A practical approach to a multi-level analysis with a sparse binary outcome within a large surgical trial

Objectives: To assess the potential source of variation that surgeon may add to patient outcome in a clinical trial of surgical procedures. Methods: Two large (n = 1380) parallel multicentre randomized surgical trials were undertaken to compare laparoscopically assisted hysterectomy with conventional methods of abdominal and vaginal hysterectomy; involving 43 surgeons. The primary end point of the trial was the occurrence of at least one major complication. Patients were nested within surgeons giving the data set a hierarchical structure. A total of 10% of patients had at least one major complication, that is, a sparse binary outcome variable. A linear mixed logistic regression model (with logit link function) was used to model the probability of a major complication, with surgeon fitted as a random effect. Models were fitted using the method of maximum likelihood in SAS((R)). Results: There were many convergence problems. These were resolved using a variety of approaches including; treating all effects as fixed for the initial model building; modelling the variance of a parameter on a logarithmic scale and centring of continuous covariates. The initial model building process indicated no significant 'type of operation' across surgeon interaction effect in either trial, the 'type of operation' term was highly significant in the abdominal trial, and the 'surgeon' term was not significant in either trial. Conclusions: The analysis did not find a surgeon effect but it is difficult to conclude that there was not a difference between surgeons. The statistical test may have lacked sufficient power, the variance estimates were small with large standard errors, indicating that the precision of the variance estimates may be questionable.

Branding in the post-internet era

The internet and its related e-technologies have to a large extent upset the asymmetry of information that for so many years worked in favour of brand managers. Consumers are now empowered to interact with brands and other consumers but also to create their own content on user generated content sites leading to a more participative approach to branding. Internet brands adopt a more relaxed stance on brand management, which involves the consumer in fundamental stages of the brand building process. In this context, the brand manager is no longer a `guardian' of the brand but becomes more of a brand `host'. The question is to what extent can traditional companies follow suit? Are they comfortable to cede control to consumers? Do we need a new theory of branding in an e-space?

Think local, act local? Issues of co-ordination and integration in Local Agenda 21

The political response to the complex package of environmental problems which threaten the future of our planet has been to introduce a new agenda of environmental action based on the principles of sustainability and subsidiarity. This has been crystallised in world agreements signed at the Earth Summit in Rio. One of these, Agenda 21, calls for the governments and communities of the world to prepare action plans for their areas which can build consensus between the various stakeholder groups and feed the principles of sustainable development back into their policies and day-to-day practices. This paper explores the experience of Local Agenda 21 type processes at three levels in the South East of England: the regional, county (sub-regional) and local level. In particular it undertakes a critical appraisal of the success of these participatory and consensus-building exercises in developing an integrated and co-ordinated approach to environmental action planning. It concludes that, although much useful work has been done in raising awareness and modifying policy and practice, there are significant cultural and institutional barriers which are hindering progress.

Networks, agency and (de)stabilisation: the issue of navigation on the River Wye, UK

This paper assesses the way in which an actor network presiding over the management of the River Wye has stabilized through accepting a particular view on the issue of navigation. The paper provides an account of how the network was challenged by a dissonant actor who, through reviving an old company, developed a counter network. It is argued that network stabilization is a form of consensus-building and it is contended that the way in which an issue is defined is crucial in terms of the successful enrolment of actors. The paper illustrates some of the conflicts and complexities encountered in resource planning, suggesting that research of this nature should trace actors back through time as well as through space if dynamics between actors involved in rural planning and management are to be effectively understood.

Content validation for level of use of feature rich systems: a Delphi study of electronic medical records systems

Introduction. Feature usage is a pre-requisite to realising the benefits of investments in feature rich systems. We propose that conceptualising the dependent variable 'system use' as 'level of use' and specifying it as a formative construct has greater value for measuring the post-adoption use of feature rich systems. We then validate the content of the construct as a first step in developing a research instrument to measure it. The context of our study is the post-adoption use of electronic medical records (EMR) by primary care physicians. Method. Initially, a literature review of the empirical context defines the scope based on prior studies. Having identified core features from the literature, they are further refined with the help of experts in a consensus seeking process that follows the Delphi technique. Results.The methodology was successfully applied to EMRs, which were selected as an example of feature rich systems. A review of EMR usage and regulatory standards provided the feature input for the first round of the Delphi process. A panel of experts then reached consensus after four rounds, identifying ten task-based features that would be indicators of level of use. Conclusions. To study why some users deploy more advanced features than others, theories of post-adoption require a rich formative dependent variable that measures level of use. We have demonstrated that a context sensitive literature review followed by refinement through a consensus seeking process is a suitable methodology to validate the content of this dependent variable. This is the first step of instrument development prior to statistical confirmation with a larger sample.

Proximity, strategic groups and reputation: an exploratory study of reputation in higher education

This paper explores the idea that stakeholder proximity, that is, how much/little experience a stakeholder has with a focal organization, impacts the extent to which stakeholders rely on strategic group characteristics as an anchor when judging the reputation of higher education institutions. We synthesize theories from psychology (ie, cognitive categorization theory) and management (ie, strategic group theory) to explore how stakeholder proximity may influence the formation of organizational reputation. Specifically, we examine how the proximity of three key stakeholders (N=1,049; prospective students, parents of students and hiring managers of new graduates) influences the perceived strategic character and generalized favorability of three distinct groups of post-secondary institutions (research-intensive universities, teaching-intensive universities and career colleges). Our results suggest that high proximity stakeholders rely less on strategic group characteristics, while reputation at a strategic group level is suggested to have greater influence on stakeholders who have less direct experience of and low proximity to an organization. Interestingly, our findings reveal some consistent differences between perceptions of prospective students and hiring managers that pose important theoretical questions about the role and impact of direct experiences in the reputation-building process, while also suggesting that higher education institutions may benefit significantly from differentiated marketing strategies according to issues of proximity.

The tendering process and performance analysis of a public building project in Ghana

A case study on the tendering process and cost/time performance of a public building project in Ghana is conducted. Competitive bids submitted by five contractors for the project, in which contractors were required to prepare their own quantities, were analyzed to compare differences in their pricing levels and risk/requirement perceptions. Queries sent to the consultants at the tender stage were also analyzed to identify the significant areas of concern to contractors in relation to the tender documentation. The five bidding prices were significantly different. The queries submitted for clarifications were significantly different, although a few were similar. Using a before-and-after experiment, the expected cost/time estimate at the start of the project was compared to the actual cost/time values, i.e. what happened in the actual construction phase. The analysis showed that the project exceeded its expected cost by 18% and its planned time by 210%. Variations and inadequate design were the major reasons. Following an exploration of these issues, an alternative tendering mechanism is recommended to clients. A shift away from the conventional approach of awarding work based on price, and serious consideration of alternative procurement routes can help clients in Ghana obtain better value for money on their projects.

Is the Indian Ocean SST variability a homogeneous diffusion process.

Whereas the predominance of El Niño Southern Oscillation (ENSO) mode in the tropical Pacific sea surface temperature (SST) variability is well established, no such consensus seems to have been reached by climate scientists regarding the Indian Ocean. While a number of researchers think that the Indian Ocean SST variability is dominated by an active dipolar-type mode of variability, similar to ENSO, others suggest that the variability is mostly passive and behaves like an autocorrelated noise. For example, it is suggested recently that the Indian Ocean SST variability is consistent with the null hypothesis of a homogeneous diffusion process. However, the existence of the basin-wide warming trend represents a deviation from a homogeneous diffusion process, which needs to be considered. An efficient way of detrending, based on differencing, is introduced and applied to the Hadley Centre ice and SST. The filtered SST anomalies over the basin (23.5N-29.5S, 30.5E-119.5E) are then analysed and found to be inconsistent with the null hypothesis on intraseasonal and interannual timescales. The same differencing method is then applied to the smaller tropical Indian Ocean domain. This smaller domain is also inconsistent with the null hypothesis on intraseasonal and interannual timescales. In particular, it is found that the leading mode of variability yields the Indian Ocean dipole, and departs significantly from the null hypothesis only in the autumn season.

Governmentality, subject-building, and the discourses and practices of devolution in the UK

This paper uses a Foucauldian governmentality framework to analyse and interrogate the discourses and strategies adopted by the state and sections of the business community in their attempts to shape and influence emerging agendas of governance in post-devolution Scotland. Much of the work on governmentality has examined the ways in which governments have developed particular techniques, rationales and mechanisms to enable the functioning of governance programmes. This paper expands upon such analyses by also looking at the ways in which particular interests may use similar procedures, discourses and practices to promote their own agendas and develop new forms of resistance, contestation and challenge to emerging policy frameworks. Using the example of business interest mobilization in post-devolution Scotland, it is argued that governments may seek to mobilize defined forms of expertise and knowledge, linking them to wider political debates. This, however, creates new opportunities for interests to shape and contest the discourses and practices of government. The governmentalization of politics can, therefore, be seen as more of a dialectical process of definition and contestation than is often apparent in existing Foucault-inspired writing.

Organizational analysis of building projects

The principles of organization theory are applied to the organization of construction projects. This is done by proposing a framework for modelling the whole process of building procurement. This consists of a framework for describing the environments within which construction projects take place. This is followed by the development of a series of hypotheses about the organizational structure of construction projects. Four case studies are undertaken, and the extent to which their organizational structure matches the model is compared to the level of success achieved by each project. To this end there is a systematic method for evaluating the success of building project organizations, because any conclusions about the adequacy of a particular organization must be related to the degree of success achieved by that organization. In order to test these hypotheses, a mapping technique is developed. The technique offered is a development of a technique known as Linear Responsibility Analysis, and is called "3R analysis" as it deals with roles, responsibilities and relationships. The analysis of the case studies shows that they tended to suffer due to inappropriate organizational structure. One of the prevailing problems of public sector organization is that organizational structures are inadequately defined, and too cumbersome to respond to environmental demands on the project. The projects tended to be organized as rigid hierarchies, particularly at decision points, when what was required was a more flexible, dynamic and responsive organization. The study concludes with a series of recommendations; including suggestions for increasing the responsiveness of construction project organizations, and reducing the lead-in times for the inception periods.

Financial protection in the UK building industry: a guide for clients and the construction supply chain.

There is a clear need for financial protection in the construction industry, both to guarantee satisfactory completion of construction projects and to guard against non-payment. However, the cost of financial protection is often felt to be disproportionately high, with unnecessary overlap between different measures. The Reading Construction Forum has commissioned and steered research which is published in this report in an effort to bring the problem out into the open and to clarify the various options open to the various parties and stakeholders in the construction process. "Financial Protection in the UK Building Industry" is the first definitive report on the subject, offering an accurate and simple guide that all levels within the construction industry can understand. This accessible new guide considers the problem of financial protection and clearly lays out the alternative solutions.It looks by turn at the client, the main contractor, and the sub-contractor, discussing which financial protection options are available to each of them, and considers the pros and cons of each option. The cost of each type of financial protection is weighed against the amount of protection provided and the risks involved. The book concludes with guidance for consultants, emphasising relevant points to consider when advising clients and contractors about which type of financial protection to choose. "Financial Protection in the UK Building Industry" was researched by a literature search, collection of statistical data, and financial data, as well as discussions with clients, contractors, sub-contractors and consultants. This investigation has shown that the direct costs of implementing financial protection measures are marginal, and that wider adoption of payment protection would create a more equitable situation between contracting parties.This guide will enable anyone in the construction industry to consider all the options, and determine what is the best solution for them. "Reading Construction Forum Financial Protection for the UK Building Industry" was complied by the University of Reading, funded by the Reading Construction Forum. The Forum has recently commissioned and steered a number of high-profile reports covering important aspects of the construction industry. Members of the Forum include major companies which are concerned with achieving high quality in the design, construction and use of commercial, retail and industrial buildings. All are committed to change and innovation in the British and European construction industries.

Requirements for building information modeling based lean production management systems for construction

Smooth flow of production in construction is hampered by disparity between individual trade teams' goals and the goals of stable production flow for the project as a whole. This is exacerbated by the difficulty of visualizing the flow of work in a construction project. While the addresses some of the issues in Building information modeling provides a powerful platform for visualizing work flow in control systems that also enable pull flow and deeper collaboration between teams on and off site. The requirements for implementation of a BIM-enabled pull flow construction management software system based on the Last Planner System™, called ‘KanBIM’, have been specified, and a set of functional mock-ups of the proposed system has been implemented and evaluated in a series of three focus group workshops. The requirements cover the areas of maintenance of work flow stability, enabling negotiation and commitment between teams, lean production planning with sophisticated pull flow control, and effective communication and visualization of flow. The evaluation results show that the system holds the potential to improve work flow and reduce waste by providing both process and product visualization at the work face.