High Dependence Research Articles

Utility of Clinical Variables for Deciding Palliative Care in Paraquat Poisoning: A Retrospective Study.

Patients with paraquat poisoning (PP) have a mortality rate comparable to that of advanced malignancies, yet palliative care is seldom considered in these patients. This audit aimed to identify triggers for early palliative care referral in critically ill patients with PP. Medical records of patients with PP were audited. Predictors of mortality within 48 hours of hospitalization and 24 hours of intensive care unit (ICU) admission were considered as triggers for palliative care referral. Among 108 patients, 84 complete records were analyzed, and 53 out of 84 (63.1%) expired. Within 48 hours after hospitalization, the lowest oxygen partial pressure in arterial blood to a fraction of inspired oxygen [the ratio of partial pressure of oxygen in arterial blood (PaO2) to the fraction of inspiratory oxygen concentration (FiO2) (PaO2/FiO2)] was the independent predictor of mortality, cut-off ≤ 197; the area under the curve (AUC), 0.924; sensitivity, 97%; specificity, 78%; p <0.001; and 95% confidence interval (CI): 0.878-0.978. Kaplan-Meier survival plot showed that the mean survival time of patients with the lowest PaO2/FiO2, ≤197, was 4.64 days vs 17.20 days with PaO2/FiO2 >197 (log-rank p < 0.001). Sequential organ failure assessment (SOFA) score within 24 hours of ICU admission had a cut-off ≥9; AUC, 0.980; p < 0.001; 95% CI: 0.955-1.000; 91% sensitivity; and 90% specificity for mortality prediction. Out of the total of 84 patients with PP analyzed, there were 11 patients admitted to the high dependency units (13.1%) and 73 patients admitted to the ICU (86.9%). Out of the total of 84 patients of PP in whom data was analyzed, 53 (63.1%) patients required ventilator support. All the 53 patients who required ventilator support due to worsening hypoxemia, eventually expired. The lowest PaO2/FiO2 ≤ 197 within 48 hours of hospitalization, SOFA score ≥9 within 24 hours of ICU admission or need for mechanical ventilation are predictors of mortality in PP patients, who might benefit from early palliative care. Rao S, Maddani SS, Chaudhuri S, Bhatt MT, Karanth S, Damani A, et al. Utility of Clinical Variables for Deciding Palliative Care in Paraquat Poisoning: A Retrospective Study. Indian J Crit Care Med 2024;28(5):453-460.

Examining the Period-Based Changes in the Effect of Socioeconomic Status in Maternal Healthcare Utilization Across Regional and Residential Contexts in Postcolonial Tanzania (1991–2016)

ABSTRACT Applying dependency theory, this manuscript uses data from the six cross-sectional Tanzania Demographic Health Surveys from 1991 to 2016 (n = 30,028) to explore temporal variations in the effect of socioeconomic status (SES) on maternal healthcare (MHC) utilization across different residences and regions. Research in this area is nonexistent in Tanzania. The results suggest a notable gap in using Tanzanian MHC based on SES and location (i.e. residence, regions). Results suggest that women from underserved groups, such as those living in rural areas or all-other (i.e. unprivileged) regions with lower SES, may have less access to MHC in the underdeveloped world. There were statistically significant socioeconomic variations in MHC use observed between residencies and regions, with stronger differences seen between residencies than regions. These findings further highlight the idea that lower use of MHC in the Global South is inseparable from economic dependency on metropolitan and Global North countries. This research calls for policymakers to recognize the roles of interactions between location and socioeconomic inequalities as factors exacerbated by higher dependency when crafting policies to modify healthcare utilization among women in underdeveloped countries.

What determines local attitudes towards Jordan’s renewable energy transition? Evidence from household surveys

ABSTRACT The potential for renewable energy to encourage sustainable development raises high hopes for the future among countries in the Global South. However, there has been less research on how energy transitions are perceived outside of the Global North and democratic contexts. This paper explores attitudes towards the energy transition in Jordan, where expert interviews reveal that a strong renewable energy industry has emerged from top-down government efforts to reduce energy dependency and costs. We perform an in-person household survey with 320 respondents in areas with different transition risks and benefits, and then test a series of hypotheses using regression analysis. In the four communities surveyed, income stress and climate concern influence attitudes, as well as perceptions of community benefits. National-level concerns also matter, including energy dependency and energy costs for all Jordanians. Our results highlight the importance of context: findings from the North are not universal and understanding transitions in the Global South requires studying them in their own right. Policy insights Jordanian policymakers should reverse their policy of blocking renewables to avoid public backlash. Jordanian policymakers and funders should promote projects in communities with high economic dependence on the fossil fuel industry to ensure local support in areas facing transition risks. Policymakers should highlight collective, not just individual benefits of transitions, as perceptions of community and country benefits increase support. Policymakers in highly energy-dependent countries like Jordan should frame renewables as an answer to local and national challenges such as high energy prices. Actors wishing to promote clean energy support in different contexts should investigate local dynamics to build communication strategies that frame transitions appropriately.

Long-Term Energy System Modelling for a Clean Energy Transition in Egypt’s Energy Sector

Egypt has the potential to generate a significant amount of energy from renewable technologies, in particular solar PV, concentrated solar power (CSP), and onshore and offshore wind. The energy sector is reliant on fossil fuels, particularly natural gas, for electricity production and is at risk of locking itself into a high carbon pathway. Globally, reducing greenhouse gas (GHG) emissions associated with national energy sectors is a target outlined in the UN’s Paris Agreement. To reduce carbon dioxide (CO2) emissions associated with a higher dependence on fossil fuels, Egypt must consider upscaling renewable energy technologies (RETs) to achieve a clean energy transition (CET). This research modelled six scenarios using clicSAND for OSeMOSYS to identify the technologies and policy target improvements that are needed to upscale RETs within Egypt’s energy sector. The results showed that solar PV and onshore wind are key technologies to be upscaled to contribute towards Egypt’s CET. The optimal renewable target is the International Renewable Energy Agency’s (IRENA) target of 53% of electricity being sourced from RETs by 2030, which will cost USD 16.4 billion more up to 2035 than Egypt’s current Integrated Sustainable Energy Strategy (ISES) target of 42% by 2035; it also saves 732.0 MtCO2 over the entire modelling period to 2070. Socio-economic barriers to this transition are considered, such as recent discoveries of natural gas reserves combined with a history of energy insecurity, political instability impacting investor confidence, and a lack of international climate funding. The paper concludes with policy recommendations that would enable Egypt to progress towards achieving a CET.

Towards the understanding of convective dissolution in confined porous media: thin bead pack experiments, two-dimensional direct numerical simulations and physical models

We consider the process of convective dissolution in a homogeneous and isotropic porous medium. The flow is unstable due to the presence of a solute that induces a density difference responsible for driving the flow. The mixing dynamics is thus driven by a Rayleigh–Taylor instability at the pore scale. We investigate the flow at the scale of the pores using Hele-Shaw type experiment with bead packs, two-dimensional direct numerical simulations and physical models. Experiments and simulations have been specifically designed to mimic the same flow conditions, namely matching porosities, high Schmidt numbers and linear dependency of fluid density with solute concentration. In addition, the solid obstacles of the medium are impermeable to fluid and solute. We characterise the evolution of the flow via the mixing length, which quantifies the extension of the mixing region and grows linearly in time. The flow structure, analysed via the centreline mean wavelength, is observed to grow in agreement with theoretical predictions. Finally, we analyse the dissolution dynamics of the system, quantified through the mean scalar dissipation, and three mixing regimes are observed. Initially, the evolution is controlled by diffusion, which produces solute mixing across the initial horizontal interface. Then, when the interfacial diffusive layer is sufficiently thick, it becomes unstable, forming finger-like structures and driving the system into a convection-dominated phase. Finally, when the fingers have grown sufficiently to touch the horizontal boundaries of the domain, the mixing reduces dramatically due to the absence of fresh unmixed fluid. With the aid of simple physical models, we explain the physics of the results obtained numerically and experimentally. The solute evolution presents a self-similar behaviour, and it is controlled by different length scales in each stage of the mixing process, namely the length scale of diffusion, the pore size and the domain height.

Optimizing energy modeling in PBF-LB/M metal additive manufacturing: a detailed analysis of resource and energy demand based on standard tensile test specimen

AbstractAdditive manufacturing is an essential tool in modern production processes. Competitive quality and the increasing importance of local manufacturing have allowed companies to maintain their production despite supply chains disrupted by the pandemic. However, the rising awareness of society towards environmental and climate protection, the increasing demand for resource-efficient products, and recent developments in energy costs are leading to a rethink in manufacturing processes. Additive manufacturing offers great potential for resource saving components. This study uses standard tensile test specimens to analyze AM processes regarding energy and material flows. The results show a high dependence of energy demand on process time and are transformed into a data-based energy model. Compared to previous energy models, the accuracy can be significantly improved using model data in combination with specific and system-oriented approaches. In addition to system-related saving potentials, design-related optimization potentials can be identified. Innovative and highly resource-saving components can be designed with a design methodology adapted to the extended degrees of freedom of AM. Further saving and recycling potentials can be identified along the material flows. A long-term goal is optimizing and predicting of resource demand in additive manufacturing with a view to the entire product lifecycle.

МОДЕЛІ БІЗНЕСУ УКРАЇНСЬКИХ ОЩАДНИХ БАНКІВ

In the banking system, savings banks represent a special component, as they form their resource base mainly due to the accumulation of population savings. Problem Statement. Ukrainian savings banks are a factor in ensuring financial stability, but at the same time they are vulnerable to depositors’ panic in conditions of systemic stresses. Therefore, the analysis of their activities is important for understanding the prospects of the banking system. Savings banks in Ukraine differ significantly in scale and level of business technology. Leading savings banks are planned by the state for privatization, so they are designed to improve their investment attractiveness, at the same time, the status of state ownership gives such banks additional advantages in the market. The purpose is a comparative analysis of the business models of savings banks in Ukraine and the behavior of such banks on the market. Methods. The authors used the methods of comparative analysis, logical generalization, analysis and synthesis. Results. In Ukraine, savings banks are divided by origin into two categories ( state and private capital), and by a business model into those, focused on lending to business clients and those with a balanced composition of the loan portfolio. The monopoly of the state bank was broken by the entry of banks with private capital to the market. Savings banks are identified based on the ratio of funds raised by individuals to the total amount of balances on customer accounts. A blueprint of two business models for the savings bank segment was built, the structure of assets and liabilities, the development of the branch network and market positions in terms of deposits were compared. The analysis of the efficiency of a sample of savings banks was carried out and compared with the indicators of the banking system (profitability, return on operating expenses, profitability of the loan portfolio, cost of funds of individuals, the branching of branch network), as well as the impact of the business model on the investment attractiveness of banks was assessed, the volumes of savings and allocation of funds in loans to individuals were compared. Conclusions. The research made it possible to identify a specific group of banks with heterogeneous business models: firstly, banks that use public funds mainly to finance business clients, secondly, banks that have a relatively balanced credit portfolio for individuals and legal entities. The segment of Ukrainian savings banks is clearly dominated by two large state-owned banks, and given the state of war and citizens' trust in the state itself, there is no reason to expect a change in leaders. Digitization of products and processes will allow savings banks to compensate for the reduction of the branch network, but other banks also take advantage of this opportunity. and return on investment in technological innovation projects will bring effect in the medium term. To a large extent, the amount of savings accumulated by banks depends on two factors - customer trust and assessment of service quality. Savings bank managers should pay primary attention to this. Excessively high dependence of banks on the funds of individuals can be considered as a disadvantage, rather than as an advantage, if a bank itself works inefficiently.

Agronomic drivers of pesticide use in small-scale horticultural systems in central Mexico: cropping and farming system factors.

Abstract Horticultural Production Systems (HPS) in Mexico face challenges due to small-scale operations, limited resources, and high dependence on family labor. This study explores the use of agrochemicals in HPS and its impact on productivity and potential exposure to pesticides. Through on-farm surveys in the Morelia-Queréndaro valley, Central Mexico, factors influencing agrochemical use and toxicity were investigated. Results show that HPS configuration plays a pivotal role in predicting agrochemical use. HPS dominated by a single crop tend to use more herbicides and fertilizers, while diversified systems use fewer herbicides. Crop-specific management practices, such as row spacing and intercropping, significantly influence herbicide usage. Surprisingly, higher volumes of insecticides and fungicides do not consistently correlate with increased yields. Additionally, relationships between pesticide use and crop yields vary across onion cropping systems, emphasizing the need for tailored management strategies. We highlight the significant toxicity of insecticides and the importance of understanding factors determining their application volumes. Overall, this research underscores the complexity of agrochemical use in HPS and emphasizes the potential of diversified farming systems to reduce reliance on agrochemical inputs while maintaining productivity. These findings contribute to a deeper understanding of sustainable agriculture practices and provide valuable insights for policy makers and farm managers.

Molecular Engineering Design of Twisted-backbone Pure Type-I Organic Photosensitizers for Hypoxic Photodynamic Therapy

Photodynamic therapy (PDT), an emerging tumor therapeutic strategy has received tremendous attention. Enslaved by the high dependence of oxygen, Type-II photosensitizers (PSs) mediated PDT is restricted by the hypoxic environment of tumors. By transferring electrons to water or other substrates instead of oxygen, Type-I PSs hold the promise of achieving an ideal therapeutic effect under hypoxic conditions. In this study, three twisted-backbone PSs (CBz-TQs-1, CBz-TQs-2 and CBz-TQs-3) are synthesized and studied. Owing to different substituent effects, the ROS generation mechanism transfers from pure Type-II of their prototype PSs (TQs-1, TQs-2 and TQs-3) to mixed Type-I/II of CBz-TQs-1 and CBz-TQs-2 to pure Type-I of CBz-TQs-3. Moreover, CBz-TQs-3 exhibits an ultra-high ROS quantum yield (∼1.0). The in vitro and in vivo PDT effects of water-dissolvable nanoparticles (NPs) of CBz-TQs-3 are investigated. The results show that the phototoxicity of CBz-TQs-3 is not affected by hypoxic environments. In addition, a remarkable tumor ablation can be found after CBz-TQs-3 NPs mediated PDT on Balb/c mice with xenograft tumors. It proves that a twisted backbone strategy is beneficial for designing pure Type-I PSs with high-efficient hypoxic PDT.

Health-Related Quality of Life in severely injured patients in Finland: an observational cohort study of 325 patients with 1-year follow-up

BackgroundMajor trauma has a significant effect on Health-Related Quality of Life (HR-QoL). It is unclear, however, which factors most affect HR-QoL. This study aims to evaluate HR-QoL after severe injury in Finland and determine how different injury patterns and patient-related factors, such as level of education and socioeconomic group, are associated with HR-QoL. We also assess how well different injury scoring systems associate with HR-QoL.MethodsWe retrospectively analyzed 325 severely injured trauma patients (aged ≥ 18 years, New Injury Severity Score, (NISS) ≥ 16, and alive at 1 year after injury) treated in the Intensive Care Unit (ICU) or High Dependence Unit (HDU) of Tampere University Hospital (TAUH) from 2013 through 2016. HR-QoL was assessed with the EQ-5D-3L questionnaire completed during ICU stay and 1 year after injury. HR-QOL index values and reported problems were further compared with Finnish population norms.ResultsThe severity of the injury (measured by ISS and NISS) had no significant association with the decrease in HR-QoL. Length of ICU stay had a weak negative correlation with post-injury HR-QoL and a weak positive correlation with the change in HR-QoL. The largest mean decrease in HR-QoL occurred in patients with spinal cord injury (Spine AIS ≥ 4) (-0.338 (SD 0.136)), spine injury in general (Spine AIS ≥ 2 (-0.201 (SD 0.279)), and a lower level of education (-0.157 (SD 0.231)). Patient’s age, sex, or socioeconomic status did not seem to associate with smaller or greater changes in HR-QoL.ConclusionsAfter serious injury, many patients have permanent disabilities which reduce HR-QoL. Injury scoring systems intended for assessing the risk for death did not seem to associate with HR-QoL and are not, therefore, a meaningful way to predict the future HR-QoL of a severely injured patient. Recovery from the injury seems to be weaker in poorer educated patients and patients with spinal cord injury, and these patients may benefit from targeted additional measures. Although there were significant differences in baseline HR-QoL levels between different socioeconomic groups, recovery from injury appears to be similar, which is likely due to equal access to high-quality trauma care.

Analysis of postural stability using foam posturography in patients with persistent postural-perceptual dizziness.

Persistent postural-perceptual dizziness (PPPD) is worsened in a standing posture, or by body movement, or visual stimulation. We aimed to evaluate postural stability in PPPD patients using foam posturography and to investigate the dependence on visual and somatosensory input in the standing posture. Foam posturography was performed on 53 PPPD patients, and data from the PPPD patients were compared with the data from an age- and sex-matched healthy controls. The PPPD patients were divided into four groups based on the findings of vestibular function tests and the effect of vestibular function on posturographic data was examined. Romberg's ratios were significantly higher in PPPD patients than in controls. The median Romberg's ratios in PPPD patients with normal vestibular function were also higher than those in controls. However, foam ratio was significantly lower in PPPD patients than in controls. The median foam ratios in PPPD patients with vestibular dysfunction were also lower than those in controls. In a standing posture, PPPD patients may be more dependent on visual input and less dependent on somatosensory input than healthy subjects. Higher dependence on visual and lower dependence on somatosensory input in PPPD may be a feature unaffected by vestibular function.

Characterization and mid-term outcomes of current out-of-hospital cardiac arrest patients admitted to intensive cardiovascular care units

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Consell Català de Resuscitació. Background Out-of-hospital cardiac arrest (OHCA) accounts the 50% of cardiovascular deaths. Being aware of characteristics and outcomes of our OHCA population is important in order to apply measures in the weaker areas to improve the results of the process. Purpose To investigate current outcomes, at 6-month follow-up, of patients admitted to an Intensive Cardiac Care Unit (ICCU) in a mediterranean area during the 2020s. Current characteristics, prehospital management and factors related to outcomes were also analyzed. Methods PCR-Cat was a prospective observational multicentre registry. OHCA patients admitted to the ICCU of 8 hospitals were included from October/2020 to December/2021. Those who survived with good neurological status, no disabilities, and remained independent for usual life activities, were classified as Good Outcome (GO). Those patients who died or had a poor neurological status, with high dependency or rested in permanent vegetative status were classified as Poor Outcome (PO). A multinomial logistic regression was done to analyze the factors independently related to PO. Results 288 patients were included, only 50 (17.36%) were women. At 6-month follow-up, 48.95% of patients had GO. Most events happened in the first month (Figure 1). The cause of death was neurological in 72.9%. Patients with PO were significantly older (63.74 vs. 58.88, p=0.003) and had more comorbidities (Table 1A). The most frequent location was on a public space (54.84%) and most were witnessed (88.93%). Cardiopulmonary resuscitation maneuvers were initiated by a bystander in 69.18% until EMS arrival, being only 20.79% done by an experienced bystander. The medium no-flow time was low (2 min) but total time until ROSC was of 28 min. First rhythm was shockable in 80%, but an automatic external defibrillator was only used in 58% of cases. Statistically significant lower values of first pH and higher values of first lactate, glucose and creatinine were related to PO (Table 1B). Patients with PO had a higher APACHE II (26 vs. 20, p&amp;lt;0.001) and SOFA (10.39 vs. 7.14, p&amp;lt;0.001) scores at admission, and required a longer time on mechanical ventilation (6 vs. 3.5 days, p=0.001). The main cause of the OHCA was acute coronary syndrome (53.82%), followed by chronic coronary syndrome (7.64%) and dilated myocardiopathy (7.64%). In the multinomial logistic regression, older age (p=0.005), male sex (p=0.016), previous stroke (p=0.046), longer ROSC time (p&amp;lt;0.001) and non-shockable first rhythm (p&amp;lt;0.001) were independently related to PO. Receiving cardiopulmonary resuscitation maneuvers by an experienced bystander was related to a reduction of 17 min of ROSC (p=0.001). Conclusions Less than a half of patients admitted to an ICCU because of an OHCA had GO at 6-month follow-up. Age, male sex, previous stroke, longer ROSC time and non-shockable first rhythm were factors independently related to PO. Interventions addressed to reduce ROSC time are urgently needed.

Navigating the uncommon: a case of caesarean section associated with exercise-induced anaphylaxis

Exercise-induced anaphylaxis (EIA) and food-dependent exercise-induced anaphylaxis (FDEIA) are rare but serious conditions where physical activity triggers severe allergic reactions. These are rarely reported in pregnant women undergoing caesarean section. We present the case of a 33-year-old woman with a history of EIA, scheduled for a caesarean section at 37 weeks of gestation. To manage the planned caesarean section, a multidisciplinary team strategy was devised to mitigate anaphylaxis risks. The surgery proceeded without complications under spinal anaesthesia, and the patient did not exhibit any anaphylactic reactions. The patient was monitored in the high dependency unit (HDU) and was discharged two days later. This case highlights the importance of individualized anaesthesia planning, multidisciplinary collaboration, and detailed preparation to ensure the safety of pregnant patients with EIA undergoing caesarean section.

Evaluation of Knowledge among Nurses about Pressure Ulcer in a Tertiary Care Hospital, Lahore

Background: Pressure ulcers are a prevalent issue in healthcare settings, leading to significant morbidity and increased healthcare costs. Nurses play a crucial role in the prevention and management of these conditions, yet gaps in knowledge can affect patient outcomes. The study aimed to assess the knowledge of nurses at a tertiary care hospital in Lahore, Pakistan, a setting where pressure ulcer management is critical yet understudied. Objective: This study aimed to evaluate the current level of knowledge among nurses regarding pressure ulcer prevention and management, and to identify any significant differences in knowledge across various critical care settings within the hospital. Methods: A cross-sectional descriptive study was conducted at Shalamar Hospital, Lahore, involving 125 staff nurses and nursing interns selected via simple random sampling. Participants were required to have at least six months of experience in general wards. Data were collected using a validated questionnaire, assessing knowledge of pressure ulcer management. Ethical approval was obtained from the Shalamar College of Nursing's ethical committee. Data analysis was performed using SPSS version 25 and Microsoft Excel, applying descriptive and inferential statistics, including the Chi-square test, with a significance level set at p&lt;0.05. Results: The study revealed that 68.8% (86/125) of nurses had average knowledge, 29.6% (37/125) demonstrated good knowledge, and only 1.6% (2/125) exhibited poor knowledge regarding pressure ulcer management. Notably, nurses in the Surgical Intensive Care Unit (SICU) and High Dependency Unit (HDU) displayed the highest levels of knowledge, whereas those in the Medical Intensive Care Unit (MICU), Cardiac Care Unit (CCU), and Emergency Room (ER) had comparatively lower knowledge levels. Conclusion: The majority of nurses at Shalamar Hospital possessed an average level of knowledge concerning pressure ulcer management. There is a critical need for targeted educational interventions to enhance knowledge and practices, particularly in units where nurses showed lower knowledge levels. Improving nurse education in pressure ulcer management could significantly impact the quality of patient care and reduce the prevalence of these injuries.

Utilization of Waste Marble and Bi2O3-NPs as a Sustainable Replacement for Lead Materials for Radiation Shielding Applications

In an attempt to reutilize marble waste, a new approach is presented in the current study to promote its use in the field of shielding against ionizing radiation. In this study, we aimed to develop a novel and sustainable/eco-friendly lead-free radiation shielding material by improving artificial marble (AM) produced from marble waste combined with polyester by reinforcing it with bismuth oxide (Bi2O3) nanoparticles. Six samples of AM samples doped with different concentrations (0%, 5%, 10%, 15%, 20%, and 25%) of Bi2O3 nanoparticles were prepared. The linear attenuation coefficient (LAC) values were measured experimentally through the narrow beam method at different energies (0.0595 MeV, 0.6617 MeV, 1.1730 MeV, and 1.330 MeV) for all samples with various concentrations of Bi2O3. Radiological shielding parameters such as half value layer (HVL), tenth-value layer (TVL), and radiation shielding efficiency (RSE) were estimated and compared for all the different samples. The results prove that increasing the concentration of Bi2O3 leads to the enhancement of the radiation shielding properties of the AM as a shielding material. It was observed that as the energy increases, the efficiency of the samples falls. High energy dependence was found when calculating the HVL and TVL values of the samples, which increased with increases in the energy of the incident photons. A comparison between the sample with the most efficient gamma radiation attenuation capability (AM-25%), concrete, and lead was conducted, and a discussion regarding their radiation shielding properties is presented herein. The results show that the AM-25% sample is superior to the ordinary concrete over all the studied energy ranges, as evidenced by its significantly lower HVLs. On the contrary, lead is superior to the AM-25% sample over all the studied energy ranges owing to its unbeatable density as a shielding material. Overall, this new type of artificial marble has the potential to be used as a radiation shielding material at low- to medium-gamma energy regions, specifically in medical imaging and radiation therapy.

A new era for African health systems: Market shaping and the African Continental Free Trade Area (AfCFTA)

AbstractThe COVID‐19 pandemic has forced a reflection on the origins of supplies in African healthcare market and underscored the need for an increase in local manufacturing of medical supplies. Several African countries’ health markets have been heavily reliant on imports. First, this article demonstrates how the African healthcare market has had a high import dependency and the role that the African Continental Free Trade Area (AfCFTA) could play to reverse this. It is estimated that African countries import between 80% and 94% of medical supplies, 75% of testing kits, between 70% and 95% of pharmaceuticals, and 99% of vaccines. Second, during the COVID‐19 pandemic, countries imposed export restrictions which impacted the flow of medical supplies to African countries. This finding highlighted the limited production capabilities on the African continent and reiterated the need to strengthen continental value chains and local manufacturing capacity to establish the continent's New Public Health Order. Third, there was the emergence of local innovations seeking to minimize the impact of these supply chain disruptions. Using case studies on the local production of COVID‐19 testing kits and personal protective equipment, the article highlights progress made toward health market reform. It calls attention to the implementation of the AfCFTA to strengthen the supply, manufacturing, and trade of medical resources. Fourth, this article highlights countries that have African‐made pharmaceuticals and vaccinations and the importance of regional hubs to expand these products in African healthcare markets. It concludes by discussing investments made to expand local manufacturing of health products.

Clinical Spectrum and Fetomaternal Outcomes in Near Miss Patients Presenting to a Tertiary Care Hospital

Background and Objectives: Maternal near miss events are life threatening obstetric conditions which need urgent medical help in order to prevent maternal death. Audit of near miss events is a surveillance tool which is used to assess the quality of antenatal care in a setting and help in identifying causes to improve the maternal outcome. The objective was to find out the frequency, clinical spectrum and fetomaternal outcome in near miss patients presenting to a tertiary care hospital.Methods: This was case-series observational study, conducted in Lady Willingdon Hospital, Lahore from January 2022 to December 2022. Eighty women were included. Each case was analyzed regarding age, gestational age, parity, examination findings, laboratory diagnosis, management plan, feto-maternal outcome, level of post-operative care, number of blood transfusions and complications.Results: Most patient's were from age bracket 30-40 years, gestational age 28-36 weeks, parity P2-P4. The leading causes of near miss events were hemorrhage (48.75%), followed by hypertensive disorders (31.25%), viral hepatitis (8.75%), uterine rupture (6.25%), sepsis (5%) and ruptured ectopic pregnancy (3.75%). As maternal outcome, there were four deaths. Our fifty-eight patients (72.5%) required regular level-1 care, eighteen patients (22.5%) required high dependency unit level-2 care and four patients (5%) required intensive care unit level-3 care. Seventy-one babies were delivered. Sixty-one were born alive while ten were still born. Neonatal ICU admissions were twenty-seven, out of these twenty-two were discharged from nursery and early neonatal deaths were five.Conclusion: Near miss events, if treated timely at well-equipped facility may prevent progression to life threatening situations.Keyword: Near miss events, hemorrhage, hypertension, antenatal care

Cross-talk between leukemic and immune cells at the tumor microenvironment in chronic lymphocytic leukemia: An update review.

Chronic lymphocytic leukemia (CLL) is a mature-type B cell malignancy correlated with significant changes and defects in both the innate and adaptive arms of the immune system, together with a high dependency on the tumor microenvironment. Overall, the tumor microenvironment (TME) in CLL provides a supportive niche for leukemic cells to grow and survive, and interactions between CLL cells and the TME can contribute to disease progression and treatment resistance. Therefore, the increasing knowledge of the complicated interaction between immune cells and tumor cells, which is responsible for immune evasion and cancer progression, has provided an opportunity for the development of new therapeutic approaches. In this review, we outline tumor microenvironment-driven contributions to the licensing of immune escape mechanisms in CLL patients.

Abstract PO3-07-02: Radiomics Models for B-mode Breast Ultrasound and Strain Elastography to improve Breast Cancer Diagnosis (INSPiRED 005): An International, Multicenter Analysis

Abstract Background: Breast Elastography, a technique that quantifies tissue stiffness, has been evaluated to objectify and improve the performance of B-mode breast ultrasound. However, large prospective trials showed benefits in BI-RADS 4a breast masses only and a high operator dependency. Modern Artificial Intelligence techniques for automated image processing like radiomics, a technique where quantified features are extracted from images, may overcome these limitations. We aimed to develop and validate radiomics models based on B-mode and Strain Elastography (SE) images for patients with BI-RADS 3 or 4 breast masses and compare their performance to the respective human experts. Methods: This is a secondary analysis of an international, multicenter trial (NCT02638935), evaluating the performance of SE in women with BI-RADS 3 or 4 breast masses. Women were recruited at 12 institutions in 7 countries and underwent B-mode breast ultrasound as well as SE. B-mode images were saved and re-assed by three ultrasound readers ( &amp;gt;10 years of experience), resulting in three independent assessments and a final consensus assessment. SE was interpreted using the E-/B ratio. B-mode and strain images were manually segmented and quantitative radiomics features were extracted using pyradiomics. We used 10-fold cross-validation to build machine learning models (XGBoostTree, MARS) based on data of 11 of 12 study sites. The data of the 12th (largest) study site was used as external validation set. Performance metrics included sensitivity, specificity and area under the receiver operator characteristic curve (AUROC). Results: The study included a total of 1288 patients, 1206 with evaluable B-mode images and 1190 with evaluable Strain images. Mean age was 46.6 years (SD 16.02) and a total number of 29.0% (350 of 1206) and 28.9% (344 of 1190) breast masses were malignant in the B-mode and Strain cohort, respectively. Distribution of BI-RADS categories was 33.0%, 34.5%, 14.5%, and 18.0% for BI-RADS 3, 4a, 4b, and 4c, respectively. In the external validation set (n = 342), the B-mode radiomics model (XGBoostTree) achieved an AUROC of 0.86 (95% CI 0.82 to 0.90), with a sensitivity of 97.4% (95% CI 0.93 to 1.00, 113 of 116) and a specificity of 27.0% (95% CI 0.21 to 0.33, 61 of 226). The model showed equivalent performance compared to the three ultrasound readers (P = 0.133); see also Table 1. In the external validation set (n = 333), the Strain radiomics model (MARS) achieved an AUROC of 0.84 (95% CI 0.79 to 0.88), with a sensitivity of 100% (95% CI 47.0 to 58.0, 115 of 115) and a specificity of 25.5% (95% CI 0.22 to 0.34, 60 of 218). The model showed equivalent performance compared to the three ultrasound readers (P = 0.696) and performed significantly better compared to SE (P = 0.002); see also Table 1. Sensitivity of the strain model was descriptively higher (100% vs. 97.4%, see Table 1). Both models were well-calibrated. Conclusion: This is the largest development and validation study for radiomics models based on B-mode breast ultrasound and SE, to date. The radiomics models performed on par with human readers, with the strain radiomics model showing potential to identify initially missed carcinomas in BI-RADS 3 breast masses. Future implementation studies may evaluate the performance of these image analysis algorithms in clinical routine and their integration into the multi-modal breast cancer diagnostics process, including mammography and MRI. Table 1. Diagnostic performance metrics Citation Format: André Pfob, Tanja He, Lie Cai, Richard G. Barr, Volker Duda, Zaher Alwafai, Corinne Balleyguier, Dirk-André Clevert, Sarah Fastner, Christina Gomez, Manuela Goncalo, Ines Gruber, Markus Hahn, André Hennigs, Panagiotis Kapetas, Sheng-Chieh Lu, Juliane Nees, Ralf Ohlinger, Fabian Riedel, Matthieu Rutten, Benedikt Schaefgen, Anne Stieber, Riku Togawa, Mitsuhiro Tozaki, Sebastian Wojcinski, Cai Xu, Geraldine Rauch, Jörg Heil, Chris Sidey-Gibbons, Michael Golatta. Radiomics Models for B-mode Breast Ultrasound and Strain Elastography to improve Breast Cancer Diagnosis (INSPiRED 005): An International, Multicenter Analysis [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-07-02.

Synergizing Battery-Powered Permanent Magnet Synchronous Motor Control with Integrated Modular Multilevel Converter Systems

This proposed work presents a comprehensive examination of a modular multilevel converter (MMC) combined with a permanent magnet synchronous motor (PMSM) for battery energy management in applications. In order to provide effective energy transfer and dynamic control, the Modular Multilevel Converter serves as a bridge between the battery system and the Permanent Magnet Synchronous Motor drive. By cleverly controlling energy flow and minimizing losses during charging and discharging cycles, the combination of MMC with PMSM seeks to increase energy efficiency and prolong battery life. Since the energy source provides all of the power for the motor, it runs at a constant pace. When the accelerating mode finishes, the energy storage receives just enough power to maintain a steady voltage. The energy storage system utilizes the majority of the renewable power generated by the electric motor when it is in deceleration mode to raise the voltage in the system. During the subsequent acceleration mode, the stored energy might be released the MMC-BESS, which combines a modular multilevel converter with a battery energy storage system, is gaining popularity due to its high adaptability and dependability. This system integrates batteries into a sub module. Sub-modular capacitor voltage fluctuations are caused by the significant reactive power that is generated through the workings of modular multilevel converters. To reduce the fluctuation, large capacitance capacitors is required, which would significantly increase the system's capacity. The proposed approach means to upgrade energy proficiency and execution in electric vehicle applications. By joining the benefits of battery power with the flexibility of MMC frameworks, the arrangement offers upgraded control accuracy, decreased misfortunes, and further developed adaptation to non-critical failure. This combination works with consistent power the executives, guaranteeing ideal use of assets while meeting severe execution prerequisites. Through exhaustive examination and recreation, the adequacy of this incorporated framework is illustrated, displaying propelling the field of electric vehicle impetus and power conversion potential.