Innovative protection schemes through hardware-in-the-loop dynamic testing.

In microgrid environments, the behaviour of Distributed Generation (DG) during fault conditionsvaries significantly based on DG types and penetration levels. Conventional Overcurrent Relays(OCRs) with standard time-current characteristics may exhibit limitations during excessive faultscenarios, leading to OCR operating delays and mis-coordination within the microgrid. This studyproposes a novel constraint on the maximum Current Multiplier Setting (CMS) and utilizes WaterCycle Algorithm (WCA) and Particle Swarm Optimization (PSO) techniques to optimize the TimeMultiplier Setting (TMS). Comparative dynamic analysis through real-time validation shows thatthe non-standard OCR approach outperforms the standard IEC scheme across all grid operationmodes with different type, size and location of DGs. For instance, under F1 conditions, thetripping time of OCR1 was reduced from 0.0226 seconds (IEC) to 0.000981 seconds (non-stan-dard). HIL results further affirm the efficacy of the proposed scheme. The optimization process,implemented in MATLAB and validated using ATP/EMTP simulations and SIPROTEC 7SJ62 re-lays, demonstrates enhanced microgrid protection coordination, improving system reliability andperformance

The recent development of protection coordination schemes based on inverse of AC microgrid: A review

Integration of distributed generation systems and diversity of microgrid operations led to a change in the structure of the power system. Due to this conversion, new challenges have arisen when employing traditional overcurrent protection schemes. As a consequence, non‐classical protection schemes have attracted significant attention in the last few years. Engineers and scholars have proposed different non‐standard methods to increase the power protection system and ensure the highly selectivity performance. Although the non‐standard characteristics and their requirements, in general, have been outlined and analyzed in the available literature, protection coordination based on voltage current–time inverse, as a branch of non‐standard optimization methods, has not yet been thoroughly discussed, compared, or debated in detail. To close this gap, this review introduces a broad overview of recent research and developments of the voltage current–time inverse based protection coordination. Focuses on assessing the potential advantages and disadvantages of related studies and provide a classification and analysis of these studies. The future trends and some recommendations have been included in this review for improving fault detection sensitivity and coordination reliability

Efficacy and safety of tocilizumab in COVID-19 patients: a living systematic review and meta-analysis

ObjectivesCytokine release syndrome with elevated interleukin-6 (IL-6) levels is associated with multiorgan damage and death in severe coronavirus disease 2019 (COVID-19). Our objective was to perform a living systematic review of the literature concerning the efficacy and toxicity of the IL-6 receptor antagonist tocilizumab in COVID-19 patients. MethodsData sources were Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, Web of Science, Scopus up, preprint servers and Google up to October 8, 2020. Study eligibility criteria were randomized controlled trials (RCTs) and observational studies at low or moderate risk of bias. Participants were hospitalized COVID-19 patients. Interventions included tocilizumab versus placebo or standard of care. We pooled crude risk ratios (RRs) of RCTs and adjusted RRs from cohorts, separately. We evaluated inconsistency between studies with I2. We assessed the certainty of evidence using the GRADE approach. ResultsOf 1156 citations, 24 studies were eligible (five RCTs and 19 cohorts). Five RCTs at low risk of bias, with 1325 patients, examined the effect of tocilizumab on short-term mortality; pooled RR was 1.09 (95%CI 0.80–1.49, I2 = 0%). Four RCTs with 771 patients examined the effect of tocilizumab on risk of mechanical ventilation; pooled RR was 0.71 (95%CI 0.52–0.96, I2 = 0%), with a corresponding number needed to treat of 17 (95%CI 9–100). Among 18 cohorts at moderate risk of bias with 9850 patients, the pooled adjusted RR for mortality was 0.58 (95%CI 0.51–0.66, I2 = 2.5%). This association was observed over all degrees of COVID-19 severity. Data from the RCTs did not show a higher risk of infections or adverse events with tocilizumab: pooled RR 0.63 (95%CI 0.38–1.06, five RCTs) and 0.83 (95%CI 0.55–1.24, five RCTs), respectively. ConclusionsCumulative moderate-certainty evidence shows that tocilizumab reduces the risk of mechanical ventilation in hospitalized COVID-19 patients. While RCTs showed that tocilizumab did not reduce short-term mortality, low-certainty evidence from cohort studies suggests an association between tocilizumab and lower mortality. We did not observe a higher risk of infections or adverse events with tocilizumab use. This review will continuously evaluate the role of tocilizumab in COVID-19 treatment

Diversity and ethics in trauma and acute care surgery teams: results from an international survey

Background Investigating the context of trauma and acute care surgery, the article aims at understanding the factors that can enhance some ethical aspects, namely the importance of patient consent, the perceptiveness of the ethical role of the trauma leader, and the perceived importance of ethics as an educational subject. Methods The article employs an international questionnaire promoted by the World Society of Emergency Surgery. Results Through the analysis of 402 fully filled questionnaires by surgeons from 72 different countries, the three main ethical topics are investigated through the lens of gender, membership of an academic or non-academic institution, an official trauma team, and a diverse group. In general terms, results highlight greater attention paid by surgeons belonging to academic institutions, official trauma teams, and diverse groups. Conclusions Our results underline that some organizational factors (e.g., the fact that the team belongs to a university context or is more diverse) might lead to the development of a higher sensibility on ethical matters. Embracing cultural diversity forces trauma teams to deal with different mindsets. Organizations should, therefore, consider those elements in defining their organizational procedures. Level of evidence Trauma and acute care teams work under tremendous pressure and complex circumstances, with their members needing to make ethical decisions quickly. The international survey allowed to shed light on how team assembly decisions might represent an opportunity to coordinate team member actions and increase performance

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

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

The recent development of protection coordination schemes based on inverse of AC microgrid: A review

Integration of distributed generation systems and diversity of microgrid operations led to a change in the structure of the power system. Due to this conversion, new challenges have arisen when employing traditional overcurrent protection schemes. As a consequence, non‐classical protection schemes have attracted significant attention in the last few years. Engineers and scholars have proposed different non‐standard methods to increase the power protection system and ensure the highly selectivity performance. Although the non‐standard characteristics and their requirements, in general, have been outlined and analyzed in the available literature, protection coordination based on voltage current–time inverse, as a branch of non‐standard optimization methods, has not yet been thoroughly discussed, compared, or debated in detail. To close this gap, this review introduces a broad overview of recent research and developments of the voltage current–time inverse based protection coordination. Focuses on assessing the potential advantages and disadvantages of related studies and provide a classification and analysis of these studies. The future trends and some recommendations have been included in this review for improving fault detection sensitivity and coordination reliability

Exploring the perception and readiness of Pharmacists towards telepharmacy implementation; a cross sectional analysis

Background Amid the turbulent nature of the COVID-19 pandemic, telepharmacy has shifted the paradigm of patient care by leveraging digital medicine. Government mandated lockdowns and norms of social distancing have further underscored the need for telepharmacy. Many developed and developing countries implemented such initiatives where pharmacists have provided tele-pharmacy services via telecommunications. However, the implementation and utilization of tele-pharmacy services are quite negligible in resource limited settings due to financial and administrative constraints. This study was aimed to ascertain the perception and readiness of pharmacists working in various sectors of a resource limiting country. Methodology A cross sectional study was carried out in all provinces of Pakistan to explore the perceptions of pharmacists towards telepharmacy implementation through a 35-items study instrument. The collected data was analyzed descriptively and scored accordingly. The chi-square test was used for inferential analysis on pharmacist’s perception regarding implementation of tele-pharmacy with their demographics. Results Of 380 pharmacists, the mean age is 27.67 ± 3.67 years with a preponderance of male pharmacists (n = 238, 62.6%). The pharmacists (n = 321, 84.5%) perceived that telepharmacy implementation improves patient’s quality of life and decreases patients’ visits (n = 291, 76.6%). Overall, pharmacists (n = 227, 59.7%) had negative perception towards benefits of telepharmacy implementation, but pharmacists had positive perception towards eligibility (n = 258, 67.9%), regulatory issues (n = 271, 71.3%) and telepharmacy during pandemic and beyond (n = 312, 82.1%). In chi-square testing gender (p = 0.03) and age (p = 0.03) had a significant association with perception regarding regulatory issues. Among perception regarding telepharmacy during COVID-19 pandemic and beyond age had a significant association (p = 0.03). Among perception regarding eligibility job location of pharmacists had significant association (p = 0.04). Conclusion The majority of pharmacists had a positive perception regarding the eligibility of patients and regulatory issues/legal framework regarding the implementation of tele-pharmacy, as well as its use during the COVID-19 pandemic and beyond. The implementation of tele-pharmacy can play a major role in providing timely and better patient care to remote patient areas and may help in the prevention and treatment of different infectious diseases

Discovery of sulfonamide-tethered isatin derivatives as novel anticancer agents and VEGFR-2 inhibitors

AbstractIn this work, new isatin-based sulphonamides (6a-i, 11a-c, 12a-c) were designed and synthesised as potential dual VEGFR-2 and carbonic anhydrase inhibitors with anticancer activities. Firstly, all target isatins were examined for in vitro antitumor action on NCI-USA panel (58 tumour cell lines). Then, the most potent derivatives were examined for the potential CA inhibitory action towards the physiologically relevant hCA isoforms I, II, and tumour-linked hCA IX isoform, in addition, the VEGFR-2 inhibitory activity was evaluated. The target sulphonamides failed to inhibit the CA isoforms that could be attributable to the steric effect of the neighbouring methoxy group, whereas they displayed potent VEGFR-2 inhibitory effect. Following that, isatins 11b and 12b were tested for their influence on the cell cycle disturbance, and towards the apoptotic potential. Finally, detailed molecular modelling analyses, including docking and molecular dynamics, were carried out to assess the binding mode and stability of target isatins

Discovery of sulfonamide-tethered isatin derivatives as novel anticancer agents and VEGFR-2 inhibitors.

In this work, new isatin-based sulphonamides (6a-i, 11a-c, 12a-c) were designed and synthesised as potential dual VEGFR-2 and carbonic anhydrase inhibitors with anticancer activities. Firstly, all target isatins were examined for in vitro antitumor action on NCI-USA panel (58 tumour cell lines). Then, the most potent derivatives were examined for the potential CA inhibitory action towards the physiologically relevant hCA isoforms I, II, and tumour-linked hCA IX isoform, in addition, the VEGFR-2 inhibitory activity was evaluated. The target sulphonamides failed to inhibit the CA isoforms that could be attributable to the steric effect of the neighbouring methoxy group, whereas they displayed potent VEGFR-2 inhibitory effect. Following that, isatins 11b and 12b were tested for their influence on the cell cycle disturbance, and towards the apoptotic potential. Finally, detailed molecular modelling analyses, including docking and molecular dynamics, were carried out to assess the binding mode and stability of target isatins