The documentation of design decisions in engineering projects:A study in infrastructure development

In most design projects, the documentation of design decisions is considered important. Among others, documentation of design decisions contributes to the traceability of decisions that shape a project’s development process, helps deal with changes in the project and prevents the recurrence of old discussions. Yet, little attention is given to documenting design decisions in civil engineering literature. In this study, a theoretical framework for the key elements of this documentation process was developed. Four road infrastructure projects were studied and compared to this framework by means of pattern matching. This method compares theoretical and empirical patterns and determines whether they match or do not match. The findings demonstrate that accessibility of documentation for all involved project parties and division of documentation tasks are in accordance with literature. However, the documentation of design decisions and their rationale is not done as completely as is recommended in theory. Literature states that the documentation of interrelations and context of decisions should be described thoroughly, but that is barely done in practice. In addition, the findings show that neither immediate documentation, nor periodical monitoring of documentation is applied. Based on these findings, this research proposes a strategy for improving the documentation of design decisions.</p

The documentation of design decisions in engineering projects: A study in infrastructure development

In most design projects, the documentation of design decisions is considered important. Among others, documentation of design decisions contributes to the traceability of decisions that shape a project’s development process, helps deal with changes in the project and prevents the recurrence of old discussions. Yet, little attention is given to documenting design decisions in civil engineering literature. In this study, a theoretical framework for the key elements of this documentation process was developed. Four road infrastructure projects were studied and compared to this framework by means of pattern matching. This method compares theoretical and empirical patterns and determines whether they match or do not match. The findings demonstrate that accessibility of documentation for all involved project parties and division of documentation tasks are in accordance with literature. However, the documentation of design decisions and their rationale is not done as completely as is recommended in theory. Literature states that the documentation of interrelations and context of decisions should be described thoroughly, but that is barely done in practice. In addition, the findings show that neither immediate documentation, nor periodical monitoring of documentation is applied. Based on these findings, this research proposes a strategy for improving the documentation of design decisions

Deplatformization and the governance of the platform ecosystem

This article analyzes deplatformization as an implied governance strategy by major tech companies to detoxify the platform ecosystem of radical content while consolidating their power as designers, operators, and governors of that same ecosystem. Deplatformization is different from deplatforming: it entails a systemic effort to push back encroaching radical right-wing platforms to the fringes of the ecosystem by denying them the infrastructural services needed to function online. We identify several deplatformization strategies, using Gab as an example of a platform that survived its relegation and which subsequently tried to build an alternative at the edge of the mainstream ecosystem. Evaluating deplatformization in terms of governance, the question that arises is who is responsible for cleansing the ecosystem: corporations, states, civil society actors, or all three combined? Understanding the implied governance of deplatformization is imperative to assess the higher stakes in future debates concerning Internet governability

Clinical and virological characteristics of hospitalised COVID-19 patients in a German tertiary care centre during the first wave of the SARS-CoV-2 pandemic: a prospective observational study

Purpose: Adequate patient allocation is pivotal for optimal resource management in strained healthcare systems, and requires detailed knowledge of clinical and virological disease trajectories. The purpose of this work was to identify risk factors associated with need for invasive mechanical ventilation (IMV), to analyse viral kinetics in patients with and without IMV and to provide a comprehensive description of clinical course. Methods: A cohort of 168 hospitalised adult COVID-19 patients enrolled in a prospective observational study at a large European tertiary care centre was analysed. Results: Forty-four per cent (71/161) of patients required invasive mechanical ventilation (IMV). Shorter duration of symptoms before admission (aOR 1.22 per day less, 95% CI 1.10-1.37, p < 0.01) and history of hypertension (aOR 5.55, 95% CI 2.00-16.82, p < 0.01) were associated with need for IMV. Patients on IMV had higher maximal concentrations, slower decline rates, and longer shedding of SARS-CoV-2 than non-IMV patients (33 days, IQR 26-46.75, vs 18 days, IQR 16-46.75, respectively, p < 0.01). Median duration of hospitalisation was 9 days (IQR 6-15.5) for non-IMV and 49.5 days (IQR 36.8-82.5) for IMV patients. Conclusions: Our results indicate a short duration of symptoms before admission as a risk factor for severe disease that merits further investigation and different viral load kinetics in severely affected patients. Median duration of hospitalisation of IMV patients was longer than described for acute respiratory distress syndrome unrelated to COVID-19

Variation in Structure and Process of Care in Traumatic Brain Injury: Provider Profiles of European Neurotrauma Centers Participating in the CENTER-TBI Study.

INTRODUCTION: The strength of evidence underpinning care and treatment recommendations in traumatic brain injury (TBI) is low. Comparative effectiveness research (CER) has been proposed as a framework to provide evidence for optimal care for TBI patients. The first step in CER is to map the existing variation. The aim of current study is to quantify variation in general structural and process characteristics among centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. METHODS: We designed a set of 11 provider profiling questionnaires with 321 questions about various aspects of TBI care, chosen based on literature and expert opinion. After pilot testing, questionnaires were disseminated to 71 centers from 20 countries participating in the CENTER-TBI study. Reliability of questionnaires was estimated by calculating a concordance rate among 5% duplicate questions. RESULTS: All 71 centers completed the questionnaires. Median concordance rate among duplicate questions was 0.85. The majority of centers were academic hospitals (n = 65, 92%), designated as a level I trauma center (n = 48, 68%) and situated in an urban location (n = 70, 99%). The availability of facilities for neuro-trauma care varied across centers; e.g. 40 (57%) had a dedicated neuro-intensive care unit (ICU), 36 (51%) had an in-hospital rehabilitation unit and the organization of the ICU was closed in 64% (n = 45) of the centers. In addition, we found wide variation in processes of care, such as the ICU admission policy and intracranial pressure monitoring policy among centers. CONCLUSION: Even among high-volume, specialized neurotrauma centers there is substantial variation in structures and processes of TBI care. This variation provides an opportunity to study effectiveness of specific aspects of TBI care and to identify best practices with CER approaches

Variation in general supportive and preventive intensive care management of traumatic brain injury: a survey in 66 neurotrauma centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study

Abstract Background General supportive and preventive measures in the intensive care management of traumatic brain injury (TBI) aim to prevent or limit secondary brain injury and optimize recovery. The aim of this survey was to assess and quantify variation in perceptions on intensive care unit (ICU) management of patients with TBI in European neurotrauma centers. Methods We performed a survey as part of the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. We analyzed 23 questions focused on: 1) circulatory and respiratory management; 2) fever control; 3) use of corticosteroids; 4) nutrition and glucose management; and 5) seizure prophylaxis and treatment. Results The survey was completed predominantly by intensivists (n = 33, 50%) and neurosurgeons (n = 23, 35%) from 66 centers (97% response rate). The most common cerebral perfusion pressure (CPP) target was > 60 mmHg (n = 39, 60%) and/or an individualized target (n = 25, 38%). To support CPP, crystalloid fluid loading (n = 60, 91%) was generally preferred over albumin (n = 15, 23%), and vasopressors (n = 63, 96%) over inotropes (n = 29, 44%). The most commonly reported target of partial pressure of carbon dioxide in arterial blood (PaCO2) was 36–40 mmHg (4.8–5.3 kPa) in case of controlled intracranial pressure (ICP) < 20 mmHg (n = 45, 69%) and PaCO2 target of 30–35 mmHg (4–4.7 kPa) in case of raised ICP (n = 40, 62%). Almost all respondents indicated to generally treat fever (n = 65, 98%) with paracetamol (n = 61, 92%) and/or external cooling (n = 49, 74%). Conventional glucose management (n = 43, 66%) was preferred over tight glycemic control (n = 18, 28%). More than half of the respondents indicated to aim for full caloric replacement within 7 days (n = 43, 66%) using enteral nutrition (n = 60, 92%). Indications for and duration of seizure prophylaxis varied, and levetiracetam was mostly reported as the agent of choice for both seizure prophylaxis (n = 32, 49%) and treatment (n = 40, 61%). Conclusions Practice preferences vary substantially regarding general supportive and preventive measures in TBI patients at ICUs of European neurotrauma centers. These results provide an opportunity for future comparative effectiveness research, since a more evidence-based uniformity in good practices in general ICU management could have a major impact on TBI outcome

‘Freshly Generated for You, and Barack Obama’: How Social Media Represent Your Life

This article discusses the ways in which social media help us craft the narratives of our lives. Many discussions of social media look at self-presentation and the construction of identity on social network sites in particular and the Internet in general. This article switches the focus from the moment of self-construction and instead looks at ways in which social media represent our lives by filtering the data we feed into them through templates and by displaying simplified patterns, visualizations and narratives back to us. The article argues that social media help users to see themselves by taking their raw data and representing them in structured form, and gives examples of different ways in which this data is presented

Digital photography: communication, identity, memory

Taking photographs seems no longer primarily an act of memory intended to safeguard a family's pictorial heritage, but is increasingly becoming a tool for an individual's identity formation and communication. Digital cameras, cameraphones, photoblogs and other multipurpose devices are used to promote the use of images as the preferred idiom of a new generation of users. The aim of this article is to explore how technical changes (digitization) combined with growing insights in cognitive science and socio-cultural transformations have affected personal photography. The increased manipulation of photographic images may suit the individual's need for continuous self-remodelling and instant communication and bonding. However, that same manipulability may also lessen our grip on our images' future repurposing and reframing. Memory is not eradicated from digital multipurpose tools. Instead, the function of memory reappears in the networked, distributed nature of digital photographs, as most images are sent over the internet and stored in virtual space