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Remdesivir, a direct-acting antiviral agent, may reduce mortality and progression to mechanical ventilation in moderately ill patients hospitalized with COVID-19 on supplemental low-flow oxygen. The benefits of remdesivir for critically ill patients requiring supplemental oxygen via high-flow nasal cannula or mask, or non-invasive mechanical ventilation, is uncertain. Remdesivir does not benefit and may harm critically ill patients already receiving mechanical ventilation or requiring extra-corporeal membrane oxygenation (ECMO), and it does not provide substantial benefit for hospitalized patients who do not require supplemental oxygen. Remdesivir appears to have comparable effects when used for 5 days or 10 days, and does not appear to be associated with significant adverse effects. Remdesivir is recommended in moderately ill hospitalized patients with COVID-19 requiring supplemental oxygen (Figure 1). Remdesivir may be considered for patients requiring oxygen supplementation via high-flow nasal cannula or mask, or non-invasive mechanical ventilation. It should not be used in critically ill patients on mechanical ventilation or those receiving ECMO. Remdesivir should not be used in patients who do not require supplemental oxygen.

The Private Finance Initiative (PFI) is a long‐term concession of services used by the UK Government to capture private capital to fund public projects. This model is being increasingly applied in Portugal and the assessment of its competitive advantage is very important to Portugal. The empiric study undertaken both in Portugal and the UK has permitted some conclusions to be drawn already. PFI has developed the way the construction industry is managed, and has increased the competitive advantage of UK construction industry acting in the four vectors of competitive advantage: innovation, quality, efficiency and attention to the client. Innovation occurred through new designs that were more efficient and cost effective through the project’s whole life cycle. There is the widespread use of management tools: whole life cycle costing, risk management and benchmarking. PFI also improved communication in the UK construction industry, forcing interaction and feedback from all stakeholders in a project.

This article proposes a U.K. Private Finance Initiative (PFI) holistic and integrative con-ceptual model that integrates a hierarchy of four levels of concepts: government ideology, principles, practices, and tools. The PFI life cycle process, value chain, and value-delivery network are also mapped. PFI is as a novel way to do business, and requires the establishment of a long-term relationship. PFI is an innovative concession as it relates the revenues for the private partner solely to the provision of a service, which in turn is performance related. To assess PFI success or failure is still premature because of the long life cycle of PFI projects, 20 to 30 years, and most projects have not yet been in operation for 10 years. In addition, based on the empirical data from the research and recurring to business information sources and academic studies on PFI (still very limited), the article addresses two important issues that emerged from the introduction of PFI: first the change in organizational culture brought about by a move into the services sector, coupled with the need to deal with long-term issues, followed by the financing structure, that is, the balancing of debt and equity and the hypothesis of considering bond issues to finance senior debt.

Complex microbial communities remain poorly characterized despite their ubiquity and importance to human and animal health, agriculture, and industry. Attempts to describe microbial communities by either traditional microbiological methods or molecular methods have been limited in both scale and precision. The availability of genomics technologies offers an unprecedented opportunity to conduct more comprehensive characterizations of microbial communities. Here we describe the application of an established molecular diagnostic method based on the chaperonin-60 sequence, in combination with high-throughput sequencing, to the profiling of a microbial community: the pig intestinal microbial community. Four libraries of cloned cpn60 sequences were generated by two genomic DNA extraction procedures in combination with two PCR protocols. A total of 1,125 cloned cpn60 sequences from the four libraries were sequenced. Among the 1,125 cloned cpn60 sequences, we identified 398 different nucleotide sequences encoding 280 unique peptide sequences. Pairwise comparisons of the 398 unique nucleotide sequences revealed a high degree of sequence diversity within the library. Identification of the likely taxonomic origins of cloned sequences ranged from imprecise, with clones assigned to a taxonomic subclass, to precise, for cloned sequences with 100% DNA sequence identity with a species in our reference database. The compositions of the four libraries were compared and differences related to library construction parameters were observed. Our results indicate that this method is an alternative to 16S rRNA sequence-based studies which can be scaled up for the purpose of performing a potentially comprehensive assessment of a given microbial community or for comparative studies.

This editorial paper introduces this special issue of the journal by giving an overview of the other papers that follow. It introduces non-construction readers to the nature of the construction process, the different levels of activity within the process, and the generic information technologies being applied in the sector. It then examines the use of information technology (IT) within different levels of coordination processes and identifies barriers to IT implementation in the sector. As a major review paper, it then examines the current use and future potential of generic technologies within the major distinct project phases of design and production. It concludes by shedding further light on the key issue of information integration before outlining some of the other issues that are impinging on how theory and practice are being taken forward together in the field.

This editorial paper introduces this special issue of the journal by giving an overview of the other papers that follow. It introduces non-construction readers to the nature of the construction process, the different levels of activity within the process, and the generic information technologies being applied in the sector. It then examines the use of information technology (IT) within different levels of coordination processes and identifies barriers to IT implementation in the sector. As a major review paper, it then examines the current use and future potential of generic technologies within the major distinct project phases of design and production. It concludes by shedding further light on the key issue of information integration before outlining some of the other issues that are impinging on how theory and practice are being taken forward together in the field.

Strategic planning in pursuit of competitive advantage has become a wide‐spread modern business objective. The construction industry shows some evidence of strategic planning implementation; however such concepts are mainly adopted by large contracting companies that have the resources to identify and develop competitive weapons such as information systems/technology (IS/IT). For professional service firms in construction, the nature of the service, the form of client‐customer relations and thus the style of competition are quite different from those followed by contractors. The relevance of competitive strategy and the competitive use of weapons such as IS/IT for professional service firms in construction has not, as yet, been quantifiably tested. Therefore this paper aims to address this imbalance in construction organization research by identifying the competitive strategies used by quantity surveyors based in the UK and assessing the support that IS/IT provides to the competitive strategies of members of this profession. A survey of quantity surveying practices questioned which competitive strategies are followed, how these strategies are implemented and the extent to which IS/IT is being used in each strategy's implementation. The results of this survey, in association with existing competitive strategy and IT literature, are used to derive a new model which proposes specific strategies that UK quantity surveyors can and are using to influence their competitive positioning.

Much of our research in IT in construction is concerned with developing technologies and prescribing how they can be applied to construction problems. Our rationale for our choice of technologies to push is often unstated and the relative significance of a range of technologies is rarely considered. The impact of emerging technologies on the strategic health of companies and professions is also rarely discussed. Few professions appear to be explicitly in control of how IT will impact their future. This paper addresses both of these issues through the example of an IT forecast for the architectural profession. It does this by examining issues of technology forecasting and development by reviewing currently emerging IT's and by conducting an opinion survey of which are of greatest significance to the architectural profession. The result is a relative assessment of the importance to architects of 10 technological mini-scenarios from which an overall architectural IT scenario is constructed.

The management of projects within various industrial sectors is an internationally recognised professional discipline which enjoys support from a small but growing community of researchers, scholars and enquiring practitioners. Specialist academic and professional journals which serve the field are relatively new. One of the prime journals, the International Journal of Project Management, celebrated ten years of continuous publication in 1992. In the ten years since its inception, the International Journal of Project Management has reached a level of stability in terms of the numbers of papers it publishes. Its papers predominantly review practical experience and literature. Some case studies have been published, but relatively few published papers have been based on empirical data. Most of the papers contribute interesting insights and describe new techniques, but few have contributed to the more formal aspects of the development of the discipline of project management by building and testing models and theories. The papers address a broad range of aspects of project management in an increasingly wide variety of industrial sectors, although the construction industry remains predominant. The journal attracts papers from practitioners and academics from various types of department, in both cases from many parts of the world. The journal has achieved a great deal in providing a forum for scholarly insights and debate about project management. However, progress has been less dramatic in terms of the development of the underlying theoretical basis of project management. Given that no other journals appear to fulfil this role, the paper concludes by speculating on the future development of project management as a discipline.

The effective application of IT in construction requires a combination of strategic and tactical developments. Much of the work of the research community has focused on tactical concerns relating to technology. One of the strategic considerations relates to the planning frameworks by which effective IT application is enabled or encouraged. Reflecting the concerns of global enterprises in a competitive economy, Earl (1989) describes the planning frameworks as those relating to: awareness, opportunity and positioning. These planning frameworks are commonly used in sectoral and business planning to guide IT developments. There is scant evidence of them being applied in construction practice or research. This paper discusses the results of an initial analysis of how these planning frameworks can be used in construction. It does so at five levels of the construction sector: the national construction industry, the professional institution, the construction enterprise , the project and the constructed product . This discussion is illustrated throughout the paper with a number of examples of conceptual planning frameworks developed at these levels. These are drawn as much as possible from the author's experiences and contributions in Singapore at the national level. The result of this analysis is an indication of how the important strategic component of planning frameworks may contribute to the overall objective of effective IT application.

Construction management as an academic discipline appears to be developing in an evolutionary way based on developments in practice which appear to be largely unaffected by mainstream management theories. There appears to be little two-way flow in construction management thought between theory and practice. There is an increasing range of customer-oriented theories emerging within the management discipline which is finding increasing acceptance and application within other management domains both from a theoretical and practical standpoint. Their application within construction appears to be delayed. This short note argues generally for a wider adoption of innovative, emerging management theories to construction. It specifically attempts to do this through an assessment and analysis of the implications of emerging principles of business process analysis based on information technology. Such an analysis results in an argument being made for the re-engineering of construction processes. Business process re-...

There have been developments in strategic planning techniques that various sectors of the economy have applied in pursuit of competitive advantage. In most sectors strategic planning applications are taking place at the level of parts of an enterprise's operations, at the general corporate level and at the level of the nation. In construction, strategic planning at any level appears to lag behind other sectors: it seems to be applied mainly by large enterprises keen on expansion, diversification and penetration of overseas markets. A previous paper by the authors has shown the implications of the developments in strategic planning concepts for the construction enterprise. This paper shows how strategic planning can be applied by professional institutions and trade associations in the construction sector. After defining a five-level framework to which strategic planning can be applied, the paper outlines the factors underlying change in the construction industry and the nature of that change. It then discu...

There is increasing evidence that the nature of corporate planning in business is moving toward external strategic concepts of sustainable competitive advantage (SCA). There is some evidence that t...

Building for a sustainable environment requires sustainable infrastructure assets. Infrastructure capacity management is the process of ensuring optimal provision of such infrastructure assets. Effectiveness in this process will enable the infrastructure asset owners and its stakeholders to receive full value on their investment. Business research has shown that an organisation can only achieve business value when it has the right capabilities. This paradigm can also be applied to infrastructure capacity management. With limited access to resources, the challenge for infrastructure organisations is to identify and develop core capabilities to enable infrastructure capacity management. This chapter explores the concept of capability and identifies the core capability needed in infrastructure capacity management. Through a case study of the Port of Brisbane, this chapter shows that infrastructure organisations must develop their intelligence gathering capability to effectively manage the capacity of their infrastructure assets.

Building for a sustainable environment requires sustainable infrastructure assets. Infrastructure capacity management is the process of ensuring optimal provision of such infrastructure assets. Effectiveness in this process will enable the infrastructure asset owners and its stakeholders to receive full value on their investment. Business research has shown that an organisation can only achieve business value when it has the right capabilities. This paradigm can also be applied to infrastructure capacity management. With limited access to resources, the challenge for infrastructure organisations is to identify and develop core capabilities to enable infrastructure capacity management. This chapter explores the concept of capability and identifies the core capability needed in infrastructure capacity management. Through a case study of the Port of Brisbane, this chapter shows that infrastructure organisations must develop their intelligence gathering capability to effectively manage the capacity of their infrastructure assets.

In higher education we give much thought to what we teach, and curricula reviews are regular parts of course development activity. We seem to give less thought to how we teach our material, and we seldom ask ourselves why we teach what we do. There appears to be an implicit assumption about what the important subject-based and skill-based objectives are for a particular discipline and how they should be met. In this paper we present data that challenge the assumption of agreement about objectives among staff, students, and employers involved in a particular education program—the baccalaureate building course at the National University of Singapore. The course aims to provide a broad education for managers in the construction industry, so we asked students, teaching staff, and prospective employers to rank a list of educational objectives in terms of \Iimportance.\N The differences we found between the rankings of the three groups are discussed, and the wider implications these may have for course design in higher education are considered.

Construction management and construction economics are internationally recognized research fields which enjoy support from a strong and growing community of researchers, scholars and practitioners. Specialist academic and professional journals which serve the fields are relatively new. One of the prime journalsConstruction Management and Economics, celebrated ten years of continuous publication in 1992. In the ten years since its inceptionConstruction Management and Economicshas grown and has become more international. Whilst it has sharpened its focus on project-level production-oriented issues it has reflected the varied activities and interests of those involved with construction management and economics research and scholarship. Analysis of the pattern of publications in the journal and of their citations suggests a strengthening of the academic base of papers although there is little evidence that this is achieved by approaches to research that are clearly driven by, or contribute to, theory. In addi...

The educational objectives of different University courses and the combination and sequence of teaching methods used for them, vary between institutions and disciplines. When designing and implementing courses in higher education, we make decisions regarding the match between educational objectives to be set and the teaching methods to adopt. We base these decisions on implicit assumptions about the relationship between teaching methods and educational objectives for the Building discipline. We tested these assumptions with a survey of staff and students involved in undergraduate courses in Building at the National University of Singapore. First, we asked both the staff and the students to rank order a set of educational objectives in terms of importance. Then we asked staff how effective they thought different teaching methods would be in meeting these objectives, and asked students how effective they thought a range of teaching methods had been. The teaching methods considered included lectures, seminar...

When designing and implementing courses in higher education, we make decisions regarding the match between the educational objectives to be set and the teaching methods to adopt. These decisions appear to be based on implicit assumptions about the relationship between teaching methods and educational objectives. In this study we explored these assumptions with a two-part survey of the staff and students involved in three different undergraduate disciplines at the National University of Singapore. First, we asked both the staff and the students to rank order a set of educational objectives in terms of importance. Then we asked staff how effective they thought different teaching methods were in meeting these objectives, and asked students how effective they thought the teaching methods actually were for particular courses. The results indicate discrepancies between staff assumptions and student perceptions of the relationship between educational objectives and different teaching methods. The implic...

This paper outlines the developments in strategic planning exemplified by the works of Porter (1979, 1985, 1990) and others. After describing the emerging concepts and techniques, it is observed that these have been applied by enterprises in other sectors of the economy in pursuit of competitive advantage. Such applications are taking place at the level of parts of an enterprise's operations and at the overall corporate level. This is contrasted with the situation in construction where strategic planning at any level is less widespread, although it is becoming more common. Several reasons are identified as hindrances to strategic planning in construction. The current and historical situation with regard to planning in construction is described. The ways in which strategic planning can be applied by construction enterprises are outlined. In conclusion, it is observed that Porter's new concepts of strategic planning have relevance to, and considerable scope for application in, construction enterprises. It i...

The financial control of construction projects is an integral part of effective project management. The subject has benefited from a number of advances in theory and techniques that have resulted from research. These have included value engineering, lifecycle costing, elemental cost planning, cost modelling, buildability, and the use of knowledge-based systems. Limitations to the use of these techniques often arise owing to a short-term view of construction being taken, the one-off nature of buildings, and the lack of continuous workloads. The paper describes two case-study financial-control systems from the public and private sectors in Singapore. It then evaluates them against a critical framework of effective practice developed in the paper. The paper describes the limitations of the two systems, and suggests how they could be improved.

The construction industries in many countries are starting to consider seriously the strategic use of information technology (IT). The use of information technology in construction is extending beyond the stage of piecemeal application for improving the efficiency of discrete operations by individual organizations to the advanced stage where IT is applied strategically in commercial enterprises, government agencies and professional institutions. Progress in construction in this regard appears to lag behind that in most other sectors of the economy. This paper considers the nature and the background of this progression in construction by examining proposals by Earl (1989) of nine basic prerequisites to the IT era which make a strategic approach timely. Each prerequisite is outlined and how it has been met in other sectors of the economy considered. The extent to which these prerequisites apply in construction and the scope for their application in the near future are examined. It is argued that all organiz...

Because of the diversity of people, organizations and activities involved in the management of construction, there is a need for great flexibility in the way in which project information can he presented. This paper describes how relational database technology can be used with integrated database design methodology to develop a flexible means of information retrieval. An implementation of a database of this type, for the purposes of research, has used project data from a real life project. The testing of the database has been of its ability to enable flexible information retrieval. The results show a significant improvement inflexibility measured on an ordinal scale. The paper thus shows how to gain greater flexibility in information retrieval for basic retrieval forms. It also presents a methodology by which flexibility can be measured and compared. It concludes by speculating on the consequences of extrapolating the results of the study to more complex forms of information retrieval.

The process of submitting lump sum competitive tenders continues to be commonly practised by UK building contractors. Most tenders are based on a detailed analysis of project details and a detailed costing of parts of the work to be done. Considerable resources are being devoted to the preparation offenders in this way. Any means of improving the efficiency of this process would be very welcome to contractors and to the construction industry as a whole. This paper presents a documentation of methods offender preparation in the form of a model of the tasks executed. This model is a description of the process in its most complex possible form as currently executed and does not attempt to portray the tendering process as it is typically performed. Variations within the model have beenfound to occur between individual contractors and for alternative means of procurement as well as for differences in project complexity. However, the model is generally representative of the means by which tenders are prepared b...

The case study of Lusoponte illustrates the concession awarded by the Portuguese Government to finance, design, build and operate two bridges over the Tagus in Lisbon, Portugal. It includes an overview of the project's background and an analysis of the main risk categories stating both the actual risks encountered and the mitigation measures adopted. Throughout the project a great attention was given to whole life cycle costs, and gains in efficiency and cost control. Among the lessons that can be learned from both the public and private sector is that a complete risk management analysis must include not only the technical factors but also a realistic assessment of environmental and social risks. These were the risks that were somewhat overseen and that caused the main problems to the project's development.

Research and innovation in the built environment is increasingly taking on an inter-disciplinary nature. The built environment industry and professional practice have long adopted multi and inter-disciplinary practices. The application of IT in Construction is moving beyond the automation and replication of discrete mono and multi-disciplinary tasks to replicate and model the improved inter-disciplinary processes of modern design and construction practice. A major long-term research project underway at the University of Salford seeks to develop IT modelling capability to support the design of buildings and facilities that are buildable, maintainable, operable, sustainable, accessible, and have properties of acoustic, thermal and business support performance that are of a high standard. Such an IT modelling tool has been the dream of the research community for a long time. Recent advances in technology are beginning to make such a modelling tool feasible. Some of the key problems with its further research and development, and with its ultimate implementation, will be the challenges of multiple research and built environment stakeholders sharing a common vision, language and sense of trust. This paper explores these challenges as a set of research issues that underpin the development of appropriate technology to support realisable advances in construction process improvements.

Good risk management is central to the success of the Private Finance Initiative (PFI). It aims at identifying all the risks involved in a PFI project, calculating the financial consequences, establishing mitigation procedures, and allocating those risks to the parties best able to manage them. Based on empirical data, the authors have developed a dynamic model of whole-life-cycle risk uncertainty for PFI projects. This model is both an assessment and a management tool for PFI risks. It presents a clear picture of how uncertainty progresses throughout the whole life cycle, and is comprehensive so as to avoid the wishful-thinking attitude that might prevent the adoption of correct risk-management measures. The whole life cycle model of risk uncertainty can be quantified and used to classify projects according to their degree of uncertainty and maturity. It is innovative as it recognizes that uncertainty is dependent on both the particular risk and on the period of the project’s life cycle. This model is also a powerful tool for structuring strategic decisions.

The achievement of IT-enabled virtual enterprises in construction is a fundamental step in order to raise productivity within construction projects, and therefore reduce costs, reduce lead times, and raise quality. Based on the patterns of successful IT-enabled virtual enterprises on manufacturing and service industries, this paper analyses what constraints and facilitates the initiation and development of electronic links within construction virtual enterprises.

(1993). Competitive Advantage In Construction: Reply. Construction Management and Economics: Vol. 11, No. 1, pp. 73-74.

Many critical issues still need to be tackled properly in order to manage concurrent engineering projects effectively. These issues include versioning, notification, and propagation, all of which need to be addressed throughout the construction project lifecycle. To this end, the COMMIT project strives to achieve an improved level of support for the versioning of project information at both the conceptual (schema evolution) and the instance levels. Versioning, notification, and propagation are addressed through the CIMM (a generic and context-independent information management model for supporting collaborative construction projects) and are described in this paper. The main concepts of the construction-oriented COMMIT Canonical Model (CCM), specialized from the CIMM, are also presented, followed by a description of the first prototype implementation of the CIMM tackling information versioning. This research is ongoing and supported by a well-established U.K. steering group.

This paper demonstrates that to understand the problems and opportunities facing the use of Information Technology (IT) to support process improvement in the construction sector, a dynamic perspective on how transformation takes place in the whole industry is required. Drawing on new process-based management and organisational methods used in manufacturing, an IT-enabled process strategy for the construction industry is derived. This enables the identification of: core and support processes; inhibitors to process flow; and construction-specific process improvements. It allows us to outline a workplan to implement these changes in order to achieve a consistent innovation strategy. The place of IT research within this workplan is specifically identified and compared with the current practice in IT application within the sector.