The prevalent theory of construction is a hindrance for innovation

It is argued that construction innovation is significantly hindered by the prevalent theory of construction, which is implicit and deficient. There are three main mechanisms through which this hindrance is being caused. Firstly, because production theories in general, as well as construction theories specifically, have been implicit, it has not been possible to transfer such radical managerial innovation as mass production or lean production from manufacturing to construction. Direct application of these production templates in construction has been limited due to different context in construction in correspondence to manufacturing. On the other hand, without explicit theories, it has not been possible to access core ideas of concepts and methods of these templates, and to recreate them in construction environment. In consequence, theory and practice of construction has not progressed as in manufacturing. Secondly, it is argued that the underlying, even if implicit, theoretical model of construction is the transformation model of production. There are two first principles in the transformation model. First, the total transformation can be achieved only by realising all parts of it. Thus, we decompose the total transformation into parts, finally into tasks, ensure that all inputs are available and assign these tasks to operatives or workstations. Second, minimising the cost of each task, i.e. each decomposed transformation, minimises the cost of production. It is argued that these principles, in which uncertainty and time are abstracted away, are counterproductive, and lead to myopic control and inflated variability. Practical examples show that these deficiencies and related practical constraints hinder the top-down implementation of innovations. Thirdly, empirical research shows that also bottom-up innovation - systematic learning and problem solving - is hindered by this deficient theory. Thus, the advancement of construction innovation requires that a new, explicit and valid theory of construction is created, and business models and control methods based on it are developed

Gastrointestinal complications of hepatic transplantation

In this series of 150 orthotopic hepatic transplants, clinically significant gastrointestinal hemorrhage occurred in 34 patients (23%). Five patients (15%) survived this complication. Enteric perforations occurred in 20 patients following 198 biliary-enteric procedures. Only one patient survived. Enteric perforations unrelated to biliary procedures fared only slightly better with one survivor among eight perforations. These results clearly do not warrant complacency. Modifications advocated are an aggressive diagnostic approach and early reoperation with establishment of extensive peritoneal drainage where necessary

Is agile project management applicable to construction?

This paper briefly summarises the evolution of Agile Project Management (APM) and differentiates it from lean and agile production and ‘leagile’ construction. The significant benefits being realized through employment of APM within the information systems industry are stated. The characteristics of APM are explored, including: philosophy, organizational attitudes and practices, planning, execution and control and learning. Finally, APM is subjectively assessed as to its potential contribution to the pre-design, design and construction phases. In conclusion, it is assessed that APM offers considerable potential for application in predesign and design but that there are significant hurdles to its adoption in the actual construction phase. Should these be overcome, APM offers benefits well beyond any individual project

The technique of prolonged thoracic duct drainage in transplantation

Prolonged thoracic duct drainage as an immunosuppressive adjunct was accomplished in 96 per cent of organ recipients upon whom it was attempted

Bored with point and click?

Computers have the potential to be exploited as one of the most exciting examples of instructional media. Yet designers often fail to realize this potential. This is, in part, due to the limitations of hardware and software and, in part, due to the lack of good theory developed through conclusive research. Good examples of computer-based learning may owe more to the imaginative flair of the courseware designer than they do to the application of explicit design guidelines and good learning theory. This paper will therefore consider a variety of issues that may be blocking theoretical development and draw conclusions for future courses of action. This starts with a statement of the problem, first by considering the macro and micro issues, and then by looking at a recent call for help in ComputerBased Learning Environment (CBLE) design. Next, the contribution of instructional design theories will be presented together with a way forward for investigating the issues. Finally the implications for future progress are presented

Liver Resection for Hepatic Adenoma

Between 1970 and 1978, eight hepatic adenomas were resected. Four of the eight patients took oral contraceptive pills before the hepatic adenoma was identified; one patient was male. Four patients had evidence of bleeding at the time of presentation. The original histologic diagnosis in the first five patients was malignant hepatoma. There has been no known recurrence of tumor and all patients are well. The use of oral contraceptives in these patients has been prohibited. Formal anatomic resection is recommended for hepatic adenoma when this procedure can be done without mortality or serious morbidity; however, in the future, less drastic treatments, such as occlusion of the hepatic arterial circulation to the tumor or discontinuation of oral contraceptives, may prove as effective as tumor resection. © 1979, American Medical Association. All rights reserved