Managing construction interfaces within the building facade

Interfaces, joints and connections between different elements or sections cause more problems than most of the rest of the building. There are challenges during design, manufacture and construction as well as implications throughout the life of the building. These challenges are particularly relevant for the building envelope. Here the joints must perform at the same level as the main areas of wall or roof, but the pressures on them are invariably much greater. They must keep out the weather but, at the same time, accommodate tolerances. and inaccuracies and cater for movements both during construction and for as long as the building lasts. Managing construction interfaces is an important part of delivering a construction project without time delays or cost additions. However the lack of written publications on how to manage interfaces within construction is a problem discovered by the author very early in the research. Therefore the main aim of the research was; to improve the management of interfaces within the construction industry, with particular reference to interfaces within the building facade. The research was based on an EPSRC funded project entitled CladdISS "A standardised strategy for window and cladding interfaces". The methodology included industrial workshops, interviews, regular steering group meetings and a questionnaire. The strategy proposed to increase productivity, quality, reduce waste and reduce costs in design, manufacture, installation, and the building life cycle. The research highlighted a wide range of interrelated problems. However, the two main issues were: Poor communication between the design team and specialist contractors and poor interface detailing. The following situations typically exist: The interface responsibility is assigned too late if at all; the term 'by others' often leads to the interfaces being poorly managed; the design team does not have a good enough understanding of the construction and manufacturing tolerances of materials at the interfaces; often the design team does not have appropriate understanding of the cladding system they are designing; the specialist cladding contractors do not have enough input to the design of the cladding and interfaces early enough. Using the CladdISS strategy will enable the supply chain to be organised and provide a template for effective interface management

Cladd:ISS – a strategy for managing cladding interfaces.

This paper covers the management aspects of Cladd:ISS, a UK Government funded research project to develop a standardised strategy for the design and management of window and cladding interfaces. Cladd:ISS covers interfaces between different cladding types and between the cladding and the frame, roof, building services, internal systems (walls, floors & ceilings) and secondary components such as sun shades, cleaning equipment and handrails. This paper explains the principles of CladdISS with access to process maps, action plans, management strategy, bibliography, advice on standards, materials, maintenance, joints, movement and tolerances. This will enable strategies to be developed to avoid the endemic problems occurring on site. It will also guide the management of the interfaces throughout the project

Designing for health and safety in cladding installation – implications from pre-assembly

Europe has legislation that requires designers to take action to remove or reduce health and safety risks for construction workers. However, even without this legislation, it can be argued that there is a moral duty on designers to address these issues. Experience in Europe has not been completely satisfactory with surveys showing that many designers are not complying with the requirements to design for health and safety. Nevertheless, there are pockets of excellence. This paper presents data and draws cladding case study exemplars from a number of Loughborough APaCHe1 projects including: D4h (Designing for Health), HASPREST2 (Health and safety benefits and implications from pre-assembly) and Better, Safer, Easier Design via CDM (Greenstreet Berman – Wright et al, 2003). The paper argues that accidents and ill-health triggers can be reduced by designer action and explains cladding designers can take appropriate action to reduce the risks during installation, providing two exemplar case studies. Neither exemplar are particularly innovative in themselves, however, design decisions were made and health and safety risks were reduced in both cases

Systematic review and evidence synthesis of non-cervical human papillomavirus-related disease health systems costs and quality of life estimates

BACKGROUND: Many economic evaluations of human papillomavirus vaccination should ideally consider multiple disease outcomes, including anogenital warts, respiratory papillomatosis and non-cervical cancers (eg, anal, oropharyngeal, penile, vulvar and vaginal cancers). However, published economic evaluations largely relied on estimates from single studies or informal rapid literature reviews. METHODS: We conducted a systematic review of articles up to June 2016 to identify costs and utility estimates admissible for an economic evaluation from a single-payer healthcare provider's perspective. Meta-analyses were performed for studies that used same utility elicitation tools for similar diseases. Costs were adjusted to 2016/2017 US$. RESULTS: Sixty-one papers (35 costs; 24 utilities; 2 costs and utilities) were selected from 10 742 initial records. Cost per case ranges were US$124-US$883 (anogenital warts), US$6912-US$52 579 (head and neck cancers), US$12 936-US$51 571 (anal cancer), US$17 524-34 258 (vaginal cancer), US$14 686-US$28 502 (vulvar cancer) and US$9975-US$27 629 (penile cancer). The total cost for 14 adult patients with recurrent respiratory papillomatosis was US$137 601 (one paper).Utility per warts episode ranged from 0.651 to 1 (12 papers, various utility elicitation methods), with pooled mean EQ-5D and EQ-VAS of 0.86 (95% CI 0.85 to 0.87) and 0.74 (95% CI 0.74 to 0.75), respectively. Fifteen papers reported utilities in head and neck cancers with range 0.29 (95% CI 0.0 to 0.76) to 0.94 (95% CI 0.3 to 1.0). Mean utility reported ranged from 0.5 (95% CI 0.4 to 0.61) to 0.65 (95% CI 0.45 to 0.75) (anal cancer), 0.59 (95% CI 0.54 to 0.64) (vaginal cancer), 0.65 (95% CI 0.60 to 0.70) (vulvar cancer) and 0.79 (95% CI 0.74 to 0.84) (penile cancer). CONCLUSIONS: Differences in values reported from each paper reflect variations in cancer site, disease stages, study population, treatment modality/setting and utility elicitation methods used. As patient management changes over time, corresponding effects on both costs and utility need to be considered to ensure health economic assumptions are up-to-date and closely reflect the case mix of patients

Designing for health – reducing occupational health risks in bored pile operations

Insitu concrete bored piling is a common foundation solution for both major building and civil engineering projects. The technique is used both for individual or grouped piles topped with a pile cap, or a line of piles, contiguous or secant, topped with a capping beam as part of a basement or abutment construction. There are many health hazards associated with bored piles. One of the main risks is the breaking down of the unwanted pile-top, typically using hand-held pneumatic breakers. This operation creates particular problems for hand arm vibration syndrome (HAVS), dust and noise. But there are several viable alternatives to this procedure that remove or significantly reduce these risks. These innovations have been developed by the construction supply chain and are readily available. D4h, a UK Government-funded research project by Loughborough University and the European Construction Institute, has demonstrated that designers can play their part in encouraging their adoption, without straying into the perceived danger of specifying means and methods. If designers are willing to identify pile-top break down as a significant residual risk in their health and safety assessment, thus requiring the Principal Contractor1 to provide proposals to address this risk – this may be the only push needed to get the industry to eliminate the major HAVS problem from insitu bored piles. This paper will benefit the health and safety research community, especially those working on designer intervention. The paper will also be of use to industry practitioners, providing innovative solutions to a significant occupational health risk as well as challenging designers to take construction health and safety more seriously

Remuneration of primary dental care in England: a qualitative framework analysis of perspectives of a new service delivery model incorporating incentives for improved access, quality and health outcomes

Objective: This study aimed to describe stakeholder perspectives of a new service delivery model in primary care dentistry incorporating incentives for access, quality and health outcomes. Design: Data were collected through observations, interviews and focus groups. Setting: This was conducted under six UK primary dental care practices, three working under the incentive-driven contract and three working under the traditional activity-based contract. Participants: Observations were made of 30 dental appointments. Eighteen lay people, 15 dental team staff and a member of a commissioning team took part in the interviews and focus groups. Results: Using a qualitative framework analysis informed by Andersen’s model of access, we found oral health assessments influenced patients’ perceptions of need, which led to changes in preventive behaviour. Dentists responded to the contract, with greater emphasis on prevention, use of the disease risk ratings in treatment planning, adherence to the pathways and the utilisation of skill-mix. Participants identified increases in the capacity of practices to deliver more care as a result. These changes were seen to improve evaluated and perceived health and patient satisfaction. These outcomes fed back to shape people’s predispositions to visit the dentist. Conclusion: The incentive-driven contract was perceived to increase access to dental care, determine dentists’ and patients’ perceptions of need, their behaviours, health outcomes and patient satisfaction. Dentists face challenges in refocusing care, perceptions of preventive dentistry, deployment of skill mix and use of the risk assessments and care pathways. Dentists may need support in these areas and to recognise the differences between caring for individual patients and the patient-base of a practice

Causal factors in construction accidents

Although the British construction industry is one of the safest in Europe, one third of all work fatalities happen in construction and construction workers are six times more likely to be killed at work than employees in other sectors. A similar situation exists for non-fatal accidents. Although previous research has led to a good understanding of the extent and pattern of accidents in the construction industry, there has been only limited objective analysis of the full range of contributory managerial, site and individual factors. With this background, the study had the following aims: 1. To collect rich, detailed data on the full range of factors involved in a large sample of construction accidents. 2. Using this information, to describe the processes of accident causation, including the contribution of management, project, site and individual factors in construction industry accidents. The research used a combination of focus groups and studies of individual accidents in pursuit of these

‘Warning: allergic to penicillin’: association between penicillin allergy status in 2.3 million NHS general practice electronic health records, antibiotic prescribing and health outcomes

Background The prevalence of reported penicillin allergy (PenA) and the impact these records have on health outcomes in the UK general population are unknown. Without such data, justifying and planning enhanced allergy services is challenging. Objectives To determine: (i) prevalence of PenA records; (ii) patient characteristics associated with PenA records; and (iii) impact of PenA records on antibiotic prescribing/health outcomes in primary care. Methods We carried out cross-sectional/retrospective cohort studies using patient-level data from electronic health records. Cohort study: exact matching across confounders identified as affecting PenA records. Setting: English NHS general practices between 1 April 2013 and 31 March 2014. Participants: 2.3 million adult patients. Outcome measures: prevalence of PenA, antibiotic prescribing, mortality, MRSA infection/colonization and Clostridioides difficile infection. Results PenA prevalence was 5.9% (IQR = 3.8%–8.2%). PenA records were more common in older people, females and those with a comorbidity, and were affected by GP practice. Antibiotic prescribing varied significantly: penicillins were prescribed less frequently in those with a PenA record [relative risk (RR)  = 0.15], and macrolides (RR = 4.03), tetracyclines (RR = 1.91) nitrofurantoin (RR = 1.09), trimethoprim (RR = 1.04), cephalosporins (RR = 2.05), quinolones (RR = 2.10), clindamycin (RR = 5.47) and total number of prescriptions were increased in patients with a PenA record. Risk of re-prescription of a new antibiotic class within 28 days (RR = 1.32), MRSA infection/colonization (RR = 1.90) and death during the year subsequent to 1 April 2013 (RR = 1.08) increased in those with PenA records. Conclusions PenA records are common in the general population and associated with increased/altered antibiotic prescribing and worse health outcomes. We estimate that incorrect PenA records affect 2.7 million people in England. Establishing true PenA status (e.g. oral challenge testing) would allow more people to be prescribed first-line antibiotics, potentially improving health outcomes