A seminal case study on application of last planner system with cash flow data for improvement in construction management practices

A major challenge faced by project managers is balancing the variables of scope, cost, and schedule. Changes in scope usually result in cost/schedule overruns. Variance in either or both of them creates disorder (typically increases it) in the estimated or projected time and cost. Therefore, controlling cost and schedule are two of the most critical aspects of a construction project. This research uses two already existing management theories, specifically Management by Means (MBM) and Management by Results (MBR), and analyzes a case where these two theories are combined with the goal of improving construction practices. This research compares an eight month schedule in a construction project and relates Percentage of Planned activities Completed (PPC) with projected and actual draw (cash) calls. The research analyzes the question of how lean construction PPC captures variance in cost. The research method is based on a literature review, data collection, case study and data interpretation to answer the hypothesis that improvement in PPC over a particular month has a positive correlation with difference between cash calls. Because this research is limited to a time frame of 8 months in a single project, it is not statistically significant. However, this research serves to create a model template or pilot study for a larger study

The study of the incidence of pregnant women with sickle cell disease

Background: The sickle cell disease is major public health problem which causes high morbidity and mortality in India. It is observed that SCD is scourge in Chhattisgarh since long past. Sickle cell disease is a term for a group of genetically inherited disorders characterized by production of abnormal hemoglobin. “Hemoglobin-S” results from a point mutation in the beta globin gene. The main objective is to study the incidence of pregnant women with sickle cell disease.Methods: It is a hospital based prospective study. It was conducted at Obstetrics and Gynecology department of LTBRKM Govt. Medical College, Jagdalpur, Chhattisgarh. The study was carried out from August 2014 to October 2015. The study included screening of all patients attending antenatal clinic and in labour ward during emergency. 75 cases were found to be sickling positive. Permission from Institutional Ethics Committee was obtained.Results: The incidence of SCD in India is 44%, in Chhattisgarh is 17%.At our institute in pregnant women is 1.75%. The incidence of HbAs group was 70.66% and HbSS was 26.66%. In Hb AS group maximum 47% patients were in age group of 26-30 years. and also in same age group the incidence of HbSS group was 60%. In age group of 31-35 years. 22% of patients were of HbAS group, but only 10% of patients were of HbSS group. HbAS group and HbSS group the percentage of primi gravida were 49% and 60% respectively. It is noted that in HbAS group only 3% of patients had parity >4, but in HbSS group it was 10%.Conclusions: In conclusion, it has been shown that the clinical statuses of the most sickle cell diseases patience were not seriously affected by pregnancy if they are given appropriate prenatal care. All pregnant women should be screened for sickle sell hemoglobinopathy in endemic region, like in our state Chhattisgarh

Uterine rupture: review of cases from tertiary care centre in India

Background: Uterine rupture is rare catastrophic complication associated with high incidence of maternal and perinatal morbidity and mortality. This study aimed at assessing the incidence of uterine rupture; maternal and fetal outcomes in cases of uterine rupture and factors associated with it.Methods: This retrospective study was carried out in the department of obstetrics and gynaecology, Late Baliram Kashyap memorial government medical college and Shaheed Mahendra Karma memorial hospital, Bastar, Chhattisgarh, India. All the cases of rupture uterus, who were admitted with the diagnosis or who had rupture during their stay in our hospital during the study duration of July 2018 to March 2020 were included in our study- 37 cases.Results: Out of 37 cases of ruptured uterus 8 rupture occurred in women with prior lower segment caesarean section (LSCS) and 29 occurred in women without prior LSCS. There were equal numbers of cases (17 cases each, 45.9%) in the age groups 25-30 years and 31 years and above. Incidence of rupture was highest in multiparous (3 and above). 70.3% of rupture were un-booked patients. 89.2% were referred from periphery. 86.5% of ruptures occurred at more than 37 weeks. 54% of rupture had of inter pregnancy interval of less than 24 months. Most common predisposing factor for uterine rupture in our study was obstructed labor. The most common site of rupture was found to be anterior surface of lower segment of uterus. Maternal morbidities seen include need for blood transfusion in 94.5% of cases. Among the maternal morbidities noted, severe anemia requiring blood transfusion was most commonly observed.Conclusions: Rupture of the pregnant uterus should be looked as a preventable entity. All possible efforts to reduce the incidence and the resultant maternal morbidity and mortality due to uterine rupture should be undertaken

Motivations for contralateral prophylactic mastectomy as a function of socioeconomic status

BACKGROUND: Despite no demonstrated survival advantage for women at average risk of breast cancer, rates of contralateral prophylactic mastectomy (CPM) continue to increase. Research reveals women with higher socioeconomic status (SES) are more likely to select CPM. This study examines how indicators of SES, age, and disease severity affect CPM motivations. METHODS: Patients (N = 113) who underwent CPM at four Indiana University affiliated hospitals completed telephone interviews in 2013. Participants answered questions about 11 CPM motivations and provided demographic information. Responses to motivation items were factor analyzed, resulting in 4 motivational factors: reducing long-term risk, symmetry, avoiding future medical visits, and avoiding treatments. RESULTS: Across demographic differences, reducing long-term risk was the strongest CPM motivation. Lower income predicted stronger motivation to reduce long-term risk and avoid treatment. Older participants were more motivated to avoid treatment; younger and more-educated patients were more concerned about symmetry. Greater severity of diagnosis predicted avoiding treatments. CONCLUSIONS: Reducing long-term risk is the primary motivation across groups, but there are also notable differences as a function of age, education, income, and disease severity. To stop the trend of increasing CPM, physicians must tailor patient counseling to address motivations that are consistent across patient populations and those that vary between populations

Study of efficacy and complication of postpartum IUCD insertion at Govt. medical college, Bastar

Background: This study is aimed at determining the safety, efficacy and expulsion of PPIUCD. This study also aims to determine the rates of complications (bleeding, pelvic infection, lost strings, and displacement) following PPIUCD insertion among the women in one year period.Methods: This study was conducted at department of obstetrics and gynecology, Late B.R.K.M Govt. medical college, Jagdalpur, Chattishgarh. Women admitted and delivered were counseled and those who fulfilled the medical eligibility criteria and had no contra indication for PPIUCD were provided the PPIUCD services.Results: Total women 600, lost to follow-up 329, complications 162 (expulsion 14, bleeding 35, string problem 44), removal 102.Conclusions: The PPIUCD (Cu380A) is demonstrably safe, effective, has high retention rate. The expulsion rate is not very high and it can be reduced with correct techniques, correct selection of clients, and correct time selection for the client

Study of near miss cases in obstetrics and maternal mortality in Bastar, Chhattisgarh, India

Background: According to millennium development goals (MDG) in 2015, the goal number five was to improve the maternal health is falling way below our target. Our aim in reducing maternal mortality by 75% has not been met with MDG. Pregnant women’s health status is not reflected by mortality indicators alone hence the concept of severe acute maternal morbidity (SAMM) is an apt for the present health providing system. The main objectives of the study were to; (1) To determine the frequency of maternal near miss, maternal near miss incidence ratio (MNMR), maternal near miss to mortality ratio and mortality index; (2) To compare the nature of near miss events with maternal mortality; (3) To observe the trend of near miss events.Methods: It was a retrospective study design conducted at Late B.R.K.M Government medical college, Jagdalpur, Chhattisgarh, India during September 2013 to August 2014. The study population includes near miss cases and maternal deaths. Cases were defined based on WHO criteria 2009.Results: Out of 3539 deliveries, 39 wear near miss cases during the study period. The maternal near miss incidence ratio was 11.9/1000 live births, maternal near miss to mortality ratio was 2.05:1, and mortality index was 32.7%. Hemorrhage was the leading cause (43.5%), followed by severe anemia (15.38%), rupture uterus (15.38%), preeclampsia/eclampsia (12.82%), sepsis (5.12%), complicated malaria (5.12%) and hepatitis (2.56%). Maternal mortality ratio (MMR) was 580/100000 live births.Conclusions: Hemorrhage was the leading cause of near miss events. As near miss analysis indicates the quality of health care, it is worth presenting in national indices

Social Network, Surgeon, and Media Influence on the Decision to Undergo Contralateral Prophylactic Mastectomy

OBJECTIVES: The rate of contralateral prophylactic mastectomy (CPM) has risen sharply in the past decade. The current study was designed to examine social network, surgeon, and media influence on patients' CPM decision-making, examining not only who influenced the decision, and to what extent, but also the type of influence exerted. METHODS: Patients (N=113) who underwent CPM at 4 Indiana University-affiliated hospitals between 2008 and 2012 completed structured telephone interviews in 2013. Questions addressed the involvement and influence of the social network (family, friends, and nonsurgeon health professionals), surgeon, and media on the CPM decision. RESULTS: Spouses, children, family, friends, and health professionals were reported as exerting a meaningful degree of influence on patients' decisions, largely in ways that were positive or neutral toward CPM. Most surgeons were regarded as providing options rather than encouraging or discouraging CPM. Media influence was present, but limited. CONCLUSIONS: Patients who choose CPM do so with influence and support from members of their social networks. Reversing the increasing choice of CPM will require educating these influential others, which can be accomplished by encouraging patients to include them in clinical consultations, and by providing patients with educational materials that can be shared with their social networks. Surgeons need to be perceived as having an opinion, specifically that CPM should be reserved for those patients for whom it is medically indicated