Evaluation Approach Research Articles

SM-GMVAE: an intelligent model for defect quantification evaluation based on few ultrasonic signals

The conventional defect quantification evaluation approaches based on machine learning requires massive amounts of labelled defect signals, which is expensive and time-consuming works. This paper proposed a novel Similarity Metric Gaussian Mixture Variational Auto-Encoder (SM-GMVAE) model, which enables quantify defect with few labelled defect signals. The SM-GMVAE model is designed based on few-shot learning, which includes two modules: feature extraction (FE) module and similarity metric (SM) module. The FE module is designed to extract the feature of defect signal via the Variational Auto-Encoder (VAE). The SM module is used to measure the similarity of two defect signals based on the Gaussian Mixture Model (GMM). Moreover, sparse filtering techniques are used to enhance the sparsity of the features in the SM module. To validate proposed model, some specimens with four various depth defects are designed and fabricated for ultrasonic non-destructive testing experiments. A dataset with defects of different depths is established to compare proposed model with other methods. Our method obtains state-of-the-art experimental results with few labelled defect signals. Different from many published papers, our model is trained with few labelled data, which is more close to engineering practical application than other evaluation model trained using large numbers of labelled data. In other words, the developed approach can realize more complex defect evaluation tasks (such as: size, location, shapes, etc) at very low data labelling cost.

Methods for evaluating intersectoral action partnerships to address the social determinants of health: a scoping review.

Many of the social and economic factors that shape conditions for population health and health equity (e.g. income, education and employment) lie outside of the health sector. Intersectoral action (ISA) is pivotal to building diverse partnerships that address these social determinants of health. Despite the significant role of ISA, there are few comprehensive reports from the health sector on how such partnerships are evaluated. The purpose of this scoping review is to provide an overview of examples of ISA partnership evaluations, including the identification of evaluation methods, tools and indicators. A literature search of two academic databases, Embase and MEDLINE, identified seven relevant studies published between 2012 and 2022. Common evaluation approaches were network analysis, community- or system- level analysis, partnership evaluation and longitudinal process evaluation. Five of the studies assessed the strength and functionality of partnerships, with reach (e.g. distance between partners) used most frequently as an indicator. Despite the complexity of evaluating ISA partnerships, such evaluations are crucial for assessing impacts on health outcomes and social determinants of health, goal achievement, accountability and sustainability. Different evaluation models are available to program planners and evaluators involved in ISA initiatives.

Numerical investigation on the tracer followability of nitrogen droplets over the airfoil in cryogenic wind tunnel

Cryogenic wind tunnels (CWT) achieve high Reynolds number aerodynamic performance measurements by cooling the medium with liquid nitrogen. Utilization of naturally-occurring liquid nitrogen droplets as tracer particles for non-intrusive measurement applications in CWT shows great potential in the previous work. However, the droplet motion characteristics over the airfoil remain to be investigated, and the followability evaluation approach is lacking. Accordingly, an Euler-Lagrange model for transonic particle flow over the NACA0012–64 airfoil was established. The effect of flow characteristics on the particle motion was explored. The results reveal that the flow separation and shock wave phenomenon over the airfoil causing velocity deviation between airflow and droplet. The shock wave is the main deviation driver, and flow separation causing trace blind zones. Droplets larger than 10 μm fail to effectively follow the variation of airflow. The blind zone enlarges with angle of attack (AoA), particularly when AoA exceeding 10 degrees. Moreover, Stokes number is found to be inadequate for characterizing the followability of tracer particles in turbulent flow. Consequently, an evaluation method based on the Basset-Boussinesq-Oseen equation was developed. This research provides theoretical and technical support for advancing the use of nitrogen droplets as tracer particles in CWT.

Advancing Nurse Practitioner proficiency and confidence: An evaluation of postgraduate training in rural and medically underserved communities.

Nurse practitioners (NPs) are critical in delivering primary health care, especially in underserved and rural areas. Transitioning from academic training to practical application poses challenges, highlighting the need for structured post-licensure training (PLT). To address the knowledge gap regarding the impact of PLT programs on the clinical development, confidence, and care delivery of NPs using an innovative evaluative approach. Using a mixed-methods approach, this study engaged 19 NP fellows in quantitative and qualitative evaluations. Assessments of clinical skills and feedback were collected using the REDCap platform, focusing on mentorship and the practical application of skills. Quantitative analysis showed improvements in several domains: patient-centered care (median score increase from 8 to 10, p = .005), knowledge of evidence-based practice (median score from 8 to 9, p = .028), and health systems (median score from 8 to 9, p = .014). Qualitative feedback underscored the benefits of the program's structured support and practical learning experiences while revealing the need for improvements in mentor preparedness. The PLT program effectively advanced NP proficiency across various domains, particularly in patient-centered care and evidence-based practice. However, it also highlighted a crucial need for focused mentorship in developing leadership skills. The study's limited scope, dependence on self-reported measures, and specific statistical methods constrain the broader applicability of its findings. Future research should aim to validate these results across diverse settings and explore long-term outcomes. This study provides new perspectives on NP workforce development, emphasizing the importance of structured mentorship and training, especially in medically underserved communities.

A damage effectiveness evaluation approach of warhead fragment group on missile target based on intuitionistic fuzzy neural network

A damage effectiveness evaluation approach of warhead fragment group on missile target based on intuitionistic fuzzy neural network

PRINCIPLES OF TEACHER TRAINING IN THE FINNISH EDUCATION SYSTEM

The article presents in detail the principles of the Finnish educational policy, which are the basis of the principles of school management and teacher training. It presents the principles that are widely used in the process of teacher training in developed European countries and the principles that are characteristic mainly of the Finnish education system. We reveal the peculiarities of the principles of Finnish teacher training by presenting the theories of adaptation of education and masterful learning based on them. The paper analyzes the principles of equality, continuity, teaching evaluation, teaching research, and trust at the same time. It presents the current stage of the teacher training process in the education system in Finland, as well as the factors that form the principles of teacher training, in particular the innovative policy of Finland in the field of education. The article analyzes the principles of systematization, consistency of state policy, strategic direction of reforms, taking into account the socio-economic goals of the country, correction and modernization of programs. It analyses as a special feature, adaptive learning theories, examines in the context of which evaluation approaches and standards. It singles out the principle of individual development of Finnish teacher training. It is noted that it acts as an alternative principle. The idea is emphasized that any principles of Finnish teacher training are based on the principles of educational reforms, which are the starting point in educational policy. The novelty of the research is that, as a result of historical comparative analysis, trends and features of the formation and development of Finnish teacher training principles were revealed.

High-Resolution Magnetic Resonance Angiography of Tumor Vasculatures with an Interlocking Contrast Agent.

The comprehensive evaluation of tumor vasculature that is crucial for the development, expansion, and spread of cancer still remains a great challenge, especially the three-dimensional (3D) evaluation of vasculatures. In this study, we proposed a magnetic resonance (MR) angiography strategy with interlocking stratagem of zwitterionic Gd-chelate contrast agents (PAA-Gd) for continuous monitoring of tumor angiogenesis progression in 3D. Owing to the zwitterionic structure and nanoscale molecular diameter, the longitudinal molar relaxivity (r1) of PAA-Gd was 2.5 times higher than that of individual Gd-chelates on a 7.0 T MRI scanner, resulting in the higher-resolution visualization of tumor vasculatures. More importantly, PAA-Gd has the appropriate blood half-life (69.2 min), emphasizing the extended imaging window compared to the individual Gd-chelates. On this basis, by using PAA-Gd as the contrast agent, the high-resolution, 3D depiction of the spatiotemporal distribution of microvasculature in solid tumors formed by different cell lines over various inoculation times has been obtained. This method offers an effective approach for early tumor diagnosis, development assessment, and prognosis evaluation.

Assessing the Certainty of the Evidence in Systematic Reviews: Importance, Process, and Use.

When interpreting results and drawing conclusions, authors of systematic reviews should consider the limitations of the evidence included in their review. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach provides a framework for the explicit consideration of the limitations of the evidence included in a systematic review, and for incorporating this assessment into the conclusions. Assessments of certainty of evidence are a methodological expectation of systematic reviews. The certainty of the evidence is specific to each outcome in a systematic review, and can be rated as high, moderate, low, or very low. Because it will have an important impact, before conducting certainty of evidence, reviewers must clarify the intent of their question: are they interested in causation or association. Serious concerns regarding limitations in the study design, inconsistency, imprecision, indirectness, and publication bias can decrease the certainty of the evidence. Using an example, this article describes and illustrates the importance and the steps for assessing the certainty of evidence and drawing accurate conclusions in a systematic review.

Evaluation Approach and Controller Design Guidelines for Subsequent Commutation Failure in Hybrid Multi-Infeed HVDC System

Due to the difference in output characteristics between the line-commutated converter-based high-voltage direct current (LCC-HVDC) and voltage-source converter-based high-voltage direct current (VSC-HVDC), the hybrid multi-infeed high-voltage direct current (HMIDC) presents complex coupling characteristics. As the AC side is disturbed, the commutation failure (CF) occurring on the LCC side is the main factor threatening the safe operation of the system. In this paper, the simplified equivalent network model of HMIDC is established by analyzing the output characteristics of VSC and LCC. Hereafter, based on the derived model and the control system of LCC-HVDC, the dynamic equations of the extinction angle are deduced. Consequently, by applying the phase portrait method, the causes of CF occurring in the HMIDC system as well as the impacts of control parameters on the transient stability are revealed. Furthermore, the stabilization boundaries for the reference value of the DC voltage are obtained via the above analysis. Finally, the theoretical analysis is verified by the simulations in the PSCAD/EMTDC.

Institutionalization of Inclusive Monitoring and Evaluation (M&E) Instruments for the Performance Challenge Fund (PCF) Program

The premise of this paper is to campaign for the inclusion of project beneficiaries or inclusion of the voice of the people when doing Monitoring and Evaluation (M&E) of LGU projects funded by the Performance Challenge Fund (PCF) program. For the DILG validators to be the bridge in promoting transparent and effective local governance thru an efficient monitoring and evaluation approach. The focus is mainly on the enhancement and development and eventual use of the PCF Program Management Office (PMO) of an inclusive M&E instruments for results-based LGU performance assessment and of using participatory methods such as the Most Significant Change (MSC) technique as part of the agenda to cascade and implement the M&E process through the two (2) project stakeholders, namely the PCF LGU beneficiaries and the community. Recommendations from this study intends to institutionalize instruments to change or address the very donor and government-centric approach to M&E to include a citizen-centric M&E towards an inclusive PCF program management.

Combining Multiple Text Representations for Improved Automatic Evaluation of Indonesian Essay Answers

multiple-choices, regarding students’ learning achievement. When the number of students in a class is huge, however, examinations using essay questions become hard to conduct and take a long evaluation time. Automatic essay evaluation has, therefore, become a potential approach in this situation. Various methods have been proposed, however, optimal solutions for such evaluation in the Indonesian language are less known. Furthermore, with the rapid development of machine learning approaches, in particular deep learning approaches, the investigation of such optimal solutions becomes more necessary. Method: To address the aforementioned issue, this study proposed the investigation of text representation approaches for optimal automatic evaluation of Indonesian essay answers. The investigation compared pre-trained word embedding methods such as Word2vec, GloVe, FastText, and RoBERTa, as well as compared text encoding methods such as long short-term memories (LSTMs) and transformers. LSTMs are able to capture temporal semantics by employing state variables, while transformers are able to capture long-term dependency between parts of their input sequences. Additionally, we investigated classification-based and similarity-based training to build text encoders. We expected that these training approaches allowed encoders to extract different views of information. We compared classification results produced by different text encoders and combinations of text encoders. Result: We evaluated various text representation approaches using the UKARA dataset. Our experiments showed that the FastText word embedding method outperformed the Word2vec, GloVe, and RoBERTa methods. The FastText method achieved an F1-score of 75.43% on validation sets, while the Word2vec, GloVe, and RoBERTa methods achieved F1-scores of 69.56%, 74.53%, and 72.87%, respectively. In addition, the experiments showed that combinations of text encoders outperformed individual encoders. The combination of the LSTM encoder, the transformer encoder, and the TF-IDF encoder obtained an F1-score of 77.22% in the best case, which is better than the best F1-scores of the individual LSTM encoders (75.35%), the best combination of transformer encoders (71.49%), and the individual TF-IDF encoder (76.69%). We observed that LSTM encoders produced better performance when they were built using classification-based training. Meanwhile, the transformer encoders obtained better performance when built using similarity-based training. Novelty: The novelty proposed in this research is the optimal combination of text encoders specifically constructed for the evaluation of essay answers in the Indonesian language. Our experiments showed that the combination of three encoders - namely the LSTM encoder built using classification-based training, the transformer encoder built using classification-based and similarity-based training, and the TF-IDF encoder - obtained the best classification performance.

Research on fault diagnosis of multi-mode electromechanical compound transmission system for hybrid electric vehicle based on global analytical redundancy relations

In order to effectively monitor the operational status and detect faults within a hybrid electric vehicle during mode transitions, this study focuses on a specific power-split hybrid electric vehicle model known as the multimode electromechanical composite transmission system (MM-EMCTS HEV). Taking into account the actual occurrence frequency and simulatability of faults in MM-EMCTS HEV, key faults are extracted. Based on the distinctive characteristics and properties of critical system faults, a fault diagnosis framework is constructed by leveraging global analytical redundancy relations (GARRs). This framework encompasses strategies for residual generation across sensors, actuators, and controlled components, alongside residual evaluation techniques employing mode-dependent adaptive thresholds. The detectability and isolatability of the MM-EMCTS are thoroughly analyzed. Subsequently, simulation and verification of the residual responses under typical faults in the MM-EMCTS are implemented in Matlab/Simulink and Simscape. The results demonstrate the efficacy of the fault diagnosis method, rooted in global analytical redundancy relations and mode-dependent adaptive thresholds, in successfully detecting and isolating faults within multimode electromechanical composite transmission systems. Furthermore, compared to conventional fixed threshold residual evaluation approaches, this method significantly mitigates the occurrence of missed detections, thus verifying the effectiveness and superiority of the proposed method.

A Reconsideration of Aesthetic Value and Moral Value of Artwork - An Immoralism Approach

While contemporary art, famous for its abstract form and transgressive nature, is prevalent in the artistic world, the artistic world hasnt established an objective aesthetic evaluating system that allows viewers to fully experience the aesthetic value of transgressive art, which is the most radical, offensive, and morally problematic art form among the contemporary arts. The article reviews the two traditional evaluative approaches, Autonomism and Moralism, and discusses their limitations. Then, the article introduces the concept of transgressive art and Immoralism. The author also recognizes the theoretical gap that fails to illustrate in what perspective viewers can fully understand the aesthetic value of transgressive art. The article then establishes that the moral value of transgressive art lies in the fact that moral defects can contribute to its aesthetic value if the artwork is viewed from a receptive and reflective perspective. The article is significant in filling the theoretical gap and establishing a more systematic evaluative system.

A study to assess the effectiveness of art therapy on pre-operative anxiety among patients undergoing surgery admitted in surgical wards of Sree Balaji Medical College and hospital, Chennai-44

The study explores the concept of health, mental wellness, and nursing. Health involves achieving human potential through goal-directed behaviour, self-care, and satisfying relationships. Mental wellness is a positive attribute, promoting emotional well-being and flexibility. Nursing focuses on protecting, promoting, and optimizing health and abilities, preventing illness and injury, and alleviating suffering. Surgery involves cutting or closing wounds. This study used an evaluative approach to assess the effectiveness of art therapy on preoperative anxiety among patients undergoing surgery. A one-group pretest-posttest design was used, with observations made before and after art therapy. The study aimed to evaluate the effects of art therapy on anxiety levels in patients undergoing surgery. The study was conducted at Sree Balaji Medical College and hospital in Chennai-44, a 1300-bed hospital with advanced facilities. The hospital admits 40-50 patients daily due to surgical problems, with 20-30 surgeries occurring in the operation theatre. Patients are accommodated in different surgical wards and shifted to the surgical Intensive Care Unit for observation. After stabilization, they return to their previous ward. The study included all patients admitted for surgery at Sree Balaji Medical College and hospital during the study period. The study involved 60 surgical patients admitted to Sree Balaji Medical College and Hospital, Chennai-44, using a convenient sampling technique, based on availability. Table 1 shows the demographic distribution of 60 patients undergoing surgery, with 20 patients aged 21-30, 31.7% aged 31-40, 31.6% aged 41-50, and 16.7% above 50. The majority were male, with 60.0% being married, and 73.3% were married. 5% were illiterate, while 8.3% had secondary education. 25.5% were unemployed, while 45% were private employees, and 20% had their own business. All patients had prior knowledge about surgery, with 33.3% getting information from relatives, 11.7% from television, and 55% from doctors. The study found a significant association between demographic variables such as educational status, family income, and type of surgery and post-operative anxiety levels in patients undergoing surgery at Sree Balaji Medical College and hospital. The pretest anxiety score significantly differed from the post-test anxiety score. The study concluded that conducting art therapy pre-operatively can reduce anxiety levels and promote recovery during surgery.

An ontology-based approach for harmonizing metrics in bike network evaluations

The urgency to decarbonize the transportation sector has accelerated the adoption of micro-mobility solutions, with cycling network development witnessing remarkable growth. Robust and quantitative evaluation frameworks are needed to evaluate the quality of such developments. While a plethora of bike network evaluation approaches exist, their diversity creates issues of interpretability and comparability due to varying metrics and domain-specific terms. We present three contributions to address these challenges. First, we construct a formal ontology, VeloNEMO, that captures key attributes of evaluation metrics for harmonizing bike network evaluation metrics. Second, we generate a machine-readable knowledge base containing these metrics, enabling meta-analyses and resolving some of the existing terminological discrepancies. Third, we propose recommendations for transparent and comparable metric descriptions across various evaluation approaches, illustrated by exploratory metric selection scenarios for a forthcoming bike network evaluation tool. In summary, our research addresses the need for a structured and shared vocabulary for bike network evaluations. This ontology-based approach aims to improve the coherence of evaluation methods as the field of bike network planning continues to evolve, ultimately supporting decision-making for sustainable transportation planning.

Ketamine Analgo-sedation for Mechanically Ventilated Critically Ill Adults: A Rapid Practice Guideline from the Saudi Critical Care Society and the Scandinavian Society of Anesthesiology and Intensive Care Medicine.

This Rapid Practice Guideline (RPG) aimed to provide evidence‑based recommendations for ketamine analgo-sedation (monotherapy and adjunct) versus non-ketamine sedatives or usual care in adult intensive care unit (ICU) patients on invasive mechanical ventilation (iMV) and to identify knowledge gaps for future research. The RPG panel comprised 23 multinational multidisciplinary panelists, including a patient representative. An up-to-date systematic review and meta-analysis constituted the evidence base. The Grading Recommendations, Assessment, Development, and Evaluation approach, and the evidence-to-decision framework were used to assess the certainty of evidence and to move from evidence to decision/recommendation. The panel provided input on the balance of the desirable and undesirable effects, certainty of evidence, patients' values and preferences, costs, resources, equity, feasibility, acceptability, and research priorities. Data from 17 randomized clinical trials (n=898) and 9 observational studies (n=1934) were included. There was considerable uncertainty about the desirable and undesirable effects of ketamine monotherapy for analgo-sedation. The evidence was very low certainty and downgraded for risk of bias, indirectness, and inconsistency. Uncertainty or variability in values and preferences were identified. Costs, resources, equity, and acceptability were considered varied. Adjunctive ketamine therapy had no effect on mortality (within 28 days) (relative risk [RR] 0.99; 95% confidence interval [CI] 0.76 to 1.27; low certainty), and may slightly reduce iMV duration (days) (mean difference [MD] -0.05 days; 95% CI -0.07 to -0.03; low certainty), and uncertain effect on the cumulative dose of opioids (mcg/kg/h morphine equivalent) (MD -11.6; 95% CI -20.4 to -2.7; very low certainty). Uncertain desirable effects (cumulative dose of sedatives and vasopressors) and undesirable effects (adverse event rate, delirium, arrhythmia, hepatotoxicity, hypersalivation, use of physical restraints) were also identified. A possibility of important uncertainty or variability in patient-important outcomes led to a balanced effect that favored neither the intervention nor the comparison. Cost, resources, and equity were considered varied. The RPG panel provided two conditional recommendations and suggested (1) against using ketamine as monotherapy analgo-sedation in critically ill adults on iMV when other analgo-sedatives are available; and (2) using ketamine as an adjunct to non-ketamine usual care sedatives (e.g., opioids, propofol, dexmedetomidine) or continuing with non-ketamine usual care sedatives alone. Large-scale trials should provide additional evidence.

A GIS-Based Approach for Assessing Urban Development Potential in Federal Capital Territory Nigeria

Urban development potential assessment is essential for guiding the spatial expansion of cities, optimizing land use, and ensuring sustainable urban growth. In the context of rapidly urbanizing regions, such as Nigeria, understanding development potential helps mitigate the challenges of urban sprawl, infrastructure strain, and environmental degradation, hence, this study is aimed at a GIS based approach for assessing urban development potential in federal capital territory Nigeria. The objectives of the study are to: identify and categorize the key factors influencing urban development in the Federal Capital Territory, Nigeria; assess the reliability of the identified factors using consistency index and sensitivity analysis; determine the potential areas for urban development in the Federal Capital Territory, Nigeria using analytical hierarchical process; and produce an urban development potential map defining the extent of urban development potential across the urban landscape of the Federal Capital Territory, Nigeria. The study employed the assessment of relative priorities in modelling and mapping urban development potential in Federal Capital Territory Nigeria. This assessment was based on a comprehensive set of criteria, including slope, elevation, proximity to road network, population density and proximity to developed areas. The Analytical Hierarchical Process was utilized to compare and establish the relative importance of these criteria by means of matrix comparisons. Subsequently, these criteria were assigned relative weights. Weighted Overlay technique was applied to generate the final development potential map. The study revealed that Abuja Municipal Area had the highest potential development area, covering an area 851.40 km2, with Bwari and Kuje Area Councils as having the second and third highest development potential with an area coverage of 312.40 km2 and 279.69 km2 respectively. Gwagwalada and Kwali Area Councils were ranked fourth and fifth with a developable area coverage of 180.20 km2 and 127.60 km2 respectively, while Abaji Area Council was ranked the least with developable area coverage of 40.27 km2. The study successfully integrated an approach to investigate development potential within the Federal Capital Territory. This evaluation approach, is hereby recommended to be used as tool for planning and decision making in urban development in the study area.

Ocean windspeeds forecast by Gaidai multivariate risk assessment method, utilizing deconvolution scheme

The current work presents spatiotemporal analysis of areal windspeeds, using state-of-the-art Gaidai multivariate hazards evaluation approach. Environmental dynamic systems being challenging to forecast using existing reliability methods due to their high dimensionality and intricate nonlinear cross-correlations between different environmental system essential dimensions or components. Developing novel multivariate reliability methods for dynamic environmental systems may assist contemporary research on the global climate change effects. Multivariate Gaidai risks evaluation approach is especially well-suited for multi-dimensional structural and environmental dynamic systems, that have been monitored physically or numerically simulated across a representative time-lapse. The current study made use of raw in-situ windspeed data, collected by NOAA (i.e., National Oceanic and Atmospheric Administration) buoys near the Hawaiian Islands in the North Pacific. Resilient island communities/infrastructure can be designed, using advocated multivariate risk/hazard assessment methodology, particularly those that are close to the ocean and hence subject to extreme weather.As was demonstrated in this study, even given limited underlying dataset, it is feasible to conservatively estimate environmental system’s hazard risks. Novel non-parametric deconvolution extrapolation scheme has been utilized to accurately assess hazard risks.

Ketamine analgo-sedation for mechanically ventilated critically ill adults: A rapid practice guideline from the Saudi Critical Care Society and the Scandinavian Society of Anesthesiology and Intensive Care Medicine.

This Rapid Practice Guideline (RPG) aimed to provide evidence-based recommendations for ketamine analgo-sedation (monotherapy and adjunct) versus non-ketamine sedatives or usual care in adult intensive care unit (ICU) patients on invasive mechanical ventilation (iMV) and to identify knowledge gaps for future research. The RPG panel comprised 23 multinational multidisciplinary panelists, including a patient representative. An up-to-date systematic review and meta-analysis constituted the evidence base. The Grading Recommendations, Assessment, Development, and Evaluation approach, and the evidence-to-decision framework were used to assess the certainty of evidence and to move from evidence to decision/recommendation. The panel provided input on the balance of the desirable and undesirable effects, certainty of evidence, patients' values and preferences, costs, resources, equity, feasibility, acceptability, and research priorities. Data from 17 randomized clinical trials (n = 898) and nine observational studies (n = 1934) were included. There was considerable uncertainty about the desirable and undesirable effects of ketamine monotherapy for analgo-sedation. The evidence was very low certainty and downgraded for risk of bias, indirectness, and inconsistency. Uncertainty or variability in values and preferences were identified. Costs, resources, equity, and acceptability were considered varied. Adjunctive ketamine therapy had no effect on mortality (within 28 days) (relative risk [RR] 0.99; 95% confidence interval [CI] 0.76 to 1.27; low certainty), and may slightly reduce iMV duration (days) (mean difference [MD] -0.05 days; 95% CI -0.07 to -0.03; low certainty), and uncertain effect on the cumulative dose of opioids (mcg/kg/h morphine equivalent) (MD -11.6; 95% CI -20.4 to -2.7; very low certainty). Uncertain desirable effects (cumulative dose of sedatives and vasopressors) and undesirable effects (adverse event rate, delirium, arrhythmia, hepatotoxicity, hypersalivation, use of physical restraints) were also identified. A possibility of important uncertainty or variability in patient-important outcomes led to a balanced effect that favored neither the intervention nor the comparison. Cost, resources, and equity were considered varied. The RPG panel provided two conditional recommendations and suggested (1) against using ketamine as monotherapy analgo-sedation in critically ill adults on iMV when other analgo-sedatives are available; and (2) using ketamine as an adjunct to non-ketamine usual care sedatives (e.g., opioids, propofol, dexmedetomidine) or continuing with non-ketamine usual care sedatives alone. Large-scale trials should provide additional evidence.

Analysis of metabolic alterations as 30 days intensive care mortality predictors for patients undergoing continuous renal replacement therapy

BackgroundAcute kidney injury patients on continuous renal replacement therapy are subjected to alterations in metabolism, which in turn are associated with worse clinical outcome and mortality. The aim of this study is to determine which metabolism indicators can be used as independent predictors of 30 days intensive care unit (ICU) mortality. MethodsThis was a prospective observational study on critical care patients on renal replacement therapy. Integrated approach of metabolism evaluation was used, combining the energy expenditure measured by indirect calorimetry, bioelectrical impedance provided fat free mass index (FFMI), amino acid and glucose concentrations. ICU mortality was defined as all cause 30 days mortality. Regression analysis was conducted to determine the conventional and metabolism associated predictors of mortality. ResultsThe study was conducted between the 2021 March and 2022 October. 60 high mortality risk patients (APACHE II of 22.98±7.87, 97% on vasopressors, 100% on mechanical ventilation) were included during the period of the study. The rate of 30 days ICU mortality was 50% (n=30). Differences across survivors and non-survivors in metabolic predictors were noted in energy expenditure (kcal/kg/day) (19.79 ±5.55 vs 10.04 ±3.97 p=0.013), amino acid concentrations (mmol/L) (2.40 ±1.06 vs 1.87 ±0.90 p=0.040) and glucose concentrations (mmol/L) (7.89 ±1.90 vs 10.04 ±3.97 p=0.010). No differences were noted in FFMI (23.38 ±4.25 vs 21.95 ±3.08 p=0.158). In the final linear regression analysis model, lower energy expenditure (exp(B)= 0.852 CI95%: 0.741-0.979 p=0.024) and higher glucose (exp(B)=1.360 CI95%: 1.013-1.824 p=0.041) remained as independent predictors of the higher mortality. ConclusionThe results of the study imply strong association between the metabolic alterations and ICU outcome. Our findings suggest that lower systemic amino acid concentration, lower energy expenditure and higher systemic glucose concentration are predictive of 30 days ICU mortality.