A Robust Artificial Intelligence Approach with Explainability for Measurement and Verification of Energy Efficient Infrastructure for Net Zero Carbon Emissions.

Rapid urbanization across the world has led to an exponential increase in demand for utilities, electricity, gas and water. The building infrastructure sector is one of the largest global consumers of electricity and thereby one of the largest emitters of greenhouse gas emissions. Reducing building energy consumption directly contributes to achieving energy sustainability, emissions reduction, and addressing the challenges of a warming planet, while also supporting the rapid urbanization of human society. Energy Conservation Measures (ECM) that are digitalized using advanced sensor technologies are a formal approach that is widely adopted to reduce the energy consumption of building infrastructure. Measurement and Verification (M&V) protocols are a repeatable and transparent methodology to evaluate and formally report on energy savings. As savings cannot be directly measured, they are determined by comparing pre-retrofit and post-retrofit usage of an ECM initiative. Given the computational nature of M&V, artificial intelligence (AI) algorithms can be leveraged to improve the accuracy, efficiency, and consistency of M&V protocols. However, AI has been limited to a singular performance metric based on default parameters in recent M&V research. In this paper, we address this gap by proposing a comprehensive AI approach for M&V protocols in energy-efficient infrastructure. The novelty of the framework lies in its use of all relevant data (pre and post-ECM) to build robust and explainable predictive AI models for energy savings estimation. The framework was implemented and evaluated in a multi-campus tertiary education institution setting, comprising 200 buildings of diverse sensor technologies and operational functions. The results of this empirical evaluation confirm the validity and contribution of the proposed framework for robust and explainable M&V for energy-efficient building infrastructure and net zero carbon emissions.

Total knee replacement following high tibial osteotomy versus total knee replacement without high tibial osteotomy: a systematic review and meta analysis.

INTRODUCTION: Currently, there is no consensus as to whether total knee replacement(TKR) following high tibial osteotomy(HTO) provides similar postoperative outcomes as compared to TKR without previous HTO. Previous studies have provided limited evidence to small sample sizes and methodological inappropriateness. METHODS: A systematic search process was conducted utilising PRISMA guidelines. Electronic, peer reviewed and published literatures were searched. Databases searched include Embase, Medline, Cochrane Library, PubMed and cross references. Methodological appropriateness was assessed with Papadokastakis system and Critical Appraisal Skills questionnaire. Data were analysed for both clinical and statistical homogeneity. Meta analytic pooling was subsequently performed. RESULTS: 11 studies including 2170 TKR procedures were analysed for systematic review. The study (TKR following previous HTO) and control (TKR without previous HTO) groups were adequately matched for age, sex ratio and follow-up. Meta analysis of six studies utilising KSS system and four studies utilising HSS system showed no significant (p > 0.05) difference between the two groups. Complications also showed no significant difference between the two groups. At an average follow-up of 7.2 years, with revision arthroplasty for any cause as the endpoint, survivorship for the study and control groups was 95 and 97 %, respectively. For revision arthroplasty with aseptic loosening as the end point, the survivorship was 98 % for both groups. CONCLUSION: Systematic review and meta analysis suggested that TKR following HTO provides similar outcomes as compared to TKR without previous HTO. Therefore, a previous HTO does not negatively influence a future TKR, though the conversion process of HTO to TKR is technically challenging. Systematic review also identified paucity in prospective and long term studies.

Statistics of dislocation slip avalanches in nanosized single crystals show tuned critical behavior predicted by a simple mean field model.

We show that slowly sheared metallic nanocrystals deform via discrete strain bursts (slips), whose size distributions follow power laws with stress-dependent cutoffs. We show for the first time that plasticity reflects tuned criticality, by collapsing the stress-dependent slip-size distributions onto a predicted scaling function. Both power-law exponents and scaling function agree with mean-field theory predictions. Our study of 7 materials and 2 crystal structures, at various deformation rates, stresses, and crystal sizes down to 75 nm, attests to the universal characteristics of plasticity.

The impact of COVID-19 infection on hip fracture 30-day mortality.

Introduction: A novel virus, SARS-CoV-2, has caused a fatal global pandemic which particularly affects the elderly and those with comorbidities. Hip fractures affect elderly populations, necessitate hospital admissions and place this group at particular risk from COVID-19 infection. This study investigates the effect of COVID-19 infection on 30-day hip fracture mortality. Method: Data related to 75 adult hip fractures admitted to two units during March and April 2020 were reviewed. The mean age was 83.5 years (range 65-98 years), and most (53, 70.7%) were women. The primary outcome measure was 30-day mortality associated with COVID-19 infection. Results: The COVID-19 infection rate was 26.7% (20 patients), with a significant difference in the 30-day mortality rate in the COVID-19-positive group (10/20, 50%) compared to the COVID-19-negative group (4/55, 7.3%), with mean time to death of 19.8 days (95% confidence interval: 17.0-22.5). The mean time from admission to surgery was 43.1 h and 38.3 h, in COVID-19-positive and COVID-19-negative groups, respectively. All COVID-19-positive patients had shown symptoms of fever and cough, and all 10 cases who died were hypoxic. Seven (35%) cases had radiological lung findings consistent of viral pneumonitis which resulted in mortality (70% of mortality). 30% (n = 6) contracted the COVID-19 infection in the community, and 70% (n = 14) developed symptoms after hospital admission. Conclusion: Hip fractures associated with COVID-19 infection have a high 30-day mortality. COVID-19 testing and chest X-ray for patients presenting with hip fractures help in early planning of high-risk surgeries and allow counselling of the patients and family using realistic prognosis.

Value of a Pharmacy-Adjudicated Community Care Prior Authorization Drug Request Service.

Background: Many veterans are eligible to receive prescriptions from community-based pharmacies. Swift and accurate review of prior authorization drug requests by the US Department of Veterans Affairs (VA) pharmacy is necessary to mitigate treatment delays, medication misuse, adverse drug events, medication errors, and unnecessary cost to the health care system. Methods: We performed a retrospective review of community care prior authorization drug requests to assess the direct cost savings achieved through a centralized process and to characterize submitted requests. Results: The centralized community care pharmacy team demonstrated a cost savings of $515,872.31 over 6 months and increased patient safety. Community care prior authorization drug requests had a 46.2% approval rate. Coordination of care took an average of 8 days. Conclusions: Use of a centralized community care pharmacy team could result in significant annual cost savings for the VA. Considering the approval rate seen in this study, VA could allocate resources to educate community-based prescribers about its formulary to increase the approval rate and reduce administrative burden for VA pharmacies and prescribers.

Design, Synthesis, and Biological Characterization of Inhaled p38α/ß MAPK Inhibitors for the Treatment of Lung Inflammatory Diseases.

The identification of novel inhaled p38α/ß mitogen-activated protein kinases (MAPK) (MAPK14/11) inhibitors suitable for the treatment of pulmonary inflammatory conditions has been described. A rational drug design approach started from the identification of a novel tetrahydronaphthalene series, characterized by nanomolar inhibition of p38α with selectivity over p38γ and p38δ isoforms. SAR optimization of 1c is outlined, where improvements in potency against p38α and ligand-enzyme dissociation kinetics led to several compounds showing pronounced anti-inflammatory effects in vitro (inhibition of TNFα release). Targeting of the defined physicochemical properties allowed the identification of compounds 3h, 4e, and 4f, which showed, upon intratracheal instillation, low plasma levels, prolonged lung retention, and anti-inflammatory effects in a rat acute model of a bacterial endotoxin-induced pulmonary inflammation. Compound 4e, in particular, displayed remarkable efficacy and duration of action and was selected for progression in disease models of asthma and chronic obstructive pulmonary disease (COPD).

The synthesis and preclinical evaluation in rhesus monkey of [¹8F]MK-6577 and [¹¹C]CMPyPB glycine transporter 1 positron emission tomography radiotracers.

Two positron emission tomography radiotracers for the glycine transporter 1 (GlyT1) are reported here. Each radiotracer is a propylsulfonamide-containing benzamide and was labeled with either carbon-11 or fluorine-18. [¹¹C]CMPyPB was synthesized by the alkylation of a 3-hydroxypyridine precursor using [¹¹C]MeI, and [¹8F]MK-6577 was synthesized by a nucleophilic aromatic substitution reaction using a 2-chloropyridine precursor. Each tracer shows good uptake into rhesus monkey brain with the expected distribution of highest uptake in the pons, thalamus, and cerebellum and lower uptake in the striatum and gray matter of the frontal cortex. In vivo blockade and chase studies of [¹8F]MK-6577 showed a large specific signal and reversible binding. In vitro autoradiographic studies with [¹8F]MK-6577 showed a large specific signal in both rhesus monkey and human brain slices and a distribution consistent with the in vivo results and those reported in the literature. In vivo metabolism studies in rhesus monkeys demonstrated that only more-polar metabolites are formed for each tracer. Of these two tracers, [¹8F]MK-6577 was more extensively characterized and is a promising clinical positron emission tomography tracer for imaging GlyT1 and for measuring GlyT1 occupancy of therapeutic compounds.

The impact of COVID-19 infection on hip fractures 30-day mortality.

Introduction: A novel virus, SARS-CoV-2 has caused a fatal global pandemic which particularly affects the elderly and those with co-morbidities. Hip fractures affect elderly populations, necessitate hospital admissions, and place this group at particular risk from COVID-19 infection. This study investigates the effect of COVID-19 infection on 30-day hip fracture mortality. Method: Data related to seventy-five adult hip fractures admitted to two units during March and April 2020 was reviewed. The mean age was 83.5 years (range 65-98 years) and most (53, 70.7%) were females. The primary outcome measure was 30-day mortality associated with COVID-19 infection. Results: The COVID-19 infection rate was 26.7% (20 patients), with a significant difference in the 30-day mortality rate in COVID-19 positive group (10/20, 50%) compared to COVID-19 negative group (4/55, 7.3%), with mean time to death of 19.8 days (95% confidence interval 17.0-22.5). The mean time from admission to surgery was 43.1 hours and 38.3 hours, in COVID-19 positive and COVID-19 negative groups, respectively. All COVID-19 positive patients had shown symptoms of fever and cough, and all ten cases who died were from hypoxia. Seven (35%) cases had radiological lung findings consistent with viral pneumonitis which resulted in mortality (70% of mortality). 30% (n = 6) contracted the COVID-19 infection in the community and 70% (n = 14) developed symptoms after hospital admission. Conclusion: Hip fractures associated with COVID-19 infection have a high 30-day mortality. COVID-19 testing and chest x-ray for patients presenting with hip fractures, helps in early planning of high-risk surgeries and allows counselling of the patients and family using realistic prognosis.

Microstructure versus size: mechanical properties of electroplated single crystalline Cu nanopillars.

We report results of uniaxial compression experiments on single-crystalline Cu nanopillars with nonzero initial dislocation densities produced without focused ion beam (FIB). Remarkably, we find the same power-law size-driven strengthening as FIB-fabricated face-centered cubic micropillars. TEM analysis reveals that initial dislocation density in our FIB-less pillars and those produced by FIB are on the order of 10(14) m(-2) suggesting that mechanical response of nanoscale crystals is a stronger function of initial microstructure than of size regardless of fabrication method.

In situ characterization of vertically oriented carbon nanofibers for three-dimensional nano-electro-mechanical device applications.

We have performed mechanical and electrical characterization of individual as-grown, vertically oriented carbon nanofibers (CNFs) using in situ techniques, where such high-aspect-ratio, nanoscale structures are of interest for three-dimensional (3D) electronics, in particular 3D nano-electro-mechanical-systems (NEMS). Nanoindentation and uniaxial compression tests conducted in an in situ nanomechanical instrument, SEMentor, suggest that the CNFs undergo severe bending prior to fracture, which always occurs close to the bottom rather than at the substrate-tube interface, suggesting that the CNFs are well adhered to the substrate. This is also consistent with bending tests on individual tubes which indicated that bending angles as large as approximately 70 degrees could be accommodated elastically. In situ electrical transport measurements revealed that the CNFs grown on refractory metallic nitride buffer layers were conducting via the sidewalls, whereas those synthesized directly on Si were electrically unsuitable for low-voltage dc NEMS applications. Electrostatic actuation was also demonstrated with a nanoprobe in close proximity to a single CNF and suggests that such structures are attractive for nonvolatile memory applications. Since the magnitude of the actuation voltage is intimately dictated by the physical characteristics of the CNFs, such as diameter and length, we also addressed the ability to tune these parameters, to some extent, by adjusting the plasma-enhanced chemical vapor deposition growth parameters with this bottom-up synthesis approach.

Universal consent practice in academic intensive care units (ICUs).

UNLABELLED: The purpose of this study was to determine national practice for obtaining consent in academic adult intensive care units (ICUs) for routine bedside procedures and to define universal consent rates by patient demographics within our own institution's ICUs. METHODS: A 10-question survey was sent to the program directors for all U.S. surgical and pulmonary critical care directors regarding consent practices. Further, the adoption of a universal consent protocol in an academic county hospital was studied. RESULTS: Cross-sectional study: Thirty-seven percent of program directors completed the survey. Consent rates varied from 35% to 97% by procedure, with only 14% using a universal consent document. Providers in Medical ICUs obtained consent more often than in Surgical ICUs for both central line and pulmonary artery catheter placement (82.8% and 93.1% vs. 52.6% and 52.6%, respectively). Prospective cohort study: At our institution, 90% of 363 patients or their proxies signed universal consent for procedures, 4.4% consent with exemptions, while 5.2% refused. Insured patients were 2.7 times more likely to sign full universal consent for bedside ICU procedures than uninsured patients. CONCLUSION: There was a national variation in ICU consent practices with an interest in a wider usage of universal consent protocols. The latter was adopted differentially based on patient demographics. Universal consent was widely accepted at our institution.

Molecular phylogeny of the Herpestidae (Mammalia, Carnivora) with a special emphasis on the Asian Herpestes.

Until now, phylogenetic studies of the mongooses (Carnivora, Herpestidae) have not included an exhaustive sampling of the Asian members of this family. In this study, we used mitochondrial (Cytochrome b and ND2), nuclear (beta-fibrinogen intron 7 and Transthyretin intron 1) sequences from almost all of the recognized mongoose species to produce a well-resolved phylogeny of the Herpestidae. We also performed molecular dating analyses to infer divergence dates of the different lineages within the Herpestidae. Our results confirmed the paraphyly of the Herpestes genus and other phylogenetic relationships, which previously had only been moderately supported. The Asian herpestid species were found to form a monophyletic group within the Herpestidae. Within the Asian species, a cyto-nuclear conflict was discovered between the small Indian mongoose (Herpestes auropunctatus), the Indian gray mongoose (Herpestes edwardsii) and the Javan mongoose (Herpestes javanicus), which may have occurred through interspecific hybridization. This study inferred an Early Miocene origin for the Herpestidae and a Middle Miocene origin for the Asian mongooses.

Optimisation of a series of potent, selective and orally bioavailable GlyT1 inhibitors.

A series of heterocyclic sulfonamides have been developed which are potent and selective inhibitors of hGlyT1. SAR studies to optimise the in vitro and in vivo properties are described. Optimisation of the central scaffold resulted in cyclohexane sulfones 28 and 29, which have good PK properties and show promise for further development.

Simultaneous metacarpophalangeal joint ulnar collateral ligament injury and carpometacarpal dislocation of the thumb in a football player: a case report.

An unusual case of ulnar collateral ligament avulsion in association with carpometacarpal dislocation of thumb is described. Symptoms and deformity caused by dislocation can mask the presence of injuries such as damage to the ulnar collateral ligament of thumb. This may lead to long term disability. A high index of suspicion and good clinical examination allows correct diagnosis and management of these uncommon injuries leading to a good clinical outcome.

Serum B-type natriuretic peptide: a marker of fluid resuscitation after injury?

BACKGROUND: Excessive volume resuscitation after injury is associated with severe complications. B-type natriuretic peptide (BNP) is secreted from myocardium under increased wall stretch and is used in medical intensive care units (ICUs) as a noninvasive method to detect heart failure. However, the use of BNP as a marker of fluid overload during resuscitation from injury has not been previously described. METHODS: Serum BNP levels were prospectively followed in 134 trauma ICU patients. Levels were obtained at admission and at 12, 24, and 48 hours. Repeated measures analysis of variance was used to test for differences in BNP levels over time. Post hoc pairwise comparisons were made with Bonferroni correction when the omnibus test indicated significance. Chest films were obtained at 24 hours and scored for the presence of pulmonary edema by a radiologist blinded to BNP measurements (n = 45). Twenty-four hour BNP levels for patients with or without radiographic evidence of pulmonary edema were compared using nonparametric analysis (Mann-Whitney U). RESULTS: Admission BNP levels were low and increased with fluid resuscitation over time in all patients (p = 0.002) as well as in a subgroup of patients <60 years of age (p = 0.003). At 24 hours, 25 patients had no pulmonary edema evident on chest X-ray, whereas 20 were scored indicating that pulmonary edema was present. Patients with evidence of pulmonary edema had higher mean BNP levels at 24 hours (110 +/- 31 pg/mL) than did patients without edema (47.0 +/- 10.8 pg/mL) (p = 0.04). CONCLUSIONS: Serum BNP levels increase with resuscitation after injury and levels are higher in patients who develop pulmonary edema. These findings suggest that BNP might be a marker of excessive volume resuscitation after injury.

Traumatic colon injury in damage control laparotomy-A multicenter trial: Is it safe to do a delayed anastomosis?

BACKGROUND: Delayed colonic anastomosis after damage control laparotomy (DCL) is an alternative to colostomies during a single laparotomy (SL) in high-risk patients. However, literature suggests increased colonic leak rates up to 27% with DCL, and various reported risk factors. We evaluated our regional experience to determine if delayed colonic anastomosis was associated with worse outcomes. METHODS: A multicenter retrospective cohort study was performed across three Level I trauma centers encompassing traumatic colon injuries from January 2006 through June 2014. Patients with rectal injuries or mortality within 24 hours were excluded. Patient and injury characteristics, complications, and interventions were compared between SL and DCL groups. Regional readmission data were utilized to capture complications within 6 months of index trauma. RESULTS: Of 267 patients, 69% had penetrating injuries, 21% underwent DCL, and the mortality rate was 4.9%. Overall, 176 received primary repair (26 in DCL), 90 had resection and anastomosis (28 in DCL), and 26 had a stoma created (10 end colostomies and 2 loop ileostomies in DCL). Thirty-five of 56 DCL patients had definitive colonic repair subsequent to their index operation. DCL patients were more likely to be hypotensive; require more resuscitation; and suffer acute kidney injury, pneumonia, adult respiratory distress syndrome, and death. Five enteric leaks (1.9%) and three enterocutaneous fistulas (ECF, 1.1%) were identified, proportionately distributed between DCL and SL (p = 1.00, p = 0.51). No difference was seen in intraperitoneal abscesses (p = 0.13) or surgical site infections (SSI, p = 0.70) between cohorts. Among SL patients, pancreas injuries portended an increased risk of intraperitoneal abscesses (p = 0.0002), as did liver injuries in DCL patients (p = 0.06). CONCLUSIONS: DCL was not associated with increased enteric leaks, ECF, SSI, or intraperitoneal abscesses despite nearly two-thirds having delayed repair. Despite this being a multicenter study, it is underpowered, and a prospective trial would better demonstrate risks of DCL in colon trauma. LEVEL OF EVIDENCE: Therapeutic study, level IV.

A pyridazine series of alpha2/alpha3 subtype selective GABA A agonists for the treatment of anxiety.

The development of a series of GABA(A) alpha2/alpha3 subtype selective pyridazine based benzodiazepine site agonists as anxiolytic agents with reduced sedative/ataxic potential is described, including the discovery of 16, a remarkably alpha3-selective compound ideal for in vivo study. These ligands are antagonists at the alpha1 subtype, with good CNS penetration and receptor occupancy, and excellent oral bioavailability.

Acute Scrotal Swelling in Henoch-Schonlein Purpura: Case Report and Review of the Literature.

Henoch-Schönlein purpura (HSP) is a systemic vasculitis characterized classically by purpura, arthritis and abdominal pain. Epididymitis/orchitis is rarely seen as a complication of HSP. Testicular or scrotal involvement has been reported in children with Henoch-Schonlein purpura and must be distinguished from testicular torsion. We report a case of a 5 year old boy diagnosed with Henoch-Schönlein purpura with acute scrotal swelling. He was managed successfully with conservative approach. The history, clinical examination findings and scrotal ultrasound evaluation should suffice to make the correct diagnosis and avoid surgery. Steroid treatment and/or antibiotics appeared to be effective for this condition.

Iliacus haematoma causing femoral nerve palsy: an unusual trampolining injury.

We report the case of a 15-year-old boy who presented to accident and emergency following a trampolining injury. Initially, the patient was discharged, diagnosed with a soft tissue injury, but he re-presented 48 h later with worsening low back pain and neurological symptoms in the left leg. Subsequent MRI revealed a left iliacus haematoma causing a femoral nerve palsy. The patient was managed conservatively and by 6 months post injury all symptoms had resolved. This is the first reported case of an iliacus haematoma causing a femoral nerve palsy, after a trampolining injury. We believe this case highlights to our fellow clinicians the importance of a detailed history when assessing patients with trampolining injuries to evaluate the true force of injury. It also acts as a reference for clinicians in managing similar cases in future.

Universal Quake Statistics: From Compressed Nanocrystals to Earthquakes.

Slowly-compressed single crystals, bulk metallic glasses (BMGs), rocks, granular materials, and the earth all deform via intermittent slips or "quakes". We find that although these systems span 12 decades in length scale, they all show the same scaling behavior for their slip size distributions and other statistical properties. Remarkably, the size distributions follow the same power law multiplied with the same exponential cutoff. The cutoff grows with applied force for materials spanning length scales from nanometers to kilometers. The tuneability of the cutoff with stress reflects "tuned critical" behavior, rather than self-organized criticality (SOC), which would imply stress-independence. A simple mean field model for avalanches of slipping weak spots explains the agreement across scales. It predicts the observed slip-size distributions and the observed stress-dependent cutoff function. The results enable extrapolations from one scale to another, and from one force to another, across different materials and structures, from nanocrystals to earthquakes.