Understanding the temporal dynamics of invasive late blight populations in India for improved management practices.

The microbial oomycete pathogen, Phytophthora infestans causes severe epidemics of potato late blight in crops globally. Disease management benefits from an understanding of the diversity of pathogen populations. In this study, we explore the dynamics of P. infestans populations in the late blight-potato agro-ecosystem across the Indian subcontinent. Investigations of the macroecological observations at the field level and microbial ecological principles provided insights into future pathogen behaviour. We use a comprehensive simple sequence repeat allele dataset to demonstrate that an invasive clonal lineage called EU_13_A2 has dominated populations over 14 years across India, Bangladesh, and Pakistan. Increasing levels of sub-clonal variation were tracked over time and space and, for the first time, populations in Asia were also compared to the source populations from Europe. Within India, a regional pathogen population structure was observed with evidence for local migration, cross-border movement between surrounding countries, and introductions via imports. There was also evidence of genetic drift and between-season transmission of more strongly pathogenic sub-clones with a complete displacement of some sub-clonal types. The limited introduction of novel genotypes and the use of resistant potato cultivars could contribute to the dominance of the 13_A2 lineage. The insights will contribute to the management of the pathogen in these key global potato production regions.

A Survey of Phytophthora spp. in Eastern Indian Nurseries and Their Sensitivity to Six Oomycete-Targeted Commercial Fungicides.

A survey of the flori-horticultural nurseries in eastern India found Phytophthora nicotianae to be the most widespread Phytophthora species associated with different foliar symptoms of nursery plants and identified the presence of P. palmivora in eastern Indian nurseries for the first time. The survey also led to the first worldwide finding of P. nicotianae on Dipteracanthus prostratus (Poir.) Nees; Ocimum tenuiflorum L. (syn. Ocimum sanctum L.); Philodendron xanadu Croat, Mayo & J. Boos; and Pyrostegia venusta (Ker-Gawl.) Miers and P. palmivora on Episcia cupreata (Hook.) Hanst., as well as the first report from India of P. nicotianae on Spathiphyllum wallisii Regel; Anthurium andraeanum Linden ex André; and Adenium obesum (Forsk.) Roem. & Schult. Sensitivity to commercial fungicides Glazer 35WS, Rallis India (metalaxyl, FRAC code 4); Ridomil Gold, Syngenta (mefenoxam + mancozeb); Revus, Syngenta (mandipropamid, FRAC code 40); Aliette Bayer (fosetyl-Al, FRAC code 33); Acrobat, BASF (dimethomorph, FRAC code 40); and Amistar, Syngenta (azoxystrobin, FRAC code 11) was analyzed, showing EC50 values ranging from 0.75 to 16.39 ppm, 0.74 to 1.45 ppm, 2.43 to 17.21 ppm, 63.81 to 327.31 ppm, 8.88 to 174.69 ppm, and 0.1 to 1.13 ppm, respectively, with no cross-resistance of the isolates to the fungicides. The baseline information produced about these Phytophthora spp. from ornamental and horticultural host associations could help prevent the pathogens from becoming primary drivers of new disease outbreaks and their large-scale distribution beyond their natural endemic ranges.

Hippocampal avoidance whole brain radiotherapy in brain metastasis using volumetric modulated arc therapy: experience from a Regional Cancer Centre of Eastern India.

Background: Whole-brain radiotherapy is associated with neurocognitive decline and decreased quality-of-life (QOL) among survivors of brain metastasis. Hippocampal-avoidance whole-brain radiotherapy (HA-WBRT) has shown advantage in delaying or preventing the neurocognitive decline while maintaining disease control. This study was done to assess the benefits and feasibility of HA-WBRT in patients with cerebral metastasis in terms of preservation of neurocognitive function and quality of life. Materials and methods: 27 patients with brain metastasis treated by HA-WBRT and having the records of detailed neurocognitive-assessments were analysed from the database of our hospital. The patients were treated with HA-WBRT to a total dose of 30 Gy in 10 fractions with LINAC based IMRT using the VMAT technique. Cognitive function assessment was carried out using "Examination of the Cognitive Functions" scale provided by Bangur-Institute-of-Neurosciences, Kolkata, 2 weeks prior to radiotherapy and post-treatment two-monthly up to 6 months followed by every 3 months till the last follow up. QOL was assessed at the same interval using the Functional Assessment of Cancer Therapy with Brain Subscale (FACT-BR). Follow-up was done till the date of death. Results: Mean relative cognitive decline percentage decreased over subsequent follow-up visits and was 13% (SD ± 6%), 5% (SD ± 5%), 5% (SD ± 9%) and 2% (SD ± 12%) at 2 months, 6 months, 9 months and 12 months, respectively (p ≤ 0.05). Statistically significant improvement was seen in the mean social-wellbeing (SWB) parameter of QOL (8%. ± 13%, 12%. ± 16%, 7%. ± 20%, no change at 2 months, 4 months, 6 months and 9 months, respectively) (p ≤ 0.05). Mean relative decline in the Emotional-Well Being (EWB) parameter was significant only at 12 months and was 20% (SD ± 35%) (p = 0.04). Mean FACT-BR total Score showed a slight decrease till 9 months from baseline, and then showed a slight improvement up to 12 months. Conclusion: HA-WBRT is feasible with LINAC-based IMRT using the VMAT technique and beneficial to the patients in preserving neurocognitive function and quality of life without compromising disease control.

Outcomes associated with the use of a new powered circular stapler for left-sided colorectal reconstructions: a propensity score matching-adjusted indirect comparison with manual circular staplers.

BACKGROUND: This was a retrospective, matching-adjusted indirect comparison of clinical outcomes between patients from a single-arm trial of the ECHELON CIRCULAR™ Powered Stapler (ECP) and those from a historical cohort of patients who underwent left-sided colorectal resection using conventional manual circular staplers, extracted from the Premier Healthcare Database. METHODS: Patients in the ECP trial cohort were propensity score matched to those in the historical cohort through nearest neighbor matching. Outcomes included 30-day readmission rates; length of stay (LOS) for the index admission; rates of anastomotic leak, pelvic abscess, ileus/small bowel obstruction, infection, bleeding, and stoma creation. RESULTS: The study included 168 patients in the ECP trial cohort and 4544 patients in the historical cohort; 165 ECP trial patients were matched to 1348 historical cohort patients. After matching, conversions were more prevalent in the historical cohort than the ECP trial cohort (4.2% ECP vs. 10.2% historical, p = 0.001). Relative to the historical cohort, the ECP trial cohort had statistically significant lower rates of 30-day inpatient readmission (6.1% vs. 10.8%, p = 0.019), anastomotic leak (1.8% vs. 6.9%, p < 0.001), ileus/small bowel obstruction (4.8% vs. 14.7%, p < 0.001), infection (1.8% vs. 5.7%, p = 0.001), and bleeding (1.8% vs. 9.2%, p < 0.001) during the index admission or within 30 days thereafter. No statistically significant differences in rates of pelvic abscess, stoma creation, or LOS were found between the two cohorts. Three sensitivity analyses to address the difference in conversion rates yielded largely consistent results, with loss of statistical significance for inpatient admission in some cases. This study is limited by its potential for differences in unmeasurable factors between the ECP trial and historical cohorts. CONCLUSIONS: In this study, the ECP trial cohort had lower incidence proportions of several surgical complications as compared with the historical cohort. Further controlled prospective clinical studies are needed to confirm the validity of this finding.

Development and analysis of a geospatial database for maritime spatial planning in Bangladesh.

In this research we collect, prepare and analyze a geospatial database of maritime activities located in the northern Bay of Bengal with the final aim to simulate maritime spatial planning (MSP) - ready information source for future sectoral and multi-sector MSP in Bangladesh. The database is composed of 28 anthropogenic and environmental layers categorized into seven Blue Economy sectors. The database is analyzed with a set of geospatial models aimed at understanding the intensity distribution of human activities at sea and the potential marine use conflicts emerging from the aggregation of human activities. Ecological resources were characterized in terms of marine mammals, lobsters, commercially important and threatened fish species, and pelagic birds and mapped as biodiversity hotspots using geographic cluster analysis. Results show that the most intensely used sea areas are located along the northeastern coast of Bangladesh, as well as in the Swatch of No Ground (SoNG) area, with maximum Marine Use Intensity (MUI) scores ranging from 5 to 8. Offshore waters of Saint Martin's Island have higher MUI scores (≥ 5) as well. The pairwise spatial conflict analysis shows that nature protection sites particularly SoNG Marine Protected Area (MPA), Nijhum Dwip Marine Reserve (MR), and Saint Martin's Island MPA are exposed to the high Marine Use Conflicts (MUC) induced by fishing and shipping activities. Fishing operations generate the highest MUC value (MUC = 30) in SoNG MPA, whereas shipping activities produce the highest MUC value (MUC = 24) in Nijhum Dwip MR. Both of the MPAs exhibit 6 to 12 MUC scores induced by shipping. The proposed database together with the illustrated analytical techniques used in this study and key findings can provide the first understanding of the priorities for Ecosystem Based Management of Bangladesh's marine space and provide valuable insights on the urgency for MSP process in the country. The study concludes with an outlook on the utility of the database for future analysis.

Assessing relative cost of complications following orthotopic liver transplant.

INTRODUCTION: Perioperative complications impose both a clinical and financial burden on patients and the healthcare system. This study sought to identify the frequency and economic impact of complications following orthotopic liver transplantation (OLT). METHODS: The Premier Perspective® Hospital Database was queried for patients undergoing OLT between 2008 and 2015. Complications were identified by ICD-9 code and grouped by complication type. Complication frequency as well as impact on clinical and economic outcomes was calculated. Complication frequency and effect on cost were combined to determine the annual impact of each complication type on perioperative OLT cost. RESULTS: Among 2747 OLT patients, the most common groups of complications following OLT were pulmonary, bleeding, and infectious. The complications with the greatest average effect on treatment-related costs were infectious, neurologic, deep vein thrombosis/pulmonary embolus, and hepatic arterial thrombosis. Infectious, pulmonary, and bleeding complications had the greatest annual effect on perioperative OLT cost. CONCLUSIONS: Efforts focused on preventing coagulopathic bleeding, improving post-operative pulmonary toilet, and minimizing sources of infection can help improve the cost-effectiveness of OLT. Additionally, the combination of these cost data and systematized protocols can help insurers construct bundled payments for OLT that more accurately reflect the cost of perioperative transplant care.

Reliability and Validity of the Work Instability Scale for Rheumatoid Arthritis.

OBJECTIVE: The objective was to evaluate the psychometric properties of the Rheumatoid Arthritis-Work Instability Scale (RA-WIS) in a clinical trial setting. METHODS: Secondary analyses were conducted using data from a 56-week, randomized controlled trial of patients with early rheumatoid arthritis (RA). Patient-reported outcome measures included the RA-WIS, the Health Assessment Questionnaire (HAQ), the Rheumatoid Arthritis Quality of Life Questionnaire, and the Global Assessment of Disease Activity and Pain, data for which were collected at baseline and at weeks 12, 16, 24, and 56. Data were analyzed for reliability, validity, and responsiveness. RESULTS: Among 148 patients whose data were analyzed, more than half were women (56.1%) with a mean age of 46.8 years. On average, patients experienced RA symptoms for 8.7 months; the mean 28-Joint Disease Activity Score (DAS28) was 5.9, and the mean HAQ - Disability Index was 1.3. The RA-WIS demonstrated excellent internal consistency and test-retest reliability (α = 0.89 and intraclass correlation coefficient = 0.91, respectively). At baseline and week 24, moderate to strong correlations were seen between RA-WIS total scores and the HAQ, the Global Assessment of Disease Activity, and the Pain Rheumatoid Arthritis Quality of Life Questionnaire, ranging from 0.47 to 0.81 (all P < 0.0001). Mean RA-WIS total scores and work disability risk levels discriminated between clinical severity scores on the DAS28, the HAQ - Disability Index, and the Physician Global Assessment of Disease Activity (all P < 0.05). Mean baseline to week 24 RA-WIS total change scores were significantly different among American College of Rheumatology responder groups (P ≤ 0.0001) and between DAS28 remission status groups (P < 0.001). CONCLUSIONS: These findings provide evidence supporting the reliability, validity, and responsiveness of the RA-WIS for evaluating work disability in patients with RA in a clinical trial setting.

Time Savings and Surgery Task Load Reduction in Open Intraperitoneal Onlay Mesh Fixation Procedure.

BACKGROUND: This study assessed the reduction in surgeon stress associated with savings in procedure time for mechanical fixation of an intraperitoneal onlay mesh (IPOM) compared to a traditional suture fixation in open ventral hernia repair. STUDY DESIGN: Nine general surgeons performed 36 open IPOM fixation procedures in porcine model. Each surgeon conducted two mechanical (using ETHICON SECURESTRAP ™ Open) and two suture fixation procedures. Fixation time was measured using a stopwatch, and related surgeon stress was assessed using the validated SURG-TLX questionnaire. T-tests were used to compare between-group differences, and a two-sided 95% confidence interval for the difference in stress levels was established using nonparametric methodology. RESULTS: The mechanical fixation group demonstrated an 89.1% mean reduction in fixation time, as compared to the suture group (p < 0.00001). Surgeon stress scores measured using SURG-TLX were 55.5% lower in the mechanical compared to the suture fixation group (p < 0.001). Scores in five of the six sources of stress were significantly lower for mechanical fixation. CONCLUSIONS: Mechanical fixation with ETHICON SECURESTRAP ™ Open demonstrated a significant reduction in fixation time and surgeon stress, which may translate into improved operating efficiency, improved performance, improved surgeon quality of life, and reduced overall costs of the procedure.

High green index electromagnetic interference shields with semiconducting Bi2S3 fillers in a PEDOT:PSS matrix.

Conventional metallic electromagnetic interference (EMI) shields, as well as the emerging 2D material-based shields, meet the shielding effectiveness (SE) needs of most applications. However, their shielding performance is dominated by the reflection of incoming radiation due to their high electrical conductivity, which leads to secondary pollution. This problem is getting exacerbated with the proliferation of electronics and communication networks in modern society. Thus, EMI shields that function dominantly by the absorption of incoming radiation are highly desirable. Such shields would be characterized by a green index, which is the ratio of absorbance over reflectance, close to or greater than one. For nonmagnetic materials, the best way to reduce the undesirable large impedance mismatch is to reduce the effective permittivity of the shield material. Here, we present a new EMI shield with a semiconductor Bi2S3 filler in a conducting PEDOT:PSS polymer matrix, instead of the conventional conductive fillers, to reduce the effective permittivity and demonstrate that even a light loading of only 10% Bi2S3 provides high SE of over 40 dB with a green index value of 0.75. Increasing the filler content to 15 wt% increases the green index close to unity while dropping the SE to 30 dB. The shielding mechanism is explained through electromagnetic parameter measurements and supplemented by density functional theory calculations. This work lays the foundation for the advancement of lightweight and ultrathin green EMI shields with minimum secondary pollution.

Economic considerations for mid-urethral sling procedures among patients with stress urinary incontinence.

OVERVIEW: Stress urinary incontinence (SUI) is associated with a hefty economic burden. Retropubic and transobturator vaginal slings have become common surgical options for women with SUI. This study examines the costs of transobturator slings for SUI surgeries. METHODS: A model was created to estimate the budget impact to hospitals of transobturator sling surgery in women with SUI. Current practice using transobturator slings including the MonarcTM Subfascial Hammock, Obtryx® Transobturator Mid-Urethral Sling System, Aris® Transobturator Sling System, Align® TO Trans-Obturator Urethral Support System, GYNECARE TVTTM Obturator System Tension-free Support for Incontinence and GYNECARE TVT ABBREVOTM Continence System were modeled. Four surgical complications were considered: re-operation due to failure, revision or removal of sling, urologic complications including urinary obstruction and urinary tract infection, and pelvic complications. This model calculates the average 1-year cost per patient with the use of each sling product and estimates the total budget for sling urinary incontinence surgery associated with each product based on these calculations. RESULTS: Average incremental cost over 1 year ranged from $2,601 (GYNECARE TVTTM Obturator) to $3,132 (Desara®) per patient. In a hypothetical population of 100 patients, a 10% shift from the most to the least expensive option was associated with a 2% decrease in hospital expenditures. With the current market share for transobturator sling products, the expected expenditure is around $285,533 for a surgical population of 100 patients. Sling costs account for approximately $105,526 (37%) of this cost, with complications comprising the remaining majority. CONCLUSION: This study represents the first comparative assessment of the costs of different sling options for stress urinary incontinence surgeries. GYNECARE TVT ABBREVOTM and GYNECARE TVTTM Obturator products represent a sound clinical and economic choice for hospitals. Moreover, the reduction in expenditures is obtained at the benefit of patients, who experience fewer complications and avoid complication-related procedures.

Impact of green factors on undergraduate students' green behavioral intentions: A hybrid two-stage modeling approach.

Consumers' unsustainable behavior contributes to environmental degradation and impedes sustainability. Using green products is one way to reduce this effect and promote environmental growth. Therefore, this study aims to investigate the green factors that impact young customers' behavioral intentions regarding green products. For this purpose, the researcher designed a research model based on the expanded theory of planned behavior (TPB). The study adopted a two-stage, hybrid model using partial least square-structural equation modeling (PLS-SEM) and necessary condition analysis (NCA) to evaluate and validate the results. A sample of 382 undergraduate students was gathered using a convenience sampling approach. The results reveal that green TPB perception (GTP), green price sensitivity (GPS), green product trust (GPT), and green product value (GPV) are significantly and positively correlated with green behavioral intention (GBI). This study's main contribution is adding a brand-new higher-order construct, GTP, in the environmental and marketing literature and validating its effect on GBI. Again, environmental awareness moderates the association between GPS and GBI. Furthermore, the NCA's findings indicated that these variables are necessary to various degrees for students' GBI. Decision-makers may use the study's insights to create successful regulations to better understand young customers and develop appropriate green initiatives for sustainable development.

Global Surgeon Opinion on the Impact of Surgical Access When Using Endocutters Across Specialties.

Background: Despite design enhancements in endocutters, key challenges related to limited surgical access and space can impact stapling and, potentially, surgical outcomes. Objectives: This study aimed to develop consensus statements outlining the clinical value of precise articulation and greater anatomical access in minimally invasive surgery performed by bariatric, colorectal, and thoracic surgeons. Methods: Colorectal, bariatric, and thoracic surgeons from Japan, the United States, United Kingdom, and France participated in a 2-round modified Delphi panel. Round 1 included binary, Likert scale-type, multiple-response, and open-ended questions. These were converted to affirmative statements for round 2 if sufficient agreement was reached. Consensus was set at a predefined threshold of at least 90% of panelists across all surgical specialties and regions selecting the same option ("agree" or "disagree") for the affirmative statements. Results: Of the 49 statements in the round 2 questionnaire, panelists (n=135) reached consensus that (1) tissue slippage outside stapler jaws can occur due to limited access and space; (2) greater jaw aperture could help to manipulate thick or fragile tissue more easily; (3) articulation of an endocutter is clinically important in laparoscopic surgeries; (4) improved access to hard-to-reach targets and in limited space would improve safety; and (5) an endocutter with improved access through greater articulation would become common use. Discussion: By understanding user-specific challenges and needs from both specialty- and region-wide perspectives, endoscopic stapling devices can continue to be refined. In this study, improved articulation and greater jaw aperture were the key design features examined. Improved articulation and greater jaw aperture were key stapler design features identified in this study that may mitigate the risk of instrument clashes and intraoperative complications such as anastomotic leaks. Conclusions: This study gained insights into surgeons' perspective across a variety of specialties and from 3 distinct geographies. Participating surgeons reached consensus that an endocutter with greater jaw aperture and articulation may improve surgical access and has potential to improve surgical outcomes.

Development of Prediction Model for Mean Parotid Dose of HNC Undergoing Radiotherapy - A Single Institutional Study.

Aim: The aim of the study was to develop a simple prediction model based on previous treatment plans for head-and-neck cancer (HNC). Materials and Methods: This study was conducted on 95 patients who underwent volumetric-modulated arc therapy (VMAT) with curative intent for HNC at our institute between January 2016 and December 2022 with intact bilateral parotid glands. Two simple prediction models were used: one linear regression model and one exponential model. Both models use fractional overlapping parotid volume with planning target volume (PTV) as a predictor of mean parotid dose. The fractional overlapping volume was calculated as the difference between the volume of the parotid gland minus the volume of the parotid gland outside the PTV plus a 2 mm margin, divided by the volume of the parotid gland. Statistical calculations were done using data analysis tools and Solver in Microsoft Excel (Microsoft Office 2013, Redmond, WA, USA). To enhance the accuracy of the results, outliers were excluded with residuals >2 standard deviations below and above the residuals. R2 and root-mean-square error were calculated for both models to evaluate the quality of the predictions. The normality of both models' residuals was validated using the Shapiro-Wilk test. Results: Both linear and exponential prediction models exhibited strong correlation statistics, with r2 = 0.85 and 0.82, respectively. The authors found a fractional overlap of 16.4% and 18.9% in linear and exponential models that predict parotid mean dose 26 Gy. The implementation was carried out on a cohort of 12 prospective patients, demonstrating a remarkable improvement in minimizing the dose to the parotid glands. Conclusion: In this single-institutional study, the authors successfully developed a prediction model for mean parotid dose in HNC patients undergoing radiotherapy. The model showed promising accuracy and has the potential to assist planners in optimizing treatment plans and minimizing radiation-related toxicity. It is possible to avoid under sparing the organs at risks in some cases and wasting time or effort on physically impossible goals in others using this prediction model. As a result, planning resources can be used much more efficiently. Future studies should focus on validating the model's performance using external datasets and exploring its integration into clinical practice.

Assessing the environmental impact of an anastomotic leak care pathway.

Background: The healthcare sector faces increasing pressure to improve environmental sustainability whilst continuing to meet the needs of patients. One strategy is to lower the avoidable demand on healthcare services, by reducing the number of surgical complications, such as anastomotic leak (AL). The aim of this study was to assess the environmental impact associated with the care pathway of AL. Methods: An environmental impact assessment was performed according to the Sustainable Healthcare Coalition (SHC) guidelines. A care pathway, describing the typical steps involved in the diagnosis and treatment of AL was developed. Activity and emission data for each stage of the care pathway were used to calculate the climate, water and waste impact of the treatment of AL patients. Results: The environmental impact assessment shows that AL is associated with an average climate, water and waste impact per patient of 1303 kg CO2-eq, 1803 m3 of water and 123 kg waste, respectively. Grade C leaks are associated with the greatest environmental impact, contributing to 89.3 %, 79.4 % and 97.9 % of each impact, respectively. A breakdown of the environmental impact of each activity shows that stoma home management is the largest contributor to the total climate (46.6 %) and waste (47.3 %) impact of AL patients, whilst in-patient hospital stay contributes greatest to the total water impact (46.7 %). Conclusions: The treatment of AL is associated with a substantial environmental impact. This study is, to our knowledge, the first to assess the environmental impact associated with the treatment of AL.

Assessment of the psychometric properties of the Short-Form Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) following surgical placement of Prolift+M: a transvaginal partially absorbable mesh system for the treatment of pelvic organ prolapse.

INTRODUCTION: Impairment of sexual function is a significant problem among women suffering from pelvic organ prolapse (POP). Because anatomical measures of POP do not always correspond with patients' subjective reports of their condition, patient-reported outcome measures may provide additional valuable information regarding the experiences of women who have undergone surgery. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) is a validated, widely used condition-specific questionnaire focused on sexual function among patients with POP or urinary incontinence. AIM: This study aims to report sexual function outcomes as measured by PISQ-12 and to evaluate the psychometric characteristics of the questionnaire following surgical mesh implant for the treatment of POP. MAIN OUTCOME MEASURES: The PISQ-12 was used to measure sexual function, while a set of other measures, namely, Pelvic Organ Prolapse Quantification, Patient Global Impression of Change, Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and Surgical Satisfaction Questionnaire, was used for validation. METHODS: Data for the study were collected from a prospective multicenter, single-arm study of surgical POP repair via the transvaginal placement of a partially absorbable mesh system. For baseline, month 3, and month 12 following POP surgery, several psychometric properties of the PISQ-12 were evaluated, including internal consistency (Cronbach's alpha), concurrent validity, discriminant validity, and responsiveness. RESULTS: As measured by the PISQ-12 questionnaire, statistically significant improvements were observed in the composite summary score as well as all three subscale scores at 1 year. The PISQ-12 generally demonstrated good psychometric properties including internal consistency reliability, validity, and responsiveness. The PISQ-12 items had good distributional properties at baseline, with substantial ceiling effects at follow-up visits reflecting improvements experienced by the patients. CONCLUSION: The PISQ-12 is a valid measure of sexual function in studies involving patients with POP.

A real-world comparative assessment of complications following various mid-urethral sling procedures for the treatment of stress urinary incontinence.

Stress urinary incontinence affects a significant proportion of the adult female population in the United States with prevalence increasing with growing age. Mid-urethral slings are among surgical options offering important improvement in the condition. The aim of this study was to evaluate clinical outcomes of different mid-urethral sling products with respect to postsurgery complications. This retrospective study utilized data from the Premier Perspective Database for mid-urethral sling procedures between 2005 and 2009. Patients were grouped into retropubic or transobturator cohorts, and these cohorts were further divided by the sling utilized during the procedure. Surgical outcomes and 12-month complication rates were assessed. In general, there were fewer complications noted for transobturator procedures than for retropubic procedures. In the retropubic category, Gynecare TVT had significantly lower rates of urinary obstruction/retention than other retropubic procedures. In the transobturator category, lower rates of overall pelvic complications as well as urologic complications, including urgency incontinence and urinary tract infections, were observed in the Gynecare TVTO subgroup than other transobturator procedures. Results of this study confirm the low overall rate of complications for midurethral sling procedures while at the same time suggesting that product choice may also have an impact on complication rates.

Surgical Complication Risk Factor Identification Using High-Dimensional Hospital Data: An Illustrative Example in Hemostasis-Related Complications.

Purpose: To describe an approach wherein high-dimensional hospital data can be used to identify generalizable risk factors for surgical complications for which there may be limited prior knowledge, as illustrated in the context of hemostasis-related complications (HRC). Patients and Methods: This was a retrospective study of the Premier Healthcare Database. Patients included for the study underwent video-assisted thoracoscopic lobectomy (VATL), laparoscopic right colectomy (LRC), or laparoscopic sleeve gastrectomy (LSG) on an inpatient setting between Oct-2015 and Feb-2020 (first = index). The outcome, HRC, comprised hemorrhage, control of bleeding, and acute posthemorrhagic anemia. For each cohort, a high-dimensional dataset (ie, comprising 1000s of candidate risk factors) was constructed using taxonomies from the Clinical Classification Software Refined (CCSR). Candidate risk factors were fed into logistic regression models with a 70%/30% train/test split for each cohort; clinically plausible risk factors that were consistently significant predictors of HRC across the 3 training models were then used in a final parsimonious model including sex, age, race, and payor; finally, the parsimonious model was applied to the test data to compare predicted risk with observed incidence of HRSC. Results: The study included 11,141 VATL, 20,156 LRC, and 121,547 LSG patients, in whom 7.5%, 7.8%, and 1.2% experienced HRSC, respectively. Ultimately, 6 clinically plausible CCSR categories were identified as being statistically significant predictors across all 3 cohorts (eg, coagulation and hemorrhagic disorders, malnutrition, alcohol-related disorders, among others). In the parsimonious model applied to the test data, the observed incidence of HRSC was substantially higher in the top quintile vs bottom quintile of predicted risk: LSG 2.05% vs 0.53%, LRC 13.30% vs 4.11%, VATS 12.49% vs 5.04%. Conclusion: High-dimensional real-world data can be useful to identify risk factors for outcomes that generalize across multiple cohorts. The risk factors identified herein should be considered for inclusion in future studies of hemostasis-related complications.

Retrospective Comparison of Clinical and Economic Outcomes of Non-Donor Patients Undergoing Radical Nephrectomy Using One of Two Different Linear Stapler Technologies for Transection of the Renal Vessels: Fixed-Height Gripping Surface Reloads vs Variable-Height Reloads.

Purpose: To compare outcomes of non-donor patients undergoing radical nephrectomy using fixed-height gripping surface (FHGS) vs variable-height Tri-Staple™ (VHTS) reloads for transection of the renal vessels. Patients and Methods: Using the Premier Healthcare Database of US hospital discharge records, we selected non-donor patients undergoing inpatient radical nephrectomy with dates of admission between 1 October 2015, and 31 December 2020 (first=index admission). The primary outcome was in-hospital hemostasis-related complications (hemorrhage, acute posthemorrhagic anemia, and/or procedure to control bleeding) during the index admission. Secondary outcomes included index admission intraoperative injury, blood transfusion, conversion from minimally invasive to open surgery, total hospital costs, length of stay (LOS), discharge status, and mortality as well as 30-day all-cause inpatient readmission. We used stable balancing weights to balance the FHGS and VHTS groups on numerous patient, procedure, and hospital/provider characteristics, allowing a maximum post-weighting standardized mean difference ≤0.01 for all covariates; we also exactly matched the groups on laterality (right vs left kidney) and intended surgical approach (open, laparoscopic, robotic). We used bivariate multilevel mixed-effects generalized linear models accounting for hospital-level clustering to compare the study outcomes between the FHGS and VHTS groups. Results: After weighting, the FHGS and VHTS groups comprised 2952 and 795 patients, respectively. The observed incidence proportion of the primary outcome of hemostasis-related complications during the index admission was similar between the groups (8.6% for FHGS vs 9.0% for VHTS, difference 0.4% [95% CI -3.2% to 2.5%], P=0.808). Differences between the FHGS and VHTS groups were not statistically significant for any of the secondary outcomes. Conclusion: Endoscopic surgical staplers have become common for transection of the renal vessels during radical nephrectomy, with FHGS and VHTS being the predominant reload types. In this retrospective study of 3747 non-donor patients undergoing radical nephrectomy, use of FHGS vs VHTS reloads was associated with similar clinical and economic outcomes.

Economic Analysis of Leak Complications in Anastomoses Performed with Powered versus Manual Circular Staplers in Left-Sided Colorectal Resections: A US-Based Cost Analysis.

PURPOSE: To estimate the cost impact of using the ECHELON CIRCULAR™ Powered Stapler (ECP) compared with manual circular staplers (standard of care, SOC) among patients undergoing colectomy procedures that involve left-sided anastomosis. METHODS: A US hospital-based budget impact model was developed to estimate the impact of ECP in reducing the surgical complication of anastomotic leak. The incremental acquisition cost of ECP vs SOC was compared to the net potential savings from reduced complication costs. The model was based on complication rates from a recently published matching-adjusted indirect comparison (MAIC) that compared clinical and healthcare utilization outcomes of patients using ECP with those of a propensity score-matched retrospective SOC control cohort from a real-world clinical practice population. The model assessed total cost, average length of stay (LOS), proportion of patients with a non-home discharge, and all-cause readmission. Deterministic (DSA) and probabilistic sensitivity analyses (PSA) were conducted to evaluate the robustness of the model assumptions and inputs. RESULTS: Despite a higher device cost of $412 for ECP compared with $298 for a manual stapler, annual savings due to avoided complications with ECP was $53,987 for anastomotic leak, assuming 100 procedures per year with each type of circular stapler. ECP also helped to avoid 27 LOS days, 0.38 readmissions and 0.22 non-home discharges. Sensitivity analyses around potential drivers of costs established the robustness of economic savings with the use of ECP - with annual savings being most impacted by the probability of anastomotic leak complication in the DSA. CONCLUSION: This model demonstrates that among patients undergoing left-sided colectomy procedures, the incremental cost of using the ECHELON CIRCULAR™ Powered Stapler instead of a manual circular stapler was offset by the savings from lowered incidence and cost of management of anastomotic leaks in the hospital setting.

Geospatial analysis of COVID-19 lockdown effects on air quality in the South and Southeast Asian region.

The COVID-19 pandemic, induced by the novel Coronavirus worldwide outbreak, is causing countries to introduce different types of lockdown measures to curb the contagion. The implementation of strict lockdown policies has had unprecedented impacts on air quality globally. This study is an attempt to assess the effects of COVID-19 induced lockdown measures on air quality in both regional, country, and city scales in the South and Southeast Asian region using open-source satellite-based data and software frameworks. We performed a systematic review of the national lockdown measures of 19 countries of the study area based on publicly available materials. We considered two temporal settings over a period of 66 days to assess and compare the effects of lockdown measures on air quality levels between standard business as usual and current situation COVID-19 lockdown. Results showed that compared to the same period of 2019, atmospheric NO2, SO2, PM2.5, and CO levels decreased by an average of 24.16%, 19.51%, 20.25%, and 6.88%, respectively during the lockdown, while O3 increased by a maximum of 4.52%. Among the 19 studied cities, Dhaka, Kathmandu, Jakarta, and Hanoi experienced the highest reduction of NO2 (40%-47%) during the lockdown period compared to the corresponding period of 2019. The methodological framework applied in this study can be used and extended to future research in the similar domain such as understanding long-term effects of COVID-19 mitigation measures on the atmospheric pollution at continental-scale or assessing the effects of the domestic emissions during the stay-at-home; a standard and effective COVID-19 lockdown measure applied in most of the countries.