Alternative Plans Research Articles

Perioperative Glucagon-Like Peptide-1 Receptor Agonists (GLP-1RA) and Gastric Point Of Care Ultrasound (POCUS)

Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are frequently used for diabetes and weight loss management. The GLP-1 RA drugs delay gastric emptying and are a concern for increased risk of aspiration in the perioperative period. Current recommendations to hold these medications before surgery are consensus based. Gastric point of care ultrasound (POCUS) can provide information regarding nature and volume of gastric contents in these patients during the perioperative period. In this case series, we present three patients where gastric POCUS helped formulate a safer, alternative anesthetic plan. Anesthetic management varied depending on the situation, urgency and needs of the procedure. We recommend gastric POCUS in this group of patients to provide objective assessment of gastric contents.

Disaster Preparedness and capacity building for Resilience in Agriculture

Abstract. Agriculture faces unprecedented challenges due to the increasing frequency and severity of natural disasters and extreme weather events. Agriculture sector needs resilience to support food production and livelihoods because it is susceptible to cyclones, floods, droughts, soil erosion, pests, and disease outbreaks. Geospatial technology plays a significant role in disaster management for agriculture, offering tools for preparedness, response, and recovery. This study explores the role of geospatial technology in early warning systems and risk assessment for different types of natural disasters that impact agriculture activity. Sustainable farming practices that are essential for resilience include crop diversity, climate-resilience varieties, and adaptation strategies. Capacity building and training are vital for effective geospatial technology utilization, especially in developing countries like India, where infrastructure and technology access may be limited. Tailored capacity-building programs are essential, emphasizing climate-smart practices, sustainable land management, and post-disaster recovery strategies. Access to financial services and insurance schemes enhances resilience by helping farmers cope with losses and recover from disasters. In order to improve resilience and sustainability in agriculture, geospatial decision support systems make it possible to evaluate alternative planning, optimise resource allocation, and implement adaptive management.

Investigating the occurrence and predictability of pitch angle scattering events at ADITYA-Upgrade tokamak with the electron cyclotron emission radiometer

This paper describes the experimental analysis and preliminary investigation of the predictability of pitch angle scattering (PAS) events through the electron cyclotron emission (ECE) radiometer signals at the ADITYA-Upgrade (ADITYA-U) tokamak. For low-density discharges at ADITYA-U, a sudden abnormal rise is observed in the ECE signature while other plasma parameters are unchanged. Investigations are done to understand this abrupt rise that is expected to occur due to PAS. The rise time is as fast as 100 μs with a single step and/or multiple step rise in ECE radiometer measurements. This event is known to limit the on-axis energy of runaway electrons. Being a repetitive event, the conditions of its repetitive occurrence can be investigated, thereby exploring the possibility of it being triggered and surveyed as an alternate runaway electron mitigation plan. Functional parameterization of such events with other discharge parameters is obtained and the possibility to trigger these events is discussed. PREDICT code is used to investigate the possible interpretations for the PAS occurrence through modeling and supporting the ECE observations. The trigger values so obtained experimentally are set as input criteria for PAS occurrence. Preliminary modeling investigations provide reliable consistency with the findings.

Analysis of the case of China’s high-speed Railway Bidding negotiation in 2004

This paper analyzes the bidding negotiation of China’s high-speed railway in 2004 from the following three elements: alternative plan, target and initial offer.In 2004, China sought high-speed rail technology, negotiating with international companies such as Siemens, Shinkansen, Alstom and Bombardier. Negotiations with Japan and Germany have faced challenges due to reluctance and high costs of technology transfer.However, China shifted strategically to negotiating with Alstom and Bombardier, and in the end, China obtained a variety of high-speed rail technologies, successfully established its own high-speed rail industry, and demonstrated an effective negotiation strategy.

Students' Creative Thinking Strategies As High-Level Thinking, Solving Hot Problems In Improving Mathematics Learning

Creative Thinking Strategy of Students as Higher-Order Thinking, Solving Hot Problems Under Mathematics Learning Improvement. In our observation during PLP at SMK 2 Pancasila Jember, all students in one flat improved their' creative thinking strategy To improve higher-order thinking in mathematics learning. Therefore, this condition results in an imbalance in learning practices. Thus, this study fills the imbalance gap by describing students' creative thinking strategies as higher-order thinking skills in improving mathematics learning. Results of the study: This can contribute knowledge for educators to manage teaching strategies that can improve mathematics learning, which refers to higher-order thinking skills for all levels of creative thinking. This study is a qualitative descriptive study. The course is SMK 2 Pancasila Jember data collection, a test, observation, and interview. Data analysis is done using the data reduction method, presenting data, and concluding. The results of this study are descriptions of students' creative thinking strategies as higher-order thinking skills in improving mathematics learning, namely students' problems in planning detailed problems; students take time breaks to make a plan, identify the core of the problem, provide original ideas, provide alternative plan solving problems, combine previous ideas with question problems; operate and implement their plans by creating various solution original.

City energy planning: Modeling long-term strategies under system uncertainties

Cities are facing the dilemma of fulfilling energy service demands for their rapidly growing population while also working towards climate mitigation efforts. City energy planning is essential to deal with this dilemma. Thus, this study explores the role of city energy plans on future cost-efficient energy systems. A technology-rich cost-optimization model was developed using TIMES with intra-sectoral and inter-sectoral interactions and applied to the Gothenburg energy system. The model outcomes are investigated with the application of policy-driven scenarios and further tested under system uncertainties and price sensitivities identified using a participatory approach. Heating sector developments include DH production based on biomass CHP and heat pumps combined with improved building energy efficiency. Cost-efficient transport sector developments show a rapid deployment of biofuel vehicles, followed by increasing electrification later in the time horizon. With the applied uncertainties, different cost-optimal district heat production mixes and heating supply solutions are observed, providing alternative planning strategies. The model results also signify competition of biomass and electricity among sectors in their development pathways. The modeling outcomes enable decision-makers to assess various energy systems transition strategies from a long-term perspective.

Explaining Countries’ Formal Engagement with the People’s Republic of China’s Digital Connectivity Plan: A Qualitative Comparative Analysis

ABSTRACT Under what conditions do countries formally engage with the People’s Republic of China’s (PRC) Digital Silk Road (DSR)? A Qualitative Comparative Analysis (QCA) highlights two main findings: first, a comprehensive strategic partnership with the PRC, individually and in combination with China being a leading importer, is a necessary condition to explain countries’ formal commitment to DSR; second, as expected, no single condition turns out to be sufficient; rather, an interplay of several factors is required. The results point to the empirical importance (though not always sufficient) of the absence of an alternative foreign-backed initiative with other major powers, the existence of a comprehensive strategic partnership with the PRC, and its presence as a leading importer. This suggests that, in the absence of alternative connectivity plans, countries’ existing economic and strategic relationships with the PRC predispose them to formally engage in the DSR. This is particularly the case for Southeast Asian countries.

IMPLANT-PROSTHETIC REHABILITATION OF PARTIALLY EDENTULOUS PATIENTS WITH SURGICAL GUIDES

Nowadays, the main goal of the oral rehabilitation treatment plan is not only to insert an implant into the bone, but to insert and integrate it so that the surrounding hard tissues and soft tissues are adequate. In this way, the long-term success of the treatment plan will be achieved. Background: The main purpose of the study was to present the advantages and disadvantages of using the dental implant insertion technique through the surgical guide as well as to evaluate the degree of its use among implantologists. Material and Methods: The study involved 120 patients who presented in the dental clinic requesting complex oral rehabilitation with restorations supported by implants. Following the anamnesis, intraoral clinical examination, laboratory and radiological evaluation, the type of edentulism was diagnosed, for which classical and alternative treatment plans were proposed. Results: From the group of edentulous patients, 40 patients chose the implant-prosthetic rehabilitation. Among them, 29 patients chose the guided method of implant insertion. Conclusions: Guided placement implant restorations are a viable solution for a painless and successful protocol in implant oral rehabilitation.

Risk management and insurance failures: the case of Ghana’s National Health Insurance Scheme

Since its inception, Ghana’s National Health Insurance Scheme (NHIS) has brought about notable improvements in healthcare access and health outcomes. However, challenges have arisen, threatening its intended function. This study aims to investigate the challenges encountered by NHIS participants and their risk management practices in response to insurance failures. Convenience and purposeful sampling techniques were employed to gather data from 45 Quality Insurance Company (QIC) employees residing in the Greater Accra area of Ghana who are NHIS members. A quantitative approach was utilized, and a questionnaire was administered to collect data. The study employed Cronbach’s alpha to assess the reliability and validity of the data. Additionally, Regression analysis, correlation, and descriptive statistics were utilized to achieve the study's objectives. The study revealed several challenges facing the NHIS, including a shortage of medical specialists, medications, and hospital beds, as well as high patient out-of-pocket expenses. Despite these challenges, the NHIS has not yet failed. However, the majority of NHIS cardholders (62.20%) would be adversely affected in the event of system failure, as they primarily rely on NHIS for risk management. Conversely, a minority of participants (37.80%) are less likely to experience the effects of failure due to alternative insurance plans and personal savings. Therefore, understanding these dynamics is crucial for policymakers and stakeholders to strengthen the NHIS and ensure sustainable healthcare access for all Ghanaians.

Results and Conclusions | On Policy-Based Papers: Large Scale. Strategic Visioning & Design

The theme of this international research project and scientific journal issue is Re- Inventing Phoeniciae (Finiq): New Inter- sections of Tradition, Innovation, Land- scapes and Tourism. The respective International PhD workshop of Polis Uni- versity and Ferrara University took place from 09-20 January 2023. This phase concluded with a series of presentations, lectures, and graphical-conceptual dia- grams. After that, the researchers worked independently for the rest of the year to elaborate further scientific specula- tions and write down articles. Tutors of the workshop and the project have been: Prof. Besnik Aliaj, Prof. Pantelis Skayan- nis, Dr. Sotir Dhamo, Dr. Skender Luarasi, Dr. Llazar Kumaraku, Dr. Malvina Istrefaj, Dr. Doriana Musaj and Sadmira Malaj. Fi- niq Municipality is located in the South of Albania, cross-bordering Greece. It is in- cluded in the Vlora’s County and it is just 9 kilometers from the port & tourism City of Saranda; not far from the UNESCO City of Gjirokastra; and adjacent to the UNESCO Archeological Site of Butrint. The settle- ment of Finiq has been the main munici- pal center since the last administrative reform. The municipality looks “poor” and neglected, but indeed is rich in all aspects. It is particularly important because of the presence of the Foinikea Archaeologi- cal Park at the top of a hill (received this status in 2005). Inside the Municipal terri- tory, there are lots of attractive sites, such as the water springs Blue Eye; main riv- ers and lakes; the Monastery of St. Nikolla (in Mesopotam village), and many other amazing churches, etc. This makes the municipality dominated by nature (e.g. flat fields; a continuous layer of hills, rivers, and lakes, etc.) and monuments that rep- resent a rich cultural heritage. Within this context, some villages arise up in moun- tains or hills, characterized mostly either by forgotten historic houses and churches or by new infrastructures and civil struc- tures built in reinforced concrete. This is due to the fact that the new buildings were built irregularly during the late post- communist decades, instead of what was built historically. Therefore the local villag- es are losing gradually their own original spirit, which could be better observed in the case of UNESCO heritage settlements like the city of Gjirokaster, or in the villages of Dropull municipality (another Greek mi- nority area as Finiq). Most of the commu- nity, especially young people left due to a massive emigration mainly in Greece and the USA, or migration to the capital region of Tirana. This means that the municipal- ity suffers now from poor human capaci- ties, poor budgets, and low tax collection baseline, while the remaining people are getting older. However, the natural and historical potential, and the nearby port and touristic cities of Saranda and Gjiro- kastra (Albania), as well as Igoumentisa and Janina (Greece) make the area highly possible to be developed soon as a sup- port territory for agricultural, historic and hospitality services. Under the conditions of massive emigration and reduction of population, the researchers put emphasis on the use of new technologies and alternative municipal planning and urban- landscape design methodologies.

Guidelines to Promote Youth Basketball for Basketball Club in Guangdong Province, the People’s Republic of China

Background and Aim: The normal operation of children's amateur basketball clubs is not only affected by external risks such as policy and economic epidemics but also influenced by the club operators' strategic consciousness, players, coaches, basketball teaching, and other aspects. The number of coaches within the club is not enough and without professional coaches and places for non-standard training, there is no cooperation from parents. These factors all affect the ability to play basketball of Chinese youth. The purpose of this study was to construct the guidelines to promote youth basketball for basketball clubs in Guangdong. Materials and Methods: This research was the mixed method. Using an expert interview form, 5 experts were interviewed to find ways to create a guideline to promote youth basketball for basketball clubs in Guangdong. Questionnaires were used for 63 basketball clubs. Criteria for selecting basketball clubs are: It is the city's top three basketball clubs. which has a total of 100 youth basketball players or more. It will use 189 questionnaires for 1 club leader and 2 basketball club coaches in each club. 9 experts for the Focus group method and connoisseurship method used 7 experts to confirm the guidelines to promote youth basketball for basketball clubs in Guangdong, all of the experts using purposive sampling. Results: The research results found that: The guidelines to promote youth basketball for basketball clubs in Guangdong consist of 4 areas: 1) The policy setting and planning to promote youth basketball for basketball club area consists of 15 guidelines; 2) The creating an atmosphere and environment in the basketball club area consists of 13 guidelines; 3) The providing club members with the ability to promote youth basketball area consists of 15 guidelines; 4) The budget support for promoting youth basketball in the clubs of club members area consists of 12 guidelines. Conclusion: The guidelines for promoting basketball clubs for youth basketball players in Guangdong Province are clear. Can be used and it is not contrary to government policy, but it must focus on providing club members with the ability to promote youth basketball area. Including presenting strategies, and alternative plans, and making recommendations for clear monitoring and evaluation. It can be applied to other sports, but it should start with a small organization first.

Vascularized Interpositional Connective Tissue Graft: An Alternative in Esthetically Demanding Regions. A Case Report and Literature Review

Objective: This case report aims to showcase the utilization of a vascularized interpositional pedicle connective tissue graft and a Maryland bridge as an alternative treatment to bone graft and implant placement. Clinical considerations: The case report illustrated the success of a well-thought-out alternative treatment plan to implant placement, achieving esthetically pleasing and functional results. Conclusion: The vascularized interpositional pedicle connective tissue graft can serve as a less invasive alternative that achieves an esthetically pleasing outcome.

A Framework for Using Regional Scenarios in Racial Equity Planning

Problem, research strategy, and findings Planning under uncertainty and planning for racial equity both require imagination. In confronting the uncertain future, regional planners often opt for exploratory scenario planning: telling multiple future stories to prepare for any outcome. For equity planning, imagination supports vision beyond the deeply unequal present condition, wherein policy tinkering is insufficient for necessary change. And yet, scenario planning and equity planning are estranged. Although regional planners wish to engage both, they lack guidance on how. I look to close this gap by providing a framework (the Framework) for using scenarios in equity planning. The Framework builds on the five types of racial equity, a six-stage hybrid scenario process, and the three outcomes of public-sector scenarios. Using the Framework, I assessed the inclusion of equity in the Delaware Valley Regional Planning Commission’s Dispatches From Alternative Futures scenario plan. This plan successfully raises racial equity as a concern for the future of the Philadelphia (PA) region. However, the stakeholder group was not sufficiently diverse for deliberative equity and the scenario planners did not use tools that could assess the distributional outcomes. Neither epistemic nor restorative equity were a significant part of the scenario plan, leaving open the possibility for co-designed scenarios for a racial equity future. Takeaway for practice Metropolitan planning organizations (MPOs) can use the Framework to ensure that exploratory scenarios advance equity goals. Although the Framework can supply a starting point for MPOs, the most important voices are those from Black, Indigenous, and people of color (BIPOC) and other marginalized communities. Scenario planners should consider how they can reach out to community members not just as stakeholders but as co-creators of a more epistemically equitable scenario planning process, one that addresses the uncertainties and aspirations that already percolate within these communities.

A lesson plan for planning lessons

BackgroundPreparing, performing, and evaluating the effectiveness of a lesson plan are essential nurse educator skills. This study describes an innovative teaching strategy designed to build a nurse educator's academic skill set. MethodQualitative retrospective exploratory descriptive design of an innovative teaching strategy meant to enhance competency and confidence in the nurse educator's lesson planning skills. The teaching strategy is described and themes were identified from student evaluative comments. Comments were analyzed using a triangulated content analysis process. ResultsData were categorized into Take-Away Point main themes with sub-themes noted in parentheses. Lesson Planning main themes were Time Consuming; Toolkits are Helpful (Madness to Methods E-cards, Alternative Plans, The Fink Lesson Map Template); Components Help Organize (Learning Objectives, Student-Centered); and Reflection Offers Growth Opportunities (Learning, and Faculty Development). The Muddiest Points' main themes were Curriculum Mapping and Experience. ConclusionGraduate nurse educator students valued structured guidance and peer collaboration while learning lesson planning. This teaching strategy may also aid faculty development by enhancing nurse educator role confidence and career fulfillment.

A marginal structural model for normal tissue complication probability.

The goal of radiation therapy for cancer is to deliver prescribed radiation dose to the tumor while minimizing dose to the surrounding healthy tissues. To evaluate treatment plans, the dose distribution to healthy organs is commonly summarized as dose-volume histograms (DVHs). Normal tissue complication probability (NTCP) modeling has centered around making patient-level risk predictions with features extracted from the DVHs, but few have considered adapting a causal framework to evaluate the safety of alternative treatment plans. We propose causal estimands for NTCP based on deterministic and stochastic interventions, as well as propose estimators based on marginal structural models that impose bivariable monotonicity between dose, volume, and toxicity risk. The properties of these estimators are studied through simulations, and their use is illustrated in the context of radiotherapy treatment of anal canal cancer patients.

Mining Enterprise Production Line Optimal Load Modelling

The article is devoted to the issues of the mining enterprise production line optimal load model. A large number of issues to related to alternative production plan implementation transition are considered in various works. A mathematical model to form an optimal plan mining enterprise raw material mixture from deposits is proposed in the study. A method of multi-criteria alternative ranking in terms of integral efficiency indicator with the following problem solution of optimal plan determination for a raw material mixture from deposits was chosen for that purpose. The article proposes an approach to determine the production line optimal loading plan of a mining enterprise based on the creation of an ore mixture with the highest utility. The value of a particular deposit is determined by a variety of factors, including the distance from the production line, the ore content in the rock, and the volume of the deposit. The paper shows that the development of a specified field management can be implemented based on solving linear programming problems. The hierarchy contains three levels: the system purpose; the factors influencing the deposit appeal (the metal content, the deposit volume, and transport accessibility); alternatives (deposits of raw materials directly). Let's assume that it is necessary to find the maximum efficiency by means of an ore mixture from the given deposits. Resource restrictions are imposed on the task: the work and machine time fund, the amount of first type reagent, and the amount of second type reagent. The composition of the constraint vector can be set depending on the value of the resources. The study found that the optimal plan is implemented under the complete resource utilization both of the first and the second types and a fifty-three percent level of the third resource utilization. Despite the low integral assessment of the raw material value of the fourth deposit, which is mainly determined by the low ore content in the rock, with respect to other deposits, its maximum utilization is also recommended, which in turn, is determined by the low resource intensity of ore extraction from this rock.

CBCT in Dental Implantology: A Key Tool for Preventing Peri-Implantitis and Enhancing Patient Outcomes.

(1) Introduction: Trust is a cornerstone of the patient-physician relationships. Unforeseen complications in the health care system could jeopardize patients' trust in their physicians. (2) Aim: This article presents a quantitative figure regarding foreseeing the necessity of a three-dimensional quantitative visualization of bone structure and concurrently preparing for an ancillary procedure by a dentist to successfully perform the surgery that could minimize unforeseen complications; (3) Materials and method: This retrospective study has been derived based on an analysis of 1134 patients who had received 4800 dental implants from January 2001 to August 2020, out of which 200 cases were randomly selected for this study. Each procedure during implant treatment was categorized as OPG (Orthopantomography) or OPG with CBCT as per all the procedures which included and were coded as follows, 1: Surgery & Restoration, 2: GBR (Guided Bone Regeneration), 3: GTR (Guided Tissue Regeneration), 4: Block Bone Graft, 5: Spreading, 6: Splitting, 7: Internal Sinus, 8: External Sinus, 9: PRF (Platelet Rich Fibrin). Any of the 200 cases in which implant placement could not have been performed for reasons related to a lack of CBCT were selected for this study. The surgery was aborted halfway through without implant placement in these cases due to a lack of bone quantity and/or lack of primary stability. These cases were registered for re-evaluation and statistical analysis; (4) Results: 7% of the cases that used OPG alone led the surgeon to unexpectedly abort in the middle of the surgery without implant placement. All (100%) of the patients who had CBCT during treatment planning were able to receive implants during the surgery. None of the patients left the surgery without receiving implants if CBCT was used (0%); (5) Discussion: Radiographic image quality is defined as the amount of information within the image that allows the radiologist to make a diagnostic decision with a particular level of certainty (Martin et al., 1999) and hence the importance of CBCT. The unexpected 7% of devastating situations for patients who started surgery but did not have implant placement led to [A] aborting the surgery, [B] procedural difficulties requiring an alternative treatment plan, [C] a negative impact on the patient's behavior, and [D] wanting to change doctor due to a lack of trust; (6) Conclusion: This study indicates that in implant dentistry patients' mistrust could be avoided by 7% if CBCT is obtained. It also shows the significance of cone-beam computed tomography as an adjunct to panoramic radiography during the diagnosis and treatment planning phase. The use of panoramic radiography alone can lead to a 7% likelihood of misdiagnosis. A lack of CBCT during treatment planning negatively affects the outcome of surgical procedures.

Modelling and comparing the use of IVF and ICSI in Australia

PurposeThis study estimates the need of IVF/ICSI in Australia as compared to its actual uptake.MethodsWe created a model estimating for the annual demand for IVF/ICSI in a hypothetical infertile population, using demographic data from medical literature and Australian government databases. For each category of infertility (tubal, severe male, endometriosis, anovulation and unexplained), our estimated need for IVF/ICSI was compared to the actual IVF/ICSI uptake (ANZARD 2019). The model consisted of three categories depending on couples’ cause of infertility, i.e. couples with absolute indications for IVF/ICSI (couples with severe male factor infertility and tubal obstruction); couples with anovulatory infertility (couples with ovulation disorders) and couples with ovulatory infertility (couples suffering from unexplained infertility and endometriosis). The model was applied to each of these categories to determine the number of couples that would require IVF/ICSI treatment after failing to conceive naturally or after following alternative treatment plans. The main outcomes of this study were the estimate of IVF/ICSI cycles and the difference between the estimate and the reported number of IVF/ICSI cycles (2019 ANZARD report).ResultsWe estimated that approximately 35,300 couples required IVF/ICSI treatment in Australia in 2019, while in 2019 according to ANZARD, 46,000 couples underwent IVF/ICSI. A higher uptake of IVF/ICSI cycles than expected was specifically reported in couples with unexplained infertility, ovulation disorders and endometriosis, while for tubal and severe male infertility uptake seemed adequate.ConclusionIn Australia, there seems to be overservicing of IVF/ICSI, specifically for unexplained, ovulatory and endometriosis-related infertility.

LMIC-25. EXPANDING THE PEDIATRIC NEURO-ONCOLOGY TELECONFERENCE EXPERIENCES, A LUXURY, OR A NECESSITY?

Abstract INTRODUCTION Videoteleconference in neurooncology is feasible and sustainable. The well-established 20 years’ Sickkids/KHCC teleconferencing is an example. Since 2018, several regional centers joined these meetings to discuss their patients’ management plans. We aimed to evaluate the impact of this experience. METHODS We retrospectively reviewed the 56 meetings’ minutes (9/2018-12/2023) and compared the pre-conference suggested plans with the post-conference recommendations. We recorded if the recommendations were implemented and the impact perceived. RESULTS In total, 251 patients were discussed: KHCC (137) and non-KHCC (114). Four of the regional participating oncologists had dedicated pediatric neuro-oncology training. Patients were selected for discussion due to challenges in their management (i.e. with relapsed tumors, rare diagnoses, unexpected tumor behavior). Main diagnoses were: Low-grade-glioma (28%), High-grade-glioma (21%), and Medulloblastoma (17%). Of the 227 patients where the local team suggested a care plan, the teleconference recommendations concurred with the proposed plan in 50% of the cases, agreed on but provided an alternative plan option in 18% and disagreed on in 32% of the cases. The difference in recommendations mostly affected the proposed treatment modality (15%). In 64% of the discordant plans and 50% of the alternative plans, the treating team applied the recommendations. Challenges to apply the recommendations were mainly linked to patients’ factors (53%, plan refusal, traveling abroad, clinical deterioration), local multidisciplinary team consensus on a different plan (29%) or logistic difficulties (18%, e.g. drug access). CONCLUSIONS Improvement in patients’ care was likely achieved with the continuous effort of the local teams to implement the recommendations. Participating oncologists valued the shared educational experience learned from each other’s case discussions, especially those related to molecular-testing and implications on treatment. Joining such regional teleconferences is of particular importance to small-volume centers or those lacking a pediatric neurooncologist. Regional and international collaborations are a necessity when it comes to improving the care of children with CNS tumors.

Enabling Building Information Model-driven human-robot collaborative construction workflows with closed-loop digital twins

The introduction of assistive construction robots can significantly alleviate physical demands on construction workers while enhancing both the productivity and safety of construction projects. Leveraging a Building Information Model (BIM) offers a natural and promising approach to driving robotic construction workflows. However, because of uncertainties inherent in construction sites, such as discrepancies between the as-designed and as-built components, robots cannot solely rely on a BIM to plan and perform field construction work. Human workers are adept at improvising alternative plans with their creativity and experience and thus can assist robots in overcoming uncertainties and performing construction work successfully. In such scenarios, it is critical to continuously update the BIM as work processes unfold so that it includes as-built information for the ensuing construction and maintenance tasks. This research introduces an interactive closed-loop digital twin framework that integrates a BIM into human-robot collaborative construction workflows. The robot’s functions are primarily driven by the BIM, but it adaptively adjusts its plans based on actual site conditions, while the human co-worker oversees and supervises the process. When necessary, the human co-worker intervenes in the robot’s plan by changing the task sequence or workspace geometry or requesting a new motion plan to help the robot overcome the encountered uncertainties. A drywall installation case study is conducted to verify the proposed workflow. In addition, experiments are carried out to evaluate the system performance using an industrial robotic arm in a research laboratory setting that mimics a construction site and in the Gazebo simulation. Integrating the flexibility of human workers and the autonomy and accuracy afforded by the BIM, the proposed framework offers significant promise of increasing the robustness of construction robots in the performance of field construction work.