Consecutive Periods Research Articles

Colorectal Cancer Survival in German-Danish Border Regions-A Registry-Based Cohort Study.

The aim of this study was (i) to update the reporting of colorectal cancer survival differences over time in the German-Danish border region (Schleswig-Holstein, Southern Denmark, and Zealand) and (ii) to assess the extent to which it can be explained by stage and primary treatment. Incident invasive colorectal cancer cases diagnosed from 2004 to 2016 with a follow-up of vital status through 31 December 2017 were extracted from cancer registries. Analyses were conducted by anatomical subsite and for four consecutive periods. Kaplan-Meier curves and log-rank tests were computed. Cox regression models using data from Schleswig-Holstein from 2004 to 2007 as the reference category were run while controlling for age, sex, stage, and treatment. The cox regression models showed decreasing hazard ratios of death for all three regions over time for both anatomical subsites. The improvement was stronger in the Danish regions, and adjustment for age, sex, stage, and treatment attenuated the results only slightly. In 2014-2016, colon cancer survival was similar across regions, while rectal cancer survival was significantly superior in the Danish regions. Regional survival differences can only partially be explained by differing stage distribution and treatment and may be linked additionally to healthcare system reforms and screening efforts.

A bimodal source for the generation of tonalitic to granitic magmas in a non-subduction-related magmatic belt: An example from the Sierra Chica of Córdoba, Argentina

A notable consensus prevails about the hybrid nature of intermediate calc-alkaline magmatism. Accordingly, petrogenetic models envisage the addition of young mantle material and cortical recycling in those geological settings where intermediate magmas are dominant. Most exhaustively studied examples are: 1) magmatic arcs associated with subduction zone settings where oceanic crust and sediments are introduced into the mantle wedge, and 2) deep crustal sections are pervaded by hot, H2O-rich mantle-derived liquids. Nevertheless, back-arc or foreland terranes of several hundred kilometers in width, frequently characterized by high heat flux, crustal melting, recycling and melt fractionation, are crucial areas to evaluate the generation of intermediate magmatism. The Sierra Chica of Córdoba (Argentina) provides an excellent example to study these processes. The high-grade crustal segment shows metamorphosed pelitic and basaltic protoliths that were part of an old sedimentary succession. We evaluate the evolution of this bimodal source during two consecutive early Paleozoic orogenic periods when it was established as the source area of intermediate to silicic magmatism far from the contemporary magmatic arcs. Field relations and new geochemical and geochronological data revealed the occurrence of two magmatic events during Cambrian and early Ordovician periods. Cambrian migmatization and partial melting (∼528 to 505 Ma) is represented by irregular-shaped monzogranites and tonalites, while early Ordovician magmatism (∼480 Ma) is characterized by dyke-shaped pegmatites and tonalite-trondhjemites. The preservation of two contrasting igneous lineages suggests a genetic linkage between metapelitic and amphibolitic migmatites and between granitic and tonalitic-trondhjemitic partial melts. Coeval with this magmatism, Famatinian tonalitic-trondhjemitic to monzogranitic magmas intruded upper crustal levels in Sierra Chica and other parts of Sierras of Córdoba. Geochemical signatures point to a bimodal (mafic/felsic) source for this intermediate to silica-rich magmatism. The evolution of partial melts studied in the Sierra Chica is depicted on the basis of geochemical projections with fractionation and hybridization models, in order to establish the primary liquids of this Famatinian magmatic belt. Trends defined by Famatinian tonalites, trondhjemites and granodiorites suggest that primary Ca-rich melts (tonalites and trondhjemites of this study) evolved through fractionation of plagioclase (30–50 vol%) compatible with the preservation of inferred co-magmatic Pl-cumulates within these plutonic bodies. Peraluminous granites and monzogranites can be explained by a simple restite unmixing process involving alkali-rich liquids generated in the metapelitic part of the source. The addition (hybridization) of up to 30 vol% of granitic melts to the tonalite-trondhjemite end-member may account for the composition of other Famatinian granodioritic to monzogranitic intrusive rocks from the plutonic belt. The crustal segments of the Sierra Chica have undergone metamorphism and partial melting in out-of-arc settings: the Cambrian fore-arc and the early Ordovician back-arc. The voluminous magmatic belt rooted in the paired metapelitic-amphibolic source area is involved in the origin of intermediate to silicic Famatinian magmatism without significant mass transfer from the mantle and crustal growth, instead it is dominated by crustal melting, recycling and fractionation.

Optimal Policies for Dynamic Pricing and Inventory Control with Nonparametric Censored Demands

We study the classic model of joint pricing and inventory control with lost sales over T consecutive review periods. The firm does not know the demand distribution a priori and needs to learn it from historical censored demand data. We develop nonparametric online learning algorithms that converge to the clairvoyant optimal policy at the fastest possible speed. The fundamental challenges rely on that neither zeroth-order nor first-order feedbacks are accessible to the firm and reward at any single price is not observable due to demand censoring. We propose a novel inversion method based on empirical measures to consistently estimate the difference of the instantaneous reward functions at two prices, directly tackling the fundamental challenge brought by censored demands. Based on this technical innovation, we design bisection and trisection search methods that attain an [Formula: see text] regret for the case with concave reward functions, and we design an active tournament elimination method that attains [Formula: see text] regret when the reward functions are nonconcave. We complement the [Formula: see text] regret upper bound with a matching [Formula: see text] regret lower bound. The lower bound is established by a novel information-theoretical argument based on generalized squared Hellinger distance, which is significantly different from conventional arguments that are based on Kullback-Leibler divergence. Both the upper bound technique based on the “difference estimator” and the lower bound technique based on generalized Hellinger distance are new in the literature, and can be potentially applied to solve other inventory or censored demand type problems that involve learning. This paper was accepted by Jeannette Song, operations management. Supplemental Material: The data files and online appendix are available at https://doi.org/10.1287/mnsc.2023.4859 .

1061 Improving the Emergency Management of Unstable Ankle Fractures in a District General Hospital: A Quality Improvement Project

Abstract Aim To assess and improve initial casting techniques in the emergency management of unstable ankle fractures. Method All patients who underwent operative management of ankle fractures over two consecutive 3-month periods were selected, before and after an intervention. Following the first cycle, an intervention included presentation of results and teaching delivery to the Emergency Department, with agreement to advocate for backslab as preferred casting technique. Results A total of fifty-two patients were identified, with an age range of 8 to 96 years. The majority were female (63%). Initial results demonstrated 61% were managed in below ankle backslabs, 33% in full casts and 1 patient in a moonboot. Subsequent loss of reduction was demonstrated in 27% of patients. Rates were higher with full casts (45.4%) compared to backslabs (20%). Following intervention, results demonstrated a 28% increase in use of backslab casting method (89%). Only 5% were managed with a full cast (28% decrease) and 1 inappropriately discharged without immobilisation. There was a 7% decrease in overall loss of reduction (21%). There was no loss of reduction within the full cast group and 22% with backslab management. Conclusions The use of backslab immobilisation in the management of unstable ankle fractures is preferred. Following a brief intervention, rates of backslab immobilisation increased and loss of reduction decreased. Results show an improvement in casting techniques in the management of these patients in an NHS Trust.

Association between Hospital-Acquired Pneumonia and In-Hospital Mortality in Solid Organ Transplant Admissions: An Observational Analysis in Spain, 2004-2021.

(1) Background: To analyze the association between hospital-acquired pneumonia (HAP) and in-hospital mortality (IHM) during hospital admission for solid organ transplant in Spain during 2004-2021. (2) Methods: We used national hospital discharge data to select all hospital admissions for kidney, liver, heart, and lung transplants. We stratified the data according to HAP status. To examine time trends, we grouped data into three consecutive 6-year periods (2004-2009; 2010-2015; and 2016-2021). We assessed in-hospital mortality (IHM) in logistic regression analyses and obtained odds ratios (ORs) with their 95% confidence intervals (CIs). (3) Results: We identified a total of 71,827 transplants (45,262, kidney; 18,127, liver; 4734, heart; and 4598, lung). Two thirds of the patients were men. Overall, the rate of HAP during admission was 2.6% and decreased from 3.0% during 2004-2009 to 2.4% during 2016-2021. The highest rate of HAP corresponded to lung transplant (9.4%), whereas we found the lowest rate for kidney transplant (1.1%). Rates of HAP for liver and heart transplants were 3.8% and 6.3%, respectively. IHM was significantly lower during 2016-2021 compared to 2004-2009 for all types of transplants (ORs (CIs) = 0.65 (0.53-0.79) for kidney; 0.73 (0.63-0.84) for liver; 0.72 (0.59-0.87) for heart; and 0.39 (0.31-0.47) for lung). HAP was associated with IHM for all types of transplants (ORs (CIs) = 4.47 (2.85-9.08) for kidney; 2.96 (2.34-3.75) for liver; 1.86 (1.34-2.57) for heart; and 2.97 (2.24-3.94) for lung). (4) Conclusions: Rates of HAP during admission for solid organ transplant differ depending on the type of transplant. Although IHM during admission for solid organ transplant has decreased over time in our country, HAP persists and is associated with a higher IHM after accounting for potential confounding variables.

Quantifying production losses associated with foot and mouth disease outbreaks on large-scale dairy farms in Rift valley, Kenya.

Foot and Mouth Disease (FMD) is a contagious viral disease to which dairy cattle are highly susceptible. An outbreak of FMD in a dairy herds can cause a drop in milk yield, increase mastitis infections, and force culling. These production losses can be substantial, but farmers undervalue the magnitude of the loss that they incur. The study quantified the association of FMD outbreaks with milk yield, mastitis incidences, and culling rates. The data was from three large-scale dairy farms with a recent history (2008 to 2018) of FMD outbreaks in a region endemic for the prevalence of serotype C of the FMD virus since the mid-1980s in the Rift valley of Kenya. A total of 507 cows were monitored for three consecutive periods of six weeks before, during, and after FMD outbreaks. Relative to the period before and after the disease outbreak, production losses were marked during the outbreak. A disease outbreak was associated with up to 4.7% of the cows drying off (n = 24) and milk production dropped by 16.1%. The incidence of mastitis increased from 5.4% to 21.5% (OR = 3.31, CI = 2.27, 4.83) and culling rates increased from 0.59% to 3.8% (OR = 6.71, CI = 1.99, 22.58).

Cancer data quality and harmonization in Europe: the experience of the BENCHISTA Project - international benchmarking of childhood cancer survival by stage.

Variation in stage at diagnosis of childhood cancers (CC) may explain differences in survival rates observed across geographical regions. The BENCHISTA project aims to understand these differences and to encourage the application of the Toronto Staging Guidelines (TG) by Population-Based Cancer Registries (PBCRs) to the most common solid paediatric cancers. PBCRs within and outside Europe were invited to participate and identify all cases of Neuroblastoma, Wilms Tumour, Medulloblastoma, Ewing Sarcoma, Rhabdomyosarcoma and Osteosarcoma diagnosed in a consecutive three-year period (2014-2017) and apply TG at diagnosis. Other non-stage prognostic factors, treatment, progression/recurrence, and cause of death information were collected as optional variables. A minimum of three-year follow-up was required. To standardise TG application by PBCRs, on-line workshops led by six tumour-specific clinical experts were held. To understand the role of data availability and quality, a survey focused on data collection/sharing processes and a quality assurance exercise were generated. To support data harmonization and query resolution a dedicated email and a question-and-answers bank were created. 67 PBCRs from 28 countries participated and provided a maximally de-personalized, patient-level dataset. For 26 PBCRs, data format and ethical approval obtained by the two sponsoring institutions (UCL and INT) was sufficient for data sharing. 41 participating PBCRs required a Data Transfer Agreement (DTA) to comply with data protection regulations. Due to heterogeneity found in legal aspects, 18 months were spent on finalizing the DTA. The data collection survey was answered by 68 respondents from 63 PBCRs; 44% of them confirmed the ability to re-consult a clinician in cases where stage ascertainment was difficult/uncertain. Of the total participating PBCRs, 75% completed the staging quality assurance exercise, with a median correct answer proportion of 92% [range: 70% (rhabdomyosarcoma) to 100% (Wilms tumour)]. Differences in interpretation and processes required to harmonize general data protection regulations across countries were encountered causing delays in data transfer. Despite challenges, the BENCHISTA Project has established a large collaboration between PBCRs and clinicians to collect detailed and standardised TG at a population-level enhancing the understanding of the reasons for variation in overall survival rates for CC, stimulate research and improve national/regional child health plans.

Dietary ω3 Fatty Acids and Phytosterols in the Modulation of the HDL Lipidome: A Longitudinal Crossover Clinical Study.

High-density lipoproteins (HDLs) are complex particles composed of a wide range of lipids, proteins, hormones and vitamins that confer to the HDL particles multiple cardiovascular protective properties, mainly against the development of atherosclerosis. Among other factors, the HDL lipidome is affected by diet. We hypothesized that diet supplementation with ω3 (docosahexaenoic acid: DHA and eicosapentaenoic acid: EPA) and phytosterols (PhyS) would improve the HDL lipid profile. Overweight subjects (n = 20) were enrolled in a two-arm longitudinal crossover study. Milk (250 mL/day), supplemented with either ω3 (EPA + DHA, 375 mg) or PhyS (1.6 g), was administered to the volunteers over two consecutive 28-day intervention periods, followed by HDL lipidomic analysis. The comprehensive lipid pattern revealed that the HDL lipidome is diet-dependent. ω3-milk supplementation produced more changes than PhyS, mainly in cholesteryl esters (CEs). After ω3-milk intake, levels of DHA and EPA within phosphatylcholines, triglycerides and CE lipids in HDLs increased (p < 0.05). The correlation between lipid species showed that lipid changes occur in a coordinated manner. Finally, our analysis revealed that the HDL lipidome is also sex-dependent. The HDL lipidome is affected by diet and sex, and the 4 weeks of ω3 supplementation induced HDL enrichment with EPA and DHA.

Identification in dynamic binary choice models

This paper studies identification in a binary choice panel data model with choice probabilities depending on a lagged outcome, additional observed regressors and an unobserved unit-specific effect. It is shown that with two consecutive periods of data identification is not possible (in a neighborhood of zero), even in the logistic case.

Integrated flexibility characterization and measurement of distributed multi-energy systems considering temporal coupling constraints

The integrated flexibility of distributed multi-energy systems (DMES) has been recognized as a valuable balancing resource to the centralized energy system, which can be characterized by an integrated flexible region (IFR) of multiple energy inputs. Notably, the IFR is only captured for one single period in previous studies, whereas the time coupling in consecutive periods has a significant impact on the integrated flexibility. This paper proposes a modified IFR-based approach to characterize and measure the integrated flexibility of DMES considering the temporal coupling constraints. First, operation constraints of the DMES are formulated, followed by a vertex search method to obtain the IFR, i. e, a polytope that visualizes those operation constraints. Then, an approximation approach is proposed to decompose the original IFR into a series of lower-dimension IFRs, each of which corresponds to a specific period. The influence of states of adjacent periods is directly reflected by the position change of the vertices. The decoupled IFRs can be incorporated conveniently into the multi-period economic dispatch of the centralized energy system. Moreover, the Volume of the IFRs (VFR) is introduced as an index to quantify the flexibility of the DMES. The performance of the proposed methods is verified by the case studies.

Spatiotemporal and multispecies comparisons between a citizen science platform and recall surveys in recreational fisheries

Smartphone applications for anglers that function as citizen science platforms are an alternative to the traditional survey methods that are used to collect data from recreational fisheries. Comparisons between these two methods are needed to understand the impacts of the biases associated with data generated from smartphone applications. However, such comparisons are uncommon, especially for multiple fisheries over time and across space. In this study, we compared catch and effort data from an electronic citizen science platform for anglers with an offsite web-based recall survey for consecutive (i) 3-month periods in a spatially distinct (i.e., the Danish island of Funen) sea trout (Salmo trutta) fishery (2017–2020), (ii) 6-month periods in coastal sea trout and coastal/offshore cod (Gadus morhua) fisheries across eight ICES management areas (2016–2020), and (iii) 6-month periods in a freshwater pike (Esox lucius) fishery (2016–2020). Catch and effort data from the two surveys were, in most cases, consistently similar over time for the Funen sea trout and Danish freshwater pike fisheries. In contrast, we found that the recall survey estimates were consistently 100–200% larger than the citizen science platform for both sea trout and cod in ICES areas. Our findings suggest that the applicability of electronic citizen science platforms for anglers can be fishery-specific, and that systematic bias may occur.

The impact of the COVID-19 pandemic in the clinical assistance to breast cancer patients.

We aimed to disclose the impact of the pandemic on breast cancer patients in a specialized breast cancer center (BCC). A total of 501 breast cancer patients with a first appointment in the BCC from April 1st, 2019 to March 31st, 2021 were divided into four consecutive periods of 6months. Data from the homologous semesters was compared. Patients with an appointment in the BCC during the study period were eligible for the secondary aim of our study (BCC workload). After the pandemic declaration (period 3), we found a decrease in the referral by screening programs (p = 0.002) and a reduction in the waiting time between the primary care referral and the first BCC appointment (p < 0.001). There were higher rates of palpable axillary nodes (p = 0.001), an increase in N stage 2 and 3 (p = 0.050), and a trend for primary endocrine therapy as the first treatment (p = 0.021) associated with higher rates of complete axillary node dissection (p = 0.030). In period 4, there were more outward diagnoses (p = 0.003) and a higher rate of surgery as the first treatment (p = 0.013). COVID-19 pandemic implied a more advanced nodal stage, which may be related to the delay in breast cancer screening.

The Incidence of Heterotopic Ossification in Surgically and Non-surgically Treated Elbow Fractures at a Municipal Hospital in Japan.

Background: Heterotopic ossification (HO) is a well-recognised complication of after elbow trauma. The prevalence and risk factors of HO have been previously reported. However, these reports were based on elbow trauma that had undergone surgical treatment and most of them were from Western countries. This study aimed to assess the incidence of HO in patients with elbow fractures who were treated surgically and non-surgically in Japan. Methods: We retrospectively identified consecutive patients who were treated of elbow fractures and fracture-dislocations at our institution in recent consecutive 3-year periods. We extracted patient demographics, injury mechanisms and treatment details from the medical records. Furthermore, we reviewed radiographs to classify the fracture pattern and identify the presence or absence of HO. Results: HO was identified in 6/97 (6%) patients. Fracture-dislocation was noted in 4/6 patients. The fracture types with HO included terrible triad injury (n = 2), isolated coronoid process fractures (n = 2), distal humerus A-type fractures (n = 1) and radial head fracture (n = 1). According to the Hastings and Graham classification, HO was classified as Class I in five patients and Class II B in one patient who underwent additional surgery for HO resection. Conclusions: The incidence of HO was relatively low in our patients. However, of the 20 conservatively treated elbows, one patient developed clinically relevant HO and required excision of HO. Even patients with elbow fractures treated conservatively should be informed of the potential risk of developing severe HO requiring surgical excision. In addition, surgeons in this region could use these data to inform patients about the risk of HO development after an elbow injury. Level of Evidence: Level IV (Therapeutic).

The effect of background audio and audiovisual stimuli on students' autonomic responses during and after an experimental academic examination.

Due to the Covid-19 pandemic lockdown during the online-distant education period, certain students tended to combine their courses and homework with TV or social media news or other media content, such as classical music, including a wealth of audio and audiovisual stimuli. As the audio and audiovisual stimuli existing in a learning environment may affect students' autonomic nervous system (ANS) responses negatively, the present study aimed to monitor the impact of background TV, classical music, and silence on students' ANS activity represented by heart rate (HR), heart rate variability (HRV), blood volume amplitude (BVA), and skin conductance level (SCL) during and after an experimental academic examination. Seventy-six students were randomly allocated to background TV, classical music, or silence groups. The experiment with repeated measures design consisted of four consecutive periods: baseline, anticipation, challenge, and recovery, lasting 4 min each. Within-subject analyses indicated significant HRV decrement only in the background TV group. Regardless of the experimental groups, HR and SCL increased while BVA decreased during the task. In addition, the between-subject analysis showed that the background TV group experienced significantly larger changes in HR and HRV parameters compared to the other experimental groups relative to their respective baseline measurements. Based on these results, we concluded that relative to classical music and silence, background TV, including audiovisual and verbal stimuli, extant in a learning environment might raise students' sympathetic activity. Further, classical music, without lyrics, may suppress the withdrawal of vagal activity and elevate the autonomic regulation capacity during the academic reading comprehension task. HRV is a more valid and reliable indicator of students' autonomic responses during a challenging academic task.

How persistent and hazardous will extreme temperature events become in a warming Portugal?

The impact of rising greenhouse gases (GHGs) in the atmosphere on the temperature distributions is felt not only in the mean values but primarily in the extremes. The temperature distributions are becoming slightly flattened and more broadened towards higher values, leading to a decrease in extreme cold events and more importantly to a considerable increase in the frequency and intensity of extreme hot events. These changes are no longer simple projections but are already occurring. It is thus imperative an assessment of the projected changes even under reduced emissions scenarios for the entire 21st century. In this study, a multi-variable ensemble based on 13 EURO-CORDEX high-resolution simulations at 0.11° resolution, was used to analyse the extreme heat events as well as the Universal Thermal Climate Index (UTCI) for such extremes between March and November over Portugal. The 13 simulations have in common three Representative Concentration Pathways (RCP), RCP2.6, RCP4.5 and RCP8.5 as well as data covering a historical period (1971–2000) and three future consecutive periods, 2011–2040, 2041–2070 and 2071–2 100. The results show that severe future heatwaves will develop beyond the extended summer months in all scenarios. Even under a high mitigation scenario (RCP2.6), the number of heatwaves will more than double in number, relative to the historical record. In the high emission scenario (RCP8.5), a sharp increase in the number, severity and areal extension of heatwaves is projected for the end of the 21st century. The analysis of the heat stress indicates that most of the projected future heatwaves will induce heat stress and the projected increase in areal extension and the number of occurrences will have an impact on morbidity and mortality rates simply due to the shear rise in the number of the affected population and the increased frequency of occurrence.

Plan of prehistoric stilt village in Maranhão Brazil may resemble the Pleiades

Archaeological surveys conducted in the Maranhão estuaries of Brazil, near the Atlantic coast, revealed the remnants of 21 prehistoric stilt villages constructed on piles of Tabebuia handroanthrus hardwood above three seasonal flood water estuaries. Radiocarbon dates of 27 samples from 11 of those sites yielded an Archaic Period of construction (6622 ± 119 calibrated years before present) followed much later by consecutive construction periods from approximately the first century B.C. to the thirteenth century A.D. (1994 to 728 cal. yrs BP). The Formoso site—currently dated as the longest occupied site (1509 to 930 cal. yrs BP)—yielded early Incised-Punctate/Arauquinoid pottery, a previously unreported pottery style in the Amazon region. Additionally, using StarryNight astronomy software, the night sky at Formoso was compared with a map of the pile dwelling layout, revealing a statistically significant resemblance to the Pleiades. This paper focuses on the Formoso site, suggesting that it may have served cultural significance to the Pleiades as early evidence for the later widespread ethnographic use of the star cluster’s annual sighting to mark the seasonal flood cycles and the management of agricultural and ecological activities throughout tropical South America.

Improving outcomes of in situ split liver transplantation in Italy over the last 25 years

Split liver transplant(ation) (SLT) is still considered a challenging procedure that is by no means widely accepted. We aimed to present data on 25-year trends in SLT in Italy, and to investigate if, and to what extent, outcomes have improved nationwide during this time. The study included all consecutive SLTs performed from May 1993 to December 2019, divided into three consecutive periods: 1993-2005, 2006-2014, and 2015-2019, which match changes in national allocation policies. Primary outcomes were patient and graft survival, and the relative impact of each study period. SLT accounted for 8.9% of all liver transplants performed in Italy. A total of 1,715 in situ split liver grafts were included inthe analysis: 868 left lateral segments (LLSs) and 847 extended right grafts (ERGs). A significant improvement in patient and graft survival (p <0.001) was observed with ERGs over the three periods. Predictors of graft survival were cold ischaemia time (CIT) <6h (p= 0.009), UNOS status 2b (p <0.001), UNOS status 3 (p= 0.009), and transplant centre volumes: 25-50 cases vs. <25 cases (p= 0.003). Patient survival was significantly higher with LLS grafts in period 2 vs. period 1 (p= 0.008). No significant improvement in graft survival was seen over the three periods, where predictors of graft survival were CIT <6h (p= 0.007), CIT <6h vs. ≥10h (p= 0.019), UNOS status 2b (p= 0.038), and UNOS status 3 (p= 0.009). Retransplantation was a risk factor in split liver graft recipients, with significantly worse graft and patient survival for both types of graft (p <0.001). Our analysis showed Italian SLT outcomes to have improved over the last 25 years. These results could help to dispel reservations regarding the use of this procedure. Split liver transplant(ation) (SLT) is still considered a challenging procedure and is by no means widely accepted. This study included all consecutive in situ SLTs performed in Italy from May 1993 to December 2019. With more than 1,700 cases, it is one of the largest series, examining long-term national trends in in situ SLT since its introduction. The data presented indicate that the outcomes of SLT improved during this 25-year period. Improvements are probably due to better recipient selection, refinements in surgical technique, conservative graft-to-recipient matching, and the continuous, yet carefully managed, expansion of donor selection criteria under a strict mandatory split liver allocation policy. These results could help to dispel reservations regarding the use of this procedure.

Vigilance Decrement During On-Road Partially Automated Driving Across Four Systems.

This study uses a detection task to measure changes in driver vigilance when operating four different partially automated systems. Research show temporal declines in detection task performance during manual and fully automated driving, but the accuracy of using this approach for measuring changes in driver vigilance during on-road partially automated driving is yet unproven. Participants drove four different vehicles (Tesla Model 3, Cadillac CT6, Volvo XC90, and Nissan Rogue) equipped with level-2 systems in manual and partially automated modes. Response times to a detection task were recorded over eight consecutive time periods. Bayesian analysis revealed a main effect of time period and an interaction between mode and time period. A main effect of vehicle and a time period x vehicle interaction were also found. Results indicated that the reduction in detection task performance over time was worse during partially automated driving. Vehicle-specific analysis also revealed that detection task performance changed across vehicles, with slowest response time found for the Volvo. The greater decline in detection performance found in automated mode suggests that operating level-2 systems incurred in a greater vigilance decrement, a phenomenon that is of interest for Human Factors practitioners and regulators. We also argue that the observed vehicle-related differences are attributable to the unique design of their in-vehicle interfaces.

Time-bin phase-encoding quantum key distribution using Sagnac-based optics and compatible electronics.

In this work, we present a new time-bin phase-encoding quantum key distribution (QKD), where the transmitter utilizes an inherently stable Sagnac-type interferometer, and has comparable electrical requirements to existing polarization or phase encoding schemes. This approach does not require intensity calibration and is insensitive to environmental disturbances, making it both flexible and high-performing. We conducted experiments with a compact QKD system to demonstrate the stability and secure key rate performance of the presented scheme. The results show a typical secure key rate of 6.2 kbps@20 dB and 0.4 kbps@30 dB with channel loss emulated by variable optical attenuators. A continuous test of 120-km fiber spool shows a stable quantum bit error rate of the time-bin basis within 0.4%∼0.6% over a consecutive 9-day period without any adjustment. This intrinsically stable and compatible scheme of time-bin phase encoding is extensively applicable in various QKD experiments, including BB84 and measurement-device-independent QKD.

Exploration of smart adherence-monitoring methods in vitamin D-deficient patients: A pilot feasibility clinical study.

Treatment adherence is an underestimated determinant of treatment success. Poor treatment adherence can also affect the efficacy of clinical trials. A combination of multiple adherence-monitoring methods is required to ensure robustness. We investigated whether multiple adherence-monitoring methods, including a novel smartwatch-based monitoring method, would yield reliable and concordant results. In this open, randomized, decentralized clinical trial, vitamin D-deficient individuals were randomized to an App - only group (an electronic medication diary) or an App + Watch group (i.e., App and smartwatch-based monitoring) groups after a week run-in period. The participants received vitamin D supplements (1000 IU) for 12 weeks (two consecutive periods of 6 weeks) with two pill counts (at the sixth week) and biweekly blood samplings for serum 25(OH) vitamin D concentration. Adherence was assessed and compared between the methods. Sixteen participants were enrolled, of which 13 completed the study. Serum 25(OH) vitamin D levels comparably increased in both groups until the first 7 weeks but trended higher in the App + Watch group in the second period. The number of doses recorded by the pill count and App did not differ significantly between the run-in and Period 1 (p = 0.5534) but became significantly discrepant in Period 2 (p = 0.0225). In contrast, the concordance for smartwatch-based monitoring was consistent in either period (p = 0.5898 and p = 0.5839, respectively). We explored multiple adherence-monitoring methods in this pilot feasibility clinical study. Smartwatch-based adherence monitoring may be an objective and sensitive method for measuring treatment adherence.