High Volume Research Articles

Preparation of continuous carbon fiber reinforced PA6 prepreg filaments with high fiber volume fraction

High-performance continuous carbon fiber prepreg filaments have been a research hotspot in the field of additive manufacturing in recent years, and are considered to be an effective option for improving the mechanical strength of thermoplastic composite parts. However, the effect of fiber volume fraction on the microstructure and tensile properties of 3D printed prepreg filaments remains miss. Therefore, this study selected suitable impregnation processes and materials to prepare prepreg filaments with different fiber volume fraction and investigated their mechanical properties and microscopic morphologies. The results show that the increase of fiber volume fraction effectively promoted the interface bonding between fiber and resin, and increased capacity for load transfer. When the fiber volume fraction was 54.0 %, the tensile strength of the prepreg filaments and specimens reached 1977 MPa and 334 MPa, respectively. This study can provide a process optimization strategy for the preparation of more types of continuous fiber prepreg filaments with high fiber volume fraction, as well as a data reference for the preparation of high-performance 3D-printed thermoplastic composites.

Description and Outcomes of an Ultrasound-Guided Technique for Catheter Placement in the Canine Quadratus Lumborum Plane: A Cadaveric Tomographic Study and Clinical Case Series.

This study aimed to describe an ultrasound-guided technique for implanting catheters for local anesthetic administration into the quadratus lumborum (QL) inter-fascial plane in canine cadavers and assessing the spread along the vertebral bodies (VBs) by computed tomography (CT). Phase 1: eight canine cadavers received one catheter per hemiabdomen, followed by injection of contrast media solution [low volume (LV) 0.3 mL kg-1 or high volume (HV) 0.6 mL kg-1]. Phase 2: postoperative pain of five dogs was managed by injecting 0.3 mL kg-1 of ropivacaine 0.5% through QL catheters every eight hours, up to 72 h after abdominal surgery. Pain was assessed using the Short Form of the Glasgow Composite Measure Pain Scale, and methadone 0.2 mg kg-1 was administered intravenously when the pain score was ≥6. The number of VBs stained by the contrast solution between the QL and psoas minor muscles was significantly higher in group HV than group LV. The catheter tip was visualized in the retroperitoneal space in 1/16 and 2/10 hemiabdomens in phases 1 and 2, respectively. Rescue analgesia was required in 3/5 dogs during the postoperative period. The QL catheter placement technique appears feasible and may be included in a multimodal analgesic approach for dogs undergoing abdominal surgeries.

A-045 Analytical and Clinical Evaluation of A1c Test by HPLC - Lifotronic™ H100Plus Analyzer - in a Brazilian Clinical Laboratory

Abstract Background Over the years, the measurement of Glycated Hemoglobin (A1c) has solidified as an important risk marker for pre-diabetic patients and for the diagnosis and control of diabetic patients. The High-Performance Liquid Chromatography (CLAE) method has been adopted in prospective studies such as the DDCT, and international certification by the NGSP is available. In this study, analytical performance metrics including imprecision, correlation, linearity, carryover, and detection of hemoglobin variants were evaluated for the Lifotronic® H100 Plus analyzer from China. Methods The results were evaluated following CLSI guidelines on samples within stability, collected according to standardized procedures. For the comparative method, 40 patient samples ranging from 4 to 15.4% were analyzed, and two concentrations of internal quality control material were used for intra-assay (5 repetitions per day) and inter-assay (over five days) imprecision testing. Linearity was assessed using samples at two concentrations, one low (4.5%) and another high (17.2%). For carryover evaluation, low (4.98%), intermediate (9.97%), and high (14.96%) concentrations were assayed in an interleaved manner. Hemoglobin variants found in the studied population were determined using the same method employed in correlation tests (HbS, HbF, HbC, HbE, and HbD). Results The method comparison study revealed a Total Error for decision levels of 5.6%: 2.23% and 6.5%: 1.70%, which were lower than the maximum allowable Total Error of 3.3% (EFLM - EuBIVAS). The difference plot showed that 95% of the results fell within acceptable limits. Positive bias was observed in 7 out of 40 tested samples, predominantly in samples with concentrations above 6,5%, although the medical team assessed it as having no clinical impact. For intra-assay imprecision, the obtained result was 0.86%, and for inter-assay imprecision, it was 0.87%, both deemed acceptable according to the 3.0 % specification proposed by the supplier for the two tested levels.Linearity tests were approved for concentrations proposed by the manufacturer between 3 and 18%, and no carryover was found between samples. All hemoglobin variants previously detected in the comparative method were also identified in the test method without exception, although the specific type of Hb variant was not identified. Conclusions The Lifotronic™ H100Plus analyzer demonstrated approved analytical performance with some notable observations: positive bias was observed in samples with concentrations above 6,5%, though it was not considered clinically relevant, the throughput of 58 tests per hour could be a limitation for laboratories with high testing volumes and the analyzer detected the presence of Hb variants, although it did not identify their specific types.

B-125 Laboratory Profiles for Diagnostic Workup of Acute Abdominal Pain in the Emergency Department: A Comparative Study of University and Non-University Acute Care Hospitals in Germany and Switzerland

Abstract Background Laboratory medicine plays a fundamental role in patient care, especially in emergency departments where rapid diagnosis is critical to the efficient management of high patient volumes. With the aim of simplifying and standardizing laboratory requests, laboratory profiles have widely been established. This study uses the laboratory profile for “acute abdominal pain” as an example to illustrate the extent to which the laboratory profiles used in hospitals differ from each other and whether they are in line with current scientific recommendations. Methods Hospital data and laboratory profiles for “acute abdominal pain” from 18 hospitals, 9 from Germany and 9 from Switzerland, were analyzed and compared. The hospitals were distinguished by bed size, inpatient and outpatient case numbers, country affiliation and university level. In addition, an 'evidence-based laboratory profile' for acute abdominal pain was created based on current guidelines for the five most important causes of acute abdominal pain and compared with hospital laboratory profiles. Results German hospitals include significantly more laboratory parameters into acute abdominal pain profiles than Swiss hospitals (p = 0,0052). No significant differences in the number of laboratory parameters were found between university and non-university hospitals (p = 0,0507). There is a significant positive correlation between the hospital bed size and the number of laboratory parameters in the profiles (r = 0,5521). The number of inpatient cases in a hospital are also positively correlated with the number of laboratory parameters in the profiles (r = 0,4751). The number of outpatient cases ist not associated with the number of laboratory in the profiles parameters (r = 0,0599). The evidence-based laboratory profile for acute abdominal pain includes 21 laboratory parameters, but only two of them are collected by all investigated hospitals (bilirubin and ALAT).There were no significant differences in the fulfillment of the evidence-based laboratory profile between Germany and Switzerland, or between university or non-university status. Conclusions The study shows that there are quantitative and qualitative differences between the laboratory profiles for investigation of acute abdominal pain within the participating hospitals. In Germany and Switzerland there is no consensus on which analyses to include into a profile investigating acute abdominal pain. For increasing efficiency and accuracy of laboratory testing in in the diagnostic workup of acute abdominal pain it seems advisable to obtain consensus on what to reasonably include into a profile on a national or international level.

Long-Term Outcomes After Septal Reduction Therapies in Obstructive Hypertrophic Cardiomyopathy: Insights From the SHARE Registry.

Septal reduction therapy (SRT) provides substantial symptomatic improvement in patients with obstructive hypertrophic cardiomyopathy (HCM). However, long-term disease course after SRT and predictors of adverse outcomes have not been systematically examined. Data from 13 high clinical volume HCM centers from the international SHARE (Sarcomeric Human Cardiomyopathy Registry) were analyzed. Patients were followed from the time of SRT until last follow-up or occurrence of heart failure (HF) composite outcome (cardiac transplantation, implantation of a left ventricular assist device, left ventricular ejection fraction <35%, development of New York Heart Association class III or IV symptoms), ventricular arrhythmias composite outcome (sudden cardiac death, resuscitated cardiac arrest, or appropriate implantable cardioverter defibrillator therapy), or HCM-related death. Cox proportional hazards models were used to identify predictors of outcome. Of the 10 225 patients in SHARE, 1832 (18%; 968 [53%] male) underwent SRT, including 455 (25%) with alcohol septal ablation and 1377 (75%) with septal myectomy. The periprocedural 30-day mortality rate was 0.4% (8 of 1832) and 1499 of 1565 (92%) had a maximal left ventricular outflow tract gradient <50 mm Hg at 1 year. After 6.8 years (range, 3.4-9.8 years; 12 565 person-years) from SRT, 77 (4%) experienced HCM-related death (0.6% per year), 236 (13%) a composite HF outcome (1.9% per year), and 87 (5%) a composite ventricular arrhythmia outcome (0.7% per year). Among adults, older age at SRT was associated with a higher incidence of HCM death (hazard ratio, 1.22 [95 CI, 1.1-1.3]; P<0.01) and the HF composite (hazard ratio, 1.14 [95 CI, 1.1-1.2] per 5-year increase; P<0.01) in a multivariable model. Female patients also had a higher risk of the HF composite after SRT (hazard ratio, 1.4 [95 CI, 1.1-1.8]; P<0.01). De novo atrial fibrillation occurred after SRT in 387 patients (21%). Among pediatric patients followed for a median of 13 years after SRT, 26 of 343 (16%) developed the HF composite outcome, despite 96% being free of recurrent left ventricular outflow tract obstruction. Successful short- and long-term relief of outflow tract obstruction was observed in experienced multidisciplinary HCM centers. A subset of patients progressed to develop HF, but event-free survival at 10 years was 83% and ventricular arrhythmias were rare. Older age, female sex, and SRT during childhood were associated with a greater risk of developing HF.

B-039 Evaluating Inter-Analytic Module Immunoassay Carryover

Abstract Background Integrated analytical systems contain both clinical chemistry analyzers and immunoassay analyzers. Immunoassays can be assigned high priority based on potential sample carryover from sample probes used in clinical chemistry analyzers. The priority designation, assigned by the vendor, determines if the immunoassay test (disposable pipette) is sampled prior to the clinical chemistry test (non-disposable pipette). However, in a modern-day core chemistry laboratory, add-on testing is prevalent. High priority assignment by analytical systems is only effective when a specimen’s tests are analyzed concurrently and doesn’t account for an add-on of any high priority immunoassays. Evaluation of carryover for high priority immunoassays on clinical chemistry analyzers provides insight on if there is clinical impact of allowing add-on testing of these analytes. Methods Intact human chorionic gonadotropin + β-subunit (HCG-BETA, Roche Diagnostics, cobas e602), Procalcitonin (PCT, Roche Diagnostics, cobas e602), and Elecsys Total Prostate-specific Antigen (TPSA, Roche Diagnostics, cobas e602) were the high priority immunoassays evaluated for carryover. High and low target pools were separated into aliquots and baselines for each pool established. High sampling volume assays to potentially generate carryover on the clinical chemistry analyzers were determined to be Sodium (Na, Roche Diagnostics, cobas ISE), Unsaturated Iron-Binding Capacity (UIBC, Roche Diagnostics, cobas c702), and Ammonia (NH3L2, Roche Diagnostics, cobas c502). The ordering sequence of high pool to low pool was then assayed in triplicate on each clinical chemistry analyzer. After potential carryover had been generated, the low pool was again assayed for the immunoassays to evaluate if carryover had occurred and if the carryover exceeded the analyte’s allowable error. Statistical analysis was then performed utilizing Microsoft Excel. Results Conclusions Add-on testing should be restricted for β-HCG and TPSA as a previous clinical chemistry analysis could lead to an errant add-on result due to carryover. PCT is unaffected by previous clinical chemistry analysis.

Deep learning-derived optimal aviation strategies to control pandemics

The COVID-19 pandemic affected countries across the globe, demanding drastic public health policies to mitigate the spread of infection, which led to economic crises as a collateral damage. In this work, we investigate the impact of human mobility, described via international commercial flights, on COVID-19 infection dynamics on a global scale. We developed a graph neural network (GNN)-based framework called Dynamic Weighted GraphSAGE (DWSAGE), which operates over spatiotemporal graphs and is well-suited for dynamically changing flight information updated daily. This architecture is designed to be structurally sensitive, capable of learning the relationships between edge features and node features. To gain insights into the influence of air traffic on infection spread, we conducted local sensitivity analysis on our model through perturbation experiments. Our analyses identified Western Europe, the Middle East, and North America as leading regions in fueling the pandemic due to the high volume of air traffic originating or transiting through these areas. We used these observations to propose air traffic reduction strategies that can significantly impact controlling the pandemic with minimal disruption to human mobility. Our work provides a robust deep learning-based tool to study global pandemics and is of key relevance to policymakers for making informed decisions regarding air traffic restrictions during future outbreaks.

A-107 Sample Matrix Matters: A Precision Study of BioRad, TechnoPath, and Patient Pooled Samples Across 20 High Volume Chemistries and Immunoassays

Abstract Background BioRad is a major provider of QC materials in the US with robust peer data, and Technopath has emerged as a recent competitor, especially on cost. While many factors are considered when selecting QC materials, primary considerations include commutability, matrix effects, decision levels, and acceptability limits. A couple studies comparing BioRad and Technopath QC performance were published in recent years. However, none have compared performance to patient-pooled samples. We undertook a comparison of BioRad/Technopath QC performance, with the addition of patient-pooled samples in order to assess potential matrix effects. Methods We compared precision for 20 high-volume chemistry/immunoassay tests (Table 1) across two levels of BioRad and Technopath QC and a patient pooled sample over 7 days on 2 Abbott Alinity-i and 4 Alinity-C instruments. Each immunoassay control level was run 5 times/day across 10 tests and 7 days per instrument, (i.e., 700 results/level), and the same for chemistry controls (1,400 results/level). Lithium-heparin plasma patient-pool was prepared by obtaining sufficient volume and preparing daily frozen aliquots (i.e., 1400 immunoassay and 2800 chemistry results). Results BioRad and Technopath Chemistry QCs were highly comparable with all levels demonstrating &amp;lt;1% CV difference. Notably, CO2, B12, FT4 pooled-patient CVs were &amp;gt;2% lower than the best performing high control. Additionally, greater differences in performance were observed across immunoassay controls with high BioRad QC performing better for 7 tests. Conclusions Chemistry QC for Technopath and BioRad are largely comparable (i.e., CV differences &amp;lt;1%). Overall, BioRad immunoassay control performance was slightly to somewhat better (i.e., B12, CA125, and CA15-3). B12 and CO2 were particularly unstable (as reflected by patient-pool CVs). That said, differences in performance were not untenable and could be handled based on a tailored approach of extending QC limits if assay/instrument performance allows, and/or changing control material or reagents on a tighter schedule.

Towards enhanced elevated-temperature mechanical properties by regulation of eutectic structure in Al-Cu-Si alloys solidified under super-gravity field

High volume fraction of tri-phase eutectic structure is challenging to obtain in ternary alloys through conventional methods. Currently, we reported that super-gravity solidification can be utilized to obtain high-volume fraction Al-Al2Cu-Si tri-phase eutectic structure in Al-Cu-Si alloys. The refinement of the eutectic structure can be detected mainly due to the enhancement of mass transfer, affecting the nucleation rate and growth of eutectic phase in the Al-Cu-Si eutectic system. Interestingly, the refined Al2Cu and Si eutectic structures are stable even up to 300 °C thermal exposure without obvious coarsening, contributing to the enhancement of elevated-temperature mechanical properties (∼268.8±8.8 MPa at 300 °C), which is ∼51.9 % higher than those solidified under normal gravity field (∼177.0±1.9 MPa). The refinement and homogeneous distribution of more Al-Al2Cu-Si tri-phase eutectic structures provide better stress dispersion, favoring crack initiation and propagation within the tri-phase eutectics, resulting in a transition from brittle fracture to ductile fracture mode.

B-121 Optimizing Test Ordering: Leveraging Heuristics in Naming Conventions - A PSA Case Study

Abstract Background A common screening test for prostate cancer is the Prostate-Specific Antigen (PSA) test, which may also be referred to as total PSA or total PSA plus free PSA, among other variations. Looking at the test menus of two major reference laboratories, it's apparent that PSA can be ordered under thirteen different test names. From an end-user perspective, the question arises: which of these thirteen tests should be ordered, and why are there so many options? This plethora of choices can lead to confusion and uncertainty for clinicians and patients alike. According to various guidelines, ordering Free PSA is only warranted when PSA values exceed 4 ng/ml. In such cases, the ratio of free PSA to total PSA can aid in further clinical decision-making and patient workup. At Zuckerberg San Francisco General Hospital (ZSFGH), we offer two tests for PSA. The first is named “Prostate Specific Antigen” is total PSA done in house, while the second is labeled “Prostate Spec. Ag. Total and Free.” which is sent out to a reference lab. Upon reviewing our send-out orders, we observed a significant increase (376%) from 2022 to 2023 in the use of the send out order. Methods The ordering data for our providers was collected from February 2022 to January 2024 for both in-house and send-out orders. The data was analyzed using descriptive statistics in Microsoft Excel. Results In our population, we observed an abnormal concentration of send-outs originating from a select group of physicians. Additional we also identified a group of providers who only selected the send out test order. Analysis of in-house assay results for PSA revealed that only 15% (1292 out of 8136) exceeded the cutoff of 4 ng/ml, necessitating further testing to inform clinical decision-making. Yet our send out volume of 4157 test is in discordance with how many PSA would need further evaluation. Based on a cost analysis reducing the send out volume by 80% could result in $53,210 savings. Therefore, to reduce the send out amount and to keep the naming convention similar we decided to implement a new test name that would reflex the PSA to Free PSA if the PSA is above 4 ng/ml. We decided on the name “Prostate Specific Antigen total with reflex to Free Prostate Specific Antigen”. Conclusions Our investigation into the variability in PSA test ordering revealed a significant disparity in the number of send-out orders, particularly originating from a select group of physicians. However, the disproportionately high volume of send-out tests suggested an inefficiency in the current testing approach. To address this issue and align with clinical guidelines, we decided to process a request to our medical executive committee for approval for this reflex test in order to meet reimbursement compliance with the Office of the Inspector General. This change aims to streamline the process, reduce unnecessary send-out tests, and ultimately improve the efficiency and accuracy of prostate cancer screening at our institution.

Randomized trial demonstrating no translocation of intact intestinal bacteria during hemodialysis or hemodiafiltration

IntroductionThe low incidence of intradialytic hypotension (IDH) in high-volume (HV) hemodiafiltration (HDF) may help maintaining gut perfusion during treatment. Preservation of gut endothelial integrity would limit or prevent bacterial translocation and subsequent systemic inflammation, which may contribute to the low mortality rate in HV-HDF. MethodsForty patients were cross-over randomized to S-HD, cool HD (C-HD) and HDF (low-volume [LV] and HV, convection volumes 15 L resp. ≥23 L/session), each for 2 weeks. Quantitative assessment of microbial DNA (mDNA) in blood was performed before and after dialysis by 16S-23S interspace profiling after DNA isolation. The intradialytic acute phase response (APR) was evaluated by high-sensitivity CRP (hs-CRP), IL-6 receptor (IL-6R), soluble CD14 (sCD14) and vascular-cell-adhesion molecule-1 (VCAM-1). Differences between modalities were primary objectives. ResultsMDNA was absent in all samples. IL-6R, sCD14, and VCAM-1 increased equally in all modalities (median increase resp.: 12.5%, 14.0%, 14.8%, P<0.05). Hs-CRP increased only in C-HD and HV-HDF (median increase: 12.6%, P<0.05). After correction for hemoconcentration, most APR-markers decreased (median: sCD14 -11.3% and VCAM-1 -14.4% in all modalities; IL-6R -13.4% in C-HD, LV- and HV-HDF; P<0.05). Hs-CRP only decreased in C-HD (-13.5%, P=0.004). Conclusions1) Circulating mDNA could not be demonstrated; 2) while in the crude analysis a similar APR was noted in all modalities, individual markers remained stable or declined after correction for hemoconcentration; 3) as neither bacterial translocation nor an APR was observed in either modality, it is highly unlikely that the superior survival of HV-HDF is explained by superior preservation of gut integrity.

Impact of Center Volume on the Use of Status 2 Exceptions for Heart Transplantation.

There are limited data examining the relationship between transplant center volume and their use of Status 2 exceptions for heart transplant (OHT). A retrospective review of the Organ Procurement and Transplantation Network (OPTN) database identified all patients undergoing OHT under Status 2 exception between late 2018 and early 2023. Demographics were collected and transplant centers were categorized based on the number of OHT performed annually (very low volume = < 5 OHT per year; low volume = 5-24 OHT per year; medium volume = 25-50 OHT per year, high volume = > 50 OHT per year). Across all centers, 6348 OHT were included, with n = 68 performed at very low volume centers, n = 1001 performed at low volume centers, n = 1834 performed at medium volume centers, and n = 3445 performed at high volume centers. Medium and high volume centers applied for at least one Status 2 exception about 30%-35% of the time, compared to 50%-60% of the time observed at very low and low volume centers. Compared to very low volume centers, medium volume centers applied for half the amount of Status 2 exceptions (IRR = 0.52 [0.35-0.76]; p < 0.001) while high volume centers applied for less than half the amount (IRR = 0.42 [0.29-0.62]; p < 0.001). High-volume centers were also 18% less likely to apply for exceptions than medium-volume centers (IRR = 0.82 [0.74-0.91]; p < 0.001). Lower volume transplant centers apply for Status 2 exceptions at a significantly higher rate, with a stepwise decrease in exception use with increasing transplant center volume.

Sustaining superior visibility within digital platforms through inside and outside competitive action repertoires

Although often credited with leveling the competitive playing field, platforms pose novel challenges for millions of complementors within their ecosystems. This study explores the tactics complementors use to maintain superior visibility on these platforms. Building on competitive repertoire theory, we conceptualize two categories of competitive actions that capture the dual environmental complexity faced by complementors: inside and outside competitive moves. We assemble a unique dataset from a leading food delivery platform in Europe, providing a comprehensive view of complementors’ competitive repertoires and visibility over ten months. We find that complementors’ inside competitive repertoires with high volume and complexity are associated with sustained superior visibility. However, we also find that complementors whose competitive repertoires diverge from those of their competitors are more likely to exit the superior visibility strata. Additionally, we identify outside action repertoires as a second pathway to differentiation, built on complementors’ idiosyncratic resources and less dependent on platform architecture and rules.

Creation and evaluation of a three-dimensional-printed synthetic vas deferens for microsurgical training

ABSTRACT Introduction: Individuals choose to undergo vasectomy reversal for a variety of reasons, including remarriage or due to the death of a child. To be proficient in this procedure, the surgeons need to be high volume and the trainees require a safe environment to develop their microsurgical skills. To overcome this challenge, we used three-dimensional (3D) printing to create a synthetic model of the vas deferens with properties similar to the human vas deferens. We distributed this model to experienced microsurgeons for evaluation. Methods: The vas deferens model was created using thermoplastic polyurethane filament. The filament was then infused with a foaming agent to allow for temperature-dependent tuning of the material’s stiffness. The model’s outer diameter was 1 mm and the inner lumen was 0.5 mm. Fellowship-trained male reproductive urologists were recruited from the Society for the Study of Male Reproduction website. They used our model and judged it on several factors by completing a 13-question survey. Results: We received completed evaluations from five microsurgeons. Eighty percent of the surgeons were able to complete a full anastomosis on the model using 9-0 and 10-0 sutures. The majority of the completed anastomoses were performed using the one-layer technique. The average responses for the model’s usefulness as a practice tool, a training tool, and overall assessment ranged from 72 to 79 out of 100. Comments for the improvement included the need for a more flexible and softer model. Conclusions: We created a 3D-printed synthetic vas deferens that serves as a valuable training and practice tool.

Achievement of international benchmark outcomes for robotic pancreaticoduodenectomy in a low volume country

BackgroundRecently, there has been an increase in the utilisation of the robotic platform to perform minimally invasive pancreaticoduodenectomy in high volume centres, with the goal of reducing morbidity and improving patient outcomes. This study reports the successful implementation of a robotic pancreaticoduodenectomy (RPD) programme in the relatively low volume setting of Australia, measured against established, internationally accepted benchmarks for low-risk open pancreaticoduodenectomy (OPD). MethodsRetrospective review of a prospectively maintained database for consecutive RPD at two Brisbane hospitals was performed, comparing data to internationally established benchmarks for low-risk OPD. A structured RPD programme was implemented by two surgeons across a study period spanning May 2017 to December 2023. ResultsOver the study period, seventy-two consecutive RPDs were performed, with 79 % for malignancy. Perioperative outcomes for transfusions, conversion rate, postoperative fistula rate, morbidity, mortality and oncological outcomes were all within established benchmark cutoffs for low-risk open pancreaticoduodenectomy (OPD), although operative time exceeded the benchmark value by 0.7hrs. ConclusionA carefully implemented RPD programme in the low volume Australian setting is feasible, with high quality outcomes achievable when compared to established benchmarks for low-risk OPD and to reported RPD series published by high volume pioneering centres.

Less Is More: Dissecting Trauma Centers by Procedural Volume.

This study aims to examine the relationship between procedural volume and annual trauma volume (ATV) of ACS Level I trauma centers (TC). Although ATV is a hard criterion for TC verification, importance of procedural interventions as a potential quality indicator is understudied. Patients managed at ACS level I TCs were identified from ACS-TQIP 2017-2021. TCs were identified using facility keys and stratified into quartiles based on ATV into low, low-medium, medium-high, and high volume. TCs were also stratified into tertiles [low (LV), medium (MV), high (HV)] based on procedural volume by assessing annual number of laparotomies, thoracotomies, craniotomies/craniectomies, angioembolizations, vascular repairs, and long bone fixations performed at each center. The Cohen κ statistic was used to assess concordance between ATV and procedural volume. A total of 182 Level I TCs were identified: 76 low, 47 low-medium, 35 high-medium, and 24 high volume. Long bone fixation, laparotomy, and craniotomy/craniectomy were the most performed procedures with a median of 65, 59, and 46 cases/center/year, respectively. Overall, 31% of HV laparotomy centers, 31% of HV thoracotomy centers, 22% of HV craniotomy/craniectomy centers, 22% of HV vascular repair centers, 32% of HV long bone fixation centers, and 33% of HV angioembolization centers contributed to the overall number of low-medium and low-volume TCs. The Cohen κ statistic demonstrated poor concordance between ATV and procedural volumes for all procedures (overall procedural volume-κ=0.378, laparotomy-κ=0.270, thoracotomy-κ=0.202, craniotomy/craniectomy-κ=0.394, vascular repair-κ=0.298, long bone fixation-κ=0.277, angioembolization-κ=0.286). ATV does not reflect the procedural interventions performed. Combination of procedural and ATV may provide a more accurate picture of the clinical experience at any given TC. Level III.

Towards Frugal Industrial AI: a framework for the development of scalable and robust machine learning models in the shop floor

AbstractArtificial intelligence (AI) among other digital technologies promise to deliver the next level of process efficiency of manufacturing systems. Although these solutions such as machine learning (ML) based condition monitoring and quality inspection are becoming popular, these work under very limited conditions. Solutions do not scale-up in the real environment, where there is a mix of manufacturing equipment, where the quality and quantity of data available changes from machine to machine, or where the process changes, changing the distribution of data (i.e. concept drift). This is particularly challenging in highly reconfigurable and flexible environments. Having to develop machine learning models from scratch every single time is not cost-effective, time-consuming, requires expert knowledge that is typically not available in the manufacturing environment as well as can be challenging when data is not available in high volumes. Model robustness, reusability, adaptability and life cycle management are the keys to scale-up this technology in the manufacturing industry. In this work, a conceptual framework to enable simple and robust ML model development for the shop floor is introduced. Referred here as Frugal Industrial AI, the approach takes advantage of existing models and their context to build more robust ones in a data-efficient manner. Using a semantic knowledge base of how to construct these models for different manufacturing applications and semi-automating the development or reuse of solutions through semantic similarity, it is demonstrated how models can be developed in a more streamlined way. In addition, it is demonstrated how capturing process context information is important for the effective reuse of existing models through continual learning. This is key to building more robust ML solutions that can deal with real changing manufacturing environments, avoiding retraining from scratch as well as enabling the non-expert to use AI effectively on the shop floor.

The more you test, the more you find: Expansion of routine urine drug screening facilitated through an embedded palliative care clinic in thoracic oncology.

194 Background: Consensus guidelines strongly recommend urine drug screening (UDS) for all patients receiving opioids for cancer pain management. However, implementation of UDS in oncology clinics is underreported. The primary aim of this study was to evaluate incidence of unexpected UDS results among patients with lung cancer after implementation of confirmatory UDS in a thoracic oncology clinic. Methods: This is a single-institution retrospective study of UDS results among patients diagnosed with any stage thoracic malignancy before and after expansion of chromatography-based UDS facilitated by a palliative care provider embedded in a thoracic medical oncology clinic. Patients were included if their first UDS was collected during the year prior to (pre-intervention) or during the 12 months after (post-intervention) opening of the embedded Thoracic Onco-Palliative Clinic on September 5, 2018. In the pre-intervention period, UDS was routinely ordered for only patients referred to a standalone palliative care clinic. This 2-step UDS includes immunoassay and chromatography-based testing followed by interpretation of results by a specialty-trained palliative care clinical pharmacist. In the post-intervention period, UDS was expanded to include any patient seen by Thoracic Medical Oncology regardless of palliative care referral status. A Kaplan-Meier curve and log-rank test were used to compare time to first unexpected UDS between cohorts. Results: More patients had UDS testing in the post-intervention (n = 182) versus pre-intervention (n = 61) period. A higher volume and proportion of patients had unexpected UDS results in the post-cohort (25/182; 13.7%) compared to pre-cohort (6/61; 9.8%), although this difference was not statistically significant (p = 0.43). The number of UDS tests per patient was significantly higher (p &lt; 0.01) in the post-cohort (mean (SD): 2.4 (2.7)) vs. pre-cohort (1.5 (1.3)). A larger proportion of pre-cohort patients completed only one UDS during the study period (pre: 73.8% (45/61); post: 53.3% (97/182); p &lt; 0.01). In the post-cohort, 58 (31.9%) patients completed UDS ordered by oncology team prior to palliative care referral compared to 0 patients in the pre-cohort; 29 (21.4%) patients completed UDS without receiving outpatient palliative care compared to 0 patients in the pre-cohort. Kaplan-Meier curves for the pre- and post-cohorts were similar during the first 6 months of drug screening (p = 0.7) and diverged after 6 months, with a higher probability of detecting an unexplained UDS in the post cohort at 24 months (Pre: 15.0%; Post: 40.0%). Conclusions: Implementation of confirmatory UDS in a thoracic oncology clinic facilitates closer monitoring for nonprescribed substance use during opioid management and continued detection of unexpected UDS results up to 24 months.

Association between Endoscopist Volume and Interval Cancers after Colonoscopy: Results from the National Colorectal Cancer Screening Program in Korea.

The rate of interval colorectal cancer (iCRC) is now accepted as a key performance indicator of organized colorectal cancer (CRC) screening programs. We aimed to examine the association between endoscopist volumes and the rate of iCRC among individuals with a positive fecal immunochemical test (FIT) within a nationwide population-based CRC screening program. Individuals aged ≥ 50 years who underwent colonoscopy after a positive FIT from January 1, 2019 until December 31, 2020 in the Korean National Cancer Screening Program (KNCSP) were enrolled. We converted the data into per-endoscopist screening results, calculated the iCRC rates per endoscopist, and compared them to the previous year's annual volume that was divided into five groups (V1, 1-9; V2, 10-29; V3, 30-59; V4, 60-119; V5, ≥ 120). A total of 10,412 endoscopists performed 216,907 colonoscopies. Overall, the average rate of iCRC per endoscopist was 8.46 per 1,000 examinations. Compared with the group with the highest volume (V5 group), the rate of iCRC was 2.21 times higher in the V1 group. Similar trends were observed in the other groups (V2: relative risks [RR], 2.15; 95% confidence interval [CI], 1.57 to 2.94; V3: RR, 1.56; 95% CI, 1.15 to 2.13; V4: RR, 1.18; 95% CI, 0.83 to 1.67). The findings emphasize that endoscopists with lower procedure volumes have higher risks of interval cancer being missed or undetected. To maximize the preventative impact of colonoscopy for CRC, this issue should be addressed by monitoring endoscopist volumes and variations in performances.

A Nomogram Predicting Testicular Sperm Extraction Success in Men With Non-obstructive Azoospermia: A Multi-center Study

ObjectivesTo develop an efficient and easy-to-use nomogram which can predict testicular sperm extraction(TESE) success in men with non‐obstructive azoospermia(NOA) by using pre-operative parameters. Materials and MetodsData of 3093 men who underwent TESE for NOA were included in this study. Demographic data, testis volumes, presence of varicocele, length of infertility, history of previous surgeries, history of genitourinary infections, smoking status, chromosome abnormalities, presence of Y-chromosome microdeletion, family history of infertility, testis biopsy, surgical data, sperm retrieval rate, final pathology obtained at testicular sperm extraction, follicle stimulating hormone, luteinizing hormone, testosterone levels were recorded. The primary outcome was to develop an efficient nomogram which can predict the TESE success in men with NOA. The secondary outcomes were identifying the significant pre-operative parameters which are associated with success in TESE. ResultsSperm retrieval rate was 50.2%(1553/3093). Testis volume, history of varicocelectomy, chromosome abnormalities, presence of Y-chromosome microdeletion were shown to affect sperm retrieval rate significantly(p<0.05). Sperm retrieval success was higher in men with older age, higher testis volume(>10mL), lower follicle stimulating hormone level(≤ 12.92mIU/mL), lower luteinizing hormone level, and higher testosterone level(p<0.05). Only testis volume and patient’s age were associated with succesful sperm retrieval in multivariate logistic regression analysis. ConclusionIn men with NOA, high testis volume, old age, low follicle stimulating hormone level, low luteinizing hormone level, and high testosterone level are advantageous for successful sperm retrieval in TESE. Herein we present a nomogram which can predict the outcome of TESE in men with NOA with adequate success.