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Central Organization (central + organization)
Selected AbstractsDeveloping interdisciplinary maternity services policy in Canada.JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 1 2010Evaluation of a consensus workshop Abstract Context, Four maternity/obstetrical care organizations, representing women, midwives, obstetricians and family doctors conducted interdisciplinary policy research under auspices of four key stakeholder groups. These projects teams and key stakeholders subsequently collaborated to develop consensus on strategies for improved maternity services in Ontario. Objectives, The objective of this study is to evaluate a 2-day research synthesis and consensus building conference to answer policy questions in relation to new models of interdisciplinary maternity care organizations in different settings in Ontario. Methods, The evaluation consisted of a scan of individual project activities and findings as were presented to an invited audience of key stakeholders at the consensus conference. This involved: participant observation with key informant consultation; a survey of attendees; pattern processing and sense making of project materials, consensus statements derived at the conference in the light of participant observation and survey material as pertaining to a complex system. The development of a systems framework for maternity care policy in Ontario was based on secondary analysis of the material. Findings, Conference participants were united on the importance of investment in maternity care for Ontario and the impending workforce crisis if adaptation of the workforce did not take place. The conference participants proposed reforming the current system that was seen as too rigid and inflexible in relation to the constraints of legislation, provider scope of practice and remuneration issues. However, not one model of interdisciplinary maternity/obstetrical care was endorsed. Consistency and coherence of models (rather than central standardization) through self-organization based on local needs was strongly endorsed. An understanding of primary maternity care models as subsystems of networked providers in complex health organizations and a wider social system emerged. The patterns identified were incorporated into a complexity framework to assist sense making to inform policy. Discussion, Coherence around core values, holism and synthesis with responsiveness to local needs and key stakeholders were themes that emerged consistent with complex adaptive systems principles. Respecting historical provider relationships and local history provided a background for change recognizing that systems evolve in part from where they have been. The building of functioning relationships was central through education and improved communication with ongoing feedback loops (positive and negative). Information systems and a flexible improved central and local organization of maternity services was endorsed. Education and improved communication through ongoing feedback loops (positive and negative) were central to building functioning relationships. Also, coordinated central organization with a flexible and adaptive local organization of maternity services was endorsed by participants. Conclusions, This evaluation used an approach comprising scoping, pattern processing and sense making. While the projects produced considerable typical research evidence, the key policy questions could not be addressed by this alone, and a process of synthesis and consensus building with stakeholder engagement was applied. An adaptive system with local needs driving a relationship based network of interdisciplinary groupings or teams with both bottom up and central leadership. A complexity framework enhanced sense making for the system approaches and understandings that emerged. [source] Medullary motor neurones associated with drinking behaviour of Japanese eelsJOURNAL OF FISH BIOLOGY, Issue 1 2003T. Mukuda A fluorescent dye, Evans blue (EB), was injected into the following seven drinking-associated muscles of the Japanese eel Anguilla japonica: the sternohyoid, third branchial, fourth branchial, opercular, pharyngeal, upper oesophageal sphincter and oesophageal body muscles. The sternohyoid muscle promotes ,ingestion', and the remaining muscles contribute to ,swallowing'. All neurones stained by EB were located ipsilaterally in the caudal medulla oblongata (MO) of the Japanese eel. Neurones projecting into the sternohyoid muscle were identified as those in the spino-occipital motor nucleus (NSO), and neurones projecting into the remaining muscles as those in the glossopharyngeal,vagal motor complex (GVC). Within the GVC, the neuronal arrangement was topological, and hence, ,swallowing' will be completed if the GVC neurones ,fire' progressively from rostral to caudal. These neurones in the NSO and GVC may use acetylcholine (ACh) as a neurotransmitter, as the EB-positive neurones in both nuclei were immunoreactive against anticholine acetyltransferase (anti-ChAT) antibody. Besides the MO, some somata in a ganglion of the vagal nerve were also stained by EB injected into the pharyngeal, the upper oesophageal sphincter and the oesophageal body muscles. The localization and the shape of the somata suggest that they are sensory neurones. These sensory neurones were not ChAT-immunoreactive. Combining these results, based on a model for ,swallowing' in mammals, a plausible model for central organization of ,drinking' in the Japanese eel is proposed, which suggests that ,drinking' in the fishes is regulated by the neuronal circuit for ,swallowing' in mammals. [source] Structure and Function of Emergency Care Research Networks: Strengths, Weaknesses, and ChallengesACADEMIC EMERGENCY MEDICINE, Issue 10 2009Linda Papa MD Abstract The ability of emergency care research (ECR) to produce meaningful improvements in the outcomes of acutely ill or injured patients depends on the optimal configuration, infrastructure, organization, and support of emergency care research networks (ECRNs). Through the experiences of existing ECRNs, we can learn how to best accomplish this. A meeting was organized in Washington, DC, on May 28, 2008, to discuss the present state and future directions of clinical research networks as they relate to emergency care. Prior to the conference, at the time of online registration, participants responded to a series of preconference questions addressing the relevant issues that would form the basis of the breakout session discussions. During the conference, representatives from a number of existing ECRNs participated in discussions with the attendees and provided a description of their respective networks, infrastructure, and challenges. Breakout sessions provided the opportunity to further discuss the strengths and weaknesses of these networks and patterns of success with respect to their formation, management, funding, best practices, and pitfalls. Discussions centered on identifying characteristics that promote or inhibit successful networks and their interactivity, productivity, and expansion. Here the authors describe the current state of ECRNs and identify the strengths, weaknesses, and potential pitfalls of research networks. The most commonly cited strengths of population- or disease-based research networks identified in the preconference survey were access to larger numbers of patients; involvement of physician experts in the field, contributing to high-level study content; and the collaboration among investigators. The most commonly cited weaknesses were studies with too narrow a focus and restrictive inclusion criteria, a vast organizational structure with a risk of either too much or too little central organization or control, and heterogeneity of institutional policies and procedures among sites. Through the survey and structured discussion process involving multiple stakeholders, the authors have identified strengths and weaknesses that are consistent across a number of existing ECRNs. By leveraging the strengths and addressing the weaknesses, strategies can be adopted to enhance the scientific value and productivity of these networks and give direction to future ECRNs. [source] ASEAN in the Asia Pacific: Central or Peripheral?ASIAN POLITICS AND POLICY, Issue 4 2010Julio Santiago Amador III The Association of Southeast Asian Nations (ASEAN) is an enduring regional organization in the Asia Pacific. However, its claim of being central to any talks on regional architecture is challenged by a multiplicity of external and internal factors. This article assesses ASEAN's centrality by looking into the possible challenges facing it, which inevitably affect its claim to be the central organization in managing the direction of the wider region. It then offers possible ways forward so that ASEAN can retain its leadership and prove to be a credible driver for regional cooperation. [source] | ||||||||||