Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

Simulation model for paddy transportation strategy in Sri Lanka

MSc in Operational ResearchCost effective paddy harvest transportation strategy is simulated in tills operational study. Paddy production of administrative districts of Sri Lanka is assumed to be distributed among the districts proportional to their respective populations. Paddy production varies highly among the administrative districts of Sri Lanka and district wise consumption also varies based on population. Aim of this study is to find out the cost benefit transportation over Sri Lanka treating it as stochastic transportation problem which describe as minimize, total transportation cost subject to with realized minimum probabiliues of supply and demand constraint. Transportation problem of each cultivation seasons of each year is solved by finding out the districts and amounts that need the commodity from osiers (called consumers) and those that can supply called suppliers. It is assumed that overall paddy production of a cultivation year is sufficient enough for total populauon. A transportation pattern is figure out from supplier districts to consumer districts by solving these deterministic transportation problems. Almost all real life problems encounter uncertainty. Therefore this analysis is extended to introduce simulation model to find out optimum transportation strategy considering unccrtainucs. Simulated transportation strategy is presented by solving the chance constrained stochastic programming problem. The classical transportation problems for the years from 1989 to 2000 are solved here. Moreover simulated and actual results arc presented for the years 2000 . Finally tins simulation model is implemented as decision support system for the cost effective transportation strategy of such products

The Impact of macroeconomic determinants on stock market development in asian region: panel data analysis

This study aims to investigate the role of macroeconomic determinants in stock market development in the Asian region. The empirical research was conducted using balanced panel data of eighteen Asian countries from 2009 to 2018. The econometric models used are Pooled OLS, Fixed Effects, and Random Effects. The study's findings include economic growth measured by per capita income, stock market liquidity measured by liquidity ratio, financial intermediaries' development measured by monetization ratio, and saving rate positively impacting stock market development. Furthermore, inflation measured by GDP Deflator is not an adequate indicator in measuring economic stability. Implications of the study are that policymakers and administrators can promote stock market development through enhancing stock market liquidity, developing financial intermediaries, and overall economic growth. Most of the economies in the Asian region are emerging economies; therefore, the economic environment and institutional environment of these economies are very different from that of developed economies. Further, equity markets in Asia have gone through many structural reforms in the past decade, and they account for 40% of the global equity market volume. Hence this study tries to identify the impact of macroeconomic determinants on stock market development specific to the Asian region