Evaluating the articulation of programme theory in practice as observed in Quality Improvement initiatives

Background: The Action-Effect Method(AEM) was co-developed by NIHR CLAHRC Northwest London (CLAHRC NWL) researchers and QI practitioners, building on Driver Diagrams(DD). This study aimed to determine AEM effectiveness in terms of technical aspects (how diagrams produced in practice compared with theoretical ideals) and social aspects (how engagement with the method related to social benefits). Methods Diagrams were scored on criteria developed on theoretical ideals of programme theory. 65 programme theory diagrams were reviewed (21 published Driver Diagrams (External DDs), 22 CLAHRC NWL Driver Diagrams (Internal DDs), and 21 CLAHRC NWL Action-Effect Diagrams(AEDs)). Social functions were studied through ethnographic observation of frontline QI teams in AEM sessions facilitated by QI experts. Qualitative analysis used inductive and deductive coding. Results ANOVA indicated the AEM significantly improved the quality of programme theory diagrams over Internal and External DDs on an average of 5 criteria from an 8-point assessment. Articulated aims were more likely to be patient-focused and high-level in AEDs than DDs. The cause/effect relationships from intervention to overall aim also tended to be clearer and were more likely than DDs to contain appropriate measure concepts. Using the AEM also served several social functions such as facilitating dialogue among multidisciplinary teams, and encouraging teams to act scientifically and pragmatically about planning and measuring QI interventions. Implications: The Action-Effect Method developed by CLAHRC NWL resulted in improvements over Driver Diagrams in articulating programme theory, which has wide-ranging benefits to quality improvement, including encouraging broad multi-disciplinary buy-in to clear aims and pre-planning a rigorous evaluation strategy

Impact of Driving Cycles on Greenhouse Gas (GHG) Emissions, Global Warming Potential (GWP) and Fuel Economy for SI Car Real World Driving

The transport sector is one of the major contributors to greenhouse gas emissions. This study investigated three greenhouse gases emitted from road transport: CO2, N2O and CH4 emissions as a function of engine warm up and driving cycles. Five different urban driving cycles were developed and used including free flow driving and congested driving. An in-vehicle FTIR (Fourier Transform Inferred) emission measurement system was installed on a EURO2 emission compliant SI (Spark Ignition) car for emissions measurement at a rate of 0.5 HZ under real world urban driving conditions. This emission measurement system was calibrated on a standard CVS (Constant Volume Sampling) measurement system and showed excellent agreement on CO2 measurement with CVS results. The N2O and CH4 measurement was calibrated using calibration gas in lab. A MAX710 real time in-vehicle fuel consumption measurement system was installed in the test vehicle and real time fuel consumption was then obtained. The temperatures across the TWC (Three Way Catalyst) and engine out exhaust gas lambda were measured. The GHG (greenhouse gas) mass emissions and consequent GWP (Global Warming Potential) for different urban diving conditions were analyzed and presented. The results provided a better understanding of traffic related greenhouse gas emission profile in urban area and will contribute to the control of climate change

Assessing the sustainability literacy of the Nigerian engineering community

Being the lifeblood of socioeconomic progress, engineering is implicated in the unprecedented challenge of sustainability. The global engineering community devised sustainable engineering as a conceptual departure from conventional engineering practices. However, the extent to which the sustainability worldview has permeated the Nigerian engineering community remains unanswered. This paper is an attempt to answer the question of how sustainability literate are the members of the Nigerian engineering community. The paper undertakes an assessment of the sustainability literacy of the community with the aid of a stakeholder survey and a devised sustainability literacy test. Three criteria that are used to gauge the stakeholders’ sustainability literacy are awareness of the UN Decade of Education for Sustainable Development, score on the sustainability literacy test, and self-assessment of sustainability knowledge. Survey participants were recruited mainly from two federally-run Nigerian higher education institutions, and engineering professional associations. The assessment reveals an unsatisfactory performance of the Nigerian engineering stakeholders on all three sustainability literacy criteria. The results show that the majority of the students (81%), educators (67%), and practitioners (64%) were unaware of the UNDESD. The paper therefore highlights the need to improve the sustainability literacy of the Nigerian engineering community, possibly through a sustainability education intervention

Capturing the realities of sports programmes: systematic ‘messiness’?

Early workings based on traditional methods (Schuman, 1967, as cited in Clarke and Dawson, 1999) have given way to more pragmatic, social paradigms with scientific realism (Pawson and Tilley, 1997) and evaluation utility (Patton, 2002) establishing evaluation research as a specialist area of applied social research. There has been more pressure for those who work in community sport to deliver with evaluation in mind. This can be interpreted as the government demanding greater accountability for its investment, but it is more than that. Community sport needs to modernise. It needs to be able to fully explain not just what works but why it works. Given the current economic and political instabilities, sport needs to work harder than ever to establish itself as a mainstream function of our communities needs and development (Coalter, 2007). Evaluation may not be a panacea but it will provide support in terms of evidence based decisions and stronger rationales for community sport’s existence. Evaluation is not an exact science and draws on a number of disciplines, using an eclectic repertoire of concepts and methods (Rossi, et al. 2004). To this end, this positional paper will reflect on the processes of a six-year community sport and physical activity strategy evaluation. Recommendations based on the reflection will be acknowledged. The strategy and the evaluation (Daniels, 2016) were developed by the Community Sport Network for this region and involved expertise from the Manchester Metropolitan University, public sector sport development and third sector sports clubs whose projects where supported by Sport England’s Community Investment Fund. The paper will present outcome patterns for the strategy and explain the methods that helped build them

Simple rules for evidence translation in complex systems: a qualitative study

Background Ensuring patients benefit from the latest medical and technical advances remains a major challenge, with rational-linear and reductionist approaches to translating evidence into practice proving inefficient and ineffective. Complexity thinking, which emphasises interconnectedness and unpredictability, offers insights to inform evidence translation theories and strategies. Drawing on detailed insights into complex micro-systems, this research aimed to advance empirical and theoretical understanding of the reality of making and sustaining improvements in complex healthcare systems. Methods Using analytical auto-ethnography, including documentary analysis and literature review, we assimilated learning from 5 years of observation of 22 evidence translation projects (UK). We used a grounded theory approach to develop substantive theory and a conceptual framework. Results were interpreted using complexity theory and ‘simple rules’ were identified reflecting the practical strategies that enhanced project progress. Results The framework for Successful Healthcare Improvement From Translating Evidence in complex systems (SHIFT-Evidence) positions the challenge of evidence translation within the dynamic context of the health system. SHIFT-Evidence is summarised by three strategic principles, namely (1) ‘act scientifically and pragmatically’ – knowledge of existing evidence needs to be combined with knowledge of the unique initial conditions of a system, and interventions need to adapt as the complex system responds and learning emerges about unpredictable effects; (2) ‘embrace complexity’ – evidence-based interventions only work if related practices and processes of care within the complex system are functional, and evidence-translation efforts need to identify and address any problems with usual care, recognising that this typically includes a range of interdependent parts of the system; and (3) ‘engage and empower’ – evidence translation and system navigation requires commitment and insights from staff and patients with experience of the local system, and changes need to align with their motivations and concerns. Twelve associated ‘simple rules’ are presented to provide actionable guidance to support evidence translation and improvement in complex systems. Conclusion By recognising how agency, interconnectedness and unpredictability influences evidence translation in complex systems, SHIFT-Evidence provides a tool to guide practice and research. The ‘simple rules’ have potential to provide a common platform for academics, practitioners, patients and policymakers to collaborate when intervening to achieve improvements in healthcare

Most Complex Non-Returning Regular Languages

A regular language $L$ is non-returning if in the minimal deterministic finite automaton accepting it there are no transitions into the initial state. Eom, Han and Jir\'askov\'a derived upper bounds on the state complexity of boolean operations and Kleene star, and proved that these bounds are tight using two different binary witnesses. They derived upper bounds for concatenation and reversal using three different ternary witnesses. These five witnesses use a total of six different transformations. We show that for each $n\ge 4$ there exists a ternary witness of state complexity $n$ that meets the bound for reversal and that at least three letters are needed to meet this bound. Moreover, the restrictions of this witness to binary alphabets meet the bounds for product, star, and boolean operations. We also derive tight upper bounds on the state complexity of binary operations that take arguments with different alphabets. We prove that the maximal syntactic semigroup of a non-returning language has $(n-1)^n$ elements and requires at least $\binom{n}{2}$ generators. We find the maximal state complexities of atoms of non-returning languages. Finally, we show that there exists a most complex non-returning language that meets the bounds for all these complexity measures.Comment: 22 pages, 6 figure

Electron gyroscale fluctuation measurements in National Spherical Torus Experiment H-mode plasmas

A collective scattering system has measured electron gyroscale fluctuations in National Spherical Torus Experiment [M. Ono et al., Nucl. Fusion 40, 557 (2000)] H-mode plasmas to investigate electron temperature gradient (ETG) turbulence. Observations and results pertaining to fluctuation measurements in ETG-stable regimes, the toroidal field scaling of fluctuation amplitudes, the relation between fluctuation amplitudes and transport quantities, and fluctuation magnitudes and k-spectra are presented. Collectively, the measurements provide insight and guidance for understanding ETG turbulence and anomalous electron thermal transport. (C) 2009 American Institute of Physics. [doi:10.1063/1.3262530]X116sciescopu