Grading Scale Research Articles

Tumour distribution and characteristics associated with poor surgical outcomes in patients with sporadic spinal schwannomas

PurposeSpinal schwannomas are benign tumours that can compress the spinal cord or nerve roots, causing neurological symptoms. Despite successful surgical resection, some patients experience suboptimal functional recovery. Several risk factors for poor prognosis have been identified, but limited research has explored the influence of tumour distribution and characteristics. In this study, we aimed to identify prognostic variables associated with residual neurological deficit in patients undergoing surgical resection for sporadic spinal schwannomas.MethodsClinical and radiological data of consecutive patients who underwent surgery for spinal schwannomas at Saitama Medical Centre between January 2010 and March 2024 were retrospectively reviewed. Patients with neurofibromatosis type 2 or foraminal and paravertebral schwannomas were excluded. Data collected included patient demographics, radiological features, and surgical complications. Residual neurological deficit was defined as a Modified McCormick scale grade of II–V, persistent neurogenic pain, or bladder/bowel dysfunction.ResultsGross total resection was achieved in 55 cases (76.4%). Postoperative complications occurred in 6 cases (8.3%), including cerebrospinal fluid fistula and vascular injury. At a median follow-up of 26.4 months, 20 patients (27.8%) had residual neurological deficits. Univariable and multivariable logistic regression identified thoracic spine involvement (odds ratio [OR], 5.03; 95% confidence interval [CI], 1.47–18.6; p = 0.01) and dumbbell-shaped tumours (OR, 0.15; 95% CI, 0.02–1.28; p = 0.04) as significantly associated with residual neurological deficits. Moreover, thoracic spinal schwannomas were associated with a significantly higher incidence of persistent postoperative neurogenic pain than that associated with cervical or lumbosacral tumours (p = 0.001).ConclusionsThoracic spine involvement and tumours that are not dumbbell-shaped were identified as significant risk factors for residual neurological deficits in patients undergoing surgical treatment for spinal schwannomas. Awareness of tumour distribution and characteristics may assist in refining preoperative assessments, guiding strategic decisions, and potentially improving surgical management for better patient care.

The ethical principles of the Portuguese psychologists: An evaluation after eleven years

Several changes were implemented in the psychology profession after the Order of Portuguese Psychologists was created. A set of ethical principles to guide psychological practice was established. Eleven years after the several changes have been initiated in the professional practice in Portugal, this study analyzes whether there are changes in the valuation of the fundamental ethical principles of Portuguese psychologists. To this end, data from 2009 and 2020 was compared. On a grading scale from 1 to 5, Portuguese psychologists allotted the importance to each general principle. We found Competence and Responsibility decreased after 11 years, and Integrity and Beneficence and Non-Maleficence increased from 2009 to 2020. We also found that Psychologists with more experience valued more the Respect for people’s rights and dignity, Integrity, and Beneficence and non-maleficence than those with lesser years of experience. Order of Portuguese Psychologists and the existence of an ethics code seems to have improved the professional identity

Efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) vs percutaneous transhepatic biliary drainage (PTBD) for cholangiocarcinoma biliary obstruction: An updated systematic review and meta analysis.

557 Background: Perioperative and/or palliative biliary drainage for the management of cholangiocarcinoma biliary obstruction has been part of the backbone of the multidisciplinary approach that this condition requires. For both intrahepatic and perihilar cholangiocarcinoma, ERCP and PTBD are the two main techniques available. There has yet to be consensus favoring one approach over the other. Methods: Following the PRISMA guidelines, a systematic review and meta-analysis were performed to determine if there was a difference in efficacy and safety of ERCP compared to PTBD for Cholangiocarcinoma Biliary Obstruction. Primary outcomes were successful biliary drainage, mean number of needed procedures, length of stay and overall adverse events rate. Data were analyzed using R version 4.2.2. The risk of bias was assessed by the Robins-I and RoB 2 tool. The quality of evidence was graded using the GRADE scale and Newcastle-Ottawa guidelines. Results: Three randomized clinical trials and two observational studies described the successful biliary drainage rate of ERCP vs PTBD for cholangiocarcinoma associated biliary obstruction, totaling 340 patients. Meta-analysis test for overall effect, showed no statistical difference between groups (RR = 0.88; 95% CI = [0.69; 1.13]; p = 0.23; Fig. 1). Similarly, in terms of the mean number of needed procedures per patient, a total of three randomized clinical trials and two observational studies, totaling 340 patients were included, no statistically significant difference was found (SMD = 0.64; 95% CI = [- 9.36; 10.63]; p = 0.57; Fig. 2). Likewise, one randomized clinical trial and two observational studies showed no statistically significant difference on the length of stay (days) mean between groups (SMD = 0.06; 95% CI = [- 1.57; 1.68]; p = 0.73; Fig. 3). Although, the three clinical trials and three observational studies showed a mild decreased adverse event and death (within 3 months) rate in the ERCP group, after undergoing statistical analysis, meta-analysis test for overall effect, showed no statistical difference (RR = 0.99; 95% CI = [0.55; 1.77]; p = 0.97; Fig. 4 and RR = 0.61; 95% CI = [0.10; 3.87]; p = 0.22; Fig. 5, respectively). The risk of bias was low with moderate-to-high quality of evidence amongst the included studies. Conclusions: Our updated systematic review and meta-analysis demonstrated no statistically significant difference in the successful biliary drainage rate, mean number of needed procedures, length of stay, death within 3 months and adverse event rate between ERCP vs PTBD for management of cholangiocarcinoma biliary obstruction. Further randomized studies are needed to confirm these findings.

The effect of using Kahoot in pediatric emergency nursing lessons on students' success and motivation levels: A randomized controlled study.

This study was planned to determine the effect of using Kahoot in pediatric emergency nursing lessons on students' lesson success and motivation levels. Pediatric emergency nursing lessons is considered to be an intensive and rich lesson that includes information about child health and development in addition to the learning outcomes of emergency nursing lessons, blending emergency and pediatric nursing. It was found to be conducted as a randomized controlled study with a total of 60 nursing students, 30 for the experimental group and 30 for the control group, who took pediatric emergency nursing lessons and had never experienced Kahoot before. Data were collected using the Information Form, Exam Success Grade and Motivation Scale for Instructional Material. Mean, percentage calculations, multi-way analysis considered to be of variance and linear regression analysis considered to be were used to analyze the data. When comparing the midterm (t = 1.203, p = 0.002), final exam (t = 1.122, p = 0.001) and end-of-semester (t = 1.126, p = 0.001) scores of the Kahoot group with those of the control group, it was found to be determined that the Kahoot group obtained statis considered to betically significantly higher scores. The effect sizes of the differences between the Kahoot and control groups were 0.4, 0.5 and 0.5, respectively, indicating a large effect. It was found to be determined that there was found to be a statis considered to betically significant difference between the mean scores of the experimental and control groups of nursing students in terms of group, time and group*time interaction. Kahoot application was found to be found to explain 45 % of the increase in exam achievement level and 45 % of the increase in motivation level related to instructional material. Kahoot application was found to be an effective method in increasing the exam achievement and motivation of nursing students taking pediatric emergency nursing lessons.

Characterizing Early-Onset Surgical Site Infection after Lower Extremity Bypass Surgery

Surgical site infections (SSI) are the most common complication following lower extremity bypass (LEB) surgery. SSIs contribute to significant patient morbidity and healthcare expenditure, and accurate detection of SSIs remains an important step in reduction efforts. In this study, we aimed to characterize early-onset SSIs among patients undergoing LEB surgery. Institutional medical records were retrospectively queried for all LEB operations performed across 3 hospitals from 2018 to 2022. All SSIs within a 90-day postoperative period were included, per CDC definition, and categorized as early- (within 7days of operation), standard- (8-30days), or delayed-onset (31-90days). The Southampton grading scale was used to stratify the severity of infection (grade 2, erythema; grade 3, erythema with serous drainage; grade 4; erythema with purulent drainage; or grade 5, severe wound necrosis). Data were analyzed using univariate tests and logistic regression analysis. A total of 517 LEB operations were performed over the 5-year study period. Median follow-up period was 18.5months. Early-, standard-, and delayed-onset SSIs were diagnosed in 2.9% (n=15), 15.1% (n=78), and 4.6% (n=24) of the patients, respectively. Compared with standard- and delayed-onset groups, patients with early-onset SSIs were more frequently nonsmokers (26.7% vs. 3.9% vs. 8.3%, P=0.03) and had lower prevalence of comorbidities. Early-onset SSIs most frequently presented as Southampton grade 2 (60.0%) or grade 5(20.0%) infections, whereas standard- and delayed-onset SSIs were more evenly distributed among grade 2 (30.4%), grade 3 (41.2%), and grade 4 (21.6%) presentations (P=0.002). The most commonly isolated organisms among the early-onset SSI group were Gram-negative rods (20.0%). In comparison, polymicrobial infections (19.6%) and Gram-positive cocci (14.7%) were most common among standard- and delayed-onset groups (P=0.04). The early-onset SSI group experienced a longer index hospitalization (11 vs. 6 vs. 8days, P=0.02) and lower 30-day readmission rates (13.3% vs. 59.0% vs. 45.8%, P=0.005) compared with standard- and delayed-onset groups. On multivariate analysis, active smoking (hazard ratio [HR] 0.15, 95% confidence interval [CI], 0.02-0.98, P=0.035), former smoking (HR 0.08, 95% CI, 0.01-0.71, P=0.02), coronary artery disease (HR 0.15, 95% CI, 0.03-0.83, P=0.03), and hypertension (HR 0.13, 95% CI, 0.03-0.68, P=0.02) were associated with a lower risk of early-onset infection, when compared with patients suffering standard- and delayed-onset SSIs. Early-onset SSIs after LEB surgery have a distinct clinical presentation, impact healthier patients, and are associated with more virulent organisms compared with standard- and delayed-onset SSIs.

Application of a Validated Assessment Tool to Compare Autonomy and Operative Performance Between Surgical Residency Programs.

Every residency has the responsibility to determine the competency of its residents and their readiness to practice after graduation, but few objective tools exist to assess residents. The Zwisch grading scale is a validated assessment tool for operative performance which has been incorporated into a smartphone application, called System for Improving and Measuring Procedural Learning (SIMPL). This application allows residents and attendings to evaluate a resident's performance in real time. Since its implementation there have been no studies that have compared scores across all participating general surgery programs in order to identify if varying procedure difficulty affect supervision and performance ratings amongst programs overall. The SIMPL database was queried for attending ratings for Post Graduate Year (PGY 1-5). Meaningful autonomy (MA) was defined as passive help or supervision only and satisfactory performance (SP) was defined as practice ready or exceptional. Procedures were classified as "core" or "advanced" based on the American Board of Surgery Surgical Council on Resident Education (SCORE) criteria. Work relative value units (wRVU) obtained from the Centers for Medicare & Medicaid services data were matched to procedures and categorized into 3 groups (<13.07, 13.07-22, >22) based on previous work. Proportions of advanced and high wRVU (>22) procedures were calculated for each program and PGY and matched back to each corresponding evaluation as potential proxies to resident exposure to more complex operations. All evaluations were divided into quintiles based on the corresponding program's proportion of advanced and high wRVU procedures. Data were summarized using descriptive statistics and generalized estimating equations (GEE) logistic regression models were used to assess whether program proportions of advanced or high wRVU procedures are predictive of MA or SP overall and among PGY 5 residents. Overall, proportions across programs ranged from 2.2% to 32.5% (mean 12.4%) and 2.4%-22.9% (mean 11.9%) for advanced or high wRVU procedures respectively. Across PGY levels, the mean proportion of advanced (7.6, 9.6, 13.1, 13.4, 14.2) and high wRVU (4.4, 6.5, 9.8, 15.3, 19.8) procedures increased with each step in PGY. In descriptive analyses of the entire group, lower numbers of MA and SP were noted with increasing proportions of advanced/high RVU. The relationship was similar for all core procedures and when limited to PGY 5 residents, however it was not entirely consistent and showed no association with advanced procedures. Similarly, in the models lower adjusted odds of MA and SP were noted for evaluations from programs with higher proportions of advanced or high wRVU procedures for the overall group but this was less consistent when limited to PGY 5 residents and even more variable when limited to advanced procedures (Table 1). There is wide variation in the proportion of advanced or high wRVU procedures reported at different programs. Overall MA and SP tended to be lower for programs reporting more advanced procedures overall and equivocal in programs with higher wRVU procedures. Programs with higher percentage of advanced procedures showed an increase in MA and SP when looking at performance as a PGY5 during core procedures only. The MA and SP of PGY5s performance during advanced procedures was not changed by an increase in exposure to advanced procedures. These results indicate that programs with more advanced cases may not necessarily train surgeons with the appropriate level of skill, knowledge or confidence needed to be an independant and safe surgeon.

Identification of major trauma using the simplified abbreviated injury scale to estimate the injury severity score: a diagnostic accuracy and validation study

BackgroundThe Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) grade the severity of injuries and are useful for trauma audit and benchmarking. However, AIS coding is complex and requires specifically trained staff. A simple yet reliable scoring system is needed. The aim of this study was two-fold. First, to develop and validate a simplified AIS (sAIS) chart centred on the most frequent injuries for use by non-trained healthcare professionals. Second, to evaluate the diagnostic accuracy of the sAIS (index test) to calculate the simplified ISS (sISS) to identify major trauma, compared with the reference AIS (rAIS) to calculate the reference ISS (rISS).MethodsThis retrospective study used data (2013–2014) from the Northern French Alps Trauma Registry to develop and internally validate the sAIS. External validation was performed with data from the Trauma Registry of Acute Care of Lausanne University Hospital, Switzerland (2019–2021). Both datasets comprised a random sample of 100 injured patients. Following the Standards for Reporting of Diagnostic Accuracy Studies 2015 guidelines, all patients completed the rAIS and the sAIS. The sISS and the rISS were calculated using the sAIS and the rAIS, respectively. Accuracy was evaluated with the mean difference between the sISS and the rISS and the Pearson correlation coefficient. A clinically relevant equivalence limit was set at ± 4 ISS points. Precision was analyzed using Bland-Altmann plots with 95% limits of agreement.ResultsAccuracy was good. The mean ISS difference of 0.97 (95% CI, −0.03 to 1.97) in the internal validation dataset and − 1.77 (95% CI, − 3.04 to 0.50) in the external validation dataset remained within the equivalence limit. The Pearson correlation coefficient was 0.93 in the internal validation dataset (95% CI, 0.90–0.95) and 0.82 in the external validation dataset (95% CI, 0.75–0.88). The limits of agreement were wider than the predetermined relevant range.ConclusionsThe sAIS is accurate, but slightly imprecise in calculating the ISS. The development of this scale increases the possibilities to use a scoring system for severely injured patients in settings with a reduced availability of the AIS.Trial registration: Retrospectively registered.

Transcatheter treatment of severe mitral regurgitation in high surgical risk patients: analysis of clinical and echocardiographic data from a referral center

Abstract Introduction Mitral regurgitation (MR) is the most common valvular heart disease, affecting 2-3% of the population, with a prevalence of around 10% in individuals over 75 years old. It is a frequent cause of decompensation in patients with heart failure (HF), associated with unfavorable clinical outcomes, including increased morbidity and mortality. Transcatheter mitral valve repair using an edge-to-edge mitral valve leaflet repair technique has become a therapeutic option for patients with severe MR who are considered high surgical risk. Transesophageal echocardiography (TEE) is crucial for determining eligibility, guiding the procedure, monitoring potential complications, and assessing the final result. Objectives To analyze data related to etiology (primary, secondary, and mixed), number of clips used, average age, severity of MR, and the final procedure outcome. Methods We conducted a descriptive analysis of a series of 43 cases of high surgical risk severe mitral regurgitation from 2019 to 2024 at a referral hospital in São Paulo, indicated for transcatheter treatment by a "heart team". We described the prevalence of etiologies, average age, pre-procedure MR severity, and final echocardiographic outcome. Continuous variables were described as mean and standard deviation. Results We analyzed 43 cases of transcatheter mitral valve implantation from 2019 to 2024. One patient died on the first day post-procedure. Of the total cases, 42% had primary MR, 38% secondary MR, and 20% mixed etiology. The average age of the patients was 79.8 years and the number of implanted clips was 1.62 ± 0.72, considering all the cases. A decrease in the average number of clips implanted is observed When analyzed separately by year: in 2019, na average of 2.3±1, and in 2023/2024, 1.8±0.7. All procedures were performed in a catheterization or hybrid room, guided by TEE with the addition of three-dimensional technology. Using a grading scale for MR from mild (1+) to severe (4+), evaluated by TEE, the average after clip implantation was 1.27 ± 0.59. Regarding the mean gradient, the average post-procedure was 3 ± 1.2 mmHg. Conclusion The use of the transcatheter mitral valve implantation, following anatomical criteria for mitral valve selection, proved to be an effective and safe therapeutic option for reducing MR in high-risk patients. TEE is an essential tool in patient eligibility, guiding the procedure, evaluating the final result, and identifying potential complications.

Grading scales for vitreous haze

Background: Grading scales for vitreous haze are crucial for the diagnosis, monitoring, and management of uveitis. The presence of inflammatory cells within the vitreous cavity is widely recognized as a key indicator of disease activity and severity, offering valuable insights into the underlying inflammatory processes. This mini-review aims to explore the evolution of vitreous haze grading scales systematically, emphasizing conventional grading methods, advances in imaging technologies, and the integration of artificial intelligence (AI) into the grading process. Methods: The PubMed/MEDLINE database was comprehensively searched for studies published between 1959 and 2024, using keywords such as “AI-based grading systems,” “artificial intelligence,” “automated grading,” “grading scales for vitreous cells,” “inflammation,” “uveitis,” and “vitreous haze.” Relevant studies were identified, and additional articles were selected by reviewing the reference lists of the included publications. The selection of articles for inclusion in the mini-review was limited to those written in English. Results: In the current literature, two grading methods are used: the National Institutes of Health (NIH) scale and the Miami scale. Despite their widespread utilization, both scales entail subjective assessments of vitreous haze, which renders them susceptible to observer bias and interobserver variability. The NIH scale uses six levels, while the Miami scale employs nine levels, both of which require subjective assessments of vitreous haze. Recent advances in objective imaging technologies, namely ultrawide-field fundus photography and advanced optical coherence tomography-based analysis, have given rise to increasingly consistent and standardized grading systems, which may enhance the reliability of these assessments. Innovative techniques have been developed to enhance accuracy and sensitivity, thereby facilitating the early detection and precise monitoring of vitreous inflammation. Despite these advances, challenges remain, including the difficulty of distinguishing subtle variations in vitreous haze and the variability of inflammatory presentations. The incorporation of AI-driven tools and state-of-the-art imaging technologies into the vitreous cell grading signifies a substantial advance in the evaluation and management of uveitis. Conclusions: The development of more objective, reproducible, and quantitative grading scales is imperative for optimizing uveitis evaluation and grading vitreous haze in clinical settings and clinical trials. These innovations will also provide robust endpoints for clinical studies, ultimately improving patient care. Moreover, objective grading criteria will enhance diagnostic precision, facilitate better management of ocular inflammatory diseases, and promote further advances in uveitis research and treatment.

Disclosing long-term tolerance, efficacy and penetration properties of hyaluronic acid-coated latanoprost-loaded liposomes as chronic glaucoma therapy.

Frequent topical administration of hypotensive eye drops in glaucoma patients may lead to the development of dry eye disease (DED) symptoms, because of tear film destabilization and the adverse effects associated with antiglaucoma formulations. To address all this, in the current study preservative-free latanoprost-loaded (0.005% w/v) synthetic phosphatidylcholine (1,2-dioleoyl-sn-glycero-3-phosphocholine 0.75% w/v, 1,2-dimyristoyl-sn-glycero-3-phosphocholine 0.25% w/v) liposomes dispersed in the mucoadhesive polymer hyaluronic acid (0.2% w/v), containing the osmoprotective ingredients betaine (0.40% w/v) and leucine (0.90% w/v) (LAT-HA-LIP), have been prepared and further characterised. Permeation and retention evaluations on a validated ex vivo porcine eye model revealed that the active metabolite latanoprost acid was quantified only starting from LAT-HA-LIP once passing conjunctiva, sclera and choroid compared to the marketed latanoprost (0.005% w/v) benchmark (MF). The liposomal formulation outperformed MF when applied to the corneal tissue. Additionally, distribution and interactions within corneal and scleral tissues were investigated by means of two-photon microscopy with liposomal formulations containing coumarin-6. Furthermore, acute and chronic tolerance studies on rabbits revealed no signs of discomfort or ocular damage. Schirmer's test, tear osmolarity, tear breakup time (TBUT) and fluorescence staining evaluated through the Oxford grading scale, were assessed as DED diagnostic parameters over a 25-day monitoring period; LAT-HA-LIP consistently maintained levels comparable to physiological solution (0.9% w/v NaCl) used as control, with a slight increase of TBUT values from day 15 (6.00±0.63s for control, 7.00±0.78s for LAT-HA-LIP at day 15, p=0.0066). A daily topical application of LAT-HA-LIP for 15 consecutive days, effectively lowered IOP in a sustained way (2.51-3.88mmHg mean IOP reduction over the 5-15-day period). These results highlight the clinical relevance of the proposed technological platform, able to provide IOP reduction during the simulated long-term administration and simultaneous ocular surface protection with potential for the treatment of glaucoma.

P0935 A systematic review and quality assessment of clinical practice nursing guidelines for ostomy care

Abstract Background Patients living with stomas face numerous challenges following abdominal stoma surgery. Stoma nurse specialists play a crucial role in supporting these patients by utilizing evidence-based practices and specialist expertise. We evaluate nursing guidelines focused on the management of patients with ostomies, identify knowledge gaps, and support the development of evidence-based patient care pathways. Methods A comprehensive literature search was conducted across MEDLINE, Embase, and major nursing organization websites up to March 25 2024, to identify evidence-based practical guidelines developed specifically for nurses managing patients with abdominal stomas post-ostomy. Pre-specified inclusion (n=5) and exclusion (n=16) criteria were applied (Table 1). Two researchers independently screened references, extracted data, summarized the evidence, and assessed guideline quality using the AGREE II instrument. Results The database search yielded 97 references, with an additional 23 guidelines identified through major nursing organization websites. A total of 14 nursing guidelines met the inclusion criteria, originated from Australia, Canada, Italy, UK, USA, and three international groups. The guidelines varied in scope; offered recommendations across all stages of care, including preoperative, peri-operative, postoperative, and post-discharge phases. Key topics are presented in Table 2. Notably, no guideline statements specifically addressed patients with Crohn’s disease and permanent ostomies. Three guidelines did not specify whether a literature search and review were conducted. Five guidelines applied an evidence scale or numerical grading system, while only three used the GRADE approach. Most recommendations were based on a low level of evidence, often relying on retrospective or observational studies and expert opinion; two guidelines claimed their statements were consensus-based due to a lack of supporting evidence. In the AGREE II assessment, most guidelines were rated as moderate quality, with recommended modifications primarily in the rigor of development and applicability. Conclusion This quality assessment of clinical practice nursing guidelines for ostomy care highlights both strengths and weaknesses within current guidelines. Nursing guidelines offer extensive coverage of ostomy care topics and provide valuable first-line care experience and consensus statements, particularly for postoperative stoma and peristomal care. These insights are essential for non-nursing healthcare providers and contribute to the development of patient care pathways for individuals with Crohn’s disease and permanent ileostomies. However, the limited availability of high-quality evidence underscores the need for further research in ostomy care.

ВЛИЯНИЕ ЛЕКАРСТВЕННОГО ПРЕПАРАТА «ВЕТОМ 2» НА ПАНТОВУЮ ПРОДУКТИВНОСТЬ МАРАЛОВ-РОГАЧЕЙ

The purpose of research is to study the effect of the drug Vetom 2 on the antler productivity of stag deer. The studies were carried out at the Abinsk maral farm Novotalitskoye Experiment Station, Federal State Budget-Funded Scientific Institution Federal Altai Scientific Centre for Agrobiotechnologies in the spring of 2022. In the process of performing the work, generally accepted zootechnical research methods were used. From the available livestock, two groups were distinguished – control (K; n=10) and experimental (O; n=10). The stags were kept separately in different winter stalls. Deer stags of the control group received the basic diet (BD). Vetom 2 was included in the diet of the experimental group in a prophylactic dose at the rate of 50 mg/kg of live weight. The selection of animals for the experiment was carried out by the method of groups-analogues by age, level of development, constitution, state of health and other qualities. The physiological state of the experimental animals was determined by the activity and the course of moulting, bottom piece shedding and the beginning of velvet antler growth. Accounting for velvet antler productivity in velvet-antler marals was carried out during the antler-cutting campaign on the farm according to the grading scale, distinguishing the livestock of the control and experimental groups according to the inventory numbers on the tags. In the experimental group of stags, an improvement in the physiological state was noted, the marals were more active, the spring molt passed almost simultaneously. Bottom piece shedding in all stags that received Vetom 2 in their diet ended earlier by an average of 2 days. In the stags of the experimental group, an increase in the concentration of erythrocytes by 23 %, hemoglobin by 8% was recorded. A slight decrease in the total amount of protein (4 %) and albumin (10–16 %) was noted, while they do not go beyond the reference range. An increase in calcium concentration by 22 % in the stags of the experimental group by the end of the experiment had a high degree of reliability. There was a superiority in the mass of raw velvet antlers per 150 grams in the experimental group compared to the antlers of the control group, but this value is unreliable between the compared groups.

PERANCANGAN SISTEM INFORMASI PRESENSI GURU BERBASIS WEB PADA SD MASEHI PAYETI 2

This study examines the importance of Information Technology implementation in schools to support teaching, learning, and administrative activities, focusing on the development of a Teacher Attendance Information System at Masehi Payeti 2 Elementary School. Currently, attendance is conducted manually, with teachers recording names and signing an attendance book, a method prone to being unstructured and susceptible to errors, data damage, and delays. To address these issues, this study aims to develop a web-based application that allows attendance to be conducted more effectively, efficiently, and managed in real time. The application is built using the Waterfall method with PHP, HTML, and MySQL programming languages. Based on usability testing using the System Usability Scale (SUS) with five respondents, the application received an average score of 70.5, which falls into the "Marginal High" category with a grade scale of C and an adjective rating of "OK." This score indicates a fairly positive user perception of the system's usability, suggesting that it is comfortable and efficient for teachers to use. This study's findings are expected to improve discipline and the accuracy of attendance data at Masehi Payeti 2 Elementary School, while also contributing to the adoption of more modern information systems within school environments.

Diagnostic performance of shape-sensing robotic-assisted bronchoscopy for pleural-based and fissure-based pulmonary lesions

BackgroundSampling of peripheral pulmonary lesions (PPLs) abutting the pleura carries a higher risk of pneumothorax and complications. Although typically performed with image-guided transthoracic biopsy, the advent of shape-sensing robotic-assisted bronchoscopy...

Utilizing objective performance indicators to assess resident autonomy during robotic cholecystectomy.

The current evaluation of surgical resident operative autonomy consists primarily of self-report and is prone to bias. Objective performance indicators (OPIs) generated from the da Vinci Surgical System capture objective intraoperative data providing an opportunity to evaluate the intraoperative resident experience more accurately. This study investigates the ability of OPIs to describe resident autonomy during robotic cholecystectomy. The Intuitive Data Recorder captured OPI data during 82 robotic cholecystectomies performed at a single high-volume academic center between July 1st, 2020, and April 30th, 2023. Autonomy was characterized by evaluating surgeon-specific OPIs: instrument active time (AT) and path length (PL). OPIs were evaluated for the overall procedure, the hepatocystic triangle dissection, and the gallbladder fossa dissection. Analysis was stratified by trainee level and case complexity as defined by the Parkland Grading Scale. Of the 82 cholecystectomies, surgical trainees participated in 77 cases, 59.7% (n = 46) involved senior trainees (PGY 4-7), and 40.3% (n = 31) involved junior trainees (PGY 2-3). By median AT, senior trainees performed 60% of the cholecystectomy (median AT 0.6 [IQR, 0.5 - 0.8]), significantly more compared to junior trainees at 40% (AT 0.4 [IQR 0.3 - 0.5]; P < 0.001). Junior residents had the least autonomy during the hepatocystic triangle dissection (P < 0.05) whereas no significant difference was present between annotated steps for senior trainees (P > 0.05). Resident autonomy did not vary significantly based on case complexity (P > 0.05). Overall, 76.1% of senior residents performed at least half of the cholecystectomy, significantly more compared to 32.3% of junior trainees (P < 0.001). OPIs differentiated the surgical trainee experience during a robotic cholecystectomy. While senior trainees performed more of the procedure, there was significant within-group heterogeneity regarding the level of autonomy allotted. Moving forward, OPIs can be a valuable tool for characterizing resident autonomy and objectively informing surgical training curricula.

PENGARUH KUALITAS LAYANAN, REVIEW ONLINE TERHADAP KEPUTUSAN PEMBELIAN TIKTOK

At this time, technology and information are increasingly sophisticated and increasingly experiencing very rapid growth. Commercial online platforms have emerged as one of the key pillars in the midst of the global commerce ecosystem in the rapidly expanding electronic age. One of the newest companies in the e-commerce space, Tiktok Shop, takes a different tack by fusing social media with online buying. defining a number of research projects, such as research models and mechanisms-based research methodologies, through data collection and testing. Reference sources must be used to support the definition of a research plan in order for the presentation to be accepted by academics. Using a quantitative approach, this study was carried out in Denpasar City, Bali, with a target demographic of Tiktok users who are familiar with and use Tiktok Shop. With 112 respondents, the sample was drawn via incidental sampling, a method for selecting samples at random or inadvertently. An online questionnaire measuring purchasing decisions, service quality, and online customer reviews using a grading scale was used to gather primary data. The SEM-PLS technique was used to analyse the data using Smart-PLS software, which included hypothesis testing, structural model evaluation (inner-model), and assessment (outer model). where the findings demonstrate that service quality significantly and favourably influences consumers' decisions to buy. Purchase decisions are also positively and significantly impacted by the influence of online consumer reviews.

Analysis of changes in the chemokine CXC ligand 13 in serum and cerebrospinal fluid of patients with neuromyelitis optica

To determine correlation between the Extended Disability Status Scale(EDSS) grade and the progression of neuromyelitis optica(NMO) patients’ levels of the chemokine CXC ligand 13 (CXCL13) in their serum and cerebrospinal fluid. This research included forty-one patients diagnosed with neuromyelitis optica(NMO) and forty-three patients diagnosed with multiple sclerosis(MS). The control group consisted of forty-three non-inflammatory neurological disease(NND) patients. The patients’ serum and cerebrospinal fluid CXCL13 levels were measured. Patients in NMO group and MS group had serum and cerebrospinal fluid with CXCL13 levels that were substantially greater than those in the NND group. When comparing the CXCL13 levels of blood and cerebrospinal fluid between patients in the EDSS ≥ 3.5 group and the EDSS<3.5 group, with the EDSS ≥ 3.5 group’s CXCL13 levels being greater(P<0.05). There was a positive correlation between the serum CXCL13 and the EDSS grades of both the NMO and MS groups(r = 0.884, P < 0.001); The cerebrospinal fluid CXCL13 of the NMO and MS groups showed a positive correlation with their EDSS grades(r = 0.681, P < 0.001). EDSS scores of NMO patients were positively correlated with their serum BLC-1 (r = 0.896, P < 0.001); EDSS scores of NMO patients were positively correlated with their cerebrospinal fluid BLC-1 (r = 0.678, P < 0.001).EDSS scores of MS patients were positively correlated with their serum BLC-1 (r = 0.852, P < 0.001); EDSS scores of MS patients were positively correlated with their cerebrospinal fluid BLC-1 (r = 0.613, P < 0.001). Serum and cerebrospinal fluid levels of CXCL13 may serve as an important biomarker for the presumptive assessment of the degree of disability in NMO and MS disease, providing a basis for the treatment and control of the disease.

Internal validation of a convolutional neural network pipeline for assessing meibomian gland structure from meibography.

Optimal meibography utilization and interpretation are hindered due to poor lid presentation, blurry images, or image artifacts and the challenges of applying clinical grading scales. These results, using the largest image dataset analyzed to date, demonstrate development of algorithms that provide standardized, real-time inference that addresses all of these limitations. This study aimed to develop and validate an algorithmic pipeline to automate and standardize meibomian gland absence assessment and interpretation. A total of 143,476 images were collected from sites across North America. Ophthalmologist and optometrist experts established ground-truth image quality and quantification (i.e., degree of gland absence). Annotated images were allocated into training, validation, and test sets. Convolutional neural networks within Google Cloud VertexAI trained three locally deployable or edge-based predictive models: image quality detection, over-flip detection, and gland absence detection. The algorithms were combined into an algorithmic pipeline onboard a LipiScan Dynamic Meibomian Imager to provide real-time clinical inference for new images. Performance metrics were generated for each algorithm in the pipeline onboard the LipiScan from naive image test sets. Individual model performance metrics included the following: weighted average precision (image quality detection: 0.81, over-flip detection: 0.88, gland absence detection: 0.84), weighted average recall (image quality detection: 0.80, over-flip detection: 0.87, gland absence detection: 0.80), weighted average F1 score (image quality detection: 0.80, over-flip detection: 0.87, gland absence detection: 0.81), overall accuracy (image quality detection: 0.80, over-flip detection: 0.87, gland absence detection: 0.80), Cohen κ (image quality detection: 0.60, over-flip detection: 0.62, and gland absence detection: 0.71), Kendall τb (image quality detection: 0.61, p<0.001, over-flip detection: 0.63, p<0.001, and gland absence detection: 0.67, p<001), and Matthews coefficient (image quality detection: 0.61, over-flip detection: 0.63, and gland absence detection: 0.62). Area under the precision-recall curve (image quality detection: 0.87 over-flip detection: 0.92, gland absence detection: 0.89) and area under the receiver operating characteristic curve (image quality detection: 0.88, over-flip detection: 0.91 gland absence detection: 0.93) were calculated across a common set of thresholds, ranging from 0 to 1. Comparison of predictions from each model to expert panel ground-truth demonstrated strong association and moderate to substantial agreement. The findings and performance metrics show that the pipeline of algorithms provides standardized, real-time inference/prediction of meibomian gland absence.

Comparison of a Novel Ultra-Widefield Three-Color Scanning Laser Ophthalmoscope to Other Retinal Imaging Modalities in Chorioretinal Lesion Imaging.

To compare the assessment of clinically relevant retinal and choroidal lesions as well as optic nerve pathologies using a novel three-wavelength ultra-widefield (UWF) scanning laser ophthalmoscope with established retinal imaging techniques for ophthalmoscopic imaging. Eighty eyes with a variety of retinal and choroidal lesions were assessed on the same time point using Topcon color fundus photography (CFP) montage, Optos red/green (RG), Heidelberg SPECTRALIS MultiColor 55-color montage (MCI), and novel Optos red/green/blue (RGB). Paired images of the optic nerve, retinal, or choroidal lesions were initially diagnosed based on CFP imaging. The accuracy of the imaging was then evaluated in comparison to CFP using a grading scale ranging from -1 (losing imaging information) to +1 (gaining imaging information). Eighty eyes of 43 patients with 116 retinal or choroidal pathologies, as well as 59 eyes with optic nerve imaging using CFP, MCI, RG, and RGB, were included in this study. Across all subgroups, RGB provided significantly more accurate clinical imaging with CFP as ground truth and compared to other modalities. This was true comparing RGB to both RG (P = 0.0225) and MCI (P < 0.001) overall. Although RGB provided more accurate clinical information overall, it was inferior to RG for melanocytic choroidal lesions (P = 0.011). RGB can be considered as a useful tool to detect characteristics of central, midperipheral, and peripheral retinal lesions. Regarding melanocytic choroidal lesions, RGB was inferior to RG, and MCI was inferior to both RG and RGB modalities due to color changes. Traditional retinal ultra-widefield imaging uses two wavelengths. Here, we evaluated three wavelengths for ultra-widefield imaging. We examined new optics (basic science) effect on patient imaging (clinical care).

Beyond traditional prognostics: integrating RAG-enhanced AtlasGPT and ChatGPT 4.0 into aneurysmal subarachnoid hemorrhage outcome prediction

To assess the predictive accuracy of advanced AI language models and established clinical scales in prognosticating outcomes for patients with aneurysmal subarachnoid hemorrhage (aSAH). This retrospective cohort study included 82 patients suffering from aSAH. We evaluated the predictive efficacy of AtlasGPT and ChatGPT 4.0 by examining the area under the curve (AUC), sensitivity, specificity, and Youden’s Index, in comparison to established clinical grading scales such as the World Federation of Neurological Surgeons (WFNS) scale, Simplified Endovascular Brain Edema Score (SEBES), and Fisher scale. This assessment focused on four endpoints: in-hospital mortality, need for decompressive hemicraniectomy, and functional outcomes at discharge and after 6-month follow-up. In-hospital mortality occurred in 22% of the cohort, and 34.1% required decompressive hemicraniectomy during treatment. At hospital discharge, 28% of patients exhibited a favorable outcome (mRS ≤ 2), which improved to 46.9% at the 6-month follow-up. Prognostication utilizing the WFNS grading scale for 30-day in-hospital survival revealed an AUC of 0.72 with 59.4% sensitivity and 83.3% specificity. AtlasGPT provided the highest diagnostic accuracy (AUC 0.80, 95% CI: 0.70–0.91) for predicting the need for decompressive hemicraniectomy, with 82.1% sensitivity and 77.8% specificity. Similarly, for discharge outcomes, the WFNS score and AtlasGPT demonstrated high prognostic values with AUCs of 0.74 and 0.75, respectively. Long-term functional outcome predictions were best indicated by the WFNS scale, with an AUC of 0.76. The study demonstrates the potential of integrating AI models such as AtlasGPT with clinical scales to enhance outcome prediction in aSAH patients. While established scales like WFNS remain reliable, AI language models show promise, particularly in predicting the necessity for surgical intervention and short-term functional outcomes. The study explored the use of advanced AI language models, AtlasGPT and ChatGPT 4.0, to predict outcomes for patients with aneurysmal subarachnoid hemorrhage (aSAH). It found that AtlasGPT provided the highest diagnostic accuracy for predicting the need for decompressive hemicraniectomy, outperforming traditional clinical scales, while both AI models showed promise in enhancing outcome predictions when integrated with established clinical assessment tools.