Improving Green Building Project Management Processes through the Lean Approach

[EN] Question: Using a Lean approach to classify issues, or wastes, experienced during the different design processes, what sustainability-related activities affect the project design development stage. Purpose: The objective of this paper is to create a new lean-based approach to analyze the design process and quantify the negative effect of detected project-management issues on the project's main resources, categorized through three different variables: costs, time and sustainability. Research Method: The research makes full use of a Lean approach intended as a standardized method to identify project wastes, classify the issues experienced during the different design processes and ultimately propose possible solutions for process optimization. The Lean approach was used as the basis to study four case studies wherein real projects were developed in different European countries under the LEED and BREEAM reference standards. The projects were analyzed against a set of guidelines developed by the Researchers with the aim of avoiding the replication of such issues in future projects. The analysis took into consideration all sustainability-related activities that affected the project design development. Findings: By identifying and estimating the effects of each issue on the project variables, researchers could rank their negative impact on the project budget, schedule and level of sustainability. The ranking allowed isolating which issues, or categories of issues, had the worst impact on the overall project from both qualitative and quantitative points of view. These research goals were achieved through the implementation of the Lean method and philosophy. Limitations: Among the main challenges related to time-variance analysis. Estimating the delay of single activities impact was sometimes difficult and ambiguous because it relied on other activities for which dependency could not be calculated. Limitations related to cost-variance analysis involved indirect costs that were difficult to estimate because they were neither related to any written document nor any formal activity or event of the project. The present research takes into consideration only four case-study projects and therefore the related conclusions cannot be generalized for all building projects. Implications: Applying the ranking of the issues identifies to a real project development with limited resources, it would be possible to highlight which problems should be addressed first in order to avoid, or at least limit, their negative impact on the project establishing a set of guidelines for future projects. Value for authors: This study sets the basis for several other research studies in relationship with green-building developments and lean approach.Orsi, A.; Abdelhamid, TS.; Pellicer, E.; Guillén Guillamón, IE. (2021). Improving Green Building Project Management Processes through the Lean Approach. Lean Construction Journal. 2021:156-179. http://hdl.handle.net/10251/190602156179202

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Measuring and evaluating physiological demands of construction work.

Construction craft work is physically demanding. Physically demanding work leads to physical fatigue that leads to decreased productivity and motivation, inattentiveness, poor judgment, poor quality work, job dissatisfaction, accidents, and injuries. In the 1950s and 1960s, there was a surge of interest in applying work physiology to investigate the physiological demands of construction work. Since then, the workforce has changed to include more women and more older workers, and the work itself has changed. Recent advances in computer and microprocessor technology enable scientists to efficiently measure the physiological response to work. In this research, physiological measures of energy expenditure, including oxygen uptake and heart rate data, were collected for 100 construction workers performing 130 actual construction work activities in 12 trades. The average oxygen uptake for the measured construction activities was 0.82 liter · min -1 (+/-0.22 liter · min-1). The average heart rate for the measured construction activities was 108 beats · min-1 (+/-17 beats · min-1). This research also considers relative physiological workload, the ratio of absolute workload expressed as mean oxygen uptake (VO2) and individual work capacity expressed as maximum oxygen uptake (VO2max). Determining VO2max is rather impractical, and may even be dangerous for unfit construction workers. Alternatively, a Time Series Analysis based statistical technique was developed to predict the relative physiological workload from sub-maximal oxygen uptake data collected in-situ. The new technique was validated on eight subjects. The standard errors in predicting %VO 2max and VO2max are +/-3.2% and +/-0.28 liter · min-1, respectively, which is much better than using the standard VO2-HR method. Using the new technique developed in this thesis, the average relative workload for the 100 construction workers was predicted to be 26 percent (i.e., 26%VO2max +/-6 percent). The lowest and highest average predicted relative workload were 15 and 48 percent, respectively. The absolute and relative workload data was evaluated against published guidelines for acceptable levels of physical performance in industrial settings. The findings of this research reveal that based on two physiological indicators of work load: oxygen uptake and heart rate, construction work is classified as moderate to heavy work. Moreover, evaluations of both absolute and relative workloads reveal that a significant number of craft workers (20 to 40%) routinely exceed generally accepted physiological thresholds for manual work. By using the methods developed and results advanced in this research and by promoting and applying concepts of work physiology at the workplace, many improvements will find their way to the occupational health and safety of the construction workforce. The methods described in this research have widespread applications in identifying excessively demanding construction tasks so the work can be better matched to the abilities of the workers. This thesis has developed the foundation for further research and practical applications regarding the physical demands of construction work.Ph.D.Animal PhysiologyApplied SciencesBiological SciencesCivil engineeringHealth and Environmental SciencesOccupational safetyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/131835/2/9938387.pd

International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010-2015: Device-associated module

•We report INICC device-associated module data of 50 countries from 2010-2015.•We collected prospective data from 861,284 patients in 703 ICUs for 3,506,562 days.•DA-HAI rates and bacterial resistance were higher in the INICC ICUs than in CDC-NHSN's.•Device utilization ratio in the INICC ICUs was similar to CDC-NHSN's. Background: We report the results of International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2010-December 2015 in 703 intensive care units (ICUs) in Latin America, Europe, Eastern Mediterranean, Southeast Asia, and Western Pacific. Methods: During the 6-year study period, using Centers for Disease Control and Prevention National Healthcare Safety Network (CDC-NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 861,284 patients hospitalized in INICC hospital ICUs for an aggregate of 3,506,562 days. Results: Although device use in INICC ICUs was similar to that reported from CDC-NHSN ICUs, DA-HAI rates were higher in the INICC ICUs: in the INICC medical-surgical ICUs, the pooled rate of central line-associated bloodstream infection, 4.1 per 1,000 central line-days, was nearly 5-fold higher than the 0.8 per 1,000 central line-days reported from comparable US ICUs, the overall rate of ventilator-associated pneumonia was also higher, 13.1 versus 0.9 per 1,000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 5.07 versus 1.7 per 1,000 catheter-days. From blood cultures samples, frequencies of resistance of Pseudomonas isolates to amikacin (29.87% vs 10%) and to imipenem (44.3% vs 26.1%), and of Klebsiella pneumoniae isolates to ceftazidime (73.2% vs 28.8%) and to imipenem (43.27% vs 12.8%) were also higher in the INICC ICUs compared with CDC-NHSN ICUs. Conclusions: Although DA-HAIs in INICC ICU patients continue to be higher than the rates reported in CDC-NSHN ICUs representing the developed world, we have observed a significant trend toward the reduction of DA-HAI rates in INICC ICUs as shown in each international report. It is INICC's main goal to continue facilitating education, training, and basic and cost-effective tools and resources, such as standardized forms and an online platform, to tackle this problem effectively and systematically

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

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