Intensive case management for severe psychotic illness: is there a general benefit for patients with complex needs? A secondary analysis of the UK700 trial data

The UK700 trial failed to demonstrate an overall benefit of intensive case management (ICM) in patients with severe psychotic illness. This does not discount a benefit for particular subgroups, and evidence of a benefit of ICM for patients of borderline intelligence has been presented. The aim of this study is to investigate whether this effect is part of a general benefit for patients with severe psychosis complicated by additional needs. In the UK700 trial patients with severe psychosis were randomly allocated to ICM or standard case management. For each patient group with complex needs the effect of ICM is compared with that in the rest of the study cohort. Outcome measures are days spent in psychiatric hospital and the admission and discharge rates. ICM may be of benefit to patients with severe psychosis complicated by borderline intelligence or depression, but may cause patients using illicit drugs to spend more time in hospital. There was no convincing evidence of an effect of ICM in a further seven patient groups. ICM is not of general benefit to patients with severe psychosis complicated by additional needs. The benefit of ICM for patients with borderline intelligence is an isolated effect which should be interpreted cautiously until further data are available.

Modelling complex systems for project planning - A semiotics motivated method

A large and complex IT project may involve multiple organizations and be constrained within a temporal period. An organization is a system comprising of people, activities, processes, information, resources and goals. Understanding and modelling such a project and its interrelationship with relevant organizations are essential for organizational project planning. This paper introduces the problem articulation method (PAM) as a semiotic method for organizational infrastructure modelling. PAM offers a suite of techniques, which enables the articulation of the business, technical and organizational requirements, delivering an infrastructural framework to support the organization. It works by eliciting and formalizing (e. g. processes, activities, relationships, responsibilities, communications, resources, agents, dependencies and constraints) and mapping these abstractions to represent the manifestation of the "actual" organization. Many analysts forgo organizational modelling methods and use localized ad hoc and point solutions, but this is not amenable for organizational infrastructures modelling. A case study of the infrared atmospheric sounding interferometer (IASI) will be used to demonstrate the applicability of PAM, and to examine its relevancy and significance in dealing with the innovation and changes in the organizations.

Innovation in facilities management: from trajectories to ownership

Purpose – Innovation in facilities management (FM) is a complex process as FM is a diverse discipline. This paper aims to use innovation trajectories to explore this complex process through the introduction of a technology innovation in two FM services of security and workspace management. It also aims to consider the discourse of individuals within their trajectory to understand their positions toward the innovation. Design/methodology/approach – A two-year case study was conducted and it was based in an in-house FM department that was part of a financial institution. The specific methods used for the paper were semi-structured interviews with key participants of the project. Critical discourse analysis was used to examine the data. Findings – Individuals who were involved in introducing the technology to the FM department were both internal and external to FM as innovation in FM does not happen in isolation to the organisation. Innovation trajectories were often intertwined or occurred simultaneously during the process of a project which sometimes resulted in conflict. Tensions within the discourse of ownership of the project were particularly apparent as this discourse had a power dimension in driving the project through to implementation. Research limitations/implications – The research is limited by being a single case study so it is not possible to generalise findings but the findings may have resonances with other organisations. Originality/value – The paper presents an original idea about how to understand innovation processes in FM services.

PINCER trial: a cluster randomised trial comparing the effectiveness and cost-effectiveness of a pharmacist-led IT-based intervention with simple feedback in reducing rates of clinically important errors in medicines management in general practices

Background: Medication errors in general practice are an important source of potentially preventable morbidity and mortality. Building on previous descriptive, qualitative and pilot work, we sought to investigate the effectiveness, cost-effectiveness and likely generalisability of a complex pharm acist-led IT-based intervention aiming to improve prescribing safety in general practice. Objectives: We sought to: • Test the hypothesis that a pharmacist-led IT-based complex intervention using educational outreach and practical support is more effective than simple feedback in reducing the proportion of patients at risk from errors in prescribing and medicines management in general practice. • Conduct an economic evaluation of the cost per error avoided, from the perspective of the National Health Service (NHS). • Analyse data recorded by pharmacists, summarising the proportions of patients judged to be at clinical risk, the actions recommended by pharmacists, and actions completed in the practices. • Explore the views and experiences of healthcare professionals and NHS managers concerning the intervention; investigate potential explanations for the observed effects, and inform decisions on the future roll-out of the pharmacist-led intervention • Examine secular trends in the outcome measures of interest allowing for informal comparison between trial practices and practices that did not participate in the trial contributing to the QRESEARCH database. Methods Two-arm cluster randomised controlled trial of 72 English general practices with embedded economic analysis and longitudinal descriptive and qualitative analysis. Informal comparison of the trial findings with a national descriptive study investigating secular trends undertaken using data from practices contributing to the QRESEARCH database. The main outcomes of interest were prescribing errors and medication monitoring errors at six- and 12-months following the intervention. Results: Participants in the pharmacist intervention arm practices were significantly less likely to have been prescribed a non-selective NSAID without a proton pump inhibitor (PPI) if they had a history of peptic ulcer (OR 0.58, 95%CI 0.38, 0.89), to have been prescribed a beta-blocker if they had asthma (OR 0.73, 95% CI 0.58, 0.91) or (in those aged 75 years and older) to have been prescribed an ACE inhibitor or diuretic without a measurement of urea and electrolytes in the last 15 months (OR 0.51, 95% CI 0.34, 0.78). The economic analysis suggests that the PINCER pharmacist intervention has 95% probability of being cost effective if the decision-maker’s ceiling willingness to pay reaches £75 (6 months) or £85 (12 months) per error avoided. The intervention addressed an issue that was important to professionals and their teams and was delivered in a way that was acceptable to practices with minimum disruption of normal work processes. Comparison of the trial findings with changes seen in QRESEARCH practices indicated that any reductions achieved in the simple feedback arm were likely, in the main, to have been related to secular trends rather than the intervention. Conclusions Compared with simple feedback, the pharmacist-led intervention resulted in reductions in proportions of patients at risk of prescribing and monitoring errors for the primary outcome measures and the composite secondary outcome measures at six-months and (with the exception of the NSAID/peptic ulcer outcome measure) 12-months post-intervention. The intervention is acceptable to pharmacists and practices, and is likely to be seen as costeffective by decision makers.

Design and management of sustainable built environments

The United Nation Intergovernmental Panel on Climate Change (IPCC) makes it clear that climate change is due to human activities and it recognises buildings as a distinct sector among the seven analysed in its 2007 Fourth Assessment Report. Global concerns have escalated regarding carbon emissions and sustainability in the built environment. The built environment is a human-made setting to accommodate human activities, including building and transport, which covers an interdisciplinary field addressing design, construction, operation and management. Specifically, Sustainable Buildings are expected to achieve high performance throughout the life-cycle of siting, design, construction, operation, maintenance and demolition, in the following areas: • energy and resource efficiency; • cost effectiveness; • minimisation of emissions that negatively impact global warming, indoor air quality and acid rain; • minimisation of waste discharges; and • maximisation of fulfilling the requirements of occupants’ health and wellbeing. Professionals in the built environment sector, for example, urban planners, architects, building scientists, engineers, facilities managers, performance assessors and policy makers, will play a significant role in delivering a sustainable built environment. Delivering a sustainable built environment needs an integrated approach and so it is essential for built environment professionals to have interdisciplinary knowledge in building design and management . Building and urban designers need to have a good understanding of the planning, design and management of the buildings in terms of low carbon and energy efficiency. There are a limited number of traditional engineers who know how to design environmental systems (services engineer) in great detail. Yet there is a very large market for technologists with multi-disciplinary skills who are able to identify the need for, envision and manage the deployment of a wide range of sustainable technologies, both passive (architectural) and active (engineering system),, and select the appropriate approach. Employers seek applicants with skills in analysis, decision-making/assessment, computer simulation and project implementation. An integrated approach is expected in practice, which encourages built environment professionals to think ‘out of the box’ and learn to analyse real problems using the most relevant approach, irrespective of discipline. The Design and Management of Sustainable Built Environment book aims to produce readers able to apply fundamental scientific research to solve real-world problems in the general area of sustainability in the built environment. The book contains twenty chapters covering climate change and sustainability, urban design and assessment (planning, travel systems, urban environment), urban management (drainage and waste), buildings (indoor environment, architectural design and renewable energy), simulation techniques (energy and airflow), management (end-user behaviour, facilities and information), assessment (materials and tools), procurement, and cases studies ( BRE Science Park). Chapters one and two present general global issues of climate change and sustainability in the built environment. Chapter one illustrates that applying the concepts of sustainability to the urban environment (buildings, infrastructure, transport) raises some key issues for tackling climate change, resource depletion and energy supply. Buildings, and the way we operate them, play a vital role in tackling global greenhouse gas emissions. Holistic thinking and an integrated approach in delivering a sustainable built environment is highlighted. Chapter two demonstrates the important role that buildings (their services and appliances) and building energy policies play in this area. Substantial investment is required to implement such policies, much of which will earn a good return. Chapters three and four discuss urban planning and transport. Chapter three stresses the importance of using modelling techniques at the early stage for strategic master-planning of a new development and a retrofit programme. A general framework for sustainable urban-scale master planning is introduced. This chapter also addressed the needs for the development of a more holistic and pragmatic view of how the built environment performs, , in order to produce tools to help design for a higher level of sustainability and, in particular, how people plan, design and use it. Chapter four discusses microcirculation, which is an emerging and challenging area which relates to changing travel behaviour in the quest for urban sustainability. The chapter outlines the main drivers for travel behaviour and choices, the workings of the transport system and its interaction with urban land use. It also covers the new approach to managing urban traffic to maximise economic, social and environmental benefits. Chapters five and six present topics related to urban microclimates including thermal and acoustic issues. Chapter five discusses urban microclimates and urban heat island, as well as the interrelationship of urban design (urban forms and textures) with energy consumption and urban thermal comfort. It introduces models that can be used to analyse microclimates for a careful and considered approach for planning sustainable cities. Chapter six discusses urban acoustics, focusing on urban noise evaluation and mitigation. Various prediction and simulation methods for sound propagation in micro-scale urban areas, as well as techniques for large scale urban noise-mapping, are presented. Chapters seven and eight discuss urban drainage and waste management. The growing demand for housing and commercial developments in the 21st century, as well as the environmental pressure caused by climate change, has increased the focus on sustainable urban drainage systems (SUDS). Chapter seven discusses the SUDS concept which is an integrated approach to surface water management. It takes into consideration quality, quantity and amenity aspects to provide a more pleasant habitat for people as well as increasing the biodiversity value of the local environment. Chapter eight discusses the main issues in urban waste management. It points out that population increases, land use pressures, technical and socio-economic influences have become inextricably interwoven and how ensuring a safe means of dealing with humanity’s waste becomes more challenging. Sustainable building design needs to consider healthy indoor environments, minimising energy for heating, cooling and lighting, and maximising the utilisation of renewable energy. Chapter nine considers how people respond to the physical environment and how that is used in the design of indoor environments. It considers environmental components such as thermal, acoustic, visual, air quality and vibration and their interaction and integration. Chapter ten introduces the concept of passive building design and its relevant strategies, including passive solar heating, shading, natural ventilation, daylighting and thermal mass, in order to minimise heating and cooling load as well as energy consumption for artificial lighting. Chapter eleven discusses the growing importance of integrating Renewable Energy Technologies (RETs) into buildings, the range of technologies currently available and what to consider during technology selection processes in order to minimise carbon emissions from burning fossil fuels. The chapter draws to a close by highlighting the issues concerning system design and the need for careful integration and management of RETs once installed; and for home owners and operators to understand the characteristics of the technology in their building. Computer simulation tools play a significant role in sustainable building design because, as the modern built environment design (building and systems) becomes more complex, it requires tools to assist in the design process. Chapter twelve gives an overview of the primary benefits and users of simulation programs, the role of simulation in the construction process and examines the validity and interpretation of simulation results. Chapter thirteen particularly focuses on the Computational Fluid Dynamics (CFD) simulation method used for optimisation and performance assessment of technologies and solutions for sustainable building design and its application through a series of cases studies. People and building performance are intimately linked. A better understanding of occupants’ interaction with the indoor environment is essential to building energy and facilities management. Chapter fourteen focuses on the issue of occupant behaviour; principally, its impact, and the influence of building performance on them. Chapter fifteen explores the discipline of facilities management and the contribution that this emerging profession makes to securing sustainable building performance. The chapter highlights a much greater diversity of opportunities in sustainable building design that extends well into the operational life. Chapter sixteen reviews the concepts of modelling information flows and the use of Building Information Modelling (BIM), describing these techniques and how these aspects of information management can help drive sustainability. An explanation is offered concerning why information management is the key to ‘life-cycle’ thinking in sustainable building and construction. Measurement of building performance and sustainability is a key issue in delivering a sustainable built environment. Chapter seventeen identifies the means by which construction materials can be evaluated with respect to their sustainability. It identifies the key issues that impact the sustainability of construction materials and the methodologies commonly used to assess them. Chapter eighteen focuses on the topics of green building assessment, green building materials, sustainable construction and operation. Commonly-used assessment tools such as BRE Environmental Assessment Method (BREEAM), Leadership in Energy and Environmental Design ( LEED) and others are introduced. Chapter nineteen discusses sustainable procurement which is one of the areas to have naturally emerged from the overall sustainable development agenda. It aims to ensure that current use of resources does not compromise the ability of future generations to meet their own needs. Chapter twenty is a best-practice exemplar - the BRE Innovation Park which features a number of demonstration buildings that have been built to the UK Government’s Code for Sustainable Homes. It showcases the very latest innovative methods of construction, and cutting edge technology for sustainable buildings. In summary, Design and Management of Sustainable Built Environment book is the result of co-operation and dedication of individual chapter authors. We hope readers benefit from gaining a broad interdisciplinary knowledge of design and management in the built environment in the context of sustainability. We believe that the knowledge and insights of our academics and professional colleagues from different institutions and disciplines illuminate a way of delivering sustainable built environment through holistic integrated design and management approaches. Last, but not least, I would like to take this opportunity to thank all the chapter authors for their contribution. I would like to thank David Lim for his assistance in the editorial work and proofreading.

Introducing matrix management within a children's services setting - personal reflections

This article reflects on the introduction of ‘matrix management’ arrangements for an Educational Psychology Service (EPS) within a Children’s Service Directorate of a Local Authority (LA). It seeks to demonstrate critical self-awareness, consider relevant literature with a view to bringing insights to processes and outcomes, and offers recommendations regarding the use of matrix management. The report arises from an East Midland’s LA initiative: ALICSE − Advanced Leadership in an Integrated Children’s Service Environment. Through a literature review and personal reflection, the authors consider the following: possible tensions within the development of matrix management arrangements; whether matrix management is a prerequisite within complex organizational systems; and whether competing professional cultures may contribute barriers to creating complementary and collegiate working. The authors briefly consider some research paradigms, notably ethnographic approaches, soft systems methodology, activity theory and appreciative inquiry. These provide an analytic framework for the project and inform this iterative process of collaborative inquiry. Whilst these models help illuminate otherwise hidden processes, none have been implemented following full research methodologies, reflecting the messy reality of local authority working within dynamic organizational structures and shrinking budgets. Nevertheless, this article offers an honest reflection of organizational change within a children’s services environment.

Change management in practice: an ethnographic study of changes to contract requirements on a hospital project

Changes to client requirements are inevitable during construction. Industry discourse is concerned with minimizing and controlling changes. However, accounts of practices involved in making changes are rare. In response to calls for more research into working practices, an ethnographic study of a live hospital project was undertaken to explore how changes are made. A vignette of a meeting exploring the investigation of changes illustrates the issues. This represents an example from the ethnographic fieldwork, which produced many observations. There was a strong emphasis on using change management procedures contained within the contract to investigate changes, even when it was known that the change was not required. For the practitioners, this was a way of demonstrating best practice, transparent and accountable decision-making regarding changes. Hence, concerns for following procedures sometimes overshadowed considerations about whether or not a change was required to improve the functionality of the building. However, the procedures acted as boundary objects between the communities of practice involved on the project by coordinating the work of managing changes. Insights suggest how contract procedures facilitate and impede the making of changes, which can inform policy guidance and contract drafting.

Information and knowledge management in complex systems

16th IFIP WG8.1 International Conference on Informatics and Semiotics in Organisations, ICISO 2015

Scalable model-based configuration management of security services in complex enterprise networks

Security administrators face the challenge of designing, deploying and maintaining a variety of configuration files related to security systems, especially in large-scale networks. These files have heterogeneous syntaxes and follow differing semantic concepts. Nevertheless, they are interdependent due to security services having to cooperate and their configuration to be consistent with each other, so that global security policies are completely and correctly enforced. To tackle this problem, our approach supports a comfortable definition of an abstract high-level security policy and provides an automated derivation of the desired configuration files. It is an extension of policy-based management and policy hierarchies, combining model-based management (MBM) with system modularization. MBM employs an object-oriented model of the managed system to obtain the details needed for automated policy refinement. The modularization into abstract subsystems (ASs) segment the system-and the model-into units which more closely encapsulate related system components and provide focused abstract views. As a result, scalability is achieved and even comprehensive IT systems can be modelled in a unified manner. The associated tool MoBaSeC (Model-Based-Service-Configuration) supports interactive graphical modelling, automated model analysis and policy refinement with the derivation of configuration files. We describe the MBM and AS approaches, outline the tool functions and exemplify their applications and results obtained. Copyright (C) 2010 John Wiley & Sons, Ltd.

Quality management for vital forest tree seedlings : Final report, Project no: P33854-1

The work concerns development of a prototype molecular tests to identify vitality status of conifer seedlings. The work is done by NSure, Holland, Dalarna University and SUAS. In case for spruce, a successful validation experiment has been performed to validate the identified frost tolerance and vitality genes. Multiple indicators were identified that can be used to either reinforce the existing ColdnSure test, but also for development of a vitality test. The identified frost tolerance and vitality genes for pine still need to be validated. NSure together with Dalarna University aim to perform a validation next season. Multiple LN indicators were identified in spruce that can be used to determine the effectiveness of a LN treatment, but they are not yet validated. In spruce and pine hardly any scientific research is performed to study the effect of a LN treatment, particularly not at molecular level. Therefore NSure together with Dalarna Research Station want to apply for a project. Within this project, we would be able to develop the tests further.

Optimized Water Demand Management Through Intelligent Sensing And Analytics: The WISDOM Approach

New business and technology platforms are required to sustainably manage urban water resources [1,2]. However, any proposed solutions must be cognisant of security, privacy and other factors that may inhibit adoption and hence impact. The FP7 WISDOM project (funded by the European Commission - GA 619795) aims to achieve a step change in water and energy savings via the integration of innovative Information and Communication Technologies (ICT) frameworks to optimize water distribution networks and to enable change in consumer behavior through innovative demand management and adaptive pricing schemes [1,2,3]. The WISDOM concept centres on the integration of water distribution, sensor monitoring and communication systems coupled with semantic modelling (using ontologies, potentially connected to BIM, to serve as intelligent linkages throughout the entire framework) and control capabilities to provide for near real-time management of urban water resources. Fundamental to this framework are the needs and operational requirements of users and stakeholders at domestic, corporate and city levels and this requires the interoperability of a number of demand and operational models, fed with data from diverse sources such as sensor networks and crowsourced information. This has implications regarding the provenance and trustworthiness of such data and how it can be used in not only the understanding of system and user behaviours, but more importantly in the real-time control of such systems. Adaptive and intelligent analytics will be used to produce decision support systems that will drive the ability to increase the variability of both supply and consumption [3]. This in turn paves the way for adaptive pricing incentives and a greater understanding of the water-energy nexus. This integration is complex and uncertain yet being typical of a cyber-physical system, and its relevance transcends the water resource management domain. The WISDOM framework will be modeled and simulated with initial testing at an experimental facility in France (AQUASIM – a full-scale test-bed facility to study sustainable water management), then deployed and evaluated in in two pilots in Cardiff (UK) and La Spezia (Italy). These demonstrators will evaluate the integrated concept providing insight for wider adoption.

PRiMA : project risk management approach

Esta tese propõe uma abordagem sistemática para gerenciar riscos em projetos de software, por meio da adaptação de processos. O objetivo da abordagem é permitir a elaboração de um processo específico para um dado projeto, visando minimizar a exposição do projeto aos riscos, identificados de acordo com o contexto do projeto. As atividades, possíveis de serem executadas em processos de projetos de uma organização, são estruturadas em um framework de processo (PRiMA-F), que inclui também os padrões de processo e organizacionais usados para descrever ações preventivas e corretivas aos riscos. A estruturação do framework básico, construído pela organização, poderá permitir distintas instanciações, como por exemplo, processos de acordo com o paradigma ágil ou planejado, ou em conformidade com normas de qualidade, como CMM e outras; além dos padrões organizacionais e de processo para gestão de riscos de projeto. PRiMA-F define o escopo maior do processo de software da organização e este é adaptado de acordo com os riscos identificados para o projeto e suas necessidades específicas, dando origem ao processo a ser usado no projeto. adaptação. Os guias descrevem como adaptar elementos de processo de acordo com o tamanho e o formalismo do projeto. Configurações de processo são modelos prédefinidos, visando atender projetos típicos ou modelos de qualidade. Prima-F pode ser estendida para novos riscos, padrões e processos, de acordo com as necessidades da organização. Utilizando o paradigma Goal/Question/Metric, no framework de processo (PRiMAF), são definidas métricas do processo de software, associadas aos riscos, para serem usadas para acompanhar o progresso dos fatores de risco, possibilitando ao gerente de projeto tomar ações corretivas, quando necessário e no momento adequado. As ações corretivas são descritas usando padrões organizacionais e de processo. Uma ferramenta de apoio à sistemática proposta (PRiMA-Tool) foi desenvolvida. Estudos de caso foram elaborados para validar a sistemática proposta