Building effectiveness communication ratios (BECs): an integrated ‘life-cycle’ methodology for mitigating energy-use in buildings

Current building regulations are generally prescriptive in nature. It is widely accepted in Europe that this form of building regulation is stifling technological innovation and leading to inadequate energy efficiency in the building stock. This has increased the motivation to move design practices towards a more ‘performance-based’ model in order to mitigate inflated levels of energy-use consumed by the building stock. A performance based model assesses the interaction of all building elements and the resulting impact on holistic building energy-use. However, this is a nebulous task due to building energy-use being affected by a myriad of heterogeneous agents. Accordingly, it is imperative that appropriate methods, tools and technologies are employed for energy prediction, measurement and evaluation throughout the project’s life cycle. This research also considers that it is imperative that the data is universally accessible by all stakeholders. The use of a centrally based product model for exchange of building information is explored. This research describes the development and implementation of a new building energy-use performance assessment methodology. Termed the Building Effectiveness Communications ratios (BECs) methodology, this performance-based framework is capable of translating complex definitions of sustainability for energy efficiency and depicting universally understandable views at all stage of the Building Life Cycle (BLC) to the project’s stakeholders. The enabling yardsticks of building energy-use performance, termed Ir and Pr, provide continuous design and operations feedback in order to aid the building’s decision makers. Utilised effectively, the methodology is capable of delivering quality assurance throughout the BLC by providing project teams with quantitative measurement of energy efficiency. Armed with these superior enabling tools for project stakeholder communication, it is envisaged that project teams will be better placed to augment a knowledge base and generate more efficient additions to the building stock.

The Irish credit union movement: member participation and organisational effectiveness

This thesis explores the relationship between organisational effectiveness and member participation in Irish credit unions. It is hypothesised that a positive relationship exists between both variables. Co-operative literature suggests that co-operatives require the involvement of the members in identifying and meeting their own needs in order to be effective organisations. Previous research studies into the issue across a variety of organisational types have shown mixed results. Related research into credit unions is sparse. The primary research undertaken is both quantitative and qualitative in approach. Organisational effectiveness is examined in both quantitative and qualitative terms. Member participation, being an organisational process, is examined in qualitative terms. Indicators of organisational effectiveness, specific to credit unions, are drawn up and form a framework through which effectiveness is examined. A typology and indicators of member participation are also developed and form a framework through which member participation is examined. The case study method is used primarily, to examine organisational effectiveness and member participation in Irish credit unions. A case study of a theoretical credit union, which is based on a composite of good practice in credit unions in Ireland and internationally, is also drawn up to develop the analysis further. The case studies allow an analysis of both organisational effectiveness and member participation, as well as an exploration of the relationship between the two. The findings support the hypothesis that there is a direct relationship between the two variables. In order to be effective, credit unions must involve their members in identifying their needs and in designing services to meet these needs. At present, they do not do this to any large extent. In order to continue to meet the needs of their members and to compete in the financial services sector, credit unions will need to find ways of involving members, drawing on good practice in other co-operatives. This will be critical to their continued success.

At what price? A cost-effectiveness analysis comparing trial of labour after previous caesarean versus elective repeat caesarean delivery

Background: Elective repeat caesarean delivery (ERCD) rates have been increasing worldwide, thus prompting obstetric discourse on the risks and benefits for the mother and infant. Yet, these increasing rates also have major economic implications for the health care system. Given the dearth of information on the cost-effectiveness related to mode of delivery, the aim of this paper was to perform an economic evaluation on the costs and short-term maternal health consequences associated with a trial of labour after one previous caesarean delivery compared with ERCD for low risk women in Ireland.Methods: Using a decision analytic model, a cost-effectiveness analysis (CEA) was performed where the measure of health gain was quality-adjusted life years (QALYs) over a six-week time horizon. A review of international literature was conducted to derive representative estimates of adverse maternal health outcomes following a trial of labour after caesarean (TOLAC) and ERCD. Delivery/procedure costs derived from primary data collection and combined both "bottom-up" and "top-down" costing estimations.Results: Maternal morbidities emerged in twice as many cases in the TOLAC group than the ERCD group. However, a TOLAC was found to be the most-effective method of delivery because it was substantially less expensive than ERCD ((sic)1,835.06 versus (sic)4,039.87 per women, respectively), and QALYs were modestly higher (0.84 versus 0.70). Our findings were supported by probabilistic sensitivity analysis.Conclusions: Clinicians need to be well informed of the benefits and risks of TOLAC among low risk women. Ideally, clinician-patient discourse would address differences in length of hospital stay and postpartum recovery time. While it is premature advocate a policy of TOLAC across maternity units, the results of the study prompt further analysis and repeat iterations, encouraging future studies to synthesis previous research and new and relevant evidence under a single comprehensive decision model.

The effectiveness of using patient-reported outcome measures as quality improvement tools

Aim: To investigate the value of using PROMs as quality improvement tools. Methods: Two systematic reviews were undertaken. The first reviewed the quantitative literature on the impact of PROMs feedback and the second reviewed the qualitative literature on the use of PROMs in practice. These reviews informed the focus of the primary research. A cluster randomised controlled trial (PROFILE) examined the impact of providing peer benchmarked PROMs feedback to consultant orthopaedic surgeons on improving outcomes for hip replacement surgery. Qualitative interviews with surgeons in the intervention arm of the trial examined the view of and reactions to the feedback. Results: The quantitative review of 17 studies found weak evidence to suggest that providing PROMs feedback to professionals improves patient outcomes. The qualitative review of 16 studies identified the barriers and facilitators to the use of PROMs based on four themes: practical considerations, attitudes towards the data, methodological concerns and the impact of feedback on care. The PROFILE trial included 11 surgeons and 215 patients in the intervention arm, and 10 surgeons and 217 patients in the control arm. The trial found no significant difference in the Oxford Hip Score between the arms (-0.7, 95% CI -1.9-0.5, p=0.2). Interviews with surgeons revealed mixed opinions about the value of the PROMs feedback and the information did not promote explicit changes to their practice. Conclusion: It is important to use PROMs which have been validated for the specific purpose of performance measurement, consult with professionals when developing a PROMs feedback intervention, communicate with professionals about the objectives of the data collection, educate professionals on the properties and interpretation of the data, and support professionals in using the information to improve care. It is also imperative that the burden of data collection and dissemination of the information is minimised.