Modeling of CPM/LOB integrated Scheduling Technique for Repetitive Construction Projects: Case of Multiple-Crews with Fuzzy Time Data

Project scheduling provides a good insight for the manager to complete the project on time. Project scheduling gives complete timing analysis of activities involved and identifies the critical ones. Critical Path Method (CPM) is the most widely used in planning and scheduling method for traditional (non-repetitive) projects to determine the critical path which determines the minimum completion time of a project.Some construction projects consist of several similar or identical units, which are called repetitive projects. LOB technique has some drawbacks such inability to generate a clear critical path of the project schedule and calculating the total float because it is a graphical technique. LOB used for scheduling repetitive typical projects because this technique considered work continuity and resource availability constraints to avoid unnecessary crew idle time.Some of the previous studies have been made to combine the benefits of CPM and LOB techniques in planning and scheduling repetitive construction projects, so, there is a model that was developed for this objective (schedule repetitive projects in an easy non-graphical manner). But, in real life, more conditions contributed to varying activity duration. Thus, the duration of project activities contains some sort of uncertainty affecting the estimating of project duration. Previous studies used fuzzy set theory instead of probability theory for quantifying the uncertainty associated with the duration of project activities.In this paper, a developed integrated model of CPM and LOB with fuzzy time data for scheduling repetitive projects is presented. The developed model provides a new technique to schedule repetitive projects with fuzzy time data in an easy non-graphical manner

Making Space, Making Place: Digital Togetherness and the Redefinition of Migrant Identities Online

Immigrants have played a fundamental role in shaping the life and form of urban public spaces for generations. Their efforts, as many scholars have observed, mostly aimed at creating places of comfort in new and sometimes hostile receiving countries. In recent years, the combined contribution of the built environment and screen-based experiences have shaped migrants’ sense of community and belonging, thus making the concept of online community central to ideas about space and public life. Drawing upon a 3-year online ethnography, the article discusses to what extent new media constitute spaces of digital togetherness, where diasporic experiences and transnational identities are constructed and negotiated. It presents a transnational model of creative media consumption, which helps give insight as to how diasporas and ethnic minorities contribute to the transformation of public space in the Digital Age

Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012

OBJECTIVE: To provide an update to the "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock," last published in 2008. DESIGN: A consensus committee of 68 international experts representing 30 international organizations was convened. Nominal groups were assembled at key international meetings (for those committee members attending the conference). A formal conflict of interest policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independent of any industry funding. A stand-alone meeting was held for all subgroup heads, co- and vice-chairs, and selected individuals. Teleconferences and electronic-based discussion among subgroups and among the entire committee served as an integral part of the development. METHODS: The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence from high (A) to very low (D) and to determine the strength of recommendations as strong (1) or weak (2). The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. Recommendations were classified into three groups: (1) those directly targeting severe sepsis; (2) those targeting general care of the critically ill patient and considered high priority in severe sepsis; and (3) pediatric considerations. RESULTS: Key recommendations and suggestions, listed by category, include: early quantitative resuscitation of the septic patient during the first 6 h after recognition (1C); blood cultures before antibiotic therapy (1C); imaging studies performed promptly to confirm a potential source of infection (UG); administration of broad-spectrum antimicrobials therapy within 1 h of the recognition of septic shock (1B) and severe sepsis without septic shock (1C) as the goal of therapy; reassessment of antimicrobial therapy daily for de-escalation, when appropriate (1B); infection source control with attention to the balance of risks and benefits of the chosen method within 12 h of diagnosis (1C); initial fluid resuscitation with crystalloid (1B) and consideration of the addition of albumin in patients who continue to require substantial amounts of crystalloid to maintain adequate mean arterial pressure (2C) and the avoidance of hetastarch formulations (1B); initial fluid challenge in patients with sepsis-induced tissue hypoperfusion and suspicion of hypovolemia to achieve a minimum of 30 mL/kg of crystalloids (more rapid administration and greater amounts of fluid may be needed in some patients (1C); fluid challenge technique continued as long as hemodynamic improvement is based on either dynamic or static variables (UG); norepinephrine as the first-choice vasopressor to maintain mean arterial pressure ≥65 mmHg (1B); epinephrine when an additional agent is needed to maintain adequate blood pressure (2B); vasopressin (0.03 U/min) can be added to norepinephrine to either raise mean arterial pressure to target or to decrease norepinephrine dose but should not be used as the initial vasopressor (UG); dopamine is not recommended except in highly selected circumstances (2C); dobutamine infusion administered or added to vasopressor in the presence of (a) myocardial dysfunction as suggested by elevated cardiac filling pressures and low cardiac output, or (b) ongoing signs of hypoperfusion despite achieving adequate intravascular volume and adequate mean arterial pressure (1C); avoiding use of intravenous hydrocortisone in adult septic shock patients if adequate fluid resuscitation and vasopressor therapy are able to restore hemodynamic stability (2C); hemoglobin target of 7-9 g/dL in the absence of tissue hypoperfusion, ischemic coronary artery disease, or acute hemorrhage (1B); low tidal volume (1A) and limitation of inspiratory plateau pressure (1B) for acute respiratory distress syndrome (ARDS); application of at least a minimal amount of positive end-expiratory pressure (PEEP) in ARDS (1B); higher rather than lower level of PEEP for patients with sepsis-induced moderate or severe ARDS (2C); recruitment maneuvers in sepsis patients with severe refractory hypoxemia due to ARDS (2C); prone positioning in sepsis-induced ARDS patients with a PaO (2)/FiO (2) ratio of ≤100 mm Hg in facilities that have experience with such practices (2C); head-of-bed elevation in mechanically ventilated patients unless contraindicated (1B); a conservative fluid strategy for patients with established ARDS who do not have evidence of tissue hypoperfusion (1C); protocols for weaning and sedation (1A); minimizing use of either intermittent bolus sedation or continuous infusion sedation targeting specific titration endpoints (1B); avoidance of neuromuscular blockers if possible in the septic patient without ARDS (1C); a short course of neuromuscular blocker (no longer than 48 h) for patients with early ARDS and a PaO (2)/FI O (2) 180 mg/dL, targeting an upper blood glucose ≤180 mg/dL (1A); equivalency of continuous veno-venous hemofiltration or intermittent hemodialysis (2B); prophylaxis for deep vein thrombosis (1B); use of stress ulcer prophylaxis to prevent upper gastrointestinal bleeding in patients with bleeding risk factors (1B); oral or enteral (if necessary) feedings, as tolerated, rather than either complete fasting or provision of only intravenous glucose within the first 48 h after a diagnosis of severe sepsis/septic shock (2C); and addressing goals of care, including treatment plans and end-of-life planning (as appropriate) (1B), as early as feasible, but within 72 h of intensive care unit admission (2C). Recommendations specific to pediatric severe sepsis include: therapy with face mask oxygen, high flow nasal cannula oxygen, or nasopharyngeal continuous PEEP in the presence of respiratory distress and hypoxemia (2C), use of physical examination therapeutic endpoints such as capillary refill (2C); for septic shock associated with hypovolemia, the use of crystalloids or albumin to deliver a bolus of 20 mL/kg of crystalloids (or albumin equivalent) over 5-10 min (2C); more common use of inotropes and vasodilators for low cardiac output septic shock associated with elevated systemic vascular resistance (2C); and use of hydrocortisone only in children with suspected or proven "absolute"' adrenal insufficiency (2C). CONCLUSIONS: Strong agreement existed among a large cohort of international experts regarding many level 1 recommendations for the best care of patients with severe sepsis. Although a significant number of aspects of care have relatively weak support, evidence-based recommendations regarding the acute management of sepsis and septic shock are the foundation of improved outcomes for this important group of critically ill patients

Role of echocardiography in reducing shock reversal time in pediatric septic shock: a randomized controlled trial

Objective: To evaluate the role of echocardiography in reducing shock reversal time in pediatric septic shock. Methods: A prospective study conducted in the pediatric intensive care unit (PICU) of a tertiary care teaching hospital from September 2013 to May 2016. Ninety septic shock patients were randomized in a 1:1 ratio for comparing the serial echocardiography‐guided therapy in the study group with the standard therapy in the control group regarding clinical course, timely treatment, and outcomes. Results: Shock reversal was significantly higher in the study group (89% vs. 67%), with significantly reduced shock reversal time (3.3 vs. 4.5 days). PICU stay in the study group was significantly shorter (8 ± 3 vs. 14 ± 10 days). Mortality due to unresolved shock was significantly lower in the study group. Fluid overload was significantly lower in the study group (11% vs. 44%). In the study group, inotropes were used more frequently (89% vs. 67%) and initiated earlier (12[0.5–24] vs. 24[6–72] h) with lower maximum vasopressor inotrope score (120[30–325] vs. 170[80–395]), revealing predominant use of milrinone (62% vs. 22%). Conclusion: Serial echocardiography provided crucial data for early recognition of septic myocardial dysfunction and hypovolemia that was not apparent on clinical assessment, allowing a timely management and resulting in shock reversal time reduction among children with septic shock

Diasporic media across Europe: multicultural societies and the universalism–particularism continuum

Europe is a cultural space of meeting, mixing and clashing; a space of sharing (and not sharing) economic, cultural and symbolic resources. Dominant ideologies of Europeanism project an image of Europe as a common and distinct cultural Home, a Home that excludes and (re-)creates Otherness when it does not fit a model of universalism and appears as competing particularism. Cultural diversity has always characterised Europe, but growing potentials for mobility and communication have led to the emergence and intensification of diverse cultural experiences and formations. In this context, the growing numbers and kinds of diasporic media have significant implications for imagining multicultural Europe and for participating (or not) in European societies and transnational communities. What is argued here is that diasporic media cultures do not emerge as projects that oppose the universalistic projects of Europe and of global communication, but that they gain from ideologies of globalisation and democratic participation as much as they gain and depend on ideologies of identity and particularism. Drawing from a cross-European mapping and three specific case studies, I try to explain why diasporic media cultures challenge both the limits of European universalism and of diasporic particularism