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A heuristic procedure based on tabu search (TS) and intelligent memory structures is developed to solve the problem of audit staff scheduling. The TS method works by developing a feasible schedule derived from a greedy forward dispatching procedure. It then improves on the initial schedule by conducting a series of intensification and diversification procedures. Test results reveal that the method can be used in highly constrained scheduling problems that include rigid precedence relations and impacted completion times and resources.

Incentives and productivity improvement (PI) are intertwined. Often, we ask what incentive program should be introduced to achieve a certain level of PI, and what is its minimal cost; or conversely, for a given incentive program, what is the maximum achievable PI? Incentives can be extended to any combination of customers, management, production staff, sales staff, and delivery staff, among others. What is the share of each of these segments in the incentive program and what is the yield for such a program in terms of productivity improvement? The answers to these questions and others are the subject of this paper. Relations between incentives of the various segments of the operation, productivity improvement, costs and earnings are determined. These relations are then used to model the problem as a nonlinear program. The solution of the model provides answers to the above questions. The solution enables us to distribute some of the extra earnings, generated from the resulting PI, among the parties contributing to productivity improvement. This method has been applied to the operation of a firm specialized in the production of ready-mixed concrete. [ABSTRACT FROM AUTHOR]

Background: Serial monitoring of dd-cfDNA and change from baseline can provide meaningful information beyond absolute thresholds. We describe dd-cfDNA trajectories from the baseline before and after acute rejection (AR) and de novo donor-specific antibodies (dnDSA) detection in kidney transplant recipients (KTRs)., Methods: We included KTR from 02/2019 to 03/2022 with serial dd-cfDNA. The primary analysis compared the time-varying change in dd-cfDNA from baseline in KTR first AR on biopsy [AR] to patients with no-AR on biopsy [no-AR]., Results: 151 KTR were analyzed (AR = 56 KTR, no-AR = 95 KTRs). In the AR group, dd-cfDNA rose ahead of diagnosis: median rise from baseline was 75% at -3 months, 32% at -2 months, and 325% at -1 month before biopsy. At the time of biopsy, the median rise in dd-cfDNA from baseline was 291% (IQR [interquartile range] 88%-1081%) in AR and 17% (IQR 0%- 194%) in no-AR (p < 0.0001). Following treatment, dd-cfDNA values fell in the AR group with a median change from baseline of 94.7% at +1 month, 10.5% at +2 months, and 0% at +3 months. These trajectories were not observed in the no-AR group. Similarly, there were no significant differences in eGFR (estimated glomerular filtration rate) trajectories between the two groups. The median change from baseline to dnDSA detection was 141% (IQR 112%-574%). In KTRs with persistent rejection, median dd-cfDNA was 0.95% (IQR 0.44-1.8) compared to 0.19% (IQR 0.12-0.31) in subjects with no rejection on follow-up (p < 0.001)., Conclusion: The significant changes from baseline observed before and after AR show how serial monitoring enhances dd-cfDNA utility and allows for earlier identification of evolving injury and monitoring treatment response., (© 2024 The Author(s). Clinical Transplantation published by Wiley Periodicals LLC.)

Background: There are limited data about the risk factors for weight changes and the association of significant weight changes with graft and metabolic outcomes after simultaneous pancreas and kidney (SPK) transplantation., Methods: We included all SPK recipients with both allografts functioning for at least 6 mo post-transplant and categorized them based on the weight changes from baseline to 6 mo post-transplant. We analyzed risk factors for significant weight gain (SWG) and significant weight loss (SWL) over 6 mo post-transplant, as well as outcomes including pancreas uncensored graft failure, pancreas death-censored graft failure (DCGF), composite pancreas graft outcomes of DCGF, use of an antidiabetic agent, or hemoglobin A1C >6.5%, and kidney DCGF., Results: Of 280 SPK recipients, 153 (55%) experienced no significant weight change, 57 (20%) SWG, and 70 (25%) SWL. At 6 mo post-transplant, mean weight changes were 1.2% gain in the no significant weight change group, 13.4% gain in SWG, and 9.6% loss in the SWL groups. In multivariate analysis, the only factor associated with decreased risk for weight gain was older recipient age (aOR, 0.97; 95% confidence intervals, 0.95-0.99). Importantly, SWG or SWL were not associated with pancreas graft failure, P-DCGF, or K-DCGF. Interestingly in the adjusted model, SWG at 6 mo was associated with a lower risk for composite outcomes (HR, 0.35; 95% confidence intervals, 0.14-0.85)., Conclusions: Forty-five percent of SPK recipients had significant weight changes by 6 mo post-transplant, but only 20% exhibited SWG. Likely because of proper management, weight changes were not associated with poor outcomes post-SPK transplant., (Copyright © 2024 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc.)

Backgrounds: Pancreatic beta cell function and islet autoantibodies classically distinguish types of diabetes (type 1 diabetes mellitus [DM] or type 2 DM). Here, we sought to evaluate simultaneous pancreas-kidney (SPK) transplant outcomes stratified by the presence or absence of beta cell function and autoantibodies., Methods: SPK recipients were eligible if pretransplant autoantibodies were measured against insulin, islet cell, or glutamic acid decarboxylase 65-kD isoform. Recipients were categorized as A + or A - based on the detection of ≥1 autoantibodies. Recipients were similarly categorized on the basis of detectable pretransplant fasting C-peptide of ≥2 ng/mL (β + ) or <2 ng/mL (β - ). Thus, recipients were categorized into 4 groups: A + β - , A - β - , A - β + , and A + β + . Outcomes of interest were overall pancreas graft failure (non-death-censored), death-censored pancreas, or kidney graft failure (death-censored pancreas graft failure [DCGF]; kidney DCGF), composite outcomes with any of the 3 outcomes as pancreas DCGF, use of an antidiabetic agent, or hemoglobin A1c >6.5., Results: One hundred eighty-three SPK recipients were included: A + β - (n = 72), A - β - (n = 42), A - β + (n = 49), and A + β + (n = 20). We did not detect a statistical difference in non-death-censored pancreas graft failure for A + β - recipients compared with other groups: A - β - (adjusted hazard ratio [aHR]: 0.44; 95% confidence interval [CI], 0.14-1.42), A - β + (aHR: 1.02; 95% CI, 0.37-2.85), and A + β + (aHR: 0.67; 95% CI, 0.13-3.33) in adjusted analyses. Similar outcomes were observed for other outcomes., Conclusions: In SPK recipients, outcomes were similar among recipients with classic features of type 1 DM and various other types of DM., (Copyright © 2024 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc.)

Frailty is commonly assessed during kidney transplant recipient (KTR) evaluation. However, individual frailty components may have varying impact on post-transplant outcomes. In this single-center study of 825 KTRs, we determined the association between the individual components of a modified Fried frailty score and delayed graft function (DGF), early hospital readmission (EHR), cardiovascular (CV) events, acute rejection (AR), death censored graft failure (DCGF), and death. Sum frailty ≥3 was significantly associated with EHR (aOR = 3.62; 95% CI: 1.21-10.80). Among individual components, only grip strength was significantly associated with EHR (aOR = 1.54; 95% CI: 1.03-2.31). The addition of grip strength to a model with the other four components resulted in Net Reclassification Improvement (NRI) of 20.51% (p = .01). Similarly, only grip strength was significantly associated with CV events (aOR = 1.79; 95% CI: 1.12-2.86). The addition of grip strength to a model with the other four components resulted in NRI of 27.37% (p = .006). No other frailty components were associated with the outcomes of interest. Based on our findings, handgrip strength may be an important tool while assessing frailty, mainly predicting early readmission and cardiovascular events post-transplant., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Introduction: Patients with end-stage renal disease (ESRD) are at a higher risk of needing hip or knee replacement (joint replacement) surgery due to the high prevalence of degenerative joint disease and other conditions. However, there remains a large debate about the timing of joint replacement surgery and whether it should be pre- vs post-transplant., Methods: We conducted a retrospective study analyzing all adult kidney transplant recipients (KTRs) at our university hospital who had undergone subsequent joint replacement between 2001 and 2017. Transplant-specific outcomes of acute rejection, death censored graft failure (DCGF), and patient death post-joint replacement surgery were outcomes of interest. Controls were selected at a 1:3 ratio based on the incidence density sampling of post-transplant interval., Results: There were 101 KTRs in the joint replacement group and were compared with 281 controls. In the multivariate analysis, the need for joint replacement was not associated with acute rejection (HR: 1.59; 95% CI: 0.77-3.29; P = 0.21); DCGF (HR: 0.89; 95% CI: 0.49-1.60; P = 0.70) or patient death (HR: 0.84, 95% CI: 0.55-1.38, P = 0.42)., Conclusion: In selected KTRs, joint replacement surgery was not associated with detrimental transplant-specific outcomes., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Introduction: BK polyomavirus (BKV) is a common infection among kidney transplant recipients (KTR). Risk factors and outcomes based on donor characteristics remain largely unknown., Methods: In this study, we aimed to analyze the impact of donor factors through a paired kidney analysis. We included 289 pairs of adult deceased donor transplants (578 KTRs total); each pair had received kidneys from the same donor. Recipient pairs were divided into three groups: "no BK group" if neither KTR developed BK viremia (n = 336), "discordant" if the only one did (n = 176), and "concordant" if both did (n = 66). Acute rejection (AR), graft failure, and BK nephropathy (BKN) were outcomes of interest., Results: Donors in the concordant group were younger, had lower kidney donor profile index (KDPI), and were less likely to be donor after circulatory death (DCD). In multivariate analyses, KTRs who had a donor with a higher body mass index (BMI) (hazard ratio (HR): 0.97; 95% confidence interval (CI): 0.95-0.99; p = .009) were less likely to develop BKV. Concordance was not associated with AR (HR: 0.83; 95% CI: 0.51-1.34; p = .45), graft failure (HR: 1.77; 95% CI: 0.42-7.50; p = .43), or BKN (HR: 1.02; 95% CI: 0.51-2.03; p = .96)., Discussion: Our study suggests lower donor BMI is associated with BKV infection, and concordance or discordance between paired kidney recipients is not associated with poor outcomes., (© 2021 Wiley Periodicals LLC.)

Jordan, a Middle Eastern country, initially responded to an outbreak of COVID-19 cases within its own borders by imposing a 7-week strict lockdown and closure of international and domestic travel. Such measures drastically influenced lifestyle behaviors of the population. This study aimed to investigate the prevalence of physical activity, and its association with mental and sleep health outcomes among Jordanians during a period of COVID-19 induced lockdown. Validated questionnaires were administered using a web-based platform to evaluate moderate-to-vigorous physical activity (MVPA), anxiety and depressive symptoms, sleep health, and sociodemographic characteristics. A modified Poisson regression model with robust error variance was used to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs). Compared to participants who met the guidelines, those who did not had significantly higher prevalence of moderate or severe anxiety symptoms than that of minimal or mild anxiety symptoms and increased depressive symptoms. Insufficient MVPA was associated with higher prevalence of poor sleep quality, short sleep duration (<7 h) and sleep problems. Overall, sufficient MVPA was associated with better mental and sleep health during the COVID-19 induced nation-wide lockdown in Jordan. While further research is necessary, promoting physical activity during the lockdown could potentially improve mental and sleep health outcomes among the population.