Extraction optimization of mucilage from Basil (Ocimum basilicum L.) seeds using response surface methodology

Aqueous extraction of basil seed mucilage was optimized using response surface methodology. A Central Composite Rotatable Design (CCRD) for modeling of three independent variables: temperature (40-91 °C); extraction time (1.6-3.3 h) and water/seed ratio (18:1-77:1) was used to study the response for yield. Experimental values for extraction yield ranged from 7.86 to 20.5 g/100 g. Extraction yield was significantly (P < 0.05) affected by all the variables. Temperature and water/seed ratio were found to have pronounced effect while the extraction time was found to have minor possible effects. Graphical optimization determined the optimal conditions for the extraction of mucilage. The optimal condition predicted an extraction yield of 20.49 g/100 g at 56.7 °C, 1.6 h, and a water/seed ratio of 66.84:1. Optimal conditions were determined to obtain highest extraction yield. Results indicated that water/seed ratio was the most significant parameter, followed by temperature and time.

Comparison of variables affecting the surgical outcomes of tubularized incised plate urethroplasty in adult and pediatric hypospadias

INTRODUCTION

The American Academy of Pediatrics recommends operating on hypospadias between the ages of 6-12 months. Since most births in developed countries are conducted in a hospital, parents are likely to be well informed and counseled about the hypospadias. However, significant numbers of births in developing countries are still conducted at home, with illiteracy, poverty and ignorance often leading to late presentation at the hospital. Reported hypospadias-repair complication rates are higher in adults compared with those having surgery in childhood. The present study's objective was to evaluate the factors affecting surgical outcome in hypospadias patients undergoing tubularized and tubularized incised plate urethroplasty (TIPU) in adulthood compared with childhood.

MATERIALS AND METHODS

A prospective study of 60 adult patients >16 years, and 60 pediatric patients <5 years who underwent TIPU for primary hypospadias between May 2008 and May 2012. Patients were operated on by a single surgeon, under similar circumstances, and were pre-operatively examined to assess meatal location, chordee, and torsion; they were also examined intra-operatively for quality of spongiosum and urethral plate width. The outcomes were assessed by patient/parents for satisfaction regarding cosmesis, urinary stream and complications.

RESULTS

The age of the patients varied from 16 to 27 years, with a mean of 20.8 years in adults, and 6 months to 5 years, with a mean of 2.1 years, in children. The type of hypospadias, degree of curvature, quality of spongiosum and urethral plate width were comparable in both groups, but complication rates were higher in adults (16.7%) than in the pediatric (6.7%) group (Figure 1A-D). Meatal stenosis responded well to dilatation, but fistulae required revision surgery and had a cure rate of 100%. The median follow-up was 37 months in adults, and 39 months in children.

DISCUSSION

The higher complication rates in adults may be due to more frequent erections; increased susceptibility to infection along with relatively reduced vascularity lead to poor wound healing and increased complication rates. The limitation of the study was the small number of patients with mid and proximal hypospadias having lesser incidences in comparison with distal hypospadias. Adequate number of patients in these subgroups could have further strengthened the statistical correlation. Secondly, there was no objective criterion like uroflowmetry to assess urinary stream.

CONCLUSIONS

Complication rates were higher in adults undergoing TIPU compared with pediatric patients, which was also statistically significant in distal hypospadias. The important factors in surgical outcome were: severity of hypospadias, degree of curvature, quality of spongiosum, and urethral plate width.

Variables associated with emergency department and/or unplanned hospital utilization for children with epilepsy

In the United States, approximately one million people are evaluated annually in an emergency department (ED) for the diagnosis of a seizure or epilepsy. The highest percentages of these patients are less than five years of age. No studies have been performed on assessing potential variables associated with recurrent ED visits and/or unplanned hospitalizations for children with epilepsy. Institutional review board approval from Nationwide Children's Hospital was obtained prior to study initiation. An accountable care organization (ACO), Partner for Kids (PFK), database was searched for patients with the highest and the lowest number of ED visits and/or unplanned hospitalizations from 2007 through 2011 using ICD-9 codes of 345.xx and 780.39. The patients were stratified into a high and a low utilizer group. The total number of visits and their associated health care costs were noted for each patient. In total, 120 patients were included for review. Information on the total number of no-shows to outpatient neurology clinic visits and telephone calls to neurology triage nursing was noted. A chart review was performed by a pediatric epileptologist to determine if each individual patient was an appropriate candidate for an emergency seizure treatment. The dose of emergency seizure medication was cross-checked to the patient's actual dose during the time of ED or hospital presentation to determine if the dose given was high, low, or accurate based on dosing recommendations. Multivariable logistic regression was used to test the effects of factors. When controlling for other factors, patients who were given an incorrect or no emergency seizure dosing had a high probability of having multiple ED visits/unplanned hospitalizations compared with patients who were given correct dosing (odds ratio=11.28, 95% CI of odds ratio=(2.42, 52.63), p value<0.01 (p=0.0021)). Using a similar model, patients who experienced a higher number of no-shows to clinic visits had a higher probability of having multiple ED visits/unplanned hospitalizations (odds ratio=5.73 per 1 more number of no-show, 95% CI of odds ratio=(1.78, 18.44), p value<0.01 (p=0.0034)). Future studies are planned to target these risk factors with the goal of decreased ED and/or hospital utilization for children with epilepsy.

Periodontal Status and Some Variables among Pregnant Women in a Nigeria Tertiary Institution

Background:

Gingival changes during pregnancy have been well-documented. The prevalence of gingivitis in pregnant women has reportedly ranged from 30% to 100%. Increase in both the rate of estrogen metabolism and synthesis of prostaglandins by the gingiva contributed to the gingival changes observed during pregnancy. In effect increased prevalence of dental caries, gingivitis, periodontitis and tooth mobility may be encountered in pregnancy.

Aim:

The purpose of the study was to determine the association of some variables and the periodontal status in a sample of pregnant women attending the Ante Natal Clinic (ANC) of Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos.

Subjects and Methods:

Women at various stages of pregnancy, attending the ANC of LASUTH, constituted the target population. The questionnaire was administered on each patient followed by dental examinations. Periodontal status was assessed using the community periodontal index (CPI) of treatment needs. Oral hygiene status was evaluated according to Green and Vermilion simplified oral hygiene index (OHI-S).

Results:

The association between the CPI scores; OHI-S scores and variables such as trimester and dental visits were statistically significant.

Conclusion:

This study indicated that the gestational age of pregnancy and dental visits have a definite impact on the periodontal status. Oral health education should be included as an integral part of antenatal care to increase the women awareness. This would improve the mothers’ dental care-seeking behavior.

Severity of electrical accidents in the construction industry in Spain

PROBLEM

This paper analyzes the severity of workplace accidents involving electricity in the Spanish construction sector comprising 2,776 accidents from 2003 to 2008.

METHOD

The investigation considered the impact of 13 variables, classified into 5 categories: Personal, Business, Temporal, Material, and Spatial.

RESULTS

The findings showed that electrical accidents are almost five times more likely to have serious consequences than the average accident in the sector and it also showed how the variables of age, occupation, company size, length of service, preventive measures, time of day, days of absence, physical activity, material agent, type of injury, body part injured, accident location, and type of location are related to the severity of the electrical accidents under consideration.

SUMMARY

The present situation makes it clear that greater effort needs to be made in training, monitoring, and signage to guarantee a safe working environment in relation to electrical hazards.

PRACTICAL APPLICATIONS

This research enables safety technicians, companies, and government officials to identify priorities and to design training strategies to minimize the serious consequences of electrical accidents for construction workers.

Response surface optimization and modeling in heavy metal removal from wastewater-a critical review

The existence of hazardous heavy metals in aquatic settings causes health risks to humans, prompting researchers to devise effective methods for removing these pollutants from drinking water and wastewater. To obtain optimum removal efficiencies and sorption capacities of the contaminants on the sorbent materials, it is normally necessary to optimize the purification technology to attain the optimum value of the independent process variables. This review discusses the most current advancements in using various adsorbents for heavy metal remediation, as well as the modeling and optimization of the adsorption process independent factors by response surface methodology. The remarkable efficiency of the response surface methodology for the extraction of the various heavy metal ions from aqueous systems by various types of adsorbents is confirmed in this critical review. For the first time, this review also identifies several gaps in the optimization of adsorption process factors that need to be addressed. The comprehensive analysis and conclusions in this review should also be useful to industry players, engineers, environmentalists, scientists, and other motivated researchers interested in the use of the various adsorbents and optimization methods or tools in environmental pollution cleanup.

OBEDIS Core Variables Project: European Expert Guidelines on a Minimal Core Set of Variables to Include in Randomized, Controlled Clinical Trials of Obesity Interventions

Heterogeneity of interindividual and intraindividual responses to interventions is often observed in randomized, controlled trials for obesity. To address the global epidemic of obesity and move toward more personalized treatment regimens, the global research community must come together to identify factors that may drive these heterogeneous responses to interventions. This project, called OBEDIS (OBEsity Diverse Interventions Sharing - focusing on dietary and other interventions), provides a set of European guidelines for a minimal set of variables to include in future clinical trials on obesity, regardless of the specific endpoints. Broad adoption of these guidelines will enable researchers to harmonize and merge data from multiple intervention studies, allowing stratification of patients according to precise phenotyping criteria which are measured using standardized methods. In this way, studies across Europe may be pooled for better prediction of individuals' responses to an intervention for obesity - ultimately leading to better patient care and improved obesity outcomes.

Data standards for heart failure: the European Unified Registries for Heart Care Evaluation and Randomized Trials (EuroHeart)

Standardized data definitions are essential for assessing the quality of care and patient outcomes in observational studies and randomized controlled trials. The European Unified Registries for Heart Care Evaluation and Randomized Trials (EuroHeart) project of the European Society of Cardiology (ESC) aims to create contemporary pan-European data standards for cardiovascular diseases, including heart failure (HF). We followed the EuroHeart methodology for cardiovascular data standard development. A Working Group including experts in HF registries, representatives from the Heart Failure Association of the ESC, and the EuroHeart was formed. Using Embase and Medline (2016-21), we conducted a systematic review of the literature on data standards, registries, and trials to identify variables pertinent to HF. A modified Delphi method was used to reach a consensus on the final set of variables. For each variable, the Working Group developed data definitions and agreed on whether it was mandatory (Level 1) or additional (Level 2). In total, 84 Level 1 and 79 Level 2 variables were selected for nine domains of HF care. These variables were reviewed by an international Reference Group with the Level 1 variables providing the dataset for registration of patients with HF on the EuroHeart IT platform. By means of a structured process and interaction with international stakeholders, harmonized data standards for HF have been developed. In the context of the EuroHeart, this will facilitate quality improvement, international observational research, registry-based randomized trials, and post-marketing surveillance of devices and pharmacotherapies across Europe.

Statistical methods to the control of the production of blood components: principles and control charts for variables

General quality control good practices require the control of the production of blood components using statistical techniques, such as mandatory by the European Commission Directives and the American Association of Blood Banks standards. Sometimes, the control procedure is exclusively in favor of the compliance verification with specifications per individual component or to compute the number of defective parts usually on a monthly basis. However, this is a critical restriction to detect unnatural patterns such as to guarantee that the production has a non-significance chance to manufacturing nonconforming components. Therefore, a crucial issue in Blood Establishments is the application of a reliable statistical process control methodology to assure products reliable and consistent to specifications. Statistical principles and control charts for variables are reviewed, discussed and recommended, based on current good practices. The empirical data demonstrate the consistency of these models on blood establishment routine. A flowchart to select the type of control chart is suggested.

Variables Contributing to Thyroid (Dys)Function in Pregnant Women: More than Thyroid Antibodies?

Variability in thyroid function in pregnant women is the result of 2 main determinants, each accounting for approximately half of it. The first is the genetically determined part of which the knowledge increases fast, but most remains to be discovered. The second determinant is caused by an ensemble of variables of which thyroid autoimmunity is the best known, but also by others such as parity, smoking, age, and BMI. More recently, new candidate variables have been proposed, such as iron, endocrine disruptors, and the ethnicity of the pregnant women. In the future, the diagnosis and treatment of thyroid (dys)function may be optimized by the use of each individual's pituitary-thyroid set point, corrected with a factor taking into account the impact of nongenetically determined variables.

Selecting appropriate variables for detecting grassland to cropland changes using high resolution satellite data

Grassland is one of the most represented, while at the same time, ecologically endangered, land cover categories in the European Union. In view of the global climate change, detecting its change is growing in importance from both an environmental and a socio-economic point of view. A well-recognised tool for Land Use and Land Cover (LULC) Change Detection (CD), including grassland changes, is Remote Sensing (RS). An important aspect affecting the accuracy of change detection is finding the optimal indicators of LULC changes (i.e., variables). Inappropriately selected variables can produce inaccurate results burdened with a number of uncertainties. The aim of our study is to find the most suitable variables for the detection of grassland to cropland change, based on a pair of high resolution images acquired by the Landsat 8 satellite and from the vector database Land Parcel Identification System (LPIS). In total, 59 variables were used to create models using Generalised Linear Models (GLM), the quality of which was verified through multi-temporal object-based change detection. Satisfactory accuracy for the detection of grassland to cropland change was achieved using all of the statistically identified models. However, a three-variable model can be recommended for practical use, namely by combining the Normalised Difference Vegetation Index (NDVI), Wetness and Fifth components of Tasselled Cap. Increasing number of variables did not significantly improve the accuracy of detection, but rather complicated the interpretation of the results and was less accurate than detection based on the original Landsat 8 images. The results obtained using these three variables are applicable in landscape management, agriculture, subsidy policy, or in updating existing LULC databases. Further research implementing these variables in combination with spatial data obtained by other RS techniques is needed.

Comparing the effect of topical anesthesia and retrobulbar block with intravenous sedation on hemodynamic changes and satisfaction in patients undergoing cataract surgery (phaco method)

BACKGROUND

Cataract is one of the most common surgical procedures in the elderly. In most cases, the elderly have cardiac ischemia or chronic coronary diseases, which would lead to more ischemic events during general anesthesia. Therefore, surgeons and anesthetists prefer regional aesthesia to the general one owing to its more advantages and less complications.

OBJECTIVES

Therefore, this study aimed to compare topical method and retrobulbar block for pain intensity, patient's satisfaction, hemodynamic changes and intra and postoperative complications.

PATIENTS AND METHODS

In a single-blinded clinical trial, 114 patients scheduled for cataract surgery, aged 50 to 90 years with ASA physical status of I-III, were randomly assigned to two groups under monitored anesthesia care as topical anesthesia and retrobulbar block. After the injection of intravenous sedation, which was the combination of midazolam 0.5-1 mg with fentanyl 0.5-1 µ/kg, patients received retro bulbar block or topical anesthesia. During the operation, heart rate, systolic and diastolic blood pressure, mean arterial blood pressure and arterial saturation of O2were measured every five minutes. In addition, pain (VAS) and satisfaction (ISAS) scores were recorded every 15 minutes, then at recovery and one hour after the ending of operation in the ward. Findings were statistically analyzed using SPSS 16.

RESULTS

In this study, no significant association was found between age, gender, education and physical condition of patients in both topical and retro bulbar block groups. Comparison of pain based on VAS, satisfaction based on ISAS score and MAP in the studied periods had no significant differences between the two groups of patients undergoing cataract surgery. However, significant differences were found between the two groups (P = 0.045, 0.02, 0.042 and P < 0.05) regarding heart rate, systolic and diastolic blood pressure and arterial oxygen saturation percentage after 20-30 minutes of the operation.

CONCLUSIONS

Both methods, topical and retro bulbar block had similar impression in cataract surgery regarding analgesia and patient satisfaction. However, in non-complicated cataract surgeries with short duration, topical anesthesia may be the preferable method, because of non-invasiveness, appropriate analgesia, patient satisfaction and hemodynamic stability.

Clinical Evaluation of Correlation Between Diabetic Retinopathy with Modifiable, Non-Modifiable and Other Independent Risk Factors in Tertiary Set-up in Central Rural India

INTRODUCTION

Diabetes mellitus and its related ocular complication like diabetic retinopathy (DR) are showing increased prevalence in India, but the magnitude of presence and progression of DR in central rural population and its relation to certain variables requires further exploration.

AIM

To study the demographic profile on diabetic retinopathy and the association between different risk factors of diabetic retinopathy with its onset and severity.

MATERIALS AND METHODS

A cross-sectional study was carried out on patients suffering from diabetes mellitus (n=100) admitted to AVBRH, Sawangi (Meghe) in a duration of 2 months from April to June 2014. Snellen's chart, slit lamp, and indirect ophthalmoscope were used for ocular examination of all patients. Comprehensive examination was used for risk factor assessment.

STATISTICAL ANALYSIS

All data was entered into the proforma. Chi-square test, Student's unpaired t-test and one way ANOVA using SPSS 17.0 and Graph Pad Prism 5.0. (p<0.05 was considered significant).

RESULTS

The study showed that among all the diabetics (mean age 56.4+11.2 years), 68% were males and 97% type 2 diabetics. This study showed statistically significant association between serum triglyceride (p=0.0003), duration since diagnosis of diabetes mellitus (p=0.0006), serum total cholesterol (p=0.0021), FBG (p=0.003), serum HDL (p=0.012) and hypertension (p=0.045) with presence of diabetic retinopathy. The study also revealed that serum triglycerides (p=0.001), serum total cholesterol (p=0.006), BMI (p=0.04) and duration of diabetes (p=0.04) are the only factors which showed significant association with the severity of diabetic retinopathy.

CONCLUSION

Effective screening strategies for early detection of both diabetes and diabetic retinopathy should be formulated especially for the rural population which is not aware about the various complications of diabetes and their final outcomes. Diabetics should follow proper guidelines to prevent or delay progression of DR.

Maternal and child health data quality in health care facilities at the Cape Coast Metropolis, Ghana

Background

The demand for quality maternal and child health (MCH) data is critical for tracking progress towards attainment of the Sustainable Development Goal 3. However, MCH cannot be adequately monitored where health data are inaccurate, incomplete, untimely, or inconsistent. Thus, this study assessed the level of MCH data quality.

Method

A facility-based cross-sectional study design was adopted, including a review of MCH service records. It was a stand-alone study involving 13 healthcare facilities of different levels that provided MCH services in the Cape Coast Metropolis. Data quality was assessed using the dimensions of accuracy, timeliness, completeness, and consistency. Health facilities registers were counted, collated, and compared with data on aggregate monthly forms, and a web-based data collation and reporting system, District Health Information System (DHIS2). The aggregate monthly forms were also compared with data in the DHIS2. Eight MCH variables were selected to assess data accuracy and consistency and two monthly reports were used to assess completeness and timeliness. Percentages and verification factor were estimated in the SPSS version 22 package.

Results

Data accuracy were recorded between the data sources: Registers and Forms, 102.1% (95% CI = 97.5%—106.7%); Registers and DHIS2, 102.4% (95% CI = 94.4%—110.4%); and Forms and DHIS2, 100.1% (95% CI = 96.4%—103.9%). Across the eight MCH variables, data were 93.2% (95% CI = 82.9%—103.5%) complete in Registers, 91.0% (95% CI = 79.5%—102.5%) in the Forms, and 94.9% (95% CI = 89.9%—99.9%) in DHIS2 database. On the average, 87.2% (95% CI = 80.5%—93.9%) of the facilities submitted their Monthly Midwife’s Returns reports on time, and Monthly Vaccination Report was 94% (95% CI = 89.3%—97.3%). The overall average data consistency was 93% (95% CI = 84%—102%).

Conclusion

Given the WHO standard for data quality, the level of MCH data quality in the health care facilities at the Cape Coast Metropolis, available through the DHIS2 is complete, reported on timely manner, consistent, and reflect accurately what exist in facility’s source document. Although there is evidence that data quality is good, there is still room for improvement in the quality of the data.

Variables related to the quality of life of families that have a child with severe to profound intellectual disabilities: A systematic review

Background

Family quality of life (FQoL) of families that have a child with severe to profound intellectual disabilities (SPID) is an important and emerging concept, however, related variables are inconclusive.

Aim

To gain a better understanding of variables related to the FQoL of families that have a child with SPID, variables related to the FQoL of families that have a child with intellectual disabilities (ID) were systematically reviewed.

Methods and procedures

A search strategy was performed in five databases. Critical appraisal tools were employed to evaluate the quality of both quantitative and qualitative studies. Data extraction and synthesis occurred to establish general study characteristics, variables, and theoretical concepts. Variables were categorised into four key concepts of the FQoL: systemic concepts, performance concepts, family-unit concepts and individual-member concepts.

Outcomes and results

A total of 40 studies were retrieved with 98 variables. Quality scores ranged from 7 to 13 (quantitative) and 5 to 13 (qualitative) out of 13 and 14 points, respectively. Five out of the 40 studies (13%) focused on individuals with SPID. Variables related positively or negatively to the FQoL, and were categorised within systemic concepts (n = 3); performance concepts (n = 11); family-unit concepts (n = 26); and individual-member concepts (n = 58).

Conclusions and implications

Several variables were found to be (inter)related to the FQoL of families that have a child with ID. A contrasting picture emerged regarding the impact of a disability in relation to transitional phases. However, studies which include families of children with SPID were minimal, therefore, it remained ambiguous to what extent the identified variables apply to these families.

Acquiring data in medical research: A research primer for low- and middle-income countries

Without data, there is no new knowledge generated. There may be interesting speculation, new paradigms or theories, but without data gathered from the universe, as representative of the truth in the universe as possible, there will be no new knowledge. Therefore, it is important to become excellent at collecting, collating and correctly interpreting data. Pre-existing and new data sources are discussed; variables are discussed, and sampling methods are covered. The importance of a detailed protocol and research manual are emphasized. Data collectors and data collection forms, both electronic and paper-based are discussed. Ensuring subject privacy while also ensuring appropriate data retention must be balanced.

Getting started with tables

Background

Tables are often overlooked by many readers of papers who tend to focus on the text. Good tables tell much of the story of a paper and give a richer insight into the details of the study participants and the main research findings. Being confident in reading tables and constructing clear tables are important skills for researchers to master.

Method

Common forms of tables were considered, along with the standard statistics used in them. Papers in the Archives of Public Health published during 2015 and 2016 were hand-searched for examples to illustrate the points being made. Presentation of graphs and figures were not considered as they are outside the scope of the paper.

Results

Basic statistical concepts are outlined to aid understanding of each of the tables presented. The first table in many papers gives an overview of the study population and its characteristics, usually giving numbers and percentages of the study population in different categories (e.g. by sex, educational attainment, smoking status) and summaries of measured characteristics (continuous variables) of the participants (e.g. age, height, body mass index). Tables giving the results of the analyses follow; these often include summaries of characteristics in different groups of participants, as well as relationships between the outcome under study and the exposure of interest. For continuous outcome data, results are often expressed as differences between means, or regression or correlation coefficients. Ratio/relative measures (e.g. relative risks, odds ratios) are usually used for binary outcome measures that take one of two values for each study participants (e.g. dead versus alive, obese versus non-obese). Tables come in many forms, but various standard types are described here.

Conclusion

Clear tables provide much of the important detail in a paper and researchers are encouraged to read and construct them with care.

[Validation and reliability study of the parent concerns about surgery questionnaire: What worries parents?]

INTRODUCTION

The study of mediating variables and psychological responses to child surgery involves the evaluation of both the patient and the parents as regards different stressors.

OBJECTIVE

To have a reliable and reproducible valid evaluation tool that assesses the level of paternal involvement in relation to different stressors in the setting of surgery.

MATERIAL AND METHOD

A self-report questionnaire study was completed by 123 subjects of both sexes, subdivided into 2populations, due to their relationship with the hospital setting. The items were determined by a group of experts and analysed using the Lawshe validity index to determine a first validity of content. Subsequently, the reliability of the tool was determined by an item-re-item analysis of the 2sub-populations. A factorial analysis was performed to analyse the construct validity with the maximum likelihood and rotation of varimax type factors.

RESULTS

A questionnaire of paternal concern was offered, consisting of 21 items with a Cronbach coefficient of 0.97, giving good precision and stability. The posterior factor analysis gives an adequate validity to the questionnaire, with the determination of 10 common stressors that cover 74.08% of the common and non-common variance of the questionnaire.

CONCLUSION

The proposed questionnaire is reliable, valid and easy-to-apply and is developed to assess the level of paternal concern about the surgery of a child and to be able to apply measures and programs through the prior assessment of these elements.

Development and validation of a risk model with variables related to non-small cell lung cancer in patients with pulmonary nodules: a retrospective study

BACKGROUND

Lung cancer is a major global threat to public health for which a novel predictive nomogram is urgently needed. Non-small cell lung cancer (NSCLC) which accounts for the main port of lung cancer cases is attracting more and more people's attention.

PATIENTS AND METHODS

Here, we designed a novel predictive nomogram using a design dataset consisting of 515 pulmonary nodules, with external validation being performed using a separate dataset consisting of 140 nodules and a separate dataset consisting of 237 nodules. The selection of significant variables for inclusion in this model was achieved using a least absolute shrinkage and selection operator (LASSO) logistic regression model, after which a corresponding nomogram was developed. C-index values, calibration plots, and decision curve analyses were used to gauge the discrimination, calibration, and clinical utility, respectively, of this predictive model. Validation was then performed with the internal bootstrapping validation and external cohorts.

RESULTS

A predictive nomogram was successfully constructed incorporating hypertension status, plasma fibrinogen levels, blood urea nitrogen (BUN), density, ground-glass opacity (GGO), and pulmonary nodule size as significant variables associated with nodule status. This model exhibited good discriminative ability, with a C-index value of 0.765 (95% CI: 0.722-0.808), and was well-calibrated. In validation analyses, this model yielded C-index values of 0.892 (95% CI: 0.844-0.940) for external cohort and 0.853 (95% CI: 0.807-0.899) for external cohort 2. In the internal bootstrapping validation, C-index value could still reach 0.753. Decision curve analyses supported the clinical value of this predictive nomogram when used at a NSCLC possibility threshold of 18%.

CONCLUSION

The nomogram constructed in this study, which incorporates hypertension status, plasma fibrinogen levels, BUN, density, GGO status, and pulmonary nodule size, was able to reliably predict NSCLC risk in this Chinese cohort of patients presenting with pulmonary nodules.

Analysis of the key factors for small and medium-sized enterprises growth using principal component analysis

Small and Medium-sized Enterprises (SMEs) significantly contribute to national economic development worldwide. However, numerous factors affect the growth of SMEs, particularly in developing economies. Due to the complexity of these variables, it is challenging to determine where to begin improving SMEs. This study aims to identify and analyse the factors that hinder the overall performance of (SMEs) to gain insights into the principal variables constituting problems. A literature survey identified and abstracted 36 variables that influence SME growth. A structured questionnaire was created using the variables and administered to the respondents in the SME sector. We collated and converted the respondents' scores into primary data. The data was analysed using Kendall's Coefficient of Concordance (W) and Principal Component Analytics (PCA) tools, and the results were presented. The result of Kendall's Coefficient of Concordance analysis was (W) = 0.52, indicating that the judges strongly agree that the 36 variables affect SME growth. The PCA analysis identified the critical variables affecting SME growth. These variables, along with their corresponding factor loading, include Marketing information = 0.80, Cost of transportation = 0.81, Information technology = 0.83, Economic initiatives = -0.83, Financial constraints = -0.80, Cultural change = 0.80, Technical know-how = 0.822, Economic factors = -0.80, and Business information system = 0.813. The implication of the study's findings for management is that SMEs should begin process improvement for effective overall performance by addressing the problems associated with the critical variables. The perceived limitation of the study is that the respondents' opinions may not reflect 100 % of the opinions of the unsampled population in the SME sector. This study's originality includes (i) holistic documentation of the myriad of variables influencing SMEs, which are fragmented in the literature, and (ii) pinpointing the critical variables affecting SME development with measurable evidence not found in the literature.

Estimating the postmortem interval: applications of forensic acarology, palynology, and taphonomy

Determination of the minimum postmortem interval remains an important factor in the investigation of deaths, especially homicides. It is important for near-accurate reconstruction of the fatal event, especially after putrefaction has commenced. It helps to weigh the alibi of suspects, and to include or exclude these individuals. The science of forensic entomology, acarology, palynology and taphonomy have been applied with varying degree of accuracy depending on a plethora of biotic and abiotic factors. Each of these specialties is most useful at specific times during decomposition and depending on local environmental factors. As decomposition progresses, the estimation of the PMI becomes more difficult. Here, we review how different forensic techniques are most appropriate for estimating the postmortem interval at different times since death. Ultimately, the determination of the interval is a difficult task requiring a multidisciplinary approach comprising many forensic specialists.

Algorithmic Relationships in Babylonian Astronomical Procedure Texts

This paper presents initial findings on the interaction between astronomical procedures on Babylonian tablets. Using algorithms as a lens, this research investigates the relationship between procedures, data provided on the tablet, and the representations of methods within the tablets. This paper first provides a critical analysis of the term "algorithm" in a historical, Mesopotamian context and how algorithms may be used as an analytical tool for thinking about the relationship between astronomical procedures. Following this description, the paper moves on to discuss a case study from the planetary procedure texts that showcases how an algorithm-based analysis can inform reinterpretations of how the individual procedures interact on a given tablet. The ultimate goal of this work is to shed new light on how the authors and users of these astronomical tablets may have interacted with them.

Roles and interrelation between variables : a study case of plastic waste management in Jakarta Bay

The accumulation of plastic waste in the marine environment has increased the global risk of marine pollution due to its negative impact on land, ecosystems, and especially the food chain and marine organisms. Ineffective plastic waste management has reduced the quality of the coastal environment including community sanitation and health, landscapes, and coastal views, and influenced economic sectors such as tourism, fisheries, and shipping. The economic and public activities within coastal areas have consistently as the source of plastic waste leakage either directly or indirectly. Various variables involved and connected each other, some influential and other existing variables were not working effectively and do not support each other optimally in the system. The policy without limitation on the plastic production and certain type of plastic such as packaging or single-use, bags, and a lack of management capacity have led to the establishment of a burden on current plastic waste management within the coastal and marine of Jakarta Bay. Therefore, the study aims to analyze the roles and interrelation of variables that influence plastic waste management in Jakarta Bay. Public participation through group discussion, interview, and Micmac analysis method was used to identify, map, and analyze their interrelationships, roles, and hierarchy in the plastic waste management system. The results showed that the dynamics of variables' interaction affect their level of performance and contribution. The variables with strong influence have the potential to strengthen others, while some had a high dependence which was vulnerable to have ineffective performance in the waste management system as their stability relied on other variables' performance. A group of variables were greatly affected by others and indicates that they had lower influence and higher dependence, while the rest of the variables were relatively disconnected from the system. The key to better waste management is to improve the performance and the quality of relationships of variables that were found in the influential and intermediate quadrants. Furthermore, the indirect influence variables also need to be considered as they have the potential to contribute to the future system strategy or scenario planning.

Where are the links? Using a causal loop diagram to assess interactions in healthcare coordination for youth experiencing homelessness in Toronto, Canada

BACKGROUND

Youth experiencing homelessness (YEH) suffer from poorer physical and mental health outcomes than stably housed youth. Additionally, YEH are forced to navigate fragmented health and social service systems on their own, where they often get lost between systems when transitioning or post-discharge. Inevitably, YEH require support with health system navigation and healthcare coordination. The aim of this study is to understand interactions within and between the emergency youth shelter (EYS) and health systems that affect healthcare coordination for YEH in Toronto, Canada, and how these interactions can be targeted to improve healthcare coordination for YEH.

METHODS

This study is part of a larger qualitative case study informed by the framework for transformative systems change. To understand interactions in healthcare coordination for YEH within and between the EYS and health systems, we developed a causal loop diagram (CLD) using in-depth interview data from 24 key informants at various levels of both systems. Open and focused codes developed during analysis using Charmaz's constructivist grounded theory methodology were re-analysed to identify key variables, and links between them to create the CLD. The CLD was then validated by six stakeholders through a stakeholder forum.

RESULTS

The CLD illustrates six balancing and one reinforcing feedback loop in current healthcare coordination efforts within the EYS and health systems, respectively. Increasing EYS funding, building human resource capacity, strengthening inter and intra-systemic communication channels, and establishing strategic partnerships and formal referral pathways were identified among several other variables to be targeted to spiral positive change in healthcare coordination for YEH both within and between the EYS and health systems.

CONCLUSIONS

The CLD provides a conceptual overview of the independent and integrated systems through which decision-makers can prioritize and guide interventions to strengthen healthcare coordination within and between the EYS and health systems. Overall, our research findings suggest that key variables such as streamlining communication and improving staff-youth relationships be prioritized, as each of these acts interdependently and influences YEH's access, quality and coordination of healthcare.