Heterogeneity Of Indicators Research Articles

249. OVERALL SURVIVAL OF PATIENTS WITH ESOPHAGEAL CANCER TREATED WITH DEFINITIVE CHEMORADIOTHERAPY: INSIGHTS FROM A RETROSPECTIVE STUDY

Abstract Background Neoadjuvant chemoradiotherapy followed by esophagectomy is the standard of care for patients with locally advanced esophageal cancer. However, definitive chemoradiotherapy (dCRT) may be considered as an alternative for those with unresectable disease, cervical location of the tumor or if a non-surgical approach is preferred based on the patient's condition. Heterogeneity in indications for dCRT makes it challenging to draw generalized conclusions regarding outcomes and survival. The aim of this study was to evaluate overall survival (OS) and recurrence patterns in patients with specified homogeneous indications for dCRT. Methods Patients with esophageal cancer treated with dCRT (50.4 Gy radiotherapy concomitant with 6 cycles of carboplatin/paclitaxel) between 2012-2022 in a tertiary referral center were identified from our institutional database. Primary endpoint was OS calculated from date of diagnosis until date of death or last day of follow-up, using the Kaplan Meier method. Secondary endpoints included the proportion of patients that completed the dCRT regimen, 30- and 90-day mortality following dCRT and disease recurrence. Results 162 patients were included, median follow-up was 74.6 months (IQR 46.2-99.3). The full dCRT regimen was completed by 116 (73.9%) patients. The 30- and 90-day mortality were 2.5% and 8.3%, respectively. The median OS was 23.7 months (95% CI 6.65-40.66) for cervical location of the tumor, 13.7 months (95% CI 7.92-29.8) for irresectable disease, 28.2 months (95% CI 12.10-44.22) for patients unfit for surgery and 20.6 months (95% CI 14.14-27.13) for those with preference for dCRT (p=0.15). Disease recurrence was observed in 74 patients (46%), located locoregional (46%), distant (19%) or both locoregional and distant (35%). Conclusion(s) Treatment with dCRT resulted in a 5-year OS of 35% and is associated with a high 90-day mortality. Disease recurrence was mostly locoregional located and was observed in 46% of patients. This emphasizes the critical necessity for enhanced treatment strategies centered on improving locoregional disease control.

Morbidity of circulatory diseases among the working-age population in the Far Eastern federal district in 2012–2021

Aim. To study the indicators and regional features of circulatory disease morbidity among the able-bodied population in the Far Eastern Federal District for the 2012–2021 period.Material and methods. A descriptive statistical study was conducted. The indicators of incidence and prevalence rates of circulatory system diseases, including ischemic heart diseases and cerebrovascular diseases, were calculated according to the data published by the Russian Research Institute of Health. To assess the statistical significance of differences in the incidence rate in 2020 and 2021 relative to the 2012–2019 period, a 95% CI for the average incidence rate in 2012–2019 was used by generating repeated samples. Differences in the incidence and prevalence rates in 2020 and 2021 above the upper or below the lower CI boundary for the average values in 2012–2019 were considered statistically significant.Results. An analysis of the incidence and prevalence rates of circulatory system diseases among the working-age population in the Far Eastern Federal District in 2012–2021 was carried out. The obtained data are characterized by a significant variability and heterogeneity of indicators, showing significant differences from the all-Russian data for the 2012–2019 period. Changes in the incidence and prevalence rates of circulatory system diseases in the Far Eastern Federal District during the spread of COVID-19 in 2020–2021 were found to be multidirectional. In general, the statistically significant increase in the incidence of coronary heart disease in the Far Eastern Federal District in 2020 and 2021 is largely associated with the growth of indicators in the Khabarovsk Krai.Conclusions. The obtained characteristics of the incidence and prevalence rates of circulatory system diseases, including ischemic heart diseases and cerebrovascular diseases, indicate the presence of pronounced regional characteristics. The revealed multiple differences in the morbidity rates in the subjects of the Far Eastern Federal District require further research to determine their priority and significance for monitoring the health of the population.

РАСПРОСТРАНЕННОСТЬ ЗУБОЧЕЛЮСТНЫХ АНОМАЛИЙ У ДЕТЕЙ СВЕРДЛОВСКОЙ ОБЛАСТИ

The problem of studying the prevalence of dentofacial abnormalities in children in the Sverdlovsk region is relevant, as the data for different regions are differ, which is confirmed by the heterogeneity of indicators and statistics in the research. In 2022, an epidemiological study was conducted among the children's population of 4 cities of the Sverdlovsk region to study the prevalence of dentofacial abnormalities in the age groups 3–5, 6, 12 and 15 years, a total of 455 children were examined. Registration of dentofacial abnormalities was carried out in the author's card of dentofacial system disorders developed, using the classifications of MGMSU and ICD-10. Statistical processing of the data obtained was carried out in STATISTICA 13.3. The study revealed a high prevalence of dentofacial abnormalities in children in the Sverdlovsk region – 71.43% ± 2.12. With age, there is a tendency to increase the frequency of dentofacial abnormalities: in children 3–5 years of dentofacial abnormalities were in 34.85% ± 5.87 cases; in the group of 6-year-olds – in 70.18% ± 4.28; and in groups of 12-year-old and 15-year-old children – 81.38% ± 3.23 and 80.00%. It was revealed that the older the children are, the more likely they have severe malocclusion compared to children aged 3–5 and 6. The groups noted high rates of dentition deformities, the number of which also increases with age (decrease in the length of the upper dentition was detected in 36.26% ± 2.25, the lower dentition – in 47.47% ± 2.34 of cases; narrowing of the upper dentition – in 55.60 ± 2.33%, lower dentition – in 45.49% ± 2.33 of cases). Dentition deformities are associated with the development of teeth abnormalities, such as teeth retention (13.10% ± 2.80 and 9.23% ± 2.54 of cases in 12- and 15-year-old children, respectively), as well as mandibular displacement (displacement to the side was detected in 22.20% ± 1.95 of cases). Performed study is justification for the development and implementation of a regional program for the prevention of dental diseases in children of the Sverdlovsk region.

An international multi-sectoral approach to financialisation

Abstract Many studies attempted to measure the degree of financialisation of an economy, generally on a country-by-country basis, given the heterogeneity of indicators and data availability. In this paper, a simple but common measure of financialisation of non-financial corporations (NFCs) is developed, namely, the participation of services provided by the financial sector (both directly and indirectly) on their value-added creation process, inspired by the methodology developed by Dávila-Fernández and Punzo (2020). To do this, we use the inter-country input-output (ICIO) matrices built by the OECD, which allow us to understand the role played by the financial sector (local or foreign) in the ‘value-added production function’ of NFCs from 45 industries, in 67 countries for the period 1995–2018. We find three main stylised facts. First, the financial sector plays a relevant role in the value-added creation process of NFCs, and its importance has increased during the last years, although there is high diversity among countries. Second, this process has been heterogeneous when different productive sectors are considered. Primary industries evidenced a low degree of financialisation, while manufacturing and the service sector generally presented a higher reliance on finance. Third, between 1995 and the global financial crisis, NFCs increased their dependence on foreign financial value-added, followed by a partial reversion of this process. Moreover, the origin of these exports of financial services changed: while some traditional financial hubs such as the UK, Switzerland and Japan decreased their importance as providers of financial value-added to NFCs, China, Russia and India became important global players.

P-663 Dydrogesterone + progesterone gel vs. subcutaneous aqueous progesterone + progesterone gel for luteal phase supplementation in IVF cycles in women with previous IVF failure

Abstract Study question Does the live birth rate differ between the two regimens for luteal phase supplementation in IVF cycles in women with a history of IVF failure? Summary answer The live birth rate did not differ with dydrogesterone + progesterone gel vs. subcutaneous aqueous progesterone + progesterone gel. What is known already Supplementation of the luteal phase in in vitro fertilization (IVF) cycles is crucial to increase the chance of a live birth. Progesterone is the treatment of choice due to a lower risk of complications compared to human chorionic gonadotropin (hCG) and gonadotropin-releasing hormone (GnRH) analogues. There is no preferred progestogen for use in the general population of women undergoing IVF. The optimal progesterone treatment regimen in the event of previous IVF failure is unknown. Study design, size, duration A prospective randomized tertiary single-center study was conducted. The study included 161 women, aged 25-43 years, with FSH on cycle day 2-4 ≤10 IU/L, with at least one failed IVF cycle, undergoing government-funded IVF in the years 2015-2016. Participants/materials, setting, methods 161 included women were randomized after oocytes retrieval to 2 groups of luteal IVF cycle phase supplementation: dydrogesterone (Duphaston®) + progesterone in vaginal gel (Crinone®) or aqueous progesterone solution in subcutaneous injection (Prolutex®) + progesterone in vaginal gel (Crinone®). At least one blastocyst was obtained in the enrolled women. All women underwent fresh embryo transfer. After viable pregnancy confirmation, treatment was continued until the 12th week of gestation. Main results and the role of chance The indications for IVF were: male factor (51%), tubal factor (27%), endometriosis (24%), decreased ovarian reserve (17%), idiopathic infertility (14%), ovulation disorders (6%), occurring in various combinations. Out of 161 women enrolled in the study, 94 had a history of 1 failed IVF cycle, and 67 had at least 2 failed IVF cycles. Among 94 women with 1 failed IVF, 62 received dydrogesterone + progesterone gel vs. 32 aqueous progesterone + progesterone gel, and the percentages of live births, clinical pregnancies and biochemical pregnancies were: 29 vs. 21% (p = 0.37), 10 vs. 6% (p = 0.53), 5 vs. 12% (p = 0.21). Among 67 women with at least 2 failed IVFs, 24 received dydrogesterone + progesterone gel vs. 43 aqueous progesterone + progesterone gel, and the percentages of live births, clinical pregnancies and biochemical pregnancies were: 17 vs. 32% (p = 0.19), 4 vs. 0% (p = 0.14), 9 vs. 9% (p = 0.95). The results were comparable with both treatment regimens. There were no significant adverse events reported for both treatment regimens. Limitations, reasons for caution The limitations of the study are the small sample size, its single-center character and heterogeneity of indications for IVF. Wider implications of the findings In light of the lack of evidence of greater efficacy of either of the two luteal phase supplementation regimens of the IVF cycle in women with a history of IVF failure, the choice of treatment should be guided by other considerations, i.e. potential side effects, dosing convenience and patient preference. Trial registration number 1072.6120.47.2021

Consensus demonstrates four indicators needed to standardize burn wound infection reporting across trials in a single-country study (ICon-B study)

Evidence-based interventions are needed to treat burn wound infection (BWI). Evidence syntheses have been limited by heterogeneity of indicators used to report BWI across trials. Consistent reporting of BWI would be facilitated by an agreed minimum set of indicators. The Infection Consensus in Burns study aimed to achieve expert consensus about a core indicator set (CIS) for BWI. The CIS was established through development of a long list of BWI indicators identified from a systematic review and expert input. In a Delphi survey, UK expert participants rated the indicators according to use in everyday practice, importance for diagnosis and frequency of observation in patients with BWI. Indicators were included in the CIS if ≥75% of participants agreed it was important for diagnosis and used in everyday practice, and ≥50% of participants rated it as frequently observed in patients with BWI. One hundred and ninety-five indicators were identified from the systematic review and reduced to 29 survey items through merging of items with the same meaning. Seventy-five UK experts participated in the Delphi survey. Following a single survey round and a consensus meeting with an expert panel, four items were included in the CIS: pyrexia, spreading erythema, change in white cell count, and presence of pathogenic microbes. To facilitate evidence synthesis, a single-country systematic, expert-informed approach was taken to develop a CIS to be reported consistently across trials reporting BWI as an outcome. Future work requires verification of the CIS with international experts.

PROBLEMS OF ASSESSING THE TOTAL REGIONAL POTENTIAL

The problem of developing a methodological apparatus for assessing the aggregate potential of a region or territory has been and continues to be in the focus of attention of scientific economists, since reliable information on themagnitude of potential capabilities of regions is important in strategic planning for the development of the territory. Modern research and clarification of the concept of the aggregate potential of the region contribute to the emergence of new qualitative and quantitative factors that must be taken into account when calculating the resulting indicator, while the aggregate potential of the region cannot be equated to the sum of the assessments of sub-potentials or the total assessment of the economic resources of the territory. The paper considers the main factors that impede the work on methodological tools, in particular, a large number of subpotentials that have some overlap and duplication in theimplementation of the assessment; the need to take into account the specifics of the functioning of each region; thepresence of qualitative aspects of subpotentials, which are almost impossible to measure using quantitative indicators; heterogeneity of indicators in terms of their meters. The author considered the main approaches to determining the total potential of a region, including a ranking approach, a multi-level approach and a method of analyzing hierarchies, an abstract review of these approaches, an approach to assessing the total potential of a region based on calculating theaverage value, and outlining the main directions of transformation of existing approaches for obtaining on their basis the resulting assessment of the total potential of the region.

The effects of handgrip exercise in reducing peripherally inserted central catheter-related venous thrombosis: a Meta-analysis

Objective To evaluate the effects on reduction of peripherally inserted central catheter-related venous thrombosis by hand grip exercise. Methods A detailed search was performed to identify literature about the impact of handgrip exercise on peripherally inserted central catheter-related venous thrombosis, using the Cochrane Library and the databases of PubMed, CINAHL, Embase, CNKI, WanFang and CBM. The meta-analysis or descriptive review were performed after two authors in-dependently searching databases,extracting data and assessing quality of included studies. Results Seven RCTs were included in a total of 789 patients. Meta-analysis showed the effectiveness of handgrip exercise on reduction of peripherally inserted central catheter-related venous thrombosis (RR=0.27, 95% CI 0.17-0.42, P<0.01); and improving vein maximum velocity (WMD=6.53, 95%CI 3.34-9.73, P<0.01) and time-mean flow velocity (WMD=6.05, 95%CI 3.24-8.87, P<0.01). Conclusions Handgrip exercise can improve axillary vein blood flow parameters and reduce peripherally inserted central catheter-related venous thrombosis. Due to a small number of included studies and heterogeneity of indicators, multi-centered, high-quality RCTs with large sample size are needed in the future to assess the effect of handgrip exercise in PICC patients. Key words: Peripherally inserted central catheter; Handgrip exercise; Venous thrombosis; Meta-analysis

Multi-speed Europe is already there: Catching up and falling behind

This paper looks at a set of European countries, addressing the issue of different performances (in various indicators) within the European Union integrated framework. The selected countries are divided into four groups, also considering their relation with the industrial core of Europe, namely Germany. Firstly, we highlight the wide heterogeneity between them with respect to GDP per capita and labour productivity. Secondly, we point to a similar heterogeneity in indicators which are generally considered representative for the performance in innovative activities. At this point, we investigate whether any process of convergence has taken place in the past two decades among these groups of countries. By applying a standard methodology on all the indicators we are able to distinguish different patterns: the southern periphery is falling behind, the eastern periphery is catching up. Finally, we move to the different patterns in productivity dynamics: through a shift-share analysis, we uncover the paramount relevance of the growth in the productivity within sectors, and we analyze the paths of structural change and the connected shifts of workers among sectors, which result to be partially accountable for such different performances.

Social vulnerability change assessment: monitoring longitudinal demographic indicators of disaster risk in Germany from 2005 to 2015

Social vulnerability assessments of disaster risks related to natural or man-made hazards have become state of the art, while not undisputed. One critique—that most assessments are static—is addressed here by analysing indicators over a 10-year period at a research area in Germany using county-level administrative units. The indicators (and an index) are displayed as maps using publicly available statistical data from a single government source to establish consistency. In addition, maps of changes in indicator values per 5 or 10 years are visualised. As a result, spatial regions within Germany that have received increases in, for instance, higher numbers of elderly citizens can be visualised. Maps visualise the increasing susceptibility to hazards such as floods, heatwaves, storms or technological accidents. At the same time, increases or decreases in capacities, such as hospital density or care homes, highlight regions that have adjusted or still have to adjust to demographic change demands. The main purpose of this paper is to test stability and heterogeneity of indicators over time and offer advice on a selection of indicators that are not only based on static and singular assessments but also take dynamics and related richness of additional temporal change information into account for longitudinal monitoring of disaster risk with a focus on vulnerability.

Modalités d’évaluation et résultats des traitements ablatifs dans le cancer de la prostate

To perform a state of the art about methods of evaluation and present results in ablative therapies for localized prostate cancer. A review of the scientific literature was performed in Medline database (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) using different associations of keywords. Publications obtained were selected based on methodology, language and relevance. After selection, 102 articles were analysed. Analyse the results of ablative therapies is presently difficult considering the heterogeneity of indications, techniques and follow-up. However, results from the most recent and homogeneous studies are encouraging. Oncologically, postoperative biopsies (the most important criteria) are negative (without any tumor cells in the treated area) in 75 to 95%. Functionally, urinary and sexual pre-operative status is spared (or recovered early) in more than 90% of the patients treated. More and more studies underline also the correlation between the results and the technique used considering the volume of the gland and, moreover, the "index lesion" localization. The post-treatment pathological evaluation by biopsies (targeted with MRI or, perhaps in a near future, with innovative ultrasonography) is the corner stone of oncological evaluation of ablative therapies. Ongoing trials will allow to standardize the follow-up and determine the best indication and the best techniques in order to optimize oncological and functional results for each patient treated.

Development process models for evaluation of performance of the educational establishments

Known methods of forming the generalized quality indicators of educational institutions, as a rule, provide for the averaging of many parameters. These technologies do not take into account the heterogeneity of indicators that cannot be represented by a single indicator. Parametric formalization of the educational system on the basis of modeling allows the switch to multifactorial quality assessment, which creates conditions for the proactive improvement and enhancement of performance of educational institutions. In this paper, a generalization of the management structure on the basis of the process approach and the factors of influence on the results of the processes to predict the quality of separate processes and organizations in general is made. The general concept for developing the forecasting models using the process structure of the organization and the vector of parameters of influence on these processes is proposed. Its essence is to create a multi-level structure of processes and calculate the quality of each process in steps, which correspond to the levels of processes. To calculate the quality of each process, the types of parameters that influence them, the methods for their normalization and determination of values are identified. Initial direct and reverse parameters are conditionally singled out. The function of the quality evaluation of processes, which is a dependence of the estimated quality on the actual values of parameters and their weights of influence on the process is proposed. The generalized concept can be applied to the development of the quality forecasting model of educational institutions.

1161 Quandry Over the Use of Antifungal Prophylaxis in Preterm Infants: Survey of Current Practice in the United Kingdom

IntroductionProphylactic anti fungal use reduces the incidence of colonisation and invasive fungal infection in premature neonates. We surveyed the current regimens for the use of antifungal prophylaxis in the tertiary...

Water balance of tissue segments from leaves of different insertion levels

Actual heterogeneity of indicators of water balance was studied on tissue segments from leaves ofBrassica oleracea L. v.acephala andNicotiana tabacum L. under controlled conditions. Maximal values of transpiration rate, water absorption rate, water transport rate and low values of WSD at the same time were observed at an initial WSD of 0% in segments from middle leaves and at an initial WSD of 20% mostly in segments from upper leaves. Although the properties of leaf tissue itself were probably the basic factors determining the actual heterogeneity of indicators of water balance, without connection with all other factors (e. g. various microclimates, supply of water) heterogeneity did not appear to a full degree.