Do-not-attempt resuscitation policy reduced in-hospital cardiac arrest rate and the cost of care in a developing country.

We aim to study the characteristics and outcomes of patients with a Do-Not-Attempt Resuscitation and to determine its impact on the Cost of In-Hospital Cardiac Arrest. A retrospective study of all adult patients admitted to the hospital from June 2021 to May 2022 who had a Do-Not-Resuscitate order. We abstracted patients' socio-demographics, physiologic parameters, primary diagnosis, and comorbidities from the electronic medical records. We calculated the potential economic cost using the median ICU length of stay for the admitted IHCA patients during the study period. There were 28,866 acute admissions over the study period, and 788 patients had DNR orders. The median (IQR) age was 71 (55-82) years, and 50.3% were males. The most prevalent primary diagnosis was sepsis, 426 (54.3%), and cancer was the most common comorbidity. More than one comorbidities were present in 642 (80%) of the cohort. Of the DNR patients, 492 (62.4%) died, while 296 (37.6%) survived to discharge. Cancer was the primary diagnosis in 65 (22.2%) of those who survived, compared with 154 (31.3%) of those who died (P = 0.002). Over the study period, 153 patients had IHCA and underwent CPR, with an IHCA rate of 5.3 per 1,000 hospital admissions. Without a DNR policy, an additional 492 patients with cardiac arrest would have had CPR, resulting in an IHCA rate of 22.3 per 1000 hospital admissions. Most DNR patients in our setting had sepsis complicated by multiple comorbidities. The DNR policy reduced our IHCA incidence by 76% and prevented unnecessary post-resuscitation ICU care.

Longitudinal changes in peri-papillary retinal nerve fiber layer thickness in patients with unilateral branch retinal vein occlusion.

Background: Associations between retinal venous occlusion (RVO), elevated intraocular pressure, and glaucoma have been reported. Further investigations into structural alterations in the fellow eyes of individuals with unilateral RVO have revealed that the peripapillary retinal nerve fiber layer is thinner than in healthy eyes, suggesting that there may be systemic risk factors common to both RVO and glaucoma. We aimed to evaluate changes in peripapillary retinal nerve fiber layer thickness (pRNFLT) among individuals with unilateral branch retinal vein occlusion (BRVO). Methods: This prospective observational study recruited 30 individuals (60 eyes) with newly diagnosed unilateral BRVO and macular edema, and a control group of 30 healthy individuals (30 eyes) with no abnormalities on fundus examination or concurrent systemic comorbidities. After baseline measurements, the participants were reassessed at 6, 12, and 24 months by measuring global and sectoral pRNFLT using spectral-domain optical coherence tomography. Results: The mean age and sex distributions were comparable between the patient and control groups (both P > 0.05). When compared to fellow eyes, global and sectoral pRNFLT in eyes with BRVO were significantly higher at baseline (all P < 0.05). Over time, pRNFLT decreased dramatically, and by the conclusion of the two-year follow-up, there was a significant reduction from baseline in the affected eyes (all P < 0.05). Likewise, affected eyes experienced a significant improvement in best-corrected distance visual acuity and central macular thickness over the two-year follow-up (both P ≤ 0.001). Comparing the global and all-sector pRNFLT of fellow eyes in the patient group with those of normal eyes in the control group, there were no significant differences at any visit, except in the temporal sector, which revealed a significant reduction in pRNFLT at 24 months in the fellow eyes of patients with unilateral BRVO (P = 0.02). Conclusions: Patients with unilateral BRVO experienced a significant reduction in pRNFLT in the affected eyes and, to a lesser extent, in the fellow eyes, compared with that of the control arm, suggesting that they are prone to retinal nerve fiber layer damage. The reduction in pRNFLT in the normal fellow eyes of patients with BRVO may be attributed to age or concurrent systemic comorbidities. Further studies with long follow-up periods are required to shed light on the etiology of functional and structural changes in both the retinal nerve fiber layer and ganglion cell complex in the normal and affected eyes of patients with unilateral BRVO.

The Incidence and Outcomes for Children with Cleft Palate and/or Lip and CHARGE Syndrome.

OBJECTIVES: Published literature on children with cleft palate and/or lip (CP + /-L) and CHARGE syndrome (CS) is limited. This study investigated cleft characteristics including surgery, and feeding and communication outcomes in children identified with CP + /-L and CS. DESIGN: Retrospective cross-sectional review. SETTING: Regional Referral Centre for Paediatric Cleft Surgery. PATIENTS: All children diagnosed with CP + /-L and CS (based on clinical features and/or CHD7 mutation testing) between 1989-2019. MAIN OUTCOME MEASURES: Cleft type, timing of CP + /-L repair, reasons for 'delayed' repair, feeding methods and communication modality. RESULTS: Twenty-two children with CP + /-L and CS were identified. Cleft sub-types (%) were: Eleven (50%) had bilateral cleft lip and palate (BCLP), six (27%) had unilateral cleft lip and palate (UCLP) and five (23%) had cleft palate (CP). Cleft repair was delayed compared to protocol care for non-syndromic children with CP + /-L. Median age for lip repair + /- vomerine flap was 9 months (range 4-22 months), and palate repair was 21 months (range 11-40 months). Median age for isolated CP repair was 13 months (range 7-23). Surgery for cardiac anomalies (36%) before cleft repair, and (59%) were classed as having severe systemic disease at the time of cleft surgery. Only 27% of the children in this study had both full oral feeding and verbal communication. CONCLUSIONS: Children with CP + /-L and CS had severe cleft types and complex medical problems leading to delayed cleft surgery. Feeding and speech outcomes were better in the children aged over ten years.

High-Energy Ball Milling for High Productivity of Nanobiochar from Oil Palm Biomass.

The current production method of nanobiochar (NBC), an emerging, environmentally friendly nanocarbon material, is tedious and lengthy. Therefore, in this study we aimed to improve the productivity of NBC via high-energy ball milling by manipulating the grinding media and processing time. The particle size distribution of the resulting NBC measured using dynamic light scattering showed that grinding media with steel balls of different sizes were more effective at producing NBC than small uniform steel balls, which failed to produce NBC even after 90 min of milling. Average NBC particles of around 95 nm were achieved after only 30 min of ball milling, and the size was further reduced to about 30 nm when the milling was prolonged to 150 min. Further prolonging the milling duration led to agglomeration, which increased the size of the biochar nanoparticles. The thermogravimetric analysis (TGA) data showed that the duration of milling and particle size did not cause noticeable differences in the thermal stability of the NBC. Based on the FTIR analysis, the chemical structure of the NBC was not affected by the ball milling. The results showed that 60 min of high-energy ball milling is sufficient to produce NBC particles of 75 nm, with a large surface area and high thermal stability. This could prove beneficial in a myriad of applications, ranging from agriculture to composite fabrication.

Combination of Passive and Active Solar Heating with Thermal Energy Storage.

This study investigated the impact of individual and combination of different sources of heating (passive solar heating, electric oil-heater, and solar air heater) in a pilot-scale building containing phase change material (PCM) for a potential reduction in energy consumption while maintaining thermal comfort. Unlike most of the recent simulations and modelling studies, this impact was tested experimentally using two identical control and test huts located at the University of Auckland. The control hut was equipped with standard gypsum boards while the test hut had gypsum boards containing PCM (PureTemp 20, PT20). The study found that combining both active and passive solar heating with a temperature-controlled electric oil heater demonstrated the ability to provide significant energy savings and maintain thermal comfort in the test hut, most notably overnight. The suggested combination was tested over different weather conditions and with different temperature constraints to maintain thermal comfort and achieve energy savings ranging from 33% to 87.5%.

Exploring the Perceptions Surrounding Hospital Chaplains in Patient Care and Healing.

The authors distributed a questionnaire to various hospital staff to explore perceptions surrounding the role of chaplains in patient care and healing through assessing opinions, beliefs, and knowledge. Results revealed a poor understanding of the role of the hospital chaplain in the UK. The authors therefore advocate education programs to increase awareness of the varied role of the hospital chaplain in fulfilling patient spiritual needs to increase referral practices, leading to improved patient outcomes.

Emerging application of biochar as a renewable and superior filler in polymer composites.

Biochar is conventionally and widely used for soil amendment or as an adsorbent for water treatment. Nevertheless, the need for transition to renewable materials has resulted in an expansion of biochar for use as a filler for polymer composites. The aim is to enhance the physical, chemical, mechanical and rheological properties of the polymer composite. The reinforcement of biochar into a polymer matrix however is still new, and limited reports are focusing on the effects of biochar towards polymer composite properties. Hence, this review highlights the unique properties of biochar and its effect on the crystallization, thermal, flammability, electrical conductivity, and mechanical properties of polymer composites. This review does not solely summarize recent studies on biochar-polymer-based composites, but also offers insights into a new direction of biochar as a renewable and superior polymer filler in the future.

Emerging Developments on Nanocellulose as Liquid Crystals: A Biomimetic Approach.

Biomimetics is the field of obtaining ideas from nature that can be applied in science, engineering, and medicine. The usefulness of cellulose nanocrystals (CNC) and their excellent characteristics in biomimetic applications are exciting and promising areas of present and future research. CNCs are bio-based nanostructured material that can be isolated from several natural biomasses. The CNCs are one-dimensional with a high aspect ratio. They possess high crystalline order and high chirality when they are allowed to assemble in concentrated dispersions. Recent studies have demonstrated that CNCs possess remarkable optical and chemical properties that can be used to fabricate liquid crystals. Research is present in the early stage to develop CNC-based solvent-free liquid crystals that behave like both crystalline solids and liquids and exhibit the phenomenon of birefringence in anisotropic media. All these characteristics are beneficial for several biomimetic applications. Moreover, the films of CNC show the property of iridescent colors, making it suitable for photonic applications in various devices, such as electro-optical devices and flat panel displays.

The conservative management of self-inflicted chemical burns: Case report and literature review.

Introduction: Chemical burns, particularly injuries related to psychiatric illnesses, are underreported in the literature. We present two cases of self-inflicted alkali chemical burns managed conservatively. Frequent clinical review of the burn was aimed to ensure appropriate healing and compliance with the treatment plan based on regular dressing changes. Case 1: A 24-year-old woman presented during the first day of the initial injury with a minor self-inflicted chemical burn to the right forearm. The causative agent was an oven cleaner containing sodium hydroxide triggering an alkali-based burn. The surface area of the injury was 0.5% total body surface area (TBSA) full-thickness burn. The patient had a complex psychiatric history diagnosed with personality disorder, anxiety and depression. Case 2: A 55-year-old woman presented with a self-inflicted left forearm full-thickness burn (0.5% TBSA). This was five days after the initial injury from an oven cleaner containing sodium hydroxide. The patient had a psychiatric history of anxiety and depressive disorder.The mainstay of burn management was conservative with regular dressing changes and a topical agent. Telemedicine via a designated email address was given to the patient for virtual clinical burn review and any urgent issues. Photograph of the initial burn was taken, and clinic visits were scheduled to determine healing progress. Conclusion: Self-inflicted chemical burns are to be managed within a multidisciplinary setting including early psychiatric involvement. We advocate a holistic approach to determine conservative or operative management, taking into account patient factors, burn complexity and clinician's judgement to streamline the treatment plan. Lay Summary: Chemical burns due to self-harm are rare to see in clinical practice. A review of two cases secondary to intentional burns sustained using an oven cleaning material. Patients had psychiatric issues and were on medications to control symptoms. Close observation with regular dressings and topical cream would allow burns to heal without the need for an operation. Our recommendation would be to treat these burns with dressings and regular follow up in the clinic or virtually till healed.

Denaturation kinetics and storage stability of Osteopontin in reconstituted infant milk formula.

Osteopontin (OPN) is a multifunctional whey protein with numerous health benefits and is recommended to supplement Infant Milk Formula (IMF) with it. For the first time, the denaturation kinetics and storage stability of bovine OPN were studied in reconstituted IMF. The effect of thermal treatments (63-90 °C) and High Pressure Processing (HPP) were investigated. OPN showed higher retention (around 90%) after both LTLT (Low Temperature Long Time) and HTST (High Temperature Short Time) treatments, however higher temperature and longer treatment induced substantial denaturation indicating UHT may not suit OPN-added items. Significant denaturation occurred at higher pressure (>400 MPa), and more pronounced OPN denaturation was observed after HPP at elevated temperature. OPN remained stable during4 °Cstorage for 14 days. This investigation deduced thermal stability of OPN as α-Lac > OPN > LF, whereas the pressure resistance observed as α-Lac > LF > OPN > ß-Lg.

Greener Pretreatment Approaches for the Valorisation of Natural Fibre Biomass into Bioproducts.

The utilization of lignocellulosic biomass in various applications has a promising potential as advanced technology progresses due to its renowned advantages as cheap and abundant feedstock. The main drawback in the utilization of this type of biomass is the essential requirement for the pretreatment process. The most common pretreatment process applied is chemical pretreatment. However, it is a non-eco-friendly process. Therefore, this review aims to bring into light several greener pretreatment processes as an alternative approach for the current chemical pretreatment. The main processes for each physical and biological pretreatment process are reviewed and highlighted. Additionally, recent advances in the effect of different non-chemical pretreatment approaches for the natural fibres are also critically discussed with a focus on bioproducts conversion.

Removal behaviour of residual pollutants from biologically treated palm oil mill effluent by Pennisetum purpureum in constructed wetland.

The reason for such enormous efforts in palm oil mill effluent research would be what has been singled out as one of the major sources of pollution in Malaysia, and perhaps the most costly and complex waste to manage. Palm oil mill final discharge, which is the treated effluent, will usually be discharged to nearby land or river since it has been the least costly way to dispose of. Irrefutably, the quality level of the treated effluent does not always satisfy the surface water quality in conformity to physicochemical characteristics. To work on improving the treated effluent quality, a vertical surface-flow constructed wetland system was designed with Pennisetum purpureum (Napier grass) planted on the wetland floor. The system effectively reduced the level of chemical oxygen demand by 62.2 ± 14.3%, total suspended solid by 88.1 ± 13.3%, ammonia by 62.3 ± 24.8%, colour by 66.6 ± 13.19%, and tannin and lignin by 57.5 ± 22.3%. Heat map depicted bacterial diversity and relative abundance in life stages from the wetland soil, whereby bacterial community associated with the pollutant removal was found to be from the families Anaerolineaceae and Nitrosomonadaceae, and phyla Cyanobacteria and Acidobacteria.

Heat and Mass Transfer Modeling to Predict Temperature Distribution during Potato Frying after Pre-Treatment with Pulsed Electric Field.

Based on unsteady state heat conduction, a mathematical model has been developed to describe the simultaneous heat and moisture transfer during potato frying. For the first time, the equation was solved using both enthalpy and Variable Space Network (VSN) methods, based on a moving interface defined by the boiling temperature of water in a potato disc during frying. Two separate regions of the potato disc namely fried (crust) and unfried (core), were considered as heat transfer domains. A variable boiling temperature of the water in potato discs was required as an input parameter for the model as the water is evaporated during frying, resulting in an increase in the soluble solid concentration of the potato sample. Pulsed electric field (PEF) pretreatment prior to frying had no significant effect on the measured moisture content, thermal conductivity or frying time compared to potatoes that did not receive a PEF pretreatment. However, a PEF pretreatment at 1.1 kV/cm and 56 kJ/kg reduced the temperature variation in the experimentally measured potato center by up to 30%. The proposed heat and moisture transfer model based on unsteady state heat conduction successfully predicted the experimental measurements, especially when the equation was solved using the enthalpy method.

Management of minor burns during the COVID-19 pandemic: A patient-centred approach.

INTRODUCTION: The UK government introduced lockdown measures on 23 March 2020 due to the first wave of the COVID-19 pandemic. A restructuring of clinical services was necessary to accommodate mandatory changes while also maintaining the best possible standards for patient care. The present study explored the initial management, follow-up and patient-reported outcomes of burn injuries <15% total body surface area (TBSA) during the height of the COVID-19 lockdown at a tertiary burns centre. METHODS: A retrospective review of all adult patients with burns <15% TBSA during the national lockdown (23 March 2020 to 10 May 2020) was undertaken at The Queen Elizabeth Hospital Birmingham (QEHB), UK. All referrals from non-QEHB telemedicine (external) or QEHB emergency (internal) departments were reviewed for management, length of hospital stay and pattern of follow-up (ward attender, self-care, community or outreach nurses). A telephone survey based on a structured questionnaire was conducted to establish patients' satisfaction. RESULTS: A total of 84 burn patients were included in the study. The mean age was 39 years (age range = 19-91 years) and the male:female ratio was 4:1. Patients were managed non-operatively (n = 69, 82%) or operatively (n = 15, 18%). Patients attended the ward attender acute burns clinic only once (n = 36, 61%). The telephone survey captured 70% (n = 59) of the study population and 57 patients (97% of respondents) were pleased with the ongoing care and burn healing. CONCLUSION: The integration of patient led self-care, reduction in admissions, minimal clinics attendance and a telemedicine follow-up is an effective model for small burns management during the COVID-19 pandemic. A high degree of patient satisfaction was achieved with continuous and approachable communication channels with the burn multidisciplinary team. We continue to implement this effective model of burns management throughout the COVID-19 pandemic and the subsequent period. LAY SUMMARY: The lockdown measures due to the first wave of COVID-19 pandemic affected the way we manage all medical emergencies including burns. The initial management, follow-up and patient satisfaction for small burn injuries during lockdown has not been reported previously. The aim of this study is to examine the outcome in terms of small burn management, hospital stay, number of clinic reviews, healing and patient satisfaction during the lockdown period in a burn centre in the UK. This would look at the need for operations and whether patients stayed longer if they required an intervention. We reviewed adult patients with small burns during the national lockdown (23 March 2020 to 10 May 2020) at The Queen Elizabeth Hospital Birmingham (QEHB). All referrals from telemedicine, referral system (external) or QEHB (internal) were reviewed for management, length of hospital stay and pattern of follow-up. Patients were reviewed in the acute burns clinic and given advice for burn management and dressing for self-care. Follow-up was mostly via email (telemedicine) A telephone survey based on a structured questionnaire was conducted to find out patients' satisfaction. Four times more men than women had small burns during the lockdown period. The average age was 39 years. The majority were managed conservatively with dressings (82%) and a small proportion required an operation (18%). Most patients attended the acute burns clinic only once (61%) for initial assessment and management. The telephone survey captured 70% of patient and 97% of respondents were pleased with the care and burn healing. The integration of patient-led self-care, reduction in admissions, minimal clinics attendance and a telemedicine follow-up is an effective model for burns management during the COVID-19 pandemic. A high degree of patient satisfaction was achieved with continuous and approachable communication channels with burn multidisciplinary team. We continue to implement this effective model of burns management throughout the COVID-19 pandemic and the subsequent period.

A rare case of Seymour fracture in an adult with non-fused growth plates.

The mechanism for growth plate fusion is not fully understood yet. We present the first reported Seymour fracture (Salter Harris I) in an adult with failed growth plate fusion. The management of Seymour fractures should be according to radiological bone age rather than actual age.

Effect of high pressure impregnation on micronutrient transfer in rice.

Rice, consumed by most people across the world, serves as a great mode for carrying nutrients. The processed, starch-rich white rice is mostly devoid of nutrients. High-pressure processing (HPP) is a technology known to produce cold gelatinizing effects in starch. This work shows the application of HPP in fortification of two types of white rice through high pressure gelatinization. The rice grains were impregnated with vitamin B1, calcium, and zinc. HPP treatment was carried out at the temperatures of 50 °C and 70 °C for up to 20 min. The samples were analysed for thiamine using the fluorometric method and minerals using ICP-MS. Results showed that the transfer of nutrients increases with treatment temperature and time, producing high level of nutrient uptake. HPP-fortified rice also showed stability after storage of two months. The moderate-temperature HPP has a great potential to be used as a method to produce a ready-to-eat variety of rice.

Improving the decolorization of glycerol by adsorption using activated carbon derived from oil palm biomass.

This study provides insight into the decolorization strategy for crude glycerol obtained from biodiesel production using waste cooking oil as raw material. A sequential procedure that includes physico-chemical treatment and adsorption using activated carbon from oil palm biomass was investigated. The results evidenced decolorization and enrichment of glycerol go hand in hand during the treatment, achieving >89% color removal and > 98% increase in glycerol content, turning the glycerol into a clear (colorless) solution. This is attributed to the complete removal of methanol, free fatty acids, and triglycerides, as well as 85% removal of water, and 93% removal of potassium. Properties of the resultant glycerol met the quality standard of BS 2621:1979. The economic aspects of the proposed methods are examined to fully construct a predesign budgetary estimation according to chemical engineering principles. The starting capital is proportionate to the number of physical assets to acquire where both entail a considerable cost at USD 13,200. Having the benefit of sizeable scale production, it reasonably reduces the operating cost per unit product. As productivity sets at 33 m3 per annum, the annual operating costs amount to USD 79,902 in glycerol decolorization. This is translatable to USD 5.38 per liter glycerol, which is ~69% lower compared to using commercial activated carbon.

Understanding the Frying Process of Plant-Based Foods Pretreated with Pulsed Electric Fields Using Frying Models.

Deep-fried foods (e.g., French fries, potato/veggie crisps) are popular among consumers. Recently, there has been an increased interest in the application of Pulsed Electric Fields (PEF) technology as a pretreatment of plant-based foods prior to deep-frying to improve quality (e.g., lower browning tendency and oil uptake) and reduce production costs (e.g., better water and energy efficiencies). However, the influence of a PEF pretreatment on the frying process and related chemical reactions for food materials is still not fully understood. PEF treatment of plant tissue causes structural modifications, which are likely to influence heat, mass and momentum transfers, as well as altering the rate of chemical reactions, during the frying process. Detailed insights into the frying process in terms of heat, mass (water and oil) and momentum transfers are outlined, in conjunction with the development of Maillard reaction and starch gelatinisation during frying. These changes occur during frying and consequently will impact on oil uptake, moisture content, colour, texture and the amount of contaminants in the fried foods, as well as the fried oil, and hence, the effects of PEF pretreatment on these quality properties of a variety of fried plant-based foods are summarised. Different mathematical models to potentially describe the influence of PEF on the frying process of plant-based foods and to predict the quality parameters of fried foods produced from PEF-treated plant materials are addressed.

Optimization of high pressure processing for microbial load reduction in Diospyros kaki 'Fuyu' pulp using response surface methodology.

Diospyros kaki L., cv. Fuyu is a non-astringent seasonally available persimmon variety from New Zealand having short shelf life. Most of the current preservation techniques like pasteurization, spray drying etc. use high temperature for microbial inactivation, which results in quality reduction. In the present study, response surface methodology having Box-Behnken design used to explore the consequence of pressure (200-600 MPa), time (5-15 min) and temperature (20-45 °C) for controlling microbial load in fruit pulp. A mathematical model created to envision the responses, and the R2 value indicated that the established model proved highly accurate in the prediction of response. The optimization process advocated non-thermal minimal processing of persimmon pulp by high pressure processing at low temperature 20 °C, 400 MPa pressure for 5 min holding time for reducing total plate count and yeast mould count.

A Review on the Effect of High Pressure Processing (HPP) on Gelatinization and Infusion of Nutrients.

High pressure processing (HPP) is a novel technology that involves subjecting foods to high hydrostatic pressures of the order of 100-600 MPa. This technology has been proven successful for inactivation of numerous microorganisms, spores and enzymes in foods, leading to increased shelf life. HPP is not limited to cold pasteurization, but has many other applications. The focus of this paper is to explore other applications of HPP, such as gelatinization, forced water absorption and infusion of nutrients. The use of high pressure in producing cold gelatinizing effects, imparting unique properties to food and improving food quality will be also discussed, highlighting the latest published studies and the innovative methods adopted.