Marginal Impact Research Articles

Impact of Surgical Margin on Prognosis and Recurrence in Intrahepatic Cholangiocarcinoma

Impact of Surgical Margin on Prognosis and Recurrence in Intrahepatic Cholangiocarcinoma

Investigation on The Effect of Low Frequency Ultrasound on The Crystallization of a Pharmaceutical Compound L+ Ascorbic Acid

One of the most crucial processes in the chemical processing industry is crystallization, which has the major challenge of producing solid products with the required purity and properties. The standard crystallization methods have various processing limitations; hence, research into alternative methods like ultrasonic-assisted crystallization has been at the forefront. The present work investigates the application of low-frequency ultrasound irradiation (40 kHz) for improving the cooling crystallization of ascorbic acid. The impact of ultrasonic irradiation on crystal size, shape, and induction time has been studied, and a comparison with the conventional method has been made. The standing time had a minor effect on particle size on average, while the initial temperature had a far more significant impact. Photographic analysis using image-analysis software indicated that when ultrasound was applied to the saturated solutions, the resulting crystals were smaller and more uniform in size and shape. The resultant crystal grows predominantly in a single direction, resembling thin prisms. The use of ultrasound was also shown to reduce the induction time significantly. This ultrasonic impact is stronger at lower initial temperatures. Indeed, the smallest induction time of 300 s was obtained for sonicated solutions at an initial temperature of 65°C and ultrasonic power of 250 w. When different levels of ultrasonic power dissipation were tested, it was established that the time required for the first nuclei to appear decreased as the power increased. There was, nevertheless, a marginal impact on average crystal size.

Urbanisasi dalam Tinjauan Historis: Studi Kasus Pemukiman Kumuh di Kelurahan 3-4 Ulu Kota Palembang, 2010-2020

This article examines the urbanization that occurred in slum settlements in Subdistrict 3-4 Ulu, Palembang City from 2010-2020. The focus of this article is on the ethnic diversity of living in slums and the socioeconomic problems faced as a result of urbanization. The research process starts from searching for data to writing articles using historical methods. This article aims to identify the impact of social exclusion and marginalization on ethnic minority groups as well as environmental damage due to urbanization. The research results show that Subdistrict 3-4 Ulu, Palembang City is classified as a very slum settlement. This can be seen in slum housing locations, lack of infrastructure, high unemployment rates, and limited access to education and health services. The studies that have been carried out contribute to providing useful insights into designing sustainable development policies in the future by proposing various mitigation efforts and solutions, including government measures, housing, and infrastructure improvement programs, as well as the importance of social integration and community participation.

Analysis of bias correction of HRRR model outputs for offshore wind power ramp events

This study examines the impact of bias correction on the prediction of offshore wind power ramp events (WPREs) using NOAA's High-Resolution Rapid Refresh (HRRR) model. The analysis focuses on New England's offshore region, using Light Detection and Ranging (LiDAR) wind observations and the power curve derived from the nearby Block Island wind farm as a reference. The study characterizes bias in terms of amplitude and phase, finding a 30-min systematic lag error and a marginal underestimation of high wind speeds. Perfect bias correction treatments including both the amplitude and the phase are applied to HRRR wind speed, and their impact on WPREs is assessed using categorical performance measures. A large discrepancy in the number of cases with HRRR having much fewer cases than the reference is found, which is attributed to the model's temporal and spatial resolution. The results show that the amplitude bias correction has a marginal impact on reducing frequency bias, while the dynamic time warping (DTW) used in the phase bias correction shows promising results but limited performance. The study concludes that phase bias correction can be a feasible option to reduce bias in WPREs in offshore power systems.

Impact of resection margin on outcome in soft-tissue sarcomas of the extremities treated with limb-sparing surgery and postoperative radiotherapy

BackgroundThe standard curative treatments for extremity soft tissue sarcoma (ESTS) include surgical resection with negative margins and perioperative radiotherapy. However, the optimal resection margin remains controversial. This study aimed to evaluate the outcomes in ESTS between microscopically positive margin (R1) and microscopically negative margin (R0) according to the Union for International Cancer Control (UICC) (R + 1 mm) classification.MethodsMedical records of patients with localized ESTS who underwent primary limb-sparing surgery and postoperative radiotherapy between 2004 and 2015 were retrospectively reviewed. Patients were followed for at least 5 years or till local or distant recurrence was diagnosed during follow-up. Outcomes were local and distal recurrences and survival.ResultsA total of 52 patients were included in this study, in which 17 underwent R0 resection and 35 underwent R1 resection. No significant differences were observed in rates of local recurrence (11.4% vs. 35.3%, p = 0.062) or distant recurrence (40.0% vs. 41.18%, p = 0.935) between R0 and R1 groups. Multivariate analysis showed that distant recurrences was associated with a Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) grade (Grade III vs. I, adjusted hazard ratio (aHR): 12.53, 95% confidence interval (CI): 2.67–58.88, p = 0.001) and tumor location (lower vs. upper extremity, aHR: 0.23, 95% CI: 0.07–0.7, p = 0.01). Kaplan–Meier plots showed no significant differences in local (p = 0.444) or distant recurrent-free survival (p = 0.161) between R0 and R1 groups.ConclusionsR1 margins, when complemented by radiotherapy, did not significantly alter outcomes of ESTS as R0 margins. Further studies with more histopathological types and larger cohorts are necessary to highlight the path forward.

Scale or effectiveness? The nonlinear impact of talent agglomeration on high-quality economic development in China

Talent agglomeration serves as a vital pathway for achieving high-quality economic development. This paper, based on provincial panel data from China spanning 2011–2020, first analyses the impact of talent agglomeration on high-quality economic development from two dimensions: the talent agglomeration scale and effectiveness. Second, with innovation activity as a threshold variable, this paper explores the nonlinear impact of the talent agglomeration scale and effectiveness on economic efficiency improvement and economic structure optimization. This study finds that (1) the main driving force for high-quality economic development within the sample period comes from the talent agglomeration scale, while the promoting role of talent agglomeration effectiveness has not yet passed significant tests. (2) Under different levels of innovation activity, the talent agglomeration scale has a diminishing marginal utility impact on economic efficiency improvement and economic structure optimization; talent agglomeration effectiveness also has different nonlinear effects on economic efficiency improvement and economic structure optimization.

Association of the Specimen and Tumor Bed Margin Status with Local Recurrence and Survival in Open Partial Laryngectomy.

Background/Objectives: Positive margins are associated with locoregional recurrence in early laryngeal cancer. The aim of this study was to evaluate the impacts of specimen-driven (ex vivo) positive margins on patients with early-stage laryngeal cancer whose tumor bed (defect-driven) margins had been negative. Methods: A retrospective study was performed on 60 consecutive T1b/T2 glottic cancer patients who underwent open frontolateral laryngectomy. The intraoperative margins were obtained from the tumor bed. Their recurrence and disease-free survival were evaluated. In all cases, negative margins were obtained from the surgical bed. The impact of positive margins from the specimen was evaluated in a paraffin study. Results: Among 10 patients with positive margins in the specimen, six experienced local relapse, and among 50 patients with negative margins in the specimen, three developed recurrence. The 5-year disease-free survival rates were 37.5% and 93.9%, respectively (p < 0.001; log-rank). Even with negative margins in the surgical bed, patients with positive margins in the specimen at the final histopathological examination had a 3.5-fold higher chance of developing local recurrence than those with negative margins (HR = 13.993; 95% CI: 3.479-56.281; p < 0.001; univariate Cox regression). Conclusions: Specimen-driven positive margins represent a significant risk factor for local recurrence, even under negative margins at the tumor bed.

Efficiency and Mergers and Acquisitions of Electric Utility Companies

Since the 1990s, market liberalization of the electricity industry has advanced all around the world. To survive in the drastically changing business environment, incumbent electric utility companies have conducted operational reforms, including Mergers and Acquisitions (M&amp;As), to enhance and/or complement existing business capabilities. The purpose of this study was to measure the operational efficiencies of 31 of the world’s largest electric utility companies using data from 2010 to 2020 and examine regional differences in and the impacts of M&amp;As on the efficiencies. For this purpose, we applied a new type of Data Envelopment Analysis (DEA) and Tobit model regression. We provide findings from the empirical analyses and discuss the business implications of M&amp;As for electric utility companies. The operational efficiency measures were different among regions, but did not show statistically significant changes over the study period from 2010 to 2020. Furthermore, the results of regression analyses indicate that the increasing number of M&amp;A buying transactions and M&amp;A total transactions has a negative marginal impact on the operational efficiency or leads to a lower operational efficiency for utility companies. Since electricity utility companies have not received gains in operational efficiency from increasing the number of M&amp;A transactions, they need to be more cautious about whether M&amp;A transactions can provide value to the operation and technology management.

On the dynamics and wakes of a freely settling Platonic polyhedron in a quiescent Newtonian fluid

We investigate systematically the free settling of a single Platonic polyhedron in an unbounded domain filled with an otherwise quiescent Newtonian fluid. We consider a particle–fluid density mimicking a rock in water. Five Platonic polyhedrons of increasing sphericity are studied for a range of Galileo numbers $10 \leqslant \mathcal {G}a \leqslant 300$ . We construct a regime map in the parameter space of Galileo number and particle volume fraction ( $\mathcal {G}a, \phi$ ), highlighting how the angularity of the Platonic polyhedron impacts its settling path and the onset of instabilities. We find that the initial angular position solely affects the transient settling process. All the Platonic polyhedrons maintain a stable settling angular position at low $\mathcal {G}a$ . Higher angularity leads to path unsteadiness at lower $\mathcal {G}a$ . Path instability progresses from steady vertical to unsteady vertical, followed by oblique settling observed for highly spherical particles, but helical settling (HS) for more angular particles. The particle autorotation is found to be the pivotal factor influencing path instability and the regime transition of angular particles. Beginning in the unsteady oblique and helical regimes, particle autorotation becomes more prevalent, escalating further in the chaotic regime as $\mathcal {G}a$ increases. The particle angular velocity vector is shown to be predominantly situated in the horizontal plane. A thorough force balance in the horizontal plane reveals that the Magnus force is the primary driving force of the HS regime. Additionally, we establish two new empirical correlations to predict the particle settling velocity and the disturbed wake length that solely require the physical properties of the system ( $\mathcal {G}a$ and $\phi$ ). Our numerical results suggest that an increase of the density ratio from $2$ to $3$ exerts only a marginal impact on the path instability of the most angular particle, the settling tetrahedron.

Impact of surgical proximal and distal margins on the recurrence of resectable colon cancer: a single-center observational cohort study.

Few studies have investigated the impact of the surgical proximal and distal margins on colon cancer recurrence. We conducted this study to investigate the effect of resection margins on the prognosis of resectable colon cancer. We analyzed data on 1458 patients who underwent colorectal resection in our institute between January, 2004 and March, 2020, including 579 patients with resectable colon cancer. The association between the resection margin and recurrence for each oncological status was assessed and the value of the resection length that influenced recurrence was analyzed. Patients who had pT4 colon cancer with margins of more than 7cm had a trend of fewer recurrences and longer relapse-free survival (RFS) than those with colon cancer of other stages (P = 0.033; hazard ratio [HR], 0.42; 95% confidence interval [CI], 0.20-0.89). Multivariate analysis identified a margin of < 7cm as an independent risk factor for RFS in patients with pT4 colon cancer (P = 0.023; HR, 2.65; 95% CI 1.013-6.17). No correlation was found between resection margins and recurrence, depending on the extent of lymph node metastasis and tumor location. A resection margin of at least 7cm should be maintained for patients with pT4 colon cancer.

The impact of vascular margin invasion on local recurrence after pancreatoduodenectomy in pancreatic adenocarcinoma

PurposePancreatic ductal adenocarcinoma (PADC) still has nowadays a very impaired long-term survival. Most studies are focused on overall survival; however, local recurrence occurs about up to 50% of cases and seems to be highly related with margin resection status. We aim to analyze the impact of vascular resection margins on local recurrence (LR) and to assess its impact on overall and disease-free survival.MethodsEighty out of 191 patients who underwent pancreatoduodenectomy in a university hospital between 2006 and 2021 with PDAC diagnosis were analyzed and vascular margin status specifically addressed. Univariate and multivariate were performed. Time to LR was compared by using the Kaplan–Meier method and prognostic factors assessed using Cox regression hazards model.ResultsLR appeared in 10 (50%) of the overall R1 resections in the venous margin and 9 (60%) in the arterial one. Time to LR was significantly shorter when any margin was overall affected (23.2 vs 44.7 months, p = 0.01) and specifically in the arterial margin involvement (13.7 vs 32.1 months, p = 0.009). Overall R1 resections (HR 2.61, p = 0.013) and a positive arterial margin (HR 2.84, p = 0.012) were associated with local recurrence on univariate analysis, whereas arterial positive margin remained significant on multivariate analysis (HR 2.70, p = 0.031).ConclusionsArterial margin invasion is correlated in our cohort with local recurrence. Given the limited ability to modify this margin intraoperatively, preoperative therapies should be considered to improve local margin clearance.

The “Benefits” of being small: Loose fiscal policy in the European Monetary Union

Independent central banks typically counteract positive fiscal shocks that would otherwise increase the inflation rate above the target. In a theoretical model, we show that, in a monetary union, this mechanism implies weaker responses to national fiscal shocks because the overarching central bank must account for the fiscal policies of all members. The model highlights that the response is especially weak for small members, given their marginal impact on the union’s aggregate inflation rate. Empirically, we exploit the exogenous variation in elections to show that the European Central Bank reacts more vigorously to fiscal shocks from larger countries. We then provide evidence that small countries take advantage of this; they engage more in fiscal expansions during election years than large countries. In an extension, we discuss, both theoretically and empirically, why the difference between small and large countries disappears in times of crisis.

Minimizing Questionable Research Practices – The Role of Norms, Counter Norms, and Micro-Organizational Ethics Discussion

AbstractBreaches of research integrity have gained considerable attention due to high-profile scandals involving questionable research practices by reputable scientists. These practices include plagiarism, manipulation of authorship, biased presentation of findings and misleading reports of significance. To combat such practices, policymakers tend to rely on top-down measures, mandatory ethics training and stricter regulation, despite limited evidence of their effectiveness. In this study, we investigate the occurrence and underlying factors of questionable research practices (QRPs) through an original survey of 3,005 social and medical researchers at Swedish universities. By comparing the role of the organizational culture, researchers´ norms and counter norms, and individual motivation, the study reveals that the counter norm of Biasedness—the opposite of universalism and skepticism—is the overall most important factor. Thus, Biasedness was related to 40–60% of the prevalence of the questionable practices. The analysis also reveals the contradictory impact of other elements in the organizational environment. Internal competition was positively associated with QRP prevalence, while group-level ethics discussions consistently displayed a negative association with such practices. Furthermore, in the present study items covering ethics training and policies have only a marginal impact on the prevalence of these practices. The organizational climate and normative environment have a far greater influence. Based on these findings, it is suggested that academic leaders should prioritize the creation and maintenance of an open and unbiased research environment, foster a collaborative and collegial climate, and promote bottom-up ethics discussions within and between research groups.

The Prognostic Impact of the Surgical Margin in Renal Cell Carcinoma Treated with Partial Nephrectomy: A Multi-Center Study.

Background: Partial nephrectomy (PN) is the preferred treatment for small, localized kidney tumors. Incomplete resection resulting in positive surgical margins (PSM) can occur after PN. The impact of PSM on the risk of recurrence and survival outcomes is not fully understood. We aimed to explore the relationship between PSM, the risk of recurrence and impact on survival after PN in a large multicenter cohort from Denmark. Methods: This was a retrospective cohort study including patients who underwent PN for renal cell carcinoma (RCC) at three departments in Denmark between 2010 and 2016. Data including pathological features, surgical techniques, and patient follow-up was retrieved from electronic medical health records and national databases. We used a combination of descriptive statistics, comparative analysis (comparisons were carried out by Mann-Whitney Test, independent Student's t-test, or Pearson's chi-Square Test), univariate and multivariate logistic regression analyses, and survival analysis methods. Results: A total of 523 patients were included, of which 48 (9.1%) had a PSM. Recurrence was observed in 55 patients (10.5%). Median follow-up time was 75 months. We found a lower incidence of PSM with robot-assisted PN (p = 0.01) compared to open or laparoscopic PN. PSM was associated with a higher risk of recurrence compared to negative margins in univariate analysis, but not multivariate analysis. However, the study was underpowered to describe this association with other risk factors. Overall survival did not differ between patients with PSM and negative margins. Conclusions: Our study presents further evidence on the negative impact of PSM on recurrence after PN for RCC, highlighting the importance of achieving NSM, thus potentially improving clinical outcomes. A surgical approach was found to be the only predictive factor influencing the risk of PSMs, with a reduced risk observed with robot-assisted laparoscopy.

Revolutionising Egyptian pavement design: a comprehensive E* database and advanced modeling approach for contextually informed performance predictions

ABSTRACT This research assesses the dynamic modulus (E*) as a pivotal rheological attribute for characterizing viscoelastic behaviour in various indigenous asphalt mixtures across diverse scenarios. An exhaustive investigation involving 32 laboratory-designed asphalt mixes and two field mixes explores the influence of traffic loading patterns, air voids, binder sources, and climatic conditions on E*. Utilizing Superpave gyratory compaction, 68 E*-specimens are compacted and subjected to E*-testing, leading to master curve development. Evaluation of NCHRP 1-37A and NCHRP 1-40D Witczak models demonstrates their fair to excellent accuracy in predicting E* for Egyptian mixes. The NCHRP 1-40D model stands out with an R² of 0.94, showcasing superior accuracy and minimal bias. This study integrates AASHTOW are Pavement ME Design (PMED) to analyse pavement sections, revealing the impact of design factors, characterized by measured E*, on predicted pavement performance, encompassing asphalt concrete rutting, alligator cracking, longitudinal cracking, and terminal international roughness index. The investigation highlights the marginal impact of substituting predicted E* for measured E* on AASHTOWare pavement performance indicators for Egyptian mixes under default binder characteristic values. This research contributes valuable insights into the interplay of E* and pavement performance, facilitating wellinformed decisions in pavement design and analysis across diverse conditions in the Egyptian context.

The impact of margins in laryngeal cancer patients treated with transoral laser microsurgery: a systematic review and meta-analysis.

In laryngeal squamous cell carcinoma (LSCC) treated with transoral laser microsurgery (TOLMS), the status of margins significantly affected local control. When a positive or close margin is present, there is no ubiquitous consensus regarding further treatments. The rationale of the present systematic review and meta-analysis is to investigate the survival impact of the status of the margins in patients affected by LSCC treated with TOLMS. PubMed, EMBASE, and Cochrane Library. We performed a systematic search, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria were: patients affected by LSCC, staged according to the American Joint Committee on Cancer Staging System and treated by TOLMS without any previous treatment; margins status (close, positive, negative) and the adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) of overall survival, disease-specific survival, and disease-free survival has to be reported. Nine studies were deemed eligible for the qualitative analysis, and 3 for the quantitative analysis to investigate the association between margin status and OS. The cumulative number of patients was 3130. The sample size ranged from 96 to 747 patients. The follow-up period ranged from 0 to 201months. The meta-analysis results show that positive margins have an aHR of 1.30 yet with CI range (0.56 to 2.97). Our current meta-analysis results are unable to definitively assess the real impact of resection margins on OS. Few authors provide accurate data regarding position and types of margins. Further prospective or high-quality studies are required.

Field Evaluation of Yellow Change and Red Clearance Intervals with Subsequent Permissive Left-Turn Flashing Yellow Arrow Indication

The flashing yellow arrow (FYA) indication has become commonly used for communicating permissive left-turn operations to road users. A conventional signal phasing communicated to left-turning drivers consists of a leading protected phase followed by a permissive phase using a FYA indication, often referred to as protected-permissive. To transition from the protected to the permissive phase, change (steady yellow arrow) and clearance (steady red arrow, all-red) intervals, or only a change interval, may be used. There is no specific guidance on the use of clearance intervals for left turns with protected-permissive phase and FYA indication. In this study, field data were collected from different geographical regions in the United States to evaluate change and clearance intervals with the objective of developing guidance. Video data were recorded at 37 intersections during peak hours, for approximately 142 h, across eight states. Overall, 4,001 observations of vehicles turning left during the change or clearance interval were analyzed. Field observations were evaluated at the approach level to assess left-turn violation rate and violations per cycle as a function of change and clearance interval configuration. At the individual vehicle level, logistic regression was implemented to evaluate the effect of change interval and clearance interval duration, delayed onset of FYA, and regional variation. The results of the analysis at the approach and individual vehicle level were consistent and indicate that: (i) a clearance interval should be included, (ii) delaying the onset of FYA indication with an extension beyond the all-red clearance interval would reduce left-turn signal violations, and (iii) duration of change intervals has a marginal impact on left-turn signal violations.

한우고기 할인판매행사가 한우 및 한돈가격 변동성과 수익률에 미친 영향

We analyzed the impact of ‘Hanwoo beef promotional sales events’, part of the Hanwoo Beef Checkoff Programs, on the volatility and rate of return for both Hanwoo and Handon wholsale prices. In order to account for information asymmetry and investigate the relationship between volatility and the rate of return, we employed the GJR-GARCH model combined with the GARCH in mean model. Our findings reveal that the implementation of ‘promotional sales events’ had a stabilizing effect on Hanwoo beef prices by lowering their volatility. It is also found that the rate of return increased. As price volatility increased, indicating an associated rise in the risk premium due to heightened market risk. Although the implementation of these events did not show statistical significance in influencing the rate of return for Handon pork, it was observed to have a marginal impact on price volatility.

Improved Metastatic-Free Survival after Systematic Re-Excision Following Complete Macroscopic Unplanned Excision of Limb or Trunk Soft Tissue Sarcoma.

Whether re-excision (RE) of a soft tissue sarcoma (STS) of limb or trunk should be systematized as adjuvant care and if it would improve metastatic free survival (MFS) are still debated. The impact of resection margins after unplanned macroscopically complete excision (UE) performed out of a NETSARC reference center or after second resection was further investigated. This large nationwide series used data from patients having experienced UE outside of a reference center from 2010 to 2019, collected in a French nationwide exhaustive prospective cohort NETSARC. Patient characteristics and survival distributions in patients reexcised (RE) or not (No-RE) are reported. Multivariate Cox proportional hazard model was conducted to adjust for classical prognosis factors. Subgroup analysis were performed to identify which patients may benefit from RE. Out of 2371 patients with UE for STS performed outside NETSARC reference centers, 1692 patients were not reviewed by multidisciplinary board before treatment decision and had a second operation documented. Among them, 913 patients experienced re-excision, and 779 were not re-excised. Characteristics were significantly different regarding patient age, tumor site, size, depth, grade and histotype in patients re-excised (RE) or not (No-RE). In univariate analysis, final R0 margins are associated with a better MFS, patients with R1 margins documented at first surgery had a better MFS as compared to patients with first R0 resection. The study identified RE as an independent favorable factor for MFS (HR 0.7, 95% CI 0.53-0.93; p = 0.013). All subgroups except older patients (>70 years) and patients with large tumors (>10 cm) had superior MFS with RE. RE might be considered in patients with STS of limb or trunk, with UE with macroscopic complete resection performed out of a reference center, and also in originally defined R0 margin resections, to improve LRFS and MFS. Systematic RE should not be advocated for patients older than 70 years, or with tumors greater than 10 cm.

‘Living between here and there’: Trans-local coping with urban marginality among internally displaced persons in urban Ethiopia

ABSTRACT Internally displaced persons (IDPs) in urban areas experience spatial, social and symbolic marginality because of interactions between the processes of displacement and the socio-spatial contexts in which they are relocated. While an increasing body of research has highlighted the agentic possibilities of urban margins, little is known about IDPs’ coping practices beyond the urban contexts that produce their marginality. Drawing on a qualitative study in two urban settlements in Ethiopia, this paper disentangles how trans-local practices of mobilities, connections and attachment, and the circulation of resources support IDPs in coping with disadvantages in urban settings. The findings show first, that constellations of mobilities across different nodal places constitute strategies to diversify the sources of livelihood thereby coping with the effects of spatial disadvantages. Second that, that trans-local connection and attachment preserves a sense of belonging to trans-local ‘homes’ and acts as a symbolic resource against the processes of exclusion and othering. Third, that the trans-local social network facilitates the exchange of material and intangible resources, and expands IDPs’ employment opportunities and social relations. This study contributes to our understanding of forced migrants’ agency to transform places and produce fluid lived spaces to reduce the impact of marginalization in relocation contexts.