Mechanical Properties and Morphological Characteristics of Polypropylene Ternary Nanocomposite (PP-LS-MWCNT) for Industrial Applications

Polymer nanocomposites are credited with better properties compared with the conventional composite made from microfillers and have found potential applications in civil constructions and fabrication of process vessels. Dispersion of multiple fillers in polymer matrix has become a subject of interest as it addresses most of the common shortcomings observed in the binary composite and enhances the development of composites with multifunctional properties. Polypropylene (PP) ternary nanocomposites of layered silicate (LS) and multiwall carbon nanotubes (MWCNT) have been prepared at a pre-determined percentage (3%) layered silicate while the MWCNT loadings were varied between 0.1 and 0.7%. The investigation focused on the effect of MWCNT loadings on the binary precursor (PP/LS) measured in terms of tensile strength and Young’s modulus. The degree of enhancement was compared with the level of dispersion measured by wide angle X-ray diffraction (WXRD) and complemented with the morphological characterization using transmission and scanning electron microscope (TEM and SEM) respectively. The results show that the Sample 1 with 0.17% MWCNT displayed highest enhancement of 52.30MPa and 1759.32MPa for tensile strength and elastic modulus respectively compared with Sample 2 and 3 with higher MWCNT content that gave 48.19 and 1679.26MPa and 47.43 and 1726.14MPa for tensile strength and Young’s modulus respectively. WXRD gave up to 28Å and 20.11Å in the clay layer distance within the composite and LS respectively, indicating intercalation in the composite system. TEM images show clearly well distributed fillers in Sample 1 with 0.17% MWCNT, partly distributed in Sample 2 with 0.45% and array of network of carbon nanotubes in Sample 3 with 0.16% MWCNT. These results were complemented with SEM images which show that the composites developed are combination of exfoliation, intercalation and some micromixing. Key words: Polypropylene ternary Nanocomposites layered silicate (LS) multiwall carbon nanotubes (PP-LS-MWCNT), tensile properties, morphological characterization

Binary Feature Mask Optimization for Feature Selection

We investigate feature selection problem for generic machine learning (ML) models. We introduce a novel framework that selects features considering the predictions of the model. Our framework innovates by using a novel feature masking approach to eliminate the features during the selection process, instead of completely removing them from the dataset. This allows us to use the same ML model during feature selection, unlike other feature selection methods where we need to train the ML model again as the dataset has different dimensions on each iteration. We obtain the mask operator using the predictions of the ML model, which offers a comprehensive view on the subsets of the features essential for the predictive performance of the model. A variety of approaches exist in the feature selection literature. However, no study has introduced a training-free framework for a generic ML model to select features while considering the importance of the feature subsets as a whole, instead of focusing on the individual features. We demonstrate significant performance improvements on the real-life datasets under different settings using LightGBM and Multi-Layer Perceptron as our ML models. Additionally, we openly share the implementation code for our methods to encourage the research and the contributions in this area

A comparison of the prevalence of orthostatic hypotension between older patients with Alzheimer's Disease, Lewy body dementia, and without dementia

Orthostatic hypotension (OH) is reported to be more prevalent particularly in patients with Dementia with Lewy bodies (DLB) because of the autonomic dysfunction, but prevalence of OH is not known in patients with Alzheimer Disease (AD). The aim of the present study was to determine whether OH can be used to distinguish DLB from AD. 38 patients with DLB, 88 patients with AD and 521 patients without dementia, underwent Comprehensive Geriatric Assessment. OH were evaluated for the 1st (OH1) and 3rd (OH3) minutes, taking the data in supine position as the basis, by Head-Up-Tilt Test. Prevalence of OH1 was 43.2% in AD, 44.7% in DLB and 17.9% in patients without dementia, and OH3 was 44.3% in AD, 47.4% in DLB and 17.9% in non-dementia group. The frequency of OH1 and OH3 was higher in the AD and DLB groups than in the patients without dementia (p0.05). The percentage of asymptomatic patients with OH was 87.2% and 89.6% during 1st and 3rd minutes, respectively, and this percentage was similar in three groups (p>0.05, for each). There was no significant difference between the two dementia groups in terms of comorbidities, drugs and laboratory values (p>0.05). OH is more prevalent in patients with AD than controls and similar levels are observed in those with DLB. The prevalence of OH equally is greater with DLB or AD disease progression. Clinicians should be aware of OH and its related consequences in the management of the AD in older adults

Spin Liquid Phases in 2D Frustrated XY Model

In this paper we consider the $J_1-J_2-J_3$ classical and quantum 2D XY model. Spin wave calculations show that a spin liquid phase still exists in the quantum case as for Heisenberg models. We formulate a semiclassical approach of these models based on spin wave action and use a variational method to study the role played by vortices. Liquid and crystal phases of vortex could emerge in this description. These phases seem to be directly correlated with the spin liquid one and to its crystalline interpretation.Comment: 16 pages, Latex, 4 figures. To be published in Phys. Rev.

Implementation of a Digitally Enabled Care Pathway (Part 2): Qualitative Analysis of Experiences of Health Care Professionals.

BACKGROUND: One reason for the introduction of digital technologies into health care has been to try to improve safety and patient outcomes by providing real-time access to patient data and enhancing communication among health care professionals. However, the adoption of such technologies into clinical pathways has been less examined, and the impacts on users and the broader health system are poorly understood. We sought to address this by studying the impacts of introducing a digitally enabled care pathway for patients with acute kidney injury (AKI) at a tertiary referral hospital in the United Kingdom. A dedicated clinical response team-comprising existing nephrology and patient-at-risk and resuscitation teams-received AKI alerts in real time via Streams, a mobile app. Here, we present a qualitative evaluation of the experiences of users and other health care professionals whose work was affected by the implementation of the care pathway. OBJECTIVE: The aim of this study was to qualitatively evaluate the impact of mobile results viewing and automated alerting as part of a digitally enabled care pathway on the working practices of users and their interprofessional relationships. METHODS: A total of 19 semistructured interviews were conducted with members of the AKI response team and clinicians with whom they interacted across the hospital. Interviews were analyzed using inductive and deductive thematic analysis. RESULTS: The digitally enabled care pathway improved access to patient information and expedited early specialist care. Opportunities were identified for more constructive planning of end-of-life care due to the earlier detection and alerting of deterioration. However, the shift toward early detection also highlighted resource constraints and some clinical uncertainty about the value of intervening at this stage. The real-time availability of information altered communication flows within and between clinical teams and across professional groups. CONCLUSIONS: Digital technologies allow early detection of adverse events and of patients at risk of deterioration, with the potential to improve outcomes. They may also increase the efficiency of health care professionals' working practices. However, when planning and implementing digital information innovations in health care, the following factors should also be considered: the provision of clinical training to effectively manage early detection, resources to cope with additional workload, support to manage perceived information overload, and the optimization of algorithms to minimize unnecessary alerts

Evaluation of a digitally-enabled care pathway for acute kidney injury management in hospital emergency admissions.

We developed a digitally enabled care pathway for acute kidney injury (AKI) management incorporating a mobile detection application, specialist clinical response team and care protocol. Clinical outcome data were collected from adults with AKI on emergency admission before (May 2016 to January 2017) and after (May to September 2017) deployment at the intervention site and another not receiving the intervention. Changes in primary outcome (serum creatinine recovery to ≤120% baseline at hospital discharge) and secondary outcomes (30-day survival, renal replacement therapy, renal or intensive care unit (ICU) admission, worsening AKI stage and length of stay) were measured using interrupted time-series regression. Processes of care data (time to AKI recognition, time to treatment) were extracted from casenotes, and compared over two 9-month periods before and after implementation (January to September 2016 and 2017, respectively) using pre-post analysis. There was no step change in renal recovery or any of the secondary outcomes. Trends for creatinine recovery rates (estimated odds ratio (OR) = 1.04, 95% confidence interval (95% CI): 1.00-1.08, p = 0.038) and renal or ICU admission (OR = 0.95, 95% CI: 0.90-1.00, p = 0.044) improved significantly at the intervention site. However, difference-in-difference analyses between sites for creatinine recovery (estimated OR = 0.95, 95% CI: 0.90-1.00, p = 0.053) and renal or ICU admission (OR = 1.06, 95% CI: 0.98-1.16, p = 0.140) were not significant. Among process measures, time to AKI recognition and treatment of nephrotoxicity improved significantly (p < 0.001 and 0.047 respectively)

Implementation of a Digitally Enabled Care Pathway (Part 1): Impact on Clinical Outcomes and Associated Health Care Costs.

BACKGROUND: The development of acute kidney injury (AKI) in hospitalized patients is associated with adverse outcomes and increased health care costs. Simple automated e-alerts indicating its presence do not appear to improve outcomes, perhaps because of a lack of explicitly defined integration with a clinical response. OBJECTIVE: We sought to test this hypothesis by evaluating the impact of a digitally enabled intervention on clinical outcomes and health care costs associated with AKI in hospitalized patients. METHODS: We developed a care pathway comprising automated AKI detection, mobile clinician notification, in-app triage, and a protocolized specialist clinical response. We evaluated its impact by comparing data from pre- and postimplementation phases (May 2016 to January 2017 and May to September 2017, respectively) at the intervention site and another site not receiving the intervention. Clinical outcomes were analyzed using segmented regression analysis. The primary outcome was recovery of renal function to ≤120% of baseline by hospital discharge. Secondary clinical outcomes were mortality within 30 days of alert, progression of AKI stage, transfer to renal/intensive care units, hospital re-admission within 30 days of discharge, dependence on renal replacement therapy 30 days after discharge, and hospital-wide cardiac arrest rate. Time taken for specialist review of AKI alerts was measured. Impact on health care costs as defined by Patient-Level Information and Costing System data was evaluated using difference-in-differences (DID) analysis. RESULTS: The median time to AKI alert review by a specialist was 14.0 min (interquartile range 1.0-60.0 min). There was no impact on the primary outcome (estimated odds ratio [OR] 1.00, 95% CI 0.58-1.71; P=.99). Although the hospital-wide cardiac arrest rate fell significantly at the intervention site (OR 0.55, 95% CI 0.38-0.76; P<.001), DID analysis with the comparator site was not significant (OR 1.13, 95% CI 0.63-1.99; P=.69). There was no impact on other secondary clinical outcomes. Mean health care costs per patient were reduced by £2123 (95% CI -£4024 to -£222; P=.03), not including costs of providing the technology. CONCLUSIONS: The digitally enabled clinical intervention to detect and treat AKI in hospitalized patients reduced health care costs and possibly reduced cardiac arrest rates. Its impact on other clinical outcomes and identification of the active components of the pathway requires clarification through evaluation across multiple sites

Risk of infection following semi-invasive ultrasound procedures in Scotland, 2010 to 2016:A retrospective cohort study using linked national datasets

Introduction Outbreak reports indicate a risk of cross-infection following medical procedures using semi-invasive ultrasound probes. This study aimed to evaluate the risk of infection, using microbiological reports and antibiotic prescriptions as proxy measures, associated with semi-invasive ultrasound probe procedures, including transoesophageal echocardiography, transvaginal and transrectal ultrasound. Methods Patient records from the Electronic Communication of Surveillance in Scotland and the Prescribing Information System were linked with the Scottish Morbidity Records for cases in Scotland between 2010 and 2016. Three retrospective cohorts were created to include inpatients/day-cases and outpatients in the following specialties: Cardiology, Gynaecology and Urology. Cox regression was used to quantify the association between semi-invasive ultrasound probe procedures and the risk of positive microbiological reports and community antibiotic prescriptions in the 30-day period following the procedure. Results There was a greater hazard ratio of microbiological reports for patients who had undergone transoesophageal echocardiography (HR: 4.92; 95% CI: 3.17–7.63), transvaginal (HR: 1.41; 95% CI: 1.21–1.64) and transrectal ultrasound (HR: 3.40; 95% CI: 2.90–3.99), compared with unexposed cohort members after adjustment for age, co-morbidities, previous hospital admissions and past care home residence. Similarly, there was a greater hazard ratio of antibiotic prescribing for those who had received transvaginal (HR: 1.26; 95% CI: 1.20–1.32) and transrectal (HR: 1.75; 95% CI: 1.66–1.84) ultrasound, compared with unexposed patients. Conclusion Analysis of linked national datasets demonstrated a greater risk of infection within 30 days of undergoing semi-invasive ultrasound probe procedures, using microbiological reports and antibiotic prescriptions as proxy measures of infection

Liax Is a Surrogate Marker For Cell Envelope Stress and Daptomycin Non-Susceptibility in Enterococcus Faecium

Daptomycin (DAP) is often used as a first-line therapy to treat vancomycin-resistan