Pragmatic trials

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Optical coherence tomography-based consensus definition for lamellar macular hole.

BackgroundA consensus on an optical coherence tomography definition of lamellar macular hole (LMH) and similar conditions is needed.MethodsThe panel reviewed relevant peer-reviewed literature to reach an accord on LMH definition and to differentiate LMH from other similar conditions.ResultsThe panel reached a consensus on the definition of three clinical entities: LMH, epiretinal membrane (ERM) foveoschisis and macular pseudohole (MPH). LMH definition is based on three mandatory criteria and three optional anatomical features. The three mandatory criteria are the presence of irregular foveal contour, the presence of a foveal cavity with undermined edges and the apparent loss of foveal tissue. Optional anatomical features include the presence of epiretinal proliferation, the presence of a central foveal bump and the disruption of the ellipsoid zone. ERM foveoschisis definition is based on two mandatory criteria: the presence of ERM and the presence of schisis at the level of Henle's fibre layer. Three optional anatomical features can also be present: the presence of microcystoid spaces in the inner nuclear layer (INL), an increase of retinal thickness and the presence of retinal wrinkling. MPH definition is based on three mandatory criteria and two optional anatomical features. Mandatory criteria include the presence of a foveal sparing ERM, the presence of a steepened foveal profile and an increased central retinal thickness. Optional anatomical features are the presence of microcystoid spaces in the INL and a normal retinal thickness.ConclusionsThe use of the proposed definitions may provide uniform language for clinicians and future research

Organizational knowledge transfer through creation, mobilization and diffusion: A case analysis of InTouch within Schlumberger

There is a paucity of theory for the effective management of knowledge transfer within large organisations. Practitioners continue to rely upon ‘experimental’ approaches to address the problem. This research attempts to reduce the gap between theory and application, thereby improving conceptual clarity for the transfer of knowledge. The paper, through an in-depth case analysis conducted within Schlumberger, studies the adoption of an intranet-based knowledge management (KM) system (called InTouch) to support, strategically align and transfer knowledge resources. The investigation was undertaken through the adoption of a robust methodological approach (abductive strategy) incorporating the role of technology as an enabler of knowledge management application. Consequently, the study addressed the important question of translating theoretical benefits of KM into practical reality. The research formulates a set of theoretical propositions which are seen as key to the development of an effective knowledge based infrastructure. The findings identify 30 generic attributes that are essential to the creation, mobilisation and diffusion of organisational knowledge. The research makes a significant contribution to identifying a theoretical and empirically based agenda for successful intranet-based KM which will be of benefit to both the academic and practitioner communities. The paper also highlights and proposes important areas for further research

Value, Kaizen and Knowledge Management: Developing a Knowledge Management Strategy for Southampton Solent University

The process of development of the strategic plan for Southampton Solent University offered a vehicle for the development of kaizen and knowledge management (KM) activities within the institution. The essential overlap between the methods offers clear benefits in the HE environment. In consideration of the aspects of KM and kaizen, various potential opportunities were identified as targets for improvement, and clarified by knowledge audit as to value and viability. The derived outcomes are listed along with some of the principal factors and perceived barriers in the practical implementation of the outcomes. Knowledge audit applied here focused on the identification of where value arises within the business. Resource constraints and the practicalities of a people-centred system limit the permissible rate of innovation, so precise focus on the areas of business activity of most significance to the mission and client base is crucial. The fundamental question of whether such a strategy should be developed as a separate strand or embedded into existing strategies is discussed. In practice, Solent has chosen to embed, principally for reasons of maintenance of ownership and commitment. Confidence in the process has been built through prior success with trialled activities around retention, where an activity-based pedagogic framework was adopted to address issues with an access course. Other areas of early intervention include the development and reengineering of recruitment and admissions processes, and the development of activities and pedagogy based on the virtual learning environment as exemplars of the importance of cyclical feedback in continuous improvement. The inherent complexity of processes running across the university as an organisation offers opportunities for benefits from the through-process approach implicit in kaizen. The business value of the institution is in the skills of its employees and its deployed intellectual property, and thus the importance of the enhancement of both tangible assets and intangible processes is critical to future success

Understanding the role of performance targets in transport policy

The measurement of performance in the public sector has become increasingly important in recent years and it is now commonplace for transport organisations, and local and national governments, to publish performance goals for service supply and quality. Such commitments, when time referenced, are known as targets. This paper explain how changes in management style, consumer rights legislation, contractual obligations and other factors have combined to make management-by targets increasingly common in the public sector. The advantages and disadvantages of management-by-targets are illustrated through discussion of the processes and experience of setting transport targets in UK national transport policy. We conclude that while some of the targets have had a significant impact on policy makers, managers and their agents, the effects have not always been as intended

Lean enough: Institutional logics of best practice and managerial satisficing in American manufacturing

Rational choice theory has been widely criticized for its unrealistic assumptions that individuals have perfect information and computer-like information processing capability, which are used to maximize utility. Sociological institutionalism and the behavioral theory of the firm have developed complementary alternatives. I combine the two into a single model of information processing. Institutional logics are central to top-down (schema-driven) processes that focus attention and guide action. Satisficing—settling for good enough based on a given aspiration level—is critical to bottomup (feedback-driven) information processing. Here I show that two practices associated with the postfordist logic of the capitalist firm—lean production and worker empowerment—are deeply institutionalized as best practice in the American manufacturing field. Based on interviews with 109 individuals in 31 firms, I demonstrate how moderate aspiration levels and conceptual schemas associated with formerly dominant fordist institutional logics both function to limit the adoption of best practice

Evolutionary macroeconomic assessment of employment and innovation impacts of climate policy packages

Climate policy has been mainly studied with economic models that assume representative, rational agents. Such policy aims, though, at changing carbon-intensive consumption and production patterns driven by bounded rationality and other-regarding preferences, such as status and imitation. To examine climate policy under such alternative behavioral assumptions, we develop a model tool by adapting an existing general-purpose macroeconomic multi-agent model. The resulting tool allows testing various climate policies in terms of combined climate and economic performance. The model is particularly suitable to address the distributional impacts of climate policies, not only because populations of many agents are included, but also as these are composed of different classes of households. The approach accounts for two types of innovations, which improve either the carbon or labor intensity of production. We simulate policy scenarios with distinct combinations of carbon taxation, a reduction of labor taxes, subsidies for green innovation, a price subsidy to consumers for less carbon-intensive products, and green government procurement. The results show pronounced differences with those obtained by rational-agent model studies. It turns out that a supply-oriented subsidy for green innovation, funded by the revenues of a carbon tax, results in a significant reduction of carbon emissions without causing negative effects on em ployment. On the contrary, demand-oriented subsidies for adopting greener technologies, funded in the same manner, result in either none or considerably less re- duction of carbon emissions and may even lead to higher unemployment. Our study also contributes insight on a potential double dividend of shifting taxes from labor to carbon

The developing field of integrated vehicle health management

The goals that are being set for aviation growth in the near future, combined with the growth in service provision, are unattainable without active health management of airplanes. Numbers associated with door to door travel time and accident rates, coupled with availability demands to provide cost-effective transport, simply do not allow time for unscheduled maintenance. We are therefore going to experience a step jump in the take up of Integrated Vehicle Health Management (IVHM) on these platforms in order to give accurate warning of sub-system and component degradation, allowing for maintenance to be carried out in a timely, scheduled, manner. This paper describes the development of IVHM, covering emerging services, standards, technology and IVHM as used in various industry sectors. This will lead to the commercial picture of today with the top level goals that are being set, providing the business push for technology and its adoption. Examples of research being conducted in the field will be shown, to support the claim that real progress is being made, with implementation of this technology on the horizon.http://www.aerojournalindia.com/journal.htm