Voice of the Clinician: the case of an Australian health system.

Purpose The Voice of the Clinician project commenced during an era when practitioner burnout, dissatisfaction, and turnover became an increasingly global health workforce concern. One key problem is clinical staff not being empowered to voice their concerns to decision-makers, as was found in this case study of an Australian public health organization. The following research question informed the present study: What is a better committee system for clinician engagement in decision-making processes? The paper aims to discuss this issue. Design/methodology/approach The Mid North Coast Local Health District in New South Wales aspired to improve engagement between frontline clinicians and decision-makers. Social network analysis methods and mathematical modeling were used in the discovery of how committees are connected to each other and subsequently to other committee members. Findings This effort uncovered a hidden organizational architecture of 323 committees of 926 members which overall cost 84,729 person hours and AUD$2.923 million per annum. Furthermore, frontline clinicians were located far from centers of influence, just 37 percent of committees had terms of reference, and clinicians reported that meeting agendas were not being met. Practical implications In response to the findings, a technological platform was created so that the board of directors could visually see all the committees and the connections between them, thus creating ways to further improve communication, transparency of process, and - ultimately - clinician engagement. Originality/value The breakthrough idea is that all organizational meetings can be seen as a system of engagement and should be analyzed to determine and describe the points and pathways where clinician voice is blocked

Sinhala and Tamil : a case of contact-induced restructuring

PhD ThesisThe dissertation presents a comparative synchronic study of the morphosyntactic features of modern spoken Sinhala and Tamil, the two main languages of Sri Lanka. The main motivation of the research is that Sinhala and Tamil, two languages of diverse origins—the New Indo-Aryan (NIA) and Dravidian families respectively—share a wide spectrum of morphosyntactic features. Sinhala has long been isolated from the other NIA languages and co-existed with Tamil in Sri Lanka ever since both reached Sri Lanka from India. This coexistence, it is believed, led to what is known as the contact-induced restructuring that Sinhala morphosyntax has undergone on the model of Tamil, while retaining its NIA lexicon. Moreover, as languages of South Asia, the two languages share the areal features of this region. The research seeks to address the following questions: (i) What features do the two languages share and what features do they not share?; (ii) Are the features that they share areal features of the region or those diffused into one another owing to contact?; (iii) If the features that they share are due to contact, has diffusion taken place unidirectionally or bidirectionally?; and (iv) Does contact have any role to play with respect to features that they do not share? The claim that this research intends to substantiate is that Sinhala has undergone morphosyntactic restructuring on the model of Tamil. The research, therefore, attempts to answer another question: (v) Can the morphosyntactic restructuring that Sinhala has undergone be explained in syntactic terms? The morphosyntactic features of the two languages are analyzed at macro- and micro-levels. At the macro-level, a wide range of morphosyntactic features of Tamil and Sinhala, and those of seven other languages of the region are compared with a view to determining the origins of these features and showing the large scale morphosyntactic convergence between Sinhala and Tamil and the divergence between Sinhala and other NIA languages. At the micro-level the dissertation analyzes in detail two morphosyntactic phenomena, namely null arguments and focus constructions. It examines whether subject/verb agreement, which is different across the two languages, plays a role in the licensing of null arguments in each language. It also examines the nature of the changes Sinhala morphosyntax has undergone because of the two kinds of Tamil focus constructions that Sinhala has replicated. It is hoped, that this dissertation will make a significant contribution to the knowledge and understanding of the morphosyntax of the two languages, the effects of language contact on morphosyntax, and more generally, the nature of linguistic variation.Scholarship Programme of the Higher Education for the Twenty First Century (HETC) Project, Ministry of Higher Education, Sri Lanka

Adaptive Data Migration in Load-Imbalanced HPC Applications

Distributed parallel applications need to maximize and maintain computer resource utilization and be portable across different machines. Balanced execution of some applications requires more effort than others because their data distribution changes over time. Data re-distribution at runtime requires elaborate schemes that are expensive and may benefit particular applications. This dissertation discusses a solution for HPX applications to monitor application execution with APEX and use AGAS migration to adaptively redistribute data and load balance applications at runtime to improve application performance and scaling behavior. This dissertation provides evidence for the practicality of using the Active Global Address Space as is proposed by the ParalleX model and implemented in HPX. It does so by using migration for the transparent moving of objects at runtime and using the Autonomic Performance Environment for eXascale library with experiments that run on homogeneous and heterogeneous machines at Louisiana State University, CSCS Swiss National Supercomputing Centre, and National Energy Research Scientific Computing Center

Software Metrics for Package Remodularisation

There is a plethora of software metrics \cite{Lore94a, Fent96a, Hend96a, Han00a, Lanz06a} and a large amount of research articles. Still there is a lack for a serious and practically-oriented evaluation of metrics. Often metrics lack the property that the software reengineer or quality expert can easily understand the situation summarized by the metrics. In particular, since the exact notion of coupling and cohesion is complex, a particular focus on such point is important. In the first chapter of the present document, we present a list of software metrics, that are commonly used to measure object-oriented programs. In the second chapter we present our proposition for package metrics that capture package aspects such as information hiding and change impact limits

Delivering on net zero: Scottish Agriculture

The aim of this study was to identify whether, how and at what cost agricultural GHG emissions in Scotland could be reduced by 35% by 2045. In 2017, Scottish agricultural GHG emissions were estimated to be 7.6 Mt CO2e making the 35% target 2.7 Mt CO2e. Building on previous work by SRUC and others, 37 different measures to reduce GHG emissions were evaluated, focusing on improvements in nitrogen fertiliser use, organic manure/slurry storage and use, mechanisation, soil management, cropping systems and management, livestock nutrition, health and breeding, as well as improved farming systems integrating multiple measures, represented by conservation agriculture, organic farming, pasture-fed livestock production and agroforestry. Land use changes, such as from agriculture to peatland or forestry, as well as non-agricultural activities (including input manufacturing, food processing, retailing and consumption) were outside the scope of the study, although consideration was given to food losses on farms arising from decisions in other sectors. Embodied GHG emissions in inputs and impacts of output changes on other countries were also not assessed. In theory, if taken up 100% and accounting for no interactions, the measures could reduce Scottish agricultural emissions by almost 100%. In practice, there are many reasons why measures might not be implemented in combination, or adopted, by all farmers. We estimated that the most promising measures could potentially deliver 2.9 Mt CO2e annually, or 38% of 2017 GHG emissions, and concluded that the 35% target is achievable by 2045. 75% of Scottish agricultural GHG emissions are related to livestock production. This is not surprising given the importance of grassland and rough grazing in Scottish agriculture, which together account for almost 80% of agricultural land. Given this context, measures focused on tillage crops are relatively unimportant with respect to their potential for GHG reduction. The measures with most potential (all specified on annual basis) that we identified were: a) Reduction in nitrogen fertiliser use. Measures to use nitrogen more efficiently, including better use of organic manures, could potentially generate reductions of nearly 350 kt CO2e, or 13% of the target, within the next 10 years, if adopted on most farms. b) More radical reductions in nitrogen fertiliser use, by encouraging the use of legumes in grassland to eliminate or substantially reduce the need for N fertiliser, could reduce emissions by nearly 300 kt CO2e, or 11% of the target, within the next 15 years, if adopted on 40% of grassland. c) The use of legumes combined with rotational grazing techniques in diverse-species grassland, which help build soil organic matter and sequester carbon, could increase the total benefit to 540 kt or 20% of the target. This could potentially be linked with a pasture-fed livestock approach. d) Reducing methane emissions associated with ruminants by using feed additives including 3NOP, nitrates, probiotics, high dietary fat sources and seaweed derivatives could make a significant contribution. In the case of 3NOP, emissions could be reduced by 265 kt or 10% of the target within 10 years, if adopted on most dairy and some other cattle farms. This would require approval of 3NOP as a feed additive so that it can be marketed, and that at an affordable price. e) Improved animal health and breeding, with increased fertility, growth rates and yields, and reduced morbidity/mortality could reduce total livestock numbers needed to deliver the same output, and deliver 366 kt emission reductions (14% of the target) with 40-50% uptake. f) Organic farming, with 40% uptake, could potentially deliver 730 kt CO2e reductions or 27% of the target. This is a result of combining no synthetic nitrogen fertiliser use with an overall 10% reduction in livestock numbers and the conversion of 20% of tillage land to rotational grassland. The financial impacts of these changes are reduced due to the premium markets for organic food. g) Agroforestry also offers potential for substantial reductions: 570 kt (21% of the target) with 30% uptake. This is assuming 10% of farmland is used for trees, with consequent output reductions for crops and livestock, although with some scope to mitigate this. Despite their emission reduction potential, organic farming and agroforestry both have the disadvantages of higher initial investment costs, greater complexity acting as a disincentive to adoption and longer lead-in times, as well as output reductions that, if demand remains unchanged, could lead to an increased requirement for imports and increased emissions elsewhere. However, the widespread adoption of these approaches would need to be considered in the context of changing human and animal diets, and the potential for reducing food losses and waste also highlighted in the report. The financial assessment of these measures indicates that many are likely to be associated with increased costs and, in the absence of other financial benefits, reduced incomes, which would need to be addressed by policy support in some form. In several cases, reductions in nitrate leaching, ammonia emissions and other impacts leading to improvements in water and air quality could provide further justifications for support. In some cases, the improved productivity, for example associated with improved animal health and breeding, could create a win-win situation, with emissions reduction combined with financial benefits. As most of the measures are unlikely to be driven by market forces, policy interventions are likely to be needed, including: • Farming system payments for innovative approaches (whole or part farm) • Input reduction and improved soil management, including support for advice and investments • Regulatory and fiscal options including input taxes and quotas or tradeable carbon quotas linked to input use and sequestration opportunties • Carbon, nitrogen and sustainability auditing • Training, advice and skills • Improved greenhouse gas monitoring and statistics • Targeted research, and • Dietary change and food waste reduction In almost all cases, the practices and systems that could be adopted are well developed and understood, but actions are needed to ensure that financial and knowledge barriers are addressed in order to facilitate their adoption so that the desired GHG mitigation targets can be achieved

Development of Conceptual Constructs for Organisational BIM Adoption and their Systematic Application within the UK Architecture Sector

Building Information Modelling (BIM) is an innovation that is transforming practices within the Architectural, Engineering, Construction and Operation (AECO) sectors. The investigation of the process of BIM adoption and diffusion has attracted significant interest from industry and academia. Drivers and factors influencing BIM adoption were examined at different levels, ranging from individual and group through organisations and supply chains to whole market level. However, there is still a dearth of studies that extensively integrate drivers and factors affecting the decision to adopt BIM by organisations. Existing studies often seek to develop approaches for forecasting BIM diffusion, and are generally focused on the diffusion phase, after BIM has been adopted. Therefore, this study aims to improve the understanding of the BIM adoption process within organisations and across markets by developing the necessary conceptual constructs (e.g., BIM adoption taxonomy, adoption process model, adoption two-dimensional characterisation model, and systems thinking models) and providing the supporting empirical evidence. This study provided an in-depth analysis of the BIM adoption process within organisations. It developed a unified BIM adoption taxonomy that contains an extensive array of adoption factors. Following the validation of the taxonomy, its factors were used within a proposed conceptual model, which combined the Innovation Diffusion Theory with the Institutional Theory, to perform a multifaceted analysis of the BIM adoption process. A set of 11 most influencing factors on BIM adoption process was identified and included: Willingness to adopt BIM, Communication behaviour of an organisation, Observability of BIM benefits, Compatibility of BIM, Social motivations among organisation's members, Relative advantage of BIM, Organisational culture, Top management support, Organisational readiness, Coercive pressures (Governmental mandate, informal mandate), and Organisation size. Focussing on these 11 most influencing factors, several analyses were performed to understand the interplays between these factors - while considering specific instances of certain factors (i.e. organisation size, and external isomorphic pressure) over time (i.e., Pre-2011, 2011-2016, and Post-2016 exemplifying three key time periods in the UK national BIM strategy). The results showed that the Relative advantage of BIM is the most important and influencing factor across all the three stages of the adoption process (i.e., Awareness stage, Intention stage, and Decision stage) of the BIM adoption process. Coercive pressures (e.g. Governmental mandate, informal mandate) had a direct influence on both formulating the intention and the decision to adopt BIM across the three-time horizons (i.e., Pre-2011, 2011-2016, and Post-2016). For the Pre-2011 period, the coercive pressures were mostly informal mandate/pressures by the parent companies and partners, while during 2011-2016 and Post-2016 periods, it is predominantly the UK Government mandate which was announced in 2011 and entered into effect in 2016. Several Systems Thinking models were developed to show the interdependencies among the factors that affect the BIM adoption process at different time periods and stages of the BIM adoption process. Such models infer patterns of behaviour of BIM adoption as complex systems and can be used to guide the development and implementation of BIM strategies. For example, by relating each factor within the system thinking model to the player group(s) who can exert influence upon it, the complementary role of the player groups can be planned to facilitate the BIM adoption process according to the patterns identified in the corresponding systems thinking model. The different patterns developed through the specialised systems thinking models can be used to develop tailored BIM adoption strategies for the different scenarios involved. At a global level (overall aim), this study provided an understanding of how intra-organisational BIM adoption and inter-organisational BIM diffusion occurs. At a local level (individual objectives), the key knowledge deliverables in this study (i.e., the taxonomy, conceptual model for BIM adoption process, two-dimensional characterisation model of BIM adoption, and systems thinking models) and the empirical investigation represent a new contribution to knowledge with each contributing from a specific standpoint. The Unified BIM Adoption Taxonomy is the first – if not the sole – statistically validated BIM adoption taxonomy that includes an extensive array of adoption drivers and factors and combines constructs from both the Institutional and the Innovation Diffusion theories. The conceptual model for analysing BIM adoption and its use for the empirical investigation of BIM adoption within the UK Architecture sector explored and identified relationships that were not known before (i.e., triggering the BIM Awareness and formulating an Intention about BIM adoption is not limited to Internal Environment Characteristics and the Innovation Characteristics respectively - as suggested by Rogers’ theory, but occurs by a combination of both characteristics). The two-dimensional characterisation model of BIM adoption clarified new interplays between adoption factors, the organisation size, and time (i.e., pairs of positively and negatively correlated factors vary based on time horizon). The classification of factors into cause and effect groups using the F-DEMATEL provided a new understanding of the independencies between factors which can be used to tailor and prioritise implementation actions and investments. The developed Systems Thinking Models enabled an attentive analysis of mutual interactions between adoption factors as part of a causal relationship networks. The developed instances of such models for different temporal scenarios and stages of the BIM adoption stage can be exploited by the industry player groups (i.e., Policy-makers, decision-makers, change agents, etc.) to promote BIM adoption process within the organisations and BIM diffusion across a market. The key knowledgeable deliverables can be used to perform various analyses of the BIM adoption process, providing evidence and insights for decision-makers within organisations and across a whole market when formulating BIM adoption and diffusion strategies. In particular, they can assist researchers, decision-makers, and policy-makers with a better understanding of the BIM adoption process and can guide the development of BIM strategies and plan for BIM adoption and diffusion. Ultimately, they contribute to promote BIM adoption within the architectural sector through the suggested adoption patterns