Propuesta guía para una planeación y ejecución en proyectos de vivienda unifamiliar con enfoque Lean Construction

Trabajo de investigaciónEste trabajo contempla el desarrollo de una matriz enfocada en la metodología Lean Construction para la planeación y ejecución en proyectos de vivienda unifamiliar. Así mismo se evidencia un análisis de manera cuantitativa y cualitativamente en la adopción de la filosofía Lean Construction en procesos de la gestión de la planeación y ejecución de proyectos, que permite establecer un orden de actividades y sub actividades que componen las fases de un proyecto de vivienda unifamiliar en la relación del alcance exitoso en productividad y rendimiento.INTRODUCCIÓN 1. GENERALIDADES 2. METODOLOGÍAS EN EL MARCO DE LA PLANEACIÓN Y EJECUCIÓN DE PROYECTOS 3. LEAN CONSTRUCTION EN ACTIVIDADES DE CONSTRUCCIÓN 4. IMPLEMENTACIÓN DE LA MATRIZ EN CASO DE ESTUDIO 5. CONCLUSIONES 6. RECOMENDACIONES BIBLIOGRAFÍA ANEXOSPregradoIngeniero Civi

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified