Soft systems methodology: a context within a 50-year retrospective of OR/MS

Soft systems methodology (SSM) has been used in the practice of operations research and management science OR/MS) since the early 1970s. In the 1990s, it emerged as a viable academic discipline. Unfortunately, its proponents consider SSM and traditional systems thinking to be mutually exclusive. Despite the differences claimed by SSM proponents between the two, they have been complementary. An extensive sampling of the OR/MS literature over its entire lifetime demonstrates the richness with which the non-SSM literature has been addressing the very same issues as does SSM

The DURAbility of Basal versus Lispro mix 75/25 insulin Efficacy (DURABLE) Trial: Comparing the durability of lispro mix 75/25 and glargine

OBJECTIVE This study compared the durability of glycemic control of twice-daily insulin lispro mix 75/25 (LM75/25: 75% insulin lispro protamine suspension/25% lispro) and once-daily insulin glargine, added to oral antihyperglycemic drugs in type 2 diabetes patients

Valgus and varus deformity after wide-local excision, brachytherapy and external beam irradiation in two children with lower extremity synovial cell sarcoma: case report

BACKGROUND: Limb-salvage is a primary objective in the management of extremity soft-tissue sarcoma in adults and children. Wide-local excision combined with radiation therapy is effective in achieving local tumor control with acceptable morbidity and good functional outcomes for most patients. CASE PRESENTATION: Two cases of deformity after wide-local excision, brachytherapy and external beam irradiation for lower-extremity synovial cell sarcoma are presented and discussed to highlight contributing factors, time course of radiation effects and orthopedic management. In an effort to spare normal tissues from the long-term effects of radiation therapy, more focal irradiation techniques have been applied to patients with musculoskeletal tumors including brachytherapy and conformal radiation therapy. As illustrated in this report, the use of these techniques results in the asymmetric irradiation of growth plates and contributes to the development of valgus or varus deformity and leg-length discrepancies. CONCLUSIONS: Despite good functional outcomes, progressive deformity in both patients required epiphysiodesis more than 3 years after initial management. There is a dearth of information related to the effects of radiation therapy on the musculoskeletal system in children. Because limb-sparing approaches are to be highlighted in the next generation of cooperative group protocols for children with musculoskeletal tumors, documentation of the effects of surgery and radiation therapy will lead to improved decision making in the selection of the best treatment approach and in the follow-up of these patients

Ifosfamide/etoposide alternating with high-dose methotrexate: evaluation of a chemotherapy regimen for poor-risk osteosarcoma

Fifteen patients with relapsed osteosarcoma were treated with an intensive combination chemotherapy schedule. Ifosfamide 2.5 g m−2 daily and etoposide 150 mg m−2 daily coincidentally for 3 days and high-dose methotrexate 8 g m−2 (with folinic acid rescue) on days 10–14 in a planned 21-day cycle. Feasibility, toxicity and response to this alternative combination for the treatment of relapsed osteosarcoma was assessed. There were 98 evaluable cycles for toxicity and tolerability. The majority of cycles were well tolerated. Haematological toxicity of grade 3/4 (common toxicity criteria) was seen in all courses. Renal tubular loss of electrolytes, particularly magnesium, occurred in 71% of cycles. Thirteen per cent of cycles were repeated within 21 days and 61% within 28 days. In the thirteen patients evaluable for response, a partial response rate of 31% was seen after two cycles. However, patients with stable disease continued on therapy, and an overall consequent response rate of 62% was observed. Four patients were alive with no evidence of disease at 8–74 months. Three are alive with disease (at 8–19 months). There were six deaths, all disease related. This regimen exhibits an encouraging response rate in a group of children with poor prognosis disease, with a tolerable toxicity profile. © 1999 Cancer Research Campaig

Logic and rationality in OR interventions : an examination in the light of the ‘critical rationalist’ approach

Historically OR has conceived of itself as a professional practice giving rational, objective advice rooted in the ethos of science. However, the claim of science to rationality and objectivity has wilted under the onslaught of relativist and post-modern attack. One proposed philosophy of science seeks to avoid such problems by adopting a strictly objectivist approach. Critical rationalism (CR), the philosophy originated by Karl Popper, attempts to eliminate all inductive, justificatory and merely subjective claims by the ruthless application of deductive logic. The philosophical development of the CR approach to practice is currently a work-in-progress; however, it is an approach that should on the face of it find favour with OR, particularly for those who want to claim that OR is logically rational. The paper, drawing on the work of David Miller, explores how such an approach can be applied in the OR context. It concludes that although as CR suggests it may be possible to drive out inductive and justificatory claims in OR, subjective choice is an essential element of managerial decision-making and cannot be ignored or assumed away. The paper identifies some of the challenges that confront philosophers of practice if OR is to take the insights of CR to heart, suggests some possible responses, and identifies areas for future research

The transformation competence perspective

Reflections on a number of participative projects have led to the conclusion that, when planning and conducting OR interventions, particular attention should be paid to the transformation to be attempted and to the competence of those who will be involved. The transformation required by a consulting project sets the scope of the ambition that is to be met by the craft skills and expertise of people, supported if appropriate by pre-defined methods. Competence refers to the skills, time and the ability to act of those involved in the intervention. In designing an intervention, activities have to be planned in the light of the transformation required, the competences of those involved and the pre-defined methods available. Pre-defined methods are characterized in terms of their transformation potential, the transformation that can be achieved by using the method in a specific context. The paper elaborates the proposed transformation competence perspective drawing on personal practical experience; its aim is to articulate an approach to the design of participative consulting interventions and compare it with alternatives

Educational, economic and community survey, Bledsoe County /

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