Pool Area Research Articles

Experimental and numerical study on welding temperature field by double-sided submerged arc welding for orthotropic steel deck

Orthotropic steel deck (OSD) is susceptible to fatigue damage when subjected to repeated traffic loads, and the welding residual stress (WRS) is an important factor contributing to fatigue damage in OSD. WRS is formed by the shrinkage of the welds due to the inhomogeneous temperature field during the welds fabrication process, and thus the study of the welding temperature field is of significance for accurately predicting the WRS. As an emerging welding technology, the double-sided submerged arc welding (DSSAW) technology can generate higher welding temperature and consequently higher welding penetration rate on U rib and deck for welding thicker base metal. However, the DSSAW technology generates more complex welding temperature field compared to the traditional arc welding technology, which has not been evaluated so far. In this study, the finite element model (FEM) of OSD with U rib-to-deck (RTD) welded joints is established to simulate the welding temperature field generated by DSSAW. Moreover, the temperature field in OSD by DSSAW is measured by using the infrared thermal imager (ITI) and the industrial temperature measurement gun (TMG) to verify the FEM simulated temperature results. It is found that large surface temperature gradient and large temperature gradient along the thickness direction would be formed at the weld toe of U rib and deck, which is generally the location where the maximum WRS is distributed and where the fatigue cracks are susceptible in OSD. Compared to the inside welding, the outside welding may generate higher welding temperature, higher temperature gradient, and larger molten pool area, resulting in larger WRS in the OSD. The findings in this study can help to an in-depth understanding of the welding temperature field caused by the new DSSAW technology and support further studies on WRS.

Fatores fisiopatológicos, benefícios e recomendações na natação para asmático

Asthma is characterized by chronic inflammation of the airways that can be induced by contact with chemical products, cigarette smoke, dry and cold environments or intense exercise. Swimming is recommended for people with asthma because it is a sport that helps to improve lung function. The aim of this study was to analyze the benefits and recommendations for swimming in children diagnosed with asthma. The methodology adopted was a bibliographical review of articles published in PUBMED in the last five years. The results of the studies showed that at least 13 countries researched the relationship between asthma and swimming in this investigated period (Poland, Turkey, Japan, France, Belgium, Finland, Norway, USA, Sweden, Brazil, China, Nigeria and Italy). Research has shown that swimming is beneficial for asthmatics, among the advantages it can be mentioned the improvements for the practitioner: 1) conditions of the respiratory and cardiovascular system, 2) quality of life and psychosocial, 3) well-being, 4) physical resistance, 5) child growth and development, and 6) reduction in asthma symptoms and clinical picture. The recommendations for the practice of swimming for asthmatics were related to: 1) maintaining the adequate amount of water purification products (with chlorine), 2) avoiding places in the pool that have dry and cold environments, 3) managing the air quality in the pool area and waiting room, 4) adequately prescribe and monitor water exercise 5) avoid excessive submersion/diving. It can be concluded that swimming is a sport that provides the asthmatic with a decrease in symptoms and an improvement in the clinical picture, as there is a decrease in the intensity, duration and frequency of bronchospasm crises, improving respiratory capacity and strengthening the respiratory muscles, in addition to providing better motor, psychological and affective-social development. However, the possible contraindication of swimming for asthmatics may come from inadequate facilities, swimming pool, medication, prescription and class control. Thus, it is suggested that there is always periodic monitoring of students by physicians and teachers/professionals able to provide adequate prescriptions, in addition to monitoring external factors that may affect asthmatics.

Characterizing the Sound-Scattering Layer and Its Environmental Drivers in the North Equatorial Current of the Central and Western Pacific Ocean

Acoustic technology is an essential tool for detecting marine biological resources and has been widely used in sound-scattering layer (SSL) research. The North Equatorial Current (NEC) warm pool region of the Central and Western Pacific Ocean has a vast distribution of micronekton and zooplankton; analyzing the SSL characteristics in this region is vital for monitoring the marine environment and studying the marine ecosystem. In this study, we statistically analyzed the spatiotemporal factors of 10–200 m SSL in the NEC of the Central and Western Pacific Ocean using acoustic survey data collected by the “Songhang” research vessel (RV) in 2022, and the influence of environmental factors on the scattering layer distribution was analyzed using the Generalized Additive Model (GAM). The results showed that the SSL in the warm pool area of the NEC is distributed in shallow waters above 100 m. The primary scatterers are micronekton and zooplankton, and this SSL had diel vertical migration behavior. By comparing Akaike’s Information Criterion of different GAMs, the model consisting of six factors, namely, temperature, current velocity, turbidity, solar altitude angle, longitude, and latitude, was remarkable. Each model’s factor effects primarily influence the contribution of the volume-backscatter strength (Sv). The cumulative deviation explanation rate of the Sv was 67.2%, among which the highest explanation rate of solar altitude angle variance was 35.4%, the most critical environmental factor. The results of this study can provide a reference for long-term studies on ecological changes and their effects on micronekton and zooplankton distribution.

Facility Utilization Study Fish Landing Base Dumai Riau Province

This study aimed to analyze the utilization study of Dumai Fish Landing Base facilities in Riau Province. This research was conducted in March 2023 at the Fish Landing Base (PPI) in Dumai City, Riau Province. The methods used in the study were surveys and interviews. The results showed that the fishing gear used by fishermen at PPI Dumai were gillnet, longline, sondong, and kurau net. The high percentage of utilization of dock facilities is about 545,45% and the port pool area is 139,98%, which means that the port pool area has exceeded highly utilized, while the utilization rate of the port pool depth is 87,5%, which means that it can still be utilized more optimally by fishermen. The utilization rate of the PPI Dumai auction building facility is 72,98%, which means that the auction building has exceeded being highly utilized

Can the Electronic Health Record Predict Risk of Falls in Hospitalized Patients by Using Artificial Intelligence? A Meta-analysis.

Because of an aging population worldwide, the increasing prevalence of falls and their consequent injuries are becoming a safety, health, and social-care issue among elderly people. We conducted a meta-analysis to investigate the benchmark of prediction power when using the EHR with artificial intelligence to predict risk of falls in hospitalized patients. The CHARMS guideline was used in this meta-analysis. We searched PubMed, Cochrane, and EMBASE. The pooled sensitivity and specificity were calculated, and the summary receiver operating curve was formed to investigate the predictive power of artificial intelligence models. The PROBAST table was used to assess the quality of the selected studies. A total of 132 846 patients were included in this meta-analysis. The pooled area under the curve of the collected research was estimated to be 0.78. The pooled sensitivity was 0.63 (95% confidence interval, 0.52-0.72), whereas the pooled specificity was 0.82 (95% confidence interval, 0.73-0.88). The quality of our selected studies was high, with most of them being evaluated with low risk of bias and low concern for applicability. Our study demonstrates that using the EHR with artificial intelligence to predict the risk of falls among hospitalized patients is feasible. Future clinical applications are anticipated.

Composite lipid indices in patients with obstructive sleep apnea: a systematic review and meta-analysis

BackgroundOne of the most prevalent sleep disorders affecting the individual’s daily life is obstructive sleep apnea (OSA), for which obesity is a major risk factor. Several novel lipid indices have been suggested to have associations with OSA, among which visceral adiposity index (VAI), atherogenic index of plasma (AIP), and lipid accumulation product (LAP) are the most important ones. Herein, the current study aimed to systematically investigate the association between these indices and OSA.MethodsFour international databases, including PubMed, Scopus, the Web of Science, and Embase were searched in order to find relevant studies that investigated LAP, VAI, or AIP in OSA and compared them with non-OSA cases or within different severities of OSA. Random-effect meta-analysis was used to generate the standardized mean difference (SMD) and 95% confidence interval (CI) of the difference in lipid indices between OSA and non-OSA cases. Moreover, the pooled area under the receiver operating characteristic curves (AUCs) observed in individual studies for diagnosis of OSA based on these lipid indices were calculated by random-effect meta-analysis.ResultsTotally 14 original studies were included, comprised of 14,943 cases. AIP, LAP, and VAI were assessed in eight, five, and five studies, respectively. Overall, these lipid indices had acceptable diagnostic ability (AUC 0.70, 95% CI 0.67 to 073). Meta-analysis revealed that AIP was significantly higher in patients with OSA (SMD 0.71, 95% CI 0.45 to 0.97, P < 0.01). Moreover, AIP also increased in higher severities of OSA. Regarding LAP, a higher LAP was observed in OSA/patients with high risk for OSA rather than in controls/low risk for OSA (SMD 0.53, 95% CI 0.25 to 0.81, P < 0.01). VAI was also increased in OSA based on results from two studies.ConclusionThese findings suggest that composite lipid indices are increased in OSA. Also, these indices can have the potential beneficiary diagnostic and prognostic ability in OSA. Future studies can confirm these findings and enlighten the role of lipid indices in OSA.

Machine vision-based multi-degree-of-freedom laser cladding system integration and process monitoring research

Abstract Machine vision-based multi-degree-of-freedom laser cladding system integration and process monitoring is an important methods to ensure high-quality laser cladding. In this paper, based on the basic theory of multi-degree of freedom of machine vision, the laser cladding system is redesigned, and the melt pool images during the cladding process are monitored and analyzed. The melt pool image is pre-processed with the help of spatial filtering, and the image is thresholded using the iterative method thresholding to analyze the melt pool image. It is proved that the larger the laser power is, the larger the melt pool area is, and the maximum melt pool area is 60,000 pix when the laser power is 200 W. The maximum melt pool area is achieved when the nozzle tilt angle is 30° and the melt pool area is vertical. The smaller the melting speed, the larger the melting area and the maximum melting pool area is up to 35000pix when the melting speed is 210mm/min. It shows that the integration and process monitoring of the multi-degree-of-freedom laser melting system based on machine vision can reasonably control the process parameters of laser melting and improve the quality of laser melting by real-time monitoring and analysis of the melting pool images.

Cenderawasih Hot Pool: The Frequent High Sea Surface Temperature Phenomena At Cenderawasih Bay, Papua

The term “warm pool” refers to a body of water with the characteristic of SST exceeding 28°C within a particular area and a relatively long period in an annual circle. However, there are regions with an annual mean SST measured above 30°C, and we classified them as hot pools because of the conditions of intense solar radiation and low wind speed. One of the Hot Pool spots was found in Indonesia, in Cenderawasih Bay. The present study examines the existence of the Cenderawasih Hot Pool using long-term observation of satellite SST data. In order to learn more about their mechanisms, we also analyzed surface wind, surface heat flux, and surface current data. The results show that SSTs in Cenderawasih Bay have a 50% chance of exceeding 30°C within the 13 years of study (2013-2015). Heat input comes from strong solar radiation, i.e., 50% of solar radiation is more than 200 W/m2. The location is also dominated by low wind speed, i.e., 80% wind speed of lower than 4 m/s, which caused the low latent loss in Cenderawasih Bay. Cenderawasih Bay is fully separated from surface currents during the dry and wet seasons since the easterly subsurface water flow does not enter the bay. The absence of strong currents prevents the mixing process, maintaining the high temperature in the surface layer. Those processes are discovered and they serve as compelling evidence to support Cenderawasih Bay as one of the Hot Pool areas within the Indonesian seas.

Comparison of anti-Müllerian hormone and antral follicle count in the prediction of ovarian response: a systematic review and meta-analysis

BackgroundIncreasingly studies reported that the Anti-Müllerian hormone (AMH) seems to be a promising and reliable marker of functional ovarian follicle reserve, even better than the AFC test. Our study aimed to conduct a meta-analysis to assess the predictive value of AMH and AFC for predicting poor or high response in IVF treatment. An electronic search was conducted, and the following databases were used: PubMed, EMBASE, and the Cochrane Library (up to 7 May 2022). The bivariate regression model was used to calculate the pooled sensitivity, specificity, and area under the receiver operator characteristic (ROC) curve. Subgroup analyses and meta-regression also were used in the presented study. Overall performance was assessed by estimating pooled ROC curves between AMH and AFC.ResultsForty-two studies were eligible for this meta-analysis. Comparison of the summary estimates for the prediction of poor or high response showed significant difference in performance for AMH compared with AFC [poor (sensitivity: 0.80 vs 0.74, P < 0.050; specificity: 0.81 vs 0.85, P < 0.001); high (sensitivity: 0.81 vs 0.87, P < 0.001)]. However, there were no significant differences between the ROC curves of AMH and AFC for predicting high (P = 0.835) or poor response (P = 0.567). The cut-off value was a significant source of heterogeneity in the present study.ConclusionsThe present meta-analysis demonstrated that both AMH and AFC have a good predictive ability to the prediction of poor or high responses in IVF treatment.

Regional Characteristics of Summer Precipitation Anomalies in the Northeastern Maritime Continent

Based on the monthly mean reanalysis data from NCEP/NCAR (National Centers for Environmental Prediction/ National Center for Atmospheric Research) and GPCP (Global Precipitation Climatology Project) (1979–2020), the regional characteristics of precipitation in the warm pool side of the Maritime Continent (MC) and the relationships between different precipitation patterns and atmospheric circulations are studied. The results show that there are significant correlations as well as differences between the precipitation in the east of the Philippines (area A) and that in the Pacific Ocean near the Northern Mariana Islands (area B). Precipitation in area A is closely related to the eastern Pacific ENSO (El Nino-Southern Oscillation) and EAP/PJ (East Asia-Pacific/Pacific-Japan) teleconnection pattern, while precipitation in area B is linked to the Indian Ocean basin-wide and the South China Sea summer monsoon. When the precipitation anomaly in area A is positive, the East Asian summer monsoon is weak. A cyclone appears to the northwest of area A at 850 hPa with convergence airflow. After filtering out the effects of precipitation in area B, the cyclone retreats to the west, and an anticyclone appears to the southeast of area A. When the precipitation is above normal in area B, the circulation and water vapor transportation are similar to that in area A but more to the east. The updraft and downdrafts to both north and south sides of area B form two closed meridional vertical circulations. When the influence of area A is moved out, the circulation center in the warm pool area moves eastward. This research contributes to a better understanding of the regional characteristics of the Maritime Continent and the East Asian summer monsoon.

Chloroform exposure in air and water in Swedish indoor swimming pools-urine as a biomarker of occupational exposure.

Disinfection by-products are produced in water disinfected with chlorine-based products. One such group is trihalomethanes, and chloroform is the most abundant trihalomethane in swimming pool areas. Chloroform can be absorbed by inhalation, ingestion, and dermal absorption, and is classified as possibly carcinogenic. To investigate if chloroform concentrations in air and water affect the chloroform concentration in urine samples of exposed swimming pool workers. Workers from 5 adventure indoor swimming pools carried personal chloroform air samplers and provided up to 4 urine samples during one workday. Chloroform concentrations were analyzed with a linear mixed model analysis to investigate a possible correlation between air and urine concentrations. The geometric mean chloroform concentration was 11 μg/m3 in air and 0.009 µg/g creatinine in urine among individuals with ≤2 h at work, 0.023 µg/g creatinine among those with >2-5 working hours, and 0.026 µg/g creatinine in the group with >5-10 working hours. A risk of higher levels of chloroform in urine was associated with longer hours at work (≤2 h versus >5-10 h, odds ratio [OR] 2.04, 95% confidence interval [CI] 1.25-3.34), personal chloroform concentrations in air (≤17.00 µg/m3 versus >28.00 µg/m3, OR 9.23, 95% CI 3.68-23.13) and working at least half the working day near the swimming pools (OR 3.16, 95% CI 1.33-7.55). Executing work tasks in the swimming pool water was not associated with higher chloroform concentrations in urine compared to only working on land (OR 0.82, 95% CI 0.27-2.45). There is an accumulation of chloroform concentrations in urine during a workday and a correlation between personal air and urine concentrations of chloroform among workers in Swedish indoor swimming pools.

Effect of scanning speed and laser power on formability, microstructure, and quality of 316L stainless steel prepared by selective laser melting

Selective Laser Melting (SLM) prepared 316L stainless steel has been widely deployed in academia and industry today. This paper studied the influence of laser power (50–450 W) and scanning speed (1000–2800 mm/s) on formability, hardness, microstructure, internal and external quality, and porosity of the built, and further analyzed the internal relationship between input energy density and them. The results revealed that high laser power needs to match high scanning speed to obtain better formability; that is, appropriate energy density was the fundamental guarantee of formability. Besides, high energy density will lead to a smaller ratio of width and height (W/H) and a larger area of the molten pool. And the cellular grain's size increased significantly from 181 to 1615 nm, with the energy density increasing from 26.8 to 750.0 J/mm3. In addition, the sample's quality was also related to the energy density. And the porosity variation trend was similar to that of surface roughness, indicating a strong correlation between internal quality and surface quality.

Two-Phase Flow Visualization and Heat Transfer Characteristics Analysis in Ultra-Long Gravity Heat Pipe

The ultra-long gravity heat pipe has a long heat transfer distance and narrow working fluid flow channel within its tube. Due to these unique design features, the vapor–liquid counter-flow and heat transfer characteristics of these heat pipes are more complex than those found in conventional-size heat pipes. This paper innovatively proposes the design of a segmented visualization window structure of an ultra-long gravity heat pipe, which successfully overcomes the challenge of visualizing the internal flow during operations. A visualization experimental platform, measuring 40 m in height with an inner diameter of 7 mm and the aspect ratio up to 5714, was built to investigate the evolving characteristics of two-phase flows with an increasing heat input and the impact of the phase change flow characteristics on the thermal performance of ultra-long gravity heat pipes. The results obtained can provide guidance for the development of the internal structure of ultra-long gravity heat pipes that are being applied in exploiting geothermal energy. The results show that, at low heat input (200 W, 250 W), there are separate flow paths between the condensate return and the steam, but the high hydrostatic pressure due to the height of the liquid injection results in the presence of an unsaturated working fluid with a higher temperature in the liquid pool area, which has a lower evaporation rate, limiting the heat transfer through the heat pipe. It is found that if increasing the heat input up to 300 W, the evaporative phase change in the heating section becomes intense and stable. At the same time, despite the intermittent formation of liquid columns in the adiabatic section due to the vapor–liquid rolls, which increases the resistance to the vapor–liquid counter-flow, the liquid columns are blocked for a short period of time, and the path of steam rises and the condensate return is smooth, which does not seriously affect the steam condensation and liquid return evaporation. At this point, the overall temperature of the heat pipe is evenly distributed along the tube and the heat transfer performance is optimal. When the heat input further increases (350 W, 400 W), a large amount of condensate is trapped in the upper part of the adiabatic section and the condensing section by long liquid plugs for a long time. At this point, the condensate flow back to the heating section is significantly reduced, and the steam is seriously prevented from entering the condensation section, resulting in a significant increase in the temperature gradient between the lower part of the evaporating section and the upper part of the adiabatic section and deterioration of the heat transfer performance.

Evaluation of Formosa score and diagnostic sensitivity and specificity of four Asian risk scores for predicting intravenous immunoglobulin resistance in Kawasaki disease: a bivariate meta-analysis.

In 2016, Lin et al. developed a prediction score of non-responsiveness to intravenous immunoglobulin (IVIG) in patients with Kawasaki disease (KD) (Lin et al., 2016). Various studies have attempted to validate the Formosa score, but inconsistent results have given us new opportunities and challenges. The aim of this meta-analysis is to explore the role of the Formosa score as a risk score in detecting IVIG-resistant KD patients and then compare the pooled sensitivity and specificity of four Asian risk scores, Egami, Formosa, Kobayashi, and Sano risk scores. A comprehensive search of Cochrane, Embase, and PubMed was conducted through 20 December 2021, using key terms relevant to the research question "What are the sensitivities and specificities of the four Asian predicting scores, Egami, Formosa, Kobayashi, and Sano, in Kawasaki disease patients with IVIG resistance?" The reference lists of the included studies were manually reviewed to identify pertinent references. A random-effects bivariate model was used to estimate the summary of sensitivity and specificity of the tools. We found 41 relevant studies of the four Asian risk scores that were eligible to analyze for pooled accuracy. Eleven studies involving 5,169 KD patients reported the diagnostic performance of the Formosa score for the risk of IVIG resistance. The overall performance of the Formosa score was as follows: pooled sensitivity, 0.60 [95% confidence interval (CI), 0.48-0.70]; pooled specificity, 0.59 (95% CI, 0.50-0.68); and area under the hierarchical summary receiver operating characteristic curve, 0.62. The Formosa score exhibited the highest sensitivity 0.76 (95% CI, 0.70-0.82) for detecting IVIG-resistant KD patients among the 21,389 children included in the 41 studies. In terms of specificity estimates, Formosa had the lowest specificity of 0.46 (95% CI, 0.41-0.51). Patients at high risk for IVIG resistance may receive adjunctive treatment to reduce coronary lesions and thus also cardiovascular morbidity. Among all of the included studies, we found Formosa score to have the best sensitivity (0.76) but unsatisfactory specificity (0.46) for predicting IVIG resistance in Kawasaki disease. In the future, network meta-analysis should also incorporate the accuracy of the new scores after they have undergone a certain degree of validation around the world. https://www.crd.york.ac.uk/PROSPERO/, PROSPERO CRD42022341410.

Spatio-temporal evolution of sodium aerosol and temperature distribution during sodium pool fire in a confined environment

In case of a Core Disruptive Accident in sodium-cooled fast reactor, sodium will be ejected from the reactor vessel into the Reactor Containment Building (RCB) and results in sodium fire. Liquid sodium combustion generates aerosol, which gets dispersed and remains suspended in RCB based on geometry of the building and degree of turbulence. The Environment Source Term (EST) primarily depends on the dynamics of sodium aerosols inside the containment. Hence, it is essential to carry out a safety analysis of SFR using computational tools and models shall be validated with experimental data, particularly aerosol dynamics inside the containment along with thermal hydraulics. Besides, all codes assume uniform aerosol concentration in large containment buildings and the evolution of suspended concentration was predicted. However, in actual case a non-uniform concentration profile exists, which leads to stratification of aerosol concentration inside the containment. Towards assessment of aerosol dynamics in realistic scenario, spatial–temporal characteristics of sodium aerosol and temperature distribution were studied by conducting sodium pool fire experiments in a large containment.The sodium fire experiment was conducted by using ∼2.0 kg of sodium in a pool area of ∼0.25 m2. The measured maximum pool and gas temperatures are 685 °C and 126 °C respectively, and the temperature gradient at the wall boundary layer was 7.5 °C/cm. The estimated average sodium burning rate and aerosol release rate are 17.3 kg/m2hr and 0.24 g/s, respectively. The spatial variation of aerosol characteristics was measured for both horizontal and vertical planes. The measured maximum aerosol concentration in the horizontal plane ranges from 2.76 to 5.32, 2.16–3.30 and 2.09–4.21 g/m3 for the bottom, middle and top elevations respectively. For the vertical plane, aerosol concentration varied from 2.16 to 3.65 g/m3 for central positions and 2.53–5.32 g/m3 for off-center positions. The trend of average suspended aerosol concentration at each elevation showed that the concentration was higher at the top elevation than at the middle and bottom for up to 15 min i.e., during aerosol generation period and after that concentration was found to be higher at the bottom elevation for the next 25 min. Based on the measurements, it is observed that the aerosol distribution is not well mixed within the experimental period. A significant difference in aerosol mass concentration was observed between each elevation, between estimation and observations based on a zero-dimensional model. The evolutions of aerosol median size by theoretical simulation capture the overall trend reasonably.

The diagnostic value of electrocardiogram-based machine learning in long QT syndrome: a systematic review and meta-analysis.

To perform a meta-analysis to discover the performance of ML algorithms in identifying Congenital long QT syndrome (LQTS). The searched databases included Cochrane, EMBASE, Web of Science, and PubMed. Our study considered all English-language studies that reported the detection of LQTS using ML algorithms. Quality was assessed using QUADAS-2 and QUADAS-AI tools. The bivariate mixed effects models were used in our study. Based on genotype data for LQTS, we performed a subgroup analysis. Out of 536 studies, 8 met all inclusion criteria. The pooled area under the receiving operating curve (SAUROC) for detecting LQTS was 0.95 (95% CI: 0.31-1.00); sensitivity was 0.87 (95% CI: 0.83-0.90), and specificity was 0.91 (95% CI: 0.88-0.93). Additionally, diagnostic odd ratio (DOR) was 65 (95% CI: 39-109). The positive likelihood ratio (PLR) was 9.3 (95% CI: 7.0-12.3) and the negative likelihood ratio (NLR) was 0.14 (95% CI: 0.11-0.20), with very low heterogeneity (I2 = 16%). We found that machine learning can be used to detect features of rare cardiovascular disease like LQTS, thus increasing our understanding of intelligent interpretation of ECG. To improve ML performance in the classification of LQTS subtypes, further research is required. identifier PROSPERO CRD42022360122.

An Updated Systematic Review and Meta-Analysis of the Association between the De Ritis Ratio and Disease Severity and Mortality in Patients with COVID-19.

Patients with Coronavirus disease 2019 (COVID-19) often have elevations in markers of liver injury, particularly serum aspartate transaminase (AST) and alanine transaminase (ALT). Such alterations may affect the AST/ALT ratio (De Ritis ratio) and, potentially, clinical outcomes. We conducted an updated systematic review and meta-analysis of the association between the De Ritis ratio and COVID-19 severity and mortality in hospitalized patients. PubMed, Web of Science, and Scopus were searched between 1 December 2019 and 15 February 2023. The Joanna Briggs Institute Critical Appraisal Checklist and the Grading of Recommendations, Assessment, Development, and Evaluation were used to assess the risk of bias and the certainty of the evidence, respectively. Twenty-four studies were identified. The De Ritis ratio on admission was significantly higher in patients with severe disease and non-survivors vs. patients with non-severe disease and survivors (15 studies, weighted mean difference = 0.36, 95% CI 0.24 to 0.49, p < 0.001). The De Ritis ratio was also associated with severe disease and/or mortality using odds ratios (1.83, 95% CI 1.40 to 2.39, p ˂ 0.001; nine studies). Similar results were observed using hazard ratios (2.36, 95% CI 1.17 to 4.79, p = 0.017; five studies). In six studies, the pooled area under the receiver operating characteristic curve was 0.677 (95% CI 0.612 to 0.743). In our systematic review and meta-analysis, higher De Ritis ratios were significantly associated with severe disease and mortality in COVID-19 patients. Therefore, the De Ritis ratio can be useful for early risk stratification and management in this patient group (PROSPERO registration number: CRD42023406916).

Prognostic and discriminatory abilities of imaging scoring systems in predicting COVID‐19 adverse outcomes

AbstractBackgroundTo evaluate the discriminatory ability of imaging modalities' scoring systems in the prediction of COVID‐19 adverse outcomes like ICU admission, ventilatory support, or mortality.MethodsWe searched PUBMED, EBSCO, WEB OF SCIENCE, and SCOPUS. Two authors independently screened the resulting papers for fulfillment criteria. Meta‐DiSc version 1.4, RevMan version 5.4, and MedCalc version 19.1 were used for test accuracy analysis, sensitivity and specificity analysis, and pooling Area under the curve for discriminatory assessment, respectively.ResultsRegarding mortality prediction, the computed tomography (CT) showed significantly higher sensitivity [80%; 95% CI 0.74–0.85] and positive likelihood ratio (PLR) [4.41 95% CI 2.94–6.61] relative to the Lung Ultrasound Score (LUS) approach, while the LUS approached the CT scan with specificity of 81% [95% CI 0.78–0.83] and negative likelihood ratio (NLR) of [0.32; 95% CI 0.16–0.64]. The pooled area under ROC for LUS was [AUC = 0.777, 95% CI 0.701–0.852; p &lt; 0.001, I2 = 74.86%, p = 0.019] while the pooled area under ROC for CT severity score was [AUC = 0.855, 95% CI 0.78–0.93; p &lt; 0.001, I2 = 93.73%, p &lt; 0.001]. Regarding adverse outcomes prediction, the LUS had a slightly higher specificity of [78%; 95% CI 0.75–0.80] and PLR of [3.60; 95% CI 2.28–5.68] compared to CT score. The pooled AUC using LUS was (0.77, 95% CI 0.719–0.832; p &lt; 0.001), while using CT severity score was (0.843, 95% CI 0.787–0.898; p &lt; 0.001), and using X‐ray scores was (0.814, 95% CI 0.751–0.878; p &lt; 0.001).ConclusionCT severity score showed a better discriminatory ability in predicting COVID‐19 adverse outcomes, as in‐hospital mortality, ICU admission, and need for ventilatory support compared to LUS and X‐RAY scores, while the LUS, being more specific, had a slightly better prognostic value.

Evaluation of Facilities Improvement and Utilization Strategy Tegal Port

According to the national port master plan, Tegal Port is a hub port. In practice, a number of fishing boats crowd the port pool area thereby disturbing the area that should be used for the port loading and unloading process. Full port facilities are not supported by this circumstance. Commercial ships wishing to enter the port must wait for the tide to enter the waters of the port pool because shipping lanes enter the port wisely around 3 LWS. This study aims to examine the relationship between the port facility utilization index and the port facility performance index in several categories of capacity accessibility and satisfactory performance levels, in the categories of safety, order, smoothness and speed, and pollution experienced unsatisfactory performance. This research uses a descriptive method. Data obtained from surveys and analyzed using the SWOT method. The SWOT analysis shows strength-opportunity (SO) conditions where managers must maximize the potential of ports that have facilities. The results of the SWOT analysis show that the right strategy to use for port development is strength-opportunity, namely improving existing facilities as well as possible, such as making repairs to facilities that are not suitable for use and adding facilities at the port and increasing cooperation with stakeholders by making more work agreements, promising and facilitating service users as well as cutting bureaucracy that does not complicate service users.

Post-neoadjuvant treatment pancreatic cancer resectability and outcome prediction using CT, 18F-FDG PET/MRI and CA 19–9

BackgroundCT prediction of resectability and prognosis following neoadjuvant treatment (NAT) in patients with pancreatic ductal adenocarcinoma (PDAC) remains challenging. This study aims to determine whether addition of 18F-fluorodeoxyglucose (FDG) postiron emission tomography (PET)/MRI and carbohydrate antigen (CA) 19–9 to contrast-enhanced CT (CECT) can improve accuracy of predicting resectability compared to CECT alone and predict prognosis in PDAC patients after NAT.MethodsIn this retrospective study, 120 PDAC patients (65 women; mean age, 66.7 years [standard deviation, 8.4]) underwent CECT, PET/MRI, and CA 19–9 examinations after NAT between January 2013 and June 2021. Three board-certified radiologists independently rated the overall resectability on a 5-point scale (score 5, definitely resectable) in three sessions (session 1, CECT; 2, CECT plus PET/MRI─no FDG avidity and no diffusion restriction at tumor-vessel contact indicated modification of CECT scores to ≥ 3; 3, CECT plus PET plus CA 19–9─no FDG avidity at tumor-vessel contact and normalized CA 19–9 indicated modification of CECT scores to ≥ 3). Jackknife free-response receiver operating characteristic method and generalized estimating equations were used to compare pooled area under the curve (AUC), sensitivity, and specificity of three sessions. Predictors for recurrence-free survival (RFS) were assessed using Cox regression analyses.ResultsEach session showed different pooled AUC (session 1 vs. 2 vs. 3, 0.853 vs. 0.873 vs. 0.874, p = 0.026), sensitivity (66.2% [137/207] vs. 86.0% [178/207] vs. 84.5% [175/207], p < 0.001) and specificity (67.3% [103/153] vs. 58.8% [90/153] vs. 60.1% [92/153], p = 0.048). According to pairwise comparison, specificity of CECT plus PET/MRI was lower than that of CECT alone (adjusted p = 0.042), while there was no significant difference in specificity between CECT alone and CECT plus PET plus CA 19–9 (adjusted p = 0.081). Twenty-eight of 69 patients (40.6%) with R0 resection experienced tumor recurrence (mean follow-up, 18.0 months). FDG avidity at tumor-vessel contact on post-NAT PET (HR = 4.37, p = 0.033) and pathologically confirmed vascular invasion (HR = 5.36, p = 0.004) predicted RFS.ConclusionCombination of CECT, PET and CA 19–9 increased area under the curve and sensitivity for determining resectability, compared to CECT alone, without compromising the specificity. Furthermore, 18F-FDG avidity at tumor-vessel contact on post-NAT PET predicted RFS.