Minimally invasive video-assisted thyroid surgery: how can we improve the learning curve?

Objective. Minimally invasive video-assisted thyroidectomy (MIVAT) is a technically demanding procedure and requires a surgical team skilled in both endocrine and endoscopic surgery. A time consuming learning and training period is mandatory at the beginning of the experience. The aim of our report is to focus some aspects of the learning curve of the surgeon who practices video-assisted thyroid procedures for the first time, through the analysis of our preliminary series of 36 cases. Patients and methods. From September 2004 to April 2005 we selected 36 patients for minimally invasive video-assisted surgery of the thyroid. The patients were considered eligible if they presented with a nodule not exceeding 35mm in maximum diameter; total thyroid volume within normal range; absence of biochemical and echographic signs of thyroiditis. We analyzed surgical results, conversion rate, operating time, post-operative complications, hospital stay, cosmetic outcome of the series. Results. We performed 36 total thyroidectomy. The procedure was successfully carried out in 33/36 cases. Post-operative complications included 3 transient recurrent nerve palsies and 2 transient hypocalcemias; no definitive hypoparathyroidism was registered. All patients were discharged 2 days after operation. The cosmetic result was considered excellent by most patients. Conclusions. Advances in skills and technology have enabled surgeons to reproduce most open surgical techniques with video-assistance or laparoscopically. Training is essential to acquire any new surgical technique and it should be organized in detail to exploit it completely.

Estimating the demand curve for sustainable use of pesticides from contingent-valuation data

Stated-preference valuation techniques are often used to assess consumers' willingness-to-pay for food items produced in farming systems that adopt a sustainable use of pesticides (SUP). We propose an innovative valuation methodology in which dichotomous-choice contingent valuation is used to estimate the demand curve (price-quantity relationship) for such food items where price means price premium for the SUP output, quantity is the probability of choosing SUP and the conventional food product is kept available in the market at the current market price. This methodology can be used to evaluate market differentiation as a policy option to promote the SUP. The methodology is tested with data from a sample of urban consumers of fruits and vegetables in Portugal. The estimated demand curve is used to define the price level maximizing the total premium revenue for the SUP sector as a whole. This optimal level of the price premium is €77.55 (or 163% of the value of the monthly basket of fruits and vegetables at current prices). Adopting the optimal price premium will decrease the number of consumers of SUP food by 54%. The reduction is even higher for low income consumers (80%) leaving them more exposed to the risks of pesticide use.

Using a CGE Model to Identify the Policy Trade-Off between Unemployment and Inflation: The Efficient Phillips Curve

This paper provides a new reading of a classical economic relation: the short-run Phillips curve. Our point is that, when dealing with inflation and unemployment, policy-making can be understood as a multicriteria decisionmaking problem. Hence, we use so-called multiobjective programming in connection with a computable general equilibrium (CGE) model to determine the combinations of policy instruments that provide efficient combinations of inflation and unemployment. This approach results in an alternative version of the Phillips curve labelled as efficient Phillips curve. Our aim is to present an application of CGE models to a new area of research that can be especially useful when addressing policy exercises with real data. We apply our methodological proposal within a particular regional economy, Andalusia, in the south of Spain. This tool can give some keys for policy advice and policy implementation in the fight against unemployment and inflation.

Economic development and Environmental quality: The environmental Kuznets curve for water pollution

The main aim of this study was to analyze evidence of an environmental Kuznets curve for water pollution in the developing and developed countries. The study was conducted based on a panel data set of 54 countries – that were categorized into six groups of “developed countries”, “developing countries”, “developed countries with low income”, “developed countries with high income” and “coastal countries”- between the years 1995 to 2006. The results do not confirm the inverted U-shape of EKC curve for the developed countries with low income. Based on the estimated turning points and the average GDP per capita, the study revealed at which point of the EKC the countries are. Furthermore, impacts of capital-and-labor ratio as well as trade openness are drawn by estimating different models for the EKC. The magnitude role of each explanatory variable on BOD was calculated by estimating the associated elasticity.

Sensitivity analysis in optimized parametric curve fitting

Purpose – Curve fitting from unordered noisy point samples is needed for surface reconstruction in many applications -- In the literature, several approaches have been proposed to solve this problem -- However, previous works lack formal characterization of the curve fitting problem and assessment on the effect of several parameters (i.e. scalars that remain constant in the optimization problem), such as control points number (m), curve degree (b), knot vector composition (U), norm degree (k), and point sample size (r) on the optimized curve reconstruction measured by a penalty function (f) -- The paper aims to discuss these issues -- Design/methodology/approach - A numerical sensitivity analysis of the effect of m, b, k and r on f and a characterization of the fitting procedure from the mathematical viewpoint are performed -- Also, the spectral (frequency) analysis of the derivative of the angle of the fitted curve with respect to u as a means to detect spurious curls and peaks is explored -- Findings - It is more effective to find optimum values for m than k or b in order to obtain good results because the topological faithfulness of the resulting curve strongly depends on m -- Furthermore, when an exaggerate number of control points is used the resulting curve presents spurious curls and peaks -- The authors were able to detect the presence of such spurious features with spectral analysis -- Also, the authors found that the method for curve fitting is robust to significant decimation of the point sample -- Research limitations/implications - The authors have addressed important voids of previous works in this field -- The authors determined, among the curve fitting parameters m, b and k, which of them influenced the most the results and how -- Also, the authors performed a characterization of the curve fitting problem from the optimization perspective -- And finally, the authors devised a method to detect spurious features in the fitting curve -- Practical implications – This paper provides a methodology to select the important tuning parameters in a formal manner -- Originality/value - Up to the best of the knowledge, no previous work has been conducted in the formal mathematical evaluation of the sensitivity of the goodness of the curve fit with respect to different possible tuning parameters (curve degree, number of control points, norm degree, etc.)

Breaking the curve with candels: a Bayesian approach to reveal the non-universality of the dust-attenuation law at high redshift

Dust attenuation affects nearly all observational aspects of galaxy evolution, yet very little is known about the form of the dust-attenuation law in the distant universe. Here, we model the spectral energy distributions of galaxies at z ~ 1.5–3 from CANDELS with rest-frame UV to near-IR imaging under different assumptions about the dust law, and compare the amount of inferred attenuated light with the observed infrared (IR) luminosities. Some individual galaxies show strong Bayesian evidence in preference of one dust law over another, and this preference agrees with their observed location on the plane of infrared excess (IRX, L_TIR/L_UV) and UV slope (β). We generalize the shape of the dust law with an empirical model, A_ λ,σ =E(B-V)k_ λ (λ / λ v)^ σ where k_λ is the dust law of Calzetti et al., and show that there exists a correlation between the color excess E(B-V) and tilt δ with δ =(0.62±0.05)log(E(B-V))+(0.26±0.02). Galaxies with high color excess have a shallower, starburst-like law, and those with low color excess have a steeper, SMC-like law. Surprisingly, the galaxies in our sample show no correlation between the shape of the dust law and stellar mass, star formation rate, or β. The change in the dust law with color excess is consistent with a model where attenuation is caused by scattering, a mixed star–dust geometry, and/or trends with stellar population age, metallicity, and dust grain size. This rest-frame UV-to-near-IR method shows potential to constrain the dust law at even higher redshifts (z>3).

LMS tables for waist circumference and waist-to-height ratio among Colombian children and adolescents: The FUPRECOL study

Background: Indices predictive of central obesity include waist circumference (WC) and waist-to-height ratio (WHtR). The aims of this study were 1) to establish a Colombian youth smoothed centile charts and LMS tables for WC and WHtR and 2) to evaluate the utility of these parameters as predictors of overweight and obesity. Method: A cross-sectional study whose sample population comprised 7954 healthy Colombian schoolchildren [boys n=3460 and girls n=4494, mean (standard deviation) age 12.8 (2.3) years old]. Weight, height, body mass index (BMI), WC and WHtR and its percentiles were calculated. Appropriate cut-offs point of WC and WHtR for overweight and obesity, as defined by the International Obesity Task Force (IOTF) definitions, were selected using receiver operating characteristic (ROC) analysis. The discriminating power of WC and WHtR was expressed as area under the curve (AUC). Results: Reference values for WC and WHtR are presented. Mean WC increased and WHtR decreased with age for both genders. We found a moderate positive correlation between WC and BMI (r= 0.756, P < 0.01) and WHtR and BMI (r= 0.604, P < 0.01). The ROC analysis showed a high discrimination power in the identification of overweight and obesity for both measures in our sample population. Overall, WHtR was slightly a better predictor for overweight/obesity (AUC 95% CI 0.868-0.916) than the WC (AUC 95% CI 0.862-0.904). Conclusion: This paper presents the first sex- and age-specific WC and WHtR percentiles for both measures among Colombian children and adolescents aged 9–17.9 years. By providing LMS tables for Latin-American people based on Colombian reference data, we hope to provide quantitative tools for the study of obesity and its comorbidities.

Triceps and subscapular skinfold thicknesses percentiles and cut-offs for overweight and obesity in a population-based sample of schoolchildren in Bogota, Colombia

OBJECTIVES: The aims of this study were to establish a Colombian smoothed centile charts and LMS tables for tríceps, subscapular and sum tríceps+subscapular skinfolds; appropriate cut-offs were selected using receiver operating characteristic analysis based in a populationbased sample of schoolchildren in Bogota, Colombia and to compare them with international studies. METHODS: A total of 9 618 children and adolescents attending public schools in Bogota, Colombia (55.7% girls; age range of 9–17.9 years). Height, weight, body mass index (BMI), waist circumference, triceps and subscapular skinfold measurements were obtained using standardized methods. We have calculated tríceps+subscapular skinfold (T+SS) sum. Smoothed percentile curves for triceps and subscapular skinfold thickness were derived by the LMS method. Receiver operating characteristics curve (ROC) analyses were used to evaluate the optimal cut-off point of tríceps, subscapular and sum tríceps+subscapular skinfolds for overweight and obesity based on the International Obesity Task Force (IOTF) definitions. Data were compared with international studies. RESULTS: Subscapular, triceps skinfolds and T+SS were significantly higher in girls than in boys (P <0.001). The median values for triceps, subscapular as well as T+SS skinfold thickness increased in a sex-specific pattern with age. The ROC analysis showed that subscapular, triceps skinfolds and T+SS have a high discrimination power in the identification of overweight and obesity in the sample population in this study. Based on the raw non-adjusted data, we found that Colombian boys and girls had high triceps and subscapular skinfolds values than their counterparts from Spain, UK, German and US. CONCLUSIONS: Our results provide sex- and age-specific normative reference standards for the triceps and subscapular skinfold thickness values in a large, population-based sample of 3 schoolchildren and adolescents from an Latin-American population. By providing LMS tables for Latin-American people based on Colombian reference data, we hope to provide quantitative tools for the study of obesity and its complications.

Factores de riesgo preoperatorios asociados a conversión a técnica abierta en colecistectomía laparoscópica de urgencia

Introducción: la colecistectomía laparoscópica es la técnica de elección en pacientes con indicación de extracción quirúrgica de la vesícula; sin embargo, en promedio 20% de éstos requieren conversión a técnica abierta. En este estudio se evaluaron los factores de riesgo preoperatorios para conversión en colecistectomía laparoscópica de urgencia. Metodología: se realizó un estudio de casos y controles no pareado. Se obtuvo información sociodemográfica y de variables de interés de los registros de historias clínicas de pacientes operados entre el 2013 y 2016. Se identificaron los motivos de conversión de técnica quirúrgica. Se caracterizó la población de estudio y se estimaron asociaciones según la naturaleza de las variables. Mediante un análisis de regresión logística se ajustaron posibles variables de confusión. Resultados: se analizaron los datos de 444 pacientes (111 casos y 333 controles). La causa de conversión más frecuente fue la dificultad técnica (50,5%). Se encontró que la mayor edad, el sexo masculino, el antecedente de cirugía abierta en hemiabdomen superior, el signo de Murphy clínico positivo, la dilatación de la vía biliar, la leucocitosis y la mayor experiencia del cirujano, fueron factores de riesgo para conversión. Se encontró un área bajo la curva ROC= 0,743 (IC95% 0,692–0,794, p= <0,001). Discusión: existen unos factores que se asocian a mayor riesgo de conversión en colecistectomía laparoscópica. La mayoría se relacionan con un proceso inflamatorio más severo, por lo que se debe evitar la prolongación del tiempo de espera entre el inicio de los síntomas y la extirpación quirúrgica de la vesícula.

Handgrip strength cut-off for cardiometabolic risk index among Colombian children and adolescents : the FUPRECOL study

Abstract Objective: Evidence shows an association between muscular strength (MS) and health among youth, however low muscular strength cut-points for the detection of high metabolic risk in Latin-American populations are scarce. The aim of this study was two-fold: to explore potential age- and sex-specific thresholds of MS, for optimal cardiometabolic risk categorization among Colombian children and adolescents; and to investigate if cardiometabolic risk differed by MS group by applying the receiver operating characteristic curve (ROC) cut point. Methods: This is a secondary analysis of a cross-sectional study (the FUPRECOL study), published elsewhere. The FUPRECOL study assessments were conducted during the 2014– 2015 school year. MS was estimated by a handle dynamometer on 1,950 children and adolescents from Colombia, using the MS relative to weight (handgrip strength/body mass). A metabolic risk score was computed from the following components: waist circumference, triglycerides, HDL-c, glucose, systolic and diastolic blood pressure. ROC analysis showed a significant discriminatory accuracy of MS in identifying the low/high metabolic risk in children and adolescents and both gender. Results: In children, handgrip strength/body mass level for a low metabolic risk were 0.359 and 0.376 in girls and boys, respectively. In adolescents, these points were 0.440 and 0.447 in girls and boys, respectively. Conclusion: In conclusion, the results suggest a hypothetical MS level relative to weight for having a low metabolic risk, which could be used to identify youths at risk.

Towards a single crystal Raman spectrum of kaolinite at 77 K

The Raman spectra at 77 K of the hydroxyl stretching of kaolinite were obtained along the three axes perpendicular to the crystal faces. Raman bands were observed at 3616, 3658 and 3677 cm−1 together with a distinct band observed at 3691 cm−1 and a broad profile between 3695 and 3715 cm−1. The band at 3616 cm−1 is assigned to the inner hydroxyl. The bands at 3658 and 3677 cm−1 are attributed to the out-of-phase vibrations of the inner surface hydroxyls. The Raman spectra of the in-phase vibrations of the inner-surface hydroxyl-stretching region are described in terms of transverse and longitudinal optic splitting. The band at 3691 cm−1 is assigned to the transverse optic and the broad profile to the longitudinal optic mode. This splitting remained even at liquid nitrogen temperature. The transverse optic vibration may be curve resolved into two or three bands, which are attributed to different types of hydroxyl groups in the kaolinite.

An infrared spectroscopic study of the some Autunite minerals

A series of selected autunites with phosphate as the anion have been studied using infrared spectroscopy. Each autunite mineral has its own characteristic spectrum. The spectra for different autunites with the same composition are different. It is proposed that this difference is due to the structure of water and hydrated cations in the interlayer region between the uranyl phosphate sheets. This structure is different for different autunites. The position of the water hydroxyl stretching bands is related to the strength of the hydrogen bonds as determined by hydrogen bond distance. The highly ordered structure of water is also observed in the water HOH bending modes where a high wavenumber bands are observed. The phosphate and uranyl stretching vibrations overlap and are obtained by curve resolution.

Deniable Authenticated Key Establishment for Internet Protocols

We propose two public-key schemes to achieve “deniable authentication” for the Internet Key Exchange (IKE). Our protocols can be implemented using different concrete mechanisms and we discuss different options; in particular we suggest solutions based on elliptic curve pairings. The protocol designs use the modular construction method of Canetti and Krawczyk which provides the basis for a proof of security. Our schemes can, in some situations, be more efficient than existing IKE protocols as well as having stronger deniability properties.

Response and damage evaluation of reinforced concrete frames subjected to blast loading

Bomb attacks carried out by terrorists, targeting high occupancy buildings, have become increasingly common in recent times. Large numbers of casualties and property damage result from overpressure of the blast followed by failing of structural elements. Understanding the blast response of multi-storey buildings and evaluating their remaining life have therefore become important. Response and damage analysis of single structural components, such as columns or slabs, to explosive loads have been examined in the literature, but the studies on blast response and damage analysis of structural frames in multi-storey buildings is limited and this is necessary for assessing the vulnerability of them. This paper investigates the blast response and damage evaluation of reinforced concrete (RC) frames, designed for normal gravity loads, in order to evaluate their remaining life. Numerical modelling and analysis were carried out using the explicit finite element software, LS DYNA. The modelling and analysis takes into consideration reinforcement details together and material performance under higher strain rates. Damage indices for columns are calculated based on their residual and original capacities. Numerical results generated in the can be used to identify relationships between the blast load parameters and the column damage. Damage index curve will provide a simple means for assessing the damage to a typical multi-storey building RC frame under an external bomb circumstance.