Numerical Data Research Articles

Comparative analysis of upfront stereotactic radiosurgery and watchful waiting in the management of newly diagnosed vestibular schwannomas: a systematic review and meta-analysis.

Vestibular schwannomas (VS) are benign intracranial tumors posing significant management challenges. This study aims to compare the outcomes of stereotactic radiosurgery (SRS) and watchful waiting (WW) in the management of newly diagnosed VS, integrating findings from both retrospective and the pioneering V-REX prospective trial. Adhering to PRISMA guidelines, a systematic review was conducted using MEDLINE, Embase, and Cochrane databases. Studies directly comparing SRS with WW for newly diagnosed VS were included. Primary outcomes focused on hearing preservation assessed through the AAO-HNS or Gardner-Robertson hearing classification scales and tumor progression, with secondary outcomes focusing on neurological symptoms, and the need for further treatment. Thirteen studies encompassing 1,635 patients (WW: 891; SRS: 744) were included.While no significant difference was found in serviceable hearing loss at last follow-up (RR = 1.51, [95%CI: 0.98, 2.32], p = 0.06), significant differences favoring WW were observed in pure tone audiometry (PTA) (MD = -13.51 [95%CI: -22.66, -4.37], p = 0.004) and word recognition score (WRS) (MD = 20.48 [95%CI: 9.72, 31.25], p = 0.0002). Analysis of tumor progression indicated no overall significant difference in risk between SRS and WW (RR = 0.40, [95%CI 0.07, 2.40], p = 0.32), but subgroup analysis suggested a lower risk with SRS in certain contexts. The need for further treatments favored SRS (RR = 0.24, [95%CI: 0.07, 0.74], p = 0.007). No significant differences were found in tinnitus and imbalance between the two groups. This comprehensive analysis suggests no marked difference in functional hearing preservation between SRS and WW in managing VS. However, untreated tumors commonly necessitate additional interventions. These findings highlight the need for individualized treatment decisions and underscore the importance of continued monitoring. The study advocates for further prospective trials to refine management strategies for VS.

Maximum displacement prediction model for steel beams with hexagonal web openings under impact loading based on artificial neural networks

The estimation of the maximum displacement of steel beams with hexagonal web openings under impact loads is crucial for the anti-impact design of structures. The dynamic characteristics are complex, and the maximum displacement can be obtained experimentally, although the time cost, and expense of such experiments are high. In this context, a 6-5-1 artificial neural network model based on the Levenberg-Marquardt backpropagation algorithm was developed, incorporating 5-fold cross-validation techniques. Due to limited experimental data, 324 high-precision finite element models were created in bulk using Python-based ABAQUS software scripts to provide additional numerical data, and 26 specimens were designed for drop hammer tests to validate the finite element models. The artificial neural network model on the test data yielded a mean squared error of 0.0268, a mean absolute error of 0.0014, and a coefficient of determination value of 0.9806, with samples having an error of less than 10% comprising 77.16% of the total samples. Using Garson’s algorithm, the contribution of input features was estimated, and a full parameter analysis of the proposed model was conducted. The results indicate that the most significant factor is the impact mass, which accounts for 37.58%. When the impact mass increased from 530 kg to 630 kg, the maximum displacement of Q235 surged by 93.75%. The factor with the least impact is the opening spacing, accounting for 2%, with an average increase in maximum displacement of only 3.45%. Finally, ANN-based equations that can be used as design tools are established.

Investigating two-dimensional adjoint QCD on the lattice

We present our investigations of SU(N) adjoint QCD in two dimensions with one Majorana fermion on the lattice. We determine the relevant parameter range for the simulations with Wilson fermions and present results for Polyakov loop, chiral condensate, and string tension. In the theory with massive fermions, all observables we checked show qualitative agreement between numerical lattice data and theory, while the massless limit is more subtle since chiral and non-invertible symmetry of the continuum theory are explicitly broken by lattice regularization. In thermal compactification, we observe N perturbative vacua for the holonomy potential at high-T with instanton events connecting them, and a unique vacuum at low-T. At finite-N, this is a cross-over and it turns to a phase transition at large-N thermodynamic limit. In circle compactification with periodic boundary conditions, we observe a unique center-symmetric minimum at any radius. In continuum, the instantons in the thermal case carry zero modes (for even N) and indeed, in the lattice simulations, we observe that chiral condensate is dominated by instanton centers, where zero modes are localized. We present lattice results on the issue of confinement vs. screening in the theory and comment on the roles of chiral symmetry and non-invertible symmetry.

Design of cold-formed high strength steel irregular octagonal hollow section columns

This paper presents experimental numerical investigations on the structural behaviour of cold-formed high strength steel irregular octagonal hollow section (OctHS) columns with both non-slender and slender cross-sections. An experimental programme, including material tests, measurements of initial global geometric imperfection, and pin-ended column tests, was first conducted. The key findings from the experimental programme are presented and discussed. Following the validation against the experimental results, the proposed finite element modelling methodology was established to replicate the test observations, and then was adopted to generate a boarder range of numerical results through parametric studies. The collected experimental and numerical data were used to evaluate the applicability of current structural steel design methods on the column buckling strength for irregular OctHS columns. Assessment results demonstrate that the design method adopted in Chinese code can provide accurate prediction, whilst modified design method adopted in Eurocode 3, considering the effect of steel grade on the column strength, has been proposed and shown to greatly enhance the prediction accuracy with improved consistency. The corresponding assessments on the design approaches adopted in American and Australian codes were also discussed.

Application of machine learning models to improve the prediction of pesticide photodegradation in water by ZnO-based photocatalysts

Pesticide pollution has been posing a significant risk to human and ecosystems, and photocatalysis is widely applied for the degradation of pesticides. Machine learning (ML) emerges as a powerful method for modeling complex water treatment processes. For the first time, this study developed novel ML models that improved the estimation of the photocatalytic degradation of various pesticides using ZnO-based photocatalysts. The input parameters encompassed the source of light, mass proportion of dopants to Zn, initial pesticide concentration (C0), pH of the solution, and irradiation time. Notably, the numerical data were extracted from the literature via relevant tables (directly) or graphs (indirectly) using the web-based tool WebPlotDigitizer. Additionally, physicochemical properties such as the molecular weight of the dopants and pesticides, as well as the water solubility of both dopants and pesticides, were considered. Four ML models including multi-layer perceptron artificial neural network (MLP-ANN), particle swarm optimization-adaptive neuro fuzzy inference system (PSO-ANFIS), radial basis function (RBF), and coupled simulated annealing-least squares support vector machine (CSA-LSSVM) were developed. In comparison, RBF showed the best accuracy of modeling among all models, with the highest determination coefficient (R2) of 0.978 and average absolute relative deviation (AARD) of 4.80%. RBF model was effective in estimating the photocatalytic degradation of pesticides except for 2-chlorophenol, triclopyr and lambda-cyhalothrin, where CSA-LSSVM model demonstrated superior performance. Dichlorvos was completely degraded by ZnO photocatalyst under visible light. The sensitivity analysis by relevancy factor exhibited that light irradiation time and initial pesticide concentration were the most important parameters influencing photocatalytic degradation of pesticides positively and negatively, respectively. The new ML models provide a powerful tool for predicting pesticide degradation in wastewater treatment, which will reduce photochemical experiments and promote sustainable development.

Lesion characteristics are associated with bowel, bladder, and overall independence following cervical spinal cord injury

Context/Objective There is a growing global interest in quantifying spinal cord lesions and spared neural tissue using magnetic resonance imaging (MRI) in individuals with spinal cord injury (SCI). The primary objective of this study was to assess the relationships between spinal cord lesion characteristics assessed on MRI and bowel, bladder, and overall independence following SCI. Design Retrospective, exploratory study. Participants 93 individuals with cervical SCI who were enrolled in a local United States Model Systems SCI database from 2010 to 2017. Methods Clinical and MRI data were obtained for potential participants, and MRIs of eligible participants were analyzed. Explanatory variables, captured on MRIs, included intramedullary lesion length (IMLL), midsagittal ventral tissue bridge width (VTBW), midsagittal dorsal tissue bridge width (DTBW), and axial damage ratio (ADR). Outcome Measures Bowel and bladder management scale of the Functional Independence Measure (FIM) and FIM total motor score. Results When accounting for all four variables, only ADR was significantly associated with bowel independence (OR = 0.970, 95% CI: 0.942–0.997, P = 0.030), and both ADR and IMLL were strongly associated with bladder independence (OR = 0.967, 95% CI: 0.936–0.999, P = 0.046 and OR = 0.948, 95% CI: 0.919–0.978, P = 0.0007, respectively). 32% of the variation in overall independence scores were explained by all four predictive variables, but only ADR was significantly associated with overall independence after accounting for all other predictive variables (β = −0.469, 95% CI: −0.719, −0.218, P = 0.0004). Conclusions Our results suggest that the MRI-measured extent of spinal cord lesion may be predictive of bowel, bladder, and overall independence following cervical SCI.

P-505 Clinical rescue rate of abnormally fertilized oocytes and the relationship with patient, embryo and laboratory features

Abstract Study question Which are the main patient, embryonic and laboratory variables associated with a diploid result in abnormally fertilized embryos? Summary answer Embryo diploid constitution is associated with maternal age, trophectoderm and inner cell mass quality as well as pronuclear (PN) number predicted by time-lapse incubator. What is known already In conventional in vitro fertilization cycles, morphological PN evaluation can identify proper fertilization and predict embryo ploidy constitution. Atypical PN patterns like 0PN, 1PN or more than 2PN are associated with ploidy abnormalities. However, we have previously shown that PN number is insufficient to predict embryo ploidy composition, and advanced single nucleotide polymorphism (SNP)-based methodologies for preimplantation genetic testing (PGT) detect a significant number of genetically diploid embryos from presumed abnormally fertilized oocytes. In this study, we characterized the diploid rescue rate associated with abnormal PN configurations, uncovering the link between ploidy results and relevant patient, embryonic and clinical/laboratory parameters. Study design, size, duration Retrospective observational study evaluating the association between diploid rescue rate of abnormally fertilized embryos and different patient, embryonic and laboratory features. Embryos were cultured in conventional or EmbryoScope™ time-lapse incubator (Vitrolife) until blastocyst stage and classified according to Gardner embryo grading system. Ploidy assessment was performed on 343 euploid trophectoderm (TE) biopsies collected between January 2021 and November 2023. Results were stratified according to patients age, embryo quality parameters and different laboratory procedures. Participants/materials, setting, methods Multi-center international study involving consenting patients using autologous gametes and undergoing PGT for aneuploidies (PGT-A) combined with ploidy analysis. Ploidy protocol was performed using a validated targeted NGS approach composed of a custom panel of 357 SNPs and a proprietary pipeline of analysis. Reliable ploidy classification was obtained using a combined algorithm strategy based on SNPs allele frequencies. Categorical variables were expressed in percentages. Nominal variables were analysed using the Cochran-Armitage test to detect trends. Main results and the role of chance Among 343 euploid embryos, diploidy rates obtained for 0PN, 1PN, 2.1PN and 3PN groups were 86.8% (n = 118/136;95%CI=79.89-91.96) 43.7% (n = 59/135;95%CI=35.19-52.50), 65.0% (n = 13/20;95%CI=40.78-84.61) and 26.9% (n = 14/52;95%CI=15.57-41.02) respectively. Regarding patient parameters, advanced maternal age, but not paternal age, was significantly associated with lower diploid rescue rates, with a decreasing trend from 72.5% (n = 79/109;95%CI=63.10-80.60) below age 35 to 42.9% (n = 30/70;95%CI=31.09-55.25) above age 40 (p < 0.01). When considering embryo morphological evaluations, Cochran Armitage test revealed a significant link between diploidy rates and TE quality with a decreasing trend going from 72.1% (n = 80/111;95%CI=62.76-80.17) to 52.7% (n = 79/150;95%CI=44.36-60.87) and 45.8% (n = 22/48;95%CI=31.37-60.83) for embryos classified with TE grade as A, B, and C, respectively (p-value<0.01). Similarly, a decreasing trend was reported in relation to inner cell mass (ICM) quality, when moving from grade A (67,1%, n = 94/140;95%CI=58.23-75.33) to grade C (54.8%, n = 17/31;95%CI=36.03-72.68) (p = 0.03). No clear association was reported for embryo expansion degree. Finally, among laboratory variables (oocyte freezing procedure, fertilization method, incubator type), only time-lapse significantly impacted expected diploid results. Overall, if abnormal PN number is confirmed by time-lapse (n = 42 samples), the accuracy in predicting ploidy abnormalities increased from 29.2% (n = 82/281;95%CI=23.93-34.87), in conventional incubators, to 83.3% (n = 35/42;95%CI=68.64-93.03) (p < 0.01). Consequently, expected diploid rescue rate decreased from 65.5% (n = 184/281;95%CI=59.60-71.03) to 16.7% (n = 7/42;95%CI=6.97-31.36) (p < 0.01). Limitations, reasons for caution Parental DNA analysis should be included to rule-out the residual risk of uniparental disomy in diploid embryos. The multi-center nature of the study didn’t support a uniform PN annotation, especially for centers lacking time-lapse observation. Future studies should focus on the clinical follow-up after the transfer of rescued euploid-diploid embryos. Wider implications of the findings We believe we reported the first evidence of maternal age effect on ploidy results in the largest dataset of abnormally fertilized embryos. We revealed a link between ploidy constitution and blastocyst morphological quality, providing important information for patient counselling. Time-lapse incubators offer a more accurate identification of abnormally fertilized oocytes. Trial registration number n/a

P-250 Only euploidy does not ensure optimal chances for successful live birth through single blastocyst cryotransfer

Abstract Study question What does a euploid blastocyst require to provide the greatest probability of successful birth? Summary answer Morphokinetic and morphological features of the inner cell mass (ICM) and trophectoderm (TE) are crucial for optimizing live birth chances in cryo-transferred euploid blastocysts. What is known already Embryo selection through preimplantation genetic testing for aneuploidy (PGT-A) alongside frozen embryo transfer strategy enhances outcomes of single-embryo transfer cycles. While euploidy is a crucial indicator, investigations on the identification of additional criteria influencing implantation and live birth rates remain imperative. Studies suggest morphokinetic and morphological quality may supplement predictive factors for euploid embryo success, with varying correlations. The impact of factors like age or gamete origin on euploid blastocyst success remains uncertain, differentiating it from clear effects on non-diagnosed embryos. Optimizing selection criteria involves navigating the intricate interplay of these variables. Study design, size, duration This retrospective study analyses the pregnancy rate (PR) in 596 single embryo cryotransfers of full euploid blastocysts (without detected mosaicism) between February 2019 and September 2023. From these, 437 had a known outcome, and the live birth rate (LBR) was calculated. The study explored the potential impact of gamete origin, oocyte provider age, recipient age, morphokinetics, and morphological quality of ICM or TE (Gardner score) on the reproductive success of the transferred embryo. Participants/materials, setting, methods All embryos were biopsied at the blastocyst stage and successively vitrified. High-resolution next-generation sequencing was used for PGT-A. Only deferred transferences of single post-thawing intact embryos were included. Morphokinetic was assessed using the KIDscoreD5 3.1. Quantitative variables (oocyte provider age, recipient age, and morphokinetic score) were compared using the t-student test, while qualitative variables (gamete origin, morphological quality of ICM and TE) were assessed using the chi-square test. Main results and the role of chance Oocytes leading to pregnancies and live births were derived from women with ages comparable to those without success (Pregnancy: 30.0±7.1 vs. 30.8±6.8, p = 0.174; Live Birth: 30.1±7.1 vs. 30.5±6.9, p = 0.499). Similar age was also observed among recipients achieving pregnancy (41.5±5.4) and live births (41.1±5.1) compared to those who did not (Pregnancy: 41.8±5.1, p = 0.506; Live Birth: 41.5±5.3, p = 0.411). The origin of oocytes and semen (own or donor) did not significantly affect PR (Oocytes: 199/273 vs. 217/323, p = 0.130; Semen: 328/473 vs. 88/123, p = 0.224) or LBR (Oocytes: 113/205 vs. 116/232, p = 0.285; Semen: 183/347 vs. 46/90, p = 0.783). Morphokinetics played a crucial role, with euploid embryos resulting in pregnancy (7.5±1.7) and live births (7.6±1.6) exhibiting significantly higher scores than those without success (6.9±1.7; 7.1±1.7; p < 0.05).199 ICM quality did not significantly impact PR (A:211/296, B:190/275, C:15/25; p = 0.469). However, higher miscarriage rates in C-quality ICM blastocysts significantly reduced the LBR (A:116/211, B:107/205, C:6/21; p < 0.05). TE quality exhibited significant differences in PR (A:221/289, B:184/289, C:11/18; p < 0.05). Since the miscarriage rate was similar among groups (p = 0.787), LBR remained higher in A-quality TE blastocysts (A:124/209, B:98/213, C:7/17; p < 0.05). Limitations, reasons for caution As a retrospective analysis, this study is inherently limited. The influence of expansion grade on success rates remains unexplored, given the use of assisted hatching on day 3 of culture. Performing assisted hatching at the time of biopsy could potentially overcome this limitation. Wider implications of the findings The pursuit of a euploid embryo often becomes the priority in IVF laboratories. However, once the milestone is achieved, morphokinetics and embryonic morphological quality must continue to be considered. This study provides valuable insights for conveying a detailed message to patients with euploid embryos about their prospects for homebirth success. Trial registration number not applicable

Calculation of a Reference Interval for Rectal Temperature in Adult Dogs Presenting for Veterinary Care Using an Algorithm for Mixed Data

Veterinarians rely on the measurement of canine body temperature to define the health status of dogs, but no studies exist defining a reference range for rectal temperature on a large group of dogs. The aim of this study was to define the rectal body temperature of dogs based on a large data set of diseased and healthy animals and to evaluate the capability of the employed algorithm to calculate reference intervals of numerical clinical data. Out of 24,013 recorded measurements, statistical analysis was applied to data from 9782 adult dogs that underwent clinical examination at a university clinic between 2008 and 2017. The reference interval was calculated using an algorithm developed by the Deutsche Gesellschaft für Klinische Chemie und Laboratoriumsmedizin e.V. as part of its Reference Limit Estimator software (version 1.40.36.07). The following values were excluded: multiple measurements in a given dog, samples without assigned age or dogs younger than one year, and values <30.0 °C and >43.0 °C. Out of 9782 adult dogs, 665 temperature measurements were identified as outliers, and 9117 were used for further statistical analysis. The mean rectal temperature was 38.6 °C (90% CI: 38.6–38.6 °C) with a reference interval of 37.7 °C (90% CI: 37.7–37.7 °C) to 39.5 °C (90% CI: 39.5–39.5 °C). Validation according to CLSI guidelines showed the results to be valid. The determination of a reference interval for rectal temperatures in dogs using an algorithm for mixed datasets yielded results comparable to the existing reference intervals. This demonstrates that the calculation of reference intervals from mixed datasets of clinical numerical data can be used to confirm existing reference intervals or establish such de novo.

Terahertz magnetic response of plasmonic metasurface resonators: origin and orientation dependence

The increasing miniaturization of everyday devices necessitates advancements in surface-sensitive techniques to access phenomena more effectively. Magnetic resonance methods, such as nuclear or electron paramagnetic resonance, play a crucial role due to their unique analytical capabilities. Recently, the development of a novel plasmonic metasurface resonator aimed at boosting the THz electron magnetic response in 2D materials resulted in a significant magnetic field enhancement, confirmed by both numerical simulations and experimental data. Yet, the mechanisms driving this resonance were not explored in detail. In this study, we elucidate these mechanisms using two semi-analytical models: one addressing the resonant behaviour and the other examining the orientation-dependent response, considering the anisotropy of the antennas and experimental framework. Our findings contribute to advancing magnetic spectroscopic techniques, broadening their applicability to 2D systems.

877 Demand-Side Barriers to Surgical Care in Low- and Middle-Income Countries - a Scoping Review

Abstract Aim Thirty per cent of diseases worldwide can be treated by surgery or require the direct care of a surgeon. The Lancet Commission (2015) found that five billion people lack access to safe surgery, predominately those living in low- and middle-income countries, where nine out of ten people cannot access basic surgical care. Numerous studies have examined supply-side barriers, but few have examined the demand-side. We report a scoping review to identify and explore the barriers that prevent patients from seeking surgical care. Method A systematic search of multiple databases using the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines was conducted, looking for papers published between January 2015 and November 2023. Two independent reviewers charted qualitative variables and significant demographic data. Results Out of 2,899 studies examined, 228 met the inclusion criteria. The studies spanned six continents and fifty-seven countries. 14% were multi-country. Forty-seven barriers were identified and organised under ten headings. The five most frequently cited barriers were distance, fear/lack of trust, transport costs, reliance on religious/traditional healers and indirect costs (food/accommodation/companion). Conclusions Our review demonstrates the breadth of barriers contributing to the unmet need for surgery amongst all surgical specialities. While countries pursue their 2030 target to increase the provision of safe surgical care, there also needs to be a clear focus on understanding the factors that prevent patients from accessing established surgical care and how to mitigate them.

RELATIONSHIP BETWEEN OPPORTUNITIES FOR ADVANCEMENT AND TEACHER MOTIVATION IN PRIVATE PRIMARY SCHOOL IN MUKUNGWE SUB-COUNTY, MASAKA DISTRICT. A CROSS-SECTIONAL STUDY.

Background The availability of opportunities for advancement motivates teachers to invest in their professional growth and development, leading to increased job satisfaction and commitment. The study aims to assess the relationship between opportunities for advancement and teacher motivation. Methodology A descriptive, cross-sectional, and correlational survey design. A qualitative approach was employed in examining the non-numerical findings of the study such as gender and attitudes of the respondents on the study variables were coded and summarized to produce descriptive findings. The quantitative approach was used to analyze and interpret numerical data for meaningful findings. Results Most respondents (51%) were in the age range of 20-35 years, followed by 37% in the age range of 36-50 years, and 12% aged 51 years and above. There was a moderately strong positive correlation between opportunities for advancement and teacher commitment (Pearson Correlation = 0.629, p = 0.002). This implies that when teachers perceive there are opportunities for advancement within the school, their commitment tends to be higher. Conclusions There was a moderately strong positive relationship between opportunities for advancement and teacher commitment implying that when teachers perceive there are opportunities for advancement within the school, their commitment tends to be higher. Recommendations Private primary schools should provide more opportunities for leadership roles, teaching specialized subjects, and bonuses for advancement to address perceived deficiencies in these areas.

Comparison of propofol versus dexmedetomidine sedation for awake C-MAC® D-Blade video laryngoscopic nasotracheal intubation in patients with difficult airway: A randomised clinical study

Background and Aims: Awake intubation is the preferred method for securing difficult airways. We compared intravenous (IV) propofol and dexmedetomidine for C-MAC® D-blade-guided anticipated difficult nasotracheal intubation under conscious sedation. Methods: This randomised study included 60 patients with difficult airway (El-Ganzouri Score 4–9). After adequate airway preparation with IV midazolam 0.03 mg/kg and IV fentanyl 1 µg/kg, in Group P, propofol was infused at 250 µg/kg/min and in Group D, dexmedetomidine was infused at 1 μg/kg over 10 min, then at 0.5 μg/kg/h till a bispectral index (BIS) value 65–70 was achieved. Patients underwent C-MAC® D-blade video laryngoscope-guided nasotracheal intubation. The intubation score was the primary outcome measure. Secondary outcome measures included haemodynamic parameters, intubation time, number of attempts, the incidence of failed awake intubation, glottic view, time to achieve desired BIS, complications, study drug consumption and patient-reported satisfaction with the awake intubation technique. Quantitative variables were compared between groups using unpaired t-test/Welsch test/Mann–Whitney Test. Qualitative variables were correlated using the Chi-square test/Fisher's exact test. A P value of <0.05 was considered statistically significant. Results: The intubation score was significantly higher in Group D versus Group P (P = 0.007). Patient reaction to intubation, haemodynamic parameters and percentage of glottis opening score were more favourable in Group P. Coughing and vocal cord movement were comparable between the groups (P > 0.05). The time to target BIS was four times longer, and the time to intubate was 6 seconds longer in Group D. Conclusion: Successful awake C-MAC® D-blade video laryngoscopic intubation can be performed under dexmedetomidine/propofol conscious sedation, with propofol giving a better intubation score.

Examining the factors behind the new UK January maximum temperature record, 28 January 2024

AbstractLarge‐scale subsidence and associated adiabatic warming through compression allowed exceptionally mild air to reach western Scotland at low elevations on 28 January 2024. Marked foehn effects were then able to mix this air mass into the boundary layer across the Scottish Highlands, where an official observation from Achfary recorded a new UK January maximum temperature of 19.9°C. Observations and some numerical weather prediction data were used to assess the likely contributions of various foehn mechanisms to this event, with findings suggesting that mechanical mixing/turbulence most likely played the dominant role.

Laparoscopic cholecystectomy with or without drainage: a systematic review and meta-analysis

Background. The abdominal drainage with a prophylactic purpose was used by surgeons for decades because of the possibility to detect early signs of postoperative complications. However, the real value of routine drainage after abdominal surgery is still debated. There are discrepancies between studies supporting the drain placement only in patients with intraoperative complications and works showing a beneficial effect of prophylactic abdominal drainage on postoperative pain, nausea, and vomiting. However, there is still a lack of evidence on the use of routine abdominal drainage following laparoscopic cholecystectomy and its clinical value. Current guidelines do not mention the role of drainage after laparoscopic cholecystectomy. Objective: to evaluate whether conventional postoperative drainage is more effective than no drainage in patients with non-complicated benign gallbladder disease after laparoscopic cholecystectomy. Materials and methods. A search in the electronic databases MEDLINE, Scopus, Cochrane Library was conducted for randomized controlled trials reporting outcomes of laparoscopic cholecystectomy with and without an abdominal drainage until January 2024. The systematic review was conducted in accordance with the PRISMA guidelines and meta-analysis — using fixed and random effects models. Odds ratio (OR) with confidence interval (CI) for qualitative variables and mean difference (MD) with CI for continuous variables were calculated using IBM SPSS Statistics 29.0.2.0. Results. Forty-four randomized controlled trials invol­ving 5,185 patients (2,592 with drains vs 2,593 without them) were included in the meta-analysis. There were no statistically significant differences in the incidence of intra-abdominal fluid accumulation (OR = 0.87; 95% CI: 0.64–1.19; p = 0.39) between two groups. Abdominal drains did not reduce the overall incidence of nausea and vomiting (OR = 1.51; 95% CI: 0.85–2.70; p = 0 .16) or shoulder pain (OR = 0.90; 95% CI: 0.58–1.41; p = 0.65). The abdominal drain group reported significantly higher pain scores (MD = 0.67; 95% CI: 0.37–0.98; p < 0.001) than patients without drains. Abdominal drainage increased operative time (MD = 3.82; 95% CI: 1.93–5.70; p < 0.001) but not the length of hospital stay after surgery (MD = 0.42; 95% CI: –0.02–0.85; p = 0.06). Wound infection (OR = 3.26; 95% CI: 2.35–4.51; p < 0.001), fever (OR = 4.40; 95% CI: 2.57–7.8554; p < 0.001) and pneumonia (OR = 4.74; 95% CI: 2.25–9.97; p < 0.001) were found to be associated with the use of abdominal drains. Conclusions. Currently, there is no evidence to support the use of routine drainage after laparoscopic cholecystectomy in non-complicated benign gallbladder disease. No drainage after laparoscopic cholecystectomy is safe and associated with fewer complications. Postoperative recovery is improved if drain is not used. Further well-designed randomized clinical trials are required to confirm this finding.

Potential role of mitochondrial uncoupling protein 2 as a biomarker in patients with sepsis and septic shock: A prospective observational study

Background and Aims: Early diagnosis of sepsis is crucial. The primary objective of this study was to explore the role of uncoupling protein 2 (UCP2) in diagnosing sepsis and septic shock. Methods: This prospective observational study was conducted over 19 months. All adult patients aged more than 18 years with a diagnosis of sepsis or septic shock based on quick sequential organ failure assessment (qSOFA) score were enroled. Blood was drawn for procalcitonin (PCT) and UCP2 on days 0, 3, 7 and 28. Blood samples from 50 healthy volunteers were used as controls. An electrochemiluminescence test was done for PCT. A quantitative enzyme-linked immune sorbent assay was used for UCP2. The Chi-square test was used for qualitative variables and the independent t-test for quantitative variables. The receiver operator characteristic curve was used to evaluate the diagnostic efficacy of UCP2. Results: A total of 128 subjects were included in the study. Out of these, 78 patients (qSOFA score ≥2) were subcategorised into the infection group, sepsis or septic shock group based on the PCT levels. The UCP2 levels in the infection, sepsis or septic shock group were significantly higher than in the control group (P > 0.001). The UCP2 levels correlated with PCT on admission, day 3 and day 7. Conclusion: The UCP2 levels were significantly higher in sepsis and septic shock groups compared to controls and hence could be a potential diagnostic biomarker of sepsis.

Determination of the minimum number of periods for assessing the sustainable development indices of the EU countries using the methods of ordinal statistics

The subject matter of the article is the process of assessing the sustainable development indices of the European Union countries. The goal of the article is to develop a methodology for determining the number of periods for which it is necessary and sufficient to assess the sustainable development indices of states. The article results the following task: to develop a methodology for determining the law of distribution of random variables of sustainable development indices. Determination of the minimum number of periods for assessing the sustainable development indices of the European Union countries. Methods used: parametric and ordinal statistics. The following results are obtained: parametric and non-parametric methods of statistics, their advantages and disadvantages are considered. Various methods of estimating the distribution function for small samples, in particular the method of rectangular contributions and the method of uncertainty reduction are analysed. Particular attention is paid to the problem of changing the law of scattering of quality indicators when changing the conditions of technology. A graph-analytical method for identifying the law of distribution of random variables based on a small amount of statistical information is proposed. For this purpose, the theory of ordinal statistics was used. A step-by-step methodology for identifying the law of distribution of random variables using 10 ordered values has been developed. The mathematical expectations of ordinal statistics for three distribution laws are proposed. A methodology for determining the number of periods for assessing the indices of sustainable development of countries using ordinal statistics is developed. The study is based on the analysis of statistical data for the last ten years and their ordering in ascending order. The mathematical expectations of ordinal statistics are used to select appropriate distribution laws. Given the limited information available when working with small samples, the article proposes a methodology that allows obtaining the maximum amount of information from the available data. The developed approach makes it possible to take into account the uncertainty of the phenomenon under study and make informed decisions based on statistical analysis. Conclusions: based on the knowledge of the law of distribution, a methodology for determining the minimum number of periods for assessing the sustainable development indices of the European Union countries is proposed. Testing of the methodology on real numerical data has confirmed that the minimum number of periods is seven, provided that the distribution law follows the normal law.

Erlotinib or Gefitinib for Treating Advanced Epidermal Growth Factor Receptor Mutation-Positive Lung Cancer in Aotearoa New Zealand: Protocol for a National Whole-of-Patient-Population Retrospective Cohort Study and Results of a Validation Substudy.

Starting in 2010, the epidermal growth factor receptor (EGFR) kinase inhibitors erlotinib and gefitinib were introduced into routine use in Aotearoa New Zealand (NZ) for treating advanced lung cancer, but their impact in this setting is unknown. The study described in this protocol aims to understand the effectiveness and safety of these new personalized lung cancer treatments and the contributions made by concomitant medicines and other factors to adverse outcomes in the general NZ patient population. A substudy aimed to validate national electronic health databases as the data source and the methods for determining patient eligibility and identifying outcomes and variables. This study will include all NZ patients with advanced EGFR mutation-positive lung cancer who were first dispensed erlotinib or gefitinib before October 1, 2020, and followed until death or for at least 1 year. Routinely collected health administrative and clinical data will be collated from national electronic cancer registration, hospital discharge, mortality registration, and pharmaceutical dispensing databases by deterministic data linkage using National Health Index numbers. The primary effectiveness and safety outcomes will be time to treatment discontinuation and serious adverse events, respectively. The primary variable will be high-risk concomitant medicines use with erlotinib or gefitinib. For the validation substudy (n=100), data from clinical records were compared to those from national electronic health databases and analyzed by agreement analysis for categorical data and by paired 2-tailed t tests for numerical data. In the validation substudy, national electronic health databases and clinical records agreed in determining patient eligibility and for identifying serious adverse events, high-risk concomitant medicines use, and other categorical data with overall agreement and κ statistic of >90% and >0.8000, respectively; for example, for the determination of patient eligibility, the comparison of proxy and standard eligibility criteria applied to national electronic health databases and clinical records, respectively, showed overall agreement and κ statistic of 96% and 0.8936, respectively. Dates for estimating time to treatment discontinuation and other numerical variables and outcomes showed small differences, mostly with nonsignificant P values and 95% CIs overlapping with zero difference; for example, for the dates of the first dispensing of erlotinib or gefitinib, national electronic health databases and clinical records differed on average by approximately 4 days with a nonsignificant P value of .33 and 95% CIs overlapping with zero difference. As of May 2024, the main study is ongoing. A protocol is presented for a national whole-of-patient-population retrospective cohort study designed to describe the safety and effectiveness of erlotinib and gefitinib during their first decade of routine use in NZ for treating EGFR mutation-positive lung cancer. The validation substudy demonstrated the feasibility and validity of using national electronic health databases and the methods for determining patient eligibility and identifying the study outcomes and variables proposed in the study protocol. Australian New Zealand Clinical Trials Registry ACTRN12615000998549; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368928. DERR1-10.2196/51381.

Compressive behaviour and capacities of S690 high strength steel welded π-shaped and cruciform section stub columns

This paper reports experimental and numerical investigations into the cross-sectional behaviour and resistances of S690 high strength steel welded π-shaped and cruciform section stub columns under compression. An experimental investigation was firstly carried out on five S690 high strength steel welded π-shaped sections and five S690 high strength steel welded cruciform sections (covering both non-slender and slender sections) and included material tensile coupon tests, initial local geometric imperfection measurements and twenty stub column tests. The experimental investigation was supplemented by a numerical modelling investigation, where finite element models were firstly developed to simulate test structural responses and subsequently adopted to conduct parametric studies to generate further numerical data. On the basis of the obtained experimental and numerical data, the relevant design rules for high strength steel welded sections under compression, as set out in the European code, American specification and Australian standard, were assessed. The assessment results indicated that (i) the European code and American specification led to overall accurate and consistent cross-section compression resistance predictions for S690 high strength steel welded π-shaped sections, but provided slightly conservative and scattered resistance predictions for their cruciform section counterparts, and (ii) the Australian standard was accurate and consistent when used for non-slender S690 high strength steel welded π-shaped sections, but the design resistances were conservative and scattered for slender S690 high strength steel welded π-shaped sections as well as non-slender and slender S690 high strength steel welded cruciform sections.

Valuation of Knowledge, Attitude, Practices of Tuberculosis among the Health Care Workers from Islamabad Pakistan

BackgroundTuberculosis (TB) as a foremost infectious disease adds massive burden to morbidity and mortality rate, despite of well-structured TB control programs around the globe. Inappropriate health care management system and poor implementation on standard in relevance to TB, remain some reasons causative to TB prevalence and its rising antimicrobial resistance. Health Care Workers (HCWs) laboring as a part of TB control system, are the vital warriors in achieving the goals of TB End Strategy by 2035. Their performance is influenced by their knowledge, attitude, and practices (KAP) toward this infectious disease. This study aimed to signify the role of KAP score of health care Workers in the better control and prevention of TB in the Islamabad Capital Territory (ICT), Pakistan. MethodsA cross-sectional study on Knowledge, Attitude and Practice study of Tuberculosis (TB) among health care Workers, was done in ICT, which is the capital of Pakistan. The KAP of TB was collected for the 306 Health Care Workers from all the Islamabad TB referring health facilities which refer the TB patients for testing to the National Reference Laboratory, Islamabad Pakistan. Eligible health care workers were requested to respond on KAP questionnaire after informed consent. KAP questionnaire comprised of knowledge, attitude, and practices section including demographic information. All the data was analyzed using IBM SPSS statistics 21. One Way Analysis of Variance (ANOVA) was applied to calculate KAP mean score against different variables. On the significant data sets of ANOVA output, Tukey's Multiple Comparison Test was applied for pairwise comparison. Pearson correlation coefficient was utilized to explore the association between two qualitative variables. The non-parametric tests were applied to evaluate difference of KAP score in relation to demographic covariates individually. ResultsFrom June to July 2023, we conducted TB KAP study among Health Care Workers of ICT, Pakistan. The average age was 33 years (range 26–30 years). Majority of the recruited subjects were not being trained for dealing with TB infection. The results demonstrated that Health Care Workers working were lacking their knowledge about mode of TB transmission, best diagnostic technique, and contraction of TB infections. The mean knowledge, attitude and practices mean scores were 15.05 (SD =3.96), 83.68 (SD =15.74) and 6.31 (SD =2.21) respectively. Mean knowledge score of Health Care Workers were significantly related to their educational level and occupation while no significant association was declared with working experience as TB staff. Pearson coefficient of attitude score with knowledge of Health Care Workers was of weak level (0.28). Practice mean score was correlated to knowledge mean score at a moderate level (r =0.40). On the other hand, practice score was r =0.29 with attitude mean score had shown weak level correlation. A number of demographic factors were strongly linked to each of the mean score of knowledge, attitude, and practices. ConclusionThese findings highlighted the significant involvement of education, profession, and professional trainings in the better knowledge, attitude, and practices of the TB related health care Workers. For a better management system of infectious diseases like TB, a well-trained and professionally competent staff of Health Care Workers is important so as to achieve the goal of TB-End strategy by 2035 from Pakistan, which is the 5th highest burden country for TB.