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Background Purpose Methods Results Conclusions The study focuses on thermal management in tumor‐treating fields (TTFields) therapy, crucial for patient compliance and therapeutic effectiveness. TTFields therapy, an established treatment for glioblastoma, involves applying alternating electric fields to the brain. However, managing the thermal effects generated by electrodes is a major challenge, impacting patient comfort and treatment efficiency.This research aims to explore methods for controlling temperature increases during TTFields therapy without reducing its duty cycle. The study emphasizes optimizing electrode configurations and array arrangements to mitigate temperature rise, thereby maintaining therapy effectiveness and patient compliance.Using a simplified multi‐layer tissue model and finite element analysis, various electrode configurations and array shapes were tested in COMSOL Multiphysics v6.0. Adjustments included changing the electrode gel layer radius from 8 to 12 mm, electrode spacing, and transitioning to a more uniform array arrangement, such as a square array or a circular array.The study revealed a strong correlation between high temperatures and edge current density distributions on electrodes. It was found that increasing the electrode gel layer's diameter, enlarging electrode spacing, and adopting a uniform array arrangement markedly mitigated temperature rises. By increasing the gel layer radius from the original 10 to 12 mm, a reduction in the peak temperature increases of approximately 0.3°C was observed. Changing the layout from rectangular to circular with the same area further reduced the peak temperature rise by 0.5°C. Additionally, enlarging the spacing between electrodes also contributed to temperature control. By integrating these strategies, we designed a new circular electrode array with an electrode spacing of 45 mm and a gel radius of 12 mm, successfully reducing the peak temperature from 42.1°C to 40.8°C, effectively achieving temperature control.The research demonstrates that improving electrode and array configurations can effectively manage temperature in TTFields therapy without compromising treatment duration. This strategy is crucial as TTFields therapy relies on prolonged field exposure for effectiveness. The findings offer valuable insights into thermal management in electrode array design and could lead to enhanced patient compliance and treatment efficacy in TTFields therapy. [ABSTRACT FROM AUTHOR]

Purpose: Temperature targets in patients with cardiac arrest and return of spontaneous circulation (ROSC) have changed. Changes to higher temperature targets have been associated with higher breakthrough fevers and mortality. A post-ROSC normothermia bundle was developed to improve compliance with temperature targets. Methods: In August 2021, "ad hoc" normothermia at the discretion of the attending intensivist was initiated. In December 2021, a post-ROSC normothermia protocol was implemented, incorporating a rigorous, stepwise approach to fever prevention (temperature ≥ 37.8). We conducted a before-after cohort study of all adult patients post-ROSC who survived to intensive care unit admission between August 1, 2021, and April 1, 2022. They were divided into "ad hoc" and "protocol" groups. Clinical outcomes compared included fevers, active cooling, and paralytic use. Results: Fifty-eight post-ROSC patients were admitted; 24 in the "ad hoc" and 34 in the "protocol" groups. Patient demographics were similar between groups. The "ad hoc" group had more shockable rhythms (67% vs 24%, P =.001) and cardiac catheterizations (42% vs 15%, P =.03). The "protocol" group were significantly less likely to have a fever at 40 h (6% vs 40%, P <.001) and 72 h (14% vs 65%, P ≤.001). Patients in the normothermia "protocol" used significantly less neuromuscular blocking agents (24% vs 50%, P =.05). The normothermia "protocol" resulted in similar mortality (56% vs 58%, P = 1.0). Conclusion: Use of a normothermia "protocol" resulted in fewer fevers and less neuromuscular blocker administration compared to "ad hoc" management. A protocolized approach for improved quality of care should be considered in institutions adopting normothermia. [ABSTRACT FROM AUTHOR]

This paper presents the design and development of an electronic controller for accurate temperature management for the storage of biological and chemical samples in healthcare applications. In the introduction, some important application aspects related to the use of temperature control devices in healthcare are discussed. Keeping these aspects in mind, a brief overview of some related works is presented. The findings are then translated to specific requirements for an electronic controller, which is to be used in a temperature control device. These requirements made necessary the development of a custom controller, as no readily available solutions could be obtained. The paper proceeds with the design of a suitable architecture and discusses some of the design choices. Then, some implementation details are presented and the prototype controller, together with its user interface, is illustrated. Experiments are conducted and several points for improvement are identified. Overall, the main task of keeping accurate, traceable temperature at all times is accomplished successfully, and the electronic controller proves to be a viable solution that conforms to the identified requirements. Future versions will improve the speed of the temperature adaptation and include better user interface and wireless connectivity for remote monitoring and control. [ABSTRACT FROM AUTHOR]

Ensuring the optimal operating temperature is imperative for achieving efficient performance in proton exchange membrane fuel cells. Consequently, this study introduces a dual-model predictive control strategy to regulate the water pump and cooling fan in a cooling system. Initially, we establish an electrochemical and thermal model for fuel cell stacks and validate the model's accuracy through experimental data. The system model is linearized, and the model predictive control (MPC) controller is formulated using the MATLAB/Simulink toolbox. Subsequently, it is collaboratively simulated with the electrochemical model of the fuel cell stack and the temperature model. To evaluate the effectiveness of the MPC controller, we conducted a comparative analysis with the traditional proportional-integral-derivative (PID) control and water pump MPC under step load, uniform load increase, and variable target scenarios. The findings indicate that in contrast to the PID control, the MPC controller significantly decreases the stack temperature difference fluctuation by more than 50%, maintaining the stack temperature within ±0.6 K of the set value. Furthermore, we independently assessed the performance of the MPC controller under varying ambient temperatures. The findings illustrate that the dual MPC method proficiently adapts cooling parameters across different ambient temperature ranges (288.15 K-308.15 K), ensuring the stable performance of the fuel cell. The model is linearized, and the simulation work is explained mainly on the MATLAB/Simulink platform. In order to compare the effectiveness of the MPC controller, the comparison with the MPC controller strategy of the water pump is added, which can better reflect the effectiveness of the proposed collaborative MPC controller strategy. [ABSTRACT FROM AUTHOR]

Accurate temperature measurement is crucial for the perioperative management of pediatric patients, and non-invasive thermometry is necessary when invasive methods are infeasible. A prospective observational study was conducted on 57 patients undergoing elective surgery. Temperatures were measured using a dual-sensor heat-flux (DHF) thermometer (Tcore™) and a rectal temperature probe (TRec), and the agreement between the two measurements was assessed. The DHF measurements showed a bias of +0.413 °C compared with those of the TRec. The limits of agreement were broader than the pre-defined ±0.5 °C range (−0.741 °C and +1.567 °C). Although the DHF sensors tended to overestimate the core temperature compared to the rectal measurements, an error grid analysis demonstrated that 95.81% of the DHF measurements would not have led to a wrong clinical decision, e.g., warming or cooling when not necessary. In conclusion, the low number of measurements that would have led to incorrect decisions suggests that the DHF sensor can be considered an option for continuous temperature measurement when more invasive methods are infeasible. [ABSTRACT FROM AUTHOR]

Severely burned patients suffer from both coagulopathy and hypothermia, with a lack of international consensus and appropriate treatment guidelines. This study examines recent developments and trends in coagulation and temperature management in European burn centers. A survey was sent to burn centers in Switzerland, Austria and Germany in 2016 and again in 2021. The analysis was performed using descriptive statistics, with categorical data reported in absolute numbers (n) and percentages (%) and numerical data reported as mean and standard deviation. The rate of completed questionnaires was 84 % (16 of 19 questionnaires) in 2016 and 91 % (21 of 22 questionnaires) in 2021. The number of global coagulation tests performed has decreased over the observation period in favor of single factor determination and bed-side point-of-care coagulation tests. This has also led to increased administration of single factor concentrates in therapy. Although many centers had a defined treatment protocol for hypothermia in 2016, coverage increased such that in 2021 all centers surveyed had such a protocol. The body temperature was measured more consistently in 2021; thus, hypothermia was more actively sought, detected and treated. A point-of-care guided, factor-based coagulation management and the maintenance of normothermia have gained importance in the care of burn patients in recent years. Severely burned patients are at particular risk of developing burn-induced coagulopathy or perioperative hypothermia. Clear guidelines regarding coagulation and temperature management are largely absent in the care of severely burned patients. In recent years, point-of-care guided, factor-based coagulation management has gained importance in European burn centers. The high rate of hypothermia management concepts in 2016 was further expanded in 2021. [ABSTRACT FROM AUTHOR]

This paper presents the design and development of an electronic controller for accurate temperature management for the storage of biological and chemical samples in healthcare applications. In the introduction, some important application aspects related to the use of temperature control devices in healthcare are discussed. Keeping these aspects in mind, a brief overview of some related works is presented. The findings are then translated to specific requirements for an electronic controller, which is to be used in a temperature control device. These requirements made necessary the development of a custom controller, as no readily available solutions could be obtained. The paper proceeds with the design of a suitable architecture and discusses some of the design choices. Then, some implementation details are presented and the prototype controller, together with its user interface, is illustrated. Experiments are conducted and several points for improvement are identified. Overall, the main task of keeping accurate, traceable temperature at all times is accomplished successfully, and the electronic controller proves to be a viable solution that conforms to the identified requirements. Future versions will improve the speed of the temperature adaptation and include better user interface and wireless connectivity for remote monitoring and control.

Managing the temperature inside greenhouses is essential for optimum crop growth and the control of diseases and physiological disorders in plants. In large-sized greenhouses, the automatic operation of small-sized multipoint suspension-type heating modules can facilitate better site-specific temperature management by providing favorable uniformity. The objective of this study was to evaluate efficiency of candidate heating modules before the prototype fabrication of a small-sized heating module for smart greenhouses temperature management. Three different heating modules (i.e., finned tubular (FT), fin element positive temperature coefficient (PTCf), and honeycomb positive temperature coefficient (PTCh)) were tested inside a closed chamber (41 m3) and a small greenhouse (98 m3). A wireless sensor network (WSN) was established to monitor the inside environment, operate heating modules, and detect their operational status. In the closed chamber, the PTCf module exhibited a temperature rise rate 8.59% and 7.36% higher than those of the FT and PTCh modules, respectively, while maintaining a superior average temperature variability range of 1.43 – 5.16 (±0.55 – ±0.85) °C. The elapsed times for the three modules were 12.70%, 8.30%, and 10.85% longer than their calculated times, indicating the effectiveness of the heating modules in regulating the environment. During the tests in the small greenhouse, the PTCf module demonstrated a greater average temperature difference between the inside and outside, followed by the FT and PTCh modules. The respective average temperature variability levels inside the greenhouse were recorded as 5.80 – 10.15 (±1.30 – ±2.68) °C, 4.90 – 8.93 (±1.35 – ±2.36) °C, and 4.86 – 9.38 (±1.25 – ±2.35) °C for the three modules. The performance of the PTCf module was better compared to the other two during the experiments in terms of efficiency and maintaining uniformity. However, large-scale field tests with multiple heating modules are required to verify these experimental findings.

This study aimed to determine the effects of a warming care protocol (WCM) on temperature control and thermal comfort perception in hypothermia following major abdominal surgery. A prospective nonrandomized controlled trial. A total of 54 patients undergoing major abdominal surgery were assigned to receive routine care (control group, 27 patients) or the WCM (intervention group, 27 patients). The body temperature (core and peripheral) was measured, and physical symptoms were monitored every hour for 4 hours after arriving at the ward and then every 4 hours for up to 12 hours. The temperature gap, calculated as the difference between the core and skin temperatures, was similar between the control and intervention groups at the end of surgery. However, the temperature gap in the intervention group decreased within 3 hours after arrival at the ward and remained lower than that in the control group. The visual analog scale score for postoperative thermal discomfort was significantly lower in the intervention group than in the control group, indicating achievement of higher comfort with the warming intervention. Patients were warmed using active warming methods under the WCM, which in turn increased the thermal comfort perception with the body temperature. Postoperative patients often require warming care for thermal comfort, which may be improved by proper observation and management within 1 to 2 hours postoperatively. Our results indicate that nurses could effectively warm the patient to maintain normal body temperature following surgery not only to improve thermal comfort, but also to prevent shivering and possibly various postoperative complications. [ABSTRACT FROM AUTHOR]

Outdoor applications integrating displays have expanded significantly during the past few years, as people want information in real‐time regardless of location or weather conditions. However, outdoor use comes with its own set of challenges. [ABSTRACT FROM AUTHOR]

Plums are primarily marketed for fresh consumption, canning, freezing, jam and jelly. Unfortunately, plum consumption has remained steady or declined. Consumers complain about a lack of flavor quality but are willing to pay for higher quality. Thus, absence of flavor and cold storage disorders are the main barriers to consumption. Plum cultivars are sensitive to gel breakdown, flesh browning and 'off flavors'. Consumer approval and postharvest life are controlled by genotype, quality attributes, harvest date and proper postharvest handling. A consumer quality index (CQI) based on soluble solids concentration (SSC) and minimum firmness is proposed to maximize flavor and postharvest life. In most cases, late harvest increases quality attributes. Our work and industry experience demonstrated that using critical bruising thresholds (CBT) based on minimum firmness measured at harvest acts as a reliable predictor of how late to harvest safely for maximum visual and sensory quality. Plums tolerated late harvest well because of their high tolerance to bruising damage, but suitable postharvest temperature management and selling within the potential postharvest life are required to maintain flavor and avoid the beginning of chilling injury. Thus, to maximize flavor and postharvest life, a CQI based on SSC and minimum firmness measured at consumption is proposed. This article provides guidance on using this CQI, combined with proper postharvest handling techniques, such as correct harvest date determination and temperature management, to maintain quality and increase consumption. [ABSTRACT FROM AUTHOR]

Abstract Background Targeted temperature management (TTM) is recommended following cardiac arrest; however, time to target temperature varies in clinical practice. We hypothesised the effects of a target temperature of 33 °C when compared to normothermia would differ based on average time to hypothermia and those patients achieving hypothermia fastest would have more favorable outcomes. Methods In this post-hoc analysis of the TTM-2 trial, patients after out of hospital cardiac arrest were randomized to targeted hypothermia (33 °C), followed by controlled re-warming, or normothermia with early treatment of fever (body temperature, ≥ 37.8 °C). The average temperature at 4 h (240 min) after return of spontaneous circulation (ROSC) was calculated for participating sites. Primary outcome was death from any cause at 6 months. Secondary outcome was poor functional outcome at 6 months (score of 4–6 on modified Rankin scale). Results A total of 1592 participants were evaluated for the primary outcome. We found no evidence of heterogeneity of intervention effect based on the average time to target temperature on mortality (p = 0.17). Of patients allocated to hypothermia at the fastest sites, 71 of 145 (49%) had died compared to 68 of 148 (46%) of the normothermia group (relative risk with hypothermia, 1.07; 95% confidence interval 0.84–1.36). Poor functional outcome was reported in 74/144 (51%) patients in the hypothermia group, and 75/147 (51%) patients in the normothermia group (relative risk with hypothermia 1.01 (95% CI 0.80–1.26). Conclusions Using a hospital’s average time to hypothermia did not significantly alter the effect of TTM of 33 °C compared to normothermia and early treatment of fever.

Xiaoqian Deng,1 Junyu Yan,2 Shaungwen Wang,3 Yifan Li,3 Yun Shi4 1Department of Anesthesiology, West China Hospital, Sichuan University and The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, People’s Republic of China; 2Department of Anesthesiology, Karamay Hospital of Integrated Traditional Chinese and Western Medicine, Karamay, People’s Republic of China; 3West China School of Medicine, Sichuan University, Chengdu, People’s Republic of China; 4Department of Anesthesiology, Children’s Hospital of Fudan University, Fudan University, Shanghai, People’s Republic of ChinaCorrespondence: Yun Shi, Department of Anesthesiology, Children’s Hospital of Fudan University, Fudan University, 399 Wanyuan Road, Minhang District, Shanghai, 201102, People’s Republic of China, Email imulashi@yahoo.comPurpose: Inadvertent intraoperative hypothermia (IIH) is generally associated with several postoperative complications. Inspite of the existing guidelines, the global incidence of IIH remains unacceptably high. Understanding the conditions that influence temperature management is critical for developing future interventions to improve the postoperative patient outcomes. This study aimed to identify the major factors that hinder the implementation of IIH prevention practices.Methods: Through a literature research, pilot small-sample investigation, and expert suggestions, 11 factors that may hinder the implementation of IIH prevention practices were identified. A questionnaire was developed, and each question was used to assess each factor. After approval by the Research Ethics Board, the questionnaires were sent to the staff anaesthesiologists at two academic hospitals via WeChat. Each answer was coded according to the degree to which the factor was affected, as anticipated. Finally, the answers were analysed based on the 80/20 rule to identify the major barriers to effective temperature management.Results: We included 195 participants. Knowledge, memory, attention and decision processes, beliefs about consequences, and environmental context and resources were the major factors, with cumulative composition ratios of 24%, 43.4%, 57.7%, and 70.7%, respectively. Meanwhile, behavioural regulation and social influence were the secondary factors, with cumulative composition ratios of 80.4% and 87.5%, respectively. Reinforcement, confidence in capacity, duty realisation, skills, and intention were the general factors with cumulative composition ratios of 94.3%, 99.8%, 100%, 100%, and 100%, respectively.Conclusion: Four factors–knowledge, memory, attention and decision process, beliefs about consequences, and environmental context and resources–were the major factors that influence the effective hypothermia prevention practice.Relevance to Clinical Practice: These major factors will be used in further studies as a basis to develop the corresponding solutions and improve the patient outcomes in clinical practice.Keywords: intraoperative hypothermia, body temperature, temperature management, 80/20 rule

Accurate temperature measurement is crucial for the perioperative management of pediatric patients, and non-invasive thermometry is necessary when invasive methods are infeasible. A prospective observational study was conducted on 57 patients undergoing elective surgery. Temperatures were measured using a dual-sensor heat-flux (DHF) thermometer (Tcore™) and a rectal temperature probe (TRec), and the agreement between the two measurements was assessed. The DHF measurements showed a bias of +0.413 °C compared with those of the TRec. The limits of agreement were broader than the pre-defined ±0.5 °C range (−0.741 °C and +1.567 °C). Although the DHF sensors tended to overestimate the core temperature compared to the rectal measurements, an error grid analysis demonstrated that 95.81% of the DHF measurements would not have led to a wrong clinical decision, e.g., warming or cooling when not necessary. In conclusion, the low number of measurements that would have led to incorrect decisions suggests that the DHF sensor can be considered an option for continuous temperature measurement when more invasive methods are infeasible.

Introduction: Targeted temperature management plays an important role in the treatment of myriad critical illnesses. Non-invasive, quick-onset options for isolated brain temperature control remain lacking. The goal of this study was to assess the safety and efficacy of a novel intranasal high flow cooled air device using a large animal model. Methods: Yorkshire swine were instrumented with temperature probes in the rectum, brain, ear, and snout, and a novel intranasal cooled air device was applied to half. The primary outcome was effectiveness of brain and snout cooling by the study device. Secondary outcomes included tympanic cooling and absence of rectal cooling, CT, CT perfusion, and histologic evidence of injury in the short- and medium-term. Results: 10 animals (54.7 kgs.+/- 19.4 SD) underwent non-survival evaluation, 3 underwent delayed evaluation (56.1 kgs.+/-6.4). From baseline to cooling period, intranasal (38.1 °C vs. 34.9 °C, p = 0.01), intracranial (38.6 °C vs. 37.2 °C, p = 0.01) and tympanic temperatures (38.3 °C vs. 37.5 °C, p = 0.01) decreased, while rectal temperature remained unchanged.After cooling, nasal temperature (34.9 °C vs. 37.6 °C, p = 0.004) and intracranial temperatures (37.2 °C vs. 37.9 °C, p = 0.01) increased. Rectal temperatures remained unchanged. A mixed effects model showed association between temperature and study period (p

This study focuses on investigating the impact of temperature on solar panels and explores various cooling techniques to enhance their efficiency. The electric power output and efficiency of Photovoltaic (PV) cells decrease as the temperature increases. The temperature reduction depends on the type of solar panels and their temperature coefficient, which typically falls within the range of -0.3% to -0.5% per degree °C. The objective of this study was to determine the most effective cooling technique for solar systems. This study analyzed and compared various cooling methods and revealed that when water cooling is applied on both sides of a solar panel, it is the most efficient method to increase the efficiency by approximately 14.1%. Furthermore, the water-cooling system achieved a temperature reduction of up to 20 °C. The advantage of water cooling supports the self-cleaning of the solar panels, which further enhances their efficiency. The ability of water to remove dust and debris from the panel surface helps maintain optimal performance over time. The findings of this study provide valuable insights into the selection of the most suitable cooling technique for solar systems. Water cooling in solar panels offers substantial improvements in efficiency and temperature reduction. [ABSTRACT FROM AUTHOR]

Background: Targeted temperature management (TTM) is recommended following cardiac arrest; however, time to target temperature varies in clinical practice. We hypothesised the effects of a target temperature of 33 °C when compared to normothermia would differ based on average time to hypothermia and those patients achieving hypothermia fastest would have more favorable outcomes.Methods: In this post-hoc analysis of the TTM-2 trial, patients after out of hospital cardiac arrest were randomized to targeted hypothermia (33 °C), followed by controlled re-warming, or normothermia with early treatment of fever (body temperature, ≥ 37.8 °C). The average temperature at 4 h (240 min) after return of spontaneous circulation (ROSC) was calculated for participating sites. Primary outcome was death from any cause at 6 months. Secondary outcome was poor functional outcome at 6 months (score of 4-6 on modified Rankin scale).Results: A total of 1592 participants were evaluated for the primary outcome. We found no evidence of heterogeneity of intervention effect based on the average time to target temperature on mortality (p = 0.17). Of patients allocated to hypothermia at the fastest sites, 71 of 145 (49%) had died compared to 68 of 148 (46%) of the normothermia group (relative risk with hypothermia, 1.07; 95% confidence interval 0.84-1.36). Poor functional outcome was reported in 74/144 (51%) patients in the hypothermia group, and 75/147 (51%) patients in the normothermia group (relative risk with hypothermia 1.01 (95% CI 0.80-1.26).Conclusions: Using a hospital's average time to hypothermia did not significantly alter the effect of TTM of 33 °C compared to normothermia and early treatment of fever. [ABSTRACT FROM AUTHOR]

Background: Evidence shows that active insulation can reduce the incidence of hypothermia during cesarean section; however, compliance is lower than recommended. Moreover, several aspects of temperature management via active heat preservation remain unclear, including patient indications, timing, methods, and duration. Therefore, promptly identifying parturients at a high risk for hypothermia during cesarean section is crucial. Objective: To develop and validate a scale for predicting hypothermia in parturients during cesarean section. Design: Prospective study. Setting: Three grade A hospitals in Hunan Province, China. Participants: The prediction scale was developed based on data from 369 parturients who underwent cesarean section from July 2018 to January 2019. Inclusion criteria were as follows: cesarean section under lumbar anesthesia, epidural anesthesia, or combined lumbar and epidural anesthesia; voluntary participation in the study and completion of the informed consent form; age >18 years. Methods: Univariate and multivariate analyses were used to determine factors influencing hypothermia and establish the predictive model for hypothermia risk during cesarean section. The Hosmer–Lemeshow test was used to determine the goodness of fit of the prediction tool, and the area under the receiver operating characteristic curve was used to determine the predictive ability of the proposed scale. The cutoff value of the prediction scale was determined according to the Youden index. Results: In the logistic regression prediction model, the Hosmer–Lemeshow goodness-of-fit test yielded a p-value of 0.425. The area under the receiver operating characteristic curve was 0.888. The model exhibited a good fitting effect and discriminant validity. Total risk scores for hypothermia ranged from 0 to 11. A score of 7 was used as the diagnostic cutoff value. Parturients during the operation who had total scores of ≥7 and

Deliberate mild hypothermia is safer from the point of view of adverse events and does not require a specific technique, unlike deep or moderate hypothermia. Therefore, mild hypothermia was widely used for neurosurgical procedures. Unfortunately, the neuroprotective efficacy of intraoperative mild hypothermia has not yet been proven; however, temperature management for intraoperative deliberate mild hypothermia has been improved over the past two decades. It is very important to achieve mild hypothermia before the commencement of the main surgery, and to maintain the patient's body temperature until the procedure is completed. In addition, it is also important to complete rewarming by the end of the surgery so that an accurate neurological evaluation can be made. Regarding the effects of mild hypothermia on outcomes, a large randomized controlled study reported that unfavorable outcomes did not differ between participants with or without hypothermia. Apart from these unfavorable outcomes, it is known that temperature management during deliberate intraoperative mild hypothermia has contributed to improvement of anesthesia practice. The accumulation of experience in this field is important. Clinical interest in deliberate mild hypothermia is currently low; however, anesthesiologists should be prepared for the time when it is required again in the future. [ABSTRACT FROM AUTHOR]

Delays in initiation of targeted temperature management (TTM) have been observed in randomized trials evaluating immediate or delayed coronary angiography among survivors of ventricular tachycardia (VT) or ventricular fibrillation (VF) out-of-hospital cardiac arrest (OHCA), but whether delays are associated with adverse clinical outcomes is unknown. Resuscitated survivors of VT/VF OHCA who received TTM between April 2011 and June 2015 were identified and time to TTM initiation was described. The association between TTM initiation <2 versus ≥2 hours, neurologically favorable, and overall survival to hospital discharge was assessed. In a propensity-weighted analysis of 2954 patients, a significantly larger proportion of patients undergoing percutaneous coronary intervention (PCI) had TTM initiation ≥2 hours (48.6%) as compared to patients undergoing angiography (41.4%) or those who did not undergo a procedure (33.0%; p < 0.001 for all comparisons). In this cohort, the odds of neurologically favorable survival (odds ratios [OR]: 0.88, 95% confidence intervals [CI] = 0.75-1.02) and overall survival (OR: 0.92, 95% CI = 0.83-1.03) to hospital discharge were similar among ST-elevation myocardial infarction (STEMI) patients who underwent PCI with TTM initiation <2 versus ≥2 hours. Patients without STEMI who underwent PCI with TTM initiation ≥2 hours and did not have a "do not resuscitate" order or withdrawal of life-sustaining care had decreased odds of neurologically favorable survival to hospital discharge (OR: 0.45, 95% CI = 0.22-0.93) compared to TTM initiation <2 hours. PCI was associated with delays in TTM initiation ≥2 hours among resuscitated survivors of VT/VF OHCA. Delays in TTM initiation ≥2 hours were associated with decreased odds of neurologically favorable survival among patients without STEMI who underwent PCI.

Abstract Background Little is known about the prevalence of altered CAR in anoxic brain injury and the association with patients’ outcome. We aimed at investigating CAR in cardiac arrest survivors treated by targeted temperature management and its association to outcome. Methods Retrospective analysis of prospectively collected data. Inclusion criteria: adult cardiac arrest survivors treated by targeted temperature management (TTM). Exclusion criteria: trauma; sepsis, intoxication; acute intra-cranial disease; history of supra-aortic vascular disease; severe hemodynamic instability; cardiac output mechanical support; arterial carbon dioxide partial pressure (PaCO2) > 60 mmHg; arrhythmias; lack of acoustic window. Middle cerebral artery flow velocitiy (FV) was assessed by transcranial Doppler (TCD) once during hypothermia (HT) and once during normothermia (NT). FV and blood pressure (BP) were recorded simultaneously and Mxa calculated (MATLAB). Mxa is the Pearson correlation coefficient between FV and BP. Mxa > 0.3 defined altered CAR. Survival was assessed at hospital discharge. Cerebral Performance Category (CPC) 3–5 assessed 3 months after CA defined unfavorable neurological outcome (UO). Results We included 50 patients (Jan 2015–Dec 2018). All patients had out-of-hospital cardiac arrest, 24 (48%) had initial shockable rhythm. Time to return of spontaneous circulation was 20 [10–35] min. HT (core body temperature 33.7 [33.2–34] °C) lasted for 24 [23–28] h, followed by rewarming and NT (core body temperature: 36.9 [36.6–37.4] °C). Thirty-one (62%) patients did not survive at hospital discharge and 36 (72%) had UO. Mxa was lower during HT than during NT (0.33 [0.11–0.58] vs. 0.58 [0.30–0.83]; p = 0.03). During HT, Mxa did not differ between outcome groups. During NT, Mxa was higher in patients with UO than others (0.63 [0.43–0.83] vs. 0.31 [− 0.01–0.67]; p = 0.03). Mxa differed among CPC values at NT (p = 0.03). Specifically, CPC 2 group had lower Mxa than CPC 3 and 5 groups. At multivariate analysis, initial non-shockable rhythm, high Mxa during NT and highly malignant electroencephalography pattern (HMp) were associated with in-hospital mortality; high Mxa during NT and HMp were associated with UO. Conclusions CAR is frequently altered in cardiac arrest survivors treated by TTM. Altered CAR during normothermia was independently associated with poor outcome.

Plums are primarily marketed for fresh consumption, canning, freezing, jam and jelly. Unfortunately, plum consumption has remained steady or declined. Consumers complain about a lack of flavor quality but are willing to pay for higher quality. Thus, absence of flavor and cold storage disorders are the main barriers to consumption. Plum cultivars are sensitive to gel breakdown, flesh browning and ‘off flavors’. Consumer approval and postharvest life are controlled by genotype, quality attributes, harvest date and proper postharvest handling. A consumer quality index (CQI) based on soluble solids concentration (SSC) and minimum firmness is proposed to maximize flavor and postharvest life. In most cases, late harvest increases quality attributes. Our work and industry experience demonstrated that using critical bruising thresholds (CBT) based on minimum firmness measured at harvest acts as a reliable predictor of how late to harvest safely for maximum visual and sensory quality. Plums tolerated late harvest well because of their high tolerance to bruising damage, but suitable postharvest temperature management and selling within the potential postharvest life are required to maintain flavor and avoid the beginning of chilling injury. Thus, to maximize flavor and postharvest life, a CQI based on SSC and minimum firmness measured at consumption is proposed. This article provides guidance on using this CQI, combined with proper postharvest handling techniques, such as correct harvest date determination and temperature management, to maintain quality and increase consumption.

'Hass' avocado fruit are usually packed the day after harvest and then immediately cooled and held no more than a few days before export. This procedure is considered to maximise the storage life and quality of the fruit. However, for packhouse logistics, there are times when it may be advantageous to aggregate fruit over a period of days before packing. It is hypothesised that the time at which fruit are cooled may be more significant to fruit quality than the time of packing. The impact of holding fruit at 7°C for up to 6 days before packing and cooling to storage temperature (5°C) has been investigated. In comparison with fruit held overnight at ambient conditions before packing and cooling, the holding of fruit at 7°C for up to 4 days before packing did not diminish the quality of the fruit markedly, either immediately out of storage (4 weeks after harvest) or after ripening at 20°C. Extending the holding period to 6 days may increase slightly the risk of fuzzy patches, stem end rots and body rots. However, there was as much variability in the incidence of disorders among orchards as there were differences among treatments. [ABSTRACT FROM AUTHOR]

The remarkable growth of cloud computing applications has caused many data centers to encounter unprecedented power consumption and heat generation. Cloud providers share their computational infrastructure through virtualization technology. The scheduler component decides which physical machine hosts the requested virtual machine. This process is virtual machine placement (VMP) which, affects the power distribution, and thereby the energy consumption of the data centers. Due to the heterogeneity and multidimensionality of resources, this task is not trivial, and many studies have tried to address this problem using different methods. However, the majority of such studies fail to consider the cooling energy, which accounts for almost 30% of the energy consumption in a data center. In this paper, we propose a metaheuristic approach based on the binary version of gravitational search algorithm to simultaneously minimize the computational and cooling energy in the VMP problem. In addition, we suggest a self-adaptive mechanism based on fuzzy logic to control the behavior of the algorithms in terms of exploitation and exploration. The simulation results illustrate that the proposed algorithm reduced energy consumption by 26% in the PlanetLab Dataset and 30% in the Google cluster dataset relative to the average of compared algorithms. The results also indicate that the proposed algorithm provides a much more thermally reliable operation. [ABSTRACT FROM AUTHOR]

Process optimization is no longer an option for processes, but an obligation to survive in the market in any industry. This argument also applies to anaerobic digestion in biogas plants. The contribution of biogas plants to renewable energy can be increased through more productive systems with less waste, which brings the common goal of minimizing costs and maximizing yields in processes. With the help of data science and predictive analytics, it is possible to take conventional process optimization and operational excellence methods, such as statistical process control and Six Sigma, to the next level. The more advanced the process optimization aspect, the more transparent and responsive the systems. In this study, seven different machine learning algorithms—linear regression, logistic regression, K-NN, decision trees, random forest, support vector machine (SVM) and XGBoost—were compared with laboratory results to define and predict the possible impacts of wide range temperature fluctuations on process stability. SVM provided the best accuracy with 0.93 according to the metric precision of the models calculated using the confusion matrix. [ABSTRACT FROM AUTHOR]

While much has been observed regarding hypothermia by way of environmental exposure, it is modern day medicine that deployed hypothermia as a therapeutic. From the early 1930s, when Temple Fay deployed "refrigeration" to treat pain, to the work of Wilfred Bigelow and Charles Drew, who utilized hypothermia in open heart surgery—the opportunities seemed endless. However, questions arose surrounding appropriate temperatures to achieve best outcomes and how to minimize adverse events, such as coagulopathy and infection. In the 1980s, hypothermia underwent a resurgence through Peter Safar's critical studies in large animals, which quickly translated into feasibility studies and the landmark trials of 2002 that paved the way for postcardiac arrest care as we currently know it. Through clinical and observational trials, modern‐day targeted temperature management continues to adapt, striving to improve patient outcomes. While hypothermia has come a long way from the writings of Hippocrates, the ideal therapy has not yet been defined, and more work is needed. While the history is long, there is more to be written and advances to be achieved as we optimize the neuroprotective effects of hypothermia for comatose survivors of cardiac arrest. [ABSTRACT FROM AUTHOR]

Background: Little is known about the prevalence of altered CAR in anoxic brain injury and the association with patients' outcome. We aimed at investigating CAR in cardiac arrest survivors treated by targeted temperature management and its association to outcome. Methods: Retrospective analysis of prospectively collected data. Inclusion criteria: adult cardiac arrest survivors treated by targeted temperature management (TTM). Exclusion criteria: trauma; sepsis, intoxication; acute intra-cranial disease; history of supra-aortic vascular disease; severe hemodynamic instability; cardiac output mechanical support; arterial carbon dioxide partial pressure (PaCO2) > 60 mmHg; arrhythmias; lack of acoustic window. Middle cerebral artery flow velocitiy (FV) was assessed by transcranial Doppler (TCD) once during hypothermia (HT) and once during normothermia (NT). FV and blood pressure (BP) were recorded simultaneously and Mxa calculated (MATLAB). Mxa is the Pearson correlation coefficient between FV and BP. Mxa > 0.3 defined altered CAR. Survival was assessed at hospital discharge. Cerebral Performance Category (CPC) 3–5 assessed 3 months after CA defined unfavorable neurological outcome (UO). Results: We included 50 patients (Jan 2015–Dec 2018). All patients had out-of-hospital cardiac arrest, 24 (48%) had initial shockable rhythm. Time to return of spontaneous circulation was 20 [10–35] min. HT (core body temperature 33.7 [33.2–34] °C) lasted for 24 [23–28] h, followed by rewarming and NT (core body temperature: 36.9 [36.6–37.4] °C). Thirty-one (62%) patients did not survive at hospital discharge and 36 (72%) had UO. Mxa was lower during HT than during NT (0.33 [0.11–0.58] vs. 0.58 [0.30–0.83]; p = 0.03). During HT, Mxa did not differ between outcome groups. During NT, Mxa was higher in patients with UO than others (0.63 [0.43–0.83] vs. 0.31 [− 0.01–0.67]; p = 0.03). Mxa differed among CPC values at NT (p = 0.03). Specifically, CPC 2 group had lower Mxa than CPC 3 and 5 groups. At multivariate analysis, initial non-shockable rhythm, high Mxa during NT and highly malignant electroencephalography pattern (HMp) were associated with in-hospital mortality; high Mxa during NT and HMp were associated with UO. Conclusions: CAR is frequently altered in cardiac arrest survivors treated by TTM. Altered CAR during normothermia was independently associated with poor outcome. [ABSTRACT FROM AUTHOR]

Background: Extremely low frequency electromagnetic field (ELF-EMF) emitted by electronic devices is associated with various biological effects on the human body. MEGAWARMER? patient temperature management system (PTMS) is widely used for the patient temperature management in anesthesia and critical care. We investigated the intensity of ELF-EMF according to the distance and target temperature of MEGAWARMER? PTMS to find the distance allowing minimized exposure to ELF-EMF. Methodology: This study was a prospective experimental study. Target temperature was set at 31?, 36? and 41?. After setting each target temperature, the intensity of ELF-EMF was measured 300 times during 10 min at interval of 2 sec, at distances of 15, 30, and 45 cm from the MEGAWARMER? PTMS, respectively. Nine measurement groups from 3 different target temperatures and 3 different distances resulted in 2700 data. Including background EMF intensity with the MEGAWARMER? PTMS also turned off, total 3000 data in 10 groups were collected. Results: At the distance of 15 cm from the MEGAWARMER? PTMS, mean values of ELF-EMF were 4.6721 milligauss (mG), where 1 G is equivalent to 10?4 Tesla (T) (or 1 mG = 0.1 µT) at 31?, 4.2852 mG at 36?, and 3.9935 mG at 41?. At the distance of 30 cm, mean values of ELF-EMF were 2.0948 mG at 31?, 2.0790 mG at 36?, and 2.0633 mG at 41?. At the distances of 15 cm and 30 cm, the lower target temperature showed statistically significantly higher mean values of ELF-EMF (p < 0.05). In all three target temperatures, longer distance made statistically significantly lower mean value of ELF-EMF (p < 0.05). Conclusions: The mean intensity of ELF-EMF from the MEGAWARMER? Patient Temperature Management at the distance of 15 cm and 30 cm exceeded 2 mG recommended by Swedish Confederation of Professional Employees guideline. [ABSTRACT FROM AUTHOR]

In this paper, the performance of fluid momentum controller (FMC) actuators in satellite temperature management is investigated based on two pyramidal and 3-axis proposed configurations. In this regard, the temperature of different satellite surfaces with fluid actuators and without actuators in an orbital period of satellite is investigated and the results are compared to each other. For FMC actuators that are closed as a loop, a Moving Reference Frame (MRF) is used and the flow inside the actuators is laminar. The effect of fluid angular velocity of actuators on the temperature of satellite surfaces with two different angular velocity has been investigated and time-dependent heat flux is applied to the satellite surfaces. The results indicate that in the pyramidal configuration, the decrease in the temperature of the satellite wall surfaces is influenced by two parameters: fluid angular velocity and orbital period of satellite, but in the critical conditions, the 3-axis configuration can carry out this temperature management more quickly.

Judy Munday,1,2 Alana Delaforce,1,3 Gillian Forbes,4 Samantha Keogh11School of Nursing and Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia; 2Department of Health and Nursing Science, University of Agder, Grimstad, Norway; 3Clinical Governance Unit, Mater Health, South Brisbane, QLD 4101, Australia; 4Department of Clinical, Educational and Health Psychology, UCL Centre for Behaviour Change, London WC1E 6BT, UKPurpose: Inadvertent perioperative hypothermia is a significant problem for surgical patients globally, and is associated with many detrimental side-effects. Despite the availability of rigorously developed international evidence-based guidelines for prevention, a high incidence of this complication persists. This qualitative study aims to identify and examine the domains which act as barriers and enablers to perioperative hypothermia prevention practices, from the perspectives of the key healthcare professionals involved with perioperative temperature management.Methods: A qualitative study employing semi-structured interviews was utilized. A purposive sample of key stakeholders involved in perioperative temperature management, including perioperative nurses, anesthetists, surgeons, and perioperative managers, were recruited via email. The interview guide was developed in reference to the Theoretical Domains Framework. All interviews were recorded, de-identified, transcribed, and coded. Belief statements were generated within each domain, and a frequency score generated for each belief. Finally, the domains were mapped to the COM-B model of the Behavior Change Wheel to develop recommendations for future interventions.Results: Twelve participants were included including eight nurses, two surgeons, and two anesthetists. Eleven key theoretical domains that influence the uptake of perioperative hypothermia practices were identified: knowledge; skills; social/professional role and identity; beliefs about capabilities; optimism; beliefs about consequences; reinforcement; goals; memory, attention, and decision processes; environmental context and resources; social influence. Suggested intervention strategies include training, reminder systems, audit, and feedback, organizational support to resolve lack of control of ambient temperature, as well as provision of accurate temperature measurement devices.Conclusion: Future interventions to address the key behavioral domains and improve perioperative hypothermia prevention need to be evaluated in the context of feasibility, effectiveness, safety, acceptability, and cost by the target users. All suggested intervention strategies need to take a team-based, multi-modal approach, as this is most likely to facilitate improvements in perioperative hypothermia prevention.Keywords: perioperative hypothermia, temperature management, Theoretical Domains Framework, multidisciplinary, COM-B, behaviour change wheel

Background: Recent studies suggest that volatile anaesthetics are safe, efficient, and reliable alternatives to the use of intravenous anaesthetics for out-of-hospital cardiac arrest (OHCA) patients admitted to the intensive care unit (ICU). We hypothesised that volatile anaesthetics may reduce the incidence of delirium rather than intravenous sedatives. This retrospective study aimed to investigate whether sevoflurane combined with higher targeted temperature management could decrease the incidence of delirium when compared with intravenous anaesthetics with lower targeted temperature management.Methods: Using a propensity score-matched analysis, we retrospectively compared a target temperature management (32-34 °C) method along with intravenous sedation (TTM-33/IV) and a modified target temperature management (34-36 °C) method along with sevoflurane sedation (mTTM-36/sevo). We used the confusion assessment method for the ICU to measure the incidence of delirium. We calculated the time-dependent risk on delirium using the multivariate Cox regression model.Results: The incidence of delirium was significantly lower (p = 0.001) in OHCA patients of the mTTM-36/sevo group (9/56, 16.1%) than in those of the TTM-33/IV group (25/67, 37.3%). Mechanical ventilation and lengths of stay in the ICU (p < 0.001) and hospital stay (p = 0.04) were shorter in the mTTM-36/sevo group. Patients in the TTM-33/IV group required more midazolam, propofol, and fentanyl. We observed no significant difference in mortality.Conclusion: A multimodal sevoflurane-based sedation regimen together with targeted temperature management resulted in a lower incidence of delirium and a shorter duration for mechanical ventilation and ICU length of stay than did the treatment with intravenous sedation combined with the classical cooling protocol. [ABSTRACT FROM AUTHOR]

Process optimization is no longer an option for processes, but an obligation to survive in the market in any industry. This argument also applies to anaerobic digestion in biogas plants. The contribution of biogas plants to renewable energy can be increased through more productive systems with less waste, which brings the common goal of minimizing costs and maximizing yields in processes. With the help of data science and predictive analytics, it is possible to take conventional process optimization and operational excellence methods, such as statistical process control and Six Sigma, to the next level. The more advanced the process optimization aspect, the more transparent and responsive the systems. In this study, seven different machine learning algorithms—linear regression, logistic regression, K-NN, decision trees, random forest, support vector machine (SVM) and XGBoost—were compared with laboratory results to define and predict the possible impacts of wide range temperature fluctuations on process stability. SVM provided the best accuracy with 0.93 according to the metric precision of the models calculated using the confusion matrix.

Neurovascular disorders, such as traumatic brain injury and stroke, persist as leading causes of death and disability – thus, the search for novel therapeutic approaches for these disorders continues. Many hurdles have hindered the translation of effective therapies for traumatic brain injury and stroke primarily because of the inherent complexity of neuropathologies and an inability of current treatment approaches to adapt to the unique cell death pathways that accompany the disorder symptoms. Indeed, developing potent treatments for brain injury that incorporate dynamic and multiple disorder-engaging therapeutic targets are likely to produce more effective outcomes than traditional drugs. The therapeutic use of hypothermia presents a promising option which may fit these criteria. While regulated temperature reduction has displayed great promise in preclinical studies of brain injury, clinical trials have been far less consistent and associated with adverse effects, especially when hypothermia is pursued via systemic cooling. Accordingly, devising better methods of inducing hypothermia may facilitate the entry of this treatment modality into the clinic. The use of the delta opioid peptide D-alanine D-leucine enkephalin (DADLE) to pharmacologically induce temperature reduction may offer a potent alternative, as DADLE displays both the ability to cause temperature reduction and to confer a broad profile of other neuroprotective and neuroregenerative processes. This review explores the prospect of DADLE-mediated hypothermia to treat neurovascular brain injuries, emphasizing the translational steps necessary for its clinical translation.

Aim: We tested a hypothesis that postoperative active warming and/or arm leg stretches reduce the difference between core and skin temperatures (primary variable) improving the peripheral circulation immediately after major abdominal surgery. Methods: Fifty‐one patients undergoing major abdominal surgeries were randomly assigned to receive one of three interventions immediately after surgery; routine care (control group), mild intermittent exercise on the bed (exercise group), and forced‐air warming (warming group). Core and skin temperatures and perfusion index were continuously measured from anesthesia induction to 12 h after arrival at the ward. Results: Core body temperature was maintained over 37°C with a relatively greater gap between core and skin temperatures over 1°C and reduced perfusion index in the early postoperative period in the control group. In the warming group, the reduced skin temperature at arrival at the ward approximated to the core temperature leading to significant reduction of the temperature gap and increasing the perfusion index to the preoperative level. Although less evident, both the temperature gap and peripheral perfusion significantly improved in the exercise group after 6 and 8 h after arrival at the ward, respectively. Conclusions: Vasoconstriction in response to cessation after anesthesia and surgery serves to maintain core temperature, but impairs peripheral circulation. Active warming and intermittent mild exercise immediately after arrival at the ward reduces the temperature gap and improves peripheral circulation during the early postoperative period. While cost‐effectiveness needs to be considered before clinical application of the intervention, the cost‐free mild exercise may be a feasible option for improving postoperative patient care. [ABSTRACT FROM AUTHOR]

This paper presents high-performance Ni-YSZ tubular catalysts for CO 2 methanation prepared by the extrusion molding. We fabricated tubular-shaped Ni-YSZ catalysts with various Ni contents (25–100 wt% NiO) and investigated the effect of Ni content on CO 2 methanation performance under various temperatures and gas flow rates. Catalysts with Ni contents >75 wt% showed CH 4 yields >91% above 270 °C with high CH 4 selectivities (>99%). High CH 4 yields were also observed under high GHSVs at 300 °C: 93% and 92% at 8700 and 17,500 h−1, respectively. Investigation of methanation with the catalysts revealed that CO 2 methanation was accelerated by a localized hotspot at the reactor inlet arising from the interaction between reaction kinetics and heat generation. Using a numerical simulation, we considered the optimum arrangement of catalytic activity in the reactor to avoid hotspot generation and realize a stable high CO 2 methanation performance. We can simultaneously achieve high CH 4 production and prevent hotspot formation by properly arranging catalysts with different activities. • Ni content >75% gave CH 4 yields >91% above 270 °C with selectivities >99%. • Inlet hotspot arises from interaction of heat generation and reaction acceleration. • Increasing catalytic activity along reactor length can avoid hotspot formation. [ABSTRACT FROM AUTHOR]

Abstract Background Moderate hypothermia after decompressive surgery might not be beneficial for stroke patients. However, normothermia may prove to be an effective method of enhancing neurological outcomes. The study aims were to evaluate the application of a pre-specified normothermia protocol in stroke patients after decompressive surgery and its impact on temperature load, and to describe the functional outcome of patients at 12 months after treatment. Methods We analysed patients with space-occupying middle cerebral artery (MCA) infarction treated with decompressive surgery and a pre-specified temperature management protocol. Patients treated primarily with device-controlled normothermia or hypothermia were excluded. The individual temperature load above 36.5 °C was calculated for the first 96 h after hemicraniectomy as the Area Under the Curve, using °C x hours. The effect of temperature load on functional outcome at 12 months was analysed by logistic regression. Results We included 40 stroke patients treated with decompressive surgery (mean [SD] age: 58.9 [10.1] years; mean [SD] time to surgery: 30.5 [16.7] hours). Fever (temperature > 37.5 °C) developed in 26 patients during the first 96 h after surgery and mean (SD) temperature load above 36.5 °C in this time period was 62,3 (+/− 47,6) °C*hours. At one year after stroke onset, a moderate to moderately severe disability (modified Rankin Scale score of 3 or 4) was observed in 32% of patients, and a severe disability (score of 5) in 37% of patients, respectively. The lethality in the cohort at 12 months was 32%. The temperature load during the first 96 h was not an independent predictor for 12 month lethality (OR 0.986 [95%-CI:0.967–1.002]; p