Isolated forearm technique: a meta-analysis of connected consciousness during different general anaesthesia regimens

BACKGROUND: General anaesthesia should prevent patients from experiencing surgery, defined as connected consciousness. The isolated forearm technique (IFT) is the current gold standard for connected consciousness monitoring. We evaluated the efficacy of different anaesthesia regimens in preventing IFT responses. METHODS: We conducted a systematic review with meta-analysis of studies evaluating IFT in adults. Proportions of IFT-positive patients were compared for inhalational versus intravenous anaesthesia and anaesthesia brain monitor (ABM)-guided versus non-ABM-guided. RESULTS: Of 1131 patients in 22 studies, 393 (34.8%) had an IFT response during induction or maintenance. IFT-positive patients were less frequent during induction (19.7% [95% CI, 17.5-22.1]) than during maintenance (31.2% [95% CI, 27.8-34.8]). Proportions of IFT-positive patients during induction and maintenance were similar for inhalational (0.51 [95% CI, 0.38-0.65]) and intravenous (0.52 [95% CI, 0.26-0.77]) anaesthesia, but during maintenance were lower with inhalational (0.18 [95% CI, 0.08-0.38]) than with intravenous (0.48 [95% CI, 0.24-0.73]) anaesthesia. Proportions of IFT-positive patients during induction and maintenance were not significantly different for ABM-guided (0.64 [95% CI, 0.39-0.83]) and non-ABM-guided (0.48 [95% CI, 0.34-0.62]) anaesthesia but during maintenance were lower with non-ABM-guided (0.19 [95% CI, 0.09-0.37]) than with ABM-guided (0.57 [95% CI, 0.34-0.77]). Proportions of IFT-positive patients decreased significantly with increasing age and premedication use. Of the 34 anaesthesia regimens, 16 were inadequate. Studies had low methodological quality (only seven randomised controlled trials) and significant heterogeneity. CONCLUSIONS: Standard general anaesthesia regimens might not prevent connected consciousness. More accurate anaesthesia brain monitor methodology to reduce the likelihood of connected consciousness is desirable

On the mitigation of renewable energy curtailment by using pumped hydro storage systems

To increase the penetration of renewable energy sources into electrical systems, it is essential to lessen renewable energy curtailment. Pumped Hydro Storage (PHS) systems are a promising alternative to achieve lower curtailment rates. This work analyses the effect of a PHS system in an electrical network regarding renewable energy curtailment behaviour. The analysis is addressed through an optimal power flow formulation to minimize power loss while satisfying operating and renewable energy curtailment constraints. Preliminary results for a modified IEEE 14-bus test feeder suggested that implementing the PHS decreased transmission losses by 2.2% and mitigated 16.8% of curtailed renewable energy for wholeyear simulations.The authors are grateful to the Foundation for Science and Technology (FCT, Portugal) for financial support through national funds FCT/MCTES (PIDDAC) to CeDRI (UIDB/05757/2020 and UIDP/05757/2020) and SusTEC (LA/P/0007/2021). This work has been supported by NORTE-01-0247-FEDER-072615 EPO – Enline Power Optimization - The supra-grid optimization software.info:eu-repo/semantics/publishedVersio

Analysis and Performance Evaluation of a Two-Stage Resonant Converter for Wide Voltage Range Operation

This paper proposes a two-stage isolated dc-dc converter for electric vehicle charging applications, where high efficiency over a wide range of battery voltages is required. It employs a first pre-regulation stage and a second half-bridge LLC stage, integrated with the first. The second stage is always operated at resonance, ensuring very high efficiency. The first pre-regulation stage is responsible for the desired input-to-output voltage conversion ratio and the zero-voltage switching operation of all the switches. This allows low conversion losses even with voltages that may vary over a wide range. The conversion structure is shown considering a first experimental prototype that interfaces a 750-V dc-link with an output bus with nominal voltage range 250V-500V. The implemented module is rated 5 kW and achieves a peak efficiency of 98.0% at 3 kW output power

Evaluation of right ventricular function performed by 3d-echocardiography in scleroderma patients

The impairment of the right ventricle (RV) in systemic sclerosis (SSc) is usually related to pulmonary arterial hypertension (PAH). New echocardiographic techniques, such as 3-dimensional echocardiography (3DE) and 2-dimensional speckle tracking (2DSTE), allow an accurate evaluation of the RV function. The aim of this study was to evaluate the RV function using 3DE and 2DSTE in SSc patients with no history of heart disease and no PAH. Forty-five SSc patients, 42 females and 3 males, 28 with limited cutaneous SSc (lcSSc) and 17 with diffuse cutaneous SSc (dcSSc), were studied. Forty-three age- and gender-matched healthy subjects were enrolled as controls. All of them underwent a 3DE and 2DSTE ecocardiographic evaluation of the RV function. Systolic pulmonary arterial pressure (sPAP) and total pulmonary vascular resistance (tPVR) were also estimated by power doppler. RV echocardiographic parameters were compared in the different subsets of SSc patients. A statistical analysis was performed by t-test, ANOVA and multiple logistic regression. RV areas in 2DSTE and volumes in 3DE were higher and RV function parameters were reduced in SSc patients compared with controls. Also sPAP and tVPR were higher, but they did not reach pathological values. Echocardiographic alterations were more pronounced in patients with lcSSc. 3DE and 2DSTE echocardiography allowed us to detect morphological and functional alterations of the RV in a group of SSc patients with no clinical signs of heart disease and no PAH. These patients had significantly higher sPAP and tPVR than healthy controls without reporting values compatible with PAH. These data suggest that RV alterations are related to a pressure overload rather than to an intrinsic myocardial involvement in SSc

Mitigation of nitrous oxide emission from cattle excreta in pasture with dicyandiamide (DCD).

Resumo

Effects of mixing state on optical and radiative properties of black carbon in the European Arctic

Atmospheric aging promotes internal mixing of black carbon (BC), leading to an enhancement of light absorption and radiative forcing. The relationship between BC mixing state and consequent absorption enhancement was never estimated for BC found in the Arctic region. In the present work, we aim to quantify the absorption enhancement and its impact on radiative forcing as a function of microphysical properties and mixing state of BC observed in situ at the Zeppelin Arctic station (78°&thinsp;N) in the spring of 2012 during the CLIMSLIP (Climate impacts of short-lived pollutants in the polar region) project.Single-particle soot photometer (SP2) measurements showed a mean mass concentration of refractory black carbon (rBC) of 39&thinsp;ng&thinsp;m−3, while the rBC mass size distribution was of lognormal shape, peaking at an rBC mass-equivalent diameter (DrBC) of around 240&thinsp;nm. On average, the number fraction of particles containing a BC core with DrBC&gt;80&thinsp;nm was less than 5&thinsp;% in the size range (overall optical particle diameter) from 150 to 500&thinsp;nm. The BC cores were internally mixed with other particulate matter. The median coating thickness of BC cores with 220&thinsp;nm&thinsp;&lt;&thinsp;DrBC&lt; 260&thinsp;nm was 52&thinsp;nm, resulting in a core–shell diameter ratio of 1.4, assuming a coated sphere morphology. Combining the aerosol absorption coefficient observed with an Aethalometer and the rBC mass concentration from the SP2, a mass absorption cross section (MAC) of 9.8&thinsp;m2&thinsp;g−1 was inferred at a wavelength of 550 nm. Consistent with direct observation, a similar MAC value (8.4&thinsp;m2&thinsp;g−1 at 550&thinsp;nm) was obtained indirectly by using Mie theory and assuming a coated-sphere morphology with the BC mixing state constrained from the SP2 measurements. According to these calculations, the lensing effect is estimated to cause a 54&thinsp;% enhancement of the MAC compared to that of bare BC particles with equal BC core size distribution. Finally, the ARTDECO radiative transfer model was used to estimate the sensitivity of the radiative balance to changes in light absorption by BC as a result of a varying degree of internal mixing at constant total BC mass. The clear-sky noontime aerosol radiative forcing over a surface with an assumed wavelength-dependent albedo of 0.76–0.89 decreased, when ignoring the absorption enhancement, by −0.12&thinsp;W&thinsp;m−2 compared to the base case scenario, which was constrained with mean observed aerosol properties for the Zeppelin site in Arctic spring. The exact magnitude of this forcing difference scales with environmental conditions such as the aerosol optical depth, solar zenith angle and surface albedo. Nevertheless, our investigation suggests that the absorption enhancement due to internal mixing of BC, which is a systematic effect, should be considered for quantifying the aerosol radiative forcing in the Arctic region.</p