Preferred Priorities Research Articles

Enhanced Milieu Teaching in resource-constrained settings: Stakeholder-informed adaptation guidelines.

Enhanced Milieu Teaching (EMT) is an evidence-based naturalistic developmental behavioural intervention (NDBI) for children with developmental disabilities. Little is known about the EMT's fit or what adaptations might be needed to improve its applicability within a resource-constrained setting. To explore stakeholders' perceptions of the contextual fit of EMT for young children with developmental disabilities in a resource-constrained context and to identify adaptations to improve EMT's contextual fit. We conducted a descriptive qualitative study using semi-structured interviews and focus groups. Participants included 5 speech and language therapists and 11 caregivers of children with developmental disabilities who speak English and Afrikaans or isiXhosa. Using thematic analysis, data were coded into 10 subthemes and grouped according to the Adaptome framework components. Overall, stakeholders view EMT as an appropriate intervention in the South African context. They indicated that certain intervention components may need to be modified. Specifically, clinicians may need to adapt intervention materials and activities to be sensitive to families' available resources, preferred activity routines and priorities. From these data, we provide guidelines to improve the fit of EMT in South Africa. Enhanced Milieu Teaching is an appropriate intervention in the South African context, although some adaptations can enhance its fit.Contribution:This article highlights the importance of engaging with stakeholders to determine the fit of NDBIs, like EMT, as they are implemented in new contexts. Based on these insights, stakeholder-informed adaptation guidelines are provided for improving the contextual fit of EMT in resource-constrained settings.

Traditional and fuzzy goal programming approaches for resource dependent assembly line balancing problem

In this study, two goal programming models are proposed for balancing resource dependent assembly lines with precise and fuzzy goals in order to provide flexibility for decision makers based on their decision environment and preferred priorities. Three conflicting goals, namely, total number of utilized workstations, cycle time and total cost of additional resources (equipment and assistant workers) are considered. The proposed models are validated on illustrative examples and scenario analyses are performed with different priority levels of the goals. The results show that the proposed goal programming formulations are valid and useful for balancing resource dependent assembly lines.

Bureaucratic Acquiescence as an Institutional Strategy in the African Union

Abstract The paper conceptualizes acquiescence as a strategy bureaucrats adopt to deal with contestation between themselves and political leaders. The literature on bureaucratic politics argues that policy outcomes result from a game of bargaining between bureaucrats and political leaders. These actors employ diverse strategies like bargaining for more authority, exploiting loopholes, challenging the political class, and, at other times, using the threat of resignation to implement their preferred priorities. However, we advance the above argument by introducing another strategy that bureaucrats use, acquiescence. We analyze African Union (AU) bureaucratic politics through speeches, press releases, and secondary materials. The paper argues that rather than opting for standard bureaucratic strategies, AU bureaucrats acquiesce because the institutional structure, material resources, and the AU solidarity norm make it difficult for them to do otherwise. Acquiescence is the reluctant acceptance of decisions in bureaucratic politics in the form of silence or an absence of protest. We show examples of AU institutional reform and the Burundi crisis debates, where acquiescence can explain decision-making outcomes in the organization. We conclude that acquiescence is a relevant conceptual tool in explaining the outcomes of bureaucratic politics in the AU and can be generalized to investigate institutional politics in other international organizations within and outside of the continent.

Implementasi Metode AHP Untuk Sistem Pendukung Keputusan Proses Kenaikan Jabatan Karyawan

Promotion or promotion is a transfer that increases the authority and responsibility of employees to higher positions within the organization so that the obligations, both status and income are greater. Almost all employees want to get a promotion. This research discusses finding the best solution to help take the decision to increase employee positions at PT. Prudential uses the Analitycal Hierarchy Process method to help determine the preferred priorities of various alternatives. This method was chosen because it is able to select the best candidates from a number of existing employees to occupy available positions based on predetermined criteria. Research is conducted by looking for weight values for each attribute, such as examples are aspects of intellectual capacity, aspects of work attitudes, and behavioral aspects, then carried out a perankingan process that will determine the optimal alternative, namely the promotion of employee positions. As a result of the application of the AHP method in this study, the value of the determination of the promotion of employee promotion 0 - 6 was declared unfit to be promoted and if the value is greater than 6, then the employee is declared worthy to be promoted to his position.

Usage of Health Information Websites: A Systematic Review of Older Adults’ Preferences for Web Features

Background : Online health information have a role in enhancing health in older adults. However, age-related physiological changes and non-senior friendly websites proved to be a challenge for older adults. Research investigating older adults’ preferences of features in health information websites is limited. Thus, in this review, we aim to summarize older adults’ preferences regarding the design and content of health websites. Methods : Medline, CINAHL, Cochrane Library, Scopus, Journal of Medical Internet Research (JMIR), and Google Scholar were searched for relevant articles, using key words ‘older adults’, ‘internet’, ‘health information’ and ‘usability’. The methodological quality of included studies was evaluated using the McMaster critical appraisal tools (quantitative and qualitative versions). Individual study design, participants’ characteristics, and identified preferences for health website features were extracted and summarized narratively. (PROSPERO registration number: CRD42018096281) Results : Five studies (3 qualitative, 2 quantitative) were included in this review. The quality appraisal score ranged from 32% to 83%. The preferences of older adults were grouped into three domains: web presentation factors, web navigation factors and health information preferences. The results highlight older adults have specific preferences when engaging with online content. Conclusion : This review suggests that readable text, simple design, consistent layout and straightforward web navigation are the preferred priorities for a health information website for older adults. Implications for practice : Findings from this review may be useful to healthcare professionals and developers to understand older adults’ preferences pertaining to web design and contents in health websites specifically designed for this population. DOI : http://dx.doi.org/10.17576/JSKM-2021-1902-13

Rate of Communicative Gestures and Developmental Outcomes in Toddlers With and Without Autism Spectrum Disorder During a Home Observation.

PurposeMost toddlers with autism spectrum disorder and other developmental delays receive early intervention at home and may not participate in a clinic-based communication evaluation. However, there is limited research that has prospectively examined communication in very young children with and without autism in a home-based setting. This study used granular observational coding to document the communicative acts performed by toddlers with autism, developmental delay, and typical development in the home environment.MethodChildren were selected from the archival database of the FIRST WORDS Project (N = 211). At approximately 20 months of age, each child participated in everyday activities with a caregiver during an hour-long, video-recorded, naturalistic home observation. Inventories of unique gestures, rates per minute, and proportions of types of communicative acts and communicative functions were coded and compared using a one-way analysis of variance. Concurrent and prospective relationships between rate of communication and measures of social communication, language development, and autism symptoms were examined.ResultsA total of 40,738 communicative acts were coded. Children with autism, developmental delay, and typical development used eight, nine, and 12 unique gestures on average, respectively. Children with autism used deictic gestures, vocalizations, and communicative acts for behavior regulation at significantly lower rates than the other groups. Statistically significant correlations were observed between rate of communication and several outcome measures.ConclusionObservation of social communication in the natural environment may improve early identification of children with autism and communication delays, complement clinic-based assessments, and provide useful information about a child's social communication profile and the family's preferred activities and intervention priorities.Supplemental Material https://doi.org/10.23641/asha.14204522

Upscaling Agroecology: A Marxist Political Economy Approach to the “Feed the World” Debate

Since the outbreak of the 2007–2008 global food crisis, the two models of industrial agriculture and agroecology have been involved in a heated debate about how to feed the world. Despite their sharp differences on the choice of agricultural technology and preferred policy priorities, both sides exhibit a narrow understanding of the relationship between technology and social institution. A Marxist political economy approach, based on the insights of classic Marxist theorists into agricultural technologies in alternative institutional contexts, is developed to look beyond the two sides of the debate. Upon careful examination of agroecology as an ecological sublation of industrial agriculture and of conscious social control of production as an institutional sublation of capitalism, this article concludes that socialism is more suitable than small peasant economy for achieving the twin goals of fully scaling up agroecology and promoting socioeconomic equality for small peasants.

Conceptualizing and measuring life priorities of Generation Y: evidences from Indian context

PurposeThe purpose of this paper is to explore the life priorities of Gen Y, the largest cohort of generation in India. Further variations in the life priorities of Gen Y with regard to their demographics have also been analyzed.Design/methodology/approachTen-item Schwartz Value Inventory was subjected to factor analysis to explore defining factors for studying the life priorities of Gen Y in Indian context. Respondents ranking of the factors so revealed will allow us to study their preferred life priorities. The effect of demographics was assessed by employing an independent sample t-test.FindingsFactor analysis revealed two factors, “materialism” and “altruism,” and Gen Y preferred materialism over altruism as their life priority. Gender and work experience did not show significant differences with regard to the life preferences Gen Y.Practical implicationsGen Y is increasing its presence at workplaces across the world, and limited research has been done to study their motivations, needs and expectations at work in Indian context. This study could help managers gain insightful information related to the life priorities of Gen Y which could be harnessed to make effective strategies for their recruitment and retention.Originality/valueThe paper provides a valuable contribution by measuring the life priorities of Gen Y in India and adds to the scant literature on this cohort of generation.

Primary care priorities in addressing health equity: summary of the WONCA 2013 health equity workshop.

BackgroundResearch consistently shows that gaps in health and health care persist, and are even widening. While the strength of a country’s primary health care system and its primary care attributes significantly improves populations’ health and reduces inequity (differences in health and health care that are unfair and unjust), many areas, such as inequity reduction through the provision of health promotion and preventive services, are not explicitly addressed by general practice. Substantiating the role of primary care in reducing inequity as well as establishing educational training programs geared towards health inequity reduction and improvement of the health and health care of underserved populations are needed.MethodsThis paper summarizes the work performed at the World WONCA (World Organization of National Colleges and Academies of Family Medicine) 2013 Meetings’ Health Equity Workshop which aimed to explore how a better understanding of health inequities could enable primary care providers (PCPs)/general practitioners (GPs) to adopt strategies that could improve health outcomes through the delivery of primary health care. It explored the development of a health equity curriculum and opened a discussion on the future and potential impact of health equity training among GPs.ResultsA survey completed by workshop participants on the current and expected levels of primary care participation in various inequity reduction activities showed that promoting access (availability and coverage) to primary care services was the most important priority. Assessment of the gaps between current and preferred priorities showed that to bridge expectations and actual performance, the following should be the focus of governments and health care systems: forming cross-national collaborations; incorporating health equity and cultural competency training in medical education; and, engaging in initiation of advocacy programs that involve major stakeholders in equity promotion policy making as well as promoting research on health equity.ConclusionsThis workshop formed the basis for the establishment of WONCA’s Health Equity Special Interest Group, set up in early 2014, aiming to bring the essential experience, skills and perspective of interested GPs around the world to address differences in health that are unfair, unjust, unnecessary but avoidable.

The simplified asset management plan for a sustainable future: indonesia’s irrigation systems

Agricultural irrigation plays a fundamental role in ensuring the food security and economy of rural communities. However, irrigation systems in many developing countries suffer from low performance, which eventually adversely affects their sustainability. To gain a more in-depth understanding of performance and sustainability in existing Indonesian irrigation systems, a set of assessment was conducted. This incorporated methods of Rapid Appraisal Process and Benchmarking, an opinion survey, and an asset survey. A triple-bottom line (TBL) sustainability assessment was also conducted to determine the levels of sustainability and performance shortfall, as well as their causes. Based on the results, a set of physical and managerial changes were proposed to improve irrigation system performance and sustainability. The viability of the proposed changes was assessed further through a stakeholder’s opinion survey and against three key sustainability issues of a TBL sustainability indicator framework: technical and economic, social, institutional and legal issue, and environmental, public health and safety. The purpose was to fi nd an alternative and robust solution that was also preferred by stakeholders. Eventually, a simplifi ed asset management planning (AMP) model was developed, which would enable water user associations to implement independently and easily. The AMP, consisting of budget planning and short-term planning, was also based on the robust preferred priorities of improving irrigation performance and sustainability.

Evaluating an holistic assessment tool for palliative care practice

To evaluate a holistic assessment tool for palliative care practice. This included identifying patients' needs using the holistic tool and exploring the usability, applicability and barriers and facilitators towards implementation in practice. The delivery of effective holistic palliative care requires a careful assessment of the patients' needs and circumstances. Whilst holistic assessment of palliative care needs is advocated, questions exist around the appropriateness of tools to assist this process. Mixed-method research design. Data collection involved an analysis of piloted holistic assessments undertaken using the tool (n = 132) and two focus groups with healthcare professionals (n = 10). The tool enabled health professionals to identify and gain an understanding of the needs of the patients, specifically in relation to the physical healthcare needs. Differences, however, between the analysis of the tool documentation and focus group responses were identified in particular areas. For example, 59 (68·8%) respondents had discussed preferred priorities of care with the patient; however, focus group comments revealed participants had concerns around this. Similarly, whilst over half of responses (n = 50; 57·5%) had considered a prognostic clinical indicator for the patient as an action, focus group results indicated questions around healthcare professionals' knowledge and perceived usefulness of such indicators. Positive aspects of the tool were that it was easy to understand and captured the needs of individuals. Negative aspects of the tool were that it was repetitive and the experience of assessors required consideration. The tool evaluation identified questions regarding holistic assessment in palliative care practice and the importance of communication. A holistic assessment tool can support patient assessment and identification of patients' needs in the 'real world' of palliative care practice, but the 'tool' is merely an aid to assist professionals to discuss difficult and sensitive aspects of care.

Explicit leader behaviour

PurposeThis article aims to introduce the theoretical underpinnings of a project that contributes to the empirical field research study literature concerning societal cultural and individual value priority effects on explicit preferred leader behaviour of employed businesspeople, and in some cases business students. The article then reviews research studies and results related to the theories and operationalisations.Design/methodology/approachThis particular article is an introduction to the history and systems of the Leader Behaviour Description Questionnaire XII (LBDQXII) instrument to assess preferred leader behaviour priorities, followed by a review of empirical studies employing the instrument.FindingsThe findings indicate that the LBDQXII is adequate for the task at hand, and that societal cultural differences moderate variability in preferences for leader behaviour associated with leadership effectiveness. The reputation of the LBDQXII has been damaged by researchers, editors, reviewers, and dissertation and thesis supervisors’ lack of knowledge or disregard of available knowledge concerning the development of the instrument, its use, and proper methods and methodology. The results in the project studies indicate that similarities such as the same local language coupled with geographic proximity lead to similar kinds of preferred leader behaviour priorities between countries and within countries having diverse sub‐cultures, such as China. Although the samples were all employed businesspeople, sample differences can have significant effects, such as influence stemming industry membership. A conclusion is that, carefully applied and analysed, the LBDQXII is a useful, reliable, and valid survey instrument that can be employed to prepare, educate, and develop expatriates and local managers as to what behaviours are expected in business organisations in different cultures.Research limitations/implicationsThe reliabilities of some scales in the LBDQXII are low for some dimension scales for some countries. An objective of the research project is to produce a shorter, more reliable survey for use across cultures. Studies in the project indicate an influence on factor structure apparently due to the overarching analytic cognition or holistic cognition nature of a society.Practical implicationsThe practical implications of the project are to identify and measure preferred leader behaviour dimensions that are similar and different across national and sub‐national cultures. Such information can be used to develop global leaders and to educate and train managerial leaders for success in multiple countries. A conclusion is that the LBDQXII can be employed to prepare, educate, and develop expatriates and local managers for international assignments.Originality/valueExplicit theories of leadership (ELTs) and implicit theories of leadership (ILTs) have received varying amounts of attention in leadership research. Reading the leadership literature, the author finds little consideration of ELTs (explicit theories of leadership), most study and report on implicit traits, or a mixture of implicit and explicit. A major contribution of this research project and this special issue of the journal is the development of testing and support of an explicit theory of leadership and presenting progress in its operationalisation, and it evaluates a widely used survey instrument across cultures.

North and South Latin America

PurposeThe study aims to investigate the national cultural clusters myth, studying the relationships between individual cultural values and preferred leader behaviour of working businesspeople in “Latin American” samples from Santiago, Chile, and Guadalajara, Mexico. The set of research questions to be addressed are: Are the rankings of value dimensions by businesspeople different between “Latin American” Chile and Mexico? Are the rankings of preferred leader behaviour dimensions different between Chile and Mexico? Are the predictive relationships of leader behaviour preferences by value dimension priorities different between Chile and Mexico?Design/methodology/approachIn an investigation of the relationships amongst preferred leader behaviour and individual value dimensions, the study employs field survey research using two experimental but well established and documented instruments, the Schwartz Values Survey and the Leader Behaviour Description Questionnaire. Comparisons between results from two samples from Chile and Mexico are carried out.FindingsTwo samples from large cities in Latin America, Santiago, Chile, and Guadalajara, Mexico, are compared using preferred leader behaviour dimensions and individual values and their relationship to one another. Significant sample and gender sub‐sample differences were observed for preferred leader behaviour, indicating that the perception of preferred leader behaviour priorities differed between businesspeople in Santiago and Guadalajara. Results indicate a general preference in both samples for a Parental Leader style, nurturing in Chile and stern in Mexico, and managerial leaders should be a source of enjoyment and pleasure in business; indications are that engaging in business is an enjoyable endeavour. Gender (sex) differences were observed between samples for preferred leader behaviour. Due to several demographic differences in job level and age in the samples, further work is required to verify the differences observed.Research limitations/implicationsSamples are from two cities, Santiago, Chile, and Guadalajara, Mexico, with an obvious requirement for studying additional regions in the country. Interpreting the findings is challenging and needs to be clarified though further focus group studies to assist in interpreting similarities and differences.Practical implicationsPractical applications of the outcomes of the study are that the results can be used to inform managerial leadership training and development and practice for expatriate and local managerial leaders working in the two cities.Social implicationsThe authors’ literature review and data analyses have some social implications as they found contradictory and misleading discussions of the relative placement of Mexico, Chile, and other countries in South, Central, and North America using cultural value dimension studies that need to be rationalised in further research.Originality/valueThe study is of value to practitioners and researchers interested in managerial leadership in Latin American countries.

A robust trust model for service-oriented systems

In service-oriented computing applications, service consumers and providers need to evaluate the trust levels of potential partners before engaging in interactions. The accuracy of trust evaluation greatly affects the success rate of the interaction. Trust evaluation is a challenging problem in open and dynamic environment as there is no central mediator to manage standardized evaluation criteria or reputation records. In this paper, a novel trust model, called the priority-based trust model, is presented. The model derives the trustworthiness of a service provider from designated referees and its historical performance. In addition, consumers can specify their preferred priorities which will affect the result of trust evaluations. The experimental results show that the proposed model has better performance than other trust models, especially in open and dynamic environments.

The emotion paradox in the aging brain

This paper reviews age differences in emotion processing and how they may relate to age-related changes in the brain. Compared with younger adults, older adults react less to negative situations, ignore irrelevant negative stimuli better, and remember relatively more positive than negative information. Older adults' ability to insulate their thoughts and emotional reactions from negative situations is likely due to a number of factors, such as being less influenced by interoceptive cues, selecting different emotion regulation strategies, having less age-related decline in prefrontal regions associated with emotional control than in other prefrontal regions, and engaging in emotion regulation strategies as a default mode in their everyday lives. Healthy older adults' avoidance of processing negative stimuli may contribute to their well-maintained emotional well-being. However, when cardiovascular disease leads to additional prefrontal white matter damage, older adults have fewer cognitive control mechanisms available to regulate their emotions, making them more vulnerable to depression. In general, although age-related changes in the brain help shape emotional experience, shifts in preferred strategies and goal priorities are also important influences.

Achieving preferred priorities for care (PPC): an audit of hospital to home discharges

IntroductionIncreasingly more patients wish to die at home. However it has been identified patients and their carers experience poor hospital discharges as a result of fragmented communication and inadequate co-ordination...

Promoting end of life care across care homes: the role of the specialist palliative care nurse

In 2008 the NAO undertook a retrospective study for all deaths in Sheffield during October 2007. 58% of these deaths occurred in hospital despite 40% having no medical reason to...

Day hospice audit to establish a baseline prior to piloting the preferred priorities for care document

In 2010 a baseline audit was conducted to establish what proportion of Day Hospice patients were aware of, had discussed or had completed a Preferred Priorities for Care document (PPC)....

Applying the preferred priorities for care document in practice

Applying the preferred priorities for care document in practice

A welcome dilemma: setting priorities for the 12th EAPC Congress

The 12th Congress of the European Association for Palliative Care (EAPC) is now just a few weeks away, and as a member of the EAPC’s Board and a nurse with an active role in the community, I have been looking through the scientific programme with interest. Many important topics will be presented and discussed— how to choose which sessions to attend? Regretting that I can’t split myself into two or three people, I have to think about what really concerns me the most and set priorities. This year my daily work shall guide me. Working as a consulting nurse in a ‘Mobile Palliative Care Team’ in Switzerland, I am confronted with highly challenging situations every day. This Monday, a patient with advanced pancreatic cancer expressed her wish to die at home. She wondered what the complications might be, how she and her husband should prepare themselves, and what would happen if she fell into a coma. Questions such as these certainly facilitate communication about end-of-life choices and allow people to prepare themselves for what may come. Nevertheless, I found this conversation very challenging, because the couple also signalled that they were not quite ready to hear information about the illness trajectory or the dying process. Unable to elaborate at this meeting, I left without clear ideas about their choices and without informing them about the existing procedures and medications that might alleviate their fears. Looking through the programme of the EAPC congress, I will surely listen to the presentation ‘Voices from the community: people’s perspectives on preferred priorities for care and communication at the end of life’, as well as ‘Recognising dying and the interplay between patients, families and professionals in palliative home care’ to gain more insights and guidance into similar situations. On Tuesday I visited a patient with advanced lung fibrosis. While elaborating his fears of suffocation, dependency, loss of control, and loss of dignity, he informed me that he had called on an organization that provides medication to allow people to commit suicide. In this consultation, I was able to introduce him to alternative ways of dealing with shortness of breath and his fear of suffocation (including the option of palliative sedation if all else fails), but building a helpful strategy to respond to his perceived loss of dignity is much more complex. Several lectures at the Congress deal with the various issues I encountered in dealing with this patient, including ‘Development of a complex intervention: a dignity care pathway for use by community nurses with people receiving end of life care at home’ and the symposium ‘How should palliative care deal with patients requesting PAS or euthanasia’ to name just two. Then on Thursday, all of the regional Mobile Palliative Care Teams met to develop guidelines to perform palliative sedation at home safely. We discussed the competencies that are needed, which people need to be accessible 24/7, and what support informal and formal caregivers need in order to cope with this exceptional procedure. As well as the EAPC White Paper on sedation, several lectures at the Congress will certainly provide helpful knowledge of this delicate therapeutic option. I look forward to hearing ‘How much longer will it take? The role of the family in the palliative sedation trajectory’. Finally, on the Friday I visited a 90-yearold man with advanced dementia at his home. Over the last 2 weeks the patient had developed pressure sores, and he increasingly suffers from dyspnoea, pulmonary secretion, fever, and a cough. Although the primary care team realized that this man’s dying process has started, Esther Schmidlin is a Nurse Consultant, Clinical Nurse, and Nurse Educator in Switzerland, and she also sits on the Board of the European Association for Palliative Care. they responded to the despair and pain of the family. The patient’s inability to swallow prompted them to feed and hydrate him through a nasogastric tube with a total of 2500 ml fluid for over a week. This was a challenging situation: our mobile team appreciated all the care and dedication that the patient had been given, but we also had to discuss the consequences of the over-hydration. Surely, the free communication sessions at the Congress, such as ‘Palliative care in advanced dementia’ and ‘Guidelines on the end-of-life care of people with dementia’, will help us in responding to the educational needs of primary health professionals as well as family members. As a frontline nurse, up-to-date clinical knowledge, practical experience, and educational skills are equally important, so I appreciate the abundant opportunities to meet, listen to, and exchange with other dedicated nurses and different professionals in this field—I am sure the EAPC Congress will be both inspiring and rewarding! l IJPN