Dispute avoidance procedure: observing the influence of legal culture towards a workable legal system

It is pertinent to specifically conduct research on the viability of introducing dispute avoidance procedure (DAP) for construction industry due to the lack of research in this area, as most of the current research covers various issues within dispute resolution procedure and management field. The objective of this study is to examine the future of DAP in the Malaysian construction industry by looking into the perceptions of the construction industry players. Data were collected through interview of selected respondents and analyses to reveal patterns to help formulate a viable DAP mechanism. NVivo software has been used to manage and organise complete interview transcripts and facilitate data analysis process for this study. This study reveals that the existing DAP mechanisms are not viable for the Malaysian construction industry at present, mainly due to the issue of costing. Thus, a modified version of DAP was formulated to promote a viable mechanism. This study suggests that the structural elements of a viable DAP mechanism could be in the form of an 'involvement of top management' from both contracting parties (without the involvement of any third parties) who are decision makers or persons with financial authority, and the process is through 'discussion and negotiation'. In essence, this study captures the legal culture and trade usage of the industry which assisted the formulation of a viable DAP mechanism

Discrete-event simulation for outpatient flow and emergency patient arrival in a haemodialysis unit

Emergency cases among dialysis patients are uncertain and if these patients failed to obtain treatment within allocated treatment, it might risk their health conditions. In relation to that, we would like to accommodate outpatients together with the emergency patients in patient scheduling problem. Discrete-event simulation is used to estimate the outpatients flow based on the mean arrival rate, ». A modified integer linear programming model is presented in this paper which highlighted on the patients arrival time, patients departure time and bed availability for emergency case. A rescheduling algorithm is also presented to accommodate existing outpatients and emergency patients. The results show that by rescheduling the existing outpatients and emergency patients in the system, there is no delaying for the outpatients dialysis treatment. Hence, the emergency patients are able to accommodate in the system

Local search heuristics for elective surgery scheduling considering patient urgency

This paper study a surgery scheduling and surgeon assignment problem in operating rooms focusing on elective patients with different urgency. A long waiting time can increase the patient’s urgency and lead to health complication. Our aim is to maximize the sum of the urgency values assigned to each surgery. An integer linear programming model is referred to solve the problem. As the model consume a high computational time to solve for a large-scale instance, we developed a local search algorithm based on a simple heuristic to deal with the problem. To test the efficiency of our proposed heuristics, we compare the solutions of integer linear programming model with the heuristics. The results show that solutions obtained by the local search algorithm are good quality and has significantly reduce the computational time even when considering more surgeries in the waiting list

Multicenter Phase 2 Trial of Sirolimus for Tuberous Sclerosis: Kidney Angiomyolipomas and Other Tumors Regress and VEGF- D Levels Decrease

Tuberous sclerosis (TSC) related tumors are characterized by constitutively activated mTOR signaling due to mutations in TSC1 or TSC2.We completed a phase 2 multicenter trial to evaluate the efficacy and tolerability of the mTOR inhibitor, sirolimus, for the treatment of kidney angiomyolipomas.36 adults with TSC or TSC/LAM were enrolled and started on daily sirolimus. The overall response rate was 44.4% (95% confidence intervals [CI] 28 to 61); 16/36 had a partial response. The remainder had stable disease (47.2%, 17/36), or were unevaluable (8.3%, 3/36). The mean decrease in kidney tumor size (sum of the longest diameters [sum LD]) was 29.9% (95% CI, 22 to 37; n = 28 at week 52). Drug related grade 1-2 toxicities that occurred with a frequency of >20% included: stomatitis, hypertriglyceridemia, hypercholesterolemia, bone marrow suppression (anemia, mild neutropenia, leucopenia), proteinuria, and joint pain. There were three drug related grade 3 events: lymphopenia, headache, weight gain. Kidney angiomyolipomas regrew when sirolimus was discontinued but responses tended to persist if treatment was continued after week 52. We observed regression of brain tumors (SEGAs) in 7/11 cases (26% mean decrease in diameter), regression of liver angiomyolipomas in 4/5 cases (32.1% mean decrease in longest diameter), subjective improvement in facial angiofibromas in 57%, and stable lung function in women with TSC/LAM (n = 15). A correlative biomarker study showed that serum VEGF-D levels are elevated at baseline, decrease with sirolimus treatment, and correlate with kidney angiomyolipoma size (Spearman correlation coefficient 0.54, p = 0.001, at baseline).Sirolimus treatment for 52 weeks induced regression of kidney angiomyolipomas, SEGAs, and liver angiomyolipomas. Serum VEGF-D may be a useful biomarker for monitoring kidney angiomyolipoma size. Future studies are needed to determine benefits and risks of longer duration treatment in adults and children with TSC.Clinicaltrials.gov NCT00126672

Comparing O’Brien test using mean, median, symmetric and asymmetric trimmed mean

The assumption of homogeneity of variances can be tested with O’Brien procedure since it is compatible with standard analysis of variance (ANOVA). The test is very sensitive to non-normality which lead to find the alternative technique by replacing the original test with the robust measure of location. This study will investigate the behaviour of O’Brien test on robustness by using the usual variances on mean, median, symmetric trimmed and asymmetric trimmed mean under normal distribution and skewed normal distributions. The results show that O’Brien test is robust when data is distributed at normal and skewed normal under certain simulation study condition

Solving overbooking appointment scheduling problem under patient no show condition using heuristics procedure and genetic algorithm

The existence of an efficient appointment schedule is important in the healthcare system since it can minimize patient waiting time, resource idle time, and resource overtime and, hence, optimize the utilization and productivity of healthcare organization. In this research, the overbooking technique is implemented to compensate for patient no-show behavior. The aims of this research are to identify the maximum number of patients that can be assigned to a time slot by examining the effects of multiple assignment and to construct a near-optimal overbooking appointment schedule. Heuristics procedure and genetic algorithm are used in this research. From the results obtained, the number of patients that can be assigned to a time slot is found to be at most three. This information can reduce the conflict which may occur when the patients arrive simultaneously. The results also show that the genetic algorithm has a better performance than the heuristics procedure in solving this problem

Modified multivariate cumulative sum control chart based on robust estimators

Integrate several robust approaches to the classical MCUSUM control chart. These approaches used robust location and scale estimator to substitute the usual mean and covariance matrix, respectively into the classical MCUSUM. The two robust location estimators used are the modified one-step M estimator (MOM) and Hodges Lehmann estimator (HL). Then, a scale estimator named Madn was introduced and functioned accordingly to the robust location estimators. Altogether, two robust MCUSUM control charts were proposed

Simulated annealing approach for outpatient scheduling in a haemodialysis unit

National Renal Registry Malaysia has reported that the dialysis treatment demand among chronic kidney and end-stage kidney disease patients rises yearly. However, available haemodialysis (HD) units have limited facilities to meet the current and increasing demand. This leads to congestion, long waiting times, and an increase in the duration of treatment (DOT) among HD patients during their treatment sessions. Two essential factors in providing optimal treatment plans are outpatient scheduling and nurse assignment. Therefore, the objectives of this study are to minimise patients’ total DOT, including the waiting time for pre-dialysis and post-dialysis sessions, which also includes determining the amount of patient flow in an HD unit. Regarding the first objective, we include simulated annealing (SA) into our simple heuristics (SH) in the patient scheduling optimisation model. Here, the initial solution obtained from the method can be improved. The backtracking heuristic (BH) is then applied to the nurse assignment problem, where at least two nurses are needed for each dialysis patient. The results show that the solutions obtained for outpatient scheduling by SA are efficient and have significantly reduced the computational time compared with the SH, even when considering more patients on the waiting list. As for total DOT, we obtain the optimum value compared to the average DOT values for both 3-hour and 4-hour sessions. Besides, a discrete-event simulation (DES) experiment of patient flow in an HD unit was performed by gradual variations in patient arrival rates, λ, to avoid congestion in the system. DES has the potential to accommodate emergency patients that seek HD treatment without causing much disruption to the system

Double solutions and stability analysis of slip flow past a stretching/shrinking sheet in a carbon nanotube

A stagnation point flow past a stretching/shrinking surface in carbon nanotubes (CNTs) with slip effects is investigated in this paper. Applying transformations of similarity, the governing partial differential equations are modified to the nonlinear ordinary differential equations. Afterward, they are numerically solved in Matlab by the bvp4c solver. The single-wall CNTs and multi-wall CNTs are used, including water as a base fluid. The effects of the flow parameters are investigated, shown in the form of graphs, and physically evaluated for the dimensionless velocity, temperature, skin friction, and Nusselt numbers. According to our findings, the unique solution exists for stretching sheets, whereas non-unique solutions are obtainable for shrinking sheets. The stability analysis is utilized to discover which solution is stable

Effect of magnetohydrodynamic Casson fluid flow and heat transfer past a stretching surface in porous medium with slip condition

Abstract In this paper, we investigate the flow of magnetohydrodynamic Casson fluid over a linear stretching surface in porous medium with slip condition. The governing partial differential equations are reduced to non-linear ordinary differential equations with the aid of similarity transformation. The transformed equations and boundary conditions are then solved by using exact analytical method. The flow field is affected by the presence of physical parameters, such as Casson fluid parameter, magnetohydrodynamic parameter, velocity slip parameter, porosity parameter, and suction/injection, whereas the temperature field is additionally affected by magnetohydrodynamic, thermal radiation, Prandtl and Eckert numbers. The effects of the pertinent physical parameters on the velocity and temperature fields are presented through graphs and discussed. Skin friction and heat transfer coefficients are tabulated and analyzed.</jats:p