A unified Minorization-Maximization approach for estimation of general mixture models

The mixed distribution model is often used to extract information from heteroge-neous data and perform modeling analysis.When the density function of mixed distribution is complicated or the variable dimension is high,it usually brings challenges to the parameter es-timation of the mixed distribution model.The application of MM algorithm can avoid complex expectation calculations,and can also solve the problem of high-dimensional optimization by decomposing the objective function.In this paper,MM algorithm is applied to the parameter estimation problem of mixed distribution model.The method of assembly and decomposition is used to construct the substitute function with separable parameters,which avoids the problems of complex expectation calculations and the inversion of high-dimensional matrices.

Supplementation of vitamin E or a botanical extract as antioxidants to improve growth performance and health of growing pigs housed under thermoneutral or heat-stressed conditions

Background Heat stress has severe negative consequences on performance and health of pigs,leading to significant economic losses.The objective of this study was to investigate the effects of supplemental vitamin E and a botanical extract in feed or drinking water on growth performance,intestinal health,and oxidative and immune status in grow-ing pigs housed under heat stress conditions.Methods Duplicate experiments were conducted,each using 64 crossbred pigs with an initial body weight of 50.7±3.8 and 43.9±3.6 kg and age of 13-week and 12-week,respectively.Pigs(n=128)were housed individually and assigned within weight blocks and sex to a 2×4 factorial arrangement consisting of 2 environments(thermo-neutral(21.2℃)or heat-stressed(30.9℃))and 4 supplementation treatments(control diet;control+100 IU/L of D-α-tocopherol in water;control+200 IU/kg of DL-α-tocopheryl-acetate in feed;or control+400 mg/kg of a botanical extract in feed).Results Heat stress for 28 d reduced(P≤0.001)final body weight,average daily gain,and average daily feed intake(-7.4 kg,-26.7%,and-25.4%,respectively)but no effects of supplementation were detected(P>0.05).Serum vitamin E increased(P<0.001)with vitamin E supplementation in water and in feed(1.64 vs.3.59 and 1.64 vs.3.24),but not for the botanical extract(1.64 vs.1.67 mg/kg)and was greater when supplemented in water vs.feed(P=0.002).Liver vitamin E increased(P<0.001)with vitamin E supplementations in water(3.9 vs.31.8)and feed(3.9 vs.18.0),but not with the botanical extract(3.9 vs.4.9 mg/kg).Serum malondialdehyde was reduced with heat stress on d 2,but increased on d 28(interaction,P<0.001),and was greater(P<0.05)for antioxidant supplementation compared to control.Cellular proliferation was reduced(P=0.037)in the jejunum under heat stress,but increased in the ileum when vitamin E was supplemented in feed and water under heat stress(interaction,P=0.04).Tumor necrosis factor-αin jejunum and ileum mucosa decreased by heat stress(P<0.05)and was reduced by vitamin E sup-plementations under heat stress(interaction,P<0.001).Conclusions The addition of the antioxidants in feed or in drinking water did not alleviate the negative impact of heat stress on feed intake and growth rate of growing pigs.

THE LONG TIME BEHAVIOR OF THE FRACTIONAL ORNSTEIN-UHLENBECK PROCESS WITH LINEAR SELF-REPELLING DRIFT

Let B^(H) be a fractional Brownian motion with Hurst index 1/2≤H<1.In this paper,we consider the equation(called the Ornstein-Uhlenbeck process with a linear self-repelling drift)dX_(t)^(H)=dB_(t)^(H)+σ X_(t)^(H)dt+vdt-θ(∫_(0)^(t)(X_(t)^(H)-X_(s)^(H))ds)dt,whereθ<0,σ,v∈ℝ.The process is an analogue of self-attracting diffusion(Cranston,Le Jan.Math Ann,1995,303:87–93).Our main aim is to study the large time behaviors of the process.We show that the solution X^(H)diverges to infinity as t tends to infinity,and obtain the speed at which the process X^(H)diverges to infinity.

BIG HANKEL OPERATORS ON HARDY SPACES OF STRONGLY PSEUDOCONVEX DOMAINS

In this article,we investigate the(big) Hankel operator H_(f) on the Hardy spaces of bounded strongly pseudoconvex domains Ω in C^(n).We observe that H_(f ) is bounded on H~p(Ω)(1 <p <∞) if f belongs to BMO and we obtain some characterizations for Hf on H^(2)(Ω) of other pseudoconvex domains.In these arguments,Amar's L^(p)-estimations and Berndtsson's L^(2)-estimations for solutions of the ■_(b)-equation play a crucial role.In addition,we solve Gleason's problem for Hardy spaces H^(p)(Ω)(1 ≤p≤∞) of bounded strongly pseudoconvex domains.

Optimality of Group Testing with Differential Misclassification

Group testing is a method that can be used to estimate the prevalence of rare infectious diseases,which can effectively save time and reduce costs compared to the method of random sampling.However,previous literature only demonstrated the optimality of group testing strategy while estimating prevalence under some strong assumptions.This article weakens the assumption of misclassification rate in the previous literature,considers the misclassification rate of the infected samples as a differentiable function of the pool size,and explores some optimal properties of group testing for estimating prevalence in the presence of differential misclassification conforming to this assumption.This article theoretically demonstrates that the group testing strategy performs better than the sample by sample procedure in estimating disease prevalence when the total number of sample pools is given or the size of the test population is determined.Numerical simulation experiments were conducted to evaluate the performance of group tests in estimating prevalence in the presence of dilution effect.

Dynamics of Advantageous Mutant Spread in Spatial Death-Birth and Birth-Death Moran Models

The spread of an advantageous mutation through a population is of fundamental interest in population genetics. While the classical Moran model is formulated for a well-mixed population, it has long been recognized that in real-world applications, the population usually has an explicit spatial structure which can significantly influence the dynamics. In the context of cancer initiation in epithelial tissue, several recent works have analyzed the dynamics of advantageous mutant spread on integer lattices, using the biased voter model from particle systems theory. In this spatial version of the Moran model, individuals first reproduce according to their fitness and then replace a neighboring individual. From a biological standpoint, the opposite dynamics, where individuals first die and are then replaced by a neighboring individual according to its fitness, are equally relevant. Here, we investigate this death-birth analogue of the biased voter model. We construct the process mathematically, derive the associated dual process, establish bounds on the survival probability of a single mutant, and prove that the process has an asymptotic shape. We also briefly discuss alternative birth-death and death-birth dynamics, depending on how the mutant fitness advantage affects the dynamics. We show that birth-death and death-birth formulations of the biased voter model are equivalent when fitness affects the former event of each update of the model, whereas the birth-death model is fundamentally different from the death-birth model when fitness affects the latter event.

Respiratory complications of propofol,sevoflurane,and dexmedetomidine anesthesia for fiberoptic bronchoscopy in children aged 1 month to 3 years:a randomized trial

Objective To evaluate the effect of propofol,sevoflurane,and dexmedetomidine on respiratory complications inchildren undergoing fiberoptic bronchoscopy(FOB).Methods This double-blind randomized clinical trial was conductedamong 120 children aged 1 month to 3 years undergoing FOB.The patients were randomized into 3 groups(n=40)foranesthesia induction with sevoflurane inhalation,1 mg/kg propofol,or 1μg/kg dexmedetomidine before bronchoscopy,andthe changes in hemodynamic parameters,sedation level,and respiratory complications during and after the procedure wereassessed.Results The patients'heart rate during bronchoscopy was significantly lower and the mean arterial blood pressuresignificantly higher in dexmedetomidine group than in sevoflurane and propofol groups(P<0.05).Cough duringbronchoscopy did not occur in any of the cases in propofol group,while the highest frequency of cough was recorded indexmedetomidine group.The incidence of laryngospasm in the propofol group(12.5%)was significantly lower than those insevoflurane and dexmedetomidine groups(30%and 32.5%,respectively)(P<0.05).Conclusion Sevoflurane and propofol aresafe and suitable for anesthesia induction in children below 3 years of age undergoing diagnostic FOB and can achieve bettersedative effect and lower the incidences of cough and respiratory complications as compared with dexmedetomidine.

Computational Analysis of Novel Extended Lindley Progressively Censored Data

A novel extended Lindley lifetime model that exhibits unimodal or decreasing density shapes as well as increasing,bathtub or unimodal-then-bathtub failure rates, named the Marshall-Olkin-Lindley (MOL) model is studied.In this research, using a progressive Type-II censored, various inferences of the MOL model parameters oflife are introduced. Utilizing the maximum likelihood method as a classical approach, the estimators of themodel parameters and various reliability measures are investigated. Against both symmetric and asymmetric lossfunctions, the Bayesian estimates are obtained using the Markov Chain Monte Carlo (MCMC) technique with theassumption of independent gamma priors. From the Fisher information data and the simulatedMarkovian chains,the approximate asymptotic interval and the highest posterior density interval, respectively, of each unknownparameter are calculated. Via an extensive simulated study, the usefulness of the various suggested strategies isassessedwith respect to some evaluationmetrics such as mean squared errors, mean relative absolute biases, averageconfidence lengths, and coverage percentages. Comparing the Bayesian estimations based on the asymmetric lossfunction to the traditional technique or the symmetric loss function-based Bayesian estimations, the analysisdemonstrates that asymmetric loss function-based Bayesian estimations are preferred. Finally, two data sets,representing vinyl chloride and repairable mechanical equipment items, have been investigated to support theapproaches proposed and show the superiority of the proposed model compared to the other fourteen lifetimemodels.

Analysis of Progressively Type-Ⅱ Inverted Generalized Gamma Censored Data and Its Engineering Application

A novel inverted generalized gamma(IGG)distribution,proposed for data modelling with an upside-down bathtub hazard rate,is considered.In many real-world practical situations,when a researcher wants to conduct a comparative study of the life testing of items based on cost and duration of testing,censoring strategies are frequently used.From this point of view,in the presence of censored data compiled from the most well-known progressively Type-Ⅱ censoring technique,this study examines different parameters of the IGG distribution.From a classical point of view,the likelihood and product of spacing estimation methods are considered.Observed Fisher information and the deltamethod are used to obtain the approximate confidence intervals for any unknown parametric function of the suggestedmodel.In the Bayesian paradigm,the same traditional inferential approaches are used to estimate all unknown subjects.Markov-Chain with Monte-Carlo steps are considered to approximate all Bayes’findings.Extensive numerical comparisons are presented to examine the performance of the proposed methodologies using various criteria of accuracy.Further,using several optimality criteria,the optimumprogressive censoring design is suggested.To highlight how the proposed estimators can be used in practice and to verify the flexibility of the proposed model,we analyze the failure times of twenty mechanical components of a diesel engine.

Evaluations of Chris-Jerry Data Using Generalized Progressive Hybrid Strategy and Its Engineering Applications

A new one-parameter Chris-Jerry distribution,created by mixing exponential and gamma distributions,is discussed in this article in the presence of incomplete lifetime data.We examine a novel generalized progressively hybrid censoring technique that ensures the experiment ends at a predefined period when the model of the test participants has a Chris-Jerry(CJ)distribution.When the indicated censored data is present,Bayes and likelihood estimations are used to explore the CJ parameter and reliability indices,including the hazard rate and reliability functions.We acquire the estimated asymptotic and credible confidence intervals of each unknown quantity.Additionally,via the squared-error loss,the Bayes’estimators are obtained using gamma prior.The Bayes estimators cannot be expressed theoretically since the likelihood density is created in a complex manner;nonetheless,Markov-chain Monte Carlo techniques can be used to evaluate them.The effectiveness of the investigated estimations is assessed,and some recommendations are given using Monte Carlo results.Ultimately,an analysis of two engineering applications,such as mechanical equipment and ball bearing data sets,shows the applicability of the proposed approaches that may be used in real-world settings.

Mineralogy and whole-rock geochemistry of the Oligocene Barail Group of rocks of Belt of Schuppen,Northeast India:Implications for tectono-provenance and paleo-weathering

The petrographic and geochemical attributes of the Oligocene Barail Group of rocks are used to decipher the likely source area(s)or tectonic domains,as this sequence of rocks was deposited in a foreland basin governed by orogenic domain,namely the North-east Arunachal Himalayas.The river system that gave rise to the Brahmaputra River(Yarlung-Tsangpo),which flowed through several tectonic domains of the Himalayan ranges,primarily from BomiChayu,Gangadese Granitoid,Higher Himalayan Leucogranites,and Namche Barwa into the proto Bengal Basin now a part of Assam Arakan Basin and Naga Schuppen Belt,was the main source of the sandstone formation of the Barail Group.The purpose of sandstone petrography,which combines modal analysis with XRF(Major Oxides)and HR-ICPMS(Trace&Rare Earth Elements)research,is to identify the type of source rock(s),their weathering pattern,and its paleo-environmental circumstances.These sandstones were formed from recycled orogen and include lithic and sublithic arenite variants with advanced texture and chemical maturity.The sediments were felsic(Th/Co:1.38,Cr/Th:9.78,La/Lu:11.58,Th/Sc:0.99,Eu/Eu*:0.66,La/Sc:3.05,La/Co:4.18),with contributions from intermediate source rocks and low-rank metamorphics deposited in an active continental margin to a continental island arc setting.Climatic conditions impacted the sediments of Barails,characterised by being warm and semi-humid to humid which resulted in moderate to a high degree of chemical weathering,as shown by weathering indices like CIA(79.14),PIA(85.47),CIW(86.9),WIP(32.50),ICV(0.71),and Th/U(6.03),which were further additionally supported by C-Value(1.01),PF(1.20),Sr/Cu(2.04),and Rb/Sr(0.97).

Recent trends in the epidemiology and clinical outcomes of inflammatory bowel disease in South Korea,2010-2018

BACKGROUND Inflammatory bowel disease(IBD)was previously regarded as a Western disease;however,its incidence is increasing in the East.The epidemiology of IBD in Asia differs significantly from the patterns in the West.AIM To comprehensively investigate the epidemiology of IBD in South Korea,inclu-ding its incidence,prevalence,medication trends,and outcomes.METHODS We analyzed claims data from the Health Insurance Review and Assessment Service and Rare and Intractable Diseases(RIDs),operated by the National Health Insurance Service of South Korea.Patients with IBD were identified based on the International Classification of Diseases,Tenth Revision,and RID diagnostic codes for Crohn’s disease(CD)and ulcerative colitis(UC)from 2010 to 2018.RESULTS In total,14498 and 31409 patients were newly diagnosed with CD and UC,respectively,between 2010 and 2018.The annual average incidence of CD was 3.11 cases per 105 person-years,and that of UC was 6.74 cases per 10^(5) person-years.Since 2014,the incidence rate of CD has been stable,while that of UC has steadily increased,shifting the peak age group from 50-year-olds in 2010 to 20-year-olds in 2018.The CD and UC prevalence increased consistently over the study period;the use of 5-aminosali-cylates and corticosteroids gradually decreased,while that of immunomodulators and biologics steadily increased in both CD and UC.The clinical outcomes of IBD,such as hospitalization and surgery,decreased during the study period.CONCLUSION The CD incidence has been stable since 2014,but that of UC has increased with a shift to a younger age at peak incidence between 2010 and 2018.IBD clinical outcomes improved over time,with increased use of immunomodu-lators and biologics.

Assessment of groundwater quantity, quality, and associated health risk of the Tano river basin, Ghana

In the Tano River Basin,groundwater serves as a crucial resource;however,its quantity and quality with regard to trace elements and microbiological loadings remain poorly understood due to the lack of groundwater logs and limited water research.This study presents a comprehensive analysis of the Tano River Basin,focusing on three key objectives.First,it investigated the aquifer hydraulic parameters and the results showed significant spatial variations in borehole depths,yields,transmissivity,hydraulic conductivity,and specific capacity.Deeper boreholes were concentrated in the northeastern and southeastern zones,while geological formations,particu-larly the Apollonian Formation,exhibit a strong influence on borehole yields.The study identified areas with high transmissivity and hydraulic conductivity in the southern and eastern regions,suggesting good groundwater avail-ability and suitability for sustainable water supply.Sec-ondly,the research investigated the groundwater quality and observed that the majority of borehole samples fall within WHO(Guidelines for Drinking-water Quality,Environmental Health Criteria,Geneva,2011,2017.http://www.who.int)limit.However,some samples have pH levels below the standards,although the groundwater generally qualifies as freshwater.The study further explores hydrochemical facies and health risk assessment,highlighting the dominance of Ca–HCO3 water type.Trace element analysis reveals minimal health risks from most elements,with chromium(Cr)as the primary contributor to chronic health risk.Overall,this study has provided a key insights into the Tano River Basin’s hydrogeology and associated health risks.The outcome of this research has contributed to the broader understanding of hydrogeologi-cal dynamics and the importance of managing groundwater resources sustainably in complex geological environments.

Efficacy of a Nutritional Cream Intervention to Treat Depression in Rescuers:A Randomized Controlled Trial

Objective To explore the effectiveness of a nutritional intervention in rescuers who screened positive for depression.Methods A randomized controlled trial design was employed.From June to August,2022,4,460 rescuers were screened using the Self-Rating Depression Scale(SDS),and 1,615 positive cases were identified.Thirty-one volunteers were recruited and randomly divided into a nutritional intervention group and a control group.The intervention group received health education and nutritional intervention(a compound paste therapy primarily composed of red roses and Seville orange flowers),while the control group received psychological education.SDS scores were assessed before and after the intervention.Results There was a statistically significant decline in SDS scores in the nutritional intervention group after the intervention(P<0.05).Furthermore,the SDS scores of the intervention group were significantly lower than those of the control group,both before and after the intervention(P<0.05).No severe adverse reactions were observed during safety evaluation.Conclusion The nutritional intervention effectively reduced the depression scores in rescuers.Early nutritional intervention is recommended for rescuers who initially screen positive for depression.

Post-fire recovery of Puya raimondii, vegetation and birds in the puna of Huascarán National Park, Perú

A large fire of 233 ha in Huascarán National Park in Peru provided an opportunity to compare plant and bird responses in burned and nearby unburned zones of the puna. Heights and live diameters of flagship Puya raimondii rosettes(assigned to four broad developmental phases), plant communities(66 species in 24 families and nine growth forms) and bird communities(77 species in six trophic guilds) were monitored after the fire. Although no mortality was observed, Puya raimondii plants were affected by the fire, losing approximately 60% of their photosynthetic area across all developmental phases, but recovered quickly during the first two years after fire. The comparison of Puya rosette recovery after fire was complicated by the changes in live rosette diameter for unburned plants, which showed plasticity of photosynthetic area linked to seasonal and annual fluctuations in precipitation in this relatively dry environment(decreased by 26% for mature adult plants over the study period). Fire caused an immediate change in the density, biomass and composition of vegetation. Although the species present remained similar, their abundances changed significantly immediately after the fire, with notable reductions in dominant tussock grasses. This provided opportunities for other plants, resulting in higher postfire diversity of plant species, genera, families and growth forms. In turn, the changes in vegetation after fire affected the composition of birds according to their trophic guild. Granivores largely disappeared,generalists were mostly unaffected, and other guilds showed a more complex response. As the vegetation recovered, most displaced birds returned within approximately one year.

Explainable Conformer Network for Detection of COVID-19 Pneumonia from Chest CT Scan: From Concepts toward Clinical Explainability

The early implementation of treatment therapies necessitates the swift and precise identification of COVID-19 pneumonia by the analysis of chest CT scans.This study aims to investigate the indispensable need for precise and interpretable diagnostic tools for improving clinical decision-making for COVID-19 diagnosis.This paper proposes a novel deep learning approach,called Conformer Network,for explainable discrimination of viral pneumonia depending on the lung Region of Infections(ROI)within a single modality radiographic CT scan.Firstly,an efficient U-shaped transformer network is integrated for lung image segmentation.Then,a robust transfer learning technique is introduced to design a robust feature extractor based on pre-trained lightweight Big Transfer(BiT-L)and finetuned on medical data to effectively learn the patterns of infection in the input image.Secondly,this work presents a visual explanation method to guarantee clinical explainability for decisions made by Conformer Network.Experimental evaluation of real-world CT data demonstrated that the diagnostic accuracy of ourmodel outperforms cutting-edge studies with statistical significance.The Conformer Network achieves 97.40% of detection accuracy under cross-validation settings.Our model not only achieves high sensitivity and specificity but also affords visualizations of salient features contributing to each classification decision,enhancing the overall transparency and trustworthiness of our model.The findings provide obvious implications for the ability of our model to empower clinical staff by generating transparent intuitions about the features driving diagnostic decisions.

Einstein Hybrid Structure of q-Rung Orthopair Fuzzy Soft Set and Its Application for Diagnosis of Waterborne Infectious Disease

This research is devoted to diagnosing water-borne infectious diseases caused by floods employing a novel diagnosis approach,the Einstein hybrid structure of q-rung orthopair fuzzy soft set.This approach integrates parts of fuzzy logic and soft set theory to develop a robust alternative for disease detection in stressful situations,especially in areas affected by floods.Compared to the traditional intuitionistic fuzzy soft set and Pythagorean fuzzy soft set,the q-rung orthopair fuzzy soft set(q-ROFSS)adequately incorporates unclear and indeterminate facts.The major objective of this investigation is to formulate the q-rung orthopair fuzzy soft Einstein hybrid weighted average(q-ROFSEHWA)operator and its specific characteristics.Moreover,our stated operator is implementing intelligentmulti-criteria group decision-making(MCGDM)methodology.Floods are severe natural catastrophes that raise the risk of diseases and epidemics,particularly those caused by contaminants in the water,such as gastrointestinal diseases,respiratory infections,vector-borne diseases,skin infections,and water-borne parasites.The designed MCGDM strategy tackles the prevalence of certain conditions in flood-affected patients.A comparative investigation determined that the suggested method for detecting water-borne infectious disease due to floods is more effective and productive than conventional methods because of its logical structure.

An Intelligent MCGDM Model in Green Suppliers Selection Using Interactional Aggregation Operators for Interval-Valued Pythagorean Fuzzy Soft Sets

Green supplier selection is an important debate in green supply chain management(GSCM),attracting global attention from scholars,especially companies and policymakers.Companies frequently search for new ideas and strategies to assist them in realizing sustainable development.Because of the speculative character of human opinions,supplier selection frequently includes unreliable data,and the interval-valued Pythagorean fuzzy soft set(IVPFSS)provides an exceptional capacity to cope with excessive fuzziness,inconsistency,and inexactness through the decision-making procedure.The main goal of this study is to come up with new operational laws for interval-valued Pythagorean fuzzy soft numbers(IVPFSNs)and create two interaction operators-the intervalvalued Pythagorean fuzzy soft interaction weighted average(IVPFSIWA)and the interval-valued Pythagorean fuzzy soft interaction weighted geometric(IVPFSIWG)operators,and analyze their properties.These operators are highly advantageous in addressing uncertain problems by considering membership and non-membership values within intervals,providing a superior solution to other methods.Moreover,specialist judgments were calculated by the MCGDM technique,supporting the use of interaction AOs to regulate the interdependence and fundamental partiality of green supplier assessment aspects.Lastly,a statistical clarification of the planned method for green supplier selection is presented.

Tree: Reducing the use of restrictive practices on psychiatric wards through virtual reality immersive technology training

BACKGROUND Restrictive practices(RPs)are defined by measures linked to physical and chemical restraints to reduce the movement or control behaviours during any emergency.Seclusion is an equal part of RPs intended to isolate and reduce the sensory stimulation to safeguard the patient and those within the vicinity.Using interventions by way of virtual reality(VR)could assist with reducing the need for RPs as it could help reduce anxiety or agitation by way of placing users into realistic and immersive environments.This could also aid staff to and change current RPs.AIM To assess the feasibility and effectiveness of using a VR platform to provide reduction in RP training.METHODS A randomised controlled feasibility study,accompanied by evaluations at 1 month and 6 months,was conducted within inpatient psychiatric wards at Southern Health National Health Service Foundation Trust,United Kingdom.Virti VR scenarios were used on VR headsets to provide training on reducing RPs in 3 inpatient psychiatric wards.Outcome measures included general self-efficacy scale,generalised anxiety disorder assessment 7(GAD-7),Burnout Assessment Tool 12,the Everyday Discrimination Scale,and the Compassionate Engagement and Action Scale.RESULTS Findings revealed statistically significant differences between the VR and treatment as usual groups,in the Everyday Discrimination Scale items Q8 and Q9:P=0.023 and P=0.040 respectively,indicating higher levels of perceived discrimination in the VR group.There were no significant differences between groups in terms of general self-efficacy,generalised anxiety disorder assessment 9,and Burnout Assessment Tool 12 scores.A significant difference was observed within the VR group for compassionate engagement from others(P=0.005)over time.Most respondents recorded System Usability Scale scores above 70,with an average score of 71.79.There was a significant reduction in rates of RPs in the VR group vs treatment as usual group with a fluctuating variability observed in the VR group likely due to external factors not captured in the study.CONCLUSION Ongoing advancement of VR technology enables the possibility of creating scenarios and simulations tailored to healthcare environments that empower staff by providing more comprehensive and effective training for handling situations.

Effect of smoking on the risk of gastrointestinal cancer after cholecystectomy: A national population-based cohort study

BACKGROUND The role of smoking in the incidence of colorectal cancer(CRC)or gastric cancer(GC)in populations undergoing cholecystectomy has not been investigated.AIM To evaluate the effect of smoking on CRC or GC development in cholecystectomy patients.METHODS A total of 174874 patients who underwent cholecystectomy between January 1,2010 and December 31,2017 were identified using the Korean National Health Insurance Service claims database.These patients were matched 1:1 with mem-bers of a healthy population according to age and sex.CRC or GC risk after cholecystectomy and the association between smoking and CRC or GC risk in cholecystectomy patients were evaluated using adjusted hazard ratios(HRs)and 95%CIs.RESULTS The risks of CRC(adjusted HR:1.15;95%CI:1.06-1.25;P=0.0013)and GC(adjusted HR:1.11;95%CI:1.01-1.22;P=0.0027)were significantly higher in cholecystectomy patients.In the population who underwent cholecystectomy,both CRC and GC risk were higher in those who had smoked compared to those who had never smoked.For both cancers,the risk tended to increase in the order of non-smokers,ex-smokers,and current smokers.In addition,a positive correlation was observed between the amount of smoking and the risks of both CRC and GC.CONCLUSION Careful follow-up and screening should be performed,focusing on the increased risk of gastrointestinal cancer in the cholecystectomy group,particularly considering the individual smoking habits.