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Background Little is known about the effects of secondhand marijuana smoke on children. We aimed to determine caregiver marijuana use prevalence and evaluate any association between secondhand marijuana smoke, childhood emergency department (ED) or urgent care (UC) visitation, and several tobacco-related illnesses: otitis media, viral respiratory infections (VRIs), and asthma exacerbations. Methods This study was a cross-sectional, convenience sample survey of 1500 subjects presenting to a pediatric ED. The inclusion criteria were as follows: caregivers aged 21-85 years, English- or Spanish-speaking. The exclusion criteria were as follows: children who were critically ill, medically complex, over 11 years old, or using medical marijuana. Results Of 1500 caregivers, 158 (10.5%) reported smoking marijuana and 294 (19.6%) reported smoking tobacco. Using negative-binomial regression, we estimated rates of reported ED/UC visits and specific illnesses among children with marijuana exposure and those with tobacco exposure, compared to unexposed children. Caregivers who used marijuana reported an increased rate of VRIs in their children (1.31 episodes/year) compared to caregivers with no marijuana use (1.04 episodes/year) (p = 0.02). Conclusions Our cohort did not report any difference with ED/UC visits, otitis media episodes, or asthma exacerbations, regardless of smoke exposure. However, caregivers of children with secondhand marijuana smoke exposure reported increased VRIs compared to children with no smoke exposure. Impact Approximately 10% of caregivers in our study were regular users of marijuana. Prior studies have shown that secondhand tobacco smoke exposure is associated with negative health outcomes in children, including increased ED utilization and respiratory illnesses. Prior studies have shown primary marijuana use is linked to negative health outcomes in adults and adolescents, including increased ED utilization and respiratory illnesses. Our study reveals an association between secondhand marijuana smoke exposure and increased VRIs in children. Our study did not find an association between secondhand marijuana smoke exposure and increased ED or UC visitation in children.

BACKGROUND African horse sickness (AHS) is a devastating viral disease of equids that was first recorded in 1327. Currently, prevention and control of the disease are based on attenuated vaccines and midge control. It has been shown that attenuated Orbivirus vaccines are not always safe as they may reverse to virulence. OBJECTIVES In the Emirate of Dubai, a vaccination experiment was carried out with an inactivated AHS vaccine produced at the Central Veterinary Research Laboratory (CVRL), Dubai, UAE to investigate the humoral antibody response of AHS-naive horses to this vaccine. Our vaccination experiment was performed to establish an AHS vaccine bank in the UAE to protect horses from the disease in case of an outbreak. Therefore, CVRL established an inactivated AHS vaccine containing all nine serotypes which induce high neutralising antibodies. STUDY DESIGN A total of 10 horses kept in a desert isolation area were subcutaneously and intramuscularly vaccinated with an inactivated vaccine containing all nine AHS serotypes previously isolated from Kenyan horse fatalities. Primary immunisation was followed by two booster immunisations 4 weeks and 6 months apart. After 13 months, an annual booster was administered. METHODS Blood samples were regularly withdrawn for ELISA and virus neutralisation testing. Additionally, EDTA blood was tested every second day for 14 days post each vaccination for the presence of AHS virus or its RNA. RESULTS Results show that ELISA and virus neutralising antibodies appeared after the first booster, declined after 4-6 months and therefore three vaccinations and an annual vaccination are necessary to achieve high protective virus neutralising antibodies. MAIN LIMITATIONS No challenge infection was carried out due to the lack of a safe facility in the UAE. CONCLUSION Before more advanced AHS vaccines become a reality, inactivated vaccines containing all nine serotypes should be used as they produce high ELISA and neutralising antibodies.

Introduction ‘Do not attempt cardiopulmonary resuscitation’ (DNACPR) documentation is essential to communicate decisions regarding ceilings of care for patients to the clinical team. Patients admitted to hospital with a fractured neck of femur (#NOF) are often elderly with multiple comorbidities, and so robust and clear anticipatory care plans are especially indicated. Method All patients admitted to a large district general hospital in Scotland with a #NOF over a three-week period between 23/10/2020 and 12/11/2020 were identified prospectively and included in this audit. Patients’ demographic information, DNACPR status and the quality of their DNACPR documentation was recorded. Results 20 patients (85% Female, 15% Male) were identified and included. Median ASA grade was 3, with 77.8% of patients ASA grade 3 or 4. 63.2% of patients had DNACPR documentation in place, all of which were ASA grade 3 or above. Most DNACPR documentation had patient information clearly identifiable (91.7%), was completed preoperatively (90.9%), and involved either the patient or appropriate relative or power of attorney (91.6%). However, only 75% of patients’ documentation had the rationale for the DNACPR decision documented and only 25% of DNACPR decisions were reviewed by a senior clinician within 72 hours. No DNACPR decisions were documented as having been communicated to the wider healthcare team. Conclusions DNACPR documentation is a crucial for anticipatory care planning in #NOF patients. This audit shows improvement is needed in documenting whether decisions have been reviewed by senior clinicians, and if they have been communicated to the wider healthcare team.

OBJECTIVE We sought to measure trends in evaluation and management of children with simple febrile seizures (SFSs) before and after the American Academy of Pediatrics updated guidelines published in 2011. METHODS In this retrospective, cross-sectional analysis, we used the Pediatric Health Information System database comprising 49 tertiary care pediatric hospitals in the United States from 2005 to 2019. We included children aged 6 to 60 months with an emergency department visit for first SFS identified using codes from the International Classification of Diseases, Ninth Revision, and International Classification of Diseases 10th Revision. RESULTS We identified 142 121 children (median age 21 months, 42.4% female) with an emergency department visit for SFS. A total of 49 668 (35.0%) children presented before and 92 453 (65.1%) after the guideline. The rate of lumbar puncture for all ages declined from 11.6% (95% confidence interval [CI], 10.8% to 12.4%) in 2005 to 0.6% (95% CI, 0.5% to 0.8%) in 2019 (P < .001). Similar reductions were noted in rates of head computed tomography (10.6% to 1.6%; P < .001), complete blood cell count (38.8% to 10.9%; P < .001), hospital admission (19.2% to 5.2%; P < .001), and mean costs ($1523 to $601; P < .001). Reductions in all outcomes began before, and continued after, the publication of the American Academy of Pediatrics guideline. There was no significant change in delayed diagnosis of bacterial meningitis (preperiod 2 of 49 668 [0.0040%; 95% CI, 0.00049% to 0.015%], postperiod 3 of 92 453 [0.0032%; 95% CI, 0.00066% to 0.0094%]; P = .99). CONCLUSIONS Diagnostic testing, hospital admission, and costs decreased over the study period, without a concomitant increase in delayed diagnosis of bacterial meningitis. These data suggest most children with SFSs can be safely managed without lumber puncture or other diagnostic testing.

Management of patients with single ventricle physiology after surgical palliation is challenging. Arginine vasopressin has gained popularity in recent years as a non-catecholamine vasoactive medication due to its unique properties. However, data regarding its use in the pediatric population is limited. Therefore, we designed a survey to explore whether and how clinicians use this medication in intensive care units for the postoperative management of single ventricle patients. This international survey aimed to assess usage, practices, and concepts related to arginine vasopressin in pediatric intensive care units worldwide. Directors of pediatric intensive care units who are members of the following international professional societies: European Society of Pediatric Neonatal Intensive Care, Association for European Pediatric and Congenital Cardiology, and Pediatric Cardiac Intensive Care Society were invited to participate in this survey. Of the 62 intensive care unit directors who responded, nearly half use arginine vasopressin in the postoperative management of neonatal single ventricle patients, and 90% also use the drug in subsequent surgical palliation. The primary indications are vasoplegia, hemodynamic instability, and refractory shock, although it is still considered a second-line medication. Conceptual benefits include improved hemodynamics and end-organ perfusion and decreased incidence of low cardiac output syndrome. Those practitioners who do not use arginine vasopressin cite lack of availability, fear of potential adverse effects, unclear indication for use, and lack of evidence suggesting improved outcomes. Both users and non-users described increased myocardial afterload and extreme vasoconstriction as potential disadvantages of the medication. Despite the lack of conclusive data demonstrating enhanced clinical outcomes, our study found arginine vasopressin is used widely in the care of infants and children with single ventricle physiology after the first stage and subsequent palliative surgeries. While many intensive care units use this medication, few had protocols, offering an area for further growth and development.

The main motto of this paper is to review the importance of image retrieval as per the different form of requirements from the user depends on the given content. The requirement varies from one to other in terms of content. The content in an image could have many interpretations from the different ends. The interpretation used to give priority to retrieve images based on colour or to retrieve images based on shape or to retrieve images based on size too. All such possible interpretations are reviewed in this paper which would result to have a proper choice in choosing the concern method among the varieties towards our interest in fetching the analysis as per our necessity. Also this survey focussed on the following agendas in the form of minimising or throw away the irrelevant form of images, using parallel retrieval system to handle images of high dimensional cum complex features, and also to perform the image retrieval in an unsupervised fashion.

New pathogenic virus outbreaks with increasing regularity are leading us to explore novel approaches, which will reduce the reliance on a time-consuming vaccine mode to halt the strike. The requirement is to find a universal approach to disarm any new and as yet unknown viruses as they appear. A promising approach could be by targeting the lipids membranes, common to all viruses and bacteria. The ongoing pandemic of the SARS-coronavirus 2 (SARS-CoV-2) has restated the importance of interactions between components of the host cell plasma membrane and the virus envelope as a critical mechanism of infection. Metadichol ®, a nano lipid emulsion, has been examined and shown to be a strong candidate to help stop the proliferation of the SARS-COV-2.Naturally derived substances, such as Cyclodextrin and sterols, reduce the infectivity of various types of viruses, including the coronavirus like SARS-COV-2, by modifying the lipid-dependent attachment to human host cells. SARS-COV-2 uses the receptor ACE2 for entry and the serine protease TMPRSS2 for S protein priming. Metadichol®, a nano lipid formulation of long-chain alcohols, has been shown to inhibit TMPRSS2 (EC50 of 96 ng/ml). Compared to the inhibitor Camostat Mesylate (26000 ng/ml), it is 270 times more potent. Also, Metadichol ® is a moderate inhibitor of ACE2 @ 31 µg/ml. In the SARS-COV2 anti-viral assay using CACO2 cells, it has an EC90 of 0.16 µg/ml.

Background African horse sickness (AHS) is a serious viral disease of equids resulting in the deaths of many equids in sub-Saharan Africa that has been recognized for centuries. This has significant economic impact on the horse industry, despite the good husbandry practices. Currently, prevention and control of the disease is based on administration of live attenuated vaccines and control of the arthropod vectors. Results A total of 29 horses in 2 groups, were vaccinated. Eighteen horses in Group 1 were further divided into 9 subgroups of 2 horses each, were individually immunised with one of 1 to 9 AHS serotypes, respectively. The eleven horses of Group 2 were immunised with all 9 serotypes simultaneously with 2 different vaccinations containing 5 serotypes (1, 4, 7–9) and 4 serotypes (2, 3, 5, 6) respectively. The duration of this study was 12 months. Blood samples were periodically withdrawn for serum antibody tests using ELISA and VNT and for 2 weeks after each vaccination for PCR and virus isolation. After the booster vaccination, these 27 horses seroconverted, however 2 horses responded poorly as measured by ELISA. In Group 1 ELISA and VN antibodies declined between 5 to 7 months post vaccination (pv). Twelve months later, the antibody levels in most of the horses decreased to the seronegative range until the annual booster where all horses again seroconverted strongly. In Group 2, ELISA antibodies were positive after the first booster and VN antibodies started to appear for some serotypes after primary vaccination. After booster vaccination, VN antibodies increased in a different pattern for each serotype. Antibodies remained high for 12 months and increased strongly after the annual booster in 78% of the horses. PCR and virus isolation results remained negative. Conclusions Horses vaccinated with single serotypes need a booster after 6 months and simultaneously immunised horses after 12 months. Due to the non-availability of a facility in the UAE, no challenge infection could be carried out.

Our investigation has shown that multiple vaccinations with inactivated African horse sickness (AHS) vaccines containing all 9 serotypes and produced at the Central Veterinary Research Laboratory in Dubai, UAE, protect horses from AHS. However, the immunization did not prevent African horse sickness fever (AHSF) in approximately 10% of the vaccinated horses despite high enzyme-linked immunosorbent assay and virus neutralizing antibodies. African horse sickness fever is a very mild form of AHS with similar clinical signs. From all 6 horses which had developed AHSF, no virus was isolated from EDTA blood withdrawn during the acute phase of infection. Despite high neutralizing antibodies, serotype 9 was detected by polymerase chain reaction in 4 of them. All 6 horses recovered within 72 hours, after they developed mild clinical signs of AHS.

The energy-efficiency aspects and cost-saving features of various radiant cooling systems have been reported in many previous studies. However, the available literature on the analysis of initial investment and maintenance costs is scanty, especially for the slab-integrated one. A field survey was carried out in a green building in Malaysia that was installed with a combined radiant-convective system. The performance of this multi-floor radiant slab cooling system was studied and the energy conservation potential was evaluated by comparing the data obtained from the building energy management system (BEMS) with the estimated energy consumption of a conventional convective air system. Also, price quotations and service maintenance contracts were obtained for a complete cost-benefit evaluation of both systems. It was found that the radiant slab cooling system was able to reduce 34% of the energy consumption compared to the conventional variable air volume system while providing the same level of air conditioning. Despite its higher initial cost, the payback period for the investment cost is about 2.5 years. These findings are particularly useful for design engineers in the tropics to consider an alternative cooling technology for large office buildings which is more energy efficient and cost effective.

Background Currently, the standard of care for treating severe hemorrhage in a military setting is Combat Gauze (CG). Previous work has shown that hydrophobically modified chitosan (hm-C) has significant hemostatic capability relative to its native chitosan counterpart. This work aims to evaluate gauze coated in hm-C relative to CG as well as ChitoGauze (ChG) in a lethal in vivo hemorrhage model. Methods Twelve Yorkshire swine were randomized to receive either hm-C gauze ( n = 4), ChG ( n = 4), or CG ( n = 4). A standard hemorrhage model was used in which animals underwent a splenectomy before a 6-mm punch arterial puncture of the femoral artery. Thirty seconds of free bleeding was allowed before dressings were applied and compressed for 3 min. Baseline mean arterial pressure was preserved via fluid resuscitation. Experiments were conducted for 3 h after which any surviving animal was euthanized. Results hm-C gauze was found to be at least equivalent to both CG and ChG in terms of overall survival (100% versus 75%), number of dressing used (6 versus 7), and duration of hemostasis (3 h versus 2.25 h). Total post-treatment blood loss was lower in the hm-C gauze treatment group (4.7 mL/kg) when compared to CG (13.4 mL/kg) and ChG (12.1 mL/kg) groups. Conclusions hm-C gauze outperformed both CG and ChG in a lethal hemorrhage model but without statistical significance for key endpoints. Future comparison of hm-C gauze to CG and ChG will be performed on a hypothermic, coagulopathic model that should allow for outcome significance to be differentiated under small treatment groups.

A 53-year-old woman is admitted with a serum creatinine of 16 mg/dl. Seven months earlier, she was diagnosed with heart failure and started on several medications, including Hydralazine. Laboratory studies revealed the presence of dual Anti-Neutrophil Cytoplasmic Antibodies (anti-MPO and anti-PR3), anti-nuclear and anti-histone antibodies. The clinical diagnosis was Drug-Induced ANCA Vasculitis (DIAV). Kidney histology, however, did not reveal crescents, but showed characteristic features of Alport’s syndrome.

(1) Background: As of 13 December 2020, Afghanistan reported around 48,952 confirmed COVID-19 cases and 1960 deaths. Lack of knowledge and perceptions among healthcare workers (HCWs) can pose challenges to disease control. Therefore, targeted, timely assessment of knowledge and perceptions are needed to address practices that might hinder efforts to stop the spreading of COVID-19 in Afghanistan. This study aimed to assess COVID-19-related knowledge, perceptions, and risk prevention practices (KPP) among frontline HCWs in Afghanistan, (2) Methods: A cross-sectional study was conducted with the support of field teams who were deployed in Afghanistan, surveyed from 14 to 22 April 2020 in eight provinces in Afghanistan with varying cumulative incidence of COVID-19 cases. A 28-item KPP survey instrument was adapted from other internationally validated questionnaires related to COVID-19. (3) Results: The survey was conducted among 213 frontline HCWs engaged in screening and treating COVID-19 patients. Survey results indicated that basic awareness of COVID-19 was 100% across all the participants. Knowledge and understanding of COVID-19 transmission, symptoms, incubation period and complications associated with COVID-19 are comprehensive and high (&gt, 90%), except available treatment for COVID-19 (84%). HCWs&rsquo, perceptions towards the prevention and control of COVID-19 were positive. However, only 63% believed that the use of N-95 face masks and disposable and fluid-resistant gowns (76%) could prevent COVID-19 transmission. This survey showed high knowledge and positive perception (72%), and only 48% of frontline HCWs had shown risk prevention practices. Addressing their perceptions and placing additional focus on practices across all health facilities is recommended as a preparedness measure.

There has been an increase in the potential use of wireless devices in healthcare domain for a variety of reasons. The most commonly used device is the cellular phone which emits strong electromagnetic energy affects the functioning of the vital medical equipment such as ventilators, ECG monitors, cardiac monitors, and defibrillators. This prompted the healthcare concerns to restrict the use of these phones in the in the proximity of critical and non-critical care medical equipment. Due to the developments made in the design of medical equipment to comply with the EMC standards, the restriction had been slowly laid off. Still, the researchers are concerned about the electromagnetic interference with medical devices by cellular phones in the healthcare domain and recommend for conducting continuous research to study their interaction with medical equipment. This paper overviews the certain investigations carried out in the recent years to study the electromagnetic interference between medical devices and 2G/3G/4G LTE cellular phones. During the initial development of cellular phones, the 2G cellular phones had caused more interference that affects the function and operation of some medical devices. The possibility of interference from 3G cellular phones with medical devices is considerably lower than the 2G phones, but still exist. Furthermore, almost all of the 4G phones have little to no interference with the medical devices. Currently, with the development of the medical devices industry, the current medical devices are designed to operate safely under any conditions of usage. Finally, a careful analysis would require statistics on the frequency of adverse events across the healthcare system, which apparently do not exist. Open Access funded by Ministry of Science & Technology, Egypt

Background A novel injectable expanding foam based on hydrophobically modified chitosan (HM-CS) was developed to improve hemostasis during surgeries. HM-CS is an amphiphilic derivative of the natural biopolymer chitosan (CS); HM-CS has been shown to improve the natural hemostatic characteristics of CS, but its internal safety has not been systematically evaluated. The goal of this study was to compare the long-term in vivo safety of HM-CS relative to a commonly used fibrin sealant (FS), TISSEEL (Baxter). Methods Sixty-four Sprague–Dawley rats (275-325 g obtained from Charles River Laboratories) were randomly assigned to control (n = 16) or experimental (n = 48) groups. Samples of the test materials (HM-CS [n = 16], CS [n = 16], and FS [n = 16]) applied to a nonlethal liver excision (0.4 ± 0.3 g of the medial lobe) in rats were left inside the abdomen to degrade. Animals were observed daily for signs of morbidity and mortality. Surviving animals were sacrificed at 1 and 6 wk; the explanted injury sites were microscopically assessed. Results All animals (64/64) survived both the 1- and 6-wk time points without signs of morbidity. Histological examination showed a comparable pattern of degradation for the various test materials. FS remnants and significant adhesions to neighboring tissues were observed at 6 wk. Residual CS and HM-CS were observed at the 6 wk with fatty deposits at the site of injury. Minimal adhesions were observed for CS and HM-CS. Conclusions The internal safety observed in the HM-CS test group after abdominal implantation indicates that injectable HM-CS expanding foam may be an appropriate internal use hemostatic candidate.

Fluidized beds are widely used in a variety of industrial processes. The air distributor being an integral part of the fluidized bed, the air flow characteristic through it is of great importance as far as the design and working of it is concerned. Inappropriate design will lead to an incomplete fluidization and improper mixing of the air and bed particles. The current study was carried out to investigate the flow characteristics and predict non-uniformity in flow through the annular distributor of a Swirling Fluidized Bed and its variation with various aspects of the distributor like blade overlap angle and blade inclination. In this study, the commercial CFD package FLUENT 6.3 was used for analysis. The velocity and pressure profiles for various blade designs were investigated at the distributor outlet based on several operating variables including air inlet velocities, blade overlap angles (9o, 12o, 15o, and 18o), blade inclinations (10oand 15o), along with variations in the opening between the distributor blades. The most significant finding of this work is that the fluid tends to flow through a path with least resistance. The flow path with the largest cross section area and shortest path length has been identified and explains the velocity profile at blade exit.

Various diffuser types characterized by the geometry are introduced in the flow line to recover the energy. A 3-D turning diffuser is a type of diffuser that its cross-section diffuses in all 3 directions of axes, i.e. x, y and z. In terms of applicability, a 3-D turning diffuser offers compactness and more outlet-inlet configurations over a 2-D turning diffuser. However, the flow within a 3-D turning diffuser is expected to be more complex which susceptible to excessive losses. As yet there is no established guideline that can be referred to choose a 3-D turning diffuser with an optimum performance. This paper aims to investigate the effects of varying inflow Reynolds number (Rein) on the performance of 3-D turning diffuser with 90o angle of turn. The outlet pressure recovery (Cp) and flow uniformity (σu) of 3-D turning diffuser with an area ratio (AR = 2.16) and outlet-inlet configurations (W2/W1 = 1.44, X2/X1 = 1.5), operated at inflow Reynolds number of Rein = 5.786E+04 - 1.775E+05 have been experimentally tested. The experimental rig was developed by incorporating several features of low subsonic wind tunnel. This was mainly to produce a perfect fully developed and uniform flow entering diffuser. Particle image velocimetry (PIV) was used to examine the flow quality, and a digital manometer was used to measure the average static pressure of the inlet and outlet of turning diffuser. There is a promising improvement in terms of flow uniformity when a 3-D turning diffuser is used instead of a 2-D turning diffuser with the same AR. An unexpected trend found with a drop of pressure recovery at maximum operating condition of Rein = 1.775E+05 shall require further investigations. The results obtained from this study will be in future used to validate the numerical codes. Upon successful validation, several other configurations will be numerically tested in order to establish the guidelines in the form of mathematical models.

Objectives Lumbar punctures (LPs) are commonly performed in febrile infants to evaluate for meningitis, and local anesthesia increases the likelihood of LP success. Traditional methods of local anesthesia require injection that may be painful or topical application that is not effective immediately. Recent advances in needle-free jet injection may offer a rapid alternative to these modalities. We compared a needle-free jet-injection system (J-Tip) with 1% buffered lidocaine to topical anesthetic (TA) cream for local anesthesia in infant LPs. Methods This was a single-center randomized double-blind trial of J-Tip versus TA for infant LPs in an urban tertiary care children's hospital emergency department. A computer randomization model was used to allocate patients to either intervention. Patients aged 0 to 4 months were randomized to J-Tip syringe containing 1% lidocaine and a placebo TA cream or J-Tip syringe containing saline and TA. The primary outcome was the difference between the Neonatal Faces Coding Scale (NFCS) before the procedure and during LP needle insertion. Secondary outcomes included changes in heart rate (HR) and NFCS throughout the procedure, difficulty with LP, number of LP attempts, provider impression of pain control, additional use of lidocaine, skin changes at LP site, and LP success. Results We enrolled 66 subjects; 32 were randomized to J-Tip with lidocaine and 34 to EMLA. Six participants were excluded from the final analysis due to age greater than 4 months, and the remaining 58 were analyzed in their respective groups (32 J-Tip, 34 TA). There was no difference detected in NFCS between the two treatment groups before the procedure and during needle insertion for the LP (p = 0.58, p = 0.37). Neither HR nor NCFS differed among the groups throughout the procedure. Median perception of pain control by the provider and the need for additional lidocaine were comparable across groups. LPs performed with a J-Tip were twice as likely to be successful compared to those performed using TA (relative risk = 2.0; 95% confidence interval = 1.01-3.93; p = 0.04) with no difference in level of training or number of prior LPs performed by providers. Conclusions In a randomized controlled trial of two modalities for local anesthesia in infant LPs, J-Tip was not superior to TA cream as measured by pain control or physiologic changes. Infant LPs performed with J-Tip were twice as likely to be successful.

The primary aim of this paper is to assess the performance of k-e turbulence models by means of adopting various near wall treatments to simulate the flow within a sharp 90° 3-D turning diffuser. The Computational Fluid Dynamics (CFD) results were validated quantitatively and qualitatively with the experimental results (using Particle Image Velocimetry (PIV)). The standard k-e adopted curvature correction and enhanced wall treatment of y+ ≈ 1.2–1.7 appears as the best validated model, producing minimal deviation with comparable flow structures to the experimental cases.

This paper reports the effects of a longitudinal plate attached at the backward stagnation point of a bank of tubes on the local static pressure distribution. The longitudinal plate is termed as an integral wake splitter. Investigations on hydrodynamic characteristics of tube banks with integral wake splitter were carried out in cross flow of air in a rectangular duct at a Reynolds number of 15950. The integral wake splitter length-to-tube-diameter ratios studied were 0.5, 1.0, 1.5 and 2.0. The tube bank consisting of 12 rows and 3 tubes per row in equilateral triangular arrangement with a transverse pitch to diameter ratio, a = 2. The results obtained were compared to the experimental data of Seri et al. (2014). It is observed that the addition of the integral wake splitter reduces the overall pressure drop.

In this whitepaper, the Manufacturing Technical Committee of the Product Quality Research Institute provides information on the common, best practices in use today in the development of high-quality chemistry, manufacturing and controls documentation. Important topics reviewed include International Conference on Harmonization, in vitro–in vivo correlation considerations, quality-by-design approaches, process analytical technologies and current scale-up, and process control and validation practices. It is the hope and intent that this whitepaper will engender expanded dialog on this important subject by the pharmaceutical industry and its regulatory bodies.

The small plug loads in the tropical buildings are among the fastest growing sources of energy use. Yet, there are comparatively fewer studies that were focused on the energy efficiency improvement potentials of the office equipment due to its elusive, more diversified and sophisticated nature. This objective of this study is to identify the opportunity for energy efficiency improvement of the frequently used office equipment in a commercial building in Malaysia, by focusing on the occupant behaviour and software power management features. The outcomes show that about 19% of the total energy demand can be reduced if the office equipment not in use are turned off, unplugged or disconnected. This also led to a significant reduction in greenhouse gases emission. This finding is particularly important for good energy demand management, as more and more modern electric appliances are introduced into the local commercial buildings which are contributing to the increase in energy consumption and subsequently, the electric bill.

Turning diffuser is an engineering device that is widely used in the industry to reduce the flow velocity as well as change the direction of the flow. Having a curvature shape causes its performance to decrease in terms of pressure recovery (Cp) and flow uniformity (σu). Therefore, this study presents the work done in designing baffles to be installed in the turning diffuser with ratio of AR=2.16 to improve the flow uniformity and pressure recovery. It also aims to investigate the mechanism of flow structure and pressure recovery in turning diffusers by means of turning baffles. The results with varying inflow Reynolds number (Rein) between 5.786E+04 1.775E+05 have been experimentally tested and compared with previous study. Particle image velocimetry (PIV) was used to determine the flow uniformity. On the other hand, a digital manometer provided the average static pressure of the inlet and outlet of turning diffuser. The best produced pressure recovery of Cp=0.526 were recorded when the system were operated at the highest Reynolds number tested Rein=1.775E+05. This result shows an improvement up to 54.625% deviation from previous study with Cp=0.239. The flow uniformity also shows an improvement of 47.127% deviation from previous study at the same Rein with σu=3.235 as compared to previous study σu=6.12.

Present study involves experimental and numerical work to investigate the effect of integral wake splitter towards the overall performance of cross-flow, circular tube, heat exchanger system. The experimental work was conducted to obtain local distribution of pressure coefficient around plain tube bank of staggered arrangement which was subjected to a cross-flow of air with Reynolds number of 15950. The numerical work consisted of 2-dimensional unsteady numerical simulation which was validated against the experimental data. The validated numerical approach was utilized to simulate cross-flow around similar tube bank but with integral wake splitter of length-to-diameter ratio of 0.5, 1, 1.5 and 2, at Reynolds number between 5000 to 50000. It is concluded that integral wake splitter is able to reduce pressure loss, which in turn reduces power requirement of a blower, which is intended in effort to increase the system efficiency. Splitter which acts as fin may improve the overall performance of the system by enhancing total heat removal via extended surface provided that certain value of fin efficiency is achieved.

3-Dstereoscopic PIV is capable of measuring 3-dimensional velocity components. Itinvolves a very sophisticated routine during setup, calibration, measurementand data processing phases. This paper aims to verify the 3-D stereoscopic PIVmeasurement procedures and to prove that the flow entering thediffuser is a fully developed flow. A diffuser inlet of rectangularcross-section, 130 mm x 50 mm is presently considered. For verification, thevelocities from PIV are compared with the velocities from pitot static probeand theory. The mean velocity obtained using pitot static probe is 2.44 m/s,whereas using PIV is 2.46 m/s. It thus gives the discrepancy of 0.8%. There isalso a good agreement between the mean velocity measured by PIV and theoreticalvalue with the discrepancy of 1.2%. This minor discrepancy is mainly due touncertainties in the experiments such as imperfect matching of coordinatesbetween the probe and laser sheet, unsteadiness of flow, variation in density andless precision in calibration. Basically, the operating procedures of 3-Dstereoscopic PIV have successfully been verified. Nevertheless, the flowentering diffuser is not perfectly developed due to the imperfect joining ductand the abrupt change of inlet cross-section introduced. Therefore, improvementto the existing rig is proposed by means of installing settling chamber withmultiple screens arrangement and contraction cone.

A turning diffuser is often introduced in the flow line to recover the energy losses by converting the kinetic energy to pressure energy. There are two types of turning diffusers, i.e. a 2-D and 3-D diffuser that are commonly defined by their expansion direction. This study aims to investigate the performance of a 2-D and a 3-D turning diffuser with 90o angle of turn and an area ratio, AR=2.16 by means of varying operating conditions. The geometry configurations applied for a 2-D turning diffuser are outlet-inlet configurations, W2/W12-D=2.160, X2/X12-D =1.000 and an inner wall length to an inlet throat width ratio, Lin/W12-D=4.370, whereas for a 3-D turning diffuser, they are W2/W13-D=1.440, X2/X13-D =1.500 and Lin/W13-D=3.970. The operating conditions represented by inflow Reynolds numbers, Rein are varied from 5.786E+04 to 1.775E+05. Particle image velocimetry (PIV) is used to examine the flow quality, and a digital manometer provides the average static pressure at the inlet and outlet of the turning diffuser. A compromise between the maximum permissible pressure recovery and flow uniformity is determined based upon the need. Whenever the flow uniformity being the need it is promising to apply a 3-D turning diffuser for Rein=1.027E+05 - 1.775E+05 and a 2-D turning diffuser for Rein=5.786E+04-6.382E+04. On the other hand, it is viable to opt for a 3-D turning diffuser for Rein=5.786E+04-6.382E+04 and a 2-D turning diffuser for Rein=1.027E+05-1.775E+05 in the case of the outlet pressure recovery being the need. The secondary flow separation takes place prior at 1/2Lin/W1 for a 2-D turning diffuser, whereas approximately at 3/4Lin/W1 for a 3-D turning diffuser.

Although diabetes mellitus (DM) and pancreatic cancer (PC) are intricately linked, a comprehensive review addressing the impact of DM on PC prognosis and surgical outcomes is lacking. PubMed search was performed (1980-2012) using keywords "pancreatic cancer", "diabetes mellitus", "glucose intolerance", "pancreatic resection", "prognosis", and "post-operative outcomes". The search results were analyzed to determine the strength of association between DM and PC and to assess the impact of DM on PC prognosis and postoperative outcomes. Thirty-one studies involving 38,777 patients were identified. Patients with non-insulin-dependent DM have 1.5-2 fold increased relative risk of developing PC. Non-insulin-dependent DM is identified in 25.7% of patients with PC compared to 10.4% age-matched controls (95% confidence interval, 1.5-4.7; P < 0.0001). Patients with PC are more likely to have a diagnosis of new-onset DM than age-matched controls (14.7% vs 2.7%; P < 0.0001). Patients with PC with DM have a significantly lower overall survival than those without DM (14.4 vs 21.7 months; P < 0.001). The presence of DM significantly increases overall postoperative complication rates (45.6% vs 35.6%; P < 0.008). Patients with new-onset non-insulin-dependent DM are at a higher risk of developing PC and have a worse long-term survival and a higher rate of postoperative complications.

A numerical investigation via commercial Computational Fluid Dynamic (CFD) package, FLUENT, was carried out to investigate the aerodynamic characteristics of air flow in a Swirling Fluidized Bed (SFB). The study focused on the distributor blade configurations whereby the effect of number of blades and blade inclination in radial plane were investigated. Twelve configurations were simulated at 30, 45 and 60 blades for four radial inclinations, 0, 10, 13.5 and 15°. Two criterions were taken as performance characteristics to evaluate each configuration namely the uniformity of tangential velocity distribution and pressure drop. High uniformity at the distributor outlet will ensure uniform solid-gas contact in the actual system while low pressure drop is vital to minimize power consumption in the system. From the results, it was evident that the 30 blades with 10E radial inclination of distributor blade in plenum chamber offer the best configuration for actual application.

In practice, it is basically difficult even with controlled measurement environment to acquire a steady, uniform and fully developed flow. The flow entering diffuser was severely distorted despite a sufficient hydrodynamic entrance length already introduced. This was mainly due to the imperfect joining of duct and the abrupt change of the inlet cross-section applied. In this study, several basic features of a low subsonic wind tunnel, i.e. a centrifugal blower with 3-phase inverter, a settling chamber, screens and a contraction cone, are designed and developed for a turning diffuser application in order to improve the flow quality. The flow profiles are examined using Pitot static probe at five measurement points within the range of inflow Reynolds number, Rein= 5.786E+04-1.775E+05. The steady, uniform and fully developed turbulent flow profiles with an average deviation with theory of about 3.5% are obtained. This proves that a good flow quality could be produced by means of incorporating some basic features of a low subsonic wind tunnel to the system.

Swirling fluidized bed (SFB) is one of the recent technologies developed in fluidization to overcome various drawbacks in the conventional fluidized beds, particularly poor lateral mixing and relatively high distributor pressure drop. Though a number of beds operating with similar technique are commercially available, very little has been published on the subject, particularly on the distributor design. The distributor of the SFB is formed by an array of blades which are inclined to the horizontal, with a centre body in the middle of the bed. Air flow investigation was carried out on the empty bed via CFD approach. The study focused on the effects of number of blades and its inclination angle on the flow distribution and pressure drop, so as to arrive at an optimum choice of the distributor design. The findings indicate that higher number of has lower open area which resulted higher jet velocity of air from the distributor. Blade inclination has significant effect on the flow distribution where lower blade inclination produces higher magnitude of tangential velocity that creates intense swirling but at an expense of higher pressure drop. In conclusion, the distributor with 30 blades and 15º inclination was found to meet the design criterion outlined.

This paper presents computational fluid dynamics (CFD) studies to characterize air velocity distribution for various bed configurations in a swirling fluidized bed (SFB). Unlike conventional fluidized beds, a SFB provides radial mixing which is desirable is fluidization. Three velocities components were observed, the tangential velocity, radial velocity and axial velocity. These velocities were created as a result of using annular blade type distributor which mimics the turbine blades. In actual industrial applications, the axial velocity will create fluidization while the tangential velocity provides swirling effect. The presence of radial velocity can be explained as a consequence of centrifugal force generated by the swirling gas. Understanding these velocity distributions will enable optimization of the annular blade distributor design towards a high efficient fluidized bed system.

Alginate is a biocompatible polysaccharide that is commonly used in the pharmaceutical, biomedical, cosmetic, and food industries. Though solid dressings composed of alginate can absorb water and promote wound healing, they are not effective hemostatic materials, particularly against massive hemorrhage. The purpose of this study is to attempt to increase the hemostatic capabilities of alginate by means of hydrophobic modification. Previous studies have illustrated that modifying a different polysaccharide, chitosan, in this way enhances its hemostatic efficacy as well as its adhesion to tissue. Here, it was hypothesized that modifying alginate with hydrophobic groups would demonstrate analogous effects.Fifteen Yorkshire swine were randomized to receive hydrophobically-modified (hm) alginate lyophilized sponges (n=5), unmodified alginate lyophilized sponges (n=5), or standard Kerlix™ gauze dressing (n=5) for hemostatic control. Following a splenectomy, arterial puncture (6mm punch) of the femoral artery was made. Wounds were allowed to freely bleed for 30s, at which time dressings were applied and compressed for 3min in a randomized fashion. Fluid resuscitation was given to preserve the baseline mean arterial pressure. Wounds were monitored for 180min after arterial puncture, and surviving animals were euthanized.Blood loss for the hm-alginate group was significantly less than the two control groups of (1) alginate and (2) Kerlix™ gauze (p=0.0001). Furthermore, 80% of hm-alginate sponges were able to sustain hemostasis for the full 180min, whereas 0% of dressings from the control groups were able to achieve initial hemostasis.Hm-alginate demonstrates a greatly superior efficacy, relative to unmodified alginate and Kerlix™ gauze dressings, in achieving hemostasis from a lethal femoral artery puncture in swine. This is a similar result as has been previously described when performing hydrophobic modification to chitosan. The current study further suggests that hydrophobic modification of a hydrophilic biopolymer backbone can significantly increase the hemostatic capabilities relative to the native biopolymer.

The technique of direct infusions into brain tissue of therapeutic molecules that would otherwise not adequately cross the blood-brain barrier (BBB) continues to be used in clinical trials. As part of our research into understanding the transport of fluids and molecules in brain tissue, we performed infusions of a saline solution of the magnetic resonance (MR) marker Gadodiamide( Omniscan) into porcine brains. We use quantitative concentration measurements of contrast reagents from MR images to both measure the distribution profile of the infusate and to elucidate important determinants of fluid flow during infusions into brain parenchyma. Based on this, and from other MRI data collected during infusion, we give preliminary results for the quantification of the expansion of the volume fraction of the interstitium particularly in white matter regions of brain during infusion-induced edema. We claim this expansion, rather than an anisotropy of fluid conductivity, makes white matter tracts a preferred pathway for flow. We also comment briefly on other determinants that are currently being pursued such as the influence of the cerebrospinal fluid and perivascular spaces that may be elucidated with quantitative tracking of tracer, but which need further studies.

In the context of intraparenchymal delivery of therapeutic agents into brain parenchyma for the purpose of treating serious brain diseases, we present the scientific and medical need for infusion from a single source to cover a large area of the cerebral cortex, which we refer to as 'surface-contoured distributions' (SCD). The designs of two devices suitable for obtaining such SCD's are described, and the results of preliminary experimental studies with prototypes of them are reported. The studies were done in ex vivo samples of mammalian brain tissues, and histological sections of the brains confirmed that we had covered the large surface area desired. Work to test that the infusate penetrates the thickness of the cortex remains for the future.

We present a method for manipulating preselected quantum dots (QDs) with nanometer precision by flow control. The accuracy of this approach scales more favorably with particle size than optical trapping, enabling more precise positioning of nanoscopic particles. We demonstrate the ability to position a single QD in a 100 microm working region to 45 nm accuracy for holding times exceeding one hour and the ability to take active quantum measurements on the dynamically manipulated QD.

Porous volumetric capture elements in microfluidic sensors are advantageous compared to planar capture surfaces due to higher reaction site density and decreased diffusion lengths that can reduce detection limits and total assay time. However a mismatch in refractive indices between the capture matrix and fluid within the porous interstices results in scattering of incident, reflected, or emitted light, significantly reducing the signal for optical detection. Here we demonstrate that perfusion of an index-matching fluid within a porous matrix minimizes scattering, thus enhancing optical signal by enabling the entire capture element volume to be probed. Signal enhancement is demonstrated for both fluorescence and absorbance detection, using porous polymer monoliths in a silica capillary and packed beds of glass beads within thermoplastic microchannels, respectively. Fluorescence signal was improved by a factor of 3.5× when measuring emission from a fluorescent compound attached directly to the polymer monolith, and up to 2.6× for a rapid 10 min direct immunoassay. When combining index matching with a silver enhancement step, a detection limit of 0.1 ng mL(-1) human IgG and a 5 log dynamic range was achieved. The demonstrated technique provides a simple method for enhancing optical sensitivity for a wide range of assays, enabling the full benefits of porous detection elements in miniaturized analytical systems to be realized.

With the rapid growth in the power requirement, the use of renewable resources is very essential to meet consumer power demand and environmental issues. Integration of the fuel cell power system with AC distribution grid using multilevel cascade H bridge inverter for improving the power quality has been analyzed and results presented in this paper. A 13 level cascade H-bridge inverter with minimum number of switches has been designed. The inverter pulses are generated with respect to common connection point Busbar voltage for synchronizing Fuel cell bus to AC grid bus Voltage. The main aim of this paper is to reduce the total harmonic distortions and improve the power quality when Fuel cell power is integrated with AC grid. The above proposed model has been analyzed under various operating conditions and the performance of the model is evaluated using MATLAB SIMULINK software. The Simulink results are evaluated and the effectiveness of the given system established.

September 11 helped India to pursue its own proactive response to terrorism, pushed the United States and Pakistan closer to one another, and served as a catalyst to move diplomatic relations between India and Pakistan forward.

A multichannel reservation-based channel-access protocol is investigated in this paper. The available system bandwidth is divided into distinct frequency channels. Under the protocol, one channel (the control channel) is used to exchange reservation messages and the remaining channels (the traffic channels) are used for information-bearing traffic. The performance of this scheme is compared to that of a single-channel reservation-based protocol. A simple contention-based slotted-Aloha protocol is also considered. Performance results take into account the effects of multiple-access interference on acquisition and packet errors. Results show that the reservation-based approach is advantageous under conditions of high traffic. In addition, a pacing mechanism that mitigates multiple-access interference and promotes fairness is described, and results are presented that demonstrate its effectiveness.

[This abstract is based on the author's abstract.] There was a high defect level (about 6000 ppm) are a plant that makes printed circuit assemblies through the wave soldering process. Because of the high defect level, 100% inspection and much rewo..

This study was conducted to assess the management of gestational trophoblastic diseases (GTN) in a district general hospital in accordance with the RCOG guidelines. A retrospective case notes review over a 5-year period found a total of 23 patients treated in this hospital. The annual incidence of hydatidiform mole was 1.3/1,000 deliveries (3,500 deliveries per annum). Ultrasound scanning diagnosed or suspected GTN in only nine of the 23 cases (39%); six women (26%) were diagnosed as missed miscarriage and another six (26%) were diagnosed as incomplete miscarriage. Eleven patients (48%) were not suspected before histological diagnosis. A total of 16 of the 23 cases (70%) were complete moles and the rest were partial moles; 19 of the 23 (83%) were referred to a specialist centre of which 60% were referred within 1 month. The rest were not documented. Contraceptive advice was documented only in 11 case notes (48%). Women with molar pregnancy should be referred to a specialist centre as early as possible and within 2-4 weeks of histological diagnosis, after appropriate counselling and contraceptive advice.

The Medical Informatics Program at the National University of Singapore was established in September 1996 with a $4 million joint funding from the National Science and Technology Board and the Ministry of Education. The primary aims of the research program are to undertake upstream basic research in medical informatics and to build a critical mass of medical informatics expertise to meet long-term research goals and to effect technology transfer to the health sector of Singapore. Research projects fall into five groups: Clinical Decision Systems, Health Information Systems, Biomedical Datamining Systems, Medical Education Systems and Medical Networking, Applications Development and Integration Systems.

This paper investigates the feasibility of magnetic fields reduction by optimization of phase relationships in a multi-circuit underground power cable system, carrying unbalanced loads. A novel algorithm was developed for fast calculation of the multi-circuit power cable system-generated magnetic field. The unbalanced load was modeled by random selection of phase current values. A computer code was written to calculate the statistical distribution of the magnetic field above the cables on the ground level. The program calculates the maximum magnetic field for different phase relationships and selects the optimum phase relationship. Several multi-circuit power cable systems used by electric utilities have been analyzed. The results show that the optimization of phase relationships effectively reduces the magnetic field for power cable systems with both single and multi-point grounded sheaths in spite of the load unbalance.

This entry first provides some of the basic concepts and definitions in relation to ultraviolet and visible spectrophotometry, such as electromagnetic radiation, absorption of light, and Beer Lambert’s Law. The entry then moves to a more detailed discussion of the applicability of the Beer’s Law and an examination of the components of the spectrophotometer.

The authors describe a serological survey on the prevalence of infectious bovine rhinotracheitis (IBR) among cattle and buffalo (Bubalus bubalis) in three southern states of India. A local isolate of bovine herpesvirus 1 (BHV-1) from an outbreak of the respiratory form of IBR was used as a source of virus antigen in avidin-biotin enzyme-linked immunosorbent assay (ELISA). The overall prevalence of antibodies to BHV-1 in cattle was 50.9%, and in buffalo was 52.5%. Among breeding bulls, 114/120 samples from Tamil Nadu (95%) and 41/99 samples from Karnataka (41.4%) were seropositive. The possible association of IBR with bovine abortions was recorded in 31/56 samples (55.4%) from aborted crossbred cows. However, virus isolation was not performed on these animals. The authors also highlight the economic importance of IBR to the rapidly developing livestock industry in India.