stochastic frontier models to the Italian water industry

inefficiency or just heterogeneity? An application of stochastic frontier models to th

Modeling the strategic bidding of the producers in competitive electricity markets with the watkins’ q (lambda) reinforcement learning

con qualsiasi mezzo (compresi microfilm e copie fotostatiche) sono riservati. PRESIDENT

Evidence from the English Water Only Sector.

con qualsiasi mezzo (compresi microfilm e copie fotostatiche) sono riservati. PRESIDENT

Reproducibility of transient elastography in the evaluation of liver fibrosis in patients with chronic liver disease

Objective: Transient elastography (TE) is gaining popularity as a non-invasive method for predicting liver fibrosis, but intraobserver and interobserver agreement and factors influencing TE reproducibility have not been adequately assessed. This study investigated these aspects. Setting: Tertiary referral liver unit. Patients: Over a 4-month period, 200 patients with chronic liver disease (CLD) with varying aetiology consecutively underwent TE and liver biopsy. Interventions: TE was performed twice by two different operators either concomitantly or within 3 days of the bioptic procedure (METAVIR classification). Main outcome measures: Intraobserver and interobserver agreement were analysed using the intraclass correlation coefficient (ICC) and correlated with different patient-related and liver disease-related covariates. Results: 800 TE examinations were performed, with an indeterminate result rate of 2.4%. The overall interobserver agreement ICC was 0.98 (95% CI 0.977 to 0.987). Increased body mass index (>25 kg/m2), steatosis, and low staging grades (fibrosis (F) stage 7.9 kPa for F\u2a7e2, >10.3 for F\u2a7e3 and >11.9 for F\u200a=\u200a4. TE values assessed by the two raters fell within the same cut-off of fibrosis in 88% of the cases for F\u2a7e2, in 92% for F\u2a7e3 and 91% for F\u200a=\u200a4. Conclusions: TE is a highly reproducible and user-friendly technique for assessing liver fibrosis in patients with CLD. However, because TE reproducibility is significantly reduced (p<0.05) in patients with steatosis, increased BMI and lower degrees of hepatic fibrosis, caution is warranted in the clinical use of TE as a surrogate for liver biopsy

Gastrointestinal nematodes of goats: host–parasite relationship differences in breeds at summer mountain pasture in northern Italy

The Orobic goat is a hardy breed native to the Orobic Alps (Lombardy, northern Italy). The aim of the study was the assessment of gastrointestinal nematode (GIN) egg excretion in Alpine and Saanen (cosmopolite breeds) and Orobic grazing goats, after a strategic treatment with eprinomectin in late June

Management of chemical immobilization of brown bear (Ursus arctos) in the Abruzzo, Lazio and Molise National Park on 235 cases from 1990 to 2013.

235 chemical immobilizations, 44 on captive and wild brown bears (Ursus arctos, n=5) and 171 on Marsican brown bears (Ursus arctos marsicanus, n=44) were recorded. Age and body weight (mean \ub1 standard deviation) of captured animals was 9.81\ub16.28 years and 149.25\ub162.29 kg and 9.68\ub16.15 years and 147.54\ub160.71 kg in brown bear and Marsican brown bears respectively. The following anesthetic combinations were injected intramuscular by a remote equipment: medetomidine 0.05-0.09 mg/kg and ketamine 3-7 mg/kg (group MK: n=209); xylazine 7-13 mg/kg and ketamine 3-8 mg/kg (group XK: n=17); tiletamine-zolazepam 4-8 mg/kg (group TZ: n=9). In MK and XK groups, atipamezol was administered at the end of the procedure. Bears were darted after physical restraint (Aldrich snares or tube trap) or in free ranging situations. Complete anesthetic record, including heart rate (HR), respiratory rate (RR), rectal body temperature (T) and saturimetry (SpO2), and biometric data form were filled in. The first physiologic parameters were recorded within 20 minutes from darting, as soon as adequate depth of anesthesia allowed safe handling of the animal, and were compared between groups with ANOVA test. Statistical significance was set at P<0.05. Anaesthesia induction time was similar between groups and ranged from 7 to 11minutes. HR was similar in groups MK and XK but higher in TZ group; HR was higher in wild than captive bears. RR was similar between groups. Recovery time was shorter in MK and XK than TZ group. Peri-operative complications were reported in 16/235 immobilizations and included vomiting and respiratory complications: 7,1%, 5% and 0% of complications were reported in group MK, XK and TZ respectively. All recoveries were uneventful. Knowledge of the target species biology, trained personnel, deep knowledge of advantages and disadvantages anesthetic drugs is mandatory during wildlife chemical immobilization

Liver and spleen stiffness for the diagnosis of oesophageal varices in adults with chronic liver disease

Objectives: This is a protocol for a Cochrane Review (diagnostic). The objectives are as follows:. To assess the diagnostic accuracy of liver stiffness and spleen stiffness, separately or in combination, as measured by vibration-controlled transient elastography (VCTE) in detection of any oesophageal varices in adults with chronic liver disease. We will regard a combination of tests as positive when at least one is positive. To compare the diagnostic accuracy of individual tests (liver stiffness and spleen stiffness measured by VCTE) directly and versus the combination of both tests (considering positive when at least one is positive) in detecting any oesophageal varices. To assess the diagnostic accuracy of liver stiffness and spleen stiffness, separately or in combination, as measured by other elastography techniques (2D-shear wave elastography (2D-SWE), point shear wave elastography (pSWE), magnetic resonance elastography (MRE)) in detection of any oesophageal varices in adults with chronic liver disease. We will regard a combination of tests as positive when at least one is positive. To compare the diagnostic accuracy of liver stiffness and spleen stiffness measured by VCTE with other techniques (pSWE, 2D-SWE, MRE) in detection of any oesophageal varices in adults with chronic liver disease. Secondary objectives To assess the diagnostic accuracy of liver stiffness and spleen stiffness, separately or in combination, as measured by vibration-controlled transient elastography (VCTE) in detection of high-risk oesophageal varices (HROVs) in adults with chronic liver disease. We will consider a combination of tests as positive when at least one is positive. To compare the diagnostic accuracy of individual tests (liver stiffness and spleen stiffness measured by VCTE) directly and versus the combination of both tests (considering positive when at least one is positive) in detecting HROVs. To assess the diagnostic accuracy of liver stiffness and spleen stiffness, separately or in combination, as measured by other different elastography techniques (2D-shear wave elastography (2D-SWE), point shear wave elastography (pSWE), magnetic resonance elastography (MRE)) in detection of HROVs in adults with chronic liver disease. We will regard a combination of tests as positive when at least one is positive. To compare the diagnostic accuracy of liver stiffness and spleen stiffness measured by VCTE with other techniques (pSWE, 2D-SWE, MRE) in detection of HROVs in adults with chronic liver disease. To investigate potential sources of heterogeneity in the results of liver stiffness and spleen stiffness, separately or in combination, as measured by VCTE, in detection of any oesophageal varices and HROVs

Magnetic resonance imaging for the diagnosis of hepatocellular carcinoma in adults with chronic liver disease.

BACKGROUND Hepatocellular carcinoma occurs mostly in people with chronic liver disease and ranks sixth in terms of global incidence of cancer, and third in terms of cancer deaths. In clinical practice, magnetic resonance imaging (MRI) is used as a second-line diagnostic imaging modality to confirm the presence of focal liver lesions suspected as hepatocellular carcinoma on prior diagnostic test such as abdominal ultrasound or alpha-fetoprotein, or both, either in surveillance programmes or in clinical settings. According to current guidelines, a single contrast-enhanced imaging study (computed tomography (CT) or MRI) showing typical hallmarks of hepatocellular carcinoma in people with cirrhosis is considered valid to diagnose hepatocellular carcinoma. The detection of hepatocellular carcinoma amenable to surgical resection could improve the prognosis. However, a significant number of hepatocellular carcinomas do not show typical hallmarks on imaging modalities, and hepatocellular carcinoma may, therefore, be missed. There is no clear evidence of the benefit of surveillance programmes in terms of overall survival: the conflicting results can be a consequence of inaccurate detection, ineffective treatment, or both. Assessing the diagnostic accuracy of MRI may clarify whether the absence of benefit could be related to underdiagnosis. Furthermore, an assessment of the accuracy of MRI in people with chronic liver disease who are not included in surveillance programmes is needed for either ruling out or diagnosing hepatocellular carcinoma. OBJECTIVES Primary: to assess the diagnostic accuracy of MRI for the diagnosis of hepatocellular carcinoma of any size and at any stage in adults with chronic liver disease. Secondary: to assess the diagnostic accuracy of MRI for the diagnosis of resectable hepatocellular carcinoma in adults with chronic liver disease, and to identify potential sources of heterogeneity in the results. SEARCH METHODS We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Hepato-Biliary Group Diagnostic Test of Accuracy Studies Register, the Cochrane Library, MEDLINE, Embase, and three other databases to 9 November 2021. We manually searched articles retrieved, contacted experts, handsearched abstract books from meetings held during the last 10 years, and searched for literature in OpenGrey (9 November 2021). Further information was requested by e-mails, but no additional information was provided. No data was obtained through correspondence with investigators. We applied no language or document-type restrictions. SELECTION CRITERIA Studies assessing the diagnostic accuracy of MRI for the diagnosis of hepatocellular carcinoma in adults with chronic liver disease, with cross-sectional designs, using one of the acceptable reference standards, such as pathology of the explanted liver and histology of resected or biopsied focal liver lesion with at least a six-month follow-up. DATA COLLECTION AND ANALYSIS At least two review authors independently screened studies, extracted data, and assessed the risk of bias and applicability concerns, using the QUADAS-2 checklist. We presented the results of sensitivity and specificity, using paired forest plots, and we tabulated the results. We used a hierarchical meta-analysis model where appropriate. We presented uncertainty of the accuracy estimates using 95% confidence intervals (CIs). We double-checked all data extractions and analyses. MAIN RESULTS We included 34 studies, with 4841 participants. We judged all studies to be at high risk of bias in at least one domain because most studies used different reference standards, often inappropriate to exclude the presence of the target condition, and the time interval between the index test and the reference standard was rarely defined. Regarding applicability, we judged 15% (5/34) of studies to be at low concern and 85% (29/34) of studies to be at high concern mostly owing to characteristics of the participants, most of whom were on waiting lists for orthotopic liver transplantation, and due to pathology of the explanted liver being the only reference standard. MRI for hepatocellular carcinoma of any size and stage: sensitivity 84.4% (95% CI 80.1% to 87.9%) and specificity 93.8% (95% CI 90.1% to 96.1%) (34 studies, 4841 participants; low-certainty evidence). MRI for resectable hepatocellular carcinoma: sensitivity 84.3% (95% CI 77.6% to 89.3%) and specificity 92.9% (95% CI 88.3% to 95.9%) (16 studies, 2150 participants; low-certainty evidence). The observed heterogeneity in the results remains mostly unexplained. The sensitivity analyses, which included only studies with clearly prespecified positivity criteria and only studies in which the reference standard results were interpreted without knowledge of the results of the index test, showed no variation in the results. AUTHORS' CONCLUSIONS We found that using MRI as a second-line imaging modality to diagnose hepatocellular carcinoma of any size and stage, 16% of people with hepatocellular carcinoma would be missed, and 6% of people without hepatocellular carcinoma would be unnecessarily treated. For resectable hepatocellular carcinoma, we found that 16% of people with resectable hepatocellular carcinoma would improperly not be resected, while 7% of people without hepatocellular carcinoma would undergo inappropriate surgery. The uncertainty resulting from the high risk of bias in the included studies and concerns regarding their applicability limit our ability to confidently draw conclusions based on our results