Poor Results Research Articles

Aeromonas trota Is Highly Refractory to Acquire Exogenous Genetic Material

Aeromonas trota is sensitive to most antibiotics and the sole species of this genus susceptible to ampicillin. This susceptibility profile could be related to its inability to acquire exogenous DNA. In this study, A. trota isolates were analyzed to establish their capacity to incorporate foreign DNA. Fourteen strains were identified as A. trota by multilocus phylogenetic analysis (MLPA). Minimal inhibitory concentrations of antibiotics (MIC) were assessed, confirming the susceptibility to most antibiotics tested. To explore their capacity to be transformed, A. trota strains were used as recipients in different horizontal transfer assays. Results showed that around fifty percent of A. trota strains were able to incorporate pBAMD1-2 and pBBR1MCS-3 plasmids after conjugal transfer. In all instances, conjugation frequencies were very low. Interestingly, several isoforms of plasmid pBBR1MCS-3 were observed in transconjugants. Strains could not receive pAr-32, a native plasmid from A. salmonicida. A. trota strains were unable to receive DNA by means of electroporation, natural transformation or vesiduction. These results confirm that A. trota species are extremely refractory to horizontal gene transfer, which could be associated to plasmid instability resulting from oligomerization or to the presence of defense systems against exogenous genetic material in their genomes. To explain the poor results of horizontal gene transfer (HGT), selected genomes were sequenced and analyzed, revealing the presence of defense systems, which could prevent the stable incorporation of exogenous DNA in A. trota.

Multiphase comparative study for WHO/ISUP nuclear grading diagnostic model based on enhanced CT images of clear cell renal cell carcinoma

To compare and analyze the diagnostic value of different enhancement stages in distinguishing low and high nuclear grade clear cell renal cell carcinoma (ccRCC) based on enhanced computed tomography (CT) images by building machine learning classifiers. A total of 51 patients (Dateset1, including 41 low-grade and 10 high-grade) and 27 patients (Independent Dateset2, including 16 low-grade and 11 high-grade) with pathologically proven ccRCC were enrolled in this retrospective study. Radiomic features were extracted from the corticomedullary phase (CMP), nephrographic phase (NP), and excretory phase (EP) CT images, and selected using the recursive feature elimination cross-validation (RFECV) algorithm, the group differences were assessed using T-test and Mann–Whitney U test for continuous variables. The support vector machine (SVM), random forest (RF), XGBoost (XGB), VGG11, ResNet18, and GoogLeNet classifiers are established to distinguish low-grade and high-grade ccRCC. The classifiers based on CT images of NP (Dateset1, RF: AUC = 0.82 ± 0.05, ResNet18: AUC = 0.81 ± 0.02; Dateset2, XGB: AUC = 0.95 ± 0.02, ResNet18: AUC = 0.87 ± 0.07) obtained the best performance and robustness in distinguishing low-grade and high-grade ccRCC, while the EP-based classifier performance in poorer results. The CT images of enhanced phase NP had the best performance in diagnosing low and high nuclear grade ccRCC. Firstorder_Kurtosis and firstorder_90Percentile feature play a vital role in the classification task.

Insights from elite soccer players: understanding the downward spiral and the complex dynamics of crises

AbstractThis study focused on identifying the factors that lead to prolonged crises in soccer teams and how players view the development of these crises. A qualitative analysis of interviews with six current and three former professional soccer players revealed that the failure to meet team expectations is often the starting point of crises, which can impact both individual and team levels. The issues at the individual level include anxiety, pressure, lack of self-confidence, somatic manifestations, negative body language, loss of motivation, rumination, and self-focus. At the team level, conflicts arise, the team atmosphere deteriorates, which is reflected in impaired communication and lack of cohesion. During soccer matches, on-field behavior frequently evolves into a more defensive mindset and a desire to avoid mistakes and responsibility, resulting in lower team performance. Poor results usually ensue, perpetuating and even intensifying the crisis process which players refer to as a vicious circle, negative spiral, or vortex. Societal factors such as media landscape, coronavirus disease 2019 (COVID-19) pandemic, club structures, or fans, and individual factors such as crisis experiences, players’ resilience, family cohesion, or support from friends affect the development of crises. The study’s insights illustrate the negative impacts of pressure on the team’s emotional state and social interaction, leading to a downward spiral, and thus, reinforcing the crisis process. The study concludes that crisis management training and support should focus on managing expectations, promoting positive affective states, and supporting healthy motivation among team members, and should expand coaches’ crisis competency training.

Surgical management and functional outcomes of perilunate dislocations and fracture dislocations through the dorsal approach.

Perilunate dislocations and perilunate fracture dislocations (PLD/PLFDs) are rare injuries of the wrist, with surgical management leading to acceptable functional results. The purpose of this study was to assess the functional outcomes of the patients of our department who were treated with surgical management of PLDs/PLFDs through dorsal approach, as well as to report any complications on their follow-up. In this retrospective study, 52 patients with PLD/PLFD, fulfilling the inclusion and exclusion criteria of the study, underwent surgical management of their injury. All patients were followed up at 6weeks, 12weeks, 6months, 1year postoperatively with radiographic imaging as well as functional scores measured with the modified mayo wrist score and the QuickDASH questionnaire. The mean postoperative modified Mayo score was 76.8 ± 8.8 and the mean QuickDASH score was 1.52 ± 2.18. Of the 52 cases, 20% had excellent results, 42% had good results, 29% had fair results and 9% had poor results as per the modified Mayo wrist score. No patient signed any symptoms of median nerve neuropathy. In conclusion, open reduction and internal fixation through dorsal approach is a reliable technique to manage perilunate injuries in spite of radiological evidence of wrist arthritis, as it also provides consistently good results in terms of functional outcomes. Retrospective case series study.

Towards Better Quantity Representations for Solving Math Word Problems

Solving a math word problem requires selecting quantities in it and performing appropriate arithmetic operations to obtain the answer. For deep learning-based methods, it is vital to obtain good quantity representations, i.e., to selectively and emphatically aggregate information in the context of quantities. However, existing works have not paid much attention to this aspect. Many works simply encode quantities as ordinary tokens, or use some implicit or rule-based methods to select information in their context. This leads to poor results when dealing with linguistic variations and confounding quantities. This paper proposes a novel method to identify question-related distinguishing features of quantities by contrasting their context with the question and the context of other quantities, thereby enhancing the representation of quantities. Our method not only considers the contrastive relationship between quantities, but also considers multiple relationships jointly. Besides, we propose two auxiliary tasks to further guide the representation learning of quantities: 1) predicting whether a quantity is used in the question; 2) predicting the relations (operators) between quantities given the question. Experimental results show that our method outperforms previous methods on SVAMP and ASDiv-A under similar settings, even some newly released strong baselines. Supplementary experiments further confirm that our method indeed improves the performance of quantity selection by improving the representation of both quantities and questions.

Comparison of 2 different fixation techniques of comminuted acetabular quadrilateral surface fractures using square bracket-shaped tubular plate or interfragmentary screws in addition to supra/infrapectineal plate fixation: An observational study.

The management of comminuted quadrilateral fractures remains challenging, and treatment options are constantly evolving. The purpose of the present study was to examine the outcomes of 2 different fixation techniques in the management of comminuted quadrilateral fractures. Twenty-two patients with comminuted quadrilateral acetabular fractures were surgically treated with interfragmentary lag screw (group 1) and square bracket-shaped tubular (SBST) plate technique (group 2), in addition to suprapectineal and infrapectineal pelvic reconstruction plate fixation between January 2016 and July 2019 at our clinic. 2 years follow-up control data of each group were compared in terms of radiological and functional results, and complications. According to the functional score comparison, the mean Merle d'Aubigne Postel scoring system (MAP) score was 15.2/15.6 (P = .632), and the mean Harris hip scoring (HHS) system score was 74.65/77.3 (P = .664) in groups 1 and 2, respectively. Radiological comparison was performed according to matta radiological criteria (MRC), and 2 excellent, 6 good, 2 poor, 4 excellent, 4 good, and 4 poor radiological results were observed in groups 1 and 2, respectively. intraarticular screw penetration was detected in 3 patients in group 1, while there was no articular implant penetration in group 2 (P = .001). We believe that satisfactory results can be obtained with the SBST plate technique, offering functional and clinical outcomes that are similar to those of the interfragmentary screw technique. The SBST plate technique is superior in terms of avoiding intraarticular screw penetration and related revision surgery.

BCG and bladder cancer. Forty-eight years after Morales report.

Although BCG use as an anticancer drug was nearly abandoned due to the poor results in most tumors, in 1976 Morales reported a relevant reduction in recurrence with intravesical BCG in few patients affected by NMIBC. Since then BCG was globally accepted as an empirical and effective therapy in treating Tis and preventing recurrence of intermediate and high risk NMIBC. Forty-eight years after Morales' report, although some open questions remain object of debate, we have been able to find answers to many doubts improving BCG activity and toxicity. We better select patients undergoing BCG and many trials have indicated the best dosage and schedule. Moreover, we are able to better identify the patient unresponsive to BCG who might benefit of a timely radical cystectomy. We are also aware of the difficulties and toxicities that can be encountered with BCG use in every-day clinical practice. Research is ongoing to obtain genetically modified BCG to increase its efficacy and reduce toxicity. Moreover, the combination of BCG with other immunotherapeutic drugs given intravesically or systemically, first immune checkpoint inhibitors, is under study to obtain a response in patients unresponsive or intolerant to BCG. Almost 50 years after Morales publication, intravesical BCG remains an inalienable tool against NMIBC.

Repositioning of Small Molecules through the Inverse Virtual Screening in silico Tool: Case of Benzothiazole-Based Inhibitors of Soluble Epoxide Hydrolase (sEH).

Computational techniques accelerate drug discovery by identifying bioactive compounds for specific targets, optimizing molecules with moderate activity, or facilitating the repositioning of inactive items onto new targets. Among them, the Inverse Virtual Screening (IVS) approach is aimed at the evaluation of one or a small set of molecules against a panel of targets for addressing target identification. In this work, a focused library of benzothiazole-based compounds was re-investigated by IVS. Four items, originally synthesized and tested on bromodomain-containing protein 9 (BRD9) but yielding poor results, were critically re-analyzed, disclosing only a partial fit with 3D structure-based pharmacophore models, which, in the meanwhile, were developed for this target. Afterwards, these compounds were re-evaluated through IVS on a panel of proteins involved in inflammation and cancer, identifying soluble epoxide hydrolase (sEH) as a putative interacting target. Three items were subsequently confirmed as able to inhibit sEH activity, spanning from 70% up to 30% when tested at 10 μM. Finally, one benzothiazole-based compound emerged as the most promising inhibitor featuring an IC50 in the low micromolar range (IC50 = 6.62 ± 0.13 μM). Our data confirm IVS as a predictive tool for accelerating the target identification and repositioning processes.

The Avantage ® dual mobility cup in primary total hip arthroplasty: a registry study

BackgroundAvantage Cup has been widely used in dual mobility implants. However, in Swedish Registry, the outcome of the Avantage Cup is reported with higher implants revision compared to control. The aim of our study was to verify if the same results are present in the Registry of Prosthetic Orthopedic Implants (RIPO) of Emilia Romagna (ER, Italy), as the Avantage cup was the most implanted dual mobility cup for a long follow-up reported in this Registry (2000-2012). Furthermore, we assessed the survival rate of the implant over the time. MethodsWe included all patients that underwent a primary THA using the Avantage cup during the period 2000-2020 in RIPO Registry. The survivorship of the primary THA implants was calculated and plotted according to Kaplan-Meier method Results886 Avantage cups were included in the analysis. During the observational period 44 hips were revised. The most common reasons for revision were: periprosthetic fractures (PPF) (n = 7, 0.8%), deep infection (n = 7, 0.8%), and cup aseptic loosening (n =13, 1.5 %).The survival rate of the implant was 96.8% (95.3-97.8) at 5 years, 95.7 at 10 years (94.0-97.0) and 92.1 at 15 years (88.5-94.6). ConclusionIn conclusion, this study has demonstrated that the Avantage cup in primary hip arthroplasty implanted with a “friendly” femoral stem granted satisfactory long-term survival. Therefore, in the Swedish Registry, the cause of the poor results presented for Avantage Cup could be the thick, rough neck stem of the widely used Lubinus stem.

Accurate object localization facilitates automatic esophagus segmentation in deep learning

BackgroundCurrently, automatic esophagus segmentation remains a challenging task due to its small size, low contrast, and large shape variation. We aimed to improve the performance of esophagus segmentation in deep learning by applying a strategy that involves locating the object first and then performing the segmentation task.MethodsA total of 100 cases with thoracic computed tomography scans from two publicly available datasets were used in this study. A modified CenterNet, an object location network, was employed to locate the center of the esophagus for each slice. Subsequently, the 3D U-net and 2D U-net_coarse models were trained to segment the esophagus based on the predicted object center. A 2D U-net_fine model was trained based on the updated object center according to the 3D U-net model. The dice similarity coefficient and the 95% Hausdorff distance were used as quantitative evaluation indexes for the delineation performance. The characteristics of the automatically delineated esophageal contours by the 2D U-net and 3D U-net models were summarized. Additionally, the impact of the accuracy of object localization on the delineation performance was analyzed. Finally, the delineation performance in different segments of the esophagus was also summarized.ResultsThe mean dice coefficient of the 3D U-net, 2D U-net_coarse, and 2D U-net_fine models were 0.77, 0.81, and 0.82, respectively. The 95% Hausdorff distance for the above models was 6.55, 3.57, and 3.76, respectively. Compared with the 2D U-net, the 3D U-net has a lower incidence of delineating wrong objects and a higher incidence of missing objects. After using the fine object center, the average dice coefficient was improved by 5.5% in the cases with a dice coefficient less than 0.75, while that value was only 0.3% in the cases with a dice coefficient greater than 0.75. The dice coefficients were lower for the esophagus between the orifice of the inferior and the pulmonary bifurcation compared with the other regions.ConclusionThe 3D U-net model tended to delineate fewer incorrect objects but also miss more objects. Two-stage strategy with accurate object location could enhance the robustness of the segmentation model and significantly improve the esophageal delineation performance, especially for cases with poor delineation results.

Harmonized NDVI time-series from Landsat and Sentinel-2 reveal phenological patterns of diverse, small-scale cropping systems in East Africa

Capturing the phenological responses of crops in diverse, small-scale agricultural systems is one of the most notable remote sensing research gaps in Eastern Africa. Because of the heterogeneous and complex agricultural environments, remote sensing methodologies successfully implemented elsewhere yield poor results in Eastern Africa. The reliance on local rainfall and dry spells can lead to alterations in planting patterns, impacting growing season timing and yield, underscoring the importance of high temporal resolution for capturing crop phenology. We generated a high-resolution land use/land cover (LULC) classification map of 10 m using Sentinel-1 and Sentinel-2 imagery together with a large set of reference data acquired in situ in 2022. The LULC classification yielded an overall accuracy of 87.9% and Cohen's kappa value of 0.83. Based on the LULC map, we investigated the phenological metrics of the most important crops in the Kamuli district of Eastern Uganda by combining a multi-sensor harmonization approach, thresholding method, and cloud computing. Previously unavailable Landsat 9 band adjustment coefficients were derived. By harmonizing Landsat (LS) 7 Enhanced Thematic Mapper Plus (ETM+), Landsat 8 and 9 Operational Land Imager (OLI), with Sentinel-2 Multispectral Instrument (MSI), the phenological patterns during the March to May growing season were captured using a dense temporal Normalized Difference Vegetation Index (NDVI) time series. The seasonal onset for most crop types was in the end of March to middle of April while the end of the growing season occurred from the end of June to middle of July. Investigation of the 13 crop types using a high-resolution LULC map and dense, harmonized NDVI time series signifies the first field-level phenological metrics estimation of smallholder farming systems in Eastern Africa. Future research should focus on expanding the methodology in space and time to provide insights into past and current growing season development.

On polling directions for randomized direct-search approaches: application to beam angle optimization in intensity-modulated proton therapy

AbstractDeterministic direct-search methods have been successfully used to address real-world challenging optimization problems, including the beam angle optimization (BAO) problem in radiation therapy treatment planning. BAO is a highly non-convex optimization problem typically treated as the optimization of an expensive multi-modal black-box function which results in a computationally time consuming procedure. For the recently available modalities of radiation therapy with protons (instead of photons) further efficiency in terms of computational time is required despite the success of the different strategies developed to accelerate BAO approaches. Introducing randomization into otherwise deterministic direct-search approaches has been shown to lead to excellent computational performance, particularly when considering a reduced number (as low as two) of random poll directions at each iteration. In this study several randomized direct-search strategies are tested considering different sets of polling directions. Results obtained using a prostate and a head-and-neck cancer cases confirmed the high-quality results obtained by deterministic direct-search methods. Randomized strategies using a reduced number of polling directions showed difficulties for the higher dimensional search space (head-and-neck) and, despite the excellent mean results for the prostate cancer case, outliers were observed, a result that is often ignored in the literature. While, for general global optimization problems, mean results (or obtaining the global optimum once) might be enough for assessing the performance of the randomized method, in real-world problems one should not disregard the worst-case scenario and beware of the possibility of poor results since, many times, it is only possible to run the optimization problem once. This is even more important in healthcare applications where the mean patient does not exist and the best treatment possible must be assured for every patient.

The Breast-Pectoralis Flap: A New Advance in Autologous Breast Reconstruction: A Preliminary Report on 20 Cases.

In the past, several publications have described breast reconstruction techniques using the contralateral breast; however, interest has diminished because of technical difficulty, scarring, and poor aesthetic results. This study aimed to present a new breast reconstruction technique that uses a combination of the breast-pectoralis flap and abdominal advancement flap. This retrospective study analyzed the results and complications of 20 consecutive breast reconstructions with the breast-pectoralis flap technique. The authors present a series of 20 breast reconstructions using the breast-pectoralis flap. Delayed breast reconstruction was performed in 13 (65%) cases, breast reconstruction in 5 (25%) patients with Poland syndrome, sequela correction after a chest wall sarcoma in 1 (5%), and sequela correction after breast cystic lymphangioma resection in 1 (5%). One complication required surgical reintervention without long-term consequences. The outcomes were considered very good in 50% of the cases, good in 45%, and fair in 5%. Breast-pectoralis flap associated with the abdominal advancement flap is an interesting advance in breast reconstruction. After the evaluation of the presented cases, we are considering widening the indications of this technique in our current practice.

Rehabilitation Program for Post-Laryngectomy Patients Following Ileocolon Flap Transfer for Voice Reconstruction--An essential part of success.

Speech restoration is important for communication and social activities after pharyngolaryngectomy in head and neck cancer or corrosive injury. Several techniques of voice restoration have been developed to improve life quality. The aim of this paper was to focus on the microsurgical transfer of ileocolon flap and outcome of further voice rehabilitation. From 2010 to 2022, 69 patients had ileocolon flap at our hospital with postoperative speech training and regular follow-up for over one year. The patients received deglutition training first, followed by voice rehabilitation. Voice outcomes were evaluated at an interval of 3 months and finally at 12 months of voice training rehabilitation. Among other examinations, the speech function was evaluated using a 4-point Likert scale and senior surgeon (HCC) scoring system. The results showed that speech function reached 13.1% of excellent voice, 65.1% of good voice, 13.1% of fair result, and 8.7% of poor result by Likert scales. Meanwhile, the senior surgeon (HCC) score showed 17.4 % of excellent, 63.8% of moderate, and 18.8% of poor results. About voice lab results, maximal phonation time (MPT) was 11.0 sec, and the average number counted in one breath was 15. Loudness and frequency showed 56.0dB and 105.0 Hz respectively. The study showed that after voice reconstruction with ileocolon flap followed by the voice rehabilitation program, the patients would have a better understanding of the altered anatomical structures and practice in a more efficient way. Adequate recommendation by the therapists to plastic surgeons for revision surgeries optimized voice function of the patients.

MANAGEMENT OF CONGENITAL TALIPES EQUINOVARUS WITH PONSETI TECHNIQUE IN CHILDREN UNDER 2 YEARS OF AGE

ABSTRACT: BACKGROUND AND OBJECTIVES: CTEV is a complex congenital deformity of the foot and occurs due to the confluence of genetic & environmental factors. If it is not treated promptly and accordingly, it limits patient mobility and results in a painful foot. In most cases, it is treated conservatively using the Ponseti technique. This method was developed by a Japanese orthopedic surgeon Ignatio Ponseti who successfully treated CTEV in infants without extensive surgery. It is a manipulative technique with percutaneous release of tendoachilles that allows the ankle to obtain correction. This study was conducted to assess the functional outcomes of CTEV management by Ponseti method. METHODS: Ethical approval was obtained from the Ethical Review Board Of Services Hospital Lahore. This descriptive study was conducted at the department of orthopedic surgery from December 2018 to December 2020. A total number of 120 patients having CTEV deformity of the foot, aged less than 2 years, were included in the study. From these, 70 children had bilateral foot involvement. It was treated with 5-7 casts with each cast applied for 07 days according to the Ponseti method. In the final cast, a percutaneous Achilles Tenotomy was performed, where the deformity was restricted to 10 degrees from the neutral. After completion of casts, each patient was braced with Foot Abduction Brace. RESULTS: We used Pirani Score for pre- and post-operative assessment of correction of deformity via Ponseti method. There were 91% excellent results achieved through this method, whilst 6% of patients had good results and 3% had poor results. CONCLUSION: Ponseti technique has got good functional & cosmetic results. It is economical and easy to apply. KEY WORDS: Club foot, Pirani Shafique score, Ponseti technique, CTEV

High-Intensity Hydraulic Fracturing May Hold Off US Gulf Oil Declines, but Shell Study Reveals That It’s No Easy Feat

_ When stimulating oil wells in the ultradeep Lower Tertiary play, “It is impossible to do too much contingency planning.” Those words rank high in a new study by Shell that shows how it has borrowed a page from the unconventional revolution to create “massive hydraulic fractures” in some of the deepest wells ever drilled in the Gulf of Mexico. Only a handful of operators can claim to have any experience in this area, but with more looking to follow suit the profile of US Gulf production may soon look a lot different. A separate study by Enverus Intelligence Research highlights that since 2016, at least 27 multistage hydraulically fractured wells have been completed in the Lower Tertiary, also called the Paleogene. That accounts for about half of all wells producing from the low-permeability trend defined by interbedded sandstones and shales that in the central US Gulf are found 5 to 6 miles below sea level. Enverus forecasts that as the share of fractured wells rises, Lower Tertiary production will more than double from 270,000 B/D in 2023 to 750,000 B/D by 2028. The market intelligence firm predicts such a surge will offset much of the anticipated declines from older Gulf projects and stabilize the region’s output at nearly 2 million B/D throughout the decade. The trailblazers are led by Chevron with 14 fractured wells at its Jack/St. Malo project followed by Shell with nine at the Great White unit and the Stones field, which at a water depth of 9,500 ft, is host to the world’s deepest production facility. The elite group is rounded out by US independent LLOG, which has three high-intensity fractured wells in the Buckskin field, and ExxonMobil with one in its Julia development. “Over the past decade the belief was that much of the Lower Tertiary would be subcommercial because many of the discoveries were around 5 to 15 md, which in the offshore context is considered super tight,” Marvin Ma, an analyst at Enverus, said. “But based on the experiences we’re seeing from Chevron and Shell, I think operators are starting to realize that it is possible to develop these projects commercially.” Indeed, the numbers shared so far are hard to ignore. Early production rates reported from some of the newest Lower Tertiary fractured wells have ranged between 15,000 and 22,000 B/D. And while poor results have been seen, Enverus believes the estimated ultimate recoveries (EURs) of many fractured wells ranges from 18–73% above the group with traditional completions. These figures translate to 6 to 10 million bbl of incremental crude. The View From 30,000 Feet If large-scale fracturing is the key to commercial success in the Lower Tertiary, it will not come easy. The remoteness poses cumbersome logistical challenges while the pressures involved with running a frac job in deepwater wells requires far more planning and modeling than usual. Ken Lizak, a completions advisor at Shell, said his team has reaped the rewards of this due diligence but noted future improvements are heavily reliant on technological progress.

Serum Progesterone Is Lower in Ovarian Stimulation With Highly Purified HMG Compared to Recombinant FSH Owing to a Different Regulation of Follicular Steroidogenesis: A Randomized Controlled Trial

(Abstracted from Hum Reprod 2024;39:393–402 Serum progesterone levels following ovarian stimulation (OS) are associated with the cycle result in terms of ongoing pregnancy and live birth rate, with levels above a certain threshold associated with poorer results. An increase in progesterone is positively associated with the ovarian response and the FSH dose administered during OS; however, this mechanism is not well understood.

Data-driven hierarchical collaborative optimization method with multi-fidelity modeling for aerodynamic optimization

The aerodynamic optimization of aircraft based on evolutionary algorithms generally requires thousands or even tens of thousands of iterations. Moreover, it faces challenges such as high-dimensional design variables and high computational costs, leading to low efficiency in algorithm search and poor optimization results. In order to enhance the efficiency of aerodynamic optimization, a data-driven collaborative optimization and multi-fidelity hierarchical modeling method is proposed. Firstly, a Clustering-Enhanced Teaching-Learning-Based Optimization (CETLBO) algorithm is introduced to improve its exploration and exploitation capabilities. By employing a collaborative optimization strategy, a divide-and-conquer paradigm is utilized to efficiently solve high-dimensional, nonlinear, and complex engineering optimization problems. Secondly, a two-stage hierarchical aerodynamic optimization framework is designed to reduce computational costs by integrating data from different fidelity levels. Stage 1 adopts a data-driven approximate optimization method to provide prior knowledge for the high-fidelity optimization of stage 2. Finally, the proposed method is applied to the optimization design of supersonic wing shapes. Compared to traditional optimization design systems, it demonstrates high efficiency in high-dimensional aerodynamic optimization problems, yielding better optimization results.

Association between socioeconomic status and hospitalisation requirement in older patients attended at the emergency department: A retrospective cohort study

Introduction and objectiveA low socioeconomic status (SES) has been associated with poor health results. The present study aimed to investigate if SES of older patients attending the emergency department is associated with the use of healthcare resources and outcomes. Patients and methodsObservational, retrospective study including consecutive patients 65 years or older admitted to the emergency department. Variables at baseline, index episode, and follow-up were recorded. SES was measured using an indirect theoretical index and patients were categorised into two groups according to whether they lived in a neighbourhood with a low or high SES. Primary outcomes included hospitalisation after the emergency department visit and prolonged hospitalisation (>7 days) at index episode. Secondary outcomes included emergency department re-consultant and hospital admission in the following 3 months after the index episode, and all-cause mortality after long-term follow-up. Logistic regression and cumulative hazards regression models were used to investigate associations between SES and outcomes. ResultsThe cohort included 553 patients (80 years [73–85], 50.5% female, 55.9% with low SES). After the emergency department visit, 234 patients (42.3%) required hospital admission. A low SES was inversely associated with hospitalisation with an adjusted odds ratio=0.654 (95% CI 0.441–0.970). Among hospitalised patients, a low SES was associated with prolonged hospitalisation (adjusted odds ratio=2.739; 95% CI 1.470–5.104). Follow-up outcomes, including all-cause mortality, were not associated with SES. ConclusionsOlder patients living in more deprived urban areas were hospitalised less often after emergency department care, but hospital stays were longer. Understanding the effect of social determinants in healthcare use is mandatory to tailor resources to patient needs.

The naval Operation Irini of the European Union: a step backwards of the csdp in the fight against the illegal immigration and search and rescue activities in the Mediterranean

Operation Irini is a new EU naval operation, in the framework of CSDP, to address violations of the arms embargo and illicit export of petroleum products in Libya, imposed by the United Nations Security Council. As a second objective, the Operation contributes to the training of Libyan coastguards in their fight against illegal immigration, as well as combating the mafias involved in the smuggling of migrants in the Central Mediterranean. From the outset, the naval operation has had scant resources and, unsurprisingly, its results have been poor in these first three years. In short, this new Operation, in the wake of Sophia’s poor results in the last months of its activity, represents a new setback for the CSDP and for the EU’s ambition to become a relevant actor in contemporary international society. Unfortunately, moreover, allegations of significant violations of migrants’ human rights by Libyan coast guard forces cast a shadow over the EU, which is assisting and training these security forces. Received: 04 September 2023Accepted: 24 January 2024