Fourth Challenge Research Articles

Challenges Facing Healthwatch, a New Consumer Champion in England.

This article engages with debates about the conceptualisation and practical challenges of patient and public involvement (PPI) in health and social care services. Policy in this area in England has shifted numerous times but increasingly a consumerist discourse seems to override more democratic ideas concerning the relationship between citizens and public services. Recent policy change in England has seen the creation of new consumer champion bodies in the form of local Healthwatch. The article describes these new organisational structures for PPI and shows how those who seek to influence planning and delivery of services or comment or complain about aspects of their care face considerable complexity. This is due, in part, to the ambiguous remit set out for newly instigated Healthwatch organisations by government. Drawing on governance theory, we show that it can also be understood as a function of an increasingly polycentric governance arena. Challenges that flow from this include problems of specifying jurisdictional responsibility, accountability, and legitimacy. We review Healthwatch progress to date, then we set out four challenges facing local Healthwatch organisations before discussing the implications of these for patients and the public. The first challenge relates to non-coterminous boundaries and jurisdictional integrity. Secondly, establishing the unique features of Healthwatch is problematic in the crowded PPI arena. The third challenge arises from limited resources as well as the fact that resources flow to Healthwatch from the local authorities that Healthwatch are expected to hold to account. The fourth challenge we identify is how local Healthwatch organisations negotiate the complexity of being a partner to statutory and other organisations, while at the same time being expected to champion local people's views.

Five challenges for public administrations in Europe

Abstract This article examines five ‘challenges’ facing most administrative systems across Europe. The first challenge stems from the increasingly asymmetric nature of European multilevel governance; the second challenge arises from the missed opportunity of reforming in the absence of a dominant administrative paradigm; the third challenge lies in rescuing and transforming the welfare state; the fourth challenge is concerned with making the most of the knowledge generated in the field of strategic management for strategically managing public services; the fifth challenge lies in staff (de)motivation. These challenges are pitched at very different levels: some are related to issues of public governance, some to issues of scholarly and practitioners’ collective understandings of public administration in Europe, and some to trends in the global economy, and notably the financial, economic and fiscal ‘crises’.

Pursuing Economic Growth in Asia: The Environmental Challenge

AbstractThis paper identifies and discusses the five main areas of environmental management public policy that pose serious challenges to Asian governments. The first is the emerging issue of siting environmentally unfriendly facilities that may be necessary for growth, but with the social and environmental costs borne primarily by local host residents and neighbourhood municipalities, more commonly known as the not‐in‐my‐backyard syndrome. The second issue is the critical need for pricing of non‐market environmental goods. Third is the issue of waste generation. The fourth challenge is that of transboundary pollution, which has become increasingly important with regard to its effects on health and foreign relations. Lastly, the paper discusses global warming and climate change. Discussions on cost–benefit analysis and the more novel method of establishing damage schedules are also presented. This is particularly relevant to fundamental differences between developed and less developed countries.

Enterprise engineering and management at the crossroads

The article provides an overview of the challenges and the state of the art of the discipline of Enterprise Architecture (EA), with emphasis on the challenges and future development opportunities of the underlying Information System (IS), and its IT implementation, the Enterprise Information System (EIS). The first challenge is to overcome the narrowness of scope of present practice in IS and EA, and re-gain the coverage of the entire business on all levels of management, and a holistic and systemic coverage of the enterprise as an economic entity in its social and ecological environment. The second challenge is how to face the problems caused by complexity that limit the controllability and manageability of the enterprise as a system. The third challenge is connected with the complexity problem, and describes fundamental issues of sustainability and viability. Following from the third, the fourth challenge is to identify modes of survival for systems, and dynamic system architectures that evolve and are resilient to changes of the environment in which they live. The state of the art section provides pointers to possible radical changes to models, methodologies, theories and tools in EIS design and implementation, with the potential to solve these grand challenges.

Is Mexico Ready for Face Transplantation?

With the limitations of surgical reconstructive procedures, the growing number of gunshot wounds, burns, and work accidents in Mexico that result in complex facial deformities leaves only 1 option—face transplantation. The National Institute of Medical Sciences and Nutrition “Salvador Zubiran” (INCMNSZ) has performed transplants since 1971. We at INCMNSZ undertook the 1st bilateral upper-limb transplantation in Latin America in 2012. We are willing to continue in this manner toward conducting face transplantation at our institute. To this end, we identified and solved various challenges. The 1st challenge was acceptance and inclusion of vascularized composite allotransplantation (VCA) within general Mexican health law and approval of the face transplantation procedure. Subsequently, the health ministry provided a license to INCMNSZ to perform the procedure. The 2nd challenge concerned who would pay for the procedure. The costs will be paid by the patient (1st-party payer), social security institutions (2nd-party payers), and the health ministry (3rd-party payer). The 3rd challenge was to maintain ongoing surgical training of the team using cadavers. The fourth challenge was to locate donors; toward this end, we developed a campaign for promoting face donation in social media, making a comic book, and training organ and tissue coordinators to further VCA. Thus, INCMNSZ has the legal, administrative, medical, and surgical wherewithal to accomplish face transplantation.

Levinas and Asian Thought ed. by Leah Kalmanson, Frank Garrett, and Sarah Mattice (review)

Reviewed by: Levinas and Asian Thought ed. by Leah Kalmanson, Frank Garrett, and Sarah Mattice David Chai (bio) Levinas and Asian Thought. Edited by Leah Kalmanson, Frank Garrett, and Sarah Mattice. Pittsburgh: Duquesne University Press, 2013. Pp. ix + 295. Paper $28.00, isbn 978-0-820-70468-5. Levinas and Asian Thought, edited by Leah Kalmanson, Frank Garrett, and Sarah Mattice, is one in a long series of works on Levinas coming out of Duquesne University Press. Structurally, the editors have divided the work into three units: Selves and Others (4 chapters); Responsibility and its Limits (4 chapters); and Practices, Norms, and Institutions (5 chapters). Of these thirteen chapters, seven are on Buddhism while the remaining six comprise an eclectic selection of topics dealing with, for example, the samurai code of bushidō, Islamic ethics, the tea ceremony, and the war crimes trials in Cambodia. Of the Introduction’s nine pages, only four are devoted to explicating the need for this book. It is here that the editors pointedly note a theme found in each of its subsequent chapters: that any comparison between Levinas and Asian philosophy must not only overcome the “double bind” of philosophy (p. 3), it must furthermore come to terms with Levinas’ disparaging views of non-Western cultures. The editors disown this “shortsightedness” of Levinas (p. 2) by directing our attention to the “many fruitful applications of the concept of alterity in postcolonial studies” (p. 2). What this has to do with the philosophical traditions of Asia is unclear, but it goes some way to explaining the preponderance of chapters on India. Another stated challenge for a comparison between Levinas and Asian thought stems from the “deep conceptual divides that separate the cosmological, ontological, and metaphysical underpinnings of his work from much of Asian philosophy” (p. 3). This issue is also conveniently avoided in that two thirds of the chapters are on ethics. A third stated challenge is the consideration of Levinas’ “deep indebtedness to Jewish theology” (p. 3), an indebtedness that is nowhere to be seen in this book. The fourth and final challenge pertains to “conceptions of subjectivity [that] reveal a divide between Levinas’s philosophical premises and mainstream Asian worldviews” (p. 3.) This is [End Page 639] without question the most relevant of the four issues and one that ultimately shapes the book’s methodology. In light of the above-stated challenges, it would have been informative to know why the Japanese tea ceremony, for example, is taken as emblematic of Asian art and aesthetics and not, say, Chinese landscape painting. The same holds true for the chapters on Sima Qian (how is the historical narrative of Sima Qian able to stand in for the writings of Confucius or Mencius?), on Watsuji Tetsurō (how is an obscure Japanese thinker more qualified to represent an Asian “theory of mind” than the Neo-Confucian Wang Yangming or the Sufi Al-Ghazali?), on the war crimes trials of the Khmer Rouge, or on the honor code of the samurai (again, why is Japanese bushidō more appropriate than the Confucian ren or Sufi futuwwah?). What is more, topics one would expect to be included in a work of this nature are surprisingly absent: temporality, hermeneutics, altruism, and gender. Another factor that contributes to the book’s unevenness stems from its many weak chapters. For example, the chapter by Frank Garrett on Levinas and Buddhist no-self uses the work of Nishida Kitarō, the founder of the Kyoto School of Zen Buddhism, to reveal Levinas’ ethics in that “the lexicon of Buddhist philosophy provides a fitting language with which to express Levinas’ own decoupling of the subjective I from the metaphysics of identity” (p. 13). In order to do this, Garrett uses three kōan to “put into question the totalization of subjectivism” (p. 13). Leaving aside the question of why Garrett feels the need for such questioning, the major issue is that he uses kōan from Linji (ninth century c.e.), a monk belonging to the Southern School of Chan Buddhism, to interpret Kitarō, while his reading of Kitarō is limited to but a single chapter of Last Writings: Nothingness and the Religious Worldview (University of Hawai...

IgE/antigen-mediated enhancement of IgE production is a mechanism underlying the exacerbation of airway inflammation and remodelling in mice.

IgE is known to enhance some antibody responses to specific antigens, but whether this contributes to allergic asthma remains unclear. We have previously found that repeated antigen challenges in mice sensitized with antigen-specific IgE monoclonal antibody (mAb) exacerbated airway inflammation and remodelling accompanied by increased levels of endogenous antigen-specific IgE and IgG1. Here, we investigated whether IgE/antigen-mediated enhancement of endogenous IgE production contributes to the exacerbation of airway inflammation and remodelling. BALB/c mice passively sensitized with ovalbumin (OVA) -specific IgE mAb were challenged with OVA intratracheally seven times; anti-IgE mAb was intraperitoneally administered 1 day before the fourth challenge. Treatment with anti-IgE mAb inhibited the increased level of endogenous OVA-specific IgE in serum, but not OVA-specific IgG1, and a biphasic increase in airway resistance at the fourth challenge. Furthermore, a biphasic increase in airway resistance, airway hyper-responsiveness to methacholine, OVA-specific IgE and IgG1 production, and infiltrations by neutrophils and eosinophils in the lungs at the seventh challenge were suppressed by treatment; airway remodelling, such as goblet cell hyperplasia and sub-epithelial fibrosis, was also reduced. In addition, the production of interleukin-17A, interleukin-33 and CXCL1 in the lungs related to these IgE-mediated responses was decreased by treatment. Collectively, we found that the mechanism leading to the exacerbation of allergic asthma is closely related to IgE/antigen-mediated enhancement of IgE production, suggesting that this may create a vicious circle leading to the chronic status in asthmatic patients having levels of antigen-specific IgE ready to form complexes with antigen.

Challenges of creating synergy between global mental health and cultural psychiatry.

This article addresses four major challenges for efforts to create synergy between the global mental health movement and cultural psychiatry. First, although they appear to share domains of mutual interest, the worlds of global mental health and cultural psychiatry have distinct lineages. Expanding their horizons by learning from adjacent disciplines would be mutually beneficial. A second challenge concerns the conceptualization of a new classification system for mental health problems. Adopting a classification system that integrates new insights from socio-neurobiology and from a networks perspective could bring cultural psychiatry and global mental health closer and change the way each field addresses the mental health gap, which constitutes the third challenge. I summarize attempts to achieve comprehensive mental health coverage around the globe and question whether the strategies employed to achieve these goals have been successful, both in high- (HIC) and low- and middle-income countries (LMIC). In LMIC, the dominant strategy needs to be complemented by mobilization of other community resources including local practitioners. A fourth challenge is the lack of mathematical models to guide action and research and solve major preoccupations such as access to care or multi-level analyses in complex ecological or health systems.

A perpetual source of DNA or something really different: ethical issues in the creation of cell lines for African genomics research.

BackgroundThe rise of genomic studies in Africa – not least due to projects funded under H3Africa – is associated with the development of a small number of biorepositories across Africa. For the ultimate success of these biorepositories, the creation of cell lines including those from selected H3Africa samples would be beneficial. In this paper, we map ethical challenges in the creation of cell lines.DiscussionThe first challenge we identified relates to the moral status of cells living in culture. There is no doubt that cells in culture are alive, and the question is how this characteristic is relevant to ethical decision-making. The second challenge relates to the fact that cells in culture are a source of cell products and mitochondrial DNA. In combination with other technologies, cells in culture could also be used to grow human tissue. Whilst on the one hand, this feature increases the potential utility of the sample and promotes science, on the other it also enables further scientific work that may not have been specifically consented to or approved. The third challenge relates to ownership over samples, particularly in cases where cell lines are created by a biobank, and in a different country than where samples were collected. Relevant questions here concern the export of samples, approval of secondary use and the acceptability of commercialisation. A fourth challenge relates to perceptions of blood and bodily integrity, which may be particularly relevant for African research participants from certain cultures or backgrounds. Finally, we discuss challenges around informed consent and ethical review.SummaryIn this paper, we sought to map the myriad of ethical challenges that need to be considered prior to making cell line creation a reality in the H3Africa project. Considering the relative novelty of this practice in Africa, such challenges will need to be considered, discussed and potentially be resolved before cell line creation in Africa becomes financially feasible and sustainable. We suggest that discussions need to be undertaken between stakeholders internationally, considering the international character of the H3Africa project. We also map out avenues for empirical research.

Allergen-specific regulation of allergic rhinitis in mice by intranasal exposure to IgG1 monoclonal antibody Fab fragments against pathogenic allergen

Fab fragments (Fabs) have the ability to bind to specific antigens but lack the Fc portion for binding to receptors on immune and inflammatory cells that play a critical role in allergic diseases. In the present study, we investigated whether Fabs of an allergen-specific IgG1 monoclonal antibody (mAb) inhibited allergic rhinitis in mice. BALB/c mice sensitized by intraperitoneal injections of ovalbumin (OVA) plus alum on days 0 and 14 were intranasally challenged with OVA on days 28–30, and 35. Fabs prepared by the digestion of an anti-OVA IgG1 mAb (O1–10) with papain were also intranasally administered 15min before each OVA challenge. The results showed that treatment with O1–10 Fabs significantly suppressed the sneezing frequency, associated with decrease of OVA-specific IgE in the serum and infiltration by mast cells in the nasal mucosa seen following the fourth antigenic challenge; additionally, the level of mouse mast cell protease-1, a marker of mast cell activation, in serum was decreased. Furthermore, infiltration of eosinophils and goblet cell hyperplasia in the nasal mucosa at the fourth challenge were inhibited by treatment with O1–10 Fabs. In conclusion, these results suggest that intranasal exposure to Fabs of a pathogenic antigen-specific IgG1 mAb may be effective in regulating allergic rhinitis through allergen capture by Fabs in the nasal mucosa before the interaction of the intact antibody and allergen.

Los retos de la produccion de anonaceas en Mexico: produccion y mercadeo

Analizando los retos actuales del Mundo de las Anonáceas en México, debemos tomar en cuenta todos los participantes, desde el productor, pasando por los mercados de destino y hasta el consumidor final. En un ambiente agroalimentario globalizado y cada vez más competitivo, los negocios que se adaptan para satisfacer las necesidades de los consumidores son los únicos que sobrevivirán y crecerán. La Cooperación Inter-Empresarial, denominada por algunos "Empresa-Red"; para explotar conjuntamente las ventajas de la gran empresa (consorcio) y de la pequeña empresa (rapidez), es el primer gran reto. Un segundo reto lo integran los factores que impulsan el mercado: La Seguridad Alimentaria, La calidad del producto, La Innovación, La disminución de Costos, y El Desarrollo de Nuevos Mercados. Un tercer reto es La adaptación competitiva de las anonáceas al cambio climático. Encontrar microorganismos eficientes de control biológico para proteger alimentos, resulta un cuarto reto y una alternativa prometedora para el control de organismos indeseables. Posicionar a las Anonáceas como la Fruta Emblemática de América Latina en los Mercados Internacionales operando una Cadena de Valor Continental, y Converger con todos los actores continentales en este gran esfuerzo que impone la dinámica mundial; es sin duda, el Gran Reto y nuestra invitación, para asumirlo, en este memorable Congreso Internacional. Así como, la Integración del Ecosistema Continental de Innovación para el Desarrollo Sustentable de las Anonáceas.

Analyzing mistuned multi-stage turbomachinery rotors with aerodynamic effects

A great deal of research has been conducted on accurately modeling large cyclic structures such as turbomachinery rotors. Accurate modeling of realistic industrial turbomachinery requires overcoming several challenges. The first is the excessively large size of the finite element models (FEMs) needed, which can contain millions of degrees of freedom per stage of the rotor. The second challenge is the presence of small random variations in the structural properties known as mistuning, which arise from operational wear and/or manufacturing tolerances, and destroy the cyclic symmetry of the FEMs. The third is the complexity of turbomachinery models, which often include multiple stages that often have a mismatched computational grid at the interface between stages. The fourth challenge is associated with modeling the aerodynamic loads on the turbomachinery rotor. Much research has been conducted to overcome the first two challenges. By combining cyclic symmetry analysis and component mode mistuning (CMM), compact single-stage reduced order models (ROMs) can be created to accurately capture the free and forced response of these systems. These highly efficient ROMs can be developed from single sector calculations and can be of the order of the number of sectors in the stage. Recently, the third challenge associated with the complexity of modeling multiple stages has been addressed by the authors. Their method uses cyclic symmetry and CMM to form single-stage ROMs (using only single sector models and single sector calculations), and then combines these single-stage ROMs by projecting the motion along the interface between stages along a set of harmonic shape functions. This method allows for the creation of compact ROMs of multi-stage systems with mistuning using sector only calculations. The fourth challenge has been addressed only for single-stage systems by computing a complex aerodynamic matrix (which contains stiffness and damping terms) using an iterative approach. In this work, some of the effects of the aerodynamics on multi-stage systems are explored. The methodology consists of first creating efficient structural ROMs of a multi-stage rotor using the method previously developed, and then iteratively calculating the complex aerodynamic matrices for each stage. A new way to account for the effects of a shift in frequency due to mistuning on the complex aerodynamic matrix is also proposed. Additionally, a new classification of complex multi-stage aeroelastic modes is introduced. The presented results focus on exploring the influences of the aerodynamics and mistuning on the multi-stage response. A variety of numerical results are analyzed for two stages of an industrial rotor.

Seven challenges for neuroscience

Although twenty-first century neuroscience is a major scientific enterprise, advances in basic research have not yet translated into benefits for society. In this paper, I outline seven fundamental challenges that need to be overcome. First, neuroscience has to become "big science" - we need big teams with the resources and competences to tackle the big problems. Second, we need to create interlinked sets of data providing a complete picture of single areas of the brain at their different levels of organization with "rungs" linking the descriptions for humans and other species. Such "data ladders" will help us to meet the third challenge - the development of efficient predictive tools, enabling us to drastically increase the information we can extract from expensive experiments. The fourth challenge goes one step further: we have to develop novel hardware and software sufficiently powerful to simulate the brain. In the future, supercomputer-based brain simulation will enable us to make in silico manipulations and recordings, which are currently completely impossible in the lab. The fifth and sixth challenges are translational. On the one hand we need to develop new ways of classifying and simulating brain disease, leading to better diagnosis and more effective drug discovery. On the other, we have to exploit our knowledge to build new brain-inspired technologies, with potentially huge benefits for industry and for society. This leads to the seventh challenge. Neuroscience can indeed deliver huge benefits but we have to be aware of widespread social concern about our work. We need to recognize the fears that exist, lay them to rest, and actively build public support for neuroscience research. We have to set goals for ourselves that the public can recognize and share. And then we have to deliver on our promises. Only in this way, will we receive the support and funding we need.

Interleukin‐33 and alveolar macrophages contribute to the mechanisms underlying the exacerbation of IgE‐mediated airway inflammation and remodelling in mice

Allergen-specific IgE has long been regarded as a major molecular component of allergic asthma. Additionally, there is increasing evidence of the important roles of interleukin-33 (IL-33) in the disease. Here, we show that IL-33 and alveolar macrophages play essential roles in the exacerbation of IgE-mediated airway inflammation and remodelling. BALB/c mice passively sensitized with ovalbumin (OVA)-specific IgE monoclonal antibody (mAb) were challenged with OVA seven times intratracheally. The seventh challenge exacerbated airway inflammation and remodelling compared with the fourth challenge; furthermore, markedly increased expression of IL-33 in the lungs was observed at the fourth and seventh challenges. When anti-IL-33 or anti-ST2 antibody was administered during the fourth to seventh challenge, airway inflammation and remodelling were significantly inhibited at the seventh challenge. Because increases of IL-33(+) and ST2(+) alveolar macrophages and ST2(+) CD4(+) T cells in the lungs were observed at the fourth challenge, the roles of macrophages and CD4(+) cells were investigated. Depletion of macrophages by 2-chloroadenosine during the fourth to seventh challenge suppressed airway inflammation and remodelling, and IL-33 production in the lung at the seventh challenge; additionally, anti-CD4 mAb inhibited airway inflammation, but not airway remodelling and IL-33 production. Meanwhile, treatment with 2-chloroadenosine or anti-CD4 mAb decreased IL-33-induced airway inflammation in normal mice; airway remodelling was repressed only by 2-chloroadenosine. These results illustrate that macrophage-derived IL-33 contributes to the exacerbation of IgE-mediated airway inflammation by mechanisms associated with macrophages and CD4(+) cells, and airway remodelling through the activation of macrophages.

Effect of fudosteine, a cysteine derivative, on airway hyperresponsiveness, inflammation, and remodeling in a murine model of asthma

AimsFudosteine is a cysteine derivative that is used as an expectorant in chronic bronchial inflammatory disorders. It has been shown to decrease the number of goblet cells in an animal model. This study examined the effects of fudosteine on airway inflammation and remodeling in a murine model of chronic asthma. Main methodsBALB/c mice were sensitized by an intraperitoneal injection of ovalbumin (OVA), and subsequently challenged with nebulized ovalbumin three days a week for four weeks. Seventy-two hours after the fourth challenge, airway hyperresponsiveness (AHR) and the cell composition of bronchoalveolar lavage (BAL) fluid were assessed. Fudosteine was administered orally at 10mg/kg or 100mg/kg body weight from the first to the fourth challenge. Key findingsWe investigated the effects of fudosteine on the development of allergic airway inflammation and airway hyperresponsiveness after chronic allergen challenges. The administration of fudosteine during the challenge with ovalbumin prevented the development of airway hyperresponsiveness and accumulation of lymphocytes in the airways. Eotaxin, IL-4, and TGF-β levels and the relative intensity of matrix metalloproteinase-2 and matrix metalloproteinase-9 (MMP-2 and MMP-9) in BAL fluid were reduced by the fudosteine treatment; however, the number of eosinophils in BAL fluid and serum IgE levels did not change. The expression of TGF-β, the development of goblet cell hyperplasia, subepithelial collagenization, and basement membrane thickening were also reduced by the fudosteine treatment. SignificanceThese results indicate that fudosteine is effective in reducing airway hyperresponsiveness, airway inflammation, and airway remodeling in a murine model of chronic asthma.

The future of quality improvement research

Presentation The history of quality improvement research (QIR) demonstrates the large growth in improvement activities from early quality assessment and small area variation work through the adoption of industrial quality improvement methods in healthcare operations to the recent opportunities inherent in the Affordable Care Act of 2010. But after 40 years of development, significant growth in these scholarly activities has not produced comparable growth in insights, practical guidance, or progress toward better care. Five challenges influence the trajectory of improvement work and implementation science. The first challenge relates to the innovations and evidence base to improve healthcare. The focus of innovation and research in improvement has been on strategies, facilities and systems that are leaders in performance and quality improvement – the organizational equivalents of healthy white males. This makes differentiation and generalizability to the range of organizational settings difficult. A concerted effort must be made to focus on research conducted within, and with relevance to, the broader practice environment. The second challenge includes multiple logistical barriers such as access to study sites, the limited funding opportunities for QIR, and the lack of consistent IRB guidance and interpretation of regulations. Underlying these barriers is a considerable lack of clarity surrounding the nature of QIR relative to other types of health research. With the exception of the recent statement on cluster randomized trials by the Ottawa Ethics of Cluster Randomized Trials Consensus Group (2012)[1], the absence of consistent guidelines for QIR poses challenges for researchers trying to obtain local IRB review as well as investigators competing with others using more traditional research methods during the grant review process. QIR researchers need to embrace the IRB process and develop explicit, consensus-based guidance to facilitate more consistent reviews at the funding and IRB stages. The third challenge includes the professional differences that stem from the diversity of academic disciplines and types of institutions from which people involved in this work emerge. The concepts and definitions arising from diverse disciplinary roots make it difficult to achieve progress and move forward collectively. These factors pose barriers to the scholarly QIR community and, more importantly, contribute to confusion and decreased credibility among external stakeholders and scientists in the more traditional fields of study surrounding QIR. Lack of consensus and clarity impede the advance of this science because researchers cannot explain the work consistently to funding agencies, editorial review boards and other stakeholders. The fourth challenge is the need to strengthen the theoretical foundations for this work. There is an urgent need to assess whether we have the right theories, too many theories or simply a lack of guidance in using theories to build the science of improvement. The weak theoretical basis for QIR contributes to the fifth and final challenge to the future, which is advancing the science through robust and appropriate research approaches, designs and methods. The field has failed to reach consensus about the major research questions and goals for QIR, and continues to debate the appropriate methods for improvement and implementation work. Different views regarding the value and need for various research approaches and methods for conducting QIR limits the production of practical and effective insights and tools for researchers, clinicians, organizations, and policy decision makers.

Environmental Knowledge Management of Finnish Food and Drink Companies in Eco-Efficiency and Waste Management

Introduction Various tools for environmental management (EM) exist but few of them integrate the product life cycle perspective and the knowledge management (KM) approach. The life cycle perspective is an essential aspect of EM, since it classifies and describes actions related to all relevant environmental knowledge areas, from product acquisition, design and manufacture, to product service and disposal. On the other hand, use of KM to tackle environmental issues can help companies to better understand what can be done about environmental problems and how to realize the benefits of environmentally responsible actions (Frick, Kaiser, & Wilson, 2004). Most of the literature on environmental knowledge management (EKM) focuses on informational and softer decision-making tools rather than on appropriate understanding of specific environmental knowledge areas and their connection to organizational structure and culture (Heeney & Murphy, 1999). Environmental knowledge management should combine tools, mechanism, processes, structures, strategies, data, and information with people's experiences and ideas to enable the creation, capture, sharing, acquisition, and use of knowledge (Huang & Shih, 2009). Consequently, this research employs knowledge management and the product life cycle approach to address individual environmental knowledge areas about eco-efficiency and waste management and their interrelations. There are four relevant challenges for this study based on the literature. The first is incoherence between environmental knowledge about management of raw materials, energy efficiency, and waste (Kaiser & Fuhrer, 2003). Companies have knowledge gaps in understanding and utilization of product life cycle processes due to the complex relationship between raw materials, energy, and waste. The second challenge is related to an inability to identify and analyze all relevant environmental aspects and impacts within the areas of raw materials, energy, and waste management. Companies need to develop an atomistic approach for every business process in order to gain understanding about the risks, costs and benefits of their actions for the each knowledge area (Ipe, 2003; Kaiser & Fuhrer, 2003). The third challenge arises from a lack of empowerment of employees, which prevents them from taking relevant environmental actions. Boiral (2002) emphasizes that managers and environmental specialists must visit work sites and discuss with employees in order to identify their knowledge and competencies as well as to encourage them to think, share, and use their environmental knowledge. Companies also need to find solutions to integrate individual knowledge, plans, experience, and goals into organizational structures. The fourth challenge is found in external contacts and knowledge acquisition from stakeholders and suppliers. This challenge is related to the ability of organizations to acquire relevant external knowledge and integrate it appropriately into internal knowledge (Jorgensen, 2006, 2008). The general aim of this research is to analyze how companies identify relevant eco-efficiency and waste management aspects, their relations and causes, and how they act to address these aspects. Additionally, employing KM and the life cycle approach, this paper sets the following specific objectives: a) to analyze how companies acquire knowledge on eco-efficiency and waste management internally and externally; b) to analyze how companies share knowledge on eco-efficiency and waste management internally and externally; c) to outline the way in which companies use and create knowledge about eco-efficiency and waste management; d) to analyze knowledge accumulation and retrieval about eco-efficiency and waste management; This research focuses on the Finnish companies in food and drink sectors. The food and drink industry is the fourth biggest industry in Finland and, at the same time, one of the greatest users of materials and energy. …

Preparing schools to accommodate the challenge of Web 2.0 technologies

With laptops, mobile phones, tablets and broadband wireless access becoming more widely available, Web 2.0 is now entering schools. This changes the way students work and communicate, altering their relationship with knowledge, and generating new objectives for media literacy in the digital society. Thus, schools face new challenges and this paper aims at highlighting four of them. A first challenge relates to trust. Web 2.0 opens the classroom to the world and educators have to face new dangers and irrelevant uses, while bringing their students to gain better access to information and culture. The second challenge relates to teachers' professional identities. The role of teachers is changing as Web 2.0 tools are being used by students, and policymakers should take this into account. A third challenge relates to a growing need to control working time, timetable organization and rhythm in schools. The fourth challenge that we underline is the need for common rules that allow students to benefit from the opportunities offered by Web 2.0 to develop their autonomy and to foster ethical practices.

Uncovering audience preferences for concert features from single-ticket sales with a factor-analytic random-coefficients model

To better plan their programs, producers of performing arts events require forecasting models that relate ticket sales to the multiple features of a program. The framework we develop, test and implement uncovers audience preferences for the features of an event program from single-ticket sales while accounting for interactions among program features and for preference heterogeneity across markets. We develop a factor-analytic random-coefficients model that overcomes four major methodological challenges. First, the historical data available from each market is limited, preventing the estimation of models at the market level and requiring some form of shrinkage estimator that also takes into account the diversity in preferences across markets as well as the fact that preferences for the many (26 in our application) program features are correlated across markets, requiring the estimation of a large covariance matrix for these preferences across markets. Our proposed factor-analytic regression formulation parsimoniously captures the principal components of the correlated preferences and provides shrinkage estimates at the individual market level. The second challenge we face is the fact that orchestras differ on how they sell season subscriptions, leading to substantial unobserved effects on ticket sales across orchestras; an added benefit of our random-coefficients approach is that it incorporates a random effect that captures any shift in the dependent variable caused by unobservable factors across all events in each individual market, such as the unobservable effect of season subscriptions on single-ticket sales.The third methodological challenge is that program features are likely to interact requiring the estimation of a large set of pair-wise interactions. We solve this problem by mapping the interactions on a reduced space, arriving at a more parsimonious model formulation. The fourth methodological challenge relates to implementation of the model results beyond the relatively small sample of markets for which historical data were available. To overcome this limitation, we demonstrate how our model can be applied to markets not included in our sample, first using only managerial insight regarding the similarity between the focal market and the ones in our sample and by updating this subjective prior as ticket sales data become available.

Uncovering Audience Preferences for Concert Features from Single-Ticket Sales with a Factor-Analytic Random-Coefficients Model

To better plan their programs, producers of performing arts events need forecasting models that relate ticket sales to the multiple features of a program. The framework we develop, test and implement uncovers audience preferences for the features of an event program from single-ticket sales, while accounting for interactions among program features and for preference heterogeneity across markets. We develop a factor-analytic random-coefficients model that overcomes four major methodological challenges. First, the historical data available from each market is limited, preventing the estimation of models at the market level, and requiring some form of shrinkage estimator that also takes into account the diversity in preferences across markets, as well as the fact that preferences for the many (26 in our application) program features are correlated across markets, requiring the estimation of a large covariance matrix for these preferences across markets. Our proposed factor-analytic regression formulation parsimoniously captures the principal components of the correlated preferences and provides shrinkage estimates at the individual market level. The second challenge we face is the fact that orchestras differ on how they sell season subscriptions, leading to substantial unobserved effects on ticket sales across orchestras; an added benefit of our random-coefficients approach is that it incorporates a random effect that captures any shift in the dependent variable caused by unobservable factors across all events in each individual market, such as the unobservable effect of season subscriptions on single-ticket sales. The third methodological challenge is that program features are likely to interact requiring the estimation of a large set of pair-wise interactions. We solve this problem by mapping the interactions on a reduced space, arriving at a more parsimonious model formulation. The fourth methodological challenge relates to implementation of the model results beyond the relatively small sample of markets for which historical data was available. To overcome this limitation, we demonstrate how our model can be applied to markets not included in our sample, first using only managerial insight regarding the similarity between the focal market and the ones in our sample and by updating this subjective prior as ticket sales data become available.