Training pharmacists to deliver a complex information technology intervention (PINCER) using the principles of educational outreach and root cause analysis

Objective: To describe the training undertaken by pharmacists employed in a pharmacist-led information technology-based intervention study to reduce medication errors in primary care (PINCER Trial), evaluate pharmacists’ assessment of the training, and the time implications of undertaking the training. Methods: Six pharmacists received training, which included training on root cause analysis and educational outreach, to enable them to deliver the PINCER Trial intervention. This was evaluated using self-report questionnaires at the end of each training session. The time taken to complete each session was recorded. Data from the evaluation forms were entered onto a Microsoft Excel spreadsheet, independently checked and the summary of results further verified. Frequencies were calculated for responses to the three-point Likert scale questions. Free-text comments from the evaluation forms and pharmacists’ diaries were analysed thematically. Key findings: All six pharmacists received 22 hours of training over five sessions. In four out of the five sessions, the pharmacists who completed an evaluation form (27 out of 30 were completed) stated they were satisfied or very satisfied with the various elements of the training package. Analysis of free-text comments and the pharmacists’ diaries showed that the principles of root cause analysis and educational outreach were viewed as useful tools to help pharmacists conduct pharmaceutical interventions in both the study and other pharmacy roles that they undertook. The opportunity to undertake role play was a valuable part of the training received. Conclusions: Findings presented in this paper suggest that providing the PINCER pharmacists with training in root cause analysis and educational outreach contributed to the successful delivery of PINCER interventions and could potentially be utilised by other pharmacists based in general practice to deliver pharmaceutical interventions to improve patient safety.

An application of life-cycle assessment for environmental planning and management: the potential environmental and human health impacts of growing genetically-modified herbicide-tolerant sugar beet

Life-Cycle Assessment (LCA) was used to assess the potential environmental and human health impacts of growing genetically-modified (GM), herbicide-tolerant sugar beet in the UK and Germany compared with conventional sugar beet varieties. The GM variety results in lower potential environmental impacts on global warming, airborne nutrification, ecotoxicity (of soil and water) and watercourse enrichment, and lower potential human health impacts in terms of production of toxic particulates, summer smog, carcinogens and ozone depletion. Although the overall contribution of GM sugar beet to reducing harmful emissions to the environment would be relatively small, the potential for GM crops to reduce pollution from agriculture, including diffuse water pollution, is highlighted.

Life cycle analysis of UK coal fired power plants

This paper examines the life cycle GHG emissions from existing UK pulverized coal power plants. The life cycle of the electricity Generation plant includes construction, operation and decommissioning. The operation phase is extended to upstream and downstream processes. Upstream processes include the mining and transport of coal including methane leakage and the production and transport of limestone and ammonia, which are necessary for flue gas clean up. Downstream processes, on the other hand, include waste disposal and the recovery of land used for surface mining. The methodology used is material based process analysis that allows calculation of the total emissions for each process involved. A simple model for predicting the energy and material requirements of the power plant is developed. Preliminary calculations reveal that for a typical UK coal fired plant, the life cycle emissions amount to 990 g CO2-e/kWh of electricity generated, which compares well with previous UK studies. The majority of these emissions result from direct fuel combustion (882 g/kWh 89%) with methane leakage from mining operations accounting for 60% of indirect emissions. In total, mining operations (including methane leakage) account for 67.4% of indirect emissions, while limestone and other material production and transport account for 31.5%. The methodology developed is also applied to a typical IGCC power plant. It is found that IGCC life cycle emissions are 15% less than those from PC power plants. Furthermore, upon investigating the influence of power plant parameters on life cycle emissions, it is determined that, while the effect of changing the load factor is negligible, increasing efficiency from 35% to 38% can reduce emissions by 7.6%. The current study is funded by the UK National Environment Research Council (NERC) and is undertaken as part of the UK Carbon Capture and Storage Consortium (UKCCSC). Future work will investigate the life cycle emissions from other power generation technologies with and without carbon capture and storage. The current paper reveals that it might be possible that, when CCS is employed. the emissions during generation decrease to a level where the emissions from upstream processes (i.e. coal production and transport) become dominant, and so, the life cycle efficiency of the CCS system can be significantly reduced. The location of coal, coal composition and mining method are important in determining the overall impacts. In addition to studying the net emissions from CCS systems, future work will also investigate the feasibility and technoeconomics of these systems as a means of carbon abatement.

Vision 2020 - A whole life-cycle information management system for built environments

A whole life-cycle information management vision is proposed, the organizational requirements for the realization of the scenario is investigated. Preliminary interviews with construction professionals are reported. Discontinuities at information transfer throughout life-cycle of built environments are resulting from lack of coordination and multiple data collection/storage practices. A more coherent history of these activities can improve the work practices of various teams by augmenting decision making processes and creating organizational learning opportunities. Therefore, there is a need for unifying these fragmented bits of data to create a meaningful, semantically rich and standardized information repository for built environment. The proposed vision utilizes embedded technologies and distributed building information models. Two diverse construction project types (large one-off design, small repetitive design) are investigated for the applicability of the vision. A functional prototype software/hardware system for demonstrating the practical use of this vision is developed and discussed. Plans for case-studies for validating the proposed model at a large PFI hospital and housing association projects are discussed.

SPICE: a business process diagnostic tool for construction projects

The construction sector is under growing pressure to increase productivity and improve quality, most notably in reports by Latham (1994, Constructing the Team, HMSO, London) and Egan (1998, Rethinking Construction, HMSO, London). A major problem for construction companies is the lack of project predictability. One method of increasing predictability and delivering increased customer value is through the systematic management of construction processes. However, the industry has no methodological mechanism to assess process capability and prioritise process improvements. Standardized Process Improvement for Construction Enterprises (SPICE) is a research project that is attempting to develop a stepwise process improvement framework for the construction industry, utilizing experience from the software industry, and in particular the Capability Maturity Model (CMM), which has resulted in significant productivity improvements in the software industry. This paper introduces SPICE concepts and presents the results from two case studies conducted on design and build projects. These studies have provided further in-sight into the relevance and accuracy of the framework, as well as its value for the construction sector.

Business life cycle and capital structure: evidence from Chinese manufacturing firms

This paper uses a panel data-fixed effect approach and data collected from Chinese public manufacturing firms between 1999 and 2011 to investigate the impacts of business life cycle stages on capital structure. We find that cash flow patterns capture more information on business life cycle stages than firm age and have a stronger impact on capital structure decision-making. We also find that the adjustment speed of capital structure varies significantly across life cycle stages and that non-sequential transitions over life cycle stages play an important role in the determination of capital structure. Our study indicates that it is important for policy-makers to ensure that products and financial markets are well-balanced.

Reliability in the whole life cycle of building systems

Purpose – The purpose of this research is to show that reliability analysis and its implementation will lead to an improved whole life performance of the building systems, and hence their life cycle costs (LCC). Design/methodology/approach – This paper analyses reliability impacts on the whole life cycle of building systems, and reviews the up-to-date approaches adopted in UK construction, based on questionnaires designed to investigate the use of reliability within the industry. Findings – Approaches to reliability design and maintainability design have been introduced from the operating environment level, system structural level and component level, and a scheduled maintenance logic tree is modified based on the model developed by Pride. Different stages of the whole life cycle of building services systems, reliability-associated factors should be considered to ensure the system's whole life performance. It is suggested that data analysis should be applied in reliability design, maintainability design, and maintenance policy development. Originality/value – The paper presents important factors in different stages of the whole life cycle of the systems, and reliability and maintainability design approaches which can be helpful for building services system designers. The survey from the questionnaires provides the designers with understanding of key impacting factors.

Model-based life cycle cost and assessment tool for sustainable building design decision

There is a growing concern in reducing greenhouse gas emissions all over the world. The U.K. has set 34% target reduction of emission before 2020 and 80% before 2050 compared to 1990 recently in Post Copenhagen Report on Climate Change. In practise, Life Cycle Cost (LCC) and Life Cycle Assessment (LCA) tools have been introduced to construction industry in order to achieve this such as. However, there is clear a disconnection between costs and environmental impacts over the life cycle of a built asset when using these two tools. Besides, the changes in Information and Communication Technologies (ICTs) lead to a change in the way information is represented, in particular, information is being fed more easily and distributed more quickly to different stakeholders by the use of tool such as the Building Information Modelling (BIM), with little consideration on incorporating LCC and LCA and their maximised usage within the BIM environment. The aim of this paper is to propose the development of a model-based LCC and LCA tool in order to provide sustainable building design decisions for clients, architects and quantity surveyors, by then an optimal investment decision can be made by studying the trade-off between costs and environmental impacts. An application framework is also proposed finally as the future work that shows how the proposed model can be incorporated into the BIM environment in practise.

A case study to investigate the life cycle carbon emissions and carbon storage capacity of a cross laminated timber, multi-storey residential building

Forests are a store of carbon and an eco-system that continually removes carbon dioxide from the atmosphere. If they are sustainably managed, the carbon store can be maintained at a constant level, while the trees removed and converted to timber products can form an additional long term carbon store. The total carbon store in the forest and associated ‘wood chain’ therefore increases over time, given appropriate management. This increasing carbon store can be further enhanced with afforestation. The UK’s forest area has increased continually since the early 1900s, although the rate of increase has declined since its peak in the late 1980s, and it is a similar picture in the rest of Europe. The increased sustainable use of timber in construction is a key market incentive for afforestation, which can make a significant contribution to reducing carbon emissions. The case study presented in this paper demonstrates the carbon benefits of a Cross Laminated Timber (CLT) solution for a multi-storey residential building in comparison with a more conventional reinforced concrete solution. The embodied carbon of the building up to completion of construction is considered, together with the stored carbon during the life of the building and the impact of different end of life scenarios. The results of the study show that the total stored carbon in the CLT structural frame is 1215tCO2 (30tCO2 per housing unit). The choice of treatment at end of life has a significant effect on the whole life embodied carbon of the CLT frame, which ranges from -1017 tCO2e for re-use to +153tCO2e for incinerate without energy recovery. All end of life scenarios considered result in lower total CO2e emissions for the CLT frame building compared with the reinforced concrete frame solution.

Time valued life cycle greenhouse gas emissions from buildings

The UK has adopted legally binding carbon reduction targets of 34% by 2020 and 80% by 2050 (measured against the 1990 baseline). Buildings are estimated to be responsible for more than 50% of greenhouse gas (GHG) emissions in the UK. These consist of both operational, produced during use, and embodied, produced during manufacture of materials and components, and during construction, refurbishments and demolition. A brief assessment suggests that it is unlikely that UK emission reduction targets can be met without substantial reductions in both Oc and Ec. Oc occurs over the lifetime of a building whereas the bulk of Ec occurs at the start of a building’s life. A time value for emissions could influence the decision making process when it comes to comparing mitigation measures which have benefits that occur at different times. An example might be the choice between building construction using low Ec construction materials versus building construction using high Ec construction materials but with lower Oc, although the use of high Ec materials does not necessarily imply a lower Oc. Particular time related issues examined here are: the urgency of the need to achieve large emissions reductions during the next 10 to 20 years; the earlier effective action is taken, the less costly it will be; future reduction in carbon intensity of energy supply; the carbon cycle and relationship between the release of GHG’s and their subsequent concentrations in the atmosphere. An equation is proposed, which weights emissions according to when they occur during the building life cycle, and which effectively increases Ec as a proportion of the total, suggesting that reducing Ec is likely to be more beneficial, in terms of climate change, for most new buildings. Thus, giving higher priority to Ec reductions is likely to result in a bigger positive impact on climate change and mitigation costs.