Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients.OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference.DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries.MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation.RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P < 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P < 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT.CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223

Maintenance cost implications of utilizing bathroom modules manufactured offsite

Though the benefits from using offsite technologies have been rehearsed, their uptake within the UK construction industry is slow. A critical barrier is the lack of cost data of using such technology. Another is the unsubstantiated perception that maintenance of offsite solutions is difficult and expensive. But, yet again, there appear to be no data publicly available on this topic. This knowledge gap is addressed by presenting the cost data of maintaining offsite and insitu bathrooms for student accommodation. The records of 732 maintenance jobs were investigated. These jobs span three years for 398 bathrooms, including precast concrete modules, glass reinforced polyester (GRP) modules and insitu bathrooms. The results suggest that GRP modules required the lowest maintenance costs, while insitu bathrooms were significantly more expensive to maintain. For offsite modules, drainage, toilets, vents and sink were identified as the main problematic areas for maintenance. The maintenance of insitu bathrooms was more complex and involved a wider range of problematic areas. The design imposed significant effects on the long-term cost of offsite bathrooms. Aspirations of clients need to be fully understood and integrated into design. The findings should facilitate the design decision making of using offsite bathrooms for residential buildings.Bathroom modules, maintenance costs, offsite, student accommodation,

The quality of accident and health data in the construction industry: interviews with senior managers

Despite recent changes in legislation and advances towards an integrated project-wide approach, health and safety management in the construction industry is still a major problem, involving a substantial cost to business, society and individuals. A prerequisite to improving the situation and developing an effective management strategy is monitoring, providing a detailed understanding of the effectiveness of different approaches to intervention. This paper describes a feasibility study using in-depth interviews with senior managers to explore the quality of accident and health data of nine large, high profile companies from the engineering construction sector. The interview dialogue comprised a series of questions and issues to be explored on the organization's accident reporting systems (e.g. what is reported, analysis performed, computerization), unsafe act and near miss auditing (e.g. definition, validity), failure type indicators (e.g. auditing, quantification) and safety culture indicators (e.g. commitment, health). Although safety was a priority for companies, health (i.e. medicals and monitoring systems) had not been given the same consideration, especially with regard to subcontracted labour. This study shows that the validity of accident statistics as a measure of safety remains a limitation, and that there is a requirement for a consistent and integrated approach to the measurement of health and safety performance.Health, Safety, Interviews, Accident Data,

Health and safety management in developing countries: a study of construction SMEs in Ghana

The construction industry plays a significant role in the economy of developing countries. The sector is, however, also one of the most hazardous with frequent accidents and health-related problems. The health and safety practices of construction small and medium-sized enterprises (SMEs) in Ghana are examined with a view to improving the health and safety performance of the sector. A survey questionnaire was administered to owner/managers of SMEs, with a response rate of 32% of the sampling frame. Few of the SMEs adopted proactive health and safety practices. However, health and safety practices identified as being particularly associated with firm characteristics were: accident investigation procedures; accident reporting procedures; use of health and safety posters; documentation of method statements; and health and safety inductions. The diversity of health and safety practices associated with different size categories of SMEs and constraints to improving health and safety are highlighted. A positive change is needed in the attitudes of owner/managers which takes into account size-related constraints in order to improve the health and safety performance of Ghanaian SMEs.Developing countries, health and safety, SMEs, survey,

Optimising construction with self-compacting concrete

Winner of the 2018 ICE Publishing Awards (Thomas Howard Medal) for the best paper of the year in the Construction Materials journal. Permission is granted by ICE Publishing to print one copy for personal use. Any other use of these PDF files is subject to reprint fees.Self-compacting concrete or self-consolidating concrete (as it is known in North America) (SCC) is used on the basis of its unique properties of flowability, passability and resistance to segregation. It requires no external energy to achieve full compaction, so is advantageous on site, but there is evidence that its higher cost is a significant barrier to greater adoption. The research entailed work measurement of 14 UK single-family home residential projects (eliciting data on construction time and labour productivity) and cost modelling of three slab scenarios (exploring the relationship between material and labour costs). The study found SCC was placed up to 73% faster than conventional concrete and, when labour and material costs are included, the supplier is able to price SCC to closely match conventional concrete, hence making SCC more viable for the contractor. This relationship between as-built costs for SCC and conventional concrete is clarified by developing Pmax, providing a new mechanism for understanding project profitability and viability of SCC

UK contractors’ views on self-compacting concrete in construction

This briefing was published in the journal Proceedings of the ICE - Construction Materials [© ICE Publishing]. The website is at: http://www.icevirtuallibrary.com/content/serial/coma. Permission is granted by ICE Publishing to print one copy for personal use. Any other use of these PDF files is subject to reprint fees.Self-compacting concrete (SCC) is claimed to offer faster construction, safer sites and more consistent concrete quality, but little corroborative research data exist on performance advantages, particularly in comparison with traditional construction. Industry opinions also appear to be divided. For these reasons, an extensive interview programme was undertaken with UK contractors – from large national concrete frame contractors to small, locally based housebuilders – to assess whether benefits were being achieved and to try to understand the reasons why SCC is, or is not, being used. The 48 participants reported that decisions on the suitability of SCC were inherently complex and, if selected, there were challenges in understanding ‘how’ construction should be planned and managed to accommodate the use of SCC and to fully utilise its advantages. The findings identify the need for a step change in the industry’s perception of SCC, such that it should be considered as a construction method, not simply as a material

Building information modelling and its effect on off-site construction in UK civil engineering

This article was published in the journal, Proceedings of the ICE - Management, Procurement and Law [© Thomas Telford Ltd.] and the website is at: http://www.icevirtuallibrary.com/content/serial/mpalIn 2011, the UK government mandated that, by March 2016, all public-sector construction projects would be undertaken within a three-dimensional building information model (BIM) environment. This has caused both construction procurers and providers to embark on a journey towards universal BIM adoption, including the integration of BIM within a revised construction process. In addition, off-site construction has seen significant development in the building sector in the past decade; however, in infrastructure, off-site constructionoff-site construction exploitation has been more limited. This paper presents findings from UK-focused research into how innovation initiatives such as BIM and off-site construction can and need to be considered together, thus allowing leaner design, a greater integration of lifetime project data and more novel technical solutions. Key themes that emerged from the thematic analysis of the interviews show the importance of configuration and interface management; information data flow; project management and delivery; procurement and contracts. The analysis outlines the benefits of utilising off-site construction within a BIM environment, the challenges currently facing the supply chain, and recommendations are made as to how best to implement the emergent benefits