Dynamic Server Allocation over Time Varying Channels with Switchover Delay

We consider a dynamic server allocation problem over parallel queues with randomly varying connectivity and server switchover delay between the queues. At each time slot the server decides either to stay with the current queue or switch to another queue based on the current connectivity and the queue length information. Switchover delay occurs in many telecommunications applications and is a new modeling component of this problem that has not been previously addressed. We show that the simultaneous presence of randomly varying connectivity and switchover delay changes the system stability region and the structure of optimal policies. In the first part of the paper, we consider a system of two parallel queues, and develop a novel approach to explicitly characterize the stability region of the system using state-action frequencies which are stationary solutions to a Markov Decision Process (MDP) formulation. We then develop a frame-based dynamic control (FBDC) policy, based on the state-action frequencies, and show that it is throughput-optimal asymptotically in the frame length. The FBDC policy is applicable to a broad class of network control systems and provides a new framework for developing throughput-optimal network control policies using state-action frequencies. Furthermore, we develop simple Myopic policies that provably achieve more than 90% of the stability region. In the second part of the paper, we extend our results to systems with an arbitrary but finite number of queues.Comment: 38 Pages, 18 figures. arXiv admin note: substantial text overlap with arXiv:1008.234

Controlled mobility in stochastic and dynamic wireless networks

We consider the use of controlled mobility in wireless networks where messages arriving randomly in time and space are collected by mobile receivers (collectors). The collectors are responsible for receiving these messages via wireless transmission by dynamically adjusting their position in the network. Our goal is to utilize a combination of wireless transmission and controlled mobility to improve the throughput and delay performance in such networks. First, we consider a system with a single collector. We show that the necessary and sufficient stability condition for such a system is given by ρ<1 where ρ is the expected system load. We derive lower bounds for the expected message waiting time in the system and develop policies that are stable for all loads ρ<1 and have asymptotically optimal delay scaling. We show that the combination of mobility and wireless transmission results in a delay scaling of Θ([1 over 1−ρ]) with the system load ρ, in contrast to the Θ([1 over (1−ρ)[superscript 2]]) delay scaling in the corresponding system without wireless transmission, where the collector visits each message location. Next, we consider the system with multiple collectors. In the case where simultaneous transmissions to different collectors do not interfere with each other, we show that both the stability condition and the delay scaling extend from the single collector case. In the case where simultaneous transmissions to different collectors interfere with each other, we characterize the stability region of the system and show that a frame-based version of the well-known Max-Weight policy stabilizes the system asymptotically in the frame length.National Science Foundation (U.S.) (Grant CNS-0915988)United States. Army Research Office. Multidisciplinary University Research Initiative (Grant W911NF-08-1-0238

Safety of hospital discharge before return of bowel function after elective colorectal surgery

Background: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function.Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien-Dindo classification system.Results: A total of 3288 patients were included in the analysis, of whom 301 (9.2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4-7) and 7 (6-8) days respectively (P &lt; 0.001). There were no significant differences in rates of readmission between these groups (6.6 versus 8.0 per cent; P = 0.499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0.90, 95 per cent c.i. 0.55 to 1.46; P = 0.659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34.7 versus 39.5 per cent; major 3.3 versus 3.4 per cent; P = 0.110).Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients

Timing of nasogastric tube insertion and the risk of postoperative pneumonia: an international, prospective cohort study

Aim: Aspiration is a common cause of pneumonia in patients with postoperative ileus. Insertion of a nasogastric tube (NGT) is often performed, but this can be distressing. The aim of this study was to determine whether the timing of NGT insertion after surgery (before versus after vomiting) was associated with reduced rates of pneumonia in patients undergoing elective colorectal surgery. Method: This was a preplanned secondary analysis of a multicentre, prospective cohort study. Patients undergoing elective colorectal surgery between January 2018 and April 2018 were eligible. Those receiving a NGT were divided into three groups, based on the timing of the insertion: routine NGT (inserted at the time of surgery), prophylactic NGT (inserted after surgery but before vomiting) and reactive NGT (inserted after surgery and after vomiting). The primary outcome was the development of pneumonia within 30 days of surgery, which was compared between the prophylactic and reactive NGT groups using multivariable regression analysis. Results: A total of 4715 patients were included in the analysis and 1536 (32.6%) received a NGT. These were classified as routine in 926 (60.3%), reactive in 461 (30.0%) and prophylactic in 149 (9.7%). Two hundred patients (4.2%) developed pneumonia (no NGT 2.7%; routine NGT 5.2%; reactive NGT 10.6%; prophylactic NGT 11.4%). After adjustment for confounding factors, no significant difference in pneumonia rates was detected between the prophylactic and reactive NGT groups (odds ratio 1.03, 95% CI 0.56–1.87, P = 0.932). Conclusion: In patients who required the insertion of a NGT after surgery, prophylactic insertion was not associated with fewer cases of pneumonia within 30 days of surgery compared with reactive insertion

Safety of hospital discharge before return of bowel function after elective colorectal surgery

© 2020 BJS Society Ltd Published by John Wiley & Sons LtdBackground: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien–Dindo classification system. Results: A total of 3288 patients were included in the analysis, of whom 301 (9·2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4–7) and 7 (6–8) days respectively (P < 0·001). There were no significant differences in rates of readmission between these groups (6·6 versus 8·0 per cent; P = 0·499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0·90, 95 per cent c.i. 0·55 to 1·46; P = 0·659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34·7 versus 39·5 per cent; major 3·3 versus 3·4 per cent; P = 0·110). Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients