From d800fd22cea44d9cb6dae22cf118dd1f5a40945d Mon Sep 17 00:00:00 2001 From: Sebastian Gibb Date: Tue, 3 Dec 2024 21:33:31 +0100 Subject: [PATCH] chore: update index.html --- index.html | 309 +++++++++++++++++++++++++++++------------------------ 1 file changed, 171 insertions(+), 138 deletions(-) diff --git a/index.html b/index.html index fc1023c..539eb0f 100644 --- a/index.html +++ b/index.html @@ -377,7 +377,7 @@

Sebastian Gibb1,✉, Nadin Möller1, Fa
This study is work-in-progress!
Please find details at https://github.com/umg-minai/vct-or.
-Manuscript date: 2024-05-24 11:51; Version: 2ac7614 +Manuscript date: 2024-12-03 21:33; Version: 5f30bf8
@@ -418,9 +418,7 @@

1 Summary

NA % in the OR with shorter anaesthesia durations and frequently inhaled induction versus NA % in the OR with longer anaesthesia duration. -We saw a weight loss over time of around -69 mg per day per absorber during -storage.

+We saw a 3.3 % weight loss over time during storage.

Conclusions: If CONTRAfluranTM absorbers are used until they are fully saturated, almost half of the sevoflurane can be recaptured, but @@ -487,7 +485,7 @@

3.2 Setting

3.3 Consumption and weight measurement

Balanced anaesthesia with VAs was given using Draeger Perseus A500 anaesthesia machines equipped with bypass vaporizers of the type Draeger D-Vapor 3000 (Draeger Medicine Deutschland GmbH, Luebeck, Germany). -The AGCs were connected to the exhaust port of the anaesthesia machines, which work in a passive mode, without an AGSS connected. +The AGCs were permanently connected to the exhaust port of the anaesthesia machines, which work in a passive mode, without an AGSS connected. We weighed the sevoflurane (SEVOrane, AbbVie Deutschland GmbH & Co. KG, Mainz, Germany) bottles before and after maximum filling of the vaporizer and used the difference in weight to record the sevoflurane consumption. The vaporizers were filled to the maximum before we attached the first CONTRAfluranTM AGC (ZeoSys medical, Luckenwalde, Germany) and started our recordings. During the study period, almost every day the two vaporizers were filled completely and the sevoflurane bottle weight difference measured by the study team, which was not involved in the anaesthesia.

@@ -506,7 +504,9 @@

3.3 Consumption and weight measur Before returning the AGCs to ZeoSys, we weighed all AGCs again to determine any potential weight loss.

All weight measurements were done with a precision scale (Kern PCB 2500-2; Kern&Sohn GmbH, Balingen-Frommern; Germany; maximum weight = 2500 g; d = 0.01 g).

-

ZeoSys stored all AGCs for a further four weeks at least, due to regulatory reasons before starting the desorption and recovery process. +

ZeoSys stored all AGCs for a further four weeks at least, due to regulatory reasons. +Before starting the desorption and recovery process they weighed all AGCs +(Sartorius Cubis II MCA5201S-2S00-0; Sartorius AG, Göttingen; Germany; maximum weight = 5200 g; d = 0.1 g). Afterwards, they sent us the information about the total amount of sevoflurane recovered from all 20 AGCs.

@@ -518,7 +518,7 @@

3.4 Outcome

3.5 Data processing and statistical analysis

All data processing and statistical analyses were performed using R version -4.3.2 +4.4.0 [8]. The two-sided Wilcoxon rank-sum test was used for statistical comparison. A p-value less than 0.05 was considered to be statistically significant. @@ -528,20 +528,20 @@

3.5 Data processing and statistic

4 Results

-
- @@ -1031,15 +1031,19 @@

4.1 Sevoflurane consumption and c

4.2 Weight loss

-

The 20 AGCs were stored for 69.0 (33.2, 120.0) days. -in median (lower and upper quartile). -Before sending all AGCs to ZeoSys, we weighed them again and found an almost -linear decrease in weight over time of around 69 mg per day -(Figure 4.1 and Supplemental Section 9.2)).

+

The 20 AGCs were stored for 69.0 (33.2, 120.0) days +in median (lower and upper quartile) in our hospital and additional +237 days at +ZeoSys before the desorption process. +During the whole storage period we observed a loss of +13.5 (11.1, 15.1) gram in median (lower and upper quartile) for each +AGC and of 262.37 gram in total. +This corresponds to 3.3 %. +(Figure 4.1).

-Weight loss of the anaesthetic gas canisters during storage. The dots represent the weight loss of each individual anaesthetic gas canister for the days after exhaustion. The dashed line is the linear fit. +Weight loss of the anaesthetic gas canisters during storage. The dots represent the weight loss of each individual anaesthetic gas canister for the days after exhaustion before shipping and desorption. The gray lines connect the same anaesthetic gas canisters measured at the two different time points.

-Figure 4.1: Weight loss of the anaesthetic gas canisters during storage. The dots represent the weight loss of each individual anaesthetic gas canister for the days after exhaustion. The dashed line is the linear fit. +Figure 4.1: Weight loss of the anaesthetic gas canisters during storage. The dots represent the weight loss of each individual anaesthetic gas canister for the days after exhaustion before shipping and desorption. The gray lines connect the same anaesthetic gas canisters measured at the two different time points.

@@ -1068,14 +1072,15 @@

5 Discussion

However, a large wastage of VA yields a higher capture efficiency.

Another major determinant for the lower capture efficiency in OR2 may be the longer duration of anaesthesia. -The slow compartments of the body, for example fat, have a huge capacity to store a large amount of -VA. +The slow compartments of the body, for example muscles and fat, +have a huge capacity to store a large amount of VA. It takes hours to saturate the slow compartments due to the long time constant for sevoflurane [11]. However, the absolute amount of VA -in the fat tissue, even before saturation, is much larger than in the -fast compartments (e.g. brain, muscle) and the blood [11]. -The fat tissue will also release the VA slowly during the emergence process, +in the muscles and fat tissue, even before saturation, is much larger than in +the fast compartments (e.g. brain, heart) and the blood [11]. +The fat tissue will also release the VA slowly during +the emergence process, due to its small part in the total cardiac output and the low partial pressure. The longer the anaesthesia lasts, the more VA will be stored in the fat tissue and carried to the post anaesthesia care unit, where it is @@ -1084,7 +1089,9 @@

5 Discussion

reduction of the capture efficiency from 82 % after one hour to 73 % after five hours anaesthesia with sevoflurane and a fresh gas flow of 0.5 l.min-1 [12]. Considering the large volume of fat tissue and the -theoretical storage capacity, this seems significantly underestimated. +theoretical storage capacity, this seems significantly underestimated and could +partially explained by the wasteful high fresh gas flow during the +induction period over 15 minutes. Hinterberg et al. had also recognised a much lower capture efficiency in longer rather than shorter anaesthesia [4]. Interestingly, Mulier et al. had not seen any correlation between the in vivo @@ -1099,7 +1106,7 @@

5 Discussion

is very similar to the 43-51 % previously reported for the AGSS-dependent SageTech Medical’s Volatile Capture Device (SageTech Medical, Paignton, UK; [6]) or the 45 % in vivo mass transfer -for CONTRAfluranTM during laparoscopic surgery [13]. +for CONTRAfluranTM during laparoscopic surgery [7]. Hinterberg et al. reported a much lower capture efficiency of just 25 % for desflurane [4]. They used a new AGC for every case, which produced underfilled AGCs @@ -1115,7 +1122,7 @@

5 Discussion

[4,12]. However, the focus on the capture efficiency as a target is misleading as a higher fresh gas flow yields a higher capture efficiency due to an increased proportion of -anaesthetic wasted and entering the AGC [14,15].

+anaesthetic wasted and entering the AGC [13,14].

Beside the volatile agent, the AGC contains a varying proportion of water, acetone and, in the case of sevoflurane, compound A-E. The absorption of the volatile agent in the AGC is based on strong non-covalent @@ -1126,19 +1133,21 @@

5 Discussion

compared to the 70 % reported previously [4]. Perhaps a connected AGSS caused a dryer AGC, which could be a reason for the very high desorption efficiency of 95.5 % sevoflurane for SageTech’s AGSS-dependent volatile capture device [6].

-

Although we stored all AGCs in a zip lock bag, we surprisingly found a -linear decrease in weight of around -69 mg per day during storage (Figure 4.1). +

Although we stored all AGCs in a zip lock bag, we found a +decrease in weight of around 3.3 % +during storage (Figure 4.1). A previous study reported a constant weight over time [4]. Because of the strong non-covalent interaction between the VA and the activated charcoal, and the hydrophobic character of the latter, -we assume that a drying or evaporation process of the captured water could explain the weight loss. +we assume that a drying or evaporation process of the captured water could partially explain the weight loss. However, we recognised some rare exhausting alarms by SENSOfluran during minimal-flow total intravenous anaesthesia, which may be due to spontaneous desorption. Weight loss during high-flow total intravenous anaesthesia was already reported -[7]. -Thus spontaneous desorption, even without any flow, may be another explanation.

-

The weight loss and the difference in desorption efficiency illustrate +[15]. +Thus spontaneous desorption, even without any flow, as already observed by +Wenzel et al. may be another explanation [16].

+

The weight loss, the unknown contribution of water and metabolic products, +and the difference in desorption efficiency illustrate that it is not possible to draw any conclusions about the overall capture efficiency of AGCs from the (in vivo) mass transfer alone.

@@ -1183,7 +1192,7 @@

5.1 Limitations

not recorded. That is why we calculate the sevoflurane consumption data for the four last anaesthesia cases as described by Biro et al. -(54.10 g; Supplemental Section 9.3) [16]. +(54.10 g; Supplemental Section 9.2) [17]. They described an overestimation of the sevoflurane consumption by 6.2 %. This would result in an error of 0.26 % @@ -1254,25 +1263,25 @@

8 References

1. van Daalen KR, Romanello M, Rocklöv J, et al. The 2022 Europe report of the Lancet Countdown on health and climate change: Towards a climate resilient future. The Lancet Public Health 2022; 7: e942–65.
-2. Hu X, Pierce JT, Taylor T, Morrissey K. The carbon footprint of general anaesthetics: A case study in the UK. Resources, Conservation and Recycling 2021; 167: 105411. +2. Hu X, Pierce JT, Taylor T, Morrissey K. The carbon footprint of general anaesthetics: A case study in the UK. Resour Conserv Recycl 2021; 167: 105411.
3. MacNeill AJ, Lillywhite R, Brown CJ. The impact of surgery on global climate: A carbon footprinting study of operating theatres in three health systems. The Lancet Planetary Health 2017; 1: e381–8.
-4. Hinterberg J, Beffart T, Gabriel A, et al. Efficiency of inhaled anaesthetic recapture in clinical practice. British Journal of Anaesthesia 2022; 129: e79–81. +4. Hinterberg J, Beffart T, Gabriel A, et al. Efficiency of inhaled anaesthetic recapture in clinical practice. Br J Anaesth 2022; 129: e79–81.
-5. Kalmar AF, Verdonck P, Saxena S, Mulier J. Proper use of CONTRAfluranTM for optimal desorption and reuse of volatile anaesthetics. Comment on Br J Anaesth 2022; 129: e79–81. British Journal of Anaesthesia 2023; 131: e71–2. +5. Kalmar AF, Verdonck P, Saxena S, Mulier J. Proper use of CONTRAfluranTM for optimal desorption and reuse of volatile anaesthetics. Comment on Br J Anaesth 2022; 129: e79–81. Br J Anaesth 2023; 131: e71–2.
-6. Gandhi J, Baxter I. Efficiency of inhaled anaesthetic recapture in clinical practice. Comment on Br J Anaesth 2022; 129: E79-E81. British Journal of Anaesthesia 2023: S0007-0912(23)00073-9. +6. Gandhi J, Baxter I. Efficiency of inhaled anaesthetic recapture in clinical practice. Comment on Br J Anaesth 2022; 129: E79-E81. Br J Anaesth 2023: S0007-0912(23)00073-9.
7. Mulier H, Struys MMRF, Vereecke H, Rex S, Teunkens A, Kalmar AF. Efficiency of CONTRAfluranTM in reducing sevoflurane pollution from maintenance anaesthesia in minimal flow end-tidal control mode for laparoscopic surgery. Anaesthesia 2024 Apr; doi gtq92r.
-8. R Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing, 2023. +8. R Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing, 2024.
9. Sjoberg DD, Whiting K, Curry M, Lavery JA, Larmarange J. Reproducible summary tables with the gtsummary package. R Journal 2021; 13: 570–80. @@ -1281,22 +1290,25 @@

8 References

10. Gibb S. VCT-OR data and analyses. 2024.
-11. Hendrickx JFA, Nielsen OJ, De Hert S, De Wolf AM. The science behind banning desflurane: A narrative review. European Journal of Anaesthesiology 2022; 39: 818–24. +11. Hendrickx JFA, Nielsen OJ, De Hert S, De Wolf AM. The science behind banning desflurane: A narrative review. Eur J Anaesthesiol 2022; 39: 818–24.
12. Dexter F, Epstein R. Associations between fresh gas flow and duration of anesthetic on the maximum potential benefit of anesthetic gas capture in operating rooms and in postanesthesia care units to capture waste anesthetic gas. Anesthesia & Analgesia 2023; 137: 1104–9.
-
-13. Mulier H, Vereecke H, Rex S, Teunkens A, Kalmar A. Importance of disconnecting CONTRAfluranTM during total intravenous anesthesia. 2024. https://esaic2024.abstractserver.com/program/#/details/presentations/983. -
-14. Shelton C, Barker K, Beatty JW. Efficiency of inhaled anaesthetic recapture in clinical practice. Comment on Br J Anaesth 2022; 129: e79–81. British Journal of Anaesthesia 2022; 129: e114–6. +13. Shelton C, Barker K, Beatty JW. Efficiency of inhaled anaesthetic recapture in clinical practice. Comment on Br J Anaesth 2022; 129: e79–81. Br J Anaesth 2022; 129: e114–6.
-15. Gandhi J, Barker K, Cross S, Goddard A, Vaghela M, Cooper A. Volatile capture technology in sustainable anaesthetic practice: A narrative review. Anaesthesia 2024; 79: 261–9. +14. Gandhi J, Barker K, Cross S, Goddard A, Vaghela M, Cooper A. Volatile capture technology in sustainable anaesthetic practice: A narrative review. Anaesthesia 2024; 79: 261–9. +
+
+15. Kalmar AF, Vereecke H, Rex S. Desorption of volatile anaesthetics from CONTRAfluran during total intravenous anaesthesia with a high fresh gas flow. Br J Anaesth 2024 Oct; doi g8qq5w. +
+
+16. Wenzel C, Flamm B, Loop T, Schumann S, Spaeth J. Efficiency of passive activated carbon anaesthetic gas capturing systems during simulated ventilation. Br J Anaesth 2024 Jul; doi g8qq56.
-16. Biro P, Kneschke O, Theusinger OM. Accuracy of calculated volatile agent consumption from fresh gas content. Acta Anaesthesiologica Scandinavica 2015; 59: 619–24. +17. Biro P, Kneschke O, Theusinger OM. Accuracy of calculated volatile agent consumption from fresh gas content. Acta Anaesthesiol Scand 2015; 59: 619–24.
@@ -1305,14 +1317,16 @@

9 Supplement

9.1 Table of anaesthetic gas canisters

- +-+++@@ -1331,7 +1345,9 @@

9.1 Table of anaesthetic gas cani

+ + @@ -1350,7 +1366,9 @@

9.1 Table of anaesthetic gas cani

+ + @@ -1367,7 +1385,9 @@

9.1 Table of anaesthetic gas cani

+ + @@ -1384,7 +1404,9 @@

9.1 Table of anaesthetic gas cani

+ + @@ -1401,7 +1423,9 @@

9.1 Table of anaesthetic gas cani

+ + @@ -1418,7 +1442,9 @@

9.1 Table of anaesthetic gas cani

+ + @@ -1435,7 +1461,9 @@

9.1 Table of anaesthetic gas cani

+ + @@ -1452,7 +1480,9 @@

9.1 Table of anaesthetic gas cani

+ + @@ -1469,7 +1499,9 @@

9.1 Table of anaesthetic gas cani

+ + @@ -1486,7 +1518,9 @@

9.1 Table of anaesthetic gas cani

+ + @@ -1503,7 +1537,9 @@

9.1 Table of anaesthetic gas cani

+ + @@ -1520,7 +1556,9 @@

9.1 Table of anaesthetic gas cani

+ + @@ -1537,7 +1575,9 @@

9.1 Table of anaesthetic gas cani

+ + @@ -1554,7 +1594,9 @@

9.1 Table of anaesthetic gas cani

+ + @@ -1571,7 +1613,9 @@

9.1 Table of anaesthetic gas cani

+ + @@ -1588,7 +1632,9 @@

9.1 Table of anaesthetic gas cani

+ + @@ -1605,7 +1651,9 @@

9.1 Table of anaesthetic gas cani

+ + @@ -1622,7 +1670,9 @@

9.1 Table of anaesthetic gas cani

+ + @@ -1639,7 +1689,9 @@

9.1 Table of anaesthetic gas cani

+ + @@ -1656,7 +1708,9 @@

9.1 Table of anaesthetic gas cani

+ + @@ -1673,7 +1727,9 @@

9.1 Table of anaesthetic gas cani

+ + @@ -1686,36 +1742,13 @@

9.1 Table of anaesthetic gas cani

Table 9.1: Details of anaesthetic gas canisters. Csev: total sevoflurane used [g]; Cavg: average sevoflurane used [g.h-1]; D: total duration [h]; Dsev: total duration of sevoflurane cases [h]; Davg: average duration of sevoflurane cases [h]; Id: lot number; MT: in vivo mass transfer [%]; N: total number of anaesthesia cases; Nsev: total number of sevoflurane cases; OR: operation room; S: days stored after exhausted before shipping; Wd: weight gain; Wf: final weight when exhausted, directly after disconnection; Wi: initial weight; Wl: weight lost after exhausted and before shipping; *: the sevoflurane consumption of 54.10 g for the last four cases was estimated (9.3).Table 9.1: Details of anaesthetic gas canisters. Csev: total sevoflurane used [g]; Cavg: average sevoflurane used [g.h-1]; D: total duration [h]; Dsev: total duration of sevoflurane cases [h]; Davg: average duration of sevoflurane cases [h]; Id: lot number; MT: in vivo mass transfer [%]; N: total number of anaesthesia cases; Nsev: total number of sevoflurane cases; OR: operation room; S: days stored after exhausted before shipping; Z: days stored before desorption; Wd: weight gain; Wf: final weight when exhausted, directly after disconnection; Wi: initial weight; Wl: weight lost after exhausted and before shipping; Wz: weight lost just before desorption; *: the sevoflurane consumption of 54.10 g for the last four cases was estimated (9.2).
Wf Wd WlWz SZ N Nsev D1456.8 425.8 9.018.0 102340 52.0 41.0 37021488.8 423.3 4.014.9 40277 46.1 29.8 38021433.2 384.5 2.115.6 18255 81.9 76.9 148241472.9 425.6 4.512.4 53290 39.1 27.0 21791438.4 390.8 0.87.2 11248 52.0 28.0 31551415.2 386.8 9.514.6 131368 49.5 34.0 27081425.9 397.3 1.512.4 26263 49.6 34.1 32071407.2 384.4 8.113.1 119356 51.0 35.0 34811437.2 407.9 4.017.4 35272 27.7 21.7 22251383.6 349.5 0.07.1 4241 70.2 64.2 125921415.2 381.0 10.613.9 159396 35.0 27.0 23951434.6 410.0 11.618.8 147384 29.9 20.9 24371404.9 384.9 8.612.3 168405 31.6 19.6 20001401.8 379.6 3.08.6 28265 51.4 34.4 36371438.1 399.0 6.011.4 76313 39.0 29.0 31521469.2 440.8 4.817.1 60297 59.6 55.6 107671461.5 421.4 7.514.6 88325 42.5 26.5 33031404.8 373.0 7.014.4 123360 75.5 68.5 95291424.8 381.0 5.18.5 94331 40.9 38.9 76851441.3 406.4 5.010.2 62299 43.5 26.0 2721
-
-

9.2 Weight lost during storage

-

After the AGCs were exhausted we stored them before shipping to ZeoSys. -We weighed them again before shipping and recognised -a nearly linear weight loss even though every AGC was stored in a zip-lock bag.

-
## 
-## Call:
-## lm(formula = LostWeight ~ 0 + DaysStored, data = agc)
-## 
-## Residuals:
-##     Min      1Q  Median      3Q     Max 
-## -3.0272 -0.2894  0.6678  1.1163  1.9567 
-## 
-## Coefficients:
-##            Estimate Std. Error t value Pr(>|t|)    
-## DaysStored 0.069150   0.003041   22.74 3.05e-15 ***
-## ---
-## Signif. codes:  0 '***' 0.001 '**' 0.01 '*' 0.05 '.' 0.1 ' ' 1
-## 
-## Residual standard error: 1.251 on 19 degrees of freedom
-## Multiple R-squared:  0.9646, Adjusted R-squared:  0.9627 
-## F-statistic:   517 on 1 and 19 DF,  p-value: 3.054e-15
-
-
-

9.3 Estimation of sevoflurane consumption

+
+

9.2 Estimation of sevoflurane consumption

After changing the last AGC CH0100012088 in OR25, the vaporizer was not refilled. Therefore, we retrospectively calculated the sevoflurane consumption for the last four anaesthesia cases utilising the user log entry provided by the Draeger Perseus anaesthesia machine. -The calculation was done as described in [16].

+The calculation was done as described in [17].

@@ -2135,11 +2168,11 @@

9.3 Estimation of sevoflurane con

Table 9.2: Overview of settings and consumption of the last four cases for AGC CH0100012088.
-
-

9.4 R session information

+
+

9.3 R session information

sessionInfo()
-
## R version 4.3.2 (2023-10-31)
-## Platform: x86_64-unknown-linux-gnu (64-bit)
+
## R version 4.4.0 (2024-04-24)
+## Platform: x86_64-unknown-linux-gnu
 ## Running under: Debian GNU/Linux 12 (bookworm)
 ## 
 ## Matrix products: default
@@ -2163,27 +2196,27 @@ 
9.4 R session information

 ## [1] lubridate_1.9.3 gtsummary_1.7.2 english_1.2-6  
 ## 
 ## loaded via a namespace (and not attached):
-##  [1] gt_0.10.1            sass_0.4.8           utf8_1.2.4          
+##  [1] gt_0.10.1            sass_0.4.9           utf8_1.2.4          
 ##  [4] generics_0.1.3       tidyr_1.3.1          xml2_1.3.6          
-##  [7] stringi_1.8.3        digest_0.6.34        magrittr_2.0.3      
-## [10] evaluate_0.23        timechange_0.3.0     bookdown_0.37       
+##  [7] stringi_1.8.4        digest_0.6.35        magrittr_2.0.3      
+## [10] evaluate_0.23        timechange_0.3.0     bookdown_0.39       
 ## [13] fastmap_1.1.1        rprojroot_2.0.4      broom.helpers_1.13.0
 ## [16] jsonlite_1.8.8       backports_1.4.1      purrr_1.0.2         
 ## [19] fansi_1.0.6          viridisLite_0.4.2    bibtex_0.5.1        
 ## [22] jquerylib_0.1.4      cli_3.6.2            rlang_1.1.3         
 ## [25] commonmark_1.9.1     withr_3.0.0          cachem_1.0.8        
-## [28] yaml_2.3.8           tools_4.3.2          dplyr_1.1.4         
+## [28] yaml_2.3.8           tools_4.4.0          dplyr_1.1.4         
 ## [31] forcats_1.0.0        broom_1.0.5          vctrs_0.6.5         
 ## [34] R6_2.5.1             lifecycle_1.0.4      stringr_1.5.1       
-## [37] pkgconfig_2.0.3      pillar_1.9.0         bslib_0.6.1         
-## [40] glue_1.7.0           xfun_0.42            tibble_3.2.1        
-## [43] tidyselect_1.2.0     highr_0.10           knitr_1.45          
-## [46] htmltools_0.5.7      rmarkdown_2.25       compiler_4.3.2      
+## [37] pkgconfig_2.0.3      pillar_1.9.0         bslib_0.7.0         
+## [40] glue_1.7.0           xfun_0.43            tibble_3.2.1        
+## [43] tidyselect_1.2.1     highr_0.10           knitr_1.46          
+## [46] htmltools_0.5.8.1    rmarkdown_2.26       compiler_4.4.0      
 ## [49] markdown_1.12
-
-

9.5 Git commit hash

-
## [1] "Git commit revision: 2ac76148bb48c051f311a1da8fce875da9d04976"
+
+

9.4 Git commit hash

+
## [1] "Git commit revision: 5f30bf8e21204cc85f5c722b7c03148e757c03c4"