Psychiatric inpatients' experience of nursing observation. A United Kingdom perspective

1. Nursing observation is a key component of psychiatric inpatient nursing care. 2. Patients' experiences of being observed are strongly influenced by the attitudes and behaviors of the observing nurses. 3. Patients prefer to be observed by nurses they know and who talk to them.     

An interactive three-stage model for mutual funds portfolio selection

The aim of this work is to be a useful instrument for helping finance practitioners on the selection of suitable mutual fund portfolios. The portfolio selection problem is characterized by imprecision and/or vagueness inherent in the required data and more generally, in the context where investors have to make decisions. In order to mitigate these problems, a three stage model has been proposed based on a multi-index model and considering several market scenarios described in an imprecise way by an expert. The proposed fuzzy model allows the Decision Maker to select, by means of an outranking method, a suitable portfolio taking into account the uncertainty related to the market scenarios and the imprecision and/or vagueness associated with the model data.     

Knowledge Management Systems in Multinational Corporations: Typology and Transitional Dynamics

Knowledge Management Systems (KMSs) are becoming part of the agenda in many of today's leading firms. Through in-depth case studies of seven multinational companies (MNCs), examined over a period of four years, we identify four distinctive types of KMS - Fragmented, Content-based, Process-based and Capability-based - and their characteristics. These characteristics include both the structure, dimension and flow of the knowledge itself, and the staffing, training and reward systems in place to support the KMS. Relevant organisational factors influencing KMS design and implementation include the level of resource commitment by the headquarters, the structure of the firm, and the distribution of roles between headquarters and subsidiaries. Key external influences include the degree of environmental change and pressures to follow industry norms in technology investment. Our empirical evidence suggests that while some MNCs adopt the same type of KMS for relatively long periods of time, others transit between different KMS types. Moreover, transitions between types may follow either an increased resource commitment and augmented KMS sophistication, or a decreased resource commitment and reduced KMS complexity. Insights from the strategy-structure-process and change management literatures are utilised to examine these transitions between KMS types. Key lessons for MNC managers are provided in relation to both the initial adoption of a KMS and the handling of transitions between different systems.     

Constructing optimal designs for fitting pharmacokinetic models

We consider some computational issues that arise when searching for optimal designs for pharmacokinetic (PK) studies. Special factors that distinguish these are (i) repeated observations are taken from each subject and the observations are usually described by a nonlinear mixed model (NLMM), (ii) design criteria depend on the model fitting procedure, (iii) in addition to providing efficient parameter estimates, the design must also permit model checking, (iv) in practice there are several design constraints, (v) the design criteria are computationally expensive to evaluate and often numerical integration is needed and finally (vi) local optimisation procedures may fail to converge or get trapped at local optima.We review current optimal design algorithms and explore the possibility of using global optimisation procedures. We use these latter procedures to find some optimal designs.For multi-purpose designs we suggest two surrogate design criteria for model checking and illustrate their use.     

The social and demographic impact of the Southeast Asian Crisis of 1997–99

When an unexpected financial crisis overtook Southeast Asia in 1997 planners and policymakers feared that the economic difficulties would unwind two decades of remarkable economic and social development. Newspaper headlines spoke of massive increases in poverty, unemployment and malnutrition, and it was speculated that family planning programs would collapse and fertility would rise dramatically. Infant and child mortality and maternal mortality were also expected to increase. This paper briefly reviews the onset of the financial crisis as a background for assessing whether speculations about die demographic and social effects tallied with reality. It is found that these effects were neither as dramatic nor as easy to monitor as some of the public debate implied. The general lesson is that the most serious social and demographic problems were not so much the products of crisis as embedded in chronic weaknesses that had become entrenched in times of economic growth. The crisis exposed these weaknesses.     

Property Loss Estimation for Wind and Earthquake Perils

This article describes the development of a generic loss assessment methodology, which is applicable to earthquake and windstorm perils worldwide. The latest information regarding hazard estimation is first integrated with the parameters that best describe the intensity of the action of both windstorms and earthquakes on building structures, for events with defined average return periods or recurrence intervals. The subsequent evaluation of building vulnerability (damageability) under the action of both earthquake and windstorm loadings utilizes information on damage and loss from past events, along with an assessment of the key building properties (including age and quality of design and construction), to assess information about the ability of buildings to withstand such loadings and hence to assign a building type to the particular risk or portfolio of risks. This predicted damage information is then translated into risk-specific mathematical vulnerability functions, which enable numerical evaluation of the probability of building damage arising at various defined levels. By assigning cost factors to the defined damage levels, the associated computation of total loss at a given level of hazard may be achieved. This developed methodology is universal in the sense that it may be applied successfully to buildings situated in a variety of earthquake and windstorm environments, ranging from very low to extreme levels of hazard. As a loss prediction tool, it enables accurate estimation of losses from potential scenario events linked to defined return periods and, hence, can greatly assist risk assessment and planning.     

Innovation Management as a Post-Modern Phenomenon: The Outsourcing of Pharmaceutical R&D

The institutionalization of R&D by large, modern organizations is regarded as one of the most significant social and economic factors of the twentieth century. In recent years post-modern organizations have begun to replace bureaucratic control with market control. This approach is particularly attractive in the case of R&D employees who have been relatively successful in resisting direct managerial control. Government statistics are used to demonstrate that external R&D increased from 5% to 16% of internal R&D expenditure between 1989 and 1995. This trend is examined in the context of consolidation within the UK pharmaceutical industry, which has considerable implications for the sustainability of high-technology industry in the UK.     

Effects of a multimodal activation program (SimA-P) in residents of nursing homes

Is it possible to maintain or even enhance functional and cognitive independence in residents of nursing homes? Little is known about the potentials and limits of therapeutic methods designed to maintain independence in elderly people already in need of residential nursing care. The aim of the “Rehabilitation in Nursing Homes” research project was to determine the practicability and effectiveness of a rehabilitative approach targeting residents of nursing homes. The main objectives of the activation program were to maintain and enhance residents’ cognitive and functional autonomy. Data on psychological, functional, and medical variables were obtained from a sample of 294 nursing home residents (age range?=?70–99 years) at three points of measurement over a 12-month period. The intervention approach draws on the theoretical and practical findings of the SimA Study (“Bedingungen der Erhaltung und Förderung von Selbstständigkeit im höheren Lebensalter,” “conditions on maintaining and supporting independent living in old age”; Oswald et al., Z. Gerontopsychol. Psychiatr., 15:61–84, 2002, Z. Gerontopsychol. Psychiatr., 15:13–31, 2002) and incorporates the results of recent therapeutic and rehabilitative studies in the fields of geriatrics and gerontopsychiatry. The intervention involves a combined program of cognitive and physical activation. An alternative program based on biographical information was designed specifically for residents with dementia. Results show that the intervention had significant effects on cognitive and functional parameters. Moreover, transfer effects were observed with respect to activities of daily living and frequency of falls.     

Estimating conditional tail expectation with actuarial applications in view

We develop statistical inferential tools for estimating and comparing conditional tail expectation (CTE) functions, which are of considerable interest in actuarial science. In particular, we construct estimators for the CTE functions, develop the necessary asymptotic theory for the estimators, and then use the theory for constructing confidence intervals and bands for the functions. Both parametric and non-parametric approaches are explored. Simulation studies illustrate the performance of estimators in various situations. Results are obtained under minimal assumptions, and the general Vervaat process plays a crucial role in achieving these goals.