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We show that the univariate Khattree–Bahuguna measure of skewness cannot exceed thereby reducing the range of feasible values stated by original authors by a factor of two. This substantially changes the interpretation of the magnitude of this measure especially for the highly skewed data. We also show that this bound cannot be improved further. A similar change in the upper bound occurs also for the two multivariate measures of skewness defined by Khattree and Bahuguna.

Most multiple imputation methods for multivariate missing data have been developed for normally distributed data. However, methods may not be suitable for nonnegative and/or highly skewed data. We propose an approach by using Expectation-Maximization (EM) method based on the assumption of multivariate Lomax distribution on non-negative skewed data. Extensive simulations show that this proposed method outperforms the regular normality-based EM and k-nearest-neighbor (kNN) imputation methods under the missing completely at random (MCAR) mechanism. An application on a real-world biomedical data is then provided.

Introduction Shortages of opioid analgesics critically disrupt clinical practice and are detrimental to patient safety. There is a dearth of studies assessing the safety implications of drug shortages. Objective We aimed to assess perioperative opioid analgesic use and related postoperative hypoxemia (oxygen saturation less than 90%) in surgical patients exposed to prescription opioid shortages compared to propensity score-matched patients non-exposed to opioid shortages. Methods We conducted a retrospective study including adult patients who underwent elective surgery at The University of California San Francisco in the period August 2018–December 2019. We conducted a Gamma log-link generalized linear model to assess the effect of shortages on perioperative use of opioids and a weighted logistic regression to assess the likelihood of experiencing postoperative hypoxemia. Results There were 1119 patients exposed to opioid shortages and 2787 matched non-exposed patients. After full matching, patients exposed to shortages used a greater mean of morphine milligram equivalents/day (146.94; 95% confidence interval 123.96–174.16) than non-exposed patients (117.92; 95% confidence interval 100.48–138.38; p  = 0.0001). The estimated effect was a 1.25 (95% confidence interval 1.12–1.40; p  = 0.0001) times greater use of opioids in patients exposed to opioid shortages than non-exposed patients. After full matching, a greater proportion of patients exposed to shortages (19.06%) experienced hypoxemia compared with non-exposed patients (16.91%). In addition, a greater proportion of patients exposed to opioid shortages (1.20%) experienced hypoxemia reversed by intravenous naloxone administration compared with non-exposed patients (0.44%). Conclusions Given the shortage prevalence, reliance on opioid medications, and related risk of respiratory depression, harm prevention measures remain critical to prevent postoperative complications that may compromise patients’ safety.

A novel electronic health records (EHR)-based workflow was implemented at a quaternary referral center to improve the efficiency of inpatient surgical consultation processes for patients requiring trauma or acute care surgery (TACS) consultation. The EHR-driven consultation workflow automated notifications, communication of patient information, and data-tracking. Timeliness of care was compared between pre-implementation (1/1/2020-1/31/2022), early post-implementation (2/1/2022-1/31/2023), and late post-implementation (2/1/2023-1/31/2024) cohorts. Of 5724 consultations, 2658 required surgery (733 pre-, 830 early post-, 1095 late post-implementation). Time between consult to OR was reduced overall by 27 ​% post-implementation (pre ​= ​726 ​min; early post ​= ​577; late post ​= ​532; p ​< ​0.001) and by 48 ​% (pre ​= ​531 ​min; early post ​= ​290; late post ​= ​277; p ​< ​0.001) for urgent/emergent cases. Length of stay decreased post-implementation with no difference in 30-day clinical outcomes. Implementation of the novel EHR consultation workflow was safe and associated with decreased time-to-OR, which persisted throughout the post-implementation phase with greatest impact on patients requiring urgent/emergent operations. •An EHR workflow for trauma and acute care surgery was designed and implemented at a quaternary referral center.•Time to operating room was reduced after implementation of the EHR workflow, particularly in urgent/emergent consults.•Length of stay was also reduced after implementation of the novel EHR workflow.•Improvements persisted more than 1 year after implementation, demonstrating sustainability of the workflow.

We study and develop some simulation and missing data imputation methods for non-normal distributions. It mainly consists of three separate parts as follows.First, we introduce the R package KbMvtSkew to assess the univariate and multivariate skewness of a data set via the measure specified by Khattree and Bahuguna in 2018. Then we concentrate on certain nonnormal multivariate probability distributions and introduce the R package NonNorMvtDist. This package is used to generate random numbers from multivariate Lomax distribution which constitutes a very flexible family of skewed multivariate distributions. Further, by applying certain useful properties of multivariate Lomax distribution, multivariate cases of generalized Lomax, Mardia’s Pareto of Type I, Logistic, Burr, Cook-Johnson’s uniform, F and inverted beta can be also considered and random numbers from these distributions can be generated. The content of this package is then extended to the methods for the probability and the equicoordinate quantile calculations for all of these distributions.In the second part, we study a connection from Lomax to exponential distribution through the limiting distribution of a Lomax distribution scaled by its shape parameter. This fact well explains the strong similarity between Lomax and exponential distribution when the shape parameter of Lomax is large. We also explore the relationships between (generalized) Lomax and other distributions of exponential family such as Gamma, Beta type II and Rayleigh. Various properties of generalized double Pareto distribution are studied including representation of mixture of Student’s t and connection to Laplace (double exponential). We then conclude a hypothesis testing problem where these ideas are used and Khattree-Bahuguna’s skewness is used as a test statistic.The last part of our work is about imputation for non-normal multivariate continuous data. We develop multivariate Lomax-based EM imputation method and compare its performance with other normality-based approaches. Then, we introduce the multiple imputation approach based on Copula transformation, which is used to effectively transform multivariate non-normal data into normal. Through simulated and real non-normal multivariate datasets, we demonstrate that copula transformation significantly mitigates the impact of blind assumption of multivariate normal for non-normal multivariate data under the assumption that data are missing completely at random (MCAR).

The Taiwan Strait (TS) is one of the main sources of phosphate that supports the large fish catches of the phosphate-limited East China Sea (ECS). The Penghu Channel is the deepest part of the TS, and most of the flow of the TS towards the ECS is principally through this channel. Empirical equations that are based on measurements made during 19 cruises (2000–2011) were combined with water velocity, salinity, and temperature, which were modeled using HYCOM (the Hybrid Coordinate Ocean Model) to obtain the annual fluxes for total alkalinity (TA), dissolved inorganic carbon (DIC), nitrate plus nitrite, phosphate, and silicate fluxes. The TA and DIC are mainly transported in the top layer (0–55 m) because the current is much stronger there than in the bottom layer (55–125 m) whereas the TA and DIC concentrations in the top layer are only slightly smaller compared with the bottom layer. In contrast, the nitrate plus nitrite flux is mainly transported in the bottom layer because the concentrations are much higher in the bottom layer. Generally, nutrient flux increases with the Pacific Decadal Oscillation (PDO) index, but TA and DIC fluxes increase as the PDO index decreases.

Against the backdrop of the global energy transition, the efficient exploitation of marine renewable energy has become a key pathway toward achieving carbon neutrality. Wind–wave hybrid systems (WWHSs) have attracted growing attention due to their resource complementarity, efficient spatial utilization, and shared infrastructure. However, most existing studies focus on single components or local optimization, while systematic integration of the full technology chain remains limited. This gap hinders the transition from demonstration projects to commercial deployment. This review provides a comprehensive overview of the technological evolution and key characteristics of offshore wind turbine (OWT) foundations and wave energy converters (WECs). Fixed-bottom foundations remain the mainstream solution for near-shore development. Floating offshore wind turbines (FOWTs) represent the core direction for deep-sea deployment. Among WEC technologies, oscillating buoy (OB) WECs are the dominant research pathway. Yet high costs and poor performance under extreme sea states remain major barriers to commercialization. On this basis, the paper summarizes three major integration modes of WWHSs. Among them, hybrid configurations have become the research focus due to their structural sharing, hydrodynamic coupling, and significant cost and energy synergies. Furthermore, the review synthesizes optimization strategies for both technology design and spatial layout, aiming to enhance energy capture, structural stability, and overall economic performance. Finally, the paper critically identifies the main research gaps and technical bottlenecks and outlines key development pathways required to achieve future commercial viability. These include the development of high-performance adaptive power take-off (PTO) systems, deeper understanding of multi-physics coupling mechanisms, intelligent operation and maintenance enabled by digital twins, and comprehensive life-cycle techno-economic and environmental assessments. Through this integrated perspective, the review seeks to provide a systematic reference for the development of multi-energy offshore systems and to support future progress in integrated energy utilization in deep-sea environments.

BackgroundMost previous risk-prediction models for gastrointestinal stromal tumors (GISTs) were based on Western populations. In the current study, we collected data from 23 hospitals in Shandong Province, China, and used the data to examine prognostic factors in Chinese patients and establish a new recurrence-free survival (RFS) prediction model.MethodsRecords were analyzed for 5285 GIST patients. Independent prognostic factors were identified using Cox models. Receiver operating characteristic curve analysis was used to compare a novel RFS prediction model with current risk-prediction models.ResultsOverall, 4216 patients met the inclusion criteria and 3363 completed follow-up. One-, 3-, and 5-year RFS was 94.6% (95% confidence interval [CI] 93.8–95.4), 85.9% (95% CI 84.7–87.1), and 78.8% (95% CI 77.0–80.6), respectively. Sex, tumor location, size, mitotic count, and rupture were independent prognostic factors. A new prognostic index (PI) was developed: PI = 0.000 (if female) + 0.270 (if male) + 0.000 (if gastric GIST) + 0.350 (if non-gastric GIST) + 0.000 (if no tumor rupture) + 1.259 (if tumor rupture) + 0.000 (tumor mitotic count < 6 per 50 high-power fields [HPFs]) + 1.442 (tumor mitotic count between 6 and 10 per 50 HPFs) + 2.026 (tumor mitotic count > 10 per 50 HPFs) + 0.096 × tumor size (cm). Model-predicted 1-, 3-, and 5-year RFS was S(12, X) = 0.9926exp(PI), S(36, X) = 0.9739exp(PI) and S(60, X) = 0.9471exp(PI), respectively.ConclusionsSex, tumor location, size, mitotic count, and rupture were independently prognostic for GIST recurrence. Our RFS prediction model is effective for Chinese GIST patients.

Broomcorn millet ( Panicum miliaceum L.), known for its traits of drought resistance, adaptability to poor soil, short growth period, and high photosynthetic efficiency as a C 4 plant, represents one of the earliest domesticated crops globally. This study reports the telomere-to-telomere (T2T) gap-free reference genome for broomcorn millet (AJ8) using PacBio high-fidelity (HiFi) long reads, Oxford Nanopore long-read technologies and high-throughput chromosome conformation capture (Hi-C) sequencing data. The size of AJ8 genome was approximately 834.7 Mb, anchored onto 18 pseudo-chromosomes. Notably, 18 centromeres and 36 telomeres were obtained. The assembled genome showed high quality in terms of completeness (BUSCO score: 99.6%, QV: 61.7, LAI value: 20.4). In addition, 63,678 protein-coding genes and 433.8 Mb (~52.0%) repetitive sequences were identified. The complete reference genome for broomcorn millet provides a valuable resource for genetic studies and breeding of this important cereal crop.

The standard of care for prostate cancer (PCa) is androgen deprivation therapy (ADT). Although hormone-sensitive PCa is curable by ADT, most conditions progress to castration-resistant prostate cancer (CRPCa) and metastatic CRPCa (mCRPCa). Front-line docetaxel has been administered to patients with CRPCa and mCRPCa. Nevertheless, docetaxel resistance after half a year of therapy has emerged as an urgent clinical concern in patients with CRPCa and mCRPCa. We verified the mechanism by which docetaxel-resistant PCa cells (DU/DX50) exhibited significant cell migration and expression of malignant tumor-related proteins. Our study shows that the biological activity of fucoidan has an important application for docetaxel-resistant PCa cells, inhibiting IL-1R by binding to P-selectin and reducing the expression levels of NF-κB p50 and Cox2 in this metastasis-inhibiting signaling pathway. Furthermore, the combined treatment of fucoidan and docetaxel showed significant anticancer and synergistic effects on the viability of DU/DX50 cells, which is relevant for overcoming the current limitations and improving treatment outcomes. Overall, fucoidan-based combination chemotherapy may exert beneficial effects and facilitate the treatment of docetaxel-resistant PCa.