Two-step Program Research Articles

A two-step linear programming approach for repeater placement in large-scale quantum networks

Thanks to the applications such as Quantum Key Distribution and Distributed Quantum Computing, the deployment of quantum networks is gaining great momentum. A major component in quantum networks is repeaters, which are essential for reducing the error rate of qubit transmission for long-distance links. However, repeaters are expensive devices, so minimizing the number of repeaters placed in a quantum network while satisfying performance requirements becomes an important problem. Existing solutions typically solve this problem optimally by formulating an Integer Linear Program (ILP). However, the number of variables in their ILPs is O(n2), where n is the number of nodes in a network. This incurs infeasible running time when the network scale is large. To overcome this drawback, this paper proposes to solve the repeater placement problem by two steps, with each step using a linear program of a much smaller scale with O(n) variables. Although this solution is not optimal, it dramatically reduces the time complexity, making it practical for large-scale networks. Moreover, it constructs networks that have higher node connectivity than those by existing solutions, since it deploys slightly more number of repeaters into networks. Our extensive experiments on both synthetic and real-world network topologies verified our claims.

Two-Step Quadratic Programming for Physically Meaningful Smoothing of Longitudinal Vehicle Trajectories

Longitudinal vehicle trajectories suffer from errors and noise because of detection and extraction techniques, challenging their applications. Existing smoothing methods either lack physical meaning or cannot ensure solution existence and uniqueness. To address this, we propose a two-step quadratic programming method that aligns smoothed speeds and higher-order derivatives with physical laws, drivers’ behaviors, and vehicle characteristics. Unlike the well-known smoothing splines method, which minimizes a weighted sum of discrepancy and roughness in a single quadratic programming problem, our method incorporates prior knowledge of position errors into two sequential quadratic programming problems. Step 1 solves half-smoothed positions by minimizing the discrepancy between them and raw positions, subject to physically meaningful bounds on speeds and higher-order derivatives of half-smoothed positions. Step 2 solves smoothed positions by minimizing the roughness while maintaining physically meaningful bounds and allowing the deviations from raw data of smoothed positions by at most those of the half-smoothed positions and prior position errors. The second step’s coefficient matrix is not positive definite, necessitating the matching of the first few smoothed positions with corresponding half-smoothed ones, with equality constraints equaling the highest order of derivatives. We establish the solution existence and uniqueness for both problems, ensuring their well-defined nature. Numerical experiments using Next Generation Simulation (NGSIM) data demonstrate that a third-order derivative constraint yields an efficient method and produces smoothed trajectories comparable with manually re-extracted ones, consistent with the minimum jerk principle for human movements. Comparisons with an existing approach and application to the Highway Drone data set further validate our method’s efficacy. Notably, our method is a postprocessing smoothing technique based on trajectory data and is not intended for systematic errors. Future work will extend this method to lateral vehicle trajectories and trajectory prediction and planning for both human-driven and automated vehicles. This approach also holds potential for broader smoothing problems with known average error in raw data. History: This paper has been accepted for the Transportation Science Special Issue on ISTTT25 Conference. Funding: The authors extend their gratitude to the Pacific Southwest Region University Transportation Center and the University of California Institute of Transportation Studies (UC ITS) Statewide Transportation Research Program (STRP) for their valuable financial support.

Implementation of two-step gradual reset scheme for enhancing state uniformity of 2D hBN-based memristors for image processing

In-memory computing facilitates efficient parallel computing based on the programmable memristor crossbar array. Proficient hardware image processing can be implemented by utilizing the analog vector-matrix operation with multiple memory states of the nonvolatile memristor in the crossbar array. Among various materials, 2D materials are great candidates for a switching layer of nonvolatile memristors, demonstrating low-power operation and electrical tunability through their remarkable physical and electrical properties. However, the intrinsic device-to-device (D2D) variation of memristors within the crossbar array can degrade the accuracy and performance of in-memory computing. Here, we demonstrate hardware image processing using the fabricated 2D hexagonal boron nitride-based memristor to investigate the effects of D2D variation on the hardware convolution process. The image quality is evaluated by peak-signal-to-noise ratio, structural similarity index measure, and Pratt’s figure of merit and analyzed according to D2D variations. Then, we propose a novel two-step gradual reset programming scheme to enhance the conductance uniformity of multiple states of devices. This approach can enhance the D2D variation and demonstrate the improved quality of the image processing result. We believe that this result suggests the precise tuning method to realize high-performance in-memory computing.

Strategy to improve synaptic behavior of ion-actuated synaptic transistors—the use of ion blocking layer to improve state retention

Synaptic transistors (STs) with a gate/electrolyte/channel stack, where mobile ions are electrically driven across the solid electrolyte, have been considered as analog weight elements for neuromorphic computing. The current (ID) between the source and drain in the ST is analogously updated by gate voltage (VG) pulses, enabling high pattern recognition accuracy in neuromorphic systems; however, the governing physical mechanisms of the ST are not fully understood yet. Our previous physics-based simulation study showed that ion movement in the electrolyte, rather than the electrochemical reactions that occur in the channel, plays an important role in switching. In this study, we experimentally explore the properties of the HfOx electrolyte and show that by tuning the density of oxygen vacancies, it can assume the dual role of electrolyte and channel. We demonstrate analog synaptic behavior using a novel ST with a two-layer stack of CuOx/HfOx, where the CuOx is the gate and Cu ion reservoir, and the HfOx is the electrolyte and channel. To improve state retention and linearity, we introduce a Cu ion transport barrier in the form of a dense and stoichiometric Al2O3 layer. The CuOx/Al2O3/HfOx exhibits excellent state retention and improved potentiation and depression response. Energy dispersive spectroscopy mapping following potentiation confirms the role of the Al2O3 layer in confining the Cu ions in the HfOx layer. We also show that a two-step programming scheme can further enhance synaptic response and demonstrate high recognition accuracy on the Fashion-MNIST dataset in simulation.

Development and validation of a microwave-assisted digestion technique as a rapid sample preparation method for the estimation of selenium in pharmaceutical dosage forms by ICP-OES.

Selenium is a class 2B element according to the International Council for Harmonization Q3D guidelines. Selenium sulfide is an anti-infective agent with antifungal and antibacterial properties used to treat dandruff and seborrheic dermatitis. The literature survey revealed that most of the analytical techniques to estimate selenium were time-consuming and/or required high skill levels. The process involved identifying the isotopes, selecting the measurement approach, and optimizing a typical microwave-aided digesting procedure. Ammonium hydrogen difluoride, water, and concentrated nitric acid were added to the samples. The confirmed microwave digestion program was a two-step program where in the initial step, the samples were ramped at 200°C for 20 min and held for 5 min. Later, samples were cooled and neutralized by boric acid, then ramped for 20 min to a temperature of 180°C and held for 10 min. Selenium was estimated at 196.090 nm by inductively coupled plasma optical emission spectroscopy (ICP-OES). System suitability was run before initiating analysis to ensure that system performance was consistent. Analytical validation parameters, such as the specificity of the method, were demonstrated at 196.090 nm, linearity was proven from 10 ppm to 150 ppm of selenium concentration, the detection limit was 1.28 ppm, and the limit of quantification was 3.89 ppm. Robustness was confirmed for small changes to ICP-OES operating conditions. The precision of the method demonstrated by analyzing the percentage relative standard deviation for six injections was found to be less than 2.0%. Accuracy was confirmed from 10 ppm to 150 ppm, and all the samples were observed to be within the range of 95%-105%. A common microwave-assisted digestion technique was developed and validated as well. The precision, specificity, linearity, accuracy, and robustness of the method for estimating selenium in selenium sulfide drug substances and various pharmaceutical dosage forms were demonstrated. This newly developed microwave-assisted digestion technique has optimum sensitivity and is highly reproducible and time-saving than the existing methods This method can be applied to numerous matrices for a finished dosage of selenium sulfide formulations.

Novel and economical approach of sulfurizationof Bi-facial CIGSe layers on flexible substrate

The surface sulfurization is significant method to enhance the VOC of Copper Indium Gallium Diselenide (CIGSe) solar cells. However, a large amount of sulfur (S) in the layer deteriorates the FF and JSC owing to the lower absorption of photons with low energy and increased deep-level recombination. Since sulfurization is temperature-dependent, it is difficult to control the diffusion depth of S in the CIGSe layer. Herein, we report the band gap engineering of CIGSe by the addition of sulfur using a simple and rapid thermal processing (RTP) technique without involving toxic H2S or H2Se gasses, and the bifacial growth of CIGSe was reported using a non-aqueous electrochemical technique. The films were heat treated in an RTP furnace in ambient S at 450 °C using a two-step program. Sulfurization was performed with 2 mg and 20 mg of S powder, and the effect of the amount of S on the various properties of the CIGSe layers was investigated. A significant improvement in the properties of CIGSe was observed upon sulfurization. X-ray Diffraction, Spectroscopy and Raman spectroscopy indicated that the sulfurization process resulted in the formation of a Copper Indium Gallium Sulfoselenide (CIGSSe) absorber layer, which was highly crystalline and did not exhibit any secondary phase formation. The development of the CIGSSe layer at the surface of CIGSe in the sulfurized sample was confirmed by the existence of distinguished S 2p doublet peaks in the CIGSe layer sulfurized with 20 mg S powder as compared to 2 mg S powder, whereas it was completely absent in the as-prepared layer in the X-ray photoelectron spectroscopy (XPS) core level spectra. Rietveld refinement confirms the formation of CIGSSe along with CIGSe in layer upon sulfurization.

The balanced maximally diverse grouping problem with attribute values

The paper investigates the assignment of items to groups such that all groups are as heterogeneous as possible and each pair of groups is as balanced as possible, i.e. all groups get the same number of items assigned, the total diversity is maximized, and all pairs of groups are as homogeneous as possible regarding the attribute values of their assigned items. We present a two-step exact mixed-integer programming approach, whereat the first step is a maximally diverse grouping problem (MDGP), i.e. our approach extends the MDGP by a balancing step. Moreover, we present a detailed complexity analysis for both steps and heuristic solution approaches based on 2-opt, very large-scale neighborhood search, and variable neighborhood search, which are, together with the mixed-integer program, evaluated in a computational study.

Development and validation of a simple microwave-assisted digestion sample preparation technique for the estimation of aluminium and magnesium in a few pharmaceutical dosage forms by an inductively coupled-mass spectrometer (ICP-MS).

Rationale: A simple, sensitive, reliable, validated, inductively coupled plasma mass spectrometric method for the determination of aluminium and magnesium using a simple common microwave-assisted digestion sample preparation technique for a few commonly used formulations was developed and validated according to International Conference on Harmonization Q3D and the United States Pharmacopeia general chapter <232> and <233>. The following pharmaceutical dosage forms were considered for estimation of aluminium and magnesium: Alumina, magnesia simethicone oral suspension, Alumina, magnesia simethicone chewable tablets, alumina and magnesia oral suspension, alumina and magnesium carbonate oral suspension. Methods: The methodology included optimizing a common microwave assisted digestion method, selecting the isotopes, choosing the measurement technique, and designating internal standards. The finalized microwave assisted procedure was a two-step program where in the first step the samples were ramped for 10 min to a temperature of 180 °C and hold for 5 min followed by ramping for 10 min to a temperature of 200 °C and hold for 10 min. Magnesium (24Mg) and aluminium (27Al) isotopes were finalized, internal standard assigned for both the isotopes was yttrium (89Y) with Helium (kinetic energy discrimination-KED) as the measuring mode. System suitability was run before initiating analysis to ensure that system performance was consistent. Results: Analytical validation parameters like specificity, linearity (from 25% to 200% of sample concentration), the detection limit and the limit of quantification were established. For all these dosage forms, the method's precision was demonstrated by analyzing the percentage relative standard deviation for six injections. Accuracy was established from 50% to 150% of instrument working concentration (J-levels) for aluminium and magnesium for all the formulations and was found to be within the range of 90-120%. Conclusion: This common analysis method, along with the common microwave-digestion technique applies to numerous types of matrices for a finished dosage form with aluminium and magnesium.

Initial Evidence for Positive Effects of a Psychological Preparation Program for MRI “iMReady” in Children with Neurofibromatosis Type I and Brain Tumors—How to Meet the Patients’ Needs Best

To provide an effective alternative to sedation during MRI examinations in pediatric cancer and NF1 patients, the aims of the present study were to (1) exploratively evaluate a behavioral MRI training program, to (2) investigate potential moderators, as well as to (3) assess the patients' well-being over the course of the intervention. A total of n = 87 patients of the neuro-oncology unit (mean age: 6.83 years) underwent a two-step MRI preparation program, including training inside the scanner, and were recorded using a process-oriented screening. In addition to the retrospective analysis of all data, a subset of 17 patients were also analyzed prospectively. Overall, 80% of the children receiving MRI preparation underwent the MRI scan without sedation, making the success rate almost five times higher than that of a group of 18 children that opted out of the training program. Memory, attentional difficulties, and hyperactivity were significant neuropsychological moderators for successful scanning. The training was associated with favorable psychological well-being. These findings suggest that our MRI preparation could present an alternative to sedation of young patients undergoing MRI examinations as well as a promising tool for improving patients' treatment-related well-being.

Risk factor-based screening compared to universal screening for gestational diabetes mellitus in marginalized Burman and Karen populations on the Thailand-Myanmar border: An observational cohort.

Background: Gestational diabetes mellitus (GDM) contributes to maternal and neonatal morbidity. As data from marginalized populations remains scarce, this study compares risk-factor-based to universal GDM screening in a low resource setting. Methods: This is a secondary analysis of data from a prospective preterm birth cohort. Pregnant women were enrolled in the first trimester and completed a 75g oral glucose tolerance test (OGTT) at 24-32 weeks' gestation. To define GDM cases, Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO trial) criteria were used. All GDM positive cases were treated. Sensitivity and specificity of risk-factor-based selection for screening (criteria: age ≥30y, obesity (Body mass index (BMI) ≥27.5kg/m 2), previous GDM, 1 st degree relative with diabetes, previous macrosomia (≥4kg), previous stillbirth, or symphysis-fundal height ≥90th percentile) was compared to universal screening using the OGTT as the gold standard. Adverse maternal and neonatal outcomes were compared by GDM status. Results: GDM prevalence was 13.4% (50/374) (95% CI: 10.3-17.2). Three quarters of women had at least one risk factor (n=271 women), with 37/50 OGTT positive cases correctly identified: sensitivity 74.0% (59.7-85.4) and specificity 27.8% (3.0-33.0). Burman women (self-identified) accounted for 29.1% of the cohort population, but 38.0% of GDM cases. Percentiles for birthweight (p=0.004), head circumference (p=0.002), and weight-length ratio (p=0.030) were higher in newborns of GDM positive compared with non-GDM mothers. 21.7% (75/346) of newborns in the cohort were small-for-gestational age (≤10 th percentile). In Burman women, overweight/obese BMI was associated with a significantly increased adjusted odds ratio 5.03 (95% CI: 1.43-17.64) for GDM compared with normal weight, whereas in Karen women, the trend in association was similar but not significant (OR 2.36; 95% CI 0.95-5.89). Conclusions: Risk-factor-based screening missed one in four GDM positive women. Considering the benefits of early detection of GDM and the limited additional cost of universal screening, a two-step screening program was implemented.

Health check-ups for the French under-consuming agricultural population: A pilot evaluation of the Instants santé MSA program

BackgroundThe social protection scheme in charge of farmers and agricultural employees (MSA) in France has developed a two-step health promotion program with a nurse appointment followed by a consultation with a doctor of the participant's choosing to reach its under-consuming beneficiaries and enroll them back into a care pathway. Our objective was to carry out a pilot evaluation of this program. MethodsThe evaluation was carried out on the population invited during the second semester of 2017 using data from the program's service providers (date of invitation, of nurse appointment…), regional MSA bodies (consultation voucher), and reimbursement data (other care consumption). Participation rates were calculated overall and by participant characteristics. Medical needs were identified during the nurse appointment and new care pathways were assessed using reimbursement data. Multivariable regression models identified factors associated with participation. Results2366 beneficiaries were included in the analysis. 1559 (65.89%) were men and mean age was 52.41 (standard deviation = 14.86). 409 (17.29%) attended the nurse appointment. There was a significant increase in participation with age, in farmers vs. employees (odds ratio = 1.905, 95% confidence interval = 1.393–2.604), and in people living in the most disadvantaged areas (odds ratio = 1.579, 95% confidence interval=1.079–2.312). Participation to the consultation following the nurse appointment was high (62.35%–73.11%). 87.53% of participants had at least one medical need, and new care pathways were more frequent among those who had attended the nurse appointment (55.50% vs. 34.80%, p < 0.0001). ConclusionsThis pilot evaluation shows promising results which need to be confirmed with a national evaluation of the program and longer-term evidence.

Stepped Behavioral and Biological Screening for Oral Oncogenic HPV DNA in Middle-aged and Elderly Adults: A Feasibility Study.

Novel preventive interventions are needed to address the rising incidence of HPV+ OPC. In this feasibility study, we characterized barriers to a two-step, behavioral and biological screening program for oral oncogenic HPV infection, an intermediate outcome for HPV+ OPC.

Predictive energy management with engine switching control for hybrid electric vehicle via ADMM

This paper studies energy management (EM) of a power-split hybrid electric vehicle (HEV) equipped with planetary gear sets. We first formulate a mixed-integer global optimal control problem that includes a binary switching variable. Convex modeling, including the fuel model for a compound energy conversion unit, is then presented to reformulate the mixed-integer EM as a two-step program. For optimizing the engine switching and battery power decisions in the first step, we employ the alternating direction method of multipliers (ADMM) algorithm where the solution of the convex relaxation is used to initialize the non-convex problem. On the standard driving cycle, simulation results indicate that the ADMM based EM method saves 7.63% fuel compared to a heuristic method, and shows 99% optimality compared to a dynamic programming method, while saving three orders of magnitude in computing time. An ADMM combined model predictive control (ADMM-MPC) method is also developed that is suitable for receding horizon control scenarios. The ADMM-MPC method shows 5.28% fuel saving when implemented using a prediction horizon of 15 samples. Meanwhile, the mean computing time for MPC updates is 3.53ms. Our results demonstrate that the proposed ADMM is capable of real-time control.

Breeding for hygienic behavior in honey bees (Apis mellifera): a strong paternal effect

The haplodiploid sex determination of honey bees and the multiple mating of queens pose challenges in determining the genetic contribution of drones (male honey bees). This is especially important for breeding programs as, for example, when attempting to reinforce traits governing social immunity against pests and diseases. Here, we focused on breeding aiming at enhancing hygienic behavior, a trait that is known to reduce parasite load in honey bee colonies. To evaluate the contribution of drones versus queens to this trait, we conducted a two-step bidirectional selection program. First, we selected colonies with consistent phenotypes for low- or high-hygienic behavior (generation P). From those, we generated two types of daughter colonies (F1). One type originated from queens that had been artificially inseminated with selected drones that originated from queens of either low- or high-hygienic phenotype. The other type of colonies was set from naturally mated queens. We then compared the hygienic performance of the progeny colonies. In the next step, we used the F1 colonies (from either artificially inseminated or naturally mated queens) to produce naturally mated queens, which subsequently generated F2 colonies. These were then examined for the level of hygienic behavior. The results demonstrate the significant contribution of both parents to the phenotype of offspring. In particular, drones had a consistent and significant influence on the hygienic performance of the progeny throughout generations. These findings emphasize the great potential to propagate the hygienic trait in local populations by selecting lines for drones that carry the high-hygienic trait.

Quantification of Hydride Coverage on Cu(111) by Electrochemical Mass Spectrometry.

Electrochemical mass spectrometry (EC-MS) is combined with chronoamperometry to quantify H coverage associated with the surface hydride phase on Cu(111) in 0.1 mol/L H2SO4. A two-step potential pulse program is used to examine anion desorption and hydride formation, and the inverse, by tracking the 2 atomic mass unit (amu) signal for H2 production in comparison to the charge passed. On the negative potential step, the reduction current is partitioned between anion desorption, hydride formation, and the hydrogen evolution reaction (HER). For modest overpotentials, variations in partial processes are evident as inflections in the chronoamperometry and EC-MS signal. On the return step to positive potentials, hydride decomposition by H recombination to H2 occurs in parallel with sulfate adsorption. The challenge associated with the inherent diffusional delay in the EC-MS response is mitigated by total H2 collection and steady-state analysis facilitated by the thin-layer EC-MS cell geometry as demonstrated for the HER on a non-hydride forming Ag electrode. Analysis of the respective transients and steady-state response on Cu(111) reveals a saturated hydride fractional coverage of 0.67 at negative potentials with an upper bound charge of 106 μC/cm2 (average electrosorption valency of ≈1.76) associated with adsorption of the () mixed sulfate-water adlayer at positive potentials.

Primal-dual path following method for nonlinear semi-infinite programs with semi-definite constraints

In this paper, we propose a primal-dual path following method for nonlinear semi-infinite semi-definite programs with infinitely many convex inequality constraints, called SISDP for short. A straightforward approach to the SISDP is to use classical methods for semi-infinite programs such as discretization and exchange methods and solve a sequence of (nonlinear) semi-definite programs (SDPs). However, it is often too demanding to find exact solutions of SDPs. In contrast, our approach does not rely on solving SDPs accurately but approximately following a path leading to a solution, which is formed on the intersection of the semi-infinite feasible region and the interior of the semi-definite feasible region. Specifically, we first present a prototype path-following method and show its global weak* convergence to a Karush-Kuhn-Tucker point of the SISDP under some mild assumptions. Next, to achieve fast local convergence, we integrate a two-step sequential quadratic programming method equipped with the Monteiro-Zhang scaling technique into the prototype method. We prove two-step superlinear convergence of the resulting algorithm using Alizadeh-Hareberly-Overton-like, Nesterov-Todd, and Helmberg-Rendle-Vanderbei-Wolkowicz/Kojima-Shindoh-Hara/Monteiro scaling directions. Finally, we conduct some numerical experiments to demonstrate the efficiency of the proposed method through comparison with a discretization method that solves SDPs obtained by finite relaxation of the SISDP.

QOL-30. Positive Effects of a psychological preparation program for MRI in children with cognitive issues – how to best meet the patients’ needs

BACKGROUND: A growing body of evidence has supported alternatives to sedation and general anesthesia for increasing treatment compliance of children during MRI examinations. Particularities in children with a brain tumor (frequency of examinations, neuropsychological deficits (attention, memory)) have a significant impact on methods of treatment and are given special consideration in this study. OBJECTIVE: The aim of the present study was to (1) evaluate the effectiveness of an MRI training program and to investigate the moderating factors for successful MRI examination for a group of young patients with pediatric brain tumors and/or NF1 and (2) to examine the effect of the training on the patient’s well-being. METHODS: A total of 87 in the retrospective analyses (Study 1) and a subgroup of 17 patients in the prospective analyses (Study 2, ClinicalTrials.gov: NCT04474678) of the neuro-oncology unit with a mean age of 6.83 years underwent a two-step program to prepare children for MRI, including an in vitro strategy training inside the scanner and were recorded using a process-oriented screening. RESULTS: 81 % of the children who had received MRI training managed to successfully undergo the MRI scan. Hence, the rate of successful MRI examinations without anesthesia was almost five times as high in the group that received MRI training compared to the group that did not. Memory, attentional difficulties and hyperactivity were significant neuropsychological moderators for successful or unsuccessful scanning. Furthermore, the training was effective in improving the psychological well-being of the patients. CONCLUSION: Based on the results, the MRI training is an effective alternative to sedation of young patients for MRI examinations and a promising tool for improving patient well-being related to the diagnostic procedure. However, the intervention needs to be customized according to the children’s individual neuropsychological difficulties, which requires specialized psychological staff and an interdisciplinary approach.

Risk factor-based screening compared to universal screening for gestational diabetes mellitus in marginalized Burman and Karen populations on the Thailand-Myanmar border: An observational cohort.

Background: Gestational diabetes mellitus (GDM) contributes significantly to maternal and neonatal morbidity, but data from marginalized populations remains scarce. This study aims to compare risk-factor-based screening to universal testing for GDM among migrants along the Thailand-Myanmar border. Methods: From the prospective cohort (September 2016, February 2019), 374 healthy pregnant women completed a 75g oral glucose tolerance test (OGTT) at 24-32 weeks gestation. Fasting, one hour and two hour cut-offs were based on Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO trial) criteria and cases were treated. The sensitivity and specificity of risk-factor-based screening criteria was calculated using OGTT as the gold standard. Risk factors included at least one positive finding among 10 criteria, e.g., obesity (body mass index (BMI) ≥27.5kg/m 2), 1 st degree relative with diabetes etc. Adverse maternal and neonatal outcomes were compared by GDM status, and risk factors for GDM were explored. Results: GDM prevalence was 13.4% (50/374) (95% CI: 10.3-17.2). Risk-factors alone correctly identified 74.0% (37/50) OGTT positive cases: sensitivity 74.0% (59.7-85.4) and specificity 27.8% (3.0-33.0). Burman women accounted for 29.1% of the cohort population, but 38.0% of GDM cases. Percentiles for birthweight (p=0.004), head circumference (p=0.005), and weight-length ratio (p=0.010) were higher in newborns of GDM mothers compared with non-GDM, yet 21.7% (75/346) of newborns in the cohort were small-for-gestational age. In Burman women, overweight/obese BMI was associated with a significantly increased adjusted odds ratio 5.03 (95% CI: 1.43-17.64) for GDM compared to normal weight, whereas underweight and overweight/obese in Karen women were both associated with similarly elevated adjusted odds, approximately 2.4-fold (non-significant) for GDM. GDM diagnosis by OGTT was highest prior to peak rainfall. Conclusions: Risk-factor-based screening was not sufficiently sensitive or specific to be useful to diagnose GDM in this setting among a cohort of low-risk pregnant women. A two-step universal screening program has thus been implemented.

Enhanced Recovery Pathway in Lung Resection Surgery: Program Establishment and Results of a Cohort Study Encompassing 1243 Consecutive Patients

Simple SummaryEnhanced Recovery Pathways (ERP) have been scarcely assessed in lung cancer surgery. We performed a two-step audit for our experience: the first dealing with our initial experience focusing on patients undergoing segmentectomies and lobectomies, the second including all subsequent consecutive patients undergoing all kind of lung resections for NSCLC. The first step aimed at auditing results of ERP on occurrence of postoperative complications and at assessing which ERP components were associated with improved short-term outcomes. We also audited late results by assessing long-term survival of patients in the first step of our study. The second step aimed at auditing on large-scale short-term results of the ERP in a real-life setting. In total, 166 patients were included in the first period. No postoperative death occurred. The overall adverse events rate was 30%. In multivariate analyzes, the only element associated with reduced adverse postoperative events was chest tube withdrawal within POD2. The 1-, 3- and 5-year survival rates were 97%, 86.1%, and 76.3%, respectively. In the second period, 1077 patients were included; 11 patients died during the postoperative period. The overall postoperative adverse event rate was 30.3%. Thoracoscore independently predicted postoperative death, the occurrence of complications (all-kind, minor, major, or respiratory ones). We conclude that compliance to ERP procedures and early chest tube removal are associated with reduced postoperative events in patients with lung resection surgery. Thoracoscore is a useful tool in predicting mortality and postoperative adverse events.Introduction: In spite of increasing diffusion, Enhanced Recovery Pathways (ERP) have been scarcely assessed in large scale programs of lung cancer surgery. The aim of this study was auditing our practice. Methods: A two-step audit program was established: the first dealing with our initial ERP experience in patients undergoing non-extended anatomical segmentectomies and lobectomies, the second including all consecutive patients undergoing all kind of lung resections for NSCLC. The first step aimed at auditing results of ERP on occurrence of postoperative complications and at assessing which ERP components are associated with improved short-term outcomes. We also audited late results by assessing long-term survival of patients in the first step of our study. The second step aimed at auditing on large-scale short-term results of the ERP in a real-life setting. Results: Over a one-year period, 166 patients were included. The median number of ERP procedures per patient was three (IQR 3–4). No postoperative death occurred. The overall adverse events rate was 30%. In multivariate analyzes, the only element associated with reduced adverse postoperative events was chest tube withdrawal within POD2 (OR = 0.21, 95% CI (0.10–0.46)). The 1-, 3-, and 5-year survival rates were 97%, 86.1%, and 76.3%, respectively. In the second period, 1077 patients were included in our ERP; 11 patients died during the postoperative period or within 30 days of operation (1.02%). The overall postoperative adverse event rate was 30.3%, major complication occurring in 134 (12.4%), and minor ones in 192 (17.8%). Respiratory complications occurred in 64 (5.9%). Thoracoscore independently predicted postoperative death, the occurrence of complications (all-kind, minor, major, or respiratory ones). Conclusions: Compliance to ERP procedures and early chest tube removal are associated with reduced postoperative events in patients with lung resection surgery. In a large setting scale, ERP can be applied with satisfactory results in terms of mortality and morbidity. Thoracoscore is a useful tool in predicting mortality and postoperative adverse events.

Learning, teaching, and training in microsurgery: A systematic review

Numerous microsurgical training techniques and materials have been developed to reduce animal use and training costs. This systematic review aimed to catalog the available microsurgery learning methods on non-living material in order to define an educational program. The PubMed database was searched for English and French articles related to the initial learning of microsurgery with inert, non-living, or digital material and containing the keywords “microsurgery”, “non-living”, “simulation” and “virtual reality”. Among the 488 articles found, 82 were included. This work reports the main microsurgery learning supports. They were classified according to the material used: inert material, cadaveric animal tissues, human cadaver model, virtual reality, and digital technologies. The educational program proposes here is a two-step program that uses non-living material (basic and deepening) before progressing to living models. This initial learning phase teaches basic microsurgical skills (precision, tremor management, and magnification). Then, frequent home training sessions help to maintain the acquired skills. Ethical, organizational, and economic constraints limit access to animal models. Therefore, inert models seem to be ideal support for initial microsurgical learning. The multiplicity of models described makes it possible to achieve progressive learning depending on which models are available.