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In patients with anorectal malformation (ARM), a divided descending colostomy is associated with high complication rates, including wound infection, dehiscence, and prolapse, and it places a significant burden on caregivers. To decrease the chances of such complications, we modified our approach for colostomy fashioning by keeping an intact skin bridge between the colostomy and mucous fistula. The objective was to compare the rate of complications among patients diagnosed with ARM who underwent a modified divided descending colostomy and classical descending colostomy. We included all the patients diagnosed with ARM who underwent a divided colostomy with modified (group A) or classical technique (group B) in the last 5 years. The type of approach used to fashion the stoma was based on the surgeon's preference than on patients' selection criteria. All patients were followed and monitored for postoperative complications. SPSS version 26 was used to analyze the data. A total of 62 patients with ARM underwent the colostomy creation; 27 in group A and 35 in group B. Males were more in both groups and other demographic variables were comparable. The most common associated anomalies were cardiac (58%). The mean duration of surgery was 72.2 ± 18.26 min in group A while 91.25 ± 21.43 min in group B (P = 0.000). The mean hospital stay was 4.28 ± 3.63 days in group A while 7.97 ± 6.12 days in group B (P = 0.007). The overall complication rate was 14.8% in group A and 34.2% in group B (P = 0.082). The modified approach to fashioning a divided colostomy is easily reproducible and carries a low risk of postoperative complications. IV. [Display omitted] • What is currently known about this topic? Divided pelvic colostomy for high anorectal malformation has been a standard for years, but it is associated with high stoma-related complications. • What new information is contained in this article? With our modified technique of leaving an intact skin bridge between two stomas, we were able to achieve no wound infection and minimal other stoma complications. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the opinions of physicians about brain surgery for drug-resistant epilepsy worldwide.Methods: Practicing neurologists, psychiatrists, and neurosurgeons from around the world were invited to participate in an online survey. The survey anonymously collected data about demographics, years in clinical practice, discipline, nation, work setting, and answers to the questions about beliefs and attitudes about brain surgery for drug-resistant epilepsy.Results: In total, 1410 physicians from 20 countries and different world regions participated. The propensity to discuss brain surgery with patients, who have drug-resistant seizures, was higher among men (versus women) [Odds Ratio (OR) 1.67, 95% CI 1.20-2.31; p = 0.002]. In comparison to neurologists, psychiatrists were less likely (OR 0.28, 95% CI 0.17-0.47; p < 0.001) and neurosurgeons were more likely (OR 2.00, 95% CI 1.08-3.72; p = 0.028) to discuss about it. Survey participants working in Africa, Asia, the Middle East, and the Former Union of Soviet Socialist Republics showed a lower propensity to discuss epilepsy surgery with patients.Conclusion: This study showed that on an international level, there is still a knowledge gap concerning epilepsy surgery and much needs to be done to identify and overcome barriers to epilepsy surgery for patients with drug-resistant seizures worldwide. [ABSTRACT FROM AUTHOR]

• 35 physical solvents were used for CO2 capture in 543 MW IGCC power plant. • The process was built in Aspen Plus and its CAPEX, OPEX, and LCOC were obtained. • DES at low temperatures showed the lowest LCOC value at $7.14/ton CO2 captured. • An ANN using Aspen Plus data was developed and used to predict the TEA results. • The ANN can perform TEA for new solvents with parameters within its boundaries. A Techno-Economic Analysis (TEA) of the CO 2 capture process in a pre-combustion 543 MWe power plant was performed for thirty-five physical solvents employed to capture 90 % of CO 2 from the sulfur-free fuel gas of the power plant. The process was built in Aspen-Plus v.11 and included one countercurrent fixed-bed CO 2 absorber, containing structured (Mellapak 250Y) or random (IMTP50) packing, three flash-drums to regenerate the solvent, and multi-stage compressors to condition the captured CO 2 for subsequent sequestration. The process operating expenditure (OPEX), capital expenditure (CAPEX), and levelized cost of CO 2 captured (LCOC) were obtained. Aspen-Plus calculations revealed that Mellapak 250Y, having larger specific surface area than IMTP50, improved gas-liquid mass transfer and decreased LCOC; low-temperature operation enhanced CO 2 solubility in the solvents and decreased solvent loss, lowering LCOC; high- temperature operation increased volatile solvent loss, increasing LCOC; and among the thirty-five solvents used, diethyl sebacate (DES) had the lowest LCOC ($7.14 per ton of CO 2 captured). All Aspen-Plus TEA results were used to develop an Artificial-Neural-Network (ANN), consisting of one-input layer with 11 nodes, two-hidden layers with 10 nodes, and one-output layer with 3 nodes. The ANN was trained, then tested with 40 % and 60 % of the data, respectively; and it predicted the process CAPEX, OPEX, and LCOC with high accuracy. Thus, this ANN can perform TEA of numerous potential new solvents for CO 2 capture in seconds compared to hours with Aspen-Plus, which is a significant timesaving, provided that plant capacity, solvent properties, and operating conditions are within its boundaries. [ABSTRACT FROM AUTHOR]

A largely neglected aspect necessary to prevent energy losses of photovoltaic (PV) panels is efficient and cost-effective mitigation of dust soiling. A potential solution is an electrodynamic dust shield (EDS) to lift and transport dust off the PV panel via electrodynamic waves generated by electrodes on the panel surface. Accordingly, the objective of this research was to determine the effects of EDS parameters on the optimal cleaning efficiency of PV panels soiled by desert dust. A discrete element method was used to computationally simulate the transport, collision, and adhesion of charged particles, representative of dust in Doha, Qatar, subject to two-phase waves on an inclined EDS. Results showed that under given conditions, the optimal distance between electrodes (pitch) was 14 mm, which resulted from a balance between increasing pitch that aided dust transport and concomitant decreasing electric field strength that hindered transport. Optimal voltage was 2.8 kV p-p , while particles remained adhered to the surface at small voltages (0.7 kV p-p ) but were repelled and attracted by the same electrode at high voltages (11.8 kV p-p ). Dust transport distance per 10 cycles generally decreased as cycle frequency increased from 0.5 to 10 Hz; however, transport distance per time was largest with an intermediate frequency of 1 Hz. Our study revealed various ways in which individual dust particles were repelled and attracted by electrodes under different conditions that produced different transport patterns, which can be used to improve the efficiency of dust mitigation for PV panels. [ABSTRACT FROM AUTHOR]

Objective: The use of electroencephalogram (EEG) has been demonstrated to have diagnostic and prognostic value in cardiac arrest patients. The use of this modality across the United States in this population is unknown.Methods: The Nationwide Inpatient Sample (NIS) is a federal database capturing 20% of all US hospital admissions. A cohort of patients who suffered both in and out of hospital cardiac arrests from the 2006 to 2012 NIS datasets was created.Results: The records of 55,208,382 hospitalizations were analyzed, of which 207,703 patients suffered a cardiac arrest. There were 2952 (1.42%) patients who also had an EEG. Patients who had an EEG compared to those who did not were: younger (62.2 years SD 16.6 vs 66.9 years SD 16.2, p<0.01), were less likely to have insurance coverage (89.9% vs 91.6%, p=0.03) and had significantly longer length of stay (8.6days IQR 3.7-17.1 vs 4.1days IQR 1.0-10.5, p<0.01). Patients treated at urban teaching hospitals were more likely to receive an EEG than patients treated at urban non-teaching and rural hospitals (p<0.01). The rate of EEG in survivors of cardiac arrest increased from 1.03% in 2006 to 2.16% in 2012, a relative increase of 110% (p<0.02). The median time to performance of an EEG was 1.6days IQR 0.33-4.53 days.Conclusion: EEG is performed on approximately 2% of patients who suffer cardiac arrest in the United States. The treatment hospital and patient characteristics of those who received an EEG different from those who did not. [ABSTRACT FROM AUTHOR]

• Hydrophobic physical solvents have been tested for pre-combustion CO 2 capture. • Lab-scale vapor liquid equilibrium data was measured for CO 2 , H 2 , N 2 and CH 4. • Pilot scale CO 2 capture by physical solvents was assessed with coal derived syngas. • Pilot plant performance data compared well to validated aspenPlus process simulations. • CASSH-1, a hydrophobic solvent, had high CO 2 uptake & low water uptake in pilot plant. Here, we present the first pilot plant data for hydrophobic physical solvents for CO 2 and H 2 S removal from coal-derived H 2 -rich syngas. Four physical solvents were tested under pre-combustion CO 2 capture conditions at bench scale and pilot plant scale: one baseline hydrophilic solvent and three hydrophobic solvents. The solvents were: (1) polyethylene-glycol-dimethyl ether (PEGDME), a hydrophilic solvent analog for the commercial process Selexol, (2) tributyl- phosphate (TBP), a commercially available hydrophobic solvent, (3) polyethylene glycol-poly(dimethylsiloxane) (PEG-PDMS-3), and (4) diethyl sebacate (CASSH-1), a novel, computationally screened hydrophobic solvent developed by the National Energy Technology Laboratory (NETL). All solvents were studied under pure gas (CO 2 /N 2 /H 2 /CH 4) equilibrium conditions at NETL followed by pilot plant testing with syngas at the University of North Dakota Energy & Environmental Research Center (UND EERC). Long term performance of CASSH-1 and PEDGME was then assessed with results compared to process simulation predictions. Within experimental uncertainties, all solvents showed comparable CO 2 absorption performance at above room temperature operation while the hydrophobic solvents had limited water uptake and low vapor pressure, which alleviates concerns related to corrosion, water absorption, and solvent loss to evaporation. These results indicate low viscosity, low vapor pressure hydrophobic solvents are a promising option for lower cost CO 2 capture from high pressure syngas applications. [Display omitted] [ABSTRACT FROM AUTHOR]

• An innovative process using SG for CO 2 capture from flue gas was developed in aspen plus v.10. • The flue gas flow rate used in the process was 44.75 tph and contained 0.0023 mol% SO 2 and 13.33 mol% CO 2. • The process was designed to remove all SO 2 , and capture 90 mol% of CO 2 from the flue gas to produce valuable NaHCO 3 nanoparticles. • The hydraulics and mass transfer of the gas-liquid systems were obtained and the CAPEX, OPEX, and LCOC of the process were calculated. • The process was able to capture 8.144 tph of CO 2 and produce 15.545 tph of NaHCO 3 nanoparticles. An innovative post-combustion process using aqueous sodium glycinates solutions (SGS) for CO 2 capture from a split flue gas stream emitted from the 600 MWe coal power plant, used in the Wolverine Clean Energy Venture (WCEV) project, was developed in Aspen Plus v.10. The flue gas flow rate used in the process was 12.43 kg/s (at 353.15 K and 101.33 kPa) and contained 0.0023 and 13.33 mol% of SO 2 and CO 2 , respectively. The overall process includes 5 main units designed to remove all SO 2 and capture more than 90 mol% of CO 2 in the flue gas stream, while producing high-value, salable sodium bicarbonate (NaHCO 3) nanomaterials to offset the total process costs. The hydraulics, mass transfer characteristics, and process performance obtained using Aspen Plus were discussed. Also, the capital expenditure (CAPEX), operating expenditure (OPEX), and Levelized cost of CO 2 capture (LCOC) were calculated to assess the feasibility of this process. The hydraulics in the SO 2 washing and CO 2 capture units showed a pressure drop of 12 and 1 kPa, respectively, and the behaviors of the liquid holdup and normalized packing specific wetted surface area were similar in both units. The gas-side mass transfer coefficients were orders of magnitude greater than the liquid-side mass transfer coefficients. The process was able to capture 2.352 kg/s of CO 2 and produce 4.486 kg/s of valuable NaHCO 3 nanomaterials. Also, the calculated CAPEX, OPEX, and LCOC of the process for a 30-year plant lifetime were ($4,450,552), (233.00 $/h) and (35.49 $/ton of CO 2 captured), respectively. [ABSTRACT FROM AUTHOR]

• A review of commercial and novel physical solvents for pre-combustion CO2 capture. • Review of techno-economic analysis (TEA) studies using physical solvents. • Key assumptions of the TEA studies have been summarized. • Lists areas of improvement for future TEAs for physical solvents. This manuscript reviews the use, development, and economic performance of physical solvents for pre-combustion CO 2 capture from high pressure H 2 rich syngas streams. Commercially available physical solvents are presented, followed by an assessment of the ideal properties that are important for development of novel solvents for CO 2 capture from high-pressure syngas streams. To compare the technical and economic performance of traditional and novel physical solvents, a review of the methods, assumptions and models used in techno-economic analysis (TEA) studies was conducted. It was found that, although some novel solvents show promising technical performance in the laboratory (e.g., high CO 2 absorption capacity and low vapor pressure), other issues (e.g., solvent viscosity and cost) may limit their industrial applications. Process simulations were useful tools for modeling the technical performance of processes using traditional and novel solvents. However, model predictions are most reliable when the methods and correlations used to develop the process simulation are validated with representative experimental data, in particular highly accurate baseline models are required for fair comparison among physical solvents. The key inputs and assumptions in pre-combustion CO 2 capture TEAs have also been summarized. Some studies showed that the promising technical performance of novel physical solvents can be offset by the high and often unknown costs of these solvents. Future development of novel physical solvents for pre-combustion CO 2 capture will benefit from more studies that conduct in-depth techno-economic analysis, specifically with validated process simulations and transparent economic models. [ABSTRACT FROM AUTHOR]

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Congenital muscular torticollis (CMT) is the third most common congenital musculoskeletal anomaly seen in children. It is a condition in which the affected sternocleidomastoid muscle becomes a fibrosed cord with associated shortening of the muscle. This leads to an ipsilateral side tilt of the neck and contralateral rotation of the face and chin to the other side. Apart from surgery various other treatment modalities are used to treat this condition. We present two siblings of Sudanese nationality with manifestation of Congenital Muscular Torticollis, a male child and female child at the age of 12 and 10 years respectively. Both had CMT of the right sternomastoid muscle. Both were delivered normally. They did not undergo any form of physiotherapy or surgical procedure since birth. Because of this neglected circumstances, the facial asymmetry and deformity were severe. Both the siblings were operated in our hospital with satisfactory result on follow up. Management for CMT starts during the early infancy and physiotherapy is the main treatment for this condition. But some of these CMT children may need surgical intervention to prevent further deterioration of cranial deformity and facial asymmetry. If these children are neglected and present later in life, they will have severe facial deformity with its associated sequelae. These patients are usually managed by other specialities worldwide. But awareness of these conditions is required among paediatric surgeons, as some of these children may be referred to them for treatment. In our case report we have also described various other modalities of treatment for this condition. [ABSTRACT FROM AUTHOR]

Abstract: Lack of food composition data, recipe information and portion sizes for ethnic foods are commonly reported problems for dietary assessment of ethnic minority groups. One of the main aims of this study was to use food composition data to validate portion sizes, identify important sources of nutrients and describe the characteristics of the South Asian diet. The top five ethnic foods containing highest levels of selected nutrients were lamb balti (3mg/100g iron), lamb kebab (3.2mg/100g zinc), mixed dhal (62μg/100g folate), fish curry (1.4μg/100g vitamin D), ghee (968μg/100g retinol) and toor dhal (9.1g/100g dietary fibre). Typical adult South Asian diets included traditional cereals (chapatti, rice and paratha) and low consumption of meat dishes; with vegetable curries contributing most towards energy intake. A higher consumption of full fat milk and fruit juices by toddlers and school children were observed when compared with the National Diet and Nutrition Survey of the UK. [Copyright &y& Elsevier]

Statement of problem. Flexural and shear strength between ZrO2 cores and veneering porcelains require investigation to facilitate clinical use.Purpose. The purpose of this study was to assess the strength of ZrO2 and a high-noble alloy with corresponding porcelains.Material and methods. Forty rectanglar (12 × 10 × 3 mm) and 20 cylindrical (5 × 5 mm) specimens of ZrO2 (Lava) and high-noble alloy (Olympia) were fabricated for 4-point flexural testing and shear testing. IPS d.SIGN veneering porcelain for high-noble alloy and Lava Ceram, 2 mm thick, were fired, joining the 2 corresponding rectangles of high-noble alloy and ZrO2 to create flexural test specimens. The same types of veneering porcelains, 3 mm in thickness, were fired on 1 side of the corresponding high-noble alloy and ZrO2 cylinders to produce shear specimens. The flexural and shear specimens were divided into 4 groups (n=10); metal ceramic and ZrO2 with and without thermal cycling. Thermal cycling was performed at 5°C and 55°C for 5000 cycles with a 20-second dwell time. Flexural and shear tests were performed using a universal testing machine. Fractures were characterized using a stereomicroscope and SEM. Data were analyzed with a 1-way ANOVA and Tukey HSD post hoc test (alpha=.05).Results. The ANOVA revealed a significant difference among flexural groups (P=.008) and among shear groups (P<.001). In flexure, the Tukey HSD post hoc test revealed a significant difference (P=.005) between metal ceramic thermal cycled and ZrO2 thermal cycled groups, with a higher value of 91.01 (22.33) MPa for the metal ceramic group. In shear, the Tukey HSD post hoc test revealed a significant difference between metal ceramic and ZrO2 groups, with a higher value of 82.00 (22.49) MPa for the metal ceramic group. Thermal cycling did not have a significant effect on flexure or shear strength. ZrO2 specimens failed cohesively within the veneering porcelain.Conclusions. There were no significant differences among the groups in flexure, except between thermal cycled metal ceramic and ZrO2 groups. There was a significant difference between the metal ceramic and ZrO2 groups in shear. Thermal cycling did not have a clear effect among different groups in both tests. [ABSTRACT FROM AUTHOR]

Abstract: Primary healing by accurate apposition is considered the ideal for epithelial wounds, and intestinal anastomoses should be no different. However, most anastomotic techniques do not aspire to accurate realignment and consequently depend on secondary healing. Most intestinal anastomoses heal uneventfully because of the relatively profuse blood supply of the bowel and the fact that the process of healing is hidden within the abdomen. Intestinal anastomoses heal in a series of overlapping phases: [•] lag phase (days 0–4), in which the acute inflammatory response clears the wound of debris [•] phase of fibroplasia (days 3–14), in which fibroblasts proliferate and immature collagen is laid down [•] maturation phase (day 10 onwards), in which collagen remodels. Intestinal anastomoses have little intrinsic resistance to distension and longitudinal distraction is weak until collagen deposition is established. Extrinsic support is required during the lag phase to maintain tissue continuity. The surgeon''s role is to provide support (usually by inserting sutures or staples), and to ensure optimal conditions for subsequent healing. Although anastomotic technique is the single most important determinant of outcome, a number of other factors affect healing (Figure 1); if these combine to make the risk of anastomotic failure high, the wisdom of performing an anastomosis should be questioned. [Copyright &y& Elsevier]

• Aspen Plus was used to perform techno-economic analysis of a CO 2 capture process in seven different power plants with capacities ranging from 54 to 543 MW. • Four physical solvents (polyethyleneglycol polydimethyl siloxane, PEGPDMS-1 and PEGPDMS-3, and ionic liquids (ILs) [bmim][Tf 2 N] and [emim][Tf 2 N]) were employed for CO 2 capture from a typical sulfur-free shifted fuel gas streams under high pressure (5.14 MPa) in a wide range of temperature from 0 to 50 °C. • The CO 2 capture process included a countercurrent packed-bed absorber and three flash drums for solvent regeneration using the pressure-swing option. • Increasing the power plant capacity decreased LCOC of the CO 2 capture process. • The OPEX contribution to the LCOC was greater than the that of the CAPEX. Recently, there has been a renewed focus in the gasification research community on the development of small-scale modular gasifiers that can take advantage of local solid feedstocks, and modular-scale synthesis reactors, which can generate local fuels, chemicals, and fertilizers. To fully realize the benefits of modular-scale systems, however, it is crucial for the cost of the required CO 2 capture to remain low, even at reduced flow rates compared with large-scale IGCC-CCS power plants. In this work, the CO 2 capture process in seven pre-combustion power plant with capacities ranging from 54 to 543 MW was modeled using Aspen Plus v8.8. Four physical solvents (PEGPDMS-1, PEGPDMS-3, [bmim][Tf 2 N], and [emim][Tf 2 N]) were used to capture CO 2 from a typical sulfur-free fuel gas streams in a countercurrent packed-bed absorber. The experimental solubilities of the fuel gas components in the solvents were modeled using the PC-SAFT Equation-of-State. For each power plant capacity, the absorber flooding was checked for all solvents under the operating conditions used. The simulation results showed that increasing power plant capacity from 54 to 543 MW increased the operating expenditure (OPEX) from 2.6 to 30 MM$/year and the capital expenditure (CAPEX) from 10 to 58 MM$. On the other hand, increasing power plant capacity decreased the OPEX and CAPEX expressed in $/ton CO 2 captured, reducing the levelized cost of the CO 2 capture (LCOC) of the process from 12.50 to 7.58 $/ton CO 2 captured, which was attributed to the increased tonnage of the CO 2 removed [ABSTRACT FROM AUTHOR]

• Aspen Plus v8.8 was used to perform techno-economic analysis (TEA) of a CO 2 capture process from a typical fuel gas stream in a 543-MW pre-combustion power plant. • Five physical solvents (Selexol, PEGPDMS-1, NMP, [aPy][Tf2N] and [hmim][Tf2N]) and two packings, Mellapak 250Y and IMTP50, were used in the simulation. • The Levelized costs of CO 2 captured (LCOC) were calculated. • Mellapak 250Y exhibited lower LCOC values than those when using IMTP50 for the five solvents under all conditions employed. • The CO 2 capture process carried out at low temperatures showed lower LCOC values than those at higher temperatures. • Comparing the lowest LCOC values for the five solvents, the hydrophobic PEGPDMS-1 solvent was the most promising one. Aspen Plus v8.8 was used to perform techno-economic analysis (TEA) of a CO 2 capture process from a typical fuel gas stream in a 543-MW pre-combustion power plant using five different physical solvents (Selexol, PEGPDMS-1, NMP, [aPy][Tf 2 N] and [hmim][Tf 2 N]). The process included a countercurrent packed-bed absorber operating under high-pressure over a wide range of temperatures and three pressure-swing flash drums for solvent regeneration. Two packings, Mellapak 250Y and IMTP50, were used and the Levelized costs of CO 2 captured (LCOC) were calculated. The simulation results indicated that using Mellapak 250Y exhibited lower LCOC values than those when using IMTP50 for the five solvents under all conditions used as it offered better mass transfer. The CO 2 capture process carried out at low temperatures showed lower LCOC values than those at higher temperatures due to the increased CO 2 solubility in the solvents at lower temperatures, requiring smaller absorber diameter and lower solvent circulation rates, which offset the cooling requirements. Comparing the lowest LCOC values for the five solvents, the hydrophobic PEGPDMS-1 solvent was the most promising one compared to the other four solvents, due to its lowest capital and operating costs and noncorrosive, which enabled using less expensive materials for the process equipment. [ABSTRACT FROM AUTHOR]

[Display omitted] • HYSYS simulation of 2 modular processes: Fischer-Tropsch and Direct CH 4 to Methanol. • Techno-economic assessment was performed comparing the two processes. • Effect of tailgas recycle ratio and water integration on F-T process were studied. • Effect of methane recycle on the performance of the DMTM were studied. • Energy and performance metrics and benchmarks were identified. The aim of this study is to perform a techno-economic assessment of the Fischer-Tropsch synthesis (FTS) process in a microchannel reactor (MCR) to produce clean syncrude, and the Direct Methane to Methanol (DMTM) process in a compact plant footprint. The operational and economic performances of the two processes were modeled using the Aspen HYSYS v7.2. The operational performance parameters include products yield and the economic performance parameters include net present value (NPV), payback period (PBP) and internal rate of return (IRR). In addition, the effects of tailgas recycle ratios and water integration on the performances of the FTS process and the effect of methane recycle ratios on the performances of the DMTM were investigated. The simulation results showed that the unit cost of the DMTM process was sensitive to the methane recycle ratio, however, that of the FTS in MCR was less sensitive to the tailgas recycle ratios. In order to maintain an IRR > 10 %, the tail gas recycle ratio of the FTS in MCR had to be greater than 8 % and 30 %, at CO conversions of 80 % and 72 %, respectively, whereas in the DMTM process, a minimum methane recycle ratio of 60 % was required to achieve any profitability. In addition, the DMTM process appeared to have significantly higher net energy requirements per product yield when compared with those of the FTS in MCR process; however, both processes had higher energy requirements than those of conventional GTL technologies. [ABSTRACT FROM AUTHOR]