Lessons learnt about water use, harvesting, recycling and drainage

This Information Paper is the third in a four-part series that looks at the lessons learnt from the BRE Innovation Park concerning compliance with the Code for Sustainable Homes published in November 2006. It focuses on water use, harvesting, recycling and drainage. The other parts deal with: building fabric; energy sources, overheating and ventilation; architecture, construction and sourcing.

Developing government policies for distance education: lessons learnt from two Sri Lankan case studies

Education, especially higher education, is considered vital for maintaining national and individual competitiveness in the global knowledge economy. Following the introduction of its “Free Education Policy” as early as 1947, Sri Lanka is now the best performer in basic education in the South Asian region, with a remarkable record in terms of high literacy rates and the achievement of universal primary education. However, access to tertiary education is a bottleneck, due to an acute shortage of university places. In an attempt to address this problem, the government of Sri Lanka has invested heavily in information and communications technologies (ICTs) for distance education. Although this has resulted in some improvement, the authors of this article identify several barriers which are still impeding successful participation for the majority of Sri Lankans wanting to study at tertiary level. These impediments include the lack of infrastructure/resources, low English language proficiency, weak digital literacy, poor quality of materials and insufficient provision of student support. In the hope that future implementations of ICT-enabled education programmes can avoid repeating the mistakes identified by their research in this Sri Lankan case, the authors conclude their paper with a list of suggested policy options.

From projects into operations: lessons for data handover

Data from civil engineering projects can inform the operation of built infrastructure. This paper captures lessons for such data handover, from projects into operations, through interviews with leading clients and their supply chain. Clients are found to value receiving accurate and complete data. They recognise opportunities to use high quality information in decision-making about capital and operational expenditure; as well as in ensuring compliance with regulatory requirements. Providing this value to clients is a motivation for information management in projects. However, data handover is difficult as key people leave before project completion; and different data formats and structures are used in project delivery and operations. Lessons learnt from leading practice include defining data requirements at the outset, getting operations teams involved early, shaping the evolution of interoperable systems and standards, developing handover processes to check data rather than documentation, and fostering skills to use and update project data in operations

International public goods through integrated natural resources management research in CGIAR partnerships

The CGIAR System conducts research to produce international public goods (IPG) that are of wide applicability creating a scientific base which speeds and broadens local adaptive development. Integrated natural resources management (INRM) research is sometimes seen to be very location specific and consequently does not lend itself readily to the production of IPGs. In this paper we analyse ways in which strategic approaches to INRM research can have broad international applicability and serve as useful foundations for the development of locally adapted technologies. The paper describes the evolution of the IPG concept within the CGIAR and elaborates on five major types of IPGs that have been generated from a varied set of recent INRM research efforts. CGIAR networks have both strengths and weaknesses in INRM research and application, with enormous differences in relative research and development capacities, responsibilities and data access of its partners, making programme process evolution critical to acceptance and participation. Many of the lessons learnt regarding challenges and corresponding IPG research approaches are relevant to designing and managing future multi-scale, multi-locational, coordinated INRM programmes involving broad-based partnerships to address complex environmental and livelihood problems for development.

The business case development process in the delivery of NHS infrastructure

There is a lack of knowledge base in relation to experiences gained and lessons learnt from previously executed National Health Service (NHS) infrastructure projects in the UK. This is in part a feature of one-off construction projects, which typify healthcare infrastructure, and in part due to the absence of a suitable method for conveying such information. The complexity of infrastructure delivery process in the NHS makes the construction of healthcare buildings a formidable task. This is particularly the case for the NHS trusts who have little or no experience of construction projects. To facilitate understanding a most important aspect of the delivery process, which is the preparation of a capital investment proposal; steps taken in developing the business case for an NHS healthcare facility are examined. The context for such examination is provided by the planning process of a healthcare project, studied retrospectively. The process is analysed using a social science based method called ‘building stories’, developed at the University of California-Berkeley. By applying this method, stories or narratives are constructed around the data captured on the case study. The findings indicate that the business case process may be used to justify, rather than identify, trusts’ requirements. The study is useful for UK public sector clients as well as consultants and professionals who aim to participate in the delivery of healthcare infrastructure projects in the UK.

A Gentle/S approach to robot assisted neuro-rehabilitation

Movement disorders (MD) include a group of neurological disorders that involve neuromotor systems. MD can result in several abnormalities ranging from an inability to move, to severe constant and excessive movements. Strokes are a leading cause of disability affecting largely the older people worldwide. Traditional treatments rely on the use of physiotherapy that is partially based on theories and also heavily reliant on the therapists training and past experience. The lack of evidence to prove that one treatment is more effective than any other makes the rehabilitation of stroke patients a difficult task. UL motor re-learning and recovery levels tend to improve with intensive physiotherapy delivery. The need for conclusive evidence supporting one method over the other and the need to stimulate the stroke patient clearly suggest that traditional methods lack high motivational content, as well as objective standardised analytical methods for evaluating a patient's performance and assessment of therapy effectiveness. Despite all the advances in machine mediated therapies, there is still a need to improve therapy tools. This chapter describes a new approach to robot assisted neuro-rehabilitation for upper limb rehabilitation. Gentle/S introduces a new approach on the integration of appropriate haptic technologies to high quality virtual environments, so as to deliver challenging and meaningful therapies to people with upper limb impairment in consequence of a stroke. The described approach can enhance traditional therapy tools, provide therapy "on demand" and can present accurate objective measurements of a patient's progression. Our recent studies suggest the use of tele-presence and VR-based systems can potentially motivate patients to exercise for longer periods of time. Two identical prototypes have undergone extended clinical trials in the UK and Ireland with a cohort of 30 stroke subjects. From the lessons learnt with the Gentle/S approach, it is clear also that high quality therapy devices of this nature have a role in future delivery of stroke rehabilitation, and machine mediated therapies should be available to patient and his/her clinical team from initial hospital admission, through to long term placement in the patient's home following hospital discharge.

MOOC experience: a participant's reflection

In this article the author reflects on the experiences of three Massive Open Online Courses (MOOCs): Edfuture (CHFE), Learning Design for 21st Century Curriculum (OLDS-MOOC), and Open Education (H817). Discussion draws on the perceived differences between OERs and MOOCs and questions the definitions of 'success', 'engagement', 'completion', and 'drop out' in a MOOC. Some lessons learnt as a participant are also discussed.

Aspects of designing and evaluating seasonal-to-interannual Arctic sea-ice prediction systems

Using lessons from idealised predictability experiments, we discuss some issues and perspectives on the design of operational seasonal to inter-annual Arctic sea-ice prediction systems. We first review the opportunities to use a hierarchy of different types of experiment to learn about the predictability of Arctic climate. We also examine key issues for ensemble system design, such as: measuring skill, the role of ensemble size and generation of ensemble members. When assessing the potential skill of a set of prediction experiments, using more than one metric is essential as different choices can significantly alter conclusions about the presence or lack of skill. We find that increasing both the number of hindcasts and ensemble size is important for reliably assessing the correlation and expected error in forecasts. For other metrics, such as dispersion, increasing ensemble size is most important. Probabilistic measures of skill can also provide useful information about the reliability of forecasts. In addition, various methods for generating the different ensemble members are tested. The range of techniques can produce surprisingly different ensemble spread characteristics. The lessons learnt should help inform the design of future operational prediction systems.

The global-scale impacts of climate change: the QUEST-GSI project

This paper introduces the special issue of Climatic Change on the QUEST-GSI project, a global-scale multi-sectoral assessment of the impacts of climate change. The project used multiple climate models to characterise plausible climate futures with consistent baseline climate and socio-economic data and consistent assumptions, together with a suite of global-scale sectoral impacts models. It estimated impacts across sectors under specific SRES emissions scenarios, and also constructed functions relating impact to change in global mean surface temperature. This paper summarises the objectives of the project and its overall methodology, outlines how the project approach has been used in subsequent policy-relevant assessments of future climate change under different emissions futures, and summarises the general lessons learnt in the project about model validation and the presentation of multi-sector, multi-region impact assessments and their associated uncertainties to different audiences.

Intra-tumor heterogeneity: lessons from microbial evolution and clinical implications

Multiple subclonal populations of tumor cells can coexist within the same tumor. This intra-tumor heterogeneity will have clinical implications and it is therefore important to identify factors that drive or suppress such heterogeneous tumor progression. Evolutionary biology can provide important insights into this process. In particular, experimental evolution studies of microbial populations, which exist as clonal populations that can diversify into multiple subclones, have revealed important evolutionary processes driving heterogeneity within a population. There are transferrable lessons that can be learnt from these studies that will help us to understand the process of intra-tumor heterogeneity in the clinical setting. In this review, we summarize drivers of microbial diversity that have been identified, such as mutation rate and environmental influences, and discuss how knowledge gained from microbial experimental evolution studies may guide us to identify and understand important selective factors that promote intra-tumor heterogeneity. Furthermore, we discuss how these factors could be used to direct and optimize research efforts to improve patient care, focusing on therapeutic resistance. Finally, we emphasize the need for longitudinal studies to address the impact of these potential tumor heterogeneity-promoting factors on drug resistance, metastatic potential and clinical outcome.

Errors associated with the preparation of aseptic products in UK hospital pharmacies: lessons from the national aseptic error reporting scheme

Background Pharmacy aseptic units prepare and supply injectables to minimise risks. The UK National Aseptic Error Reporting Scheme has been collecting data on pharmacy compounding errors, including near-misses, since 2003. Objectives The cumulative reports from January 2004 to December 2007, inclusive, were analysed. Methods The different variables of product types, error types, staff making and detecting errors, stage errors detected, perceived contributory factors, and potential or actual outcomes were presented by cross-tabulation of data. Results A total of 4691 reports were submitted against an estimated 958 532 items made, returning 0.49% as the overall error rate. Most of the errors were detected before reaching patients, with only 24 detected during or after administration. The highest number of reports related to adult cytotoxic preparations (40%) and the most frequently recorded error was a labelling error (34.2%). Errors were mostly detected at first check in assembly area (46.6%). Individual staff error contributed most (78.1%) to overall errors, while errors with paediatric parenteral nutrition appeared to be blamed on low staff levels more than other products were. The majority of errors (68.6%) had no potential patient outcomes attached, while it appeared that paediatric cytotoxic products and paediatric parenteral nutrition were associated with greater levels of perceived patient harm. Conclusions The majority of reports were related to near-misses, and this study highlights scope for examining current arrangements for checking and releasing products, certainly for paediatric cytotoxic and paediatric parenteral nutrition preparations within aseptic units, but in the context of resource and capacity constraints.