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Rapid screening of bacteriostatic and bactericidal antimicrobial agents against Escherichia coli by combining machine learning (artificial intelligence) and UV-VIS spectroscopy. Analyst 2024; 149:1597-1608. [PMID: 38291984 DOI: 10.1039/d3an01608k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Antibiotics are compounds that have a particular mode of action upon the microorganism they are targeting. However, discovering and developing new antibiotics is a challenging and timely process. Antibiotic development process can take up to 10-15 years and over $1billion to develop a single new therapeutic product. Rapid screening tools to understand the mode of action of the new antimicrobial agent are considered one of the main bottle necks in the antimicrobial agent development process. Classical approaches require multifarious microbiological methods and they do not capture important biochemical and organism therapeutic-interaction mechanisms. This work aims to provide a rapid antibiotic-antimicrobial biochemical diagnostic tool to reduce the timeframes of therapeutic development, while also generating new biochemical insight into an antimicrobial-therapeutic screening assay in a complex matrix. The work evaluates the effect of antimicrobial action through "traditional" microbiological analysis techniques with a high-throughput rapid analysis method using UV-VIS spectroscopy and chemometrics. Bacteriostatic activity from tetracycline and bactericidal activity from amoxicillin were evaluated on a system using non-resistant Escherichia coli O157:H7 by confocal laser scanning microscopy (CLSM), scanning electron microscopy (SEM), and UV-VIS spectroscopy (high-throughput analysis). The data were analysed using principal component analysis (PCA) and support vector machine (SVM) classification. The rapid diagnostic technique could easily identify differences between bacteriostatic and bactericidal mechanisms and was considerably quicker than the "traditional" methods tested.
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7MO Sotorasib in KRAS G12C-mutated advanced non-small cell lung cancer (aNSCLC): Overall survival (OS) data from the global expanded access program (EAP study-436). J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00261-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
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84O Neoadjuvant nivolumab (N) + platinum-doublet chemotherapy (C) for resectable NSCLC: 3-y update from CheckMate 816. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00338-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
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145MO Updated survival, efficacy and safety of adjuvant (adj) atezolizumab (atezo) after neoadjuvant (neoadj) atezo in the phase II LCMC3 study. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00339-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
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Separation, reserve estimation and radioactivity responsibility of the economic heavy minerals of East El- Arish black sand, North Sinai, Egypt. Sci Rep 2023; 13:4608. [PMID: 36944796 PMCID: PMC10030898 DOI: 10.1038/s41598-023-31440-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 03/11/2023] [Indexed: 03/23/2023] Open
Abstract
Multi-heavy mineral separation techniques like density, magnetic, and electromagnetic techniques are followed by picking, grain counting, and mineralogical examinations conducted with an environmental scanning electron microscope (ESEM). These techniques have been applied to several drill hole (well) composite samples representing beach sand and dunes of East El-Arish area, North Sinai, Egypt. The results explain the remarkable enrichment in total heavy minerals (THM) of beach sand (4.4%) compared to sand dunes (2.6%): this is due to the natural concentration of the currents of the Mediterranean Sea. After characterizing the heavy minerals in terms of the abundance of each mineral species, the mean values of content relative to total economic heavy minerals (TEHM) were determined as 70.03% ilmenite, 3.81% leucoxene, 3.03% magnetite, 8.7% garnet, 10.6% zircon, 3.13% rutile, 0.37% monazite, and 0.31% titanite in the sand dune samples. The total economic heavy minerals in the beach samples were 64.08% ilmenite, 1.6% leucoxene, 2.84% magnetite, 18.16% garnet, 10.4% zircon, 2.18% rutile, 0.61% monazite, and 0.13% titanite. Monazite, thorite, zircon, and apatite are the main radioactive minerals in the study area. The combination of two specific characteristics of the studied monazite (relatively high Th-U content and high frequency) makes monazite the main contributor to radioactivity of the study area.
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Defining benchmarks for fellowship training in foregut surgery: a 10-year review of fellowship council index cases. Surg Endosc 2022; 36:8856-8862. [PMID: 35641699 DOI: 10.1007/s00464-022-09317-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 04/27/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Surgical treatment of foregut disease is a complex field that demands advanced expertise to ensure favorable outcomes for patients. To address the growing need for foregut surgeons, leaders within several national societies have become interested in developing a foregut fellowship. The aim of this study was to develop data-driven benchmarks that will aid in defining appropriate accreditation criteria for these fellowships. METHODS We obtained case log data for Fellowship Council fellows trained from 2009-2019. We identified 78 complex foregut (non-bariatric) case codes and divided them into 5 index case categories including (1) hiatal/paraoesophageal hernia repair, (2) fundoplication, (3) esophageal myotomy, (4) major organ resection, and (5) minor organ resection. Median volumes in each index category were compared over time using Kruskall-Wallis tests. The share of cases done using open, laparoscopic, or robotic approaches were analyzed using linear regression analysis. RESULTS For the 10 years analyzed, 1362 fellows logged 82,889 operations and 111,799 endoscopies. Median foregut cases per fellow grew significantly from 42 (IQR = 24-74) cases in 2010 to 69 (IQR = 33-106) cases in 2019. Median endoscopy volumes also grew significantly from 42 (IQR = 7-88) in 2010 to 69 (IQR 32-123) in 2019.The volume of hiatal/paraoesophageal hernia repairs increased significantly over time while volumes in the remaining 4 index categories remained stable. The share of robotic cases exhibited near perfect linear growth from 2.2% of all foregut cases in 2010 to 14.4% in 2019 (R = 0.99, p < 0.0001). Open cases exhibited linear decay from 7.2% of cases in 2010 to 4.7% of cases in 2019 (R = 0.92, p = 0.0001). Laparoscopic/thoracoscopic cases also exhibited linear decay from 90.6% of cases in 2010 to 80.9% of cases in 2019 (R = 0.98, p < 0.00001). CONCLUSIONS FC fellows are exposed to robust volumes of foregut cases. This rich data set provides an evidence-based guide for establishing criteria for potential foregut fellowships.
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Quality of Life after Large Maxillomandibular Advancement Surgery for Obstructive Sleep Apnea using a Single-Item Global Instrument. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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A Comprehensive Strategy for Improving Nasal Outcomes after Large Maxillomandibular Advancement for Obstructive Sleep Apnea. Sleep Med 2022. [DOI: 10.1016/j.sleep.2022.05.628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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754P A phase I/IIa dose escalation study of AFM24 in patients with epidermal growth factor receptor-expressing (EGFR) solid tumors: Results from phase I. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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1173P Early safety, tolerability, and efficacy of REGN5093 in patients (pts) with MET-altered advanced non-small cell lung cancer (aNSCLC) from a first in human (FIH) study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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453O DS-7300 (B7-H3 DXd antibody-drug conjugate [ADC]) shows durable antitumor activity in advanced solid tumors: Extended follow-up of a phase I/II study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Radioactive risk assessment of beach sand along the coastline of Mediterranean Sea at El-Arish area, North Sinai, Egypt. MARINE POLLUTION BULLETIN 2022; 177:113494. [PMID: 35245768 DOI: 10.1016/j.marpolbul.2022.113494] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/19/2022] [Accepted: 02/22/2022] [Indexed: 06/14/2023]
Abstract
Beach sand includes various levels of natural radioactivity, which can cause health effects. The natural radioactivity was measured in the beach sand along the coastline of the Mediterranean Sea at the east of the El-Arish area, Egypt. Using the HPGe spectrometer, the contribution of radionuclides 226Ra, 232Th and 40K in the gamma emitted radiation illustrated that the 226Ra, 232Th and 40K activity concentrations are 8.8 ± 3.9, 30.8 ± 12.2 and 106.9 ± 46.8 Bq kg-1, respectively, which is lower than the reported worldwide limit 33, 45 and 412 Bq kg-1. The radioactive hazards associated with the beach sand along the coastline of the Mediterranean Sea at the east of the El-Arish area were investigated. The obtained results among the radiological hazard parameters, the radium equivalent content (Raeq), the absorbed dose rate (Dair), annual effective dose (AED), external (Hex) and internal (Hin) hazard indices were estimated. Moreover, the excess lifetime cancer risk (ELCR) and the annual gonadal dose equivalent (AGDE) were also computed and illustrated their values less than the recommended levels. Multivariate statistical approaches like Pearson correlation, the principal component analysis (PCA) and the hierarchical cluster analysis (HCA) were applied to investigate the correlation between the radionuclides and the corresponding radiological hazard variables. Based on the statistical analysis, the 226Ra and 232Th mainly contribute to the radioactive risk of beach sand. Finally, no significant risk of the public associated with utilizing beach sand in building materials.
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Phosphorus release from apatite mineral using some organic amendments and their effect on some clay loam soil properties. ARCHIVES OF AGRICULTURE SCIENCES JOURNAL 2022; 0:38-52. [DOI: 10.21608/aasj.2022.127621.1109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Violence, runaway, and suicide attempts among people living with schizophrenia in China: Prevalence and correlates. PeerJ 2022; 10:e13033. [PMID: 35251789 PMCID: PMC8896021 DOI: 10.7717/peerj.13033] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/08/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND People living with schizophrenia are at higher risk of disruptive behaviors, including violence, running away from home, and suicide attempts, which often co-occur and are highly correlated, yet seldom studied together. The current study investigated the frequency and correlates of disruptive behaviors among a Chinese community sample of individuals living with schizophrenia. METHODS A cross-sectional study was conducted among 400 individuals living with schizophrenia from 12 communities. Data about disruptive behaviors in the past 2 months was collected using self-designed questionnaires. Clinical characteristics including psychiatric symptoms, depression, anxiety, disability, and functioning were collected by internationally standardized assessment instruments. RESULTS About one-fifth (21%) of the subjects had experienced at least one form of disruptive behavior in the past 2 months. Violence was the most commonly reported (17.25%), which included damaging property (15%) and physical violence toward others (7.5%); followed by running away (6.5%), and suicide attempts (4%). Logistic regression analysis suggested that medication non-adherence (OR = 4.96, 95% CI [1.79-13.72]), involuntary hospital admission (OR = 5.35, 95% CI [2.06-13.87]), depression (OR = 2.34, 95% CI [1.07-5.10]), and lower social functioning (OR = 0.97, 95% CI [0.93-0.99]) were independently associated with a higher risk of disruptive behaviors. CONCLUSIONS The overlap among three forms of disruptive behaviors warrants them to be assessed and studied together in clinical, research, and policy fields. The significant association between disruptive behaviors with medication non-adherence, involuntary admission, depression, and lower social functioning indicates the need for integrated, targeted, and needs-based intervention programs to be developed for the prevention and treatment of these disruptive behaviors.
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Abstract
Background Antimicrobial stewardship programmes (ASPs) have been widely implemented in medical practice to improve antimicrobial prescribing and reduce selection for multidrug-resistant pathogens. Objectives To implement different antimicrobial stewardship intervention packages in 135 veterinary practices and assess their impact on antimicrobial prescribing. Methods In October 2018, general veterinary clinics were assigned to one of three levels of ASP, education only (CON), intermediate (AMS1) or intensive (AMS2). De-identified prescribing data (1 October 2016 to 31 October 2020), sourced from VetCompass Australia, were analysed and a Poisson regression model fitted to identify the effect of the interventions on the incidence rates of antimicrobial prescribing. Results The overall incidence rate (IR) of antimicrobial prescribing for dogs and cats prior to the intervention was 3.7/100 consultations, which declined by 36% (2.4/100) in the implementation period, and by 50% (1.9/100) during the post-implementation period. Compared with CON, in AMS2 there was a 4% and 6% reduction in the overall IR of antimicrobial prescribing, and a 24% and 24% reduction in IR of high importance antimicrobial prescribing, attributable to the intervention in the implementation and post-implementation periods, respectively. A greater mean difference in the IR of antimicrobial prescribing was seen in high-prescribing clinics. Conclusions These AMS interventions had a positive impact in a large group of general veterinary practices, resulting in a decline in overall antimicrobial use and a shift towards use of antimicrobials rated as low importance, with the greatest impact in high-prescribing clinics.
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A Comprehensive Strategy for Improving Nasal Outcomes After Large Maxillomandibular Advancement for Obstructive Sleep Apnea. Facial Plast Surg Aesthet Med 2021; 23:437-442. [PMID: 34287054 DOI: 10.1089/fpsam.2020.0569] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: Rate of corrective nasal surgery after maxillomandibular advancement (MMA) for obstructive sleep apnea (OSA) has been reported to be 18.7% for functional and aesthetic indications. Objective: Describe a comprehensive strategy to optimize nasal outcomes with MMA for OSA. Methods: A retrospective review of patients undergoing MMA for OSA in a tertiary referral center was performed, with a comprehensive perioperative intervention to optimize nasal outcomes from January 2014 to February 2018. Outcomes included the Apnea-Hypopnea Index (AHI), oxygen saturation (SpO2) nadir, corrective nasal surgery needed after MMA, and Nasal Obstruction Symptom Evaluation (NOSE) scores. Results: AHI after MMA showed significant reduction (-34.65, p < 0.001), SpO2 nadir increased (+6.08, p < 0.001), and NOSE scores decreased (-5.96, p < 0.001). Corrective nasal surgery needed after MMA was reported in 6.5% (8 of 122) subjects at a mean of 8.5 months, ranging from 1 to 24.7 months. Six subjects underwent either septoplasty and/or valve stenosis repair, and two subjects underwent functional and aesthetic rhinoplasty. Conclusion: A perioperative strategy was applied since 2014 that showed effectiveness in reducing post-MMA corrective nasal surgery to 6.5%.
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Letter to the Editor on "Complications Following Robotic Hiatal Hernia Repair Are Higher Compared to Laparoscopy". J Gastrointest Surg 2021; 25:3028-3029. [PMID: 34357531 DOI: 10.1007/s11605-021-05090-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 07/03/2021] [Indexed: 01/31/2023]
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FP03.03 ECOG PS of 0-1 and Very High PD-L1 Expression ≥90% Are Associated With Clinical Benefit From First-Line Chemo-Immunotherapy in Advanced NSCLC. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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516MO Phase I/II study of eprenetapopt (APR-246) in combination with pembrolizumab in patients with solid tumor malignancies. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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The Pen is Mightier: Online Write‐To‐Learn Activities in Large‐Enrollment Classes. FASEB J 2021. [DOI: 10.1096/fasebj.2021.35.s1.04282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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P14.21 Baseline Derived Neutrophil-to-Lymphocyte Ratio (dNLR) and Clinical Outcomes to First-Line Pembrolizumab in NSCLC with High PD-L1 (≥50%). J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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P14.26 Diminished Efficacy of PD-(L)1 Inhibition in STK11- and KEAP1-Mutant Lung Adenocarcinoma is Impacted by KRAS Mutation Status. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.532] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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P75.03 KEYNOTE-U01: A Phase 2 Umbrella Study of Investigational Agents Plus Pembrolizumab-Based Therapy for Advanced NSCLC. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.1037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Photovoltaic Performance of Thin-Film CdTe for Solar Cell Applications. JOURNAL OF NANOFLUIDS 2021. [DOI: 10.1166/jon.2021.1763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In the current investigation, we report a theoretical study to acquire the highest feasible efficiency of cadmium telluride (CdTe) thin-films. It is well recognized that CdTe crystallizes in cubic zinc-blende structure and its direct band gap of 1.5 eV turned it out as a potential candidate
for photovoltaic (PV) applications. Our calculations are founded on Shockley-Queisser (SQ) limit to simulate the open-circuit voltage, current density, and filling factor versus the variation of photon energy up to 4.0 eV. These key parameters of SQ change with the variation of energy between
0.3 to 3.5 eV. This is owing to the strong optical absorption (> 104 cm−1) and direct band gap of 1.5 eV, which make CdTe thin-film suitable for single junction solar cell and ideal for PV applications. It is observed that the optical absorption enhances as the
thickness of the absorbed layer increases. This will effectively provide a theoretical support to the industry of global solar energy that is anticipated to be sustainable in the future.
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FP14.07 Combination Osimertinib plus Selpercatinib for EGFR-mutant Non-Small Cell Lung Cancer (NSCLC) with Acquired RET fusions. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.150] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Experimental Investigation on the Performance of Radial Flow Desiccant Bed Using Activated Alumina (Dept.M). MEJ. MANSOURA ENGINEERING JOURNAL 2020; 35:51-62. [DOI: 10.21608/bfemu.2020.124642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Operative performance outcomes of a simulator-based robotic surgical skills curriculum. Surg Endosc 2020; 34:4543-4548. [PMID: 31732857 DOI: 10.1007/s00464-019-07243-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 10/28/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Robotic technology has become increasingly prevalent throughout modern surgical practice as surgical training programs are determining how to best include this robotic training in their curricula. In this study, we sought to measure changes in performance and workload metrics in the live operative setting following completion of a novel simulator-based robotic skills curriculum. METHODS 31 surgical residents naïve to robotic platforms were recruited. They first participated in a live robotic case and had a baseline assessment using RO-SCORE, a robotic modification of the O-SCORE tool, and self-assessed their workload using the NASA Task Load Index (NTLX). Subjects then completed the curriculum, created by an expert panel, on a da Vinci Skills Simulator to pre-set proficiency goals. Subjects were encouraged to train on their own time and could complete the curriculum in one or more sittings, in a 1-month time period. Subjects were then assessed after another live case. Data were analyzed using paired Student's t test. RESULTS Completion of the curriculum was associated with significant RO-SCORE improvements in operative performance across all domains including Camera Control (pre-curriculum mean: 1.9; post-curriculum mean: 4.8; p < 0.001), Needle Control (pre-curriculum mean: 1.7; post-curriculum mean: 4.4; p < 0.001), Tissue Handling (pre-curriculum mean: 2.0; post-curriculum mean: 4.4; p < 0.001). There were significant reductions in all NTLX workload domains including Physical Demand (pre-curriculum mean: 5.2; post-curriculum mean: 2.1; p < 0.001), and Frustration (pre-curriculum mean: 6.4; post-curriculum mean: 1.42; p < 0.001). CONCLUSIONS We describe a feasible robotic simulation curriculum that requires a reasonable amount of time and is self-directed. Significant improvements were seen across all performance metrics and subjective operator workload. Importantly, this is translated to the clinical environment. These types of curricula will be necessary for improving the skills and confidence of trainees and attending surgeons as robotic technology becomes more pervasive.
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Incidence of presenting complaints and diagnoses in insured Australian dogs. Aust Vet J 2020; 98:326-332. [PMID: 32662531 DOI: 10.1111/avj.12981] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 11/30/2022]
Abstract
Knowledge of the most common presenting complaints and diagnoses in companion animals is valuable in preparing veterinary students and veterinarians to manage the most frequently observed conditions in clinical practice. Pet insurance databases provide access to large sample populations and have been previously used to describe disease incidence in companion animals. The aim of this study was to determine the incidence of presenting complaints and diagnoses in insured Australian dogs through the use of a pet insurance database. Analysis of a de-identified dataset containing pet insurance claims associated with presenting complaints and diagnoses from 488,472 insured Australian dogs insured in the years 2016 and 2017, was performed. Annual incidence rates of presenting complaints and diagnoses were calculated and expressed as, number of events per 1,000 dog years at risk. The presenting complaints with the highest incidence were vomiting (14.21 events per 1,000 dog years at risk in 2016, 15.80 events per 1,000 dog years at risk in 2017) and pruritus (8.79 events per 1,000 dog years at risk in 2016, 10.30 events per 1,000 dog years at risk in 2017). Presenting complaints affecting the gastrointestinal system were the most common (19.20 events per 1,000 dog years at risk in 2016, 20.77 events per 1,000 dog years at risk in 2017). The diagnoses with the highest incidence were otitis externa (34.12 events per 1,000 dog years at risk in 2016, 34.82 events per 1,000 dog years at risk in 2017) and dermatitis (28.05 events per 1,000 dog years at risk in 2016, 29.99 events per 1,000 dog years at risk in 2017). Diagnoses affecting the integument were the most common (216.56 events per 1,000 dog years at risk in 2016, 219.06 events per 1,000 dog years at risk in 2017). The results from this study can aid in the design of relevant veterinary curricula and may be helpful in prioritising research on common clinical conditions.
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Abstract
This article focuses on the role of skeletal surgery within the modified Stanford protocol with particular attention focused on the evolved role of MMA. First, surgery in patients presenting with congenital dentofacial deformity or characteristic drug-induced sleep endoscopy findings, then the growing role of maxillary expansion in a newly identified patient phenotype, and finally genioglossus advancement, are discussed. Less commonly used and validated techniques, such as isolated mandibular advancement and maxillomandibular expansion are not discussed in this article.
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Abstract
BACKGROUND Minimally invasive surgery may introduce new ergonomic challenges for surgeons. Increased patient body mass index (BMI) may further add to this ergonomic stress. OBJECTIVES The objective of this study was to quantify the ergonomic impact of patient BMI on surgeons during laparoscopic surgery. SETTING University Hospital, USA. METHODS This prospective cohort study analyzed five minimally invasive surgeons during 24 laparoscopic procedures. Each subject's muscle stress was assessed by recording surface electromyography (EMG) data from eight upper body muscle groups during laparoscopic procedures. EMG data was normalized against the maximal voluntary contraction (MVC) of each muscle measured before the start of surgery to create a percentage of the MVC value (%MVC). Subject workload was assessed through the NASA Task Load Index (NTLX). Statistical analysis was used to determine significance between surgeons operating on patients with or without obesity for %MVC and NTLX scores. RESULTS There was no significant difference (p > 0.05) in both the average muscle activation of all eight muscle groups and NTLX scores during laparoscopic surgery in surgeons operating on patients with BMI > = 30 compared with patients with a BMI < 30. CONCLUSIONS We detected no differences in ergonomic stress or workload for surgeons operating on patients with or without obesity. For surgeons, the laparoscopic approach may offer an additional advantage over open surgery in patients with obesity. This advantage may be due to an "equalizing effect" of laparoscopy-that surgical ergonomics are less affected by the BMI of the patient when using laparoscopic tools.
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Palatopharyngoplasty Resolves Concentric Collapse in Patients Ineligible for Upper Airway Stimulation. Laryngoscope 2020; 130:E958-E962. [PMID: 32109324 DOI: 10.1002/lary.28595] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/05/2020] [Accepted: 02/05/2020] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To determine if a modified tissue-preserving palatopharyngoplasty could convert retropalatal concentric collapse to anteroposterior or lateral patterns of collapse on drug-induced sleep endoscopy (DISE) in patients who are not candidates for upper airway stimulation due to complete circumferential collapse at the velum. METHODS A prospective, nonconsecutive, single-blinded cohort study was performed by two sleep surgeons at a tertiary care center from 2015 to 2018. Inclusion criteria included adults > 18 years of age with a diagnosis of obstructive sleep apnea with an Apnea-Hypopnea Index (AHI) > 15, a body mass index (BMI) < 32, and < 25% central apneas on polysomnography. Twelve patients with complete circumferential collapse underwent a modified palatopharyngoplasty. Postoperatively, a repeat sleep study was performed. A repeat DISE was recommended for those with incomplete surgical response (clinically and/or AHI). RESULTS Twelve patients with complete circumferential collapse were eligible for the study. Mean BMI was 30.5. Mean preoperative AHI was 54.0 events per hour. Following a modified palatopharyngoplasty, the mean AHI was reduced to 33.1 events per hour, and 100% (12 of 12) of the patients converted from a pattern of complete circumferential collapse to either no collapse at the level of the velum (3) or an anteroposterior pattern of collapse (9). CONCLUSION We demonstrate that a modified palatopharyngoplasty can successfully convert collapse patterns in patients with complete circumferential collapse. Further studies are required to determine the outcome of these patients following upper airway stimulation implantation. LEVEL OF EVIDENCE 1B Laryngoscope, 2020.
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MA09.11 Mechanisms of Resistance to MET Tyrosine Kinase Inhibitors in Patients with MET Exon 14 Mutant Non-Small Cell Lung Cancer. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Changing practice: Trends in skeletal surgery for obstructive sleep apnea. J Craniomaxillofac Surg 2019; 47:1185-1189. [DOI: 10.1016/j.jcms.2018.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/25/2018] [Accepted: 11/05/2018] [Indexed: 10/27/2022] Open
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Abstract
IMPORTANCE The Implicit Association Test (IAT) is a validated tool used to measure implicit biases, which are mental associations shaped by one's environment that influence interactions with others. Direct evidence of implicit gender biases about women in medicine has yet not been reported, but existing evidence is suggestive of subtle or hidden biases that affect women in medicine. OBJECTIVES To use data from IATs to assess (1) how health care professionals associate men and women with career and family and (2) how surgeons associate men and women with surgery and family medicine. DESIGN, SETTING, AND PARTICIPANTS This data review and cross-sectional study collected data from January 1, 2006, through December 31, 2017, from self-identified health care professionals taking the Gender-Career IAT hosted by Project Implicit to explore bias among self-identified health care professionals. A novel Gender-Specialty IAT was also tested at a national surgical meeting in October 2017. All health care professionals who completed the Gender-Career IAT were eligible for the first analysis. Surgeons of any age, gender, title, and country of origin at the meeting were eligible to participate in the second analysis. Data were analyzed from January 1, 2018, through March 31, 2019. MAIN OUTCOMES AND MEASURES Measure of implicit bias derived from reaction times on the IATs and a measure of explicit bias asked directly to participants. RESULTS Almost 1 million IAT records from Project Implicit were reviewed, and 131 surgeons (64.9% men; mean [SD] age, 42.3 [11.5] years) were recruited to complete the Gender-Specialty IAT. Healthcare professionals (n = 42 991; 82.0% women; mean [SD] age, 32.7 [11.8] years) held implicit (mean [SD] D score, 0.41 [0.36]; Cohen d = 1.14) and explicit (mean [SD], 1.43 [1.85]; Cohen d = 0.77) biases associating men with career and women with family. Similarly, surgeons implicitly (mean [SD] D score, 0.28 [0.37]; Cohen d = 0.76) and explicitly (men: mean [SD], 1.27 [0.39]; Cohen d = 0.93; women: mean [SD], 0.73 [0.35]; Cohen d = 0.53) associated men with surgery and women with family medicine. There was broad evidence of consensus across social groups in implicit and explicit biases with one exception. Women in healthcare (mean [SD], 1.43 [1.86]; Cohen d = 0.77) and surgery (mean [SD], 0.73 [0.35]; Cohen d = 0.53) were less likely than men to explicitly associate men with career (B coefficient, -0.10; 95% CI, -0.15 to -0.04; P < .001) and surgery (B coefficient, -0.67; 95% CI, -1.21 to -0.13; P = .001) and women with family and family medicine. CONCLUSIONS AND RELEVANCE The main contribution of this work is an estimate of the extent of implicit gender bias within surgery. On both the Gender-Career IAT and the novel Gender-Specialty IAT, respondents had a tendency to associate men with career and surgery and women with family and family medicine. Awareness of the existence of implicit biases is an important first step toward minimizing their potential effect.
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Rotational thromboelastometry (ROTEM®)-guided diagnosis and management of amniotic fluid embolism. Int J Obstet Anesth 2019; 38:127-130. [DOI: 10.1016/j.ijoa.2018.09.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 07/10/2018] [Accepted: 09/03/2018] [Indexed: 11/27/2022]
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0556 Upper Airway Stimulation:Who are the Patients Really Going for It? Sleep 2019. [DOI: 10.1093/sleep/zsz067.554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Abstract
Whereas the original Stanford protocol relied on a tiered approach to care to avoid unnecessary surgery, it did not address the issue of surgical relapse, a common concern among sleep medicine specialists. With 3 decades of experience since the original 2-tiered Powell-Riley protocol was introduced and the role of evolving skeletal techniques and upper airway stimulation, we are pleased to present our current protocol. This update includes emphasis on the facial skeletal development with impact on function including nasal breathing, and the incorporation of upper airway stimulation. The increased versatility of palatopharyngoplasty as an adjunctive procedure is also discussed.
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Abstract
Maxillomandibular advancement (MMA) for the treatment of obstructive sleep apnea (OSA) has remained a reliable and highly effective surgical intervention since its introduction in 1989. Modifications have been made to maximize skeletal movement and upper airway stability without compromising facial balance. Contemporary indications of recommending MMA prior to other soft tissue surgery are described. MMA poses unique challenges to surgeons. There are patient-related factors, including OSA, a chronic inflammatory condition with associated cardiovascular and metabolic comorbidity. Perioperative management is more complex than routine orthognathic patients. Key details are shared from a 3-decade experience at Stanford.
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Endotracheal intubation results in acute tracheal damage induced by mtDNA/TLR9/NF-κB activity. J Leukoc Biol 2018; 105:577-587. [PMID: 30548974 PMCID: PMC7379990 DOI: 10.1002/jlb.5a0718-254rr] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 10/19/2018] [Accepted: 11/25/2018] [Indexed: 12/11/2022] Open
Abstract
Tracheitis secondary to placement of an endotracheal tube (ETT) is characterized by neutrophil accumulation in the tracheal lumen, which is generally associated with epithelial damage. Mitochondrial DNA (mtDNA), has been implicated in systemic inflammation and organ dysfunction following trauma; however, less is known about the effects of a foreign body on local trauma and tissue damage. We hypothesized that tracheal damage secondary to the ETT will result in local release of mtDNA at sufficient levels to induce TLR9 and NF‐κB activation. In a swine model we compared the differences between uncoated, and chloroquine (CQ) and N‐acetylcysteine (NAC) coated ETTs as measured by tracheal lavage fluids (TLF) over a period of 6 h. The swine model allowed us to recreate human conditions. ETT presence was characterized by neutrophil activation, necrosis, and release of proinflammatory cytokines mediated by TLR9/NF‐κB induction. Amelioration of the tracheal damage was observed in the CQ and NAC coated ETT group as shown in tracheal tissue specimens and TLF. The role of TLR9/NF‐κB dependent activity was confirmed by HEK‐Blue hTLR9 reporter cell line analysis after coincubation with TLF specimens with predetermined concentrations of NAC or CQ alone or TLR9 inhibitory oligodeoxynucleotide (iODN). These findings indicate that therapeutic interventions aimed at preventing mtDNA/TLR9/NF‐κB activity may have benefits in prevention of acute tracheal damage.
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P1.01-35 Tumor Volume Analysis In ALK-Rearranged NSCLC Treated with Crizotinib: Identifying an Early Marker for Clinical Outcome. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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MA04.05 Outcomes in NSCLC Patients Treated with First-Line Pembrolizumab and a PD-L1 TPS of 50-74% vs 75-100% or 50-89% vs 90-100%. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.343] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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MA11.10 Identification of Mismatch Repair Deficient Lung Adenocarcinomas Using Targeted Next-Generation Sequencing. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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P3.04-02 Early Plasma ctDNA Response Anticipates Clinical Response to First-Line Immunotherapy in Advanced NSCLC. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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P2.16-03 CheckMate 816: A Phase 3 Trial of Neoadjuvant Nivolumab Plus Ipilimumab or Chemotherapy vs Chemotherapy in Early-Stage NSCLC. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1478] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Serum leptin and homeostasis model assessment-IR as novel predictors of early liver fibrosis in chronic hepatitis B virus infection. Br J Biomed Sci 2018; 75:192-196. [PMID: 30079841 DOI: 10.1080/09674845.2018.1505187] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The relationship between hepatitis B virus (HBV) infection, leptin and insulin resistance remains unclear. We hypothesised links between serum leptin and insulin resistance in non-diabetic patients with chronic viral hepatitis B infection and their relation to liver fibrosis. METHODS We recruited 190 untreated patients with chronic HBV infection and 72 healthy controls. Serum leptin, fasting glucose, insulin, liver function tests (LFTs), C-peptide and Homeostasis model assessment-IR (HOMA-IR) were measured/calculated by ELISA and standard techniques. RESULTS Serum leptin, C-peptide (both P < 0.001), HOMA-IR (P = 0.021) and several LFTs were increased in patients with chronic HBV-infection. In multivariate regression analysis, both HOMA-IR (P = 0.003) and leptin (P = 0.002) were significant independent predictors of HBV infection. There were significant positive correlations (P < 0.01) between leptin and HOMA-IR (r = 0.81), between serum leptin and METAVIR activity (r = 0.95), and between HOMA-IR and BMI (r = 0.75), fasting glucose (r = 0.005), and fasting insulin (r = 0.81). Several LFTs, glucose and insulin correlated modestly (r = 0.61-0.69, P < 0.05) with leptin. CONCLUSION Serum leptin may be related to the rate of fibrosis progression in nondiabetic patients with chronic HBV infection. Follow-up by serial measurement of serum leptin and HOMA-IR in non diabetic HBV-infected patients may be used as a non-invasive marker of early liver fibrosis.
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Enhanced recovery protocol in total hip replacement does not increase general practitioner visits. Br J Anaesth 2018; 121:682-683. [PMID: 30115274 DOI: 10.1016/j.bja.2018.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/02/2018] [Accepted: 06/10/2018] [Indexed: 11/28/2022] Open
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