Diffusion of innovations and decentralized green stormwater infrastructure : a case study of the headwaters of Waller Creek Watershed, Austin, Texas

This Report was undertaken as partial fulfillment of the requirements for the degree of a Master of Science in Community and Regional Planning and also as an investigation into how the City of Austin’s Watershed Protection Department (WPD) can advance the particular goals of their Pilot Project: “Rain Catcher”. The Report explores and discusses: 1) the ways in which infrastructure in cities has been regarded and constructed over time, 2) how these perspectives and approaches have influenced stormwater management in the United States, 3) what this has entailed in the case of Austin, Texas, specifically and 4) what are the current barriers and opportunities for the WPD Rain Catcher Pilot Project. With this Pilot Project, the WPD seeks to understand if installing green stormwater systems (e.g. rain gardens and cisterns) on private and public parcels is a feasible alternative service delivery model for stormwater management. To identify the potential barriers and opportunities (i.e financial, technical, cultural, etc.), this study conducted a survey of residents in the headwaters of Waller Creek. In order to interpret the survey results and provide recommendations to WPD, I applied the social science theory Diffusions of Innovations. Results of the survey indicate that the diffusion process of rain gardens and cisterns is in its early stages. Relatively few respondents had already adopted these green stormwater systems (GSI) at their residences and even fewer had familiarity with what constituted a rain garden. Despite this, there was a willingness by a majority of those surveyed to install GSI. The primary obstacles facing greater adoption expressed by residents are 1) cost 2) maintenance 3) help with installation. These practical barriers were also mirrored in people’s yard management: money, time, and knowledge were identified as the three primary reasons why respondents did not have their “ideal yard”. Currently, the majority of respondents do not manage yards that are eco-centric and instead prioritize convenience and keeping costs low. Notable distinctions were revealed between adopter categories (innovators, early adopters, late majority/laggards) however: innovators do value yards that are more eco-centric, ones that can provide a variety of ecosystem services. Additionally, innovators and early adopters had greater levels of education, were wealthier and younger. Diffusion of Innovation theory can provide a framework for the WPD to encourage the greater adoption of GSI. For example, tailoring these GSI to have greater “relative advantage” (i.e. by lessening yard management costs or maintenance needs) would encourage adoption. Reducing the “complexity” of these systems (either in how they are perceived or in terms of providing assistance in their installation, for example), will also help in this regard. To enable greater “compatibility” for GSI, in terms of cultural and social norms, could entail not only simplifying these systems but also promoting yard management practices that are more eco-centric. Finally, Diffusion of Innovation literature suggests that also providing more “trialability” and “observability” opportunities of rain gardens and cisterns will aid in their adoption.Community and Regional Plannin

Quantifying bacterial transfer from patients to staff during burns dressing and bed changes : implications for infection control

Routine nursing activities such as dressing/bed changes increase bacterial dispersal from burns patients, potentially contaminating healthcare workers (HCW) carrying out these tasks. HCW thus become vectors for transmission of nosocomial infection between patients. The suspected relationship between %total body surface area (%TBSA) of burn and levels of bacterial release has never been fully established. Bacterial contamination of HCW was assessed by contact plate samples (n = 20) from initially sterile gowns worn by the HCW during burns patient dressing/bed changes. Analysis of 24 gowns was undertaken and examined for relationships between %TBSA, time taken for activity, and contamination received by the HCW. Relationships between size of burn and levels of HCW contamination, and time taken for the dressing/bed change and levels of HCW contamination were best described by exponential models. Burn size correlated more strongly (R2 = 0.82, p < 0.001) than time taken (R2 = 0.52, p < 0.001), with levels of contamination received by the HCW. Contamination doubled with every 6–9% TBSA increase in burn size. Burn size was used to create a model to predict bacterial contamination received by a HCW carrying out bed/dressing changes. This may help with the creation of burn-specific guidelines on protective clothing worn by HCW caring for burns patients

Airborne bacterial dispersal during and after dressing and bed changes on burns patients

It is acknowledged that activities such as dressing changes and bed sheet changes are high-risk events; creating surges in levels of airborne bacteria. Burns patients are particularly high dispersers of pathogens; due to their large, often contaminated, wound areas. Prevention of nosocomial cross-contamination is therefore one of the major challenges faced by the burns team. In order to assess the contribution of airborne spread of bacteria, air samples were taken repeatedly throughout and following these events, to quantify levels of airborne bacteria. Air samples were taken at 3-min intervals before, during and after a dressing and bed change on a burns patient using a sieve impaction method. Following incubation, bacterial colonies were enumerated to calculate bacterial colony forming units per m3 (cfu/m3) at each time point. Statistical analysis was performed, whereby the period before the high-risk event took place acted as a control period. The periods during and after the dressing and bed sheet changes were examined for significant differences in airborne bacterial levels relative to the control period. The study was carried out four times, on three patients with burns between 35% total burn surface area (TBSA) and 51% TBSA. There were significant increases in airborne bacteria levels, regardless of whether the dressing change or bed sheet change took place first. Of particular note, is the finding that significantly high levels (up to 2614 cfu/m3) of airborne bacteria were shown to persist for up to approximately 1 h after these activities ended. This is the most accurate picture to date of the rapidly changing levels of airborne bacteria within the room of a burns patient undergoing a dressing change and bed change. The novel demonstration of a significant increase in the airborne bacterial load during these events has implications for infection control on burns units. Furthermore, as these increased levels remained for approximately 1 h afterwards, persons entering the room both during and after such events may act as vectors of transmission of infection. It is suggested that appropriate personal protective equipment should be worn by anyone entering the room, and that rooms should be quarantined for a period of time following these events

Stakeholder perspectives on intensive support teams for adults with intellectual disabilities who display behaviour that challenges in England

BACKGROUND: Adults with intellectual disabilities often display behaviour that challenges that is a result of biological differences, psychological challenges, and lack of appropriate social support. Intensive Support Teams (IST) are recommended to support the care needs of this group and avoid hospitalisation. However, little attention has been paid to the perspectives of stakeholders who manage, work in, or use ISTs. METHOD: Interviews and focus groups were conducted with 50 stakeholders (IST service managers and professionals, adults with intellectual disabilities, and family and paid carers) of ISTs. Services operated according to one of two service models previously identified in ISTs in England (enhanced or independent). RESULTS: Thematic analysis identified accessible and flexible support, individualised care, and the involvement of carers and other relevant agencies in management plans and reviews as features of good IST care highlighted by all stakeholder groups. IST managers and professionals described the key challenges of current IST provision as unclear referral criteria, limited interfaces with other local services, and perceived threats associated with funding and staff retention. Findings were similar between the two IST models. CONCLUSIONS: ISTs are able to offer care and specialist support that is valued by families, service users and other care providers. However, they face several operational challenges that should be addressed if ISTs are to reach their potential along with community intellectual disability services in supporting adults with intellectual disabilities who display behaviour that challenges in the community

Clinical and cost evaluation of intensive support team (IST) models for adults with intellectual disabilities who display challenging behaviour: a comparative cohort study protocol

Introduction: Approximately 17% of adults with intellectual disabilities (ID) living in the community display behaviours that challenge. Intensive support teams (ISTs) have been recommended to provide high-quality responsive care aimed at avoiding unnecessary admissions and reducing lengthy inpatient stays in England. We have identified two models of ISTs (model 1: enhanced provision and model 2: independent provision). This study aims to investigate the clinical and cost-effectiveness of the two models of ISTs. Methods and analysis: A cohort of 226 adults with ID displaying behaviour that challenges who receive support from ISTs from each model will be recruited and assessed at baseline and 9 months later to compare the clinical and cost-effectiveness between models. The primary outcome is reduction in challenging behaviour measured by the Aberrant Behaviour Checklist-Community (ABC-C). The mean difference in change in ABC score between the two IST models will be estimated from a multilevel linear regression model. Secondary outcomes include mental health status, clinical risk, quality of life, health-related quality of life, level of functioning and service use. We will undertake a cost-effectiveness analysis taking both a health and social care and wider societal perspective. Semistructured interviews will be conducted with multiple stakeholders (ie, service users, paid/family carers, IST managers/staff) to investigate the experience of IST care as well as an online survey of referrers to capture their contact with the teams. Ethics and dissemination: The study was approved by the London–Bromley Research Ethics Committee (REC reference: 18/LO/0890). Informed consent will be obtained from the person with ID, or a family/nominated consultee for those lacking capacity and from his/her caregivers. The findings of the study will be disseminated to academic audiences, professionals, experts by experience and arm’s-length bodies and policymakers via publications, seminars and digital platforms. Trial registration number: ClinicalTrials.gov Registry (NCT03586375)

Evaluating specialist intensive support teams for adults with intellectual disabilities who display behaviours that challenge: The IST-ID mixed methods study

Background Intensive Support Teams (ISTs) are recommended for individuals with intellectual disabilities who display behaviours that challenge. However, there is currently little evidence about the clinical and cost effectiveness of IST models operating in England. Aims To investigate the clinical and cost effectiveness of IST models. Methods We carried out a cohort study to evaluate the clinical and cost-effectiveness of two previously identified IST models (independent and enhanced) in England. Adult participants (n=226) from 21 ISTs (10 independent and 11 enhanced) were enrolled. The primary outcome was change in challenging behaviour between baseline and 9 months measured by the Aberrant Behaviour Checklist-Community 2. Results We found no statistically significant differences between models for the primary outcome (adjusted β: 4.27; 95% CI: -6.34 to 14.87; p=0.430) or any secondary outcomes. Quality Adjusted Life Years (0.0158; 95% CI: -0.0088 to 0.0508) and costs (£3409.95; 95% CI: -£9957.92 to £4039.89) of the two models were comparable. Conclusions The study provides evidence that both models were associated with clinical improvement for similar costs at follow-up. We recommend that the choice of service model should rest with local services. Further research should investigate the critical components of IST care to inform the development of fidelity criteria, and policy makers should consider whether roll out of such teams should be mandated. Study registration number ClinicalTrials.gov NCT03586375 ; IRAS 239820; National Institute for Health Research (NIHR) Central Portfolio Management System (CPMS) 38554

Clinical and cost evaluation of two models of specialist intensive support teams for adults with intellectual disabilities who display behaviours that challenge: the IST-ID mixed-methods study

Background: Intensive support teams (ISTs) are recommended for individuals with intellectual disabilities who display behaviours that challenge. However, there is currently little evidence about the clinical and cost-effectiveness of IST models operating in England.// Aims: To investigate the clinical and cost-effectiveness of IST models.// Method: We carried out a cohort study to evaluate the clinical and cost-effectiveness of two previously identified IST models (independent and enhanced) in England. Adult participants (n = 226) from 21 ISTs (ten independent and 11 enhanced) were enrolled. The primary outcome was change in challenging behaviour between baseline and 9 months as measured by the Aberrant Behaviour Checklist-Community version 2.// Results: We found no statistically significant differences between models for the primary outcome (adjusted β = 4.27; 95% CI −6.34 to 14.87; P = 0.430) or any secondary outcomes. Quality-adjusted life-years (0.0158; 95% CI: −0.0088 to 0.0508) and costs (£3409.95; 95% CI −£9957.92 to £4039.89) of the two models were comparable. Conclusions The study provides evidence that both models were associated with clinical improvement for similar costs at follow-up. We recommend that the choice of service model should rest with local services. Further research should investigate the critical components of IST care to inform the development of fidelity criteria, and policy makers should consider whether roll out of such teams should be mandated

Data Quality Barriers for Transparency in Public Procurement

Governments need to be accountable and transparent for their public spending decisions in order to prevent losses through fraud and corruption as well as to build healthy and sustainable economies. Open data act as a major instrument in this respect by enabling public administrations, service providers, data journalists, transparency activists, and regular citizens to identify fraud or uncompetitive markets through connecting related, heterogeneous, and originally unconnected data sources. To this end, in this article, we present our experience in the case of Slovenia, where we successfully applied a number of anomaly detection techniques over a set of open disparate data sets integrated into a Knowledge Graph, including procurement, company, and spending data, through a linked data-based platform called TheyBuyForYou. We then report a set of guidelines for publishing high quality procurement data for better procurement analytics, since our experience has shown us that there are significant shortcomings in the quality of data being published. This article contributes to enhanced policy making by guiding public administrations at local, regional, and national levels on how to improve the way they publish and use procurement-related data; developing technologies and solutions that buyers in the public and private sectors can use and adapt to become more transparent, make markets more competitive, and reduce waste and fraud; and providing a Knowledge Graph, which is a data resource that is designed to facilitate integration across multiple data silos by showing how it adds context and domain knowledge to machine-learning-based procurement analytics.publishedVersio

Stakeholder perspectives on intensive support teams for adults with intellectual disabilities who display behaviour that challenges in England

Background Adults with intellectual disabilities often display behaviour that challenges that is a result of biological differences, psychological challenges, and lack of appropriate social support. Intensive Support Teams (IST) are recommended to support the care needs of this group and avoid hospitalisation. However, little attention has been paid to the perspectives of stakeholders who manage, work in, or use ISTs. Method Interviews and focus groups were conducted with 50 stakeholders (IST service managers and professionals, adults with intellectual disabilities, and family and paid carers) of ISTs. Services operated according to one of two service models previously identified in ISTs in England (enhanced or independent). Results Thematic analysis identified accessible and flexible support, individualised care, and the involvement of carers and other relevant agencies in management plans and reviews as features of good IST care highlighted by all stakeholder groups. IST managers and professionals described the key challenges of current IST provision as unclear referral criteria, limited interfaces with other local services, and perceived threats associated with funding and staff retention. Findings were similar between the two IST models. Conclusions ISTs are able to offer care and specialist support that is valued by families, service users and other care providers. However, they face several operational challenges that should be addressed if ISTs are to reach their potential along with community intellectual disability services in supporting adults with intellectual disabilities who display behaviour that challenges in the community