Rising frequency of ozone-favorable synoptic weather patterns contributes to 2015-2022 ozone increase in Guangzhou.

Objective weather classification methods have been extensively applied to identify dominant ozone-favorable synoptic weather patterns (SWPs), however, the consistency of different classification methods is rarely examined. In this study, we apply two widely-used objective methods, the self-organizing map (SOM) and K-means clustering analysis, to derive ozone-favorable SWPs at four Chinese megacities in 2015-2022. We find that the two algorithms are largely consistent in recognizing dominant ozone-favorable SWPs for four Chinese megacities. In the case of classifying six SWPs, the derived circulation fields are highly similar with a spatial correlation of 0.99 between the two methods, and the difference in the mean frequency of each SWP is less than 7%. The six dominant ozone-favorable SWPs in Guangzhou are all characterized by anomaly higher radiation and temperature, lower cloud cover, relative humidity, and wind speed, and stronger subsidence compared to climatology mean. We find that during 2015-2022, the occurrence of ozone-favorable SWPs days increases significantly at a rate of 3.2 day/year, faster than the increases in the ozone exceedance days (3.0 day/year). The interannual variability between the occurrence of ozone-favorable SWPs and ozone exceedance days are generally consistent with a temporal correlation coefficient of 0.6. In particular, the significant increase in ozone-favorable SWPs in 2022, especially the Subtropical High type which typically occurs in September, is consistent with a long-lasting ozone pollution episode in Guangzhou during September 2022. Our results thus reveal that enhanced frequency of ozone-favorable SWPs plays an important role in the observed 2015-2022 ozone increase in Guangzhou.

Selection criteria and husbandry practices of indigenous chicken producers in Northwest Ethiopia.

This study was conducted to identify the selection criteria and husbandry practices of chicken producers in different agro-ecological zones of Northwest Ethiopia as input for designing a breeding program. The study employed a purposive selection of districts and peasant associations with high indigenous chicken potential. The study areas were stratified based on the major agro-ecologies (highland, midland, and lowland). A total of 360 households were included in the study, and data on chicken breeding practices, selection criteria, and reproductive performance were collected and analyzed using SPSS software. In all agro-ecologies, egg production was prioritized by chicken owners when choosing female chickens. For male chickens, plumage color (index = 0.27), appearance (index = 0.24), and growth rate (index = 0.23) were the main selection factors. Farmers kept chickens primarily to generate cash through the sale of eggs and live animals (male chickens). There was a significant difference (p < 0.01) among agro-ecologies in nutritional management and housing of chickens. Chicken flock composition showed a highly significant difference (p < 0.001) among agro-ecologies, except layers. Most of the farmers had their own cock born in the flock. Chicken owners found in all agro-ecologies were practicing culling unwanted chickens. All the reproductive performance traits have shown a highly significant (p < 0.001) difference among agro-ecologies. A relatively higher inbreeding coefficient (0.18) was obtained in the highland agro-ecology compared to midland (0.16) and lowland (0.12). The study highlighted the importance of designing breeding programs that align with farmers' production objectives and trait preferences based on specific agro-ecologies for sustainable increases in chicken productivity.

Error assessment of subjective estimates of linear breast dimensions versus the objective method.

Objective: The study aimed to investigate the subjective method of estimating linear breast dimensions in comparison to the objective method. Methods: The reproducibility and accuracy of the subjective method of estimating linear breast dimensions during a simplified breast shape analysis were examined. Four linear breast dimensions including the distance from the sternal notch to the nipple, distance from the nipple to the inframammary fold, distance from the nipple to the midline and under-breast width were evaluated based on subjective estimates. Images from 100 women with natural breasts and without any history of breast surgery were reviewed by two examiners three times each. The cases were obtained from a large database of breast images captured using the Vectra Camera System (Canfield Scientific Inc., USA). The subjective data were then compared with the objective linear data from the Vectra Camera System in the automated analysis. Statistical evaluation was conducted between the three repeated estimates of each examiner, between the two examiners and between the objective and subjective data. Results: The intra-individual variations of the three subjective estimates were significantly greater in one examiner than in the other. This trend was consistent across all eight parameters in the majority of the comparisons of the standard deviations and variation coefficients, and the differences were significant in 14 out of 16 comparisons (p<0.05). Conversely, in the comparison between the subjective and objective data, the estimates were closer to the measurements in one examiner than the other. In contrast to the reproducibility observed, the assessment of the accuracy revealed that the examiner who previously presented with less reproducibility of the estimated data overall showed better accuracy in comparison to the objective data. The overall differences were inconsistent, with some being positive and others being negative. Regarding the distances from the sternal notch to the nipple and breast width, both examiners underestimated the values. However, the deviations were at different levels, particularly when considering the objective data from the Vectra Camera System as the gold standard data for comparison. Regarding the distance from the nipple to the inframammary fold, one examiner underestimated the distance, while the other overestimated it. An opposite trend was noted for the distance from the nipple to the midline. There were no differences in the estimates between the right and left sides of the breasts. The correlations between the measured and estimated distances were positive: as the objective distances increased, the subjective distances also increased. In all cases, the correlations were significant. However, the correlation for the breast width was notably weaker than that for the other distances. Conclusions: The error assessment of the subjective method reveals that it varies significantly and unsystematically between examiners. This is true when assessing the reproducibility as well as the accuracy of the method in comparison to the objective data obtained with an automated system.

Unveiling the potential of a novel portable air quality platform for assessment of fine and coarse particulate matter: in-field testing, calibration, and machine learning insights.

Although low-cost air quality sensors facilitate the implementation of denser air quality monitoring networks, enabling a more realistic assessment of individual exposure to airborne pollutants, their sensitivity to multifaceted field conditions is often overlooked in laboratory testing. This gap was addressed by introducing an in-field calibration and validation of three PAQMON 1.0 mobile sensing low-cost platforms developed at the Mining and Metallurgy Institute in Bor, Republic of Serbia. A configuration tailored for monitoring PM2.5 and PM10 mass concentrations along with meteorological parameters was employed for outdoor measurement campaigns in Bor, spanning heating (HS) and non-heating (NHS) seasons. A statistically significant positive linear correlation between raw PM2.5 and PM10 measurements during both campaigns (R > 0.90, p ≤ 0.001) was observed. Measurements obtained from the uncalibrated NOVA SDS011 sensors integrated into the PAQMON 1.0 platforms exhibited a substantial and statistically significant correlation with the GRIMM EDM180 monitor (R > 0.60, p ≤ 0.001). The calibration models based on linear and Random Forest (RF) regression were compared. RF models provided more accurate descriptions of air quality, with average adjR2 values for air quality variables in the range of 0.70 to 0.80 and average NRMSE values between 0.35 and 0.77. RF-calibrated PAQMON 1.0 platforms displayed divergent levels of accuracy across different pollutant concentration ranges, achieving a data quality objective of 50% during both measurement campaigns. For PM2.5, uncertainty ( U r ) was below 50% for concentrations between 9.06 and 34.99 µg/m3 in HS and 5.75 and 17.58 µg/m3 in NHS, while for PM10, it stayed below 50% from 19.11 to 51.13 µg/m3 in HS and 11.72 to 38.86 µg/m3 in NHS.

Efficacy and safety of PARPis combined with an ICIs for advanced or metastatic triple-negative breast cancer: a single-arm meta-analysis.

Although the intervention for triple-negative breast cancer (TNBC) patients has improved and survival time has increased, the combination of immune checkpoint inhibitors(ICIs) and PARP inhibitors (Poly ADP-Ribose Polymerase inhibitors, PARPis) is still controversial. Previous studies revealed that the combined use of ICIs and PARPis led to increased antitumor activity. However, most of these combined regimens are nonrandomized controlled trials with small sample sizes. The purpose of this meta-analysis was to evaluate the efficacy and safety of ICIs combined with PARPis in patients with advanced or metastatic TNBC. The PubMed, Embase, Cochrane Library and Web of Science databases were systematically searched. The results including the objective remission rate (ORR), disease control rate (DCR), progression-free survival (PFS) and adverse events (AEs), were subjected to further analysis. Four studies involving 110 subjects were included in this meta-analysis. The combined ORR and DCR were 23.6% and 53.6%, respectively; while the ORR and DCR of BRCAmut patients were 38.1% and 71.4%, respectively. The median PFS of the patients was 4.29 months. As for safety, the most common AEs were nausea (49.0%), anemia (44.3%) and fatigue (40.6%). Most of them were grade 1 or 2, and the incidence of adverse events ≥ III was obviously low. Except for anemia, the incidence of AEs ≥ III was < 10%. This meta-analysis revealed that the combination of ICIs and PARPis has good efficacy and safety for advanced or metastatic TNBC patients.

Exploring the Relationships Between Clinical Examination Findings, Subjective Reported Symptoms and Objective Nasal Patency Measures in Nasal Obstruction: A Baseline NAIROS Sub-Study Analysis.

BACKGROUND: The role of objective nasal airflow measures using peak nasal inspiratory flow (PNIF) and rhinospirometry in supporting clinical examination findings when offering patients septoplasty remain undefined. OBJECTIVE: To explore the baseline relationships between clinical examination findings, subjective reported symptoms and objective nasal patency measures in nasal obstruction. METHODS: This is a sub-study of the NAIROS trial. Participants with nasal obstruction secondary to septal deviation were included in this NAIROS sub-study. The side of septal deviation, enlargement of inferior turbinate (IT), the need for IT reduction if septoplasty was being performed, the area of septum deflecting into the airway and observer rated airway block (ORAB-arbitrarily divided by <50% and >50% blockage) were assessed by clinicians. The subjective score of nasal obstruction was assessed using the Double Ordinal Assessed Subjective Scale (DOASS). Objective nasal patency measures (e.g., nasal partitioning ratio, [NPR] and PNIF) were measured using PNIF and rhinospirometry. RESULTS: The mean NPR for left-sided, both-sided and right-sided septal deviation was -0.35, -0.02 and 0.51, respectively (p < 0.001). There was very weak correlation between the requirement for IT reduction and PNIF change (0.13, p < 0.01). There was no difference in mean PNIF (94 L/min vs. 93 L/min) and mean DOASS (0.33 vs. 0.38) for participants with ORAB rated <50% and >50%. The mean NPR for participants with ORAB >50% was higher than for those with ORAB <50% (0.51 vs. 0.41, p = 0.002). There was strong correlation between the DOASS and NPR (+0.737, p < 0.001). The mean DOASS score for right-sided, both-sided and left-sided septal deviation was 0.32, 0.05 and -0.29, respectively (p < 0.001). CONCLUSION: This study identified strong relationships between the clinician rated side of septal deflection, the patient reported DOASS and the objective NPR measurements. NPR and the clinician rated degree of airway blockage were concordant.

Opposing objective and subjective wellbeing outcomes within an environmentally vulnerable delta: a case study of Volta Delta, Ghana.

Introduction: Despite a growing interest in the measurement and conceptualization of wellbeing, the integration within sustainability research, and the understanding of how different wellbeing outcomes relate, is limited. Many studies focus on singular, often objectively measured, outcomes, without acknowledging the breadth of available measures. This approach can result in crucial subjective information, which can be explored to understand actors' behaviors and responses, being omitted from research and policy. This study explores objective and subjective wellbeing outcomes, and how they relate, within an environmentally vulnerable context. Wellbeing and environmental services are intrinsically interlinked, therefore, appropriate policy solutions are required to address human needs and pressures on supporting ecosystems. Methods: This paper uses binary logistic regression modelling, and qualitative participatory rural appraisal methods, to understand the environmental conditions, including climatic hazards and landscape characteristics, associated with households experiencing different objective/subjective wellbeing outcomes within Volta Delta, Ghana. Results: The mixed method approach highlights a differing relationship between inland agricultural areas impacted by drought and erosion, and coastal/riverine, peri-urban landscapes exposed to flooding and salinization. Agricultural areas associate with "poor but happy" outcomes, whereas peri-urban landscapes associate with being "non-poor but unhappy." Drawing on existing literature, and both quantitative and qualitative results, these varying outcomes are hypothesized to be driven by differences in livelihood vulnerability, relative comparisons to others, responses to climatic hazards, and individualistic/collective wellbeing conceptualizations. Discussion: Our study concludes that environmental conditions influence objective and subjective wellbeing through different mechanisms. Sustainable development research should incorporate both objective and subjective measures when implementing and monitoring policy to more comprehensibly capture, and improve, wellbeing in environmentally vulnerable locations.

An extended goal programming approach with piecewise penalty functions for uncertain supplier-material selection problem in cardboard box manufacturing systems.

In this study a real case multi-objective material and supplier selection problem in cardboard box production industries is studied. This problem for the first time optimizes the objective functions such as total wastage amounts remained from all raw sheets, total costs of the system including purchasing cost and transportation cost (including fixed and variable costs) of the raw sheets, and total overplus of produced cardboard boxes. To be closer to the real situations, as a novelty, the problem is formulated in belief-degree-based uncertain environment with normal distribution where this type of uncertainty applies the ideas of experts. A solution approach including two steps is proposed to solve the problem. In the first step, the proposed uncertain formulation is converted to a crisp form using a typical chance constrained programming scheme. In the second step, a new goal programming approach containing a piecewise penalty function is developed in order to solve the obtained multi-objective crisp formulation. In this approach, based on the ideas of experts, multiple goals are considered with different penalty values. A case study from cardboard box industries is considered to evaluate the proposed formulations and solution approach. According to the obtained results, the proposed solution approach is compared to similar approaches of the literature and its efficiency is studied.

Evaluation of the repeatability of kinesiological measurements of spontaneous infant movements using OSESEC computer analysis algorithms.

Purpose: There is a need to create objective and reproducible tool for assessing the quality of infant movements. It's substantially important to detect movement disorders in infants as early as possible. The study aimed to evaluate the reproducibility of kinesiological measurements of spontaneous movements performed by 51 infants (aged 6 to 15 weeks) recorded three times for two consecutive days using OSESEC computer analysis algorithms by determining numerical values of parameters, i.e., speed, acceleration, direction, and movement trajectory. Methods: The study group consisted of 51 infants. The diagnostic method of Prechtl was used for qualitative assessment. The quantitative assessment was based on the use of a OSESEC system. Numerical values for all movement parameters were determined, and the data obtained in the study were used for statistical analysis. Results: Analysis including movement parameter values on three consecutive recordings for the same infant revealed no statistically significant differences in location ( p = 0.073), range ( p = 0.557), shape ( p = 0.289), mean acceleration ( p = 0.124) and mean speed ( p = 0.767). This confirms the reproducibility of measurements of the proposed parameters of the objectification of spontaneous infant movements. Conclusions: The interpretability and accuracy of the presented parameters were proved. All parameters estimation is fully automated. Further research and testing requires a larger study group to create an objective diagnostic device for infants.

Efficacy of orthokeratology lens with the modified small treatment zone on myopia progression and visual quality: a randomized clinical trial.

BACKGROUND: To evaluate the long-term effectiveness of orthokeratology (ortho-K) lenses with small treatment zone (STZ) or conventional treatment zone (CTZ) in controlling axial elongation in children with myopia as well as the impact on visual quality. We also sought to determine the effect of retinal visual signal quality on axial elongation. METHODS: This is a prospective randomized controlled study. A total of 140 participants (age ranging from 8 to 12 years) were randomly assigned to wear either STZ or CTZ ortho-K lenses. STZ ortho-K lenses design was achieved by changing the depth of reverse zone and the sagitta height of the optical zone. Using the IOL-Master 500, axial length (AL) was measured at baseline and after 6, 12 and 18 months of ortho-K treatment. Spherical aberration (SA) and corneal topographic parameters were obtained by the Pentacam anterior segment analyzer at baseline and the 1-month follow-up visit, and optical qualities were assessed by optical quality analysis system-II (OQAS-II) at baseline and after 1 month of lens wearing. Optical quality parameters mainly included the modulation transfer function (MTF) cutoff, Strehl ratio (SR), objective scattering index (OSI), and predicted visual acuity (PVA). RESULTS: A total of 131 participants completed the study, including 68 in the STZ group and 63 in the CTZ group. The STZ group had significantly reduced AL elongation compared to the CTZ group after treatment (12 months: 0.07 ± 0.11 mm vs. 0.14 ± 0.12 mm, P = 0.002; 18 months: 0.17 ± 0.15 mm vs. 0.26 ± 0.16 mm, P = 0.002). The topography in the STZ group showed a smaller treatment zone (TZ) diameter (2.50 ± 0.23 mm vs. 2.77 ± 0.18 mm, P < 0.001), a wider defocus ring width (2.45 ± 0.28 mm vs. 2.30 ± 0.30 mm, P = 0.006), and larger values of total amount of defocus (119.38 ± 63.71 D·mm2 vs. 91.40 ± 40.83 D·mm2, P = 0.003) and total SA (0.37 ± 0.25 µm vs. 0.25 ± 0.29 µm, P = 0.015), compared with the CTZ group. Objective visual quality decreased in both groups (P < 0.001). This was evidenced by a greater decrease in MTF cutoff (- 14.24 ± 10.48 vs. - 10.74 ± 9.46, P = 0.047) and SR values (- 0.09 ± 0.07 vs. - 0.06 ± 0.07, P = 0.026), and an increase in OSI value (0.84 ± 0.72 vs. 0.58 ± 0.53, P = 0.019). PVA9% decreased significantly in the STZ group but not the CTZ group. A statistically significant negative correlation was found between the changes in total SA and MTF cutoff values (r = - 0.202, P = 0.025). AL changes were associated with sex, change of MTF cutoff value, increment of total SA and TZ area. CONCLUSIONS: Compared with CTZ ortho-K lenses, STZ ortho-K lenses significantly inhibited axial elongation in children with myopia while moderately reducing their objective visual quality. Axial elongation was affected by retinal visual quality, and it may be a possible mechanism for ortho-K slowing myopia progression. Trial registration This trial is registered at Chinese Clinical Trial Registry on November 5, 2019 with trial registration number: ChiCTR1900027218. https://www.chictr.org.cn/showproj.html?proj=45380.

Strengthening the planning and design of Objective Structured Clinical Examinations.

Background: Although Objective Structured Clinical Examinations (OSCEs) offer innovative, objective, and fair methods of clinical assessment, their quality is compromised by poor planning and design. Aim: This study aimed to describe the development and present evidence-based recommendations on strengthening the planning and design of OSCEs for a South African public College of Nursing. Setting: A South African public College of Nursing. Methods: Recommendations were developed based on synthesising two sets of qualitative data. Set 1 included two main themes with each of the four sub-themes related to barriers and facilitators towards quality in OSCE designs from 14 nurse educator interviews and 15 external moderator reports. Set 2 included 12 quality measures to be adopted in the quality design of OSCEs derived from an integrative literature review. The draft recommendations were reviewed by eight experts to be finalised. Results: Seven recommendations were developed for strengthening OSCEs' planning and design, related to: (1) policy framework, standard operating procedures and stakeholder code of conduct; (2) blueprinting and mapping of the OSCE content; (3) developing a bank of OSCE stations; (4) scoring rubric and standard-setting method selection; (5) examiners and standardised patients' recruitment and training; (6) venue selection; and (7) station piloting. Conclusion: The seven developed recommendations can strengthen the quality of OSCEs in the South African public College of Nursing context. Contribution: The developed recommendations can assist nurse educators in planning and designing to conduct quality OSCEs following piloting and implementation.

Water quality constrained adjustment planning for regional breeding management with nonlinear programming model under uncertainty in Wenchang City, China.

Basin water pollution caused by livestock, poultry and fish breeding is still a serious problem for remote villages, however, reliable regional breeding management programming have the potentials to improve pollution status. This paper focuses on the optimal model design and water quality analysis of the livestock, poultry and fish breeding system for Wenchang City, China. Methods of multi-objective programming (MOP), interval parameter programming (IPP), fuzzy-stochastic parameter programming (FSPP), and chance constrained programming (CCP) were incorporated into the developed model to tackle multi uncertainties described by interval values, probability distributions, fuzzy membership function. Based on the estimation of local breeding potential and current situation of surface water section, a multi-objective mixed fuzzy-stochastic nonlinear programming optimization model is presented with one-dimensional water quality model. In order to evaluate the environmental carrying capacity of livestock, poultry and fishery manure, predict its development trend and investigate the implementation effect of different emission reduction policies, this paper designs quantization system of the urban water environmental carrying capacity for the model. The results indicated that the water environment pollutant absorption capacity and carrying capacity of Wenchang city have approached the limit especially the towns in the northeast of City which limited the overall development space of the City. The modeling results are valuable for supporting the adjustment of the existing livestock, poultry and fish breeding schemes within a complicated system benefit and surface water quality situation under uncertainty.

Septal Perforation Quality of Life questionnaire (SEPEQOL): validation of a new instrument to assess patients undergoing endoscopic repair of a nasal septal perforation.

PURPOSE: Nasoseptal perforations (NSP) are a clinically heterogeneous group of disorders with a wide range of available treatments. Patient-reported outcome measures (PROMs) can provide valuable insights for assessing clinical and surgical outcomes. This study aims to develop and validate a novel-specific questionnaire for patients with NSP. METHODS: A multi-centre prospective observational study was conducted at two tertiary referral hospitals. "Septal Perforation Quality of Life" (SEPEQOL) was developed by a committee of experts. The psychometric properties, including reproducibility, reliability, validity, and responsiveness, were assessed. RESULTS: The study included 96 symptomatic NSP patients and 30 healthy controls. SEPEQOL internal consistency was satisfactory [Cronbach´s α = 0.7843; 95% confidence interval (CI), 0.702-0.856]. Test-retest reliability was excellent, demonstrated by the absolute intraclass correlation (ICC = 0.974; 95% CI, 0.935-0.989, P-value < 0.001) and Bland-Altman plot (line bias = 1.6 ± 4.57; 95% CI -0.54-3.74, P-value < 0.001). The mean total SEPEQOL score was higher before surgery (25.16 ± 1.65) compared to 6-months after the procedure (13.72 ± 11.39), with a mean difference of 12.19 [standard deviation (SD) 10.76], P-value < 0.001. CONCLUSIONS: SEPEQOL is reliable, consistent, valid, and sensitive to change over time. SEPEQOL assesses the impact of health-related quality of life on NSP and its management in clinical practice. Moreover, it is easy to apply in clinical settings with minimal burden.

Constant head-transient method using pressure and flow data for determining permeability and specific storage of tight rocks.

This paper describes a 'constant head-transient method' for estimating permeability and specific storage of tight rock samples, such as shale and crystalline rocks. Experimental tests are conducted using a cylindrical rock sample subjected to confining pressure, through which pressure diffusion occurs from a constant upstream pressure (or constant head) to a finite downstream storage. Unlike the pulse-transient method, the upstream fluid flow into the sample can be measured using a syringe pump because of no change in upstream pressure. By minimizing the downstream storage, the test time can be significantly reduced, but only the downstream pressure transient data do not yield accurate results on permeability and specific storage estimations. By combining the flow data with the pressure data, the proposed method aims at saving the test time and improving the accuracy of their estimations in extremely low permeability rock samples.•A constant head-transient method for measuring the hydraulic properties of tight rocks was developed with a boundary condition of constant upstream pressure and finite downstream storage.•The test time can be saved by minimizing the downstream storage, and the upstream flow can be measured to improve the accuracy in measuring the hydraulic properties.•Combining the flow and pressure objective functions yields the best curve fitting for both pressure and flow curves.

Novel workflow analysis of robot-assisted hysterectomy through objective performance indicators: a pilot study.

Introduction: The curriculum for a da Vinci surgeon in gynecology requires special training before a surgeon performs their first independent case, but standardized, objective assessments of a trainee's workflow or skills learned during clinical cases are lacking. This pilot study presents a methodology to evaluate intraoperative surgeon behavior in hysterectomy cases through standardized surgical step segmentation paired with objective performance indicators (OPIs) calculated directly from robotic data streams. This method can provide individual case analysis in a truly objective capacity. Materials and methods: Surgical data from six robot-assisted total laparoscopic hysterectomies (rTLH) performed by two experienced surgeons was collected prospectively using an Intuitive Data Recorder. Each rTLH video was annotated and segmented into specific, functional surgical steps based on the recorded video. Once annotated, OPIs were compared through workflow analysis and across surgeons during two critical surgical steps: colpotomy and vaginal cuff closure. Results: Through visualization of the individual steps over time, we observe workflow consistencies and variabilities across individual surgeons of a similar experience level at the same hospital, creating unique surgeon behavior signatures across each surgical case. OPI differences across surgeons were observed for both the colpotomy and vaginal cuff closure steps, specifically reflecting camera movement, energy usage and clutching behaviors. Comparing colpotomy and vaginal cuff closure time needed for the step and the events of energy use were significantly different (p < 0.001). For the comparison between the two surgeons only the event count for camera movement during colpotomy showed significant differences (p = 0.03). Conclusion: This pilot study presents a novel methodology to analyze and compare individual rTLH procedures with truly objective measurements. Through collection of robotic data streams and standardized segmentation, OPI measurements for specific rTLH surgery steps can be reliably calculated and compared to those of other surgeons. This provides opportunity for critical standardization to the gynecology field, which can be integrated into individualized training plans in the future. However, more studies are needed to establish context surrounding these metrics in gynecology.

Objective Performance Indicators During Robotic Right Colectomy Differ According to Surgeon Skill.

INTRODUCTION: Surgeon assessment tools are subjective and nonscalable. Objective performance indicators (OPIs), machine learning-enabled metrics recorded during robotic surgery, offer objective insights into surgeon movements and robotic arm kinematics. In this study, we identified OPIs that significantly differed across expert (EX), intermediate (IM), and novice (NV) surgeons during robotic right colectomy. METHODS: Endoscopic videos were annotated to delineate 461 surgical steps across 25 robotic right colectomies. OPIs were compared among two EX, two IM, and eight NV surgeons during mesenteric dissection, vascular pedicle ligation, right colon and hepatic flexure mobilization, and preparation of the proximal and distal bowel for transection. RESULTS: Compared to NV's, EX's exhibited greater velocity, acceleration and jerk for camera, dominant, nondominant, and third arms across all steps. Compared to NV's, IM's exhibited more arm swaps and master clutch use, higher camera-related metrics (movement, path length, moving time, velocity, acceleration, and jerk), greater dominant wrist pitch and nondominant wrist articulations (roll, pitch, and yaw), longer dominant and nondominant arm path length, and higher velocity, acceleration and jerk for dominant, nondominant, and third arms across all steps. Compared to NV's, EX/IM surgeons utilized more arm swaps, higher camera-related metrics (movement, path length, velocity, acceleration, and jerk), longer nondominant arm path length, and greater velocity, acceleration and jerk for dominant, nondominant, and third arms across all steps. CONCLUSIONS: We report OPIs that discriminate EX, IM, and NV surgeons during RRC. This study is the first to demonstrate feasibility of using OPIs as an objective, scalable way to classify surgeon skill during RRC steps.

The MOEO algorithm for multi-objective optimization of the cancer immuno-chemotherapy.

In cancer treatment, chemotherapy has the disadvantage of killing both healthy and cancerous cells. Hence, the mixed-treatment of cancer such as chemo-immunotherapy is recommended. However, deriving the optimal dosage of each drug is a challenging issue. Although metaheuristic algorithms have received more attention in solving engineering problems due to their simplicity and flexibility, they have not consistently produced the best results for every problem. Thus, the need to introduce novel algorithms or extend the previous ones is felt for important optimization problems. Hence, in this paper, the multi-objective Equilibrium Optimizer algorithm, as an extension of the single-objective Equilibrium Optimizer algorithm, is recommended for cancer treatment problems. Then, the performance of the proposed algorithm is considered in both chemotherapy and mixed chemo-immunotherapy of cancer, considering the constraints of the tumor-immune dynamic system and the health level of the patients. For this purpose, two different patients with real clinical data are considered. The Pareto front obtained from the multi-objective optimization algorithm shows the points that can be selected for treatment under different criteria. Using the proposed multi-objective algorithm has reduced the total chemo-drug dose to 138.92 and 5.84 in the first patient, and 16.9 and 0.4384 in the second patient, for chemotherapy and chemo-immunotherapy, respectively. Comparing the results with previous studies demonstrates MOEO's superior performance in both chemotherapy and chemo-immunotherapy. However, it is shown that the proposed algorithm is more suitable for mixed-treatment approaches.

Numerical study on the forward and inverse problems of the mobile pump truck frame.

Aiming at the requirements of strong mobility and high flexibility of rescue and relief mobile pump trucks, this paper designs a new type of mobile pump truck frame based on existing mobile vehicle frame models. The materials used for the frame are 40Cr and Q235, and the finite element method is utilized to carry out static mechanical analysis and dynamic characteristic analysis. Simultaneously utilizing topology optimization and multi-objective genetic algorithm to optimize the design of the frame structure. The results show that the optimized pump truck frame can meet the strength design requirements of four typical working conditions: full load bending, full load torsion, emergency turning and emergency braking, while avoiding resonance phenomena caused by road surface and diesel engine vibration. Compared with the original frame model, the weight of the optimized frame is reduced by 87.88 kg, with a weight reduction rate of 10.89%, realizing the lightweight design requirements.

Investigating the use of signal detection information in supervised learning-based image denoising with consideration of task-shift.

Purpose: Recently, learning-based denoising methods that incorporate task-relevant information into the training procedure have been developed to enhance the utility of the denoised images. However, this line of research is relatively new and underdeveloped, and some fundamental issues remain unexplored. Our purpose is to yield insights into general issues related to these task-informed methods. This includes understanding the impact of denoising on objective measures of image quality (IQ) when the specified task at inference time is different from that employed for model training, a phenomenon we refer to as "task-shift." Approach: A virtual imaging test bed comprising a stylized computational model of a chest X-ray computed tomography imaging system was employed to enable a controlled and tractable study design. A canonical, fully supervised, convolutional neural network-based denoising method was purposely adopted to understand the underlying issues that may be relevant to a variety of applications and more advanced denoising or image reconstruction methods. Signal detection and signal detection-localization tasks under signal-known-statistically with background-known-statistically conditions were considered, and several distinct types of numerical observers were employed to compute estimates of the task performance. Studies were designed to reveal how a task-informed transfer-learning approach can influence the tradeoff between conventional and task-based measures of image quality within the context of the considered tasks. In addition, the impact of task-shift on these image quality measures was assessed. Results: The results indicated that certain tradeoffs can be achieved such that the resulting AUC value was significantly improved and the degradation of physical IQ measures was statistically insignificant. It was also observed that introducing task-shift degrades the task performance as expected. The degradation was significant when a relatively simple task was considered for network training and observer performance on a more complex one was assessed at inference time. Conclusions: The presented results indicate that the task-informed training method can improve the observer performance while providing control over the tradeoff between traditional and task-based measures of image quality. The behavior of a task-informed model fine-tuning procedure was demonstrated, and the impact of task-shift on task-based image quality measures was investigated.

Efficacy and safety of PD-1/L1 inhibitors as first-line therapy for metastatic colorectal cancer: a meta-analysis.

Objective: To evaluate the efficacy and safety of PD-1/L1 inhibitors as first-line therapy in metastatic colorectal cancer(mCRC). Method: Articles evaluating first-line PD-1/L1 inhibitors for mCRC were sought in four databases (Pubmed, Embase, Web of Science, and the Cochrane Library) from the inception of the databases until 11 November 2023. Meta-analyses were conducted to assess the rates of progression-free survival (PFS), overall survival (OS), complete response (CR), partial response (PR), stable disease (SD), progressive disease (PD), objective response rate (ORR), disease control rate (DCR), and grade ≥ 3 treatment-related adverse events (trAEs). Results: Totally nine studies were included for meta-analysis. A subgroup analysis was performed based on mismatch repair(MMR) status and regimens. In patients diagnosed with mismatch repair-deficient(dMMR) mCRC who received PD-1/L1 inhibitors as their first-line treatment, the ORR was 0.54 (95% CI, 0.39 to 0.68), the median PFS was 53.2 months, the Grade≥ 3 TRAEs rate was 0.33(95% CI, 0.12 to 0.60) and the median OS was not determined. For patients with proficient mismatch repair (pMMR) mCRC who underwent a combined treatment of PD-1/L1 inhibitors, anti-VEGF monoclonal antibody and chemotherapy as their first-line therapy, the ORR was 0.62 (95% CI, 0.56 to 0.68), the median PFS was 10.1 months, the median OS was 26.7 months, and the Grade≥ 3 TRAEs rate was 0.59(95% CI, 0.39 to 0.77). Conclusion: Our results revealed that the utilization of PD-1/L1 inhibitors as first-line therapy for dMMR mCRC yielded highly favorable outcomes, while maintaining an acceptable level of safety. Administering a combination of PD-1/L1 inhibitors, anti-VEGF monoclonal antibody, and chemotherapy as first-line treatment in patients with pMMR mCRC led to an improved ORR. However, there was no significant improvement in the long-term prognosis of the tumor. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024506196, identifier CRD42024506196.