Change Management Research Articles

‘Changing the Course of a Super Tanker’: A Study of Senior and Junior Managers’ Enactments of a Transition Narrative

ABSTRACT This paper investigates how a mnemonic community of a senior and junior generation of frontline managers, respectively with first-hand and second-hand memories of the organizational past, enact a shared historical transition narrative as part of their everyday practice of change management in a Scandinavian telecommunications company. The study shows the importance of actors’ individual trajectories and generational memberships for the understanding of collective memory in organizations. Based on the construct narrative habitus, the paper offers, as its primary theoretical contribution, a practice-theoretical framework for the study of mnemonic socialization and cross-generational dynamics of organizational mnemonic communities.

Most preoperative stress tests fail to comply with practice guideline indications and do not reduce cardiac events.

There is wide variation in stress test utilization before major vascular surgery and adherence to practice guidelines is unclear. We defined rates of stress test compliance at our institution and led a quality improvement initiative to improve compliance with American Heart Association (ACC/AHA) guidelines. We implemented a stress testing order set in the electronic medical record at one tertiary hospital. We reviewed all patients who underwent elective, major vascular surgery in the 6 months before (Jan 1, 2022 - Jul 1, 2022) and 6 months after (Aug 1, 2022 - Jan 31, 2023) implementation. We studied stress test guideline compliance, changes in medical or surgical management, and major adverse cardiac events (MACE). Before order set implementation, 37/122 patients (30%) underwent stress testing within the past year (29 specifically ordered preoperatively) with 66% (19/29) guideline compliance. After order set implementation, 50/173 patients (29%) underwent stress testing within the past year (41 specifically ordered preoperatively) with 80% (33/41) guideline compliance. In the pre- and postimplementation cohorts, stress testing led to a cardiovascular medication change or preoperative coronary revascularization in 24% (7/29) and 27% (11/41) of patients, and a staged surgery or less invasive anesthetic strategy in 14% (4/29) and 4.9% (2/41) of patients, respectively. All unindicated stress tests were surgeon-ordered and none led to a change in management. There was no change in MACE after order set implementation. Electronic medical record-based guidance of perioperative stress testing led to a slight decrease in overall stress testing and an increase in guideline-compliant testing. Our study highlights a need for improved preoperative cardiovascular risk assessment prior to major vascular surgery, which may eliminate unnecessary testing and more effectively guide perioperative decision-making.

Digital Twins in Agriculture: Orchestration and Applications.

Digital Twins have emerged as an outstanding opportunity for precision farming, digitally replicating in real-time the functionalities of objects and plants. A virtual replica of the crop, including key agronomic development aspects such as irrigation, optimal fertilization strategies, and pest management, can support decision-making and a step change in farm management, increasing overall sustainability and direct water, fertilizer, and pesticide savings. In this review, Digital Twin technology is critically reviewed and framed in the context of recent advances in precision agriculture and Agriculture 4.0. The review is organized for each step of agricultural lifecycle, edaphic, phytotechnologic, postharvest, and farm infrastructure, with supporting case studies demonstrating direct benefits for agriculture production and supply chain considering both benefits and limitations of such an approach. Challenges and limitations are disclosed regarding the complexity of managing such an amount of data and a multitude of (often) simultaneous operations and supports.

The roots of errors in adaptive performance: clustering behavioral patterns after the introduction of a change

Purpose The purpose of this study was to investigate work-related adaptive performance from a longitudinal process perspective. This paper clustered specific behavioral patterns following the introduction of a change and related them to retentivity as an individual cognitive ability. In addition, this paper investigated whether the occurrence of adaptation errors varied depending on the type of change content. Design/methodology/approach Data from 35 participants collected in the simulated manufacturing environment of a Research and Application Center Industry 4.0 (RACI) were analyzed. The participants were required to learn and train a manufacturing process in the RACI and through an online training program. At a second measurement point in the RACI, specific manufacturing steps were subject to change and participants had to adapt their task execution. Adaptive performance was evaluated by counting the adaptation errors. Findings The participants showed one of the following behavioral patterns: (1) no adaptation errors, (2) few adaptation errors, (3) repeated adaptation errors regarding the same actions, or (4) many adaptation errors distributed over many different actions. The latter ones had a very low retentivity compared to the other groups. Most of the adaptation errors were made when new actions were added to the manufacturing process. Originality/value Our study adds empirical research on adaptive performance and its underlying processes. It contributes to a detailed understanding of different behaviors in change situations and derives implications for organizational change management.

Affecting and Success factors to implement Total Quality Management in Industries

Total quality management (TQM) is an integrated management philosophy aimed at continuously improving the quality of products and processes to achieve better customer satisfaction. It has been accepted by managers and quality practitioners as a change management quality approach and plays a vital role in the development of management practices. TQM is an approach to improve effectiveness, flexibility, and competitiveness of a business to meet customers' requirements, as a source of sustainable competitive advantage, as a source of attaining excellence, creating a right first-time attitude, acquiring efficient business solutions, and delighting customers and suppliers [2].. Key Words: TQM, Dimensions, implementation, tools and techniques

Navigating business transformation and strategic decision-making in multinational energy corporations with geodata

In the dynamic landscape of multinational energy corporations, navigating business transformation and strategic decision-making requires innovative approaches. Geodata, encompassing spatial and location-based information, emerges as a pivotal asset in this endeavor. This paper outlines the integration of geodata into the fabric of energy corporations, facilitating informed decisions and operational excellence. The introduction elucidates the significance of geodata amidst evolving business paradigms within the energy sector. It explores the transformative potential of geospatial intelligence in fostering agility and resilience, crucial attributes for multinational corporations. Understanding business transformation delves into the fundamental concepts and drivers reshaping the energy industry. Drawing from case studies, it illustrates how corporations leverage strategic shifts to adapt to market dynamics and emerging technologies. The subsequent section emphasizes the pivotal role of geodata in strategic decision-making processes. It elucidates the diverse applications of geospatial information in optimizing operations, mitigating risks, and capitalizing on market opportunities. Integrating geodata into business processes outlines the methodologies and technologies underpinning effective utilization of spatial data. It underscores the importance of robust data management and geospatial analysis techniques for deriving actionable insights. Leveraging geodata for operational excellence explores how energy corporations optimize asset management, streamline supply chains, and enhance risk assessment through geospatial analytics. Case studies and best practices offer real-world examples of successful geodata integration, highlighting key lessons and future trends. Challenges and considerations encompass the complexities of data quality, regulatory compliance, and organizational change management. In conclusion, the paper underscores the transformative potential of geodata in shaping the future trajectory of multinational energy corporations, advocating for a strategic embrace of geospatial intelligence in decision-making processes. Keywords: Business Transformation, Strategic Decision-Making, Multinational Energy Corporations,  Geodata.

Effective food waste management model for the sustainable agricultural food supply chain

The extensive research examines the current state of agricultural food supply chains, with focus on waste management in Bandung Regency, Indonesia. The study reveals that a significant proportion of food within the agricultural supply chain goes to waste and discusses the various challenges and complexities involved in managing food waste. The research presents a conceptual model based on the ADKAR change management paradigm to promote waste utilization, increase awareness and change people's behaviors. The model emphasizes the importance of creating awareness, fostering desire, providing knowledge, implementing changes, and reinforcing and monitoring the transformation process. It also addresses the challenges, barriers, and drivers that influence waste utilization in the agricultural supply chain, highlighting the need for economic incentives and a shift in public awareness to drive meaningful change. Ultimately, this study serves as a comprehensive exploration of food waste management in Bandung Regency, shedding light on the complexities of the issue and offering a systematic approach to transition towards more sustainable waste utilization practices.

Impact of Drought in Northeastern Algeria: Comparative Study of the SPI and SPEI Índices

Purpose: The study aimed to evaluate drought trends in Annaba, Algeria, considering global warming and extreme weather, using quantitative indices for improved drought comprehension and prediction.   Theoretical Framework:The study assesses changes in drought frequency and severity in the Annaba region of Algeria due to global warming and extreme weather conditions. It employs quantitative indices to enhance drought understanding and prediction.   Methodology: The study analyzes temperature and precipitation data (1981-2021) from an Annaba weather station to assess drought characteristics.Standardized indices (SPI, SPEI) and extreme value analysis (Generalized Pareto Distribution) are used to quantify drought intensity, duration, and temperature impacts.   Findings: Our analyses reveal a critical divergence in drought assessment tools. While stable monthly temperatures suggest a constant influence on evapotranspiration, the SPEI index (including temperature) indicates increasing drought compared to the precipitation-only SPI. This highlights the importance of considering temperature alongside precipitation for accurate drought assessment.   Research Practical and Social Implication: This study emphasizes the significance of considering the interplay among temperature, precipitation, and evapotranspiration for better understanding and predicting drought changes in the Annaba region, Algeria. These insights are crucial for sustainable water resource management and climate change adaptation in the region.   Originality/Value:This study distinguishes itself by its comprehensive analysis of long-term climate data to examine drought trends in a specific region (Annaba, Algeria) severely impacted by climate change. By comparing the effectiveness of two drought indices (SPEI and SPI), it offers valuable insights into how to improve drought assessments by considering the role of temperature in evapotranspiration. This research enriches the existing literature on drought management and climate change adaptation, providing a valuable case study for similar arid and semi-arid regions worldwide.

Mitigating Emerging and Reemerging Diseases of Fruit and Vegetable Crops in a Changing Climate.

Fruit and vegetable crops are important sources of nutrition and income globally. Producing these high-value crops requires significant investment of often scarce resources, and, therefore, the risks associated with climate change and accompanying disease pressures are especially important. Climate change influences the occurrence and pressure of plant diseases, enabling new pathogens to emerge and old enemies to reemerge. Specific environmental changes attributed to climate change, particularly temperature fluctuations and intense rainfall events, greatly alter fruit and vegetable disease incidence and severity. In turn, fruit and vegetable microbiomes, and subsequently overall plant health, are also affected by climate change. Changing disease pressures cause growers and researchers to reassess disease management and climate change adaptation strategies. Approaches such as climate smart integrated pest management, smart sprayer technology, protected culture cultivation, advanced diagnostics, and new soilborne disease management strategies are providing new tools for specialty crops growers. Researchers and educators need to work closely with growers to establish fruit and vegetable production systems that are resilient and responsive to changing climates. This review explores the effects of climate change on specialty food crops, pathogens, insect vectors, and pathosystems, as well as adaptations needed to ensure optimal plant health and environmental and economic sustainability.

Abstract PO2-08-01: Universal Multi-Gene Panel Testing of Newly Diagnosed Breast Cancer Patients in a Community Healthcare System

Abstract Introduction Multi-gene panel, germline genetic testing has emerged over the last decade as a useful tool in the assessment of hereditary cancer syndromes. As barriers to genetic testing are reduced, offering universal genetic testing to all cancer patients is a practice gaining traction. We present outcomes data specific to the offering of universal, multi-gene panel testing to newly diagnosed breast cancer patients in a community hospital setting. Methods A retrospective chart review was performed for all newly diagnosed breast cancer patients (n=1005) at a community hospital between 8/5/2019 and 8/5/2022. Uptake and outcomes of genetic counseling and genetic testing were assessed. All patients were offered genetic counseling, and those who consented to genetic testing were offered a multi-gene panel (37-93 genes). The National Comprehensive Cancer Network (NCCN) Genetic/Familial High-Risk Assessment: Breast, Ovarian, and Pancreatic (2020) guidelines were utilized to distinguish which patients met traditional genetic testing criteria. Results Of all newly diagnosed breast cancer patients, 915 (91.1%) patients underwent genetic counseling and 871 (86.7%) patients elected for genetic testing. Of those who declined genetic testing (n=134), 39 (29.1%) reported previous genetic testing. Of patients tested, 489 (56.1%) met NCCN criteria. Overall, 114 (13.1%) of tested patients received results with likely pathogenic/pathogenic (LP/P) variants. Of those, 86 (75.4%) had a clinically significant variant, a high-risk, moderate-risk or another dominantly inherited gene variant, while 28 (24.6%) were identified as genetic carriers; Table 1 summarizes genes with LP/P variants in this cohort, with 10 patients receiving results for 2 variants. Of the patients with clinically significant genetic results, 58 (67.4%) met NCCN criteria. Furthermore, 65 patients (75.6%) reported a family history of cancer relevant to the identified LP/P variant. The average age of the total population, and of those with a positive result, was 62 years. While nearly 19% of all patients tested were under age 50, patients under 50 comprised only 14.0% (n=12) of patients with a clinically significant result. Breast cancer management changes, including addition of a PARP inhibitor to chemotherapy regimen and/or elected bilateral mastectomies in the setting of unilateral disease, were noted in 71.4% (n=20) of patients with high-risk genetic findings and 20.6% (n=7) of patients with moderate-risk genetic findings. Conclusion The 86.7% uptake of genetic testing suggests implementation of universal testing in a community setting is feasible and favored by patients. Clinically significant genetic results would have gone undetected in 32.6% of patients if NCCN criteria was strictly utilized to offer testing. In addition to the 62 patients with high and moderate risk genetic results, utilization of expanded panel testing provided benefit for an additional 24 patients found to have an actionable variant in a gene that would not have been detected on traditional breast cancer panels. Our data supports the offering of genetic testing to all newly diagnosed breast cancer patients, regardless of age, family history, or other criterion, to inform precise breast cancer management and overall, lifetime cancer risks. Genetic Findings of Universal Multi-Gene Panels in a Community Setting Citation Format: Natalie Johns, Jody Wallace, Darbey Raible, Jordan Brady, Grace Miller, Brooke Phillips. Universal Multi-Gene Panel Testing of Newly Diagnosed Breast Cancer Patients in a Community Healthcare System [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-08-01.

Abstract PO1-09-03: Clinical Impact of Multigene Panel Testing in Patients with a Personal or Family History of Breast or Ovarian Cancer Previously Negative for BRCA1/2 Genes

Abstract Rapid developments in cancer genetics and hereditary cancer risk assessments have enabled the identification of individuals at elevated risk for hereditary malignancies to guide enhanced cancer screening and prevention efforts. Multigene panel testing has emerged as the standard approach as emphasized in the National Comprehensive Cancer Network (NCCN) guidelines. The purpose of this study was to investigate the frequency of other pathogenic mutations identified through multigene panel testing in individuals who previously tested negative for germline BRCA1/2 and assess the clinical impact of panel testing. Patients either previously diagnosed with breast cancer or with a family history of breast or ovarian cancer that had also been seen by Oncology Genetics at a single institution and tested negative for BRCA1/2 genes but had not undergone prior multigene panel testing were invited via a letter to return for an additional genetic counseling visit to discuss multigene panel testing. Patients were also able to opt-in to a survey component of the study and received an email to fill out the Multidimensional Impact of Cancer Risk Assessment (MICRA) and Cancer Worry Scale (CWS). Surveys were completed prior to the initial genetic counseling appointment and repeated after discussion of the multigene panel test results. A total 24 women met with a genetic counselor of which 22 (92%) had a personal history of breast cancer, 1 (4%) had a family history of breast cancer, and 1 (4%) had a family history of ovarian cancer. The mean age was 52.6 years (range, 42-68) and 100% of women were Caucasian. Of the 24 women, 17 (71%) completed multigene panel testing. Of the women that underwent testing, 7 (41%) had negative results, 6 (35%) had variants of unknown significance (VUS), and 4 (24%) had a pathogenic mutation identified in another gene (CDKN2A, CHEK2, and CFTR). There was no significant change in MICRA or CWS scores after multigene panel results were reviewed in the 9 patients that completed both pre- and post-genetic testing surveys. The mean/median summary MICRA scores pre- and post-counselling were 30 (SD 12.4), median 26 (min 18, max 56), and 21.2 (SD 15.4), median 21 (min 3, max 43), respectively (p=0.19, Wilcoxon signed ranks test). The mean/median summary CWS scores pre- and post-counselling were 14.3 (SD 5), median 15 (min 7, max 24), and 13.6 (SD 2.59), median 14 (min 10, max 17), respectively (p=0.53, Wilcoxon signed ranks test). Of the 4 patients with newly identified pathogenic mutations, 2 started new screening protocols and 1 underwent a prophylactic mastectomy. In conclusion, multigene panel testing identified pathogenic mutations in a subset of individuals who previously tested negative for BRCA1/2 genes leading to changes in clinical management. The completion of multigene panel testing did not lead to a significant increase in MICRA or CWS scores. Key limitations of this study include a small sample size and an all Caucasian population. Citation Format: Devon Miller, Stephanie Pritzl, Angela Tess, Jessica Gooding, Lisa Barroilhet, Lori Dubenske, Kari Wisinski. Clinical Impact of Multigene Panel Testing in Patients with a Personal or Family History of Breast or Ovarian Cancer Previously Negative for BRCA1/2 Genes [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-09-03.

Abstract PO4-07-09: CONTRAST-ENHANCED MAMMOGRAPHY IN LOCAL STAGING OF SCREEN-DETECTED BREAST CANCER: ADDITIONAL LESIONS AND CHANGES TO CLINICAL MANAGEMENT

Abstract Background BreastScreen Australia, a mammographic population screening program, provides assessment of suspected breast cancer to the point of diagnosis using a combination of conventional imaging and percutaneous biopsy. Comprehensive local staging, not performed at BreastScreen, determines the extent of disease and may identify additional clinically significant breast abnormalities. Local staging options include completion of bilateral mammographic work-up, ultrasound, and/or contrast-based imaging (CBI) (magnetic resonance imaging (MRI) or contrast-enhanced mammography (CEM)), with biopsy as required. We introduced CBI for local staging after diagnosis of screen-detected cancer at our academic hospital breast service in Melbourne, Australia. We report diagnostic findings for otherwise occult disease and their impact on treatment decisions in women who underwent CEM for local staging. Material and methods Women with screen-detected breast cancer who underwent CEM for local staging between November 2018 to April 2022 were identified retrospectively. The reporting breast-specialised radiologist compared BreastScreen and CEM images to identify additional enhancing abnormalities. Additional abnormalities were further investigated with preoperative percutaneous biopsy, surgical biopsy, or problem-solving CBI. Additional CEM-detected abnormalities were documented, with invasive cancer or DCIS recorded as true positive (TP) and any other findings as false positive (FP). Impact on surgical decisions was assessed. Results 204 patients underwent CEM. 62/204 (30%) patients had 76 additional abnormalities, of which 36 (47%) were TP and 40 (53%) FP. CEM identified otherwise occult malignant lesions in 30/204 (15%) patients. TPs comprised 75% invasive cancers and 25% DCIS. 83% (30/36) of malignant abnormalities were ipsilateral to the index lesion, while 17% (6/36) were contralateral. The majority of additional invasive cancers were Grade 2 (20/27, 74.1%), followed by Grade 1 (4/27, 14.8%) then Grade 3 (3/27, 11.1%). All additional invasive cancers had the same phenotype as the patient’s index cancer (ER+/HER2-), except for one abnormality which was ER+/HER2+ where the index cancer was ER+/HER2-. The FP abnormalities consisted of normal breast tissue (20/40, 50%), benign lesions (16/40, 40%) and atypical proliferative lesions (4/40, 10%). Occult malignancies were more common for patients with higher background parenchymal enhancement (20% for moderate/marked vs 4% for minimal/mild, p=0.0023), with no statistically significant differences found by breast density (BIRADS A or B = 12%, vs BIRADS C or D = 20%, p=0.23) or by age (40-49=38%, 50-59=13%, 60-69=13%, ³70=19%, p=0.88). Additional abnormalities found on CEM resulted in surgical management change in 45/204 (22%) patients, including wider resection (24/45), conversion to mastectomy (8/45), contralateral breast surgery (6/45), additional ipsilateral excision (5/45), and bracketing (2/45). Conclusions The use of CEM for local staging of screen-detected breast cancers identified otherwise occult malignancy in 15% of patients. Age and mammographic density did not identify groups at minimal risk of additional findings. Pathology of additional malignancy suggests it is clinically significant. CEM may improve local staging and direct appropriate management of screen-detected breast cancers. Citation Format: Caroline MacCallum, Kenneth Elder, Carolyn Nickson, Kelly Ruecker, Allan Park, Bruce Mann. CONTRAST-ENHANCED MAMMOGRAPHY IN LOCAL STAGING OF SCREEN-DETECTED BREAST CANCER: ADDITIONAL LESIONS AND CHANGES TO CLINICAL MANAGEMENT [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-07-09.

Abstract PO1-08-04: Universal Germline Genetic Testing for Breast Cancer: Implementation in a Rural Practice and Impact on Shared Decision Making

Abstract Background: Prior work from our group has shown a high rate of familial breast cancer (BC) among rural BC patients (pts), with 33% reporting > 1 first-degree family members with BC and 55% meeting NCCN germline genetic testing (GGT) criteria (Shelton CH et al. NC Med. J; 2022). In 2018, we increased GGT to include all BC pts and observed: 1) many pts were out-of-criteria per NCCN guidelines but had actionable pathogenic germline variants (PGVs) and 2) knowledge of GGT factored significantly into shared decision making by providers and patients, including for positive and negative results. Beginning in 2019, concurrent with the recommendation from the American Society of Breast Surgeons, we expanded this model of universal GGT to an IRB-approved study to measure the impact of prospective testing on shared decision-making. Herein we report the real-world implementation of universal GGT for patients with BC and genetics-informed treatment decision-making in a rural community practice. Methods: From 2019-2022 all BC pts at a small, rural community hospital were offered GGT. Demographics, clinical features, and GGT results were collected along with clinician-reported clinical recommendations for treatment based on GGT results. Descriptive statistics and two-tailed Fisher’s exact test were employed and significance was set at p< 0.05. Results: 210 BC pts were offered GGT and 192 (91%) underwent testing [97% female, 95% non-Hispanic White, mean age at diagnosis of 62, 75% Stage I], with all but 7 pts completing GGT before primary treatment decisions. 104 (54%) of patients were in-criteria (IC) and 88 (46%) out-of-criteria (OOC) with NCCN GGT guidelines. PGVs were identified in 25 pts (13%) and 15 genes, most commonly BRCA1/2 (5 pts), PALB2 (3), monoallelic MUTYH (3) and ATM, BARD1, CHEK2 (2 pts each). PGV frequencies were 15% in IC and 11% in OOC patients (p=0.495). 46 (24%) pts had only a variant of uncertain significance (VUS) results. 70% of patients had > 1 clinical management change based on their GGT results. Changes in breast surgery, uptake of risk-reducing bilateral salpingo-oophorectomy, surveillance and clinical follow-up were significantly higher in patients with PGV compared to those with VUS/negative results (p < 0.0001). Compared to those with negative results, patients with PGVs in BRCA1 and BRCA2 were significantly more likely to undergo bilateral mastectomy (BLM) while those with PGVs in other genes or with VUS were not significantly more likely to elect for BLM than those with negative results. Clinicians reported that return of GGT reinforced their recommendation for 73/138 (53%) of patients who underwent breast-conserving therapy. GGT results aided in radiation therapy strategy for 54% of pts, most often resulting in dose de-escalation (accelerated fractionation) for negative/VUS pts (Table). Conclusions: Universal GGT for patients with BC was successfully implemented in a rural community practice with >90% uptake. Treatment was enhanced in those with clinically actionable PGVs and de-escalated in those without PGVs. Universal GGT for patients with BC is feasible to implement as the standard of practice within rural populations, enabling optimization of clinical care to patients’ genetic profile and may reduce unnecessary healthcare resource utilization. Universal Germline Genetic Testing for Breast Cancer: Implementation in a Rural Practice and Impact on Shared Decision Making Changes in Radiation Therapy Strategy based on GGT Citation Format: Charles Shelton, Sarah Nielsen, Antonio Ruiz, Lauren Shelton, Karen Freas, Sarah Poll, Brandie Heald, Daniel Pineda-Alvarez, Edward Esplin, Rachel Ellsworth, Hannah Montgomery. Universal Germline Genetic Testing for Breast Cancer: Implementation in a Rural Practice and Impact on Shared Decision Making [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-08-04.

Quantifying farm sustainability through the lens of ecological theory.

The achievements of the Green Revolution in meeting the nutritional needs of a growing global population have been won at the expense of unintended consequences for the environment. Some of these negative impacts are now threatening the sustainability of food production through the loss of pollinators and natural enemies of crop pests, the evolution of pesticide resistance, declining soil health and vulnerability to climate change. In the search for farming systems that are sustainable both agronomically and environmentally, alternative approaches have been proposed variously called 'agroecological', 'conservation agriculture', 'regenerative' and 'sustainable intensification'. While the widespread recognition of the need for more sustainable farming is to be welcomed, this has created etymological confusion that has the potential to become a barrier to transformation. There is a need, therefore, for objective criteria to evaluate alternative farming systems and to quantify farm sustainability against multiple outcomes. To help meet this challenge, we reviewed the ecological theories that explain variance in regulating and supporting ecosystem services delivered by biological communities in farmland to identify guiding principles for management change. For each theory, we identified associated system metrics that could be used as proxies for agroecosystem function. We identified five principles derived from ecological theory: (i) provide key habitats for ecosystem service providers; (ii) increase crop and non-crop habitat diversity; (iii) increase edge density: (iv) increase nutrient-use efficiency; and (v) avoid extremes of disturbance. By making published knowledge the foundation of the choice of associated metrics, our aim was to establish a broad consensus for their use in sustainability assessment frameworks. Further analysis of their association with farm-scale data on biological communities and/or ecosystem service delivery would provide additional validation for their selection and support for the underpinning theories.

Explaining the changes in procrastination in an ACT-based course – psychological flexibility and time and effort management as mediators

IntroductionThe aim of our study is to explore the relationship between procrastination, time management skills and psychological flexibility and the changes in them during an Acceptance and Commitment therapy (ACT)-based course that included time management training. We also explored the effects of time management skills and psychological flexibility on procrastination. The study used an experimental design in an ACT-based well-being course that included time management training.MethodsThe participants were 109 students taking the course and 27 waiting list students. Analyses were conducted with Pearson correlation, mixed ANOVA and causal mediation analysis.Results and discussionOur results show that time management skills, psychological flexibility and procrastination were related to each other, and all changed during the course. In addition, change in both time management and psychological flexibility had an impact on the change in procrastination during the course. The results show that both time management and psychological flexibility influence the change in procrastination during an ACT-based course.

Improving Adherence to Clinical Practice Guidelines for Managing Gastric Intestinal Metaplasia Among Gastroenterologists at a US Academic Institution.

Clinical guidelines reserve endoscopic surveillance after a gastric intestinal metaplasia (GIM) diagnosis for high-risk patients. However, it is unclear how closely guidelines are followed in clinical practice. We examined the effectiveness of a standardized protocol for the management of GIM among gastroenterologists at a US hospital. This was a preintervention and postintervention study, which included developing a protocol and education of gastroenterologists on GIM management. For the preintervention study, 50 patients with GIM were randomly selected from a histopathology database at the Houston VA Hospital between January 2016 and December 2019. For the postintervention study, we assessed change in GIM management in a cohort of 50 patients with GIM between April 2020 and January 2021 and surveyed 10 gastroenterologists. The durability of the intervention was assessed in a cohort of 50 GIM patients diagnosed between April 2021 and July 2021. In the preintervention cohort, GIM location was specified (antrum and corpus separated) in 11 patients (22%), and Helicobacter pylori testing was recommended in 11 of 26 patients (42%) without previous testing. Gastric mapping biopsies were recommended in 14% and surveillance endoscopy in 2%. In the postintervention cohort, gastric biopsy location was specified in 45 patients (90%, P <0.001) and H. pylori testing was recommended in 26 of 27 patients without prior testing (96%, P <0.001). Because gastric biopsy location was known in 90% of patients ( P <0.001), gastric mapping was not necessary, and surveillance endoscopy was recommended in 42% ( P <0.001). One year after the intervention, all metrics remained elevated compared with the preintervention cohort. GIM management guidelines are not consistently followed. A protocol for GIM management and education of gastroenterologists increased adherence to H. pylori testing and GIM surveillance recommendations.

Changes in Inpatient Brain Arteriovenous Malformation Management in the United States Following the ARUBA Trial: analysis of an interrupted time series design

Changes in Inpatient Brain Arteriovenous Malformation Management in the United States Following the ARUBA Trial: analysis of an interrupted time series design

Groundwater: Sinking Cities, Urbanisation, Global Drying, Population Growth

An examination of a few examples of aquifer-use shows the importance and fragility of groundwater, with poor management leading to over-extraction by individuals and authorities producing subsidence – sinking cities. Freshwater is one of our most precious resources and it is rapidly disappearing, leading to global drying. At the same time, the global and urban populations are increasing, with civil unrest increasing due, in part, to freshwater shortages. The increasing global population and global urbanisation are driving an increase in water use, restriction of aquifer recharge and increased aquifer pollution. It is argued that urban population growth with attendant increased water use, combined with climate change and poor management, is significant in water stress. Particular attention must be paid to the effect of rising populations on local water resources, especially groundwater, and the knock-on effect on urban sustainability.

PHYSICAL ACTIVITY AND SPINAL CORD INJURY: BEHAVIOUR, BARRIERS, MOTIVATIONS AND GAINS

INTRODUCTION &amp; AIMS To attain a comprehensive understanding of physical activity (PA) behaviour in individuals with a spinal cord injury (SCI) in Australia. Investigation and analysis included volumes, guideline-adherence, barriers, motivators, and perceived benefits of PA. METHODS Methodology included quantitative and qualitative approaches. Statistical tests were used on national survey data (n=1,579) to scrutinise PA volumes and guideline-adherence. Semi-structured interviews (n=105) were used to explore barriers to PA, whilst focus groups (six groups of six people) were used to uncover motivations for, and gains of, PA. RESULTS The average PA per week was 333 (+/-318) minutes, 42% of people were sedentary, and less than half (47%) of individuals met PA-specific guidelines. Sociodemographic and injury characteristics displayed very weak capacity (2-5% variance) in predicting PA volume. Barriers pertained to cost, accessibility, pain, self-consciousness, and a perceived lack of return of investment in PA. Whilst appearance/weight management and improved health appeared initially as motivators to PA, participants reported they gained more affiliation and revitalisation through PA, and less appearance/weight management and health change than they had anticipated. Focus group analysis highlighted that the primary (and more significant) motivators and benefits of PA include independence, reclamation of identity, restitution, reduced familial burden, and mitigation of perceived hastened aging. CONCLUSION People with SCI in Australia are amongst the most sedentary in the nation, and less than half of individuals meet PA guidelines. Specific attention is needed toward females, older individuals and people injured non-traumatically. Barriers are significant and affordable and accessible services, skilful and knowledgeable clinicians, and an inclusive environment are needed to improve consumer confidence. Motivation and perceived benefits extend beyond obvious physical advantages of PA. Clinicians and scientists need to understand the psychosocial influence of PA in this sedentary population and harness this knowledge to improve participation and quality of life.

Integrated 4D Design Change Management Model for Construction Projects

Integrated 4D Design Change Management Model for Construction Projects