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Highlights This study presented a new optimization methodology using a prismatic joint with high stiffness and damping. The virtual suspension model contained the main bodies, an optimization subsystem, and a free-floating cylinder. Under aggressive terrain, an optimized chassis platform resulted in a 19.5% increase in boom height stability. Abstract. Multibody dynamics (MBD) models are continuing to be valuable for engineering design and product development, especially regarding subsystem optimization. Most MBD optimization processes begin with a sensitivity analysis of treatment factors and levels to understand how uncertainty in model inputs can be attributed to different sources of uncertainty within model outputs; however, this study developed a new MBD methodology to automatically determine the optimized dynamic chassis suspension responses on each corner of the vehicle from a single simulation for a self-propelled sprayer model as the chosen application use-case. This technique leveraged a prismatic joint (with a high spring stiffness and damping coefficient) connected between the chassis mainframe and the simplified optimization tire to create a distance constraint that held the chassis body at a near-consistent height above the ground. Then the solver optimized the response of the chassis suspension system to maintain a stable chassis platform relative to the terrain beneath it as the vehicle traversed across dynamic terrain conditions. This optimization response was also accomplished by replacing the baseline chassis suspension components with a free-floating cylinder, which permitted the unrestricted, optimized motion needed to keep the chassis body at a near-level position with respect to the roll and pitch profiles of the terrain. For a simulation with an aggressive terrain configuration, the analysis showed that an optimized suspension system resulted in a 46% decrease in operator comfort and a 19.5% increase in overall boom height stability as the boom height control system better maintained a dynamic position closer to the specified target height. Keywords: Boom height, Chassis suspension, Multibody dynamics (MBD), Optimization, Prismatic joint, Simulation, Terrain.

Introduction: Faecal diversion is an effective procedure to protect bowel anastomosis at high risk for leak. Loop ileostomy is more or less acceptable method for faecal diversion. Some concerns still exist regarding the risk for a significant morbidity and complications associated to ileostomy creation itself and moreover to its closure. Surgical expertise and closure techniques are considered potential factors influencing mortality. Aim of the study is to present a single institutional experience with ileostomy closures, in a high-volume training hospital, where ileostomy reversal is mainly performed by young surgeons. Methods: A retrospective study was done to evaluate data of patients who underwent loop ileostomy and ileostomy closure between June 2017 to June 2021 at Dhiraj Hospital Sumandeep Vidyapeeth , Pipariya , vadodara. Ileostomy closure was always done in hand-sewn fashion, performing either a direct closure (DC) or a resection plus end-to-end anastomosis (EEA). Postoperative morbidity was graded according to Clavien-Dindo classification. Outcomes after both methods were compared by Fisher’s exact test and Wilcoxon rank-sum test. Results: Hundred and four patients were included. Ileostomy reversal was performed by EEA in 86 patients (82.69%) and by DC in 18 patients (17.30%). Surgery was performed with a peristomal access in 93 cases (89.42%).

Image Patching with Convolutional Neural Networks

Peripheral vascular disease is circulation disorders that affect blood vessels outside of the heart and brain. It often neglected by patients but in later stage it causes serious problems. Smoking tobacco is the main culprit for PVD. So, this challenging subject is taken up for the present study in which we will be studying the clinical profile and management modalities for PVD in our hospital. This prospective study was conducted between September 2014 to September 2021on patients admitted to Smt. B. K. Shah Medical Institute and Research Centre, Dhiraj Hospital Piparia Vadodara. 50 patients having symptoms of peripheral vascular disease. This prospective study conducted at S.B.K.S.M.I.R&C. Dhiraj Hospital Piparia Vadodara, included 50 patients with acute pancreatitis, male and female (M: F =41:9),mean age is 35.5 years, smoking is the significant risk factor, medical therapy is more preferable in initial of disease while surgical treatment late phase. Peripheral vascular disease is mainly seen in elderly male specially seen in smokers and tobacco chewer ,claudication ,restpain,ulcer are the main symptoms , management is based upon claudication grading grade 1 and grade 2 can be manged conservatively while grade 3 and 4 required surgical management. Ilizarov, vascular bypass graft.

Background The incidence of end-stage heart failure necessitating advanced cardiac therapy continues to increase in the United states. Implantable left ventricular assist devices (LVADs) represent an important modality that is utilized both as a bridge to heart transplant or as destination therapy. LVAD-associated infections, ranging from driveline exit site or pocket infections to endovascular infections, are a major complication with high mortality. Antibiotic prophylaxis at time of LVAD implantation is therefore an important strategy to mitigate infections. However, a clear surgical infection prophylaxis regimen and associated outcomes have not been reported. Methods We performed a single center, retrospective cohort study evaluating the impact of antimicrobial prophylaxis on risk of infection in patients who underwent LVAD implantation between February 2007 and June 2019 at Mayo Clinic. LVAD-specific and related infections were defined according to the International Society of Heart Lung Transplantation criteria. Single drug prophylaxis (SDP) included cefazolin only, vancomycin only, or cefazolin and vancomycin; multidrug (MDP) regimen includes either of the SDP regimens plus another antibiotic. We compared incidence of infection within 90-day and within one-year of implantation, as well as risk of C. difficile infections between the SDP and MDP cohorts. Results We reviewed 403 patients who received LVAD implantation (Table 1), 402 of had information on surgical prophylaxis. 307 (76%) patients received SDP and 95 patients (24%) received MDP. 14 patients developed an infection within 1 year of implantation (Table 2). There was no difference in the incidence of infections between SDP and MDP arms both at 90 days and 1-year post-implantation (p=0.11). The median time of infection since LVAD implantation was similar between SDP and MDP (p=0.37) arms. Incidence of C. difficile infection was not different between groups (p=0.10) (Table 3). Conclusion There was no significant difference in incidence or time to first infection, within 90-day and 1-year of implantation, between single- and multidrug antibiotic surgical prophylaxis regimens administered at the time of LVAD implantation. Future prospective trials are needed to develop a clear LVAD antibiotic prophylaxis protocol. Disclosures John C. O'Horo, Sr., MD, MPH, Bates college: Advisor/Consultant|MITRE corporation: Grant/Research Support|nferenec, Inc: Grant/Research Support.

Background Leptotrichia spp. are anaerobic, gram-negative bacilli that are part of the normal oral and intestinal microbiota. Although traditionally considered non-pathogenic, these bacteria can result in invasive infections including bacteremia in immunosuppressed patients, particularly those with neutropenia. There are limited published data to inform best management strategies in those with Leptotrichia bacteremia. Methods All cases of Leptotrichia spp. bacteremia between January 2012 and 2022 at our tertiary academic medical center were retrospectively reviewed to determine patient risk factors, clinical outcomes, and antimicrobial susceptibilities. Descriptive statistical methods were used. Antimicrobial susceptibilities were performed by agar dilution. Results 26 cases of Leptotrichia spp. bacteremia were identified (Figure 1). The mean patient age was 55 years (SD 17), with 9 female patients (35%). All 26 patients were immunocompromised, predominantly due to hematologic malignancy (69%) or hematopoietic stem cell transplant (23%) (HSCT). 25 of 26 patients were actively neutropenic, with a median duration of neutropenia of 21 days (13-26) (Table 1). The most frequent sources of Leptotrichia bacteremia were gastrointestinal translocation (60%), followed by catheter-related infection (35%). 10 patients had polymicrobial bacteremia (38.5%). The primary antibiotics utilized to treat Leptotrichia bacteremia included metronidazole (42%), piperacillin-tazobactam (27%), and carbapenems (19%). Overall, the mean duration of treatment was 11 days, with a 60-day all-cause mortality of 19% (Table 1) with no cases of microbiologic relapse. In the 22 clinical isolates evaluated for susceptibility, Leptotrichia spp. were largely susceptible to metronidazole, penicillin, ertapenem, and piperacillin-tazobactam, but uniformly resistant to moxifloxacin (Table 2). Figure 1:Leptotrichia spp. identified as cause of bacteremia in 26 patientsTable 1:Baseline characteristics of patients with Leptotrichia bacteremia (n=26) between January 2012 to January 2022Table 2:Antimicrobial susceptibility profile of the Leptotrichia spp. (n=22) Conclusion Leptotrichia spp. may be a rare cause of bacteremia in neutropenic hosts, particularly those with underlying hematologic malignancies and HSCT. The pathogen has a favorable susceptibility profile to penicillins and carbapenems, but has high degree of resistance to fluoroquinolones. Disclosures All Authors: No reported disclosures.

In a cohort of 483 high-risk patients treated with nirmatrelvir/ritonavir for COVID-19, 2 patients (0.4%) required hospitalization by day 30. Four patients (0.8%) experienced rebound of symptoms, which were generally mild, at a median of 9 days after treatment, and all resolved without additional COVID-19–directed therapy.

Background Legumes contain several healthy essential nutrients and bioactive compounds, and their symbiotic nitrogen fixation ability confers substantial economic and environmental advantages. The traditional perception that legume flours are unsuitable for extrusion cooking is now proving to be outdated. Recent research suggests that legumes have great potential for replacing cereals in extruded snacks due to their healthier nutritional profile and remarkable functional characteristics. Scope and approach In this paper, the scientific and technological challenges associated with incorporating legume-based flours into extruded cereal-based snacks are reviewed. After comparing the nutritional properties of cereals and legumes, technological properties of extrudates (i.e. expansion ratio, bulk density, sensory properties etc.) enriched with legumes are explored. The current market situation and the future of legume-based extruded snacks are also discussed. Key findings and conclusions Due to their functional characteristics, legume flours demonstrate good potential in the manufacture of extruded healthier snacks in which cereal flours are partially or entirely substituted. Lab-scale extrusion trials produce a wealth of information affirming that incorporating legume flours significantly affects the final extrudate structure and subsequent quality/sensory attributes of snacks. However, more work needs to be carried out to identify the most appropriate combination of flours and to optimise processing conditions to improve sensory and quality attributes and promote consumer acceptance. Increasing application of legumes in extruded snacks will continue to drive the global legumes market.

INTRODUCTION: Incisional hernia, a failure of the abdominal wall fascia to heal, is a common postoperative complication following abdominal surgery with an incidence varying between 2% and 50%. Incisional hernia entails signicant morbidity and discomfort resulting in disturbances in day to day activities. In spite of various available techniques available to surgeon, these hernias recur leading the surgeon to search for an ideal procedure of their repair with preferably zero or universally acceptable minimal recurrence rate. Laparoscopic incisional hernia repair, controversy has endured despite of numerous studies and data suggesting success of laparoscopic incisional hernia repair. However, there is relative lack of evidence to support adoption of laparoscopic repair as standard technique in regard to post operative morbidity and cost effectiveness. AIMS AND OBJECTIVE: To compare open and laparoscopic incisional hernia repair technique with respect to the post-operative complications and perioperative morbidity. MATERIAL AND METHODS: This is prospective, observational, comparative study, comparing patients who underwent laparoscopic incisional hernia and open incisional hernia repair during study period of November 2015 to August 2017 in Department of General Surgery, J.L.N. Hospital and Research centre, Bhilai. STATISTICAL METHOD: Data is analyse using percentages , mean and standard deviation. Continuous variable analysed by Unpaired T-test. Categorical data analyzed using chi square test or Fisher exact test. CONCLUSION: In our study laparoscopic incisinal hernia repair has more favourable outcome in terms of less hospital stay, shorter duration of surgery, less post-operative pain, early to resume daily activity and lesser wound related complications.

The use of polymer matrix composite materials in primary load-bearing structures has increased in the aerospace industry primarily due to their high strength-to-weight ratios and stiffnesses. However, composites are susceptible to delamination due to their low interlaminar fracture resistance, which can result in stiffness degradation, thereby decreasing the structural integrity of the part. Strains obtained from embedded optical fibers can be used to detect and monitor damages. Optical fiber strain sensors are lightweight, easy to embed, and offer higher resolution and data acquisition rates. In this study, double cantilever beam (DCB) specimens fabricated from Hexcel IM7/8552 carbon/epoxy prepreg are embedded with optical fibers. Outof- plane displacements of the DCB specimens were calculated using optical fiber strains and show excellent agreement with deflections measured using the DIC system.

This experimental laboratory-based study evaluated two disinfectants’ efficacy against replication-competent severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) on three surfaces. Disinfectants were effictive at eliminating the presence, viability, and subsequent replication of SARS-CoV-2 on all surfaces. Although SARS-CoV-2 likely spreads primarily via airborne transmission, layered mitigation should include high-touch surface disinfection.

Systemic lupus erythematosus (SLE) is a multi-system autoimmune disease characterized by a series of exacerbations and remissions. The disease involves antibody formation against DNAand nuclear proteins, which attack tissues of multiple-organ systems. SLE is 8 to 15 times more common in women of reproductive age compared with age-matched men. Being rarer in males, it can result in delayed diagnosis leading to poorer outcomes. When compared to women, men have a more aggressive clinical course and rapid development of organ damage, which leads to a worse prognosis. Studies have shown that male patients have an increased prevalence of cytopenia, hemolytic anaemia, nephritis, thrombotic events and seizures. This is why prompt diagnosis and treatment are important to prevent the progression of the disease. We report a case of SLE in a young male patient who presented with fever, joint pain, easy fatigability and oral ulcers. Prompt diagnosis and comprehensive laboratory workup can help an alert primary care physician be instrumental in ensuring better outcomes.

Social media has emerged as a tool to facilitate communication and dissemination of information for both patients and healthcare professionals. We describe 3 social media engagement strategies used to reach a broad and diverse audience on the topics of infectious diseases and antimicrobial stewardship, including the use of memes, a clue-based knowledge assessment quiz, and a personality quiz. We describe a novel acronym “VIRAL” to guide engaging social media strategies in healthcare, including eye catching Visuals, Interactive content, showing Respect and empathy for the audience, Adapting to new technology, and making Learning fun.

CYP3A5 enzymes belong to the phase I Group of drug-metabolizing enzymes, which are involved in the metabolism of 50% of the drugs. Participants with CYP3A5 genotype: CYP3A5 *1/*1 are fast metabolizers of drugs and hence will require higher dosing. Whereas those with CYP3A5 * 3/*3 are poor metabolizers of drugs and will require a lower dose to achieve target drug concentration in the blood and those with CYP3A5 * 1/*3 have intermediate drug metabolizing activity. Pharmacogenetic evaluation may improve disease outcomes by maximizing the efficacy and minimizing the toxicity of drugs in patients.This is a single-center cross-sectional study conducted in the year 2018-2019 to study the population prevalence of genetic polymorphisms of CYP3A5 in healthy participants from western India. Eligible participants willing to give written, informed consent were enrolled in the study. Subsequently, 2 ml venous blood was collected the deoxyribonucleic acid was extracted and then stored at ‒20°C. Genotyping was done by a polymerase chain reaction and restriction fragment length polymorphism.A total of 400 participants with a median age of 22 years (range: 18-58 years) were included. Among them, the genotype prevalence for CYP3A5 * 1/*1 was 17% (n = 67/400); CYP3A5 * 1/*3 was 37% (n = 149/400) and that of CYP3A5 * 3/*3 was 46% (184/400). Out of the total 400 healthy participants analyzed, the allele frequency for CYP3A5 * 1 was 35% (142/400) and that of CYP3A5*3 was 65% (259/400).The genotype prevalence for CYP3A5 * 3*3 (46%) and the allele frequency for CYP3A5 * 3 (65%) respectively were the highest among the western Indian population.

In a cohort of 483 high-risk patients treated with nirmatrelvir/ritonavir for coronavirus disease-2019, two patients (0.4%) required hospitalization by day 30. Four patients (0.8%) experienced rebound of symptoms, which were generally mild, at median of 9 days after treatment, and all resolved without additional COVID-19-directed therapy.

The World Health Organization declared COVID-19 a global pandemic in March 2020. A major challenge in this worldwide pandemic has been efficient and effective large-scale testing for the disease. In this communication, we discuss lessons learned in the set up and function of a locally organized drive-through testing facility.

In a single-center review of antibiotic prescribing in COVID-19 patients, 10% of patients received antimicrobials, and inpatients encounters had the highest rate and spectrum of prescribing. Prescribing rate, spectrum, and duration appeared to increase with disease severity in inpatients. Antimicrobial prescribing in patients managed in ambulatory encounters was less common.