Total Loss Research Articles

Innovative hemostasis technique for cesarean section in placenta previa: A retrospective study.

To evaluate hemostatic efficacy, complications, and subsequent pregnancy outcomes in women with placenta previa who underwent combined vertical compression sutures in the lower uterine segment and intrauterine balloon tamponade (Hot-Dog method) to achieve hemostasis after cesarean section. We retrospectively reviewed data for 117 women with singleton pregnancy diagnosed with placenta previa who underwent cesarean section between 29 and 38 weeks' gestation. Treatments were as follows: (1) conventional-intravenous oxytocin administration after placental detachment and suturing of bleeding points at the detachment site as needed (conventional group) (n = 47). (2) Intrauterine balloon tamponade alone (balloon group) (n = 41). (3) Vertical compression sutures + intrauterine balloon tamponade (Hot-Dog group) (n = 29). The placenta accreta spectrum prevalence was significantly higher in the balloon and Hot-Dog groups versus the conventional group. The prevalence of anteriorly located placenta was significantly higher in the Hot-Dog versus balloon groups. Intraoperative and total blood loss were significantly higher in the Hot-Dog versus conventional groups. Postoperative blood loss was significantly lower in the Hot-Dog versus balloon groups. Fewer additional procedures for managing postoperative hemorrhage were required in the Hot-Dog versus conventional and balloon groups. The number of subsequent pregnancies in the conventional, balloon, and Hot-Dog groups was 11 (23.4%), 8 (19.5%), and 4 (13.8%), respectively; all resulted in live births at term without serious obstetric complications. The Hot-Dog method is a straightforward and safe hemostasis technique for placenta previa that preserves fertility and controls severe bleeding.

Comparative assessment of thermal oils and water as working fluids in parabolic trough collectors for enhanced solar power generation

Examining the thermal behavior of specific working fluids, namely Syltherm800 and TherminolVP-1, in parabolic trough collectors (PTCs) is imperative for enhancing power generation. This study addresses a crucial gap by conducting computational fluid dynamics simulations through COMSOL Multiphysics software and experimental tests to explore the advantages of utilizing thermal oils over water as a working fluid in PTCs. Experimental tests were performed on a water-based PTC in Iraq to validate the numerical model, considering various operating conditions such as input temperature (323.15–423.15 K) and mass flow rates (0.00926–0.0556 kg/s). Key parameters including output temperature, thermal efficiency, useful heat, and total heat losses were evaluated. The numerical model was validated against experimental data, showing good agreement with an overall discrepancy of 1.7% for the current experiments and 3.18% for literature results. The results indicated that Syltherm800, particularly with a high mass flow rate, outperformed TherminolVP-1 and water in terms of overall thermal performance. The optimal PTC thermal efficiency was achieved in July with a mass flow rate of 0.0556 kg/s and an input temperature of 348.15 K. The optimal range for PTC thermal efficiency over four months was between 50% and 70%. The endorsement of thermal oils in PTCs is supported by their low vapor pressure, superior thermal stability, and extended lifespan.

Synthesis of a green functional carbon dioxide‐based polycarbonate using bio‐based monomers

AbstractA PPC‐dodecyl glucoside (PPC‐APG) polymer was synthesized by the terpolymerization of carbon dioxide (CO2), propylene oxide (PO), and the bio‐based monomer APG for the first time. The thermal stability and mechanical properties of PPC‐APG were significantly improved compared with those of conventional polypropylene carbonate (PPC), and its glass transition temperature (Tg) was increased by 14°C compared with that of PPC. The 5% heat loss temperature (Td,−5%) and total heat loss temperature (Td,max) of PPC‐APG were increased by 89.1 and 92.1°C, respectively, compared with those of PPC. The tensile strength of PPC‐APG was increased to 25.6 MPa, its elongation at break was decreased to 125.1%, and its thermal elongation and permanent deformation were reduced to 97.2% and 62.9%, respectively, which improved the processability of the material. In addition, the introduction of bio‐based monomers also rendered PPC‐APG functional, and its surface tension reached a maximum of 61.3 mN/m at a concentration of 0.05 g/mL, with a good degradability. The higher surface tension and enhanced degradability of PPC‐APG indicate its potential for application as a plastic printing substrate.

Compact Heat Exchangers With Curved Fins for Hydrogen Turbofan Intercooling

Abstract Hydrogen is being considered as a possible path toward carbon-neutral aviation. There are additional advantages besides its main benefit of CO2-free combustion. One application is to use it for aero engine heat management due to its cryogenic temperature and high heat capacity, including intercooling and exhaust heat recuperation. The focus of this paper is on the design of a compact heat exchanger (HEX) integrated into an intermediate compressor duct (ICD), which could decrease compression work and specific fuel consumption (SFC). This compact heat exchanger features curved fins to promote flow turning and decrease pressure losses compared to more conventional straight fin heat exchangers. Conceptual design and duct shape optimization has been carried out which produced integrated ICD heat exchanger designs with significantly lower air-side total pressure losses compared to their conventional straight fin counterparts, which could improve system level integration and engine performance. A direct outcome of this study is a pressure loss correlation, which can be used in future engine system-level trade studies.

Superficial circumflex iliac artery perforator propeller flap for penoscrotal extramammary Paget's disease.

Extramammary Paget's disease (EMPD) is a rare intra-epidermal adenocarcinoma, and reconstruction of the penoscrotal region remains a clinical challenge. The superficial circumflex iliac artery perforator (SCIP) flap has been successfully used as a free flap, while its application as a propeller flap in the reconstruction of penoscrotal EMPD defect is rarely reported. The objective was to evaluate the safety and efficacy of the SCIP propeller flap in the reconstruction of penoscrotal defects in EMPD. Between September 2010 and August 2022, consecutive patients diagnosed with penoscrotal EMPD were enrolled. All patients underwent penoscrotal EMPD excision and reconstruction with SCIP propeller flap combined with other flaps or skin grafts on individual defects. Demographic information, surgical parameters, postoperative complications, patient satisfaction, and recurrence rates were analyzed. Twenty-four patients (mean age, 73 ± 8.8 years; mean BMI, 23.98 ± 3.62 kg/m2) with 33 SCIP propeller flaps (mean size 120.1 cm2; range, 24-208 cm2) were included, and the mean defect size was 67.4 cm2 (range, 12-255 cm2). The mean operative duration was 385.4 ± 146.8 min. Fifteen patients received autologous full-thickness skin grafts, and four received other flaps simultaneously. All flaps survived without total or partial loss, and all donor sites achieved primary closure, though local hematoma (one case) and limited skin graft necrosis (two cases) were observed. All patients experienced complete wound healing and maintained penoscrotal morphology and function without recurrent lesions over a mean follow-up of 59 months. The SCIP propeller flap seems a safe and effective reconstructive method for penoscrotal EMPD. IV.

Methods for Determining Losses and Parameters of Cylindrical-Rotor Medium-Power Synchronous Generators

This paper presents the analytical and numerical application of a method to determine the parameters and power losses in the core of two medium-power synchronous generators. These generators are used as emergency power sources powered by diesel engines, gas engines, and gas turbines. They cover peak electricity demand but can also be used in traction drives. This article presents a new numerical method for determining losses in the generator core based on the use of a time-stepping solution using the FEM method and calculating these losses using analytical formulas. In calculating the losses for the FEM method, approximations of the loss characteristics of the sheet were used with a wide range of induction values and frequencies. This method is specific to the solution used and was adapted from the authors’ previous work on losses in induction machines. A one-phase winding with alternating voltage was supplied to determine the basic parameters in the form of synchronous reactance. Also, an important novelty is the introduction of a new method of determining the saturation state of the magnetic circuit, which significantly affects the machine parameters. The obtained results were used in analytical calculations and implemented in a computer program that allows for the calculation of electromagnetic parameters, operating characteristics, and core losses, taking into account additional losses, total losses, and efficiency, as well as machine parameters in unsteady operating states and the current characteristics of a three-phase symmetrical short circuit at the machine terminals. The calculations obtained were verified experimentally by measurements of real machines.

МЕТОДИКА РАСЧЕТА ЭНЕРГЕТИЧЕСКИХ ХАРАКТЕРИСТИК И ТОКА КОРОТКОГО ЗАМЫКАНИЯ ЭЛЕКТРИЧЕСКИХ МАШИН ОТКРЫТОГО ИСПОЛНЕНИЯ

The article is devoted to the consideration of issues related to the design of electric motors and the use of submersible electric machines in the marine environment on drilling rigs and platforms. The article describes the calculation of parameters and energy characteristics of asynchronous electric motors of submersible electric machines. The mathematical apparatus for calculating the energy characteristics and short-circuit current of asynchronous electric motors of electric machines of open design is given. Some characteristic features of calculating the energy characteristics and short-circuit current of asynchronous electric motors of electric machines of open design, taking into account the efficiency coefficient in relation to the useful power consumed and the total losses in them, are also considered.

Continuous Glucose Monitoring Captures Glycemic Variability After Roux-en-Y Gastric Bypass in Patients with and Without Type 2 Diabetes Mellitus: A Prospective Cohort Study.

To evaluate glycemic variability (GV) using continuous glucose monitoring (CGM) in individuals with and without type 2 diabetes mellitus (T2DM) undergoing Roux-en-Y gastric bypass (RYGB). This prospective cohort study compared the CGM data of fourteen patients with T2DM (n = 7) and without T2DM (n = 7) undergoing RYGB. After 6months, these patients were compared to a non-operative control group (n = 7) matched by BMI, sex, and age to the T2DM group. Fourteen patients underwent RYGB, with a mean BMI of 46.9 ± 5.3kg/m2 and an average age of 47.9 ± 8.9years; 85% were female. After 6months post-surgery, the total weight loss (TWL) was 27.1 ± 6.3%, with no significant differences between the groups. Patients without diabetes had lower mean interstitial glucose levels (81 vs. 94 and 98mg/dl, p < 0.01) and lower glucose management indicator (GMI) (5.2 vs. 5.6 and 5.65%, p = 0.01) compared to the control and T2DM groups, respectively. The coefficient of variation (CV) significantly increased only in patients with diabetes (17% vs. 26.7%, p < 0.01). Both groups with (0% vs. 2%, p = 0.03) and without (3% vs. 22%, p = 0.03) T2DM experienced an increased time below range with low glucose (54-69mg/dL). However, patients without T2DM had significantly less time in rage (70-180mg/dL) (97% vs. 78%, p = 0.04). Significant differences in CGM metrics among RYGB patients suggest an increase in glycemic variability after surgery, with a longer duration of hypoglycemia, especially in patients without T2DM.

Comprehensive economic losses assessment of storm surge disasters using open data: a case study of Zhoushan, China

ABSTRACT As climate change continues to worsen, coastal areas are increasingly vulnerable to more frequent and severe storm surges. This poses a significant risk to economic entities, particularly in areas that have undergone rapid development. However, quantitative assessment of economic losses from storm surge disasters in China has been challenging due to limited exposure and vulnerability data. This study proposes a framework for comprehensive economic losses assessment of storm surge disasters using open data, focusing on Zhoushan City as an example. The study quantifies economic loss ratios caused by storm surges by identifying essential urban land use/cover (EULUC) and considering the water depth of different EULUC types for quantitative vulnerability assessment. The study then calculates direct economic losses using the loss ratio maps and gridded gross domestic product data and quantifies indirect economic losses (IEL) using an input–output model to account for inter-industry correlation. Results show that under the scenario of a super typhoon intensity (915 hPa), the total economic loss can reach 131 million CNY, with IEL accounting for 60% of the total. The construction and industrial sectors experience higher IEL due to excessive dependence on upstream and downstream industries, with IEL accounting for approximately 70%.

Monitoring and Analysis of Prestress Loss in Prestressed Box Girder Bridges Strengthened with External Prestressing

To investigate the effects of long-term prestress loss on concrete box girders strengthened with external prestressing, a large-span box girder, in service for over 20 years and strengthened with external prestressing, was monitored for four months. Prestress loss in the longitudinal, vertical, and transverse directions of the box girder was calculated according to Chinese code requirements. Magnetic flux rope force transducers were used to monitor the prestress loss in the external prestressing cables. Fiber Bragg Grating (FBG) sensors were used to monitor deflection changes at the mid-span of the bridge. Finally, the effect of prestress loss in the longitudinal, vertical, and transverse tendons on mid-span deflection was investigated through simulations using ABAQUS software. The results show that instantaneous prestress loss accounts for most of the total loss compared to long-term loss, and that longitudinal prestress loss has the most significant effect on mid-span deflection. The impact of longitudinal prestress loss on deflection before and after strengthening was also compared. The downward deflection and up-ward arch caused by longitudinal tendon prestress loss were reduced after strengthening, con-firming the effectiveness of the external prestressing method.

Effect of laparoscopic sleeve gastrectomy versus laparoscopic Roux-en-Y gastric bypass on body composition.

There is limited data with respect to body composition changes for laparoscopic sleeve gastrectomy (SG) and laparoscopic Roux-en-Y gastric bypass (RYGB). The objective of this study was to analyse changes in body composition between these two procedures during the first year after bariatric surgery. A prospective study was performed in patients undergoing bariatric surgery at two tertiary hospitals between 2017 and 2023. Body composition was assessed with dual-energy x-ray absorptiometry immediately before surgery, and at 1-, 6-, 12-, 18- and 24-months post-operatively, with a subgroup analysis performed for patients who undertook a scan at 18- and 24-months. Total weight loss (TWL), body mass index (BMI), fat mass (FM), lean body mass (LBM) and bone mineral content (BMC) parameters were compared between SG and RYGB. Forty-five patients were included in this series (SG n = 30, RYGB n = 15). There was a significant reduction in mean %TWL of 26.94 ± 8.86% and mean BMI of 11.12 ± 3.70 kg/m2 over 12-months. LBM accounted for 17.8% of TWL over 12-months, SG and RYGB did not differ in terms of loss of FM or LBM. For both procedures, the loss of LBM appeared to plateau at 6-months post-operatively. The only statistically significant finding between the two procedures was that RYGB resulted in an additional 0.06 kg loss compared with SG. SG and RYGB have been shown to have comparable weight loss and body composition changes in the short-to-medium term following surgery. LBM reduction was most significant in the early post-operative period across the entire cohort.

The forest loss within small reservoirs surpasses that of large reservoirs across the tropics

The vast potential of hydropower remains crucial in addressing the escalating need for clean energy, particularly in Tropical Moist Forests (TMFs) regions. Yet, the widespread construction of reservoirs within TMFs has resulted in the inundation of forested areas, exacerbating the fragmentation of forest landscapes and contributing additional loss of carbon stored in these ecosystems. Despite this, the scale and degree of forest loss within reservoirs due to inundation from reservoir construction remain poorly quantified and mapped across tropical regions. Here, we leverage long-term TMFs data spanning from 1990 to 2021 to investigate forest loss within reservoirs across tropical regions. We reveal that forest losses within reservoirs total 3521 km2, constituting a relatively small fraction of total forest loss. Nonetheless, the spatial distribution of forest loss within reservoirs varies significantly across the tropics, with patchy distributions observed in the American and African TMFs, and striped patterns evident in the Asian TMFs. Contrary to common assumptions, we show that small reservoirs exhibit higher levels of forest loss compared to large reservoirs, particularly pronounced in the African TMFs region. Furthermore, our projections indicate that the exclusive construction of small reservoirs contributes to approximately 27% of Africa’s total forest area lost. We underscore the importance of policymakers carefully evaluating the trade-offs associated with the construction of large versus small reservoirs in TMF regions, to minimize the adverse impacts of hydropower development on forest ecosystems.

Assessing the predictive value of the suppressed 1 mg overnight dexamethasone suppression test in success of bariatric surgery.

Bariatric surgery has been proven to be a successful intervention for managing obesity. There are numerous studies in the literature aiming to predict the factors influencing the success of bariatric surgery. Our study aims to determine whether preoperative 1 mg overnight dexamethasone suppression test (1 mg-DST) serum cortisol levels can serve as predictors of the effectiveness of bariatric surgery in severe obese patients without Cushing syndrome. A total of 98 patients who underwent bariatric surgery were included in the study. The preoperative 1 mg-DST levels, insulin levels, thyroid function tests, and lipid profiles of the patients were recorded. The patients' preoperative, postoperative 3rd, and 6th month weights were recorded and the percent total weight loss (%TWL) is calculated. Patients were categorized into 2 groups based on their TWL at 6 months. The 1 mg-DST results were significantly lower in the high-TWL-6 group (0.93 ± 0.37 μg/dL) compared to the low-TWL-6 group (1.09 ± 0.36 μg/dL, P = .040). Similarly, Homeostatic Model Assessment for Insulin Resistance values were lower in the high-TWL-6 group (5.63 ± 2.21) compared to the low-TWL-6 group (6.63 ± 2.55, P = .047). The optimal cutoff value found for 1 mg-DST level was 0.97 µg/dL, providing 50% sensitivity and 70% specificity. This study is the first to examine the predictive role of suppressed 1 mg-DST levels on postoperative weight loss in nondiabetic patients. The most prominent result of this study was that we observed a negative correlation between 1 mg-DST levels and %TWL.

New information about the cyclable capacity fading process of a pouch cell with Li-rich layered oxide cathodes.

Most studies investigate the cyclable capacity fading mechanism of Li-rich layered oxides (LLOs) from the microscopic structure level, lacking discussions about how the structure degradation influences the performance of the pouch cell precisely and quantitatively. Based on the analysis of the evolution of key parameters during the whole cycling period, a new transition-type fading mechanism is proposed. From the early-to-middle stage of the cycling period, polarization increases, most of which is interface-related, causing about 67% of the whole capacity loss. From the middle-to-late stage of the cycling period, active material losses turn out to be the dominating factor, inducing about 61% of the total capacity loss. Diffusion-related polarization, replacing the interface type, is responsible for most of the increased overpotential. Relative analysis confirms that during the early stage, the increase of the charge transfer resistance, induced by CEI (cathode electrolyte interface) growth and initial surface layered-structure degradation, is the main source of interface polarization. As the cycling evolves to the late stage, severe bulky structure degradation, including lattice-oxygen release, Li/Ni mixture and generation of a new spinel phase, turns out to be the major factor, causing further capacity fading.

Weight loss after Roux-en-Y gastric bypass and single anastomosis duodenoileostomy following failed sleeve gastrectomy.

While sleeve gastrectomy (SG) results in sustained weight loss for the majority of patients, some will experience inadequate weight loss or weight regain requiring revision. The objective of this study was to evaluate differences in weight loss over time between patients undergoing Roux-en-Y gastric bypass (RYGB) or single anastomosis duodenoileostomy (SADI) after SG. We queried a single institution's bariatrics registry to identify patients who underwent RYGB or SADI after previous SG over a three-year period. Demographics, operative characteristics, and post-operative complications were evaluated. Interval total body weight loss (TBWL) and excess body weight loss (EBWL) were calculated from available follow-ups within 2years. We identified 124 patients who underwent conversion to RYGB (n = 61) or SADI (n = 63) following previous SG. There were no differences in sex, age, or medical comorbidities between groups. The median initial BMI was higher in the SADI group (44.9 vs. 41.9 for RYGB, p = 0.03) with greater excess body weight (56.7 vs. 64.3kg, p = 0.04). The SADI group had a shorter median operative duration (157 vs. 182min for RYGB, p < 0.01) and lower readmission rates (0 vs. 14.75%, p < 0.01). There was no difference in post-operative complications or need for rehydration therapy between the groups. Among 122 patients (98.4%) that had follow-up weights available, there were no differences in TBWL between groups. RYGB patients had a higher EBWL at 2, 3, and 6months (p < 0.05 for all comparisons), but there were no differences between RYGB and SADI at 1 or 2 years. Both RYGB and SADI conversions proved effective for further weight loss following failed SG at our academic center. While neither demonstrated clear superiority in long-term (> 1year) weight loss, RYGB's restrictive gastric pouch may explain its early weight loss advantage.

Advancing DIEP Flap Monitoring with Optical Imaging Techniques: A Narrative Review

Objectives: This review aims to explore recent advancements in optical imaging techniques for monitoring the viability of Deep Inferior Epigastric Perforator (DIEP) flap reconstruction. The objectives include highlighting the principles, applications, and clinical utility of optical imaging modalities such as near-infrared spectroscopy (NIRS), indocyanine green (ICG) fluorescence angiography, laser speckle contrast imaging (LSCI), hyperspectral imaging (HSI), dynamic infrared thermography (DIRT), and short-wave infrared thermography (SWIR) in assessing tissue perfusion and oxygenation. Additionally, this review aims to discuss the potential of these techniques in enhancing surgical outcomes by enabling timely intervention in cases of compromised flap perfusion. Materials and Methods: A comprehensive literature review was conducted to identify studies focusing on optical imaging techniques for monitoring DIEP flap viability. We searched PubMed, MEDLINE, and relevant databases, including Google Scholar, Web of Science, Scopus, PsycINFO, IEEE Xplore, and ProQuest Dissertations &amp; Theses, among others, using specific keywords related to optical imaging, DIEP flap reconstruction, tissue perfusion, and surgical outcomes. This extensive search ensured we gathered comprehensive data for our analysis. Articles discussing the principles, applications, and clinical use of NIRS, ICG fluorescence angiography, LSCI, HSI, DIRT, and SWIR in DIEP flap monitoring were selected for inclusion. Data regarding the techniques’ effectiveness, advantages, limitations, and potential impact on surgical decision-making were extracted and synthesized. Results: Optical imaging modalities, including NIRS, ICG fluorescence angiography, LSCI, HSI, DIRT, and SWIR offer a non- or minimal-invasive, real-time assessment of tissue perfusion and oxygenation in DIEP flap reconstruction. These techniques provide objective and quantitative data, enabling surgeons to monitor flap viability accurately. Studies have demonstrated the effectiveness of optical imaging in detecting compromised perfusion and facilitating timely intervention, thereby reducing the risk of flap complications such as partial or total loss. Furthermore, optical imaging modalities have shown promise in improving surgical outcomes by guiding intraoperative decision-making and optimizing patient care. Conclusions: Recent advancements in optical imaging techniques present valuable tools for monitoring the viability of DIEP flap reconstruction. NIRS, ICG fluorescence angiography, LSCI, HSI, DIRT, and SWIR offer a non- or minimal-invasive, real-time assessment of tissue perfusion and oxygenation, enabling accurate evaluation of flap viability. These modalities have the potential to enhance surgical outcomes by facilitating timely intervention in cases of compromised perfusion, thereby reducing the risk of flap complications. Incorporating optical imaging into clinical practice can provide surgeons with objective and quantitative data, assisting in informed decision-making for optimal patient care in DIEP flap reconstruction surgeries.

Impact and Technical Solutions of Hydrodynamic and Thermodynamic Processes in Liquefied Natural Gas Regasification Process

Transporting natural gas in liquid form increases opportunities for storage and export worldwide, thus making transportation more sustainable. However, liquefied natural gas (LNG) is in an unsteady state, leading to LNG conversion to the gas state occurring throughout the storage, loading, unloading, and transportation processes. To observe the transition of LNG to natural gas, mathematical models are developed to monitor technical parameters. This research analyses a floating storage and regasification unit for and adopts a mathematical model of the LNG regasification system, aiming for improved observation of hydrodynamic, dynamic, and thermo-physical properties. The complex mathematical model of the system was implemented using the Fortran programming language and MATLAB R28a. From the investigation of the total LNG regasification system, it could be concluded that increasing the outlet pressure of the system results in a decrease in the velocity of LNG. It was found that the total hydraulic energy losses of the total LNG regasification system were approximately 41.3 kW (with outlet pressure of 2 MPa), 12.75 kW (with outlet pressure of 5 MPa), and 4.24 kW (with outlet pressure of 7 MPa).

Liraglutide for the Treatment of Weight Regain After Bariatric Surgery: A Systematic Review and Meta-analysis.

The efficacy of liraglutide for treating type 2 diabetes mellitus and obesity is well established, but their role in the treatment of weight regain after bariatric surgery remains unclear. We searched PubMed, Embase, and Cochrane Library databases in January 2024. A random-effects model was employed to compute mean differences (MD) and events per 100 observations with 95% confidence intervals (CI) for continuous and binary endpoints. Statistical analysis was performed using R software. A total of 16 studies were included and 881 individuals. Patients were mostly female (50%), aged 36 to 55years, with a mean body mass index (BMI) of 39.4kg/m2, and had BS surgery 5years prior. Over a mean follow-up time ranging from 3months to 4years, it was observed a statistically significant reduction in BMI (MD - 8.56kg/m2; 95% CI 3.34 to 13.79; p < 0.01) and a mean reduction in total weight (MD - 16.03kg; 95% CI 0.03 to 32.02; p = 0.05) after liraglutide use. Additionally, 65% of patients undertaking liraglutide showed total body weight loss (BWL) above 5% (65.8 events per 100 observations; 95% CI 54.96 to 75.20; p < 0.01), while 26% lost more than 10% of total BWL (26.77 events per 100 observations; 95% CI 19.17 to 36.02; p < 0.01). A limitation is a variability between the studies. Our findings support the use of liraglutide for weight management in patients who experience weight regain after BS. Liraglutide is well tolerated and promotes significant weight loss, providing clinicians with a therapeutic option for this clinical challenge.

Evaluation of Snowmelt and Rainfall Erosion in the Total Soil Losses in a Typical Small Watershed in Black Soil Region of Northeast China

Evaluation of Snowmelt and Rainfall Erosion in the Total Soil Losses in a Typical Small Watershed in Black Soil Region of Northeast China

Optimizing Hospital Performance Evaluation in Total Weight Loss Outcomes After Bariatric Surgery: A Retrospective Analysis to Guide Further Improvement in Dutch Hospitals.

Bariatric surgery aims for optimal patient outcomes, often evaluated through the percentage total weight loss (%TWL). Quality registries employ funnel plots for outcome comparisons between hospitals. However, funnel plots are traditionally used for dichotomous outcomes, requiring %TWL to be dichotomized, potentially limiting feedback quality. This study evaluates whether a funnel plot around the median %TWL has better discriminatory performance than binary funnel plots for achieving at least 20% and 25% TWL. All hospitals performing bariatric surgery were included from the Dutch Audit for Treatment of Obesity. A funnel plot around the median was constructed using 5-year %TWL data. Hospitals positioned above the 95% control limit were colored green and those below red. The same hospitals were plotted in the binary funnel plots for 20% and 25% TWL and colored according to their performance in the funnel plot around the median. We explored the hospital's procedural mix in relation to %TWL performance as possible explanatory factors. The median-based funnel plot identified four underperforming and four outperforming hospitals, while only one underperforming and no outperforming hospitals were found with the binary funnel plot for 20% TWL. The 25% TWL binary funnel plot identified two underperforming and three outperforming hospitals. The proportion of sleeve gastrectomies performed per hospital may explain part of these results as it was negatively associated with median %TWL (β = - 0.09, 95% confidence interval [- 0.13 to - 0.04]). The funnel plot around the median discriminated better between hospitals with significantly worse and better performance than funnel plots for dichotomized %TWL outcomes.