Spirituality and the care of patients at the end-of-life: an essential component of care

Spirituality is an essential component of the care of patients with serious illness and those that are dying. Dame Cicely Saunders developed the hospice movement based on the biopsychosocialspiritual model of care, in which all four dimensions are important in the care of patients. Of all the models of care, hospice and palliative care recognize the importance of spiritual issues in the care of patients and their families. The National Consensus Project Guidelines for Quality Palliative Care, in the United States, provides specific recommendations about all domains of care including the spiritual domain, which is recognized as a critical component of care (The National Consensus Project for Quality Palliative Care www.nationalconsensusproject.org). Studies indicate that the majority of patients would like their spiritual issues addressed, yet find that their spiritual needs are not being met by the current system of care. Interestingly, spirituality is the one dimension that seems to get slightly less emphasis than the biopsychosocial dimensions of care. Some reasons may include the difficulty with definitions of spirituality for clinical and research purposes, the time constraints and financial burdens in the current healthcare system in the United States, and the lack of uniform training for all healthcare professionals. Yet, there are theoretical and ethical frameworks that support spiritual care as well as some educational models in spirituality and health that have been successful in medical education in the United States. Spirituality can be seen as the essential part of the humanity of all people. It is at its root, relational and thus forms the basis of the altruistic care healthcare professionals are committed to. Spirituality has to do with respecting the inherent value and dignity of all persons, regardless of their health status. It is the part of humans that seeks healing, particularly in the midst of suffering. Spiritual care models are based on an intrinsic aspect that calls for compassionate presence to patients as well as an extrinsic component where healthcare professionals address spiritual issues with patients and their loved ones. Currently in the healthcare system, evidence-base models are the criteria for practice recommendations. Yet, spirituality may not be amenable entirely to strict evidence-base criteria. As hospice and palliative care continues to develop as a field, healthcare professionals are challenged to think of ways to advocate for and include the spiritual dimension of care.     

Idiocentrism, allocentrism, psychological well being and suicidal ideation: a cross cultural study

The present study examined the relationship between idiocentrism, allocentrism, psychological well being (self-esteem, depression, and social support), and suicidal ideation among 283 American college students and 343 Chinese college students. Idiocentrism was correlated with high self-esteem, high depression, and low social support, but the relationships were more likely to be significant for women than for men in both cultures. Allocentrism was primarily related to social support. As predicted, high levels of suicidal ideation were correlated with more idiocentrism, but only for women. Allocentrism was related to lower levels of suicidal ideation in both cultures, but the relationship was small. As suicide prevention may start from suicidal ideation treatment, the treatment of suicidal ideation may have to take into account cultural and personal characteristics, such as idiocentrism.     

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.     

Complexity and Adaptivity in Supply Networks: Building Supply Network Theory Using a Complex Adaptive Systems Perspective*

Supply networks are composed of large numbers of firms from multiple interrelated industries. Such networks are subject to shifting strategies and objectives within a dynamic environment. In recent years, when faced with a dynamic environment, several disciplines have adopted the Complex Adaptive System (CAS) perspective to gain insights into important issues within their domains of study. Research investigations in the field of supply networks have also begun examining the merits of complexity theory and the CAS perspective. In this article, we bring the applicability of complexity theory and CAS into sharper focus, highlighting its potential for integrating existing supply chain management (SCM) research into a structured body of knowledge while also providing a framework for generating, validating, and refining new theories relevant to real‐world supply networks. We suggest several potential research questions to emphasize how a CAS perspective can help in enriching the SCM discipline. We propose that the SCM research community adopt such a dynamic and systems‐level orientation that brings to the fore the adaptivity of firms and the complexity of their interrelations that are often inherent in supply networks.     

Focusing on Customer Time in Field Service: A Normative Approach

Although customer convenience should be rightfully considered a central element in field services, the customer experience suggests that service enterprises rarely take the customer's preferred time into account in making operational and scheduling decisions. In this paper we present the results of our exploratory research into two interrelated topics: the explicit inclusion of customer time in nonemergency field service delivery decisions and the analysis of trade‐off between the customer's convenience and field service provider's cost. Based on prior research in service quality we identify and illustrate two time‐based performance metrics that are particularly appropriate for assessing service quality in nonemergency field services: performance and conformance quality. To determine vehicle routes, we develop a hybrid heuristic derived from the existing and proven heuristic methods. A numerical example closely patterned after real‐life data is generated and used within a computational experiment to investigate alternate policies for promise time windows. Our experiment shows that over a reasonable range of customer cost parameters the policy of shorter promise time windows reduces the combined total cost incurred by the provider and the customers and should be considered a preferred policy by the field service provider. Managerial implications of this result are discussed.     

The Effect of Timing on Jump Bidding in Ascending Auctions

We investigate the role of timing in ascending auctions under the premise that time is a valuable resource. Traditional models of the English auction ignore timing issues by assuming that the auction occurs instantaneously. However, when auctions are slow, as Internet auctions used for procurement often are, there are significant opportunity or monitoring costs to bidders, and the choice of the size of the jump bid becomes a strategic decision. We study the choice in the experimental laboratory by systematically varying the opportunity costs associated with fast bidding. When time is more valuable bidders respond by choosing larger jump bids. Surprisingly, the economic performance of the auction is not significantly affected. We develop a simple model of ascending auctions with impatient bidders that provides insights into the effect jump bids have on auction performance.     

Growth and Heat Resistance Kinetic Variation Among Various Isolates of Salmonella and its Application to Risk Assessment

The abilities of cells of a particular type of bacteria to leave lag phase and begin the process of dividing or surviving heat treatment can depend on the serotypes or strains of the bacteria. This article reports an investigation of serotype-specific differences in growth and heat resistance kinetics of clinical and food isolates of Salmonella. Growth kinetics at 19 degrees C and 37 degrees C were examined in brain heart infusion broth and heat resistance kinetics for 60 degrees C were examined in beef gravy using a submerged coil heating apparatus. Estimates of the parameters of the growth curves suggests a small between-serotype variance of the growth kinetics. However, for inactivation, the results suggest a significant between-serotype effect on the asymptotic D-values, with an estimated between-serotype CV of about 20%. In microbial risk assessment, predictive microbiology is used to estimate growth and inactivation of pathogens. Often the data used for estimating the growth or inactivation kinetics are based on measurements on a cocktail--a mixture of approximately equal proportions of several serotypes or strains of the pathogen being studied. The expected growth or inactivation rates derived from data using cocktails are biased, reflecting the characteristics of the fastest growing or most heat resistant serotype of the cocktail. In this article, an adjustment to decrease this possible bias in a risk assessment is offered. The article also presents discussion of the effect on estimating growth when stochastic assumptions are incorporated in the model. In particular, equations describing the variation of relative growth are derived, accounting for the stochastic variations of the division of cells. For small numbers of cells, the expected value of the relative growth is not an appropriate "representative" value for actual relative growths that might occur.     

Risk Modeling, Assessment, and Management of Lahar Flow Threat

The 1991 eruption of Mount Pinatubo in the Philippines is considered one of the most violent and destructive volcanic activities in the 20th century. Lahar is the Indonesian term for volcanic ash, and lahar flows resulting from the massive amount of volcanic materials deposited on the mountain's slope posed continued post-eruption threats to the surrounding areas, destroying lives, homes, agricultural products, and infrastructures. Risks of lahar flows were identified immediately after the eruption, with scientific data provided by the Philippine Institute of Volcanology, the U.S. Geological Survey, and other research institutions. However, competing political, economic, and social agendas subordinated the importance of scientific information to policy making. Using systemic risk analysis and management, this article addresses the issues of multiple objectives and the effective integration of scientific techniques into the decision-making process. It provides a modeling framework for identifying, prioritizing, and evaluating policies for managing risk. The major considerations are: (1) applying a holistic approach to risk analysis through hierarchical holographic modeling, (2) applying statistical methods to gain insight into the problem of uncertainty in risk assessment, (3) using multiobjective trade-off analysis to address the issue of multiple decisionmakers and stakeholders in the decision-making process, (4) using the conditional expected value of extreme events to complement and supplement the expected value in quantifying risk, and (5) assessing the impacts of multistage decisions. Numerical examples based on ex post data are formulated to illustrate applications to various problems. The resulting framework from this study can serve as a general baseline model for assessing and managing risks of natural disasters, which the Philippines' lead agency-the National Disaster Coordinating Council (NDCC)-and other related organizations can use for their decision-making processes.