A knowledge creation perspective on ‘LEAN’ approaches to policing in England and Wales

The police service in England and Wales continue to face intense pressures to manage and reduce budgets while simultaneously maintaining and improving levels of service. In achieving reform, attention has been directed towards the implementation of proven operational improvement frameworks, such as ‘lean thinking’ taken from the automotive industry. However, the qualitatively different contexts have resulted in ‘lean’ interventions making only limited contribution to police reform. This research draws on contemporary views of ‘lean’ as a knowledge creation process to assess how such a reconceptualization may contribute to more successful police transformation

From footway design to the street environment: removing the barriers to walking

7-9 October 200

Mapping the Curricular Structure and Contents of Network Science Courses

As network science has matured as an established field of research, there are already a number of courses on this topic developed and offered at various higher education institutions, often at postgraduate levels. In those courses, instructors adopted different approaches with different focus areas and curricular designs. We collected information about 30 existing network science courses from various online sources, and analyzed the contents of their syllabi or course schedules. The topics and their curricular sequences were extracted from the course syllabi/schedules and represented as a directed weighted graph, which we call the topic network. Community detection in the topic network revealed seven topic clusters, which matched reasonably with the concept list previously generated by students and educators through the Network Literacy initiative. The minimum spanning tree of the topic network revealed typical flows of curricular contents, starting with examples of networks, moving onto random networks and small-world networks, then branching off to various subtopics from there. These results illustrate the current state of consensus formation (including variations and disagreements) among the network science community on what should be taught about networks and how, which may also be informative for K--12 education and informal education.Comment: 17 pages, 11 figures, 2 tables; to appear in Cramer, C. et al. (eds.), Network Science in Education -- Tools and Techniques for Transforming Teaching and Learning (Springer, 2017, in press

Mediating boundaries between knowledge and knowing: ICT and R4D praxis

Research for development (R4D) praxis (theory-informed practical action) can be underpinned by the use of Information and Communication Technologies (ICTs) which, it is claimed, provide opportunities for knowledge working and sharing. Such a framing implicitly or explicitly constructs a boundary around knowledge as reified, or commodified – or at least able to be stabilized for a period of time (first order knowledge). In contrast ‘third-generation knowledge’ emphasizes the social nature of learning and knowledge-making; this reframes knowledge as a negotiated social practice, thus constructing a different system boundary. This paper offers critical reflections on the use of a wiki as a data repository and mediating technical platform as part of innovating in R4D praxis. A sustainable social learning process was sought that fostered an emergent community of practice among biophysical and social researchers acting for the first time as R4D co-researchers. Over time the technologically mediated element of the learning system was judged to have failed. This inquiry asks: How can learning system design cultivate learning opportunities and respond to learning challenges in an online environment to support R4D practice? Confining critical reflection to the online learning experience alone ignores the wider context in which knowledge work took place; therefore the institutional setting is also considered

Functional outcome of patients with spinal cord injury: rehabilitation outcome study

Objective: To increase our knowledge of neurological recovery and functional outcome of patients with spinal cord injuries in order to make more successful rehabilitation programmes based on realistic goals.Design: Descriptive analysis of data gathered in an information system.Setting: Rehabilitation centre in The Netherlands with special department for patients with spinal cord injuries.Subjects: Fifty-five patients with traumatic spinal cord lesions admitted to the rehabilitation centre from 1988 to 1994. Main outcome measures: The functional improvement was presented in terms of progress in independence in nine daily activity skills. Independence was rated on a four-point scale.Results: From admission to discharge, lesions in 100% of patients with tetraplegia and 96% of patients with paraplegia remained complete. Significant progress in independence was made in self-care, ambulation and bladder and bowel care. Differences were found in the extent of functional improvement between subgroups of patients with different levels and extent of lesion. Contrary to expectations based on theoretical models, patients with complete paraplegia did not achieve maximal independence in self-care. Independent walking was only attained by patients with incomplete lesions. Regarding outcome of bladder and bowel care, poor results were found, especially the independence in defaecation and toilet transfers.Conclusions: The results of this study provided more insight into the functional outcome of a group of patients with traumatic spinal cord injury. More research is needed to evaluate the rehabilitation programmes for these patients

Validation of chronic obstructive pulmonary disease recording in the Clinical Practice Research Datalink (CPRD-GOLD)

Objectives: The optimal method of identifying people with chronic obstructive pulmonary disease (COPD) from electronic primary care records is not known. We assessed the accuracy of different approaches using the Clinical Practice Research Datalink, a UK electronic health record database. Setting: 951 participants registered with a CPRD practice in the UK between 1 January 2004 and 31 December 2012. Individuals were selected for ≥1 of 8 algorithms to identify people with COPD. General practitioners were sent a brief questionnaire and additional evidence to support a COPD diagnosis was requested. All information received was reviewed independently by two respiratory physicians whose opinion was taken as the gold standard. Primary outcome measure: The primary measure of accuracy was the positive predictive value (PPV), the proportion of people identified by each algorithm for whom COPD was confirmed. Results: 951 questionnaires were sent and 738 (78%) returned. After quality control, 696 (73.2%) patients were included in the final analysis. All four algorithms including a specific COPD diagnostic code performed well. Using a diagnostic code alone, the PPV was 86.5% (77.5-92.3%) while requiring a diagnosis plus spirometry plus specific medication; the PPV was slightly higher at 89.4% (80.7-94.5%) but reduced case numbers by 10%. Algorithms without specific diagnostic codes had low PPVs (range 12.2-44.4%). Conclusions: Patients with COPD can be accurately identified from UK primary care records using specific diagnostic codes. Requiring spirometry or COPD medications only marginally improved accuracy. The high accuracy applies since the introduction of an incentivised disease register for COPD as part of Quality and Outcomes Framework in 2004

The Chelsea Critical Care Physical Assessment Tool (CPAx): validation of an innovative new tool to measure physical morbidity in the general adult critical care population; an observational proof-of-concept pilot study.

Objective To develop a scoring system to measure physical morbidity in critical care – the Chelsea Critical Care Physical Assessment Tool (CPAx). Method The development process was iterative involving content validity indices (CVI), a focus group and an observational study of 33 patients to test construct validity against the Medical Research Council score for muscle strength, peak cough flow, Australian Therapy Outcome Measures score, Glasgow Coma Scale score, Bloomsbury sedation score, Sequential Organ Failure Assessment score, Short Form 36 (SF-36) score, days of mechanical ventilation and inter-rater reliability. Participants Trauma and general critical care patients from two London teaching hospitals. Results Users of the CPAx felt that it possessed content validity, giving a final CVI of 1.00 (P < 0.05). Construct validation data showed moderate to strong significant correlations between the CPAx score and all secondary measures, apart from the mental component of the SF-36 which demonstrated weak correlation with the CPAx score (r = 0.024, P = 0.720). Reliability testing showed internal consistency of α = 0.798 and inter-rater reliability of κ = 0.988 (95% confidence interval 0.791 to 1.000) between five raters. Conclusion This pilot work supports proof of concept of the CPAx as a measure of physical morbidity in the critical care population, and is a cogent argument for further investigation of the scoring system