Scheduling process operations under uncertainty and integration with long term planning

This thesis centers upon the application of mathematical modelling, optimization theory and uncertainty analysis to the problem of scheduling batch operations for large scale industries. Over the years, decision making strategies such as scheduling, that deals with allocation of plant resources, has been widely adopted by industries to efficiently carry out their operations and achieve the desired targets. In this thesis, the focus is on planning and scheduling under endogenous uncertainty in the context of multijob, multitasking batch plants. This class of scheduling problems are of practical importance, specially in the analytical services sector, where effective scheduling models could increase the efficiency in carrying out the plant operations and may lead to increased throughput, or reduced makespan, resulting in greater profits or customer satisfaction

Effectiveness of nutrition interventions in low and middle income countries: an evidence summary

This is an independent report commissioned under the DFID Systematic Review Programme for SouthAsia. This material has been funded by South Asia Research Hub, Research and Evidence Division,Department for International Development,Government of UK. The views expressed do not necessarilyreflect the UK Government’s official policies

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

The Impact of On-Campus Health Promotion Activities on Healthy Lifestyle Behaviours of Indian University Students

Background: A paucity of information exists on the impact of health-promoting activities conducted in low-and-middle-income country settings including Indian Higher Education Institution (HEI). Health promoting universities offer a variety of on-campus health promotion activities to improve the health and lifestyle of the university students. However, the information on the impact of such programmes are scanty. Aim: The study aimed to assess the university students' Health-Promoting Lifestyle Profiles (HPLP) before and after exposure to the ongoing on-campus health promotional activities for one year. Methods: All freshmen admitted to an international university in India, with campuses across the major cities, were enrolled in the study. The study was conducted in two phases; phase 1 assessed the baseline existing HPLP scores of these students and phase 2 investigated the impact of on-campus health promotion activities for one year on the HPLP scores, a proxy for healthy lifestyle behaviour. Results: The total HPLP scores differed significantly between the two phases (137.9 vs 130.9; p=0.000). Similarly, a significant increase in physical activity scores between the two phases was observed (17.8 vs 19.5; p=0.000). A gender-wise comparison of total and sub-scale HPLP scores of phase I reported significantly higher total HPLP, health responsibility, nutrition, and interpersonal sub-scale scores in females; and significantly higher physical activity scores in males (18.5 vs 17.3; p=0.000). In phase 2, females had significantly higher scores in total HPLP, nutrition, interpersonal, and physical activity sub-scale scores. In both phases females had significantly higher total HPLP scores than males (Phase 1: 137.6 vs 139.8; p=0.000; Phase 2 130.6 vs 131.3; p=0.000). Conclusions: A gender-wise difference on the impact of on-campus health promoting activities with higher impact on females was observed. A more focused, systematic and targeted approach through curricular, co-curricular and extracurricular courses may further improve the HPLP scores of Indian university students

Concurrent micronutrient deficiencies are prevalent in nonpregnant rural and tribal women from central India.

OBJECTIVE: The existence of concurrent micronutrient deficiencies in Indian women of reproductive age has received little attention. This study aimed to comprehensively assess the micronutrient status of nonpregnant rural and tribal women 18-30 y from central India. METHODS: Participants (n = 109) were randomly selected using a stratified (rural-tribal) proportionate-to-population size cluster sampling method from 12 subcenters in Ramtek block, Nagpur. Sociodemographic, anthropometric, dietary, and biochemical data, including blood and urine samples, were obtained. RESULTS: Tribal and rural women had similar sociodemographic characteristics and anthropometric status; 63% of women had a body mass index <18.5 kg/m(2). The median urinary iodine concentration was 215 μg/L (IQR: 127, 319). The mean (SD) concentration of hemoglobin, serum zinc, retinol, and folate was 112 (13) g/L, 10.8 (1.6) μmol/L, 1.2 (0.3) μmol/L, 18.4 (8.4) nmol/L, respectively, with a geometric mean serum vitamin B(12) concentration of 186 pmol/L. The percentage of women with low values for hemoglobin (<120 g/L), serum zinc (<10.7 μmol/L), vitamin B(12) (<148 pmol/L), retinol (<0.7 μmol/L), and folate (<6.8 nmol/L) was 66%, 52%, 34%, 4%, and 2%, respectively. Tribal women had a higher prevalence of zinc deficiency (58% versus 39%, P = 0.054) and concurrent deficiency of any two micronutrients (46% versus 26%; P = 0.034), including zinc and anemia (38% versus 21%, P = 0.024). CONCLUSION: Zinc, vitamin B(12), and iron constitute the principal micronutrient deficiencies in these women. Existing supplementation programs should be extended to include 18- to 30-y-old nonpregnant women as the majority of childbearing occurs within this timeframe