International Benchmarking Research Articles

Description of Candida auris Occurrence in a Tertiary Health Institution in Riyadh, Saudi Arabia.

Candida auris is an emerging multidrug-resistant fungal pathogen that represents a current serious threat to healthcare settings. The objective was to determine the prevalence of C. auris in a Riyadh hospital since its initial detection in late 2019. Using an adapted risk assessment tool, we reviewed the charts and medical files of all suspected and confirmed cases of C. auris infections reported at King Khalid University Hospital, Riyadh, between November 2019 and December 2022. Anonymized data were retrieved in a pre-established datasheet and analyzed to determine the epidemiological characteristics of C. auris infections in our facility. We analyzed prevalence by age, gender, risk factors, and according to sampling source. Of the 53 confirmed C. auris-positive cases during the study period, 33 (62%) were males. Their ages ranged between 15 and 98, with most positive cases occurring in those aged 50 and above. Only one of the confirmed cases was hospital-acquired. All patients had at least one risk factor, and urine samples yielded the greatest number of positive cases, while admission to healthcare facilities constituted the highest risk in our study. Establishing a local prevalence pattern could serve as a baseline/benchmark to compare with regional and international benchmarks.

The macrologistics effect of a state-owned enterprise, Transnet, on the South African economy

Background: Transnet moves around 80% of South Africa’s rail-friendly freight tonne-kilometres, which drops to less than 40% if the rail-only coal and iron ore export lines are excluded.Objectives: Calculating the costs, negative externalities, and job losses caused by Transnet’s recent and historical operational issues and using the results to inform future reform possibilities.Method: Aspects contributing to Transnet’s failures are indicated through an assessment of rail freight’s decreasing market share and infrastructure investment, port ownership and inefficiency concerns, Transnet’s deteriorating financial performance, loss of critical skills, and instances of state capture. Resultant costs and their impact on employment are calculated across various freight flow segments, whereafter reform models are suggested through international benchmarking and extracting lessons from relevant global reforms.Results: The cost of Transnet’s failures are estimated as 7.43% of gross domestic product. A healthy relationship between the government and the private sector is a frequent occurrence in successful reforms seen globally. Locally, recent government reforms acknowledge a meaningful role for the private sector, which is in turn offering pragmatic and achievable solutions.Conclusion: Improved private sector participation can contribute to Transnet’s recovery. South Africa depends on this collaboration and the development of port and rail master plans to guide the infrastructure development required to meet its overall transportation needs.Contribution: Actionable implications for policy implementation, the economic regulation and horizontal separation of the freight railway, shifting freight from road to rail, the corporatisation of the port authority, and increasing port efficiency and capacity.

Navigating Interoperability in Disaster Management: Insights of Current Trends and Challenges in Saudi Arabia

In this rapid review, we critically scrutinize the disaster management infrastructure in Saudi Arabia, illuminating pivotal issues of interoperability, global cooperation, established procedures, community readiness, and the integration of cutting-edge technologies. Our exploration uncovers a significant convergence with international benchmarks, while pinpointing areas primed for enhancement. We recognize that continual commitments to infrastructural progression and technology adoption are indispensable. Moreover, we underscore the value of robust community involvement and cross-border collaborations as key factors in bolstering disaster response capabilities. Importantly, we spotlight the transformative influence of emerging technologies, such as artificial intelligence and the Internet of Things, in elevating the effectiveness of disaster management strategies. Our review champions in all-encompassing approach to disaster management, which entails harnessing innovative technologies, nurturing resilient communities, and promoting comprehensive disaster management strategies, encapsulating planning, preparedness, response, and recovery. As a result of our analysis, we provide actionable recommendations to advance Saudi Arabia’s disaster management framework. Our insights are timely and crucial, considering the escalating global focus on disaster response in the face of increasing disaster and humanitarian events.

OP102 Towards Universal Health Coverage: Health Technology Assessment Roadmap Development In The Emirate Of Abu Dhabi Involving The Whole Ecosystem

IntroductionThe mission of the Department of Health (DoH) of Abu Dhabi in the United Arab Emirates is to provide its population with a healthy life and world leading preventive and curative services. While the DoH has regulations in place to grant market approval to new health technologies, there is a need to develop a clear overall framework for reimbursement and disinvestment decisions. Establishing a structured health technology assessment (HTA) framework is critical for informing decisions on health technologies that offer value for money, with the aim of improving equitable access to health care, financial risk protection, and, ultimately, better health outcomes.MethodsDuring 2022, the DoH collaborated with the Radboud University Medical Center to explore the feasibility of applying an evidence-informed deliberative process (EDP) HTA approach through workshops and interviews involving all stakeholders in the ecosystem, such as policy makers, principal investigators, providers, patients and public groups, product manufacturers, payers, and purchasers. A situational analysis was conducted to collect stakeholders’ views and build EDPs. Based on this analysis, a structured roadmap was developed.ResultsThe comprehensive five-year roadmap to implement a holistic HTA framework in Abu Dhabi consisted of five major elements, starting with the establishment of an appropriate HTA policy framework as a foundation. Abu Dhabi should firmly establish its HTA structure and program (in one to two years), and at the same time invest in developing and retaining HTA training capacity so that over time (within three to five years) the country can build up its own expertise to sustain the program. This needs to be accompanied by continuous awareness raising among all relevant stakeholders.ConclusionsThis roadmap is the first and most important step toward implementing a holistic HTA framework in Abu Dhabi. Technical work needs to be complemented by continuously raising awareness and involving all relevant stakeholders. Looking at the initial results and international benchmarks, HTA will significantly contribute to achieving a sustainable, high quality healthcare system.

Staring at the Sun with the Keck Planet Finder: An Autonomous Solar Calibrator for High Signal-to-noise Sun-as-a-star Spectra

Extreme precision radial velocity (EPRV) measurements contend with internal noise (instrumental systematics) and external noise (intrinsic stellar variability) on the road to 10 cm s−1 “exo-Earth” sensitivity. Both of these noise sources are well-probed using “Sun-as-a-star” RVs and cross-instrument comparisons. We built the Solar Calibrator (SoCal), an autonomous system that feeds stable, disk-integrated sunlight to the recently commissioned Keck Planet Finder (KPF) at the W. M. Keck Observatory. With SoCal, KPF acquires signal-to-noise ratio (S/N) ∼ 1200, R = 98,000 optical (445–870 nm) spectra of the Sun in 5 s exposures at unprecedented cadence for an EPRV facility using KPF’s fast readout mode (<16 s between exposures). Daily autonomous operation is achieved by defining an operations loop using state machine logic. Data affected by clouds are automatically flagged using a reliable quality control metric derived from simultaneous irradiance measurements. Comparing solar data across the growing global network of EPRV spectrographs with solar feeds will allow EPRV teams to disentangle internal and external noise sources and benchmark spectrograph performance. To facilitate this, all SoCal data products are immediately available to the public on the Keck Observatory Archive. We compared SoCal RVs to contemporaneous RVs from NEID, the only other immediately public EPRV solar data set. We find agreement at the 30–40 cm s−1 level on timescales of several hours, which is comparable to the combined photon-limited precision. Data from SoCal were also used to assess a detector problem and wavelength calibration inaccuracies associated with KPF during early operations. Long-term SoCal operations will collect upwards of 1000 solar spectra per six-hour day using KPF’s fast readout mode, enabling stellar activity studies at high S/N on our nearest solar-type star.

Analysis of the Integrated Basic Sanitation Concession Model Adopted by the Municipality of São Simão, Goiás

Objective: To assess the integrated concession model adopted by São Simão, a municipality in the state of Goiás, which encompasses water supply, sanitary sewage, and urban solid waste management services. Theoretical Framework: Law 14,026 established the year 2033 for the universalization of water supply and sanitation services and the year 2024 for the implementation of environmentally adequate final disposal in Brazilian municipalities (Brasil, 2020a). Due to reduced federal funding for investment, the federal government has sought the involvement of private entities to ensure the capacity for investment, operation, and maintenance of these services. Method: Information about the federal government's strategy was obtained from the websites of the Ministries of Regional Development and Economy and the Caixa Econômica Federal. For the case study of the integrated concession, research was conducted on the reference studies of the modeling and the bidding notice, made publicly available by the municipality on its website. Results and Conclusion: The tariffs obtained in the concession modeling indicate an average commitment of 4.12% of the household income, in line with international benchmarks for expenditure on basic sanitation and consistent with market-practice values. Tariff affordability and the economic-financial feasibility of the project were enhanced by the synergy among the three sanitation sectors. Research implications: The model enables the achievement of the goals set by the new legal framework for sanitation through a standard concession, without any counterpart or additional input from the municipality. Originality/Value: The integrated concession model represents an innovative venture with the potential to boost the economic and financial sustainability of universal access to basic sanitation in the country.

Towards an All-Ireland Diamond Open Access Publishing Platform

This talk will present a progress report on the ‘PublishOA.ie’, project in Ireland (2022-24). The objective of PublishOA.ie is to conduct a feasibility study for an All-Ireland digital publishing platform for Diamond Open Access (OA) journals and books, designed to advance best practice and meet the needs of authors, readers, publishers and funders in Irish scholarly publishing.The project is unique in its mandate to report on the feasibility of a shared platform that will be ‘national’ in scope, but encompass academic publishing across two jurisdictions, which are now, post-Brexit, inside and outside the EU: the Republic of Ireland and Northern Ireland in the United Kingdom. The project is led by the Royal Irish Academy (RIA) and Trinity College Dublin (TCD) with 16 partners and affiliates from universities and organisations from the island of Ireland. It is supported by the National Open Research Forum of Ireland (NORF). Publishers and authors of books and journals are collaborating with international and national experts to conduct this feasibility study. First, a research exercise to map Irish academic publishing is being carried out for the first time, and a directory of all publishers in Ireland was published in June 2023.The feasibility study will be based on a review of publishing practices in the island of Ireland, with gap analysis on standards, technology, processes, copyright practices and funding models for Diamond OA, international benchmarking and requirements specification leading to the delivery of a pilot national publishing platform. A set of demonstrator journals and monographs will be published using the platform, which will be actively trialled by the partner publishers and authors.PublishOA.ie is guided by the experience and expertise from members of our international advisory group, including TSV (Finland), Openjournals.nl, DOAJ, SDG Academy, JSTOR, cOAlition S and DIAMAS. Consultation with these international organisations and institutions, all of which have demonstrable and significant experience in the field, are assisting us in analysing and discussing potential solutions to deploy, and where relevant, avail of existing developments. These discussions are proving especially valuable in the context of policy compliance (e.g. cOAlition S), technical advice (e.g. TSV’s use of Public Knowledge Project’s Open Journal Systems), and potential OA content provision.Diverse disciplinary perspectives e.g. from Irish Humanities Alliance, TCD Long Room Hub, Moore Institute (Arts and Humanities) at the University of Galway, Irish Open Access Publishers (IOAP) (multiple disciplines including Social Sciences and STEM), Dublin Institute of Advanced Studies (DIAS) (Physics, Irish language) and the RIA (multiple disciplines including STEM) will be integrated with international best practice. This will inform decisions on models and technical infrastructure tested and trialled ensuring their validity in the Irish context as well as their international validity.Bibliodiversity is at the heart of the PublishOA.ie project, as is long-term sustainability. Publishing in Ireland must always have regard to the considerably larger and better resourced publishing trade in the next-door United Kingdom, where Irish authors, writing as they do in English, have historically had strong representation.PublishOA.ie, aims to increase all-island connections and relationships within and between groups and individuals in scholarly publishing. The All-Ireland nature of the project strengthens the Shared Island initiative of the Government of Ireland.PublishOA.ie aims to deliver evidence-based understanding of Irish scholarly publishing and of the requirements of publishers to transition in whole or in part to Diamond OA. It will result in increased knowledge of the needs of publishers and authors in Ireland to move towards Diamond OA publishing. Critically, PublishOA.ie will aim to increase awareness and engagement by policymakers of the system-level risks, challenges and opportunities for a publicly owned, centralised platform for Diamond OA publication of journals and books in Ireland.

Challenges in permeability characterisation for modelling the manufacture of wind turbine blades

As wind turbine blades continue to increase in size, and market competition grows, lean manufacturing has become even more important for OEMs. The rapid development of new blade designs, with greater performance, and reduced production waste are driving the need for predictive modelling of the blade infusion process. Such simulations are reliant upon Darcy’s Law for the description of fluid flow through porous materials and therefore depend greatly on the permeability properties of the blade preform materials. The characterisation of fabric permeability, although unstandardised, has been well studied in recent years as the focus of numerous international benchmarking efforts. However, the effective permeability properties of infusion consumables, core materials, and pre-cast elements are not so well defined or validated, despite their significance on infusion behaviour. Hence, the great variety of preform materials, stacking configurations, geometric features, and transition regions in wind turbine blades present considerable challenges in terms of permeability characterisation and subsequent modelling. This article reviews some of the challenges, opportunities, and alternatives for characterising permeability in common blade preform materials, along with examples of how these properties have been applied in numerical models to better simulate the resin infusion manufacturing process for wind turbine blades.

How ready is the wind energy industry for the circular economy?

Despite the strong contribution of wind energy for decarbonisation, the readiness of the wind industry for the transition to a sustainable circular economy (CE) is still unclear. To support CE innovation in the wind industry, this paper assesses the circularity readiness of six business units from three global manufacturers of wind turbine components (Siemens Gamesa Renewable Energy - gearboxes and blades, INGETEAM - generators and power converters, and HINE - hydraulic units and cooling systems). The readiness assessment was carried out in a workshop setting following the ready2LOOP methodology, covering eight business dimensions: i) Organisation; ii) Strategy and Business Model Innovation; iii) Product and Service Innovation; iv) Manufacturing and Value Chain; v) Technology and Data; vi) Use, Support and Maintenance; vii) Takeback and End-of-Life Management; and viii) Policy and Market. Subsequently, the circularity readiness profile of each business unit was analysed in relation to internal and external benchmarking (between business units and across machinery manufacturing companies, respectively). On the basis of the readiness assessment, six areas were prioritised for CE innovation within the wind industry, namely: (1) implementing circular criteria and indicators in product design and public tender processes; (2) ensuring components´ tracking and monitoring over their life cycle; (3) implementing efficient reverse logistics; (4) exploring alternative business model concepts; (5) improving recycling technologies for higher material quality outcomes; and (6) develop circular wind hubs for information and data sharing. The findings provide guidance for renewable energy policymakers, researchers, and industry stakeholders in pursuing the sustainable energy transition, through enhanced circularity performance.

Development and implementation of quality indicators in a group of nine psychiatric hospitals

Quality indicators (QI) are becoming increasingly important in mental healthcare in Germany. QI can be used for various purposes, such as for creating transparency as well as for benchmarking between hospitals. QI themselves are subject to high quality standards. The aim of this report is to describe the development and implementation of QI in a group of psychiatric hospitals. Since 2015, the LVR hospital group has developed and gradually implemented QI for the purposes of quality measurement, quality assurance and internal benchmarking in its nine psychiatric hospitals in a comprehensive, multidisciplinary, scientifically accompanied process. The full LVR-QI set, consisting of eight structure-, twelve process- and four outcome indicators as well as one patient satisfaction questionnaire, was implemented by 2019. In order to create high documentation quality and acceptance by clinicians, various implementation and dissemination strategies were used, such as written documentation manuals, staff training as well as regular face-to-face communication between the LVR hospitals, the LVR Institute for Health Services Research as the central coordinating body and the headquarters of the LVR hospital group. The QI led to a quality-oriented dialogue within and between the LVR hospitals.

European value-based healthcare benchmarking: moving from theory to practice.

Value-based healthcare (VBHC) is a conceptual framework to improve the value of healthcare by health, care-process and economic outcomes. Benchmarking should provide useful information to identify best practices and therefore a good instrument to improve quality across healthcare organizations. This paper aims to provide a proof-of-concept of the feasibility of an international VBHC benchmarking in breast cancer, with the ultimate aim of being used to share best practices with a data-driven approach among healthcare organizations from different health systems. In the VOICE community-a European healthcare centre cluster intending to address VBHC from theory to practice-information on patient-reported, clinical-related, care-process-related and economic-related outcomes were collected. Patient archetypes were identified using clustering techniques and an indicator set following a modified Delphi was defined. Benchmarking was performed using regression models controlling for patient archetypes and socio-demographic characteristics. Six hundred and ninety patients from six healthcare centres were included. A set of 50 health, care-process and economic indicators was distilled for benchmarking. Statistically significant differences across sites have been found in most health outcomes, half of the care-process indicators, and all economic indicators, allowing for identifying the best and worst performers. To the best of our knowledge, this is the first international experience providing evidence to be used with VBHC benchmarking intention. Differences in indicators across healthcare centres should be used to identify best practices and improve healthcare quality following further research. Applied methods might help to move forward with VBHC benchmarking in other medical conditions.

Stem Detection from Terrestrial Laser Scanning Data with Features Selected via Stem-Based Evaluation

Terrestrial laser scanning (TLS) is an effective tool for extracting stem distribution, providing essential information for forest inventory and ecological studies while also assisting forest managers in monitoring and controlling forest stand density. A feature-based method is commonly integrated into the pipelines of stem detection, facilitating the transition from stem point to stem instance, but most studies focus on feature effectiveness from the point level, neglecting the relationship between stem point extraction and stem detection. In this paper, a feature-based method is proposed to identify stems from TLS data, with features selected from stem levels. Firstly, we propose a series of voxel-based features considering the stem characteristics under the forest. Then, based on the evaluation of some commonly used and proposed features, a stem-based feature selection method is proposed to select a suitable feature combination for stem detection by constructing and evaluating different combinations. Experiments are carried out on three plots with different terrain slopes and tree characteristics, each having a sample plot size of about 8000 m2. The results show that the voxel-based features can supplement the basic features, which improve the average accuracy of stem point extraction and stem detection by 9.5% and 1.2%, respectively. The feature set obtained by the proposed feature selection method achieves a better balance between accuracy and feature number compared with the point-based feature selection method and the features used in previous studies. Moreover, the accuracies of the proposed stem detection methods are also comparable to the three methods evaluated in the international TLS benchmarking project.

Mapping Two Decades of Research Productivity in the Middle Eastern and Arab Countries: A Comprehensive Bibliometric Analysis

Middle Eastern and Arab countries have been experiencing significant advancements in scientific research and development over the past few decades. Understanding the trends, patterns, and impact of research within this region can provide valuable insights into its scientific landscape, identify areas of strength, and uncover potential areas for improvement. This study presents a comprehensive bibliometric analysis of research productivity in the Middle Eastern and Arab region over a 20-year period. The findings revealed a consistent increase in research productivity, yet mapped significant disparities between countries in scholarly output, excellence, and impact. Adjusting for population size and GDP, Iran displayed the highest publication activity, trailed by Egypt and Turkey. Delving into the distribution of research output across different journal quartiles, the results revealed that this region has a lower percentage of scholarly output published in high-impact journals (both the top 10% and the top 25% categories). Compared to North America and the European Union, the Middle Eastern and Arab region consistently exhibited lower performance in terms of top 10% citations, average citations per publication, and field-weighted citation impact. The field of physical sciences took the lead as the most prevalent subject area in the Middle Eastern and Arab region, comprising about 60.5% of the research emphasis. Conversely, social sciences garnered comparatively less research attention, making up approximately 8.9% of the focus. The region showed strong international collaboration levels (40.5%), yet relatively low national (24.4%) and academic–corporate collaborations (1.5%). The outcomes of this study can facilitate international comparisons and benchmarking, allowing Middle Eastern and Arab countries to position themselves within the global scientific community. There remains a need to prioritize quality over quantity by emphasizing rigorous research practices and collaboration. An ongoing evaluation of research performance using a combination of indicators can help track progress and adjust strategies as needed.

Internal and cross sectional benchmarking of electrical energy use in opencast coal mine

Electrical energy consumption in the opencast coal mine is very high. Electric shovels, pumps and coal handling plants consume 75% of the total electricity consumption of an opencast coal mine. In this paper, a modelling framework has been developed for electrical energy use benchmarking (internal as well as cross-sectional) of the mine. To develop a mine specific model for benchmarking electrical energy use statistical approach (linear regression method) has been applied. Specific power consumption (SPC) is used as a benchmarking index to assess the operating energy performance of a specific mine and multiple coal mines of India based on the field studies. Seasonal analysis of the electrical energy usage has also been analysed. Our results show the benchmark SPC as 0.50 kWh/t and the energy-saving potential as 10.7% for a single mine and the benchmark SPC of multiple coal mines as 0.52 kWh/t. The result concludes that SPC widely depends on its capacity and mining method and the developed model are useful for benchmarking and targeting for efficient electrical energy use in opencast mine.

Procedural sedation programme minimising adverse events: a 3-year experience from a tertiary paediatric emergency department

IntroductionA well-developed procedural sedation programme in the paediatric emergency department can minimise adverse events. We examined how adherence to current best evidence ensures safe delivery of paediatric sedation in a...

Expanding the utility of robotics for pancreaticoduodenectomy: a 10-year review and comparison to international benchmarks in pancreatic surgery.

Robotic pancreaticoduodenectomy (RPD) is an emerging alternative to open pancreaticoduodenectomy (OPD). Although RPD offers various theoretical advantages, it is used in less than 10% of all pancreaticoduodenectomies. The aim of this study was to report our 10-year experience and compare RPD outcomes with international benchmarks for OPD. A retrospective review of a prospectively maintained institutional database was performed of consecutive patients who underwent RPD between January 2011 and December 2021. Patients were categorized into low-risk and high-risk groups according to the selection criteria set by the benchmark study. Their outcomes were compared to the international benchmark cut off values. Outcomes were then evaluated over time to identify improvements in practice and establish a learning curve. Of 201 RPDs, 36 were low-risk and 165 high-risk patients. Compared to the OPD benchmarks, outcomes of low-risk patients were within the cutoff values. High-risk patients were outside the cutoff for blood transfusions (26% vs. ≤ 23%), overall complications (78% vs. ≤ 73%), grade I-II complications (68% vs. ≤ 62%), and readmissions (22% vs ≤ 21%). Oncologic outcomes for high-risk patients were within benchmark cutoffs. Cases at the end of the learning curve included more pancreatic cancer (42% from 17%) and fewer low-risk patients (10% from 24%) than those at the beginning. After 41 RPD there was a decline in conversion rates and operative time. Between 95 and 143 cases operative time, transfusion rates, and LOS declined significantly. Complications did not differ over time. RPD yields results comparable to the established benchmarks in OPD in both low- and high-risk patients. Along the learning curve, RPD evolved with the inclusion of more high-risk cases while outcomes remained within benchmarks. Addition of a robotic HPB surgery fellowship did not compromise outcomes. These results suggest that RPD may be an option for high-risk patients at specialized centers.

How to improve mortality statistics nationally and internationally?

Cause-of-death statistics is an essential part of health information system. Finland has collected statistics on causes of death for more than 250 years. Since 1936 medical experts at Statistics Finland has been in charge of the coding. Changes in ICD-classification and coding praxis as well as the use of different standard populations and short-lists hampers time trend analyses and international benchmarking. The five Nordic countries and three Baltic countries has made cause-of-death coding comparisons since 2001. A random sample of death certificates are regularly reviewed. This exercise has demonstrated that national coding systems have not always agreed on the main causes of death. However, there has been a clear trend towards greater agreement, even for specific diagnostic groups, such as cancers, external causes and respiratory conditions. Most of the international data collection is voluntary, but the European Union has adopted a mandatory Regulation to ensure that cause-of-death statistics provide adequate information for all EU Member States to monitor Community actions in the field of public health. Since 2011 the data on causes-of-death have to be provided within 24 months after the end of the reference year. Therefore, causes-of-death statistics at Eurostat is more up-to-date than in other international databases.

Automatically transferring supervised targets method for segmenting lung lesion regions with CT imaging

BackgroundTo present an approach that autonomously identifies and selects a self-selective optimal target for the purpose of enhancing learning efficiency to segment infected regions of the lung from chest computed tomography images. We designed a semi-supervised dual-branch framework for training, where the training set consisted of limited expert-annotated data and a large amount of coarsely annotated data that was automatically segmented based on Hu values, which were used to train both strong and weak branches. In addition, we employed the Lovasz scoring method to automatically switch the supervision target in the weak branch and select the optimal target as the supervision object for training. This method can use noisy labels for rapid localization during the early stages of training, and gradually use more accurate targets for supervised training as the training progresses. This approach can utilize a large number of samples that do not require manual annotation, and with the iterations of training, the supervised targets containing noise become closer and closer to the fine-annotated data, which significantly improves the accuracy of the final model.ResultsThe proposed dual-branch deep learning network based on semi-supervision together with cost-effective samples achieved 83.56 ± 12.10 and 82.67 ± 8.04 on our internal and external test benchmarks measured by the mean Dice similarity coefficient (DSC). Through experimental comparison, the DSC value of the proposed algorithm was improved by 13.54% and 2.02% on the internal benchmark and 13.37% and 2.13% on the external benchmark compared with U-Net without extra sample assistance and the mean-teacher frontier algorithm, respectively.ConclusionThe cost-effective pseudolabeled samples assisted the training of DL models and achieved much better results compared with traditional DL models with manually labeled samples only. Furthermore, our method also achieved the best performance compared with other up-to-date dual branch structures.

Standardization of global hip fracture audit could facilitate learning, improve quality, and guide evidence-based practice.

National hip fracture registries audit similar aspects of care but there is variation in the actual data collected; these differences restrict international comparison, benchmarking, and research. The Fragility Fracture Network (FFN) published a revised minimum common dataset (MCD) in 2022 to improve consistency and interoperability. Our aim was to assess compatibility of existing registries with the MCD. We compared 17 hip fracture registries covering 20 countries (Argentina; Australia and New Zealand; China; Denmark; England, Wales, and Northern Ireland; Germany; Holland; Ireland; Japan; Mexico; Norway; Pakistan; the Philippines; Scotland; South Korea; Spain; and Sweden), setting each of these against the 20 core and 12 optional fields of the MCD. The highest MCD adherence was demonstrated by the most recently established registries. The first-generation registries in Scandinavia collect data for 60% of MCD fields, second-generation registries (UK, other European, and Australia and New Zealand) collect for 75%, and third-generation registries collect data for 85% of MCD fields. Five of the 20 core fields were collected by all 17 registries (age; sex; surgery date/time of operation; surgery type; and death during acute admission). Two fields were collected by most (16/17; 94%) registries (date/time of presentation and American Society of Anesthesiologists grade), and five more by the majority (15/17; 88%) registries (type, side, and pathological nature of fracture; anaesthetic modality; and discharge destination). Three core fields were each collected by only 11/17 (65%) registries: prefracture mobility/activities of daily living; cognition on admission; and bone protection medication prescription. There is moderate but improving compatibility between existing registries and the FFN MCD, and its introduction in 2022 was associated with an improved level of adherence among the most recently established programmes. Greater interoperability could be facilitated by improving consistency of data collection relating to prefracture function, cognition, bone protection, and follow-up duration, and this could improve international collaborative benchmarking, research, and quality improvement.

ARCHITECT HBsAg Next assay is positioned better to resolve and refine challenging weak reactive clinical samples.

Ultrasensitive HBsAg assays are replacing the previous versions. Unlike the sensitivity, the specificity, and its positioning to resolve weak-reactives (WR) are not studied. We investigated the ability of ARCHITECT HBsAg-Next (HBsAg-Nx) assay to resolve WR and sought its clinical validation and correlation with confirmatory/reflex testing. Among 99,761 samples between Jan 2022 - 2023, 248 reactive samples in HBsAg-Qual-II were compared with HBsAg-Nx assay. Sufficient samples were further subjected to neutralization (n=108) and reflex (anti-HBc total/anti-HBs antibody) testing. Out of 248 initial reactive samples in HBsAg-Qual-II, 180 (72.58%) were repeat reactive, and 68 (27.42%) were negative, whereas in HBsAg-Nx, 89 (35.89%) were reactive and 159 (64.11%) were negative (p<0.0001). Comparing the results of two assays (Qual-II/Next), 57.67% (n=143) were concordant (++/-) and 105 (42.33%) were discordant (p=0.0025). Testing of HBsAg-Qual-II + & HBsAg-Nx - samples revealed that 85.71% (n=90) were anti-HBc total negative and 98.08% (n=51) were not neutralized as well as significant proportion (89%) had no clinical correlation. The proportion of samples neutralized was significantly different between ≤5 S/Co (26.59%) and >5 S/Co (71.42%) (p=0.0002). All samples (n=26) with enhanced reactivity in HBsAg-Nx were effectively neutralized, while samples with no increase in reactivity, 89% (n=72) failed neutralization (p=<0.001). HBsAg-Nx assay is positioned better to resolve and refine challenging WR samples than Qual-II which correlated well with confirmatory/reflex tests and clinical disease. This superior internal benchmarking significantly reduced the cost and quantum of retesting, confirmatory/reflex testing in the diagnosis of HBV infection.