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A 43-year-old male with history of pulmonary embolism defaulted on anti-coagulation and presented with recurrent massive pulmonary embolism. Echocardiography revealed a serpiginous freely floating right atrial thrombus prolapsing through the tricuspid valve into the right ventricle. Thrombus was also seen crossing the interatrial septum into the left atrium and prolapsing into the left ventricle. Right-sided chambers were dilated with right ventricular dysfunction. Left ventricle was functioning normally. After evaluation by the pulmonary embolism response team, thrombolysis was done with alteplase which resulted in dramatic improvement of the symptoms and complete resolution of the intra-cardiac thrombus. Regular follow-up and counselling are advised henceforth to ensure drug compliance. LEARNING OBJECTIVES: 1. In patients with right heart thrombus crossing an intracardiac communication into left-sided chambers carries an additional risk. 2. Pulmonary embolism response team is essential for clinical decision-making. 3. Echocardiography plays a critical role to diagnose and assess the extent of the intracardiac thrombus and ventricular function. 4. On computed tomography, right ventricular (RV)/left ventricular diameter ratio of >0.9 and the presence of septal bowing signifies the presence of RV strain. 5. Adequate counselling ensuring patient compliance and regular follow up is of utmost importance.

Efficient structural repair of wind turbine blades is essential to limiting global warming and reducing the Levelized Cost of Energy (LCOE). Repairs carried out up-tower are sensitive to environmental conditions whose effect on the material properties during processing needs to be accounted for to accurately predict the repair outcome. This study investigates the effect of moisture content from environmental exposure on the cure kinetics of an infusion resin system used in wind turbine blade manufacturing and repair and provides an experimentally validated finite element tool for the analysis of cure cycle repairs as a function of repair geometry and moisture content. Moisture absorption tests on the two-part infusion system reported up to 12% moisture uptake by the curing agent under high temperature and relative humidity conditions. Differential scanning calorimetric measurements of resin in the presence of moisture revealed an accelerated cure behavior. Numerical predictions of a repair model agreed very well with the corresponding lab-scale repair and revealed a substantial temperature lag within the repair patch which resulted in thermal gradients and spatial distribution of the degree of cure. It was shown that the repair geometry and the accelerated-cure kinetics greatly influenced the temperature and cure distribution within the repair. The proposed approach can be used to reduce turbine downtime by minimizing the curing time., 29 pages, 12 figures

Background The contagious coronavirus disease-2019 (COVID-19) pandemic has had a significant psychological impact on healthcare workers. Intensive care unit (ICU) and emergency room (ER) providers have functioned in an environment of fear for their health as well as their family well-being. Aim and objective The aim and objective of the article was to study mental health disorders (anxiety, depression, stress, post-traumatic stress disorder (PTSD), and sleep quality) in frontliners and to identify factors affecting mental health indices. Materials and methods A survey of 153 doctors and nurses working in ICU and ER was conducted from December 2020 to January 2021 using questionnaire with clinically validated scales: Acute Stress Disorder Scale, Perceived Stress Scale, Beck's Depression Inventory (BDI), Zung Self-rating Anxiety Scale (SAS), Global Pittsburgh Sleep Quality Index (PSQI), Multidimensional Scale of Perceived Social Support (MSPS), and New General Self-efficacy (NGSE) Scale. Analysis was performed to identify of gender, age, place of work, self-efficacy, and social support using logistic regression. Results Of the 153 participants, 21.6% had PTSD, 88.6% had moderate to high stress, 16.3% had anxiety, and 59.5% had poor sleep. Of these, the majority were females and those aged ≤30 years. Males had lesser depression, anxiety, and poor sleep compared to females (p

Increasing consumption of meat-free meals can help reduce demand for factory farmed animal products and anthropogenic greenhouse gas emissions. But relatively little research has been conducted on how meat-free meal selection is influenced by menu options, such as the availability of meat-analogue options or different types of meat.We conducted a preregistered reanalysis of data from a series of hypothetical discrete choice experiments from Brachem et al. (2019). We explored how meat-free meal selection by 1348 respondents (mostly German students) across 26 different menus correlated with the number of meat-free options and the availability of options containing fish/poultry meat or meat-analogues. Our reanalysis has several important limitations that should be noted before considering the implications of the correlations we found. These limitations include: (i) exploring hypotheses that the original study was not designed to evaluate; (ii) de facto observational study design; (iii) possible non-random correlations between the presence of poultry/fish or meat-analogue menu options and the appealingness of other dishes; (iv) analysis of self-reported, hypothetical meal preferences, rather than actual behavior; and (v) meat-analogues in the study not reflecting prominent products attracting significant financial investment.Notwithstanding these caveats, our reanalysis found meat-free meal selection odds were: (i) higher among menus with an extra meat-free option (odds ratio of 2.3, 90% CI [1.8 to 3.0]); (ii) lower among menus featuring poultry or fish options (odds ratio of 0.7, 90% CI [0.6 to 0.9]); and (iii) not significantly associated with the presence of meat-analogues on a menu (odds ratio of 1.2 (90% CI [0.9 to 1.6])).Despite the many limitations, these findings might slightly update our beliefs to the extent we believe correlations would be expected if causation were occurring. The poultry/fish option correlation highlights the potential for welfare losses from substitution towards small-bodied animals from menu changes as well as shifts in consumer preferences.Given the study didn’t feature very prominent meat analogues, the absence of a correlation in this reanalysis cannot credibly be used to refute a belief that high-quality analogues play an important role in reducing meat consumption. But when coupled with the strong correlation on an additional meat-free option, we think the reanalysis highlights the need for further research on the most effective ways to encourage selection of meat-free meals. It remains an open question whether, at the margin, it would be more cost-effective to advocate for more menu options featuring meat-analogues specifically, or for more meat-free options of any kind.

Background/aimsPatients with Barrett's esophagus are at increased risk of developing esophageal adenocarcinoma. Endoscopic therapies aim to eradicate dysplastic and metaplastic tissues. Hybrid argon plasma coagulation (hybrid-APC) utilizes submucosal fluid injection to create a protective cushion prior to ablation that shields the submucosa from injury. We performed a pooled meta-analysis to evaluate the safety and efficacy of hybrid-APC.MethodsWe conducted a systematic search of major electronic databases in April 2022. Studies that included patients with dysplastic and non-dysplastic Barrett's esophagus undergoing treatment with hybrid-APC were eligible for inclusion. Outcome measures included complete remission of intestinal metaplasia (CR-IM), stricture formation, serious adverse events, and number of sessions necessary to achieve CR-IM.ResultsOverall pooled CR-IM rate for patients undergoing hybrid-APC was 90.8% (95% confidence interval [CI], 0.872-0.939; I2=0%). Pooled stricture rate was 2.0% (95% CI, 0.005-0.042; I2=0%). Overall serious adverse event rate was 2.7% (95% CI, 0.007-0.055; I2=0%).ConclusionResults of the current meta-analysis suggest that hybrid-APC is associated with high rates of CR-IM and a favorable safety profile. Interpretation of these results is limited by the inclusion of retrospective cohort and case series data. Randomized controlled trials that standardize treatment and outcome evaluation protocols are necessary to understand how this treatment option is comparable to the current standards of care.

An exploration of how meat-free meal selection varies with the number of meat-free menu options; the availability of meat-analogues; and availability of options produced using the meat of small-bodied animals.

Introduction The COVID-19 pandemic impacted significantly on dental service delivery across England.Objective To explore how and why the pandemic affected antibiotic prescribing by primary care dentists.Methods Mixed-methods study: secondary analysis of routinely collected NHS dental antibiotic prescribing data from before and during the pandemic; and an online survey of dentists (NHS and private) across England's regions.Results Dental antibiotic prescribing increased 22% in the pandemic's first year, with regional variation from a 12.1% increase in London to 29.1% in East of England. Of 159 dentists surveyed, 60% had prescribed 'many more' antibiotics. Some urgent dental centres required antibiotics before accepting referrals, irrespective of clinical appropriateness. Diagnosing remotely was hard. Antibiotics were used to delay aerosol generating procedures and fill gaps in services. Widespread frustration existed.Discussion Maintaining access to urgent dental care during a future pandemic would include availability of high-grade personal protective equipment for dental teams. Everyone must understand the impact of restricted dental access on antibiotic overprescribing and hence antibiotic resistance.Conclusion Reduced dental access and changes in dental service delivery because of the pandemic increased antibiotic prescribing. Ensuring uninterrupted access for all to effective urgent dental care is an important element of global efforts to tackle antibiotic resistance.

Integrating sustainable waste management and procurement into daily practice will encourage the dental profession to tackle environmental change.

A computational process modeling framework, informed by accurate material characterization, is presented for virtual manufacturing of wind energy thermoset composites. Process modeling simulations of composite microstructures are carried out to predict in-situ matrix property evolution and performance-altering residual stress generation. To achieve this, comprehensive material characterization effort is carried out. A novel material property dataset for a widely-used wind energy thermoset system is generated as a function of the temperature and curing. Informed by these material properties, the ability of the process model to reliably estimate manufacturing-induced residual stresses is highlighted. For a prescribed cure cycle, in-situ elastic modulus evolution, chemical and thermal strains, and random fiber distribution are shown to significantly influence residual stress generation. The results also show that a full process modeling analysis that includes the complete cure cycle (instead of the standard approach of just considering post-processing cool-down) is necessary to accurately predict manufacturing-induced residual stresses.

Video 1Hybrid APC for Barrett's esophagus.

This session discusses the empirical and research implementation of INDOT concrete pavement design.

Epoxy resins are used extensively in composite materials for a wide range of engineering applications, including structural components of aircraft and spacecraft. The processing of fiber-reinforced epoxy composite structures requires carefully selected heating and cooling cycles to fully cure the resin and form strong crosslinked networks. To fully optimize the processing parameters for effective epoxy monomer crosslinking and final product integrity, the evolution of mechanical properties of epoxies during processing must be comprehensively understood. Because the full experimental characterization of these properties as a function of the degree of cure is difficult and time-consuming, efficient computational predictive tools are needed. The objective of this research is to develop an experimentally validated Molecular Dynamics (MD) modeling method, which incorporates a reactive force field, to accurately predict the thermo-mechanical properties of an epoxy resin as a function of the degree of cure. Experimental rheometric and mechanical testing are used to validate an MD model which is subsequently used to predict mass density, shrinkage, elastic properties, and yield strength as a function of the degree of cure. The results indicate that each of the physical and mechanical properties evolve uniquely during the crosslinking process. These results are important for future processing modeling efforts., Comment: 21 pages, 17 figures

It is thought that frontostriatal circuits play an important role in mediating conditioned behavioral responses to environmental stimuli that were previously encountered during drug administration. However, the neural correlates of conditioned responses to drug-associated cues are not well understood at the level of large populations of simultaneously recorded neurons, or at the level of local field potential (LFP) synchrony in the frontostriatal network. Here we introduce a behavioral assay of conditioned arousal to cocaine cues involving pupillometry in awake head-restrained mice. After just 24 h of drug abstinence, brief exposures to olfactory stimuli previously paired with cocaine injections led to a transient dilation of the pupil, which was greater than the dilation effect to neutral cues. In contrast, there was no cue-selective change in locomotion, as measured by the rotation of a circular treadmill. The behavioral assay was combined with simultaneous recordings from dozens of electrophysiologically identified units in the medial prefrontal cortex (mPFC) and ventral striatum (VS). We found significant relationships between cocaine cue-evoked pupil dilation and the proportion of inhibited principal cells in the mPFC and VS. Additionally, LFP coherence analysis revealed a significant correlation between pupillary response and synchrony in the 25-45 Hz frequency band. Together, these results show that pupil dilation is sensitive to drug-associated cues during acute stages of abstinence, and that individual animal differences in this behavioral arousal response can be explained by two complementary measures of frontostriatal network activity.

The cold spray process is an additive manufacturing technology primarily suited for ductile metals, and mainly utilized in coating surfaces, manufacturing of freeform parts and repair of damaged components. The process involves acceleration of solid micro-particles in a supersonic gas flow and coating build-up by bonding upon high velocity impact onto a substrate. Coating deposition relies on the kinetic energy of the particles. The main objective of this study was to investigate the mechanics of polymer cold spray process and deformation behavior of polymers to improve technological implementation of the process. A finite element model was created to simulate metal particle impact for copper and aluminum. These results were compared to the numerical and experimental results found in the literature to validate the model. This model was then extended to cover a wide range of impact conditions, in order to reveal the governing mechanisms of particle impact and rebound during cold spray. A systematic analysis of a single high-density polyethylene particle impacting on a semi-infinite high density polyethylene substrate was carried out for initial velocities ranging between 150m/s and 250m/s by using the finite element analysis software ABAQUS. A series of numerical simulations were performed to study the effect of a number of key parameters on the particle impact dynamics. These key parameters include: particle impact velocity, particle temperature, particle diameter, and particle density, composition of the polyethylene particle, surface composition and the thickness of a polyethylene film on a hard metal substrate. The effect of these parameter variations were quantified by tracking the particle temperature, deformation, plastic strain and rebound kinetic energy. The variation of these parameters helped define a window of deposition where the particle is mostly likely to adhere to the substrate.