Content Analysis of Three-Dimensional Model Technologies and Applications for Construction: Current Trends and Future Directions.

The proliferation of digital technologies is substantially transforming inspection methodologies for construction activities. Although the implementation of a three-dimensional (3D) model has emerged as an advantageous, feasible inspection application, the selection of the most suitable 3D models is challenging due to multiple technology options. The primary objectives of this study were to investigate current trends and identify future technologies for 3D models in the construction industry. This study utilized systematic reviews by identifying and selecting quality journals, analyzing selected articles, and conducting content analysis and meta-analysis to identify dominant themes in 3D models. Results showed that the top technologies used to model construction projects are building information models, remote sensing, stereo vision system/photo processing programs, and augmented reality/virtual reality. The main benefits and challenges of these technologies for modeling were also determined. This study identified three areas with significant knowledge gaps for future research: (1) the amalgamation of two or more technologies to overcome project obstacles; (2) solution optimization for inspections in remote areas; and (3) the development of algorithm-based technologies. This research contributes to the body of knowledge by exploring current trends and future directions of 3D model technologies in the construction industry.

Stable platinum nanoclusters on genomic DNA-graphene oxide with a high oxygen reduction reaction activity.

Nanosize platinum clusters with small diameters of 2-4 nm are known to be excellent catalysts for the oxygen reduction reaction. The inherent catalytic activity of smaller platinum clusters has not yet been reported due to a lack of preparation methods to control their size (<2 nm). Here we report the synthesis of platinum clusters (diameter ≤1.4 nm) deposited on genomic double-stranded DNA-graphene oxide composites, and their high-performance electrocatalysis of the oxygen reduction reaction. The electrochemical behaviour, characterized by oxygen reduction reaction onset potential, half-wave potential, specific activity, mass activity, accelerated durability test (10,000 cycles) and cyclic voltammetry stability (10,000 cycles) is attributed to the strong interaction between the nanosize platinum clusters and the DNA-graphene oxide composite, which induces modulation in the electronic structure of the platinum clusters. Furthermore, we show that the platinum cluster/DNA-graphene oxide composite possesses notable environmental durability and stability, vital for high-performance fuel cells and batteries.

Environmental applications using graphene composites: water remediation and gas adsorption.

This review deals with wide-ranging environmental studies of graphene-based materials on the adsorption of hazardous materials and photocatalytic degradation of pollutants for water remediation and the physisorption, chemisorption, reactive adsorption, and separation for gas storage. The environmental and biological toxicity of graphene, which is an important issue if graphene composites are to be applied in environmental remediation, is also addressed.

Total intravenous anesthesia with propofol augments the potency of mivacurium.

BACKGROUND: Little is known about the potentiating effect of propofol on neuromuscular blocking drugs. However, some animal studies indicate a dose-dependent increase of the potency of neuromuscular blocking drugs by propofol. This study compared mivacurium potency after five minutes and after 20 min of total intravenous anesthesia with propofol (TIVA propofol). METHODS: Twenty-eight patients were randomized into two groups, after approval of the Ethics Committee and written consent. Anesthesia was induced, in all patients, using remifentanil 0.5 microg.kg(-1).min(-1) for two minutes, after which: 3 mg.kg(-1) of propofol was injected; a laryngeal mask airway was inserted; and intermittent, positive pressure ventilation was initiated. Anesthesia was maintained using TIVA propofol (titrated using bispectral index monitoring to 40-45). Neuromuscular monitoring consisted of phonomyography at the adductor pollicis muscle. In Groups 5 min and 20 min, a tetanic stimulation of the ulnar nerve commenced after four minutes and after 19 min of TIVA, respectively, followed by controlled, single twitch stimulation at 1 Hz for one minute. Boli of 60, 30, 30, and 30 microg.kg(-1) mivacurium, respectively, were administered (each drug increment was administered after the effect of the previous dose had caused a stable response), and single twitch stimulation continued at 0.1 Hz. The dose-response curve was determined for both groups; potency was calculated using log-probit analysis. Data were presented as mean (SD) and were compared using two-sided analysis of variance, P < 0.05. RESULTS: Patient characteristics were similar in the two groups. The corresponding ED(50) and ED(95) values were greater, at 76.7 +/- 12.4 microg.kg(-1) and 146.6 +/- 27.6 microg.kg(-1) for Group 5 min, vs 46.7 +/- 12.2 microg.kg(-1) and 101.1 +/- 20.2 microg.kg(-1) for Group 20 min, respectively. CONCLUSIONS: After 20 min of TIVA propofol, the potency of mivacurium is approximately 50% greater than after five minutes of TIVA propofol. For clinical purposes, it is important, therefore, to consider the duration of TIVA propofol before determining the dose of neuromuscular blocking drug.

A novel approach for pain management in cardiac surgery via median sternotomy: bilateral single-shot paravertebral blocks.

Regional analgesia has entered cardiac anesthesia in the form of spinal or epidural analgesia. However, the risk of spinal or epidural hematoma is a constant worry. Alternative regional techniques might be applicable in cardiac surgery. The purpose of this study is to present a novel technique of bilateral single-shot paravertebral blocks (BSS-PVB) for cardiac surgery via median sternotomy and compare its efficacy versus high thoracic epidural analgesia (TEA). Fifty-two patients were compared in this prospective cohort audit. In 26 patients, cardiac surgery was performed using low-dose fentanyl/BSS-PVB (bilateral blocks of 3 mL bupivacaine 0.5% each, T1-7) and general anesthesia; in another 26 patients, TEA (bupivacaine 0.125% at 10 mL/hour) and general anesthesia were used. Patients were assigned to cohorts according to their preoperative data and types of surgery. All patient data are shown as mean +/- SD; pain scores were compared between groups using the t test immediately, 6 hours, and 24 hours after surgery (P < .05). In the BSS-PVB-group (19 men, 7 women), mean age was 65 +/- 11 years, weight 74 +/- 16 kg, ejection fraction 59% +/- 12%, and duration of surgery 130 +/- 27 minutes; in the TEA-group (17 men, 9 women), mean age was 63 +/- 10 years, weight 75 +/- 16 kg, ejection fraction 58% +/- 12%, and duration of surgery 113 +/- 27 minutes. These data and preoperative comorbidity variables were not significantly different between the two groups. In each group, 18 patients underwent off-pump coronary artery bypass grafting, 3 on-pump and 5 mitral valve replacements. All patients were successfully immediately extubated. Postoperative pain scores were at any point significantly lower with TEA, immediately at 2.4 +/- 2.2 versus 3.7 +/- 2.6, at 6 hours at 1.1 +/- 1.5 versus 2.4 +/- 1.8, and at 24 hours at 1.0 +/- 1.4 versus 2.3 +/- 1.6 (0 = no pain, 10 = maximum pain). There was no complications related to epidural catheter placement or BSS-PVB. Using both techniques, immediate extubation after cardiac surgery is feasible; TEA provides better pain relief after cardiac surgery than BSS-PVB.

Brief review: Neuromuscular monitoring: an update for the clinician.

PURPOSE: To review established techniques and to provide an update on new methods for clinical monitoring of neuromuscular function relevant to anesthesia. SOURCE: A PubMed search of relevant article for the period 1985-2005 was undertaken, and bibliographies were scanned for additional sources. PRINCIPAL FINDINGS: There is no substitute for objective neuromuscular monitoring; for research purposes, mechanomyography (MMG) is the gold standard; however, the most versatile method in the clinical setting is acceleromyography since it can be applied at various muscles and has a long track record of clinical utility. Kinemyography is valid to monitor recovery of neuromuscular transmission at the adductor pollicis muscle (AP), whereas phonomyography is easy to apply to various muscles and shows promising agreement with MMG. Monitoring of the corrugator supercilii muscle (CS) may be used to determine the earliest time for tracheal intubation as it reflects laryngeal relaxation better than monitoring at the AP. Recovery of neuromuscular transmission is best monitored at the AP, since it is the last muscle to recover from neuromuscular blockade (NMB). If train-of-four (TOF) stimulation is used, a TOF-ratio > 0.9 should be the target before awakening the patient. If surgery or the type of anesthesia necessitates NMB of a certain degree, e.g., TOF-ratio = 0.25, monitoring of muscles which best reflect the degree of NMB at the surgical site is preferable. CONCLUSION: Objective methods should be used to monitor neuromuscular function in clinical anesthesia. Acceleromyography offers the best compromise with respect to ease of use, practicality, versatility, precision and applicability at various muscles. The CS is the optimal muscle to determine the earliest time for intubation, e.g., for rapid sequence induction.

Immediate extubation after aortic valve surgery using high thoracic epidural analgesia or opioid-based analgesia.

OBJECTIVE: Fast-track anesthesia has gained widespread use in cardiac centers around the world. No study has been published focusing on immediate extubation after aortic valve surgery. This study examines the feasibility and hemodynamic stability of immediate extubation after simple or combined aortic valve surgery using either thoracic epidural analgesia or opioid-based analgesia. DESIGN: Prospective audit, pilot study. SETTING: Single-institution university medical center. PARTICIPANTS: Adult patients undergoing aortic valve replacement (N = 45). INTERVENTIONS: Forty-five patients undergoing aortic valve surgery with an ejection fraction of more than 30% were included in this prospective audit. Induction of anesthesia was done using fentanyl, 2 to 4 mug/kg, propofol, 1 to 2 mg/kg, and endotracheal intubation facilitated by rocuronium; anesthesia was maintained using sevoflurane titrated according to bispectral index (BIS [BIS target: 50]). Perioperative analgesia was provided by high thoracic epidural analgesia (TEA group, bupivacaine 0.125%, 6 to 14 mL/h) or fentanyl, up to 10 microg/kg, followed by patient-controlled analgesia with morphine (OPIOID group). MEASUREMENTS AND MAIN RESULTS: Success of extubation within 30 minutes after surgery was recorded. Hemodynamic data during surgery were compared by using an analysis of variance test; p < 0.05 was considered as showing a significant difference. Data presented as median (25th-75th percentile). In the TEA group, patients underwent simple aortic valve replacement (N = 21) or combined aortic valve surgery (N = 14), with additional coronary artery bypass grafting (N = 10) and replacement of the ascending aorta (Bentall, N = 4). In the OPIOID group, patients underwent simple aortic valve replacement (N = 5) or combined aortic valve surgery (N = 5), with additional aortocoronary bypass grafting (N = 2), replacement of the ascending aorta (Bentall, N = 2), and reconstruction of the mitral valve (N = 1). All 45 patients were extubated within 15 minutes after surgery. There was no need for reintubation; pain scores were lower in the TEA group than in the OPIOID group immediately after surgery and at 6 hours, 24 hours, and 48 hours after surgery. For the TEA group and OPIOID group, the pain scores were 0 (0-2), 0 (0-2), 0 (0-1.5), and 0 (0-0) and 5 (4-5.75), 4 (3-4.5), 4 (3.25-4), and 1 (0-2.5), respectively. During and up to 6 hours after surgery, there was no significant hemodynamic difference between the TEA and OPIOID groups. Eighteen of 45 patients needed temporary pacemaker activation. There were no epidural hematoma or neurologic complications related to TEA. CONCLUSION: Immediate extubation is feasible after aortic valve surgery using either high thoracic epidural analgesia or opioid-based analgesia; both techniques maintain hemodynamic stability throughout surgery. TEA provides superior pain control.

Immediate Extubation after Aortic Valve Surgery Using High Thoracic Epidural Anesthesia.

Abstract Purpose: Fast-track anesthesia has gained widespread use in cardiac centers around the world. No study has focused on immediate extubation after aortic valve surgery. This study examines the feasibility and hemodynamic stability of immediate extubation after simple or combined aortic valve surgery using thoracic epidural anesthesia. Methods: Thirty patients undergoing aortic valve surgery with an ejection fraction of more than 30% were included in this prospective audit. After insertion of a high thoracic epidural catheter, induction with fentanyl 2 to 4 microg/kg, administration of propofol 1 to 2 mg/kg, and endotracheal intubation facilitated by rocuronium, anesthesia was maintained with sevoflurane titrated according to bispectral index (target, 50). Perioperative analgesia was provided by high thoracic epidural analgesia (TEA) (bupivacaine 0.125% 6-14 mL/h). Hemodynamic data were compared by Friedman test. P <.05 was considered to show a significant difference. Data are presented as median (25th-75th percentile). Results: Patients underwent simple aortic valve surgery (n = 17) or combined aortic valve surgery (n = 13) with additional coronary artery bypass grafting (n = 8), replacement of the ascending aorta (Bentall procedure) (n = 4), and repair of open foramen ovale (n = 1). All 30 patients were extubated within 15 minutes after surgery at 36.5 degrees C (36.4 degrees C-36.6 degrees C). There was no need for reintubation. Pain scores were low immediately after surgery and 6, 24, and 48 hours after surgery at 0 (0-3.5), 0 (0-2), 0 (0-2), and 0 (0-2), respectively. During and up to 6 hours after surgery, there was no significant hemodynamic change due to TEA. Fifteen of 30 patients needed temporary pacemaker activation. There were no complications related to TEA. Conclusions: Immediate extubation is feasible after aortic valve surgery with high thoracic epidural analgesia and maintenance of hemodynamic stability throughout surgery. Immediate extubation after aortic valve surgery is a promising new path in cardiac anesthesia.