Leadership of healthcare commissioning networks in England: a mixed-methods study on clinical commissioning groups.

To explore the relational challenges for general practitioner (GP) leaders setting up new network-centric commissioning organisations in the recent health policy reform in England, we use innovation network theory to identify key network leadership practices that facilitate healthcare innovation.

Healthcare human reliability analysis - By heart

As part of the investigations into a surgical incident involving the accidental retention inside a patient's venous system of a guide wire for central venous catheterisation (CVC), the Human Error Assessment and Reduction Technique (HEART) was used to examine the potential for further occurrences. It was found to be time-efficient and to yield plausible probabilities of human error, although its use in healthcare has challenges, suggesting adaptation would be beneficial.

BWR fuel design options for self-sustainable Th-233U fuel cycle

In this work, we investigate a number of fuel assembly design options for a BWR core operating in a closed self-sustainable Th-233U fuel cycle. The designs rely on axially heterogeneous fuel assembly structure in order to improve fertile to fissile conversion ratio. One of the main assumptions of the current study was to restrict the fuel assembly geometry to a single axial fissile zone "sandwiched" between two fertile blanket zones. The main objective was to study the effect of the most important design parameters, such as dimensions of fissile and fertile zones and average void fraction, on the net breeding of 233U. The main design challenge in this respect is that the fuel breeding potential is at odds with axial power peaking and therefore limits the maximum achievable core power rating. The calculations were performed with BGCore system, which consists of MCNP code coupled with fuel depletion and thermo-hydraulic feedback modules. A single 3-dimensional fuel assembly with reflective radial boundaries was modeled applying simplified restrictions on maximum central line fuel temperature and Critical Power Ratio. It was found that axially heterogeneous fuel assembly design with single fissile zone can potentially achieve net breeding. In this case however, the achievable core power density is roughly one third of the reference BWR core.

A sustainable PWR fuel cycle with complete TRU recycling using fertile-free fuel

The feasibility of a conventional PWR fuel cycle with complete recycling of TRU elements in the same reactor is investigated. A new Combined Non-fertile and Uranium (CONFU) fuel assembly where about 20% of the uranium fuel pins are replaced with fertile free fuel (FFF) hosting TRU generated in the previous cycle is proposed. In this sustainable fuel cycle based on the CONFU fuel assembly concept, the amount and radiotoxicity of the nuclear waste can be significantly reduced in comparison with the conventional once-through UO 2 fuel cycle. It is shown that under the constraints of acceptable power peaking limits, the CONFU assembly exhibits negative reactivity feedback coefficients comparable in values to those of the reference UO2 fuel. Moreover, the effective delayed neutron fraction is about the same as for UO2-fueled cores. Therefore, feasibility of the PWR core operation and control with complete TRU recycle has been shown in principle. However, gradual build up of small amounts of Cm and Cf challenges fuel reprocessing and fabrication due to the high spontaneous fissions rates of these nuclides and heat generation by some Pu, Am, and Cm isotopes. Feasibility of the processing steps becomes more attainable if the time between discharge and reprocessing is 20 years or longer. The implications for the entire fuel cycle will have to be addressed in future studies.

A value mapping tool for sustainable business modelling

Purpose: Although business models that deliver sustainability are increasingly popular in the literature, few tools that assist in sustainable business modelling have been identified. This paper investigates how businesses might create balanced social, environmental and economic value through integrating sustainability more fully into the core of their business. A value mapping tool is developed to help firms create value propositions better suited for sustainability. Design/methodology/approach: In addition to a literature review, six sustainable companies were interviewed to understand their approaches to business modelling, using a case study approach. Building on the literature and practice, a tool was developed which was pilot tested through use in a workshop. The resulting improved tool and process was subsequently refined through use in 13 workshops. Findings: A novel value mapping tool was developed to support sustainable business modelling, which introduces three forms of value (value captured, missed/destroyed or wasted, and opportunity) and four major stakeholder groups (environment, society, customer, and network actors). Practical implications: This tool intends to support business modelling for sustainability by assisting firms in better understanding their overall value proposition, both positive and negative, for all relevant stakeholders in the value network. Originality/value: The tool adopts a multiple stakeholder view of value, a network rather than firm centric perspective, and introduces a novel way of conceptualising value that specifically introduces value destroyed or wasted/ missed, in addition to the current value proposition and new opportunities for value creation. © Emerald Group Publishing Limited.