Continuum Of Options Research Articles

Use of conditional medical orders to minimize moral, ethical, and legal risk in critical care.

Risk managers and ethicists monitor adherence to codes of conduct in the delivery of medical services and proactively participate with providers to create protocols that minimize the moral, ethical, and legal risks inherent in many commonly used medical protocols. “Code/no code” medical orders work well for patients at the extremes who always or never want to undergo a procedure, but they create troubling uncertainties for others by preventing them from expressly requesting procedures under some circumstances but not others. Obeying binary orders such as DNAR (Do Not Attempt Resuscitation) can allow deaths that a patient might want to delay or can expose patients to prolonged suffering they wish to avoid. These risks can be reduced by: (1) fully explaining the nature of proposed interventions and their possible beneficial and adverse effects in varying circumstances; and (2) replacing the traditional dichotomy with a continuum of options from always, through conditionally sometime, to never orders adapted to a range of situations and preferences. The Conditional Medical Orders (CMO) form summarizes patients’ preferences regarding resuscitation, ventilation, and artificial hydration and nutrition (ANH) is an efficient way to increases the chance that patients will undergo only the treatments they want.

Producing wood at least cost to biodiversity: integrating Triad and sharing-sparing approaches to inform forest landscape management.

Forest loss and degradation are the greatest threats to biodiversity worldwide. Rising global wood demand threatens further damage to remaining native forests. Contrasting solutions across a continuum of options have been proposed, yet which of these offers most promise remains unresolved. Expansion of high-yielding tree plantations could free up forest land for conservation provided this is implemented in tandem with stronger policies for conserving native forests. Because plantations and other intensively managed forests often support far less biodiversity than native forests, a second approach argues for widespread adoption of extensive management, or 'ecological forestry', which better simulates natural forest structure and disturbance regimes - albeit with compromised wood yields and hence a need to harvest over a larger area. A third, hybrid suggestion involves 'Triad' zoning where the landscape is divided into three sorts of management (reserve, ecological/extensive management, and intensive plantation). Progress towards resolving which of these approaches holds the most promise has been hampered by the absence of a conceptual framework and of sufficient empirical data formally to identify the most appropriate landscape-scale proportions of reserves, extensive, and intensive management to minimize biodiversity impacts while meeting a given level of demand for wood. In this review, we argue that this central challenge for sustainable forestry is analogous to that facing food-production systems, and that the land sharing-sparing framework devised to establish which approach to farming could meet food demand at least cost to wild species can be readily adapted to assess contrasting forest management regimes. We develop this argument in four ways: (i) we set out the relevance of the sharing-sparing framework for forestry and explore the degree to which concepts from agriculture can translate to a forest management context; (ii) we make design recommendations for empirical research on sustainable forestry to enable application of the sharing-sparing framework; (iii) we present overarching hypotheses which such studies could test; and (iv) we discuss potential pitfalls and opportunities in conceptualizing landscape management through a sharing-sparing lens. The framework we propose will enable forest managers worldwide to assess trade-offs directly between conservation and wood production and to determine the mix of management approaches that best balances these (and other) competing objectives. The results will inform ecologically sustainable forest policy and management, reduce risks of local and global extinctions from forestry, and potentially improve a valuable sector's social license to operate.

Muslim women’s service utilization for intimate partner violence: Front line service providers’ perceptions of what constitutes a culturally informed response

We explored Muslim women’s involvement in social services in response to intimate partner violence [IPV] from the perspective of frontline service providers. Participants identified several barriers embedded in current services including the absence of individualized support which offers women a continuum of options based on their needs and preferences. Furthermore, lack of sensitivity and appropriate response to abuse experiences based on women’s culture leads to further marginalization of women in services, which decreases service utilization. Participants suggested a strong collaboration among mainstream services, and Muslim centered services providing coordinated community response to IPV. Given women’s collectivist culture, involvement of women’s collective such as family member, and cultural community leaders upon women’s discretion was also recommended. Finally, participants recommended cultural diversity of service providers, while providing an ongoing education on culturally informed practices for all frontline workers. Our results support the development of survivor-defined and culturally informed services in addressing varied needs. To do so, we recommend building a bridge between Muslim communities and formal services, which help with the development of high quality services, and also facilitate women’s access to and use of formal support for IPV.

An Axiomatization of the Shapley-Shubik Index for Interval Decisions

The Shapley-Shubik index was designed to evaluate the power distribution in committee systems drawing binary decisions and is one of the most established power indices. It was generalized to decisions with more than two levels of approval in the input and output. In the limit we have a continuum of options. For these games with interval decisions we prove an axiomatization of a power measure and show that the Shapley-Shubik index for simple games, as well as for (j,k) simple games, occurs as a special discretization. This relation and the closeness of the stated axiomatization to the classical case suggests to speak of the Shapley-Shubik index for games with interval decisions, that can also be generalized to a value.

Tourism planning and place making: place-making or placemaking?

ABSTRACTTourism destination planning and marketing are fundamentally place making actions intended to shape the image and imageability of a place. Place making is an innate human behavior, ranging from the organic and unplanned actions of individuals, defined here as ‘place-making,’ to planned and intentional global theming by governments and tourism authorities, defined here as ‘placemaking.’ Place-making and placemaking are ends on a continuum of options, with most places have a mix of local and global elements. These elements also range from the tangible (base in urban design) to the intangible (peoplescapes and imaginations). The tools of place making are essentially the same for both organic place-making and planned placemaking, but the intentions and outcomes can vary enormously. Tourism development, as an economic activity, almost always has a neoliberal planned placemaking agenda. Organic place-making emerges through individual agency, which if allowed to proceed, will make its imprint even in a heavily master planned tourism landscape. An understanding of place-making and placemaking gives insight into research questions on the political economy of tourism and the roles of hosts and guest in co-producing tourism places. Examining the elements of place making in a tourism landscape can more clearly identify how different worldview perspectives have contribute over time to the making of tourism places, and thereby assist in planning for the future development of destination communities.

Research or teaching oriented? Game theory models for the strategic decision-making process of universities with the external environment held neutral

A key choice that must be made by a new or young university is that of the selected balance between research and teaching on the continuum of options. We approach this choice from a strategic decision-making perspective, by implementing a game theory approach to analyse the selection process. Three main groups of players were identified: faculty members or academicians, university management members, and board of trustees’ members. The decisions of these players were then analysed by the use of a Fuzzy TOPSIS method. Our findings show how, in choosing from the options continuum, the players arrived at equilibria points that best satisfied their collective perspectives as to the required balance, for the purpose of achieving optimal benefit.

From Canada to Kircubbin: learning from America on housing an ageing population – part 2

Purpose – The purpose of this paper is to learn lessons from North America on housing an ageing population, both in terms of supporting people to “age in place”, and available options for those who need/wish to move. The project, funded by the Winston Churchill Memorial Trust, comprised a six-week travel fellowship to USA and Canada to meet with housing professionals from the public and private sectors and find out about best practice initiatives and efficient models for housing older people. Design/methodology/approach – The paper is in two parts, of which this is the second. Part 2 focuses on the links between housing and health and, recognising significant differences between the countries, draws out lessons which may be applied as similar challenges of austerity, an ageing population and the increasing interest in personal budgets are faced. Findings – There is no one size fits all approach to addressing the housing needs of the older population; a continuum of options across tenures is required. There are opportunities for growth in the private and non-profit sectors in terms of the provision of services for the ageing population. Large scale social change comes from better cross-departmental coordination and cannot be achieved by the isolated intervention of a single organisation. Originality/value – This was a unique opportunity to learn lessons from North America on how to effectively meet the needs of the older population, now and in the future. The findings are based on the personal observations and conclusions of a housing practitioner.

Flexibility in the implementation of intellectual property rights in agricultural biotechnology

In this paper I discuss the fact that economists define optimal IP rights as a continuum of options in three dimensions: height, breadth and length. At the operational level we see the impossibility of multiplying rights indefinitely (due to prohibitive transaction costs), as well as the use of a limited number of IP tools which have led to the implementation of flexibilities. These flexibilities are designed to limit certain perverse effects of rights ill-adjusted to the characteristics of some economic sectors (agricultural biotechnologies, pharmacy, etc.). In this context, I analyse how these flexibilities are implemented in TRIPS and TRIPS+ agreements and I study the consequences for Developing Countries.

CBT Modification Promising in Treating Schizophrenia

CBT Modification Promising in Treating Schizophrenia

A Product and Process Model of the Technology‐Sourcing Decision

The technology‐sourcing decision traditionally has examined the choice either to innovate internally or to acquire technology from outside sources. The increasing complexity of this decision requires a move beyond the simple “make‐versus‐buy” dichotomy. We seek to test factors that influence the technology decision of subsidiaries for product and process technology across the continuum of options from internal development to outsourcing. We also explore concordance between the research streams of new product development and technology sourcing.Regression models are used to analyze data from 187 subsidiaries that suggest product and process technology development decisions sometimes are associated with similar factors and at other times they diverge. In particular, we find that external product and process technology acquisition decisions are associated negatively with differentiation goals and associated positively with product dynamism. While external product acquisition is associated negatively with a low cost goal and positively with increasing distance between primary marketing and R&D operations, external process technology acquisition is associated positively with high competitive intensity.Implications include the following: (1) While external product technology acquisition may provide quicker or even less expensive initial solutions, external reliance makes it difficult to maintain a long‐term positional advantage; (2) When greater distances separate key functional activities, external partners may provide solutions that are more responsive to local consumer needs, and the potential for improved communication may allow for quicker adaptation and increased flexibility; (3) In highly dynamic product situations, internal development, while providing greater control, can be expensive and can result in technologies that are not accepted by the marketplace; and (4) As competitive intensity increases, strategic imperatives may reduce the focus on product design and development and may require increasing concentration on manufacturing costs and efficiencies.

Working with Metaphor in Narrative Therapy

Very few approaches allow the client generated metaphor to be the central theme of therapy without prescriptive and interpretative intervention from the therapist. This paper explores the development of client generated metaphors from the narrative therapy perspective. The temptation to follow therapist directed metaphors is discussed. The process of externalization as the development of a client-generated metaphor is considered. We discuss the use of metaphor in generating solutions that consider a continuum of options which reflects the complexity and depth of many clients' ‘problem-saturated’ stories.

Guardianship as a Therapeutic Option

The HIV/AIDS epidemic has posed a significant challenge to our legal system, demanding that it evolve to provide more flexible ways for parents to transfer guardianship of their children to other caring adults in a timely and minimally traumatic manner. Although a number of states have responded to the challenge, adopting new guardianship options such as delegations of parental authority for limited purposes, standby guardianship, co-guardianships, and subsidized guardianships, the majority of states still do not provide this continuum of options. Moreover, few states have established multidisciplinary programs that help parents take full advantage of the new guardianship options. Few have even begun to address the complex needs of the "second" families. Few have developed plans to meet the needs of the older AIDS-affected youth. How well we ensure the quality and continuity of parental care for children whose parents are living with HIV and AIDS, or who later die of it, is one of the tests of our generation. If we fail to meet this challenge, we are knowingly placing thousands of children and youth at enormous, predictable, and potentially fatal risk.

No More "Let Them Eat Admonitions": The Clinton Administration's Emerging Approach to Minority Health

The startling health disparities between whites and racial and ethnic minorities in the United States are partly the result of six major assumptions about health promotion that permeated the Reagan and Bush Administrations. These assumptions, which placed the responsibility for maintaining health on individual Americans, are consistent with policymakers' reliance on market forces to address social issues. While this model may serve persons with a continuum of options and resources to elicit change, it does not benefit the underserved. In contrast, the Clinton Administration's approach, rooted in broad-based participation and multisector planning, is consistent with international models and promises long-overdue recognition that health problems in underserved communities stem from poverty--not the poor.

A Continuum of Options for Developing Instructional Plans in Reading for Elementary Mildly and Moderately Handicapped Students

Instructional alternatives to basal reading texts and a monitoring system are presented as options for teaching handicapped students.

‘Upstream/downstream’ – locating the ‘social’ in health promotion and HIV/AIDS in south africa?

ABSTRACT Strengthening HIV prevention remains an urgent global health priority. The problem is that ‘advancement’ in HIV prevention often stands for the development of biomedical technologies or interventions. Theories and practices of health promotion have been advocating a shift from a biological/medical preventive focus to a more social one; from the level of individuals to organisations, communities and broader social policy. It seems, however, that in practice a real shift in the desired direction remains an elusive goal. This article explores HIV/AIDS health promotion efforts in South Africa, focusing on the traditional dichotomies of bio–social; individual–society and downstream–upstream, in order to draw attention to associated complexities that should be taken on board. Relying on evidence from South Africa (past and present), the main thesis in the article demonstrates the limitation of these efforts, and argues for a more comprehensive approach along a flexible continuum of options, with a focus on the ‘social’. The main argument advanced here, rests on the premise that there is a lack of fit between the forces that shaped the epidemic and efforts to prevent its rapid spread, despite the existence of an adequate sociological understanding of these forces. A model based on the critique developed in the article is presented as a ‘way forward’, suggesting solutions along a flexible ‘continuum of options’ that take the ‘social’ on board. While the focus of the article is on HIV/AIDS, the insights offered in the final thesis and the way forward should prove useful for health promotion efforts in dealing with other health problems as well.