Challenges of UK/Irish Contractors Regarding Material Management and Logistics in Confined Site Construction

The aim of this paper is to identify the various managerial issues encountered by UK/Irish contractors in the management of materials in confined urban construction sites. Through extensive literature review, detailed interviews, case studies, cognitive mapping, causal loop diagrams, questionnaire survey and documenting severity indices, a comprehensive insight into the materials management concerns within a confined construction site environment is envisaged and portrayed. The leading issues highlighted are: that contractors’ material spatial requirements exceed available space, it is difficult to coordinate the storage of materials in line with the programme, location of the site entrance makes delivery of materials particularly difficult, it is difficult to store materials on-site due to the lack of space, and difficult to coordinate the storage requirements of the various sub-contractors. With the continued development of confined urban centres and the increasing high cost of materials, any marginal savings made on-site would translate into significant monetary savings at project completion. Such savings would give developers a distinct competitive advantage in this challenging economic climate. As on-site management professionals successfully identify, acknowledge and counteract the numerous issues illustrated, the successful management of materials on a confined urban construction site becomes attainable.

Bedside application of the Neonatal Facial Coding System in pain assessment of premature neonates

Assessment of infant pain is a pressing concern, especially within the context of neonatal intensive care where infants may be exposed to prolonged and repeated pain during lengthy hospitalization. In the present study the feasibility of carrying out the complete Neonatal Facial Coding System (NFCS) in real time at bedside, specifically reliability, construct and concurrent validity, was evaluated in a tertiary level Neonatal Intensive Care Unit (NICU). Heel lance was used as a model of procedural pain, and observed with n = 40 infants at 32 weeks gestational age. Infant sleep/wake state, NFCS facial activity and specific hand movements were coded during baseline, unwrap, swab, heel lance, squeezing and recovery events. Heart rate was recorded continuously and digitally sampled using a custom designed computer system. Repeated measures analysis of variance (ANOVA) showed statistically significant differences across events for facial activity (P <0.0001) and heart rate (P <0.0001). Planned comparisons showed facial activity unchanged during baseline, swab and unwrap, then increased significantly during heel lance (P <0.0001), increased further during squeezing (P <0.003), then decreased during recovery (P <0.0001). Systematic shifts in sleep/wake state were apparent. Rise in facial activity was consistent with increased heart rate, except that facial activity more closely paralleled initiation of the invasive event. Thus facial display was more specific to tissue damage compared with heart rate. Inter-observer reliability was high. Construct validity of the NFCS at bedside was demonstrated as invasive procedures were distinguished from tactile. While bedside coding of behavior does not permit raters to be blind to events, mechanical recording of heart rate allowed for an independent source of concurrent validation for bedside application of the NFCS scale.

Quality Management and Managerialism in Healthcare:: A Critical Historical Survey

Quality Management and Managerialism in Healthcare creates a comprehensive and systematic international survey of various perspectives on healthcare quality management together with some of their most pertinent critiques. Chapter one starts with a general discussion of the factors that drove the introduction of management paradigms into public sector and health management contexts in the mid to late 1980s. Chapter two explores the rise of risk awareness in medicine; which, prior to the 1980s, stood largely in isolation to the implementation of managerial performance targets. Chapter three investigates the widespread adoption of performance management and clinical governance frameworks during the 1980s and 1990s. This is followed by Chapters four and five which examine systems based models of patient safety and the evidence-based medicine movement as exemplars of managerial perspectives on healthcare quality. Chapter six discusses potential future avenues for the development of alternative perspectives on quality of care which emphasise workforce involvement. The book concludes by reviewing the factors which have underpinned the managerialist trajectory of healthcare management over the past decades and explores the potential impact of nascent technologies such as 'connected health' and 'telehealth' on future developments.

European Cystic Fibrosis Society Standards of Care: Quality Management in cystic fibrosis

Since the earliest days of cystic fibrosis (CF) treatment, patient data have been recorded and reviewed in order to identify the factors that lead to more favourable outcomes. Large data repositories, such as the US Cystic Fibrosis Registry, which was established in the 1960s, enabled successful treatments and patient outcomes to be recognized and improvement programmes to be implemented in specialist CF centres. Over the past decades, the greater volumes of data becoming available through Centre databases and patient registries led to the possibility of making comparisons between different therapies, approaches to care and indeed data recording. The quality of care for individuals with CF has become a focus at several levels: patient, centre, regional, national and international. This paper reviews the quality management and improvement issues at each of these levels with particular reference to indicators of health, the role of CF Centres, regional networks, national health policy, and international data registration and comparisons. 

HpMC: An Energy- Aware Management System for Multi-Level Memory Architectures

DRAM technology faces density and power challenges to increase capacity because of limitations of physical cell design. To overcome these limitations, system designers are exploring alternative solutions that combine DRAM and emerging NVRAM technologies. Previous work on heterogeneous memories focuses, mainly, on two system designs: PCache, a hierarchical, inclusive memory system, and HRank, a flat, non-inclusive memory system. We demonstrate that neither of these designs can universally achieve high performance and energy efficiency across a suite of HPC workloads. In this work, we investigate the impact of a number of multilevel memory designs on the performance, power, and energy consumption of applications. To achieve this goal and overcome the limited number of available tools to study heterogeneous memories, we created HMsim, an infrastructure that enables n-level, heterogeneous memory studies by leveraging existing memory simulators. We, then, propose HpMC, a new memory controller design that combines the best aspects of existing management policies to improve performance and energy. Our energy-aware memory management system dynamically switches between PCache and HRank based on the temporal locality of applications. Our results show that HpMC reduces energy consumption from 13% to 45% compared to PCache and HRank, while providing the same bandwidth and higher capacity than a conventional DRAM system.

Hierarchical energy management system for multi-source multi-product microgrids

This paper proposes a hierarchical energy management system for multi-source multi-product (MSMP) microgrids. Traditional energy hub based scheduling method is combined with a hierarchical control structure to incorporate transient characteristics of natural gas flow and dynamics of energy converters in microgrids. The hierarchical EMS includes a supervisory control layer, an optimizing control layer, and an execution control layer. In order to efficiently accommodate the systems multi time-scale characteristics, the optimizing control layer is decomposed into three sub-layers: slow, medium and fast. Thermal, gas and electrical management systems are integrated into the slow, medium, and fast control layer, respectively. Compared with wind energy, solar energy is easier to integrate and more suitable for the microgrid environment, therefore, potential impacts of the hierarchical EMS on MSMP microgrids is investigated based on a building energy system integrating photovoltaic and microturbines. Numerical studies indicate that by using a hierarchical EMS, MSMP microgrids can be economically operated. Also, interactions among thermal, gas, and electrical system can be effectively managed.

Qualidade em saúde: que trajetos de formação dos enfermeiros?

ENQUADRAMENTO: A avaliação da qualidade dos serviços de saúde, a crescente melhoria do desempenho dos profissionais, e a monitorização sistemática das atividades desenvolvidas pelas instituições de saúde, potenciam a qualidade dos cuidados prestados. A intervenção dos enfermeiros e dos restantes profissionais de saúde é imprescindível na promoção desta qualidade conforme defendem os diversos modelos da sua gestão. Para a generalidade destes, considera-se que a supervisão clínica em enfermagem e a formação dos profissionais são ferramentas de eleição para a promoção da excelência clínica. OBJETIVO: Analisar as principais dimensões a considerar num processo de supervisão e formação para a avaliação e acreditação da qualidade duma instituição hospitalar, numa perspetiva ecológica. MÉTODO: Trata-se de um estudo de caso que abrange uma unidade de cuidados de um hospital. Para a colheita de dados recorreu-se a um conjunto de técnicas e instrumentos, entre as quais a observação participante, entrevistas semiestruturadas e um questionário, aplicados aos enfermeiros dessa unidade. A informação obtida foi submetida à análise qualitativa e quantitativa, com recurso aos programas NUD*IST QSR N6 e SPSS 17, respetivamente. RESULTADOS E DISCUSSÃO: Os resultados obtidos permitiram caracterizar quatro dimensões: i) Processos de qualidade; ii) Práticas supervisivas; iii) Formação em contexto de trabalho; e iv) Relações interpessoais. A partir destas compreendeu-se que a acreditação deve ser um processo contínuo e documentado da análise das atividades de enfermagem, visando a realização de mudanças nos processos de gestão, na orientação das atividades de aperfeiçoamento dos recursos humanos, na pesquisa de respostas às dificuldades no ato de cuidar enfrentadas e identificadas, e nas atividades administrativas ligadas às modificações de processos assistenciais e de gestão. O cruzamento dos dados com os referenciais teóricos veio corroborar a importância da implementação de um processo de gestão de qualidade para os cuidados de enfermagem, num hospital, onde são decisivos os processos supervisivos e formativos, assim como se tornou emergente atender-se às relações interpessoais nas equipas.

Avaliação da Implementação de um Sistema de Gestão da Qualidade num Centro de Formação Profissional

Relatório de estágio de mestrado, Ciências da Educação (Especialização em Avaliação em Educação), Universidade de Lisboa, Instituto de Educação, 2015