Planning Bill (4): Implementation, Performance and Decision making: Issues of Capacity, Delivery and Quality

This paper examines issues of capacity, delivery and quality in relation to the Planning Bill. It is one of four papers and follows a common format highlighting the key issues arising in the Bill; summarising the findings of the public consultation and the Government’s response; reviewing comparable arrangements in comparable jurisdictions and highlighting potential contentious issues.

Protocol: Quality of Life, Decision Making, Costs and Impact on Carers in People Managed without Dialysis - The PACKS Study

Rapid tryptophan depletion improves decision-making cognition in healthy humans without affecting reversal learning or set shifting

Rapid tryptophan (Trp) depletion (RTD) has been reported to cause deterioration in the quality of decision making and impaired reversal learning, while leaving attentional set shifting relatively unimpaired. These findings have been attributed to a more powerful neuromodulatory effect of reduced 5-HT on ventral prefrontal cortex (PFC) than on dorsolateral PFC. In view of the limited number of reports, the aim of this study was to independently replicate these findings using the same test paradigms. Healthy human subjects without a personal or family history of affective disorder were assessed using a computerized decision making/gambling task and the CANTAB ID/ED attentional set-shifting task under Trp-depleted (n=17; nine males and eight females) or control (n=15; seven males and eight females) conditions, in a double-blind, randomized, parallel-group design. There was no significant effect of RTD on set shifting, reversal learning, risk taking, impulsivity, or subjective mood. However, RTD significantly altered decision making such that depleted subjects chose the more likely of two possible outcomes significantly more often than controls. This is in direct contrast to the previous report that subjects chose the more likely outcome significantly less often following RTD. In the terminology of that report, our result may be interpreted as improvement in the quality of decision making following RTD. This contrast between studies highlights the variability in the cognitive effects of RTD between apparently similar groups of healthy subjects, and suggests the need for future RTD studies to control for a range of personality, family history, and genetic factors that may be associated with 5-HT function.

Decision making in childhood asthma exacerbation – a clinical judgement analysis

Background: Clinical decisions which impact directly on patient safety and quality of care are made during acute asthma attacks by individual doctors on the basis of their knowledge and experience. These include administration of systemic corticosteroids (CS), oral antibiotics, and admission to hospital. Clinical judgement analysis provides a methodology for comparing decisions between practitioners with different training and experience, and improving decision making. Methods: Stepwise linear regression was used to select clinical cues based on visual analogue scale assessments of the propensity of 62 clinicians to prescribe a short course of oral CS (decision 1), a course of antibiotics (decision 2), and/or admit to hospital (decision 3) for 60 â??paperâ?? patients. Results:When compared by specialty, paediatriciansâ?? models for decision 1 were more likely to include as a cue level of alertness (54% v. 16%); for decision 2 presence of crepitations (49% v. 16%), and less likely to include inhaled CS (8% v. 40%), respiratory rate (0% v. 24%), and air entry (70% v. 100%). When compared to other grades, the models derived for decision 3 by consultants/general practitioners were more likely to include wheeze severity as a cue (39% v. 6%). Conclusions: Clinicians differed in their use of individual cues and the number included in their models. Patient safety and quality of care will benefit from clarification of decision making strategies as general learning points during medical training, in the development of guidelines and care pathways, and by clinicians developing self-awareness of their own preferences.

Grading gems: Appraising the quality of research about social work and social care.

The impetus towards basing practice and policy decisions more explicitly on sound research requires tools to facilitate the systematic appraisal of the quality of research encompassing a diverse range of methods and designs. Five exemplar tools were developed and assessed in terms of their usefulness in selecting studies for inclusion in a systematic review. The widely used ‘hierarchy of evidence’ was adapted and used to appraise internal validity. Four tools were then developed to appraise the external validity dimensions of generalizability (two scales) and methods of data collection (two scales). Methods of combining the scores generated by each tool were explored. Qualitative and quantitative studies were appraised, not separated into two spheres but by using complementary tools developed to appraise different aspects of rigour. There was a high level of agreement between researchers in applying the tools to twenty-two studies on decision making by professionals about the longterm care of older people. The scales for internal validity and generalizability discriminated between the qualities of studies appropriately. The two tools to appraise data collection gave diverse results. Excluding studies that scored in the lowest category on any scale appeared to be the scoring system that was most justifiable. This approach is presented to stimulate debate about the practical application of the evidence-based initiative to social work and social care. This study may assist in developing clearer definitions and common language about appraising rigour that should further the process of selecting robust research for synthesis to inform practice and policy decisions.

The use of material flow analysis and the ecological footprint in regional policy-making: application and insights from Northern Ireland.

This paper aims to contribute to the ongoing debate on the use of resource accounting tools in regional policy making. The Northern Limits project applied Material Flow Analysis and Ecological Footprinting to regional policy making in Northern Ireland over a number of years. The early phase of the research informed the regions first sustainable development strategy which was published in 2006 with key targets relating to the Ecological Footprint and improving the resource efficiency of the economy. Phase II identified the next steps required to address data availability and quality and the use of MFA and EF in providing a measurement and monitoring framework for the strategy and in the development of the strategy implementation plan. The use of MFA and Ecological Footprinting in sustainable regional policy making and the monitoring of its implementation is an ongoing process which has raised a number of research issues which can inform the ongoing application and development of these and other resource accounting tools to within Northern Ireland, provide insights for their use in other regions and help set out the priorities for research to support this important policy area.

Comparative study of tool life and hole quality in drilling of CFRP/titanium stack using coated carbide drill

The use of hybrid materials including carbon fiber reinforced plastics (CFRPs) and lightweight metals such as titanium are increasing particularly in aerospace applications. Multi-material stacks require a number of holes for the assembly purposes. In this research, drilling trials have been carried out in CFRP, Ti-6Al-4V and CFRP/Ti-6Al-4V stack workpieces using AlTiN coated tungsten carbide drill bit. The effects of process parameters have been investigated. The thrust force, torque, burr formation, delamination, surface roughness and tool wear have been analyzed at various processing condition. The experimental results have shown that the thrust force, torque, burr formation and the average surface roughness increase with the increased feed rate and decrease with the increased cutting speed in drilling of Ti-6Al-4V. In drilling CFRP, delamination and the average surface roughness has similar tendency with the cutting parameters however thrust force and torque rises with the increased cutting speed. The results showed that after making 15 holes in CFRP/Ti-6Al-4V stack, measured thrust forces were increased by 20% in CFRP and by 45% in Ti-6Al-4V. Delamination was found to be much smaller in drilling of CFRP in stack from compared to drilling single CFRP. Tool life was significantly shortened in drilling of stack due to the combination of the wear mechanisms.

Unravelling the migration decision-making process: English early retirees moving to rural mid-Wales

There are established migrant reasons to explain rural in-migration. These include quality of life, rural idyll and lifestyle motivations. However, such one-dimensional sound bites portray rural in-migration in overly simplistic and stereotypical terms. In contrast, this paper distinguishes the decision to move from the reason for moving and in doing so sheds new light on the interconnections between different domains (family, work, finance, health) of the migrant's life which contribute to migration behaviour. Focussing on early retirees to mid-Wales and adopting a life course perspective the overall decision to move is disaggregated into a series of decisions. Giving voices to the migrants themselves demonstrates the combination of life events necessary to lead to migration behaviour, the variable factors (and often economic dominance) considered in the choice of destination (including that many are reluctant migrants to Wales), and the perceived 'accidental' choice of location and/or property. It is argued that quality of life, rural idyll and lifestyle sound bites offer an inadequate understanding of rural in-migration and associated decision-making processes. Moreover, they disguise the true nature of migrant decision making.

Bond quality of cross-laminated timber from Irish Sitka spruce

The potential use of Irish-grown Sitka spruce for cross-laminated timber (CLT) manufacture is investigated as this would present new opportunities and novel products for Irish timber in the home and export markets. CLT is a prefabricated multilayer engineered wood product made of at least three orthogonally bonded layers of timber. In order to increase rigidity and stability, successive layers of boards are placed cross-wise to form a solid timber panel. Load-bearing CLT wall and floor panels are easily assembled on site to form multi-storey buildings. This improves construction and project delivery time, reduces costs,
and maximises efficiency on all levels.

The paper addresses the quality of the interface bond between the laminations making up the panels, which is of fundamental importance to the load bearing capacity. Therefore, shear tests were carried out on nine test bars of three glue lines each. Moreover, delamination tests were performed on samples subjected to accelerated aging, in order to assess the durability of bonds subjected to severe environmental conditions. In addition, this paper gives an indication on thickness tolerances of planed Irish Sitka spruce lamellas, which is likely to be a critical factor for bonding quality and adhesive selection. The test results of bond quality presented in this study were within requirements of prEN 16351:2013.

Tool life and hole surface integrity studies for hole-making of Ti6Al4V Alloy

With a significant growth in the use of titanium alloys in the aviation manufacturing industry, the key challenge of making high-quality holes in the aircraft assembly process needs to be addressed. In this work, case studies deploying traditional drilling and helical milling technologies are carried out to investigate the tool life and hole surface integrity for hole-making of titanium alloy. Results show that the helical milling process leads to much longer tool life, generally lower hole surface roughness, and higher hole subsurface microhardness. In addition, no plastically deformed layer or white layer has been observed in holes produced by helical milling. In contrast, a slightly softened region was always present on the drilled surface. The residual stress distributions within the hole surface, including compressive and tensile residual stress, have also been investigated in detail.