Evaluating the Efficacy of a Dedicated Last Planner® System Facilitator to Enhance Construction Productivity

Construction unknowingly plans for poor levels of productivity with substantial waste, inefficiency, and rework stemming from a proliferation of non-value-adding activities embedded within traditional delivery processes. This approach negatively influences construction’s economic and environmental sustainability. Last Planner® System (LPS) is a key tool of Lean Construction (LC) and is lauded as a value-add process that prioritises flow efficiency by addressing workflow variability and waste elimination on construction projects. This research evaluates how the presence of a dedicated knowledgeable and competent LPS Facilitator, enabling a complete LPS implementation, contributes to improved construction flow, efficiency, and productivity. The study adopted a mixed-methods approach utilising case study design and data collected from a literature review, site observation diary, site documentation analysis, and semi-structured interviews. Limitations exist around small survey size, lack of generalisability, and potential bias of researchers. Findings posit considerable productivity increase; more reliable, predictable, and stable workflow; enhanced team collaboration; as well as accrual of safety, quality, cost, and schedule benefits. Embedding a knowledgeable and competent LPS Facilitator appears to assist successful implementation of LPS with sectoral and societal value-add opportunities. &nbsp

The Rigidity of Infinite Graphs II

Inductive constructions are established for countably infinite simple graphs which have minimally rigid locally generic placements in R^2. This generalises a well-known result of Henneberg for generically rigid finite graphs. Inductive methods are also employed in the determination of the infinitesimal flexibility dimension of countably infinite graphs associated with infinitely faceted convex polytopes in R^3. In particular, a generalisation of Cauchy's rigidity theorem is obtained

Development of a core outcome set for traumatic brachial plexus injuries (COMBINE): a study protocol

Introduction: Traumatic brachial plexus injury (TBPI) involves major trauma to the large nerves of the arm which control the movement and sensation. Fifty percent of injuries result in complete paralysis of the arm with many other individuals having little movement, sensation loss and unremitting pain. The injury often causes severe and permanent disability affecting work and social life, with an estimated cost to the NHS and the economy of £35 million per annum. Advances in microsurgery have resulted in an increase in interventions aimed at reconstructing these injuries. However, data to guide evidence-based decisions is lacking. Different outcomes are used across studies to assess the effectiveness of treatments. This has impeded our ability to synthesise results to determine which treatments work best. Studies frequently report short-term clinical outcomes but rarely report longer-term outcomes, and those focused on quality of life. This project aims to produce a Core Outcome Set (COS) for surgical and conservative management of TBPI. The TBPI COS will contain a minimum set of outcomes to be reported and measured in effectiveness studies and collected through routine clinical care. Methods and analysis: This mixed-methods project will be conducted in two phases. In phase 1 a long-list of patient-reported and clinical outcomes will be identified through a systematic review. Interviews will then explore outcomes important to patients. In phase 2 the outcomes identified across the systematic review and interviews will be included in a three round online Delphi exercise aiming to reach consensus on the COS. The Delphi process will include patient and healthcare participants. A consensus meeting will be held to achieve the final COS. Ethics and dissemination: The use of a COS in TBPI will increase the relevance of research and clinical care to all stakeholders, facilitate evidence synthesis and evidence-based decision making. The study has ethical approval

The generic rigidity of triangulated spheres with blocks and holes

A simple graph G = (V,E) is 3-rigid if its generic bar-joint frameworks in R^3 are infinitesimally rigid. Block and hole graphs are derived from triangulated spheres by the removal of edges and the addition of minimally rigid subgraphs, known as blocks, in some of the resulting holes. Combinatorial characterisations of minimal 3-rigidity are obtained for these graphs in the case of a single block and finitely many holes or a single hole and finitely many blocks. These results confirm a conjecture of Whiteley from 1988 and special cases of a stronger conjecture of Finbow-Singh and Whiteley from 2013

Coboundary operators for infinite frameworks

We consider, from the point of view of operator theory, a class of infinite matrices in which the matrix entries are determined by an underlying graph structure with accompanying geometric data. This class includes the rigidity matrices of infinite bar-joint frameworks as well as the incidence matrices of infinite directed graphs. We consider the following questions: When do these matrices give rise to bounded operators? Can we compute the operator norm? When are these operators compact? And when are they bounded below

The rigidity of a partially triangulated torus

A simple graph is 3-rigid if its generic embeddings in R^3 are infinitesimally rigid. Necessary and sufficient conditions are obtained for the minimal 3-rigidity of a simple graph obtained from a triangulated torus by the deletion of edges interior to an embedded triangulated disc

Computed tomography diagnosed cachexia and sarcopenia in 725 oncology patients: is nutritional screening capturing hidden malnutrition?

Background: Nutrition screening on admission to hospital is mandated in many countries, but to date, there is no consensus on which tool is optimal in the oncology setting. Wasting conditions such as cancer cachexia (CC) and sarcopenia are common in cancer patients and negatively impact on outcomes; however, they are often masked by excessive adiposity. This study aimed to inform the application of screening in cancer populations by investigating whether commonly used nutritional screening tools are adequately capturing nutritionally vulnerable patients, including those with abnormal body composition phenotypes (CC, sarcopenia, and myosteatosis). Methods: A prospective study of ambulatory oncology outpatients presenting for chemotherapy was performed. A detailed survey incorporating clinical, nutritional, biochemical, and quality of life data was administered. Participants were screened for malnutrition using the Malnutrition Universal Screening Tool (MUST), Malnutrition Screening Tool (MST), and the Nutritional Risk Index (NRI). Computed tomography (CT) assessment of body composition was performed to diagnose CC, sarcopenia, and myosteatosis according to consensus criteria. Results: A total of 725 patients (60% male, median age 64 years) with solid tumours participated (45% metastatic disease). The majority were overweight/obese (57%). However, 67% were losing weight, and CT analysis revealed CC in 42%, sarcopenia in 41%, and myosteatosis in 46%. Among patients with CT-identified CC, the MUST, MST, and NRI tools categorized 27%, 35%, and 7% of them as ‘low nutritional risk’, respectively. The percentage of patients with CT-identified sarcopenia and myosteatosis that were categorised as ‘low nutritional risk’ by MUST, MST and NRI were 55%, 61%, and 14% and 52%, 50%, and 11%, respectively. Among these tools, the NRI was most sensitive, with scores <97.5 detecting 85.8%, 88.6%, and 92.9% of sarcopenia, myosteatosis, and CC cases, respectively. Using multivariate Cox proportional hazards models, NRI score < 97.5 predicted greater mortality risk (hazard ratio 1.8, confidence interval: 1.2–2.8, P = 0.007). Conclusions: High numbers of nutritionally vulnerable patients, with demonstrated abnormal body composition phenotypes on CT analysis, were misclassified by MUST and MST. Caution should be exercised when categorizing the nutritional risk of oncology patients using these tools. NRI detected the majority of abnormal body composition phenotypes and independently predicted survival. Of the tools examined, the NRI yielded the most valuable information from screening and demonstrated usefulness as an initial nutritional risk grading system in ambulatory oncology patients

changing face of lung cancer: oligometastatic renal metastasis post chemo-immunotherapy combination

This report describes a rare case of oligometastatic renal disease in a 69 year-old Caucasian male with non-small cell lung cancer (NSCLC). Diagnosed with Stage IIIb, NSCLC he completed chemoradiotherapy followed by 1 year of immunotherapy. Surveillance CT scans after nearly three years showed an ill-defined lesion in the left kidney. Biopsy results were consistent with metastasis from the known lung carcinoma. Following neo-adjuvant Pembrolizumab (200mg, q3w), the patient underwent a left radical nephrectomy, without complications. One year post-operatively, CT of the thorax, abdomen and pelvis (TAP) did not identify any recurrence. Renal metastases were historically demonstrated predominantly by autopsy studies[1]. Any mass manifesting in the kidney in the context of previous NSCLC warrants comprehensive investigations. The combination of immunotherapy followed by definitive treatment appears to be a promising management strategy[2]. With regards to local curative options, the advantages and disadvantages of surgery and radiotherapy have been well described[3-4]

Pembrolizumab-induced follicular eruption and response to isotretinoin

Background: Pembrolizumab is a monoclonal antibody targeting PD-1. Folliculitis secondary to pembrolizumab has rarely been reported in the treatment of malignant melanoma. Case: A 49-year-old with a history of mild lower limb folliculitis developed metastatic malignant melanoma, and immunotherapy with pembrolizumab was initiated. Following 19 doses of pembrolizumab, a folliculocentric pustular eruption developed on the lower legs. Biopsy was consistent with folliculitis. Treatment with topical corticosteroids, high-dose prednisolone, lymecycline, clarithromycin, trimethoprim and clindamycin was unsuccessful. Pembrolizumab was stopped after 22 cycles, but the folliculitis persisted. Oral isotretinoin was required for disease control. Discussion: Drug-induced follicular eruptions have rarely been described with anti PD-1 therapy. Isotretinoin may be required to achieve remission. Lay abstract: Pembrolizumab (trade name Keytruda©) is a type of immune therapy that stimulates the body's immune system to fight cancer cells. This immune therapy can cause a variety of rashes. In this article, the authors describe a patient who developed a rash around hair follicles that is not commonly described with pembrolizumab. A man with a history of mildly infected hair follicles on his legs was diagnosed with advanced melanoma and was treated with pembrolizumab. After 19 treatments, he developed a rash on his legs, centered around hair follicles. Treatment with steroid ointments, steroid tablets and antibiotic tablets was not helpful. Pembrolizumab was stopped, but the rash persisted. A medicine called isotretinoin was required to control the rash. This type of rash has rarely been described with this kind of immune therapy, and isotretinoin might be required to treat it