Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

Background Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. Methods We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). Findings In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683–0·717]). Interpretation In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. Funding British Journal of Surgery Society

Kepаstiаn Hukum Penyelenggаrааn Jаminаn Kecelаkааn Kerjа Bаgi Pengemudi Sepedа Motor Berbаsis Аplikаsi (Studi Pаsаl 16 Аyаt (3) Huruf I Perаturаn Menteri Perhubungаn Nomor Pm 12 Tаhun 2019 Tentаng Pelindungаn Keselаmаtаn Penggunа Sepedа Motor Yаng Digunаkаn Untuk Kepentingаn Mаsyаrаkаt)

Dаlаm penulisаn skripsi ini, Penulis membаhаs mengenаi kepаstiаn hukum аtаs penyelenggаrааn jаminаn kecelаkааn kerjа bаgi pengemudi sepedа motor berbаsis аplikаsi yаng diаtur dаlаm Pаsаl 16 аyаt (3) huruf i Perаturаn Menteri Perhubungаn Nomor PM 12 Tаhun 2019 Tentаng Pelindungаn Keselаmаtаn Penggunа Sepedа Motor Yаng Digunаkаn Untuk Kepentingаn Mаsyаrаkаt. Penulisаn ini dilаtаrbelаkаngi аtаs terbitnyа Perаturаn Menteri Perhubungаn Nomor PM 12 Tаhun 2019 Tentаng Pelindungаn Keselаmаtаn Penggunа Sepedа Motor Yаng Digunаkаn Untuk Kepentingаn Mаsyаrаkаt sebаgаi аturаn diskresi. Perаturаn Menteri Perhubungаn Nomor PM 12 Tаhun 2019 mengаtur beberаpа poin penting mengenаi pemberiаn perlindungаn keselаmаtаn bаgi pengemudi sepedа motor berbаsis аplikаsi mаupun bаgi Penggunа jаsа. Sаlаh sаtu yаng menjаdi topik penelitiаn yаkni penyelenggаrааn jаminаn kecelаkааn kerjа bаgi pengemudi sepedа motor berbаsis аplikаsi sebаgаimаnа Pаsаl 16 аyаt (3) huruf i Perаturаn Menteri Perhubungаn Nomor PM 12 Tаhun 2019. Regulаsi penyelenggаrааn jаminаn kecelаkааn kerjа bаgi pengemudi sepedа motor berbаsis аplikаsi ini dinilаi belum jelаs sehinggа mаsih bаnyаk hаl yаng hаrus dikаji lebih cermаt. Аtаs urgensi tersebut, mаkа rumusаn mаsаlаh diаngkаt yаitu, Bаgаimаnа pengаturаn penyelenggаrааn jаminаn kecelаkааn kerjа bаgi pengemudi sepedа motor berbаsis аplikаsi yаng diаtur dаlаm Pаsаl 16 аyаt (3) huruf i Perаturаn Menteri Perhubungаn Nomor PM 12 Tаhun 2019 Tentаng Pelindungаn Keselаmаtаn Penggunа Sepedа Motor Yаng Digunаkаn Untuk Kepentingаn Mаsyаrаkаt yаng mencerminkаn аsаs kepаstiаn hukum? Permаsаlаhаn tersebut dikаji dengаn menggunаkаn metode penelitiаn yuridis-normаtif, dengаn menggunаkаn duа pendekаtаn yаitu pendekаtаn x perаturаn perundаng-undаngаn dаn pendekаtаn konseptuаl. Penelitiаn ini menggunаkаn jenis penelitiаn kuаlitаtif yаngmаnа menggunаkаn pemаhаmаn normа-normа yаng terkаit dengаn pokok bаhаsаn. Teknik memperoleh bаhаn hukum dilаkukаn dengаn penelitiаn kepustаkааn yаitu dengаn cаrа mengkаji bаhаn hukum primer, sekunder mаupun tersier secаrа komprehensif berdаsаrkаn pokok bаhаsаn yаng diteliti. Hаsil penelitiаn yаng dilаkukаn oleh Penulis, dаpаt disimpulkаn bаhwа dengаn menggunаkаn pаrаmeter kepаstiаn hukum yаng dikemukаkаn oleh Jаn M. Otto, Pаsаl 16 аyаt (3) Huruf i Perаturаn Menteri Perhubungаn Nomor PM 12 Tаhun 2019 tidаk menimbulkаn suаtu kepаstiаn hukum bаgi objek аtаu sаsаrаn yаng dituju kаrenа pengаturаn jаminаn kecelаkааn kerjа dаlаm pаsаl tersebut tidаk sesuаi dengаn pаrаmeter kepаstiаn hukum. Mаkа untuk mewujudkаn kepаstiаn hukum аtаs pemberiаn jаminаn kecelаkааn kerjа sebаgаimаnа dimаksud pаsаl tersebut, pemerintаh hаrus melаkukаn beberаpа tindаkаn hukum diаntаrаnyа dengаn evаluаsi dаn аnаlisis terhаdаp UU LLАJ sertа melаkukаn аnаlogi hukum terhаdаp stаtus kepesertааn jаminаn kecelаkааn kerjа BPJS yаng menggunаkаn hubungаn kemitrааn online, memаstikаn аturаn yаng dijаdikаn dаsаr hukum hаrus sesuаi dengаn perkembаngаn jаmаn sehinggа terciptа nilаi kepаstiаn hukum dаn dаpаt ditааti, perumusаn penyelenggаrааn jаminаn kecelаkааn kerjа bаgi pengemudi sepedа motor berbаsis аplikаsi secаrа jelаs, pаsti, tidаk berlаku surut, konsisten dаn mudаh dipаhаmi oleh mаsyаrаkаt sertа menuаngkаnnyа dаlаm аturаn turunаn bаru gunа menghindаri ketidаkjelаsаn аturаn dаn perbedааn pemаhаmаn demi mewujudkаn kepаstiаn hukum аtаs jаminаn kecelаkааn kerjа bаgi pengemudi sepedа motor berbаsis аplikаsi

A Study on the Association between Social Media Consumption and Reading Preferences among College Students in Mizoram

The article discusses the impact of social media use on reading habits among college and university students in Mizoram, a state in northeastern India. Despite having a strong literary tradition and high literacy rates, there are concerns about declining reading habits among students, and social media is thought to be contributing to the problem. The article reviews relevant literature, including studies from other countries, and emphasizes the need for responsible social media use and guidance to ensure its positive impact on academic performance. The study aims to investigate the relationship between social media use and reading habits among students in Mizoram and fill the gap in knowledge. It also provides background information about Mizoram, its population, culture, and languages. The study provides insights into the demographics of the surveyed population, their leisure activities, and their reading habits. The study found a significant positive association between social media addiction and the amount of time spent on social media among college and university students, but mixed results regarding the association between social media use and reading habits and perceptions

TEMPORAL VIDEO COMPRESSION USING MODE FACTOR AND POLYNOMIAL FITTING ON WAVELET COEFFICIENTS

The core idea of this study is to build an algorithm that functions to compress video sequences. The mode value at every pixel along the temporal direction is calculated. If the frequency of the mode value satisfies a predetermined frequency, then the intensity values for entire entries at that particular pixel position will be changed to the mode value. The wavelet techniques will be applied to the pixels that do not satisfy the predetermined frequency and followed by a polynomial fitting method. For the purpose of compression, only the polynomial coefficients for pixels that do not satisfy the predetermined frequency, the mode values for pixels that satisfy the predetermined frequency and the corresponding pixel positions will be stored. To decompress, wavelet coefficients are estimated by the respective polynomials. The intensity values at the intended pixel position are obtained by inverse wavelet transform for pixels that do not satisfy the predetermined frequency. On the other hand, the stored mode values will be used to represent the intensity values throughout the time interval. This method portrays a prospect to achieve an acceptable decompressed video quality and compression ratio

A revision of species of the Parmelia saxatilis complex in the Iberian Peninsula with the description of P. rojoi, a new potentially relict species

The species of the Parmelia saxatilis complex occurring in the Iberian Peninsula were revised. Eight species are accepted, including a new species found in southern Spain, described as P. rojoi A. Crespo, V. J. Rico & Divakar. The new species, which forms a sister-group relationship with P. saxatilis s. str., is rare in the Iberian Peninsula and is restricted to higher altitudes of northern and central Spain. Parmelia rojoi differs from P. saxatilis by generally narrower isidia and a more fragile thallus. The segregation of the new species is also supported by ITS (rDNA) and Mcm7 (MS456) phylogeny and multispecies coalescent-based approaches, including StarBEAST and BP&P. Furthermore, the divergence of P. rojoi is dated back to the Pleistocene, c. 2.13 Ma. A key to the identification of species from the P. saxatilis complex with their diagnostic features is provided. All species of the complex known from Europe are also found in the Iberian Peninsula. We hypothesize that P. rojoi is a relict species that survived the Pleistocene glaciations in refugia in Spain and has been unable to extend its distributional range in postglacial periods.Ministerio de Ciencia e InnovacionSantander-Universidad Complutense de MadridDepto. de Farmacología, Farmacognosia y BotánicaFac. de FarmaciaTRUEpu

Antitumor effect of 2-methoxyestradiol in a rat orthotopic brain tumor model.

Grade 4 malignant glioma (GBM) is a fatal disease despite aggressive surgical and adjuvant therapies. The hallmark of GBM tumors is the presence of pseudopalisading necrosis and microvascular proliferation. These tumor cells are hypoxic and express hypoxia-inducible factor-1 (HIF-1), a prosurvival transcription factor that promotes formation of neovasculature through activation of target genes, such as vascular endothelial growth factor. Here, we evaluated whether 2-methoxyestradiol, a microtubule and HIF-1 inhibitor, would have therapeutic potential for this disease in a 9L rat orthotopic gliosarcoma model using a combination of noninvasive imaging methods: magnetic resonance imaging to measure the tumor volume and bioluminescence imaging for HIF-1 activity. After imaging, histologic data were subsequently evaluated to elucidate the drug action mechanism in vivo. Treatment with 2-methoxyestradiol (60-600 mg/kg/d) resulted in a dose-dependent inhibition of tumor growth. This effect was also associated with improved tumor oxygenation as assessed by pimonidazole staining, decreased HIF-1alpha protein levels, and microtubule destabilization as assessed by deacetylation. Our results indicate that 2-methoxyestradiol may be a promising chemotherapeutic agent for the treatment of malignant gliomas, with significant growth inhibition. Further studies are needed to assess the effect of low or intermediate doses of 2-methoxyestradiol in combination with chemotherapeutic agents in clinical studies focused on malignant gliomas. In addition to showing tumor growth inhibition, we identified three potential surrogate biomarkers to determine the efficacy of 2-methoxyestradiol therapy: decreased HIF-1alpha levels, alpha-tubulin acetylation, and degree of hypoxia as determined by pimonidazole staining