7,190 research outputs found

    TeamSTEPPS and Organizational Culture

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    Patient safety issues remain despite several strategies developed for their deterrence. While many safety initiatives bring about improvement, they are repeatedly unsustainable and short-lived. The index hospital’s goal was to build an organizational culture within a groundwork that improves teamwork and continuing healthcare team engagement. Teamwork influences the efficiency of patient care, patient safety, and clinical outcomes, as it has been identified as an approach for enhancing collaboration, decreasing medical errors, and building a culture of safety in healthcare. The facility implemented Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS), an evidence-based framework which was used for team training to produce valuable and needed changes, facilitating modification of organizational culture, increasing patient safety compliance, or solving particular issues. This study aimed to identify the correlation between TeamSTEPPS enactment and improved organizational culture in the ambulatory care nursing department of a New York City public hospital

    An Exploration of the Suitability of Pharmacy Education in Saudi Arabia to Prepare Graduates to Meet Healthcare Needs: a Mixed-Methods Study

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    The key role of pharmacists within the health system, particularly in optimising safe, responsible and effective use of medicines, underpins the demand for a highly skilled and competent workforce. Therefore, developing the capacity of pharmacists to attain and maintain essential competencies relevant to the population’s health needs is required to ensure a high standard of patient care, thereby helping to improve patient and population health. In Saudi Arabia, little evidence exists regarding the assessment of national educational programmes’ structure and outcomes. Moreover, no national competency framework exists for pharmacists in any sector or stage of practice. In the absence of such core quality elements to inform pharmacy education assessment and development, the extent to which pharmacy schools in Saudi Arabia prepare competent pharmacists to address societal needs from pharmacy services is unclear. Therefore, this study aimed to explore the extent to which pharmacy education can prepare competent pharmacists to address the healthcare needs for pharmacy practice in Saudi Arabia. An exploratory sequential mixed methods research design was used to address the aim of this study in three phases: individual interviews and focus groups were employed with a purposively selected sample of pharmacy policy makers, pharmacists and the public to explore societal healthcare needs and the roles required of pharmacists to meet those needs; a national online survey of pharmacists and an online nominal group consensus method of pharmacy experts were used to identify competencies considered essential to develop a profession-wide national foundation level competency framework; and a case study in which curriculum mapping of two purposively selected Doctor of Pharmacy (PharmD) curricula was used to assess the extent to which the current pharmacy programme in Saudi Arabia meets the identified competencies of the developed national competency framework. Based on qualitative and quantitative analyses of societal healthcare needs, pharmacists’ roles, core competencies and curricular contents within the local context of Saudi Arabia, findings showed that there is a mismatch between initial education and real practice needs and expectations. While the country’s current needs from pharmacists are to optimise health system capacity and increase access to primary care services and medicines expertise in community pharmacies, the study indicated local education is product-oriented with a focus of curricular content and experiential training opportunities in most schools on preparing future pharmacists for hospital pharmacy practice. The study also identified several gaps between current initial education programmes and the competencies required to practise the expected roles, suggesting that current initial education might not prepare the students sufficiently to provide the full range of quality pharmaceutical services as per the country’s pharmacy practice needs. The study provided a new understanding of graduates’ readiness to practise as per the country’s pharmacy practice needs, the quality of educational programmes and pharmacists' professional development opportunities in Saudi Arabia. Findings maybe used to inform the development of competency-based education and maximise graduates’ capacity to deliver and develop pharmaceutical services effectively to best meet societal healthcare needs in Saudi Arabia

    An empirical investigation of the relationship between integration, dynamic capabilities and performance in supply chains

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    This research aimed to develop an empirical understanding of the relationships between integration, dynamic capabilities and performance in the supply chain domain, based on which, two conceptual frameworks were constructed to advance the field. The core motivation for the research was that, at the stage of writing the thesis, the combined relationship between the three concepts had not yet been examined, although their interrelationships have been studied individually. To achieve this aim, deductive and inductive reasoning logics were utilised to guide the qualitative study, which was undertaken via multiple case studies to investigate lines of enquiry that would address the research questions formulated. This is consistent with the author’s philosophical adoption of the ontology of relativism and the epistemology of constructionism, which was considered appropriate to address the research questions. Empirical data and evidence were collected, and various triangulation techniques were employed to ensure their credibility. Some key features of grounded theory coding techniques were drawn upon for data coding and analysis, generating two levels of findings. These revealed that whilst integration and dynamic capabilities were crucial in improving performance, the performance also informed the former. This reflects a cyclical and iterative approach rather than one purely based on linearity. Adopting a holistic approach towards the relationship was key in producing complementary strategies that can deliver sustainable supply chain performance. The research makes theoretical, methodological and practical contributions to the field of supply chain management. The theoretical contribution includes the development of two emerging conceptual frameworks at the micro and macro levels. The former provides greater specificity, as it allows meta-analytic evaluation of the three concepts and their dimensions, providing a detailed insight into their correlations. The latter gives a holistic view of their relationships and how they are connected, reflecting a middle-range theory that bridges theory and practice. The methodological contribution lies in presenting models that address gaps associated with the inconsistent use of terminologies in philosophical assumptions, and lack of rigor in deploying case study research methods. In terms of its practical contribution, this research offers insights that practitioners could adopt to enhance their performance. They can do so without necessarily having to forgo certain desired outcomes using targeted integrative strategies and drawing on their dynamic capabilities

    Utilitarianism and the Social Nature of Persons

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    This thesis defends utilitarianism: the view that as far as morality goes, one ought to choose the option which will result in the most overall well-being. Utilitarianism is widely rejected by philosophers today, largely because of a number of influential objections. In this thesis I deal with three of them. Each is found in Bernard Williams’s ‘A Critique of Utilitarianism’ (1973). The first is the Integrity Objection, an intervention that has been influential whilst being subject to a wide variety of interpretations. In Chapter Two I give my interpretation of Williams’s Integrity objection; in Chapter Three I discuss one common response to it, and in Chapters Four and Five I give my own defence of utilitarianism against it. In Chapter Six I discuss a second objection: the problem of pre-emption. This problem is also found in Williams, but has received greater attention through the work of other authors in recent years. It suggests that utilitarianism is unable to deal with some of the modern world’s most pressing moral problems, and raises an internal tension between the twin utilitarian aims of making a difference and achieving the best outcomes. In Chapter Seven I discuss a third objection: that utilitarianism is insufficiently egalitarian. I find this claim to be unwarranted, in light of recent social science and philosophy. My responses to Williams’s objections draw upon resources from the socialist tradition – in particular, that tradition’s emphasis on the importance of social connections between individuals. Socialists have often been hostile to utilitarianism, in part for socialist-inflected versions of Williams’s objections. Thus, in responding to these objections I aim to demonstrate that socialist thought contains the means to defuse not only mainstream philosophy’s rejection of utilitarianism but also its own, and thus to re-open the possibilities for a productive engagement between the two traditions

    Tourism and heritage in the Chornobyl Exclusion Zone

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    Tourism and Heritage in the Chornobyl Exclusion Zone (CEZ) uses an ethnographic lens to explore the dissonances associated with the commodification of Chornobyl's heritage. The book considers the role of the guides as experience brokers, focusing on the synergy between tourists and guides in the performance of heritage interpretation. Banaszkiewicz proposes to perceive tour guides as important actors in the bottom-up construction of heritage discourse contributing to more inclusive and participatory approach to heritage management. Demonstrating that the CEZ has been going through a dynamic transformation into a mass tourism attraction, the book offers a critical reflection on heritagisation as a meaning-making process in which the resources of the past are interpreted, negotiated, and recognised as a valuable legacy. Applying the concepts of dissonant heritage to describe the heterogeneous character of the CEZ, the book broadens the interpretative scope of dark tourism which takes on a new dimension in the context of the war in Ukraine. Tourism and Heritage in the Chornobyl Exclusion Zone argues that post-disaster sites such as Chornobyl can teach us a great deal about the importance of preserving cultural and natural heritage for future generations. The book will be of interest to academics and students who are engaged in the study of heritage, tourism, memory, disasters and Eastern Europe

    Knowledge-based Modelling of Additive Manufacturing for Sustainability Performance Analysis and Decision Making

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    Additiivista valmistusta on pidetty kÀyttökelpoisena monimutkaisissa geometrioissa, topologisesti optimoiduissa kappaleissa ja kappaleissa joita on muuten vaikea valmistaa perinteisillÀ valmistusprosesseilla. Eduista huolimatta, yksi additiivisen valmistuksen vallitsevista haasteista on ollut heikko kyky tuottaa toimivia osia kilpailukykyisillÀ tuotantomÀÀrillÀ perinteisen valmistuksen kanssa. Mallintaminen ja simulointi ovat tehokkaita työkaluja, jotka voivat auttaa lyhentÀmÀÀn suunnittelun, rakentamisen ja testauksen sykliÀ mahdollistamalla erilaisten tuotesuunnitelmien ja prosessiskenaarioiden nopean analyysin. Perinteisten ja edistyneiden valmistusteknologioiden mahdollisuudet ja rajoitukset mÀÀrittelevÀt kuitenkin rajat uusille tuotekehityksille. Siksi on tÀrkeÀÀ, ettÀ suunnittelijoilla on kÀytettÀvissÀÀn menetelmÀt ja työkalut, joiden avulla he voivat mallintaa ja simuloida tuotteen suorituskykyÀ ja siihen liittyvÀn valmistusprosessin suorituskykyÀ, toimivien korkea arvoisten tuotteiden toteuttamiseksi. Motivaation tÀmÀn vÀitöstutkimuksen tekemiselle on, meneillÀÀn oleva kehitystyö uudenlaisen korkean lÀmpötilan suprajohtavan (high temperature superconducting (HTS)) magneettikokoonpanon kehittÀmisessÀ, joka toimii kryogeenisissÀ lÀmpötiloissa. Sen monimutkaisuus edellyttÀÀ monitieteisen asiantuntemuksen lÀhentymistÀ suunnittelun ja prototyyppien valmistuksen aikana. Tutkimus hyödyntÀÀ tietopohjaista mallinnusta valmistusprosessin analysoinnin ja pÀÀtöksenteon apuna HTS-magneettien mekaanisten komponenttien suunnittelussa. TÀmÀn lisÀksi, tutkimus etsii mahdollisuuksia additiivisen valmistuksen toteutettavuuteen HTS-magneettikokoonpanon tuotannossa. Kehitetty lÀhestymistapa kÀyttÀÀ fysikaalisiin kokeisiin perustuvaa tuote-prosessi-integroitua mallinnusta tuottamaan kvantitatiivista ja laadullista tietoa, joka mÀÀrittelee prosessi-rakenne-ominaisuus-suorituskyky-vuorovaikutuksia tietyille materiaali-prosessi-yhdistelmille. Tuloksina saadut vuorovaikutukset integroidaan kaaviopohjaiseen malliin, joka voi auttaa suunnittelutilan tutkimisessa ja tÀten auttaa varhaisessa suunnittelu- ja valmistuspÀÀtöksenteossa. TÀtÀ varten testikomponentit valmistetaan kÀyttÀmÀllÀ kahta metallin additiivista valmistus prosessia: lankakaarihitsaus additiivista valmistusta (wire arc additive manufacturing) ja selektiivistÀ lasersulatusta (selective laser melting). Rakenteellisissa sovelluksissa yleisesti kÀytetyistÀ metalliseoksista (ruostumaton terÀs, pehmeÀ terÀs, luja niukkaseosteinen terÀs, alumiini ja kupariseokset) testataan niiden mekaaniset, lÀmpö- ja sÀhköiset ominaisuudet. LisÀksi tehdÀÀn metalliseosten mikrorakenteen karakterisointi, jotta voidaan ymmÀrtÀÀ paremmin valmistusprosessin parametrien vaikutusta materiaalin ominaisuuksiin. Integroitu mallinnustapa yhdistÀÀ kerÀtyn kokeellisen tiedon, olemassa olevat analyyttiset ja empiiriset vuorovaikutus suhteet, sekÀ muut tietopohjaiset mallit (esim. elementtimallit, koneoppimismallit) pÀÀtöksenteon tukijÀrjestelmÀn muodossa, joka mahdollistaa optimaalisen materiaalin, valmistustekniikan, prosessiparametrien ja muitten ohjausmuuttujien valinnan, lopullisen 3d-tulosteun komponentin halutun rakenteen, ominaisuuksien ja suorituskyvyn saavuttamiseksi. ValmistuspÀÀtöksenteko tapahtuu todennÀköisyysmallin, eli Bayesin verkkomallin toteuttamisen kautta, joka on vankka, modulaarinen ja sovellettavissa muihin valmistusjÀrjestelmiin ja tuotesuunnitelmiin. VÀitöstyössÀ esitetyn mallin kyky parantaa additiivisien valmistusprosessien suorituskykyÀ ja laatua, tÀten edistÀÀ kestÀvÀn tuotannon tavoitteita.Additive manufacturing (AM) has been considered viable for complex geometries, topology optimized parts, and parts that are otherwise difficult to produce using conventional manufacturing processes. Despite the advantages, one of the prevalent challenges in AM has been the poor capability of producing functional parts at production volumes that are competitive with traditional manufacturing. Modelling and simulation are powerful tools that can help shorten the design-build-test cycle by enabling rapid analysis of various product designs and process scenarios. Nevertheless, the capabilities and limitations of traditional and advanced manufacturing technologies do define the bounds for new product development. Thus, it is important that the designers have access to methods and tools that enable them to model and simulate product performance and associated manufacturing process performance to realize functional high value products. The motivation for this dissertation research stems from ongoing development of a novel high temperature superconducting (HTS) magnet assembly, which operates in cryogenic environment. Its complexity requires the convergence of multidisciplinary expertise during design and prototyping. The research applies knowledge-based modelling to aid manufacturing process analysis and decision making in the design of mechanical components of the HTS magnet. Further, it explores the feasibility of using AM in the production of the HTS magnet assembly. The developed approach uses product-process integrated modelling based on physical experiments to generate quantitative and qualitative information that define process-structure-property-performance interactions for given material-process combinations. The resulting interactions are then integrated into a graph-based model that can aid in design space exploration to assist early design and manufacturing decision-making. To do so, test components are fabricated using two metal AM processes: wire and arc additive manufacturing and selective laser melting. Metal alloys (stainless steel, mild steel, high-strength low-alloyed steel, aluminium, and copper alloys) commonly used in structural applications are tested for their mechanical-, thermal-, and electrical properties. In addition, microstructural characterization of the alloys is performed to further understand the impact of manufacturing process parameters on material properties. The integrated modelling approach combines the collected experimental data, existing analytical and empirical relationships, and other data-driven models (e.g., finite element models, machine learning models) in the form of a decision support system that enables optimal selection of material, manufacturing technology, process parameters, and other control variables for attaining desired structure, property, and performance characteristics of the final printed component. The manufacturing decision making is performed through implementation of a probabilistic model i.e., a Bayesian network model, which is robust, modular, and can be adapted for other manufacturing systems and product designs. The ability of the model to improve throughput and quality of additive manufacturing processes will boost sustainable manufacturing goals

    Meta-ontology fault detection

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    Ontology engineering is the field, within knowledge representation, concerned with using logic-based formalisms to represent knowledge, typically moderately sized knowledge bases called ontologies. How to best develop, use and maintain these ontologies has produced relatively large bodies of both formal, theoretical and methodological research. One subfield of ontology engineering is ontology debugging, and is concerned with preventing, detecting and repairing errors (or more generally pitfalls, bad practices or faults) in ontologies. Due to the logical nature of ontologies and, in particular, entailment, these faults are often both hard to prevent and detect and have far reaching consequences. This makes ontology debugging one of the principal challenges to more widespread adoption of ontologies in applications. Moreover, another important subfield in ontology engineering is that of ontology alignment: combining multiple ontologies to produce more powerful results than the simple sum of the parts. Ontology alignment further increases the issues, difficulties and challenges of ontology debugging by introducing, propagating and exacerbating faults in ontologies. A relevant aspect of the field of ontology debugging is that, due to the challenges and difficulties, research within it is usually notably constrained in its scope, focusing on particular aspects of the problem or on the application to only certain subdomains or under specific methodologies. Similarly, the approaches are often ad hoc and only related to other approaches at a conceptual level. There are no well established and widely used formalisms, definitions or benchmarks that form a foundation of the field of ontology debugging. In this thesis, I tackle the problem of ontology debugging from a more abstract than usual point of view, looking at existing literature in the field and attempting to extract common ideas and specially focussing on formulating them in a common language and under a common approach. Meta-ontology fault detection is a framework for detecting faults in ontologies that utilizes semantic fault patterns to express schematic entailments that typically indicate faults in a systematic way. The formalism that I developed to represent these patterns is called existential second-order query logic (abbreviated as ESQ logic). I further reformulated a large proportion of the ideas present in some of the existing research pieces into this framework and as patterns in ESQ logic, providing a pattern catalogue. Most of the work during my PhD has been spent in designing and implementing an algorithm to effectively automatically detect arbitrary ESQ patterns in arbitrary ontologies. The result is what we call minimal commitment resolution for ESQ logic, an extension of first-order resolution, drawing on important ideas from higher-order unification and implementing a novel approach to unification problems using dependency graphs. I have proven important theoretical properties about this algorithm such as its soundness, its termination (in a certain sense and under certain conditions) and its fairness or completeness in the enumeration of infinite spaces of solutions. Moreover, I have produced an implementation of minimal commitment resolution for ESQ logic in Haskell that has passed all unit tests and produces non-trivial results on small examples. However, attempts to apply this algorithm to examples of a more realistic size have proven unsuccessful, with computation times that exceed our tolerance levels. In this thesis, I have provided both details of the challenges faced in this regard, as well as other successful forms of qualitative evaluation of the meta-ontology fault detection approach, and discussions about both what I believe are the main causes of the computational feasibility problems, ideas on how to overcome them, and also ideas on other directions of future work that could use the results in the thesis to contribute to the production of foundational formalisms, ideas and approaches to ontology debugging that can properly combine existing constrained research. It is unclear to me whether minimal commitment resolution for ESQ logic can, in its current shape, be implemented efficiently or not, but I believe that, at the very least, the theoretical and conceptual underpinnings that I have presented in this thesis will be useful to produce more foundational results in the field

    An exploration of adherence and persistence in overactive bladder and other long-term conditions

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    Background and aims Overactive bladder is a common, bothersome, and chronic condition associated with symptoms of urinary urgency, incontinence, increased daytime micturition frequency and nocturia. Despite exerting a significant burden on quality of life, adherence, and persistence behaviours with OAB are particularly poor in comparison with other long-term conditions. The aims of the present work were to explore themes relating to medicine-taking behaviours in OAB and other long-term conditions and to suggest ways to improve them. Methods A systematic literature review was undertaken to understand the current landscape of qualitative work exploring adherence and persistence with OAB patients. A qualitative study involving 1:1 semi-structured interviews was conducted with OAB patients to explore the context and drivers for adherence and persistence behaviours using thematic analysis. A comparative analysis was then undertaken with qualitative papers exploring medicinetaking behaviours in a chronic bowel condition, type II diabetes, and multimorbidity to explore the themes identified in the OAB study for convergence and divergence in other conditions and to contextualise the learnings from the former study. Results The systematic literature review revealed a gap in the literature of qualitative exploration of adherence and persistence behaviours in OAB patients. The OAB study found a range of drivers for non-adherent behaviours including a perceived lack of treatment efficacy, side effects, unclear instructions, and drug and condition hierarchies, as well as the rich context within which these themes sit. The comparative analysis study supported the findings of the OAB study demonstrating evidence of key themes transcending across conditions, including a perceived lack of treatment efficacy and side effects, as well as nuances associated with the OAB experience. Conclusions The present work has identified key drivers for non-adherent behaviours in OAB patients and sets out a number of recommendations categorised within the World Health Organisation’s 5 dimensions of adherence. These include addressing the poor understanding and illness perception of OAB by patients and others, by improving the provision and availability of information, as well as the work of patient support groups; scrutiny on the support within primary care to OAB patients before and after diagnosis; and the encouragement of realistic expectations of the condition and treatment with mindful use of prescriber’s language at the point of prescribing. The present work has further highlighted the utility of conceptual models of adherence such as COM-B and the NCF in understanding medicine-taking behaviours in the context of OAB

    Effects of Sarbanes-Oxley Act 2002 on the Quality of Corporate Reporting by UK Listed Companies

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    The Sarbanes-Oxley Act 2002 (SOA) was passed in the US in direct response to the spectacular collapse of Enron and subsequently Arthur Andersen, one of the then Big 5 Audit firms in the USA. We utilized institutional theory to study the extent to which UK financial reporting practices have changed by the passage of this Act by examining the corporate governance sections of selected financial reports. We examined the financial reports of 5 UK companies listed in the US and 5 UK only listed against the corporate governance introductions, internal control disclosures, audit committee disclosures, and external auditors reports in the pre and post-SOA period (2000-2016) and found that whereas the UK SOA compliant companies made all the necessary adjustments to comply with the Act, the UK only listed companies also began making similar changes in their disclosures when there was no such requirement in the UK. We have observed that the standard and quantity of information provided by UK companies listed in the US in corporate disclosures have improved during the SOA period when compared to the pre-SOA period. Likewise, we have noticed a similar trend in the corporate disclosures of UK-only listed companies in the post-SOA period compared to the period preceding it. Overall, we conclude that there has been a substantial decrease in the use of generic language and boiler plateism in both sets of our sample companies' corporate and audit reports during the post-SOA period. Based on these findings, we suggest that the SOA has had a favourable impact on corporate reporting in the UK. Our research adds to the ongoing modifications to the UK Corporate Governance framework, where the Financial Reporting Council is presently adopting a UK SOx-style corporate governance system in the UK, replacing FRC with ARGA, similar to the PCAOB
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