Meet Government Targets Research Articles

The association of breast surgery ASPIRE: breast pain pathway rapid evaluation project - study protocol.

Breast pain accounts for 20-40% of new referrals to breast units in the UK and these patients have a very low risk of breast cancer. Patients have previously been assessed in resource-intensive, cancer-exclusion, one stop clinics, which are now failing to meet government targets due to excessive demand. UK Breast units are increasingly piloting Breast Pain-only Pathways (BPP) to assess these patients, and there is no consensus for the optimal pathway. The aim of this prospective multicentre study is to assess the safety and patient satisfaction of different BPPs to inform future BPP design and implementation. All UK breast units will be invited to join the ASPIRE study between January 2023 and December 2023. Units with a BPP are invited to submit their pathway for evaluation; and those without a BPP who see patients with breast pain-only in a one stop clinics setting are also invited to join the study to evaluate the traditional pathway model concurrently. Patient satisfaction assessments will be collected after their initial consultation and patient outcomes, including subsequent cancer diagnosis, will be followed up at 12 months to determine if they have cancer diagnosis after discharge to assess pathway safety.

The socio-technical dynamics of net-zero industrial megaprojects: Outside-in and inside-out analyses of the Humber industrial cluster

Although energy-intensive industries are often seen as ‘hard-to-decarbonise’, net-zero megaprojects for industrial clusters promise to improve the technical and economic feasibility of hydrogen fuel switching and carbon capture and storage (CCS). Mobilising insights from the megaproject literature, this paper analyses the dynamics of an ambitious first-of-kind net-zero megaproject in the Humber industrial cluster in the United Kingdom, which includes CCS and hydrogen infrastructure systems, industrial fuel switching, CO2 capture, green and blue hydrogen production, and hydrogen storage. To analyse the dynamics of this emerging megaproject, the article uses a socio-technical system lens to focus on developments in technology, actors, and institutions. Synthesising multiple megaproject literature insights, the paper develops a comprehensive framework that addresses both aggregate (‘outside-in’) developments and the endogenous (‘inside-out’) experiences and activities regarding three specific challenges: technical system integration, actor coordination, and institutional alignment. Drawing on an original dataset involving expert interviews (N = 46), site visits (N = 7), and document analysis, the ‘outside-in’ analysis finds that the Humber megaproject has progressed rapidly from outline visions to specific technical designs, enacted by new coalitions and driven by strengthening policy targets and financial support schemes. The complementary ‘inside-out’ analysis, however, also finds 12 alignment challenges that can delay or derail materialisation of the plans. While policies are essential aggregate drivers, institutional misalignments presently also prevent project-actors from finalising design and investment decisions. Our analysis also finds important tensions between the project's high-pace delivery focus (to meet government targets) and allowing sufficient time for pilot projects, learning-by-doing, and design iterations.

Retrofit and the assessment of traditional buildings

Retrofitting buildings will be an integral part of meeting government targets around reducing energy usage in coming years. If carried out using the correct methods and materials, with good design and installation, retrofit can be successful in improving the energy efficiency of buildings. It is important to recognise, however, that buildings can also suffer from defects if retrofit of insulation is not successful. Buildings that are of traditional construction are particularly vulnerable to defects associates with retrofit as they have particular requirements around moisture and condensation as well as ventilation. This paper considers retrofit of traditionally constructed buildings with a focus on some of the defects that may be found as a result of unsuccessful retrofit. As the volume of such work increases, so too does the likelihood that those assessing buildings will find defects related to or exacerbated by retrofit. This is not to say that traditional buildings cannot or should not be improved, as research has shown they can and should, but rather seeks to highlight a potential future cause of building defects.

Projections of dependency and associated social care expenditure for the older population in England to 2038: effect of varying disability progression.

Objectivesto assess the effect of recent stalling of life expectancy and various scenarios for disability progression on projections of social care expenditure between 2018 and 2038, and the likelihood of reaching the Ageing Society Grand Challenge mission of five extra healthy, independent years at birth.Designtwo linked projections models: the Population Ageing and Care Simulation (PACSim) model and the Care Policy and Evaluation Centre long-term care projections model, updated to include 2018-based population projections.PopulationPACSim: about 303,589 individuals aged 35 years and over (a 1% random sample of the England population in 2014) created from three nationally representative longitudinal ageing studies.Main outcome measuresTotal social care expenditure (public and private) for older people, and men and women’s independent life expectancy at age 65 (IndLE65) under five scenarios of changing disability progression and recovery with and without lower life expectancy.Resultsbetween 2018 and 2038, total care expenditure was projected to increase by 94.1%–1.25% of GDP; men’s IndLE65 increasing by 14.7% (range 11.3–16.5%), exceeding the 8% equivalent of the increase in five healthy, independent years at birth, although women’s IndLE65 increased by only 4.7% (range 3.2–5.8%). A 10% reduction in disability progression and increase in recovery resulted in the lowest increase in total care expenditure and increases in both men’s and women’s IndLE65 exceeding 8%.Conclusionsinterventions that slow down disability progression, and improve recovery, could significantly reduce social care expenditure and meet government targets for increases in healthy, independent years.

Methane emissions along biomethane and biogas supply chains are underestimated

Methane emissions along biomethane and biogas supply chains are underestimated

Varying Coefficient Models and Design Choice for Bayes Linear Emulation of Complex Computer Models with Limited Model Evaluations

Computer models are widely used to help make decisions about real-world systems. As computer models of large and complex systems can have long run-times and high-dimensional input spaces, it is often necessary to use emulation to assess uncertainties in computer model output. This paper presents methodology for emulation of complex computer models motivated by a real-world example in energy policy. The computer model studied is an economic model of investment in electricity generation in Great Britain. The computer model was used to select parameters in a government policy designed to incentivize investment in renewable technologies to meet government targets. Limited computing time meant that few runs of the computer model were available to fit an emulator. The statistical methodology developed was therefore focused on accurately capturing the uncertainty in computer model output arising from the small number of available model runs. A varying coefficient emulator is proposed to model uncertainty in model output when extrapolating away from model runs. To maximize use of the small number of runs available, this varying coefficient emulator is paired with a criterion-based procedure for design selection.

Actual and projected gaps in the provision of residential aged care in New South Wales, Australia.

Objective The need for residential care services will grow significantly over the coming years as the general population in Australia continues to age. The aim of this study was to assess the adequacy of residential care services across New South Wales (NSW), Australia, in relation to the current and predicted future aging population. Method This study was a secondary data analysis. Existing datasets were compiled for analysis by creation of a temporal geodatabase, with predicted population data from 2019 to 2029 linked to corresponding geographic zones. Results Demand for operational places was over capacity in 2019, at 101.5%. From 2019 to 2029, this will grow to 120.2% of 2019 capacity by 2024 and to 135.6% by 2029. An additional 25 800 operational places will be required by 2029 to meet targets. During the previous decade of 2008-18, operational places grew by only 11 502 places. Conclusions NSW was not providing an adequate level of residential aged care and, under current allocations, this problem will worsen substantially over time, with flow-on impacts for the health sector. With aged care reform a current federal government focus, the results of this study may guide decisions that better support the provision of residential aged care. What is known about this topic? The recently completed Australian Royal Commission into aged care noted widespread system failure and highlighted the gaps in medical services that older Australians were experiencing. What does this paper add? This paper reports that demand for residential aged care places in NSW was already over capacity in 2019 and that the availability of places varies considerably across the state. Further, an additional 25 800 operational places are required by 2029 to meet government targets. If the growth rate from the past decade is maintained, this will result in a shortfall of 14 298 aged care places in NSW alone. What are the implications? Without significant increases in the current rate of growth for aged care places, the mainstream medical and health sectors will face significant additional pressures arising from unmet need in both older patients and their informal carers.

Effects of Physical Sample Approval Practice on Performance and Competitiveness of Export-Oriented Garment Industries in Ethiopia

The textile sector is one of the major economic pillars in Ethiopia. The sector is generating foreign currency by exporting textile and finished garments. However, the competitiveness of this sector is not as per the expectation due to the long delivery time and excessive manufacturing cost. This study aims to assess the main approval processes in handling garment samples between manufacturers and buyers. The study also examines the effect of physical sample approval process on export performance and competitiveness of the industry. The study employed an explanatory and exploratory multiple-case study research approach in four apparel exporting companies. Both primary and secondary data were collected using questionnaires, semistructured interviews, and observation. Result from this study showed that the export performance and competitiveness of apparel industries are mainly affected by the traditional sample approval system due to long delivery time, unnecessary approval process cost, and poor inventory management of the sampling department. The result also indicates that long lead time and costly process system made the sector incompetent in international market. Therefore, it can be concluded that the apparel manufacturing and exporting industries in Ethiopia should modify their approach to nurture better speed and comparably lower process costs. Ethiopia’s apparel sector needs also to invest in creating a reliable quality manufacturing system to grow and meet government targets for expanding export sales.

Social equity-based timetabling and ticket pricing for high-speed railways

High-speed railways are expanding rapidly over the world, providing fast, convenient, and comfortable transport. It is therefore important to ensure that people are not excluded from high-speed railway use due to relatively high ticket prices. We aim to develop a railway timetable according to passenger requirements that explicitly considers social equity by applying variable ticket prices to trains. Specifically, we want to optimize ticket prices for trains operating during off-peak hours to improve accessibility for low-income passengers to improve social justice. A mixed integer linear programming model is formulated to solve our problem. In this timetabling-based model, we not only minimize the total general travel cost from a passenger perspective but also ensure that the revenue of the train company is no less than a specified value and that social equity is maintained at a specific level. To do this, we consider the social equity constraint and the minimum revenue requirement constraint, in addition to the traditional passenger-centric (-oriented) train timetabling-related constraints. Finally, we test our model on both a hypothetical high-speed railway network and the Guangzhou–Nanning and Guangzhou–Guilin high-speed railway network in China. The results demonstrate that the proposed optimization framework can provide a convenient timetable for passengers, adequate revenue for train companies and enhance social equity to meet government targets.

Distributing Social Transfers in Rwanda: The Case of the Vision 2020 Umurenge Programme (VUP)

This paper examines the political dynamics shaping the distribution of Rwanda’s Vision 2020 Umurenge Programme (VUP). Established in 2008, the VUP aims to provide cash transfers to the poorest people in Rwanda, largely conditional on participation in public works. However, the programme also aims to make a productive contribution to the economy through infrastructure development and the promotion of graduation of participants from support. Based on detailed fieldwork in two districts in Rwanda in 2018, the paper analyses implementation using Mann’s concept of ‘infrastructural power’, highlighting two main findings. First, despite selecting ‘most likely’ cases for variation within Rwanda, the research finds little evidence of systematic variation in state capacity and programme implementation between research sites. This suggests that the government’s stated commitment to uniform implementation across the country may have addressed past variation in the reach of the state. Second, despite relatively high levels of infrastructural power across the sites, significant challenges remain. Notably, the pressures of top-down performance assessment have tended to prioritise the productive aspects of the programme, forcing local officials to make difficult choices that undermine the VUP’s protective role. For example, households classified as non-poor are selected for public works and non-creditworthy participants are pressured to take loans, in order to meet government targets. As such, the paper highlights the importance not just of infrastructural power, but the purposes to which that power is deployed.

Exploring the Benefits of Early Contractor Involvement (ECI) and the Mechanism for Automated 5D BIM Quantification Process in Offsite Modular Construction

The UK Construction Industry through its Government Construction Strategy has recently been mandated to implement Level 2 Building Information Modelling (BIM) on public sector projects. This move, along with other initiatives is key to driving a requirement for 25% cost reduction (establishing the most cost-effective means) on. Other key deliverables within the strategy include reduction in overall project time, early contractor involvement, improved sustainability and enhanced product quality. Collaboration and integrated project delivery is central to the level 2 implementation strategy yet the key protocols or standards relative to cost within BIM processes is not well defined. As offsite construction becomes more prolific within the UK construction sector, this construction approach coupled with BIM, particularly 5D automated quantification process, and early contractor involvement provides significant opportunities for the sector to meet government targets. Early contractor involvement is supported by both the industry and the successive Governments as a credible means to avoid and manage project risks, encourage innovation and value add, making cost and project time predictable, and improving outcomes. The contractor is seen as an expert in construction and could be counter intuitive to exclude such valuable expertise from the pre-construction phase especially with the BIM intent of äóÖbuild it twiceäó», once virtually and once physically. In particular when offsite construction is used, the contractoräó»s construction expertise should be leveraged for the virtual build in BIM-designed projects to ensure a fully streamlined process. Building in a layer of automated costing through 5D BIM will bring about a more robust method of quantification and can help to deliver the 25% reduction in overall cost of a project. Using a literature review and a case study, this paper will look into the benefits of Early Contractor Involvement (ECI) and the impact of 5D BIM on the offsite construction process.

Energy efficiency uptake and energy savings in English houses: A cohort study

The UK Government estimates that approximately 22TWh of energy can be saved from English dwellings by 2020 from a range of fabric and heating energy efficiency retrofits. Yet the rate of retrofit uptake has been less than is needed to meet government targets and the retrofits impact on energy demand has been less than predicted. Two questions that must be addressed are: who have (and have not) taken up retrofits and what household factors affect this; and, what impact have these retrofits had on energy use and how does this differ among households. The purpose of this study is to provide a better understanding of the uptake of energy efficiency retrofits and the resulting change in energy demand. A cohort of 168,998 dwellings gas-heated English dwellings was used to examine retrofit uptake from 2002 to 2007 and the change in gas use from 2005 to 2007. The findings show that retrofits do have an attributable impact on reducing energy demand and that combining retrofits displays a dose–response like effect, after controlling for household and dwelling factors. Energy savings play a central role in meeting UK climate change mitigation targets and therefore understanding the take up of energy efficiency retrofits and their impact on energy demand and variations in these retrofits across the population is vital to understand their potential.

Examining the decision-making theories employed by nurses to diagnose a patient presenting with a rectal bleed

As part of advanced practice in colorectal care, advanced nurse practitioners (ANP) and clinical nurse specialists (CNS) increasingly are seeing patients in 2-week wait clinics to meet government targets. The author presents a case history of a patient with rectal bleeding referred via the 2-week wait pathway, and considers the decision-making theories that informed practice and led to a differential diagnosis. An eclectic model provides a comprehensive approach to decision making that encompasses the broader aspects of health; however, accurate judgement is dependent on the theoretical and clinical knowledge of the colorectal nurse specialist.

Administração Pública e Responsabilidade Social e Sustentabilidade, Compromisso da Instituição de Ensino Pública: Um Estudo de Caso do Instituto Federal Fluminense

A escola é parte da comunidade e como tal deve proporcionar debates permanentes que permitam a construção de uma sociedade socialmente mais justa, tendo além da preocupação com a formação educacional e profissional o objetivo de formar cidadãos, livres, críticos e solidários. Na busca deste objetivo a educação surge como mola mestra para o desenvolvimento sustentável com inclusão social, derrubando algumas barreiras construídas com a necessidade de atendimento as premissas governamentais em seus projetos e discutindo possibilidade de considerações das particularidades locais, potencializando o ser humano que busca um caminho de vida mais digno. Os objetivos desta pesquisa são analisar o compromisso das instituições públicas de ensino com a questão social e sustentabilidade, identificar as principais dificuldades de implantação de projetos sociais conforme diretrizes do governo federal, considerando não só características gerais, mas, também, as especificidades das comunidades locais, entender a importância da educação para a melhoria das condições de vida comunitária contribuindo para a solidez da aliança entre comunidade e escola para o enfrentamento das questões sociais e identificar as práticas adotadas na atualidade, através da revisão de literatura e do estudo de caso explorado, para melhor gestão das ações futuras. Para responder as questões da pesquisa, foi utilizada como metodologia a aplicação de questionários e realização de entrevistas, observação direta da autora, revisão da literatura e estudo de melhores práticas identificadas no decorrer da mesma, e a utilização do conceito de responsabilidade social e sustentabilidade para análise de políticas públicas voltadas para a educação e o estudo de caso do Instituto Federal de Educação, Ciência e Tecnologia Fluminense para maior aproveitamento e entendimento dos dados da pesquisa. Verificou-se que a maior dificuldade existente nos projetos criados pelo governo federal e operacionalizados pelo Instituto Federal Fluminense refere-se à falta de planejamento, que ocorre pela deficiência de estrutura frente a necessidade de cumprir metas estabelecidas, ou seja, os projetos vestem-se de uma roupagem social destoante da realidade, que está interiormente mais comprometida com o atendimento a índices governamentais e melhoria de imagem. Analisando o desenvolvimento dos projetos em curso no IFF, percebe-se a necessidade de alterações que possibilitem melhor gestão, considerando a construção em conjunto com a comunidade, a melhoria no planejamento e controle dos projetos, maior autenticidade das ações de responsabilidade social e a implementação de Indicadores. Quando a instituição pública de ensino assume o seu compromisso ético e social, realizando efetivamente ações para o desenvolvimento da comunidade, e quando esse movimento acontece sem a conotação de interesse próprio ou político, conquista-se o real comprometimento de todos os atores sociais, tais como: escola, comunidade, governo em todas as esferas e sociedade civil organizada, fortalecendo vínculos e gerando benefícios para todos. Agir de forma socialmente responsável significa agir de forma integral, com justiça social, econômica e ambiental, buscando continuamente a melhoria de suas ações baseando-se em relações cooperativas pautadas na ética e transparência.

Finance, fibromyalgia, caring, & communication.

Yonder: a diverse selection of primary care relevant research stories from beyond the traditional biomedical literature Finance: In Denmark, much like in the UK, the GP workforce is under much strain due to flexible working and increasing population health needs. National health authorities are keen to restructure primary care services to meet this mismatch between supply and demand. In a recent article in the European Journal of Health Economics , the employment preferences of Danish GP trainees were examined using a web-based survey.1 They found that these young doctors were far more likely to opt for shared practices than previous generations, who had to be incentivised to leave solo practice. However, the predominant preference is for smaller shared practices (two GPs) and the authors suggest financial incentives may convince them to meet government targets and …

East meets West

A delegation from RCN Publishing and the RCN visited Beijing in September, where they saw how the city's hospitals integrate traditional Chinese and western medicine. Nursing schools in China are expanding their student intake to meet government targets. At the same time, nursing representatives are forging links and exchanging ideas with their counterparts in other countries, including the UK.

German Energiewende and the Heating Market - Impact and Limits of Policy

The German Energiewende envisages achieving a climate-neutral building stock in 2050 by means of two major pillars of regulation: First, residential buildings should consume 80% less primary energy and, second, the remaining energy demand should be covered primarily with renewables. This paper simulates the future heating market in Germany under different policy scenarios in order to evaluate the impact and limits of recent and conceivable heating market policy. The investigation is based upon a dual model approach, linking a residential heating model to a discrete choice model for the heating system purchase decision. The major finding is that current ‚regulations will not be suitable for meeting government targets. Carbon emission reductions in scenarios assuming current regulation nearly equal those where there is no regulation. In terms of economic efficiency, all calculated policy alternatives perform better than the regulation currently in place. The model results highlight two policy implications. First, rising renewable requirements deliver better results at lower costs. Second, renewable obligations for heating systems must include the existing building stock in order to achieve the postulated political targets.

Investigating variations in the provision of digital services in public libraries using network-based GIS models

Public libraries have been seen to have an important role in providing digital services to potentially excluded groups in order to help meet government targets regarding the delivery of digital services. Geographical information systems (GIS) have been used to investigate library service areas, to aid initial location decisions, and to model the implications of the opening and closure of library services. Recent studies have promoted the use of GIS-based techniques to investigate spatial variations in accessibility to public and private services in relation to socio-economic characteristics of population groups. One such technique, based on floating catchment area (FCA) approaches, has been primarily used to investigate potential inequalities in health services, access to employment and leisure opportunities, as well as planning public transport. In this study, FCA techniques are used to research variations in accessibility to public library facilities using bespoke application tools developed within a commercial GIS package. Drawing on a preliminary analysis of variations in accessibility to library services in a local authority area in south Wales, UK, a case study is presented whereby GIS-based models can be used to investigate spatial variations in digital services provision. As a result, provision gaps of such services can be identified. This study's findings help guide national government delivery programs to promote digital inclusion.

The role of public health in climate change and sustainability: is the UK public health community’s response adequate?

Climate change is the greatest public health disaster facing us today. Sucharita Yarlagadda, Premila Webster and Elizabeth Haworth from the University of Oxford suggest that only with firm and decisive action now can we hope to avert or mitigate an impending public health catastrophe1 While there is a scientific consensus that the global climate is changing, with increasing climate variability and extremes, rising temperatures and sea levels and increased frequency of natural disasters which impact on human health,2,3,4 against a backdrop of persistent world economic pressures, the role of the specialty of public health in responding to environmental and climate change is not clear and needs to be defined. Many governments, including those of the UK have committed to tackling climate change through adaptation and mitigation and carbon abatement measures. The Climate Change Act 2008 sets a legally binding target for reducing UK greenhouse gas emissions by at least 34% by 2020 and by 80% by 2050, using the 1990 baseline.5 The NHS has shown leadership in this area through the Good Corporate Citizenship model,6 the NHS carbon reduction strategy7 and the NHS Sustainable Development Unit's route map for sustainable health.8 These aim to, at least, meet government targets and demonstrate early success with a 10% reduction of the 2007 NHS carbon footprint by 2015. Since April 2010, a new mandatory emissions trading scheme has come into force, requiring increased efforts by NHS organizations to meet government carbon targets.9 Alongside this is growing evidence of substantial financial and health benefits of low carbon business models in response to climate change and sustainability.6,10 As recommended by the Lancet and University College London a new Public Health movement is needed.4 The time to act is now. However, there still seems to be a huge gap between knowledge/ evidence and coordinated public health action. To clarify the public health role, a UK-wide internet based survey of public health departments (service public health, academic public health and the health protection units) was conducted in April 2010. It sought to allow an assessment of climate change as a public health problem, identify actions and innovations already taken, and to promote a coordinated public health response. The preliminary results were presented at the 2010 Faculty of Public Health Conference. The response rate of 32% overall was disappointing, despite a reminder. Over 90% of this considerable UK public health workforce who responded agreed that climate change is an important health problem requiring public health action. Many respondents highlighted the need for a stronger NHS mandate and prioritisation, such as through the NHS operational framework. Most believed that further training and development is essential for effective action, but the urgency is sidelined by current restriction of financial resources to deal with this problem. Although the public health workforce believes that action is needed and there is a public health strategy11 and encouraging response by primary care trusts12 neither an overarching plan nor effective coordination exists. What is good for the planet is also good for health and policies and structural drivers to mitigate and adapt to climate change would have a large positive effect on population health, for example the health co-benefits of walking or cycling to work that both reduce emissions and improve health and wellbeing.13 Emergency plans must be improved, kept up to date and include an effective service response to unpredictable weather patterns because of climate associated disasters and problems. These include floods and related water contamination incidents, droughts, heat waves, food shortages, as well as the problem of emerging diseases such as arthropod-borne infections and other environmentally linked diseases such as skin cancers and cataracts due to reduction/loss of the ozone layer. …

BiotecVisions 2012, April

BiotecVisions 2012, April