Virtual Reality Interactive Learning Environment

Open Building Manufacturing (ManuBuild) aims to promote the European construction industry beyond the state of the art. However, this requires the different stakeholders to be well informed of what ‘Open Building Manufacturing’ actually entails with respect to understanding the underlying concepts, benefits and risks. This is further challenged by the ‘traditional ways of learning’ which have been predominantly criticised for being entrenched in theories with little or no emphasis on practical issues. Experiential learning has long been suggested to overcome the problems associated with the traditional ways of learning. In this respect, it has the dual benefit of appealing to adult learner's experience base, as well as increasing the likelihood of performance change through training. On-the-job-training (OJT) is usually sought to enable ‘experiential’ learning; and it is argued to be particularly effective in complex tasks, where a great deal of independence is granted to the task performer. However, OJT has been criticised for being expensive, limited, and devoid of the actual training context. Consequently, in order to address the problems encountered with OJT, virtual reality (VR) solutions have been proposed to provide a risk free environment for learning without the ‘do-or-die’ consequences often faced on real construction projects. Since ManuBuild aims to promote the EU construction industry beyond the state of the art; training and education therefore needs also to go beyond the state of the art in order to meet future industry needs and expectations. Hence, a VR interactive learning environment was suggested for Open Building Manufacturing training to allow experiential learning to take place in a risk free environment, and consequently overcome the problems associated with OJT. This chapter discusses the development, testing, and validation of this prototype

Multidrug-Resistant Tuberculosis in Patients without HIV Infection

BACKGROUND Investigations of outbreaks of multidrug-resistant tuberculosis have found low rates of treatment response and very high mortality, and they have mainly involved patients with advanced human immunodeficiency virus (HIV) infection. For patients without HIV infection, one study reported an overall rate of response to treatment of 56 percent, and the mortality from tuberculosis was 22 percent. We investigated treatment response and mortality rates in 26 HIV-negative patients in New York with multidrug-resistant tuberculosis. METHODS We obtained detailed data from seven teaching hospitals in New York City on patients with multidrug-resistant tuberculosis--defined as tuberculosis resistant at least to isoniazid and rifampin--who were HIV-negative on serologic testing. Lengths of times from diagnosis to the initiation of appropriate therapy and from the initiation of appropriate therapy to conversion to negative cultures were assessed. Therapeutic responses were evaluated by both microbiologic and clinical criteria. RESULTS Between March 1991 and September 1994, 26 HIV-negative patients were identified and treated. Of the 25 patients for whom adequate data were available for analysis, 24 (96 percent) had clinical responses; all 17 patients for whom data on microbiologic response were available had such a response. The median times from diagnosis to the initiation of appropriate therapy and from the initiation of therapy to culture conversion were 44 days (range, 0 to 181) and 69 days (range, 2 to 705), respectively. Side effects requiring the discontinuation of medication occurred in 4 of 23 patients (17 percent) who were treated with second-line antituberculosis medications. The median follow-up for the 23 patients who responded and who received appropriate therapy was 91 weeks (range, 41 to 225). CONCLUSIONS In this report from New York City, HIV-negative patients with multidrug-resistant tuberculosis, contrary to previous reports, responded well to appropriate chemotherapy, both clinically and microbiologically

Industrialising the construction industry : a collaborative training and education model

The United Kingdom (UK) construction industry has long been the centre of criticism and debate for its relative poor performance and high turnover. In this respect, the UK Government embarked on reviving Offsite Production (OSP) in an attempt to negate these issues, whilst simultaneously reducing the dependence on manual skills. However, extant literature highlights that professional (non-manual) skill shortages are just as acute. Notwithstanding these factors, from a training and education perspective, it is widely acknowledged that the myriad of approaches currently deployed to address professional education and training needs have systematically failed to fully satisfy industry's expectations. This is due in part to the lack of a 'common language' between the construction industry and the training/education providers. Given that OSP training and education is a predominant driver for the successful and wider uptake of OSP, there is no direct empirical evidence on the type, level, or priorities of OSP training and education required to meet the new exigent business drivers. This research focuses on addressing the polarised silos that currently exist between industry and training/education providers through the provision of a flexible collaborative model. This model embodies multi-criteria and multistakeholder perceptions and imperatives in order to help provide a 'shared' language and understanding across these multivariate issues to formally identify and prioritise OSP training and education needs. This research adopted a system approach to OSP training and education using the Quality Function Deployment (QFD) method to develop an OSP-QFD model. The positioning of this research adopts the positivism paradigm to infer OSP skills requirements, underpinned and supported by a triangulation approach to define the measures to satisfy those needs and help increase the validity and reliability of the data obtained. The model was iteratively tested and validated using domain experts from industry, academia and research organisations. Research findings confirmed the scepticism and misconception of the construction industry and academia with regard to OSP and industryacademia collaboration. However, the developed OSP-QFD model demonstrated that it could be used to shape, structure, and document the skills needed from multivariate viewpoints, thereby addressing the different drivers and expectations of the polarised stakeholders. Furthermore, the OSP-QFD model accommodates design flexibility, so that individual priorities can be independently assessed and analysed.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Offsite Production: A Model for Building Down Barriers: A European Construction Industry Perspective

Purpose – Recent calls were launched worldwide for the “revival” of offsite production (OSP) (under numerous nomenclatures) in order to improve the construction industry, meet market demand; and furthermore, overcome the dependence on skilled labour. Despite the well-documented benefits of OSP, the construction industry seems to be somewhat hesitant in effectively responding to those calls. Forming part of a triangulated research, this paper aims to explore the European Union (EU) construction industry main patterns of concern with regard to OSP. The findings from this paper are set to guide the development of an OSP training and education model (not reported in this paper). Design/methodology/approach – A qualitative approach using the content analysis technique was employed to analyse secondary data (transcripts) from 54 open-ended questionnaires carried out under the ManuBuild EU research project, to deeply explore the EU construction industry main perceptions/concerns which may represent a barrier to the wider uptake of OSP. Findings – The EU construction industry reluctance to embrace OSP practices is largely attributable (amongst others) to the unsuccessful past experiences associated with this approach. While the findings were in line with extant literature “hard” issues/concerns such as cost and productivity, additional findings revealed “softer” issues/concerns such as the flexibility of the OSP approach, preservation of the identity of cities, and the ability to adapt OSP buildings to older generations' needs and requirements. Originality/value – This paper condensed and synchronised all OSP-related patterns of concern in a conceptual model. The model expanded on the well documented triad model of “people”, “technology”, and “process”; and further added the “product” and “market” pattern to it. Should all these main five OSP patterns of concerns be addressed, it is postulated that this would help support the wider uptake of OSP within the EU construction industry; and furthermore create a shared understanding between industry and training/education institutions to enable an OSP knowledgeable industry

Offsite Production in the UK: The Way Forward?, A UK Construction Industry Perspective

Purpose – The purpose of this paper is to report on findings from the first stage of an ongoing research with regard to the UK construction industry's perception of offsite production (OSP) adoption/uptake, in an attempt to inform the second stage of the research (not reported in this paper) to infer the skills/knowledge areas needed for the wider uptake of OSP. Design/methodology/approach – The objective of this paper was to capture the UK construction industry's perception vis-à-vis OSP characteristics using a quantitative approach. Postal surveys were employed to collect industry perception which was then analysed statistically for inference and conclusion. Findings – Findings from 36 large construction organisations suggest that irrespective of respondents' organisations prime activity or professions, the majority of respondents perceive OSP to be the future of the UK construction industry; with a considerable belief that the industry is ready to embrace OSP. Nevertheless, the industry do not seem to fully appreciate OSP, which is implied by the uncertainty recorded in most of the responses. Research limitations/implications – Whilst the data validity and sample set coherence can be considered robust and defendable, it should be acknowledged that care needs to be taken when interpreting results, especially as the data collected depended heavily on the survey approach. Furthermore, these findings are limited to the UK context only, as such, the level of generalisability/repeatability outside this context may not be representative of the findings presented here. Originality/value – OSP falls under the overarching umbrella of modern methods of construction, which is high on the UK Government Agenda. OSP has attracted numerous research over the last decades; however, there is limited literature to quantify industry perception in this regard, especially to enable the inference and prioritisation of skills and knowledge areas needed to support the wider uptake of OSP (not reported in this paper)

Construction Industry Offsite Production: A Virtual Reality Interactive Training Environment Prototype

The ‘traditional’ constructionindustry has constantly been challenged to improve its inherent problematic practices. Offsite production (OSP), under the umbrella of modern methods of construction (MMC), has been acknowledged as a means to help improve constructionindustry performance as well as meet new market demands through the provision of improved, adaptable, and sustainable buildings. However, the deployment of OSP systems, if not managed properly, may adversely affect the end result and be counterproductive. It is therefore imperative that the constructionindustry stakeholders learn and appreciate the specifics, merits, as well as the risks associated with OSP systems in order to achieve the desired outcomes and consequently improve industry performance. On-the-job-training (OJT) is usually sought to facilitate ‘experiential’ learning, which is argued to be particularly effective where a great deal of independence is granted to the task performer. However, OJT has been criticised for being expensive, limited, and sometimes devoid of the actual training context. In order to address the problems encountered with OJT, several virtualreality (VR) solutions have been proposed. This paper introduces one such VR solution prototype, in order to provide a risk-free environment for learning without the ‘do-or-die’ consequences often faced on real construction projects. The proffered solution provides a unique VR environment for practicing new working conditions associated with OSP practices. While the ‘scenes’ of the VR environment take place on aconstruction site, the environment predominantly targets professionals, such as project managers, construction managers, architects, designers, suppliers and manufacturers, to allow multidisciplinary learning to occur, and hence overcome ‘knowledge silos’ or ‘knowledge compartmentation’. The VR environment enables unforeseen problems often caused by professionals’ decisions, faulty work, and health and safety issues to occur; where the implications of which can be evaluated in respect of time, cost and resources. The VR environment proposed does not aim to resolve problems associated with OSP per se, rather aims to allow ‘things to go wrong’ and consequently allows users not only to ‘experience’ the resulting implications but also to reflect on those implications as part of the learning process. This paper discusses and presents the prototype for the first development phase of the VR interactivetrainingenvironment. While the prototype was tested and validated with domain experts from industry, the research community, and academia from different EU countries, the data used in developing the prototype was constrained to one project in the UK which may limit the generalisability of results

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research