Vicente Gonzalez

Investigating the relationship between planning reliability and project performance

Variability is a well-known problem in construction projects, which leads to the general deterioration of project performance. During the last decade, the Last Planner System (LPS™), a production planning and control system based on lean production principles, has been increasingly applied in the construction industry to improve planning reliability reducing the negative impacts of variability. LPS™ promotes actions to increase planning reliability, monitoring the percentage of plan completed (PPC) in a short-term period. However, there is limited research evidence about the relationship between planning reliability and project performance. In this paper, the authors report on a detailed research analysing this relationship during the construction phase of a home building project at activity and project levels. By doing so, two indexes are proposed: an activity planning reliability index called the process reliability index (PRI), and a project aggregate labour productivity index, called the project productivity index (PPI). Statistical analyses using the proposed indexes were conducted showing positive and strong relationships between planning reliability and performance at activity and project levels. Finally, the research findings provide the guidelines of a preliminary methodology to forecast the impacts of planning reliability over project performance, when lean production methodologies are applied in project planning and control.

Tormenta de citoquinas: reacción adversa inhabitual por rituximab. Caso Clínico

Rituximab is a plausible alternative first-line treatment of ANCA-associated vasculitis. Adverse effects related to its infusion are common and usually have a benign course. However, there have been reports of refractory cardiogenic shock simulating septic shock. We report an 81 years male with the diagnosis of ANCA associated vasculitis. Rituximab 500 mg was administered intravenously for a relapse. The infusion proceeded without incident. However, 24 hours after its administration the patient began with fever, chills, coughing and strong malaise. The patient was transferred to the critical patient unit where a septic shock was suspected and resuscitative measures were started. However, the fast response to moderate doses of vasoactive drugs and complementary tests did not support an infectious etiology for the shock. Antimicrobials were discontinued and systemic corticosteroids were maintained, achieving remission of the symptoms. Shock as an unusual adverse reaction to Rituximab was suspected.

Módulos interactivos en línea de semiología médica: Una herramienta para estandarizar el aprendizaje clínico

Background: The learning process for medical semiology depends on multidisciplinary teaching activities, including simulation tools. These tools should achieve a standardization level aiming at a same level of basic knowledge in each student. Aim: To evaluate an interactive online semiology learning tool. Material and methods: An interactive online learning method for medical semiology was developed. It focused mainly on physical examination and incorporated audiovisual and self-explanatory elements, to strengthen the acquisition of skills and basic knowledge for each standardized clinical learning simulation session. Subsequently, a satisfaction survey was conducted. Also the performance of students in a clinical examination was compared with that of students of the previous year. Results: Student satisfaction was outstanding, and there was a significant improvement in the performance on the final exam. Conclusions: The use of interactive self-learning online content for medical semiology provides an effective tool to improve student learning.