Lack Of Clear Direction Research Articles

Blockchain: Exploring its Impact on the Business Models of Australian Accounting Firms

AbstractThis paper reports on a study that investigated how the business models of Australian accounting firms are impacted by audit clients using blockchain technology. Semi-structured interviews with a range of stakeholders including audit partners from big-4 accounting firms reveal that firms are gradually adapting their business models by offering value propositions that involve efficiency, complementarities and novelty, despite a formative blockchain ecosystem in Australia. This ecosystem is characterized by clients’ reluctance to use blockchain platforms for financial systems and a lack of clear direction on applicable accounting standards and consensus on blockchain standards and governance.

Urgency to secure funding for the promised national school food program amidst the rise of food costs and chronic disease

An overwhelming number of Canadians believe that a national school food program (SFP) would benefit children, but concerns around limited funding are frequently raised. SFPs across Canada are struggling to meet increasing demands due to rising food costs, meaning that food quality and quantity within existing SFPs are suffering. This paper discusses the urgency to implement a cost-shared and federally funded SFP amidst the current economic context and lack of clear direction from the federal government. The paper also explores ways in which federal funding for school meals can help to reduce the rate of chronic diseases and actualize many proven physical and mental health benefits for Canadians, all of which have positive and long-term downstream effects on the country’s economy.

Implementasi Tugas Penggembalaan Berdasarkan Mazmur 23:1-4 Bagi Pemimpin Gereja Masa Kini

In recent years, the church has faced great challenges in fulfilling its role as a shepherd who leads, protects, and nurtures the congregation. Church leadership that lacks this role has led to instability and lack of clear direction among the congregation. This paper aims to highlight the importance of implementing Psalm 23:1-4 in today's church. Using the text analysis method, this study delves deeply into the meaning and implications of these verses and applies them to church leadership today. Church leaders are able to understand their responsibilities as pastors and to apply the principles contained in Psalm 23:1-4 in their ministry to the congregation.

COVID-19 in the Workplace in Indonesia

Coronavirus Disease 2019 (COVID-19) has been declared a pandemic because of its worldwide spread. The COVID-19 pandemic does not only impact public health but also the operations of businesses and workers’ safety in their workplace. The objectives of this study were to provide a broad perspective of COVID-19 prevention and control implementation in industries, investigate barriers and challenges as well as drivers in implementing COVID-19 prevention and control, and provide key recommendations to the policy makers regarding COVID-19 prevention and control in industries. This study was conducted through online interviews with selected organizations in various industries which were selected by the granting body, including agriculture and animal husbandry; construction; manufacturing; and logistic and goods transportation. It also involved policy makers from government agencies including the Ministry of Manpower, Ministry of Health, Indonesian Safety and Health Council, International Labor Organization, and Indonesian COVID-19 Task Force. The participants of this study were chosen using convenience sampling. The findings of this study indicate that health protocols are implemented to varying degrees in companies, both within and across the sectors, and that drivers to comply with the Health Protocols include compliance, business continuity, and top management commitment. The significant barriers and challenges include a perceived lack of clear direction from the government, rapid changes in directives’, poor worker awareness, and limited organizational resources. The key recommendations to the policy maker include harmonization of the guidelines and legislation, additional schemes to provide funding in the COVID-19 prevention and control implementation, as well as facilitate the ongoing education of the general working public.

Foreign language and intercultural development in the Japanese context – a case study

ABSTRACT Recently, the Japanese Ministry of Education, Culture, Sports, Science and Technology (MEXT) has produced several internationalisation policies to develop their notion of guroubaru-jinzai (global human resources). However, a lack of clear direction regarding theories and approaches about how to achieve these initiatives has created a gap in the research. Therefore, this paper seeks to fill that gap by introducing an interdisciplinary approach towards creating a foreign language and intercultural development framework. A case study results suggest that the framework can be useful to encourage students’ attitudes and perceptions of foreign language and intercultural development towards developing global human resources.

A nurses' ethical commitment to people with intellectual and developmental disabilities.

Aim: This article explores the issues of knowledge deficits of healthcare professionals in meeting the needs of people with IDD throughout the life span, and to identify factors that contribute to these deficits. Although statistics vary due to census results and the presence of a "hidden population," approximately 1%-3% of the global population identify as living with an intellectual or developmental disability. People with intellectual or developmental disability experience health inequities and confront multiple barriers in society, often related to the stigma of intellectual or developmental disability. Disparities in care and service are attributed to a lack of knowledge and understanding among healthcare providers about people with intellectual or developmental disability, despite their increased risk for chronic health problems. The near absence of educational programs in nursing both nationally and internationally contributes to this significant knowledge deficit. In addition, ethical considerations between paternalistic beneficence and idealized autonomy have resulted in a lack of clear direction in working with a population that is often ignored or exploited. Nurses who view people with intellectual or developmental disability as vulnerable without assessing or acknowledging their capabilities may err toward paternalism in an effort to "first do no harm." Likewise, nurses who fail to recognize the challenges and limitations faced by people with intellectual or developmental disability may not provide sufficient protections for a vulnerable person. People with intellectual or developmental disability are not binary, but rather complex individuals with a myriad of presentations. This article seeks to encourage a well-informed model of nursing care. Through an ethical lens, this article explores the nurse's ethical commitments in cases of victimization, access to care, decision making, and the provision of optimal end-of-life care for people with intellectual or developmental disability.

Rethinking Directions of Politics and Bureaucracy Post-Neo-Liberalism: An Indonesian Experience

The reforms triggered by the economic crisis that hit Indonesia and a number of other Asian countries in 1998 have resulted in not only an improvement over a system that has been in force for the past 30 years but also fundamental changes. Although reform is born by a spirit of renewal, in response to the failure of the state to develop a system that can generate prosperity and justice for the people, both in the political and economic fields, but in the process has not produced a better relationship system between politics and public administration, which is professional, effective, efficient and free from corruption. This unsuccessfulness is predictable because the administrative reform is not based on a strict economic school. We had previously applied the Keynesian school, then Neo-liberalism, up until now the world is still searching for a new school. No exception for Indonesia. Reform has established a new system, completely different from the previous system, but without consistent ideology and paradigm. The lack of clear direction is the cause of the failure of administrative reform in Indonesia. The paper will analyze the cause of this unsuccessful, and propose recommendations for improvement.

Genetic non-discrimination policy in Canada: Assessing windows of opportunity for policy change

As the ease of obtaining genetic information for both the diagnosis and treatment of diseases has become increasingly common, so have concerns about the misuse of such information. The obstacles Canada faces in adopting genetic non-discrimination legislation have left health leaders with a lack of clear direction. Using the Kingdon agenda-setting framework, this article will identify lost opportunities for policy change and will analyze the potential for the adoption of a genetic non-discrimination policy in Canada. Windows of opportunity for policy change have existed in the past, but these windows have closed prior to a policy being adopted. More recently, the alignment of problem, policy, and politics streams in the agenda-setting process has resulted in a new window of opportunity. The adoption of a clear and coherent policy will provide the public with protection and health leaders with greater direction around genetic information.

VETORES DE DIREÇÕES OPOSTAS

Este trabalho propõe uma análise diacrônica das diferentes gestões do sistema de ensino estadual de São Paulo, a partir de um levantamento de instrumentos normativos ao longo de 20 anos, de 1995 a 2015. Neste período, houve uma movimentação legal significativa, o que faz supor ser a área educacional valorizada ao longo desses anos. No entanto, também foi possível identificar que o discurso empresarial para a construção de uma estrutura mais eficiente não foi efetivado e, em diversos casos, as ações específicas dos diferentes secretários de educação acabavam por se anular por falta de direcionamento claro, indicando uma falta de projeto educacional de longo prazo, o que faz com que, depois de tantos anos de gestão a rede de ensino de São Paulo não se aproxima do pretendido e anunciado nos discursos políticos.

Subcutaneous (SC) Administration Of Bortezomib: A Pilot Survey Of Oncology Nurses

BackgroundThe SC route of administration for bortezomib was approved in the USA in January 2012 and the EU in September 2012, in addition to the intravenous (IV) route. Although there is limited guidance in the US Prescribing Information and EU SmPC regarding how to administer SC bortezomib, more broadly there is a lack of clear direction in the literature on administering SC injections. Studies in non-oncology fields suggest that injection site reactions, pain, and bruising can be reduced by using small, short needles, the air bubble rather than purge technique, and slower injections. Inconsistent or poor administration techniques may increase injection site reactions and could contribute to patients stopping effective treatment. Thus, it is important to identify how oncology nurses are administering SC bortezomib. This observational survey of oncology nurses practicing in US community oncology clinics (Cancer Clinics of Excellence) aimed to identify the techniques used and explore nurses' opinions about SC bortezomib administration. MethodsA 41-question electronic survey on SC bortezomib administration was developed, with all questions based on current literature regarding appropriate techniques for administering SC injections. The questions explored site of administration, needle length, angle of insertion, use of air purge or bubble technique, and duration of administration. Questions were also included regarding convenience of SC administration, nurses' opinions on patients' preferences for administration site, and correlation between facility layout and administration site. Nurses at 19 clinics who had administered SC bortezomib were invited to participate in the survey, with limitations imposed on respondent numbers to ensure country-wide input. ResultsA total of 43 nurses from 17 clinics responded to the survey. The majority (74%) had been practicing oncology nursing for >5 years, including 21% for >20 years. Most respondents (93%) indicated that oncologists were responsible for ordering bortezomib for SC administration. Nurse practitioners shared this responsibility according to 53% of respondents. 60% of nurses indicated that they always/sometimes provided input into the decision to use SC administration, with 40% always/sometimes responsible for bortezomib reconstitution. Nurses reported using the abdomen (98%), thigh (19%), and arm (53%) for SC bortezomib. Only the abdomen and thigh were used in the phase 3 study of SC vs IV bortezomib (Moreau et al, Lancet Oncol 2011). The abdomen (88%) and arm (12%) were nurses' preferred sites due to presence of more tissue, ease of access, less irritation, and patient preference. Nurses believed that patients preferred SC injections in the abdomen (72%) and arm (28%). Nurses' injection site preferences differed significantly according to facility layout. All respondents indicated a preference for abdominal injection in private/somewhat private facilities, while the abdomen (76%) and arm (24%) were preferred in non-private facilities (p=0.02). Nurses used 25 gauge 5/8 inch (42%) and 27–30 gauge ≤1/2 inch (56%) needles, with both 45º (61%, 42%) and 90º (39%, 58%) angles of insertion used with these respective needle sizes (p=0.21). The air purge technique was used by 49% of nurses, with 51% using an air bubble. Nurses took 3–5 (49%), 5–10 (35%), 10–30 (9%), and >30 seconds (7%) to administer each mL of SC bortezomib injection. All but 1 nurse (98%) indicated that SC administration was much more or somewhat more convenient than IV, with 95% indicating that SC administration took much less or somewhat less time than IV. Most nurses (86%) believed that patients preferred the SC route for reasons including less time spent at clinic, avoidance of IV access, and less toxicity. All nurses completely agreed (77%) or somewhat agreed (23%) that developing a practice guideline would be important, and all but 1 completely agreed (67%) or somewhat agreed (30%) that nurses would change their practice to be consistent with such a guideline. ConclusionsThese findings indicate the heterogeneity of techniques used for SC bortezomib administration, and will help inform the development of practice guidelines with the aim of achieving greater consistency among oncology nurses. Disclosures:Martin:ONS: Edge: Membership on an entity's Board of Directors or advisory committees; Millennium: The Takeda Oncology Company: Employment. Zhu:Millennium: The Takeda Oncology Company: Employment. Agretelis:Millennium: The Takeda Oncology Company: Employment; Takeda Pharmaceutical Company Limited: Equity Ownership.

Cofiring biomass with coal: Opportunities for Malaysia

Malaysia generated 108,175 GWh of electricity in 2010 where 39.51 % was sourced from coal. Coal power generation is also planned to overtake natural gas as the main fuel for electricity generation within the next two decades. Malaysia also has a vast biomass resource that is currently under-utilised for electricity generation. This paper studies the option of cofiring biomass in existing Malaysian coal power plants to increase the nation's renewable energy mix as well as to reduce its power sector carbon dioxide emission. Benefits of cofiring to the nation were discussed and agricultural residues from palm oil and paddy was identified as a potential source of biomass for cofiring. It was also found that there is a willingness for cofiring by stakeholders but barriers existed in the form of technical issues and lack of clear direction and mechanism.

Who do you think you are? Pharmacists' perceptions of their professional identity

The aim of this study was to examine pharmacists' perceptions of their professional identity, both in terms of how they see themselves and how they think others view their profession. A qualitative study was undertaken, using group and individual interviews with pharmacists employed in the community, hospital and primary care sectors of the profession in England. The data were recorded, transcribed verbatim and analysed using the framework method. Forty-three pharmacists took part in interviews. A number of elements help determine the professional identities of pharmacists, including attributes (knowledge and skills), personal traits (aptitudes, demeanour) and orientations (preferences) relating to pharmacists' work. The study identified the presence of nine identities for pharmacists: the scientist, the medicines adviser, the clinical practitioner, the social carer, the medicines maker, the medicines supplier, the manager, the business person and the unremarkable character. While the scientist was the strongest professional identity to emerge it nevertheless seemed to overlap and compete with other professional identities, such as that of the medicines maker. The relatively high number of identities may reflect some degree of role ambiguity and lack of clear direction and ownership of what makes pharmacists unique, but also suggests a flexible view of their role.

Information and Communication Technology to Support Self-management of Patients with Mild Acquired Cognitive Impairments: Systematic Review

BackgroundMild acquired cognitive impairment (MACI) is a new term used to describe a subgroup of patients with mild cognitive impairment (MCI) who are expected to reach a stable cognitive level over time. This patient group is generally young and have acquired MCI from a head injury or mild stroke. Although the past decade has seen a large amount of research on how to use information and communication technology (ICT) to support self-management of patients with chronic diseases, MACI has not received much attention. Therefore, there is a lack of information about what tools have been created and evaluated that are suitable for self-management of MACI patients, and a lack of clear direction on how best to proceed with ICT tools to support self-management of MACI patients.ObjectiveThis paper aims to provide direction for further research and development of tools that can support health care professionals in assisting MACI patients with self-management. An overview of studies reporting on the design and/or evaluation of ICT tools for assisting MACI patients in self-management is presented. We also analyze the evidence of benefit provided by these tools, and how their functionality matches MACI patients’ needs to determine areas of interest for further research and development.MethodsA review of the existing literature about available assistive ICT tools for MACI patients was conducted using 8 different medical, scientific, engineering, and physiotherapy library databases. The functionality of tools was analyzed using an analytical framework based on the International Classification of Functioning, Disability and Health (ICF) and a subset of common and important problems for patients with MACI created by MACI experts in Sweden.ResultsA total of 55 search phrases applied in the 8 databases returned 5969 articles. After review, 7 articles met the inclusion criteria. Most articles reported case reports and exploratory research. Out of the 7 articles, 4 (57%) studies had less than 10 participants, 5 (71%) technologies were memory aids, and 6 studies were mobile technologies. All 7 studies fit the profile for patients with MACI as described by our analytical framework. However, several areas in the framework important for meeting patient needs were not covered by the functionality in any of the ICT tools.ConclusionsThis study shows a lack of ICT tools developed and evaluated for supporting self-management of MACI patients. Our analytical framework was a valuable tool for providing an overview of how the functionality of these tools matched patient needs. There are a number of important areas for MACI patients that are not covered by the functionality of existing tools, such as support for interpersonal interactions and relationships. Further research on ICT tools to support self-management for patients with MACI is needed.

Psychotherapy Training for IMGs: Attending to the “How to” and “What to” Teach

International Medical Graduates (IMGs) make up a significant portion of the United States and Canadian workforce, and are well represented in psychiatry residency training programs. A review of the literature indicates that before entering residency training, many IMGs have minimal exposure to the behavioral sciences and poor communication skills-training; significant issues for learning psychotherapy. Given the lack of clear direction in the literature, this article presents empirically-informed guidelines relevant to the training of International Medical Graduates in psychotherapy.

Medical Progress and the Influenza Pandemic of 1918

ABSTRACT The influenza outbreak of 1918 spread around the world and left millions of people dead. This pandemic was both a crisis for human life and a crisis for medical professionals attempting to combat the disease. During a period when medicine had become thoroughly professionalized and had made numerous advances in medical treatment, medical professionals perceived their field to be rapidly and consistently progressing, and many believed that there was little medicine could not overcome. Success against such diseases as yellow fever fed the idea that science and rational thought could conquer society's ills drove medical professionals' efforts. However, these modern ideas of progress, perfectibility, and medicine's pending triumph over disease adversely affected the medical profession's ability to deal effectively with the influenza pandemic of 1918. Physicians' efforts had not prevented a serious outbreak, and once it had exploded, they could not control it. Looking specifically at the British medical profession's struggle with the pandemic, as it coursed through both Britain and Britain's armies abroad, this paper examines physicians' own writings and investigates both their initial confidence in the face of disease and their disappointment, fear, and lack of clear direction as the pandemic exploded. In the aftermath of the pandemic, their confusion, dearth of understanding, and pressure to fill the void in knowledge are evident. This paper, then, discusses how confidence affected their mindset when they confronted the pandemic, and how the pandemic, in turn, affected their concept of progress, the ability of medicine, and their duty thereafter.

Media Reporting, Mobility and Trauma

Media Reporting, Mobility and Trauma

Assessing Operating Room Efficiency and Parallel Processing

Assessing Operating Room Efficiency and Parallel Processing

From rhetoric to reality: including patient voices in supportive cancer care planning

To explore the extent and manner of patient participation in the planning of regional supportive care networks throughout the province of Ontario. We consider the disconnect between the rhetoric and reality of patient involvement in network planning and co-ordination. In 1997, the Province of Ontario, Canada, established a new, regionalized cancer care system. By transferring responsibility to the regional level and to networks, the architects of the new provincial system hoped to broaden participation in decision making and to enhance the responsiveness of decisions to communities. Through a qualitative, multiple case study approach we evaluated the processes of involving patients in network development. In-depth, semi-structured interviews and document analysis were complemented by observations of provincial meetings, regional council and network meetings. The network development processes in the three case study regions reveal a significant gap between intentions to involve patients in health planning and their actual involvement. This gap can be explained by: (i) a lack of clear direction regarding networks and patient participation in these networks; (ii) the dominance of regional cancer centres in network planning activities; and, (iii) the emergence of competing provincial priorities. These three trends expose the complexity of the notion of public participation and how it is embedded in social and political contexts. The failed attempt at involving patients in health planning efforts is the result of benign neglect of public participation intents and the social and political contexts in which public and patient participation is meant to occur.

Screening for Vertebrobasilar Insufficiency in Patients With Neck Pain: Manual Therapy Decision-Making in the Presence of Uncertainty

Growing evidence supports the effectiveness of manual therapy interventions in patients with neck pain; however, considerable attention has also been afforded to the potential risks such as vertebrobasilar insufficiency (VBI). Despite the existence of guidelines advocating specific screening procedures, research does not support the ability to accurately identify patients at risk. The logical question becomes, "How does one proceed in the absence of certainty?" Given the lack of clear direction for decision making in the peer-reviewed literature, this commentary discusses the uncertainties that exist regarding the ability to identify patients at risk for VBI. The authors hope that this commentary adds additional perspective on manual therapy decision-making strategies in the presence of uncertainty.

Redirection for Environmental Justice

AbstractPresident Clinton issued an environmental justice executive order that made each federal agency responsible to promote environmental justice as part of its mission. Generally, this executive order was not substantively implemented. For example, implementation of the executive order by the Clinton administration's Environmental Protection Agency (EPA) was frustrated by a lack of clear direction and federal court decisions that limited the EPA's approach of using a civil rights statute to challenge state environmental decisions.The Bush administration's EPA reconfirmed that environmental justice is a high agency priority. However, the EPA could be signaling a different approach. This article examines the reasons why implementation of environmental justice stalled at the end of the Clinton administration and the forecast for a significant shift in the EPA's approach.This article discusses how implementation of environmental justice fared at the end of the Clinton administration and during the first year and a half of the Bush administration.1 The Clinton administration left office with expectations unfulfilled. The Bush administration, through Environmental Protection Agency (EPA) Administrator Christine Todd Whitman, has reconfirmed that environmental justice remains a priority. Administrator Whitman, however, appears to be moving toward a NEPA‐like approach and away from relying on civil rights laws as the primary tool to assess the effects of state environmental decisions on minority and low‐income communities. © 2002 Wiley Periodicals, Inc.