Consortium for DEWATS Dissemination Society

Abstract A man in his 60s presented to RESUS by ambulance on the hottest day of the year with suspected STEMI and collapse at home. The patient was intubated and unresponsive (GCS 5), with global rigors. Hospital ECG showed sinus tachycardia. Body temperature was in excess of 41°C, confirmed on central temperature monitoring. Bilateral clear fluid was noted to be discharging from both ear canals. Query CSF leak was indication for CT head, which was unremarkable. Considering this, efforts were focused on optimising body temperature. This was done with the use of ice packs and fans as well as continuous misting of cool water over the exposed patient. Improvement was shown with temperatures decreasing to 38°C. In questioning the cause of the “clear fluid,” a swab of it placed on an icepack swiftly returned the fluid to its natural consistency of ear wax. As a result of the extraordinarily high body temperatures, ear wax had melted in both ear canals and started to leak out, giving the impression of a CSF leak. This was simply identified at the bedside to refute the idea of a CSF leak. As CSF leak was the indication for a CT head, this could have been avoided with rapid cooling initiated earlier. Unfortunately, this patient later died due to heat stroke. Whilst avoiding the delay of a CT head most likely would not have changed the prognosis for this patient, it is useful to note the importance of logical thinking in an emergency setting.

ObjectivesIt is vital that Child Protection (CP) Assessments are performed in a timely manner to protect children and gain evidence. We assessed Standards 2 and 8 of the Good practice service delivery standards for the management of children referred for CP medical assessments.1 2 Prior to this audit CDDFT aimed to see children for a physical abuse within 48 hours. At CDDFT we concerned that physical abuse referrals for children > 2 years on a Friday were being delayed and whether safety measures considered. The audit assessed whether child protection documentation completed correctly.MethodsRetrospective audit of CP medical reports, covering 98 cases from September 2021 to February 2022. We collected data on date of referral, assessment, child’s age and type of abuse. We differentiated between cases seen by safeguarding (SG) consultant or acute Paediatricians. We investigated the reasons for the delay for more than 48 hours and the day of the week when the child was referred. We evaluated whether there was documentation of safety measures agreed by social care when assessments delayed. We verified the presence of interim reports and the use of the correct age proforma.ResultsGraph shows Time child seen after referral24% of cases had a delayed CP medical assessment (24/98)92% of cases delayed were referred on Friday (22/24)No clear documentation about time of the referral on Friday83% of cases had section 47 enquiry and safety measures in place (20/24)12% of cases with > 48 hours delay (3/24) had medical review on the same day85% of cases correct age porforma used (84/98)48% of cases no evidence of interim report (48/98)43% of cases were non accidental injuries (43/98)ConclusionOur safeguarding team need to address the recurring delays in CP medical assessments where physical abuse is suspected. We need to consider rescheduling Friday clinics, CP medicals performed by the acute team over the weekend or ensuring injuries are photographed and child in a place of safety whilst awaiting their medical. When CP assessments are unavoidably delayed, it is imperative to ensure clear documentation in medical notes, along with the formulation of a safety plan in collaboration with social care. A reminder about interim reports will be circulated. Furthermore, children’s outpatient nurses should ensure age-appropriate proforma utilized. We have since changed local SG policy aiming to see children within 24 hours.3 We plan to repeat this audit in one year. 6386 Figure 1ReferencesRCPCH Good practice service delivery standards for the management of children referred for child protection medical assessments, October 2020Standard 2: Clinicians at the health provider organisation respond to requests for a child protection medical assessment in a timely fashion, following agreed documented local processes.Standard 8: The assessment, professional opinion and outcome from a child protection medical assessment is clearly recorded and communicated to the requesting professional as well as to the family and child as appropriateRCPCH Child Protection Portal, Chapter 6: The Medical Assessment and Admission to Hospital, 2013.CDDFT Child Protection Medical Assessments policy, January 2023.

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The goal of this work is to develop the controlling manipulator for the remote control of fixed wing aircraft. It consists of the mechanical part of manipulator, it`s electronics and software written for the microcontrollers. This paper describes the process of developing controlling manipulator using 3D printing technologies for mechanical part and creating a flexible software for microcontrollers which will be relevant and easy to maintain and recreate in the future. The technologies used in the development process, the materials and part manufacturing process, the software libraries were integrated into the project, the main approaches to software development, as well as an explanation of why this particular stack of technologies and engineering decisions were preferred for the implementation of this project have been described. To make sure that developed system meets its requirements it has been tested for its practical use cases

O objetivo deste trabalho é avaliar as propriedades estruturais, energéticas e eletrônicas da interação da beta-ciclodextrina (β-CD) e/ou grafeno com a molécula de ftalato de bezilbutil (BBP), através de simulações computacionais de primeiros princípios.Essas nanoestruturas podem ser usadas como possíveis nanofiltros para adsorção de ftalatos, pois a β-CD é útil na formação de inclusão de complexos e o grafeno é um nanomaterial com uma grande área superficial que possibilita a adsorção de moléculas.A avaliação é baseada na Teoria do Funcional da Densidade (DFT) através do programa Siesta.Os resultados obtidos, mostram que os sistemas mais estáveis apresentaram valores de energia de ligação entre o BBP e o grafeno/β

Abstract Estimates of accumulated quantities and qualities (Q&Q) of faecal sludge are essential for developing city-wide management plans. However, standardized approaches are lacking, and examples in scientific literature make use of diverse methodologies and parameters, making their comparability and transferability difficult. This study field-tested an approach for estimating Q&Q in Sircilla, India, and compared three methods for measuring accumulated sludge: (1) faecal sludge accumulation rate from in situ measurement with a core sampler; (2) faecal sludge accumulation rate with volume emptied by desludging truck; and (3) sludge blanket accumulation rate in situ with a core sampler. Measurements were taken at households and commercial establishments, samples were analysed for characteristics, and demographic, environmental, and technical data were collected with a questionnaire. The median total solids (TS), volatile solids (VS), and chemical oxygen demand (COD) concentrations for all containments were 26.8, 17.8, and 32.0 g/L, respectively. The median faecal sludge accumulation rate estimated with the core sampler and truck were 53 and 96 L/cap·year, respectively. The median sludge blanket accumulation rate was 17 L/cap·year. Continued data collection in this fashion will lead to a better understanding of what is accumulating in onsite containments at regional levels.

Urbanization often comes with proven benefits of economic growth and development. But it also brings with it social and environmental challenges. Solid waste is one such burgeoning challenge. With 32% of India living in urban areas, and the average per capita waste generation, not less than 210 g (Asnani, 2006), the situation is becoming critical. The Indian government has adopted a paradigm shift with the focus of the various centrally sponsored schemes being on service outcomes rather than on infrastructure creation (HPEC 2013). This study aims to review service outcomes by assessing performance at the urban local government level for municipal solid waste management (MSWM) systems. A city might perform at higher efficiency in one activity, say collection from the primary source, while lagging behind in another, say treatment. The efficiency in the entire MSWM system of a city can be increased through identifying performance gaps in the system and introducing improvements, thus facilitating a higher level of performance. By drawing insights on the performance for a particular activity in the solid waste management cycle we could go towards building a body of best practices in solid waste management.

<div class="section abstract"><div class="htmlview paragraph">In the context of evolving market conditions, the three-way catalyst (TWC) design is entering an exciting new phase. It remains the main emission control strategy for gasoline powered vehicles in the broad context of evolving engine technology; the move to more real-world, transient testing and much tighter tailpipe emissions regulations. The specific context here is the launch of BSVI regulations for gasoline passenger cars in India.</div><div class="htmlview paragraph">The key approach described here is to achieve highly beneficial emission performance based on low PGM levels with the emphasis on new materials technology to significantly alter the functional balance between PGM and “promoters”. We will focus on the design of materials with the spinel structure and have developed catalyst products that synergize low levels of PGM (so-called SPGM) leveraging the key properties of the advanced spinel oxides. Microstructure studies on the spinel oxide with newly developed composition confirm the aging stability [<span class="xref">1</span>,<span class="xref">2</span>]. Vehicle test data are reported for 10 g/ft<sup>3</sup> SPGM close-coupled (CC) and 2 g/ft<sup>3</sup> SPGM Underfloor (UF) catalysts based on the advanced spinel material. In addition transient performance of the SPGM TWC (with Spinel) will be illustrated with WLTC with a manifold mounted single CCC. Engine-out conditions at critical “stress points” will be analyzed with a view to the critical NOx conversion challenge in WLTC.</div><div class="htmlview paragraph">Prior to testing on tier2 bin 4 turbo gasoline direct injection (TGDi) vehicle using FTP and US06 drive cycles, the tested SPGM CC and UF catalysts are aged under standard 4-mode aging cycle. Our initial data show that SPGM UF performs as effectively as the standard high PGM technology UF catalyst, with lower weighted tailpipe NOx. In addition, SPGM CC catalyst with the low PGM loading (10 g/ft<sup>3</sup>) performs as effectively as the standard high PGM (>100 g/ft<sup>3</sup>) technology CC catalyst for NOx and CO conversions, but leaving a room for the improvement of non-methane hydrocarbon (NMHC) conversion performance.</div></div>

Purpose. To evaluate early and mid-term risk factors and dislocation rates in the posterior surgical approach in three separate community private practices using a short curved neck-sparing total hip stem design.Material and Methods.The three senior authors performed 338 short curved neck-sparing stem designs since April 2010 to June 2014. Various cementless acetabular components were used for all three surgical centers based on preoperative and intraoperative risk factors. All cases were reviewed retrospectively for incidence of dislocation after surgery.Version and inclination of the acetabular component and version of the femoral component were assed intra-operatively prior to final implantation. Various risk factors were reviewed including surgical approach, cup position, combined cup and stem positioning, and femoral head size.There have been significant papers in the past ten years that have recommended large head diameters to reduce the chances of head/neck mechanical impingement. Since the neck-sparing designs have a potentially increased risk of mechanical impingement head diameters were restricted to 32 mm or larger. In the smaller patient profile if a 32 mm head size could not be reached a dual-mobility style implant was chosen or stem choice was changed to a conventional style design.Results.Historically the posterior approach has had higher reports of dislocations as compared to direct anterior, anterolateral or straight lateral approach in conventional cemented and cementless implant designs. Older neck-sparing designs of conventional stem length by Freeman, Townley and Whiteside have not reported any increased dislocation problems but these stems have been associated with modified acetabular component designs, including the short curved neck sparing design of Pipino back in the 1980s.Incidence of dislocation in our series utilizing a short curved neck-sparing stem with more traditional hemispherical cementless acetabular components was 3 or 0.88%.Conclusion.Neck sparing stem designs do save significantly more bone and require less soft tissue dissection as compared to conventional cementless stem designs. Mechanical risk factors are increased with the use of short curved neck-sparing stem designs. Careful pre-operative and intra-operative evaluation does reduce the risk factors resulting in low and in some cases lower than previous published rates with conventional style stems.Short curved neck sparing stems do provide safe and reliable reproduction of the joint mechanics in routine primary total hip arthroplasty in both short and mid term results.Key Words: hip, arthroplasty, posterior approach, dislocation, neck sparing, and risk factors

Fourteen 2,3-pyrazole ring-substituted 4,4-dimethyl lithocholic acid derivatives were designed and synthesized as novel PTP1B inhibitors with good potency, selectivity as well as cell permeability.