Split-Apply-Combine with Dynamic Grouping

Retrospective cohort study. To identify patient or procedure related predictors of postoperative blood transfusions in posterior lumbar fusion (PSF). The rate of PSF surgery has increased significantly. It remains the most common surgical procedure used to stabilize the spine; however, the impact of blood loss requiring blood transfusions remains a significant concern. Analysis of data from the Canadian Spine Outcomes and Research Network. Patients who underwent PSF between 2008 and 2015 were identified. Multivariate analysis was used to identify predictors of blood transfusion from the collected information. Seven hundred seventy two patients have undergone PSF, 18% required blood transfusion, 54.8% were females and the mean age was 60 years. The analysis revealed five significant predictors: American Society of Anesthesiologist class (ASA), operative time, multilevel fusion, sacrum involvement, and open posterior approach. The odds of transfusion for those with ASA >1 were 6 times those with ASA1 (odds ratio [OR] 6.1, 95% confidence interval [CI] 1.4-27.1, P < 0.018). For each 60-minute increase in operative time, the odds of transfusion increased by 4.2% (OR 1.007, 95% CI 1.004-1.009, P < 0.001). The odds of transfusion were 6 times higher for multilevel fusion (OR 5.8, 95% CI 2.6-13.2, P < 0.001). Extending fusion to the sacrum showed 3 times higher odds for blood transfusion (OR 3.2, 95% CI 1.8-5.8, P < 0.001). The odds of transfusion for patients undergoing open approach were 12 times those who had minimal invasive surgery (OR 12.5, 95% CI 1.6-97.4, P < 0.016). Finally, patients receiving transfusions were more likely to have extended hospital stay. ASA >1, prolonged operative time, multilevel fusion, sacrum involvement, and open posterior approach were significant predictors of blood transfusion in PSF. 3.

Laparoscopic cholecystectomy is one of the most common surgical procedures. Here we report our experience with the use of monopolar electrocautery to control the cystic artery during laparoscopic cholecystectomy. Data regarding the site, number, size, and method of control of the cystic artery during laparoscopic cholecystectomy were prospectively collected. Other data collected included the operative time, intraoperative difficulties, and postoperative complications. The study included 158 laparoscopic cholecystectomies. Two arteries were controlled in 25 patients (15.8%) and one artery in 122 patients (77.2%), while the cystic artery was not identified in 11 patients (7%). The artery was graded as small, medium, and large in 43, 72, and 32 patients, respectively. Patients with unidentified cystic artery were excluded from our data analysis. The artery was controlled using monopolar electrocautery in 114 patients (77.5%) and by metal clips in 33 patients (22.5%). The cystic artery was controlled lateral to the cystic lymph node in the majority of patients (68%). Neither bleeding nor bile duct injury was encountered throughout the study period. Electrocautery is safe and effective for control of the cystic artery during laparoscopic cholecystectomy. A future randomized study is needed to confirm the findings of the present study.

Introduction: Cesarean section (C/S) is a common surgical procedure used to deliver a baby when vaginal delivery is not possible or poses risks to the mother or baby. With the rising rates of C/S globally, there is growing concern about the impact of repeat C-sections on perinatal outcomes. Methods: This observational cross-sectional study was conducted Department of Obstetrics &amp; Gynaecology, Chittagong Medical College &amp; Hospital, from December 2016 to June 2017. All the pregnant women who underwent repeat Caesarean section in Chittagong Medical College Hospital, Chittagong during the study period were considered as the study population. A total of 100 study subjects were selected by consecutive convenient sampling techniques. Data analysis was done by SPSS (Statistical Package for Social Sciences) 16. In all cases, p-value &lt;05 was considered significant. Result: The results indicate that perinatal morbidity was significantly higher in women with three previous cesarean sections, with increased rates of respiratory distress syndrome (28.6%) and umbilical sepsis (42.9%). In contrast, birth asphyxia (11.6%) and prematurity (8.7%) were more prevalent in women with only one prior C-section. No significant correlation was found between the number of previous cesarean sections and perinatal mortality. Neonatal death rates were higher in women with two previous C-sections (20.8%) compared to those with one (11.6%), but no deaths occurred in those with three prior C-sections. Conclusion: This study concludes that perinatal morbidity increases significantly with a history of more than two cesarean sections, particularly with respiratory distress syndrome and umbilical sepsis. Birth asphyxia and prematurity were more common in those with only one previous C-section. However, no significant association between perinatal mortality and the number of previous C-sections was found.

The computation of multidimensional aggregates is a common operation in OLAP applications. The major bottleneck is the large volume of data that needs to be processed which leads to prohibitively expensive query execution times. On the other hand, data analysts are primarily concerned with discerning trends in the data and thus a system that provides approximate answers in a timely fashion would suit their requirements better. In this article we present the prime factor scheme, a novel method for compressing data in a warehouse. Our data compression method is based on aggregating data on each dimension of the data warehouse. We used both real world and synthetic data to compare our scheme against the Haar wavelet and our experiments on range-sum queries show that it outperforms the latter scheme with respect to both decoding time and error rate, while maintaining comparable compression ratios. One encouraging feature is the stability of the error rate when compared to the Haar wavelet. Although wavelets have been shown to be effective at compressing data, the approximate answers they provide varies widely, even for identical types of queries on nearly identical values in distinct parts of the data. This problem has been attributed to the thresholding technique used to reduce the size of the encoded data and is an integral part of the wavelet compression scheme. In contrast the prime factor scheme does not rely on thresholding but keeps a smaller version of every data element from the original data and is thus able to achieve a much higher degree of error stability which is important from a Data Analysts point of view.

Injection molding is one of the most common operations and versatile for mass production of complex plastic components. Injection molding is a process of plastic forming into a desired shape by means of pressing molten plastic into a space (cavity). Injection molding has a multi-step process, starting from inserting plastic pellets into the hopper, then plastic pellets into barrels / heating which makes the plastic material is melted. Melting plastic material is driven by the rotation of the screw, so that the flow to the nozzle, and then toward the sprue, runner, gate and into the cavity. Then the material present in the cavity will be retained within the mold under a certain pressure (holding pressure) to keep no shringkage when the product cooling process (cooling).The purpose of this study was to obtain the optimization of the cycle time and the percentage of production reject the bottle cap 500 ml in PT Berlina Tbk. The method used for this research is the method of response surface analysis, method surface respone is statistical and mathematical methods used to examine the relationship between one or more variables with the qualitative form of the response variables that aims to optimize and develop the response in an experiment. The data is optimized using Minitab software 16 produces an output response parameter setting optimization to inject pressure, nozzle temperature and cooling time. From the data analysis using the software Minitab 16 is obtained from the optimum situation results generated under conditions injection amounting to 1420 bar pressure; nozzle temperature at 264.7912 ° C; and the cooling time of 14.08 seconds. In this state of production can be increased by 10.836%. From the state of the optimum cycle time generated is 27.9161 seconds, net produced according to the standard that is 33.5820 grams and reject percentage the resulting is 11.11%. With a cycle time 27.9161 seconds with a net according to the standard and the percentage of rejects decreased 3.89%, the resulting product amounts to ± 15,517 /shift or up approximately 10.836%. The amount is based on the number of products produced in the cycle time previous of 30 seconds to produce ± 14,000 /shift.&#x0D; Keywords: Injection moulding, box-benhken design, Response surface methodology

The research into data analysis over large quantities of data requires different strategies from traditional computation, in order to allow data processing in this scenario and extract valuable information from it. Cross join is a common operation from the relational algebra that other operations can be derived from it, like the Theta-join operation. Implementing it, however, implies excessive data traffic over network. We propose to use the cross join operation with input files, and use metadata information from the distributed filesystem such as data locality and data replication to distribute the operation among the machines that store parts of the files. The results showed that using this strategy, the data traffic necessary to the operation can be significantly reduced, increasing application performance.

A criação de um banco de dados sobre as demandas otorrinolaringológicas no SUS poderá fornecer informações para organizar estratégias de saúde e criar ou otimizar recursos do governo ou privados. OBJETIVOS: Determinar em pacientes até 17 anos de idade: 1) As principais doenças otorrinolaringológicas diagnosticadas; 2) Exames complementares mais solicitados; 3) Medicamentos mais prescritos; 4) Procedimentos ambulatoriais realizados e as indicações cirúrgicas; 5) Estado empregatício dos pais e o número de irmãos dependentes; 6) Comparar e analisar estatisticamente os dados nos locais estudados. MATERIAL E MÉTODO: Estudo prospectivo e análise estatística das variáveis obtidas nas primeiras-consultas na Policlínica de Mariana, na sede Consórcio Intermunicipal de Saúde da Microrregião de Sete Lagoas e na Triagem da Otorrinolaringologia da UNIFESP-EPM. RESULTADOS: Há diferenças estatisticamente significativas quanto às variáveis idade, média salarial dos pais empregados, número de irmãos até 17 anos, rinite, doenças otológicas, exames solicitados, prescrições e indicações de cirurgias micro-otológicas. CONCLUSÕES: O diagnóstico mais encontrado foi respiração oral. O exame complementar e a cirurgia mais indicados foram a radiografia de cavum e a adenoamigdalectomia. O nível de desemprego, a baixa média salarial e o número de dependentes na família dificultam tratamentos que não estejam disponíveis na rede pública de saúde.

Caesarean section (CS) is the most common inpatient surgical procedure performed in Canada. CS is known to cause moderate-to-severe pain, which is suggested to be associated with postpartum depression and persistent pain. Existing limitations in multimodal analgesia and conscious attempts to avoid opioids highlight the need for non-pharmacological strategies. Photobiomodulation therapy (PBMT) uses light-emitting diode (LED) and laser and has suggested potential for improving pain control and wound healing. This study aims to evaluate the effectiveness of PBMT as part of existing multimodal analgesia after elective CSs. This placebo-controlled, two-arm, multi-centre, parallel-design randomized controlled trial includes women aged ≥16 years with planned CS under spinal anesthesia (Clinical Trials Registration: NCT05738239). Patients will be randomized post-CS to intervention (n = 90) or placebo (n = 90). Study interventions will be carried out using equipment supported by Meditech International Incorporated (approved by Health Canada for pain relief). Patients will receive a maximum of 5 post-surgical treatment sessions of active PBMT (intervention: LED therapy: DUO 240 [red at 660nm and near-infrared at 840nm] applied parallel to the abdominal incision scar, followed by BIOFLEX LDR-100 laser probe (660nm red light) and the LD1-200 laser probe (825nm near-infrared light), applied at the incision wound edges) or non-effective doses of LED array and laser therapy (placebo), 4-6 hrs post-CS, and at 8am and 7pm of postoperative days 1 and 2. Patients, research assistants involved in patient recruitment and follow-up, health care providers, and data analysts will be blinded. All patients will have access to routine multimodal analgesia. Patients will be followed up in hospital on the evening of surgery and on postoperative days 1 and 2 (morning, noon, and evening); at 6 weeks; and at 3 months by telephone. Primary outcome is pain intensity with movement (elicited by asking the patient to move from supine to sitting position) using 0-10 Numerical Rating Scale (0 = no pain, 10 = worst possible pain). The results of this study may result in improved pain control, maternal satisfaction and wound healing; decrease the use of perioperative opioids; potentially decrease the incidence of postpartum depression and persistent pain; and overall lead to better postoperative outcomes thereby decreasing healthcare costs.

Sleeve gastrectomy and gastric bypass are the most common bariatric surgical procedures in the world; however, their long-term medication discontinuation and comorbidity resolution remain unclear. To compare the incidence of medication discontinuation and restart of diabetes, hypertension, and hyperlipidemia medications up to 5 years after sleeve gastrectomy or gastric bypass. This comparative effectiveness research study of adult Medicare beneficiaries who underwent laparoscopic sleeve gastrectomy or Roux-en-Y gastric bypass between January 1, 2012, to December 31, 2018, and had a claim for diabetes, hypertension, or hyperlipidemia medication in the 6 months before surgery with a corresponding diagnosis used instrumental-variable survival analysis to estimate the cumulative incidence of medication discontinuation and restart. Data analyses were performed from February to June 2021. Laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. The primary outcome was discontinuation of diabetes, hypertension, and hyperlipidemia medication for any reason. Among patients who discontinued medication, the adjusted cumulative incidence of restarting medication was calculated up to 5 years after discontinuation. Of the 95 405 patients included, 71 348 (74.8%) were women and the mean (SD) age was 56.6 (11.8) years. Gastric bypass compared with sleeve gastrectomy was associated with a slightly higher 5-year cumulative incidence of medication discontinuation among 30 588 patients with diabetes medication use and diagnosis at the time of surgery (74.7% [95% CI, 74.6%-74.9%] vs 72.0% [95% CI, 71.8%-72.2%]), 52 081 patients with antihypertensive medication use and diagnosis at the time of surgery (53.3% [95% CI, 53.2%-53.4%] vs 49.4% [95% CI, 49.3%-49.5%]), and 35 055 patients with lipid-lowering medication use and diagnosis at the time of surgery (64.6% [95% CI, 64.5%-64.8%] vs 61.2% [95% CI, 61.1%-61.3%]). Among the subset of patients who discontinued medication, gastric bypass was also associated with a slightly lower incidence of medication restart up to 5 years after discontinuation. Specifically, the 5-year cumulative incidence of medication restart was lower after gastric bypass compared with sleeve gastrectomy among 19 599 patients who discontinued their diabetes medication after surgery (30.4% [95% CI, 30.2%-30.5%] vs 35.6% [95% CI, 35.4%-35.9%]), 21 611 patients who discontinued their antihypertensive medication after surgery (67.2% [95% CI, 66.9%-67.4%] vs 70.6% [95% CI, 70.3%-70.9%]), and 18 546 patients who discontinued their lipid-lowering medication after surgery (46.2% [95% CI, 46.2%-46.3%] vs 52.5% [95% CI, 52.2%-52.7%]). Findings of this study suggest that, compared with sleeve gastrectomy, gastric bypass was associated with a slightly higher incidence of medication discontinuation and a slightly lower incidence of medication restart among patients who discontinued medication. Long-term trials are needed to explain the mechanisms and factors associated with differences in medication discontinuation and comorbidity resolution after bariatric surgery.

Complementary and alternative medicine (CAM) usage is becoming increasingly common throughout the world. This study explored the prevalence and usage pattern of CAM in patients who underwent common day-case elective operations in a general surgical department in a teaching hospital in Pakistan. A questionnaire covering socio-demographic information and CAM usage, the reasons for its use and opinions on its efficacy, was administered to participants during a 3-month study. Data analysis was conducted using SPSS (v-22.0) for descriptive statistics and chi-square testing. The questionnaire was completed by 392 patients, 216 of whom were males (55.1%). The day-case surgery most commonly performed was laparoscopic cholecystectomy (41.6%), followed by hemorrhoidectomy (24.7%). Overall, 217 patients (55.4%) reported CAM usage and 42 (19.3%) used more than one type of CAM. Other non-herbal treatments were reported by 64.5%. CAM users were more likely to be older, male and less educated (P-value <0.05). Relatives/neighbors (57.2%) followed by television/radio (36.6%) were the main sources of information on CAM. Over half (60%) stated that their GP was unaware they were using CAM. More than half of the patients in the study used CAM. Despite medical concerns regarding the efficacy, safety and cost-effectiveness of CAM, its use amongst surgical patients is common. The surgical team should enquire specifically about CAM use during the pre-operative assessment and be aware of possible drug interactions with herbal remedies, and should inform the patients about potential side effects of CAM.

Baseline data from American Society for Metabolic and Bariatric Surgery-designated Bariatric Surgery Centers of Excellence using the Bariatric Outcomes Longitudinal Database

Summary form only given. Advances in information technology contributed powerful tools for the development of scientific applications. Today scientists routinely exploit data mining and analysis tools, visualization tools, and increasingly leverage database and workflow management systems. Some of these tools run out-of-the-box, others require customization. But when it comes to metadata management, there is very little reusable technology that scientists can draw upon. Manipulating metadata, such as database schemas, taxonomies, interface definitions, and mappings between them, requires tedious object-at-a-time programming and in-depth database expertise. Recently, researchers embarked on factoring out common metadata management operations and packaging them as reusable tools that offer a higher-level abstraction for solving metadata problems. In this article the author attempts to draw a big picture, highlight the challenges, and outline some ongoing efforts

Benchmarking the perioperative process: II. Introducing anesthesia clinical pathways to improve processes and outcomes and to reduce nursing labor intensity in ambulatory orthopedic surgery

Background:Cataract extraction is the most common intraocular surgery taught to residents.Aim:This study aims to review the complications of trainee-performed extracapsular cataract extraction (ECCE) so as to identify the steps in which the trainee can benefit from closer supervision and practice.Subjects and Methods:This was a descriptive retrospective study of complications in the initial 150 ECCE with intraocular lens implant performed by two Ophthalmologists, from the University of Nigeria Teaching Hospital, Enugu, who visited a high volume training center. Both the intraoperative and early post-operative complications were studied. Data entry and analysis were performed descriptively using the Statiscal Package for the Social Sciences, SPSS version 15.0 (Chicago, IL, USA).Results:The age range of the patients was 40-95 years. The intraoperative complications included capsular flaps 12/161 (7.5%), posterior capsule rent, 10/161 (6.2%) and vitreous loss, 8/161 (5.0%). Corneal complications (striate keratopathy, superior corneal edema, generalized corneal edema and corneal folds) ranked highest in post-operative complications accounting for 34% (56/164).Conclusions:Performance of adequate and proper anterior capsulotomy, minimal handling of the cornea and avoidance of posterior capsular rent are some of the challenges of the trainee in mastering ECCE. Stepwise supervised training can help a trainee master these steps while keeping the complications at acceptably low levels.

Drilling is a quite common operation being performed in the manufacturing of components. Instrumental response in drilling is geometrical accuracy and surface integrity of the drilled parts. For the application where geometrical tolerance is very small, an operation is to be carried out very carefully. If not, rejection of drilled samples will be higher and consequently production loss will be higher. The use of prediction model in this scenario is much more appropriate and cost-effective. This research aimed to apply extreme gradient boosting (XGBoost) regressor to develop a drilling prediction model. Drilling experiments were conducted after developing design of experiments with twenty-seven unique sets. Experimental data analysis was then carried out on experimental data sets that have features such as speed, feed, angle, hole length, and surface roughness. After correlation analysis, the k-fold cross validation method was applied for parameterisation. Hyperparameters estimated from the k-fold cross validation were then applied to train and test the XGBoost regressor-based machine learning (ML) model. It is concluded from the model evaluation metric (R2) that the XGBoost regressor model has resulted 0.89 before tuning and 0.94 after tuning of the model, which is higher than the polynomial regressor and support vector regressor.