Citigroup

Colorectal cancer with peritoneal metastases (PM) presents a significant therapeutic challenge. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is one option to prolong survival. While completeness of cytoreduction (CC) score 0 is associated with improved outcomes, the clinical value of near-complete CC-score 1 versus open-close laparotomy (CC-3) remains unclear. This retrospective study evaluates overall survival (OS) in patients with colorectal cancer PM scheduled for CRS and HIPEC from 23 global peritoneal-surface oncology centers from 2006 to 2023. A propensity score matching was performed using tumor location (colon/rectum), lymph node status, liver metastases, signet-ring histology, preoperative chemotherapy, peritoneal cancer index, and treatment year. Matching was performed using the nearest neighbor method with a caliper of 0.1, chosen after several iterations to optimize intergroup balance. Balance was assessed using standardized mean differences. Sensitivity analyses with alternative calipers and multivariable Cox regression in the unmatched cohort were considered to test the robustness of the findings. The study time-period was divided into 4 equal quartiles for analysis. In the unmatched cohort (n=284), patients with CC-1 had significantly longer median OS compared to those with CC-3 (22.2 vs. 9.4 months, p<0.001). After 1:1 matching (n=172), the OS advantage of CC-1 persisted, with a median OS of 18.9 months (95% CI: 14.2-24.7) versus 10.5 months (95% CI: 9.4-12.3) for CC-3, p<0.0001, HR 0.4 (95% CI:0.27-0.56). Multivariable Cox regression confirmed CC-1 as a significant predictor of survival (HR: 0.15, 95% CI: 0.08-0.26). The CC-1 proportion went from 55 to 65% in time-periods 1 & 2-39% in period 3, to 11% in period 4; leading to significantly reduced survival rates in the latter time-periods 3 & 4. Near complete cytoreduction is associated with improved overall survival compared to open-close laparotomy. Prospective or standardized multicenter analyses will be required to confirm the clinical value of a near complete cytoreduction.

Purpose The aims of this study are as follows: Analyzing the various categories of building walls and façades with respect to material composition, functionality and suitability for diverse climatic conditions across Iran. Analyzing the codes and standards requirements governing building wall and façade systems. Developing wall and façade systems evaluation criteria and determining their importance weights. Comprehensive assessment and ranking of wall and façade systems utilizing established evaluation criteria. Developing a software framework aimed at facilitating decision-making processes and identifying the most suitable façade and wall system, allowing users to implement minor modifications according to their individual preferences. Design/methodology/approach The methodology involves a multi-stage process. Firstly, a comprehensive literature review and expert consultation are conducted to identify key performance parameters for wall and façade systems. Next, the study utilizes a weighting method to determine the importance weight of each criteria. The final step involves applying the weighted criteria to a series of widely recognized types of wall and façade systems and materials, showcasing the framework’s effectiveness in evaluating most optimal wall and façade systems and their design combinations. Findings The comprehensive evaluation of wall systems identified the top-performing materials as: AAC wall panel, AAC block, prefabricated wall Sandwich panel, Wallcrete panel and LECA block. Additionally, an analysis of the performance of these systems under different climatic conditions was carried out, leading to the creation of three separate tables that illustrate the rankings for each specific climate. The evaluation of façade systems revealed that the precast concrete façade, stone façade (utilizing indirect fixing), Glass Fiber Reinforced Concrete (GFRC) façade, Terracotta Cladding (also employing indirect fixing) and Stucco façade received the highest overall scores. Originality/value This research aimed to determine and formalize the evaluation criteria for the optimal selection of buildings envelope systems for residential constructions in Iran, implementing a novel methodology that has not reported.

Determining delivery routes thatminimize total cost is a key issue in goodsdistribution. This study focuses on a bottleddrinking water (AMDK) company in City X thatdistributes its products to multiple retail outlets withdifferent service time requirements. Such conditionsfall within the scope of the Vehicle Routing Problemwith Time Windows (VRPTW). In this study, a softtime windows approach is adopted, allowing vehiclesto serve retailers beyond their specified time limitsat the expense of penalty costs. The main objective isto identify optimal delivery routes under the softtime windows policy while minimizing total cost. Theresults demonstrate that the Hybrid GeneticAlgorithm outperforms the initial solution in termsof total cost reduction. The initial routes aregenerated using the Nearest Insertion Heuristic andsubsequently refined through mutation processeswithin the genetic algorithm framework.

This study focuses on the City of Carmona, Cavite, and aims to describe the problems the city has in maintaining the Seal of Good Local Governance. It seeks to determine what the challenges are to the Local Government Units’ (LGU) ability to keep the SGLG status, how these challenges affect the city’s operations, then provide recommendations to address these challenges. Based on the data and a "Strongly Agree" consensus from respondents, the Local Government Unit of Carmona has a considerable capacity to sustain its governance practices. This is attributable to the governance framework being grounded on well-defined and institutionalized policies and sufficiency of resources, ability to balance SGLG compliance and SGLG urgent local priorities, and active participation from stakeholders. On the other hand, respondents "Agree" that there are risks to the long-term sustainability of the LGU, which include policy gaps, and unclarity of mandates, inadequate funding, political shifts, the turnover of leadership, natural calamities, and disasters.

The rapid integration of immersive digital technologies is fundamentally reshaping how cultural content is experienced, challenging museums to adapt to the expectations of digitally native audiences, particularly Generation Z. This study empirically examines whether digital, virtual, and multimedia content serves as a motivational factor for museum visitation and enhances the user experience among this generational cohort. An empirical, cross-sectional study was conducted using a structured, anonymous questionnaire administered to 97 undergraduate students (aged 19–25) at the University of Zagreb, Faculty of Graphic Arts. The results indicate that 64% of respondents perceive digitally enhanced museum content as a motivating factor for more frequent visits, while 76% believe such solutions foster a new form of experiential engagement. Concurrently, a notable proportion of respondents express caution toward technology-mediated interpretation, underscoring generational heterogeneity and the importance of user autonomy. The findings are interpreted through established theoretical frameworks, including the Technology Acceptance Model (TAM), Uses and Gratifications Theory (U&amp;amp;G), and Self-Determination Theory (SDT), and are contextualized by a systematic literature review. The study contributes to ongoing debates on digital transformation by providing empirically grounded insights into the motivational dynamics of Generation Z. It concludes that digital technologies are effective when thoughtfully aligned with user expectations, educational goals, and institutional values.

Abstract Glioblastoma (GBM) remains the most aggressive primary brain tumor, particularly among older adults, with limited therapeutic advancements over the past two decades. Temozolomide was approved in 2005 and tumor treating fields (TTF) in 2011, yet the impact of these therapies on long-term survival remains unclear. We used the SEER 17 database to identify patients aged 65 and older diagnosed with GBM between 2000 and 2021. Overall survival (OS) was estimated using Kaplan-Meier methods, and median OS along with 1-, 2-, 3-, 4-, and 5-year survival rates were compared across four treatment eras: pre-temozolomide (2000–2004), post-temozolomide (2005–2010), post-TTF (2011–2016), and the modern era (2017–2021). Across all eras, survival declined with increasing age, and females consistently demonstrated better survival than males in corresponding age groups. A statistically significant improvement in survival was observed across eras (log-rank p &amp;lt; 0.001), with the most notable gains occurring during the 2011–2016 period. The 65–69 age group consistently exhibited the highest survival probabilities at each interval, while the ≥80 age group showed the poorest outcomes. Although short-term survival has improved modestly over time,likely reflecting better diagnostics, supportive care, and initial therapeutic impact, 5-year survival remains low across all eras, suggesting minimal long-term benefit from currently approved treatments. These findings underscore the persistent challenges in managing GBM in the elderly population and highlight age and sex as important prognostic factors. Despite the introduction of temozolomide and TTF, long-term survival in older adults with GBM has not significantly improved, emphasizing the need for more effective and personalized therapeutic strategies. Continued investment in novel treatments and clinical trials focused on older adults is essential to improve outcomes in this vulnerable population.