Achieving excellence in lean implementation at construction companies - A case study from Brazil

Lean Construction has become a popular concept to improve performance and reduce costs in construction projects. Assessment tools and implementation strategies that focus on lean practices such as the Last Planner System, the use of Kanbans, the routine of Kaizens and, recently, the integration with information technology are also common. However, barriers to the wide adoption of lean principles remain and implementation challenges continue to intrigue scholars. Previous studies suggest that barriers to the successful implementation can be either political, economical, social and/or technical, with the focus on lack of knowledge about lean concepts, resistance to the required organisational culture change, and lack of support from top management. Few studies present the lean implementation process from the practitioners’ perspective. Using the narrative enquiry methodology, the authors aim to describe how a construction company from Brazil matured from the implementation of lean operational tools to achieve excellence in the lean culture and mindset. Key themes that emerge from this study for a successful lean construction journey are; effort to stabilise the environment, knowledge creation and management, transparency in the process to enable simplicity and shared understanding, and building trust for further growth.

The traditional knowledge on stingless bees (Apidae: Meliponina) used by the Enawene-Nawe tribe in western Brazil

<p>Abstract</p> <p>Background</p> <p>This paper presents the Enawene-Nawe Society's traditional knowledge about stingless bees. The Enawene-Nawe are an Aruak speaking people, indigenous to the Meridian Amazon. Specifically, they live in the Jurema River hydrological basin, located in the northwestern region of the Mato Grosso state.</p> <p>Methods</p> <p>The stingless bees were sampled from two ecologically similar regions in the interior of Enawene-Nawe Land. The first sampling took place around the village, i.e., adjacent to houses, by the edge of the Iquê River, next to food leftovers, around human excrement, and simply when the insects were found flying or reposing on a human body. The second round of sampling happened from 29/10 to 02/11/94, during an expedition for honey collection that took place throughout the ciliar bushes of the Papagaio River, an important tributary of Juruena River. We sampled bees adjacent to their nests following the beehive inspection or during the honey extraction.</p> <p>In this work, the main bee species of the sub tribe Meliponina, which were handled by the Enawene-Nawe, was identified, and a brief ethnographic description of the honey collection expeditions and its social-cosmologic meaning for the group was done.</p> <p>Results and Discussion</p> <p>Similar to other indigenous people in Brazil, the Enawene-Nawe recognized 48 stingless bee species. They identified each bee species by name and specified each one's ecological niche. A brief ethnographic description of the honey collection expeditions and bees' social-cosmologic meaning for the group is included.</p> <p>Conclusion</p> <p>We concluded that, as an example of other indigenous people, the Enawene-Nawe classify and identify the bees based not only on their structure and morphological aspects but also on the ecological, etiological, and social characteristics of the species.</p

Stroke Correlates in Chagasic and Non-Chagasic Cardiomyopathies

BACKGROUND: Aging and migration have brought changes to the epidemiology and stroke has been shown to be independently associated with Chagas disease. We studied stroke correlates in cardiomyopathy patients with focus on the chagasic etiology. METHODOLOGY/PRINCIPAL FINDINGS: We performed a cross-sectional review of medical records of 790 patients with a cardiomyopathy. Patients with chagasic (329) and non-chagasic (461) cardiomyopathies were compared. There were 108 stroke cases, significantly more frequent in the Chagas group (17.3% versus 11.1%; p<0.01). Chagasic etiology (odds ratio [OR], 1.79), pacemaker (OR, 2.49), atrial fibrillation (OR, 3.03) and coronary artery disease (OR, 1.92) were stroke predictors in a multivariable analysis of the entire cohort. In a second step, the population was split into those with or without a Chagas-related cardiomyopathy. Univariable post-stratification stroke predictors in the Chagas cohort were pacemaker (OR, 2.73), and coronary artery disease (CAD) (OR, 2.58); while atrial fibrillation (OR, 2.98), age over 55 (OR, 2.92), hypertension (OR, 2.62) and coronary artery disease (OR, 1.94) did so in the non-Chagas cohort. Chagasic stroke patients presented a very high frequency of individuals without any vascular risk factors (40.4%; OR, 4.8). In a post-stratification logistic regression model, stroke remained associated with pacemaker (OR, 2.72) and coronary artery disease (OR, 2.60) in 322 chagasic patients, and with age over 55 (OR, 2.38), atrial fibrillation (OR 3.25) and hypertension (OR 2.12; p = 0.052) in 444 non-chagasic patients. CONCLUSIONS/SIGNIFICANCE: Chagas cardiomyopathy presented both a higher frequency of stroke and an independent association with it. There was a high frequency of strokes without any vascular risk factors in the Chagas as opposed to the non-Chagas cohort. Pacemaker rhythm and CAD were independently associated with stroke in the Chagas group while age over 55 years, hypertension and atrial fibrillation did so in the non-Chagas cardiomyopathies

Portuguese recommendations for the use of biological and targeted synthetic diseasemodifying antirheumatic drugs in patients with rheumatoid arthritis – 2020 update

Objective: To update the recommendations for the treatment of rheumatoid arthritis (RA) with biological and targeted synthetic disease-modifying antirheumatic drugs (bDMARDs and tsDMARDs), endorsed by the Portuguese Society of Rheumatology (SPR). Methods: These treatment recommendations were formulated by Portuguese rheumatologists taking into account previous recommendations, new literature evidence and consensus opinion. At a national meeting, in a virtual format, three of the ten previous recommendations were re-addressed and discussed after a more focused literature review. A first draft of the updated recommendations was elaborated by a team of SPR rheumatologists from the SPR rheumatoid arthritis study group, GEAR. The resulting document circulated among all SPR rheumatologists for discussion and input. The level of agreement with each of all the recommendations was anonymously voted online by all SPR rheumatologists. Results: These recommendations cover general aspects such as shared decision, treatment objectives, systematic assessment of disease activity and burden and its registry in Reuma.pt. Consensus was also achieved regarding specific aspects such as initiation of bDMARDs and tsDMARDs, assessment of treatment response, switching and definition of persistent remission. Conclusion: These recommendations may be used for guidance of treatment with bDMARDs and tsDMARDs in patients with RA. As more evidence becomes available and more therapies are licensed, these recommendations will be updated.info:eu-repo/semantics/publishedVersio

Acesso a Tratamento Endovascular para Acidente Vascular Cerebral Isquémico em Portugal

Introduction: Since the publication of endovascular treatment trials and European Stroke Guidelines, Portugal has re-organized stroke healthcare. The nine centers performing endovascular treatment are not equally distributed within the country, which may lead to differential access to endovascular treatment. Our main aim was to perform a descriptive analysis of the main treatment metrics regarding endovascular treatment in mainland Portugal and its administrative districts. Material and methods: A retrospective national multicentric cohort study was conducted, including all ischemic stroke patients treated with endovascular treatment in mainland Portugal over two years (July 2015 to June 2017). All endovascular treatment centers contributed to an anonymized database. Demographic, stroke-related and procedure-related variables were collected. Crude endovascular treatment rates were calculated per 100 000 inhabitants for mainland Portugal, and each district and endovascular treatment standardized ratios (indirect age-sex standardization) were also calculated. Patient time metrics were computed as the median time between stroke onset, first-door, and puncture. Results: A total of 1625 endovascular treatment procedures were registered. The endovascular treatment rate was 8.27/100 000 inhabitants/year. We found regional heterogeneity in endovascular treatment rates (1.58 to 16.53/100 000/year), with higher rates in districts closer to endovascular treatment centers. When analyzed by district, the median time from stroke onset to puncture ranged from 212 to 432 minutes, reflecting regional heterogeneity. Discussion: Overall endovascular treatment rates and procedural times in Portugal are comparable to other international registries. We found geographic heterogeneity, with lower endovascular treatment rates and longer onset-to-puncture time in southern and inner regions. Conclusion: The overall national rate of EVT in the first two years after the organization of EVT-capable centers is one of the highest among European countries, however, significant regional disparities were documented. Moreover, stroke-onset-to-first-door times and in-hospital procedural times in the EVT centers were comparable to those reported in the randomized controlled trials performed in high-volume tertiary hospitals.info:eu-repo/semantics/publishedVersio