Search

The most challenging circumstance of forced oscillations (FOs) is when the power system is forced to oscillate at its natural frequencies. This paper uses a novel PMU data-driven mechanism to pinpoint the source of such phenomena under resonance. Following the detection of FOs, the instantaneous changes in the output power and angular velocity of the rotors are calculated. Accordingly, an energy-driven multilateral interaction pattern is obtained for all synchronous generators. Next, an appropriate positive weighted undirected graph is constructed through these functional patterns based on the spectral graph theory. These quantitative indicators are then analyzed through the eigenvalue spectrum of the normalized Laplacian matrix of the system graph reduced to the internal generator buses. Finally, the smallest value in eigenvectors corresponding to the two largest eigenvalues reveals the location of the source. The proposed methodology's validation and verification studies have been performed on the WECC 3-machine 9-bus and New England 10-machine 39-bus benchmark power systems modeled in the Real-Time Digital Simulator (RTDS) and then analyzed in the MATLAB environment. The proposed methodology revealed to be fast and accurate in locating the source of FOs under challenging resonance situations with promising results while addressing the generator side origins. [ABSTRACT FROM AUTHOR]

Background: There is a paucity of studies regarding oxidative balance and selenium (Se) status in congenital hypothyroidism. Recently, more attention has been given to the use of Se supplementation as a new treatment for thyroid disorders. Oxidative stress increases in different thyroid disorders and causes many pathological outcomes. The present study aimed to determine the serum prooxidant-antioxidant balance (PAB), Se, thyroid stimulating hormone (TSH) and free thyroxine (FT4) concentration in congenital hypothyroidism (CH) patients and the association of their probable change with hematological indices. Methods: Blood samples were collected from 60 healthy and 39 CH subjects. Serum PAB values were measured and Se, TSH, FT4 and hematological indices were determined. Data were analyzed by SPSS version 16 and p value less than 0.05 was considered statistically significant. Results: Serum TSH concentration was significantly higher in CH patients group compared to the controls (p value < 0.05); however, FT4 was in the same concentration in patients and controls. Platelet (Plt) and lymphocytes (Lym) counts markedly decreased in all patients and showed a significant direct correlation with serum TSH levels (rs = 0.307, p value = 0.004 and RS = 0.413, p value < 0.0001). Serum PAB and Se had no significant correlation with hematological indices in the studied subjects. Conclusions: Although there was no correlation between PAB and also Se with hematologic and biochemical markers in CH patients, changes in these two factors might be considered as a potential risk factor due to the other known effects of high PAB values and low Se concentrations.

Introduction: Dry eye disease (DED) can impact the accuracy of biometry measurements prior to cataract surgery (CS), influence visual performance post-CS, and can be exacerbated by CS. We performed a survey to evaluate the DED practice of clinicians directly caring for CS patients., Design: Prospective face-to-face survey., Method: Face-to-face survey consisting of 12 questions relating to CS clinicians' estimations of DED pre- and post-CS, dry eye tests performed, and the management of DED., Result: There were one hundred and twenty-seven responders (39% consultants, 37% trainees/fellows, 8% associate specialists, 6% specialty doctors, 8% optometrists, 2% nurse specialists), with a 100% response rate. Sixty-seven percent routinely assessed for DED pre-CS, with 81% anticipating mild to moderative negative effects of CS on DED. Approximately 75% estimated that over 10% of pre-operative patients had asymptomatic DED, with another 10% or more suffering symptomatic DED. Almost 80% estimated that 10% or more of patients suffered DED post-CS. More DED tests were performed pre- compared to post-operatively (p = 0.02). More consultants performed dry eye tests post-operatively compared to non-consultants (p = 0.02). Most common treatment options included lubricating drops (95%), lid hygiene (75%) and night ointment/gels (54%). Seventy-six percent of surgeons performing CS stated they coated the ocular surface with an ophthalmic visco-surgical device and 34% limited intra-operative light exposure peri-operatively to limit DED., Discussion: Despite the anticipated negative effects of CS on DED, 1 in 3 clinicians in our survey were not assessing routinely for DED prior to CS, and fewer dry eye tests were performed post-operatively compared to pre-surgery., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Purpose: To investigate the effects of cylinder axis-flip after toric intraocular lens (TIOL) implantation on vision and patient-reported outcome measures (PROMs)., Setting: Teaching hospital in the United Kingdom., Design: Post hoc analysis of data from patients who participated in a prospective randomized study of TIOLs., Methods: Axis-flip was defined as a change in postoperative refractive cylinder (RC) axis of 90 ± 22.5 degrees from the preoperative biometric axis. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), residual RC, and CATPROM-5 and EQ-5D-3L quality-of-life scores were analyzed., Results: At 6 months, axis-flip occurred in 29 (34.5%) of 84 eyes of which 28 had with-the-rule (WTR) astigmatism preoperatively. Mean (±SD) UDVA (logMAR) was 0.13 (0.16) in flipped cases (FCs) and 0.10 (0.14) in unflipped cases (UFs) ( P = .88). CDVA was 0.01 (0.11) in FC and was 0.00 (0.09) in UF ( P = .68). Mean RC was 0.74 diopters (D) (0.41) in FC and 0.93 D (0.47) in UF ( P = .08). Mean CATPROM-5 score was -6.22 (2.56) in FC and -5.52 (3.03) in UF ( P = .29). Mean EQ-5D-3L calibrated score was 0.89 (0.19) in FC and 0.85 (0.19) in UF ( P = .35). Retrospectively applying coefficients of adjustment to account for posterior corneal astigmatism (PCA) suggested that 6 eyes (21%) of FC with WTR might have avoided axis-flip., Conclusions: Axis flipping after TIOL implantation did not adversely influence visual acuity or PROMs scores. Most FC had WTR preoperatively. Adjusting for PCA might have reduced axis-flip in some of these eyes., (Copyright © 2024 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)

Introduction: Although there are guidance tables in the literature on surgical dosage for primary medial rectus resection-lateral rectus recession surgery, there is a lack of consensus on the surgical gains in medial rectus re-advancement (MRR) for the management of consecutive exotropia. We compared the surgical outcomes of primary medial rectus resection-lateral recession (RR) surgery, to MRR in patients with consecutive exotropia. Methods: Retrospective, electronic note review of consecutive patients undergoing primary RR surgery for basic exotropia (RR group), convergence insufficiency-type exotropia, and divergence excess, and consecutive patients undergoing MRR with or without lateral rectus recession (MRR group) for consecutive exotropia in a teaching university hospital. Results: There were 84 patients in the RR group and 27 patients in the MRR group. The median age in the RR group was 25.50 years (range 4-79) and 45 years (18-87) in the MRR group ( p  = .002). Median follow-up was 7 months (3-43) in the RR group and 1 month (1-12) in the MRR group. Post-operatively, there was a median exotropia reduction of 27.00 prism diopters (PD) (range +5, -65; p  < .0001) for near, and 27.00 PD (+10, -51; p  < .0001) for distance in the RR group. In the MRR group, the median exotropia reduction was 34.50 PD (2, -67; p  < .0001) for near and 33.00 PD (1, -67; p  < .0001) for distance. There was a greater reduction in the exotropia in the MRR group compared to the RR group for distance ( p  = .047), but this did not meet statistical significance for near ( p  = 0.10). The median dose-effect relationship (PD/millimeter) was higher in the MRR group both for near deviation (2.90 vs 2.15, p  = .0073) and for distance deviation (2.91 vs 2.15, =0.0041). Conclusion: Based on our study cohort, medial rectus re-advancement appears to have a greater dose-effect in reducing the distance angle of deviation for both near and distance compared to primary recess-resect surgery. Further prospective longitudinal studies would shed further light on the dose-effect relationship over time.

The study examined mass transfer coefficients in a structured CO 2 absorption column using machine learning (ML) and response surface methodology (RSM). Three correlations for the fractional effective area (a f ), gas phase mass transfer coefficient (k G ), and liquid phase mass transfer coefficient (k L ) were derived with coefficient of determination (R 2 ) values of 0.9717, 0.9907 and 0.9323, respectively. To develop these correlations, four characteristics of structured packings, including packing surface area (a p ), packing corrugation angle (θ), packing channel base (B), and packing crimp height (h), were used. ML used five models, represented as random forest (RF), radial basis function neural network (RBF), multilayer perceptron (MLP), XGB Regressor, and Extra Trees Regressor (ETR), with the best models being radial basis function neural network (RBF) for a f (R 2  = 0.9813, MSE = 0.00088), RBF for k G (R 2  = 0.9933, MSE = 0.00056), and multilayer perceptron (MLP) for k L (R 2  = 0.9871, MSE = 0.00089). The channel base had the most impact on a f and k L , while crimp height affected k G the most. Although the RSM method produced adequate equations for each output variable with good predictability, the ML method provides superior modeling capabilities., (© 2024. The Author(s).)

This work presents a novel approach to investigating the slip effect in nanofiber filter media. Electrospun nanofiber media with high efficiency and low pressure drop were produced at different concentrations and durations. The surface and cross-sectional morphology of nanofiber media were studied using FE-SEM. Fiber orientation and diameter distributions were also examined. The 3D virtual nanofiber media was modeled using this information along with the experimentally measured porosity and thickness of the media. The effect of the slip phenomenon in nanofiber media was studied numerically, and the results were compared to experimental data. Excellent agreements were found between the measured and simulation results. Additionally, filtration simulations considering aerosols injected with airflow through the nanofibrous filter media were conducted by considering the slip effect, and the effect of filter structure on filtration performance (removal efficiency and pressure drop) was investigated., (© 2024. The Author(s).)

Flue gas desulfurization (FGD) is a critical process for reducing sulfur dioxide (SO 2 ) emissions from industrial sources, particularly power plants. This research uses calcium silicate absorbent in combination with machine learning (ML) to predict SO 2 concentration within an FGD process. The collected dataset encompasses four input parameters, specifically relative humidity, absorbent weight, temperature, and time, and incorporates one output parameter, which pertains to the concentration of SO 2 . Six ML models were developed to estimate the output parameters. Statistical metrics such as the coefficient of determination (R 2 ) and mean squared error (MSE) were employed to identify the most suitable model and assess its fitting effectiveness. The random forest (RF) model emerged as the top-performing model, boasting an R 2 of 0.9902 and an MSE of 0.0008. The model's predictions aligned closely with experimental results, confirming its high accuracy. The most suitable hyperparameter values for RF model were found to be 74 for n&#95;estimators, 41 for max&#95;depth, false for bootstrap, sqrt for max&#95;features, 1 for min&#95;samples&#95;leaf, absolute&#95;error for criterion, and 3 for min&#95;samples&#95;split. Three-dimensional surface plots were generated to explore the impact of input variables on SO 2 concentration. Global sensitivity analysis (GSA) revealed absorbent weight and time significantly influence SO 2 concentration. The integration of ML into FGD modeling offers a novel approach to optimizing the efficiency and effectiveness of this environmentally crucial process., (© 2024. The Author(s).)

Objectives: To investigate patient understanding of, and attitudes to, premium (toric, extended depth of focus/multifocal) intraocular lenses (premIOLs) in public health sector patients undergoing cataract surgery (CS) in the UK., Methods: A 12 question survey with Likert scale questions was designed, to assess patient attitudes to post-operative spectacle dependence, refractive target and desirability of spectacle independence whilst considering possible complications of dysphotopsias and need for premIOL exchange/adjustment., Results: 360 surveys were collected. CS had not been performed in 66.5%. Separate spectacles were worn for reading and distance in 28.8%, 19.2% had varifocals, 11.2% bifocals, 22.9% reading glasses only and 1.6% computer glasses only. Contact lenses were not worn in 95.7%. Only 41.6% were drivers. Most patients (85.8%) did not mind wearing glasses after CS, with 78.9% preferring reading glasses, compared with 29.7% preferring distance glasses. Most patients (75.3%) were not familiar with premIOLs, with 58.9% not willing to consider them in the context of a 2% risk of debilitating dysphotopsia and 54.2% rejecting a 5% risk of second surgery., Conclusions: There is a lack of awareness of premIOLs in public health sector (NHS) patients in the UK, suggesting limitations in the "fully informed" consent process for CS. Most NHS CS patients are currently willing to wear spectacles after CS, especially reading glasses. There is reluctance in such patients to consider premIOLs on a background of small risks of debilitating dysphotopsias and increased risks of a second operation., (© 2023. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

Background: To compare productivity of National Health Service cataract lists performing unilateral cataract (UC) surgery vs Immediate Sequential Bilateral Cataract Surgery (ISBCS)., Methods: Five 4-hour lists with ISBCS cases and five with UC were observed using time and motion studies (TMS). Individual tasks and timings of each staff member in theatre was recorded by two observers. All operations were performed by consultant surgeons under local anaesthesia (LA)., Results: Median number of eyes operated per 4-hour list was 8 (range 6-8) in the ISBCS group and 5 (5-7) in the UC group (p = 0.028). Mean total theatre time (defined as time between the entry of the first patient and the exit of the last patient from theatre) was 177.12 (SD 73.62) minutes in the ISBCS group and 139.16 (SD 47.73) minutes in the UC group (p = 0.36). Mean time to complete two consecutive unilateral cataract surgery operations was 48.71 minutes compared to 42.23 minutes for a single ISBCS case (13.30% time saved). Based on our collected TMS data, a possible 5 consecutive ISBCS cases and 1 UC (total 11 cataract surgeries) could be performed during a four-hour theatre session, with a theatre utilisation quotient of 97.20%, contrasting to nine consecutive UC, with a theatre utilisation quotient of 90.40%., Discussion: Performing consecutive ISBCS cases under LA on routine cataract surgery lists can increase surgical efficiency. TMS are a useful way to investigate surgical productivity and test theoretical models for efficiency improvements., (© 2023. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

Background: The FAKHRAVAC®, an inactivated SARS-CoV-2 vaccine, was assessed for safety and immunogenicity., Methods and Findings: In this double-blind, placebo-controlled, phase I trial, we randomly assigned 135 healthy adults between 18 and 55 to receive vaccine strengths of 5 or 10 μg/dose or placebo (adjuvant only) in 0-14 or 0-21 schedules. This trial was conducted in a single center in a community setting. The safety outcomes in this study were reactogenicity, local and systemic adverse reactions, abnormal laboratory findings, and Medically Attended Adverse Events (MAAE). Immunogenicity outcomes include serum neutralizing antibody activity and specific IgG antibody levels.The most frequent local adverse reaction was tenderness (28.9%), and the most frequent systemic adverse reaction was headache (9.6%). All adverse reactions were mild, occurred at a similar incidence in all six groups, and were resolved within a few days. In the 10-µg/dose vaccine group, the geometric mean ratio for neutralizing antibody titers at two weeks after the second injection compared to the placebo group was 9.03 (95% CI: 3.89-20.95) in the 0-14 schedule and 11.77 (95% CI: 2.77-49.94) in the 0-21 schedule. The corresponding figures for the 5-µg/dose group were 2.74 (1.2-6.28) and 5.2 (1.63-16.55). The highest seroconversion rate (four-fold increase) was related to the 10-µg/dose group (71% and 67% in the 0-14 and 0-21 schedules, respectively)., Conclusions: FAKHRAVAC® is safe and induces a strong humoral immune response to the SARS-CoV-2 virus at 10-µg/dose vaccine strength in adults aged 18-55. This vaccine strength was used for further assessment in the phase II trial.Trial registrationThis study is registered with https://www.irct.ir; IRCT20210206050259N1., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: SGH, PKH, MH, SKH, MSH, HM, SM, BSH, HA, AM, and AKH are employees of Milad Daro Noor Pharmaceutical (MDNP). MSD is an Iran University of Medical Science (IUMS) employee. MSD, AA, MA, ASH, ZR, FGH, and KG are members of the clinical trial center of the Iran University of Medical Science that acted as academic CRO. All other authors declare no other competing interests., (© 2023 The Authors.)

Background: The FAKHRAVAC®, an inactivated SARS-CoV-2 vaccine, was assessed for safety and immunogenicity in a phase II trial., Methods: We did a phase II, single-centered, randomized, double-blind, placebo-controlled clinical trial of the FAKHRAVAC inactivated SARS-CoV-2 vaccine on adults aged 18 to 70. The two parallel groups received two intramuscular injections of either a 10-µg vaccine or a placebo at 2-week intervals. The participants' immunogenicity responses and the occurrence of solicited and unsolicited adverse events were compared over the study period of up to 6 months. Immunogenicity outcomes include serum neutralizing antibody activity and specific IgG antibody levels., Results: Five hundred eligible participants were randomly (1:1) assigned to vaccine or placebo groups. The median age of the participants was 36 years, and 75% were male. The most frequent local adverse reaction was tenderness (21.29% after the first dose and 8.52% after the second dose), and the most frequent systemic adverse reaction was headache (11.24% after the first dose and 8.94% after the second dose). Neutralizing antibody titers two and four weeks after the second injection in the vaccine group showed about 3 and 6 times increase compared to the placebo group (GMR = 2.69, 95% CI 2.32-3.12, N:309) and (GMR = 5.51, 95% CI 3.94-8.35, N:285). A four-fold increase in the neutralizing antibody titer was seen in 69.6% and 73.4% of the participants in the vaccine group two and four weeks after the second dose, respectively. Specific ELIZA antibody response against a combination of S1 and RBD antigens 4 weeks after the second injection increased more than three times in the vaccine compared to the placebo group (GMR = 3.34, 95% CI 2.5-4.47, N:142)., Conclusions: FAKHRAVAC® is safe and induces a significant humoral immune response to the SARS-CoV-2 virus at 10-µg antigen dose in adults aged 18-70. A phase III trial is needed to assess the clinical efficacy., Trial Registration: Trial Registry Number: Ref., IRCT20210206050259N2 ( http://irct.ir ; registered on 08/06/2021)., (© 2023. The Author(s).)

Background/objectives: During the COVID-19, elective cataract surgery (CS) was significantly curtailed. We investigated whether consequent reduction of micro-surgical skills practice might lead to higher operative complications., Methods: Single-centre, electronic note review of consecutive patients undergoing CS during three periods: 1 st February 2019 to 13 th January 2020 (P1) prior to pandemic; 3rd June 2020 to 11th January 2021 after 1 st lockdown (P2); and 25 th January to 30 th July 2021 (P3) after/during second lockdown., Results: 2276 operations occurred during P1, 999 during P2, 846 during P3. During P1, posterior capsular rupture (PCR) rate was 1.67%, similar to P2 (1.30%, p = 0.54), but lower than P3 (3.55%, p = 0.002). There was no difference in PCR risk percentage scores between routine and PCR cases during P1 (1.90% vs 2.03%, p = 0.83), P2 (2% vs 2.18%, p = 0.18), or P3 (1.87% vs. 2.71%, p = 0.08). During P2 and P3, there was a higher rate of cystoid macular oedema (CMO) compared with P1 (4.9% and 6.86% vs. 1.93%, p = 0.0001), with no differences in proportion of diabetics or cases with CMO in combination with PCR. There was no difference in surgeons grade experiencing PCR., Conclusions: In P3 following 9 months of curtailed elective CS, PCR rates were increased across all surgeon grades, occurring in cases with similar risk percentage scores. CMO rates were increased during COVID and not related to proportion of diabetics or increased PCR rates. The reduction in elective CS during the pandemic was associated with more complications, perhaps due to attenuation of microsurgical skills., (© 2022. The Author(s).)

Objective: To report multicentred use of the heavy silicone oil Densiron 68 for anatomical reattachment following rhegmatogenous retinal detachment (RRD) repair and its associated complications., Methods and Analysis: Patients from seven vitreoretinal units within the UK that underwent RRD repair with Densiron 68 between January 2015 and December 2019 were identified. Primary outcome measures were primary and final reattachment rate, retained Densiron and failure rate. Secondary outcome measures were duration of tamponade, final visual acuity (VA) and complications of heavy silicone oil., Results: 134 eyes of 134 patients were involved in the study. Primary surgical success was achieved in 48.5%, while a final reattachment rate of 73.4% was observed. The mean duration of Densiron 68 tamponade was 139.5 days. Mean final VA was 1.01 (range 0-2.9). 8 eyes (6.0%) required long-term topical steroids for anterior uveitis, whereas none of the eyes required long-term pressure-lowering treatment. Emulsification rate was 10.7% (6 eyes)., Conclusion: This is the largest real-world study on Densiron 68 in the UK. Densiron 68 facilitates tamponade of inferior retinal pathology and may be considered as an option for tamponade of inferior retinal pathologies., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The presence of pharmaceuticals as the emerging contaminates needs novel approaches and new materials to be remediated. This study aimed to develop and apply MWCNTs reinforced with glutaraldehyde cross-linked poly (vinyl alcohol)/chitosan nanocomposite (MWCNTs/CS-PVA/GA NC) for removal of tetracycline (TC) as a model of antibiotics from aqueous solutions. The successful synthesis of NC was supported by techniques of SEM, XRD, TGA, FTIR, and EDX. The prepared NC was then utilized for TC adsorption under the main effective parameters of TC concentration (25-125 mg/L), sonication time (0-8 min), NC dose (1-130 mg), and tempearure (5-45 °C). The process behavior was comparably explored with different methods of central composite design (CCD), artificial neural networks (ANN), and general regression neural network (GRNN). The results showed that under the optimum settings presented by desirability function (DA), in which the respective values for the factors were 125 mg/L, 6.8 min, 130 mg, and 45 °C, the efficiency and adsorption capacity of NC is supposed to be 99.07% and ∼525 mg/g, respectively. From the models studied, although all were able to express the process with satisfactory accuracy, ANN provided the best accuracy and reliability owning to the highest R 2 (0.999) and lowest RMSE, ADD, MAE. The kinetics, isotherms, and thermodynamic studies showed that the process is fast (over 4.5 min), chemisorption, heterogeneous with multilayer nature, spontaneous, feasible, and endothermic. In addition, the as prepared NC could be recycled for five times without significant fail in its performance. All in all, the developed MWCNTs/CS-PVA/GA NC can be considered as a promising candidate in dealing with aqueous solutions' pollution with antibiotic., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Antibiotic resistance is considered a universal health threat of the 21st century which its distribution and even development are mainly mediated by water-based media. Disinfection processes with the conventional methods are still the most promising options to combat such crises in aqueous matrices especially wastewater. Knowing that the extent of effectiveness and quality of disinfection is of great importance, this paper aimed to systematically review and discuss ozonation (as one of the main disinfectants with large scale application) effect on removing antibiotic resistant bacteria (ARB) and antibiotic resistance genes (ARGs) from aqueous solutions, for which no study has been reported. For this, a comprehensive literature survey was performed within the international databases using appropriate keywords which yielded several studies involving different aspects and the effectiveness extent of ozonation on ARB & ARGs. The results showed that no definite conclusion could be drawn about the superiority of ozone alone or in a hybrid form. Mechanism of action was carefully evaluated and discussed although it is still poorly understood. Evaluation of the studies from denaturation and repairment perspectives showed that regrowth cannot be avoided after ozonation, especially for some ARB & ARGs variants. In addition, the comparison of the effectiveness on ARB & ARGs showed that ozonation is more effective for resistant bacteria than their respective genes. The degradation efficiency was found to be mainly influenced by operational parameters of CT (i.e. ozone dose & contact time), solids, alkalinity, pH, and type of pathogens and genes. Moreover, the correlation between ARB & ARGs removal and stressors (such as antibiotic residuals, heavy metals, aromatic matters, microcystins, opportunistic pathogens, etc.) has been reviewed to give the optimal references for further in-depth studies. The future perspectives have also been reported., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

The aim of this review was to discuss frequently encountered themes such as cataract surgery in presence of age-related macular degeneration (AMD), dementia, Immediate Sequential Bilateral Cataract Surgery (ISBCS), discussing non-standard intraocular lens (IOL) options during consultation in the National Health Services (NHS) and the choice of the biometric formulae based on axial length. Individual groups of authors worked independently on each topic. We found that cataract surgery does improve visual acuity in AMD patients but the need for cataract surgery should be individualised. In patients with dementia, cataract surgery should be considered 'sooner rather than later' as progression may prevent individuals presenting for surgery. This should be planned after discussion of patients' best interests with any carers; multifocal IOLs are not proven to be the best option in these patients. ISBCS gives comparable outcomes to delayed sequential surgeries with a low risk of bilateral endophthalmitis and it can be cost-saving and efficient. Patients are entitled to know all suitable IOL options that can improve their quality of life. Deliberately withholding this information or pressuring patients to choose a non-standard IOL is inappropriate. However, one should be mindful of the not spending inappropriate amounts of time discussing these in the NHS setting which may affect care of other NHS patients. Evidence suggests Hoffer Q, Haigis, Hill-RBF and Kane formulae for shorter eyes; Barrett Universal II (BU II), Holladay II, Haigis and Kane formulae for longer eyes and BU II, Hill-RBF and Kane formulae for medium axial length eyes., (© 2021. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

Aims: To report 12-month outcomes of randomised controlled trial comparing conventional phacoemulsification surgery (CPS) with femtosecond laser-assisted cataract surgery (FLACS)., Methods: This was a single-centre, prospective single-masked randomised case-controlled trial. Four hundred patients were randomised to CPS or FLACS with the LenSx platform (Alcon Laboratories Inc.). Visual acuity, refraction, central corneal thickness, endothelial cell loss (ECL), adverse events and quality of life outcomes, using EuroQOL 5-dimensions (EQ-5D-3 L) and cataract surgery patient-reported outcome measures (PROMs) questionnaires (Cat-PROM5), were recorded., Results: Two hundred and thirty four patients (58.5%) attended 12-month follow-up (116 FLACS, 118 CPS). Mean LogMAR unaided distance visual acuity) (±SD) was 0.12 (0.18) with FLACS and 0.13 (0.19) with CPS (p=0.68; 95% Confidence Interval [CI]-0.06,0.04). Mean spherical equivalent (SE) refraction was -0.1±0.6 diopters (D) with FLACS and -0.2±0.6 D with CPS (p=0.44; 95% CI -0.09, 0.21). Mean corrected distance visual acuity (±SD) was -0.01 (0.1) with FLACS and 0(0.1) with CPS (p=0.45; 95% CI -0.04,0.02). Two patients per group underwent YAG laser capsulotomy for posterior capsular opacification (p=1). Mean ECL (per mm 2 ±SD) was 301±320 with FLACS and 228±303 with CPS (p=0.07; 95% CI -7.26, 153.26). Mean Cat-PROM scores (±SD) were -5.5 (2.6) with FLACS and -5.8 (2.5) with CPS (p=0.3; 95% CI 0.31,1.01). EQ5-3DL mean index score (±SD) was 0.92 (0.13) with FLACS and 0.89 (0.14) with CPS (p=0.1; 95% CI -0.1, 0.01). Vector analysis comparing manual limbal relaxing incisions (LRIs) and intrastromal femtosecond laser-assisted astigmatic keratotomies (iFAKs) showed a greater correction index (p=0.02; 95% CI 0.06 to 0.60) and smaller difference vector (p=0.046; 95% CI -0.54, -0.01) with iFAK., Conclusions: There were no differences in vision, refraction, adverse postoperative events or PROMs between FLACS and CPS groups at 12 months. iFAKs may provide more effective astigmatic correction compared to LRIs, 12 months postoperatively., Competing Interests: Competing interests: Professor O’Brart has held non-commercial grants from Alcon, Rayner and Avedro. Harry Roberts has undertaken consultancy work for Alcon in the past 12 months., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Antibiotic resistance against uro-pathogens is a worldwide health concern. The aim of this study was to determine the causative bacteria and antibiotic susceptibility patterns among hospitalized patients with community acquired urinary tract infection (UTI)., Methods: This cross-sectional study was performed in 2016-2018 in Isfahan, Iran. Urine samples were examined for strain identification and antimicrobial resistance pattern using standard tests. Stratification was done based on gender and age (<20 and >20 years) groups. Chi-square and Fisher exact tests were applied to assess differences in etiology and susceptibility rates between groups., Results: Among 1180 patients, Escherichia coli was the commonest pathogen (68.1%) followed by Enterococcus spp. (8.8%) and Klebsiella pneumonia (8.0 %). Non- E. coli pathogens were more frequent among males (41.8% versus 24.8% in females, P <0.01) and in those aged under 20 years (61.0% versus 22.2% in older than 20 years, P <0.01). Isolated bacteria revealed high susceptibility to imipenem (94.9%), meropenem (92.2%), and amikacin (91.9%); moderate sensitivity to gentamicin (64.4%), cefepime (52.6%) and ceftazidime (47.2%); and low susceptibility to ceftriaxone (41.8%), cefotaxime (40.0%), ciprofloxacin (38.6%) and trimethoprim-sulfamethoxazol (31.3%). The sensitivity of isolates to ceftriaxone, ceftazidime, cefepime, imipenem, meropenem, amikacin and ciprofloxacin was significantly higher in females. Compared to the older age group, uro-pathogens were more susceptible to ciprofloxacin, ceftazidime and gentamicin in patients aged under 20 years., Conclusion: We found that imipenem, meropenem and amikacin were good choices for empiric therapy of complicated or severe hospitalized patients with community acquired UTI; and gentamicin, cefepime and ceftazidime were acceptable as initial choices in non-severe infections in the area., (© 2021 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Purpose: To compare the rates of rhegmatogenous retinal detachment (RRD) following an anterior vitrectomy (AV) alone during cataract surgery, compared to cases requiring a subsequent pars plana vitrectomy (PPV) for dropped nuclear lens fragments (DNLFs)., Methods: Retrospective electronic note review of consecutive patients with a posterior capsular rupture (PCR) requiring either AV or subsequent PPV for DNLF over a 5-year period., Results: A total of 20,235 cataract operations were performed during the defined period with 199 cases (eyes) of PCR (0.98%). One hundred forty-four of these (72.4%) were managed with AV, and the remaining 55 cases were further complicated by DNLF and thus underwent secondary PPVs. A total of 80.0% of cases in the AV group had a final BCVA of 0.30 logMAR or better, and 77.35% in the DNLF group had a BCVA of 0.30 logMAR or better (p = 0.069). Final BCVA was 0.30 (range-0.18 to 3.0) in the AV group and 0.32 (range-0.18 to 1.8) in the DNLF group (p = 0.82). Final BCVA in those patients who suffered a RRD was poorer than the rest of the cohort in the AV group (p = 0.03). Seven of 144 cases in the AV group went on to develop a RRD with a median time of 11 months (range 1-18 months). None of the cases in the DNLF group went on to develop a RRD (P = 0.048)., Conclusion: Following an anterior vitrectomy during complicated cataract surgery, the risk of RRD may be lower in patients who require a subsequent PPV for management of DNLF compared to patients who are managed with anterior vitrectomy alone.

Objective: To ascertain patient acceptance of immediate sequential bilateral cataract surgery (ISBCS) in the National Health Service (NHS)., Methods: A survey was devised using a 5-point Likert scale for questions related to ISBCS, which patients undertook during their cataract outpatient appointment pre-COVID-19 lockdown and by telephone during the lockdown., Results: Questionnaires were completed for 267 patients. Most respondents were aged over 71 (51%) and were female individuals (60%). Forty-five per cent agreed/strongly agreed with opting for ISBCS. A positive correlation was identified between opting for ISBCS and convenience to the patient ( r =0.76, p<0.01) and family/carer/partner ( r =0.71, p<0.01) and wanting to limit numbers of hospital visits (r=0.57, p<0.01). Fifty per cent agreed/strongly agreed that they were worried about the risk of simultaneous bilateral ocular complications, with this correlating with being less likely to opt for ISBCS ( r =-0.49, p<0.01) and being scared of ISBCS ( r =0.67, p<0.01). During COVID-19 lockdown, patients were less likely to want to minimise the time taken off work (p<0.05) and less intolerant of a prolonged hospital visit (p<0.05). Only 23% of respondents agreed/strongly agreed that they had familiarity with ISBCS., Conclusions: ISBCS was acceptable to 45% of our sampled population, suggesting limited routine implementation in the NHS is possible. Convenience and reduction in hospital visits appeared to contribute to this acceptance. Half of the patients expressed concern regarding bilateral complications and such concerns need addressing. Some attitudes did appear to change during the COVID-19 lockdown period. The familiarity of the concept of ISBCS is low suggesting the need for patient education., Competing Interests: Competing interests: DO’B holds non-commercial research grants with Rayner Ltd and Avedro. He has undertaken consultancy work for Avedro, Sparca and Alcon in the past 12 months. He holds stock in Sparca., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Isfahan Antibiotic Resistance Surveillance System-1 has been instituted in Isfahan, Iran to construct a project for surveillance of clinically significant bacteria, and to help raise a logic regional stewardship program for prevention and control of disseminating-resistant organisms., Methods: During March 2016 to March 2018, an antibiotic resistance surveillance system was designed and implemented by Isfahan Infectious Diseases and Tropical Medicine Research Center. The surveillance program was implemented in three general hospitals in Isfahan. In addition to the routine microbiology data, clinical data (differentiation between true infections and contamination, healthcare-associated infections (HCAI) and community-acquired infections (CAI), as well as determination of the infection site) were obtained and analyzed by WHONET software., Results: During a 2-year period, from 7056 samples that revealed growth of bacteria, 3632 (51.5%) isolates were detected as contamination and 3424 (48.5%) true bacterial isolates were identified. Of these, about 32% of isolates were recognized as HCAI. Totally, the most recognized infections were urinary tract infection, bloodstream infection and skin and soft tissue infections. In patients with HCAIs, 70% of isolates were gram negative and in patients with CAIs 73% isolates were gram negative bacteria., Conclusions: The strength of the project is gathering enough clinical information in addition to microbiologic data, which would increase application of the results for empiric treatment and prevention of the infectious diseases in clinical settings., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 International Journal of Preventive Medicine.)

Aim: To review published literature concerning cataract surgery and dry eye disease (DED)., Methods: A search was undertaken using the following: PubMed (all years), Web of Science (all years), Ovid MEDLINE(R) (1946 to 12 December 2019), Ovid MEDLINE(R) Daily Update 10 December 2019, MEDLINE and MEDLINE non-indexed items, Embase (1974-2019, week 49), Ovid MEDLINE (R) and Epub Ahead of Print, In-Process and Other Non-Indexed Citations and Daily (1946 to 12 December 2019), CENTRAL (including Cochrane Eyes and Vision Trials Register; Cochrane Library: Issue 12 of 12 December 2019), metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrial.gov) and WHO International Clinical Trials Registry Platform (www.who.int/ictrp/search/en). Search terms included 'cataract surgery', 'phacoemulsification' and 'cataract extraction', combined with 'dry eyes' and 'ocular surface'. Relevant in-article references not returned in our searches were also considered., Results: Publications identified included systematic reviews, meta-analysis, randomized controlled trials, cohort studies, case series and laboratory-based studies. Published data highlighting the burden of DED both prior and following cataract surgery were reviewed as well as studies highlighting the effects of cataract surgery on the ocular surface, intra-operative measures to reduce deleterious effects on the ocular surface and current evidence on the management options of post-operative DED., Conclusions: DED is common and can be exacerbated by cataract surgery. Ophthalmologists need to assess for pre-existing DED and instigate treatment before surgery; be aware of reduced accuracy of measurements for surgical planning in the presence of DED; limit intra-operative surgical factors damaging to the ocular surface; and consider management to reduce DED post-operatively.

In this paper, a power efficient, low-noise and high swing capacitively-coupled amplifier (CCA) for neural recording applications is proposed. The use of current splitting technique and current scaling technique in a current mirror operational transconductance amplifier (CM-OTA) has lead to a very good trade-off between power and noise. The presented architecture is simple, without cascode transistor while it has more than 80 dB open-loop gain without extra power consumption. As a result, the proposed structure has a better power efficiency factor (PEF) and output swing in comparison with previous reported architectures is increased to the 2Vov below the maximum supply voltage. In order to reduce flicker noise and achieve better trade-off between the power and noise, PMOS transistors with an optimum size have been utilized which operate in sub-threshold region. The amplifier is designed and simulated in a commercially available 0.18 μm CMOS technology. Monte Carlo simulations for process and mismatch have been carried out. The gain of the proposed amplifier is 39.22 dB in its bandwidth (3 Hz - 5 kHz). Total input-referred noise is 3.03 μVrms over 1 Hz - 10 kHz. The power consumption of the amplifier is 2.98 μW at supply voltage of 1.4 V. The noise efficiency factor (NEF) and PEF are 2.4 and 8.06, respectively. The output swing is about 1.16 V. It means the proposed amplifier can tolerate up to 13.2 mV peak-to-peak input signal while its total harmonic distortion (THD) is less than 1%.

Objective: To test a hypothesis that operating room (OR) productivity in the National Health Service (NHS) can be improved with the introduction of immediately sequential bilateral cataract surgery (ISBCS)., Methods and Analysis: Previously published time and motion data of 140 unilateral cataract surgeries conducted at five different NHS locations were reanalysed to construct a hypothetical model where only ISBCS (±one unilateral case) were conducted while maintaining time durations of all key tasks previously studied. Possible time efficiency savings were calculated for the ISBCS model and percentage increases in numbers of eyes operated per 4-hour theatre session calculated. Gains in efficiency were correlated with factors from the baseline data to predict which settings could improve efficiency most by undertaking ISBCS., Results: Based on remodelling our time and motion study (TMS) data as hypothetical ISBCS cases, we could expect a mean 16% reduction (range 9.8%-17.8%) in the time taken for two cataract operations, translating into a mean 54% improvement (range 38%-67%) in number of cases currently performed per list and an 18% improvement (range 9%-28%) even if the number of unilateral cases per list had been fully maximised. An average number of four ISBCS cases per list (range 3-6) were required to achieve sufficient time savings to allow an extra unilateral surgery to be conducted., Conclusion: The introduction of routine ISBCS has the potential to improve the productivity of cataract surgery within the NHS, with efficiencies being possible in both high-volume and low-volume surgical models., Competing Interests: Competing interests: DO’B holds non-commercial research grants with Alcon Inc and Rayner Ltd. He has undertaken consultancy work for Alcon Inc, Avedro Inc, Sooft Italia S.P.A. and Sparca Inc in the past 36 months. HR has undertaken consultancy work for Alcon Inc in the past 18 months., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Current evidence suggests dementia and pathology in Alzheimer's Disease (AD) are both dependent and independent of amyloid processing and can be induced by multiple 'hits' on vital neuronal functions. Type 2 diabetes (T2D) poses the most important risk factor for developing AD after ageing and dysfunctional IR/PI3K/Akt signalling is a major contributor in both diseases. We developed a model of T2D, coupling subdiabetogenic doses of streptozotocin (STZ) with a human junk food (HJF) diet to more closely mimic the human condition. Over 35 weeks, this induced classic signs of T2D (hyperglycemia and insulin dysfunction) and a modest, but stable deficit in spatial recognition memory, with very little long-term modification of proteins in or associated with IR/PI3K/Akt signalling in CA1 of the hippocampus. Intracerebroventricular infusion of soluble amyloid beta 42 (Aβ42) to mimic the early preclinical rise in Aβ alone induced a more severe, but short-lasting deficits in memory and deregulation of proteins. Infusion of Aβ on the T2D phenotype exacerbated and prolonged the memory deficits over approximately 4 months, and induced more severe aberrant regulation of proteins associated with autophagy, inflammation and glucose uptake from the periphery. A mild form of environmental enrichment transiently rescued memory deficits and could reverse the regulation of some, but not all protein changes. Together, these data identify mechanisms by which T2D could create a modest dysfunctional neuronal milieu via multiple and parallel inputs that permits the development of pathological events identified in AD and memory deficits when Aβ levels are transiently effective in the brain.

Amyloid fibrils were produced in a solution of bovine serum albumin (BSA) in buffer solution in the presence of fructose. The solution was incubated for 20 weeks in the dark. We used glycation induced bovine serum albumin in which fibrilogenesis (nano fibrils) followed by using fluorescence (Thioflavin T), Dynamic Light Scattering (DLS) and Transmission Electron Microscopy (TEM) to achieve the size and morphology of fibrils. A novel electrochemical biosensor for the detection of hydrogen peroxide was developed based on immobilizing poly (alizarin yellow R) and amyloid nano-fibrils on glassy carbon electrode (PAYR/AMLNFibs/GCE). The electrocatalytic response of the biosensor was proportional to the hydrogen peroxide concentration in the range of 1 μM to 2.2 mM with a limit of detection and sensitivity of 290 nM and 0.024 μA/μM, respectively. The modified electrode demonstrated many advantages such as high sensitivity, low detection of limit and excellent catalytic activity., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background: Vitamin D has health benefits in many respiratory diseases but the evidence in CF is unclear. Induction of the antimicrobial peptides cathelicidin (LL37) and human-beta-defensin-2 (HBD-2) may be the mechanism of any benefit. We hypothesised that antimicrobial peptide levels would be decreased, and airway infection and inflammation greater, in CF children with vitamin D deficiency. The objective of the study was to explore relationships between vitamin D, LL37 and HBD-2, and airway infection, inflammation and physiology in children with CF., Methods: Bronchoalveolar lavage (BALF) and blood were obtained from children undergoing fibreoptic bronchoscopy. Serum vitamin D, BALF HBD-2 and LL37, cultured bacteria and inflammatory markers were measured. Clinical parameters were recorded., Results: 113 patients with CF, 23 with non-CF chronic suppurative lung disease (CSLD) and 6 healthy controls were included. We found no relationship between serum vitamin D and BALF HBD-2 or LL-37. There were no differences in infective or inflammatory markers between vitamin D sufficient and deficient groups. Vitamin D deficient patients (<50 nmol/L) did not have a worse FEV 1 (CF: 66 (58-71)% vs. 71.5 (61-76)%, ns; non-CF CSLD: 69 (36-88)% vs. 70 (62-95)%, ns)., Conclusions: In the first bronchoscopic study exploring this question, we demonstrate that vitamin D deficiency is not associated with immunological, infective or clinical markers of disease severity in patients with CF or CSLD., (Copyright © 2018 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.)

Background: Trauma is the leading health concern among young adults. Blunt abdominal trauma (BAT) is the most common type of blunt traumas. BAT patients may prove normal in the initial clinical assessments, but since the time required for an intra-abdominal injury to be clinically apparent is not predictable, deciding when to safely discharge these patients could be a dilemma. The purpose of this study is to determine whether follow-up of the early discharged or further diagnostic assessment of the later discharged BAT patients with normal initial findings reveals any abnormal findings., Methods: Totally, 389 hemodynamically-stable patients suspected of BAT who arrived at the emergency department (ED) of two university hospitals in Tehran from September 2013 to September 2014 were included in this study. Upon arrival at the ED, all subjects underwent abdominal examination and FAST, and were assessed for hematocrit and base deficit levels and presence of hematuria. These assessments were repeated in the patients who were discharged after 6 h, at 6 or 12 h post-arrival. All patients were followed-up after 24 h and one week by phone call., Results: Out of all study participants, 158 patients (40.6%) had normal findings in all initial assessments. These patients were discharged from the ED after a median of 5 h. After one week of follow-up, none of them had any symptom or complication, or had sought medical attention after being discharged from the study hospitals. Out of these patients, 78 patients (49.4%) were discharged after 6 hours by their physician's decision, and underwent the same diagnostic assessments for the second or third time. None of these assessments revealed any abnormal findings., Conclusions: A combination of normal abdominal exam, normal FAST, normal hematocrit, normal base deficit, and absence of hematuria rules out intra-abdominal injury in BAT patients. It is safe to discharge patients after they prove normal for these assessments. Longer observation and repeated diagnostic assessment of these patients does not yield any new findings, and seems to be unnecessary.

The effect of sonic waves, in particular, ultrasonic radiation, on immiscible displacement in porous media and enhanced oil recovery has been of interest for more than five decades. Attempts were made to investigate the effect through core scale experimental or theoretical models. Visual experiments are useful to scrutinize the reason for improved oil recovery under acoustic waves of different frequency but are not abundant in literature. In this paper, we report observations and analyses as to the effects of ultrasonic energy on immiscible displacement and interaction of the fluid matrix visually in porous media through two-dimensional (2D) sand pack experiments. 2D glass bead models with different wettabilities were saturated with different viscosity oils and water was injected into the models. The experiments were conducted with and without ultrasound. Dynamic water injection experiments were preferred as they had both viscous and capillary forces in effect. The displacement patterns were evaluated both in terms of their shape, size, and the interface characteristics quantitatively and qualitatively to account for the effects of ultrasonic waves on the displacement and the reason for increased oil production under this type of sonic wave. More compact clusters were observed when ultrasonic energy was present in water-wet systems. In the oil-wet cases, more oil was produced after breakthrough when ultrasound was applied and no compact clusters were formed in contrast to the water-wet cases., (© 2011 American Physical Society)

RNA polymerase II is an essential nuclear multi subunit enzyme that transcribes nearly the whole genome. Its inhibition by the alpha-amanitin toxin leads to cell death. The enzyme of Plasmodium falciparum remains poorly characterized. Using a complementation assay in yeast as a genetic test, we demonstrate that five Plasmodium putative RNA polymerase subunits are indeed functional in vivo. The active site of this enzyme is built from the two largest subunits. Using site directed mutagenesis we were able to modify the active site of the yeast RNA polymerase II so as to introduce Plasmodium or human structural motifs. The resulting strains allow the screening of chemical libraries for potential specific inhibitors., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Oil saturated cylindrical sandstone cores were placed into imbibition cells where they contacted with an aqueous phase and oil recovery performances were tested with and without ultrasonic radiation keeping all other conditions and parameters constant. Experiments were conducted for different initial water saturation, oil viscosity and wettability. The specifications of acoustic sources such as ultrasonic intensity (45-84W/sqcm) and frequency (22 and 40kHz) were also changed. An increase in recovery was observed with ultrasonic energy in all cases. This change was more remarkable for the oil-wet medium. The additional recovery with ultrasonic energy became lower as the oil viscosity increased. We also designed a setup to measure the ultrasonic energy penetration capacity in different media, namely air, water, and slurry (sand+water mixture). A one-meter long water or slurry filled medium was prepared and the ultrasonic intensity and frequency were monitored as a function of distance from the source. The imbibition cells were placed at certain distances from the sources and the oil recovery was recorded. Then, the imbibition recovery was related to the ultrasonic intensity, frequency, and distance from the ultrasonic source., (Copyright 2009 Elsevier B.V. All rights reserved.)