Understanding stakeholder requirements on an NHS hospital project: application of semiotics-rooted theories.

Hospitals represent complex and difficult contexts for AEC (architecture, engineering and construction) professionals to engage with due to their functional complexity and diversity of stakeholder interests (i.e. patient, visitor, medical specialist). Hospital designers need to take note of changing NHS policy contexts (e.g. the possible empowerment of general practitioners to shape services), technological advances in medical equipment design and the potential health needs of future generations. It is imperative for hospital designers and architects to align their processes and methodologies (e.g. briefing and requirements capture) to the needs and desires of their clients so that a medical facility design is produced which is truly aligned to the requirements of the hospital stakeholders. Semiotics, the “study” or “discipline” of signs aims to investigate the nature of signs (their inception, representation and meaning), whilst semiotics-rooted theories are concerned with investigating how meaning and understanding is mobilized between persons and between organisations. This paper details a semiotics-rooted research approach for investigating the interactions between hospital designers and stakeholders on a forthcoming NHS hospital project in the UK. A semiotics grounded study will potentially provide a deeper understanding of how meaning and understanding is established between hospital project stakeholders and construction professionals.

Pressure-relieving equipment: promoting its correct use amongst nurses via differing modes of educational delivery

Aims and objectives. To examine the impact of written and verbal education on bed-making practices, in an attempt to reduce the prevalence of pressure ulcers. Background. The Department of Health has set targets for a 5% reduction per annum in the incidence of pressure ulcers. Electric profiling beds with a visco-elastic polymer mattress are a new innovation in pressure ulcer prevention; however, mattress efficacy is reduced by tightly tucking sheets around the mattress. Design. A prospective randomized pre/post-test experimental design. Methods. Ward managers at a teaching hospital were approached to participate in the study. Two researchers independently examined the tightness of the sheets around the mattresses. Wards were randomized to one of two groups. Groups A and B received written education. In addition, group B received verbal education on alternate days for one week. Beds were re-examined one month later. One researcher was blinded to the educational delivery received by the wards. Results. Twelve wards agreed to participate in the study and 245 beds were examined. Before education, 113 beds (46%) had sheets tucked correctly around the mattresses. Following education, this increased to 215 beds (87.8%) (chi(2) = 68.03, P < 0.001). There was no significant difference in the number of correctly made beds between the two different education groups: 100 (87.72%) beds correctly made in group A vs. 115 (87.79%) beds in group B (chi(2) = 0, P 0.987). Conclusions. Clear, concise written instruction improved practice but verbal education was not additionally beneficial. Relevance to clinical practice. Nurses are receptive to clear, concise written evidence regarding pressure ulcer prevention and incorporate this into clinical practice.

Design issues toward a cost effective physical layer for multiband OFDM (ECMA-368) in consumer products

The creation of Wireless Personal Area Networks (WPANs) offers the Consumer Electronics industry a mechanism to truly unwire consumer products, leading to portability and ease of installation as never seen before. WPAN's can offer data-rates exceeding those that are required to convey high quality broadcast video, thus users can easily connect to high quality video for multimedia presentations in education, libraries, advertising, or have a wireless connection at home. There have been many WPAN proposals, but this paper concentrates on ECMA-368 as this standard has the largest industrial and implementers' forum backing. With the aim to effective consumer electronic define and create cost equipment this paper discusses the technology behind ECMA-368 physical layer, the design freedom availabilities, the required processing, buffer memory requirements and implementation considerations while concentrating on supporting all the offered data-rates(1).

Expert system aid for design of overload line distribution networks

The use of expert system techniques in power distribution system design is examined. The selection and siting of equipment on overhead line networks is chosen for investigation as the use of equipment such as auto-reclosers, etc., represents a substantial investment and has a significant effect on the reliability of the system. Through past experience with both equipment and network operations, most decisions in selection and siting of this equipment are made intuitively, following certain general guidelines or rules of thumb. This heuristic nature of the problem lends itself to solution using an expert system approach. A prototype has been developed and is currently under evaluation in the industry. Results so far have demonstrated both the feasibility and benefits of the expert system as a design aid.

Power distribution network design aided by an expert system

The next couple of years will see the need for replacement of a large amount of life-expired switchgear on the UK 11 kV distribution system. Latest technology and alternative equipment have made the choice of replacement a complex task. The authors present an expert system as an aid to the decision process for the design of the 11 kV power distribution network.

Exploiting a hybrid environmental design strategy in the continental climate of Beijing

The built environment in China is required to achieve a 50% reduction in carbon emissions by 2020 against the 1980 design standard. A particular challenge is how to maintain acceptable comfort conditions through the hot humid summers and cold desiccating winters of its continental climate regions. Fully air-conditioned sealed envelopes, often fully glazed, are becoming increasingly common in these regions. Remedial strategies involve technical refinements to the air-handling equipment and a contribution from renewable energy sources in an attempt to achieve the prescribed net reduction in energy use. However an alternative hybrid environmental design strategy is developed in this research project. It exploits observed temperate periods of weeks, days, even hours in duration to free-run an office and exhibition building configured to promote natural stack ventilation when ambient conditions permit and mechanical ventilation when conditions require it, the two modes delivered through the same physical infrastructure. The proposal is modelled in proprietary software and the methodology adopted is described. The challenge is compounded by its first practical application to an existing reinforced concrete frame originally designed to receive a highly glazed envelope. This original scheme is reviewed in comparison. Furthermore the practical delivery of the proposal value engineered out a proportion of the ventilation stacks. The likely consequence of this for the environmental performance of the building is investigated through a sensitivity study.

Using the Technology Acceptance Model to explore community dwelling older adults’ perceptions of a 3D interior design application to facilitate pre-discharge home adaptations

Background In the UK occupational therapy pre-discharge home visits are routinely carried out as a means of facilitating safe transfer from the hospital to home. Whilst they are an integral part of practice, there is little evidence to demonstrate they have a positive outcome on the discharge process. Current issues for patients are around the speed of home visits and the lack of shared decision making in the process, resulting in less than 50 % of the specialist equipment installed actually being used by patients on follow-up. To improve practice there is an urgent need to examine other ways of conducting home visits to facilitate safe discharge. We believe that Computerised 3D Interior Design Applications (CIDAs) could be a means to support more efficient, effective and collaborative practice. A previous study explored practitioners perceptions of using CIDAs; however it is important to ascertain older adult’s views about the usability of technology and to compare findings. This study explores the perceptions of community dwelling older adults with regards to adopting and using CIDAs as an assistive tool for the home adaptations process. Methods Ten community dwelling older adults participated in individual interactive task-focused usability sessions with a customised CIDA, utilising the think-aloud protocol and individual semi-structured interviews. Template analysis was used to carry out both deductive and inductive analysis of the think-aloud and interview data. Initially, a deductive stance was adopted, using the three pre-determined high-level themes of the technology acceptance model (TAM): Perceived Usefulness (PU), Perceived Ease of Use (PEOU), Actual Use (AU). Inductive template analysis was then carried out on the data within these themes, from which a number of sub-thmes emerged. Results Regarding PU, participants believed CIDAs served as a useful visual tool and saw clear potential to facilitate shared understanding and partnership in care delivery. For PEOU, participants were able to create 3D home environments however a number of usability issues must still be addressed. The AU theme revealed the most likely usage scenario would be collaborative involving both patient and practitioner, as many participants did not feel confident or see sufficient value in using the application autonomously. Conclusions This research found that older adults perceived that CIDAs were likely to serve as a valuable tool which facilitates and enhances levels of patient/practitioner collaboration and empowerment. Older adults also suggested a redesign of the interface so that less sophisticated dexterity and motor functions are required. However, older adults were not confident, or did not see sufficient value in using the application autonomously. Future research is needed to further customise the CIDA software, in line with the outcomes of this study, and to explore the potential of collaborative application patient/practitioner-based deployment.