An examination of the relationship between skills development and productivity in the construction industry

In recent years, the UK government skills policy has emphasised the role of workforce skills development as a key driver of economic success and improving productivity across all sectors of the economy. The importance of skills (as a vehicle for enhancing productivity performance) is highlighted within numerous government reports, such as Skills White Papers (2003 and 2005), in addition to the Leitch Review of Skills (2006) which coincided with the outset of this research. Thus, the aim of this research was to examine the relationship between skills development and productivity in the construction industry in order to assess the assumptions of government skills policy in the context of the sector. A multi-method approach was adopted in this research. This involved the analysis of: official construction statistics, levy/grant and financial accounts data of construction companies, in addition to a telephone survey. The main findings of the research are published in five peer reviewed academic papers, demonstrating the tenuous nature of the relationship between skills development and productivity performance, particularly when considering the heterogeneous nature of the construction industry. Government claims about the mono-causal relationship between skills and productivity should be treated with caution. A simple boost in qualification levels or participation rates of training is unlikely to lead to productivity improvements in the construction sector.However, skills development and training activities needs to be targeted and focused if the desired outcome of enhancing productivity performance is to be achieved. Construction companies needs to be proactive in addressing the skills and training needs of their business through drawing on the various support available through CITBConstructionSkills training grants or participating in appropriate skills/training initiatives, such as apprenticeship schemes. The provision of 'productivity-based' training grants should be considered by CITB-CS in order to prompt construction companies to consider training as a plausible means for enhancing their productivity performance. Finally, the recommendations presented in this thesis and areas for further research sets out the potential way forward in terms of advancing knowledge in this area

Multiple damage detection and localization in beam-like and complex structures using co-ordinate modal assurance criterion combined with firefly and genetic algorithms

Damage detection and localization in civil engineering constructions using dynamic analysis has become an important topic in recent years. This paper presents a methodology based on non-destructive detection, localization and quantification of multiple damages in simple and continuous beams, and a more complex structure, namely two-dimensional frame structure. The proposed methodology makes used of Firefly Algorithm and Genetic Algorithm as optimization tools and the Coordinate Modal Assurance Criterion as an objective function. The results show that the proposed combination of Coordinate Modal Assurance Criterion and Firefly Algorithm or Genetic Algorithm can be easily used to identify multiple local structural damages in complex structures. However, the convergence rate becomes slower for the case of multiple damages compared to the case of single damage. The effect of noise on the algorithm is further investigated. It is found that the proposed technique is able to detect the damage location and its severity with high accuracy in the presence of noise, although the convergence rate became slower than in the case when no noise is present. It is also found that the convergence rate of Firefly Algorithm is much faster than that of Genetic Algorithm

Semiocclusive Therapy Versus Full Thickness Skin Grafts Versus Reverse Flow Homodigital Island Flaps in Reconstruction of Volar Oblique Fingertip Injuries

Background: Fingertip amputations are among the most common injuries seen in the hand. The mechanism, level, and direction of amputation are important factors in choosing the appropriate reconstructive option. Optimal management is a much-debated topic with advocates for operative and non-oper¬ative treatment. Aim of the Work: To compare the outcome of healing by secondary intention, full thickness skin grafts from the ulnar border of the hand, and reverse flow homodigital island flaps in the management of volar oblique fingertip amputations in the hand according to time of complete healing, aesthetic outcome, return to work timing and according to complications rate. Patients and Methods: This study was conducted on 75 patients who were presented to ER department, with volar oblique fingertip injury. Patients are classified into three equal groups, each group contain 25 patients. First group was managed conservatively with semiocclusive dressing. Second group was reconstructed with full thickness skin grafts. Third group was reconstructed with reverse flow homodigital island flaps. Results: In this study, we can confirm that surgical intervention with either technique, reconstruction with full thickness skin graft or reconstruction with reverse flow homodigital island flap is too much better than healing with secondary intention. With better results with full thickness skin grafts over homodigital island flaps specially in small defects with no exposed bones, a lesion represent most of fingertip cases in surgery. On the other hand homodigital island flaps are better in big defects and in cases with exposed bones.            Conclusion: Fingertip injuries are the most common injuries in hand trauma patients. The major cause for adult patients is occupational accidents etiology. There are several classifications for fingertip injuries. Treatment options vary depending on the injury mechanism, defect’s size and plane, surgeon’s intention, patient’s needs, condition of the stump and the amputated part. Despite ongoing publication of new flaps for fingertip reconstruction, there is a paucity of evidence to support improved healing and function in a surgically reconstructed fingertip compared to conservative wound management. Controlled trials are sorely needed to distill the truth as to whether surgery is superior to secondary healing or no

Republished Paper. Multiple damage detection and localization in beam-like and complex structures using co-ordinate modal assurance criterion combined with firefly and genetic algorithms

Damage detection and localization in civil engineering constructions using dynamic analysis has become an important topic in recent years. This paper presents a methodology based on non-destructive detection, localization and quantification of multiple damages in simple and continuous beams, and a more complex structure, namely two-dimensional frame structure. The proposed methodology makes used of Firefly Algorithm and Genetic Algorithm as optimization tools and the Coordinate Modal Assurance Criterion as an objective function. The results show that the proposed combination of Coordinate Modal Assurance Criterion and Firefly Algorithm or Genetic Algorithm can be easily used to identify multiple local structural damages in complex structures. However, the convergence rate becomes slower for the case of multiple damages compared to the case of single damage. The effect of noise on the algorithm is further investigated. It is found that the proposed technique is able to detect the damage location and its severity with high accuracy in the presence of noise, although the convergence rate became slower than in the case when no noise is present. It is also found that the convergence rate of Firefly Algorithm is much faster than that of Genetic Algorithm

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe