Total Turnaround Time Research Articles

Integrated berth allocation and quay crane assignment with maintenance activities

With the rapid development of worldwide container trade, quay cranes and other resources in container terminals are suffering from increasing workloads. To reduce their failure probabilities, quay cranes usually require preventive maintenance. However, these important activities are often ignored during quay crane planning in literature. This work studies an integrated berth allocation, quay crane assignment and specific quay crane assignment problem where quay crane maintenance is involved, and establishes an integer linear programming with the objective of minimising the total turnaround time. Due to the NP-hardness of the problem, CPLEX only solves instances with up to 18 vessels. For solving larger instances, we propose Left-and-Right Vessel Move (LRVM) algorithm and improved Genetic Algorithm (GA). Experimental results reveal that GA slightly outperforms LRVM with respect to solution quality as the solution of LRVM serves as one of the initial chromosomes of GA. LRVM can output feasible solutions within seconds, even for instances with 50 vessels. We further present a sensitivity analysis of preferred berth segments, and make numerical comparison on algorithm performance for the relevant model without quay crane maintenance. Both the models and proposed heuristics in this work help in dealing with the operational management of container terminal resources in practice.

Evaluation of a new extraction platform in combination with molecular assays useful for monitoring immunosuppressed patients

BackgroundIn the immunosuppressed, detection of viral reactivation at the earliest convenience and molecular monitoring are of paramount importance. Nucleic acid extraction has a major impact on the reliability of results obtained from molecular assays. ObjectivesThe aim of this study was to investigate the accuracy of the new EMAG® nucleic acid extraction platform and to compare the performance of the new platform to that of the standard NucliSENS® easyMAG® instrument in the routine clinical laboratory. Study designFor accuracy testing, reference material and for comparison studies, clinical specimens were used. In addition, a lab-flow analysis including estimation of hands-on time and that for automated extraction was performed. ResultsWhen accuracy was tested, all 89 results obtained were found to be concordant with the results expected. When 648 clinical results were compared, 85.7% were found to be within ±0.5 log10 unit, 9.5% between ±0.5 and ±1.0 log10 unit, and 4.8% more than ±1.0 log10 unit. The overall time required for nucleic acid extraction of 8 samples in parallel was 94 min for the fully automated extraction mode and 82 min for the partly automated mode with the new platform, and 73 min with the standard instrument. Hands-on time was found to be shorter with the new platform. ConclusionsThe extraction performance of both platforms was found to be similar for EDTA whole blood, BAL, and urine specimens. The total turn-around time for nucleic acid extraction was found to be longer with the EMAG® platform, whereas hands-on time was reduced.

The stochastic discrete berth allocation problem

This paper deals with the discrete berth allocation problem with stochastic arrival times of vessels. The problem is to assign incoming vessels to a finite set of berthing points (berths) and to schedule them. The major objective is to minimize the expected total turnaround time of the vessels. We develop several new proactive, reactive and proactive/reactive approaches to this problem. Numerical experiments enable to compare these approaches. They show the impact of using full stochastic information instead of using mean values in a deterministic setting. The proactive/reactive approach, based on iterated tabu search and stochastic dynamic programming, provides good results when uncertainties on arrival times remain limited, while requiring only a few minutes of computing time on average. For larger levels of uncertainty, the proposed pure reactive approach clearly outperforms the others.

Nonaplex PCR using Cliffhanger primers to identify diarrhoeagenic Escherichia coli from crude lysates of human faecal samples.

Sensitive, probe-based detection of multiple DNA targets is limited by the competitive reannealing of the antiparallel duplex DNA helix with the complementary DNA strand. To address this, we developed Cliffhanger primers, which create single-stranded DNA overhangs on PCR amplicons while simultaneously increasing the multiplex PCR efficacy and allowing PCR amplification using crude lysates of human faecal samples. A multiplex PCR that targeted eight genes from diarrhoeagenic Escherichia coli plus an internal control was performed and compared to a routine method that consisted of culture followed by multiplex PCR with fragment length separation. A total of 2515 clinical faecal samples from patients with diarrhoea were tested using both methods, and there was a significant increase in clinical sensitivity and negative predictive value with the Cliffhanger method for seven out of eight genes. All Cliffhanger-only positive samples were confirmed by Sanger sequencing of the PCR amplicon. Notably, the Cliffhanger method reduced the total sample turn-around time in the laboratory from 20 hours to 6 hours. Hence, use of Cliffhanger primers increased assay robustness, decreased turn-around time and increased PCR efficacy. This increased the overall clinical sensitivity without the loss of specificity for a heavily multiplexed PCR assay.

Analysis of Turnaround Time during Casefile and Sample Processing in Forensic Science Laboratory

Turnaround time (TAT), is the total time interval from when a request for forensic laboratory analysis is received until when the results are collected by the client. The performance of the forensic science laboratory (FSL) is affected by extended TAT in the case-file and sample processing steps necessitating critical analysis reported in this paper. The total TAT was obtained as the sum of measured time interval for each work station (six of which were studied). Extended TAT leads not only to customer complaints, but also paves way for customers to seek for services from competitors, leading to lost competitive edge for the FSL. This study was conducted to establish the baseline data on TAT (between 2014 and 2015) to enable implementation of corrective actions. Six casefile processing steps were identified for which starting and completion times were recorded in dates, giving TAT values in days. The TAT data for each step was collected as each case file is processed and analyzed separately using statistical analysis while comparing the data for the two years (Y2014 and Y2015) and among three forensic science laboratory disciplines (biology/DNA, chemistry and toxicology). The overall turnaround time (TTAT) was the highest for forensic biology/DNA compared to forensic toxicology and chemistry. The analysis time (TAT2) was the longest of all six case-file processing steps. Using Pareto analysis, the three major steps necessitating root-cause analysis and intervention to minimize TAT were analysis turnaround time (TAT2), report collection time (TAT6) and report review time (TAT4). It was concluded that the causes for extended TAT are within control by the FSL management, although financial and human resources are required.

Short-Term Scheduling of Vehicle Testing System Using Object Petri Net

This paper addresses the modeling, analysis, and scheduling optimization of a vehicle testing system, a widely used facility in China’s transportation management and automotive manufactures. To do so, object Petri net models are built to describe its resources (including testing equipment and field) and operations. Based on these models, a short-term scheduling framework and an algorithm for optimally generating a vehicle’s testing sequence are presented. By this framework, a waiting area with adjustable capacity is set for vehicles to be inspected in the system. The complete permutations of vehicles in the waiting area are considered as tokens in an object Petri net. In this way, with the models, the total testing turnaround time of a vehicle sequence can be calculated and the optimal one can be chosen. Experimental results show that the proposed method can reduce the average testing turnaround time by about 31% compared with the traditional first-come-first-served-based one. In addition, the proposed method can obtain a shorter average testing turnaround time when the re-inspection rates are 25%, 50%, 75%, and 100%. Thus, it is applicable and effective.

Clinical Evaluation of QMAC-dRAST for Direct and Rapid Antimicrobial Susceptibility Test with Gram-Positive Cocci from Positive Blood Culture Bottles

Background Timely intervention in the treatment of bloodstream infection is important for prescription of appropriate antimicrobials. With prompt determination of the antimicrobial susceptibility of a causative agent, rapid antimicrobial susceptibility test (AST) can help select the appropriate antimicrobial therapy. This clinical study is for evaluation of the clinical performance of the QMAC-dRAST for rapid AST directly from positive blood culture (PBC)s with Gram-positive cocci. Methods A total of 115 PBC samples with Grampositive organisms (76 Staphylococcus spp. and 39 Enterococcus spp.) were evaluated by the QMAC-dRAST system, and their pure culture isolates were evaluated by the MicroScan WalkAway (Beckman Coulter, USA) as the comparative AST system. Thirteen antimicrobial agents were included, and the agreement and discrepancy rates of the QMAC-dRAST system (Quantamatrix Inc., Republic of Korea) compared to the MicroScan WalkAway were calculated. To resolve discrepancies, the broth microdilution method was performed. Results The QMAC-dRAST system exhibited a categorical agreement rate of 94.9% (1,126/1,187) and an essential agreement rate of 98.3% (1,167/1,187). The QMAC-dRAST system yielded very major (false-susceptible) errors at 1.0% (5/485), major (false-resistant) errors at 1.3% (9/693), and minor errors at 4.0% (47/1,187) compared to the MicroScan WalkAway. The QMAC-dRAST system significantly eliminated 30 hours of total turnaround time by combination of direct inoculation of PBC and an image-based approach. Conclusion The results of the QMAC-dRAST system were highly accurate. Thereby, the QMAC-dRAST may provide essential information to accelerate therapeutic decisions for earlier and adequate antibiotic treatment and patient management in clinical settings.

A Simulation Study of Collaborative Approach to Berth Allocation Problem under Uncertainty

ABSTRACT The Berth Allocation Problem (BAP) is a critical issue for the efficient operation of a container terminal. While there are many works on berth allocation, most of the BAP models have used the assumption of a deterministic situation where arrival time and number of containers brought by a vessel are known in advance. Such a deterministic assumption, however, never holds true in real life. The purpose of this paper is to examine how collaboration between berth terminals could affect the port performance when dealing with uncertainty. Given the complexity of the problem, we have used discrete event simulation to model the system. Two major scenarios were evaluated, namely non-collaborative-response and collaborative-response. Collaborative-response is implemented by sharing resources such as berth, quay cranes and container yard among two terminals. The port performance was evaluated based on ship waiting time, container handling time and total ship turnaround time. The results show that collaborative strategy can reduce overall waiting time, container-handling time and total ship turnaround time; however, the impacts on each terminal vary.

Effects of Regulatory Support Services on Institutional Review Board Turnaround Times.

We evaluated how regulatory support services provided by University of Illinois at Chicago's Center for Clinical and Translational Science may reduce Institutional Review Board (IRB) turnaround times. IRB applications were categorized by receipt of any regulatory support and amount of support received. Turnaround time included total turnaround time, time for IRB review, and time for investigators to modify protocols. There were no differences in any turnaround times for supported versus nonsupported applications. However, for supported applications, those receiving more intensive support had total turnaround times 16.0 days ( SE 7.62, p < .05) faster than those receiving less intensive support. Receiving higher regulatory support may be associated with faster approval of IRB submissions.

Molecular Testing Turnaround Time for Non–Small Cell Lung Cancer in Routine Clinical Practice Confirms Feasibility of CAP/IASLC/AMP Guideline Recommendations: A Single-center Analysis

IntroductionMolecular testing to identify targetable driver mutations is the standard of care for patients with advanced-stage non–small cell lung cancer. Recent guideline recommendations by the College of American Pathologists (CAP), International Association for the Study of Lung Cancer (IASLC), and Association for Molecular Pathology (AMP) established a benchmark turnaround time (TAT) target of 10 working days for results to be available to the treating oncologist and ≤ 3 days for specimens to arrive at a commercial testing laboratory if testing is not performed in-house. Methods and MaterialsTo provide insights regarding the pre-testing, post-testing, and testing intervals that constitute the overall TAT target, we performed a detailed workflow analysis. A total of 157 lung cancer specimens were sent out for molecular testing at a commercial vendor from a single academic medical center during the calendar year 2015. ResultsOverall, 128 specimens (81.5%) met the recommended 10-working day TAT, with a median total TAT of 9 weekdays (mean ± standard deviation, 9.17 ± 4.15 days). The pre-testing interval was ≤ 3 days for 146 specimens (93.0%), and the post-testing reporting interval was < 1 day for 116 cases (73.9%). The TAT variance was not related to intrinsic specimen characteristics. ConclusionOverall, the findings indicated that the CAP/IASLC/AMP TAT guideline recommendations are feasible for most lung cancer specimens when a streamlined system is in place.

Efficiency Evaluation of Urine Collection Vessels with Impeded Urine Adulteration/Substance of Abuse (SOA) Rapid Detection Test Strips

Laboratory testing for drugs of abuse has become standard practice in many settings both forensic and clinical. Sending the specimen to any laboratory is waste of time and sometimes the rapid urine testing is a target. A limitation inherent in all urine drug testing is the possibility of sample adulteration or substitution. The aim of the current study is to prove the validity by deeply investigated procedures for urine collection vessels with impeded urine adulteration/substance of abuse (SOA) Test Strips (two types of investigated kits) and evaluation of their total turnaround time and efficacy for cannabinoids, opiates, benzodiazepines, tramadol and amphetamines in-comparison with immunoassay screening and GC-MS confirmatory procedures. Both Investigated Kits have the capability of detecting variable procedures of adulteration by a high efficiency degree. Therefore, SOA tests with rapid releasing results can improve patient management protocol with few percentage of pseudo-positivity/negativity results, unfortunately the operators immediate start the clinical action and realize the limitations of the test and wait for follow-up confirmation testing as appropriate before definitive medico-legal action.

Stability of Biochemical Components in Blood Samples Transported by Tempus600/Sysmex GLP Robot Reception System.

The Department of Clinical Immunology and Biochemistry, Lillebaelt Hospital, Denmark, and TIMEDICO invented and developed the Tempus600®, a pneumatic tube system (PTS). This system is only 2.5 cm in diameter and sends blood tubes directly, without packing before transport. Request forms need not be enclosed, since samples are labeled with patient and barcode ID. At the end of the pipes, a robot receives and places the tubes onto a GLP transport system after the principle of "first in, first out" (FIFO), whereafter the tubes are delivered to centrifuges and analytical equipment. The whole system has decreased the total turnaround time (ToTAT) from 2 to 3 h to <60 min. The aim of the study was to validate the Tempus600/GLP robot system for the 89 most frequent or critical components. Two sets of blood samples were drawn from 100 patients. One set was sent by the Tempus600/GLP robot system, and the other was couriered directly to the laboratory for analysis. Results were compared using difference plots. The results for 85 of the components did not deviate from the optimized fast courier reference transport more than could be expected by the analytical variation. O2 saturation, oxyhemoglobin, and partial pressure of oxygen (Po2) deviated considerably from a clinical point of view. Partial pressure of carbon dioxide (Pco2) results were clinically acceptable for assessing patients with obstructive lung disease for hypercapnia. The Tempus600/GLP robot system can be used for transport of the majority of routinely used analytical tests.

Development of 2, 7-Diamino-1, 8-Naphthyridine (DANP) Anchored Hairpin Primers for RT-PCR Detection of Chikungunya Virus Infection.

A molecular diagnostic platform with DANP-anchored hairpin primer was developed and evaluated for the rapid and cost-effective detection of Chikungunya virus (CHIKV) with high sensitivity and specificity. The molecule 2, 7-diamino-1, 8-naphthyridine (DANP) binds to a cytosine-bulge and emits fluorescence at 450 nm when it is excited by 400 nm light. Thus, by measuring the decline in fluorescence emitted from DANP—primer complexes after PCR reaction, we could monitor the PCR progress. By adapting this property of DANP, we have previously developed the first generation DANP-coupled hairpin RT-PCR assay. In the current study, we improved the assay performance by conjugating the DANP molecule covalently onto the hairpin primer to fix the DANP/primer ratio at 1:1; and adjusting the excitation emission wavelength to 365/430 nm to minimize the background signal and a ‘turn-on’ system is achieved. After optimizing the PCR cycle number to 30, we not only shortened the total assay turnaround time to 60 minutes, but also further reduced the background fluorescence. The detection limit of our assay was 0.001 PFU per reaction. The DANP-anchored hairpin primer, targeting nsP2 gene of CHIKV genome, is highly specific to CHIKV, having no cross-reactivity to a panel of other RNA viruses tested. In conclusion, we report here a molecular diagnostic assay that is sensitive, specific, rapid and cost effective for CHIKV detection and can be performed where no real time PCR instrumentation is required. Our results from patient samples indicated 93.62% sensitivity and 100% specificity of this method, ensuring that it can be a useful tool for rapid detection of CHIKV for outbreaks in many parts of the world.

Distributed Late-binding Scheduling and Cooperative Data Caching

Pull-based overlays are used in some of today’s largest computational grids. Job agents are submitted to resources with the duty of retrieving real workload from a central queue at runtime and executing it. This model helps overcome the problems of direct job submission in the highly complex grid environments, namely, heterogeneity, imprecise status information, relatively high failure rates and slow adaptation to changes of grid conditions or user priorities. This article presents a distributed scheduling architecture for such late-binding overlays. In this architecture, execution nodes share a distributed hash table and cooperatively perform job assignment. As our experiments prove, scalability problems of centralized matching are avoided, achieving low and predictable scheduling overheads even for execution of large workflows, and total turnaround times are improved. This is in line with the predictions of a theoretical model of grid workflow execution that the article also discusses. Scalability makes fine-grained scheduling possible and enables new functionalities, like a distributed data cache shared by the execution nodes, which helps alleviate the commonly congested storage services. In addition, we show that our system is more resilient to problems like communication breakdowns between computation centres. Moreover, the new architecture is better prepared to deal with demanding scenarios like intense demand of popular data files or remote data processing.

Advantages and disadvantages from enforcing emission restrictions within emission control areas

Purpose Emissions produced by oceangoing vessels not only negatively affect the environment but also may deteriorate health of living organisms. Several regulations were released by the International Maritime Organization (IMO) to alleviate negative externalities from maritime transportation. Certain polluted areas were designated as “Emission Control Areas” (ECAs). However, IMO did not enforce any restrictions on the actual quantity of emissions that could be produced within ECAs. This paper aims to perform a comprehensive assessment of advantages and disadvantages from introducing restrictions on the emissions produced within ECAs. Two mixed-integer non-linear mathematical programs are presented to model the existing IMO regulations and an alternative policy, which along with the established IMO requirements also enforces restrictions on the quantity of emissions produced within ECAs. A set of linearization techniques are applied to linearize both models, which are further solved using the dynamic secant approximation procedure. Numerical experiments demonstrate that introduction of emission restrictions within ECAs can significantly reduce pollution levels but may incur increasing route service cost for the liner shipping company. Design/methodology/approach Two mixed-integer non-linear mathematical programs are presented to model the existing IMO regulations and an alternative policy, which along with the established IMO requirements also enforces restrictions on the quantity of emissions produced within ECAs. A set of linearization techniques are applied to linearize both models, which are further solved using the dynamic secant approximation procedure. Findings Numerical experiments were conducted for the French Asia Line 3 route, served by CMA CGM liner shipping company and passing through ECAs with sulfur oxide control. It was found that introduction of emission restrictions reduced the quantity of sulfur dioxide emissions produced by 40.4 per cent. In the meantime, emission restrictions required the liner shipping company to decrease the vessel sailing speed not only at voyage legs within ECAs but also at the adjacent voyage legs, which increased the total vessel turnaround time and in turn increased the total route service cost by 7.8 per cent. Research limitations/implications This study does not capture uncertainty in liner shipping operations. Practical implications The developed mathematical model can serve as an efficient practical tool for liner shipping companies in developing green vessel schedules, enhancing energy efficiency and improving environmental sustainability. Originality/value Researchers and practitioners seek for new mathematical models and environmental policies that may alleviate pollution from oceangoing vessels and improve energy efficiency. This study proposes two novel mathematical models for the green vessel scheduling problem in a liner shipping route with ECAs. The first model is based on the existing IMO regulations, whereas the second one along with the established IMO requirements enforces emission restrictions within ECAs. Extensive numerical experiments are performed to assess advantages and disadvantages from introducing emission restrictions within ECAs.

Assessment of HER2 amplification status in breast cancer using a new automated HER2 IQFISH pharmDx™ (Dako Omnis) assay

In breast cancer the human epidermal growth factor receptor 2 (HER2) is an important target for a number of different HER2 inhibitors. Different slide-based assays are available for assessment of treatment eligibility, which include fluorescence in situ hybridization (FISH) or other in situ hybridization (ISH) methods for assessment of the HER2 gene status. Here we report a summary of the validation data on HER2 IQFISH pharmDx™ (Dako Omnis), a newly developed assay for the automated staining platform Dako Omnis. The assay uses a non-toxic buffer that significantly reduces the hybridization time, which results in a total turnaround time of 3½ to 4h from deparaffinization to counting of the gene and centromere signals. The data reported in the current summary covers method comparison, assessment of staining quality, observer-to-observer reproducibility as well as reproducibility within and between laboratories. Based on data from the different studies it was concluded that HER2 IQFISH pharmDx (Dako Omnis) is a reliable and robust assay with a high precision that is at least comparable to the manual HER2 IQFISH pharmDx™ assay and the PathVysion®HER-2 DNA Probe Kit.

Analysis of HER2 status in gastroesophageal tumor specimens using a new automated HER2 IQFISH pharmDx™ (Dako Omnis) assay.

The human epidermal growth factor receptor 2 (HER2) is an important target for treatment of gastroesophageal cancer. Different slide-based assays are available for assessment of HER2 status. Overexpression of the HER2 protein is assessed by immunohistochemistry (IHC) whereas amplification of the HER2 gene is assessed by fluorescence in situ hybridization (FISH) or other in situ hybridization (ISH) methods. Here we report a summary of the validation data on HER2 IQFISH pharmDx™ (Dako Omnis), a newly developed assay for the automated staining platform Dako Omnis. This assay uses a non-toxic buffer that significantly reduces the hybridization time, which results in a total turnaround time of less than 4 hours from deparaffinization to counting of the gene and centromere signals. The data reported in the current summary cover method comparison, assessment of staining quality, observer-to-observer reproducibility as well as reproducibility within and between laboratories. Based on data from the different studies it was concluded that HER2 IQFISH pharmDx (Dako Omnis) is a reliable and robust assay, with high precision and at least comparable to the manual HER2 IQFISH pharmDx™ assay. The HER2 IQFISH pharmDx (Dako Omnis) assay is currently not commercially available outside the Europe Union.

Implementation of a new 'community' laboratory CD4 service in a rural health district in South Africa extends laboratory services and substantially improves local reporting turnaround time.

The CD4 integrated service delivery model (ITSDM) provides for reasonable access to pathology services across South Africa (SA) by offering three new service tiers that extend services into remote, under-serviced areas. ITSDM identified Pixley ka Seme as such an under-serviced district. To address the poor service delivery in this area, a new ITSDM community (tier 3) laboratory was established in De Aar, SA. Laboratory performance and turnaround time (TAT) were monitored post implementation to assess the impact on local service delivery. Using the National Health Laboratory Service Corporate Data Warehouse, CD4 data were extracted for the period April 2012-July 2013 (n=11,964). Total mean TAT (in hours) was calculated and pre-analytical and analytical components assessed. Ongoing testing volumes, as well as external quality assessment performance across ten trials, were used to indicate post-implementation success. Data were analysed using Stata 12. Prior to the implementation of CD4 testing at De Aar, the total mean TAT was 20.5 hours. This fell to 8.2 hours post implementation, predominantly as a result of a lower pre-analytical mean TAT reducing from a mean of 18.9 to 1.8 hours. The analytical testing TAT remained unchanged after implementation and monthly test volumes increased by up to 20%. External quality assessment indicated adequate performance. Although subjective, questionnaires sent to facilities reported improved service delivery. Establishing CD4 testing in a remote community laboratory substantially reduces overall TAT. Additional community CD4 laboratories should be established in under-serviced areas, especially where laboratory infrastructure is already in place.

64 Comparison of Total Turnaround Times for Urine versus Whole Blood Point-of-Care Pregnancy Testing Using a Nursing Protocol

64 Comparison of Total Turnaround Times for Urine versus Whole Blood Point-of-Care Pregnancy Testing Using a Nursing Protocol

To batch or not to batch? linkseq real-time PCR vs. SSO-luminex, a comparison of high throughput HLA typing methods

Aim For high-throughput histocompatibility applications such as HLA typing of transplant candidates, conventional wisdom suggests SSO with Luminex® provides a fair balance of productivity, turnaround time (TAT) and cost as long as the laboratory can wait to receive sufficient samples to batch them together in one run. A recent, competitive alternative is Linkage Biosciences’ LinkSēq™ HLA typing using real-time PCR. This technology is gaining in popularity and acceptance because of its rapid protocol, far fewer manual steps than either SSO or SSP techniques, intermediate resolution, and fully automated analysis. The goal of this study was to directly compare high throughput performance between Linkage’s LinkSēq real-time PCR technology and One Lambda’s LabType® SSO-Luminex method. Methods 14 samples were typed by one technologist at nine loci: HLA-A, B, C, DRB1, DRB345, DQA1, and DQB1 using both LinkSēq and LabType. Total TAT was measured starting at initial setup and ending at the final HLA assignment for each method. Results LinkSēq was 97 min faster (4 h and 2 min) compared to LabType (5 h and 39 min), with less hands-on time and less analysis time. LinkSēq’s analysis software, SureTyper, generated quick and complete data for each sample and also resolved an ambiguity that appeared with one LabType assignment. Conclusion LinkSēq was faster and required less user intervention compared to LabType, enabling greater laboratory staff productivity. Because LinkSēq doesn’t require batch processing, it is equally efficient running one or 14 samples and thus can deliver on-demand service and the flexibility to add urgent testing as needed.