Transforming the English NHS using information technology: the story so far

The use of information and communication technologies (ICT) for transforming the way publicservices are delivered, has been an area of investment and focus in many countries in recentyears. The UK government envisioned moving from e-Government to transformationalgovernment by 2008, and initiatives such as the National Programme for IT (NPfIT) wereunderway towards this end. NPfIT was the largest civil IT programme worldwide at an initialestimated cost of £12.4bn over a ten-year period. It was launched in 2002 by the UKgovernment as part of its policy to transform the English NHS and to implement standardised ITsolutions at a national level. However, this top down, government led approach came underincreasing scrutiny, and is now being reconfigured towards a more decentralised mode of operations. This paper looks into the implementation of NPfIT and analyses the reasons behindits failure, and what effect the new NHS reforms are likely to have on the health sector. Wedraw from past studies (Weill and Ross, 2005) to highlight the key areas of concern in ITgovernance, using the NPfIT as an illustration

Story telling in sustainable development projects

This paper constitutes an attempt to find a means to represent multiple stories in the strong narrative of conventional sustainable development (SD) projects. The authors' experience of such projects in various parts of the world indicates that they have a tendency to arise from and reflect a dominant mindset, placing the SD project in what can be a working environment that is inimical to the very ideals that SD is supposed to represent. Short-termism and value for money drive project formats and objectives, whilst counter-narratives and alternative stories arising from stakeholders in such projects are often ignored. Yet these alternative threads often contain strong SD messages of their own and could, if effectively utilized, enhance the SD project process. This paper sets out the case for a new field - 'project ethnography' - allied with the growing use of meta-analysis to compare project 'stories'. The analytical model applied to compare projects is based on the Kolb learning cycle and involves a (3 X 4)-fold questioning of project conceptual ization and roll-out. Copyright @ 2oo6 John Wiley & Sons, Ltd and ERP Environment.

Illustration of micro-scale advection using grid-pattern mini-lysimeters

Twenty-five small soil-filled perspex boxes arranged in a square, with dwarf sunflowers growing in them, were used to study micro-scale advection. Hydrological heterogeneity was introduced by applying two different amounts of irrigation water (low-irrigation, L, versus high-irrigation, H). The nine central boxes (4 H, 4 L and I bare box) were precision weighing lysimeters, yielding diurnal measurements of evaporation. After the onset of soil water stress, a large difference in latent heat flux (up to 4-fold) was observed between the lysimeters of the H and L treatments, mainly caused by large differences between H and L stomatal conductance values. This resulted in micro-advection, causing H soil-sunflower systems to evaporate well above equilibrium latent heat flux. The occurrence of micro-advective enhancement was reflected in large values of the Priestley-Taylor constant (often larger than 2.0) and generally negative values of sensible heat flux for the H treatment. (c) 2005 Elsevier B.V. All rights reserved.

Putting the pieces back together again: an illustration of the problem of interpreting development indicators using an African case study

Indicators are commonly recommended as tools for assessing the attainment of development, and the current vogue is for aggregating a number of indicators together into a single index. It is claimed that such indices of development help facilitate maximum impact in policy terms by appealing to those who may not necessarily have technical expertise in data collection, analysis and interpretation. In order to help counter criticisms of over-simplification, those advocating such indices also suggest that the raw data be provided so as to allow disaggregation into component parts and hence facilitate a more subtle interpretation if a reader so desires. This paper examines the problems involved with interpreting indices of development by focusing on the United Nations Development Programmes (UNDP) Human Development Index (HDI) published each year in the Human Development Reports (HDRs). The HDI was intended to provide an alternative to the more economic based indices, such as GDP, commonly used within neo-liberal development agendas. The paper explores the use of the HDI as a gauge of human development by making comparisons between two major political and economic communities in Africa (ECOWAS and SADC). While the HDI did help highlight important changes in human development as expressed by the HDI over 10 years, it is concluded that the HDI and its components are difficult to interpret as methodologies have changed significantly and the 'averaging' nature of the HDI could hide information unless care is taken. The paper discusses the applicability of alternative models to the HDI such as the more neo-populist centred methods commonly advocated for indicators of sustainable development. (C) 2003 Elsevier Ltd. All rights reserved.

Autopoietic organization of firm: an illustration for the construction industry

Generally poor productivity, delays, low profitability and exceeded budgets are Common problems in modern construction management, however it seems that a basic obstacle lies far deeper in the understanding of a firm's fundamental mission, its existence. The main objective of this paper therefore is to examine the operational living of a construction firm and by doing that to reveal the key problem or the solution for a construction firm - its organization. A firm as a social system in which interactions between its constitutive components (employees) are surordinated to its maintenance (keeping a system alive) is an autopoietic social system. Two domains of external perturbations are uncovered to which a construction firm has to adapt (market driven and project driven perturbations). Constructed conceptual model of an autopoietic organization is based upon two necessary and sufficient operational domains that a firm has to create in order to become an autopoietic, adaptive social system. The first one is a domain of interactions between employees and other operationally external systems, which is representing an idea-generating domain of interactions. The second is employee's autonomous operational domain, which embodies employee's autonomy and individuality and represents a necessary condition for the establishment of an idea-generating domain. Finally, it is recognized that interactions within these four domains keep a construction firm alive.

Use and abuse of mathematical models: an illustration from the 2001 foot and mouth disease epidemic in the United Kingdom

Foot and mouth disease (FMD) is a major threat, not only to countries whose economies rely on agricultural exports, but also to industrialised countries that maintain a healthy domestic livestock industry by eliminating major infectious diseases from their livestock populations. Traditional methods of controlling diseases such as FMD require the rapid detection and slaughter of infected animals, and any susceptible animals with which they may have been in contact, either directly or indirectly. During the 2001 epidemic of FMD in the United Kingdom (UK), this approach was supplemented by a culling policy driven by unvalidated predictive models. The epidemic and its control resulted in the death of approximately ten million animals, public disgust with the magnitude of the slaughter, and political resolve to adopt alternative options, notably including vaccination, to control any future epidemics. The UK experience provides a salutary warning of how models can be abused in the interests of scientific opportunism.

Productivity change in Polish agriculture: an illustration of a bootstrapping procedure applied to Malmquist indices

This article illustrates the usefulness of applying bootstrap procedures to total factor productivity Malmquist indices, derived with data envelopment analysis (DEA), for a sample of 250 Polish farms during 1996-2000. The confidence intervals constructed as in Simar and Wilson suggest that the common portrayal of productivity decline in Polish agriculture may be misleading. However, a cluster analysis based on bootstrap confidence intervals reveals that important policy conclusions can be drawn regarding productivity enhancement.

Formulating generalised 'goal games' against nature: An illustration from decision-making under uncertainty in agriculture

The games-against-nature approach to the analysis of uncertainty in decision-making relies on the assumption that the behaviour of a decision-maker can be explained by concepts such as maximin, minimax regret, or a similarly defined criterion. In reality, however, these criteria represent a spectrum and, the actual behaviour of a decision-maker is most likely to embody a mixture of such idealisations. This paper proposes that in game-theoretic approach to decision-making under uncertainty, a more realistic representation of a decision-maker's behaviour can be achieved by synthesising games-against-nature with goal programming into a single framework. The proposed formulation is illustrated by using a well-known example from the literature on mathematical programming models for agricultural-decision-making. (c) 2005 Elsevier Inc. All rights reserved.

An illustration of the modelling of cost and efficacy data from a clinical trial

Health care providers, purchasers and policy makers need to make informed decisions regarding the provision of cost-effective care. When a new health care intervention is to be compared with the current standard, an economic evaluation alongside an evaluation of health benefits provides useful information for the decision making process. We consider the information on cost-effectiveness which arises from an individual clinical trial comparing the two interventions. Recent methods for conducting a cost-effectiveness analysis for a clinical trial have focused on the net benefit parameter. The net benefit parameter, a function of costs and health benefits, is positive if the new intervention is cost-effective compared with the standard. In this paper we describe frequentist and Bayesian approaches to cost-effectiveness analysis which have been suggested in the literature and apply them to data from a clinical trial comparing laparoscopic surgery with open mesh surgery for the repair of inguinal hernias. We extend the Bayesian model to allow the total cost to be divided into a number of different components. The advantages and disadvantages of the different approaches are discussed. In January 2001, NICE issued guidance on the type of surgery to be used for inguinal hernia repair. We discuss our example in the light of this information. Copyright © 2003 John Wiley & Sons, Ltd.

The cyclopropene pyrolysis story

Cyclopropene is the last of the small strained ring hydrocarbons to have its thermal decomposition subjected to intensive investigation. This critical review describes the nearly 40 year history of this investigation largely by gas kinetic methods with chromatographic analysis. These studies have revealed that cyclopropenes can decompose by a variety of mechanisms involving diradicals, vinylcarbenes and vinylidenes. Much detailed information has been obtained about the reactivity of these intermediates which has wider implications for thermal hydrocarbon pyrolysis. Theory has also played a important role. Cyclopropene itself has been shown to be an intermediate in the allene A propyne rearrangement. The story itself illustrates how the evolution of mechanistic understanding has been anything but straightforward. (68 references.).