Embodied CO2 analysis of a secondary school

This paper describes the process, challenges and results of a carbon profiling tool used as part of the design process at White Design Associates. The paper first explores the need amongst designers for a carbon profiling tool to enable and encourage a focus on carbon reduction, as a key element in the fight against global warming. Next it describes the methodology adopted by White Design Associates to develop a tool to be used throughout the building design process, to inform design decisions, and begin to quantify the climate change impact of the finished building. Examples from the most recent iteration of the tool, used during the construction of John Ferneley College, illustrate the development of the tool, the challenges that were faced, and the "headline" results of the analysis. It also illustrates how White Design incorporated the results into the curriculum through web updates and highlights the Carbon Stacks visualisation tool

Carriage of Staphylococcus aureus in the elderly

The point prevalence and incidence of Staphylococcus aureus (methicillin-sensitive and -resistant) carriage by inpatients on acute elderly care wards was estimated. The relationship to body site and to previous admissions to hospital or other institutions was determined. Fifty-five patients were included in the point prevalence study and 136 in the incidence study, which was performed over a two-month period. One in three patients carried S. aureus and 1 in 20 was infected. The incidence rate for MRSA was 2.9%. No endemic strain was found. Nostrils were significantly associated with carriage, and skin break isolates were significant in the point prevalence survey. Screening these sites alone would be most cost effective

Prognostic value of lymph node ratio and extramural vascular invasion on survival for patients undergoing curative colon cancer resection

There was no study funding. We are grateful to Tony Rafferty (Tailored Information for the People of Scotland, TIPs) for providing survival data.Peer reviewedPublisher PD

Principles for the design and operation of engineer-to-order supply chains in the construction sector

By integrating the approaches of Forrester and Burbidge [Forrester, J. W. 1961. Industrial Dynamics. Pegasus Communications; Burbidge, J. L. 1961. “The “New Approach” to Production.” Production Engineer 40: 769–784], a set of five design principles have emerged which provide a foundation for sound supply chain design. The ‘FORRIDGE’ principles have since been shown to be a powerful guide for effective design of make-to-stock supply chains. However, some have questioned the applicability of generic supply chain thinking, arguing for a tailored approach. Hence, the goal here is to investigate how these principles should be adapted for engineer-to-order (ETO) industries, such as construction, capital goods and shipbuilding. The empirical elements draw on an extensive study of 12 suppliers and two large contractors in the construction industry. Supply chain tactics are identified for this range of companies, which are matched with real world problems, and linked with the FORRIDGE principles. This results in an additional ‘Design for X’ principle being proposed. The contributions made are the adaptation of established principles for the ETO sector, and the framework behind these principles

Projecting Pharmaceutical Expenditure in EU5 to 2021: Adjusting for the Impact of Discounts and Rebates

Within (European) healthcare systems, the main goal for pharmaceutical expenditure is cost containment. This is due to a general belief among healthcare policy makers that pharmaceutical expenditure—driven by high prices—will be unsustainable unless further reforms are enacted.The aim of the research published in this paper is to provide more realistic expectations of pharmaceutical expenditure for all key stakeholder groups by estimating pharmaceutical expenditure at ‘net’ prices. We also aim to estimate any gaps developing between list and net pharmaceutical expenditure for the EU5 countries (i.e. France, Germany, Italy, Spain, and the UK). We adjusted an established forecast of pharmaceutical expenditure for the EU5 countries, from 2017 to 2021, by reflecting discounts and rebates not previously considered, i.e. we moved from ‘list’ to ‘net’ prices, as far as data were available.We found an increasing divergence between expenditure measured at list and net prices. When the forecasts for the five countries were aggregated, the EU5 (unweighted) average historical growth (2010–2016) rate fell from 3.4% compound annual growth rate at list to 2.5% at net. For the forecast, the net growth rate was estimated at 1.5 versus 2.9% at list.Our results suggest that future growth in pharmaceutical expenditure in Europe is likely to be (1) lower than previously understood from forecasts based on list prices and (2) below predicted healthcare expenditure growth in Europe and in line with long-term economic growth rates. For policy makers concerned about the sustainability of pharmaceutical expenditure, this study may provide some comfort, in that the perceived problem is not as large as expected

Exploiting the concept of a manufacturing system part I

Purpose – The purpose of this paper is to establish the influence and discipline of process control and systems engineering theory plus engineering practices in the chemical process industry on current operations management development. Thus, part I lays the requisite groundwork for subsequent papers, part II covering the concept of a manufacturing system and part III its expansion and exploitation into the managing-by-projects engineering change methodology to output an integrated whole. Design/methodology/approach – Extensive literature and wide ranging project review identifying relevance, mode of transference and application of process control techniques in discrete manufacture and other enterprises. Findings – Such “technology transfer” of the systems method has visibly improved discrete production performance, often to a state of international competitiveness. Contributions are made at many levels. These range from exploiting elements of the business process systems engineering (BPSE) toolkit is used to analyse material flow right up to examples of successfully enabling of the corporate achievement plan in large organisations. Research limitations/implications – Established systems philosophy is widely relevant. However, the point at which it transforms into systems engineering is application specific. Practical implications – No constraints are evident on application, but the extent of useful application is critically dependent on competence and culture of the enterprise. BPSE cannot be regarded as a “quick fix” panacea. It requires extensive and effective investment in people. For this reason a caveat emptor warning appears that applying the systems approach will fail unless taken seriously at all levels in the business. Originality/value – Originality confined to the domain of bringing existing knowledge together and exploiting it in such a way that the contribution to knowledge is greater than the sum of the constituent parts

Rheumatic fever in indigenous Australian children.

Rheumatic heart disease (RHD) caused by acute rheumatic fever (ARF) is a disease of poverty, poor hygiene and poor living standards. RHD remains one of the major causes of childhood cardiac disease in developing nations. Within developed nations, there has been a dramatic drop in the prevalence of RHD because of the improvement of living standards, access to health care and the widespread availability of penicillin-based drugs. Despite a dramatic reduction of RHD in Australia overall, it continues to be a major contributor to childhood and adult cardiac disease in Indigenous communities throughout northern and central Australia. Currently, Australia has among the highest recorded rates of ARF and RHD in the world. The most accurate epidemiological data in Australia come from the Northern Territory's RHD control programme. In the Northern Territory, 92% of people with RHD are Indigenous, of whom 85% live in remote communities and towns. The incidence of ARF is highest in 5-14-year-olds, ranging from 150 to 380 per 100,000. Prevalence rates of RHD since 2000 have steadily increased to almost 2% of the Indigenous population in the Northern Territory, 3.2% in those aged 35-44 years. Living in remote communities is a contributing factor to ARF/RHD as well as a major barrier for adequate follow-up and care. Impediments to ARF/RHD control include the paucity of specialist services, rapid turnover of health staff, lack of knowledge of ARF/RHD by health staff, patients and communities, and the high mobility of the Indigenous population. Fortunately, the recently announced National Rheumatic Fever Strategy, comprising recurrent funding to the Northern Territory, Queensland and Western Australia for control programmes, as well as the creation of a National Coordination Unit suggest that RHD control in Australia is now a tangible prospect. For the disease to be eradicated, Australia will have to address the underpinning determinants of poverty, social and living conditions