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Objective To explore the feasibility of building a primary care performance dashboard using DHIS2 data from Ethiopia's largest urban (Addis Ababa), agrarian (Oromia) and pastoral (Somali) regions. Methods We extracted 26 data elements reported by 12 062 health facilities to DHIS2 for the period 1 July 2022 to 30 June 2023. Focusing on indicators of effectiveness, safety and user experience, we built 14 indicators of primary care performance covering reproductive, maternal and child health, human immunodeficiency virus, tuberculosis, noncommunicable disease care and antibiotic prescription. We assessed data completeness by calculating the proportion of facilities reporting each month, and examined the presence of extreme outliers and assessed external validity. Findings At the regional level, average completeness across all data elements was highest in Addis Ababa (82.9%), followed by Oromia (66.2%) and Somali (52.6%). Private clinics across regions had low completeness, ranging from 38.6% in Somali to 58.7% in Addis Ababa. We found only a few outliers (334 of 816 578 observations) and noted that external validity was high for 11 of 14 indicators of primary care performance. However, the 12-month antiretroviral treatment retention rate and proportions of patients with controlled diabetes or hypertension exhibited poor external validity. Conclusion The Ethiopian DHIS2 contains information for measuring primary care performance, using simple analytical methods, at national and regional levels and by facility type. Despite remaining data quality issues, the health management information system is an important data source for generating health system performance assessment measures on a national scale. [phrase omitted] [phrase omitted] Objectif Determiner s'il est possible de creer un tableau de bord des performances de soins de sante primaires en utilisant les donnees du DHIS2 issues des plus grandes regions urbaines (Addis-Abeba), agricoles (Oromia) et pastorales (Somali) d'Ethiopie. Methodes Nous avons extrait 26 elements de donnees transmis au DHIS2 par 12 062 etablissements de sante pour la periode allant du 1er juillet 2022 au 30 juin 2023. En nous focalisant sur l'efficacite, la securite et l'experience vecue par les patients, nous avons defini 14 indicateurs de performances pour les soins de sante primaires, couvrant des domaines tels que la sante reproductive, maternelle et infantile, le virus de l'immunodeficience humaine, la tuberculose, la prise en charge des maladies non transmissibles et la prescription d'antibiotiques. Nous avons evalue l'exhaustivite des donnees en calculant le pourcentage d'etablissements produisant un rapport mensuel, avant d'examiner la presence de valeurs aberrantes extremes et la validite externe. Resultats A l'echelle regionale, c'est a Addis-Abeba (82,9 %) que l'exhaustivite moyenne pour l'ensemble des elements de donnees etait la plus elevee, suivie d'Oromia (66,2 %) et de Somali (52,6 %). Dans toutes les regions, les cliniques privees affichaient un faible taux d'exhaustivite compris entre 38,6 % au Somali et 58,7 % a Addis-Abeba. Nous n'avons trouve que quelques valeurs aberrantes (334 sur 816 578 observations) et avons constate un haut degre de validite externe pour 11 des 14 indicateurs de performances des soins de sante primaires. Toutefois, le degre de validite du taux de maintien du traitement antiretro viral sur 12 mois ainsi que de la proportion de patients avec une hypertension ou un diabete sous controle s'est revele moindre. Conclusion Le DHIS2 ethiopien contient des informations utiles pour mesurer les performances des soins de sante primaires a l'aide de methodes analytiques simples, tant au niveau national que regional et selon les types d'etablissements. Malgre les quelques problemes qui subsistent en termes de qualite, ce dispositif de gestion des informations sanitaires represente une precieuse source de donnees pour elaborer des outils permettant d'evaluer les performances du systeme de sante a l'echelle nationale. [phrase omitted] Objetivo Explorar la viabilidad de crear un tablero de rendimiento de la atencion primaria utilizando datos DHIS2 de las principales regiones urbanas (Addis Abeba), agrarias (Oromia) y pastorales (Somali) de Etiopia. Metodos Se extrajeron 26 elementos de datos notificados por 12 062 centros sanitarios a DHIS2 para el periodo comprendido entre el 1 de julio de 2022 y el 30 de junio de 2023. A partir de indicadores de eficacia, seguridad y experiencia de los usuarios, se elaboraron 14 indicadores del rendimiento de la atencion primaria que abarcan la salud reproductiva, materna e infantil, el virus de la inmunodeficiencia humana, la tuberculosis, la atencion de enfermedades no transmisibles y la prescripcion de antibioticos. Se evaluo la exhaustividad de los datos al calcular el porcentaje de centros que informaban cada mes y se examino la presencia de valores atipicos y de la validez externa. Resultados A nivel regional, el nivel medio de exhaustividad de todos los datos fue mas alto en Addis Abeba (82,9%), seguida de Oromia (66,2%) y Somalia (52,6%). Las clinicas privadas de todas las regiones presentaban un bajo nivel de exhaustividad, que oscilaba entre el 38,6% en Somalia y el 58,7% en Addis Abeba. Solo se encontraron unos pocos valores atipicos (334 de 816 578 observaciones) y se observo que la validez externa era alta para 11 de los 14 indicadores de rendimiento de la atencion primaria. Sin embargo, la tasa de retencion del tratamiento antirretroviral a los 12 meses y los porcentajes de pacientes con diabetes o hipertension controladas mostraron una escasa validez externa. Conclusion El DHIS2 etiope contiene informacion para medir el rendimiento de la atencion primaria, utilizando metodos analiticos sencillos, a escala nacional y regional y por tipo de centro. A pesar de los problemas de calidad de los datos que aun persisten, el sistema de informacion sobre la gestion sanitaria es una fuente de datos importante para generar medidas de evaluacion del rendimiento del sistema sanitario a escala nacional., Introduction Functioning primary care is essential for improving population health. A greater emphasis on primary care in the health-care system can reduce costs, improve access and reduce inequities in population [...]

Minimally invasive surgery (MIS), including laparoscopic and robot‐assisted procedures, has rapidly advanced in the treatment of gynecologic malignancies worldwide. However, its adoption and insurance coverage in AOFOG countries remain limited, particularly for advanced uterine and ovarian cancers. This limitation poses a challenge to the widespread use of MIS, highlighting the need for a more comprehensive evaluation of its role and the skills required by gynecologic oncologists to ensure safe and effective treatment. Furthermore, the Laparoscopic Approach to Cervical Cancer trial significantly impacted perceptions of MIS, revealing higher recurrence rates and inferior overall survival for minimally invasive radical hysterectomy (MIS‐RH) compared to abdominal radical hysterectomy. Subsequent studies confirmed these findings, raising questions about the suitability of MIS‐RH, particularly in centers with limited experience. Key issues affecting MIS outcomes include surgical expertise and tumor spillage prevention. As the landscape of cervical cancer treatment evolves, the integration of radiotherapy, chemotherapy, and immune therapies has challenged the traditional reliance on surgical monotherapy. There also exists ongoing debate over the optimal use of MIS in primary treatment and salvage surgery for cervical cancer to refine MIS techniques and explore their role in preserving fertility and managing residual disease post‐chemoradiotherapy. For ensuring MIS as a viable treatment option, it is continuously necessary accumulating real‐world data and reassessing surgical strategies to balance efficacy, safety, and patient preferences. [ABSTRACT FROM AUTHOR]

Unilateral biportal endoscopic (UBE) microdiscectomy is an emerging minimally invasive surgery technique for treating symptomatic lumbar disc herniation. There is limited literature regarding outcomes. Here, we assess surgical outcomes and pain medication consumption for UBE vs. tubular lumbar microdiscectomy. This was a retrospective cohort study of adult patients undergoing primary, single-level UBE or tubular lumbar microdiscectomy surgery at a high-volume institution between 2018 and 2023. Variables of interest included operative time, complications and reoperations, as well as postoperative opioid and nonopioid pain medication consumption from discharge to 6 months. Opioid consumption was converted to morphine milligram equivalents. Standard statistical analyses were performed for comparative analyses. One hundred two patients—48 UBE and 54 tubular—were included. Average operative time (minutes) was higher for UBE patients (133.1 UBE vs. 86.6 tubular, P < 0.001), which trended downward over time but did not reach statistical significance (P = 0.07). There were no differences in complication or reoperation rates. Average daily MME was lower from discharge to 2-week follow-up in the UBE group (11.1 v. 14.1, P = 0.02), but were comparative thereafter. Nonopioid medication prescription was lower in the UBE cohort from discharge to 2 weeks (70.8% vs. 92.6%, P = 0.01) and 2 to 6 weeks (52.1% vs. 85.2%, P < 0.001), with no significant differences thereafter. UBE microdiscectomy is associated with longer operating times. Both opioid and nonopioid pain medication consumption were lower for UBE patients during the initial postoperative period, perhaps owing to the less-invasive nature of the surgery. [ABSTRACT FROM AUTHOR]

Anterior column realignment via anterior, oblique, or lateral lumbar interbody fusion is increasingly recognized as a powerful mechanism for indirect decompression and sagittal realignment in flexible deformity. Single-position lateral surgery is a popular variation that places patients in the lateral decubitus position, allowing concomitant placement of lateral interbodies and posterior segmental instrumentation without the need for repositioning the patient. The addition of robotics to this technique can help to overcome ergonomic limitations of the placement of pedicle screws in the lateral decubitus position; however, its description in the literature is relatively lacking. In this review we aim to discuss the indications, advantages, and pitfalls of this approach. [ABSTRACT FROM AUTHOR]

The development of metal–insulator–semiconductor (MIS) capacitors requires device miniaturization and excellent electrical properties. Traditional SiO2 gate dielectrics have reached their physical limits. In this context, high-k materials such as TiO2 are emerging as promising alternatives to SiO2. However, the deposition of dielectric layers in MIS capacitors typically requires high-vacuum equipment and challenging processing conditions. Therefore, in this study, we present a new method to effectively fabricate a poly(vinylidene fluoride) (PVDF)-based TiO2 dielectric layer via electrospinning. Nano-microscale layers were formed via electrospinning by applying a high voltage to a polymer solution, and electrical properties were analyzed as a function of the TiO2 crystalline phase and residual amount of PVDF at different annealing temperatures. Improved electrical properties were observed with increasing TiO2 anatase content, and the residual amount of PVDF decreased with increasing annealing temperature. The sample annealed at 600 °C showed a lower leakage current than those annealed at 300 and 450 °C, with a leakage current density of 7.5 × 10−13 A/cm2 when Vg = 0 V. Thus, electrospinning-based coating is a cost-effective method to fabricate dielectric thin films. Further studies will show that it is flexible and dielectric tunable, thus contributing to improve the performance of next-generation electronic devices. [ABSTRACT FROM AUTHOR]

Mitochondrial dysfunction is closely linked to obesity and diabetes, with declining lung function in aging increasing diabetes risk, potentially due to elevated serum levels of dioxin-like mitochondria inhibitor substances (MIS) from prolonged exposure to environmental pollutants. However, the mechanisms connecting MIS, mitochondria, lung function, and metabolic disorder remain unclear. In this study, we analyzed data from 1371 adults aged 40–69 years in the 2008 Korean Genome Epidemiologic Study (KoGES) Ansung cohort. We indirectly estimated dioxin-like MIS levels by measuring intracellular ATP (MISATP) and reactive oxygen species (MISROS) in cultured cells treated with the serum of participants. Using correlation analysis and structural equation modeling (SEM), we explored the relationships among MIS, mitochondrial function, body mass index (BMI), and lung function (FEV1 and FVC). Our findings revealed that MISATP was associated with BMI in females and with FVC in males, while MISROS correlated with both BMI and FVC in males, not in females. Significant associations between BMI and FVC were found in the highest MIS subgroup in both sexes. SEM analyses demonstrated that MIS negatively influenced mitochondrial function, which in turn affected BMI and lung function. Age-related declines in lung function were also linked to mitochondrial dysfunction. This study underscores the potential of MIS assays as alternatives for assessing mitochondrial function and highlights the importance of mitochondrial health in metabolic disorders and lung function. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to design and test a platform of key performance indicators (KPIs) and indices emphasizing achievements and improvement and helping decision-making. Methods: An operations research study was designed to analyze data from the Hospital Management Information System (HMIS) from July 2017 to June 2018 at the Research Institute of Ophthalmology (RIO), Giza, Egypt. The HMIS data were submitted to reform covering parameters in service delivery and corresponding indicators and indices. Data were grouped into four themes: human resources and outpatient, inpatient, and surgical operations. A total of 14 performance indicators were deployed to four specific indices and total performance indices and applied to six teams of ophthalmologists at RIO. The decision matrices were deliberated to demonstrate achievements and provide recommendations for subsequent improvements. Results: Throughout 1 year, six teams of ophthalmologists (n = 222) at RIO provided the following services: outpatient (n = 116,043), inpatient (n = 8,081), and surgical operations (n = 9,174). Teams 2, 1, and 6 were the top teams in the total performance index. Team 4 had plunges in the outpatient index, and Team 5 faced limitations in the inpatient index. Conclusion: The study provided a model for upgrading the performance of the management information system (MIS) in health organizations. The KPIs and indices were used not only for documenting successful models of efficient service delivery but also as examples of limitations for further support and interventions. [ABSTRACT FROM AUTHOR]

Background/Objectives: Protein–energy wasting (PEW) and sarcopenia are common in chronic hemodialysis (HD) patients, leading to numerous complications and increased mortality. This study aimed to compare the reliability of the SARC-F (Strength, Assistance in walking, Rise from a chair, Climb stairs, and Falls) and the Malnutrition–Inflammation Score (MIS) in assessing sarcopenia and predicting negative outcomes in HD patients. Methods: This cross-sectional study enrolled 109 HD patients. Nutritional assessments were performed, and blood samples were taken for routine blood laboratory investigations. The MIS was used as a scoring system to represent the severity of PEW, while the SARC-F was applied as an indicator of sarcopenia risk and general functional capacity. A multivariable logistic regression was conducted to analyze the association of several predictors with a negative cross-sectional outcome (death). Results: Patients with SARC-F scores ≥ 4 and MISs ≥ 6 were older, had significantly lower albumin and prealbumin levels, and more severe anemia. They were also more likely to report weight loss and poor appetite. A higher MIS was closely associated with unfavourable nutritional status according to the International Society of Renal Nutrition and Metabolism (ISRNM) criteria for PEW. However, in 71.25% of patients with satisfactory functional capacity (SARC-F scores 0–3), some form of PEW was still observed. After performing logistic regression modelling, only the MIS remained strongly associated with the probability of a negative outcome. Conclusions: The SARC-F alone often did not correspond to an increased sarcopenia risk or clear clinical and biochemical indicators of PEW in HD patients. When assessing nutritional risk in this group, it is recommended to use more detailed tools, such as the MIS, to ensure the accurate identification of those at the highest risk for negative outcomes. [ABSTRACT FROM AUTHOR]

(1) Background: Our team has previously introduced the Single-Step Pedicle Screw System (SSPSS), which eliminates the need for K-wires, as a safe and effective method for percutaneous minimally invasive spine (MIS) pedicle screw placement. Despite this, there are ongoing concerns about the reliability and accuracy of screw placement in MIS procedures without traditional tools like K-wires and Jamshidi needles. To address these concerns, we evaluated the accuracy of the SSPSS workflow by comparing the planned intraoperative screw trajectories with the final screw positions. Traditionally, screw placement accuracy has been assessed by grading the final screw position using postoperative CT scans. (2) Methods: We conducted a retrospective review of patients who underwent lumbar interbody fusion, using intraoperative 3D navigation for screw placement. The planned screw trajectories were saved in the navigation system during each procedure, and postoperative CT scans were used to evaluate the implanted screws. Accuracy was assessed by comparing the Gertzbein and Robbins classification scores of the planned trajectories and the final screw positions. Accuracy was defined as a final screw position matching the classification of the planned trajectory. (3) Results: Out of 206 screws, 196 (95%) were accurately placed, with no recorded complications. (4) Conclusions: The SSPSS workflow, even without K-wires and other traditional instruments, facilitates accurate and reliable pedicle screw placement. [ABSTRACT FROM AUTHOR]

Mohs Micrographic Surgery (MMS) for treatment of melanoma offers several advantages over wide local excision (WLE), including complete histologic margin evaluation, same-day resection and closure, and sparing of healthy tissue in critical anatomic sites. Recently, a large volume of clinical data demonstrating efficacy in MMS treatment of melanoma was published, leading to emerging patient safety considerations of incurred treatment costs, risk of tumor upstaging, and failure of care coordination for sentinel lymph node biopsy (SLNB). MMS offers a safe, effective, and value-based treatment for both melanoma in situ (MIS) and invasive melanoma (IM), particularly with immunohistochemistry use on frozen sections. Compared to wide local excision, MMS treatment demonstrates similar or improved outcomes for local tumor recurrence, melanoma-specific survival, and overall survival at long-term follow-up. Tumor upstaging risk is low, and if present, alteration to clinical management is minimal. Discussion of SLNB for eligible head and neck IM cases should be done prior to MMS. Though challenging, successful multidisciplinary coordination of SLNB with MMS has been demonstrated. Herein, we provide a detailed clinical review of evidence for MMS treatment of cutaneous melanoma and offer recommendations to address current controversies surrounding the evolving paradigm of surgical management for both MIS and invasive melanoma (IM). [ABSTRACT FROM AUTHOR]

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Recent research in the medical field has increasingly focused on tissue repair, tumor detection, and associated therapeutic techniques. A significant challenge in Minimally Invasive Surgery (MIS) is the loss of direct tactile sensation by surgeons, as they cannot physically feel the organs they operate on. Tactile feedback enhances patient safety by tissue differentiation and reducing inadvertent damage risks. Addressing this challenge, this study introduces a novel tactile sensor designed for compliance detection to enhance tactile feedback in MIS. The sensor operates on a 2-Degree-of-Freedom (2-DOF) vibration absorber system, utilizing a piezoelectric actuator with a calibrated stiffness of 188 N/m. It interprets tissue stiffness regarding a spring constant, Ko, and measures changes in soft tissue stiffness by analyzing variations in the vibration absorber frequency, specifically at the frequency which causes the first mass to exhibit zero amplitude. The effectiveness of this sensor was evaluated through tests on polydimethylsiloxane (PDMS) specimens, which were engineered to replicate varying stiffness found in human organ tissues. Young's modulus of these specimens was determined using a universal testing machine, showing a range from 10.12 to 226.89 kPa. Additionally, the sensor was applied to measure the stiffness of various chicken tissues - liver, heart, breast, and gizzard with respective Young's moduli being 1.97, 9.47, 19.55, and 96.36 kPa. This sensor successfully differentiated between tissue types non-invasively, without requiring substantial deformation or penetration of the tissues. Given its piezoelectric nature, the sensor also holds significant potential for miniaturization through Micro-Electro-Mechanical Systems technology (MEMS), broadening its applicability in surgical environments. [ABSTRACT FROM AUTHOR]

Digital transformation (DX) is complex with many automated parts, underlying integrations and processes that need to fit all together. Tools to support the management of DX activities are, therefore, crucial for every business. However, there are just a few of such tools available these days that can help businesses with the DX management both effectively and comprehensively, but none of them was designed particularly for small- and medium-size enterprises (SMEs) of Vietnam. In this study, we will conduct an overview of recent studies on DX, methods and models for SMEs, and relevant research works regarding information support systems for the management of DX for SMEs. We then propose a novel administrative support system that not only addresses the shortcomings of the current state-of-the-art DX management systems but also meets the requirements of DX for SMEs in Vietnam. In addition to the system design and development, we also implement and benchmark the software product at 11 SMEs in Vietnam (and some results if any).

Resumen: Introducción: Las fracturas de tercio distal femoral son una causa importante de morbimortalidad, siendo su tratamiento actualmente controvertido. Objetivos: Comparar los resultados entre técnicas mínimamente invasivas frente a exposición del foco de fractura. Secundariamente, evaluar la relación entre factores demográficos, mecanismo lesional y demora quirúrgica con el pronóstico de los pacientes. Método: Estudio tipo cohortes retrospectivas realizado entre 2015 y 2021 en un hospital de tercer nivel. La recogida de datos se realizó mediante la revisión de historias clínicas, midiendo parámetros demográficos, hospitalarios y estrategia de tratamiento definitivo. Se completó un año de seguimiento en todos los pacientes, evaluando la aparición de complicaciones quirúrgicas y mortalidad. Se realizó un análisis estratificado de las variables de interés entre pacientes mayores de 65 años. Resultados: Se registraron 128 fracturas, realizándose osteosíntesis definitiva en 117. Los pacientes intervenidos mediante técnicas mínimamente invasivas requirieron una menor estancia hospitalaria (9 [7-12] vs. 12 [8,75-16] días) (p = 0,007), sin diferencias en mortalidad o complicaciones durante el seguimiento. En mayores de 65 años, la apertura del foco de fractura asoció un aumento del riesgo de infección frente a las técnicas mínimamente invasivas (33,3% vs. 2%) (p = 0,507). Todos los fallecidos fueron pacientes mayores de 65 años (33,7% al año). La demora quirúrgica superior a 48 horas aumentó la mortalidad un 10% entre los mayores de 65 años (p = 0,3). Los traumatismos de alta energía presentaron mayor proporción de pseudoartrosis (27,6% vs. 6,1%) (p = 0,011). Conclusiones: Las técnicas mínimamente invasivas disminuyeron la estancia hospitalaria pero no las complicaciones ni la mortalidad a largo plazo.Nivel de evidencia: IIb. Abstract: Introduction: Fractures of the distal femoral third are an important cause of morbidity and mortality, and their treatment is currently controversial. Objectives: To compare the results between minimally invasive techniques versus exposure of the fracture site. Secondly, to evaluate the relationship between demographic factors, mechanism of injury and surgical delay with patient prognosis. Method: Retrospective cohort study carried out between 2015 and 2021 in a tertiary hospital. Data collection was performed by reviewing medical histories, measuring demographic and hospital parameters and definitive treatment strategy. One year of follow-up was completed in all patients, assessing the occurrence of surgical complications and mortality. A stratified analysis of the variables of interest was performed among patients over 65 years of age. Results: 128 fractures were recorded, with definitive osteosynthesis being performed in 117. Patients who underwent minimally invasive techniques required a shorter hospital stay (9 [7-12] vs. 12 [8.75-16] days) (p = 0.007), with no differences in mortality or complications during follow-up. In those over 65 years of age, opening the fracture site was associated with an increased risk of infection compared to minimally invasive techniques (33.3% vs. 2%) (p = 0.507). All the deceased were patients over 65 years of age (33.7% at one year). Surgical delay longer than 48 hours increased mortality by 10% among those older than 65 years (p = 0.3). High-energy trauma had a higher proportion of pseudarthrosis (27.6% vs. 6.1%) (p = 0.011). Conclusions: Minimally invasive techniques decreased hospital stay but not complications or long-term mortality.Level of evidence: IIb.

The palaeotropical-subtropical moth Ophiusa tirhaca (Cramer, 1777) (Lepidoptera: Erebidae) has been known in Romania based on a single (undated) specimen collected in Iași (north-eastern Romania), at least 55–60 years ago. As a consequence, this species has either been excluded or regarded as data deficient in various checklists of Romanian Lepidoptera. Here we present the first fully documented record of O. tirhaca from Romania. A single specimen was found in August 2022 on the Black Sea coast, east of Agigea town (Marine Dunes from Agigea nature reserve), caught by a mist net. Since this thermophilous species cannot become established in the climatic conditions of Romania, the specimen is most likely an immigrant, although it might also represent an accidental arrival due to the close proximity of Constanța harbour (virtually bordering the collection site). The occurrence of O. tirhaca in south-eastern Romania underlines the importance of the western Black Sea coast as a corridor for migratory or expansive species, adding to an increasing series of recent Lepidoptera reports such as Grammodes bifasciata (Petagna, 1787), Acontia candefacta (Hübner, 1831), Dysgonia rogenhoferi (Bohatsch, 1880), Thysanoplusia orichalcea (Fabricius, 1775), Utetheisa pulchella (Linnaeus, 1758).

Background: Although minimally invasive hepato-pancreato-biliary (MIS HPB) surgery can be performed with good outcomes, there are currently no standardized requirements for centers or surgeons who wish to implement MIS HPB surgery. The aim of this study was to create a consensus statement regarding safe dissemination and implementation of MIS HPB surgical programs. Methods: Sixteen key questions regarding safety in MIS HPB surgery were generated after a focused literature search and iterative review by three field experts. Participants for the working group were then selected using sequential purposive sampling and snowball techniques. Review of the 16 questions took place over a single 2-h meeting. The senior author facilitated the session, and a modified nominal group technique was used. Results: Twenty three surgeons were in attendance. All participants agreed or strongly agreed that formal guidelines should exist for both institutions and individual surgeons interested in implementing MIS HPB surgery and that routine monitoring and reporting of institutional and surgeon technical outcomes should be performed. Regarding volume cutoffs, most participants (91%) agreed or strongly agreed that a minimum annual institutional volume cutoff for complex MIS HPB surgery, such as major hepatectomy or pancreaticoduodenectomy, should exist. A smaller proportion (74%) agreed or strongly agreed that a minimum annual surgeon volume requirement should exist. The majority of participants agreed or strongly agreed that surgeons were responsible for defining (100%) and enforcing (78%) guidelines to ensure the overall safety of MIS HPB programs. Finally, formal MIS HPB training, minimum case volume requirements, institutional support and infrastructure, and mandatory collection of outcomes data were all recognized as important aspects of safe implementation of MIS HPB surgery. Conclusions: Safe implementation of MIS HPB surgery requires a thoughtful process that incorporates structured training, sufficient volume and expertise, a proper institutional ecosystem, and monitoring of outcomes. [ABSTRACT FROM AUTHOR]

The public's unsatisfied desire for information and change is the impact of the development of Information Systems Technology that we are currently experiencing. To control this system, a Management Information System (SIM) was created and ethics were also required in using the SIM. This article aims to discuss the concept of SIM ethics starting from the factors that influence SIM ethics, to the opportunities that can be generated in this discussion and their relationship to the field of education. The method used is a literature review by collecting data through existing research sources/articles. The results of this literature study are the benefits that arise when using ethics in SIM in educational institutions and the need to maintain ethics in the use of information technology so that it does not cause harm and cause negative issues in society. [ABSTRACT FROM AUTHOR]

Background: We aim to compare early surgical results between groups who underwent minimally invasive surgery (MIS) vs open first metatarsophalangeal (MTP) arthrodesis to treat end-stage hallux rigidus. Methods: We conducted a retrospective cohort review of 65 patients who underwent a first MTP fusion procedure at an academic medical center between 2015 and 2023. Success of fusion was determined radiographically. Postoperative complications were identified through medical record review. Results: Sixty-seven first MTP fusion surgeries (41 open and 26 MIS) were performed on 65 patients with a primary diagnosis of hallux rigidus. Open surgery and MIS groups had similarly high fusion rates: 95% (39/41) and 96% (25/26), respectively (P =.84). We identified no difference in overall complication rates: 20% for open surgery and 23% for MIS (P =.73). Conclusion: This retrospective analysis of 67 first MTP arthrodesis procedures showed no significant differences in fusion success or complications in the short term when comparing MIS to open surgery. Further studies are needed to elucidate potential differences between MIS vs open surgery. Level of Evidence: Level III, retrospective comparative study. [ABSTRACT FROM AUTHOR]

Background: Hallux valgus deformity affects more than 35% of people aged ≥65 years. Surgical correction in this population can be more complicated because of poor bone quality, worse deformity, and postoperative recovery challenges. The purpose of this study was to compare the radiographic and clinical outcomes of patients aged ≥65 years who underwent either open Lapidus or minimally invasive chevron Akin osteotomy for bunion correction. Methods: A retrospective review identified 62 patients aged ≥65 years who were treated surgically for hallux valgus with at least 1-year postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores (physical function and pain interference). Preoperative and at least 6-month postoperative radiographs were measured for the hallux valgus angle and intermetatarsal angle. PROMIS scores were obtained preoperatively and at 1 and/or 2 years postoperatively. Differences in demographic, clinical, and radiographic outcomes were assessed using the Mann Whitney U test and P values were adjusted for a false discovery rate of 5%. Results: There was no difference between the MIS and open cohorts in pre- or postoperative radiographic measurements or clinical outcomes at any time point. At 1 year postoperatively, both groups had statistically significant improvements in the PROMIS pain interference domain but only the MIS group had a statistically significant improvement in the PROMIS physical function domain. Clinical significance was equivocal. At 2 years postoperatively, there were clinically and statistically significant improvements in the PROMIS pain interference and physical function domains for the open and MIS groups. Conclusion: Patients in both surgical groups had improvement in radiographic measurements and 2-year PROMIS scores, although there was no clinical or statistical difference found between groups. MIS and open surgical techniques appear to be safe and effective in correcting hallux valgus in older patients; however, patients may need to be counseled that maximum improvement after surgery may take more than 1 year. Level of Evidence: Level III, retrospective cohort study. [ABSTRACT FROM AUTHOR]

Prior studies have demonstrated the adverse effects of upper respiratory infections on the pediatric population, such as increased risk for acute otitis media (AOM). Other studies have noted decreased otitis media complaints during the COVID-19 pandemic. This project aims to identify whether individuals who tested positive for COVID-19 at the Emergency Department (ED) visit had an increased risk of developing severe complications. Additionally, we will study whether vaccination helped decrease following COVID-19 complications. Utilizing the TriNetX database, we obtained de-identified electronic medical records for children under five and 6–10 years old from 2020–2023 in the United States. The study population was propensity-matched for gender, index age, and comorbidities. Complications within eight weeks of the ED visit were compared between COVID-19 vaccinated and unvaccinated children. Risk ratio was used to measure associations between our groups. A p-value less than or equal to 0.05 was considered significant. After propensity matching, a total of 211,138 children were identified. Within eight weeks after the ED visit, unvaccinated children <5 years old who tested negative for COVID-19 had a 30 % relative risk reduction for AOM, 52 % for sinusitis, 76 % for multisystem inflammatory system (MIS), 17 % for acute respiratory failure, and 37 % for septic shock when compared to those with a positive COVID-19 result (p ≤ 0.05). Unvaccinated 6–10 years old children who tested negative for COVID-19 had an 18 % risk reduction for AOM, 44 % reduction for sinusitis, 63 % reduction for MIS, and 42 % for acute respiratory failure (p ≤ 0.05) compared to those that tested positive for COVID-19. Vaccinated children with positive COVID-19 results have no significant risk of AOM or acute respiratory failure. Additionally, children 6–10 years old with positive COVID-19 results did not have a substantial risk of sinusitis. COVID-19′s effects require continued investigation in children. This study showed that there are some increased risks of severe complications following this viral infection. [ABSTRACT FROM AUTHOR]

Quaternary crustal movement of the Japanese islands caused the rapid uplift of mountain ranges and the relative subsidence of coastal and inland basins. Chronostratigraphic and facies analyses of Pliocene to Quaternary sediments of 33 areas in the central Honshu reveals that the Tectono-sedimentary History developed in the following four stages. 1) From the Pliocene to the early Early Pleistocene, inland basins formed and turbidite accumulated in deep sea basins. 2) From the late Early Pleistocene to the early Middle Pleistocene, the uplift of the island arc occurred, and the subsiding areas of the inland basins expanded and differentiated, while in marine areas the slopes were buried by fan-deltas as the fan area expanded. 3) In the late Middle Pleistocene, the crustal uplift of the island arc was accelerated, and at the same time sediments accumulated in coastal basins in correspondence with sea-level changes. 4) Since the Late Pleistocene, terraces were formed due to falling sea-level and crustal uplift. It is considered that these characteristics of such Quaternary crustal movements were formed through large-scale uplift of island arc crust and sea-level change. Especially after the late Middle Pleistocene (0.43 Ma), it is possible that the current topography was formed by a new large uplift movement and sea-level rise of about 1,000 m. The formation of the island arc by large-scale uplift and sea-level rise cannot be explained by the plate subduction or collision. [ABSTRACT FROM AUTHOR]

ObjectivesThis study aims to design and test a platform of key performance indicators (KPIs) and indices emphasizing achievements and improvement and helping decision-making.MethodsAn operations research study was designed to analyze data from the Hospital Management Information System (HMIS) from July 2017 to June 2018 at the Research Institute of Ophthalmology (RIO), Giza, Egypt. The HMIS data were submitted to reform covering parameters in service delivery and corresponding indicators and indices. Data were grouped into four themes: human resources and outpatient, inpatient, and surgical operations. A total of 14 performance indicators were deployed to four specific indices and total performance indices and applied to six teams of ophthalmologists at RIO. The decision matrices were deliberated to demonstrate achievements and provide recommendations for subsequent improvements.ResultsThroughout 1 year, six teams of ophthalmologists (n = 222) at RIO provided the following services: outpatient (n = 116,043), inpatient (n = 8,081), and surgical operations (n = 9,174). Teams 2, 1, and 6 were the top teams in the total performance index. Team 4 had plunges in the outpatient index, and Team 5 faced limitations in the inpatient index.ConclusionThe study provided a model for upgrading the performance of the management information system (MIS) in health organizations. The KPIs and indices were used not only for documenting successful models of efficient service delivery but also as examples of limitations for further support and interventions.

Introduction: Fractures of the distal femoral third are an important cause of morbidity and mortality, and their treatment is currently controversial. Objectives: To compare the results between minimally invasive techniques versus exposure of the fracture site. Secondly, to evaluate the relationship between demographic factors, mechanism of injury and surgical delay with patient prognosis. Method: Retrospective cohort study carried out between 2015 and 2021 in a tertiary hospital. Data collection was performed by reviewing medical histories, measuring demographic and hospital parameters and definitive treatment strategy. One year of follow-up was completed in all patients, assessing the occurrence of surgical complications and mortality. A stratified analysis of the variables of interest was performed among patients over 65 years of age. Results: 128 fractures were recorded, with definitive osteosynthesis being performed in 117. Patients who underwent minimally invasive techniques required a shorter hospital stay (9 [7–12] vs. 12 [8.75–16] days) (p = 0.007), with no differences in mortality or complications during follow-up. In those over 65 years of age, opening the fracture site was associated with an increased risk of infection compared to minimally invasive techniques (33.3% vs. 2%) (p = 0.507). All the deceased were patients over 65 years of age (33.7% at one year). Surgical delay longer than 48 h increased mortality by 10% among those older than 65 years (p = 0.3). High-energy trauma had a higher proportion of pseudarthrosis (27.6% vs. 6.1%) (p = 0.011). Conclusions: Minimally invasive techniques decreased hospital stay but not complications or long-term mortality.Level of evidence: IIb. Resumen: Introducción: Las fracturas de tercio distal femoral son una causa importante de morbimortalidad, siendo su tratamiento actualmente controvertido. Objetivos: Comparar los resultados entre las técnicas mínimamente invasivas frente a la exposición del foco de fractura. Secundariamente, evaluar la relación entre los factores demográficos, el mecanismo lesional y la demora quirúrgica con el pronóstico de los pacientes. Método: Estudio tipo cohortes retrospectivas realizado entre 2015 y 2021 en un hospital de tercer nivel. La recogida de datos se realizó mediante la revisión de historias clínicas, midiendo los parámetros demográficos, hospitalarios y la estrategia de tratamiento definitivo. Se completó un año de seguimiento en todos los pacientes, evaluando la aparición de complicaciones quirúrgicas y mortalidad. Se realizó un análisis estratificado de las variables de interés entre pacientes mayores de 65 años. Resultados: Se registraron 128 fracturas, realizándose la osteosíntesis definitiva en 117. Los pacientes intervenidos mediante técnicas mínimamente invasivas requirieron una menor estancia hospitalaria (9 [7-12] vs. 12 [8,75-16] días) (p = 0,007), sin diferencias en la mortalidad o complicaciones durante el seguimiento. En mayores de 65 años, la apertura del foco de fractura asoció un aumento del riesgo de infección frente a las técnicas mínimamente invasivas (33,3% vs. 2%) (p = 0,507). Todos los fallecidos fueron pacientes mayores de 65 años (33,7% al año). La demora quirúrgica superior a 48 horas aumentó la mortalidad un 10% entre los mayores de 65 años (p = 0,3). Los traumatismos de alta energía presentaron una mayor proporción de pseudoartrosis (27,6% vs. 6,1%) (p = 0,011). Conclusiones: Las técnicas mínimamente invasivas disminuyeron la estancia hospitalaria pero no las complicaciones ni la mortalidad a largo plazo.Nivel de evidencia: IIb.

Objective The aim of this study was to introduce a cost-effective and less invasive method for the evacuation of intraparenchymal hemorrhage (IPH).

BackgroundPerineal hernias can be secondarily acquired following abdominoperineal resection of the rectum. While transabdominal minimally invasive techniques have traditionally used laparoscopy, there are few studies published on the robotic platform, which has been gaining popularity for other types of hernia repairs. We review the existing literature, share a video vignette, and provide practical tips for surgeons interested in adopting this approach.MethodsA literature search in Pubmed was performed to include all articles in English describing robotic repair of perineal hernias with identification of variables of interest related to repair. A case presentation with an accompanying video vignette and lessons learned from the experience are provided.ResultsSeven case reports (four containing video) published between 2019 and 2022 were included. Most articles (n = 5) utilized the Da Vinci Si or Xi, and most patients (n = 5) had undergone abdominoperineal resection with neoadjuvant chemotherapy to treat rectal cancer. Patients were positioned in Trendelenburg with rightward tilt (n = 2), modified lithotomy (n = 1), or a combination of the two (n = 1). All articles (n = 7) reported closing the defect and using mesh. Three articles describe placing five ports (one camera, three robotic, one assistant). There were no significant intraoperative or postoperative complications reported, and no recurrence noted at 3-27 months follow-up. Based on our experience, as shown in the video vignette, we recommend lithotomy positioning, using porous polypropylene mesh anchored to the periosteum of the sacrum and peritoneum overlying the bladder and side wall, and placing a drain above the mesh.ConclusionsA robotic transabdominal approach to perineal hernia repair is a viable alternate to laparoscopy based on low complication rates and lack of recurrence. Prospective and longer duration data are needed to compare the techniques.

Solar blind ultraviolet (UV) photodetectors utilizing AlGaN/GaN high electron mobility transistor (HEMT) structure offer a very high responsivity, photo‐to‐dark current ratio (PDCR), and detectivity. However, the performance of conventional mesa‐isolated photo‐HEMT is limited due to current leakage paths through the side wall and AlGaN barrier. In this work, apart from conventional mesa‐type isolation, ion implantation and metal‐insulator‐semiconductor (MIS) schemes are adopted to isolate the channels of AlGaN/GaN photo‐HEMTs. A significant reduction in dark current is achieved for MIS photo‐HEMT of around four and three orders of magnitude as compared to those of conventional mesa‐ and ion‐implanted photo‐HEMTs, respectively. Moreover, the responsivity and PDCR of MIS photo‐HEMT are around three and four orders of magnitude higher than those of conventional mesa‐isolated photo‐HEMT. Subsequently, MIS photo‐HEMT on Si substrate has achieved a very high detectivity of 4.63 × 1016 Jones at the UV incidence wavelength of 360 nm. The results presented in this work establish the advantages of MIS photo‐HEMT over other types of photo‐HEMTs. In addition, compatibility with GaN device fabrication technology and significantly enhanced optoelectronic performance suggest AlGaN/GaN MIS photo‐HEMTs as a promising candidate for a variety of advanced UV sensing applications. [ABSTRACT FROM AUTHOR]

The transforaminal lumbar interbody fusion (TLIF) has seen significant evolution since its early inception, reflecting advancements in surgical techniques, patient safety, and outcomes. Originally described as an improvement over the posterior lumbar interbody fusion (PLIF), the TLIF began as an open surgical procedure, that notably reduced the need for the extensive neural retractation that hindered the PLIF. In line with the broader practice of surgery, trending toward minimally invasive access, the TLIF was followed by the development of the minimally invasive TLIF (MIS-TLIF), a technique that further decreased tissue trauma and postoperative complications. Subsequent advancements, including Trans-Kambin's Triangle TLIF (percLIF) and transfacet LIF, have continued to refine surgical access, minimize surgical footprint, and reduce the risk of injury to the patient. The latest evolution, as we will describe it, the patient-specific TLIF, is a culmination of the aforementioned adaptations and incorporates advanced imaging and segmentation technologies into perioperative planning, allowing surgeons to tailor approaches based on individual patient anatomy and pathology. These developments signify a shift towards more precise methods in spine surgery. The ongoing evolution of the TLIF technique illustrates the dynamic nature of surgery and emphasizes the need for continued adaptation and refinement. [ABSTRACT FROM AUTHOR]

Study Design.: Prospective randomized. Objective.: Intraoperative methylprednisolone is a common adjunct following microscopic laminectomy/microdiscectomy. The goal of epidural instillation is a rapid symptomatic reduction in irritation of neural elements. There is inconsistent data supporting its use intraoperatively. To understand whether this maneuver results in any clinical effect, we performed a multiyear prospective study. Summary of Background Data.: Previous work has demonstrated equivocal effects on pain with a suggestion of an increased risk of complication. These studies tend to suffer from small sample sizes and short follow-ups. Materials and Methods.: Study obtained IRB approval. During the study period from 2013 to 2019, nearly equivalent numbers of patients who had received steroids during MIS decompressions were followed. Primary outcomes included pain (visual analog scale) and disability [Oswestry Disability Index (ODI)] at 2 weeks and 4 months. Secondary outcomes included complications, readmissions, and reoperation rates during the study period. Results.: Four hundred eighty-six patients were followed for a mean follow-up of 5.17 years. The index case was more likely to be a revision surgery in the steroid group. Across all patients, there was no difference in pain at 2 weeks or 4 months. Disability was reduced at 2 weeks in the steroid group (ODI: 16.71 vs. 21.02, P = 0.04) but not at 4 months. By subgroup analysis, this is largely explained by ODI reduction in patients with high preoperative ODI (13.00 vs. 43.43, P = 0.03). Patients in the steroid cohort were more likely to undergo subsequent spinal surgery during the study period. Conclusion.: Methylprednisolone instillation is associated with a large, transient reduction in ODI for patients with high preoperative ODI; there is no measurable effect on pain. There is equivocal effect on risk of subsequent reoperation. This issue was clarified in peer review but changes did not make it to the abstract. Therefore, the technique is likely best reserved for patients with significant preoperative disability. [ABSTRACT FROM AUTHOR]

Background: Percutaneous Zadek osteotomy (ZO) has emerged as a surgical treatment of insertional Achilles tendinopathy (IAT) over the last decade. Existing literature is limited regarding the comparison of this approach with the more established, open ZO technique. This systematic review aims to evaluate and compare the current data on open vs percutaneous ZO approaches to help set evidence-based guidelines. Methods: A systematic literature search was performed using the keywords (Zadek osteotomy) OR (Keck and Kelly osteotomy) OR (dorsal closing wedge calcaneal osteotomy) OR (Haglund Deformity) OR (Haglund Syndrome) OR (Insertional Achilles Tendinopathy) and MeSH terms Osteotomy, Calcaneus, Syndrome, Insertional, Achilles tendon, and Tendinopathy. Our search included the following databases: PubMed, Embase, and the Cochrane Library. The PRISMA protocol and the Cochrane Handbook guidelines were followed. All studies included were published from 2009 to 2024 and included the use of open or percutaneous approaches of ZO for the treatment of IAT with at least a 12-month follow-up. The MINORS score criteria were used to evaluate the strength and quality of studies. Results: A total of 17 studies were reviewed, including 611 subjects and 625 ZO procedures. Of these procedures, 81 (11%) subjects had a percutaneous and 544 (89%) subjects had an open ZO. The mean follow-up time was 16.1 months for patients treated with percutaneous ZO and 36.1 months for patients treated with open ZO. Both open and percutaneous studies included in this review showed postoperative improvements in AOFAS, FFI, VISA-A, and VAS scores in patients with IAT. The reported complication rate was 5.8% among patients treated with percutaneous ZO and 10.2% among patients treated with open ZO. Conclusion: Percutaneous ZO is an emerging approach with substantially fewer documented cases compared with the open ZO. Both percutaneous and open ZO appear to be relatively effective treatments for insertional Achilles tendinopathy with Haglund's deformity. The lower complication rates reported for percutaneous ZO is encouraging. Further investigation with more subjects undergoing percutaneous ZO is clearly needed. [ABSTRACT FROM AUTHOR]

Since the end of the 20th century and the establishment of minimally invasive techniques, they have become the preferred operative method by many surgeons. These techniques were applied to liver surgery for the first time in 1991, while as far as transplantation is concerned their application was limited to the living donor procedure. We performed a review of the literature by searching in Pubmed and Scopus using the following keywords: Liver transplantation, Minimally invasive surgery(MIS) living liver donor surgery. Applications of MIS are recorded in surgeries involving the donor and the recipient. Regarding the recipient surgeries, the reports are limited to 25 patients, including combinations of laparoscopic, robotic and open techniques, while in the living donor surgery, the reports are much more numerous and with larger series of patients. Shorter hospitalization times and less blood loss are recorded, especially in centers with experience in a large number of cases. Regarding the living donor surgery, MIS follows the same principles as a conventional hepatectomy and is already the method of choice in many specialized centers. Regarding the recipient surgery, significant questions arise mainly concerning the safe handling of the liver graft. [ABSTRACT FROM AUTHOR]

Background: Robotic-assisted, endoscopic transforaminal lumbar interbody fusion (RE-TLIF) is a promising, minimally invasive surgical option for degenerative lumbar spondylosis/spondylolisthesis; however, outcomes data and efficacy are limited, especially in multilevel disease. Here, we present the first reported series of patients that underwent either single or multilevel RE-TLIF. Methods: A retrospective review was performed on 23 consecutive patients who underwent a single level or multilevel RE-TLIF by a single surgeon. Variables included demographics, perioperative results, pain scores, and functional outcome scores. Results: Eighteen patients (78.3 %) underwent single level RE-TLIF and 5 patients (21.7 %) underwent multilevel RE-TLIF. The median reduction of visual analog scale (VAS) for low back pain (LBP) of all subjects was 6 (IQR = 4.5, 6.5) with no significant difference between single level and multilevel RE-TLIF (p = 0.565). The median reduction of VAS for leg pain of all subjects 7 (IQR = 6, 8) with no significant difference between single level and multilevel RE-TLIF (p = 0.702). Median blood loss was 25 cc (IQR = 25, 25) and 50 cc (IQR = 25, 100) for single and multilevel RE-TLIF, respectively (p = 0.025), whereas median length of stay was 1 (IQR = 1, 1; mean = 1.0 ± 00.18) days and 1 (IQR = 1, 2; mean = 1.4 ± 00.54) days, respectively (p = 0.042). One major complication was observed requiring reoperation for demineralized bone matrix migration resulting in an L5 radiculopathy. Conclusions: Single and multi-level RE-TLIF appears to be a safe and efficacious approach with comparable outcomes to open and other minimally invasive approaches. Additionally, we observed favorable accuracy in robot-assisted pedicle screw, endoscope, and interbody device placement.

Since the end of the 20th century and the establishment of minimally invasive techniques, they have become the preferred operative method by many surgeons. These techniques were applied to liver surgery for the first time in 1991, while as far as transplantation is concerned their application was limited to the living donor procedure. We performed a review of the literature by searching in Pubmed and Scopus using the following keywords: Liver transplantation, Minimally invasive surgery(MIS) living liver donor surgery. Applications of MIS are recorded in surgeries involving the donor and the recipient. Regarding the recipient surgeries, the reports are limited to 25 patients, including combinations of laparoscopic, robotic and open techniques, while in the living donor surgery, the reports are much more numerous and with larger series of patients. Shorter hospitalization times and less blood loss are recorded, especially in centers with experience in a large number of cases. Regarding the living donor surgery, MIS follows the same principles as a conventional hepatectomy and is already the method of choice in many specialized centers. Regarding the recipient surgery, significant questions arise mainly concerning the safe handling of the liver graft.

Objective The aim of this study was to introduce a cost-effective and less invasive method for the evacuation of intraparenchymal hemorrhage (IPH). Background IPH in the presence or absence of intraventricular hemorrhage has severe morbidity and has almost 50% mortality whether the patient is managed surgically or medically. Development of minimally invasive surgical techniques offers better outcomes but requires the use of special instruments and a unique skill set that is costly and requires special training. Method We inserted infant feeding tube within the hematoma via the left Kocher's burr hole. We instilled 40,000 IU of urokinase serially at an 8 hours interval for 3 days to evacuate the left gangliocapsular hematoma. Result We have treated a 50 years old hypertensive male patient with left gangliocapsular IPH and right hemiparesis (power: ⅖ on admission). After a month, on follow-up, the patient was conscious and oriented with improved right hemiparesis (power: ⅘). Conclusion This technique of evacuating hematoma is instrumental in peripheral centers in developing as well as under-developed countries where there are limited resources and a better outcome is expected with minimal morbidity. [ABSTRACT FROM AUTHOR]

Abstract Background Malaria is one of the most prominent illnesses affecting children, ranking as one of the key development concerns for many low- and middle-income countries (LMICs). There is not much information available on the use of anti-malarial drugs in LMICs in children under five. The study aimed to investigate disparities in anti-malarial drug consumption for malaria among children under the age of five in LMICs. Methods This study used recent available cross-sectional data from the Malaria Indicator Survey (MIS) datasets across five LMICs (Guinea, Kenya, Mali, Nigeria, and Sierra Leone), which covered a portion of sub-Saharan Africa. The study was carried out between January 2, 2023, and April 15, 2023, and included children under the age of five who had taken an anti-malarial drug for malaria 2 weeks before the survey date. The outcome variable was anti-malarial drug consumption, which was classified into two groups: those who had taken anti-malarial drugs and those who had not. Results In the study of LMICs, 32,397 children under five were observed, and among them, 44.1% had received anti-malarial drugs. Of the five LMICs, Kenya had the lowest (9.2%) and Mali had the highest (70.5%) percentages of anti-malarial drug consumption. Children under five with malaria are more likely to receive anti-malarial drugs if they are over 1 year old, live in rural areas, have mothers with higher education levels, and come from wealthier families. Conclusion The study emphasizes the importance of developing universal coverage strategies for anti-malarial drug consumption at both the national and local levels. The study also recommends that improving availability and access to anti-malarial drugs may be necessary, as the consumption of these drugs for treating malaria in children under the age of five is shockingly low in some LMICs.

Mitochondrial dysfunction is closely linked to obesity and diabetes, with declining lung function in aging increasing diabetes risk, potentially due to elevated serum levels of dioxin-like mitochondria inhibitor substances (MIS) from prolonged exposure to environmental pollutants. However, the mechanisms connecting MIS, mitochondria, lung function, and metabolic disorder remain unclear. In this study, we analyzed data from 1371 adults aged 40–69 years in the 2008 Korean Genome Epidemiologic Study (KoGES) Ansung cohort. We indirectly estimated dioxin-like MIS levels by measuring intracellular ATP (MISATP) and reactive oxygen species (MISROS) in cultured cells treated with the serum of participants. Using correlation analysis and structural equation modeling (SEM), we explored the relationships among MIS, mitochondrial function, body mass index (BMI), and lung function (FEV1 and FVC). Our findings revealed that MISATP was associated with BMI in females and with FVC in males, while MISROS correlated with both BMI and FVC in males, not in females. Significant associations between BMI and FVC were found in the highest MIS subgroup in both sexes. SEM analyses demonstrated that MIS negatively influenced mitochondrial function, which in turn affected BMI and lung function. Age-related declines in lung function were also linked to mitochondrial dysfunction. This study underscores the potential of MIS assays as alternatives for assessing mitochondrial function and highlights the importance of mitochondrial health in metabolic disorders and lung function.

The development of metal–insulator–semiconductor (MIS) capacitors requires device miniaturization and excellent electrical properties. Traditional SiO2 gate dielectrics have reached their physical limits. In this context, high-k materials such as TiO2 are emerging as promising alternatives to SiO2. However, the deposition of dielectric layers in MIS capacitors typically requires high-vacuum equipment and challenging processing conditions. Therefore, in this study, we present a new method to effectively fabricate a poly(vinylidene fluoride) (PVDF)-based TiO2 dielectric layer via electrospinning. Nano-microscale layers were formed via electrospinning by applying a high voltage to a polymer solution, and electrical properties were analyzed as a function of the TiO2 crystalline phase and residual amount of PVDF at different annealing temperatures. Improved electrical properties were observed with increasing TiO2 anatase content, and the residual amount of PVDF decreased with increasing annealing temperature. The sample annealed at 600 °C showed a lower leakage current than those annealed at 300 and 450 °C, with a leakage current density of 7.5 × 10−13 A/cm2 when Vg = 0 V. Thus, electrospinning-based coating is a cost-effective method to fabricate dielectric thin films. Further studies will show that it is flexible and dielectric tunable, thus contributing to improve the performance of next-generation electronic devices.

Introduction: Over the years, congenital lung malformations (CLM) management remains a controversial topic in pediatric thoracic surgery. The Italian Society of Pediatric Surgery performed a national survey to study the current management variability among centers, trying to define national guidelines and a standardized approach of children with congenital lung malformations. Methods: Following a National Society approval, an electronic survey including 35 items on post-natal management was designed, focusing on surgical, anesthesiology, radiology and pneumology aspects. The survey was conducted contacting all pediatric surgical units performing thoracic surgery. Results: 39 pediatric surgery units (97.5%) participated in the study. 13 centers (33.3%) were classified as high-volume (Group A), while 26 centers (66.7%) were low volume (Group B). Variances in diagnostic imaging protocols were observed, with Group A performing fewer CT scans compared to Group B (p = 0.012). Surgical indications favored operative approaches for asymptomatic CLM and pulmonary sequestrations in both groups, while a wait-and-see approach was common for congenital lobar emphysema. Surgical timing for asymptomatic CLM differed significantly, with most high-volume centers operating on patients younger than 12 months (p = 0.02). Thoracoscopy was the preferred approach for asymptomatic CLM in most of centers, while postoperative long-term follow-up was not performed in most of the centers. Conclusion: Thoracoscopic approach seems uniform in asymptomatic CLM patients and variable in symptomatic children. Lack of uniformity in surgical timing and preoperative imaging assessment has been identified as key areas to establish a common national pattern of care for CLM. [ABSTRACT FROM AUTHOR]

This work extensively investigates the operation of an Al/ Si3N4/p-Si Schottky-type photodiode under dark and varying illumination intensities. The photodiode is fabricated by employing the metal–organic chemical vapor deposition (MOCVD) method. A thorough electrical characterization is performed at room temperature, encompassing measurements of current–voltage (I–V), current–time (I–t), capacitance–time (C–t), and conductance time (G–t). The photodiode's rectification factor and reverse bias area increased under illumination. The relationship between light power density, barrier height, and diode ideality factor is found. The study also found a strong correlation between light intensity and applied voltage on series resistance (Rs) and shunt resistance (Rsh). Rs values are calculated using Cheung's functions, revealing the diode's resistance behavior. The study also examines the photodiode's photoconductivity and photoconductance, finding a non-linear relationship between photocurrent and illumination intensity, suggesting bimolecular recombination. Calculated photosensitivity (K), responsivity (R), and detectivity (D*) values show the device's light response effectiveness, but efficiency decreases at higher illumination intensities. Transient experiments indicate stable and reproducible photocurrent characteristics, revealing photogenerated charge temporal evolution. This study provides a complete understanding of the Al/Si3N4/p-Si Schottky photodiode's behavior under different illumination intensities. The findings advance optoelectronic device knowledge and enable their use in advanced technologies. [ABSTRACT FROM AUTHOR]

Robotics may facilitate the realization of fully minimally invasive right hemicolectomy, including intra-corporeal anastomosis and off-midline extraction, when compared to laparoscopy. Our aim was to compare laparoscopic right hemicolectomy with robotic right hemicolectomy in terms of peri-operative outcomes. MEDLINE was searched for original studies comparing laparoscopic right hemicolectomy with robotic right hemicolectomy in terms of peri-operative outcomes. The systematic review complied with the PRISMA 2020 recommendations. Variables related to patients’ demographics, surgical procedures, post-operative recovery and pathological outcomes were collected and qualitatively assessed. Two-hundred and ninety-three publications were screened, 277 were excluded and 16 were retained for qualitative analysis. The majority of included studies were observational and of limited sample size. When the type of anastomosis was left at surgeon’s discretion, intra-corporeal anastomosis was favoured in robotic right hemicolectomy (4/4 studies). When compared to laparoscopy, robotics allowed harvesting more lymph nodes (4/15 studies), a lower conversion rate to open surgery (5/14 studies), a shorter time to faeces (2/3 studies) and a shorter length of stay (5/14 studies), at the cost of a longer operative time (13/14 studies). Systematic review of existing studies, which are mostly non-randomized, suggests that robotic surgery may facilitate fully minimally invasive right hemicolectomy, including intra-corporeal anastomosis, and offer improved post-operative recovery. [ABSTRACT FROM AUTHOR]

The article chronicles the period from 1991 to 1995, a crucial era in Algerian history. It scrutinizes the activities, ideologies, and objectives of two moderate Islamist parties: The Movement for an Islamic Society (Harakat li-Mujtama' Islami, MIS) and the Islamic Renaissance Movement (Harakat al-Nahdha al-Islamiyya or al-Nahda). Among the objectives of this scholarly investigation is to delve into the political initiatives of the leaders of these parties, Mahfouz Nahnah and Abdallah Jaballah, whose identities are intricately intertwined with the operational dynamics of their respective political entities. This research seeks to illuminate their engagements not only with fellow Islamic factions but also with diverse political entities and governmental authorities. Employing a comparative analytical approach, the article aims to underscore the disparities in perspectives and actions undertaken by these influential political figures, notwithstanding the congruence in the overarching political objectives pursued by MIS and Nahda. Both MIS and Nahda fundamentally aspired to institute an Islamic state in Algeria and sought to incorporate Islamic jurisprudence (Sharia) into the nation's political and legal frameworks. The concept of "moderate Islamism" as elucidated in this study offers a balanced approach to navigating the intersection of Islamic values and democratic governance, presenting a pathway towards the coexistence of religious traditions and modern political frameworks. The methodological framework of the study constitutes a rigorous and systematic endeavor to assess the contributions of Mahfouz Nahnah and Abdallah Ja-ballah to Algerian politics within the spectrum of moderate Islamism, offering insights into the complexities of their ideological positions and their impacts on the Algerian political landscape. [ABSTRACT FROM AUTHOR]

Background Malaria is one of the most prominent illnesses afecting children, ranking as one of the key development concerns for many low- and middle-income countries (LMICs). There is not much information available on the use of anti-malarial drugs in LMICs in children under fve. The study aimed to investigate disparities in antimalarial drug consumption for malaria among children under the age of fve in LMICs. Methods This study used recent available cross-sectional data from the Malaria Indicator Survey (MIS) datasets across fve LMICs (Guinea, Kenya, Mali, Nigeria, and Sierra Leone), which covered a portion of sub-Saharan Africa. The study was carried out between January 2, 2023, and April 15, 2023, and included children under the age of fve who had taken an anti-malarial drug for malaria 2 weeks before the survey date. The outcome variable was anti-malarial drug consumption, which was classifed into two groups: those who had taken anti-malarial drugs and those who had not. Results In the study of LMICs, 32,397 children under fve were observed, and among them, 44.1% had received antimalarial drugs. Of the fve LMICs, Kenya had the lowest (9.2%) and Mali had the highest (70.5%) percentages of antimalarial drug consumption. Children under fve with malaria are more likely to receive anti-malarial drugs if they are over 1 year old, live in rural areas, have mothers with higher education levels, and come from wealthier families. Conclusion The study emphasizes the importance of developing universal coverage strategies for anti-malarial drug consumption at both the national and local levels. The study also recommends that improving availability and access to anti-malarial drugs may be necessary, as the consumption of these drugs for treating malaria in children under the age of fve is shockingly low in some LMICs. [ABSTRACT FROM AUTHOR]

Background: CDH1 gene mutations are the leading etiology of hereditary diffuse gastric cancer with cumulative lifetime risk ranging up to 83%. Prophylactic total gastrectomy (PTG) is, therefore, recommended for CDH1 carriers. A laparoscopic approach may reduce operative risk versus an open operation, thus leading more patients with CDH1 mutations to pursue PTG prior to cancer development. However, more experience and oncologic outcome data are needed for a laparoscopic approach and indicated lymphadenectomy. Methods: A retrospective descriptive cohort study of adult patients with CDH1 mutations who underwent laparoscopic PTG with D1 lymphadenectomy between 2012 and 2022 was conducted at a single institution. All patients had preoperative EGD screening, and those with visible tumor lesions on surveillance EGD were excluded and not considered prophylactic. Demographics, family history, pathology, and operative course were obtained. Outcomes included complications, readmission, and postoperative weight change. Results: Among 23 patients, median age was 48 years (IQR 37, 53) and 15 (65%) were female. Family history for gastric and/or lobular breast cancer was present in 22 (96%) patients. The median [IQR] time from positive genetic testing to PTG was 347 days [140, 625]. Pathologic evaluation showed five (22%) patients with foci of gastric cancer on pre-operative EGD biopsies, 10 (44%) in resected stomach specimens. All lymph nodes were negative. To address early postoperative complications, EJ anastomotic technique changed from EEA to GIA over the course of the study and feeding jejunostomy was no longer placed during PTG with minimal change in postoperative weight loss. Conclusions: This is the largest series, spanning 10 years at a single institution, dedicated solely to a laparoscopic approach for risk-reducing PTG. A laparoscopic approach with limited lymphadenectomy resulted in acceptable surgical and oncologic outcomes. Despite no visible cancer, over half of our patients had foci of early gastric cancer. Therefore, CDH1 carriers should consider laparoscopic PTG. [ABSTRACT FROM AUTHOR]