Postfault operation of five-phase induction machine with minimum total losses under aingle open-phase fault

Five-phase induction machines (FPIM) have attracted notable interest in safety critical applications as well as wind energy generation systems. This is largely due to their additional degrees of freedom that retain the machine starting/running steadily under fault conditions. In the available literature, postfault operation of multiphase machines is typically implemented using two techniques: minimum losses (ML) or maximum torque per ampere (MT) strategies. The optimization embedded into the control strategy, however, mostly addresses minimization of the stator copper loss, while the effect of the rotor loss and core loss are discarded in the optimal current calculation. This paper revisits postfault operation of the FPIM under single open phase fault (1OPF) by including the effect of both rotor loss and core loss on the machine's optimal current calculation over the full achievable loading range. The proposed searching algorithm, which combines the advantages of both MT and ML techniques, attempts to minimize the total machine losses induced by the current components of both the fundamental \alpha \beta and the secondary xy subspaces. The theoretical findings have been experimentally validated using a 1.5Hp five-phase prototype system

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Strengthening of Cutouts in Existing One-Way Spanning R. C. Flat Slabs Using CFRP Sheets

Abstract Openings in slabs are usually required for many different applications such as aeriation ducts and air conditioning. Opening in concrete slabs due to cutouts significantly decrease the member stiffness. There are different techniques to strengthen slabs with opening cutouts. This study presents experimental and numerical investigations on the use of Carbon Fiber Reinforced Polymers (CFRP) as strengthening material to strengthen and restore the load carrying capacity of R.C. slabs after having cutout in the hogging moment region. The experimental program consisted of testing five (oneway spanning R.C. flat slabs) with overhang. All slabs were prismatic, rectangular in cross-section and nominally 2000 mm long, 1000 mm width, and 100 mm thickness with a clear span (distance between supports) of 1200 mm and the overhang length is 700 mm. All slabs were loaded up to 30 kN (45% of ultimate load for reference slab, before yielding of the longitudinal reinforcement), then the load was kept constant during cutting concrete and steel bars (producing cut out). After that operation, slabs were loaded till failure. An analytical study using finite element analysis (FEA) is performed using the commercial software ANSYS. The FEA has been validated and calibrated using the experimental results. The FE model was found to be in a good agreement with the experimental results. The investigated key parameters were slab aspect ratio for the opening ratios of [1:1, 2:1], CFRP layers and the laminates widths, positions for cutouts and the CFRP configurations around cutouts

Shear Strengthening of Reinforced Concrete Beams Using Engineered Cementitious Composites and Carbon Fiber-Reinforced Polymer Sheets

This study evaluates the performance of Reinforced Concrete (RC) beams enhanced in shear using Engineered Cementitious Composites (ECCs) and Carbon Fiber-Reinforced Polymers (CFRPs). The experimental study encompasses fifteen RC beams. This set includes one control specimen and fourteen beams fortified in shear with Externally Bonded (EB) composites. Two of these specimens were enhanced with ECC layers, while the remaining were augmented with combined CFRP-ECC layers. Variables in the test included the ECC layer thickness, matrix type, number of CFRP layers, and strengthening configurations such as full wrapping, vertical strips, and inclined strips. The results indicated that the shear capacity of the fortified beams increased by 61.1% to 160.1% compared to the control specimen. The most effective structural performance was observed in the full wrapping method, which utilized a single CFRP layer combined with either 20 mm or 40 mm ECC thickness, outperforming other techniques. However, the inclined strip method demonstrated a notably higher load-bearing capacity than the full wrapping approach for beams with double CFRP layers paired with 20 mm and 40 mm ECC thicknesses. This configuration also exhibited superior ductility compared to the rest. Furthermore, the experimental shear capacities obtained were juxtaposed with theoretical values from prevailing design standards

Psoriasis paradox—infliximab-induced psoriasis in a patient with Crohn’s disease: a case report and mini-review

Biologic drugs are therapeutic modalities designed to inhibit specific cytokine signaling pathways. The introduction of these drugs in the management of autoimmune diseases has dramatically changed the treatment paradigm of chronic systemic immune-mediated inflammatory disorders. However, despite their overall acceptable safety profiles, paradoxical reactions have been reported in some real-life cases including case studies and clinical trials. In this study, we report a patient with Crohn’s disease who developed infliximab-induced psoriasis vulgaris after starting infliximab treatment. In this case, infliximab was discontinued, and low-dose steroids and subcutaneous methotrexate were introduced to control both his psoriasis and bowel condition with satisfying responses

Drip Irrigation and Compost Applications Improved the Growth, Productivity, and Water Use Efficiency of Some Varieties of Bread Wheat

In hyper-arid and arid zones, management of crop water requirements is considered a vital component for sustaining crop production. The efficiency of the irrigation method and the application of many kinds of organic matter are practices that should be followed in Egypt to maximize the use of irrigation water. Two field experiments were conducted during the two successive winter seasons of 2020/2021 and 2021/2022 to study the effect of drip irrigation systems and of several types of compost on yield and yield attributes of four cultivars of wheat in newly reclaimed sandy soils. Studied factors were irrigation levels based on the amount of water evapotranspiration (ET) (I1, I2, I3) and the application of compost types (Com1, Com2 and Com3) on four bread wheat cultivars. The parameters measured at each irrigation level were: heading date (day), plant height (cm2), number of spikes/m2, number of grains/spike, 1000-grain weight (g), grain yield (t/fed.), Biological yield (kg/fed.) and harvest index (%). The farmyard manure (Com3) gave the maximum values under irrigation shortages, reflected in producing the maximum values for traits measured in the 2020/2021 season as compared to (Com1) or (Com2) applications, which scored lower values for the traits for the different cultivars for wheat. The interaction (I1, I2) × Com3 × (Mis1, Mis2) led to a significant increase during both seasons for all the yield and yield components studied. A drip irrigation system at the level of 80% of ET and application of Com3 is recommended to optimize wheat productivity from the unit area. The savings in water irrigation would allow expansion of the cultivated area to decrease the gap between local crop production and local requirements

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

Background: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit