Machine acceleration time series prediction for dimensional accuracy of 3D printed parts

This study explores the influence of infill patterns on machine acceleration prediction in the realm of three-dimensional(3D)printing,particularly focusing on extrusion technology.Our primary objective was to develop a long short-term memory(LSTM)network capable of assessing this impact.We conducted an extensive analysis involving 12 distinct infill patterns,collecting time-series data to examine their effects on the acceleration of the printer’s bed.The LSTM network was trained using acceleration data from the adaptive cubic infill pattern,while the Archimedean chords infill pattern provided data for evaluating the network’s prediction accuracy.This involved utilizing offline time-series acceleration data as the training and testing datasets for the LSTM model.Specifically,the LSTM model was devised to predict the acceleration of a fused deposition modeling(FDM)printer using data from the adaptive cubic infill pattern.Rigorous testing yielded a root mean square error(RMSE)of 0.007144,reflecting the model’s precision.Further refinement and testing of the LSTM model were conducted using acceleration data from the Archimedean chords infill pattern,resulting in an RMSE of 0.007328.Notably,the developed LSTM model demonstrated superior performance compared to an optimized recurrent neural network(RNN)in predicting machine acceleration data.The empirical findings highlight that the adaptive cubic infill pattern considerably influences the dimensional accuracy of parts printed using FDM technology.

Economic Analysis of Port and PICC in Long-term Intravenous Administration for Malignant Tumor Patients in Chinese Oncology Hospital Setting

OBJECTIVE: To calculate and compare the cost of Port and PICC's application in long-term intravenous administration, and to support the decision making of hospital manager. METHODS: Literature review and patient survey in 2 oncology centers in China were carried out to investigate the cost and impact of Port and PICC for patients. The cost at different time of intravenous administration was calculated and compared. One-way sensitivity analysis was performed and tornado graph was drawn. RESULTS: Direct cost of Port at 0.5, 1, 1.5, and 2 years were7442, 8005, 8553, and 9131 CNY, and 4700, 9399, 14032, 18799 CNY for PICC respectively. Direct & indirect cost at 0.5, 1, 1.5, and 2 years were 9291, 11704, 14101, 16529 CNY for Port and 9697, 19393, 29023, 38787 CNY for PICC. Sensitivity analysis showed that productivity loss and device maintenance cost were the most in?uential factors to the result. CONCLUSION: Port had higher cost in short term and less in long term compared with PICC. Patients expected to get intravenous administration more than 0.5 year should use Port if both direct and indirect costs were included.

Isolated traumatic orbital floor fracture:An analysis of the National Trauma Data Bank

Objectives:To date,no study provides a comprehensive analysis of traumatic orbital floor fractures across the United States.We aimed to characterize patient demographics,injury-related variables,and operative management in this population.Method:The National Trauma Data Bank was queried for open or closed orbital floor fractures from 2008 to 2016.Clinical data were extracted.Results:Overall,148,592 orbital floor fractures were identified,with 142,577(95.9%)closed-and 6158(4.1%)open-type fractures.A total of 106,243(71.5%)patients were male and the median patient age was 41 years.The majority of patients(79.2%)had abbreviated injury scale scores of≤2,indicating minor/moderate injury.Fracture mechanism of injury(MOI)differed by gender,with the most frequent being unarmed fights in men(34.3%)and falls in women(14.0%).There were 29,600 patients(19.9%)with isolated orbital floor(I-OF)fractures.The MOI most strongly associated with operative intervention of with I-OF fractures were penetrating injuries caused by a firearm(odds ratio[OR]:2.91;95%confidence interval[CI]:1.62–5.20)and cuttings/piercings(OR:2.17;95%CI:1.29–3.65).Conclusion:This large epidemiological study reveals that orbital floor fractures tend to present with minor or moderate injuries and are more likely to require operative intervention in setting of firearm or cut/pierce injuries.

Salient concerns in using analgesia for cancer pain among outpatients: A cluster analysis study

AIM To identify unique clusters of patients based on their concerns in using analgesia for cancer pain and predictors of the cluster membership.METHODS This was a 3-mo prospective observational study(n = 207).Patients were included if they were adults(≥ 18 years), diagnosed with solid tumors or multiple myelomas, and had at least one prescription of around the clock pain medication for cancer or cancer-treatment-related pain.Patients were recruited from two outpatient medical oncology clinics within a large health system in Philadelphia.A choice-based conjoint(CBC) analysis experiment was used to elicit analgesic treatment preferences(utilities).Patients employed trade-offs based on five analgesic attributes(percent relief from analgesics, type of analgesic, type of sideeffects, severity of side-effects, out of pocket cost).Patients were clustered based on CBC utilities using novel adaptive statistical methods.Multiple logistic regression was used to identify predictors of cluster membership.RESULTS The analyses found 4 unique clusters: Most patients made trade-offs based on the expectation of pain relief(cluster 1, 41%).For a subset, the main underlying concern was type of analgesic prescribed, i.e., opioid vs non-opioid(cluster 2, 11%) and type of analgesic side effects(cluster 4, 21%), respectively.About one in four made trade-offs based on multiple concerns simultaneously including pain relief, type of side effects, and severity of side effects(cluster 3, 27.5%).In multivariable analysis, to identify predictors of cluster membership, clinical and socioeconomic factors(education, health literacy, income, social support) rather than analgesic attitudes and beliefs were found important; only the belief, i.e., pain medications can mask changes in health or keep you from knowing what is going on in your body was found significant in predicting two of the four clusters [cluster 1(-); cluster 4(+)].CONCLUSION Most patients appear to be driven by a single salient concern in using analgesia for cancer pain.Addressing these concerns, perhaps through real time clinical assessments, may improve patients' analgesic adherence patterns and cancer pain outcomes.

A comprehensive review and characterization of nasopharyngeal carcinoma clinical trials

Objective:Although standard of care for primary nasopharyngeal carcinoma(NPC)is chemoradiotherapy,there remains no consensus on management of recurrent or metastatic disease.We characterized recent clinical trials on NPC to assess trends in NPC treatment and establish promising areas for future research.Study Design:Retrospective database study.Setting:ClinicalTrials.gov database.Methods:Retrospective review of all NPC trials from November 1999 to June 2021.For each study,the following variables were extracted:study characteristics,intervention,outcome measures,and inclusion criteria.Secondary searches via PubMed and Google scholar determined trial publication status.Results:A total of 448 clinical trials were identified:72(16%)observational and 376(84%)interventional,of which there were 30(8%)Phase I,183(49%)Phase II,86 Phase III(23%),and 5(1%)Phase IV trials.Fifty-four percent of trials included only primary NPC while 111(25%)exclusively studied recurrent cancers.The most common interventions were cisplatin(n=64)and intensity modulated radiation therapy(n=54);there were 38 trials involving PD-1 monoclonal antibodies.Thirty-four studies examined quality of life measures,including xerostomia and mucositis.Of the completed studies,53.2%have published manuscripts.Poor patient accrual was the most common reason for premature study termination.Conclusions:Novel immunotherapies have been increasingly incorporated into NPC studies in recent years,however,chemotherapy and radiation,despite their numerous side effects,are still widely used due to their clinical effectiveness.Future trials are warranted to determine the optimal therapeutic regimens to decrease relapse rates and side effects.

A quiet place:The impact of the word"quiet"on clinical workload

Purpose:This study aimed to determine the impact of uttering the word"quiet"on clinical workload during the overnight otolaryngology call shift and understand the factors contributing to resident busyness.Materials and Methods:A multicenter,single-blind,randomized-controlled trial was conducted.A total of 80 overnight call shifts covered by a pool of 10 residents were randomized to the quiet or to the control group.At the start of shift,residents were asked to state aloud,"Today will be a quiet night"(quiet group)or"Today will be a good night"(control group).Clinical workload,as measured by number of consults,was the primary outcome.Secondary measures included number of sign-out tasks,unplanned inpatient and operating room visits,number of phone calls and hours of sleep,and self-perceived busyness.Results:There was no difference in the number of total(P=0.23),nonurgent(P=0.18),and urgent(P=0.18)consults.Tasks at signout,total phone calls,unplanned inpatient visits,and unplanned operating room visits did not differ between the control and quiet groups.While there were more unplanned operating room visits in the quiet group(29,80.6%)compared to the control group(34,94.4%),this was not found to be significant(P=0.07).The majority of residents reported feeling"not busy"during control nights(18,50.0%)compared to feeling"somewhat busy"during quiet nights(17,47.2%;P=0.42).Conclusion:Contrary to popular belief,there is no clear evidence that uttering the word"quiet"significantly increases clinical workload.

Gender analysis of the top classic papers in otolaryngology head and neck surgery

Objective:The aim of this study was to identify and analyze the gender breakdown of first authorship contributing to the most-cited papers in the field of otolaryngology,with a goal of identifying trends in gender representation in publishing.Methods:The top 150 most-cited papers were identified using the Science Citation Index of the Institute for Scientific Information.Among the first authors,gender,h-index,percentage of first,last,and corresponding authorship positions,total publications,and citations were analyzed.Results:The majority of papers were in the English language,from the United States,of clinical nature,and on otologic topics.Eighty-one percent of papers(n=122)had men who were first authors,although there was no difference inh-index score,authorship position,number of publications,citations,and average citations/year between men and women first authors.Upon subgroup analysis by decade(1950s-2010s),there was no difference in the number of articles by women first authors(P=0.11);however,there was a statistically significant increase in the percentage of women authors(P=0.001)in papers published later compared to those published earlier.Conclusions:While a promising number of women otolaryngologists are publishing high-powered articles,future initiatives to promote academic inclusivity of women should be considered.

East meets West: what opportunities arise in comparing international guidelines for management of cirrhosis?

The management of patients with cirrhosis is complex and subject to ever-evolving literature and recommendations.In the most recent Japanese practice guidelines for liver cirrhosis(1),Yoshiji et al.provide a number of key updates to guidance based on evidence reflective of practice in Japan that are worth emphasizing.

Modern internet search analytics and thyroidectomy:What are patients asking?

Objectives:Thyroidectomy is among the most commonly performed head and neck surgeries,however,limited existing information is available on topics of interest and concern to patients.Study Design:Observational.Setting:Online.Methods:A search engine optimization tool was utilized to extract metadata on Google‐suggested questions that“People Also Ask”(PAA)pertaining to“thyroidectomy”and“thyroid surgery.”These questions were categorized by Rothwell criteria and topics of interest.The Journal of the American Medical Association(JAMA)benchmark criteria enabled quality assessment.Results:A total of 250 PAA questions were analyzed.Future‐oriented PAA questions describing what to expect during and after the surgery on topics such as postoperative management,risks or complications of surgery,and technical details were significantly less popular among the“thyroid surgery”group(P<0.001,P=0.005,and P<0.001,respectively).PAA questions about scarring and hypocalcemia were nearly threefold more popular than those related to pain(335 and 319 vs.113 combined search engine response page count,respectively).The overall JAMA quality score remained low(2.50±1.07),despite an increasing number of patients searching for“thyroidectomy”(r(77)=0.30,P=0.007).Conclusions:Patients searching for the nonspecific term“thyroid surgery”received a curated collection of PAA questions that were significantly less likely to educate them on what to expect during and after surgery,as compared to patients with higher health literacy who search with the term“thyroidectomy.”This suggests that the content of PAA questions differs based on the presumed health literacy of the internet user.

Implementation of an enhanced recovery after surgery protocol for head and neck cancer patients:Considerations and best practices

Enhanced recovery after surgery(ERAS)protocols have been developed in numerous surgical specialties as a means of systematically improving patient recovery,functional outcomes,cost savings,and resource utilization.Such multidisciplinary initiatives seek to minimize variability in several aspects of perioperative patient care,helping to reduce inpatient length of hospital stay,complications,and the overall resource and financial burden of surgical care.Head and neck oncology patients stand to benefit from the implementation of comprehensive ERAS protocols,as these patients have complex medical needs that may dramatically impact multiple aspects of their recovery,including breathing,eating,nutrition,pain,speech,swallowing,and communication.Implementing ERAS protocols for head and neck cancer patients may present unique challenges,and require significant interdisciplinary coordination and collaboration.We therefore sought to provide a comprehensive guide to the planning and institution of such ERAS systems at institutions undertaking care of head and neck cancer patients.Key elements to consider in the implementation of successful ERAS protocols for this population include organizing a team consisting of frontline leaders such as nursing staff,medical specialists,and associated health professionals;designing interventions based on systematically evaluated,high-quality literature;and instituting a clear methodology for regularly updating protocols and auditing the success or potential limitations of a given intervention.Potential obstacles to the success of ERAS interventions for head and neck cancer patients include challenges in systematically tracking progress of the protocol,as well as resource limitations in a given health system.

Enhanced recovery after surgery protocols for outpatient operations in otolaryngology:Review of literature

Objective:Enhanced recovery after surgery(ERAS)protocols are patient-centered,evidence-based pathways designed to reduce complications,promote recovery,and improve outcomes following surgery.These protocols have been successfully applied for the management of head and neck cancer,but relatively few studies have investigated the applicability of these pathways for other outpatient procedures in otolaryngology.Our goal was to perform a systematic review of available evidence reporting the utility of ERAS protocols for the management of patients undergoing outpatient otolaryngology operations.Methods:A systematic literature review was conducted using MEDLINE,EMBASE,SCOPUS,and gray literature.We identified studies that evaluated ERAS protocols among patients undergoing otologic,laryngeal,nasal/sinus,pediatric,and general otolaryngology operations.We assessed the outcomes and ERAS components across protocols as well as the study design and limitations.Results:A total of eight studies fulfilled the inclusion criteria and were included in the analysis.Types of procedures evaluated with ERAS protocols included tonsillectomy and adenoidectomy,functional endoscopic sinus surgery,tympanoplasty and mastoidectomy,and septoplasty.A reduction in postoperative length of stay and hospital costs was reported in two and three studies,respectively.Comparative studies between ERAS and control groups showed persistent improvement in pre-and postoperative anxiety and pain levels,without an increase in postoperative complications and readmission rates.Conclusions:A limited number of studies discuss implementation of ERAS protocols for outpatient operations in otolaryngology.These clinical pathways appear promising for these procedures as they may reduce length of stay,decrease costs,and improve pain and anxiety postoperatively.

Use of the O-Z flap as an alternative to free tissue transfer for reconstruction of large scalp defects

Objective:The reconstruction of large scalp defects poses both functional and cosmetic challenges.While free tissue transfer remains the standard for defects larger than 30 cm^(2),prolonged anesthesia and postoperative complications remain significant limitations.The purpose of this study is to evaluate the use of O-Z flaps for the reconstruction of large scalp defects and to describe the techniques employed.Methods:This is a retrospective analysis of ten patients who underwent reconstructive surgery using an O-Z flap approach for large scalp defects between July 2017 and June 2019.The parameters included in this study were patient demographics,tumor characteristics,and postoperative management,collected for at least a year after surgery.Results:In this cohort,the mean age was 76.1 years and 90%were male.All patients were treated for neoplastic skin lesions,with 70%located on the vertex and 30%located on the temporoparietal region.The mean size of defect was 52.0 cm^(2)(range:38.6 to 63.8 cm^(2)).The maximum hospital stay was two days,and no patients were readmitted within 30 days of surgery.There were no cases of wound infection or flap necrosis.All patients reported pain control with acetaminophen and ibuprofen.Four patients received adjuvant radiation,and there was no delay to receiving treatment following surgery.Conclusions:The O-Z flap is a reliable alternative for the reconstruction of non-irradiated scalp defects in the vertex and temporoparietal regions up to 63 cm^(2).This technique provides advantages for patients,including hairline preservation,shorter hospital stays,and decreased postoperative complications.

Costs and cost-effectiveness of HIV early infant diagnosis in low- and middle-income countries: a scoping review

Background:Continuing progress in the global pediatric human immunodeficiency virus(HIV)response depends on timely identification and care of infants with HIV.As countries scale-out improvements to HIV early infant diagnosis(EID),economic evaluations are needed to inform program design and implementation.This scoping review aimed to summarize the available evidence and discuss practical implications of cost and cost-effectiveness analyses of HIV EID.Methods:We systematically searched bibliographic databases(Embase,MEDLINE and EconLit)and grey literature for economic analyses of HIV EID in low-and middle-income countries published between January 2008 and June 2021.We extracted data on unit costs,cost savings,and incremental cost-effectiveness ratios as well as outcomes related to health and the HIV EID care process and summarized results in narrative and tabular formats.We converted unit costs to 2021 USD for easier comparison of costs across studies.Results:After title and abstract screening of 1278 records and full-text review of 99 records,we included 29 studies:17 cost analyses and 12 model-based cost-effectiveness analyses.Unit costs were 21.46-51.80 USD for point-of-care EID tests and 16.21-42.73 USD for laboratory-based EID tests.All cost-effectiveness analyses stated at least one of the interventions evaluated to be cost-effective.Most studies reported costs of EID testing strategies;however,few studies assessed the same intervention or reported costs in the same way,making comparison of costs across studies challenging.Limited data availability of context-appropriate costs and outcomes of children with HIV as well as structural heterogeneity of cost-effectiveness modelling studies limits generalizability of economic analyses of HIV EID.Conclusions:The available cost and cost-effectiveness evidence for EID of HIV,while not directly comparable across studies,covers a broad range of interventions and suggests most interventions designed to improve EID are cost-effective or cost-saving.Further studies capturing costs and benefits of EID services as they are delivered in real-world settings are needed.

卫生经济学评价报告标准共识2022(CHEERS 2022):卫生经济学评价报告指导意见更新版

卫生经济学评价是对备选行动方案的成本和结果的比较分析。2013年发表的《卫生经济学评价报告标准共识》(CHEERS)提出了卫生经济学评价的特点,确保结果正确阐释,以支持决策制订。2013版CHEERS旨在指导研究报告撰写者准确报告卫生干预和对照措施、背景、过程、结果等评价细节,使审稿人理解文章内容,帮助读者使用研究结果。本版共识将取代2013版共识,其更加适用于各类卫生经济学评价,结合学科发展和方法更新的需要,更注重患者、公众等相关利益方的参与。本共识适用多种个体或人群健康干预措施(简单或复杂)在不同政策场景的应用分析,包括医疗服务、公共卫生、教育、社会服务等。本文概要介绍了CHEERS 2022共识中包含的28个检查项及每一个检查项的相关建议。CHEERS 2022共识主要用于指导研究人员撰写拟投递同行评议学术期刊的卫生经济学评价文章,亦可用于期刊编辑和审稿专家对待发表文章的评价。熟悉了解本共识要求,还有助于研究人员规划评价研究。随着决策透明度要求提高,本共识可支持卫生技术评估机构建立评价报告标准。

Nonopioid perioperative analgesia in head and neck cancer surgery:A systematic review

Objective:Management of postoperative pain after head and neck cancer surgery is a complex issue,requiring a careful balance of analgesic properties and side effects.The objective of this review is to discuss the efficacy and safety of multimodal analgesia(MMA)for these patients.Methods:Pubmed,Cochrane,Embase,Scopus,and clinicaltrials.gov were systematically searched for all comparative studies of patients receiving MMA(nonsteroidal anti-inflammatory drugs(NSAIDs),acetaminophen,anticonvulsants,local anesthetics,and corticosteroids)for head and neck cancer surgeries.The primary outcome was additional postoperative opioid usage,and secondary outcomes included subjective pain scores,complications,adverse effects,and 30-day outcomes.Results:A total of five studies representing 592 patients(MMA,n=275;non-MMA,n=317)met inclusion criteria.The most commonly used agents were gabapentin,NSAIDs,and acetaminophen(n=221),NSAIDs(n=221),followed by corticosteroids(n=35),dextromethorphan(n=40),and local nerve block(n=19).Four studies described a significant decrease in overall postoperative narcotic usage with two studies reporting a significant decrease in hospital time.Subjective pain scores widely varied with two studies reporting reduced pain at postoperative day 3.There were no differences in surgical outcomes,medical complications,adverse effects,or 30-day mortality and readmission rates.Conclusion:MMA is an increasingly popular strategy that may reduce dependence on opioids for the treatment of postoperative pain.A variety of regimens and protocols are available for providers to utilize in the appropriate head and neck cancer patient.