Library Search Research Articles

Comparative Effectiveness of Different Cystic Duct Ligation Techniques in Laparoscopic Cholecystectomy: A Systematic Review and Network Meta-Analysis.

Background: Laparoscopic cholecystectomy is one of the most common surgical procedures. Several techniques of ligating the cystic duct have been compared in randomized trials, but data on comparative effectiveness are missing. Our aim was to systematically review the literature and, if appropriate, synthesize the available evidence. Methods: A systematic search of PubMed, Scopus, Ovid, and Cochrane Library was conducted to identify randomized studies comparing different ligation techniques of the cystic duct in laparoscopic cholecystectomy. Network meta-analysis synthesized evidence from all available techniques. Techniques compared were metal (MC), absorbable (AC), or polymer clips (PC), suture ligation (SL), and ultrasonic shears (US). Results: Twenty-three randomized studies with 2851 patients were included in our study. A well-connected network was formed for bile leak and a star-shaped network for operative time, with MC as the common comparator. No difference was found when SL, AC, US, or PC were compared for bile leak. Operative time was statistically significantly reduced when US were compared to MC (mean difference [MD] = -14.32 [-19.37, -9.28]), SL MD = -20.16 (-10.84, -29.47), and AC MD = -18.32 (-1.25, -35.39). The remaining techniques had similar operative times. PC had the highest probability of being the best technique P = 41.8, and SL had the highest probability P = 46.1 of being the second best for bile leak. US had a 98.1% chance of being the best technique for operative time. Conclusions: Given that all techniques demonstrate similar efficacy, the decision should be based on cost, familiarity with the technique, and environmental factors.

PICOT questions and search strategies formulation: A novel approach using artificial intelligence automation.

The aim of this study was to evaluate and compare artificial intelligence (AI)-based large language models (LLMs) (ChatGPT-3.5, Bing, and Bard) with human-based formulations in generating relevant clinical queries, using comprehensive methodological evaluations. To interact with the major LLMs ChatGPT-3.5, Bing Chat, and Google Bard, scripts and prompts were designed to formulate PICOT (population, intervention, comparison, outcome, time) clinical questions and search strategies. Quality of the LLMs responses was assessed using a descriptive approach and independent assessment by two researchers. To determine the number of hits, PubMed, Web of Science, Cochrane Library, and CINAHL Ultimate search results were imported separately, without search restrictions, with the search strings generated by the three LLMs and an additional one by the expert. Hits from one of the scenarios were also exported for relevance evaluation. The use of a single scenario was chosen to provide a focused analysis. Cronbach's alpha and intraclass correlation coefficient (ICC) were also calculated. In five different scenarios, ChatGPT-3.5 generated 11,859 hits, Bing 1,376,854, Bard 16,583, and an expert 5919 hits. We then used the first scenario to assess the relevance of the obtained results. The human expert search approach resulted in 65.22% (56/105) relevant articles. Bing was the most accurate AI-based LLM with 70.79% (63/89), followed by ChatGPT-3.5 with 21.05% (12/45), and Bard with 13.29% (42/316) relevant hits. Based on the assessment of two evaluators, ChatGPT-3.5 received the highest score (M = 48.50; SD = 0.71). Results showed a high level of agreement between the two evaluators. Although ChatGPT-3.5 showed a lower percentage of relevant hits compared to Bing, this reflects the nuanced evaluation criteria, where the subjective evaluation prioritized contextual accuracy and quality over mere relevance. This study provides valuable insights into the ability of LLMs to formulate PICOT clinical questions and search strategies. AI-based LLMs, such as ChatGPT-3.5, demonstrate significant potential for augmenting clinical workflows, improving clinical query development, and supporting search strategies. However, the findings also highlight limitations that necessitate further refinement and continued human oversight. AI could assist nurses in formulating PICOT clinical questions and search strategies. AI-based LLMs offer valuable support to healthcare professionals by improving the structure of clinical questions and enhancing search strategies, thereby significantly increasing the efficiency of information retrieval.

Effects of femtosecond laser on hard dental tissues: A scoping review.

Traditional tooth preparation can cause patient discomfort, thermal damage to tissues, and occupational health risks for clinicians. Laser-based techniques, particularly femtosecond lasers, offer an alternative due to precise, non-invasive treatment without the thermal and mechanical drawbacks. The objective of this study was to assess available evidence on the effects of femtosecond laser treatment on enamel and dentin. The study design included in vitro or in vivo studies on human teeth reporting on qualitative and quantitative parameters of laser-dental tissue interaction. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) statement. The review was registered in the Open Science Framework registry. A comprehensive literature search of PubMed, Scopus, EMBASE/Ovid, Cochrane Library, DARE, LILACS and Pro Quest databases was conducted by three reviewers until 10th January 2024 and then updated on18th August 2024. Eligibility criteria included peer-reviewed articles published in English, focusing on human teeth, with available full text excluding reviews, conference proceedings and gray literature. The outcomes of interest were the quality of tooth preparation, surface characteristics, bond strength, thermal effects and damage to adjacent tissues with variables being laser parameters and tooth types. Methodological quality of studies was not conducted. The search yielded 48 articles after the removal of duplicates, irrelevant and non-retrievable articles. All were original in vitro studies investigating reporting on the outcomes of interest. Measurement methods included a range of microscopy, spectroscopy, optical coherence tomography, universal force testing and thermal imaging. Sapphire lasers were most commonly used with a wide range of parameters. Laser produced sharp-edged cavities with ablated surfaces free of melting (seen in approximately 10% of the craters), cracking, debris, with open dentinal tubules, increased wetting (Contact angle mean range 39.63 ̊(± 1.84 ̊) to 70.47 ̊(± 10.27 ̊) and roughness mean range 0.82 (± 0.05) to 4.20 (± 1.10)µm). Effects of femtosecond laser on bonding efficiency were inconsistent when compared to no treatment, conventional acid etching or Er:YAG laser. Femtosecond laser was shown to achieve precise tooth preparation with no or minimal thermal, mechanical and structural effects on adjacent tissue, however with variable bonding efficiency. Further research is needed to optimize laser parameters, investigate antibacterial effects, and establish long-term clinical outcomes and safety profiles.Date of registration: July 1st, 2024.Registration ID: OSF.IO/UQMNB.

The Identity Algorithm: How the Most Popular Electron Ionization Mass Spectral Library Search Engine Actually Works.

The Identity algorithm implemented in the MS Search (NIST) software is widely used for library searches of gas chromatography/mass spectrometry data against electron ionization mass spectral databases. It has been available to researchers since 1993, with the release of MS Search 1.5a. Despite its extensive use, the operational details of the algorithm have remained ambiguous. Attempts to replicate the algorithm have been unsuccessful because, as found in this research, the description in the manual is neither fully complete nor accurate. The main novelty of this work is the development of a unique approach for deconstructing the Identity algorithm. It is purely based on analyzing library search results obtained from several groups of synthetic mass spectra, each tailored to isolate and examine specific components of the algorithm. This approach facilitated a comprehensive understanding of the Identity algorithm and led to the development of a custom implementation that fully replicates the results obtained from the original MS Search software. The custom implementation of the Identity algorithm is now available in the mssearchr R package, enhancing accessibility for researchers.

Content comparison of multidimensional functional outcome measures in rehabilitation and the ICF clinical functioning information tool: A scoping literature review

Background: The ICF-based Clinical Functioning Information Tool (ClinFIT) was developed as a standardized tool to facilitate the assessment of functioning in clinical and, research settings. Objective: This review describes the contents of commonly used multidimensional outcome measures that describe functioning in rehabilitation settings and maps these measures to ICF categories covered by the ClinFIT to identify commonalities and discrepancies in the content. Methods: A scoping review included a systematic search of PubMed, Embase, Cochrane Library, and other resources. Twelve outcome measures were selected, and their meaningful concepts were linked to the ClinFIT by 2 authors using established ICF linking rules. Content density, bandwidth, and content diversity indices were calculated for each measure. Results: A total of 369 meaningful concepts from the 292 items from 12 measures were selected. Of these, 293 (79.4%) concepts were linked to the ClinFIT categories, with a majority (80.5%) linked to “activities and participation”; however, 76 (20.6%) meaningful concepts could not be linked to any ClinFIT categories. The extent of content coverage varied significantly between measures, reflecting the differences in the scope of each measure. The “activity and participation” categories had the highest bandwidth for all measures (range: 28.6%–71.4%), while the “body function” category was less represented (range: 0%–33.3%). Conclusions: ClinFIT can be the useful outcome measure for functional assessment in rehabilitation settings, as it covers wider concepts, considered important in rehabilitation settings, compared with other common functional outcome measures. It can establish comparability of a minimal data set on functional outcomes across various medical conditions and settings.

Comparison of da Vinci Robotic Cholecystectomy and Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis of Postoperative Outcomes and Cost-Effectiveness.

Robotic cholecystectomy (RC) using the da Vinci surgical system has been introduced as a potential alternative to the gold standard laparoscopic cholecystectomy (LC) for gallbladder removal. This systematic review aims to evaluate and compare the postoperative outcomes (operative time, bile leak, and postoperative complications) and cost-effectiveness between da Vinci RC and LC. A comprehensive search of electronic databases, including EMBASE, MEDLINE, Cochrane Library, and PubMed, used Medical Subject Headings terms and Boolean operators to identify relevant studies. Comparative trials assessing postoperative outcomes and costs between RC and LC were included. Data were extracted independently by researchers and analyzed using the RevMan 5.4 software (The Cochrane Collaboration, London, UK). The analysis included six studies with a total of 1,013 patients, comprising three randomized controlled trials (RCTs) and three cohorts conducted across Switzerland, Taiwan, the USA, and Italy. Results showed that LC had a significantly shorter operation duration than RC (standardized mean difference: 0.27; 95% CI, 0.05-0.49; p = 0.01). No significant differences were observed between RC and LC in terms of bile leak rates (odds ratio, 0.37; 95% CI, 0.06-2.21; p = 0.27) or postoperative complications (odds ratio, 0.50; 95% CI, 0.18-1.37; p = 0.18). Cost analysis revealed that RC was more cost-effective than LC (standardized mean difference, 3.16; 95% CI, 0.39-5.93; p = 0.03), with substantial heterogeneity noted among the studies. The findings suggest that RC does not provide significant clinical advantages over LC in postoperative outcomes and incurs higher costs. Due to the heterogeneity and the limited number of RCTs included, a major multicenter RCTis recommended to validate these results further. In conclusion, LC remains the preferred approach due to its shorter operative time and cost-effectiveness, with no significant differences in clinical outcomes compared to da Vinci RC. Further research with larger, multicenter trials is warranted to confirm these findings and guide clinical decision-making.

HPB SO69 - Comparison of radical antegrade modular pancreatosplenectomy with standard pancreatosplenectomy for left sided pancreatic cancer

Abstract Background Long term survival of patients undergoing distal pancreatosplenectomy for left sided pancreatic cancer has not been satisfactory owing to inability to achieve negative resection margins. Radical antegrade modular pancreatosplenectomy (RAMPS) has been designed to achieve better margin resection and better lymph node clearance compared to the standard distal pancreatosplenectomy (SDP) for left sided pancreatic cancer. This results in better oncological outcomes and patient survival rates. The aim of this study was to compare clinical outcomes from RAMPS and SDP. Method Literature search was performed to identify studies published in Pubmed, Embase, Cochrane library and google search. 13 Studies comparing RAMPS versus standard method of distal pancreatecetomy were included in the final meta-analysis. Revman 5.4 was used to perform the analysis and random effects model was used with results shown on forest plot. A total of 1450 patients were enrolled in the meta analysis with 685 in RAMPS and 765 patients in SDP group. R0 resection rate, recurrence rate, better overall survival and number of harvested lymph nodes were taken as primary outcomes. Results RAMPS was associated with better overall survival than SDP (HR-0.62, 95% CI - 0.38-0.91, p=0.03). The recurrence rate (OR-0.68, 95% CI 0.47-0.97, p=0.04) was significantly less. R0 resection rate was higher in RAMPS but did not reach statistical significance (OR-1.47 CI0.93-2.3, p=0.10). Complications notably pancreatic fistula Showed favourable results in RAMPS along with other variables such as hospital stay, operative stay and blood loss but didn’t reach statistical Significance. Conclusion This study clearly signifies the importance of RAMPS being able to achieve higher R0 resection rate as well as less complications which results in better surgical and long term clinical outcomes for the patients. With more expertise and surgical training, this novel procedure promises to be a more safer and feasible technique than the conventional pancreatosplenectomy.

Abstract 4137188: Racial and Ethnic Disparities in Catheter Ablation for Atrial Fibrillation: A Systematic Review and Meta-Analysis

Background: Atrial fibrillation (AF) is the most prevalent arrhythmia globally, with an escalating incidence in the United States. It is known that racial and ethnic disparities exist in the management of AF. Although current guidelines recommend catheter ablation (CA) as one of the most effective rhythm control strategies, recent data suggest that minority populations, including Black, Hispanic, and Asian individuals with AF, are less likely to undergo CA, and aggregate data are lacking in this area. Aims/Hypothesis: To determine differences in CA rates and the likelihood of undergoing CA for AF in racial/ethnic minority populations compared to Caucasians. We hypothesized that minorities are less likely to undergo CA for AF than their non-minority counterparts. Methods: A systematic search of PubMed, EMBASE, and Cochrane Library, based on an a priori registered protocol (PROSPERO Registration CRD42024496174), from January 1st, 2010, to January 2nd, 2024, was conducted to identify studies with ≥ 500 participants assessing CA use in AF in at least two racial/ethnic groups. Data were combined using a random-effects model meta-analysis. Results: A total of 431 non-duplicate records were identified. After independent screening based on inclusion/exclusion criteria, 19 studies comprising 12,598,109 patients were included. Among them, 9,577,652 (76.0%) were White, 789,954 (6.3%) were Black, 476,216 (3.8%) were Hispanic, 113,005 (0.9%) were Asian, while 1,641,282 (13.0%) were classified as other or were missing race/ethnicity data. The proportion of White subjects who underwent CA for AF was 4% (95% CI 3-5%). In contrast, the proportion of Black, Hispanic, and Asian individuals with AF who underwent CA was 2% (95% CI 1-3%), respectively, for each group. Pooled odds ratios (OR) of having CA for AF compared to Whites were 0.68 (95% CI 0.56 - 0.83), 0.72 (95% CI 0.63 - 0.82), 0.64 (95% CI 0.48 - 0.86) for Blacks, Hispanics, and Asians, respectively. Conclusions: The use of CA among the total AF population was low across all ethnic groups. Moreover, racial/ethnic minority groups were significantly less likely to undergo CA compared to White patients.

Abstract 4135984: Comparison of Immediate and Staged Complete Revascularization in STEMI Patients with Multivessel Disease: Meta-Analysis of Randomized Controlled Trial

Background: Patients diagnosed with ST-segment elevation myocardial infarction (STEMI) frequently present with multivessel coronary artery disease (CAD) at the time of primary percutaneous coronary intervention (PCI). The optimal timing of complete revascularization (CR) in these cases remains a subject of ongoing debate. Objective: To assess major cardiovascular outcomes and procedural complications in STEMI patients with multivessel CAD undergoing immediate versus staged CR post index procedure. Methods: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing immediate to staged CR in STEMI and multivessel CAD. Trials were identified via a systematic search of MEDLINE, Embase, and Cochrane Libraries from database inception to March 6, 2024. The data were analyzed using RevMan software. Results: Among five RCTs (n=1,415) the majority of participants were male, the weighted mean follow-up duration across studies was 15.6 months. Immediate versus staged CR showed no significant differences in MACE (13.3% vs 9.8%; RR: 1.07, 95% CI [0.62, 1.83]), all-cause mortality (3% vs 4.55%; RR: 0.70, 95% CI [0.41, 1.21]), or MI (4.5% vs 2.6%; RR: 1.43, 95% CI [0.58, 3.55]). However, the staged group had higher unplanned revascularization incidence (8.6% vs 4.4%; RR: 1.92, 95% CI [1.21, 3.04]). Conclusion: Staged revascularization in STEMI patients with multivessel CAD demonstrates comparable effectiveness to immediate revascularization but leads to a greater number of unplanned revascularization procedures, likely due to delayed intervention. The early implementation of staged PCI during the initial hospitalization phase may provide equivalent efficacy to immediate complete revascularization. Nonetheless, further research is necessary to corroborate these findings.

Efficacy and safety of multi-day antiemetic treatment for patients undergoing multi-day chemotherapy: a systematic review of Clinical Practice Guidelines for Antiemesis 2023 from Japan Society of Clinical Oncology.

A standardized multi-day antiemetic regimen for multi-day chemotherapy remains elusive. This systematic review evaluated the efficacy and safety of multi-day antiemetic regimens in patients undergoing multi-day intravenous chemotherapy. We conducted a comprehensive search of PubMed, Cochrane Library, and Ichushi-Web databases for relevant studies published from January 1990 to December 2020. We included studies comparing multi-day and single-day antiemetic regimens for preventing chemotherapy-induced nausea and vomiting. No studies directly comparing multi-day versus single-day antiemetic regimens were found. Despite expanding control group criteria beyond "single-day antiemetic therapy" limited high-quality studies and variations in cancer types, chemotherapy regimens, and antiemetic treatments precluded meta-analysis. Among the included studies, some randomized controlled trials (RCTs) focused on complete response and vomiting rates. Two studies comparing two- and three-drug combinations reported higher complete response and no-vomiting rates with the three-drug regimen. Limited RCTs explored "nausea control" and "cost," and assessing "adverse events" proved challenging due to inconsistent reporting. The research on multi-day antiemetic therapy is limited, necessitating further investigation. Nonetheless, our findings suggest that three-drug combination therapy, including aprepitant, may offer superior antiemetic efficacy compared to two-drug regimens. Multi-day antiemetic therapy is strongly recommended during multi-day intravenous administration of cytotoxic anticancer drugs.

Scientometric analysis of articles of respiratory gas mixtures and their application in emergency medicine

Relevance. In humans, specific respiratory gas mixtures (RGMs) significantly maximize the effect of anesthesia and treatment of certain diseases, as well as enhance body functional reserves and exercise performance. The objective is to identify major research prospects on the RGM capacity to optimize the functional status of humans, as represented in publications by Russian investigators.Methods. In response to the RGMs query, the Scientific Electronic Library search engine generated a dataset of 513 publications by Russian investigators, published from 2006 to 2023. For further analysis of the publications, the VOSviewer 1.6.20 software was implemented for clustering of keywords with a frequency of ≥ 4 presented in ≥ 8 publications either by individual authors or co-authorship networks.Results and discussion. The average annual number of articles was (23 ± 3). The dynamics of increasing publications were revealed. The scientometric analysis of the selected publications revealed that the content was highly demanded among readers. For instance, the average citation number per paper was 3.29, with a substantial self-citation rate of 30.2 %. Journals with the largest number of publications by top scientific networks were identified. The VOSviewer analysis produced 7 keyword clusters: Cluster 1 for xenon anesthesia – 258 papers (35 %) with the total link strength of 29 %; Cluster 2 for hypoxic training – 171 papers (23.2%) with the total link strength of 22.5 %; Cluster 3 for gas composition in confined spaces – 76 papers (10.3 %) and 22 % total link strength; Cluster 4 for oxygen-helium gas mixture – 132 papers (17.9 %) with 16.4 % total link strength; Cluster 5 for the neuroprotective effects of gas mixtures – 32 papers (4.3 %) with 3.6 % total link strength; Cluster 6 for the anti-stress effect of xenon-rich inhalation therapy – 40 papers (5.4 %) with 3.6 % total link strength; Cluster 7 for low-flow anesthesia – 28 papers (3.8 %) with 3.6 % total link strength.Conclusion. Scientometric studies can enhance the data support for scientific research of advanced strategies to optimize human functional status and increasing performance at work for professionals operating in extreme occupational environments.

Targeted and Untargeted Amine Metabolite Quantitation in Single Cells with Isobaric Multiplexing.

We developed a single cell amine analysis approach utilizing isobarically multiplexed samples of 6 individual cells along with analyte abundant carrier. This methodology was applied for absolute quantitation of amino acids and untargeted relative quantitation of amines in a total of 108 individual cells using nanoflow LC with high-resolution mass spectrometry. Together with individually determined cell sizes, this provides accessible quantification of intracellular amino acid concentrations within individual cells. The targeted method was partially validated for 10 amino acids with limits of detection in low attomoles, linear calibration range covering analyte amounts typically from 30 amol to 120 fmol, and correlation coefficients (R) above 0.99. This was applied with cell sizes recorded during dispensing to determine millimolar intracellular amino acid concentrations. The untargeted approach yielded 249 features that were detected in at least 25 % of the single cells, providing modest cell type separation on principal component analysis. Using Greedy forward selection with regularized least squares, a sub-selection of 100 features explaining most of the difference was determined. These features were annotated using MS2 from analyte standards and accurate mass with library search. The approach provides accessible, sensitive, and high-throughput method with the potential to be expanded also to other forms of ultrasensitive analysis.

A REVIEW ON EFFECTIVENESS OF AROMATHERAPY ON MENTAL HEALTH AND WELL-BEING

Aromatherapy has been used as an alternative medicine and complementary therapy, for the effective treatment of mental health and well-being. Essential oil is the main agents, which is abstracted from the flower, bark, roots, leaves or certain parts of plants which contains aromatic molecules in the cells of the plants (Steflitsch & Steflitsch, 2008). Objectives: this study aims to know the effectiveness of aromatherapy on mental health and well-being. Aromatherapy may be utilized to provide advantages through inhalation, topical application, and baths. Aromatherapy can treat depression, indigestion, headaches, sleeplessness, muscular discomfort, respiratory problems, skin illnesses, swollen joints, and urinary issues (Ali, et al, 2015). Aromatherapy can be benefited by adopting a balanced and healthy diet, as well as taking precautions recommended by health specialists and aromatherapist. This review paper is based on secondary data collected through literature searches in electronic journals and book reviews, which were analyse and assess articles from certain journals utilizing Google Scholar, PubMed, Academia, Science Direct, Web of Science, and the Library Search.

Educational Mobile Apps Enhancing Communication Skills in Children With Autism in Arab Countries

This exploratory literature review investigates the landscape of educational mobile applications designed for children with autism spectrum disorder (ASD) in Arab countries, with a specific focus on their efficacy in improving communication skills. After a comprehensive search of academic databases and digital libraries, nine studies were reviewed. These studies discussed seven Arabic-language applications designed for ASD children. Consistent with previous research findings, these applications were found to be effective in enhancing communication skills among ASD individuals. By shedding light on the few existing Arabic-language educational mobile applications for ASD children in Arab countries, this comprehensive review contributes significantly to the discourse surrounding ASD interventions. Additionally, it highlights the immediate need for linguistically and culturally sensitive educational applications, designed for a specific population of Arab children with ASD.

Migraine and the correlation between stroke: A systematic review and meta-analysis.

This study aims to analyze and evaluate the correlation between migraines and the onset of stroke, and further explore whether migraines increase the risk of stroke. Two researchers independently conducted a comprehensive search of Chinese biomedical literature databases (CBM disc), PubMed, Embase, Cochrane Library, and Web of Science databases, using a combination of subject terms and free words. Literature that met the inclusion and exclusion criteria was selected, and quality assessment was performed using The Newcastle-Ottawa Scale (NOS). Data necessary for the study were extracted as effect size as needed, and meta-analysis was conducted using Review Manager 5.4 software and Stata 16 software to calculate the combined odds ratio and its 95% confidence interval. The relevant data were analyzed, and publication bias was evaluated. After conducting a meta-analysis of the 9 final included articles, the heterogeneity test showed chi2 = 10.7, df = 8 (P = .22), I2 = 25%. Therefore, a fixed-effect model was used for analysis. The combined odds ratio (OR) for the risk of stroke in migraine patients compared to non-migraine patients was 2.04, with a 95% confidence interval [1.73, 2.4], which was statistically significant. In the analysis of migraine with aura, the respective ORs were 2.32 with a 95% CI of [1.70-3.18] and 1.77 with a 95% CI of [1.34-2.33]. Subgroup analysis of female migraine patients and young migraine patients showed statistically significant results, with ORs of 2.26 (95% CI [1.67-3.05]) and 2.39 (95% CI [1.9-3.01]), respectively. The relevant literature and results were evaluated for publication bias and assessed using the NOS, indicating the reliability of the results. The results of the meta-analysis indicate that there is a certain relationship between migraine and the onset of stroke, and the results are relatively reliable. The analysis of migraine with aura shows that both the presence and absence of aura are associated with an increased risk of stroke. Subgroup analysis based on gender and age shows that the increased risk of stroke is associated with females and young individuals. However, due to the limited data in subgroup analysis, the above conclusions still require further research for validation.

Advances in ArborX to support exascale applications

ArborX is a performance portable geometric search library developed as part of the Exascale Computing Project (ECP). In this paper, we explore a collaboration between ArborX and a cosmological simulation code HACC. Large cosmological simulations on exascale platforms encounter a bottleneck due to the in-situ analysis requirements of halo finding, a problem of identifying dense clusters of dark matter (halos). This problem is solved by using a density-based DBSCAN clustering algorithm. With each MPI rank handling hundreds of millions of particles, it is imperative for the DBSCAN implementation to be efficient. In addition, the requirement to support exascale supercomputers from different vendors necessitates performance portability of the algorithm. We describe how this challenge problem guided ArborX development, and enhanced the performance and the scope of the library. We explore the improvements in the basic algorithms for the underlying search index to improve the performance, and describe several implementations of DBSCAN in ArborX. Further, we report the history of the changes in ArborX and their effect on the time to solve a representative benchmark problem, as well as demonstrate the real world impact on production end-to-end cosmology simulations.

Effectiveness of Telemedicine and Remote Monitoring in Reducing Postpartum Hemorrhage Rates: A Meta-Analysis

Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality worldwide, particularly in low- and middle-income countries (LMICs) with limited access to healthcare. Telemedicine and remote monitoring technologies offer potential solutions for early detection and management of PPH. This meta-analysis aimed to evaluate the effectiveness of these technologies in reducing PPH rates. A systematic search of PubMed, Embase, Cochrane Library, and Web of Science was conducted for studies published between 2013 and 2024 investigating the impact of telemedicine and remote monitoring interventions on PPH rates. Randomized controlled trials (RCTs) and observational studies with a control group were included. The primary outcome was the incidence of PPH (blood loss ≥500 ml after vaginal delivery or ≥1000 ml after cesarean delivery). Pooled risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model. Publication bias was assessed using funnel plot asymmetry and Egger's test. Six studies involving 4200 women met the inclusion criteria. The pooled analysis demonstrated a statistically significant reduction in PPH rates in the intervention groups compared to the control groups (RR 0.56; 95% CI 0.47-0.67; p<0.00001). The funnel plot was symmetrical, and Egger's test was not statistically significant (p=0.45), suggesting no evidence of publication bias. Telemedicine and remote monitoring interventions are associated with a significant reduction in PPH rates. These findings support the integration of these technologies into postpartum care to improve maternal outcomes, particularly in resource-constrained settings.

Predicting Intensive Care Admission in Children with Acute Asthma: A Meta-Analysis of Predictive Models

Background: Acute asthma is a common cause of pediatric emergency department visits and hospitalizations. Early identification of children at high risk of requiring intensive care unit (ICU) admission is crucial for optimal management and resource allocation. This meta-analysis aimed to evaluate the performance of predictive models for ICU admission in children presenting with acute asthma. Methods: A systematic search of PubMed, Embase, and Cochrane Library was conducted for studies published between 2013 and 2024 that developed or validated predictive models for ICU admission in children with acute asthma. Studies reporting sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) were included. Methodological quality was assessed using the QUADAS-2 tool. Pooled estimates of diagnostic accuracy were calculated using a random-effects model. Results: Six studies (n = 2,850 children) met the inclusion criteria. The predictive models included clinical features (respiratory rate, oxygen saturation, accessory muscle use), lung function measures (peak expiratory flow rate), and blood gas analysis. Pooled sensitivity ranged from 0.71 (95% CI 0.59-0.82) to 0.78 (95% CI 0.72-0.83), specificity from 0.79 (95% CI 0.75-0.83) to 0.86 (95% CI 0.78-0.91), and AUROC from 0.79 (95% CI 0.72-0.86) to 0.88 (95% CI 0.84-0.92). Conclusion: Several predictive models demonstrate moderate to high accuracy in identifying children with acute asthma at risk of ICU admission. However, heterogeneity in model performance highlights the need for further research to validate existing models in diverse populations and develop more robust tools to guide clinical decision-making.

Autologous chondrocyte implantation, matrix-induced autologous chondrocyte implantation, osteochondral autograft transplantation and osteochondral allograft improve knee function and pain with considerations for patient and cartilage defects characteristics: A systematic review and meta-analysis.

Previous studies have reported on the outcomes of autologous chondrocyte implantation (ACI) versus matrix-induced ACI (MACI) and microfracture. Specific clinical outcomes of ACI, MACI, osteochondral autograft transplantation (OAT) and osteochondral allograft (OCA) have not been well studied. The purpose of this systematic review and meta-analysis was to analyze the outcomes of these regenerative surgical techniques with an emphasis on comparing their effectiveness using the International Knee Documentation Committee (IKDC) subjective score, the Lysholm Knee Scoring Scale, the Tegner Activity Scale and the Visual Analogue Scale (VAS) score for the surgical treatment of tibiofemoral joint cartilage defects. An electronic search of MEDLINE, Embase and Cochrane Library was performed to identify studies that reported clinical outcomes for ACI, MACI, OAT and OCA procedures. The literature review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and only studies involving cartilage defects in the tibiofemoral joint were included. Outcomes were measured with the IKDC evaluation, Lysholm Knee Scoring Scale, Tegner Activity Scale and the VAS. Outcomes were compared to the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS). The methodological quality of the included studies was analyzed by the Methodological Index for Nonrandomized Studies and the Jadad scale. Forty-seven studies were included representing a total of 1993 patients with a mean follow-up time of 57.2 ± 40.3 months (range: 4.0-160.0 months). The location of cartilage defects was reported in 46 studies, with a total of 1922 cartilage defects. There were 1277 medial femoral condyle cartilage defects, 488 lateral femoral condyle cartilage defects, 139 unspecified femoral condyle cartilage defects and 18 tibial plateau cartilage defects. All four procedures reported significant improvements in the Lysholm, IKDC, Tegner and VAS scores with no significant differences between them. The OAT technique surpassed the PASS threshold for the IKDC score while all four techniques surpassed the PASS threshold for Tegner and Lysholm scores. Additionally, all procedures met the MCID for each clinical outcome. This systematic review and meta-analysis indicate that ACI, MACI, OAT and OCA all result in significant improvements in knee function and pain for cartilage defects of the tibiofemoral joint. When selecting a procedure, patient and cartilage defect characteristics should be assessed to determine the best technique for each individual patient. Systematic review and meta-analysis. Level III.

Fluid intake impact on heart failure: Systematic review and meta-analysis with trial sequential analysis

BackgroundHeart failure (HF) management lacks clarity regarding fluid balance strategies, with some studies suggesting potential benefits of liberal fluid intake. This review aims to evaluate both unrestricted and restricted fluid intake, including sodium restriction, in adult HF. MethodsA thorough search of electronic databases, including PubMed, MEDLINE, and Cochrane Library, identified relevant studies examining fluid intake effects on adult heart failure patients, categorized by liberal or restricted intake, with subgroup analysis on sodium restriction. Pooled odds ratios (OR) and weighted mean differences (WMD) were calculated, employing trial sequential analysis (TSA) for reliability. Nine studies involving 961 patients were included, with follow-up durations ranging from 2 days to 6 months. ResultsDaily fluid intake ranged from 0.8 to 1.5 L for the intervention group, and sodium intake varied from 2.0 to 5.0 g per day across five studies. No significant differences were observed in re-hospitalization rate, mortality rate, thirst, quality of life, doses of diuretics, or serum sodium levels between liberal and restricted intake groups. However, fluid-restricted patients exhibited increased serum creatinine levels, decreased serum B-type natriuretic peptide (BNP) levels and reduced body weight. ConclusionsIn summary, the existing studies on this topic are hindered by heterogeneity and relatively small sample sizes. However, when the available data is combined, it suggests that HF patients managed with either liberal or restrictive fluid intake exhibit similar clinical outcomes. It's worth noting that fluid restriction in HF patients might lead to increased serum creatinine levels, decreased BNP and body weight.