Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

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

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

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

Modeling of Botnet Detection Using Chaotic Binary Pelican Optimization Algorithm With Deep Learning on Internet of Things Environment

Nowadays, there are ample amounts of Internet of Things (IoT) devices interconnected to the networks, and with technological improvement, cyberattacks and security threads, for example, botnets, are rapidly evolving and emerging with high-risk attacks. A botnet is a network of compromised devices that are controlled by cyber attackers, frequently employed to perform different cyberattacks. Such attack disrupts IoT evolution by disrupting services and networks for IoT devices. Detecting botnets in an IoT environment includes finding abnormal patterns or behaviors that might indicate the existence of these malicious networks. Several researchers have proposed deep learning (DL) and machine learning (ML) approaches for identifying and categorizing botnet attacks in the IoT platform. Therefore, this study introduces a Botnet Detection using the Chaotic Binary Pelican Optimization Algorithm with Deep Learning (BNT-CBPOADL) technique in the IoT environment. The main aim of the BNT-CBPOADL method lies in the correct detection and categorization of botnet attacks in the IoT environment. In the BNT-CBPOADL method, Z-score normalization is applied for pre-processing. Besides, the CBPOA technique is derived for feature selection. The convolutional variational autoencoder (CVAE) method is applied for botnet detection. At last, the arithmetical optimization algorithm (AOA) is employed for the optimal hyperparameter tuning of the CVAE algorithm. The experimental valuation of the BNT-CBPOADL technique is tested on a Bot-IoT database. The experimentation outcomes inferred the supremacy of the BNT-CBPOADL method over other existing techniques with maximum accuracy of 99.50&#x0025;

Intelligent Intrusion Detection Using Arithmetic Optimization Enabled Density Based Clustering with Deep Learning

Rapid advancements in the internet and communication domains have led to a massive rise in the network size and the equivalent data. Consequently, several new attacks have been created and pose several challenging issues for network security. In addition, the intrusions can launch several attacks and can be handled by the use of intrusion detection system (IDS). Though several IDS models are available in the literature, there is still a need to improve the detection rate and decrease the false alarm rate. The recent developments of machine learning (ML) and deep learning (DL)-based IDS systems are being deployed as possible solutions for effective intrusion detection. In this work, we propose an arithmetic optimization-enabled density-based clustering with deep learning (AOEDBC-DL) model for intelligent intrusion detection. The presented AOEDBC-DL technique follows a data clustering process to handle the massive quantity of network data traffic. To accomplish this, the AOEDBC-DL technique applied a density-based clustering technique and the initial set of clusters are initialized using the arithmetic optimization algorithm (AOA). In order to recognize and classify intrusions, a bidirectional long short term memory (BiLSTM) mechanism was exploited in this study. Eventually, the AOA was applied as a hyperparameter tuning procedure of the BiLSTM model. The experimental result analysis of the AOEDBC-DL algorithm was tested using benchmark IDS datasets. Extensive comparison studies highlighted the enhancements of the AOEDBC-DL technique over other existing approaches

BIM-based architectural analysis and optimization for construction 4.0 concept (a comparison)

The growing need for electricity has put Pakistan's burgeoning economy in peril. The notion of “Construction 4.0″ is considered in this study since it enables the greatest utilization of energy and architectural analysis. A case study and a method for building information modelling are used to analyze the concepts of green building. The case study building is represented as a parametric model using the Autodesk Revit platform with the original blueprints and data. Using Autodesk Insight 360, an energy analysis and comparison of optimization case study of the A-Block and Z-Block COMSATS Abbottabad, Pakistan is chosen. This study analyses an academic building's energy performance as a case study to reduce energy usage. By turning the building 360 degrees at 45-degree intervals and utilizing BIM to install energy-efficient construction materials, this study analyses the energy efficiency of an academic building. The average annual energy cost for blocks A and Z is decreased from 228 kWh/m2 to 160 kWh/m2 and 192 kWh/m2, respectively

Henry Gas Solubility Optimization With Deep Learning Based Facial Emotion Recognition for Human Computer Interface

Automated facial emotion recognition (FER) is one of the important fields of human-computer interaction (HCI). FER remains challenging due to facial accessories, non-uniform illumination, pose variation, etc. Emotion detection exploiting conventional algorithms has the demerit of mutual optimization of classification and feature extraction. Artificial intelligence (AI) techniques can be employed to identify FER automatically. Deep learning (DL) driven FER models have recently allowed for designing an end-to-end learning process. Therefore, this study designs a Henry Gas Solubility Optimization with Deep Learning Based FER (HGSO-DLFER) technique for HCI. The HGSO-DLFER technique aims to recognize and identify various kinds of facial emotions. To accomplish this, the HGSO-DLFER technique employs adaptive fuzzy filtering (AFF) for noise removal. In addition, the MobileNet model is used for feature vector generation, and the HGSO algorithm optimally chooses its hyperparameter scan. For the recognition of facial emotions, the HGSO-DLFER technique uses an autoencoder (AE) classifier with a Nadam optimizer. A widespread experimental analysis is made to facilitate a better understanding of the FER results by the HGSO-DLFER technique. The comparative analysis showed the effective performance of the HGSO-DLFER technique over other FER techniques with maximum accuracy of 98.65&#x0025;

Manta Ray Foraging Optimization Transfer Learning-Based Gastric Cancer Diagnosis and Classification on Endoscopic Images

Gastric cancer (GC) diagnoses using endoscopic images have gained significant attention in the healthcare sector. The recent advancements of computer vision (CV) and deep learning (DL) technologies pave the way for the design of automated GC diagnosis models. Therefore, this study develops a new Manta Ray Foraging Optimization Transfer Learning technique that is based on Gastric Cancer Diagnosis and Classification (MRFOTL-GCDC) using endoscopic images. For enhancing the quality of the endoscopic images, the presented MRFOTL-GCDC technique executes the Wiener filter (WF) to perform a noise removal process. In the presented MRFOTL-GCDC technique, MRFO with SqueezeNet model is used to derive the feature vectors. Since the trial-and-error hyperparameter tuning is a tedious process, the MRFO algorithm-based hyperparameter tuning results in enhanced classification results. Finally, the Elman Neural Network (ENN) model is utilized for the GC classification. To depict the enhanced performance of the presented MRFOTL-GCDC technique, a widespread simulation analysis is executed. The comparison study reported the improvement of the MRFOTL-GCDC technique for endoscopic image classification purposes with an improved accuracy of 99.25%