Stacked Hybridization to Enhance the Performance of Artificial Neural Networks (ANN) for Prediction of Water Quality Index in the Bagh River Basin, India

Data availability statement: The data pertaining to this study have not been deposited in a publicly accessible repository, given that all relevant data are thoroughly detailed in the article or appropriately cited in the manuscript.Water quality assessment is paramount for environmental monitoring and resource management, particularly in regions experiencing rapid urbanization and industrialization. This study introduces Artificial Neural Networks (ANN) and its hybrid machine learning models, namely ANN-RF (Random Forest), ANN-SVM (Support Vector Machine), ANN-RSS (Random Subspace), ANN-M5P (M5 Pruned), and ANN-AR (Additive Regression) for water quality assessment in the rapidly urbanizing and industrializing Bagh River Basin, India. The Relief algorithm was employed to select the most influential water quality input parameters, including Nitrate (NO3-), Magnesium (Mg2+), Sulphate (SO42-), Calcium (Ca2+), and Potassium (K+). The comparative analysis of developed ANN and its hybrid models was carried out using statistical indicators (i.e., Nash-Sutcliffe Efficiency (NSE), Pearson Correlation Coefficient (PCC), Coefficient of Determination (R2), Mean Absolute Error (MAE), Root Mean Square Error (RMSE), Relative Root Square Error (RRSE), Relative Absolute Error (RAE), and Mean Bias Error (MBE) and graphical representations (i.e., Taylor diagram). Results indicate that the integration of support vector machine (SVM) with ANN significantly improves performance, yielding impressive statistical indicators: NSE (0.879), R2 (0.904), MAE (22.349), and MBE (12.548). The methodology outlined in this study can serve as a template for enhancing the predictive capabilities of ANN models in various other environmental and ecological applications, contributing to sustainable development and safeguarding natural resources.No funding was received for conducting this study

Documenting the Recovery of Vascular Services in European Centres Following the Initial COVID-19 Pandemic Peak: Results from a Multicentre Collaborative Study

Objective: To document the recovery of vascular services in Europe following the first COVID-19 pandemic peak. Methods: An online structured vascular service survey with repeated data entry between 23 March and 9 August 2020 was carried out. Unit level data were collected using repeated questionnaires addressing modifications to vascular services during the first peak (March – May 2020, “period 1”), and then again between May and June (“period 2”) and June and July 2020 (“period 3”). The duration of each period was similar. From 2 June, as reductions in cases began to be reported, centres were first asked if they were in a region still affected by rising cases, or if they had passed the peak of the first wave. These centres were asked additional questions about adaptations made to their standard pathways to permit elective surgery to resume. Results: The impact of the pandemic continued to be felt well after countries’ first peak was thought to have passed in 2020. Aneurysm screening had not returned to normal in 21.7% of centres. Carotid surgery was still offered on a case by case basis in 33.8% of centres, and only 52.9% of centres had returned to their normal aneurysm threshold for surgery. Half of centres (49.4%) believed their management of lower limb ischaemia continued to be negatively affected by the pandemic. Reduced operating theatre capacity continued in 45.5% of centres. Twenty per cent of responding centres documented a backlog of at least 20 aortic repairs. At least one negative swab and 14 days of isolation were the most common strategies used for permitting safe elective surgery to recommence. Conclusion: Centres reported a broad return of services approaching pre-pandemic “normal” by July 2020. Many introduced protocols to manage peri-operative COVID-19 risk. Backlogs in cases were reported for all major vascular surgeries

Utilization of mechanical power and associations with clinical outcomes in brain injured patients. a secondary analysis of the extubation strategies in neuro-intensive care unit patients and associations with outcome (ENIO) trial

BackgroundThere is insufficient evidence to guide ventilatory targets in acute brain injury (ABI). Recent studies have shown associations between mechanical power (MP) and mortality in critical care populations. We aimed to describe MP in ventilated patients with ABI, and evaluate associations between MP and clinical outcomes.MethodsIn this preplanned, secondary analysis of a prospective, multi-center, observational cohort study (ENIO, NCT03400904), we included adult patients with ABI (Glasgow Coma Scale <= 12 before intubation) who required mechanical ventilation (MV) >= 24 h. Using multivariable log binomial regressions, we separately assessed associations between MP on hospital day (HD)1, HD3, HD7 and clinical outcomes: hospital mortality, need for reintubation, tracheostomy placement, and development of acute respiratory distress syndrome (ARDS).ResultsWe included 1217 patients (mean age 51.2 years [SD 18.1], 66% male, mean body mass index [BMI] 26.3 [SD 5.18]) hospitalized at 62 intensive care units in 18 countries. Hospital mortality was 11% (n = 139), 44% (n = 536) were extubated by HD7 of which 20% (107/536) required reintubation, 28% (n = 340) underwent tracheostomy placement, and 9% (n = 114) developed ARDS. The median MP on HD1, HD3, and HD7 was 11.9 J/min [IQR 9.2-15.1], 13 J/min [IQR 10-17], and 14 J/min [IQR 11-20], respectively. MP was overall higher in patients with ARDS, especially those with higher ARDS severity. After controlling for same-day pressure of arterial oxygen/fraction of inspired oxygen (P/F ratio), BMI, and neurological severity, MP at HD1, HD3, and HD7 was independently associated with hospital mortality, reintubation and tracheostomy placement. The adjusted relative risk (aRR) was greater at higher MP, and strongest for: mortality on HD1 (compared to the HD1 median MP 11.9 J/min, aRR at 17 J/min was 1.22, 95% CI 1.14-1.30) and HD3 (1.38, 95% CI 1.23-1.53), reintubation on HD1 (1.64; 95% CI 1.57-1.72), and tracheostomy on HD7 (1.53; 95%CI 1.18-1.99). MP was associated with the development of moderate-severe ARDS on HD1 (2.07; 95% CI 1.56-2.78) and HD3 (1.76; 95% CI 1.41-2.22).ConclusionsExposure to high MP during the first week of MV is associated with poor clinical outcomes in ABI, independent of P/F ratio and neurological severity. Potential benefits of optimizing ventilator settings to limit MP warrant further investigation

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Assessing Salinity Hazards in Coastal Aquifers: Implications of Temperature Boundary Conditions on Aquifer-Ocean Interaction

......This study did not receive any funding. Alban Kuriqi acknowledges the Foundation for Science and Technology's support through funding UIDB/04625/2020 from the research unit CERIS

Enhanced Groundwater Availability through Rainwater Harvesting and Managed Aquifer Recharge in Arid Regions Applied Water Science

...Alban Kuriqi is grateful for the Foundation for Science and Technology's help through funding UIDB/04625/2020 from the research unit CERIS

Effect of the number of incubated eggs and nurturing squabs on the behaviour and performance of breeding pigeons

The objective of this study was to evaluate the incubated egg and nurturing squab numbers on breeding pigeon behaviour and performance. Fifteen pairs of mature Egyptian Baladi Pigeons (12-18 months) were divided into 3 groups (one pair x 5 replicates for each group). Group1 (G1): each pair incubated one egg and reared one squab, Group2 (G2): parents incubated 2 eggs and reared 2 squabs and Group3 (G3): incubated 3eggs and reared 3 squabs. Maintenance and reproductive behaviour were recorded for each pair of parents using a digital camera and then analysed. In addition, the performance of adults and brooded squabs was evaluated. Results showed that the frequency of foraging and walking behaviour of females was significantly higher in G3. On the other hand, the other comfort behaviour was significantly higher for both parents in G1 compared to other groups indicating more welfare they had. No a significant impact was observed on other maintenance behaviour of breeding pigeons. Nest defence behaviour and prolactin level were increased with increasing the reared chicks or incubated eggs, while nest building was significantly decreased. Besides the prolonged incubation period & egg laying intervals in G3, the body weight (at 7 days old) and body weight gain (BWG) of squab at 7 and 14 days old declined significantly. A significant increase in body weight loss of female and male with increasing the number of reared chicks, moreover, raising the prolactin level in G3 compared to G1&G2. It concluded that, neither adult behaviour nor squab performance were adversely affected by increasing nurturing squab or incubated egg up to 3 squabs or 3 eggs which could be recommended practice for raising the economic profit in addition to feed supplements for a breeding pigeon to alleviate the loss in body mass at brooding period

Effect of the number of incubated eggs and nurturing squabs on the behaviour and performance of breeding pigeons

The objective of this study was to evaluate the incubated egg and nurturing squab numbers on breeding pigeon behaviour and performance. Fifteen pairs of mature Egyptian Baladi Pigeons (12-18 months) were divided into 3 groups (one pair x 5 replicates for each group). Group1 (G1): each pair incubated one egg and reared one squab, Group2 (G2): parents incubated 2 eggs and reared 2 squabs and Group3 (G3): incubated 3eggs and reared 3 squabs. Maintenance and reproductive behaviour were recorded for each pair of parents using a digital camera and then analysed. In addition, the performance of adults and brooded squabs was evaluated. Results showed that the frequency of foraging and walking behaviour of females was significantly higher in G3. On the other hand, the other comfort behaviour was significantly higher for both parents in G1 compared to other groups indicating more welfare they had. No a significant impact was observed on other maintenance behaviour of breeding pigeons. Nest defence behaviour and prolactin level were increased with increasing the reared chicks or incubated eggs, while nest building was significantly decreased. Besides the prolonged incubation period & egg laying intervals in G3, the body weight (at 7 days old) and body weight gain (BWG) of squab at 7 and 14 days old declined significantly. A significant increase in body weight loss of female and male with increasing the number of reared chicks, moreover, raising the prolactin level in G3 compared to G1&G2. It concluded that, neither adult behaviour nor squab performance were adversely affected by increasing nurturing squab or incubated egg up to 3 squabs or 3 eggs which could be recommended practice for raising the economic profit in addition to feed supplements for a breeding pigeon to alleviate the loss in body mass at brooding period