Constructing a clinical decision-making framework for image-guided radiotherapy using a Bayesian Network

A decision-making framework for image-guided radiotherapy (IGRT) is being developed using a Bayesian Network (BN) to graphically describe, and probabilistically quantify, the many interacting factors that are involved in this complex clinical process. Outputs of the BN will provide decision-support for radiation therapists to assist them to make correct inferences relating to the likelihood of treatment delivery accuracy for a given image-guided set-up correction. The framework is being developed as a dynamic object-oriented BN, allowing for complex modelling with specific sub-regions, as well as representation of the sequential decision-making and belief updating associated with IGRT. A prototype graphic structure for the BN was developed by analysing IGRT practices at a local radiotherapy department and incorporating results obtained from a literature review. Clinical stakeholders reviewed the BN to validate its structure. The BN consists of a sub-network for evaluating the accuracy of IGRT practices and technology. The directed acyclic graph (DAG) contains nodes and directional arcs representing the causal relationship between the many interacting factors such as tumour site and its associated critical organs, technology and technique, and inter-user variability. The BN was extended to support on-line and off-line decision-making with respect to treatment plan compliance. Following conceptualisation of the framework, the BN will be quantified. It is anticipated that the finalised decision-making framework will provide a foundation to develop better decision-support strategies and automated correction algorithms for IGRT.

The importance of importance : its impact on decision-making in mall retail categories during an economic downturn

The study examines how, during an economic downturn, the perceived importance of the value offering of retail store categories, as identified by a major international mall operator based in Australia, influences the relationship between consumers’ shopping attitudes and likelihood of purchasing in those categories. The findings show variance in the importance pertaining to retail store categories between those that have and those that have not altered their shopping behaviour. Different mediating effects were found in the major, mini-major, leisure, apparel, and mobile phone categories, suggestive of each group having differing levels of self-interest in the value offerings of each category, thus, symptomatic of dissimilar decision-making strategies for each group. Contributions to theory and practice are discussed.

The potential of XML technology as an answer to the data interchange problems of the construction industry

The complex supply chain relations of the construction industry, coupled with the substantial amount of information to be shared on a regular basis between the parties involved, make the traditional paper-based data interchange methods inefficient, error prone and expensive. The successful information technology (IT) applications that enable seamless data interchange, such as the Electronic Data Interchange (EDI) systems, have generally failed to be successfully implemented in the construction industry. An alternative emerging technology, Extensible Markup Language (XML), and its applicability to streamline business processes and to improve data interchange methods within the construction industry are analysed, as is the EDI technology to identify the strategic advantages that XML technology provides to overcome the barriers to implementation. In addition, the successful implementation of XML-based automated data interchange platforms for a large organization, and the proposed benefits thereof, are presented as a case study.

Self-management associated with fatigue in patients with advanced cancer : a prospective longitudinal study

Cancer-related fatigue is one of the most distressing symptoms experienced by patients with advanced cancer. This doctoral study identified that patients with advanced cancer commonly use a number of self-management strategies in response to fatigue, although these strategies had varying levels of effectiveness in reducing the symptom. The study identified that enhancing self-efficacy and managing depressive symptoms are important factors to consider in the design of future interventions to support fatigue self-management.

Sustainability in post disaster road infrastructure recovery projects and asset management

Civil infrastructure and especially roads are being impacted with increasing frequency by flood, Tsunami, cyclone related natural and manmade disasters in the world. Responding to such events and in preparing for more regular and intense climate-change induced events in future, the road governing agencies are reviewing how postdisaster road infrastructure recovery projects are best planned and delivered. In particular, there is awareness that rebuilding such infrastructure require sustainable asset management strategies across economic, environmental and social dimensions. A comprehensive asset management framework for pre and post disaster situations can minimize negative impacts on our communities, economy and environment. This research paper is focused on post disaster management in road infrastructures and road infrastructure asset management strategies used by road authorities. Analyzing the implications of disruption to transport network and associated services is an important part of preparing local and regional responses to the impacts of disasters. This research paper will contribute to strategic infrastructure asset planning, management leading to safe, efficient and integrated transport system that supports sustainable economic, social and environmental outcomes. This paper also focuses on proper asset management, governance and engineering principles which should be followed and adopted in post disaster recovery projects to maximize sustainability in environmental, social and economic dimensions.

The Interaction of lean and building information modeling in construction

Lean construction and building information modeling (BIM) are quite different initiatives, but both are having profound impacts on the construction industry. A rigorous analysis of the myriad specific interactions between them indicates that a synergy exists which, if properly understood in theoretical terms, can be exploited to improve construction processes beyond the degree to which it might be improved by application of either of these paradigms independently. Using a matrix that juxtaposes BIM functionalities with prescriptive lean construction principles, 56 interactions have been identified, all but four of which represent constructive interaction. Although evidence for the majority of these has been found, the matrix is not considered complete but rather a framework for research to explore the degree of validity of the interactions. Construction executives, managers, designers, and developers of information technology systems for construction can also benefit from the framework as an aid to recognizing the potential synergies when planning their lean and BIM adoption strategies.

The once-and-for-all withdrawal of the Liverpool Care Pathway in the UK : what are the implications for Australia?

This Perspective reflects on the withdrawal of the Liverpool Care Pathway in the UK, and its implications for Australia. Integrated care pathways are documents which outline the essential steps of multidisciplinary care in addressing a specific clinical problem. They can be used to introduce best clinical practice, to ensure that the most appropriate management occurs at the most appropriate time and that it is provided by the most appropriate health professional. By providing clear instructions, decision support and a framework for clinician-patient interactions, care pathways guide the systematic provision of best evidence-based care. The Liverpool Care Pathway (LCP) is an example of an integrated care pathway, designed in the 1990s to guide care for people with cancer who are in their last days of life and are expected to die in hospital. This pathway evolved out of a recognised local need to better support non-specialist palliative care providers’ care for patients dying of cancer within their inpatient units. Historically, despite the large number of people in acute care settings whose treatment intent is palliative, dying patients receiving general hospital acute care tended to lack sufficient attention from senior medical staff and nursing staff. The quality of end-of-life care was considered inadequate, therefore much could be learned from the way patients were cared for by palliative care services. The LCP was a strategy developed to improve end-of-life care in cancer patients and was based on the care received by those dying in the palliative care setting.

What information is necessary to assess the environmental impacts of deconstruction?

4D modeling - the simulation and visualisation of the construction process - is now a common method used during the building construction process with reasonable support from existing software. The goal of this paper is to examine the information needs required to model the deconstruction/demolition process of a building. The motivation is the need to reduce the impacts on the local environment during the deconstruction process. The focus is on the definition and description of the activities to remove building components and on the assessment of the noise, dust and vibration implications of these activities on the surrounding environment. The outcomes of the research are: i. requirements specification for BIM models to support operational deconstruction process planning, ii. algorithms for augmenting the BIM with the derived information necessary to automate planning of the deconstruction process with respect to impacts on the surrounding environment, iii. algorithms to build naive deconstruction activity schedules.

Improved procedures for business accommodation on transportation construction projects

Highway construction projects have direct impacts on adjacent businesses. The nature and the degree of impact depend on individual business characterization and project specific factors. The type of business is also a relevant factor in predicting the impact of transportation construction projects. This paper presents the results of research focused on developing an in-depth understanding of these relationships. The study includes project case studies of three transportation construction projects in Florida. Surveys were conducted with all adjacent businesses, which were combined with analyses of the business accommodation procedures employed by State Highway Agencies (SHAs) nationwide to provide measure the efficiency of present rules. The results include an analysis of differing priorities for different classification of businesses and development of design and construction management best practices to better accommodate businesses during highway construction. A pilot project that employed business accommodation principles devised in this research, and improvements to business accommodations observed were compared to cases where no measures were taken.

Ethics in project management : some Aristotelian insights

Purpose My aim is to introduce, in the project management field, an Aristotelian ethics lens moving beyond the classical deontological and consequentialism approaches underlying the current ethical practices and codes of ethics and professional conducts. In doing so, I wish to pose the premises of a debate on the implications of a conscious ethical perspective for the structure and agency relationship within the project management field Design/methodology/approach Project management is a knowledge field on its own right. However the current perspectives applied to make sense and develop the field (modernism vs. postmodernism) leads to dichotomous thinking rather than recognizing the merits and contextual validity of both sides. I call for Aristotelian Ethics as a way of moving beyond this dichotomous thinking. I introduce briefly Aristotelian Ethics and its consequences in term of relation theory – practice, means and ends, facts and values, and finally politics (i.e. being part of a community of practitioners). Then I illustrate some consequences for the field taking PMI Code of Ethics and Professional Conduct and APM Code of Professional Conduct as supports for discussion Findings I suggest a need for revisiting and/or redesigning the codes of ethics and professional conducts for project management according to an Aristotelian perspective, in order to move beyond the normative limitations of classical deontological (conflict between competing duties, exemplified by PMI Code) or consequentialism (focusing on the "right" outcome to the detriment of duties, exemplified by APM Code) approaches (both, in fact, leading to a disconnection means and ends, and facts and values). This implicates shifting our view from the question "what is my duty?" to the questions "why should I undertake my duty?" and "how ought I act in this situation?" Practical implications Raising Professional Bodies, Industry and Education institutions awareness and consciousness and leading them to rethink about codes of ethics and the implications for the way they conceive practice and research, bodies of knowledge, credentialing, education... Originality/value To the best of my knowledge, this kind of discussion has not yet been conducted within the project management field, and considering the implication of project management in our life and for the well being of the society, an ethical debate may present some value(s)

Economic development and construction productivity in Malaysia

The productivity of the construction industry has a significant effect on national economic growth. Gains from higher construction productivity flow through the economy, as all industries rely on construction to some extent as part of their business investment. Contractions and expansions of economic activity are common phenomena in an economy. Three construction cycles occurred between the years 1970 and 2011 in Malaysia. The relationships between construction productivity and economic development are examined by the partial correlation method to establish the underlying factors driving the change in construction productivity. Construction productivity is statistically significantly correlated with gross domestic product (GDP) per capita in a positive direction for the 1985–98 and 1998–2009 cycles, but not the 1970–85 cycle. Fluctuations in construction activities and the influx of foreign workers underlie the changes of construction productivity in the 1985–98 cycle. There was less fluctuation in construction activities in the 1998–2009 cycle, with changes being mainly due to the fiscal stimulation policies of the government in attempting to stabilize the economy. The intensive construction of mega-projects resulted in resource constraints and cost pressures during the 1980s and 1990s. A better management of the ‘boom-bust’ nature of the construction business cycle is required to maintain the capability and capacity of the industry.

Climate variability, climate change and land degradation

Effective response by government and individuals to the risk of land degradation requires an understanding of regional climate variations and the impacts of climate and management on condition and productivity of land and vegetation resources. Analysis of past land degradation and climate variability provides some understanding of vulnerability to current and future climate changes and the information needs for more sustainable management. We describe experience in providing climate risk assessment information for managing for the risk of land degradation in north-eastern Australian arid and semi-arid regions used for extensive grazing. However, we note that information based on historical climate variability, which has been relied on in the past, will now also have to factor in the influence of human-induced climate change. Examples illustrate trends in climate for Australia over the past decade and the impacts on indicators of resource condition. The analysis highlights the benefits of insights into past trends and variability in rainfall and other climate variables based on extended historic databases. This understanding in turn supports more reliable regional climate projections and decision support information for governments and land managers to better manage the risk of land degradation now and in the future.

Revisiting the adoption of innovative products on Australian road infrastructure projects

Construction product innovation can exert a positive influence on project and industry performance. However, guidance is scarce on product innovation diffusion for road infrastructure, in contrast to the large body of literature on the manufacturing industry. A conceptual framework is proposed to understand these processes. Advice is given to managers based on the framework and a large quantitative survey. The framework focuses on contextual characteristics that influence the decision to adopt new-to-industry product innovation, as part of a diffusion process. Case study data are interpreted within the revised framework to test its value and disaggregate the broad obstacles to innovation. A large quantitative survey was then conducted to rank the relative importance of the obstacles constraining the adoption of innovative products on road construction projects. The three most important obstacles were found to be: (1) overemphasis on up-front project costs during tender stage; (2) disagreement over who carries the risk of new product failure; and (3) adversarial contract relations. The results suggest refinements to the conceptual framework to make it a more powerful tool for categorizing and analysing construction innovation obstacles. Results also suggest well-resourced repeat interactions within complementary procurement and regulatory systems will enhance the project teams’ ability to recognize and address innovation obstacles. Further, improved relationships are expected to decrease the need for an overly conservative approach to product approval and prescriptive specifications.

Developing an evaluation framework for hospital disaster resilience : tertiary hospitals of Shandong Province, China

This thesis provided a definition and conceptual framework for hospital disaster resilience; it used a mixed-method, including an empirical study in tertiary hospitals of Shandong Province in China, to devise an assessment instrument for measuring hospital resilience. The instrument is the first of its type and will allow hospitals to measure their resilience levels. The concept of disaster resilience has gained prominence in the light of the increased impact of various disasters. The notion of resilience encompasses the qualities that enable the organisation or community to resist, respond to, and recover from the impact of disasters. Hospital resilience is essential as it provides 'lifeline' services which minimize disaster impact. This thesis has provided a framework and instrument to evaluate the level of hospital resilience. Such an instrument could be used to better understand hospital resilience, and also as a decision-support tool for its promoting strategies and policies.

Event interval analysis: Why do processes take time?

Through the application of process mining, valuable evidence-based insights can be obtained about business processes in organisations. As a result the field has seen an increased uptake in recent years as evidenced by success stories and increased tool support. However, despite this impact, current performance analysis capabilities remain somewhat limited in the context of information-poor event logs. For example, natural daily and weekly patterns are not considered. In this paper a new framework for analysing event logs is defined which is based on the concept of event gap. The framework allows for a systematic approach to sophisticated performance-related analysis of event logs containing varying degrees of information. The paper formalises a range of event gap types and then presents an implementation as well as an evaluation of the proposed approach.