Radiation therapy prior to a pancreaticoduodenectomy for adenocarcinoma is associated with longer operative times and higher blood loss

BACKGROUND Pancreatic adenocarcinoma is currently the fourth leading cause of cancer-related deaths in the United States.In patients with“borderline resectable”disease,current National Comprehensive Cancer Center guidelines recommend the use of neoadjuvant chemoradiation prior to a pancreaticoduodenectomy.Although neoadjuvant radiotherapy may improve negative margin resection rate,it is theorized that its administration increases operative times and complexity.AIM To investigate the association between neoadjuvant radiotherapy and 30-d morbidity and mortality outcomes among patients receiving a pancreaticoduodenectomy for pancreatic adenocarcinoma.METHODS Patients listed in the 2015-2019 National Surgery Quality Improvement Program data set,who received a pancreaticoduodenectomy for pancreatic adenocarcinoma,were divided into two groups based off neoadjuvant radiotherapy status.Multivariable regression was used to determine if there is a significant correlation between neoadjuvant radiotherapy,perioperative blood transfusion status,total operative time,and other perioperative outcomes.RESULTS Of the 11458 patients included in the study,1470(12.8%)underwent neoadjuvant radiotherapy.Patients who received neoadjuvant radiotherapy were significantly more likely to require a perioperative blood transfusion[adjusted odds ratio(aOR)=1.58,95%confidence interval(CI):1.37-1.82;P<0.001]and have longer surgeries(insulin receptor-related receptor=1.14,95%CI:1.11-1.16;P<0.001),while simultaneously having lower rates of organ space infections(aOR=0.80,95%CI:0.66-0.97;P=0.02)and pancreatic fistula formation(aOR=0.50,95%CI:0.40-0.63;P<0.001)compared to those who underwent surgery alone.CONCLUSION Neoadjuvant radiotherapy,while not associated with increased mortality,will impact the complexity of surgical resection in patients with pancreatic adenocarcinoma.

Wedding Ceremony EncounteredThree Times a Day

Having taken a night’s rest after our arrival at Likeng Village in Wuyuan County of Jiangxi Province, we were attracted to the riverside at the village entrance by bursts of firecrackers and the sound of gongs and drums. Both banks of the river were crowded with locals and tourists. Many women who had been washing clothes were crowded under a small bridge. They were wielding wooden clubs while talking and laughing loudly. It turned out that this was the day parents

ON SOLUTIONS OF BACKWARD STOCHASTIC DIFFERENTIAL EQUATIONS WITH JUMPS, WITH UNBOUNDED STOPPING TIMES AS TERMINAL AND WITH NON-LIPSCHITZ COEFFICIENTS, AND PROBABILISTIC INTERPRETATION OF QUASI-LINEAR ELLIPTIC TYPE INTEGRO- DIFFERENTIAL EQUATIO

The existence and uniqueness of solutions to backward stochastic differential equations with jumps and with unbounded stopping time as terminal under the non_Lipschitz condition are obtained. The convergence of solutions and the continuous dependence of solutions on parameters are also derived. Then the probabilistic interpretation of solutions to some kinds of quasi_linear elliptic type integro_differential equations is obtained.

Emergency Department Waiting Times and Determinants of Prolonged Length of Stay in a Botswana Referral Hospital

Introduction: Emergency medicine is a critical component of quality public health service. In fact length of stay and waiting times in the Emergency department are key indicators of quality. The aim of this study was to determine waiting times and determinants of prolonged length of stay (LOS) in the Princess Marina Hospital Emergency Department. Methods: This was a retrospective observational study. It was done at Princess Marina, a referral hospital in Gaborone, Botswana. Triage forms of patients who presented between 19/11/ 2018 and 18/12/2018 were reviewed. Data from patient files was used to determine time duration from triage to being reviewed by a doctor, time duration from review by emergency doctor to patients’ disposition and the time duration from patient’s triage to disposition (length of stay). Prolonged length of stay was defined as duration > 6 hours. Results: A total of 1052 files repre- senting patients seen over a 1-month period were reviewed. 72.5% of the patients had a prolonged length of stay. The median emergency doctor waiting time was 4.5 hours (IQR 1.6 - 8.3 hours) and the maximum was 27.1 hours. The median length of stay in the emergency department was 9.6 hours (IQR 5.8 - 14.6 hours) and the maximum was 45.9 hours. Patient’s age (AOR 1.01), mental status (AOR 0.61), admission to internal medicine service (AOR 5.12) and pediatrics admissions (AOR 0.11) were significant predictors of prolonged length of stay in the emergency department. Conclusion: Princess Marina Hospital emergency department waiting times and length of stay are long. Age, normal mental status and internal medicine admission were independent predictors of prolonged stay (>6 hours). Admission to the pediatrics service was associated with shorter length of stay. There is a need for interventions to address the long waiting times and length of stay. Interventions should particularly focus on the identified predictors.

Waiting Times and Length of Stay of Trauma Patients in a Botswana Referral Hospital Emergency Department

Background: Mortality and morbidity due to trauma are a significant public health challenge. There is paucity of data on the waiting times and length of stay (LOS) of trauma patients in emergency departments in Botswana. The aim of this study was to determine the Emergency Department (ED) waiting times and LOS of trauma patients at Princess Marina Hospital in Gaborone, Botswana. Methods: This was a retrospective medical records review of waiting times (time from triage to review by ED medical officer) and LOS (time from triage to disposition from the emergency department). The waiting times for the different assigned acuities were assessed against the South African Triage System (SATS) standards. All trauma patients seen from 19/11/2018 to 18/12/2018 were included in the study. Prolonged length of stay was defined as duration > 6 hours. Categorical data was summarized with frequencies while numeric data was summarized with medians and interquartile ranges. Results: A total of 187 trauma patients’ files were analyzed. Of these, 72 (38.5%) were females. The median waiting time was 3.8 hours and the maximum was 19.2 hours. The median length of stay (LOS) was 8.8 hours with a maximum of 37.2 hours. Only 53 (28.3%) of the participants had a LOS of less than 6 hours. None of the emergent patients were seen immediately. Only 5 (4.0%) of the very urgent patients were seen within the target of 10 minutes. Finally, only 10 (20.4%) of urgent patients were seen within the target time of 1 hour. Conclusion: The waiting times and length of stay in Princess Marina Hospital were mostly above the recommended standards. Urgent interventions are needed to reduce waiting times and length of stay for trauma patients. More studies are needed to explore the sources of delay and investigate possible solutions to this public health challenge.

Online scheduling of jobs with kind release times and deadlines on a single machine

This paper studies online scheduling of jobs with kind release times on a single machine. Here "kind release time" means that in online setting, no jobs can be released when the machine is busy. Each job J has a kind release time r(J) ≥ 0, a processing time p(J) > 0 and a deadline d(J) > 0. The goal is to determine a schedule which maximizes total processing time( p(J)E(J)) or total number( E(J)) of the accepted jobs. For the first objective function p(J)E(J), we first present a lower bound 2(1/2), and then provide an online algorithm LEJ with a competitive ratio of 3. This is the first deterministic algorithm for the problem with a constant competitive ratio. When p(J) ∈ {1, k}, k > 1 is a real number, we first present a lower bound min{(1 + k)/k, 2 k/(1 + k)}, and then we show that LEJ has a competitive ratio of1 + k/k. In particular, when all the k length jobs have tight deadlines, we first present a lower bound max{4/(2 + k), 1}(for p(J)E(J)) and 4/3(for E(J)). Then we prove that LEJ is k/k-competitive for p(J)E(J) and we provide an online algorithm H with a competitive ratio of 2 k/( k + 1) for the second objective function E(J).

MOMENTS OF PASSAGE TIMES AND ASYMPTOTIC BEHAVIOR OF INCREASING SELF-SIMILAR MARKOV PROCESSES

By using Lamperti＇s bijection between self-similar Markov processes and L@vy processes~ we prove finiteness of moments and asymptotic behavior of passage times for increasing self-similar Markov processes valued in （0, ~）. We Mso investigate the behavior of the process when it crosses a level. A limit theorem concerning the distribution of the process immediately before it crosses some level is proved. Some useful examples are given.

泰克TPS2000示波器荣获EE Times ACE电子发明奖——被EE Times和eeProductCenter读者和编辑评选为2004年“最优秀的产品”

2005年3月24日泰克公司宣布TPS2000系列数字存储示波器(DSO)已经荣获EE Times每年电子发明(ACE)奖。

Waiting times and stopping probabilities for patterns in Markov chains

Suppose that C is a finite collection of patterns. Observe a Markov chain until one of the patterns in C occurs as a run. This time is denoted by τ. In this paper, we aim to give an easy way to calculate the mean waiting time E(τ) and the stopping probabilities P(τ = τA)with A ∈ C, where τA is the waiting time until the pattern A appears as a run.

Estimation of Residence Times and Recharge Area of Groundwater in the Moulares Mining Basin by Using Carbon and Oxygen Isotopes (South Western Tunisia)

Radiogenic carbon (14C) of the DIC (Dissolved Inorganic Carbon) and oxygen-18 were used to understand the hydro- dynamic functioning of the multilayer aquifer system in the Moulares mining basin, southern Tunisia. The results of this study permits identify two groundwater types. A- an old paleoclimatic groundwater, marked by low carbon-14 (14C) activities. B - a recent groundwater, was distinguished by relatively high carbon-14 activities. In addition to these two water types, other groundwater, indicating a mixing effect, is resulting presumably from upward movement from the deeper groundwater. Based on 14C activity and the piston flow type theory the groundwater residence time varies from 5 Kyear to 35 Kyear. Carbon-14 activity and oxygen-18 in Groundwater are active since Mio-Plio-Quaternary and Upper Cretaceous aquifers lead to the identification of paleorecharged water probably during Late Pleistocene and Early to Middle Holocene. The water feedings of these aquifers are mainly provided by infiltration of precipitations, infiltration of irrigation water, lateral feeding from cretaceous relieves from the South and the North and along recent and fossil drainage networks that constitute major fresh water sources in groundwater tables.

The Effect of Hydraulic Retention Times and Loading Rates on the Removal of Pollutants from Fish Processing Wastewater by Anaerobic Process

Anaerobic treatment model treats fish processing wastewater to be necessary for a small and medium factory that is very popular in Vietnam and other countries.Several techniques have been proposed.However,they are quite expensive and hard to operate,especially in remote areas.In this study,the hydraulic retention times(HRT)including 3,5,and 7 hours with a various organic loading rate of 1.5 to 6.5 kg COD/m3/day were investigated.Biomass concentration as mix-liquor volatile suspended solid(MLVSS)in the model is at 6,000 to 9,000 mg/L.On the basis of the result the optimal HRT with a 4.0 kg COD/m3/day organic loading rate was 8 hours which BOD5,COD removal efficiency were 92.18,87.36 percent respectively.By the end of the optimal hydraulic retention times,the total methane gas volume as a by-product was collected with 2.6 liters.

Reproductive Development of Lotus tenuis (Fabaceae) Crop Defoliated at Different Times and Intensities

Lotus tenuis forage yield has been quantified under defoliation conditions in pastures, grasslands and under dual-purpose production of both livestock forage and seeds. However, little is known about the effects of defoliation management on L. tenuis flower and pod production and subsequent seed yield. Two field experiments were conducted to study the response of L. tenuis to defoliation at different flowering stages and intensities. In Experiment 1, crops were defoliated at the beginning of the flowering (DBF), mid-flowering (DMF) or full flowering (DFF). In Experiment 2, defoliation was in vegetative stage at low (LDI) or high (HDI) intensities. Defoliation in Experiment 1 neither affected plant cover nor the photosynthetically active radiation intercepted by the crop during pod production. There were less umbels with dehiscent (shattered) pods in the DFF treatment than in Control, DBF and DMF treatments. Flower peak occurred first in the Control, DBF and DMF treatments, and eight days later in DFF plots, however, seed yield was not affected (1324 ± 32.8 kg·ha-1). Defoliation intensity did not affect seed yield (962 ± 25.9 kg·ha-1) because of self-compensation which increased harvest index in HDI (14.5% ± 0.6%) compared to the Control and LDI (12.0% ± 0.3%) treatments. Plant survival was not affected by defoliation treatments in any of the experiments. Flowering can be synchronized through defoliation. The blooming of large numbers of flowers in a short time was achieved, reducing the number of shattered pods. Compensatory responses through plant plasticity conferred L. tenuis the ability to overcome defoliation without affecting seed yield. Lotus tenuis defoliation as management tool will be considered in future researches because it is possible to harvest forage and to increase seed yield through a reduction of shattered pods.

Patron Survey of Acceptable Wait Times at Transit Bus Stops in the District of Columbia

The wait time of bus patrons at bus stops is one of several measures for assessing reliability of transit services, especially in urban areas. The uncertainty associated with waiting affects bus patrons’ perception of quali of the service provided. Studies in this subject area have therefore been of interest to transit service agencies and officials. This paper presents the findings of a study conducted to determine patrons’ maximum acceptable wait times (beyond the scheduled arrival time) at bus stops in an urban area. In all, 3387 bus patrons at 71 selected bus stops were surveyed over a period of 9 months. The results of the survey showed that the least acceptable wait time beyond the scheduled arrival time was 1 minute, while the maximum acceptable wait time was reported to be 20 minutes. Also, only one-third (33%) of the total number of patrons surveyed were willing to wait up to 5 minutes beyond the scheduled arrival time of buses. In addition, patrons are willing to wait longer in warm weather. On average, white patrons were found to have the least maximum acceptable wait times, followed by Hispanics, Asians, and then Blacks.

SINGLE MACHINE SCHEDULING WITH CONTROLLABLE PROCESSING TIMES AND COMPRESSION COSTS （PART I：EQUAL TIMES AND COSTS）

Abstract Most papers in scheduling research have treated individual job processing times as fixed parameters. However, in many practical situations, a manager may control processing time by reallocating resources. In this paper, authors consider a machine scheduling problem with controllable processing times. In the first part of this paper, a special case where the processing times and compression costs are uniform among jobs is discussed. Theoretical results are derived that aid in developing an O(n 2) algorithm to slove the problem optimally. In the second part of this paper, authors generalize the discussion to general case. An effective heuristic to the general problem will be presented.

SINGLE MACHINE SCHEDULING WITH CONTROLLABLE PROCESSING TIMES AND COMPRESSION COSTS ： PROOF OF THEOREMS

Abstract This report is virtually the appendix part of the author's previous paper which includes the proofs for the theorems and lemmas.

RL and AHP-Based Multi-Timescale Multi-Clock Source Time Synchronization for Distribution Power Internet of Things

Time synchronization(TS)is crucial for ensuring the secure and reliable functioning of the distribution power Internet of Things(IoT).Multi-clock source time synchronization(MTS)has significant advantages of high reliability and accuracy but still faces challenges such as optimization of the multi-clock source selection and the clock source weight calculation at different timescales,and the coupling of synchronization latency jitter and pulse phase difference.In this paper,the multi-timescale MTS model is conducted,and the reinforcement learning(RL)and analytic hierarchy process(AHP)-based multi-timescale MTS algorithm is designed to improve the weighted summation of synchronization latency jitter standard deviation and average pulse phase difference.Specifically,the multi-clock source selection is optimized based on Softmax in the large timescale,and the clock source weight calculation is optimized based on lower confidence bound-assisted AHP in the small timescale.Simulation shows that the proposed algorithm can effectively reduce time synchronization delay standard deviation and average pulse phase difference.

Achieving Common Development in Step with the Times

As long as China and the EU adhere to strategic consensuses,keep in step with the times,and maintain mutual trust,they will be able to ensure the prosperity and stability of both sides.

Communication Resource-Efficient Vehicle Platooning Control With Various Spacing Policies

Platooning represents one of the key features that connected automated vehicles may possess as it allows multiple automated vehicles to be maneuvered cooperatively with small headways on roads. However, a critical challenge in accomplishing automated vehicle platoons is to deal with the effects of intermittent and sporadic vehicle-to-vehicle data transmissions caused by limited wireless communication resources. This paper addresses the co-design problem of dynamic event-triggered communication scheduling and cooperative adaptive cruise control for a convoy of automated vehicles with diverse spacing policies. The central aim is to achieve automated vehicle platooning under various gap references with desired platoon stability and spacing performance requirements, while simultaneously improving communication efficiency. Toward this aim, a dynamic event-triggered scheduling mechanism is developed such that the intervehicle data transmissions are scheduled dynamically and efficiently over time. Then, a tractable co-design criterion on the existence of both the admissible event-driven cooperative adaptive cruise control law and the desired scheduling mechanism is derived. Finally, comparative simulation results are presented to substantiate the effectiveness and merits of the obtained results.

Association of daily sitting time and leisure-time physical activity with body fat among U.S.adults

Background:Prolonged sitting and reduced physical activity lead to low energy expenditures.However,little is known about the joint impact of daily sitting time and physical activity on body fat distribution.We investigated the independent and joint associations of daily sitting time and physical activity with body fat among adults.Methods:This was a cross-sectional analysis of U.S.nationally representative data from the National Health and Nutrition Examination Survey2011-2018 among adults aged 20 years or older.Daily sitting time and leisure-time physical activity(LTPA)were self-reported using the Global Physical Activity Questionnaire.Body fat(total and trunk fat percentage)was determined via dual X-ray absorptiometry.Results:Among 10,808 adults,about 54.6%spent 6 h/day or more sitting;more than one-half reported no LTPA(inactive)or less than 150 min/week LTPA(insufficiently active)with only 43.3%reported 150 min/week or more LTPA(active)in the past week.After fully adjusting for sociodemographic data,lifestyle behaviors,and chronic conditions,prolonged sitting time and low levels of LTPA were associated with higher total and trunk fat percentages in both sexes.When stratifying by LTPA,the association between daily sitting time and body fat appeared to be stronger in those who were inactive/insuufficiently active.In the joint analyses,inactive/insuufficiently active adults who reported sitting more than 8 h/day had the highest total(female:3.99%(95%confidence interval(95%CI):3.09%-4.88%);male:3.79%(95%CI:2.75%-4.82%))and trunk body fat percentages(female:4.21%(95%CI:3.09%-5.32%);male:4.07%(95%CI:2.95%-5.19%))when compared with those who were active and sitting less than 4 h/day.Conclusion:Prolonged daily sitting time was associated with increased body fat among U.S.adults.The higher body fat associated with 6 h/day sitting may not be offset by achieving recommended levels of physical activity.