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In this paper, we study several closely related invariants associated to Dirac operators on odd-dimensional manifolds with boundary with an action of the compact group H of isometries. In particular, the equality between equivariant winding numbers, equivariant spectral flow and equivariant Maslov indices is established. We also study equivariant η -invariants which play a fundamental role in the equivariant analog of Getzler's spectral flow formula. As a consequence, we establish a relation between equivariant η -invariants and equivariant Maslov triple indices in the splitting of manifolds. [ABSTRACT FROM AUTHOR]

A self-loop graph GS is a simple graph G obtained by attaching loops at S ⊆ V (G). To such GS an Euclidean metric function is assigned to its vertices, forming the so-called Sombor matrix. In this paper, we derive two summation formulas for the spectrum of the Sombor matrix associated with GS, for which a Forgotten-like index arises. We explicitly study the Sombor energy ꜪSO of complete graphs with self-loops (Kn)S, as the sum of the absolute value of the difference of its Sombor eigenvalues and an averaged trace. The behavior of this energy and its change for a large number of vertices n and loops σ is then studied. Surprisingly, the constant 4 √ 2 is obtained repeatedly in several scenarios, yielding a quantization of the energy change of 1 loop for large n and σ. Finally, we provide a McClelland-type and determinantal-type upper and lower bounds for ꜪSO(GS), which generalizes several bounds in the literature. [ABSTRACT FROM AUTHOR]

Background and objective: Psychotropic medications are frequently prescribed during acute care, even in older patients. They represent a risk for inappropriate long-term use and increase the overall risk of morbidity and mortality in this population. Our project aimed to evaluate the feasibility of a psychotropic medication stewardship program led by pharmacists. Methods: We conducted a prospective, observational pilot study in patients aged 75 years and older, admitted to a surgical unit with at least one active prescription of a psychotropic medication (antipsychotic, benzodiazepine or non-benzodiazepine receptor agonist). Each psychotropic medication was assessed for potential deprescription, and if eligible, a recommendation from the stewardship pharmacist was made to the medical team. Results: Among 183 patients, 93.4% were eligible for a potential deprescription. A total of 298 prescriptions were evaluated by the stewardship pharmacists, of which 57.7% were antipsychotics, 22.8% were benzodiazepines and 19.5% were non-benzodiazepine receptor agonists. Most of the assessed prescriptions were started during current hospitalization (62.7%). The median time required for the intervention per patient was 17 min 30 s. The stewardship pharmacists made 192 suggestions for 258 eligible prescriptions, with 69.8% being deprescription recommendations. Of all the deprescription suggestions, 75.4% were accepted by the medical team and 84.8% of those accepted persisted at discharge. Conclusion: The implementation of a pharmacist-led psychotropic medication stewardship program on surgical units in our hospital is feasible and is a promising approach to improve geriatric care. [ABSTRACT FROM AUTHOR]

This is a case study on the development of the Gardens by the Bay, Bay South and Conservatory Complex to provide intelligent and integrated building responses. This article demonstrates the effectiveness of combining a number of environmental design and building services optimization steps to achieve a sustainable design. Key initiatives undertaken include high-level daylighting design of the building skin to achieve exacting natural light requirements inside the spaces, while at the same time limiting thermal loads. Desiccant dehumidification systems are applied to minimize system cooling loads, so that waste heat from biomass combined heat and power (CHP) can drive substantive portions of the conditioning requirements. A waste stream made up of horticultural biomass is also identified and proposed to be utilized to provide the primary fuel for the biomass CHP system. In addition, this article provides a case study of how external structures are integrated to the building to provide ventilation and renewable energy harvesting. [ABSTRACT FROM AUTHOR]