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COVID-19 has affected energy consumption and production pattern in various sectors in both rural and urban areas. Consequently, energy demand has increased. Therefore, most health care centers report a shortage of energy, particularly during the summer seasons. Therefore, integrating renewable energies into hospitals is a promising method that can generate electricity demand reliably and emits less CO2. In this research paper, a hybrid renewable energy system (HRES) with hydrogen energy storage is simulated to cover the energy demand of sections and wards of a hospital that dealt with COVID-19 patients. Produced Oxygen from the hydrogen storage system is captured and stored in medical capsules to generate the oxygen demand for the patients. Results indicate that 29.64% of the annual consumed energy is utilized in COVID-19 sections. Afterward, modeled system has been optimized with a neural network-genetic algorithm to compute the optimum amount of the demand power from the grid, CO2 emission, oxygen capsules, and cost rate. Results determine that by having 976 PV panels, 179 kW fuel cell, and 171.2 kW electrolyzer, annual CO2 emission is 315.8 tons and 67,833 filled medical oxygen capsules can be achieved. The cost rate and demand electricity from the grid for the described system configuration are 469.07 MWh/year and 18.930 EUR/hr, respectively.
In this systematic review, we aimed to identify the impact of the COVID-19 pandemic on children/adolescents with a diagnosis of autism spectrum disorder (ASD). The protocol was registered on PROSPERO CRD42021255848. Articles were selected from PubMed, Embase, and LILACS according to these characteristics patients from zero to 18years old, exposed to the COVID-19 pandemic, impact on social communication/interaction and restricted/repetitive behavior domains. The Newcastle-Ottawa Scale was used to assess methodological quality and the risk of bias. Of the 351 articles initially identified, 26 were finally included with information on 8,610 patients. Although the studies were heterogeneous, they indicated that the pandemic-related issues experienced by patients with ASD were mostly manifested in their behavior and sleep patterns.

The online version contains supplementary material available at 10.1007/s40489-022-00344-4.
The online version contains supplementary material available at 10.1007/s40489-022-00344-4.In this article, we study the local political mobilization effects of political protests in the context of the Black Lives Matter (BLM) movement. We analyze monthly voter registration data from 2136 US counties across 32 states, leveraging variation in the exposure to BLM protests across counties in a two-way fixed-effects framework with a matched control group. In contrast to previous studies, which reported substantial mobilization effects of local protests in other contexts, we show that voter registrations in the aggregate were insensitive to the presence of local BLM protests. We further disentangle the effects along party lines and the degree to which protests were associated with violent behaviors and find similarly insignificant effects. We present some preliminary evidence that the large scale of the protests and their extensive news coverage might have reduced the importance of experiencing a protest firsthand.Background Early (2020) reports on mortality in patients with coronavirus disease 2019 (COVID-19) who underwent orthopedic surgery ranged from 20.5% to 56%, but these studies included elderly patients with multiple comorbidities. The mortality rate for younger and asymptomatic COVID-19-positive patients undergoing orthopedic surgery after high-energy trauma is underreported. The purpose of this study was to compare the 30-day mortality of asymptomatic COVID-19-positive patients and COVID-19-negative patients surgically treated for orthopedic trauma at a Level I trauma center during the coronavirus pandemic. A secondary objective was to compare the patients' postoperative hospital course and length of stay. Methods This study is a single-center retrospective review of all patients who underwent an orthopedic surgical procedure at a Level I trauma center during a 3-month period early in the COVID-19 pandemic. All patients received a preoperative nasopharyngeal swab to determine COVID-19 infection status. Preoperative demographic variables, perioperative and postoperative mortality within 30 days, length of stay, and intensive care unit days were compared between COVID-19-positive and COVID-19-negative patients. Results Of the 471 total patients, 13 were COVID-19-positive and 458 were COVID-19-negative prior to surgery. The average age of all patients was 40.5 ± 19.8 years. The mortality rate in the COVID-19-positive group was 0% vs 0.7% in the COVID-19-negative group, with no significant difference between groups (P=0.77). The COVID-19-positive group vs the COVID-19-negative group had no significant difference in hospital length of stay (7.4 days vs 4.4 days, respectively, P=0.12). Conclusion Asymptomatic COVID-19-positive orthopedic trauma patients treated with surgery at a Level I trauma center in a 3-month period during the COVID-19 pandemic had a 0% mortality rate, and we found no differences between COVID-19-positive and COVID-19-negative patients with respect to mortality and hospital length of stay.Background To meet increased community and regional needs for quality services, our hospital system concluded that its established surgical oncology program-consisting of gynecologic oncology (4 physicians), surgical oncology (2 physicians), and otolaryngologic oncology (2 physicians)-would be best served by the transition of the comprehensive surgical oncology program to a new oncology-naive hospital. We describe the overall strategy and approach involved with this move, its implementation, operating room efficiency results, and physician satisfaction associated with the relocation. Methods The purpose of the systematic plan for relocation, which was developed and refined during the 2 years preceding the move, was to facilitate a collective awareness and understanding of important patient-centered concepts and essential workflow. All parties involved in direct patient cancer care participated in multiple workgroups to successfully transition the surgical oncology practice. Following the transition to the oncatic alignment among stakeholders. The success of this transition required transparency, open and honest communication, and problem solving at all levels. The move of a surgical oncology program to an oncology-naive hospital was deemed successful without deterioration of time-related variables associated with operating room efficiency and physician satisfaction. The breakdown and analysis of key components of the surgical day offered additional opportunities for quality improvement in operating room efficiency.Background Low back pain affects the lives of millions of people in the United States and the world. Not only does low back pain affect the quality of life for the individual patient, but it also accounts for many emergency department and health care visits. For a subset of patients, conservative measures such as medications and physical therapy, nonsurgical interventions, and surgery are not effective. Peripheral nerve stimulation is an emerging treatment option for patients with chronic low back pain. This case series assesses 6 patients' experiences with lumbar level peripheral nerve stimulation. Case Report Three male and 3 female patients underwent lumbar level peripheral nerve stimulation as a treatment for chronic low back pain. The average age of the patients was 63.5 years, and they demonstrated an average pain reduction of 64.8%. Conclusion This series provides evidence that lumbar level peripheral nerve stimulation may be an efficacious treatment for chronic low back pain that is refractory to conservative measures. Large studies are needed to assess the outcomes and durations of improvement associated with this treatment.Background Ketamine is a noncompetitive N-methyl-D-aspartate receptor antagonist that has been proposed as a safe and effective nonopioid analgesic when given in lower doses than those historically used for general anesthesia. Case reports have demonstrated efficacy using low-dose ketamine for pain management and opioid weaning in patients with chronic noncancer pain, but reports of successful use in patients with sickle cell pain are limited. Case Report A 35-year-old African American male with sickle cell disease presented to the emergency department with severe generalized body aches and left flank pain. Several days later, his pain became localized to the bilateral lower extremities. Escalating opioid doses provided no improvement. Workup was negative for infection, deep venous thrombosis, ischemia, and infarct. On hospital day 29, the Acute Pain Management Service was consulted and initiated a low-dose ketamine infusion for analgesia and to facilitate opioid weaning. Five days later, the patient was discharged pain-free. Conclusion Ketamine is a potent nonopioid analgesic, and this report adds to the body of literature supporting the use of low-dose ketamine in patients with sickle cell disease to treat poorly controlled pain and opioid-induced hyperalgesia.Background Sedation and analgesia in the intensive care unit (ICU) are major clinical challenges, and several continuous infusion medications have been used for these purposes. The use of these sedative medications has been associated with hemodynamic effects that complicate the patient's critical illness. Continuous ketamine infusion is an emerging sedative option that has been used more frequently in the ICU since 2017. SP-2577 supplier The purpose of this study was to characterize the hemodynamic differences between 3 continuous sedative infusions ketamine, propofol, and midazolam. Methods For this single-center retrospective cohort study, we collected data for patients hospitalized between January 2015 and April 2020 at Saint Luke's Health System in Kansas City, Missouri. Adult patients in the ICU requiring a norepinephrine infusion and sedation were included. The change in norepinephrine requirement from baseline at 1 hour was the primary outcome. The change in vasopressor requirement at 3 and 30 hours after initiation of the infusion was also tabulated. Results Sixty-eight critically ill patients with several types of shock requiring vasopressor support with norepinephrine were enrolled in our study. Patients who received ketamine had an increase in norepinephrine requirement compared to midazolam and propofol, although this difference was not statistically significant. Conclusion In our study, continuous ketamine infusion did not reveal a statistically significant favorable hemodynamic effect compared with propofol and midazolam because of the small sample size. A trend toward an unfavorable hemodynamic effect is not expected, but large randomized trials are needed to further evaluate the hemodynamic effects of continuous ketamine infusion in the ICU.Background Amniotic fluid embolism (AFE) is a rare cause of severe maternal morbidity and mortality. No well-studied protocols are available for management of AFE. We present a case of cardiac arrest secondary to presumed AFE and the use of atropine-ondansetron-ketorolac (AOK). Case Report A 34-year-old gravida 4, para 2012 underwent a repeat cesarean section at 39 weeks of gestation. After delivery of the placenta, hypoxia and hypotension developed, followed by cardiac arrest. Protocols for management of maternal cardiac arrest were followed. Echocardiogram demonstrated right ventricular dilation and hypokinesis. AOK was administrated during prolonged cardiac arrest, and spontaneous circulation returned. The patient was extubated on postoperative day 3 and discharged on postoperative day 10 without neurologic deficits. Conclusion Management of AFE should include consideration of the addition of AOK to typical guidelines.
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