Effectiveness Of Different Approaches Research Articles

Abstract Su205: Using Emergency Medical Services Monitors for Cardiac Arrest Patients in the Emergency Department is Associated with Faster Initial Rhythm Analysis and Defibrillation

Introduction: The 2020 American Heart Association guidelines for Cardiopulmonary Resuscitation (CPR) emphasizes the importance of high-quality CPR and early defibrillation in improving cardiac arrest (CA) survival. Using our emergency department (ED) CA video review registry, we can capture metrics to reliably assess the effectiveness of different approaches to CA management. Goals/Hypothesis: We propose that emergency medical services (EMS) pads and defibrillators should be used to initially analyze cardiac rhythm in the ED. We hypothesize that this “EMS Equipment” approach is associated with shorter time to first ED rhythm detection and defibrillation, higher chest compression fraction (CCF), and improved return of spontaneous circulation (ROSC) rates. Methods: This is a single center, retrospective cohort study using our CA video review registry between 10/03/2018 – 2/20/2024. Atraumatic, out-of-hospital CA patients ≥18 years were included while patients arriving to the ED with ROSC were excluded. The “EMS Equipment” group utilized EMS pads and defibrillators while the “ED Equipment” group utilized ED pads and defibrillators for the first ED rhythm analysis. Wilcoxon rank sum tests were used to assess differences in time to first rhythm check and first defibrillation among the two groups. Chi-square tests were used to assess whether the proportions of patients achieving above median CCF, ROSC, survival to admission and discharge in the two groups were different. Results: A total of 247 patients were included in the analysis with 69 patients in the EMS Equipment group (27.9%) and 178 patients in the ED Equipment group (72.1%). The EMS Equipment group had a shorter median time to first ED rhythm detection (96 vs. 255 seconds, p <0.00001). Among the 63 patients defibrillated in the ED, the EMS Equipment group had a shorter median time to first ED defibrillation (103 vs. 413 seconds, p = 0.0024). There was no significant difference in CCF, ROSC rates, survival to admission or discharge. ROSC was achieved in 36% of cases. Conclusion: In conclusion, initial rhythm analysis with EMS pads and defibrillators was associated with shorter time to initial ED rhythm detection and defibrillation, but not improved CCF, ROSC rates, and survival. Larger studies are needed to verify these exploratory results in more diverse settings.

Understanding the Roles and Regulation Methods of Key Adsorption Species on Ni-Based Catalysts for Efficient Hydrogen Oxidation Reactions in Alkaline Media.

This review focuses on recent advancements in the development and understanding of nickel-based catalysts for the hydrogen oxidation reaction in alkaline media. Given the economic and environmental limitations associated with platinum group metals, nickel-based catalysts have emerged as promising alternatives due to their abundance, lower cost, and comparable catalytic properties. The review begins with an exploration of the fundamental HOR mechanisms, emphasizing the key roles of the reactive species in optimizing the catalytic activity of Ni-based catalysts. Thermodynamic and stability optimizations of nickel-based catalysts are thoroughly examined, focusing on alloying strategies, heteroatom incorporation, and the use of various support materials to enhance their catalytic performance and durability. The review also addresses the challenge of catalyst poisoning, particularly by carbon monoxide, and evaluates the effectiveness of different approaches to improve poison resistance. Finally, the review concludes by summarizing the key findings and proposing future research directions to further enhance the efficiency and stability of nickel-based catalysts for practical applications in anion exchange membrane fuel cells. The insights gained from this comprehensive analysis aim to contribute to the development of cost-effective and sustainable catalysts and facilitate the broader adoption of AEMFCs in the quest for clean energy solutions.

Understanding the complexity of barriers and facilitators to adherence to oral nutritional supplements among patients with malnutrition: a systematic mixed-studies review.

The aim of this systematic mixed-studies review is to summarise barriers/facilitators to adherence to and/or consumption of oral nutritional supplements (ONS) among patients with disease-related malnutrition. In March 2022, the Cochrane CENTRAL, PUBMED, PsycINFO (Ovid) and CINAHL were searched for articles with various study designs, published since 2000. Articles were identified on the basis of 'population' (patients ≥18 years with malnutrition/at nutritional risk), 'intervention' (ONS with ≥2 macronutrients and micronutrients), 'comparison' (any comparator/no comparator) and 'outcome' (factors affecting adherence or consumption) criteria. A sequential exploratory synthesis was conducted: first, a thematic synthesis was performed identifying barriers/facilitators; and second, the randomised controlled trials (RCTs) were used to support these findings. The five WHO dimensions of adherence guided the analysis. Study inclusion, data extraction, analysis and risk-of-bias assessment (MMAT 2018) were carried out independently by two researchers. From 21 835 screened articles, 171 were included with 42% RCTs and 20% qualitative studies. The two major populations were patients with malignancies (34%) and older adults (35%). In total, fifty-nine barriers/facilitators were identified. Patients' health status, motivation, product tolerance and satisfaction as well as well-functioning healthcare routines and support were factors impacting ONS consumption. Few barriers/facilitators (n = 13) were investigated in RCTs. Two of those were serving a small ONS volume and integrating ONS into ward routines. Given the complexity of ONS adherence, non-adherence to ONS should be addressed using a holistic approach. More studies are needed to investigate the effect of different approaches to increase adherence to ONS.

Іnternational and foreign practice of compensation for war crimes

The scientific article is dedicated to the study of international and foreign practices of compensation for war crimes. The article analyzes legal mechanisms and tools used for compensating victims of war crimes in various countries of Europe and the world. The main focus is on the practice of international courts, such as the International Criminal Court (ICC), as well as national judicial institutions that handle war crime cases. Specific cases and decisions that have influenced the development of law enforcement practices in this area are examined. One of the key aspects of the work is the analysis of international treaties and conventions that regulate compensation issues, including the Convention on the Non-Applicability of Statutory Limitations to War Crimes and Crimes Against Humanity, as well as the Rome Statute of the ICC. Various compensation models are considered, including monetary compensation, rehabilitation, and other forms of reparation. The article also explores the role of non-governmental organizations and international funds in the process of compensating war crime victims. The effectiveness of different approaches and mechanisms used to ensure justice and restore the rights of victims is analyzed. The work pays attention to the problems and challenges faced by law enforcement agencies when handling war crime cases, as well as the prospects for improving the international legal mechanism for protecting the rights of victims. The research is based on the analysis of specific cases, court decisions, and legal acts, allowing conclusions to be drawn about the current state and possible ways of developing the compensation system for war crimes. Thus, the article contributes to the scientific discussion on improving the mechanisms of legal protection for victims of war crimes and ensuring justice in international law.

Effect of Different Approaches of Delivering Local Dental Anesthesia on Pain Perception in Children. A Double Blinded Randomized Controlled Clinical Trial.

Effect of Different Approaches of Delivering Local Dental Anesthesia on Pain Perception in Children. A Double Blinded Randomized Controlled Clinical Trial.

Effect of different approaches of direct radiation on the surface structure and caries susceptibility of enamel

It is not clear whether different radiation methods have different effects on enamel. The purpose of this study was to compare the effects of single and fractionated radiation on enamel and caries susceptibility and to provide an experimental basis for further study of radiation‑related caries. Thirty-six caries-free human third molars were collected and randomly divided into three groups (n = 12). Group1 (control group) was not exposed to radiation. Group 2 received single radiation with a cumulative dose of 70 Gy. Group 3 underwent fractionated radiation, receiving 2 Gy/day for 5 days followed by a 2-day rest period, for a total of 7 weeks with a cumulative dose of 70 Gy. Changes in microhardness, roughness, surface morphology, bacterial adhesion and ability of acid resistance of each group were tested. Scanning electron microscope revealed that the enamel surface in both radiation groups exhibited unevenness and cracks. Compared with the control group, microhardness and acid resistance of enamel decreased, while roughness and bacterial adhesion increased in both the single radiation and fractionated radiation groups. Compared with the single radiation group, the enamel surface microhardness and acid resistance decreased in the fractionated radiation group, while roughness and bacterial adhesion increased. Both single radiation and fractionated radiation resulting in changes in the physical and biological properties of enamel, with these changes being more pronounced in the fractionated radiation group. Therefore, fractionated radiation is recommended as a more suitable method for constructing a radiation‑related caries model in vitro.

Effect of Different Approaches of Nutrient Application on Soil Quality Index Under Maize-Wheat Cropping System in Mollisol Region of Uttarakhand

ABSTRACT A field experiment was conducted at GBPUA&T, Pantnagar, to study the effect of different approaches of nutrient application on soil fertility and soil quality under maize-wheat cropping system. Nine treatment combinations were compared namely, Recommended Doses of Fertilizers (RDF), Soil Test Crop Response (STCR), and various combinations of organic and inorganic fertilizers. This paper aims to develop Soil Quality Index (SQI) based on Minimum Data Set (MDS) using Principal Component Analysis (PCA). Different indicators were employed to formulate the SQI, derived from surface soil layer measurements (0–15 cm). Each MDS indicator was then converted into a dimensionless score using linear scoring function and then integrated into SQI. Results showed that the key soil quality indicators identified as MDS using PCA under maize-wheat cropping system were Water Holding Capacity, organic carbon, available N and dehydrogenase activity. These soil quality indicators were found to be best for monitoring soil health status. After rabi wheat 2019–2020, SQI varied from 1.22 to 2.21 across the treatments whereas, after rabi wheat 2020–2021, SQI varied from 1.13 to 2.23 across the treatments. Among different approaches of nutrient application, STCR-based use of fertilizers along with FYM (T4) helped in maintaining better soil physical, chemical and biological properties and ultimately sustaining soil quality, which was followed by the treatment receiving 75% STCR dose of N (inorganic mode) + full P and K (T5). Integration of organics with inorganic fertilizers maintained soil quality, environmental health and reduced greater dependency on chemical fertilizers.

Removal of leads broken during extraction: A comparison of different approaches and tools.

Extraction of a broken lead fragment (BLF) has received scant attention in the literature. Retrospective analysis was to compare the effectiveness of different approaches and tools used for BLF removal during 127 procedures. A superior approach was the most popular (75.6%), femoral (15.7%) and combined (8.7%) approaches were the least common. Of 127 BLFs 78 (61.4%) were removed in their entirety and BLF length was significantly reduced to less than 4 cm in 21 (16.5%) or lead tip in 12 (9.4%) cases. The best results were achieved when BLFs were longer (>4 cm) (62/93 66.7% of longer BLFs), either in the case of BLFs free-floating in vascular bed including pulmonary circulation (68.4% of them) but not in cases of short BLFs (20.0% of short BLFs). Complete procedural success was achieved in 57.5% of procedures, the lead tip retained in the heart wall in 12 cases (9.4%) and short BLFs were found in 26.0%, whereas BLFs >4 cm were left in place in four cases (3.1%) of procedures only. There was no relationship between approach in lead remnant removal and long-term mortality. (1) Effectiveness of fractured lead removal is satisfactory: entire BLFs were removed in 61.4% (total procedural success-57.5%, was lower because five major complications occurred) and BLF length was significantly reduced in 26.0%. (2) Among the broken leads, leads with a long stay in the patient (16.3 years on average), passive leads (97.6%) and pacemaker leads 92.1% are significantly more common, but not ICD leads (only 7.9% of lead fractures) compared to TLE without lead fractures. (3) Broken lead removal (superior approach) using a CS access sheath as a "subclavian workstation" for continuation of dilatation with conventional tools deserves attention. (4) Lead fracture management should become an integral part of training in transvenous lead extraction.

Trajectories of socio-ecological systems: Does social capital matter? A case study in the tropical Andes

Between natural and social systems there are two-way interactions, which determine the path of change in the Socio-Ecological System. For example, the type of land use decisions that society makes could lead to the deterioration of the biophysical system and its ecological functioning, causing effects on social well-being. Conceptual and simulation models of socio-ecological systems allow an understanding of such interactions and the development of trajectories. In this manuscript we explore the link between three lines of research that overlap but have been studied separately (i) Governance, (ii) Socio-ecological systems, and (iii) social capital. This paper analyzes the dynamics of social capital and its influence on governance and Land Use and Land Cover Changes in a basin of the Colombian Andes. To this end, we develop a Systems Dynamics model (SD). This research contributes to the (i) understanding of how the institutions, their policies, the actors, and the interactions generated between them in a territory influence the management of natural resources, which is indispensable to supporting the decision-making process; and (ii) operationalization of the social capital elements on the SES model through an integrated analysis with consideration of feedback mechanisms between natural and social system. With this model, a scenario evaluation is developed to analyze the effect of different approaches of the social capital organization on land cover in the basin case study.

The Overview on Effectiveness of Quality Enhancement for Enhancing Health Care and Professional Practice

Reorganizing the structure and delivery of services has been a typical focus of initiatives to improve the standard, safety, and effectiveness of health care delivery. Continuous quality improvement (CQI), a technique commonly used in the manufacturing and industrial sectors, has been applied to the health sector. Given the complexity and diversity of health systems, questions about CQI's efficacy persist despite its increased focus. This review evaluates CQI's efficacy in various healthcare environments and looks into the significance of the approach's many elements. Twenty- eight RCTs assessed the effectiveness of different approaches to CQI in a variety of scenarios using a non- CQI comparison. The methodologies used, the duration of the meetings, the participants, and the type of training provided varied throughout the interventions. It was believed that bias might taint any RCT and affect the results. The benefits of CQI compared to a non-CQI comparison on clinical process, patient, and other outcomes were not great, as evidenced by the fact that less than half of RCTs showed any effect. Benefits were usually demonstrated in clinical process metrics; these were impacted by the frequency (weekly), the type of meeting (leaders discussing implementation), and the methodology (Plan-Do-Study-Act, improvement methodology). Studying health disparities caused by socioeconomic status.

Evaluating intrusion detection for microservice applications: Benchmark, dataset, and case studies

Microservices are predominant for cloud-based applications, which serve millions of customers daily, that commonly run business-critical systems on software containers and multi-tenant environments; so, it is of utmost importance to secure these systems. Intrusion detection is a widely applied technique that is now being used in microservices to build behavior detection models and report possible attacks during runtime. However, it is cumbersome to evaluate and compare the effectiveness of different approaches. Standardized frameworks are non-existent and without fairly comparing new techniques to the state-of-the-art, it is difficult to understand their pros and cons. This paper presents a comprehensive approach to evaluate and compare different intrusion detection approaches for microservice applications. A benchmarking methodology is proposed to allow users to standardize the process for a representative and reproducible evaluation. We also present a dataset that applies representative workloads and technologies based on microservice applications state-of-the-art. The benchmark and dataset are used in three case studies, characterized by dynamicity, scalability, and continuous delivery, to evaluate and compare state-of-the-art algorithms with the objective of tackling intrusion detection in microservices. Experiments show the usefulness and wide application range of the benchmark while showing the capacity of intrusion detection algorithms in different applications and deployments.

Lead break during extraction - predisposing factors and impact on procedure complexity and outcome on the basis of analysis of 3825 procedures

Abstract Background There are no reports describing lead break (LB) during transvenous lead extraction (TLE). Our aim was to compare the effectiveness of different approaches and tools used for LB removal during 127 procedures. Methods Retrospective analysis of 3825 consecutive TLEs using mechanical sheaths. Results Fracture of the lead defined as LB with a long lead fragment (LF) occurred in 2.48%, LB with a short LF in 1.20%, LB with the tip of the lead in 1.78% and LB with loss of a free-floating LF in 0.57% of cases. In total, extractions with LB occurred in 6.04%. In cases in which lead remnant was equivalent to a lead fragment (more than the lead tip only) there was a 50.31% chance of removing the LF in its entirety and an 18.41% chance of significantly reducing its length (to less than 4 cm). Risk factors for LB are similar to those for major complications and increased procedure complexity: long lead dwell time [OR=1.018], higher LV ejection fraction, multiple previous CIED-related procedures and extraction of passive fixation leads. A superior approach was the most popular (75.59%), femoral (15.75%) and combined (8.66%) approaches were the least common. Broken lead fragments (BLFs) were removed in their entirety in 63.78% and BLF length was significantly reduced (to less than 4 cm) in 24.41%. The best results were achieved when BLFs were longer (>4 cm) (66.67%), either free-floating or in the pulmonary circulation (68.42%) but not in cases of short BLFs (20.0%). Complete procedural success was achieved in 70.87% of procedures, the lead tip retained in the heart wall and short BLFs were found in 25.98%, whereas BLFs > 4 cm were left in place in 3.15% of procedures only. There was no relationship between approach in lead remnant removal and long-term mortality. All forms of LB were associated with increased procedure complexity and major complications (9.96% and 1.53%). There was no procedure-related death among such patients and LB did not affect survival after TLE. Conclusions 1. LB during TLE occurs in 6.04% of procedures and it increases procedure complexity and risk of major complications. Thus, the possibility of LB should be taken into account when planning lead extraction strategy and training. 2. Effectiveness of fractured lead removal is satisfactory. 3.Risk factors for lead fracture are implant duration (16.27 years on average), ventricular leads (71.65%), passive fixation leads (97.63%) and pacemaker leads (92.13%), but not ICD leads (only 7.87% of lead fractures). 4. Broken lead removal using a coronary sinus access sheath as a "subclavian workstation" for continuation of dilatation with conventional tools deserves attention.

A Compliance Return Method to Evaluate Different Approaches to Implementing Regulations: The Example of Food Hygiene Standards

Abstract We investigate how different approaches to the implementation of regulations affect compliance by evaluating the implementation of food hygiene standards in four English authorities. We draw upon regulatory theory in general together with specific literature on food hygiene standards to advance a new “compliance return” concept, which enables compliance outcomes and resource inputs to be considered jointly. We operationalize “compliance return” as part of a low-cost methodology for evaluating the relative effectiveness of different approaches to implementing food hygiene standards. We find that different approaches to implementation have significant impacts on food policy outcomes. Specifically, implementation ranged from a greater emphasis on deterrence to a greater emphasis on cooperation, with cooperation resulting in greater compliance and deterrence requiring less resource input. When compliance level is considered alongside resource input, to assess the overall “compliance return,” a stronger case emerges for a deterrence approach. The food policy implications are two-fold: (i) implementation affects policy outcomes, and (ii) the measure of “compliance return” developed and implemented in this article offers a low-cost approach to support the ex-post evaluation of implementation choices. The Compliance Return approach may be applicable more widely, especially where there is discretion regarding how regulations are to be implemented.

Service design for children and young people with common mental health problems: literature review, service mapping and collective case study.

The mental health of children/young people is a growing concern internationally. Numerous reports and reviews have consistently described United Kingdom children's mental health services as fragmented, variable, inaccessible and lacking an evidence base. Little is known about the effectiveness of, and implementation complexities associated with, service models for children/young people experiencing 'common' mental health problems like anxiety, depression, attention deficit hyperactivity disorder and self-harm. To develop a model for high-quality service design for children/young people experiencing common mental health problems by identifying available services, barriers and enablers to access, and the effectiveness, cost effectiveness and acceptability of such services. Evidence syntheses with primary research, using a sequential, mixed-methods design. Inter-related scoping and integrative reviews were conducted alongside a map of relevant services across England and Wales, followed by a collective case study of English and Welsh services. Global (systematic reviews); England and Wales (service map; case study). Literature reviews: relevant bibliographic databases and grey literature. Service map: online survey and offline desk research. Case study: 108 participants (41 children/young people, 26 parents, 41 staff) across nine case study sites. A single literature search informed both reviews. The service map was obtained from an online survey and internet searches. Case study sites were sampled from the service map; because of coronavirus disease 2019, case study data were collected remotely. 'Young co-researchers' assisted with case study data collection. The integrative review and case study data were synthesised using the 'weaving' approach of 'integration through narrative'. A service model typology was derived from the scoping review. The integrative review found effectiveness evidence for collaborative care, outreach approaches, brief intervention services and the 'availability, responsiveness and continuity' framework. There was cost-effectiveness evidence only for collaborative care. No service model appeared to be more acceptable than others. The service map identified 154 English and Welsh services. Three themes emerged from the case study data: 'pathways to support'; 'service engagement'; and 'learning and understanding'. The integrative review and case study data were synthesised into a coproduced model of high-quality service provision for children/young people experiencing common mental health problems. Defining 'service model' was a challenge. Some service initiatives were too new to have filtered through into the literature or service map. Coronavirus disease 2019 brought about a surge in remote/digital services which were under-represented in the literature. A dearth of relevant studies meant few cost-effectiveness conclusions could be drawn. There was no strong evidence to suggest any existing service model was better than another. Instead, we developed a coproduced, evidence-based model that incorporates the fundamental components necessary for high-quality children's mental health services and which has utility for policy, practice and research. Future work should focus on: the potential of our model to assist in designing, delivering and auditing children's mental health services; reasons for non-engagement in services; the cost effectiveness of different approaches in children's mental health; the advantages/disadvantages of digital/remote platforms in delivering services; understanding how and what the statutory sector might learn from the non-statutory sector regarding choice, personalisation and flexibility. This study is registered as PROSPERO CRD42018106219. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/09/08) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 13. See the NIHR Funding and Awards website for further award information.

The effectiveness of parenteral agents for pain reduction in patients with migraine presenting to emergency settings: Asystematic review and network analysis.

To assess the comparative effectiveness and safety of parenteral agents for pain reduction in patients with acute migraine. Parenteral agents have been shown to be effective in treating acute migraine pain; however, the comparative effectiveness of different approaches is unclear. Nine electronic databases and gray literature sources were searched to identify randomized clinical trials assessing parenteral agents to treat acute migraine pain in emergency settings. Two independent reviewers completed study screening, data extraction, and Cochrane risk-of-bias assessment, with differences being resolved by adjudication. The protocol of the review was registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42018100096). A total of 97 unique studies were included, with most studies reporting a high or unclear risk of bias. Monotherapy, as well as combination therapy, successfully reduced pain scores prior to discharge. They also increased the proportion of patients reporting pain relief and being pain free. Across the pain outcomes assessed, combination therapy was one of the higher ranked approaches and provided robust improvements in pain outcomes, including lowering pain scores (mean difference -3.36, 95% confidence interval [CI] -4.64 to -2.08) and increasing the proportion of patients reporting pain relief (risk ratio [RR] 2.83, 95% CI 1.74-4.61). Neuroleptics and metoclopramide also ranked high in terms of the proportion of patients reporting pain relief (neuroleptics RR 2.76, 95% CI 2.12-3.60; metoclopramide RR 2.58, 95% CI 1.90-3.49) and being pain free before emergency department discharge (neuroleptics RR 4.8, 95% CI 3.61-6.49; metoclopramide RR 4.1, 95% CI 3.02-5.44). Most parenteral agents were associated with increased adverse events, particularly combination therapy and neuroleptics. Various parenteral agents were found to provide effective pain relief. Considering the consistent improvements across various outcomes, combination therapy, as well as monotherapy of either metoclopramide or neuroleptics are recommended as first-line options for managing acute migraine pain. There are risks of adverse events, especially akathisia, following treatment with these agents. We recommend that a shared decision-making model be considered to effectively identify the best treatment option based on the patient's needs.

Study of Demographic Patterns and Treatment Approaches of Ocular Surface Squamous Neoplasia in a Tertiary Care Centre

Abstract Background: Ocular surface squamous neoplasia (OSSN) includes a wide spectrum of conjunctival and corneal intraepithelial neoplasia, which can manifest as mild, moderate, severe dysplasia, carcinoma-in-situ and invasive squamous cell carcinoma. OSSN can mimic many common indolent lesions like pterygium and have a potential for causing ocular and systemic morbidity and mortality. OSSN is more common in elderly males. ultraviolet-B light, human immune deficiency, and human papilloma virus have been proposed as major risk factors in aetiopathogenesis. Though diagnosis of OSSN is mainly based on clinical suspicion, definitive diagnosis needs histopathological evaluation. Anterior segment optical coherence tomography, ultrasonic bio microscopy, and impression cytology are nonsurgical tools used for diagnosis and management, of which anterior segment optical coherence tomography has brought about a paradigm shift in the diagnosis of OSSN. Aim: The aim of the study was to demonstrate the demographics, clinical profile, types of OSSN, management approaches, histopathology and the effectiveness of different approaches in patients with OSSN in a tertiary care centre in Tamil Nadu. Materials and Methods: It was a hospital-based prospective interventional study where 51 eyes of 50 patients with clinically suspicious OSSN were studied between July 2021 and January 2023 (over 18 months) with a minimum follow-up of 6 months. Results: The age group for the patients ranged between 30 and 79 years. Out of 50 patients, 26 were men and 24 were women with no sex predilection in our study. Unilateral involvement was seen in 49 patients and only one patient had bilateral involvement. Twenty-nine patients presented with gelatinous-like lesions, six with leukoplakic lesions, five with papilliform like lesion, nine with pigmented lesions and one with nodulo ulcerative type lesion. On histopathological examination, majority (21 patients) were severe dysplasia. Majority (78.4%) underwent surgical clearance with no recurrence. Adjunctive therapy to reduce recurrence included intraoperative cryotherapy and postoperative topical chemotherapy using mitomycin C. Conclusion: In our series, the most common morphological type of lesion was gelatinous, and surgical management using Shield’s technique was commonly used as the management option for unifocal lesions less than 5 mm with less than 4 clock hours involvement. The demographic profile was comparable with other studies on OSSN. Being a potentially malignant condition, a study on OSSN helps us in understanding the disease better and helps in early detection, leading to timely intervention and improved treatment outcomes. Furthermore, research on OSSN contributes to enhancing our knowledge on ocular oncology.

Systematic evaluation of B-cell clonal family inference approaches

The reconstruction of clonal families (CFs) in B-cell receptor (BCR) repertoire analysis is a crucial step to understand the adaptive immune system and how it responds to antigens. The BCR repertoire of an individual is formed throughout life and is diverse due to several factors such as gene recombination and somatic hypermutation. The use of Adaptive Immune Receptor Repertoire sequencing (AIRR-seq) using next generation sequencing enabled the generation of full BCR repertoires that also include rare CFs. The reconstruction of CFs from AIRR-seq data is challenging and several approaches have been developed to solve this problem. Currently, most methods use the heavy chain (HC) only, as it is more variable than the light chain (LC). CF reconstruction options include the definition of appropriate sequence similarity measures, the use of shared mutations among sequences, and the possibility of reconstruction without preliminary clustering based on V- and J-gene annotation. In this study, we aimed to systematically evaluate different approaches for CF reconstruction and to determine their impact on various outcome measures such as the number of CFs derived, the size of the CFs, and the accuracy of the reconstruction. The methods were compared to each other and to a method that groups sequences based on identical junction sequences and another method that only determines subclones. We found that after accounting for data set variability, in particular sequencing depth and mutation load, the reconstruction approach has an impact on part of the outcome measures, including the number of CFs. Simulations indicate that unique junctions and subclones should not be used as substitutes for CF and that more complex methods do not outperform simpler methods. Also, we conclude that different approaches differ in their ability to correctly reconstruct CFs when not considering the LC and to identify shared CFs. The results showed the effect of different approaches on the reconstruction of CFs and highlighted the importance of choosing an appropriate method.

Best practices for managing malodorous and infected wounds in advanced cervical cancer.

This cross-sectional study was conducted to examine the most effective strategies for managing malodorous and infected wounds in patients who have been diagnosed with advanced cervical cancer. The research was conducted in Liupanshui, China. The study specifically examined demographic profiles, wound characteristics and effectiveness of wound management approaches. The study incorporated the heterogeneous sample of 289 participants who fulfilled the inclusion criteria. Data collection was conducted via structured questionnaires and medical record evaluations. Descriptive statistics and statistical analyses, such as regression analysis, were utilized to evaluate demographic attributes, wound profiles and effects of different approaches to wound management. The findings unveiled the heterogeneous demographic composition of patients, encompassing differences in socioeconomic standing, educational attainment and age. A wide range of wound characteristics were observed, as 65.7% of lesions during the acute phase with diameter between 2 and 5 centimetres, while 41.5% of lesions had this range. The most prevalent types of infections were those caused by fungi (48.4%), followed by bacterial infections lacking resistance (38.1%). A moderate degree of odour intensity was prevalent, affecting 45.0% of the cases. With maximal odour reduction of 80%, a mean healing time of 25 days and patient satisfaction rating of 4.5 out of 5, Negative Pressure Wound Therapy demonstrated itself to be the most efficacious treatment method. Additional approaches, such as photodynamic therapy and topical antibiotic therapy, demonstrated significant effectiveness, as evidenced by odour reductions of 70% and 75%, respectively, and patient satisfaction ratings of 4.3 and 4.2. Thus, the study determined challenges associated with management of malodorous and infected lesions among patients with advanced cervical cancer. The results underscored the significance of individualized care approaches, drew attention to efficacious wound management techniques and identified critical determinants that impacted patient recuperation. The findings of this study hold potential for advancing palliative care for individuals diagnosed with advanced cervical cancer.

Indonesia vs. Malaysia: The Battle for Border Territory Resolved

This paper provides a comprehensive analysis of the resolution of the longstanding border dispute between Indonesia and Malaysia. The study delves into the complex dynamics of this conflict, offering insights into its historical context, the key issues at stake, and the eventual resolution reached between the two nations. The Indonesia-Malaysia border dispute has been a contentious issue for decades, marked by conflicting territorial claims and occasional tensions between the two neighboring countries. Rooted in historical and geopolitical factors, the dispute has encompassed various regions along the land border, including areas rich in natural resources and strategic importance. This paper examines the factors that fueled the dispute, ranging from historical grievances to economic interests and geopolitical considerations. It explores how these factors influenced the negotiation process and shaped the positions of both Indonesia and Malaysia. Central to the analysis is the discussion of the diplomatic efforts and mechanisms employed to address the dispute. From bilateral negotiations to third-party mediation, the paper evaluates the effectiveness of different approaches in facilitating dialogue and fostering cooperation between the two nations. Furthermore, the paper highlights the role of international law and norms in guiding the resolution process. It assesses how principles of territorial sovereignty, boundary delimitation, and peaceful dispute resolution were applied in reaching a mutually acceptable agreement. Finally, the study discusses the outcome of the resolution and its implications for Indonesia, Malaysia, and the broader region. It examines the terms of the agreement, including any concessions made by either party, and considers the potential impact on bilateral relations, economic development, and regional stability. By providing a nuanced analysis of the Indonesia-Malaysia border dispute and its resolution, this paper contributes to a deeper understanding of interstate conflicts and the mechanisms available for their peaceful resolution in Southeast Asia.

Development of a Natural Language Processing System to Identify Clinical Documentation of Electronic Cigarette Use.

Electronic Nicotine Delivery Systems (ENDS) use has increased substantially in the United States since 2010. To date, there is limited evidence regarding the nature and extent of ENDS documentation in the clinical note. In this work we investigate the effectiveness of different approaches to identify a patient's documented ENDS use. We report on the development and validation of a natural language processing system to identify patients with explicit documentation of ENDS using a large national cohort of patients at the United States Department of Veterans Affairs.