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The article provides an overview of the International Society for Pediatric Neurosurgery (ISPN) and its history, highlighting key milestones and achievements over the past 50 years. It discusses the global and diverse nature of the ISPN, emphasizing the importance of collaboration and inclusivity within the organization. The article also delves into recent changes in ISPN's leadership structure and initiatives, such as the ISPN Library, aimed at enhancing educational resources and promoting global outreach. Additionally, it touches on efforts to train pediatric neurosurgeons and offers advice to the younger generation in the field. [Extracted from the article]

Background: Standardisation, a widely accepted concept for risk management, entails designing and implementing task-specific operating procedures. In community pharmacies, Standardised Operating Procedures (SOPs) are a mandatory requirement and are recognised as essential for upholding safety and quality. Aim: This study aimed to investigate community pharmacists' (CPs) compliance with SOPs when checking prescriptions, and the reasons for variations between standardised protocols and practice. Method: Eight sets of SOPs underwent hierarchical task analysis (HTA) to generate a normative description of clinical checking execution as per protocols. Subsequently, twelve CPs were engaged in a simulated clinical checking exercise, verbalising their thoughts while checking virtual prescriptions. Transcribed data underwent content analysis, aligned with a descriptive model to uncover engagement patterns, and disparities between SOPs and CPs' practices. Finally, a focus group discussion took place to contextualise the observed variations. Results: HTA aided in constructing a clinical checking model with six primary subtasks and 28 lower subtasks. CPs often omitted subtasks during checks, diverging from prescribed protocols. These deviations, observed in controlled environment, reveal an ingrained aspect within the professional culture of pharmacists, where there may be a tendency not to strictly adhere to protocols, despite variations in work conditions. Contributing factors to this culture include the exercise of professional judgment, reliance on others, and prioritisation of patient preferences. Conclusion: This study highlights ongoing deviations from SOPs during clinical prescription checks in community pharmacies, suggesting a cultural tendency. Future research should delve into risk management strategies for these deviations and address the delicate balance between flexibility and stringent compliance. [ABSTRACT FROM AUTHOR]

Background: Wastewater can contain a complex mixture of organic micropollutants, with both chemical analysis and effect-based methods needed to identify relevant micropollutants and detect mixture effects. Solid-phase extraction (SPE) is commonly used to enrich micropollutants prior to analysis. While the recovery and stability of individual micropollutants by SPE has been well studied, few studies have optimized SPE for effect-based methods. The aim of the current study was to develop and evaluate two standard operating procedures (SOPs) for the enrichment of micropollutants in preparation for chemical analysis and bioanalysis, one covering a broad range of chemicals and the other selective for estrogenic chemicals. Results: Pristine surface water spiked with > 600 micropollutants was used to develop a generic extraction method for micropollutants with a wide range of physiochemical properties, while water spiked with estrogenic chemicals was used to identify a selective extraction method. Three different SPE sorbents were tested, with recoveries of individual chemicals and effect in assays indicative of mutagenicity, estrogenic activity, and fish embryo toxicity assessed. The sorbent HRX at pH 7 was selected for the generic extraction method as it showed the best recovery of both individual chemicals and effect in the bioassays. The sorbent HLB at pH 3 showed optimal recovery of estrogenic chemicals and estrogenic activity. The two optimal SPE methods were applied to spiked and unspiked wastewater effluents, with the concentrations of detected chemicals and observed effects similar to those of previous studies. The long-term storage of both extracts and SPE cartridges for estrogens and estrogenic activity after extraction with the HRX and HLB methods were evaluated, with estrogenic effectiveness close to 100% after 112 days when HLB was used. Conclusions: HRX is recommended for generic extraction, while HLB is optimal for the selective extraction of estrogenic micropollutants. However, if a laboratory only wants to use a single SPE sorbent, HLB can be used for both generic and selective extraction as it yielded similar chemical and effect recovery as HRX for a wide range of micropollutants. This paper is supplemented by the final SOP that includes a variant for generic extraction and one for the extraction of estrogenic chemicals. [ABSTRACT FROM AUTHOR]

In the Korean cement industry, cement is not produced using fossil fuel such as bituminous coal alone but rather using combustible waste as an auxiliary fuel. The standards for using alternative fuel in cement processes are specified in the "Waste Management Laws." However, an analysis process has not been clearly defined, which hinders the development of appropriate standard operating procedures (SOPs) required to objectively evaluate the use of waste as an alternative fuel for cement production. This study proposed clear SOPs to expand the utilization of alternative fuels in cement production, and these procedures were derived by selecting appropriate analysis methods and standards. The thermal, environmental, and quality characteristics of non-recyclable wastes and cement samples treated based on the SOPs were critically examined. Non-recyclable wastes showed a higher calorific value (7010 kcal/kg) and lower chlorine content (0.08 wt.%) compared to bituminous coal, and the cement analysis indicated that the characteristics did not change based on the type of fuel used. Nonrecyclable waste is appropriate for application if processed with a fuel manufacturing system. These findings provide procedural guidelines to promote the use of combustible waste as auxiliary fuels in the cement industry. [ABSTRACT FROM AUTHOR]

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Background: Microvascular decompression (MVD) is a well-established and effective treatment for primary trigeminal neuralgia (TN). Endoscopy has been implemented to provide a comprehensive view of neurovascular conflict and minimizes the damages of brain retraction during MVD. Objectives: To preliminarily evaluate the surgical safety and efficacy of fully endoscopic microvascular decompression (EMVD) for primary TN with surgeon performing two-hand manipulation and assistant holding endoscope. Methods: Retrospective clinical analysis of 189 patients with primary TN underwent EMVD between June 2019 and August 2022 was performed. By analyzing the intraoperative situation, the outcomes of postoperative symptoms and the main complications, we evaluated the reliability and effectivity of the operative technique in the treatment of primary TN. Results: We summarized the standard operating procedure of EMVD for primary TN with surgeon performing two-hand manipulation and assistant holding endoscope. In addition, acicular bipolar electrocoagulation technique was developed to handle venous compression. During the follow-up period, good pain relief was achieved in 178 patients (94.2%) and recurrence of pain was observed in 4 patients (2.1%). Postoperative temporary complications included trigeminal dysesthesias (7 patients, 4.8%), cerebrospinal fluid leak (2 patients, 1.1%), hearing difficulty (3 patient, 1.6%), facial paresis (2 patients, 1.1%) and vertigo (5 patients, 2.7%). There were no cases of intracranial hemorrhage, cerebellar swelling and death. Conclusion: This EMVD technique is reliable and effective, and can be used as a routine surgical procedure for primary TN. [ABSTRACT FROM AUTHOR]

Towards a better characterization of the increasing blast overpressure threat, person-borne sensors are being considered for large military population segments potentially subjected to explosive blast and firing of crew served weapons. Training and field data, tracked longitudinally across a soldier's entire career, can help with the diagnosis of blast injuries and the improvement of standard operating procedures for both explosive forced entry and large weapons firing. However, a current challenge with person-born blast dosimeters resides with the position of the overpressure sensors themselves. Often, the sensors are not fully exposed to the blast locally, resulting in pressure measurements not representative of the blast conditions surrounding an individual. While fielding multiple individual and uncoupled dosimeter units around the body increases the likeliness of catching the representative blast exposure, issues arise from differences in internal clock, potential partial triggering, and the complexity of merging data from different sources. Instead, integrating multiple overpressure sensors pointing in different directions, within a single device that captures and records all data simultaneously, proves highly beneficial for data analysis and interpretation. This paper presents algorithms that combine the overpressure data collected from such multiple coupled sensors for each blast event to minimize the effect of blast directionality. In particular, an algorithm estimating the equivalent side-on blast overpressure is presented, facilitating injury estimates from existing established blast injury models adapted for the outputs from the blast dosimeters. An algorithm is also presented that estimates the orientation or provenance of an explosive blast relative to the soldier. [ABSTRACT FROM AUTHOR]

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One of the major attributes of boiled cassava roots is its ability to soften within a short period, otherwise known as mealiness. This study aimed to establish and validate standard operating procedures for assessing the mealiness of boiled cassava roots. Twenty cassava genotypes, including landrace and improved varieties, were selected for the protocol development, with an additional ten genotypes used for validation. Following cooking, the cassava roots were evaluated for hardness and work done in extrusion using a texturometer equipped with a five-blade Ottawa cell probe. The same samples were assessed for sensory texture analysis using trained panelists for parameters such as softness and chewiness. Pearson's correlation analysis revealed significant positive correlations (p < 0.01) between sensory softness and instrumental texture measurements, as well as between softness and cooking time (p < 0.01, r = 0.94), and between chewiness and cooking time (p < 0.05, r = 0.81). Validation results confirmed significant correlations (p < 0.01) between cooking time, sensory softness, and chewiness. These findings suggest that cooking time can serve as a reliable indicator, closely associated with sensory attributes, in determining the mealiness of boiled cassava roots. This approach offers a practical, mid-throughput method for assessing cassava root mealiness, with implications for breeding improved varieties, farmers adoption, and consumer acceptance. [ABSTRACT FROM AUTHOR]

Over the years, survival of children with chronic diseases has significantly improved and a large proportion of them now are entering into adulthood. Transition of Care (ToC) of such patients with having childhood onset of chronic diseases to the adult health care system is well organized in developed countries, although it is an emerging concept in India. In situations where the systems for ToC are not in place, such cases are fraught with unsatisfactory health outcomes. With proper ToC in place, these patients are likely to receive uninterrupted care by the adult care physicians and hence reach their full potential. This document highlights the need, rationale and way forward for ToC of youth with special health care needs (YSHCN) across the country. It also describes the standard operating procedures to develop the ToC at a hospital level for clinicians and administrators. [ABSTRACT FROM AUTHOR]

This study aimed to reduce instrument packaging defects in the Central Sterile Supply Department (CSSD) using action research. Data of the instrument packs packaged by the packaging personnel at the CSSD of the authors' institution during March to May 2023 were collected and analyzed. After identifying the problems, 2 rounds of cyclic process of "plan-action-observe-reflect" were implemented to standardize the packaging procedures and develop and improve the applicable check of standard operating procedures for the CSSD. After strictly implementing the packaging operation standards and checklists, the number of packaging defect cases dropped from 274 to 41. A significant difference was identified between the number of packaging personnel who achieved a "pass" in the assessment of 3 items for maintenance. Also, 1 item for assembly had significant differences compared with the baseline number after the first cycle (P ≤ 0.001). A significant difference was identified between the number of packaging personnel who achieved a "pass" in the assessment of 20 items for 6 components after the second cycle compared with that after the first cycle (P ≤ 0.05). Through action research methodology, strict implementation of standardized packaging procedures in the CSSD can reduce packaging defects, thereby decreasing clinical complaints and ensuring patient safety. [ABSTRACT FROM AUTHOR]

Background: PET scans using zirconium-89 labelled monoclonal antibodies (89Zr-mAbs), known as 89Zr-immuno-PET, are made to measure uptake in tumour and organ tissue. Uptake is related to the supply of 89Zr-mAbs in the blood. Measuring activity concentrations in blood, however, requires invasive blood sampling. This study aims to identify the best delineation strategy to obtain the image-derived blood concentration (IDBC) from 89Zr-immuno-PET scans. Methods: PET imaging and blood sampling of two 89Zr-mAbs were included, 89Zr-cetuximab and 89Zr-durvalumab. For seven patients receiving 89Zr-cetuximab, PET scans on 1–2 h, 2 and 6 days post-injection (p.i.) were analysed. Five patients received three injections of 89Zr-durvalumab. The scanning protocol for the first two injections consisted of PET scanning on 2, 5 and 7 days p.i. and for the third injection only on 7 days p.i. Blood samples were drawn with every PET scan and the sample-derived blood concentration (SDBC) was used as gold standard for the IDBC. According to an in-house developed standard operating procedure, the aortic arch, ascending aorta, descending aorta and left ventricle were delineated. Bland–Altman analyses were performed to assess the bias (mean difference) and variability (1.96 times the standard deviation of the differences) between IDBC and SDBC. Results: Overall, the activity concentration obtained from the IDBC was lower than from the SDBC. When comparing IDBC with SDBC, variability was smallest for the ascending aorta (20.3% and 17.0% for 89Zr-cetuximab and 89Zr-durvalumab, respectively). Variability for the other regions ranged between 17.9 and 30.8%. Bias for the ascending aorta was − 10.9% and − 11.4% for 89Zr-cetuximab and 89Zr-durvalumab, respectively. Conclusions: Image-derived blood concentrations should be obtained from delineating the ascending aorta in 89Zr-immuno-PET scans, as this results in the lowest variability with respect to sample-derived blood concentrations. [ABSTRACT FROM AUTHOR]

The use of laboratory animals in research has been extensively criticized. While most of the critique has been centered around the ethical aspect, also the economic and scientific aspects have been frequently mentioned as points of concern. As a result, the use of alternative methods has gradually become more enticing. The most used alternatives to laboratory animals are the 2D monolayer cell cultures. However, the limited translatability of these monolayer cell cultures to in vivo has led to the development of 3D cell cultures that are believed to better capture the in vivo physiology and pathology. Here we report on the development of a physiologically more relevant 3D cell model (spheroids) comprised of human bronchial epithelial (16HBE14o-) cells, for use in respiratory toxicity research. Culturing 16HBE14o-cells as hanging-drops led to the formation of stable spheroids which showed an increased expression of CLDN1 when compared to 2D monolayer cultured cells. In addition, cell-cycle analysis revealed an increased sub-G0 population and signs of G0/G1 arrest in spheroids. Afterwards, standard operating procedures (SOPs) were established, and existing protocols optimized, for compatibility with spheroids. Spheroids were successfully used to assess cytotoxicity, genotoxicity, apoptosis/necrosis, and oxidative stress after exposure to known cytotoxic or genotoxic compounds. The development of the bronchial epithelial spheroids and the establishment of SOPs can contribute to a more reliable toxicity assessment of chemicals and may aid in bridging the gap between in vivo and in vitro experiments. [ABSTRACT FROM AUTHOR]

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In this work, we introduce a novel technique that optimizes the design and properties of support structures for Powder Bed Fusion–Laser-Based Metal (PBF-LB/M) processes. The goal is to significantly ease support removal during post-processing without compromising print quality. We propose an additive manufacturing (AM) workflow that streamlines the end-to-end AM process through the creation and integration of innovative support systems, modeling software, and efficient support removal techniques. This approach enhances productivity and minimizes trial and error between design and 3D printing. Our key concept revolves around developing a "soft" support system, which can be easily removed using sandblasting. Compared to manual or machining removal, this method substantially reduces cost and time, particularly in areas with limited or no access. For locations with steep overhangs and large cross-sectional areas, the traditional strong support system can be implemented as a "hard" support. The proposed workflow allows for the development of a hybrid system combining hard and soft supports, effectively manufacturing parts with minimal design constraints. The workflow begins from a standard operating procedure (SOP) for evaluating the appropriate printing parameters to achieve a support that can be soft enough to be sandblasted for removal, yet sufficient strong to support the overhang part structure and prevent distortion. A simulation platform is developed to assess the ideal placement and combination of the hybrid support design, achieving a balance between post-processing cost and effort, and print quality. The development of this solution truly reflects the advantage of metal 3D printing technology, i.e., design freedom. [ABSTRACT FROM AUTHOR]

Introduction: Internal hernia is one of the most frequent long-term complications after laparoscopic gastric bypass surgery (RYGB). Surgical treatment of an internal hernia itself has risks that can largely be avoided by the implementation of institutional standards and a structured approach. Material and methods: From 2012 until 2022, we extracted all consecutive bariatric cases from the prospectively collected national database (StuDoQ). Data from all patients undergoing internal hernia repair were then collected from our hospital information management system and retrospectively analyzed. We compared patient characteristics and surgical outcome of patients before and after the implementation of standard operating procedures for institutional and perioperative aspects (first vs. second time span). Results: Overall, 37 patients were identified (median age 43 years, 86.5% female). Internal hernia was diagnosed after substantial weight loss (17.2 kg/m2) and on average about 34 months after RYGB. Baseline characteristics (age, sex, BMI, achieved total weight loss% and time interval to index surgery were comparable between the two groups). After local standardization, the conversion rate decreased from 52.6 to 5.6% (p = 0.007); duration of surgery from 92 to 39 min (p = 0.003), and length of stay from 7.7 to 2.8 days (p = 0.019). Conclusion: In this study, we could demonstrate that the surgical therapy of internal hernia after gastric bypass can be significantly improved by implementing institutional and surgical standards. The details described (including a video) may provide valuable information for non-specialized surgeons to avoid pitfalls and improve surgical outcomes. [ABSTRACT FROM AUTHOR]

The isolation and purification of protactinium from uranium materials is essential for 231Pa–235U radiochronometry, but separating Pa from uranium-niobium alloys, a common material in the nuclear fuel cycle, is challenging due to the chemical similarity of Pa and Nb. Here we present three resin chromatography separation techniques for isolating Pa from U and Nb which were independently developed by three different laboratories through ad hoc adaptations of standard operating procedures. Our results underscore the need for and value of purification methods suitable for a diversity of uranium-based materials to ensure the operational readiness of nuclear forensics laboratories. [ABSTRACT FROM AUTHOR]

The rapid proliferation of smokeless tobacco (SLT) in India has occurred without adequate information on the possible dangers and toxicity of these products. Tobacco flavors as well as nicotine (both protonated and un-protonated) are responsible for health dangers and addiction. The study aimed to offer information on the physical characteristics of commonly used smokeless tobacco products (including microscopic analysis), along with nicotine content (both total and un-protonated), pH, moisture, and flavors. The Standard Operating Procedures (SOPs) validated by the World Health Organization (WHO) recognized Tobacco Testing Laboratory TobLabNet) were applied for the analysis of various constituents of the SLTs. The microscopic analysis indicated that some of the SLT products like khaini were finely processed and available in filter pouches for users' convenience and prolonged use leading to prolonged retention and addiction potential. Nicotine absorption and availability (both protonated and un-protonated) are affected by moisture and pH. Essences provide a pleasant aroma and flavor, with an increased risk of misuse and other health problems. Few chewing tobacco and Zarda had the lowest levels of un-protonated nicotine (0.10–0.52% and 0.15–0.21%, respectively), whereas Gul, Gudhaku, and Khaini had the highest levels, ranging from 95.33 to 99.12%. Moisture and pH ranged from 4.54 to 50.19% and 5.25–10.07 respectively. Menthol (630.74–9681.42 µg/g) was the most popular flavour, followed by Eucalyptol (118.16–247.77 µg/g) and camphor (148.67 and 219.317 µg/g). SLT's health concerns and addiction dangers are exacerbated by the high proportion of bioavailable nicotine coupled with flavors. The findings of this study have important implications for the regulation and use of SLT in countries where use of SLT is prevalent. [ABSTRACT FROM AUTHOR]

Andexanet alfa (AA) is a recombinant factor Xa competing for binding with factor Xa inhibitors, thereby reversing their anticoagulation effects. Since 2019, it has been approved for individuals under apixaban or rivaroxaban therapy suffering from life-threatening or uncontrolled bleeding. Apart from the pivotal trial, real-world data on the use of AA in daily clinics are scarce. We reviewed the current literature on patients with intracranial hemorrhage (ICH) and summarized the available evidence regarding several outcome parameters. On the basis of this evidence, we provide a standard operating procedure (SOP) for routine AA application. We searched PubMed and additional databases through 18 January 2023 for case reports, case series, studies, reviews, and guidelines. Data on hemostatic efficacy, in-hospital mortality, and thrombotic events were pooled and compared with the pivotal trial data. While hemostatic efficacy in world-wide clinical routine seems to be comparable to the pivotal trial, thrombotic events and in-hospital mortality appear to be substantially higher. Various confounding factors responsible for this finding such as exclusion and inclusion criteria resulting in a highly selected patient cohort within the controlled clinical trial have to be considered. The SOP provided should support physicians in patient selection for AA treatment as well as facilitate routine use and dosing. This review underlines the urgent need for more data from randomized trials to appreciate the benefit and safety profile of AA. Meanwhile, this SOP should help to improve frequency and quality of AA use in patients suffering from ICH while on apixaban or rivaroxaban treatment. [ABSTRACT FROM AUTHOR]

Quantification of subvisible particles, which are generally defined as those ranging in size from 2 to 100 µm, is important as critical characteristics for biopharmaceutical formulation development. Micro Flow Imaging (MFI) provides quantifiable morphological parameters to study both the size and type of subvisible particles, including proteinaceous particles as well as non-proteinaceous features incl. silicone oil droplets, air bubble droplets, etc., thus enabling quantitative and categorical particle attribute reporting for quality control. However, limitations in routine MFI image analysis can hinder accurate subvisible particle classification. In this work, we custom-built a subvisible particle-aware Convolutional Neural Network, SVNet, which has a very small computational footprint, and achieves comparable performance to prior state-of-art image classification models. SVNet significantly improves upon current standard operating procedures for subvisible particulate assessments as confirmed by thorough real-world validation studies. [ABSTRACT FROM AUTHOR]

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Managing organ transplant networks is a complex task. It intertwines between locating the organ procurement and distribution organization (OPDO) (long-term decision) and allocating organs to the suitable destination (short-term decision). The literature lacks deliberation on the effect of those long-term decisions on short-term ones under the influence of clinical and non-clinical factors. This paper addresses this gap using a k-sum model for locational choice, and a discrete simulation approach for the allocation procedure for a real-life case study from a developing economy perspective. The study explores the trade-off between efficiency (distance-centric models) and equity (the result of time-centric allocation models). Our analysis of the efficiency of locational models and equity of the allocation policies reveal strong inter-dependence of both these decisions, a significant finding of this research. These findings offer an integrated model for high-level decision-makers, which can be used during the locational planning stage and provide input to design standard operating procedures for transplantation schemes. [ABSTRACT FROM AUTHOR]

Three-dimensional exoscopes have been designed to overcome certain insufficiencies of operative microscopes. We aimed to explore the clinical use in various spinal surgeries. We performed surgery on patients with different spine entities in a neurosurgical department according to the current standard operating procedures over a 4-week period of time. The microsurgical part has been performed with Aesculap AEOS 3D microscope. Three neurosurgeons with different degree of surgical expertise completed a questionnaire with 43 items based on intraoperative handling and feasibility after the procedures. We collected and analyzed data from seventeen patients (35% male/65% female) with a median age of 70 years [CI 47–86] and median BMI of 25.8 kg/m2 [range 21–33]. We included a variety of spinal pathologies (10 degenerative, 4 tumor and 3 infectious cases) with different level of complexity. Regarding setup conflicts we observed issues with adjustment of the monitor position or while using additional equipment (e.g. fluoroscopy in fusion surgery) (p = 0.007/p = 0.001). However image resolution and sharpness as well as 3D-depth perception were completely satisfactory for all surgeons in all procedures. The utilization of the exoscopic arm was easy for 76.5% of the surgeons, and all of them declared a significant improvement of the surgical corridor. The 3D-exoscope implementation appears to achieve very satisfactory results in spinal procedures especially with minimally invasive approaches. [ABSTRACT FROM AUTHOR]

Mucormycosis is a life threatening, opportunistic infection often seen in individuals with a weak immune system. With an upsurge of cases of Covid-19, a drastic increase in cases of Rhino-Orbito-Cerebral Mucormycosis is being witnessed at present. This article has been written with the purpose of understanding the factors responsible for it and the challenges it brings along for the Indian health-care system at present. Possible solutions for dealing with these problems have also been included in the manuscript. Google, PubMed and ENT Cochrane databases were searched without a time limit using key words like "Mucormycosis", "Rhino-cerebral-mucormycosis" in conjunction with "COVID-19" and "SARS CoV-2". We found 34 articles to be relevant and hence included them to write this review. Rhino-Orbito-Cerebral Mucormycosis is being seen due to coming together of the three entities-the agent, host and environment that constitute the epidemiological triad for this disease in India. Responsible factors are uncontrolled diabetes mellitus, overzealous use of steroids and antibiotics and other environment related issues. The solutions for these problems lie in spreading awareness about prevention of these practices along with early diagnosis and treatment of mucormycosis. To deal effectively with this situation, particularly when there is an existing overload on otolaryngologists and the rest of the health-care system, a multipronged and multilevel collaborative approach is the need of the hour. With effective Standard Operating Procedures and guidelines promoting a multidisciplinary approach for early diagnosis and treatment, we can surely overcome this situation. [ABSTRACT FROM AUTHOR]

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Standard operating procedures (SOPs) contain general instructions and principles to standardize care, to improve effective and safe healthcare. Developing new, or updating current, SOPs is, however, challenging in fields where high-level evidence is limited. Still, SOPs alone have been shown to result in less complications. In this narrative review, we describe the process of creating a consensus-based SOP that is pragmatic for clinical practice since it can be created regardless of the current level of evidence. Through live audience engagement platforms, a group of experts will be able to both anonymously respond to a created questionnaire, and (subsequently) discuss the results within the same meeting. This modified Digital Delphi method as described here can be used as a tool toward consensus-based healthcare. [ABSTRACT FROM AUTHOR]

In today's digital world, it is hard to imagine the Information Technology field without cloud computing as it saves millions of dollars every year and enables it to focus on its core business rather than on managing complex computing infrastructure. However, the adoption of the cloud opens the window for cloud crimes. Hence, cloud forensics is the need of the hour. Law Enforcement Agencies (LEAs) have to depend on Cloud Service Providers (CSPs) for investigating cloud crimes. Unfortunately, the LEAs are not aware of the forensic procedures implemented by the CSPs, nor are the details corresponding to forensic procedures are properly documented by the CSPs. This paper aims to study the forensic readiness of the leading CSPs and present their forensic workflow. We also compared these CSPs against various parameters based on the cloud services provisioned by them for forensics. The recent research published in this domain lists the challenges of cloud forensics and describes the proposed solutions. However, the current forensic procedures implemented by the leading CSPs have not been detailed in any of these papers. Thus, we believe that this survey would help the LEAs, forensic experts, security analysts, and first incident responders with an insight on the current forensic procedures implemented by the leading CSPs and help them in their investigation, designing standard operating procedures, etc. [ABSTRACT FROM AUTHOR]

Background: Each year there are 7.3 million emergencies for the German rescue service, trend rising and around 59% of the emergency patients are treated by paramedics only; however, most of the studies focus on physicians, while their practical skills at the scene are rarely necessary. Accordingly, the responsibility for the patient lies with the paramedics most of the time. Their duty is to execute life-saving measures, stabilize the patient for the transport and the regular documentation of the operation. Retrospectively, the emergencies can only be analyzed based on the emergency protocols, which are mostly paper-based and handwritten. That causes an increased effort in the evaluation, which makes studies for the whole country hardly feasible. As of now there are only few data on quality of healthcare and documentation by the paramedics. Both were analyzed in this survey based on the emergency protocols. Method: A retrospective analysis of emergency protocols from June to July 2018 took place in Aachen, a major German city. A specific feature of Aachen is a 24‑h available emergency physician via telemedicine. The quality of documentation and healthcare was analyzed by including standard operating procedures. Primary endpoints were the frequency of documentation, the achievement of complete documentation, the correct indications for a physician, the development of critical vital signs and the average on-scene time of the ambulance. Results: Overall, 1935 protocols were analyzed. A complete documentation was achieved in 1323 (68.4%) suspected diagnoses, 456 (23.6%) anamneses, 350 (18.1%) initial and 52 (2.7%) vital signs at handover. Based on the documentation, there were 531 cases (27%) of patients treated by paramedics only, even though a physician would have been indicated. Out of those patients 410 critical initial vital signs were documented of which 69 (16.8%) improved, while there was no documentation of vital signs at handover in 217 (52.9%). Also, there was a significantly prolonged on-scene time for patients with belated indications for an emergency physician with 15:02 min in comparison to 13:05 min for patients without indications. Conclusion: Deficient documentation was found in multiple cases and several important vital signs for a complete differential diagnosis were missing. Furthermore, a quarter of all patients might have benefited from an emergency physician as they were taken to hospital with no or insufficient treatment, despite standard operating procedures. From a forensic point of view there is an alarmingly incomplete documentation of vital signs at handover. The on-scene time in general was within the predetermined time frame, but can still be reduced in different scenarios. Overall, we recommend strict adherence to the standard operating procedures and algorithms, to remove unnecessary documentation and implement a structured quality assurance. Moreover, the quality of treatment might benefit from the rising number of more specialized paramedics and an increasing use of telemedicine. [ABSTRACT FROM AUTHOR]

Introduction: The metabolomics quality assurance and quality control consortium (mQACC) is enabling the identification, development, prioritization, and promotion of suitable reference materials (RMs) to be used in quality assurance (QA) and quality control (QC) for untargeted metabolomics research. Objectives: This review aims to highlight current RMs, and methodologies used within untargeted metabolomics and lipidomics communities to ensure standardization of results obtained from data analysis, interpretation and cross-study, and cross-laboratory comparisons. The essence of the aims is also applicable to other 'omics areas that generate high dimensional data. Results: The potential for game-changing biochemical discoveries through mass spectrometry-based (MS) untargeted metabolomics and lipidomics are predicated on the evolution of more confident qualitative (and eventually quantitative) results from research laboratories. RMs are thus critical QC tools to be able to assure standardization, comparability, repeatability and reproducibility for untargeted data analysis, interpretation, to compare data within and across studies and across multiple laboratories. Standard operating procedures (SOPs) that promote, describe and exemplify the use of RMs will also improve QC for the metabolomics and lipidomics communities. Conclusions: The application of RMs described in this review may significantly improve data quality to support metabolomics and lipidomics research. The continued development and deployment of new RMs, together with interlaboratory studies and educational outreach and training, will further promote sound QA practices in the community. [ABSTRACT FROM AUTHOR]

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Background: Physical fitness status is a key aspect of health and, consequently, it is important to create and adopt appropriate interventions to maintain or improve it, and assess it using valid measures. While in other testing contexts, standard operating procedures (SOPs) are commonly and widely adopted, in physical fitness testing, a variety of unstandardized testing protocols are proposed. Aims: The topic of this review was to evaluate the existing literature on SOPs in physical fitness assessment and to provide guidelines on how SOPs could be created and adopted. Method: The electronic databases PubMed, Web of Science and Scopus were screened and original, peer-reviewed studies that included SOPs, related to physical fitness, were recorded. Results: After the inclusion and exclusion criteria screening, a total of six studies were included and these were critically and narratively analyzed. Conclusions: Standard operating procedures are rarely adopted in the field of physical fitness and a step by step guide has been provided in this manuscript. In the future, it is suggested to follow protocols as a routine, because this is the only way to generalize and contextualize findings. [ABSTRACT FROM AUTHOR]

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This paper aims to develop an automated web application to generate validated daily effective reproduction numbers (Rt) which can be used to examine the effects of super-spreading events due to mass gatherings and the effectiveness of the various Movement Control Order (MCO) stringency levels on the outbreak progression of COVID-19 in Malaysia. The effective reproduction number, Rt, was estimated by adopting and modifying an Rt estimation algorithm using a validated distribution mean of 3.96 and standard deviation of 4.75 with a seven-day sliding window. The Rt values generated were validated using thea moving window SEIR model with a negative binomial likelihood fitted using methods from the Bayesian inferential framework. A Pearson's correlation between the Rt values estimated by the algorithm and the SEIR model was r = 0.70, p < 0.001 and r = 0.81, p < 0.001 during the validation period The Rt increased to reach the highest values at 3.40 (95% CI 1.47, 6.14) and 1.72 (95% CI 1.54, 1.90) due to the Sri Petaling and Sabah electoral process during the second and third waves of COVID-19 respectively. The MCOs was able to reduce the Rt values by 63.2 to 77.1% and 37.0 to 47.0% during the second and third waves of COVID-19, respectively. Mass gathering events were one of the important drivers of the COVID-19 outbreak in Malaysia. However, COVID-19 transmission can be fuelled by noncompliance to Standard Operating Procedure, population mobility, ventilation and environmental factors. [ABSTRACT FROM AUTHOR]

Background: In German emergency rescue services, inhalation treatment is routinely carried out by qualified health personnel. Standard operating procedures (SOP) for nebulization are neither uniform throughout Germany nor available in all federal states. Standardized recommendations with respect to which nebulizer type should be used are missing. The aerosol output as well as the drug deposition rates of jet and mesh nebulizers, however, differ considerably. Mesh devices can achieve a threefold higher lung deposition. Their use in emergency departments has also been shown to be associated with a better patient outcome when compared to jet nebulizers.Objective: This survey was designed to evaluate the type of nebulizer used in the south German rescue services. Special attention was paid to the influence of existing SOP on the decision to perform nebulization during emergency treatment.Material and Methods: A total of 4800 emergency paramedics working in Baden-Württemberg, Bavaria and Rhineland-Palatinate received a questionnaire with a total of 17 questions on the implementation of drug nebulization in the daily practice.Results: Despite the existence of more efficient nebulizer types, the jet nebulizer was by far the most frequently used nebulizer in the south German rescue services. The deposition rates of both the jet and mesh nebulizers were considerably overestimated by most respondents; however, 77.5% of all respondents could not give any information about the deposition rates of the mesh nebulizer. Only two thirds of all respondents carried out nebulization treatment on the basis of SOP. The implementation of SOP, however, was pivotal to the application of nebulization during emergencies. If SOP were in place,76.9% of the responders used aerosol treatment compared to 23.1% when there were none. The perceived safety when using nebulization during emergencies was also significantly higher (p = 0.013) when SOP were implemented.Conclusion: The exclusive use of mesh nebulizers could standardize the treatment of emergency patients in the south German rescue services. The use of mesh devices might possibly improve patient outcomes, even if clinical studies are still lacking. Nebulizer treatment differs between the federal states. A comprehensive implementation of SOP for nebulization treatment might support this process and could increase the application frequency and the perceived safety of nebulization during emergencies. A better training of paramedic personnel could improve the knowledge of aerosols as a treatment option for emergency patients and help to classify the advantages and disadvantages of the different aerosol generators available. [ABSTRACT FROM AUTHOR]

This review provides an updated analysis of the main aspects involving the diagnosis and the management of children with acute ischemic stroke. Acute ischemic stroke is an emergency of rare occurrence in children (rate of incidence of 1/3500 live birth in newborns and 1–2/100,000 per year during childhood with peaks of incidence during the perinatal period, under the age of 5 and in adolescence). The management of ischemic stroke in the paediatric age is often challenging because of pleomorphic age-dependent risk factors and aetiologies, high frequency of subtle or atypical clinical presentation, and lacking evidence-based data about acute recanalization therapies. Each pediatric tertiary centre should activate adequate institutional protocols for the optimization of diagnostic work-up and treatments. Conclusion: The implementation of institutional standard operating procedures, summarizing the steps for the selection of candidate for neuroimaging among the ones presenting with acute neurological symptoms, may contribute to shorten the times for thrombolysis and/or endovascular treatments and to improve the long-term outcome. What is Known: •Acute ischemic stroke has a higher incidence in newborns than in older children (1/3500 live birth versus 1–2/100,000 per year). •Randomized clinical trial assessing safety and efficacy of thrombolysis and/or endovascular treatment were never performed in children What is New: •Recent studies evidenced a low risk (2.1% of the cases) of intracranial haemorrhages in children treated with thrombolysis. •A faster access to neuroimaging and hyper-acute therapies was associated with the implementation of institutional protocols for the emergency management of pediatric stroke. [ABSTRACT FROM AUTHOR]

This paper aims to identify indicators of community preparedness for disasters and apply these indicators to a critical case study context, namely the local communities in two districts of Lombok Island of Indonesia, which were stricken by earthquakes in 2018 and 2019. Community preparedness indicators are identified through a systematic literature review (SLR) and in-depth interviews with governmental and non-governmental stakeholders. These indicators are grouped into capability, coordination and networking, legal and institutional support, facilities and infrastructure, disaster management plan, and early warning system. Preparedness is then assessed using these indicators as a framework for conducting interviews and observations in the two districts. Results from the case study indicate that most villages are relatively prepared for disasters because they conduct regular meetings concerning disaster preparedness, participate in disaster simulations, and receive socialization/education from the government and humanitarian organizations, including the Indonesian Red Cross. Most villages also have disaster preparedness infrastructure in place, such as disaster risk maps, evacuation routes, and a standard operating procedure to follow in the event of a disaster. This preparedness was reflected in the involvement of communities in the early response to the 2019 earthquake. However, further enhancement is still needed to ensure that all disaster-prone villages have the required disaster preparedness infrastructure, and the communities are actively involved in disaster preparedness activities. This research contributes to better understanding disaster preparedness at the community level in a critical case study context. The results are valuable for governmental and non-governmental agencies to optimize the pre- and post-disaster planning. [ABSTRACT FROM AUTHOR]

Inclusion of pesticide monitoring data in pesticide risk assessment is important yet challenging for several reasons, including infrequent or irregular data collection, disparate sources procedures and associated monitoring periods, and interpretation of the data itself in a policy context. These challenges alone, left unaddressed, will likely introduce unintentional and unforeseen risk assessment conclusions. While individual water quality monitoring programs report standard operating procedures and quality control practices for their own data, cross-checking data for duplicated data from one database to another does not routinely occur. Consequently, we developed a novel quality control and assurance methodology to identify errors and duplicated records toward creating an aggregated, single pesticide database toward use in ecological risk assessment. This methodology includes (1) standardization and reformatting practices, (2) data error and duplicate record identification protocols, (3) missing or inconsistent limit of detection and quantification reporting, and (4) site metadata scoring and ranking procedures to flag likely duplicate records. We applied this methodology to develop an aggregated (multiple-source), national-scale database for atrazine from a diverse set of surface water monitoring programs. The resultant database resolved and/or removed approximately 31% of the total ~ 385,000 records that were due to duplicated records. Identification of sample replicates was also developed. While the quality control and assurances methodologies developed in this work were applied to atrazine, they generally demonstrate how a properly constructed and aggregated single pesticide database would benefit from the methods described herein before use in subsequent statistical and data analysis or risk assessment. [ABSTRACT FROM AUTHOR]

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Modern biobanks maintain valuable living materials for medical diagnostics, reproduction medicine, and conservation purposes. To guarantee high quality during long-term storage and to avoid metabolic activities, cryostorage is often conducted in the N2 vapour phase or in liquid nitrogen (LN) at temperatures below − 150 °C. One potential risk of cryostorage is microbial cross contamination in the LN storage tanks. The current review summarises data on the occurrence of microorganisms that may compromise the safety and quality of biological materials during long-term storage. We assess the potential for the microbial contamination of LN in storage tanks holding different biological materials based on the detection by culture-based and molecular approaches. The samples themselves, the LN, the human microbiome, and the surrounding environment are possible routes of contamination and can cause cross contaminations via the LN phase. In general, the results showed that LN is typically not the source of major contaminations and only a few studies provided evidence for a risk of microbial cross contamination. So far, culture-based and culture-independent techniques detected only low amounts of microbial cells, indicating that cross contamination may occur at a very low frequency. To further minimise the potential risk of microbial cross contaminations, we recommend reducing the formation of ice crystals in cryotanks that can entrap environmental microorganisms and using sealed or second sample packing. A short survey demonstrated the awareness for microbial contaminations of storage containers among different culture collections. Although most participants consider the risk of cross contaminations in LN storage tanks as low, they prevent potential contaminations by using sealed devices and − 150 °C freezers. It is concluded that the overall risk for cross contaminations in biobanks is relatively low when following standard operating procedures (SOPs). We evaluated the potential sources in detail and summarised our results in a risk assessment spreadsheet which can be used for the quality management of biobanks. Key points: • Identification of potential contaminants and their sources in LN storage tanks. • Recommendations to reduce this risk of LN storage tank contamination. • Development of a risk assessment spreadsheet to support quality management. [ABSTRACT FROM AUTHOR]

Retinal vessel phenotype is predictive for cardiovascular outcome. This cross-sectional population-based study aimed to quantify normative data and standard operating procedures for static and dynamic retinal vessel analysis. We analysed central retinal arteriolar (CRAE) and venular (CRVE) diameter equivalents, as well as retinal endothelial function, measured by flicker light‐induced maximal arteriolar (aFID) and venular (vFID) dilatation. Measurements were performed in 277 healthy individuals aged 20 to 82 years of the COmPLETE study. The mean range from the youngest compared to the oldest decade was 196 ± 13 to 166 ± 17 µm for CRAE, 220 ± 15 to 199 ± 16 µm for CRVE, 3.74 ± 2.17 to 3.79 ± 2.43% for aFID and 4.64 ± 1.85 to 3.86 ± 1.56% for vFID. Lower CRAE [estimate (95% CI): − 0.52 (− 0.61 to − 0.43)], CRVE [− 0.33 (− 0.43 to − 0.24)] and vFID [− 0.01 (− 0.26 to − 0.00)], but not aFID, were significantly associated with older age. Interestingly, higher blood pressure was associated with narrower CRAE [− 0.82 (− 1.00 to − 0.63)] but higher aFID [0.05 (0.03 to 0.07)]. Likewise, narrower CRAE were associated with a higher predicted aFID [− 0.02 (− 0.37 to − 0.01)]. We recommend use of defined standardized operating procedures and cardiovascular risk stratification based on normative data to allow for clinical implementation of retinal vessel analysis in a personalized medicine approach. [ABSTRACT FROM AUTHOR]

The survival of the severely injured is dependent on the rapid and efficient prehospital treatment. Despite all efforts over the last decades and despite an improved network of rescue helicopters, the time delay between the accident event and admission to the trauma room could not be reduced. A certain proportion of the severely injured need induction of anesthesia even before arrival in hospital (typically as rapid sequence induction, RSI). Due to the medical and technical progress in video laryngoscopy as well as in the means of air rescue used in German-speaking countries, under certain conditions the possibility to carry out induction of anesthesia and airway management in the cabin of the rescue helicopter, i.e. during the transportation, seems to be a possible option to reduce the prehospital time. The aspects dealt with in this article are elementary for a safe execution. A procedure that has been tried and trusted for some time is presented as an example; however, the in-cabin RSI should only be carried out by pretrained teams using a clear standard operating procedure. [ABSTRACT FROM AUTHOR]

Introduction: Metabolomics applications to the aquaculture research are increasing steadily. The use of standardized proton nuclear magnetic resonance (1H NMR) spectroscopy can provide the aquaculture industry with an unbiased, reproducible, and high-throughput screening tool, which can help to diagnose nutritional and disease-related metabolic disorders in farmed fish. Objective: Standard operating procedures developed for analysing (human) plasma by 1H NMR were applied to fingerprint the metabolome in plasma samples collected from Atlantic salmon. The aim was to explore the metabolome of salmon plasma in relation to growth stage and sampling site. Methods: A total of 72 salmon were collected from three aquaculture sites in Norway (Lat. 65, 67, and 70 °N) and over two sampling events (December 2017 and November 2018). Plasma drawn from each salmon was measured by 1H NMR and metabolites were quantified using the SigMa software. The NMR data was analysed by principal component analysis (PCA) and ANOVA-simultaneous component analysis (ASCA). Results: Important metabolic differences were evidenced, with adult salmon having a much higher content of very low-density lipoproteins and cholesterol in their plasma, while smolts displayed significantly higher levels of propylene glycol. Overall, 24% of the metabolite variation was due to the growth stage, whereas 12% of the metabolite variation was related to the aquaculture site and practice (p < 0.001). Conclusion: This study provides a baseline investigation of the plasma metabolome of the Atlantic salmon and demonstrates how 1H NMR metabolomics can be used in future investigations for comparing aquaculture practices and their influence on the fish metabolome. [ABSTRACT FROM AUTHOR]

Introduction: The mission of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) is to innovate, educate, and collaborate to improve patient care. A critical element in meeting this mission is the publishing of trustworthy and current guidelines for the practicing surgeon.Methods: In this manuscript, we outline the steps of developing high quality practice guidelines using a completely volunteer-based professional organization.Results: SAGES has developed a standardized approach to train volunteer surgeons and trainees alike to develop clinically pertinent guidelines in a timely manner, without sacrificing quality.Conclusions: This methodology can be used more widely by volunteer organizations to efficiently develop effective tools for practicing physicians. [ABSTRACT FROM AUTHOR]

A standard operating procedure for a fluorescence-based thermal shift assay (FTSA) is provided describing its typical applications, advantages and limitations. FTSA is a simple, robust, universal and quick assay to determine protein–ligand binding affinities and protein stabilities in the presence of various excipients and solution conditions. Therefore, the assay is very useful for the straightforward characterization of new recombinantly produced proteins. The assay has a wide dynamic range enabling simultaneous determination of affinities in the milimolar to picomolar range. The assay could be used for essentially any protein that is sufficiently soluble and stable in the studied aqueous solution. Here we provide examples and typical experimental protocols for both affinity and stability determinations. [ABSTRACT FROM AUTHOR]

This manuscript is intended to give a step-by-step standard operating procedure (SOP) about how to properly conduct a microscale thermophoresis (MST), also known as temperature-related intensity change (TRIC) experiment using the NanoTemper Technology GmbH Monolith instruments. [ABSTRACT FROM AUTHOR]

This Standard Operating Protocol (SOP) describes the key steps of experimental setup for an inhibition assay of enzymatic activity. The protocol begins with the design of an experiment, including the choice of a catalytic reaction, optimal conditions, fraction and concentration of the active enzyme, substrate and inhibitor concentrations and the positive and negative controls. The protocol ends with the data analysis followed by a typical example of an experiment. Despite an apparently standard procedure, the assay has a number of possible pitfalls such as low fraction of the active enzyme or errors in the analysis such as application of an improper model or incorrect determination of the inhibition constant while not recognizing the dependence on enzyme concentration. The protocol provides examples of necessary steps and controls to avoid these problems and obtain highly reliable results. [ABSTRACT FROM AUTHOR]

There is currently a large panel of technologies available to address molecular interactions in vitro. Each technology presents individual advantages and drawbacks, and it becomes challenging to choose which technology will be best suited for a molecular interaction of interest. Approaches can be broadly categorized as either microfluidic surface-bound methods (such as Surface Plasmon Resonance (SPR) or switchSENSE) or in-solution methods (such as Isothermal Titration Calorimetry (ITC) or MicroScale Thermophoresis (MST)). In-solution methods are advantageous in terms of sample preparation and ease of use as none of the binding partners are subjected to immobilization. On the other hand, surface-based techniques require only small amounts of immobilized interaction partner and provide off-rate characterization as unbound analytes can be removed from the surface to observe analyte dissociation. Here, a standard operating procedure (SOP) for the switchSENSE method is presented, which aims to guide new users through the process of a switchSENSE measurement, covering sample preparation, instrument and biochip handling as well as data acquisition and analysis. This guide will help researchers decide whether switchSENSE is the right method for their application as well as supporting novice users to get the most information out of a switchSENSE measurement. switchSENSE technology offers the unique advantage of a controlled DNA-based ligand surface within a microfluidic channel which allows the user to distribute specifically up to two different ligand molecules on the surface at a customized density and ratio. The technology offers multi-parameter characterization of binding kinetics, affinity, enzymatic activity, and changes in protein conformation. [ABSTRACT FROM AUTHOR]

Isothermal titration calorimetry (ITC) is currently widely used in many applied areas of research, spanning protein–ligand binding, metal–ligand interactions, DNA/DNA or protein/DNA interactions, partition to membranes, and polymer surfactant interactions, to mention just a few. This is due to the availability of commercial instruments, and thus the production and spread of an accepted and widely followed SOP is felt by most users, in an effort to produce results that are scientifically correct and comparable. Therefore, within the efforts of Working Group 4 of the ARBRE-MOBIEU COST Action (CA15126), this ITC SOP was generated, alongside SOPs for several other biophysical techniques. Here, we discuss the factors that are fundamental for good experimental design and that need to be carefully considered, as well as machine calibration, in particular chemical calibration, linked to another outcome of Working Group 4 on ITC benchmarking, to be also published in this Special Issue. [ABSTRACT FROM AUTHOR]

Background: The diagnosis of major complications seems to be more challenging in obese patients. We aimed to show the relevance of routinely assessed clinical and paraclinical parameters as well as the relevance of CT scans in the diagnosis of major complications after bariatric procedures. Methods: All patients who underwent operations (primary or revisional) in a 3-year period were retrospectively studied after bariatric surgery with a specific focus on the routinely assessed clinical parameters (tachycardia, temperature), paraclinical parameters on postoperative day (POD) 1 and 3 (C-reactive protein (CRP), leukocytes), and additional computed tomography (CT) scan results for the diagnosis of leakage, bleeding, intraabdominal abscess, superficial abscess, and other complications. Results: A total of 587 patients were examined. In this cohort, 73 CT scans were performed due to suspected intraabdominal or pulmonary complication according to our hospital standard operating procedure. In total, 14 patients (2.4%) had a major complication (Clavien-Dindo grade IV/V). Of those, 10 patients (1.7%) had postoperative leakage. While the correct leakage diagnosis was only found in 33% of the patients by CT scan, the overall specificity of CT as a diagnostic tool for all kinds of complications remained high. Especially for abscess detection, CT scan showed a sensitivity and specificity of 100%. Multivariate analysis showed a significantly higher risk of leakage development characterized by a doubling of postoperative CRP level (odds ratio 4.84 (95% confidence interval 2.01–11.66, p < 0.001)). To simplify the use of CRP as a predictive factor for the diagnosis of leakage, a cut-off value of 2.4 was determined for the CRP quotient (POD3/POD1) with a sensitivity of 0.88 and a specificity of 0.89. Conclusion: CT diagnostic after bariatric surgery has a high positive predictive value, especially for intraabdominal abscess formation. Nevertheless, CT scan for the diagnosis of leakage has a low sensitivity. Thus, a negative CT scan does not exclude the presence of a leakage. Using the described CRP quotient with a cut-off of 2.4, the risk of early leakage can be easily estimated. Furthermore, in any uncertain case of clinically suspected leakage, diagnostic laparoscopy should be performed. [ABSTRACT FROM AUTHOR]