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Microstructural and electrochemical corrosion behaviours of Al40(SiCrFeMnNiCu)60(at %) high entropy alloy (HEA) were studied. The as-cast-alloy formed B2 and Cr5Si3intermetallic phases. The HEA showed active, passive and transpassive behaviour for pH (0–3), and spontaneous passivity for pH (14–11). The HEA showed higher transpassive dissolution at low pH values than alkaline pH values. This has been attributed to minor variation in the passive film composition of the HEA between the acidic and alkaline pH condition as observed using X–ray photoelectron spectroscopy (XPS). Considering the beneficial role of copper and silicon in sulphuric acid in stabilizing the passive film in reducing the critical current density for passivation and also the role of silicon in stabilizing the passive film, they are suggested to be responsible for the improved passivity. In 3.5 wt% NaCl solution, the alloy did not show any kind of passivity. The selective dissolution of the alloy was evident at B2/Cr5Si3interface regions and the Cr5Si3phase showed relatively more resistance to corrosion.

Patella fractures in the pediatric age group often have a dilemma in their ease of diagnosis and treatment required. Indications for conservative management or surgical intervention in the pediatric population during growth phase are not clearly defined. The current systematic review aims to provide a consensus on the morphological types, treatment options, indications, the outcomes expected and complications and their management.

BACKGROUND The diagnosis of pulmonary embolism (PE) can be vexing for clinicians because the signs and symptoms that manifest are vague, broad, and nonspecific. Patients can present with a spectrum [...]

SummaryThe UK's services for adult attention-deficit hyperactivity disorder (ADHD) are in crisis, with demand outstripping capacity and waiting times reaching unprecedented lengths. Recognition of and treatments for ADHD have expanded over the past two decades, increasing clinical demand. This issue has been exacerbated by the COVID-19 pandemic. Despite an increase in specialist services, resource allocation has not kept pace, leading to extended waiting times. Underfunding has encouraged growth in independent providers, leading to fragmentation of service provision. Treatment delays carry a human and financial cost, imposing a burden on health, social care and the criminal justice system. A rethink of service procurement and delivery is needed, with multiple solutions on the table, including increasing funding, improving system efficiency, altering the service provision model and clinical prioritisation. However, the success of these solutions hinges on fiscal capacity and workforce issues.

The role of applied strain in altering the nature of corrosion attack on AA 7004 having two different microstructures is studied using electrochemical noise technique. The current and potential responses between electrodes of identical temper, with one electrode being subjected to slow strain rate loading, are recorded at every 8 h intervals. The obtained current and potential data are analyzed using statistical and shot noise analysis. The effect of strain in altering corrosion attack, localized or uniform, depends on the microstructure of the material. The microstructure wherein predominantly G.P. zones are present showed lower standard deviation values of the current and potential signals, and a lower ratio of characteristic charge to characteristic frequency (q/fn) under strained condition than in the un-strained condition. On the contrary, when the alloy had predominantly η’/ηprecipitates, a higher standard deviation values of the current and potential signals and a higher q/fnvalue for the stained specimen as compared to that of the un-strained specimen were observed. Thus, straining in case of the former microstructure promoted a relatively uniform corrosion attack, as planar slip activity is expected to result in successive film rupture at same site, resulting in lower values of standard deviations of current and potential while in latter case (that of microstructure with predominantly η’/ηprecipitates) a more localized attack was observed due to occurrence of wavy slip.

The study was aimed to remove the fluoride from aqueous solution by plant materials through batch experiment. The bio-adsorbents (Manilkara zapotaand peels of Solanum tuberosum) were thermally activated and converted into ash. The batch study was performed in a laboratory and optimized by dose and time. The maximum removal of fluoride was observed in 0.8 g/100 ml for 77.6% and in 150 and 180 min for 77.6% in M. zapotaand S. tuberosum. In the dosage optimization, the higher fluoride was removed in 77.6% in 0.8 g/100 ml in M. zapotaand in 73% removal noticed for 0.8 g/100 ml in S. tuberosum. In IR spectra, M. zapotahas showed several active functional groups such as Alkyl Halide, Alkyl, Alkene, Alcohol, Alkane and Amides that were recorded between 549.71 and 3192.19 cm−1. The surface structure of micropores, rough surface, and crystalline clusters was observed in SEM analysis. The water quality parameters of the drinking water after biosorbtion of the biomaterials, maximum purity and good condition of water quality were observed in both, but M. zapotais a better sorbent. The plant materials are to be a suitable low-cost technique for the mass scale removal of fluoride from industrial effluents.

BACKGROUND In the decade since the passage of the Affordable Care Act and its incentivization of the adoption of electronic health records (EHRs), the availability of electronic health information has [...]

BACKGROUND Clinical decision support (CDS) assists clinicians with accessing and processing information to enhance healthcare delivery. Evolving alongside rapid advancements in medicine over the past several decades, the adoption of [...]

Post-operative physiotherapy is a major component of the effectiveness of knee replacement. Adequate rehabilitation protocols are required for better functional outcomes. With the advent of smartphones and smartwatches, the use of telerehabilitation has increased recently. This study aims to compare tele rehabilitation using various mobile-based applications to conventional rehabilitation protocols.

Background: Despite the variability in glenoid sizes geographically, most of the currently available commercial glenoid component designs are based on the glenoid parameters of the Caucasian population which may not be suitable for the Indian population due to a mismatch between the prosthesis and native anatomy. The aim of the present study is to systematically review the literature to determine the average glenoid anthropometric parameters in the Indian population. Methods: A comprehensive literature search was conducted using preferred reporting items for systematic reviews and meta-analyses guidelines in the PubMed, EMBASE, Google Scholar, and Cochrane Library databases from the date of inception to May 2021. Any observational study conducted on the Indian population measuring the glenoid diameters, glenoid index, version, inclination, or any other glenoid measurements were included in the review. Results: A total of 38 studies were included in this review. The glenoid parameters were assessed on intact cadaveric scapulae in 33 studies, on 3DCT in three studies, and 2DCT in one study. The pooled average of glenoid dimensions are as the following- the superoinferior diameter or height was 34.65 mm, anteroposterior1 diameter or maximum width was 23.72 mm, anteroposterior2 diameter or maximum width of the upper part of the glenoid was 17.05 mm, the glenoid index was 67.88, and the glenoid version was 1.75-degree retroversion. Males were having a mean height of 3.65 mm and maximum width of 2.74 mm larger than the females. A subgroup analysis revealed no significant difference between different parts of India in glenoid parameters. Conclusion: The glenoid dimensions in the Indian population are smaller compared to the average European and American populations. The average glenoid maximum width of the Indian population is 1.3 mm smaller than the minimum glenoid baseplate size available in reverse shoulder arthroplasty. Glenoid components specific to the Indian market need to be designed to reduce glenoid failure attributable to the above findings. Level of evidence: III.

Purpose: The current generation has witnessed significant progress in the field of knee arthroscopy. Suture tapes have gained immense popularity due to perceived improved biomechanical support to the graft while it heals. The purpose of the present systematic review is to analyze the biomechanical construct of suture tapes in ACL repairs and reconstructions along with clinical outcomes. Methods: Cochrane Library, PubMed, and Embase were searched until December 2021. All Biomechanical Studies on animal or cadaver knees that compared construct characteristics of suture tape in ACL repair or reconstruction and clinical studies in English focusing on outcomes following suture tape augmentation in ACL repair or reconstruction were included. The quality of clinical studies using the Modified Coleman Methodology Score (MCMS). Results: A total of 16 studies biomechanical and 23 clinical studies were included in qualitative synthesis, leaving nine biomechanical studies for final quantitative analyses. Suture tape revealed biomechanical superiority in terms of ultimate strength, stiffness, cyclic displacement, and elongation of graft, while comparing ACLR with internal brace to standard ACLR. No significant difference in retear rates was seen in clinical studies. Clinical score(IKDC score) was found similar in both augmented and non-augmented construct. Similar results were obtained in biomechanical studies. Conclusion: The use of suture tape as a ligament augmentation in both ACL reconstruction and ACL repair offers more strength, less elongation or displacement, and is biomechanically stable and sound. There is a lack of data to comprehensively comment upon the clinical superiority of the use of internal augmentation. However, a meta-analysis of the retear rates and clinical outcome score revealed similar outcomes between suture tape augmented and nonaugmented groups.

Introduction: Tuberculosis of the hip joint is a debilitating disease that can result in severe joint destruction, eventually leading to painful arthritis of the hip. Total hip arthroplasty (THA) in patients with advanced arthritis offers a painless and mobile joint with good functional outcome but some aspects of THA in TB hip have been controversial in the past due to the concerns of disease reactivation, especially when disease activity is factored in. Various factors like timing of surgery, Antitubercular therapy (ATT) initiation timing, reactivation, complications etc needs to be evaluated very carefully before planning for such cases. Methods: Electronic databases like MEDLINE, EMBASE, Cochrane library, Clinicaltrials gov and OpenGrey were searched. The key words used were “Tuberculosis”, “Tuberculosis of hip”, Hip tuberculosis, “TB”, “THR”, “total hip replacement”, “total hip arthroplasty”,”THA”, “ankylosed hip”, “fused hip”, “arthrodesis” along with boolean operators “AND” and “OR”. Out of a total of 1634 articles, 38 were selected for full text review and 22 articles were finally included in the study. Results: For the timing of surgery most authors relied on the inflammatory markers to settle down with ATT before performing THA. 15 authors advocated use of pre-operative ATT with 6 studies recommending at least 2 weeks and 3 studies advocating atleast 3 months of ATT pre surgery.Single stage THA was performed in most studies(214 hips vs 18 hips) as opposed to 2 or 3 stage surgery. In the active disease 72.8% of the hips had uncemented prosthesis, 25.6% hips underwent cemented and 1.5% hips had hybrid THA fixation. Overall reactivation of the infection was seen in 2.47% cases. All authors reported excellent clinical improvement (mean HHS improvement 37.17 to 88.62).

Precipitation hardenable 17–4 PH stainless steel was subjected to a solution-annealing heat treatment followed by ageing treatments at 580 °C for durations up to 6 h. Slow-strain rate testing (SSRT) has been done for the material in the solution-annealed condition, peak-aged condition and overaged condition in a chloride environment at a strain rate of 3 × 10–7/s. The stress corrosion cracking (SCC) susceptibility of the material in different aged conditions was evaluated by comparing the percentage reduction in ductility in the environment in the SSRT test reference to the ductility of the individual material conditions in air. Results indicated that the solution-annealed material is more resistant to stress corrosion cracking than the material in aged conditions, i.e. ageing treatment leads to a deterioration in the stress corrosion cracking resistance of the material in chloride environment with the maximum susceptibility in peak-aged condition. The SCC susceptibility of the material in chloride environment has been found to be directly related to the strength of the material.

BackgroundEye protection is a mandatory component of the personal protective equipment in healthcare settings, especially for suspected or confirmed cases of COVID-19 and during aerosolising procedures. Fogging of protective eyewear is a frequent problem experienced by providers. The hydrophilic property of a sulfonated polymer, BiaXam, may be able to decrease fogging through wicking moisture from the lens. In this study, we tested the anti-fogging properties of this polymer when applied to protective eyewear.MethodsAn investigator-initiated prospective, randomised, single-blinded cross-over study was conducted in an emergency department in a large, tertiary care hospital. Participants were blinded and randomised first to either a pair of anti-fog coated or uncoated eyewear, and then to the alternative pair after 2 hours. Study participants completed an identical survey at the end of each 2-hour period.Results50 emergency medicine healthcare providers were enrolled and 48 completed the study. Results demonstrated a significant difference in fogging between the coated and uncoated eyewear, as 81% of the participants reported fogging of the uncoated lenses and only 55% of the participants reported fogging in the coated pair (p=0.0029). Participants reported that the uncoated lenses fogged two times as frequently on a 10-point Likert scale (4.5±3.3 vs 2.1±2.5; p<0.0001). Subgroup analysis of participants who wore only a surgical mask demonstrated even more efficacious results with coated eyewear.ConclusionOverall, sulfonated polymer-coated eyewear improved provider visualisation, user experience and perceived mitigation of potential medical errors.

The work aims to understand the influence of oxide scales and chloride ions on the pickling behaviour of hot-rolled steel coil. The thickness and nature of the oxide scale (such as the content of the phases and the phases present in different regions) were found to vary across the width of the steel coil. NaCl addition to 10% HCl reduced pickling time by 3.3 times and the corrosion rate of the bare steel by 1.5 times. Chlorides enhanced chemical dissolution of the oxide scale, by complexing, and inhibiting corrosion of steel through the familiar Temkin adsorption mechanism.

Purpose: Surgical wound closure is of paramount importance, especially in total joint replacement surgeries wherein correct closure technique not only aids in rapid healing, but with lesser complications, we would be looking at a quicker rehabilitation of the patients. Bidirectional barbed sutures appear to reduce the wound closure time in all the planes and are cost-effective in comparison with traditional sutures. This study is aimed at evaluating the efficacy and superiority of bidirectional barbed sutures in comparison to traditional suturing techniques. Methods: Electronic databases like Embase, PubMed, Cochrane Library, Lilacs were searched up to February 2021. 16 high-quality randomized-controlled trials (RCT) were selected in this study. The search method identified 2168 total knee replacements (TKR) and 229 total hip replacements (THR) among 2397 patients. All the studies compared barbed sutures with traditional wound closure techniques. Data of wound closure time, overall cost, length of hospital stay, overall wound complications, suture-related complications, range of motion data, and knee society scores were collected and further analyzed. Results: The baseline patient characteristics were identical among all the included studies. Compared to traditional sutures a significantly decreased wound closure time in both THR and TKRs (p&lt; 0.00001) and cost (p&lt; 0.00001) was noted, although no statistically significant difference was found in overall complications in THRs (p= 0.95) and TKRs (p= 0.69). ROM (p= 0.54—6 weeks after surgery and p= 0.68—3 months after surgery) and Knee society scores (p= 0.92) in both the groups of patients undergoing TKR. However, the length of hospital stay was prolonged in the barbed suture group (p= 0.01), pinpricks (p= 0.02), and broken sutures (p= 0.02). Conclusions: Novel methods of wound closure such as barbed sutures achieve satisfactory surgical implementation being more efficient in the form of decreasing the overall wound closure time, with comparable wound complication rates and being cost-effective. But the drawbacks like the incidence of broken sutures and pinpricks are more. Overall using barbed sutures in place of traditional sutures may be considered safe and a viable alternative choice for suturing in total joint replacements. Level of Evidence: Level I, Systematic review and Meta-analysis of RCT.

Purpose: Patients with varus knee osteoarthritis usually compensate at the ankle and typically walk with hindfoot valgus alignment. As the neutral weight-bearing axis of the lower limbs is restored with Total Knee Arthroplasty (TKA), ankle and hindfoot biomechanics also acutely change. This study aims to investigate whether any ankle clinical-radiographical changes occur as a result of bilateral mechanical TKA in patients with bilateral Osteoarthritis knee at a minimum follow-up of 6 months. Methods: The prospective observational study included 61 patients (122 knees) undergoing simultaneous bilateral TKA (mechanical alignment). Tibio-talar angle(TTA), tibial Anterior Surface angle (TAS), lateral distal tibial angle (LDTA), talar-tilt angle (TT), anatomical talocrural angle (aTC), ground surface and distal tibial plafond angle (GP), ground surface and an upper surface of talus angle (GT)and tibial plateau and tibial plafond angle (PP) were measured on long-film radiographs to look for changes in the ankle, whereas functional assessment was done using American Foot and Ankle Society (AOFAS), Foot and Ankle Disability Index (FADI), and Forgotten Joint (FJS-12) scores. Patients were sub-grouped based on the Hip-Knee-Ankle (HKA) axis, and the effect of the severity of knee varus on the ankles after TKA was also analyzed. The minimum follow-up was 6 months. Results: A significant decrease in the tibial plateau-tibial plafond (PP), ground-tibial plafond (GP), and ground-talar dome (GT) angles was noted after TKA (p-value &lt; 0.05). Postoperative functional parameters were comparable to the preoperative status except for FADI, which significantly improved (p-value-0.03). Sub-group analysis based on the severity of knee varus (HKA) revealed GT to be most significantly reduced (p-value-0.036), while the talar tilt (TT) increased (p-value-0.044). Functional outcomes of the ankles clinically improved with the correction of severe knee varus after TKA. At a mean follow-up of 13.2 months post-TKA, 7 out of 61 (11.4%) patients complained of post-TKA ipsilateral ankle pain. Conclusion: Mechanically aligned bilateral TKA in severe varus deformity of the knee significantly decreases the GT angle but increases the varus tilt of the talus with lateral talar incongruency and under-coverage. Although the acute correction of severe knee varus deformity aligns the tibia more neutrally, resulting in an overall clinically evident improvement in ankle functional outcome, the increased varus talar tilt remains a deep concern. Level of Evidence: Prospective, observational, comparative study Level II.

In the quest for creating a sustainable future, coal-fired boilers and nuclear reactors are increasingly moving towards higher steam temperatures and pressures that can help in reducing emissions and increase operational efficiencies. This trend has now transitioned to adopting Advanced Ultra-Supercritical (AUSC) water technology that involves steam temperatures and pressures as high as 760 ℃ and 32 MPa. This transition poses serious material challenges, and one such is the demanding steam oxidation resistance expected of the candidate Ni-base alloys. Steam oxidation is a severe problem that can cause significant downtime in power generation. Several studies have focused on testing the steam oxidation resistance of candidate Ni-base alloys in supercritical water environments under varying test conditions. They differ from each other in terms of various operational parameters, including the time, temperature, pressure, alloy surface condition, dissolved oxygen (DO) content, steam flow/stagnancy conditions, and presence of additional oxidants like acids, salt, etc. The presence of so many such variables and the complex interplay between them makes it challenging to compare the oxidation performance of various Ni-base alloys and understand the effect of each operational parameter towards oxidation. In addition, widely differing opinions are being held about the role of several operating parameters in causing steam oxidation. This review work is an attempt to consolidate all such relevant works, critically analyze the results reported, generalize the trends observed, identify the variations among reported works and throw light on the shortcomings.

Introduction: Diagnosing postero-lateral knee instability is a challenge from both clinical and radiologic perspective and can lead to significant morbidity if left untreated. Delayed diagnosis leads to a more demanding surgery and prolonged rehabilitation for the patient. Kneeling stress radiograph is a lost art but remains invaluable in the assessment of postero-lateral knee instability. Methods: This prospective observational study is aimed at re-exploring the undeniable utility of this forgotten tool in early diagnosis of posterolateral knee instability and identifying the mean posterior tibial translation distance (PTTD) and also assessing side to side difference (SSD) between the injured and the contralateral normal knee. Results: Total 27 patients were included in the study, with males being 4.4 times more commonly injured as compared to females. The most common mode of injury was motor vehicle accident (MVA). Out of 27 patients, 11 had isolated PCL (posterior cruciate ligament) injury while the rest had PLC (posterolateral corner) involvement. The mean SSD of PTTD was 8.79 mm in patient with isolated PCL. This was increased by 1.65 times (14.52 mm) in patients with co-existing PLC involvement. Conclusion: Stress radiography is an indelible tool and serves as an adjunct to MRI imaging. It is not a substitute for clinical assessment but assists in early diagnosis and management, facilitating surgical planning and furnishing objective evidence of PCL/PLC functionality which is not possible with any other imaging modality.

In the present investigation, the enhanced pesticidal activity of fungal-based pesticidal metabolites extracted from a well-known fungal biocontrol agent biogenic silver nanoparticles–fungal-based insecticidal metabolite (AgNp–FM) was evaluated against major lepidopteron pest Spodoptera litura(Fab.). Nanoconjugate was prepared from silver nanoparticles–pesticidal metabolites extracted from Nomuraea rileyi; adopting in vitro green science principles reveals highly stable, amorphous, monodispersive nanodimensional particles. Determination of pesticidal activity was studied by measuring pesticidal activity against major lepidopteron pest Spodoptera litura(Fab.). Nanoconjugate thus synthesised brought about notable mortality against all the larval instars. Developmental parameters were also highly affected in nanoconjugate treatment. High efficacy of the nanoconjugate thus obtained would suggest the possible utilisation of nanoconjugate as an effective, safe pesticidal agent against economically important insect pests.

Despite high levels of prenatal alcohol exposure in the UK, evidence on the prevalence of fetal alcohol spectrum disorders (FASD) is lacking. This paper reports on FASD prevalence in a small sample of children in primary school. A 2‐phase active case ascertainment study was conducted in 3 mainstream primary schools in Greater Manchester, UK. Schools were located in areas that ranged from relatively deprived to relatively affluent. Initial screening of children aged 8–9 years used prespecified criteria for elevated FASD risk (small for age; special educational needs; currently/previously in care; significant social/emotional/mental health symptoms). Screen‐positive children were invited for detailed ascertainment of FASD using gold standard measures that included medical history, facial dysmorphology, neurological impairment, executive function, and behavioral difficulties. Of 220 eligible children, 50 (23%) screened positive and 12% (26/220) proceeded to Phase 2 assessment. Twenty had a developmental disorder, of whom 4 had FASD and 4 were assessed as possible FASD. The crude prevalence rate of FASD in these schools was 1.8% (95% CI: 1.0%, 3.4%) and when including possible cases was 3.6% (2.1%, 6.3%). None of these children had previously been identified with a developmental diagnosis. FASD was found to be common in these schools and most of these children's needs had not previously been identified. A larger, more definitive study that uses a random sampling technique stratified by deprivation level to select schools is needed to make inferences regarding the population prevalence of FASD. A two‐phase active case ascertainment study in mainstream primary schools in the UK where 220 children aged 8‐9 years were screened for elevated FASD risk and screen positive children were invited for detailed ascertainment of FASD using gold standard measures. The crude prevalence rate of FASD was 1.8% (95%CI: 1.0%, 3.4%). The rate was 3.6% (2.1%, 6.3%), if any possible cases were included. FASD was found to be common in these schools, but limitations to the sampling restrict inferences to a population prevalence.

Emergency departments (EDs) often serve vulnerable populations who may lack primary care and have suffered disproportionate COVID-19 pandemic effects. Comparing patients having and lacking a regular source of medical care and other ED patient characteristics, we assessed COVID-19 vaccine hesitancy, reasons for not wanting the vaccine, perceived access to vaccine sites, and willingness to get the vaccine as part of ED care.

Non-Hermitian photonic systems with gains and/or losses have recently emerged as a powerful approach for topology-protected optical transport and novel device applications. To date, most of these systems employ coupled optical systems of diffraction-limited dielectric waveguides or microcavities, which exchange energy spatially or temporally. Here, we introduce a diffraction-unlimited approach using a plasmon–exciton coupling (polariton) system with tunable plasmonic resonance (energy and line width) and coupling strength. By designing a chirped silver nanogroove cavity array and coupling a single tungsten disulfide monolayer with a large contrast in resonance line width, we show the tuning capability through energy level anticrossing and plasmon–exciton hybridization (line width crossover), as well as spontaneous symmetry breaking across the exceptional point at zero detuning. This two-dimensional hybrid material system can be applied as a scalable and integratable platform for non-Hermitian photonics, featuring seamless integration of two-dimensional materials, broadband tuning, and operation at room temperature.

We present a strong coupling system realized by coupling the localized surface plasmon mode in individual silver nanogrooves and propagating surface plasmon modes launched by periodic nanogroove arrays with varied periodicities on a continuous silver medium. When the propagating modes are in resonance with the localized mode, we observe a √Nscaling of Rabi splitting energy, where Nis the number of propagating modes coupled to the localized mode. Here, we confirm a giant Rabi splitting on the order of 450–660 meV (N= 2) in the visible spectral range, and the corresponding coupling strength is 160–235 meV. In some of the strong coupling cases studied by us, the coupling strength is about 10% of the mode energy, reaching the ultrastrong coupling regime.

With the proliferation of ultrahigh-speed mobile networks and internet-connected devices, along with the rise of artificial intelligence (AI)1, the world is generating exponentially increasing amounts of data that need to be processed in a fast and efficient way. Highly parallelized, fast and scalable hardware is therefore becoming progressively more important2. Here we demonstrate a computationally specific integrated photonic hardware accelerator (tensor core) that is capable of operating at speeds of trillions of multiply-accumulate operations per second (1012MAC operations per second or tera-MACs per second). The tensor core can be considered as the optical analogue of an application-specific integrated circuit (ASIC). It achieves parallelized photonic in-memory computing using phase-change-material memory arrays and photonic chip-based optical frequency combs (soliton microcombs3). The computation is reduced to measuring the optical transmission of reconfigurable and non-resonant passive components and can operate at a bandwidth exceeding 14 gigahertz, limited only by the speed of the modulators and photodetectors. Given recent advances in hybrid integration of soliton microcombs at microwave line rates3–5, ultralow-loss silicon nitride waveguides6,7, and high-speed on-chip detectors and modulators, our approach provides a path towards full complementary metal–oxide–semiconductor (CMOS) wafer-scale integration of the photonic tensor core. Although we focus on convolutional processing, more generally our results indicate the potential of integrated photonics for parallel, fast, and efficient computational hardware in data-heavy AI applications such as autonomous driving, live video processing, and next-generation cloud computing services.

During the coronavirus disease 2019 pandemic, there was a higher rate of physical intimate partner violence (IPV), with more severe injuries on radiologic images, despite fewer patients reporting IPV.

Estimates for the UK suggest that alcohol consumption during pregnancy and prevalence of fetal alcohol spectrum disorder (FASD)—the most common neurodevelopmental condition—are high. Considering the significant health and social impacts of FASD, there is a public health imperative to prioritise prevention, interventions and support. In this article, we outline the current state of play regarding FASD knowledge and research in the UK, which is characterised by a lack of evidence, a lack of dedicated funding and services, and consequently little policy formulation and strategic direction. We highlight progress made to date, as well as current knowledge and service gaps to propose a way forward for UK research.

Emergency department (ED) crowding continues to be a major challenge and has important ramifications for patient care quality. One strategy to decrease ED crowding has been to implement alternative pathways to traditional hospital admission. Through a survey-based retrospective cohort study, we aimed to assess the patient experience for those who agreed to transfer and admission to an affiliated community hospital from a large, academic center’s ED. In all, 85% of participants rated their overall experience as either great or good, 92% did not find it hard to make the decision to be transferred, and 95% found the transfer process itself to be easy.

Aluminum has attracted a great deal of attention as an alternative plasmonic material to silver and gold because of its natural abundance on Earth, material stability, unique spectral capability in the ultraviolet spectral region, and complementary metal-oxide-semiconductor compatibility. Surprisingly, in some recent studies, aluminum has been reported to outperform silver in the visible range due to its superior surface and interface properties. Here, we demonstrate excellent structural and optical properties measured for aluminum epitaxial films grown on sapphire substrates by molecular-beam epitaxy under ultrahigh vacuum growth conditions. Using the epitaxial growth technique, distinct advantages can be achieved for plasmonic applications, including high-fidelity nanofabrication and wafer-scale system integration. Moreover, the aluminum film thickness is controllable down to a few atomic monolayers, allowing for plasmonic ultrathin layer devices. Two kinds of aluminum plasmonic applications are reported here, including precisely engineered plasmonic substrates for surface-enhanced Raman spectroscopy and high-quality-factor plasmonic surface lattices based on standing localized surface plasmons and propagating surface plasmon polaritons, respectively, in the entire visible spectrum (400–700 nm).

Our pooled analysis showed that hip fracture for which surgery is recommended is diagnosed in four to nine of every 10 elderly patients clinically suspected to have hip fracture but with negative or equivocal initial radiographs; further advanced imaging (preferably MRI) may be clinically appropriate.

Microwave photonic technologies, which upshift the carrier into the optical domain, have facilitated the generation and processing of ultra-wideband electronic signals at vastly reduced fractional bandwidths. For microwave photonic applications such as radars, optical communications and low-noise microwave generation, optical frequency combs are useful building blocks. By virtue of soliton microcombs, frequency combs can now be built using CMOS-compatible photonic integrated circuits. Yet, currently developed integrated soliton microcombs all operate with repetition rates significantly beyond those that conventional electronics can detect, preventing their use in microwave photonics. Access to this regime is challenging due to the required ultra-low waveguide loss and large dimensions of the nanophotonic resonators. Here, we demonstrate soliton microcombs operating in two widely employed microwave bands, the X-band (~10 GHz, for radar) and the K-band (~20 GHz, for 5G). Driven by a low-noise fibre laser, these devices produce more than 300 frequency lines within the 3 dB bandwidth, and generate microwave signals featuring phase noise levels comparable to modern electronic microwave oscillators. Our results establish integrated microcombs as viable low-noise microwave generators. Furthermore, the low soliton repetition rates are critical for future dense wavelength-division multiplexing channel generation schemes and could significantly reduce the system complexity of soliton-based integrated frequency synthesizers and atomic clocks.

In the current era of frequent chest computed tomography (CT) for adult blunt trauma evaluation, many minor injuries are diagnosed, potentially rendering traditional teachings obsolete. We seek to update teachings in regard to thoracic spine fracture by determining how often such fractures are observed on CT only (ie, not visualized on preceding trauma chest radiograph), the admission rate, mortality, and hospital length of stay of thoracic spine fracture patients, and how often thoracic spine fractures are clinically significant.

Surface-enhanced Raman spectroscopy (SERS) is an ultrasensitive technique to identify vibrational fingerprints of trace analytes. However, present SERS techniques suffer from the lack of uniform, reproducible, and stable substrates to control the plasmonic hotspots in a wide spectral range. Here, we report the promising application of epitaxial aluminum films as a scalable plasmonic platform for SERS applications. To assess the uniformity of aluminum substrates, atomically thin transition metal dichalcogenide monolayers are used as the benchmark analyte due to their inherent two-dimensional homogeneity. Besides the distinctive spectral capability of aluminum in the ultraviolet (325 nm), we demonstrate that the aluminum substrates can even perform comparably with the silver counterparts made from single-crystalline colloidal silver crystals using the same SERS substrate design in the visible range (532 nm). This is unexpected from the prediction solely based on optical dielectric functions and illustrate the superior surface and interface properties of epitaxial aluminum SERS substrates.

High-speed actuation of laser frequency1is critical in applications using lasers and frequency combs2,3, and is a prerequisite for phase locking, frequency stabilization and stability transfer among optical carriers. For example, high-bandwidth feedback control of frequency combs is used in optical-frequency synthesis4, frequency division5and optical clocks6. Soliton microcombs7,8have emerged as chip-scale frequency comb sources, and have been used in system-level demonstrations9,10. Yet integrated microcombs using thermal heaters have limited actuation bandwidths11,12of up to 10 kilohertz. Consequently, megahertz-bandwidth actuation and locking of microcombs have only been achieved with off-chip bulk component modulators. Here we demonstrate high-speed soliton microcomb actuation using integrated piezoelectric components13. By monolithically integrating AlN actuators14on ultralow-loss Si3N4photonic circuits15, we demonstrate voltage-controlled soliton initiation, tuning and stabilization with megahertz bandwidth. The AlN actuators use 300 nanowatts of power and feature bidirectional tuning, high linearity and low hysteresis. They exhibit a flat actuation response up to 1 megahertz—substantially exceeding bulk piezo tuning bandwidth—that is extendable to higher frequencies by overcoming coupling to acoustic contour modes of the chip. Via synchronous tuning of the laser and the microresonator, we exploit this ability to frequency-shift the optical comb spectrum (that is, to change the comb’s carrier-envelope offset frequency) and make excursions beyond the soliton existence range. This enables a massively parallel frequency-modulated engine16,17for lidar (light detection and ranging), with increased frequency excursion, lower power and elimination of channel distortions resulting from the soliton Raman self-frequency shift. Moreover, by modulating at a rate matching the frequency of high-overtone bulk acoustic resonances18, resonant build-up of bulk acoustic energy allows a 14-fold reduction of the required driving voltage, making it compatible with CMOS (complementary metal–oxide–semiconductor) electronics. Our approach endows soliton microcombs with integrated, ultralow-power and fast actuation, expanding the repertoire of technological applications of microcombs.

Timely treatment is essential for optimal outcomes after burn injury, but the method of resource distribution to ensure access to proper care in developing countries remains unclear. We therefore sought to examine access to burn care and the presence/absence of resources for burn care in India. We surveyed all eligible burn centers (n = 67) in India to evaluate burn care resources at each facility. We then performed a cross-sectional geospatial analysis using geocoding software (ArcGIS 10.3) and publicly available hospital-level data (WorldStreetMap, WorldPop database) to predict the time required to access care at the nearest burn center. Our primary outcome was the time required to reach a burn facility within India. Descriptive statistics were used to present our results. Of the 67 burn centers that completed the survey, 45% were government funded. More than 1 billion (75.1%) Indian citizens live within 2 hours of a burn center, but only 221.9 million (15.9%) live within 2 hours of a burn center with both an intensive care unit (ICU) and a skin bank. Burn units are staffed primarily by plastic surgeons (n = 62, 93%) with an average of 5.8 physicians per unit. Most burn units (n = 53, 79%) have access to hemodialysis. While many Indian citizens live within 2 hours of a burn center, most centers do not offer ICU and skin bank services that are essential for modern burn care. Reallocation of resources to improve transportation and availability of ICU and skin bank services is necessary to improve burn care in India.

The effect of urgent cares on local emergency department (ED) patient volumes is presently unknown. In this paper, we aimed to assess the change in low-acuity ED utilization at 2 academic medical centers in relation to patient proximity to an affiliated urgent care.

ABSTRACTAs the technology is developing, many research works are conducted every day over alternate fuels, and it is very much necessary to preserve the existing petroleum resources for future generations. It is suggested to switch over to an alternate source of energy, which is easily available, renewable as well as environment-friendly. The main objective of this investigation is to describe the use of canola oil with magnesium oxide as nanoadditive and compare it with pure diesel in terms of its performance and emission characteristics. The canola oil biodiesel is produced by using transesterification reaction. The experiment was done by using four different blends (B10, B20, B30 and B40). The experimental results concluded that blend B20 gives good performance when compared to other blends. This study also resulted in another new alternative in the biodiesel category which is environment-friendly.

Background: Patient-centered approaches in the evaluation of patient experience are increasingly important priorities for quality improvement in health-care delivery. Our objective was to investigate common themes in patient-reported data to better understand areas for improvement in the emergency department (ED) experience.Methods: A large urban, tertiary-care ED conducted phone interviews with 2607 patients who visited the ED during 2015. Patients were asked to identify one area that would have significantly improved their visit. Transcripts were analyzed using content analysis, and the results were summarized with descriptive statistics.Results: The most commonly cited themes for improvement in the patient experience were wait time (49.4%) and communication (14.6%). Related, but more nuanced, themes emerged around the perception of ED crowding and compassionate care as additional important contributors to the patient experience. Other frequently cited factors contributing to a negative experience were the discharge process and inability to complete follow-up plan (8.0%), environmental factors (7.9%), perceived competency of providers in the evaluation or treatment (7.4%), and pain management (7.4%).Conclusions: Wait times and perceptions of ED crowding, as well as provider communication and compassionate care, are significant factors identified by patients that affect their ED experience.

Highly stable nano scale silver nanoparticles synthesis by the algal biomass was recorded at 48 h. UV visible absorption spectra demonstrate the sharp peak at 420 nm specific to silver nanoparticles, and the peak at 220–240 nm reveals the presence of proteins. Heat shock proteins are mainly enzymes produced in response to the heat treatment of algal biomass responsible for reducing silver nitrate into silver nanoparticles. High crystalline phase of the silver nanoparticles was confirmed by X ray diffraction (XRD) showed four major distinct diffraction peaks [38.068 (1 1 1), 44.28 (2 0 0), 64.34 (2 2 0), 77.41 (3 1 1)] corresponding to four diffraction facets of silver. Particles morphology by scanning electron microscopy (SEM) showed nanoscale particles with a size ranging from 55 - 80 nm. Synthesized nanoparticles were screened for waster water treatment efficacy against brewery waste water which was represented as treatment efficacy (TE). In the case of pH, the nanoparticles treatment group revealed 45.0%,76.0% and 92.0% TE at 10, 20 and 30 days. A sharp increase in TE was also noticed in the remaining tested parameters. Silver nanoparticles were not induced any undesirable phytotoxic effect on the tested plants by recording complete seedlings' emergence parameters and no impact on the antioxidants profile. No sign of toxic effect on the selected biofertilisers; biocontrol agents in the nanoparticle's treatment have proved the best compatibility. No impact on the enzyme activity of all the tested enzymes confirmed the best compatibility.

With increased use of chest computed tomography (CT) in trauma evaluation, traditional teachings in regard to rib fracture morbidity and mortality may no longer be accurate. We seek to determine rates of rib fracture observed on chest CT only; admission and mortality of patients with isolated rib fractures, rib fractures observed on CT only, and first or second rib fractures; and first or second rib fracture–associated great vessel injury.

The smart behavior of magneto-rheological (MR) fluid is used in the present work in designing, experimentally characterizing and analyzing a MR damper for automotive application using the twin-tube damper concept. A commercially available passive damper of a passenger van was tested to find the characteristic damping requirement of the vehicle. With this as reference, a twin-tube MR damper working in valve mode was designed and fabricated. The magnetic flux density induced in the fluid flow gap is maximized using Taguchi analysis and finite element method magnetics (FEMM) software. The FEMM results are validated by verifying with results obtained analytically using electromagnetic circuit theory. The MR damper filled with commercially available MR fluid was experimentally tested in damper testing machine. The results demonstrate that the force developed by the MR damper is indeed increasing with the value of the current supplied. At various frequencies of input oscillation, the energy dissipated by the MR damper in a single cycle increases significantly with current supplied. The novelty of this work is that a twin-tube MR damper working in valve mode was designed as a replacement for the passive damper used in a passenger van. The MR damper thus developed is capable of producing practical levels of damping force at actual operating frequencies and amplitudes of the passive damper in the passenger van. For further analysis, the behavior of the MR damper is modeled by using the Bouc–Wen model for hysteretic systems. A proportional–integral–derivative controller is used to track the desired damping force in time domain to demonstrate the application of the MR damper in a semi-active suspension system.