Causes of Change Orders and Its Impact on Road Maintenance Contracts

Change orders (CO) commonly generate cost-growth, schedule-growth or both, in construction as well as in maintenance contracts. Literature reviews revealed that the causes and impact of CO on new construction contracts had been comprehensively studied, but the causes and impact of CO in maintenance contracts remained neglected. This study collected CO data on road maintenance contracts to determine the amount of CO and the most frequent and high-risk road maintenance activities that had CO. A Delphi study was conducted with 33 maintenance engineers from the state Department of Transportation (DOT) to identify causes of CO and its impact on cost and schedule of road maintenance contracts. The results showed that the three important reasons of CO on the maintenance contracts were: changes in work scope, errors in the estimate, and failure to verify work site conditions before signing a contract. To reduce these CO, three most important preventive measures agreed by participants were: reviewing specifications, preparing accurate estimates, and reviewing the design drawing before bid solicitation. In this study, the CO contingency estimation tool was prepared using an artificial neural network (ANN) and a linear regression method. Historical CO data was used to predict the contingency cost for maintenance contracts. In order to reduce the negative impact on the schedule-growth, a schedule-crashing optimization tool was also developed. Hence, the primary contributions of this research to the body of knowledge are the quantification of the CO, the identification of the causes and preventive measures of CO, and the development of the tools to manage cost and schedule growth in road maintenance contracts

Change Orders on Road Maintenance Contracts: Causes and Preventive Measures

A Delphi study was conducted with maintenance engineers of state DOTs in the United States to identify the causes and preventive measures of change orders (COs) in road maintenance projects. Five road maintenance activities that are frequently conducted were selected in order to identify the causes and preventive measures of COs; these were chip seal, striping, asphalt overlay, slope repairs, and debris removal. The intraclass correlation coefficient (ICC) values, which showed the overall agreement of the respondents as to the causes and preventive measures of COs, were determined. It was found that the respondents had excellent agreement with the causes of change orders for all activities (ICC...) (see abstract in article)

Stability Analysis of Shallow Tunnel of Norra Länken

Shallow Tunneling through highly populated areas of big cities is a challenging task. Almost in all the tunneling projects of shallow tunnel some or the other types of tunneling problems have been encountered and are still being faced. The stability of shallow tunnel is also influenced by many factors, primarily the in situ stress, geological structures, groundwater, rock mass quality, shape of tunnel etc. The design of shallow tunnel in past was almost purely a matter of experience. During last decays computational methods have been introduced as powerful design aids tool to arrive at safe and economical shallow tunnel structure. The purpose of this thesis work is to provide technical criteria and guidance for the design, and stability of Norra Länken shallow tunnel in rock for civil works projects. The design of shallow tunnels in highly dense areas is an iterative process. A good starting point is essential to the process and facilitates safe and economic design. Currently there are many practical two and three-dimensional software tools available for carrying out the task. This master thesis provides an overview of a methodology being used by tunneling experts, which captures the three-dimensional essentials of tunnel behaviour with two-dimensional analysis tools, PLAXIS. Though it is not a full and final situation and conclusion, but there is a lot to learn from such conditions

Stability Analysis of Shallow Tunnel of Norra Länken

Shallow Tunneling through highly populated areas of big cities is a challenging task. Almost in all the tunneling projects of shallow tunnel some or the other types of tunneling problems have been encountered and are still being faced. The stability of shallow tunnel is also influenced by many factors, primarily the in situ stress, geological structures, groundwater, rock mass quality, shape of tunnel etc. The design of shallow tunnel in past was almost purely a matter of experience. During last decays computational methods have been introduced as powerful design aids tool to arrive at safe and economical shallow tunnel structure. The purpose of this thesis work is to provide technical criteria and guidance for the design, and stability of Norra Länken shallow tunnel in rock for civil works projects. The design of shallow tunnels in highly dense areas is an iterative process. A good starting point is essential to the process and facilitates safe and economic design. Currently there are many practical two and three-dimensional software tools available for carrying out the task. This master thesis provides an overview of a methodology being used by tunneling experts, which captures the three-dimensional essentials of tunnel behaviour with two-dimensional analysis tools, PLAXIS. Though it is not a full and final situation and conclusion, but there is a lot to learn from such conditions

Prevalence of migraine and tension‐type headache among undergraduate medical students of Kathmandu Valley: A cross‐sectional study

Abstract Background Headache is the most prevalent neurological symptom which can be of a serious condition, as in brain tumor, but mostly it is a benign condition that includes primary headache such as migraine or tension‐type headache (TTH). Migraine reoccurs frequently and is more severe but owing to the high prevalence of TTH, however, impaired quality of life due to TTH is greater than that of migraine at the population level. Medical students are constantly subjected to stress and in such a condition, it was necessary to find out the burden of headache among medical students. This cross‐sectional study done among medical students aims to generate some data and literature which will change the outlook of stakeholders towards headache disorders among medical students. Methods This cross‐sectional study is based upon Headache Screening Questionnaire—English Version questionnaire based upon the ICHD‐3 beta criteria. Medical students of Kathmandu valley were sampled by using convenient sampling and data were collected. Data were refined in Microsoft Excel and imported to SPSS 20 for analysis. Results A total of 352 individuals were part of this study, out of which 229 (65.1%) were males and 123 (34.9%) were females with a mean age of 21.72 ±  1.601 years (mean ± SD). Prevalence of migraine and TTH was found to be 15.3% (95% confidence interval [CI]: 11.7%–19.3%) and 40.3% (95% CI: 34.9–45.2), respectively. Through multivariate binomial regression, it was observed that the odds of being diagnosed with migraine increased with age (adjusted odds ratio [AOR] = 1.266 [1.013–1.583], p = 0.038), females had twice the odds of experiencing migraine headaches compared to males (AOR = 2.119 [1.074–4.180], p = 0.03), and medical students who stayed at the hostel were at lesser odds of experiencing migraine headache (AOR = 2.772 [1.501–5.118], p = 0.01). Conclusion Prevalence of migraine and TTH among undergraduate medical students was found to be 15.3% and 40.3%, respectively

A Road Maintenance Management Tool for Rural Roads in Kenya

ABSTRACT Road maintenance programs generally are divided into three categories: routine maintenance; periodic maintenance; and the rehabilitation of roads, slab culverts, and bridges. Although the budgets for these maintenance activities are planned prudently, based on the engineer's estimate, changes usually occur in the work plans after the maintenance work starts. The road maintenance activities are broken down into packages, and each package is awarded to the lowest bidding contractor. Progress made on the contract is recorded on a monthly basis, and the reports are generated on a monthly, quarterly, or yearly basis for each region or for an entire country. To perform these works more efficiently, software known as the Road Maintenance Management System (RMMS) was designed and implemented in 47 regions of the Kenya Rural Road Authority (KeRRA), Africa. The software is capable of tracking the change orders in every activity in the work plan and recording the construction progress in detail. As a main objective, this paper discusses the framework of the RMMS system. This paper also identifies five main road maintenance activities that experienced a high number of change orders for road maintenance projects of Kenya

An assessment of surgical outcome with the influencing factors of horizontal strabismus surgery

Background: Influencing factors of conventional horizontal surgery for surgical outcome has not been assessed in Nepal. Aims and Objective: To assess the pre-operative factors that influences the surgical outcome of horizontal strabismus surgery. Materials and Methods: The medical records of 68 patients who underwent their first horizontal strabismus surgery at Lumbini Eye Institute from 1st January to 30th December 2015 were retrospectively reviewed. The collected clinical data included diagnosis, age group, visual acuity, binocular function, extraocular motility and pre and postoperative deviation. The success of surgery was defined by eye deviation less than 10 prism diopters (PD) at 6 weeks after operation. The influencing factors for surgical success (diagnosis, age group, visual acuity, binocular function, and angle deviations) were analyzed using chi square test and Mann-Whitney - U test, where ever appropriate. Results: Out of 113 patients who underwent strabismus surgery during the year, 68 patients were enrolled in the study. Majority of the patients (27, 39.7%) were >9 years of age and 52.9% were female. Thirty seven patients (54.4%) were esotropic whereas, 31 were exotropic. Preoperatively, angle of deviation ranged from 20 to 90 PD with binocular vision present in 57.4% cases. Overall, success was seen in 26 patients (38.2%). Pre-operative angle of deviation and binocular vision had statistical significance with surgical success (p = 0.012 and 0.026 respectively). Conclusion: Larger angle of deviation and poor binocular vision at presentation has higher failure rate for horizontal strabismus surgery

Bloodstream infection among children presenting to a general hospital outpatient clinic in urban Nepal.

BACKGROUND: There are limited data on the etiology and characteristics of bloodstream infections in children presenting in hospital outpatient settings in South Asia. Previous studies in Nepal have highlighted the importance of murine typhus as a cause of febrile illness in adults and enteric fever as a leading bacterial cause of fever among children admitted to hospital. METHODS: We prospectively studied a total of 1084 febrile children aged between 2 months and 14 years presenting to a general hospital outpatient department in Kathmandu Valley, Nepal, over two study periods (summer and winter). Blood from all patients was tested by conventional culture and by real-time PCR for Rickettsia typhi. RESULTS: Putative etiological agents for fever were identified in 164 (15%) patients. Salmonella enterica serovar Typhi (S. Typhi) was identified in 107 (10%), S. enterica serovar Paratyphi A (S. Paratyphi) in 30 (3%), Streptococcus pneumoniae in 6 (0.6%), S. enterica serovar Typhimurium in 2 (0.2%), Haemophilus influenzae type b in 1 (0.1%), and Escherichia coli in 1 (0.1%) patient. S. Typhi was the most common organism isolated from blood during both summer and winter. Twenty-two (2%) patients were PCR positive for R. typhi. No significant demographic, clinical and laboratory features distinguished culture positive enteric fever and murine typhus. CONCLUSIONS: Salmonella infections are the leading cause of bloodstream infection among pediatric outpatients with fever in Kathmandu Valley. Extension of immunization programs against invasive bacterial disease to include the agents of enteric fever and pneumococcus could improve the health of children in Nepal

Pathogens responsible for blood stream infections according to age group^*.

*<p>Data are no. (%) or no. unless stated otherwise. Percents shown for column totals only for bacterial isolates by blood culture.</p>†<p>Pathogens isolated by blood culture unless indicated otherwise.</p>‡<p>Median age in months.</p>††<p>4 patients with <i>S.</i> Typhi and 1 patient with <i>S.</i> Paratyphi A were PCR positive for <i>R. typhi.</i></p