bluuebunny/crossref_metadata_2025 huggingface dataset:
Thermal Performance Analysis of a Rectangular Finned Heat Sink under Dust Deposition
Authors: Islam Mohammad Tarequl , Fahim Tanvir Ahmed , Ali Mohammad , Hassan Joyeb
Published: April 2024

This study investigated the effect of dust deposition on the fin surfaces of a rectangular finned heat sink for natural convection. Therefore, experimental analysis was carried out on two cases, i.e., under fine dust and fiber dust conditions. The experiment was conducted inside a closed duct on the heat sink consisting of 17 fins. After analyzing the data and variation of temperature values at various positions of the fin surfaces, it was observed that the fine dust accumulation had a negligible effect on the thermal performance. However, fiber dust accumulation had a significant effect on the thermal performance. Moreover, the obtained values of Nusselt number were 26.68, 26.21, and 23.75 for natural convection under no dust, fine dust, and fiber dust conditions, respectively. Hence, the amount of heat dissipated by natural convection was minimal under fiber dust conditions.
Improvement of Machinability of Hardened Steel in Turning Operation Using Cryogenically Treated Cutting Tool
Authors: Tomal A N M Amanullah , Rashid A B , Sami A S , Shahriar S M , Sultana E
Published: April 2024

Hardened steels need special cutting tools like PCBN and ceramic to be machined. But these cutting tools aren’t cost-effective and require machine tool structures that are stiff and don’t let vibrations through. The current trend is to find other, less expensive ways to make these materials easier to work with. Cryo-treating cutting tools is an effective way to improve the way the tool materials work when they are cut. Cryogenically treated tungsten carbide inserts in dry turning operations were looked at in this study. For hard turning of hardened mild steel (48 HRC), the performance of cryogenically treated Tungsten Carbide (WC) inserts was compared with that of untreated inserts in terms of chip-tool interface temperature and surface roughness under dry cutting conditions. The cutting tool (Untreated and Treated), and cutting speed (375, 512, 706 rpm) were selected as experiment parameters at a constant feed rate of 0.0841mm/rev and depth of cut 1mm. The chip-tool interface temperature analysis results revealed that temperature increases with the increasing cutting velocities. A better surface finish can be found at a higher cutting speed. The lower value of Ra was found at 1.75 μm (without cryogenic treatment) and 1.05 μm (with cryogenic treatment) for cutting speed at 706 rpm.
Topology optimization and 3D printing of a unibody quadcopter airframe
Authors: Asif Sajjid Hasan , Hasan Kamrul , Dhar N R
Published: April 2024

The performance of any unmanned aerial vehicle largely depends upon its weight as this characteristic dictates its payload capacity and flight duration. This paper presents a multiphysics simulation method for designing a unibody quadcopter airframe with optimum weight in SolidWorks. By adopting the computer-aided topology optimization concept, the mass of the frame is decreased by 91% (from 1558.44 to 134.738 grams) after getting rid of the unwanted elements, while not compromising its structural rigidity. The efficacy of the model is assessed by finite element analysis and it is found that the stress would remain within the acceptable limit. The optimized structure shows an operating life of 1.6×105 cycles in the fatigue analysis and experiences significantly less drag force in the computational fluid dynamics test than the original airframe for several angles of attack, thus proving the superiority of the optimized frame over the initial model. Finally, additive manufacturing is performed to fabricate the optimized structure using PLA material. 3D printing through the fused deposition modeling technique is chosen since it is ideal for fabricating intricate engineering prototypes compared to orthodox manufacturing processes. While creating the frame, a 45° overhang angle is maintained to ensure the usage of less support material.
Design and Construction of a Rapid Milk Chiller Using Cold Energy Storage System in the Context of Bangladesh
Authors: Paul Aranya Aumit , Biswas Anindya , Saha Showvik , Moon Mehrab Khan
Published: April 2024

Milk is a highly sensitive product that must be collected and cooled within a few hours to reduce losses due to chemical spoilage and to preserve quality. As milk production is often remote from markets and processing facilities, milk chillers using thermal energy storage (TES) units provide the means for preserving quality through chilling during a power cut and hygienic storage before onward transportation to processing facilities and operation of the chiller at maximum thermal efficiency. This study gives an overview of thermal energy storage (TES) base rapid milk chiller. A review of TES for cold storage applications utilizing solid-liquid phase change materials has been done. Various perspectives were focused on the different stages of the work: phase change materials (PCMs), exemplification, improvement in exchange of heat, and the impact of the whole process on the quality of the milk Materials used as potential PCMs by specialists at low temperatures (less than 4 °C) are condensed and a portion of their thermo-physical properties are accounted for. The concept of planning and measuring procedures based on the determined load profile for structure day is introduced. In this design of a milk chilling unit using thermal energy storage, two cycles have been combined to get the desired cooling temperature. One is the vapor compression cycle, which can also be called the ice storage cycle. Another one is the milk chilling cycle. The main purpose of the milk chilling cycle is to keep the milk temperature between 2°C to 4°C. The comparison of using cold water with ethylene glycol (PCM) as a storage source of refrigeration for the milk cooling process based on the compressor capacity, ice storage box volume, and power consumed at the variable of cooling load is presented. Also, the effect of using cold storage to reduce the refrigeration capacity and energy saving is presented. The time duration of the milk chiller’s capacity to keep a specific amount (20 liters) of milk cool has been calculated to determine the variance and efficiency of the system compared to other milk chilling processes. Some suggestions concerning the planning of milk chiller hardware are given. Unique consideration was paid to the examination of explicit highlights of heat transfer phenomena in ice storage boxes including the appraisal of the length and the rate of ice arrangement and dissolution. The approach of estimating parts of the ice storage capacity framework incorporated into the milk chilling framework arranged in hot, wet, and dry atmospheres is exhibited. In light of the hourly cooling burden figuring that was completed utilizing Carrier’s Hourly Analysis Program, estimating the ice thermal capacity framework for various working procedures including full, chiller priority, and ice priority storage tasks for the design are displayed. At last, an examination of some operational qualities of the framework is broken down.
Design and Development of Smart Blind Stick for Visually Impaired People
Authors: Javed M O A , Rahman Z U , Saad K S K , Ashrafi M S , Akter S F , Rashid A B
Published: April 2024

Blindness is a condition in which a person loses their ability to see because of physiological or neurological issues. This paper suggests a smart blind stick that uses modern technologies to make traveling easier for visually impaired people. Ultrasonic, light, water, and height sensors are used in the blind stick. An ultrasonic sensor is used to identify obstacles ahead of blind people. In addition, water sensors detect the presence of water and leaks when deployed in regions. One ultrasonic sensor is placed on the walking stick to classify the height of a barrier. An LDR is used to provide information about day and night. It also has GPS to help blind people track their location. Furthermore, a voice recognition system was employed to deliver the message by the human voice. Its height can be adjusted easily. After understanding customers’ demands, some ideas are added to create a product prototype. A cost analysis has been conducted, and it is discovered that mass production of the product is quite profitable. The smart blind stick is a low-cost, fast, and easy solution for blind and visually impaired people in third-world countries.
An Experimental Investigation into Wind Effect on Tall Buildings with Pentagonal Cross Section
Authors: Majumder M M H , Bhuiyan M S H , Islam M Q
Published: April 2024

The effect of wind load is one of the very significant factors in building and structure design. An investigation has been carried out into the wind effect on a Pentagonal cross-section with an open circuit wind tunnel. The experiment was conducted at a constant flow velocity of 13.2 m/s and a Reynolds number of 4.22 x 104. The test was carried out on a single cylinder positioned facing across the flow direction at various angles of attack from 0° to 72° at a step of 9°. Each face of a pentagonal cylindrical model was divided into five tapping points and connected with inclined multi-manometers using copper capillary and plastic tubes to measure the surface static pressure on the cylinder surface. Pressure coefficients were calculated from the measured surface static pressure, which was then used to estimate the drag and lift coefficients. A significant drop of 0.52 in the drag coefficient values has been observed for the single pentagonal cylinder in comparison to that of the single square cylinder. The overall lift coefficient values of the single pentagonal cylinder are found to be lower than that of a single square cylinder except at 90. The fluctuation of the lift coefficient curve has a 90 phase shift than that of the square cylinder; however, the pattern of their variations has shown a similar trend except for the angle of attack of 00. The stagnation point was identified on the front face of the pentagonal cylinder. These findings will assist engineers and architects in designing much safer buildings.
Interactions of CaO with pure Mg and Mg-Ca alloys—an in situ synchrotron radiation diffraction study
Authors: Wiese B , Mendis C L , Tolnai D , Hort N
Published: April 2024

CaO additions are used as an inexpensive replacement for Ca in Mg alloys. CaO dissociation in Mg has been reported in literature without a clear mechanism as to why this occurs. In situ synchrotron radiation diffraction investigation of the melting and solidification of Mg with CaO shows, that the stability of CaO was overestimated in Mg melts compared with MgO. The experiments that were performed on the Mg-20CaO and Mg-xCa-6CaO (x = 6 and 16 wt.%) alloys, show the dissociation and formation of various phases during melting and solidification. The results indicate that Mg can reduce CaO even in the solid state, which is the opposite of that proposed by the Ellingham diagrams for stoichiometric reaction. Phase formations during the in situ experiment are compared with published thermodynamic calculations for the interaction between Mg-Ca alloys and oxides.
Assessment of precipitation and near-surface temperature simulation by CMIP6 models in South America
Authors: Reboita Michelle Simões , Willian de Souza Ferreira Glauber , Gabriel Martins Ribeiro João , Ali Shaukat
Published: April 2024

This study evaluated the performance of 50 global climate models (GCMs) from the Coupled Model Intercomparison Project Phase 6 (CMIP6) in simulating the statistical features of precipitation and air temperature in five subdomains of South America during the historical period (1995–2014). Monthly precipitation and temperature simulations were validated with data from the Climate Prediction Center Merged Analysis of Precipitation, the Global Precipitation Climatology Project, and the ERA5 reanalysis. The models’ performance was evaluated using a ranking analysis with statistical metrics such as mean, standard deviation, Pearson’s spatial correlation, annual cycle amplitude, and linear trend. The analyses considered the representation of precipitation and air temperature separately for each subdomain, the representation for all five regions together, and the joint representation of precipitation and air temperature for all five subdomains. In the Brazilian Amazon, the best-performing models were EC-Earth3-Veg, INM-CM4-8, and INMCM5-0 (precipitation), and IPSL-CM6A-LR, MPI-ESM2-0, and IITM-ESM (temperature). In the La Plata Basin, KACE-1-0-G, ACCESS-CM2, and IPSL-CM6A-LR (precipitation), and GFDL-ESM4, TaiESM1, and EC-Earth3-Veg (temperature) yielded the best simulations. In Northeast Brazil, SAM0-UNICON, CESM2, and MCM-UA-1-0 (precipitation), BCC-CSM2-MR, KACE-1-0-G, and CESM2 (temperature) showed the best results. In Argentine Patagonia, the GCMs ACCESS-CM2, ACCESS-ESM1-5 and EC-Earth3-Veg-LR (precipitation), and CAMS-CSM1-0, CMCC-CM2-HR4, and GFDL-ESM4 (temperature) outperformed. Finally, for Southeast Brazil, the models ACCESS-CM2, ACCESS-ESM1-5, and EC-Earth3-Veg-LR (precipitation), and CAMS-CSM1-0, CMCC-CM2-HR4, and GFDL-ESM4 (temperature) yielded the best simulations. The joint evaluation of the regions and variables indicated that the best models are CESM2, TaiESM1, CMCC-CM2-HR4, FIO-ESM-2-0, and MRI-ESM2-0.
The Concept of Political Legitimacy
Authors: Brinkmann Matthias
Published: April 2024

This chapter outlines a broad understanding of the problem of legitimacy as the moral justification of power, which is not limited to the justification of coercion or the liberal-democratic state. It then discusses relational views which define legitimacy as the right to rule. The most plausible upshot of this paradigm is that different institutions possess different (Hohfeldian) bundles of the right to rule, which might vary from person to person and context to context. By contrast, a minimalist approach to legitimacy is defended on which legitimacy is, conceptually, merely the permission to exercise power. This entails that the problem of legitimacy is decoupled from the problem of justifying moral relations between rulers and ruled, including the problem of political obligation.
Indirect Instrumentalism
Authors: Brinkmann Matthias
Published: April 2024

Instrumentalism claims that political legitimacy should be distributed in such a way that justice is promoted best. Building on a distinction made by consequentialists in moral philosophy, this chapter argues that instrumentalists should distinguish two levels of normative thinking about legitimacy, the critical (or foundational) and the applied (or practical) level. The crucial insight is that the content of the moral and political principles on the critical level can diverge from the content of the practical standards that should guide us in moral and political life. An indirect instrumentalism which acknowledges this distinction has significant advantages over structurally simpler forms of instrumentalism that do not; in particular, such an instrumentalism can answer various counter-examples that have been brought against the position. The chapter also answers various objections against indirect instrumentalism, for example, that it is impracticable or repugnant.
Rights, Consent, and Legitimacy
Authors: Brinkmann Matthias
Published: April 2024

This chapter tackles a problem for any instrumentalist view that endorses liberal premises and denies that governments possess authority: it seems that we either need to deny that individuals possess strong moral rights or accept that consent is necessary for legitimacy. The chapter rejects various attempts to escape the dilemma, such as arguing that people have forfeited their rights, claiming that infringing rights is necessary to save people, or weakening rights by making them infringeable. Instead, the chapter proposes a solution in terms of a ‘pre-established harmony’ that allows for legitimacy without consent while recognizing strong, moral individual rights.
stDiff: a diffusion model for imputing spatial transcriptomics through single-cell transcriptomics
Authors: Li Kongming , Li Jiahao , Tao Yuhao , Wang Fei
Published: April 2024

Spatial transcriptomics (ST) has become a powerful tool for exploring the spatial organization of gene expression in tissues. Imaging-based methods, though offering superior spatial resolutions at the single-cell level, are limited in either the number of imaged genes or the sensitivity of gene detection. Existing approaches for enhancing ST rely on the similarity between ST cells and reference single-cell RNA sequencing (scRNA-seq) cells. In contrast, we introduce stDiff, which leverages relationships between gene expression abundance in scRNA-seq data to enhance ST. stDiff employs a conditional diffusion model, capturing gene expression abundance relationships in scRNA-seq data through two Markov processes: one introducing noise to transcriptomics data and the other denoising to recover them. The missing portion of ST is predicted by incorporating the original ST data into the denoising process. In our comprehensive performance evaluation across 16 datasets, utilizing multiple clustering and similarity metrics, stDiff stands out for its exceptional ability to preserve topological structures among cells, positioning itself as a robust solution for cell population identification. Moreover, stDiff’s enhancement outcomes closely mirror the actual ST data within the batch space. Across diverse spatial expression patterns, our model accurately reconstructs them, delineating distinct spatial boundaries. This highlights stDiff’s capability to unify the observed and predicted segments of ST data for subsequent analysis. We anticipate that stDiff, with its innovative approach, will contribute to advancing ST imputation methodologies.
Attention-guided variational graph autoencoders reveal heterogeneity in spatial transcriptomics
Authors: Lei Lixin , Han Kaitai , Wang Zijun , Shi Chaojing , Wang Zhenghui , Dai Ruoyan , Zhang Zhiwei , Wang Mengqiu , Guo Qianjin
Published: April 2024

The latest breakthroughs in spatially resolved transcriptomics technology offer comprehensive opportunities to delve into gene expression patterns within the tissue microenvironment. However, the precise identification of spatial domains within tissues remains challenging. In this study, we introduce AttentionVGAE (AVGN), which integrates slice images, spatial information and raw gene expression while calibrating low-quality gene expression. By combining the variational graph autoencoder with multi-head attention blocks (MHA blocks), AVGN captures spatial relationships in tissue gene expression, adaptively focusing on key features and alleviating the need for prior knowledge of cluster numbers, thereby achieving superior clustering performance. Particularly, AVGN attempts to balance the model’s attention focus on local and global structures by utilizing MHA blocks, an aspect that current graph neural networks have not extensively addressed. Benchmark testing demonstrates its significant efficacy in elucidating tissue anatomy and interpreting tumor heterogeneity, indicating its potential in advancing spatial transcriptomics research and understanding complex biological phenomena.
Microwave-assisted dehydration, long-term storage at non-freezing temperatures, and rehydration of cat germinal vesicles
Authors: Lee Pei-Chih , Comizzoli Pierre
Published: April 2024

Germinal vesicles are alternative targets for female fertility preservation due to their availability and high resilience against non-physiological conditions. Preserved germinal vesicles can then be transferred to fresh cytoplasts to reconstitute viable oocytes. Here, we describe a germinal vesicle preservation method that employs non-ionizing microwave radiations imparting energy to water molecules, which results in rapid and homogeneous drying of the sample. Trehalose is added as a xero-protectant before the radiations, enabling isothermal vitrification of the disaccharide sugar during drying. While the technique is still considered experimental, studies have shown that DNA and structural integrity can be effectively maintained in dried/rehydrated germinal vesicles. Importantly, the dry-preservation approach allows supra-zero temperature storage of the samples, offering a cost-effective and energy-saving alternative to traditional methods relying on ultra-low freezing temperatures. The protocol outlines a comprehensive procedure involving germinal vesicle oocyte collection, trehalose loading, microwave drying, storage, and rehydration. The simplicity of the protocol facilitates the ease of manipulation, making it an accessible method for researchers. While initially developed for domestic cats, the protocol can be adapted for other species with necessary modifications, considering potential species-specific responses to dehydration stress.
Unpredictable digital intimacies and virtual backstabbing: the feminist coalition’s political effect in Nigeria
Authors: Faniyi Ololade
Published: April 2024

This article explores digital intimacies within Nigeria’s networked political discourse, focusing on the resurgence of the Feminist Coalition (FemCo), known for their involvement in Nigeria’s 2020 #EndSARS (Special Anti-Robbery Squad) movement against police brutality, as feminist political subjects during the 2023 election campaigns. It analyzes Twitter-networked interactions as FemCo was unexpectedly thrust into hypervisibility when asked to endorse Peter Obi, the Labor Party’s presidential candidate, despite prior criticism of their #EndSARS activism. Employing close feminist reading and social network analysis of Twitter data, informed by a contextual feminist/computational approach, this article explores how processes of unpredictable digital intimacies and virtual backstabbing unfold when feminist political subjects are exploited by opposing clusters online. Investigating how affects circulate and transform feminist political subjects into bodies of hate/value, this article sheds light on the affective contexts of political communication in Nigeria, beset by a range of actors, including, activists, influencers, and citizen-users, wielding central power.
A comprehensive analysis of future solar energy potential variations using a CMIP6 multi-model ensemble approach in Colombia
Authors: Arregocés Heli A , Rojano Roberto , Pinto Pimienta Daiver
Published: April 2024

Climate change is predicted to significantly impact solar energy generation, which is particularly concerning given that photovoltaic (PV) energy is critical to the global transition to clean energy in underdeveloped countries. This study analyses the PV potential variations in Colombia using a Coupled Model Intercomparison Project Phase 6 (CMIP6) multi-model ensemble approach under two shared socio-economic pathway scenarios for the near (2025–50) and far (2051–2100) future. During the near-future period, the Pacific, Andean and Orinoquía regions are expected to experience a decrease in PV potential ranging from 10% to 23% for all shared socio-economic pathways. It will be particularly noticeable during the March/April/May and June/July/August seasons. On the other hand, CMIP6 estimations indicate a 1–4% increase in PV potential across the Amazon region during the June/July/August and September/October/November seasons. For the far future, it has been projected that the Pacific, Andean and Orinoquía regions may experience a significant decline in solar power generation due to increased cloud cover and reduced sunshine. The decrease in PV potential during the June/July/August season could range from 8% to 27% for all considered scenarios, with the Pacific region being the most affected. The Pacific region is projected to experience a decrease ranging from 10% to 35% for all seasons. It is worth noting that there are noticeable differences in PV potential across various regions, which can result in changes in cloud cover and atmospheric aerosols. Overall, the study provides valuable insights into the PV potential in Colombia and highlights the importance of considering regional variations and climate change scenarios in future energy planning.
Cardiovascular imaging research and innovation in 2023
Authors: Barison Andrea , Timoteo Ana Teresa , Liga Riccardo , Borodzicz-Jazdzyk Sonia , El Messaoudi Saloua , Luong Christina , Mandoli Giulia Elena , Moscatelli Sara , Ramkisoensing Arti Anushka , Moharem-Elgamal Sarah , Pontone Gianluca , Neglia Danilo
Published: April 2024

In 2023, cardiovascular imaging has made significant advancements, in terms of technology, pathophysiology, and clinical application. In this review, the most recent research findings in the field of cardiovascular imaging are discussed. Artificial intelligence and large population cohorts, together with several technical improvements, have had a crucial impact on the technological advancements of echocardiography, cardiovascular magnetic resonance, computed tomography (CT), and nuclear medicine. In the field of ischaemic heart disease, it has been demonstrated that appropriate non-invasive imaging strategies improve patients’ management and reduce invasive procedures and the need for additional testing at follow-up. Moreover, improvements in plaque characterization with CT are an expanding field of research with relevant implications for the prediction of disease severity, evolution, and response to treatment. In the field of valvular heart disease, imaging techniques have advanced alongside improvements in transcatheter treatment for aortic stenosis, mitral, and tricuspid regurgitation. Finally, in the field of heart failure and cardiomyopathies, cardiovascular imaging has reinforced its crucial role in early diagnosis and risk evaluation, showcasing advanced techniques that outperform traditional methods in predicting adverse outcomes.
Ablation of the epicardial substrate in patients with long-QT syndrome at risk of sudden death
Authors: Pappone Carlo , Boccellino Antonio , Ciconte Giuseppe , Anastasia Luigi
Published: April 2024

Sudden cardiac death remains a critical public health concern globally, affecting millions annually. Recent advances in cardiac arrhythmia mapping have demonstrated that the ventricular epicardial region has a critical arrhythmogenic role in some inherited cardiogenetic diseases. Among these, long-QT syndrome (LQTS) exposes patients to the risk of life-threatening arrhythmic events. Despite advancements, there is a need for more effective therapeutic strategies. A recent study has uncovered a noteworthy connection between LQTS and epicardial structural abnormalities, challenging the traditional view of LQTS as purely an electrical disorder. High-density mapping revealed electroanatomic abnormalities in the right ventricular epicardium, presenting a potential target for catheter ablation, to finally suppress ventricular fibrillation recurrences in high-risk LQTS patients.
Understanding the Therapeutic Action of Antipsychotics: From Molecular to Cellular Targets With Focus on the Islands of Calleja
Authors: Direktor Merve , Gass Peter , Inta Dragos
Published: April 2024

The understanding of the pathophysiology of schizophrenia as well as the mechanisms of action of antipsychotic drugs remains a challenge for psychiatry. The demonstration of the therapeutic efficacy of several new atypical drugs targeting multiple different receptors, apart from the classical dopamine D2 receptor as initially postulated unique antipsychotic target, complicated even more conceptualization efforts. Here we discuss results suggesting a main role of the islands of Calleja, still poorly studied GABAergic granule cell clusters in the ventral striatum, as cellular targets of several innovative atypical antipsychotics (clozapine, cariprazine, and xanomeline/emraclidine) effective in treating also negative symptoms of schizophrenia. We will emphasize the potential role of dopamine D3 and M4 muscarinic acetylcholine receptor expressed at the highest level by the islands of Calleja, as well as their involvement in schizophrenia-associated neurocircuitries. Finally, we will discuss the implications of new data showing ongoing adult neurogenesis of the islands of Calleja as a very promising antipsychotic target linking long-life neurodevelopment and dopaminergic dysfunction in the striatum.
Participatory Rebel Governance and Durability of Peace
Authors: Park Hyunjung
Published: April 2024

Rebel groups often develop governance during war by establishing administrative structures, engaging in taxation, and providing social services to the local population. Rebel governance structures, however, vary depending on the extent to which they include participatory arrangements. Some rebel groups allow civilian participation in their governance during the war, while others have highly hierarchical structures strictly limiting civilian participation. This paper examines whether and how the governance activities of rebel groups and participatory arrangements and institutions that they adopt during the war affect the durability of peace. I argue that participatory rebel governance can be particularly effective in establishing durable peace after the war. Civilian participation under rebel governance facilitates civilian political participation after conflict ends, which, in turn, discourages the use of political violence in response to grievances. Using rebel governance data between 1945 and 2012, I find strong empirical support for my argument. I then demonstrate the plausibility of the causal mechanism in the case of Indonesian and the Philippine civil wars. By establishing a strong positive empirical relationship between rebel wartime governance and the durability of peace, this paper identifies another important effect of rebel governance on conflict processes and outcomes in addition to its demonstrated effect on negotiations between warring parties and post-war democratization.
Dietary monoglyceride supplementation to support intestinal integrity and host defenses in health-challenged weanling pigs
Authors: White Cameron S , Hung Chien-Che , Lanka Saraswathi , Maddox Carol W , Barri Adriana , Sokale Adebayo O , Dilger Ryan N
Published: April 2024

Frequent incidence of postweaning enterotoxigenic Escherichia coli (ETEC) diarrhea in the swine industry contributes to high mortality rates and associated economic losses. In this study, a combination of butyric, caprylic, and capric fatty acid monoglycerides was investigated to promote intestinal integrity and host defenses in weanling pigs infected with ETEC. A total of 160 pigs were allotted to treatment groups based on weight and sex. Throughout the 17-d study, three treatment groups were maintained: sham-inoculated pigs fed a control diet (uninfected control [UC], n = 40), ETEC-inoculated pigs fed the same control diet (infected control [IC], n = 60), and ETEC-inoculated pigs fed the control diet supplemented with monoglycerides included at 0.3% of the diet (infected supplemented [MG], n = 60). After a 7-d acclimation period, pigs were orally inoculated on each of three consecutive days with either 3 mL of a sham-control (saline) or live ETEC culture (3 × 109 colony-forming units/mL). The first day of inoculations was designated as 0 d postinoculation (DPI), and all study outcomes reference this time point. Fecal, tissue, and blood samples were collected from 48 individual pigs (UC, n = 12; IC, n = 18; MG, n = 18) on 5 and 10 DPI for analysis of dry matter (DM), bacterial enumeration, inflammatory markers, and intestinal permeability. ETEC-inoculated pigs in both the IC and MG groups exhibited clear signs of infection including lower (P < 0.05) gain:feed and fecal DM, indicative of excess water in the feces, and elevated (P < 0.05) rectal temperatures, total bacteria, total E. coli, and total F18 ETEC during the peak-infection period (5 DPI). Reduced (P < 0.05) expression of the occludin, tumor necrosis factor α, and vascular endothelial growth factor A genes was observed in both ETEC-inoculated groups at the 5 DPI time point. There were no meaningful differences between treatments for any of the outcomes measured at 10 DPI. Overall, all significant changes were the result of the ETEC infection, not monoglyceride supplementation.
9 Differential Coagulation Factor Activity in Obese vs. Non-Obese Burn Injured Patients
Authors: Mathew Shane , Pinto Desiree , Carney Bonnie C , Moffatt Lauren T , Shupp Jeffrey W , Tejiram Shawn
Published: April 2024

Introduction

Obesity confers a prothrombotic state through an imbalance in hemostasis due to chronic inflammation and inhibition of the fibrinolytic pathway, and it may worsen the coagulopathy seen in burn patients. There is a paucity of data on the role obesity plays in burn injury and controversy exists with some literature indicating a survival benefit termed the “obesity paradox.” This analysis aims to define whether obesity promotes a hypercoagulable state in burn patients through measurement of coagulation factor activity at admission with extrinsic pathway factors expected to be elevated.

Methods

Burn patients admitted to a regional burn center between 2012-2017 were prospectively enrolled and patient demographics, burn injury characteristics, and blood were collected within two hours of admission. Assays were performed to measure the activity of Factors ll, V, Vll, Vlll, lX, X, Xl, and Xll and concentration of Factor lb. To identify differences, patients were stratified into two groups: non-obese (BMI 18.5-29.9 kg/m2) and obese (BMI >30kg/m2). Comparisons were made with the t-test or Mann-Whitney test and chi-square or Fisher’s exact test as appropriate.

Results

There were 129 patients included in the analysis. Of those included, 64% were male with an average age of 42.0 ± 1.4 years and total body surface area (TBSA) burn of 22.5% ± 1.9%. There were no significant differences in age, sex, and percent TBSA between the non-obese and obese groups. While PTT was not different between the non-obese and obese groups (29.59 ± 0.72 vs 27.4 ± 0.58, p=0.18), INR was significantly higher in non-obese patients (1.18 ± 0.03 vs 1.07 ± 0.01, p=0.005), although both groups remained within normal range. Factor IX activity level was above the normal range in both groups and significantly different between non-obese and obese patients (150.4% ± 4.7% vs 183.0% ± 9.6%, p=0.002). Factors Vlll (330.2% ± 14.4% vs 318.6% ± 26.5%, p=0.47) and XI (125.4% ± 5.0% vs 136.5% ± 9.1%, p=0.12) were above normal factor activity levels and Factor VIII was almost double normal levels in both groups. Factors lb, ll, V, Vll, X, and Xll were within normal factor activity, but lb, ll, Vll, and X were significantly higher in the obese group.

Conclusions

Burn injury promotes an early prothrombotic response and produces differential levels of factor activity following injury. Factor IX was significantly higher in obese patients compared to non-obese patients while Factors VIII and XI were elevated in all patients. Classic coagulation measures such as PT, PTT, and INR remain ineffective in determining specific coagulopathies following burn injury. Further study will be necessary to examine the relationship obesity plays in burn induced coagulopathy.

Applicability of Research to Practice

Examination of the impact of obesity on burn induced coagulopathy may identify targets for future interventions.
16 Circulating Cytokine Ratios Demonstrate the Balance of the Pro and Anti-Inflammatory Response After Burn Injury
Authors: Le Tuan D , Pinto Desiree , Pusateri Anthony , McLawhorn Melissa M , Moffatt Lauren T , Shupp Jeffrey W
Published: April 2024

Introduction

Burn injury results in a significant inflammatory response. The pro and anti-inflammatory responses in burn patients are typically studied independently with an emphasis on proinflammation, and as a staged process occurring during specific time frames after burn injury. In other disease processes, the interactions of these systems have shown to be more significant. This study connects the inflammatory responses by developing cytokine protein ratios. We predict that ratios will further characterize the inflammatory response after burn injury and that an unbalanced response will be associated with mortality.

Methods

This prospective observational study enrolled patients admitted to a regional burn center. Patient demographics, injury characteristics, and blood samples of cytokine protein levels (IL-6, IL-10, TNF-α), were collected at admission. IL-6 and TNF-α were considered pro-inflammatory and IL-10 was considered anti-inflammatory. Likelihoods of mortality were calculated using logistic regression for cytokine protein levels at admission. The optimal cut-off values for IL-6 and IL-10 were obtained by logistic regression and area under the curve (AUC) analysis with the Youden index. These cut-off points were then used to develop four pro/anti-inflammatory groups: low IL-6/low IL-10, low IL-6/high IL-10, high IL-6/low IL-10, and high IL-6/high IL-10. Rates of mortality were then compared among these groups.

Results

Of 158 patients, 115 met inclusion criteria. Most patients were male (68.7%), with a median age of 40 and a median TBSA of 11.8%. Overall mortality was 11.3%. The AUC of IL-6 (0.893), IL-10 (0.892), and TNF-α (0.812) revealed all cytokines as excellent predictors of mortality individually. When IL-6 and IL-10 levels were combined, the ability to predict mortality was not improved (AUC 0.885). Based on the AUC and Youden index, the optimal cutoff point for IL-6 was 10.5ng/dL (sensitivity 99.9%, specificity 68.6%), and IL-10 was 8.5ng/dL (sensitivity 84.6%, specificity 84.3%). Most of our patients (52%) were in the low IL-6/low IL-10 group and none of these patients died. A high IL-6/ low IL-10 was associated with a 15.8% mortality rate and a high IL-6/ high IL-10 was associated with a 38.5% mortality rate (p < 0.0001). No patient was in the low IL-6/ high IL-10 group.

Conclusions

Both the pro and anti-inflammatory systems are stimulated following burn injury and their balance analyzed through cytokine ratios is associated with mortality. At admission, patients with a balanced, but significantly elevated pro and anti-inflammatory response have the highest mortality rates.

Applicability of Research to Practice

A balanced, but elevated inflammatory response immediately following burn injury demonstrates a pathologic response. Cytokine ratios may be useful as early biomarkers for disease progression after burn injury.
26 Formalizing Burn Nurse Education, a Literature Review on Nursing Fellowships and Discussion for Furthering Training
Authors: Hao-Smith Alison , Fletcher Elisabeth , Lodin Daud
Published: April 2024

Introduction

With the recent implementation of the exam for Certified Burn Registered Nurses (CBRN) by the Board of Certification for Emergency Nursing (BCEN), a curriculum for burn nursing has been developed to better strengthen and standardize burn nursing care. Given the depth of the curriculum and the overall demand of becoming a burn nurse, the need for creating an educational track for burn nursing becomes apparent. While most burn centers utilize a preceptorship model to help train registered nurses to become burn nurses, a nationally recognized fellowship has not been developed. This study discusses the outcome of formalized nursing fellowships and how it could impact burn nursing training.

Methods

This is a literature review of published data from 2000 to 2023. This review utilizes PubMed to search indexed articles, using the terms “nursing fellowship”, “nurses fellowship”, and “nurse fellowship”. The articles were examined for content and outcomes. Articles discussing fellowships for advanced practitioners and those that did not discuss the direct benefit of their programs were excluded. The results were collated based on specialty, type of fellowship, and both the positive and negative outcomes discussed in these articles.

Results

Eleven articles were identified related to nursing fellowships. These involved formalized training programs in primary care, addiction medicine, leadership, research, gastroenterology, perioperative care, and critical care. Many articles discussed the benefit of increased knowledge and student performance in fellowship graduates. From an expense perspective, the articles identified cost benefits from employee retention and prevention of error resulting in decreased cost of hospitalization and litigation. One publication discussed an improvement in measured professionalism inventory scores in graduates. Several articles commented on nursing retention, which noted that in some instances, units were able to improve retention by over 40 percent.

Conclusions

The development of burn nursing certification paves the way for the development of a burn nursing fellowship. This literature review identifies benefits that other specialties have had with the development of formalized nursing fellowships, which include increased knowledge, improved skills, fewer errors, and increased retention.

Applicability of Research to Practice

This study discusses the potential to improve burn nursing education in a formalized setting, intended to improve nursing knowledge and skills, and ultimately improve outcomes.
36 The Impact of Sensory Issues on Health-related Quality of Life for People with Burn Injuries
Authors: Oh Geun-woo , Orton Caitlin M , Stewart Barclay T , Schneider Jeffrey C , Yenikomshian Haig A , deGrauw Xinyao , Pacleb Maiya I
Published: April 2024

Introduction

The association between sensory issues with lowered health-related quality of life (HRQOL) has been repeatedly described, mainly in the elderly population with age-related hearing and vision issues. Although sensory issues after major burn injuries are common, the relationship between these new impairments and HRQOL after burn injury is unknown. We aimed to understand the impact of sensory issues on HRQOL to inform care and rehabilitation paradigms.

Methods

Data from a multicenter national longitudinal database of people living with burn injuries were analyzed. Participant data were stratified into self-report (yes/no) of currently experiencing hearing loss, vision problems, dual sensory impairment (DSI), or no issues at the time of data collection (discharge, 6-, 12-, and 24-months post-injury). The primary outcome, patient-reported VR-12/PROMIS Global-10 physical component scores (PCS) and mental component scores (MCS), were collected at discharge (pre-injury recall) and all follow-up time points. Mixed-effect linear regressions were used to assess the impact of sensory issues on MCS and PCS at each time point.

Results

The study included 1,113 participants. Participants with sensory issues had significantly lower MCS and PCS scores than those without sensory issues at pre-injury (p < 0.05, Figures 1 and 2). All cohorts experienced a significant PCS loss at 6-, 12-, and 24-months post-injury compared to pre-injury scores (p < 0.001). All cohorts experienced a significant MCS loss at 6 months post-injury compared to pre-injury (p < 0.05). The hearing-only and no sensory impairments cohorts continued to experience a significant MCS loss at 12- and 24-month post-injury (p < 0.05). DSI cohort continued to experience a significant MCS loss at 12- months (p < 0.05). The vision-only cohort had more PCS loss than the no sensory impairment cohort at 24-months (-3.3, p< 0.05).

Conclusions

Although there were no statistically significant losses of participants with sensory impairments compared to those with no sensory issues, these cohorts reported consistently lower scores overall during the 24 months post-injury. Given these lower HRQOL scores, systematic screening and focused management of sensory impairments during and after rehabilitation from a burn injury should be considered.

Applicability of Research to Practice

Integration of specialized mental and physical health burn rehabilitation programs that address person-specific needs may improve short- and long-term outcomes for people with hearing problems, vision issues, or DSI.
45 Utility of the Severity-of-Illness Score for Toxic Epidermal Necrolysis (SCORTEN) in Pediatric Stevens-Johnson Syndrome Patients
Authors: Gust Nina K B , Adams Rebecca M , Frei Ashley , Coughlin Michelle , Klein Justin D , Ridelman Elika , Shanti Christina M
Published: April 2024

Introduction

The Severity-of-Illness Score for Toxic Epidermal Necrolysis (SCORTEN) is a scoring system that seeks to predict in-hospital mortality for disorders affecting skin integrity. The scoring system has been validated and is widely utilized in the adult population, but not for pediatric patients. This study aims to determine the accuracy of the SCORTEN in pediatric patients.

Methods

A retrospective review of pediatric patients admitted at a verified pediatric burn center with Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) from 2008 to 2022 was performed. SCORTEN risk factors were calculated.

Results

Twenty-seven eligible SJS/TEN patients were identified. Three patients were excluded due to incomplete data, allowing twenty-four patients to be analyzed. Ten patients had 0-1 risk factors (3.2% mortality rate), thirteen had 2 risk factors (12.1% mortality risk) and one had 3 risk factors (35.1% mortality risk). No patients received points for age over 40, presence of malignancy, blood urea nitrogen (BUN) greater than 28 mg/dL or glucose greater than 250 mg/dL. Zero patients died during initial admission. There was no correlation between initial BUN, bicarbonate, glucose, or initial heart rate on the length of ICU stay or ventilator days. Hospital length of stay and feeding tube days were positively correlated (p < 0.001) along with length of stay and maximum TBSA (p < 0.05). Student T-tests were performed comparing the 0-1 vs. 2 risk factor groups. Those with 2 risk factors had significantly higher TBSA affected on admission and maximum TBSA recorded (32.72 ± 20.55 and 44.97 ± 24.25 vs 8.26 ± 13.55 and 16.28 ± 22.19, p = .0005 and p=0.011). Interestingly, hospital length of stay, intensive care unit (ICU) length of stay, and ventilator days were not statistically significant between those having 0-1 and 2 risk factors.

Conclusions

Most SCORTEN variables (age over 40, presence of malignancy, BUN, and glucose) were not helpful in our patient population, as zero patients received points in these categories. Additionally, initial BUN, bicarbonate, glucose and heart rate showed no correlation to ICU or ventilator days. A higher SCORTEN category did not correlate to a longer hospital stay, ICU days or ventilator days. This study suggests that the SCORETEN system is not accurate in pediatric patients. A different scoring system is needed to estimate the severity of disease in pediatric SJS/TEN patients.

Applicability of Research to Practice

This data suggests that SCORTEN does not have utility in a pediatric SJS population and therefore a different scoring system is necessary. In practice, it would not be valid to use SCORTEN to predict mortality or severity of disease in the pediatric SJS population as it has not been found to be accurate.