Patient and health care professional decision-making to commence and withdraw from renal dialysis: A systematic review of qualitative research

Background and objectives. To ensure decisions to start and stop dialysis in end stage kidney disease are shared, the factors that affect patients and healthcare professionals in making such decisions need to be understood. This systematic review aims to explore how and why different factors mediate the choices about dialysis treatment. Design, setting, participants, and measurements. Medline, Embase, CINAHL and PsychINFO were searched for qualitative studies of factors that affect patients’ and/or healthcare professionals’ decisions to commence or withdraw from dialysis. A thematic synthesis was conducted. Results. Of 494 articles screened, 12 studies (conducted: 1985-2014) were included. These involved 206 predominantly haemodialysis patients and 64 healthcare professionals (age range: patients 26-93; professionals 26-61 years). (i) Commencing dialysis: patients based their choice on ‘gut-instinct’ as well as deliberating the impact of treatment on quality-of-life and survival. How individuals coped with decision-making was influential, some tried to take control of the problem of progressive renal failure, whilst others focussed on controlling their emotions. Healthcare professionals weighed-up biomedical factors and were led by an instinct to prolong life. Both patients and healthcare professionals described feeling powerless. (ii) Dialysis withdrawal: Only after prolonged periods of time on dialysis, were the realities of life on dialysis fully appreciated and past choice questioned. By this stage however patients were physically treatment dependent. Similar to commencing dialysis, individuals coped with treatment withdrawal in a problem or emotion-controlling way. Families struggled to differentiate choosing versus allowing death. Healthcare teams avoided and queried discussions regarding dialysis withdrawal. Patients however missed the dialogue they experienced during pre-dialysis education. Conclusions. Decision-making in end stage kidney disease is complex, dynamic, and evolves over time and towards death. The factors at work are multi-faceted and operate differently for patients and health professionals. More training and research on open-communication and shared decision-making is needed

When Service Ecosystems Collapse: Understanding the Demise of the UK Green Deal

The concept of the service ecosystem is increasingly being drawn upon to explain the drivers, occurrences and consequences of socio-economic actors’ service exchanges towards value creation. Existing research has proposed how service ecosystems may successfully transform, but no work to our knowledge has examined how transformations may fail. To address this gap, this paper examines how a service ecosystem fails to transform and survive by developing a conceptual framework based on the concept of entropy from systems theory. A series of propositions are formulated, linking inadequate management of entropy to a service ecosystem’s subsequent state of disorder and collapse. The conceptual framework is illustrated through a unique case: the introduction and demise of the Green Deal in the UK. We propose that entropy is intrinsically embedded in systems’ trajectories and can be understood as the tendency towards loss of value co-creation. The viability of a service ecosystem depends on its capacity to reduce entropy, which requires continuous action to import resources from the environment, achieve heteropathic resource integration and/or re-institutionalise. Where systemic actors and networks of actors within the system fail to manage increasing entropy, resources from the system are dissipated back to the environment and institutional arrangements collapse

Beyond drivers and barriers: a theoretical framework addressing the engagement of UK construction practitioners in retrofit for energy efficiency

To meet statutory carbon reduction targets in the UK, a radical transformation of existing building stock is needed. To achieve this, engagement of the practitioners involved in the Repair-Maintain-Improve (RMI) subsector – small builders and tradespeople - is essential. Previous attempts at investigating this topic have been atheoretical, presenting lists of drivers and barriers. Such lists are frequently arbitrarily categorised, limiting their usefulness to programmes of change. This study makes a novel contribution by applying an established model of behaviour change, the Capability, Opportunity, Motivation – Behaviour (COM-B) model, to a data set of 31 interviews with RMI practitioners in the UK. COM-B proposes that behaviour results from individuals possessing the capability to take action as well as the opportunity and the motivation to do so. The analysis identified capabilities including knowledge and co-ordination of people and resources; opportunities including state action and customer demand; and motivations including pride in work, maintaining a viable business, and co-worker and customer relationships. Recommendations are presented on the implications for policy. For successful transition to zero carbon homes, initiatives are needed to address the multiple factors which determine engagement in energy-efficient retrofit: capacities, opportunities and motivations

Domestic retrofit: understanding capabilities of micro enterprise building practitioners

To deliver effective domestic retrofit at scale, it is essential to understand the current and required capabilities of building practitioners working in the repair, maintenance and improvement (RMI) of existing buildings. Capability research in the construction sector has previously focused on large projects, but small, and particularly, micro-firms that undertake RMI and form 77% of workers in construction, are under-researched. This gap is addressed by the present study on the capabilities of the practitioners and the contextual opportunities to deploy capabilities. The study analysed data from interviews (n = 27) with micro-enterprise building practitioners working in the UK’s RMI sector. Template analysis was conducted by applying an established model of behaviour change: Capability, Opportunity, Motivation—Behaviour (COM-B). Under Capability, three main themes were identified: knowledge, business management and individual characteristics. Under Opportunities, the main themes were state action, market and customer demand, technology diffusion, networks and business management. Under Motivation the themes were pride in work, good working relationships, maintaining a viable business and customer satisfaction. Practitioners are continually learning and problem-solving, developing trust and creating positive professional relationships. Working with these existing capabilities, experiential learning on-site and peer-to-peer training are recommended to scale up capability. For capabilities to be deployed, policy must enable opportunities across the multiple contexts micro-enterprise practitioners operate within, including training and incentives across the supply chain network and in stimulating demand

A study of polar ozone depletion based on sequential assimilation of satellite data from the ENVISAT/MIPAS and Odin/SMR instruments

International audienceThe objective of this study is to demonstrate how polar ozone depletion can be mapped and quantified by assimilating ozone data from satellites into the wind driven transport model DIAMOND, (Dynamical Isentropic Assimilation Model for OdiN Data). By assimilating a large set of satellite data into a transport model, ozone fields can be built up that are less noisy than the individual satellite ozone profiles. The transported fields can subsequently be compared to later sets of incoming satellite data so that the rates and geographical distribution of ozone depletion can be determined. By tracing the amounts of solar irradiation received by different air parcels in a transport model it is furthermore possible to study the photolytic reactions that destroy ozone. In this study, destruction of ozone that took place in the Antarctic winter of 2003 and in the Arctic winter of 2002/2003 have been examined by assimilating ozone data from the ENVISAT/MIPAS and Odin/SMR satellite-instruments. Large scale depletion of ozone was observed in the Antarctic polar vortex of 2003 when sunlight returned after the polar night. By mid October ENVISAT/MIPAS data indicate vortex ozone depletion in the ranges 80?100% and 70?90% on the 425 and 475 K potential temperature levels respectively while the Odin/SMR data indicates depletion in the ranges 70?90% and 50?70%. The discrepancy between the two instruments has been attributed to systematic errors in the Odin/SMR data. Assimilated fields of ENVISAT/MIPAS data indicate ozone depletion in the range 10?20% on the 475 K potential temperature level, (~19 km altitude), in the central regions of the 2002/2003 Arctic polar vortex. Assimilated fields of Odin/SMR data on the other hand indicate ozone depletion in the range 20?30%

Florida Energy Assurance Plan

This spring, Florida held the nations first statewide emergency preparedness training and exercises geared specifically to the aftermath of severe geomagnetic events. Funded by the State of Florida Division of Emergency Management (FDEM) via a Department of Energy grant and held in collaboration with Watch House International, Inquesta Corporation, and the Florida Institute of Technology, the 17-19 April 2012 workshop had 99 on-site attendees in an oceanfront hotel in Melbourne, Florida, as well as 16 over live Web streaming. The workshop was the capstone to a three-month season of 21 regional space weather training sessions and workshops serving 386 attendees in total

Engaging UK repair–maintain–improve practitioners in improved building performance

Purpose: To improve building performance and meet statutory carbon reduction targets, a radical transformation of existing UK building stock is needed. Much previous research on building performance has focussed on large-scale construction. However, retrofit of existing housing stock – which will contribute the majority of the requisite efficiency improvement – is carried out by practitioners in the repair–maintain–improve (RMI) subsector. These practitioners are the sole traders and micro-firms who constitute two-fifths of employment in the construction sector. The study aims to examine the factors influencing these practitioners in RMI work to understand how better to engage them with improved building performance. Design/methodology/approach: A total of 31 semi-structured interviews were conducted with RMI professionals from around the UK and analysed using template analysis. Findings: The analysis identified capabilities of the practitioners who influence building performance, including knowledge and co-ordination of people and resources; opportunities including state action and customer demand; and motivations including pride in work, customer care and satisfaction, maintaining a viable business and working relationships. Research limitations/implications: The participants were a small, mixed group in terms of firm size and specialisation. The qualitative approach adopted provided detailed insights but does not make claims for statistical generalisability or representativeness of the findings. Future work could look to extend the findings with a statistically representative survey. Practical implications: For a successful transition to high standards of building performance, modelling is not enough. Initiatives are needed to address the multiple factors which determine engagement in energy-efficient retrofit: capacities, opportunities and motivations. The desire of RMI practitioners to meet customer expectations could be used to develop pragmatic building performance evaluation, guided by householder satisfaction criteria. Originality/value: The study examined the attitudes and experiences of an under-researched sector who are essential to the delivery of improved building performance. This study makes a novel contribution by applying an established psychological model of behaviour change, the capability, opportunity, motivation – behaviour model, for the first time in this domain