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Distributed machine learning (DML) is an increasingly important workload. In a DML job, each communication stage can comprise a coflow, and there are dependencies among its coflows. Thus, efficient coflow scheduling becomes critical for DML jobs. However, the majority of existing solutions focus on scheduling single-stage coflows with no dependencies. While there are a few studies schedule dependent coflows of multi-stage jobs, they suffer from either practical or theoretical issues. In this paper, we study how to schedule dependent coflows of multiple DML jobs to minimize the total job completion time (JCT) in a shared cluster. To solve this problem without any prior knowledge of job information, we present an online coflow-aware optimization framework called Parrot. The core idea in Parrot is to infer the job with the shortest remaining processing time (SRPT) each time and dynamically control the inferred job's bandwidth based on how confident it is an SRPT job while being mindful of not starving any other job. We have proved that Parrot algorithm has an approximation ratio of $O(M)$ , where M is the number of jobs. The results from large-scale trace-driven simulations further demonstrate that our Parrot can reduce the total JCT by up to 58.4%, compared to the state-of-the-art solution Aalo.

This article investigates the impacts of uncertainties in duration and resource availability and usage on project time and cost. This is done by modeling different scenarios as relevant resource-constrained project scheduling problems. The aim is to develop a scheduling risk assessment framework (SRAF) to model uncertainties in duration and resources and to observe their impact on project objectives (i.e., completion time and cost). This framework provides appropriate information for managers and decision makers and facilitates project planning (scheduling and budgeting) by incorporating uncertainties and risks. To visualize the risk, this article uses an extended version of the integrated definition standard as the example business process. To demonstrate the applicability of the proposed SRAF under varied dynamic conditions, we have considered and solved a practical case study using a self-developed heuristic approach, titled enhanced move-based local search heuristic. The computational results and useful insights open an avenue for future research in the field of project management, which will provide some important propositions or guidelines for project management practitioners.

Task scheduling is one of the major issues in cloud computing environment. Efficient task scheduling is substantial to attain cost-effective execution and improve resource utilization. The task scheduling problem is classified to be a nondeterministic polynomial time (NP)-hard problem. This feature attracts researchers to utilize nature inspired metaheuristic algorithms. Initializing searching solutions randomly is one of the key features in such optimization algorithms. However, assisting metaheuristic algorithms with effective initialized solutions can significantly improve its performance. In this paper, an improved initialization of particle swarm optimization (PSO) using heuristic algorithms is proposed. Longest job to fastest processor (LJFP) and minimum completion time (MCT) algorithms are used to initialize the PSO. The performance of the proposed LJFP-PSO and MCT-PSO algorithms are evaluated in minimizing the makespan, total execution time, degree of imbalance, and total energy consumption metrices. Moreover, the performance of the proposed algorithms is compared with recent task scheduling methods. Simulation results revealed the effectiveness and superiority of the proposed LJFP-PSO and MCT-PSO compared to the conventional PSO and comparative algorithms.

Data-parallel computing platforms, such as Hadoop and Spark, are deployed in computing clusters for big data analytics. There is a general tendency that multiple users share the same computing cluster. The schedule of multiple jobs becomes a serious challenge. Over a long period in the past, the Shortest-Job-First (SJF) method has been considered as the optimal solution to minimize the average job completion time. However, the SJF method leads to a low system throughput in the case where a small number of short jobs consume a large amount of resources. This factor prolongs the average job completion time. We propose an improved heuristic job scheduling method, called the Densest-Job-Set-First (DJSF) method. The DJSF method schedules jobs by maximizing the number of completed jobs per unit time, aiming to decrease the average Job Completion Time (JCT) and improve the system throughput. We perform extensive simulations based on Google cluster data. Compared with the SJF method, the DJSF method decreases the average JCT by 23.19% and enhances the system throughput by 42.19%. Compared with Tetris, the job packing method improves the job completion efficiency by 55.4%, so that the computing platforms complete more jobs in a short time span.

Since scheduling literature has a wide range of uncertainties, it is crucial to take these into account when solving performance measure problems. Otherwise, the performance may severely be affected in a negative way. In this paper, an algorithm is proposed to minimize the total completion time (TCT) of a two-machine no-wait flowshop with uncertain setup times within lower and upper bounds. The results are compared to the best existing algorithm in scheduling literature: the programming language Python is used to generate random samples with respect to various distributions, and the TCT of the proposed algorithm is compared to that of the best existing one. Results reveal that the proposed one significantly outperforms the best one given in literature for all considered distributions. Specifically, the average percentage improvement of the proposed algorithm over the best existing one is over 90%. A test of hypothesis is conducted to further confirm the results.

Objective: The aim of the study is to assess the feasibility, sustainability, and effectiveness of task-specific memory exergame training on motor-cognitive performance in older adults. Materials and Methods: Fifty older adults (age: 78.8 ± 7.0 years) participated in a randomized controlled trial with a 10-week intervention and 3-month follow-up period. Both the intervention group (IG: n = 29) and control group (CG: n = 21) underwent a once-weekly exercise program, including strength and balance exercises, while the IG performed an additional exergame training, combining dynamic balance with visuospatial memory tasks. Outcome measures were completion time for distinct levels of memory exergame tasks without (condition 1) and with procedural support (condition 2) and (sub)-total game scores documented by a game-specific assessment strategy. Results: Significant improvements in the IG compared with the CG over the intervention period were found for completion times in most of the analyzed levels of condition 1 (P

Background: This study aims to evaluate the effectiveness of an online Moodle-based lesson for pharmacy students developed and designed for a research course focused on different methodologies, study variables, and research process applications. Methods: An experimental research methodology was used to determine the effectiveness of the Moodle-based lesson. All fourth term Pharm.D. students were required to complete and provide self-reflection reports. The outcome variables were cluster-based completion time, earned score, subjective feedback on contents, gender differences, and performance. Mean values were used to conduct statistical analysis, and a logistic regression model was applied to identify the significance of independent variables. Results: A total of 35 students completed the Moodle-based lesson. The mean earned score for the module was 81.0%, with an average completion time of 28.5 (range 26.8-30.1) hours. Females showed completion in less time compared to males. The reported knowledge and understanding showed a significant (p

Randall S Porter,1 Kathleen Holt,2 Rajeev S Ramchandran3 1Pediatric Ophthalmology and Ocular Genetics Service, University of Rochester Flaum Eye Institute, Rochester, NY, USA; 2University of Rochester Clinical & Translational Science Institute, Rochester, NY, USA; 3Retina and Vitreous Service, University of Rochester Flaum Eye Institute, Rochester, NY, USACorrespondence: Randall S PorterFlaum Eye Institute, Box 659, 601 Elmwood Ave, Rochester, NY, 14642, USATel +1 585 275-7039Fax +1 585 275-2352Email Randall_Porter@urmc.rochester.eduPurpose: The full utility of general health Patient-Reported Outcomes Measurement Information System® (PROMIS) surveys in the eye care setting has not been previously demonstrated. This report demonstrates the feasibility of implementing PROMIS in an eye care clinic.Patients and Methods: Over 2 months, general health and functioning PROMIS surveys were offered to all patients in an optometric clinic in Rochester, NY. Demographic and clinical variables were recorded along with percent completion and time to completion of the survey.Results: Across 651 patients, 258 chose to attempt PROMIS. Patients with low visual acuity were less likely to attempt the survey (p=0.049), and younger patients were more likely to complete the survey (p=0.025); no other patient characteristics were found to differ between those who did and did not participate in, nor complete, PROMIS. A total of 193 patients completed the survey (74.8%) in a mean time of 6.36 minutes (range = [1.43, 51.92] minutes; standard deviation = 5.62 minutes). Time to completion did not vary significantly across any groups.Conclusion: Our relatively high completion rate among those who attempted PROMIS indicates that PROMIS surveys are feasible to implement in an optometry clinic. While most patients completed the survey in little time, the large range of time to completion may indicate that some patients had difficulty completing the survey. Furthermore, the significant difference in visual acuity between those who participated in the survey and those who did not highlights the need to address the way PROMIS is delivered in order to foster greater inclusion.Keywords: patient-reported outcome, PRO, ophthalmology, optometry, clinic

The objective of this study was to compare instruments from the Patient-Reported Outcomes Information System (PROMIS) with previously validated acetabulum fracture outcome instruments.This study included adult patients presenting for routine follow-up at least 3 months after surgical treatment of an acetabulum fracture. Participants completed four different patient-reported outcomes in a randomized order: PROMIS Mobility, PROMIS Physical Function, Short Form 36 (SF-36), and Short Musculoskeletal Functional Assessment (SMFA). Primary outcomes were the correlations between instruments, floor/ceiling effects, and survey completion time. The effects of age, education, and race on survey completion time were also evaluated.Overall strong correlations were observed between PROMIS instruments and the SMFA/SF-36 (r = 0.73 to 0.86, P0.05) with weaker, more moderate correlations in those with18 months of follow-up (r = 0.41 to 0.76, P0.05). No instruments demonstrated notable floor or ceiling effects. The PROMIS outcomes required less time to complete (PROMIS [56 to 59 seconds] than SF-36 [5 minutes 22 seconds] and SMFA [6 minutes 35 seconds]; P0.001). Older individuals required more time to complete the PROMIS PF (0.5 s/yr, P = 0.03), SF-36 (2.35 s/yr, P = 0.01), and SMFA (3.85 s/yr, P0.01). Level of education did not affect completion time; however, African Americans took significantly longer than Caucasians to complete the SMFA and SF-36 by 151 and 164 seconds (P0.01).This study supports that the PROMIS Mobility and Physical Function surveys are much more efficient instruments for evaluating patients with acetabulum fractures when compared with the SMFA and SF-36. Convergent validity of the PROMIS instruments was overall strong but weaker and more moderate in those with a long-term follow-up, and additional study is suggested for longer-term outcomes. Level of education did not influence survey completion time; however, it took markedly longer time for older individuals and African Americans to complete the SMFA and SF-36.

Few studies have investigated the environmental factors of participants completing online self-report surveys, such as the presence of others and engagement in multitasking. The current study examined the environmental factors of 1023 participants drawn from two popular convenience populations—college students (n = 512) and Mechanical Turk workers (n = 511). All participants completed online measures of computer self-efficacy, the five-factor model of personality, and social desirability, as well as a questionnaire about their environment and activities when completing the measures. The two samples differed in terms of environmental factors, with college students significantly more likely to report: (1) being in a location other than their place of residence, (2) interacting with others, (3) being interrupted, (4) engaging in multitasking, (5) being under the influence of alcohol or other substances, and (6) completing the study using a laptop computer. The presence of others interacted with sample to predict personality and social desirability scores. Additionally, both presence of others and engaging in multitasking predicted longer completion time.

The use of methcathinone (MCAT), a psychostimulant drug that can lead to long-term health risks and executive dysfunction, increased to an alarming rate in recent years. Impairments in low-level executive function have been reported in substance use disorder. However, little empirical evidence is available regarding high-level executive function (e.g., problem solving), which may act as a risk factor for relapse. The present study aimed to investigate whether the problem-solving ability was altered in abstinent individuals with methcathinone use disorder (MCUD). Here, we tested fifty male MCUD individuals (short-term MCUD group: twenty-nine patients with MCAT use less than 3 years, long-term MCUD group: twenty-one patients with MCAT use longer than 3 years, which were split by medium years of drug use) and twenty-four well-matched healthy controls (HC) in the Tower of Hanoi task (TOH) to assess the impact of task difficulty on drug-related changes in problem-solving performance. We used several measures to characterize problem-solving performance: the number of mistakes made, the completion time of the task, and the thinking time before the first move. In the low task difficulty condition, the MCUD group and HC group showed similar levels of mistakes and completion time, while in the high task difficulty condition, the MCUD group reported more mistakes (the mean number of mistakes in each trial: 1.41 ± 1.15 vs 0.79 ± 0.76, P = 0.019, Cohen’s d = 0.635) and longer completion time in the task (the mean completion time in each trial: 45.83 ± 20.51 s vs 33.40 ± 15.10 s, P = 0.010, Cohen’s d = 0.690) than the HC group. The thinking time before the first move did not differ significantly between groups (P = 0.257). We further found that the long-term (more than 3 years) MCUD group made more mistakes than the short-term MCUD group and HC group, mainly in the highly difficult subtasks. The longer time than HCs was reported in the long-term MCUD group among high task difficulty of subtasks. In addition, there was a positive correlation between years of MCAT use and the number of mistakes made in high task difficulty TOH task (r = 0.326, P = 0.021). Chronic methcathinone use was associated with deficits in problem-solving performance, which depended on the degree of task difficulty. The impairment was more evident in the long-term (> 3 years) MCAT group.

Background and study aims Endoscopic submucosal dissection (ESD) is technically challenging, difficult to learn, and carries a substantial risk of perforation, all of which remain significant barriers to its adoptability. We aimed to determine whether use of a novel scissor-type knife improved efficacy and safety among novice performers of ESD.Materials and methods Following a brief didactic session on ESD, participants performed ESD of two lesions (2 cm diameter) in an ex vivo porcine gastric model. One resection was performed with a conventional knife and the other with the scissor knife (order of knife randomized). We recorded procedure time, successful en bloc resection, and adverse events (including full-thickness perforation and muscle injury) for each dissection. Participants completed a post-study survey.Results 10 endoscopists (8 trainees, 2 staff) considered novices in ESD participated. Compared with the conventional knife, use of the scissor knife was associated with a significantly shorter time to completion of submucosal dissection (mean 6.2 [SD 5.6] vs. 15.6 [SD 15.6] minutes; P = 0.04) and total procedure time was not significantly different (22.1 [SD 13.3] vs. 24.9 [SD 26.5] minutes; P = 0.65). Scissor knife use was also associated with a significantly lower proportion of perforation and/or muscle injury (10.0 % vs. 70.0 %; P Conclusions Among novices performing ESD on an ex vivo animal model, use of a scissor knife was associated with a significantly lower proportion of adverse events without prolonging procedure time. Scissor-type knives may improve ESD safety, at least among novices.

PT. LPA is one of textile manufacturing company who is still doing the production process by woven fabrics (Weaving) and finishing fabrics (Printing, Dyeing and White). The problems that are often faced by PT. LPA is the completion time of production which is still not according to the targets that have been planned, then the production effectiveness would not be achieved so with the suitability of orders or quality which has not been met with expectation. This research aims to find out the impact of production planning on raw material control, schedule control and production control as well as the impact from raw material control to production effectiveness, schedule control affect on production effectiveness and production control affect on production effectiveness. Questionnaire data analysis which involves 65 respondents, those employees from PT. LPA then the data would be processed through validity and reliability test using the PLS-SEM analysis method. So the results that obtained from this research were production planning had a positive and significant impact on raw material control, production planning had a positive and significant impact on schedule control, production planning had a positive and significant impact on production control, raw material control had a positive and significant impact on production effectiveness, schedule control had a positive and significant impact on production effectiveness, production control had a positive and significant impact on production effectiveness.

The aggregation behavior shown by swarm robots to establish coordination among each other is a basic behavior that is used in swarm robotics. This study proposes an aggregation method based on flocking for self-organizing aggregation behavior in swarm robotics. In the proposed method, a decision-making structure that determines robot movements for the swarm robots to show aggregation behavior is utilized. Each swarm robot can aggregate by decision-making only by itself without needing a control unit by using the proposed aggregation method. In the study, with swarm robots that have basic features, the aggregation method is applied in the simulation environment for different arena sizes, different numbers of robots and different detection distances. The performance of the proposed aggregation method is statistically examined for different arena sizes, different detection limits and different numbers of robots. Additionally, the proposed method is compared to a method in the literature in terms of aggregation completion time. According to the results, the proposed method realizes the aggregation behavior in a shorter time than the other method in all systematic simulations.

Background and Aims: Expert endoscopists previously reported ERCP outcomes for the first commercialized single-use duodenoscope. We aimed to document usability of this device by endoscopists with different levels of ERCP experience. Methods: Fourteen “expert” (>2000 lifetime ERCPs) and 5 “less-expert” endoscopists performed consecutive ERCPs in patients without altered pancreaticobiliary anatomy. Outcomes included ERCP completion for the intended indication, rate of crossover to another endoscope, device performance ratings, and serious adverse events. Results: Two hundred ERCPs including 81 (40.5%) with high complexity (American Society for Gastrointestinal Endoscopy grades 3-4) were performed. Crossover rate (11.3% vs 2.5%, P =.131), ERCP completion rate (regardless of crossovers) (96.3% vs 97.5%, P =.999), median ERCP completion time (25.0 vs 28.5 minutes, P =.130), mean cannulation attempts (2.8 vs 2.8, P =.954), and median overall satisfaction with the single-use duodenoscope (8.0 vs 8.0 [range, 1.0-10.0], P =.840) were similar for expert versus less-expert endoscopists, respectively. The same metrics were similar by procedural complexity except for shorter median completion time for grades 1 to 2 versus grades 3 to 4 (P Conclusions: In consecutive ERCPs including high complexity procedures, endoscopists with varying ERCP experience had good procedural success and reported high device performance ratings. (Clinical trial registration number: NCT04223830.)

Learning to use a surgical microscope is a fundamental step in otolaryngology training; however, there is currently no objective method to teach or assess this skill. Tympanostomy tube placement is a common otologic procedure that requires skilled use of a surgical microscope. This study was designed to (1) implement metrics capable of evaluating microscope use and (2) establish construct validity. This was a prospective cohort study. Eight otolaryngology trainees and three otolaryngology experts were asked to use a microscope to insert a tympanostomy tube into a cadaveric myringotomy in a standardized setting. Microscope movements were tracked in a three-dimensional space, and tracking metrics were applied to the data. The procedure was video-recorded and then analyzed by blinded experts using operational metrics. Results from both groups were compared, and discriminatory metrics were determined. The following tracking metrics were identified as discriminatory between the trainee and expert groups: total completion time, operation time, still time, and jitter (movement perturbation). Many operational metrics were found to be discriminatory between the two groups, including several positioning metrics, optical metrics, and procedural metrics. Performance metrics were implemented, and construct validity was established for a subset of the proposed metrics by discriminating between expert and novice participants. These discriminatory metrics could form the basis of an automated system for providing feedback to residents during training while using a myringotomy surgical simulator. Additionally, these metrics may be useful in guiding a standardized teaching and evaluation methodology for training in the use of surgical microscopes.

BACKGROUND Perioperative stroke is associated with high rates of morbidity and mortality, yet there is no validated screening tool. The modified National Institutes of Health Stroke Scale (mNIHSS) is validated for use in nonsurgical strokes but is not well-studied in surgical patients. We evaluated perioperative changes in the mNIHSS score in noncardiac, non-neurological surgery patients, feasibility in the perioperative setting, and the relationship between baseline cognitive screening and change in mNIHSS score. METHODS Patients aged 65 years and above presenting for noncardiac, non-neurological surgery were prospectively recruited. Those with significant preoperative cognitive impairment (Montreal Cognitive Assessment score [MoCA] ≤17) were excluded. mNIHSS was assessed preoperatively, on postoperative day (POD) 0, POD 1, and POD 2, demographic data collected, and feedback solicited from participants. Changes in mNIHSS from baseline, time to completion, and relationship between baseline MoCA score and change in mNIHSS score were analyzed. RESULTS Twenty-five patients were enrolled into the study; no overt strokes occurred. Median mNIHSS score increased between baseline (0 interquartile range [IQR 0 to 1]) and POD 0 (2 [IQR 0 to 3.5]; P

Surgical residencies have implemented boot-camps for early acquisition of basic technical skills for interns. However, educators worry that retention is poor. We hypothesized that a structured boot-camp curriculum would improve skills.Interns underwent eight boot-camp sessions at the beginning of residency. Interns completed pre-, post-boot-camp, and end-of-year skills assessments, as well as post-boot camp and end-of-year porcine procedure labs. Proficiency was measured on a 5-point scale and by completion time.After boot-camp, interns improved all domains of knot-tying. Median time decreased for skin-closure (8.3 vs 9.9 min, p 0.01), peg transfer (57 vs 87 s, p 0.01), intracorporeal (178 vs 300 s, p 0.01), and extracorporeal knot-tying (140 vs 259 s, p 0.01). At the end-of-year assessment, interns exhibited retention of all skills and improved in knot-tying and central line skills. During the retention porcine lab, interns progressed basic but not complex skills.An eight-week boot-camp effectively improved technical skills among surgery interns. Interns retained all skills and improved upon techniques frequently practiced during intern year.

This study describes the learning curve associated with ArtiSential articulating laparoscopic instruments (ALI) in a simulated environment and the early paediatric clinical implementation of this skill set. The study was performed as a single-centre feasibility study. Baseline performance for a peg board transfer task requiring 3D object translation was established with standard instruments (SI) and ALI. Completion time and number of pegs dropped were recorded. Participants completed 5 h of distributed practice followed by a repeat timed performance. ArtiSential articulating instruments were subsequently used in 3 laparoscopic cases using an iterative learning model and the learning points are described. Median baseline completion time with SI and ALI were not significantly different [7.3 min SI vs 10.5 min ALI (p = 0.138), ALI times significantly improved with 5 h training (10.5 min vs 3.5 min (p = 0.014)]. 19 pegs were dropped using SI, while 7 were dropped with ALI (p = 0.028). Two laparoscopic cholecystectomies and a laparoscopic fundoplication were performed using a hybrid approach with articulating instruments and standard laparoscopic instruments with operating times of 164, 94 and 120 min, respectively. There is a short learning curve with rapid acquisition of the articulating skill set using this training program, with intuitive translation to the clinical setting, permitting increased dexterity and range of movement compared to SI. Limitations including air-leak and loss of angulation during dissection respond to modification of surgical set-up and refining technique.

Land is considered an asset that promises high value, so it is not surprising that land disputes occur in order to maintain ownership rights to land. The land dispute resolution process can be carried out by litigation or non-litigation. In the context of the implementation of land dispute resolution conducted at the Sambas BPN office, it is carried out through a mediation process (non-litigation). Based on the facts in the field in 2018 and 2019, there were many land disputes that were not resolved through mediation. This research focuses on what factors are causing the failure of mediation conducted at the Sambas BPN Office and how the legal consequences of resolving land disputes are resolved through mediation. The research uses empirical methods, and is analytical descriptive. To obtain primary data observation and unstructured interviews were conducted with respondents and sampling using purposive sampling. The results showed that: first, the factors causing the failure of mediation were the factors of the parties, the completion time factor, and supporting data factors. Second, the legal consequences of resolving land disputes resolved through mediation bind the parties to the dispute.

Many recent works utilize scheduling to minimize the Flow Completion Time (FCT) in Data Center Networks (DCN), like PIAS using Shortest Job First (SJF) scheduling and pFabric using Shortest Remaining Size First (SRSF) scheduling. However, they only consider the flow size information, without consideration of available bandwidth of the network, leading to inferior performance when the network is congested. Besides, information on flow size is hard to obtain in practice. Moreover, although a centralized scheduler may have optimal scheduling decisions, it suffers from high system overhead. Therefore, a new DCN scheme is expected which is deployment-friendly and implements SRTF scheduling in a distributed manner. In this paper, we propose D-SRTF , a light-weight yet effective DCN scheme to implement SRTF scheduling. D-SRTF determines the remaining time of each flow according to the estimated remaining flow size and the available bandwidth, in order to determine the priority of each flow. Switches perform Strict Priority (SP) scheduling according to the priority of each flow, in order to realize SRTF scheduling. Experiments show that D-SRTF performs better than the currently best implementable scheme, PIAS, and could perform better than pFabric if information on flow size is available.

Introduction The purpose of this investigation was to determine the impact of simulator practice on task completion time, radiation use, success rate, and overall quality in a simulation of placing a distal locking screw. Methods This was a prospective, randomized control trial with one-to-one randomization and parallel group design. Twenty-eight volunteer novice trainees (medical and premedical students) participated. Using the TraumaVision Virtual Reality Simulator (Swemac, Sweden), subjects performed locking screw placement using the "perfect circle" technique. All subjects underwent a pretest and posttest on the simulator. The simulator group completed three additional simulator training sessions. The primary outcome variables were simulator-collected task completion time, success rate, radiation exposure time, and overall score. Results No notable difference existed between groups for pretest completion time, radiation use, success rate, or overall score. No notable difference in posttest radiation use or overall procedure score was found between groups. A significant difference existed in posttest total completion time (trained = 251.2 ± 103.4; control = 497.3 ± 223.1; P = 0.001) and success rate (64.3% versus 100%; P = 0.041) between groups. In addition, a significant difference existed in variance between groups for completion time (P = 0.029). Conclusions These findings suggest that independent simulator practice leads to improved speed and success rates; however, radiation use and overall score do not improve in the same manner. The design of simulator-based curriculum must be tailored to specific educational objectives and ultimately validated in the clinical setting.

Emergency front of neck access (eFONA) is a critical step in oxygenation in cases of unrelieved airway obstruction. Multiple techniques are used in clinical practice without agreement regarding the optimal approach. We evaluated a novel device, the Cric-Guide (CG), a channelled bougie introducer that enters the airway in a single action and compared it with a scalpel-bougie-tube (SBT) technique in laboratory benchtop model. Seven anaesthesiologists attempted eFONA on both obese and non-obese models using both techniques in randomized order on an excised porcine trachea with an intact larynx with variable subcutaneous tissue depth. The primary outcome was successful tracheal cannulation. Secondary outcomes included false passage rate, time and tissue injury. Anaesthesiologists performed 4 cricothyroidotomies on each model with each device. The CG was more successful in airway cannulation (47/56 [89.4%] vs. 33/56 [58.9%], P = 0.007). This difference was observed in the obese model only. The CG was associated with fewer false passages than the standard technique in the obese model (8/56 [14.3%] vs. 23/56 [41.1%], P = 0.006). There were no significant differences in time to completion or injury patterns between the techniques in the obese model, but the SBT was faster in the non-obese model. There was no difference in the proportion of specimens injured. The Cric-Guide device was more successful than the standard SBT technique in airway cannulation in an obese neck model and with equivalent frequency and distribution of injury but performed equivalently in the non-obese model.

Purpose: To describe the heart-rate (HR) response during a prolonged, submaximal, multirepetition swimming bout (ie, typical early-season swimming training), as there is currently little or no literature on this topic. Methods: A total of 12 collegiate swimmers were instructed to complete sixty 91.4-m (100-yd) freestyle repetitions at their fastest sustainable pace, allowing between 5 and 10 seconds of rest between repetitions. Each swimmer was outfitted with a cardiotachometer, which monitored HR throughout the trial. Completion time (CT) was also recorded for each repetition. Individual means of HR and CT were calculated, and linear mixed models were used to determine the trend across repetitions and between- and within-subject SD for HR and CT. Results: The mean (SD) value for HR was 167.8 (10.8) beats per minute (bpm), for CT was 68.7 (4.1) seconds, and for percentage of best time was 71.2% (4.5%). There was no change (Δ rep 55–6) in HR (−0.1 bpm; 95% confidence interval, −6.8 to 6.6 bpm; P = .97), whereas CT increased (3.0 s; 95% confidence interval, 1.5–4.4 s; P = .001). The between-subjects SD (95% confidence interval) for HR was 12.6 (8.4–19.3 bpm) and for CT was 4.6 (3.1–7.0 s). The within-subject SDs for HR and CT were 4.0 (3.8–4.3 bpm) and 0.9 (0.8–0.95 s), respectively. Conclusions: The inherent individual variability between swimmers in HR during training suggests that coaches carefully consider the common practice of prescribing workout intensity using rigid HR zones.

Background:Modern breast cancer (BC) treatment involves the use of multimodality therapy. Treatment delays are common and can be multifactorial. There are few studies examining the association between the duration of the time from diagnosis to completion of all acute BC treatment modalities and survival. This study is designed to determine if there is an association between time to complete treatment and survival. Study Design:A retrospective analysis was performed using data from The National Cancer Database (NCDB) to determine whether an association exists between the duration of time from diagnosis to completing all acute BC treatment (surgery, chemotherapy and radiation therapy) and survival. A second analysis was performed to determine if the association between treatment duration and survival varies by receptor status. Results:The NCDB data from BC patients diagnosed in 2010 was analyzed. The inclusion criteria included less than 80 years of age with a single cancer diagnosis, Stage I through III invasive breast cancer who required treatment with surgery, chemotherapy and radiation therapy. A total of 28,284 patients were included in the analysis. Median follow-up was 5.8 years. The order of treatment included 20,772 patients had treatment in the order of surgery, chemotherapy and radiation therapy and 7,512 patients had treatment order chemotherapy, surgery and radiation therapy. A Cox proportional hazards model was developed and identified a cut off showing the risk of delaying completion of all treatment beyond 38 weeks was associated with decrease in overall survival. This was statistically significant with an adjusted hazard Ratio of 1.21. This cut off of 38 weeks was found to be significant regardless of receptors type. The statistically significant Hazard ratios for receptor subtypes include: Triple negative (HR: 1.188, 95%CI: 1.06-1.34), ER+PR+Her2- (HR: 1.22, 95%CI: 1.09-1.36), ER-PR-Her2+ (HR: 1.29, 95%CI: 1.004-1.67) and ER+PR+Her2+ (HR: 1.32, 95%CI: 1.01-1.72). The patients with treatment duration greater than 38 weeks were comprised of 4768(63.47%) neo-adjuvant chemotherapy patients and 8191 (39.43%) of the surgery first group. Conclusion: Efforts to improve the efficiency of multimodality BC treatment and reduce treatment delays should be a priority to optimize BC patient outcomes. Citation Format: Debra Ann Pratt, Talia Burneikis, Chao Tu, Stephen R. Grobmyer. Time to completion of breast cancer treatment and survival [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS11-34.

Background: Standard personal protective equipment guidelines are insufficient to prevent contamination of healthcare workers with droplet spread during the COVID-19 crisis. The added challenge of adequate aerosol protection has led to the development of an initial prototype intubation box. The primary objective was to determine the impact of an intubation box on the mean time to completion of intubation in a simulated airway. Secondary objectives included the best laryngoscopic view, the effect of intubator seniority and mode of laryngoscopy on intubation. Methods: This was a randomised crossover study of the influence of an intubation box on mean time to completion of intubation of an airway management part-task trainer. Senior anaesthesiology staff were assigned to two groups and recordings of their attempts at intubation were analysed by two independent observers. Results: The intubation box led to a significantly longer mean time to completion of intubation of 7.6 seconds (95% CI 3.1; 12.2; p = 0.001) with direct laryngoscopy and 9.2 seconds (95% CI 3.8; 14.7; p = 0.001) with videolaryngoscopy. It did not influence best glottic view. Conclusion: We found that the use of an intubation box significantly prolonged the time to completion of intubation, but the clinical significance of the effect size is uncertain.

Background and aims The COVID-19 pandemic has led to a rapid growth in the use of telemedicine for delivery of ambulatory diabetes care. This study evaluated the feasibility of remote HbA1c monitoring via dried blood spot (DBS) testing to support assessment of glycemic control for telemedicine visits and examined clinical and demographic characteristics associated with patient completion of DBS testing. Methods Providers could place orders for DBS HbA1c 3 weeks prior to telemedicine visits. Feasibility was assessed by examining DBS completion rates, time to completion, and availability of DBS results prior to telemedicine visits. Chi-square tests and Mann Whitney tests were used to assess whether completion rates were associated with participant characteristics. Results Of 303 DBS orders placed for telemedicine visits in June 2020, 162 patients completed the DBS test for a completion rate of (53.4%). Average time from collection at home to result being reported was 6.9 (3.8) days. The DBS result was available in 67.6% of patients who completed successful DBS, before the telemedicine clinic visit. HbA1c was lower in the DBS completion group as compared to the non-completion group (8.2% vs. 8.9%, p = 0.01). No other clinical or demographic characteristics were significantly different between the two groups. Conclusion Remote HbA1c monitoring via DBS is feasible and offers an avenue to support assessment of glycemic control for patients seen via telemedicine. Future work should focus on improving clinic and laboratory processes to support remote DBS collection.

Background: The Patient-Reported Outcomes Measurement Information System (PROMIS) was developed to provide an easily administered patient-outcome questionnaire that was adaptable to a variety of medical and surgical subspecialties. Numerous authors have examined the effectiveness of PROMIS in various areas of spine surgery. Our goal was to systematically review PROMIS scores compared with legacy patient-reported outcomes measures (PROMs) in spinal surgery and spine pathology. Methods: A systematic search of the PubMed, EMBASE, and Cochrane databases using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines was performed, yielding 254 unique studies reporting on “PROMIS” in “spine.” Each study was independently reviewed. A total of 16 studies were selected for inclusion. Results: The pooled sample size yielded a total of 4268 patients. In the cervical population, PROMIS physical function (PF; |r| = .47–.87, pain intensity (PIn; |r| = .61–.74), pain interference (PIf; |r| = .65–.88), and pain behavior (PB; |r| = .59–.74) correlated with the Neck Disability Index (NDI). PROMIS PF also strongly correlated with the modified Japanese Orthopaedic Association scale (mJOA; |r| = .61–.72). Among patients with lumbar pathology and adult spinal deformities, PROMIS PF (|r| = .53–.85), PIn (|r| = .73–.78), PIf (|r| = .59–.89), and PB (|r| = .58–.82) strongly correlated with the Oswestry Disability Index (ODI). PF (|r| = .51–.78), PIf (|r| = .60–.70), and anxiety (|r| = .73) also strongly correlated with the Scoliosis Research Society (SRS)-22 and SRS-30. When comparing measures of global health, PROMIS PF was strongly correlated with the Short Form (SF)-12 and SF-36 (|r| = .50–.85). On average, all PROMIS domains required less time to complete (49.6–56 seconds) than the ODI (176 seconds), NDI (190.3 seconds), SF-12 (214 seconds), and SF-36 physical function domains (99 seconds). The responsiveness of the PROMIS PF, PIf, and PB was comparable to that of legacy measures ODI, NDI, and SF-12. Conclusions: The PROMIS PF, PIn, PIf, and PB demonstrated moderate to strong correlations with NDI, mJOA, ODI, SRS, and SF-12 measures in various populations of spine patients. All PROMIS domains had decreased time to completion and similar responsiveness compared with legacy measures. Level of Evidence: 2. Clinical Relevance: These results highlight the potential of PROMIS as a valid and reliable tool to assess patient-reported outcomes in spinal surgery patients and support more widespread use of PROMIS in spine.

Purpose Evaluate the ability of the “simplified Zulfiqar frailty scale” (sZFS) tool to detect frailty as defined by Fried's criteria among a group of patients aged 65 and older. Methods Prospective study conducted in Champagne-Ardennes (France) for 12 months on patients aged 65 and over and considered autonomous in terms of the ADL scale. To be eligible, the patients could not reside in a nursing home and needed an ADL score of 4 or higher. Results With this tool, the threshold for identifying frailty was≥1 out of 5 criteria. It was quick (average completion time of 110 s) with a sensitivity score of 91.1% and a negative predictive value of 97.1%. Conclusion The “simplified Zulfiqar frailty scale” tool measures frailty just as effectively as Fried's criteria, with sensitivity and negative predictive values no lower than the latter.

Background Schizophrenia is associated with widespread cognitive impairment. The MATRICS Consensus Cognitive Battery (MCCB) is most frequently used to assess cognitive function. However, the MCCB test is time consuming for the clinician. Virtual reality (VR) has emerged as an adjunctive tool to overcome this limitation and provides a new means to assess cognitive function. Methods The present study examined the validity and safety of using VR technology to assess cognitive function in Han Chinese patients with schizophrenia (SZs). The VR cognition training system (VRCTS) was used to simulate real-life supermarkets and assess cognitive function. Thirty-two SZs and 25 healthy controls (HCs) underwent VRCTS and MCCB assessments. An auxiliary diagnosis model was created based on the outcomes of the VRCTS to classify SZs and HCs by cognitive impairment. Results Significant differences in completion time between the SZs and HCs were detected using the VRCTS. SZs spent more time completing tasks than HCs. The outcome of VRCTS significantly correlated with the MCCB. The auxiliary diagnosis model had a sensitivity of 88.89% and a specificity of 88.89%. Conclusions These results support the use of VR technology in the assessment of cognitive impairment in Han Chinese schizophrenia patients. Trial registration China Clinical Trial Registry, ChiVTR1800016121. Registered 13 May 2018, http://www.chictr.org.cn/showproj.aspx?proj=27233

To evaluate the correlation between Visual Prostate Symptom Score (VPSS) and the International Prostate Symptom Score (IPSS) and uroflowmetry parameters in men with lower urinary tract symptoms (LUTS) with literature review.Patients were pooled from 4 different urology clinics in Turkey and divided into 3 groups according to their educational level. The scores of IPSS and the VPSS questionnaire, assistance requirement, and completion time of the questionnaires were recorded. Maximum flow rate (QA total of 342 patients were evaluated (group 1, n = 168; group 2, n = 108; group 3, n =66). Median age of all groups was 61 (40-89). There was a significantly higher rate of the completion of VPSS than IPSS without assistance in total (P.001). Educational level was not found as an independent factor with assistance requirement to complete VPSS while university educational level was found as an independent factor to complete IPSS (odds ratio = 9.735, P.001).There was a significantly lower completion time for VPSS in all groups when compared to IPSS (P.001 for all groups). Significant positive correlations were found between VPSS and IPSS questions (P.001). There were significant negative correlations between total score and weak stream question of VPSS and QVPSS can be more practical than IPSS to evaluate LUTS in men with low educational levels and/or in large populations. Some modifications are needed to increase the availability of VPSS.

OBJECTIVE To determine whether (1) initial baseline scores are significantly better for those who have valid (initial valid) versus invalid scores (initial invalid) on their concussion baseline testing, (2) retesting results in significantly improved baseline scores, and (3) there is a significant difference in scores between those who have valid scores on their initial attempt and those who retook baseline tests (retest valid). DESIGN Prospective, repeated-measures. SETTING Two years of collegiate preparticipation concussion baseline testing. PARTICIPANTS Five hundred forty-seven male and female Division I collegiate athletes (19.02 ± 1.31 years, female = 217). INDEPENDENT VARIABLES Participants were divided into initial valid and initial invalid. The retest group was further divided into their initial (initial invalid) and final valid attempt (retest valid). MAIN OUTCOME MEASURES Data were analyzed to determine the relationship between the 3 groups and overall initial and final scores on 28 individual items: total symptoms score, coordination, near-point convergence, CNS Vital Signs (CNSVS), Senaptec Sensory Station, and Neurocom Sensory Organization Test (SOT). RESULTS The initial valid group scored significantly better than the initial invalid group on 8 CNSVS items and 5 Senaptec items (P < 0.002). The retest valid scores were significantly better compared with the initial invalid scores on 17 items (P < 0.002). CONCLUSIONS Retesting is recommended for individuals who score below acceptable ranges. This is important because athletes may experience a learning effect and are highly motivated during postinjury testing, so accurate baseline scores are imperative for athlete safety. Completion time for the coordination test may be a more informative option.

Purpose The purpose of this study was to evaluate the cost-effectiveness of introducing cone-beam computed tomography (CBCT) in the management of the complex finger fractures with articular involvement. Methods We created a decision tree model simulating the diagnostic pathway of complex finger fractures, suggesting the use of CBCT as alternative to multi-slice computed tomography (MSCT), and we compared their clinical outcomes, costs, and cost-effectiveness for a hypothetical cohort of 10,000 patients. Measures of effectiveness are analysed by using quality-adjusted life years, incremental cost-effectiveness ratio, and net monetary benefit. Results Diagnosis of a complex finger fracture performed with CBCT costed 67.33€ per patient, yielded 9.08 quality-adjusted life years, and gained an incremental cost-effectiveness ratio of 29.94€ and a net monetary benefit of 9.07 € at 30,000€ threshold. Using MSCT for diagnosis costed 106.23 €, yielded 8.18 quality-adjusted life years, and gained an incremental cost-effectiveness ratio of 371.15 € and a net monetary benefit of 8.09 €. CBCT strategy dominated the MSCT strategy. The acceptability curve shows that there is 98% probability of CBCT being the optimal strategy at 30,000€ threshold (1 EUR equal to 1.11 USD; updated on 02/02/2020). Conclusion CBCT in complex finger fractures management is cost saving compared with MSCT and may be considered a valuable imaging tool in preoperative assessment, allowing early detection and appropriate treatment. It shortens the time to completion of diagnostic work-up, reduces the number of additional diagnostic procedures, improves quality of life, and may reduce costs in a societal perspective.

Objective: To evaluate the success, degree of difficulty and completion time of endotracheal intubation without removing the endotracheal tube in the event of an oesophageal intubation. Methods: The prospective, randomised crossover study was conducted at Gulhane Training and Research Hospital, Ankara, Turkey, from July 1, 2018, to August 31, 2018, and used a manikin model. Endotracheal intubation was performed using Miller, Macintosh blades and a video laryngoscope. The procedures were randomised into two groups, with group E+ being subjected to it while an endotracheal tube ETT was placed in the oesophagus (E+) simulating the oesophageal intubation, and control group E- getting the standard procedure without the endotracheal tube in the oesophagus. All methods were evaluated for their success, completion time, and degree of difficulty. Data was analysed using SPSS 22. Results: There were 120 manikins, with 60(50%) in each of the two groups. The mean completion time with Miller in E+ group was 19.05±9.65 and for E- it was 17.55±11.95 seconds. With Macintosh, E+ had a mean completion time of 19.85±12.66 seconds and E- had 16.75±8.66. With video laryngoscope, E+ group had a mean completion time of 16.75±8.66 seconds, while E- had it 14.60±8.17. No significant difference was found in the paired group comparisons in terms of the degree of task difficulty (p>0.05). Conclusion: In case of inadvertent oesophageal intubation condition, leaving the tube in the oesophagus and performing subsequent endotracheal intubation attempts was not found to decrease the rate of success regardless of the laryngoscope type. Continuous…

The authors tested the use of tablets to collect breast cancer risk data and compared the approach against paper-based scantrons. The goal was to examine the usability of digital technology for data collection in underserved populations. A total of 340 individuals were randomized to answer a breast health survey via either tablets (170) or paper forms (170). Post questionnaire surveys were conducted to evaluate the usability of tablets. Outcomes included completion time, satisfaction, and the numbers and types of questions raised by patients during the survey. There was no significant difference in questionnaire completion time between two groups (12.5 vs. 12.1 minutes, p = 0.07). The tablet group was more satisfied with the experience (p < 0.001). Low health literacy women spent more time on the questionnaire (p < 0.05). Electronic devices can be utilized to collect breast cancer risk data in underserved, ethnically diverse populations. Future healthcare questionnaire applications should focus on accessibility improvements for these populations.

Aim: The study aimed to identify possible dysphagia in elderly patients with neurological deficits. Design: A cross-sectional study. Methods: A cross-sectional study was carried out using a standardized tool, the Brief Bedside Dysphagia Screening Test-Revised (BBDST-R). The study comprised 141 patients. Data were statistically processed; the sensitivity and specificity of the screening tool were calculated. The level of significance was set at 5%. Results: In the sample, the majority of screening results were positive (67.4%), that is, most patients had possible swallowing disorders. There was a statistically significant difference in the presence of possible dysphagia depending on cognitive functioning. As many as 77% of individuals with cognitive impairment had possible dysphagia. Analysis of the data suggested an increase in the proportion of individuals with possible dysphagia with increasing age. The sensitivity of the screening test with regard to speech pathology assessment was 100% (CI = 89.7–100.0%.). The mean time needed to complete the BBDST-R in one person was 1.3 minutes. Conclusion: For its high sensitivity and short completion time, the BBDST-R is suitable for use in clinical practice to detect possible swallowing disorders in elderly patients with neurological deficits.

Food deprivation is a common condition for visceral surgeons and especially laparoscopic approaches require high levels of concentration. The current literature does not provide adequate answers whether intraoperative breaks, especially food intake, might influence the quality of the surgical skills. Thus, the primary aim of this trial was to analyze the influence of food deprivation on the laparoscopic performance.37 laparoscopic novices participated from 10/2017 to 04/2018 in this single center, prospective-randomized trial and were trained during laparoscopic training sessions until they reached a predefined level of proficiency. Subsequently, participants were randomized into 3 different groups: food deprivation of 8 hours, 4 hours, or carbohydrate loading directly prior to the laparoscopic exam. The exam comprised PEG-transfer, precise cutting, gallbladder resection and surgical knot.Completion time for PEG-transfer, precise cutting, gallbladder resection and surgical knot was 63s, 139s, 192s and 272s respectively. Participants starving for 8 hours performed 3 of 4 tasks more slowly whilst participants starving for 4 hours performed 3 of 4 tasks faster than the average. Analyzing self-reported level of appetite revealed: Students with an intermediate level were significantly faster (p0.05) during complex procedures compared to participants that reported hunger prior to performing these tasks (192s vs. 307s). Additionally, hungry students had been more inaccurate during the surgical knot (p0.05) whilst students with intermediate appetite level tend to be most accurate (p - value 0.012).The subjective level of appetite rather than the absolute number of fasting hours influences the laparoscopic performance most. Thus, any extreme level of appetite may be avoided and surgeons may achieve the best performance when they have an intermediate level of appetite. In consequence, heavy meals may be omitted immediately prior to demanding laparoscopic procedures and surgeons may have access to mini-breaks and refreshers during major procedures.

Objective:On-scene prehospital conditions and patient instability may warrant a during-transport ultrasound (US) exam. The objective of this study was to assess the effect of ambulance turbulence on the performance of the Focused Assessment with Sonography in Trauma (FAST) with a handheld US device.Methods:This was a randomized controlled trial in which participants were randomized to perform a FAST in either a stationary or an in-motion military ambulance. Participants were physicians and physician assistants (PAs) with previous FAST training. All exams were performed on an US phantom model. The primary outcome was FAST completion time, reported as a mean, in seconds. Secondary outcomes included image acquisition score (range of 0-24, reported as a mean), diagnostic accuracy (reported as sensitivity and specificity), and a post-participation survey with five-item Likert-type scales.Results:Twenty-seven participants performed 27 FASTs, 14 in the stationary ambulance and 13 in the in-motion ambulance. All participants obtained the four requisite views of the FAST. A significant difference was detected in image acquisition scores in favor of the stationary ambulance group (19.4 versus 16.7 [95% CI for difference, 0.9-4.4]; P Conclusion:Vehicular motion did not affect FAST completion time and diagnostic accuracy; however, it did reduce FAST image acquisition scores. The results suggest timely and diagnostically accurate FASTs may be completed by experienced sonographers during moderate levels of ambulance turbulence. Further investigation assessing the utility and limitations of newer handheld US devices in various prehospital conditions is warranted.

As more people use mobile devices to complete Web surveys, it is critical to verify that current Web survey design practices carry over to mobile Web. One such practice is to bold the question to draw attention to the start of each question and to italicize instructions to facilitate filtering of potentially unneeded information. We conducted a laboratory experiment to investigate whether the common Web survey design practice of utilizing typographic cues to indicate different categories of question text is beneficial for surveys designed for smartphones. Thirty participants completed a 5-question survey on an iPhone. Each participant was randomly assigned to one of the four designs: (1) bolded questions and italicized instructions, (2) bolded questions and plain instructions, (3) plain questions and italicized instructions, (4) plain questions and plain instructions. Survey performance was measured with survey completion time, difficulty rating, and preference. We found that italicizing the instructions led to shorter completion times, while bolded questions had no effect on performance. All designs were rated easy to use. The designs with bolded questions were preferred by 83% of the participants. We argue that italicized instructions assist in visual filtering by providing a cue to respondents that they may not need to read the instructions in detail but may scan or skim the instructions instead. Scanning or skimming leads to shorter completion time without detriment to accuracy because respondents can still acquire the relevant instructions.

We examine trends in bankruptcy completion times and financial characteristics for farmers filing for chapter 12 bankruptcy after it became a permanent fixture in bankruptcy law to assess justifications for the recently enacted Family Farmer Bankruptcy Clarification Act of 2017 and Family Farmer Relief Act of 2019. Since 2007, chapter 12 filers have seen noticeable increases in their debt levels whereas alternative business bankruptcies have either stagnated or declined in their debt. Using survival analysis methods to correct for the censored nature of open cases, we find that the average time to completion has consistently been longer for chapter 12 than the comparable chapters (7, 11, and 13) of business bankruptcies. Although chapter 12 completion times have not been increasing over time, we find that chapter 7 and 11 completion times have been declining over time for comparable businesses and that debt levels are a significant factor in increased completion times. Our results are consistent with claims that farmers have had rising debt levels in comparison to similar businesses filing for bankruptcy and provide evidence that farmers with increasing debt have had a more difficult time restructuring through chapter 12. EconLit citations: G33, K35, Q14, Q18.

A multipath TCP (MPTCP) scheduler selects a suitable path for each data packet and helps to improve the performance of MPTCP. In this paper, we analyze various existing schedulers and find some current open issues like head-of-line blocking problem, receive window limitation, and out-of-order packet delivery. All these issues degrade the performance of MPTCP, which can be overcome by the careful design of an MPTCP scheduler. We then propose a new MPTCP packet scheduler named as an adaptive and efficient packet scheduler (AEPS) that not only overcomes these issues but also provides high throughput with a minimum completion time by utilizing the bandwidth of all the available paths. AEPS delivers the data packets in-order to the receiver, and its performance does not affect by the size of the receiver buffer and data size that is being transferred. We show experimentally and analytically that the proposed scheduler outperforms the existing schedulers.

Objective The number of mass casualty incidents (MCIs) has been steadily increasing. High‐priority MCI patient outcomes are highly dependent on rapid identification, treatment, and transport. Although there are several methods used to mark patients for rapid extraction, most current methods utilize low‐profile tags, with no gold standard. This study examines if the use of a vertical cue, a triage flag, to identify high priority MCI patients results in faster extraction times than those with a wrist triage tag alone. Methods A prospective randomized crossover study was conducted with medical students trained in basic disaster life support, who completed 2 extraction simulations. Two fields were each arranged with 32 randomly placed, pretriaged manikins (10 red, 17 yellow, 5 black). The manikins were marked with either triage tags alone or with triage tags and flags. The total time elapsed for participants to report all high‐priority manikin triage tag numbers was recorded. Results Eighty‐two participants completed both simulations. The average completion time for the “tags‐only” simulation was 94.5 seconds (±16.4 seconds) compared to 70.7 seconds (±13.2 seconds) for the flags and tags simulation. This corresponds to an average decrease of 23.8 seconds (P

Preventive maintenance (PM) planning becomes a crucial issue in the real world of the manufacturing process. It is important in the manufacturing industry to maintain the optimum level of production and minimize its investments. Thus, this paper focuses on multiple jobs with a single production line by considering stochastic machine breakdown time. The aim of this paper is to propose a good integration of production and PM schedule that will minimize total completion time. In this study, a hybrid method, which is a genetic algorithm (GA), is used with the Monte Carlo simulation (MCS) technique to deal with the uncertain behavior of machine breakdown time. A deterministic model is adopted and tested under different levels of complexity. Its performance is evaluated based on the value of average completion time. The result clearly shows that the proposed integrated production with PM schedule can reduce the average completion time by 11.68% compared to the production scheduling with machine breakdown time.

Apache Spark provides a well-known MapReduce computing framework, aiming to fast-process big data analytics in data-parallel manners. With this platform, large input data are divided into data partitions. Each data partition is processed by multiple computation tasks concurrently. Outputs of these computation tasks are transferred among multiple computers via the network. However, such a distributed computing framework suffers from system overheads, inevitably caused by communication and disk I/O operations. System overheads take up a large proportion of the Job Completion Time (JCT). We observed that excessive computational resources incurs considerable system overheads, prolonging the JCT. The over-allocation of individual jobs not only prolongs their own JCTs, but also likely makes other jobs suffer from under-allocation. Thus, the average JCT is suboptimal, too. To address this problem, we propose a prediction model to estimate the changing JCT of a single Spark job. With the support of the prediction method, we designed a heuristic algorithm to balance the resource allocation of multiple Spark jobs, aiming to minimize the average JCT in multiple-job cases. We implemented the prediction model and resource allocation method in ReB, a Resource-Balancer based on Apache Spark. Experimental results showed that ReB significantly outperformed the traditional max-min fairness and shortest-job-optimal methods. The average JCT was decreased by around 10%-30% compared to the existing solutions.

Efficient scheduling policy is crucial in wireless networks due to delay-sensitivity of many emerging applications. In this work, we consider a joint user pairing and scheduling (UPaS) scheme for multi-carrier non-orthogonal multiple access (MC-NOMA)-enabled wireless networks to reduce the maximum completion time of serving uplink users. The NOMA scheduling problem is shown to be NP-hard and a shortest processing time (SPT)-based strategy to solve the same problem within affordable time and complexity is introduced. The simulation results confirm the efficacy of the proposed scheduling scheme in terms of the maximum completion time in comparison with orthogonal multiple access (OMA) and random NOMA pairing.

Batch processes have been playing a crucial role for the flexibility in producing low-volume and high-value-added products. Due to the fluctuations of raw materials and operation conditions, the ba...

Background Technological advances have led to the development of state-of-the-art simulators for training surgeons; few train basic surgical skills, such as vessel ligation. Methods A novel low-cost bench-top simulator with auditory and visual feedback that measures forces exerted during knot tying was tested on 14 surgical residents. Pre- and post-training values for total force exerted during knot tying, maximum pulling and pushing forces and completion time were compared. Results Mean time to reach proficiency during training was 11:26 min, with a mean of 15 consecutive knots. Mean total applied force for each knot were 35% lower post-training than pre-training (7.5 vs. 11.54 N (N), respectively, p = 0.039). Mean upward peak force was significantly lower after, compared to before, training (1.29 vs. 2.12 N, respectively, p = 0.004). Conclusions Simulator training with visual and auditory force feedback improves knot-tying skills of novice surgeons.

BackgroundUser-testing and subsequent modification of clinical guidelines increases health professionals’ information retrieval and comprehension. No study has investigated whether this results in safer care.ObjectiveTo compare the frequency of medication errors when administering an intravenous medicine using the current National Health Service Injectable Medicines Guide (IMG) versus an IMG version revised with user-testing.MethodSingle-blind, randomised parallel group in situ simulation. Participants were on-duty nurses/midwives who regularly prepared intravenous medicines. Using a training manikin in their clinical area, participants administered a voriconazole infusion, a high-risk medicine requiring several steps to prepare. They were randomised to use current IMG guidelines or IMG guidelines revised with user-testing. Direct observation was used to time the simulation and identify errors. Participant confidence was measured using a validated instrument. The primary outcome was the percentage of simulations with at least one moderate-severe IMG-related error, with error severity classified by an expert panel.ResultsIn total, 133 participants were randomised to current guidelines and 140 to user-tested guidelines. Fewer moderate-severe IMG-related errors occurred with the user-tested guidelines (n=68, 49%) compared with current guidelines (n=79, 59%), but this difference was not statistically significant (risk ratio: 0.82; 95% CI 0.66 to 1.02). Significantly more simulations were completed without any IMG-related errors with the user-tested guidelines (n=67, 48%) compared with current guidelines (n=26, 20%) (risk ratio: 2.46; 95% CI 1.68 to 3.60). Median simulation completion time was 1.6 min (95% CI 0.2 to 3.0) less with the user-tested guidelines. Participants who used user-tested guidelines reported greater confidence.ConclusionUser-testing injectable medicines guidelines reduces the number of errors and the time taken to prepare and administer intravenous medicines, while increasing staff confidence.Trial registration numberresearchregistry5275.

Time-management refers to planning the available time in correspondence with personal goals and preferences of the employee. The criterion for efficient time-management lies in achieving definite goals in minimum possible time. This paper presents a short review of the literature on time-management. It is shown how scheduling theory may be used for optimal planning in time-management. The problem of minimizing the total (average) weighted completion time of the planned jobs by an employee is considered provided that only lower and upper bounds of the possible processing time of each job are known before scheduling. Software for constructing a permutation of the given jobs with the largest relative semi-perimeter of the optimality parallelepiped has been developed. Computational experiment on the computer showed the effectiveness of the developed algorithms for constructing schedules for time-management.