Seeking the Pressure Points: Catalysing Low Carbon Changes from the Middle-Out in Offices and Schools

Non-domestic buildings are frequently characterised as resistant to top-down low-carbon and energy-efficiency policy. Complex relationships amongst building stakeholders are often blamed. “Middle actors”—professionals situated between policymakers and building users—can use their agency and capacity to facilitate energy and carbon decision-making from the “middle-out”. We use semi-structured interviews with expert middle actors working with schools and commercial offices, firstly, to explore their experience of energy and low-carbon decision-making in buildings and, secondly, to reflect on the evolution of middle actors’ role within it. Our exploratory findings suggest that a situated sensitivity to organisational “pressure points” can enhance middle actors’ agency and capacity to catalyse change. We find shifts in the ecology of the “middle”, as the UK’s Net Zero and Environmental, Social and Governance (ESG) agendas pull in new middle actors (such as the financial community) and issues (such as wellbeing and social value) to non-domestic buildings. These issues may work in reinforcing ways with organisational pressure points. Policy should capitalise on this impetus by looking beyond the physicality of individual buildings and engage with middle actors at a systemic level. This could create greater synergies with organisational concerns and strategies of building stakeholders

An Adaptive Fuzzy Logic System for the Compensation of Nonlinear Distortion in Wireless Power Amplifiers

Computational intelligent systems are becoming an increasingly attractive solution for power amplifier (PA) behavioural modelling, due to their excellent approximation capability. This paper utilizes an adaptive fuzzy logic system (AFLS) for the modelling of the highly nonlinear MIMIX CFH2162-P3 PA. Moreover, PA’s inverse model based also on AFLS has been developed in order to act as a pre-distorter unit. Driving an LTE 1.4 MHz 64 QAM signal at 880 MHz as centre frequency at PA’s input, very good modelling performance was achieved, for both PA’s forward and inverse dynamics. A comparative study of AFLS and neural networks (NN) has been carried out to establish AFLS as an effective, robust, and easy-to-implement baseband model, which is suitable for inverse modelling of PAs and capable to be used as an effective digital pre-distorter. Pre-distortion system based on AFLS, achieved distortion suppression of 84.2%, compared to the 48.4% gained using the NN-based equivalent schem

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Owner-managed SME responses to innovative energy data and management tools: an action research case study

SMEs use more than 13% of global energy, so they are an important target to help achieve UK Net Zero targets. However, SMEs manage energy poorly, and little is understood about how to influence them to improve energy management. Responding to this challenge, from 2018-2020, the UK Government delivered an £8.8 million Non-Domestic Smart Energy Management Innovation Competition (NDSEMIC), which funded the development of innovative smart meter data-based energy management tools. This thesis presents an action research study exploring the question: How do owner-managed SMEs respond to the development and testing of new smart meter data-based energy management tools? The study involved working with one of the Competition participants, a technology innovation business, to inform the design of the tools from which a prototype was developed. Subsequently, the tools were tested, and other applications for smart meter and related data were explored with three owner-managed SMEs, two small independent chains of coffee-shops and cycle-shops and a coffee roastery business. The findings identify that SMEs respond entrepreneurially to developing and testing smart meter data-based tools. Entrepreneurial activities led to identifying new potential uses for the tools to those anticipated at the outset; identifying operational roles, such as managing quality, productivity and premises security. Entrepreneurialism theory, developed in SME business management research includes heuristics called Causation, Effectuation and Absence of Strategy. These heuristics are used to help better understand SME decision-making when responding to the development and testing of new energy management tools. These heuristics are recommended as a helpful approach to better conceptualise how to influence SME decision-making to improve energy management