Articulating current service development practices: a qualitative analysis of eleven mental health projects.

BACKGROUND: The utilisation of good design practices in the development of complex health services is essential to improving quality. Healthcare organisations, however, are often seriously out of step with modern design thinking and practice. As a starting point to encourage the uptake of good design practices, it is important to understand the context of their intended use. This study aims to do that by articulating current health service development practices. METHODS: Eleven service development projects carried out in a large mental health service were investigated through in-depth interviews with six operation managers. The critical decision method in conjunction with diagrammatic elicitation was used to capture descriptions of these projects. Stage-gate design models were then formed to visually articulate, classify and characterise different service development practices. RESULTS: Projects were grouped into three categories according to design process patterns: new service introduction and service integration; service improvement; service closure. Three common design stages: problem exploration, idea generation and solution evaluation - were then compared across the design process patterns. Consistent across projects were a top-down, policy-driven approach to exploration, underexploited idea generation and implementation-based evaluation. CONCLUSIONS: This study provides insight into where and how good design practices can contribute to the improvement of current service development practices. Specifically, the following suggestions for future service development practices are made: genuine user needs analysis for exploration; divergent thinking and innovative culture for idea generation; and fail-safe evaluation prior to implementation. Better training for managers through partnership working with design experts and researchers could be beneficial.

Is UK Planning a Barrier to Energy Efficient Heritage Retrofit: A Comparative Analysis of a Selection of London Boroughs

This paper is part of a larger PhD research project examining the apparent conflict in UK planning between energy efficiency and conservation for the retrofit of the thermal envelope of the existing building stock. Review of the literature shows that the UK will not meet its 2050 emission reduction target without substantial improvement to the energy performance of the thermal envelope of the existing building stock and that significantly, 40% of the existing stock has heritage status and may be exempted from Building Regulations. A review of UK policy and legislation shows that there are clear national priorities towards reducing emissions and addressing climate change, yet also shows a movement towards local decision making and control. This paper compares the current status of thirteen London Boroughs in respect to their position on thermal envelope retrofit for heritage and traditionally constructed buildings. Data collection is through ongoing surveys and interviews that compare statistical data, planning policies, sustainability and environmental priorities, and Officer decision-making. This paper finds that there is a lack of consistency in application of planning policy across Boroughs and suggests that this is a barrier to the up-take of energy efficient retrofit. Various recommendations are suggested at both national and local level which could help UK planning and planning officers deliver more energy efficient heritage retrofits.

The adoption of sustainable remediation behaviour in the US and UK: a cross country comparison and determinant analysis.

The sustainable remediation concept, aimed at maximizing the net environmental, social, and economic benefits in contaminated site remediation, is being increasingly recognized by industry, governments, and academia. However, there is limited understanding of actual sustainable behaviour being adopted and the determinants of such sustainable behaviour. The present study identified 27 sustainable practices in remediation. An online questionnaire survey was used to rank and compare them in the US (n=112) and the UK (n=54). The study also rated ten promoting factors, nine barriers, and 17 types of stakeholders' influences. Subsequently, factor analysis and general linear models were used to determine the effects of internal characteristics (i.e. country, organizational characteristics, professional role, personal experience and belief) and external forces (i.e. promoting factors, barriers, and stakeholder influences). It was found that US and UK practitioners adopted many sustainable practices to similar extents. Both US and UK practitioners perceived the most effectively adopted sustainable practices to be reducing the risk to site workers, protecting groundwater and surface water, and reducing the risk to the local community. Comparing the two countries, we found that the US adopted innovative in-situ remediation more effectively; while the UK adopted reuse, recycling, and minimizing material usage more effectively. As for the overall determinants of sustainable remediation, the country of origin was found not to be a significant determinant. Instead, organizational policy was found to be the most important internal characteristic. It had a significant positive effect on reducing distant environmental impact, sustainable resource usage, and reducing remediation cost and time (p<0.01). Customer competitive pressure was found to be the most extensively significant external force. In comparison, perceived stakeholder influence, especially that of primary stakeholders (site owner, regulator, and primary consultant), did not appear to have as extensive a correlation with the adoption of sustainability as one would expect.

The temporal and spatial evaluation on China's agricultural policy output since 1978

Since reform and opening up, how much contribution has China's implementation of new agricultural policy made to agricultural output? This paper is trying to establish an agricultural policy output econometric model for doing a quantitative analysis of China's new agricultural policy. The results show that China's agricultural policies on agricultural output have an average contribution rate of about 7% since 1978, which is consistent with the OECD's basic forecast. There are obvious temporal and spatial differences. Generally speaking, we can divide the contribution of agricultural policy into three periods, which are the start-up phase from 1978 to 1991 (14 years), the stationary phase from 1992 to 2002 (11 years) and the rising phase from 2003 to 2008 (6 years). In space, the contribution of agricultural policy underwent a process from the all-low in the start-up phase, the gradual increase in the stationary phase to the all-high in the rising phase. Northern and western regions are more sensitive to policies. There are three major factors that can affect the contribution of regional agricultural policies, which are the process of national industrialization strategy, terrain and the level of local finance.

Accelerated partial irradiation for breast cancer: Systematic review and meta-analysis of 8653 women in eight randomized trials

Background and purpose: Accelerated partial breast irradiation (APBI) is the strategy that allows adjuvant treatment delivery in a shorter period of time in smaller volumes. This study was undertaken to assess the effectiveness and outcomes of APBI in breast cancer compared with whole-breast irradiation (WBI). Material and methods: Systematic review and meta-analysis of randomized controlled trials of WBI versus APBI. Two authors independently selected and assessed the studies regarding eligibility criteria. Results: Eight studies were selected. A total of 8653 patients were randomly assigned for WBI versus APBI. Six studies reported local recurrence outcomes. Two studies were matched in 5 years and only one study for different time of follow-up. Meta-analysis of two trials assessing 1407 participants showed significant difference in the WBI versus APBI group regarding the 5-year local recurrence rate (HR = 4.54, 95% CI: 1.78-11.61, p = 0.002). Significant difference in favor of WBI for different follow-up times was also found. No differences in nodal recurrence, systemic recurrence, overall survival and mortality rates were observed. Conclusions: APBI is associated with higher local recurrence compared to WBI without compromising other clinical outcomes. (C) 2014 Elsevier Ireland Ltd. All rights reserved.

Training needs analysis of healthcare library staff, undertaken for South Yorkshire Workforce Development Confederation

Urquhart, C., Durbin, J. & Spink, S. (2004). Training needs analysis of healthcare library staff, undertaken for South Yorkshire Workforce Development Confederation. Aberystwyth: Department of Information Studies, University of Wales Aberystwyth. Sponsorship: South Yorkshire WDC (NHS)

Entrepreneurship and rural economic development: a scenario analysis approach

Fuller-Love, N., Midmore, P., Thomas, D., Henley, A. (2006). Entrepreneurship and rural economic development: A scenario analysis approach. International Journal of Entrepreneurial Behaviour and Research, 12 (5), 289-305. RAE2008

No Muslims Allowed? An analysis of the State of Pluralism in the West

Dissertação de Mestrado apresentada à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Relações Internacionais com o Mundo Árabe e Islâmico.

Preserving Bandwidth Using A Lazy Packet Discard Policy in ATM Networks

A number of recent studies have pointed out that TCP's performance over ATM networks tends to suffer, especially under congestion and switch buffer limitations. Switch-level enhancements and link-level flow control have been proposed to improve TCP's performance in ATM networks. Selective Cell Discard (SCD) and Early Packet Discard (EPD) ensure that partial packets are discarded from the network "as early as possible", thus reducing wasted bandwidth. While such techniques improve the achievable throughput, their effectiveness tends to degrade in multi-hop networks. In this paper, we introduce Lazy Packet Discard (LPD), an AAL-level enhancement that improves effective throughput, reduces response time, and minimizes wasted bandwidth for TCP/IP over ATM. In contrast to the SCD and EPD policies, LPD delays as much as possible the removal from the network of cells belonging to a partially communicated packet. We outline the implementation of LPD and show the performance advantage of TCP/LPD, compared to plain TCP and TCP/EPD through analysis and simulations.

An Adaptive Policy Management Approach to BGP Convergence

The Border Gateway Protocol (BGP) is the current inter-domain routing protocol used to exchange reachability information between Autonomous Systems (ASes) in the Internet. BGP supports policy-based routing which allows each AS to independently adopt a set of local policies that specify which routes it accepts and advertises from/to other networks, as well as which route it prefers when more than one route becomes available. However, independently chosen local policies may cause global conflicts, which result in protocol divergence. In this paper, we propose a new algorithm, called Adaptive Policy Management Scheme (APMS), to resolve policy conflicts in a distributed manner. Akin to distributed feedback control systems, each AS independently classifies the state of the network as either conflict-free or potentially-conflicting by observing its local history only (namely, route flaps). Based on the degree of measured conflicts (policy conflict-avoidance vs. -control mode), each AS dynamically adjusts its own path preferences—increasing its preference for observably stable paths over flapping paths. APMS also includes a mechanism to distinguish route flaps due to topology changes, so as not to confuse them with those due to policy conflicts. A correctness and convergence analysis of APMS based on the substability property of chosen paths is presented. Implementation in the SSF network simulator is performed, and simulation results for different performance metrics are presented. The metrics capture the dynamic performance (in terms of instantaneous throughput, delay, routing load, etc.) of APMS and other competing solutions, thus exposing the often neglected aspects of performance.

An Adaptive Management Approach to Resolving Policy Conflicts

The Border Gateway Protocol (BGP) is the current inter-domain routing protocol used to exchange reachability information between Autonomous Systems (ASes) in the Internet. BGP supports policy-based routing which allows each AS to independently define a set of local policies on which routes it accepts and advertises from/to other networks, as well as on which route it prefers when more than one route becomes available. However, independently chosen local policies may cause global conflicts, which result in protocol divergence. In this paper, we propose a new algorithm, called Adaptive Policy Management Scheme(APMS), to resolve policy conflicts in a distributed manner. Akin to distributed feedback control systems, each AS independently classifies the state of the network as either conflict-free or potentially conflicting by observing its local history only (namely, route flaps). Based on the degree of measured conflicts, each AS dynamically adjusts its own path preferences---increasing its preference for observably stable paths over flapping paths. APMS also includes a mechanism to distinguish route flaps due to topology changes, so as not to confuse them with those due to policy conflicts. A correctness and convergence analysis of APMS based on the sub-stability property of chosen paths is presented. Implementation in the SSF network simulator is performed, and simulation results for different performance metrics are presented. The metrics capture the dynamic performance (in terms of instantaneous throughput, delay, etc.) of APMS and other competing solutions, thus exposing the often neglected aspects of performance.

Compilation and analysis of integrated regional input-output tables for NUTS 2 regions in Ireland

In 1966, Roy Geary, Director of the ESRI, noted “the absence of any kind of import and export statistics for regions is a grave lacuna” and further noted that if regional analyses were to be developed then regional Input-Output Tables must be put on the “regular statistical assembly line”. Forty-five years later, the lacuna lamented by Geary still exists and remains the most significant challenge to the construction of regional Input-Output Tables in Ireland. The continued paucity of sufficient regional data to compile effective regional Supply and Use and Input-Output Tables has retarded the capacity to construct sound regional economic models and provide a robust evidence base with which to formulate and assess regional policy. This study makes a first step towards addressing this gap by presenting the first set of fully integrated, symmetric, Supply and Use and domestic Input-Output Tables compiled for the NUTS 2 regions in Ireland: The Border, Midland and Western region and the Southern & Eastern region. These tables are general purpose in nature and are consistent fully with the official national Supply & Use and Input-Output Tables, and the regional accounts. The tables are constructed using a survey-based or bottom-up approach rather than employing modelling techniques, yielding more robust and credible tables. These tables are used to present a descriptive statistical analysis of the two administrative NUTS 2 regions in Ireland, drawing particular attention to the underlying structural differences of regional trade balances and composition of Gross Value Added in those regions. By deriving regional employment multipliers, Domestic Demand Employment matrices are constructed to quantify and illustrate the supply chain impact on employment. In the final part of the study, the predictive capability of the Input-Output framework is tested over two time periods. For both periods, the static Leontief production function assumptions are relaxed to allow for labour productivity. Comparative results from this experiment are presented.

An investigation of the utilisation of health impact assessments (HIAs) in Irish public policy making

It is the aim of this thesis to investigate Health Impact Assessment (HIA) use in public policy formulation in Northern Ireland and in the Republic of Ireland. The influences affecting the use of HIAs will be examined in this study. Four case studies, where HIA has been conducted, will be used for research analysis. This includes HIAs conducted on traffic and transport in Dublin, Traveller accommodation in Donegal, a draft air quality action plan in Belfast and on a social housing regeneration project in Derry. HIA aims to identify possible intended and unintended consequences that a project, policy or programme will have on the affected population’s health. Although it has been acknowledged as a worthwhile tool to inform decision-makers, the extent to which it is used in policy in Ireland is subject to scrutiny. A theoretical framework, drawing from institutionalist, impact assessment and knowledge utilisation theories and schools of literature, underpin this study. The investigation involves an examination of the unit of analysis which consists of the HIA steering groups. These are made up of local authority decision makers, statutory health practitioners and community representatives. The overarching structure and underlying values which are hypothesized as present in each HIA case are investigated in this research. Chapters 2 and 3 outline the main literature in the area which includes theories from the public health and health promotion paradigm, the policy sciences and impact assessment techniques. Chapter 4 describes the methodology in this research which is a multiple case study design. This is followed by an analysis of the cases and then concludes with practical recommendations for HIA in Ireland and theoretical conclusions of the research.

The intra-Traveller debate on ‘Traveller ethnicity’ in the Republic of Ireland. A critical discourse analysis

This dissertation assesses from an under-explored angle the enduring contention over Travellers’ ethnic recognition in the Republic of Ireland, particularly over the last decade. The novelty of this study concerns not only its specific focus on and engagement with the debate on ‘Traveller ethnicity’ among Traveller activists. It also pertains to the examination of Travellers’ arguments for and against ethnicity in light of critical theorisations as well as insights from identity politics. Furthermore, the adoption of a Critical Discourse Analytical framework offers new perspectives to this controversy and its potential implications. Finally, this thesis’ relevance extends beyond the contention on ‘Traveller ethnicity’ in itself. It also draws attention to the complex dynamics of colonisation and appropriation between the global and the local. Particularly, it points to the interplay between international human rights discourses and the local ones, formulated by NGOs struggling for equality. In this way it sheds light on more general issues such as the dialectical potential of human rights discourses: the benefits and pitfalls of framing recognition claims in the legalistic terms of human rights. In this study it is argued that the contention on ‘Traveller ethnicity’ defies a simplistic polarisation between Irish Travellers and the Irish State since it has been simultaneously played out within the Travelling community. Specifically, this study explores how ‘Traveller ethnicity’ has been introduced, embraced, promoted and contested within Traveller politics to the point of becoming a hotly debated and divisive issue among Traveller activists and at the heart of the community itself. Putting Traveller activists centre-stage, their discourses for and against ‘Traveller ethnicity’ are examined and assessed against one another and their potential implications for Traveller politics, policies and identities are pointed out. Contending discourses are historically contextualised as the product of specific structural, material and discursive configurations of power and socio-economic relations within Irish society. Discourses for and against ‘Traveller ethnicity’ are assessed as being significant beyond the representational level. They are regarded as contributing to dialectically constitute Travellers’ ways of being, representing and acting. Furthermore these discourses are considered as sites and means of power struggles, whose stakes are not only words, but relate to issues of power and leadership within the Travelling community; adjudications over material resources; the adoption of certain policy approaches over others; and, finally, the consolidation of certain subject positions over others for Travellers to draw upon and relate to mainstream society. This study highlights an ongoing ideological struggle for the naturalisation of ‘Traveller ethnicity’ as a self-evident ‘fact’, which involves no active choice by Travellers themselves. Overall, ‘Traveller ethnicity’ appears to constitute an enduring source of dilemmas for the Travelling community. These revolve around the contradictory potential of ethnicity claims-making —both its perils and advantages— and its status as a potent political strategic resource that can both challenge and reinforce existing power relations, policies and identities.

The quality of diabetes care in the community: practice, policy and culture

Aim: Diabetes is an important barometer of health system performance. This chronic condition is a source of significant morbidity, premature mortality and a major contributor to health care costs. There is an increasing focus internationally, and more recently nationally, on system, practice and professional-level initiatives to promote the quality of care. The aim of this thesis was to investigate the ‘quality chasm’ around the organisation and delivery of diabetes care in general practice, to explore GPs’ attitudes to engaging in quality improvement activities and to examine efforts to improve the quality of diabetes care in Ireland from practice to policy. Methods: Quantitative and qualitative methods were used. As part of a mixed methods sequential design, a postal survey of 600 GPs was conducted to assess the organization of care. This was followed by an in-depth qualitative study using semi-structured interviews with a purposive sample of 31 GPs from urban and rural areas. The qualitative methodology was also used to examine GPs’ attitudes to engaging in quality improvement. Data were analysed using a Framework approach. A 2nd observation study was used to assess the quality of care in 63 practices with a special interest in diabetes. Data on 3010 adults with Type 2 diabetes from 3 primary care initiatives were analysed and the results were benchmarked against national guidelines and standards of care in the UK. The final study was an instrumental case study of policy formulation. Semi-structured interviews were conducted with 15 members of the Expert Advisory Group (EAG) for Diabetes. Thematic analysis was applied to the data using 3 theories of the policy process as analytical tools. Results: The survey response rate was 44% (n=262). Results suggested care delivery was largely unstructured; 45% of GPs had a diabetes register (n=157), 53% reported using guidelines (n=140), 30% had formal call recall system (n=78) and 24% had none of these organizational features (n=62). Only 10% of GPs had a formal shared protocol with the local hospital specialist diabetes team (n=26). The lack of coordination between settings was identified as a major barrier to providing optimal care leading to waiting times, overburdened hospitals and avoidable duplication. The lack of remuneration for chronic disease management had a ripple effect also creating costs for patients and apathy among GPs. There was also a sense of inertia around quality improvement activities particularly at a national level. This attitude was strongly influenced by previous experiences of change in the health system. In contrast GP’s spoke positively about change at a local level which was facilitated by a practice ethos, leadership and special interest in diabetes. The 2nd quantitative study found that practices with a special interest in diabetes achieved a standard of care comparable to the UK in terms of the recording of clinical processes of care and the achievement of clinical targets; 35% of patients reached the HbA1c target of <6.5% compared to 26% in England and Wales. With regard to diabetes policy formulation, the evolving process of action and inaction was best described by the Multiple Streams Theory. Within the EAG, the formulation of recommendations was facilitated by overarching agreement on the “obvious” priorities while the details of proposals were influenced by personal preferences and local capacity. In contrast the national decision-making process was protracted and ambiguous. The lack of impetus from senior management coupled with the lack of power conferred on the EAG impeded progress. Conclusions: The findings highlight the inconsistency of diabetes care in Ireland. The main barriers to optimal diabetes management center on the organization and coordination of care at the systems level with consequences for practice, providers and patients. Quality improvement initiatives need to stimulate a sense of ownership and interest among frontline service providers to address the local sense of inertia to national change. To date quality improvement in diabetes care has been largely dependent the “special interest” of professionals. The challenge for the Irish health system is to embed this activity as part of routine practice, professional responsibility and the underlying health care culture.