bluuebunny/crossref_metadata_2025 huggingface dataset:
Multi-agent Reinforcement Learning-based Adaptive Heterogeneous DAG Scheduling
Authors: Zhadan Anastasia , Allahverdyan Alexander , Kondratov Ivan , Mikheev Vikenty , Petrosian Ovanes , Romanovskii Aleksei , Kharin Vitaliy
Published: July 2023

Static scheduling of computational workflow represented by a directed acyclic graph (DAG) is an important problem in many areas of computer science. The main idea and novelty of the proposed algorithm is an adaptive heuristic or graph metric that uses a different heuristic rule at each scheduling step depending on local workflow. It is also important to note that multi-agent reinforcement learning is used to determine scheduling policy based on adaptive metrics. To prove the efficiency of the approach, a comparison with the state-of-the-art DAG scheduling algorithms is provided: DONF, CPOP, HCPT, HPS, and PETS. Based on the simulation results, the proposed algorithm shows an improvement of up to 30% on specific graph topologies and an average performance gain of 5.32%, compared to the best scheduling algorithm, DONF (suitable for large-scale scheduling), on a large number of random DAGs. Another important result is that using the proposed algorithm it was possible to cover 30.01% of the proximity interval from the best scheduling algorithm to the global optimal solution. This indicates that the idea of an adaptive metric for DAG scheduling is important and requires further research and development.
Management Practice and Clinical Outcomes of Dementia in Sub-Saharan Africa: A Systematic Review
Authors: Beyene Dessale Abate , Berha Alemseged Beyene
Published: July 2023

Background. Dementia is a severe neurodegenerative disorder and it is a group of acquired symptoms associated with impaired cognitive functions. In low-income settings particularly in Sub-Saharan Africa (SSA), it is often seen as part of normal aging. Environmental, behavioral, and lifestyle interventions have the potential to alter the disease course of dementia. Objective. This study is aimed to synthesize the literature/evidence(s) on the management practice and treatment outcomes of dementia in SSA. Method. Comprehensive literature was searched in PubMed database, Cochrane Library, and Google Scholar. Eligibility has been set, and based on the criteria, initially, a total of 442 results were obtained, and from those around 183 articles were duplicated. After examining titles and abstracts of records 26 articles were identified. Finally, five randomized clinical trials (RCT) and three prospective cohort studies that were reported on the management practice and treatment outcome of dementia in SSA were eligible for analysis. RCT and prospective cohort studies were used to strengthen the quality of evidence. The quality of the included RCT studies was assessed by using the Cochrane Risk of Bias Tool. Result. A total of 2781 patient data were included in the final analysis. Of these, 2354 patients were obtained from 5 RCTs and 427 patients from 3 prospective cohort studies, which were conducted in SSA countries. RCT studies were done on the feasibility and clinical effectiveness of cognitive stimulation therapy (CST) showed improvements in language memory domains and physical health. In addition, studies that focus on the management of human immunodeficiency virus-associated dementia (HIVAD) were reported to improve neurocognitively. Conclusion. CST is applicable in low-resource settings and it shows improvements in cognitive function and quality of life. Early initiation of combination antiretroviral therapy in resource-limited settings has been associated with improvement in the cognitive function of HIVAD.
Forecasting Regional Energy Consumption via Jellyfish Search-Optimized Convolutional-Based Deep Learning
Authors: Chou Jui-Sheng , Nguyen Ngoc-Quang
Published: July 2023

The energy sector must achieve a delicate balance between energy supply and demand. Highly accurate energy consumption forecasts can help plant operators achieve this goal. In this study, various techniques from three artificial intelligence categories, namely, convolutional neural networks (CNNs), machine learning (ML), and time-series deep learning (DL), were applied to predict short-term regional energy consumption from a power company. An image conversion process was proposed to utilize the powerful image-processing capabilities of CNNs, in which numerical matrices of input values created by the sliding-window technique are encoded into two-dimensional grayscale images as input for CNN models. The proposed method outperformed conventional numerical input methods. Then, the best ML and time-series DL models were combined into ensemble models with ImageNet-winning CNN architectures based on the rationale of utilizing the strengths of each approach and compensating for their limitations. However, according to the numerical experiments for the regional energy consumption prediction, the ensemble models had lower performance than CNNs alone. Various leading models performing single-step or multistep forecasting and models that use seasonal or annual data were constructed. The performance of all the constructed models was evaluated, and the most efficient models were determined as proposed models. Finally, a nature-inspired optimization algorithm, Jellyfish Search (JS), was used to fine-tune the proposed models’ hyperparameters to minimize prediction error. The results revealed that the fine-tuning of hyperparameters via the JS algorithm significantly enhanced the precision of the CNN models, resulting in a mean absolute percentage error (MAPE) improvement range of 4.4% to 17.5% compared to the default models. The proposed models can help utilities plan daily power allocation and match supply and demand to maintain a stable power system.
An Improved P&O Based MPPT for PV Systems with Reduced Steady-State Oscillation
Authors: Saberi Ali , Niroomand Mehdi , Dehkordi Behzad Mirzaeian
Published: July 2023

This paper proposes a perturb and observe (P&O) maximum power point tracking (MPPT) algorithm for photovoltaic (PV) systems. P&O is a simple technique that comes with serious problems, steady-state oscillation, and deviation from the maximum power point (MPP). This algorithm uses variable step size to decrease the convergence time, and it uses the average value of the last three duty cycle to find MPP fast and accurately. In addition, the probability of deviation has been reduced using the direction of the current when the irradiance changes. The irradiance change identifier, steady-state determiner, duty cycle selector, step size alternator, and boundary condition imposer are the extramodules attached to the structure of the original P&O algorithm to change the step size. This algorithm has been tested along with different types of P&O and INC algorithms in MATLAB software and practical experiments using a boost switching converter. The irradiance pattern used in the simulation includes step and slop, increasing and decreasing patterns, and the proposed algorithm obtained an overall efficiency of 98.54%.
Examining Car Accident Prediction Techniques and Road Traffic Congestion: A Comparative Analysis of Road Safety and Prevention of World Challenges in Low-Income and High-Income Countries
Authors: Berhanu Yetay , Alemayehu Esayas , Schröder Dietrich
Published: July 2023

Road accidents are a significant negative outcome of transportation systems, causing injuries, fatalities, traffic congestion, and economic losses. As cities expand and the number of vehicles on the road increases, traffic accidents (TAs) have become a significant problem. Studies have shown that urban development plays a more significant role in transportation safety than previously thought. Low-income countries have higher fatality rates than high-income countries, according to the Permanent International Association of Road Congress (PIARC) and the World Health Organization (WHO). Predicting and preventing the occurrence of accidents and congestion is necessary worldwide, especially in developing countries where fatality rates are higher. The objective of this study is to examine and make a comparative analysis in low-income and high-income countries of the existing literature on the global challenge of car accidents and use its prediction techniques to enhance road safety and reduce traffic congestion. The study evaluates various approaches such as logistic regression, decision tree, random forest, deep neural network, support vector machine, random forest, K-nearest neighbors, Naïve Bayes, empirical Bayes, geospatial analysis methods, and UIMA, NSGA-II, and MOPS algorithms. The research identifies current challenges, prevention ideas, and future directions for preventing accidents and congestion on the road network. Integrating GIS-based spatial statistical methods and temporal data and utilizing advanced optimization algorithms and machine learning methods can result in accurate prediction models that can help identify accident hotspots and reduce congestions and enhance traffic safety and mitigate their occurrence. Effectively preventing urban traffic congestion requires the integration of spatial data into precise accident prediction models. By employing spatial analysis, road safety planning can be enhanced, high-risk areas can be identified, interventions can be evaluated, and resources can be optimally allocated to facilitate effective road safety measures and decision-making, especially in settings with limited resources. Therefore, it is crucial to consider ML and spatial analysis techniques and advanced optimization algorithms to enhance traffic flow control, in road safety research and transport planning efforts.
Multidrug-Resistant Pathogens in Burn Wound, Prevention, Diagnosis, and Therapeutic Approaches (Conventional Antimicrobials and Nanoparticles)
Authors: Hemmati Jaber , Azizi Mehdi , Asghari Babak , Arabestani Mohammad Reza
Published: July 2023

Multidrug-resistant pathogens are one of the common causes of death in burn patients and have a high risk of nosocomial infections, especially pneumonia, urinary tract infections, and cellulitis. The role of prolonged hospitalization and empirical antibiotics administration in developing multidrug-resistant pathogens is undeniable. In the early days of admitting burn patients, Gram-positive bacteria were the dominant isolates with a more sensitive antibiotic pattern. However, the emergence of Gram-negative bacteria that are more resistant later occurs. Trustworthy guideline administration in burn wards is one of the strategies to prevent multidrug-resistant pathogens. Also, a multidisciplinary therapeutic approach is an effective way to avoid antibiotic resistance that involves infectious disease specialists, pharmacists, and burn surgeons. However, the emerging resistance to conventional antimicrobial approaches (such as systemic antibiotic exposure, traditional wound dressing, and topical antibiotic ointments) among burn patients has challenged the treatment of multidrug-resistant infections, and using nanoparticles is a suitable alternative. In this review article, we will discuss different aspects of multidrug-resistant pathogens in burn wounds, emphasizing the full role of these pathogens in burn wounds and discussing the application of nanotechnology in dealing with them. Also, some advances in various types of nanomaterials, including metallic nanoparticles, liposomes, hydrogels, carbon quantum dots, and solid lipid nanoparticles in burn wound healing, will be explained.
Genetic Characteristics of Three Single-Farm-Isolated Porcine Reproductive and Respiratory Syndrome Viruses with Novel Recombination among NADC30-Like, JXA1-Like, and QYYZ-Like Strains
Authors: Cao Xiaoyu , Ge Xinna , Zhang Yongning , Guo Xin , Han Jun , Zhou Lei , Yang Hanchun
Published: July 2023

Porcine reproductive and respiratory syndrome virus (PRRSV) is an economically devastating pathogenic microorganism that greatly affects the pork industry in the world. The genetic variation and frequent emergence of novel strains greatly hinder the control efforts of PRRSV. Therefore, monitoring the evolutionary dynamics is long and rewarding work for PRRSV researchers and practitioners to make the control strategy. Here, three novel PRRSV strains named CHbj2101, CHbj2102, and CHbj2103 were isolated from different nursery barns with various mortality rates from 6% to 17%, belonging to the same farm, but at different periods of the outbreak. The genomic sequencing and phylogenetic analyses indicated that these three isolates were all clustered with NADC30-like virus CHsx1401, sharing higher genomic similarity from 87.3% to 89.8%, and having the same molecular marker of 131 amino acid residues deletion at their nsp2 coding region, but varied mutagenesis among the antigenic sites in the region of GP2 to GP5. Among the available PRRSV sequences in the GenBank, the isolates CHbj2101 and CHbj2102 display the highest genomic identity (90.1% and 89.8%) with NADC30-like recombinant strain 15LN3, and the rest CHbj2103 shows the highest genomic identity (90.8%) with NADC30-like virus strain 15SC3. The recombination analysis indicated that all three isolates are generated by multiple recombination events among the NADC30-like virus (major parent, Lineage 1), HP-PRRSV vaccine-like virus (minor parent, Lineage 8), and QYYZ-like virus (minor parent, Lineage 3). The isolates CHbj2101 and CHbj2102 shared a similar recombination pattern, but CHbj2103 has a different pattern in nonstructural protein coding regions. To further investigate the recombination characteristics of QYYZ-like strains, we analyzed all available whole genomic sequences of QYYZ-like PRRSV, submitted during the year 1991 and 2021 (n = 83) in China. The result shows that almost all QYYZ-like strains were products of recombination and their immunogenicity or protective protein fragments (nsp2–nsp7 and GP2–GP4) were mainly from QYYZ. These results provide us with some better insight into the evolution process of PRRSV strains in the field and warn us to pay more attention to monitoring and reducing the PRRSV variant on farms to reduce the risk of novel emergence and outbreak.
Intraspecific oophagy in Hierophis viridiflavus (Serpentes: Colubridae) during oviposition in a controlled environment
Authors: Paterna Alessandro
Published: July 2023

Following the observation of adult pairs of the Western Whipsnake, Hierophis viridiflavus, in a controlled environment, two distinct but related phenomena were observed: egg deposition and predation of freshly laid eggs by the male. Data about deposition, number and morphology of the eggs, hatching and offspring are presented and compared with the literature. The episode of oophagy is described, confirming the inclination to predate snake eggs and intraspecific oophagy in this species.
Age at Menopause, Leukocyte Telomere Length, and Coronary Artery Disease in Postmenopausal Women
Authors: Schuermans Art , Nakao Tetsushi , Uddin Md Mesbah , Hornsby Whitney , Ganesh Shriie , Shadyab Aladdin H. , Liu Simin , Haring Bernhard , Shufelt Chrisandra L. , Taub Margaret A. , Mathias Rasika A. , Kooperberg Charles , Reiner Alexander P. , Bick Alexander G. , Manson JoAnn E. , Natarajan Pradeep , Honigberg Michael C.
Published: July 2023

BACKGROUND:

Premature menopause is a risk factor for accelerated cardiovascular aging, but underlying mechanisms remain incompletely understood. This study investigated the role of leukocyte telomere length (LTL), a marker of cellular aging and genomic instability, in the association of premature menopause with cardiovascular disease.

METHODS:

Participants from the UK Biobank and Women’s Health Initiative with complete reproductive history and LTL measurements were included. Primary analyses tested the association between age at menopause and LTL using multivariable-adjusted linear regression. Secondary analyses stratified women by history of gynecologic surgery. Mendelian randomization was used to infer causal relationships between LTL and age at natural menopause. Multivariable-adjusted Cox regression and mediation analyses tested the joint associations of premature menopause and LTL with incident coronary artery disease.

RESULTS:

This study included 130 254 postmenopausal women (UK Biobank: n=122 224; Women’s Health Initiative: n=8030), of whom 4809 (3.7%) had experienced menopause before age 40. Earlier menopause was associated with shorter LTL (meta-analyzed ß=−0.02 SD/5 years of earlier menopause [95% CI, −0.02 to −0.01];
P
=7.2×10
-12
). This association was stronger and significant in both cohorts for women with natural/spontaneous menopause (meta-analyzed ß=−0.04 SD/5 years of earlier menopause [95% CI, −0.04 to −0.03];
P
<2.2×10
-16
) and was independent of hormone therapy use. Mendelian randomization supported a causal association of shorter genetically predicted LTL with earlier age at natural menopause. LTL and age at menopause were independently associated with incident coronary artery disease, and mediation analyses indicated small but significant mediation effects of LTL in the association of menopausal age with coronary artery disease.

CONCLUSIONS:

Earlier age at menopause is associated with shorter LTL, especially among women with natural menopause. Accelerated telomere shortening may contribute to the heightened cardiovascular risk associated with premature menopause.
Temporal Trends in Infarct Severity Outcomes in ST‐Segment–Elevation Myocardial Infarction: A Cardiac Magnetic Resonance Imaging Study
Authors: Lechner Ivan , Reindl Martin , Tiller Christina , Holzknecht Magdalena , Fink Priscilla , Troger Felix , Angerer Georg , Angerer Simon , Henninger Benjamin , Mayr Agnes , Klug Gert , Bauer Axel , Metzler Bernhard , Reinstadler Sebastian J.
Published: July 2023

Background

Severity of myocardial tissue injury is a main determinant of morbidity and death related to ST‐segment–elevation myocardial infarction (STEMI). Temporal trends of infarct characteristics at the myocardial tissue level have not been described. This study sought to assess temporal trends in infarct characteristics through a comprehensive assessment by cardiac magnetic resonance imaging at a standardized time point early after STEMI.

Methods and Results

We analyzed patients with STEMI treated with percutaneous coronary intervention at the University Hospital of Innsbruck who underwent cardiac magnetic resonance imaging between 2005 and 2021. The study period was divided into terciles. Myocardial damage characteristics were assessed using a multiparametric cardiac magnetic resonance imaging protocol within the first week after STEMI and compared between groups. A total of 843 patients with STEMI (17% women) with a median age of 57 (interquartile range, 51–66) years were analyzed. While age, sex, and the clinical risk profile expressed as thrombolysis in myocardial infarction risk score were comparable across the study period, there were differences in guideline‐recommended therapies. At the same time, there was no significant change in infarct size (
P
=0.25), microvascular obstruction (
P
=0.50), and intramyocardial hemorrhage (
P
=0.34). Left ventricular remodeling indices and left ventricular ejection fraction remained virtually unchanged (all
P
>0.05). Major adverse cardiovascular events at 4 (interquartile range, 4–5) months were similar between groups (
P
=0.36).

Conclusions

In this magnetic resonance imaging study investigating patients with STEMI treated with primary percutaneous coronary intervention over the past 15 years, no change in infarct severity at the myocardial level has been observed. Clinical research on novel therapeutic approaches to reduce myocardial tissue injury should be a priority.
State of Shock: Contemporary Vasopressor and Inotrope Use in Cardiogenic Shock
Authors: Bloom Jason E. , Chan William , Kaye David M. , Stub Dion
Published: July 2023

Cardiogenic shock is characterized by tissue hypoxia caused by circulatory failure arising from inadequate cardiac output. In addition to treating the pathologic process causing impaired cardiac function, prompt hemodynamic support is essential to reduce the risk of developing multiorgan dysfunction and to preserve cellular metabolism. Pharmacologic therapy with the use of vasopressors and inotropes is a key component of this treatment strategy, improving perfusion by increasing cardiac output, altering systemic vascular resistance, or both, while allowing time and hemodynamic stability to treat the underlying disease process implicated in the development of cardiogenic shock. Despite the use of mechanical circulatory support recently garnering significant interest, pharmacologic hemodynamic support remains a cornerstone of cardiogenic shock management, with over 90% of patients receiving at least 1 vasoactive agent. This review aims to describe the pharmacology and hemodynamic effects of current pharmacotherapies and provide a practical approach to their use, while highlighting important future research directions.
Integrative revision of the Blommersia wittei complex, with description of a new species of frog from western and north-western Madagascar
Authors: VENCES MIGUEL , MULTZSCH MALTE , KÖHLER JÖRN , CROTTINI ANGELICA , ANDREONE FRANCO , RAKOTOARISON ANDOLALAO , SCHERZ MARK D. , GLAW FRANK
Published: July 2023

Frogs of the Blommersia wittei complex are widespread in western and northern Madagascar, and are one of two clades of the family Mantellidae that have colonized the Comoran island of Mayotte. Based on a comprehensive set of DNA sequences of the mitochondrial 16S rRNA gene and the nuclear-encoded RAG1 and SACS genes, integrated with morphological and bioacoustic data, we here analyze the genetic differentiation of populations of this complex across Madagascar. We confirm that a candidate species named B. sp. Ca5 in previous studies represents a genetically well-defined evolutionary lineage distributed over much of western Madagascar, which we describe herein as Blommeria bara sp. nov. based on its molecular and bioacoustic differentiation. Blommersia wittei occurs across northern Madagascar but its type locality Ambanja, at the lower Sambirano river, is very close to the range of another, newly discovered microendemic lineage that was only found at two sites along the upper Sambirano river (here named as candidate species B. sp. Ca12). The B. wittei complex thus provides an example of a clade of closely related Malagasy frogs that contains species widespread over hundreds of kilometers, as well as extreme microendemics. For a full resolution of this species complex, more data need to be collected on the geographical contact among these two lineages, on the morphology and bioacoustics of B. sp. Ca12, and on the north-eastern populations of B. wittei at Sambava, which are weakly differentiated in mitochondrial genes but differ in bioacoustics and possibly in the extent of foot webbing.
Platytomus pittinoi Minkina & Byk, a new species of Psammodiini (Coleoptera: Scarabaeidae: Aphodiinae) from Greece
Authors: MINKINA ŁUKASZ , BYK ADAM , NOWAK CEZARY , BIDAS MAREK , MOKRZYCKI TOMASZ
Published: July 2023

Platytomus pittinoi Minkina & Byk, a new species of Psammodiini (Coleoptera: Scarabaeidae: Aphodiinae) from Greece is described and illustrated. Newly described species is compared to the morphologically most similar species Platytomus laevistriatus (Perris, 1870).
Soret-Dufour Mechanisms on the Thermal Loading of Catteneo-Christov Theories on Magnetohydrodynamic (MHD) Casson Nanofluid Dynamics Over a Stretching Sheet
Authors: Gladys T. , Reddy G. V. Ramana
Published: July 2023

The dynamics of Casson nanofluid with chemically reactive and thermally conductive medium past an elongated sheet were investigated in this study. The thermal loading of the fluids is considered while experimenting the Cattaneo-Christov theories with MHD boundary layer flow. The Rosseland
approximation is used on the radiative heat flux because the fluids are optically thin. Partial differential equations were used in the flow model (PDEs). These PDEs were converted to ordinary differential equations (ODEs). The Runge-kutta method and firing techniques were used to solve the
altered equations numerically. Graphs were used to depict the effect of relevant flow parameters, while computations on engineering values of relevance were tabulated. The velocity profile was found to degenerate when the visco-inelastic parameter (Casson) was set to a higher value. The boundary
layer distributions degenerate when the unsteadiness parameter (A) is increased. The findings revealed that, the plastic dynamic viscosity of the Casson fluid causes reduction to the velocity profile. This paper is unique because it examined the simultaneous thermal loading of two non-Newtonian
fluids (Casson-Williamson) nanofluids with experimentation of Cattaneo-Christov theories. To the very best of our knowledge, no study has explored study of this type in literature.
Numerical Analysis of Velocity and Thermal Wall Slip Effects on the Boundary Layer Flow Over an Exponentially Stretching Bullet-Shaped Object in Presence of Suction and Injection
Authors: Ali Mohammad , Alim Md. Abdul
Published: July 2023

A steady two-dimensional axisymmetric incompressible flow over an exponentially stretching bullet-shaped surface has been considered. The present work is mainly focused on fluid flow by the effect of multiple slips. The governing partial differential equations and auxiliary boundary
conditions have been converted into higher-order equations by using assisting similarity transformations. These higher-order ODEs are then transformed into a 1st-order system of LDEs by the method of spectral quasi-linearization (SQLM). The validity, accuracy, and convergence of the solution
have been performed by using SQLM. The fluid velocity, temperature, skin friction coefficient, and Nusselt number have been depicted graphically for the mentioned parameters as also the numerical values of velocity gradient, and Nusselt number in a table. The numerical investigation shows
that the velocity gradient enhances due to the parameter of magnetic, thermal slip, and Prandtl number whereas the remaining parameters have a reverse effect on it. The heat transfer rate reduces for the parameters of magnetic, multiple slip, injection, and viscous dissipation but suction
and heat generation have a reverse effect on it. The results of in this work have been justified due to the validity and accuracy of the present problem. Due to the endless application of Newtonian fluids in engineering and industry, no attempt has been taken to inspect the MHD flow with a
dual slip effect along with exponential stretching bullet-shaped surface. Also, the current work is of immediate interest to those systems that are highly influenced by the heat transfer process and desired product quality.
Natural Convection in a Newtonian Nanoliquid-Saturated Porous Enclosure with Local Thermal Non-Equilibrium Effect
Authors: Siddabasappa C. , Aishwarya K. , Babitha
Published: July 2023

Buoyancy-driven convective flow and heat transfer characteristics in a Newtonian nanoliquid-saturated porous square enclosure are analyzed numerically using a local thermal non-equilibrium model. An enclosure’s horizontal walls are considered free–free and adiabatic, and
the vertical walls are free–free isothermal boundaries. The dimensionless governing equations are solved using a central finite difference scheme with second-degree accuracy, and the results are in satisfactory agreement with the earlier works. The impact of various parameters on streamlines
and isotherms is analyzed and depicted graphically. The effect of Darcy number, thermal Rayleigh number, and the ratio of thermal conductivities slow down the liquid flow. The temperature distribution is maximum at sidewalls and diminishes the amount of heat transport. The opposite phenomenon
is observed for the solute Rayleigh number and interphase transfer coefficient of liquid-particle phases. For large values of interphase heat transfer coefficients, liquid-solid and liquid-particle are said to be in the local thermal equilibrium phase. The amount of heat transfer increases
with an increasing interphase heat transfer coefficient and the ratio of the phases’ thermal conductivities. Results of local thermal equilibrium situation can be obtained as the particular case of the study. The amount of heat transfer is maximum in the local thermal non-equilibrium
situation, and enhanced by 0.09% compared with the local thermal equilibrium situation. Heat transport is 0.74% less in the sparsely packed porous medium compared with the low-porosity medium.
Robotic Left Hepatectomy for Hemorrhagic Hepatocellular Adenoma: The Role of Robotic Surgery in a Semi-Acute Setting
Authors: Sucandy Iswanto , Ross Sharona , Lim-Dy Allyson , Younos Ahmed , Rosemurgy Alexander
Published: July 2023

Hepatocellular adenomas are benign liver tumors, more frequently seen in young women with a history of long-standing use of estrogenic hormonal contraception. An acute rupture of these adenomas can be the first sign of symptoms; however, they can be life-threatening. The definitive management of hepatic adenoma is liver resection for those larger than 4 cm as this cutoff size is known to be associated with an exponential risk of harboring malignancy and an increased risk for intratumor bleeding. Once intratumor hemorrhage occurs however, the management of hepatic adenoma becomes much more timely critical. In this study, we describe the use of robotic liver resection for the management of hemorrhagic hepatocellular adenoma in a semi-acute setting. We also include a series of robotic hepatic adenoma resection completed in our hepatobiliary program since 2016, which demonstrated the safety, feasibility, and reproducibility of robotic technique in treating hepatic adenoma.
Risk Factors for Acute Renal Failure After Endovascular Aneurysm Repair
Authors: Zambetti Benjamin R. , Zickler William P. , Byerly Saskya , Garrett H. Edward , Magnotti Louis J.
Published: July 2023

Background

Acute kidney injury (AKI) after endovascular aortic aneurysm repair (EVAR) is uncommon though carries significant morbidity. Procedural risk factors are not well established for acute renal failure (ARF) that requires initiation of dialysis. The goal of this study was to examine the impact of ARF on patients undergoing EVAR and identify risk factors for ARF using a large, national dataset.

Methods

Patients undergoing EVAR were identified from the National Surgical Quality Improvement Program (NSQIP) database over 9 years, ending in 2019. Demographics, indication for repair, comorbidities, procedural details, complications, hospital and ICU LOS, and mortality were recorded. Patients were stratified by presence of ARF and compared. Patients were further stratified by indication for EVAR and presence of ARF. Multivariable logistic regression (MLR) analysis was performed to determine the independent predictors of ARF.

Results

18 347 patients were identified. Of these 234 (1.3%) developed ARF requiring dialysis. Mortality (40 vs 1.8%, P < .0001), ICU LOS (5 vs 0 days, P < .0001), and hospital LOS (11 vs 2 days, P < .0001) were all significantly increased in patients with ARF. Multivariable logistic regression identified increasing diameter, creatinine, operative time, preoperative transfusions, ASA class, emergent repair, female gender, and juxtarenal/suprarenal proximal landing zone as predictors of ARF.

Conclusions

ARF after EVAR causes significant morbidity, prolongs hospitalizations, and increases mortality rates. Those patients at risk of ARF after EVAR should be closely monitored to reduce both morbidity and mortality.
Influence of Prognostic Nutritional Index on the Surveillance After Surgery-Based Systematic Therapy for Breast Cancer
Authors: Zhang Xiaoyu , Liu Yue , Mu Dali
Published: July 2023

Objective

Prognostic nutritional index (PNI) is a comprehensive reflection of the nutritional and immune status of the patient, which is closely related to the ability of the organism to clear tumor cells and reduce local recurrence. Several findings suggested that PNI was a prognostic indicator for breast cancer, but the conclusions were conflicting. We aimed to comprehensively elucidate the prognostic value of PNI in breast cancer patients.

Methods

Relevant studies in PubMed, Embase, Cochrane Library, and Web of Science databases were searched through March 2023. Data extraction and literature quality assessment of the screened studies were performed. The associations between PNI and overall survival (OS), disease-free survival (DFS), and progression-free survival (PFS) in breast cancer patients who received clinical treatment were assessed by hazard ratios ( HR) and 95% confidence intervals ( CIs).

Results

A total of 7 studies involving 2212 patients met the inclusion criteria. High PNI was a favorable independent predictor of prolonged OS and PFS after clinical treatment in breast cancer patients compared to low PNI (for OS: HR = .38, 95% CIs .31 ∼ .46, P < .001; for DFS: HR = .32, 95% CIs .19 ∼ .51, P < .001). In subgroup analysis, high PNI was a prognostic factor for extended DFS in the context of a study sample size ≥300 ( HR = .39, 95% CIs .28 ∼ .54, P < .001) and patients not receiving neoadjuvant chemotherapy ( HR = .51, 95% CIs .37 ∼ .70, P < .001).

Conclusion

The PNI has a significant correlation with the prognosis of breast cancer patients. We suggest that individualized targeted treatment and long-term surveillance should be implemented for patients with different levels of PNI.
Incentives as a Driving Force for Scholarly Activity in General Surgery Training: Survey of Program Directors and our Institution’s Experience
Authors: Katuwal Binit , Flynn Jeffrey C. , Mittal Vijay K.
Published: July 2023

Introduction

Scholarly activity in a few of the domains is required for both residents and faculty per Accreditation Council for Graduate Medical Education’s Common Program Requirements. Increased burden in clinical activities and economic changes in the health care environment have created new challenges, which have negatively affected faculty and residents to participate in scholarly activity. Various avenues are being sought which might help in improving the scholarly activity in an institution by providing dedicated time, salaried positions, grants, paid conferences, and financial incentives.

Methods

A survey was sent to program directors of surgery residency programs in 2020 to evaluate the impact of financial incentives on scholarly activity. Data was analyzed on SPSS 20, and descriptive statistics using frequencies and percentages were done.

Results

Out of 230 surveys sent, 80 (35%) program directors responded (35%). 52 (65%) of respondents were from university hospitals and 28 (35%) were from community hospitals. Both the faculty and residents were required to publish in 56 (70%) of the institutions surveyed. 59 (73.7%) considered a PubMed publication as a scholarly activity. Only 9 (11%) programs were supportive of residents being involved in research activities that had a designated rotation. 48 (60%) respondents stated that residents and faculty would be more likely to pursue research endeavors if they were provided some form of financial incentive, but only 9 (11%) had some sort of incentive program in place.

Conclusion

Given the results of the survey, there is a need to seek uniform, acceptable, and sustainable alternative incentive programs to help promote and increase the scholarly activity of residents and faculty.
Chinese Railroad Workers, the Transcontinental Railroad, and the Indispensability of Immigration to America
Authors: Nakayama Don K.
Published: July 2023

Asian migration to America began with Chinese railroad workers on the transcontinental railroad (1862-1869). Their labor saved the foundering Central Pacific Railroad, challenged by building a rail line through the Sierra Nevada. By mid-1864 only 50 miles of track had been laid, grueling work that dissuaded its white workforce from going any further. To save the railroad 50 Cantonese workers were hired in early 1864 from neighboring mines to lay rail through forests, canyons, and granite mountains. High explosives, rockslides, cave-ins, and winter avalanches were constant dangers. The trial worked so well that thousands of Chinese joined the effort, many from the rural districts surrounding Guangzhou (Canton). The wages, less than half of that paid to white workers, were beyond the imaginations of subsistence farmers escaping abject poverty, plague, and famine. A good proportion of their earnings were remitted to families back home. As many as 20,000 may have worked on the railway. The death toll was staggering, estimated in the thousands. After Promontory Summit in 1869, Chinese were in great demand, building scores of rail lines throughout the country and Canada. Just 13 years later rising anti-Asian sentiment led to the passage of the Chinese Restriction Act of 1882 that for the first time barred a racial group from American shores. But they opened America to Asian immigrants that includes today’s Asian surgical community, which owes its present-day success to the hardworking forebears that created a global country with ribbons of steel rail.
The Price of Courage: The Life and Legacy of Dr LaSalle D. Leffall Jr
Authors: Williams Jeroson , Ndubisi Emeka , Lovasik Brendan , Keiler James , Srinivasan Jahnavi , Greene Wendy
Published: July 2023

This historical retrospective details the life and legacy of Dr LaSalle D. Leffall Jr, a leader in the field of surgical oncology, passionate surgical educator, and indelible mentor. His courage, against the backdrop of the many obstacles presented by American racism, paved the way for the inclusion of multiple generations of women and minority surgeons leaving a lasting impact on the history of American surgery.
Adverse Events of Surgical Drain Placement: An Analysis of the NSQIP Database
Authors: Talwar Abhinav , Bansal Ashir , Knight Gabriel , Caicedo Juan-Carlos , Riaz Ahsun , Salem Riad
Published: July 2023

Background

Surgical site drainage is important to prevent hematoma, seroma, and abscess formation. However, the placement of drain placement also predispose patients to several postoperative complications. The aim of this study is to clarify the risk-benefit profile of surgical drain placement.

Methods

The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Procedure-Targeted Databases were used to identify patients who underwent hepatectomy, pancreatectomy, nephrectomy, cystectomy, and prostatectomy. Patients who underwent each procedure were divided into 2 groups based on intraoperative drain placement. Propensity score-matched cohorts of these 2 groups were compared in terms of postoperative adverse events, readmission, reoperation, and length of stay.

Results

Hepatectomy patients with drains experienced organ space infections ( P < .001), sepsis ( P < .001), and readmission ( P = .021) more often than patients without drains. Patients who underwent pancreatectomy and had drains placed experienced wound dehiscence less frequently than those without drains ( P = .04). For hepatectomy, pancreatectomy, nephrectomy, and prostatectomy populations, patients with drains had longer lengths of stay ( P < .05). Matched populations across all procedures did not differ in terms of reoperation rate.

Discussion

Prophylactic surgical drain placement may be associated with increased infectious complications and prolonged length of stay. Further studies are needed to elucidate the complete adverse event profile of surgical drains. Nonetheless, outcomes may be improved with better patient selection or advancements in drain technology.
Association Between All-Cause Mortality and High-Sensitivity Cardiac Troponin Concentrations in Patients With Chest Pain
Authors: Annie Frank H. , Kepfinger Joshua , Ahmed Fatima , Pervez Muhammad Ijaz , Elashery Ahmad
Published: July 2023

We assessed the association between troponin levels and all-cause mortality in individuals with chest pain who presented to the Charleston Area Medical Center Emergency Department (CAMC). We identified adult patients with chest pain as defined in the International Classification of Diseases 10 (R07) family group from the CAMC data warehouse between June 6, 2020, and June 6, 2021. These cases required a visit to the emergency room. We created 3 different cohorts to assess the endpoints of all-cause mortality at 30 days and 6 months. Patients were divided into the following 3 categories: negative troponin level, defined as high sensitivity troponin I (HSTNI) assay ≤15 pg/mL for women and ≤20 pg/mL for men; weakly positive, 21–88 pg/mL for men and 16–88 pg/mL for women; and strongly positive, >88 pg/mL for men and women. A propensity score matching analysis was also conducted using the negative group as a control; the weakly and strongly positive groups were compared to the control across differing cardiology covariates. This study introduces novel cutoffs for high-sensitivity troponin I (Beckman Coulter assay, Beckman Coulter, Inc., Chaska Campus, 1000 Lake Hazeltine Drive, Chaska, Minnesota 55318).
Increased Sleep Latency and Decreased Sleep Duration are Associated With Elevated Risk of Bed Sharing Among Mother-Infant Dyads
Authors: Massare Brittany A. , Irvin Christine N. , Hicks Steven D.
Published: July 2023

Bed sharing increases risk of sleep-related infant deaths. We hypothesized that infant sleep difficulties increase bed sharing, independent of social determinants of health (SDOH). In total, 191 mother-infant dyads in a prospective, longitudinal cohort study completed the Brief Infant Sleep Questionnaire at 1, 4, 6, and 12 months. Sleep characteristics at 1 month (latency, duration, night awakenings) were compared between dyads with/without bed sharing in the first 12 months. Infants who participated in bed sharing slept fewer hours at night (7.1 ± 1.7 hours vs 8.3 ± 1.5 hours, P = .001, d = −0.79), and took longer to fall asleep (0.7 ± 0.6 hours vs 0.5 ± 0.5 hours, P = .021, d = 0.43), even when controlling for SDOH variables that influence bed sharing. Maternal perception of sleep problems did not differ between groups ( P = .12). Our findings suggest that infants with quantifiable sleep difficulties at 1 month are more likely to bed share.
Discourse of Composite Budgeting System in Ghana: Contextual Perspectives on Its Potentials and Constraints from the Wa Municipality, Upper West Region
Authors: Sanyare Francis Nangbeviel , N-yilyari Wisdom , Lagnang Ernest Malir
Published: July 2023

Decentralization is accepted globally as a way of enhancing development and a trigger for good governance. Effective decentralization is premised on fiscal decentralization, which transfers finances to the local level. To make fiscal decentralization a reality, Ghana implemented the composite budgeting system (CBS) in 2011. This paper used qualitative case study design, where in-depth interviews from key informants were the main methods used to collect data. We found six main challenges of the CBS thus: policy and regulatory challenges; inadequate knowledge on the CBS by staff; political meddling in the implementation of projects; and untimely and inconsistent release of funds for the Assembly. We also found that CBS holds the following prospects: waste is minimized; transparency in resource use is assured; unified processes of budgeting and monitoring and evaluation; and ensures local participation. We conclude that district assemblies while “muddling through” intractable challenges, could strive to maximize on the potentials identified.
Transferred Malice: Historical Underpinnings of the Rule and Legal Arguments for Its Abrogation
Authors: Mastrolia Pasquale
Published: July 2023

The history of transferred malice is as long as that of the offence of murder with respect to how it was conceived and is traditionally applied. It ensures the maximum protection of human life, transferring mens rea away from the intended victim of the offence to the actual victim. The Italian Criminal Code in force places the rule in the ‘General Part’ of the law, formally enabling its application to every offence. The first part of this essay focuses on the development of transferred malice across the earlier criminal codes of the Italian kingdoms. Then, I present the highlights of the development of the academic debate at the time the criminal code in force was drafted. Finally, I claim the rule should be repealed because of its contradiction with European and domestic rules on victim protection and the strict liability principle in criminal matters.
The Relationship Between Work-Induced Sexual Abstinence and Psychological Health of Chinese Male Seafarers: The Positive Influence of Job Satisfaction
Authors: Dong Bin , Carrera Maria , Baumler Raphael , Tang Chuanzhong
Published: July 2023

The specific nature of the seafaring occupation keeps seafarers away from partners and shore life for long periods at sea. Therefore, seafarers suffer many challenges in the workplace including frustration of their sexual needs. This study aimed to investigate the relationship between work-induced sexual abstinence, psychological health and job satisfaction among seafarers. A mixed-method approach focusing on cross-sectional survey-based quantitative research was used. The sample included 617 Chinese active seafarers who experienced sexual abstinence on board. Hierarchical cluster analysis was conducted to divide the respondents into different groups corresponding to 14 psychological problems induced by sexual abstinence and experienced in the workplace. Multiple linear regression analysis was applied to identify the relationship between tolerance level of seafarers to sexual abstinence and their job satisfaction. Four distinct groups of seafarers, influenced differently by sexual abstinence, were identified, namely “Saint,” “Adapter,” “Average people,” and “Sufferer” clusters. Multiple linear regression analysis indicated that tolerance level of seafarers to sexual abstinence was positively influenced by overall job satisfaction, perceived working environment, ability utilization for other jobs, own choice for working as a seafarer and perceived friendliness of co-workers, while it was negatively influenced by perceived job responsibility. The study innovates by examining the relationship between sexual abstinence and the psychological health of seafarers. It also extends the function of job satisfaction, which can contribute positively to the tolerance level to sexual abstinence. Management recommendations to address sexual abstinence issues are proposed to better protect the health and psychological well-being of seafarers and enhance operational safety on board.
Distributed observer-based resilient control of islanded DC microgrids under actuator faults
Authors: Jiao Yan-Tao , Ding Li , Kong Zheng-Min , Chen Chao-Yang
Published: July 2023

In this paper, a distributed observer-based resilient control scheme is proposed to solve the voltage regulation and current sharing problems of islanded direct current (DC) microgrids under actuator faults. First, an observer-based distributed fault estimation design is presented to estimate fault signals with high accuracy. Then, based on the estimated information, a primary decentralized fault-tolerant control layer is designed to ensure accurate voltage reference tracking. A secondary cooperative control layer is employed to achieve the goal of current sharing. Besides, both the fault estimation observers and the fault-tolerant controllers are designed in a plug-and-play fashion, which guarantees the scalability of the DC microgrid. The simulation and experimental results show that the proposed control strategy can efficiently improve the reliability and resilience of the DC microgrid.
Earnings Management and Investor Protection During a Banking Crisis: The Role of the “Spare Tire” Effect
Authors: Imperatore Claudia , Trombetta Marco
Published: July 2023

This article analyzes the association between earnings management and investor protection during banking crises. Using a sample of firms from 16 European countries for the period 2006–2018, we show that, as banking conditions worsen, firms are more likely to manage earnings upward in countries with a stronger institutional environment, where alternative sources of financing are better available and more accessible. Moreover, we show that this strategy is successful because these firms are able to raise relatively more equity financing.

JEL Classification

M41, G14