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Abstract Potassium-ion batteries (KIBs) are emerging as a promising alternative technology to lithium-ion batteries (LIBs) due to their significantly reduced dependency on critical minerals. KIBs may also present an opportunity for superior fast-charging compared to LIBs, with significantly faster K-ion electrolyte transport properties already demonstrated. In the absence of a viable K-ion electrolyte, a full-cell KIB rate model in commercial cell formats is required to determine the fast-charging potential for KIBs. However, a thorough and accurate characterisation of the critical electrode material properties determining rate performance—the solid state diffusivity and exchange current density—has not yet been conducted for the leading KIB electrode materials. Here, we accurately characterise the effective solid state diffusivities and exchange current densities of the graphite negative electrode and potassium manganese hexacyanoferrate $${{{{\rm{K}}}}}_{2}{{{\rm{Mn}}}}[{{{\rm{Fe}}}}{({{{\rm{CN}}}})}_{6}]$$ K 2 Mn [ Fe ( CN ) 6 ] (KMF) positive electrode, through a combination of optimised material design and state-of-the-art analysis. Finally, we present a Doyle-Fuller-Newman model of a KIB full cell with realistic geometry and loadings, identifying the critical materials properties that limit their rate capability.

Objective Fluoropyrimidine chemotherapy is a first-line treatment for many gastrointestinal (GI) cancers, however, cardiotoxicity concerns may limit administration in patients with pre-existing cardiovascular disease (CVD). This study investigated the association of pre-existing CVD with use of fluoropyrimidine chemotherapy in tumour-eligible GI cancer patients.Methods and analysis National cancer registry data from the Virtual Cardio-Oncology Research Initiative from England between 2014 and 2018 was used to identify GI cancer patients eligible to receive fluoropyrimidine chemotherapy. Linkage to Hospital Episode Statistics and CVD registry data were used to ascertain prior CVD and outcomes. Primary outcome was first administration of fluoropyrimidine chemotherapy following cancer diagnosis. Cox proportional hazard models determined HR and 95% CIs for the association between initiation of fluoropyrimidine treatment and prior CVD.Results 112 726 eligible patients were identified (median age 71 years (IQR 62–80), 39.7% female). 33 026 (29.3%) had pre-existing CVD. 73 392 (65.1%) patients had a diagnosis of colorectal, 23 208 (20.6%) oesophageal, 14 788 (13.1%) gastric and 1338 (1.2%) small bowel cancer. Individuals with pre-existing CVD had a 27% reduced rate of receiving fluoropyrimidine chemotherapy (HR, 0.73; 95% CI 0.70 to 0.75) on multivariable analysis. Significantly reduced rates of fluoropyrimidine administration were found across all subtypes of pre-existing CVD.Conclusions GI cancer patients with all types of pre-existing CVD are less likely to receive fluoropyrimidine chemotherapy despite eligibility. This suggests widespread caution regarding administration of fluoropyrimidines across this population; further research is needed to assess whether such conservatism is justified.

Complexes of [Fe(paptH)2][X]2.nH2O, (paptH = 2-(pyridin-2-ylamino)-4-(pyridin-2-yl)- thiazole, X = CF3SO3 and n = 1.5, and X2 = [Fe(CN)5NO] and n = 3) have been characterized in magnetic, Mössbauer, and electronic spectral properties. The studies reveal that the two complexes are predominantly quintet state at room temperature, but singlet at low temperature (below 91K). The change is assigned as a thermally spin state transition, singlet 1A1g (LS, low-spin) ↔ quintet 5T2g (HS, high-spin), in iron(II), being gradual, continuous, and incomplete at the experimental temperature range, and without hysteresis in these instances. The two complexes were yellowish brown at room temperature (~ 298K) but darkening to reddish brown at the lower temperatures.

Predicting the behavior of individuals acting under their own motivation is a challenge shared across multiple scientific fields, from economic to ecological systems. In rivers, fish frequently change their orientation even when stimuli are unchanged, which makes understanding and predicting their movement in time-varying environments near built infrastructure particularly challenging. Cognition is central to fish movement, and our lack of understanding is costly in terms of time and resources needed to design and manage water operations infrastructure that is able to meet the multiple needs of human society while preserving valuable living resources. An open question is how best to cognitively account for the multi-modal, -attribute, -alternative, and context-dependent decision-making of fish near infrastructure. Here, we leverage agent- and individual-based modeling techniques to encode a cognitive approach to mechanistic fish movement behavior that operates at the scale in which water operations river infrastructure is engineered and managed. Our cognitive approach to mechanistic behavior modeling uses a Eulerian-Lagrangian-agent method (ELAM) to interpret and quantitatively predict fish movement and passage/entrainment near infrastructure across different and time-varying river conditions. A goal of our methodology is to leverage theory and equations that can provide an interpretable version of animal movement behavior in complex environments that requires a minimal number of parameters in order to facilitate the application to new data in real-world engineering and management design projects. We first describe concepts, theory, and mathematics applicable to animals across aquatic, terrestrial, avian, and subterranean domains. Then, we detail our application to juvenile Pacific salmonids in the Bay-Delta of California. We reproduce observations of salmon movement and passage/entrainment with one field season of measurements, year 2009, using five simulated behavior responses to 3-D hydrodynamics. Then, using the ELAM model calibrated from year 2009 data, we predict the movement and passage/entrainment of salmon for a later field season, year 2014, which included a novel engineered fish guidance boom not present in 2009. Central to the fish behavior model’s performance is the notion that individuals are attuned to more than one hydrodynamic signal and more than one timescale. We find that multi-timescale perception can disentangle multiplex hydrodynamic signals and inform the context-based behavioral choice of a fish. Simulated fish make movement decisions within a rapidly changing environment without global information, knowledge of which direction is downriver/upriver, or path integration. The key hydrodynamic stimuli are water speed, the spatial gradient in water speed, water acceleration, and fish swim bladder pressure. We find that selective tidal stream transport in the Bay-Delta is a superset of the fish-hydrodynamic behavior repertoire that reproduces salmon movement and passage in dam reservoir environments. From a cognitive movement ecology perspective, we describe how a behavior can emerge from a repertoire of multiple fish-hydrodynamic responses that are each tailored to suit the animal’s recent past experience (localized environmental context). From a movement behavior perspective, we describe how different fish swim paths can emerge from the same local hydrodynamic stimuli. Our findings demonstrate that a cognitive approach to mechanistic fish movement behavior modeling does not always require the maximum possible spatiotemporal resolution for representing the river environmental stimuli although there are concomitant tradeoffs in resolving features at different scales. From a water operations perspective, we show that a decision-support tool can successfully operate outside the calibration conditions, which is a necessary attribute for tools informing future engineering design and management actions in a world that will invariably look different than the past.

Salt of [Cu(bptrzH)Cl2], (bptrzH = 3,5-bis(pyridin-2-yl)-H-1,2,4-triazole) has been prepared and characterized its electronic spectral and magnetic properties. This salt is paramagnetic with magnetic moment, μs, being 1.77–1.78 BM at 293 K, but decreased significantly with decreasing temperature to be 0.60–0.63 BM at 90 K, indicating antiferromagnetic nature. This is associated with Cu–Cu magnetic interactions at low temperatures, and suggests that the salt adopt an octahedrally polymeric structure. The electronic spectrum of this salt reveals a strong ligand field band centered at about 13,000 cm–1 and a very strong charge transfer absorption at about 23,000–24,000 cm–1. The spectrum is better resolved at lower temperature and this is parallel to the slight change in color from yellowish-green at room temperature to bright green at low temperature (90 K). The powder XRD of this complex was refined by Le Bail method of Rietica program and found to be fit as triclinic symmetry of space group PĪ with the figure of merit: Rp = 5.02; Rwp = 7.95; Rexp = 5.40; Bragg R-Factor = 0.05; and GOF = 2.166.

OBJECTIVES:. Differences and biases between directly measured intra-arterial blood pressure and intermittingly measured noninvasive blood pressure using an oscillometric cuff method have been reported in adults and children. At the bedside, clinicians are required to assign a confidence to a specific blood pressure measurement before acting upon it, and this is challenging when there is discordance between measurement techniques. We hypothesized that big data could define and quantify the relationship between noninvasive blood pressure and intra-arterial blood pressure measurements and how they can be influenced by patient characteristics, thereby aiding bedside decision-making. DESIGN:. A retrospective analysis of cuff blood pressure readings with associated concurrent invasive arterial blood pressure measurements (452,195 noninvasive blood pressure measurements). SETTING:. Critical care unit at The Hospital for Sick Children, Toronto. PATIENTS:. Six-thousand two-hundred ninety-seven patients less than or equal to 18 years old, hospitalized in a critical care unit with an indwelling arterial line. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Two-dimensional distributions of intra-arterial blood pressure and noninvasive blood pressure were generated and the conditional distributions of intra-arterial blood pressure examined as a function of the noninvasive systolic, diastolic, or mean blood pressure. Modification of these distributions according to age and gender were examined using a multilevel mixed-effects model. For any given combination of patient age and noninvasive blood pressure, the expected distribution of intra-arterial blood pressure readings exhibited marked variability at the population level and a bias that significantly depended on the noninvasive blood pressure value and age. We developed an online tool that allows exploration of the relationship between noninvasive blood pressure and intra-arterial blood pressure and the conditional probability distributions according to age. CONCLUSIONS:. A large physiologic dataset provides clinically applicable insights into the relationship between noninvasive blood pressure and intra-arterial blood pressure measurements that can help guide decision-making at the patient bedside.

Testing during the COVID-19 pandemic has been crucial to public health surveillance and clinical care. Supply chain constraints—spanning limitations in testing kits, reagents, pipet tips, and swabs availability—have challenged the ability to scale COVID-19 testing. During the early months, sample collection kits shortages constrained planned testing expansions. In response, the University of Vermont Medical Center, University of Vermont College of Medicine, Vermont Department of Health Laboratory, Aspenti Health, and providers across Vermont including 16 area hospitals partnered to surmount these barriers. The primary objectives were to increase supply availability and manage utilization. Within the first month of Vermont’s stay-at-home order, the University of Vermont Medical Center laboratory partnered with College of Medicine to create in-house collection kits, producing 5000 per week. University of Vermont Medical Center reassigned 4 phlebotomists, laboratory educators, and other laboratory staff, who had reduced workloads, to participate (requiring a total of 5.3-7.6 full-time equivalent (FTE) during the period of study). By August, automation at a local commercial laboratory produced 22,000 vials of media in one week (reducing the required personnel by 1.2 FTE). A multisite, cross-institutional approach was used to manage specimen collection kit utilization across Vermont. Hospital laboratory directors, managers, and providers agreed to order only as needed to avoid supply stockpiles and supported operational constraints through ongoing validations and kit assembly. Throughout this pandemic, Vermont has ranked highly in number of tests per million people, demonstrating the value of local collaboration to surmount obstacles during disease outbreaks and the importance of creative allocation of resources to address statewide needs.

Introduction Numbers of patients undergoing mitral valve repair (MVr) surgery for severe mitral regurgitation have grown and will continue to rise. MVr is routinely performed via median sternotomy; however, there is a move towards less invasive surgical approaches.There is debate within the clinical and National Health Service (NHS) commissioning community about widespread adoption of minimally invasive MVr surgery in the absence of robust research evidence; implementation requires investment in staff and infrastructure.The UK Mini Mitral trial will provide definitive evidence comparing patient, NHS and clinical outcomes in adult patients undergoing MVr surgery. It will establish the best surgical approach for MVr, setting a standard against which emerging percutaneous techniques can be measured. Findings will inform optimisation of cost-effective practice.Methods and analysis UK Mini Mitral is a multicentre, expertise based randomised controlled trial of minimally invasive thoracoscopically guided right minithoracotomy versus conventional sternotomy for MVr. The trial is taking place in NHS cardiothoracic centres in the UK with established minimally invasive mitral valve surgery programmes. In each centre, consenting and eligible patients are randomised to receive surgery performed by consultant surgeons who meet protocol-defined surgical expertise criteria. Patients are followed for 1 year, and consent to longer term follow-up.Primary outcome is physical functioning 12 weeks following surgery, measured by change in Short Form Health Survey (SF-36v2) physical functioning scale. Early and 1 year echo data will be reported by a core laboratory. Estimates of key clinical and health economic outcomes will be reported up to 5 years.The primary economic outcome is cost effectiveness, measured as incremental cost per quality-adjusted life year gained over 52 weeks following index surgery.Ethics and dissemination A favourable opinion was given by Wales REC 6 (16/WA/0156). Trial findings will be disseminated to patients, clinicians, commissioning groups and through peer reviewed publication.Trial registration number ISRCTN13930454.

Objective To compare clinical and health economic outcomes after manubrium-limited mini-sternotomy (intervention) and conventional median sternotomy (usual care).Design A single-blind, randomised controlled trial.Setting Single centre UK National Health Service tertiary hospital.Participants Adult patients undergoing aortic valve replacement (AVR) surgery.Interventions Intervention was manubrium-limited mini-sternotomy performed using a 5–7 cm midline incision. Usual care was median sternotomy performed using a midline incision from the sternal notch to the xiphisternum.Primary and secondary outcome measures The primary outcome was the proportion of patients who received a red cell transfusion postoperatively and within 7 days of index surgery. Secondary outcomes included proportion of patients receiving a non-red cell blood component transfusion and number of units transfused within 7 days and during index hospital stay, quality of life and cost-effectiveness analyses.Results 270 patients were randomised, received surgery and contributed to the intention to treat analysis. No difference between mini and conventional sternotomy in red-cell transfusion within 7 days was found; 23/135 patients in each arm received a transfusion, OR 1.0 (95% CI 0.5 to 2.0) and risk difference 0.0 (95% CI −0.1 to 0.1). Mini-sternotomy reduced chest drain losses (mean 181.6 mL (SD 138.7) vs conventional, mean 306·9 mL (SD 348.6)); this did not reduce red-cell transfusions. Mean valve size and postoperative valve function were comparable between mini-sternotomy and conventional groups; 23 mm vs 24 mm and 6/134 moderate or severe aortic regurgitation vs 3/130, respectively. Mini-sternotomy resulted in longer bypass (82.7 min (SD 23.5) vs 59.6 min (SD 15.1)) and cross-clamp times (64.1 min (SD 17.1) vs 46·3 min (SD 10.7)). Conventional sternotomy was more cost-effective with only a 5.8% probability of mini-sternotomy being cost-effective at a willingness to pay of £20 000/QALY (Quality Adjusted Life Years).Conclusions AVR via mini-sternotomy did not reduce red blood cell transfusion within 7 days following surgery when compared with conventional sternotomy.Trial registration number ISRCTN29567910; Results.

Abstract Endothelial cell (EC) dysfunction is a critical mediator of the acute respiratory distress syndrome (ARDS). Recent studies have demonstrated that stromal cell-derived factor 1α (SDF-1α) promotes EC barrier integrity. Our previous studies used a SDF-1α analogue CTCE-0214 (CTCE) in experimental sepsis and demonstrated that it attenuated vascular leak and modulated microRNA (miR) levels. We examined the hypothesis that CTCE improves EC function in lipopolysaccharide (LPS)-induced ARDS through increasing miR-126 expression. Human microvascular endothelial cells (HMVECs) were treated with thrombin to disrupt the EC integrity followed by incubation with CTCE or SDF-1α. Barrier function was determined by trans-endothelial electrical resistance assay. CTCE-induced alterations in miRNA expression and signaling pathways involved in barrier function were determined. Thrombin-induced vascular leak was abrogated by both CTCE and SDF-1α. CTCE also prevented thrombin-induced decreases of vascular endothelial (VE)-cadherin cell surface expression and expansion of the intercellular space. CTCE increased miR-126 levels and induced activation of AKT/Rac 1 signaling. Cotreatment with a miR-126 inhibitor blocked the protective effects of CTCE on AKT activation and endothelial permeability. In subsequent in vivo studies, ARDS was induced by intratracheal instillation of LPS. Intravenous injection of CTCE diminished the injury severity as evidenced by significant reductions in protein, immune cells, inflammatory cytokines and chemokines in the bronchoalveolar lavage fluid, increased miR-126 expression and decreased pulmonary vascular leak and alveolar edema. Taken together, our data show that CTCE improves endothelial barrier integrity through increased expression of miR-126 and activation of Rac 1 signaling and represents an important potential therapeutic strategy in ARDS.

There has been a growing interest in computational electroencephalogram (EEG) signal processing in a diverse set of domains, such as cortical excitability analysis, event-related synchronization, or desynchronization analysis. In recent years, several inconsistencies were found across different EEG studies, which authors often attributed to methodological differences. However, the assessment of such discrepancies is deeply underexplored. It is currently unknown if methodological differences can fully explain emerging differences and the nature of these differences. This study aims to contrast widely used methodological approaches in EEG processing and compare their effects on the outcome variables. To this end, two publicly available datasets were collected, each having unique traits so as to validate the results in two different EEG territories. The first dataset included signals with event-related potentials (visual stimulation) from 45 subjects. The second dataset included resting state EEG signals from 16 subjects. Five EEG processing steps, involved in the computation of power and phase quantities of EEG frequency bands, were explored in this study: artifact removal choices (with and without artifact removal), EEG signal transformation choices (raw EEG channels, Hjorth transformed channels, and averaged channels across primary motor cortex), filtering algorithms (Butterworth filter and Blackman–Harris window), EEG time window choices (−750 ms to 0 ms and −250 ms to 0 ms), and power spectral density (PSD) estimation algorithms (Welch’s method, Fast Fourier Transform, and Burg’s method). Powers and phases estimated by carrying out variations of these five methods were analyzed statistically for all subjects. The results indicated that the choices in EEG transformation and time-window can strongly affect the PSD quantities in a variety of ways. Additionally, EEG transformation and filter choices can influence phase quantities significantly. These results raise the need for a consistent and standard EEG processing pipeline for computational EEG studies. Consistency of signal processing methods cannot only help produce comparable results and reproducible research, but also pave the way for federated machine learning methods, e.g., where model parameters rather than data are shared.