In this paper, a smart optimized control technique is proposed. Structures are modelled using a coupled finite element method (FEM) and boundary element method (BEM), where building floors are ...modeled using BEM, and vertical elements are modeled using FEM without lumping of masses. Genetic Algorithm (GA) and Particle Swarm Optimization (PSO) are combined to find the best configuration for MR dampers within a given structure and determine values of the performance function weighting matrices, respectively. Effective evaluation criteria are carried out against benchmark earthquakes. The proposed semi-active controller is compared with an ideal active and passive ON/OFF control systems.
Rectangular openings are sometimes required in existing concrete beams to pass the electromechanical utility ducts. These openings may be located at the beam's shear regions. The web openings enable ...the designer to keep the clear height of the floors and reduce the height of the structure, which is required especially for tall building construction, thus leading to an economic design. This research aims to study various strengthening techniques for beams with web opening using steel plates and carbon fiber reinforced polymer (CFRP) laminates. Seven reinforced concrete T-beams were cast with overall depth and length of 400-mm and 4500-mm, respectively. The top flange was 600-mm wide and 80-mm thick, and the web width equal to 200-mm. Each specimen was tested twice, the first test was done for 3000- mm clear span as a simple beam and the second test was done for the untested zone with 1400-mm clear span as a cantilever. This paper concerned with the seven tests, related to the simple beam behavior. Two specimens were tested as a control with and without web opening, while the remining five specimens were strengthened before testing using different strengthening schemes. The opening dimensions were 200x800 mm located at the shear zone region of specimens. An analytical model based on the stress-strain characteristics of concrete, steel and FRP was adopted and supported by a three-dimensional finite element analysis using ABAQUS software. It was found that the type of material used for strengthening and its configuration scheme significantly affect the efficiency of strengthening in terms of beam deflection, steel strain, cracking, ultimate capacity, and failure mode of the beam. Finally, some important conclusions are reported.
Nowadays, wind turbines are built in huge dimensions to cope with the high demand on renewable energy. Nevertheless, large and slender dimensions for blades and tower have fostered the problem of ...increased structural vibrations which led to undesirable deformations and destabilization in generator power production. Moreover, large dynamic responses for structural elements greatly reduces lifetime for these sensitive structures. During the past few decades, works on structural control of wind turbines have been carried out. However, their effectiveness is not significant in terms of reducing dynamic responses with minimum effort. This work introduces a Particle Swarm optimized (PSO) semi-active controller which exploits Magnetorheological (MR) dampers to mitigate edgewise blade displacements. MR dampers are placed inside of each of the blades to effectively supress their dynamic vibrations. The proposed controller is tested on a benchmark 5-MW wind turbine for validity of application. The proposed approach showed significant reductions in blades peak and peak-to-peak displacements which promotes longevity of wind turbines and optimizing the wind turbine energy output.
Patients with head and neck cancer have a substantial risk of chronic opioid dependence following surgery due to pain and psychosocial consequences from both the disease process and its treatments. ...Conditioned open-label placebos (COLPs) have been effective for reducing the dose of active medication required for a clinical response across a wide range of medical conditions. We hypothesise that the addition of COLPs to standard multimodal analgesia will be associated with reduced baseline opioid consumption by 5 days after surgery in comparison to standard multimodal analgesia alone in patients with head and neck cancer.
This randomised controlled trial will evaluate the use of COLP for adjunctive pain management in patients with head and neck cancer. Participants will be randomised with 1:1 allocation to either the treatment as usual or COLP group. All participants will receive standard multimodal analgesia, including opioids. The COLP group will additionally receive conditioning (ie, exposure to a clove oil scent) paired with active and placebo opioids for 5 days. Participants will complete surveys on pain, opioid consumption and depression symptoms through 6 months after surgery. Average change in baseline opioid consumption by postoperative day 5 and average pain levels and opioid consumption through 6 months will be compared between groups.
There remains a demand for more effective and safer strategies for postoperative pain management in patients with head and neck cancer as chronic opioid dependence has been associated with decreased survival in this patient population. Results from this study may lay the groundwork for further investigation of COLPs as a strategy for adjunctive pain management in patients with head and neck cancer. This clinical trial has been approved by the Johns Hopkins University Institutional Review Board (IRB00276225) and is registered on the National Institutes of Health Clinical Trials Database.
NCT04973748.
Background
The impact of close surgical margins on oncologic outcomes in HPV‐related oropharyngeal squamous cell carcinoma (HPV + OPSCC) is unclear.
Methods
Retrospective case series including ...patients undergoing single modality transoral robotic surgery (TORS) for HPV + OPSCC at three academic medical centers from 2010 to 2019. Outcomes were compared between patients with close surgical margins (<1 mm or requiring re‐resection) and clear margins using the Kaplan–Meier method.
Results
Ninety‐nine patients were included (median follow‐up 21 months, range 6–121). Final margins were close in 22 (22.2%) patients, clear in 75 (75.8%), and positive in two (2.0%). Eight patients (8.1%) recurred, including two local recurrences (2.0%). Four patients died during the study period (4.0%). Local control (p = 0.470), disease‐free survival (p = 0.513), and overall survival (p = 0.064) did not differ between patients with close and clear margins.
Conclusions
Patients with close surgical margins after TORS for HPV + OPSCC without concurrent indications for adjuvant therapy may be considered for observation alone.
The association between pretreatment nutritional status and immunotherapy response in patients with advanced head and neck cancer is unclear. We retrospectively analyzed a cohort of 99 patients who ...underwent treatment with anti-PD-1 or anti-CTLA-4 antibodies (or both) for stage IV HNSCC between 2014 and 2020 at the Johns Hopkins Hospital. Patient demographics and clinical characteristics were retrieved from electronic medical records. Baseline prognostic nutritional index (PNI) scores and pretreatment body mass index (BMI) trends were calculated. Associations between PNI and BMI were correlated with overall survival (OS), progression-free survival (PFS), and immunotherapy response. In univariate analysis, there was a significant correlation between OS and PFS with baseline PNI (OS: HR: 0.464; 95% CI: 0.265–0.814; PFS: p = 0.007 and HR: 0.525; 95% CI: 0.341–0.808; p = 0.003). Poor OS was also associated with a greater decrease in pretreatment BMI trend (HR: 0.42; 95% CI: 0.229–0.77; p = 0.005). In multivariate analysis, baseline PNI but not BMI trend was significantly associated with OS and PFS (OS: log (HR) = −0.79, CI: −1.6, −0.03, p = 0.041; PFS: log (HR) = −0.78, CI: −1.4, −0.18, p = 0.011). In conclusion, poor pretreatment nutritional status is associated with negative post-immunotherapy outcomes.
•Cardiac affection in systemic diseases shows widespread prevalence, which entails cardiac surveillance at the point of care.•STE can detect subclinical systolic dysfunction in many systemic ...diseases.•Contrast echocardiography increases feasibility and allows myocardial perfusion imaging.•3DE is used for real-time volume quantification and valve representation.•Machine learning enables less experienced personnel to obtain comprehensive cardiac assessment.
Cardiovascular disease (CVD) has been showing patterns of extensive rise in prevalence in the contemporary era, affecting the quality of life of millions of people and leading the causes of death worldwide. It has been a provocative challenge for modern medicine to diagnose CVD in its crib, owing to its etiological factors being attributed to a large array of systemic diseases, as well as its non-binary hideous nature that gradually leads to functional disability. Novel echocardiography techniques have enabled the cardiac ultrasound to provide a comprehensive analysis of the heart in an objective, feasible, time- and cost-effective manner. Speckle tracking echocardiography, contrast echocardiography, and 3D echocardiography have shown the highest potential for widespread use. The uses of novel modalities have been elaborately demonstrated in this study as a proof of concept that echocardiography has a place in routine general practice with supportive evidence being as recent as its role in the concurrent COVID-19 pandemic. Despite such evidence, many uses remain off-label and unexploited in practice. Generalization of echocardiography at the point of care can become a much-needed turning point in the clinical approach to case management. To actualize such aspirations, we recommend further prospective and interventional studies to examine the effect of implementing advanced techniques at the point of care on the decision-making process and evaluate their effectiveness in prevention of cardiovascular morbidities and mortalities.
Pain management is an important consideration for Head and Neck Cancer (HNC) patients as they are at an increased risk of developing chronic opioid use, which can negatively impact both quality of ...life and survival outcomes. This retrospective cohort study aimed to evaluate pain, opioid use and opioid prescriptions following HNC surgery. Participants included patients undergoing resection of a head and neck tumor from 2019–2020 at a single academic center with a length of admission (LOA) of at least 24 h. Exclusion criteria were a history of chronic pain, substance-use disorder, inability to tolerate multimodal analgesia or a significant post-operative complication. Subjects were compared by primary surgical site: Neck (neck dissection, thyroidectomy or parotidectomy), Mucosal (resection of tumor of upper aerodigestive tract, excluding oropharynx), Oropharyngeal (OP) and Free flap (FF). Average daily pain and total daily opioid consumption (as morphine milligram equivalents, MME) and quantity of opioids prescribed at discharge were compared. A total of 216 patients met criteria. Pain severity and daily opioid consumption were comparable across groups on post-operative day 1, but both metrics were significantly greater in the OP group on the day prior to discharge (DpDC) (5.6 (1.9–8.6),
p
< 0.05; 49 ± 44 MME/day,
p
< 0.01). The quantity of opioids prescribed at discharge was associated with opioid consumption on the DpDC only in the Mucosal and FF groups, which had longer LOA (6–7 days) than the Neck and OP groups (1 day,
p
< 0.001). Overall, 65% of patients required at least one dose of an opioid on the DpDC, yet 76% of patients received a prescription for an opioid medication at discharge. A longer LOA (aOR = 0.82, 95% CI: 0.63–0.98) and higher Charlson Comorbidity Index (aOR = 0.08, 95% CI: 0.01–0.48) were negatively associated with receiving an opioid prescription at the time of discharge despite no opioid use on the DpDC, respectively. HNC patients, particularly those with shorter LOA, may be prescribed opioids in excess of their post-operative needs, highlighting the need the for improved pain management algorithms in this patient population. Future work aims to use prospective surveys to better define post-operative and outpatient pain and opioid requirements following HNC surgery.
Introduction
A yield of ≥18 nodes from neck dissection has been shown to be associated with improved locoregional recurrence rates and survival. We sought to determine factors associated with lymph ...node yields below this threshold.
Materials and Methods
A retrospective review of patients who underwent neck dissection as part of definitive surgical treatment for mucosal head and neck squamous cell carcinoma (SCC) between January 2015 and December 2018 at an academic tertiary referral center was performed. Patients with a history of prior radiation or neck dissection were excluded.
Results
There were 412 neck dissections performed in 323 patients. Specimens containing <18 nodes decreased from 16.2% in 2015–2016 to 7.4% of neck dissections in 2017–2018. The proportion of neck dissections removing <3 levels decreased from 9.1% of neck dissections in 2015–2016 to 4.0% in 2017–2018. Multivariable regression analysis demonstrated that dissection of ≥3 levels (OR = 0.2 0.1–0.4) and neck dissection in 2017–2018 compared to 2015–2016 (OR = 0.4 0.2–0.8) were significantly associated with a lower odds of <18 nodes. Stage, site, race, sex, human papillomavirus status, positive nodes, surgeon volume, and pathologist volume were not associated with neck dissection specimens with <18 nodes, after controlling for all other variables.
Conclusions
Increased recognition of the importance of node count as a quality indicator, and the extent of neck dissection is associated with increased nodal yield from neck dissection. These data suggest that node count can be used as a quality measure of neck dissection for mucosal SCC.
Level of Evidence
4 Laryngoscope, 133:2160–2165, 2023
In this retrospective review, a yield of <18 nodes from neck dissection significantly decreased in 2017–2018 compared to 2015–2016, following routine incorporation of node count into tumor board discussions of surgical care. These findings suggest that lymph node yield can be used as a measure of quality of neck dissection for mucosal SCC to identify modifiable gaps in care and variability in practice patterns.
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