Operational Stress Research Articles

Specimen Size Effect on the Tensile Properties of Rolled Steel of Long-Term-Operated Portal Crane.

This paper presents the research results on the mechanical behavior of the low-carbon rolled steel of a sea portal crane after a 33-year operation depending on the operational stresses and rolling direction in order to assess its serviceability. The tensile properties of steels were investigated using rectangular cross-section specimens with different thicknesses and the same width. Strength indicators were slightly dependent on the considered factors (operational conditions, the cutting direction, and thickness of specimens). However, a clear trend of higher ultimate strength for thinner specimens was noticed, especially in the case of more brittle material due to its operational degradation. Plasticity of the tested steel specimens was more sensitive to the influence of the above-mentioned factors than strength but less sensitive than impact toughness. Uniform elongation was slightly less for thinner specimens regardless of the investigated steel state or the orientation of specimens relative to the rolling direction. The post-necking elongation was lower for transversal specimens compared with longitudinal ones, and the effect was more significant when testing steel with the lowest brittle fracture resistance. Among the tensile properties, non-uniform elongation was demonstrated to be the most effective for assessing the operational changes in the state of rolled steels.

Effects of Health Risks and Operational Work Stress to Eastern Police District Police Officers During Covid 19 Pandemic

Effects of Health Risks and Operational Work Stress to Eastern Police District Police Officers During Covid 19 Pandemic

Thoracoscopic partial pericardiectomy for the treatment of pericardial effusion in dogs

Thoracoscopy is a minimally invasive imaging method used in the imaging of the thoracic cavity. In comparison with thoracotomy, thoracoscopy provides better visualization of even the smallest lesions localized in the thoracic cavity. With the use of thoracoscopy, the operation stress in the patient and tissue trauma are reduced, and operating time is shortened. The aim of this study was to evaluate 20 dogs with severe pericardial effusion, which manifested as severe circulation disorder and respiratory distress. The patients determined with pericardial effusion as a result of radiographic and echocardiographic examinations were applied with partial pericardiectomy to achieve permanent health and it was decided to apply this with the minimally invasive thoracoscopic method. The paraxiphoid-transdiaphragmatic approach was applied to the first ten patients and the intercostal approach to the latter. Applicability of thoracoscopic partial pericardiectomy, advantages compared to open surgery, differences between two approach techniques, disadvantages, complications, and success rates were evaluated. It was concluded that this procedure was a successful procedure for dogs and the transdiaphragmatic approach was more useful. In conclusion, thoracoscopic partial pericardiectomy was determined to be easy to apply and more advantageous than open thoracotomy operations.

Patient-reported outcome measures (PROMs) of leucocyte and platelet-rich fibrin (L-PRF) or hemostatic agent application at palatal donor sites after free gingival graft harvesting: a randomized controlled clinical trial.

The aim of this study was to evaluate the patient's morbidity and post-surgical complications after treatment of palatal donor sites after free gingival graft (FGG) harvesting using Leucocyte-and Platelet Rich Fibrin (L-PRF) membranes or a hemostatic agent with oxidized and regenerated cellulose. Forty-two palatal donar sites after FGG haversting in 42 patients were randomly assigned to experimental (L-PRF membrane) or control procedure (hemostatic agent). The primary outcome was postoperative pain related to the wound located at palatal area, while the secondary outcomes were post-operative discomfort, inability to chew, post-operative stress, surgical chair time, thickness of palatal fibromucosa and thickness of FGG. The PROMs were recorded after one week. After one week, a statistically significant difference was found between groups in terms of post operative stress (p=0.0083). No statistically significant differences in terms of postoperative pain (p=0.326), patient discomfort (p=0.509), inability to chew (p=0.936), surgical chair time (p=0.932) were recorded between test and control group. No statistically significant differences were recorded in terms of thickness of palatal fibromucosa (p=0.647) and thickness of FGG (P=0.756) between groups. Post-surgical wound healing complications (i.e., necrosis or infections) were not observed in both groups. Within their limitations, the present outcomes indicated that the application of L-PRF membrane at palatal donor sites after FGG harvesting did not produce significant advantages for the patients.

Microfluidic device using metallic nanostructure arrays for the isolation, detection, and purification of exosomes

Microfluidic devices are widely used in disease detection and specimen separation due to their low cost, rapid processing, and the ability to use even minuscule samples. This study reports on the embedding of metallic nanostructure arrays (MeNTAs) with tube-like features in microfluidic devices for the immunoaffinity-based detection and efficient isolation of exosomes. We assessed MeNTA candidates in terms of their ability to withstand the mechanical stress of microfluidic operations (indentation analysis) as well as X-ray diffraction, zeta potential, and electrostatic interactions involving antibody coatings. Note that Zr60Cu25Al10Ni5 thin film metallic glass (Zr-TFMG) features outstanding mechanical properties and a negative zeta potential exceeding those of other common materials (e.g., Cu, Bronze, Ag, 7075Al, Ti64, 718Ni, SS316, Cu-TFMG, W-TFMG, and Al-TFMG). The resulting microfluidic device featured Zr-based MeNTAs with an interdigital electrode embedded in a microchannel. When applied to MCF-7 derived exosomes using a liquid biopsy of only 500 μL, the proposed device (∼6.25 million nanostructures/cm2) achieved an exosome recovery rate of 95.3% within 1 h, while resisting nonspecific binding to HeLa-derived exosomes (recovery rate of<0.1%). The device enabled the isolation of 1 × 108 exosome particles per mL–1 for detection via electrochemical impedance spectroscopy. It also enabled the efficient release of captured exosomes via cyclic voltammetry (CV) operations over a potential range of –0.8 to +0.8 V. The proposed Zr-MeNTA microfluidic device has considerable potential for the isolation, detection, and purification of exosomes in liquid biopsy samples for cancer diagnosis.

The Mediating Role of Social Support in the Relationship between Operational Stress and Well-Being in Military Personnel

Introduction. Little is known about the activity of the military gendarmes in south-eastern Europe, which involves managing high-risk missions. In order to understand the factors underlying well-being in this population, the aim was to examine the relationship between operational stress and well-being, as well as the mediating role of social support and coping strategies. Methodology. This a cross-sectional corellational study of the relationship between perceived operational stress and well-being. Moreover, the mediating role of social support and coping strategies (seeking social support, positive reassessment, self-control) was examined. Results. Stress has a significant negative effect on well-being. Social support, but not the coping strategies, acts as a mediator of the relationship between operational stress and well-being. Discussions and conclusions.The results have implications for improving the overall well-being of military gendarmes, by developing intervention strategies focused on raising awareness of the importance of social support, increasing perceptions of available support, understanding supplier value and developing skills to provide support within the military organization.

Effects of nanosecond impulse and step excitation in pulsed electro acoustic measurements on signals for space charge determination in high-voltage electrical insulation

The presence of space charges in high-voltage insulation can influence the operational stresses of the dielectric materials; the topic is present in various, even distant domains such as power grids or transportation segments that are represented by electromobility, rail, more-electric aircraft, and space systems. In this article, the effects of nanosecond impulse and step excitation in the pulsed electro-acoustic measurements (PEA) of space charges in high-voltage electrical insulation have been investigated. Various parameters of a pulser (such as impulse width, rise time, and sensor thickness) have been investigated by using a designed programable pulser. The investigations have been performed on a polyethylene sample in one- or double-layer configurations. In the latter, an interlayer sprinkled charge was analyzed. The experimental results have shown the main PEA effect during the transition phase of the applied voltage. It was observed that the pulse transition has a critical importance for stimulating space-charge vibrations and generating elastic waves. Hence, the slope’s rise and fall times are crucial in pulser design. The pulser width also has an impact on a signal’s magnitude as well as on its dispersion and attenuation. The correspondence between a pulse and step excitation was presented. Some advantages are attributed to the step-based excitation in terms of fewer wave reflections and interferences as well as the avoidance of the wavelet cancelation effect for a very narrow pulse width. Hence, step excitation can result in the easier postprocessing and interpretation of individual peaks in the acquired PEA signal. Another advantage may be recognizing the space-charge polarity instead of the net result. Important recommendations refer to the tuning of pulser timing settings with respect to signal attenuation (especially in thicker specimens) and the adequate adjustment of the sensor’s thickness. The presented analysis and experimental results extend the insight into PEA measurement – especially with a focus on diagnostic applications.

Investigation on the impact of electrical faults on the loads and exposures of wind turbine gears

For the design of a wind turbine, it is necessary that the design process takes into account the stresses of real operation to a high degree of detail so that targeted dimensioning can be carried out. Depending on its design, the drivetrain of a wind turbine includes a gearbox that connects the rotor to the generator. During operation of a wind turbine, transient load conditions can occur due to loopback from the power grid and faults in the frequency converter. The influence of the resulting stress and possible damage to the gears used in the gearbox is unclear in the design phase. While the stresses on the gears can often be simulated with a high degree of accuracy for constant operating conditions and can thus be integrated into the drivetrain design, this is not the state of the art for dynamic load conditions. The objective of this report is a method for considering dynamic loading events in the design of the cylindrical gear stage used in wind turbine gearboxes using a coupled multi-body simulation and a finite element based tooth contact analysis. Afterwards the method is used to quantify the stress on the tooth flank and tooth root due to special electrical events such as short circuits between the frequency converter and generator or power grid faults for various converter designs. The simulation analyses show that different converter concepts have different effects on the resulting gear load during electrical faults, but are not significantly decisive for the accumulated damage due to elastic material behavior between generator and gear.

Association of Insurance Type with Inpatient Surgical 30-day Readmissions, Emergency Department Visits/Observation Stays, and Costs.

To assess the association of Private, Medicare, and Medicaid/Uninsured insurance type with 30-day Emergency Department visits/Observation Stays (EDOS), readmissions, and costs in a safety-net hospital (SNH) serving diverse socioeconomic status patients. Medicare's Hospital Readmission Reduction Program (HRRP) disproportionately penalizes SNHs. This retrospective cohort study used inpatient National Surgical Quality Improvement Program (2013-2019) data merged with cost data. Frailty, expanded Operative Stress Score, case status, and insurance type were used to predict odds of EDOS and readmissions, as well as index hospitalization costs. The cohort had 1,477 Private; 1,164 Medicare; and 3,488 Medicaid/Uninsured cases with a patient mean age 52.1 years [SD=14.7] and 46.8% of the cases were performed on male patients. Medicaid/Uninsured (aOR=2.69, CI=2.38-3.05, P<.001) and Medicare (aOR=1.32, CI=1.11-1.56, P=.001) had increased odds of urgent/emergent surgeries and complications versus Private patients. Despite having similar frailty distributions, Medicaid/Uninsured compared to Private patients had higher odds of EDOS (aOR=1.71, CI=1.39-2.11, P<.001), and readmissions (aOR=1.35, CI=1.11-1.65, P=.004), after adjusting for frailty, OSS, and case status, while Medicare patients had similar odds of EDOS and readmissions versus Private. Hospitalization variable cost %change was increased for Medicare (12.5%) and Medicaid/Uninsured (5.9%), but Medicaid/Uninsured was similar to Private after adjusting for urgent/emergent cases. Increased rates and odds of urgent/emergent cases in Medicaid/Uninsured patients drive increased odds of complications and index hospitalization costs versus Private. SNHs care for higher cost populations while receiving lower reimbursements and are further penalized by the unintended consequences of HRRP. Increasing access to care, especially for Medicaid/Uninsured patients, could reduce urgent/emergent surgeries resulting in fewer complications, EDOS/readmissions, and costs.

Stakeholder experiences of a public safety personnel work reintegration program

Public safety personnel (PSP) are at risk of experiencing operational stress injuries (OSIs). The functional impairments caused by OSIs can contribute to challenges with returning to pre-injury operational requirements. A Canadian municipal policing agency developed a peer-led workplace reintegration program (RP) to assist PSP in their workplace reintegration after an illness or injury. Although this RP has been used internationally, there is a paucity of research on this program and its implementation by PSP organizations. The perspectives of key stakeholders are important for capturing the current state of RPs and future directions for the advocacy, implementation, sustainability, and spread of the RP, and to set the stage for future research. The purpose of this study was to explore the experiences and perspectives of key stakeholders engaged in the creation, implementation, facilitation, and execution of RPs in Alberta, Canada. This will help identify strengths, barriers, facilitators, needs, processes, and attitudes associated with the RPs and direction for future research. A qualitative thematic analysis of focus groups (N=8) involving key stakeholders (N=30) from five PSP organizations with RPs was conducted using a community-engaged research approach as part of a larger mixed-methods study. Four key themes emerged from the participants: (1) Integral elements of success, (2) Integral needs, (3) Key areas of growth, and (4) Evolution of the Program. While RPs are highly regarded by the key stakeholders, it is essential that evidence-based research guide the evaluation, modification, implementation, spread, and scale of RPs globally.

Association of Routine Preoperative Frailty Assessment With 1-Year Postoperative Mortality

Patient frailty is a known risk factor for adverse outcomes following surgery, but data are limited regarding whether systemwide interventions related to frailty are associated with improved patient outcomes. To evaluate whether a frailty screening initiative (FSI) is associated with reduced late-term mortality after elective surgery. This quality improvement study with an interrupted time series analysis used data from a longitudinal cohort of patients in a multihospital, integrated health care system in the US. Beginning in July 2016, surgeons were incentivized to measure frailty with the Risk Analysis Index (RAI) for all patients considering elective surgery. Implementation of the BPA occurred in February 2018. The cutoff for data collection was May 31, 2019. Analyses were conducted between January and September 2022. The exposure of interest was an Epic Best Practice Alert (BPA) used to identify patients with frailty (RAI ≥42) and prompt surgeons to document a frailty-informed shared decision-making process and consider additional evaluation by a multidisciplinary presurgical care clinic or the primary care physician. The primary outcome was 365-day mortality after the elective surgical procedure. Secondary outcomes included 30-day and 180-day mortality as well as the proportion of patients referred for additional evaluation based on documented frailty. A total of 50 463 patients with at least 1 year of postsurgical follow-up (22 722 before intervention implementation and 27 741 after) were included (mean [SD] age, 56.7 [16.0] y; 57.6% women). Demographic characteristics, RAI score, and operative case mix, as defined by Operative Stress Score, were similar between time periods. After BPA implementation, the proportion of frail patients referred to a primary care physician and presurgical care clinic increased significantly (9.8% vs 24.6% and 1.3% vs 11.4%, respectively; both P < .001). Multivariable regression analysis demonstrated an 18% reduction in the odds of 1-year mortality (0.82; 95% CI, 0.72-0.92; P < .001). Interrupted time series models demonstrated a significant slope change in the rate of 365-day mortality from 0.12% in the preintervention period to -0.04% in the postintervention period. Among patients triggering the BPA, estimated 1-year mortality changed by -4.2% (95% CI, -6.0% to -2.4%). This quality improvement study found that implementation of an RAI-based FSI was associated with increased referrals of frail patients for enhanced presurgical evaluation. These referrals translated to a survival advantage among frail patients of similar magnitude to those observed in a Veterans Affairs health care setting, providing further evidence for both the effectiveness and generalizability of FSIs incorporating the RAI.

Position of surgical treatment in step-up management of severe acute pancreatitis.

The incidence of acute pancreatitis has been increasing over the past twenty years and there is still no causal treatment available. Although cases of severe acute pancreatitis account for only about a fifth of all cases of acute pancreatitis, high morbidity and lethality call for an optimization and unification of treatment procedures. We operated on 27 patients suffering from severe acute pancreatitis in the past five years. We compared selected parameters such as gender, age, body mass index, aetiology, presence of type 2 diabetes, BISAP score, previous minimally invasive treatment and presence of the intraabdominal compartment syndrome. The average age of men and women was similar in our group. Most patients were overweight or obese. Alcoholic aetiology was more common in men while biliary aetiology prevailed in women. The mortality rate was 26% in our group. The intra-abdominal compartment syndrome followed by emergency decompression surgery was present in one fourth of the patients. A minimally invasive approach was used in approximately in one half of the patients, and surgical treatment was used only in cases where the minimally invasive approach failed. After each surgical revision, clinical deterioration of the patient´s condition occurs during the first two to three days in response to operative stress. Therefore, the current trend in the treatment of acute pancreatitis is to proceed as conservatively as possible, or using the minimally invasive approach, and surgical treatment should be reserved only for conditions that cannot be managed otherwise. If surgical treatment is used, it is advisable to perform cholecystectomy, whatever the aetiology of the pancreatitis.

Military tactical adaptive decision making during simulated military operational stress is influenced by personality, resilience, aerobic fitness, and neurocognitive function.

The present investigation sought to determine the impact of a 48-h simulated military operational stress (SMOS) on military tactical adaptive decision making, and the influence of select psychological, physical performance, cognitive, and physiological outcome measures on decision making performance. Male (n = 48, 26.2 ± 5.5 years, 177.7 ± 6.6 cm, 84.7 ± 14.1 kg.) subjects currently serving in the U.S. military were eligible to participate in this study. Eligible subjects completed a 96-h protocol that occurred over five consecutive days and four nights. Day 2 (D2) and day 3 (D3) consisted of 48-h of SMOS wherein sleep opportunity and caloric needs were reduced to 50%. Differences in SPEAR total block score from baseline to peak stress (D3 minus D1) were calculated to assess change in military tactical adaptive decision making and groups were stratified based on increase (high adaptors) or decrease (low adaptors) of the SPEAR change score. Overall, military tactical decision-making declined 1.7% from D1 to D3 (p < 0.001). High adaptors reported significantly higher scores of aerobic capacity (p < 0.001), self-report resilience (p = 0.020), extroversion (p < 0.001), and conscientiousness (p < 0.001). at baseline compared to low adaptors, while low adaptors reported greater scores in Neuroticism (p < 0.001). The present findings suggest that service members whose adaptive decision making abilities improved throughout SMOS (i.e., high adaptors) demonstrated better baseline psychological/self-reported resilience and aerobic capacity. Further, changes in adaptive decision-making were distinct from those of lower order cognitive functions throughout SMOS exposure. With the transition of future military conflicts placing higher priority on enhancing and sustaining cognitive readiness and resiliency, data presented here demonstrates the importance of measuring and categorizing baseline measures inherent to military personnel, in order to change and train one's ability to suffer less of a decline during high stress conditions.

Pathological Background and Clinical Procedures in Oral Surgery Haemostasis Disorders: A Narrative Review

Haemostasis disorders are serious pathologies that could put dental and surgical procedures at risk as they are associated with postoperative bleeding, which in some circumstances could be prolonged and dangerous for the patient. In-depth knowledge of the problems associated with coagulation pathologies and the suitable specific procedures should be implemented in dental practice. A good awareness of the clinical protocols to be used in these circumstances may help reduce operator stress and increase patient compliance. Collaboration with the haematologist is always recommended to establish an adequate treatment plan, both regarding the administration of therapies that promote haemostasis and for assessing the operative risk. Hereby, we summarize the congenital and hereditary pathologies that lead to haemostasis disorders, which can be found in patients undergoing dental procedures. The purpose of this narrative review is to frame the diseases from a clinical, anamnestic, and etiopathological standpoint, as well as to evaluate an operative approach to the pathology under consideration, with particular attention to anaesthesia manoeuvres and post-surgical haemostasis, to avoid hematoma formation and uncontrolled bleeding which can lead procedure failure up and even death. Of note, it is likewise important to educate the patient about prevention, to keep the oral cavity healthy and avoid invasive procedures, limiting the number of operative sessions.

Etiology and Pathogenesis of Postoperative Cognitive Dysfunction (Review)

Impairment of higher mental functions can complicate the course of the postoperative period even after short and minimally invasive, including laparoscopic, surgical procedures. Postoperative cognitive dysfunction significantly challenges patients’ quality of life, negating real success of surgical intervention and anesthetic support. In some cases, early postoperative cognitive dysfunction may be one of the main predictors of persistent cognitive impairment.The purpose of the review. To contemplate etiology, pathogenesis and the current perspective of postoperative cognitive dysfunction.We analyzed 96 publications in various databases (PubMed, Medline, RSCI and others), including 67 papers published over the past 5 years.The review provides an overview of current definitions and classification of postoperative cognitive dysfunction, data on the prevalence, polyethyology and risk factors, potential impact of the type of anesthesia and surgical intervention on the development of postoperative cognitive dysfunction. Various pathogenetic mechanisms of higher mental functions impairment alongside with available effective pharmacotherapies to correct them were considered.Conclusion. Numerous adverse factors of the perioperative period, such as neurotoxic effects of general anesthetics, neuroinflammation in response to operational stress and surgical trauma, impaired autoregulation of the cerebral blood flow, imperfect oxygen homeostasis, interactions of neurotransmitter, etc., can potentially cause postoperative cognitive dysfunction. Further deeper insights into etiology and pathogenesis of early postoperative cognitive dysfunction are relevant and necessary to improve prevention strategies and identify most effective pharmacotherapies to correct such disorders.

Efficacy validation of a low-cost handmade simulator (SIMCA-COW) in palpation, ultrasonography evaluation, and artificial insemination in cows.

Using simulators in high education enables practical training by repetition in circumstances close to reality reducing the stress of both animal and operator. The limited resources of veterinary schools, the increase in the number of students in lecture halls, and the low availability of animals for teaching due to welfare regulations, reduce teaching opportunities with live animals being simulator as the better alternative. This study aimed to assess the efficacy of a low-cost handmade simulator (SIMCA-COW) in eight veterinary students inexperienced in palpation, ultrasonography evaluation, and artificial insemination in cows. Two sets of exercises were carried out: structure localization by rectal palpation and ultrasonography were evaluated by the inexpert veterinary students in the SIMCA-COW simulator. Also, evaluated the length of time to insert the insemination catheter through the cervix in the inert simulator during four sessions. All the students were able to palpate both structures and to locate the body and both uterine horns by ultrasonography. Cervix and follicles were located by 5/8 (62.5%) students and 3/8 (37.5%) students found the corpus luteum by ultrasonography. A reduction in time span between the first and fourth intrauterine insemination attempts was observed (8.26 ± 2.7 vs. 3.69 ± 1.7; mean ± standard error; p < 0.05). The simulator validated in this study (SIMCA-COW) allows training and learning by repetition, saving the limitations found in live animal practice.

Wheel load reconstruction using strain gauge measurements on the bogie frame for strain prediction and fatigue assessment

Knowledge of actual wheel-rail contact forces under a service environment is critical for fatigue damage prediction of rail vehicle bogies. This paper presents a method for reconstructing operational wheel loads based on the strain gauge measurements on the bogie of a tram. The strain gauge placement is solved as an optimisation problem, and the actual load–strain relationship is verified by physical calibrations. A novel calibration arrangement is presented to produce linearly independent load cases for a fully equipped bogie. A good correlation of the reconstructed operational stresses with the measured stresses indicated that the identified loads are valid for fatigue assessment.

Effect of the method of anesthetic aid on cellular immunity in periprosthetic infection of the hip joint: : a prospective open randomized study

BACKGROUND: Periprosthetic infection after primary hip replacement is a serious complication. For the anesthetic support of revision operations, both general and neuroaxial anesthesia methods can be used. The question of choosing an anesthetic aid that, with adequate modulation of the operational stress response, would have a minimal immunosuppressive effect is relevant.&#x0D; AIM: To examine the effect of general and combined spinalepidural anesthesia during revision operations in patients with periprosthetic hip joint infection on the parameters of cellular immunity.&#x0D; MATERIALS AND METHODS: An open prospective randomized study was performed on 25 patients (11 women and 14 men). The patients underwent surgical interventions of revision prosthetics with the replacement of all components of the prosthesis. Group 1 (n=10) underwent general anesthesia (GA), and group 2 (n=15) underwent surgery under combined spinalepidural anesthesia (CSEA). The indices of cellular immunity, namely, CD4+, CD8+, CD4+/CD8+, and B-lymphocytes, were evaluated. Blood sampling was performed in the morning on the day of surgery and then on days 1, 3, 5, and 7 after surgery.&#x0D; RESULTS: The CD4+ (%) level in the CSEA group was significantly higher than in the GA group on days 3 and 7 after surgery (p 0.05). Changes in the percentage of CD8+ lymphocytes, the immunoregulatory index, and the percentage of B-lymphocytes between the groups had no statistically significant differences.&#x0D; CONCLUSION: The CD4+ (%) level in the CSEA group was significantly higher than that in the GA group on days 3 and 7 after surgery (p 0.05). Statistically significant differences in the dynamics of CD8+, immunoregulatory index, and B-lymphocytes were not found, which may indicate a lesser effect of the type of anesthesia on these indicators.

Structural design challenges and implications for high temperature concentrating solar power receivers

High operating temperatures along with diurnal cycling and high operating stresses bring many material and engineering challenges for concentrated solar power (CSP) receivers. Current design rules in ASME Boiler and Pressure Vessel (B&PV) Code for high temperature structural components were not intended for CSP components. The paper reviews the design rules in several sections of ASME B&PV Code in terms of their applicability in designing high temperature CSP receivers. With some restrictions and modifications, the conditions assumed in the design rules in Section III, Division 5 of ASME B&PV Code are found to closely resemble the loading conditions of CSP receiver, including accounting for the interaction between creep and fatigue damage. The paper applies the proposed design rules to an external tubular receiver design and discusses several lessons learned from the design study. The creep damage accumulation due to high thermal stresses resulting from circumferentially non-uniform flux distribution is found to control the design of CSP receivers. Several mitigation actions to improve the design life of receivers are also discussed.

Integrating the Fast-Track surgery concept into the surgical treatment of gynecomastia

Background: The use of fast-track surgery pathway has been reported to reduce the stress of operation and accelerate rehabilitation in various surgical specialties. However, there has been a relative dearth of research on this subject for surgical treatment of gynecomastia. Materials and methods: The gynecomastia was treated by liposuction plus pull-through technique. The safety and recovery profiles were retrospectively compared between the patients in a standard pathway (including general anesthesia and postoperative drainage) and those in a fast-track pathway (including patient education, local tumescent anesthesia, no drainage, and effective pain control). Registered outcomes included postoperative complications, time to normal life, length of stay, patient satisfaction, etc. Results: From October of 2017 to October of 2021, 126 gynecomastia patients with Simon’s grade I or II who underwent the surgical treatments were included in the study, of which 25 patients were treated according to standard pathway, and 101 patients underwent the fast-track pathway. During the follow-up, there was no difference between the cohorts in the incidence of postoperative complications. Both the time to normal life and length of stay significantly decreased to 0 after the introduction of fast-track pathway. Overall, 94.1% of the patients ranked the fast-track surgical pathway as ‘great’ or ‘moderate' at the 3-month follow-up. Conclusions: The proposed fast-track pathway is feasible for surgical treatment of gynecomastia, leading to an enhanced recovery and high patient satisfaction without increasing the rate of complications. The fast-track surgery concept with implementation of local anesthetic techniques should be given serious consideration in gynecomastia management.