4E analysis of a two-stage refrigeration system through surrogate models based on response surface methods and hybrid grey wolf optimizer

Refrigeration systems are complex, non-linear, multi-modal, and multi-dimensional. However, traditional methods are based on a trial and error process to optimize these systems, and a global optimum operating point cannot be guaranteed. Therefore, this work aims to study a two-stage vapor compression refrigeration system (VCRS) through a novel and robust hybrid multi-objective grey wolf optimizer (HMOGWO) algorithm. The system is modeled using response surface methods (RSM) to investigate the impacts of design variables on the set responses. Firstly, the interaction between the system components and their cycle behavior is analyzed by building four surrogate models using RSM. The model fit statistics indicate that they are statistically significant and agree with the design data. Three conflicting scenarios in bi-objective optimization are built focusing on the overall system following the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) and Linear Programming Technique for Multidimensional Analysis of Preference (LINMAP) decision-making methods. The optimal solutions indicate that for the first to third scenarios, the exergetic efficiency (EE) and capital expenditure (CAPEX) are optimized by 33.4% and 7.5%, and the EE and operational expenditure (OPEX) are improved by 27.4% and 19.0%. The EE and global warming potential (GWP) are also optimized by 27.2% and 19.1%, where the proposed HMOGWO outperforms the MOGWO and NSGA-II. Finally, the K-means clustering technique is applied for Pareto characterization. Based on the research outcomes, the combined RSM and HMOGWO techniques have proved an excellent solution to simulate and optimize two-stage VCRS

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Two-Phase Non-Newtonian Pulsatile Blood Flow Simulations in a Rigid and Flexible Patient-Specific Left Coronary Artery (LCA) Exhibiting Multi-Stenosis

Coronary artery disease (CAD) is stated as one of the most common causes of death all over the world. This article explores the influence of multi stenosis in a flexible and rigid left coronary artery (LCA) model using a multiphase blood flow system which has not yet been studied. Two-way fluid–solid interaction (FSI) is employed to achieve flow within the flexible artery model. A realistic three-dimensional model of multi-stenosed LCA was reconstructed based on computerized tomography (CT) images. The fluid domain was solved using a finite volume-based commercial software (FLUENT 2020). The fluid (blood) and solid (wall) domains were fully coupled by using the ANSYS Fluid-Structure Interaction solver. The maximum pressure drops, and wall shear stress was determined across the sever stenosis (90% AS). The higher region of displacement occurs at the pre-stenosis area compared to the other area of the left coronary artery model. An increase in blood flow velocity across the restricted regions (stenosis) in the LCA was observed, whereas the recirculation zone at the post-stenosis and bifurcation regions was noted. An overestimation of hemodynamic descriptors for the rigid models was found as compared to the FSI models