Real Time Net Zero Energy Building Energy Manager with Heterogeneous Wireless Ad hoc Network Adaptable To IoT Architectures

Significant energy consumption by buildings from utility grid has made researchers revisit existing Building Energy Management Systems (BEMS). Most of the developing countries have taken a green initiative of Net Zero Energy Buildings (NZEB) to reduce carbon foot print and fast depletion of conventional energy sources. Though the integration of solar and wind based systems to grid is successful in recent years, residential building energy management systems with renewable energy sources is still an evolving research area. Monitoring, control and actuation systems should be tightly coupled with the help of any to any device communication namely Internet of Things (IoT) to realize an efficient NZEB. In this paper a real time NZEB is proposed and developed with bi-directional wireless sensor and actuation system. Proposed NZEB central server collects and maintains a database of on site solar generation, battery state of charge and load power consumption data of a building with help of IEEE 802.15.4 and IEEE 802.11 wireless networks. Proposed system was deployed as a test bed with sensing, control, actuation and server modules and connecting them with a bi-directional wireless network architecture similar to IoT. Data observed at experimental test bed confirm that developed system can estimate on site solar power generation, state of charge on battery bank and load power consumption with negligible error. A simulation study with experimental data collected at NZEB test bed shows that NZEB can optimally schedule loads between local generation and utility grid thereby minimizing peak demand on the grid

WSN based power monitoring in smart grids

Smart grid technology is one of the recent developments in the area of electric power systems that aid the use of non-conventional sources of energy in parallel with the conventional sources of energy. Monitoring and control of smart grids is essential for its efficient and effective functioning. In this paper, we propose an architecture for monitoring power in smart grid applications using wireless sensor network (WSN) technology. A prototype power sensing module is designed and developed to calculate the power for any kind of loads. Using WSN technology, the monitored power is communicated to the sink at periodic intervals. Multi hop wireless mesh network is set up using IRIS motes to enhance the communication between the power sensing nodes and the sink. The data collected is a rich source of repository for data analysis and modelling. A number of smart actions and applications, such as power theft detection, energy efficient building design, smart automation systems and smart metering can evolve out of the proposed model. A novel Power theft detection algorithm is proposed and simulated in this paper. The system is also scaled using GSM technology to extend the range of communication. Load monitoring can aid distributed architecture in smart grids with automated technology to switch between the non-conventional source of energy and the grid

Telemedicine During COVID-19 and Beyond: A Practical Guide and Best Practices Multidisciplinary Approach for the Orthopedic and Neurologic Pain Physical Examination.

BACKGROUND:The COVID pandemic has impacted almost every aspect of human interaction, causing global changes in financial, health care, and social environments for the foreseeable future. More than 1.3 million of the 4 million cases of COVID-19 confirmed globally as of May 2020 have been identified in the United States, testing the capacity and resilience of our hospitals and health care workers. The impacts of the ongoing pandemic, caused by a novel strain of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have far-reaching implications for the future of our health care system and how we deliver routine care to patients. The adoption of social distancing during this pandemic has demonstrated efficacy in controlling the spread of this virus and has been the only proven means of infection control thus far. Social distancing has prompted hospital closures and the reduction of all non-COVID clinical visits, causing widespread financial despair to many outpatient centers. However, the need to treat patients for non-COVID problems remains important despite this pandemic, as care must continue to be delivered to patients despite their ability or desire to report to outpatient centers for their general care. Our national health care system has realized this need and has incentivized providers to adopt distance-based care in the form of telemedicine and video medicine visits. Many institutions have since incorporated these into their practices without financial penalty because of Medicare\u27s 1135 waiver, which currently reimburses telemedicine at the same rate as evaluation and management codes (E/M Codes). Although the financial burden has been alleviated by this policy, the practitioner remains accountable for providing proper assessment with this new modality of health care delivery. This is a challenge for most physicians, so our team of national experts has created a reference guide for musculoskeletal and neurologic examination selection to retrofit into the telemedicine experience. OBJECTIVES:To describe and illustrate musculoskeletal and neurologic examination techniques that can be used effectively in telemedicine. STUDY DESIGN:Consensus-based multispecialty guidelines. SETTING:Tertiary care center. METHODS:Literature review of the neck, shoulder, elbow, wrist, hand, lumbar, hip, and knee physical examinations were performed. A multidisciplinary team comprised of physical medicine and rehabilitation, orthopedics, rheumatology, neurology, and anesthesia experts evaluated each examination and provided consensus opinion to select the examinations most appropriate for telemedicine evaluation. The team also provided consensus opinion on how to modify some examinations to incorporate into a nonhealth care office setting. RESULTS:Sixty-nine examinations were selected by the consensus team. Household objects were identified that modified standard and validated examinations, which could facilitate the examinations.The consensus review team did not believe that the modified tests altered the validity of the standardized tests. LIMITATIONS:Examinations selected are not validated for telemedicine. Qualitative and quantitative analyses were not performed. CONCLUSIONS:The physical examination is an essential component for sound clinical judgment and patient care planning. The physical examinations described in this manuscript provide a comprehensive framework for the musculoskeletal and neurologic examination, which has been vetted by a committee of national experts for incorporation into the telemedicine evaluation

Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial

Aims  The third Universal Definition of Myocardial Infarction (MI) Task Force classified MIs into five types: Type 1, spontaneous; Type 2, related to oxygen supply/demand imbalance; Type 3, fatal without ascertainment of cardiac biomarkers; Type 4, related to percutaneous coronary intervention; and Type 5, related to coronary artery bypass surgery. Low-density lipoprotein cholesterol (LDL-C) reduction with statins and proprotein convertase subtilisin–kexin Type 9 (PCSK9) inhibitors reduces risk of MI, but less is known about effects on types of MI. ODYSSEY OUTCOMES compared the PCSK9 inhibitor alirocumab with placebo in 18 924 patients with recent acute coronary syndrome (ACS) and elevated LDL-C (≥1.8 mmol/L) despite intensive statin therapy. In a pre-specified analysis, we assessed the effects of alirocumab on types of MI. Methods and results  Median follow-up was 2.8 years. Myocardial infarction types were prospectively adjudicated and classified. Of 1860 total MIs, 1223 (65.8%) were adjudicated as Type 1, 386 (20.8%) as Type 2, and 244 (13.1%) as Type 4. Few events were Type 3 (n = 2) or Type 5 (n = 5). Alirocumab reduced first MIs [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.77–0.95; P = 0.003], with reductions in both Type 1 (HR 0.87, 95% CI 0.77–0.99; P = 0.032) and Type 2 (0.77, 0.61–0.97; P = 0.025), but not Type 4 MI. Conclusion  After ACS, alirocumab added to intensive statin therapy favourably impacted on Type 1 and 2 MIs. The data indicate for the first time that a lipid-lowering therapy can attenuate the risk of Type 2 MI. Low-density lipoprotein cholesterol reduction below levels achievable with statins is an effective preventive strategy for both MI types.For complete list of authors see http://dx.doi.org/10.1093/eurheartj/ehz299</p

Effect of alirocumab on mortality after acute coronary syndromes. An analysis of the ODYSSEY OUTCOMES randomized clinical trial

Background: Previous trials of PCSK9 (proprotein convertase subtilisin-kexin type 9) inhibitors demonstrated reductions in major adverse cardiovascular events, but not death. We assessed the effects of alirocumab on death after index acute coronary syndrome. Methods: ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) was a double-blind, randomized comparison of alirocumab or placebo in 18 924 patients who had an ACS 1 to 12 months previously and elevated atherogenic lipoproteins despite intensive statin therapy. Alirocumab dose was blindly titrated to target achieved low-density lipoprotein cholesterol (LDL-C) between 25 and 50 mg/dL. We examined the effects of treatment on all-cause death and its components, cardiovascular and noncardiovascular death, with log-rank testing. Joint semiparametric models tested associations between nonfatal cardiovascular events and cardiovascular or noncardiovascular death. Results: Median follow-up was 2.8 years. Death occurred in 334 (3.5%) and 392 (4.1%) patients, respectively, in the alirocumab and placebo groups (hazard ratio [HR], 0.85; 95% CI, 0.73 to 0.98; P=0.03, nominal P value). This resulted from nonsignificantly fewer cardiovascular (240 [2.5%] vs 271 [2.9%]; HR, 0.88; 95% CI, 0.74 to 1.05; P=0.15) and noncardiovascular (94 [1.0%] vs 121 [1.3%]; HR, 0.77; 95% CI, 0.59 to 1.01; P=0.06) deaths with alirocumab. In a prespecified analysis of 8242 patients eligible for ≥3 years follow-up, alirocumab reduced death (HR, 0.78; 95% CI, 0.65 to 0.94; P=0.01). Patients with nonfatal cardiovascular events were at increased risk for cardiovascular and noncardiovascular deaths (P<0.0001 for the associations). Alirocumab reduced total nonfatal cardiovascular events (P<0.001) and thereby may have attenuated the number of cardiovascular and noncardiovascular deaths. A post hoc analysis found that, compared to patients with lower LDL-C, patients with baseline LDL-C ≥100 mg/dL (2.59 mmol/L) had a greater absolute risk of death and a larger mortality benefit from alirocumab (HR, 0.71; 95% CI, 0.56 to 0.90; Pinteraction=0.007). In the alirocumab group, all-cause death declined wit h achieved LDL-C at 4 months of treatment, to a level of approximately 30 mg/dL (adjusted P=0.017 for linear trend). Conclusions: Alirocumab added to intensive statin therapy has the potential to reduce death after acute coronary syndrome, particularly if treatment is maintained for ≥3 years, if baseline LDL-C is ≥100 mg/dL, or if achieved LDL-C is low. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01663402

Primary Breast Cancer in Aberrant Breast Tissue in the Axilla

Primary breast cancer in aberrant axillary breast tissue is rare. Breast cancer in the axilla is most often due to lymph node metastases from an ipsilateral breast tumor or from an occult primary lesion. We describe two patients with primary breast cancer in aberrant breast tissue in the axilla, and review the literature to define guidelines for diagnosis and treatment

Characterization of the hot cracking resistance using the Essential Work of Fracture (EWF) - application to duplex stainless steels

International audienceDuplex stainless steels (DSS) involve two ductile phases, i.e. ferrite and austenite, with a proportion of each phase around 50%. The main advantage in comparison with other austenitic and ferritic stainless steels is the excellent combination of high strength and corrosion resistance together with good formability and weldability. Unfortunately, DSS present in general a poor hot workability. Standard hot ductility tests like hot tensile or hot torsion tests are always helpful to compare the fracture resistance of two very ductile materials. A new method based on the essential work of fracture (EWF) concept has been used in order to determine the hot cracking resistance. The EWF concept was introduced to address ductile fracture based on the entire load-displacement response up to the complete fracture of a specimen and not from the initiation measurements such as in classical fracture mechanics concepts. The aim of the method consists in separating, based on dimensional considerations, the work performed within the plastic zone from the total work of fracture in order to provide an estimate of the work spent per unit area within the fracture process zone to break the material. This method proved to be very well adapted to high temperature cracking. Two different duplex stainless steels have been characterized by the essential work of fracture method. Examination of the fracture micrographs and profiles match the EWF results. This method turns out to be a discriminating tool for quantifying hot cracking and to generate a physically relevant fracture index to guide the optimization of microstructures towards successful forming operations

Duplex Stainless Steel Microstructural Developments as Model Microstructures for Hot Ductility Investigations

Duplex stainless steels (DSS) are alloys made of ferrite and austenite, with a proportion of each phase around 50%. Their main advantage in comparison with other austenitic and ferritic stainless steels is the attractive combination of high strength and corrosion resistance together with good formability and weldability. Unfortunately, DSS often present a poor hot workability. This phenomenon can stem from different factors associated to the balance of the phases, the nature of the interface, the distribution, size and shape of the second phase, and possibly also from difference in rheology between ferrite and austenite. In order to determine the specific influence of phase morphology on the hot-workability of DSS, two austenite morphologies (E: Equiaxed and W: Widmanstätten) with very similar phase ratio have been generated using appropriate heat treatments. It was checked that the latter treatments generate stable microstructures so that subsequent hot mechanical tests are performed on the microstructures of interest. One microstructure consists of a ferritic matrix with austenitic equiaxed islands while the other microstructure is composed of a ferritic matrix with Widmanstätten austenite. The latter morphology corresponds to the morphology observed in as-cast slabs