A randomized, double-blind, dose-controlled study of the use of dexmedetomidine alone for procedural sedation of children and adolescents undergoing MRI scans

BACKGROUND

Dexmedetomidine is a selective α2-adrenergic agonist originally approved for sedation of adults in the intensive care unit and subsequently approved for procedural sedation in adults undergoing medical procedures. Dexmedetomidine is widely used off-label for procedural sedation in children.

AIMS

To evaluate efficacy and safety of monotherapy dexmedetomidine for magnetic resonance imaging procedural sedation of children ≥1month-<17years across three ascending doses.

METHODS

Randomized, double-blind, dose-ranging study of procedural sedation recruited patients at USA and Japanese sites from February 2020 to November 2021. Patients were stratified into Cohort A (≥1month-<2years) or Cohort B (≥2-<17years). Cohort A loading doses/maintenance infusions: 0.5 mcg/kg/0.5 mcg/kg/h, 1.0 mcg/kg/1.0 mcg/kg/h, and 1.5 mcg/kg/1.5 mcg/kg/h. Cohort B loading doses/maintenance infusions: 0.5 mcg/kg/0.5 mcg/kg/h, 1.2 mcg/kg/1.0 mcg/kg/h, and 2.0 mcg/kg/1.5 mcg/kg/h. Primary endpoint was percentage of overall patients completing MRI without rescue propofol at the high versus low dose. Key secondary endpoint was percentage in each age cohort who did not require propofol at the high versus low dose.

RESULTS

One hundred twenty-two patients received high- (n = 38), middle- (n = 42), or low-dose (n = 42) dexmedetomidine. A greater percentage completed MRI without propofol rescue, while receiving high- versus low-dose dexmedetomidine (24/38 [63.2%] vs. 6/42 [14.3%]) (odds ratio: 10.29, 95% confidence interval: 3.47-30.50, p < .001). Similar results were seen in both age cohorts. The most common adverse events were bradypnea, bradycardia, hypertension, and hypotension, and the majority were of mild-to-moderate severity.

CONCLUSIONS

Dexmedetomidine was well tolerated. The high dose was associated with meaningfully greater efficacy compared with lower doses. Based on these results, the recommended starting dose for procedural sedation in children ≥1month-<2years is loading dose 1.5 mcg/kg/maintenance infusion 1.5 mcg/kg/h; children ≥2-<17years is loading dose 2.0 mcg/kg/maintenance infusion 1.5 mcg/kg/h.

Correction: Integrated silicon photonic MEMS

[This corrects the article DOI: 10.1038/s41378-023-00498-z.].

Clinical outcomes of myocardial infarction with non-obstructive coronary arteries presenting with diabetic ketoacidosis: a propensity score-matched analysis

INTRODUCTION AND OBJECTIVE

There is a paucity of data on patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) and a decompensated diabetic state, diabetic ketoacidosis (DKA). Therefore, we aimed to investigate the outcomes of patients with MINOCA presenting with or without DKA.

METHODS

We conducted this retrospective propensity score-matched analysis from January 1, 2015, to December 4, 2022. The patients with a principal admission diagnosis of ST-Elevation MI (STEMI) and discharge labeled as MINOCA (ICD-10-CM code 121.9) with DKA were analyzed. We performed a comparative analysis for MINOCA with and without DKA before and after propensity score matching for primary and secondary endpoints.

RESULTS

Three thousand five hundred sixty-three patients were analyzed, and 1150 (32.27%) presented with DKA, while 2413 (67.72%) presented as non-DKA. The DKA cohort had over two-fold mortality (5.56% vs. 1.19%; p = 0.024), reinfarction (5.82% vs. 1.45%; p = 0.021), stroke (4.43% vs. 1.36%; p = 0.035), heart failure (6.89% vs. 2.11%; p = 0.033), and cardiogenic shock (6.43% vs. 1.78%; p = 0.025) in a propensity score-matched analysis. There was an increased graded risk of MINOCA with DM (RR (95% CI): 0.50 (0.36-0.86; p = 0.023), DKA (RR (95% CI): 0.46 (0.24-0.67; p = 0.001), and other cardiovascular (CV) risk factors.

CONCLUSION

DKA complicates a portion of MINOCA and is associated with increased mortality and major adverse cardiovascular events (MACE).

Standards for clinical trials for treating TB

BACKGROUND: The value, speed of completion and robustness of the evidence generated by TB treatment trials could be improved by implementing standards for best practice.METHODS: A global panel of experts participated in a Delphi process, using a 7-point Likert scale to score and revise draft standards until consensus was reached.RESULTS: Eleven standards were defined: Standard 1, high quality data on TB regimens are essential to inform clinical and programmatic management; Standard 2, the research questions addressed by TB trials should be relevant to affected communities, who should be included in all trial stages; Standard 3, trials should make every effort to be as inclusive as possible; Standard 4, the most efficient trial designs should be considered to improve the evidence base as quickly and cost effectively as possible, without compromising quality; Standard 5, trial governance should be in line with accepted good clinical practice; Standard 6, trials should investigate and report strategies that promote optimal engagement in care; Standard 7, where possible, TB trials should include pharmacokinetic and pharmacodynamic components; Standard 8, outcomes should include frequency of disease recurrence and post-treatment sequelae; Standard 9, TB trials should aim to harmonise key outcomes and data structures across studies; Standard 10, TB trials should include biobanking; Standard 11, treatment trials should invest in capacity strengthening of local trial and TB programme staff.CONCLUSION: These standards should improve the efficiency and effectiveness of evidence generation, as well as the translation of research into policy and practice.

Evaluating newly approved drugs in combination regimens for multidrug-resistant tuberculosis with fluoroquinolone resistance (endTB-Q): study protocol for a multi-country randomized controlled trial

BACKGROUND

Treatment for fluoroquinolone-resistant multidrug-resistant/rifampicin-resistant tuberculosis (pre-XDR TB) often lasts longer than treatment for less resistant strains, yields worse efficacy results, and causes substantial toxicity. The newer anti-tuberculosis drugs, bedaquiline and delamanid, and repurposed drugs clofazimine and linezolid, show great promise for combination in shorter, less-toxic, and effective regimens. To date, there has been no randomized, internally and concurrently controlled trial of a shorter, all-oral regimen comprising these newer and repurposed drugs sufficiently powered to produce results for pre-XDR TB patients.

METHODS

endTB-Q is a phase III, multi-country, randomized, controlled, parallel, open-label clinical trial evaluating the efficacy and safety of a treatment strategy for patients with pre-XDR TB. Study participants are randomized 2:1 to experimental or control arms, respectively. The experimental arm contains bedaquiline, linezolid, clofazimine, and delamanid. The control comprises the contemporaneous WHO standard of care for pre-XDR TB. Experimental arm duration is determined by a composite of smear microscopy and chest radiographic imaging at baseline and re-evaluated at 6 months using sputum culture results: participants with less extensive disease receive 6 months and participants with more extensive disease receive 9 months of treatment. Randomization is stratified by country and by participant extent-of-TB-disease phenotype defined according to screening/baseline characteristics. Study participation lasts up to 104 weeks post randomization. The primary objective is to assess whether the efficacy of experimental regimens at 73 weeks is non-inferior to that of the control. A sample size of 324 participants across 2 arms affords at least 80% power to show the non-inferiority, with a one-sided alpha of 0.025 and a non-inferiority margin of 12%, against the control in both modified intention-to-treat and per-protocol populations.

DISCUSSION

This internally controlled study of shortened treatment for pre-XDR TB will provide urgently needed data and evidence for clinical and policy decision-making around the treatment of pre-XDR TB with a four-drug, all-oral, shortened regimen.

TRIAL REGISTRATION

ClinicalTrials.Gov NCT03896685. Registered on 1 April 2018; the record was last updated for study protocol version 4.3 on 17 March 2023.

Thermal analysis of micropolar hybrid nanofluid inspired by 3D stretchable surface in porous media

Applications: the study of highly advanced hybrid nanofluids has aroused the interest of academics and engineers, particularly those working in the fields of chemical and applied thermal engineering. The improved properties of hybrid nanoliquids are superior to those of earlier classes of nanofluids (which are simply referred to as nanofluids). Therefore, it is essential to report on the process of analyzing nanofluids by passing them through elastic surfaces, as this is a typical practice in engineering and industrial applications. Purpose and methodology: the investigation of hybrid nanoliquids was the sole focus of this research, which was conducted using a stretched sheet. Using supporting correlations, an estimate was made of the improved thermal conductivity, density, heat capacitance, and viscosity. In addition, the distinctiveness of the model was increased by the incorporation of a variety of distinct physical limitations, such as thermal slip, radiation, micropolarity, uniform surface convection, and stretching effects. After that, a numerical analysis of the model was performed, and the physical results are presented. Core findings: the results of the model showed that it is possible to attain the desired momentum of hybrid nanofluids by keeping the fluidic system at a uniform suction, and that this momentum may be enhanced by increasing the force of the injecting fluid via a stretched sheet. Surface convection, thermal radiation, and high dissipative energy are all great physical instruments that can be used to acquire heat in hybrid nanofluids. This heat acquisition is significant from both an applied thermal engineering perspective and a chemical engineering perspective. The features of simple nano and common hybrid nanoliquids have been compared and the results indicate that hybrid nanofluids exhibit dominant behavior when measured against the percentage concentration of nanoparticles, which enables them to be used in large-scale practical applications.

MHD rotating flow over a stretching surface: The role of viscosity and aggregation of nanoparticles

The magnetohydrodynamic (MHD) rotating flow that occurs across a stretching surface has numerous practical applications in a variety of domains. These fields include astronomy, engineering, the material sciences, and space exploration. The combined examination of magnetohydrodynamics rotating flow across a stretching surface, taking into consideration fluctuating viscosity and nanoparticle aggregation, has significant ramifications across several different domains. It is essential for both the growth of technology and the attainment of deeper insights into the complicated fluid dynamics to maintain research in this field. Given the aforementioned motivation, the principal aim of this study is to examine the effects of variable viscosity on the bidirectional rotating magnetohydrodynamic flow over a stretching surface. Aggregation effects on nanoparticles are used in the analysis. Titania ( T i O 2 ) is taken nanoparticle and ethylene glycol as base fluid. The nonlinear ordinary differential equations and the boundary conditions that correspond to them can be transformed into a dimensionless form by using a technique called similarity transformation. To get a numerical solution to the transformed equation, the Runge-Kutta 4th order (RK-4) method is utilized, and this is done in conjunction with the shooting method. The impact of various leading variables on dimensionless velocity, the coefficients of temperature, skin friction and local Nusselt number are graphically represented. Velocity profiles in both direction increases with increasing values of φ . The Nusselt number increases with increasing values of the radiation and temperature ratio parameters. When a 1 % volume fraction of nanoparticles is introduced, the Nusselt number exhibits a 0.174 % increase for the aggregation model compared to the regular fluid in the absence of radiation effects. When the aggregation model is used with a 1 % volume fraction of nanoparticles, the skin friction increases by 0.1153 % in the x direction and by 0.1165 % in the y direction compared to the regular fluid. Tables show the variation in Nusselt numbers, as well as a comparison of the effects of nanoparticle's aggregation model without and with radiation. Moreover, the numerical results obtained were compared with previously published data, demonstrating a satisfactory agreement. We firmly believe that this finding will have extensive implications for engineering and various industries.

Flow and heat transfer of Al2O3 and γ-Al2O3 through a channel with non-parallel walls: a numerical study

Nanofluids are referred to as nanometer suspensions in standard nanometer-sized fluid transfer. In this study, our focus was to examine the flow and transmission of heat through a non-parallel walled channel of nanofluids. For this purpose, we used the thermal transport in H2O composed of Al2O3 and γ-Al2O3 nanomaterials within the convergent/divergent channel for stretching/shrinking parameters. The flow was considered two-dimensional and unsteady. As a result, the flow of an unstable fluid, including various nanoparticles, was modeled within the convergent/divergent channel. A suitable similarity transformation was used to convert the complicated coupled system of differential equations into a non-dimensional form. For numerical solutions, the complicated system of equations was first transformed into a set of first-order differential equations using the shooting method. The Runge-Kutta (RK-4) method was then used to solve the reduced first-order equations. To comprehend the flow pattern and temperature and velocity profile deviations caused by dimensionless parameters, a graphical investigation was performed. Graphs were also used to investigate the variation in the velocity and temperature profiles for various emerging factors.

Spontaneous Confinement of mRNA Molecules at Biomolecular Condensate Boundaries

Cellular biomolecular condensates, termed ribonucleoprotein (RNP) granules, are often enriched in messenger RNA (mRNA) molecules relative to the surrounding cytoplasm. Yet, the spatial localization and diffusion of mRNAs in close proximity to phase separated RNP granules are not well understood. In this study, we performed single-molecule fluorescence imaging experiments of mRNAs in live cells in the presence of two types of RNP granules, stress granules (SGs) and processing bodies (PBs), which are distinct in their molecular composition and function. We developed a photobleaching- and noise-corrected colocalization imaging algorithm that was employed to determine the accurate positions of individual mRNAs relative to the granule's boundaries. We found that mRNAs are often localized at granule boundaries, an observation consistent with recently published data. We suggest that mRNA molecules become spontaneously confined at the RNP granule boundary similar to the adsorption of polymer molecules at liquid-liquid interfaces, which is observed in various technological and biological processes. We also suggest that this confinement could be due to a combination of intermolecular interactions associated with, first, the screening of a portion of the RNP granule interface by the polymer and, second, electrostatic interactions due to a strong electric field induced by a Donnan potential generated across the thin interface.

The Digital Hospital: A Scoping Review of How Technology Is Transforming Cardiopulmonary Care

BACKGROUND

Innovative models of health care that involve advanced technology in the form of a digital hospital are emerging globally. Models include technology such as machine learning and smart wearables, that can be used to integrate patient data and improve continuity of care. This model may have benefits in situations where patient deterioration must be detected quickly so that a rapid response can occur such as cardiopulmonary settings.

AIM

The purpose of this scoping review was to examine the evidence for a digital hospital model of care, in the context of cardiac and pulmonary settings.

DESIGN

Scoping review.

DATA SOURCES

Databases searched were using PsycInfo, Ovid MEDLINE, and CINAHL. Studies written in English and containing key terms related to digital hospital and cardiopulmonary care were included. The Joanna Briggs Institute methodology for systematic reviews was used to assess the risk of bias.

RESULTS

Thirteen (13) studies fulfilled the inclusion criteria. For cardiac conditions, a deep-learning-based rapid response system warning system for predicting patient deterioration leading to cardiac arrest had up to 257% higher sensitivity than conventional methods. There was also a reduction in the number of patients who needed to be examined by a physician. Using continuous telemonitoring with a wireless real-time electrocardiogram compared with non-monitoring, there was improved initial resuscitation and 24-hour post-event survival for high-risk patients. However, there were no benefits for survival to discharge. For pulmonary conditions, a natural language processing algorithm reduced the time to asthma diagnosis, demonstrating high predictive values. Virtual inhaler education was found to be as effective as in-person education, and prescription error was reduced following the implementation of computer-based physician order entry electronic medical records and a clinical decision support tool.

CONCLUSIONS

While we currently have only a brief glimpse at the impact of technology care delivery for cardiac and respiratory conditions, technology presents an opportunity to improve quality and safety in care, but only with the support of adequate infrastructure and processes.

PROTOCOL REGISTRATION

Open Science Framework (OSF: DOI 10.17605/OSF.IO/PS6ZU).

Impact of variable thermal conductivity on flow of trihybrid nanofluid over a stretching surface

The present article describes the impact of variable thermal conductivity on the flow of ternary hybrid nanofluid with cylindrical shape nanoparticles over a stretching surface. Three nanoparticles combine in base fluid polymer. The assumption made will be used to model an equations. Modeled equations are in the form of a system of partial differential equations are difficult to solve can be converted to system of an ordinary differential equations, through resemblance substitutions, and will be solved numerically. Numerical scheme of Runge-Kutta order four is coupled with the shooting method to solve the resulting equations. The graphs in the study illustrate how physical quantities, such as magnetic field, injection/suction, nanoparticles volume fraction, and variable thermal conductivity, affected the velocity, skin friction, temperature, and local Nusselt number. The velocity profiles deflate as the volume fraction rises. While the temperature rises with an increase in the volume fraction of nanoparticles for both injection and suction, the velocity profiles also decline as the injection and suction parameter increases. Furthermore, as the magnetic field increases, the temperature profile rises while the velocity profile falls. The temperature curves increase as thermal conductivity increases. Finally, as the magnetic field is strengthened, the Nusselt number and skin friction decrease. The combination of mathematical modeling, numerical solution techniques, and the analysis of physical quantities contributes to the advancement of knowledge in this ternary hybrid nanofluid.

Mathematical analysis of radius and length of CNTs on flow of nanofluid over surface with variable viscosity and joule heating

The transfer of heat is a phenomenon that is significant in a variety of contexts due to the different ways in which it may be utilized in industrial settings. To increase the rate at which heat is transferred, carbon nanotubes (CNTs), which can either be single-wall or multi-walled, are suspended in base fluids, and the resulting mixture is referred to as a "nanofluid. This study looks at how heat transfers through nanofluids that are suspended in carbon nanotubes with different lengths and radii over a stretching surface. It also looks at how changing viscosity and joule heating affect motion. Water is taken as base fluid. This study looks at both carbon nanotubes with one wall and those with more than one. The flow is governed by a series of partial differential equations, which, to control the flow, are transformed into a series of nonlinear ordinary differential equations. Similarity transformation is used to convert the obtained nonlinear ordinary differential equations and accompanying boundary conditions into a form that is dimensionless. To numerically solve the transformed equation, RK-4 with shooting method is used. Graphs and in-depth discussions are used to look at how velocity and temperature profiles are affected by the leading variables. The expression for skin friction and local Nusselt number are written down and graphs show how these two numbers change for different parameter values. The temperature profile goes down when the viscosity parameter goes down, but the velocity profile goes up. When the magnetic parameter goes up, the velocity profile f'(η), goes down, but the velocity profile g(η) and temperature θ(η) both go up at the same time. The rate of heat transfer increases with the addition of φ and S. When the suction parameter (S = 2.1) with 1% of φ is used, it is reported that rate of heat transfer increases by 1.135% for Single walled and 1.275% for Multi Walled carbon nanotubes. To determine whether or not the proposed numerical model is legitimate, a comparison is made between the current results and those that have previously been published.

Outcomes of WHO-conforming, longer, all-oral multidrug-resistant TB regimens and analysis implications

BACKGROUND: Evidence of the effectiveness of the WHO-recommended design of longer individualized regimens for multidrug- or rifampicin-resistant TB (MDR/RR-TB) is limited.OBJECTIVES: To report end-of-treatment outcomes for MDR/RR-TB patients from a 2015-2018 multi-country cohort that received a regimen consistent with current 2022 WHO updated recommendations and describe the complexities of comparing regimens.METHODS: We analyzed a subset of participants from the endTB Observational Study who initiated a longer MDR/RR-TB regimen that was consistent with subsequent 2022 WHO guidance on regimen design for longer treatments. We excluded individuals who received an injectable agent or who received fewer than four likely effective drugs.RESULTS: Of the 759 participants analyzed, 607 (80.0%, 95% CI 77.0-82.7) experienced successful end-of-treatment outcomes. The frequency of success was high across groups, whether stratified on number of Group A drugs or fluoroquinolone resistance, and ranged from 72.1% to 90.0%. Regimens were highly variable regarding composition and the duration of individual drugs.CONCLUSIONS: Longer, all-oral, individualized regimens that were consistent with 2022 WHO guidance on regimen design had high frequencies of treatment success. Heterogeneous regimen compositions and drug durations precluded meaningful comparisons. Future research should examine which combinations of drugs maximize safety/tolerability and effectiveness.

Mathematical analysis of mixed convective stagnation point flow over extendable porous riga plate with aggregation and joule heating effects

It is still not quite apparent how suspended nanoparticles improve heat transmission. Multiple investigations have demonstrated that the aggregation of nanoparticles is a critical step in improving the thermal conductivity of nanofluids. However, the thermal conductivity of the nanofluid would be greatly affected by the fractal dimension of the nanoparticle aggregation. The purpose of this research is to learn how nanoparticle aggregation, joule heating, and a heat source affect the behavior of an ethylene glycol-based nanofluid as it flows over a permeable, heated, stretched vertical Riga plate and through a porous medium. Numerical solutions to the present mathematical model were obtained using Mathematica's Runge-Kutta (RK-IV) with shooting technique. In the stagnation point flow next to a permeable, heated, extending Riga plate, heat transfer processes and interrupted flow phenomena are defined and illustrated by diagrams in the proposed mixed convection, joule heating, and suction variables along a boundary surface. Data visualizations showed how different variables affected temperature and velocity distributions, skin friction coefficient, and the local Nusselt number. The rates of heat transmission and skin friction increased when the values of the suction parameters were raised. The temperature profile and the Nusselt number both rose because of the heat source setting. The increase in skin friction caused by changing the nanoparticle volume fraction from φ=0.0 to φ=0.01 for the without aggregation model was about 7.2% for the case of opposing flow area (λ=-1.0) and 7.5% for the case of aiding flow region (λ=1.0). With the aggregation model, the heat transfer rate decreases by approximately 3.6% for cases with opposing flow regions (λ=-1.0) and 3.7% for cases with assisting flow regions (λ=1.0), depending on the nanoparticle volume fraction and ranging from φ=0.0 to φ=0.01, respectively. Recent findings were validated by comparing them to previously published findings for the same setting. There was substantial agreement between the two sets finding.

Sustaining Life versus Altering Life-Saving Drugs: Insights to Explain the Paradoxical Effect of Extracorporeal Membrane Oxygenation on Drugs

There has been a substantial increase in the use of extracorporeal membrane oxygenation (ECMO) support in critically ill adults. Understanding the complex changes that could affect drugs' pharmacokinetics (PK) and pharmacodynamics (PD) is of suitable need. Therefore, critically ill patients on ECMO represent a challenging clinical situation to manage pharmacotherapy. Thus, clinicians' ability to predict PK and PD alterations within this complex clinical context is fundamental to ensure further optimal and, sometimes, individualized therapeutic plans that balance clinical outcomes with the minimum drug adverse events. Although ECMO remains an irreplaceable extracorporeal technology, and despite the resurgence in its use for respiratory and cardiac failures, especially in the era of the COVID-19 pandemic, scarce data exist on both its effect on the most commonly used drugs and their relative management to achieve the best therapeutic outcomes. The goal of this review is to provide key information about some evidence-based PK alterations of the drugs used in an ECMO setting and their monitoring.

Integrated silicon photonic MEMS

Silicon photonics has emerged as a mature technology that is expected to play a key role in critical emerging applications, including very high data rate optical communications, distance sensing for autonomous vehicles, photonic-accelerated computing, and quantum information processing. The success of silicon photonics has been enabled by the unique combination of performance, high yield, and high-volume capacity that can only be achieved by standardizing manufacturing technology. Today, standardized silicon photonics technology platforms implemented by foundries provide access to optimized library components, including low-loss optical routing, fast modulation, continuous tuning, high-speed germanium photodiodes, and high-efficiency optical and electrical interfaces. However, silicon's relatively weak electro-optic effects result in modulators with a significant footprint and thermo-optic tuning devices that require high power consumption, which are substantial impediments for very large-scale integration in silicon photonics. Microelectromechanical systems (MEMS) technology can enhance silicon photonics with building blocks that are compact, low-loss, broadband, fast and require very low power consumption. Here, we introduce a silicon photonic MEMS platform consisting of high-performance nano-opto-electromechanical devices fully integrated alongside standard silicon photonics foundry components, with wafer-level sealing for long-term reliability, flip-chip bonding to redistribution interposers, and fibre-array attachment for high port count optical and electrical interfacing. Our experimental demonstration of fundamental silicon photonic MEMS circuit elements, including power couplers, phase shifters and wavelength-division multiplexing devices using standardized technology lifts previous impediments to enable scaling to very large photonic integrated circuits for applications in telecommunications, neuromorphic computing, sensing, programmable photonics, and quantum computing.

Mathematical analysis of heat and mass transfer on unsteady stagnation point flow of Riga plate with binary chemical reaction and thermal radiation effects

To aid in the prevention of reaction explosions, chemical engineers and scientists must analyze the Arrhenius kinetics and activation energies of chemical reactions involving binary chemical mixtures. Nanofluids with an Arrhenius kinetic are crucial for a broad variety of uses in the industrial sector, involving the manufacture of chemicals, thermoelectric sciences, biomedical devices, polymer extrusion, and the enhancement of thermal systems via technology. The goal of this study is to determine how the presence of thermal radiation influences heat and mass transfer during free convective unsteady stagnation point flow across extending/shrinking vertical Riga plate in the presence of a binary chemical reaction where the activation energy of the reaction is known in advance. For the purpose of obtaining numerical solutions to the mathematical model of the present issue the Runge-Kutta (RK-IV) with shooting technique in Mathematica was used. Heat and mass transfer processes, as well as interrupted flow phenomena, are characterized and explained by diagrams in the suggested suction variables along boundary surface in the stagnation point flow approaching a permeable stretching/shrinking Riga Plate. Graphs illustrated the effects of many other factors on temperature, velocity, concentration, Sherwood and Nusselt number as well as skin friction in detail. Velocity profile increased with Z , λ and S and decreased with ε . Increasing values of ε , λ and S decline the temperature profile. The concentration profile boosts up with Z , α and slow down with ε , S c , β , δ and n 1 parameters. Skin friction profile increased with Z and S and decreased with ε . Nusselt number profile increased with S , Z , ε and radiation. Sherwood number profile shows upsurges with ε , Z , α , S c , β , S and n 1 whereas slow down with δ . So that the verdicts could be confirmed, a study was done to compare the most recent research with the results that had already been published for a certain case. The outcomes demonstrated strong concordance between the two sets of results.

Mathematical analysis of nonlinear thermal radiation and nanoparticle aggregation on unsteady MHD flow of micropolar nanofluid over shrinking sheet

Significance of study

Typical liquids aren't great for engineering because of their low heat conductivity. To enhance heat transfer capabilities in industries as diverse as computers, pharmaceuticals, and molten metals, researchers and scientists have developed nanofluids, which are composed of nanoparticles distributed in a base fluid.

Aim of study

Mathematical modeling of micropolar C u - H 2 O nanofluid driven by a deformable sheet in the stagnation area with nanoparticle aggregation, thermal radiation, and the mass suction action has been investigated in this paper. In this case, copper ( C u ) nanoparticles make up the nanofluid.

Method

ology: We have used suitable transformations to arrive at a system of nonlinear ODEs, which we then solve numerically in MATHEMATICA using Runge-Kutta methods of the fourth order coupled with shooting approaches.

Findings

Tables and graphs are used to examine the effects of immersed flow and display profiles of physical parameters of interest. This includes velocities, temperatures, skin friction, and Nusselt numbers. The average heat transfer rate increased to 17 . 725 % as the volume percentage of copper nanoparticles in micropolar nanofluid increased from 0.0 to 0.01 . Additionally, the results showed that the local Nusselt number of the micropolar nanofluid increased along with an increase in the unsteady and radiation parameters. However, its value is reduced in an undeniable fashion if a material parameter is present. The impact of radiation on the aggregation of nanoparticles is compared and contrasted with the effects of a non-radiative scenario, and the resulting fluctuations in Nusselt numbers are provided in tables. When the results of this study were compared to data that had already been published about some cases, a lot of agreement was found.

Impact of suction with nanoparticles aggregation and joule heating on unsteady MHD stagnation point flow of nanofluids over horizontal cylinder

Significance of study

Nanofluids with aggregation effects mediated by nanoparticles, like geothermal panels and crossflow heat exchangers, ignite new industrial interests. Polymer and conversion processes have transport phenomena in the stagnation zone that must be continuously improved to raise the process quality standard.

Aim of study

Hence, the current computational study examines a T i O 2 - C 2 H 6 O 2 nanofluid's unsteady stagnation-point flow performance via a shrinking horizontal cylinder. In addition, the effects of a magnetic field, joule-heating viscous dissipation, nanoparticles aggregation and mass suction on the boundary layer flow are reflected.

Method

ology: The RK-IV with shooting method is applied to resolve the simplified mathematical model numerically in computing software MATHEMATICA. In certain circumstances, comparing the current and prior findings indicates good agreement with a relative error of around 0%.

Findings

The implementation of a heat transfer operation may be improved by increasing suction settings. Unsteadiness, nanoparticle volume fraction, magnetic, curvature, and Eckert number (implies the operating Joule heating and viscous dissipation) all influence heat transfer rate. The velocity and temperature profiles both increase as the unsteadiness, magnetic field, and nanoparticle volume fraction parameters increase, whereas the curvature and suction parameters show the opposite behavior. When the values of the suction parameters were changed from 2.0 to 2.5 with φ  = 0.01, the heat transfer rates rose by 4.751%. A comparison shows that the model with aggregation has a better velocity profile, while the model without aggregation has a better temperature profile.

Vacuum-sealed silicon photonic MEMS tunable ring resonator with an independent control over coupling and phase

Ring resonators are a vital element for filters, optical delay lines, or sensors in silicon photonics. However, reconfigurable ring resonators with low-power consumption are not available in foundries today. We demonstrate an add-drop ring resonator with the independent tuning of round-trip phase and coupling using low-power microelectromechanical (MEMS) actuation. At a wavelength of 1540 nm and for a maximum voltage of 40 V, the phase shifters provide a resonance wavelength tuning of 0.15 nm, while the tunable couplers can tune the optical resonance extinction ratio at the through port from 0 to 30 dB. The optical resonance displays a passive quality factor of 29 000, which can be increased to almost 50 000 with actuation. The MEMS rings are individually vacuum-sealed on wafer scale, enabling reliable and long-term protection from the environment. We cycled the mechanical actuators for more than 4 × 10⁹ cycles at 100 kHz, and did not observe degradation in their response curves. On mechanical resonance, we demonstrate a modulation increase of up to 15 dB, with a voltage bias of 4 V and a peak drive amplitude as low as 20 mV.

Impact of an effective Prandtl number model on the flow of nanofluids past an oblique stagnation point on a convective surface

The stretched surface's convective heat transfer capability can be improved by using nanoparticles. There is a significant role of the Prandtl number in determining the thermal and momentum stretching layer surfaces. It is proposed in this study that an effective Prandtl number model be used to explore the two-dimensional oblique stagnation point flow of γ A l 2 O 3 - H 2 O and γ A l 2 O 3 - C 2 H 6 O 2 nanofluids moving over a convective stretching surface. The fluid in question is subjected to a thorough investigation. It is necessary to apply non-linear ordinary differential equations in order to connect the controlling partial differential equations with the boundary conditions. To solve these equations, an efficient and reliable numerical technique is used. Shooting Method with Runge Kutta-IV in Mathematica software. Visual representations of normal and tangential velocity and temperature as well as streamlines as a function of many physical parameters are shown. The results show that as the volume fraction of nanoparticles increases, the fluid flow f ( y ) , h ( y ) and velocity f ' ( y ) , h ' ( y ) all increase, whereas the flow f ( y ) and velocity f ' ( y ) both increase against the stretching ratio parameter, while the flow h ( y ) and velocity h ' ( y ) both decrease. When the volume percentage of nanoparticles and the Biot number are both increased, the temperature rises. However, when the stretching ratio parameter is increased, the temperature falls. Physical attributes like the local skin friction coefficient and the heat flow may be characterized in many ways. A nanofluid comprised of γ A l 2 O 3 - C 2 H 6 O 2 outperformed a γ A l 2 O 3 - H 2 O nanofluid in terms of heat transfer rate. The source of zero skin friction may be observed to move to the left or right depending on the balance of obliqueness and straining motion at point x s . The computed numerical results of the current research correspond well with those accessible in the literature for the limiting scenario.

In vivo detection of bile duct pre-cancer with endoscopic light scattering spectroscopy

Bile duct cancer is the second most common primary liver cancer, with most diagnoses occurring in the advanced stages. This leads to a poor survival rate, which means a technique capable of reliably detecting pre-cancer in the bile duct is urgently required. Unfortunately, radiological imaging lacks adequate accuracy for distinguishing dysplastic and benign biliary ducts, while endoscopic techniques, which can directly assess the bile duct lining, often suffer from insufficient sampling. Here, we report an endoscopic optical light scattering technique for clinical evaluation of the malignant potential of the bile duct. This technique employs an ultraminiature spatial gating fiber optic probe compatible with cholangioscopes and endoscopic retrograde cholangiopancreatography (ERCP) catheters. The probe allowed us to investigate the internal cellular composition of the bile duct epithelium with light scattering spectroscopy (LSS) and phenotypic properties of the underlying connective tissue with diffuse reflectance spectroscopy (DRS). In a pilot in vivo double-blind prospective study involving 29 patients undergoing routine ERCP procedures, the technique detected malignant transformation with 97% accuracy, showing that biliary duct pre-cancer can be reliably identified in vivo non-invasively.

Double-diffusive stagnation point flow over a vertical surface with thermal radiation: Assisting and opposing flows

In numerous industrial procedures, the main concern of design engineers is ensuring adequate heat and mass transfer, such as in the heating and cooling practices of solar water heaters, geothermal systems, extrusion of metal, insulation of buildings, electronics, turbines, aerodynamics, electronics, paper manufacturing, and glass fiber production. The unsteady double-diffusive mixed convection flow of boundary layer nanofluids above a vertical region near stagnation point flow is developed and examined here. The Brownian motion and thermophoresis effects are incorporated by using Buongiorno's model. In the thermal energy equations, diffusion of regular and cross types is also used. By the use of the local similarity method along with suitable similarity transformations, nonlinear unsteady partial differential equations are converted to nonlinear ordinary differential equations and are numerically solved by the Keller-Box method. The investigation expresses that these profiles of solute concentration and nanoparticle concentration, temperature, and velocity in their boundary layers, respectively, depending on several parameters. A graphic analysis of all these parameters' possessions on nature's boundary layers is depicted. The highest rate of heat transfer is obtained with negligible thermophoresis effect. Furthermore, it is perceived that an increase in Nc and Nt results in a reduction in the reduced Sherwood number of nanoparticles, whereas addition results in an increase in the Nb number. There is a reverse effect on the temperature field and layer thickness for heat generation. In the wake of the above-mentioned potential applications, the current study of fluid flow has been found to be very interesting and innovative in the analysis of the influence of Brownian motion and thermophoresis effects near stagnation point flow, which will further make revolutions in industrial fields. Moreover, Buongiorno's model predicts the characteristics of double-diffusive fluids in enhancing heat transfers. This investigation has been established as a result of the numerous industrial applications mentioned above.

Concordance of three approaches for operationalizing outcome definitions for multidrug-resistant TB

BACKGROUND: The WHO provides standardized outcome definitions for rifampicin-resistant (RR) and multidrug-resistant (MDR) TB. However, operationalizing these definitions can be challenging in some clinical settings, and incorrect classification may generate bias in reporting and research. Outcomes calculated by algorithms can increase standardization and be adapted to suit the research question. We evaluated concordance between clinician-assigned treatment outcomes and outcomes calculated based on one of two standardized algorithms, one which identified failure at its earliest possible recurrence (i.e., failure-dominant algorithm), and one which calculated the outcome based on culture results at the end of treatment, regardless of early occurrence of failure (i.e., success-dominant algorithm).METHODS: Among 2,525 patients enrolled in the multi-country endTB observational study, we calculated the frequencies of concordance using cross-tabulations of clinician-assigned and algorithm-assigned outcomes. We summarized the common discrepancies.RESULTS: Treatment success calculated by algorithms had high concordance with treatment success assigned by clinicians (95.8 and 97.7% for failure-dominant and success-dominant algorithms, respectively). The frequency and pattern of the most common discrepancies varied by country.CONCLUSION: High concordance was found between clinician-assigned and algorithm-assigned outcomes. Heterogeneity in discrepancies across settings suggests that using algorithms to calculate outcomes may minimize bias.

Unsteady three-dimensional nodal stagnation point flow of polymer-based ternary-hybrid nanofluid past a stretching surface with suction and heat source

As a result of the many real-world applications that may be derived from understanding stagnation point flow in designing, such as the coolant of nuclear reactors, there has been a great deal of interest in the topic. Consequently, the purpose of this research was to offer a numerical analysis of an unstable three-dimensional (3D) nodal stagnation point flow of polymer-based A l 2 O 3 - C u O - T i O 2 / p o l y m e r ternary nanofluid past a stretching surface with mass suction and heat source effects. In order to simplify the underlying partial differential equations, an appropriate similarity transformation is applied to them. This simplifies the ordinary differential equations. The shooting with the Runge-Kutta approach is used by the MATHEMATICA software to do the numerical calculation. Suction, stretching, unsteadiness, heat source, and nanoparticle volume fractions are other elements that play a role in regulating the flow and heat transfer as well as drag force profiles and how they affect the problem. The amount of heat transferred, and the friction coefficient increased in both directions when the suction parameter values were raised. In a ternary-hybrid nanofluid, the overall heat transfer rate decreases as the value of the heat source increases. Variations in the nanoparticles' volume fraction parameter cause an intensification in skin friction in both directions. Expanding the unstable and nanoparticles volume fraction parameters also reduces the Nusselt number. Furthermore, the heat transfer presentation of ternary-hybrid nanofluid has superior to the hybrid nanofluid and the normal nanofluid for the suction parameter. When the results of the current research were compared to those of a study that had already been done and published, they were found to be in good agreement.

Using otolith and body shape to discriminate between stocks of European anchovy (Engraulidae: Engraulis encrasicolus) from the Aegean, Marmara and Black Seas

European anchovy, a small pelagic fish, plays a significant role in the blue economy, with remarkable commercial, ecological and culinary values. In this study, the variability in the shapes of the body and sagitta otoliths was examined to identify the different anchovy stocks in the Black Sea (26.5°E-39.9°E, 38.7° N-42.1°N) and adjacent regions, i.e., the Sea of Marmara and the Aegean Sea. The body shape was assessed with geometric morphometrics, while shape indices and elliptic Fourier analysis were used to evaluate the shape of the sagitta otoliths. The data were analysed using multivariate and univariate analysis of variance, discriminant function and principal component analysis. The anchovy population could be divided into five distinct stocks based on body shape, with an overall leave-one-out cross-validated correct classification of 85.6%. The geometric morphometrics revealed significant differences in body depth, snout, lower jaw and caudal fin. The differences in sagitta otolith shape also revealed the existence of four distinct stocks with an overall leave-one-out cross-validated correct classification of 46.5%-69.3%. The elliptic Fourier analysis revealed two main stocks of anchovy from the Black Sea as the Eastern-Middle Black Sea stock and the Western Black Sea stock. Based on the elliptic Fourier analysis, the differences in the sagitta otoliths increase in magnitude with increasing geographic separation, first manifested at the otolith anterior notch, followed by changes in the otolith width. The findings affirmed the existence of distinct stocks that should have important implications for effective management of this pelagic fish in the Black Sea and adjacent regions.

Biopsy channel of the endoscope as a potential source of infectious droplets during GI endoscopy

BACKGROUND AND AIMS

During endoscopy, droplets with the potential to transmit infectious diseases are known to emanate from a patient's mouth and anus, but they may also be expelled from the biopsy channel of the endoscope. The main goal of our study was to quantify droplets emerging from the biopsy channel during clinical endoscopy.

METHODS

A novel light-scattering device was used to measure droplets emanating from the biopsy channel. An endoscopy model was created, and in vitro measurements were carried out during air insufflation, air and water suctioning, and the performance of biopsy sampling. Similar measurements were then made on patients undergoing endoscopy, with all measurements taking place over 2 days to minimize variation.

RESULTS

During in vitro testing, no droplets were observed at the biopsy channel during air insufflation or air and water suctioning. In 3 of 5 cases, droplets were observed during biopsy sampling, mostly when the forceps were being removed from the endoscope. In the 22 patients undergoing routine endoscopy, no droplets were observed during air insufflation and water suctioning. Droplets were detected in 1 of 11 patients during air suctioning. In 9 of 18 patients undergoing biopsy sampling and 5 of 6 patients undergoing snare polypectomies, droplets were observed at the biopsy channel, mostly when instruments were being removed from the endoscope.

CONCLUSIONS

We found that the biopsy channel may be a source of infectious droplets, especially during the removal of instruments from the biopsy channel. When compared with droplets reported from the mouth and anus, these droplets were larger in size and therefore potentially more infectious.

SumStatsRehab: an efficient algorithm for GWAS summary statistics assessment and restoration

Background

Generating polygenic risk scores for diseases and complex traits requires high quality GWAS summary statistic files. Often, these files can be difficult to acquire either as a result of unshared or incomplete data. To date, bioinformatics tools which focus on restoring missing columns containing identification and association data are limited, which has the potential to increase the number of usable GWAS summary statistics files.

Results

SumStatsRehab was able to restore rsID, effect/other alleles, chromosome, base pair position, effect allele frequencies, beta, standard error, and p-values to a better extent than any other currently available tool, with minimal loss.

Conclusions

SumStatsRehab offers a unique tool utilizing both functional programming and pipeline-like architecture, allowing users to generate accurate data restorations for incomplete summary statistics files. This in turn, increases the number of usable GWAS summary statistics files, which may be invaluable for less researched health traits.

A comparative analysis of current phasing and imputation software

Whole-genome data has become significantly more accessible over the last two decades. This can largely be attributed to both reduced sequencing costs and imputation models which make it possible to obtain nearly whole-genome data from less expensive genotyping methods, such as microarray chips. Although there are many different approaches to imputation, the Hidden Markov Model (HMM) remains the most widely used. In this study, we compared the latest versions of the most popular HMM-based tools for phasing and imputation: Beagle5.4, Eagle2.4.1, Shapeit4, Impute5 and Minimac4. We benchmarked them on four input datasets with three levels of chip density. We assessed each imputation software on the basis of accuracy, speed and memory usage, and showed how the choice of imputation accuracy metric can result in different interpretations. The highest average concordance rate was achieved by Beagle5.4, followed by Impute5 and Minimac4, using a reference-based approach during phasing and the highest density chip. IQS and R2 metrics revealed that Impute5 and Minimac4 obtained better results for low frequency markers, while Beagle5.4 remained more accurate for common markers (MAF>5%). Computational load as measured by run time was lower for Beagle5.4 than Minimac4 and Impute5, while Minimac4 utilized the least memory of the imputation tools we compared. ShapeIT4, used the least memory of the phasing tools examined with genotype chip data, while Eagle2.4.1 used the least memory phasing WGS data. Finally, we determined the combination of phasing software, imputation software, and reference panel, best suited for different situations and analysis needs and created an automated pipeline that provides a way for users to create customized chips designed to optimize their imputation results.

Thermal mechanism in magneto radiated [(Al2O3-Fe3O4)/blood]hnf over a 3D surface: Applications in Biomedical Engineering

Nanofluids are a new generation of fluids which help in improving the efficiency of thermal systems by improving heat transport rate and extensive applications of this class extensively fall in biomedical engineering, the electronics industry, applied thermal and mechanical engineering, etc. The core concern of this study is to examine the interaction of Al₂O₃-Fe₃O₄ hybrid nanoparticles of lamina shaped with blood over a 3D surface by impinging novel impacts of non-linear thermal radiations, stretching, velocity slippage, and magnetic field. This leads to a mathematical flow model in terms of highly non-linear differential equations via nanofluid-effective characteristics and similarity rules. To know the actual behavior of (Al₂O₃-Fe₃O₄)/blood inside the concerned region, mathematical investigation is performed via numerical technique and the results are obtained for different parameter ranges. The imposed magnetic field of high strength is a better tool to control the motion of (Al₂O₃-Fe₃O₄)/blood inside the boundary layer, whereas, stretching of the surface is in direct proportion of the fluid movement. Furthermore, thermal radiations (Rd) and γ1 are observed to be beneficial for thermal enhancement for both (Al₂O₃-Fe₃O₄)/blood and (Al₂O₃)/blood.

MHD mixed convective stagnation point flow of nanofluid past a permeable stretching sheet with nanoparticles aggregation and thermal stratification

Using a thermally stratified water-based nanofluid and a permeable stretching sheet as a simulation environment, this research examines the impact of nanoparticle aggregation on MHD mixed convective stagnation point flow. Nanoparticle aggregation is studied using two modified models: the Krieger-Dougherty and the Maxwell-Bruggeman. The present problem's governing equations were transformed into a solvable mathematical model utilizing legitimate similarity transformations, and numerical solutions were then achieved using shooting with Runge-Kutta Fehlberg (RKF) technique in Mathematica. Equilibrium point flow toward permeable stretching surface is important for the extrusion process because it produces required heat and mass transfer patterns and identifies and clarifies fragmented flow phenomena using diagrams. Nanoparticle volume fraction was shown to have an impact on the solutions' existence range, as well. Alumina and copper nanofluids have better heat transfer properties than regular fluids. The skin friction coefficients and Nusselt number, velocity, temperature profiles for many values of the different parameters were obtained. In addition, the solutions were shown in graphs and tables, and they were explained in detail. A comparison of the current study's results with previous results for a specific instance is undertaken to verify the findings, and excellent agreement between them is observed.

Incisional hernia following colorectal cancer surgery according to suture technique: Hughes Abdominal Repair Randomized Trial (HART)

BACKGROUND

Incisional hernias cause morbidity and may require further surgery. HART (Hughes Abdominal Repair Trial) assessed the effect of an alternative suture method on the incidence of incisional hernia following colorectal cancer surgery.

METHODS

A pragmatic multicentre single-blind RCT allocated patients undergoing midline incision for colorectal cancer to either Hughes closure (double far-near-near-far sutures of 1 nylon suture at 2-cm intervals along the fascia combined with conventional mass closure) or the surgeon's standard closure. The primary outcome was the incidence of incisional hernia at 1 year assessed by clinical examination. An intention-to-treat analysis was performed.

RESULTS

Between August 2014 and February 2018, 802 patients were randomized to either Hughes closure (401) or the standard mass closure group (401). At 1 year after surgery, 672 patients (83.7 per cent) were included in the primary outcome analysis; 50 of 339 patients (14.8 per cent) in the Hughes group and 57 of 333 (17.1 per cent) in the standard closure group had incisional hernia (OR 0.84, 95 per cent c.i. 0.55 to 1.27; P = 0.402). At 2 years, 78 patients (28.7 per cent) in the Hughes repair group and 84 (31.8 per cent) in the standard closure group had incisional hernia (OR 0.86, 0.59 to 1.25; P = 0.429). Adverse events were similar in the two groups, apart from the rate of surgical-site infection, which was higher in the Hughes group (13.2 versus 7.7 per cent; OR 1.82, 1.14 to 2.91; P = 0.011).

CONCLUSION

The incidence of incisional hernia after colorectal cancer surgery is high. There was no statistical difference in incidence between Hughes closure and mass closure at 1 or 2 years.

REGISTRATION NUMBER

ISRCTN25616490 (http://www.controlled-trials.com).

Thermal efficiency in hybrid (Al2O3-CuO/H2O) and tri-hybrid (Al2O3-CuO-Cu/H2O) nanofluids between converging/diverging channel with viscous dissipation function: Numerical analysis

Heat transfer and energy storage remain a core problem for industrialists and engineers. So, the concept of new heat transfer fluids, namely, nanofluids and hybrid nanofluids, has been introduced so far. Recently, a new third generation of heat transfer fluids has been developed known as modified hybrid nanofluids (MHNs), synthesized by ternary nanomaterials and the host fluid. Therefore, the study was conducted to investigate the energy storage efficiency between (Al2O3-CuO-Cu/H2O)mhnf and (Al2O3-CuO/H2O)hnf in the presence of novel viscous dissipation effects. The problem is developed for a channel with stretchable walls via thermophysical attributes of binary and ternary guest nanomaterials and the host liquid. The model is tackled numerically and furnished results for the dynamics, most specifically energy storage efficiency in (Al2O3-CuO-Cu/H2O)mhnf. It is examined that the third generation of heat transfer fluids (Al2O3-CuO-Cu/H2O)mhnf has high thermal energy storage efficiency than traditional nano and hybrid nanofluids. Therefore, these new insights in heat transfer would be beneficial and cope with the problems of energy storage in the modern technological world.

Irreversibility analysis for flow of nanofluids with aggregation in converging and diverging channel

In the current research article, the two-dimensional, incompressible, steady fluid flow is considered. The heat transfer rate of water-based aggregated fluid between converging/diverging channels of shrinking/stretching walls due to the effects of thermal radiation has been examined. The strong static magnetic field is applied perpendicular to the radial direction. The modeled governing equations are transformed into non-linear dimensionless ordinary differential equations by considering appropriate similarity transformations. Since the obtained ODEs are strongly non-linear and the exact solution of these equations is not possible, thus we applied the numerical method RK4 combined with the shooting technique to handle the equations. The impacts of several influential parameters on velocity, temperature, and entropy generation profiles are examined graphically.

Temperature, meal size and body size effects on the gastric evacuation of rainbow trout: modelling optimum and upper thermal limits

This study examined the rate and course of gastric evacuation (GE) in rainbow trout Oncorhynchus mykiss in relation to meal size, body size and temperature. The GE experiments were performed on small (mean ± 95% C.I., 17.7 ± 0.5 cm total length), medium (22. 9 ± 0.2 cm) and large (28.3 ± 0.3 cm) rainbow trout fed meals of different sizes using commercial food pellets at water temperatures T ranging from 7.8°C to 19.2°C. Estimating the shape parameter of a general power function suggested that the square root function adequately described the GE in rainbow trout independently of meal size. The effects of total body length L and weight W on gastric evacuation rate (GER) were described by simple power functions. The square root function was further expanded by a temperature function with temperature optimum to describe the effect of temperature. The expanded square root function revealed a considerable effect of body size and temperature on the GER of rainbow trout. The GER increased exponentially with rising temperature, reached an optimum at c. 18.5°C and then declined abruptly to zero at c. 21°C. The GER of rainbow trout could thus be described by d S t d t = - 0.00152 L 0.75 e 0.08 T 1 - e 1.18 T - 20.9 S t (g h^-1 ) or d S t d t = - 0.00440 W 0.26 e 0.08 T 1 - e 0.97 T - 21.1 S t (g h^-1 ), where S_t is the current stomach content mass (g), and at post-prandial time t (h). These functions should prove useful to calculate total GE time as well as stomach fullness at different post-prandial times and therefore provide valuable information to develop optimal feeding strategies for farming of rainbow trout.

The impact of COVID-19 pandemic on type A aortic dissection care

Funding Acknowledgements

Type of funding sources: None.

Introduction

COVID-19 created a challenging situation for cardiac surgery and associated acute care programs around the world. While non-urgent cases might be postponed, operating on life-threatening conditions, including type A aortic dissection (TAAD), must be sustained despite the ongoing pandemic. Therefore, we investigated the impact of the COVID-19 pandemic on our urgent aortic program.

Methods

36 individuals presenting with TAAD in a single centre were analysed from the pre-pandemic period (2019, n=16) and the pandemic era (2020, n=20). Retrospective data review was conducted on patient characteristics, TAAD presenting symptoms, operative techniques, postoperative outcomes and length of stay. A comparison was made between both eras applying appropriate testing methods, and a p-value <0.05 was considered statistically significant.

Results

A 25% increase in TAAD referrals occurred during the pandemic era. Patients were featured by younger age of presentation in contrast to Western data (pre-pandemic group: 47.6 ± 18.7, and the pandemic group: 50.6 ± 16.2 years, p=0.6) but showed similar male predominance (4:1) in both groups. There was no statistical difference in baseline comorbidities between the groups. Length of hospital and intensive care unit stays were comparable between both groups. Low rates of postoperative complications were registered in both groups with no significant between-group difference.

Conclusion

Emergent surgical management remains essential in patients with TAAD regardless of the pandemic. Furthermore, temporary structural departmental re-configuration and optimal personal protective equipment utilisation warrant maintained satisfactory outcomes in such critical healthcare scenarios.

Highly Conductive Networks of Silver Nanosheets

Although printed networks of semiconducting nanosheets have found success in a range of applications, conductive nanosheet networks are limited by low conductivities (<10⁶ S m^-1 ). Here, dispersions of silver nanosheets (AgNS) that can be printed into highly conductive networks are described. Using a commercial thermal inkjet printer, AgNS patterns with unannealed conductivities of up to (6.0 ± 1.1) × 10⁶  S m^-1 are printed. These networks can form electromagnetic interference shields with record shielding effectiveness of >60 dB in the microwave region at thicknesses <200 nm. High resolution patterns with line widths down to 10 µm are also printed using an aerosol-jet printer which, when annealed at 200 °C, display conductivity >10⁷  S m^-1 . Unlike conventional Ag-nanoparticle inks, the 2D geometry of AgNS yields smooth, short-free interfaces between electrode and active layer when used as the top electrode in vertical nanosheet heterostructures. This shows that all-printed vertical heterostructures of AgNS/WS₂ /AgNS, where the top electrode is a mesh grid, function as photodetectors demonstrating that such structures can be used in optoelectronic applications that usually require transparent conductors.

A205 IS REPEAT ERCP REQUIRED AFTER INITIAL ENDOSCOPIC MANAGEMENT OF POST-SURGICAL BILE LEAKS? MULTI-CENTER VALIDATION OF THE CALGARY BILE LEAK RULE

Background

The Calgary Bile Leak Rule was developed to identify patients in whom biliary stent removal via gastroscopy could be safely performed in lieu of ERCP for post-surgical bile leaks.

Aims

This study aimed to evaluate a Modified Calgary Bile Leak Rule (MCBLR) for a cohort of patients who underwent laparoscopic cholecystectomy complicated by bile leak.

Methods

This retrospective cohort study included patients who underwent ERCP for management of laparoscopic cholecystectomy-induced bile leaks between 2005 and 2017. The primary outcome was defined as the absence of persisting bile leak or other pathology on follow-up ERCP. The MCBLR includes a) normal post-surgical serum alkaline phosphatase, b) small or absent leak with no other biliary pathology on initial ERCP, and c) time between initial and follow-up ERCP was 4–8 weeks. Test performance of the prediction rule was analyzed by calculating sensitivity, specificity, positive predictive value and negative predictive value.

Results

124 cases met inclusion criteria, of which 116 (94%) of bile leak cases had no leak identified during the follow-up ERCP. 8 (6.4%) had a persisting bile leak on follow-up ERCP. Bivariate analysis found no factors significantly associated with the primary outcome. The MCBLR demonstrated a sensitivity of 100% (95% CI 63% - 100%), a specificity of 35% (95% CI 26% - 44%), a positive predictive value of 10% (95% CI 4% - 18%), and a negative predictive value of 100.0% (91% to 100%).

Conclusions

The MCBLR demonstrated high sensitivity and negative predictive value for determining the need for repeat ERCP following endoscopic management of laparoscopic cholecystectomy-induced bile leaks.

Funding Agencies

None

Machine Learning and Internet of Things Enabled Monitoring of Post-Surgery Patients: A Pilot Study

Artificial Intelligence (AI) and Internet of Things (IoT) offer immense potential to transform conventional healthcare systems. The IoT and AI enabled smart systems can play a key role in driving the future of smart healthcare. Remote monitoring of critical and non-critical patients is one such field which can leverage the benefits of IoT and machine learning techniques. While some work has been done in developing paradigms to establish effective and reliable communications, there is still great potential to utilize optimized IoT network and machine learning technique to improve the overall performance of the communication systems, thus enabling fool-proof systems. This study develops a novel IoT framework to offer ultra-reliable low latency communications to monitor post-surgery patients. The work considers both critical and non-critical patients and is balanced between these to offer optimal performance for the desired outcomes. In addition, machine learning based regression analysis of patients’ sensory data is performed to obtain highly accurate predictions of the patients’ sensory data (patients’ vitals), which enables highly accurate virtual observers to predict the data in case of communication failures. The performance analysis of the proposed IoT based vital signs monitoring system for the post-surgery patients offers reduced delay and packet loss in comparison to IEEE low latency deterministic networks. The gradient boosting regression analysis also gives a highly accurate prediction for slow as well as rapidly varying sensors for vital sign monitoring.