Execution Plan Research Articles

Safety of performing multiple free flap surgeries by a single surgeon in a single day

With the growing popularity of the use of free flaps, surgeons may frequently encounter situations necessitating the performance of multiple free flap surgeries in a single day. Given its prolonged duration and technical complexity, concerns remain regarding their safety. This study investigated whether a single surgeon conducting multiple free flap surgeries in a day heightens the risk of complications. Patients who underwent free flap-based reconstruction from March 2002 to May 2023 were reviewed and categorized into 3 groups: one flap per day (Group 1), multiple flaps per day on the same patient (Group 2), and multiple flaps per day on different patients (Group 3). Outcomes, particularly perfusion-related complications (PRCs), were compared. In total, 1910 cases were analyzed: 1570 in Group 1, 126 in Group 2, and 214 in Group 3. Over time, the proportion of cases in Group 3 increased. Group 3 had fewer breast reconstruction cases but more lower extremity reconstructions, with a higher prevalence of chronic wounds. Although the rates of PRCs varied among groups, multivariable analysis exhibited no association of performing multiple flaps in a day with their occurrence, regardless of breast or nonbreast reconstruction. The rate of arterial insufficiency was significantly higher in group 3 compared with group 1 after adjusting for other variables. Performing multiple free flaps in a single day may not significantly increase the risks of overall PRCs. However, there appears to be a higher incidence of arterial insufficiency, emphasizing the need for careful planning and precise execution of procedures.

Implementing a nutrition education intervention in Eastern Norwegian Kindergartens: barriers and facilitators

BackgroundImplementations to improve healthy eating in kindergartens may play a pivotal role in shaping children’s dietary behaviors. There is limited research on the implementation and key implementation determinants (barriers and facilitators) of interventions in kindergarten settings. The aim of this study was to explore kindergarten staff members’ experiences with the implementation of a nutrition education intervention to identify implementation barriers and facilitators.MethodsWe interviewed 12 employees from five different kindergartens in an Eastern Norwegian municipality between 2019 until 2020. The individual interviews were guided by the consolidated framework for implementation research. The interviews were recorded, transcribed verbatim, and analyzed inductively, inspired by Braun and Clarke’s reflexive thematic analysis.ResultsImplementation facilitators were satisfactory planning and presentation execution, including tailoring to kindergarten and staff needs, food and meals being a kindergarten/staff priority, and confidence-building of staff. Barriers included unsatisfactory planning and presentation execution, the presentation as a one-time event, non-tailoring to kindergarten and staff needs, and kindergartens/staff not prioritizing food and meals.ConclusionsWhen developing and implementing similar kindergarten interventions, the following should be considered: a participatory approach, active engagement of staff, the physical learning environment, and the frequency of opportunities to revisit topics.

Optimizing Database Performance in Complex Event Processing through Indexing Strategies

Complex event processing (CEP) systems have gained significant importance in various domains, such as finance, logistics, and security, where the real-time analysis of event streams is crucial. However, as the volume and complexity of event data continue to grow, optimizing the performance of CEP systems becomes a critical challenge. This paper investigates the impact of indexing strategies on the performance of databases handling complex event processing. We propose a novel indexing technique, called Hierarchical Temporal Indexing (HTI), specifically designed for the efficient processing of complex event queries. HTI leverages the temporal nature of event data and employs a multi-level indexing approach to optimize query execution. By combining temporal indexing with spatial- and attribute-based indexing, HTI aims to accelerate the retrieval and processing of relevant events, thereby improving overall query performance. In this study, we evaluate the effectiveness of HTI by implementing complex event queries on various CEP systems with different indexing strategies. We conduct a comprehensive performance analysis, measuring the query execution times and resource utilization (CPU, memory, etc.), and analyzing the execution plans and query optimization techniques employed by each system. Our experimental results demonstrate that the proposed HTI indexing strategy outperforms traditional indexing approaches, particularly for complex event queries involving temporal constraints and multi-dimensional event attributes. We provide insights into the strengths and weaknesses of each indexing strategy, identifying the factors that influence performance, such as data volume, query complexity, and event characteristics. Furthermore, we discuss the implications of our findings for the design and optimization of CEP systems, offering recommendations for indexing strategy selection based on the specific requirements and workload characteristics. Finally, we outline the potential limitations of our study and suggest future research directions in this domain.

Understanding the differences in the use of graphic tool and planning during graphic execution between individuals with autism and typically developing individuals

Individuals with autism (ASD) often face difficulty in executing graphic tasks. This can be related to how one uses a graphic tool (e.g., pen) and plans ahead the graphic execution. Use of graphic tool can be captured using attributes, e.g., pen-tip pressure, number of pen lifts, etc. One’s ability to plan a graphic execution can be quantified using the total duration of pen lifts (i.e., air time). Though pen-and-paper-based Trail Making Test-Part A (TMT-A) can estimate planning of graphic execution, yet it cannot capture other attributes, e.g., pen-tip pressure, pen lift, etc. This can be possible if TMT-A is administered on a pressure-sensitive tablet as seen from existing studies with typically developing (TD) individuals. However, quantification of such attributes using TMT-A administered on a pressure-sensitive tablet remains unexplored for individuals with ASD. In addition, such objective measures can help to understand variations in the use of graphic tool and ability to plan graphic execution even outside the TMT-A task, e.g., while drawing shapes which is important to the development of children’s graphic skills. Here, we conducted a study with 12 pairs of TD children and those with ASD who executed TMT-A (in Phase-I) and shape drawing (in Phase-II) on a pressure-sensitive tablet. Results of our study show differences in the use of graphic tool and planning ahead the graphic execution between two participant groups in both the Phases. Such insights can offer clinical inputs that can be helpful in designing individualized intervention paradigms for children facing difficulties in graphic execution.

Simultaneous correction of leg length discrepancy and angular deformity of the distal femur with retrograde Precice nails: a retrospective analysis of 45 patients.

Magnetically controlled motorized intramedullary lengthening nails (ILNs) can be employed for simultaneous correction of angular deformities of the distal femur and leg length discrepancy. This spares typical complications of external fixators but requires precise preoperative planning and exact intraoperative execution. To date, its results are insufficiently reported. We aimed to elucidate the following questions: (i) Is acute angular deformity correction and gradual femoral lengthening via a retrograde ILN a reliable and precise treatment option? (ii) What are the most common complications of treatment? Acute angular deformity correction and subsequent gradual lengthening of the distal femur with retrograde ILN was retrospectively analyzed in 45 patients (median patient age: 15 years, interquartile range [IQR] 13-19 and median follow-up: 40 months, IQR 31-50). Outcome parameters were accuracy, precision, reliability, bone healing, and complications of treatment. The median distraction was 46 mm (IQR 29-49), median distraction and consolidation index 0.9 mm/day (IQR 0.7-1.0) and 29 days/cm (IQR 24-43), respectively. The median preoperative mechanical axis deviation (MAD) was 30 mm (IQR 23-39) in the varus cohort and -25 mm (IQR -29 to -15) in the valgus cohort and reduced to a mean of 8 mm (standard deviation [SD] 8) and -3 (SD 10), respectively. Accuracy, precision, and reliability of lengthening were 94%, 95% and 96%, respectively. Accuracy and precision of deformity correction were 92% and 89%, respectively. In total, 40/45 of patients achieved distraction with a difference of less than 1 cm from the initial plan and a postoperative MAD ranging from -10 mm to +15 mm. In 13/45 patients unplanned additional surgeries were conducted to achieve treatment goal with nonunion being the most frequent (4/45) and knee subluxation (3/45) the most severe complication. Acute deformity correction and subsequent lengthening of the distal femur with retrograde ILN is a reliable and accurate treatment achieving treatment goal in 89% but unplanned additional surgeries in 29% of patients should be anticipated.

Engaging primary care professionals in OECD’s international PaRIS survey: a documentary analysis

Healthcare professionals have first-hand experience with patients in clinical practice and the dynamics in the healthcare system, which can be of great value in the design, implementation, data analysis and dissemination of research study results. Primary care professionals are particularly important as they provide first contact, accessible, coordinated, comprehensive and continuous people-focused care. However, in-depth examination of the engagement of health professionals in health system research and planning activities—how professionals are engaged and how this varies across national contexts- is limited, particularly in international initiatives. There is a need to identify gaps in the planning of engagement activities to inform the design and successful implementation of future international efforts to improve the responsiveness of health systems to the changing needs of patients and professionals. The aim of this study was to explore how primary care professionals were engaged in the design and implementation plans of an international health policy study led by the Organisation for Economic Co-operation and Development (OECD). The OECD’s international PaRIS survey measures and disseminates information on patient-reported outcome and experience measures (PROMs and PREMs) of people living with chronic conditions who are managed in primary care. A documentary analysis of 17 written national implementation plans (country roadmaps) was conducted between January and June 2023. Two reviewers independently performed the screening and data abstraction and resolved disagreements by discussion. We reported the intended target primary care professionals, phase of the study, channel of engagement, level of engagement, and purpose of engagement. All 17 countries aimed to engage primary care professionals in the execution plans for the international PaRIS survey. While organisations of primary care professionals, particularly of family doctors, were the most commonly targeted group, variation was found in the timing of engagement activities during the different phases of the study and in the level of engagement, ranging from co-development (half of the countries co-developed the survey together with primary care professionals) to one-off consultations with whom. International guidance facilitated the participation of primary care professionals. Continuous collaborative efforts at the international and national levels can foster a culture of engagement with primary care organisations and individual professionals and enhance meaningful engagement of primary care professionals.

The Nine ‘S’ Model for Strategy Implementation: A Review

Abstract This review analyzes the progression of strategic planning and implementation models from McKinsey 7’s’ to Higgins 8’s’ and then to the 9’s. It examines how these frameworks improve strategy plan execution, leading to better organizational performance and competitive advantage. Integrating empirical and theoretical findings, the analysis compares these models, emphasizing leadership roles, the nexus between internal and external factors, and the critical integration of supply chains, goal-setting, and synergy. The study reveals that although McKinsey and Higgins’ models offer initial insights into implementing strategies, they do not address the complexities between the organization’s components. On the other hand, 9 ‘S,’ which encompasses supply chain, objective focus, and synergy, offers an integrative approach to refining strategic execution and operational efficiency. The recommendation for organizations is a shift towards the 9’S’ model, surpassing previous frameworks by focusing on supply chain management, precise goal articulation, and fostering collaborative synergy. This approach will help businesses develop integrated implementation processes concerning changing business climates, enhancing management capabilities, and maintaining competitive strength.

Model of performance indicators for the evaluation of state public health expenditures in Brazil

Objective: To present a proposal on a set of performance indicators that can be used in audits of state audit courts to assess the effectiveness of budget spending on public health. Methodology: This is quantitative research, with the application of statistical techniques related to Data Envelopment Analysis (DEA) in two stages and estimation of linear longitudinal regression models for strongly balanced short panel data, on the budget expenditures made in the period from 2015 to 2019 by the States and the Federal District on public health. Results: It was found that there is no use of performance indicators in the elaboration and execution of Multi-Annual Plans (MAPs) by governments to evaluate the effectiveness of spending on public actions; that the mention of "performance indicators" refers exclusively to percentages to compare what was accomplished in relation to what was predicted; that records of duplicate public actions were found in the MAPs by some entities, and that overvaluation was identified in the records of the resources provided for in most of the MAPs. The degree of statistical explanation of the proposed set of indicators reached an average of 87% of statistical confidence. None of the public entities was 100% effective in the expenditures made. 69% of the auditors of the Courts of Auditors legitimized the set of indicators proposed to evaluate the effectiveness of state public health spending. Finally, it is concluded that the proposed performance evaluation indicators can be used to verify the effectiveness of state public health spending. Contributions of the study: It presents performance indicators, created by means of a statistical method, to evaluate the effectiveness of spending on state public health, since the specialized literature indicates little or no discussion about it. It indicates that the actions included in the MAPs are not audited by the courts of auditors and that the legislative branch is silent in the supervision between what is foreseen and what is carried out, considering that there are repeated and overvalued actions.

Executive compensation: The trend toward one-size-fits-all

I report and analyze a recent “one-size-fits-all” trend in the structure of executive compensation plans. Since 2006, 24% of the variation in the distribution of CEO compensation across pay components — salary, bonus, stock awards, options, non-equity incentives, pensions, and perquisites — disappeared. This uniformity might come at the expense of optimal incentives, as increases in pay structure similarity translate into lower shareholder value. Using panel data regressions and plausibly exogenous shocks, I find that institutional investors’ influence, proxy advisors’ recommendations, and expanded compensation disclosure are salient drivers of this standardization. The findings highlight an unintended consequence of recent regulations enhancing shareholders’ participation and expanding compensation disclosure.

Heterogeneity in the integration of ESG measures in executive compensation: Determinants, contracting details and outcomes

Corporate social responsibility (CSR) contracting incorporates environmental, social, and governance (ESG) related measures in executive compensation plans. Current research on this practice is limited to a US setting, despite global adoption. We investigate heterogeneity in CSR contracting using data from 59 countries between 2002 and 2019. We find that besides firm-level past ESG performance and the industry-level adoption rate, country-level ESG regulations have significant explanatory power in firms’ tendencies to adopt CSR contracting. Hand-collected data reveal significant cross-country differences in CSR contracting details. Finally, CSR contracting is positively associated with subsequent financial performance only in countries with more stringent ESG regulations and stronger legal enforcement. In contrast, CSR contracting is associated with subsequent ESG performance regardless of country-level factors.

A novel query execution time prediction approach based on operator iterate-aware of the execution plan on the graph database

Query execution time prediction is essential for database query optimization tasks, such as query scheduling, progress monitoring, and resource allocation. In the query execution time prediction tasks, the query plan is often used as the modeling object of a prediction model. Although the learning-based prediction models have been proposed to capture plan features, there are two limitations need to be considered more. First, the parent–child dependencies between plan operators can be captured, but the operator’s branch independence cannot be distinguished. Second, each operator’s output row is its following operator input, but the data iterate transfer operations between operators are ignored. In this study, we propose a graph query execution time prediction model containing a plan module, a query module, a plan-query module, and a prediction module to improve prediction effectiveness. Specifically, the plan module is used to capture the data iterate transfer operations and distinguish independent of branch operators; the query module is used to learn features of query terms that have an influence on the composition of operators; the plan-query interaction module is used to learn the logical correlations of plan and query. The experiment on datasets proves the effectiveness of the operator iterate-aware and query-plan interaction method in our proposed graph query execution prediction model.

How Much Is an Idea Worth?

The value of an idea in the world of investing is often overestimated, as investors are more interested in the team’s ability to turn the idea into a product or service that meets customers’ needs and wants. While an idea is the starting point, it holds no value until it faces market realities, competitors, regulations, and other factors that shape its worth. Investors look for startups with a robust execution plan, a resilient team, scalability, adaptability, early validation, and a compelling pitch. Scientific results also hold value as a starting point for potential therapies or products, but their ultimate worth depends on successful translation. The key lesson for startups and investors alike is to not overestimate the value of raw ideas or scientific results without considering the execution process’s challenges and requirements.

Root cause analysis and strategies for reducing falls amonginpatients in healthcare facilities: A narrative review.

Root Cause Analysis (RCA) is a systematic process which can be applied to analyze fall incidences in reactive manner to identify contributing factors and propose actions for preventing future falls. To better understand cause of falls and effective interventions for their reduction we conducted a narrative review of RCA and Strategies for Reducing Falls among Inpatients in Healthcare Facilities. In this narrative review, databases including Scopus, ISI Web of Science, Cochrane, and PubMed were searched to obtain the related literature published. Databases were searched from January 2005 until the end of March 2023. The Joanna Briggs Institute (JBI) tool was used for quality assessment of articles. To analyze the data, a five-stage framework analysis method was utilized. Seven articles that fulfilled the inclusion criteria were identified for this study. All of the selected studies were interventional in nature and employed the RCAmethod to ascertain the underlying causes of inpatient falls. The root causes discovered for falls involved patient-related factors (37.5%), environmental factors (25%), organizational and process factors (19.6%), staff and communication factors (17.9%). Strategies to reduce falls involved environmental measures and physical protection (29.4%), identifying, and displaying the causes of risk (23.5%), education and culturalization (21.6%), standard fall risk assessment tool (13.7%), and supervision and monitoring (11.8%). the findings identify the root causes of falls in inpatient units and provide guidance for successful action plan execution. Additionally, it emphasizes the importance of considering the unique characteristics of healthcare organizations and adapting interventions accordingly for effectiveness in different settings.

ADVANCED QUERY OPTIMIZATION IN SQL DATABASES FOR REAL-TIME BIG DATA ANALYTICS

This study investigates the effectiveness of advanced query optimization techniques in SQL databases, focusing on multi-level indexing, query rewriting, and dynamic query execution plans. The research employs a qualitative approach, gathering data from a variety of SQL databases characterized by large datasets typical of big data environments. Through structured interviews, focus groups, and observational methods, insights from database administrators highlight the practical benefits and challenges associated with implementing these techniques. The findings reveal significant improvements in query performance, with multi-level indexing reducing data retrieval times by approximately 40%, query rewriting decreasing execution times by 35%, and dynamic query execution plans enhancing resource utilization efficiency by 25%. These techniques were also praised for their ease of use, adaptability to different data types and query complexities, and overall reliability. This study contributes to the existing body of knowledge by providing a comprehensive analysis of the practical applications and performance enhancements offered by advanced query optimization methods in SQL databases, underscoring their value in managing large-scale, dynamic data environments.

Using Wargaming to Model Cyber Defense Decision-Making: Observation-Based Research in Locked Shields

Defensive Cyber Operations (DCO) in complex environments, such as cyber wargames, require in-depth cybersecurity knowledge and the ability to make quick decisions. In a typical DCO, execution rarely follows a pre-planned path because of extensive adversary influence, challenging an already complex decision-making environment. Decision-making models have been extensively studied from perspectives of military operations and business management, but they are not sufficiently researched in the context of cyber. This paper responds to this need by examining the decision-making models of DCO leaders in a live-fire wargame environment. This study was conducted by observing leaders of cyber operations during the world's largest live-fire cyber exercise, NATO Locked Shield 2023. In this exercise, the blue teams plan and execute their defensive cyber operation in a realistic operational environment, while the red team conducts attacks against the defended environment. The large-scale, wargaming-style environment of Locked Shield is one of the best environments for modelling DCO decision-making models; in this exercise, the DCO is broad and multi-faceted, a perspective which cannot be achieved in a typical capture-the-flag competition or a single security incident. DCO leaders must be able to manage two distinct decision-making processes with different sets of required skills to be successful in the mission. While the primary process relates to the execution and evolution of the pre-designed plan with traditional operational leadership skills, the secondary process deals with unplanned and deliberately caused cyber-related events that require a deep understanding of cybersecurity. In this respect, the main contribution of this research is the constructed decision-making model of the DCO leader. This model is based on observations collected and presented in the context of multiple well-known decision-making frameworks. This model can be further used to train future DCO leaders and assess artificial intelligence's usability to support and automate decision-making in such operations.

Evaluation of the Dimensional Accuracy of Robot-Guided Laser Osteotomy in Reconstruction with Patient-Specific Implants-An Accuracy Study of Digital High-Tech Procedures.

Background/Objective: With the rapid advancement in surgical technologies, new workflows for mandibular reconstruction are constantly being evaluated. Cutting guides are extensively employed for defining osteotomy planes but are prone to errors during fabrication and positioning. A virtually defined osteotomy plane and drilling holes in robotic surgery minimize potential sources of error and yield highly accurate outcomes. Methods: Ten mandibular replicas were evaluated after cutting-guided saw osteotomy and robot-guided laser osteotomy following reconstruction with patient-specific implants. The descriptive data analysis summarizes the mean, standard deviation (SD), median, minimum, maximum, and root mean square (RMS) values of the surface comparison for 3D printed models regarding trueness and precision. Results: The saw group had a median trueness RMS value of 2.0 mm (SD ± 1.7) and a precision of 1.6 mm (SD ± 1.4). The laser group had a median trueness RMS value of 1.2 mm (SD ± 1.1) and an equal precision of 1.6 mm (SD ± 1.4). These results indicate that robot-guided laser osteotomies have a comparable accuracy to cutting-guided saw osteotomies, even though there was a lack of statistical significance. Conclusions: Despite the limited sample size, this digital high-tech procedure has been shown to be potentially equivalent to the conventional osteotomy method. Robotic surgery and laser osteotomy offers enormous advantages, as they enable the seamless integration of precise virtual preoperative planning and exact execution in the human body, eliminating the need for surgical guides in the future.

Enhancing anterior maxillary esthetics: A case report

This case study delves into the complex process of esthetic restoration in the anterior maxilla, highlighting the careful planning and precise execution needed to achieve optimal results. Tarting with a thorough assessment of the patient's dental health, including bone structure and soft tissue condition, a customized treatment plan was crafted through the collaborative efforts of the implant surgeon and restorative dentist. The surgical placement of a single tooth implant was performed with precision, ensuring optimal positioning and angulation to achieve natural-looking results while preserving the surrounding tissues. Prosthetic restoration utilized carefully chosen materials and techniques to integrate seamlessly with the natural teeth. Through interdisciplinary collaboration and precise attention to detail, the anterior maxilla was successfully esthetically rehabilitated, showcasing the transformative capabilities of modern implant dentistry.

Robotic-assisted Total Hip Arthroplasty and Spinopelvic Parameters: A Review.

Total hip arthroplasty (THA) is an effective treatment for osteoarthritis, and the popularity of the direct anterior approach has increased due to more rapid recovery and increased stability. Instability, commonly caused by component malposition, remains a significant concern. The dynamic relationship between the pelvis and lumbar spine, deemed spinopelvic motion, is considered an important factor in stability. Various parameters are used in evaluating spinopelvic motion. Understanding spinopelvic motion is critical, and executing a precise plan for positioning the implant can be difficult with manual instrumentation. Robotic and/or navigation systems have been developed in the effort to enhance THA outcomes and for implementing spinopelvic parameters. These systems can be classified into three categories: X-ray/fluoroscopy-based, imageless, and computed tomography (CT)-based. Each system has advantages and limitations. When using CT-based systems, preoperative CT scans are used to assist with preoperative planning and intraoperative execution, providing feedback on implant position and restoration of hip biomechanics within a functional safe zone developed according to each patient's specific spinopelvic parameters. Several studies have demonstrated the accuracy and reproducibility of robotic systems with regard to implant positioning and leg length discrepancy. Some studies have reported better radiographic and clinical outcomes with use of robotic-assisted THA. However, clinical outcomes comparable to those for manual THA have also been reported. Robotic systems offer advantages in terms of accuracy, precision, and potentially reduced rates of dislocation. Additional research, including conduct of randomized controlled trials, will be required in order to evaluate the long-term outcomes and cost-effectiveness of robotic-assisted THA.

A Real-Time Rescheduling Algorithm for Multi-robot Plan Execution

A Real-Time Rescheduling Algorithm for Multi-robot Plan Execution

Micro-robotic percutaneous targeting of type II endoleaks in the angio-suite

PurposeEndovascular aneurysm repair has emerged as the standard therapy for abdominal aortic aneurysms. In 9–30% of cases, retrograde filling of the aneurysm sac through patent branch arteries may result in persistence of blood flow outside the graft and within the aneurysm sac. This condition is called an endoleak type II, which may be treated by catheter-based embolization in case of continued sac enlargement. If an endovascular access is not possible, percutaneous targeting of the perfused nidus remains the only option. However, this can be very challenging due to the difficult access and deep puncture with risk of organ perforation and bleeding. Innovative targeting techniques such as robotics may provide a promising option for safe and successful targeting.MethodsIn nine consecutive patients, percutaneous embolization of type II endoleaks was performed using a table-mounted micro-robotic targeting platform. The needle path from the skin entry to the perfused nidus was planned based on the C-arm CT image data in the angio-suite. Entry point and path angle were aligned using the joystick-operated micro-robotic system under fluoroscopic control, and the coaxial needle was introduced until the target point within the perfused nidus was reached.ResultsAll punctures were successful, and there were no puncture-related complications. The pre-operative C-arm CT was executed in 11–15 s, and pathway planning required 2–3 min. The robotic setup and sterile draping were performed in 1–2 min, and the alignment to the surgical plan took no longer than 30 s.ConclusionDue to the small size, the micro-robotic platform seamlessly integrated into the routine clinical workflow in the angio-suite. It offered significant benefits to the planning and safe execution of double-angulated deeply localized targets, such as type II endoleaks.