Operative Logs Research Articles

A Multi-institutional Study From the United States Resident Operative Experience Consortium Examining Factors Associated With Exposure and Pursuit of Colorectal Fellowship Following General Surgery Residency.

Colon and rectal surgery is a popular fellowship following general surgery residency. The impact of a resident's colon and rectal surgery experience during residency may impact their career trajectory and pursuit of colon and rectal surgery. This study aims to identify individual and program factors associated with matriculation into colon and rectal surgery fellowship compared to other career trajectories. An analysis of case logs and demographic data from graduates of 19 accredited general surgery residency programs from the Accreditation Council for Graduate Medical Education between 2010-2020 was completed utilizing the United States Resident Operative Experience Consortium. The demographics and operative experience of residents who pursued colon and rectal surgery fellowship were compared to those who did not. This study is a retrospective review of resident specialty selection, demographic information, and operative case logs. Graduates of 19 accredited general surgery residency programs from the Accreditation Council for Graduate Medical Education between 2010-2020 participated in the study. Resident demographics, general and colon and rectal surgery-related program-specific characteristics, and resident operative case logs associated with entrance into colon and rectal surgery fellowship served as the primary outcome measures. Those in the colon and rectal surgery cohort were more likely to be female sex and have completed a dedicated research experience. No association was noted with co-location of a colon and rectal surgery fellowship and general surgery residency. Multivariable analysis demonstrated a higher likelihood of colon and rectal surgery fellowship matriculation for female sex residents and residents who completed a clinical fourth-year colon and rectal surgery rotation. Higher logged colon and rectal surgery-specific case volume was associated with those matriculating into colon and rectal surgery. Self-reported case log data, differences in residency structures in offering colon and rectal surgery rotations to clinical fourth-year residents, academic bias of participating residency programs. This study identified individual and program-specific factors associated with matriculating into colon and rectal surgery fellowship, such factors include female sex, colon and rectal surgery-specific rotation in the fourth clinical year, and higher volume of colon and rectal surgery-specific cases. These data may optimize resident colon and rectal surgery experience and strengthen the colon and rectal surgery fellowship pipeline. See Video Abstract.

Reprocessing of eXpendable BathyThermograph (XBT) profiles from the Ligurian and Tyrrhenian seas over the time period 1999–2019 with a full metadata upgrade

Abstract. The advent of open science and the United Nations Decade of Ocean Science for Sustainable Development are revolutionizing the ocean-data-sharing landscape for an efficient and transparent ocean information and knowledge generation. This blue revolution raised awareness on the importance of metadata and community standards to activate interoperability of the digital assets (data and services) and guarantee that data-driven science preserves provenance, lineage and quality information for its replicability. Historical data are frequently not compliant with these criteria, lacking metadata information that was not retained, crucial at the time of data generation and further ingestion into marine data infrastructures. The present data review is an example attempt to fill this gap through a thorough data reprocessing starting from the original raw data and operational log sheets. The data gathered using XBT (eXpendable BathyThermograph) probes during several monitoring activities in the Tyrrhenian and Ligurian seas between 1999 and 2019 have first been formatted and standardized according to the latest community best practices and all available metadata have been inserted, including calibration information never applied, uncertainty specification and bias correction from Cheng et al. (2014). Secondly, a new automatic quality control (QC) procedure has been developed and a new interpolation scheme applied. The reprocessed (REP) dataset has been compared to the data version, presently available from the SeaDataNet (SDN) data access portal, processed according to the pioneering work of Manzella et al. (2003) conducted in the framework of the European Union Mediterranean Forecasting System Pilot Project (Pinardi et al., 2003). The comparison between REP and SDN datasets has the objective to highlight the main differences derived from the new data processing process. The maximum discrepancy among the REP and SDN data versions always resides within the surface layer (REP profiles are warmer than SDN ones) until 150 m depth generally when the thermocline settles (from June to November). The overall bias and root mean square difference are equal to 0.002 and 0.041 °C, respectively. Such differences are mainly due to the new interpolation technique (Barker and McDougall, 2020) and the application of the calibration correction in the REP dataset. The REP dataset (Reseghetti et al., 2024; https://doi.org/10.13127/rep_xbt_1999_2019.2) is available and accessible through the INGV (Istituto Nazionale di Geofisica e Vulcanologia, Bologna) ERDDAP (Environmental Research Division's Data Access Program) server, which allows for machine-to-machine data access in compliance with the FAIR (findable, accessible, interoperable and reusable) principles (Wilkinson et al., 2016).

Flexibility in Surgical Training Does Not Affect American Board of Surgery Board Eligibility or Certification: Long-term Outcomes from a Prospective, Multi-Institutional Study of General Surgery Residents.

In 2011, the American Board of Surgery (ABS) implemented a policy to permit greater flexibility in the structure of general surgery (GS) residency training. Our goal was to investigate the impact of flexibility in surgical training (FIST) on resident success in obtaining ABS board eligibility and certification. A prospective, multi-institutional study was conducted to examine the feasibility of incorporating flexibility tracks across residency programs and measure educational outcomes including ABS In-service Training Exam (ABSITE) scores, Accreditation Council for Graduate Medical Education (ACGME) Milestones, operative case log volumes, and ABS Qualifying (QE) and Certifying (CE) Examinations scores. We compared residents participating in flexibility tracks ("FIST residents") to contemporaneous residents not involved in subspecialty tracks ("non-FIST residents"). Seven academic GS residency programs. GS residents at participating institutions were granted the opportunity to customize up to 12 of the final 24 months of residency with subspecialty rotations. From 2013 to 2019, 186 (52.2%) of 356 residents participated in a flexibility track. The most frequently selected subspecialty tracks were hepatobiliary (26.9%), gastrointestinal (15.1%), and cardiothoracic surgery (15.1%). There was no significant difference in ABSITE scores (573.0 vs. 562.0; p = 0.191) or total major operations performed (1056.5 vs 1018.0; p = 0.074) between FIST and non-FIST post-graduate year 5 residents. Residents participating in FIST scored significantly higher on 15 of 16 ACGME Milestones when compared to non-FIST residents. The first-time pass rate for the ABS QE was 92.2% and 91.1% for FIST and non-FIST residents, respectively (p = 0.756). The first-time pass rate for the ABS CE was 85.8% and 83.6% for FIST and non-FIST residents, respectively (p = 0.687). Overall, FIST residents had a higher first-time pass on both the QE (92.2% vs. 90.6%) and CE (85.8% vs. 81.7%), when compared to the national average. Despite spending more time on subspecialty-focused flexible rotations, residents participating in FIST perform similarly to their peers in multiple measures, including on the ABS QE and CE. Incorporating integrated subspecialty training within GS residency does not interfere with the future success of trainees in obtaining ABS board certification. These findings could help inform modifications to the structure of surgical training, including allowing for earlier entry into subspecialty training.

AI-enhanced predictive maintenance systems for critical infrastructure: Cloud-native architectures approach

Critical infrastructure (CI), such as power grids, transportation systems, and telecommunications networks, is becoming increasingly complex, requiring sophisticated maintenance strategies and procedures to guarantee optimal performance and system durability. This paper examines the transformational potential of AI-driven predictive maintenance systems, highlighting their ability to prevent system failures, minimize downtime, and enhance resource efficiency. Integrating machine learning algorithms with real-time data analytics allows predictive maintenance frameworks to accurately foresee equipment failures, facilitating timely interventions that reduce the risk of catastrophic infrastructure breakdowns. This study primarily examines the development of cloud-native architectures, which include containers, microservices, and orchestration tools like Kubernetes, to facilitate the scalability, flexibility, and resilience required for contemporary CI maintenance systems. These designs facilitate the seamless integration of predictive maintenance solutions across geographically dispersed infrastructure, enabling effective administration of extensive datasets produced by Internet of Things (IoT) sensors, operational logs, and edge computing nodes. The document examines the essential function of intelligent data orchestration in facilitating the prompt gathering, processing, and analysis of operational data, which is vital for AI models to provide precise predictions. The amalgamation of AI-driven predictive maintenance with 5G and forthcoming 6G networks is poised to transform real-time system monitoring, diminishing latency and enhancing decision-making efficacy. Utilizing AI and cloud-native technologies substantially enhances system reliability, cost-effectiveness, and comprehensive infrastructure optimization. This article thoroughly analyses how AI, cloud-native platforms, and intelligent data orchestration may be utilized to tackle the changing maintenance issues of critical infrastructure by examining real-world case studies from sectors like power grids, telecommunications, and transportation. Integrating AI, cloud computing, and IoT in predictive maintenance improves system reliability and prepares critical infrastructure for future autonomous management and optimization developments. The study finishes by discussing new trends, such as the integration of digital twins and the synergies between AI and cloud-native solutions, which will enhance predictive maintenance capabilities.

Teleoperated forwarder with VR: impact of latency on operator log handling performance

ABSTRACT This study uses a full scale cut to length forwarder prototype to explore crane log handling during teleoperation (remote-control). Visual feedback is provided from stereo cameras into a VR headset. Details of the system are provided along with measurements on key properties. The system allows for an artificial latency (the delay between a command and the observed response) to be introduced. A setup to allow repeated crane operations is used to evaluate operator performance at different latencies and also to compare teleoperation with in-machine operation. The results indicate that teleoperation of crane log handling can achieve comparable performance to traditional in-machine operation. Notably, the performance is consistent even at transmission latencies that surpass those expected in 4 G internet connections. This suggests a potential for remotely operating forwarders from both on-site and potentially off-site locations. This research did not delve into actual forwarding work or the implications of wireless connection bandwidth or alternative technologies like Wi-Fi or 5 G. Future investigations should consider these factors, along with the requirement for enhanced camera systems to ensure holistic machine visibility and consequently, safe teleoperation.

Long-term Survival of Bladder Augmentation is Influenced by its Shape and Mucosal Lining

IntroductionBladder augmentation in the UK has been largely by enterocystoplasty or ureterocystoplasty (UC). Ileocystoplasty can be simple patch placement (SPP), or formation of an ileal cup (IC). Urothelium is the “right” mucosa, whereas intestinal mucosa exhibits absorption, mucus production, malignancy. On videourodynamics it can be shown that SPP fills with a poor conformation (irregular shape), while IC was good, and UC adequate.Our aim was to measure the long-term outcomes of augmentation, comparing UC (“right” mucosa and adequate conformation), to SPP (“wrong” mucosa and poor conformation) to IC (“wrong mucosa” and good conformation). MethodsSingle-centre retrospective review. Patients were identified from operative logs for the period 2005 to 2022. Registered as an audit (CARMS 31503). Data collected included: demographics, dates: operation, redo-surgery, imaging, stones (renal/bladder) and any intervention. Data were given as numbers (%), median (range) analysed by Fisher exact test where P < 0.05 was taken as significant. ResultsThere were 168 bladder augmentations: UC (n = 24), SPP (n = 72), and IC (n = 72). Follow-up was no different for IC 4.23 (0.05–11.50) vs SPP 4.43 (0.15–13) yrs, but was longer for UC at 6.2 (4.1–8.9) yrs. Age at augmentation was 6.7 (2.5–17.1) vs 8.1 (2–17) vs 11.6 (5.9–17) yrs respectively (UC vs IC vs SPP, P = 0.0001).Revision surgery was required in 3/24 (12.5 %) UC, 6/72 (8.3 %) SPP, and 0/72 (0 %) IC. IC had fewer redos than SPP, P = 0.028. Long-term survival was significantly better for IC (100 % at 10 years, vs UC 85 % at 10 years and SPP 96 % at 5 yrs and 75 % at 10 yrs, log-rank P < 0.05).Imaging follow-up was available in SPP (n = 56) IC (n = 62), UC (n = 24) with renal stones identified in 7/56 (%) SPP, 2/62 (%) IC, and 0 in UC. Bladder stones were present in SPP 5/56 (8.9 %) vs IC 2/62 (3.2 %), NS. Stone-free survival was 100 % at 10yrs in UC, 95 % in IC, and 62 % in SPP, P = 0.028.Combining bladder failure leading to reaugmentation and bladder stones requiring surgery, allows comparison between SPP and IC: In SPP bladder stones and augment failure occurred in 15.3 %, vs 2.8 % in IC. There is a 6.3-fold increase in bladder stones and augment redo with SPP [irregular filling bladder (poor conformation) and the “wrong” mucosa] vs IC (good confirmation, but “wrong” mucosa). ConclusionAugmentation survival is influenced by conformation and presence of the “right” mucosa. UC is only possible in 14 % of cases, and an IC is preferable to SPP when an enterocystoplasty is needed.

Seismometer Orientation Measurements of Broadband Seismic Stations in the China Digital Seismograph Network

ABSTRACT The China Digital Seismograph Network, one of the largest national seismic networks, has been operating for over four decades which provides valuable seismic data for various scientific studies. Our investigation gathered a comprehensive dataset comprising 5,456,816 three-component waveforms from 3187 seismic events that took place over nine years (2014–2022). We assessed sensor orientations at 1056 broadband stations using the P-wave polarization method. Together with our calculation results, operation and maintenance log of regional networks, on-site checking, and manual inspection, we identified and addressed issues related to temporal changes of orientation, polarity reversal, and channel mislabeling. We found that ∼65.8% of seismometers (694) were well aligned with the absolute misorientation angle ≤3°, 20.8% of seismometers (220) were fairly well aligned with the absolute misorientation angle lying between 3° and 10°, 3.6% (38) of seismometers were misaligned exceeding 10°, and 9.8% of seismometers (104) showed a temporal variation in alignment. The fairly high consistency between our numerical results and gyrocompass measurements confirms the reliability of our investigation. We further compared the results of P-wave receiver functions analysis before and after sensor orientation correction. The findings indicate that sensor misorientation angles may lead to inaccurate and unstable seismological results. Therefore, conducting a systematic assessment, diagnosis, and correction for sensor orientation would be beneficial for advancing seismological analysis by promoting consistency, efficiency, accuracy, collaboration, reproducibility, and adaptability in data processing and interpretation.

Quantifying the vibrancy of streets: Large-scale pedestrian density estimation with dashcam data

This paper proposes a new methodology for measuring street-level pedestrian density that combines the strengths of image-based observations with the scalability of drive-by sensing. Despite its importance, existing methods for measuring pedestrian activity have several limitations, including high costs, limited coverage, and privacy concerns. To overcome these issues, our approach exploits operation logs generated by dashboard cameras of moving vehicles to estimate pedestrian density for each street, which is validated with data from approximately 3,000 taxis operating in central Tokyo. We produce vibrancy maps for 292 station areas in central Tokyo by leveraging machine learning to estimate pedestrian density in streets where measurement data is scarce. We also evaluate the reliability and coverage of the measurement and illustrate how the measured pedestrian density data can be utilized for assessing the validity of walkability measures. The paper concludes that this approach could provide valuable data to inform urban planning and city operations.

See one, do one, teach one - Trends in resident autonomy and teaching assistant cases during general surgery residency in the United States: A nationwide retrospective analysis

IntroductionAutonomy during residency is crucial to the training and development of competent surgeons. An essential component of this process is the ‘teaching assistant (TA)’ case, an indispensable opportunity for residents to gain confidence and hone intraoperative skills. However, high-quality data on the volume and diversity of cases that graduates perform are scarce. MethodsA retrospective analysis was performed from publicly collected data of operative case logs from general surgery residents graduating from ACGME-accredited programs from 2006 to 2023. Data on the median overall number of surgeon chief and TA cases were retrieved. Collected data were organized based on sub-specialties. The Mann-Kendall trend test was used to investigate trends in TA cases and surgeon chief operative volume. ResultsBetween 2007 and 2023, the surgeon chief cases gradually increased from 229 to 274 (19.6 ​% increase; τ ​= ​0.610, p ​= ​0.001). There was a concurrent 72.7 ​% increase in TA cases from a median of 22–38 (τ ​= ​0.574, p ​= ​0.001). Surgeon chief (283 per resident) and TA cases (43 per resident) peaked in 2018–2019 and 2016–2017.The uptrend in TA cases was associated with the significant increase in colorectal (τ ​= ​0.559, p ​= ​0.001), general surgery-other (τ ​= ​0.404, p ​= ​0.018), and hepatopancreaticobiliary (HPB) (τ ​= ​0.596, p ​= ​0.001) subspecialties. Trauma and vascular surgery did not change significantly. With respect to total chief cases, general surgery-other (τ ​= ​0.956, p=<0.001), HPB (τ ​= ​0.713, p=<0.001) and colorectal (τ ​= ​0.522, p ​= ​0.004) volume increased. There was no significant change in trauma and foregut volume, while the volume of endocrine (τ ​= ​−0.485, p ​= ​0.006) and vascular surgery (τ ​= ​0.603, p ​= ​0.001) dropped significantly.The procedural category with the highest chief and TA volume was ‘colorectal tract - large intestine.’ Most procedural categories (53.49 ​%) retained a median of 0 teaching cases. No chief cases were logged for the specialties generally not considered part of general surgery (genitourinary, nervous system, orthopedics, and gynecology), although a median of 1 surgeon chief genitourinary case was recorded from 2018 to 2023. ConclusionsOver the past seventeen years, there has been a gradual uptrend in the number of surgeon chief and TA cases. While this is a positive indicator of improved autonomy, further research must focus on strategies to improve resident autonomy to train well-rounded surgeons safely.

Predicting the future caretakers of traumatic vascular injury management via operative exposure among surgical trainees

BackgroundThe management of vascular trauma requires specialized training and expertise. Although traumatic vascular injury is treated currently by both vascular and trauma surgeons in modern practice, it remains unclear who will inherit the role of managing vascular trauma in the coming decades. In this study, we examined disparities in operative experience in vascular trauma among surgical trainees across different surgical specialties. MethodsAccreditation Council for Graduate Medical Education national operative log reports were collected for graduating vascular surgery residents (VSRs), vascular surgery fellows (VSFs), and general surgery residents (GSRs) from 2012 to 2022. Total operative volume for traumatic vascular injury was examined, as were the five major contributing operative domains (neck, thoracic, abdominal, peripheral, and fasciotomy). ResultsA total of 22,052 GSRs, 334 VSRs, and 1672 VSFs graduated over the 10-year study period. VSR had the highest vascular trauma case volume (24.9 ± 3.9 cases/5 years), followed by VSF (22.1 ± 1.5 cases/2 years) then GSR (2.4 ± 0.3 cases/5 years; P < .001). Thoracic vessel exploration/repair (0.7 cases vs 0.6 cases vs 0.0 cases), abdominal vessel exploration/repair (1.0 cases vs 0.9 cases vs 0.0 cases), neck vessel exploration/repair (4.0 cases vs 3.4 cases vs 0.2 cases), peripheral vessel exploration/repair (12.1 cases vs 9.5 cases vs 1.1 cases), and lower extremity fasciotomy for trauma (7.2 cases vs 7.6 cases vs 1.1 cases) were most frequent among the VSR and VSF groups (P < .001 each). On linear regression analysis, both VSF (+0.5 cases/y; R2 = 0.81; P < .001) and GSR (+0.1 cases/y; R2 = 0.75; P = .001) groups experienced a growth in vascular trauma volume. Contrariwise, vascular trauma volume did not change among graduating VSRs (R2 = 0.13; P = .31). ConclusionsDedicated vascular surgical training provides the highest operative exposure to civilian vascular trauma in the United States.

Research on relay safety output control method based on BP neural network

With the continuous improvement and expansion of the metro network, the issues of train safety capacity, transportation effi-ciency and maintenance cost will become increasingly prominent. As an indispensable switching and controlling device of train safety control system, the health status of relay is the foundation of low-cost, high safety and efficient development of subway. This paper designs and proposes a BP neural network based relay safety output control method, this method utilizes BP neural net-work on the basis of improved two-take-two hardware structure to do fault prediction and safety state management with real-time retrieved detection signals, finally uploads operation and mainte-nance logs to the platform to guide subsequent fault trouble-shooting and maintenance.

Trends in Operative Case Logs of Chief Residents in Surgery by Sex and Race: A 5-year National Study.

To examine case logs reported by general surgery residents and identify potential disparities in operative experience. A recent study of 21 institutions noted significant differences between the number of cases reported during general surgery residency by trainees who are underrepresented in medicine (URiM) versus trainees who are not URiM (non-URiM). This study also identified differences between female residents and male residents. We partnered with the Accreditation Council for Graduate Medical Education to examine case logs reported from all accredited general surgery programs in the United States. This is the first time these data have been examined nationally. We examined total case logs submitted by graduating residents between 2017 and 2022. Group differences in mean reported case logs were examined using paired t tests for female versus male and URiM versus non-URiM overall case numbers. A total of 6458 residents submitted case logs from 319 accredited programs. Eight-hundred fifty-four (13%) were URiM and 5604 (87%) were non-URiM. Over the 5-year study period, URM residents submitted 1096.95 (SD ± 160.57) major cases versus 1115.96 (±160.53) for non-URiM residents (difference = 19 cases, P = 0.001). Case logs were submitted by 3833 (60.1%) male residents and 2625 (39.9%) female residents over the 5-year study period. Male residents reported 1128.56 (SD ± 168.32) cases versus 1091.38 (±145.98) cases reported by females (difference = 37.18, P < 0.001). When looking at surgeon chief and teaching assistant cases, there was no significant difference noted between cases submitted by URiM versus non- URiM residents. However, male residents reported significantly more in both categories than their female peers ( P < 0.001). Overall, URiM residents submitted fewer cases in the 5-year study period than their non-URiM peers. The gap in submitted cases between male and female residents was more pronounced, with male residents submitting significantly more cases than their female counterparts. This finding was consistent and statistically significant throughout the entire study period, in most case categories, and without narrowing of difference over time. A difference of 30 to 40 cases can amount to 1 to 3 months of surgical training and is a concerning national trend deserving the attention of every training program and our governing institutions.

Prediction of financial customer buying behavior based on machine learning

This study investigates the prediction of online purchasing behavior on the palm life APP through comprehensive analysis of customer operation logs, attribute sets, and purchase labels. Utilizing advanced feature engineering techniques, including time-based metrics, frequency analyses, and category-specific operations, we constructed a robust feature system comprising 61 associated features. The predictive models, leveraging Logistic Regression and LightGBM algorithms, were evaluated using cross-validation and AUC scores, demonstrating strong generalization capabilities and effectiveness in predicting customer behavior. Findings highlight the significance of personalized recommendations and targeted marketing strategies in enhancing customer engagement and optimizing operational efficiencies for e-commerce platforms. This research contributes to both theoretical advancements in consumer behavior prediction and practical implications for enhancing customer experience and service personalization in fintech applications.

Laparoscopy experience in East, Central, and Southern Africa: insights from operative case volume analysis

BackgroundWith the primary objective of addressing the disparity in global surgical care access, the College of Surgeons of East, Central, and Southern Africa (COSECSA) trains surgeons. While sufficient operative experience is crucial for surgical training, the extent of utilization of minimally invasive techniques during COSECSA training remains understudied.MethodsWe conducted an extensive review of COSECSA general surgery trainees' operative case logs from January 1, 2015, to December 31, 2020, focusing on the utilization of minimally invasive surgical procedures. Our primary objective was to determine the prevalence of laparoscopic procedures and compare this to open procedures. We analyzed the distribution of laparoscopic cases across common indications such as cholecystectomy, appendicitis, and hernia operations. Additionally, we examined the impact of trainee autonomy, country development index, and hospital type on laparoscopy utilization.ResultsAmong 68,659 total cases, only 616 (0.9%) were laparoscopic procedures. Notably, 34 cases were conducted during trainee external rotations in countries like the United Kingdom, Germany, and India. Gallbladder and appendix pathologies were most frequent among the 582 recorded laparoscopic cases performed in Africa. Laparoscopic cholecystectomy accounted for 29% (276 of 975 cases), laparoscopic appendectomy for 3% (76 of 2548 cases), and laparoscopic hernia repairs for 0.5% (26 of 5620 cases). Trainees self-reported lower autonomy for laparoscopic (22.5%) than open cases (61.5%). Laparoscopy usage was more prevalent in upper-middle-income (2.7%) and lower-middle-income countries (0.8%) compared with lower-income countries (0.5%) (p < 0.001). Private (1.6%) and faith-based hospitals (1.5%) showed greater laparoscopy utilization than public hospitals (0.5%) (p < 0.001).ConclusionsThe study highlights the relatively low utilization of minimally invasive techniques in surgical training within the ECSA region. Laparoscopic cases remain a minority, with variations observed based on specific diagnoses. The findings suggest a need to enhance exposure to minimally invasive procedures to ensure well-rounded training and proficiency in these techniques.

AI-enhanced subsea maintenance for improved safety and efficiency: Exploring strategic approaches

As the oil and gas industry increasingly explores deeper and more remote offshore sites, the maintenance of subsea infrastructure becomes paramount. The use of Artificial Intelligence (AI) in subsea maintenance offers promising solutions to enhance safety and efficiency in these challenging environments. This review explores strategic approaches to integrating AI into subsea maintenance operations. AI facilitates predictive maintenance by analyzing vast amounts of data collected from sensors and historical maintenance records. Machine learning algorithms can detect patterns and predict equipment failures before they occur, enabling proactive maintenance scheduling. This predictive capability reduces downtime and minimizes the risk of accidents by addressing potential issues before they escalate. AI-enabled autonomous underwater vehicles (AUVs) and remotely operated vehicles (ROVs) play a crucial role in subsea inspections and repairs. These AI-enhanced robots can navigate complex subsea environments, perform inspections, and execute maintenance tasks with greater precision and efficiency than human divers. By reducing the need for human intervention in hazardous environments, AI-driven AUVs and ROVs significantly improve safety. Furthermore, AI algorithms can optimize maintenance schedules based on factors such as equipment condition, environmental conditions, and operational requirements. By dynamically adjusting maintenance plans, operators can maximize equipment uptime while minimizing costs and risks. This proactive approach ensures that maintenance activities are conducted at the most opportune times, reducing the likelihood of unplanned downtime and improving overall efficiency. Moreover, AI facilitates condition-based maintenance strategies, where equipment health is continuously monitored in real-time. Sensors installed on subsea infrastructure collect data on factors such as temperature, pressure, and vibration, which is then analyzed by AI algorithms to assess equipment condition. By detecting early signs of degradation or malfunction, AI enables timely interventions, preventing costly breakdowns and ensuring optimal performance. In addition to predictive and condition-based maintenance, AI-driven analytics offer insights into operational performance and asset integrity. By analyzing data from various sources, including sensors, historical records, and operational logs, AI can identify trends, anomalies, and optimization opportunities. These insights enable operators to make data-driven decisions that enhance overall system reliability and efficiency. Strategic approaches to implementing AI in subsea maintenance require collaboration between technology providers, operators, and regulatory bodies. Establishing industry standards and guidelines for AI applications in subsea operations is crucial to ensure safety, reliability, and interoperability. Furthermore, investing in research and development to enhance AI algorithms and robotics technology is essential to unlock the full potential of AI in subsea maintenance. AI-enhanced subsea maintenance offers significant benefits in terms of safety and efficiency. By leveraging predictive analytics, autonomous robotics, and real-time monitoring, operators can optimize maintenance activities, reduce downtime, and minimize risks. Strategic approaches to integrating AI into subsea operations require collaboration, investment, and a commitment to advancing technology to meet the challenges of offshore environments.

Thực trạng và một số yếu tố ảnh hưởng đến công tác quản lý trang thiết bị y tế tại khoa hồi sức tích cực – chống độc của bệnh viện đa khoa tỉnh Trà Vinh năm 2020

Objectives: This study has two objectives, as follows: to describe the management situation. Medical devices and some factors affecting medical devices management in hospitals in Tra Vinh province, 2020. Methods: This is a cross-sectional descriptive study, combining quantitative and qualitative methods. Quantitative data was collected via a self-administered questionnaire among 25 staffs directly managing medical devices and 124 medical devices records. Qualitative data was collected from four in-depth interviews and two focus group discussions. Main findings: Medical devices invested by the hospital (59.7%), low frequency of use of medical devices accounted for 0%, and unused equipment accounted for 0%. Dossiers of incomplete equipment, mainly lack of operational logs and documents for maintenances and repairs; medical devices with qualified certificates accounted for 100%; all equipments are built using procedures and operating procedures; but inspections and verifications are only carried out periodically and incompletely; post-repair inspections have not been carried out, equipment maintenance costs still remains low. However, maintenance budget constraints were observed, and the information system and maintenance work did not fully meet requirements due to various reasons, primarily financial issues. Hospital chairmans identified financial concerns as a key issue and planned to solve them in the near future to utilize the quality of medical devices according to regulations. Key words: Medical devices, influenced factor, Tra Vinh province hospital.

Does Transparency of Ankle Implant Costs Influence Surgeon Behavior?

Ankle fractures are a common injury treated by orthopaedic surgeons. Unstable, displaced ankle fractures are often fixed with open reduction internal fixation (ORIF) using different implant constructs at various cost. No study to date has looked at transparency in ankle implant costs to surgeon behavior. Our surgeons self-identified that the biggest barrier for lowering implant cost was the lack of cost transparency. This was a surgeon-led-study to evaluate whether increased transparency in implant costs affected surgeon behavior. Monthly operative logs from December 2021 to September 2022 were reviewed at our level 1 trauma center for operative fixation of ankle fractures. The cost data of each fixation construct was reported to trauma-trained surgeons at the end of each month from March 2022 to June 2022. Average costs of implants were compared before and after education. A linear mixed model was used to explore what factors were associated with changes in costs. Surgeons also participated in a poststudy survey. The implant costs of 110 ankle fracture fixations were reviewed over the period before education (n = 60), during education (n = 30), and after education (n = 20). The mean implant cost difference for unimalleolar fractures was -$204.80 (P = .68), whereas the mean cost difference for bimalleolar fractures was -$9.82 (P = .98). Trimalleolar fractures had a mean cost difference of +$94.47 (P = .84). Linear mixed model demonstrated fracture pattern as the only factor significantly associated with implant costs (P < .01). Post-education surgeon survey revealed that 6 of 7 surgeons felt that monthly updates affected their implant selection. However, only 2 surgeons demonstrated a change in practice with decreased implant costs during the study. The majority of surgeons self-reported being influenced by the implant cost education, but the detected change in implant cost was only observed in less than one-third of surgeons. Our results suggest implant selection and related costs are not influenced by increased cost transparency education alone. Level III, case control study.

Hybrid Encryption for Securing and Tracking Goods Delivery by Multipurpose Unmanned Aerial Vehicles in Rural Areas Using Cipher Block Chaining and Physical Layer Security

This paper investigated the use of unmanned aerial vehicles (UAVs) for the delivery of critical goods to remote areas in the absence of network connectivity. Under such conditions, it is important to track the delivery process and record the transactions in a delay-tolerant fashion so that this information can be recovered after the UAV’s return to base. We propose a novel framework that combines the strengths of cipher block chaining, physical layer security, and symmetric and asymmetric encryption techniques in order to safely encrypt the transaction logs of remote delivery operations. The proposed approach is shown to provide high security levels, making the keys undetectable, in addition to being robust to attacks. Thus, it is very useful in drone systems used for logistics and autonomous goods delivery to multiple destinations. This is particularly important in health applications, e.g., for vaccine transmissions, or in relief and rescue operations.

Changes in CA 125 Level Pre and Post Ovarian Cancer Surgery

Background: Ovarian cancer is one of the gynecological cancers that has a fairly high mortality rate and has a poor prognosis. Ovarian cancer management includes optimal operation followed by chemotherapy, which at follow up will have an effect on decreasing CA 125 levels. But in fact there are several studies showing increased CA 125. Given these differences in findings, this study attempted to evaluate the pre and post operation changes in CA 125 levels in ovarian cancer patients.Objective: This study aims to determine the changes in pre and post operation CA 125 levels in ovarian cancer patients. And to find out the optimal relationship between CA 125 level post operation and post operation.Methods: The type of research is an analytic study with a prospective cohort design. The source comes from secondary data taken from Simetris dr. Sardjito Hospital within 6 months.Results: The distribution of the age &lt; 40 years was 11 and 19 were 40 years old. There was a significant change in pre operation log CA 125 levels (mean = 2,53 or 902,03U/ml) and post operation log CA 125 levels (mean = 1,92 or 406,23 U/ml). With a difference or delta mean of 0,61 or 495,80 U/ml and p value = 0.001. There was a significant difference in post operation log CA 125 levels between optimal and non optimal operation. Based on risk factors, there was a significant change or decrease in log CA 125 levels pre and post operation, but there was no significant difference in log CA 125 levels pre and post operation.Conclusion: There was a significant decrease in log CA 125 levels pre and post operation in patients with ovarian cancer who underwent operation. The post operation log CA 125 level in optimal operation is lower than in non-optimal operation.Keywords: CA 125, Ovarian Cancer, Operation, Optimal

Trends in gastric surgery operative experience among general surgery residents in the United States: A nationwide retrospective analysis

BackgroundGastric surgery is a crucial component of general surgery training. However, there is a paucity of high-quality data on operative volume and the diversity of surgical procedures that general surgery residents are exposed to. MethodsWe conducted a retrospective analysis of operative case logs of all general surgery residents graduating from the American College of Graduate Medical Education–accredited program from 2009 to 2022. Data on the mean number of gastric procedures, including the mean in each subcategory, were retrieved. A Mann-Kendall trend test was used to investigate trends in operative volume. ResultsBetween 2009 and 2022, the mean overall logged gastric procedures rose significantly (τ = 0.722, P < .001) from 36.2 in 2009 to 49.2 in 2022 (35.9% increase). The most substantial growth was seen in laparoscopic gastric reduction for morbid obesity (mean 1.9 in 2017 to 19 in 2022; τ = 0.670, P = .009). A statistically significant increase was also seen in laparoscopic partial gastric resections, repair of gastric perforation, and “other major stomach procedures” (P < .05 for all comparisons).Open gastrostomy, open partial gastric resections, and open vagotomy all significantly decreased (P < .05 for all comparisons). There was no significant change in the volume of laparoscopic gastrectomy, total gastric resections, and non-laparoscopic gastric reductions for morbid obesity (P > .05 for all comparisons). ConclusionThere has been a substantial increase in the volume of gastric surgery during residency over the past 14 years, driven mainly by an increase in laparoscopic gastric reduction. However, there may still be a need for further gastric surgical training to ensure well-rounded general surgeons.