Exploring business transformation : the challenges of developing a benefits realization capability.

The successful management of change continues to be a major issue for organizations. This article draws on rich qualitative data to provide evidence of issues faced by organizations as they try to realize benefits from investments in IT-enabled change, and as they try to develop and enhance their benefits realization capability. Several of these issues are not effectively covered by previous research, for example managing the overall portfolio of change initiatives and how to develop the capacity of the organization for benefits realization. The research also provides empirical evidence that supports the theoretical propositions from dynamic capability theory that routines (practices) are often similar across different organizations, and that organizations go through a number of stages in developing competences. A further contribution of the research is to develop an enhanced model of an organizational competence, which has important implications for the action required to develop competences

Diet-induced Ketoacidosis in a Non-diabetic: A Case Report

Introduction: Anion gap metabolic acidosis is a common disorder seen in the emergency department. The differential can include toxicological, renal, endocrine, infectious, and cardiogenic disorders. Ketosis, however, is one of the rarer causes of metabolic acidosis seen by the emergency physician in developed nations.Case Report: A 53-year-old female presented after starting a low-carbohydrate ketogenic diet for weight loss. She reported xerostomia, nausea with abdominal pain and a 17-pound weight loss over the previous 22 days. Labs revealed an anion-gap metabolic acidosis with ketosis. She was treated with 5% dextrose in normal saline and a sliding scale insulin coverage. Her anion gap corrected during her hospital course and was discharged on hospital day three.Discussion: The ketogenic diet typically consists of a high-fat, adequate protein and low carbohydrate diet that has previously been thought to be relatively safe for weight loss. However, when carbohydrates are completely removed from the diet an overproduction of ketones bodies results in ketoacidosis. Treatment should be aimed at halting the ketogenic process and patient education.Conclusion: Although rarely included in the differential for metabolic acidosis, diet-induced ketosis should be included by the emergency physician when faced with a patient who recently changed their eating patterns

Observing bullying at school: The mental health implications of witness status

This study explores the impact of bullying on the mental health of students who witness it. A representative sample of 2,002 students aged 12 to 16 years attending 14 schools in the United Kingdom were surveyed using a questionnaire that included measures of bullying at school, substance abuse, and mental health risk. The results suggest that observing bullying at school predicted risks to mental health over and above that predicted for those students who were directly involved in bullying behavior as either a perpetrator or a victim. Observing others was also found to predict higher risk irrespective of whether students were or were not victims themselves. The results are discussed with reference to past research on bystander and witness behavior

Direct numerical simulation of buoyantly driven turbulence

Numerical simulations of homogeneous turbulence subject to buoyant forcing were performed. The presence of a mean temperature gradient combined with a gravitational field results in a forcing term in the momentum equations. The development of the turbulence was studied and compared to the decay of similar fields in the absence of gravity. In the buoyantly driven field, the vorticity is preferentially aligned with the intermediate eigenvector of the strain-rate tensor and the local temperature gradient is more likely to be aligned with the most compressive eigenvector. These relationships are qualitatively similar to those observed in previous shear flow results studied by Ashurst (1987). A tensor diffusivity model for passive scalar transport developed from shear flow results in Rogers, Moin, and Reynolds (1986) also predicts this buoyant scalar transport, indicating that the relationship between the scalar flux and the Reynolds stress is similar in both flows

Development of advanced fabrication techniques for regeneratively cooled thrust chambers by the gas-pressure-bonding process Final report, 29 Jun. 1967 - 30 Apr. 1970

Production of regeneratively cooled rocket thrust chambers by removable tooling and subsequent hot isostatic pressing in gas autoclav

Compressibility effects on the scalar mixing in reacting homogeneous turbulence

The compressibility and heat of reaction influence on the scalar mixing in decaying isotropic turbulence and homogeneous shear flow are examined via data generated by direct numerical simulations (DNS). The reaction is modeled as one-step, exothermic, irreversible and Arrhenius type. For the shear flow simulations, the scalar dissipation rate, as well as the time scale ratio of mechanical to scalar dissipation, are affected by compressibility and reaction. This effect is explained by considering the transport equation for the normalized mixture fraction gradient variance and the relative orientation between the mixture fraction gradient and the eigenvectors of the solenoidal strain rate tensor.Comment: In Turbulent Mixing and Combustion, eds. A. Pollard and S. Candel, Kluwer, 200

Development and implementation of a decision pathway for general practitioners for the management or referral of suspected allergy.

Many patients with suspected allergy are referred to specialist care inappropriately. We aimed to develop and implement an online decision pathway to aid General Practitioners' (GPs) management decisions in suspected allergy. Our study involved 1487 GPs, 3 referral management centres, 5 GP system suppliers, 4 primary care trusts, and 1 specialist allergy clinic. The pathway was implemented by 3/5 GP system suppliers, published to Map of Medicine and on a specialist clinic website. In the first year, the pathway ranked in the top 10/160 local care maps accessed via Map of Medicine and was viewed 900 times. Only 96 GPs registered to use the clinic website. Only 110 (7%) GPs responded to the feedback request, of which 13/110 (12%) had used the pathway; nearly all thought it useful. It was used by referral management centres as explanation of rejected referrals. Alternative approaches to embed its use are required. Significance for public healthOne in three people in the UK are affected by allergies during their lifetime. Early diagnosis and appropriate management can improve quality of life and reduce emergency hospitalisation. However, referring patients to secondary care is costly in terms of time and resources. We developed a pathway algorithm to support General Practitioners' (GPs) allergy management and referral decisions to ensure that all referrals to specialist clinics were appropriate. The study illustrates a real world implementation with lessons for those seeking to improve the primary-secondary care interface, implementing pathways in various formats. In the UK, Map of Medicine seems to be the most used software. We demonstrated the difficulty of reaching GPs to encourage adoption of online decision support and suggest new ways forward by expanding care pathways into more detailed protocols for use directly by patients

Disseminated Gonorrhea

Sexually transmitted infections have risen sharply over the last decade in the United States. The incidence of gonorrhea has risen to 172 reported cases per 100,000 people over the past year. This likely represents an under-representation due to many cases going unreported. Disseminated gonorrhea can present with nonspecific symptoms including arthralgia, cutaneous lesions, or tenosynovitis. Diagnosis is based upon a degree of high clinical suspicion and serology. Emergency department treatment includes ceftriaxone and azithromycin

Workforce development and effective evaluation of projects

Date of Acceptance: 01/05/2014The success of a project or programme is typically determined in relation to outputs. However, there is a commitment among UK public services to spending public funds efficiently and on activities that provide the greatest benefit to society. Skills for Health recognised the need for a tool to manage the complex process of evaluating project benefits. An integrated evaluation framework was developed to help practitioners identify, describe, measure and evaluate the benefits of workforce development projects. Practitioners tested the framework on projects within three NHS trusts and provided valuable feedback to support its development. The prospective approach taken to identify benefits and collect baseline data to support evaluation was positively received and the clarity and completeness of the framework, as well as the relevance of the questions, were commended. Users reported that the framework was difficult to complete; an online version could be developed, which might help to improve usability. Effective implementation of this approach will depend on the quality and usability of the framework, the willingness of organisations to implement it, and the presence or establishment of an effective change management culture.Peer reviewedFinal Accepted Versio