The development of a structure for the design of hazard audits.

Hazard auditing, which is a formal, systematic, critical examination of a situation or set of circumstances to identify hazards, is fundamental to hazard management. Auditing is facilitated by "an audit" that details activities, procedures, systems and artefacts, where hazards might be identified. This thesis describes the development of a structure, in the form of a hierarchy, that can be used in the design of hazard audits. An examination of systems such as manufacturing and process plants, for hazards, is usually undertaken by examining the subsystems, (i.e. activities, systems, and procedures). Existing audits therefore, tend to be specific, as for example, audits of unsafe acts, unsafe conditions, technical functioning of materials and machinery, management. This type of audit restricts the examination to a closed system within observable and well described physical and organisational boundaries. It is argued in this thesis that examinations for hazards should go beyond this closed system and also look for hazards within the larger systems of society and industry. An examination of hazards can be seen as a search for evidence of proneness to failure. The hierarchy developed in this research focuses on hazard auditing for a construction project. Construction, which is associated with the construction industry, is only one phase in a larger system, the project, which encompasses development, use, and withdrawal from use. It is argued that evidence of proneness to failure of a construction project may be found in these systems, (project and industry), in the larger system of a social environment, and in the subsystems that are part of a construction project. These hazards are described in terms cf concepts, and presented in the form of a hierarchy that indicates inter-dependencies between concepts. This hierarchy is a basic structure to be used in the design of hazard audits. The concepts incorporated into the hierarchy are discussed and described in terms of their potential to provide evidence of proneness to failure. Sections of hierarchy are built up and presented at appropriate positions in the thesis. It is proposed that this approach to hazard auditing will allow for flexibility in dealing with specific situations, yet provide for the identification of hazards that can exist and develop outside of those situations. It is suggested that such an approach should be regarded as a specialist activity of hazard management. Further, it is argued that the activity of hazard engineering should be recognized as a separate discipline within its own right

Stationary Distribution Analysis of a Queueing Model with Local Choice

The paper deals with load balancing between one-server queues on a circle by a local choice policy. Each one-server queue has a Poissonian arrival of customers. When a customer arrives at a queue, he joins the least loaded queue between this queue and the next one, ties solved at random. Service times have exponential distribution. The system is stable if the arrival-to-service rate ratio called load is less than one. When the load tends to zero, we derive the first terms of the expansion in this parameter for the stationary probabilities that a queue has 0 to 3 customers. We investigate the error, comparing these expansion results to numerical values obtained by simulations. Then we provide the asymptotics, as the load tends to zero, for the stationary probabilities of the queue length, for a fixed number of queues. It quantifies the difference between policies with this local choice, no choice and the choice between two queues chosen at random

Performance analysis and optimization of a N-class bipolar network

A wireless network with unsaturated traffic and N classes of users sharing a channel under random access is analyzed here. Necessary and sufficient conditions for the network stability are derived, along with simple closed formulas for the stationary packet transmission success probabilities and mean packet delays for all classes under stability conditions. We also show, through simple and elegant expressions, that the channel sharing mechanism in the investigated scenario can be seen as a process of partitioning a well-defined quantity into portions, each portion assigned to each user class, the size of which determined by system parameters and performance metrics of that user class. Using the derived expressions, optimization problems are then formulated and solved to minimize the mean packet delay and to maximize the channel throughput per unit of area. These results indicate that the proposed analysis is capable of assessing the trade-off involved in radio-resource management when different classes of users are considered7135118135132CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQCOORDENAÇÃO DE APERFEIÇOAMENTO DE PESSOAL DE NÍVEL SUPERIOR - CAPESFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESP311485/2015-4não tem2017/21347-0This work was supported in part by the Foundation for Research Support of the State of São Paulo under Grant 2017/21347-0, in part by the Brazilian National Council for Scientific and Technological Development under Grant 311485/2015-4, in part by the Academy of Finland via the ee-IoT Project under Grant 319009, in part by the FIREMAN Consortium under Grant CHIST-ERA 326270, in part by the EnergyNet Research Fellowship under Grant 321265 and Grant 328869, in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior–Brazil (CAPES) under Grant 001, in part by the RNP, with resources from MCTIC, under the Radiocommunication Reference Center (CRR) Project of the National Institute of Telecommunications (Inatel), Brazil, under Grant 01250.075413/2018-0

Mortality and pulmonary complications in patients undergoing surgery with perioperative sars-cov-2 infection: An international cohort study

Background The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (740%) had emergency surgery and 280 (248%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (261%) patients. 30-day mortality was 238% (268 of 1128). Pulmonary complications occurred in 577 (512%) of 1128 patients; 30-day mortality in these patients was 380% (219 of 577), accounting for 817% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 175 [95% CI 128-240], p<00001), age 70 years or older versus younger than 70 years (230 [165-322], p<00001), American Society of Anesthesiologists grades 3-5 versus grades 1-2 (235 [157-353], p<00001), malignant versus benign or obstetric diagnosis (155 [101-239], p=0046), emergency versus elective surgery (167 [106-263], p=0026), and major versus minor surgery (152 [101-231], p=0047). Interpretation Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Can mHealth Technology Help Mitigate the Effects of the COVID-19 Pandemic?

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Stationary analysis of the shortest queue problem

International audienceA simple analytical solution is proposed for the stationary loss system of two parallel queues with finite capacity K, in which new customers join the shortest queue, or one of the two with equal probability if their lengths are equal. The arrival process is Poisson, service times at each queue have exponential distributions with the same parameter, and both queues have equal capacity. Using standard generating function arguments, a simple expression for the blocking probability is derived, which as far as we know is original. Using coupling arguments and explicit formulas, comparisons with related loss systems are then provided. Bounds are similarly obtained for the average total number of customers, with the stationary distribution explicitly determined on {K,…,2K}, and elsewhere upper bounded. Furthermore, from the balance equations, all stationary probabilities are obtained as explicit combinations of their values at states (0,k) for 0≤k≤K. These expressions extend to the infinite capacity and asymmetric cases, i.e., when the queues have different service rates. For the initial symmetric finite capacity model, the stationary probabilities of states (0,k) can be obtained recursively from the blocking probability. In the other cases, they are implicitly determined through a functional equation that characterizes their generating function. The whole approach shows that the stationary distribution of the infinite capacity symmetric process is the limit of the corresponding finite capacity distributions. For the infinite capacity symmetric model, we provide an elementary proof of a result by Cohen which gives the solution of the functional equation in terms of an infinite product with explicit zeroes and poles