An Exploratory Study of Patient Falls

Debate continues between the contribution of education level and clinical expertise in the nursing practice environment. Research suggests a link between Baccalaureate of Science in Nursing (BSN) nurses and positive patient outcomes such as lower mortality, decreased falls, and fewer medication errors. Purpose: To examine if there a negative correlation between patient falls and the level of nurse education at an urban hospital located in Midwest Illinois during the years 2010-2014? Methods: A retrospective crosssectional cohort analysis was conducted using data from the National Database of Nursing Quality Indicators (NDNQI) from the years 2010-2014. Sample: Inpatients aged ≥ 18 years who experienced a unintentional sudden descent, with or without injury that resulted in the patient striking the floor or object and occurred on inpatient nursing units. Results: The regression model was constructed with annual patient falls as the dependent variable and formal education and a log transformed variable for percentage of certified nurses as the independent variables. The model overall is a good fit, F (2,22) = 9.014, p = .001, adj. R2 = .40. Conclusion: Annual patient falls will decrease by increasing the number of nurses with baccalaureate degrees and/or certifications from a professional nursing board-governing body

Using real options to select stable Middleware-induced software architectures

The requirements that force decisions towards building distributed system architectures are usually of a non-functional nature. Scalability, openness, heterogeneity, and fault-tolerance are examples of such non-functional requirements. The current trend is to build distributed systems with middleware, which provide the application developer with primitives for managing the complexity of distribution, system resources, and for realising many of the non-functional requirements. As non-functional requirements evolve, the `coupling' between the middleware and architecture becomes the focal point for understanding the stability of the distributed software system architecture in the face of change. It is hypothesised that the choice of a stable distributed software architecture depends on the choice of the underlying middleware and its flexibility in responding to future changes in non-functional requirements. Drawing on a case study that adequately represents a medium-size component-based distributed architecture, it is reported how a likely future change in scalability could impact the architectural structure of two versions, each induced with a distinct middleware: one with CORBA and the other with J2EE. An option-based model is derived to value the flexibility of the induced-architectures and to guide the selection. The hypothesis is verified to be true for the given change. The paper concludes with some observations that could stimulate future research in the area of relating requirements to software architectures

A mixed integer linear programming model for optimal sovereign debt issuance

Copyright @ 2011, Elsevier. NOTICE: this is the author’s version of a work that was accepted for publication in the European Journal of Operational Research. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version is available at the link below.Governments borrow funds to finance the excess of cash payments or interest payments over receipts, usually by issuing fixed income debt and index-linked debt. The goal of this work is to propose a stochastic optimization-based approach to determine the composition of the portfolio issued over a series of government auctions for the fixed income debt, to minimize the cost of servicing debt while controlling risk and maintaining market liquidity. We show that this debt issuance problem can be modeled as a mixed integer linear programming problem with a receding horizon. The stochastic model for the interest rates is calibrated using a Kalman filter and the future interest rates are represented using a recombining trinomial lattice for the purpose of scenario-based optimization. The use of a latent factor interest rate model and a recombining lattice provides us with a realistic, yet very tractable scenario generator and allows us to do a multi-stage stochastic optimization involving integer variables on an ordinary desktop in a matter of seconds. This, in turn, facilitates frequent re-calibration of the interest rate model and re-optimization of the issuance throughout the budgetary year allows us to respond to the changes in the interest rate environment. We successfully demonstrate the utility of our approach by out-of-sample back-testing on the UK debt issuance data

The informativeness of stochastic frontier and programming frontier efficiency scores: Cost efficiency and other measures of bank holding company performance

This paper examines the properties of the X-inefficiencies in U.S. bank holding companies derived from both stochastic and linear programming frontiers. This examination allows the robustness of results across methods to be compared. While we find that calculated programming inefficiency scores are two to three times larger than those estimated using a stochastic frontier, the patterns of the scores across banks and time are similar, and there is a relatively high correlation of the rankings of banks' efficiencies under the two methods. However, when we examine the "informativeness" of the efficiency measured by the two different techniques, we find some large differences. We find evidence that the stochastic frontier scores are more closely related to risk-taking behavior, managerial competence, and bank stock returns. Based on these findings, we conclude that while both methods produce informative efficiency scores, for this data set decision makers should put more weight on the stochastic frontier efficiency estimates.Bank holding companies ; Banks and banking - Costs

Working in decentralised service systems: challenges and choices for the Australian aid program

The report examined Australia’s support for service systems in decentralised contexts - the evaluation focussed on the health, education and infrastructure (water, sanitation and roads) sectors. Foreword Public services have been decentralised in most countries where Australia provides aid. This means Australia, like other donors, must be willing and able to engage effectively with developing country governments at all levels to improve service delivery. To ensure sustainable improvements, this engagement should carefully coordinate support for governance reforms with assistance to strengthen or expand service delivery systems. As the World Bank has observed, done well, decentralisation can result in more efficient and effective services for communities. However, done poorly, or where the context is inappropriate, decentralisation may have negative effects. This evaluation builds on the Office of Development Effectiveness’s 2009 evaluation of Australian aid for service delivery. It answers important questions about whether Australian aid has appropriately considered the role of subnational authorities, including specific issues identified in 2009. It assesses how well Australian aid has addressed the challenges of decentralisation, with a focus on the major sectors of education, health and infrastructure. This evaluation utilised a clear methodology, applied it consistently, and draws together a range of evidence to provide a balanced account of Australian aid performance. It concludes that Australian aid is beginning to respond to the challenges of supporting service delivery in decentralised contexts, but notes that results are mixed and there is room for further improvement. The evaluation suggests Australia needs to improve its country-level analysis, program planning and design to better address decentralisation. In particular, there is a need to carefully assess short-term service delivery needs against long-term structures and incentives for governments to achieve sustainable service delivery and meet sovereign responsibilities. Australia needs to get the right balance of engagement with different levels of government, and appropriately address both supply and demand aspects of service delivery, especially to improve equity.   &nbsp

United Nations Development Assistance Framework for Kenya

The United Nations Development Assistance Framework (2014-2018) for Kenya is an expression of the UN's commitment to support the Kenyan people in their self-articulated development aspirations. This UNDAF has been developed according to the principles of UN Delivering as One (DaO), aimed at ensuring Government ownership, demonstrated through UNDAF's full alignment to Government priorities and planning cycles, as well as internal coherence among UN agencies and programmes operating in Kenya. The UNDAF narrative includes five recommended sections: Introduction and Country Context, UNDAF Results, Resource Estimates, Implementation Arrangements, and Monitoring and Evaluation as well as a Results and Resources Annex. Developed under the leadership of the Government, the UNDAF reflects the efforts of all UN agencies working in Kenya and is shaped by the five UNDG programming principles: Human Rights-based approach, gender equality, environmental sustainability, capacity development, and results based management. The UNDAF working groups have developed a truly broad-based Results Framework, in collaboration with Civil Society, donors and other partners. The UNDAF has four Strategic Results Areas: 1) Transformational Governance encompassing Policy and Institutional Frameworks; Democratic Participation and Human Rights; Devolution and Accountability; and Evidence-based Decision-making, 2) Human Capital Development comprised of Education and Learning; Health, including Water, Sanitation and Hygiene (WASH), Environmental Preservation, Food Availability and Nutrition; Multi-sectoral HIV and AIDS Response; and Social Protection, 3) Inclusive and Sustainable Economic Growth, with Improving the Business Environment; Strengthening Productive Sectors and Trade; and Promoting Job Creation, Skills Development and Improved Working Conditions, and 4) Environmental Sustainability, Land Management and Human Security including Policy and Legal Framework Development; and Peace, Community Security and Resilience. The UNDAF Results Areas are aligned with the three Pillars (Political, Social and Economic) of the Government's Vision 2030 transformational agenda

Mission Investing in Europe – A Meta-analysis

Unter dem Oberbegriff “Mission Investing” (MI) versteht sich die Praxis bei Nonprofit Organisationen (NPO), das organisationseigene Sachziel in die Anlagestrategie mit einzuschliessen. Trotz stets steigender Popularität fehlt dem Konzept bisher weitgehend eine wissen schaftliche Fundierung. Mittels einer begrifflichen Diskussion identifiziert dieser Beitrag Schlüsselmerkmale des Anlagekonzepts. Diese Merkmale umfassen unter anderem den Einschluss von non-monetären Anlagezielen, welche eng mit dem Organisationszweck verwandt sind, sowie die Zielsetzung der effektiveren Umsetzung des Organisationszwecks durch die Verknüpfung von Anlage - und Förderpolitik. Weiter vergleicht dieser Beitrag im Rahmen einer Metaanalyse neu erschienene Daten zum aktuellen Umsetzungsstand von MI in Europa. Ausgehend von den drei Instrumenten des MI(Screening, Shareholder Advocacy und Proactive Mission Investing) wird dieses derzeit am häufigsten mittels Screening umgesetzt

Power, Responsibility, and Accountability: Re-Thinking the Legitimacy of Institutions for Climate Finance

Offers lessons from current mechanisms to finance climate mitigation and adaptation and considerations for legitimacy in new ones: the capacity to determine outcomes, the exercise of power as intended, and standards and systems to ensure accountability