevance for communication scholarships and activities....

  6. Mathematical modeling environment as a promoter changes traditional conceptions of the math teacher

    Directory of Open Access Journals (Sweden)

    Arthur Gonçalves Machado Junior


    Full Text Available The purpose of this paper is to present, through episodes, modifications made by the teacher during the interaction in the research environment, a state public school in the outskirts of Belem. Were analyzed four episodes, in which we see significant changes in his posture classroom. The episodes are meant to highlight these changes, which we believe are the interactions of the characters from the environment, the teacher with the teacher-researcher and it with his students

  7. The impact of healthcare workers job environment on their mental-emotional health. Coping strategies: the case of a local general hospital

    Directory of Open Access Journals (Sweden)

    Aristotelis Koinis


    Full Text Available Workplace stress can influence healthcare professionals’ physical and emotional well-being by curbing their efficiency and having a negative impact on their overall quality of life. The aim of the present study was to investigate the impact that work environment in a local public general hospital can have on the health workers’ mental-emotional health and find strategies in order to cope with negative consequences. The study took place from July 2010 to October 2010. Our sample consisted of 200 healthcare professionals aged 21-58 years working in a 240-bed general hospital and the response rate was 91.36%. Our research protocol was first approved by the hospital’s review board. A standardized questionnaire that investigates strategies for coping with stressful conditions was used. A standardized questionnaire was used in the present study Coping Strategies for Stressful Events, evaluating the strategies that persons employ in order to overcome a stressful situation or event. The questionnaire was first tested for validity and reliability which were found satisfactory (Cronbach’s α=0.862. Strict anonymity of the participants was guaranteed. The SPSS 16.0 software was used for the statistical analysis. Regression analysis showed that health professionals’ emotional health can be influenced by strategies for dealing with stressful events, since positive re-assessment, quitting and seeking social support are predisposing factors regarding the three first quality of life factors of the World Health Organization Quality of Life -BREF. More specifically, for the physical health factor, positive re-assessment (t=3.370, P=0.001 and quitting (t=−2.564, P=0.011 are predisposing factors. For the ‘mental health and spirituality’ regression model, positive re-assessment (t=5.528, P=0.000 and seeking social support (t=−1.991, P=0.048 are also predisposing factors, while regarding social relationships positive re-assessment (t=4.289, P=0

  8. The Impact of Healthcare Workers Job Environment on Their Mental-emotional Health. Coping Strategies: The Case of a Local General Hospital. (United States)

    Koinis, Aristotelis; Giannou, Vasiliki; Drantaki, Vasiliki; Angelaina, Sophia; Stratou, Elpida; Saridi, Maria


    Workplace stress can influence healthcare professionals' physical and emotional well-being by curbing their efficiency and having a negative impact on their overall quality of life. The aim of the present study was to investigate the impact that work environment in a local public general hospital can have on the health workers' mental-emotional health and find strategies in order to cope with negative consequences. The study took place from July 2010 to October 2010. Our sample consisted of 200 healthcare professionals aged 21-58 years working in a 240-bed general hospital and the response rate was 91.36%). Our research protocol was first approved by the hospital's review board. A standardized questionnaire that investigates strategies for coping with stressful conditions was used. A standardized questionnaire was used in the present study Coping Strategies for Stressful Events, evaluating the strategies that persons employ in order to overcome a stressful situation or event. The questionnaire was first tested for validity and reliability which were found satisfactory (Cronbach's α=0.862). Strict anonymity of the participants was guaranteed. The SPSS 16.0 software was used for the statistical analysis. Regression analysis showed that health professionals' emotional health can be influenced by strategies for dealing with stressful events, since positive re-assessment, quitting and seeking social support are predisposing factors regarding the three first quality of life factors of the World Health Organization Quality of Life - BREF. More specifically, for the physical health factor, positive re-assessment (t=3.370, P=0.001) and quitting (t=-2.564, P=0.011) are predisposing factors. For the 'mental health and spirituality' regression model, positive re-assessment (t=5.528, P=0.000) and seeking social support (t=-1.991, P=0.048) are also predisposing factors, while regarding social relationships positive re-assessment (t=4.289, P=0.000) is a predisposing factor

  9. Adaptation, plasticity, and extinction in a changing environment: towards a predictive theory.

    Directory of Open Access Journals (Sweden)

    Luis-Miguel Chevin


    Full Text Available Many species are experiencing sustained environmental change mainly due to human activities. The unusual rate and extent of anthropogenic alterations of the environment may exceed the capacity of developmental, genetic, and demographic mechanisms that populations have evolved to deal with environmental change. To begin to understand the limits to population persistence, we present a simple evolutionary model for the critical rate of environmental change beyond which a population must decline and go extinct. We use this model to highlight the major determinants of extinction risk in a changing environment, and identify research needs for improved predictions based on projected changes in environmental variables. Two key parameters relating the environment to population biology have not yet received sufficient attention. Phenotypic plasticity, the direct influence of environment on the development of individual phenotypes, is increasingly considered an important component of phenotypic change in the wild and should be incorporated in models of population persistence. Environmental sensitivity of selection, the change in the optimum phenotype with the environment, still crucially needs empirical assessment. We use environmental tolerance curves and other examples of ecological and evolutionary responses to climate change to illustrate how these mechanistic approaches can be developed for predictive purposes.

  10. Developing an integrated design model incorporating technology philosophy for the design of healthcare environments : a case analysis of facilities for psychogeriatric and psychiatric care in The Netherlands

    NARCIS (Netherlands)

    van Hoof, J.; Verkerk, M.J.

    The design of healthcare facilities is a complex and dynamic process, which involves many stakeholders each with their own set of needs. In the context of healthcare facilities, this complexity exists at the intersection of technology and society because the very design of these buildings forces us

  11. Strategic learning in healthcare organizations. (United States)

    O'Sullivan, M J


    the answers; to concede that we do not always know what to do; to admit that past actions and solutions may no longer be appropriate, in fact may have been the incubators of today's problems; to question basic assumptions long held about running the institution; and to make ourselves vulnerable to the political dynamics prevalent in all organizations. Hospitals and other healthcare organizations must seek to develop and maintain a continuing state of readiness in which everyone in the organization, from front-line clinician to senior management, is poised to act in anticipation of and in response to unforeseen changes in the environment and to learn from their own experiences in confronting the future.

  12. How smartphones are changing the face of mobile and participatory healthcare: an overview, with example from eCAALYX


    Boulos, Maged N Kamel; Wheeler, Steve; Tavares, Carlos; Jones, Ray


    The latest generation of smartphones are increasingly viewed as handheld computers rather than as phones, due to their powerful on-board computing capability, capacious memories, large screens and open operating systems that encourage application development. This paper provides a brief state-of-the-art overview of health and healthcare smartphone apps (applications) on the market today, including emerging trends and market uptake. Platforms available today include Android, Apple iOS, RIM Bla...

  13. How smartphones are changing the face of mobile and participatory healthcare: an overview, with example from eCAALYX. (United States)

    Boulos, Maged N Kamel; Wheeler, Steve; Tavares, Carlos; Jones, Ray


    The latest generation of smartphones are increasingly viewed as handheld computers rather than as phones, due to their powerful on-board computing capability, capacious memories, large screens and open operating systems that encourage application development. This paper provides a brief state-of-the-art overview of health and healthcare smartphone apps (applications) on the market today, including emerging trends and market uptake. Platforms available today include Android, Apple iOS, RIM BlackBerry, Symbian, and Windows (Windows Mobile 6.x and the emerging Windows Phone 7 platform). The paper covers apps targeting both laypersons/patients and healthcare professionals in various scenarios, e.g., health, fitness and lifestyle education and management apps; ambient assisted living apps; continuing professional education tools; and apps for public health surveillance. Among the surveyed apps are those assisting in chronic disease management, whether as standalone apps or part of a BAN (Body Area Network) and remote server configuration. We describe in detail the development of a smartphone app within eCAALYX (Enhanced Complete Ambient Assisted Living Experiment, 2009-2012), an EU-funded project for older people with multiple chronic conditions. The eCAALYX Android smartphone app receives input from a BAN (a patient-wearable smart garment with wireless health sensors) and the GPS (Global Positioning System) location sensor in the smartphone, and communicates over the Internet with a remote server accessible by healthcare professionals who are in charge of the remote monitoring and management of the older patient with multiple chronic conditions. Finally, we briefly discuss barriers to adoption of health and healthcare smartphone apps (e.g., cost, network bandwidth and battery power efficiency, usability, privacy issues, etc.), as well as some workarounds to mitigate those barriers.

  14. How smartphones are changing the face of mobile and participatory healthcare: an overview, with example from eCAALYX

    Directory of Open Access Journals (Sweden)

    Tavares Carlos


    Full Text Available Abstract The latest generation of smartphones are increasingly viewed as handheld computers rather than as phones, due to their powerful on-board computing capability, capacious memories, large screens and open operating systems that encourage application development. This paper provides a brief state-of-the-art overview of health and healthcare smartphone apps (applications on the market today, including emerging trends and market uptake. Platforms available today include Android, Apple iOS, RIM BlackBerry, Symbian, and Windows (Windows Mobile 6.x and the emerging Windows Phone 7 platform. The paper covers apps targeting both laypersons/patients and healthcare professionals in various scenarios, e.g., health, fitness and lifestyle education and management apps; ambient assisted living apps; continuing professional education tools; and apps for public health surveillance. Among the surveyed apps are those assisting in chronic disease management, whether as standalone apps or part of a BAN (Body Area Network and remote server configuration. We describe in detail the development of a smartphone app within eCAALYX (Enhanced Complete Ambient Assisted Living Experiment, 2009-2012, an EU-funded project for older people with multiple chronic conditions. The eCAALYX Android smartphone app receives input from a BAN (a patient-wearable smart garment with wireless health sensors and the GPS (Global Positioning System location sensor in the smartphone, and communicates over the Internet with a remote server accessible by healthcare professionals who are in charge of the remote monitoring and management of the older patient with multiple chronic conditions. Finally, we briefly discuss barriers to adoption of health and healthcare smartphone apps (e.g., cost, network bandwidth and battery power efficiency, usability, privacy issues, etc., as well as some workarounds to mitigate those barriers.

  15. Healthcare avoidance: a critical review. (United States)

    Byrne, Sharon K


    The purpose of this study is to provide a critical review and synthesis of theoretical and research literature documenting the impact of avoidance on healthcare behaviors, identify the factors that influence healthcare avoidance and delay in the adult population, and propose a direction for future research. The Theory of Reasoned Action, Theory of Planned Behavior, Theory of Care-Seeking Behavior, the Transtheoretical Model, and the Behavioral Model of Health Services Use/Utilization are utilized to elaborate on the context within which individual intention to engage in healthcare behaviors occurs. Research literature on the concept of healthcare avoidance obtained by using computerized searches of CINAHL, MEDLINE, PSYCH INFO, and HAPI databases, from 1995 to 2007, were reviewed. Studies were organized by professional disciplines. Healthcare avoidance is a common and highly variable experience. Multiple administrative, demographic, personal, and provider factors are related to healthcare avoidance, for example, distrust of providers and/or the science community, health beliefs, insurance status, or socioeconomic/income level. Although the concept is recognized by multiple disciplines, limited research studies address its impact on healthcare decision making. More systematic research is needed to determine correlates of healthcare avoidance. Such studies will help investigators identify patients at risk for avoidant behaviors and provide the basis for health-promoting interventions. Methodological challenges include identification of characteristics of individuals and environments that hinder healthcare behaviors, as well as, the complexity of measuring healthcare avoidance. Studies need to systematically explore the influence of avoidance behaviors on specific healthcare populations at risk.

  16. Redefining the Core Competencies of Future Healthcare Executives under Healthcare Reform (United States)

    Love, Dianne B.; Ayadi, M. Femi


    As the healthcare industry has evolved over the years, so too has the administration of healthcare organizations. The signing into law of the Patient Protection and Affordable Care Act (ACA) has brought additional changes to the healthcare industry that will require changes to the healthcare administration curriculum. The movement toward a…

  17. Individual Differences in Behavioural Reaction to a Changing Environment in Mice and Rats

    NARCIS (Netherlands)

    Benus, R.F.; Koolhaas, J.M.; Oortmerssen, G.A. van


    Aggressive and non-aggressive male mice differ in their reaction to a changing social environment. In order to investigate if this differentiation holds also for non-social situations male mice are trained in a standard maze task, whereafter a change (extramaze and intramaze, respectively) is

  18. Robust online belief space planning in changing environments: Application to physical mobile robots

    KAUST Repository

    Agha-mohammadi, Ali-akbar; Agarwal, Saurav; Mahadevan, Aditya; Chakravorty, Suman; Tomkins, Daniel; Denny, Jory; Amato, Nancy M.


    , such as the discrepancy between computational models and real physical models. In this paper, we propose a dynamic replanning scheme in belief space to address such challenges. Moreover, we present techniques to cope with changes in the environment (e.g., changes

  19. Obesity and the built environment: changes in environmental cues cause energy imbalances. (United States)

    Cohen, D A


    The past 30 years have seen dramatic changes in the food and physical activity environments, both of which contribute to the changes in human behavior that could explain obesity. This paper reviews documented changes in the food environment, changes in the physical activity environment and the mechanisms through which people respond to these environments, often without conscious awareness or control. The most important environmental changes have been increases in food accessibility, food salience and decreases in the cost of food. The increases in food marketing and advertising create food cues that artificially stimulate people to feel hungry. The existence of a metabolic pathway that allows excess energy to be stored as fat suggests that people were designed to overeat. Many internal mechanisms favor neurophysiologic responses to food cues that result in overconsumption. External cues, such as food abundance, food variety and food novelty, cause people to override internal signals of satiety. Other factors, such as conditioning and priming, tie food to other desirable outcomes, and thus increase the frequency that hunger is stimulated by environmental cues. People's natural response to the environmental cues are colored by framing, and judgments are flawed and biased depending on how information is presented. People lack insight into how the food environment affects them, and subsequently are unable to change the factors that are responsible for excessive energy consumption. Understanding the causal pathway for overconsumption will be necessary to interrupt the mechanisms that lead to obesity.

  20. Change: Threat or opportunity for human progress? V. 5. Ecological change: Environment, development and poverty linkages

    International Nuclear Information System (INIS)

    Kirdar, U.


    This volume consists of 18 articles that examine the changing ecological balance of the world and its effect on human prosperity. The problems caused by global warning, climate change and environmental degradation will have serious effects in both the short and the long term. Two of the 18 articles fall within INIS scope: these have been indexed separately. Tabs

  1. Change: Threat or opportunity for human progress V. 5. Ecological change: Environment, development and poverty linkages

    Energy Technology Data Exchange (ETDEWEB)

    Kirdar, U [ed.


    This volume consists of 18 articles that examine the changing ecological balance of the world and its effect on human prosperity. The problems caused by global warning, climate change and environmental degradation will have serious effects in both the short and the long term. Two of the 18 articles fall within INIS scope: these have been indexed separately. Tabs.

  2. Learning Is Change: Creating an Environment for Sustainable Organizational Change in Continuing and Higher Education (United States)

    Schultz, Christie


    This article explores the ways in which learning itself is a form of organizational change and, as such, supports organizational readiness for change. The study considers a continuing education unit within a major Canadian university that managed to transform its decentralized and independent student records and administration system (student…

  3. Blueprint for Sustainable Change in Diversity Management and Cultural Competence: Lessons From the National Center for Healthcare Leadership Diversity Demonstration Project. (United States)

    Dreachslin, Janice L; Weech-Maldonado, Robert; Gail, Judith; Epané, Josué Patien; Wainio, Joyce Anne

    How can healthcare leaders build a sustainable infrastructure to leverage workforce diversity and deliver culturally and linguistically appropriate care to patients? To answer that question, two health systems participated in the National Center for Healthcare Leadership's diversity leadership demonstration project, November 2008 to December 2013. Each system provided one intervention hospital and one control hospital.The control hospital in each system participated in pre- and postassessments but received no preassessment feedback and no intervention support. Each intervention hospital's C-suite leadership and demonstration project manager worked with a diversity coach provided by the National Center for Healthcare Leadership to design and implement an action plan to improve diversity and cultural competence practices and build a sustainable infrastructure. Plans explored areas of strength and areas for improvement that were identified through preintervention assessments. The assessments focused on five competencies of strategic diversity management and culturally and linguistically appropriate care: diversity leadership, strategic human resource management, organizational climate, diversity climate, and patient cultural competence.This article describes each intervention hospital's success in action plan implementation and reports results of postintervention interviews with leadership to provide a blueprint for sustainable change.

  4. New hospital structure in the twenty-first century: the position of level III (tertiary) neurological and stroke care in a changing healthcare system. (United States)

    Szentes, Tamás; Kovács, László; Óváry, Csaba


    The determination of the necessary capacity and number of neurology wards of level III progressivity that can be defined in the system of criteria detailed in this article and which possess optimal operating conditions in Hungarian terms. We used the National Health Insurance Company's database to calculate case numbers and capacity for different levels of neurological and stroke care. We also revised the allocation of advanced diagnostic and therapeutic technologies, and proposed changes, based on health insurance data. We also discussed these propositions with clinical experts to test their viability. We determined the adequate number of organisational units capable of providing special neurological healthcare services on the basis of the basic data of the Hungarian healthcare system, specifying this number as 6 instead of the current 11. In our study, we have identified significant bias in the nationwide level of neurological and stroke care organisation, which needs revised allocation of healthcare resources. Naturally, this can only be carried out through the restructuring of the emergency care system and the expansion of pre-hospital care.

  5. European research on Climat change impact on human health and environment


    Pogonysheva I. A.; Kuznetsova V. P.; Pogonyshev D. A.; Lunyak I. I.


    European countries have accumulated a considerable body of research that proves both direct and indirect influence of climate change on human health. The article analyses “Protecting health in an environment challenged by climate change: European Regional Framework for Action”. The article gives a detailed analysis of the work of European Office of World Health Organisation and The United Nations Economic Commission for Europe related to climate change.

  6. Informatics and Nursing in a Post-Nursing Informatics World: Future Directions for Nurses in an Automated, Artificially Intelligent, Social-Networked Healthcare Environment. (United States)

    Booth, Richard G


    The increased adoption and use of technology within healthcare and society has influenced the nursing informatics specialty in a multitude of fashions. Namely, the nursing informatics specialty currently faces a range of important decisions related to its knowledge base, established values and future directions - all of which are in need of development and future-proofing. In light of the increased use of automation, artificial intelligence and big data in healthcare, the specialty must also reconceptualize the roles of both nurses and informaticians to ensure that the nursing profession is ready to operate within future digitalized healthcare ecosystems. To explore these goals, the author of this manuscript outlines an examination of technological advancements currently taking place within healthcare, and also proposes implications for the nursing role and the nursing informatics specialty. Finally, recommendations and insights towards how the roles of nurses and informaticians might evolve or be shaped in the growing post-nursing informatics era are presented. Copyright © 2016 Longwoods Publishing.

  7. Analysis of the evolution of precipitation in the Haihe river basin of China under changing environment (United States)

    Ding, Xiangyi; Liu, Jiahong; Gong, Jiaguo


    Precipitation is one of the important factors of water cycle and main sources of regional water resources. It is of great significance to analyze the evolution of precipitation under changing environment for identifying the evolution law of water resources, thus can provide a scientific reference for the sustainable utilization of water resources and the formulation of related policies and measures. Generally, analysis of the evolution of precipitation consists of three levels: analysis the observed precipitation change based on measured data, explore the possible factors responsible for the precipitation change, and estimate the change trend of precipitation under changing environment. As the political and cultural centre of China, the climatic conditions in the Haihe river basin have greatly changed in recent decades. This study analyses the evolution of precipitation in the basin under changing environment based on observed meteorological data, GCMs and statistical methods. Firstly, based on the observed precipitation data during 1961-2000 at 26 meteorological stations in the basin, the actual precipitation change in the basin is analyzed. Secondly, the observed precipitation change in the basin is attributed using the fingerprint-based attribution method, and the causes of the observed precipitation change is identified. Finally, the change trend of precipitation in the basin under climate change in the future is predicted based on GCMs and a statistical downscaling model. The results indicate that: 1) during 1961-2000, the precipitation in the basin showed a decreasing trend, and the possible mutation time was 1965; 2) natural variability may be the factor responsible for the observed precipitation change in the basin; 3) under climate change in the future, precipitation in the basin will slightly increase by 4.8% comparing with the average, and the extremes will not vary significantly.

  8. Innovative use of the integrative review to evaluate evidence of technology transformation in healthcare. (United States)

    Phillips, Andrew B; Merrill, Jacqueline A


    Healthcare is in a period significant transformational activity through the accelerated adoption of healthcare technologies, new reimbursement systems that emphasize shared savings and care coordination, and the common place use of mobile technologies by patients, providers, and others. The complexity of healthcare creates barriers to transformational activity and has the potential to inhibit the desired paths toward change envisioned by policymakers. Methods for understanding how change is occurring within this complex environment are important to the evaluation of delivery system reform and the role of technology in healthcare transformation. This study examines the use on an integrative review methodology to evaluate the healthcare literature for evidence of technology transformation in healthcare. The methodology integrates the evaluation of a broad set of literature with an established evaluative framework to develop a more complete understanding of a particular topic. We applied this methodology and the framework of punctuated equilibrium (PEq) to the analysis of the healthcare literature from 2004 to 2012 for evidence of technology transformation, a time during which technology was at the forefront of healthcare policy. The analysis demonstrated that the established PEq framework applied to the literature showed considerable potential for evaluating the progress of policies that encourage healthcare transformation. Significant inhibitors to change were identified through the integrative review and categorized into ten themes that describe the resistant structure of healthcare delivery: variations in the environment; market complexity; regulations; flawed risks and rewards; change theories; barriers; ethical considerations; competition and sustainability; environmental elements, and internal elements. We hypothesize that the resistant nature of the healthcare system described by this study creates barriers to the direct consumer involvement and engagement

  9. Rural Settlement Development and Environment Carrying Capacity Changes in Progo River Basin


    Su Ritohardoyo; P Priyono


    Generally the broader rural settlement the heavier population pressure on agricultural land. It indicates that carrying capacity of the rural environment threatened lower. The spatial distribution of the threat in a river basin is quite important as one of the river basin management inputs. Therefore, this article aims at exposing result of research about influence rural population growth and rural settlement land changes to environment carrying capacity. This research was carried out in the ...

  10. Yoga Therapy: Building a Holding Environment for Somatic and Psyche Change. (United States)

    McClure, Bud


    Drawing on ideas from D.W. Winnicott and the work of Quaker theologian Parker Palmer, this article discusses the concept of a holding environment, its refined understanding in the literature over the years, and how it can be optimally used in yoga therapy. The evidence shows that effectively establishing a holding environment can facilitate both somatic and deep structural change in a client, facilitating healing from primal wounding as well as the potential reconnection to the true self.

  11. Complex Genotype by Environment interactions and changing genetic architectures across thermal environments in the Australian field cricket, Teleogryllus oceanicus

    Directory of Open Access Journals (Sweden)

    Dowling Damian K


    Full Text Available Abstract Background Biologists studying adaptation under sexual selection have spent considerable effort assessing the relative importance of two groups of models, which hinge on the idea that females gain indirect benefits via mate discrimination. These are the good genes and genetic compatibility models. Quantitative genetic studies have advanced our understanding of these models by enabling assessment of whether the genetic architectures underlying focal phenotypes are congruent with either model. In this context, good genes models require underlying additive genetic variance, while compatibility models require non-additive variance. Currently, we know very little about how the expression of genotypes comprised of distinct parental haplotypes, or how levels and types of genetic variance underlying key phenotypes, change across environments. Such knowledge is important, however, because genotype-environment interactions can have major implications on the potential for evolutionary responses to selection. Results We used a full diallel breeding design to screen for complex genotype-environment interactions, and genetic architectures underlying key morphological traits, across two thermal environments (the lab standard 27°C, and the cooler 23°C in the Australian field cricket, Teleogryllus oceanicus. In males, complex three-way interactions between sire and dam parental haplotypes and the rearing environment accounted for up to 23 per cent of the scaled phenotypic variance in the traits we measured (body mass, pronotum width and testes mass, and each trait harboured significant additive genetic variance in the standard temperature (27°C only. In females, these three-way interactions were less important, with interactions between the paternal haplotype and rearing environment accounting for about ten per cent of the phenotypic variance (in body mass, pronotum width and ovary mass. Of the female traits measured, only ovary mass for crickets

  12. Dousing our inflammatory environment(s): is personal carbon trading an option for reducing obesity--and climate change? (United States)

    Egger, G


    Obesity and climate change are two problems currently challenging humanity. Although apparently unrelated, an epidemiological approach to both shows a similar environmental aetiology, based in modern human lifestyles and their driving economic forces. One way of analysing this is through inflammation (defined as '. . . a disturbance of function following insult or injury') of both the internal (biological) and external (ecological) environments. Chronic, low-grade, systemic inflammation has recently been shown to accompany obesity, as well as a range of biological pathologies associated with obesity (diabetes, heart disease, some cancers, etc.). This is influenced by the body's inability to soak up excess glucose as a result of insulin resistance. In a broader sense, inflammation is a metaphor for ecological 'pathologies', manifest particularly in unnatural disturbances like climate change, ocean acidity, rising temperatures and species extinction, associated with the inability of the world's environmental 'sinks' to soak up carbon dioxide ('carbon resistance'?). The use of such a metaphorical analysis opens the possibilities for dealing with two interdisciplinary problems simultaneously. Strategies for managing climate change, including personal carbon trading, could provide a 'stealth intervention' for reducing population levels of obesity by increasing personal energy expenditure and decreasing energy-dense food intake, as well as reducing the carbon emissions causing climate change.

  13. Changing the navigator's course: How the increasing rationalization of healthcare influences access for undocumented immigrants under the Affordable Care Act. (United States)

    López-Sanders, Laura


    A number of researchers have shown that brokers (e.g., navigators and street-level bureaucrats) bridge access to healthcare services and information for immigrant patients through rich personal relationships and a mission of ethical care. An open question remains concerning how the increasing rationalization of healthcare over the past few decades influences brokerage for undocumented immigrant patients. Drawing from fieldwork and interviews conducted in California, as the Affordable Care Act (ACA) was implemented, I develop the concept of the "double-embedded-liaison." While other studies treat brokers as acting either as gatekeepers or patient representatives, this study explains how brokers simultaneously operate on multiple planes when new roles are added. I argue that with more formalization and scrutiny at health centers, the impact of brokerage is destabilized and, subsequently, diminished. Two consequences of the double-embedded-liaison brokerage form are: (1) some brokers become disillusioned and exit -resulting in the loss of valuable resources at the health centers, and (2) immigrants move away from the health centers that historically served them. In looking at brokers' simultaneous performance as gatekeepers and representatives, this research extends brokerage typologies and street-level bureaucracy arguments that largely treat brokerage in a mono-planar rather than in a bi-planar mode. Furthermore, in examining the risks and opportunities brokerage brings to addressing health disparities, the study provides insights into the effects of replacing the ACA or repealing it all together in the Post-Obama era. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Strategic alliances in healthcare: opportunities for the Veterans Affairs healthcare system. (United States)

    Halverson, P K; Kaluzny, A D; Young, G J


    Strategic alliances are proving to be effective strategies for responding and adapting to changing environments, and as such they offer the U.S. Department of Veterans Affairs (VA) healthcare system valuable opportunities for accomplishing the goals of its major reorganization effort. This article begins with an examination of basic strategic-alliance structures that are employed across many different types of industries. Next, consideration is given to the ways in which these basic alliance structures may be adapted to the unique organizations and individuals that serve as providers, purchasers, and consumers of health services. Finally, this article explores how models of strategic alliance in healthcare can be tailored to the specific needs and constraints of the VA healthcare system through an examination of existing and potential alliance opportunities.

  15. Total Environment of Change: Impacts of Climate Change and Social Transitions on Subsistence Fisheries in Northwest Alaska

    Directory of Open Access Journals (Sweden)

    Katie J. Moerlein


    Full Text Available Arctic ecosystems are undergoing rapid changes as a result of global climate change, with significant implications for the livelihoods of Arctic peoples. In this paper, based on ethnographic research conducted with the Iñupiaq communities of Noatak and Selawik in northwestern Alaska, we detail prominent environmental changes observed over the past twenty to thirty years and their impacts on subsistence-based lifestyles. However, we suggest that it is ultimately insufficient to try to understand how Arctic communities are experiencing and responding to climate change in isolation from other stressors. During interviews and participant observation documenting local observations of climatic and related environmental shifts and impacts to subsistence fishing practices, we find the inseparability of environmental, social, economic, cultural, and political realms for community residents. Many of our informants, who live in a mixed economy based on various forms of income and widespread subsistence harvesting of fish and game, perceive and experience climate change as embedded among numerous other factors affecting subsistence patterns and practices. Changing lifestyles, decreasing interest by younger generations in pursuing subsistence livelihoods, and economic challenges are greatly affecting contemporary subsistence patterns and practices in rural Alaska. Observations of climate change are perceived, experienced, and articulated to researchers through a broader lens of these linked lifestyle and cultural shifts. Therefore, we argue that to properly assess and understand the impacts of climate change on the subsistence practices in Arctic communities, we must also consider the total environment of change that is dramatically shaping the relationship between people, communities, and their surrounding environments.

  16. Interactions of forests, climate, water resources, and humans in a changing environment: research needs (United States)

    Ge Sun; Catalina Segura


    The aim of the special issue “Interactions of Forests, Climate, Water Resources, and Humans in a Changing Environment” is to present case studies on the influences of natural and human disturbances on forest water resources under a changing climate. Studies in this collection of six papers cover a wide range of geographic regions from Australia to Nigeria with spatial...



    Louckx, Yulia


    The efficient distribution strategy formulation becomes vital to the success and survival of any organization, especially when it is involved in international trade. Today’s world is particularly challenging due to rapidly changing market conditions. Therefore, in order to able to compete, satisfy customers, and meet the needs of other stakeholders profitably, it is crucial for any company to make profound market environment analyses, react to changes in the market and adjust strategies accor...

  18. Changes in hospital nurse work environments and nurse job outcomes: an analysis of panel data. (United States)

    Kutney-Lee, Ann; Wu, Evan S; Sloane, Douglas M; Aiken, Linda H


    One strategy proposed to alleviate nursing shortages is the promotion of organizational efforts that will improve nurse recruitment and retention. Cross-sectional studies have shown that the quality of the nurse work environment is associated with nurse outcomes related to retention, but there have been very few longitudinal studies undertaken to examine this relationship. To demonstrate how rates of burnout, intention to leave, and job dissatisfaction changed in a panel of hospitals over time, and to explore whether these outcomes were associated with changes in nurse work environments. A retrospective, two-stage panel design was chosen for this study. Survey data collected from large random samples of registered nurses employed in Pennsylvania hospitals in 1999 and 2006 were used to derive hospital-level rates of burnout, intention to leave current position, and job dissatisfaction, and to classify the quality of nurses' work environments at both points in time. A two-period difference model was used to estimate the dependence of changes in rates of nurse burnout, intention to leave, and job dissatisfaction on changes in nurse work environments between 1999 and 2006 in 137 hospitals, accounting for concurrent changes in nurse staffing levels. In general, nurse outcomes improved between 1999 and 2006, with fewer nurses reporting burnout, intention to leave, and job dissatisfaction in 2006 as compared to 1999. Our difference models showed that improvements in work environment had a strong negative association with changes in rates of burnout (β=-6.42%, pjob dissatisfaction (β=-8.00%, pburnout, intention to leave current position, and job dissatisfaction. Copyright © 2012 Elsevier Ltd. All rights reserved.

  19. The persistence of the attentional bias to regularities in a changing environment. (United States)

    Yu, Ru Qi; Zhao, Jiaying


    The environment often is stable, but some aspects may change over time. The challenge for the visual system is to discover and flexibly adapt to the changes. We examined how attention is shifted in the presence of changes in the underlying structure of the environment. In six experiments, observers viewed four simultaneous streams of objects while performing a visual search task. In the first half of each experiment, the stream in the structured location contained regularities, the shapes in the random location were randomized, and gray squares appeared in two neutral locations. In the second half, the stream in the structured or the random location may change. In the first half of all experiments, visual search was facilitated in the structured location, suggesting that attention was consistently biased toward regularities. In the second half, this bias persisted in the structured location when no change occurred (Experiment 1), when the regularities were removed (Experiment 2), or when new regularities embedded in the original or novel stimuli emerged in the previously random location (Experiments 3 and 6). However, visual search was numerically but no longer reliably faster in the structured location when the initial regularities were removed and new regularities were introduced in the previously random location (Experiment 4), or when novel random stimuli appeared in the random location (Experiment 5). This suggests that the attentional bias was weakened. Overall, the results demonstrate that the attentional bias to regularities was persistent but also sensitive to changes in the environment.

  20. New type of Piezoresistive Pressure Sensors for Environments with Rapidly Changing Temperature

    Directory of Open Access Journals (Sweden)

    Tykhan Myroslav


    Full Text Available The theoretical aspects of a new type of piezo-resistive pressure sensors for environments with rapidly changing temperatures are presented. The idea is that the sensor has two identical diaphragms which have different coefficients of linear thermal expansion. Therefore, when measuring pressure in environments with variable temperature, the diaphragms will have different deflection. This difference can be used to make appropriate correction of the sensor output signal and, thus, to increase accuracy of measurement. Since physical principles of sensors operation enable fast correction of the output signal, the sensor can be used in environments with rapidly changing temperature, which is its essential advantage. The paper presents practical implementation of the proposed theoretical aspects and the results of testing the developed sensor.

  1. Generic framework for meso-scale assessment of climate change hazards in coastal environments

    DEFF Research Database (Denmark)

    Appelquist, Lars Rosendahl


    coastal environments worldwide through a specially designed coastal classification system containing 113 generic coastal types. The framework provides information on the degree to which key climate change hazards are inherent in a particular coastal environment, and covers the hazards of ecosystem......This paper presents a generic framework for assessing inherent climate change hazards in coastal environments through a combined coastal classification and hazard evaluation system. The framework is developed to be used at scales relevant for regional and national planning and aims to cover all...... and computing requirements, allowing for application in developing country settings. It is presented as a graphical tool—the Coastal Hazard Wheel—to ease its application for planning purposes....

  2. Healthcare Lean. (United States)

    Long, John C


    Lean Thinking is an integrated approach to designing, doing and improving the work of people that have come together to produce and deliver goods, services and information. Healthcare Lean is based on the Toyota production system and applies concepts and techniques of Lean Thinking to hospitals and physician practices.

  3. Climate Change Education: Quantitatively Assessing the Impact of a Botanical Garden as an Informal Learning Environment (United States)

    Sellmann, Daniela; Bogner, Franz X.


    Although informal learning environments have been studied extensively, ours is one of the first studies to quantitatively assess the impact of learning in botanical gardens on students' cognitive achievement. We observed a group of 10th graders participating in a one-day educational intervention on climate change implemented in a botanical garden.…

  4. [Impact of new trend of ecological environment changes on growth, reproduction and diffusion of Oncomelania hupensis]. (United States)

    Juan, Xie; Li-Yong, Wen


    Oncomelania hupensis is the only intermediate host of Schistosoma japonicum , and the growth, reproduction and distribution of O.hupensis play an important role in schistosomiasis prevalence and transmission. This article reviews the influence of the new trend of ecological environment changes on the growth, reproduction and diffusion of the snails.

  5. Effects of Conceptual Change Text Based Instruction on Ecology, Attitudes toward Biology and Environment (United States)

    Çetin, Gülcan; Ertepinar, Hamide; Geban, Ömer


    The purpose of this study is to investigate the effects of the conceptual change text based instruction on ninth grade students' understanding of ecological concepts, and attitudes toward biology and environment. Participants were 82 ninth grade students in a public high school in the Northwestern Turkey. A treatment was employed over a five-week…

  6. Measuring the mechanical behavior of paperboard in a changing humidity environment (United States)

    Dennis E. Gunderson; John M. Considine


    “Both the strength and stability of compressively loaded paperboard are known to be adversely affected by cyclic changes in relative humidity. Current research at the Forest Products Laboratory (FPL) seeks to observe and explain this phenomenon and to develop a simple, practical test to determine allowable "working loads" in cyclicmoisture environments. A new...

  7. Nursing Workload and the Changing Health Care Environment: A Review of the Literature (United States)

    Neill, Denise


    Changes in the health care environment have impacted nursing workload, quality of care, and patient safety. Traditional nursing workload measures do not guarantee efficiency, nor do they adequately capture the complexity of nursing workload. Review of the literature indicates nurses perceive the quality of their work has diminished. Research has…

  8. Teaching Music Online: Changing Pedagogical Approach When Moving to the Online Environment (United States)

    Johnson, Carol


    The development of educational technology has provided platforms for undergraduate music courses to take place in an online environment. While technology is available, this does not mean that all teaching staff are ready for the pedagogical change required to implement teaching online. A transformation of pedagogical practice (that is, to online…

  9. Testing Models for the Contributions of Genes and Environment to Developmental Change in Adolescent Depression. (United States)

    Gillespie, Nathan A; Eaves, Lindon J; Maes, Hermine; Silberg, Judy L


    We tested two models to identify the genetic and environmental processes underlying longitudinal changes in depression among adolescents. The first assumes that observed changes in covariance structure result from the unfolding of inherent, random individual differences in the overall levels and rates of change in depression over time (random growth curves). The second assumes that observed changes are due to time-specific random effects (innovations) accumulating over time (autoregressive effects). We found little evidence of age-specific genetic effects or persistent genetic innovations. Instead, genetic effects are consistent with a gradual unfolding in the liability to depression and rates of change with increasing age. Likewise, the environment also creates significant individual differences in overall levels of depression and rates of change. However, there are also time-specific environmental experiences that persist with fidelity. The implications of these differing genetic and environmental mechanisms in the etiology of depression are considered.

  10. Uma Abordagem Para o Desenvolvimento de Aplicações no Cuidado de Saúde Pervasivo Através do Uso de Arquétipos (An Approach to Developing Applications in the Pervasive Healthcare Environment through the use of Archetypes)

    NARCIS (Netherlands)

    Cardoso de Moraes, J.L.; Lopes de Souza, Wanderley; Ferreira Pires, Luis; Cavalini, Luciana Tricai; do Prado, Antonio Francisco


    This paper proposes an approach to develop applications in the Pervasive Healthcare environment, through the use of Archetypes. Materials and methods: Pervasive Healthcare focuses on the use of new technologies, tools, and services, to help patients to play a more active role in the treatment of

  11. Tracking a changing environment: optimal sampling, adaptive memory and overnight effects. (United States)

    Dunlap, Aimee S; Stephens, David W


    Foraging in a variable environment presents a classic problem of decision making with incomplete information. Animals must track the changing environment, remember the best options and make choices accordingly. While several experimental studies have explored the idea that sampling behavior reflects the amount of environmental change, we take the next logical step in asking how change influences memory. We explore the hypothesis that memory length should be tied to the ecological relevance and the value of the information learned, and that environmental change is a key determinant of the value of memory. We use a dynamic programming model to confirm our predictions and then test memory length in a factorial experiment. In our experimental situation we manipulate rates of change in a simple foraging task for blue jays over a 36 h period. After jays experienced an experimentally determined change regime, we tested them at a range of retention intervals, from 1 to 72 h. Manipulated rates of change influenced learning and sampling rates: subjects sampled more and learned more quickly in the high change condition. Tests of retention revealed significant interactions between retention interval and the experienced rate of change. We observed a striking and surprising difference between the high and low change treatments at the 24h retention interval. In agreement with earlier work we find that a circadian retention interval is special, but we find that the extent of this 'specialness' depends on the subject's prior experience of environmental change. Specifically, experienced rates of change seem to influence how subjects balance recent information against past experience in a way that interacts with the passage of time. Copyright © 2011 Elsevier B.V. All rights reserved.

  12. Healthcare technology in the home

    DEFF Research Database (Denmark)

    Ballegaard, Stinne Aaløkke


    it is relevant to examine the changes induced by this development: How is healthcare technology appropriated and domesticated by users, how does the development affect the role of the patient, and how is the relationship between home patients, family caregivers and healthcare professionals transformed? The role...

  13. Changes in school environments with implementation of Arkansas Act 1220 of 2003. (United States)

    Phillips, Martha M; Raczynski, James M; West, Delia S; Pulley, LeaVonne; Bursac, Zoran; Gauss, C Heath; Walker, Jada F


    Changes in school nutrition and physical activity policies and environments are important to combat childhood obesity. Arkansas Act 1220 of 2003 was among the first and most comprehensive statewide legislative initiatives to combat childhood obesity through school-based change. Annual surveys of principals and superintendents have been analyzed to document substantial and important changes in school environments, policies, and practices. For example, results indicate that schools are more likely to require that healthy options be provided for student parties (4.5% in 2004, 36.9% in 2008; P ban commercial advertising by food or beverage companies (31.7% in 2005, 42.6% in 2008; P vending machines available during the lunch period (72.3% in 2004, 37.2% in 2008; P vending machines (83.8% in 2004, 73.5% in 2008; P changes were noted in foods and beverages offered in the cafeteria, in classrooms, and at school events, as well as in fund-raising and physical activity practices. A significant number of school districts have modified physical education requirements for elementary schools and developed policies prohibiting the use of physical activity as a punishment. We conclude that Arkansas Act 1220 of 2003 is associated with a number of changes in school environments and policies, resulting from both statewide and local initiatives spawned by the Act.

  14. 11th National Conference on Science, Policy, and the Environment: Our Changing Oceans

    Energy Technology Data Exchange (ETDEWEB)

    Peter Saundry


    On January 19-21, 2011, The National Council for Science and the Environment (NCSE) successfully convened its 11th National Conference on Science, Policy and the Environment: Our Changing Oceans in Washington, DC at the Ronald Reagan Building and International Trade Center. Over 1,247 participants attended the conference, representing federal, state and local governments, university and colleges across the US, civil society organizations, the business community, and international entities. In addition, the conference was webcast to an audience across several states. The conference provided a forum to examine the profound changes our ocean will undergo over the next 25-50 years and share various perspectives on the new research, tools, and policy initiatives to protect and sustain our ocean. Conference highlights and recommendations are available to the public on NCSE's conference website,

  15. Review of the Korean SSAC According to Changes in the Nuclear Environment

    International Nuclear Information System (INIS)

    Kim, Min Su; Yoon, Wan Ki; Choe, Kwan Kyoo; Jo, Seong Youn; Park, Jae Bum


    Korea has been maintaining efficient and systematic State System for Accounting and Control of nuclear materials (SSAC) for elevation of our nuclear transparency and reliability to international society. So far, Korean SSAC had been considered as a good example of SSAC together with Euratom, Japan, ABACC. But, owing to changing environment such as a series trial due to the KAERI's past nuclear material experiments, strengthened international nonproliferation scheme, advent of integrated safeguards and technology development in nuclear fields, voices of demand for changes in Korean SSAC are being brought up. Therefore, this study grasped and analyzed international nuclear environment and direction of changes in nuclear control regime, besides re-examine the roles of Korean SSAC and proposed the direction where Korean SSAC should be shifted

  16. Mapping of Danish Law Related to Companies' Impact on Environment and Climate Change

    DEFF Research Database (Denmark)

    Buhmann, Karin; Østergaard, Kim; Feldthusen, Rasmus Kristian

    for Danish law related to environment and climate change and CSR in a general sense, sources of law and jurisdiction specific issues, types of companies, shareholding structure etc. (section 1); the purpose of the company, duties and competence of the company organs, and corporate governance issues (section......This overview of Danish law related to companies’ conduct and impact on environment and climate change has been undertaken under the ‘Sustainable Companies’ project hosted at the Department of Private Law at the University of Oslo. The ‘mapping’ of national law – including in particular company law....... Environmental law has been seen under the project as essentially related to climate change. Some other issues related to sustainable development and company conduct have been addressed as well, in particular in relation to Corporate Social Responsibility (CSR). In the current paper, this particularly applies...

  17. The NHS and market forces in healthcare: the need for organisational ethics. (United States)

    Frith, Lucy


    The NHS in England is an organisation undergoing substantial change. The passage of the Health and Social Care Act 2012, consolidates and builds on previous health policies and introduces further 'market-style' reforms of the NHS. One of the main aspects of these reforms is to encourage private and third sector providers to deliver NHS services. The rationale for this is to foster a more competitive market in healthcare to encourage greater efficiency and innovation. This changing healthcare environment in the English NHS sharpens the need for attention to be paid to the ethical operation of healthcare organisations. All healthcare organisations need to consider the ethical aspects of their operation, whether state or privately run. However, the changes in the type of organisations used to provide healthcare (such as commercial companies) can create new relationships and ethical tensions. This paper will chart the development of organisational ethics as a concern in applied ethics and how it arose in the USA largely owing to changes in the organisation of healthcare financing and provision. It will be argued that an analogous transition is happening in the NHS in England. The paper will conclude with suggestions for the development of organisational ethics programmes to address some of the possible ethical issues raised by this new healthcare environment that incorporates both private and public sector providers.

  18. Improving the adaptability of simulated evolutionary swarm robots in dynamically changing environments.

    Directory of Open Access Journals (Sweden)

    Yao Yao

    Full Text Available One of the important challenges in the field of evolutionary robotics is the development of systems that can adapt to a changing environment. However, the ability to adapt to unknown and fluctuating environments is not straightforward. Here, we explore the adaptive potential of simulated swarm robots that contain a genomic encoding of a bio-inspired gene regulatory network (GRN. An artificial genome is combined with a flexible agent-based system, representing the activated part of the regulatory network that transduces environmental cues into phenotypic behaviour. Using an artificial life simulation framework that mimics a dynamically changing environment, we show that separating the static from the conditionally active part of the network contributes to a better adaptive behaviour. Furthermore, in contrast with most hitherto developed ANN-based systems that need to re-optimize their complete controller network from scratch each time they are subjected to novel conditions, our system uses its genome to store GRNs whose performance was optimized under a particular environmental condition for a sufficiently long time. When subjected to a new environment, the previous condition-specific GRN might become inactivated, but remains present. This ability to store 'good behaviour' and to disconnect it from the novel rewiring that is essential under a new condition allows faster re-adaptation if any of the previously observed environmental conditions is reencountered. As we show here, applying these evolutionary-based principles leads to accelerated and improved adaptive evolution in a non-stable environment.

  19. Improving the Adaptability of Simulated Evolutionary Swarm Robots in Dynamically Changing Environments (United States)

    Yao, Yao; Marchal, Kathleen; Van de Peer, Yves


    One of the important challenges in the field of evolutionary robotics is the development of systems that can adapt to a changing environment. However, the ability to adapt to unknown and fluctuating environments is not straightforward. Here, we explore the adaptive potential of simulated swarm robots that contain a genomic encoding of a bio-inspired gene regulatory network (GRN). An artificial genome is combined with a flexible agent-based system, representing the activated part of the regulatory network that transduces environmental cues into phenotypic behaviour. Using an artificial life simulation framework that mimics a dynamically changing environment, we show that separating the static from the conditionally active part of the network contributes to a better adaptive behaviour. Furthermore, in contrast with most hitherto developed ANN-based systems that need to re-optimize their complete controller network from scratch each time they are subjected to novel conditions, our system uses its genome to store GRNs whose performance was optimized under a particular environmental condition for a sufficiently long time. When subjected to a new environment, the previous condition-specific GRN might become inactivated, but remains present. This ability to store ‘good behaviour’ and to disconnect it from the novel rewiring that is essential under a new condition allows faster re-adaptation if any of the previously observed environmental conditions is reencountered. As we show here, applying these evolutionary-based principles leads to accelerated and improved adaptive evolution in a non-stable environment. PMID:24599485

  20. Transpiration of shrub species, Alnus firma under changing atmospheric environments in montane area, Japan (United States)

    Miyazawa, Y.; Maruyama, A.; Inoue, A.


    In the large caldera of Mt. Aso in Japan, grasslands have been traditionally managed by the farmers. Due to changes in the social structure of the region, a large area of the grassland has been abandoned and was invaded by the shrubs with different hydrological and ecophysiological traits. Ecophysiological traits and their responses to seasonally changing environments are fundamental to project the transpiration rates under changing air and soil water environments, but less is understood. We measured the tree- and leaf-level ecophysiological traits of a shrub, Alnus firma in montane region where both rainfall and soil water content drastically changes seasonally. Sap flux reached the annual peak in evaporative summer (July-August) both in 2013 and 2014, although the duration was limited within a short period due to the prolonged rainy season before summer (2014) and rapid decrease in the air vapor pressure deficit (D) in late summer. Leaf ecophysiological traits in close relationship with gas exchange showed modest seasonal changes and the values were kept at relatively high levels typical in plants with nitrogen fixation under nutrient-poor environments. Stomatal conductance, which was measured at leaf-level measurements and sap flux measurements, showed responses to D, which coincided with the theoretical response for isohydric leaves. A multilayer model, which estimates stand-level transpiration by scaling up the leaf-level data, successfully captured the temporal trends in sap flux, suggesting that major processes were incorporated. Thus, ecophysiological traits of A. firma were characterized by the absence of responses to seasonally changing environments and the transpiration rate was the function of the interannually variable environmental conditions.

  1. A Data Stream Model For Runoff Simulation In A Changing Environment (United States)

    Yang, Q.; Shao, J.; Zhang, H.; Wang, G.


    Runoff simulation is of great significance for water engineering design, water disaster control, water resources planning and management in a catchment or region. A large number of methods including concept-based process-driven models and statistic-based data-driven models, have been proposed and widely used in worldwide during past decades. Most existing models assume that the relationship among runoff and its impacting factors is stationary. However, in the changing environment (e.g., climate change, human disturbance), their relationship usually evolves over time. In this study, we propose a data stream model for runoff simulation in a changing environment. Specifically, the proposed model works in three steps: learning a rule set, expansion of a rule, and simulation. The first step is to initialize a rule set. When a new observation arrives, the model will check which rule covers it and then use the rule for simulation. Meanwhile, Page-Hinckley (PH) change detection test is used to monitor the online simulation error of each rule. If a change is detected, the corresponding rule is removed from the rule set. In the second step, for each rule, if it covers more than a given number of instance, the rule is expected to expand. In the third step, a simulation model of each leaf node is learnt with a perceptron without activation function, and is updated with adding a newly incoming observation. Taking Fuxi River catchment as a case study, we applied the model to simulate the monthly runoff in the catchment. Results show that abrupt change is detected in the year of 1997 by using the Page-Hinckley change detection test method, which is consistent with the historic record of flooding. In addition, the model achieves good simulation results with the RMSE of 13.326, and outperforms many established methods. The findings demonstrated that the proposed data stream model provides a promising way to simulate runoff in a changing environment.

  2. Autonomous Collision-Free Navigation of Microvehicles in Complex and Dynamically Changing Environments. (United States)

    Li, Tianlong; Chang, Xiaocong; Wu, Zhiguang; Li, Jinxing; Shao, Guangbin; Deng, Xinghong; Qiu, Jianbin; Guo, Bin; Zhang, Guangyu; He, Qiang; Li, Longqiu; Wang, Joseph


    Self-propelled micro- and nanoscale robots represent a rapidly emerging and fascinating robotics research area. However, designing autonomous and adaptive control systems for operating micro/nanorobotics in complex and dynamically changing environments, which is a highly demanding feature, is still an unmet challenge. Here we describe a smart microvehicle for precise autonomous navigation in complicated environments and traffic scenarios. The fully autonomous navigation system of the smart microvehicle is composed of a microscope-coupled CCD camera, an artificial intelligence planner, and a magnetic field generator. The microscope-coupled CCD camera provides real-time localization of the chemically powered Janus microsphere vehicle and environmental detection for path planning to generate optimal collision-free routes, while the moving direction of the microrobot toward a reference position is determined by the external electromagnetic torque. Real-time object detection offers adaptive path planning in response to dynamically changing environments. We demonstrate that the autonomous navigation system can guide the vehicle movement in complex patterns, in the presence of dynamically changing obstacles, and in complex biological environments. Such a navigation system for micro/nanoscale vehicles, relying on vision-based close-loop control and path planning, is highly promising for their autonomous operation in complex dynamic settings and unpredictable scenarios expected in a variety of realistic nanoscale scenarios.

  3. Climate Change Potential Impacts on the Built Environment and Possible Adaptation Strategies (United States)

    Quattrochi, Dale A.


    The built environment consists of components that exist at a range of scales from small (e.g., houses, shopping malls) to large (e.g., transportation networks) to highly modified landscapes such as cities. Thus, the impacts of climate change on the built environment may have a multitude of effects on humans and the land. The impact of climate change may be exacerbated by the interaction of different events that singly may be minor, but together may have a synergistic set of impacts that are significant. Also, mechanisms may exist wherein the built environment, particularly in the form of cities, may affect weather and the climate on local and regional scales. Hence, a city may be able to cope with prolonged heat waves, but if this is combined with severe drought, the overall result could be significant or even catastrophic, as accelerating demand for energy to cooling taxes water supplies needed both for energy supply and municipal water needs. This presentation surveys potential climate change impacts on the built environment from the perspective of the National Climate Assessment, and explores adaptation measures that can be employed to mitigate these impacts.

  4. Food Environment and Weight Change: Does Residential Mobility Matter?: The Diabetes Study of Northern California (DISTANCE). (United States)

    Laraia, Barbara A; Downing, Janelle M; Zhang, Y Tara; Dow, William H; Kelly, Maggi; Blanchard, Samuel D; Adler, Nancy; Schillinger, Dean; Moffet, Howard; Warton, E Margaret; Karter, Andrew J


    Associations between neighborhood food environment and adult body mass index (BMI; weight (kg)/height (m)2) derived using cross-sectional or longitudinal random-effects models may be biased due to unmeasured confounding and measurement and methodological limitations. In this study, we assessed the within-individual association between change in food environment from 2006 to 2011 and change in BMI among adults with type 2 diabetes using clinical data from the Kaiser Permanente Diabetes Registry collected from 2007 to 2011. Healthy food environment was measured using the kernel density of healthful food venues. Fixed-effects models with a 1-year-lagged BMI were estimated. Separate models were fitted for persons who moved and those who did not. Sensitivity analysis using different lag times and kernel density bandwidths were tested to establish the consistency of findings. On average, patients lost 1 pound (0.45 kg) for each standard-deviation improvement in their food environment. This relationship held for persons who remained in the same location throughout the 5-year study period but not among persons who moved. Proximity to food venues that promote nutritious foods alone may not translate into clinically meaningful diet-related health changes. Community-level policies for improving the food environment need multifaceted strategies to invoke clinically meaningful change in BMI among adult patients with diabetes. © The Author 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail:

  5. Climate Change and Regulation in International and Regional Level, Especially the Built Environment

    Directory of Open Access Journals (Sweden)

    Putnoki Zsuzsanna


    Full Text Available The article starts with a brief insight into the history of climate change, with a scope on the international and legal aspects of ever-changing regulations. The regional level is in the article is The European Union, as the only regional economic integration organization under the Kyoto Protocol. It deals with the United Nation’s international agreements like UNFCCC its Kyoto’s Protocol and the Post-Kyoto era. It also analyses the EU’s system in the climate change law with correspondence the international rules. Comparison between international and regional legislation in the climate change is used as a tool of analysis. Finally an insight is given into a special field in the climate change, the build environment, reflecting on the related United Nation’s recommendation and the EU’s regulation.

  6. Complexity science and leadership in healthcare. (United States)

    Burns, J P


    The emerging field of complexity science offers an alternative leadership strategy for the chaotic, complex healthcare environment. A survey revealed that healthcare leaders intuitively support principles of complexity science. Leadership that uses complexity principles offers opportunities in the chaotic healthcare environment to focus less on prediction and control and more on fostering relationships and creating conditions in which complex adaptive systems can evolve to produce creative outcomes.

  7. Feature Optimization for Long-Range Visual Homing in Changing Environments

    Directory of Open Access Journals (Sweden)

    Qidan Zhu


    Full Text Available This paper introduces a feature optimization method for robot long-range feature-based visual homing in changing environments. To cope with the changing environmental appearance, the optimization procedure is introduced to distinguish the most relevant features for feature-based visual homing, including the spatial distribution, selection and updating. In the previous research on feature-based visual homing, less effort has been spent on the way to improve the feature distribution to get uniformly distributed features, which are closely related to homing performance. This paper presents a modified feature extraction algorithm to decrease the influence of anisotropic feature distribution. In addition, the feature selection and updating mechanisms, which have hardly drawn any attention in the domain of feature-based visual homing, are crucial in improving homing accuracy and in maintaining the representation of changing environments. To verify the feasibility of the proposal, several comprehensive evaluations are conducted. The results indicate that the feature optimization method can find optimal feature sets for feature-based visual homing, and adapt the appearance representation to the changing environments as well.

  8. The influence of recent climate change on tree height growth differs with species and spatial environment. (United States)

    Messaoud, Yassine; Chen, Han Y H


    Tree growth has been reported to increase in response to recent global climate change in controlled and semi-controlled experiments, but few studies have reported response of tree growth to increased temperature and atmospheric carbon dioxide (CO₂) concentration in natural environments. This study addresses how recent global climate change has affected height growth of trembling aspen (Populus tremuloides Michx) and black spruce (Picea mariana Mill B.S.) in their natural environments. We sampled 145 stands dominated by aspen and 82 dominated by spruce over the entire range of their distributions in British Columbia, Canada. These stands were established naturally after fire between the 19th and 20th centuries. Height growth was quantified as total heights of sampled dominant and co-dominant trees at breast-height age of 50 years. We assessed the relationships between 50-year height growth and environmental factors at both spatial and temporal scales. We also tested whether the tree growth associated with global climate change differed with spatial environment (latitude, longitude and elevation). As expected, height growth of both species was positively related to temperature variables at the regional scale and with soil moisture and nutrient availability at the local scale. While height growth of trembling aspen was not significantly related to any of the temporal variables we examined, that of black spruce increased significantly with stand establishment date, the anomaly of the average maximum summer temperature between May-August, and atmospheric CO₂ concentration, but not with the Palmer Drought Severity Index. Furthermore, the increase of spruce height growth associated with recent climate change was higher in the western than in eastern part of British Columbia. This study demonstrates that the response of height growth to recent climate change, i.e., increasing temperature and atmospheric CO₂ concentration, did not only differ with tree species, but

  9. Changes to the school food and physical activity environment after guideline implementation in British Columbia, Canada (United States)


    Background High rates of childhood obesity have generated interest among policy makers to improve the school food environment and increase students’ levels of physical activity. The purpose of this study was to examine school-level changes associated with implementation of the Food and Beverage Sales in Schools (FBSS) and Daily Physical Activity (DPA) guidelines in British Columbia, Canada. Methods Elementary and middle/high school principals completed a survey on the school food and physical activity environment in 2007–08 (N = 513) and 2011–12 (N = 490). Hierarchical mixed effects regression was used to examine changes in: 1) availability of food and beverages; 2) minutes per day of Physical Education (PE); 3) delivery method of PE; and 4) school community support. Models controlled for school enrollment and community type, education and income. Results After policy implementation was expected, more elementary schools provided access to fruits and vegetables and less to 100% fruit juice. Fewer middle/high schools provided access to sugar-sweetened beverages, French fries, baked goods, salty snacks and chocolate/candy. Schools were more likely to meet 150 min/week of PE for grade 6 students, and offer more minutes of PE per week for grade 8 and 10 students including changes to PE delivery method. School community support for nutrition and physical activity policies increased over time. Conclusion Positive changes to the school food environment occurred after schools were expected to implement the FBSS and DPA guidelines. Reported changes to the school environment are encouraging and provide support for guidelines and policies that focus on increasing healthy eating and physical activity in schools. PMID:24731514

  10. Strategic Environmental Assessment Framework for Landscape-Based, Temporal Analysis of Wetland Change in Urban Environments. (United States)

    Sizo, Anton; Noble, Bram F; Bell, Scott


    This paper presents and demonstrates a spatial framework for the application of strategic environmental assessment (SEA) in the context of change analysis for urban wetland environments. The proposed framework is focused on two key stages of the SEA process: scoping and environmental baseline assessment. These stages are arguably the most information-intense phases of SEA and have a significant effect on the quality of the SEA results. The study aims to meet the needs for proactive frameworks to assess and protect wetland habitat and services more efficiently, toward the goal of advancing more intelligent urban planning and development design. The proposed framework, adopting geographic information system and remote sensing tools and applications, supports the temporal evaluation of wetland change and sustainability assessment based on landscape indicator analysis. The framework was applied to a rapidly developing urban environment in the City of Saskatoon, Saskatchewan, Canada, analyzing wetland change and land-use pressures from 1985 to 2011. The SEA spatial scale was rescaled from administrative urban planning units to an ecologically meaningful area. Landscape change assessed was based on a suite of indicators that were subsequently rolled up into a single, multi-dimensional, and easy to understand and communicate index to examine the implications of land-use change for wetland sustainability. The results show that despite the recent extremely wet period in the Canadian prairie region, land-use change contributed to increasing threats to wetland sustainability.

  11. Get Active Orlando: changing the built environment to increase physical activity. (United States)

    McCreedy, Malisa; Leslie, Jill G


    Active Living by Design's Get Active Orlando partnership (GAO) focused on downtown Orlando's Community Redevelopment Area, including the Parramore Heritage District, home to many low-income and ethnically diverse residents, including many seniors. The area had undergone substantial development, and GAO aimed to incorporate active living considerations into the city's changing landscape. Get Active Orlando conducted a baseline survey of all streets, sidewalks, and bicycle lanes in the project area and identified a sequence of plans and policies in which to incorporate changes identified in the assessment. To create more immediate opportunities for active living, the partnership initiated a senior walking program, a bicycle refurbishment and giveaway program, and community bicycle-riding events, and led a social-marketing campaign that emphasized simple lifestyle changes. Get Active Orlando influenced adoption of public policies supporting active living in Orlando, including the Downtown Transportation Plan, Streetscape Guidelines, Design Standards Review Checklist, and growth management policies. Establishment of the Mayor's Advisory Council on Active Living is testament to the heightened significance of active living in Orlando. Initial assessment data served as a strong platform for policy change. Creating connections across disciplines including land-use planning, transportation, public health, and economic development allowed GAO to secure substantial policy change to influence design of the built environment. Engaging community members, including youth, as leaders was an important factor in program success. The physical environment in Orlando's Community Redevelopment Area is beginning to change as a reflection of a new policy framework designed to support active living.

  12. Building a Healthcare System's Innovation Program. (United States)

    Conger, Michelle D


    OSF HealthCare, based in Peoria, Illinois, has developed an innovative strategy to adapt to the changes and forces disrupting the healthcare environment. This strategy evolved organically from the performance improvement efforts we began more than 15 years ago, as well as from the lessons we learned from years of research into the innovative practices and platforms of other healthcare institutions and of companies in other industries. More important, the strategy reflects our mission "to serve persons with the greatest care and love."The OSF innovation model has three components: internal innovations, partnering with external entities, and validating innovations through simulation. OSF has an ongoing and comprehensive commitment to innovation. Examples include our initiative to transform our model of care in primary care clinics by expanding access, reducing costs, and increasing efficiency; our partnerships with outside entities to find revolutionary solutions and products in which we can invest; and our establishment of a world-class simulation and education center.OSF HealthCare could not do any of this if it lacked the support of its people. To that end, we continue to work on embedding a culture of innovation across all of our facilities. Ours is a culture in which everyone is encouraged to voice creative ideas and no one is afraid to fail-all for the betterment of our organization and the patients we serve.

  13. UV-C decontamination of hand-held tablet devices in the healthcare environment using the Codonics D6000™ disinfection system. (United States)

    Muzslay, M; Yui, S; Ali, S; Wilson, A P R


    Mobile phones and tablet computers may be contaminated with microorganisms and become a potential reservoir for cross-transmission of pathogens between healthcare workers and patients. There is no generally accepted guidance how to reduce contamination on mobile devices in healthcare settings. Our aim was to determine the efficacy of the Codonics D6000™ UV-C disinfection device. Daily disinfection reduced contamination on screens and on protective cases (test) significantly, but not all cases (control) could be decontaminated. The median aerobic colony count on the control and the test cases was 52 (IQR 33-89) cfu/25cm 2 and 22 (IQR 10.5-41) cfu/25cm 2 respectively before disinfection. Copyright © 2018. Published by Elsevier Ltd.

  14. The change in body stressed to relaxed body through breathing, visualization and a protective environment together

    Directory of Open Access Journals (Sweden)

    Evelyn I. Rodríguez Morrill


    Full Text Available This work shows several ways to meet and relax the body through personal knowledge and techniques encounter with nature. Modern life and fast, the constant pressure from childhood to adulthood, in the modes of interaction between individuals and groups, they lead to construction of bodies that reflect emotional anatomy visible loss of balance, contractures, inflammation, multiple imbalances by lack of knowledge and awareness especially being in the world fully, the person has moved away from its ecological relationship with itself and the environment. Methods are shown to positively change a condition of constant stress and chronic discomfort, a learned condition of physical and psychological wellbeing, with a series of movements, recovering the body through exercise, to tend to personal balance, obtaining a positive relationship with the environment and the people attended. The proposal starts promoting new habits that can be saved in consciousness. Partly, mainly of breath, alignment with the music and the environment and personal and group work

  15. Impact of climate change on the domestic indoor environment and associated health risks in the UK. (United States)

    Vardoulakis, Sotiris; Dimitroulopoulou, Chrysanthi; Thornes, John; Lai, Ka-Man; Taylor, Jonathon; Myers, Isabella; Heaviside, Clare; Mavrogianni, Anna; Shrubsole, Clive; Chalabi, Zaid; Davies, Michael; Wilkinson, Paul


    There is growing evidence that projected climate change has the potential to significantly affect public health. In the UK, much of this impact is likely to arise by amplifying existing risks related to heat exposure, flooding, and chemical and biological contamination in buildings. Identifying the health effects of climate change on the indoor environment, and risks and opportunities related to climate change adaptation and mitigation, can help protect public health. We explored a range of health risks in the domestic indoor environment related to climate change, as well as the potential health benefits and unintended harmful effects of climate change mitigation and adaptation policies in the UK housing sector. We reviewed relevant scientific literature, focusing on housing-related health effects in the UK likely to arise through either direct or indirect mechanisms of climate change or mitigation and adaptation measures in the built environment. We considered the following categories of effect: (i) indoor temperatures, (ii) indoor air quality, (iii) indoor allergens and infections, and (iv) flood damage and water contamination. Climate change may exacerbate health risks and inequalities across these categories and in a variety of ways, if adequate adaptation measures are not taken. Certain changes to the indoor environment can affect indoor air quality or promote the growth and propagation of pathogenic organisms. Measures aimed at reducing greenhouse gas emissions have the potential for ancillary public health benefits including reductions in health burdens related heat and cold, indoor exposure to air pollution derived from outdoor sources, and mould growth. However, increasing airtightness of dwellings in pursuit of energy efficiency could also have negative effects by increasing concentrations of pollutants (such as PM2.5, CO and radon) derived from indoor or ground sources, and biological contamination. These effects can largely be ameliorated by mechanical

  16. Climate change: Its possible impact on the environment and the people of northern regions

    International Nuclear Information System (INIS)

    Roots, F.


    A detailed overview is presented of the possible impacts of climate change on the Arctic environment, ecosystems, and human activities. The extent of global climate change is examined through the use of historical and paleoclimatologic records of temperature and stratospheric ozone. The effects of precipitation distribution and airborne particulates on climate change are also outlined. Changes in the Arctic are then examined, with an explanation of why global change in the Arctic is likely to be exaggerated. Likely scenarios of Arctic climate change involve milder winter temperatures, wetter and cloudier summers, more stormy weather and snowfall, greater variability in regional weather patterns, and dramatic changes in the extent of sea ice. Biological responses of wetland, northern forest, tundra, Arctic desert, below-ground, and marine ecosystems are assessed. Features of northern and Arctic ecosystems that may be particularly vulnerable to climate change are noted. Finally, the impacts of climate change on traditional activities and lifestyles, resource management and harvesting, agriculture, forestry, mining and fossil-fuel development, offshore operations, and human infrastructures are summarized. 5 figs

  17. A new workforce in the making? A case study of strategic human resource management in a whole-system change effort in healthcare. (United States)

    Macfarlane, Fraser; Greenhalgh, Trish; Humphrey, Charlotte; Hughes, Jane; Butler, Ceri; Pawson, Ray


    This paper seeks to describe the exploration of human resource issues in one large-scale program of innovation in healthcare. It is informed by established theories of management in the workplace and a multi-level model of diffusion of innovations. A realist approach was used based on interviews, ethnographic observation and documentary analysis. Five main approaches ("theories of change") were adopted to develop and support the workforce: recruiting staff with skills in service transformation; redesigning roles and creating new roles; enhancing workforce planning; linking staff development to service needs; creating opportunities for shared learning and knowledge exchange. Each had differing levels of success. The paper includes HR implications for the modernisation of a complex service organisation. This is the first time a realist evaluation of a complex health modernisation initiative has been undertaken.

  18. Exploring technology impacts of Healthcare 2.0 initiatives. (United States)

    Randeree, Ebrahim


    As Internet access proliferates and technology becomes more accessible, the number of people online has been increasing. Web 2.0 and the social computing phenomena (such as Facebook, Friendster, Flickr, YouTube, Blogger, and MySpace) are creating a new reality on the Web: Users are changing from consumers of Web-available information and resources to generators of information and content. Moving beyond telehealth and Web sites, the push toward Personal Health Records has emerged as a new option for patients to take control of their medical data and to become active participants in the push toward widespread digitized healthcare. There is minimal research on the impact of Web 2.0 in healthcare. This paper reviews the changing patient-physician relationship in the Healthcare 2.0 environment, explores the technological challenges, and highlights areas for research.

  19. Plio-Pleistocene climate change and geographic heterogeneity in plant diversity-environment relationships

    DEFF Research Database (Denmark)

    Svenning, J.-C.; Normand, Signe; Skov, Flemming


    Plio-Pleistocene climate change may have induced geographic heterogeneity in plant species richness-environment relationships in Europe due to greater in situ species survival and speciation rates in southern Europe. We formulate distinct hypotheses on how Plio-Pleistocene climate change may have...... affected richness-topographic heterogeneity and richness-water-energy availability relationships, causing steeper relationships in southern Europe. We investigated these hypotheses using data from Atlas Florae Europaeae on the distribution of 3069 species and geographically weighted regression (GWR). Our...... analyses showed that plant species richness generally increased with topographic heterogeneity (ln-transformed altitudinal range) and actual evapotranspiration (AET). We also found evidence for strong geographic heterogeneity in the species richness-environment relationship, with a greater increase...

  20. Chaos and the (un)predictability of evolution in a changing environment. (United States)

    Rego-Costa, Artur; Débarre, Florence; Chevin, Luis-Miguel


    Among the factors that may reduce the predictability of evolution, chaos, characterized by a strong dependence on initial conditions, has received much less attention than randomness due to genetic drift or environmental stochasticity. It was recently shown that chaos in phenotypic evolution arises commonly under frequency-dependent selection caused by competitive interactions mediated by many traits. This result has been used to argue that chaos should often make evolutionary dynamics unpredictable. However, populations also evolve largely in response to external changing environments, and such environmental forcing is likely to influence the outcome of evolution in systems prone to chaos. We investigate how a changing environment causing oscillations of an optimal phenotype interacts with the internal dynamics of an eco-evolutionary system that would be chaotic in a constant environment. We show that strong environmental forcing can improve the predictability of evolution by reducing the probability of chaos arising, and by dampening the magnitude of chaotic oscillations. In contrast, weak forcing can increase the probability of chaos, but it also causes evolutionary trajectories to track the environment more closely. Overall, our results indicate that, although chaos may occur in evolution, it does not necessarily undermine its predictability. © 2017 The Author(s). Evolution © 2017 The Society for the Study of Evolution.

  1. Facilitation among plants in alpine environments in the face of climate change

    Directory of Open Access Journals (Sweden)

    Fabien eAnthelme


    Full Text Available While there is a large consensus that plant–plant interactions are a crucial component of the response of plant communities to the effects of climate change, available data remain scarce, particularly in alpine systems. This represents an important obstacle to making consistent predictions about the future of plant communities. Here, we review current knowledge on the effects of climate change on facilitation among alpine plant communities and propose directions for future research. In established alpine communities, while warming seemingly generates a net facilitation release, earlier snowmelt may increase facilitation. Some nurse plants are able to buffer microenvironmental changes in the long term and may ensure the persistence of other alpine plants through local migration events. For communities migrating to higher elevations, facilitation should play an important role in their reorganization because of the harsher environmental conditions. In particular, the absence of efficient nurse plants might slow down upward migration, possibly generating chains of extinction. Facilitation–climate change relationships are expected to shift along latitudinal gradients because (1 the magnitude of warming is predicted to vary along these gradients, and (2 alpine environments are significantly different at low vs. high latitudes. Data on these expected patterns are preliminary and thus need to be tested with further studies on facilitation among plants in alpine environments that have thus far not been considered. From a methodological standpoint, future studies will benefit from the spatial representation of the microclimatic environment of plants to predict their response to climate change. Moreover, the acquisition of long-term data on the dynamics of plant–plant interactions, either through permanent plots or chronosequences of glacial recession, may represent powerful approaches to clarify the relationship between plant interactions and

  2. Facilitation among plants in alpine environments in the face of climate change. (United States)

    Anthelme, Fabien; Cavieres, Lohengrin A; Dangles, Olivier


    While there is a large consensus that plant-plant interactions are a crucial component of the response of plant communities to the effects of climate change, available data remain scarce, particularly in alpine systems. This represents an important obstacle to making consistent predictions about the future of plant communities. Here, we review current knowledge on the effects of climate change on facilitation among alpine plant communities and propose directions for future research. In established alpine communities, while warming seemingly generates a net facilitation release, earlier snowmelt may increase facilitation. Some nurse plants are able to buffer microenvironmental changes in the long term and may ensure the persistence of other alpine plants through local migration events. For communities migrating to higher elevations, facilitation should play an important role in their reorganization because of the harsher environmental conditions. In particular, the absence of efficient nurse plants might slow down upward migration, possibly generating chains of extinction. Facilitation-climate change relationships are expected to shift along latitudinal gradients because (1) the magnitude of warming is predicted to vary along these gradients, and (2) alpine environments are significantly different at low vs. high latitudes. Data on these expected patterns are preliminary and thus need to be tested with further studies on facilitation among plants in alpine environments that have thus far not been considered. From a methodological standpoint, future studies will benefit from the spatial representation of the microclimatic environment of plants to predict their response to climate change. Moreover, the acquisition of long-term data on the dynamics of plant-plant interactions, either through permanent plots or chronosequences of glacial recession, may represent powerful approaches to clarify the relationship between plant interactions and climate change.

  3. Improving healthcare using Lean processes. (United States)

    Baker, G Ross


    For more than a decade, healthcare organizations across Canada have been using Lean management tools to improve care processes, reduce preventable adverse events, increase patient satisfaction and create better work environments. The largest system-wide effort in Canada, and perhaps anywhere, is currently under way in Saskatchewan. The jury is still out on whether Lean efforts in that province, or elsewhere in Canada, are robust enough to transform current delivery systems and sustain new levels of performance. This issue of Healthcare Quarterly features several articles that provide a perspective on Lean methods in healthcare. Copyright © 2014 Longwoods Publishing.

  4. Healthcare liquid waste management. (United States)

    Sharma, D R; Pradhan, B; Pathak, R P; Shrestha, S C


    The management of healthcare liquid waste is an overlooked problem in Nepal with stern repercussions in terms of damaging the environment and affecting the health of people. This study was carried out to explore the healthcare liquid waste management practices in Kathmandu based central hospitals of Nepal. A descriptive prospective study was conducted in 10 central hospitals of Kathmandu during the period of May to December 2008. Primary data were collected through interview, observation and microbiology laboratory works and secondary data were collected by records review. For microbiological laboratory works,waste water specimens cultured for the enumeration of total viable counts using standard protocols. Evidence of waste management guidelines and committees for the management of healthcare liquid wastes could not be found in any of the studied hospitals. Similarly, total viable counts heavily exceeded the standard heterotrophic plate count (p=0.000) with no significant difference in such counts in hospitals with and without treatment plants (p=0.232). Healthcare liquid waste management practice was not found to be satisfactory. Installation of effluent treatment plants and the development of standards for environmental indicators with effective monitoring, evaluation and strict control via relevant legal frameworks were realized.

  5. Education on human rights and healthcare: evidence from Serbia. (United States)

    Vranes, Aleksandra Jovic; Mikanovic, Vesna Bjegovic; Vukovic, Dejana; Djikanovic, Bosiljka; Babic, Momcilo


    Ensuring and enforcing human rights in patient care are important to promote health and to provide quality and appropriate healthcare services. Therefore, continued medical education (CME) is essential for healthcare professionals to utilize their sphere of influence to affect change in healthcare practice. A total of 123 participants attended three CME courses. Course topics covered: (i) the areas of human rights and healthcare, (ii) rights, obligations and responsibilities of healthcare professionals in relation to human rights and the rights of patients, (iii) healthcare of vulnerable groups and (iv) access to essential medical services. Evaluation of the CME courses involved two components: evaluation of participants' performance and the participants' evaluation of the teaching process. The participants were assessed at the beginning and end of each course. Each of the courses was evaluated by the participants through a questionnaire distributed at the end of each course. Descriptive statistics was used for data interpretation. Knowledge of the healthcare professionals improved at the end of all the three courses. The participants assessed several aspects of the courses, including the course topics, educational methods, the course methods, organization, duration and dynamics as well as the physical environment and the technical facilities of the course, and rated each very highly. Our results corroborate the importance and necessity of courses to heighten awareness of the state of current healthcare and human rights issues to increase the involvement of healthcare professionals both locally and globally. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email:

  6. People-centric sensing in assistive healthcare

    DEFF Research Database (Denmark)

    Giannetsos, Thanassis; Dimitriou, Tassos; Prasad, Neeli R.


    , we discuss the latest advances in security and privacy protection strategies that hold promise in this new exciting paradigm. We hope this work will better highlight the need for privacy in people-centric sensing applications and spawn further research in this area. Copyright © 2011 John Wiley & Sons......As the domains of pervasive computing and sensor networking are expanding, there is an ongoing trend towards assistive living and healthcare support environments that can effectively assimilate these technologies according to human needs. Most of the existing research in assistive healthcare...... follows a more passive approach and has focused on collecting and processing data using a static-topology and an application-aware infrastructure. However, with the technological advances in sensing, computation, storage, and communications, a new era is about to emerge changing the traditional view...

  7. Changes of radiological situation of Polish environment in 10 years period after Chernobyl accident

    International Nuclear Information System (INIS)

    Jagielak, J.; Biernacka, M.; Grabowski, D.; Henschke, J.


    The content of natural and artificial radioisotopes in environment in Poland before and after Chernobyl accident was analyzed. The methods used in radiation monitoring in Poland and results of these measurements in the period 1986-1996 were presented. Since the Chernobyl accident changes of contamination of soils, southern Baltic sea water, other surface waters, deposits in Baltic sea, rivers and lakes in Poland were observed. Also concentration of radioisotopes in foodstuffs: mushrooms, fruits, meat, milk, eggs was described

  8. Changes to the school food and physical activity environment after guideline implementation in British Columbia, Canada


    Watts, Allison W; Mâsse, Louise C; Naylor, Patti-Jean


    Background High rates of childhood obesity have generated interest among policy makers to improve the school food environment and increase students’ levels of physical activity. The purpose of this study was to examine school-level changes associated with implementation of the Food and Beverage Sales in Schools (FBSS) and Daily Physical Activity (DPA) guidelines in British Columbia, Canada. Methods Elementary and middle/high school principals completed a survey on the school food and physical...

  9. Thermal changes of the environment and their influence on reinforced concrete structures (United States)

    Fojtik, R.; Cajka, R.


    The thermal expansion of concrete elements concerns both monolithic and prefabricated structures. Inappropriate design of dilation segments may cause minor but even larger failures. Critical environment factors are temperature-changing operations, such as unheated underground garages, where temperature fluctuations may occur depending on the exterior conditions. This paper numerically and experimentally analyses the thermal deformation of selected girders in the underground garages and the consequent structure failures, their causes, possible prevention and appropriate remediation.

  10. The development and change study of cost accounting in the IT environment

    Institute of Scientific and Technical Information of China (English)

    Zilian Li; Qiumei Hu


    Relative to costs of computerized accounting, the cost accounting information further to get rid of the shackles of artificial accounting, reflecting a pure information management thinking, which contains a richer content, and traditional cost accounting theory a profound impact on the system. Clear understanding of the environment in the IT development process cost accounting will help us actively to promote cost accounting change, innovation and development.

  11. Climate change damage functions in LCA – (1) from global warming potential to natural environment damages

    DEFF Research Database (Denmark)

    Callesen, Ingeborg; Hauschild, Michael Zwicky; Bagger Jørgensen, Rikke

    Energy use often is the most significant contributor to the impact category ‘global warming’ in life cycle impact assessment. However, the potential global warming effects on the climate at regional level and consequential effects on the natural environment are not thoroughly described within LCA...... methodology. The current scientific understanding of the extent of climate change impacts is limited due to the immense complexity of the multi-factorial environmental changes and unknown adaptive capacities at process, species and ecosystem level. In the presentation we argue that the global warming impacts...

  12. Porter's generic strategies, discontinuous environments, and performance: a longitudinal study of changing strategies in the hospital industry. (United States)

    Lamont, B T; Marlin, D; Hoffman, J J


    Changes in generic strategies in response to discontinuous environments have been relatively ignored in the management literature. This study reports an examination of the relationships between Porter's (1980) generic strategies, discontinuous environments, and performance. Archival data for 1984 and 1988 were collected for 172 acute care hospitals in Florida in order to test these relationships. To examine fully the performance impact of changes in strategy in a discontinuous environment, a longitudinal research design that identified a firm's strategy at two points in time, 1984 and 1988, was used. Results indicate that firms with a proper strategy environment fit performed the highest, firms that did not change their strategy had no change in performance, and firms that changed their strategy toward a proper strategy environment showed an increase in performance. Findings support the notion that hospitals with appropriate strategy-environment combinations will exhibit higher performance.

  13. A Governing Framework for Climate Change Adaptation in the Built Environment

    Directory of Open Access Journals (Sweden)

    Daniel A. Mazmanian


    Full Text Available Developing an approach to governing adaptation to climate change is severely hampered by the dictatorship of the present when the needs of future generations are inadequately represented in current policy making. We posit this problem as a function of the attributes of adaptation policy making, including deep uncertainty and nonstationarity, where past observations are not reliable predictors of future outcomes. Our research links organizational decision-making attributes with adaptation decision making and identifies cases in which adaptation actions cause spillovers, free riding, and distributional impacts. We develop a governing framework for adaptation that we believe will enable policy, planning, and major long-term development decisions to be made appropriately at all levels of government in the face of the deep uncertainty and nonstationarity caused by climate change. Our framework requires that approval of projects with an expected life span of 30 years or more in the built environment include minimum building standards that integrate forecasted climate change impacts from the Intergovernmental Panel on Climate Change (IPCC intermediate scenario. The intermediate IPCC scenario must be downscaled to include local or regional temperature, water availability, sea level rise, susceptibility to forest fires, and human habitation impacts to minimize climate-change risks to the built environment. The minimum standard is systematically updated every six years to facilitate learning by formal and informal organizations. As a minimum standard, the governance framework allows jurisdictions to take stronger actions to increase their climate resilience and thus maintain system flexibility.

  14. VECTORS of change in the marine environment: Ecosystem and economic impacts and management implications (United States)

    Austen, M. C.; Crowe, T. P.; Elliott, M.; Paterson, D. M.; Peck, M. A.; Piraino, S.


    Human use of the European marine environment is increasing and diversifying. This is creating new mechanisms for human induced-changes in marine life which need to be understood and quantified as well as the impact of these changes on ecosystems, their structures (e.g. biodiversity) and functioning (e.g. productivity), and the social and economic consequences that arise. The current and emerging pressures are multiple and interacting, arising, for example, from transport, platforms for renewable and non-renewable energy, exploitation of living and non-living resources, agricultural and industrial discharges, together with wider environmental changes (including climate change). Anticipating the future consequences of these pressures and vectors of change for marine life and of adaptation and mitigation measures (such as the introduction of new technologies and structures, new ballast water practices, ocean and offshore wind energy devices and new fishing strategies) is a prerequisite to the development and implementation of strategies, policies and regulations to manage the marine environment, such as the IMO Convention on ballast water management and the EU Maritime Policy and Marine Strategy Framework Directive.

  15. 3. Neural changes in different gravity and ecophysiological environments - A survey (United States)

    Slenzka, K.

    Neural changes or neuronal plasticity occur after and during different stimulations and inputs in general. Gravity is one major input to the brain transferred from the vestibular system. However, often also direct effects of gravity on the cellular level are discussed. Our group was investigating the influence of different gravity environments on a large variety of neuronal enzymes in the developing fish brain. Long-term space travel or bases on Moon and Mars will have to deal not only with neural changes based on the different gravity environment, but also with potential negative or even toxic changes in the respective life support system. Our goal is now to identify reported enzyme activity changes in the brain based for example on potential toxic drugs or endocrine disruptors in combination with gravity induced changes. In this paper a survey will be undertaken discussing recent results obtained in ecotoxicology, gravitational biology combined with new data from our group regarding potential differences in brain glucose-6-phosphate dehydrogenase of medaka and zebrafish.

  16. Diurnal changes in epidermal UV transmittance of plants in naturally high UV environments. (United States)

    Barnes, Paul W; Flint, Stephan D; Slusser, James R; Gao, Wei; Ryel, Ronald J


    Studies were conducted on three herbaceous plant species growing in naturally high solar UV environments in the subalpine of Mauna Kea, Hawaii, USA, to determine if diurnal changes in epidermal UV transmittance (T(UV)) occur in these species, and to test whether manipulation of the solar radiation regime could alter these diurnal patterns. Additional field studies were conducted at Logan, Utah, USA, to determine if solar UV was causing diurnal T(UV) changes and to evaluate the relationship between diurnal changes in T(UV) and UV-absorbing pigments. Under clear skies, T(UV), as measured with a UV-A-pulse amplitude modulation fluorometer for leaves of Verbascum thapsus and Oenothera stricta growing in native soils and Vicia faba growing in pots, was highest at predawn and sunset and lowest at midday. These patterns in T(UV) closely tracked diurnal changes in solar radiation and were the result of correlated changes in fluorescence induced by UV-A and blue radiation but not photochemical efficiency (F(v)/F(m)) or initial fluorescence yield (F(o)). The magnitude of the midday reduction in T(UV) was greater for young leaves than for older leaves of Verbascum. Imposition of artificial shade eliminated the diurnal changes in T(UV) in Verbascum, but reduction in solar UV had no effect on diurnal T(UV) changes in Vicia. In Vicia, the diurnal changes in T(UV) occurred without detectable changes in the concentration of whole-leaf UV-absorbing compounds. Results suggest that plants actively control diurnal changes in UV shielding, and these changes occur in response to signals other than solar UV; however, the underlying mechanisms responsible for rapid changes in T(UV) remain unclear.

  17. Changes in mental state associated with prison environments: a systematic review. (United States)

    Walker, J; Illingworth, C; Canning, A; Garner, E; Woolley, J; Taylor, P; Amos, T


    To develop an understanding of the stability of mental health during imprisonment through review of existing research evidence relating physical prison environment to mental state changes in prisoners. A systematic literature search was conducted looking at changes in mental state and how this related to various aspects of imprisonment and the prison environment. Fifteen longitudinal studies were found, and from these, three broad themes were delineated: being imprisoned and aspects of the prison regime; stage of imprisonment and duration of sentence; and social density. Reception into prison results in higher levels of psychiatric symptoms that seem to improve over time; otherwise, duration of imprisonment appears to have no significant impact on mental health. Regardless of social density, larger prisons are associated with poorer mental state, as are extremes of social density. There are large gaps in the literature relating prison environments to changes in mental state; in particular, high-quality longitudinal studies are needed. Existing research suggests that although entry to prison may be associated with deterioration in mental state, it tends to improve with time. Furthermore, overcrowding, ever more likely as prison populations rise, is likely to place a particular burden on mental health services. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. Complexity in organizations and environment - adaptive changes and adaptive decision-making

    Directory of Open Access Journals (Sweden)

    Robert Fabac


    Full Text Available The features of complexity are ever more present in modern organizations and in environments in which they operate, trying to survive and be as competitive as possible. In the processes of, the so-called emergence, the formal organizational structure, designed purposefully and with a plan, is going through a change due to complexity and the need for adaptation. As a result, there is a variety of new informal groups. At the same time, the intended structural changes and business process changes occur because of the perception that the leadership and senior organizational management have of the strategic situation. Managers in modern organizations often use business intelligence (BI systems when making important business decisions. These systems offer support to the decision-making by gathering and processing relevant data and information about the company performance, but also about the data on conditions in close and remote environment. A modern company is characterized by the complex adaptive system, but the environment in which it operates together with other business subjects (agents is also complex. Consequently, the requirements for appropriate or optimal decisions and successfully completed activities are hard to meet. Given that expected future events and circumstances often occur in nonlinear mechanisms, the decisions made by following the models of traditional predicting and planning are not satisfactory. This calls for new approaches to decision making and acting.

  19. Non-Equilibrium Relations for Bounded Rational Decision-Making in Changing Environments

    Directory of Open Access Journals (Sweden)

    Jordi Grau-Moya


    Full Text Available Living organisms from single cells to humans need to adapt continuously to respond to changes in their environment. The process of behavioural adaptation can be thought of as improving decision-making performance according to some utility function. Here, we consider an abstract model of organisms as decision-makers with limited information-processing resources that trade off between maximization of utility and computational costs measured by a relative entropy, in a similar fashion to thermodynamic systems undergoing isothermal transformations. Such systems minimize the free energy to reach equilibrium states that balance internal energy and entropic cost. When there is a fast change in the environment, these systems evolve in a non-equilibrium fashion because they are unable to follow the path of equilibrium distributions. Here, we apply concepts from non-equilibrium thermodynamics to characterize decision-makers that adapt to changing environments under the assumption that the temporal evolution of the utility function is externally driven and does not depend on the decision-maker’s action. This allows one to quantify performance loss due to imperfect adaptation in a general manner and, additionally, to find relations for decision-making similar to Crooks’ fluctuation theorem and Jarzynski’s equality. We provide simulations of several exemplary decision and inference problems in the discrete and continuous domains to illustrate the new relations.

  20. Local Fitness Landscapes Predict Yeast Evolutionary Dynamics in Directionally Changing Environments. (United States)

    Gorter, Florien A; Aarts, Mark G M; Zwaan, Bas J; de Visser, J Arjan G M


    The fitness landscape is a concept that is widely used for understanding and predicting evolutionary adaptation. The topography of the fitness landscape depends critically on the environment, with potentially far-reaching consequences for evolution under changing conditions. However, few studies have assessed directly how empirical fitness landscapes change across conditions, or validated the predicted consequences of such change. We previously evolved replicate yeast populations in the presence of either gradually increasing, or constant high, concentrations of the heavy metals cadmium (Cd), nickel (Ni), and zinc (Zn), and analyzed their phenotypic and genomic changes. Here, we reconstructed the local fitness landscapes underlying adaptation to each metal by deleting all repeatedly mutated genes both by themselves and in combination. Fitness assays revealed that the height, and/or shape, of each local fitness landscape changed considerably across metal concentrations, with distinct qualitative differences between unconditionally (Cd) and conditionally toxic metals (Ni and Zn). This change in topography had particularly crucial consequences in the case of Ni, where a substantial part of the individual mutational fitness effects changed in sign across concentrations. Based on the Ni landscape analyses, we made several predictions about which mutations had been selected when during the evolution experiment. Deep sequencing of population samples from different time points generally confirmed these predictions, demonstrating the power of landscape reconstruction analyses for understanding and ultimately predicting evolutionary dynamics, even under complex scenarios of environmental change. Copyright © 2018 by the Genetics Society of America.

  1. An examination of extratropical cyclone response to changes in baroclinicity and temperature in an idealized environment (United States)

    Tierney, Gregory; Posselt, Derek J.; Booth, James F.


    The dynamics and precipitation in extratropical cyclones (ETCs) are known to be sensitive to changes in the cyclone environment, with increases in bulk water vapor and baroclinicity both leading to increases in storm strength and precipitation. Studies that demonstrate this sensitivity have commonly varied either the cyclone moisture or baroclinicity, but seldom both. In a changing climate, in which the near-surface equator to pole temperature gradient may weaken while the bulk water vapor content of the atmosphere increases, it is important to understand the relative response of ETC strength and precipitation to changes in both factors simultaneously. In this study, idealized simulations of ETC development are conducted in a moist environment using a model with a full suite of moist physics parameterizations. The bulk temperature (and water vapor content) and baroclinicity are systematically varied one at a time, then simultaneously, and the effect of these variations on the storm strength and precipitation is assessed. ETC intensity exhibits the well-documented response to changes in baroclinicity, with stronger ETCs forming in higher baroclinicity environments. However, increasing water vapor content produces non-monotonic changes in storm strength, in which storm intensity first increases with increasing environmental water vapor, then decreases above a threshold value. Examination of the storm geographic extent indicates cyclone size also decreases above a threshold value of bulk environmental temperature (and water vapor). Decrease in storm size is concomitant with an increase in the convective fraction of precipitation and a shift in the vertical distribution of latent heating. The results indicate the existence of at least two regimes for ETC development, each of which exhibit significantly different distributions of PV due to differences in timing and location of convective heating.

  2. A Comparison of the Water Environment Policy of Europe and South Korea in Response to Climate Change

    Directory of Open Access Journals (Sweden)

    Heejung Kim


    Full Text Available Climate change not only increases the atmospheric temperature, but also changes the precipitation conditions and patterns, which can lead to an increase in the frequency of occurrence of natural disasters, such as flooding and drought. The Intergovernmental Panel on Climate Change (IPCC has reported fluctuations in the precipitation levels for each country from 1900 to 2005, based on global climate change, suggesting that environmental changes due to climate change manifest very differently based on the region. According to the results of studies that have been carried out recently, changes in the precipitation patterns based on climate change result in changes in the water environment, including alterations to the vegetation, land use, and river flow, while considerably influencing the rate of development of groundwater as well. In this study, the 3Is, which are the important variables of Ideas, Institutions, and Interests that are universal to the international field of political science, were used to comparatively analyze the water environment policies of South Korea and Europe. The first variable, Ideas, examined the influence of awareness on establishing the water environment policy in response to climate change. In particular, differences in the conceptual awareness of the water environment with regard to hyporheic zones were studied. The second variable, Institutions, examined the differences in the water environment policy within the national administration in response to climate change. The South Korean administration’s Ministry of Land, Infrastructure, and Transport and the Ministry of Environment were used in a case study. Finally, the results drawn from the third variable, i.e., Interests, for South Korea appear to differ from those of Europe, in terms of water environment policy. In this study, the water environment policy of South Korea was analyzed and compared to that of Europe in order to identify problems in South Korea

  3. The effect of fidelity: how expert behavior changes in a virtual reality environment. (United States)

    Ioannou, Ioanna; Avery, Alex; Zhou, Yun; Szudek, Jacek; Kennedy, Gregor; O'Leary, Stephen


    We compare the behavior of expert surgeons operating on the "gold standard" of simulation-the cadaveric temporal bone-against a high-fidelity virtual reality (VR) simulation. We aim to determine whether expert behavior changes within the virtual environment and to understand how the fidelity of simulation affects users' behavior. Five expert otologists performed cortical mastoidectomy and cochleostomy on a human cadaveric temporal bone and a VR temporal bone simulator. Hand movement and video recordings were used to derive a range of measures, to facilitate an analysis of surgical technique, and to compare expert behavior between the cadaveric and simulator environments. Drilling time was similar across the two environments. Some measures such as total time and burr change count differed predictably due to the ease of switching burrs within the simulator. Surgical strokes were generally longer in distance and duration in VR, but these measures changed proportionally to cadaveric measures across the stages of the procedure. Stroke shape metrics differed, which was attributed to the modeling of burr behavior within the simulator. This will be corrected in future versions. Slight differences in drill interaction between a virtual environment and the real world can have measurable effects on surgical technique, particularly in terms of stroke length, duration, and curvature. It is important to understand these effects when designing and implementing surgical training programs based on VR simulation--and when improving the fidelity of VR simulators to facilitate use of a similar technique in both real and simulated situations. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  4. The influence of the WIC food package changes on the retail food environment in New Orleans. (United States)

    Rose, Donald; O'Malley, Keelia; Dunaway, Lauren Futrell; Bodor, J Nicholas


    To examine the effect of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package changes on availability of healthy foods in small stores. Pre-post comparison group design with repeat in-store observations. New Orleans. Small stores (n = 102; 77% of total) were visited in 2009. Of these, 91% were observed again in 2010, including both WIC (n = 27) and non-WIC (n = 66) stores. The 2009 WIC food package changes to include healthier foods. Change in store availability of fruits, vegetables, lower-fat milks, whole wheat bread, and brown rice. Change in number of varieties and shelf length of fruits and vegetables. Difference-in-differences analysis using logit models for change in availability and regression models for change in number of varieties or shelf length. The WIC stores were more likely to improve availability of lower-fat milks than non-WIC stores (adjusted odds ratio, 5.0, 95% confidence interval, 1.2-21.0). An even greater relative improvement was seen with whole grains. The WIC stores showed a relative increase in number of varieties of fresh fruits (0.9 ± 0.3; P New Orleans. Similar changes throughout the country could have a significant impact on neighborhood food environments. Copyright © 2014 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

  5. Rural Settlement Development and Environment Carrying Capacity Changes in Progo River Basin

    Directory of Open Access Journals (Sweden)

    Su Ritohardoyo


    Full Text Available Generally the broader rural settlement the heavier population pressure on agricultural land. It indicates that carrying capacity of the rural environment threatened lower. The spatial distribution of the threat in a river basin is quite important as one of the river basin management inputs. Therefore, this article aims at exposing result of research about influence rural population growth and rural settlement land changes to environment carrying capacity. This research was carried out in the rural area in Progo river basin consists 56 sub districts (34 sub districts part of Jawa Tengah Province, and 22 sub districts part of Yogyakarta Special Region. The whole sub districts are such as unit analysis, and research method is based on secondary data analysis. Several data consist Districts Region in Figure 1997 and 2003 (Temanggung, Magelang, Kulon Progo, Sleman and Bantul such as secondary data analysis. Data analysis employs of frequency and cross tabulation, statistics of regression and test. Result of the research shows that population growth of the rural areas in Progo river basin are about 0.72% annum; or the household growth about 3.15% annum as long as five years (1996-2003. Spatial distribution of the population growth in the upper part of the Progo river basin is higher than in the middle and lower part of the basin. The number proportion of farmer in every sub district area in this river basin have increased from 69.95% in 1997 to 70.81% in the year of 2003. It means that work opportunities broadening are still sluggish. However, the number proportion of farmers in the upper part of the Progo river basin is lower than in the middle and lower part of the basin. The rates of settlement land areas changes (0.32 ha/annum as long as five years (1997-2003 is not as fast as the rates of agricultural land areas changes (0.47 ha/annum. Spatial land settlement areas changes in the lower (6.1 ha/annum and middle parts (2.4 ha/annum faster than

  6. Barriers and facilitators to healthcare professional behaviour change in clinical trials using the Theoretical Domains Framework: a case study of a trial of individualized temperature-reduced haemodialysis. (United States)

    Presseau, Justin; Mutsaers, Brittany; Al-Jaishi, Ahmed A; Squires, Janet; McIntyre, Christopher W; Garg, Amit X; Sood, Manish M; Grimshaw, Jeremy M


    Implementing the treatment arm of a clinical trial often requires changes to healthcare practices. Barriers to such changes may undermine the delivery of the treatment making it more likely that the trial will demonstrate no treatment effect. The 'Major outcomes with personalized dialysate temperature' (MyTEMP) is a cluster-randomised trial to be conducted in 84 haemodialysis centres across Ontario, Canada to investigate whether there is a difference in major outcomes with an individualized dialysis temperature (IDT) of 0.5 °C below a patient's body temperature measured at the beginning of each haemodialysis session, compared to a standard dialysis temperature of 36.5 °C. To inform how to deploy the IDT across many haemodialysis centres, we assessed haemodialysis physicians' and nurses' perceived barriers and enablers to IDT use. We developed two topic guides using the Theoretical Domains Framework (TDF) to assess perceived barriers and enablers to IDT ordering and IDT setting (physician and nurse behaviours, respectively). We recruited a purposive sample of haemodialysis physicians and nurses from across Ontario and conducted in-person or telephone interviews. We used directed content analysis to double-code transcribed utterances into TDF domains, and inductive thematic analysis to develop themes. We interviewed nine physicians and nine nurses from 11 Ontario haemodialysis centres. We identified seven themes of potential barriers and facilitators to implementing IDTs: (1) awareness of clinical guidelines and how IDT fits with local policies (knowledge; goals), (2) benefits and motivation to use IDT (beliefs about consequences; optimism; reinforcement; intention; goals), (3) alignment of IDTs with usual practice and roles (social/professional role and identity; nature of the behaviour; beliefs about capabilities), (4) thermometer availability/accuracy and dialysis machine characteristics (environmental context and resources), (5) impact on workload (beliefs

  7. Cyberterrorism: is the U.S. healthcare system safe? (United States)

    Harries, David; Yellowlees, Peter M


    The Internet has brought with it many benefits; key among them has been its ability to allow the expansion of communication and transfer of all kinds of information throughout the U.S. healthcare system. As a consequence, healthcare has become increasingly dependent on the activities carried out in that environment. It is this very dependence that increases the likelihood of individuals or organizations conducting activities through the Internet that will cause physical and/or psychological harm. These activities have become known by the term "cyberterrorism." In the healthcare landscape this can appear in a variety of forms, such as bringing down a hospital computer system or publicly revealing private medical records. Whatever shape it takes, the general effects are the same: patient care is compromised, and trust in the health system is diminished. Fortunately no significant cyber attack has been successfully launched against a U.S. healthcare organization to date. However, there is evidence to suggest that cyber threats are increasing and that much of the U.S. healthcare system is ill equipped to deal with them. Securing cyberspace is not an easy proposition as the threats are constantly changing, and recognizing that cyberterrorism should be part of a broader information technology risk management strategy, there are several"best practices" that can be adopted by healthcare organizations to protect themselves against cyber attacks.

  8. How Customer Facing Professionals Adapt to Changing Customer Needs in a Digital Environment: A Single Case Study (United States)

    Hendriks, Stefan


    This qualitative single case study explored how customer facing professionals (CFPs) adapt to changing customer needs in a digital environment. This study focuses on: (1) Changing customer needs; (2) Competencies needed in a digital environment; (3) How they learn; and (4) What factors help or hinder their success. The site is a global Human…

  9. EU-China Cooperation In the Field of Energy, Environment and Climate Change

    Directory of Open Access Journals (Sweden)

    Pietro De Matteis


    Full Text Available The evolution of the energy market and the intrinsic worldwide scope of environmental threats, such as climate change, are two elements that have pushed the world towards shared approaches to global governance via bilateral institutions and international regimes. This article, with the aid of an institutionalist approach, presents the current status of the EU-China relationship, which is characterised by high institutionalisation, and it underlines how their bilateral cooperation has progressively focused on energy and climate change-related issues. In particular, the article sheds some light on the linkages between energy, environment and climate change and how these have created the basis for the upgrade of the EU-China bilateral relationship to its current level. To do so, it underlines some of the tools, the main frameworks and some of the key outcomes of their bilateral cooperation in these fields.

  10. Adaptation measures for climate change and the urban heat island in Japan's built environment

    International Nuclear Information System (INIS)

    Shimoda, Y.


    Climate change scenarios are discussed for Japan with clear implications drawn for the built environment in terms of increased temperatures of 4-5 o C, rising sea levels and subterranean water tables. Research on the impacts and adaptation measures for global warming in Japan is reviewed. One of the most significant impacts of climate change in Japan will exacerbate the existing heat island phenomenon in cities by absorbing increased solar radiation. This will lead to further increases in temperatures in an urban microclimate with negative implications for energy and water consumption, human health and discomfort, and local ecosystems. The current urban heat island phenomenon and its impacts are described. The relationships between climate change and urban heat island impacts are discussed. Potential adaptation measures to those impacts are also discussed and proposed. (author)

  11. Distributive justice in American healthcare: institutions, power, and the equitable care of patients. (United States)

    Putsch, Robert W; Pololi, Linda


    The authors argue that the American healthcare system has developed in a fashion that permits and may support ongoing, widespread inequities based on poverty, race, gender, and ethnicity. Institutional structures also contribute to this problem. Analysis is based on (1) discussions of a group of experts convened by the Office of Minority Health, US Department of Health and Human Services at a conference to address healthcare disparities; and (2) review of documentation and scientific literature focused on health, health-related news, language, healthcare financing, and the law. Institutional factors contributing to inequity include the cost and financing of American healthcare, healthcare insurance principles such as mutual aid versus actuarial fairness, and institutional power. Additional causes for inequity are bias in decision making by healthcare practitioners, clinical training environments linked to abuse of patients and coworkers, healthcare provider ethnicity, and politics. Recommendations include establishment of core attributes of trust, relationship and advocacy in health systems; universal healthcare; and insurance systems based on mutual aid. In addition, monitoring of equity in health services and the development of a set of ethical principles to guide systems change and rule setting would provide a foundation for distributive justice in healthcare. Additionally, training centers should model the behaviors they seek to foster and be accountable to the communities they serve.

  12. Changes in food and beverage environments after an urban corner store intervention. (United States)

    Cavanaugh, Erica; Green, Sarah; Mallya, Giridhar; Tierney, Ann; Brensinger, Colleen; Glanz, Karen


    In response to the obesity epidemic, interventions to improve the food environment in corner stores have gained attention. This study evaluated the availability, quality, and price of foods in Philadelphia corner stores before and after a healthy corner store intervention with two levels of intervention intensity ("basic" and "conversion"). Observational measures of the food environment were completed in 2011 and again in 2012 in corner stores participating in the intervention, using the Nutrition Environment Measures Survey for Corner Stores (NEMS-CS). Main analyses included the 211 stores evaluated at both time-points. A time-by-treatment interaction analysis was used to evaluate the changes in NEMS-CS scores by intervention level over time. Availability of fresh fruit increased significantly in conversion stores over time. Specifically, there were significant increases in the availability of apples, oranges, grapes, and broccoli in conversion stores over time. Conversion stores showed a trend toward a significantly larger increase in the availability score compared to basic stores over time. Interventions aimed at increasing healthy food availability are associated with improvements in the availability of low-fat milk, fruits, and some vegetables, especially when infrastructure changes, such as refrigeration and shelving enhancements, are offered. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. The Working Environment and Changing Role of Corporate Librarians in Taiwan

    Directory of Open Access Journals (Sweden)

    Hsueh-hua Chen


    Full Text Available Influenced by the concept of “Knowledge Economics”, knowledge management (KM is getting a lot of attention in the field of business administration recently. Corporate centers are mostly affected by KM either in their working environment or in the role of their daily operation in the field of Library and Information Science. In the United States, the Special Library Association (SLA conducted numerous studies about the working environment and the changing role of corporate librarians in the past ten years. Due to the differences in politics, economics, and culture between Taiwan and the western countries, the organizational structure and corporate culture of the enterprise will not be exactly the same. Therefore, local studies on similar topics are needed. The purpose of this study is to explore the influence of the KM on the working environment and the changing roles of the corporate librarians in Taiwan based on the result of National Science Council Research Project executed by the authors.[Article content in Chinese

  14. Environment

    International Nuclear Information System (INIS)

    McIntyre, A.D.; Turnbull, R.G.H.


    The development of the hydrocarbon resources of the North Sea has resulted in both offshore and onshore environmental repercussions, involving the existing physical attributes of the sea and seabed, the coastline and adjoining land. The social and economic repercussions of the industry were equally widespread. The dramatic and speedy impact of the exploration and exploitation of the northern North Sea resources in the early 1970s, on the physical resources of Scotland was quickly realised together with the concern that any environmental and social damage to the physical and social fabric should be kept to a minimum. To this end, a wide range of research and other activities by central and local government, and other interested agencies was undertaken to extend existing knowledge on the marine and terrestrial environments that might be affected by the oil and gas industry. The outcome of these activities is summarized in this paper. The topics covered include a survey of the marine ecosystems of the North Sea, the fishing industry, the impact of oil pollution on seabirds and fish stocks, the ecology of the Scottish coastline and the impact of the petroleum industry on a selection of particular sites. (author)

  15. Risk attitudes in a changing environment: An evolutionary model of the fourfold pattern of risk preferences. (United States)

    Mallpress, Dave E W; Fawcett, Tim W; Houston, Alasdair I; McNamara, John M


    A striking feature of human decision making is the fourfold pattern of risk attitudes, involving risk-averse behavior in situations of unlikely losses and likely gains, but risk-seeking behavior in response to likely losses and unlikely gains. Current theories to explain this pattern assume particular psychological processes to reproduce empirical observations, but do not address whether it is adaptive for the decision maker to respond to risk in this way. Here, drawing on insights from behavioral ecology, we build an evolutionary model of risk-sensitive behavior, to investigate whether particular types of environmental conditions could favor a fourfold pattern of risk attitudes. We consider an individual foraging in a changing environment, where energy is needed to prevent starvation and build up reserves for reproduction. The outcome, in terms of reproductive value (a rigorous measure of evolutionary success), of a one-off choice between a risky and a safe gain, or between a risky and a safe loss, determines the risk-sensitive behavior we should expect to see in this environment. Our results show that the fourfold pattern of risk attitudes may be adaptive in an environment in which conditions vary stochastically but are autocorrelated in time. In such an environment the current options provide information about the likely environmental conditions in the future, which affect the optimal pattern of risk sensitivity. Our model predicts that risk preferences should be both path dependent and affected by the decision maker's current state. (c) 2015 APA, all rights reserved).

  16. Bivalve aquaculture-environment interactions in the context of climate change. (United States)

    Filgueira, Ramón; Guyondet, Thomas; Comeau, Luc A; Tremblay, Réjean


    Coastal embayments are at risk of impacts by climate change drivers such as ocean warming, sea level rise and alteration in precipitation regimes. The response of the ecosystem to these drivers is highly dependent on their magnitude of change, but also on physical characteristics such as bay morphology and river discharge, which play key roles in water residence time and hence estuarine functioning. These considerations are especially relevant for bivalve aquaculture sites, where the cultured biomass can alter ecosystem dynamics. The combination of climate change, physical and aquaculture drivers can result in synergistic/antagonistic and nonlinear processes. A spatially explicit model was constructed to explore effects of the physical environment (bay geomorphic type, freshwater inputs), climate change drivers (sea level, temperature, precipitation) and aquaculture (bivalve species, stock) on ecosystem functioning. A factorial design led to 336 scenarios (48 hydrodynamic × 7 management). Model outcomes suggest that the physical environment controls estuarine functioning given its influence on primary productivity (bottom-up control dominated by riverine nutrients) and horizontal advection with the open ocean (dominated by bay geomorphic type). The intensity of bivalve aquaculture ultimately determines the bivalve-phytoplankton trophic interaction, which can range from a bottom-up control triggered by ammonia excretion to a top-down control via feeding. Results also suggest that temperature is the strongest climate change driver due to its influence on the metabolism of poikilothermic organisms (e.g. zooplankton and bivalves), which ultimately causes a concomitant increase of top-down pressure on phytoplankton. Given the different thermal tolerance of cultured species, temperature is also critical to sort winners from losers, benefiting Crassostrea virginica over Mytilus edulis under the specific conditions tested in this numerical exercise. In general, it is

  17. Footprints of air pollution and changing environment on the sustainability of built infrastructure. (United States)

    Kumar, Prashant; Imam, Boulent


    Over 150 research articles relating three multi-disciplinary topics (air pollution, climate change and civil engineering structures) are reviewed to examine the footprints of air pollution and changing environment on the sustainability of building and transport structures (referred as built infrastructure). The aim of this review is to synthesize the existing knowledge on this topic, highlight recent advances in our understanding and discuss research priorities. The article begins with the background information on sources and emission trends of global warming (CO(2), CH(4), N(2)O, CFCs, SF(6)) and corrosive (SO(2), O(3), NO(X)) gases and their role in deterioration of building materials (e.g. steel, stone, concrete, brick and wood) exposed in outdoor environments. Further section covers the impacts of climate- and pollution-derived chemical pathways, generally represented by dose-response functions (DRFs), and changing environmental conditions on built infrastructure. The article concludes with the discussions on the topic areas covered and research challenges. A comprehensive inventory of DRFs is compiled. The case study carried out for analysing the inter-comparability of various DRFs on four different materials (carbon steel, limestone, zinc and copper) produced comparable results. Results of another case study revealed that future projected changes in temperature and/or relatively humidity are expected to have a modest effect on the material deterioration rate whereas changes in precipitation were found to show a more dominant impact. Evidences suggest that both changing and extreme environmental conditions are expected to affect the integrity of built infrastructure both in terms of direct structural damage and indirect losses of transport network functionality. Unlike stone and metals, substantially limited information is available on the deterioration of brick, concrete and wooden structures. Further research is warranted to develop more robust and

  18. Climate Change Impacts on the Built Environment in the United States and Implications for Sustainability (United States)

    Quattrochi, Dale A.


    As an integral part of the National Climate Assessment (NCA), technical assessment reports for 13 regions in the U.S. that describe the scientific rationale to support climate change impacts within the purview of these regions, and provide adaptation or mitigation measures in response to these impacts. These technical assessments focus on climate change impacts on sectors that are important environmental, biophysical, and social and economic aspects of sustainability within the U.S.: Climate change science, Ecosystems and biodiversity, Water resources, Human health, Energy supply and use, Water/energy/land use, Transportation, Urban/infrastructure/vulnerability, Agriculture, Impacts of climate change on tribal/indigenous and native lands and resources, Forestry, Land use/land cover change, Rural communities development, and Impacts on biogeochemical cycles, with implications for ecosystems and biodiversity. There is a critical and timely need for the development of mitigation and adaptation strategies in response to climate change by the policy and decision making communities, to insure resiliency and sustainability of the built environment in the future.

  19. Web of power. Information and technology are changing the face of healthcare and its leadership, according to this year's 7th annual 100 Most Powerful People in Healthcare ranking. (United States)

    Lubell, Jennifer


    The Internet and technology helped catapult this year's No. 1 to the top of the Most Powerful People in Healthcare roster, along with the No. 2 and No. 3 picks. But politicians also had a good showing in the top 10, including presidential candidates Barack Obama and John McCain, and ailing Democratic lion, Sen. Edward Kennedy, left.

  20. Working in mental health: practice and policy in a changing environment

    National Research Council Canada - National Science Library

    Phillips, Peter; Sandford, Tom; Johnston, Claire, MSc RGN


    .... A more influential service user movement, a range of new community-based mental healthcare programmes delivered by an increasing plurality of providers and new mental health policy and legislation...

  1. Change Of Learning Environment Using Game Production ­Theory, Methods And Practice

    DEFF Research Database (Denmark)

    Reng, Lars; Kofoed, Lise; Schoenau-Fog, Henrik


    will focus on cases in which development of games did change the learning environments into production units where students or employees were producing games as part of the learning process. The cases indicate that the motivation as well as the learning curve became very high. The pedagogical theories......Game Based Learning has proven to have many possibilities for supporting better learning outcomes, when using educational or commercial games in the classroom. However, there is also a great potential in using game development as a motivator in other kinds of learning scenarios. This study...... and methods are based on Problem Based Learning (PBL), but are developed further by combining PBL with a production-oriented/design based approach. We illustrate the potential of using game production as a learning environment with investigation of three game productions. We can conclude that using game...

  2. Evolution of regulatory networks towards adaptability and stability in a changing environment (United States)

    Lee, Deok-Sun


    Diverse biological networks exhibit universal features distinguished from those of random networks, calling much attention to their origins and implications. Here we propose a minimal evolution model of Boolean regulatory networks, which evolve by selectively rewiring links towards enhancing adaptability to a changing environment and stability against dynamical perturbations. We find that sparse and heterogeneous connectivity patterns emerge, which show qualitative agreement with real transcriptional regulatory networks and metabolic networks. The characteristic scaling behavior of stability reflects the balance between robustness and flexibility. The scaling of fluctuation in the perturbation spread shows a dynamic crossover, which is analyzed by investigating separately the stochasticity of internal dynamics and the network structure differences depending on the evolution pathways. Our study delineates how the ambivalent pressure of evolution shapes biological networks, which can be helpful for studying general complex systems interacting with environments.

  3. Changes in the acoustic environment alter the foraging and sheltering behaviour of the cichlid Amititlania nigrofasciata. (United States)

    McLaughlin, Kirsty Elizabeth; Kunc, Hansjoerg P


    Anthropogenic noise can affect behaviour across a wide range of species in both terrestrial and aquatic environments. However, behaviours might not be affected in isolation. Therefore, a more holistic approach investigating how environmental stressors, such as noise pollution, affect different behaviours in concert is necessary. Using tank-based noise exposure experiments, we tested how changes in the acoustic environment affect the behaviour of the cichlid Amatitlania nigrofasciata. We found that exposure to anthropogenic noise affected a couple of behaviours: an increase in sheltering was accompanied by a decrease in foraging. Our results highlight the multiple negative effects of an environmental stressor on an individual's behaviour. Copyright © 2015 Elsevier B.V. All rights reserved.

  4. Does opening a supermarket in a food desert change the food environment? (United States)

    Ghosh-Dastidar, Madhumita; Hunter, Gerald; Collins, Rebecca L; Zenk, Shannon N; Cummins, Steven; Beckman, Robin; Nugroho, Alvin K; Sloan, Jennifer C; Wagner, La'Vette; Dubowitz, Tamara


    Improving access to healthy foods in low-income neighborhoods is a national priority. Our study evaluated the impact of opening a supermarket in a 'food desert' on healthy food access, availability and prices in the local food environment. We conducted 30 comprehensive in-store audits collecting information on healthy and unhealthy food availability, food prices and store environment, as well as 746 household surveys in two low-income neighborhoods before and after one of the two neighborhoods received a new supermarket. We found positive and negative changes in food availability, and an even greater influence on food prices in neighborhood stores. The supermarket opening in a 'food desert' caused little improvement in net availability of healthy foods, challenging the underpinnings of policies such as the Healthy Food Financing Initiative. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Changes of the agricultural enterprises economic environment originated by the agribusiness development

    Directory of Open Access Journals (Sweden)

    Věra Bečvářová


    Full Text Available Based upon analyses of the Common Agricultural Policy development and its economic tools reforming the process of changing is characterised there. It deals with the multifunctionality of agriculture as well as the influence of the CAP on environment of the production tasks of agriculture and food processing industry accomplishment. Paper generalises results of new trends of the agribusiness economic environment development and the opportunity of an effective utilization of production factors in agriculture. It deals with the sources and economic implications of partial enhancement of interest and redirection of support within framework and type of tools of agrarian policy. New quality of structure of relevant information needs and economic support for agricultural enterprises decision making process are pointed out.

  6. Social marketing in healthcare

    Directory of Open Access Journals (Sweden)

    Radha Aras


    Full Text Available BackgroundSocial marketing is an important tool in the delivery ofhealthcare services. For any healthcare programme orproject to be successful, community/consumer participationis required. The four principles of social marketing can guidepolicymakers and healthcare providers to successfully planand implement health programmes.AimTo review the existing literature in order to project thebenefits of social marketing in healthcare.MethodA search of periodical literature by the author involvingsocial marketing and marketing concepts in health wascarried out. Items were identified initially through healthorientedindexing services such as Medline, Health STARand Cinahl, using the identifiers “social marketing“ and“marketing in health”. An extensive search was also carriedout on educational database ERIC.ResultsA literature review of various studies on social marketingindicated that the selection of the right product (accordingto the community need at the right place, with the rightstrategy for promotion and at the right price yields goodresults. However, along with technical sustainability(product, price, promotion and place, financialsustainability, institutional sustainability and marketsustainability are conducive factors for the success of socialmarketing.ConclusionThe purpose of this literature review was to ascertain thelikely effectiveness of social marketing principles andapproaches and behaviour change communication towardshealth promotion.It is important for all healthcare workers to understand andrespond to the public’s desires and needs and routinely useconsumer research to determine how best to help thepublic to solve problems and realise aspirations. Socialmarketing can optimise public health by facilitatingrelationship-building with consumers and making their liveshealthier.

  7. Robust online belief space planning in changing environments: Application to physical mobile robots

    KAUST Repository

    Agha-mohammadi, Ali-akbar


    © 2014 IEEE. Motion planning in belief space (under motion and sensing uncertainty) is a challenging problem due to the computational intractability of its exact solution. The Feedback-based Information RoadMap (FIRM) framework made an important theoretical step toward enabling roadmap-based planning in belief space and provided a computationally tractable version of belief space planning. However, there are still challenges in applying belief space planners to physical systems, such as the discrepancy between computational models and real physical models. In this paper, we propose a dynamic replanning scheme in belief space to address such challenges. Moreover, we present techniques to cope with changes in the environment (e.g., changes in the obstacle map), as well as unforeseen large deviations in the robot\\'s location (e.g., the kidnapped robot problem). We then utilize these techniques to implement the first online replanning scheme in belief space on a physical mobile robot that is robust to changes in the environment and large disturbances. This method demonstrates that belief space planning is a practical tool for robot motion planning.

  8. The Integration of Two Healthcare Systems: A Common Healthcare Problem. (United States)

    Cassatly, Hannah; Cassatly, Michael


    The change in reimbursement mandated by the Affordable Care Act is causing a rapid consolidation of the marketplace as well as the delivery of clinical care in a team-based model. This case report examines the successful joining of two clinical teams concurrent with the merger of two healthcare organizations and discusses some of the difficulties encountered. A subsequent discussion focuses on the resolution: the need for physicians to embrace the team concept of healthcare delivery and for healthcare systems to facilitate this transition with team and leadership coaching.

  9. Serious electronic games as behavioural change interventions in healthcare-associated infections and infection prevention and control: a scoping review of the literature and future directions. (United States)

    Castro-Sánchez, Enrique; Kyratsis, Yiannis; Iwami, Michiyo; Rawson, Timothy M; Holmes, Alison H


    The uptake of improvement initiatives in infection prevention and control (IPC) has often proven challenging. Innovative interventions such as 'serious games' have been proposed in other areas to educate and help clinicians adopt optimal behaviours. There is limited evidence about the application and evaluation of serious games in IPC. The purposes of the study were: a) to synthesise research evidence on the use of serious games in IPC to support healthcare workers' behaviour change and best practice learning; and b) to identify gaps across the formulation and evaluation of serious games in IPC. A scoping study was conducted using the methodological framework developed by Arksey and O'Malley. We interrogated electronic databases (Ovid MEDLINE, Embase Classic + Embase, PsycINFO, Scopus, Cochrane, Google Scholar) in December 2015. Evidence from these studies was assessed against an analytic framework of intervention formulation and evaluation. Nine hundred sixty five unique papers were initially identified, 23 included for full-text review, and four finally selected. Studies focused on intervention inception and development rather than implementation. Expert involvement in game design was reported in 2/4 studies. Potential game users were not included in needs assessment and game development. Outcome variables such as fidelity or sustainability were scarcely reported. The growing interest in serious games for health has not been coupled with adequate evaluation of processes, outcomes and contexts involved. Explanations about the mechanisms by which game components may facilitate behaviour change are lacking, further hindering adoption.

  10. Potential Climate Change Impacts on the Built Environment in the United States and Implications for Sustainability (United States)

    Quattrochi, D.


    The built environment consists of components that have been made by humans at a range of scales from small (e.g., houses, shopping malls) to large (e.g., transportation networks) to highly modified landscapes such as cities. The impacts of climate change on the built environment, therefore, may have a multitude of effects on humans and the land. The impact of climate change may be exacerbated by the interaction of different events that singly may be minor, but together may have a synergistic set of impacts that are significant. Also, there may be feedback mechanisms wherein the built environment, particularly in the form of cities, may affect weather and the climate on local and regional scales. Besides having a host of such interactions, the impacts of climate change on urban areas will likely have thresholds, below which effects are incidental or of mild consequence, but beyond which the effects quickly become major. Hence, a city may be able to cope with prolonged heat waves, but if this is combined with severe drought, the overall result could be significant or even catastrophic, as accelerating demand for energy to cooling taxes water supplies needed both for energy supply and municipal water needs. Moreover, urban areas may be affected by changes in daily and seasonal high or low temperatures or precipitation, which may have a much more prolonged impact than the direct effect of these events. Thus, the cumulative impacts of multiple events may be more severe than those of any single event. Primary hazards include sea level rise and coastal storms, heat waves, intense precipitation, drought, extreme wind events, urban heat islands, and secondary air pollutants, and cold air events including frozen precipitation. Indicators need to be developed to provide a consistent, objective, and transparent overview of major variations in climate impacts, vulnerabilities, adaptation, and mitigation activities. Overall, indicators of climate change on the built environment

  11. LEAN thinking in Finnish healthcare. (United States)

    Jorma, Tapani; Tiirinki, Hanna; Bloigu, Risto; Turkki, Leena


    Purpose - The purpose of this study is to evaluate how LEAN thinking is used as a management and development tool in the Finnish public healthcare system and what kind of outcomes have been achieved or expected by using it. The main focus is in managing and developing patient and treatment processes. Design/methodology/approach - A mixed-method approach incorporating the Webropol survey was used. Findings - LEAN is quite a new concept in Finnish public healthcare. It is mainly used as a development tool to seek financial savings and to improve the efficiency of patient processes, but has not yet been deeply implemented. However, the experiences from LEAN initiatives have been positive, and the methodology is already quite well-known. It can be concluded that, because of positive experiences from LEAN, the environment in Finnish healthcare is ready for the deeper implementation of LEAN. Originality/value - This paper evaluates the usage of LEAN thinking for the first time in the public healthcare system of Finland as a development tool and a management system. It highlights the implementation and achieved results of LEAN thinking when used in the healthcare environment. It also highlights the expectations for LEAN thinking in Finnish public healthcare.

  12. The Future of Coral Reefs Subject to Rapid Climate Change: Lessons from Natural Extreme Environments

    Directory of Open Access Journals (Sweden)

    Emma F. Camp


    Full Text Available Global climate change and localized anthropogenic stressors are driving rapid declines in coral reef health. In vitro experiments have been fundamental in providing insight into how reef organisms will potentially respond to future climates. However, such experiments are inevitably limited in their ability to reproduce the complex interactions that govern reef systems. Studies examining coral communities that already persist under naturally-occurring extreme and marginal physicochemical conditions have therefore become increasingly popular to advance ecosystem scale predictions of future reef form and function, although no single site provides a perfect analog to future reefs. Here we review the current state of knowledge that exists on the distribution of corals in marginal and extreme environments, and geographic sites at the latitudinal extremes of reef growth, as well as a variety of shallow reef systems and reef-neighboring environments (including upwelling and CO2 vent sites. We also conduct a synthesis of the abiotic data that have been collected at these systems, to provide the first collective assessment on the range of extreme conditions under which corals currently persist. We use the review and data synthesis to increase our understanding of the biological and ecological mechanisms that facilitate survival and success under sub-optimal physicochemical conditions. This comprehensive assessment can begin to: (i highlight the extent of extreme abiotic scenarios under which corals can persist, (ii explore whether there are commonalities in coral taxa able to persist in such extremes, (iii provide evidence for key mechanisms required to support survival and/or persistence under sub-optimal environmental conditions, and (iv evaluate the potential of current sub-optimal coral environments to act as potential refugia under changing environmental conditions. Such a collective approach is critical to better understand the future survival of

  13. Changes in psychosocial work environment and depressive symptoms: a prospective study in junior physicians. (United States)

    Li, Jian; Weigl, Matthias; Glaser, Jürgen; Petru, Raluca; Siegrist, Johannes; Angerer, Peter


    We examined the impact of changes in the psychosocial work environment on depressive symptoms in a sample of junior physicians, a high risk group for stress and mental disorders. This is a three-wave prospective study in 417 junior physicians during their residency in German hospitals. The psychosocial work environment was measured by the Effort-Reward Imbalance (ERI) Questionnaire at Waves 1 and 2, and the depressive symptoms were assessed with the State-Trait Depression Scales at all three waves. Multivariate linear regression was applied for prospective associations between ERI across Waves 1 and 2, and baseline-adjusted depressive symptoms at Wave 3. Compared with the ERI scores at Wave 1, at Wave 2, and mean scores between the two waves, the baseline-adjusted ERI change scores between the two waves showed slightly better statistical power, predicting depressive symptoms at Wave 3 (β = 0.78, 95% CI = 0.38-1.18 for increased ERI per SD, β = 0.64, 95% CI = 0.22-1.06 for increased effort per SD, β = -0.65, 95% CI = -1.06 to -0.24 for increased reward per SD, and β = 0.68, 95% CI = 0.27-1.09 for increased overcommitment per SD). Negative changes in the psychosocial work environment, specifically increased ERI, are associated with depressive symptoms in German junior physicians. Reducing the non-reciprocity of working life, particularly improving reward at work, may have beneficial effects on prevention of mental health problems in the hospital workplace. © 2013 Wiley Periodicals, Inc.

  14. A high parasite density environment induces transcriptional changes and cell death in Plasmodium falciparum blood stages. (United States)

    Chou, Evelyn S; Abidi, Sabia Z; Teye, Marian; Leliwa-Sytek, Aleksandra; Rask, Thomas S; Cobbold, Simon A; Tonkin-Hill, Gerry Q; Subramaniam, Krishanthi S; Sexton, Anna E; Creek, Darren J; Daily, Johanna P; Duffy, Michael F; Day, Karen P


    Transient regulation of Plasmodium numbers below the density that induces fever has been observed in chronic malaria infections in humans. This species transcending control cannot be explained by immunity alone. Using an in vitro system we have observed density dependent regulation of malaria population size as a mechanism to possibly explain these in vivo observations. Specifically, Plasmodium falciparum blood stages from a high but not low-density environment exhibited unique phenotypic changes during the late trophozoite (LT) and schizont stages of the intraerythrocytic cycle. These included in order of appearance: failure of schizonts to mature and merozoites to replicate, apoptotic-like morphological changes including shrinking, loss of mitochondrial membrane potential, and blebbing with eventual release of aberrant parasites from infected erythrocytes. This unique death phenotype was triggered in a stage-specific manner by sensing of a high-density culture environment. Conditions of glucose starvation, nutrient depletion, and high lactate could not induce the phenotype. A high-density culture environment induced rapid global changes in the parasite transcriptome including differential expression of genes involved in cell remodeling, clonal antigenic variation, metabolism, and cell death pathways including an apoptosis-associated metacaspase gene. This transcriptional profile was also characterized by concomitant expression of asexual and sexual stage-specific genes. The data show strong evidence to support our hypothesis that density sensing exists in P. falciparum. They indicate that an apoptotic-like mechanism may play a role in P. falciparum density regulation, which, as in yeast, has features quite distinguishable from mammalian apoptosis. Gene expression data are available in the GEO databases under the accession number GSE91188. © 2017 Federation of European Biochemical Societies.

  15. Impact of anthropogenic climate change and human activities on environment and ecosystem services in arid regions. (United States)

    Mahmoud, Shereif H; Gan, Thian Y


    The implications of anthropogenic climate change, human activities and land use change (LUC) on the environment and ecosystem services in the coastal regions of Saudi Arabia were analyzed. Earth observations data was used to drive land use categories between 1970 and 2014. Next, a Markov-CA model was developed to characterize the dynamic of LUC between 2014 and 2100 and their impacts on regions' climate and environment. Non-parametric change point and trend detection algorithms were applied to temperature, precipitation and greenhouse gases data to investigate the presence of anthropogenic climate change. Lastly, climate models were used to project future climate change between 2014 and 2100. The analysis of LUC revealed that between 1970 and 2014, built up areas experienced the greatest growth during the study period, leading to a significant monotonic trend. Urban areas increased by 2349.61km 2 between 1970 and 2014, an average increase of >53.4km 2 /yr. The projected LUC between 2014 and 2100 indicate a continued increase in urban areas and irrigated cropland. Human alteration of land use from natural vegetation and forests to other uses after 1970, resulted in a loss, degradation, and fragmentation, all of which usually have devastating effects on the biodiversity of the region. Resulting in a statistically significant change point in temperature anomaly after 1968 with a warming trend of 0.24°C/decade and a downward trend in precipitation anomaly of 12.2mm/decade. Total greenhouse gas emissions including all anthropogenic sources showed a statistically significant positive trend of 78,090Kt/decade after 1991. This is reflected in the future projection of temperature anomaly between 1900 and 2100 with a future warming trend of 0.19°C/decade. In conclusion, human activities, industrial revelation, deforestation, land use transformation and increase in greenhouse gases had significant implications on the environment and ecosystem services of the study area

  16. Tracking of Environment Changes by Exploitation of Suomi-NPP VIIRS Data (United States)

    Ibrahim, W.; Greene, E.; van Poollen, C.; Cumpton, D.


    NOAA's next-generation environmental satellite system, Joint Polar Satellite System (JPSS), replaces the current Polar-orbiting Operational Environmental Satellites. JPSS satellites carry sensors which collect meteorological, oceanographic, climatological, and solar-geophysical observations of the earth, atmosphere, and space. The first JPSS satellite, Suomi National Polar-orbiting Partnership (S-NPP), was launched in 2011. The JPSS ground system is the Common Ground System (CGS), and provides command, control, and communications (C3) and data processing (DP). S-NPP satellite includes the Visible Infrared Imaging Radiometer Suite (VIIRS), a 22-band scanning radiometer that provides top-of-atmosphere radiances and reflectances at a range of visible and infrared frequencies. Data collected from VIIRS are output by CGS DP into Raw Data Records (RDRs; Level-0), Sensor Data Records (SDRs; Level-1B) and Environmental Data Records (EDRs; Level-1C). This paper presents a methodology of monitoring and tracking impact of weather conditions on environment changes by exploitation of data from S-NPP VIIRS products. Three different products created from VIIRS data, SDR M-band True-Color (TC) composite visible imagery RGB (M5, M4 and M3), SDR M-band Natural-Color (NC) composite imagery RGB (M10, M7 and M5) and Vegetation Index (VI) EDR, are used to analyze the change in springtime vegetation and snowpack in California, USA, over four years from the height of the drought in 2014 to its end in 2017. While the TC composite images are more appealing to the human observer, utilization of the NC composite images allows for tracking and monitoring the changes in the snowpack in the Sierra Nevada, the reappearance of bodies of water and the changes in the vegetation composite. The VI product uses NDVI to characterize the vegetation temporally. By combining multiple VIIRS products, complex scenes can be visualized and analyzed temporally and spatially more accurately than just using a

  17. Latest Achievements on Climate Change and Forest Interactions in a Polluted Environment

    DEFF Research Database (Denmark)

    Carriero, Giulia; Tuovinen, Juha-Pekka; Clarke, Nicholas


    the information from European forest research/monitoring networks; the development of a new concept of forest sites for research and monitoring (Supersites); the identification of the main knowledge gaps; and the definition of priorities for forest adaptation to climate change in a polluted environment...... pollution dynamics into prospects for forest research and monitoring, with focus on the carbon, ozone, nitrogen and water budgets. The aim of this paper is to summarize scientific activities and achievements of MAFor: the creation of a meta-database for highlighting the available data and integrating...

  18. Welfare Mix and Hybridity. Flexible Adjustments to Changed Environments. Introduction to the Special Issue

    DEFF Research Database (Denmark)

    Henriksen, Lars Skov; Smith, Steven Rathgeb; Zimmer, Annette


    Present day welfare societies rely on a complex mix of different providers ranging from the state, markets, family, and non-profit organizations to unions, grassroots organizations, and informal networks. At the same time changing welfare discourses have opened up space for new partnerships...... organizations and organizational fields adjust to a new environment that is increasingly dominated by the logic of the market, and how in particular nonprofit organizations, as hybrids by definition, are able to cope with new demands, funding structures, and control mechanisms....

  19. Student beliefs and learning environments: Developing a survey of factors related to conceptual change (United States)

    Hanrahan, Mary


    This paper presents a model for the type of classroom environment believed to facilitate scientific conceptual change. A survey based on this model contains items about students' motivational beliefs, their study approach and their perceptions of their teacher's actions and learning goal orientation. Results obtained from factor analyses, correlations and analyses of variance, based on responses from 113 students, suggest that an empowering interpersonal teacher-student relationship is related to a deep approach to learning, a positive attitude to science, and positive self-efficacy beliefs, and may be increased by a constructivist approach to teaching.

  20. MANAGING SOCIAL CHANGE IN THE TURBULENT ENVIRONMENT (review of the scientific conference

    Directory of Open Access Journals (Sweden)

    N. G. Dehanova


    Full Text Available Current article is dedicated to All-Rissian scientific conference “ Managing social change in the turbulent environment”.Modern social unstable environment determine the search for new solutions in managing change. The crucial transformations and changes take place in the main subjects of social life – family organizations and the state. External and internal risks actualize the study of adaptation processes in the management of social change at every level of social policy. It is necessary to identify the impact of new technological, demographic and cultural factors on the established trends of social dynamics.The main aim of the conference was an identification of new trends in the managing social processes on the base of cooperation between the state, nongovernmental organizations and people. The scientific conference was devoted to the analysis of social change in the conditions of uncertainty and ambiguity. The proposals for optimization of social dynamics will revise the experience of social practices in theRussian Federationand foreign countries.