Foodomics-based metabolites profiling of the Greek yogurt incorporated with unripened papaya peel powder.

The food waste of the fruit processing industry is rich in many bio-active components such as polysaccharides, polyphenols, peptides, etc. that own multifaceted health benefits. The valorization of this waste is an intriguing optimization method for various dairy products. Meanwhile, LC-MS-based foodomics has been an emerging approach for the quantitative and qualitative analysis of dairy foods. Untargeted metabolomics has been done of the optimized functional yogurt that contains different levels of unripened papaya peel powder (UPPP) using high-resolution mass spectroscopy for analysis of added bio-active components in the matrix. UPPP comprises a high content of phytochemicals which could give functionality and therapeutic effect to the Greek yogurt. A total of 36 functional metabolites have been identified which have various health-beneficial attributes. Kaempferol, ostruthin, putative carpaine derivatives, etc. are some of the metabolites of high importance with a wide area coverage in the metabolome. This work highlights the bioactivity of the UPPP and its prebiotic properties added to the functional yogurt as an independent ingredient. The incorporated plant-based ingredients like UPPP can effectively enhance the functional attributes of Greek yogurt, which is a potential synbiotic food.

Adopting the New Norms of Monitoring Postoperative Patients with Wearable Devices in Ireland - Advantages and Challenges.

There has been a growing interest in wearable devices to monitor postoperative patients, providing the healthcare professionals with real-time information on vital signs to detect potential complications and hence, take timely actions to prevent them. Several studies and pilot programme in Ireland and worldwide indicated the effectiveness of wearable devices in monitoring patients, which could result in better patient outcomes and more efficient healthcare system. As more healthcare providers adopt this new technology, better patient outcomes and a more efficient healthcare system can be anticipated. Key Words: Wearable devices, Continuous monitoring, Patient safety.

Pseudo-teams in Healthcare: The Perils of Impersonating a Cohesive Unit.

Teamwork is a critical aspect of healthcare and is widely recognised as a cornerstone of effective patient care. However, not all healthcare teams are created equal, and some teams that appear to work well together on the surface are better described as pseudo-teams rather than true teams. This issue is frequently disregarded and overlooked despite its importance, yet it significantly impacts patient care and staff morale. We wish to describe the concept of pseudo teams in healthcare, their perils, and ways to create true teams characterised by shared goals, open communication, and a commitment to each other's success.

Improving patient safety during position changes under general anaesthesia: "CHOPP check"- a new patient safety and educational tool.

The requirement to change position whilst under general anaesthesia may expose patients to significant risks. We devised and implemented a concise and comprehensive patient positioning safety tool with the aim of reducing risks and improving patient safety during position changes under anaesthesia.

Osmotherapy and the management of traumatic brain injury: still a dilemma.

Despite extensive study and use, selecting an osmotherapy agent for traumatic brain injury remains a dilemma. This article explores the challenges in managing patients with traumatic brain injury and the ongoing debate surrounding the efficacy of different hyperosmolar agents as treatment options.

Pragmatic anesthetic approach for extracranial to intracranial bypass surgery in a patient with moyamoya disease and sickle cell disease: a case report.

BACKGROUND: Moyamoya disease is a chronic progressive cerebrovascular disorder. A proportion of 10-20% of patients with sickle cell disease have associated moyamoya disease and may require surgical revascularization as definitive treatment. CASE PRESENTATION: A 22-year-old African lady with sickle cell disease and moyamoya disease, with extensive cerebral vasculopathy, was scheduled for elective extracranial to intracranial bypass surgery. She presented with right-sided weakness secondary to a hemorrhagic stroke of the left lentiform nucleus. She required a multidisciplinary team approach for preprocedural optimization. Her preoperative hemoglobin SS levels were reduced to less than 20%, with preoperative red blood cell transfusion to avoid sickling. We maintained normal physiology and optimal analgesia perioperatively. She was extubated after the successful surgical procedure and was transferred to Intensive care unit (ICU) for invasive monitoring, with subsequent discharge to the ward several days later. CONCLUSION: Optimal preprocedural optimization can decrease complications in patients with critically comprised cerebral circulation booked for extensive surgery such as ECIC bypass. We believe the presentation of anesthetic management of a patient with moyamoya disease and sickle cell disease may prove helpful.

COVID-19-related Posterior Reversible Encephalopathy Syndrome in an Adult ICU Patient in Ireland.

Radiologically confirmed, novel coronavirus disease 2019 (COVID-19)-related neurological manifestations are being reported with increasing frequency since the outbreak of the disease. We describe a 54-year-old male with COVID-19, who demonstrated radiological and clinical findings of posterior reversible encephalopathy syndrome(PRES). The proposed mechanism suggested for COVID-19-related PRES is a disease induced inflammatory storm, which causes endothelial injury, resulting in endothelialdysfunction (ED), interstitial fluid extravasation and cerebral edema. Key Words: COVID-19, Encephalopathy, Neurological complications, PRES.

Covid-19, Sixteen Months Into The Pandemic: A Narrative Review.

COVID-19, the disease caused by the newly-discovered SARS-CoV-2 virus, has quickly spread from China throughout the world since January 2020. Its potential severity, despite in a minority of cases, has paralysed healthcare systems struggling for adequate resources, as well as entire nations often forced to adopt radical measures, such as lockdowns and surveillance, to contain the disease and restrict its spread. Initially presenting as a respiratory infectious disease, it can not only progress to an acute respiratory distress syndrome, but also have multisystemic consequences. There are many proving theories as regards to the pathophysiology and there are currently no proven definitive treatments. Due to its high transmissibility and the risk of infecting healthcare workers, hospitals also had to rethink their organisation. We have completed a literature review of the sixteen months of the pandemic, with attention to pathophysiology, key epidemiological concepts, hospital organisation, critical care considerations, and finally current and prospective treatments.

Preparing for a Pandemic: Our Plans and Lessons Learnt as a Department in a Tertiary Care Hospital.

This is a descriptive article aiming to present and analyse the steps of preparedness and troubleshooting of problems faced at operating rooms and intensive care unit during the ongoing coronavirus infectious disease 2019 (COVID-19) pandemic in Our Lady of Lourdes Hospital, a tertiary care hospital in Ireland from February 2020 to March 2020. Concerning preparation, we reviewed all aspects of our clinical and potential logistic  issues and their accessible solutions in times of limited resources. Analysing availability of critical care staff and essential escalation of care area capacity during the ongoing pandemic, we observed that there was strong communication, commitment and team work among departmental and other non-critical care staff, and disciplines. Being the only  regional teaching hospital with critical care unit in county Louth, we found ourselves confident and content with our preparation. We found good communication and training as critical factors in the preparation for a pandemic. Key Words: COVID-19, Pandemic, Preparation, Challenges.

Per-cutaneous dilatation tracheostomy (PCTD) in COVID-19 patients and peri-tracheostomy care: A case series and guidelines.

BACKGROUND & OBJECTIVE: COVID 19 patients with severe respiratory failure may require prolonged mechanical ventilation. Placement of a tracheostomy tube often becomes necessary for such patients. The steps of tracheostomy procedure and post tracheostomy care of these patients can be classified as aerosol generating. We wish to highlight our modified technique to address these issues. METHODOLOGY: We performed percutaneous dilation tracheostomy in three clinically challenging COVID-19 patients in our ICU and developed guidelines aiming to minimise aerosolisation during and after the tracheostomy procedure to safeguard healthcare workers. RESULTS: Percutaneous tracheostomy was performed by a team of three experienced anaesthetists and an ICU nurse. CONCLUSION: The decision of surgical or percutaneous tracheostomy should be dependent on the experience of the tracheostomy performer, health-care worker safety, resource availability, and patient-centred care. We believe our modified strategic approach of brief bronchoscopy, minimum PEEP and gas flows and step-wise planned approach for PCDT offers an extra level of safety to healthcare workers.

Study of the effect of loop inductance on the RF transmission line to cavity coupling coefficient.

Coupling of RF power is an important aspect in the design and development of RF accelerating structures. RF power coupling employing coupler loops has the advantage of tunability of ß, the transmission line to cavity coupling coefficient. Analytical expressions available in literature for determination of size of the coupler loop using Faraday's law of induction show reasonably good agreement with experimentally measured values of ß below critical coupling (ß ≤ 1) but show large deviation with experimentally measured values and predictions by simulations for higher values of ß. In actual accelerator application, many RF cavities need to be over-coupled with ß > 1 for reasons of beam loading compensation, reduction of cavity filling time, etc. This paper discusses a modified analytical formulation by including the effect of loop inductance in the determination of loop size for any desired coupling coefficient. The analytical formulation shows good agreement with 3D simulations and with experimentally measured values. It has been successfully qualified by the design and development of power coupler loops for two 476 MHz pre-buncher RF cavities, which have successfully been conditioned at rated power levels using these coupler loops.

Airway management and postoperative length of hospital stay in patients undergoing head and neck cancer surgery.

BACKGROUND AND AIMS: General anesthesia and airway management of patients for head and neck cancer surgery is a challenge for the anesthesiologist. Appropriate assessment and planning are essential for successful airway management. Our objectives were to review airway management strategies in patients undergoing head and neck cancer surgery in our tertiary care institution and also to observe the effect of airway management techniques on postoperative length of hospital stay (PLOS). MATERIAL AND METHODS: A retrospective medical record review of 400 patients who underwent major head and neck cancer surgery in our institution was conducted. A special form was used, and records were searched for airway and anesthetic management in the operating room and recovery room, and for PLOS. RESULTS: 289 (72.25%) of the patients were male, and 111 (27.75%) female. 49.8% of patients had Mallampati score of 3 and 4. Airway was managed with tracheostomy in 81 (20.25%) patients; nasal intubation was performed in 177 (44.25%) and oral intubation in 142 (35.5%) patients. Postoperative emergency tracheostomy was not done in any of the patients. CONCLUSION: Median postoperative hospital stay was significantly longer (P = 0.0005) in patients who had a tracheostomy performed compared with those where the airway was managed without it.

Airway Management in a Patient with Severe Ankylosing Spondylitis Causing Bamboo Spine: Use of Aintree Intubation Catheter.

Management of a case of ankylosing spondylitis can be very challenging as the airway and the central neuraxial blockade are extremely difficult to handle. Fiberoptic intubation may lead to predictable success in the face of difficult airway. We are presenting a new technique of fiberoptic intubation in a young patient, suffering from severe ankylosing spondylitis, came for total hip replacement surgery. There was anticipated difficult airway due to severe limitation in neck movement and it was successfully managed by using Aintree Intubation Catheter (AIC) with intubating fiberoptic bronchoscope.

Study of beam loading and its compensation in the Compact Ultrafast Terahertz Free-Electron Laser injector linac.

The RF properties of an accelerating structure, and the pulse structure and charge per bunch in the electron beam propagating through it are important parameters that determine the impact of beam loading in the structure. The injector linac of the Compact Ultrafast Terahertz Free-Electron Laser (CUTE-FEL) has been operated with two different pulse structures during initial commissioning experiments and the effect of beam loading on the accelerated electron beam parameters has been studied analytically for these two pulse structures. This paper discusses the analytical study of beam loading in a Standing Wave, Plane Wave Transformer linac employed in the CUTE-FEL setup, and a possible technique for its compensation for the electron beam parameters of the CUTE-FEL. A parametric study has been performed to study beam loading for different beam currents and to optimize injection time of the electron beam to compensate beam loading. Results from the parametric study have also been used to explain previously observed results from acceleration experiments in the CUTE-FEL setup.

A novel scaling law relating the geometrical dimensions of a photocathode radio frequency gun to its radio frequency properties.

Developing a photocathode RF gun with the desired RF properties of the π-mode, such as field balance (e(b)) ~1, resonant frequency f(π) = 2856 MHz, and waveguide-to-cavity coupling coefficient ß(π) ~1, requires precise tuning of the resonant frequencies of the independent full- and half-cells (f(f) and f(h)), and of the waveguide-to-full-cell coupling coefficient (ß(f)). While contemporary electromagnetic codes and precision machining capability have made it possible to design and tune independent cells of a photocathode RF gun for desired RF properties, thereby eliminating the need for tuning, access to such computational resources and quality of machining is not very widespread. Therefore, many such structures require tuning after machining by employing conventional tuning techniques that are iterative in nature. Any procedure that improves understanding of the tuning process and consequently reduces the number of iterations and the associated risks in tuning a photocathode gun would, therefore, be useful. In this paper, we discuss a method devised by us to tune a photocathode RF gun for desired RF properties under operating conditions. We develop and employ a simple scaling law that accounts for inter-dependence between frequency of independent cells and waveguide-to-cavity coupling coefficient, and the effect of brazing clearance for joining of the two cells. The method has been employed to successfully develop multiple 1.6 cell BNL∕SLAC/UCLA type S-band photocathode RF guns with the desired RF properties, without the need to tune them by a tiresome cut-and-measure process. Our analysis also provides a physical insight into how the geometrical dimensions affect the RF properties of the photo-cathode RF gun.