Integrated clinical pathway management for medical quality improvement-based on a semiotically inspired systems architecture

Clinical pathway is an approach to standardise care processes to support the implementations of clinical guidelines and protocols. It is designed to support the management of treatment processes including clinical and non-clinical activities, resources and also financial aspects. It provides detailed guidance for each stage in the management of a patient with the aim of improving the continuity and coordination of care across different disciplines and sectors. However, in the practical treatment process, the lack of knowledge sharing and information accuracy of paper-based clinical pathways burden health-care staff with a large amount of paper work. This will often result in medical errors, inefficient treatment process and thus poor quality medical services. This paper first presents a theoretical underpinning and a co-design research methodology for integrated pathway management by drawing input from organisational semiotics. An approach to integrated clinical pathway management is then proposed, which aims to embed pathway knowledge into treatment processes and existing hospital information systems. The capability of this approach has been demonstrated through the case study in one of the largest hospitals in China. The outcome reveals that medical quality can be improved significantly by the classified clinical pathway knowledge and seamless integration with hospital information systems.

Urban retrofitting: identifying disruptive and sustaining technologies using performative and foresight techniques

Cities, which are now inhabited by a majority of the world's population, are not only an important source of global environmental and resource depletion problems, but can also act as important centres of technological innovation and social learning in the continuing quest for a low carbon future. Planning and managing large-scale transitions in cities to deal with these pressures require an understanding of urban retrofitting at city scale. In this context performative techniques (such as backcasting and roadmapping) can provide valuable tools for helping cities develop a strategic view of the future. However, it is also important to identify ‘disruptive’ and ‘sustaining’ technologies which may contribute to city-based sustainability transitions. This paper presents research findings from the EPSRC Retrofit 2050 project, and explores the relationship between technology roadmaps and transition theory literature, highlighting the research gaps at urban/city level. The paper develops a research methodology to describe the development of three guiding visions for city-regional retrofit futures, and identifies key sustaining and disruptive technologies at city scale within these visions using foresight (horizon scanning) techniques. The implications of the research for city-based transition studies and related methodologies are discussed.

On the environmental valuation of catastrophe: revisiting mining disasters in the United Kingdom, 1851-1962

In the context of environmental valuation of natural disasters, an important component of the evaluation procedure lies in determining the periodicity of events. This paper explores alternative methodologies for determining such periodicity, illustrating the advantages and the disadvantages of the separate methods and their comparative predictions. The procedures employ Bayesian inference and explore recent advances in computational aspects of mixtures methodology. The procedures are applied to the classic data set of Maguire et al (Biometrika, 1952) which was subsequently updated by Jarrett (Biometrika, 1979) and which comprise the seminal investigations examining the periodicity of mining disasters within the United Kingdom, 1851-1962.

Infection Control in design and construction work

Objective: To clarify how infection control requirements are represented, communicated, and understood in work interactions through the medical facility construction project life cycle. To assist project participants with effective infection control management by highlighting the nature of such requirements and presenting recommendations to aid practice. Background: A 4-year study regarding client requirement representation and use on National Health Service construction projects in the United Kingdom provided empirical evidence of infection control requirement communication and understanding through design and construction work interactions. Methods: An analysis of construction project resources (e.g., infection control regulations and room data sheets) was combined with semi-structured interviews with hospital client employees and design and construction professionals to provide valuable insights into the management of infection control issues. Results: Infection control requirements are representationally indistinct but also omnipresent through all phases of the construction project life cycle: Failure to recognize their nature, relevance, and significance can result in delays, stoppages, and redesign work. Construction project resources (e.g., regulatory guidance and room data sheets) can mask or obscure the meaning of infection control issues. Conclusions: A preemptive identification of issues combined with knowledge sharing activities among project stakeholders can enable infection control requirements to be properly understood and addressed. Such initiatives should also reference existing infection control regulatory guidance and advice.

The use of non-hypothetical experimental markets for measuring the acceptance of genetically modified foods

The findings from a study measuring consumer acceptance of genetically modified (GM) foods are presented. The empirical data were collected in an experimental market, an approach used extensively in experimental economics for measuring the monetary value of goods. The approach has several advantages over standard approaches used in sensory and marketing research (e.g., surveys and focus groups) because of its non-hypothetical nature and the realism introduced by using real goods, real money, and market discipline. In each of three US locations, we elicited the monetary compensation consumers required to consume a GM food. Providing positive information about the benefits of GM food production, in some cases, reduced the level of monetary compensation demanded to consume the GM food. (C) 2004 Elsevier Ltd. All rights reserved.

Clothing consumption in two recent EU Member States: a cross-cultural study

Marketing research efforts across Eastern European countries continue growing since the introduction of market reforms in this region. Nonetheless, questions remain unanswered as to cross-cultural differences in Eastern Europeans' consumer behavior. The present research addresses this knowledge gap by developing and testing hypotheses about cross-cultural variations in a number of clothing-related consumer behavior phenomena in the Czech Republic and Bulgaria. Our findings indicate significant differences regarding consumer interest in clothing, preference for utilitarian, self-expressive and hedonic meanings of clothing artifacts, preference for well-known clothing brands, brand loyalty, and importance of clothing attributes. The study advances research in marketing by investigating clothing value-expressive symbolism and consumption in the tworecentEUMember States. The study provides valuable insights to marketers for developing effective marketing strategies.

Bayesian parameter estimation for latent Markov random fields and social networks

Undirected graphical models are widely used in statistics, physics and machine vision. However Bayesian parameter estimation for undirected models is extremely challenging, since evaluation of the posterior typically involves the calculation of an intractable normalising constant. This problem has received much attention, but very little of this has focussed on the important practical case where the data consists of noisy or incomplete observations of the underlying hidden structure. This paper specifically addresses this problem, comparing two alternative methodologies. In the first of these approaches particle Markov chain Monte Carlo (Andrieu et al., 2010) is used to efficiently explore the parameter space, combined with the exchange algorithm (Murray et al., 2006) for avoiding the calculation of the intractable normalising constant (a proof showing that this combination targets the correct distribution in found in a supplementary appendix online). This approach is compared with approximate Bayesian computation (Pritchard et al., 1999). Applications to estimating the parameters of Ising models and exponential random graphs from noisy data are presented. Each algorithm used in the paper targets an approximation to the true posterior due to the use of MCMC to simulate from the latent graphical model, in lieu of being able to do this exactly in general. The supplementary appendix also describes the nature of the resulting approximation.

An experimental test of response consistency in contingent valuation

We compare hypothetical and observed (experimental) willingness to pay (WTP) for a gradual improvement in the environmental performance of a marketed good (an office table). First, following usual practices in marketing research, subjects’ stated WTP for the improvement is obtained. Second, the same subjects participate in a real reward experiment designed to replicate the scenario valued in the hypothetical question. Our results show that, independently of the degree of the improvement, there are no significant median differences between stated and experimental data. However, subjects reporting extreme values of WTP (low or high) exhibit a more moderate behavior in the experiment.

The STEP scale: a measure of short-term export performance improvement

This article is a direct response to a recent observation in the literature that managers appear to be short-term oriented in their assessment of the performance of an export venture (Madsen 1998). On the basis of a cross-national survey of exporting firms, the authors present a three-dimensional scale for assessing managerial judgment of short-term export performance (i.e., the STEP scale). The three dimensions are (1) satisfaction with short-term performance improvement, (2) short-term exporting intensity improvement, and (3) expected short-term performance improvement. The scale presents evidence of reliability as well as convergent, discriminant, and nomological validity, and it reveals factorial similarity and factorial equivalence across both samples. The authors outline managerial and public policy implications that stem from the scale and identify avenues for further export marketing research.

The fractured lives of German Bohemian children, born 1933-40 in the area known as Sudetenland: a memory study, Nablonz-Neugablonz

At the Paris Peace Conferences of 1918-1919, new states aspiring to be nation-states were created for 60 million people, but at the same time 25 million people found themselves as ethnic minorities. This change of the old order in Europe had a considerable impact on one such group, more than 3 million Bohemian German-speakers, later referred to as Sudeten Germans. After the demise of the Habsburg Empire In 1918, they became part of the new state of Czechoslovakia. In 1938, the Munich Agreement – prelude to the Second World War – integrated them into Hitler’s Reich; in 1945-1946 they were expelled from the reconstituted state of Czechoslovakia. At the centre of this War Child case study are German children from the Northern Bohemian town and district, formerly known as Gablonz an der Neisse, famous for exquisite glass art, now Jablonec nad Nisou in the Czech Republic. After their expulsion they found new homes in the post-war Federal Republic of Germany. In addition, testimonies have been drawn upon of some Czech eyewitnesses from the same area, who provided their perspective from the other side, as it were. It turned out to be an insightful case study of the fate of these communities, previously studied mainly within the context of the national struggle between Germans and Czechs. The inter-disciplinary research methodology adopted here combines history and sociological research to demonstrate the effect of larger political and social developments on human lives, not shying away from addressing sensitive political and historical issues, as far as these are relevant within the context of the study. The expellees started new lives in what became Neugablonz in post-war Bavaria where they successfully re-established the industries they had had to leave behind in 1945-1946. Part 1 of the study sheds light on the complex Czech-German relationship of this important Central European region, addressing issues of democracy, ethnicity, race, nationalism, geopolitics, economics, human geography and ethnography. It also charts the developments leading to the expulsion of the Sudeten Germans from Czechoslovakia after 1945. What is important in this War Child study is how the expellees remember their history while living as children in Sudetenland and later. The testimony data gained indicate that certain stereotypes often repeated within the context of Sudeten issues such as the confrontational nature of inter-ethnic relations are not reflected in the testimonies of the respondents from Gablonz. In Part 2 the War Child Study explores the memories of the former Sudeten war children using sociological research methods. It focuses on how they remember life in their Bohemian homeland and coped with the life-long effects of displacement after their expulsion. The study maps how they turned adversity into success by showing a remarkable degree of resilience and ingenuity in the face of testing circumstances due to the abrupt break in their lives. The thesis examines the reasons for the relatively positive outcome to respondents’ lives and what transferable lessons can be deduced from the results of this study.

Using palaeo-climate comparisons to constrain future projections in CMIP5

We present a selection of methodologies for using the palaeo-climate model component of the Coupled Model Intercomparison Project (Phase 5) (CMIP5) to attempt to constrain future climate projections using the same models. The constraints arise from measures of skill in hindcasting palaeo-climate changes from the present over three periods: the Last Glacial Maximum (LGM) (21 000 yr before present, ka), the mid-Holocene (MH) (6 ka) and the Last Millennium (LM) (850–1850 CE). The skill measures may be used to validate robust patterns of climate change across scenarios or to distinguish between models that have differing outcomes in future scenarios. We find that the multi-model ensemble of palaeo-simulations is adequate for addressing at least some of these issues. For example, selected benchmarks for the LGM and MH are correlated to the rank of future projections of precipitation/temperature or sea ice extent to indicate that models that produce the best agreement with palaeo-climate information give demonstrably different future results than the rest of the models. We also explore cases where comparisons are strongly dependent on uncertain forcing time series or show important non-stationarity, making direct inferences for the future problematic. Overall, we demonstrate that there is a strong potential for the palaeo-climate simulations to help inform the future projections and urge all the modelling groups to complete this subset of the CMIP5 runs.