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Following the first COVID-19 infected cases, Malta rapidly imposed strict lockdown measures, including restrictions on international travel, together with national social distancing measures, such as prohibition of public gatherings and closure of workplaces. The study aimed to elucidate the effect of the intervention and relaxation of the social distancing measures upon the infection rate by means of a trendline analysis of the daily case data. In addition, the study derived a predictive model by fitting historical data of the SARS-CoV-2 positive cases within a two-parameter Weibull distribution, whilst incorporating swab-testing rates, to forecast the infection rate at minute computational expense. The trendline analysis portrayed the wave of infection to fit within a tri-phasic pattern, where the primary phase was imposed with social measure interventions. Following the relaxation of public measures, the two latter phases transpired, where the two peaks resolved without further escalation of national measures. The derived forecasting model attained accurate predictions of the daily infected cases, attaining a high goodness-of-fit, utilising uncensored government-official infection-rate and swabbing-rate data within the first COVID-19 wave in Malta.

Conventional liquefied natural gas (LNG) cargo vessels are imposed with tank-fill limitations as precautions to prevent structural damage and stability-loss due to high-impact sloshing, enforcing cargo volume-fills to be lower than 10% or higher than 70% of the tank height. The restrictions, however, limit commercial operations, specifically when handling spot trades and offshore loading/unloading at multiple ports along a shipping route. The study puts forward a computational fluid dynamic (CFD) sloshing analysis of partially-filled chamfered rectangular tanks undergoing sinusoidal oscillatory kinetics with the use of the explicit volume-of-fluid and non-iterative time-advancement schemes. Establishing a 20% to 60% fill-range, the sloshing dynamics were acknowledged within an open-bore, partitioned, and perforated-partitioned tank when oscillating at frequencies of 0.5 Hz and 1 Hz. The overall torque and static pressure induced on the tank walls were investigated. High-impact slamming at the tank roof occurred at 40% and 60% fills, however, the implementation of the partition and perforated-partition barriers successfully reduced the impact due to suppression and dissipation of the wave dynamics.

Introducing a duct along the perimeter of a rotor has been acknowledged to augment turbine performance. The outcome causation due to a bi-directional, cylindrical shroud, however, is uncertain. This study analyses the hydrodynamic swallowing capacity of a true-scale, vacant duct for tidal turbine applications in aligned and yawed inlet flow conditions by utilising three-dimensional unsteady computational fluid dynamics. The performance is investigated within free-stream magnitudes of 1 to 7 m.s−1, and a bearing angular range of 0° to 45° with the duct axis. In proportion to the free-stream magnitude, the normalised axial velocity through the duct increases as a result of a diminishment in pressure drag. Within yawed flow, the maximum capacity falls at a bearing of 23.2°, resulting in a performance increase of 4.13% above that at aligned flow conditions. The analysis concludes that the augmentation at yawed flow occurs due to the duct cross-sectional profile lift variation with angle-of-attack. Towards nominal yaw angle, the internal static pressure reduces, permitting a higher mass-flow rate. Beyond the nominal angle-of-attack, flow separation occurs within the duct, increasing pressure drag, thereby reducing the swallowing capacity.

Summary The workshop entitled 'Interventions to Slow Aging in Humans: Are We Ready?' was held in Erice, Italy, on October 8-13, 2013, to bring together leading experts in the biology and genetics of aging and obtain a consensus related to the discovery and development of safe interventions to slow aging and increase healthy lifespan in humans. There was consensus that there is sufficient evidence that aging interventions will delay and prevent disease onset for many chronic conditions of adult and old age. Essential pathways have been identified, and behavioral, dietary, and pharmacologic approaches have emerged. Although many gene targets and drugs were discussed and there was not complete consensus about all interventions, the participants selected a subset of the most promising strategies that could be tested in humans for their effects on healthspan. These were: (i) dietary interventions mimicking chronic dietary restriction (periodic fasting mimicking diets, protein restriction, etc.); (ii) drugs that inhibit the growth hormone/IGF-I axis; (iii) drugs that inhibit the mTOR-S6K pathway; or (iv) drugs that activate AMPK or specific sirtuins. These choices were based in part on consistent evidence for the pro-longevity effects and ability of these interventions to prevent or delay multiple age-related diseases and improve healthspan in simple model organisms and rodents and their potential to be safe and effective in extending human healthspan. The authors of this manuscript were speakers and discussants invited to the workshop. The following summary highlights the major points addressed and the conclusions of the meeting.

Abstract Background Drain insertion following chronic subdural hematoma (CSDH) evacuation improves patient outcomes. Objective To examine whether this is influenced by variation in drain location, positioning or duration of placement. Methods We performed a subgroup analysis of a previously reported multicenter, prospective cohort study of CSDH patients performed between May 2013 and January 2014. Data were analyzed relating drain location (subdural or subgaleal), position (through a frontal or parietal burr hole), and duration of insertion, to outcomes in patients aged >16 yr undergoing burr-hole drainage of primary CSDH. Primary outcomes comprised modified Rankin scale (mRS) at discharge and symptomatic recurrence requiring redrainage within 60 d. Results A total of 577 patients were analyzed. The recurrence rate of 6.7% (12/160) in the frontal subdural drain group was comparable to 8.8% (30/343) in the parietal subdural drain group. Only 44/577 (7.6%) patients underwent subgaleal drain insertion. Recurrence rates were comparable between subdural (7.7%; 41/533) and subgaleal (9.1%; 4/44) groups (P = .95). We found no significant differences in discharge mRS between these groups. Recurrence rates were comparable between patients with postoperative drainage for 1 or 2 d, 6.4% and 8.4%, respectively (P = .44). There was no significant difference in mRS scores between these 2 groups (P = .56). CONCLUSION Drain insertion after CSDH drainage is important, but position (subgaleal or subdural) and duration did not appear to influence recurrence rate or clinical outcomes. Similarly, drain location did not influence recurrence rate nor outcomes where both parietal and frontal burr holes were made. Further prospective cohort studies or randomized controlled trials could provide further clarification.

IntroductionInadequate treatment of enlarged lateral lymph nodes (LLNs) in rectal cancer patients is associated with an increased lateral local recurrence (LLR) risk, despite neoadjuvant treatment and total mesorectal excision (TME) surgery. There is a promising role for LLN dissection (LLND) to lower this risk, but this challenging procedure requires appropriate training. This study protocol describes a prospective evaluation of oncological outcomes after standardised treatment based on multidisciplinary training, thereby aiming for a 50% reduction in LLR rate.Methods and analysisA prospective registration study will be opened in hospitals in which the involved multidisciplinary team members (radiologists, radiation oncologists, surgeons and pathologists) have received dedicated training to enhance knowledge and awareness of LLNs and in which standardised treatment including LLND has been implemented. Patients with rectal cancer and at least one enlarged LLN (short-axis ≥7.0 mm), or intermediate LLN (short-axis 5.0–6.9 mm) with at least one malignant feature on primary MRI, evaluated by a trained radiologist, are eligible. Patients will undergo neoadjuvant treatment by trained radiation oncologists, followed by TME surgery in combination with a minimally invasive, nerve-sparing LLND performed by trained surgeons. LLND specimens are evaluated by trained pathologists or grossing assistants. The primary outcome is LLR rate 3 years postoperatively. Secondary outcomes are morbidity, disease-free survival, overall survival and quality of life. To demonstrate a significant reduction in LLR rate from 13% (based on historical control data) to 6% after optimised treatment, 200 patients with enlarged LLNs are required.Ethics and disseminationThe medical ethics board of the Vrije Universiteit Medical Centre (VUMC), the Netherlands, approved the study on 23 November 2022 (reference: 2021.0524). Participating centres must obtain local approval and participants are required to provide written informed consent. Results obtained from this study will be communicated via peer-reviewed medical journals and presentations at conferences.Trail registration number NCT04486131, 24 July 2020, https://clinicaltrials.gov/ct2/show/NCT04486131.

BackgroundChronic subdural hematoma (CSDH) is a common neurological condition; surgical evacuation is the mainstay of treatment for symptomatic patients. No clear evidence exists regarding the impact of timing of surgery on outcomes. We investigated factors influencing time to surgery and its impact on outcomes of interest.MethodsPatients with CSDH who underwent burr-hole craniostomy were included. This is a subset of data from a prospective observational study conducted in the UK. Logistic mixed modelling was performed to examine the factors influencing time to surgery. The impact of time to surgery on discharge modified Rankin Scale (mRS), complications, recurrence, length of stay and survival was investigated with multivariable logistic regression analysis.Results656 patients were included. Time to surgery ranged from 0 to 44 days (median 1, IQR 1–3). Older age, more favorable mRS on admission, high preoperative Glasgow Coma Scale score, use of antiplatelet medications, comorbidities and bilateral hematomas were associated with increased time to surgery. Time to surgery showed a significant positive association with length of stay; it was not associated with outcome, complication rate, reoperation rate, or survival on multivariable analysis. There was a trend for patients with time to surgery of ≥7 days to have lower odds of favorable outcome at discharge (p=0.061).ConclusionsThis study provides evidence that time to surgery does not substantially impact on outcomes following CSDH. However, increasing time to surgery is associated with increasing length of stay. These results should not encourage delaying operations for patients when they are clinically indicated.

The Mortgage Loan Opinion Report covers issues that typically arise in legal opinions rendered in connection with commercial mortgage transactions. The Report recommends a Form of Model Opinion and contains extensive explanatory endnotes. The Report was approved by the Committee on Real Property Law of the Association of the Bar of the City of New York and by the Executive Committee of the Real Property Law Section of the New York State Bar Association.