The rhetoric of failure: a hyper-dialog about method in economics and how to get things going

All are agreed that orthodox economics is unsatisfactory but there is wide disagreement, especially among heterodox critics, whether the problems lie at the level of substantive theory or at the level of methodology. This paper gives first an overview of the methodological questions at issue. The frame of reference includes J. S. Mill, Jevons, Popper, Keynes, and Lawson. Drawing on the conclusions, the domain of economics is subsequently refocused. Human behavior is moved from the center to the periphery. From elementary systemic properties the relation of income and profit is then consistently derived. This solves the profit conundrum

Computerization of workflows, guidelines and care pathways: a review of implementation challenges for process-oriented health information systems

There is a need to integrate the various theoretical frameworks and formalisms for modeling clinical guidelines, workflows, and pathways, in order to move beyond providing support for individual clinical decisions and toward the provision of process-oriented, patient-centered, health information systems (HIS). In this review, we analyze the challenges in developing process-oriented HIS that formally model guidelines, workflows, and care pathways. A qualitative meta-synthesis was performed on studies published in English between 1995 and 2010 that addressed the modeling process and reported the exposition of a new methodology, model, system implementation, or system architecture. Thematic analysis, principal component analysis (PCA) and data visualisation techniques were used to identify and cluster the underlying implementation ‘challenge’ themes. One hundred and eight relevant studies were selected for review. Twenty-five underlying ‘challenge’ themes were identified. These were clustered into 10 distinct groups, from which a conceptual model of the implementation process was developed. We found that the development of systems supporting individual clinical decisions is evolving toward the implementation of adaptable care pathways on the semantic web, incorporating formal, clinical, and organizational ontologies, and the use of workflow management systems. These architectures now need to be implemented and evaluated on a wider scale within clinical settings

A system dynamics-based simulation study for managing clinical governance and pathways in a hospital

This paper examines the development of clinical pathways in a hospital in Australia based on empirical clinical data of patient episodes. A system dynamics (SD)-based decision support system (DSS) is developed and analyzed for this purpose. System dynamics was used as the simulation modeling tool because of its rigorous approach in capturing interrelationships among variables and in handling dynamic aspects of the system behavior in managing healthcare. The study highlights the scenarios that will help hospital administrators to redistribute caseloads amongst admitting clinicians with a focus on multiple Diagnostic Related Groups (DRG’s) as the means to improve the patient turnaround and hospital throughput without compromising quality patient care. DRG’s are the best known classification system used in a casemix funding model. The classification system groups inpatient stays into clinically meaningful categories of similar levels of complexity that consume similar amounts of resources. Policy explorations reveal various combinations of the dominant policies that hospital management can adopt. The analyses act as a scratch pad for the executives as they understand what can be feasibly achieved by the implementation of clinical pathways given a number of constraints. With the use of visual interfaces, executives can manipulate the DSS to test various scenarios. Experimental evidence based on focus groups demonstrated that the DSS can enhance group learning processes and improve decision making. The simulation model findings support recent studies of CP implementation on various DRG’s published in the medical literature. These studies showed substantial reductions in length of stay, costs and resource utilization

Rethinking fuelwood: people, policy and the anatomy of a charcoal supply chain in a decentralizing Peru

In Peru, as in many developing countries, charcoal is an important source of fuel. We examine the commercial charcoal commodity chain from its production in Ucayali, in the Peruvian Amazon, to its sale in the national market. Using a mixed-methods approach, we look at the actors involved in the commodity chain and their relationships, including the distribution of benefits along the chain. We outline the obstacles and opportunities for a more equitable charcoal supply chain within a multi-level governance context. The results show that charcoal provides an important livelihood for most of the actors along the supply chain, including rural poor and women. We find that the decentralisation process in Peru has implications for the formalisation of charcoal supply chains, a traditionally informal, particularly related to multi-level institutional obstacles to equitable commerce. This results in inequity in the supply chain, which persecutes the poorest participants and supports the most powerful actors

Automatic production and integration of knowledge to the support of the decision and planning activities in medical-clinical diagnosis, treatment and prognosis.

El concepto de procedimiento médico se refiere al conjunto de actividades seguidas por los profesionales de la salud para solucionar o mitigar el problema de salud que afecta a un paciente. La toma de decisiones dentro del procedimiento médico ha sido, por largo tiempo, uno de las áreas más interesantes de investigación en la informática médica y el contexto de investigación de esta tesis. La motivación para desarrollar este trabajo de investigación se basa en tres aspectos fundamentales: no hay modelos de conocimiento para todas las actividades médico-clínicas que puedan ser inducidas a partir de datos médicos, no hay soluciones de aprendizaje inductivo para todas las actividades de la asistencia médica y no hay un modelo integral que formalice el concepto de procedimiento médico. Por tanto, nuestro objetivo principal es desarrollar un modelo computable basado en conocimiento que integre todas las actividades de decisión y planificación para el diagnóstico, tratamiento y pronóstico médico-clínicos. Para alcanzar el objetivo principal, en primer lugar, explicamos el problema de investigación. En segundo lugar, describimos los antecedentes del problema de investigación desde los contextos médico e informático. En tercer lugar, explicamos el desarrollo de la propuesta de investigación, basada en cuatro contribuciones principales: un nuevo modelo, basado en datos y conocimiento, para la actividad de planificación en el diagnóstico y tratamiento médico-clínicos; una novedosa metodología de aprendizaje inductivo para la actividad de planificación en el diagnóstico y tratamiento médico-clínico; una novedosa metodología de aprendizaje inductivo para la actividad de decisión en el pronóstico médico-clínico, y finalmente, un nuevo modelo computable, basado en datos y conocimiento, que integra las actividades de decisión y planificación para el diagnóstico, tratamiento y pronóstico médico-clínicos.The concept of medical procedure refers to the set of activities carried out by the health care professionals to solve or mitigate the health problems that affect a patient. Decisions making within a medical procedure has been, for a long time, one of the most interesting research areas in medical informatics and the research context of this thesis. The motivation to develop this research work is based on three main aspects: Nowadays there are not knowledge models for all the medical-clinical activities that can be induced from medical data, there are not inductive learning solutions for all the medical-clinical activities, and there is not an integral model that formalizes the concept of medical procedure. Therefore, our main objective is to develop a computable model based in knowledge that integrates all the decision and planning activities for the medical-clinical diagnosis, treatment and prognosis. To achieve this main objective: first, we explain the research problem. Second, we describe the background of the work from both the medical and the informatics contexts. Third, we explain the development of the research proposal based on four main contributions: a novel knowledge representation model, based in data, to the planning activity in medical-clinical diagnosis and treatment; a novel inductive learning methodology to the planning activity in diagnosis and medical-clinical treatment; a novel inductive learning methodology to the decision activity in medical-clinical prognosis, and finally, a novel computable model, based on data and knowledge, which integrates the decision and planning activities of medical-clinical diagnosis, treatment and prognosis

Public complaints: An instrument to improve services in public institution of higher learning in post modern era. Case study: Student Affairs Department in Universiti Utara Malaysia

Jurgen Habermas dan Anthony Giddens are among other postmodern thinkers have proposed the theory of public sphere and social reflexivity. Because postmodenism has undermined the structure and function of the society and gives extra power to the periphery and individuals, the rise for individual participation in voicing out their need and wants is seen as important so that decision made at the top rung of the society reflect the masses. According to Habermas, in post modern era where tradition is lacking, people are losing trust and confidence in an abstract system – the system governing them beyond their immediate surrounding. To encounter it, citizen should be given power to participate in decision making. Habermas idea is supported by Giddens with his social reflexivity concept that suggests inputting public trust back into social institution. In coherence with this argument, the paper will discuss on the public complaint in public institution which is seen as a way to improve public services. The study is carried out in Student Affairs department in Universiti Utara Malaysia in 2003. The objectives of the study is to measure the level of awareness of the services offered at the Complaint Unit HEP and complaints by the students of the university. The paper will then discuss the findings and suggests ways to improve existing systems so that the quality of service is further enhanced

Managing Growth: Best Practices of Family-Owned Businesses

Family-owned businesses represent the majority of business in the United States. As consumers and employees, we are compelled to their sense of trustworthiness that all too often disappears in the business world. Our economy depends on the success of family-owned businesses, but only one third of these organizations successfully transition to the second generation and only one in ten survive to the third generation. While a series of best practices attempt to prescribe solutions their challenges, these practices fail to account for the various types of family-owned businesses. More specifically, many types of family-owned businesses exist as evident by specific transitions in terms of ownership, family and business. Therefore, the study of best practices in family firms must consider the timing of implementation. This study analyzes three family-owned businesses that successfully transitioned from start-up businesses owned by a single controlling owner ready to give up control to an expanding business owned by a sibling partnership with young children. From this analysis of a specific type of family-owned business, six common practices emerged

A quality-of-data aware mobile decision support system for patients with chronic illnesses

We present a mobile decision support system (mDSS) which runs on a patient Body Area Network consisting of a smartphone and a set of biosensors. Quality-of-Data (QoD) awareness in decision making is achieved by means of a component known as the Quality-of-Data Broker, which also runs on the smartphone. The QoD-aware mDSS collaborates with a more sophisticated decision support system running on a fixed back-end server in order to provide distributed decision support. This distributed decision support system has been implemented as part of a larger system developed during the European project MobiGuide. The MobiGuide system is a guideline-based Patient Guidance System designed to assist patients in the management of chronic illnesses. The system, including the QOD-aware mDSS, has been validated by clinicians and is being evaluated in patient pilots against two clinical guidelines