Governance for e-learning ecosystem

Governance has emerged as an important issue for organisations across the world. Governance is the combined activities of developing and managing cohesive and consistent policies, processes and decisions right for a given area of responsibility. For an e-learning ecosystem to work effectively, it is essential that we have the right regulatory, technological and social conditions. This paper discusses a framework to support the successful implementation of an e-learning system includes (1) organisational decision making structures, (2) processes which include operational and technical supports, and (3) communications and relational mechanisms. Six characteristics and dimensions of Darking's [12] digital ecosystem governance were used to enhance the framework. E-learning information seurity governance is also discussed in the paper. The underlying goals for adopting e-learning governance practices are improvement of business performance and conformance to regulations. This paper discusses governance for e-learning ecosystems within the digital business ecosystms (DBE)

Out-of-hours primary care. Implications of organisation on costs

BACKGROUND: To perform out-of-hours primary care, Dutch general practitioners (GPs) have organised themselves in large-scale GP cooperatives. Roughly, two models of out-of-hours care can be distinguished; GP cooperatives working separate from the hospital emergency department (ED) and GP cooperatives integrated with the hospital ED. Research has shown differences in care utilisation between these two models; a significant shift in the integrated model from utilisation of ED care to primary care. These differences may have implications on costs, however, until now this has not been investigated. This study was performed to provide insight in costs of these two different models of out-of-hours care. METHODS: Annual reports of two GP cooperatives (one separate from and one integrated with a hospital emergency department) in 2003 were analysed on costs and use of out-of-hours care. Costs were calculated per capita. Comparisons were made between the two cooperatives. In addition, a comparison was made between the costs of the hospital ED of the integrated model before and after the set up of the GP cooperative were analysed. RESULTS: Costs per capita of the GP cooperative in the integrated model were slightly higher than in the separate model (ε 11.47 and ε 10.54 respectively). Differences were mainly caused by personnel and other costs, including transportation, interest, cleaning, computers and overhead. Despite a significant reduction in patients utilising ED care as a result of the introduction of the GP cooperative integrated within the ED, the costs of the ED remained the same. CONCLUSION: The study results show that the costs of primary care appear to be more dependent on the size of the population the cooperative covers than on the way the GP cooperative is organised, i.e. separated versus integrated. In addition, despite the substantial reduction of patients, locating the GP cooperative at the same site as the ED was found to have little effect on costs of the ED. Sharing more facilities and personnel between the ED and the GP cooperative may improve cost-efficiency

Culturally induced range infilling of eastern redcedar: a problem in ecology, an ecological problem, or both?

The philosopher John Passmore distinguished between (1) “problems in ecology,” or what we might call problems in scientific understanding of ecological change, and (2) “ecological problems,” or what we might call problems faced by societies due to ecological change. The spread of eastern redcedar (Juniperus virginiana) and conversion of the central and southern Great Plains of North America to juniper woodland might be categorized as a problem in ecology, an ecological problem, or both. Here, we integrate and apply two interdisciplinary approaches to problem-solving—social-ecological systems thinking and ecocriticism—to understand the role of human culture in recognizing, driving, and responding to cedar’s changing geographic distribution. We interpret the spread of cedar as a process of culturally induced range infilling due to the ongoing social-ecological impacts of colonization, analyze poetic literary texts to clarify the concepts that have so far informed different cultural values related to cedar, and explore the usefulness of diverse interdisciplinary collaborations and knowledge for addressing social-ecological challenges like cedar spread in the midst of rapidly unfolding global change. Our examination suggests that it is not only possible, but preferable, to address cedar spread as both a scientific and a social problem. Great Plains landscapes are teetering between grassland and woodland, and contemporary human societies both influence and choose how to cope with transitions between these ecological states. We echo previous studies in suggesting that human cultural values about stability and disturbance, especially cultural concepts of fire, will be primary driving factors in determining future trajectories of change on the Great Plains. Although invasion-based descriptors of cedar spread may be useful in ecological research and management, language based on the value of restraint could provide a common vocabulary for effective cross-disciplinary and interdisciplinary communication about the relationship between culture and cedar, as well as an ethical framework for cross-cultural communication, decision-making, and management

Doublethink and scale mismatch polarize policies for an invasive tree

Mismatches between invasive species management policies and ecological knowledge can lead to profound societal consequences. For this reason, natural resource agencies have adopted the scientifically-based density-impact invasive species curve to guide invasive species management. We use the density-impact model to evaluate how well management policies for a native invader (Juniperus virginiana) match scientific guidelines. Juniperus virginiana invasion is causing a sub-continental regime shift from grasslands to woodlands in central North America, and its impacts span collapses in endemic diversity, heightened wildfire risk, and crashes in grazing land profitability. We (1) use land cover data to identify the stage of Juniperus virginiana invasion for three ecoregions within Nebraska, USA, (2) determine the range of invasion stages at individual land parcel extents within each ecoregion based on the density-impact model, and (3) determine policy alignment and mismatches relative to the density-impact model in order to assess their potential to meet sustainability targets and avoid societal impacts as Juniperus virginiana abundance increases. We found that nearly all policies evidenced doublethink and policy-ecology mismatches, for instance, promoting spread of Juniperus virginiana regardless of invasion stage while simultaneously managing it as a native invader in the same ecoregion. Like other invasive species, theory and literature for this native invader indicate that the consequences of invasion are unlikely to be prevented if policies fail to prioritize management at incipient invasion stages. Theory suggests a more realistic approach would be to align policy with the stage of invasion at local and ecoregion management scales. There is a need for scientists, policy makers, and ecosystem managers to move past ideologies governing native versus non-native invader classification and toward a framework that accounts for the uniqueness of native species invasions, their anthropogenic drivers, and their impacts on ecosystem services

Regeneration of the intervertebral disc

Degeneration of intervertebral disc (IVD) seems to be one of the main causes associated to lower back pain (LBP), one of the most common painful conditions that lead to work absenteeism, medical visits, and hospitalization in actual society [1,2]. This complex fibro-cartilaginous structure is composed by two structures, an outer multilayer fiber structure (annulus fibrosus, AF) and a gel-like inner core (nucleus pulposus, NP), which are sandwiched in part between two cartilage endplates (CEP) [1]. Existing conservative and surgical treatments for LBP are directed to pain relief and do not adequately restore disc structure and mechanical function [2]. In the last years, several studies have been focusing on the development of tissue engineering (TE) approaches aiming to substitute/regenerate the AF or NP, or both by developing an artificial disc that could be implanted in the body thus replacing the damaged disc [3]. TE strategies aiming to regenerate NP tissue often rely on the use of natural hydrogels, due to the number of advantages that these highly hydrated networks can offer. Nevertheless, several of the hydrogel systems developed still present numerous problems, such as variability of production, and inappropriate mechanical and degradation behaviour. Recently, our group has proposed the use of gellan gum (GG) and its derivatives, namely the ionic- and photo-crosslinked methacrylated gellan gum (GG-MA) hydrogels, as potential injectable scaffolds for IVD regeneration [4,5]. Work has been conducted regarding the improvement of GG mechanical properties either by chemically modifying the polymer (allowing to better control in situ gelation and hydrogel stability) [4] or by reinforcing it with biocompatible and biodegradable GG microparticles (enabling the control of degradation rate and cell distribution) [5]. Another strategy currently under investigation relies on the development of a biphasic scaffold that mimics the total disc by using a reverse engineering approach

Thermal tolerance limits of the Chinese mystery snail (\u3ci\u3eBellamya chinensis\u3c/i\u3e): Implications for management

The Chinese mystery snail, Bellamya chinensis (Gray, 1834) is a gastropod native to East Asia and is considered an invasive species in North America where its impacts on native species and ecosystems are not well understood. Scientific literature describing its biology and life history are sparse. Thermal tolerance limits, or the maximum and minimum temperature under which a species can survive, are key to identifying the potential geographical range of a species. The ability of managers to control invasive species is directly impacted by the thermal tolerance limits of a species. We attempted to identify the thermal tolerance limits of B. chinensis in a laboratory setting. Using a random sampling design, we exposed groups of wild-caught B. chinensis to either extreme high or low temperature treatments. We identified the upper temperature tolerance limit as between 40 and 45 °C. This result indicates some hot water management techniques may successfully prevent spread of B. chinensis among waterways. Despite exposing B. chinensis to freezing temperatures for extended periods of time we did not identify a lower temperature limit. Identifying the thermal tolerance limits of this and other invasive species informs predictions of range expansion and identification of potential prevention efforts

Landscape of Medication Management in the Minnesota Patient-Centered Medical Home (PCMH)

Purpose: To describe the landscape of medication management within the patient-centered medical homes (PCMH) in the state of Minnesota. Methods: An electronic survey of care coordinators within PCMHs certified with the Department of Health in state of Minnesota was conducted. The survey and follow up were distributed by the Minnesota Department of Health. At the time the survey was distributed, there were 161 certified PCMHs in the state. Results: The final analysis included 21 respondents. Size, setting, and time as a certified PCMH varied between practices. PCMHs reported a higher percentage of patients enrolled at lower complexity tiers (35.0 percent at tier I and 40.4 percent enrolled at tier II), with PCMHs with clinical pharmacist services reporting slightly increased frequency of higher complexity patients. The composition of the care team varied from clinic to clinic, but all clinics were multidisciplinary with a mean of 5.8 different provider types listed for each clinic. Physicians were the most common providers of medication management across all settings, and one respondent reported that medication management services are not formally provided in his/her clinic. The presence or absence of a clinical pharmacist did not significantly influence care coordination time dedicated to medication-related activities. Respondents residing in a clinic with clinical pharmacist services reported a high level of satisfaction with pharmacist-provided services. Conclusion: The implementation of the PCMH model in many of the participating clinics was relatively recent and there remains much to be learned regarding the landscape of comprehensive medication management in the PCMH. The reported distribution of patients in complexity tiers suggests that clinics may use different strategies to determine resource allocation. Although the presence of a clinical pharmacist did not influence care coordination time dedicated, care coordinators valued services provided by clinical pharmacists.   Type: Original Researc

Quantifying spatial resilience

1. Anthropogenic stressors affect the ecosystems upon which humanity relies. In some cases when resilience is exceeded, relatively small linear changes in stressors can cause relatively abrupt and nonlinear changes in ecosystems. 2. Ecological regime shifts occur when resilience is exceeded and ecosystems enter a new local equilibrium that differs in its structure and function from the previous state. Ecological resilience, the amount of disturbance that a system can withstand before it shifts into an alternative stability domain, is an important framework for understanding and managing ecological systems subject to collapse and reorganization. 3. Recently, interest in the influence of spatial characteristics of landscapes on resilience has increased. Understanding how spatial structure and variation in relevant variables in landscapes affects resilience to disturbance will assist with resilience quantification, and with local and regional management. 4. Synthesis and applications. We review the history and current status of spatial resilience in the research literature, expand upon existing literature to develop a more operational definition of spatial resilience, introduce additional elements of a spatial analytical approach to understanding resilience, present a framework for resilience operationalization and provide an overview of critical knowledge and technology gaps that should be addressed for the advancement of spatial resilience theory and its applications to management and conservation

Inpatient prescribing of dual antiplatelet therapy according to the guidelines:a prospective intervention study

Background: In dual antiplatelet therapy (DAPT), low-dose acetylsalicylic acid is combined with a P2Y12 inhibitor. However, combining antithrombotic agents increases the risk of bleeding. Guidelines on DAPT recommend using this combination for a limited period of between three weeks and 30 months. This implies the risk of DAPT being erroneously continued after the intended stop date. Objective: The primary objective of this study is to assess the proportion of hospitalized patients treated with DAPT whose treatment deviated erroneously and unintentionally from the guidelines. We also assessed risk factors and the effect of a pharmacist intervention. Methods: All patients admitted to the Spaarne Gasthuis (Haarlem/ Hoofddorp, the Netherlands) who used DAPT between March 25th , 2019, and June 14th , 2019, were, in addition to receiving regular care, reviewed to assess whether their therapy was in line with the guidelines' recommendation and whether deviations were unintended and erroneous. In the event of an unintended deviation, the pharmacist intervened by contacting the prescriber by phone and giving advice to adjust the antithrombotic therapy in line with the guideline. Results: We included 411 patients, of whom 21 patients (5.1%) had a treatment that deviated from the guidelines. For 11 patients (2.7%), the deviation was unintended and erroneous. The major risk factor for erroneous deviation was the use of DAPT before hospital admission (OR 18.7; 95%Cl 4.79-72.7). In patients who used DAPT before admission, 18 out of 58 (31.0%) had a deviation from the guidelines of whom 8 (13.8%) were erroneous. For these eight patients, the pharmacist contacted the prescriber, and in these cases the therapy was adjusted in line with the guidelines. Conclusions: Adherence to the guidelines recommending DAPT was high within the hospital. However, patients who used DAPT before hospital admission had a higher risk of erroneous prescription of DAPT. Intervention by a pharmacist increased adherence to guidelines and may reduce the number of preventable bleeding cases

Out-of-hours care in western countries: assessment of different organizational models

Contains fulltext : 81655.pdf (publisher's version ) (Open Access)BACKGROUND: Internationally, different organizational models are used for providing out-of-hours care. The aim of this study was to assess prevailing models in order to identify their potential strengths and weaknesses. METHODS: An international web-based survey was done in 2007 in a sample of purposefully selected key informants from 25 western countries. The questions concerned prevailing organizational models for out-of-hours care, the most dominant model in each country, perceived weaknesses, and national plans for changes in out-of-hours care. RESULTS: A total of 71 key informants from 25 countries provided answers. In most countries several different models existed alongside each other. The Accident and Emergency department was the organizational model most frequently used. Perceived weaknesses of this model concerned the coordination and continuity of care, its efficiency and accessibility. In about a third of the countries, the rota group was the most dominant organizational model for out-of-hours care. A perceived weakness of this model was lowered job satisfaction of physicians. The GP cooperative existed in a majority of the participating countries; no weaknesses were mentioned with respect to this model. Most of the countries had plans to change the out-of-hours care, mainly toward large scale organizations. CONCLUSION: GP cooperatives combine size of scale advantages with organizational features of strong primary care, such as high accessibility, continuity and coordination of care. While specific patients require other organizational models, the co-existence of different organizational models for out-of-hours care in a country may be less efficient for health systems