Comprehensive Assessment Research Articles

Predictors of the severity of the course of COVID-19: demographic factors, clinical signs and laboratory markers.

Introduction. The Coronavirus Disease 2019 (COVID-19) pandemic has had a significant impact on global healthcare, with high mortality and severe complications remaining a major concern. Understanding the predictors of COVID-19 severity may improve patient management and outcomes. While considerable research has focused on the pathogenesis of the virus and vaccine development, the identification of reliable demographic, clinical and laboratory predictors of severe disease remains critical.Hypothesis. Specific demographic factors, clinical signs and laboratory markers can reliably predict the severity of COVID-19. A comprehensive analysis integrating these predictors could provide a more accurate prognosis and guide timely interventions.Aim. The aim of this study is to identify and evaluate the demographic, clinical and laboratory factors that can serve as reliable predictors of severe COVID-19, thereby aiding in the prediction and prevention of adverse outcomes.Methodology. The methods of analysis, synthesis, generalization and descriptive statistics were used to achieve this objective.Results. The analysis showed that demographic factors such as age over 60 and male sex are significant predictors of severe COVID-19. Clinical predictors include respiratory symptoms, especially dyspnoea, and comorbidities such as hypertension, coronary artery disease, chronic obstructive pulmonary disease, respiratory failure, asthma, diabetes mellitus and obesity. Laboratory markers with high prognostic value include elevated levels of C-reactive protein, interleukin-6, ferritin, neutrophil/lymphocyte ratio, d-dimer, aspartate aminotransferase enzyme and decreased lymphocyte count.Conclusion. The study concludes that a holistic approach incorporating demographic, clinical and laboratory data is essential to accurately predict the severity of COVID-19. This integrated model may significantly improve patient prognosis by facilitating early identification of high-risk individuals and allowing timely, targeted interventions. The results highlight the importance of comprehensive patient assessment in managing and mitigating the impact of COVID-19.

Assessing the impact of the European Union-Vietnam free trade agreement on labor market and employment in Vietnam

PurposeThis study investigates the impact of the European Union-Vietnam Free Trade Agreement (EVFTA) on Vietnam’s labor market and employment outcomes, considering the potential distributional consequences across various groups of workers and regions.Design/methodology/approachA comprehensive quantitative framework is employed, combining the gravity model of trade to estimate the EVFTA’s effects on trade flows, the CISAF_M1 model to simulate sectoral employment impacts and econometric models to analyze the effects on wages and decent work. The analysis draws upon a rich dataset spanning the period before and after the EVFTA’s implementation.FindingsThe EVFTA has significantly boosted Vietnam’s exports to the EU, leading to substantial job creation in labor-intensive sectors such as textiles, apparel and footwear. The agreement has also contributed to wage growth and improved access to social insurance for workers in export-oriented industries. However, the impact on other aspects of job quality is less clear. The distributional analysis reveals that the EVFTA’s employment effects have been relatively balanced across gender but have favored younger and less skilled workers as well as those in rural areas.Originality/valueThis study provides a comprehensive and nuanced assessment of the EVFTA’s impact on Vietnam’s labor market, addressing a gap in the literature on the employment effects of new-generation free trade agreements in developing countries. The findings highlight the importance of considering distributional aspects when evaluating the socioeconomic implications of trade liberalization and offer valuable insights for policymakers aiming to promote inclusive growth in the context of deepening international economic integration.Peer reviewThe peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-03-2024-0236

Safety-risk assessment system for prefabricated building construction in China

PurposePrefabricated building (PB) uses factory production and onsite assembly, which differs from traditional construction methods. This special construction approach may lead to dissimilar safety risks and challenges. Traditional safety assessment methods may not adequately and accurately assess the safety risks of PB construction. This paper aims to develop a new concept and methodology for targeted improvement in assessing PB safety risks.Design/methodology/approachRisk factors and indicators were established based on literature review and expert inputs. A structural equation model (SEM) was developed to investigate the relationships among three main risk categories: objects, workers and management. SEM analyzed the intricate associations between indicators and deepened understanding of safety risks. The model was tailored for China’s PB construction projects to enhance safety-risk management.FindingsThe cloud model evaluation validated the SEM model. A PB case study project tested and verified the model, evaluated its efficacy and quantified its safety performance and grade. We identified significant safety risk impacts across the three risk categories, safety-control level and specific areas that require improvement. The SEM model established a robust safety evaluation indicator system for comprehensive safety assessment of PB construction.Practical implicationsPractical recommendations provide valuable insights for decision-makers to enhance construction efficiency without compromising safety. This study contributed to the conceptual foundation and devised a novel method for evaluating safety performance in PB construction for safer and more efficient practices.Originality/valueThis study departed from the traditional method of calculating weights, opting instead for the SEM method to determine the weights of individual risk indicators. Additionally, we leveraged the cloud model to mitigate the influence of subjective factors in analyzing questionnaire survey responses. The feasibility and reliability of our proposed method were rigorously tested and verified by applying it to the PB case.

Surgical treatment of meningiomas improves neurocognitive functioning and quality of life – a prospective single-center study

Abstract Background and purpose Early diagnosis and the refinement of treatment of patients with intracranial meningiomas have brought quality of life (QoL) and neurocognitive functioning as outcome measures into focus. The aim of this study is a comprehensive assessment of neurocognitive function, quality of life and the presence of depression in meningioma patients before and after surgery. Methods Patients with MRI diagnosis of intracranial meningioma and indication for surgery were prospectively included. A clinical neuropsychologist performed neurocognitive assessments within 3 months before and 12 months after surgery. The test battery included investigation of selective and divided attention, verbal and figural memory, executive functioning, and word fluency. Self-report questionnaires to assess depressive symptoms, QoL, and disease coping were administered. Raw values and t-values were compared pre-and postoperatively. Outcome was stratified by tumor- and peritumoral brain edema (PTBE) volumes, postoperative resolution of PTBE and WHO grade. The study included 18 predominantly female patients (83%) with a median age of 59 years and mostly CNS WHO grade 1 meningiomas (83%). Results There was a significant postoperative improvement in the ability to selectively react under stress, in working memory and improved delayed reproduction of verbal and visual memory content. QoL improved regarding a reduction in physical problems, an improvement in energy, and social functioning. There was a trend towards worse preoperative scores in all tests, and greater postoperative improvement in patients with PTBE. Tumor volume had no effect on the measured outcome. The patients did not suffer from depressive symptoms before the surgery but improved postoperatively and most patients had an active, problem-oriented coping strategy. Conclusion Resection of intracranial meningiomas leads to an improvement in multiple neurocognitive domains and QoL. There is a trend towards poorer preoperative neurocognitive functioning and greater postoperative improvement in patients with PTBE. Depression appears to play a minor role in the context of neurocognitive functioning and disease coping.

Comprehensive durability assessment of in-service concrete bridges based on combination weighting and extenics cloud model

In recent years, with the continuous development of urban transportation, the durability of concrete bridge structures has become increasingly prominent. Many in-service concrete bridges exhibit issues such as cracks, excessive deflection, and a significant reduction in load-bearing capacity during their service life. To meet the requirements of sustainable development, it is urgent to assess the durability of bridges accurately. Therefore, this paper establishes a scientific and reliable evaluation index system for the durability of in-service concrete bridges. Based on a review of the literature and relevant standards and specifications, this paper establishes an evaluation index system for the durability of in-service concrete bridges and calculates the weights using a combination weighting method. The durability of the bridges is assessed using the extension cloud model theory, and MATLAB is utilized for efficient and accurate computation and analysis, ultimately determining the durability grades of the bridges. The method was applied to the durability assessment of five in-service concrete bridges, and the results were in high agreement with the measured data, proving its effectiveness and accuracy. The research results provide a scientific basis for the management and maintenance of concrete bridges, which can help extend their service life. Future studies will expand the sample to cover more bridge types to comprehensively assess and enhance the durability of bridges.

Comparative analysis of embodied carbon in modular and conventional construction methods in Hong Kong

Addressing the rise in global temperatures and the associated increase in greenhouse gases, particularly carbon dioxide, is a critical challenge necessitating innovative approaches within the building sector, a significant contributor to worldwide carbon emissions. While previous studies have demonstrated the prefabrication’s potential in reducing emissions, comprehensive assessments using actual project data for buildings constructed entirely with modular methods in Hong Kong are lacking. This study bridges this gap by evaluating the modular integrated construction (MiC) method through an embodied carbon assessment of the Kai Tak Community Isolation Facility. Using comprehensive project data from China State Construction (HK) Limited, the research conducts a comparative analysis between the actual emissions of the MiC method and those of a hypothetical conventional construction approach. Quantitative analysis reveals that MiC achieves a 20.7% reduction in embodied carbon, primarily due to shortened construction timelines, decreased waste generation, and optimized material usage. This significant reduction suggests substantial potential for decreasing the construction industry’s carbon footprint. The study provides empirical evidence supporting the environmental benefits of MiC in Hong Kong construction industry, promoting its broader adoption of MiC as a strategy for achieving carbon reduction targets. The findings align with Hong Kong’s carbon neutrality goals and contribute to the global initiative to mitigate the effects of climate change.

Monetary discounts, metaphoric communication and mass prestige based branding: a comprehensive assessment

Purpose This study aims to examine the role of price discounts and how to communite such discounts for masstige brands. While a price discount might encourage potential (first time) customers seeking higher status to buy a masstige brand, it might deter existing (repeat) customers from purchasing the brand due to a decline in perceived status. Such paradoxical effect of price discounts on masstige brand’s purchase requires a detail investigation into whether masstige brands should offer price discounts and if so, how to communicate such discounts. Current research investigates this phenomenon. Design/methodology/approach Four experimental studies were executed. Study 1 investigated the impact of monetary discount (absent vs. present) on the purchase intention of masstige brands for different customer types (potential vs. existing). Study 2 investigated the mediating role of perceived status. Study 3 examined the effectiveness of metaphoric communication of monetary discounts (absent vs present) on masstige brand’s purchase. Study 4 tested the moderating effect of customers’ need for cognition. Findings Overall, monetary discounts positively affect purchase intention of masstige brand; however, the effect is negative for existing customers and positive for potential customers owing to differences in perceived status these customer groups experience (positive for potential and negative for existing customers). Metaphoric communications of monetary discounts restrict the declining purchase intention and status perception of existing customers besides keeping the potential customers’ purchase intention intact. Research limitations/implications This research is confined to a particular country limiting the gneralisability of the study’s findings. Furthermore, this research is cross-sectional in nature. Practical implications The findings of this research provide valuable insights and actionable recommendations for masstige brands to effectively leverage price discounts, especially in the emerging markets. Originality/value To date, a question of whether or not masstige brands should offer price discounts and if so, how to communicate such discounts remain opaque. This is the pioneering study exploring this phenomenon.

Prioritizing Performance Indicators for the Circular Economy Transition in Healthcare Supply Chains

AbstractThe emergence of the circular economy (CE) paradigm is a key driver in steering industrial sectors towards sustainability. The formulation of a robust circularity strategy depends on a comprehensive assessment, which is closely related to the overarching goal of managing the transition to circularity. The initial phase of transition within the healthcare sector reinforces the need to seamlessly integrate CE principles. It is therefore imperative to define and carefully monitor indicators that will help assess and improve sustainability, operational efficiency, supply chain resilience and stakeholder satisfaction, including both consumers and patients. The primary objective of this research is to prioritize relevant performance indicators that will be critical in measuring the effectiveness of the transition to a circular economy within the healthcare supply chain. To achieve this objective, the study employs the Analytic Hierarchy Process (AHP), a well-established methodology known for its effectiveness in solving complex multi-criteria challenges. The AHP is used to prioritize performance indicators that facilitate the management of the circular economy transition in the healthcare supply chain. The focus is on improving the quality of care, optimizing delivery efficiency, and emphasizing environmental sustainability within the healthcare paradigm. The methodological framework includes the identification of key main criteria covering environmental, social, economic, and logistical dimensions. These criteria are further refined with the inclusion of 14 sub-criteria, resulting in a list of 16 key performance indicators (KPIs). Additionally, the study proposes an alternative business model advocating for the implementation of the Circular Supply Chain Operation Reference Model (circular SCOR). This model offers a perspective for rapid change in supply chain processes towards circular transition within the healthcare system. The final stage of the research involves verifying the results through sensitivity analysis and correlation mapping of the indicator results with the Circular SCOR model. This process helps organizations refine their performance measurement protocols, enhancing their capacity for effective evaluation and strategic decision-making within the circular economy framework. This comprehensive approach enables healthcare organizations to proactively contribute to a more sustainable and environmentally conscious future while maintaining a focus on quality care for patient well-being.

Disabling foot pain and its impact on daily living among people with psoriatic arthritis in Singapore: a cross-sectional observational investigation

BackgroundPsoriatic Arthritis (PsA)-related foot involvement has been shown to have a profound impact on daily functioning, with most studies having focused on predominantly Caucasian populations. The aim was to describe disabling foot pain (DFP) and its impact on daily living in PsA in Singapore.MethodsA cross-sectional, retrospective study was conducted using clinical data collected during a single-visit to a rheumatology clinic in Singapore. Records for adults with physician-diagnosed PsA were reviewed for sociodemographic information, disease characteristics, global disease activity and burden. Foot-specific measures included clinical assessment and the Manchester Foot Pain and Disability Index used to define DFP and evaluate between-group differences.ResultsForty-two participants with PsA (83% female, 57% Chinese, 31% Malay, 9.5% Indian, mean (SD) age 54-years (16)) attended the rheumatology clinic over the study-period. The median (IQR) disease duration was 2-years (11) and all were taking current DMARDs. Global disease measures demonstrated mild-to-moderate global disease activity and mild functional impairment, and were significantly higher in those with DFP. Despite 90% reporting to be coping well with their condition, self-care and having emotional support (n = 38), this study sample demonstrated high levels of anxiety/depression (29%), sleep disturbance (34%) and fatigue (24%), and a lack of disease- and drug-specific knowledge (64%). Further management was indicated for medication adherence counselling (48%), occupational therapy (43%), physiotherapy (36%) and podiatry (30%). Nearly half had current foot pain with 40% reporting DFP (n = 17), which caused significantly greater difficulty walking 3 km than those without DFP (p < 0.05). Rearfoot enthesitis (plantar fasciitis, Achilles enthesitis) was the most common cause of DFP (67%) with pain lasting longer than 1-year. 72% were overweight or obese, with a high proportion not engaging in any cardiovascular exercise (70%). Three of 42 participants had previously seen a podiatrist.ConclusionsPeople with DFP in PsA experience more severe global disease activity, reduced mobility and higher levels of negative impact on their daily lives in Singapore. In the absence of working in a multidisciplinary-team, there is value in comprehensive assessments that have potential to capture a holistic view of personal impact and improve person-centred care in PsA.

Mapping coastal resilience: a Gis-based Bayesian network approach to coastal hazard identification for Queensland’s dynamic shorelines

Coastal regions worldwide face increasing threats from climate change-induced hazards, necessitating more accurate and comprehensive vulnerability assessment tools. This study introduces an innovative approach to coastal vulnerability assessment by integrating Bayesian Networks (BN) with the modern coastal vulnerability (CV) framework. The resulting BN-CV model was applied to Queensland's coastal regions, with a particular focus on tide-modified and tide-dominated beaches, which constitute over 85% of the studied area. The research methodology involved beach classification based on morphodynamic characteristics, spatial subdivision of Queensland's coast into 78 sections, and the application of the BN-CV model to analyze interactions between geomorphological features and oceanic dynamics. This approach achieved over 90% accuracy in correlating beach types with vulnerability factors, significantly outperforming traditional CVI applications. Key findings include the identification of vulnerability hotspots and the creation of detailed exposure and sensitivity maps for Gold Coast City, Redland City, Brisbane City, and the Sunshine Coast Regional area. The study revealed spatial variability in coastal vulnerability, providing crucial insights for targeted management strategies. The BN-CV model demonstrates superior precision and customization capabilities, offering a more nuanced understanding of coastal vulnerability in regions with diverse beach typologies. This research advocates for the adoption of the BN-CV approach to inform tailored coastal planning and management strategies, emphasizing the need for regular reassessments and sustained stakeholder engagement to build resilience against climate change impacts.Recommendations include prioritizing adaptive infrastructure in high-exposure areas like the Gold Coast, enhancing flood management in Brisbane, improving socio-economic adaptive capacity in Redland, and maintaining natural defences in Moreton Bay. This study contributes significantly to the field of coastal risk management, providing a robust tool for policymakers and coastal managers to develop more effective strategies for building coastal resilience in the face of climate change.

Clinical Measures Associated with Subsequent Injury after Adolescent Concussion: A Prospective Cohort Study

ABSTRACT Purpose To examine associations between clinical measures (self-reported and clinician-administered) and subsequent injury rates in the year after concussion return to play (RTP) among adolescent athletes. Methods We performed a prospective, longitudinal study of adolescents ages 13-18 years. Each participant was initially assessed within 21 days of concussion and again within 5 days of receiving RTP clearance from their physician. Participants completed self-report measures: the Pittsburgh Sleep Quality Index (PSQI) and Tampa Scale of Kinesiophobia (TSK), and clinician-administered measures: single and dual-task tandem gait (TG) and reaction time (RT; simple and clinical) assessments. They then completed monthly surveys for a year after RTP which assessed exposure to injury (sport participation) and subsequent injuries (musculoskeletal or concussions) sustained. We used Poisson regression models to calculate injury rate ratios with number of subsequent injuries sustained as the outcome, adjusted for RTP clearance time and competitive exposures for each measure. Results 41 participants were included (age = 15.5±1.3 years, 56% female, 9.6±4.6 days post-concussion; 38.0±31.5 days to RTP). A higher injury rate per athletic exposure was observed for simple RT≥505 ms vs &lt;505 ms (injury rate ratio = 3.22; 95% confidence interval = 1.56, 7.12; p = 0.002). Injury rates did not significantly differ by PSQI or TSK scores, single/dual-task TG time, or clinical RT. Conclusions Simple reaction time may be one risk factor that is associated with higher rates of subsequent injury after adolescent concussion. A simple reaction time measure incorporated into a comprehensive concussion RTP assessment may identify some individuals at higher risk of subsequent injury in the year following concussion, though further research is needed to better understand this relationship.

Optimizing care for MRKH patients: From malformation screening to uterus transplantation eligibility.

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome with utero-vaginal aplasia is the most severe form of the Müllerian duct anomalies and can be associated with extra-genital abnormalities such as renal or skeletal anomalies, hearing loss, or cardiac defects. The past two decades have witnessed significant advances both in understanding the etiologies of MRKH and in the development of fertility treatments such as uterine transplantation. The present work aimed to determine the rate of women with MRKH syndrome who underwent optimal initial management (after comprehensive malformation assessment) and to establish the rate of patients eligible for uterine transplantation (i.e., those with a vaginal length ≥7 cm without reconstruction using a bowel segment, and an anti-Müllerian hormone level >1.5 ng/mL before 35 years). Cohort study of 85 women with MRKH syndrome consulting in our tertiary center. 62.4% of women with MRKH syndrome had an exhaustive malformative evaluation according to the French guidelines (Protocole National de Diagnostic et de Soin [PNDS]), of which 76.5% had associated malformations (MRKH type II). Pedigree, when available, showed a family history of infertility or a urogenital tract spectrum anomaly in 60% of cases. Concerning the uterine transplantation selection criteria, when evaluated, 22.6% of women had an anti-Müllerian hormone level <1.5 ng/mL and 36% a vaginal length <7 cm. On the 21 women with complete evaluation of both primary and secondary outcomes, 14 of them would be eligible for a uterine transplantation program at the time of consultation according to the main inclusion criteria of uterine transplantation program. Women with MRKH syndrome are often inadequately explored for associated malformations. Early assessment and monitoring of the ovarian reserve is key for fertility preservation, especially in the era of uterine transplantation.

Facia-fix: mobile application for bell’s palsy diagnosis and assessment using computer vision and deep learning

Facial paralysis (FP) is a condition characterized by the inability to move some or all of the muscles on one or both sides of the face. Diagnosing FP presents challenges due to the limitations of traditional methods, which are time-consuming, uncomfortable for patients, and require specialized clinicians. Additionally, more advanced tools are often uncommonly available to all healthcare providers. Early and accurate detection of FP is crucial, as timely intervention can prevent long-term complications and improve patient outcomes. To address these challenges, our research introduces Facia-Fix, a mobile application for Bell's palsy diagnosis, integrating computer vision and deep learning techniques to provide real-time analysis of facial landmarks. The classification algorithms are trained on the publicly available YouTube FP (YFP) dataset, which is labeled using the House-Brackmann (HB) method, a standardized system for assessing the severity of FP. Different deep learning models were employed to classify the FP severity, such as MobileNet, CNN, MLP, VGG16, and Vision Transformer. The MobileNet model which uses transfer learning, achieved the highest performance (Accuracy: 0.9812, Precision: 0.9753, Recall: 0.9727, F1 Score: 0.974), establishing it as the optimal choice among the evaluated models. The innovation of this approach lies in its use of advanced deep learning models to provide accurate, objective, non-invasive and real-time comprehensive quantitative assessment of FP severity. Preliminary results highlight the potential of Facia-Fix to significantly improve the diagnostic and follow-up experiences for both clinicians and patients.

Manifestations and outcomes of digestive tract involvement in adult Langerhans cell histiocytosis.

Langerhans cell histiocytosis (LCH) is a heterogeneous histiocytosis characterized by proliferation of Langerhans cells. While less common, manifestations of digestive tract involvement in LCH remain largely unrevealed. We conducted a retrospective analysis of demographics, clinical, endoscopic, genetic and follow-up data from 13 adult patients with pathologically confirmed gastrointestinal involvement of LCH (LCH-GI), in a single-center cohort of 465 patients. Digestive tract involvement was observed in 2.80% of LCH patients. At LCH-GI diagnosis, 7 patients (53.8%) had unifocal lesions, and 6 patients (46.2%) had multisystem disease. 6 patients (46.2%) experienced no gastrointestinal symptoms at LCH-GI onset, while others were symptomatic. Stomach was most commonly affected (61.5%), followed by esophagus (23.1%), colon (7.7%) and anus (7.7%). Endoscopic findings varied among 12 patients, including submucosal bulge (8 patients, 66.7%) and non-bulging lesions (4 patients, 33.3%) such as erosions, coarse granular mucosa, and regional abnormal coloration. Among 8 patients with genetic analysis, BRAFV600E mutation was detected in 5 patients (62.5%). The estimated 1-year overall survival rate was 91.7%. Progression-free survival of patients with submucosal bulges under endoscopy was significantly better than those with non-bulging lesions. This study presents 13 cases of LCH with digestive tract involvement. We emphasize the importance of endoscopy and biopsy for pathological examination of lesions such as submucosal bulges and erosions under endoscopy to assist in early detection of LCH. Comprehensive systemic assessment and regular endoscopic monitoring are essential in patient management. Treatment should be individualized with dynamic adjustments during follow-up.

A Novel Model for Sustainable Supplier Selection in the Paint and Coating Industry

Given the significance of sustainability in the current global market, doing a comprehensive and current assessment of a supplier’s sustainability might be beneficial for improving a firm’s competitiveness. This study aims to develop sustainable supplier selection criteria, examine their interrelationships, and determine the critical criteria in the paint and coating industry. This study employed a focus group discussion (FGD), the Delphi method, a decision-making trial and evaluation laboratory-based analytical network process (DANP), and a measurement of alternatives and ranking according to compromise solution (MARCOS). The findings indicated that most sub−criteriasub−criteriaexperts agreed that 11 economic sub−criteria, five environmental sub−criteria, and three social sub−criteria should be considered when selecting a sustainable supplier. The results show that the most influential criteria are environmental criteria, while the critical criteria are social criteria. In addition, “Service” (E4), “Green Material” (L3), and “Health and Safety” (S1) sub−criteria should be considered to assess the supplier because they have high relation and prominence. Globally, the top five highest weighted sub−criteria are “Respect for the Law” (S2), “Health and Safety” (S1), “Worker’s Social Rights” (S3), “Waste Management” (L5), and “Environment Management System” (L1). We practically selected 12 providers from the paint and coating sector to assess the scheme’s practicality. This work introduced a novel model for selecting a sustainable supplier that helps industries understand their core criteria and sub−criteria. This will enhance the industry’s competitiveness and sustainability by evaluating suppliers based on economic, environmental, and social criteria.

Systematic preoperative approach for bariatric surgery, perioperative results, and economic impact

IntroductionObesity is a complex systemic condition, involving numerous anatomical and metabolic changes. Therefore, a comprehensive preoperative assessment is essential for each patient contemplating bariatric surgery.ObjetiveThis study presents the findings of a proposed protocol designed to streamline the pre-anesthesia consultation process. Our aim was to compare the efficiency and costs of consultations guided by the protocol with those conducted without a specific strategy. The secondary outcomes assessed included postoperative (PO) length of hospital stay and surgical duration.Matherial and methodsWe conducted a retrospective cross-sectional analysis involving 206 clinical cases. Statistical analyses, including the chi-squared test, Student’s t-test, and Mann–Whitney U test, were utilized based on the type of variables.ResultsThe results showed a significant reduction in the costs, pre-anesthesia consultation duration, time spent in the recovery unit, and the need for referrals. However, no statistically significant differences were observed in the delay before surgery and length of hospital stays, measured in days.ConclusionThis algorithm offers a promising approach for optimizing perioperative management in bariatric surgery, demonstrating its effectiveness in cutting costs and reducing the need for referrals.

Rapid assessment of cardiac autonomic modulation and adaptive stress responses: Automatic calculation of time-varying parasympathetic, sympathetic, and Baevsky stress indexes

Cardiac autonomic modulation (CAM), which is regulated by the balance between the sympathetic and parasympathetic nervous systems, is involved in various physiological and pathological conditions. Heart rate variability (HRV) analysis has been used to explore the complex relationship between the brain and heart, as described by Porges&amp;rsquo; polyvagal theory and Thayer&amp;rsquo;s neurovisceral integration model. Recently, an automated calculation of new parasympathetic, sympathetic, and Baevsky stress indexes based on HRV parameters has been introduced for faster and more comprehensive CAM assessment, though their normal ranges remain undefined. This study aimed to determine the average values of these indexes in a healthy population of different ages during rest, daily activities, non-rapid eye movement sleep, graded physical effort, and acute psychophysiological stress. At rest, the parasympathetic and sympathetic indexes were consistently within the proposed normal range and inversely related. However, Baevsky stress index values from Kubios were higher than expected, conflicting with the assumption that they are simply the square root of those calculated using the original formula. Despite this, time-varying assessment of all indexes can provide valuable insights into CAM adaptation during physical effort and acute psychophysiological stress in real-world critical situations. Notably, our novel finding shows that the inverse correlation between parasympathetic and sympathetic/stress indexes under stress is better explained by non-linear functions, offering a potential new measure of brain&amp;ndash;heart interaction during real-life critical events.

Evaluation navigation controlled gate of aging spillway on cavitation damage.

High-speed flow of clean water or water with sediment released from aging spillways may cause abrasion and cavitation on the concrete surface gradually. The occurrence of irregularities on the concrete surface can exacerbate the erosion problem. Which might jeopardize the safety of dams constantly, hence the rehabilitation efforts become urgent tasks in dam safety projects. This study employs a 3D Computational Fluid Dynamics (CFD) model to quantitatively analyze the cavitation risk on the aging concrete surface of the Chay 5 spillway in Ha Giang, Vietnam, under various operation scenarios. There are two standards used to measure cavitation: the cavitation index (σ) which indicates the danger due to the drop of pressure in rapid flow, and the new gasification index (β) which takes into consideration the formation and collapse of bubbles behind asperities. Three extreme flood cases may not result in potential cavitation because both σ and β exceed critical thresholds. Regarding the six controlled gate scenarios with normal water level, the σ profiles are approximated 1,0 showing a low likelihood of cavitation damage while the β values are smaller than 0.8, indicating a considerable risk of cavitation. Besides, the opening height of 100 cm poses the greatest risk of creating severe cavitation erosion in the concave area and slope portion. The flip bucket experienced the most vulnerable cavitation when the opening height is 400 cm. In addition, an approach to spillway surface rehabilitation involving specialized mortars has been presented. For aging conveyance structure, gasification index (β) takes into account irregularities surface, providing a more comprehensive assessment of the likelihood of cavitation damage than cavitation index (σ). After rehabilitation with anti-shrinkage high abrasion resistance mortar, the entire spillway surface is smooth. This allows for reducing the cavitation risk and improvement of life service thereof.

Assessment and forecasting of water ecological security and obstacle factor diagnosis in the Hexi Corridor of Northwest China

The water ecological security pattern is a core factor. A scientific, accurate, and practical evaluation of water ecological security provides a theoretical basis for regional water ecological management. Using water resource data from five cities in the Hexi Corridor of Gansu Province (Jiuquan (JQ), Jiayuguan (JYG), Zhangye (ZY), Jinchang (JC), and Wuwei (WW)) from 2006 to 2021, a water ecological security evaluation index system based on the PSR (pressure-state-response) framework was constructed, covering 27 factors related to water resources, socio-economics, and the ecological environment. The main obstacle factors of water ecological security were identified using the obstacle degree model, and the grey GM(1,1) model was employed to predict water ecological security. Results indicated that the comprehensive assessment index of water ecology in the Hexi Corridor increased from 2006 to 2021, showing a transition from relatively unsafe (0.319) to basic safety and then to relatively safe (0.672). The pressure and response systems were the main limiting factors affecting water ecological security in the Hexi Corridor. After a slight decline in 2008, the overall spatial distribution continued to rise, with WW City and ZY City leading since 2016. ZY had a higher safety grade proportion (25%) compared to other areas in the Hexi region. The pressure system was the most significant obstacle to water ecological security after 2006. Prediction results indicated that the comprehensive evaluation index of water ecological security would continue to rise annually from 2022 to 2031, reaching a very safe level by 2025. The evaluation results provide a scientific basis for ecological security and risk decision-making in the study area.

Assessing the psychobiological demands of high-fidelity training in pre-hospital emergency medicine

BackgroundIndividuals who provide critical emergency care mount rapid psychobiological responses when faced with an incident. These responses are adaptive and ensure resources at time of demand; however, frequent activation with minimal opportunity for recovery can have negative consequences for health and wellbeing. Monitoring individuals in real emergency situations would provide an understanding of their stress responses during the provision of critical care; however, this presents logistical challenges. An alternative is to assess individuals during high-fidelity training scenarios. This is the first comprehensive assessment of psychobiological responding during continuous high-fidelity training in pre-hospital emergency medicine.MethodsA sample of doctors and paramedics (N = 27) participated during 10 days of training and a weekend of no activities. Training involved the acquisition of human factors, non-technical and surgical skills, and their application in complex high-fidelity scenarios including road-traffic accidents, firearms incidents, and swift water rescue operations. On each day participants reported levels of state, cognitive, and somatic anxiety, and self-confidence following waking and before sleep, and their anticipated (at wake) and experienced (before sleep) demands of the day. Saliva samples were obtained each day for assessment of diurnal cortisol indices and the Cortisol Awakening Response (CAR). Garmin smartwatches were worn throughout for the collection of heart rate and HRV-derived stress.ResultsThere were significant (p < 0.001) differences across days for state, cognitive, and somatic anxiety; self-confidence; anticipated and experienced demands; aggregated measures of heart rate and HRV-derived stress; levels of cortisol at waking (p = 0.002) and for the CAR (p < 0.001). Measures of psychobiological responding during training were distinct from the weekend and the highest levels of psychobiological responding occurred on days characterised by greater anticipated and experienced demands.DiscussionThis high-fidelity training is typical of the day-to-day requirements of emergency services and these observations are representative of functioning during real-life critical care emergencies. Increased responding during times of demand is adaptive; however, frequent and sustained responding increases allostatic load and is a contributor to burnout. As burnout is a significant concern in emergency medicine, this study identifies patterns of responding and recovery that may impact upon longer-term health and wellbeing.