Worst Rate Research Articles

Comparison of gallbladder extraction via the subxiphoid port and the supraumbilical port during laparoscopic cholecystectomy: a prospective randomized clinical trial

Background: Postoperative pain after laparoscopic cholecystectomy (LC) is the most frequent postoperative complaint. To date, gallbladder extraction via the subxiphoid port (SXP) versus the supraumbilical port (SUP) is still controversial. Thus, we performed this randomized controlled trial to compare postoperative pain between the SXP and SUP for LC. Method: From June 2021 to June 2023, patients who met the inclusion criteria were randomly assigned to two groups. The perioperative data of both groups were recorded and compared. Results: A total of 253 patients were enrolled in the analysis. There were 126 in the SXP group and 127 in the SUP group. There was no significant difference between the two groups in terms of the duration of gallbladder extraction, whether the incision was extended, the least rate of pain, the average rate of pain, the right-now rate of pain, postoperative pain on the 5th, 7th, and 14th days, postoperative complications and Vancouver Scar scale (VSS). However, the SUP group had a lower the worst rate of pain (4.24±2.45 vs. 4.91±2.45, P=0.031) and 3 days of pain (3.35±1.57 vs. 3.75±1.52, P=0.045) than did the SXP group. The influence of pain on general activity (4.51±2.90 vs. 3.76±2.92, P=0.041), mood (3.62±2.66 vs. 2.92±2.36, P=0.028), walking ability (4.40±3.01 vs. 3.66±2.76, P=0.044), and enjoyment of life (3.19±2.68 vs. 2.32±2.34, P=0.007) in the SXP was more severe than that in the SUP. Conclusion: The extraction of the gallbladder via the SUP is superior to that via the SXP because the early postoperative 24-hour pain and pain on the third day are mild and do not increase the duration of gallbladder extraction or the risk of infection or hernia.

You Don’t Have to be Their Best Friend: Complicating the Instructor-Student Relationship through a Mixed-Method Typology

The purpose of this study was to explore the nuances of instructor-student relationships with a nationally representative sample of students. Participants were randomly assigned to describe relationships with their best, worst, and/or last instructor and rate their satisfaction with each relationship, and the level of closeness with the instructor. Coding of student descriptions revealed 13 themes, organized into six pairs of constructive/destructive relationship anchors and one neutral category (Professional Relationship). Importantly, professional relationships were not as close as constructive relationships but were equally satisfying, indicating the closeness in instructor-student relationships has diminishing returns. Results are discussed in the context of instructional communication research and pedagogy.

Right ventricular-pulmonary artery coupling and in-hospital mortality of patients with first acute coronary syndrome

Abstract Background Right ventricular-pulmonary artery (RV-PA) coupling is a means of indexing RV performance to the existent RV afterload. Although non-invasive analysis of RV-PA coupling is a well-recognized prognosticator in chronic RV pressure overload conditions such as heart failure and pulmonary hypertension, its impact in patients with myocardial infarction and acute elevations in RV afterload remains undetermined. Aim This study sought to investigate the associations and short term prognostic value of RV-PA coupling in patients with first acute coronary syndrome (ACS), as assessed by two standard echocardiographic measurements: tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP). Methods A total of 300 consecutive patients with first ACS (mean age 61.2±11.8 years, 74% males) were prospectively enrolled. A comprehensive transthoracic echocardiographic assessment was undertaken within 24 hours after revascularization. In-hospital mortality was the study endpoint. The study population was dichotomized according to the optimal TAPSE/PASP cut-off, as determined by receiver-operating characteristic curve analysis. Univariable and multivariable logistic regression analysis was performed to determine predictors of impaired TPASE/PASP and the association of TAPSE/PASP with in-hospital mortality. To further assess the incremental prognostic value of TAPSE/PASP over a baseline model the change in x² was assessed using the likelihood ratio test. Results A total of 23 (7.7%) patients died in-hospital despite successful revascularization. The optimal cut-off value of TAPSE/PASP to determine in-hospital mortality was 0.49. Among others, univariable associates of impaired TAPSE/PASP were the Global Registry of Acute Coronary event (GRACE) risk score, Killip Class >2, late presentation after symptoms onset, NT-pro-BNP, and left ventricular ejection fraction (LVEF). In multivariable analysis LVEF was the only independent predictor of impaired TAPSE/PASP (OR 0.889, 95% CI [0.821-0.963], p=0.004). The subgroup of patients with LVEF<40% and TAPSE/PASP<0.49mm/mmHg exhibited the worst in-hospital mortality rate (Abstract Picture 1). TAPSE/PASP was significantly associated with in-hospital mortality (OR 0.037, 95% CI [0.009-0.153], p<0.001), and retained this association after adjusting for GRACE risk score and LVEF (OR 0.137, 95% CI [0.032-0.578], p=0.007). The incremental prognostic value of TAPSE/PASP<0.49mm/mmHg for in-hospital mortality was evaluated by adding it to a model including the GRACE risk-score, LVEF<40% and TAPSE<17mm. The further addition of impaired TAPSE/PASP significantly increased the x² of the model from 21.627 to 86.213, p<0.001 (Abstract Picture 2). Conclusion RV-PA coupling assessed non-invasively by echocardiography 24 hours after revascularization was an independent predictor of in-hospital mortality in patients with first ACS and may improve risk stratification.In hospital mortality ratesIncremental prognostic value

Epidemiology, characteristics, and outcomes of adult haemophagocytic lymphohistiocytosis in the USA, 2006–19: a national, retrospective cohort study

Haemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening syndrome characterized by an excessive inflammatory response. Limited data exist on adult HLH. In this national, retrospective cohort study, we analysed data from the US National Inpatient Sample database collected between October 1, 2006 and December 31, 2019. Using the International Classification of Diseases (ICD) codes, we identified all adult patients who were admitted non-electively with the diagnosis of HLH. We described demographic characteristics, triggers, and associated conditions. Trends of diagnosis, treatment, and in-hospital mortality were analysed using joinpoint models. In-hospital mortality rates were compared using multivariable logistic regression models that adjusted for demographic characteristics and associated conditions. Finally, we described resource utilization outcomes including cost of hospitalization and length of stay. We identified 16,136 non-elective adult HLH admissions. The population pyramid showed a bimodal distribution, with peaks in young adults (16-30 years) and older adults (56-70 years). Joinpoint regression analysis revealed a significant increase in HLH incidence per 100,000 admissions over the study period (Average Annual Percent Change [APC]=25.3%, p<0.0001), and no significant change in rates of in-hospital mortality (slope=-0.01; p=0.95) or administration of in-hospital HLH treatment (slope=0.46, p=0.20). The most common associated conditions were malignancy (4953 admissions [30.7%]), infections (3913 admissions [24.3%]), autoimmune conditions (3362 admissions [20.8%]), organ transplant status (639 admissions [4%]), and congenital immunodeficiency syndromes (399 admissions [2.5%]). In-hospital mortality was higher in older adults and males. Furthermore, Congenital immunodeficiency syndromes had the worst in-hospital mortality rate (mortality rate 31.1%, adjusted OR 2.36 [1.56-3.59]), followed by malignancies (mortality rate 28.4%, adjusted OR 1.80 [1.46-2.22]), infections (mortality rate 21.4%, adjusted OR 1.33 [1.10-1.62]), other/no trigger (mortality rate 13.6%, adjusted OR 0.73 [0.58-0.92]), autoimmune (mortality rate 13%, adjusted OR 0.72 [0.57-0.92]), and post-organ transplant status (mortality rate 14.1%, adjusted OR 0.64 [0.43-0.97]). The overall mean length of stay was 14.3±13.9 days, and the mean cost of hospitalization was $54,900±59,800. We provide insight into the burden of adult HLH in the USA. The incidence has been increasing and the outcomes remain dismal. This signifies the growing need for the development of updated diagnosis and treatment protocols that are specific to adult HLH. None.

Concordancia clínica y patológica en tumores conjuntivales: Análisis de 195 casos

PurposeThe present study aims to assess the agreement between clinical and pathological diagnosis in conjunctival tumours in a specialist ocular oncology unit. MethodsA retrospective study of consecutive patients with conjunctival tumours diagnosed at the Ocular Oncology Unit of the University Hospital of Valladolid was performed from 1992 to 2017. Tumours were classified according to their origin (epithelial, melanocytic, lymphoid, and others) and degree of malignancy (benign, premalignant, and malignant). A biopsy was performed in cases of symptomatic or growing lesions. Cohen's kappa (κ) statistics was used as an indicator of agreement between clinical and pathological diagnosis. ResultsOf 462 consecutive patients, a biopsy was required in 195 (42.2%). The agreement with the pathological diagnosis was successful in 154 (79%) cases. Analysis according to the grade of malignancy showed the lowest rate of agreement among benign (n = 83; 91.6%) and premalignant (n = 62; 90.3%) lesions, with a total agreement in malignant lesions (n = 50; 100%); the Cohen's kappa coefficient (κ) was 0.90. The highest rates of concordance were found in epithelial, melanocytic and soft tissue lesions with κ values of 1, 0.8 and 1, respectively. The worst rate of concordance was found in lymphoid lesions with a κ value of 0.3. ConclusionsMost of the conjunctival tumours were correctly identified clinically; benign and malignant lesions showed the highest rate of accuracy; however, premalignant tumours can hide micro-invasive diseases that can go unnoticed on clinical examination. The biopsy is essential for accurate diagnosis and treatment.

Clinic-pathological agreement in the diagnosis of conjunctival tumours: Analysis of 195 cases

PurposeThe present study aims to assess the agreement between clinical and pathological diagnosis in conjunctival tumours in a specialist ocular oncology unit. Methodsretrospective study of consecutive patients with conjunctival tumours diagnosed at the Ocular Oncology Unit of the University Hospital of Valladolid was performed from 1992 to 2017. Tumours were classified according to their origin (epithelial, melanocytic, lymphoid and others) and degree of malignancy (benign, premalignant, malignant). A biopsy was performed in cases of symptomatic or growing lesions. Cohen´s kappa (κ) statistics was used as an indicator of agreement between clinical and pathological diagnosis. ResultsOf 462 consecutive patients, a biopsy was required in 195 (42.2%). The agreement with the pathological diagnosis was successful in 154 (79.0%) cases. Analysis according to the grade of malignancy showed the lowest rate of agreement among benign (n = 83; 91.6%) and premalignant (n = 62; 90.3%) lesions, with a total agreement in malignant lesions (n = 50; 100%); the Cohen´s kappa coefficient (κ) was 0.90. The highest rates of concordance were found in epithelial, melanocytic and soft tissue lesions with κ values of 1, 0.8 and 1 respectively. The worst rate of concordance was found in lymphoid lesions with a κ value of 0.3. ConclusionMost of the conjunctival tumours were correctly identified clinically; benign and malignant lesions showed the highest rate of accuracy; however, premalignant tumours can hide micro-invasive diseases that can go unnoticed on clinical examination. The biopsy is essential for accurate diagnosis and treatment.

MDB-01. ELUCIDATING THE ROLE OF THE BAIAP2-CDC42 INTERACTION MEDULLOBLASTOMA

Abstract Medulloblastoma is the most common malignant pediatric brain tumor. Despite advancements in treatment, there is still no significant improvement in survival rates. This indicates novel, more effective treatment options are necessary. In addition, when medulloblastoma is metastasized outside the central nervous system, there is worst mortality rate. The regulatory properties of metastasis and invasion are still not well understood. We sought to identify potential key regulators for these processes in medulloblastoma. Single-cell RNA sequencing data was collected for medulloblastoma patients and an experiment with a Tg (Neurod-Smoothened*A1) mouse. We identified BAIAP2 and CDC42 to be differentially expressed compared to non-tumor brain cells. Previous literature shows that these genes are implicated in oncogenic properties including invasion, migration, and proliferation in different cancers and neurological diseases. We hypothesize that distinct cell populations within medulloblastoma should show different expressions of BAIAP2 and CDC42, specifically those involved in invasion and migration. We determined that BAIAP2 and CDC42 have higher expression in medulloblastoma tumors compared to the control. In our data, the cell population enriched for microtubule depolymerization had a high expression of BAIAP2, unlike the other clusters. This study is important because BAIAP2 and CDC42 have yet to be characterized in medulloblastoma. Our data suggest a potential role for BAIAP2 and CDC42 in the pathophysiology of medulloblastoma which can possibly be a target for future studies.

Value of simple otoscopy in diagnosing otitis media with effusion in children

AimsTo explore the value of otoscopy in diagnosing OME when performed by otorhinolaryngology, pediatrics, and primary care physicians; to evaluate the interobserver and intraobserver agreement of interpretation of otoscopy images. Material and methodsA cross-sectional study using an anonymous mailed survey was used. We presented pre-recorded otoscopy images of pediatric patients to otorhinolaryngology, pediatrics, and primary care physicians (ten volunteer specialists and residents from each medical specialty). All participants had to answer “yes” or “no” if they considered that the image corresponded or not to an OME case, respectively. We considered that the images were positive for OME whenever the respective tympanogram was type B. ResultsThirty-one otoscopy images and 1860 responses provided by sixty physicians were analyzed. The accuracy of otoscopy in diagnosing OME was highest in the Otolaryngologists group (mean 74.8%), with the worst rate observed in the primary care residents group (mean 51.3%). Overall sensitivity, specificity, and positive predictive value of otoscopy for diagnosing OME were significantly higher when performed by otorhinolaryngologists (75.8%, 72.8%, 66.8%, respectively). Fleiss' kappa showed that interobserver agreement was globally weak within each group of specialties, with overall better interobserver agreement observed among otorhinolaryngologists (κ = 0.30; 95% CI 0.27–0.32). ConclusionAccording to our data, simple otoscopy as a single diagnostic method in pediatric OME is insufficient, even for otorhinolaryngologists. Current recommendations must be followed to improve diagnostic accuracy.

Cutaneous Squamous Cell Carcinoma in Immunocompromised Patients-A Comparison between Different Immunomodulating Conditions.

Immunosuppression is strongly associated with an increased risk of developing cutaneous squamous cell carcinoma (cSCC). Studies on solid organ transplant recipients (SOTR) and chronic lymphocytic leukemia (CLL) patients have already demonstrated higher rates of aggressive cSCC tumors in these populations compared to immunocompetent controls. Studies on other immunosuppressed patient groups are scarce. This study was aimed at assessing the effects of different immunomodulating conditions on patients diagnosed with cSCC. We sought to compare the clinical features, treatments, and survival rates among the different study groups, as well as outcomes to those of immunocompetent controls with cSCC. A retrospective analysis of 465 cSCC patients, both immunosuppressed (IS) and immunocompetent controls. Etiologies for immunosuppression included SOTR, CLL, chronic kidney disease (CKD), psoriasis, rheumatoid arthritis (RA) and systemic lupus erythematous (SLE). Compared to the control group, IS patients demonstrated several significant differences. These include higher rates of positive resection margins, higher recurrence rates, and multiple SCC tumors. Patients in the IS group, who were also given immunomodulating agents, demonstrated even lower survival rates. Cox regression analysis demonstrated statistically significant decreased overall survival (OS) rates for IS patients compared to the controls (OR = 1.9, p = 0.031). SOTR patients tend to have multiple cSCC tumors (35%), with the highest number of primary tumors compared to controls (2.54 tumors per patient on average, p < 0.001), but also compared to all other IS groups. The average SCC lesion size in the SOTR group was the smallest, measuring at 13.5 mm, compared to the control group and all other IS groups. Decreased survival rates were seen on Cox regression analysis compared to controls (HR = 2.4, p = 0.001), but also to all other IS groups. CLL patients also had the highest rates of positive margins compared to controls (36% vs. 9%, p < 0.01) and to all other IS groups. They were also most likely to get adjuvant or definitive oncological treatments, either radiotherapy or chemotherapy, compared to controls (36% vs. 15%, p = 0.02) and to other IS groups. Patients in the CKD group demonstrated the highest rates for multiple cSCC (OR = 4.7, p = 0.001) and the worst rates of survival on Cox regression analysis (HR = 3.2, p = 0.001). Both rheumatoid arthritis and psoriasis patients demonstrated the shortest disease-free survival rates (2.9y ± 1.1, 2.3y ± 0.7, respectively), compared to controls (4.1y ± 2.8) and to all other IS groups. Among cSCC patients, immunosuppression due to SOTR, CLL, CKD, RA, and psoriasis is associated with worse outcomes compared to controls and other IS groups. These patients should be regarded as high-risk for developing aggressive cSCC tumors. This study is the first to assess and compare cSCC outcomes among multiple IS patient groups.

The Educational Needs of Adolescent and Young Adult Renal Transplant Recipients-A Scoping Review.

Renal transplantation is the gold-standard treatment for adolescents and young adults with end-stage renal disease. Despite enjoying excellent short-term outcomes, they suffer the worst rates of premature transplant function loss. Health behaviors: such as lack of adherence to immunosuppressive medications, are felt to be the major contributory factor. Understanding the educational needs of young renal transplant recipients allows healthcare practitioners to better support patients in managing their chronic disease. The aim of this scoping review was to understand what is known about their educational needs. A scoping review methodology was followed. Following an online search, study titles, and abstracts were screened for eligibility, followed by full-text assessment and data extraction. Data were qualitatively analyzed using thematic analysis. A total of 29 studies were included in the scoping review. In young people who struggled with self-management, three themes were identified (1) the Needs of the disrupted youth, (2) the Needs of the disorganized youth (3) the Needs of the distressed youth. There was a paucity of research to identify the protective factors that enable young recipients to successfully manage their health. This review outlines current knowledge of the patient education needs of young transplant recipients. It also highlights remaining research gaps that will need to be addressed with future research.

COVID-19 in Latin America and the Caribbean with a Special Focus on Perú, México, and Cuba

This essay offers a summary of the impact of COVID-19 and efficacy of the responses in Latin America and the Caribbean, with a particular focus on Perú, México, and Cuba. Because so much has already been written on COVID-19, the goal of this article is to move beyond what has already been said, providing a briefing on what has been most unusual and counter-intuitive regarding the pandemic in the region. Focusing on Perú, México, and Cuba allows the spotlighting of several critical issues. Cuba, with a model public health care system and successful bio-tech sector, was largely spared the first wave of the pandemic, only to be severely affected by the Omicron variants. Perú and México have suffered during the pandemic the very worst excess mortality rates in the world. This essay explores these matters, explaining how a lethal confluence of negative forces came together with deadly consequences for the people of Latin America and the Caribbean.

Abstract B019: Identify features of fibroblast and macrophage which regulate metastasis of triple-negative breast cancer

Abstract The tumor microenvironment (TME), which the cancer is known to remodel, can interact with cancer in various ways, such as promoting or hindering metastasis. The challenge with comprehending TME is that each patient's individual variance makes it difficult to carry out a consistent analysis. We used the PDX model to analyze the alterations entirely brought about by cancer cells of each patient in the same environment exclusively. In 121 breast cancer patients, we created a PDX model and performed WES and RNA-seq. We repeatedly performed metastatic induction tests on the models of 26 TNBC patients among the PDX models we generated. The replicated experiments confirmed that cancer cells with frequent metastasis usually spread well, while cancer cells with seldom metastases rarely metastasize. For each of the five samples that had the greatest and worst rates of metastasis, the pre-metastatic xenograft tumor was analyzed using scRNA-seq. Metastasis could not be predicted by only cancer cells because there was no difference between the two groups. Still, fibroblasts and macrophages had distinct gene markers before metastasis which can predict metastasis. To explore TME that develops pre-metastatic niches (PMN) in organs that would be metastasis targets, we developed a metastatic model using 4T1 cell lines. Daily lung macrophage RNA-seq, lung WES, and lung scRNA-seq procedures were carried out for four weeks to examine the precise timing of metastasis and the daily changes in the transcriptome. Surprisingly, a few days before the presence of any cancer cells, the gene expression of lung macrophages had already undergone significant modification. Additionally, only injections of tumor-conditioned media that mimicked metastasis could activate PMN in lung macrophages. Citation Format: Woochan Lee, Hyewon Chung, Woohang Heo, Hyeong-Gon Moon, Seung Hyeok Seok, Jong-Il Kim. Identify features of fibroblast and macrophage which regulate metastasis of triple-negative breast cancer [abstract]. In: Proceedings of the AACR Special Conference: Cancer Metastasis; 2022 Nov 14-17; Portland, OR. Philadelphia (PA): AACR; Cancer Res 2022;83(2 Suppl_2):Abstract nr B019.

Value of simple otoscopy in diagnosing otitis media with effusion in children

AimsTo explore the value of otoscopy in diagnosing OME when performed by otorhinolaryngology, pediatrics, and primary care physicians; to evaluate the interobserver and intraobserver agreement of interpretation of otoscopy images. Material and methodsA cross-sectional study using an anonymous mailed survey was used. We presented pre-recorded otoscopy images of pediatric patients to otorhinolaryngology, pediatrics, and primary care physicians (ten volunteer specialists and residents from each medical specialty). All participants had to answer “yes” or “no” if they considered that the image corresponded or not to an OME case, respectively. We considered that the images were positive for OME whenever the respective tympanogram was type B. ResultsThirty-one otoscopy images and 1860 responses provided by sixty physicians were analyzed. The accuracy of otoscopy in diagnosing OME was highest in the Otolaryngologists group (mean 74.8%), with the worst rate observed in the primary care residents group (mean 51.3%). Overall sensitivity, specificity, and positive predictive value of otoscopy for diagnosing OME were significantly higher when performed by otorhinolaryngologists (75.8%, 72.8%, 66.8%, respectively). Fleiss' kappa showed that interobserver agreement was globally weak within each group of specialties, with overall better interobserver agreement observed among otorhinolaryngologists (κ = 0.30; 95% CI 0.27–0.32). ConclusionAccording to our data, simple otoscopy as a single diagnostic method in pediatric OME is insufficient, even for otorhinolaryngologists. Current recommendations must be followed to improve diagnostic accuracy.

Pipeline, Pathway, Burrow

Pipeline, Pathway, Burrow

Health Communications Trial with a Resistant Population to Increase Public Health Compliance during a Pandemic

Background: Georgia has among the worst rates of COVID-19 hospitalization and death rates in the nation. Many identifying as politically conservative resist public health mitigation measures, similar to populations in other politically conservative geographical areas. There are limited peer-reviewed public health communications designed for this population. We aimed to determine if an intervention using a fear appeal approach with efficacy during a pandemic can positively affect knowledge, attitude, perception, and/or behavior (KAP) in Georgia with this population. Methods: We delivered online video stimuli tailored to the geocultural characteristics of the target population. designed to stimulate fear, encourage efficacy, and counter mis- and disinformation. It used three routes to affect participants: narrative, direct messaging, and non-message cues. We measured risk aversion and conspiratorial ideation as moderating psychological factors using psychological batteries. Census and voting data were used to identify a convenience sample of 829 Georgia adults in an outer Atlanta suburb. Results: Exposure to the video, moderated by risk aversion, resulted in increased recommended mitigating behavior to prevent COVID-19 (13.7%, 95% CI: 2.7% to 24.7%,) and increased positive attitude toward the recommendations (7.7%, 95% CI: 5.9% to 9.3%). Exposure to the video, moderated by conspiratorial ideation, resulted in an increase in perception of COVID-19 risk (7.6% 95% CI: 1.8% to 13.5%) among participants. Conclusions: An intervention using a fear appeal approach with efficacy during a pandemic can positively affect attitude and risk perception of a politically conservative population. Scaling similar interventions with resistant geocultural populations has promise of increasing adherence to public health recommendations. The moderating factor of conspiratorial ideation is relevant given conspiracies during pandemics, such as COVID-19. This multidisciplinary study contributes to the extant literature by providing insights of populations influenced by contrary political attitudes.

Optimal Sizing of a Hybrid Renewable Photovoltaic-Wind System-Based Microgrid Using Harris Hawk Optimizer

Hybrid renewable energy microgrid has become an attractive solution to electrify urban areas. This research proposes a microgrid design problem including photovoltaic (PV) arrays, wind turbine, diesel, and batteries for which Harris hawk optimization (HHO), a metaheuristic technique, is applied. Based on a long-term techno-economic assessment, the HHO approach is used to determine the best hybrid microgrid size for a community in Saudi Arabia’s northern region. The efficacy of HHO is investigated, and its performance was compared with seven metaheuristic techniques, grasshopper optimization algorithm (GOA), cuckoo search optimizer (CSO), genetic algorithm (GA), Big Bang–Big Crunch (BBBC), coyote optimizer, crow search, and butterfly optimization algorithm (BOA), to attain the HRE microgrid optimal sizing based on annualized system cost (ASC) reduction. Some benchmarks (optimum and worst solutions, mean, median, standard deviation, and rate of convergence) are used to distinguish and analyze the performance of these eight metaheuristic-based approaches. The HHO surpassed the other seven metaheuristic techniques in achieving the best HRE microgrid solution with the lowest ASC (USD 149229.9) followed by GOA (USD 149380.5) and CSO (USD 149382.5). The findings revealed that the HHO, GOA, CSO, and coyote have acceptable performance in terms of capturing the global solution and the speed of convergence, with only minimal oscillations. The BBBC, crow search, GA, and BA, on the other hand, have unacceptably poor performance, trapping to the local solution, oscillations, and a long convergence time. In terms of optimal solution and convergence rate, the BBBC and GA both perform poorly when compared to the other metaheuristic techniques.

Indoor CO2 and Thermal Conditions in Twenty Scottish Primary School Classrooms with Different Ventilation Systems during the COVID-19 Pandemic

Healthy indoor environments influence the comfort, health and wellbeing of the occupants. Monitoring the indoor temperature, relative humidity and CO2 levels in primary schools during the COVID-19 pandemic was mandated by a local authority in Scotland. The aim was to investigate the comfort and safety of the teachers and their pupils. This paper presents the measurements of indoor climate in 20 classrooms in four different primary schools in Scotland. The schools were of different architypes. The classrooms were of different sizes, orientations and occupancy, and had different ventilation systems. Ventilation was achieved either by manually opening the windows, or by a mechanical ventilation system. Indoor air temperature, relative humidity and carbon dioxide (CO2) concentrations were continuously monitored for one week during the heating season 2020/21. Occupancy and opening of the windows were logged in by the teachers. The ventilation rates in the classrooms were estimated by measuring the CO2 concentrations. On the 20 classrooms of the study, data of 19 were analysed. The results show that four of the five mechanically ventilated classrooms performed better than natural ventilation, which indicates that opening the windows depended on the customs and habits. Classrooms in naturally ventilated Victorian buildings have the worst average ventilation rate (4.38 L/s per person) compared to the other classrooms (5.8 L/s per person for the more recent naturally ventilated ones, and 6.08 L/s per person for the mechanically ventilated ones). The results of this preliminary study will be used as the basis to find ways to ensure adequate ventilation in natural ventilated classrooms.

Supporting Success: ASTHO's Strategies for Reducing Maternal Mortality and Morbidity.

Supporting Success: ASTHO's Strategies for Reducing Maternal Mortality and Morbidity.

Geographical and Meteorological Evaluations of COVID-19 Spread in Iran

Since late 2019 many people all over the world have become infected and have died due to coronavirus. There have been many general studies about the spread of the virus. In this study, new and accumulated confirmed cases (NCC and ACC), new and accumulated recovered cases (NRC and ARC), and new and accumulated deaths (ND and AD) were evaluated by geographical properties, meteorological parameters and air particulate matters between 3 April 2020 and 11 June 2020 within 15 provinces in Iran. Meteorological parameters, air particulate matters and COVID-19 data were collected from Iran Meteorological Organization, the Environmental Protection Agency and Aftabnews website, respectively. The results of the study show that provinces in dry lands (i.e., Kerman and South Khorasan) not only had low admission of NCC, ACC, ARC and AD but also presented lower rates of NCC, ACC and AD per 105 population. Air temperature showed positive and significant correlation with the number of COVID-19 cases. This is because of hot outdoor air especially in costal and equatorial regions that forces people to stay in closed environments with no ventilation and with closed-cycle air conditioners. Maximum air pressure was found to be the most frequent (66%) and significant parameter correlating with health outcomes associated with COVID-19. The most engaged province in this study was Khuzestan, while provinces in dry lands (i.e., Kerman and South Khorasan) showed low number of health endpoints associated with COVID-19. The highest rate of accumulated and new recovered cases per 105 population were also found in Khuzestan and Kerman provinces. North Khorasan also showed the worst rate of N&amp;ARC/105 population. Therefore, air temperature, dry lands and population were the most important factors for the control of coronavirus spread.

58 Burn Injuries in Asia: A Global Burden of Disease Study

IntroductionBurn injuries disproportionately affect low- and middle-income countries. Work conditions, rapid industrialization, social conditions, cultural activities, political conflict, and lack of access to safe and affordable surgery are key barriers to effective burn care in Asia. This study aimed to better define the burn burden in Asia, its sub-regions, and related sex and age disparities to elucidate populations where targeted burn care interventions are most needed.MethodsThe 2019 Global Burden of Disease (GBD19) of the Global Health Data Exchange was used to acquire 151,741 sources of epidemiological data on fire, heat, and hot substance-related injuries for 53 countries in Asia from 1990 to 2019. Measures used to derive summative statistics included incidence, deaths, disability-adjusted life years (DALYs), and mortality ratio (deaths: incidence) by year, sex, age, and location. Spatial mapping was performed to geographically delineate burn indicators.ResultsFrom 1990 to 2019, an estimated 117 million burns occurred in Asia. The relative proportion of global burns, deaths, and DALYs from Asia increased during that time. By 2019, 46% of global burn cases, 47% of deaths, and 46% of DALYs were from Asia. The two most burdened regions were South and Southeast Asia, accounting for 30-40% of all global cases, deaths, and DALYs. Compared to global averages, the incidence, death, and DALY rates for Asia were 32%, 22%, and 23% higher. Central Asia had the worst rates, averaging 2.9, 2.3, and 2.6 times the global averages. Throughout Asia, men were 32%, 63%, and 47% more likely to be burned, die, and suffer DALYs than women versus the global disparities of 7%, 26%, and 10%. Only South Asia’s trend was reversed with women suffering 15%, 20%, and 27% more burns, deaths, and DALYs than men. In Asia, those under 5 years were most impacted by DALYs (314 years/100,000 people), 5-14 year olds had the highest burn rate (219 cases/100,000), and 70+ year olds had the highest death rate (8.4 deaths/100,000) and mortality ratio (54%).ConclusionsIn 2019, Asia had an estimated 3.8 million burns comprising nearly half of all the world’s burn cases, deaths, and DALYs. While Asia’s burn indicators have declined since 1990, global improvements have surpassed Asia’s. South and Southeast Asia accounted for the greatest burden of burn morbidity and mortality, but Central Asia consistently had the highest rates relative to overall population. Men were more affected than women, except in South Asia, and the extremes of age (< 5 and 70+ years) suffered the greatest rates of disability and death.