Time Dependent Capacity Increase for Driven Pile in Cohesionless Soil

The increase in driven pile capacity with time is termed set-up. The mechanism contributing to this phenomenon is not yet fully understood. Moreover, a rational approach to account for the increase in driven pile capacity with time in design has not yet been developed. In this study, a database comprising of 55 pile load tests (static and dynamic tests) were collected from the current engineering literature. The piles were driven in cohesionless soils with sand relative density varying from loose to dense. The measured capacities of the database piles with time were correlated to pile characteristics and soil properties. Pile set-up was found to be a phenomenon related to an increase in pile shaft friction with time and increases with decreasing pile diameter. On the other hand, pile setup was found to increase with increasing pile penetration depth and thus with pile slenderness ratio. A new approach for the estimation of pile set-up in cohesionless soils is presented in this study. The new approach considers the effects of pile characteristics and soil properties. Comparison of predicted and measured pile set-up using the developed method in this study indicates reasonable agreement. Also, comparison of prediction using the new approach with those made using previously published methods indicates that the developed method in this study yields better results

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

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

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

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

High-Performance and Power-Saving Mechanism for Page Activations Based on Full Independent DRAM Sub-Arrays in Multi-Core Systems

Modern DRAM devices&#x2019; performance and energy efficiency are significantly improved when the row-buffer locality is exploited properly. In multi-core architectures, however, the DRAM-based main memory banks used by the processing units, called cores, are shared. Memory interference, also known as memory contention, occurs when many cores contend for simultaneous access to the shared banks. The performance benefits provided by utilizing the available row-buffer locality are diminished by the increased memory contention brought on by the integration of more cores. Large DRAM page sizes are therefore activated in order to access only a tiny amount of data. Poor energy efficiency or wasted opportunity to loosen DRAM power timing restrictions are both downsides to this page over-fetching issue. This study introduces a Fine-Grained Activation (FGA) technique to reduce the number of involved bitlines when accessing DRAM memory. This technique significantly improves the parallelism at the DRAM subarray level to support multiple memory accesses routed to distinct subarrays inside the same memory bank. The FGA technique presented in this research intends to provide large energy savings while simultaneously delivering significant performance gains. Our evaluation findings with 4-core multi-program benchmarks demonstrate that the FGA technique proposed in this paper can significantly improve both DRAM performance and DRAM energy efficiency with a negligible area overhead. In comparison to the baseline, the Half-DRAM page activation mechanism, and the recently suggested FGA mechanism, the proposed technique in this study reduces the average DRAM memory access latency for the evaluated four-core applications by 25.6&#x0025;, 27.1&#x0025;, and 14.8&#x0025;, respectively. Our introduced technique also decreases the DRAM activation power by an average of 46.7&#x0025;, 27.1&#x0025;, and 14.7&#x0025;, respectively, when compared with the baseline, Half-DRAM technique, and the recently proposed FGA mechanism

Hybrid Chain: Blockchain Enabled Framework for Bi-Level Intrusion Detection and Graph-Based Mitigation for Security Provisioning in Edge Assisted IoT Environment

Internet of Things (IoT) is an emerging technology and its applications are flattering amidst many users, as it makes everything easier. As a consequence of its massive growth, security and privacy are becoming crucial issues where the IoT devices are perpetually vulnerable to cyber-attacks. To overcome this issue, intrusion detection and mitigation is accomplished which enhances the security in IoT networks. In this paper, we proposed Blockchain entrenched Bi-level intrusion detection and graph based mitigation framework named as HybridChain-IDS. The proposed work embrace four sequential processes includes time-based authentication, user scheduling and access control, bi-level intrusion detection and attack graph generation. Initially, we perform time-based authentication to authenticate the legitimate users using NIK-512 hashing algorithm, password and registered time are stored in Hybridchain which is an assimilation of blockchain and Trusted Execution Environment (TEE) which enhances data privacy and security. After that, we perform user scheduling using Cheetah Optimization Algorithm (COA) which reduces the complexity and then the access control is provided to authorized users by smart contract by considering their trust and permission level. Then, we accomplish bi-level intrusion detection using ResCapsNet which extracts sufficient features and classified effectively. Finally, risk of the attack is evaluated, and then the attacks graphs are generated by employing Enhanced k-nearest neighbor (KNN) algorithm to identify the attack path. Furthermore, the countermeasures are taken based on the attack risk level and the attack graph is stored in Hybridchain for eventual attack prediction. The implementation of this proposed work is directed by network simulator of NS-3.26 and the performance of the proposed HybridChain-IDS is enumerated based on various performance metrics