Alternative project delivery in rural Alaska: experiences, quality and claims

Master's Project (M.S.) University of Alaska Fairbanks, 2015The popularity of alternative project delivery systems has expanded beyond the private sector and into the public sector. Alaska embodies unique challenges that may present obstacles while using alternative project delivery systems. This analysis will provide an understanding of alternative project delivery systems in Alaska and how local experiences, quality and claims are affected. Alaska's unique characteristics present both challenges and opportunities for implementing alternative project delivery systems. This report begins with a discussion of experiences from several rural Alaska projects, and how alternative project delivery systems can be utilized. Some impacts that alternative project delivery systems have on quality are then presented, including a perspective on quality and recommendations for achieving customer satisfaction. A treatment of construction claims is then provided, followed by conclusions and recommendations for stakeholders in selecting an appropriate project delivery system. Alternative project delivery systems were researched by means of scholarly literature reviews, professional interviews and seminars. The report of these findings is intended to provide owners and contractors with a concise presentation of the challenges and advantages for using alternative project delivery systems in Alaska

Metabolic implications when employing heavy pre- and post-exercise rapid-acting insulin reductions to prevent hypoglycaemia in Type 1 diabetes patients: a randomised clinical trial

Aim To examine the metabolic, gluco-regulatory-hormonal and inflammatory cytokine responses to large reductions in rapid-acting insulin dose administered prandially before and after intensive running exercise in male type 1 diabetes patients. Methods This was a single centre, randomised, controlled open label study. Following preliminary testing, 8 male patients (24±2 years, HbA1c 7.7±0.4%/61±4 mmol.l−1) treated with insulin's glargine and aspart, or lispro attended the laboratory on two mornings at ∼08:00 h and consumed a standardised breakfast carbohydrate bolus (1 g carbohydrate.kg−1BM; 380±10 kcal) and self-administered a 75% reduced rapid-acting insulin dose 60 minutes before 45 minutes of intensive treadmill running at 73.1±0.9% VO2peak. At 60 minutes post-exercise, patients ingested a meal (1 g carbohydrate.kg−1BM; 660±21 kcal) and administered either a Full or 50% reduced rapid-acting insulin dose. Blood glucose and lactate, serum insulin, cortisol, non-esterified-fatty-acids, β-Hydroxybutyrate, and plasma glucagon, adrenaline, noradrenaline, IL-6, and TNF-α concentrations were measured for 180 minutes post-meal. Results All participants were analysed. All glycaemic, metabolic, hormonal, and cytokine responses were similar between conditions up to 60 minutes following exercise. Following the post-exercise meal, serum insulin concentrations were lower under 50% (p<0.05) resulting in 75% of patients experiencing hyperglycaemia (blood glucose ≥8.0 mmol.l−1; 50% n = 6, Full n = 3). β-Hydroxybutyrate concentrations decreased similarly, such that at 180 minutes post-meal concentrations were lower than rest under Full and 50%. IL-6 and TNF-α concentrations remained similar to fasting levels under 50% but declined under Full. Under 50% IL-6 concentrations were inversely related with serum insulin concentrations (r = −0.484, p = 0.017). Conclusions Heavily reducing rapid-acting insulin dose with a carbohydrate bolus before, and a meal after intensive running exercise may cause hyperglycaemia, but does not augment ketonaemia, raise inflammatory cytokines TNF-α and IL-6 above fasting levels, or cause other adverse metabolic or hormonal disturbances. Trial Registration ClinicalTrials.gov NCT0153185