Journal articles on the topic 'Philip Markoff'

penelitian ini bertujuan untuk : 1. mengidentifikasi alasan mahasiswa STIE Binaniaga memilih merek handphone tertentu sebagai alat komunikasi, 2. untuk mengetahui perpindahan penggunaan suatu merek handphone ke merek lainnya, dan 3. membuat proyeksi pangsa pasar handphone dikalangan mahasiswa. Dengan responden mahasiswa STIE Binaniaga sebanyak 76 orang dan menggunakan analisis Rantai Markov diperoleh kesimpulan bahwa : • Merek handphone yang banyak diminati responden adalah Nokia, dipilih karena pengoperasiannya mudah serta fiturnya lengkap. Urutan kedua ditempati Sony Ericsson dipilih karena mudah pengoperasian, fiturnya lengkap dan sekedar mencoba-coba. Sedangkan Motorola dibeli karena fitur lengkap dan harganya murah. Merek lainnya juga dipilih karena murah harganya. • Merek handphone seperti Nokia, Siemen, Philips, Samsung, Motorola mengalami pergeseran peminatan kecuali Sony Ericsson dan merek handphone lainnya (merek-merek yang tidak diperhitungkan) mengalami kenaikkan. • Pangsa pasar yang tetap stabil dalam tahun 2007-2009 diprediksi adalah Sony Ericsson, sedangkan Nokia, Motorola dan Samsung mengalami penurunan..

Abstract Purpose Proton beam therapy (PBT) is associated with less toxicity relative to conventional photon radiotherapy for head-and-neck cancer (HNC). Upfront delivery costs are greater, but PBT can provide superior long-term value by minimizing treatment-related complications. Cost-effectiveness models (CEMs) estimate the relative value of novel technologies (such as PBT) as compared with the established standard of care. However, the uncertainties of CEMs can limit interpretation and applicability. This review serves to (1) assess the methodology and quality of pertinent CEMs in the existing literature, (2) evaluate their suitability for guiding clinical and economic strategies, and (3) discuss areas for improvement among future analyses. Materials and Methods PubMed was queried for CEMs specific to PBT for HNC. General characteristics, modeling information, and methodological approaches were extracted for each identified study. Reporting quality was assessed via the Consolidated Health Economic Evaluation Reporting Standards 24-item checklist, whereas methodologic quality was evaluated via the Philips checklist. The Cooper evidence hierarchy scale was employed to analyze parameter inputs referenced within each model. Results At the time of study, only 4 formal CEMs specific to PBT for HNC had been published (2005, 2013, 2018, 2020). The parameter inputs among these various Markov cohort models generally referenced older literature, excluding many clinically relevant complications and applying numerous hypothetical assumptions for toxicity states, incorporating inputs from theoretical complication-probability models because of limited availability of direct clinical evidence. Case numbers among study cohorts were low, and the structural design of some models inadequately reflected the natural history of HNC. Furthermore, cost inputs were incomplete and referenced historic figures. Conclusion Contemporary CEMs are needed to incorporate modern estimates for toxicity risks and costs associated with PBT delivery, to provide a more accurate estimate of value, and to improve their clinical applicability with respect to PBT for HNC.

Background and objectivesSystematic reviews and economic modelling of clinical effectiveness and cost-effectiveness of therapeutic monitoring of tumour necrosis factor alpha (TNF-α) inhibitors [using LISA-TRACKER®enzyme-linked immunosorbent assay (ELISA) kits (Theradiag, Marne La Vallee, France, or Alpha Laboratories, Heriot, UK), TNF-α-Blocker ELISA kits (Immundiagnostik AG, Bensheim, Germany) and Promonitor®ELISA kits (Proteomika, Progenika Biopharma, Bizkaia, Spain)] versus standard care for Crohn’s disease (CD).MethodsMultiple electronic databases were searched from inception to December 2014 in order to identify primary studies and meta-analyses.PopulationPatients with moderate to severe active CD treated with infliximab (IFX) (Remicade®, Merck Sharp & Dohme Ltd, Kenilworth, NJ, USA) or adalimumab (ADA) (Humira®, AbbVie Inc., North Chicago, IL, USA).InterventionMonitoring of serum anti-TNF-α (IFX or ADA) and/or of anti-drug antibody levels using test assays with a test–treatment algorithm.ComparatorStandard care.OutcomesAny patient-related outcome, test agreement and cost-effectiveness estimates. The quality assessments used recognised checklists (Quality Assessment of Diagnostic Accuracy Studies-2, Cochrane, Philips and Consolidated Health Economic Evaluation Reporting Standards). Evidence was synthesised using narrative review and meta-analysis. A Markov model was built in TreeAge Pro 2013 (TreeAge Software, Inc., Williamstown, MA, USA). The model had a 4-week cycle and a 10-year time horizon, adopted a NHS and Personal Social Services perspective and used a linked evidence approach. Costs were adjusted to 2013/14 prices and discounted at 3.5%.ResultsWe included 68 out of 2434 and 4 out of 2466 studies for the clinical effectiveness and cost-effectiveness reviews, respectively. Twenty-three studies comparing test methods were identified. Evidence on test concordance was sparse and contradictory, offering scant data for a linked evidence approach. Three studies [two randomised controlled trials (RCTs) and one retrospective observational study] investigated outcomes following implementation of a test algorithm. None used the specified commercial ELISA immunoassay test kits. Neither of the two RCTs demonstrated clinical benefit of a test–treatment regimen. A meta-analysis of 31 studies to estimate test accuracy for predicting clinical status indicated that 20–30% of test results are likely to be inaccurate. The four cost-effectiveness studies suggested that testing results in small cost reductions. In the economic analysis the base-case analysis showed that standard practice (no testing/therapeutic monitoring with the intervention tests) was more costly and more effective than testing for IFX. Sensitivity and scenario analyses gave similar results. The probabilistic sensitivity analysis indicated a 92% likelihood that the ‘no-testing’ strategy was cost-effective at a willingness to pay of £20,000 per quality-adjusted life-year.Strengths and limitationsRigorous systematic reviews were undertaken; however, the underlying evidence base was poor or lacking. There was uncertainty about a linked evidence approach and a lack of gold standard for assay comparison. The only comparative evidence available for economic evaluation was for assays other than the intervention assays.ConclusionsOur finding that testing is not cost-effective for IFX should be viewed cautiously in view of the limited evidence. Clinicians should be mindful of variation in performance of different assays and of the absence of standardised approaches to patient assessment and treatment algorithms.Future work recommendationsThere is substantial variation in the underlying treatment pathways and uncertainty in the relative effectiveness of assay- and test-based treatment algorithms, which requires further investigation. There is very little research evidence on ADA or on drug monitoring in children with CD, and conclusions on cost-effectiveness could not be reached for these.Study registrationThis study is registered as PROSPERO CRD42014015278.FundingThe National Institute for Health Research Health Technology Assessment programme.

Background Lynch syndrome is an inherited genetic condition that is associated with an increased risk of certain cancers. The National Institute for Health and Care Excellence has recommended that people with colorectal cancer are tested for Lynch syndrome. Routine testing for Lynch syndrome among people with endometrial cancer is not currently conducted. Objectives To systematically review the evidence on the test accuracy of immunohistochemistry- and microsatellite instability-based strategies to detect Lynch syndrome among people who have endometrial cancer, and the clinical effectiveness and the cost-effectiveness of testing for Lynch syndrome among people who have been diagnosed with endometrial cancer. Data sources Searches were conducted in the following databases, from inception to August 2019 – MEDLINE ALL, EMBASE (both via Ovid), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (both via Wiley Online Library), Database of Abstracts of Reviews of Effects, Health Technology Assessment Database (both via the Centre for Reviews and Dissemination), Science Citation Index, Conference Proceedings Citation Index – Science (both via Web of Science), PROSPERO international prospective register of systematic reviews (via the Centre for Reviews and Dissemination), NHS Economic Evaluation Database, Cost-Effectiveness Analysis Registry, EconPapers (Research Papers in Economics) and School of Health and Related Research Health Utilities Database. The references of included studies and relevant systematic reviews were also checked and experts on the team were consulted. Review methods Eligible studies included people with endometrial cancer who were tested for Lynch syndrome using immunohistochemistry- and/or microsatellite instability-based testing [with or without mutL homologue 1 (MLH1) promoter hypermethylation testing], with Lynch syndrome diagnosis being established though germline testing of normal (non-tumour) tissue for constitutional mutations in mismatch repair. The risk of bias in studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool, the Consolidated Health Economic Reporting Standards and the Philips’ checklist. Two reviewers independently conducted each stage of the review. A meta-analysis of test accuracy was not possible because of the number and heterogeneity of studies. A narrative summary of test accuracy results was provided, reporting test accuracy estimates and presenting forest plots. The economic model constituted a decision tree followed by Markov models for the impact of colorectal and endometrial surveillance, and aspirin prophylaxis with a lifetime time horizon. Results The clinical effectiveness search identified 3308 studies; 38 studies of test accuracy were included. (No studies of clinical effectiveness of endometrial cancer surveillance met the inclusion criteria.) Four test accuracy studies compared microsatellite instability with immunohistochemistry. No clear difference in accuracy between immunohistochemistry and microsatellite instability was observed. There was some evidence that specificity of immunohistochemistry could be improved with the addition of methylation testing. There was high concordance between immunohistochemistry and microsatellite instability. The economic model indicated that all testing strategies, compared with no testing, were cost-effective at a willingness-to-pay threshold of £20,000 per quality-adjusted life-year. Immunohistochemistry with MLH1 promoter hypermethylation testing was the most cost-effective strategy, with an incremental cost-effectiveness ratio of £9420 per quality-adjusted life-year. The second most cost-effective strategy was immunohistochemistry testing alone, but incremental analysis produced an incremental cost-effectiveness ratio exceeding £130,000. Results were robust across all scenario analyses. Incremental cost-effectiveness ratios ranged from £5690 to £20,740; only removing the benefits of colorectal cancer surveillance produced an incremental cost-effectiveness ratio in excess of the £20,000 willingness-to-pay threshold. A sensitivity analysis identified the main cost drivers of the incremental cost-effectiveness ratio as percentage of relatives accepting counselling and prevalence of Lynch syndrome in the population. A probabilistic sensitivity analysis showed, at a willingness-to-pay threshold of £20,000 per quality-adjusted life-year, a 0.93 probability that immunohistochemistry with MLH1 promoter hypermethylation testing is cost-effective, compared with no testing. Limitations The systematic review excluded grey literature, studies written in non-English languages and studies for which the reference standard could not be established. Studies were included when Lynch syndrome was diagnosed by genetic confirmation of constitutional variants in the four mismatch repair genes (i.e. MLH1, mutS homologue 2, mutS homologue 6 and postmeiotic segregation increased 2). Variants of uncertain significance were reported as per the studies. There were limitations in the economic model around uncertainty in the model parameters and a lack of modelling of the potential harms of gynaecological surveillance and specific pathway modelling of genetic testing for somatic mismatch repair mutations. Conclusion The economic model suggests that testing women with endometrial cancer for Lynch syndrome is cost-effective, but that results should be treated with caution because of uncertain model inputs. Future work Randomised controlled trials could provide evidence on the effect of earlier intervention on outcomes and the balance of benefits and harms of gynaecological cancer surveillance. Follow-up of negative cases through disease registers could be used to determine false negative cases. Study registration This study is registered as PROSPERO CRD42019147185. Funding This project was funded by the National Institute for Health Research (NIHR) Evidence Synthesis programme and will be published in full in Health Technology Assessment; Vol. 25, No. 42. See the NIHR Journals Library website for further project information.

Saint Sampson, whose feast is celebrated on June 27, was depicted among holy physicians. However, his images were not frequent. He was usually accompanied with Saint Mokios (in Saint Sophia in Kiev, the Transfiguration church in the Mirozh monastery and the church of the Presentation of the Holy Virgin in the Temple in the monastery of Saint Euphrosyne; possibly also in Saint Panteleimon in Nerezi and Saint Demetrios in the village of Aiani near Kozani; furthermore, in the church of Saint Nicholas in Manastir and, afterwards, in the katholikon of the Vatopedi monastery). In a later period, he was usually shown in the vicinity of Saint Diomedes (in the churches of Saint Achillius in Arilje, Saint George in the village Vathiako on Crete, Saint Nicholas Orphanos in Thessaloniki, the Annunciation in Gracanica, the narthexes of the Hilandar katholikon and the church of the Holy Virgin in the monastery of Brontocheion at Mistra, the katholicon of the Pantokrator monastery and the church of Saint Demetrios in Markov Manastir). There are no substantial data regarding the identity of the saints depicted next to him in the metropolitan Church of Saint Demetrios at Mistra, while in a number of cases the image of the saint shown next to him has not been preserved (e.g. Saint Irene in the village of Agios Mamas on Crete, Gregory?s Gallery in the church of Saint Sophia in Ohrid and the church of the Holy Virgin (Panagia Kera) near the village Chromonastiri on Crete). On the other hand, in the church of the Holy Virgin in Mateic, Saint Sampson is, exceptionally, depicted among bishops, while in the church of the Holy Archangels in Prilep and the chapel of the Holy Anargyroi in Vatopedi, he is, as usual, surrounded by holy physicians but his mates are not featured - neither Saint Mokios, not Saint Diomedes. The earliest known commemorative text dedicated to him is the extensive hagiography - Vita Sampsonis I, composed in the seventh or the early eighth century. Other hagiographies, which mostly date from the tenth century, are completely based on the earlier writing. Such a composition can be found in the Synaxarion of the Church of Constantinople. In the extensive text (Vita Sampsonis II), Symeon Metaphrastes added a part that included detailed descriptions of a number of posthumous miracles, mostly healings; all these events are also mentioned in the short Hagiography. Finally, in the late thirteenth century, Constantine Akropolites wrote the still unpublished Hagiography (Vita Sampsonis III), in which he presented an account of events from the later history of the Saint?s hospital. The hagiographies inform us that Sampson was a Roman by birth and a kin of Emperor Constantine. He inherited a fortune, which he distributed to the poor. Then, he departed for Constantinople, where he found a modest home. Patriarch Menas ordained him a priest. Relying on the medical knowledge, Sampson was saving the sick and he even cured Emperor Justinian from an incurable disease. For that reason, the Emperor found a large house, in which he established and fully equipped a xenon (hospital, ?????), whereas Sampson was appointed as the skeuophylax of the Great Church. The Blessed continued to work there until his death. His venerable leipsana, which rested in the church of Saint Mokios, constantly issued the cures. His feast was celebrated in the hospital founded by him. Long time had passed between the period in which the Saint had lived and the epoch in which his earliest hagiography was compiled. During that time, some events could have fallen into oblivion and accounts of other events could have been invented. Accordingly, the results of the researchers of Saint Sampson?s xenon?s history are valuable. The hospital was housed in Sampson?s home, where he provided not only health care, but also food and bed. It was presumably founded in the fourth century. The xenon was burned in the Nika riots in 532 and Emperor Justinian had it renovated and expanded. Based on some documents issued in the Empire of Nicaea, it may be concluded that the xenon had vast estates. The Crusaders first sacked it, to subsequently use it for their own needs, as they established the Order of Saint Sampson. The hospital soon received many properties in Constantinople and its environs, Hungary and Flanders. It seems that after the liberation of Constantinople, the activities of Saint Sampson?s hospital were ceased and that there was a monastery at its place in the Palaiologan period. Anyway, the reputation of its holy founder persisted throughout the thirteenth century. Constantine Akropolites wrote the already mentioned Hagiography, and in one of his letters he spoke of the Saint, who was also mentioned in a poem by Manuel Philes (died around 1345). In Constantinople, the veneration of Saint Sampson had two centres - the hospital named after him and the church of Saint Mokios, where his leipsana rested. According to the synaxaria of the Typikon of the Great Church and the Church of Constantinople, the feast dedicated to the Saint was celebrated at his xenon. The former text informs us that the service was held by the Patriarch, whereas Symeon Metaphrastes relates that the vigil on the eve of the feast took place over the relics in the church of Saint Mokios. The Patriarch celebrated the feast dedicated to Saint Sampson with hospital clergy in the church within the xenon, both mentioned by Metaphrastes. It was either this church or a shrine from a later period that housed the iconostasis noted down by Constantine Stilbes, an eyewitness of the Latin capture of the Byzantine capital. Written sources and archaeological finds are consistent in that the hospital was located between the churches of Saint Sophia and Saint Irene. However, the first excavations carried out at the site of the xenon were not properly documented, whereas archaeologists involved in further investigations could not rely on reliable data, though they carefully examined all finds. The question arises why Saint Sampson was at first usually depicted in the company of Saint Mokios, a presbyter who died a martyr?s death in Constantinople (May 11), and later, together with Saint Diomedes, the physician who died in Nicaea (August 16). Therefore, this paper briefly presents the hagiographies of the two saints and the churches in the Byzantine capital where their relics rested - the monastery of Saint Mokios, which did not exist in the mid-fourteenth century, and Saint Diomedes, which was counting its last days in the fourteenth century, reduced to a small monastery. Dobrynja Jadrejkovic (subsequently Antony, archbishop of Novgorod) noted down around 1200 that the saint?s stick, epitrachelion and robes were kept at the hospital of Saint Sampson, whereas in the church of Saint Mokios, under the altar, rested Saint Mokios and Saint Sampson. He also mentioned that water flew from the latter?s grave, as well as that the church of Saint Diomedes was near the Golden Gate and that the relics of Saint Diomedes rested there. However, the Russian pilgrims who visited Constantinople during the Palaiologan period mentioned neither Saint Sampson?s hospital, not the church of Saint Mokios, whereas the church of Saint Diomedes, but not his relics, was noted down only by an unknown traveller who described the pilgrimage undertaken between the late 1389 and the early 1391. The answer to the question of what happened to the leipsana that once laid in these churches is not possible to provide. The fate of the relics of Saint Sampson, previously kept in his xenon, is not known, nor is it known where the commemorations of the three saints were held in the capital during the Palaiologan period. Anyway, the depictions of Saint Sampson accompanied by Saint Diomedes - whose oldest examples are preserved in Arilje - indicate that the connection of these two priest-physicians had already begun by the time when the church was painted (1295/1296), but, judging by the available sources, the only evidence on the process is given by the paintings. Although Saint Sampson founded the hospital which was probably the oldest in Constantinople, and though his leipsana, kept in the church of Saint Mokios, had healing powers, while his relics in the xenon were visited by pilgrims, it seems that the respect for this saint in the Byzantine capital was not reflected in the frequency of his images among holy physicians: he was fairly rarely shown among them. As a matter of fact, the earliest representations of Saint Sampson originated from Constantinople. They can be found on lead seals made for the hospital in the second half of the sixth and during the seventh century. On the other hand, there is no any known preserved depiction of this saint in the mural decoration of the early churches. Accordingly, it may be assumed that the veneration of Saint Sampson was initially limited to Constantinople, and that it was only later, since the time when his short hagiography was included in the synaxarium and his extensive hagiography was written for the Metaphrastes?s comprehensive work, that it was adopted in other areas of the East Christian world. It may seem paradoxical that the preserved images of the Saint dating from the period when his xenon flourished are less numerous than those from the time when the hospital, in all probability, did not exist. It seems that after the liberation of Constantinople from Latin rule, Saint Sampson was earnestly honoured and that the believers frequented the monastery at the site of the old xenon, though the hospital did not exist anymore. The former assumption is corroborated by the writings of Constantine Akropolites and Manuel Philes, whereas the latter is supported by the coins from the Palaiologan period found in the sacral building within the complex that once belonged to Saint Sampson?s hospital. Although his miraculous leipsana rested in the church of Saint Mokios, the posthumous miracles of Saint Sampson, described in later hagiographies, mostly took place in his xenon, which housed the relics that were visited by pilgrims and where commemorative services dedicated to him were held. The veneration of the Saint was long fostered within the institution founded by him - the ancient hospital where trained doctors worked - i.e. it was nurtured between the reputation of medical skills based on secular knowledge and miraculous healings.

Abstract Background The present study aimed to identify and critically appraise the quality of model-based economic evaluation studies in mental health prevention. Methods A systematic search was performed on MEDLINE, EMBASE, EconLit, PsycINFO, and Web of Science. Two reviewers independently screened for eligible records using predefined criteria and extracted data using a pre-piloted data extraction form. The 61-item Philips Checklist was used to critically appraise the studies. Systematic review registration number: CRD42020184519. Results Forty-nine studies were eligible to be included. Thirty studies (61.2%) were published in 2015–2021. Forty-seven studies were conducted for higher-income countries. There were mainly cost-utility analyses (n = 31) with the dominant primary outcome of quality-adjusted life year. The most common model was Markov (n = 26). Most of the studies were conducted from a societal or health care perspective (n = 37). Only ten models used a 50-year time horizon (n = 2) or lifetime horizon (n = 8). A wide range of mental health prevention strategies was evaluated with the dominance of selective/indicate strategy and focusing on common mental health problems (e.g., depression, suicide). The percentage of the Philip checkilst’s criteria fulfilled by included studies was 69.3% on average and ranged from 43.3 to 90%. Among three domains of the Philip checklist, criteria on the model structure were fulfilled the most (72.1% on average, ranging from 50.0% to 91.7%), followed by the data domain (69.5% on average, ranging from 28.9% to 94.0%) and the consistency domain (54.6% on average, ranging from 20.0% to 100%). The practice of identification of ‘relevant’ evidence to inform model structure and inputs was inadequately performed. The model validation practice was rarely reported. Conclusions There is an increasing number of model-based economic evaluations of mental health prevention available to decision-makers, but evidence has been limited to the higher-income countries and the short-term horizon. Despite a high level of heterogeneity in study scope and model structure among included studies, almost all mental health prevention interventions were either cost-saving or cost-effective. Future models should make efforts to conduct in the low-resource context setting, expand the time horizon, improve the evidence identification to inform model structure and inputs, and promote the practice of model validation.

The journal is pleased to publish the abstracts of the six finalists of the 2020 Manufacturing and Service Operations Management Society’s student paper competition. The 2020 prize committee was chaired by Vishal Agrawal (Georgetown), Feryal Erhun (University of Cambridge), and Jun Li (University of Michigan). The judges were Adem Orsdemir, Antoine Desir, Anton Ovchinnikov, Anyan Qi, Arian Aflaki, Arzum Akkas, Ashish Kabra, Bin Hu, Bob Batt, Bora Keskin, Can Zhang, Carri Chan, Chloe Kim Glaeser, Daniel Lin, Eduard Calvo, Ekaterina Astashkina, Elena Belavina, Elodie Adida, Enis Kayış, Ersin Korpeoglu, Fabian Sting, Fang Liu, Fanyin Zheng, Fei Gao, Florin Ciocan, Gah-Yi Ban, Gizem Korpeoglu, Guihua Wang, Guillaume Roels, Guoming Lai, Hessam Bavafa, Hummy Song, Ioannis (Yannis) Stamatopoulos, Ioannis Bellos, Iris Wang, Itir Karaesmen, Jiankun Sun, Jiaru Bai, Jing Wu, Joann de Zegher, Joel Wooten, John Silberholz, Jose Guajardo, Kaitlin Daniels, Karen Zheng, Ken Moon, Kenan Arifoglu, Lennart Baardman, Leon Valdes, Lesley Meng, Linwei Xin, Luyi Gui, Luyi Yang, Mary Parkinson, Mazhar Arikan, Michael Freeman, Ming Hu, Morvarid Rahmani, Mumin Kurtulus, Nan Yang, Necati Tereyagoglu, Nektarios Oraiopoulos, Nikos Trichakis, Nil Karacaoglu, Nitin Bakshi, Niyazi Taneri, Nur Sunar, Olga Perdikaki, Ovunc Yilmaz, Ozan Candogan, Ozge Sahin, Panos Markou, Pascale Crama, Pengyi Shi, Pnina Feldman, Qiuping Yu, Renyu (Philip) Zhang, Robert Bray, Ruslan Momot, Ruxian Wang, Saed Alizamir, Safak Yucel, Samantha Keppler, Santiago Gallino, Serdar Simsek, Seyed Emadi, Shiliang (John) Cui, Shouqiang Wang, Simone Marinesi, So Yeon Chun, Song-Hee Kim, Soo-Haeng Cho, Soroush Saghafian, Stefanus Jasin, Suresh Muthulingam, Suvrat Dhanorkar, Tian Chan, Tim Kraft, Tom Tan, Tugce Martagan, Velibor Misic, Weiming Zhu, Xiaoshan Peng, Xiaoyang Long, Yasemin Limon, Yehua Wei, Yiangos Papanastasiou, Ying-Ju Chen, and Zumbul Atan.

Introduction: Pulse detection during out-of-hospital cardiac arrest (OHCA) is a challenge still not satisfactorily solved. An automated and accurate method for detecting pulse would reduce hands-off intervals and allow for more prompt post-cardiac arrest care. The aim of this study was to develop a method based on machine learning (ML) to detect pulse during OHCA. Materials and methods: Data were gathered from 187 OHCA patients treated by Tualatin Valley Fire & Rescue (Tigard, OR, USA) using the Philips HeartStart MRx monitor/defibrillator between 2010 and 2014. The dataset used in the study contained 1140 5-s epochs presenting organized rhythms, 792 pulse-generating rhythms (PRs) and 348 pulseless electrical activity (PEA), annotated by consensus between two clinicians and a biomedical engineer using the available clinical information and the capnography signal. The dataset was split patient-wise into training (60%) and test (40%) sets. Each epoch contained the ECG and the thoracic impedance that were first preprocessed and then used to adaptively extract the impedance circulation component (ICC). The ICC shows a small fluctuation with each effective heartbeat. A total of 7 well-known waveform features were computed from the ECG and ICC and fed as observations to a discrete observation density hidden Markov model that classified each observation as PR (pulse) or PEA (no-pulse). The training set was used to develop and optimize the method, while the test set was used to measure the performance in terms of sensitivity (PR detection) and specificity (PEA detection). This procedure was repeated 50 times to estimate the distributions of the performance metrics. Results: The method showed a mean (SD) sensitivity and specificity of 95.4%(2.2) and 91.6% (3.4), respectively. Results were slightly above those previously reported by other authors using different ML techniques. Conclusions: A method based on a discrete observation density hidden Markov model can accurately detect pulse during OHCA. Further studies with larger datasets are needed to confirm these findings.

Gadfly petrels (genus Pterodroma) are one of the most threatened groups of birds. They are exceptionally well adapted to forage over enormous areas to maximize chances of encountering prey. Their wide-ranging travel, extensive use of oceanic habitats beyond national jurisdictions (the high seas), and limited information on their at-sea distributions and foraging ecology pose several management challenges. Here, we examined the foraging distributions and habitat preferences of three gadfly petrels that breed on Phillip Island (Norfolk Island Group), in the southwest Pacific Ocean, and tested the ability of species distribution models (SDMs) to predict important marine habitats. GPS loggers were deployed in 2018 and 2019 on chick-provisioning black-winged petrels (P. nigripennis) and white-necked petrels (P. cervicalis) and in 2020 on Kermadec petrels (P. neglecta), and hidden Markov models (HMMs) were used to estimate behavioral states across 387 foraging trips. SDMs were built using six algorithms and the predictive performance of models constructed using conventional random cross-validation (CV) was compared to those constructed with spatially independent CV. All three species demonstrated dual-foraging strategies with short trips closer to the colony and longer, presumably self-provisioning, trips with maximum distances from the colony of several thousand kilometers for black-winged and white-necked petrels. Foraging areas of each species were distinctly partitioned across the Tasman Sea during long trips, but there was high overlap during short trips. Black-winged and white-necked petrels exhibited area-restricted search foraging behavior throughout their foraging ranges which spanned almost the entire Tasman Sea and into the western Pacific, whereas the foraging range of Kermadec petrels was restricted closer to the colony. Approximately half of each species’ foraging range extended into the high seas. Response curves and variable importance between the two SDM CV approaches were similar, suggesting that model fitting was robust to the CV approach. However, evaluation using spatially independent CV indicated that generalizability of ensemble SDMs to new data ranged from poor to fair for all three species. This suggests that the maximal-area foraging strategy of gadfly petrels (whereby they search opportunistically for resources across expansive oceanic habitats) results in weak or wide associations with environmental features making predicting important habitats extremely challenging.