Important Cause Of Delay Research Articles

Knowledge of stroke risk factors and warning symptoms among adults with type 2 diabetes in Addis Ababa, Ethiopia, 2021: an institution-Based cross-sectional study

BackgroundStroke is a global public health concern with type 2 diabetes being one of the common risk factors. Knowledge of stroke risk factors and warning symptoms among type 2 diabetes patients is largely unknown in developing countries like Ethiopia. The inability to recognize stroke warning symptoms accurately is an important cause of delay in seeking medical attention. We investigated knowledge of stroke risk factors and warning symptoms among adults with type 2 diabetes and the factors associated with these variables.MethodsThis was an institution-based cross-sectional study. We enrolled 470 adult type 2 diabetes patients using a systematic random sampling method from four government-managed hospitals in Addis Ababa from 1 to 30 February 2021. The Stroke Recognition Questionnaire was adapted to measure the knowledge of stroke risk factors and warning symptoms. Sociodemographic characteristics, source of information, and reaction to stroke were also measured. Data were analyzed using SPSS version 25 and linear regression analysis was used to determine factors independently associated with knowledge of stroke risk factors and warning symptoms.ResultThe mean age of the participants was 50.6 ± 12.9 years. The mean score of knowledge of stroke risk factors and warning symptoms was 67.2% and 63.9%, respectively. Higher educational level (B = 2.007, 95% CI = 1.101, 2.914, P < 0.001), knowing someone diagnosed with stroke (B = 3.328, 95% CI = 2.734, 3.922, P < 0.001), and living with others (B = 2.28, 95% CI = 1.606, 2.954, P < 0.001) were independently associated with knowledge of stroke risk factors. Younger age (B = − 0.021, 95% CI= -0.038, 0.005, P = 0.01), higher educational level (B = 1.873, 95% CI = 1.017, 2.730, P < 0.001), and knowing someone diagnosed with stroke (B = 3.64, 95% CI = 3.079, 4.200, P < 0.001) were independently associated with knowledge of warning symptoms of stroke.ConclusionThe mean score of knowledge of stroke risk factors and warning symptoms was 67.2% and 63.9%, respectively. Younger age, higher educational level, and living with other people are predictors of better knowledge of stroke risk factors and warning symptoms in this study. Future educational interventions should target type 2 diabetes adults with advancing age and the involvement of their family members.

Investigation and ranking the causes of delay in EPC projects of nonindustrial buildings of 9, 10, 19, 20 and 21 phases of South Pars of Iran

Delay is one of the most common causes of construction projects failure in Iran. The larger sizes of the projects, the more risks and costs of delays. In this paper, the causes of delays in EPC contracts of nonindustrial buildings were excavated from the related previous research and several interviews with experts of this subject, and adjusted by the brainstorming technique, Delphi and reconciling the nature of these projects. Then, a questionnaire was distributed among 52 experts working in the South Pars project, and the data were analyzed by descriptive and factor analysis methods. Descriptive analysis revealed that “Inflation and escalation of material prices and human resources salaries”, “Unrealistic contract duration and requirements imposed” and “Political situation” were the most significant delay factors. Meanwhile, factor analysis indicates that “Improper construction methods”, “Shortage of experienced and skilled labor” and “Long acceptance process (shop drawings, permits, tests and samples)” were the most important causes of delay.

Investigation and Analysis of Factor Affecting Cost Overrun For Bridge Construction

Abstract: Construction duration and the cost of project at the closing date are the two important criteria to describe a construction project as successful. Most civil engineering large projects, regularly, have delays and cost overruns. Also most of the construction projects are facing with low quality, and health and safety accidents during construction. A questionnaire was undertaken to investigate factor affecting cost overrun for construction. In this project the result of the questionnaire was summarized and discussed. Major factors affecting the success of a construction project categories in the questionnaire and they were ranked with respect to the frequency and importance indices separately. It was obtained that, inadequate contractor experience, poor supervision and site management, shortage of skilled labor, financial difficulties of contractor were the most important causes of delay, cost overrun, low quality, and health &amp; safety problems on the construction sites.

Exploring Causes of Delays in National Road and Highway Projects in Developing Construction Economy

Delay in construction projects, especially in road and highway projects, is a universal phenomenon. Afghanistan construction industry is no exception. There are factors causing delays in the Afghanistan construction industry which have negative effects on the key project stakeholders and the project’s deliverables and outcomes. This research aims to identify the causes of delays that affect highway and road projects in Afghanistan and to provide recommendations in order to minimize or control delays in such projects. This will help, in return, facilitate and improve the delivery of roads and highways projects in Afghanistan. To achieve this aim, the study sets out to achieve the following objectives: 1) to determine the most important causes of delay that affect road and highway projects in Afghanistan, 2) to identify the severity of the delay causes from clients’ and contractors’ perspectives, 3) to investigate the differences and discrepancies between clients’ and contractors’ opinions and views, and based on first three objectives, 4) to finally provide recommendations for minimizing and/or controlling delays in road and highway projects, to improve the status-quo and to facilitate procurement/delivery of road and highway projects in Afghanistan. Causes of delay were gathered upon conducting a critical literature review of different types of construction, in different countries. An expert interview and a questionnaire survey formed the basis of this paper, listing 29 important causes of delay in such projects. The major causes of delay then were categorized into three groups following main stages of the highway projects, namely: 1) preparation, 2) procurement, and 3) implementation. The questionnaire survey was distributed to 100 construction participants and 79 were received who represent the government in road projects and contractors. Relative importance index (RII) was calculated and according to the highest values the top ten delay causes of road projects in Afghanistan were determined. Spearman correlation index was used to assess the correlation of causes and groups between clients and contractors. The findings of the study revealed that the top 10 significant factors causing a delay in road projects in Afghanistan are; security (war, theft, kidnapping, etc.), shortage of equipment and material or financial status of contractors, land acquisition, corruption in the procurement process, progress payment delays by owners/clients, non-consideration of security risks in the procurement process, Inaccurate design and bills of quantities, insufficient contractors’ experience, poor qualification of the contractors’ technical staff and award project to lowest bids. The findings will help clients and contractors to mitigate or prevent delays in road and highway projects in Afghanistan. Finally, to help overcome delays in road and highway projects more effectively, recommendations have been made for fundamental reforms in procurement systems for major projects.

Detección de barreras e implementación de procedimientos para reducir la demora en el tratamiento del síndrome coronario agudo con elevación del segmento ST mediante angioplastia primaria. Experiencia de 20 años de un centro de referencia en una ciudad de alta densidad demográfica

Background: The delay to reperfusion of ST-segment elevation acute coronary syndrome (STEACS) is a key factor in its prognosis, and its reduction could reduce morbidity and mortality. Objective: The aim of this study was to identify and modify the barriers detected in 20 years of STEACS treatment in a tertiary care center of a densely populated city to evaluate their effect on the outcome of the procedure. Methods: A total of 3007 patients with STEACS within 12 hours of symptoms onset were prospectively and consecutively included to undergo primary percutaneous coronary intervention (PCI) from January 1, 2000 to December 31, 2019. Time from symptoms onset to balloon inflation was divided into intervals. After barriers were identified (2000-2009), the procedure was changed. The population was divided into two groups (G) G1: pre-implementation (2000-2009) and G2: post-implementation (2010-2019) of changes. Results: G1 included 1409 and G2 1598 patients with no demographic differences except for the type of PCI. Delays were identified in diagnosis, communication between physicians, transfer and admission of the patient to the hemodynamics lab. Procedural changes decreased first medical contact-hemodynamic team contact interval [G1: 90 min (36-168) vs. G2: 77 min (36-144) p –0.01] and hemodynamic team contact-hemodynamics lab admission interval [G1: 75 min (55-100) vs. G2: 51 min (34-70) p –0.01] and reduced in-hospital (G1: 9,2% vs. G2: 6,7% p –0,01) and 6-month (G1: 13.1% vs. G2: 7.5% p –0. 01) mortality. Conclusions: Delay in diagnosis, difficulty in communication and type of transfer were the most important causes of delay. Implementing a procedural protocol reduced delays. Continuous evaluation of results and permanent education constitute the fundamental cornerstones for optimizing network care programs

Knowledge of Risk Factors and Warning Signs of Stroke Among Patients with Heart Disease at Tikur Anbessa Specialized Hospital.

BackgroundStroke is a leading cause of mortality and disability worldwide and the economic costs of treatment and post-stroke care are extensive. The inability to identify stroke warning signs accurately is an important cause of delay in seeking medical attention, leading to potential ineligibility for acute intervention and which leads to secondary complications.PurposeTo identify cardiac patients’ knowledge of stroke risk factors and warning signs.Patients and MethodsThe institutional based cross-sectional study design was employed. Participants were selected using systematic random sampling. Close-ended questionnaires were pre-tested and validated for consistency before data collection. Then after data collection, data were checked and entered into Epi-data 4.6. Finally, the cleaned data were exported to SPSS version 25 for analysis. Statistical analysis using binary logistic regression was done and Predictors with a p-value of <0.05 were considered statistically significant.ResultsA total of 227 patients were included in the study, of which 140 (61.7%) of them identified physical inactivity, followed by hypertension126 (55.5%) as stroke risk factor while 15.4% of them did not know any risk factor of stroke. Amongst the study participants, 45.81% of them had adequate knowledge of stroke risk factors. Regarding stroke warning signs the most identified sign was sudden unilateral weakness 142 (62.6%) while 46 (20.26%) of them did not know at least one warning sign of a stroke. Based on multivariable logistic regression analysis, higher education level AOR 3.05 (95% CI 1.62–5.74) and Urban residence area AOR 2.07 (95% CI 1.05–4.1) were significantly associated with knowledge of stroke risk factors with p-value<0.05.ConclusionStudy participants had inadequate knowledge of stroke risk factors and warning signs. Educational status and information about stroke are significantly associated with adequate knowledge of stroke risk factors, raising stroke awareness is the mainstay to reduce stroke burden.

Comparison of eight prehospital stroke scales to detect intracranial large-vessel occlusion in suspected stroke (PRESTO): a prospective observational study

Due to the time-sensitive effect of endovascular treatment, rapid prehospital identification of large-vessel occlusion in individuals with suspected stroke is essential to optimise outcome. Interhospital transfers are an important cause of delay of endovascular treatment. Prehospital stroke scales have been proposed to select patients with large-vessel occlusion for direct transport to an endovascular-capable intervention centre. We aimed to prospectively validate eight prehospital stroke scales in the field. We did a multicentre, prospective, observational cohort study of adults with suspected stroke (aged ≥18 years) who were transported by ambulance to one of eight hospitals in southwest Netherlands. Suspected stroke was defined by a positive Face-Arm-Speech-Time (FAST) test. We included individuals with blood glucose of at least 2·5 mmol/L. People who presented more than 6 h after symptom onset were excluded from the analysis. After structured training, paramedics used a mobile app to assess items from eight prehospital stroke scales: Rapid Arterial oCclusion Evaluation (RACE), Los Angeles Motor Scale (LAMS), Cincinnati Stroke Triage Assessment Tool (C-STAT), Gaze-Face-Arm-Speech-Time (G-FAST), Prehospital Acute Stroke Severity (PASS), Cincinnati Prehospital Stroke Scale (CPSS), Conveniently-Grasped Field Assessment Stroke Triage (CG-FAST), and the FAST-PLUS (Face-Arm-Speech-Time plus severe arm or leg motor deficit) test. The primary outcome was the clinical diagnosis of ischaemic stroke with a proximal intracranial large-vessel occlusion in the anterior circulation (aLVO) on CT angiography. Baseline neuroimaging was centrally assessed by neuroradiologists to validate the true occlusion status. Prehospital stroke scale performance was expressed as the area under the receiver operating characteristic curve (AUC) and was compared with National Institutes of Health Stroke Scale (NIHSS) scores assessed by clinicians at the emergency department. This study was registered at the Netherlands Trial Register, NL7387. Between Aug 13, 2018, and Sept 2, 2019, 1039 people (median age 72 years [IQR 61-81]) with suspected stroke were identified by paramedics, of whom 120 (12%) were diagnosed with aLVO. Of all prehospital stroke scales, the AUC for RACE was highest (0·83, 95% CI 0·79-0·86), followed by the AUC for G-FAST (0·80, 0·76-0·84), CG-FAST (0·80, 0·76-0·84), LAMS (0·79, 0·75-0·83), CPSS (0·79, 0·75-0·83), PASS (0·76, 0·72-0·80), C-STAT (0·75, 0·71-0·80), and FAST-PLUS (0·72, 0·67-0·76). The NIHSS as assessed by a clinician in the emergency department did somewhat better than the prehospital stroke scales with an AUC of 0·86 (95% CI 0·83-0·89). Prehospital stroke scales detect aLVO with acceptable-to-good accuracy. RACE, G-FAST, and CG-FAST are the best performing prehospital stroke scales out of the eight scales tested and approach the performance of the clinician-assessed NIHSS. Further studies are needed to investigate whether use of these scales in regional transportation strategies can optimise outcomes of patients with ischaemic stroke. BeterKeten Collaboration and Theia Foundation (Zilveren Kruis).

Prehospital Triage of Patients with Suspected Stroke (PRESTO): A Prospective In-Field Validation of Eight Prehospital Stroke Scales to Detect Intracranial Large Vessel Occlusion

Background: Due to the time-sensitive effect of endovascular treatment (EVT), rapid prehospital identification of large vessel occlusion (LVO) in suspected stroke patients is essential to optimize outcome. Inter-hospital transfers are an important cause of delay of EVT. Prehospital stroke scales have been proposed to select patients with LVO for direct transport to an endovascular-capable intervention centre. We aimed to prospectively validate eight prehospital stroke scales in the field. Methods: In a multi-centre prospective observational cohort study, we included suspected stroke patients transported by ambulance in the Southwest Netherlands. Paramedics assessed items from eight prehospital stroke scales: Rapid Arterial oCclusion Evaluation (RACE), Los Angeles Motor Scale (LAMS), Cincinnati Stroke Triage Assessment Tool (C-STAT), Gaze-Face-Arm-Speech-Time (G-FAST), Prehospital Acute Stroke Severity (PASS), Cincinnati Prehospital Stroke Scale (CPSS), Conveniently-Grasped Field Assessment Stroke Triage (CG-FAST), and the FAST PLUS Test. Patients that presented beyond six hours from symptom onset were excluded. Primary outcome was the clinical diagnosis of ischaemic stroke with a proximal intracranial LVO in the anterior circulation (aLVO) on CT-angiography. Prehospital stroke scale performance was expressed as the area under the receiver operating characteristic curve (AUC) and was compared with National Institute of Health Stroke Scale (NIHSS) scores assessed by physicians at the emergency department. Findings: We included 1039 patients, of which 121 patients (12%) were diagnosed with aLVO. AUCs for the prehospital stroke scales ranged from 0·69 (FAST PLUS) to 0·82 (RACE). The performance of RACE was not significantly different from G-FAST (AUC=0·80, p=0·14) and CG-FAST (AUC=0·80, p=0·09), but was significantly different from the other scales (p-values<0·05). The NIHSS performed somewhat better (AUC 0·86, p-values<0·05). Interpretation: Prehospital stroke scales detect aLVO with good accuracy and approach the performance of the physician-assessed NIHSS. RACE is the best performing prehospital stroke scale, but does not differ significantly from G-FAST and CG-FAST. Trial Registration: This study was registered at the Netherlands Trial Register (www.trialregister.nl), NL7387 Funding: BeterKeten collaboration and Theia Foundation (Zilveren Kruis) Declaration of Interests: Diederik Dippel and Aad van der Lugt report funding from the Dutch Heart Foundation, Brain Foundation Netherlands, The Netherlands Organisation for Health Research and Development, Health Holland Top Sector Life Sciences & Health, and unrestricted grants from Penumbra Inc., Stryker, Stryker European Operations BV, Medtronic, Thrombolytic Science, LLC and Cerenovus for research, all paid to institution. Pieter Jan van Doormaal reports funding from Stryker, paid to institution and an unrestricted fee from Bayer. All other authors declare no conflict of interest. Ethics Approval Statement: This study was conducted in accordance with the Dutch Agreement on Medical Treatment Act and the European General Data Protection Regulation. The Institutional Review Board of the Erasmus MC University Medical Centre has reviewed the study protocol and confirmed that the Dutch Medical Research Involving Human Subjects Act is not applicable. Because our study met the exceptions of informed consent regulations, the need for informed consent was waived. Patients or their relatives were informed about the study and could withdraw from the study through an opt-out system.

Multinational Association of Supportive Care in Cancer (MASCC) 2020 clinical practice recommendations for the management of severe gastrointestinal and hepatic toxicities from checkpoint inhibitors.

Immune-related adverse events (IrAEs) affecting the gastrointestinal (GI) tract and liver are among the most frequent and most severe inflammatory toxicities from contemporary immunotherapy. Inflammation of the colon and or small intestines (entero)colitis is the single most common GI IrAE and is an important cause of delay of discontinuation of immunotherapy. The severity of these GI IrAEs can range from manageable with symptomatic treatment alone to life-threatening complications, including perforation and liver failure. The frequency and severity of GI IrAEs is dependent on the specific immunotherapy given, with cytotoxic T lymphocyte antigen (CTLA)-4 blockade more likely to induce severe GI IrAEs than blockade of either programmed cell death protein 1 (PD-1) or PD-1 ligand (PD-L1), and combination therapy showing the highest rate of GI IrAEs, particularly in the liver. To date, we have minimal prospective data on the appropriate diagnosis and management of GI IrAEs, and recommendations are based largely on retrospective data and expert opinion. Although clinical diagnoses of GI IrAEs are common, biopsy is the gold standard for diagnosis of both immunotherapy-induced enterocolitis and hepatitis and can play an important role in excluding competing, though less common, diagnoses and ensuring optimal management. GI IrAEs typically respond to high-dose corticosteroids, though a significant fraction of patients requires secondary immune suppression. For colitis, both TNF-α blockade with infliximab and integrin inhibition with vedolizumab have proved highly effective in corticosteroid-refractory cases. Detailed guidelines have been published for the management of low-grade GI IrAEs. In the setting of more severe toxicities, involvement of a GI specialist is generally recommended. The purpose of this review is to survey the available literature and provide management recommendations focused on the GI specialist.

A study on non-healing plantar diabetic foot ulcers to assess the effect of compliance of using customised footwear in wound healing

Background: Foot infection is one of the commonest reasons for hospital admission of individuals with diabetes in India. Prescription footwear is an intricate aspect of a treatment program, not a therapy unto itself. Custom-made footwear can only be effective in preventing diabetic foot ulcers if worn by the patient as advised. This study was done in patients who are already prescribed customised footwear and evaluated the need for compliance based on the healing of these plantar foot ulcers.Methods: 85 diabetic patients with severe neuropathy and a non-healing callus ulcer or trophic ulcer (diameter 1-3 cm) for more than 3 months were included in the study. All these patients were followed up on weekly basis for 3 months and questioned about the use of customized footwear on regular basis. At the end of three months, the healing of these foot ulcers was compared based on whether they had been compliant with the customized footwear advice.Results: Of the 85 patients, 25 (29.4%) had shown improvement in wound healing with regular use of footwear. 60 (70.5%) patients who were not using the customized footwear had not shown any improvement in the plantar ulcers. The reasons for not using the recommended footwear were many commonest being wearing footwear only when going out and not inside the home.Conclusions: Non-compliance with customised footwear is emerging as an important cause of delay in wound healing of plantar foot ulcers.

Evaluation of Construction Delay of Public Projects in Erbil Governorate

Delay is one of the greatest challenges facing the implementation of construction projects. The completion project time is considered one of the measure indicators for assessing the success of any project. Delays usually have negative impacts of financial and social to all parties involved in the projects. The aim of the study is to find the most important causes of delay by evaluating the common causes of delays in terms of frequency, severity, and important indices in implementation of public construction projects in Erbil Governorate related to owners, contractors, consultants, and external factors. The data gathered through conducting a questionnaire for perception various parties involved in implementation of public construction projects. For these purpose, 104 forms of questionnaire were distributed to various parts to identify the delay causes in accordance with their opinions. It was concluded that the most significant factors causing the delay in construction of public project in Erbil Governorate related to the owner were “variation orders by owner during the construction” which came in the first rank, while the cause of delay related to the consultant that came in the first rank was “unclear and inadequate details in drawings,” whereas the factor related to the contractor which came in the first rank was “selecting incompetent contractor.”

Causes of delays in the construction phase of Chinese building projects

PurposeDelays during construction are one of the common scenarios in the construction industry. The purpose of this paper is to identify the primary causes of delays in the construction phase of building construction projects in China.Design/methodology/approachQuestionnaire survey approach was adopted across the four typical cities in China, namely, Beijing, Shanghai, Chongqing and Shenzhen. In total, 115 sets of valid responded questionnaires were collected and analyzed.FindingsThe results show that the causes of variations, delays in progress payments, exceptionally low bids and subcontractors’ poor performance and communication issues were the most important causes of delays in China.Originality/valueThis research is the first questionnaire survey on the causes of delays in the construction phase of building construction projects in China. The comparative analysis shows two unique causes of delays in the Chinese construction industry, such as “difficulty in claiming indemnity” and “unreasonable upfront capital demanded by client.” It also reveals different ranked causes of delays as per distinguished political and economic situations in China. The research findings can be referred by construction projects in other countries that are funded or partnered with China.

Delays in new product introduction

PurposeSpeed to the market is becoming a key competitive priority in developing countries’ environments even though lack of technology, poor skilled labour and under-developed infrastructure remain daunting challenges. The purpose of this paper is to examine the causes and relative importance of delay factors in the introduction of food products to the market in the era of time-based competition.Design/methodology/approachThe study employed a case study approach in understanding the phenomenon in its natural settings and making sense of it through process and participants observations. Again, a two-stage approach (first, interviews and second, questionnaire) was used in collecting data from the respondents who work in a project team for a large food processing firm. The data was analysed using the relative importance index technique.FindingsThe results show that the most important causes of delays in new products introduction, especially in the food processing industry, are: high number of projects running concurrently; lack of project management process; lack of consistent project management structure; high workload on project team and delays caused by external laboratory.Originality/valueThis study sought to identify detailed delay factors in the introduction of new products with respect to the food processing industry and more importantly established the relative importance of these delay factors as a decision support system for managers in the food processing industry.

Construction delays in privately funded large building projects in Bangladesh

Schedule delay in building construction projects is considered as one of the main reasons for project failure in developing countries. Likewise, privately funded building construction projects in Bangladesh have been suffering due to schedule delays. This study investigated the main causes of delay in privately funded large building projects in Bangladesh. To determine the causes of delay, a structured interview with 70 respondents was conducted with project owners, consultants, and contractors. Using the importance index analysis method, the study identified the critical causes of delays. The ten most important causes are: (1) lack of experienced construction managers; (2) lowest bidder selection; (3) owners' fund shortage; (4) lack of proper management by the owners; (5) improper planning and scheduling; (6) lack of skilled workers; (7) inaccurate time and cost estimation by the contractors; (8) site constraints; (9) improper progress monitoring and cost control; and (10) contractors' cash flow problem during construction. Furthermore, Kruskal-Wallis test indicates that there is no significant variation among the three groups of respondents, i.e., owners, consultants, and contractors. The finding of this study is significant for identifying the most important causes of delay in large building projects. It also identifies the responsibility of major stakeholders (i.e., owners, consultants, and contractors) in causing a schedule delay, which helps them to find mitigation measures for the potential delays of upcoming projects in advance. Although this study provides the insight into the causes of delay in privately funded large building projects in Bangladesh, it is also significant for other similar developing countries.

Does stroke health promotion increase awareness of appropriate behavioural response? Impact of the face, arm, speech and time (FAST) campaign on population knowledge of stroke risk factors, warning signs and emergency response.

Inability to identify stroke warning signs accurately is an important cause of delay in seeking medical attention, leading to potential ineligibility for acute intervention. We report on post-campaign findings (wave 2) of national surveys to estimate changes in population knowledge following a media-based Face, Arm, Speech, Time stroke awareness campaign, comparing findings to those of a pre-campaign population survey (wave 1).Participants and methods: One thousand and ten randomly selected adults (18+) completed the Stroke Awareness Questionnaire on knowledge of warning signs, risk factors and response to stroke at wave 2 and findings were compared to wave 1 survey results. Logistic regression was used to examine the association between demographic characteristics and self-reported risk factors with knowledge of stroke and emergency response. No significant differences existed in the ability of respondents to define stroke or to identify two or more stroke risk factors between waves 1 and 2 surveys (71% and 70%, respectively). Respondents to the wave 2 survey were five times more likely (odds ratio 4.9, p < .001) than those responding at wave 1 to know at least two warning signs of stroke (67% vs. 31%, respectively), specifically those targeted by the Face, Arm, Speech, Time campaign. While significant improvement in intention to call an ambulance was noted (odds ratio 1.5, p < .001, 57% at wave 2 compared to 47% at wave 1), for almost half of respondents (43%) this would not have been their first response to stroke. Less than 5% of respondents to both surveys identified thrombolysis as an emergency treatment for stroke (3.9% at wave 2 compared to 1.8% at wave 1). Although significant improvements were made in several areas of stroke knowledge and intended response, awareness of acute stroke interventions was poor and intended behavioural response was suboptimal. Findings from this study indicate need for targeted campaigns to improve population understanding of the reasons underlying the importance of rapid emergency response to stroke.

Causes of delay on highway construction projects in Thailand

Delay in construction project is an important issue in construction management. This is because delay will cause negative impacts on both the owner and the contractor. For owner, it will lead to the late opening of new road. For contractor, it will cause extra operating cost. In this paper, therefore, the causes of delay in road construction projects are researched. This paper studied a list of road construction delay causes gathered from literature having different countries. Internationally, twenty-six factors that might cause delays of road construction projects are identified in this research. Among 26 factors, considering in Thailand, eight key factors are typically found as the cause of delays in road construction projects. These 8 factors are then prioritized to identify the most important causes of delays in road construction projects in Thailand. A questionnaire and personal interviews through project engineer have formed the basis of this paper. The study indicates that the 5 top factors affecting road construction delays are: incomplete drawings, lack of equipment efficiency or financial status of contractors, delay in relocating existing infrastructure structures, less of project engineer experiences, and delay in relieving environmental impact, respectively

Workflow and factors associated with delay in the delivery of intra-arterial treatment for acute ischemic stroke in the MR CLEAN trial

ObjectiveThe effect of intra-arterial treatment (IAT) for acute ischemic stroke is highly time-dependent. We investigated the delay of IAT and factors associated with such delay.MethodsMR CLEAN was a randomized trial...

Delay Factors and Time-Cost Performance of Construction Projects in Gaborone City Council, Botswana

The problem of delays in the construction industry is a global phenomenon and the construction industry in Botswana is not an exception. The objectives of this study were to confirm the presence of significant delay in GCC projects; to identify and rank the perceived delay causes; and construct a Bromilow-type time-cost model for the council’s projects. The study made use of archival data and questionnaire survey soliciting the perceived causes and effects of delay from the clients, consultants, and contractors that are associated with GCC projects. Chi-square statistical method was employed to prove the presence of statistically significant delay in the council’s project. About 150 respondents drawn from three client organizations, five consulting firms and 23 construction contracting companies participated in the survey to rank the perceived causes of delay. The study identified 10 most important causes of delay from a list of twenty eight different causes and six different effects of delay. The ten most important causes are: contractor’s improper planning, contractor's poor site management, inadequate contractor experience, inadequate client's finance and payments for completed work, problems with subcontractors, shortage in material, labor supply, equipment availability and failure, lack of communication between parties, and mistakes during the construction stage. The six main effects of delay were: time overrun cost overrun, disputes, arbitration, litigation and total abandonment. In addition, archival data were used to establish the time-cost relationship of the council’s projects using Bromilow’s model. The derived relationship was given by Time = 1.18Cost0.361861. The adjusted R2 of the model was 0.817812 showing that the model had high predictability. It was concluded that the results of this study can be of immense assistance to the stakeholders of GCC projects in terms of planning future projects and better understanding of the dynamics of project management as lessons for reducing the incidences of project delay and high cost.

FUZZY BELIEF STRUCTURE BASED VIKOR METHOD: AN APPLICATION FOR RANKING DELAY CAUSES OF TEHRAN METRO SYSTEM BY FMEA CRITERIA

Public transport is a critical part of civilization in this decade. The amount of money invested and the criticality of transferring people in an acceptable time and without any conflict made it a challenging problem for managers, especially in metropolises. Absolutely, making effective decisions in this area requires considering different aspects. Waiting time is a key criterion in apprising quality of public transport. In this paper, a real world case study of ranking causes of delay in Tehran (Iran) metro system is solved by developing multi attribute group decision-making VIšeKriterijumska Optimizacija I KOmpromisno Rešenje (in Serbian, VIKOR) method under uncertainty, where this uncertainty is captured by Fuzzy Belief Structures (FBS). The obtained results are then compared with a previously proposed Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) method with FBSs. The results show that human related issues, along with the problems related to line and transportation system are the most important causes of delay. The obtained results of the problem seem acceptable for decision makers.

Optimising enteral nutrition in critically ill patients by reducing fasting times.

Enteral nutrition is currently the route of choice for feeding critically ill patients with a functioning gut but delivery is commonly associated with disruptions. Common reasons for interruptions to enteral nutrition are fasting for diagnostic procedures, surgery and airway management. These interruptions result in significant calorie deficits that are associated with increased complications. We aimed to describe the specific interruptions in our patient group and the impact they have on nutrition delivery before and after implementation of a fasting guideline. A service improvement project was undertaken over two different time points, 1 year apart, to evaluate the effectiveness of a fasting guideline in a general/trauma ICU in a London teaching hospital. There were 62 interruptions to enteral nutrition delivery with the first data collection and 64 in the second. Prolonged fasting before and after surgery and airway procedures were initially identified as the two most important causes of delays. Implementation of the fasting guideline resulted in statistical and clinical improvements in reducing fasting for airways procedures. The calorie deficit also statistically and clinically decreased as a result of the guideline. We conclude that the introduction of a simple guideline stipulating reduced fasting times before ICU procedures can result in less time lost in feed interruptions and improved enteral nutrition delivery.