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The sugar industry is of great importance to the Thai economy. In general, the government sets sugarcane prices at the beginning of each harvesting season based on type (fresh or fired), sweetness (sugar content) and gross weight. The main aim of the present research is to use optimal control to find optimal sugarcane harvesting policies for fresh and fired sugarcane for the four sugarcane producing regions of Thailand, namely North, Central, East and North-east, for harvesting seasons 2012/13, 2013/14, 2014/15, 2017/18 and 2018/19. The optimality problem is to determine the harvesting policy which gives maximum profit to the farmers subject to constraints on the maximum amount that can be cut in each day, where a harvesting policy is defined as the amount of each type of sugarcane harvested and delivered to the sugar factories during each day of a harvesting season. The results from the optimal control methods are also compared with results from three optimization methods, namely bi-objective, linear programming and quasi-Newton. The results suggest that discrete optimal control is the most effective of the five methods considered. The data used in this paper were obtained from the Ministry of Industry and the Ministry of Agriculture and Co-operatives of the Royal Thai government.

Background: Opioid use disorder (OUD) continues to be a growing and major public health issue in the United States. In an effort to increase OUD treatment access, medication-assisted treatment with buprenorphine via telehealth is emerging as the leading treatment option., Objective: This study sought to describe the experiences of adults with OUD receiving medication-assisted treatment buprenorphine in a nurse-practitioner-facilitated telehealth program., Methods: Using a descriptive qualitative design, convenience sampling was used to recruit participants who were currently receiving OUD treatment in one telehealth program with locations in California and Michigan. Participants were invited to participate in the study via an email flyer sent to all clients of the telehealth program. Participants completed demographic data and took part in individual, semistructured interviews that were conducted online., Results: The study sample included 15 largely White, married, college-educated men (n = 8, 53%) and women (n = 7, 47%). Qualitative content analysis of interview data revealed three overall themes and associated subthemes: (a) improved access to care, (b) isolation, and (c) feeling normal on buprenorphine., Conclusion: Our findings support a nurse-practitioner-facilitated telehealth treatment program for OUD. However, in a program that offers patient-centered care that does not have a one-size-fits-all approach to service, goals of care must be reevaluated throughout treatment. Moreover, given the increased risk of patients feeling isolated with telehealth appointments and the lack of physical face-to-face interactions, healthcare providers should explore ways to engage patients in meaningful support resources and reduce stigma., Competing Interests: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article., (Copyright © 2021 International Nurses Society on Addictions.)

Aim: To compare the outcomes of a cohort of Crohn's disease (CD) patients undergoing early surgery (ES) to those undergoing initial medical therapy (IMT)., Methods: We performed a review of a prospective database CD patients managed at a single tertiary institution. Inclusion criteria were all patients with ileal or ileocolonic CD between 1995-2014. Patients with incomplete data, isolated colonic or perianal CD were excluded. Primary endpoints included the need for, and time to subsequent surgery. Secondary endpoints included the number and duration of hospital admissions, and medical therapy., Results: Forty-two patients underwent ES and 115 underwent IMT. The operative intervention rate at 5 years in the ES group was 14.2% vs IMT 31.3% (HR = 0.41, 95%CI: 0.23-0.72, P = 0.041). The ES group had fewer hospital admissions per patient [median 1 vs 3 (P = 0.012)] and fewer patients required anti-TNF therapy than IMT (33.3% vs 57%, P = 0.003). A subgroup analysis of 62 IMT patients who had undergone surgery were compared to ES patients, and showed similar 5 year (from index surgery) re-operation rates 16.1% vs 14.3%. In this subset, a significant difference was still found in median number of hospital admissions favouring ES, 1 vs 2 (P = 0.002)., Conclusion: Our data supports other recent studies suggesting that patients with ileocolonic CD may have a more benign disease course if undergoing early surgical intervention, with fewer admissions to hospital and a trend to reduced overall operation rates.