Success Criteria Research Articles

Measurement of Patients' Acceptable Symptom Levels and Priorities for Symptom Improvement in Advanced Prostate Cancer.

Limited research has evaluated the success criteria and priorities for symptom improvement of patients with cancer to inform patient-centered care. In this study, we adapted and tested a measure of these constructs, the Patient-Centered Outcomes Questionnaire (PCOQ), for patients with advanced prostate cancer. We compared acceptable symptom severity levels following symptom treatment across 10 symptoms and identified patient subgroups based on symptom importance. Patients with advanced prostate cancer (N = 99) participated in a one-time survey, which included a modified version of the PCOQ, standard symptom measures, and additional clinical characteristics. The modified PCOQ demonstrated construct validity through its correlations with related theoretical constructs. There was a moderate correlation between symptom severity and importance. Acceptable symptom severity levels were generally low, with sexual dysfunction having a higher acceptable severity than most other symptoms. Three patient subgroups were identified: (1) those who rated all symptoms as low in importance (n = 43); (2) those who rated all symptoms as moderately important (n = 33); and (3) those who rated all symptoms as highly important (n= 18). Subgroups were associated with functional status, fatigue, sleep problems, pain, and emotional distress. The modified PCOQ demonstrated preliminary evidence of construct validity. Patients generally considered low symptom severity to be acceptable, with variations across symptoms. Results suggest that symptom severity and importance are related but distinct aspects of the symptom experience in advanced prostate cancer. Patients' diverse priorities for symptom improvement point to the need for individualized treatment plans.

Redefining Oswestry Disability Index success criteria to assess the effect of consecutive surgeries on lumbar spinal stenosis

BACKGROUNDRegister studies have shown that chances of success after surgery for lumbar spinal stenosis (LSS) decrease with increasing numbers of previous operations. However, these studies presumed that success criteria remain constant with each consecutive spinal surgery. PURPOSEWe aimed to redefine success criteria specific for each consecutive surgery. Also, we assessed if fusion could be an effective procedure for LSS patients with previous decompression(s). STUDY DESIGNWe retrospectively analyzed prospectively collected patient-reported outcome measures (PROMs) from surgically treated LSS patients enrolled in The NORspine Register. PATIENT SAMPLEPatients operated for lumbar spinal stenosis. OUTCOME MEASURESPROMs: Oswestry Disability Index (ODI) percentage (%) change and Global Perceived Effect (GPE). METHODSWe categorized the LSS cohort by number of previous spine surgeries (none to ≥3). ROC analyses gave the most accurate cut-offs for ODI% change that corresponded to success, anchored by GPE, i.e., “much improved” and “completely recovered”. Areas under the ROC curves (AUCs) indicated how well ODI discriminated between success and nonsuccess for each consecutive surgery: good (0.8–0.89) and excellent (0.9–0.99). We then calculated proportions of successfully treated patients by number of consecutive surgeries. We also analyzed whether fusion succeeded in patients with previous lumbar decompression(s). RESULTSAt 12 months, 8,919 (75%) responded; 6,961 (78%) had no previous LSS surgery, 1,338 (15%) had one, 417 (5%) had 2, and 203 (2%) had ≥3 previous surgeries. Preoperative ODI (95% CI) was 38.7 (38.2–39.1) for no previous surgery versus 49.4 (46.9–51.9) for patients with ≥3 previous surgeries. The postoperative ODIs (95% CI) were 21.9 (21.4–22.4) and 37.9 (34.9–40.8) for patients with no and ≥3 previous surgeries, respectively.For patients with no previous surgeries, ODI% change of 37.6% most accurately defined success (AUC [95% CI]=0.909 [0.903–0.916]), and 57.1% reported success. For patients with ≥3 previous surgeries, success was an ODI% change of 25.0% (AUC [95%CI]=0.930 [0.890–0.971]), and 46.3% reported success.Finally, 350 patients received fusion after previous decompression(s). ODI% change of 34.6% defined success (AUC [95% CI]=0.920 [0.890–0.949]). The proportion of successfully treated fusion patients was 47.7%, compared to 54.3% for the entire cohort. CONCLUSIONSWe redefined ODI success criteria for patients with consecutive lumbar spinal stenosis surgeries. Our register study found the detrimental effect of consecutive surgeries on success rates to be less pessimistic than previously reported; fusion may be an effective option for LSS patients with previous decompression.

Factors Influencing the Success Criteria of ICT Project Management Case Study Constructions in Mogadishu

Being a developing nation, our nation's project construction is advanced in comparison to earlier years. Therefore, the overall goal of this study is to evaluate and examine the local elements influencing the success criteria of ICT project management in the construction sectors. The purpose of this study is to evaluate the technical factors that affect the success of ICT project management in the Somali construction industry. To determine the organizational factors that affect the ICT project management success in the Somali construction industry. And to investigate the cultural factors that affect the success of ICT project management in the construction industry. The most recent study to look at environmental factors influencing the performance of ICT project management in the Somali construction industry. The report focuses on construction initiatives completed in Somalia's capital city of Mogadishu. Both interviews and questionnaires were used to gather the data. The questionnaire was completed online using Google Form, and the respondents were clients, consultants, and contractors. The researchers used practical sampling to gather 100 surveys. There are four case study companies that I have chosen as an experiment construction companies are utilized as a case study for this research project. The data from the questionnaires were analyzed using SPSS to produce the average index from the study; Dalbile construction and contracting company, Bile home repair and Construction service, Qidmad Construction Company and Gaabow Construction Company. Due to the growing technological uncertainty, the building sector is dynamic. Building projects are getting easier and more advanced today. The coordination between the project participants is what has an impact on how well construction projects execute when using the design build method of procurement. The Somali government should establish and enforce strict penalties to combat fraudulence activities, the licensing of contractors and consultants should be thoroughly scrutinized to ensure that they are qualified and have the tools necessary to perform their jobs, and the contractors should enhance their estimation methods and take into account all external factors that could affect their projects.

Real World Evidence of User Experience with Microenemas for Relief of Constipation.

Constipation is a commonly reported gastrointestinal complaint. Research on this widespread condition focuses mainly on clinical trials for chronic constipation with less emphasis on patient experience and nonchronic situations. Sufferers report that constipation interferes with daily activities and quality of life. It is likely that this is common among all sufferers of constipation, regardless of how often the condition is experienced. This work explored attitudes and perceptions of people who experience occasional constipation and self-treat with over the counter products, particularly Microlax® microenemas. In this retrospective study, real-world data were collected from 1635 respondents from France and Russia who experienced occasional constipation. Participants completed a questionnaire about their experiences with occasional (not chronic) constipation and perceptions of over the counter treatments of oral laxatives, suppositories, and Microlax microenemas. Questions focused on comfort, quality of life, ease of use, and reliability of these treatments. Participants had used the microenema for treatment of occasional constipation within 3 months of study participation. Occasional constipation was based on the Rome IV diagnostic criteria for adults and babies. Data were analyzed across the total population of all groups, then by subgroup. Success criteria were defined as of at least 70% agreement with the statements scoring ≥ 7 on the scale of 0-10. The proportion of respondents agreeing with the individual statements was calculated using the denominator for the total sample within each group. This study shows that experiencing even occasional bouts of constipation negatively affect quality of life and well-being. Participants (women aged 25-54 years, older men, and women aged 60-80 years) reported that it severely limited daily life and activities and caused negative emotions and embarrassment. Pregnant women and mothers with babies showed great concern that constipation indicated a serious and painful condition and was bad for their babies. Participants agreed that using Microlax microenema provided greater ease of use, comfort, reliability, and safety than oral laxatives and rectal suppositories. Sufferers of occasional constipation report that these bouts interfere with their daily lives and reduce quality of life, similar to what is reported for those with chronic constipation based on existing literature. The microenema, Microlax, showed benefits in the relief of occasional constipation compared with oral laxatives and rectal suppositories. Trepidation about using the microenema, experienced before using it, was greatly reduced after the first and subsequent uses. Microlax microenema enabled users to regain the feeling of control and provided positive impacts on quality of life and well-being.

Chitosan-enhanced sensitivity of mercaptoundecanoic acid (MUA)- capped gold nanorod based localized surface plasmon resonance (LSPR) biosensor for detection of alpha-synuclein oligomer biomarker in parkinson's disease.

Alpha-synuclein oligomers play a crucial role in the early diagnosis of Parkinson's disease (PD). In this study, a mercaptoundecanoic acid (MUA)-capped gold nanorod (GNR)-coated and chitosan (CH)-immobilized fiber optic probe has shown considerable sensitivity of its detection. The proposed U-shaped fiber optic biosensor based on localized surface plasmon resonance (LSPR) was applied to detect α-syn oligomer (OA) biomarker. By analyzing OA concentrations, the biosensor achieved a limit of detection of (LOD) 11pM within the concentration range of 10-100pM and the sensitivity value was found as 502.69 Δλ/RIU. Upon analysis of the CV% (coefficient of variation) and accuracy/recovery values, it is revealed that the sensor successfully fulfilled the criteria for success, displaying accuracy/recovery values within the range of 80%-120% and CV% values below 20%. This sensor presents significant advantages, including high sensitivity, specificity, and ability to detect very low concentrations of OA. In conclusion, the suggested U-shaped fiber optic biosensor has the potential to be valuable in the early detection of PD from a clinical perspective.

Expectations in patients undergoing spine surgery are high and unmet

BACKGROUND CONTEXTDefining success in spine surgery lacks a standardized approach, and all existing concepts are based on registrations after surgery. PURPOSETo examine patients’ expectations before spine surgery assessed by a modified Oswestry Disability Index (ODI) and Numeric Rating Scale (NRS). The authors asked: how do the expectations align with actual outcomes and can a patient's individual expectations be used as a success criterion in itself? STUDY DESIGN /SETTINGProspective single-center study. PATIENT SAMPLEPatients scheduled for spine surgery at Akershus University Hospital (AHUS) were included in the study. They underwent 1 of 3 procedures: decompression for spinal stenosis, disc removal for lumbar disc herniation, or spinal fusion for degenerative disc disease. OUTCOME MEASURESModified and standard version of ODI and NRS (back and leg pain). METHODSPreoperatively, the patients were given a modified ODI and NRS questionnaire in which they were asked to register the minimum acceptable functional impairment and pain they anticipated to have postsurgery. The patients’ expectations were compared with 3-and 12-month follow-up data from the Norwegian Registry for Spine Surgery (NORspine) with ODI, NRS and Global Perceived Effect (GPE) scale. We used simple descriptive statistics. RESULTSA total of 93 patients completed the pre-op questionnaire. Of these, 65 responded to the 3-month follow-up and 53 at 12-month follow-up. The mean (95%CI) ODI before surgery was 38.3 (34.2–42.3), the mean (95% CI) preoperative NRS back pain was 6.34 (5.81–6.88), and leg pain was 6.67 (6.08–7.26). The patients expected a mean (95% CI) ODI of 10.5 (7.5–13.5), mean (95%CI) NRS back pain of 2.5 (2.1–3.0), and NRS leg pain of 1.8 (1.5–2.2). The actual clinical outcome after 12 months were a mean (95% CI) ODI of 21.7 (17.0–26.5), NRS back pain of 3.4 (2.8–4.1), and leg pain of 2.8 (2.0–3.5). Only 12 (30.8%) patients achieved their expected ODI, while 26 (65.0%) classified themselves as significantly better according to GPE. CONCLUSIONSPatients seem to have high expectations before spine surgery, and the expectations may exceed the clinical outcome. Only 30.8% had their ODI expectations met, but perceived benefit was higher. High expectations may be due to inadequate preoperative information and/or the unsuitability of ODI for capturing expectations.

Study on the effects of accident-tolerant fuels on the safety of CPR1000 nuclear power plants

Abstract In this paper, CPR1000 Nuclear power plant was taken as the reference unit. According to CPR1000 Probabilistic Safety Analysis (PSA), the Large Break loss of coolant accident (LOCA), Medium Break LOCA, Small Break LOCA, Station Blackout (SBO), Total Loss of Feed water (TLOFW) and Anticipated transient without trip (ATWT) with Loss of Main Feed water (LOMF) were selected as the representative accident scenarios. The house holding deterministic programs LOCUST were used to analyze each of the above selected scenarios for five different accident tolerant fuels (ATF). The effects on accident process, reactor core damage time, system success criteria and personnel response time were analyzed under the above scenarios. The above results for the five ATF materials were compared to those for standard UO2-Zr in the same scenarios, then some useful conclusions were obtained which can be used to support ATF material selection. In the end, based on the deterministic calculations, the effects of different ATF materials on CPR1000 PSA results such as core damage frequency (CDF) were evaluated in detail with traditional PSA software Risk Spectrum. According to the results, ATFs have some advantages on core damage time, success criteria or operators’ action time window. But the CDF was changed little compared to standard UO2-Zr system. Through the studies, it is found the most important thing is that due to the much longer time windows some new plant modifications can be provided to mitigate the accidents which can contribute to the plant safety and decrease risk more.

Percutaneous endoscopic interlaminar discectomy for high-grade migrated lumbar disc herniation: clinical efficacy and safety assessment.

This study aimed to assess the clinical effectiveness and safety of percutaneous endoscopic interlaminar discectomy (PEID) in the management of high-grade migrated Lumbar disc herniation (LDH). A total of 328 patients who underwent PEID for high-grade migrated LDH between May 2020 and January 2023 in our hospital were selected. Patients were categorized into high-grade migrated group and low-grade migrated group according to preoperative MRI findings. The preoperative and postoperative evaluations of clinical outcomes, such as Visual Analogue Scale (VAS) for lower backs and legs, Oswestry Disability Index (ODI), and modified MacNab criteria for surgical success, were compared between groups. No statistically significant differences were found in hospitalization time, surgery time, intraoperative hemorrhage, number of intraoperative fluoroscopies, or incision length between the two groups. The lower back and leg VAS scores and ODI exhibited a statistically significant decrease in both groups across all postoperative time intervals. However, the difference between the two groups was not statistically significant. Postoperative nerve root stimulation symptoms were reported in two and three cases in the high-grade migrated group and low-grade migrated group, respectively. One patient in the high-grade migrated group underwent reoperation due to re-herniation at the same segment. There was no significant difference in the rate of excellent-good cases between the two groups, with an overall rate of 94.7%. In treating high-grade migrated disc herniation, PEID offers advantages such as reduced trauma, small incision, quicker recovery and satisfactory clinical safety and efficacy.

Depression in type 2 diabetes mellitus: Prevalence, characteristics, associated factors, and treatment outcomes

BackgroundPrevious studies have demonstrated that sertraline has a positive impact on improving depression; however, data on the prevalence and treatment outcomes of sertraline among patients with comorbid Type 2 diabetes mellitus and depression remain limited. ObjectivesDetermine the prevalence and associated factors of depression, and evaluate the treatment outcomes of sertraline intervention at two dosage levels (50 mg per day and 100 mg per day) in patients with comorbid depression and type 2 diabetes mellitus in Vietnam. Materials and methodsThe study included type 2 diabetes mellitus patients receiving outpatient treatment at Bac Lieu General Hospital from March 2023 to March 2024. Following the assessment of depression prevalence and associated factors, a randomized, single-blind clinical trial was conducted. Patients were randomly assigned to two groups: odd-numbered patients received treatment with 50 mg/day sertraline dosage, while even-numbered patients received treatment with 100 mg/day sertraline dosage. The criteria for success included improvement in symptoms and severity of depression after 6 months of treatment. ResultsA total of 225 type 2 diabetes mellitus patients with a mean age of 63.8 ± 10.7 years were included, among whom 72 were diagnosed with depression, accounting for a prevalence rate of 32 %. Among these patients, 51 were female (70.8 %) and 21 were male (29.2 %). Female gender, overweight, obesity, diabetes duration over 36 months, and a history of cardiovascular disease were found to be associated with depression. However, in the multivariate model, only overweight, obesity, HbA1c ≥ 6.5 %, and a history of cardiovascular disease were identified as independent factors contributing to depression in type 2 diabetes mellitus patients, with odds ratios of 4.12 (95 % CI: 1.78–9.56; p = 0.001), 0.37 (95 % CI: 0.15–0.95; p = 0.038) and 25.90 (95 % CI: 9.05–74.12; p < 0.001), respectively. Following 6 months of treatment, in the 50 mg/day dosage group, the proportion of patients with moderate to severe depression decreased from 77.8 % to 33.3 % (p < 0.001). Similarly, in the 100 mg/day dosage group, the proportion of patients with moderate to severe depression decreased from 94.4 % to 52.8 % (p < 0.001). ConclusionDepression accounts for approximately one-third of type 2 diabetes mellitus cases. Overweight, obesity, HbA1c levels, and cardiovascular disease are independent factors associated with depression. Intervention with sertraline for depression treatment at both 50 mg/day and 100 mg/day dosages demonstrates significant improvements in depression severity after 6 months of treatment.

Differences in Success Rate of Two-Stage Revision for Periprosthetic Joint Infection of the Knee Depending on the Applied Definition

BackgroundSuccess rates of two-stage exchange arthroplasty are subject to substantial variance in the literature. An explanation is the lack of a universally accepted definition of what constitutes treatment success for periprosthetic joint infection. Therefore, the main objective of this study was to assess success rates, applying four definitions to identify the one definition that best captures “true” success from both a clinical and patient-centered perspective. MethodsThis was a retrospective study investigating the outcome of a consecutive series of 78 chronic knee periprosthetic joint infections that were treated with a two-stage revision at a single center between 2017 and 2020. Kaplan-Meier survival analyses were conducted to estimate success rates. ResultsAfter a mean follow-up of 36 months (range, 25 to 60), 64 patients (82%) were reimplanted after a mean interim period of 90 days (range, 22 to 201). There was one patient (1%) lost to follow-up, and the overall mortality was 15% (n = 12). Kaplan-Meier survival analyses were used to estimate treatment success at two and three years: implant survival was 93% (95% confidence interval [CI]: 82 to 97) and 87% (95% CI: 73 to 94), infection control was 90% (95% CI: 79 to 95) and 87% (95% CI: 73 to 93), success according to Delphi criteria was 88% (95% CI: 78 to 94), and success according to Musculoskeletal Infection Society criteria was 65% (95% CI: 53 to 74) at both timepoints. ConclusionsSuccess rates were ranging between 65 and 93% depending on the applied definition, highlighting the need for universal success criteria. This variability mainly results from the differing approaches to patients who did not undergo reimplantation or passed away within a year of surgery. These patients exemplify cases of fatal treatment failures. Consequently, the Musculoskeletal Infection Society criteria should be routinely employed to accurately report the “true” success rate.

Catamaran SI Joint Fusion System(R) MAINSAILTM Study: a prospective, single-arm, multi-center, post-market study of six-month clinical outcomes and twelve-month radiographic findings

ABSTRACT Background Minimally invasive surgical techniques for sacroiliac joint (SIJ) fixation have the potential to reduce risk and improve patient outcomes, but evidence remains limited. This interim analysis presents initial findings from an ongoing prospective study evaluating the safety and efficacy of the Catamaran System. Methods The primary endpoint of success at 6 months was defined as a ≥20 mm improvement in SIJ pain (Visual Analog Scale, VAS), no neurologic worsening, absence of device-related serious adverse events (SAEs), and no surgical reintervention. Secondary endpoints included 6 month evaluation of the Oswestry Disability Index (ODI), patient satisfaction, and 12 month radiographic CT fusion, performed by an indpendent radiologist. Results Thirty-three consecutive patients (mean age: 58.9 years; %-females: 76%; Body Mass Index: 30.5) were treated across six U.S. clinical sites. At the primary endpoint of 6 months, 80% of patients met the criteria for success, with no device-related SAEs and no surgical reintervention reported. VASSIJ-Pain significantly decreased from preoperative levels (mean: 80.9 mm) to 6 months postoperatively (31.1 mm; p < 0.001). Mean ODI scores also showed a significant improvement from preoperative values (51.9%) to 6 months postoperatively (29.6%, p < 0.01). Patients reported high satisfaction rates throughout all follow-ups, with 93.3% of patients being satisfied at 6 months. Conclusion In patients diagnosed with chronic SIJ pain, minimally invasive inferior-posterior delivery of the Catamaran implant was safe and effective in relieving pain and reducing disability.

Deceptive Measures of "Success" in Early Cancer Detection.

Early detection of cancer is considered a cornerstone of preventive medicine and is widely perceived as the gateway to reducing cancer deaths. Based on this assumption, large trials are currently underway to evaluate the accuracy of early detection tests. It is imperative, therefore, to set meaningful "success criteria" in early detection that reflect true improvements in health outcomes. This article discusses the pitfalls of measuring the success of early detection tests for cancer, particularly in the context of screening programs, and provides illustrative examples that demonstrate how commonly used metrics can be deceptive. Early detection can result in downstaging (favourable stage shift) when more early-stage cancers are diagnosed, even without reducing late-stage disease, potentially leading to overdiagnosis and overtreatment. Survival statistics, primarily cancer-specific survival, can be misleading due to lead time, where early detection simply extends the known duration of the disease without prolonging actual lifespan or improving overall survival. Additionally, the misuse of relative measures, such as proportions, ratios, and percentages, often make it impossible to ascertain the true benefit of a procedure and can distort the impact of screening as they are influenced by diagnostic practices, misleadingly improving perceived mortality reductions. Understanding these biases is crucial for accurately assessing the effectiveness of cancer detection methods and ensuring appropriate patient care.

Critical success criteria for construction projects: a systematic literature evaluation

PurposeEvaluating project success within the construction industry presents challenges due to the unique characteristics of the sector, the complexity of projects, and the involvement of diverse stakeholders. Conducting a bibliometric analysis, this paper aims to unravel the major research themes and methodologies utilised by researchers in studying the critical success criteria for construction projects, as well as extracting these success criteria.Design/methodology/approachThe researchers systematically searched and screened 95 papers from Scopus and Web of Science (WoS) databases. This study conducted research focus parallelship network (RFPN) analysis and keywords co-occurrence network (KCON) analysis using BibExcel and Gephi to cluster the papers, illuminate the relationships among keywords within each cluster, and identify the primary research directions.FindingsUsing the RFPN analysis, this study classified the papers into three distinct clusters: infrastructure and public projects success, risk and knowledge management, and contractors and procurement management. Statistical techniques such as structural equation modelling (SEM) and multi-criteria decision-making methods such as analytic hierarchy process (AHP) have been used to analyse project success in the construction industry.Research limitations/implicationsConsidering the intensified demand for streamlined digital interactions and the increasing emphasis on sustainability and safety performance, construction companies are recommended to allocate greater investments toward the automation and digitisation of their products and processes. Prioritising modular construction and embracing transformative technologies alongside data science is crucial for enabling well-informed decision-making, and enhancing project success.Originality/valueThis study contributes to the existing body of knowledge by conducting a quantitative and systematic evaluation of the literature on project success criteria in the construction industry and uncovering key research areas. It addresses the pressing need to understand the complexities of construction projects amidst evolving industry dynamics and emerging disruptions. Moreover, by highlighting the implications of digital innovations and modular construction, this study urges deeper exploration into their impact on project performance and stakeholder satisfaction. This research sets a comprehensive framework for investigating the interplay between project complexity, technological advancements, and sustainable practices in the construction sector, paving the way for strategic advancements in the field.

Railways Tender Price Prediction Using Machine Learning and Deep Learning Algorithms

The idea of determining the optimum bid amount in any railway tender competition has been a complex and critical task. Reasonable pricing is the main gateway in the process of winning contracts. The approach presented here is based on data-driven pricing to maximize tender wins and reduce potential profit loss. The model shall make use of historical tender data, competitor pricing data, and market indicators in order to predict the optimal bid amounts. This advanced ML model runs advanced machine learning algorithms, including regression models and ensembles, to study the intricate relationship between factors that would affect the successful execution of a bid. Deep learning models are integrated into the model to provide it with better handling of temporal dependencies and other hidden patterns in data, hence yielding accurate and robust predictions. The key objective of the work is to increase the winning rate of tender contracts by at least 10%, while competitive profitability is ensured. Because of precise competitor price predictions, business success criteria are oriented to reaching this higher win rate on tenders. The Machine learning success criteria target a price prediction accuracy of at least 90%. Another important set of economic success criteria that should be targeted is an improvement in profit margins of at least 5% through more accurate pricing strategies and a reduction in the number of rejected bids. It will offer great value to the businesses operating in the railway industry in making proper decisions on operations and strategic planning. The paper develops a fusion of traditional statistical methodologies with advanced ML and DL techniques in order to provide a robust solution for competitive advantage and increased profitability in the dynamic and competitive railway tender market.

Letters or not, here we come! A communal perspective on credentials needed for a productive career in veterinary pathology.

Veterinary pathology credentials serve as a concise means attesting to educational attainments and experiences indicating a readiness for professional practice. Given the cost, time, and stress associated with obtaining different qualifications, pathologists must consider what credentials enhance their readiness. In this commentary, the authors describe how their various degrees and certifications have facilitated their individual and organizational success. The minimum credentials for proficient veterinary pathology practice are a veterinary medical degree (DVM or equivalent) and advanced pathology training (residency and/or on-the-job "apprenticeship") ideally culminating in board certification in pathology (American College of Veterinary Pathologists [ACVP] diplomate status or equivalent). Graduate degrees (MS, PhD, MPH, etc) and/or other qualifications in allied biomedical fields (eg, board certification in internal medicine, laboratory animal medicine, poultry medicine, preventive medicine, or toxicology) may improve employability by affirming specialty knowledge in another complementary discipline. The authors note that pathology positions may be obtained without a long list of degrees or certifications, and that more credentials may provide occupational flexibility for some employers. However, a good work ethic, experience in the field, ability to adapt to changes, job satisfaction, good attitude, and demonstrated productivity are also important, and indeed, they are often the paramount criteria for career success as a veterinary pathologist.

APPROACH TO THE ANALYSIS OF SUCCESS CRITERIA AS A COMPONENT OF PROBABILISTIC PHYSICAL PROTECTION ANALYSIS OF NUCLEAR FACILITIES

An approach to adapting the methodology for analyzing success criteria from traditional probabilistic safety analysis (PSA) of nuclear power plants (NPPs) to probabilistic physical protection analysis (PPA) of nuclear facilities is demonstrated using the hypothetical nuclear facility SNRI as an example. Generally speaking, using the traditional PSA methodology for assessing the physical protection of nuclear facilities allows for the identification of new vulnerabilities in the physical protection systems of nuclear facilities, the development of recommendations to enhance physical protection efficiency, the performance of more substantiated cost-benefit analyses, and more.

One-year follow-up of clinical convergence measures in children enrolled in the Convergence Insufficiency Treatment Trial-Attention and Reading Trial.

To assess the long-term stability of clinical measures of convergence (near point of convergence [NPC] and positive fusional vergence [PFV]) in participants enrolled in the Convergence Insufficiency Treatment Trial-Attention and Reading Trial (CITT-ART) who received 16 weeks of office-based vergence/accommodative therapy. A total of 310 children, 9-14 years old, with symptomatic convergence insufficiency were enrolled in CITT-ART. Some 270 completed both their 16-week primary outcome visit followed by a 1-year follow-up visit. Of those 270, 181 (67%) were randomised to the vergence/accommodative therapy. Of the 181 in the vergence/accommodative group, 121 (67%) reported not receiving any additional treatment after the 16-week primary outcome visit. The mean change in NPC, PFV and percentages of children classified by the predetermined success criteria of convergence (normal NPC [<6 cm] and/or improved by ≥4 cm; normal PFV [passing Sheard's criterion and base-out break >15Δ] and/or improved by ≥10Δ) were compared at the 16-week primary outcome visit and 1 year later. Of the 121 who returned for their 1-year follow-up visit, there was no significant change in mean adjusted NPC (reduction of -0.2 cm; 95% CI: -1.0 to 0.5 cm) at 1 year. There was a statistically significant decrease in mean-adjusted PFV (-4.7∆; 95% CI: -6.5 to -2.8Δ) at 1 year. There were similar percentages of participants classified as 'normal' (p = 0.30), 'normal and/or improved' (p > 0.50) and 'normal and improved' (p > 0.14) based on NPC and PFV at the 1-year visit compared with the 16-week primary outcome visit. The improvements in NPC and PFV following 16 weeks of vergence/accommodative therapy (with no reported additional treatment thereafter) in children with symptomatic convergence insufficiency persisted 1-year post-treatment.

Barriers to Early Progress in Adult Cochlear Implant Outcomes.

Adult cochlear implant (CI) recipients obtain varying levels of speech perception from their device. Adult CI users adapt quickly to their CI if they have no peripheral "bottom-up" or neurocognitive "top-down" limiting factors. Our objective here was to understand the influence of limiting factors on the progression of sentence understanding in quiet and in noise, initially and over time. We hypothesized that the presence of limiting factors, detected using a short test battery, would predictably influence sentence recognition with practical consequences. We aimed to validate the test battery by comparing the presence of limiting factors and the success criteria of >90% sentence understanding in quiet 1 month after activation. The study was a single-clinic, cross-sectional, retrospective design incorporating 32 adult unilateral Nucleus CI users aged 27 to 90 years (mean = 70, SD = 13.5). Postoperative outcome was assessed through sentence recognition scores in quiet and in varying signal to noise ratios at 1 day, 1 to 2 months, and up to 2 years. Our clinic's standard test battery comprises physiological and neurocognitive measures. Physiological measures included electrically evoked compound action potentials for recovery function, spread of excitation, and polarity effect. To evaluate general cognitive function, inhibition, and phonological awareness, the Montreal Cognitive Assessment screening test, the Stroop Color-Word Test, and tests 3 and 4 of the French Assessment of Reading Skills in Adults over 16 years of age, respectively were performed. Physiological scores were considered abnormal, and therefore limiting, when total neural recovery periods and polarity effects, for both apical and basal electrode positions, were >1.65 SDs from the population mean. A spread of excitation of >6 electrode units was also considered limiting. For the neurocognitive tests, scores poorer than 1.65 SDs from published normal population means were considered limiting. At 1 month, 13 out of 32 CI users scored ≥90% sentence recognition in quiet with no significant dependence on age. Subjects with no limiting peripheral or neurocognitive factors were 8.5 times more likely to achieve ≥90% score in quiet at 1 month after CI switch-on (p = 0.010). In our sample, we detected 4 out of 32 cases with peripheral limiting factors that related to neural health or poor electrode-neural interface at both apical and basal positions. In contrast, neurocognitive limiting factors were identified in 14 out of 32 subjects. Early sentence recognition scores were predictive of long-term sentence recognition thresholds in noise such that limiting factors appeared to be of continuous influence. Both peripheral and neurocognitive processing factors affect early sentence recognition after CI activation. Peripheral limiting factors may have been detected less often than neurocognitive limiting factors because they were defined using sample-based criteria versus normal population-based criteria. Early performance was generally predictive of long-term performance. Understanding the measurable covariables that limit CI performance may inform follow-up and improve counseling. A score of ≥90% for sentence recognition in quiet at 1 month may be used to define successful progress; whereas, lower scores indicate the need for diagnostic testing and ongoing rehabilitation. Our findings suggest that sentence test scores as early as 1 day after activation can provide vital information for the new CI user and indicate the need for rehabilitation follow-up.

Xen gel stent implant for persistent glaucoma after silicone oil removal.

To evaluate the effectiveness and safety of the XEN-Stent for managing unresponsive to medical therapy secondary glaucoma after silicone oil (SO) removal. This retrospective chart reviewed 12 patients who underwent vitrectomy and SO endotamponade. They experienced intraocular pressure (IOP) elevation after SO removal despite taking the maximum tolerated glaucoma medication. Eleven eyes underwent an XEN-implant, while 1 underwent an XEN-implant with phacoemulsification/IOL implantation. The primary outcome was to achieve success criteria: IOP <18 mmHg and >20% IOP reduction without medication (complete success) or with medication (qualified success) and without a secondary IOP-lowering procedure. IOP, best-corrected visual acuity (BCVA), and the number of glaucoma medications (Glaucoma Medication Score-GMS) were recorded at baseline, 1 day, 1 week, 1 (M1), 3 (M3), 6 (M6), and 12 (M12) months postoperatively. Baseline characteristics included males percentage 66.6%, mean age of 61.8 ± 5.7 years, BCVA 0.69 ± 0.3 logMAR, IOP 30 ± 4.2 mmHg, and GMS 3.1 ± 0.5. There was a significant reduction in IOP by 14 ± 1.9 mmHg and GMS by 0.27 ± 0.6 at M12 compared to baseline (p < 0.01), but no significant change in BCVA (p = 0.21). Complete success dropped to 50% (M3), rising to 75% (M6, M12) after needling. Two patients achieved qualified success at M12. Needling was performed in 6 eyes, with 3 requiring a second procedure. Ex-PRESS was required in 1 eye. One eye experienced hypotony and hyphema, which resolved within a week. XEN implant may be an initial treatment for persistent post SO removal glaucoma with minimal complications. Needling procedures can help maintain or restore surgical success.

Textbook anastomotic success in patients with low rectal cancer treated by intersphincteric resection: reappraising surgical, oncological, and functional outcomes.

Previous studies on successful anastomosis after intersphincteric resection (ISR) for low rectal cancer (LRC) primarily focused on anastomotic complications rather than functional outcomes. Here, we improved the anastomotic success criteria by considering surgical, oncological, and functional outcomes and proposed a new composite outcome, "textbook anastomotic success" (TASS). This retrospective single-center study included patients with LRC treated with ISR from January 2014 to April 2020. TASS was defined as (1) no anastomotic complications occurring after ISR; (2) ileostomy was closed and there was no severe intestinal dysfunction 2years after ISR; and (3) no local recurrence within 2years of surgery. TASS was achieved upon meeting all indicators. We analyzed 259 patients with LRC, with 125 (48.3%) achieving TASS. Multivariate analysis showed that male sex (OR 0.47; 95% CI 0.27-0.81; p = 0.007), hypertension (OR 0.48; 95% CI 0.24-0.97; p = 0.041), ASA score ≥ 3 (OR 0.28; 95% CI 0.10-0.81; p = 0.018), pre-treatment major low anterior resection syndrome (OR 0.37; 95% CI 0.15-0.94; p = 0.037), and preoperative neoadjuvant chemoradiotherapy (OR 0.41; 95% CI 0.22-0.77; p = 0.006) were independent risk factors for not achieving TASS. Conversely, transverse coloplasty pouch (OR 2.13; 95% CI 1.07-4.25; p = 0.032) and higher anastomosis level (OR 1.56; 95% CI 1.05-2.30; p = 0.026) were independent protective factors for achieving TASS. The nomogram constructed to evaluate the probability of achieving TASS demonstrated good accuracy in the dataset (area under curve, 0.737). TASS provides a comprehensive quality assessment for ISR in patients with LRC. The nomogram predicting TASS may assist surgeons in decision-making for managing LRC.