Efficient Project Delivery Using Lean Principles - An Indian Case Study

Construction industry in India is growing at a rapid pace. Along with this growth, the industry is facing numerous challenges that are making delivery of projects inefficient. Experts believe that capacity constraints in the industry need to be addressed immediately. Government has recommended ‘introduction of efficient technologies and modern management techniques’ to increase the productivity of the industry. In this context, lean principles can act as a lever to make project delivery more efficient and provide the much needed impetus to the Indian construction sector. Around the globe lean principles are showing positive results on the projects. Project teams are reporting improvements in construction time, cost and quality along with softer benefits of enhanced collaboration, coordination and trust in project teams. Can adoption of lean principles provide similar benefits in the Indian construction sector? This research was conducted to answer this question. Using an action research approach a key lean construction tool called Last Planner System (LPS) was tested on a large Indian construction project. The work described in this work investigates the improvements achieved in project delivery by adopting LPS in Indian construction sector. Comparison in pre- and post-implementation data demonstrates increase in the certainty of work-flow and improves schedule compliance. This is measured through a simple LPS metric called percent plan complete. Explicit improvements in schedule performance are seen during 8 week LPS implementation along with implicit improvements in coordination, collaboration and trust in the project team. This work reports the findings of LPS implementation on the case study project outlining the barriers and drivers to adoption, strategies needed to ensure successful implementation and roadmap for implementation. Based on the findings the authors envision that lean construction can make project delivery more efficient in India

Association between convalescent plasma treatment and mortality in COVID-19: a collaborative systematic review and meta-analysis of randomized clinical trials.

Funder: laura and john arnold foundationBACKGROUND: Convalescent plasma has been widely used to treat COVID-19 and is under investigation in numerous randomized clinical trials, but results are publicly available only for a small number of trials. The objective of this study was to assess the benefits of convalescent plasma treatment compared to placebo or no treatment and all-cause mortality in patients with COVID-19, using data from all available randomized clinical trials, including unpublished and ongoing trials (Open Science Framework, https://doi.org/10.17605/OSF.IO/GEHFX ). METHODS: In this collaborative systematic review and meta-analysis, clinical trial registries (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform), the Cochrane COVID-19 register, the LOVE database, and PubMed were searched until April 8, 2021. Investigators of trials registered by March 1, 2021, without published results were contacted via email. Eligible were ongoing, discontinued and completed randomized clinical trials that compared convalescent plasma with placebo or no treatment in COVID-19 patients, regardless of setting or treatment schedule. Aggregated mortality data were extracted from publications or provided by investigators of unpublished trials and combined using the Hartung-Knapp-Sidik-Jonkman random effects model. We investigated the contribution of unpublished trials to the overall evidence. RESULTS: A total of 16,477 patients were included in 33 trials (20 unpublished with 3190 patients, 13 published with 13,287 patients). 32 trials enrolled only hospitalized patients (including 3 with only intensive care unit patients). Risk of bias was low for 29/33 trials. Of 8495 patients who received convalescent plasma, 1997 died (23%), and of 7982 control patients, 1952 died (24%). The combined risk ratio for all-cause mortality was 0.97 (95% confidence interval: 0.92; 1.02) with between-study heterogeneity not beyond chance (I2 = 0%). The RECOVERY trial had 69.8% and the unpublished evidence 25.3% of the weight in the meta-analysis. CONCLUSIONS: Convalescent plasma treatment of patients with COVID-19 did not reduce all-cause mortality. These results provide strong evidence that convalescent plasma treatment for patients with COVID-19 should not be used outside of randomized trials. Evidence synthesis from collaborations among trial investigators can inform both evidence generation and evidence application in patient care

Effects of Once-Weekly Exenatide on Cardiovascular Outcomes in Type 2 Diabetes.

Abstract BACKGROUND: The cardiovascular effects of adding once-weekly treatment with exenatide to usual care in patients with type 2 diabetes are unknown. METHODS: We randomly assigned patients with type 2 diabetes, with or without previous cardiovascular disease, to receive subcutaneous injections of extended-release exenatide at a dose of 2 mg or matching placebo once weekly. The primary composite outcome was the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. The coprimary hypotheses were that exenatide, administered once weekly, would be noninferior to placebo with respect to safety and superior to placebo with respect to efficacy. RESULTS: In all, 14,752 patients (of whom 10,782 [73.1%] had previous cardiovascular disease) were followed for a median of 3.2 years (interquartile range, 2.2 to 4.4). A primary composite outcome event occurred in 839 of 7356 patients (11.4%; 3.7 events per 100 person-years) in the exenatide group and in 905 of 7396 patients (12.2%; 4.0 events per 100 person-years) in the placebo group (hazard ratio, 0.91; 95% confidence interval [CI], 0.83 to 1.00), with the intention-to-treat analysis indicating that exenatide, administered once weekly, was noninferior to placebo with respect to safety (P<0.001 for noninferiority) but was not superior to placebo with respect to efficacy (P=0.06 for superiority). The rates of death from cardiovascular causes, fatal or nonfatal myocardial infarction, fatal or nonfatal stroke, hospitalization for heart failure, and hospitalization for acute coronary syndrome, and the incidence of acute pancreatitis, pancreatic cancer, medullary thyroid carcinoma, and serious adverse events did not differ significantly between the two groups. CONCLUSIONS: Among patients with type 2 diabetes with or without previous cardiovascular disease, the incidence of major adverse cardiovascular events did not differ significantly between patients who received exenatide and those who received placebo. (Funded by Amylin Pharmaceuticals; EXSCEL ClinicalTrials.gov number, NCT01144338 .)

Hospitality and tourism management: adopting Lean Six Sigma, achieving service excellence

The hospitality and tourism industry is very much people-driven, despite the incipient advances and adoption of technology. Given the increased integration of the latter into the service sector, there must be ways to measure or calibrate the quality of service in the industry. Because tourism is a business like any other and compounded by mobility, a business management system approach to performance analysis and process adjustment can be adopted. One such management system is the Lean Six Sigma, which is a process method to improve the efficiency of business operations, in order to achieve high customer satisfaction (Farrington et al. 2018). This method allows experts in the tourism and hospitality business to identify product and operations deficiencies, and thereby enhance service quality and standards, thus leading to service excellence in the industry. Much research has been conducted on the application of Lean Six Sigma in industries such as logistics and sales (Gutierrez- Gutierrez et al. 2016; Zhang et al. 2016), financial, healthcare, and retail. The goal of this paper is to shed light on the possibility of the tourism and hospitality sector adopting a management system such as Lean Six Sigma as a continuous improvement method to achieve service excellence (Ivasciuc and Epuran 2015; Basu 2011; Farrington et al. 2018). The basic rationale of Lean Management is to reduce non-value-adding components of processes, and maintain only processes which add direct value to the company’s customers (Kaufmann 2012)