An integrated DEMATEL and system dynamic model for project cost prediction.

Actual cost fluctuations in construction projects are common in the construction industry, including the Kingdom of Saudi Arabia (KSA). This study's objective is to establish a simulation forecasting model for Saudi projects' cost changes that will be used to anticipate the actual cost spent at the project's end. It also indicates if there are cost overruns or savings by considering ten identified cost-risk impact factors. The study involves a systematic, integrated approach to developing system dynamics (SD) to reflect the ten cost overrun impact factors (COICs) in the KSA construction industry. Thus, the Decision-Making Trial and Evaluation Laboratory (DEMATEL) technique aids in evolving a Causal Loop Diagram (CLD) in the SD modeling stages. After performing the consistency and extreme tests, the model is verified by being applied in two case studies (an academic building and an infrastructure project) in Riyadh City, KSA. The main findings reveal that the model provided cost savings for the first and second case studies of 4.8% and 3.76%, respectively. Different experts have evaluated the developed dynamic system. According to the experts who support the developed model, the model is applicable if the contractor has a reasonable profit margin. In contrast, opponents' experts noted that the system still generates a profit margin despite change orders and project delays. The main conclusion that the experts recognize is that the approach successfully considered the relationships between the influencing factors. The findings can be utilized to create an integrated conceptual framework for construction management, which could result in a rapid and profitable project launch.

Efficacy and safety of corpus callosotomy versus vagus nerve stimulation as long-term adjunctive therapies in children with Lennox-Gastaut syndrome: Experience of a tertiary care center.

OBJECTIVES: To compare the efficacy and safety of corpus callosotomy versus vagus nerve stimulation (VNS) as long-term adjunctive therapies in children with Lennox-Gastaut syndrome. METHODS: This retrospective study was conducted in King Fahad Medical City between 2010 and 2019. The authors identified and followed 9 patients with Lennox-Gastaut syndrome (LGS) who underwent corpus callosotomy or VNS implantation for at least 12 months; seizure frequency and major complications were monitored. Five patients with a mean age of 10.8±1.3 years had corpus callosotomy, and 4 patients with a mean age of 13.8±3.9 years were implanted with VNS stimulators. RESULTS: Reduction in seizure frequency was achieved in all 5 patients who underwent corpus callosotomy, with greater than 75% seizure reduction in more than 50% in one, and greater than 25% in 2 respectively. However, in those implanted with VNS, 2 (50%) patients achieved a reduction in seizure frequency of greater than 75% and 2 (50%) greater than 25%, respectively. No significant difference was observed between the 2 treatment groups. One patient who underwent corpus callosotomy suffered cerebrospinal fluid leakage, and swallowing difficulties in one patient who underwent VNS. CONCLUSION: Both corpus callosotomy and VNS are safe and effective as adjunctive treatments for LGS patients.

A Young man with Peri-ictal water drinking.

Neuro-vegetative features have been linked to epilepsy arising from the temporal lobe, which can be seen during ictal events and play an important role in determining the focal side of the lesion. Among the rare known features is peri-ictal water drinking (PIWD). Here, we present the case of a 31-year-old male with refractory temporal epilepsy, having episodes of PIWD. The patient was considered a candidate for resective surgery and was investigated accordingly, including long-term video electroencephalogram (EEG), brain magnetic resonance imaging (MRI), and neuropsychology assessment, which pointed towards a lesioned temporal lobe over the non-dominant hemisphere. The patient had an excellent outcome following right anterior temporal lobectomy. The lateralization significance of PIWD has not yet been established definitively in the literature, partly due to a limited number of published cases. This case highlights the previously observed association between PIWD and the involvement of the non-dominant hemisphere in epilepsy patients.

Can renal scan findings predict biopsy-proven allograft rejection?

OBJECTIVES: To assess the usefulness of isotopic renogram in diagnosing acute renal graft rejection. MATERIALS AND METHODS: Degree of perfusion and allograft uptake of tracer were correlated with the clinical and biopsy diagnoses in 15 postrenal transplant patients with varying degrees of renal impairment. Renographic findings and perfusion calculations were done by a blinded observer. RESULTS: A strong correlation was found between renal histology and renal scan findings in 13 of 15 patients. Sensitivity and specificity of renal scanning in diagnosing acute rejection were 85% and 50% respectively (using renal biopsy findings as the gold standard). CONCLUSION: Our results demonstrate a strong correlation between blinded perfusion assessment and biopsy-proven acute rejection. We conclude, therefore, that single renal flow scan with DTPA (noninvasive/nonnephrotoxic) allows a physician to tailor therapy for acute renal graft dysfunction. We suggest that in cases with a renographic diagnosis of AR, the patient should receive standard antirejection therapy. Renal biopsy should be reserved for those instances when the renographic findings are not definitive and those when the patient fails to respond to a standard methylprednisolone therapy.