Clinical characteristics and selection of treatment modality for patients with vitreomacular traction:real-world implementation of NICE guidance (TA297)

Aim: To investigate the qualitative aspects in patient selection and the quantitative impact of disease burden in real world treatment of vitreomacular traction (VMT) and implementation of the National Institute for Health and Care Excellence (NICE) guidance (TA297). Methods: A monocentric, retrospective review of consecutive patients undergoing optical coherence tomography (OCT) imaging over a 3 month period. Patients with VMT in at least one eye were identified for further data collection on laterality, visual acuity, symptoms, presence of epiretinal membrane, macular hole and treatment selection. Results: A total of 3472 patients underwent OCT imaging with a total of 6878 eyes scanned. Out of 87 patients, 74 patients had unilateral VMT (38 right, 36 left) and 13 patients had bilateral VMT. Eighteen patients with unilateral VMT satisfied NICE criteria of severe sight problems in the affected eye. Eight were managed for a coexisting pathology, one refused treatment, one patient did not attend, two closed spontaneously, and one received ocriplasmin prior to the study start date. Only two patients with unilateral VMT received ocriplasmin and three underwent vitrectomy. Those failing to meet NICE criteria for unilateral VMT were predominantly asymptomatic (n=49) or had coexisting ERM (n=5) or both (n=2). Conclusion: Ocriplasmin provides an alternative treatment for patients with symptomatic VMT. Our data shows that the majority of patients with VMT do not meet NICE TA297 primarily due to lack of symptoms. Those meeting NICE criteria, but not treated, tended to have coexisting macular pathology. Variation in patient selection due to subjective factors not outlined in NICE guidance suggests that real world outcomes of ocriplasmin therapy should be interpreted with caution.

Decision support system for project selection

The evaluation and selection of industrial projects before investment decision is customarily done using marketing, technical, and financial information. Subsequently, environmental impact assessment and social impact assessment are carried out mainly to satisfy the statutory agencies. Because of stricter environment regulations in developed and developing countries, quite often impact assessment suggests alternate sites, technologies, designs, and implementation methods as mitigating measures. This causes considerable delay to complete project feasibility analysis and selection as complete analysis requires to be taken up again and again until the statutory regulatory authority approves the project. Moreover, project analysis through the above process often results in suboptimal projects as financial analysis may eliminate better options as more environment friendly alternative will always be cost intensive. In this circumstance, this study proposes a decision support system which analyses projects with respect to market, technicalities, and social and environmental impact in an integrated framework using analytic hierarchy process, a multiple attribute decision-making technique. This not only reduces duration of project evaluation and selection, but also helps select an optimal project for the organization for sustainable development. The entire methodology has been applied to a cross-country oil pipeline project in India and its effectiveness has been demonstrated. © 2008, IGI Global.

The DRAMA methodology for analysing strategy and its links with production system design

This paper describes a methodology: 'decision rules for analyzing manufacturing activities', which is designed to be a practical system of enquiry linking a strategic analysis to the design of production systems. The paper describes the development of the system, an industry specific design methodology, into DRAMA II which is a model that serves as an analytical tool for studying decision processes and implementation of production systems.

Developing and evaluating a methodology for business process improvement

Purpose – There appears to be an ever-insatiable demand from markets for organisations to improve their products and services. To meet this, there is a need to provide business process improvement (BPI) methodologies that are holistic, structured and procedural. Therefore, this paper describes research that has formed and tested a generic and practical methodology termed model-based and integrated process improvement (MIPI) to support the implementation of BPI; and to validate its effectiveness in organisations. This methodology has been created as an aid for practitioners within organisations. Design/methodology/approach – The research objectives were achieved by: reviewing and analysing current methodologies, and selecting a few frameworks against key performance indicators. Using a refined Delphi approach and semi-structured interview with the “experts” in the field. Intervention, case study and process research approach to evaluating a methodology. Findings – The BPI methodology was successfully formed and applied by the researcher and directly by the companies involved against the criteria of feasibility, usability and usefulness. Research limitations/implications – The paper has demonstrated a new knowledge on how to systematically assess a BPI methodology in practice. Practical implications – Model-based and integrated process improvement methodology (MIPI) methodology offers the practitioner (experienced and novice) a set of step-by-step aids necessary to make informed, consistent and efficient changes to business processes. Originality/value – The novelty of this research work is the creation of a holistic workbook-based methodology with relevant tools and techniques. It extends the capabilities of existing methodologies.

An analysis of the role of soft systems methodology in the change process and the contribution of the facilitator within this process

This research aims to examine the effectiveness of Soft Systems Methodology (SSM) to enable systemic change within local goverment and local NHS environments and to examine the role of the facilitator within this process. Checkland's Mode 2 variant of Soft Systems Methodology was applied on an experimental basis in two environments, Herefordshire Health Authority and Sand well Health Authority. The Herefordshire application used SSM in the design of an Integrated Care Pathway for stroke patients. In Sandwell, SSM was deployed to assist in the design of an Infonnation Management and Technology (IM&T) Strategy for the boundary-spanning Sandwell Partnership. Both of these environments were experiencing significant organisational change as the experiments unfurled. The explicit objectives of the research were: To examine the evolution and development of SSM and to contribute to its further development. To apply the Soft Systems Methodology to change processes within the NHS. To evaluate the potential role of SSM in this wider process of change. To assess the role of the researcher as a facilitator within this process. To develop a critical framework through which the impact of SSM on change might be understood and assessed. In developing these objectives, it became apparent that there was a gap in knowledge relating to SSM. This gap concerns the evaluation of the role of the approach in the change process. The case studies highlighted issues in stakeholder selection and management; the communicative assumptions in SSM; the ambiguous role of the facilitator; and the impact of highly politicised problem environments on the effectiveness of the methodology in the process of change. An augmented variant on SSM that integrates an appropriate (social constructivist) evaluation method is outlined, together with a series of hypotheses about the operationalisation of this proposed method.

Bayesian regression filter and the issue of priors

We propose a Bayesian framework for regression problems, which covers areas which are usually dealt with by function approximation. An online learning algorithm is derived which solves regression problems with a Kalman filter. Its solution always improves with increasing model complexity, without the risk of over-fitting. In the infinite dimension limit it approaches the true Bayesian posterior. The issues of prior selection and over-fitting are also discussed, showing that some of the commonly held beliefs are misleading. The practical implementation is summarised. Simulations using 13 popular publicly available data sets are used to demonstrate the method and highlight important issues concerning the choice of priors.

Assessing the financial impact of 6-Sigma in an automotive company

This paper reports on an assessment of an ongoing 6-Sigma program conducted within a UK based (US owned) automotive company. It gives an overview of the management of the 6-sigma programme and the 23 in-house methodology used. The analysis given in the paper pays particular focus to the financial impacts that individual projects have had. Three projects are chosen from the hundreds that have been completed and are discussed in detail, including which specific techniques have been used and how financially successful the projects were. Commentary is also given on the effectiveness of the overall program along with a critique of how the implementation of 6-Sigma could be more effectively managed in the future. This discussion particularly focuses upon issues such as: project selection and scoping, financial evaluation and data availability, organisational awareness, commitment and involvement, middle management support, functional variation, and maintaining momentum during the rollout of a lengthy program.

Analytic hierarchy process helps evaluate projects in Indian oil pipeline industry

Conventionally, oil pipeline projects are evaluated thoroughly by the owner before investment decision is made using market, technical and financial analysis sequentially. The market analysis determines pipelines throughput and supply and demand points. Subsequent, technical analysis identifies technological options and economic and financial analysis then derives the least cost option among all technically feasible options. The subsequent impact assessment tries to justify the selected option by addressing environmental and social issues. The impact assessment often suggests alternative sites, technologies, and/or implementation methodology, necessitating revision of technical and financial analysis. This study addresses these issues via an integrated project evaluation and selection model. The model uses analytic hierarchy process, a multiple-attribute decision-making technique. The effectiveness of the model has been demonstrated through a case application on cross-country petroleum pipeline project in India.

Integrated approach to project feasibility analysis:a case study

Feasibility studies of industrial projects consist of multiple analyses carried out sequentially. This is time consuming and each analysis screens out alternatives based solely on the merits of that analysis. In cross-country petroleum pipeline project selection, market analysis determines throughput requirement and supply and demand points. Technical analysis identifies technological options and alternatives for pipe-line routes. Economic and financial analysis derive the least-cost option. The impact assessment addresses environmental issues. The impact assessment often suggests alternative sites, routes, technologies, and/or implementation methodology, necessitating revision of technical and financial analysis. This report suggests an integrated approach to feasibility analysis presented as a case application of a cross-country petroleum pipeline project in India.

Risk based decision support system for effective implementation of projects

Conventional project management techniques are not always sufficient to ensure time, cost and quality achievement of large-scale construction projects due to complexity in planning, design and implementation processes. The main reasons for project non-achievement are changes in scope and design, changes in government policies and regulations, unforeseen inflation, underestimation and improper estimation. Projects that are exposed to such an uncertain environment can be effectively managed with the application of risk management throughout the project's life cycle. However, the effectiveness of risk management depends on the technique through which the effects of risk factors are analysed/quantified. This study proposes the Analytic Hierarchy Process (AHP), a multiple attribute decision making technique, as a tool for risk analysis because it can handle subjective as well as objective factors in a decision model that are conflicting in nature. This provides a decision support system (DSS) to project management for making the right decision at the right time for ensuring project success in line with organisation policy, project objectives and a competitive business environment. The whole methodology is explained through a case application of a cross-country petroleum pipeline project in India and its effectiveness in project management is demonstrated.

Strategic group theory:review, examination and application in the UK pharmaceutical industry

Purpose – The purpose of this paper is to consider the current status of strategic group theory in the light of developments over the last three decades. and then to discuss the continuing value of the concept, both to strategic management research and practising managers. Design/methodology/approach – Critical review of the idea of strategic groups together with a practical strategic mapping illustration. Findings – Strategic group theory still provides a useful approach for management research, which allows a detailed appraisal and comparison of company strategies within an industry. Research limitations/ implications – Strategic group research would undoubtedly benefit from more directly comparable, industry-specific studies, with a more careful focus on variable selection and the statistical methods used for validation. Future studies should aim to build sets of industry specific variables that describe strategic choice within that industry. The statistical methods used to identify strategic groupings need to be robust to ensure that strategic groups are not solely an artefact of method. Practical implications – The paper looks specifically at an application of strategic group theory in the UK pharmaceutical industry. The practical benefits of strategic groups as a classification system and of strategic mapping as a strategy development and analysis tool are discussed. Originality/value – The review of strategic group theory alongside alternative taxonomies and application of the concept to the UK pharmaceutical industry.

The primal sketch revisited: locating and representing edges in human vision via Gaussian-derivative filtering

Marr's work offered guidelines on how to investigate vision (the theory - algorithm - implementation distinction), as well as specific proposals on how vision is done. Many of the latter have inevitably been superseded, but the approach was inspirational and remains so. Marr saw the computational study of vision as tightly linked to psychophysics and neurophysiology, but the last twenty years have seen some weakening of that integration. Because feature detection is a key stage in early human vision, we have returned to basic questions about representation of edges at coarse and fine scales. We describe an explicit model in the spirit of the primal sketch, but tightly constrained by psychophysical data. Results from two tasks (location-marking and blur-matching) point strongly to the central role played by second-derivative operators, as proposed by Marr and Hildreth. Edge location and blur are evaluated by finding the location and scale of the Gaussian-derivative `template' that best matches the second-derivative profile (`signature') of the edge. The system is scale-invariant, and accurately predicts blur-matching data for a wide variety of 1-D and 2-D images. By finding the best-fitting scale, it implements a form of local scale selection and circumvents the knotty problem of integrating filter outputs across scales. [Supported by BBSRC and the Wellcome Trust]

Advanced manufacturing technology adoption in developing countries:the role of buyer-supplier relationships

Purpose – Developing countries are heavily dependent on the resources and commitment of foreign providers to ensure successful adoption of advanced manufacturing technology (AMT). The purpose of this paper is to describe the important role of buyer-supplier relationships (BSRs) in the process of technology selection, acquisition and implementation. Design/methodology/approach – A survey of 147 Malaysian manufacturing firms is the main instrument used in the research investigations and data analysis is carried out by the structured equation modelling (SEM) technique. In particular, the authors examine the impact on performance of different patterns of relationship between technology buyers and suppliers. Findings – Although the majority of the firms reported improvements in their performance since the acquisition of AMT, closer investigation reveals that those demonstrating a closer relationship with their suppliers are more likely to achieve higher levels of technology and implementation performance (IP) than those that do not. Research limitations/implications – The paper only assesses the strength of BSR from the buyers' perspective and they may have limited experience of acquisition, whereas suppliers may have more experience of selling AMT. Also, the research is undertaken in Malaysia and the findings may be different in other countries, especially where the technology being acquired is not imported but sourced locally. Practical implications – The findings relating to BSR, technology acquisition and IP have important implications both for customers and supplier firms as well as for industrial policy makers in developing countries. Originality/value – The result of the research provides useful insights that are especially pertinent to an improved understanding of BSRs in the procurement of capital equipment, about which the current research literature is limited.

A systems approach to strategic manpower planning for technological development under conditions of manpower scarcity and centralised control

This thesis deals with the integration of the manpower criterion with the strategic decision making processes of technological projects in developing countries. This integration is to be achieved by ensuring the involvement of the actors, who have relevant roles and responsibilities along the whole life cycle of the project, in the strategic decision making phases of the project. The relevance of the actors is ascertained by the use of a responsibility index which relates their responsibility to the project's constituent stages. In the context of a technological project in a typical centrally-planned developing environment, the actors are identified as Arbiters, Planners, Implementors and Operators and their roles, concerns and objectives are derived. In this context, the actors are usually government and non-government organisations. Hence, decision making will involve multiple agencies as well as multiple criteria. A methodology covering the whole decision-making process, from options generation to options selection, and adopting Saaty's Analytical Hierarchy Process as an operational tool is proposed to deal with such multiple-criteria, multipleagency decision situations. The methodology is intended to integrate the consideration of the relevant criteria, the prevailing environmental and policy factors, and the concerns and objectives of the relevant actors into a unifying decision-making process which strives to facilitate enlightened decision making and to enhance learning and interaction. An extensive assessment of the methodology's feasibility, based on a specific technological project within the Iraqi oil industry is included, and indicates that the methodology should be both useful and implementable.