Management Center Research Articles

Association between atherogenic index of plasma and type 2 diabetic complications: a cross-sectional study

BackgroundThe Atherogenic Index of Plasma (AIP) was originally developed primarily as a marker for assessing atherosclerosis. Consequently, this study investigates the potential association between AIP and type 2 diabetic complications through a cross-sectional design.MethodsThe National Metabolic Management Center(MMC) serves as a comprehensive platform dedicated to the establishment of standardized protocols for the diagnosis, treatment, and long-term follow-up of metabolic diseases. Following the relevant inclusion and exclusion criteria, a total of 3,094 patients were enrolled for subsequent analysis. In this study, logistic regression, restricted cubic splines, and subgroup analyses were employed to evaluate the association between the AIP and four major complications of type 2 diabetes, namely, type 2 diabetes with carotid atherosclerosis (DA), diabetic kidney disease (DKD), diabetic retinopathy (DR), and diabetic peripheral neuropathy (DPN).ResultsThe logistic regression results demonstrate that in the fully adjusted model, each SD increase in AIP correlates with an elevated risk of type 2 diabetic kidney disease (DKD), with the risk of kidney damage intensifying alongside higher AIP groupings. The RCS analysis and subgroup analyses similarly revealed a dose-response relationship between AIP levels and the risk of DKD. Furthermore, the AIP was not found to be statistically significantly associated with DA, DR,and DPN.ConclusionsThe AIP may serve as a valuable predictive indicator for evaluating kidney damage in patients with type 2 diabetes, and regular screening of AIP in this population could provide significant benefits in the prevention of DKD.

Effective Waste Management in Urban Centres in South Sudan

Purpose: The objective of this study was to assess effective solid waste management in urban centres in South Sudan with special reference to Juba City Council. This included the types of solid waste generated, solid waste management practices and factors hindering effective solid waste management in relation to population growth and behavior. Methodology: The study used random sampling technique to determine a sample size of 200 respondents who were versed or partly versed with the subject in question. This included the Ministry of environment officials, City council waste management directorate, Members of parliament and the residents of Juba city council. Qualitative data was obtained from interviews using interview guides which were coded, interpreted. Further data was analyzed to give it a broader and more meaningful picture of the sample. Findings: The study findings revealed that paper and carton, yard trimmings, food, scraps, wood, glass, plastics, metal and clothes were the types of solid waste generated within the urban centres in South Sudan. The study further revealed that urban population growth significantly affects solid waste management in Juba city and poses the challenges of solid waste segregation since the waste is indiscriminately disposed of. In addition, insufficient funding led to inadequate provision of facilities and equipment for solid waste management coupled with inadequate enforcement of public health legislations and solid waste management by-laws. Unique Contribution to Theory, Policy and Practice: The study therefore recommended the use of integrated solid waste management, adequate resourcing, law enforcement and strengthening of the capacity of the Juba City/Municipal/urban councils’ policies and regulations.

Flooding distributed denial of service detection in software-defined networking using k-means and naïve Bayes

Software-defined networking (SDN) is a network architecture that enables the separation of the control plane and data plane, facilitating centralized management of the network. While centralized control offers numerous benefits, it also comes with certain drawbacks. Flooding distributed denial of service (DDoS) attacks pose a significant threat in SDN environments. These attacks involve overwhelming a target system with a large volume of packets, aiming to disrupt its functionality. In this paper, we propose a new approach for detecting DDoS attacks based on multiple k-means models and the naive Bayes algorithm. Our methodology involves training multiple k-means models to cluster each data point within every column of the dataset, where each column represents a feature. This process results in a new dataset with the same shape, containing only clusters, except the column containing the target variable (labels). These clusters are then used as input by naïve Bayes to perform binary classification. We assessed our approach using the InSDN and CIC-DDoS2017 datasets. The results underscore the impressive accuracy of our model, achieving 99.9839% on the InSDN dataset and 99.7030% on the CIC-DDoS2017 dataset. This performance was achieved by optimizing the desired number of clusters.

Biomedical outcomes and cardiovascular risks in Chinese adults with type 2 diabetes in the metabolic management center program: Alongitudinal comparative study.

To assess the extent to which biomedical outcomes and cardiovascular risk profile were improved in the management of Chinese patients with type 2 diabetes enrolled in the metabolic management center (MMC) program. We performed propensity score matching of diabetic patients in the MMC program for at least 12 months to those with diabetes under usual primary care, based on age, sex, fasting plasma glucose (FPG) level, and diabetes duration. Difference-in-difference analysis was conducted to compare changes in biomedical outcomes, attainment of treatment targets, and cardiovascular disease (CVD) risk reduction. Of 557 pairs of diabetic patients matched 1:1 (n = 1,114), the MMC cohort exhibited greater improvements in FPG (-0.84 mmol/L, 95% confidence interval [CI] -1.22 to -0.46, P < 0.001), diastolic blood pressure [BP] (-2.08 mmHg, 95%CI -3.21 to -0.94, P < 0.001), body mass index [BMI] (-0.29 kg/m2, 95%CI -0.51 to -0.07, P = 0.009), low-density lipoprotein cholesterol (0.13 mmol/L, 95%CI 0.04-0.23, P = 0.008), high-density lipoprotein cholesterol (0.05 mmol/L, 95%CI 0.01-0.08, P = 0.017), and 10-year CVD risk (Framingham CVD risk, -0.94%, 95%CI -1.71 to -0.17, P = 0.017; atherosclerotic CVD risk, -0.77%, 95%CI -1.34 to -0.20, P = 0.009) when compared to the usual primary care cohort after adjustment for confounders. More patients in the MMC cohort achieved treatment targets with lifestyle modifications than their counterparts under primary care. Enrolment in the MMC program appears promising in the management of FPG, BP, BMI, lifestyle, and CVD risk in diabetic patients, suggesting the necessity of incorporating the MMC program into routine primary care.

The 2024 American Association for Thoracic Surgery expert consensus document: Current standards in donor lung procurement and preservation.

Donor lung procurement and preservation is critical for lung transplantationsuccess. Unfortunately, the large variability in techniques impacts organ utilization rates and transplantation outcomes. Compounding this variation, recent developments in cold static preservation and new technological advances with machine perfusion have increased the complexity of the procedure. The objective of the American Association for Thoracic Surgery (AATS) Clinical Practice Standards Committee (CPSC) expert panel was to make evidence-based recommendations for best practices in donor lung procurement and preservationbased on review of the existing literature. The AATS CPSC assembled an expert panel of 16 lung transplantation surgeons from 14 centers who developed a consensus document of recommendations. The panel was divided into 7 subgroups covering (1) intraoperative donor assessment, (2) surgical techniques, (3) ex situ static lung preservation methods, (4) hypothermic preservation, (5) normothermic exvivo lung perfusion (EVLP), (6) donation after circulatory death (DCD) and normothermic regional perfusion, and (7) donor management centers, organ assessment centers, and third-party procurementteams. Following a focused literature review, each subgroup formulated recommendation statements for each subtopic, which were reviewed and further refined using a Delphi process until a 75% consensus was achieved on each final statement by the voting group. The expert panel achieved consensus on 34 recommendations for current best practices in donor lung procurement and preservation both in brain-dead as well as DCD donation. The use of new methods of cold preservation, the role of EVLP, and DCD with and without concomitant heart donation are described in detail. Consistent and best practices in donor lung procurement and preservationare critical to improve both lung transplantation numbers as well as recipient outcomes. The recommendations described here provide guidance forprofessionals involved in the care of patients with end-stage lung disease considered for transplantation.

Streamlining enterprise data management: A centralized approach for seamless database migration and data extraction

In an era where data is paramount, organizations face the monumental task of managing vast amounts of information. Effective data management strategies for enterprise data frameworks and warehousing are crucial for making informed decisions, enhancing customer experiences, and gaining a competitive edge. This paper examines the challenges of database migration and daily data extraction, presenting a comprehensive solution designed to streamline these processes. By leveraging a centralized App Manager and a customizable File Transfer App, the proposed system automates the data pipeline with minimal human intervention. This innovative approach ensures seamless data integration, robust governance, and efficient data warehousing, ultimately enhancing operational efficiency and organizational success.

Sustainable DevOps: Minimizing the carbon footprint of banking data centers

Sustainable DevOps methods drive results in banking, given data centers account for most energy usage and environmental damage. Our study demonstrates how sustainability practices join with DevOps techniques to lower the ecological impact of banking data centers while achieving performance and security requirements. The paper illustrates how microservices and containerization technology help banking data centers work better with their resources by automatically scaling and lowering electricity consumption. The evaluation compares Jenkins and Ansible with other automation tools to show how they simplify repetitive work and shut down systems when usage drops to save energy. The study proves why advanced monitoring tools are necessary to track real-time power usage so data center managers can redistribute or stop using servers when needed. The analysis shows how banks can use cloud solutions that depend on green energy and infrastructure architectures to build sustainability practices. Beyond new technology tools, this research pushes for cultural change by supporting business units that add environmental effect measures to their new product development process. This study examines how banking industries can use sustainable DevOps practices to reduce energy use and environmental damage while maintaining regulatory standards and stable operations. The study provides technical and action-based methods that allow DevOps processes to support ecological preservation for finance companies.

Utilizing IT-supported precision management measures to enhance rational drug use in primary healthcare institutions: a study of an internet-based regional prescription audit center

This study aimed to elevate the qualified rate (QR) of prescriptions and improve rational drug use while also minimizing adverse drug events in primary healthcare institutions within a designated region through information technology (IT)-supported precision management.In this study, a retrospective analysis was performed to evaluate the changes in the QR and adverse event rate associated with 5,923,764 prescriptions across 13 community health service centers in Tianhe District, Guangzhou, Guangdong Province, before and after the implementation of IT support. Detailed records and analyses were conducted on specific psycho-narcotic drugs, the appropriate use of antimicrobial prescriptions, and the incidence of adverse events following the introduction of IT support.Following the IT-supported precision management, 13 community health service centers witnessed a notable surge in the average QR of prescriptions, rising from 91.90% to 96.97% from 2018 to 2021 (P < 0.05). Among this, the average QR of psychotropic and anesthetic drugs, as well as antibiotics prescriptions at the same center showed a significant increase, while the average utilization rate of antibiotics demonstrated a marked decrease. Furthermore, the average incidence rate of adverse events caused by high-alert drugs dwindled from 225 cases/year in 2020 to 109 cases/year in 2021.The integration of a regional remote prescription audit center for IT-supported precision management of drug use in primary healthcare institutions has improved prescription quality and diminished the incidence rate of adverse drug events, indicating a significant contribution to the distribution of high-quality pharmacy resources of Grade IIIA hospitals to primary healthcare institutions. This initiative also improves rational drug use, marking a pioneering innovation in pharmacy practice that deserves commendation.

Outcome-based simulation training for ultrasound-guided central venous catheter placement: clinical impact on preventing mechanical complications

BackgroundCentral venous catheter placement has been associated with mechanical complications, some of which can be life-threatening. Recent studies have shown that simulation-based education on ultrasound-guided central venous catheter placement improves puncture success rates; however, its effect on reducing mechanical complications remains unclear. This observational study examined how outcome-based simulation training for ultrasound-guided central venous catheter placement affects the incidence of mechanical complications in a clinical setting.MethodsThe Safe Central Venous Catheter Placement and Management Committee established a reporting system to monitor central venous catheter placement. In 2016, a skill assessment of ultrasound-guided central venous catheter placement was conducted. Outcome-based simulation training was introduced in 2017. Skills were evaluated using the skill assessment tool developed by the Japanese Society for Medical Simulation.ResultsAfter implementing skill assessment and outcome-based simulation training, the mechanical complication rate decreased from 2.2% in 2015 to 1.2% in 2023.ConclusionsA recent meta-analysis reported a 2.3% mechanical complication rate during ultrasound-guided central venous catheter placement. In comparison, the 1.2% complication rate at our institution is notably lower. This study suggests that outcome-based simulation training for ultrasound-guided central venous catheter placement may help reduce the incidence of mechanical complications in clinical settings.

Unsustainable Complexity: insights from ecology and anthropology on the dynamics of complexity in church systems

Cycles of growth and decay are observable in both human and natural systems. In these cycles increasing followed by decreasing levels of system complexity are also observed. These dynamics have been studied by both ecologists and anthropologists. Of particular interest for this paper is the work of ecologist C. S. Holling and the anthropologist Joseph A. Tainter. This paper explores whether insights of natural and human systems from these disciplines may be useful when considering how complexity increases, is sustained, and decreases in church life. If insights from these disciplines are applicable to church life, it suggests that a strategy of conscious simplification of church structures, and the devolution of power and authority downwards to more autonomous units of church, would be a preferable strategy at all levels of church life at this point in the church’s history where resources available to the church are insufficient to maintain inherited and now maladapted systems of organisation. Such a strategy contrasts with the strategy currently most dominantly espoused by National Church Institutions of the Church of England of seeking growth through increasingly centralised management and control of resources.

Nonlinear association between liver fat content and lumbar bone mineral density in overweight and obese individuals: evidence from a large-scale health screening data in China.

The impact of fatty liver disease on lumbar bone mineral density (BMD) represents an intriguing area of study, particularly in light of established research linking obesity to bone metabolism. However, there remains limited investigation into the correlation between quantifying liver fat content (LFC) and lumbar BMD among overweight and obese populations, particularly within the Chinese demographic. This study aims to accurately quantify LFC and investigate its association with lumbar BMD in overweight or obese individuals. This cross-sectional study was conducted at the Health Management Center of Henan Provincial People's Hospital from January 2019 to February 2023, involving 6996 participants with a body mass index (BMI) of 24 kg/m² or higher. LFC and lumbar BMD were assessed using computed tomography. The study utilized one-way ANOVA, subgroup analysis, multifactor regression analysis, smooth curve fitting, and threshold and saturation effect analysis to explore the relationship between LFC and lumbar BMD. Furthermore, inflammatory cell analysis was included to investigate the potential mediating role of inflammatory cells in the association between LFC and lumbar BMD. After adjusting for confounding variables, multivariate regression analysis revealed a significant negative association between LFC and lumbar BMD (β = -0.323, 95% CI: -0.464 to -0.183, P < 0.001). Particularly, participants in the highest baseline LFC quartile (Q4 group) exhibited a more pronounced negative impact on lumbar BMD compared to those in the lowest quartile (Q1 group) (β = -5.026, 95% CI: -7.040 to -3.012, P < 0.001). Threshold saturation effect analysis identified a turning point in the LFC-BMD relationship (K = 5.4). Below this point, LFC showed a positive correlation with lumbar BMD (β = 0.962, 95% CI: 0.016-1.907, P < 0.05), whereas above it, LFC was significantly negatively correlated with lumbar BMD (β = -0.405, 95% CI: -0.558 to -0.253, P < 0.001). Additionally, mediation analysis indicated that leukocytes and monocytes potentially mediated the association between LFC and lumbar BMD, with mediation ratios of -5.78 and -6.68%, respectively. Among individuals categorized as overweight or obese, elevated levels of LFC were associated with reduced lumbar BMD, particularly noticeable above a threshold of 5.4%. Additionally, various types of inflammatory cells are presumed to exert a substantial mediating influence on the correlation between LFC and lumbar BMD.

Application of situated and simulation-based learning technologies in the formation of communication skills in medical students

Aim. To improve the effectiveness of the formation of communication skills in medical students by means of situated and simulation-based learning education.Material and methods. A survey of patients was conducted in order to identify the main problems of communication with doctors. Physician's behavior in situations of interaction with patients was studied. A teaching methodology for the formation of communication skills of future doctors, built on situated and simulation-based learning technologies, was developed and tested.Results. The efficiency of situated and simulation-based learning education in forming the doctor's communication skills is substantiated, using the cases with participation of patient-actors. The content and process block includes cases developed taking into account the variability of the main psychological characteristics of patients; assessment criteria in the form of assessment checklists, including a curator's list, an actor's assessment list, an expert's assessment list; guidelines for patient-actors. The basic characteristics for simulation center management are given: briefing rooms, workplaces for experts equipped with video and audio equipment, hospital ward simulations or an examination room equipped with video cameras for expert assessment.Conclusion. The introduction of situated and simulation-based learning education in specially created conditions increases the effectiveness of the formation of communication skills in students. The conducted analysis of academic performance showed an increase by 40%, compared with the standard practical classes with elements of roleplaying situations by students in pairs.

Hereditary colorectal cancer syndromes and inflammatory bowel disease: results from a registry-based study

PurposeIn this study, we investigated the progression of high-grade dysplasia (HGD)/CRC in patients with hereditary colorectal cancer syndromes (HCSS) and concomitant inflammatory bowel diseases (IBDs).MethodsWe described the natural history of a series of patients with confirmed diagnosis of hereditary colorectal cancer syndromes (HCCSs) and concomitant IBDs who were referred to the Hereditary Digestive Tumors Registry at the Fondazione IRCCS Istituto Nazionale dei Tumori of Milan.ResultsBetween January 1989 and April 2024, among 450 patients with APC-associated polyposis and 1050 patients with Lynch syndrome (LS), we identified six patients with IBDs (five with UC, one with ileal penetrating CD) and concomitant HCCSs (five with LS, one with APC-associated polyposis). Three patients developed CRC (two patients with stage IIA, and one with stage IIIA); in one patient, CRC occurred over a median follow-up of 12 months after IBD diagnosis, while in two, both conditions were diagnosed simultaneously. The median age at initial diagnosis of CRC was 33 years (range 27–41). Five patients (83.3%) underwent surgical procedures (three colonic resections for carcinoma and two for other reasons). Most of them progressed to precancerous or cancerous colonic lesions at a young age. Notably, all patients with CRC had a diagnosis of UC.ConclusionIBD patients with coexistent HCCSs can develop early CRC onset at an advanced stage. These patients should be always referred to tertiary referral centers for strict surveillance programs and early surgical management of advanced colorectal neoplastic lesions. Noninvasive biomarkers of neoplastic changes are advocated to further improve the management of IBD patients with HCCSs.

Decentralized Energy Swapping for Sustainable Wireless Sensor Networks Using Blockchain Technology

Wireless sensor networks deployed in energy-constrained environments face critical challenges relating to sustainability and protection. This paper introduces an innovative blockchain-powered safe energy-swapping protocol that enables sensor nodes to voluntarily and securely trade excess energy, optimizing usage and prolonging lifespan. Unlike traditional centralized management schemes, the proposed approach leverages blockchain technology to generate an open, immutable ledger for transactions, guaranteeing integrity, visibility, and resistance to manipulation. Employing smart contracts and a lightweight Proof-of-Stake consensus mechanism, computational and power costs are minimized, making it suitable for WSNs with limited assets. The system is built using NS-3 to simulate node behavior, energy usage, and network dynamics, while Python manages the blockchain architecture, cryptographic security, and trading algorithms. Sensor nodes checked their power levels and broadcast requests when energy fell under a predefined threshold. Neighboring nodes with surplus power responded with offers, and intelligent contracts facilitated secure exchanges recorded on the blockchain. The Proof-of-Stake-based consensus process ensured efficient and secure validation of transactions without the energy-intensive need for Proof-of-Work schemes. The simulation results indicated that the proposed approach reduces wastage and significantly boosts network resilience by allowing nodes to remain operational longer. A 20% increase in lifespan is observed compared to traditional methods while maintaining low communication overhead and ensuring secure, tamper-proof trading of energy. This solution provides a scalable, safe, and energy-efficient answer for next-generation WSNs, especially in applications like smart cities, precision agriculture, and environmental monitoring, where autonomy of energy is paramount.

Evaluating the Adoption of Evidence-Based Management Practices in Eye Hospitals

Background: Delivering sustainable, high-quality eye care requires a comprehensive understanding of patient conditions, clinical evidence, patients’ preferences, demand patterns, quality supplies, outcomes, financial sustainability, and satisfaction metrics. Evidence-based management (EBM) offers a structured approach to align actions with evidence, enabling effective decision-making and better organizational outcomes. Evaluating current practices against EBM principles fosters awareness and promotes an EBM culture in eye hospitals, supporting improved and sustainable service delivery. Methods: A descriptive cross-sectional survey was conducted in 2023–2024 among 94 eye hospitals worldwide, selected from two networks, using the Centre for Evidence-Based Management (CEBM) assessment questionnaire. Follow-up reminders resulted in 43 responses. Data analysis utilized frequency distributions and Pearson’s correlation to explore relationships between variables. Results: A strong positive correlation was observed between data accessibility and the capacity to interpret data in fostering evidence-based decision-making (r = 0.69, p &lt; 0.01). Additionally, leveraging internal expertise and engaging stakeholders in assessing and utilizing data showed a moderate association with EBM practices (r = 0.48, p &lt; 0.01). Conclusions: Eye hospitals demonstrate alignment with EBM principles, though regional variations exist. Organizations with robust data utilization systems, analytical expertise, and a commitment to continuous improvement are more effective in practicing EBM. Educational and peer-learning initiatives can further support hospitals in adopting EBM principles, strengthening their capacity for evidence-based decision-making, and enhancing eye care services.

Diverse Care Needs Assessment for Older Adults in China: A Latent Profile Analysis Study.

Grasping the nuanced needs of older adults is paramount for the efficacious provision of day-care services. Our study sought to identify the demand patterns for day-care services in China and to explore the underlying factors. This study aims to offer useful evidence that can refine nursing care strategies and guide policy development within day-care settings. We implemented a comprehensive electronic survey comprising 46 questions targeting older adults across nine day-care centers in Nanjing, China. Employing latent profile analysis (LPA), we systematically examined and categorized the demand characteristics for day-care services. This analysis was conducted using Mplus version 8.3 and SPSS version 26.0 software, ensuring a rigorous and precise methodological approach. Our study involved a comprehensive survey of 1016 older adults. The participants were categorized into three groups based on their demand for day-care services: high demand (n = 127), medium demand (n = 197), and low demand (n = 692). The low-demand group exhibited higher levels of social support and better activities of daily living (ADL) scores compared to their counterparts. Multivariate regression analysis indicated that older adults characterized by male gender, advanced age, higher levels of education, receipt of support from a child, presence of chronic diseases, and lower social support and ADL scores exhibited a statistically significant inclination towards moderate to high demand for day-care services (p <0.05). The demand for day-care services for older adults in China is intricately influenced by a complex array of interrelated factors. Tailoring service offerings to meet the varied physical and emotional needs of older adults is essential, with a particular focus on health and wellness management in day-care centers.

P0614 Positive association of inflammatory bowel disease service research activity and adult patient-reported quality of care in the United Kingdom

Abstract Background Engagement with research has been shown to be associated with improved patient experience and outcomes at an institutional level in several disease areas1-3. However, this relationship has so far not been explored in inflammatory bowel disease (IBD). The aim of the present study was to assess the relationship between research activity of IBD services across the United Kingdom (UK) and patient-reported quality of care provided by that service. Methods Patient-reported care quality data was collected across the UK through the 2023 IBD UK Patient Survey. Patients rated the overall quality of their care in the preceding 12 months as “poor”, “fair”, “good”, “very good” or “excellent”. High-quality care was defined as responses of “excellent,” “very good,” or “good”. Data related to paediatric services and adult services with fewer than 5 patient responses were excluded. The proportion of patients reporting high quality care at each service was compared with the number of patients recruited to research studies registered with the national central portfolio management system (CPMS) within the previous three years (2020-2022). The CPMS is a cloud-based system that holds the National Institute for Health and Care Research (NIHR) clinical research network portfolio of studies in England, in addition to the network of portfolios in Northern Ireland, Scotland and Wales. Analyses were performed where recruitment identified IBD as the primary subspecialty and gastroenterology was the managing specialty. Results Research recruitment data from 32,432 recruited research participants across 192 IBD services were aligned with 11,738 care quality responses and included in the analysis. Overall, there was a positive correlation between the number of patients recruited to research studies in an IBD service and the proportion of patients reporting high quality care (Spearman r (95% CI) 0.2044 (0.06047-0.3400) p=0.0045). An iterative Grubbs’ Test identified 6 IBD services as outliers. After excluding these services, the positive correlation was maintained (Spearman r (95% CI) 0.1946 (0.04788-0.3331) p=0.0078; Figure 1). Conclusion This study identifies a positive association between the research activity of IBD services and patient-perceived quality of care, highlighting the benefits of active research engagement in IBD care. Acknowledgements We are grateful to the patients who submitted survey responses and to the IBD UK Board members.

Real-world long-term outcomes of peripheral nerve stimulation: a prospective observational study.

We aimed to evaluate real-world outcomes of peripheral nerve stimulation (PNS) used to treat chronic neuropathic pain (CNP) at a tertiary pain management center. Thirty adults who underwent PNS for CNP between June 2015 and September 2021 completed pain and psychosocial assessments in the 6 months before, and 2-3 years after PNS treatment. Pain intensity was measured using the NIH Patient Reported Outcomes Measurement Information System (PROMIS) Pain Intensity Short From (3A). Psychosocial outcomes including depression, anxiety, and sleep disturbance were also measured. Prior to receiving PNS, long-term responders reported significantly fewer depressive symptoms compared to non-responders (PROMIS depression t-score 50.3 [10.7] vs 57.9 [8.9]; p-value = 0.05). Eleven participants (36.7%) reported long-term treatment response. There was a significantly greater improvement in pain intensity among responders compared to non-responders who reported increased pain (PROMIS Pain Intensity score -9.0 [-4.2] vs. +3.1[+3.2]; p-value < 0.0001). Patients report clinically meaningful long-term pain relief after receiving PNS through both 60-day and permanent implant systems, with significant reductions in pain intensity observed in long-term responders. Long-term responders reported fewer depressive symptoms compared to non-responders prior to receiving therapy, emphasizing the importance of psychological screening and psychological optimization prior to receiving PNS.

Out-of-Distribution Detection via outlier exposure in federated learning.

Among various out-of-distribution (OOD) detection methods in neural networks, outlier exposure (OE) using auxiliary data has shown to achieve practical performance. However, existing OE methods are typically assumed to run in a centralized manner, and thus are not feasible for a standard federated learning (FL) setting where each client has low computing power and cannot collect a variety of auxiliary samples. To address this issue, we propose a practical yet realistic OE scenario in FL where only the central server has a large amount of outlier data and a relatively small amount of in-distribution (ID) data is given to each client. For this scenario, we introduce an effective OE-based OOD detection method, called internal separation & backstage collaboration, which makes the best use of many auxiliary outlier samples without sacrificing the ultimate goal of FL, that is, privacy preservation as well as collaborative training performance. The most challenging part is how to make the same effect in our scenario as in joint centralized training with outliers and ID samples. Our main strategy (internal separation) is to jointly train the feature vectors of an internal layer with outliers in the back layers of the global model, while ensuring privacy preservation. We also suggest an collaborative approach (backstage collaboration) where multiple back layers are trained together to detect OOD samples. Our extensive experiments demonstrate that our method shows remarkable detection performance, compared to baseline approaches in the proposed OE scenario.

Structural reversal of disc cupping measured in Bruch’s membrane opening-based OCT morphometry after PRESERFLO microshunt implantation for open-angle glaucoma

Background/ AimsTo analyze the longitudinal change in Bruch’s membrane opening minimal rim width (BMO-MRW) and peripapillary retinal nerve fiber layer (pRNFL) thickness using optical coherence tomography (OCT) after implantation of a PRESERFLO® microshunt for surgical glaucoma management in adult glaucoma patients.MethodsRetrospective data analysis of 59 eyes of 59 participants undergoing implantation of a PRESERFLO microshunt between 2019 and 2022 at a tertiary center for glaucoma management. Surgical management included primary temporary occlusion of the glaucoma shunt to prevent early hypotony. Pre- and post-operative OCT examinations of the optic nerve head (ONH) and intraocular pressure (IOP) were assessed. Longitudinal change in morphometric spectral domain OCT parameters of the ONH was correlated to change in IOP.ResultsBMO-MRW increased significantly between baseline (BL) and follow-up (FU) within the first three months after surgery (BL = 171.15 ± 66.80 μm; FU = 180.78 ± 70.394 μm; p = 0.034). For the same postoperative period, the mean preoperative IOP of 24.97 ± 7.22mmHg was lowered after surgery to 13.70 ± 5.09 mmHg. Eighteen months after surgery, there was no significant change in BMO-MRW compared to baseline (BL = 169.83 ± 52.69 μm; FU = 164.98 ± 55.85 μm; p = 0.271), while mean IOP was 13.08 ± 4.48 mmHg. A decrease in IOP correlated significantly with a change in BMO-MRW (r = 0.453, p < 0.05) three months after surgery. Peripapillary RNFL thickness was unchanged in follow-up after three months (p > 0.16) and significantly decreased in later follow-up (p = 0.009).ConclusionPRESERFLO® microshunt implantation with primary temporary occlusion leads to a significant transient increase in BMO-MRW. This phenomenon is also known as structural reversal of disc cupping (SRDC). The effect seems to be less pronounced and of shorter duration when compared to previous data after trabeculectomy with comparable pre- and postoperative IOP levels.