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Objective The objective was to develop a novel scoring system that would be predictive of postoperative pulmonary complications in critically ill patients after cardiac and major vascular surgery. Methods A total of 17,433 postoperative patients after coronary artery bypass graft, valve, or thoracic aorta repair surgery admitted to the cardiovascular intensive care units at Cleveland Clinic Main Campus from 2009 to 2015. The primary outcome was the composite of postoperative pulmonary complications, including pneumonia, prolonged postoperative mechanical ventilation (>48 hours), or reintubation occurring during the hospital stay. Elastic net logistic regression was used on the training subset to build a prediction model that included perioperative predictors. Five-fold cross-validation was used to select an appropriate subset of the predictors. The predictive efficacy was assessed with calibration and discrimination statistics. Post hoc, of 13,353 adult patients, we tested the clinical usefulness of our risk prediction model on 12,956 patients who underwent surgery from 2015 to 2019. Results Postoperative pulmonary complications were observed in 1669 patients (9.6%). A prediction model that included baseline and demographic risk factors along with perioperative predictors had a C-statistic of 0.87 (95% confidence interval, 0.86-0.88), with a corrected Brier score of 0.06. Our prediction model maintains satisfactory discrimination (C-statistics of 0.87) and calibration (Brier score of 0.07) abilities when evaluated on an independent dataset of 12,843 recent adult patients who underwent cardiovascular surgery. Conclusions A novel prediction nomogram accurately predicted postoperative pulmonary complications after major cardiac and vascular surgery. Intensivists may use these predictors to allow for proactive and preventative interventions in this patient population.

The goal of this study was to see how much genetic and environmental interaction affects essential oil yield and patchouli alcohol content and find superior genotypes over the years of patchouli's unique aroma in India. The tests were carried out for one year in 2013–2014 (initial evaluation trial) and then for three years in 2015–2016, 2016–2017, and 2017–2018 (major yield assessment trials). The fourteen patchouli genotypes and one commercial variety (CIM- Samarth) were studied in an RBD design with three replications. A pooled analysis of variance was performed across the environments/years for the eleven economic attributes. The results showed that most of the attributes had significant differences. In all three environments/years, genetic correlations between economic traits played a critical role in genetic improvement, for example, the traits X3-vs-X4, X3-vs-X5, and X4-vs-X5. As a result, according to correlations throughout the selective environments/years, picking these features will be favorable. Furthermore, the heritability in a broad sense (h2BS) was expressed as a percentage. The scores for all ten attributes ranged from 87.13 to 99.25%. The genetic advance over mean (GAM) percent, which ranged from 13.42 to 162.83%, was equally fascinating. The four winning genotypes for essential oil yield, G/PATC-11, G/PATC-1, G/PATC-2, and G/PATC-5, and the lines G/PATC-1, G/PATC-4, G/PATC-9, and G/PATC-11 for patchouli alcohol percent), were explained by biplot analysis as stable and higher-yielding genotypes. The percentage of ar-curcumene in stable genotypes with a distinct fragrance ranged from 8.60 to 8.71% in G/PATC 4, G/PATC 11, G/PATC 14, and G/PATC 1. Ar-curcumene has been found for the first time in the patchouli (Pogostemon cablin (Blanco) Benth) species. As a result, it may be prudent to cultivate these stable genotypes on a big scale in India.

Water electrolysis is a promising technology to produce hydrogen but it was severely restricted by the slow oxygen evolution reaction (OER). Herein, we firstly reported an advanced electrocatalyst of MOF-derived hollow Zn–Co–Ni sulfides (ZnS@Co9S8@Ni3S2-1/2, abbreviated as ZCNS-1/2) nanosword arrays (NSAs) with remarkable hydrogen evolution reaction (HER), OER and corresponding water electrolysis performance. To reach a current density of 10 mA cm−2, the cell voltage of assembled ZCNS-1/2//ZCNS-1/2 for urea electrolysis (1.314 V) is 208 mV lower than that for water electrolysis (1.522 V) and stably catalyzed for over 15 h, substantially outperforming the most reported water and urea electrolysis electrocatalysts. Density functional theory calculations and experimental result clearly reveal that the properties of large electrochemical active surface area (ECSA) caused by hollow NSAs and fast charge transfer resulted from the Co9S8@Ni3S2 heterostructure endow the ZCNS-1/2 electrode with an enhanced electrocatalytic performance.

Statement of problem Bilateral balanced occlusion has been advocated over nonbalanced occlusion for improved removable complete denture stability and function. However, assessments of quality of life and patient satisfaction studies between the 2 occlusion schemes are lacking. Purpose The objective of this parallel randomized control trial was to determine the difference in quality of life and patient satisfaction between the nonbalanced and bilaterally balanced occlusal schemes. Material and methods Sixty participants were included in the parallel randomized control trial of nonbalanced and bilaterally balanced complete dentures. Thirty were recruited into each group with definitive inclusion and exclusion criteria as per the Consolidated Standards of Reporting Trials (CONSORT) guidelines. Quality of life was estimated from the oral health quality of life (Oral Health Impact profile) for edentulous patients questionnaire, and patient satisfaction was analyzed from a visual analog scale. The estimation was made at 0, 3, and 6 months after denture insertion. The data were statistically analyzed with the Friedman, Mann-Whitney, and t test (α=.05). Results The mean ±standard deviation Oral Health Impact profile score was 60.81 ±8.87 for nonbalanced dentures and 64.12 ±8.98 for bilaterally balanced dentures. The mean ±standard deviation visual analog scale score was 2.84 ±0.28 for nonbalanced dentures and 2.90 ±0.31 for bilaterally balanced dentures. The Mann-Whitney and t test indicated nonsignificant differences between the 2 groups and at different time intervals for Oral Health Impact profile and visual analog scale scores (P>.05). Conclusions The study detected no significant differences between the 2 occlusal schemes in quality of life or patient satisfaction.

The prone position is extensively used to improve oxygenation in patients with severe acute respiratory distress syndrome caused by SARS-CoV-2 pneumonia. Occasionally, these patients exhibit cardiac and respiratory functions so severely compromised they cannot tolerate lying in the supine position, not even for the time required to insert a central venous catheter. The authors describe three cases of successful ultrasound-guided internal jugular vein cannulation in prone position. The alternative approach here described enables greater safety and well-being for the patient, reduces the number of episodes of decompensation, and risk of tracheal extubation and loss of in-situ vascular lines.

Background Coma is one of the frequently encountered clinical conditions in any intensive care unit (ICU), which is responsible for considerable morbidity and mortality. Therefore, this study was designed to look at the clinical and EEG profile of Nonconvulsive Status Epilepticus (NCSE) in comatose ICU patients using portable electroencephalography (EEG). Methods In all 102 patients of unresponsive coma (GCS ≤ 8), who remained in poor sensorium despite 48 h of optimum treatment in ICU, were included in the study. All patients underwent 1 h of electroencephalography (EEG) monitoring with a portable EEG machine. All EEGs were screened according to Salzburg Consensus Criteria (SCC) for Nonconvulsive Status Epilepticus (NCSE). Patients with evidence of NCSE were administered parenteral Antiepileptic Drugs (AED). A repeat EEG was done after 24 h of baseline to ascertain the effect of AED. The primary outcome was the recognition of patients with NCSE on the basis of established EEG criteria. The secondary outcome measure was the Glasgow outcome scale (GOS) at the time of discharge. Results Out of 102 cases enrolled, 12 (11.8%) cases were detected to have NCSE on portable EEG. The mean age of patients with NCSE was 52.2 years. In terms of gender distribution, 2/12 (17%) were female, and 10/12 (83%) were male (M: F = 5:1). Median GCS was 6 (range 3–8). Looking at CNS infections, 4/12 (33.3%) had evidence of some form of CNS infection in the NCSE group, compared to 16/90 (18%) in the group without NCSE. This difference was statistically significant (P-value 2 points) after administration of AED’ was noted with good clinical outcomes (GOS 5). In five of these 12 cases, death was the final outcome (GOS 1). Conclusions NSCE should be considered in the differential diagnosis of all unresponsive comatose ICU patients. In resource-limited settings, where continuous EEG monitoring may not be feasible, bedside portable EEG testing can be used to diagnose patients with NCSE. Treating NCSE reverses epileptiform EEG changes and improves clinical outcomes in a subset of comatose ICU patients.

Presbyphonia negatively impacts quality of life in patients with age-related voice changes. A proof-of-concept study showed promise for high vocal intensity exercise to treat presbyphonia, which became the basis for a novel intervention for age-related voice changes known as Phonation Resistance Training Exercises (PhoRTE). Expiratory Muscle Strength Training (EMST) has also been proposed as an additional intervention to target and strengthen the aging respiratory system; however, EMST has undergone limited evaluation as an adjunct treatment for elderly patients undergoing voice therapy for presbyphonia. This study determined if the addition of EMST to PhoRTE voice therapy (PhoRTE + EMST) is at least as effective at voice improvement as PhoRTE alone.Prospective, randomized, controlled, single-blinded, non-inferiority.Participants aged 55 years or older with a diagnosis of vocal fold atrophy were randomized to complete PhoRTE therapy or PhoRTE + EMST. The primary outcome was change in Voice Handicap Index-10 (VHI-10). Secondary outcomes included the Aging Voice Index, maximum expiratory pressure, and acoustic and aerodynamic measures of voice. Repeated measures linear mixed models were constructed to analyze outcomes at a significance level of α = 0.10.Twenty-six participants were recruited for the study, and 24 participants were randomized to either treatment arm. Sixteen participants completed the entire study. Both treatment arms showed statistically significant and clinically meaningful improvements in VHI-10 (PhoRTE mean [M] = -8.20, P0.001; PhoRTE + EMST M = -9.58, P0.001), and PhoRTE + EMST was noninferior to PhoRTE alone (P = 0.069). Both groups experienced a statistically significant pre-post treatment decrease (improvement) in AVI scores (PhoRTE M = -18.40, P = 0.004; PhoRTE + EMST M = -16.28, P = 0.005). PhoRTE+EMST had statistically significantly greater changes in maximum expiratory pressure compared to PhoRTE alone (PhoRTE M = 8.24 cm HThis study demonstrates that voice therapy targeting high vocal intensity exercise (eg, PhoRTE) and EMST can play a role in improving voice outcomes for patients with presbyphonia.

Background Carbapenemase producing gram-negative bacteria (GNB) has become a huge problem in majority of tertiary care centers worldwide. They are associated with very high morbidity and mortality rates, especially when they cause invasive infections. Therefore, rapid detection of these organisms is very important for prompt and adequate antibiotic therapy as well as infection control. The aim of this study was rapid detection of carbapenemase genes and thereby likely carbapenem resistance, 24–48 hours in advance, directly from the positive-flagged blood culture bottles using CHROMagar and Xpert® Carba-R. Methods Aspirate from positively flagged blood culture bottles was subjected to differential centrifuge. All gram-negative bacilli on gram stain from the deposit were processed in Xpert® Carba-R and inoculated on CHROMagar. The presence of genes and growth on CHROMagar was compared with carbapenem resistance on VITEK-2 Compact. Results A total of 119 GNB isolates were processed. One or more of the carbapenemase genes were detected in 80 isolates. On comparison with VITEK-2 result, 92 samples showed concordance for carbapenem resistance 48 hours in advance. There was discordance in 21 isolates with 12 major errors and 09 minor errors. The sensitivity of direct Xpert® Carba-R test for rapid detection of carbapenem resistance, 48 hours in advance, was 81.42%. The sensitivity of direct CHROMagar test for accurate detection of carbapenem resistance, 24 hours in advance, was 92.06%. Conclusion The ability to detect carbapenem resistance with very high accuracy, 48 hours in advance, helps in appropriate antibiotic therapy and implementation of effective infection control practices.

Nb2O5 nanoparticles with an average particle size of 10 nm supported on a rhombic dodecahedral metal organic framework (MOF) were successfully synthesized by a facile one-pot hydrothermal reaction and subsequent calcination process. Experimental results demonstrated that the prepared catalyst drastically improved the hydrogen storage behavior of MgH2. 7 wt% Nb2O5@MOF doped MgH2 started to desorb hydrogen at 181.9 °C and 6.2 wt% hydrogen could be released within 2.6 min and 6.3 min at 275 °C and 250 °C, respectively. The fully dehydrogenated composite also displayed excellent hydrogenation by decreasing the onset absorption temperature to 25 °C and taking up 4.9 wt% and 6.5 wt% hydrogen within 6 min at 175 °C and 150 °C, respectively. Moreover, the corresponding activation energy was calculated to be 75.57 ± 4.16 kJ mol−1 for desorption reaction and 51.38 ± 1.09 kJ mol−1 for absorption reaction. After 20 cycles, 0.5 wt% hydrogen capacity was lost for the MgH2+7 wt% Nb2O5@MOF composite, much lower than 1.5 wt% of the MgH2+7 wt% Nb2O5 composite. However, the addition of Nb2O5@MOF had limited effect on reducing the dehydrogenation enthalpy of MgH2. Microstructure analysis revealed that Nb2O5 particles were uniformly distributed on surface of the MgH2 matrix and synergistically improved the hydrogen storage property of MgH2 with MOF.

As an innovative propulsion technique, laser augmented chemical propulsion (LACP) seems superior to the traditional ones. However, the corresponding combustion theories have still to be ascertained for LACP. Burning rate of 5-aminotetrazole (5-ATZ) propellant has been studied by testing pressed samples under different combustor pressures and laser powers. Based on micro computed tomography (MicroCT), an advanced thickness-over-time (TOT) method to characterize the regression of the produced non-planar burning surface is established. Because of a shell structure covering the combustion surface, the burning rate of the implemented 5-ATZ propellant is not constant during laser ablation. Resorting to functional fitting, a new law of non-constant burning including the effect of the observed unique burning surface structures is proposed. Accordingly, applicable combustion conditions of 5-ATZ based propellants have been preliminarily speculated for future research activities.

The electrochemical performance of solid oxide cells (SOCs) is investigated under both fuel cell and electrolyzer operations to understand their asymmetric behavior between the two operation modes. The current–voltage and electrochemical impedance characteristics of a hydrogen-electrode-supported cell are experimentally analyzed. Also, a numerical model is developed to reproduce the cell performance and to understand the internal resistances of the cell. Partial pressures of supplied gas and load current are varied to evaluate their effects on the cell performance. The gas partial pressures of hydrogen and steam supplied to the hydrogen electrode are kept equivalent so that the cell performance can be fairly compared between the two operation modes when the same current is applied. It is found that the origin of the asymmetry is mostly from the hydrogen electrode; both activation and concentration overpotentials show asymmetric behavior particularly at high current densities. A numerical experiment is also conducted by deliberately changing parameters in the model. Asymmetry in the activation overpotential is found to be originated from the non-identical charge-transfer coefficients in the Butler–Volmer equation and also from the non-uniform gas concentration formed in the hydrogen electrode under current-biased conditions. On the other hand, asymmetry in the concentration overpotential is associated with the non-equimolar counter diffusion of hydrogen and steam caused by the effect of Knudsen diffusion. Therefore, enhancing gas transport in the hydrogen electrode and reducing the contribution of Knudsen diffusion are effective approaches to reduce asymmetry not only in the concentration overpotential but also in the activation overpotential.

Statement of problem A consensus on the clinical performance of implant-supported removable partial dentures (ISRPDs) is lacking. Purpose The purpose of this systematic review and meta-analysis was to evaluate the clinical performance of ISRPDs in terms of the implant survival rates, marginal bone loss, and patient-reported outcome measures (PROMs). Material and methods Four electronic databases (MEDLINE/PubMed, EMBASE, Web of Science, and Cochrane Library) were independently searched by 2 reviewers for articles published up to December 2020. A single-arm meta-analysis was performed to evaluate the implant survival rates and marginal bone loss by using the R program. The Cochrane collaboration tool was used to evaluate the risk of bias of randomized controlled trials (RCTs), and the Newcastle-Ottawa scale for non-RCT studies. Results Sixteen studies were included, with a total of 334 participants and a mean age of 58 years. The participants received a total of 581 dental implants, 475 conventional and 106 mini-implants. All included studies reported implant survival rate above 90% (range: 92% to 100%). Meta-analysis indicated a high proportion of implant survival rates of 3% (95% confidence interval [CI]: 2% to 5%) and a low mean raw score of marginal bone loss 0.98 mm (CI: 0.61 to 1.36 mm). Compared with conventional RPDs, improved patient quality of life and satisfaction were reported by studies that evaluated ISRPDs. RCT studies exhibited a low risk of bias for most domains, while most non-RCT studies were classified as good quality. Conclusions ISRPDs exhibited high implant survival rates and acceptable bone loss with improvement in the quality of life and satisfaction of patients when compared with conventional RPDs. Therefore, they can be considered suitable for the rehabilitation of partially edentulous patients.

The vetiver is an excellent source for essential oil, fodder, thatching, handicrafts, and mulching. Besides its various utility, a limited study has been done as fodder for ruminants. The major studies in the vetiver were focused on oil production, soil/water conservation. The study related to livestock cattle feeding on vetiver is very meager. The essential oil content, yield, nutritional, and protein quality of the fodder are highly affected by the G × E interaction. Objectives were to determine the extent of genotype × environment interaction for the nutritional quality of fodder, oil yield and to identify stable genotypes for the future breeding program. The thirty lines were evaluated to meet the above objectives to select genotypes with high oil yield and fodder quality. The genotypes were planted in RBD at the Institute in three years. The observations were recorded on twenty traits. The roots were distilled for oil by hydro-distillation for 24 h. GC analysis was performed in a Varian CP 3800 system using an Elite-5 fused silica column (30 m × 0.25 mm × 0.25 μm). The pooled mean observations of all characters were analyzed for stability by the GGE biplot. For after the pooled ANOVA across years, all the twenty traits showed highly significant variations except four. Except for one variable, essential oil content, genotype was very significant for all twenty traits (%). For maturity stage × year interaction, all the twenty traits also showed high significance except four traits. For the maturity stage × genotypes interaction, all the twenty traits also showed highly significant variations except four traits. For years × genotypes interaction, all twenty traits also showed highly significant differences. For the maturity stage× years × genotypes interaction, all the twenty traits also showed high significance except one trait. The genotype Vg-11/selection 24 expressed the highest performance for eight traits: digestibility, protein, potassium, phosphorus (%), iron, copper, and manganese (mg/Kg) in vetiver leaves and the root yield/plot (g). The genotype Vg-15 for the three traits: calcium (%), khusinol, and β-vetivone (%) in essential oil. Despite the importance of essential oil, its leaves are vital due to their nutritional quality and can be used as fodder. Genotype Vg-11/selection 24 may recommend as a suitable and nutritious fodder and Vg-13 for high oil. The vetiver also has a perfect opportunity to be as nutritious fodder in livestock for nutrition and production.

Background Since July 2019, Pakistan and Afghanistan have been facing an outbreak of serotype-2 circulating vaccine derived poliovirus (cVDPV2) in addition to continued transmission of serotype-1 wild poliovirus (WPV1) and SARS-CoV-2 in 2020. Understanding the risks of cVDPV2 transmission due to pause of global vaccination efforts and the impact of potential vaccination response strategies in the current context of COVID-19 mitigation measures is critical. Methods We developed a stochastic, geographically structured mathematical model of cVDPV2 transmission which captures both mucosal and humoral immunity separately and allows for reversion of serotype-2 oral polio vaccine (OPV2) virus to cVDPV2 following vaccine administration. The model includes geographic heterogeneities in vaccination coverage, population immunity and population movement. The model was fitted to historic cVDPV2 cases in Pakistan and Afghanistan between January 2010-April 2016 and July 2019-March 2020 using iterated particle filtering. The model was used to simulate spread of cVDPV2 infection from July 2019 to explore impact of various proposed vaccination responses on stopping transmission and risk of spread of reverted Sabin-2 under varying assumptions of impacts from COVID-19 lockdown measures on movement patterns as well as declines in vaccination coverage. Results Simulated monthly incidence of cVDPV2 from the best-fit model demonstrated general spatio-temporal alignment with observed cVDPV2 cases. The model predicted substantial spread of cVDPV2 infection, with widespread transmission through 2020 in the absence of any vaccination activities. Vaccination responses were predicted to substantially reduce transmission and case burden, with a greater impact from earlier responses and those with larger geographic scope. While the greatest risk of seeding reverted Sabin-2 was predicted in areas targeted with OPV2, subsequent spread was greatest in areas with no or delayed response. The proposed vaccination strategy demonstrated ability to stop the cVDPV2 outbreak (with low risk of reverted Sabin-2 spread) by February 2021. Conclusion Outbreak response vaccination campaigns against cVDPV2 will be challenging throughout the COVID-19 pandemic but must be implemented urgently when feasible to stop transmission of cVDPV2.

Converting CO2 to valuable materials is attractive in environmental protection and resource utilization. In this study, a vapor–liquid interface reaction system for mass production of high-quality graphene is reported. The graphene obtained has high crystallinity and few defects during the reaction of CO2 and Mg melt. The growth mechanism of graphene is demonstrated in vapor–liquid interface area by combining the CO2 bubbles as a soft template to guide growth with the confinement effect of dense MgO nanoparticles. The quality of the graphene is verified by epoxy composites with high electromagnetic shielding effectiveness. Additionally, the V–L reaction method ingeniously solves the dispersion of graphene in metal, providing a preparation strategy of Mg matrix composites with structure and function integration.

Owing to the advantages of high operating voltage, environmental benignity, and low cost, potassium-based dual-ion batteries (KDIBs) have been considered as a potential candidate for large-scale energy storage. However, KDIBs generally suffer from poor cycling performance and unsatisfied capacity, and inactive components of conductive agents, binders, and current collector further lower their overall capacity. Herein, we prepare coral-like carbon nanowires (CCNWs) doped with nitrogen as a binder-free anode material for K+-ion storage, in which the unique coral-like porous nanostructure and amorphous/short-range-ordered composite feature are conducive to enhancing the structural stability, to facilitating the ion transfer and to boosting the full utilization of active sites during potassiation/de-potassiation process. As a result, the CCNW anode possesses a hybrid K+-storage mechanism of diffusive behavior and capacitive adsorption, and stably delivers a high capacity of 276 mAh g-1 at 50 mA g-1, good rate capability up to 2 A g-1, and long-term cycling stability with 93 % capacity retention after 2000 cycles at 1 A g-1. Further, assembling this CCNW anode with an environmentally benign expanded graphite (EG) cathode yields a proof-of-concept KDIB, which shows a high specific capacity of 134.4 mAh g-1 at 100 mA g-1, excellent rate capability of 106.5 mAh g-1 at 1 A g-1, and long-term cycling stability over 1000 cycles without negligible capacity loss. This study provides a feasible approach to developing high-performance anodes for potassium-based energy storage devices.

Objectives Deep hypothermic circulatory arrest (DHCA) is often required for patients undergoing repair of descending thoracic aortic aneurysm (DTAA) or thoracoabdominal aortic aneurysm via left thoracotomy when proximal crossclamping is not feasible or when aneurysmal disease extends into the transverse aortic arch. Historical literature suggests higher complications rates due to the technical complexity of this approach; we examined outcomes with this approach at our center. Methods Between January 2008 and May 2018, 84 patients with DTAA or Crawford extent I thoracoabdominal aortic aneurysm underwent open repair. DHCA was employed in 46 of 84 (55%) patients, of which 33 (72%) required repair of distal arch and DTAA, and 13 (28%) required repair of the distal arch and extent I thoracoabdominal aortic aneurysm. Patients who underwent DHCA had more chronic dissections than those in the non-DHCA group (70% vs 34%; P ≤ .05). Results Major adverse outcomes for the DHCA group versus non-DHCA group were as follows: early mortality 3 out of 46 (7%) versus 4 out of 38 (11%) (P = .70), stroke 3 out of 46 (7%) versus 1 out of 38 (3%) (P = .62), permanent spinal cord deficit 2 out of 46 (4%) versus 3 out of 38 (8%) (P = .65), permanent renal failure necessitating dialysis 1 out of 46 (2%) versus 2 out of 38 (5%) (P = .59). Freedom from major adverse outcomes was 38 out of 46 (83%) versus 31 out of 38 (82%) for DHCA versus non-DHCA (P = 1). Conclusions DHCA can be employed via left thoracotomy for combined arch and DTAA or extent I thoracoabdominal aortic aneurysm open repair.

Long bone metastases are a disease of high social importance. The goals of surgical treatment are to relieve pain, maintain or restore joint function, and prevent or treat pathological fractures. "Oligometastases" is a disease with a limited number (3-5) of metastatic lesions in the same body district, where an aggressive treatment can be carried out with "curative" intent. This study aimed to evaluate patients with bone metastases surgically treated to determine how surgical treatment can influence prognosis and quality of life, comparing solitary metastasis, oligometastases, and multiple metastases.This is a retrospective analysis of 130 patients with long bone metastases surgically treated between October 2015 and August 2019: 40 patients had solitary metastasis; 38 had less than three metastases (oligometastases), and 52 had multiple metastases. Surgery was resection and reconstruction with a cemented prosthesis (95) or nailing (35).Overall survival was significantly better in patients with solitary metastasis or oligometastases than in those with multiple metastases (p0.0001). Patients treated with resection and prosthesis had significantly better survival than those treated with nailing (p0.0001). Implant complications requiring surgical revision occurred in 20 patients treated with prostheses, while no complications occurred in patients treated with nailing.Survival of cancer patients has improved in the last two decades, leading to an increase of diagnosed metastases. Patients with oligometastases have a survival similar to those with a single metastasis. Optimal implants survival curves should stay above the curves of patients survival.Since there are no differences in survival, patients with oligometastases should be treated as patients with a solitary lesion, with more aggressive surgery (wide resection and reconstruction with prosthesis). Intramedullary nailing is still indicated in metaphyseal or diaphyseal metastases in patients with advanced disease or poor prognosis when the life expectancy does not overcome the expected survival of the nail, avoiding the need for further surgery.

Objective The study objective was to investigate the impact of multiple arterial grafting on long-term all-cause mortality in women undergoing isolated coronary artery bypass grafting. Methods A comprehensive search was performed to identify observational studies reporting outcomes after coronary artery bypass grafting reported by sex and stratified into multiple arterial grafting versus single arterial grafting strategies. Articles were considered for inclusion if they were written in English and were propensity-matched observational studies. Included studies were then pooled in a meta-analysis performed using the generic inverse variance method. The primary outcome was long-term all-cause mortality. Secondary outcomes were operative mortality and spontaneous myocardial infarction. Meta-regression was used to explore the effects of preoperative and intraoperative variables on the primary outcome. Results A total of 6 studies with 32,793 women (25,714 single arterial grafting and 7079 multiple arterial grafting) were included. Women who received multiple arterial grafting had lower long-term mortality (incidence rate ratio, 0.86; 95% confidence interval, 0.76-0.96; P = .007) and spontaneous myocardial infarction (incidence rate ratio, 0.80; 95% confidence interval, 0.68-0.93; P = .003) compared with women who received single arterial grafting, but the difference in mortality disappeared when including only the 3 largest studies. There was no difference between groups in operative mortality (odds ratio, 0.99; 95% confidence interval, 0.84-1.17; P = .91). Meta-regression did not identify any associations with the incidence rate ratio for long-term mortality. Conclusions The use of multiple arterial grafting in women undergoing coronary artery bypass grafting is associated with lower long-term mortality, although the difference is mostly driven by small series. Further studies, including randomized trials, are needed to evaluate the efficacy of multiple arterial grafting in women undergoing coronary artery bypass grafting.

Purpose Despite evidence that cognitive remediation improves cognitive and employment outcomes in persons with severe mental illnesses (SMI), its effects have not been systematically compared between Black and White participants. Considering that Black adults have more negative experiences receiving mental health treatment, providers may have greater difficulty engaging and retaining Black Americans in cognitive remediation. Due to the effects of structural racism on reducing employment opportunities for Black Americans, it is unclear whether Black participants will reap the same benefits of cognitive remediation on work outcomes as White Americans. This paper addressed this question. Methods A secondary analysis was conducted of five randomized controlled trials comparing cognitive remediation (the Thinking Skills for Work program: TSW) and vocational rehabilitation vs. vocational rehabilitation only in 137 Black and 147 White Americans (64.2% schizophrenia-schizoaffective disorder) who were followed up for two years. Results Comparable proportions of Black and White participants were engaged and retained in TSW (>75%). Participants who received TSW improved significantly more in cognition than those receiving vocational services alone, with no racial differences in benefit. Participants in TSW obtained more work, earned more wages, and worked more weeks than those receiving vocational services alone, with no differences between the races. Conclusions The findings indicate that Black Americans with SMI receiving vocational services could be successfully engaged in and benefit from cognitive remediation, highlighting the vital role of healthcare service systems in giving credence to structural racism to more effectively mitigate racial disparities in treatment outcomes.

The lack of passive fit in implant-supported restorations can lead to mechanical and biological complications and compromise the longevity of the prosthesis. The manufacturing technique and evaluation site are factors that may affect the passive fit of multiunit screw-retained implant frameworks. However, scientific information regarding this issue is lacking.The purpose of this in vitro study was to investigate the effect of manufacturing technique and evaluation site on the passive fit of multiunit screw-retained implant frameworks.Two multiunit implant analogs were placed into the right second premolar and second molar sites of a mandibular typodont model. A total of 50 3-unit Co-Cr frameworks were fabricated with 3 indirect (conventional technique, polymethyl methacrylate milling, stereolithography) and 2 direct techniques (selective laser melting and soft alloy milling). The patterns obtained by indirect techniques were subsequently cast. The Sheffield test was used for the assessment. Digital images of the sites were obtained by using a stereomicroscope at ×40 magnification, and the measurement points (n=10 for each site) were examined to record the vertical marginal discrepancy values (μm) with the aid of a measuring software program. The collected data were subjected to the 2-way ANOVA and Tukey honestly significant difference test (α=.05).The influence of the manufacturing technique (variable 1) on the vertical marginal discrepancy values was statistically significant (P.001). However, the evaluation site (variable 2) (P=.097) and the interaction of the variables (P=.960) were not statistically significant. The lowest misfit values were observed for selective laser melting (74.2 ±20.5 μm) followed by stereolithography (92.8 ±23.9 μm), soft alloy milling (108.4 ±12.0 μm), polymethyl methacrylate milling (116.7 ±17.0 μm), and conventional technique (137.5 ±18.9 μm). The vertical marginal discrepancy values of the selective laser melting group were significantly lower than those of all other groups (P.05).The manufacturing technique significantly affected the passive fit. selective laser melting-fabricated frameworks demonstrated superior fitting accuracy. Among the indirect techniques, stereolithography-fabricated frameworks revealed the lowest misfit values. The vertical marginal discrepancy values of all manufacturing groups were within the range of clinical acceptability (150 μm).

Statement of problem Evidence for the efficacy and safety of natural products for the treatment of denture stomatitis is lacking. Purpose The purpose of this systematic review was to answer the question “Are topical natural substances effective and safe compared with conventional antifungals in the treatment of denture stomatitis?” Material and methods A structured search in 11 databases, including non-peer-reviewed, was undertaken. Two authors independently selected the studies, extracted the data, assessed the study quality, and graded the evidence, with disagreement resolved with a third reviewer. Data were evaluated descriptively by following Synthesis Without Meta-analysis (SWiM) reporting items. This study was registered at the International Prospective Register of Systematic Reviews (PROSPERO), number CRD42020216213. Results After the removal of duplicates, 1925 records remained, and after a 2-phase reading of abstracts and full texts, 17 studies were included. Propolis, green tea, ginger, Zataria multiflora, chitosan, garlic, Artemisia, Schinus terebinthifolius Raddi, Uncaria tomentosa, Punica granatum, and Ricinus communis appeared to have similar efficacy and safety when compared with nystatin or miconazole. Most of the studies presented a high risk of bias. Conclusions Certainty in the body of evidence that natural products might be appropriately used in the treatment of denture stomatitis is low. Well-designed randomized controlled trials are still needed to evaluate the topic better because there is high heterogeneity among the studies.

Monitoring the degradation of induction motors is an essential concern for industries, especially when there are high costs related to maintenance and their stops. Nowadays, there are many non-invasive ways to monitor the health status of induction motors, including sensors to measure temperature, magnetic field, vibration, current, and power. However, installing these sensors may not be a simple task since intrusive procedures such as engine disassembling, wire separation, and engine interruption are commonly observed. Thus, we propose MUCLA (Multiphase Clamp and Tracking - patent pending) as a new device and methodology for monitoring motor degradation by analyzing its stator current. MUCLA introduces a non-invasive current sensors array on a proposed clamp in the hardware perspective, while a spectral tracking methodology refers to our novelty in the software viewpoint. For end-users, the main MUCLA contribution relies on the combination of the simplicity of installation and the possibility of using the proposed device even when considering Variable-Frequency Drive powered engines. The results obtained with both simulation and practical tests show encouraging results over different input workloads and emulated degradation. Compared to the current initiatives, we can classify MUCLA as a better solution for industrial plants in terms of installation time, installation complexity, and cost.

The reliability of the result significantly affects the use of the Coefficient of Variation (within the test variation), which reflects the variability of the concrete properties rather than the standard deviation. For the estimation of reliability and precision, comprehensive statistical analysis (within test variation) is conducted on 534 test samples using a rebound hammer. Different standards, like BIS, EN, ACI, and ASTM, are used in this study to compare the test results. Empirical research revealed that there are contradictions in literature as well as the standards used in many countries. The present paper focuses on detailed investigations of uncertainty measurements of the surface hardness test by statistical parameters (range of rebound index, standard deviation, and Coefficient of Variation). The unbiased estimate of the variability parameters from the published results has been verified concerning to the European standard. Concrete parameters namely cement type, water to cement ratio, compaction deficiency, curing condition, and elevated temperature have an impact on the output of the rebound hardness in terms of the variability of the compressive strength. Based on the results, the authors are willing to propose amendments to the Indian code graciously in compliance with the variability of the rebound hammer.

The Piper hispidinervium leaves and thin stems were dried under laboratory and field conditions. Laboratory drying was performed using a shade dryer operating with and without forced convection and an oven dryer operating at 30 and 40 °C. Field experiments were conducted using solar dryers with three different covers, i.e., transparent, black plastic, and palm straw covers. The essential oil extraction was performed by steam distillation, and the safrole content was analyzed by gas chromatography. Five mathematical models (Page, logarithmic, Henderson and Pabis, fractional, and diffusion) were fitted with the experimental data and compared based on the coefficient of determination (R2), root mean square error (RMSE) and χ2. Results suggest that the best model was the logarithmic model (R2 > 0.99, RMSE

In the present study, the unique three-dimensional graphene coated nickel (Ni/C) foam reinforced silicon carbide (Ni/C@SiC) composites were first obtained via the precursor impregnation and pyrolysis (PIP) processes. The microstructure images indicated that the SiC fillers were successfully prepared in the skeleton pores of the Ni/C foam. The influence of the PIP cycles on the microwave absorption performances was researched, and the results indicated that after the primary PIP process, Ni/C@SiC–I possessed the optimal microwave absorbing performance with a minimum reflection loss(RL) of −25.87 dB at 5.28 GHz and 5.00 mm. Besides, the RL values could be below −10.00 dB from 5.88 GHz to 7.74 GHz when the corresponding matching thickness was 3.85 mm. However, the microwave absorption properties of Ni/C@SiC-II and Ni/C@SiC-III were tremendously degraded as the PIP times increased. At last, the electromagnetic parameter, dielectric loss, attenuation constant as well as impedance matching coefficient were further investigated to analyze the absorbing mechanism, which opened a new path for the certain scientific evaluation of the absorbing materials and had extremely important to the defence technology.

A series of CoPd/KIT-6 bimetallic catalysts with various Co:Pd molar ratios at different calcination temperatures were prepared and used for the direct synthesis of H2O2 from H2 and O2. These catalysts were characterized by nitrogen adsorption-desorption, low and wide-angle X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), transmission electron microscopy (TEM), scanning electron microscopy (SEM), elemental mapping and energy-dispersive X-ray (EDX) methods. It was found that the particle size, electronic interactions, morphology, and textural properties of these catalysts as well as their catalytic activity in the reaction of H2 with O2 were affected by Co addition and different calcination temperatures. Also, the results showed that while the H2O2 selectivity depends on Pd2+ species, the H2 conversion is related to Pd0 active sites. Among these catalysts, CoPd/KIT-6 calcined at 350 °C (CoPd/KIT-350 catalyst) showed the best catalytic activity with 50 % of H2O2 selectivity and 51 % conversion of H2.

Energy piles have attracted increasing interest for application in ground source heat pumps, because it is environment-friendly, energy-efficient, and without additional drilling cost. However, when there is a large difference between the heating and cooling loads, the system will suffer from a soil thermal imbalance which may further decline the system performance and even cause a system failure. A hybrid ground source heat pump system that integrates auxiliary equipment can solve the problem, however, it needs additional investment and a complicated control strategy. In this paper, the zoning operation of energy piles can effectively improve the temperature recovery ability of soil in the energy pile group and thus alleviate the soil thermal imbalance. Specifically, a heating-dominated residential building in Beijing is selected for a case study, with 144 energy piles arranged in a 12 × 12 layout. An analytical model of the spiral-coil energy pile group with seepage will be adopted, which can consider the groundwater flow, the geometry of spiral coils, and the thermal interaction among different energy piles, achieving high calculation accuracy and fast calculation speed. Based on this analytical energy pile model, a system model will be built to investigate the system performance influenced by different zoning operation strategies. Results show that intensive heat injection into the center of the pile group (Strategy 2 and Strategy 3) or heat extraction from the outer layer of the pile group (Strategy 4) can relieve the cold accumulation. Strategy 2 can relieve the outlet temperature decline from 5.54 °C to 4.46 °C and improve the heating COP from 3.297 to 3.423 compared to the conventional full operation strategy. Although the annual heat pump COP of Strategy 2 is a little lower than that of conventional full operation strategy, Strategy 2 has the shortest unmet heating or cooling time. Therefore, the proposed zoning operation strategy can achieve good system efficiency and excellent system reliability compared to the conventional strategy.

Defect-engineered carbon materials have been emerged as promising electrocatalysts for oxygen reduction reaction (ORR) in metal-air batteries. Developing a facile strategy for the preparation of highly active nanocarbon electrocatalysts remains challenging. Herein, a low-cost and simple route is developed to synthesize defective graphene by pyrolyzing the mixture of glucose and carbon nitride. Molecular dynamics simulations reveal that the graphene formation is ascribed to two-dimensional layered feature of carbon nitride, and high compatibility of carbon nitride/glucose systems. Structural measurements suggest that the graphene possesses rich edge and topological defects. The graphene catalyst exhibits higher power density than commercial Pt/C catalyst in a primary Zn-air battery. Combining experimental results and theoretical thermodynamic analysis, it is identified that graphitic nitrogen-modified topological defects at carbon framework edges are responsible for the decent ORR performance. The strategy presented in this work can be can be scaled up readily to fabricate defective carbon materials.

Background The impact of online care on patients’ functional and psychological outcomes is critical to determine yet still unknown. Objective To evaluate how a novel online health model that facilitates physician-patient collaboration compares with in-person care for improving psoriasis patients’ functional status and mental health. Methods This 12-month randomized controlled equivalency trial randomized psoriasis patients 1:1 to online or in-person care. Functional impairment and depression were assessed at baseline and at 3-month intervals using the 5-level EuroQol-5 Dimensions (EQ-5D-5L) and Patient Health Questionnare-9 (PHQ-9). Results 296 patients were randomized to online or in-person groups. The between-group difference in overall improvement in EQ VAS (EuroQol Visual Analogue Scale) was -0.002 (95% CI -2.749, 2.745), falling within equivalence margin ±8. The between-group difference in overall improvement in EQ-5D-5L index was 0 (95% CI -0.003, 0.003), falling within equivalence margin ±0.1. The between-group difference in overall improvement in PHQ-9 was -0.33 (95% CI -1.20, 0.55), falling within equivalence margin ±3. Limitations Slightly different attrition rates between online and in-person arms (11% versus 9%), but no impact on outcomes. Conclusion The online health model was equivalent to in-person care for reducing functional impairment and depressive symptoms in psoriasis patients.

With the recent advancement in baseband integrated circuits and radio frequency (RF) technology, there is a strong demand to minimize the size of array-based microwave systems. However, array aperture miniaturization often leads to strong mutual coupling in the arrays. To date, mitigating and/or compensating the mutual coupling (nonlinear) effect remains a technical challenge. For instance, realizing microwave orientations in the presence of strong mutual coupling is a challenge. In this paper, we propose a unified electromagnetic machine learning (EMML) technique for overcoming this challenge. Antenna current’s Green function (ACGF) is employed for characterization of the EM response of elements in form of digital signal processing (DSP) module with the inclusion of mutual coupling effect among the elements. An EMML framework is then formulated and combined with the DSP module based on ACGF, to consequently come up with a nonlinear mutual coupling mitigation framework that provides better decoupling capability than the previous linear techniques. EMML is verified by application to a multiple signal classification (MUSIC)-based direction-of-arrival estimation scenario, and compared with the conventional methods. The results obtained show the validity, effectiveness of the EMML method. This method can be further used in coupled array-based beam forming, steering, and nulling applications.

Energy conversion technologies like fuel cells and metal-air batteries require oxygen reduction reaction (ORR) electrocatalysts with low cost and high catalytic activity. Herein, N-doped carbon spheres (N-CS) with rich micropore structure have been synthesized by a facile two-step method, which includes the polymerization of pyrrole and formaldehyde and followed by a facile pyrolysis process. During the preparation, zinc chloride (ZnCl2) was utilized as a catalyst to promote polymerization and provide a hypersaline environment. In addition, the morphology, defect content and activity area of the resultant N-CS catalysts could be regulated by controlling the content of ZnCl2. The optimum N-CS-1 catalyst demonstrated much better catalytic activity and durability towards ORR in alkaline conditions than commercial 20 wt% Pt/C catalysts, of which the half-wave potential reached 0.844 V vs. RHE. When applied in the Zn-air batteries as cathode catalysts, N-CS-1 showed a maximum power density of 175 mW cm-2 and long-term discharging stability of over 150 h at 10 mA cm-2, which outperformed 20 wt% Pt/C. The excellent performance could be due to its ultrahigh specific surface area of 1757 m2 g-1 and rich micropore channels structure. Meanwhile, this work provides an efficient method to synthesize an ultrahigh surface porous carbon material, especially for catalyst application.

A study was carried out at CSIR-CIMAP, RC. Hyderabad (India) to study the impact of coppicing time on the oil percent and its chemical composition of different cultivars of lemongrass using a randomized block design. The freshly harvested herb was used for the hydro-distillation for essential oil, and subsequent chemical analysis. The chemical components identification of the essential oil was performed by GC–MS. In the results coppicing time influenced significant changes in the essential oil content, essential oil yield, and its chemical composition especially, total citral, and geraniol content. The four top rankers varieties/cultivars of lemongrass for the essential oil yield were CIM-Shikhar > Krishna > CKP-25 > CIMAP-Suwarna; for the essential oil content CIM–Shikhar > Krishna > CIMAP-Suwarna > Praman; for total citral content Nima > CIM–Shikhar > Krishna > Pragati, and for the total geraniol content Himrosa > CN-5 > Tawirosa > Kalam, respectively. Therefore, we can recommend these varieties/cultivars for commercial cultivation in large areas under the semi-arid region of south India.

Background and Objectives The literature supporting Mohs micrographic surgery and staged excision in treating primary cutaneous melanoma is growing but has not been critically reviewed for bias. Methods Articles concerning Mohs micrographic surgery and staged excision for melanoma were assessed using modified “Risk of Bias in Non-randomized Studies of Interventions” (ROBINS-I) criteria, which measures bias in 7 categories. Results Forty-seven of 48 (97.9%) studies reviewed had serious or critical bias. None were randomized controlled trials. The most frequent cause of critical bias was poorly defined outcomes. The least frequent form of bias observed was change in intervention. Limitations The modified ROBINS-I criteria cannot account for all study limitations. Modification of the criteria leads to some degree of subjectivity. Conclusion The current body of literature suffers from limitations due to serious or critical bias in 1 or more ROBINS-I criteria. Local recurrence rate definitions are often poorly defined or not defined at all. Longer follow-up times, clear tumor classifications, and prospective, randomized study designs are necessary to improve the quality of future research.

Statement of problem When 3-dimensional printing casts, the operator can change the type of resin and the printing layer thickness, reducing the fabrication time. However, how these parameters affect the accuracy of 3-dimensionally printed casts is unknown. Purpose The purpose of this in vitro study was to evaluate the accuracy of 3-dimensionally printed casts by using a stereolithography (SLA) 3-dimensional printer (Forms2) with 3 different layer thickness (25, 50, and 100 μm) and 2 different resins (Gray and Cast) and by comparing the time to obtain each cast. Material and Methods One master cast was scanned, and a single file was printed several times. The printed casts were then scanned by using a laboratory scanner. The standard tessellation language (STL) files provided by the laboratory scanner were superimposed and compared by using a software program (Geomagic Control; 3D Systems). The 2-way ANOVA test was used for the trueness evaluation, followed by the Tukey test to identify differences among the groups (α=.05). Results No statistically significant differences in accuracy were found among the 3 different layers for either resin (P>.05). Printing time doubled as layer thickness decreased. Conclusions This study showed that when printing casts, the fastest printing settings can be used without losing accuracy and that the laboratory digital workflow can be accelerated with selection of the resin and cast layer, as the type of resin and layer thickness did not influence the quality of the casts.

Establishing highly effective charge transfer channels in carbon nitride (g-C3N4) to enhance its photocatalytic activity is still a challenging issue. Herein, the delaminated 2D Ti3C2 MXene nanosheets were employed to decorate the P-doped tubular g-C3N4 (PTCN) for engineering 1D/2D Schottky heterojunction (PTCN/TC) through electrostatic self-assembly. The optimized PTCN/TC exhibited the highest hydrogen evolution rate (565 μmol/h/g), which was 4.3 and 2.0 -fold higher than pristine bulk g-C3N4 and PTCN, respectively. Such enhancement may be primarily attributed to the phosphorus heteroatom doped and unique structure of 1D/2D g-C3N4/Ti3C2 Schottky heterojunction, enhancing the light-harvesting and charges’ separation. One-dimensional pathway of g-C3N4 tube and built-in electric field of interfacial Schottky effect can significantly facilitate the spatial separation of photogenerated charge carriers, simultaneously inhibit their recombination via Schottky barrier. In this composite, metallic Ti3C2 was served as electrons sink and photons collector. Moreover, ultrathin Ti3C2 flake with exposed terminal metal sites as a co-catalyst exhibited higher photocatalytic reactivity in H2 evolution compared to carbon materials (such as reduced graphene oxide). This work not only proposed the mechanism of tubular g-C3N4/Ti3C2 Schottky junction in photocatalysis, but also provided a feasible way to load ultrathin Ti3C2 as a co-catalyst for designing highly efficient photocatalysts.

The automobile catalytic converter (ACC) contains a huge number of precious metals as catalysts. When an ACC fails to meet standards, it is removed from the exhaust of an automobile but retains some catalytic activity. However, the recovery and/or activation of this waste is a high-cost process and includes several chemical treatments. Catalytic wet air oxidation (CWAO) has been reported as an effective wastewater treatment method. The most important disadvantage of CWAO is cost-nonefficiency. Herein, to overcome these problems, the simple recovery of catalysts from waste ACC for reuse in CWAO was investigated. The optimum conditions of reaction were investigated through response surface methodology (RSM). The optimum removal efficiency was 88% when the reaction conditions were set on the 20 bar of pressure at 111.5 °C over 77 min and using 0.41 g of recovered catalyst. In addition, toxicity testing was performed on a model of malathion-contaminated wastewater before and after CWAO treatment. Final product identification was performed which showed that CWAO eliminated the toxicity of wastewater and was determined to be malaoxon, present at acceptable concentrations, and tributyl phosphate. In conclusion, there may be important potential for the use of recovered ACC catalyst in the treatment of toxic wastewater.

Objective To evaluate the benefits and harmful effects of conservative versus liberal oxygen therapy in patients admitted to the Intensive Care Unit (ICU). Design A systematic review and meta-analysis was carried out. Setting ICU. Participants Adult patients (aged 18 years or older) were randomized to either a lower oxygenation target strategy (conservative oxygen therapy) or a higher oxygenation target strategy (liberal oxygen therapy) in the ICU. Interventions Patients received different oxygenation target strategies. Results Ten studies involving 5429 adult patients admitted to the ICU were included in the meta-analysis. The pooled results showed no decreased all-cause mortality at 28 days (RR 0.90; 95%CI 0.75–1.09; p = 0.28), 90 days (RR 1.02; 95%CI 0.92–1.13; p = 0.71) or longest follow-up (RR 0.97; 95%CI 0.88–1.08; p = 0.63) among patients administered conservative oxygen therapy. Secondary outcomes were comparable between the two groups. The results of sensitivity analyses and subgroup analyses were consistent with the main analyses. Conclusion No beneficial or harmful effects of conservative oxygen therapy were found compared to liberal oxygen therapy in relation to all-cause mortality among adult patients in the ICU. Conservative oxygen therapy did not reduce all-cause mortality at 28 days, 90 days or longest follow-up. Other important clinical outcomes were also comparable between the two groups.

The 0 to 10 numeric rating scale (NRS) of pain intensity is a standard outcome in randomized controlled trials (RCTs) of pain treatments. For individuals taking analgesics, there may be a disparity between “observed” pain intensity (the NRS, irrespective of concurrent analgesic use), and “underlying” pain intensity (what the NRS would be had concurrent analgesics not been taken). Using a contemporary causal inference framework, we compare analytic methods that can potentially account for concurrent analgesic use, first in statistical simulations, and second in analyses of real (non-simulated) data from an RCT of lumbar epidural steroid injections (LESI). The default analytic method was ignoring analgesic use, which is the most common approach in pain RCTs. Compared to ignoring analgesic use and other analytic methods, simulations showed that a quantitative pain and analgesia composite outcome based on adding 1.5 points to observed pain intensity for those who were taking an analgesic (the QPAC1.5) optimized power and minimized bias. Analyses of real RCT data supported the results of the simulations, showing greater power with analysis of the QPAC1.5 as compared to ignoring analgesic use and most other methods examined. We propose alternative methods that should be considered in the analysis of pain RCTs.

Along with the environmental pollution, the scarcity of clean water seriously threatens the sustainable development of human society. Recently, the rapid development of solar evaporators has injected new vitality into the field of water purification. However, the industry faces a considerable challenge of achieving comprehensive purification of ions, especially the efficient removal of mercury ions. In this work, we introduce an ideal mercury-removal platform based on facilely and cost-effectively synthesized polysulfide nanoparticles (PSNs). Further development of PSN-functionalized reduced graphene oxide (PSN-rGO) aerogel evaporator results in achieving a high evaporation rate of 1.55 kg m−2 h−1 with energy efficiency of 90.8% under 1 sun. With the merits of interconnected porous structure and adsorption ability, the photothermal aerogel presents overall purification of heavy metal ions from wastewater. During solar desalination, salt ions can be rejected with long-term stability. Compared with traditional water purification technologies, this highly efficient solar evaporator provides a new practical method to utilize clean energy for clean water production.

According to scientific studies dealing with the statistics of ICE (internal combustion engine) failures, most of them are registered in the ignition system (25%) and the power system (35%). The operable state of the ICE fuel system can be maintained by developing effective testing methods. For the purpose of theoretical research, a DBD-4 testing device was designed in the methodological part of the research. The use of the developed methodologies and instrumentation allowed carrying out experimental studies to diagnose the operability of the fuel supply system. Analyzing the obtained experimental data, it can be affirmed that: there is a stable relationship between the change in the ICE crankshaft speed and the change in the injection duration of the electromagnetic injector; the degree of wear of the electric fuel pump (EFP) is determined by the shift of the stable value of the crankshaft speed to the zone of low speed values at the same injection durations. The data obtained after testing the EFP allows planning a further algorithm of actions to maintain the operability of the fuel supply system.

This paper explores the potential of water jet eductor to replace large condensers and vacuum pump in the thermal desalination systems, with heat source temperatures below 95 °C. The operational limit of eductor has been investigated for active vapor transport and condensation to produce permeate. Combined system and its operational principle have been proposed with critical examination based on suction performance of Eductor. Experimental and computational study are the primary methodology of this work. The computational analysis of single-phase flow in Eductor, is in proper agreement with the experimental data. The result showed primary pressure & area ratio has positive impact and swirl ratio has negative impact on suction. The extended thermal analysis summarizes strength of Eductor while working with lower temperature sources and optimum cooling capacity of proposed system. Considering the simplicity and reduction in footprint, proposed application has been highlighted. The research disseminates knowledge on maximum vacuum generation capacity of Eductor and operational limit of thermal desalination system.

The photovoltaic-thermal collector is one of the most interesting technology for solar energy conversion, combining electric and thermal energy production in a single device. Vapour-compression heat pump is already considered the most suitable clean technology for buildings thermal energy needs. The combination of these two technologies in an integrated ”photovoltaic-thermal solar-assisted heat pump” (PVT-SAHP) system allows reaching a high fraction of the building thermal needs covered by renewable energy sources and to improve the performances of both the photovoltaic-thermal collector and the heat pump. The first is cooled down increasing its energy conversion efficiency, while providing low-temperature thermal energy to the second, which benefits from a higher evaporation temperature. The review study presents the state-of-art of photovoltaic-thermal solar-assisted heat pump systems intended to cover thermal energy needs in buildings, with a particular focus on the integration methodologies, the possible configurations, the use of different sources and the design of sub-system components. These issues are addressed by much scientific research, to improve the reliability and applicability of this technology, as an option for the building decarbonization. This study aims to present PVT-SAHP systems in an organic and critical way to propose a useful tool for future research developments. More in detail, the work highlights the fact that the integration of photovoltaic-thermal collectors as evaporator of the heat pump in direct-expansion systems allows the highest heat recovery and performances. However, the distinction of the two circuits lead to more reliable, flexible and robust systems, especially when combined with a second heat source, being able to cover both heating and cooling needs. The implementation of real-time control strategy, as well as the continuous development of the compressor and refrigerant industries is positively influencing this technology, which is receiving more and more attention from scientific research as a suitable solution for nearly zero energy buildings.

Photocatalytic oxidation of toxic pollutants is a proficient technique to solve the problems associated with the treatment of bisphenol-A which is classified as 1B reprotoxic substance. In this paper, Ag2C2O4/Ag@GNS nanocomposite whereas Ag and graphene nanosheets (GNS) used as the charge carriers, which is combined through peroxymonosulfate (PMS) for the removal of bisphenol-A (BiP-A) for the first time. The XRD, UV-DRS, SEM, and TEM studies were performed to confirm the phase structure and the purity. Ag2C2O4/Ag@GNS nanocomposite exhibited superior photocatalytic performance and removal rate when compared with pure Ag2C2O4 and pure GNS. In Ag2C2O4/Ag@GNS photocatalyst, the deposited Ag on the surface of Ag2C2O4 rods effectively formed a metal and semiconductor heterostructure, thus photogenerated charge carriers were separated easily by the surface plasmon resonance effect (SPR) effect of noble Ag. Hence charge carriers lifetime has been extended to a great extent for the better photocatalytic performance. The experimental results confirmed that the O2−, OH, SO4− radicals were played major role in the photolysis process. Furthermore, the effect of the photocatalyst & PMS concentration, pH and co-existing ions towards the BiP-A degradation were studied in detail. According to the mass spectroscopy studies BiP-A pollutant was effectively deteriorated into smaller molecules and CO2, H2O. Furthermore, we have proposed the possible degradation pathway and photocatalytic mechanism for better understanding.

The methanol decomposition reaction has gained substantial attention due to the wide range of applications that its intermediates offer. In this work, methanol (CH3OH) decomposition on Copper-embedded graphene (CuG) surface has been investigated via density functional theory with Grimme-D2 dispersion correction. The charge density of the CuG surface has been analyzed and the redistribution of the electron density of the surface has been represented via the electron density difference (EDD) map. Moreover, the decomposition reaction mechanism of CH3OH on the CuG surface through the cleavage of C–H, O–H and C–O bonds has been investigated in detail. In the initial state, the C–O and O–H bonds of CH3OH have similar activation barriers, thereby the adsorption and degradation mechanism of the intermediate states arising through O–H bond cleavage on the CuG surface has been investigated. In addition, the charge density calculations of the transition state geometries have been conducted and examined with EDD maps. The results have revealed that the previously adsorbed oxygen molecule exhibited high catalytic activity towards O–H decomposition compared to the bare surface. The CuG surface has offered higher activity on the C–H bonds compared to the C–O bonds of the intermediate states generated by CH3OH decomposition. The results revealed that the proposed CuG structure can be utilized as an alternative electrode catalyst that can prevent the CO poisoning issue in direct methanol fuel cells. © 2021 Hydrogen Energy Publications LLC

Graphene oxide (GO) is regarded as a promising candidate to construct solar absorbers for addressing freshwater crisis, but the easy delamination of GO in water poses a critical challenge for practical solar desalination. Herein, we improve the stability of GO membranes by a self-crosslinking poly (ionic liquid) (PIL) in a mild condition, which crosslinks neighbouring GO nanosheets without blemishing the hydrophilic structure of GO. By further adding carbon nanotubes (CNTs), the sandwiched GO/CNT@PIL (GCP) membrane displays a good stability in pH = 1 or 13 solution even for 270 days. The molecular dynamics simulation results indicate that the generation of water nanofluidics in nanochannels of GO nanosheets remarkably reduces the water evaporation enthalpy in GCP membrane, compared to bulk water. Consequently, the GCP membrane exhibits a high evaporation rate (1.87 kg m−2 h−1) and displays stable evaporation rates for 14 h under 1 kW m−2 irradiation. The GCP membrane additionally works very well when using different water sources (e.g., dye-polluted water) or even strong acidic solution (pH = 1) or basic solution (pH = 13). More importantly, through bundling pluralities of GCP membrane, an efficient solar desalination device is developed to produce drinkable water from seawater. The average daily drinkable water amount in sunny day is 10.1 kg m−2, which meets with the daily drinkable water needs of five adults. The high evaporation rate, long-time durability and good scalability make the GCP membrane an outstanding candidate for practical solar seawater desalination.

This paper describes the life-saving mechanism in accidents while a force wheeler drives on the lane. Safety systems in automobile have slowly gained attention over the past decade. Airbags are among the greatest significant products for automotive security, as they have been shown to upsurge passenger safety in a variety of ways. An airbag is an automobile safety device used to save both drivers and passenger’s lives during a collision. The airbag modules contains of an initiator inflator, a pad of textiles, and frame. An airbag's function is to shield occupants during a crash and protect their bodies when they hit interior objects like steering or window, etc. The use of the airbag system reduces the number of injuries by decreasing the force exerted at any point on the body by the steering wheel, Windows and dashboard. Many researches are going to improve the airbag's features. However, the effectiveness of any safety equipment depends on its proper implementation and on certain guidelines to be followed.

Stealth aircraft use Stealth Technology in order to evade recognition by utilizing mix of highlights with the goal that Aircraft can invade with RADAR and furthermore decrease the deceivability in “radio frequency (RF) range”, sound and infrared visual. During the most recent decades, stealth technology has demonstrated to be one of the best methodologies to the extent the undertaking to escape radar systems is concerned. Stealth intends to evade the recognition or attempt to cover up, for planes, avoiding radar implied stealth. The idea utilized in the stealth innovation isn’t so difficult. It utilizes the guideline to retain and mirror the radar waves. Airplane redirects the radar waves in different ways and limits the radar waves which return back to radar. Another marvel which permits the air ship maintain completely the incoming radar wavelengths to inhabit the electromagnetic reincorporated energy in various way. The structure and material used to manufacture air ship choose the degree of stealth accomplish via air ship. The thought for the radar radio wire to release Radio energy that is then returned through any item that occurs to recognize. The time taken for the reflection to come is measure by the radar radio wire and it can tell how far off an object is.