MODELING AND TESTING OF A MAINTENANCE PROJECT USING SIMPHONY: CASE STUDY

Unlike building a new project, the maintenance and rehabilitation of an existing project are complex. The complexity is driven by different factors such as limited access to the site, limited working hours, restricted storage area, a limited number of allowed crews to work simultaneously, etc. Considering all of these factors is essential for construction process planning. Hence, testing the maintenance project under different project scenarios will help to identify the optimum resources configuration. In this paper, we present a  case study of a maintenance project located in Al Khodh, Oman. It is required to model and simulate the maintenance operation, given many client-based work constraints. The project was modelled using a Simphony simulation environment. The simulation model was tested in different resource configurations, including several floor accesses, other tiles breaking and tiles installation teams, and a different number of waterproofing teams. This study demonstrated that the tiles installation team is the most influencing resource in the project.  Given one floor access at a time and using two tiles installation produces the most economical resources configuration. Three tiles installation teams are the best selection for two-floor accesses, and seven tiles installation teams selection is best for three floors

Infection among renal transplant patients in the Kingdom of Bahrain: A ten year retrospective study ( 2004-2014)

Introduction:  Kidney transplantation is the process of transplanting the organ to a patient with end stage renal disease. Complications with transplant can be encountered during or for a varying period post operatively. As graft survival and immunosuppressant regimens have improved, infection of grafts have become a leading concern. The diagnosis of infection in such patients is challenging too due to the lack of the typical infection indicators like fever as the patients are immunocompromised. The focus of our study is to study the extent of infection on the transplanted patients. The research will look into the type of microorganisms encountered, their management and outcome. Methods  & Materials: A retrospective study was carried out between the periods of 1st of January 2004 to 31st of December of the same year 2014. All renal transplant patients admitted during this period were segregated according to the reason of admission. Only those with impression of infection were enrolled.   Results: A total of 108 patients admitted between the period of 1st of January 2004 and 31st of December 2014 with impression of infection post renal transplant. Some of the patients had recurrent history during those ten years for infectious purposes. From the 108 patients, 74 of them received transplant from living donors (68.52%). The diagnosis on admission was limited to certain differentials. 35.19% patients were admitted with the impression of urinary tract infection. Pneumonia was diagnosed in 10.19%.  patients.  Majority of patient (89.96%) were on maintenance dose of steroids. That was followed by MMF, Tacrolimus and cyclosporine with a percentage of 81.48%, 46.3% and 25.93% respectively. Regarding the antibiotics, 86.11% of the admitted patient were started on single antibiotic on admission including those with recurrent admission. Conclusion: Fever is a common presenting symptom in our population of transplant recipients which reflects the possibility of infection. The majority responded to a single antibiotic use.  The limitation of our study is the small number of the transplanted patients. &nbsp

Comparative analysis of gradient-boosting ensembles for estimation of compressive strength of quaternary blend concrete

Concrete compressive strength is usually determined 28 days after casting via crushing of samples. However, the design strength may not be achieved after this time-consuming and tedious process. While the use of machine learning (ML) and other computational intelligence methods have become increasingly common in recent years, findings from pertinent literatures show that the gradient-boosting ensemble models mostly outperform comparative methods while also allowing interpretable model. Contrary to comparison with other model types that has dominated existing studies, this study centres on a comprehensive comparative analysis of the performance of four widely used gradient-boosting ensemble implementations [namely, gradient-boosting regressor, light gradient-boosting model (LightGBM), extreme gradient boosting (XGBoost), and CatBoost] for estimation of the compressive strength of quaternary blend concrete. Given components of cement, Blast Furnace Slag (GGBS), Fly Ash, water, superplasticizer, coarse aggregate, and fine aggregate in addition to the age of each concrete mixture as input features, the performance of each model based on R2, RMSE, MAPE and MAE across varying training–test ratios generally show a decreasing trend in model performance as test partition increases. Overall, the test results showed that CatBoost outperformed the other models with R2, RMSE, MAE and MAPE values of 0.9838, 2.0709, 1.5966 and 0.0629, respectively, with further statistical analysis showing the significance of these results. Although the age of each concrete mixture was found to be the most important input feature for all four boosting models, sensitivity analysis of each model shows that the compressive strength of the mixtures does increase significantly after 100 days. Finally, a comparison of the performance with results from different ML-based methods in pertinent literature further shows the superiority of CatBoost over reported the methods

Quality of Sleep and Its Effect on Glycemic Control

Diabetes mellitus (DM) is a widespread illness that affects around 347 million individuals globally. DM not only has many clinical implications but also has a detrimental impact on the quality of sleep in patients. Insufficient sleep quality hinders the proper regulation of blood sugar levels, which is considered a fundamental aspect of managing diabetes. It also has other harmful repercussions that significantly affect one's overall quality of life. Increasing data suggests that sleep disturbances and sleep deprivation have an impact on glucose metabolism and insulin resistance. Simultaneously, changes in glucose metabolism can potentially affect the quality of sleep. The association between T2DM and sleep-disturbed breathing has been thoroughly investigated. Individuals diagnosed with T2DM exhibit a remarkably elevated incidence of obstructive sleep apnea, which subsequently leads to suboptimal management of blood sugar levels. Conversely, the correlation between T1DM and sleep has not been well-studied

The Saudi Critical Care Society practice guidelines on the management of COVID-19 in the ICU: Therapy section

BACKGROUND: The rapid increase in coronavirus disease 2019 (COVID-19) cases during the subsequent waves in Saudi Arabia and other countries prompted the Saudi Critical Care Society (SCCS) to put together a panel of experts to issue evidence-based recommendations for the management of COVID-19 in the intensive care unit (ICU). METHODS: The SCCS COVID-19 panel included 51 experts with expertise in critical care, respirology, infectious disease, epidemiology, emergency medicine, clinical pharmacy, nursing, respiratory therapy, methodology, and health policy. All members completed an electronic conflict of interest disclosure form. The panel addressed 9 questions that are related to the therapy of COVID-19 in the ICU. We identified relevant systematic reviews and clinical trials, then used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach as well as the evidence-to-decision framework (EtD) to assess the quality of evidence and generate recommendations. RESULTS: The SCCS COVID-19 panel issued 12 recommendations on pharmacotherapeutic interventions (immunomodulators, antiviral agents, and anticoagulants) for severe and critical COVID-19, of which 3 were strong recommendations and 9 were weak recommendations. CONCLUSION: The SCCS COVID-19 panel used the GRADE approach to formulate recommendations on therapy for COVID-19 in the ICU. The EtD framework allows adaptation of these recommendations in different contexts. The SCCS guideline committee will update recommendations as new evidence becomes available

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Efficacy and Safety of Lopinavir/Ritonavir for Treatment of COVID-19: A Systematic Review and Meta-Analysis

(Background) Lopinavir-ritonavir (LPV/RTV) is a human immunodeficiency virus (HIV) antiviral combination that has been considered for the treatment of COVID-19 disease. (Aim) This systematic review aimed to assess the efficacy and safety of LPV/RTV in COVID-19 patients in the published research. (Methods) A protocol was developed based on the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statement. Articles were selected for review from 8 electronic databases. This review evaluated the effects of LPV/RTV alone or in combination with standard care ± interferons/antiviral treatments compared to other therapies, regarding duration of hospital stay, risk of progressing to invasive mechanical, time to virological cure and body temperature normalization, cough relief, radiological progression, mortality and safety. (Results) A consensus was reached to select 32 articles for full-text screening; only 14 articles comprising 9036 patients were included in this study; and eight of these were included for meta-analysis. Most of these studies did not report positive clinical outcomes with LPV/RTV treatment. In terms of virological cure, three studies reported less time in days to achieve a virological cure for LPV/RTV arm relative to no antiviral treatment (−0.81 day; 95% confidence interval (CI), −4.44 to 2.81; p = 0.007, I2 = 80%). However, the overall effect was not significant (p = 0.66). When comparing the LPV/RTV arm to umifenovir arm, a favorable affect was observed for umifenovir arm, but not statically significant (p = 0.09). In terms of time to body normalization and cough relief, no favorable effects of LPV/RTV versus umifenovir were observed. The largest trials (RECOVERY and SOLIDARITY) have shown that LPV/RTV failed to reduce mortality, initiation of invasive mechanical ventilation or hospitalization duration. Adverse events were reported most frequently for LPV/RTV (n = 84) relative to other antivirals and no antiviral treatments. (Conclusions) This review did not reveal any significant advantage in efficacy of LPV/RTV for the treatment of COVID-19 over standard care, no antivirals or other antiviral treatments. This result might not reflect the actual evidence