Half Years Research Articles

Challenges Associated with Investigating Salmonella Enteritidis with Low Genomic Diversity in New York State: The Impact of Adjusting Analytical Methods and Correlation with Epidemiological Data.

Defining investigation-worthy genomic clusters among strains of Salmonella Enteritidis is challenging because of their highly clonal nature. We investigated a cluster identified by core genome multilocus sequence typing (cgMLST) consisting of 265 isolates with isolation dates spanning two and a half years. This cluster experienced chaining, growing to a range of 14 alleles. The volume of isolates and broad allele range of this cluster made it difficult to ascertain whether it represented a common-source outbreak. We explored laboratory-based methods to subdivide and refine this cluster. These methods included using cgMLST with a narrower allele range, whole genome multilocus sequence typing (wgMLST) and high-quality single-nucleotide polymorphism (hqSNP) analysis. At each analysis level, epidemiologists retroactively reviewed exposures, geography, and temporality for potential commonalities. Lowering the threshold to 0 alleles using cgMLST proved an effective method to refine this analysis, resulting in this large cluster being subdivided into 34 smaller clusters. Additional analysis by wgMLST and hqSNP provided enhanced cluster resolution, with the majority of clusters being further refined. These analysis methods combined with more stringent allele thresholds and layering of epidemiologic data proved useful in helping to subdivide this large cluster into actionable subclusters.

Encefalitis por anticuerpos contra el receptor NMDA en tres pacientes pediátricos no asociados a tumor

La encefalitis asociada a anticuerpos contra el receptor N metil D aspartato (anti-R NMDA) fue descrita por primera vez en 2005. Hoy en día es la segunda causa de encefalitis autoinmune en la población pediátrica. A diferencia de la presentación en adultos, en niños la encefalitis anti-R NMDA se asocia en menor escala a tumores y los trastornos de movimiento son más comunes. Aquí presentamos tres casos en niños, con un rango de edad entre 3 y 7 años. Las discinesias fueron el síntoma de presentación en el primer caso, y no se evidenciaron síntomas psiquiátricos. La paciente posteriormente desarrolló un estatus convulsivo y deterioro de conciencia, con alteraciones del lenguaje. El segundo caso, luego de un periodo prodrómico, desarrolló cambios comportamentales, discinesias, disautonomía, estatus convulsivo y deterioro de conciencia. En ambos casos el desenlace fue favorable con el tratamiento y en el seguimiento ambos pacientes se encontraron con buena clase funcional. Se concluye que una alta sospecha diagnóstica que permita la instauración de un tratamiento adecuado y oportuno lleva a una recuperación funcional en el tiempo, y requiere el apoyo de un equipo multidisciplinario.

A literature review on the beneficial effects of music on aging auditory cortex and memory

AbstractBackgroundRecent studies examining the impact of music on long‐ and short‐term memory, as well as cognitive function, have emerged with contradictory findings. This study investigates the positive impact of music on memory and the auditory cortex in people of all ages.MethodIn the PubMed database, we searched for studies that have examined the impact of music on memory and auditory function. From January 2011 to June 2021, we searched for studies on the adult population that were “clinical trials, case control cohort and cross‐sectional studies, systematic reviews and meta analyses” in English. In our search, we used a combination of the keywords “Music, Aging, Memory, Auditory Cortex.” Four reviewers independently extracted and assessed the studies based on predetermined criteria. To eliminate bias, the results were double‐checked by six people (fellows, researchers, etc.).ResultWe chose eight studies from a total of 108. Two studies linked music exposure to improved executive function in the aging brain, four studies examined the correlation between music exposure and improved auditory memory, one study compared the aging brains of musicians and non‐musicians, and two studies pointed at music in dementia and Alzheimer’s patients. The total number of participants in the study was 409, with an average age of 54 years and a range of 17 to 91 years. The duration of exposure to music varies between less than five and eleven years, with an average of eight and a half years. The primary finding is that music has a positive influence on aging brains' auditory cortex, memory, and executive skills. The impact of music on specific parts of the aging brain is a secondary outcome.ConclusionMusic has a positive influence on the auditory cortex, memory, and several brain executive functions, according to our findings. Adults should participate in music‐related activities to promote a healthy auditory cortex and memory aging. The absence of prior research on this topic was one of the study’s limitations. More research is needed to better understand the impact of music on the aging brain.

Cultivating Students Learning Motivation Through Mathematics Lessons in a Lower Primary School of Seychelles

Every child is born with the potential to acquire and apply knowledge and skills. It is the teachers’ role to develop and nurture this competence in a holistic way. Eccles and Roeser believed that in doing so, teachers need to apply motivational activities within a conducive environment. The link between students’ learning motivation and constructive learning effects has been established by researchers like Ryan and Deci. However, even though motivation is known to be a major influence on students learning, it is a demanding task for teachers to cultivate learning motivation among young students. Therefore, this study aims at exploring teachers’ understanding of students’ learning motivation and the motivational strategies used to teach Mathematics in a lower primary school. A qualitative case study was conducted in a lower primary state school in Seychelles with the objective of finding out the teachers’ understanding of students’ learning motivation; exploring the motivation strategies used by them, and examining the influence of motivation on students’ learning. The study hopes to explore the strategies that Mathematics teachers used to cultivate motivation in Seychelles’s Mathematics classroom and identify the influence of motivation on students’ learning. The participants of this study comprised four lower primary Mathematics teachers and sixty-six students aged between five and a half to seven and a half years old. The study was conducted between March and May of 2021. The results showed that at the beginning of the school year, the teachers found that most students lack motivation in class. However, the level of students’ interest and motivation increased when they learned the topics in Mathematics that are related to their everyday life. The students also showed pleasure in learning when teachers included learning strategies like educational play, inquiry-based learning as well as the use of information, communication and technology (ICT) in the classroom as they reduce Mathematics negativity, which is a stressor for students. The study found that the more students experienced learning that interests them in Mathematics classes, the higher the level of their motivational drive, and this, in turn, helps them to display learning behavior that impacts positively on their Mathematics learning.

Connecting scientists in the era of Solar Orbiter

The first post-launch science meeting dedicated to the ESA/NASA Solar Orbiter spacecraft met in-person in Belfast nearly two and a half years into the mission, focusing on building new collaborations and rekindling old friendships.

Pine root exploration of standing dead tree trunks: a short-cut biocycling process

Aim of study: To characterize the colonization of Pinus herrerae roots in trunks of dead standing trees and to evaluate the composition of roots and decomposing tissues of standing dead trees.
 Area of study. Jaguariaíva, Paraná state, Southern Brazil.
 Material and methods: This study evaluated root attributes in the soil, litter, and trunks of dead standing trees and the composition of wood and bark of trees. Root traits (length, mass mycorrhizal colonization, and mean nutrient concentrations), soil and organic layers, and mean nutrient concentrations of wood and bark for were analyzed by non-parametric test.
 Main results: Approximately 2 to 3.5 years after tree death, roots of adjacent trees in F and H horizon litter migrate into the wood/bark interface. Eight and a half years after tree death, roots of adjacent trees reached up to 3.3 m above the litter surface. At the wood/bark interface, a root mantle formed (length greater than 1 km m-2) with ~5% ectomycorrhizal colonization. Root presence in the wood/bark interface reduced P, K, and Fe concentration of dead wood and Zn concentration in bark.
 Research highlights: Our results indicate that roots of P. herrerae are capable of colonizing dead tree trunks as a nutrient resource pool. This nutrient acquisition mechanism may function as a shortcut in the biogeochemical cycling of nutrients in forest systems.

Clinical profile of accidental ingestion of poisonous substances in children during COVID era

Background: Poisoning and drug overdose is a common medical emergency for children. Majority of childhood poisonings are unintentional. To see the change in epidemiology and spectrum of poisoning in children during COVID period this study was conducted because COVID-19 has changed the mental, socioeconomical, education status of people which also effected mental health of children. Methods: Prospective cross-sectional observation study was done in 95 children aged 0-15 years over a period of two and half years at tertiary care centre of Uttarakhand. Results: Most common age group was affected was 1-5 years (44.21%). Most common poisonous substance intake was pesticides and insecticides 18.9% followed by medications 17.89%. Most of the children (44.21%) were asymptomatic at time of presentation and required only observation care. Conclusions: During COVID time medicine became more common after pesticides in developing country. This spectrum is close to studies done in developed countries. Family education, interaction with children, close vigilance and proper storage of poisonous substance is important to avoid such incidences.

Epidemiology and SARS-CoV-2 Infection Patterns among Youth Followed at a Large Los Angeles Health Network during 2020-2022: Clinical Presentation, Prevalent Strains, and Correlates of Disease Severity.

Outcomes of SARS CoV-2 infection in infants, children and young adults are reported less frequently than in older populations. The evolution of SARS-CoV-2 cases in LA County youths followed at a large health network in southern California over two years was evaluated. A prospective cohort study of patients aged 0-24 years diagnosed with COVID-19 was conducted. Demographics, age distribution, disease severity, circulating variants of concern (VOCs), and immunization rates were compared between first and second pandemic years. Logistic regression estimated odds ratios (OR) and 95% confidence intervals (CI) of factors associated with severe/critical COVID-19. In total, 61,208 patients 0-24 years of age were tested for SARS-CoV-2 by polymerase chain reaction (PCR); 5263 positive patients (8.6%) with available data were identified between March 2020 and March 2022. In Year 1, 5.8% (1622/28,088) of youths tested positive, compared to 11% (3641/33,120) in Year 2 (p < 0.001). Most youths had mild/asymptomatic illness over two years. SARS-CoV-2 positivity was >12% across all age groups in the second half of Year 2, when Omicron prevailed. Pulmonary disease was associated with higher risk of severe COVID-19 in both years (OR: 2.4, 95% CI: 1.4-4.3, p = 0.002, Year 1; OR: 11.3, 95% CI: 4.3-29.6, Year 2, p < 0.001). Receipt of at least one COVID-19 vaccine dose was protective against severe COVID-19 (OR: 0.3, 95% CI: 0.11-0.80, p < 0.05). Despite different VOCs and higher rates of test positivity in Year 2 compared to Year 1, most youths with COVID-19 had asymptomatic/mild disease. Underlying pulmonary conditions increased the risk of severe COVID-19, while vaccination was highly protective against severe disease in youths.

Histopathologic Examination of Ovarian Lesions: A Prospective Observational Study in Women from Central India

Background: There is age related increase in the incidence of ovarian cancer. Most Indian population-based cancer registries have reported a gradual rise in the ovarian cancer incidence over the years. Since ovary is composed of totipotent gametocytes and multipotent mesenchymal tissues, almost any type of tumor can arise from these tissues. Therefore, their proper recognition and classification is important for appropriate therapy and better prognosis.Aim: to look at the histopathological profile of various ovarian lesions in the local female subjects from central India.Methods: A prospective observational study was carried out on the surgically resected ovarian samples that were referred to the Pathology department over two and half year. A total of 100 ovarian cases were included. Histopathological examination of the specimen was done using standard protocols.Results: On gross examination, majority of non-neoplastic specimen showed unremarkable findings. Microscopic examination of non-neoplastic cases revealed that most of the cases were of follicular cyst followed by corpus luteum cyst. On the contrary, majority of neoplastic specimen showed cystic external surface on gross examination. Surface epithelial tumor was the most common histologic type amongst neoplastic cases. Most common histologic subtype amongst the surface epithelial tumors was found to be benign simple serous cystadenoma. Conclusion: In women from central India, commonest non-neoplastic lesion of ovary is follicular cyst whereas most common neoplastic lesion is surface epithelial tumor (benign simple serous cystadenoma).

Internal Organization Analysis Of Unilever

The outbreak of Covid-19 in 2020 has brought downturn to the global economy and many companies went bankrupt during the epidemic. However, according to Unilever's financial report for the first half year, its sales fell only by 1.6% and its financial situation is still stable. The reason for it is not only for Unilever's action of taking Covid-19 as normalization, but also for its differentiation strategies, which make Unilever a competitive enterprise when the consumer products are in demand in Covid-19. Through the literature research method, this article uses the combination of SWOT (strengths, weaknesses, opportunities and threats) and PEST (political, economic, social and technological factors) models to explore the internal and external environments of Unilever in 2020, and concludes that under the multiple impacts of the external environment, Unilever still has great opportunities to make development relying on its own excellent internal conditions.

(428) Complex Treatment of Venous Leak with Embolisation and Autological Stem Cells Injections

Abstract Introduction The venous leakage is one of the most often reason of erectile dysfunction (ED) in young and middle age men. The main reason of veno-occlusive ED (VOED) is the insufficiency venous obstruction in corpora cavernosa under tunica albuginea that is why all types of veno-occlusive operations have particular and short term effect up to renovation of venous leakage in half year. Conservative treatment of VOED with PDE-5 has a low effectiveness. Evermore young patients deny Penile prosthesis implantation for psychological reason. Objective We want to stimulate growth of endothelial valves under tunica albuginea with injections autological mesenchymal stem cells (ASC) and autological VEGF (Vascular endothelial growth factor) and combine it with veno-occlusive surgeries (embolization and/or ligation). Methods On the basis of Andrology deratment in 2012-2022 we treated 184 patients with VOED. The average patient age is 36.1 +4.1 years. Patients with prostatitis or depression/anxiety were excluded from the investigation or treated previously. We embolizated deep dorsal and Santorini plexus veins for patients with distal form of VOED–47 patients -Group 1. We ligated deep dorsal and penile veins for proximal form of VOED – 68 patients – Group 2. And we made both methods together for 71 patients –Group 3 with combination of proximal and distal leak. Patients with only surgical methods created subgroup A – 106 men. For improving of veno-occlusive mechanism for 78 patients (subgroup B) we injected to each corpus cavernosa 1 mln of autological stem cells 5 times (2 times before and 3 times after surgery) each 1.5-2 months and we performed 15 microinjections of VEGF each 10 days. Then we compared short (2 months) and long term (10 months) results. Results The efficacy of surgical treatment according to subjective data (questionnaires on IIEF-5) in 2 months was almost equal (16.7+3.1 and 16.9+3.0), but in 10 months significantly higher in SubGroup B (14.3+3.2 and 19.7+3.4). According to Ultrasound and Cavernosography in 10 months adding microinjections ASC and VEGF to surgery significantly improves Erectile function (absence of venous leakage) 56.4% - subgroup A and 87.4% - subgroup B. Conclusions Half year injections of autological stem cells and VEGF improve of veno-occlusive mechanism and increases effectiveness and long term result of veno-occlusive operations for treatment of VOED. This method can be offer as second line therapy of ED for young patients with venous leak. Disclosure No

80. The Over-tightened Neck: Causes, Complications, and Management

PURPOSE: The over-tightened neck following necklift procedures is a clinical problem that has received little attention in plastic surgical literature. Possibly, plastic surgeons are either reluctant to discuss it or see few cases. Also, an overtightened neck reflects both the subjective and objective opinions of the patient along with objective clinical findings. METHODS: A retrospective review of 250 consecutive necklift procedures from 2013 to 2020 was performed, of whom 211 (84%) had a submental crease incision with anterior neck tightening of platysmal bands combined with a lateral neck plication. Follow-up continued was at least one year. RESULTS: A total of five patients (2%) presented with complaints of an over-tightened neck that caused pain (5) and difficulty swallowing, interference with speech (1), dyspnea (1), and fat necrosis (1). Three patients had anatomical evidence of a long neck that measured 11cm. Three patients complained throughout and at the end of the first year. Two other patients who had a necklift elsewhere which included anterior platysmaplasty were referred for evaluation. Their procedures has been performed one and one and a half years previously. All five patients were evaluated by neck CT (3) and neck MRI (2). Two patients had videofluroscopy and barium swallow studies that were negative. CONCLUSION: The overtightened neck is an uncommon postoperative sequel to a necklift procedure that may be difficult to assess because of its subjective nature. It can, however, be associated with severe symptoms requiring recognition and appropriate diagnostic work-up.

M100 ExaData: a data collection campaign on the CINECA’s Marconi100 Tier-0 supercomputer

Supercomputers are the most powerful computing machines available to society. They play a central role in economic, industrial, and societal development. While they are used by scientists, engineers, decision-makers, and data-analyst to computationally solve complex problems, supercomputers and their hosting datacenters are themselves complex power-hungry systems. Improving their efficiency, availability, and resiliency is vital and the subject of many research and engineering efforts. Still, a major roadblock hinders researchers: dearth of reliable data describing the behavior of production supercomputers. In this paper, we present the result of a ten-year-long project to design a monitoring framework (EXAMON) deployed at the Italian supercomputers at CINECA datacenter. We disclose the first holistic dataset of a tier-0 Top10 supercomputer. It includes the management, workload, facility, and infrastructure data of the Marconi100 supercomputer for two and half years of operation. The dataset (published via Zenodo) is the largest ever made public, with a size of 49.9TB before compression. We also provide open-source software modules to simplify access to the data and provide direct usage examples.

Experience of establishing a lifestyle medicine clinic at primary care level- challenges and lessons learnt

On an international level, for more than 30 years, Lifestyle Medicine (LSM) Practice has had a great impact on both health Promotion and disease prevention. A practice which on a national KSA level, we are in eager need to adopt, due to the high prevalence of chronic diseases and unhealthy lifestyles. The establishment of the LSM clinic inside the Wazarat Health Center (WHC) more than one and half year ago, was a great advancement towards offering very important preventive and promotive services for people in real high need to these underutilized main elements in Primary Health Care (PHC) features. We identified quality oriented Key Performance Indicators and the clinically important outcomes for our patients. Our initial data showed great achievement on both fronts. We are currently studying the satisfaction of our customers and working on improving their level of health awareness and help seeking behavior. Furthermore, we are looking to benchmark our results. From our pilot project in WHC, we are preparing for an expansion plan to branch out other Primary Care centers in the Riyadh area to serve more people, and we aim to share the experience with other similar services and within the PHC centers allover KSA.

MANAGEMENT OF ASRIGDARA – A CASE REPORT

Asrigdara is a condition, were excessive, irregular and intermenstrual bleeding per vagina has been described mainly as the symptoms. The mode of approach through oral treatment acts as vatapitta shamaka, amapachaka, stambhaka, Hridya, Grahi, soolahara, stambhana actions. So viparita lajjalu ksheerapaka was selected to manage Asrigdara. METHODOLOGY: A patient aged 40 years with complaints of increased flow and duration of menstruation with clots since one and a half years, came to OPD Aswini Ayurveda specialty clinic Omalloor, Pathanamthitta ,Kerala diagnosed by clinical examination and ultrasonography which shows endometrial hyperplasia. Past history revealed the recurrent similar complaints for which she took hormonal treatment,but didn't get relived and hence treated with viparita lajjalu ksheerapaka morning and evening in empty stomach and musalikadiradi kashayam 30ml + 45 ml lukewarm water morning and evening before food for 3 months. RESULTS: There was reduction in amount of bleeding and duration of menstrual flow, without clots. And patient remained, fully asymptomatic in an observation for total 3 months. Duration starting from the 30th day of intervention. CONCLUSION: Viparita lajjalu ksheerapaka and Musalikadiradikashyam can be considered as a safe and convenient option in Asrigdara as it helps to tones up the uterine musculature and corrects excessive bleeding.

Viridocoria –Green reflex in immunocompromised cytomegalovirus retinitis patient

We report a case of middle aged immunocompromised female with cytomegalovirus retinitis presenting with green reflex in pupillary y area of Right eye, her chief complaints were diminished vision in both eyes since one month, she was on HART for 3 years, discontinued for one and half year and again started after the advice of physician, apart from history, systemic and ocular examination done in detailed. BCVA, slit lamp examination, indirect ophthalmoscopy, FFA, B Scan and documentation done, Right eye was observed to note the further changes in fundus where as Left eye was treated with intra vitreal injection Ganciclovir to preserve the vison. Patient treated with intra vitreal Ganciclovir 500 micro grams, twice weekly with interval of 3days for three weeks, once the activity is decreased, injections were given weekly once, same dose continued for three more weeks and advised to follow every month to observe the fundus changes in left eye. Every visit patient was examined in detail, BCVA, anterior segment, fundus and also OCT in left eye to see the central macular thickness. Documentation done in every visit, macular changes after intra vitreal injection was documented by taking both horizontal and vertical OCT.

The Negotiated Desecuritization Of Turkey in Saudi Foreign Policy

AbstractSaudi‐Turkey relations hit one of their lowest points due to the Arab uprisings and the regional shock of the Gulf crisis. The tension resulted from, and in turn exacerbated, a process of securitization of Saudi discourse, whereby officials labeled Turkey as a threat. But after three and a half years of the Gulf crisis, the Al‐Ula accords allowed reconciliation among the regional states and opened the way for the construction of new understandings based on diplomacy, tolerance of differences on regional and domestic security, and respect of sovereignty. This spurred Saudi policy makers to de‐securitize their discourse concerning Turkey—that is, to talk of it not as a threat, but as a potential partner. This process continues to develop gradually through cooperation on economics and investment, but it has required time to re‐establish confidence among Saudi decision makers. This article analyzes the discourses of Saudi leaders and policy makers and shows how they affected Saudi Arabia's relations with Turkey, both negatively and positively.

Long-term outdoor performance of grid-connected photovoltaic power plant in a desert climate

In this paper, a 2.25 kWp grid integrated with the tied solar park has been implanted in the Renewable Energy Applied Research Unit (URAER) in a dry and harsh desert region. The PV plant uses micromorph thin-film solar modules (a-Si/μc-Si) technology. The photovoltaic module systems (PVS) were evaluated from May 2015 to December 2020 (around five and a half years of operation), and the electricity was injected into the internal network of the low-voltage power supply. Performance evolution has been conducted in this work as stated by the IEC61724 guideline. The monthly and annual performance indicators analyzed and assessed consist of reference yield, array yield, final yield, system losses, capture losses, PV module efficiency, system efficiency, inverter efficiency, capacity factor, and performance ratio. The annual electricity production is 3688.28 kWh, 3188.25 kWh, 3306.28 kWh, 3136.05 kWh, and 2952.81 kWh for 2016, 2017, 2018, 2019, and 2020 operating periods, respectively. The solar park's total produced energy yield over the monitored period and the quantity of CO2 emissions avoided are 16,271.67 kWh and 14.17 tons, respectively, which can significantly contribute to and help in purifying the environment from pollution. In addition, the energy results produced by the PVS were compared to those found by the four widely used PV simulation tools (PVsys, PVGIS, NREL's PVWatts® Calculator and Solar Med-Atlas). Furthermore, this work investigates and quantifies the degradation phenomenon of solar PVS power output after five years and a half years of outdoor exposure. There is around 0.22 % degradation per year. When this rate was compared to other studies conducted worldwide, it was shown to be highly appropriate. Technical-economic research was also conducted, revealing that the system's PVS period, which establishes its sustainability, is between 9 and 12 years. The results demonstrate that micromorph thin-film modules perform better and are more efficient under harsh real-world outdoor environmental conditions. Inventux modules preserve most of their better performance even with increasing module temperature. This kind of PV module technology is low-insensitive to the highest PV module temperature. Compared to the literature, micromorph thin-film technologies are better and preferable than crystalline modules under desert environmental conditions. The results also indicate that grid-connected solar park plants using this kind of technology are feasible in the hot arid climate to produce electricity and may participate in future energy projects in the country.

Artificial Intelligence-Human Hybrid Workflow Enhances Teleophthalmology for the Detection of Diabetic Retinopathy

Detection of diabetic retinopathy (DR) outside of specialized eye care settings is an important means of access to vision-preserving health maintenance. Remote interpretation of fundus photographs acquired in a primary care or other nonophthalmic setting in a store-and-forward manner is a predominant paradigm of teleophthalmology screening programs. Artificial intelligence (AI)-based image interpretation offers an alternative means of DR detection. IDx-DR (Digital Diagnostics Inc) is a Food and Drug Administration-authorized autonomous testing device for DR. We evaluated the diagnostic performance of IDx-DR compared with human-based teleophthalmology over 2 and a half years. Additionally, we evaluated an AI-human hybrid workflow that combines AI-system evaluation with human expert-based assessment for referable cases. Prospective cohort study and retrospective analysis. Diabetic patients ≥ 18 years old without a prior DR diagnosis or DR examination in the past year presenting for routine DR screening in a primary care clinic. Macula-centered and optic nerve-centered fundus photographs were evaluated by an AI algorithm followed by consensus-based overreading by retina specialists at the Stanford Ophthalmic Reading Center. Detection of more-than-mild diabetic retinopathy (MTMDR) was compared with in-person examination by a retina specialist. Sensitivity, specificity, accuracy, positive predictive value, and gradability achieved by the AI algorithm and retina specialists. The AI algorithm had higher sensitivity (95.5% sensitivity; 95% confidence interval [CI], 86.7%-100%) but lower specificity (60.3% specificity; 95% CI, 47.7%-72.9%) for detection of MTMDR compared with remote image interpretation by retina specialists (69.5% sensitivity; 95% CI, 50.7%-88.3%; 96.9% specificity; 95% CI, 93.5%-100%). Gradability of encounters was also lower for the AI algorithm (62.5%) compared with retina specialists (93.1%). A 2-step AI-human hybrid workflow in which the AI algorithm initially rendered an assessment followed by overread by a retina specialist of MTMDR-positive encounters resulted in a sensitivity of 95.5% (95% CI, 86.7%-100%) and a specificity of 98.2% (95% CI, 94.6%-100%). Similarly, a 2-step overread by retina specialists of AI-ungradable encounters improved gradability from 63.5% to 95.6% of encounters. Implementation of an AI-human hybrid teleophthalmology workflow may both decrease reliance on human specialist effort and improve diagnostic accuracy. Proprietary or commercial disclosure may be found after the references.

Steam allocation for SAGD: Multi-pad multi-criteria short and long-term real-time performance management

Optimizing steam allocation is critical for long-term performance goals in Steam-Assisted Gravity Drainage (SAGD) recovery. The steam supply mainly contributes to the economics, steam chamber conformance, greenhouse gas emissions, and ultimate bitumen recovery. Therefore, SAGD real-time optimization (RTO) must balance steam chamber development and economics to achieve long-term goals. However, in RTO, general-purpose optimization algorithms decide based on short-term responses, unlike long-term optimization processes. Using economic Key Performance Indicators (KPI) such as Net Present Value (NPV) in a single objective, the RTO determines the smallest amount of steam that results in the highest economic returns. Injecting a small amount of steam reduces steam chamber heat loss, growth, and long-term ultimate bitumen recovery. As a result, a suitable selection of critical KPIs is required to balance the development and economics of the steam chamber.This work presents a study of multiple combinations of SAGD KPIs for a multi-pad real-time steam allocation. The KPI combinations used in this study are NPV, cumulative steam-oil-ratio (cSOR), recovery factor (RF), and average pad temperature (aveTemp). A Box-Jenkins-based data-driven model simulates the SAGD recovery process, and a first principle simulator is used as a substitute for an actual reservoir. The Alternating Direction Method of Multipliers (ADMM) is proposed for multi and many-objective optimization for real-time steam allocation across multiple pads. A compromise programming approach guides the decision-makers choice of the optimum control setpoints of the non-dominated solutions on each horizon. At the end of three and half years of RTO, the optimal KPI combination is ranked based on the aggregated performance of NPV, cSOR, and RF of SAGD multi-pad steam allocation. A synthetic Western Canadian reservoir model with four pads and 33 well pairs developed from publicly available data is used for this study.The aggregated performance of this study's results showed that joint optimization of an economic and a steam chamber growth KPIs of two is better than a combination of three or four. The choice of the joint economic and steam chamber growth KPIs depends on the average pad temperature at the start of RTO to achieve optimal fluid balance in the long term. cSOR or NPV with RF joint KPI performs optimally at average pad temperatures above 90 °C, while cSOR or NPV with aveTemp below 90 °C at the start of RTO to achieve injected and produced fluid balance. Optimum economic return, recovery, and greenhouse gas emission of the SAGD process are achieved with cSOR KPI as the primary economic objective.