Adverse Events Associated with Implantable Dopplers during Microvascular Surgery.

BACKGROUND: Implantable Dopplers (IDs) are widely used for postoperative free flap vascular monitoring. However, IDs may contribute to free flap complications or failure and better understanding of device malfunctions is needed. METHODS: The U.S. Food and Drug Administration's Manufacturer and User Facility Device Experience database was queried for all reports of ID adverse events from two leading manufacturers (Cook Vascular and Synovis Life Technologies) in free flap surgery from January 2010 to March 2020. Reports were reviewed and categorized. A comparison of reoperations within select categories was performed using Chi-square analysis. RESULTS: Of 209 included reports, the most common device malfunctions were venous anastomotic coupler misalignment (35.4%) and coupler ring detachment (24.4%). Synovis devices were used in 100% of reports of vessel compression and Cook Vascular devices were used in 77.7% of reports of probe detachment. Of 74 patient-related adverse events, the most common were reoperation (47.3%) and vessel occlusion (28.4%). Of five reported events of flap failure, two were associated with loss of ID signal. The proportion of Doppler signal loss events leading to reoperation was significantly greater than the proportion of any other Doppler-related event leading to reoperation. Intraoperative coupler replacement was the most commonly reported intervention (n = 86), and venous anastomosis with hand-suturing occurred in 30 device malfunctions. CONCLUSION: This study demonstrates a variety of ID-related malfunctions. One-third of device malfunctions were associated with patient complications, and false-positive Doppler signal loss contributed substantially to the requirement of surgical re-exploration. These are important considerations for surgical teams utilizing IDs in free tissue transfer procedures.

A review of the techno-economic potential and environmental impact analysis through life cycle assessment of parabolic trough collector towards the contribution of sustainable energy.

Parabolic trough collectors (P.T.Cs) are efficient solar energy harvesting devices utilized in various industries, for instance, space heating, solar cooling, solar drying, pasteurization, sterilization, electricity generation, process heat, solar cooking, and many other applications. However, their usage is limited as the high capital and operating costs; according to the International Renewable Energy Agency's 2020 report, the global weighted average levelized cost of electricity (L.C.O.E) for P.T.Cs was 0.185 $/kWh in 2018. This work analyses the economic, technical, and environmental potential of sustainable energy to increase the use of P.T.Cs in different sectors. To study how self-weight, heat loss, and wind velocity affect P.T.C performance, prototype testing, and wind flow analysis were used. Although P.T.Cs outperform in capacity factor, gross-to-net conversion, and annual energy production, improving their overall efficiency is crucial in reducing total energy production costs. Wire coils, discs, and twisted tape-type inserts can enhance their performance by increasing turbulence and heat transfer area. Improving the system's overall efficiency by enhancing the functioning and operation of individual components will also help decrease total energy production costs. The aim is to minimize the L.C.O.E associated with a P.T.C in order to enhance its economic viability for an extended period. When the nanofluid-oriented P.T.C was included in the conventional P.T.C workings, there was a decrease in the L.C.O.E by 1%. Of all the technologies available, ocean, geothermal, and C.S.P parabolic trough plants generate lower amounts of waste and harmful gases, with average emissions of 2.39%, 2.23%, and 2.16%, respectively, throughout their lifespan. For solar-only and non-hybrid thermal energy storage plants, the range of greenhouse gas emissions is between 20 and 34 kgCO2 equivalents per megawatt-hour. Coal, natural gas steam turbines, nuclear power plants, bioenergy, solar PV, geothermal, concentrated solar power, hydropower reservoir, hydropower river, ocean, and wind power plants all release greenhouse gases at rates of 1022, 587.5, 110.5, 633, 111, 48, 41, 82.5, 7.5, 12.5, and 41.5 gCO2-e/kWh, respectively. This information is useful to compare the environmental effect of various energy sources and help us to choose cleaner, more sustainable options for the production of electricity. The ongoing advancements and future scope of P.T.Cs could potentially make them more economically viable for domestic, commercial, and industrial applications.

Tracheostomy in the extremely premature neonate - Long term outcomes in a multi-institutional study.

OBJECTIVES: To describe the long-term outcomes related to breathing, feeding, and neurocognitive development in extremely premature infants requiring tracheostomy. STUDY DESIGN: Pooled cross-sectional survey. SETTING: Multi-institutional academic children's hospitals. METHODS: Extremely premature infants who underwent tracheostomy between January 1, 2012, and December 31, 2019, at four academic hospitals were identified from an existing database. Information was gathered from responses to a questionnaire by caregivers regarding airway status, feeding, and neurodevelopment 2-9 years after tracheostomy. RESULTS: Data was available for 89/91 children (96.8%). The mean gestational age was 25.5 weeks (95% CI 25.2-25.7) and mean birth weight was 0.71 kg (95% CI 0.67-0.75). Mean post gestational age at tracheostomy was 22.8 weeks (95% CI 19.0-26.6). At time of the survey, 18 (20.2%) were deceased. 29 (40.8%) maintained a tracheostomy, 18 (25.4%) were on ventilatory support, and 5 (7%) required 24-h supplemental oxygen. Forty-six (64.8%) maintained a gastrostomy tube, 25 (35.2%) had oral dysphagia, and 24 (33.8%) required a modified diet. 51 (71.8%) had developmental delay, 45 (63.4%) were enrolled in school of whom 33 (73.3%) required special education services. CONCLUSIONS: Tracheostomy in extremely premature neonates is associated with long term morbidity in the pulmonary, feeding, and neurocognitive domains. At time of the survey, about half are decannulated, with a majority weaned off ventilatory support indicating improvement in lung function with age. Feeding dysfunction is persistent, and a significant number will have some degree of neurocognitive dysfunction at school age. This information may help caregivers regarding expectations and plans for resource management.

Virtual Shadowing Program for Preclinical Medical Students.

Our annual summer shadowing program for preclinical medical students faced significant challenges due to COVID-19-related safety and resource concerns during Summer 2020. We created a pilot 7-week virtual shadowing program with the goal of providing virtual observational clinical experiences to increase students' clinical exposure and understanding of medical specialties. Faculty and preclinical medical students were matched via student preference selection and mentor availability. A practice guide was developed that outlined suggested virtual shadowing procedures. Afterward, participating faculty and students were surveyed on their experience. Overall, both faculty and students found the program effective and experienced limited technological difficulty.

The Virtual Mock Oral Examination: A Multi-institutional Study of Resident and Faculty Receptiveness.

Due to the coronavirus disease 2019 (COVID-19) pandemic, several American Board of Medical Specialties members have implemented board exams in an online format. In response, we decided to evaluate the efficacy and receptiveness of otolaryngology faculty and residents to a web-based virtual mock oral examination (MOE). Faculty and residents from DC-metropolitan institutions were recruited for decentralized virtual MOE in early 2020. A total of 28 faculty and 20 residents signed up. Follow-up included a survey study consisting of Likert scale and free-text questions to evaluate receptiveness. Helpfulness of the exercise was rated as an average of 8.8 and 9.06, respectively, by faculty and residents on a 10-point Likert scale. Likelihood to recommend a similar exercise to others was 9.2 and 9.3, respectively, for faculty and residents. All survey respondents said they would participate again if given the opportunity. We conclude that existing videoconferencing technologies can be effective tools for conducting virtual MOE by otolaryngology residency programs.

Transoral robotic surgery versus nonrobotic resection of oropharyngeal squamous cell carcinoma.

The aim of this study is to evaluate the impact of transoral robotic surgery (TORS) compared to nonrobotic surgery (NRS) on overall survival in oropharyngeal squamous cell carcinoma (OPSCC). We performed a retrospective study of patients with HPV+ and HPV- OPSCC undergoing TORS or NRS with neck dissection using the National Cancer Database from the years 2010-2016. Among patients with OPSCC in our cohort, 3167 (58.1%) patients underwent NRS and 2288 (41.9%) underwent TORS. TORS patients demonstrated better overall survival than NRS patients (HPV+ patients: aHR 0.74, p = 0.02; HPV- patients: aHR 0.58, p < 0.01). Subsite analysis showed TORS was correlated with improved survival in base of tongue (BoT) primaries for both HPV+ (aHR 0.46, p = 0.01) and HPV- (aHR 0.42, p = 0.01) OPSCC. Compared to NRS, TORS is associated with improved overall survival for HPV+ and HPV- OPSCC, as well as greater overall survival for BoT primaries.