Meta-analysis of individual patient data from randomised trials: a review of methods used in practice

Background: Meta-analyses based on individual patient data (IPD) are regarded as the gold standard for systematic reviews. However, the methods used for analysing and presenting results from IPD meta-analyses have received little discussion. Methods We review 44 IPD meta-analyses published during the years 1999–2001. We summarize whether they obtained all the data they sought, what types of approaches were used in the analysis, including assumptions of common or random effects, and how they examined the effects of covariates. Results: Twenty-four out of 44 analyses focused on time-to-event outcomes, and most analyses (28) estimated treatment effects within each trial and then combined the results assuming a common treatment effect across trials. Three analyses failed to stratify by trial, analysing the data is if they came from a single mega-trial. Only nine analyses used random effects methods. Covariate-treatment interactions were generally investigated by subgrouping patients. Seven of the meta-analyses included data from less than 80% of the randomized patients sought, but did not address the resulting potential biases. Conclusions: Although IPD meta-analyses have many advantages in assessing the effects of health care, there are several aspects that could be further developed to make fuller use of the potential of these time-consuming projects. In particular, IPD could be used to more fully investigate the influence of covariates on heterogeneity of treatment effects, both within and between trials. The impact of heterogeneity, or use of random effects, are seldom discussed. There is thus considerable scope for enhancing the methods of analysis and presentation of IPD meta-analysis.

The business case development process in the delivery of NHS infrastructure

There is a lack of knowledge base in relation to experiences gained and lessons learnt from previously executed National Health Service (NHS) infrastructure projects in the UK. This is in part a feature of one-off construction projects, which typify healthcare infrastructure, and in part due to the absence of a suitable method for conveying such information. The complexity of infrastructure delivery process in the NHS makes the construction of healthcare buildings a formidable task. This is particularly the case for the NHS trusts who have little or no experience of construction projects. To facilitate understanding a most important aspect of the delivery process, which is the preparation of a capital investment proposal; steps taken in developing the business case for an NHS healthcare facility are examined. The context for such examination is provided by the planning process of a healthcare project, studied retrospectively. The process is analysed using a social science based method called ‘building stories’, developed at the University of California-Berkeley. By applying this method, stories or narratives are constructed around the data captured on the case study. The findings indicate that the business case process may be used to justify, rather than identify, trusts’ requirements. The study is useful for UK public sector clients as well as consultants and professionals who aim to participate in the delivery of healthcare infrastructure projects in the UK.

Comparative costs of the commercial process in different construction procurement methods

The commercial process in construction projects is an expensive and highly variable overhead. Collaborative working practices carry many benefits, which are widely disseminated, but little information is available about their costs. Transaction Cost Economics is a theoretical framework that seeks explanations for why there are firms and how the boundaries of firms are defined through the “make-or-buy” decision. However, it is not a framework that offers explanations for the relative costs of procuring construction projects in different ways. The idea that different methods of procurement will have characteristically different costs is tested by way of a survey. The relevance of transaction cost economics to the study of commercial costs in procurement is doubtful. The survey shows that collaborative working methods cost neither more nor less than traditional methods. But the benefits of collaboration mean that there is a great deal of enthusiasm for collaboration rather than competition.

An entropy-based financial decision support system (e-FDSS) for project analysis in construction SMEs

Uncertainty contributes a major part in the accuracy of a decision-making process while its inconsistency is always difficult to be solved by existing decision-making tools. Entropy has been proved to be useful to evaluate the inconsistency of uncertainty among different respondents. The study demonstrates an entropy-based financial decision support system called e-FDSS. This integrated system provides decision support to evaluate attributes (funding options and multiple risks) available in projects. Fuzzy logic theory is included in the system to deal with the qualitative aspect of these options and risks. An adaptive genetic algorithm (AGA) is also employed to solve the decision algorithm in the system in order to provide optimal and consistent rates to these attributes. Seven simplified and parallel projects from a Hong Kong construction small and medium enterprise (SME) were assessed to evaluate the system. The result shows that the system calculates risk adjusted discount rates (RADR) of projects in an objective way. These rates discount project cash flow impartially. Inconsistency of uncertainty is also successfully evaluated by the use of the entropy method. Finally, the system identifies the favourable funding options that are managed by a scheme called SME Loan Guarantee Scheme (SGS). Based on these results, resource allocation could then be optimized and the best time to start a new project could also be identified throughout the overall project life cycle.

Towards a holistic modelling framework for embodied carbon and waste in the building lifecycle

As the building industry proceeds in the direction of low impact buildings, research attention is being drawn towards the reduction of carbon dioxide emission and waste. Starting from design and construction to operation and demolition, various building materials are used throughout the whole building lifecycle involving significant energy consumption and waste generation. Building Information Modelling (BIM) is emerging as a tool that can support holistic design-decision making for reducing embodied carbon and waste production in the building lifecycle. This study aims to establish a framework for assessing embodied carbon and waste underpinned by BIM technology. On the basis of current research review, the framework is considered to include functional modules for embodied carbon computation. There are a module for waste estimation, a knowledge-base of construction and demolition methods, a repository of building components information, and an inventory of construction materials’ energy and carbon. Through both static 3D model visualisation and dynamic modelling supported by the framework, embodied energy (carbon), waste and associated costs can be analysed in the boundary of cradle-to-gate, construction, operation, and demolition. The proposed holistic modelling framework provides a possibility to analyse embodied carbon and waste from different building lifecycle perspectives including associated costs. It brings together existing segmented embodied carbon and waste estimation into a unified model, so that interactions between various parameters through the different building lifecycle phases can be better understood. Thus, it can improve design-decision support for optimal low impact building development. The applicability of this framework is anticipated being developed and tested on industrial projects in the near future.

Goal-refinement appraisal of soft projects (GRASP)

Industrial projects are often complex and burdened with time pressures and a lack of information. The term 'soft-project' used here stands for projects where the ‘what’ and/or the ‘how’ is uncertain, which is often the experience in projects involving software intensive systems developments. This thesis intertwines the disciplines of project management and requirements engineering in a goal-oriented application of the maxim ‘keep all objectives satisfied’. It thus proposes a method for appraising projects. In this method, a goal-oriented analysis establishes a framework with which expert judgements are collected so as to construct a confidence profile in regard to the feasibility and adequacy of the project's planned outputs. It is hoped that this appraisal method will contribute to the activities of project ‘shaping’ and aligning stakeholders’ expectations whilst helping project managers appreciate what parts of their project can be progressed and what parts should be held pending further analysis. This thesis offers the following original contribution: an appreciation of appraisal in the project context; a goal-oriented confidence profiling technique; and: a technique to produce goal-refinement diagrams – referred to as Goal Sketching. Collectively these amount to a method for the ‘Goal Refinement Appraisal of Soft-Projects’ (GRASP). The validity of the GRASP method is shown for two projects. In the first it is used for shaping a business investigation project. This is done in real-time in the project. The second case is a retrospective study of an enterprise IT project. This case tests the effectiveness of forecasting project difficulty from an initial confidence profile.

Isotype in Africa, 1952–58

A review of work done by the Isotype Institute in the 1940s and 1950s, associated with Africa. The chapter discusses Otto Neurath's growing interest in the last years of his life in the issue of presenting information to (West) Africans through Isotype methods. Although this interest was not realised by Otto Neurath in the form of completed work during his lifetime, Marie Neurath and the Isotype Institute did successfully carry out numerous projects in Britain's West African colonies during the 1950s, in Sierra Leone, Gold Coast (Ghana), and most extensively in the Western Region of Nigeria. Discussion of these projects illustrates the means by which Isotype work was carried out in a developing world context, the difficulties that were encountered, and the issues of effectiveness and sustainability the work raised.