Innovation care pathways and the healthcare built environment: An explanatory framework and research agenda

The built environment in which health and social care is delivered can have an impact on the efficiency and outcomes of care processes. The health-care estate is large and growing and is expensive to build, adapt and maintain. The design of these buildings is a complex, difficult and political process. Better use of care pathways as an input to the design and use of the built environment has the potential to deliver significant benefits. A number of variations on the idea of care pathways are already used in designing health-care buildings but this is under-researched. This paper provides a framework for thinking about care pathways and the health-care built environment. The framework distinguishes between five different pathway ‘types’ defined for the purpose of understanding the relationship between pathways and infrastructure. The five types are: ‘care pathways’, ‘integrated care pathways’, ‘patient pathways’, ‘patient journeys’ and ‘patient flows’. The built environment implications of each type are discussed and recommendations made for those involved in either building development or care pathway projects.

Responsiveness to change by standard-form contract drafters: A case study of the FIDIC White Book

Purpose – The purpose of this paper is to focus on the Fédération Internationale des Ingénieurs-Conseils (FIDIC) White Book standard form of building contract. It tracks the changes to this contract over its four editions, and seeks to identify their underlying causes. Design/methodology/approach – The changes made to the White Book are quantified using a specific type of quantitative content analysis. The amended clauses are then examined to understand the nature of the changes made. Findings – The length of the contract increased by 34 per cent between 1990 and 2006. A large proportion of the overall increase can be attributed to the clauses dealing with “conflict of interest/corruption” and “dispute resolution”. In both instances, the FIDIC drafting committees have responded to international developments to discourage corruption, and to encourage the use of alternative dispute resolution. Between 1998 and 2006, the average length of the sentences increased slightly, raising the question of whether long sentences are easily understood by users of contracts. Research limitations/implications – Quantification of text appears to be particularly useful for the analysis of documents which are regularly updated because changes can be clearly identified and the length of sentences can be determined, leading to conclusions about the readability of the text. However, caution is needed because changes of great relevance can be made to contract clauses without actually affecting their length. Practical implications – The paper will be instructive for contract drafters and informative for users of FIDIC's White Book. Originality/value – Quantifying text has been rarely used regarding standard-form contracts in the field of construction.

Built environment education, research and practice: integrating diverse interests to make an impact

The role of the academic in the built environment seems generally to be not well understood or articulated. While this problem is not unique to our field, there are plenty of examples in a wide range of academic disciplines where the academic role has been fully articulated. But built environment academics have tended not to look beyond their own literature and their own vocational context in trying to give meaning to their academic work. The purpose of this keynote presentation is to explore the context of academic work generally and the connections between education, research and practice in the built environment, specifically. By drawing on ideas from the sociology of the professions, the role of universities, and the fundamentals of social science research, a case is made that helps to explain the kind of problems that routinely obstruct academic progress in our field. This discussion reveals that while there are likely to be great weaknesses in much of what is published and taught in the built environment, it is not too great a stretch to provide a more robust understanding and a good basis for developing our field in a way that would enable us collectively to make a major contribution to theory-building, theory-testing and to make a good stab at tackling some of the problems facing society at large. There is no reason to disregard the fundamental academic disciplines that underpin our knowledge of the built environment. If we contextualise our work in these more fundamental disciplines, there is every reason to think that we can have a much greater impact that we have experienced to date.

Virtual reality as a visualisation tool: benefits and constraints

The benefits and applications of virtual reality (VR) in the construction industry have been investigated for almost a decade. However, the practical implementation of VR in the construction industry has yet to reach maturity owing to technical constraints. The need for effective information management presents challenges: both transfer of building data to, and organisation of building information within, the virtual environment require consideration. This paper reviews the applications and benefits of VR in the built environment field and reports on a collaboration between Loughborough University and South Bank University to overcome constraints on the use of the overall VR model for whole lifecycle visualisation. The work at each research centre is concerned with an aspect of information management within VR applications for the built environment, and both data transfer and internal data organisation have been investigated. In this paper, similarities and differences between computer-aided design (CAD) and VR packages are first discussed. Three different approaches to the creation of VR models during the design stage are identified and described, with a view to providing sharing understanding across the interdiscipliary groups involved. The suitable organisation of building information within the virtual environment is then further investigated. This work focused on the visualisation of the degradation of a building, through its lifespan, with the view to provide a visual aid for developing an effective and economic project maintenance programme. Finally consideration is given to the potential of emerging standards to facilitate an integrated use of VR. The convergence towards similar data structures in VR and other construction packages may enable visualisation to be better utilised in the overall lifecycle model.

A holistic method to assess building energy efficiency combining D-S theory and the evidential reasoning approach

The assessment of building energy efficiency is one of the most effective measures for reducing building energy consumption. This paper proposes a holistic method (HMEEB) for assessing and certifying building energy efficiency based on the D-S (Dempster-Shafer) theory of evidence and the Evidential Reasoning (ER) approach. HMEEB has three main features: (i) it provides both a method to assess and certify building energy efficiency, and exists as an analytical tool to identify improvement opportunities; (ii) it combines a wealth of information on building energy efficiency assessment, including identification of indicators and a weighting mechanism; and (iii) it provides a method to identify and deal with inherent uncertainties within the assessment procedure. This paper demonstrates the robustness, flexibility and effectiveness of the proposed method, using two examples to assess the energy efficiency of two residential buildings, both located in the ‘Hot Summer and Cold Winter’ zone in China. The proposed certification method provides detailed recommendations for policymakers in the context of carbon emission reduction targets and promoting energy efficiency in the built environment. The method is transferable to other countries and regions, using an indicator weighting system to modify local climatic, economic and social factors.

Unsteady flow simulation of a vertical axis augmented wind turbine: a two-dimensional study

As the integration of vertical axis wind turbines in the built environment is a promising alternative to horizontal axis wind turbines, a 2D computational investigation of an augmented wind turbine is proposed and analysed. In the initial CFD analysis, three parameters are carefully investigated: mesh resolution; turbulence model; and time step size. It appears that the mesh resolution and the turbulence model affect result accuracy; while the time step size examined, for the unsteady nature of the flow, has small impact on the numerical results. In the CFD validation of the open rotor with secondary data, the numerical results are in good agreement in terms of shape. It is, however, observed a discrepancy factor of 2 between numerical and experimental data. Successively, the introduction of an omnidirectional stator around the wind turbine increases the power and torque coefficients by around 30–35% when compared to the open case; but attention needs to be given to the orientation of the stator blades for optimum performance. It is found that the power and torque coefficients of the augmented wind turbine are independent of the incident wind speed considered.

Establishment of a Cross-European Field Site Network in the ALARM Project for Assessing Large-Scale Changes in Biodiversity

The field site network (FSN) plays a central role in conducting joint research within all Assessing Large-scale Risks for biodiversity with tested Methods (ALARM) modules and provides a mechanism for integrating research on different topics in ALARM on the same site for measuring multiple impacts on biodiversity. The network covers most European climates and biogeographic regions, from Mediterranean through central European and boreal to subarctic. The project links databases with the European-wide field site network FSN, including geographic information system (GIS)-based information to characterise the test location for ALARM researchers for joint on-site research. Maps are provided in a standardised way and merged with other site-specific information. The application of GIS for these field sites and the information management promotes the use of the FSN for research and to disseminate the results. We conclude that ALARM FSN sites together with other research sites in Europe jointly could be used as a future backbone for research proposals

An Integrated Assessment of changes in the thermohaline circulation

This paper discusses the risks of a shutdown of the thermohaline circulation (THC) for the climate system, for ecosystems in and around the North Atlantic as well as for fisheries and agriculture by way of an Integrated Assessment. The climate model simulations are based on greenhouse gas scenarios for the 21st century and beyond. A shutdown of the THC, complete by 2150, is triggered if increased freshwater input from inland ice melt or enhanced runoff is assumed. The shutdown retards the greenhouse gas-induced atmospheric warming trend in the Northern Hemisphere, but does not lead to a persistent net cooling. Due to the simulated THC shutdown the sea level at the North Atlantic shores rises by up to 80 cm by 2150, in addition to the global sea level rise. This could potentially be a serious impact that requires expensive coastal protection measures. A reduction of marine net primary productivity is associated with the impacts of warming rather than a THC shutdown. Regional shifts in the currents in the Nordic Seas could strongly deteriorate survival chances for cod larvae and juveniles. This could lead to cod fisheries becoming unprofitable by the end of the 21st century. While regional socioeconomic impacts might be large, damages would be probably small in relation to the respective gross national products. Terrestrial ecosystem productivity is affected much more by the fertilization from the increasing CO2 concentration than by a THC shutdown. In addition, the level of warming in the 22nd to 24th century favours crop production in northern Europe a lot, no matter whether the THC shuts down or not. CO2 emissions corridors aimed at limiting the risk of a THC breakdown to 10% or less are narrow, requiring departure from business-as-usual in the next few decades. The uncertainty about THC risks is still high. This is seen in model analyses as well as in the experts’ views that were elicited. The overview of results presented here is the outcome of the Integrated Assessment project INTEGRATION.

Evaluating the century C model using long-term fertilizer trials in the Indo-Gangetic Plains, India

The GEFSOC Project developed a system for estimating soil carbon (C) stocks and changes at the national and sub-national scale. As part of the development of the system, the Century ecosystem model was evaluated for its ability to simulate soil organic C (SOC) changes in environmental conditions in the Indo-Gangetic Plains, India (IGP). Two long-term fertilizer trials (LTFT), with all necessary parameters needed to run Century, were used for this purpose: a jute (Corchorus capsularis L.), rice (Oryza sativa L.) and wheat (Triticum aestivum L.) trial at Barrackpore, West Bengal, and a rice-wheat trial at Ludhiana, Punjab. The trials represent two contrasting climates of the IGP, viz. semi-arid, dry with mean annual rainfall (MAR) of < 800 mm and humid with > 1600 turn. Both trials involved several different treatments with different organic and inorganic fertilizer inputs. In general, the model tended to overestimate treatment effects by approximately 15%. At the semi-arid site, modelled data simulated actual data reasonably well for all treatments, with the control and chemical N + farm yard manure showing the best agreement (RMSE = 7). At the humid site, Century performed less well. This could have been due to a range of factors including site history. During the study, Century was calibrated to simulate crop yields for the two sites considered using data from across the Indian IGP. However, further adjustments may improve model performance at these sites and others in the IGP. The availability of more longterm experimental data sets (especially those involving flooded lowland rice and triple cropping systems from the IGP) for testing and validation is critical to the application of the model's predictive capabilities for this area of the Indian sub-continent. (C) 2007 Elsevier B.V. All rights reserved.

The role of the Madden-Julian Oscillation in the El Nino and Indian drought of 2002

In 2002 India experienced a severe drought, one among the five worst droughts since records began in 1871, notable for its countrywide influence. The drought was primarily due to an unprecedented break in the monsoon during July, which persisted for almost the whole month and affected most of the sub-continent. The failure of the monsoon in 2002 was not predicted and India was not prepared for the devastating impacts on, for example, agriculture. This paper documents the evolution of the 2002 Indian summer monsoon and considers the possible factors that contributed to the drought and the failure of the forecasts. The development of the 2002/2003 El Nino and the unusually high levels of Madden-Julian Oscillation (MJO) activity during the monsoon season are identified as the central players. The 2002/2003 El Nino was characterised by very high sea-surface temperatures (SSTs) in the central Pacific that developed rapidly during the monsoon season. It is suggested that the unusual character of the developing El Nino was associated with the MJO and was a consequence of the eastward extension of the West Pacific Warm Pool, brought about primarily by a series of westerly wind events (WWEs) as part of the eastward movement of the active phase of the MJO. During the boreal summer, the MJO is usually characterised by northward movement, but in 2002 the northward component of the MJO was weak and the MJO was dominated by a strong eastward component, probably driven by the abnormally high SSTs in the central Pacific. It is suggested that a positive feedback existed between the developing El Nino and the eastward component of the MJO, which weakened the active phases of the monsoon. In particular, the unprecedented monsoon break in July could be associated with the juxtaposition of strong MJO activity with a developing El Nino, both of which interfered constructively with each other to produce major perturbations to the distribution of tropical heating. Subsequently, the main impact of the developing El Nino was a modulation of the Walker circulation that led to the overall suppression of the Indian monsoon during thess latter part of the season. It is argued that the unique combination of a rapidly developing El Nino and strong MJO activity, which was timed within the seasonal cycle to have maximum impact on the Indian summer monsoon, meant that prediction of the prolonged break in July and the seasonally deficient rainfall was a challenge for both the empirical and dynamical forecasting systems. Copyright (C) 2006 Royal Meteorological Society.