19 research outputs found

    Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

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    PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

    Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

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    PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

    An Analytical Process Model of Two-Party Negotiations

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    Genetic Algorithms for Product Design

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    Product design is increasingly recognized as a critical activity that has a significant impact on the performance of firms. Consequently, when firms undertake a new (existing) product design (redesign) activity, it is important to employ techniques that will generate optimal solutions. As optimal product design using conjoint analysis data is an NP-hard problem, heuristic techniques for its solution have been proposed. This research proposes the use of and evaluates the performance of Genetic Algorithms (GA), which is based on the principles of natural selection, as an alternative procedure for generating "good" (i.e., close to optimal) solutions for the product design problem. The paper focuses on (1) how GA can be applied to the product design problems, (2) determining the comparative performance of GA vis-à-vis the dynamic programming (DP) heuristic (Kohli and Krishnamurti [Kohli, R., R. Krishnamurti. 1987. A heuristic approach to product design. Management Sci. 33(12) 1523--1533.], [Kohli, R., R. Krishnamurti. 1989. Optimal product design using conjoint analysis: Computational complexity and algorithms. Eur. J. Oper. Res. 40 186--195.]) in generating solutions to the product design problems, (3) the sensitivity of the GA solutions to variations in parameter choices, and (4) generalizing the results of the dynamic programming heuristic to product designs involving attributes with varying number of levels and studying the impact of alternate attribute sequencing rules.marketing, product policy, conjoint analysis, heuristics, buyers' welfare

    Evolutionary disruption of S&P 500 trading concentration: An intriguing tale of a financial innovation.

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    The novel finding of Balakrishnan, Miller & Shankar (2008) that investors, overwhelmed by the plethora of stock investment offerings, limit their analysis and daily choices to only a small subset of stocks (i.e., herding behavior) now seems to be common wisdom (Iosebashvili, 2019). We investigate whether the introduction of an innovation in financial products designed to allow investors to trade the entire product bundle of S&P 500 stocks, namely S&P 500 index funds, altered "herding behavior" by creating a new class of index investors. We model the distribution of daily trading concentration as a power law function and examine changes over the last six decades. Intriguingly, we discover a unique pattern in the trading concentration distribution that exhibits two distinct trends. For the period 1960-75, the trading concentration of the S&P 500 stocks tracks the increasing trend for the entire market, i.e., the unevenness in trading has steadily increased. However, after the introduction of S&P 500 index funds in 1975, concentration of trading in the S&P 500 stocks has steadily decreased, i.e., trading distribution has become more even across all 500 stocks, contrary to the current belief of equity analysts. This is also in sharp contrast to the case of U.S. stocks that are not in the S&P 500 index where trading concentration has steadily increased. We further corroborate the uniqueness of the inverted V-shape by a counterfactual investigation of the trading concentration patterns for other sets of 500 stock portfolios. This uniquely distinctive trading concentration pattern for S&P 500 stocks appears to be driven by the increasing dominance of bundle trading by index investors

    Hydrogen-bonding patterns in bis(cytosinium) tartarate monohydrate

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    The asymmetric unit of the title cystosinium salt derivative, 2C4H6N3O+·C4H4O62−·H2O, contains two cytosinium cations, one tartaric acid anion and a water molecule. The two cytosinium cations are almost planar (r.m.s. deviations of the fitted atoms are 0.0151 and 0.0213 Å). The crystal structure features C—H...O, N—H...O and O—H...O interactions. Further C—O...π and π–π interactions are observed along the ab plane, contributing to the crystal stability
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