Robust hybrid synchronization control of chaotic 3-cell CNN with uncertain parameters using smooth super twisting algorithm

This paper presents the control design framework for the hybrid synchronization (HS) and parameter identification of the 3-Cell Cellular Neural Network. The cellular neural network (CNN) of this kind has increasing practical importance but due to its strong chaotic behavior and the presence of uncertain parameters make it difficult to design a smooth control framework. Sliding mode control (SMC) is very helpful for this kind of environment where the systems are nonlinear and have uncertain parameters and bounded disturbances. However, conventional SMC offers a dangerous chattering phenomenon, which is not acceptable in this scenario. To get chattering-free control, smooth higher-order SMC formulated on the smooth super twisting algorithm (SSTA) is proposed in this article. The stability of the sliding surface is ensured by the Lyapunov stability theory. The convergence of the error system to zero yields hybrid synchronization and the unknown parameters are computed adaptively. Finally, the results of the proposed control technique are compared with the adaptive integral sliding mode control (AISMC). Numerical simulation results validate the performance of the proposed algorithm

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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Mitigation of Circulating Currents for Parallel Connected Sources in a Standalone DC Microgrid

In a standalone DC microgrid, sources are interconnected in a parallel configuration. When sources of different power ratings are parallel connected, there arises a major issue of circulating currents which disturb current sharing by sources as per their capacity. Consequently, the voltage regulation becomes poorer. Additionally, connecting line resistances also play their part to contribute to abnormal current sharing. Droop controllers are normally preferred for the mitigation of circulating currents among parallel-connected sources. However, droop controllers cannot eliminate circulating currents for different rating sources. Hence, current sharing and voltage regulation cannot be ensured simultaneously. To address the issues, a distributed architecture-based Sliding Mode Control (SMC) technique is proposed in this paper. An analysis of the circulating currents for a two-source system is presented. Simulation results are presented to show the effectiveness and fail-safe operation of the proposed technique in a steady-state condition

Robust Control Design of Multiple Quadrotors Formation

In this study, a control strategy is presented for multiple quadrotors, inclusive of sliding mode control and proportional derivative (PD) control, with the goal of providing stability, robustness, reduced disturbance, and formation tracking in uncertain conditions and environments. The presented control technique is based on Newton-Euler equations and satisfying Lyapunov’s stability conditions, using sliding mode controller design and PD controller design. The designed control technique was implemented, and the desired results were achieved with minimized position error, orientation error, and distance error, while adhering to Lyapunov’s stability conditions

Exploring the Antioxidant and Anti-Inflammatory Potential of Wilckia maritima: In Vitro and In Silico Investigations

This research aimed to assess the anti-inflammatory and antioxidant potential of methanol extract of Wilckia maritima, a plant belonging to the family Brassicaceae, which is enriched with natural antioxidants. Qualitative phytochemical studies showed the presence of numerous compounds including glycosides, phenols, triterpenoids, and GC-MS studies revealed the presence of 35 bioactive components, including n-hexadecanoic acid (26.96%), 9,12,15 octadecatrienoic acid (cis) (25.52%), 3,5 di-hydroxy-6-methyl 2,3-di-hydro-4-pyran 4-one (14.35%), and 3-tertiary butyl-4-hydroxy-anisol (11.68%) as major components, which are thought to be responsible for anti-inflammatory and antioxidant potentials of methanol extract of W. maritima., flavonoids, steroids, tannins, and saponins. The antioxidant potential of the extract was determined by performing various assays, including DPPH free radical scavenging, ferrous reducing, and hydrogen peroxide assays, which showed significant percentage inhibition (83.55 +/- 0.89, 79.40 +/- 1.17, and 81.26 +/- 0.36%, respectively) as compared to ascorbic acid (standard). The extract also exhibited significant anti-inflammatory activity with percentage inhibition 65.66 +/- 0.42% compared to standard ibuprofen, which showed 73.20 +/- 0.21% inhibition. In vivo analysis further confirmed this anti-inflammatory potential of the extract, showing a 75.55 +/- 0.11% reduction in edema at 300 mg/kg as compared with standard diclofenac sodium 70.27 +/- 0.012%. Moreover, in silico investigations revealed that the phytocompounds in W. maritima exhibited excellent antioxidant and anti-inflammatory characteristics, which could provide novel biological molecules for target receptors. Overall, our findings suggest that W. maritima can be utilized as a potential resource of natural compounds with antioxidants and anti-inflammatory potential, with promising therapeutic effect in relieving various ailments related to inflammatory response.Funding Agencies|King Saud University, Riyadh, Saudi Arabia [RSP-2023R437]</p

Zircon U-Pb Ages, Petrogenesis, and Tectono-Magmatic Evolution of Late Jurassic–Early Cretaceous S-Type Granitoid in Wujinshan Area of Northwestern Zhejiang, South China

Northwest Zhejiang area (NWZJ) is one of the important parts of the large Qingzhou-Hangzhou mineralized belt in South China formed during the Late Jurassic–Early Cretaceous period. Through the study of zircon LA-ICPMS U-Pb dating, whole-rock geochemistry, and Sr-Nd isotopes for the Wujinshan granitoid in NWZJ, two distinct S-type granitic rocks of porphyry type granodiorite and granite were identified, and the two ages of 146.4 ± 1.5 Ma for granodiorite porphyry and 141.9 ± 1.4 Ma for granite porphyries were obtained. These rocks exhibited a geochemical affinity for S-type granitoid, and the two magmatic ages indicate that these rocks were intruded in two magmatic pulses. The Late Jurassic granodiorite porphyry showed moderate SiO2 (64.38–67.89 wt.%) with higher K2O + Na2O (6.22–6.78 wt.%), lower K2O/Na2O (0.57–0.96), moderate Zr (170–215 ppm), high Sr (302–475 ppm), and low Mg# (31–32) contents. The Early Cretaceous granite porphyries contained high SiO2 (69.68–74.85 wt.%), variable K2O + Na2O (4.60–6.99), high K2O/Na2O (1.72–23.53), slightly higher Zr (160–255 ppm), variable Sr (25–412 ppm), and very low to intermediate Mg# (13–44). The granodiorites had intermediate ∑REE (149–177 ppm), while granite samples showed moderate to high ∑REE content (147–271 ppm), and both rocks showed negative Eu anomalies (0.18–0.29). We propose that these two rocks were predominantly generated by the partial melting of Mesoproterozoic metamorphic basement and underwent variable degrees of fractionation and evolution. The Late Jurassic granodiorite porphyry was formed by the partial melting of Mesoproterozoic metamorphic basement with slab-derived melts or basaltic lower crust input following fractional crystallization, while the Early Cretaceous granite porphyries were generated by the partial melting of Mesoproterozoic metamorphic basement and crystal fractionation with variable magma mixing and assimilation in the upper crust. Tectonically, the Wujinshan granitoid formed in a volcanic arc setting largely affected by the subduction and slab rollback of the paleo-Pacific Plate

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care

BJS commission on surgery and perioperative care post-COVID-19

Background: Coronavirus disease 2019 (COVID-19) was declared a pandemic by the WHO on 11 March 2020 and global surgical practice was compromised. This Commission aimed to document and reflect on the changes seen in the surgical environment during the pandemic, by reviewing colleagues experiences and published evidence. Methods: In late 2020, BJS contacted colleagues across the global surgical community and asked them to describe how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had affected their practice. In addition to this, the Commission undertook a literature review on the impact of COVID-19 on surgery and perioperative care. A thematic analysis was performed to identify the issues most frequently encountered by the correspondents, as well as the solutions and ideas suggested to address them. Results: BJS received communications for this Commission from leading clinicians and academics across a variety of surgical specialties in every inhabited continent. The responses from all over the world provided insights into multiple facets of surgical practice from a governmental level to individual clinical practice and training. Conclusion: The COVID-19 pandemic has uncovered a variety of problems in healthcare systems, including negative impacts on surgical practice. Global surgical multidisciplinary teams are working collaboratively to address research questions about the future of surgery in the post-COVID-19 era. The COVID-19 pandemic is severely damaging surgical training. The establishment of a multidisciplinary ethics committee should be encouraged at all surgical oncology centres. Innovative leadership and collaboration is vital in the post-COVID-19 era