RESUMEN
Hollow-core anti-resonant fibers (HC-ARFs) are en route to compete with and surpass the transmission performance of standard single-mode fibers (SSMFs). Recently, nested cladding elements emerged as a key enabler in reaching ultra-low transmission losses over a wide bandwidth. However, implementing nested geometry features poses a great challenge even in the current state-of-the-art fiber fabrication technology, often leading to structural imperfections, which ultimately worsen overall fiber performance. This article provides insights into the impact of fabrication-based perturbations of the cladding elements on the transmission performance and identifies areas of highest susceptibility. The impact of random outer and nested cladding tube misalignments as well as their anisotropic deformation on the propagation loss is analyzed based on observations of experimentally fabricated fibers. A dominance of the deformation effect over the misalignment effect is observed, with higher-order modes (HOMs) being affected one order of magnitude stronger than the fundamental mode (FM). The impact on propagation loss by structural perturbations is highly wavelength dependent, ranging from negligibly small values up to loss increases of 65% and 850% for FM and HOM propagation, respectively. The investigations are directly linked to fabrication metrics and therefore pave the way for assessing, predicting, and improving the transmission quality of fabricated hollow-core fibers.
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OBJECTIVE: Methods currently used to triage patients from mass casualty events have a sparse evidence basis. The objective of this project was to assess gaps of the widely used Simple Triage and Rapid Transport (START) algorithm using a large database when it is used to triage low-acuity patients. Subsequently, we developed and tested evidenced-based improvements to START. METHODS: Using the National Trauma Database (NTDB), a large set of trauma victims were assigned START triage levels, which were then compared to recorded patient mortality outcomes using area under the receiver-operator curve (AUC). Subjects assigned to the "Minor/Green" level who nevertheless died prior to hospital discharge were considered mistriaged. Recursive partitioning identified factors associated with of these mistriaged patients. These factors were then used to develop candidate START models of improved triage, whose overall performance was then re-evaluated using data from the NTDB. This process of evaluating performance, identifying errors, and further adjusting candidate models was repeated iteratively. RESULTS: The study included 322,162 subjects assigned to "Minor/Green" of which 2,046 died before hospital discharge. Age was the primary predictor of under-triage by START. Candidate models which re-assigned patients from the "Minor/Green" triage level to the "Delayed/Yellow" triage level based on age (either for patients >60 or >75), reduced mortality in the "Minor/Green" group from 0.6% to 0.1% and 0.3%, respectively. These candidate START models also showed net improvement in the AUC for predicting mortality overall and in select subgroups. CONCLUSION: In this research model using trauma registry data, most START under-triage errors occurred in elderly patients. Overall START accuracy was improved by placing elderly but otherwise minimally injured-mass casualty victims into a higher risk triage level. Alternatively, such patients would be candidates for closer monitoring at the scene or expedited transport ahead of other, younger "Minor/Green" victims.
Asunto(s)
Incidentes con Víctimas en Masa , Triaje/métodos , Adulto , Anciano , Algoritmos , Área Bajo la Curva , Femenino , Mortalidad Hospitalaria , Humanos , Masculino , Persona de Mediana Edad , Sistema de RegistrosRESUMEN
The purpose of the study was to determine whether there was a difference in the length of stay (LOS) for inpatients diagnosed with intracranial hemorrhage (ICH) or pulmonary embolism (PE) prior to and following implementation of an (AI) triage software. A retrospective review was performed for patients that underwent CT imaging procedures related to ICH and PE from April 2016 to October 2019. All patient encounters that included noncontrast head computed tomography (CT) or CT chest angiogram (CTCA) procedures, identified by the DICOM study descriptions, from April 2016 to April 2019 were included for ICH and PE, respectively. All patients that were diagnosed with ICH or PE were identified using ICD9 and ICD10 codes. Three separate control groups were defined as follows: (i) all remaining patients that underwent the designated imaging studies, (ii) patients diagnosed with hip fractures, and (iii) all hospital wide encounters, during the study period. Pre-AI and post-AI time periods were defined around the deployment dates of the ICH and PE modules, respectively. The reduction in LOS was 1.30 days (95% C.I. 0.1-2.5), resulting in an observed percentage decrease of 11.9% (p value = 0.032), for ICH and 2.07 days (95% C.I. 0.1-4.0), resulting in an observed percentage decrease of 26.3% (p value = 0.034), for PE when comparing the pre-AI and post-AI time periods. Reductions in LOS were observed in the ICH pre-AI and post-AI time period group for patients that were not diagnosed with ICH, but that underwent related imaging, 0.46 days (95% C.I. 0.1-0.8) resulting in an observed percentage decrease of 5% (p value = 0.018), and inpatients that were diagnosed with hip fractures, 0.60 days (95% C.I. 0.1-1.2) resulting in an observed percentage decrease of 8.3% (p value = 0.004). No other significant decrease in length of stay was observed in any of the other patient groups. The introduction of computer-aided triage and prioritization software into the radiological workflow was associated with a significant decrease in length of stay for patients diagnosed with ICH and PE.
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As biorationals, plant oils offer numerous advantages such as being natural products, with low ecotoxicological side effects, and high biodegradability. In particular, drying glyceride plant oils, which are rich in unsaturated fatty acids, might be promising candidates for a more sustainable approach in the discussion about plant protection and the environment. Based on this, we tested the protective and curative efficacy of an oil-in-water-emulsion preparation using drying plant oils (linseed oil, tung oil) and a semi-drying plant oil (rapeseed oil) separately and in different mixtures. Plant oils were tested in greenhouse experiments (in vivo) on green beans (Phaseolus vulgaris L.) against bean rust (Uromyces appendiculatus). We observed that a 2% oil concentration showed no or very low phytotoxic effects on green beans. Both tested drying oils showed a protective control ranging from 53-100% for linseed oil and 32-100% for tung oil. Longer time intervals of 6 days before inoculation (6dbi) were less effective than shorter intervals of 2dbi. Curative efficacies were lower with a maximum of 51% for both oils when applied 4 days past inoculation (4dpi) with the fungus. Furthermore, the results showed no systemic effects. These results underline the potential of drying plant oils as biorationals in sustainable plant protection strategies.