The COVID-19 pandemic had an unprecedented impact on global mental health and well-being, including across the Asia-Pacific. Efforts to mitigate virus spread led to far-reaching disruption in the delivery of health and social services. In response, there was a rapid shift to the use of digital mental health (DMH) approaches. Though these technologies helped to improve access to care for many, there was also substantial risk of access barriers leading to increased inequities in access to mental health care, particularly among at-risk and equity-deserving populations. The objective of this study was to conduct a needs assessment and identify priorities related to equitable DMH access among at-risk and equity-deserving populations in the Asia Pacific region during the first year of the COVID-19 pandemic. The study consisted of a modified Delphi consensus methodology including two rounds of online surveys and online consultations with stakeholders from across the region. Study participants included policy makers, clinicians and service providers, and people with lived experience of mental health conditions. Results demonstrate that vulnerabilities to negative mental health impacts and access barriers were compounded during the pandemic. Access barriers included a lack of linguistically and culturally appropriate DMH options, low mental health literacy and poor access to technological infrastructure and devices, low levels of awareness and trust of DMH options, and lack of policies and guidelines to support effective and equitable delivery of DMH. Recommendations to improve equitable access include ensuring that diverse people with lived experience are engaged in research, co-design and policy development, the development and implementation of evidence-based and equity-informed guidelines and frameworks, clear communication about DMH evidence and availability, and the integration of DMH into broader health systems. Study results can inform the development and implementation of equitable DMH as its use becomes more widespread across health systems.

Mars has always been a critical subject of debate since ancient times and humans have always been fascinated with the Red Planet. However, early science fiction literature including the works of Edgar Rice Burroughs and H.G. Wells that featured stories of humans traveling to Mars and encountering alien species on Mars have fueled the interest of humans in Mars exploration. As recently as today, Elon Musk's SpaceX hopes to facilitate the colonization of Mars so the human species can survive for long, and for that 2029 has been predicted as the year when humans will land on Mars. But then, Mars is nothing like Earth and the environment and its geography still needs to be explored. Martian atmospheric density dominated by CO2 is one of the major concerns for both aerial exploration and human colonization. Exploration and understanding of Mars could be facilitated with the UAVs, however flying on Mars is really challenging, unlike Earth. Besides the thin density, the speed of sound on Mars is roughly two-thirds of Earth which creates a notable difference on cruising Mach Number and this difference needs to be taken into account while designing and operating any aerospace system in Martian atmosphere. This study has been taken to understand how aerodynamics and turbulence behave in the Martian atmosphere. For this purpose, two low Reynolds number airfoils and one high lift airfoil viz., Drela Apex 16 with transonic characteristics, Drela DAE 31 is a low Reynolds number airfoil and Eppler E420 is high lift airfoil, are studied with multi-element airfoil approach to understand the flow of fluid around the 2D infinite wing. These airfoils are deployed with the trailing-edge flap that is 20% of the airfoil's length and the flap angle is 15 degrees. Commercially available CFD tool Ansys FLUENT is being used with the SST-k-omega turbulence model to study the 2D airfoil for cruising Mach numbers of 0.10 and 0.31. The Martian atmospheric conditions, such as temperature, density, viscosity, pressure, and specific heat ratio are defined in the Ansys solver settings. The CFD results suggest that the Drela DAE31 has the highest lift characteristics while E420 being a high-lift airfoil has little to offer in terms of aerodynamics in the Martian atmosphere. The results also suggest that the TKE on Mars is lower than on Earth, which demands further exploration. Moreover, the TDR (epsilon) on Earth is also higher than that on Mars as suggested by the CFD results of E420 airfoil.

Background: There is increasing attention on strategies to improve patient outcomes and the delivery of surgical services in the United States (US). Liver resections (LR) remain an exemplar model of complex surgery and encompass a broad array of operations from simple excisions to technically challenging reconstructive procedures in specialized units. The purpose of this study was to assess the national profile of LR in the United States and evaluate progress in current practice.

Mars has always been a critical subject of debate since ancient times and humans have always been fascinated with the Red Planet. However, early science fiction literature including the works of Edgar Rice Burroughs and H.G. Wells that featured stories of humans traveling to Mars and encountering alien species on Mars have fueled the interest of humans in Mars exploration. As recently as today, Elon Musk’s SpaceX hopes to facilitate the colonization of Mars so the human species can survive for long, and for that 2029 has been predicted as the year when humans will land on Mars. But then, Mars is nothing like Earth and the environment and its geography still needs to be explored. Martian atmospheric density dominated by CO2 is one of the major concerns for both aerial exploration and human colonization. Exploration and understanding of Mars could be facilitated with the UAVs, however flying on Mars is really challenging, unlike Earth. Besides the thin density, the speed of sound on Mars is roughly two-thirds of Earth which creates a notable difference on cruising Mach Number and this difference needs to be taken into account while designing and operating any aerospace system in Martian atmosphere. This study has been taken to understand how aerodynamics and turbulence behave in the Martian atmosphere. For this purpose, two low Reynolds number airfoils and one high lift airfoil viz., Drela Apex 16 with transonic characteristics, Drela DAE 31 is a low Reynolds number airfoil and Eppler E420 is high lift airfoil, are studied with multi-element airfoil approach to understand the flow of fluid around the 2D infinite wing. These airfoils are deployed with the trailing-edge flap that is 20% of the airfoil’s length and the flap angle is 15 degrees. Commercially available CFD tool Ansys FLUENT is being used with the SST-k-ω turbulence model to study the 2D airfoil for cruising Mach numbers of 0.10 and 0.31. The Martian atmospheric conditions, such as temperature, density, viscosity, pressure, and specific heat ratio are defined in the Ansys solver settings. The CFD results suggest that the Drela DAE31 has the highest lift characteristics while E420 being a high-lift airfoil has little to offer in terms of aerodynamics in the Martian atmosphere. The results also suggest that the TKE on Mars is lower than on Earth, which demands further exploration. Moreover, the TDR (ε) on Earth is also higher than that on Mars as suggested by the CFD results of E420 airfoil.

Introduction: Enhanced-recovery pathways after pancreaticoduodenectomy (PD) often include epidural anesthesia, but data are mixed as to the effect of epidurals on postoperative outcomes. Method: Patients undergoing PD between 2012-2020 were prospectively followed, and their complications graded using the Modified Accordion Grading System (MAGS). Complications were categorized as non-severe if MAGS 1-2 and severe if MAGS ≥3. Patient characteristics and perioperative outcomes were compared in univariate and multivariate analysis for patients with and without epidurals. The analysis was then repeated by sex after 1:1 propensity score matching. Results: Between 2012-2020, 565 patients underwent PD and 50.8% had epidural anesthesia. Patients with epidurals were older (p=0.038), had longer operative times (p<0.001) and lower intraoperative blood loss (p<0.001), as well as higher rates of non-severe delayed gastric emptying (p=0.040), and urinary retention (p=0.017). On multivariate analysis, epidural was independently associated with urinary retention (OR 2.03, p=0.019), while female sex was protective (OR 0.51, p=0.014). Propensity-score matched patients (171 pairs) with epidurals were more likely to have suffered severe complications (p=0.030), urinary retention (p=0.016), and DVT (p=0.022). Male propensity-score matched patients (85 pairs) with epidurals were more likely to suffer non-severe delayed gastric emptying (p=0.045) and urinary retention (p=0.008) compared to matched patients without epidurals. There were no differences in postoperative outcomes for propensity-score matched female patients (76 pairs) with and without epidurals. Conclusion: Epidural anesthesia was independently associated with urinary retention after PD, specifically in male patients. Further research should focus on tailoring enhanced-recovery pathways to bridge sex disparities in clinical outcomes.

Introduction: Domino liver transplantation (DLT) has emerged as a rational approach to help organ shortage concerns. but remains restricted to a small number of centers. The purpose of this study was to assess the national profile of DLT in the United States and evaluate current donor and recipient outcomes. Methods: National data from 1987 - 2020 was extracted from the United Network for Organ Sharing (UNOS) database. Analyses included all pediatric and adult donors and recipients of DLT during this study period. Results: A total of 181,976 liver transplants were performed in the US between 1987 and 2020 of which 185 were DLTs (0.1%) performed in 42 centers. The median (IQR) donor and recipient wait-times for transplantation were 180 (85 –413) and 213 (81 –525) days, respectively. Since 1996, amyloidosis accounted for 210 of all LTs and 103 (49%) of DLTs. Of the 227 patients receiving LT for maple syrup urine disease (MSUD), 50 (22%) were used for DLT. Thirty-two patients with homozygous familial hypercholesterolemia received a standard LT and 4 (14%) were DLT allografts. Recipient DLT graft survival was 91%, 79% and 73% at 1-, 3- and 5-years with an overall survival of 93%, 83% and 76%. Conclusion: Accounting for only 0.1% of all liver transplants to date, DLT has yet to be fully embraced by US programs. A small proportion of explants with amyloidosis and MSUD may be wrongly discarded. Despite this caveat, domino recipients showed excellent survival outcomes postoperatively that appear comparable to standard liver transplantation approaches.

Presenter: Ola Ahmed MD | Washington University, St. Louis Background: The majority of pancreatic pseudocysts resolve without the need for operative intervention. In a select few, surgery may be warranted for large cysts causing symptoms and unamenable to endoscopic or percutaneous drainage procedures Methods: We present the case of 2 patients: a 35 year old lady with a background of EtOH-related pancreatitis and a 43 year old gentleman with a history of gallstone pancreatitis. Both patients developed large symptomatic pancreatic pseudocysts that were unsuited to drain insertion because of the size of the cavity and the presence of a large amount of necrotic debris. Their symptoms of abdominal pain, fullness and early satiety persisted over an 8 – 10 week period and the patients underwent a robotic cystgastrostomy with pancreatic debridement. Results: The post-operative course for both was uneventful and one patient was discharged post-op day 1 while the second patient required a longer stay for social issues and was discharged on day 6. Conclusion: Pancreatic pseudocysts seldom require operative intervention. In a select number of patients, robotic cystgastrostomy is safe and feasible and the robotic approach can be advantageous with enhanced angulation and offering 3 dimensional views for complex retroperitoneal structures

Background The COVID-19 pandemic is expected to have profound mental health impact, including in the Asia Pacific Economic Cooperation (APEC) region. Some populations might be at higher risk of experiencing negative mental health impacts and may encounter increased barriers to accessing mental health care. The pandemic and related restrictions have led to changes in care delivery, including a rapid shift to the use of e-mental health and digital technologies. It is therefore essential to consider needs and opportunities for equitable mental health care delivery to the most at-risk populations. This rapid scoping review: 1) identifies populations in the APEC region that are at higher risk of the negative mental health impacts of COVID-19, 2) identifies needs and gaps in access to standard and e-mental health care among these populations, and 3) explores the potential of e-mental health to address these needs. Methods We conducted a rapid scoping review following the PRISMA Extension for Scoping Reviews (PRISMA-ScR). We searched Medline, Embase and PsychInfo databases and Google Scholar using a search strategy developed in consultation with a biomedical librarian. We included records related to mental health or psychosocial risk factors and COVID-19 among at-risk groups; that referred to one or more APEC member economies or had a global, thus generalizable, scope; English language papers, and papers with full text available. Results A total of 132 records published between December 2019 and August 2020 were included in the final analysis. Several priority at-risk populations, risk factors, challenges and recommendations for standard and e-mental health care were identified. Results demonstrate that e-mental health care can be a viable option for care delivery but that specific accessibility and acceptability considerations must be considered. Options for in-person, hybrid or “low-tech” care must also remain available. Conclusions The COVID-19 pandemic has highlighted the urgent need for equitable standard and e-mental health care. It has also highlighted the persistent social and structural inequities that contribute to poor mental health. The APEC region is vast and diverse; findings from the region can guide policy and practice in the delivery of equitable mental health care in the region and beyond.

Introduction: For members of remote Indigenous communities, accessing healthcare often requires travel to off-reserve locations, which is both burdensome to the individual and increases the risk of contracting COVID-19. Remotely Piloted Aircraft Systems (RPAS), or drones, offer a potentially cost-effective method for reducing that burden and risk by removing geographic barriers and increasing timeliness and accessibility of supplies, equipment, and remote care. Objectives: To demonstrate the potential of RPAS-delivered technology and supplies in diagnosis, evaluation, and treatment, including RPAS-delivered ultrasound (US) machines;to co-develop governance and operating manuals with local Indigenous communities;and to use this work as a scalable model for fully operational RPAS-based medical delivery systems. Methods: Our team is developing and pilot-testing innovative RPASbased medical delivery solutions at the systems, regulatory, technological (software and hardware), and procedural levels. This includes working with Transport Canada for Beyond Visual Line of Sight approval;RPAS fleet development and testing;custom payload system design and fabrication (i.e. refrigerated unit for vaccine delivery);procedural development (i.e. risk and safety assessments);Detect and Avoid System testing and refinement;and pilot-testing COVID-19 test kit fidelity and remote US functionality. Results: We have successfully delivered PPE (gloves, gowns, masks) and COVID-19 test kits. We confirmed that the delivered RNA COVID- 19 test samples contained no decay in signal or testing capabilities. We also delivered a sanitized Tele-mentored Self-Diagnostic US and successfully Tele-mentored a patient in performing a proficient selfadministered US at a remote location. Conclusion: RPAS-based medical delivery models offer an innovative approach to addressing longstanding issues of healthcare access and equity, and are particularly relevant in the context of COVID-19 and preventing pandemic spread.

Gurney Flap is a small tab projecting from the trailing edge of the wing. Typically, it is set perpendicular to the chord line on the pressure side of the wing and ranging usually 1% to 3% of the wing chord. This trailing edge device can improve the performance of simple airfoils to nearly the same level as complex high-performance design. It is an intriguing device for high-lift design because of the mechanical simplicity of the device and the significant impact on the aerodynamic performance. Subsonic aircraft could greatly benefit from the use of this simple flat-plate device. Low speed and subsonic high lift airfoils such as Wortmann FX 63-137 and Selig S1223 are used in high lift cargo planes, high endurance Unmanned Aerial Vehicles (UAV), Sailplanes/Gliders and Wind Turbines. This numerical research investigates the aerodynamic characteristics of both the airfoils by deploying gurney flaps on a two-dimensional airfoil for different angle of attacks. By adding a flap at the trailing edge, it is shown that the manufacturing process of the sharp trailing edge of both airfoils may be eased while the aerodynamic efficiency is also optimized simultaneously. The CFD results are obtained using the Ansys Fluent.

and mortality than for M0 disease.The knowledge of shortterm outcomes provided herein is important to weigh perioperative risks against the potential benefits of PNET primary tumor resection in the setting of M1 disease.This can support both decision-making and patient counselling.