Where lean construction and value management meet

The lean construction (LC) community’s key vision and goal is to provide value, yet they are increasingly challenged with understanding and dealing with the concept of value, with reports that value is one of the weakest points. Regardless of the previous studies and contributions already made on the concept of value in LC, the absence of a consistent understanding of value has resulted in misperceptions and indistinct boundaries with other construction value-related disciplines. Without a consistent understanding of value, the full potential of applying value-established concepts will not occur. Thus, the study of different concepts in construction will open new opportunities to deliver value in the future. Literature reviewed only revealed a small number of interdisciplinary comparisons of Lean manufacturing and LC with value management (VM)/value engineering (VE) on value. Secondary data was used to present an in-depth comparison of the principal points of the current practice and theories of LC and VM, which are seen as ways to improve the delivery of value to clients and building users. The study revealed a range of similarities at a high level, which could easily point to an early conclusion that LC and VM are interchangeable, leading to the same goal of value delivery and shared misapplication of cost reduction techniques. However, a more detailed examination indicates significant differences in the philosophy and scope in different areas, including project timing, practitioner duties, and areas of practice which could complement each other. Also the study identified that LC is a broader philosophy which covers more aspects than VM, it is evident that LC has advanced over the years towards discussions on the concept of value. The current work in LC on value relies less on other construction value-related disciplines such as VM, VE and partnering. Furthermore, LC literature still views value as a confusing concept associated with different interpretations, forming the basisof its understanding. The study established that value plays a central role in both LC and VM. Their combination could offer great synergy regarding the concept of value

Appraisal of the Performance of Contingency Cost Provision for Building Projects in Nigeria

The paper appraised performance of contingency allowance in addressing projects’ cost risk. To achieve this aim, impact of contingency provision in some selected building projects were evaluated. Data for the study was collected by means of checklist from 40 completed projects’ files. Furthermore, 100 questionnaires on project cost contingency were randomly distributed to quantity Surveyors out of whom 67 completed responses were returned. The results showed that there is significant difference between projects with and without contingency with respect to the accuracy of cost estimates. The study revealed that although the inclusion of contingency allowance reduces the incidence of project cost overrun, majority of the projects under study (55%) had cost overrun. It was also found that the projects exceeded their initial estimate by an average value of 5.07% where contingency was included and by an average value of 9.52% where contingency was not included. The study showed that there is a lack of application of quantitative risks analysis in the determination of contingency fund. Therefore, to improve the accuracy of cost contingency allowance, application of quantitative risks analysis in its determination has been recommended.Keywords: Contingency, Risks, performance, Building

A framework for implementing target value delivery to enhance value creation in the construction industry

The general view of most construction challenges points towards an inability to deliver value. Value creation has not been established enough in the construction industry, regardless of past initiatives to improve it. The literature review highlights the importance of practices that promote value creation, such as target value design (TVD), which has roots in both lean construction and value management, both of which support project environments with favourable features to generate value. With recent reports of TVD successes in various countries, researchers suggest more studies are needed on its wider applications in other procurement routes employing evidence-based decisions, especially in developing countries. However, the application of TVD in the Nigerian construction industry (NCI) has not been fully explored. Additionally, it is not clear how the current design management practices in the NCI align with the underlying benchmarks and practices of TVD. Attempting to develop an appropriate approach that advances current practice is challenging, largely due to a lack of empirical supportive data. Globally, the basic principles of TVD take time to comprehend and can seem discouraging when implemented for the first time on actual projects; the different levels of collaboration can be easily confused and wrongly used interchangeably in TVD projects, and there is also a need for TVD projects to report on value generation and quality as past research has focused more on cost and time savings. In view of these challenges, this study of the NCI was undertaken to explore the current design management practices in relation to TVD, to implement TVD and to develop and test a framework to support construction stakeholders in the implementation of TVD. The applied nature of Design Science Research (DSR) was deemed appropriate for this research. Both qualitative and quantitative methods were used in this investigation. Data were collected from across the building, highways infrastructure and rail sectors of the NCI through observing 17 projects, conducting four in-depth case studies, conducting 101 interviews, and analysing 189 questionnaire survey responses. Initial results revealed a limited awareness of TVD, and that some fundamental TVD practices recognized by the literature partially aligned with current NCI design management practices. From the case studies findings, the level of implementation of individual TVD benchmarks ranged up to 81%. This is the first recorded case of TVD implementation in the NCI, with findings that support evidence of a positive impact in the literature. TVD has been successfully applied in both design and build and traditional procurement routes, especially at the construction stage of public and private sector projects concerning provisional and prime cost sums. Additionally, TVD in bid process was reported as beneficial as it fostered the early participation of selected tenderers during the tender process. Results reveal that TVD flourishes with both face to face and virtual collaboration. The major conclusion is that value creation can be improved using a more structured process. The findings have highlighted the need for a guide to assist NCI professionals, thus prompting the development of the Framework for Implementing Target Value Delivery (FFITVD) with additional embedded processes and strategy enhancing its contribution, which have not been addressed in other frameworks. Thus, this framework expands over and beyond previous frameworks, which focused more on the pre-design and design stages of projects. Testing the FFITVD on a live construction project revealed that the framework is comprehensive enough to be understood by stakeholders and has the capability of sustaining the implementation of TVD. This research has continued to influence research in the USA, academics in the UK and practice in the NCI

Isolation of Lupeol from the Stem Bark of Leptadenia hastata (Pers.) Decne

Dried stem bark powder of Leptadania hastata was subjected to maceration with methanol to afford crude methanol extract, which was partitioned with n-hexane, ethylacetate, chloroform and n- butanol to afford different their respective fractions. Extensive phytochemical screening of the n-hexane fraction using column chromatography resulted to the isolation of a white solid substance. The substance was identified as of lupeol using IR, 1D \u2013 NMR, 2D \u2013 NMR data and by comparison with reference spectral data

Epidemiology of Epilepsy in Nigeria: A Community-Based Study From 3 Sites

BACKGROUND: We determined the prevalence, incidence, and risk factors for epilepsy in Nigeria. METHODS: We conducted a door-to-door survey to identify cases of epilepsy in 3 regions. We estimated age-standardized prevalence adjusted for nonresponse and sensitivity and the 1-year retrospective incidence for active epilepsy. To assess potential risk factors, we conducted a case-control study by collecting sociodemographic and risk factor data. We estimated odds ratios using logistic regression analysis and corresponding population attributable fractions (PAFs). RESULTS: We screened 42,427 persons (age ≥6 years), of whom 254 had confirmed active epilepsy. The pooled prevalence of active epilepsy per 1,000 was 9.8 (95% confidence interval [CI] 8.6-11.1), 17.7 (14.2-20.6) in Gwandu, 4.8 (3.4-6.6) in Afikpo, and 3.3 (2.0-5.1) in Ijebu-Jesa. The pooled incidence per 100,000 was 101.3 (95% CI 57.9-167.6), 201.2 (105.0-358.9) in Gwandu, 27.6 (3.3-128.0) in Afikpo, and 23.9 (3.2-157.0) in Ijebu-Jesa. Children's significant risk factors included febrile seizures, meningitis, poor perinatal care, open defecation, measles, and family history in first-degree relatives. In adults, head injury, poor perinatal care, febrile seizures, family history in second-degree relatives, and consanguinity were significant. Gwandu had more significant risk factors. The PAF for the important factors in children was 74.0% (71.0%-76.0%) and in adults was 79.0% (75.0%-81.0%). CONCLUSION: This work suggests varied epidemiologic numbers, which may be explained by differences in risk factors and population structure in the different regions. These variations should differentially determine and drive prevention and health care responses

Spontaneous Massive Streptococcus constellatus Empyema Thoracis in a healthy individual: a case report

Empyema thoracis is a well-known condition that is characterised by a collection of pus in the pleural space and has historically been related to high mortality rate. The cause of high mortality rate is unknown, but it may have higer risk in pneumonia cases or immunocompromised patients. This case study presented a 50-year-old man with no chronic co-morbidities, admitted with the diagnosis of sepsis secondary to community-acquired pneumonia, which was covered with ceftriaxone. Subsequently, he developed massive spontaneous right lung empyema, necessitating an urgent thoracotomy and comprehensive right decortication. Broad-spectrum antibiotics, meropenem, was then given to him. Streptococcus constellatus was discovered in the pleural fluid’s culture and sensitivity test. On his tenth day of stay, the patient had a right thoracotomy and decortication. The patient was extubated on day two post-operative and recovered on subsequent days. He was then discharged at 30 days post-operatively. We reported a case of adult spontaneous empyema thoracis from a patient with few risk factors: he was not immunocompromised, had no chronic illnesses and had no interaction with tuberculosis patients

Association between proton pump inhibitor therapy and clostridium difficile infection: a contemporary systematic review and meta-analysis.

Abstract Introduction Emerging epidemiological evidence suggests that proton pump inhibitor (PPI) acid-suppression therapy is associated with an increased risk of Clostridium difficile infection (CDI). Methods Ovid MEDLINE, EMBASE, ISI Web of Science, and Scopus were searched from 1990 to January 2012 for analytical studies that reported an adjusted effect estimate of the association between PPI use and CDI. We performed random-effect meta-analyses. We used the GRADE framework to interpret the findings. Results We identified 47 eligible citations (37 case-control and 14 cohort studies) with corresponding 51 effect estimates. The pooled OR was 1.65, 95% CI (1.47, 1.85), I2 = 89.9%, with evidence of publication bias suggested by a contour funnel plot. A novel regression based method was used to adjust for publication bias and resulted in an adjusted pooled OR of 1.51 (95% CI, 1.26–1.83). In a speculative analysis that assumes that this association is based on causality, and based on published baseline CDI incidence, the risk of CDI would be very low in the general population taking PPIs with an estimated NNH of 3925 at 1 year. Conclusions In this rigorously conducted systemic review and meta-analysis, we found very low quality evidence (GRADE class) for an association between PPI use and CDI that does not support a cause-effect relationship

Comparison of diagnostic tests for the detection of Brucella spp. in camel sera

<p>Abstract</p> <p>Background</p> <p>Brucellosis in livestock causes enormous losses for economies of developing countries and poses a severe health risk to consumers of dairy products. Little information is known especially on camel brucellosis and its impact on human health. For surveillance and control of the disease, sensitive and reliable detection methods are needed. Although serological tests are the mainstay of diagnosis in camel brucellosis, these tests have been directly transposed from cattle without adequate validation. To date, little information on application of real-time PCR for detection of <it>Brucella </it>in camel serum is available. Therefore, this study was performed to compare the diagnostic efficiency of different serological tests and real-time PCR in order to identify the most sensitive, rapid and simple combination of tests for detecting <it>Brucella </it>infection in camels.</p> <p>Findings</p> <p>A total of 895 serum samples collected from apparently healthy Sudanese camels was investigated. Sudan is a well documented endemic region for brucellosis with cases in humans, ruminants, and camels. Rose Bengal Test (RBT), Complement Fixation Test (CFT), Slow Agglutination Test (SAT), Competitive Enzyme Linked Immunosorbant Assay (cELISA) and Fluorescence Polarization Assay (FPA) as well as real-time PCR were used. Our findings revealed that <it>bcsp31 </it>kDa real-time PCR detected <it>Brucella </it>DNA in 84.8% (759/895) of the examined samples, of which 15.5% (118/759) were serologically negative. Our results show no relevant difference in sensitivity between the different serological tests. FPA detected the highest number of positive cases (79.3%) followed by CFT (71.4%), RBT (70.7%), SAT (70.6%) and cELISA (68.8%). A combination of real-time PCR with one of the used serological tests identified brucellosis in more than 99% of the infected animals. 59.7% of the examined samples were positive in all serological tests and real-time PCR. A subpopulation of 6.8% of animals was positive in all serological tests but negative in real-time PCR assays. The high percentage of positive cases in this study does not necessarily reflect the seroprevalence of the disease in the country but might be caused by the fact that the camels were imported from brucellosis infected herds of Sudan, accidentally. Seroprevalence of brucellosis in camels should be examined in confirmatory studies to evaluate the importance of brucellosis in this animal species.</p> <p>Conclusion</p> <p>We suggest combining <it>bcsp31 </it>real-time PCR with either FPA, CFT, RBT or SAT to screen camels for brucellosis.</p

BPI-fold (BPIF) containing/plunc protein expression in human fetal major and minor salivary glands.

The aim of this study was to determine expression, not previously described, of PLUNC (palate, lung, and nasal epithelium clone) (BPI-fold containing) proteins in major and minor salivary glands from very early fetal tissue to the end of the second trimester and thus gain further insight into the function of these proteins. Early fetal heads, and major and minor salivary glands were collected retrospectively and glands were classified according to morphodifferentiation stage. Expression of BPI-fold containing proteins was localized through immunohistochemistry. BPIFA2, the major BPI-fold containing protein in adult salivary glands, was detected only in the laryngeal pharynx; the lack of staining in salivary glands suggested salivary expression is either very late in development or is only in adult tissues. Early expression of BPIFA1 was seen in the trachea and nasal cavity with salivary gland expression only seen in late morphodifferentiation stages. BPIFB1 was seen in early neural tissue and at later stages in submandibular and sublingual glands. BPIFA1 is significantly expressed in early fetal oral tissue but BPIFB1 has extremely limited expression and the major salivary BPIF protein (BPIFA2) is not produced in fetal development. Further studies, with more sensitive techniques, will confirm the expression pattern and enable a better understanding of embryonic BPIF protein function

Monophasic synovial sarcoma presenting as a primary ileal mass: a case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>Synovial sarcoma is a rare malignant mesenchymal tumor mainly arising in the peri-articular tissue in young adults. There are few cases reported in other areas.</p> <p>Case presentation</p> <p>We report the case of a 29-year-old Saudi woman of Arabian ethnicity with synovial sarcoma arising primarily from the ileum who presented with abdominal pain, a palpable mass and incomplete intestinal obstruction. A literature review was performed to gather information on this rare gastrointestinal tract sarcoma.</p> <p>Conclusions</p> <p>Although it is a rare tumor of the pre-articular tissues, synovial sarcoma can present, in exceedingly rare cases, in unusual anatomical sites such as the gastrointestinal tract. We believe the reporting of all rare or unexpected presentations of sarcoma will eventually improve our understanding of this relatively unusual malignancy.</p