A Systematic Review for The Implementation of Risk Management Within Construction of Mega Housing Projects

Recent years have seen an increase in the number of Mega housing Projects around the world. This increase was to cater for increased population growth, increased urbanisation, scarcity of land, and due to changes in the way we work and live. This trend is likely to continue for a while. Mega housing projects are characterized by their high construction budget, complexity, and their benefits to the society. Mega housing projects, however, raise a number of different challenges and complexities, which need consideration in order to successfully deliver them within cost, time and specified quality parameters. The paper addresses the main construction challenges and opportunities of mega housing projects. Furthermore, consideration is given to the human resources (HR) challenges and opportunities, as well as the efficiency of risk management processes throughout the construction of mega housing projects. Different Case studies are analysed, and a risk register for the successful delivery of mega housing projects in construction is proffered. Conclusions for the benefit of contractors, policymakers, and academics are documented, together with selected recommendations around "value-add" from effective risk management of new mega housing projects

A Conceptual Risk Management Framework in the Construction of Mega Housing Projects in Egypt

Recent years have seen an increase in the number of Mega housing Projects around the world. This increase was to cater for increased population and urbanization. Construction of mega housing projects in Egypt faced a lot of challenges during the construction phase. There is no targeted framework that allows contractors to improve their risk management practice and project success during the construction of mega housing projects in Egypt. The aim of the paper is to design a conceptual Risk Management Framework for Mega Housing Projects in Egypt to improve risk practices and project success during the construction phase. The objective of the paper is to design a conceptual risk management framework to guide contractors to an efficient risk management practice during construction of mega housing projects in Egypt. The study is to review risk standards, to recognize developed risk frameworks, and to design a conceptual risk management framework (CRMF). The framework guide contractors’ in Egypt towards successful risk management practice. The CRMF included steps of risk identification, assessment, response, and risk control. Risk identification adopted risk principles from the International Standardization (ISO31000, 2018). Principles of risk management included knowledge, risk skills, challenges, and opportunities. Interviews and NVivo analysis are used as a technique of risk identification. Qualitative risk analysis included risks obtained from the identification process as input. Technique of questionnaire can guide contractors to prioritize risks based on their significance. Contractors can use Monte Carlo simulation as a quantitative technique to obtain time and cost contingency before and after adding responses. The technique of Monte Carlo analysis is used in the risk control process to highlight new contingencies after adding responsive strategies. The literature of risk management and standards were used as a backdrop to design a CRMF. The framework recognized contractors’ recent knowledge and skills and improves risk management practices during construction of mega housing projects. Contractors can use the designed conceptual risk management framework in reporting and communicating risk activities during construction of mega housing projects in Egypt

The economic impact of periprosthetic infection in total hip arthroplasty

© 2020 Canadian Medical Association. All rights reserved. Background: Periprosthetic joint infection (PJI) is the third leading cause of total hip arthroplasty (THA) failure. Although controversial, 2-stage revision remains the gold standard treatment for PJI in most situations. To date, there have been few studies describing the economic impact of PJI in today\u27s health care environment. The purpose of the current study was to obtain an accurate estimate of the institutional cost associated with the management of PJI in THA and to assess the economic burden of PJI compared with primary uncomplicated THA. Methods: We conducted a review of primary THA cases and 2-stage revision THA for PJI at our institution. Patients were matched for age and body mass index. All costs associated with each procedure were recorded. Descriptive statistics were used to summarize the collected data. Mean costs, length of stay, clinic visits and readmission rates associated with the 2 cohorts were compared. Results: Fifty consecutive cases of revision THA were matched with 50 cases of uncomplicated primary THA between 2006 and 2014. Compared with the primary THA cohort, PJI was associated with a significant increase in mean length of hospital stay (26.5 v. 2.0 d, p \u3c 0.001), mean number of clinic visits (9.2 v. 3.8, p \u3c 0.001), number of readmissions (12 v. 1, p \u3c 0.001) and average overall cost (Can$38 107 v. Can$6764, t = 8.3, p \u3c 0.001). Conclusion: Treatment of PJI is a tremendous economic burden. Our data suggest a 5-fold increase in hospital expenditure in the management of PJI compared with primary uncomplicated THA

A large gastrointestinal stromal tumor of the duodenum: a case report

<p>Abstract</p> <p>Introduction</p> <p>Gastrointestinal stromal tumors of the duodenum are uncommon. They can reach a large size. Diagnosis can be elusive and managing them can be difficult. Our case report aims to increase awareness and highlight some issues related to the diagnosis and management of duodenal gastrointestinal stromal tumors.</p> <p>Case presentation</p> <p>We present the case of a 38-year-old Middle Eastern woman with a large, slowly-growing gastrointestinal stromal tumor of the duodenum. Her complaints were minor epigastric discomfort and swelling. A pancreaticoduodenectomy with complete tumor excision was performed. She was doing very well with no evidence of disease recurrence when she was last seen 34 months after her operation.</p> <p>Conclusion</p> <p>Gastrointestinal stromal tumors of the duodenum should be suspected in any patient with a duodenal wall mass. Extramural growth and central ulceration with or without bleeding should alert the endoscopist to the possibility of a duodenal gastrointestinal stromal tumor diagnosis. There is more than one surgical approach available; however, complete surgical excision, with negative margins, is the absolute requirement. Preoperative imatinib mesylate can be considered in unresectable or borderline resectable cases.</p

Incidence of Nosocomial Infection with Nasal Continuous Positive Air Way Pressure Versus Mechanical Ventilation During Treatment of Respiratory Distress in Preterm Neonates

Abstract: Objective: to determine the incidence of nosocomial infections in preterm infants with respiratory distress, if treatment with continuous positive air way pressure (CPAP) compared to treatment with mechanical ventilation (MV). Patients and Methods: Sixty premature neonates admitted to the intensive care unit in Al Galaa Teaching Hospital, in their first day of life suffering from respiratory distress, the infants were divided into two groups, 1 st group include 30 patients supported by CPAP and the 2 nd group include 30 patients who were supported by mechanical ventilation. Blood cultures and early endotracheal cultures were taken in the 1 st day of life from the sixty neonates in both groups then another late endotracheal culture was taken from them in the 5 th day of life. Results: 36.67% of patients in the MV group had +ve blood culture and 63.33% had no growth, while in the CPAP group 16.67% had +ve blood culture and 83.33% showed no growth. Early endotracheal cultures showed +ve growth in 63.33% in the MV groups a 23.33% in the CPAP group. (P=0.002), on the other hand late endotracheal cultures showed +ve growth in 36.67% in the MV group and 16.67% in the CPAP group. Klebsiella was the most frequent organism in all +ve cultures. Conclusion: The incidence of positive infection in blood cultures and endotracheal cultures is higher in the MV group than in the CPAP group. The incidence of klebsiella among the whole population in the two studied groups was higher in MV group more than in the CPAP group in all the cultures. Within the cases having positive cultures, MV patients needed longer duration on ventilation than patients on CPAP (whether the cultures were taken from the blood or endotracheal)

Complications and failure modes of coronary embolic protection devices: Insights from the MAUDE database

BACKGROUND: There is limited data on complications associated with the use of coronary embolic protection devices (EPDs). METHODS: We queried the Manufacturer and User Facility Device Experience database between November 2010 and November 2020 for reports on coronary EPDs: Spider FX (Medtronic, Minneapolis, MN) and Filterwire EZ (Boston Scientific, Natick, MA). RESULTS: We retrieved 119 reports on coronary EPD failure (Spider FX n = 33 and Filterwire EZ n = 86), most of which (78.2%) occurred during saphenous vein graft interventions. The most common failure mode was inability to retrieve the EPD (49.6%), with the filter trapped against stent struts in 76.2% of the cases. Other device complications included filter fracture (28.6%), failure to cross (7.6%), failure to deploy (7.6%), and failure to recapture the filter (3.4%). Filter fracture (54.5 vs. 29.1%) and failure to recapture (9.1 vs. 2.1%) were more commonly reported, while failure to deploy the filter (0 vs. 10.5%) was less commonly reported with the Spider-FX. CONCLUSIONS: The most common modes of failure of coronary EPDs are the failure of retrieval (49.6%), followed by the filter fracture (28.6%). When using EPDs, careful attention to the technique is essential to avoid failures and subsequent complications