Medicines optimisation for young people with juvenile arthritis and other long-term conditions:system-level barriers to engagement

To explore the views of pharmacy and rheumatology stakeholders about system-related barriers to medicines optimisation activities with young people with long-term conditions. A three-phase consensus-building study comprising (1) focus groups with community and hospital pharmacists; (2) semi-structured telephone interviews with lay and professional adolescent rheumatology stakeholders and pharmacy policymakers, and (3) multidisciplinary discussion groups with community and hospital pharmacists and rheumatology staff. Qualitative verbatim transcripts from phases 1 and 2 were subjected to framework analysis. Themes from phase 1 underpinned a briefing for phase 2 interviewees. Themes from phases 1 and 2 generated elements of good pharmacy practice and current/future pharmacy roles for ranking in phase 3. Results from phase 3 prioritisation and ranking exercises were captured on self-completion data collection forms, entered into an Excel spreadsheet and subjected to descriptive statistical analysis. Institutional ethical approval was given by Aston University Health and Life Sciences Research Ethics Committee. Four focus groups were conducted with 18 pharmacists across England, Scotland and Wales (7 hospital, 10 community and 1 community/public health). Fifteen stakeholders took part in telephone interviews (3 pharmacist commissioners; 2 pharmacist policymakers; 2 pharmacy staff members (1 community and 1 hospital); 4 rheumatologists; 1 specialist nurse, and 3 lay juvenile arthritis advocates). Twenty-five participants took part in three discussion groups in adolescent rheumatology centres across England and Scotland (9 community pharmacists; 4 hospital pharmacists; 6 rheumatologists; 5 specialist nurses, and 1 physiotherapist). In all phases of the study, system-level issues were acknowledged as barriers to more engagement with young people and families. Community pharmacists in the focus groups reported that opportunities for engaging with young people were low if parents collected prescriptions alone, which was agreed by other stakeholders. Moreover, institutional/company prescription collection policies – an activity largely disallowed for a young person under 16 without an accompanying parent - were identified by hospital and community pharmacists as barriers to open discussion and engagement. Few community pharmacists reported using Medicines Use Review (England/Wales) or Chronic Medication Service (Scotland) as a medicines optimisation activity with young people; many were unsure about consent procedures. Despite these limitations, rheumatology stakeholders ranked highly the potential of pharmacists empowering young people with general health care skills, such as repeat prescription ordering. The pharmacy profession lacks vision for its role in the care of young people with long-term conditions. Pharmacists and rheumatology stakeholders identified system-level barriers to more engagement with young people who take medicines regularly. We acknowledge that the modest number of participants may have had a specific interest and thus bias for the topic, but this underscores their frank admission of the challenges. Professional guidance and policy, practice frameworks and institutional/company policies must promote flexibility for pharmacy staff to recognise and empower young people who are able to give consent and take responsibility for medicines activities. This will increase mutual confidence and trust, and foster pharmacy’s role in teaching general health care skills. In this way, pharmacists will be able to build long-term relationships with young people and families.

Macro-level change and micro-level effects:a twenty year perspective on changing grocery shopping behaviour in Britain

In this paper we summarise key elements of retail change in Britain over a twenty-year period. The time period is that covered by a funded study into long-term change in grocery shopping habits in Portsmouth, England. The major empirical findings—to which we briefly allude—are reported elsewhere: the present task is to assess the wider context underlying that change. For example, it has frequently been stated that retailing in the UK is not as competitive as in other leading economies. As a result, the issue of consumer choice has become increasingly important politically. Concerns over concentration in the industry, new format development and market definition have been expressed by local planners, competition regulators and consumer groups. Macro level changes over time have also created market inequality in consumer opportunities at a local level—hence our decision to attempt a local-level study. Situational factors affecting consumer experiences over time at the local level involve the changing store choice sets available to particular consumers. Using actual consumer experiences thus becomes a yardstick for assessing the practical effectiveness of policy making. The paper demonstrates that choice at local level is driven by store use and that different levels of provision reflect real choice at the local level. Macro-level policy and ‘one size fits all’ approaches to regulation, it is argued, do not reflect the changing reality of grocery shopping. Accordingly, arguments for a more local and regional approach to regulation are made.

Establishing a framework for dynamic risk management in 'intelligent' aero-engine control

The behaviour of control functions in safety critical software systems is typically bounded to prevent the occurrence of known system level hazards. These bounds are typically derived through safety analyses and can be implemented through the use of necessary design features. However, the unpredictability of real world problems can result in changes in the operating context that may invalidate the behavioural bounds themselves, for example, unexpected hazardous operating contexts as a result of failures or degradation. For highly complex problems it may be infeasible to determine the precise desired behavioural bounds of a function that addresses or minimises risk for hazardous operation cases prior to deployment. This paper presents an overview of the safety challenges associated with such a problem and how such problems might be addressed. A self-management framework is proposed that performs on-line risk management. The features of the framework are shown in context of employing intelligent adaptive controllers operating within complex and highly dynamic problem domains such as Gas-Turbine Aero Engine control. Safety assurance arguments enabled by the framework necessary for certification are also outlined.

The Internet's unexploited path diversity

The connectivity of the Internet at the Autonomous System level is influenced by the network operator policies implemented. These in turn impose a direction to the announcement of address advertisements and, consequently, to the paths that can be used to reach back such destinations. We propose to use directed graphs to properly represent how destinations propagate through the Internet and the number of arc-disjoint paths to quantify this network's path diversity. Moreover, in order to understand the effects that policies have on the connectivity of the Internet, numerical analyses of the resulting directed graphs were conducted. Results demonstrate that, even after policies have been applied, there is still path diversity which the Border Gateway Protocol cannot currently exploit.

Parallel implementation of image segmentation algorithms on a network of transputers

Image segmentation is one of the most computationally intensive operations in image processing and computer vision. This is because a large volume of data is involved and many different features have to be extracted from the image data. This thesis is concerned with the investigation of practical issues related to the implementation of several classes of image segmentation algorithms on parallel architectures. The Transputer is used as the basic building block of hardware architectures and Occam is used as the programming language. The segmentation methods chosen for implementation are convolution, for edge-based segmentation; the Split and Merge algorithm for segmenting non-textured regions; and the Granlund method for segmentation of textured images. Three different convolution methods have been implemented. The direct method of convolution, carried out in the spatial domain, uses the array architecture. The other two methods, based on convolution in the frequency domain, require the use of the two-dimensional Fourier transform. Parallel implementations of two different Fast Fourier Transform algorithms have been developed, incorporating original solutions. For the Row-Column method the array architecture has been adopted, and for the Vector-Radix method, the pyramid architecture. The texture segmentation algorithm, for which a system-level design is given, demonstrates a further application of the Vector-Radix Fourier transform. A novel concurrent version of the quad-tree based Split and Merge algorithm has been implemented on the pyramid architecture. The performance of the developed parallel implementations is analysed. Many of the obtained speed-up and efficiency measures show values close to their respective theoretical maxima. Where appropriate comparisons are drawn between different implementations. The thesis concludes with comments on general issues related to the use of the Transputer system as a development tool for image processing applications; and on the issues related to the engineering of concurrent image processing applications.

Adaptive congestion control of DSRC vehicle networks for collaborative road safety applications

Congestion control is critical for the provisioning of quality of services (QoS) over dedicated short range communications (DSRC) vehicle networks for road safety applications. In this paper we propose a congestion control method for DSRC vehicle networks at road intersection, with the aims of providing high availability and low latency channels for high priority emergency safety applications while maximizing channel utilization for low priority routine safety applications. In this method a offline simulation based approach is used to find out the best possible configurations of message rate and MAC layer backoff exponent (BE) for a given number of vehicles equipped with DSRC radios. The identified best configurations are then used online by an roadside access point (AP) for system operation. Simulation results demonstrated that this adaptive method significantly outperforms the fixed control method under varying number of vehicles. The impact of estimation error on the number of vehicles in the network on system level performance is also investigated.

Network learning:Exploring learning by interorganizational networks

The importance of interorganizational networks in supporting or hindering the achievement of organizational objectives is now widely acknowledged. Network research is directed at understanding network processes and structures, and their impact upon performance. A key process is learning. The concepts of individual, group and organizational learning are long established. This article argues that learning might also usefully be regarded as occurring at a fourth system level, the interorganizational network. The concept of network learning - learning by a group of organizations as a group - is presented, and differentiated from other types of learning, notably interorganizational learning (learning in interorganizational contexts). Four cases of network learning are identified and analysed to provide insights into network learning processes and outcomes. It is proposed that 'network learning episode' offers a suitable unit of analysis for the empirical research needed to develop our understanding of this potentially important concept.

Modelling and simulation strategies for the electric systems of large passenger aircraft

The simulation of a power system such as the More Electric Aircraft is a complex problem. There are conflicting requirements of the simulation, for example in order to reduce simulation run-times, power ratings that need to be established over long periods of the flight can be calculated using a fairly coarse model, whereas power quality is established over relatively short periods with a detailed model. An important issue is to establish the requirements of the simulation work at an early stage. This paper describes the modelling and simulation strategy adopted for the UK TIMES project, which is looking into the optimisation of the More Electric Aircraft from a system level. Essentially four main requirements of the simulation work have been identified, resulting in four different types of simulation. Each of the simulations is described along with preliminary models and results.

Performance modelling and analysis of multiple coexisting IEEE 802.15.4 wireless sensor networks

With the features of low-power and flexible networking capabilities IEEE 802.15.4 has been widely regarded as one strong candidate of communication technologies for wireless sensor networks (WSNs). It is expected that with an increasing number of deployments of 802.15.4 based WSNs, multiple WSNs could coexist with full or partial overlap in residential or enterprise areas. As WSNs are usually deployed without coordination, the communication could meet significant degradation with the 802.15.4 channel access scheme, which has a large impact on system performance. In this thesis we are motivated to investigate the effectiveness of 802.15.4 networks supporting WSN applications with various environments, especially when hidden terminals are presented due to the uncoordinated coexistence problem. Both analytical models and system level simulators are developed to analyse the performance of the random access scheme specified by IEEE 802.15.4 medium access control (MAC) standard for several network scenarios. The first part of the thesis investigates the effectiveness of single 802.15.4 network supporting WSN applications. A Markov chain based analytic model is applied to model the MAC behaviour of IEEE 802.15.4 standard and a discrete event simulator is also developed to analyse the performance and verify the proposed analytical model. It is observed that 802.15.4 networks could sufficiently support most WSN applications with its various functionalities. After the investigation of single network, the uncoordinated coexistence problem of multiple 802.15.4 networks deployed with communication range fully or partially overlapped are investigated in the next part of the thesis. Both nonsleep and sleep modes are investigated with different channel conditions by analytic and simulation methods to obtain the comprehensive performance evaluation. It is found that the uncoordinated coexistence problem can significantly degrade the performance of 802.15.4 networks, which is unlikely to satisfy the QoS requirements for many WSN applications. The proposed analytic model is validated by simulations which could be used to obtain the optimal parameter setting before WSNs deployments to eliminate the interference risks.

Standing in front of bulldozers? Explaining policy stability in land use planning

Policy towards planning presents scholars of politics and public policy with a significant puzzle. Since 1947, there has been a surprising level of stability in the system used to plan the use of land. On the other hand, there has been growing evidence that insufficient land has been released for development. The paper considers the question why, in spite of the planning system demonstrably failing to allocate sufficient land, fundamental reform of the system has not been achieved. In answering the question, the paper considers in particular attempts at reform under the Labour governments from 1997 to 2010. It argues that there is an interplay of interests, ideas and institutions: public attitudes, the interests of certain sections of the population, and institutions which are responsive to these attitudes and interests combined to stymie policy reform. As a consequence, radical reform was not achieved, and the paper concludes that attempt to find a technical “fix” to the planning system are unlikely to succeed. A diagnosis recognising the political and distributive nature of the problem will be required.

Understanding policy implementation processes as self-organizing systems

Implementation studies and related research in organizational theory can be enhanced by drawing on the field of complex systems to understand better and, as a consequence, more successfully manage change. This article reinterprets data previously published in the British Journal of Management to reveal a new contribution, that policy implementation processes should be understood as a self-organizing system in which adaptive abilities are extremely important for stakeholders. In other words, national policy is reinterpreted at the local level, with each local organization uniquely mixing elements of national policy with their own requirements making policy implementation unpredictable and more sketchy. The original article explained different paces and directions of change in terms of traditional management processes: leadership, politics, implementation and vision. By reinterpreting the data, it is possible to reveal that deeper level processes, which are more emergent, are also at work influencing change, which the authors label possibility space. Implications for theory, policy and practice are identified.

An expert system for the development of a health and safety policy/risk assessment in the plastics industry

Health and safety policies may be regarded as the cornerstone for positive prevention of occupational accidents and diseases. The Health and Safety at Work, etc Act 1974 makes it a legal duty for employers to prepare and revise a written statement of a general policy with respect to the health and safety at work of employees as well as the organisation and arrangements for carrying out that policy. Despite their importance and the legal equipment to prepare them, health and safety policies have been found, in a large number of plastics processing companies (particularly small companies), to be poorly prepared, inadequately implemented and monitored. An important cause of these inadequacies is the lack of necessary health and safety knowledge and expertise to prepare, implement and monitor policies. One possible way of remedying this problem is to investigate the feasibility of using computers to develop expert system programs to simulate the health and safety (HS) experts' task of preparing the policies and assisting companies implement and monitor them. Such programs use artificial intelligence (AI) techniques to solve this sort of problems which are heuristic in nature and require symbolic reasoning. Expert systems have been used successfully in a variety of fields such as medicine and engineering. An important phase in the feasibility of development of such systems is the engineering of knowledge which consists of identifying the knowledge required, eliciting, structuring and representing it in an appropriate computer programming language.

A comparison of the vocational training system of Britain and West Germany as experienced by minimum-age school leavers.

The sectoral and occupational structure of Britain and West Germany has increasingly changed over the last fifty years from a manual manufacturing based to a non-manual service sector based one. There has been a trend towards more managerial and less menial type occupations. Britain employs a higher proportion of its population in the service sector than in manufacturing compared to West Germany, except in retailing, where West Germany employs twice as many people as Britain. This is a stable sector of the economy in terms of employment, but the requirements of the workforce have changed in line with changes in the industry in both countries. School leavers in the two countries, faced with the same options (FE, training schemes or employment) have opted for the various options in different proportions: young Germans are staying longer in education before embarking on training and young Britons are now less likely to go straight into employment than ten years ago. Training is becoming more accepted as the normal route into employment with government policy leading the way, but public opinion still slow to respond. This study investigates how vocational training has adapted to the changing requirements of industry, often determined by technological advancements. In some areas e.g. manufacturing industry the changes have been radical, in others such as retailing they have not, but skill requirements, not necessarily influenced by technology have changed. Social-communicative skills, frequently not even considered skills and therefore not included in training are coming to the forefront. Vocational training has adapted differently in the two countries: in West Germany on the basis of an established over-defined system and in Britain on the basis of an out-dated ill-defined and almost non-existent system. In retailing German school leavers opt for two or three year apprenticeships whereas British school leavers are offered employment with or without formalised training. The publicly held view of the occupation of sales assistant is one of low-level skill, low intellectual demands and a job anyone can do. The traditional skills - product knowledge, selling and social-communicative skills have steadily been eroded. In the last five years retailers have recognised that a return to customer service, utilising the traditional skills was going to be needed of their staff to remain competitive. This requires training. The German retail training system responded by adapting its training regulations in a long consultative process, whereas the British experimented with YTS, a formalised training scheme nationwide being a new departure. The thesis evaluates the changes in these regulations. The case studies in four retail outlets demonstrate that it is indeed product knowledge and selling and social-communicative skills which are fundamental to being a successful and content sales assistant in either country. When the skills are recognised and taught well and systematically the foundations for career development in retailing are laid in a labour market which is continually looking for better qualified workers. Training, when planned and conducted professionally is appreciated by staff and customers and of benefit to the company. In retailing not enough systematic training, to recognisable standards is carried out in Britain, whereas in West Germany the training system is nevertheless better prepared to show innovative potential as a structure and is in place on which to build. In Britain the reputation of the individual company has a greater role to play, not ensuring a national provision of good training in retailing.

Designing a safety management support system using open architecture databases: the requirements of information representation in the support of managers' risk-related decision-making

This research was conducted at the Space Research and Technology Centre o the European Space Agency at Noordvijk in the Netherlands. ESA is an international organisation that brings together a range of scientists, engineers and managers from 14 European member states. The motivation for the work was to enable decision-makers, in a culturally and technologically diverse organisation, to share information for the purpose of making decisions that are well informed about the risk-related aspects of the situations they seek to address. The research examined the use of decision support system DSS) technology to facilitate decision-making of this type. This involved identifying the technology available and its application to risk management. Decision-making is a complex activity that does not lend itself to exact measurement or precise understanding at a detailed level. In view of this, a prototype DSS was developed through which to understand the practical issues to be accommodated and to evaluate alternative approaches to supporting decision-making of this type. The problem of measuring the effect upon the quality of decisions has been approached through expert evaluation of the software developed. The practical orientation of this work was informed by a review of the relevant literature in decision-making, risk management, decision support and information technology. Communication and information technology unite the major the,es of this work. This allows correlation of the interests of the research with European public policy. The principles of communication were also considered in the topic of information visualisation - this emerging technology exploits flexible modes of human computer interaction (HCI) to improve the cognition of complex data. Risk management is itself an area characterised by complexity and risk visualisation is advocated for application in this field of endeavour. The thesis provides recommendations for future work in the fields of decision=making, DSS technology and risk management.