Outcomes for Congenital Diaphragmatic Hernia in Three Decades: A Report From a UK Surgical Centre.

AimsCongenital diaphragmatic hernia (CDH) is associated with lung hypoplasia, pulmonary hypertension and high mortality. Three decades experience from a UK centre is reported.MethodsMedical records of CDH newborns between February 1990 and November 2021 and attending a multidisciplinary clinic were examined. Survival and health outcomes are recorded.ResultsOf 220 CDH newborns, left-sided defects were 177 (80%) cases. Diaphragm patch was required in 91 (41%) patients and 42 (19%) additionally required abdominal wall prosthesis. Materials deployed included Gore-Tex biological Surgisis patches all had early recurrences. Diaphragmatic patch was significantly associated with fundoplication (p 0.005). Overall survival rate was 85%-(90% survival primary defect vs. 79% patch) (p 0.035). Comparing decades, the post-2010 CDH study cohort was a sicker patient group comprising more index cases with cardiac malformations (69% vs. 28%, p ConclusionWhile a modestly excellent 85% survival rate is reported over three decades, CDH management at this UK university surgical centre witnessed a growing complexity of patients with mixed severity phenotype(s). Future challenges remain to be solved to improve survival for the most complex vulnerable patients

Factors impacting the complexity of the leporid intracranial joint.

Leporid lagomorphs, the rabbits and hares, exhibit unique cranial traits that distinguish them from their closest relatives, the Ochotonidae (pikas), and all other mammals. Among these features, the intracranial joint stands out as the only example of cranial kinesis in mammals and is hypothesised to dissipate kinetic energy during high-speed locomotion. Despite its potential functional importance, the morphology of the joint remains understudied. High complexity in other cranial sutures has been associated with behavioural traits such as feeding and head butting. In this study, we quantified the complexity of the intracranial joint using two independent metrics and explored its relationships with overall cranial shape, locomotor mode, cranial size and body mass, burrowing habit, and facial tilt angle. We found significant correlations between complexity and locomotor mode as well as with facial tilt angle, indicating that cursorial species have less complex sutures and highlighting a potential link between the complexity of suture interdigitation and facial tilting. However, complexity did not correlate with size or burrowing habit. Our findings shed more light on the functional anatomy of the leporid cranium and emphasise the need for further research on ontogenetic development, biomechanics, and behaviour to fully understand the evolutionary and functional significance of these unique cranial traits

Flash Profile method, is it suitable for complex multi-layered products? Application to strawberry-filled biscuits: a “SWEET project”

Composite foods are consumed daily, but understanding their sensory properties is a major challenge. This study aims to evaluate the efficiency of Flash Profile (FP) method to characterize strawberry-filled biscuits properties, in a context of sugar reduction. Investigations were carried out on fillings (with/without added sugar, with/without strawberry aroma), then biscuits (with sugar or maltitol or sorbitol, with/without vanilla aroma) and finally on the complex fruit-filled biscuits, corresponding to a progressive matrix complexification strategy. FP allowed a discrimination of the products for the 3 matrices according to their formulation and flavouring. Fruit fillings and biscuits were described with both flavour and texture attributes, whereas fruit-filled biscuits were mainly described with texture attributes. This texture predominance could result from complex changes of texture perceived during chewing. Panellists may also have focused on the first perceived characteristics or on the product's most distinguishing features to ease the task. FP was efficient to discriminate samples in each set of samples according to formulation. The characteristics allowing differentiation between samples varied depending on the matrix. Flavour attributes were mainly used for fluid matrices while texture was dominant for solid matrices. In our study, all panellists evaluated the 3 sets of products in the same order which could have influence their evaluation of complex products during the last session. Further investigations about the evaluation of complex solid products with FP may determine if texture is always dominant, even with a lower number of products

Pacing with a heart rate monitor for people with myalgic encephalomyelitis/chronic fatigue syndrome and long COVID: a feasibility study

People living with ME/CFS and LC frequently live with post-exertional malaise (PEM), which is associated with impairments in aerobic metabolism. They often use pacing with a heart rate monitor (HRM) to minimize time spent above the anaerobic threshold; however, there is limited research on the feasibility and efficacy. To establish the acceptability, adherence, outcomes, and adverse events associated with pacing with an HRM for a future definitive study. After informed consent and baseline measurements (including 10 min stand test, 5 questionnaires, accelerometry, heart rate variability, and lactate), participants were randomized into a control or intervention group using simple randomization and sealed envelopes. The intervention group used a heart rate monitor with weekly online HRM pacing advice (how to use the HRM, problem solving), and the control group received weekly online pacing advice (how to pace, problem solving). Follow-up measures were repeated, and semi-structured interviews were conducted at two and six months post-enrolment. 47 participants were recruited; however, recruiting people with LC was difficult due to wanting to use/already using HR monitoring. The interviews identified that the procedure was acceptable, and the majority of the participants completed the outcome measures. There were some changes from baseline to follow-up in all the outcome measures except the 10-minute stand test and accelerometry. There were no serious adverse events. Follow-up interviews identified 89% continued using HRM at 8 weeks and 66% after 6 months. Studies of HRM are feasible and acceptable for ME/CFS and LC, although recruitment strategies should be reviewed for LC. Clinical Trial registration number: ISRCTN10554129

How does virtual reality adoption affect firm risk? The role of external market environments

It is unclear whether adopting virtual reality technologies in a firm’s manufacturing processes is a risky decision or serves to reduce risk. Our study answers this question by combining the Mahalanobis distance matching with the difference-in-differences (DID) analysis to quantify the effect of virtual reality-enabled manufacturing practices (VRMPs) on firm risk. We also consider how external market environments, in terms of market competition, dynamism, and munificence, influence the relationship between VRMPs and firm risk. Our DID analysis, based on 74 treatment firms that adopted VRMPs and 72 matched control firms without such adoption, suggests that VRMP adoption helps reduce firm risk. Moreover, the risk-reduction effect is more significant for firms operating in highly competitive and dynamic markets, but less so in the contexts of high market munificence. These results demonstrate VRMPs’ potential to reduce firm risk and highlight the important role of external market environments in shaping this relationship

Sensorless beta-particle-filter strategy for optimizing solar trackers under Partial Shading Condition

The solar tracking system is one of the effective methods to enhance Photovoltaic (PV) power generation efficiency. However, existing systems face challenges in managing power losses when PV panels experience partial shading, resulting in prolonged tracking times and reduced average power output. In this study, we propose a sensorless Beta-Particle-Filter (BPF) solar tracking method that introduces a Beta parameter to define a restricted search area, thereby avoiding unnecessary global exploration. Additionally, a shadow identification process is incorporated, allowing the system to dynamically adjust the initial tracking range according to the shading level, thereby significantly reducing search time. Simulations and experiments demonstrate that the proposed solar tracking method increases the power generation by 60% under the Partial Shading Condition (PSC) compared to the fixed PV panel and achieves an 8% improvement in power generation compared to the latest particle filter method

Impact of acoustic environment in intensive care unit on nurses' well-being during COVID-19: A qualitative interview study.

ObjectiveThis study aimed to investigate the effects of acoustic environments in intensive care units (ICUs) on nurses' well-being.Setting and sampleThe research was conducted with 14 ICU registered nurses recruited from four different hospitals in China.Research methodologySemi-structured interviews were conducted via video calls to explore ICU nurses' perceptions, reactions, and coping strategies related to noise exposure. A grounded theory approach was used to analyse the data.FindingsThe study identified five categories and 11 themes based on nurses' experiences with noise exposure in ICUs. These themes were interconnected to develop a conceptual model. According to the model, exposure to human and non-human noises led to negative emotions and disturbances in ICU activities, such as medical procedures and conversations. Nurses employed various coping strategies to manage negative perceptions of noise. Several nurses expressed concerns about their physical and mental health, which are related to noise exposures. Additionally, their noise perception and coping strategies were influenced by intervening conditions, such as noise sensitivity, attitudes towards colleagues and patients, and childcare.Implications for clinical practiceThis study highlights the potential risk of physical and mental well-being among ICU nurses. The findings suggest the necessity of interventions to enhance the acoustic environments of ICUs, such as implementing noise reduction strategies, optimising alarm systems, and providing adequate training and support for staff to cope with noise-related stress

Microbially Induced Carbonate Precipitation for Soil Improvement: Insights from a Meter-Scale Radial Grouting Trial

Despite the growing interest in microbially induced carbonate precipitation (MICP) for geotechnical applications, reports on meter-scale MICP trials for soil improvement remain limited, and controlling and predicting cementation efficiency on a large-scale is even more scarce. This study presented a meter-scale improvement of a poorly-graded sand (initial dry density: 1581 kg/m3, porosity: 40%) through MICP in a cylindrical cell (diameter: 1 m; thickness: 15 cm) using a radial flow injection strategy, which involves injecting fluids radially from a single well located at the center while maintaining a constant hydraulic head at the outer boundary. Nine cycles of a two-phase MICP treatment were applied: Phase 1- injection of 0.7 pore volumes (PVs) of bacterial solution and 1-L water pulse; Phase 2- injection of 1.4 PVs of 0.5 M cementing solution in two stages (i) 0.7 PV injection two hours after the bacteria were injected, and (ii) a further 0.7 PV injection the following morning after an overnight static reaction period. We observed non-uniform CaCO3 precipitations along the distance from the central well and over the depth, which was induced by the decreasing flux towards the outer boundary under the radial flow pattern, along with influences from layered soil packing and hydraulically induced flow channels. CaCO3 precipitation with distance from the central well follows a symmetric Gaussian-type distribution, with sufficient cementation to retrieve full-length cores occurring near the midpoint between the central well and the outer boundary. The unconfined compressive strengths of the full-length cores were in the range of 1.2-6.8 MPa with CaCO3 contents of 0.08-0.17. Our study suggests that cementation level under radial flow conditions is controllable on a large scale and highly dependent on the injection volume of both bacteria and rinsing water pulse. The study provides a solid baseline for predicting and controlling CaCO3 distribution in large-scale MICP soil improvement using a two-phase radial injection approach