Expedient Delivery Research Articles

Access to Functionalized Amines and Medium N-Heterocycles via Amine-Enabled Remote C-H Alkynylation.

By using weakly coordinating amines, we developed remote C-H alkynylation with precise control of reactivity and regioselectivity, enabling modification of complex drugs, natural products, and materials. The readily transformable alkyne-containing amine products would facilitate expedient delivery of molecular libraries of functionalized amines and medium N-heterocycles, which are previously elusive to access. Moreover, the introduced alkyne functionality could serve as a versatile handle to expand the diversity and synthetic application of this remote C-H functionalization.

APPLICATION OF INFORMATION TECHNOLOGIES IN MEMORY OBJECTS ON THE EXAMPLE OF THE TERRITORY OF BABYN YAR

The article is dedicated to researching the possibilities of interaction of modern information and communication technologies with objects of memory, which in the long term will remain the main examples of architectural and sculptural means for immortalizing certain figures, events, circumstances in Ukrainian society, primarily related to the military aggression of the Russian Federation. The relevance of this topic also lies in local familiarization with modern multimedia techniques and information methods, with the help of which it is now possible to emotionally influence the observer and more fully and clearly convey a certain message of a significant place or building. An overview of the currently available studies that fully or tangentially touch on the raised issues has been conducted. The essence of the concept of the research object and its basic provisions are formulated. Significant installations and places of the territory of the National Historical and Memorial Reserve «Babyn Yar» are described in detail, which serve as reference points, samples, based on which conclusions are formed regarding the quality and feasibility of using information technologies. The material on memory objects has been analyzed and synthesized, which can become an impetus for further research and a basis for the creation of memorials and monuments of various types. Еhe use of information and communication technologies in the process of functional-spatial formation of memory objects is the latest effective method for the most complete preservation and the brightest, most expedient delivery of information, strengthening the impression of a place, expressing the composition, etc.

Public–private partnership in the UK fusion program

Fusion power could be one of a few sustainable options in a portfolio required to replace fossil fuels as the world's primary energy source. The attractive properties of fusion combined with the imperative to address climate change has resulted in a burgeoning interest in the field with a dramatic growth in privately funded fusion ventures in recent years. Historically, fusion has been developed by governments globally, including through ITER, the largest scientific collaborative project ever undertaken. The result is that the majority of people working in fusion today as well as most of the intellectual property reside within the public sector. However, there is equally a recognition that the private sector plays a vital role in delivering large-scale infrastructure projects, especially at the pace and agility required in the case of fusion and because it is the private sector that ultimately will deliver a fleet of fusion plants. Therefore, many countries are increasingly pursuing variants of public–private partnerships in the delivery of fusion. In this paper, we provide the perspective of expedient delivery of fusion through public–private partnership as presently intended in the UK fusion program.

Construction of Rings via Metal‐Catalyzed C−H Annulation with Unsymmetrical Internal Alkynes: Selectivity and Applications

AbstractSelective and concise construction of ring systems that are ubiquitous skeletons across chemistry, drugs and materials, is indispensable for human life. Of note, directed C−H annulation with alkynes for the expedient delivery of ring systems holds great importance, featuring step‐ and atom‐economy, mild conditions, and broad substrate scope. However, regioselectivity issues remained when using unsymmetrical alkynes for the directed C−H annulation. Herein, we summarized recent achievements towards solving this problem by developing directing groups, metal catalysts, and alkynes with versatile and traceless functionality that ensure the overall regioselectivity, enantioselectivity, efficiency, and synthetic application. We hope this concept will promote the further development of the precise construction of functional molecules using C−H annulation with unsymmetrical alkynes.

475 Financial Toxicity in Dementia Caregiving

OBJECTIVES/GOALS: Financial toxicity describes the adverse effects of medical expenses on financial security and health related quality of life. Though dementia caregiving carries serious costs, financial toxicity has not been studied in this context. Here we assess the prevalence of financial toxicity in dementia caregiving and its sociodemographic correlates. METHODS/STUDY POPULATION: We utilized the COmprehensive Score for financial Toxicity (COST)— 12-item questionnaire validated to quantify financial toxicity in patients and their caregivers— to conduct a nationally representative survey of 317 US dementia caregivers, oversampling non-Hispanic Black (n = 75) and Hispanic (n = 61) caregivers. Participants were required to be currently providing unpaid care to someone 50 years or older with dementia. Financial toxicity was defined as COST 0 & RESULTS/ANTICIPATED RESULTS: COST scores ranged between 0 and 44, with a survey-weighted mean of 24.57 and standard deviation of 9.8. Weighted analysis revealed 52.7% of American dementia caregivers experience some degree of financial toxicity. Of those who experience financial toxicity, 73.1% are classified as mild, 25.7% as moderate, and 1.2% as severe. Financial toxicity was identified in 69.5% of non-Hispanic Black, 54.1% of Hispanic, and 42.3% of non-Hispanic White caregivers, with non-Hispanic Black caregivers significantly more likely to experience financial toxicity compared to their non-Hispanic White counterparts (p = 0.017). DISCUSSION/SIGNIFICANCE: Most US dementia caregivers experience financial toxicity, though prevalence varies significantly by caregiver race. Discerning the pervasiveness of financial toxicity in this population and significant correlates will inform the development and expedient delivery of resources for patients and families.

ACE Question

Article| September 2022 ACE Question ASA Monitor September 2022, Vol. 86, 13. https://doi.org/10.1097/01.ASM.0000874216.72620.21 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Cite Icon Cite Get Permissions Search Site Citation ACE Question. ASA Monitor 2022; 86:13 doi: https://doi.org/10.1097/01.ASM.0000874216.72620.21 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest filter your search All ContentAll PublicationsASA Monitor Search Advanced Search Topics: anesthesiology continuing education (ace) Which of the following complications is MOST likely to be associated with vasa previa? Vasa previa (Figure) is a velamentous insertion of the fetal vessels overlying the cervical os ahead of the fetal presenting part. This leaves the fetal vessels unprotected by the placenta or umbilical cord and at risk of being compressed by the fetal presenting part or disrupted during rupture of the fetal membranes. There is a high risk of fetal mortality due to exsanguination, as the blood volume of the term fetus is only 80 to 100 mL/kg. Immediate cesarean delivery is required, with the largest focus being on expedient delivery of the fetus and subsequent volume resuscitation of the fetus with colloid, balanced salt solutions, or blood transfusion. The two main causes of vasa previa are velamentous insertions (where the cord inserts directly into the membranes, leaving unprotected vessels running to the placenta) and... You do not currently have access to this content.

An Email Spam Filtering Model Using Ensemble of Machine Learning Techniques

The growth of spam emails is on the increase responsible for larger portions of the global email traffics. Aside the annoyance and the time wasted sifting through the unwanted messages; spam emails can also cause immeasurable harms through malicious software capable of damaging systems and compromising confidential information. The risks of filtering spam emails is that sometimes, legitimate mails are marked as spam, yet the results of not filtering spam are the constant flood of spam clogs on networks that adversely impacts users inboxes while draining valuable resources on the networks such as bandwidth and storage capacity, productivity loss and interfere with the expedient delivery of legitimate emails. Several researchers had worked on the design of models for spam email filtering using different techniques, however the detection accuracy of these models have also become subject of discussions. This study developed spam email filtering model using Ensemble of Decision Tree, Support Vector Machine and Multilayer Perceptron (DT-SVM-MLP) technique as a solution approach to solving issues of low spam emails detection accuracy. The ensemble model was trained using forward propagation training technique and the performance was evaluated using five performance metrics of Accuracy, False Positive (FP) Rate, Precision, Recall and F-Measure.

Liver pathology in pregnancy.

Liver dysfunction occurs in up to 3% of pregnancies and can be due to pregnancy-associated liver injury, exacerbation of pre-existing liver disease, or co-incident with pregnancy. The most common form of pregnancy-associated liver injury is intrahepatic cholestasis of pregnancy (ICP). This condition is typically benign and self-limited, but is associated with fetal morbidity and mortality with high levels of serum bile acids. Acute fatty liver of pregnancy (AFLP) and the hypertensive disorders of pregnancy (including pre-eclampsia, eclampsia, and hemolysis, elevated liver enzymes, and low platelets [HELLP] syndrome) are more commonly associated with maternal and fetal complications and may necessitate expedient delivery. Histologically, ICP shows nonspecific features of cholestasis, while AFLP and the hypertensive disorders have more characteristic histologic findings. While not a true liver disease, hyperemesis gravidarum can cause elevated liver enzymes. Pregnant patients are at increased risk of developing severe hepatitis E and herpesvirus infections, Budd-Chiari syndrome, and gallstones, and they may also experience worsening of known chronic liver disease. Mass lesions in pregnancy including hemangiomas, focal nodular hyperplasia, and hepatocellular adenomas and carcinomas can present unique challenges for diagnosis and management. This review will explore the pathophysiology, presentation, histologic features, and management of these conditions.

Editors' Note: Multimodal CT or MRI for IV Thrombolysis in Ischemic Stroke With Unknown Time of Onset

In their retrospective analysis of 184 patients treated with intravenous thrombolysis for an unknown time of stroke onset, Macha et al. compared treatment times and outcomes based on assessment using multimodal computed tomography (CT) or magnetic resonance imaging (MRI). Unsurprisingly, patients selected for thrombolysis based on CT were treated more quickly than those who underwent brain MRI (mean difference 28 minutes); however, there were no significant differences in the rate of symptomatic intracranial hemorrhage or favorable outcome at 90 days between the imaging groups. Kumar and Singh comment that MRI has other advantages, such as the detection of microhemorrhages, higher spatial resolution for brain injury, lack of intravenous contrast requirement, and more rapid imaging acquisition with recent technological advancements. The investigators agree that MRI offers unique advantages over CT; however, these advantages are outweighed by the more expedient delivery of acute stroke care with CT, as has been confirmed in the recent EXTEND trial. Both the investigators and the commenters share optimism about the use of tenecteplase over alteplase as a means of shortening treatment delays; however, the safety and efficacy of tenecteplase beyond 4.5 hours (or in the unknown time window) have not yet been established. In their retrospective analysis of 184 patients treated with intravenous thrombolysis for an unknown time of stroke onset, Macha et al. compared treatment times and outcomes based on assessment using multimodal computed tomography (CT) or magnetic resonance imaging (MRI). Unsurprisingly, patients selected for thrombolysis based on CT were treated more quickly than those who underwent brain MRI (mean difference 28 minutes); however, there were no significant differences in the rate of symptomatic intracranial hemorrhage or favorable outcome at 90 days between the imaging groups. Kumar and Singh comment that MRI has other advantages, such as the detection of microhemorrhages, higher spatial resolution for brain injury, lack of intravenous contrast requirement, and more rapid imaging acquisition with recent technological advancements. The investigators agree that MRI offers unique advantages over CT; however, these advantages are outweighed by the more expedient delivery of acute stroke care with CT, as has been confirmed in the recent EXTEND trial. Both the investigators and the commenters share optimism about the use of tenecteplase over alteplase as a means of shortening treatment delays; however, the safety and efficacy of tenecteplase beyond 4.5 hours (or in the unknown time window) have not yet been established.

S3344 A Tight Squeeze: A Case of Metastatic Poorly Differentiated Gastric Adenocarcinoma Presenting as Malignant Biliary Strictures After a Recent Laparoscopic Cholecystectomy

INTRODUCTION: Biliary strictures are subdivided into benign and malignant etiologies. Benign strictures often result from an array of causes including chronic or autoimmune pancreatitis, Mirizzi syndrome, and iatrogenic causes, including post-cholecystectomy strictures. Malignant strictures are often seen as a result of cholangiocarcinoma or pancreatic adenocarcinoma. Gastric adenocarcinoma is an exceedingly rare cause of biliary strictures, with resultant obstruction estimated in 1.3-2.3% of cases. Differentiating between these stricture types is of the utmost importance given vast differences in management. This case represents a diagnostic challenge in a patient presenting with biliary strictures after a recent laparoscopic cholecystectomy who was found to have metastatic gastric adenocarcinoma. CASE DESCRIPTION/METHODS: A 32-year-old female with a past medical history significant for a laparoscopic cholecystectomy four months prior to admission presented with subacute fatigue, jaundice, and dark urine. Initial laboratory values were notable for a direct pre-dominant hyperbilirubinemia. An MRCP showed stricturing at the confluence of the biliary ductal system, moderate ascites, and enlarged para-aortic/retroperitoneal nodes that were visualized four months prior. Initial provider concerns included post-cholecystectomy complications; however, the persistent lymphadenopathy remained a cause for concern. An ERCP demonstrated erythematous mucosa throughout the stomach and severe biliary strictures in the entire main bile duct, with a thickened gastric fold biopsy revealing poorly differentiated gastric adenocarcinoma (surgical pathology from her recent cholecystectomy demonstrated only acute and chronic calculous cholecystitis). Her hospital course was complicated by peritoneal carcinomatosis, peritonitis, recurrent gastric outlet obstructions, and enteral and biliary stent placement. Palliative chemotherapy was initiated in the inpatient setting prior to discharge. DISCUSSION: Given the temporal relationship of the patient’s symptoms to her recent cholecystectomy, initial concerns involved post-cholecystectomy complications such as benign biliary strictures. However, the importance of the patient’s persistent lymphadenopathy was noted and additional procedures were pursued, leading to the diagnosis of malignancy as the cause of the patient’s strictures. Determining the etiology of the patient’s biliary stricture was of paramount importance to ensure the expedient delivery of chemotherapy.

DETERMINATION OF ECONOMIC ADVISABLE DISTANCES OF AUTOMOBILE DELIVERY ON AUTOSERVICE ENTERPRISE

In order to increase the efficiency of the operation of motor transport enterprises, the structure of production units for maintenance and repair of cars should be determined by the scope of work, taking into account the cost of implementation of the unit labor complexity of works. In case of inappropriateness of creating or maintaining an MTE of separate production units, maintenance and repairs of cars should be carried out at specialized service centers. Therefore, with the improvement of production units of motor transport enterprises structure, it is important to provide economically expedient delivery distances for maintenance works and repair of cars by co-operation in car service companies, which provide relevant services. The determination method of economically expedient distances of cars delivery and repair fund for car service companies is given. The cost of cars delivery and repair fund for 1 km to the car service companies or other motor transport enterprises (MTE), which accounts for 1 man-hour of labor-intensive maintenance and repair is determined. The economically expedient delivery distances for maintenance and cars repair by cooperation in car service companies are determined. The results of the calculations show that for taxi-driven MTE economically appropriate in modern conditions of distance of delivery of cars to perform maintenance-1 and maintenance-2 are close to those recommended in literary sources. For truck and bus MTE the corresponding delivery distances for maintenance-1, maintenance-2 performance, ongoing repairs are significantly lower. When performing diagnostic works D-1 and D-2, most of the the district works of the ongoing repair, the economically reasonable distances of delivery to the car service companies are obtained that substantially exceed the recommendations given in the scientific literature.

Innovations in Care Delivery of Stroke from Emergency Medical Services to the Neurointerventional Operating Room.

Acute ischemic stroke (AIS) and its care is currently one of the most dynamic and evolving illnesses across the globe. Among the most crucial factors in providing the best care to patients are the expedient delivery of thrombolytics and endovascular intervention when indicated. Here, we review our unique model of efficient care centered in our innovative Neurological Emergency Department (Neuro ED). The Neuro ED acts as our hub for EMS communication, imaging, administration of intravenous alteplase, and transition to the Neurointerventional OR. Our structure with its enabling of shortened IV alteplase delivery times and faster door-to-needle (DTN) times may serve as an international model for stroke centers.

Principles of Antibiotic Management of Community-Acquired Pneumonia.

Community-acquired pneumonia (CAP) encompasses a broad spectrum of disease severity and may require outpatient, inpatient, or intensive care management. Successful treatment hinges on expedient delivery of appropriate antibiotic therapy tailored to both the likely offending pathogens and the severity of disease. This review summarizes key principles in starting treatment and provides recommended empiric therapy regimens for each site of care. In addition, we discuss the antimicrobial and anti-inflammatory role macrolides play in CAP, as well as specific information for managing individual CAP pathogens such as community-acquired methicillin-resistant Staphylococcus aureus and drug-resistant Streptococcus pneumoniae. We also examine several novel antibiotics being developed for CAP and review the evidence guiding duration of therapy and current best practices for the transition of hospitalized patients from intravenous antibiotics to oral therapy.

Recent advances in managing a spinal cord injury secondary to trauma.

Traumatic spinal cord injuries (SCIs) affect 1.3 million North Americans, producing devastating physical, social, and vocational impairment. Pathophysiologically, the initial mechanical trauma is followed by a significant secondary injury which includes local ischemia, pro-apoptotic signaling, release of cytotoxic factors, and inflammatory cell infiltration. Expedient delivery of medical and surgical care during this critical period can improve long-term functional outcomes, engendering the concept of “Time is Spine”. We emphasize the importance of expeditious care while outlining the initial clinical and radiographic assessment of patients. Key evidence-based early interventions (surgical decompression, blood pressure augmentation, and methylprednisolone) are also reviewed, including findings of the landmark Surgical Timing in Acute Spinal Cord Injury Study (STASCIS). We then describe other neuroprotective approaches on the edge of translation such as the sodium-channel blocker riluzole, the anti-inflammatory minocycline, and therapeutic hypothermia. We also review promising neuroregenerative therapies that are likely to influence management practices over the next decade including chondroitinase, Rho-ROCK pathway inhibition, and bioengineered strategies. The importance of emerging neural stem cell therapies to remyelinate denuded axons and regenerate neural circuits is also discussed. Finally, we outline future directions for research and patient care.

Finance-based scheduling using meta-heuristics: discrete versus continuous optimization problems

Purpose – The purpose of this paper is to compare the performance of the genetic algorithm (GA), simulate annealing (SA) and shuffled frog-leaping algorithm (SFLA) in solving discrete versus continuous-variable optimization problems of the finance-based scheduling. This involves the minimization of the project duration and consequently the time-related cost components of construction contractors including overheads, finance costs and delay penalties. Design/methodology/approach – The meta-heuristics of the GA, SA and SFLA have been implemented to solve non-deterministic polynomial-time hard (NP-hard) finance-based scheduling problem employing the objective of minimizing the project duration. The traditional problem of generating unfeasible solutions in scheduling problems is adequately tackled in the implementations of the meta-heuristics in this paper. Findings – The obtained results indicated that the SA outperformed the SFLA and GA in terms of the quality of solutions as well as the computational cost based on the small-size networks of 30 activities, whereas it exhibited the least total duration based on the large-size networks of 120 and 210 activities after prolonged processing time. Research limitations/implications – From researchers’ perspective, finance-based scheduling is one of the few domain problems which can be formulated as discrete and continuous-variable optimization problems and, thus, can be used by researchers as a test bed to give more insight into the performance of new developments of meta-heuristics in solving discrete and continuous-variable optimization problems. Practical implications – Finance-based scheduling discrete-variable optimization problem is of high relevance to the practitioners, as it allows schedulers to devise finance-feasible schedules of minimum duration. The minimization of project duration is focal for the minimization of time-related cost components of construction contractors including overheads, finance costs and delay penalties. Moreover, planning for the expedient project completion is a major time-management aspect of construction contractors towards the achievement of the objective of client satisfaction through the expedient delivery of the completed project for clients to start reaping the anticipated benefits. Social implications – Planning for the expedient project completion is a major time-management aspect of construction contractors towards the achievement of the objective of client satisfaction. Originality/value – SFLA represents a relatively recent meta-heuristic that proved to be promising, based on its limited number of applications in the literature. This paper is to implement SFLA to solve the discrete-variable optimization problem of the finance-based scheduling and assess its performance by comparing its results against those of the GA and SA.

Triage, treatment, and transfer: evidence-based clinical practice recommendations and models of nursing care for the first 72 hours of admission to hospital for acute stroke.

Stroke is a medical emergency and care provided in the first hours is critical in shaping patients’ long-term recovery and prognosis.1 There is robust evidence demonstrating significant reductions in death and disability with early interventions in acute stroke care, including antiplatelet therapy2 stroke unit (SU) care3 and thrombolysis.4 International clinical guidelines for stroke provide key recommendations to guide clinical practice5–8; however, uptake of evidence-based care is variable and often less than optimal.9–14 For example, among patients with ischemic stroke, rates for treatment with intravenous recombinant tissue-type plasminogen activator (r-tPA) are relatively low in the USA (5%)9 and Australia (7%),10 compared with Canada (12%)11 and some European centers (14%).15 Nurses play a pivotal role in rapid identification and triage of patients with acute stroke, initial assessment, and coordinating the timely flow of patients with acute stroke through the health system. Nurses enable delivery of relevant time critical treatments, and rapid transfer to acute SUs for ongoing assessment and provision of further treatment. The purpose of this article is to highlight nursing’s essential contribution to the expedient delivery of acute stroke care by providing evidence-based recommendations for clinical practice processes of care and models of care where nurses have a pivotal role during the first 72 hours from arrival at the emergency department through to SU care. A more detailed comprehensive overview of nursing and interdisciplinary care for patients with acute ischemic stroke extending beyond the first 72 hours has been published previously.16 Where available in existing guidelines, the class and level of evidence for recommendations shown in tables have been provided using the American Heart Association taxonomy.6 As there is a dearth of evidence from high-quality stroke nursing research, not all the recommendations described …

‘Interception’: a model for specialist prehospital care provision when helicopters are not available

The deployment of specialist teams to incident scenes by helicopter and the delivery of critical care interventions such as Rapid Sequence Induction of anaesthesia to patients are becoming well-established components...

Delivering student feedback in higher education: the role of podcasting

Student numbers across the higher education sector have risen over recent years and the challenge of creating and delivering an effective learning experience grows evermore complex for the educator. It is necessary to provide prompt feedback to students on their current progress and personal areas for development, which is paramount for improving the quality of their future assessed work and also impacts significantly on individual motivation. Podcasting offers a timely and expedient delivery method for a wide range of teaching resources especially when combined with iconic and ubiquitous mp3 devices such as Apple's iPod. The culture of learning and its integration into students' daily lives is changing, and higher education institutions in the United States and Europe have been quick to embrace the potential of this technology, although much of the current research focus is on the delivery and reinforcement of curriculum material. This paper reports on a qualitative study within a music department, using semi-structured interviews and questionnaires to evaluate whether student feedback can also be delivered using audio-based podcasts, and whether this has a significant impact on how students respond to and use the information received. The findings conclude that delivering audio feedback produces a high-quality, personalized and appropriately detailed tutor response that students feel has significantly greater value for learning than more traditional written comments.

Fixation of the Medial Malleolar Fracture: A Simplified Technique

A technique for fixation of the medial malleolar fracture is presented as an alternative to cannulated screws or conventional screw fixation. Two partially threaded screws are inserted in to the same corridors created by the temporary fixation after anatomic reduction. The procedure minimizes soft tissue stripping of the fracture fragments and facilitates expedient delivery of the hardware. In addition to the simplicity of the technique, there is substantial cost savings and better thread purchase compared to cannulated screws.

Advancing Nursing Practice

Both patient and staff satisfaction with the SNP role has been high as it relates to quality of care delivery and accessibility of care and service. In particular, patients express satisfaction with the continuity of care experienced throughout the stroke care continuum, from acute in-hospital care to postdischarge follow-up. Improvements have been realized in systems and processes of care with the implementation of the SNP role. These include reductions in door-to-needle times in the administration of tPA (from 90 minutes to 60 minutes), rapid assessment and diagnostic interventions through coordination of are activities (e.g., door-to-CT scan times reduced from 60 minutes to 30 minutes), and faster consultation responses within the organization. Instituting the nurse practitioner role early in the development of the Calgary Stroke Program enhanced patient care while advancing the nursing discipline. The SNP has created a role that extends beyond that of physician helper to an autonomous nursing practice that has been beneficial to both patients with stroke and the regional healthcare delivery system. With the ability to practice autonomously, the nurse practitioner can aid in the expedient delivery of complex, comprehensive stroke care, as has been the case in the Calgary Stroke Program.