Optimizing Electricity Load and Cost for Demand Side Management in Smart Grid

This paper proposes a mechanism for OELC (Optimizing Electricity Load and Cost) for smart grid. The load of every smart home is predicted one-hour prior to their actual usage. To fulfill PL (Predicted Load) of each consumer, multiple resources of electricity are considered, including RE (Renewable Energy) resources. Furthermore, cost to get PL from multiple resources is calculated. In proposed model 3-4 smart homes are grouped in the form of clusters. To reduce the amount of electricity bills, system also allows privileges to share electricity between adjacent smart homes within a cluster. To validate the OELC mechanism, extensive numerical simulations are conducted which shows a significant reduction in electricity load and cost for electricity consumers. In future, to enhance the functionality of OELC, security from cyber-attacks can be considere

Pulse Oximeter Perfusion Index as an Early Indicator of Onset of Sympathectomy After Epidural Anaesthesia

Objective: To establish a reliable indicator of epidural effectiveness, we compared the frequency of subjects achieving sympathectomy onset in patients undergoing lower limb surgeries under lumbar epidural anaesthesia in terms of changes in perfusion index (PI), mean arterial pressures (MAP), and toe temperature. Methodology:  This descriptive case series study was conducted at the Department of Anesthesiology, Holy Family Hospital, Rawalpindi from July 2018 - January 2019. A total of 96 patients were included, all of them received lumbar epidural catheters for lower limb surgeries and were given 10 ml of epidural bupivacaine 0.5% through the epidural catheter. Baseline values were recorded for PI in toe, MAP and temperature of toe. At 5, 10 and 20 minutes after epidural anaesthesia, these values were re-recorded. Data collection was completed before the start of surgery. Criteria for clinically evident sympathectomy was defined beforehand. The frequency of subjects reaching these predefined targets were analyzed at said time intervals using Mc-Nemar test at each time interval. Results: For PI 66/96, 88/96 and 96/96 of subjects in the study fulfilled the criteria of achieving sympathectomy at 5, 10 and 20 minutes , respectively, compared to 7/96 , 15/96 and 59/96 for MAP changes and 0/96, 29/96 and 45/96 for changes in temperature of toe. Conclusion: As per this study, PI seemed to be a faster, clearer and a more objective indicator of the onset of sympathectomy after epidural anaesthesia than toe temperature or MAP

Comparison of Fully Deflated with Partially Inflated Technique for Ease of Insertion of Laryngeal Mask Airways in Adults

Objective: To compare the frequency of ease of insertion of the laryngeal mask airway (LMA) between fully deflated and partially inflated laryngeal mask airway, in anesthetized mechanically ventilated adult patients undergoing different non-emergency short-term surgical and gynecological procedures. Methodology: A total of 104 patients were recruited in this RCT. Using computer generated random numbers, patients were allocated to two groups: fully deflated LMAs in A and partially inflated LMAs in B. Pre-operative assessment was done and informed consent was taken. All subjects were 20–40 years of age, ASA-I and ASA- II, planned for short surgical and gynaecological cases (elective) that required general anaesthesia with mechanical ventilation. Premedication with 2 mg midazolam IV was done 30 minutes before the start of the operation. Monitors were attached. One 18G cannula was maintained. IV fluids were administered to each patient as per patient’s and procedure's requirements. Pre-oxygenation was done with 100% oxygen with a face mask for three minutes. Glycopyrrolate IV 0.2mg/kg and nalbuphine IV 0.15mg/kg were given to all at induction by an anesthetist. Results:  In Group A, 98% of patients had ease of insertion while 2% of patients didn’t have ease of insertion, whereas in Group B 90% of patients had ease of insertion and 10% of patients didn’t. Ease of insertion was measured by the number of attempts (first attempt insertion – ease of insertion). Conclusion: Our study concludes that the fully deflated technique is superior as compared to the partially inflated technique in terms of easier insertion in Laryngeal mask airways

Global surgery research collaborations during the COVID-19 pandemic

The COVID-19 pandemic created an unprecedented burden on health systems, including surgical services, which have been indirectly affected by the growing number of cases due to cancellation of operations, delayed screening and a lack of adequate resources such as PPE and ventilators. In addition to logistical challenges, the pandemic also raised imminent clinical questions that required immediate answers. Global collaborations have been vital to identifying challenges by pooling data and collecting evidence to provide critical information to guide clinical and surgical care. Research partnerships have been the driving force behind global surgery research; however, since the pandemic, there has been an increased need for equitable collaboration and innovation between high-income and low-income research institutions to continue making steady progress towards providing access to safe, affordable surgical care. This article explores academic research partnerships formed during the pandemic and identifies challenges and opportunities presented to researchers and institutions. Finally, this paper recommends that further collaborations be made between HIC and LMICs to ensure policies that global surgery ensures that key stakeholders are at the centre of research. Such policies need to focus on the access to education and mentorship, micro-grants for researchers, and publication opportunities

Exploring Emotional and Psychological Impacts of Mammography in Women

Introduction: Mammography is a diagnostic tool that is routinely used to test women for breast cancer. While it has been shown to be beneficial in detecting early-stage malignancies, it can also have emotional and psychological consequences for patients. The goal of this study is to dive into the emotional and psychological experiences of mammography patients. We hope to obtain a better understanding of the potential complications and problems faced by women during the screening process by investigating these elements. Materials and Methods: The Psychological Consequences Questionnaire (PCQ) and a self-administered questionnaire were used to collect data. SPSS was used for statistical analysis. All participants were given information about mammography technology and safety, and their participation was based on informed consent. Results: The study included 60 women ranging in age from 40 to 67 years old, with a mean age of 50.22. The PCQ results revealed a high prevalence of symptoms such as difficulty sleeping, changes in appetite, depression or unhappy feelings, fear and panic, nervousness or tension, feeling under pressure, withholding items, venting frustrations on others, withdrawal from relationships, difficulty with daily tasks, and difficulties fulfilling obligations. These findings shed light on the psychological repercussions that people face and point to the necessity for support networks or therapy to address these concerns. Conclusion:  This research focuses on the emotional and psychological effects of mammography on women. The data suggest that anxiety is a common feeling for women undergoing mammography, which could be exacerbated by previous negative experiences or fear of breast cancer. In order to provide holistic and comprehensive care, healthcare providers must recognize and meet patients\u27 emotional and psychological needs

Effect of a Health Education Intervention on Practices of Hospital Laboratory Staff; A Quasi-Experimental Study

Background: The incidence of Laboratory acquired infections is on the rise despite the existence and continuous upgradation of infection prevention protocols. The objective of this study was to determine the practice of lab staff before and after carrying out an intervention in the form of health education intervention based on WHO protocols for infection prevention. Methods: This is a Quasi-experimental study carried out in three hospitals in Rawalpindi. A total of n=38 technical and non-technical lab staff participated in the study. Laboratory practices were observed by the researchers themselves for a week. Then an education session was conducted for the staff regarding the World Health Organization (WHO) standard protocols for infection control. The post-intervention data were collected after about two weeks of health education sessions. Data were analyzed using SPSS version 22. Paired t-test was applied to compare the mean scores of pre- and post-interventional data. Results: The laboratory staff participated in the study mostly 19(50%) belonging to the age(years) range of 20-27. The percentage of respondents having good practice of infection prevention protocols before intervention was 7.5%, after the intervention this increased to 57.9%. Paired t-test showed that the difference in practice mean score of pre- and post-interventional data was statistically significant (CI=21.55-15.33 p-value=0.001). Conclusion: Pre-intervention data showed that the practice of the staff was not completely in accordance with WHO infection prevention. After delivering the education session on WHO infection prevention protocols, there was a significant improvement in the practices of laboratory staff

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Adolescent transport and unintentional injuries: a systematic analysis using the Global Burden of Disease Study 2019

Background: Globally, transport and unintentional injuries persist as leading preventable causes of mortality and morbidity for adolescents. We sought to report comprehensive trends in injury-related mortality and morbidity for adolescents aged 10–24 years during the past three decades. Methods: Using the Global Burden of Disease, Injuries, and Risk Factors 2019 Study, we analysed mortality and disability-adjusted life-years (DALYs) attributed to transport and unintentional injuries for adolescents in 204 countries. Burden is reported in absolute numbers and age-standardised rates per 100 000 population by sex, age group (10–14, 15–19, and 20–24 years), and sociodemographic index (SDI) with 95% uncertainty intervals (UIs). We report percentage changes in deaths and DALYs between 1990 and 2019. Findings: In 2019, 369 061 deaths (of which 214 337 [58%] were transport related) and 31·1 million DALYs (of which 16·2 million [52%] were transport related) among adolescents aged 10–24 years were caused by transport and unintentional injuries combined. If compared with other causes, transport and unintentional injuries combined accounted for 25% of deaths and 14% of DALYs in 2019, and showed little improvement from 1990 when such injuries accounted for 26% of adolescent deaths and 17% of adolescent DALYs. Throughout adolescence, transport and unintentional injury fatality rates increased by age group. The unintentional injury burden was higher among males than females for all injury types, except for injuries related to fire, heat, and hot substances, or to adverse effects of medical treatment. From 1990 to 2019, global mortality rates declined by 34·4% (from 17·5 to 11·5 per 100 000) for transport injuries, and by 47·7% (from 15·9 to 8·3 per 100 000) for unintentional injuries. However, in low-SDI nations the absolute number of deaths increased (by 80·5% to 42 774 for transport injuries and by 39·4% to 31 961 for unintentional injuries). In the high-SDI quintile in 2010–19, the rate per 100 000 of transport injury DALYs was reduced by 16·7%, from 838 in 2010 to 699 in 2019. This was a substantially slower pace of reduction compared with the 48·5% reduction between 1990 and 2010, from 1626 per 100 000 in 1990 to 838 per 100 000 in 2010. Between 2010 and 2019, the rate of unintentional injury DALYs per 100 000 also remained largely unchanged in high-SDI countries (555 in 2010 vs 554 in 2019; 0·2% reduction). The number and rate of adolescent deaths and DALYs owing to environmental heat and cold exposure increased for the high-SDI quintile during 2010–19. Interpretation: As other causes of mortality are addressed, inadequate progress in reducing transport and unintentional injury mortality as a proportion of adolescent deaths becomes apparent. The relative shift in the burden of injury from high-SDI countries to low and low–middle-SDI countries necessitates focused action, including global donor, government, and industry investment in injury prevention. The persisting burden of DALYs related to transport and unintentional injuries indicates a need to prioritise innovative measures for the primary prevention of adolescent injury. Funding: Bill & Melinda Gates Foundation

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic