Estimation of High-Resolution Evapotranspiration in Heterogeneous Environments Using Drone-Based Remote Sensing

Evapotranspiration (ET) is a key element of hydrological cycle analysis, irrigation demand, and for better allocation of water resources in the ecosystem. For successful water resources management activities, precise estimate of ET is necessary. Although several attempts have been made to achieve that, variation in temporal and spatial scales constitutes a major challenge, particularly in heterogeneous canopy environments such as vineyards, orchards, and natural areas. The advent of remote sensing information from different platforms, particularly the small unmanned aerial systems (sUAS) technology with lightweight sensors allows users to capture high-resolution data faster than traditional methods, described as “flexible in timing”. In this study, the Two Source Energy Balance Model (TSEB) along with high-resolution data from sUAS were used to bridge the gap in ET issues related to spatial and temporal scales. Over homogeneous vegetation surfaces, relatively low spatial resolution information derived from Landsat (e.g., 30 m) might be appropriate for ET estimate, which can capture differences between fields. However, in agricultural landscapes with presence of vegetation rows and interrows, the homogeneity is less likely to be met and the ideal conditions may be difficult to identify. For most agricultural settings, row spacing can vary within a field (vineyards and orchards), making the agricultural landscape less homogenous. This leads to a key question related to how the contextual spatial domain/model grid size could influence the estimation of surface fluxes in canopy environments such as vineyards. Furthermore, temporal upscaling of instantaneous ET at daily or longer time scales is of great practical importance in managing water resources. While remote sensing-based ET models are promising tools to estimate instantaneous ET, additional models are needed to scale up the estimated or modeled instantaneous ET to daily values. Reliable and precise daily ET (ETd) estimation is essential for growers and water resources managers to understand the diurnal and seasonal variation in ET. In response to this issue, different existing extrapolation/upscaling daily ET (ETd) models were assessed using eddy covariance (EC) and sUAS measurements. On the other hand, ET estimation over semi-arid naturally vegetated regions becomes an issue due to high heterogeneity in such environments where vegetation tends to be randomly distributed over the land surface. This reflects the conditions of natural vegetation in river corridors. While significant efforts were made to estimate ET at agricultural landscapes, accurate spatial information of ET over riparian ecosystems is still challenging due to various species associated with variable amounts of bare soil and surface water. To achieve this, the TSEB model with high-resolution remote sensing data from sUAS were used to characterize the spatial heterogeneity and calculate the ET over a natural environment that features arid climate and various vegetation types at the San Rafael River corridor

A System Approach For Defining Data Center Value Proposition

Organizations invest heavily in IT infrastructure and the data center’s share of these investments is not marginal. Organizations face the challenge of justifying capital and operational spending on these facilities and often measuring the performance of data center is ignored. Performance measurements focus on analyzing the performance of servers and software applications rather than that of the impact of the data center on the organization. Various methods that have been currently used do not convey the actual value of the data center and do not provide accurate predications of its benefit and expected performance. This report introduces a method to define the value proposition of a data center using a set of metrics that provide measures for a number of variables that define the behavior and outcomes of a data center. An analysis of the data center behavior and outcome will provide a system model from which stakeholder value can be defined

Myomectomy for fibroids during cesarean section: A randomized controlled trial

Background: There is a considerable debate about the management of myoma during cesarean section (CS). Recently, several studies indicated the safety and feasibility of undertaking myomectomy during CS.Objectives: To evaluate the safety, accessibility, and short-term morbidity of myomectomy for fibroids during cesarean section.Patients and Methods: This was a randomized controlled trial that included 72 patients who were admitted to the Obstetrics & Gynecology Department, Menoufia University Hospital with uterine fibroids during pregnancy; who were randomly allocated equally into a group of cesarean myomectomy (CM; n=36) and another group of CS only (n=36). The operative events and the outcome were recorded and analyzed.Results: CM group showed a longer duration of surgery and longer hospital stay, higher amount of blood loss, and higher mean pain sores, with a highly statistically significant difference (p = 0.000). No cases in both groups required blood transfusion or ICU admission. No statistically significant differences were noted between both groups as regards the fetal outcome measures (p=0.583 & 0.601).Conclusion: CM is safe and applicable in selected cases without deleterious maternal complications. Special precautions ought to be paid during the procedure, particularly in the intramural type and with large fibroids

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Universal Dental Adhesives: Cost-Effectiveness and Duration of Use

The purpose of this study was to conduct a cost-effectiveness analysis (CEA) of different brands of universal dental adhesives used for composite restorations. Four adhesive brands were included: Single-Bond Universal (SB), Tetric N-Bond Universal VivaPen (TN), OptiBond All-In-One (OB), and G-Premio Bond (GP). Adhesives were applied 5 times daily in a standardized class II cavity onto a plastic tooth. A precision-analysis scale was used to measure all of the following parameters before and after use: adhesive bottle, applicator, dosing plate, and plastic tooth. CEA was done by measuring the amount of material utilized/day, waste/day, efficacy, efficiency, average cost-effectiveness ratio (ACER), and incremental cost-effectiveness ratio (ICER). Data were analyzed using Kruskal&ndash;Wallis and Dunn&rsquo;s tests with Bonferroni correction at 0.05 significance level. CEA tested parameters were significantly different between groups (p &lt; 0.001) except for ICER (p = 0.112). GP was the least effective (median = 0.062), and SB was the least efficient (median = 0.366). The highest and lowest ACER values were associated with TN (median cost &asymp; USD 317) and SB (median cost &asymp; USD 317), respectively. ICER analysis reported an incremental cost for extra material utilized per milliliter of &asymp;USD 208 for TN, USD 3.8 for GP, and USD &minus;38 for OB, compared to SB. TN seems to be the most efficient and cost-effective dental adhesive

Universal Dental Adhesives: Cost-Effectiveness and Duration of Use

The purpose of this study was to conduct a cost-effectiveness analysis (CEA) of different brands of universal dental adhesives used for composite restorations. Four adhesive brands were included: Single-Bond Universal (SB), Tetric N-Bond Universal VivaPen (TN), OptiBond All-In-One (OB), and G-Premio Bond (GP). Adhesives were applied 5 times daily in a standardized class II cavity onto a plastic tooth. A precision-analysis scale was used to measure all of the following parameters before and after use: adhesive bottle, applicator, dosing plate, and plastic tooth. CEA was done by measuring the amount of material utilized/day, waste/day, efficacy, efficiency, average cost-effectiveness ratio (ACER), and incremental cost-effectiveness ratio (ICER). Data were analyzed using Kruskal–Wallis and Dunn’s tests with Bonferroni correction at 0.05 significance level. CEA tested parameters were significantly different between groups (p p = 0.112). GP was the least effective (median = 0.062), and SB was the least efficient (median = 0.366). The highest and lowest ACER values were associated with TN (median cost ≈ USD 317) and SB (median cost ≈ USD 317), respectively. ICER analysis reported an incremental cost for extra material utilized per milliliter of ≈USD 208 for TN, USD 3.8 for GP, and USD −38 for OB, compared to SB. TN seems to be the most efficient and cost-effective dental adhesive