Cross jurisdictional collaboration efforts and emergency vaccine plans that are consistent with Tribal sovereignty are essential to public health emergency preparedness. The widespread adoption of clearly written federal, state, and local vaccine plans that address fundamental assumptions in vaccine distribution to Tribal nations is imperative for future pandemic response.

A top management team (TMT) has been identified as one of the key factors driving changes in tax planning strategy. Based on upper echelons theory, this study investigates whether configurations of TMT characteristics influence enterprise tax planning strategy by using the fuzzy-set qualitative comparative analysis (fsQCA). Using a panel data of China public companies, we found three configurations conducive to aggressive tax planning and two combinations conducive to low tax planning. Specifically, the level of education, (...) tenure, age, career experience, and size of the top management team affect a firm’s propensity to engage in tax planning. Further, the results show that top management teams are not alike and highlight the differences in how these characteristics combine to impact tax planning. (shrink)

This study presented the policy of functional integration of the product planning team as a strategy for the development of the pharmaceutical industry in Palestine. The study population consists of all the workers in companies operating in the field of medicine in Palestine, which are (5) companies producing in the West Bank only for pharmaceuticals used by these companies, which are (296) employees, and was used a simple random sample to choose the sample and size (87) employees of (...) the study population, and to achieve the objectives of the study (87) questionnaires were distributed. The descriptive analytical method was used, and SPSS was used to answer and discuss the study's questions. The results showed that there is a significant relationship between the effectiveness of the policy of product development and the competitiveness of pharmaceutical companies in Palestine (West Bank), where the policy of product development efficiency accounts for 56.6% of the total change in the competitiveness of companies. The product quality component was most influential at all levels of product development effectiveness policy, followed by product identification, product cost reduction, packaging and product deletion. The weakest areas of strategic direction in pharmaceutical companies in Palestine (West Bank) are 67%. The weakest aspects of job integration are: non-regular meetings of representatives of different positions to participate in any project related to product development, to achieve spatial convergence of members of the product planning policy team in offices, laboratories and workplaces. (shrink)

The core question in aesthetics now and in the future is, how to combine philosophical theory with practice. Though reference is made to applied philosophy, and particularly to applied ethics, it is seldom made to applied aesthetics, even though we have a social need for it. The function of applied environmental aesthetics is to lay a foundation for practical actions. The goal is to connect the theoretical side closely to everyday problem solving. This means proceeding from a "passive" outsider aesthetics (...) to an "active", influencing and participating insider aesthetics. The process begins with a theory of applicability, after which actual problem cases follow. The aesthetic point of view is united with ethical, social, and cultural discussions, as well as with the expertise of environmental professionals in education, administration, design and planning, business, etc. The theoreticians and the practitioners form two teams, which should meet and co-operate with each other. In stepping from being a bystander to becoming a participant, the aestheticians will link their work to a network of specialists and professionals. (shrink)

In philosophical action theory there is a wide agreement that intentions, often understood in terms of plans, play a major role in the deliberation of rational agents. Planning accounts of rational agency challenge game- and decision-theoretical accounts in that they allow for rationality of actions that do not necessarily maximize expected utility but instead aim at satisfying long-term goals. Another challenge for game-theoretical understanding of rational agency has recently been put forth by the theory of team reasoning in (...) which the agents select their actions by doing their parts in the collective action that is best for the group. Both planning and team reasoning can be seen as instances of a similar type of reasoning in which actions are selected on the basis of an evaluation of a larger unit than an individual’s momentary act. In recent theories of collective agency, both planning and team reasoning have been defended against orthodox game theory, but, interestingly, by different authors: Raimo Tuomela has defended team reasoning in his theory of group agency, but he ignores temporally extended planning in this context. Michael Bratman has extended his theory of planning to the case of shared agency, but he does not seem to see a role for team reasoning in understanding shared intentional activities. In this paper, we argue that both accounts suffer from this one-sidedness. We aim to combine the main insights of Tuomela’s we-mode approach and Bratman’s planning approach into a fruitful synthesis that we think is necessary for understanding the nature of group agency. (shrink)

Team science models are frequently promoted as the best way to study complex societal and environmental problems. Despite increasing popularity, there is relatively little research on the processes and mechanisms that facilitate the emergence of integration of interdisciplinary teams. This article evaluates a suite of recent team-building and grant-writing activities designed to address water management in the Western U.S. We use qualitative methods to document the emergence of integrative capacity at the individual, group, and institutional levels, with particular (...) attention to the role of graduate students and non-academic practitioners in a team science planning project. Our findings highlight the importance of social integration as a basis for conceptual integration and an ability to relate these concepts to real-world problems. The findings also demonstrate the value of qualitative evaluation measures of team readiness, capacity, and intellectual outputs to complement conventional evaluation indicators that rely on quantitative scientific outputs, particularly for team science projects still in the planning stages. (shrink)

Complex work in teams requires coordination across team members and their technology as well as the ability to change and adapt over time to achieve effective performance. To support such complex interactions, recent efforts have worked toward the design of adaptive human-autonomy teaming systems that can provide feedback in or near real time to achieve the desired individual or team results. However, while significant advancements have been made to better model and understand the dynamics of team interaction (...) and its relationship with task performance, appropriate measures of team coordination and computational methods to detect changes in coordination have not yet been widely investigated. Having the capacity to measure coordination in real time is quite promising as it provides the opportunity to provide adaptive feedback that may influence and regulate teams’ coordination patterns and, ultimately, drive effective team performance. A critical requirement to reach this potential is having the theoretical and empirical foundation from which to do so. Therefore, the first goal of the paper is to review approaches to coordination dynamics, identify current research gaps, and draw insights from other areas, such as social interaction, relationship science, and psychotherapy. The second goal is to collate extant work on feedback and advance ideas for adaptive feedback systems that have potential to influence coordination in a way that can enhance the effectiveness of team interactions. In addressing these two goals, this work lays the foundation as well as plans for the future of human-autonomy teams that augment team interactions using coordination-based measures. (shrink)

People with dementia have commonly been excluded from research. The adverse impacts of this exclusion are now being recognized and research literature, position statements, and ethics guidelines increasingly call for inclusion of people with dementia in research. However, few published studies investigate the views of potential participants on taking part in research should they experience dementia-related cognitive impairment. This cross-sectional survey examined the views of people aged sixty and older attending hospital outpatient clinics about clinical research participation if they had (...) dementia and impaired decision-making ability. Over 90 percent of respondents were agreeable to participating in a wide range of research activities, such as cognitive testing, physical measurements, imaging procedures, and blood draws. For drug studies, however, agreement dropped to 60 percent. Altruism was a strong motivator for research participation. In regard to who should be involved in decisions about their participation in research during periods of incapacity, respondents mostly preferred the person they appoint as their substitute decision-maker for healthcare matters or a doctor or health professional on the research team. Over three-quarters expressed interest in making an advance research directive. The study findings are discussed in relation to law reforms in Australia that aim to strengthen respect and inclusion for people with impaired decision-making capacity, especially by providing frameworks for advance planning for research participation. (shrink)

Many European planning schools recently celebrated their 50th anniversary: a sign that planning education became a distinct and established discipline in Europe. Simultaneously, political regimes, paradigms, cultures, and economies continue fueling mixed connotations within the planning sector. Additionally, growing wicked problems in built areas emphasize an even greater need for well-trained planners. These challenges span climate crises, wars, authoritarian regimes, socio-political instability, and constantly changing global geopolitics. The increasingly complex demands on planners are highly pertinent for Young (...) Academics (YA). They require political, regulatory, and technical knowledge to navigate the profession. To support them and represent their voices in planning debates, the YA network (YAN) of AESOP was established in 2003. We, the current Coordination Team, use this paper to voice our take on the question of what planning challenges dominate and what can be done to prepare YAs better for the future. Building on plenty discussions within the YAN, literature, and AESOP’s activities at large, we propose: A challenge compilation for the profession, a list of core capacities, and a framework for future education. This shall aid in enabling YAs and educators today to set the foundation for planning sustainable and people-centered settlements tomorrow. (shrink)

In the context of the current uncertain, complex, and interdependent work systems, teams have become organizations’ substantial working unit, which in turn challenges the traditional view of employee performance and ultimately results in the emergence of team member work role performance. Employee team-oriented work role behaviors with proficiency, adaptivity, and proactivity, which are integrated by the new construct, are so crucial to team effectiveness that many organizations keenly expect to achieve team member work role performance through (...) implementing a dispersed pay-for-performance plan within a team. This study seeks to address the organizational practitioners’ main concern that whether pay dispersion among team members could actually help realize team member work role performance and further examines why and when an employee could respond to HPD within a team by engaging in team member work role behaviors from the perspective of the performance-shaping basis and team member’s workplace benign envy. Drawing on emotion-related theory, social comparison theory, legitimacy theory, expectation theory, and relative deprivation theory, it proposes that performance-based HPD could not only positively impact team member work role performance via workplace benign envy but also exert a direct-positive effect. Moreover, the activating effect of performance-based HPD on workplace benign envy and the mediating role are much stronger when a team member’s pay position is higher. The multi-source data including objective information and subjective perception among 362 ordinary employees within 66 Chinese organizational teams primarily supported the moderated mediation model. Yet, the direct-positive effect was not established. (shrink)

Clinical guidelines are special types of plans realized by collective agents. We provide an ontological theory of such plans that is designed to support the construction of a framework in which guideline-based information systems can be employed in the management of workflow in health care organizations. The framework we propose allows us to represent in formal terms how clinical guidelines are realized through the actions of are realized through the actions of individuals organized into teams. We provide various levels of (...) implementation representing different levels of conformity on the part of health care organizations. Implementations built in conformity with our framework are marked by two dimensions of flexibility that are designed to make them more likely to be accepted by health care professionals than standard guideline-based management systems. They do justice to the fact 1) that responsibilities within a health care organization are widely shared, and 2) that health care professionals may on different occasions be non-compliant with guidelines for a variety of well justified reasons. The advantage of the framework lies in its built-in flexibility, its sensitivity to clinical context, and its ability to use inference tools based on a robust ontology. One disadvantage lies in its complicated implementation. (shrink)

If group members aim to fulfill a collective obligation, they must act in such a way that the composition of their individual actions amounts to a group action that fulfills the collective obligation. We study a strong sense of joint action in which the members of a group design and then publicly adopt a group plan that coordinates the individual actions of the group members. We characterize the conditions under which a group plan successfully coordinates the group members' individual actions, (...) and study how the public adoption of a plan changes the context in which individual agents make a decision about what to do. (shrink)

Research has revealed how inherent self-organizing tendencies in athletes and sports teams can be exploited to facilitate emergence of dynamical patterns in synergy formation in sports teams. Here, we discuss how game models, and associated tactical principles of play, may be implemented to constrain co-existing global-to-local and local-to-global self-organization tendencies in team sports players during training and performance. Understanding how to harness the continuous interplay between these co-existing, bi-directional, and coordination tendencies is key to shaping system behaviors in sports (...) training. Training programs are traditionally dominated by designs, which shape the self-organizing tendencies of players and teams at a global-to-local scale by coaches imposing a tactical/strategical plan with associated tactical principles of play. Nevertheless, recent research suggests that performers also need to be provided with opportunities to explore self-organizing tendencies that emerge at the local-to-global scale in training. This directional tendency in synergy formation can be facilitated by players being given opportunities to actively explore different adaptive and innovative performance solutions, coherent with principles of play circumscribed in an overarching game model. Developing methods (coaching sessions rooted on principles of dynamical systems theory that foment the development of such local-to-global relations) to exploit the continuous interplay between these co-existing tendencies within sports teams may promote more effective and efficient athlete skill training programs, in addition to enhancing performance. (shrink)

Sometimes we make a decision about an action we will undertake later and form an intention, but our judgment of what it is best to do undergoes a temporary shift when the time for action comes round. What makes it rational not to give in to temptation? Many contemporary solutions privilege diachronic rationality; in some “rational non-reconsideration” (RNR) accounts once the agent forms an intention, it is rational not to reconsider. This leads to other puzzles: how can someone be motivated (...) to follow a plan that is contrary to their current judgment? How can it be rational to form a plan to resist if we can predict that our judgment will shift? I show how these puzzles can be solved in a framework where there are multiple units of agency, distinguishing between the judgments of the timeslice and those of the person over time, and allowing that the timeslice can “self identify”, taking the person over time as the relevant unit of agency and doing intrapersonal team reasoning (with a different causal role for intentions than RNR accounts). On my account, resisting temptation is compatible with synchronic rationality, so synchronic and diachronic rationality are aligned. However, either resisting or succumbing to temptation can be instrumentally rational, depending on the unit of agency that is identified with. In order to show why we ought to resist temptation, we need to draw on a non-instrumental rationale. I sketch possible routes for doing this. (shrink)

The purpose of this paper is to encourage reflection about the harm that could result if the positive aspects of team-organized health care are compromised during the health care reform process. While other models of health care delivery could replace teamwork and serve patients as well or better, the interdisciplinary health care team probably will not be abandoned. However, one or more disciplines whose members play important roles on various teams may be sacrificed in the hasty effort to (...) define essential health care. Moreover, a significant proportion of the types of IHCTs in existence could be rashly eliminated from health plans. These changes should not take place randomly or by default. (shrink)

Background A team-based approach has been advocated for advance care planning in nursing homes. While nurses are often put forward to take the lead, it is not clear to what extent other professions could be involved as well. Objectives To examine to what extent engagement in advance care planning practices (e.g. conversations, advance directives), knowledge and self-efficacy differ between nurses, care assistants and allied care staff in nursing homes. Design Survey study. Participants/setting The study involved a purposive (...) sample of 14 nursing homes in Flanders, Belgium. Nurses, care assistants and allied care staff (e.g. social workers, physical therapists) completed a survey. Ethical considerations The study was approved by the University Hospital of Brussels (B.U.N. 143201834759), as part of a cluster randomized controlled trial (clinicaltrials.gov NCT03521206). Results One hundred ninety-six nurses, 319 care assistants and 169 allied staff participated (67% response rate). After adjusting for confounders, nurses were significantly more likely than care assistants to have carried out advance care planning conversations (odds ratio 4; 95% confidence interval 1.73–9.82; p < 0.001) and documented advance care planning (odds ratio 2.67; 95% confidence interval 1.29–5.56; p < 0.001); differences not found between allied staff and care assistants. Advance care planning knowledge total scores differed significantly, with nurses (estimated mean difference 0.13 (score range 0–1); 95% confidence interval 0.08–0.17; p < 0.001) and allied staff (estimated mean difference 0.07; 95% confidence interval 0.03–0.12; p < 0.001) scoring higher than care assistants. We found no significant differences regarding self-efficacy. Discussion While nursing home nurses conducted more advance care planning conversations and documentation than allied care staff and care assistants, these two professional groups may be a valuable support to nurses in conducting advance care planning, if provided with additional training. Conclusions Allied care staff and care assistants, if trained appropriately, can be involved more strongly in advance care planning to enhance relational and individual autonomy of nursing home residents, alongside nurses. Future research to improve and implement advance care planning should consider this finding at the intervention development stage. (shrink)

Background: A high prevalence of cognitive impairment and frailty complicates the feasibility of advance care planning in the long-term-care population. Research aim: To identify challenges in implementing the ‘Let Me Decide’ advance care planning programme in long-term-care. Research design: This feasibility study had two phases: (1) staff education on advance care planning and (2) structured advance care planning by staff with residents and families. Participants and research context: long-term-care residents in two nursing homes and one community (...) hospital. Ethical considerations: The local research ethics committee granted ethical approval. Findings: Following implementation, over 50% of all residents had completed some form of end-of-life care plan. Of the 70 residents who died in the post-implementation period, 14% had no care plan, 10% (with capacity) completed an advance care directive and lacking such capacity, 76% had an end-of-life care plan completed for them by the medical team, following discussions with the resident (if able) and family. The considerable logistical challenge of releasing staff for training triggered development of an e-learning programme to facilitate training. Discussion: The challenges encountered were largely concerned with preserving resident’s autonomy, avoiding harm and suboptimal or crisis decision-making, and ensuring residents were treated fairly through optimisation of finite resources. Conclusions: Although it may be too late for many long-term-care residents to complete their own advance care directive, the ‘ Let Me Decide’ programme includes a feasible and acceptable option for structured end-of-life care planning for residents with variable capacity to complete an advance care directive, involving discussion with the resident (to the extent they were able) and their family. While end-of-life care planning was time-consuming to deliver, nursing staff were willing to overcome this and take ownership of the programme, once the benefits in improved communication and enhanced peace of mind among all parties involved became apparent in practice. (shrink)

In its reaction on the terroristic attacks of September 9th, 2001, the US-government threatened Afghanistan's Taleban with war in order to force them to extradite terrorist leader Bin Laden; the Taleban said that they would not surrender to this kind of blackmail – and so, they were removed from Kabul by means of military force. The rivalling versions of this story depend crucially on notions such as "terrorism" and "blackmail". Obviously you'll gain public support for your preferrend version of the (...) story if you are able to determine how those notions are to be used. So we had better reflect about their very meaning and about the moral implications of their proper usage. To gain a deeper understanding of our notions of "blackmail" and "terrorism" I shall propose an extreme thought experiment: Cassandra's plan. Cassandra foresees that sooner or later one of the nuclear powers might take the liberty to use atomic bombs. From fright she founds an NGO for blackmailing the statesmen who are in charge of nuclear weapons; she announces in public that all ministers and leaders of any government shall be hunted down, and executed, whose soldiers drop but one atomic bomb. (Cassandra's NGO keeps killer teams in constant training so as to increase the effect of the threat; this is being financiated from private donations). In my paper I shall raise two questions (without claiming to provide definite answers). First, would we have to say that Cassandra's NGO was a terrorist organisation? Second, would it be morally wrong if Cassandra blackmailed statesmen in the way indicated? (shrink)

Using conversation analysis, this study investigates how Japanese rehabilitation team members use their geographic knowledge to search for long-term care facilities for stroke survivors in multidisciplinary team interactions. The study uncovers the orderly use of decision rules during discharge planning activities by exploring the following two questions: What decision criteria are discursively used? In what order are the criteria handled through sequential operations? The data comprise 65 video-recorded rehabilitation team meetings and ethnographic information regarding local care (...) facilities and patients’ residential addresses. The analysis shows that the participants deal with decision criteria in an orderly manner. They identify the type of facility and location preferred by the patient’s family and search for a facility accordingly. Moreover, they routinely select facilities closer to the patients’ and their families’ homes. However, these rules are modified if the family’s choice is inappropriate, or when a facility in a different location is preferred by the family. The study contributes to the conversation analytic understanding of interprofessional decision making and prioritization through the analysis of orderly methods of search procedures interactively accomplished by participants in ongoing medical team interactions. (shrink)

In a clinic-wide approach to establish liberal policies, a closed psychiatric ward was planned to be opened. The leaders of the multi-professional team of this ward requested continuous ethics support during the first few months after the transition from their previously closed ward into an open one. During the process of accompanying the team through this ethically sensitive period of institutional change, several variations of ethics consultation were developed: the ‘context-adjusted’ clinical ethics support. Some ethics consultations focused on (...) a retrospective evaluation of a patient case, in other ethics consultations consolidation of a previous case discussion was worked out, and/or reflections on fundamental ethical issues were included. Based on our experiences and the feedback of the team, we consider this context-adjusted clinical ethics support as feasible and effective. (shrink)

This paper is an empirical investigation of how Agile and Plan-based companies address teamwork. We have performed an investigation interviewing managers of 64 companies, 23 agile (hereafter defined with the term “agile companies”) and 41 non-agile (“plan-based”). The results of the study evidence a quite different approach to teamwork and team organization. Such differences are mainly in the selection of the developers and in the emphasis of the collaboration in the development teams.

We propose a domain-level ontology of plays for the facilitation of play-based collaborative autonomy among unmanned and manned-unmanned aircraft teams in the Army’s Unmanned Aircraft System (UAS) mission domain. We define a play as a type of plan that prescribes some pattern of intentional acts that are intended to reliably result in some goal in some competitive context, and which specifies one or more roles that are realized by those prescribed intentional acts. The ontology is well suited to be extended (...) to other types of military and nonmilitary unmanned vehicle operations. (shrink)

The study aims to analyze the impact of top management support for strategic planning on crisis management in UNRWA-Gaza Strip field in Palestine. Several descriptive analytical methods were used for this purpose, and a survey as a tool for data collection. Community size was (881), and the study sample was stratified random (268). The overall findings of the current study show that top management provides needed HR for strategic planning but with no financial support. Also there are shortcomings (...) in the way that organization manages the crises before and after they occur. A crisis management is only practicing during the crisis. The study suggest that top management must provide the financial support for strategic planning, periodic meetings to prepare how to deal with potential crisis in the future, establishing a specialized team and provide them with all sources needed. (shrink)

An increasing recognition over the past five decades of the importance of patients’ autonomy and the right to be able to choose to limit medical treatment at the end of life has led to the development of a number of documents related to advance care planning, including the advance directive, medical power of attorney, and portable orders for life-sustaining treatment (POLST). While these documents are important aspects of advance care planning, without having goals-ofcare conversations, a specific plan, and (...) necessary supports to achieve these goals, the documents alone offer a false promise. Healthcare professionals must be trained on how to have indepth goals-of-care conversations with patients and their families, and effectively document the decisions. Advance care planning needs to be viewed as a process that must continue as the patient’s health status, social support system, and living environment change. Designating a healthcare representative who participates in goals-of-care conversations and can work with the healthcare team to make “just in time” decisions about care reduces the burden and stress on friends and family. In this article we discuss the strengths and limitations of advance directives, medical power of attorney forms, and POLST forms; propose concrete changes to optimize the effectiveness of each; and present a comprehensive approach to advance care planning that we hope will improve care for those nearing the end of life, and ensure that their wishes and goals to have or to limit treatment are more consistently honored. (shrink)

In 2018, the remarkable rescue of twelve young boys and their football coach trapped in a flooded cave in Thailand captured worldwide attention. The rescue required the boys to be dived out of the cave system while fully anaesthetized which presented unique practical and ethical challenges for the rescue team. Major departures from normal anaesthetic practice were required. Taking anaesthetized children underwater was unprecedented, complex, and dangerous. To do this underground in a flooded cave meant the risks were extreme. (...) Using a principlist approach, this essay will outline the rescue plan highlighting the ethical dilemmas faced by the rescue team. Informed consent and full disclosure of information are justifiably waived in emergency disaster scenarios. Beneficence as a guiding principle becomes a major challenge when all rescue options appear destined to cause likely fatalities of healthy young boys. Importantly, virtues and virtue ethics also have a vital role to play when confronting and dealing with ethical challenges in disaster scenarios—this will be discussed with particular reference to the cave rescue. (shrink)

In Japan, most residents with Hansen’s disease live in dedicated sanatoria because of an established quarantine policy, even after being cured of the primary disease. They suffer from secondary diseases and are advancing in age, and advance care planning is increasingly crucial for them to live their lives with dignity in a sanatorium. In this study, we have three aims: to understand how to promote communication about their wishes for medical treatment, care, and recuperation; to identify required assistance; and (...) to explore how to promote ACP in a sanatorium. This study is a qualitative research conducted through semi-structured interviews. The study included 57 ex-Hansen’s disease patients and 66 staff from 10 facilities. Ex-Hansen’s disease patients were expected to consider ACP, but this was in the context of uncertainty about whether a sanatorium would close and whether there would be doctors to manage their needs. They reported being confused when staff rushed to confirm their advance directives, feeling that they were not provided with enough information before being approached. Barriers to promoting ACP were found to be insufficient of team-based care and information sharing, ex-Hansen’s disease patients’ weak interest in their end of life, and their conservative thoughts. We believe that ACP can be achieved by listening to the wishes of recovered patients through regular home care visits by nurses and everyday support by care workers. Furthermore, multidisciplinary coordination is urgently needed for promoting ACP. (shrink)

Artificial Intelligence (AI) and machine learning (ML) are rapidly evolving and have already had major impacts on military capabilities in the battlefield, making new kinds of tools and tactics available. A less examined area of application for AI in a military context, however, is its impact on human strategic decision making. This article focuses on the more subtle cognitive influences of AI and how they can be strategically deployed to aid decision making around the state-level resort to force, in particular. (...) I will argue that AI-driven technologies can be used to improve certain critical cognitive resources (e.g. memory, planning, mind-modelling, etc.) of decision makers, thereby providing valuable strategic advantages to those actors who use them successfully. At the same time, I will also caution against the risks of human decision makers becoming overly reliant on AI-support systems. Both the potential advantages and risks are areas that demand further study and consideration. (shrink)

Although lean search is seen as an important action in lean startup, previous studies have less knowledge on how to realize it, especially in the face of traditional plans that cannot cope with sudden changes in the environment. To fill the research gap, this study investigates the effects of improvisation on lean search. Meanwhile, this research also discusses the moderating effects of entrepreneurial team heterogeneity and the environmental uncertainty to identify the boundary conditions of this relationship. Supported by the (...) cross-sectional data from 203 Chinese startups, the results show that explorative and ambidextrous improvisation are positively associated with lean search. However, the effect of exploitative improvisation on lean search is unsupported. Additionally, technology uncertainty positively moderates the relationship between exploitative improvisation and lean search. Market uncertainty positively moderates the relationship between explorative improvisation and lean search. However, the entrepreneurial team heterogeneity negatively moderates the relationship between ambidextrous improvisation and lean search. These findings contribute to understanding how startups could conduct lean search in a rapidly changing environment, which provides theoretical guidance for improving the success rate of startups. (shrink)

For the philosopher Ivan Illich, society became a set of systems rather than a group of people. As such, society depersonalizes life and brings the need for open non-systematized spaces where people can act and interact outside their typical roles. On the other hand, an absence of formal structures may simply open spaces for the informal reproduction of society’s already well-established structures. Given this conjuncture, can systems be designed to foster personal expression? The answer I found in cybernetics is self-organization, (...) a process of adaptation to a context that can grow different organizations depending on what this context provides. This implies that personal expression is a concern in society’s emergent organizations, calling for meta planning to design the context of some of society’s self-organization processes. The cybernetician Gordon Pask argued that depersonalization follows from non-conversational communications, like the ones that develop in large committees. In response, Pask’s fellow cybernetician Stafford Beer proposed a meeting protocol called Team Syntegrity allowing large groups to subdivide into small integrated discussion groups. While Beer’s work has been extensively discussed in existent literature, this article presents the results of four experiments conducted by using variations of Beer’s protocol to understand both the ease with which it can be adapted to different situations, and the implications of its conversational structure on personal expression. The experiment’s realization demonstrates that the protocol’s preparation is laborious and hard to adapt in a timely manner in situations where participant numbers fluctuate. Automation of these processes, however, offers possibilities to use the approach in loosely organized groups. Automation can also help choosing the most appropriate protocol for particular situations through the manipulation of its configuration. Despite difficulties, the protocol offers promise for different purposes, encouraging personal expression in a way that reverberates with others’ personal perspectives. (shrink)

While facing cuts, downsizing and revenue losses, media organizations experience paradoxical demands in being organized for print or linear production with daily deadlines and simultaneously striving to be ‘digital first’ and produce and publish stories online on a continuous basis throughout the day. In this paper, we describe efforts applied when introducing the metaphor flowline in a medium-sized newspaper organization in Norway with the aim of aligning their production and publishing processes to readers’ consumption of online news. Both the production (...) volume of journalistic content, reader consumption and the newsroom workers’ experience of mastering their everyday work life increased dramatically in a very short time. The involvement of a temporary autonomous team in the planning and designing of a test pilot aiming to make flowline “as practice”, was integral to the digital transformation success, allowing for participative action across newsroom boundaries. Based on the empirical findings from the local newspaper organization and drawing on theories on liminality and metaphorical work, this article presents a set of six interrelated steps incorporating a structure for autonomous teams and their role in enabling lasting change in organizations facing digital transformation. (shrink)

The difficulty of handling complex problems has spawned challenges to the traditional paradigm of technical rationality in design, planning, and policy making. One of the most frequently proposed solutions is an interdisciplinary approach, though few writers have described the operational dynamics of such an approach. A global model of interdisciplinary problem-solving is presented based on the premise that the unity of the interdisciplinary approach derives from the creation of an intermediary process that relies on common language, shared information, a (...) mutual sense of stakeholding, and the resolution of disciplinary differences. The theoretical underpinning of this approach is the conceptualization of interdisciplinary problem-solving as a communicative process that requires attention to the rhetorical and political dynamics of working with competing interests, practices, and disciplines. The practice portion is a composite picture of effective models, skills, activities, strategies, and techniques employed by actuals interdisciplinary teams. This global model offers a way of both theoretically and practically visualizing Th. K. van Lohuizen's ideal of achieving unity of town planning, an ideal that has profound implications for the organization of both professional practice and training. (shrink)

For several years, MBA students enrolled in a Business & Society/Business Ethics class at the University of Wisconsin-Madison have been volunteering their services at homeless shelters and in low-income communities. Students also work with low-income residents and relevant stakeholders on evolutionary team projects aimed at improving living conditions in low-income communities. These projects include starting a grocery co-op, credit union, day-care center, job training center and a transportation business. In addition, student groups develop service networks that link low-income communities (...) with student organizations, other university professors and United Way volunteers. This article provides an evolutionary summary of these projects with the hope that other professors will adopt them for their classes. (shrink)

This study aims to determine possible associations between strength parameters, injury rates, and performance outcomes over six seasons in professional basketball settings. Thirty-six male professional basketball players [mean ± standard deviation : age, 30.5 ± 4.7 years; height, 199.5 ± 9.5 cm; body mass, 97.9 ± 12.9 kg; BMI 24.6 ± 2.5 kg/m2] participated in this retrospective observational study, conducted from the 2008–09 to the 2013–14 season. According to their epidemiological records, each player followed an individual plan designed within different (...) strength training programs: Functional, Eccentric, or Resistance. Seven hundred and fourteen valid records were obtained from 170 individual strength tests during 31 sessions. Tests performed were leg press, squat, and jerk. Parameters recorded were force, power, velocity, peak velocity, and time to peak velocity for strength; time loss injury and muscle injury for injury rate; and games won, games lost, and championships for performance outcomes. All the strength variables and injuries are independent of the strength programs. The correlation analysis showed very significant relationships between muscular injuries and time to peak velocity, significant relationships between force and games lost, and muscular injuries with games lost per season. Mean values per season described a possible association of force, time to peak velocity, and muscular injuries with performance outcomes. In this specific context, strength variables and injury rate data show no association with a single type of strength training program in this cohort of high-performance basketball players. (shrink)

In this article we study how members of an interdisciplinary research team use an online forum for communicating about their research project. We use the concepts of "community of practice" and "connectivity" to consider the online interaction within a wider question of how people from different academic traditions "do" interdisciplinarity. The online forum for this Grey and Pleasant Land project did not take off as hoped, even after a series of interventions and amendments, and we consider what the barriers (...) were and how they might be overcome. Barriers to involvement included participants' expectations of interaction and collaboration--expectation that real interaction happens elsewhere, tensions between academic discourse and forum talk norms, unfamiliarity with the technology, and different conceptions of appropriate academic discussion. We suggest that common academic practice does not prepare us well for creating interdisciplinary research communities through online collaboration tools, whereas such tools are our best bet currently for including geographically dispersed members in collaborative projects. Therefore, careful planning and competence building would be necessary if such tools are to be used in collaborative research. Suggested interventions, based on our experience, include providing a more focused forum, making technical support easily available, and setting up particular tasks or items to debate, within a preset, synchronous timeframe, focusing on issues relevant to the project at that time. (shrink)

The paper presents the outlines of an ontology of plans and guidelines, which is then used as the basis for a framework for implementing guideline-based systems for the management of workflow in health care organizations. The framework has a number of special features, above all in that it enables us to represent in formal terms assignments of work-items both to individuals and to teams and to tailor guideline to specific contexts of application in health care organizations. It is designed also (...) to enable implementations to do justice to the fact that the processes carried out in health care organizations may deviate in different ways from the norms set forth in corresponding guideline definitions. This means that implementations built in conformity with the framework will be marked by a type of flexibility that might make them more likely to be accepted by healthcare professionals than are standard guideline-based management systems. (shrink)

Michurinist biology was introduced to China in 1948; granted a state supported monopoly in 1952; and reduced to parity with western genetics from 1956. The Soviets exported it through the propaganda agencies Sino Soviet Friendship Association and VOKS. China’s Ministry of Agriculture achieved broad public awareness and acceptance of Michurinist biology through a translation, publication, and Soviet guest speakers campaign – all managed by a team of agriculturalists led by Luo Tianyu, a veteran CCP cadre. The campaign grew exponentially, (...) but did not affect university or Chinese Academy of Sciences biology. Luo Tianyu’s failed attempt to force Michurinist biology on a Beijing university triggered its second stage: monopoly status and a ban on “Mendelist-Morganist” biology in teaching, research, and publication. The CCP Central Committee supported this policy believing that Michurinst biology would increase agricultural production for the forthcoming first Five Year Plan; whereas, western genetics had no practical value. Michurinist biology flourished at all levels of education, research, and science literature; Western genetics was completely shut down. This only began to change when the CCP Central Committee became wary of China’s dependency on Soviet technical expertise and failure to fully utilize that of China. Change was further promoted by significant attacks on Michurinist biology by Soviet and East German biologists. Soon, these developments informed China’s “genetics question,” which became a test case for larger questions about the definition of science and the relationship between scientists and the state. Under the guidance of Lu Dingyi’s Central Committee Propaganda Department, the CCP eventually decided that, henceforth, science controversies would only be resolved by the science community; and that monopolies or ideological orthodoxies would not be imposed on science. At the same time, the CCP rescinded Michurinist biology’s monopoly and the ban on western genetics. By the mid-1960s western genetics had successfully restored itself, largely due to the leadership of C. C. Tan, a former student of Dobzhansky. Michurinist biology’s presence shrank and it became marginalized. (shrink)

Identity leadership (IL) describes that the effectiveness of a leader will depend upon his capacity to represent a given group, to make the group go forward, to create a group identity, and to make the group matter. An identity leader may increase commitment among his followers by increasing the perception of shared identity and giving more weight in the decision process to his followers. We aim to explore the mechanisms through which a leader who creates a shared group identity can (...) increase organizational commitment. In the first study, we plan to conduct a cross-cultural correlational study where we aim to test if the relationship between IL and organizational commitment is mediated by team identification and mediated-moderated by participation in decision making (PDM) and collective efficacy. In the second study, we aim to explore the direction of the causality between IL and PDM. To test this hypothesis, we will conduct an experimental study in which (1) we will manipulate IL to test its influence on the perception of PDM and (2) we will manipulate PDM to test its influence on the perception of IL. Thus, we will be able to identify the role of IL and the perception of PDM on organizational commitment. (shrink)

Due to their understanding of self-management, healthcare team members responsible for depressed older persons can experience an ethical dilemma. Each team member contributes important knowledge and experience pertaining to the management of depression, which should be reflected in the management plan. The aim of this study was to explore healthcare team members’ reflections on the ethical dilemmas involved in promoting self-management among depressed older persons. A qualitative design was used and data were collected by means of focus (...) group interviews. The results revealed one main theme: ‘Lack of trust in the community health care system’s commitment to bringing about effectiveness and change, based on three themes; ‘Struggling to ensure the reliable transfer of information about depressed older persons to professionals and family members’, ‘Balancing autonomy, care and dignity’ and ‘Differences in the understanding of responsibility’. Lack of engagement on the part of and trust between the various professional categories who work in the community are extremely counterproductive and have serious implications for patient dignity as well as safety. In conclusion, ethical dilemmas occur when staff members are unable to act in accordance with their professional ethical stance and deliver an appropriate standard of care. (shrink)

This article is dealing with the professionalization intention of a physiotherapy trainer through an innovative plan called «Training group on the analysis of rehabilitation practicing». This innovative plan has been created by the management team of a physiotherapy training institute, in South of France, in response to the 2015 reforms about the studies leading to the state-registered diploma of physiotherapist. Thanks to the studies of both the genesis and goal of that plan, plus the observation of its application by (...) a trainer, this study is trying to give a few answers to the following question: How role-playing and the collective analysis the TGARP has implemented can help physiotherapy students develop their professionalization and reflexivity during their full-time education? (shrink)

Developing a care plan in a critical care context can be challenging when the therapeutic alliance between clinicians and families is compromised by anger. When these cases occur, clinicians often turn to clinical ethics consultants to assist them with repairing this alliance before further damage can occur. This paper describes five different reasons family members may feel and express anger and offers concrete strategies for clinical ethics consultants to use when working with angry families acting as surrogate decision makers for (...) critical care patients. We reviewed records of consults using thematic analysis between January 2015 and June 2016. Each case was coded to identify whether the case involved a negative encounter with an angry family. In our review, we selected 11 cases with at least one of the following concerns or reasons for anger: perceived or actual medical error, concerns about the medical team’s competence, miscommunication, perceived conflict of interest or commitment, or loss of control. To successfully implement these strategies, clinical ethics consultants, members of the medical team, and family members should share responsibility for creating a mutually respectful relationship. (shrink)

Background: Serious Illness Conversations aim to discuss patient goals. However, on acute medicine units, seriously ill patients may undergo distressing interventions until death. Objectives: To investigate the feasibility of using the Surprise Question, “Would you be surprised if this patient died within the next year?” to identify patients who would benefit from early Serious Illness Conversations and study any changes in the interdisciplinary team’s beliefs, confidence, and engagement as a result of asking the Surprise Question. Design: A prospective cohort (...) pilot study with two Plan-Do-Study-Act cycles. Participants/context: Fifty-eight healthcare professionals working on Acute Medicine Units participated in pre- and post-intervention questionnaires. The intervention involved asking participants the Surprise Question for each patient. Patient charts were reviewed for Serious Illness Conversation documentation. Ethical considerations: Ethical approval was granted by the institutions involved. Findings: Equivocal overall changes in the beliefs, confidence, and engagement of healthcare professionals were observed. Six out of 23 patients were indicated as needing a Serious Illness Conversation; chart review provided some evidence that these patients had more Serious Illness Conversation documentation compared with the 17 patients not flagged for a Serious Illness Conversation. Issues were identified in equating the Surprise Question to a Serious Illness Conversation. Discussion: Appropriate support for seriously ill patients is both a nursing professional and ethical duty. Flagging patients for conversations may act as a filtering process, allowing healthcare professionals to focus on conversations with patients who need them most. There are ethical and practical issues as to what constitutes a “serious illness” and if answering “no” to the Surprise Question always equates to a conversation. Conclusion: The barriers of time constraints and lack of training call for institutional change in order to prioritise the moral obligation of Serious Illness Conversations. (shrink)

Despite clear legislative and judicial support, a well established ethical consensus, and increased efforts at information dissemination and education, proxy decision making for incapacitated patients continues to produce moral muddle and poor resolutions in end-of-life care.In her analysis of the proxy-doctor relationship, Nancy Dubler spells out the institutionalized patterns that keep the promise of proxy directives so often unrealized. Facing medically complex care of an incapacitated patient, health care teams are apt to view the proxy as a potentially indecisive or (...) unrealistically demanding decision-maker, less a stand-in for the patient than an interloper whose improper, misguided, or self-interested decisions will work against the patient's best interests. So perceived, proxies are routinely relegated to the edges of care planning discussions, left relatively uninformed and unconsulted, and then suddenly thrust center stage to face decisions they find overwhelming. Confronting such decisions, proxies need support and compassion. What they often find is isolation and distrust, a web of professional and institutional practices that trammel their efforts to understand and execute their role. (shrink)

This book has grown out of eight years of close collaboration among its authors. From the very beginning we decided that its content should come out as the result of a truly common effort. That is, we did not "distribute" parts of the text planned to each one of us. On the contrary, we made a point that each single paragraph be the product of a common reflection. Genuine team-work is not as usual in philosophy as it is in (...) other academic disciplines. We think, however, that this is more due to the idiosyncrasy of philosophers than to the nature of their subject. Close collaboration with positive results is as rewarding as anything can be, but it may also prove to be quite difficult to implement. In our case, part of the difficulties came from purely geographic separation. This caused unsuspected delays in coordinating the work. But more than this, as time passed, the accumulation of particular results and ideas outran our ability to fit them into an organic unity. Different styles of exposition, different ways of formalization, different levels of complexity were simultaneously present in a voluminous manuscript that had become completely unmanageable. In particular, a portion of the text had been conceived in the language of category theory and employed ideas of a rather abstract nature, while another part was expounded in the more conventional set-theoretic style, stressing intui tivity and concreteness. (shrink)

In 1966, a team made up of Brazilian and foreign scientists spent a week carefully recording the body temperature and other clinical signs and symptoms of 110 Tiriyó Indigenous people in their communities along the Brazil-Suriname border. Led by the Yale University virologist and immunologist Francis Black, the researchers faced an "epidemic" with a special profile, distinct from those most common in Indigenous populations, which usually resulted in widespread illness, the collapse of subsistence activities, hunger, and as a rule, (...) elevated mortality.Rather, what was happening with the Tiriyó was a planned event, controlled and carefully... (shrink)

The clinical clerkships in medical school are the first formal opportunity for trainees to apply bioethics concepts to clinical encounters. These clerkships are also typically trainees’ first sustained exposure to the “reality” of working in clinical teams and the full force of the challenges and ethical tensions of clinical care. We have developed a specialized, embedded ethics curriculum for Vanderbilt University medical students during their second year to address the unique experience of trainees’ first exposure to clinical care. Our embedded (...) curriculum is centered around core “ethics competencies” specific to the clerkship: for Medicine, advanced planning and end-of-life discussions; for Surgery, informed consent; for Pediatrics, the patient-family-provider triad; for Obstetrics and Gynecology, women’s autonomy, unborn child’s interests, and partner’s rights; and for Neurology/Psychiatry, decision-making capacity. In this paper, we present the rationale for these competencies, how we integrated them into the clerkships, and how we assessed these competencies. We also review the additional ethical issues that have been identified by rotating students in each clerkship and discuss our strategies for continued evolution of our ethics curriculum. (shrink)

Background: In 2019, an outbreak of COVID-19 broke out in Hubei, China. Medical workers from all over the country rushed to Hubei and participated in the treatment and care of COVID-19 patients. These nurses, dedicated to their professional practice, volunteered to provide compassion and expert clinical care during the pandemic. As with other acts of heroism, the ethical dilemmas associated with working on the front line must be considered for future practice. Purpose: To explore the ethical dilemmas of frontline nurses (...) of Jiangsu Province in China during deployment to Wuhan to fight the novel coronavirus pneumonia, and to provide a basis for developing strategies to help nursing staff address personal and practice concerns in order to work more effectively during this pandemic and other disasters in the future. Research design and method: Using the phenomenological research method and the purpose sampling method, semi-structured interviews were conducted with 10 nurses, post-deployment to Wuhan, who had worked on the front line to fight the novel coronavirus. Ethical considerations: The research proposal was approved by the Research Ethic Committee of Yangzhou University, China. Findings: From the analysis of the interviews of the 10 participants, three main themes were identified: ethical dilemmas in clinical nursing, ethical dilemmas in interpersonal relationships, and ethical dilemmas in nursing management. Conclusion: During a quick response to public health emergencies, where nurses are deployed immediately as a call to action, the issues surrounding ethical dilemmas from several perspectives must be considered. This research suggests that a team approach to proactive planning and open communication during the emergency is an efficient and productive strategy to improve the nurses’ experience and sense of well-being. (shrink)

BackgroundRandomized controlled trials (RCTs) are often complex and expensive to perform. Less than one third achieve planned recruitment targets, follow-up can be labor-intensive, and many have limited real-world generalizability. Designs for RCTs conducted using cohorts and routinely collected health data, including registries, electronic health records, and administrative databases, have been proposed to address these challenges and are being rapidly adopted. These designs, however, are relatively recent innovations, and published RCT reports often do not describe important aspects of their methodology in (...) a standardized way. Our objective is to extend the Consolidated Standards of Reporting Trials (CONSORT) statement with a consensus-driven reporting guideline for RCTs using cohorts and routinely collected health data.MethodsThe development of this CONSORT extension will consist of five phases. Phase 1 (completed) consisted of the project launch, including fundraising, the establishment of a research team, and development of a conceptual framework. In phase 2, a systematic review will be performed to identify publications (1) that describe methods or reporting considerations for RCTs conducted using cohorts and routinely collected health data or (2) that are protocols or report results from such RCTs. An initial “long list” of possible modifications to CONSORT checklist items and possible new items for the reporting guideline will be generated based on the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) and The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) statements. Additional possible modifications and new items will be identified based on the results of the systematic review. Phase 3 will consist of a three-round Delphi exercise with methods and content experts to evaluate the “long list” and generate a “short list” of key items. In phase 4, these items will serve as the basis for an in-person consensus meeting to finalize a core set of items to be included in the reporting guideline and checklist. Phase 5 will involve drafting the checklist and elaboration-explanation documents, and dissemination and implementation of the guideline.DiscussionDevelopment of this CONSORT extension will contribute to more transparent reporting of RCTs conducted using cohorts and routinely collected health data. (shrink)

_2020 PROSE Award Winner, Education Theory Category 2019 Outstanding Academic Title, _Choice_ In _Where Teachers Thrive_, Susan Moore Johnson outlines a powerful argument about the importance of the school as an organization in nurturing high‐quality teaching._ Based on case studies conducted in fourteen high-poverty, urban schools, the book examines why some schools failed to make progress, while others achieved remarkable results. It explores the challenges that administrators and teachers faced and describes what worked, what didn’t work, and why. Johnson draws (...) on vivid portraits of schools to highlight an array of school‐based systems and practices that support teachers’ professional growth and effectiveness. These include a rich and interactive hiring process; team‐based curriculum planning and assessment; and informative feedback and ongoing professional learning. Critical to all of these is the role of the principal as an essential agent in a school’s success. Although these elements may vary from school to school, Johnson argues that together these systems provide a comprehensive, mutually reinforcing set of well-orchestrated strategies that can help schools deliver results that exceed the sum of teachers’ individual efforts. Since 2000, policy makers and education officials have diligently sought to improve schools by improving the quality of individual teachers. However, even if those teachers are skilled and committed, the schools where they work are all too often disjointed, dysfunctional organizations that serve no one well. _Where Teachers Thrive _explains clearly how educators within a school can join together to adopt systems of practice that ensure growth and success by all teachers and their students. (shrink)

BackgroundEmergency separation of conjoined twins is performed when one twin is already dead or dying and threatens the survival of the other. The particular decision to perform an emergency separation of conjoined twins provides an ethical dilemma that needs special attention. Adding to the complexity of surgical and postsurgical management in emergency separation, ethical and sociocultural aspects further complicate decision-making.Case presentationFrom 1987 to 2022, 18 conjoined twin separations were performed in our centre. This paper describes three conjoined twin emergency separations. (...) In the first case of thoracoomphalopagus babies at nine days of age, one baby was diagnosed with necrotizing enterocolitis with frequent desaturation and seizures, and the other baby was healthy. Emergency separation was performed on the twelfth day of age; unfortunately, neither baby survived the surgery. In the second case, emergency separation was performed on the 110th day of life due to sepsis in one baby. The nonseptic twin passed away six hours after surgery, while the septic twin died 12 days after surgery due to wound dehiscence and abdominal sepsis. The third case was of an omphalopagus conjoined twin with a parasitic twin. The healthy baby was deemed nonviable but found to be healthy upon birth. Immediate emergency separation was performed at 2 h of age. The living baby survived the surgery but passed away two months later.ConclusionsWhen separation is deemed necessary to save one twin, it becomes difficult to apply standard ethical medical reasoning. The decision to separate results in most cases in very high-risk surgeries with poor outcomes during surgery and postsurgery. Compounded by the complexity of the case, sociocultural and religious aspects further add to the dynamics of decision-making. A multidisciplinary team must work together with a health ethics committee and navigate through this ethical conundrum with the patient and family at its decision-making centre to decide on the best plan of care. (shrink)