Outcomes of Early Versus Delayed Completion Thyroidectomy for Malignancy

Purpose To determine whether time interval between hemi-thyroidectomy and subsequent completion thyroidectomy impacts outcomes. Methods Retrospective review of 68 patients having completion thyroidectomy from August 2012 to December 2019. Patients were separated into two groups based on the time interval between surgeries: early (≤10 days) or delayed (≥90 days). Results Patients who underwent delayed completion thyroidectomy (n = 17) had significantly higher rates of hypocalcemia and/or hypoparathyroidism ( P = .03) and higher rates of requiring postoperative hospitalization ( P=.07) compared to those who underwent early completion thyroidectomy (n = 51). Delayed completion had significantly lower risk of developing one or more of dysphonia, dysphagia, or vocal cord paresis postoperatively ( P=.02). No patients developed hematoma or wound infection. Conclusions Delayed completion thyroidectomy is associated with increased rates of hypocalcemia, but lower rates of dysphonia and dysphagia. Given the low risk of long-term complications in both groups, it may be beneficial to perform completion thyroidectomy early in order to expedite cancer treatment.

Physiology, Growth, and Productivity of Spring–Summer Black Gram (Vigna mungo L. Hepper) as Influenced by Heat and Moisture Stresses in Different Dates of Sowing and Nutrient Management Conditions

Heat and soil moisture stress account for serious abiotic constraint in black gram (Vigna mungo (L.) Hepper) production during spring–summer under Gangetic plains of Eastern India. Concurrence of these two can bring about early completion of phenophases that hampers normal metabolism of legumes by disrupting their defense mechanism, leading to poor seed set. The field experiment was conducted with two different sowing dates as the main plot, soil application of cobalt (Co) as subplots and foliar sprays of potassium (K) and boron (B) either alone or in combination as sub–sub plot treatment in a split–split plot design during spring–summer seasons of 2020 and 2021 with black gram (variety: Pant U 31). The study was aimed at evaluating the impact of sowing time and nutrients application alleviating adversities of abiotic stress during reproductive development of black gram. The March first week sown crop took significantly higher days to complete its life cycle compared to March third week sown one (82.0 vs. 78.2 and 81.8 vs. 78.8). This in turn relatively allowed a broader window for leaf area expansion, flowering, and seed filling in the first crop compared to the second one leading to the attainment of superior yield in the normal sown crop during the consecutive years. Crop growth rate (CGR), net assimilation rate (NAR), pod number per plant, seed yield, and harvest index were significantly higher (p ≤ 0.05) with soil Co @ 4 kg ha−1 and foliar 1.25% K + 0.2% B applications through stress mitigation by stimulating chlorophyll biosynthesis, nitrate reductase activity, proline accumulation, and cell membrane stability, irrespective of the years. Fluctuations in per plant pod number explained about 96 and 94% variations in seed yield through linear regressions in respective years. Optimum sowing date along with soil Co application combined with foliar K+B sprays manifested immense potential to achieve higher black gram production. In addition, this nutrient schedule proved to be efficient enough to promote satisfactory growth and optimum seed yield of late sown blackgram through relief of stress during the spring–summer season.

Early Completion of Model-Assisted Designs for Dose-Finding Trials

PURPOSE We propose a novel early completion method for phase I dose-finding trials using model-assisted designs. The trials can halt when a maximum tolerated dose (MTD) is estimated with sufficient accuracy. Early completion can reduce the average number of patients treated relative to the planned number, thereby allowing the trial to proceed to enrolling an expansion cohort for efficacy and enabling the trial to reach the next phase faster. METHODS Early completion is conducted on the basis of a dose-retainment probability using dose-assignment decisions. We evaluated early the completion for two actual trials. In addition, we performed a computer simulation to confirm the percentage of correctly selected MTDs, the early completion percentage, and the average number of patients treated. RESULTS In the evaluation of the two actual trials, we confirmed that the trials completed early. In the simulation results, we confirmed that the percentages of correct MTD selection were maintained relative to the original model-assisted designs. The early completion percentages ranged from 50% to 90%, and the number of patients treated reduced from 20%-60% relative to the planned number of patients. CONCLUSION We conclude that the early completion method can be applied unproblematically to the model-assisted design of phase I dose-finding trials.

Flexible Mixed-Criticality Scheduling with Dynamic Slack Management

Mixed-criticality (MC) system has attracted a lot of research attention in the past few years for its resource efficiency. Recent work attempted to provide a new MC model, the so-called Flexible Mixed-Criticality (FMC) task model, to relax the pessimistic assumptions in classic MC scheduling. However, in FMC, the behavior of MC tasks is still analyzed in offline stage. The run-time behavior such as dynamic slack has not yet been studied in FMC scheduling framework. In this paper, we present a utilization-based slack scheduling framework for FMC tasks. In particular, we monitor task execution on run time and collect dynamic slacks generated by task early completion. And these slacks can then be used either by high-criticality tasks to reduce mode-switches, or by low-criticality tasks so that less suspensions are triggered with more execution time, and thus quality of service is improved. We evaluate our approach with extensive simulations, and experiment results demonstrate the effectiveness of the proposed approaches.

COMPARISON BETWEEN THE TERMS CONSTRUCTABILITY AND BUILDABILITY: A SYSTEMATIC LITERATURE REVIEW

Buildability deals with the optimal integration of construction expertise at various project stages to achieve the overall project goals. Incorporation of buildability improves the construction project performance in terms of its cost, quality, productivity, safety, and results early completion. Thus, having a sound understanding of buildability concept is paramount for finding solutions for transforming current practices towards successful project deliveries. The numerous past studies reviewing the concept of buildability in the past have highlighted the interchangeability of the terms “constructability” and “buildability”. However, in some studies, these two terms contradict rather than considered similar. Moreover, the application of the concept of buildability is widely discussed during the design phase while some studies recommend it to be applied in the construction phase. Thus, there is no clear consensus on the clarity of the key constructs of these terms or when to apply buildability. This paper aims to systematically review the application of the concepts “buildability” and “constructability” in the construction sector and compare the definitions to understand the key constructs and best phase of the construction project for its applicability. A structured literature review covering indexed publications from 2011-2021 was carried out to identify the existing literature. Following a Systematic Literature Review (SLR) technique, a total of 38 out of 162 research contributions have been considered for an in-depth analysis. The choice of interpretations, comments, statements, perspectives, and definitions used in 38 studies were examined. The study identified the key constructs of two terms and recommends applying buildability throughout the lifecycle of the project.

Microsoft teams virtual handover system

AimsAccurate and timely handover of clinical information is of great importance to continuity and safety of care. Psychiatry doctors typically cover a number of sites across a catchment when they are on-call. Consequently, handover between on-call teams and day teams in psychiatric hospitals is reliant on using the nursing staff as an intermediary to flag concerns or relying on the day teams proactively checking the notes on daily basis for outstanding tasks.The key objective of this project was to use Microsoft teams to establish a handover system that is efficient, safe, reliable, easy to use and replicable.MethodA microsoft teams group was created comprising of all the medical staff members working at inpatient units across three sites that are part of Birmingham and Solihull Mental Health Trust. These members were divided into two groups - the ‘on-call team’ and the ‘day team’. Within the ‘day team’, every consultant was grouped with their junior doctors to form multiple subgroups.A system was established wherein the two teams could communicate with each other by posting a message and tagging the appropriate team. A provision was made to create a channel for every ward to allow for easy segregation and monitoring of tasks.Qualitative information about the use of the tool was monitored by monthly focus group meetings. A formal review of the messages was conducted after 8 weeks to assess the following parameters:Number of messages postedNumber of messages acknowledgedNumber of safety-related incidentsResultInitial evaluation of the results suggests that the new handover system was perceived to be safe, accurate and efficient while being intuitive and hassle-free. This increased the quantity and enhanced the quality of communication between the ‘on-call’ and the ‘day teams’ and allowed for early completion of tasks while reducing the number of safety-related incidents.ConclusionThe Microsoft teams proved to be a viable alternate tool to create a virtual handover process that is efficient, safe, reliable and user-friendly. It also has the potential to enhance the communication between inpatient and community teams.

Time-cost optimization in repetitive project scheduling with limited resources

PurposeThe purpose of this research is to develop a time-cost optimization model to schedule repetitive projects while considering limited resource availability.Design/methodology/approachThe model is based on the constraint programming (CP) framework; it integrates multiple scheduling characteristics of repetitive activities such as continuous or fragmented execution, atypical activities and coexistence of different modes in an activity. To improve project performance while avoiding inefficient hiring and firing conditions, the strategy of bidirectional acceleration is presented and implemented, which requires keeping regular changes in the execution modes between successive subactivities in the same activity.FindingsTwo case studies involving a real residential building construction project and a hotel refurbishing project are used to demonstrate the application of the proposed model based on four different scenarios. The results show that (1) the CP model has great advantages in terms of solving speed and solution quality than its equivalent mathematical model, (2) higher project performance can be obtained compared to using previously developed models and (3) the model can be easily replicated or even modified to enable multicrew implementation.Originality/valueThe original contribution of this research is presenting a novel CP-based repetitive scheduling optimization model to solve the multimode resource-constrained time-cost tradeoff problem of repetitive projects. The model has the capability of minimizing the project total cost that is composed of direct costs, indirect costs, early completion incentives and late completion penalties.

Indonesia

Indonesia has responded with a bold and comprehensive policy package to cushion the impact of the COVID-19 pandemic. The economy rebounded in the third quarter of 2020, and the economic recovery is projected to strengthen in 2021 and 2022. Strong policy support and an improving global economy will be the main drivers initially, and greater mobility and confidence will follow with the planned vaccination program in 2021. The uncertainty surrounding the growth outlook is larger than usual. Early completion of a widespread vaccination program is an upside risk, while a protracted pandemic remains a downside risk. The macro-financial fallout of the pandemic and economic downturn could be larger than expected, and credit conditions could be slow to improve. Ongoing reforms aimed at promoting investment are expected to help mitigate the scarring effects from the pandemic and put the economy on a sustained growth path that builds on Indonesia’s favorable demographics.