56 research outputs found

    Effects of Spatial Food Distribution on Search Behavior in Rats (Rattus norvegicus)

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    To analyze how search strategies are adapted according to the geometric distribution of food sources, the authors submitted rats to a search task in which they had to explore 9 food trays in an open field and avoid visiting already-depleted trays. Trays were spatially arranged in 4 independent configurations: a cross, a 3 × 3 matrix, 3 clusters of 3 trays each, and a random configuration. Rats exhibited differential search efficiency as a specific effect of the susceptibility of the configurations to being explored in a principled way: Crosses were first, matrices or clusters were in the middle, and random configurations were last. Although no exhaustive searches or highly principled patterns were observed in any of the configurations, performances improved as the sessions went by. Thus, structural affordances of the environment influence the construction not only of search strategies but also of information linked to where the reward is. © 2007 American Psychological Association

    Postpartum hemorrhage management, the importance of timing.

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    Postpartum hemorrhage is defined as a blood loss equal to or greater than 500 ml, which can occur from 24 hours to six weeks after delivery. It is a critical event with a rapid and devastating evolution, which can quickly lead to maternal shock and death. Many efforts have been made to create international and multisectoral guidelines that allow to face an event that represents the cause of about one quarter of maternal deaths. It is crucial to create a team able to act promptly in accordance with shared protocols. The availability of shared guidelines and protocols and the organization of periodic simulations and teamwork training are part of the fundamental initiatives that can promote the safety of perinatal care. The purpose of this document is to give clinicians the tools to minimize the risks associated with inadequate management of hemorrhagic emergency, avoiding the risk of “too little or too late” and giving patients maximum safety

    Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

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    IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

    Coronary microvascular resistance: methods for its quantification in humans

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    Coronary microvascular dysfunction is a topic that has recently gained considerable interest in the medical community owing to the growing awareness that microvascular dysfunction occurs in a number of myocardial disease states and has important prognostic implications. With this growing awareness, comes the desire to accurately assess the functional capacity of the coronary microcirculation for diagnostic purposes as well as to monitor the effects of therapeutic interventions that are targeted at reversing the extent of coronary microvascular dysfunction. Measurements of coronary microvascular resistance play a pivotal role in achieving that goal and several invasive and noninvasive methods have been developed for its quantification. This review is intended to provide an update pertaining to the methodology of these different imaging techniques, including the discussion of their strengths and weaknesses

    Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

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    Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

    The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

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    AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

    Coupled uRANS and FW- H Analysis of Installed Pusher Propeller Aircraft Configurations

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    In this paper the aeroacoustic phenomena characteristic of a pusher-propeller cofiguration and their aerodynamic causes are discussed and analyzed. The work was done in the frame of the European-funded project CESAR (Cost Effective Small AiRcraft). The configuration under study is an industrially relevant design with a wing-mounted pusher propeller, which features a close coupling of the turboshaft engines exhaust nozzles and a five bladed propeller. An established numerical analysis approach is applied in this study, which couples a high-fidelity unsteady aerodynamic simulation using the DLR TAU-Code with the DLR APSIM Code for a subsequent aeroacoustic evaluation. APSIM computes the sound propagation into the fareld based on the Ffowcs-Williams/Hawkings (FW-H) equations. A detailed analysis of the contributions of various components of the installation as well as flight condition specific parameters toward the overall noise generation by the propeller is presented. Furthermore, the possible scattering effect of the wing and nacelle is discussed. A detailed analysis of specific aspects of the numerical approach for the aeroacoustic analysis is made through a comparison between the results achieved using both a FW-H impermeable and permeable formulation. The numerical error due to both jet exhaust and propeller wake impingement on the FW-H permeable surface as well as the impact of cutting a hole in this permeable surface to avoid possible issues of these effects are discussed

    Digital twin of a combustion furnace operating in flameless conditions: Reduced-order model development from CFD simulations

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    The present paper presents the first-of-its-kind digital twin for a furnace operating in flameless combustion conditions. A methodology combining data compression, by means of Proper Orthogonal Decomposition (POD), and interpolation, using Kriging, was developed to design physics-based, reduced-order models (ROMs) for the prediction of combustion data at unexplored operating conditions. Three-dimensional simulations with detailed chemistry were carried out, spanning a wide range of operating conditions in terms of fuel composition (methane-hydrogen mixtures from pure methane to pure hydrogen), equivalence ratio (from 0.7 to 1) and air injector diameter (to adjust the air jet entrainment). Based on the available simulations, a ROM was developed, to predict both spatial fields, local and integral values of thermochemical variables at working conditions not included in the ROM development. Results showed that the developed ROM could reliably predict the temperature and main chemical species distribution in the furnace with an overall error below 10%, proving the effectiveness of the approach for the development of digital twins of combustion systems. A remarkable accuracy was observed for the prediction of specific quantities, including wall temperatures, OH decay length, OH peak value and location and exhaust gas composition, including pollutants, with prediction errors always below 5%, showing the potential of the approach to develop soft sensors.SCOPUS: ar.jinfo:eu-repo/semantics/publishe
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