LPS IMPLEMENTATION USING PHYSICAL AND DIGITAL VISUAL MANAGEMENT-BASED TOOLS: A CASE STUDY IN LUXEMBOURG

The Work described in this paper presents the results of a lean construction research project. The objective was to evaluate the impact of Visual Management-based tools to improve Last Planner® System implementation in Luxembourg. To drive this project, a Design Science Research methodology has been used on two construction sites. The first step of the research focuses on the use of physical supports to design visual management-based tools to implement LPS conversations. The results show a very positive impact as it tackles LPS implementation challenges (collaboration between trades, skills acquisition, change management) but also show that the workload to manage LPS conversation is a serious problem. The second step of the research tackles this workload issue by digitizing the Visual Management-based tools designed in the first iteration. The results show a huge improvement for users allowing more efficient meetings, better access to data, improved use of LPS outputs to communicate between the client and the project management team and even more flexibility to respect COVID 19 sanitary rules. The paper concludes with the limit of the digital solution which was used in this project. As it is not specially dedicated to LPS it lacks the possibility to calculate and simulate planning and production data. © Prof. Luis F. Alarcón and Assoc. Prof. Vicente González, IGL2021 All rights reserved.

Effect of antiplatelet therapy on monocyte-platelet aggregates

Background : In addition to their role in thrombosis and hemostasis, platelets are key mediators of inflammation and altered immunity. Circulating monocyte-platelet aggregates (MPA) represent the crossroads between thrombosis and inflammation and may represent a therapeutic target. While antiplatelet therapy (APT) reduces platelet activity and thrombosis, its effect on MPA is uncertain. Aims : To analyze the effect of APT on MPA in vitro. Methods : The effect of different platelet-activating agonists (thromboxane analog U-46619, ADP, PAR4, collagen, and epinephrine) on MPA formation in whole blood (WB) was measured via flow cytometry. Agonist-stimulated WB was incubated in the presence of inhibitors against P-selectin, PSGL-1, PAR1 (ML161), P2Y12 (AZD1283), GPIIb/IIIa (eptifibatide), acetyl salicylic acid (ASA), and dipyridamole and assessed for MPA formation. RNA-Seq data sets of monocytes incubated with healthy platelet releasates (PR) were used to identify platelet-induced upregulation of monocyte transcripts and were validated by RT-qPCR in monocyte-PR co-incubation assays in the presence of APT. Results : Circulating MPA are increased in prothrombotic and inflammatory diseases including the most recent COVID-19. Monocytes aggregated to platelets have more CD40 and tissue factor expression than monocytes not aggregated to platelets ( P < 0.05 for each comparison). As expected, targeting P-selectin (85.4% reduction) and PSGL-1 (88.2% reduction) had the greatest attenuation of MPA. Among platelet inhibitors, P2Y12 inhibition was most effective in lowering MPA formation (30.7% reduction) (figure 1). Flow cytometry analysis of MPA. Incubation of monocytes with platelet releasate induced upregulation of inflammatory mRNA transcripts suppressor of cytokine signaling 3 ( SOCS3 ) and o ncostatin m ( OSM ). Following pretreatment of platelets with APT, both GPIIb/IIIa and P2Y12 inhibition was associated with lower expression of SOCS3 and OSM (figure 2) . SOCS3 and OSM in monocytes incubated with APT-treated PR. Conclusions : Circulating MPA represent a crossroad of platelet and monocyte activation. We show that APT is associated with both reduced MPA formation and platelet-induced monocyte activation.

Intraoperative use and validation of a novel negative pressure, face-mounted antechamber to minimize aerosolization of particles during endoscopic skull base surgery

Background: The COVID-19 pandemic has revealed deficiencies in the adequacy of personal protective equipment (PPE) forhealth care workers. Endoscopic endonasal skull base surgery (ESBS) is thought to be among the highest risk aerosol-generating procedures (AGPs) for surgeons and operating room personnel. Objective: To validate the efficacy and clinical feasibility of a novel surgical device. Methods: A low-cost, modifiable, and easily producible negative pressure, face-mounted antechamber was developedutilizing 3D printing and silicone molding. Efficacy was evaluated using an optical particle sizer (OPS) to quantify aerosolsgenerated during both cadaver and intraoperative human use with high-speed drilling. Results: Particle counts in the cadaver showed that drilling led to a 2.49-fold increase in particles ≤5 μm ( p = 0.001), andthat the chamber was effective at reducing particles to levels not significantly different than baseline. In humans, drillingled to a 37-fold increase in in particles ≤5 μm ( p < 0.001), and the chamber was effective at reducing particles to a level notsignificantly different than baseline. Use of the antechamber in 6 complex cases did not interfere with the ability to performsurgery. Patients did not report any facial discomfort after surgery related to antechamber use. Conclusions: The use of a negative pressure facial antechamber can effectively reduce aerosolization from endoscopicdrilling without disturbing the flow of the operation. The antechamber, in conjunction with appropriate PPE, will be usefulduring the COVID-19 pandemic, as well as during flu season and any future viral outbreaks.