Low-complexity Procedures Research Articles

Colombian surgical outcomes study insights on perioperative mortality rate, a main indicator of the lancet commission on global surgery – a prospective cohort study

Surgical care holds significant importance in healthcare, especially in low and middle-income countries, as at least 50% of the 4.2 million deaths within the initial 30 days following surgery take place in these countries. The Lancet Commission on Global Surgery proposed six indicators to enhance surgical care. In Colombia, studies have been made using secondary data. However, strategies to reduce perioperative mortality have not been implemented. This study aims to describe the fourth indicator, perioperative mortality rate (POMR), with primary data in Colombia. A multicentre prospective cohort study was conducted across 54 centres (hospitals) in Colombia. Each centre selected a 7-day recruitment period between 05/2022 and 01/2023. Inclusion criteria involved patients over 18 years of age undergoing surgical procedures in operating rooms. Data quality was ensured through a verification guideline and statistical analysis using mixed-effects multilevel modelling with a case mix analysis of mortality by procedure-related, patient-related, and hospital-related conditions. 3807 patients were included with a median age of 48 (IQR 32-64), 80.3% were classified as ASA I or II, and 27% of the procedures had a low-surgical complexity. Leading procedures were Orthopedics (19.2%) and Gynaecology/Obstetrics (17.7%). According to the Clavien-Dindo scale, postoperative complications were distributed in major complications (11.7%, 10.68-12.76) and any complication (31.6%, 30.09-33.07). POMR stood at 1.9% (1.48-2.37), with elective and emergency surgery mortalities at 0.7% (0.40-1.23) and 3% (2.3-3.89) respectively. The POMR was higher than the ratio reported in previous national studies, even when patients had a low-risk profile and low-complexity procedures. The present research represents significant public health progress with valuable insights for national decision-makers to improve the quality of surgical care. This work was supported by Universidad del Rosario and Fundación Cardioinfantil-Instituto de Cardiología grant number CTO-057-2021, project-ID IV-FGV017.

“O.R. GOES GREEN”: a first step toward reducing our carbon footprint in the operating room and hospital

Hospitals in Europe produce approximately 6 million tons of medical waste annually, about one-third of this originating in operating rooms. Most of it is solid waste, which can be recycled if bodily fluids do not contaminate it. Only 2–3% of hospital waste must be disposed of as infectious waste, and this is much lower than the 50–70% of garbage in the biohazard waste stream. In June 2021, at the main operating room of the Department of General Surgery of the University of Turin, we began a separate collection program for materials consisting of plastic, paper, TNT (material not contaminated by bodily fluids), and biohazardous waste. We calculated the number of boxes and the weight of special waste disposed produced every month in one operating room for 18 months. The monthly number of Sanibox and the monthly weight of biohazardous waste decreased during the observation period. The reduction trend was not constant but showed variations during the 18 months. Direct proportionality between number of low-complexity procedures and production of biohazardous waste was found (p = 0.050). We observed an optimization in the collection and filling of plastic, paper and TNT boxes separated and sent for recycling. One of the barriers to recycling hospital waste, and surgical waste in particular, is the failure to separate infectious waste from clean waste. A careful separate collection of waste in the operating room is the first step in reducing environmental pollution and management costs for the disposal of hospital waste.

Pediatric sedation for emergency, imaging and endoscopic procedures: a worldwide review from the last five years

Introduction: Anatomical, physiological, pharmacokinetic, pharmaco dynamic and behavioral particularities relevant to the pediatric population make its sedation challenging for quick and low-complexity procedures. Robust evidence on this subject is still scarce, and the variety of drugs available, with their multiple routes of administration and dosage schemes, makes it difficult for providers to make a decision. Methods: Through research in four databases, we found 170 articles that addressed pediatric sedation and, after applying the exclusion criteria, we selected 32 articles for analysis. Results: In sedation for invasive or painful procedures, Esketamine in monotherapy was effective, despite the significant incidence of adverse effects. Satisfactory responses were also obtained with associations between Esketamine and Propofol and Fentanyl with Propofol or Midazolam. To perform imaging tests, continuous infusions of Propofol or Dexmedetomidine were sufficient, with associations with Esketamine or opioids associated with a higher incidence of adverse effects. Endoscopic procedures have been successfully performed after administration of continuous infusion of Propofol or Dexmedetomidine, associated with Remifentanil infusion or Fentanyl bolus. Esketamine in monotherapy was also effective. Discussion: The drugs studied have an adverse effect profile compatible with safe pediatric sedation, whether administered by a specialist or not. However, alternative administration routes and dosages still need further studies before being routinely applied. Conclusion: Sedation in pediatrics is still an open field for research in our country.

Which Volume Matters More? Systematic Review and Meta-Analysis of Hospital vs Surgeon Volume in Intra-Abdominal Emergency Surgery.

Understanding the impact of hospital and surgeon volume on emergency intra-abdominal surgery procedures and determining which measure is more influential in improving outcomes can guide regionalization of care. This systematic review, meta-analysis, and meta-regression synthesizes evidence regarding the impact of hospital and surgeon volume on mortality. A literature search without language restriction was performed in the PubMed, Web of Science, and Cochrane databases. Cohort studies assessing the impact of hospital/surgeon volume on mortality after intra-abdominal emergency procedures with data collected after the year 2000 were included and analyzed using a random effects model. A sub-group analysis assessing impact of hospital volume on high and low complexity procedures and ruptured aortic artery aneurysm (RAAA) repair was performed. Another sub-group analysis comparing high-volume surgeons in a low-volume hospital and low-volume surgeons in a high-volume hospital was also performed. PROSPERO: CRD42022358879. The search yielded 2153 articles, of which 33 cohort studies were included and determined to be good quality using the Newcastle Ottawa Scale. In 22 studies with available data for the meta-analysis, mortality was significantly higher in the low hospital volume and low surgeon volume cohort. The sub-group analysis found significantly higher mortality only in high complexity procedures and RAAA repair. Mortality was significantly lower in the cohort with high-volume surgeons at low-volume hospitals. High hospital volume was associated with lower mortality in all except low-complexity intra-abdominal emergency procedures. High surgeon volume was associated with lower mortality and there is limited evidence of it being the most protective.

Comparative effectiveness of telesimulation versus standard simulation for pediatric Minimally Invasive Surgery (MIS) essential skills training

Proctored on site simulation-based surgical education has been integrated in our residents curricula since 2012. Due to COVID-19 pandemic and social distance protocols, we developed a Tele-assisted Essential Skills Training Module (T-ESTM). The aim of this study is to evaluate comparative effectiveness between Telesimulation (T) versus Standard Simulation (S) for minimally invasive surgery (MIS) essential skills training. ESTM includes academic lectures, tutorials for ergonomics and 7 hands-on tasks scheduled into 2 sessions of 3hours. Initial and final assessment scoring (adapted from GOALS) as well as timing for 3 of the tasks were registered. Telesimulation (T) group accessed the content online and completed their Hands-On practice through a digital communication platform. Standard Simulation (S) group attended conferences and Hands-On practice at the simulation center. Both groups were proctored by the same educators with summative and formative feedback and debriefing. Data was analyzed with the R-studio software program. Each group had 20 participants with a mean age of 28±5 years. 67.5% were surgeons in training, 47.5% had performed low complexity procedures and 40% had previous experience with simulation training. We observed a significant improvement in scoring and time reduction for all assessed tasks in Sand T groups (p<0.001), with no statistically significant differences when comparing both groups. Similar performance could be achieved with both strategies. Telesimulation is a reproducible and effective educational tool for remote MIS essential skills training, and should be considered as an alternative to on-site simulation programs. Level II. Clinical Research.

A Bernstein–Bézier Lagrange–Galerkin method for three-dimensional advection-dominated problems

We present a high-order Bernstein–Bézier finite element discretization to accurately solve three-dimensional advection-dominated problems on unstructured tetrahedral meshes. The key idea consists of implementing a modified method of characteristics to discretize the advection terms in a Bernstein–Bésier finite element framework. The proposed Bernstein–Bézier Lagrange–Galerkin method has been designed so that the Courant–Friedrichs–Lewy condition is strongly relaxed using semi-Lagrangian time discretization. A low complexity procedures in building finite element matrices and load vectors is also achieved in the present work by both the analytical rule and the sum factorization method using the tensorial feature of Bernstein polynomials. Several numerical examples including advection–diffusion equations with known analytical solutions and the viscous Burgers problem are considered to illustrate the accuracy, robustness and performance of the proposed approach. The computed results support our expectations for a stable and highly accurate Bernstein–Bézier Lagrange–Galerkin finite element method for three-dimensional advection-dominated problems.

V-023 R-TAPP AS A TRAINING MODEL IN ROBOTIC SURGERY

Abstract Aim The main aim of the project will be evaluating the effectiveness of an experimental structured didactic program in robotic surgery in filling the training gap caused by the pandemic. We intend to evaluate how establishing a training pathway could improve young surgeons’ robotic skills and implement their participation in robotic procedures during the COVID-19 pandemic. We will also evaluate the learning curve of robotic transabdominal preperitoneal inguinal hernia repair (TAPP) for young surgeons with limited experience as first operators at the dual console. Matherials and Methods We designed an experimental stepwise training program in robotic surgery that starts from a first step of theoretical and laboratory lessons, followed by a second phase of bedside assistance training, and finally the completion of low complexity procedures by the trainees proctored at the dual console by senior surgeons. Robotic TAPP was selected as training model. The performance of each trainee will be registered in an evaluation data sheet and Learning scores will be recorded by the tutor with the evaluation of 6 corner steps of the procedure. Results Preliminary results showed improved technical skills and increased team spirit and wellbeing. Conclusions TAPP is a good training model because involves technical steps useful for more complex procedures. The robotic dual console represent an extraordinary training tool and a structured training program positively impacts technical skills and could help filling the training gap caused by the pandemic.

Pocket-sized, wireless-Bluetooth ultrasound system to perform diagnostic and low-complexity interventional procedures in bedridden patients during the COVID-19 pandemic: from intensive care unit to domiciliary service?

The use of a pocked-sized, wireless-Bluetooth ultrasound portable system with display images presented on a tablet facilitated the work of our radiologists during the first wave of coronavirus disease 2019 (COVID-19) to perform diagnostic and interventional procedures in bedridden patients. The device is equipped with a battery-powered probe without cables that transmits images to a tablet (or a cell phone) through a dedicated App. We hypothesise in future to extend diagnostic and low-complexity interventional procedures from hospitalised patients to at-home patients who are not able to mobilise out of bed or are difficult to transport. This domiciliary service might also reduce the overhead of hospital accesses.

Simulation in plastic and reconstructive surgery: a scoping review

Abstract Introduction Since the origins of surgery, simulation has played an important role in surgical education, particularly in plastic and reconstructive surgery. This has greater relevance in contemporary settings of reduced clinical exposure resulting in limited work-based learning opportunities. With changing surgical curricula, it is prescient to examine the role of simulation in plastic and reconstructive surgery. Methods A scoping review protocol was used to identify relevant studies, with an iterative process identifying, reviewing and charting the data to derive reported outcomes and themes. Results Of the 554 studies identified, 52 studies were included in this review. The themes identified included simulator modalities, curriculum elements targeted and relevant surgical competencies. There was a predominance of synthetically based simulators, targeting technical skills largely associated with microsurgery, paediatric surgery and craniomaxillofacial surgery. Discussion Existing simulators largely address high-complexity procedures. There are multiple under-represented areas, including low-complexity procedures and simulation activities addressing communication, collaboration, management and leadership. There are many opportunities for simulation in surgical education, which requires a contextual appreciation of educational theory. Simulation may be used both as a learning method and as an assessment tool. Conclusion This review describes the literature relating to simulation in plastic and reconstructive surgery and proposes opportunities for incorporating simulation in a broader sense, in the surgical curriculum.

Effectiveness of telesimulation for pediatric minimally invasive surgery essential skills training

BackgroundIn the context of the COVID-19 pandemic and social distancing rules, access to in-person training activities had temporarily been interrupted, speeding up the implementation of telesimulation for minimally invasive surgery (MIS) essential skills training (T-ESTM, Telesimulation - Essential Skills Training Module) in our center. The aim of this study was to explore the effectiveness of T-ESTM. MethodsT-ESTM was scheduled into 2 sessions of 3 h through the Zoom® virtual meeting platform. The academic lectures, the tutorials for box-trainer set-up and 7 performance tasks were accessed through an online campus previous to the remote encounter for personalized guidance and debriefing.Initial (pre-telementoring) and final (post 6-hour telementoring) assessment scoring as well as timing for Task 2 (circle-cutting pattern), 3 (extracorporeal Roeder knot) and 5 (intracorporeal Square knot) were registered. Results61 participants were recruited. The mean age was 31±5 years. 65% were surgical residents. 48% performed low complexity procedures. 52% had previous experience with simulation training.In Task 2, there was a 21% improvement in the final score obtained, as well as a significant decrease in time of 33%; in Task 3, there was an increase of 39% in the scoring and a decrease of 49% in the timing; and in Task 5, participants improved their technique a 30% and decreased the performance time a 47%. All the differences were statistically significant. DiscussionOur data support T-ESTM as a reproducible and effective educational tool for remote MIS essential skills hands-on training.Level of Evidence: II

Frequency domain Bernstein-Bézier finite element solver for modelling short waves in elastodynamics

This work presents a high-order Bernstein-Bézier finite element (FE) discretisation to accurately solve time harmonic elastic wave problems on unstructured triangular mesh grids. Although high-order FEs possess many advantages over standard FEs, the computational cost of matrix assembly is a major issue in high-order computations. A key ingredient to address this drawback is to resort to low complexity procedures in building the local high order FE matrices. This is achieved in this work by exploiting the tensorial property of Bernstein polynomials and applying the sum factorisation method for curved elements. An efficient implementation of the analytical rules for affine elements is also proposed. Furthermore, element-level static condensation of the interior degrees of freedom is performed to reduce the memory requirements. Additionally, the applicability of the method with a variable polynomial order, based on a simple a priori indicator, is investigated.The computational complexities of sum factorisation, analytical rules and standard quadrature are first evaluated, in terms of the CPU time against the polynomial order. The analysis shows that the achieved numerical complexities compare favourably to those expected theoretically. A significant runtime saving is also obtained by using analytical rules and sum factorisation. The performance of the Bernstein-Bézier FEs is then assessed on various benchmark tests, over a wide range of frequencies. Results from the elastic wave scattering problem demonstrate the effectiveness of this method in coping with the pollution error, and its accuracy in resolving high order evanescent wave modes. Additionally, a wave transmission problem with high wave speeds contrast and a curved interior interface is considered, where a simple a priori indicator is proposed to assign the variable polynomial order. The study provides evidence of the great benefit of a non uniform p-refinement in reducing the computational cost and enhancing accuracy.

Abstract P119: Cardiovascular Risk And Subclinical Target Organ Damage In A Young Adult Population Provided By A Primary Healthcare Center In Brazil (Laparc Study)

Background: In this young and apparently healthy population, it is important to identify early CV risk factors and subclinical target organ damage (TOD) with low complexity procedures, aiming regression, control and primary prevention with future reduction of CV morbidity and mortality. Objectives: To evaluate subclinical TOD using Ankle-Brachial Index (ABI), Office and Home Pulse Pressure (PP), identifying arterial stiffness. Methods: A cross-sectional population study for CV risk assessment in adults aged 20-50 years old provided by a Primary Healthcare Center in Brazil. A total of 632 individuals were evaluated (40% male; mean age 36 ± 9 years). Socio-demographic, anthropometric data, and lifestyle evaluation were recorded. All underwent Office Blood Pressure (OBP) measurements in the 4 limbs to calculate the ABI and office PP. All received the Home Blood Pressure Monitoring (HBPM) device (7 days protocol) and the mean of the general BP and the calculation of the PP were evaluated. They also performed an ECG to calculate Sokolow-Lyon Index (SLI) and Cornell Voltage Index (CVI). Results: The prevalence of hypertension according to OBP was 16% and 18% according to HBPM, but with a low agreement between diagnoses (kappa = 0.385). HBPM identified 4 phenotypes: normotension (74%), sustained hypertension (8%), masked hypertension (10%), and white coat hypertension (8%). The median of office PP was 46 [39-52] mmHg and of Home PP was 45 [41-50] mmHg. Elevated Office PP and Home PP (&gt; 60 mmHg) were identified in 64 and 28 participants, respectively. High office PP was more frequent in men, obese, with increased neck circumference and lower ABI. It was also associated with higher SLI and CVI. High Home PP was also more frequent in men, obese, with increased neck circumference and higher CVI. The median of the ABI was 1.14 [1.08-1.22], which is the cutoff point we used to define early changes in the ABI. Individuals with decreased ABI are more obese, with smaller neck circumference and lower OBP control. They also had higher systolic BP values and office PP (49 vs 43 mmHg, p&lt;0.001). Conclusion: In this young population, early changes in subclinical TOD already identify a higher CV risk profile, indicating the importance of implementing prevention measures to reduce this risk.

Electrical biosensing with synthetic nanopores and nanochannels

The integration of constriction structures such as nanopores and nanochannels into fluidic devices discloses powerful biosensing capabilities that can be tuned to a wide range of analytes through conceptually simple size calibrations. The practical implementation of this tuning requires a nontrivial manipulation of matter at nanoscale with further requirements for low complexity and low-cost procedures that may be adapted to industrial production. Here, we review the recent progress on the fabrication techniques of nanopores and nanochannels, together with the efforts to realize their full biosensing potential by understanding and amending the problems still afflicting the measurement performed during operation. • Confining fluidic nanostructures provide single-molecule sensitivity to biosensors. • Crucial tuning of nanostructure size stimulates the research on fabrication. • D materials boost the performance of nanopore technology. • Polymeric nanochannels pave the way for high-throughput applications in biosensing.

Equivalent performance of single-use and reusable duodenoscopes in a randomised trial

ObjectiveSingle-use duodenoscopes have been recently developed to eliminate risk of infection transmission from contaminated reusable duodenoscopes. We compared performances of single-use and reusable duodenoscopes in patients undergoing endoscopic retrograde cholangiopancreatography...

Italian survey on the residents' surgical level in gynecology and obstetrics.

Purpose:The present study aims to investigate the number of surgical procedures performed by Italian residents and their confidence to carry out different surgeries in obstetrics and gynecology.Methods:The present study is a national survey including all Italian gynecology and obstetrics senior residents. A questionnaire including 25 questions was provided. The free Google Forms site was used to create the survey. The study was conducted from April to October 2019. The survey started from the University Hospital of Parma, a tertiary hospital, and was sent to all the Italian post-graduation medical school in gynecology and obstetrics. An e-mail was sent to all representative residents in gynecology and obstetrics in Italy, then forwarded to all the senior residents.Results:Of the 555 residents enrolled, 100 joined the survey (18.2%). The analysis of the different procedures performed by residents has shown that 53%, 57%, and 77% of the residents had never performed a laparotomic, laparoscopic, and vaginal hysterectomy, respectively. The analysis of cesarean section skills has shown that 1% of residents had never performed any simple cesarean section, and 6% of residents had never performed any complex cesarean section. Fifty-two doctors in training had never performed an operative vaginal delivery. Seventy-three and ninety-three residents performed more than thirty uterine curettages and sutures of 1st or 2nd degree tears, respectively.Conclusions:In Italy, senior residents are generally confident with the low-complexity procedures and also with complex cesarean sections. The number of Italian residents confident to perform a hysterectomy is poor. (www.actabiomedica.it)

Clinical Practice Patterns of Interventional Radiologists by Gender.

OBJECTIVE. Given recent specialty attention to workforce diversity, we aimed to characterize potential gender differences in the practice patterns of interventional radiologists (IRs). MATERIALS AND METHODS. Using Medicare claims data, we identified IRs on the basis of the distribution of their billed clinical work effort and descriptively characterized practice patterns by gender. RESULTS. Women represented 8.2% (241/2936) of all IRs identified nationally. Female representation varied geographically (≤ 2% in nine states, ≥ 20% in three states) and by career stage (9.4% among early-career IRs and 6.4% among late-career IRs; 18.8% among early-career IRs in the Northeast). For both female IRs and male IRs, interventional case mixes were similar across service categories (e.g., venous and hemodialysis access, arterial and venous interventions, biopsies and drainages) and by procedural complexity (e.g., 5.7% vs 4.3% for low-complexity procedures and 59.5% vs 61.3% for high-complexity procedures). Average patient complexity scores were also similar for female (2.7 ± 12 [SD]) and male (2.8 ± 12) IRs. Female IRs spent slightly lower portions of their work effort rendering invasive services (66.5% vs 70.0%, respectively) and noninvasive diagnostic imaging (19.0% vs 22.2%) than male IRs but spent more time in evaluation and management clinical visits (14.5% vs 7.9%). Both female IRs and male IRs rendered a majority of their services to female patients (53.4% vs 53.1%). CONCLUSION. Although women remain underrepresented in interventional radiology, female IRs' interventional case composition, procedural complexity, and patient complexity are similar to those of their male colleagues. Female IRs' higher proportion of evaluation and management clinical visits supports the specialty's increased focus on longitudinal care so that interventional radiology will thrive alongside other clinical specialties.

Improving Access to Safe Anesthetic Care in Rural and Remote Communities in Affluent Countries.

Inadequate access to anesthesia and surgical services is often considered to be a problem of low- and middle-income countries. However, affluent nations, including Canada, Australia, and the United States, also face shortages of anesthesia and surgical care in rural and remote communities. Inadequate services often disproportionately affect indigenous populations. A lack of anesthesia care providers has been identified as a major contributing factor to the shortfall of surgical and obstetrical care in rural and remote areas of these countries. This report summarizes the challenges facing the provision of anesthesia services in rural and remote regions. The current landscape of anesthesia providers and their training is described. We also explore innovative strategies and emerging technologies that could better support physician-led anesthesia care teams working in rural and remote areas. Ultimately, we believe that it is the responsibility of specialist anesthesiologists and academic health sciences centers to facilitate access to high-quality care through partnership with other stakeholders. Professional medical organizations also play an important role in ensuring the quality of care and continuing professional development. Enhanced collaboration between academic anesthesiologists and other stakeholders is required to meet the challenge issued by the World Health Organization to ensure access to essential anesthesia and surgical services for all.

Acetuino-A Handy Open-Source Radiochemistry Module for the Preparation of [1-11C]Acetate.

Radiosynthesis of [1-11C]acetate is well described in literature, but all syntheses either require adaptations in complex commercial synthesizers or rely on closed-source hardware and software control. Arduino microcontrollers are ideal for the compact, flexible, and inexpensive control of low-complexity hardware, making them particularly suited for radiochemistry where operation in space-limited shielded hot cells is mandatory. We established a [1-11C]acetate radiosynthesis module for combination with a [11C]MeI module available in almost every lab working with 11C. Its small footprint even enables back-to-back production in a hot cell already occupied by other modules. Using this setup, we achieved a reliable and flexible supply of this tracer, with radiochemical yields of 51.4 ± 28.2% and radiochemical purities (RCPs) of 94.4 ± 6.7% ( n = 9) in a synthesis time of 15 minutes. Positron emission tomography (PET) and biodistribution analysis demonstrated low background uptake in healthy mice, with highest uptake in liver and kidneys. Arduino microcontrollers have become valuable and versatile tools in our lab for the automatization of low-complexity procedures not requiring full-blown commercial radiochemistry synthesizers, as showcased here for the production of [1-11C]acetate.

Start and development of uniportal video-assisted thoracic surgery (VATS) in Dominican Republic: surgeries and training experience

Video-assisted thoracic surgery (VATS) through a uniportal approach its actually successfully performed for several diseases and gaining adepts everywhere. By 2016 more than 10 thousand reports in literatures reviews and evidence revision. The benefits of this technique support the great interest globally and the Dominican Republic, a non-continental Caribbean country of the 3rd world is already taking steps to get onboard performing the procedure. Since 2016 under the guidance of the pioneer Dr. Diego Gonzalez-Rivas in this country have been performed close to 50 cases of benign and low complexity procedures. Recently, to continue learning and developing this technique in the country, a right upper lobectomy in a cancer patient was made in the context of the 1st masterclass of uniportal VATS.

Simple modeling of photovoltaic solar cells for indoor harvesting applications

In this paper, using an extended version of the 1-diode/2-resistors (1D&2R) circuit model, we propose a methodology suitable for modeling Photovoltaic Solar Cells (PVSCs) operating in indoor environments. With low-cost equipment and low-complexity procedures, this methodology finds an equivalent circuit that reproduces the worst-case performance of a harvester based on indoor PVSCs for a continuous illuminance range at room temperature. This methodology is validated using a commercial indoor PVSC that has been tested for several illuminance levels at a room temperature and warm white LED (light-emitting diode) spectrum. The extracted model achieves a mean absolute percentage error (MAPE) of 4.85% for the illuminance ranging from 177 to 33.3×103lm/m2. Furthermore, this model achieves a MAPE of 0.57% at maximum power point (MPP), and a MAPE of 2.07% around the MPP.