bluuebunny/crossref_metadata_2025 huggingface dataset:
The tactical mimicry of social enterprise strategies: Acting ‘as if’ in the everyday life of third sector organizations
Authors: Dey Pascal , Teasdale Simon
Published: February 2015

Using England as a paradigmatic case of the ‘enterprising up’ of the third sector through social enterprise policies and programs, this article sheds light on practitioners’ resistance as enacted through dramaturgical identification with government strategies. Drawing from a longitudinal qualitative research study, which is interpreted via Michel de Certeau’s theory of the prosaic of the everyday, we present the case study of Teak, a charitable regeneration company, to illustrate how its Chief Executive Liam ‘acted as’ a social entrepreneur in order to gain access to important resources. Specifically, we establish ‘tactical mimicry’ as a sensitizing concept to suggest that third sector practitioners’ public identification with the normative premises of ‘social enterprise’ is part of a parasitical engagement with governmental power geared toward appropriating public money. While tactical mimicry conforms to governmental strategies only in order to exploit them, its ultimate aim is to increase potential for collective agency outside the direct influence of power. The contribution we make is threefold: first, we extend the recent debate on ‘productive resistance’ by highlighting how ‘playing the game’ without changing existing relations of power can nevertheless produce largely favorable outcomes. Second, we suggest that recognition of the potentiality of tactical mimicry requires methodologies that pay attention to the spatial and temporal dynamics of resistance. Finally, we argue that explaining the normalizing power of ‘social enterprise’ without consideration of the non-discursive, mainly financial resources made available to those who identify with it, necessarily risks overlooking a crucial element of the dramaturgical dynamic of discourse.
Telepsychology for Posttraumatic Stress Disorder: A systematic review
Authors: Bolton AJ , Dorstyn DS
Published: February 2015

Summary

The effectiveness of psychological services provided remotely, telepsychology, for the management of Posttraumatic Stress Disorder (PTSD) was evaluated. Eleven studies ( n = 472 participants) were identified from electronic database searches. Study quality was assessed, with studies characterised by small and underpowered samples. Effect sizes and associated confidence intervals (CIs) were calculated to determine the direction and magnitude of treatment change. Short-term treatment gains were reported for internet and video-based interventions. This included significant medium to large improvements ( d range = 0.66–3.22) in cognitive and behavioural symptoms of depression, generalised anxiety and posttraumatic stress. However, the equivalence of telepsychology and face-to-face psychotherapy could not be determined, with few comparative studies available. Both treatment gains and deterioration were noted 1 to 6 months following treatment cessation, although this was based on limited follow-up data. Further larger scale and longitudinal research will help to ascertain the minimum requirements for the management and treatment of PTSD in a technology-supported environment.
Can risk and illness perceptions predict breast cancer worry in healthy women?
Authors: Gibbons Andrea , Groarke AnnMarie
Published: February 2015

Predictors of breast cancer worry in healthy women remain unclear. Healthy women less than 50 years ( N = 857) completed measures of family history, anxiety, absolute and comparative risk perceptions, illness perceptions, and breast cancer worry. Regression analyses revealed that having a family history of breast cancer, greater anxiety, higher absolute risk perceptions and negative illness perceptions predicted 45 per cent of the variance in breast cancer worry. Risk perceptions also partially mediated the relationship between illness perceptions and worry. This study provides novel evidence that both illness and risk perceptions are predictors of breast cancer worry in younger women from the community.
Knowledge and understanding of antibiotic resistance and the risk of becoming a carrier when travelling abroad: A qualitative study of Swedish travellers
Authors: Wiklund S. , Fagerberg I. , Örtqvist Å. , Vading M. , Giske C. G. , Broliden K. , Tammelin A.
Published: February 2015

Background: Increasing globalisation, with the migration of people, animals and food across national borders increases the risk of the spread of antibiotic-resistant bacteria. To avoid becoming a carrier of antibiotic-resistant bacteria when travelling, knowledge about antibiotic resistance is important. Materials and methods: We aimed to describe the knowledge and understanding of antibiotic-resistant bacteria, and of the risk for becoming a carrier of such bacteria, among Swedish travellers before their travel to high-risk areas. A questionnaire with three open-ended questions was distributed to 100 individuals before departure. Results: The travellers’ answers were analysed using content analysis, resulting in the theme ‘To be an insecure traveller who takes control over one’s own journey’. Our results showed that the travellers were aware of what the term ‘antimicrobial resistance’ meant, but did not understand its real significance, nor the consequences for the individual nor for society. They also distanced themselves from the problem. Few thought that their travel would entail a risk of becoming a carrier of resistant bacteria. The lack of knowledge caused an uncertainty among the travellers, whom tried to master the situation by using coping strategies. They proposed a number of measures to prevent carriership. The measures were general and primarily aimed at avoiding illness abroad, particularly acute gastro-intestinal infection. Conclusions:In health care and vaccination clinics, there is a need for improved information for persons intending to travel to high-risk areas, both about the risks of contracting antibiotic- resistant bacteria and about effective preventive measures.
A bed sheet is not as effective as a pelvic circumferential compression device in generating pelvic compression in patients with a suspected pelvic fracture
Authors: Sinha Shrestha , Ellicott Helen , Gee Ed , Steel Alistair
Published: February 2015

Introduction

The Advanced Trauma Life Support protocol for emergent management of pelvic ring disruptions includes advising circumferential application of a bed sheet. A number of purpose-designed pelvic circumferential compression devices are commercially available. We assessed whether the Advanced Trauma Life Support-recommended simple bed sheet was able to generate the same pelvic pressure as provided by a pelvic circumferential compression device.

Methods

A healthy volunteer was laid supine on an examination trolley and a pressure transducer was placed overlying the volunteer’s greater trochanters. Two pelvic compression devices, a commercially available SAM Pelvic Sling II™ and a standard hospital bed sheet, were applied single handedly. The SAM Sling was applied according to the manufacturer’s instructions and the bed sheet was applied in the way the participant felt best. The pressures generated at the level of the greater trochanters were measured at 2 min. The mean of the left and right pressures was recorded. Following removal of the first device, the second device was then placed and the pressures were again recorded at 2 min.

Results

Twelve participants completed the study. The mean (standard deviation) pressure generated by the SAM sling was 107 (28.4) mmHg and by the bed sheet 54 (26.3) mmHg; the SAM sling generated significantly greater pressure ( p < 0.0001). A variety of different methods for applying the bed sheet were observed.

Conclusion

In patients with a suspected pelvic fracture, a bed sheet is unable to reliably generate pressures approaching those of a commercially available pelvic circumferential compression device.
Nickel–multiwalled carbon nanotube composite coating on aluminum alloy rotor for textile industries
Authors: Selvakumar A , Perumalraj R , Sudagar J , Mohan S
Published: February 2015

Nickel-based multiwalled carbon nanotube (Ni–MWCNT) composite coatings were electrodeposited over the inner groove of an aluminim alloy rotor with Zn–Ni interlayer. The surface of the composite coating was investigated by X-ray diffraction and scanning electron microscopy. The hardness of the coating was determined by Vicker's method. It was revealed that Ni–MWCNT composite coating has uniformity in thickness over the surface of the aluminim groove and also better particle distribution over the area. It was found that there was a significant improvement in the microhardness values of Ni–MWCNT composite coating than uncoated aluminum alloy rotor. In addition, the wear resistance of the composite coated increased nine times than the uncoated substrate. Thus, Ni–MWCNT composite coated aluminum alloy rotor can enhance the performance and life-time of the rotor in the textile industries.
The variable status of the classics in differing narratives of the sociological tradition
Authors: Levine Donald N
Published: February 2015

Warrants for continued attention to the sociological classics take diverse forms. This variation appears to be linked to a diversity of narrative interpretations of the sociological tradition. Positivist narratives affirm classics as building blocks for a naturalistic social science and as sources of material not yet incorporated into mainstream sociology. Pluralist narratives celebrate classics as exemplars of different legitimate perspectives. In synthetic narratives, classics are hailed for raising fundamental problems and pointing the way toward culminating syntheses. In humanistic narratives, classics appear as texts of enduring significance for their admixture of poetic insight and moral rumination as well as deep sociological analyses. Contextualist narratives view classics as expressive documents, giving voice to a cultural ambience or complex of collective interests. Dialogical narratives hail classics as parties to transnational and transgenerational conversations. This schema helps organize the wide array of interpretations of Émile Durkheim.
‘Marketing earthquakes’
Authors: Hamlin Robert P. , Bishop David , Mather Damien W.
Published: February 2015

This article examines the evolution of brands within fast-moving consumer goods (FMCG) markets using existing theory from the palaeontology literature. This article demonstrates that the theory of evolution by punctuated equilibrium can be applied to the development of FMCG markets and brands to explain the highly destructive ‘marketing earthquakes’ that periodically occur within them. The mechanisms of punctuated equilibrium are presented, and the means by which they can be applied to the development of FMCG brands and markets is explained. It is proposed that genes and species and memes and brands are highly analogous to one another and that the marketing environment is particularly suited to the application of existing palaeontological mechanisms. Two recent case studies of marketing earthquakes from New Zealand are presented. A final section showing how this theory can be applied to develop analytical tools that are capable of identifying critically stable brands and markets that may be prone to earthquake-like punctuation events concludes the article.
HRD Education in Developing Countries
Authors: McLean Gary N. , Akaraborworn Chiraprapha Tan
Published: February 2015

The Problem

Human resource development (HRD) university programs, so named, have been found dominantly in the United States. However, university programs in HRD have emerged elsewhere, interestingly, more often in developing countries than in other developed countries. But, globally, we know virtually nothing about these programs, their histories, their curricula, their missions, and their research, as there is an almost complete gap in international literature.

The Solution

Two countries in ASEAN (Association of Southeast Asian Nations), Thailand and Malaysia, were selected as case studies for HRD education in developing countries or upper-middle income countries as defined by the World Bank; they are also the most active in the Academy of HRD (AHRD) in Asia as they have hosted the Asian AHRD conference twice within a decade. Because of the paucity of literature on this topic, we accessed related websites to determine details about the HRD programs, supplemented by our own information related to these two countries based on our knowledge of HRD education in these two countries. The study showed that HRD education in these two countries is at the stage of established, based on the taxonomy developed within the article. More than one university in each country is offering HRD majors in undergraduate, master’s, and doctoral levels.

The Stakeholders

The information in this article should be of interest to anyone interested in international or global HRD, potential students who wish to study HRD in these countries, officers and members of the AHRD, members of the Program Excellence Network (PEN) of AHRD, and anyone generally interested in HRD in higher education.
Enriching HRD Education Through Professional Organizations
Authors: McLean Gary N. , Akdere Mesut
Published: February 2015

The Problem

Human resource development (HRD) education does not take place only in academic institutions. There are hundreds of global professional organizations or associations that are designed to give professionals in the field of HRD opportunities to share their knowledge. Yet, there has been little research to determine what such organizations anticipate contributing to professionals’ education. Particularly problematic is the large number of professional organizations at global, regional, country, and local levels, all of which claim to add to professionals’ expertise.

The Solution

There is little literature focusing on specific HRD professional organizations. In this article, we explore samples of both academic and practitioner professional organizations globally and on each populated continent. We have identified educational outcomes that are part of the educational missions of professional organizations and associated modes. Data were gathered through websites, interaction with professional networks, and our personal experiences.

The Stakeholders

HRD practitioners and academics need to be aware of the significant contributions made by professional organizations to HRD education. This is especially important in countries where there is little to no formal HRD education offered in universities, as well as for all professionals, academics and practitioners, who desire to expand their global knowledge. Greater intentionality of this mission may improve the outcomes experienced by professional organizations and help others select appropriate organizations with which to affiliate.
Bacteriological Investigation of Chronic Wounds in a Specialized Wound Healing Department
Authors: Wu MinJie , Ruan Hong , Huang Yao , Liu ChuanBo , Ni PengWen , Ye JunNa , Lu ShuLiang , Xie Ting
Published: February 2015

To investigate the information of chronic wounds, especially in the aspect of microbiological profile and to explore the relationship between the wound culture result and chronic wounds infection, we retrospectively reviewed the medical records of 107 patients with chronic wounds from January 2011 to December 2013. The sociodemographic data, wound-related information, therapeutic type, and wound infection status were extracted. Microbial specimens were obtained and processed using standard hospital procedure for wound culture. The predominant pathogen isolated was Staphylococcus aureus (n = 11, 26.2%), followed by Escherichia coli (n = 6, 14.3%), Enterobacter cloacae (n = 3, 7.1%), and Pseudomonas aeruginosa (n = 3, 7.1%). Sixty percent of the infectious chronic wounds had positive culture, and 96.2% of the noninfectious wounds had negative culture. In conclusion, the microbial characteristics were mostly in the site of lower extremity, gram-negative bacteria, and monopathogen, respectively. Furthermore, the relationship between the wound culture result and chronic wound infection was not exactly coincident. It may be useful for guiding the empiric therapy of chronic wounds.
Survey of Policies and Guidelines on Antioxidant Use for Cancer Prevention, Treatment, and Survivorship in North American Cancer Centers
Authors: Hong Gyeongyeon , White Jennifer , Zhong Lihong , Carlson Linda E.
Published: February 2015

Background. Health care policies and guidelines that are clear and consistent with research evidence are important for maximizing clinical outcomes. To determine whether cancer centers in Canada and the United States had policies and/or guidelines about antioxidant use, and whether policies were aligned with the evidence base, we reviewed current research evidence in the field, and we undertook a survey of the policies and guidelines on antioxidant use at cancer institutions across North America. Methods. A survey of policies and guidelines on antioxidant use and the development and communication of the policies and guidelines was conducted by contacting cancer institutions in North America. We also conducted a Website search for each institution to explore any online resources. Results. Policies and guidelines on antioxidant use were collected from 78 cancer institutions. Few cancer institutions had policies (5%) but most provided guidelines (69%). Antioxidants from diet were generally encouraged at cancer institutions, consistent with the current research evidence. In contrast, specific antioxidant supplements were generally not recommended at cancer institutions. Policies and guidelines were developed using evidence-based methods (53%), by consulting another source (35%), or through discussions/conference (26%), and communicated mainly through online resources (65%) or written handouts (42%). For cancer institutions that had no policy or guideline on antioxidants, lack of information and lack of time were the most frequently cited reasons. Conclusions. Policies and guidelines on antioxidants from diet were largely consistent with the research evidence. Policies and guidelines on antioxidant supplements during treatment were generally more restrictive than the research evidence might suggest, perhaps due to the specificity of results and the inability to generalize findings across antioxidants, adding to the complexity of their optimal and safe use. Improved communication of comprehensive research evidence to cancer institutions may aid in the development of more evidence-based policies and guidelines.
SIRT1 attenuates high glucose-induced insulin resistance via reducing mitochondrial dysfunction in skeletal muscle cells
Authors: Zhang Hao-Hao , Ma Xiao-Jun , Wu Li-Na , Zhao Yan-Yan , Zhang Peng-Yu , Zhang Ying-Hui , Shao Ming-Wei , Liu Fei , Li Fei , Qin Gui-Jun
Published: February 2015

Insulin resistance is often characterized as the most critical factor contributing to the development of type 2 diabetes mellitus (T2DM). Sustained high glucose is an important extracellular environment that induces insulin resistance. Acquired insulin resistance is associated with reduced insulin-stimulated mitochondrial activity as a result of increased mitochondrial dysfunction. Silent information regulator 1 (SIRT1) is one member of the SIRT2 (Sir2)-like family of proteins involved in glucose homeostasis and insulin secretion in mammals. Although SIRT1 has a therapeutic effect on metabolic deterioration in insulin resistance, it is still not clear how SIRT1 is involved in the development of insulin resistance. Here, we demonstrate that pcDNA3.1 vector-mediated overexpression of SIRT1 attenuates insulin resistance in the high glucose-induced insulin-resistant skeleton muscle cells. These beneficial effects were associated with ameliorated mitochondrial dysfunction. Further studies have demonstrated that SIRT1 restores mitochondrial complex I activity leading to decreased oxidative stress and mitochondrial dysfunction. Furthermore, SIRT1 significantly elevated the level of another SIRT which is named SIRT3, and SIRT3 siRNA-suppressed SIRT1-induced mitochondria complex activity increments. Taken together, these results showed that SIRT1 improves insulin sensitivity via the amelioration of mitochondrial dysfunction, and this is achieved through the SIRT1–SIRT3–mitochondrial complex I pathway.
Effect of three different bariatric obesity surgery procedures on nutrient and energy digestibility using a swine experimental model
Authors: Gandarillas Mónica , Hodgkinson Suzanne Marie , Riveros José Luis , Bas Fernando
Published: February 2015

Morbid obesity is a worldwide health concern that compromises life quality and health status of obese human subjects. Bariatric surgery for treating morbid obesity remains as one of the best alternatives to promote excess weight loss and to reduce co-morbidities. We have not found studies reporting nutrients and energy balance considering digestibility trials in humans following surgery. The purpose of this study was to determine protein, lipid, fiber, energy, calcium, and phosphorous digestibility in a swine model that underwent ileal transposition (IT), sleeve gastrectomy with ileal transposition (SGIT), Roux-en-Y gastric bypass (RYGBP), and with sham operated animals (SHAM). Thirty-two pigs were randomly assigned to four laparoscopic procedures: IT (n = 8), RYGBP (n = 8), SGIT (n = 8), and Sham-operated pigs (n = 8). From day 0 postsurgery to 130, pigs were weighed monthly to determine live weight and weight gain was calculated for each month postsurgery until day 130. Food intake in a metabolic weight basis was calculated by measuring ad libitum food intake at day 130. Swine were fitted into metabolic crates to determine digestibility coefficients of dry matter, protein, fat, fiber, ash, energy, calcium, and phosphorous from day 130. A one-way ANOVA and Student–Newman–Keuls were used to detect differences in weight, food intake, and digestibility coefficients. Digestibility values for dry matter, fiber, phosphorus, and energy showed no differences among groups ( P > 0.05). However, significant differences ( P ≤ 0.05) were encountered among groups for fat, protein, ash, and calcium digestibilities. The RYGBP procedure, when applied to the pig model, significantly reduced calcium, fat, and ash digestibility, which did not occur with SGIT or IT procedure, when compared with Sham-operated animals.
Ovarian hormone level alterations during rat post-reproductive life-span influence CD8 + T-cell homeostasis
Authors: Arsenović-Ranin Nevena , Kosec Duško , Nacka-Aleksić Mirjana , Pilipović Ivan , Stojić-Vukanić Zorica , Djikić Jasmina , Bufan Biljana , Leposavić Gordana
Published: February 2015

The study examined the putative role of ovarian hormones in shaping of rat peripheral T-cell compartment during post-reproductive period. In 20-month-old rats ovariectomized (Ox) at the very end of reproductive period, thymic output, cellularity and composition of major TCRαβ + peripheral blood lymphocyte and splenocyte subsets were analyzed. Ovariectomy led to the enlargement of CD8 + peripheral blood lymphocyte and splenocyte subpopulations. This reflected: (i) a more efficient thymic generation of CD8 + cells as indicated by increased number of CD4+CD8 + double positive and the most mature CD4-CD8+TCRαβhighthymocytes and CD8 + recent thymic emigrants (RTEs) in peripheral blood, but not in the spleen of Ox rats, and (ii) the expansion of CD8 + memory/activated peripheral blood lymphocytes and splenocytes. The latter was consistent with a greater frequency of proliferating cells among freshly isolated memory/activated CD8 + peripheral blood lymphocytes and splenocytes and increased proliferative response of CD8 + splenocytes to stimulation with plate-bound anti-CD3 antibody. The former could be related to the rise in splenic IL-7 and IL-15 mRNA expression. Although ovariectomy affected the overall number of CD4 + T cells in none of the examined compartments, it increased CD4+FoxP3 + peripheral blood lymphocyte and splenocyte counts by enhancing their generation in periphery. Collectively, the results suggest that ovariectomy-induced long-lasting disturbances in ovarian hormone levels (mirrored in diminished progesterone serum level in 20-month-old rats) affects both thymic CD8 + cell generation and peripheral homeostasis and leads to the expansion of CD4+FoxP3 + cells in the periphery, thereby enhancing autoreactive cell control on account of immune system efficacy to combat infections and tumors.
Germanium in ginseng is low and causes no sodium and water retention or renal toxicity in the diuretic-resistant rats
Authors: Tan Chunjiang , Xiao Lu , Chen Wenlie , Chen Songming
Published: February 2015

Ginseng preparations contain high concentrations of germanium (Ge), which was reported to contribute to diuretic resistance or renal failure. However, Ge content in ginseng and the influence on renal functions remain unclear. Forty rats were randomly divided into control group, low, moderate, and high Ge ginseng-treated group and observed for 25 days. Daily urine, renal functions, and serum and urine electrolytics were measured. Ge retention in the organs and renal histological changes were also evaluated. Ge content ranged from 0.007 to 0.450 µg/g in various ginseng samples. Four groups showed no difference in the daily urine output, glomerular filtration rate, urinary electrolytes excretions, 24 h-urine protein, as well as plasma and urine urea nitrogen, creatinine, osmotic pressure, and pH values. Ge did not cause any renal pathological effects in this study. No Na and water retention was detected in the ginseng-treated groups. Ge retention in various organs was found highest in spleen, followed by the kidney, liver, lung, stomach, heart, and pancreas. The total Ge contents in various ginsengs were low, and ginseng treatment did not affect renal functions or cause renal histological changes.
Situation Awareness
Authors: Flach John M.
Published: February 2015

The construct of situation awareness (SA) and Endsley’s 1995 model of SA are considered in the context of the history of the struggle to determine the role of matter (situations) and mind (awareness) for both basic and applied cognitive science. This struggle is framed in terms of two alternative views of the underlying semiotic system. The dyadic view puts the focus on structures of mind. This view leads to a dualistic ontology in which mind and matter tend to be considered as two distinctive systems. The triadic view puts the focus on mind as a means for adapting to the functional demands of situations. This view leads to a monist ontology whereby mind and matter interact as a single system shaping human experience. As a result of Endsley’s model, today the debate is framed in terms of SA.
How can computer-based methods help researchers to investigate news values in large datasets? A corpus linguistic study of the construction of newsworthiness in the reporting on Hurricane Katrina
Authors: Potts Amanda , Bednarek Monika , Caple Helen
Published: February 2015

This article uses a 36-million word corpus of news reporting on Hurricane Katrina in the United States to explore how computer-based methods can help researchers to investigate the construction of newsworthiness. It makes use of Bednarek and Caple’s discursive approach to the analysis of news values, and is both exploratory and evaluative in nature. One aim is to test and evaluate the integration of corpus techniques in applying discursive news values analysis (DNVA). We employ and evaluate corpus techniques that have not been tested previously in relation to the large-scale analysis of news values. These techniques include tagged lemma frequencies, collocation, key part-of-speech tags (POStags) and key semantic tags. A secondary aim is to gain insights into how a specific happening – Hurricane Katrina – was linguistically constructed as newsworthy in major American news media outlets, thus also making a contribution to ecolinguistics.
MEK and PI3K inhibition in solid tumors: rationale and evidence to date
Authors: Jokinen E. , Koivunen J.P.
Published: February 2015

PI3K-AKT-mTOR and Ras-Raf-MEK-ERK are the most commonly altered oncogenic pathways in solid malignancies. There has been a lot of enthusiasm to develop inhibitors to these pathways for cancer therapy. Unfortunately, the antitumor activities of single-agent therapies have generally been disappointing, excluding B-Raf mutant melanoma and renal cell cancer. Preclinical studies have suggested that concurrent targeting of the PI3K-AKT-mTOR and Ras-Raf-MEK-ERK pathways is an active combination in various solid malignancies. In the current work, we review the preclinical data of the PI3K and MEK dual targeting as a cancer therapy and the results of early-phase clinical trials, and propose future directions.
Electronic Health Records and the Evolution of Diabetes Care
Authors: Patel Vishal , Reed Mary E. , Grant Richard W.
Published: February 2015

Adoption of electronic health records (EHRs) has increased dramatically since the 2009 implementation of the Health Information Technology for Economic and Clinical Health (HITECH) Act. The latest data from the Centers for Disease Control and Prevention (CDC) indicate that the majority of U.S. hospitals and nearly half of U.S. health care professionals have implemented an EHR with advanced functionality.1 The goals of the HITECH act were not only to incentivize the adoption of EHRs, but also to increase the quality, safety, and efficiency of health care by promoting the concept of “meaningful use.”2,3 The stepwise implementation of “meaningful use” is now entering the latter stages with a focus on improving patient outcomes.4
Building Health
Authors: Edelstein Eve A.
Published: February 2015

Biological and medical research offer rigorous techniques and scientific methodologies to explore how features of the built environment influence human health, performance, and well-being. Practice guidelines from evidence-based medicine and translational science provide models for translating biomedical information into design principles applicable to healthcare environments. Examples from recent scientific discoveries highlight how scientific evidence may inform healthcare design. The interaction between stress and environmental stimuli such as light, sound, and location are relevant to patients, visitors, and staff, influencing cardiac and stress responses as well as cognitive functions such as memory and navigation abilities. Research demonstrating the pervasive influence of light on human biological systems includes epidemiological and laboratory studies that suggest an association between light exposure and increased cardiac or cancer risk. Advances in laboratory research and the development of wearable devices that may be used on-site in healthcare settings facilitate more precise measurement of the environmental features that influence healthcare users and providers. The data derived may serve as the foundation for new evidence-based performance criteria, supporting the use of existing materials and methods, as well as the creation of new design solutions to meet health needs in addition to operational outcomes.
Organizational Transformation: A Model for Joint Optimization of Culture Change and Evidence-Based Design
Authors: Hamilton D. Kirk , Orr Robin Diane , Raboin W. Ellen
Published: February 2015

Healthcare organizations face continuous and accelerating external change and thus must be prepared to manage their own change initiatives proactively. Given that many believe that the U.S. healthcare system is broken and most healthcare organizations are dealing with pervasive problems, some organizations may choose to seek transformational change to achieve the six aims identified by the Institute of Medicine: healthcare that is safe, effective, patient-centered, timely, efficient, and equitable. Transformational change will almost certainly involve organizational culture. Culture change may be most effective when linked to other organizational change initiatives such as organizational strategy, structure, policies, procedures, and recruiting. Significant organizational change often requires accompanying facility change. There is an interdependent relationship between facility design and organizational culture. They affect each other and both impact organizational performance. Sociotechnical theory promotes joint optimization of the social (culture) and technical (facilities) aspects of an organization to achieve sustained positive change. To achieve organizational transformation and to sustain positive change, organizations must be prepared to adopt collaborative efforts in culture change and facility design. The authors propose a model for accomplishing joint optimization of culture change and evidence-based facility design.
Neuroesthetics and Healthcare Design
Authors: Nanda Upali , Pati Debajyoti , McCurry Katie
Published: February 2015

While there is a growing consciousness about the importance of visually pleasing environments in healthcare design, little is known about the key underlying mechanisms that enable aesthetics to play an instrumental role in the caregiving process. Hence it is often one of the first items to be value engineered. Aesthetics has (rightfully) been provided preferential consideration in such pleasure settings such as museums and recreational facilities; but in healthcare settings it is often considered expendable. Should it be?

In this paper the authors share evidence that visual stimuli undergo an aesthetic evaluation process in the human brain by default, even when not prompted; that responses to visual stimuli may be immediate and emotional; and that aesthetics can be a source of pleasure, a fundamental perceptual reward that can help mitigate the stress of a healthcare environment. The authors also provide examples of studies that address the role of specific visual elements and visual principles in aesthetic evaluations and emotional responses. Finally, they discuss the implications of these findings for the design of art and architecture in healthcare.
The Challenge of Integrating Evidence-Based Design
Authors: Martin Caren S.
Published: February 2015

This paper discusses the integration of evidence-based design (EBD) into the design process as an innovation, illuminates the significance and progress of the diffusion of this innovation, and identifies EBD advocates and the consequences of meeting the EBD challenge. A free tool for engaging in EBD is explored. Healthcare designers are leading the EBD charge, because their clients depend on it. But not all designers engage in EBD, because it may be beyond the resources of a firm or outside its culture. However, as with other meaningful design innovations, designers who do not practice EBD could fall by the wayside. EBD is a product of the diffusion of the innovation of evidence-based medicine. The academy (i.e., the collective of institutions of higher education), design organizations, design communities, and the media all contribute to the diffusion of EBD. However, the quantity, quality, and understandability of evidence continue to challenge its broad adoption. InformeDesign®, a free, Internet-based tool, presents information to designers in a concise, understandable way. Firms must invest in EBD incrementally as a value-added component of design to meet current and future challenges. It is important for designers to realize that engaging in EBD is not a rejection of creativity, but a means by which to elevate their design solutions.
National Healthcare Capital Project Benchmarking—An Owner's Perspective
Authors: Kahn Noah
Published: February 2015

Few sectors of the economy have been left unscathed in these economic times. Healthcare construction has been less affected than residential and nonresidential construction sectors, but driven by re-evaluation of healthcare system capital plans, projects are now being put on hold or canceled. The industry is searching for ways to improve the value proposition for project delivery and process controls. In other industries, benchmarking component costs has led to significant, sustainable reductions in costs and cost variations. Kaiser Permanente and the Construction Industry Institute (CII), a research component of the University of Texas at Austin, an industry leader in benchmarking, have joined with several other organizations to work on a national benchmarking and metrics program to gauge the performance of healthcare facility projects. This initiative will capture cost, schedule, delivery method, change, functional, operational, and best practice metrics. This program is the only one of its kind. The CII Web-based interactive reporting system enables a company to view its information and mine industry data. Benchmarking is a tool for continuous improvement that is capable not only of grading outcomes; it can inform all aspects of the healthcare design and construction process and ultimately help moderate the increasing cost of delivering healthcare.
Identification of Critical Factors Affecting Flexibility in Hospital Construction Projects
Authors: Olsson Nils O. E. , Hansen Geir K.
Published: February 2015

Objective:

This paper analyzes the dynamics relating to flexibility in a hospital project context. Three research questions are addressed: (1) When is flexibility used in the life cycle of a project? (2) What are the stakeholders' perspectives on project flexibility? And (3) What is the nature of the interaction between flexibility in the process of a project and flexibility in terms of the characteristics of a building?

Background:

Flexibility is discussed from both a project management point of view and from a hospital architecture perspective. Flexibility in project life cycle and from a stakeholder perspective is examined, and the interaction between flexibility in scope lock-in and building flexibility is investigated.

Methods:

The results are based on case studies of four Norwegian hospital projects. Information relating to the projects has been obtained from evaluation reports, other relevant documents, and interviews. Observations were codified and analyzed based on selected parameters that represent different aspects of flexibility.

Results:

One of the cases illustrates how late changes can have a significant negative impact on the project itself, contributing to delays and cost overruns. Another case illustrates that late scope lock-in on a limited part of the project, in this case related to medical equipment, can be done in a controlled manner. Project owners and users appear to have given flexibility high priority. Project management teams are less likely to embrace changes and late scope lock-in. Architects and consultants are important for translating program requirements into physical design. A highly flexible building did not stop some stakeholders from pushing for significant changes and extensions during construction.
Redefining Healthcare Infrastructure: Moving toward Integrated Solutions
Authors: Tillmann Patricia A. , Tzortzopoulos Patricia , Formoso Carlos T.
Published: February 2015

Currently in the United Kingdom there is a trend to broaden the scope of service provision in the healthcare sector. Not only are new healthcare-related services being provided to the community, but also there is increasing concern for providing services to extend the life cycle of built facilities. This trend is similar to what has been observed in manufacturing, where different approaches are used to combine products and services, generating high-value integrated solutions.

This article analyzes integrated-solution approaches that have been adopted in the manufacturing sector and compares them to trends that are emerging in the healthcare sector. The practical implications of these trends in the UK healthcare sector are also pointed out. This study discusses how to improve value generation by combining products and services; it also addresses the need for a value-creating system that is capable of developing and sustaining new healthcare infrastructures. Some of the major changes needed to achieve fully integrated solutions in healthcare—such as supporting policies for innovation and stakeholder engagement—are pointed out. However, understanding the theoretical concept behind such approaches (and thus how value can be generated) and the challenges associated with introducing them into practice seem to be the first steps toward achieving integrated solutions in the healthcare context.
Chemical Hazards Analysis of Resilient Flooring for Healthcare
Authors: Lent Tom , Silas Julie , Vallette Jim
Published: February 2015

This article addresses resilient flooring, evaluating the potential health effects of vinyl flooring and the leading alternatives—synthetic rubber, polyolefin, and linoleum—currently used in the healthcare marketplace. The study inventories chemicals incorporated as components of each of the four material types or involved in their life cycle as feedstocks, intermediary chemicals, or emissions. It then characterizes those chemicals using a chemical hazard-based framework that addresses persistence and bioaccumulation, human toxicity, and human exposures.
Knowledge Modeling Tool for Evidence-Based Design
Authors: Durmisevic Sanja , Ciftcioglu Özer
Published: February 2015

Aim of the Study:

The aim of this study is to take evidence-based design (EBD) to the next level by activating available knowledge, integrating new knowledge, and combining them for more efficient use by the planning and design community. This article outlines a framework for a performance-based measurement tool that can provide the necessary decision support during the design or evaluation of a healthcare environment by estimating the overall design performance of multiple variables.

Background:

New knowledge in EBD adds continuously to complexity (the “information explosion”), and it becomes impossible to consider all aspects (design features) at the same time, much less their impact on final building performance.

Research Questions:

How can existing knowledge and the information explosion in healthcare—specifically the domain of EBD—be rendered manageable? Is it feasible to create a computational model that considers many design features and deals with them in an integrated way, rather than one at a time?

Approach:

The found evidence is structured and readied for computation through a “fuzzification” process. The weights are calculated using an analytical hierarchy process. Actual knowledge modeling is accomplished through a fuzzy neural tree structure. The impact of all inputs on the outcome—in this case, patient recovery—is calculated using sensitivity analysis. Finally, the added value of the model is discussed using a hypothetical case study of a patient room.

Conclusion:

The proposed model can deal with the complexities of various aspects and the relationships among variables in a coordinated way, allowing existing and new pieces of evidence to be integrated in a knowledge tree structure that facilitates understanding of the effects of various design interventions on overall design performance.
Investigating Walking Environments in and around Assisted Living Facilities: A Facility Visit Study
Authors: Lu Zhipeng
Published: February 2015

Objective:

This study explores assisted living residents' walking behaviors, locations where residents prefer to walk, and walking environments in and around assisted living facilities.

Background:

Regular walking is beneficial to older adults' physical and psychological health. Yet frail older residents in assisted living are usually too sedentary to achieve these benefits. The physical environment plays an important role in promoting physical activity. However, there is little research exploring this relationship in assisted living settings.

Methods:

The researcher visited 34 assisted living facilities in a major Texas city. Methods included walk-through observation with the Assisted Living Facility Walking Environment Checklist, and interviews with administrators by open- and close-ended questions. The data from 26 facilities were analyzed using descriptive statistics (for quantitative data) and content analysis (for qualitative data).

Results:

The results indicate that (a) residents were walking both indoors and outdoors for exercise or other purposes (e.g., going to destinations); (b) assisted living facility planning and design details—such as neighborhood sidewalk conditions, facility site selection, availability of seating, walking path configuration (e.g., looped/nonlooped path), amount of shading along the path, presence of handrails, existence of signage, etc.—may influence residents' walking behaviors; and (c) current assisted living facilities need improvement in all aspects to make their environments more walkable for residents.

Conclusion:

Findings of the study provide recommendations for assisted living facilities to improve the walkability of environments and to create environmental interventions to promote regular walking among their residents. This study also implies several directions for future research.
An Empirical Examination of Patient Room Handedness in Acute Medical-Surgical Settings
Authors: Pati Debajyoti , Cason Carolyn , Harvey Thomas E. , Evans Jennie
Published: February 2015

Objective:

The study objective was to examine whether standardized same-handed room configurations contribute more to operational performance in comparison to standardized mirror-image room configurations. Based on a framework that physical environment standardization supports process and workflow standardization, thus contributing to safety and efficiency, the study examined the comparative effectiveness of the standardized same-handed configuration and the standardized mirror-image configuration.

Background:

Patient room handedness has emerged as an important issue in inpatient unit design, with many hospitals adopting the standardized same-handed room concept at all levels of patient acuity. Although it is argued that standardized same-handed rooms offer greater levels of safety and efficiency in comparison to standardized mirror-image rooms, there is little empirical evidence either to support or refute these contentions.

Method:

An experimental setting was developed where elements of the physical environment and approach to the caregiver zone were systematically manipulated. Twenty registered nurses (10 left-handed and 10 right-handed) provided three types of care to a patient-actor across nine physical design configurations, which were videotaped in 540 separate segments. Structured interviews of the subjects were conducted at the end of each individual set of simulation runs to obtain triangulation data. Video segments were coded by nursing experts. Statistical and content analyses of the data were conducted.

Results:

Study data show that standardized same-handed configurations may not contribute to process and workflow standardization—hence, to safety and efficiency—any more than standardized mirror-image configurations in acute medical-surgical settings. Data suggest that a global view of the patient care environment upon entry is the most sought-after familiarization factor to reduce cognitive load.