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.

Opening up climate research: A linked data approach to publishing data provenance

Traditionally, the formal scientific output in most fields of natural science has been limited to peer- reviewed academic journal publications, with less attention paid to the chain of intermediate data results and their associated metadata, including provenance. In effect, this has constrained the representation and verification of the data provenance to the confines of the related publications. Detailed knowledge of a dataset’s provenance is essential to establish the pedigree of the data for its effective re-use, and to avoid redundant re-enactment of the experiment or computation involved. It is increasingly important for open-access data to determine their authenticity and quality, especially considering the growing volumes of datasets appearing in the public domain. To address these issues, we present an approach that combines the Digital Object Identifier (DOI) – a widely adopted citation technique – with existing, widely adopted climate science data standards to formally publish detailed provenance of a climate research dataset as an associated scientific workflow. This is integrated with linked-data compliant data re-use standards (e.g. OAI-ORE) to enable a seamless link between a publication and the complete trail of lineage of the corresponding dataset, including the dataset itself.

An interdisciplinary modelling approach asessing the cost-effectiveness of agri-environmental measures on reducing nutrient concentration to WFD thresholds under climate change: the case of the Louros catchment

The application of the Water Framework Directive (WFD) in the European Union (EU) targets certain threshold levels for the concentration of various nutrients, nitrogen and phosphorous being the most important. In the EU, agri-environmental measures constitute a significant component of Pillar 2—Rural Development Policies in both financial and regulatory terms. Environmental measures also are linked to Pillar 1 payments through cross-compliance and the greening proposals. This paper drawing from work carried out in the REFRESH FP7 project aims to show how an INtegrated CAtchment model of plant/soil system dynamics and instream biogeochemical and hydrological dynamics can be used to assess the cost-effectiveness of agri-environmental measures in relation to nutrient concentration targets set by the WFD, especially in the presence of important habitats. We present the procedures (methodological steps, challenges and problems) for assessing the cost-effectiveness of agri-environmental measures at the baseline situation, and climate and land use change scenarios. Furthermore, we present results of an application of this methodology to the Louros watershed in Greece and discuss the likely uses and future extensions of the modelling approach. Finally, we attempt to reveal the importance of this methodology for designing and incorporating alternative environmental practices in Pillar 1 and 2 measures.

The emergence of integrated private reporting

Purpose: Private social and environmental reporting (SER) has grown considerably in recent years, consistent with a rise in institutional investor engagement and dialogue with investee companies. We interpret the emergence of integrated private reporting through the lens of institutional logics. We frame the emergence of integrated private reporting as a merging of two hitherto separate and possibly rival institutional logics. Methodology/Approach: We interviewed 19 companies listed on the FTSE100 and 20 UK institutional investors. The interviews were semi-structured and analysed in an interpretive fashion. Findings and Implications: We provide evidence to suggest that private SER is beginning to merge with private financial reporting and that, as a result integrated private reporting is emerging. This trend is mirroring the international trend in public reporting toward an integrated approach. Specifically, we find that specialist social responsible investment managers are starting to attend private financial reporting meetings whilst mainstream fund managers are starting to attend private meetings on environmental, social and governance (ESG) issues. Further, senior company directors are becoming increasingly conversant with ESG issues. We interpret our findings as two possible scenarios: (i) there is a genuine hybridisation occurring in UK institutional investment such that integrated private reporting is emerging, or; (ii) the financial logic is absorbing and effectively neutralising the responsible investment logic. Originality: This is the first research investigating the evolution of private integrated reporting.

Rainfall estimation by rain gauge-radar combination: a concurrent multiplicative-additive approach

A procedure (concurrent multiplicative-additive objective analysis scheme [CMA-OAS]) is proposed for operational rainfall estimation using rain gauges and radar data. On the basis of a concurrent multiplicative-additive (CMA) decomposition of the spatially nonuniform radar bias, within-storm variability of rainfall and fractional coverage of rainfall are taken into account. Thus both spatially nonuniform radar bias, given that rainfall is detected, and bias in radar detection of rainfall are handled. The interpolation procedure of CMA-OAS is built on Barnes' objective analysis scheme (OAS), whose purpose is to estimate a filtered spatial field of the variable of interest through a successive correction of residuals resulting from a Gaussian kernel smoother applied on spatial samples. The CMA-OAS, first, poses an optimization problem at each gauge-radar support point to obtain both a local multiplicative-additive radar bias decomposition and a regionalization parameter. Second, local biases and regionalization parameters are integrated into an OAS to estimate the multisensor rainfall at the ground level. The procedure is suited to relatively sparse rain gauge networks. To show the procedure, six storms are analyzed at hourly steps over 10,663 km2. Results generally indicated an improved quality with respect to other methods evaluated: a standard mean-field bias adjustment, a spatially variable adjustment with multiplicative factors, and ordinary cokriging.

Agroforestry: integrating apple and arable production as an approach to reducing copper use in organic and low-input apple production

Integrating top fruit production into an agroforestry system, where trees are integrated with arable crop production may have a beneficial effect on the control of plant pathogens such as scab (Venturia inaequalis). Apple yields and pest and disease levels were assessed in a novel apple/arable agroforestry system in Suffolk, and compared with a modern local organic orchard in 2012. Despite 2012 being a very bad year for apple production in the UK, apple yields in the agroforestry system appeared to be comparable with standard figures when scaled up from 2.5% land area under apple production to 100% apples, and even at just 2.5% cover, outperformed the organic orchard used for comparison. Initial indications are that scab levels were over twice as high in the organic orchard than in the agroforestry, indicating that this approach may offer some potential in reducing copper use in organic apple production. However, further research will be required to confirm these early results.

The co-development of technology and new buildings: incorporating building integrated photovoltaics

Current approaches for the reduction of carbon emissions in buildings are often predicated on the integration of renewable technologies into building projects. Building integrated photovoltaics (BIPV) is one of these technologies and brings its own set of challenges and problems with a resulting mutual articulation of this technology and the building. A Social Construction of Technology (SCOT) approach explores how negotiations between informal groups of project actors with shared interests shape the ongoing specification of both BIPV and the building. Six main groups with different interests were found to be involved in the introduction of BIPV (Cost Watchers, Design Aesthetes, Green Guardians, Design Optimizers, Generation Maximizers and Users). Their involvement around three sets of issues (design changes from lack of familiarity with the technology, misunderstandings from unfamiliar interdependencies of trades and the effects of standard firm procedure) is followed. Findings underline how BIPV requires a level of integration that typically spans different work packages and how standard contractual structures inhibit the smooth incorporation of BIPV. Successful implementation is marked by ongoing (re-)design of both the building and the technology as informal fluid groups of project actors with shared interests address the succession of problems which arise in the process of implementation.

Perspectives on the specification of Building Integrated Photovoltaic (BIPV) technology in construction projects

Innovative, low carbon technologies are already available for use in the construction of buildings, but the impact of their specification on construction projects is unclear. This exploratory research identifies issues which arise following the specification of BIPV in non-residential construction projects. Rather than treating the inclusion of a new technology as a technical problem, the research explores the issue from a socio-technical perspective to understand the accommodations which the project team makes and their effect on the building and the technology. The paper is part of a larger research project which uses a Social Construction of Technology Approach (SCOT) to explore the accommodations made to working practices and design when Building Integrated PhotoVoltaic (BIPV) technology is introduced. The approach explores how the requirements of the technology from different groups of actors (Relevant Social Groups or RSG's) give rise to problems and create solutions. As such it rejects the notion of a rational linear view of innovation diffusion; instead it suggests that the variety and composition of the Relevant Social Groups set the agenda for problem solving and solutions as the project progresses. The research explores the experiences of three people who have extensive histories of involvement with BIPV in construction, looks at how SCOT can inform our understanding of the issues involved and identifies themes and issues in the specification of BIPV on construction projects. A key finding concerns the alignment of inflection points at which interviewees have found themselves changing from one RSG to another as new problems and solutions are identified. The points at which they change RSG often occurred at points which mirror conventional construction categories (in terms of project specification, tender, design and construction).

Achieving customer satisfaction through integrated products and services: an exploratory study

Complex products such as manufacturing equipment have always needed maintenance and repair services. Increasingly, leading manufacturers are integrating products and services to generate increased revenues and achieve customer satisfaction. Designing integrated products and services requires a different approach to new product development and a clear understanding of how customers perceive the value they obtain from actual usage of products and services—so-called value-in-use. However, there is a lack of research on integrated products and services and how they impact customer satisfaction. An exploratory study was undertaken to understand customers’ views on integrated products and services and the value-in-use derived from such offerings. As value-in-use and its impacts are complicated concepts, a technique from psychology—Repertory Grid Technique—was used to gather data in 33 interviews. The interviews allowed a deep understanding of customer views on integrated products and services to be obtained, and a systematic analysis identified the key attributes of value-in-use. In order to probe further, the data were then analyzed using Honey’s procedure, which identified the impact of the attributes of value-in-use on customer satisfaction. Two key attributes—relational dynamic and access—were found to have the most influence on customer satisfaction. This paper contributes to the innovation field by identifying customer needs for integrated products and services and how these impact customer satisfaction. These are key points and need to be fully considered by managers during new product and service development. Similarly, the paper identifies a number of important areas for further research.