Simultaneous Approach Research Articles

A CIRCULATION-FIRST APPROACH FOR RESUSCITATION OF TRAUMA PATIENTS WITH HEMORRHAGIC SHOCK.

The original guidelines of cardiopulmonary resuscitation focused on the establishment of an airway and rescue breathing before restoration of circulation through cardiopulmonary resuscitation. As a result, the airway-breathing-circulation approach became the central guiding principle of resuscitation. Despite new guidelines by the American Heart Association for a circulation-first approach, Advanced Trauma Life Support guidelines continue to advocate for the airway-breathing-circulation sequence. Although definitive airway management is often necessary for severely injured patients, endotracheal intubation (ETI) before resuscitation in patients with hemorrhagic shock may worsen hypotension and precipitate cardiac arrest. In severely injured patients, a paradigm shift should be considered, which prioritizes restoration of circulation before ETI and positive pressure ventilation while maintaining a focus on basic airway assessment and noninvasive airway interventions. For this patient population, the most reasonable current strategy may be to target a simultaneous resuscitation approach, with immediate efforts to control hemorrhage and provide basic airway interventions while prioritizing volume resuscitation with blood products and deferring ETI until adequate systemic perfusion has been attained. We believe that a circulation-first sequence will improve both survival and neurologic outcomes for a traumatically injured patient and will continue to advocate this approach, as additional clinical evidence is generated to inform how to best tailor circulation-first resuscitation for varied injury patterns and patient populations.

Identification of the reaction network for the synthesis of adipic acid using machine learning coupling with target factor analysis

AbstractThis study investigated the reaction network of the oxidation of cyclohexanone with nitric acid through machine learning (ML) model coupling with target factor analysis (TFA). Experiments for the synthesis of adipic acid (AA) were carefully designed and carried out in a microreactor system. An artificial neural network (ANN) model was applied and optimized by training on experimental data. To assess the established ANN model, a comparison between the predicted concentrations of the products and those calculated with the power law kinetic model was implemented. TFA was then performed on both the experimental data and the data simulated by ANN for identifying the candidate reactions and finding out the temperature boundaries. Based on the identification results of the reaction network, the kinetic characteristics of this oxidation process under various operational conditions were further researched through the incremental approach and simultaneous approach.

The effect of firm-level uncertainty on R&D investment and corporate risk-taking of firms in BRICS countries: a simultaneous approach

ABSTRACT This study examines the effect of firm-level uncertainty on R&D investment and corporate risk-taking. The current study uses unbalanced panel data of nonfinancial listed firms in BRICS countries (i.e. Brazil, Russia, India, China, and South Africa) for the period 2009–2020, totalling 24,564 observations. We applied a robust two-step generalized method of moments (GMM) to estimate the model and control for endogeneity issues. The findings show that firm-level uncertainty significantly influences R&D investment and corporate risk-taking in BRICS countries. The panel vector autoregression (PVAR) provides more robust results and confirms the significant impact of firm-level uncertainty on R&D investment and corporate risk-taking. The result indicates that firm-level uncertainty has a significant negative effect on R&D investment but a significant positive impact on corporate risk-taking. This study offers important implications for managers, policymakers, and investors in emerging markets where the relationship has remained ambiguous and applies both theories to analytically investigate the impact of uncertainty on R&D investment and corporate risk-taking of firms in BRICS countries.

Bayesian forecasting of tumor size metrics and overall survival.

The tumor size ratio (TSR), time-to-tumor growth (TTG), and tumor growth rate (kG) are frequently suggested as model-based predictors of overall survival (OS) for different types of tumors. When the tumor metrics are applied in forecasting of the outcome for individual patients at an early stage, the tumor data might be sparse resulting in imprecise prediction. This simulation study aimed to investigate how the tumor follow-up data and estimation approaches influence the accuracy in the tumor size metrics and the predicted hazard of death for individual patients. Longitudinal tumor size and OS data were simulated using tumor growth inhibition and Weibull distribution models, respectively. Based on the model and increasing measurement durations, the accuracy (defined as 80-125% of the simulated "true" value) in individual metrics and hazard was computed. TSR week 6 (TSRw6) accuracy was adequate for 91% of the patients when tumor size was measured up to 12 weeks. For TTG and kG metrics, the highest accuracy observed was lower (43 and 77%, respectively) and occurred later (42 and 60 weeks, respectively). The simultaneous (joint) and sequential estimation approaches resulted in similar accuracies, however, in general, the sequential approach where individual tumor size parameters are fixed, demonstrated inferior estimation properties. The TSRw6 and the model-predicted tumor time course (absolute or relative change) had better forecasting properties than TTG or kG. The population pharmacokinetic (PK) parameters and data approach performed similarly or better than the simultaneous approach and had a better accuracy in estimating individuals' hazard of death than the individual PK parameters method.

Foreign ownership, bank efficiency and stability: Whether the institutional quality of countries is important?

AbstractThis article is aimed to investigate the extent to which the home and host countries' institutional quality helps explain the efficiency and stability differences between the domestic and foreign banks operating in Tunisia and Morocco over the 2005–2017. For this purpose, a simultaneous equations approach was considered to investigate the dynamics between efficiency and stability. Our framework follows the premise that stability is endogenously related to efficiency only for Moroccan banks' sample when models' estimation has been administered considering each country separately. The findings reveal also the persistence of a positive effect of foreign ownership on bank efficiency, highlighting that banking efficiency need be effectively sustained with a reasonable level of institutional development. Moreover, the institutional differences characterizing the home and host countries has a negative impact on the foreign banks' stability. Accordingly, policy makers in the Great Maghreb area could well aspire to enhance foreign ownership in their banking sector, on the ground that it helps remarkably in improving corporate governance and boosting efficiency, given mainly the acquired technical advantages often associated with their developed home countries. The generalized moments method estimator outlines the persistence of a noticeable banking inefficiency and stability, with a significant effect of the stability variable on banks' inefficiency and performance, suggesting that banking‐efficiency boosting policies might well ultimately guide and veer management choices towards less risky investments.

Can leisure and entertainment lifestyle promote health among older people living alone in China?-A simultaneous equation approach.

ObjectivesWith the surging number of older people living alone, their lifestyles and health status have aroused increasing concern. This study aims to investigate whether a leisure and entertainment lifestyle (LEL) can improve the multidimensional health among older people living alone and try to identify the latent mechanisms among them.MethodFor this purpose, we extracted data from the Chinese General Social Survey (CGSS) and established a simultaneous equations model, comprising ordinary least square regression (OLS), two-stage least squares (2SLS), and the mediating effect model.ResultsOlder people living alone in China reported relatively better mental health status (3.64 ± 1.07), followed by physical health (3.41 ± 1.26) and social health (2.75 ± 1.18). In the OLS model, LEL significantly improved the social health of older people living alone (β = 0.054, P < 0.01), followed by physical health (β = 0.042, P < 0.01) and mental health (β = 0.027, P < 0.01). After endogenous tests from 2SLS model and robustness tests, we found that more active LEL was associated with higher levels of physical health and mental health. However, LEL had no significant effect on the improvement of the social health of the older people living alone. Using the mediation analysis, exercise efficacy partially mediated the relationship of LEL with physical health and mental health, and the ratios were 19.75 and 24.85%, respectively. Similarly, positive life attitudes partially mediated the relationship between LEL and physical health, and LEL and mental health, with ratios of 10.65 and 26.83%, respectively.ConclusionOur findings suggested that LEL is significantly associated with better physical and mental health for older people living alone in China, and the association is mediated by exercise efficacy and positive attitudes toward life. Promoting more leisure and recreational activities, upgrading exercise efficacy, and encouraging positive life attitudes are necessary health promotion measures in active aging policies for the wellbeing of older people living alone.

Effect of Credit and Liquidity Risks on Bank Stability: Empirical Evidence from Afghanistan

This study investigates the effects of liquidity and credit risks on the stability of banks with empirical evidence from the Afghanistan banking sector over the period 2014–2020. The stability of a bank is measured through the dependent variable of its capital adequacy ratio. Credit risk (calculated by the ratio of impaired loans) is included as an independent variable along with liquidity risk. The bank specific factors, namely bank net interest margin, size of the bank, return on assets, loan growth rate, liquidity gap, return on equity, loan to asset and macro-economic factors, inflation and GDP growth rate are included as control variables. This study includes all 10 operationalized banks in Afghanistan, excluding the two branches of foreign banks. The panel dataset was collected from banks’ websites and the macroeconomic data was derived from World Bank reports. This study employed the simultaneous equation approach of a two-stage least square and a fixed effect panel regression model to investigate the affiliation between liquidity and credit risks and their effects on the stability of banks. The results of this study indicate that liquidity and credit risks don’t have a mutual relationship, while the interaction of both types of risks jointly impacts bank stability. It shows that NIM, loan assets, ROA, liquidity gap, loan growth rate, and ROE have positive impacts on bank stability, whereas the size of the bank has negative effects on bank stability. Among the macroeconomic variables, only the growth rate of GDP signifies a negative effect on the stability of banks. The finding under this paper recommends that the governance body of the banking sector drafts policies aimed at strengthening bank capital and taking liquidity measurement according to the best standards introduced by the Basel committee. Also, to create frameworks for measuring liquidity and capital standards.

Building bridges: simultaneous multimodal neuroimaging approaches for exploring the organization of brain networks.

.Brain organization is evident across spatiotemporal scales as well as from structural and functional data. Yet, translating from micro- to macroscale (vice versa) as well as between different measures is difficult. Reconciling disparate observations from different modes is challenging because each specializes within a restricted spatiotemporal milieu, usually has bounded organ coverage, and has access to different contrasts. True intersubject biological heterogeneity, variation in experiment implementation (e.g., use of anesthesia), and true moment-to-moment variations in brain activity (maybe attributable to different brain states) also contribute to variability between studies. Ultimately, for a deeper and more actionable understanding of brain organization, an ability to translate across scales, measures, and species is needed. Simultaneous multimodal methods can contribute to bettering this understanding. We consider four modes, three optically based: multiphoton imaging, single-photon (wide-field) imaging, and fiber photometry, as well as magnetic resonance imaging. We discuss each mode as well as their pairwise combinations with regard to the definition and study of brain networks.

Experiences in successive forensic analysis of GSR and DNA traces collected on a single tape lift stub.

Gunshot residue (GSR) and deoxyribonucleic acid (DNA) analyses are used in the reconstruction of shooting incidents involving firearms. In both fields, adhesive tapes are commonly applied to recover traces. Using a simultaneous sampling approach for retrieving both types of traces from objects related to a shooting can be powerful. We present the results for DNA testing and GSR analysis using "DNA stubs" to recover both types of traces in one sampling. The analyses are successive: stubs are first examined with scanning electron microscopy for the presence of GSR and next subjected to DNA extraction and short tandem repeat (STR) typing. The results show no negative effect on the DNA and GSR results. The risk of DNA contamination during GSR analysis is addressed, showing that it is negligible. Our experiences in casework show that the approach can be successfully implemented.

A comparison of the simultaneous, liver-first, and colorectal-first strategies for surgical treatment of synchronous colorectal liver metastases at two major liver-surgery institutions in Sweden

BackgroundThe optimal treatment strategy for patients with synchronous colorectal liver metastases (CRLM) is unclear. The aim of this study was to compare the outcome of the simultaneous, liver-first, and colorectal-first surgical approaches. MethodsAll consecutive patients who had been resected with curative intent for CRLM were included. A Cox regression model was constructed, and an intention-to-treat analysis was performed between the liver-first and the simultaneous approaches, after propensity score matching. Results658 patients were included in the analysis. 92 patients had a simultaneous resection, 163 patients had liver-first, and 403 patients had a colorectal-first approach. Overall survival was 54.9 months (95% CI 39.2–70.4) in the liver-first group, 54.5 months (95% CI 46.8–62.3) in colorectal-first group, and 59.6 months (95% CI 42.2–77.0) in the simultaneous group (log-rank p =0.850). In the matched cohort there were no differences in Clavien-Dindo 3a (p = 0.992) or 3b and greater (p = 0.999). Median overall survival was for liver-first group 42.2 months (95% CI 26.3–58.2), and for the simultaneous group 56.2 months (95% CI 47.1–65.4) (stratified log-rank p = 0.455). ConclusionA simultaneous approach was not associated with worse overall survival or morbidity compared to a liver-first approach.

Intermarket Analysis: Oil, Gold, US Dollar and Stock Market

The interdependence among the prices of oil, gold, the US dollar and stock market prices is of fundamental importance for any investment decision. This paper studies the bilateral relationships between these asset classes in order to identify direct and indirect relationships, positive and negative interactions by using regression analysis, and then tries to demonstrate if a simultaneous relationship exists between the four asset classes via the empirical methodology: the simultaneous equation approach. The international data used to do a regression analysis to identify the bilateral relationships between assets is from November, 2011 to October, 2021 on a monthly basis. The study relies on many theoretical findings to identify the negative or positive linkage. The main goal of quantifying these relationships, is to check if they are helpful in predicting and timing the next phase of the economic cycle. The findings reveal strong cross-market interactions. An inverse relationship between oil prices and stock prices was discovered, whereas gold and the USD had a large and positive impact on oil prices. Oil, USD, and stock market developments have an impact on the gold rate. The stock market, as well as the price of gold and oil, have a considerable negative impact on the US dollar. Therefore, after studying the relationships between those assets, the results will be helpful in predicting the economic cycle.

Empirical analysis of impact of multi-class commercial vehicles on multi-lane highway traffic characteristics under mixed traffic conditions

The presence and movement of multi-class commercial vehicles (CVs) under different traffic conditions in a shared roadway influences the highway traffic characteristics. The purpose of this study is to quantify the impact of the varying proportion of multi-class commercial vehicles (CVs) on the speed, dynamic passenger car unit (DPCU), capacity, and level of service (LoS) of the highways through empirical analysis. The speed-flow data were collected at highway sections in India, utilizing an Infra-Red (IR) sensor device. Individual vehicle speeds are predicted using the simultaneous equations approach, which are used to determine the respective DPCU factors of the vehicles and highway capacity at different proportions of multi-class CVs. The LoS threshold values are established based on the volume to capacity (v/C) ratio for the various percentages of multi-class CVs. The study results reveal that the multi-class CVs have had a unique effect on DPCU factors of the different vehicle categories under the influence of varying proportions of multi-class CVs. The highway speed reduced by 27.76% at 30% multi-class CVs compared to 5% multi-class CVs. Eventually, the highway capacity reduced by 24.25% at 30% multi-class CVs compared to 5% multi-class CVs. The LoS varied for each highway section accordingly from free-flow condition to the congested condition due to the incremental variation in the percentage of the multi-class CVs. The study indicates that the presence of a higher proportion of multi-class CVs significantly affects the speed, DPCU, capacity, and LoS of the highways.

A sensitive simultaneous detection approach for the determination of 30 atmospheric carbonyls by 2,4-dinitrophenylhydrazine derivatization with HPLC-MS technique and its preliminary application.

Atmospheric carbonyls are important precursors of PM2.5 and ground-level ozone, and some carbonyls are toxic and harmful; thus, it is crucial to obtain accurate information on the ambient levels of carbonyls. However, the detection of carbonyls is difficult due to their relatively higher reactivities and chemical instabilities; therefore, accurate determination of atmospheric carbonyls is important. In this study, an analytical method for atmospheric carbonyls with high concentration or reactivity was developed, the precursor ion of each carbonyl compound was selected, and the declustering potential (DP) and entrance potential (EP) for each precursor ion were optimized. A 2,4-dinitrophenylhydrazine cartridge derivatization-high performance liquid chromatography/atmospheric pressure chemical ionization-mass spectrometry (DNPH-HPLC/APCI-MS) method for the determination of 30 carbonyls was established. The results showed that the linear range of 24 carbonyls was 1.2-600 ng/mL, while other 6 carbonyls was 1.2-300 ng/mL, and the detection limits of 30 carbonyls ranged from 0.092 to 0.947ng/mL (0.005-0.049μg/m3 with an ambient air sampling volume of 96L). The intra-day and inter-day repeatability ranges were 0.55-4.20% and 1.40-12.48%, respectively. A preliminary application of the method was carried out in the urban area of Beijing in spring and summer of 2021, and it was found that the mean total mass concentration of 30 carbonyls was 35.894μg/m3. This study provided additional concentration information for 14 atmospheric carbonyls, including mono-, di-, oxygen-containing and heterocyclic carbonyls, which accounted for 38% and 35% of the total mass concentration and OH radical reactivities of 30 carbonyls, respectively. This is the first investigation of simultaneous quantitative analysis of multiple atmospheric carbonyls based on commercial standard derivatives. The optimized method could provide more comprehensive information for atmospheric carbonyls and further support research concerning the role of chemical reaction processes and health effects than traditional measuring techniques.

Tideline by Krystyna Dąbrowska

Reviewed by: Tideline by Krystyna Dąbrowska Alice-Catherine Carls Krystyna Dąbrowska Tideline Trans. Karen Kovacik, Antonia Lloyd-Jones & Mira Rosenthal. Brookline, Massachusetts, Zephyr Press. 2022. 162 pages. KRYSTYNA DĄBROWSKA (b. 1979) has published five volumes of poetry and won prestigious prizes, including the Kościelski Prize, the first Szymborska Award in 2013, and the Literary Award of the Capital City of Warsaw in 2019. A photographer and a graduate of Warsaw’s Academy of Fine Arts, she recently brought Louise Glück and Nuala Ní Dhomhnaill into Polish. Since her poetic debut in 2006, she has been translated in twenty languages. Her first full volume in English, Tideline includes translations from her first four poetry collections: Biuro podróży (Travel agency); Białe krzesła (White chairs); Czas i przesłona (Time and aperture); and Ścieżki dźwiękowe (Soundtracks). Many of these poems have seen prior publication: in Harper’s, Harvard Review, Brooklyn Rail, Southern Review, and Los Angeles Review, as well as in Scattering the Dark, an anthology of Polish women poets edited by Karen Kovacik. Kovacik is currently translating Dąbrowska’s fifth book, Miasto z indu (City of indium). Offering glimpses into the proverbial “it takes a village,” Tideline begs the question of how to best present an author’s work in translation. One solution retains the translators’ individual styles and allows the reader a rare opportunity to experience a simultaneous multivoiced approach to the poems. Another solution eliminates all but one filter between the original and the translation and unifies the translators’ polyphonic voices, including the differences between British English and American English. Encouraged by Zephyr’s editor, Christopher Mattison, who tightened the translations and smoothed out differences of diction and style, Tideline shows a high level of stylistic integration while retaining the essential personality of each translator—a model of collaboration. Tideline is a translation “by eight hands,” if one counts the poet’s participation. The book cover was chosen from one of Dąbrowska’s photographs that reflects both the volume’s title and the poem “Yesterday I Saw a Dog at the Tideline” in Rosenthal’s translation. Kovacik shaped Tideline’s structure, defining a loose thematic structure in four numbered but untitled sections for which she selected three dozen poems, ensuring a balance among the translators’ contributions across each section. Adding a subtle reference to the order of publication of Dąbrowska’s volumes of poetry, the eponymous title poems of her first, second, and fourth books, “Travel Agency,” “White Chairs,” and “Soundtracks,” are placed in sections 1, 2, and 4, respectively. The eponymous poem of Dąbrowska’s third volume of poetry, Time and Aperture, is echoed in the theme of the third section. Section 1 focuses on travel and water, Section 2 contains speculations about self and other, section 3 includes personal and family memories and survival, and section 4 focuses on artmaking. None of these editorial and methodical choices are explained in the volume, however, forcing the reader into active reading—frustratingly unsettling for some, fun guessing for others. How best to read? To count or feel? To deconstruct or to dive into the poems? This reviewer, for example, only noticed the translators’ initials at the bottom of each poem upon a second reading. Regardless, the poems take one straight to language, rhythm, and style. The images and alliterations, so important for a visual poet such as Dąbrowska, are felicitously translated. The translation has an unhurried, conversational feeling that smooths the terseness of some of the Polish phrasing, especially when the sentences and verses’ caesura deviate from the original. But it is the organization of the volume, and in particular the fluid, overlapping themes of the four sections, that convincingly lead the reader into Dąbrowska’s world. This organization mirrors her true poetic personality, namely her journey to the apparent simplicity that characterizes the most difficult works of art. This is indeed quite a tour de force. What emerges is a poetry suffused with the ability to notice the imperceptible, subtle, intimate origin of change and to anchor it in visual cues—a refreshing, quietly revolutionary approach. The poet describes the modes by...

Examining model performances and parameter uncertainty for streamflow and suspended sediment regime simulation: Comparison of three calibration methods

Spatially distributed watershed models are commonly utilized to address a wide range of water-related issues. However, setting up a reliable watershed model is a difficult task involving several essential decisions making. Choice of calibration method is one of the most important decisions that has been sparsely investigated in semi-distributed watershed models. In this study, therefore, we used the Soil and Water Assessment Tool (SWAT) model to investigate the impact of three calibration methods: sequential (SQN), simultaneous (SML) and sequential-simultaneous (SQN_SML) on model performance and parameter uncertainty in the Kantamal catchment of the Mahanadi basin, India. The findings across the calibration methods; evaluated fit scores of streamflow for respective calibration and validation period; showed that SQN_SML calibration has the least amount of bias (PBAIS = 1.7, −4.2), the highest NSE (0.91, 0.92), KGE (0.95, 0.94) and R2 (0.91, 0.92). Furthermore, SQN_SML outperformed the other two methods in all three streamflow regimes (low, medium and high) of flow duration curve analysis. Suspended sediment load (SSL) analyses of partitioned sediment duration curve showed the best performance of SQN_SML for mid and low SSL regimes while all three calibration methods performed similarly in the high SSL regime. SML calibration approach showed the least parameter uncertainty followed by SQN_SML and SQN. The P-factor for sediment simulation was better for the SQN_SML approach, indicating the minimal model error for sediment simulation. The SQN_SML produced the least equifinal solution, while the SQN approach produced the highest equifinal solution. Overall, the findings of this study may help the watershed modelling communities for selecting suitable calibration strategies when dealing with integrated water resources management.

Dual breaking of ionic association in water-in-LiTFSI electrolyte for low temperature battery applications

This paper deals with the low temperature performance of Li-ion aqueous battery in water-in-LiTFSI electrolyte. Two simultaneous approaches have been adopted to reduce the ionic interaction of lithium cation with TFSI anion. First, the LiTFSI eutectic mixture has been prepared with trifluoroacetamide (TFA) that shows liquid-like properties due to the strong interaction of amide-group with TFSI−. The eutectic behavior is explained by the interaction of trifluoroacetamide with bulky TFSI− anion that reduced the melting point of mixture to −55.3 °C. Despite such eutectic behavior, the low conductivity still remains an issue which is solved by increasing water content that improves the hydration degree of lithium. Molecular dynamic simulation (MD) studies show that the addition of water at low molar ratio is sufficient for lithium ion hydration and about five times improves the conductivity of electrolyte. A dual approach to break the ionic association in LiTFSI strongly influences the activation barrier for the movement of ions and is facilitated by water, which is fully utilized for the solvation of lithium and no free water is available to participate in faradaic reactions.

Insights into Nanoparticles, Electrokinetics and Hybrid Techniques on Improving Oil Recovered in Carbonate Reservoirs

Use of nanoparticles as a method for enhancing oil recoveries has become an attractive prospect. Experimental evidence has shown that this technique possesses the ability to improve recoveries via wettability alteration and interfacial tension reduction amongst other strategies. In this study, we analyze the potential of nanoparticles employed in coreflood experiments. Low concentration acid was added to aid in the dispersion of the nanoparticles in the brine by protecting them from being aggregated, while enhancing the stimulation of the tight porous media. Electrokinetics was also implemented following a sequential as well as a simultaneous approach to further stimulate the fluids injected, controlling their mobility, and therefore, increasing the depth of penetration within the porous media. Several coreflood experiments were carried out on highly heterogeneous carbonate samples of Middle Eastern origin with permeabilities of around 0.1 mD. Zeta potential measurements were conducted on the inlet side of the preserved core-plugs after the conclusion of each coreflood. The findings indicated a close connection between the rate of wettability alteration observed over the duration of nano-acid fluid injection and mode of electrokinetic application. The best performing nano-acid fluids correlated with the highest shift in the magnitude of the zeta potential across all tested strategies. Results show that oil recovered via this hybrid technique was mostly 10–15% higher than that derived when only smart brine was employed.

Staged vs. simultaneous bilateral nephrectomy and kidney transplantation in patients with autosomal dominant polycystic kidney disease: Outcomes and costs.

We sought to compare cost and safety outcomes of patients who received a kidney transplant and bilateral nephrectomy in either a simultaneous or staged approach. We reviewed all adult patients with autosomal dominant polycystic kidney disease (ADPKD) who received a kidney transplant and underwent bilateral nephrectomy between 2008 and 2019. Patients were divided into two groups: staged (nephrectomy prior to transplant) and simultaneous (nephrectomy at the time of transplant). The primary outcome was cumulative cost of nephrectomy and transplantation ($CAD). We analyzed several secondary outcomes, including 90-day Clavien-Dindo complication rates. A total of 114 patients with ADPKD received a kidney transplant over 11 years. Of these, 28 patients underwent both nephrectomy and transplantation (10 staged, 18 simultaneous). More patients in the simultaneous group had a living donor transplant (83% vs. 0%, p<0.001). Creatinine clearance at one year/last followup did not differ between groups (p=0.12). With similar overall complication rates between groups, the transfusion rate was also similar between groups (simultaneous 50% vs. staged 40%, p=0.91). Total cost was lower in the simultaneous group ($23 775.33 CAD vs. $35 048.83 CAD, p<0.001), largely owing to a longer total length of stay in the staged group as compared to the simultaneous group (8.1 vs. 14.5 days, p<0.001). These data suggest that a simultaneous approach to bilateral nephrectomy and kidney transplantation provides potential cost savings with no adverse outcomes. This provides a rationale to investigate simultaneous nephrectomy and transplantation in the deceased donor setting.

Efficiency of Writer’s Workshop and Traditional Writing Instruction on Preschool Children of Nigeria

The writers’ workshop approach was used in this study to examine the relationship between preschool children’s literacy growth and traditional writing instruction. As well, the student group looked at the students’ conception of learning before and after the two (2) groups’ executions. The research employed a simultaneous three-way approach to collect quantitative and qualitative evidence in order to cross-validate and confirm the findings. The t-test was used to evaluate individual literacy ratings. Interviews were also used to collect and analyze data. In this analysis, the literacy rates of the two (2) studied classes did not differ significantly. Students in both classes considered themselves to be “good” writers, according to interviews. Through the challenge educators face to find new and creative ways to reach students, this study has the potential to generate social change. As a result of this study, educators will be able to differentiate between children and scaffold their learning so that everyone can learn at their own rate.

COVID-19 contagion forecasting framework based on curve decomposition and evolutionary artificial neural networks: A case study in Andalusia, Spain

Many types of research have been carried out with the aim of combating the COVID-19 pandemic since the first outbreak was detected in Wuhan, China. Anticipating the evolution of an outbreak helps to devise suitable economic, social and health care strategies to mitigate the effects of the virus. For this reason, predicting the SARS-CoV-2 transmission rate has become one of the most important and challenging problems of the past months. In this paper, we apply a two-stage mid and long-term forecasting framework to the epidemic situation in eight districts of Andalusia, Spain. First, an analytical procedure is performed iteratively to fit polynomial curves to the cumulative curve of contagions. Then, the extracted information is used for estimating the parameters and structure of an evolutionary artificial neural network with hybrid architectures (i.e., with different basis functions for the hidden nodes) while considering single and simultaneous time horizon estimations. The results obtained demonstrate that including polynomial information extracted during the training stage significantly improves the mid- and long-term estimations in seven of the eight considered districts. The increase in average accuracy (for the joint mid- and long-term horizon forecasts) is 37.61% and 35.53% when considering the single and simultaneous forecast approaches, respectively.