Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Rate after-effects fail to transfer cross-modally: evidence for distributed sensory timing mechanisms

Accurate time perception is critical for a number of human behaviours, such as understanding speech and the appreciation of music. However, it remains unresolved whether sensory time perception is mediated by a central timing component regulating all senses, or by a set of distributed mechanisms, each dedicated to a single sensory modality and operating in a largely independent manner. To address this issue, we conducted a range of unimodal and cross-modal rate adaptation experiments, in order to establish the degree of specificity of classical after- effects of sensory adaptation. Adapting to a fast rate of sensory stimulation typically makes a moderate rate appear slower (repulsive after-effect), and vice versa. A central timing hypothesis predicts general transfer of adaptation effects across modalities, whilst distributed mechanisms predict a high degree of sensory selectivity. Rate perception was quantified by a method of temporal reproduction across all combinations of visual, auditory and tactile senses. Robust repulsive after-effects were observed in all unimodal rate conditions, but were not observed for any cross-modal pairings. Our results show that sensory timing abilities are adaptable but, crucially, that this change is modality-specific - an outcome that is consistent with a distributed sensory timing hypothesis

Vessel's trim optimization using IoT data and machine learning models

The shipping industry is an important source of greenhouse gas emissions, such as carbon dioxide, methane and nitrogen oxides. In the past few years, environmental and policy reasons dictate the immense reduction of greenhouse gas emissions in industries worldwide. Towards this direction, the shipping industry has focused on ship trim optimization in the last few years as an operational measure for better energy efficiency and thus a way to reduce consumption and energy-related emissions. In this paper, we present a machine learning solution to the problem of trim optimization. Specifically, we use Internet of Things (IoT) data for speed, draft, and trim in order to accurately predict shaft power. After our machine learning model is trained, we use its predicting capabilities to create the shaft power surface as part of the trim monitoring user interface of the maritime company infrastructure. © 2022 IEEE

Artificial Intelligence, Big Data Analytics, and Smart Cities

Modern urban life is seeing an increasing rate of adoption of artificial intelligence and smart solutions; however, citizens are still struggling to keep up the pace, and the rate at which they acquire skills and knowledge around artificial intelligence and data analysis in smart cities is lagging behind. This paper is an attempt to determine which digital skills are necessary when dealing with smart cities. This article is structured as follows: we first refer to the two basic and fundamental branches of artificial intelligence and continue with applications that exist in these branches regarding smart environments. The research contribution of this article is important since it is one of the few in the international literature dealing with all branches of AI and big data (e.g., machine learning and rule-based applications) in smart cities. The conclusion of the present work is that there is an urgent need to create an education system in the new concepts of AI and big data analysis not only for scientists but also for citizens. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG

Heterologous, Fresh, Human Donor Sclera as Patch Graft Material in Glaucoma Drainage Device Surgery

Purpose: To determine the safety and efficacy of fresh, human sclera allografts as a patch graft material in glaucoma drainage device (GDD) surgery. Design: Retrospective, noncomparative, interventional, consecutive case series. Subjects: All GDD cases operated between 2008 and 2013 in which fresh human corneoscleral rims were used immediately after the central corneal button was used for penetrating or endothelial keratoplasty. Methods: Surgery was performed by 2 surgeons at 2 facilities. The Ahmed Glaucoma Valve (FP-7) was used exclusively in this cohort. Sixty-four eyes of 60 patients were identified; demographic data were recorded along with intraocular pressure (IOP), medication requirements, visual acuity, complications, and subsequent interventions. Main Outcome Measures: Incidence of complications. IOP and medication requirements at the last follow-up. Quilified success utilizing Tube Versus Trabeculectomy study criteria. Results: The mean age of the cohort was 66.2±19.1 years; the average preoperative IOP was 33.2±11.1 mm Hg on 4.2±1.3 IOP-lowering agents before GDD surgery. IOP decreased significantly to 14.1±4.7 mm Hg (P<0.001) on 1.6±1.2 IOP-lowering agents (P<0.001) after an average follow-up of 18.2±15.4 months. There were no cases of early or late blebitis or endophthalmitis, and there was 1 case of conjunctival erosion and tube/plate exposure (1.6%) occurring 30 days after surgery. Qualified success was estimated as 90.5% and 81% at 1 and 2 years, respectively, using Tube Versus Trabeculectomy study criteria. Conclusions: Heterologous, fresh, human donor sclera appears to be a safe material for GDD tube coverage. It provides a cost-efficient alternative compared with traditional patch graft materials associated with a low risk of pathogen transmission. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved

Anterior chamber morphology before and after laser peripheral iridotomy determined by scheimpflug technology in white patients with narrow angles

PURPOSE:: To investigate the changes of anterior segment morphology in patients with narrow angles using a rotating Scheimpflug camera before and after laser peripheral iridotomy (LPI). MATERIALS AND METHODS:: Forty-six eyes of 46 patients classified as primary angle closure suspect, primary angle closure, primary angle closure glaucoma, acute angle closure glaucoma, fellow eyes of acute angle closure glaucoma, and iris plateau configuration were enrolled in this prospective interventional case series. Anterior chamber volume (ACV), anterior chamber depth (ACD), and anterior chamber angle (ACA) were evaluated with an Scheimpflug camera, before and after LPI. RESULTS:: After LPI, the average anterior chamber depth increased from 1.88±0.36 to 1.93±0.32 mm (P=0.49). The mean ACV increased from 74.6±25 to 89.4±21.1 mm (P=0.003). The average ACA increased from 21.1±4.8 to 23.4±3.8 degrees (P=0.01). Eyes with synechial angle closure (primary angle closure and primary angle closure glaucoma) demonstrated a significantly smaller change in ACV compared with eyes with appositional angle closure (primary angle closure suspect). CONCLUSIONS:: ACV and ACA determined by Scheimpflug technology increase to a statistically significant degree and this change appears to be more pronounced in cases of appositional angle closure. Copyright © 2012 by Lippincott Williams & Wilkins

A pilot study on ocular safety and efficacy of infliximab as an antifibrotic agent after experimental filtration surgery

Purpose To evaluate the safety and efficacy of infliximab as an antifibrotic agent after experimental glaucoma filtration surgery in rabbits. Methods In a randomized, prospective, masked-observer study, 30 New Zealand Albino rabbits underwent glaucoma filtration surgery. The animals were allocated to receive either intraoperative application of infliximab (group A) or mitomycin C (MMC) at a concentration of 0.2mg/ml (group B) or balanced salt solution (BSS, control)(group C). Different infliximab doses, namely 1.0mg, 2.0mg, 3.0mg, 4.0mg, 5.0mg in 0.1ml were applied. Bleb survival and characteristics were evaluated over a 30day period. The animals were killed on postoperative day 15 and 30. Histology of the operated eyes was performed to evaluate and grade the amount of scarring in each group.Cellular density was evaluated in each case. Results Infliximab did not appear to improve the outcome of filtration surgery in this model of glaucoma filtration surgery.There was a significant decrease in cellular density in the MMC group compared to the control group (p=0.0352). There was neither a significant decrease in cellular density between the infliximab group and the control group nor between the infliximab group and the MMC group. Overall there was no difference in terms of fibrosis between the three different groups. There was slightly less inflammation in the infliximab group, but not significant. Conclusions In this study intraoperative application of infliximab does not appear to be superior to the application of MMC or a control with regard to bleb survival and fibrosis. This study however demonstrates that intraoperative application of MMC significantly reduces the cellular density of the filtration bleb

Live Vessels' Monitoring using Geographic Information and Internet of Things

The purpose of this paper is to present the GIS Vessels Monitoring Platform, an integration platform, which collects information from various, heterogeneous internal and external sources and represents the collected information in a uniform way using a Geographical Information System. Furthermore, the collected information from Internet of Things (IoT) data sources for various critical parameters, such as the engine performance, gas emissions, navigation and vessel performance, is further used for analysis and as an input to both a decision support and an alerting system operated by the Maritime Company that monitors the vessels. More specifically, the paper discusses how the platform provides the management company and their departments with all the necessary information for monitoring a vessel in near real time. © 2022 IEEE