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This paper investigates the planning of virtual ward (VW) capacity including the remote monitoring of frail and elderly patients. The main objective is to optimize VW hub locations across a region in the United Kingdom. Furthermore, assigning the optimal number of clinicians to different regions needs to be considered. We develop a mathematical model that minimizes the setup and travel costs of VW hubs and staff. Our experimental analysis evaluates different levels of demand considering postcode areas within different Trusts, also known as Health Boards, in the National Health Service (NHS). Furthermore, our experiments provide insights into how many hub locations should be deployed and staffed. This can be used to individually find the number of remote monitors and clinicians for each facility as well as the system overall. [ABSTRACT FROM AUTHOR]

Why did a Conservative UK government decide to cut back road building during a time of austerity in the 1990s, whereas a Conservative-led Coalition government decided to substantially increase road building during a time of austerity after 2010? This study aims to answer that question drawing on 32 interviews with ministers, advisors and others, and secondary analysis of media coverage and public opinion. It uses Critical Realist methods in a more specific way than previous studies, representing the key actors, causal mechanisms and changes in underlying social structures in diagrammatic form. It concludes that three mechanisms: a rational response to changing transport circumstances, changing economic ideology prompted by the recession of 2007–9 and public opinion, influenced by the protest movement in the 1990s, explain the contrasting decisions. It identifies key actors who influenced government decisions and explains how a Critical Realist analysis questions the traditional concept in transport studies of causal factors and their relative importance. • Why did Conservative-led UK governments cut back road building during the 1990s but increase substantially increase it after 2010? • This study aims to answer that question drawing on 32 interviews with ministers, advisors and others. • It uses Critical Realist methods in a more specific way than previous studies. • Three causal mechanisms explain the difference: a rational response to changing circumstances, economic ideology and public opinion, influenced by protests in the 1990s. [ABSTRACT FROM AUTHOR]

Much of England is seriously water stressed and future droughts will present major challenges to the water industry if socially and economically damaging supply restrictions are to be avoided. Demand management is seen as a key mechanism for alleviating water stress, yet there are no truly effective incentives to encourage widespread adoption of the behavioural and technological demand management practices available. Water pricing could promote conservation, but on its own it is an inefficient tool for dealing with short term restriction in water supply. Raising prices over the short term in response to a drought is likely to be ineffectual in lowering demand sufficiently; conversely, maintaining high prices over the long term implies costs to the consumer which are needlessly high most of the time. We propose a system for developing resilience to drought in highly water stressed areas, based on a cap and trade (C&T) model. The system would represent a significant innovation in England's water market. However, international experience shows that C&T is successful in other sectors, and need not be overly complex. Here, we open the debate on how a C&T system might work in England. [ABSTRACT FROM AUTHOR]

The article presents a study that evaluated the effect of different demand management strategies on biochemistry test requesting activity in a tertiary Intensive Care Unit (ICU) at a teaching hospital in Great Britain. It states that an observational longitudinal study was made in which biochemistry requesting activity was collected from 2009-2013. It found that removal of minimum re-testing intervals (MRIs) produced reduction on the ICU.

Background Demand management defines any method used to monitor, direct, or regulate patient referrals. Strategies have been developed to manage the referral of patients to secondary care, with interventions that target primary care, specialist services, or infrastructure. Aim To review the international evidence on interventions to manage referral from primary to specialist care. Design and setting Systematic review. Method Iterative, systematic searches of published and unpublished sources public health, health management, management, and grey literature databases from health care and other industries were undertaken to identify recent, relevant studies. A narrative synthesis of the data was completed to structure the evidence into groups of similar interventions. Results The searches generated 8327 unique results, of which 140 studies were included. Interventions were grouped into four intervention categories: GP education (n = 50); process change (n = 49); system change (n = 38); and patient-focused (n = 3). It is clear that there is no 'magic bullet' to managing demand for secondary care services: although some groups of interventions may have greater potential for development, given the existing evidence that they can be effective in specific contexts. Conclusions To tackle demand management of primary care services, the focus cannot be on primary care alone; a whole-systems approach is needed because the introduction of interventions in primary care is often just the starting point of the referral process. In addition, more research is needed to develop and evaluate interventions that acknowledge the role of the patient in the referral decision. [ABSTRACT FROM AUTHOR]

Socio-economic change, severe droughts, and environmental concerns focus attention on sustainability of water supplies and the ability of water utilities to meet levels of service. Traditionally, water management has been supply-side dominated and long-term demand forecasting has received relatively little attention. However, it is increasingly recognised that water demand management could be a 'low regret' adaptation measure (both financially and environmentally) given large uncertainties about future non-climate and climate pressures. This paper begins with a brief history of household water demand management in the UK. We then review approaches to water demand estimation and forecasting over the short- (daily to season) and long-term (years to decade) and note the paucity of studies on weather and climate. We discuss peak household water use behaviours identified from metering trials, micro-component diary-based studies, and statistical techniques for long-term demand forecasting. We refer to the Anglian Water Services (AWS) 'Golden 100' data to illustrate the significant practical and conceptual issues faced when mining household water use data for weather signals, especially when the data are noisy and originally intended for other applications. Further research is needed into the relationships between climate variables and household micro-component water use, especially for peak demands. [ABSTRACT FROM AUTHOR]

Abstract: Rainwater harvesting is increasingly becoming an integral part of the sustainable water management toolkit. Despite a plethora of studies modelling the feasibility of the utilisation of rainwater harvesting (RWH) systems in particular contexts, there remains a significant gap in knowledge in relation to detailed empirical assessments of performance. Domestic systems have been investigated to a limited degree in the literature, including in the UK, but there are few recent longitudinal studies of larger non-domestic systems. Additionally, there are few studies comparing estimated and actual performance. This paper presents the results of a longitudinal empirical performance assessment of a non-domestic RWH system located in an office building in the UK. Furthermore, it compares actual performance with the estimated performance based on two methods recommended by the British Standards Institute – the Intermediate (simple calculations) and Detailed (simulation-based) Approaches. Results highlight that the average measured water saving efficiency (amount of mains water saved) of the office-based RWH system was 87% across an 8-month period, due to the system being over-sized for the actual occupancy level. Consequently, a similar level of performance could have been achieved using a smaller-sized tank. Estimated cost savings resulted in capital payback periods of 11 and 6 years for the actual over-sized tank and the smaller optimised tank, respectively. However, more detailed cost data on maintenance and operation is required to perform whole life cost analyses. These findings indicate that office-scale RWH systems potentially offer significant water and cost savings. They also emphasise the importance of monitoring data and that a transition to the use of Detailed Approaches (particularly in the UK) is required to (a) minimise over-sizing of storage tanks and (b) build confidence in RWH system performance. [Copyright &y& Elsevier]

Summary The problem of managing demand: Most healthcare systems have 'third-party payers' who face the problem of keeping within budgets despite pressures to increase resources due to the ageing population, new technologies and patient demands to lower thresholds for care. This paper uses the UK National Health Service as a case study to suggest techniques for system-based demand management, which aims to control demand and costs whilst maintaining the cost-effectiveness of the system. Technique for managing demand: The technique for managing demand in primary, elective and urgent care consists of managing treatment thresholds for appropriate care, using a whole-systems approach and costing the care elements in the system. It is important to analyse activity in relation to capacity and demand. Examples of using these techniques in practice are given. Conclusion: The practical effects of using such techniques need evaluation. If these techniques are not used, managing demand and limiting healthcare expenditure wilt be at the expense of clinical outcomes and unmet need, which wilt perpetuate financial crises. [ABSTRACT FROM AUTHOR]